diff --git a/.gitignore b/.gitignore index 80d1b0e..d12b74c 100644 --- a/.gitignore +++ b/.gitignore @@ -10,3 +10,6 @@ ingestion/example_files/bigquery/**/*.json ingestion/example_files/bigquery/*.json +# ignore all .csv files located in enrichment/example_data +enrichment/example_data/**/*.csv + diff --git a/descriptive/example1/code/descriptive.ipynb b/descriptive/example1/code/descriptive.ipynb new file mode 100644 index 0000000..7e49b33 --- /dev/null +++ b/descriptive/example1/code/descriptive.ipynb @@ -0,0 +1 @@ +{"cells":[{"cell_type":"markdown","metadata":{"colab_type":"text","id":"QvNdV8lVbozM"},"source":["# Descriptive statistics"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"qY6Djzavbya7"},"source":["## Library imports"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"7GMyMAQSbEk3"},"outputs":[],"source":["import pandas as pd\n","from scipy import stats # A great statistical module from the scipy library"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"srfntVDKcQa9"},"source":["## Data import"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"runAmOfktIjB"},"source":["### Connecting to Google Drive and importing the data"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"nzpnpiildUPE"},"outputs":[],"source":["df = pd.read_csv('descriptive/example1/data/data.csv') # Import the csv file"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"8yXnhtOOdYya"},"outputs":[],"source":["df # Display the dataframe to the screen"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"AJ5g0VEytPeT"},"source":["### Examining the dataframe object"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"zgNzoKkTnuOW"},"source":["We investigate the data by looking at the number of subjects (rows) and the number of statistical variable (columns)."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"BiEZ6TT2n7E-"},"outputs":[],"source":["df.shape # Using the .shape property (attribute)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"ez7uPFifoS4J"},"source":["We see 200 participants in our study, with data collected for 13 variables."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"zYUsi-LPoA-Z"},"source":["Let's have a look at all the statistical variables."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"_MXiaVe2oEoB"},"outputs":[],"source":["df.columns # Name of each column"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"eaDFW2h8oYna"},"source":["The data represent a small study on cholesterol values before and after taking either a placebo or an active drug."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"jX1RyII3oH6B"},"source":["Finally, we can view the data types of each variable (column)."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"AB1FQEiDol5h"},"outputs":[],"source":["df.dtypes # Pandas data type of each column"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"z--RBhkQoztR"},"source":["## Counting"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"j7n5uO0_sKuD"},"source":["### Frequencies"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"Jw4pFfnEpA4B"},"source":["Counting how many times a sample space element of a categorical variable occurs is a good start. In our dataframe object, we have a *Group* variable. Let's first see what the sample space of this variable is. The `unique` method will return an array of the unqiue elements it finds in a specified column."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"j2NszAdlpKAf"},"outputs":[],"source":["df.Group.unique() # The .unique() method returns the sample space elements of a column (pandas series object)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"WBGb-COXpZU9"},"source":["As mentioned, patients received either a placebo (*Control* group) or an active drug (*Active* group). These two terms are the sample space elemnts of the nominal categorical variable *Group*."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"sPATSsSGpsiZ"},"source":["We can now count how many times each of these elements appear in the *Group* column, using the `.value_counts()` method. This gives us the **frequency** of each value."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"cEwk4zTVp4RZ"},"outputs":[],"source":["df.Group.value_counts() # Counting the number of times the unique values appear"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"V6toqec3qCiC"},"source":["We see that there are 100 participants in each group. We can express the counts as a fraction, called a **relative frequency**. Thsi is done by setting the `normalize=` argumen to `True`."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"TqB3E4BRrBJY"},"outputs":[],"source":["df.Group.value_counts(normalize=True) # Expressing the relative frequency"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"VZzl62v3rLqx"},"source":["As expected, we see each element taking up a half of the total number of participants. We can multiply this by 100 to get a percentage."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"sbaxut6-rXPS"},"outputs":[],"source":["df.Group.value_counts(normalize=True) * 100 # Expressing the relative frequency as a percentage"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"mR4CVCdUqKMQ"},"source":["#### Exercise"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"ki2WTaN0qL2h"},"source":["The *Smoke* column indicates wheter particpants never smoked (*0*), are smokers (*1*), or have smoked before (*2*). Calculate the frequency with which each element appears."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"EbfUpYpJqjax"},"source":["#### Solution"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"eHqEnvAQqlEG"},"outputs":[],"source":["df.Smoke.value_counts()"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"Qr7-GrdGri-R"},"outputs":[],"source":["df.Smoke.value_counts(ascending=True, normalize=True) * 100"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"NmbMStMlsToh"},"source":["### Grouped frequencies"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"HkDgMd3jsbbJ"},"source":["We can calculate *combined frequencies*. As an example, consider the number of participants in each group of the study that chose each of the five possible values in the survey question."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"oO5VbZdOstNR"},"source":["We can do this with the pandas `crosstab()` function."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"yioZnTziszlK"},"outputs":[],"source":["pd.crosstab(df.Survey, df.Group) # Row and column variable"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"Z_nU-yw8fwqx"},"source":["## Measures of central tendency (point estimates)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"tbNCmuyEtW2h"},"source":["**Measures of central tendency** or **Point estimates** are single values that are representative of a list of continuous numerical values. There are a few that we will discuss here."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"eRFQIdV3f3kQ"},"source":["### Mean (average)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"YI7xbvbAtgeQ"},"source":["The **mean** or the **average** is more properly known as the **arithmetic mean**. It is simply the sum of all the continuous numerical variables divided by the number of values."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"nIuaGkiPtl6R"},"source":["Let's start learning about the information in our data by asking some questions."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"84JxSkA8f7L5"},"source":["- What is the mean age of all the patients?"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"1w_fl954t5XZ"},"source":["A pandas series object has many useful methods that are geared towards summary statistics. The `.mean()` method calculates the mean."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"lnW0iZSBde3N"},"outputs":[],"source":["# Using the .mean() method\n","df.Age.mean()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"0dOjaj7WgKj4"},"source":["- What is the mean heart rate of all the patients?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"3TJ1fhNogA56"},"outputs":[],"source":["# Using alternative column (variable) reference\n","df['HR'].mean()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"W2vbqS-Pge9H"},"source":["- What is the mean age of the patients who smoke (indicated as *1* in the *Smoke* column)?"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"MF4YroUquV4a"},"source":["We looked at conditional in the previous notebook, where we selected only certain rows in a pandas series."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"zMpOcQbBgaOk"},"outputs":[],"source":["# Using a conditional on the Smoke column\n","df[df.Smoke == 1]['Age'].mean()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"1T7Z3timg3h4"},"source":["- What is the mean age of the patients who do not smoke (indicated as *0* in the *Smoke* column)?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"yzFrSWOXguu5"},"outputs":[],"source":["# Using a conditional on the Smoke column\n","df[df.Smoke == 0]['Age'].mean()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"S6h0Ot0MukbA"},"source":["We have learned something usefull with this summary statistic. The patients who smoke are quite a bit older than those who do not. Is this a significant difference? What test can we use to discover this? What about the third group, the ex-smokers? All will be revealed."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"aG8WcojNhDNu"},"source":["- What are the mean ages of the patients who smoke compared to those who do not smoke?"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"vebMvujIvaBx"},"source":["We can save a lot of time and typing by calculating the age means for all the smoker groups."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"WlwifbqdvDLQ"},"source":["The `.groupby()` method can create groups from the unique elements in a column and then call a method on another column."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"DtqvwNbehB-w"},"outputs":[],"source":["# Use the .groupy() method\n","df.groupby('Smoke')['Age'].mean()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"kTrVr7X9wJyC"},"source":["By the way, the `.mean()` method has some useful arguments. We can use `skipna=True` to skip over any missing values (this is the default behaviour of this method). We can also use `numeric_only=True` if there are data values that were not captured as numbers."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"JKYNO02bwQ_Z"},"source":["### Geometric mean"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"byJiOpjXwS_5"},"source":["The **geometric mean** multiplies all the continous numerical variables and take the *n*-th root of that product, where *n* is the number of values. At the beginning of this notebook we imported the stats module from the scipy library. It contains many functions that we will use in the statistical analysis of our data. The `gmean()` function calculates the geometric mean. It can take a pandas series as argument."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"aRDDpR2xwrt4"},"outputs":[],"source":["stats.gmean(df.Age)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"7aD4OQQYhS_l"},"source":["### Median"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"B4VdrM95TFq1"},"source":["The mean makes an assumption of the data values and that is that they should be normally distriuted. We will learn much more about distributions in the next notebook. For now, we can view the normal distribution as the familiar bell-shaped curve."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"uwAJDTiDTWPO"},"source":["Not all data value for a continuous numerical value follow a nice bell-shaped curve. We can have quite different *shapes* (distributions) or many outliers (values that are way-off from all the others). In this case, the mean is not a good representative summary of all the data values. Here, we rather use the median."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"mhq-qnyDTo5X"},"source":["The **median** puts all the values in a sorted order. If there are an odd number of values, then the median is the middle value. If there are an even number of values, then the mean of the middle two values as taken."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"YtCauitGhjmM"},"source":["- What is the median heart rate of patients older than $50$?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"fNCXvRhLhP2D"},"outputs":[],"source":["# Using the .median() function\n","df[df.Age > 50]['HR'].median()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"iShT33mWxrvt"},"source":["#### Exercise"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"7T8e8tzGx12Q"},"source":["Calculate the median age of the participants who smoke (*1*) and have a heart rate of more than 70."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"m8R_UTK3xwYQ"},"outputs":[],"source":["df.columns"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"QqnAneXFxu1g"},"source":["#### Solution"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"_WeNyUp1yOKY"},"outputs":[],"source":["df.loc[(df.Smoke == 1) & (df.HR > 70), 'Age'].median()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"0LxzmfOrh0OJ"},"source":["### Mode"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"YPQs8H68T-tt"},"source":["The last measure of central tendency that we will take a look at is the mode. The **mode** is used for categorical of discrete data types. It simply return the value(s) that occurs most commonly. If a single sample space element occurs most commonly, that will be the single mode. Somethimes more than one sample space element shares the spoils. This variable is then bimodal. As you might imagine, there are terms such as tri-modal and multi-modal."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"nbHeKQ_yh5CF"},"source":["- What is the mode of the smoking variable?"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"1BGjsmonyvAZ"},"source":["We use the `.value_counts()` method do calculate the frequency. The `ascending=` argument is set to `False` by default and the `sort=` is set to `True`, such that we get the mode at the top."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"F2SOtFbvhrFt"},"outputs":[],"source":["df.Smoke.value_counts()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"ZSx4BfkLiTbK"},"source":["## Measures of dispersion (spread)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"xAdT_qaXVRad"},"source":["**Measure of dispersion** give us an indication of how spread out our data is."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"d0Xj_HL-iYPe"},"source":["### Standard deviation and variance"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"PfWzikN1Wl4N"},"source":["The **standard deviation** can be understood as the average difference between each continuous numerical data value and the mean of that variable. Difference infers subtraction. As some values will be larger than the mean and some smaller, subtraction from the mean will lead to positive numbers and negative numbers. In fact, from the way we calculate the mean, if we sum up all these differences (so as to calculate a mean difference), we will get 0. To mitigate this, we sqaure all of the differences. Squaring (multiplying by itself) returns positive values. Now we can sum all these values and divide by the number of values. This gives us the **variance**."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"8c_8KrJEXfb3"},"source":["Variances are very useful in statistics. We need to express the spread in the same units as our variable for it to make sense as a summary statistics. The *age* variable had a unit of years. What then, is a $\\text{years}^2$. Instead, we take the square root of the variance to get the standard deviation, now expressed in the same units as the variable and a true measure of the average difference between all the values and the mean."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"e3GqwhglYCi3"},"source":["The `.std()` method returns the standard deviation of a series object and the `.var()` method returns the variance."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"XTma-V9silDy"},"source":["- What is the standard deviation of the age of patients who smoke vs those who do not smoke?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"dn9I-qw9iOP0"},"outputs":[],"source":["# Group by the Smoke column\n","df.groupby('Smoke')['Age'].std()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"l4TdG6qui8X8"},"source":["- What is the variance of the age of patients who smoke vs those who do not smoke?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"8SWKWbwEiyn9"},"outputs":[],"source":["df.groupby('Smoke')['Age'].var()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"plDKTmT9jRcy"},"source":["### Range"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"idtxsoxhVeum"},"source":["The **range** is the difference between the minimum and the maximum value of a continuous numerical variable. The `min()` and the `max()` methods for series objects give these values. Let's see then how old our youngest and oldest participants are."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"Pa41MN06jUAy"},"source":["- What is the minimum age of all the participants?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"O_7EvljzjIHJ"},"outputs":[],"source":["# Using the .min() functuion\n","df.Age.min()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"WRrZ812Sjdto"},"source":["- What is the maximum age of all the participants?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"rP9QmY39jYGJ"},"outputs":[],"source":["# Using the .max() function\n","df.Age.max()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"7CNM2qCnjnAq"},"source":["- What is the range in the age of all the participants?\n"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"dpxIwNoy0FUB"},"source":["We simply subtract the minimum value from the maximum value."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"h1UFkaz1jlP6"},"outputs":[],"source":["# Difference between maximum and minimum ages\n","df.Age.max() - df.Age.min()"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"XSubh4N1j1Uh"},"source":["### Quantiles"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"GdwRlW3-Zjq0"},"source":["Just as we divided our continuous numerical variables up into two halves for the mean, so we can divide them up into quarters. In fact, we can divide it up at any percentage level from 0% to 100% (fraction of 0.0 to 1.0). Here 0% would be the minimum value and 100% would be the maximum value. Dividing the values up into these bins give us **quantiles**."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"5tIKnoESZ8Vu"},"source":["We can divide the values up into four bins with three values. These values are the **quartiles**."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"J7MmotgG1jrw"},"source":["The lowest of these three values (the **first quartile**), divide the data into two parts, with a quarter being lower than that value and three-quarters being higher. The second divide the data values equally (the median or **second quartile**). The third is a value that has three-quarters of the values less than and a quarter more than it (the **third quartile**)."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"fC36pjCHkCvx"},"source":["- What are the quartile values for the age of all the patients?"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"BmjgyJwrape4"},"source":["The `.quantile()` method allows us to choose, as a fraction, any of these cut-off values. For the quartiles, we create a list `[0.25, 0.5, 0.75]`."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"U9iW7ZNsjvht"},"outputs":[],"source":["# Specifying the quartiles as fractions\n","df.Age.quantile([0.25, 0.5, 0.75])"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"YPltHdznkZ83"},"source":["- What is the $95$th percentile values in age of the patients who smoke vs those that do not?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"xN5sCHO-kRJk"},"outputs":[],"source":["df.groupby('Smoke')['Age'].quantile(0.95)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"PtyTBD7a1BFw"},"source":["The **interquartile range** is the difference between the third and the first quartile."]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"DXoM5qY-k4ll"},"source":["- What is the interquartile range of the age of all the patients?"]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"i1gNieQ4krVW"},"outputs":[],"source":["df.Age.quantile(0.75) - df.Age.quantile(0.25)"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"A3_x8T-w1MAt"},"source":["## Conclusion"]},{"cell_type":"markdown","metadata":{"colab_type":"text","id":"T7MeslD41O96"},"source":["We now know a lot more about our data. Be encouraged to learn even more by asking some question about this mock study and see if you can calculate the required value."]},{"cell_type":"code","execution_count":null,"metadata":{"colab":{},"colab_type":"code","id":"eLPUPr11Qccg"},"outputs":[],"source":[]}],"metadata":{"colab":{"collapsed_sections":["JWZAUQEhbuHb","qY6Djzavbya7","srfntVDKcQa9","runAmOfktIjB","AJ5g0VEytPeT","z--RBhkQoztR","j7n5uO0_sKuD","mR4CVCdUqKMQ","EbfUpYpJqjax","NmbMStMlsToh","Z_nU-yw8fwqx","eRFQIdV3f3kQ","JKYNO02bwQ_Z","7aD4OQQYhS_l","iShT33mWxrvt","QqnAneXFxu1g","0LxzmfOrh0OJ","ZSx4BfkLiTbK","d0Xj_HL-iYPe","plDKTmT9jRcy","XSubh4N1j1Uh","A3_x8T-w1MAt"],"name":"04 Descriptive statistics.ipynb","provenance":[],"toc_visible":true},"kernelspec":{"display_name":"Python 3.6.4 64-bit ('3.6.4')","language":"python","name":"python3"},"language_info":{"codemirror_mode":{"name":"ipython","version":3},"file_extension":".py","mimetype":"text/x-python","name":"python","nbconvert_exporter":"python","pygments_lexer":"ipython3","version":"3.6.4"},"vscode":{"interpreter":{"hash":"f691c77f2932b50764e6cbe55ba6da9aefcdc0d1195f88baaf9e9338c7c6b4c0"}}},"nbformat":4,"nbformat_minor":0} diff --git a/descriptive/example1/code/requirements.txt b/descriptive/example1/code/requirements.txt new file mode 100644 index 0000000..11ef38f --- /dev/null +++ b/descriptive/example1/code/requirements.txt @@ -0,0 +1,4 @@ +pandas +scipy +tableone +researchpy diff --git a/descriptive/example1/code/researchpy_example.ipynb b/descriptive/example1/code/researchpy_example.ipynb new file mode 100644 index 0000000..3df6458 --- /dev/null +++ b/descriptive/example1/code/researchpy_example.ipynb @@ -0,0 +1,157 @@ +{ + "cells": [ + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/" + }, + "id": "Yuib-1s1YRlt", + "outputId": "687cb64c-995a-43b1-ed47-185cb32e2008" + }, + "outputs": [], + "source": [ + "!pip install researchpy" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "id": "Tz1qKEMxYTCT" + }, + "outputs": [], + "source": [ + "import researchpy as rp\n", + "import pandas as pd" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/", + "height": 424 + }, + "id": "NHJ4xg5DYXZx", + "outputId": "03263426-2e84-4445-f952-8d10fbdff94e" + }, + "outputs": [], + "source": [ + "df = pd.read_csv('./data.csv')\n", + "df" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/" + }, + "id": "2HyFY1tKgwDk", + "outputId": "f3c62ea7-52e8-463c-cf34-f1febaf833c0" + }, + "outputs": [], + "source": [ + "rp.codebook(df)" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/" + }, + "id": "IBby_YNohrHl", + "outputId": "da650c24-9910-47e5-c8f4-7b0c65bbb7e7" + }, + "outputs": [], + "source": [ + "df.columns" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/", + "height": 179 + }, + "id": "fF8x6Hvdh5Tr", + "outputId": "34642f22-9b01-46fc-8940-4e7f32d09334" + }, + "outputs": [], + "source": [ + "## example of getting descriptives for single or group of continuous variables\n", + "\n", + "rp.summary_cont(df[['Age', 'HR', 'sBP']])" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/", + "height": 206 + }, + "id": "7dUKqxsOiXkQ", + "outputId": "f4b7fa5e-473f-4407-b749-975623aae1e0" + }, + "outputs": [], + "source": [ + "rp.summary_cat(df[['Group', 'Smoke']])" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/" + }, + "id": "g3kA2jJoijzO", + "outputId": "f8556125-835f-43c4-b9e6-6f4878fc450d" + }, + "outputs": [], + "source": [ + "df['Group'].value_counts()" + ] + }, + { + "cell_type": "code", + "execution_count": null, + "metadata": { + "colab": { + "base_uri": "https://localhost:8080/" + }, + "id": "sYipIGGximTA", + "outputId": "dc23d990-1a4d-45ac-b53c-79d743334215" + }, + "outputs": [], + "source": [ + "df['Smoke'].value_counts()" + ] + } + ], + "metadata": { + "colab": { + "collapsed_sections": [], + "provenance": [] + }, + "kernelspec": { + "display_name": "Python 3", + "name": "python3" + }, + "language_info": { + "name": "python" + } + }, + "nbformat": 4, + "nbformat_minor": 0 +} diff --git a/descriptive/example1/code/tableone.py b/descriptive/example1/code/tableone.py new file mode 100644 index 0000000..b7e0277 --- /dev/null +++ b/descriptive/example1/code/tableone.py @@ -0,0 +1,36 @@ +import pandas as pd +from tableone import TableOne, load_dataset + +##### DATASET 1 ##### +example_data = load_dataset('pn2012') +# # littlerecode death where 0 is alive and 1 is dead +# example_data['death'] = example_data['death'].replace(0, 'alive') +example_data.dtypes +example_data_columns = ['Age', 'SysABP', 'Height', 'Weight', 'ICU', 'death'] +example_data_categorical = ['ICU', 'death'] +example_data_groupby = ['death'] +example_data_labels={'death': 'mortality'} +exampleTab1 = TableOne(example_data, columns=example_data_columns, + categorical=example_data_categorical, groupby=example_data_groupby, + rename=example_data_labels, pval=False) +exampleTab1 +print(exampleTab1.tabulate(tablefmt = "fancy_grid")) +exampleTab1.to_csv('descriptive/example1/data/test.csv') + + + +##### DATASET 2 ##### +my_data = pd.read_csv('descriptive/example1/data/data.csv') +df2 = my_data.copy() +df2.dtypes +list(df2) +df2.head(5) +df2['Smoke'] +df2_columns = ['Age', 'HR', 'Group', 'sBP', 'Smoke'] +df2_categories = ['Smoke', 'Group'] +df2_groupby = ['Smoke'] +# df2['Vocation'].value_counts() +df2_table1 = TableOne(df2, columns=df2_columns, + categorical=df2_categories, groupby=df2_groupby, pval=False) +print(df2_table1.tabulate(tablefmt = "fancy_grid")) +df2_table1.to_csv('descriptive/example1/data/test2.csv') \ No newline at end of file diff --git a/descriptive/example1/data/Altair.csv b/descriptive/example1/data/Altair.csv new file mode 100644 index 0000000..aa009e0 --- /dev/null +++ b/descriptive/example1/data/Altair.csv @@ -0,0 +1,101 @@ +SampleID,Type,Grade,MeasureA,MeasureB,MeasureC +1,I,2,25,31.3,110.1891467 +2,II,4,22,23.8,99.61951223 +3,I,3,22,27.6,87.55160191 +4,II,2,28,33.2,85.56734707 +5,II,4,30,31.8,110.2700532 +6,I,3,26,26.4,99.84167892 +7,I,2,26,33.7,76.78406754 +8,II,3,28,35.8,92.68980598 +9,I,4,23,25,105.3292932 +10,II,2,25,26.9,102.7667628 +11,II,4,26,32.8,103.1580788 +12,I,3,22,28.9,99.63755467 +13,I,2,28,36.5,93.36849383 +14,II,4,24,27.3,104.725783 +15,I,3,22,27.9,87.67951762 +16,II,2,23,25.4,93.92992221 +17,II,3,24,28.5,102.3853207 +18,I,4,27,36.7,100.0448647 +19,I,2,21,29.5,96.14677609 +20,II,4,25,25.5,90.0584909 +21,I,3,26,33.2,106.2905857 +22,II,2,20,26.7,110.9012447 +23,II,4,24,29,102.9123925 +24,I,3,26,34.6,109.5989193 +25,I,2,20,25.6,120.3092205 +26,II,3,29,30.7,80.76294849 +27,I,4,25,27.4,90.33607983 +28,II,2,23,25.1,111.3001142 +29,II,4,22,30.4,111.3810443 +30,I,3,29,36.5,113.3473012 +31,I,2,21,27,99.29337329 +32,II,4,30,30.3,102.409397 +33,I,3,21,24.9,94.59506272 +34,II,2,23,29.5,105.072395 +35,II,3,27,29.4,95.22285424 +36,I,4,28,31.9,115.8428138 +37,I,2,29,33.8,93.20039257 +38,II,4,26,34.5,91.80364222 +39,I,3,28,28.7,105.1201517 +40,II,2,20,20.9,89.95307887 +41,II,4,25,29.4,100.082686 +42,I,3,20,23.8,105.1388602 +43,I,2,25,27.7,96.57069437 +44,II,3,29,31,89.02825048 +45,I,4,27,28.1,115.9905033 +46,II,2,24,33.1,109.6808062 +47,II,4,25,25.5,97.9233459 +48,I,3,23,27.4,91.43744805 +49,I,2,24,29.4,89.17425205 +50,II,4,23,30.9,104.5168731 +51,I,3,23,31.3,120.8590099 +52,II,2,26,34.5,103.1805883 +53,II,3,20,22.7,92.01241296 +54,I,4,26,33.8,98.24382294 +55,I,2,28,37.9,112.6216806 +56,II,4,30,32.5,114.5057637 +57,I,3,29,32.1,85.65551755 +58,II,2,21,22.6,99.92775192 +59,II,4,20,29.4,101.7370707 +60,I,3,29,32.3,104.6963938 +61,I,2,30,35.1,90.68274837 +62,II,3,22,28.6,104.945687 +63,I,4,27,35.2,100.5862524 +64,II,2,22,28.3,101.9664154 +65,II,4,30,37.5,117.9238576 +66,I,3,24,32.7,99.11348868 +67,I,2,28,34.6,87.66866232 +68,II,4,22,29.5,103.8499839 +69,I,3,27,37,105.52171 +70,II,2,28,29.2,98.54170359 +71,II,3,23,24.1,102.9014881 +72,I,4,30,33.6,96.67562447 +73,I,2,27,32,103.6666286 +74,II,4,23,27.4,96.26970859 +75,I,3,25,33.6,97.88947741 +76,II,2,26,33.4,89.36824634 +77,II,4,27,29.8,79.41290868 +78,I,3,25,31.9,111.6602743 +79,I,2,23,30.5,118.6330966 +80,II,3,28,37.8,102.7833759 +81,I,4,27,29.1,105.0360624 +82,II,2,28,34.2,92.0825595 +83,II,4,29,35.9,95.7516333 +84,I,3,23,26.5,92.06924539 +85,I,2,20,23.1,86.0933612 +86,II,4,25,25.5,112.4517925 +87,I,3,22,25,104.4103507 +88,II,2,29,34.3,98.8985973 +89,II,3,23,26.1,96.47799202 +90,I,4,24,30.4,101.1108615 +91,I,2,27,33.4,98.05828612 +92,II,4,24,25.9,112.3727757 +93,I,3,24,30.1,91.94633635 +94,II,2,21,28.5,115.3320592 +95,II,4,29,29.2,96.69564868 +96,I,3,21,25,103.2237425 +97,I,2,26,26.4,101.1300201 +98,II,3,21,24,117.7524212 +99,I,4,30,36.3,101.5227999 +100,II,2,23,29.3,80.16592453 diff --git a/descriptive/example1/data/Cholesterol.csv b/descriptive/example1/data/Cholesterol.csv new file mode 100644 index 0000000..c7208ac --- /dev/null +++ b/descriptive/example1/data/Cholesterol.csv @@ -0,0 +1,301 @@ +Group,Delta +Active,0.8 +Active,0.9 +Control,1.7 +Active,-1.1 +Control,1.7 +Control,-0.8 +Active,-0.5 +Control,0.8 +Active,0.3 +Active,1.4 +Control,-0.2 +Active,-2.3 +Control,0.3 +Control,-1.3 +Active,0.3 +Control,-1.6 +Active,-0.4 +Active,-0.7 +Control,-1.5 +Active,0.4 +Control,0.7 +Control,-0.8 +Active,-0.6 +Control,-0.7 +Active,0.1 +Active,0.5 +Control,1.9 +Active,0.2 +Control,-0.3 +Control,-0.4 +Active,0.8 +Control,-0.6 +Active,-1.3 +Active,-0.7 +Control,-0.1 +Active,1.1 +Control,-1.1 +Control,-0.5 +Active,-0.6 +Control,0.3 +Active,-0.9 +Active,-1 +Control,0 +Active,0.9 +Control,-0.3 +Control,0.2 +Active,-0.4 +Control,-0.3 +Active,-0.3 +Active,0.6 +Control,0.7 +Active,-0.9 +Control,-0.1 +Control,-0.8 +Active,-0.8 +Control,0.1 +Active,0.3 +Active,-1 +Control,-1.4 +Active,-0.8 +Control,1.2 +Control,1.7 +Active,-0.2 +Control,-1.4 +Active,1.8 +Active,0.9 +Control,0.8 +Active,-1.9 +Control,-0.7 +Control,-1.4 +Active,-0.2 +Control,-0.5 +Active,-1.3 +Active,0.1 +Control,0.4 +Active,-1.1 +Control,0.1 +Control,-0.2 +Active,-1.1 +Control,-1 +Active,1.4 +Active,1.5 +Control,0.2 +Active,-3.7 +Control,0.1 +Control,0.5 +Active,0.1 +Control,0 +Active,-1.5 +Active,-0.7 +Control,1.1 +Active,2 +Control,0 +Control,1 +Active,0.6 +Control,-1.5 +Active,-0.7 +Active,0 +Control,-0.8 +Active,1.1 +Control,0.3 +Control,-0.9 +Active,-0.6 +Control,0.3 +Active,1.5 +Active,0.9 +Control,1.4 +Active,1.2 +Control,0.3 +Control,-2.1 +Active,-0.6 +Control,0 +Active,-1.3 +Active,0.1 +Control,1.5 +Active,0.1 +Control,1.3 +Control,1.1 +Active,-0.4 +Control,1.3 +Active,0.3 +Active,0.2 +Control,1.1 +Active,1.6 +Control,0.8 +Control,1.5 +Active,0 +Control,-0.5 +Active,-0.9 +Active,-0.5 +Control,-0.1 +Active,-1.7 +Control,-0.3 +Control,0.9 +Active,1.9 +Control,2.1 +Active,0.6 +Active,-0.5 +Control,-2.1 +Active,0.8 +Control,-0.8 +Control,0 +Active,1.8 +Control,-0.5 +Active,0.3 +Active,-0.5 +Control,0.5 +Active,0.1 +Control,0.4 +Control,1.1 +Active,0 +Control,1.2 +Active,2 +Active,-2.2 +Control,0.5 +Active,0 +Control,0.3 +Control,-0.3 +Active,-0.7 +Control,-1.2 +Active,-1.3 +Active,-1 +Control,0.7 +Active,1 +Control,0 +Control,-0.6 +Active,1.4 +Control,0.7 +Active,0.3 +Active,-0.2 +Control,-1.4 +Active,0.7 +Control,1.1 +Control,1.2 +Active,0.6 +Control,0.7 +Active,0.4 +Active,-0.8 +Control,-0.8 +Active,-0.1 +Control,1.5 +Control,-0.9 +Active,-0.2 +Control,-0.5 +Active,-0.9 +Active,-0.7 +Control,2.2 +Active,0.8 +Control,1.6 +Control,1.4 +Active,-0.7 +Control,0.5 +Active,-1.4 +Active,-0.4 +Control,-3.1 +Active,0.3 +Control,0.9 +Control,1.3 +Active,-0.5 +Control,-0.3 +Active,-2.5 +Active,-0.3 +Control,0.8 +Active,-2.3 +Control,-0.6 +Control,-0.8 +Active,-0.1 +Control,0.4 +Active,0 +Active,-0.5 +Control,0.6 +Active,-1.6 +Control,2.6 +Control,1.7 +Active,-0.1 +Control,1.2 +Active,-1.5 +Active,0.6 +Control,-0.6 +Active,0.8 +Control,-0.6 +Control,1.3 +Active,0.3 +Control,-0.7 +Active,0.3 +Active,0.9 +Control,1 +Active,-0.9 +Control,-1.5 +Control,1.5 +Active,0.2 +Control,-0.5 +Active,0.6 +Active,-0.6 +Control,-0.2 +Active,-0.9 +Control,0.5 +Control,0.2 +Active,0.5 +Control,-0.4 +Active,0.5 +Active,-0.5 +Control,-2 +Active,-0.3 +Control,0.1 +Control,-1.3 +Active,-0.3 +Control,0.8 +Active,0.6 +Active,-1.9 +Control,-3.3 +Active,1.1 +Control,-1 +Control,3.2 +Active,0.7 +Control,0.8 +Active,-2.2 +Active,0.4 +Control,-1.2 +Active,0.4 +Control,0.3 +Control,-0.2 +Active,-0.8 +Control,0.2 +Active,0.1 +Active,-0.4 +Control,1.1 +Active,-0.6 +Control,0.9 +Control,-0.4 +Active,1.9 +Control,-1.2 +Active,-0.8 +Active,1.4 +Control,1.4 +Active,1.1 +Control,1.5 +Control,0.3 +Active,0 +Control,-1.1 +Active,0.1 +Active,0.5 +Control,-1.4 +Active,0.5 +Control,-0.3 +Control,0.2 +Active,-0.8 +Control,-1.7 +Active,0.3 +Active,-0.8 +Control,-0.9 +Active,-0.7 +Control,0 +Control,-1.6 +Active,1.2 +Control,1 +Active,0.4 +Active,1.9 +Control,0 +Active,-0.5 diff --git a/descriptive/example1/data/data.csv b/descriptive/example1/data/data.csv new file mode 100644 index 0000000..51224b3 --- /dev/null +++ b/descriptive/example1/data/data.csv @@ -0,0 +1,201 @@ +"Name","DOB","Age","Vocation","Smoke","HR","sBP","CholesterolBefore","TAG","Survey","CholesterolAfter","Delta","Group" +"Dylan Patton",1981-10-07,43,"Energy manager",0,47,145,1.2,1.2,1,0.7,0.5,"Active" +"Sandra Howard",1993-01-27,53,"Tax adviser",0,51,115,1.2,0.6,3,1,0.2,"Active" +"Samantha Williams",1973-12-21,33,"IT consultant",0,54,120,2,1.3,3,1.7,0.3,"Active" +"Ashley Hensley",1981-12-01,43,"Nurse, children's",0,54,103,2.1,1.6,4,2.1,0,"Active" +"Robert Wilson",1964-06-23,46,"Clinical embryologist",0,61,138,2.8,2.1,5,2.8,0,"Active" +"Leslie Diaz",1994-08-25,48,"Politician's assistant",0,59,122,2.8,1.4,4,2.6,0.2,"Active" +"Frank Zimmerman",1981-03-04,54,"Police officer",0,60,129,2.9,2.4,1,2.6,0.3,"Active" +"Aaron Harris",1948-01-10,58,"Nurse, children's",0,61,131,3.1,2.2,1,2.9,0.2,"Active" +"William Smith",1998-11-20,44,"Scientific laboratory technician",0,58,111,3.1,2.4,1,2.8,0.3,"Control" +"Andrea Fletcher",1955-12-23,31,"Lexicographer",0,59,122,3.2,1.7,5,2.8,0.4,"Active" +"James Wells",1998-08-09,45,"Charity fundraiser",0,62,121,3.2,1.7,4,2.7,0.5,"Active" +"Lisa Perez",1983-09-05,35,"Chief Marketing Officer",0,61,119,3.3,2,3,2.9,0.4,"Active" +"Desiree Sandoval",1981-11-08,49,"Hydrologist",0,61,135,3.3,2.3,5,3.1,0.2,"Active" +"Karen Knight",1941-06-14,56,"Advertising account planner",0,62,134,3.4,2.1,2,3.3,0.1,"Control" +"Evan Stewart",1934-12-22,57,"Web designer",0,75,162,3.5,2.4,3,3.4,0.1,"Active" +"Mark Johnson",1958-11-22,38,"Lobbyist",2,62,140,3.5,2.6,1,2.9,0.6,"Active" +"Roger Chen",1985-11-19,35,"Photographer",0,59,121,3.5,2.3,2,3.4,0.1,"Control" +"Dennis Sanchez",1945-10-25,50,"Chartered loss adjuster",0,63,129,3.5,2.5,1,3.5,0,"Active" +"Eric Hendrix",1969-05-04,45,"Community education officer",2,61,138,3.6,2.3,1,3.2,0.4,"Control" +"Kathleen Burnett",1970-03-23,49,"Occupational hygienist",0,64,144,3.7,2.2,1,3.7,0,"Active" +"Mr. Bradley Bailey",1990-09-15,63,"Conservation officer, nature",0,64,136,3.7,2,4,3.6,0.1,"Active" +"Lacey Wilcox",1998-02-24,45,"Chemist, analytical",0,60,115,3.7,2.1,5,3.4,0.3,"Control" +"James Aguilar",2000-11-05,51,"Immunologist",0,64,134,3.7,2,1,3.5,0.2,"Control" +"Michael Banks",1977-08-19,43,"Exhibition designer",2,62,132,3.7,2.6,3,3.6,0.1,"Control" +"Clifford Williams",1957-05-04,31,"Special effects artist",2,60,134,3.7,2.5,4,3.5,0.2,"Control" +"Danny Smith",1941-01-09,58,"Broadcast presenter",2,65,136,3.8,2.1,2,3.3,0.5,"Active" +"Lori Herrera",1960-01-17,40,"Psychologist, occupational",0,63,122,3.8,2.7,1,3.5,0.3,"Active" +"Melinda Ingram",1944-07-07,47,"Midwife",0,65,130,3.9,2.8,3,3.6,0.3,"Active" +"Sonya Hale",1945-06-14,45,"Meteorologist",2,67,154,3.9,2.6,3,3.5,0.4,"Active" +"Lisa Patrick",1958-11-02,41,"Sports therapist",0,65,145,3.9,2.2,4,3.5,0.4,"Active" +"Brittany Valenzuela",1992-08-02,47,"Therapist, horticultural",0,59,132,3.9,2.6,2,3.5,0.4,"Control" +"David Kane",1981-08-11,38,"Mining engineer",0,63,143,4,2.2,5,3.8,0.2,"Control" +"Douglas Hardin",1971-06-01,54,"Estate agent",0,63,128,4,2.3,3,3.8,0.2,"Control" +"Kyle Boyd",1959-12-30,30,"Waste management officer",0,63,133,4,2.5,5,3.8,0.2,"Control" +"Mr. Tyler Strickland DDS",1940-08-27,46,"Tourist information centre manager",0,62,136,4.1,2.3,2,3.8,0.3,"Control" +"William Evans",1957-08-04,64,"Lecturer, higher education",0,61,127,4.2,2.2,5,3.9,0.3,"Control" +"Darryl Howell",1996-09-13,41,"Research scientist (physical sciences)",1,65,140,4.2,3.1,5,4.1,0.100000000000001,"Active" +"Jeremiah Carter",1954-02-08,40,"Technical brewer",0,64,139,4.2,3.1,4,4.1,0.100000000000001,"Control" +"Derek Long",1997-06-22,45,"Minerals surveyor",0,65,128,4.2,2.6,3,4.1,0.100000000000001,"Control" +"Derrick Lopez",1934-01-02,65,"Commercial/residential surveyor",0,66,128,4.2,2.3,5,3.9,0.3,"Active" +"Laurie Clay",1981-06-12,74,"Lecturer, further education",2,67,136,4.2,3,2,3.9,0.3,"Active" +"Joseph Price",1938-02-21,55,"Programmer, systems",0,54,104,4.3,3.1,2,4,0.3,"Control" +"Tammy Schwartz",1975-08-11,58,"Insurance claims handler",2,69,133,4.3,3,2,4,0.3,"Active" +"Joshua Avila",1978-01-19,53,"Media planner",0,64,129,4.3,2.5,2,4.1,0.2,"Control" +"Kenneth Bowman",1934-07-13,68,"Magazine features editor",1,68,135,4.3,3.1,1,4.2,0.1,"Active" +"Blake Fritz",1952-08-07,54,"Research scientist (medical)",0,62,133,4.3,2.5,3,4.2,0.1,"Control" +"Brian Olson",1958-12-14,72,"Arts administrator",0,67,132,4.3,3.1,1,3.9,0.4,"Active" +"Michael White",1954-11-24,32,"Museum/gallery exhibitions officer",0,63,137,4.3,3,5,4,0.3,"Control" +"Matthew Sellers",1957-09-17,38,"Scientist, research (physical sciences)",0,65,132,4.3,3.1,5,4.2,0.1,"Control" +"Matthew Brown",1939-09-06,59,"Journalist, magazine",0,63,137,4.3,2.2,2,4.1,0.2,"Control" +"Joshua Lewis",1985-09-20,53,"Professor Emeritus",0,66,140,4.4,2.4,3,4,0.4,"Control" +"Kayla Mendoza",1979-08-05,69,"Buyer, industrial",1,66,133,4.4,2.8,5,4.1,0.300000000000001,"Control" +"Kathy Padilla",1983-01-03,42,"Journalist, newspaper",0,68,139,4.4,2.8,5,3.9,0.5,"Active" +"Christopher Abbott",1963-06-12,67,"Ergonomist",2,66,128,4.4,2.6,2,4.2,0.2,"Control" +"Stephanie Jacobs",1977-06-18,38,"Estate manager/land agent",0,69,139,4.4,2.7,2,4,0.4,"Active" +"Juan Johnson",1956-12-09,51,"Logistics and distribution manager",0,65,141,4.5,2.9,5,4,0.5,"Control" +"Craig King",2001-03-06,37,"Scientist, audiological",0,67,135,4.5,3.2,5,4.3,0.2,"Control" +"Tracy Palmer",1950-10-08,36,"Counselling psychologist",0,65,148,4.5,3.2,5,3.8,0.7,"Control" +"John Boyle",1979-07-30,34,"Pharmacist, community",1,66,148,4.5,3.2,2,4.4,0.1,"Control" +"Jeremy Dennis",1983-02-03,38,"Midwife",1,69,158,4.5,2.7,5,4.4,0.1,"Active" +"Janet Young",1981-03-18,31,"Aeronautical engineer",1,65,133,4.5,2.3,3,4.1,0.4,"Control" +"Mr. James Rowe",1995-08-10,48,"Advertising copywriter",0,64,144,4.6,2.6,2,4,0.6,"Control" +"Scott Sherman",1965-02-26,49,"Landscape architect",0,68,145,4.6,2.5,2,4.4,0.199999999999999,"Active" +"Stephanie Miles",1942-04-25,62,"Psychologist, sport and exercise",0,66,150,4.6,2.6,2,4.8,-0.2,"Control" +"Katrina Gilbert",1964-06-08,39,"Surveyor, hydrographic",0,68,133,4.6,2.9,5,4.4,0.199999999999999,"Control" +"Joseph Smith",1981-11-17,74,"Secretary, company",0,66,147,4.6,3.3,1,4.6,0,"Control" +"Jeremy Ellis",1986-07-26,41,"Financial controller",1,68,132,4.6,3.2,4,4.3,0.3,"Active" +"Linda Kennedy",1993-10-24,42,"Teacher, secondary school",0,65,136,4.7,3.1,5,4.1,0.600000000000001,"Control" +"Mandy Garcia",1985-05-31,60,"Cabin crew",2,71,154,4.7,2.4,4,4.5,0.2,"Active" +"Maria Ruiz",1999-01-14,67,"Cartographer",1,65,149,4.7,3.3,1,4.7,0,"Active" +"Gary Pineda",1960-02-16,42,"Scientist, research (physical sciences)",1,66,132,4.7,2.4,2,4.7,0,"Control" +"Tina Martinez",1941-05-31,74,"Passenger transport manager",1,69,146,4.8,3.1,4,4.5,0.3,"Active" +"Denise Long",1945-03-13,52,"Graphic designer",1,83,168,4.9,2.7,2,4.4,0.5,"Control" +"Daniel White",1975-03-23,37,"Brewing technologist",1,65,136,4.9,2.5,1,4.5,0.4,"Control" +"Kyle Moore",1963-12-26,61,"Industrial buyer",1,65,141,4.9,2.8,1,4.4,0.5,"Active" +"Diana Miller",1958-06-29,54,"Designer, textile",1,68,142,4.9,3,5,4.7,0.2,"Control" +"Steven Hunt",1967-11-25,72,"Nature conservation officer",1,69,158,4.9,2.9,2,4.4,0.5,"Control" +"Haley Tucker",1999-11-11,36,"Set designer",1,69,158,4.9,3.2,4,4.8,0.100000000000001,"Active" +"John Estrada",2000-11-13,49,"Information officer",1,68,137,4.9,3,3,4.5,0.4,"Control" +"Scott Ramsey",1951-07-03,47,"Product designer",1,67,138,5,3,5,4.6,0.4,"Control" +"Cynthia Mercado",1942-07-23,49,"Contractor",2,65,126,5,3.1,5,4.7,0.3,"Control" +"Marissa Anderson PhD",1940-05-15,49,"Nurse, learning disability",1,75,170,5,2.7,3,4.7,0.3,"Active" +"Justin Bennett",1963-04-04,69,"Insurance broker",1,66,142,5,3,4,4.6,0.4,"Control" +"Laura Mcdonald",1981-04-29,43,"Hydrographic surveyor",1,66,127,5,3,3,4.5,0.5,"Control" +"Thomas Cole",1944-08-07,38,"Corporate investment banker",1,72,141,5,2.8,2,4.7,0.3,"Active" +"Levi Lopez",1980-09-24,60,"Bookseller",1,71,159,5,3,5,4.9,0.1,"Active" +"Jeffrey Washington",1994-12-04,45,"Waste management officer",1,67,154,5.1,2.8,2,4.7,0.4,"Control" +"Christopher Carter",1966-12-07,71,"Lawyer",2,67,151,5.1,3.2,1,5,0.1,"Control" +"Daniel Miller",1975-09-08,65,"Surveyor, mining",1,70,143,5.1,3.5,5,5,0.1,"Control" +"Tara Powell",1996-06-29,73,"Engineer, mining",1,69,137,5.2,2.7,2,5.2,0,"Control" +"Richard Pierce",1966-12-16,60,"Dealer",2,69,147,5.2,2.9,5,5,0.2,"Control" +"Dylan Dixon",1965-03-10,70,"Psychotherapist, child",1,73,158,5.3,3.5,3,4.9,0.4,"Active" +"John Dawson",1979-06-14,45,"Computer games developer",1,73,158,5.3,3.6,5,5.3,0,"Control" +"Shari Wagner",2001-08-29,49,"Paramedic",2,68,149,5.3,3.6,2,5,0.3,"Control" +"Sharon Cain",1981-06-15,65,"Clinical biochemist",1,72,139,5.5,2.8,1,5.5,0,"Control" +"Heidi Hernandez",1995-12-23,53,"Forensic psychologist",1,77,167,5.5,3.3,5,5.3,0.2,"Active" +"Brandi Ibarra",1973-11-01,30,"Communications engineer",1,72,159,5.5,3.7,1,5.3,0.2,"Control" +"Jason Williams",1944-12-22,58,"Herpetologist",1,71,148,5.6,3.4,4,5.3,0.3,"Control" +"Robert Pruitt",1966-07-15,50,"Midwife",1,75,150,5.6,3.3,1,5.3,0.3,"Active" +"Brittany Richardson",1947-11-23,69,"Engineer, manufacturing",1,72,146,5.7,3.3,2,5.3,0.4,"Control" +"Kristina Zimmerman",1994-01-01,72,"Agricultural consultant",0,70,157,5.7,3.6,1,5.3,0.4,"Control" +"Jennifer Key",1995-12-13,61,"Engineer, energy",0,70,151,5.7,3.5,2,5.6,0.100000000000001,"Control" +"Christine King",1983-07-27,33,"Community pharmacist",0,78,151,5.9,3.8,4,5.6,0.300000000000001,"Active" +"Mary Rodriguez",2001-07-07,30,"Music tutor",0,74,168,5.9,3.4,4,5.6,0.300000000000001,"Control" +"Austin Fuller",1965-02-17,44,"Trading standards officer",0,75,165,6,4,5,5.9,0.1,"Control" +"Lauren Ramos",1970-09-21,71,"Statistician",0,77,160,6,3.7,2,5.8,0.2,"Active" +"James Huffman",1941-05-05,49,"Manufacturing systems engineer",0,75,157,6,3.9,4,5.8,0.2,"Control" +"Kelly Rivera",1939-07-05,75,"Call centre manager",0,78,170,6,3.2,4,5.9,0.1,"Active" +"Charles Torres",1998-10-17,43,"Control and instrumentation engineer",0,73,146,6.1,3.1,2,5.5,0.6,"Control" +"Todd Rice",1951-04-02,35,"Medical sales representative",2,75,165,6.2,3.5,2,5.9,0.3,"Control" +"Ashley Fischer",1968-01-16,55,"Trade union research officer",0,78,164,6.2,4,1,5.9,0.3,"Active" +"Craig Raymond",1945-03-18,38,"Engineer, energy",0,73,162,6.2,3.2,2,5.9,0.3,"Control" +"Gregory Avila",1956-09-30,36,"Trade mark attorney",0,78,168,6.3,3.9,3,6.2,0.1,"Active" +"Matthew Gonzalez",1965-01-31,46,"Publishing copy",0,75,169,6.3,3.9,2,6,0.3,"Control" +"Vicki Sweeney",1997-12-08,60,"Mental health nurse",0,79,163,6.3,3.8,4,6,0.3,"Control" +"Charles Garcia",1983-10-16,40,"Music tutor",2,80,165,6.4,3.5,1,6,0.4,"Active" +"Shannon Hammond",1939-05-18,57,"Maintenance engineer",0,81,174,6.4,3.9,2,6,0.4,"Active" +"Tina Cabrera",1983-08-22,69,"Translator",0,82,180,6.6,3.6,2,6.2,0.4,"Active" +"Patrick Perez",1982-05-07,56,"Volunteer coordinator",0,82,159,6.7,4.1,4,6.3,0.4,"Active" +"Molly Davis",1996-06-24,66,"Secretary/administrator",0,78,176,6.7,3.6,1,6.3,0.4,"Control" +"Jonathan Williams",1982-08-12,60,"Museum/gallery conservator",0,78,160,6.8,4.4,4,6.7,0.1,"Control" +"Bonnie Johnson",1959-08-09,42,"Biomedical scientist",0,78,158,6.9,4,1,6.7,0.2,"Control" +"Barbara Lawson",1969-03-08,49,"Medical illustrator",2,78,159,7,4.2,5,6.6,0.4,"Control" +"Natalie Hanna",1992-05-14,68,"Geophysicist/field seismologist",2,83,181,7,4.3,4,7,0,"Active" +"Renee Schneider",1948-09-24,32,"Corporate treasurer",0,83,170,7,4.1,2,6.7,0.3,"Active" +"Victoria Gordon",1956-08-05,31,"Pharmacist, community",0,83,165,7,4.2,2,6.7,0.3,"Active" +"Diana Burch",1984-06-22,56,"Corporate treasurer",0,83,174,7,3.7,2,6.7,0.3,"Active" +"Michael Black",1973-03-18,35,"Fish farm manager",0,85,178,7.1,3.9,4,6.9,0.199999999999999,"Active" +"Kevin Levine",1947-02-03,63,"Immunologist",0,79,167,7.2,4.5,4,7.1,0.100000000000001,"Control" +"Laura Kelly",1959-05-28,54,"Dancer",0,79,173,7.2,4.4,1,7.3,-0.1,"Control" +"Stephanie Pruitt",1996-01-09,68,"Heritage manager",0,85,186,7.3,3.8,3,7,0.3,"Active" +"Douglas Evans",1948-07-15,72,"Dancer",0,83,166,7.3,4.4,1,7.1,0.2,"Control" +"Andre Brown",1949-02-18,40,"Legal executive",0,84,187,7.3,4.3,5,6.9,0.4,"Active" +"Cindy Perkins",1963-03-23,41,"Energy engineer",1,85,175,7.4,4.2,3,7.1,0.300000000000001,"Active" +"Jason Grimes",1989-01-27,66,"Musician",1,84,179,7.4,3.7,3,7.1,0.300000000000001,"Active" +"Maureen Stark",1972-02-28,73,"Contractor",1,78,153,7.4,4.1,2,7.2,0.2,"Control" +"Curtis Diaz",1961-11-01,36,"Careers information officer",2,81,157,7.4,4.2,1,6.9,0.5,"Control" +"Christopher Henry",1958-09-23,54,"Careers adviser",1,85,170,7.5,3.9,5,7,0.5,"Active" +"April Clarke DDS",1948-06-08,57,"Oncologist",1,85,181,7.5,4.4,2,7.3,0.2,"Control" +"Carrie Sanders",1971-03-14,74,"Video editor",1,85,173,7.5,4.4,2,7.4,0.1,"Active" +"Jeremiah Taylor",1973-06-30,48,"Engineering geologist",1,24,52,7.6,4.1,2,7.3,0.3,"Control" +"Laurie Strong",1942-06-27,72,"Surveyor, building control",2,85,168,7.6,4.4,5,7.1,0.5,"Active" +"Nichole Best",1954-10-31,54,"Careers information officer",1,82,175,7.6,3.9,5,7.4,0.199999999999999,"Control" +"Jeremy Wagner",1938-12-10,71,"Cytogeneticist",1,104,205,7.7,4.3,3,7.6,0.100000000000001,"Active" +"Tammy Hamilton",1994-02-20,42,"Journalist, magazine",1,87,193,7.7,4.6,1,7.3,0.4,"Active" +"Kevin Shields",1982-04-19,54,"Accommodation manager",2,86,190,7.7,4,4,7.3,0.4,"Active" +"Jennifer Kelly",1970-11-05,66,"Public house manager",1,85,189,7.7,4.7,5,7.7,0,"Control" +"Greg Lewis",1978-01-28,58,"Production manager",1,86,191,7.8,4.3,3,7.3,0.5,"Control" +"Matthew Campbell",1970-09-11,60,"Bonds trader",1,86,185,7.8,4.3,3,7.7,0.1,"Active" +"Jane Stone",1984-03-13,63,"Electrical engineer",2,82,159,7.8,4.8,4,7.4,0.4,"Active" +"Angela Clark",1950-04-30,44,"Media buyer",1,86,173,7.8,4.4,2,7.3,0.5,"Active" +"Lisa Rhodes",1989-05-03,55,"English as a foreign language teacher",1,86,179,7.8,4.7,4,7.3,0.5,"Active" +"Andrea Anderson",1974-04-08,73,"Horticultural consultant",1,85,183,7.9,4.2,4,7.7,0.2,"Control" +"Christopher Luna",1992-11-22,55,"Accountant, chartered certified",2,87,187,7.9,4.9,1,7.7,0.2,"Active" +"Linda Evans",1962-12-25,40,"Archivist",1,86,167,7.9,4.5,4,7.8,0.100000000000001,"Active" +"Margaret Thompson",1985-05-29,43,"Development worker, international aid",1,86,174,7.9,4.2,3,7.7,0.2,"Active" +"Erin Burton",1942-10-06,71,"Biomedical scientist",1,86,179,7.9,4.8,1,7.8,0.100000000000001,"Active" +"Jodi Wood",1946-11-29,54,"Animal technologist",0,87,173,8,4,5,7.7,0.3,"Active" +"Angela Long",1976-06-07,61,"Engineer, civil (contracting)",2,80,158,8,4.6,4,8,0,"Control" +"Bob Williams",1991-03-10,55,"Commercial/residential surveyor",1,82,167,8.1,4.1,2,7.8,0.3,"Active" +"Elizabeth Ashley",1949-11-23,67,"Newspaper journalist",1,87,187,8.1,4.3,2,7.5,0.6,"Active" +"April Reyes",1948-10-21,55,"Engineer, electronics",1,87,193,8.1,4.1,5,7.9,0.199999999999999,"Active" +"Monica Kelley",1981-04-07,68,"Police officer",1,87,176,8.1,4.3,1,8,0.1,"Active" +"Shannon Neal",1973-12-28,71,"Administrator, sports",2,88,194,8.1,4.7,1,8,0.1,"Active" +"Adam Smith",1941-07-21,54,"Journalist, broadcasting",1,88,183,8.1,4.7,1,8,0.1,"Active" +"Connor Torres",1988-01-06,42,"Radiation protection practitioner",1,87,190,8.2,4.9,5,8.2,0,"Active" +"Brandy Johnson",1978-04-13,53,"Private music teacher",1,88,196,8.2,4.4,4,8.1,0.1,"Active" +"Heather King",1940-08-01,69,"Adult guidance worker",1,88,178,8.2,4.9,5,7.8,0.4,"Active" +"Angela Boyer",1977-06-11,57,"Dancer",1,88,174,8.2,5,2,8,0.199999999999999,"Active" +"Kathryn Smith",1963-08-07,45,"Scientist, marine",2,88,192,8.2,4.2,5,7.9,0.299999999999999,"Active" +"Mary Aguilar",1952-01-09,62,"Furniture designer",0,88,182,8.3,5.1,2,8.2,0.100000000000001,"Control" +"Mary Barnett",1993-10-21,33,"Operational investment banker",1,88,179,8.3,4.9,3,8.1,0.200000000000001,"Active" +"Kathleen Goodwin",1938-05-14,74,"Therapeutic radiographer",1,86,182,8.3,4.9,2,8.1,0.200000000000001,"Control" +"Debra Hoover",1971-07-16,74,"Building control surveyor",1,88,195,8.3,5,4,8.2,0.100000000000001,"Active" +"Heidi Gaines",1974-06-26,64,"Occupational therapist",1,89,198,8.4,4.5,4,8.3,0.1,"Active" +"Nicole Vance",1990-07-17,43,"Personnel officer",1,87,193,8.4,5,2,8.2,0.200000000000001,"Control" +"Alejandro Love",1957-05-03,35,"Fashion designer",2,85,167,8.4,4.5,2,8.3,0.1,"Control" +"Michael Richardson",2001-08-15,57,"Hydrographic surveyor",1,88,184,8.5,4.3,5,8.5,0,"Active" +"Jonathan Bautista",1938-06-28,64,"Landscape architect",1,89,198,8.5,4.8,1,8.1,0.4,"Control" +"Steven Wilson",1947-02-17,55,"Surveyor, planning and development",1,89,194,8.6,5.3,1,8.3,0.299999999999999,"Active" +"Paula White",1979-03-04,74,"Engineer, control and instrumentation",0,89,187,8.6,4.6,5,8.2,0.4,"Active" +"Deborah Shelton",1934-11-10,50,"Designer, textile",1,90,179,8.6,4.7,3,8.6,0,"Control" +"James Rojas",1965-11-02,40,"Solicitor, Scotland",1,44,98,8.7,5,1,8.3,0.399999999999999,"Control" +"Leah Blankenship",1938-09-22,62,"Dramatherapist",0,90,176,8.7,5.3,3,8.5,0.199999999999999,"Active" +"Angela Wilson",1988-05-19,65,"Building control surveyor",1,90,190,8.8,4.5,4,8.5,0.300000000000001,"Active" +"James Wright",1997-09-20,63,"Advertising account executive",1,87,193,8.8,5.3,3,8.5,0.300000000000001,"Control" +"Heather Sawyer",1946-01-12,68,"Sport and exercise psychologist",1,89,179,9,5.2,3,8.8,0.199999999999999,"Control" +"Kristie Morris",1994-01-16,45,"Senior tax professional/tax inspector",1,91,185,9,4.6,4,8.6,0.4,"Active" +"Joan Chavez",1999-10-07,41,"Energy manager",0,93,182,9.1,5,2,8.8,0.299999999999999,"Control" +"Patricia Miller",1972-11-15,54,"Psychologist, educational",1,92,198,9.3,4.9,5,9,0.300000000000001,"Active" +"Rachel Mcguire",1970-12-23,62,"Medical sales representative",1,92,203,9.3,5.1,4,8.9,0.4,"Control" +"Angela Wilson",1983-08-24,65,"Designer, television/film set",1,92,202,9.3,5,5,9,0.300000000000001,"Active" +"Carrie Stevens",1985-12-11,72,"Ergonomist",1,95,192,9.6,5.3,2,9.4,0.199999999999999,"Control" +"Eric Rodriguez",2001-08-14,61,"Geneticist, molecular",0,95,191,9.7,5.2,4,9.5,0.199999999999999,"Control" +"Jeffery Silva",1973-11-25,70,"Bookseller",1,94,203,9.9,5.4,1,9.6,0.300000000000001,"Control" +"John Curtis",1936-11-25,66,"Sales professional, IT",1,96,201,10.1,5.1,5,10,0.1,"Control" +"Jessica Tanner",1986-07-01,54,"Paramedic",1,93,183,10.1,5.3,5,10,0.1,"Control" +"Charles Smith",1959-01-30,61,"Chartered certified accountant",0,99,212,10.1,5.6,4,9.7,0.4,"Control" +"Barry Porter",1979-05-30,65,"Dancer",1,98,200,10.1,5.3,3,10,0.1,"Control" +"Julie Barrett",1972-07-27,66,"Theme park manager",1,102,208,11.1,5.7,2,10.7,0.4,"Active" diff --git a/descriptive/example1/data/test.csv b/descriptive/example1/data/test.csv new file mode 100644 index 0000000..fa3e7a7 --- /dev/null +++ b/descriptive/example1/data/test.csv @@ -0,0 +1,13 @@ +,,Grouped by mortality,Grouped by mortality,Grouped by mortality,Grouped by mortality +,,Missing,Overall,0,1 +n,,,1000,864,136 +"Age, mean (SD)",,0,65.0 (17.2),64.0 (17.4),71.7 (14.0) +"SysABP, mean (SD)",,291,114.3 (40.2),115.4 (38.3),107.6 (49.4) +"Height, mean (SD)",,475,170.1 (22.1),170.3 (23.2),168.5 (11.3) +"Weight, mean (SD)",,302,82.9 (23.8),83.0 (23.6),82.3 (25.4) +"ICU, n (%)",CCU,0,162 (16.2),137 (15.9),25 (18.4) +"ICU, n (%)",CSRU,,202 (20.2),194 (22.5),8 (5.9) +"ICU, n (%)",MICU,,380 (38.0),318 (36.8),62 (45.6) +"ICU, n (%)",SICU,,256 (25.6),215 (24.9),41 (30.1) +"mortality, n (%)",0,0,864 (86.4),864 (100.0), +"mortality, n (%)",1,,136 (13.6),,136 (100.0) diff --git a/descriptive/example1/data/test2.csv b/descriptive/example1/data/test2.csv new file mode 100644 index 0000000..601a09c --- /dev/null +++ b/descriptive/example1/data/test2.csv @@ -0,0 +1,11 @@ +,,Grouped by Smoke,Grouped by Smoke,Grouped by Smoke,Grouped by Smoke,Grouped by Smoke +,,Missing,Overall,0,1,2 +n,,,200,88,85,27 +"Age, mean (SD)",,0,53.1 (12.6),50.1 (12.0),56.2 (12.4),53.0 (12.9) +"HR, mean (SD)",,0,74.7 (12.2),70.1 (10.7),79.6 (12.6),74.0 (9.5) +"Group, n (%)",Active,0,100 (50.0),41 (46.6),45 (52.9),14 (51.9) +"Group, n (%)",Control,,100 (50.0),47 (53.4),40 (47.1),13 (48.1) +"sBP, mean (SD)",,0,157.2 (25.7),147.8 (22.3),167.5 (26.8),155.6 (20.3) +"Smoke, n (%)",0,0,88 (44.0),88 (100.0),, +"Smoke, n (%)",1,,85 (42.5),,85 (100.0), +"Smoke, n (%)",2,,27 (13.5),,,27 (100.0) diff --git a/enrichment/code/code.py b/enrichment/code/code.py new file mode 100644 index 0000000..808bb02 --- /dev/null +++ b/enrichment/code/code.py @@ -0,0 +1,40 @@ +import pandas as pd + +######################## +### load in the data +######################## +patients = pd.read_csv('enrichment/example_data/patients.csv') +patients + +medications = pd.read_csv('enrichment/example_data/medications.csv') + +patients.columns +medications.columns + +patients['Id'] +medications['PATIENT'] + + +######################## +### merge examples +# add medications to patients +######################## +patients_simple = patients[['Id', 'SSN']] +medications_simple = medications[['PATIENT', 'DESCRIPTION']] + +patients_medications = patients_simple.merge(medications_simple, + how='left', + left_on='Id', right_on='PATIENT') + +print(patients_medications.head(5).to_markdown()) + +patients_medications = patients_medications.drop(columns=['PATIENT']) + +######################## +### concat examples +######################## + +patient_sample_1 = patients.sample(n=10) +patient_sample_2 = patients.sample(n=10) + +patients_s1_s2_concat = pd.concat([patient_sample_1, patient_sample_2]) \ No newline at end of file diff --git a/enrichment/example_data/readme_toDownloaddata.md b/enrichment/example_data/readme_toDownloaddata.md new file mode 100644 index 0000000..2753560 --- /dev/null +++ b/enrichment/example_data/readme_toDownloaddata.md @@ -0,0 +1,5 @@ +# Download data +- Data from: https://synthea.mitre.org/downloads +- Please look at: 1K Sample Synthetic Patient Records, CSV | [mirror]: 9 MB +- This has a variety of different data files to look at +- You can then place the files inside of this folder (e.g., enrichment/example_data/careplans, enrichment/example_data/devices, enrichment/example_data/patients, etc...) \ No newline at end of file diff --git a/transformation/dataFiles/clean/113243405_StonyBrookUniversityHospital_standardcharges_clean.csv b/transformation/dataFiles/clean/113243405_StonyBrookUniversityHospital_standardcharges_clean.csv new file mode 100644 index 0000000..26bb314 --- /dev/null +++ b/transformation/dataFiles/clean/113243405_StonyBrookUniversityHospital_standardcharges_clean.csv @@ -0,0 +1,152629 @@ +,HospCode,Code,Description,Code_Type,Gross Charge,Discounted Cash Price,Minimum Negotiated Charge,Maximum Negotiated Charge,variable,value +0,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,1199-Commercial, +1,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,1199-Commercial, +2,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,1199-Commercial, +3,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,1199-Commercial, +4,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,1199-Commercial, +5,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,1199-Commercial, +6,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,1199-Commercial, +7,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,1199-Commercial, +8,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,1199-Commercial, +9,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,1199-Commercial,373964.14 +10,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,1199-Commercial, +11,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,1199-Commercial, +12,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,1199-Commercial,148452.26 +13,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,1199-Commercial, +14,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,1199-Commercial, +15,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,1199-Commercial,46571.77 +16,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,1199-Commercial,50626.81 +17,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,1199-Commercial, +18,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,1199-Commercial, +19,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,1199-Commercial, +20,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,1199-Commercial, +21,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,1199-Commercial, +22,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,1199-Commercial, +23,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,1199-Commercial, +24,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,1199-Commercial, +25,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,1199-Commercial, +26,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,1199-Commercial, +27,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,1199-Commercial, +28,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,1199-Commercial, +29,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,1199-Commercial, +30,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,1199-Commercial,45656.3 +31,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,1199-Commercial,53181.14 +32,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,1199-Commercial, +33,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,1199-Commercial, +34,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,1199-Commercial, +35,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,1199-Commercial, +36,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,1199-Commercial, +37,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,1199-Commercial, +38,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,1199-Commercial, +39,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,1199-Commercial, +40,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,1199-Commercial, +41,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,1199-Commercial, +42,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,1199-Commercial,29767.43 +43,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,1199-Commercial, +44,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,1199-Commercial,26924.72 +45,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,1199-Commercial,22731.6 +46,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,1199-Commercial, +47,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,1199-Commercial, +48,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,1199-Commercial, +49,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,1199-Commercial, +50,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,1199-Commercial, +51,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,1199-Commercial, +52,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,1199-Commercial, +53,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,1199-Commercial,19781.51 +54,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,1199-Commercial, +55,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,1199-Commercial, +56,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,1199-Commercial, +57,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,1199-Commercial, +58,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,1199-Commercial,39975.04 +59,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,1199-Commercial, +60,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,1199-Commercial, +61,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,1199-Commercial, +62,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,1199-Commercial, +63,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,1199-Commercial,28378.81 +64,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,1199-Commercial,20474.64 +65,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,1199-Commercial,27797.6 +66,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,1199-Commercial,9958.02 +67,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,1199-Commercial, +68,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,1199-Commercial, +69,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,1199-Commercial, +70,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,1199-Commercial, +71,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,1199-Commercial, +72,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,1199-Commercial, +73,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,1199-Commercial,52372.61 +74,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,1199-Commercial,14830.69 +75,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,1199-Commercial, +76,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,1199-Commercial, +77,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,1199-Commercial, +78,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,1199-Commercial, +79,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,1199-Commercial, +80,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,1199-Commercial, +81,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,1199-Commercial, +82,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,1199-Commercial,23813.62 +83,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,1199-Commercial, +84,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,1199-Commercial, +85,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,1199-Commercial, +86,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,1199-Commercial, +87,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,1199-Commercial, +88,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,1199-Commercial, +89,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,1199-Commercial, +90,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,1199-Commercial,15979.39 +91,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,1199-Commercial, +92,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,1199-Commercial, +93,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,1199-Commercial, +94,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,1199-Commercial, +95,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,1199-Commercial, +96,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,1199-Commercial, +97,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,1199-Commercial, +98,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,1199-Commercial, +99,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,1199-Commercial, +100,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,1199-Commercial, +101,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,1199-Commercial, +102,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,1199-Commercial, +103,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,1199-Commercial, +104,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,1199-Commercial, +105,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,1199-Commercial, +106,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,1199-Commercial,20325.25 +107,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,1199-Commercial, +108,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,1199-Commercial, +109,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,1199-Commercial, +110,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,1199-Commercial, +111,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,1199-Commercial,8446.42 +112,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,1199-Commercial, +113,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,1199-Commercial, +114,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,1199-Commercial, +115,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,1199-Commercial, +116,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,1199-Commercial, +117,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,1199-Commercial, +118,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,1199-Commercial, +119,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,1199-Commercial, +120,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,1199-Commercial,11311.25 +121,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,1199-Commercial,39598.92 +122,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,1199-Commercial, +123,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,1199-Commercial,18834.16 +124,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,1199-Commercial, +125,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,1199-Commercial, +126,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,1199-Commercial, +127,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,1199-Commercial, +128,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,1199-Commercial, +129,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,1199-Commercial, +130,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,1199-Commercial, +131,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,1199-Commercial,17206.3 +132,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,1199-Commercial,32916.31 +133,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,1199-Commercial, +134,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,1199-Commercial, +135,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,1199-Commercial,38368.8 +136,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,1199-Commercial,27101.41 +137,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,1199-Commercial, +138,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,1199-Commercial, +139,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,1199-Commercial, +140,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,1199-Commercial, +141,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,1199-Commercial, +142,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,1199-Commercial, +143,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,1199-Commercial,22590.47 +144,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,1199-Commercial, +145,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,1199-Commercial, +146,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,1199-Commercial, +147,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,1199-Commercial, +148,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,1199-Commercial, +149,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,1199-Commercial, +150,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,1199-Commercial, +151,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,1199-Commercial, +152,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,1199-Commercial, +153,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,1199-Commercial, +154,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,1199-Commercial, +155,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,1199-Commercial, +156,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,1199-Commercial, +157,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,1199-Commercial, +158,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,1199-Commercial, +159,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,1199-Commercial, +160,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,1199-Commercial, +161,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,1199-Commercial, +162,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,1199-Commercial, +163,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,1199-Commercial, +164,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,1199-Commercial, +165,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,1199-Commercial, +166,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,1199-Commercial, +167,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,1199-Commercial, +168,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,1199-Commercial, +169,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,1199-Commercial, +170,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,1199-Commercial, +171,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,1199-Commercial, +172,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,1199-Commercial,55030.63 +173,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,1199-Commercial, +174,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,1199-Commercial, +175,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,1199-Commercial, +176,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,1199-Commercial, +177,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,1199-Commercial,62056.32 +178,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,1199-Commercial, +179,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,1199-Commercial, +180,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,1199-Commercial, +181,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,1199-Commercial, +182,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,1199-Commercial,31159.86 +183,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,1199-Commercial,52369.74 +184,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,1199-Commercial, +185,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,1199-Commercial, +186,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,1199-Commercial, +187,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,1199-Commercial, +188,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,1199-Commercial, +189,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,1199-Commercial, +190,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,1199-Commercial, +191,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,1199-Commercial, +192,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,1199-Commercial, +193,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,1199-Commercial, +194,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,1199-Commercial, +195,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,1199-Commercial, +196,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,1199-Commercial,106756.7 +197,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,1199-Commercial, +198,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,1199-Commercial, +199,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,1199-Commercial, +200,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,1199-Commercial, +201,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,1199-Commercial, +202,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,1199-Commercial, +203,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,1199-Commercial, +204,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,1199-Commercial,46925.89 +205,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,1199-Commercial, +206,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,1199-Commercial, +207,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,1199-Commercial, +208,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,1199-Commercial, +209,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,1199-Commercial,13848.85 +210,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,1199-Commercial, +211,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,1199-Commercial, +212,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,1199-Commercial, +213,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,1199-Commercial, +214,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,1199-Commercial, +215,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,1199-Commercial, +216,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,1199-Commercial, +217,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,1199-Commercial, +218,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,1199-Commercial, +219,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,1199-Commercial, +220,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,1199-Commercial, +221,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,1199-Commercial, +222,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,1199-Commercial, +223,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,1199-Commercial, +224,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,1199-Commercial, +225,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,1199-Commercial, +226,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,1199-Commercial, +227,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,1199-Commercial, +228,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,1199-Commercial, +229,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,1199-Commercial, +230,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,1199-Commercial, +231,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,1199-Commercial,20581.33 +232,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,1199-Commercial, +233,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,1199-Commercial, +234,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,1199-Commercial,21355.32 +235,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,1199-Commercial, +236,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,1199-Commercial, +237,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,1199-Commercial, +238,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,1199-Commercial, +239,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,1199-Commercial, +240,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,1199-Commercial,73353.56 +241,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,1199-Commercial, +242,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,1199-Commercial, +243,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,1199-Commercial, +244,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,1199-Commercial, +245,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,1199-Commercial, +246,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,1199-Commercial,16372.99 +247,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,1199-Commercial, +248,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,1199-Commercial, +249,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,1199-Commercial, +250,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,1199-Commercial, +251,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,1199-Commercial, +252,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,1199-Commercial,23166.58 +253,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,1199-Commercial, +254,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,1199-Commercial, +255,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,1199-Commercial, +256,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,1199-Commercial, +257,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,1199-Commercial, +258,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,1199-Commercial, +259,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,1199-Commercial, +260,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,1199-Commercial, +261,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,1199-Commercial, +262,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,1199-Commercial,27953.65 +263,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,1199-Commercial, +264,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,1199-Commercial, +265,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,1199-Commercial, +266,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,1199-Commercial, +267,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,1199-Commercial, +268,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,1199-Commercial, +269,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,1199-Commercial, +270,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,1199-Commercial,21343.81 +271,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,1199-Commercial,32702.47 +272,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,1199-Commercial, +273,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,1199-Commercial, +274,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,1199-Commercial, +275,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,1199-Commercial,13916.1 +276,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,1199-Commercial, +277,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,1199-Commercial, +278,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,1199-Commercial, +279,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,1199-Commercial, +280,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,1199-Commercial, +281,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,1199-Commercial, +282,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,1199-Commercial, +283,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,1199-Commercial,9166.56 +284,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,1199-Commercial, +285,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,1199-Commercial,25610.01 +286,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,1199-Commercial,7582.33 +287,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,1199-Commercial, +288,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,1199-Commercial,22567.82 +289,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,1199-Commercial, +290,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,1199-Commercial,12272.22 +291,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,1199-Commercial, +292,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,1199-Commercial, +293,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,1199-Commercial,45698.38 +294,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,1199-Commercial, +295,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,1199-Commercial,148391.73 +296,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,1199-Commercial, +297,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,1199-Commercial, +298,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,1199-Commercial, +299,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,1199-Commercial, +300,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,1199-Commercial, +301,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,1199-Commercial, +302,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,1199-Commercial, +303,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,1199-Commercial, +304,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,1199-Commercial, +305,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,1199-Commercial, +306,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,1199-Commercial, +307,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,1199-Commercial, +308,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,1199-Commercial, +309,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,1199-Commercial,48830.66 +310,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,1199-Commercial, +311,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,1199-Commercial,13955.37 +312,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,1199-Commercial, +313,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,1199-Commercial, +314,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,1199-Commercial, +315,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,1199-Commercial, +316,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,1199-Commercial, +317,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,1199-Commercial, +318,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,1199-Commercial,12525.79 +319,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,1199-Commercial, +320,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,1199-Commercial,126582.35 +321,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,1199-Commercial, +322,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,1199-Commercial, +323,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,1199-Commercial,130146.44 +324,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,1199-Commercial, +325,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,1199-Commercial, +326,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,1199-Commercial,86137.56 +327,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,1199-Commercial, +328,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,1199-Commercial, +329,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,1199-Commercial, +330,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,1199-Commercial,49532.47 +331,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,1199-Commercial, +332,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,1199-Commercial, +333,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,1199-Commercial, +334,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,1199-Commercial, +335,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,1199-Commercial,42665.23 +336,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,1199-Commercial,41486.31 +337,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,1199-Commercial, +338,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,1199-Commercial, +339,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,1199-Commercial, +340,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,1199-Commercial, +341,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,1199-Commercial, +342,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,1199-Commercial, +343,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,1199-Commercial, +344,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,1199-Commercial, +345,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,1199-Commercial, +346,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,1199-Commercial,62581.34 +347,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,1199-Commercial, +348,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,1199-Commercial, +349,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,1199-Commercial, +350,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,1199-Commercial, +351,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,1199-Commercial, +352,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,1199-Commercial, +353,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,1199-Commercial, +354,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,1199-Commercial, +355,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,1199-Commercial, +356,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,1199-Commercial, +357,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,1199-Commercial, +358,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,1199-Commercial, +359,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,1199-Commercial, +360,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,1199-Commercial, +361,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,1199-Commercial, +362,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,1199-Commercial, +363,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,1199-Commercial, +364,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,1199-Commercial, +365,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,1199-Commercial, +366,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,1199-Commercial, +367,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,1199-Commercial, +368,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,1199-Commercial, +369,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,1199-Commercial, +370,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,1199-Commercial, +371,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,1199-Commercial, +372,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,1199-Commercial, +373,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,1199-Commercial, +374,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,1199-Commercial, +375,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,1199-Commercial, +376,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,1199-Commercial, +377,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,1199-Commercial, +378,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,1199-Commercial,15429.65 +379,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,1199-Commercial, +380,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,1199-Commercial, +381,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,1199-Commercial, +382,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,1199-Commercial, +383,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,1199-Commercial, +384,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,1199-Commercial,16731.92 +385,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,1199-Commercial, +386,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,1199-Commercial, +387,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,1199-Commercial, +388,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,1199-Commercial, +389,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,1199-Commercial, +390,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,1199-Commercial, +391,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,1199-Commercial, +392,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,1199-Commercial, +393,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,1199-Commercial, +394,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,1199-Commercial, +395,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,1199-Commercial,11902.05 +396,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,1199-Commercial, +397,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,1199-Commercial, +398,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,1199-Commercial, +399,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,1199-Commercial, +400,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,1199-Commercial, +401,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,1199-Commercial, +402,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,1199-Commercial, +403,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,1199-Commercial, +404,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,1199-Commercial, +405,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,1199-Commercial, +406,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,1199-Commercial, +407,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,1199-Commercial, +408,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,1199-Commercial, +409,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,1199-Commercial, +410,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,1199-Commercial, +411,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,1199-Commercial, +412,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,1199-Commercial, +413,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,1199-Commercial, +414,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,1199-Commercial, +415,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,1199-Commercial, +416,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,1199-Commercial, +417,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,1199-Commercial, +418,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,1199-Commercial, +419,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,1199-Commercial, +420,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,1199-Commercial, +421,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,1199-Commercial, +422,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,1199-Commercial, +423,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,1199-Commercial, +424,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,1199-Commercial, +425,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,1199-Commercial, +426,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,1199-Commercial, +427,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,1199-Commercial, +428,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,1199-Commercial, +429,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,1199-Commercial, +430,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,1199-Commercial, +431,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,1199-Commercial, +432,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,1199-Commercial, +433,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,1199-Commercial,22591.1 +434,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,1199-Commercial, +435,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,1199-Commercial, +436,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,1199-Commercial, +437,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,1199-Commercial, +438,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,1199-Commercial, +439,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,1199-Commercial, +440,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,1199-Commercial, +441,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,1199-Commercial, +442,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,1199-Commercial,12194.64 +443,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,1199-Commercial, +444,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,1199-Commercial,17319.37 +445,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,1199-Commercial,16555.46 +446,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,1199-Commercial, +447,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,1199-Commercial, +448,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,1199-Commercial,11498.33 +449,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,1199-Commercial, +450,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,1199-Commercial, +451,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,1199-Commercial, +452,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,1199-Commercial,92534.11 +453,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,1199-Commercial, +454,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,1199-Commercial, +455,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,1199-Commercial, +456,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,1199-Commercial, +457,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,1199-Commercial, +458,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,1199-Commercial, +459,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,1199-Commercial, +460,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,1199-Commercial,30658.35 +461,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,1199-Commercial, +462,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,1199-Commercial, +463,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,1199-Commercial, +464,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,1199-Commercial, +465,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,1199-Commercial, +466,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,1199-Commercial, +467,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,1199-Commercial, +468,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,1199-Commercial, +469,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,1199-Commercial, +470,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,1199-Commercial, +471,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,1199-Commercial, +472,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,1199-Commercial, +473,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,1199-Commercial, +474,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,1199-Commercial, +475,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,1199-Commercial, +476,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,1199-Commercial, +477,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,1199-Commercial,29352.45 +478,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,1199-Commercial,19285.91 +479,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,1199-Commercial, +480,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,1199-Commercial, +481,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,1199-Commercial, +482,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,1199-Commercial, +483,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,1199-Commercial, +484,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,1199-Commercial,16633.23 +485,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,1199-Commercial, +486,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,1199-Commercial,16997.98 +487,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,1199-Commercial,41778.4 +488,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,1199-Commercial, +489,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,1199-Commercial, +490,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,1199-Commercial,13936.28 +491,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,1199-Commercial, +492,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,1199-Commercial, +493,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,1199-Commercial, +494,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,1199-Commercial, +495,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,1199-Commercial, +496,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,1199-Commercial, +497,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,1199-Commercial, +498,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,1199-Commercial, +499,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,1199-Commercial, +500,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,1199-Commercial, +501,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,1199-Commercial, +502,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,1199-Commercial, +503,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,1199-Commercial, +504,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,1199-Commercial, +505,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,1199-Commercial, +506,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,1199-Commercial,51528.06 +507,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,1199-Commercial,28729.97 +508,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,1199-Commercial, +509,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,1199-Commercial, +510,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,1199-Commercial, +511,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,1199-Commercial, +512,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,1199-Commercial, +513,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,1199-Commercial, +514,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,1199-Commercial, +515,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,1199-Commercial, +516,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,1199-Commercial, +517,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,1199-Commercial, +518,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,1199-Commercial, +519,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,1199-Commercial,16235.48 +520,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,1199-Commercial,22470.09 +521,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,1199-Commercial,17218.39 +522,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,1199-Commercial, +523,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,1199-Commercial, +524,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,1199-Commercial,14722.99 +525,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,1199-Commercial,20464.6 +526,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,1199-Commercial,34284.59 +527,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,1199-Commercial,22290.4 +528,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,1199-Commercial,22994.28 +529,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,1199-Commercial, +530,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,1199-Commercial,105454.16 +531,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,1199-Commercial,105827.65 +532,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,1199-Commercial, +533,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,1199-Commercial,19829.93 +534,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,1199-Commercial,16836.09 +535,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,1199-Commercial,2890.25 +536,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,1199-Commercial, +537,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,1199-Commercial, +538,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,1199-Commercial, +539,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,1199-Commercial, +540,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,1199-Commercial, +541,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,1199-Commercial, +542,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,1199-Commercial, +543,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,1199-Commercial, +544,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,1199-Commercial,20467.23 +545,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,1199-Commercial,15536.74 +546,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,1199-Commercial,13124.59 +547,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,1199-Commercial,66394.99 +548,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,1199-Commercial, +549,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,1199-Commercial, +550,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,1199-Commercial, +551,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,1199-Commercial,25052.65 +552,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,1199-Commercial,179628.36 +553,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,1199-Commercial, +554,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,1199-Commercial, +555,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,1199-Commercial,20598.59 +556,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,1199-Commercial, +557,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,1199-Commercial, +558,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,1199-Commercial, +559,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,1199-Commercial, +560,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,1199-Commercial, +561,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,1199-Commercial, +562,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,1199-Commercial, +563,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,1199-Commercial, +564,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,1199-Commercial, +565,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,1199-Commercial, +566,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,1199-Commercial, +567,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,1199-Commercial, +568,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,1199-Commercial, +569,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,1199-Commercial, +570,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,1199-Commercial,6960.93 +571,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,1199-Commercial,21822.03 +572,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,1199-Commercial, +573,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,1199-Commercial, +574,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,1199-Commercial, +575,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,1199-Commercial, +576,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,1199-Commercial, +577,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,1199-Commercial, +578,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,1199-Commercial, +579,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,1199-Commercial, +580,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,1199-Commercial, +581,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,1199-Commercial, +582,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,1199-Commercial, +583,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,1199-Commercial, +584,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,1199-Commercial, +585,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,1199-Commercial, +586,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,1199-Commercial, +587,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,1199-Commercial,171081.53 +588,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,1199-Commercial,62184.21 +589,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,1199-Commercial, +590,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,1199-Commercial, +591,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,1199-Commercial, +592,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,1199-Commercial,39394.72 +593,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,1199-Commercial, +594,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,1199-Commercial, +595,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,1199-Commercial, +596,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,1199-Commercial, +597,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,1199-Commercial,32415.08 +598,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,1199-Commercial, +599,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,1199-Commercial, +600,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,1199-Commercial,181969.08 +601,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,1199-Commercial,45215.18 +602,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,1199-Commercial,29903.78 +603,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,1199-Commercial, +604,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,1199-Commercial,16949.28 +605,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,1199-Commercial,20128.0 +606,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,1199-Commercial, +607,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,1199-Commercial, +608,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,1199-Commercial, +609,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,1199-Commercial,42517.0 +610,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,1199-Commercial,16938.54 +611,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,1199-Commercial, +612,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,1199-Commercial, +613,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,1199-Commercial, +614,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,1199-Commercial, +615,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,1199-Commercial,11395.9 +616,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,1199-Commercial, +617,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,1199-Commercial, +618,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,1199-Commercial, +619,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,1199-Commercial, +620,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,1199-Commercial, +621,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,1199-Commercial, +622,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,1199-Commercial, +623,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,1199-Commercial, +624,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,1199-Commercial, +625,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,1199-Commercial, +626,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,1199-Commercial, +627,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,1199-Commercial,11751.01 +628,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,1199-Commercial, +629,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,1199-Commercial, +630,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,1199-Commercial,30727.74 +631,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,1199-Commercial, +632,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,1199-Commercial, +633,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,1199-Commercial, +634,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,1199-Commercial, +635,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,1199-Commercial, +636,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,1199-Commercial, +637,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,1199-Commercial, +638,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,1199-Commercial, +639,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,1199-Commercial, +640,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,1199-Commercial, +641,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,1199-Commercial, +642,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,1199-Commercial, +643,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,1199-Commercial, +644,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,1199-Commercial, +645,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,1199-Commercial,112885.11 +646,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,1199-Commercial, +647,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,1199-Commercial, +648,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,1199-Commercial, +649,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,1199-Commercial, +650,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,1199-Commercial, +651,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,1199-Commercial,90472.9 +652,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,1199-Commercial, +653,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,1199-Commercial, +654,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,1199-Commercial,23396.13 +655,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,1199-Commercial, +656,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,1199-Commercial, +657,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,1199-Commercial, +658,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,1199-Commercial,3627.0 +659,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,1199-Commercial, +660,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,1199-Commercial, +661,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,1199-Commercial, +662,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,1199-Commercial, +663,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,1199-Commercial,3915.0 +664,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,1199-Commercial, +665,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,1199-Commercial,2853.0 +666,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,1199-Commercial, +667,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,1199-Commercial,1949.0 +668,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,1199-Commercial, +669,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,1199-Commercial, +670,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,1199-Commercial, +671,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,1199-Commercial, +672,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,1199-Commercial, +673,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,1199-Commercial, +674,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,1199-Commercial, +675,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,1199-Commercial, +676,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,1199-Commercial, +677,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,1199-Commercial, +678,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,1199-Commercial, +679,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,1199-Commercial, +680,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,1199-Commercial, +681,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,1199-Commercial, +682,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,1199-Commercial, +683,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,1199-Commercial, +684,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,1199-Commercial, +685,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,1199-Commercial, +686,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,1199-Commercial,3570.0 +687,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,1199-Commercial, +688,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,1199-Commercial, +689,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,1199-Commercial, +690,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,1199-Commercial, +691,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,1199-Commercial, +692,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,1199-Commercial, +693,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,1199-Commercial, +694,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,1199-Commercial, +695,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,1199-Commercial,2272.0 +696,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,1199-Commercial, +697,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,1199-Commercial, +698,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,1199-Commercial, +699,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,1199-Commercial, +700,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,1199-Commercial, +701,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,1199-Commercial, +702,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,1199-Commercial,2272.0 +703,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,1199-Commercial, +704,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,1199-Commercial,2272.0 +705,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,1199-Commercial, +706,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,1199-Commercial,4544.0 +707,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,1199-Commercial, +708,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,1199-Commercial, +709,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,1199-Commercial, +710,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,1199-Commercial, +711,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,1199-Commercial,4544.0 +712,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,1199-Commercial, +713,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,1199-Commercial, +714,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,1199-Commercial, +715,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,1199-Commercial, +716,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,1199-Commercial, +717,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,1199-Commercial, +718,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,1199-Commercial, +719,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,1199-Commercial, +720,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,1199-Commercial, +721,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,1199-Commercial, +722,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,1199-Commercial, +723,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,1199-Commercial, +724,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,1199-Commercial, +725,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,1199-Commercial, +726,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,1199-Commercial, +727,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,1199-Commercial, +728,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,1199-Commercial, +729,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,1199-Commercial, +730,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,1199-Commercial, +731,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,1199-Commercial, +732,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,1199-Commercial, +733,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,1199-Commercial, +734,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,1199-Commercial, +735,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,1199-Commercial, +736,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,1199-Commercial, +737,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,1199-Commercial, +738,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,1199-Commercial, +739,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,1199-Commercial, +740,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,1199-Commercial, +741,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,1199-Commercial, +742,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,1199-Commercial,1949.0 +743,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,1199-Commercial,1949.0 +744,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,1199-Commercial, +745,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,1199-Commercial, +746,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,1199-Commercial,1949.0 +747,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,1199-Commercial, +748,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,1199-Commercial, +749,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,1199-Commercial, +750,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,1199-Commercial, +751,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,1199-Commercial, +752,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,1199-Commercial, +753,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,1199-Commercial, +754,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,1199-Commercial, +755,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,1199-Commercial, +756,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,1199-Commercial,2272.0 +757,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,1199-Commercial, +758,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,1199-Commercial, +759,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,1199-Commercial, +760,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,1199-Commercial, +761,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,1199-Commercial, +762,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,1199-Commercial, +763,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,1199-Commercial, +764,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,1199-Commercial,1949.0 +765,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,1199-Commercial, +766,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,1199-Commercial, +767,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,1199-Commercial, +768,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,1199-Commercial, +769,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,1199-Commercial, +770,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,1199-Commercial, +771,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,1199-Commercial, +772,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,1199-Commercial, +773,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,1199-Commercial, +774,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,1199-Commercial, +775,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,1199-Commercial, +776,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,1199-Commercial, +777,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,1199-Commercial, +778,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,1199-Commercial, +779,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,1199-Commercial, +780,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,1199-Commercial, +781,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,1199-Commercial, +782,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,1199-Commercial, +783,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,1199-Commercial, +784,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,1199-Commercial, +785,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,1199-Commercial, +786,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,1199-Commercial, +787,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,1199-Commercial, +788,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,1199-Commercial, +789,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,1199-Commercial, +790,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,1199-Commercial, +791,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,1199-Commercial, +792,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,1199-Commercial, +793,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,1199-Commercial, +794,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,1199-Commercial, +795,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,1199-Commercial, +796,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,1199-Commercial, +797,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,1199-Commercial, +798,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,1199-Commercial, +799,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,1199-Commercial, +800,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,1199-Commercial, +801,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,1199-Commercial, +802,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,1199-Commercial, +803,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,1199-Commercial, +804,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,1199-Commercial, +805,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,1199-Commercial, +806,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,1199-Commercial, +807,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,1199-Commercial, +808,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,1199-Commercial, +809,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,1199-Commercial, +810,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,1199-Commercial, +811,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,1199-Commercial,2272.0 +812,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,1199-Commercial, +813,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,1199-Commercial, +814,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,1199-Commercial, +815,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,1199-Commercial,2272.0 +816,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,1199-Commercial, +817,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,1199-Commercial, +818,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,1199-Commercial, +819,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,1199-Commercial, +820,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,1199-Commercial, +821,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,1199-Commercial, +822,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,1199-Commercial, +823,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,1199-Commercial, +824,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,1199-Commercial, +825,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,1199-Commercial, +826,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,1199-Commercial, +827,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,1199-Commercial, +828,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,1199-Commercial, +829,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,1199-Commercial, +830,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,1199-Commercial,4544.0 +831,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,1199-Commercial, +832,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,1199-Commercial,4033.4 +833,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,1199-Commercial, +834,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,1199-Commercial,4482.28 +835,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,1199-Commercial, +836,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,1199-Commercial, +837,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,1199-Commercial,4490.5 +838,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,1199-Commercial, +839,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,1199-Commercial, +840,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,1199-Commercial, +841,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,1199-Commercial, +842,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,1199-Commercial, +843,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,1199-Commercial, +844,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,1199-Commercial, +845,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,1199-Commercial, +846,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,1199-Commercial,4437.0 +847,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,1199-Commercial, +848,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,1199-Commercial, +849,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,1199-Commercial, +850,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,1199-Commercial,6020.5 +851,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,1199-Commercial, +852,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,1199-Commercial, +853,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,1199-Commercial, +854,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,1199-Commercial, +855,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,1199-Commercial, +856,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,1199-Commercial, +857,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,1199-Commercial, +858,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,1199-Commercial, +859,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,1199-Commercial, +860,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,1199-Commercial, +861,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,1199-Commercial,6117.0 +862,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,1199-Commercial, +863,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,1199-Commercial, +864,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,1199-Commercial, +865,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,1199-Commercial, +866,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,1199-Commercial, +867,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,1199-Commercial, +868,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,1199-Commercial, +869,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,1199-Commercial, +870,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,1199-Commercial, +871,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,1199-Commercial, +872,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,1199-Commercial, +873,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,1199-Commercial, +874,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,1199-Commercial, +875,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,1199-Commercial, +876,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,1199-Commercial, +877,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,1199-Commercial, +878,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,1199-Commercial, +879,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,1199-Commercial, +880,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,1199-Commercial, +881,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,1199-Commercial, +882,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,1199-Commercial, +883,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,1199-Commercial, +884,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,1199-Commercial, +885,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,1199-Commercial, +886,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,1199-Commercial, +887,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,1199-Commercial,3786.67 +888,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,1199-Commercial, +889,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,1199-Commercial, +890,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,1199-Commercial, +891,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,1199-Commercial, +892,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,1199-Commercial, +893,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,1199-Commercial, +894,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,1199-Commercial, +895,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,1199-Commercial, +896,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,1199-Commercial, +897,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,1199-Commercial, +898,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,1199-Commercial, +899,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,1199-Commercial, +900,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,1199-Commercial, +901,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,1199-Commercial, +902,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,1199-Commercial, +903,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,1199-Commercial, +904,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,1199-Commercial, +905,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,1199-Commercial, +906,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,1199-Commercial, +907,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,1199-Commercial, +908,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,1199-Commercial, +909,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,1199-Commercial, +910,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,1199-Commercial, +911,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,1199-Commercial, +912,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,1199-Commercial, +913,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,1199-Commercial, +914,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,1199-Commercial, +915,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,1199-Commercial, +916,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,1199-Commercial, +917,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,1199-Commercial, +918,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,1199-Commercial, +919,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,1199-Commercial, +920,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,1199-Commercial, +921,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,1199-Commercial, +922,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,1199-Commercial, +923,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,1199-Commercial, +924,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,1199-Commercial, +925,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,1199-Commercial, +926,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,1199-Commercial, +927,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,1199-Commercial, +928,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,1199-Commercial, +929,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,1199-Commercial, +930,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,1199-Commercial, +931,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,1199-Commercial, +932,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,1199-Commercial, +933,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,1199-Commercial, +934,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,1199-Commercial, +935,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,1199-Commercial, +936,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,1199-Commercial, +937,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,1199-Commercial, +938,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,1199-Commercial,3693.0 +939,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,1199-Commercial, +940,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,1199-Commercial, +941,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,1199-Commercial, +942,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,1199-Commercial, +943,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,1199-Commercial, +944,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,1199-Commercial, +945,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,1199-Commercial, +946,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,1199-Commercial, +947,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,1199-Commercial, +948,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,1199-Commercial, +949,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,1199-Commercial, +950,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,1199-Commercial, +951,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,1199-Commercial, +952,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,1199-Commercial, +953,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,1199-Commercial, +954,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,1199-Commercial, +955,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,1199-Commercial, +956,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,1199-Commercial, +957,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,1199-Commercial, +958,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,1199-Commercial, +959,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,1199-Commercial, +960,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,1199-Commercial, +961,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,1199-Commercial, +962,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,1199-Commercial, +963,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,1199-Commercial, +964,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,1199-Commercial, +965,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,1199-Commercial, +966,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,1199-Commercial, +967,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,1199-Commercial, +968,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,1199-Commercial, +969,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,1199-Commercial, +970,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,1199-Commercial, +971,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,1199-Commercial, +972,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,1199-Commercial, +973,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,1199-Commercial, +974,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,1199-Commercial, +975,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,1199-Commercial, +976,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,1199-Commercial, +977,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,1199-Commercial, +978,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,1199-Commercial, +979,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,1199-Commercial, +980,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,1199-Commercial,4703.0 +981,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,1199-Commercial, +982,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,1199-Commercial, +983,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,1199-Commercial, +984,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,1199-Commercial, +985,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,1199-Commercial, +986,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,1199-Commercial, +987,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,1199-Commercial, +988,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,1199-Commercial, +989,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,1199-Commercial, +990,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,1199-Commercial, +991,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,1199-Commercial, +992,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,1199-Commercial, +993,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,1199-Commercial, +994,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,1199-Commercial, +995,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,1199-Commercial, +996,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,1199-Commercial, +997,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,1199-Commercial, +998,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,1199-Commercial, +999,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,1199-Commercial, +1000,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,1199-Commercial, +1001,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,1199-Commercial, +1002,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,1199-Commercial, +1003,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,1199-Commercial, +1004,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,1199-Commercial, +1005,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,1199-Commercial, +1006,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,1199-Commercial, +1007,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,1199-Commercial, +1008,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,1199-Commercial, +1009,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,1199-Commercial, +1010,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,1199-Commercial,1949.0 +1011,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,1199-Commercial, +1012,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,1199-Commercial, +1013,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,1199-Commercial, +1014,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,1199-Commercial, +1015,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,1199-Commercial, +1016,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,1199-Commercial, +1017,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,1199-Commercial, +1018,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,1199-Commercial, +1019,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,1199-Commercial,3487.5 +1020,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,1199-Commercial, +1021,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,1199-Commercial, +1022,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,1199-Commercial, +1023,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,1199-Commercial, +1024,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,1199-Commercial, +1025,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,1199-Commercial, +1026,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,1199-Commercial, +1027,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,1199-Commercial, +1028,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,1199-Commercial,5016.0 +1029,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,1199-Commercial, +1030,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,1199-Commercial, +1031,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,1199-Commercial, +1032,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,1199-Commercial, +1033,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,1199-Commercial, +1034,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,1199-Commercial, +1035,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,1199-Commercial, +1036,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,1199-Commercial,4929.0 +1037,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,1199-Commercial, +1038,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,1199-Commercial, +1039,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,1199-Commercial, +1040,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,1199-Commercial, +1041,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,1199-Commercial, +1042,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,1199-Commercial, +1043,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,1199-Commercial, +1044,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,1199-Commercial, +1045,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,1199-Commercial, +1046,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,1199-Commercial, +1047,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,1199-Commercial,4287.0 +1048,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,1199-Commercial, +1049,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,1199-Commercial, +1050,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,1199-Commercial, +1051,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,1199-Commercial, +1052,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,1199-Commercial, +1053,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,1199-Commercial,2006.0 +1054,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,1199-Commercial,1949.0 +1055,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,1199-Commercial, +1056,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,1199-Commercial, +1057,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,1199-Commercial, +1058,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,1199-Commercial, +1059,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,1199-Commercial, +1060,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,1199-Commercial, +1061,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,1199-Commercial, +1062,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,1199-Commercial, +1063,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,1199-Commercial, +1064,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,1199-Commercial, +1065,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,1199-Commercial, +1066,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,1199-Commercial,3435.78 +1067,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,1199-Commercial, +1068,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,1199-Commercial, +1069,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,1199-Commercial, +1070,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,1199-Commercial, +1071,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,1199-Commercial, +1072,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,1199-Commercial, +1073,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,1199-Commercial,4287.0 +1074,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,1199-Commercial, +1075,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,1199-Commercial, +1076,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,1199-Commercial, +1077,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,1199-Commercial, +1078,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,1199-Commercial, +1079,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,1199-Commercial,4544.0 +1080,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,1199-Commercial, +1081,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,1199-Commercial, +1082,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,1199-Commercial, +1083,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,1199-Commercial, +1084,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,1199-Commercial, +1085,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,1199-Commercial,3215.25 +1086,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,1199-Commercial, +1087,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,1199-Commercial, +1088,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,1199-Commercial, +1089,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,1199-Commercial, +1090,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,1199-Commercial, +1091,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,1199-Commercial, +1092,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,1199-Commercial, +1093,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,1199-Commercial, +1094,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,1199-Commercial, +1095,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,1199-Commercial, +1096,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,1199-Commercial, +1097,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,1199-Commercial, +1098,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,1199-Commercial, +1099,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,1199-Commercial, +1100,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,1199-Commercial, +1101,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,1199-Commercial, +1102,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,1199-Commercial, +1103,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,1199-Commercial, +1104,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,1199-Commercial, +1105,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,1199-Commercial, +1106,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,1199-Commercial, +1107,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,1199-Commercial, +1108,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,1199-Commercial, +1109,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,1199-Commercial, +1110,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,1199-Commercial, +1111,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,1199-Commercial, +1112,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,1199-Commercial, +1113,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,1199-Commercial, +1114,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,1199-Commercial, +1115,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,1199-Commercial, +1116,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,1199-Commercial, +1117,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,1199-Commercial, +1118,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,1199-Commercial, +1119,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,1199-Commercial, +1120,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,1199-Commercial, +1121,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,1199-Commercial, +1122,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,1199-Commercial, +1123,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,1199-Commercial, +1124,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,1199-Commercial, +1125,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,1199-Commercial, +1126,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,1199-Commercial, +1127,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,1199-Commercial, +1128,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,1199-Commercial, +1129,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,1199-Commercial, +1130,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,1199-Commercial, +1131,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,1199-Commercial, +1132,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,1199-Commercial, +1133,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,1199-Commercial, +1134,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,1199-Commercial, +1135,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,1199-Commercial, +1136,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,1199-Commercial, +1137,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,1199-Commercial,5793.65 +1138,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,1199-Commercial, +1139,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,1199-Commercial, +1140,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,1199-Commercial, +1141,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,1199-Commercial, +1142,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,1199-Commercial, +1143,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,1199-Commercial, +1144,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,1199-Commercial, +1145,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,1199-Commercial, +1146,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,1199-Commercial, +1147,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,1199-Commercial,4544.0 +1148,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,1199-Commercial, +1149,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,1199-Commercial, +1150,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,1199-Commercial, +1151,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,1199-Commercial, +1152,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,1199-Commercial, +1153,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,1199-Commercial, +1154,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,1199-Commercial, +1155,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,1199-Commercial, +1156,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,1199-Commercial, +1157,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,1199-Commercial, +1158,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,1199-Commercial,2686.0 +1159,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,1199-Commercial, +1160,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,1199-Commercial, +1161,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,1199-Commercial, +1162,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,1199-Commercial, +1163,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,1199-Commercial, +1164,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,1199-Commercial, +1165,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,1199-Commercial, +1166,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,1199-Commercial, +1167,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,1199-Commercial, +1168,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,1199-Commercial, +1169,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,1199-Commercial, +1170,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,1199-Commercial, +1171,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,1199-Commercial, +1172,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,1199-Commercial, +1173,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,1199-Commercial, +1174,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,1199-Commercial, +1175,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,1199-Commercial, +1176,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,1199-Commercial, +1177,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,1199-Commercial, +1178,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,1199-Commercial,3024.0 +1179,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,1199-Commercial, +1180,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,1199-Commercial, +1181,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,1199-Commercial, +1182,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,1199-Commercial, +1183,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,1199-Commercial, +1184,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,1199-Commercial, +1185,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,1199-Commercial, +1186,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,1199-Commercial,4437.0 +1187,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,1199-Commercial, +1188,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,1199-Commercial, +1189,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,1199-Commercial,4544.0 +1190,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,1199-Commercial, +1191,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,1199-Commercial, +1192,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,1199-Commercial, +1193,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,1199-Commercial, +1194,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,1199-Commercial, +1195,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,1199-Commercial, +1196,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,1199-Commercial, +1197,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,1199-Commercial, +1198,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,1199-Commercial, +1199,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,1199-Commercial, +1200,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,1199-Commercial, +1201,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,1199-Commercial, +1202,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,1199-Commercial, +1203,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,1199-Commercial, +1204,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,1199-Commercial, +1205,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,1199-Commercial, +1206,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,1199-Commercial, +1207,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,1199-Commercial, +1208,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,1199-Commercial, +1209,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,1199-Commercial, +1210,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,1199-Commercial,6280.5 +1211,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,1199-Commercial, +1212,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,1199-Commercial, +1213,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,1199-Commercial, +1214,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,1199-Commercial, +1215,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,1199-Commercial, +1216,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,1199-Commercial, +1217,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,1199-Commercial, +1218,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,1199-Commercial, +1219,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,1199-Commercial, +1220,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,1199-Commercial, +1221,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,1199-Commercial, +1222,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,1199-Commercial, +1223,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,1199-Commercial, +1224,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,1199-Commercial, +1225,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,1199-Commercial, +1226,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,1199-Commercial, +1227,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,1199-Commercial, +1228,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,1199-Commercial, +1229,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,1199-Commercial,4437.0 +1230,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,1199-Commercial, +1231,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,1199-Commercial, +1232,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,1199-Commercial, +1233,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,1199-Commercial, +1234,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,1199-Commercial, +1235,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,1199-Commercial, +1236,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,1199-Commercial, +1237,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,1199-Commercial, +1238,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,1199-Commercial, +1239,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,1199-Commercial,2683.0 +1240,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,1199-Commercial, +1241,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,1199-Commercial, +1242,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,1199-Commercial, +1243,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,1199-Commercial, +1244,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,1199-Commercial, +1245,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,1199-Commercial, +1246,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,1199-Commercial, +1247,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,1199-Commercial, +1248,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,1199-Commercial, +1249,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,1199-Commercial, +1250,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,1199-Commercial,4772.0 +1251,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,1199-Commercial,4544.0 +1252,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,1199-Commercial, +1253,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,1199-Commercial, +1254,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,1199-Commercial, +1255,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,1199-Commercial, +1256,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,1199-Commercial, +1257,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,1199-Commercial, +1258,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,1199-Commercial, +1259,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,1199-Commercial, +1260,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,1199-Commercial, +1261,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,1199-Commercial, +1262,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,1199-Commercial, +1263,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,1199-Commercial, +1264,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,1199-Commercial, +1265,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,1199-Commercial, +1266,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,1199-Commercial, +1267,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,1199-Commercial, +1268,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,1199-Commercial, +1269,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,1199-Commercial, +1270,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,1199-Commercial, +1271,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,1199-Commercial, +1272,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,1199-Commercial,4795.0 +1273,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,1199-Commercial, +1274,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,1199-Commercial, +1275,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,1199-Commercial, +1276,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,1199-Commercial, +1277,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,1199-Commercial,3915.0 +1278,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,1199-Commercial, +1279,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,1199-Commercial, +1280,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,1199-Commercial, +1281,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,1199-Commercial, +1282,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,1199-Commercial,1949.0 +1283,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,1199-Commercial, +1284,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,1199-Commercial,1949.0 +1285,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,1199-Commercial, +1286,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,1199-Commercial,1949.0 +1287,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,1199-Commercial, +1288,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,1199-Commercial, +1289,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,1199-Commercial,1949.0 +1290,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,1199-Commercial,1977.5 +1291,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,1199-Commercial,1949.0 +1292,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,1199-Commercial, +1293,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,1199-Commercial, +1294,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,1199-Commercial, +1295,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,1199-Commercial, +1296,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,1199-Commercial,5347.05 +1297,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,1199-Commercial, +1298,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,1199-Commercial, +1299,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,1199-Commercial, +1300,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,1199-Commercial,2272.0 +1301,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,1199-Commercial, +1302,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,1199-Commercial, +1303,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,1199-Commercial,2272.0 +1304,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,1199-Commercial,7302.74 +1305,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,1199-Commercial, +1306,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,1199-Commercial, +1307,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,1199-Commercial, +1308,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,1199-Commercial, +1309,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,1199-Commercial,4544.0 +1310,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,1199-Commercial, +1311,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,1199-Commercial, +1312,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,1199-Commercial, +1313,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,1199-Commercial, +1314,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,1199-Commercial, +1315,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,1199-Commercial,4544.0 +1316,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,1199-Commercial, +1317,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,1199-Commercial, +1318,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,1199-Commercial, +1319,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,1199-Commercial, +1320,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,1199-Commercial, +1321,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,1199-Commercial, +1322,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,1199-Commercial,4929.0 +1323,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,1199-Commercial, +1324,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,1199-Commercial, +1325,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,1199-Commercial, +1326,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,1199-Commercial, +1327,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,1199-Commercial, +1328,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,1199-Commercial, +1329,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,1199-Commercial, +1330,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,1199-Commercial, +1331,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,1199-Commercial, +1332,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,1199-Commercial, +1333,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,1199-Commercial, +1334,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,1199-Commercial, +1335,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,1199-Commercial, +1336,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,1199-Commercial, +1337,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,1199-Commercial, +1338,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,1199-Commercial, +1339,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,1199-Commercial, +1340,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,1199-Commercial,4287.0 +1341,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,1199-Commercial, +1342,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,1199-Commercial, +1343,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,1199-Commercial, +1344,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,1199-Commercial, +1345,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,1199-Commercial, +1346,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,1199-Commercial, +1347,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,1199-Commercial, +1348,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,1199-Commercial, +1349,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,1199-Commercial, +1350,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,1199-Commercial, +1351,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,1199-Commercial, +1352,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,1199-Commercial, +1353,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,1199-Commercial, +1354,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,1199-Commercial,5260.0 +1355,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,1199-Commercial, +1356,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,1199-Commercial, +1357,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,1199-Commercial, +1358,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,1199-Commercial, +1359,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,1199-Commercial, +1360,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,1199-Commercial, +1361,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,1199-Commercial, +1362,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,1199-Commercial, +1363,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,1199-Commercial, +1364,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,1199-Commercial, +1365,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,1199-Commercial, +1366,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,1199-Commercial, +1367,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,1199-Commercial, +1368,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,1199-Commercial,2272.0 +1369,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,1199-Commercial, +1370,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,1199-Commercial, +1371,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,1199-Commercial, +1372,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,1199-Commercial, +1373,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,1199-Commercial, +1374,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,1199-Commercial, +1375,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,1199-Commercial, +1376,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,1199-Commercial, +1377,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,1199-Commercial, +1378,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,1199-Commercial, +1379,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,1199-Commercial,3364.5 +1380,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,1199-Commercial, +1381,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,1199-Commercial, +1382,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,1199-Commercial, +1383,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,1199-Commercial, +1384,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,1199-Commercial, +1385,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,1199-Commercial, +1386,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,1199-Commercial,2272.0 +1387,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,1199-Commercial, +1388,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,1199-Commercial,4287.0 +1389,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,1199-Commercial, +1390,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,1199-Commercial, +1391,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,1199-Commercial, +1392,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,1199-Commercial, +1393,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,1199-Commercial, +1394,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,1199-Commercial, +1395,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,1199-Commercial, +1396,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,1199-Commercial, +1397,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,1199-Commercial, +1398,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,1199-Commercial, +1399,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,1199-Commercial, +1400,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,1199-Commercial, +1401,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,1199-Commercial,3915.0 +1402,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,1199-Commercial, +1403,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,1199-Commercial, +1404,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,1199-Commercial, +1405,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,1199-Commercial, +1406,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,1199-Commercial, +1407,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,1199-Commercial, +1408,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,1199-Commercial, +1409,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,1199-Commercial, +1410,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,1199-Commercial, +1411,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,1199-Commercial, +1412,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,1199-Commercial, +1413,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,1199-Commercial, +1414,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,1199-Commercial, +1415,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,1199-Commercial, +1416,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,1199-Commercial, +1417,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,1199-Commercial, +1418,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,1199-Commercial, +1419,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,1199-Commercial, +1420,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,1199-Commercial, +1421,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,1199-Commercial, +1422,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,1199-Commercial, +1423,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,1199-Commercial, +1424,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,1199-Commercial, +1425,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,1199-Commercial, +1426,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,1199-Commercial, +1427,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,1199-Commercial, +1428,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,1199-Commercial, +1429,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,1199-Commercial, +1430,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,1199-Commercial, +1431,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,1199-Commercial, +1432,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,1199-Commercial, +1433,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,1199-Commercial, +1434,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,1199-Commercial, +1435,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,1199-Commercial, +1436,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,1199-Commercial, +1437,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,1199-Commercial, +1438,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,1199-Commercial, +1439,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,1199-Commercial, +1440,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,1199-Commercial, +1441,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,1199-Commercial, +1442,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,1199-Commercial, +1443,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,1199-Commercial, +1444,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,1199-Commercial,4544.0 +1445,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,1199-Commercial,1893.79 +1446,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,1199-Commercial, +1447,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,1199-Commercial, +1448,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,1199-Commercial, +1449,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,1199-Commercial, +1450,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,1199-Commercial, +1451,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,1199-Commercial, +1452,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,1199-Commercial, +1453,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,1199-Commercial, +1454,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,1199-Commercial, +1455,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,1199-Commercial, +1456,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,1199-Commercial, +1457,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,1199-Commercial, +1458,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,1199-Commercial, +1459,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,1199-Commercial, +1460,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,1199-Commercial, +1461,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,1199-Commercial, +1462,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,1199-Commercial, +1463,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,1199-Commercial, +1464,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,1199-Commercial, +1465,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,1199-Commercial, +1466,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,1199-Commercial, +1467,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,1199-Commercial, +1468,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,1199-Commercial,4861.95 +1469,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,1199-Commercial, +1470,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,1199-Commercial,4544.0 +1471,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,1199-Commercial,6466.83 +1472,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,1199-Commercial, +1473,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,1199-Commercial,2143.5 +1474,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,1199-Commercial, +1475,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,1199-Commercial, +1476,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,1199-Commercial, +1477,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,1199-Commercial, +1478,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,1199-Commercial, +1479,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,1199-Commercial, +1480,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,1199-Commercial, +1481,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,1199-Commercial, +1482,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,1199-Commercial,1949.0 +1483,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,1199-Commercial,43.4 +1484,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,1199-Commercial, +1485,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,1199-Commercial,1903.29 +1486,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,1199-Commercial, +1487,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,1199-Commercial, +1488,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,1199-Commercial, +1489,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,1199-Commercial, +1490,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,1199-Commercial,6429.25 +1491,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,1199-Commercial, +1492,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,1199-Commercial, +1493,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,1199-Commercial, +1494,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,1199-Commercial, +1495,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,1199-Commercial,5177.0 +1496,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,1199-Commercial, +1497,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,1199-Commercial, +1498,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,1199-Commercial, +1499,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,1199-Commercial, +1500,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,1199-Commercial, +1501,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,1199-Commercial, +1502,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,1199-Commercial, +1503,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,1199-Commercial, +1504,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,1199-Commercial, +1505,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,1199-Commercial,161.54 +1506,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,1199-Commercial, +1507,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,1199-Commercial, +1508,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,1199-Commercial,2556.0 +1509,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,1199-Commercial, +1510,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,1199-Commercial, +1511,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,1199-Commercial, +1512,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,1199-Commercial, +1513,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,1199-Commercial, +1514,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,1199-Commercial,4437.0 +1515,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,1199-Commercial, +1516,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,1199-Commercial, +1517,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,1199-Commercial, +1518,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,1199-Commercial, +1519,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,1199-Commercial, +1520,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,1199-Commercial, +1521,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,1199-Commercial, +1522,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,1199-Commercial, +1523,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,1199-Commercial, +1524,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,1199-Commercial, +1525,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,1199-Commercial, +1526,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,1199-Commercial, +1527,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,1199-Commercial, +1528,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,1199-Commercial, +1529,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,1199-Commercial, +1530,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,1199-Commercial, +1531,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,1199-Commercial, +1532,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,1199-Commercial, +1533,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,1199-Commercial, +1534,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,1199-Commercial, +1535,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,1199-Commercial, +1536,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,1199-Commercial, +1537,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,1199-Commercial, +1538,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,1199-Commercial, +1539,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,1199-Commercial, +1540,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,1199-Commercial, +1541,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,1199-Commercial, +1542,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,1199-Commercial, +1543,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,1199-Commercial, +1544,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,1199-Commercial, +1545,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,1199-Commercial, +1546,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,1199-Commercial, +1547,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,1199-Commercial, +1548,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,1199-Commercial, +1549,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,1199-Commercial, +1550,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,1199-Commercial, +1551,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,1199-Commercial, +1552,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,1199-Commercial, +1553,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,1199-Commercial, +1554,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,1199-Commercial, +1555,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,1199-Commercial, +1556,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,1199-Commercial, +1557,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,1199-Commercial, +1558,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,1199-Commercial, +1559,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,1199-Commercial, +1560,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,1199-Commercial, +1561,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,1199-Commercial, +1562,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,1199-Commercial, +1563,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,1199-Commercial, +1564,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,1199-Commercial, +1565,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,1199-Commercial,4544.0 +1566,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,1199-Commercial, +1567,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,1199-Commercial, +1568,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,1199-Commercial,4544.0 +1569,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,1199-Commercial, +1570,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,1199-Commercial, +1571,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,1199-Commercial, +1572,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,1199-Commercial, +1573,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,1199-Commercial, +1574,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,1199-Commercial, +1575,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,1199-Commercial, +1576,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,1199-Commercial, +1577,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,1199-Commercial, +1578,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,1199-Commercial, +1579,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,1199-Commercial, +1580,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,1199-Commercial, +1581,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,1199-Commercial, +1582,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,1199-Commercial,2272.0 +1583,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,1199-Commercial, +1584,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,1199-Commercial, +1585,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,1199-Commercial, +1586,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,1199-Commercial, +1587,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,1199-Commercial, +1588,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,1199-Commercial, +1589,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,1199-Commercial, +1590,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,1199-Commercial, +1591,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,1199-Commercial, +1592,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,1199-Commercial, +1593,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,1199-Commercial,3024.0 +1594,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,1199-Commercial, +1595,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,1199-Commercial, +1596,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,1199-Commercial, +1597,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,1199-Commercial, +1598,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,1199-Commercial,4287.0 +1599,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,1199-Commercial, +1600,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,1199-Commercial, +1601,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,1199-Commercial, +1602,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,1199-Commercial, +1603,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,1199-Commercial, +1604,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,1199-Commercial, +1605,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,1199-Commercial,4544.0 +1606,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,1199-Commercial, +1607,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,1199-Commercial, +1608,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,1199-Commercial, +1609,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,1199-Commercial,1949.0 +1610,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,1199-Commercial, +1611,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,1199-Commercial, +1612,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,1199-Commercial, +1613,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,1199-Commercial, +1614,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,1199-Commercial, +1615,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,1199-Commercial, +1616,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,1199-Commercial, +1617,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,1199-Commercial, +1618,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,1199-Commercial, +1619,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,1199-Commercial, +1620,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,1199-Commercial, +1621,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,1199-Commercial, +1622,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,1199-Commercial, +1623,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,1199-Commercial, +1624,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,1199-Commercial, +1625,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,1199-Commercial, +1626,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,1199-Commercial, +1627,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,1199-Commercial, +1628,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,1199-Commercial, +1629,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,1199-Commercial, +1630,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,1199-Commercial, +1631,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,1199-Commercial, +1632,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,1199-Commercial,1949.0 +1633,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,1199-Commercial, +1634,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,1199-Commercial, +1635,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,1199-Commercial, +1636,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,1199-Commercial, +1637,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,1199-Commercial, +1638,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,1199-Commercial,4570.0 +1639,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,1199-Commercial, +1640,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,1199-Commercial, +1641,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,1199-Commercial, +1642,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,1199-Commercial,4544.0 +1643,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,1199-Commercial, +1644,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,1199-Commercial, +1645,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,1199-Commercial,3024.0 +1646,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,1199-Commercial, +1647,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,1199-Commercial, +1648,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,1199-Commercial, +1649,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,1199-Commercial, +1650,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,1199-Commercial, +1651,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,1199-Commercial, +1652,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,1199-Commercial, +1653,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,1199-Commercial, +1654,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,1199-Commercial, +1655,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,1199-Commercial, +1656,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,1199-Commercial,2395.75 +1657,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,1199-Commercial, +1658,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,1199-Commercial, +1659,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,1199-Commercial, +1660,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,1199-Commercial,4544.0 +1661,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,1199-Commercial,2143.5 +1662,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,1199-Commercial,4544.0 +1663,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,1199-Commercial, +1664,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,1199-Commercial, +1665,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,1199-Commercial,6915.0 +1666,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,1199-Commercial,3990.0 +1667,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,1199-Commercial, +1668,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,1199-Commercial, +1669,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,1199-Commercial,3693.0 +1670,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,1199-Commercial, +1671,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,1199-Commercial,4287.0 +1672,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,1199-Commercial, +1673,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,1199-Commercial,4362.0 +1674,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,1199-Commercial, +1675,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,1199-Commercial, +1676,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,1199-Commercial, +1677,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,1199-Commercial, +1678,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,1199-Commercial,5248.5 +1679,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,1199-Commercial,4437.0 +1680,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,1199-Commercial, +1681,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,1199-Commercial,4287.0 +1682,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,1199-Commercial,4437.0 +1683,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,1199-Commercial,4287.0 +1684,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,1199-Commercial, +1685,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,1199-Commercial, +1686,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,1199-Commercial, +1687,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,1199-Commercial, +1688,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,1199-Commercial,10448.25 +1689,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,1199-Commercial, +1690,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,1199-Commercial, +1691,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,1199-Commercial, +1692,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,1199-Commercial, +1693,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,1199-Commercial, +1694,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,1199-Commercial, +1695,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,1199-Commercial, +1696,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,1199-Commercial, +1697,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,1199-Commercial, +1698,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,1199-Commercial, +1699,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,1199-Commercial, +1700,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,1199-Commercial,7860.0 +1701,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,1199-Commercial, +1702,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,1199-Commercial, +1703,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,1199-Commercial, +1704,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,1199-Commercial, +1705,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,1199-Commercial, +1706,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,1199-Commercial, +1707,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,1199-Commercial, +1708,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,1199-Commercial, +1709,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,1199-Commercial, +1710,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,1199-Commercial, +1711,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,1199-Commercial, +1712,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,1199-Commercial, +1713,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,1199-Commercial, +1714,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,1199-Commercial, +1715,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,1199-Commercial, +1716,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,1199-Commercial, +1717,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,1199-Commercial, +1718,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,1199-Commercial, +1719,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,1199-Commercial, +1720,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,1199-Commercial, +1721,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,1199-Commercial, +1722,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,1199-Commercial, +1723,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,1199-Commercial, +1724,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,1199-Commercial, +1725,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,1199-Commercial, +1726,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,1199-Commercial, +1727,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,1199-Commercial, +1728,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,1199-Commercial, +1729,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,1199-Commercial, +1730,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,1199-Commercial, +1731,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,1199-Commercial, +1732,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,1199-Commercial, +1733,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,1199-Commercial, +1734,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,1199-Commercial, +1735,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,1199-Commercial, +1736,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,1199-Commercial, +1737,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,1199-Commercial, +1738,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,1199-Commercial, +1739,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,1199-Commercial, +1740,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,1199-Commercial, +1741,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,1199-Commercial, +1742,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,1199-Commercial, +1743,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,1199-Commercial, +1744,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,1199-Commercial,4124.67 +1745,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,1199-Commercial, +1746,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,1199-Commercial,3701.93 +1747,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,1199-Commercial, +1748,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,1199-Commercial, +1749,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,1199-Commercial, +1750,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,1199-Commercial,4544.0 +1751,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,1199-Commercial, +1752,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,1199-Commercial, +1753,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,1199-Commercial, +1754,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,1199-Commercial,4287.0 +1755,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,1199-Commercial, +1756,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,1199-Commercial, +1757,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,1199-Commercial, +1758,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,1199-Commercial, +1759,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,1199-Commercial, +1760,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,1199-Commercial, +1761,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,1199-Commercial, +1762,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,1199-Commercial, +1763,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,1199-Commercial, +1764,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,1199-Commercial, +1765,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,1199-Commercial, +1766,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,1199-Commercial, +1767,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,1199-Commercial, +1768,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,1199-Commercial, +1769,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,1199-Commercial, +1770,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,1199-Commercial, +1771,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,1199-Commercial, +1772,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,1199-Commercial, +1773,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,1199-Commercial, +1774,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,1199-Commercial, +1775,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,1199-Commercial, +1776,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,1199-Commercial, +1777,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,1199-Commercial, +1778,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,1199-Commercial, +1779,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,1199-Commercial, +1780,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,1199-Commercial, +1781,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,1199-Commercial, +1782,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,1199-Commercial, +1783,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,1199-Commercial, +1784,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,1199-Commercial, +1785,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,1199-Commercial, +1786,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,1199-Commercial, +1787,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,1199-Commercial, +1788,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,1199-Commercial, +1789,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,1199-Commercial, +1790,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,1199-Commercial, +1791,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,1199-Commercial, +1792,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,1199-Commercial, +1793,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,1199-Commercial, +1794,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,1199-Commercial, +1795,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,1199-Commercial, +1796,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,1199-Commercial, +1797,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,1199-Commercial, +1798,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,1199-Commercial, +1799,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,1199-Commercial, +1800,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,1199-Commercial, +1801,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,1199-Commercial, +1802,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,1199-Commercial,12339.14 +1803,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,1199-Commercial,8089.0 +1804,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,1199-Commercial, +1805,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,1199-Commercial, +1806,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,1199-Commercial, +1807,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,1199-Commercial, +1808,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,1199-Commercial, +1809,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,1199-Commercial, +1810,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,1199-Commercial, +1811,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,1199-Commercial, +1812,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,1199-Commercial, +1813,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,1199-Commercial, +1814,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,1199-Commercial,7631.0 +1815,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,1199-Commercial, +1816,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,1199-Commercial, +1817,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,1199-Commercial, +1818,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,1199-Commercial, +1819,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,1199-Commercial, +1820,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,1199-Commercial, +1821,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,1199-Commercial, +1822,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,1199-Commercial, +1823,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,1199-Commercial, +1824,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,1199-Commercial, +1825,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,1199-Commercial, +1826,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,1199-Commercial, +1827,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,1199-Commercial, +1828,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,1199-Commercial, +1829,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,1199-Commercial, +1830,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,1199-Commercial, +1831,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,1199-Commercial, +1832,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,1199-Commercial, +1833,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,1199-Commercial, +1834,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,1199-Commercial, +1835,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,1199-Commercial,8089.0 +1836,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,1199-Commercial,7631.0 +1837,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,1199-Commercial, +1838,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,1199-Commercial, +1839,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,1199-Commercial, +1840,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,1199-Commercial, +1841,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,1199-Commercial,8089.0 +1842,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,1199-Commercial, +1843,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,1199-Commercial, +1844,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,1199-Commercial,4044.5 +1845,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,1199-Commercial, +1846,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,1199-Commercial, +1847,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,1199-Commercial, +1848,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,1199-Commercial,6657.0 +1849,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,1199-Commercial,8089.0 +1850,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,1199-Commercial, +1851,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,1199-Commercial, +1852,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,1199-Commercial,11446.5 +1853,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,1199-Commercial,11905.5 +1854,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,1199-Commercial, +1855,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,1199-Commercial, +1856,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,1199-Commercial, +1857,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,1199-Commercial, +1858,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,1199-Commercial, +1859,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,1199-Commercial, +1860,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,1199-Commercial, +1861,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,1199-Commercial,2853.0 +1862,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,1199-Commercial, +1863,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,1199-Commercial, +1864,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,1199-Commercial, +1865,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,1199-Commercial, +1866,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,1199-Commercial, +1867,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,1199-Commercial,4544.0 +1868,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,1199-Commercial, +1869,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,1199-Commercial, +1870,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,1199-Commercial, +1871,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,1199-Commercial, +1872,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,1199-Commercial, +1873,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,1199-Commercial, +1874,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,1199-Commercial, +1875,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,1199-Commercial, +1876,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,1199-Commercial,9286.0 +1877,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,1199-Commercial, +1878,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,1199-Commercial, +1879,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,1199-Commercial, +1880,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,1199-Commercial, +1881,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,1199-Commercial, +1882,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,1199-Commercial, +1883,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,1199-Commercial, +1884,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,1199-Commercial, +1885,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,1199-Commercial, +1886,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,1199-Commercial,2272.0 +1887,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,1199-Commercial, +1888,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,1199-Commercial, +1889,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,1199-Commercial, +1890,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,1199-Commercial, +1891,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,1199-Commercial, +1892,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,1199-Commercial, +1893,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,1199-Commercial, +1894,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,1199-Commercial, +1895,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,1199-Commercial,1646.05 +1896,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,1199-Commercial, +1897,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,1199-Commercial, +1898,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,1199-Commercial, +1899,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,1199-Commercial,671.89 +1900,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,1199-Commercial,350.37 +1901,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,1199-Commercial, +1902,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,1199-Commercial, +1903,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,1199-Commercial,4544.0 +1904,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,1199-Commercial, +1905,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,1199-Commercial, +1906,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,1199-Commercial, +1907,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,1199-Commercial, +1908,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,1199-Commercial, +1909,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,1199-Commercial, +1910,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,1199-Commercial, +1911,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,1199-Commercial,4703.0 +1912,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,1199-Commercial, +1913,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,1199-Commercial, +1914,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,1199-Commercial, +1915,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,1199-Commercial, +1916,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,1199-Commercial, +1917,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,1199-Commercial, +1918,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,1199-Commercial, +1919,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,1199-Commercial, +1920,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,1199-Commercial,4643.0 +1921,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,1199-Commercial, +1922,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,1199-Commercial, +1923,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,1199-Commercial, +1924,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,1199-Commercial, +1925,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,1199-Commercial, +1926,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,1199-Commercial,5491.7 +1927,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,1199-Commercial, +1928,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,1199-Commercial, +1929,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,1199-Commercial, +1930,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,1199-Commercial, +1931,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,1199-Commercial,4929.0 +1932,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,1199-Commercial, +1933,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,1199-Commercial, +1934,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,1199-Commercial,5026.41 +1935,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,1199-Commercial, +1936,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,1199-Commercial, +1937,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,1199-Commercial, +1938,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,1199-Commercial,4544.0 +1939,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,1199-Commercial, +1940,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,1199-Commercial, +1941,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,1199-Commercial,4544.0 +1942,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,1199-Commercial, +1943,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,1199-Commercial, +1944,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,1199-Commercial, +1945,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,1199-Commercial, +1946,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,1199-Commercial, +1947,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,1199-Commercial, +1948,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,1199-Commercial, +1949,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,1199-Commercial, +1950,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,1199-Commercial, +1951,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,1199-Commercial, +1952,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,1199-Commercial, +1953,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,1199-Commercial, +1954,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,1199-Commercial, +1955,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,1199-Commercial, +1956,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,1199-Commercial, +1957,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,1199-Commercial, +1958,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,1199-Commercial, +1959,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,1199-Commercial, +1960,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,1199-Commercial,4544.0 +1961,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,1199-Commercial,4544.0 +1962,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,1199-Commercial, +1963,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,1199-Commercial,1949.0 +1964,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,1199-Commercial, +1965,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,1199-Commercial,4703.0 +1966,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,1199-Commercial, +1967,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,1199-Commercial, +1968,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,1199-Commercial, +1969,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,1199-Commercial, +1970,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,1199-Commercial, +1971,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,1199-Commercial, +1972,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,1199-Commercial, +1973,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,1199-Commercial, +1974,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,1199-Commercial, +1975,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,1199-Commercial, +1976,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,1199-Commercial, +1977,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,1199-Commercial, +1978,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,1199-Commercial, +1979,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,1199-Commercial, +1980,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,1199-Commercial, +1981,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,1199-Commercial, +1982,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,1199-Commercial, +1983,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,1199-Commercial, +1984,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,1199-Commercial, +1985,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,1199-Commercial,6685.5 +1986,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,1199-Commercial, +1987,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,1199-Commercial,6816.0 +1988,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,1199-Commercial, +1989,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,1199-Commercial, +1990,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,1199-Commercial, +1991,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,1199-Commercial, +1992,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,1199-Commercial, +1993,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,1199-Commercial, +1994,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,1199-Commercial, +1995,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,1199-Commercial, +1996,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,1199-Commercial, +1997,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,1199-Commercial, +1998,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,1199-Commercial, +1999,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,1199-Commercial, +2000,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,1199-Commercial, +2001,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,1199-Commercial, +2002,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,1199-Commercial, +2003,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,1199-Commercial, +2004,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,1199-Commercial, +2005,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,1199-Commercial, +2006,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,1199-Commercial, +2007,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,1199-Commercial, +2008,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,1199-Commercial, +2009,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,1199-Commercial, +2010,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,1199-Commercial, +2011,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,1199-Commercial, +2012,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,1199-Commercial, +2013,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,1199-Commercial, +2014,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,1199-Commercial, +2015,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,1199-Commercial, +2016,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,1199-Commercial, +2017,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,1199-Commercial, +2018,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,1199-Commercial, +2019,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,1199-Commercial, +2020,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,1199-Commercial, +2021,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,1199-Commercial, +2022,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,1199-Commercial,715.0 +2023,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,1199-Commercial, +2024,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,1199-Commercial, +2025,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,1199-Commercial, +2026,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,1199-Commercial, +2027,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,1199-Commercial, +2028,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,1199-Commercial, +2029,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,1199-Commercial, +2030,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,1199-Commercial, +2031,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,1199-Commercial, +2032,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,1199-Commercial, +2033,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,1199-Commercial,467.0 +2034,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,1199-Commercial, +2035,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,1199-Commercial,2272.0 +2036,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,1199-Commercial, +2037,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,1199-Commercial, +2038,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,1199-Commercial, +2039,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,1199-Commercial, +2040,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,1199-Commercial, +2041,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,1199-Commercial, +2042,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,1199-Commercial, +2043,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,1199-Commercial, +2044,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,1199-Commercial, +2045,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,1199-Commercial, +2046,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,1199-Commercial, +2047,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,1199-Commercial, +2048,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,1199-Commercial, +2049,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,1199-Commercial, +2050,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,1199-Commercial, +2051,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,1199-Commercial, +2052,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,1199-Commercial, +2053,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,1199-Commercial, +2054,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,1199-Commercial, +2055,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,1199-Commercial, +2056,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,1199-Commercial, +2057,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,1199-Commercial, +2058,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,1199-Commercial, +2059,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,1199-Commercial, +2060,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,1199-Commercial, +2061,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,1199-Commercial, +2062,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,1199-Commercial,2207.75 +2063,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,1199-Commercial, +2064,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,1199-Commercial, +2065,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,1199-Commercial, +2066,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,1199-Commercial, +2067,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,1199-Commercial,4544.0 +2068,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,1199-Commercial, +2069,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,1199-Commercial,2272.0 +2070,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,1199-Commercial, +2071,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,1199-Commercial, +2072,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,1199-Commercial,2207.75 +2073,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,1199-Commercial, +2074,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,1199-Commercial, +2075,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,1199-Commercial,8089.0 +2076,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,1199-Commercial, +2077,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,1199-Commercial, +2078,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,1199-Commercial,8089.0 +2079,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,1199-Commercial, +2080,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,1199-Commercial, +2081,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,1199-Commercial, +2082,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,1199-Commercial, +2083,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,1199-Commercial,8089.0 +2084,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,1199-Commercial, +2085,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,1199-Commercial, +2086,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,1199-Commercial, +2087,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,1199-Commercial, +2088,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,1199-Commercial, +2089,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,1199-Commercial, +2090,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,1199-Commercial, +2091,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,1199-Commercial, +2092,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,1199-Commercial, +2093,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,1199-Commercial, +2094,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,1199-Commercial,7421.25 +2095,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,1199-Commercial,6376.88 +2096,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,1199-Commercial, +2097,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,1199-Commercial, +2098,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,1199-Commercial, +2099,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,1199-Commercial, +2100,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,1199-Commercial, +2101,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,1199-Commercial, +2102,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,1199-Commercial, +2103,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,1199-Commercial, +2104,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,1199-Commercial, +2105,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,1199-Commercial, +2106,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,1199-Commercial, +2107,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,1199-Commercial, +2108,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,1199-Commercial, +2109,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,1199-Commercial, +2110,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,1199-Commercial, +2111,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,1199-Commercial, +2112,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,1199-Commercial, +2113,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,1199-Commercial, +2114,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,1199-Commercial, +2115,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,1199-Commercial, +2116,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,1199-Commercial, +2117,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,1199-Commercial,4544.0 +2118,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,1199-Commercial,5418.0 +2119,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,1199-Commercial, +2120,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,1199-Commercial,4544.0 +2121,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,1199-Commercial,5418.0 +2122,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,1199-Commercial,4544.0 +2123,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,1199-Commercial, +2124,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,1199-Commercial, +2125,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,1199-Commercial, +2126,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,1199-Commercial,3915.0 +2127,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,1199-Commercial, +2128,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,1199-Commercial, +2129,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,1199-Commercial,6517.0 +2130,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,1199-Commercial, +2131,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,1199-Commercial, +2132,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,1199-Commercial, +2133,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,1199-Commercial,4544.0 +2134,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,1199-Commercial, +2135,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,1199-Commercial, +2136,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,1199-Commercial, +2137,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,1199-Commercial, +2138,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,1199-Commercial, +2139,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,1199-Commercial, +2140,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,1199-Commercial,3693.0 +2141,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,1199-Commercial, +2142,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,1199-Commercial, +2143,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,1199-Commercial, +2144,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,1199-Commercial, +2145,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,1199-Commercial, +2146,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,1199-Commercial,1398.73 +2147,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,1199-Commercial, +2148,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,1199-Commercial, +2149,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,1199-Commercial, +2150,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,1199-Commercial, +2151,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,1199-Commercial, +2152,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,1199-Commercial, +2153,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,1199-Commercial, +2154,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,1199-Commercial, +2155,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,1199-Commercial, +2156,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,1199-Commercial, +2157,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,1199-Commercial, +2158,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,1199-Commercial, +2159,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,1199-Commercial, +2160,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,1199-Commercial, +2161,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,1199-Commercial, +2162,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,1199-Commercial, +2163,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,1199-Commercial, +2164,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,1199-Commercial, +2165,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,1199-Commercial, +2166,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,1199-Commercial, +2167,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,1199-Commercial, +2168,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,1199-Commercial, +2169,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,1199-Commercial,1297.93 +2170,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,1199-Commercial, +2171,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,1199-Commercial,1250.0 +2172,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,1199-Commercial, +2173,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,1199-Commercial, +2174,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,1199-Commercial, +2175,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,1199-Commercial, +2176,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,1199-Commercial, +2177,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,1199-Commercial,4287.0 +2178,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,1199-Commercial, +2179,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,1199-Commercial, +2180,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,1199-Commercial,738.53 +2181,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,1199-Commercial, +2182,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,1199-Commercial, +2183,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,1199-Commercial,4544.0 +2184,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,1199-Commercial, +2185,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,1199-Commercial, +2186,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,1199-Commercial, +2187,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,1199-Commercial, +2188,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,1199-Commercial, +2189,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,1199-Commercial, +2190,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,1199-Commercial, +2191,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,1199-Commercial, +2192,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,1199-Commercial, +2193,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,1199-Commercial, +2194,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,1199-Commercial, +2195,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,1199-Commercial,6706.12 +2196,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,1199-Commercial, +2197,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,1199-Commercial, +2198,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,1199-Commercial, +2199,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,1199-Commercial, +2200,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,1199-Commercial,3915.0 +2201,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,1199-Commercial, +2202,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,1199-Commercial, +2203,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,1199-Commercial, +2204,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,1199-Commercial, +2205,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,1199-Commercial,2714.1 +2206,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,1199-Commercial, +2207,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,1199-Commercial, +2208,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,1199-Commercial, +2209,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,1199-Commercial, +2210,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,1199-Commercial, +2211,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,1199-Commercial, +2212,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,1199-Commercial, +2213,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,1199-Commercial, +2214,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,1199-Commercial, +2215,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,1199-Commercial, +2216,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,1199-Commercial, +2217,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,1199-Commercial,4544.0 +2218,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,1199-Commercial, +2219,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,1199-Commercial, +2220,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,1199-Commercial, +2221,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,1199-Commercial, +2222,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,1199-Commercial, +2223,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,1199-Commercial, +2224,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,1199-Commercial,4297.5 +2225,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,1199-Commercial, +2226,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,1199-Commercial, +2227,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,1199-Commercial, +2228,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,1199-Commercial, +2229,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,1199-Commercial, +2230,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,1199-Commercial, +2231,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,1199-Commercial, +2232,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,1199-Commercial, +2233,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,1199-Commercial, +2234,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,1199-Commercial, +2235,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,1199-Commercial, +2236,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,1199-Commercial, +2237,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,1199-Commercial, +2238,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,1199-Commercial, +2239,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,1199-Commercial, +2240,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,1199-Commercial, +2241,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,1199-Commercial, +2242,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,1199-Commercial, +2243,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,1199-Commercial, +2244,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,1199-Commercial, +2245,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,1199-Commercial, +2246,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,1199-Commercial, +2247,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,1199-Commercial, +2248,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,1199-Commercial, +2249,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,1199-Commercial, +2250,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,1199-Commercial, +2251,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,1199-Commercial, +2252,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,1199-Commercial, +2253,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,1199-Commercial, +2254,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,1199-Commercial, +2255,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,1199-Commercial, +2256,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,1199-Commercial, +2257,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,1199-Commercial, +2258,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,1199-Commercial, +2259,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,1199-Commercial,4287.0 +2260,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,1199-Commercial, +2261,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,1199-Commercial, +2262,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,1199-Commercial, +2263,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,1199-Commercial, +2264,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,1199-Commercial, +2265,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,1199-Commercial, +2266,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,1199-Commercial, +2267,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,1199-Commercial, +2268,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,1199-Commercial, +2269,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,1199-Commercial, +2270,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,1199-Commercial, +2271,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,1199-Commercial, +2272,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,1199-Commercial,4544.0 +2273,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,1199-Commercial, +2274,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,1199-Commercial, +2275,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,1199-Commercial, +2276,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,1199-Commercial, +2277,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,1199-Commercial, +2278,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,1199-Commercial, +2279,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,1199-Commercial, +2280,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,1199-Commercial, +2281,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,1199-Commercial, +2282,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,1199-Commercial, +2283,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,1199-Commercial, +2284,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,1199-Commercial, +2285,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,1199-Commercial, +2286,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,1199-Commercial, +2287,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,1199-Commercial,2465.0 +2288,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,1199-Commercial,4644.56 +2289,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,1199-Commercial, +2290,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,1199-Commercial, +2291,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,1199-Commercial, +2292,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,1199-Commercial, +2293,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,1199-Commercial, +2294,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,1199-Commercial, +2295,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,1199-Commercial, +2296,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,1199-Commercial, +2297,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,1199-Commercial, +2298,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,1199-Commercial, +2299,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,1199-Commercial, +2300,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,1199-Commercial, +2301,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,1199-Commercial, +2302,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,1199-Commercial, +2303,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,1199-Commercial, +2304,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,1199-Commercial, +2305,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,1199-Commercial, +2306,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,1199-Commercial, +2307,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,1199-Commercial, +2308,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,1199-Commercial,5680.0 +2309,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,1199-Commercial, +2310,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,1199-Commercial, +2311,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,1199-Commercial,4544.0 +2312,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,1199-Commercial, +2313,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,1199-Commercial, +2314,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,1199-Commercial, +2315,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,1199-Commercial, +2316,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,1199-Commercial, +2317,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,1199-Commercial, +2318,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,1199-Commercial, +2319,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,1199-Commercial, +2320,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,1199-Commercial, +2321,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,1199-Commercial, +2322,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,1199-Commercial, +2323,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,1199-Commercial, +2324,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,1199-Commercial, +2325,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,1199-Commercial, +2326,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,1199-Commercial, +2327,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,1199-Commercial, +2328,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,1199-Commercial,4544.0 +2329,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,1199-Commercial, +2330,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,1199-Commercial,4544.0 +2331,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,1199-Commercial, +2332,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,1199-Commercial, +2333,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,1199-Commercial, +2334,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,1199-Commercial, +2335,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,1199-Commercial, +2336,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,1199-Commercial, +2337,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,1199-Commercial, +2338,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,1199-Commercial, +2339,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,1199-Commercial, +2340,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,1199-Commercial, +2341,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,1199-Commercial, +2342,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,1199-Commercial, +2343,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,1199-Commercial, +2344,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,1199-Commercial, +2345,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,1199-Commercial, +2346,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,1199-Commercial, +2347,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,1199-Commercial, +2348,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,1199-Commercial, +2349,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,1199-Commercial, +2350,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,1199-Commercial,2143.5 +2351,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,1199-Commercial, +2352,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,1199-Commercial, +2353,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,1199-Commercial, +2354,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,1199-Commercial, +2355,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,1199-Commercial, +2356,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,1199-Commercial, +2357,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,1199-Commercial, +2358,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,1199-Commercial, +2359,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,1199-Commercial, +2360,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,1199-Commercial, +2361,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,1199-Commercial, +2362,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,1199-Commercial, +2363,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,1199-Commercial, +2364,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,1199-Commercial, +2365,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,1199-Commercial,4437.0 +2366,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,1199-Commercial, +2367,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,1199-Commercial,5177.0 +2368,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,1199-Commercial, +2369,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,1199-Commercial, +2370,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,1199-Commercial, +2371,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,1199-Commercial, +2372,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,1199-Commercial, +2373,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,1199-Commercial,5418.0 +2374,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,1199-Commercial, +2375,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,1199-Commercial, +2376,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,1199-Commercial, +2377,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,1199-Commercial, +2378,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,1199-Commercial, +2379,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,1199-Commercial, +2380,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,1199-Commercial, +2381,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,1199-Commercial, +2382,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,1199-Commercial, +2383,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,1199-Commercial, +2384,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,1199-Commercial,213.18 +2385,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,1199-Commercial, +2386,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,1199-Commercial, +2387,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,1199-Commercial,255.56 +2388,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,1199-Commercial,1467.34 +2389,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,1199-Commercial, +2390,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,1199-Commercial, +2391,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,1199-Commercial, +2392,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,1199-Commercial, +2393,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,1199-Commercial, +2394,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,1199-Commercial, +2395,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,1199-Commercial, +2396,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,1199-Commercial, +2397,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,1199-Commercial, +2398,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,1199-Commercial,1119.01 +2399,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,1199-Commercial, +2400,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,1199-Commercial,5747.57 +2401,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,1199-Commercial,5747.57 +2402,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,1199-Commercial, +2403,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,1199-Commercial,1932.46 +2404,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,1199-Commercial,3149.9 +2405,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,1199-Commercial, +2406,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,1199-Commercial, +2407,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,1199-Commercial,5845.69 +2408,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,1199-Commercial, +2409,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,1199-Commercial,2984.66 +2410,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,1199-Commercial, +2411,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,1199-Commercial,4823.9 +2412,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,1199-Commercial, +2413,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,1199-Commercial,429.57 +2414,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,1199-Commercial,312.88 +2415,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,1199-Commercial,179.52 +2416,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,1199-Commercial, +2417,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,1199-Commercial, +2418,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,1199-Commercial,691.6 +2419,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,1199-Commercial, +2420,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,1199-Commercial, +2421,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,1199-Commercial,1335.12 +2422,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,1199-Commercial,6009.15 +2423,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,1199-Commercial, +2424,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,1199-Commercial, +2425,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,1199-Commercial,3039.4 +2426,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,1199-Commercial, +2427,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,1199-Commercial, +2428,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,1199-Commercial, +2429,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,1199-Commercial,173.23 +2430,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,1199-Commercial,301.94 +2431,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,1199-Commercial,557.9 +2432,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,1199-Commercial,297.57 +2433,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,1199-Commercial,333.9 +2434,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,1199-Commercial, +2435,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,1199-Commercial, +2436,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,1199-Commercial,230.7 +2437,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,1199-Commercial,379.26 +2438,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,1199-Commercial,302.94 +2439,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,1199-Commercial, +2440,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,1199-Commercial,309.01 +2441,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,1199-Commercial,477.32 +2442,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,1199-Commercial, +2443,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,1199-Commercial,935.79 +2444,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,1199-Commercial, +2445,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,1199-Commercial, +2446,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,1199-Commercial, +2447,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,1199-Commercial, +2448,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,1199-Commercial, +2449,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,1199-Commercial, +2450,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,1199-Commercial, +2451,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,1199-Commercial, +2452,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,1199-Commercial, +2453,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,1199-Commercial, +2454,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,1199-Commercial,2538.31 +2455,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,1199-Commercial, +2456,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,1199-Commercial, +2457,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,1199-Commercial, +2458,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,1199-Commercial,4030.6 +2459,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,1199-Commercial,274.59 +2460,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,1199-Commercial, +2461,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,1199-Commercial, +2462,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,1199-Commercial,1527.18 +2463,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,1199-Commercial, +2464,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,1199-Commercial, +2465,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,1199-Commercial, +2466,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,1199-Commercial,3267.44 +2467,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,1199-Commercial, +2468,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,1199-Commercial, +2469,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,1199-Commercial,300.77 +2470,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,1199-Commercial, +2471,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,1199-Commercial, +2472,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,1199-Commercial,270.2 +2473,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,1199-Commercial, +2474,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,1199-Commercial, +2475,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,1199-Commercial, +2476,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,1199-Commercial,312.37 +2477,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,1199-Commercial,306.0 +2478,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,1199-Commercial,205.33 +2479,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,1199-Commercial,338.78 +2480,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,1199-Commercial,230.38 +2481,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,1199-Commercial,609.0 +2482,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,1199-Commercial,277.65 +2483,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,1199-Commercial,641.41 +2484,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,1199-Commercial, +2485,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,1199-Commercial, +2486,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,1199-Commercial, +2487,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,1199-Commercial, +2488,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,1199-Commercial,2678.2 +2489,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,1199-Commercial,3127.6 +2490,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,1199-Commercial, +2491,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,1199-Commercial,281.17 +2492,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,1199-Commercial, +2493,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,1199-Commercial, +2494,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,1199-Commercial,220.29 +2495,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,1199-Commercial, +2496,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,1199-Commercial, +2497,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,1199-Commercial,211.79 +2498,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,1199-Commercial,327.04 +2499,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,1199-Commercial,231.08 +2500,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,1199-Commercial,382.2 +2501,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,1199-Commercial, +2502,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,1199-Commercial,289.38 +2503,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,1199-Commercial, +2504,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,1199-Commercial,344.4 +2505,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,1199-Commercial,304.48 +2506,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,1199-Commercial,161.94 +2507,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,1199-Commercial,352.8 +2508,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,1199-Commercial,325.5 +2509,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,1199-Commercial, +2510,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,1199-Commercial, +2511,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,1199-Commercial, +2512,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,1199-Commercial, +2513,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,1199-Commercial,2930.9 +2514,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,1199-Commercial,2037.55 +2515,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,1199-Commercial,1733.41 +2516,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,1199-Commercial, +2517,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,1199-Commercial, +2518,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,1199-Commercial,302.84 +2519,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,1199-Commercial,427.31 +2520,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,1199-Commercial, +2521,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,1199-Commercial, +2522,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,1199-Commercial, +2523,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,1199-Commercial, +2524,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,1199-Commercial, +2525,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,1199-Commercial,1674.7 +2526,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,1199-Commercial,2886.09 +2527,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,1199-Commercial, +2528,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,1199-Commercial,1439.32 +2529,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,1199-Commercial,3535.99 +2530,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,1199-Commercial, +2531,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,1199-Commercial, +2532,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,1199-Commercial, +2533,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,1199-Commercial,569.8 +2534,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,1199-Commercial,575.98 +2535,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,1199-Commercial,609.7 +2536,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,1199-Commercial,609.7 +2537,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,1199-Commercial, +2538,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,1199-Commercial, +2539,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,1199-Commercial, +2540,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,1199-Commercial, +2541,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,1199-Commercial, +2542,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,1199-Commercial, +2543,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,1199-Commercial, +2544,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,1199-Commercial, +2545,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,1199-Commercial, +2546,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,1199-Commercial, +2547,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,1199-Commercial, +2548,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,1199-Commercial,1143.1 +2549,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,1199-Commercial, +2550,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,1199-Commercial, +2551,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,1199-Commercial, +2552,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,1199-Commercial, +2553,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,1199-Commercial,3503.3 +2554,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,1199-Commercial,273.39 +2555,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,1199-Commercial,840.7 +2556,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,1199-Commercial,1877.45 +2557,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,1199-Commercial, +2558,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,1199-Commercial, +2559,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,1199-Commercial, +2560,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,1199-Commercial, +2561,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,1199-Commercial, +2562,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,1199-Commercial, +2563,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,1199-Commercial, +2564,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,1199-Commercial, +2565,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,1199-Commercial, +2566,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,1199-Commercial, +2567,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,1199-Commercial, +2568,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,1199-Commercial, +2569,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,1199-Commercial, +2570,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,1199-Commercial, +2571,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,1199-Commercial, +2572,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,1199-Commercial, +2573,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,1199-Commercial, +2574,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,1199-Commercial, +2575,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,1199-Commercial, +2576,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,1199-Commercial, +2577,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,1199-Commercial, +2578,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,1199-Commercial, +2579,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,1199-Commercial,293.22 +2580,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,1199-Commercial, +2581,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,1199-Commercial, +2582,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,1199-Commercial, +2583,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,1199-Commercial, +2584,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,1199-Commercial, +2585,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,1199-Commercial, +2586,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,1199-Commercial, +2587,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,1199-Commercial, +2588,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,1199-Commercial,290.43 +2589,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,1199-Commercial,400.42 +2590,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,1199-Commercial,620.2 +2591,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,1199-Commercial,323.01 +2592,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,1199-Commercial,378.32 +2593,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,1199-Commercial,799.6 +2594,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,1199-Commercial, +2595,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,1199-Commercial,807.8 +2596,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,1199-Commercial, +2597,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,1199-Commercial,356.8 +2598,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,1199-Commercial, +2599,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,1199-Commercial, +2600,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,1199-Commercial, +2601,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,1199-Commercial, +2602,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,1199-Commercial, +2603,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,1199-Commercial, +2604,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,1199-Commercial, +2605,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,1199-Commercial, +2606,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,1199-Commercial, +2607,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,1199-Commercial, +2608,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,1199-Commercial, +2609,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,1199-Commercial, +2610,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,1199-Commercial, +2611,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,1199-Commercial,2460.5 +2612,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,1199-Commercial,2460.5 +2613,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,1199-Commercial,2361.8 +2614,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,1199-Commercial,399.09 +2615,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,1199-Commercial, +2616,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,1199-Commercial, +2617,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,1199-Commercial, +2618,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,1199-Commercial, +2619,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,1199-Commercial,235.37 +2620,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,1199-Commercial,167.07 +2621,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,1199-Commercial, +2622,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,1199-Commercial, +2623,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,1199-Commercial, +2624,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,1199-Commercial, +2625,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,1199-Commercial, +2626,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,1199-Commercial, +2627,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,1199-Commercial, +2628,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,1199-Commercial, +2629,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,1199-Commercial, +2630,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,1199-Commercial, +2631,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,1199-Commercial, +2632,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,1199-Commercial, +2633,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,1199-Commercial, +2634,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,1199-Commercial, +2635,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,1199-Commercial, +2636,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,1199-Commercial,2966.6 +2637,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,1199-Commercial, +2638,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,1199-Commercial,85.66 +2639,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,1199-Commercial,119.0 +2640,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,1199-Commercial,98.46 +2641,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,1199-Commercial,285.63 +2642,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,1199-Commercial,653.1 +2643,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,1199-Commercial,475.7 +2644,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,1199-Commercial,352.33 +2645,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,1199-Commercial,401.4 +2646,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,1199-Commercial, +2647,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,1199-Commercial, +2648,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,1199-Commercial,694.4 +2649,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,1199-Commercial,102.85 +2650,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,1199-Commercial, +2651,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,1199-Commercial, +2652,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,1199-Commercial, +2653,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,1199-Commercial, +2654,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,1199-Commercial,2386.43 +2655,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,1199-Commercial,8367.0 +2656,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,1199-Commercial, +2657,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,1199-Commercial, +2658,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,1199-Commercial, +2659,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,1199-Commercial, +2660,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,1199-Commercial, +2661,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,1199-Commercial, +2662,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,1199-Commercial, +2663,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,1199-Commercial,1327.47 +2664,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,1199-Commercial,429.3 +2665,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,1199-Commercial,8367.0 +2666,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,1199-Commercial, +2667,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,1199-Commercial, +2668,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,1199-Commercial, +2669,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,1199-Commercial, +2670,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,1199-Commercial,1003.16 +2671,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,1199-Commercial, +2672,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,1199-Commercial, +2673,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,1199-Commercial, +2674,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,1199-Commercial, +2675,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,1199-Commercial, +2676,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,1199-Commercial,2506.18 +2677,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,1199-Commercial, +2678,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,1199-Commercial, +2679,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,1199-Commercial, +2680,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,1199-Commercial, +2681,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,1199-Commercial,127.53 +2682,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,1199-Commercial, +2683,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,1199-Commercial,802.98 +2684,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,1199-Commercial,948.5 +2685,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,1199-Commercial, +2686,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,1199-Commercial,1055.63 +2687,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,1199-Commercial, +2688,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,1199-Commercial, +2689,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,1199-Commercial, +2690,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,1199-Commercial,1238.69 +2691,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,1199-Commercial, +2692,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,1199-Commercial,1866.67 +2693,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,1199-Commercial, +2694,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,1199-Commercial, +2695,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,1199-Commercial,5239.5 +2696,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,1199-Commercial, +2697,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,1199-Commercial, +2698,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,1199-Commercial, +2699,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,1199-Commercial, +2700,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,1199-Commercial, +2701,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,1199-Commercial, +2702,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,1199-Commercial,5188.4 +2703,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,1199-Commercial, +2704,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,1199-Commercial,633.93 +2705,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,1199-Commercial, +2706,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,1199-Commercial, +2707,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,1199-Commercial,1287.89 +2708,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,1199-Commercial, +2709,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,1199-Commercial,872.17 +2710,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,1199-Commercial, +2711,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,1199-Commercial, +2712,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,1199-Commercial, +2713,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,1199-Commercial, +2714,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,1199-Commercial, +2715,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,1199-Commercial,6389.64 +2716,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,1199-Commercial, +2717,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,1199-Commercial,1401.0 +2718,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,1199-Commercial,1009.05 +2719,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,1199-Commercial, +2720,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,1199-Commercial, +2721,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,1199-Commercial, +2722,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,1199-Commercial, +2723,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,1199-Commercial,129.22 +2724,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,1199-Commercial,90.04 +2725,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,1199-Commercial,144.91 +2726,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,1199-Commercial, +2727,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,1199-Commercial,163.1 +2728,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,1199-Commercial, +2729,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,1199-Commercial,254.19 +2730,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,1199-Commercial,170.91 +2731,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,1199-Commercial,76.11 +2732,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,1199-Commercial, +2733,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,1199-Commercial, +2734,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,1199-Commercial, +2735,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,1199-Commercial, +2736,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,1199-Commercial, +2737,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,1199-Commercial,51.67 +2738,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,1199-Commercial,124.6 +2739,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,1199-Commercial,39.2 +2740,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,1199-Commercial, +2741,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,1199-Commercial, +2742,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,1199-Commercial, +2743,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,1199-Commercial, +2744,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,1199-Commercial,11.9 +2745,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,1199-Commercial,22.8 +2746,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,1199-Commercial,74.92 +2747,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,1199-Commercial,15.4 +2748,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,1199-Commercial, +2749,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,1199-Commercial, +2750,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,1199-Commercial, +2751,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,1199-Commercial, +2752,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,1199-Commercial,92.97 +2753,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,1199-Commercial, +2754,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,1199-Commercial, +2755,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,1199-Commercial, +2756,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,1199-Commercial, +2757,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,1199-Commercial, +2758,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,1199-Commercial, +2759,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,1199-Commercial, +2760,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,1199-Commercial, +2761,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,1199-Commercial, +2762,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,1199-Commercial,230.61 +2763,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,1199-Commercial,159.38 +2764,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,1199-Commercial, +2765,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,1199-Commercial, +2766,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,1199-Commercial,159.38 +2767,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,1199-Commercial, +2768,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,1199-Commercial, +2769,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,1199-Commercial, +2770,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,1199-Commercial, +2771,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,1199-Commercial, +2772,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,1199-Commercial, +2773,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,1199-Commercial, +2774,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,1199-Commercial, +2775,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,1199-Commercial, +2776,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,1199-Commercial, +2777,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,1199-Commercial, +2778,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,1199-Commercial, +2779,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,1199-Commercial,71.61 +2780,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,1199-Commercial, +2781,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,1199-Commercial,29.95 +2782,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,1199-Commercial,11.9 +2783,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,1199-Commercial, +2784,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,1199-Commercial, +2785,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,1199-Commercial, +2786,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,1199-Commercial, +2787,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,1199-Commercial, +2788,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,1199-Commercial, +2789,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,1199-Commercial, +2790,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,1199-Commercial, +2791,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,1199-Commercial, +2792,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,1199-Commercial, +2793,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,1199-Commercial, +2794,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,1199-Commercial, +2795,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,1199-Commercial, +2796,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,1199-Commercial, +2797,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,1199-Commercial,171.33 +2798,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,1199-Commercial,934.35 +2799,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,1199-Commercial, +2800,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,1199-Commercial, +2801,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,1199-Commercial, +2802,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,1199-Commercial, +2803,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,1199-Commercial, +2804,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,1199-Commercial, +2805,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,1199-Commercial, +2806,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,1199-Commercial, +2807,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,1199-Commercial,1276.1 +2808,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,1199-Commercial, +2809,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,1199-Commercial,87.18 +2810,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,1199-Commercial,108.9 +2811,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,1199-Commercial,66.5 +2812,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,1199-Commercial,121.83 +2813,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,1199-Commercial, +2814,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,1199-Commercial, +2815,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,1199-Commercial, +2816,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,1199-Commercial, +2817,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,1199-Commercial, +2818,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,1199-Commercial, +2819,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,1199-Commercial, +2820,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,1199-Commercial, +2821,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,1199-Commercial, +2822,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,1199-Commercial, +2823,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,1199-Commercial, +2824,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,1199-Commercial, +2825,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,1199-Commercial, +2826,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,1199-Commercial, +2827,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,1199-Commercial, +2828,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,1199-Commercial, +2829,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,1199-Commercial, +2830,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,1199-Commercial, +2831,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,1199-Commercial, +2832,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,1199-Commercial, +2833,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,1199-Commercial, +2834,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,1199-Commercial, +2835,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,1199-Commercial, +2836,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,1199-Commercial, +2837,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,1199-Commercial, +2838,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,1199-Commercial, +2839,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,1199-Commercial, +2840,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,1199-Commercial, +2841,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,1199-Commercial, +2842,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,1199-Commercial, +2843,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,1199-Commercial, +2844,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,1199-Commercial, +2845,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,1199-Commercial, +2846,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,1199-Commercial, +2847,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,1199-Commercial, +2848,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,1199-Commercial, +2849,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,1199-Commercial, +2850,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,1199-Commercial, +2851,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,1199-Commercial, +2852,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,1199-Commercial, +2853,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,1199-Commercial, +2854,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,1199-Commercial, +2855,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,1199-Commercial, +2856,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,1199-Commercial, +2857,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,1199-Commercial, +2858,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,1199-Commercial,115.23 +2859,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,1199-Commercial,171.33 +2860,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,1199-Commercial,188.1 +2861,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,1199-Commercial,176.28 +2862,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,1199-Commercial,527.73 +2863,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,1199-Commercial, +2864,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,1199-Commercial, +2865,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,1199-Commercial, +2866,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,1199-Commercial, +2867,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,1199-Commercial,632.8 +2868,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,1199-Commercial, +2869,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,1199-Commercial, +2870,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,1199-Commercial,265.87 +2871,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,1199-Commercial,18.9 +2872,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,1199-Commercial, +2873,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,1199-Commercial,33.09 +2874,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,1199-Commercial,25.15 +2875,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,1199-Commercial,55.13 +2876,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,1199-Commercial,3.83 +2877,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,1199-Commercial, +2878,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,1199-Commercial,62.88 +2879,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,1199-Commercial, +2880,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,1199-Commercial,118.77 +2881,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,1199-Commercial, +2882,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,1199-Commercial, +2883,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,1199-Commercial,84.16 +2884,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,1199-Commercial, +2885,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,1199-Commercial,54.6 +2886,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,1199-Commercial,91.23 +2887,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,1199-Commercial,79.91 +2888,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,1199-Commercial, +2889,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,1199-Commercial,36.12 +2890,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,1199-Commercial,45.03 +2891,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,1199-Commercial, +2892,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,1199-Commercial, +2893,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,1199-Commercial, +2894,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,1199-Commercial, +2895,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,1199-Commercial,86.1 +2896,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,1199-Commercial,38.91 +2897,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,1199-Commercial,11.0 +2898,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,1199-Commercial, +2899,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,1199-Commercial, +2900,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,1199-Commercial, +2901,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,1199-Commercial,330.4 +2902,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,1199-Commercial,23.0 +2903,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,1199-Commercial,25.96 +2904,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,1199-Commercial,52.13 +2905,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,1199-Commercial, +2906,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,1199-Commercial,9.8 +2907,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,1199-Commercial,53.05 +2908,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,1199-Commercial, +2909,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,1199-Commercial,131.48 +2910,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,1199-Commercial,20.65 +2911,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,1199-Commercial, +2912,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,1199-Commercial, +2913,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,1199-Commercial, +2914,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,1199-Commercial,76.11 +2915,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,1199-Commercial,32.92 +2916,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,1199-Commercial, +2917,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,1199-Commercial,10.73 +2918,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,1199-Commercial,50.03 +2919,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,1199-Commercial, +2920,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,1199-Commercial, +2921,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,1199-Commercial,32.41 +2922,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,1199-Commercial, +2923,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,1199-Commercial,183.65 +2924,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,1199-Commercial,65.53 +2925,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,1199-Commercial,42.63 +2926,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,1199-Commercial, +2927,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,1199-Commercial, +2928,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,1199-Commercial,39.17 +2929,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,1199-Commercial,49.06 +2930,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,1199-Commercial, +2931,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,1199-Commercial, +2932,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,1199-Commercial,65.8 +2933,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,1199-Commercial,116.9 +2934,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,1199-Commercial,32.2 +2935,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,1199-Commercial,18.9 +2936,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,1199-Commercial,76.2 +2937,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,1199-Commercial, +2938,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,1199-Commercial,94.58 +2939,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,1199-Commercial, +2940,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,1199-Commercial, +2941,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,1199-Commercial, +2942,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,1199-Commercial,7.0 +2943,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,1199-Commercial,158.64 +2944,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,1199-Commercial, +2945,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,1199-Commercial, +2946,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,1199-Commercial,73.02 +2947,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,1199-Commercial, +2948,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,1199-Commercial, +2949,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,1199-Commercial, +2950,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,1199-Commercial, +2951,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,1199-Commercial,127.4 +2952,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,1199-Commercial,216.95 +2953,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,1199-Commercial,128.1 +2954,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,1199-Commercial, +2955,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,1199-Commercial,146.39 +2956,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,1199-Commercial,214.9 +2957,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,1199-Commercial, +2958,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,1199-Commercial,110.33 +2959,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,1199-Commercial,160.76 +2960,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,1199-Commercial,6.94 +2961,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,1199-Commercial,32.23 +2962,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,1199-Commercial,26.09 +2963,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,1199-Commercial, +2964,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,1199-Commercial,18.45 +2965,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,1199-Commercial,60.74 +2966,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,1199-Commercial,14.3 +2967,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,1199-Commercial,38.32 +2968,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,1199-Commercial, +2969,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,1199-Commercial,42.93 +2970,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,1199-Commercial,47.15 +2971,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,1199-Commercial,109.0 +2972,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,1199-Commercial,115.52 +2973,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,1199-Commercial, +2974,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,1199-Commercial, +2975,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,1199-Commercial,132.3 +2976,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,1199-Commercial, +2977,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,1199-Commercial, +2978,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,1199-Commercial,73.97 +2979,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,1199-Commercial, +2980,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,1199-Commercial,148.4 +2981,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,1199-Commercial, +2982,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,1199-Commercial, +2983,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,1199-Commercial, +2984,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,1199-Commercial,117.9 +2985,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,1199-Commercial, +2986,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,1199-Commercial, +2987,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,1199-Commercial, +2988,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,1199-Commercial,78.12 +2989,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,1199-Commercial,157.58 +2990,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,1199-Commercial,210.7 +2991,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,1199-Commercial,24.18 +2992,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,1199-Commercial,86.1 +2993,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,1199-Commercial,225.48 +2994,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,1199-Commercial,54.79 +2995,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,1199-Commercial, +2996,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,1199-Commercial, +2997,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,1199-Commercial,3.35 +2998,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,1199-Commercial,83.0 +2999,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,1199-Commercial,34.6 +3000,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,1199-Commercial, +3001,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,1199-Commercial, +3002,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,1199-Commercial,33.47 +3003,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,1199-Commercial,44.75 +3004,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,1199-Commercial, +3005,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,1199-Commercial, +3006,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,1199-Commercial, +3007,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,1199-Commercial, +3008,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,1199-Commercial, +3009,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,1199-Commercial,6.88 +3010,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,1199-Commercial, +3011,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,1199-Commercial, +3012,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,1199-Commercial,219.84 +3013,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,1199-Commercial,198.98 +3014,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,1199-Commercial,8.8 +3015,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,1199-Commercial,26.13 +3016,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,1199-Commercial,12.6 +3017,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,1199-Commercial,41.91 +3018,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,1199-Commercial,52.05 +3019,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,1199-Commercial, +3020,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,1199-Commercial, +3021,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,1199-Commercial,248.97 +3022,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,1199-Commercial, +3023,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,1199-Commercial, +3024,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,1199-Commercial,98.06 +3025,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,1199-Commercial, +3026,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,1199-Commercial,18.19 +3027,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,1199-Commercial,27.54 +3028,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,1199-Commercial,31.67 +3029,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,1199-Commercial, +3030,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,1199-Commercial, +3031,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,1199-Commercial, +3032,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,1199-Commercial, +3033,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,1199-Commercial,51.53 +3034,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,1199-Commercial,44.85 +3035,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,1199-Commercial,17.59 +3036,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,1199-Commercial, +3037,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,1199-Commercial,113.62 +3038,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,1199-Commercial,194.97 +3039,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,1199-Commercial,327.22 +3040,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,1199-Commercial, +3041,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,1199-Commercial,117.63 +3042,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,1199-Commercial,30.6 +3043,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,1199-Commercial,19.35 +3044,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,1199-Commercial,40.6 +3045,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,1199-Commercial,38.0 +3046,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,1199-Commercial,73.31 +3047,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,1199-Commercial, +3048,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,1199-Commercial, +3049,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,1199-Commercial, +3050,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,1199-Commercial, +3051,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,1199-Commercial,10.0 +3052,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,1199-Commercial,20.3 +3053,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,1199-Commercial, +3054,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,1199-Commercial,9.1 +3055,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,1199-Commercial, +3056,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,1199-Commercial,40.41 +3057,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,1199-Commercial,21.39 +3058,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,1199-Commercial,10.5 +3059,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,1199-Commercial,29.9 +3060,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,1199-Commercial,45.01 +3061,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,1199-Commercial, +3062,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,1199-Commercial,137.08 +3063,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,1199-Commercial, +3064,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,1199-Commercial, +3065,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,1199-Commercial, +3066,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,1199-Commercial, +3067,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,1199-Commercial, +3068,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,1199-Commercial,106.65 +3069,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,1199-Commercial,78.46 +3070,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,1199-Commercial,66.84 +3071,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,1199-Commercial,23.57 +3072,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,1199-Commercial,34.39 +3073,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,1199-Commercial,75.03 +3074,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,1199-Commercial, +3075,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,1199-Commercial,144.61 +3076,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,1199-Commercial,226.54 +3077,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,1199-Commercial,21.0 +3078,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,1199-Commercial,51.1 +3079,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,1199-Commercial,59.5 +3080,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,1199-Commercial,83.24 +3081,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,1199-Commercial,18.12 +3082,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,1199-Commercial,25.94 +3083,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,1199-Commercial,65.36 +3084,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,1199-Commercial,70.39 +3085,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,1199-Commercial,84.97 +3086,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,1199-Commercial,160.28 +3087,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,1199-Commercial, +3088,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,1199-Commercial,37.54 +3089,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,1199-Commercial,12.4 +3090,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,1199-Commercial,39.09 +3091,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,1199-Commercial, +3092,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,1199-Commercial, +3093,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,1199-Commercial, +3094,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,1199-Commercial, +3095,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,1199-Commercial,9.8 +3096,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,1199-Commercial,42.0 +3097,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,1199-Commercial,25.59 +3098,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,1199-Commercial, +3099,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,1199-Commercial,179.7 +3100,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,1199-Commercial,139.7 +3101,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,1199-Commercial, +3102,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,1199-Commercial, +3103,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,1199-Commercial,34.66 +3104,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,1199-Commercial,19.0 +3105,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,1199-Commercial,12.38 +3106,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,1199-Commercial,12.1 +3107,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,1199-Commercial,73.01 +3108,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,1199-Commercial,44.63 +3109,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,1199-Commercial, +3110,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,1199-Commercial,35.46 +3111,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,1199-Commercial, +3112,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,1199-Commercial,62.3 +3113,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,1199-Commercial, +3114,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,1199-Commercial, +3115,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,1199-Commercial,165.2 +3116,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,1199-Commercial,366.1 +3117,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,1199-Commercial, +3118,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,1199-Commercial, +3119,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,1199-Commercial, +3120,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,1199-Commercial, +3121,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,1199-Commercial, +3122,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,1199-Commercial,190.4 +3123,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,1199-Commercial, +3124,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,1199-Commercial, +3125,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,1199-Commercial, +3126,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,1199-Commercial, +3127,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,1199-Commercial, +3128,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,1199-Commercial, +3129,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,1199-Commercial, +3130,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,1199-Commercial, +3131,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,1199-Commercial, +3132,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,1199-Commercial, +3133,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,1199-Commercial, +3134,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,1199-Commercial,147.75 +3135,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,1199-Commercial,119.0 +3136,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,1199-Commercial, +3137,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,1199-Commercial, +3138,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,1199-Commercial, +3139,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,1199-Commercial, +3140,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,1199-Commercial, +3141,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,1199-Commercial, +3142,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,1199-Commercial,97.5 +3143,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,1199-Commercial,40.79 +3144,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,1199-Commercial,142.1 +3145,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,1199-Commercial,74.04 +3146,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,1199-Commercial, +3147,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,1199-Commercial,47.49 +3148,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,1199-Commercial, +3149,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,1199-Commercial,10.35 +3150,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,1199-Commercial,58.33 +3151,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,1199-Commercial,8.48 +3152,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,1199-Commercial, +3153,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,1199-Commercial, +3154,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,1199-Commercial,242.8 +3155,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,1199-Commercial, +3156,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,1199-Commercial,4.2 +3157,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,1199-Commercial,79.97 +3158,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,1199-Commercial, +3159,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,1199-Commercial,82.39 +3160,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,1199-Commercial,60.94 +3161,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,1199-Commercial,22.96 +3162,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,1199-Commercial,70.45 +3163,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,1199-Commercial,50.44 +3164,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,1199-Commercial,54.86 +3165,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,1199-Commercial,195.14 +3166,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,1199-Commercial,64.27 +3167,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,1199-Commercial, +3168,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,1199-Commercial,9.8 +3169,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,1199-Commercial,359.99 +3170,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,1199-Commercial, +3171,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,1199-Commercial, +3172,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,1199-Commercial,49.63 +3173,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,1199-Commercial, +3174,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,1199-Commercial,105.14 +3175,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,1199-Commercial,135.39 +3176,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,1199-Commercial,196.0 +3177,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,1199-Commercial,36.3 +3178,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,1199-Commercial,219.8 +3179,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,1199-Commercial,134.08 +3180,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,1199-Commercial,193.56 +3181,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,1199-Commercial, +3182,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,1199-Commercial,32.09 +3183,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,1199-Commercial,28.62 +3184,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,1199-Commercial,124.0 +3185,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,1199-Commercial,22.0 +3186,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,1199-Commercial, +3187,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,1199-Commercial,124.36 +3188,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,1199-Commercial, +3189,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,1199-Commercial, +3190,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,1199-Commercial, +3191,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,1199-Commercial, +3192,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,1199-Commercial, +3193,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,1199-Commercial,46.2 +3194,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,1199-Commercial, +3195,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,1199-Commercial, +3196,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,1199-Commercial, +3197,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,1199-Commercial, +3198,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,1199-Commercial,228.9 +3199,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,1199-Commercial,338.8 +3200,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,1199-Commercial, +3201,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,1199-Commercial,37.39 +3202,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,1199-Commercial,40.19 +3203,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,1199-Commercial,255.5 +3204,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,1199-Commercial, +3205,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,1199-Commercial,67.2 +3206,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,1199-Commercial, +3207,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,1199-Commercial, +3208,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,1199-Commercial, +3209,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,1199-Commercial, +3210,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,1199-Commercial,16.8 +3211,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,1199-Commercial,21.7 +3212,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,1199-Commercial,158.95 +3213,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,1199-Commercial,111.19 +3214,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,1199-Commercial,138.6 +3215,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,1199-Commercial, +3216,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,1199-Commercial,7.43 +3217,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,1199-Commercial,7.7 +3218,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,1199-Commercial,7.7 +3219,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,1199-Commercial, +3220,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,1199-Commercial,142.1 +3221,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,1199-Commercial, +3222,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,1199-Commercial,57.4 +3223,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,1199-Commercial,14.49 +3224,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,1199-Commercial,16.98 +3225,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,1199-Commercial,40.65 +3226,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,1199-Commercial,27.22 +3227,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,1199-Commercial, +3228,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,1199-Commercial, +3229,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,1199-Commercial,14.0 +3230,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,1199-Commercial, +3231,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,1199-Commercial, +3232,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,1199-Commercial,44.38 +3233,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,1199-Commercial,46.67 +3234,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,1199-Commercial, +3235,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,1199-Commercial, +3236,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,1199-Commercial, +3237,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,1199-Commercial,54.26 +3238,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,1199-Commercial,56.42 +3239,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,1199-Commercial,45.93 +3240,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,1199-Commercial,64.94 +3241,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,1199-Commercial,40.81 +3242,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,1199-Commercial,6.3 +3243,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,1199-Commercial, +3244,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,1199-Commercial, +3245,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,1199-Commercial,120.36 +3246,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,1199-Commercial,144.9 +3247,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,1199-Commercial, +3248,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,1199-Commercial, +3249,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,1199-Commercial,62.24 +3250,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,1199-Commercial,10.78 +3251,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,1199-Commercial, +3252,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,1199-Commercial,98.0 +3253,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,1199-Commercial,111.3 +3254,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,1199-Commercial,58.8 +3255,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,1199-Commercial, +3256,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,1199-Commercial, +3257,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,1199-Commercial,51.67 +3258,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,1199-Commercial,145.6 +3259,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,1199-Commercial, +3260,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,1199-Commercial, +3261,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,1199-Commercial, +3262,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,1199-Commercial,34.22 +3263,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,1199-Commercial,167.3 +3264,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,1199-Commercial, +3265,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,1199-Commercial,87.36 +3266,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,1199-Commercial,70.81 +3267,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,1199-Commercial, +3268,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,1199-Commercial, +3269,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,1199-Commercial,405.92 +3270,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,1199-Commercial, +3271,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,1199-Commercial,704.25 +3272,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,1199-Commercial,537.9 +3273,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,1199-Commercial,233.1 +3274,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,1199-Commercial, +3275,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,1199-Commercial,288.63 +3276,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,1199-Commercial,288.63 +3277,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,1199-Commercial, +3278,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,1199-Commercial, +3279,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,1199-Commercial,254.94 +3280,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,1199-Commercial,846.74 +3281,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,1199-Commercial,463.3 +3282,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,1199-Commercial, +3283,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,1199-Commercial,222.59 +3284,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,1199-Commercial,85.88 +3285,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,1199-Commercial,159.51 +3286,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,1199-Commercial,96.24 +3287,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,1199-Commercial, +3288,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,1199-Commercial,38.48 +3289,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,1199-Commercial,72.01 +3290,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,1199-Commercial,72.27 +3291,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,1199-Commercial,101.12 +3292,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,1199-Commercial,64.4 +3293,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,1199-Commercial,75.46 +3294,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,1199-Commercial, +3295,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,1199-Commercial, +3296,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,1199-Commercial, +3297,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,1199-Commercial, +3298,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,1199-Commercial, +3299,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,1199-Commercial,10.73 +3300,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,1199-Commercial, +3301,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,1199-Commercial,9.63 +3302,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,1199-Commercial, +3303,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,1199-Commercial, +3304,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,1199-Commercial, +3305,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,1199-Commercial, +3306,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,1199-Commercial, +3307,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,1199-Commercial,125.03 +3308,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,1199-Commercial, +3309,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,1199-Commercial,50.92 +3310,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,1199-Commercial, +3311,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,1199-Commercial,37.16 +3312,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,1199-Commercial, +3313,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,1199-Commercial,36.43 +3314,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,1199-Commercial,81.9 +3315,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,1199-Commercial, +3316,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,1199-Commercial,43.97 +3317,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,1199-Commercial, +3318,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,1199-Commercial, +3319,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,1199-Commercial,103.18 +3320,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,1199-Commercial,71.4 +3321,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,1199-Commercial, +3322,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,1199-Commercial, +3323,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,1199-Commercial,4.4 +3324,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,1199-Commercial,11.0 +3325,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,1199-Commercial,47.96 +3326,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,1199-Commercial, +3327,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,1199-Commercial,36.26 +3328,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,1199-Commercial, +3329,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,1199-Commercial,69.3 +3330,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,1199-Commercial, +3331,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,1199-Commercial, +3332,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,1199-Commercial, +3333,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,1199-Commercial,70.1 +3334,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,1199-Commercial,15.39 +3335,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,1199-Commercial, +3336,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,1199-Commercial, +3337,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,1199-Commercial,19.8 +3338,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,1199-Commercial, +3339,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,1199-Commercial,69.58 +3340,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,1199-Commercial, +3341,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,1199-Commercial, +3342,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,1199-Commercial,138.25 +3343,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,1199-Commercial,197.43 +3344,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,1199-Commercial,48.09 +3345,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,1199-Commercial,34.08 +3346,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,1199-Commercial,294.83 +3347,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,1199-Commercial,78.35 +3348,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,1199-Commercial, +3349,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,1199-Commercial, +3350,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,1199-Commercial,28.47 +3351,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,1199-Commercial, +3352,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,1199-Commercial, +3353,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,1199-Commercial,112.94 +3354,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,1199-Commercial,192.23 +3355,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,1199-Commercial,24.05 +3356,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,1199-Commercial, +3357,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,1199-Commercial,124.6 +3358,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,1199-Commercial, +3359,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,1199-Commercial,442.4 +3360,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,1199-Commercial, +3361,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,1199-Commercial, +3362,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,1199-Commercial, +3363,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,1199-Commercial, +3364,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,1199-Commercial,134.75 +3365,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,1199-Commercial,98.64 +3366,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,1199-Commercial,244.49 +3367,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,1199-Commercial, +3368,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,1199-Commercial,1079.34 +3369,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,1199-Commercial,72.19 +3370,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,1199-Commercial, +3371,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,1199-Commercial, +3372,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,1199-Commercial,122.85 +3373,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,1199-Commercial,159.81 +3374,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,1199-Commercial,29.32 +3375,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,1199-Commercial,119.75 +3376,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,1199-Commercial, +3377,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,1199-Commercial,71.45 +3378,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,1199-Commercial,60.61 +3379,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,1199-Commercial, +3380,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,1199-Commercial, +3381,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,1199-Commercial, +3382,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,1199-Commercial, +3383,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,1199-Commercial, +3384,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,1199-Commercial, +3385,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,1199-Commercial, +3386,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,1199-Commercial, +3387,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,1199-Commercial,79.9 +3388,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,1199-Commercial, +3389,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,1199-Commercial,95.38 +3390,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,1199-Commercial, +3391,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,1199-Commercial, +3392,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,1199-Commercial, +3393,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,1199-Commercial, +3394,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,1199-Commercial, +3395,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,1199-Commercial,261.1 +3396,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,1199-Commercial, +3397,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,1199-Commercial,312.13 +3398,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,1199-Commercial, +3399,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,1199-Commercial, +3400,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,1199-Commercial, +3401,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,1199-Commercial,741.65 +3402,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,1199-Commercial, +3403,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,1199-Commercial,84.15 +3404,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,1199-Commercial, +3405,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,1199-Commercial,154.28 +3406,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,1199-Commercial,293.3 +3407,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,1199-Commercial, +3408,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,1199-Commercial, +3409,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,1199-Commercial, +3410,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,1199-Commercial,193.9 +3411,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,1199-Commercial,238.13 +3412,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,1199-Commercial, +3413,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,1199-Commercial, +3414,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,1199-Commercial, +3415,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,1199-Commercial,429.1 +3416,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,1199-Commercial, +3417,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,1199-Commercial, +3418,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,1199-Commercial, +3419,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,1199-Commercial, +3420,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,1199-Commercial, +3421,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,1199-Commercial, +3422,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,1199-Commercial, +3423,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,1199-Commercial, +3424,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,1199-Commercial,331.8 +3425,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,1199-Commercial,392.21 +3426,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,1199-Commercial, +3427,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,1199-Commercial, +3428,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,1199-Commercial, +3429,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,1199-Commercial, +3430,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,1199-Commercial, +3431,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,1199-Commercial, +3432,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,1199-Commercial, +3433,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,1199-Commercial, +3434,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,1199-Commercial, +3435,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,1199-Commercial, +3436,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,1199-Commercial,36.57 +3437,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,1199-Commercial,51.8 +3438,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,1199-Commercial,47.58 +3439,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,1199-Commercial, +3440,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,1199-Commercial, +3441,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,1199-Commercial, +3442,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,1199-Commercial, +3443,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,1199-Commercial,723.85 +3444,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,1199-Commercial, +3445,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,1199-Commercial, +3446,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,1199-Commercial, +3447,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,1199-Commercial, +3448,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,1199-Commercial, +3449,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,1199-Commercial, +3450,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,1199-Commercial, +3451,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,1199-Commercial,412.4 +3452,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,1199-Commercial, +3453,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,1199-Commercial,45.41 +3454,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,1199-Commercial, +3455,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,1199-Commercial, +3456,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,1199-Commercial, +3457,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,1199-Commercial,43.8 +3458,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,1199-Commercial,214.45 +3459,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,1199-Commercial, +3460,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,1199-Commercial, +3461,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,1199-Commercial, +3462,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,1199-Commercial, +3463,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,1199-Commercial,298.64 +3464,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,1199-Commercial, +3465,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,1199-Commercial, +3466,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,1199-Commercial, +3467,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,1199-Commercial,243.13 +3468,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,1199-Commercial, +3469,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,1199-Commercial, +3470,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,1199-Commercial, +3471,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,1199-Commercial, +3472,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,1199-Commercial, +3473,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,1199-Commercial, +3474,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,1199-Commercial, +3475,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,1199-Commercial, +3476,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,1199-Commercial, +3477,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,1199-Commercial, +3478,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,1199-Commercial, +3479,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,1199-Commercial, +3480,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,1199-Commercial, +3481,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,1199-Commercial,3393.49 +3482,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,1199-Commercial, +3483,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,1199-Commercial,3393.49 +3484,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,1199-Commercial,825.6 +3485,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,1199-Commercial, +3486,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,1199-Commercial,257.63 +3487,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,1199-Commercial, +3488,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,1199-Commercial, +3489,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,1199-Commercial,877.1 +3490,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,1199-Commercial,877.1 +3491,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,1199-Commercial, +3492,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,1199-Commercial, +3493,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,1199-Commercial, +3494,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,1199-Commercial, +3495,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,1199-Commercial, +3496,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,1199-Commercial, +3497,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,1199-Commercial, +3498,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,1199-Commercial, +3499,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,1199-Commercial, +3500,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,1199-Commercial, +3501,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,1199-Commercial, +3502,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,1199-Commercial, +3503,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,1199-Commercial, +3504,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,1199-Commercial, +3505,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,1199-Commercial, +3506,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,1199-Commercial, +3507,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,1199-Commercial, +3508,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,1199-Commercial, +3509,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,1199-Commercial,173.25 +3510,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,1199-Commercial, +3511,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,1199-Commercial, +3512,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,1199-Commercial,245.45 +3513,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,1199-Commercial, +3514,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,1199-Commercial,267.03 +3515,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,1199-Commercial, +3516,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,1199-Commercial,1239.7 +3517,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,1199-Commercial, +3518,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,1199-Commercial,1239.7 +3519,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,1199-Commercial, +3520,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,1199-Commercial, +3521,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,1199-Commercial,224.97 +3522,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,1199-Commercial, +3523,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,1199-Commercial,115.82 +3524,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,1199-Commercial,408.1 +3525,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,1199-Commercial,114.73 +3526,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,1199-Commercial,880.43 +3527,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,1199-Commercial,358.83 +3528,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,1199-Commercial, +3529,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,1199-Commercial, +3530,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,1199-Commercial, +3531,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,1199-Commercial,115.82 +3532,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,1199-Commercial,342.3 +3533,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,1199-Commercial,456.86 +3534,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,1199-Commercial,348.6 +3535,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,1199-Commercial,465.5 +3536,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,1199-Commercial, +3537,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,1199-Commercial, +3538,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,1199-Commercial,418.6 +3539,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,1199-Commercial, +3540,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,1199-Commercial, +3541,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,1199-Commercial, +3542,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,1199-Commercial, +3543,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,1199-Commercial, +3544,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,1199-Commercial, +3545,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,1199-Commercial, +3546,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,1199-Commercial,577.77 +3547,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,1199-Commercial, +3548,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,1199-Commercial, +3549,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,1199-Commercial, +3550,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,1199-Commercial, +3551,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,1199-Commercial, +3552,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,1199-Commercial, +3553,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,1199-Commercial, +3554,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,1199-Commercial, +3555,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,1199-Commercial, +3556,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,1199-Commercial,1239.7 +3557,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,1199-Commercial, +3558,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,1199-Commercial, +3559,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,1199-Commercial, +3560,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,1199-Commercial,7900.32 +3561,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,1199-Commercial, +3562,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,1199-Commercial,6407.5 +3563,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,1199-Commercial, +3564,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,1199-Commercial, +3565,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,1199-Commercial, +3566,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,1199-Commercial, +3567,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,1199-Commercial,20652.0 +3568,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,1199-Commercial, +3569,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,1199-Commercial,8469.0 +3570,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,1199-Commercial, +3571,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,1199-Commercial, +3572,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,1199-Commercial, +3573,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,1199-Commercial,236.43 +3574,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,1199-Commercial,914.37 +3575,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,1199-Commercial, +3576,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,1199-Commercial, +3577,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,1199-Commercial, +3578,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,1199-Commercial, +3579,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,1199-Commercial, +3580,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,1199-Commercial, +3581,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,1199-Commercial,1949.0 +3582,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,1199-Commercial, +3583,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,1199-Commercial,3253.65 +3584,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,1199-Commercial,544.95 +3585,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,1199-Commercial,3091.2 +3586,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,1199-Commercial, +3587,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,1199-Commercial,3646.46 +3588,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,1199-Commercial, +3589,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,1199-Commercial,852.71 +3590,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,1199-Commercial,901.6 +3591,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,1199-Commercial,673.1 +3592,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,1199-Commercial,4178.3 +3593,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,1199-Commercial, +3594,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,1199-Commercial,84.5 +3595,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,1199-Commercial, +3596,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,1199-Commercial, +3597,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,1199-Commercial, +3598,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,1199-Commercial, +3599,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,1199-Commercial, +3600,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,1199-Commercial, +3601,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,1199-Commercial, +3602,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,1199-Commercial,7741.67 +3603,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,1199-Commercial, +3604,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,1199-Commercial,8469.0 +3605,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,1199-Commercial, +3606,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,1199-Commercial, +3607,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,1199-Commercial, +3608,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,1199-Commercial, +3609,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,1199-Commercial, +3610,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,1199-Commercial, +3611,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,1199-Commercial, +3612,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,1199-Commercial, +3613,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,1199-Commercial,6396.0 +3614,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,1199-Commercial, +3615,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,1199-Commercial, +3616,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,1199-Commercial, +3617,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,1199-Commercial, +3618,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,1199-Commercial, +3619,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,1199-Commercial, +3620,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,1199-Commercial, +3621,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,1199-Commercial, +3622,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,1199-Commercial, +3623,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,1199-Commercial,38349.64 +3624,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,1199-Commercial, +3625,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,1199-Commercial, +3626,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,1199-Commercial,2272.0 +3627,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,1199-Commercial, +3628,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,1199-Commercial, +3629,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,1199-Commercial,239.4 +3630,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,1199-Commercial, +3631,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,1199-Commercial,1417.25 +3632,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,1199-Commercial, +3633,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,1199-Commercial,943.25 +3634,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,1199-Commercial, +3635,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,1199-Commercial, +3636,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,1199-Commercial, +3637,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,1199-Commercial, +3638,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,1199-Commercial, +3639,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,1199-Commercial, +3640,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,1199-Commercial, +3641,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,1199-Commercial,1036.36 +3642,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,1199-Commercial,1524.6 +3643,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,1199-Commercial, +3644,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,1199-Commercial, +3645,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,1199-Commercial, +3646,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,1199-Commercial, +3647,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,1199-Commercial, +3648,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,1199-Commercial,242.51 +3649,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,1199-Commercial,414.72 +3650,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,1199-Commercial, +3651,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,1199-Commercial, +3652,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,1199-Commercial, +3653,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,1199-Commercial, +3654,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,1199-Commercial, +3655,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,1199-Commercial,1949.0 +3656,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,1199-Commercial, +3657,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,1199-Commercial, +3658,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,1199-Commercial, +3659,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,1199-Commercial,680.13 +3660,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,1199-Commercial,232.89 +3661,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,1199-Commercial, +3662,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,1199-Commercial, +3663,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,1199-Commercial, +3664,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,1199-Commercial, +3665,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,1199-Commercial, +3666,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,1199-Commercial, +3667,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,1199-Commercial, +3668,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,1199-Commercial, +3669,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,1199-Commercial, +3670,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,1199-Commercial, +3671,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,1199-Commercial, +3672,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,1199-Commercial, +3673,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,1199-Commercial, +3674,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,1199-Commercial, +3675,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,1199-Commercial,4062.6 +3676,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,1199-Commercial,3679.27 +3677,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,1199-Commercial, +3678,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,1199-Commercial,2593.82 +3679,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,1199-Commercial,592.9 +3680,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,1199-Commercial,782.6 +3681,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,1199-Commercial, +3682,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,1199-Commercial, +3683,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,1199-Commercial,136.71 +3684,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,1199-Commercial, +3685,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,1199-Commercial, +3686,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,1199-Commercial, +3687,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,1199-Commercial, +3688,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,1199-Commercial, +3689,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,1199-Commercial, +3690,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,1199-Commercial, +3691,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,1199-Commercial, +3692,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,1199-Commercial, +3693,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,1199-Commercial, +3694,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,1199-Commercial, +3695,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,1199-Commercial, +3696,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,1199-Commercial, +3697,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,1199-Commercial, +3698,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,1199-Commercial, +3699,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,1199-Commercial, +3700,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,1199-Commercial, +3701,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,1199-Commercial,478.67 +3702,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,1199-Commercial,459.6 +3703,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,1199-Commercial, +3704,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,1199-Commercial, +3705,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,1199-Commercial, +3706,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,1199-Commercial,448.44 +3707,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,1199-Commercial,477.43 +3708,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,1199-Commercial,1603.19 +3709,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,1199-Commercial,880.68 +3710,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,1199-Commercial,252.7 +3711,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,1199-Commercial, +3712,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,1199-Commercial,1193.58 +3713,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,1199-Commercial,1800.62 +3714,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,1199-Commercial,573.13 +3715,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,1199-Commercial,1308.35 +3716,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,1199-Commercial,837.04 +3717,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,1199-Commercial,449.3 +3718,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,1199-Commercial,1949.0 +3719,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,1199-Commercial,1957.24 +3720,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,1199-Commercial,1507.83 +3721,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,1199-Commercial,796.92 +3722,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,1199-Commercial, +3723,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,1199-Commercial, +3724,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,1199-Commercial,538.29 +3725,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,1199-Commercial,726.16 +3726,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,1199-Commercial,2635.52 +3727,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,1199-Commercial,1133.89 +3728,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,1199-Commercial,1815.43 +3729,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,1199-Commercial,3089.69 +3730,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,1199-Commercial,1755.28 +3731,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,1199-Commercial, +3732,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,1199-Commercial,1821.81 +3733,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,1199-Commercial,192.36 +3734,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,1199-Commercial, +3735,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,1199-Commercial,46.44 +3736,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,1199-Commercial, +3737,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,1199-Commercial,58.5 +3738,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,1199-Commercial, +3739,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,1199-Commercial, +3740,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,1199-Commercial, +3741,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,1199-Commercial,66.41 +3742,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,1199-Commercial,198.13 +3743,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,1199-Commercial,110.45 +3744,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,1199-Commercial, +3745,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,1199-Commercial, +3746,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,1199-Commercial, +3747,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,1199-Commercial, +3748,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,1199-Commercial,39.13 +3749,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,1199-Commercial,163.09 +3750,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,1199-Commercial, +3751,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,1199-Commercial,130.22 +3752,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,1199-Commercial,191.25 +3753,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,1199-Commercial, +3754,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,1199-Commercial, +3755,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,1199-Commercial,135.88 +3756,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,1199-Commercial,193.6 +3757,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,1199-Commercial, +3758,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,1199-Commercial, +3759,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,1199-Commercial,84.22 +3760,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,1199-Commercial,107.38 +3761,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,1199-Commercial, +3762,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,1199-Commercial, +3763,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,1199-Commercial, +3764,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,1199-Commercial,218.47 +3765,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,1199-Commercial,136.43 +3766,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,1199-Commercial, +3767,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,1199-Commercial, +3768,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,1199-Commercial,919.8 +3769,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,1199-Commercial,963.83 +3770,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,1199-Commercial, +3771,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,1199-Commercial, +3772,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,1199-Commercial,258.31 +3773,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,1199-Commercial, +3774,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,1199-Commercial, +3775,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,1199-Commercial,213.92 +3776,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,1199-Commercial, +3777,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,1199-Commercial, +3778,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,1199-Commercial, +3779,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,1199-Commercial, +3780,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,1199-Commercial, +3781,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,1199-Commercial, +3782,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,1199-Commercial,89.98 +3783,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,1199-Commercial,259.59 +3784,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,1199-Commercial,260.88 +3785,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,1199-Commercial,217.8 +3786,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,1199-Commercial, +3787,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,1199-Commercial, +3788,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,1199-Commercial, +3789,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,1199-Commercial, +3790,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,1199-Commercial, +3791,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,1199-Commercial,1537.83 +3792,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,1199-Commercial,1785.33 +3793,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,1199-Commercial,1788.7 +3794,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,1199-Commercial,1875.67 +3795,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,1199-Commercial,2258.54 +3796,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,1199-Commercial,1720.0 +3797,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,1199-Commercial, +3798,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,1199-Commercial, +3799,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,1199-Commercial, +3800,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,1199-Commercial, +3801,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,1199-Commercial, +3802,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,1199-Commercial, +3803,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,1199-Commercial, +3804,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,1199-Commercial, +3805,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,1199-Commercial, +3806,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,1199-Commercial, +3807,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,1199-Commercial, +3808,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,1199-Commercial, +3809,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,1199-Commercial, +3810,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,1199-Commercial, +3811,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,1199-Commercial, +3812,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,1199-Commercial, +3813,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,1199-Commercial, +3814,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,1199-Commercial, +3815,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,1199-Commercial, +3816,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,1199-Commercial,98.93 +3817,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,1199-Commercial, +3818,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,1199-Commercial, +3819,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,1199-Commercial, +3820,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,1199-Commercial,2006.73 +3821,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,1199-Commercial, +3822,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,1199-Commercial, +3823,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,1199-Commercial, +3824,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,1199-Commercial, +3825,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,1199-Commercial, +3826,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,1199-Commercial, +3827,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,1199-Commercial, +3828,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,1199-Commercial, +3829,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,1199-Commercial, +3830,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,1199-Commercial, +3831,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,1199-Commercial, +3832,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,1199-Commercial, +3833,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,1199-Commercial, +3834,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,1199-Commercial, +3835,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,1199-Commercial, +3836,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,1199-Commercial, +3837,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,1199-Commercial, +3838,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,1199-Commercial, +3839,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,1199-Commercial, +3840,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,1199-Commercial, +3841,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,1199-Commercial, +3842,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,1199-Commercial, +3843,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,1199-Commercial, +3844,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,1199-Commercial, +3845,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,1199-Commercial, +3846,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,1199-Commercial, +3847,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,1199-Commercial, +3848,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,1199-Commercial, +3849,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,1199-Commercial, +3850,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,1199-Commercial, +3851,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,1199-Commercial, +3852,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,1199-Commercial, +3853,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,1199-Commercial, +3854,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,1199-Commercial, +3855,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,1199-Commercial, +3856,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,1199-Commercial, +3857,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,1199-Commercial, +3858,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,1199-Commercial, +3859,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,1199-Commercial, +3860,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,1199-Commercial, +3861,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,1199-Commercial, +3862,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,1199-Commercial, +3863,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,1199-Commercial, +3864,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,1199-Commercial, +3865,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,1199-Commercial, +3866,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,1199-Commercial, +3867,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,1199-Commercial, +3868,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,1199-Commercial, +3869,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,1199-Commercial, +3870,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,1199-Commercial, +3871,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,1199-Commercial, +3872,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,1199-Commercial, +3873,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,1199-Commercial, +3874,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,1199-Commercial, +3875,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,1199-Commercial, +3876,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,1199-Commercial, +3877,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,1199-Commercial, +3878,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,1199-Commercial, +3879,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,1199-Commercial, +3880,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,1199-Commercial, +3881,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,1199-Commercial, +3882,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,1199-Commercial, +3883,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,1199-Commercial, +3884,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,1199-Commercial, +3885,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,1199-Commercial, +3886,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,1199-Commercial, +3887,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,1199-Commercial, +3888,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,1199-Commercial, +3889,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,1199-Commercial, +3890,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,1199-Commercial, +3891,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,1199-Commercial, +3892,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,1199-Commercial, +3893,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,1199-Commercial, +3894,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,1199-Commercial, +3895,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,1199-Commercial, +3896,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,1199-Commercial, +3897,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,1199-Commercial, +3898,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,1199-Commercial, +3899,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,1199-Commercial, +3900,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,1199-Commercial, +3901,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,1199-Commercial, +3902,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,1199-Commercial, +3903,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,1199-Commercial, +3904,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,1199-Commercial, +3905,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,1199-Commercial, +3906,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,1199-Commercial, +3907,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,1199-Commercial, +3908,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,1199-Commercial, +3909,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,1199-Commercial, +3910,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,1199-Commercial, +3911,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,1199-Commercial, +3912,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,1199-Commercial, +3913,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,1199-Commercial, +3914,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,1199-Commercial, +3915,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,1199-Commercial, +3916,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,1199-Commercial, +3917,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,1199-Commercial, +3918,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,1199-Commercial, +3919,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,1199-Commercial, +3920,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,1199-Commercial, +3921,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,1199-Commercial, +3922,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,1199-Commercial, +3923,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,1199-Commercial, +3924,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,1199-Commercial, +3925,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,1199-Commercial, +3926,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,1199-Commercial, +3927,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,1199-Commercial, +3928,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,1199-Commercial, +3929,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,1199-Commercial, +3930,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,1199-Commercial, +3931,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,1199-Commercial, +3932,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,1199-Commercial, +3933,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,1199-Commercial, +3934,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,1199-Commercial, +3935,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,1199-Commercial, +3936,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,1199-Commercial, +3937,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,1199-Commercial, +3938,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,1199-Commercial, +3939,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,1199-Commercial, +3940,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,1199-Commercial, +3941,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,1199-Commercial, +3942,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,1199-Commercial, +3943,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,1199-Commercial, +3944,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,1199-Commercial, +3945,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,1199-Commercial, +3946,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,1199-Commercial, +3947,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,1199-Commercial, +3948,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,1199-Commercial, +3949,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,1199-Commercial, +3950,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,1199-Commercial, +3951,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,1199-Commercial, +3952,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,1199-Commercial, +3953,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,1199-Commercial, +3954,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,1199-Commercial, +3955,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,1199-Commercial, +3956,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,1199-Commercial, +3957,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,1199-Commercial, +3958,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,1199-Commercial, +3959,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,1199-Commercial, +3960,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,1199-Commercial, +3961,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,1199-Commercial, +3962,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,1199-Commercial, +3963,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,1199-Commercial, +3964,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,1199-Commercial, +3965,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,1199-Commercial, +3966,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,1199-Commercial, +3967,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,1199-Commercial, +3968,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,1199-Commercial, +3969,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,1199-Commercial, +3970,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,1199-Commercial, +3971,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,1199-Commercial, +3972,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,1199-Commercial, +3973,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,1199-Commercial, +3974,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,1199-Commercial, +3975,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,1199-Commercial, +3976,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,1199-Commercial, +3977,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,1199-Commercial, +3978,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,1199-Commercial, +3979,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,1199-Commercial, +3980,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,1199-Commercial, +3981,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,1199-Commercial, +3982,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,1199-Commercial, +3983,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,1199-Commercial, +3984,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,1199-Commercial, +3985,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,1199-Commercial, +3986,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,1199-Commercial, +3987,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,1199-Commercial, +3988,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,1199-Commercial, +3989,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,1199-Commercial, +3990,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,1199-Commercial, +3991,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,1199-Commercial, +3992,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,1199-Commercial, +3993,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,1199-Commercial, +3994,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,1199-Commercial, +3995,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,1199-Commercial, +3996,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,1199-Commercial, +3997,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,1199-Commercial, +3998,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,1199-Commercial, +3999,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,1199-Commercial, +4000,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,1199-Commercial, +4001,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,1199-Commercial, +4002,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,1199-Commercial, +4003,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,1199-Commercial, +4004,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,1199-Commercial, +4005,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,1199-Commercial, +4006,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,1199-Commercial, +4007,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,1199-Commercial, +4008,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,1199-Commercial, +4009,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,1199-Commercial, +4010,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,1199-Commercial, +4011,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,1199-Commercial, +4012,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,1199-Commercial, +4013,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,1199-Commercial, +4014,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,1199-Commercial, +4015,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,1199-Commercial, +4016,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,1199-Commercial, +4017,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,1199-Commercial, +4018,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,1199-Commercial, +4019,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,1199-Commercial, +4020,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,1199-Commercial, +4021,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,1199-Commercial, +4022,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,1199-Commercial, +4023,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,1199-Commercial, +4024,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,1199-Commercial, +4025,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,1199-Commercial, +4026,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,1199-Commercial, +4027,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,1199-Commercial, +4028,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,1199-Commercial, +4029,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,1199-Commercial, +4030,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,1199-Commercial, +4031,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,1199-Commercial, +4032,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,1199-Commercial, +4033,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,1199-Commercial, +4034,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,1199-Commercial, +4035,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,1199-Commercial, +4036,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,1199-Commercial, +4037,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,1199-Commercial, +4038,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,1199-Commercial, +4039,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,1199-Commercial, +4040,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,1199-Commercial, +4041,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,1199-Commercial, +4042,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,1199-Commercial, +4043,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,1199-Commercial, +4044,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,1199-Commercial, +4045,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,1199-Commercial, +4046,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,1199-Commercial, +4047,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,1199-Commercial, +4048,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,1199-Commercial, +4049,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,1199-Commercial, +4050,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,1199-Commercial, +4051,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,1199-Commercial, +4052,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,1199-Commercial, +4053,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,1199-Commercial, +4054,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,1199-Commercial, +4055,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,1199-Commercial, +4056,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,1199-Commercial, +4057,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,1199-Commercial, +4058,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,1199-Commercial, +4059,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,1199-Commercial, +4060,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,1199-Commercial, +4061,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,1199-Commercial, +4062,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,1199-Commercial, +4063,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,1199-Commercial, +4064,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,1199-Commercial, +4065,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,1199-Commercial, +4066,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,1199-Commercial, +4067,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,1199-Commercial, +4068,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,1199-Commercial, +4069,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,1199-Commercial, +4070,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,1199-Commercial, +4071,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,1199-Commercial, +4072,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,1199-Commercial, +4073,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,1199-Commercial, +4074,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,1199-Commercial, +4075,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,1199-Commercial, +4076,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,1199-Commercial, +4077,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,1199-Commercial, +4078,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,1199-Commercial, +4079,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,1199-Commercial, +4080,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,1199-Commercial, +4081,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,1199-Commercial, +4082,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,1199-Commercial, +4083,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,1199-Commercial, +4084,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,1199-Commercial, +4085,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,1199-Commercial, +4086,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,1199-Commercial, +4087,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,1199-Commercial, +4088,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,1199-Commercial, +4089,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,1199-Commercial, +4090,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,1199-Commercial, +4091,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,1199-Commercial, +4092,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,1199-Commercial, +4093,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,1199-Commercial, +4094,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,1199-Commercial, +4095,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,1199-Commercial, +4096,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,1199-Commercial, +4097,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,1199-Commercial, +4098,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,1199-Commercial, +4099,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,1199-Commercial, +4100,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,1199-Commercial, +4101,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,1199-Commercial,489.11 +4102,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,1199-Commercial,878.69 +4103,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,1199-Commercial,1506.4 +4104,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,1199-Commercial,736.42 +4105,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,1199-Commercial,1163.78 +4106,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,1199-Commercial, +4107,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,1199-Commercial,2410.1 +4108,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,1199-Commercial, +4109,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,1199-Commercial, +4110,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,1199-Commercial, +4111,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,1199-Commercial, +4112,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,1199-Commercial,67.09 +4113,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,1199-Commercial, +4114,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,1199-Commercial, +4115,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,1199-Commercial, +4116,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,1199-Commercial, +4117,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,1199-Commercial, +4118,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,1199-Commercial,261.1 +4119,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,1199-Commercial,91.7 +4120,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,1199-Commercial, +4121,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,1199-Commercial, +4122,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,1199-Commercial, +4123,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,1199-Commercial, +4124,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,1199-Commercial,2632.0 +4125,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,1199-Commercial, +4126,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,1199-Commercial, +4127,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,1199-Commercial, +4128,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,1199-Commercial, +4129,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,1199-Commercial, +4130,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,1199-Commercial, +4131,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,1199-Commercial,112.7 +4132,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,1199-Commercial, +4133,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,1199-Commercial, +4134,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,1199-Commercial, +4135,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,1199-Commercial, +4136,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,1199-Commercial, +4137,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,1199-Commercial,297.85 +4138,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,1199-Commercial, +4139,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,1199-Commercial, +4140,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,1199-Commercial, +4141,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,1199-Commercial, +4142,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,1199-Commercial, +4143,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,1199-Commercial, +4144,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,1199-Commercial, +4145,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,1199-Commercial, +4146,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,1199-Commercial, +4147,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,1199-Commercial,498.62 +4148,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,1199-Commercial, +4149,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,1199-Commercial, +4150,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,1199-Commercial, +4151,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,1199-Commercial, +4152,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,1199-Commercial, +4153,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,1199-Commercial, +4154,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,1199-Commercial, +4155,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,1199-Commercial, +4156,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,1199-Commercial, +4157,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,1199-Commercial, +4158,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,1199-Commercial,572.0 +4159,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,1199-Commercial,2786.0 +4160,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,1199-Commercial,3867.0 +4161,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,1199-Commercial, +4162,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,1199-Commercial, +4163,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,1199-Commercial, +4164,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,1199-Commercial, +4165,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,1199-Commercial,725.0 +4166,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,1199-Commercial,270.97 +4167,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,1199-Commercial, +4168,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,1199-Commercial,2576.0 +4169,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,1199-Commercial,175.95 +4170,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,1199-Commercial,6722.0 +4171,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,1199-Commercial, +4172,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,1199-Commercial, +4173,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,1199-Commercial, +4174,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,1199-Commercial,1068.0 +4175,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,1199-Commercial,7363.52 +4176,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,1199-Commercial, +4177,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,1199-Commercial,240.5 +4178,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,1199-Commercial, +4179,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,1199-Commercial, +4180,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,1199-Commercial, +4181,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,1199-Commercial, +4182,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,1199-Commercial, +4183,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,1199-Commercial,2003.12 +4184,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,1199-Commercial, +4185,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,1199-Commercial, +4186,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,1199-Commercial, +4187,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,1199-Commercial, +4188,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,1199-Commercial, +4189,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,1199-Commercial, +4190,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,1199-Commercial, +4191,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,1199-Commercial, +4192,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,1199-Commercial, +4193,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,1199-Commercial, +4194,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,1199-Commercial, +4195,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,1199-Commercial, +4196,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,1199-Commercial, +4197,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,1199-Commercial, +4198,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,1199-Commercial, +4199,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,1199-Commercial,2660.88 +4200,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,1199-Commercial, +4201,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,1199-Commercial, +4202,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,1199-Commercial, +4203,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,1199-Commercial, +4204,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,1199-Commercial, +4205,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,1199-Commercial, +4206,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,1199-Commercial, +4207,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,1199-Commercial, +4208,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,1199-Commercial,50.0 +4209,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,1199-Commercial, +4210,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,1199-Commercial, +4211,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,1199-Commercial,280.0 +4212,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,1199-Commercial,21.5 +4213,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,1199-Commercial, +4214,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,1199-Commercial, +4215,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,1199-Commercial, +4216,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,1199-Commercial, +4217,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,1199-Commercial, +4218,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,1199-Commercial, +4219,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,1199-Commercial,144.68 +4220,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,1199-Commercial, +4221,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,1199-Commercial, +4222,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,1199-Commercial, +4223,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,1199-Commercial, +4224,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,1199-Commercial, +4225,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,1199-Commercial, +4226,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,1199-Commercial, +4227,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,1199-Commercial, +4228,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,1199-Commercial, +4229,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,1199-Commercial, +4230,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,1199-Commercial, +4231,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,1199-Commercial, +4232,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,1199-Commercial, +4233,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,1199-Commercial, +4234,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,1199-Commercial, +4235,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,1199-Commercial, +4236,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,1199-Commercial, +4237,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,1199-Commercial,23.59 +4238,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,1199-Commercial, +4239,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,1199-Commercial, +4240,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,1199-Commercial, +4241,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,1199-Commercial, +4242,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,1199-Commercial, +4243,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,1199-Commercial,219.24 +4244,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,1199-Commercial, +4245,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,1199-Commercial, +4246,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,1199-Commercial, +4247,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,1199-Commercial, +4248,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,1199-Commercial, +4249,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,1199-Commercial, +4250,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,1199-Commercial, +4251,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,1199-Commercial, +4252,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,1199-Commercial, +4253,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,1199-Commercial, +4254,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,1199-Commercial, +4255,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,1199-Commercial, +4256,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,1199-Commercial, +4257,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,1199-Commercial,64.91 +4258,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,1199-Commercial, +4259,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,1199-Commercial, +4260,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,1199-Commercial, +4261,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,1199-Commercial, +4262,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,1199-Commercial, +4263,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,1199-Commercial, +4264,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,1199-Commercial, +4265,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,1199-Commercial, +4266,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,1199-Commercial, +4267,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,1199-Commercial, +4268,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,1199-Commercial, +4269,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,1199-Commercial, +4270,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,1199-Commercial, +4271,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,1199-Commercial, +4272,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,1199-Commercial, +4273,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,1199-Commercial, +4274,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,1199-Commercial, +4275,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,1199-Commercial, +4276,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,1199-Commercial, +4277,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,1199-Commercial, +4278,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,1199-Commercial, +4279,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,1199-Commercial, +4280,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,1199-Commercial, +4281,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,1199-Commercial, +4282,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,1199-Commercial, +4283,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,1199-Commercial, +4284,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,1199-Commercial, +4285,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,1199-Commercial, +4286,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,1199-Commercial, +4287,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,1199-Commercial, +4288,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,1199-Commercial, +4289,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,1199-Commercial, +4290,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,1199-Commercial, +4291,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,1199-Commercial, +4292,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,1199-Commercial, +4293,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,1199-Commercial, +4294,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,1199-Commercial, +4295,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,1199-Commercial, +4296,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,1199-Commercial, +4297,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,1199-Commercial, +4298,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,1199-Commercial,189.37 +4299,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,1199-Commercial, +4300,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,1199-Commercial, +4301,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,1199-Commercial,95.68 +4302,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,1199-Commercial, +4303,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,1199-Commercial,73.72 +4304,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,1199-Commercial,91.27 +4305,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,1199-Commercial, +4306,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,1199-Commercial,5957.33 +4307,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,1199-Commercial, +4308,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,1199-Commercial, +4309,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,1199-Commercial, +4310,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,1199-Commercial, +4311,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,1199-Commercial, +4312,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,1199-Commercial,213.66 +4313,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,1199-Commercial, +4314,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,1199-Commercial, +4315,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,1199-Commercial, +4316,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,1199-Commercial, +4317,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,1199-Commercial, +4318,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,1199-Commercial, +4319,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,1199-Commercial, +4320,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,1199-Commercial, +4321,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,1199-Commercial,44.6 +4322,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,1199-Commercial, +4323,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,1199-Commercial, +4324,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,1199-Commercial,137.97 +4325,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,1199-Commercial, +4326,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,1199-Commercial, +4327,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,1199-Commercial, +4328,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,1199-Commercial, +4329,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,1199-Commercial, +4330,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,1199-Commercial, +4331,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,1199-Commercial, +4332,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,1199-Commercial, +4333,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,1199-Commercial, +4334,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,1199-Commercial, +4335,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,1199-Commercial, +4336,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,1199-Commercial, +4337,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,1199-Commercial, +4338,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,1199-Commercial, +4339,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,1199-Commercial, +4340,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,1199-Commercial, +4341,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,1199-Commercial, +4342,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,1199-Commercial, +4343,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,1199-Commercial,1280.16 +4344,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,1199-Commercial, +4345,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,1199-Commercial, +4346,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,1199-Commercial, +4347,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,1199-Commercial,92.67 +4348,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,1199-Commercial, +4349,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,1199-Commercial,313.27 +4350,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,1199-Commercial,14.41 +4351,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,1199-Commercial,63.4 +4352,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,1199-Commercial, +4353,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,1199-Commercial,37.1 +4354,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,1199-Commercial, +4355,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,1199-Commercial, +4356,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,1199-Commercial, +4357,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,1199-Commercial, +4358,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,1199-Commercial, +4359,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,1199-Commercial, +4360,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,1199-Commercial, +4361,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,1199-Commercial,268.58 +4362,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,1199-Commercial, +4363,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,1199-Commercial,2353.58 +4364,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,1199-Commercial, +4365,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,1199-Commercial, +4366,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,1199-Commercial, +4367,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,1199-Commercial, +4368,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,1199-Commercial, +4369,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,1199-Commercial,5178.88 +4370,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,1199-Commercial, +4371,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,1199-Commercial, +4372,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,1199-Commercial, +4373,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,1199-Commercial,3.39 +4374,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,1199-Commercial, +4375,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,1199-Commercial, +4376,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,1199-Commercial, +4377,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,1199-Commercial,7.25 +4378,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,1199-Commercial,3.22 +4379,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,1199-Commercial, +4380,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,1199-Commercial, +4381,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,1199-Commercial,55792.28 +4382,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,1199-Commercial,158433.19 +4383,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,1199-Commercial, +4384,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,1199-Commercial, +4385,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,1199-Commercial, +4386,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,1199-Commercial,2065.36 +4387,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,1199-Commercial,756.7 +4388,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,1199-Commercial, +4389,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,1199-Commercial, +4390,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,1199-Commercial, +4391,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,1199-Commercial,12843.6 +4392,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,1199-Commercial, +4393,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,1199-Commercial, +4394,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,1199-Commercial, +4395,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,1199-Commercial, +4396,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,1199-Commercial, +4397,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,1199-Commercial,216.22 +4398,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,1199-Commercial,14.81 +4399,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,1199-Commercial, +4400,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,1199-Commercial,1.14 +4401,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,1199-Commercial,12.56 +4402,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,1199-Commercial,119.52 +4403,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,1199-Commercial, +4404,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,1199-Commercial,21.0 +4405,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,1199-Commercial, +4406,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,1199-Commercial, +4407,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,1199-Commercial,4720.79 +4408,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,1199-Commercial,140.0 +4409,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,1199-Commercial, +4410,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,1199-Commercial,71.43 +4411,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,1199-Commercial,24.73 +4412,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,1199-Commercial, +4413,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,1199-Commercial,3.0 +4414,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,1199-Commercial, +4415,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,1199-Commercial, +4416,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,1199-Commercial, +4417,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,1199-Commercial, +4418,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,1199-Commercial, +4419,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,1199-Commercial,3.99 +4420,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,1199-Commercial, +4421,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,1199-Commercial, +4422,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,1199-Commercial, +4423,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,1199-Commercial, +4424,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,1199-Commercial, +4425,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,1199-Commercial, +4426,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,1199-Commercial,1.84 +4427,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,1199-Commercial, +4428,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,1199-Commercial,14.22 +4429,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,1199-Commercial,6.98 +4430,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,1199-Commercial, +4431,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,1199-Commercial, +4432,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,1199-Commercial, +4433,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,1199-Commercial, +4434,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,1199-Commercial,12795.76 +4435,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,1199-Commercial, +4436,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,1199-Commercial, +4437,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,1199-Commercial, +4438,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,1199-Commercial, +4439,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,1199-Commercial,3.35 +4440,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,1199-Commercial,660.34 +4441,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,1199-Commercial,15016.56 +4442,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,1199-Commercial, +4443,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,1199-Commercial,65.79 +4444,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,1199-Commercial,4.53 +4445,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,1199-Commercial, +4446,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,1199-Commercial, +4447,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,1199-Commercial, +4448,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,1199-Commercial, +4449,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,1199-Commercial, +4450,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,1199-Commercial, +4451,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,1199-Commercial,136.2 +4452,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,1199-Commercial,14.74 +4453,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,1199-Commercial,2.75 +4454,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,1199-Commercial, +4455,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,1199-Commercial,518.7 +4456,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,1199-Commercial, +4457,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,1199-Commercial, +4458,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,1199-Commercial, +4459,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,1199-Commercial,11020.5 +4460,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,1199-Commercial, +4461,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,1199-Commercial, +4462,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,1199-Commercial, +4463,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,1199-Commercial,21.14 +4464,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,1199-Commercial,349.98 +4465,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,1199-Commercial,3.18 +4466,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,1199-Commercial, +4467,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,1199-Commercial, +4468,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,1199-Commercial, +4469,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,1199-Commercial,3064.6 +4470,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,1199-Commercial, +4471,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,1199-Commercial, +4472,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,1199-Commercial, +4473,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,1199-Commercial, +4474,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,1199-Commercial,39.64 +4475,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,1199-Commercial,10044.63 +4476,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,1199-Commercial, +4477,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,1199-Commercial,13.06 +4478,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,1199-Commercial,18.12 +4479,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,1199-Commercial, +4480,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,1199-Commercial, +4481,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,1199-Commercial,42.44 +4482,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,1199-Commercial,16.0 +4483,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,1199-Commercial, +4484,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,1199-Commercial, +4485,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,1199-Commercial, +4486,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,1199-Commercial,16.79 +4487,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,1199-Commercial,4.48 +4488,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,1199-Commercial,5.28 +4489,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,1199-Commercial,5.24 +4490,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,1199-Commercial,15.85 +4491,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,1199-Commercial,10.2 +4492,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,1199-Commercial,7.0 +4493,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,1199-Commercial, +4494,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,1199-Commercial, +4495,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,1199-Commercial, +4496,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,1199-Commercial, +4497,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,1199-Commercial, +4498,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,1199-Commercial, +4499,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,1199-Commercial, +4500,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,1199-Commercial, +4501,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,1199-Commercial, +4502,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,1199-Commercial, +4503,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,1199-Commercial, +4504,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,1199-Commercial, +4505,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,1199-Commercial, +4506,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,1199-Commercial,1.6 +4507,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,1199-Commercial, +4508,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,1199-Commercial, +4509,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,1199-Commercial, +4510,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,1199-Commercial, +4511,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,1199-Commercial,3.16 +4512,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,1199-Commercial,6.05 +4513,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,1199-Commercial,8.16 +4514,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,1199-Commercial, +4515,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,1199-Commercial, +4516,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,1199-Commercial, +4517,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,1199-Commercial, +4518,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,1199-Commercial,2.36 +4519,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,1199-Commercial,1.2 +4520,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,1199-Commercial, +4521,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,1199-Commercial, +4522,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,1199-Commercial, +4523,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,1199-Commercial, +4524,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,1199-Commercial, +4525,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,1199-Commercial, +4526,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,1199-Commercial, +4527,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,1199-Commercial, +4528,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,1199-Commercial, +4529,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,1199-Commercial,2748.11 +4530,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,1199-Commercial, +4531,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,1199-Commercial, +4532,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,1199-Commercial, +4533,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,1199-Commercial, +4534,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,1199-Commercial, +4535,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,1199-Commercial, +4536,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,1199-Commercial, +4537,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,1199-Commercial, +4538,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,1199-Commercial,26.08 +4539,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,1199-Commercial, +4540,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,1199-Commercial, +4541,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,1199-Commercial, +4542,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,1199-Commercial, +4543,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,1199-Commercial, +4544,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,1199-Commercial, +4545,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,1199-Commercial, +4546,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,1199-Commercial, +4547,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,1199-Commercial, +4548,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,1199-Commercial, +4549,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,1199-Commercial, +4550,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,1199-Commercial, +4551,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,1199-Commercial, +4552,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,1199-Commercial,26.87 +4553,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,1199-Commercial, +4554,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,1199-Commercial,900.73 +4555,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,1199-Commercial, +4556,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,1199-Commercial,130.77 +4557,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,1199-Commercial, +4558,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,1199-Commercial, +4559,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,1199-Commercial, +4560,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,1199-Commercial, +4561,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,1199-Commercial, +4562,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,1199-Commercial, +4563,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,1199-Commercial, +4564,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,1199-Commercial, +4565,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,1199-Commercial,493.92 +4566,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,1199-Commercial, +4567,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,1199-Commercial, +4568,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,1199-Commercial, +4569,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,1199-Commercial,21763.17 +4570,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,1199-Commercial, +4571,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,1199-Commercial, +4572,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,1199-Commercial, +4573,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,1199-Commercial, +4574,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,1199-Commercial, +4575,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,1199-Commercial, +4576,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,1199-Commercial, +4577,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,1199-Commercial, +4578,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,1199-Commercial, +4579,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,1199-Commercial,8459.89 +4580,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,1199-Commercial, +4581,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,1199-Commercial, +4582,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,1199-Commercial, +4583,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,1199-Commercial, +4584,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,1199-Commercial, +4585,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,1199-Commercial, +4586,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,1199-Commercial, +4587,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,1199-Commercial, +4588,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,1199-Commercial, +4589,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,1199-Commercial,2329.1 +4590,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,1199-Commercial, +4591,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,1199-Commercial, +4592,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,1199-Commercial, +4593,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,1199-Commercial, +4594,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,1199-Commercial, +4595,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,1199-Commercial,229.12 +4596,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,1199-Commercial, +4597,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,1199-Commercial, +4598,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,1199-Commercial, +4599,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,1199-Commercial,35.41 +4600,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,1199-Commercial, +4601,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,1199-Commercial, +4602,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,1199-Commercial,1271.67 +4603,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,1199-Commercial, +4604,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,1199-Commercial, +4605,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,1199-Commercial, +4606,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,1199-Commercial, +4607,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,1199-Commercial, +4608,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,1199-Commercial, +4609,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,1199-Commercial, +4610,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,1199-Commercial, +4611,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,1199-Commercial, +4612,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,1199-Commercial, +4613,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,1199-Commercial, +4614,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,1199-Commercial, +4615,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,1199-Commercial, +4616,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,1199-Commercial, +4617,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,1199-Commercial,3222.8 +4618,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,1199-Commercial, +4619,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,1199-Commercial, +4620,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,1199-Commercial, +4621,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,1199-Commercial,4718.32 +4622,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,1199-Commercial, +4623,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,1199-Commercial, +4624,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,1199-Commercial,1537.12 +4625,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,1199-Commercial, +4626,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,1199-Commercial, +4627,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,1199-Commercial, +4628,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,1199-Commercial, +4629,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,1199-Commercial, +4630,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,1199-Commercial, +4631,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,1199-Commercial,0.69 +4632,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,1199-Commercial, +4633,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,1199-Commercial,243.23 +4634,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,1199-Commercial, +4635,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,1199-Commercial, +4636,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,1199-Commercial, +4637,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,1199-Commercial, +4638,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,1199-Commercial, +4639,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,1199-Commercial, +4640,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,1199-Commercial, +4641,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,1199-Commercial, +4642,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,1199-Commercial, +4643,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,1199-Commercial, +4644,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,1199-Commercial, +4645,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,1199-Commercial, +4646,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,1199-Commercial, +4647,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,1199-Commercial, +4648,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,1199-Commercial, +4649,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,1199-Commercial, +4650,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,1199-Commercial, +4651,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,1199-Commercial, +4652,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,1199-Commercial, +4653,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,1199-Commercial, +4654,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,1199-Commercial, +4655,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,1199-Commercial, +4656,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,1199-Commercial, +4657,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,1199-Commercial, +4658,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,1199-Commercial,250.07 +4659,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,1199-Commercial, +4660,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,1199-Commercial, +4661,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,1199-Commercial,188.28 +4662,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,1199-Commercial, +4663,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,1199-Commercial,79.06 +4664,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,1199-Commercial, +4665,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,1199-Commercial,85.53 +4666,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,1199-Commercial,2272.0 +4667,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,1199-Commercial,2070.89 +4668,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,1199-Commercial,49.88 +4669,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,1199-Commercial,171.02 +4670,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,1199-Commercial,35.54 +4671,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,1199-Commercial,105.0 +4672,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,1199-Commercial,35.0 +4673,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,1199-Commercial, +4674,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,1199-Commercial,145.88 +4675,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,1199-Commercial, +4676,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,1199-Commercial, +4677,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,1199-Commercial, +4678,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,1199-Commercial, +4679,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,1199-Commercial, +4680,3934,30000012,PRIVATE,,8380.0,8380.0,,,1199-Commercial, +4681,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,1199-Commercial, +4682,3934,30000038,ICU,,12700.0,12700.0,,,1199-Commercial, +4683,3934,30000046,BURN UNIT,,12700.0,12700.0,,,1199-Commercial, +4684,3934,30000053,NICU,,12700.0,12700.0,,,1199-Commercial, +4685,3934,30000061,ICR ROOM,,7630.0,7630.0,,,1199-Commercial, +4686,3934,30000079,PSYCH,,7630.0,7630.0,,,1199-Commercial, +4687,3934,30000087,NEWBORN,,4140.0,4140.0,,,1199-Commercial, +4688,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,1199-Commercial, +4689,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,1199-Commercial, +4690,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,1199-Commercial, +4691,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4692,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,1199-Commercial, +4693,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,1199-Commercial, +4694,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4695,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,1199-Commercial, +4696,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,1199-Commercial, +4697,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,1199-Commercial, +4698,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,1199-Commercial, +4699,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,1199-Commercial, +4700,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,1199-Commercial, +4701,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,1199-Commercial, +4702,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,1199-Commercial, +4703,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,1199-Commercial, +4704,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,1199-Commercial, +4705,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,1199-Commercial, +4706,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,1199-Commercial, +4707,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,1199-Commercial, +4708,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4709,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,1199-Commercial, +4710,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,1199-Commercial, +4711,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,1199-Commercial, +4712,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,1199-Commercial, +4713,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4714,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,1199-Commercial, +4715,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,1199-Commercial, +4716,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,1199-Commercial, +4717,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,1199-Commercial, +4718,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,1199-Commercial, +4719,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4720,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,1199-Commercial, +4721,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,1199-Commercial, +4722,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,1199-Commercial, +4723,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,1199-Commercial, +4724,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4725,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,1199-Commercial, +4726,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,1199-Commercial, +4727,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4728,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,1199-Commercial, +4729,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,1199-Commercial, +4730,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,1199-Commercial, +4731,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,1199-Commercial, +4732,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,1199-Commercial, +4733,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,1199-Commercial, +4734,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,1199-Commercial, +4735,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,1199-Commercial, +4736,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4737,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,1199-Commercial, +4738,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,1199-Commercial, +4739,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,1199-Commercial, +4740,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,1199-Commercial, +4741,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,1199-Commercial, +4742,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4743,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,1199-Commercial, +4744,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,1199-Commercial, +4745,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,1199-Commercial, +4746,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,1199-Commercial, +4747,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,1199-Commercial, +4748,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,1199-Commercial, +4749,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,1199-Commercial, +4750,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,1199-Commercial, +4751,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,1199-Commercial, +4752,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4753,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,1199-Commercial, +4754,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,1199-Commercial, +4755,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,1199-Commercial, +4756,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,1199-Commercial, +4757,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,1199-Commercial, +4758,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,1199-Commercial, +4759,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,1199-Commercial, +4760,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4761,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,1199-Commercial, +4762,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,1199-Commercial, +4763,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4764,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,1199-Commercial, +4765,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,1199-Commercial, +4766,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,1199-Commercial, +4767,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,1199-Commercial, +4768,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,1199-Commercial, +4769,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,1199-Commercial, +4770,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,1199-Commercial, +4771,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,1199-Commercial, +4772,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4773,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,1199-Commercial, +4774,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,1199-Commercial, +4775,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,1199-Commercial, +4776,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,1199-Commercial, +4777,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,1199-Commercial, +4778,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4779,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,1199-Commercial, +4780,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,1199-Commercial, +4781,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,1199-Commercial, +4782,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,1199-Commercial, +4783,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,1199-Commercial, +4784,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4785,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,1199-Commercial, +4786,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,1199-Commercial, +4787,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,1199-Commercial, +4788,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,1199-Commercial, +4789,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,1199-Commercial, +4790,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4791,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,1199-Commercial, +4792,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,1199-Commercial, +4793,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,1199-Commercial, +4794,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,1199-Commercial, +4795,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,1199-Commercial, +4796,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,1199-Commercial, +4797,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,1199-Commercial, +4798,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4799,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,1199-Commercial, +4800,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,1199-Commercial, +4801,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,1199-Commercial, +4802,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,1199-Commercial, +4803,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,1199-Commercial, +4804,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,1199-Commercial, +4805,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,1199-Commercial, +4806,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,1199-Commercial, +4807,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,1199-Commercial, +4808,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,1199-Commercial, +4809,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4810,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,1199-Commercial, +4811,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,1199-Commercial, +4812,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,1199-Commercial, +4813,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,1199-Commercial, +4814,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4815,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,1199-Commercial, +4816,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,1199-Commercial, +4817,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4818,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,1199-Commercial, +4819,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,1199-Commercial, +4820,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,1199-Commercial, +4821,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,1199-Commercial, +4822,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,1199-Commercial, +4823,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4824,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,1199-Commercial, +4825,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,1199-Commercial, +4826,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4827,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,1199-Commercial, +4828,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,1199-Commercial, +4829,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,1199-Commercial, +4830,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,1199-Commercial, +4831,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,1199-Commercial, +4832,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,1199-Commercial, +4833,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,1199-Commercial, +4834,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,1199-Commercial, +4835,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,1199-Commercial, +4836,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,1199-Commercial, +4837,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4838,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,1199-Commercial, +4839,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,1199-Commercial, +4840,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,1199-Commercial, +4841,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,1199-Commercial, +4842,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,1199-Commercial, +4843,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,1199-Commercial, +4844,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,1199-Commercial, +4845,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4846,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4847,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,1199-Commercial, +4848,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,1199-Commercial, +4849,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,1199-Commercial, +4850,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4851,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,1199-Commercial, +4852,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,1199-Commercial, +4853,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4854,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,1199-Commercial, +4855,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,1199-Commercial, +4856,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,1199-Commercial, +4857,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,1199-Commercial, +4858,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,1199-Commercial, +4859,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,1199-Commercial, +4860,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,1199-Commercial, +4861,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,1199-Commercial, +4862,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4863,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,1199-Commercial, +4864,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,1199-Commercial, +4865,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,1199-Commercial, +4866,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,1199-Commercial, +4867,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,1199-Commercial, +4868,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4869,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,1199-Commercial, +4870,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,1199-Commercial, +4871,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,1199-Commercial, +4872,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,1199-Commercial, +4873,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,1199-Commercial, +4874,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4875,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,1199-Commercial, +4876,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,1199-Commercial, +4877,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,1199-Commercial, +4878,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,1199-Commercial, +4879,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,1199-Commercial, +4880,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4881,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,1199-Commercial, +4882,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,1199-Commercial, +4883,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,1199-Commercial, +4884,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,1199-Commercial, +4885,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,1199-Commercial, +4886,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4887,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,1199-Commercial, +4888,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,1199-Commercial, +4889,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,1199-Commercial, +4890,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,1199-Commercial, +4891,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,1199-Commercial, +4892,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4893,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,1199-Commercial, +4894,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,1199-Commercial, +4895,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,1199-Commercial, +4896,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,1199-Commercial, +4897,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,1199-Commercial, +4898,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,1199-Commercial, +4899,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4900,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,1199-Commercial, +4901,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,1199-Commercial, +4902,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,1199-Commercial, +4903,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,1199-Commercial, +4904,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,1199-Commercial, +4905,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4906,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,1199-Commercial, +4907,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,1199-Commercial, +4908,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,1199-Commercial, +4909,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,1199-Commercial, +4910,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,1199-Commercial, +4911,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4912,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,1199-Commercial, +4913,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,1199-Commercial, +4914,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,1199-Commercial, +4915,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4916,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4917,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4918,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4919,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4920,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4921,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4922,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4923,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4924,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4925,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4926,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4927,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4928,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4929,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4930,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4931,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4932,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4933,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4934,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,1199-Commercial, +4935,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,1199-Commercial, +4936,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4937,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,1199-Commercial, +4938,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4939,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4940,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4941,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4942,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4943,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4944,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4945,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4946,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4947,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4948,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4949,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4950,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,1199-Commercial, +4951,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,1199-Commercial, +4952,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4953,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4954,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,1199-Commercial, +4955,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4956,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +4957,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4958,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4959,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4960,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4961,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,1199-Commercial, +4962,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,1199-Commercial, +4963,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4964,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4965,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,1199-Commercial, +4966,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,1199-Commercial, +4967,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,1199-Commercial, +4968,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,1199-Commercial, +4969,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,1199-Commercial, +4970,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,1199-Commercial, +4971,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,1199-Commercial, +4972,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,1199-Commercial, +4973,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,1199-Commercial, +4974,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,1199-Commercial, +4975,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4976,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,1199-Commercial, +4977,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,1199-Commercial, +4978,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,1199-Commercial, +4979,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,1199-Commercial, +4980,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +4981,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,1199-Commercial, +4982,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,1199-Commercial, +4983,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,1199-Commercial, +4984,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,1199-Commercial, +4985,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4986,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,1199-Commercial, +4987,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,1199-Commercial, +4988,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,1199-Commercial, +4989,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,1199-Commercial, +4990,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,1199-Commercial, +4991,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,1199-Commercial, +4992,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,1199-Commercial, +4993,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,1199-Commercial, +4994,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,1199-Commercial, +4995,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,1199-Commercial, +4996,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,1199-Commercial, +4997,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,1199-Commercial, +4998,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,1199-Commercial, +4999,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,1199-Commercial, +5000,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,1199-Commercial, +5001,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5002,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,1199-Commercial, +5003,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,1199-Commercial, +5004,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,1199-Commercial, +5005,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,1199-Commercial, +5006,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,1199-Commercial, +5007,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5008,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,1199-Commercial, +5009,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,1199-Commercial, +5010,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5011,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,1199-Commercial, +5012,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5013,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,1199-Commercial, +5014,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,1199-Commercial, +5015,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5016,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +5017,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,1199-Commercial, +5018,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,1199-Commercial, +5019,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,1199-Commercial, +5020,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,1199-Commercial, +5021,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,1199-Commercial, +5022,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5023,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,1199-Commercial, +5024,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,1199-Commercial, +5025,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,1199-Commercial, +5026,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,1199-Commercial, +5027,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,1199-Commercial, +5028,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,1199-Commercial, +5029,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,1199-Commercial, +5030,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,1199-Commercial, +5031,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,1199-Commercial, +5032,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,1199-Commercial, +5033,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5034,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,1199-Commercial, +5035,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,1199-Commercial, +5036,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,1199-Commercial, +5037,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,1199-Commercial, +5038,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,1199-Commercial, +5039,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,1199-Commercial, +5040,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,1199-Commercial, +5041,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,1199-Commercial, +5042,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,1199-Commercial, +5043,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,1199-Commercial, +5044,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,1199-Commercial, +5045,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,1199-Commercial, +5046,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,1199-Commercial, +5047,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,1199-Commercial, +5048,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,1199-Commercial, +5049,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,1199-Commercial, +5050,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,1199-Commercial, +5051,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5052,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,1199-Commercial, +5053,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,1199-Commercial, +5054,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,1199-Commercial, +5055,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,1199-Commercial, +5056,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,1199-Commercial, +5057,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,1199-Commercial, +5058,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,1199-Commercial, +5059,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,1199-Commercial, +5060,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,1199-Commercial, +5061,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,1199-Commercial, +5062,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,1199-Commercial, +5063,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,1199-Commercial, +5064,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,1199-Commercial, +5065,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5066,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,1199-Commercial, +5067,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,1199-Commercial, +5068,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,1199-Commercial, +5069,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,1199-Commercial, +5070,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,1199-Commercial, +5071,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,1199-Commercial, +5072,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,1199-Commercial, +5073,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,1199-Commercial, +5074,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5075,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,1199-Commercial, +5076,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,1199-Commercial, +5077,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,1199-Commercial, +5078,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,1199-Commercial, +5079,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,1199-Commercial, +5080,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,1199-Commercial, +5081,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,1199-Commercial, +5082,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,1199-Commercial, +5083,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,1199-Commercial, +5084,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5085,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,1199-Commercial, +5086,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,1199-Commercial, +5087,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,1199-Commercial, +5088,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,1199-Commercial, +5089,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,1199-Commercial, +5090,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,1199-Commercial, +5091,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,1199-Commercial, +5092,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,1199-Commercial, +5093,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5094,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,1199-Commercial, +5095,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,1199-Commercial, +5096,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,1199-Commercial, +5097,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,1199-Commercial, +5098,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,1199-Commercial, +5099,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,1199-Commercial, +5100,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,1199-Commercial, +5101,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5102,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,1199-Commercial, +5103,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,1199-Commercial, +5104,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,1199-Commercial, +5105,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,1199-Commercial, +5106,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,1199-Commercial, +5107,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,1199-Commercial, +5108,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5109,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,1199-Commercial, +5110,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,1199-Commercial, +5111,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,1199-Commercial, +5112,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,1199-Commercial, +5113,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,1199-Commercial, +5114,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5115,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,1199-Commercial, +5116,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,1199-Commercial, +5117,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,1199-Commercial, +5118,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,1199-Commercial, +5119,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5120,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,1199-Commercial, +5121,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,1199-Commercial, +5122,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,1199-Commercial, +5123,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,1199-Commercial, +5124,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,1199-Commercial, +5125,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,1199-Commercial, +5126,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,1199-Commercial, +5127,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,1199-Commercial, +5128,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,1199-Commercial, +5129,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,1199-Commercial, +5130,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,1199-Commercial, +5131,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,1199-Commercial, +5132,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,1199-Commercial, +5133,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,1199-Commercial, +5134,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,1199-Commercial, +5135,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,1199-Commercial, +5136,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,1199-Commercial, +5137,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,1199-Commercial, +5138,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,1199-Commercial, +5139,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,1199-Commercial, +5140,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,1199-Commercial, +5141,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,1199-Commercial, +5142,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,1199-Commercial, +5143,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,1199-Commercial, +5144,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,1199-Commercial, +5145,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,1199-Commercial, +5146,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,1199-Commercial, +5147,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,1199-Commercial, +5148,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,1199-Commercial, +5149,3934,37112000,ACUTE ED,,1580.0,1580.0,,,1199-Commercial, +5150,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,1199-Commercial, +5151,3934,37112034,TRIAGE,,277.0,277.0,,,1199-Commercial, +5152,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,1199-Commercial, +5153,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,1199-Commercial, +5154,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,1199-Commercial, +5155,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,1199-Commercial, +5156,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,1199-Commercial, +5157,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,1199-Commercial, +5158,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,1199-Commercial, +5159,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,1199-Commercial, +5160,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,1199-Commercial, +5161,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,1199-Commercial, +5162,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,1199-Commercial, +5163,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,1199-Commercial, +5164,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,1199-Commercial, +5165,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,1199-Commercial, +5166,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,1199-Commercial, +5167,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,1199-Commercial, +5168,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,1199-Commercial, +5169,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,1199-Commercial, +5170,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,1199-Commercial, +5171,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,1199-Commercial, +5172,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,1199-Commercial, +5173,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,1199-Commercial, +5174,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,1199-Commercial, +5175,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,1199-Commercial, +5176,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,1199-Commercial, +5177,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,1199-Commercial, +5178,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,1199-Commercial, +5179,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,1199-Commercial, +5180,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,1199-Commercial, +5181,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,1199-Commercial, +5182,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,1199-Commercial, +5183,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,1199-Commercial, +5184,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,1199-Commercial, +5185,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,1199-Commercial, +5186,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,1199-Commercial, +5187,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,1199-Commercial, +5188,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,1199-Commercial, +5189,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,1199-Commercial, +5190,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,1199-Commercial, +5191,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,1199-Commercial, +5192,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,1199-Commercial, +5193,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,1199-Commercial, +5194,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,1199-Commercial, +5195,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,1199-Commercial, +5196,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,1199-Commercial, +5197,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,1199-Commercial, +5198,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,1199-Commercial, +5199,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,1199-Commercial, +5200,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,1199-Commercial, +5201,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,1199-Commercial, +5202,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,1199-Commercial, +5203,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,1199-Commercial, +5204,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,1199-Commercial, +5205,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,1199-Commercial, +5206,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,1199-Commercial, +5207,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,1199-Commercial, +5208,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,1199-Commercial, +5209,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,1199-Commercial, +5210,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,1199-Commercial, +5211,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,1199-Commercial, +5212,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,1199-Commercial, +5213,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,1199-Commercial, +5214,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,1199-Commercial, +5215,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,1199-Commercial, +5216,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,1199-Commercial, +5217,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,1199-Commercial, +5218,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,1199-Commercial, +5219,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,1199-Commercial, +5220,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,1199-Commercial, +5221,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,1199-Commercial, +5222,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,1199-Commercial, +5223,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,1199-Commercial, +5224,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,1199-Commercial, +5225,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,1199-Commercial, +5226,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,1199-Commercial, +5227,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,1199-Commercial, +5228,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,1199-Commercial, +5229,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,1199-Commercial, +5230,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,1199-Commercial, +5231,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,1199-Commercial, +5232,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,1199-Commercial, +5233,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,1199-Commercial, +5234,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,1199-Commercial, +5235,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,1199-Commercial, +5236,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,1199-Commercial, +5237,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,1199-Commercial, +5238,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,1199-Commercial, +5239,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,1199-Commercial, +5240,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,1199-Commercial, +5241,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,1199-Commercial, +5242,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,1199-Commercial, +5243,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,1199-Commercial, +5244,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,1199-Commercial, +5245,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,1199-Commercial, +5246,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,1199-Commercial, +5247,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,1199-Commercial, +5248,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,1199-Commercial, +5249,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,1199-Commercial, +5250,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,1199-Commercial, +5251,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,1199-Commercial, +5252,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5253,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5254,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5255,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5256,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5257,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,1199-Commercial, +5258,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,1199-Commercial, +5259,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,1199-Commercial, +5260,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5261,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5262,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5263,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,1199-Commercial, +5264,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,1199-Commercial, +5265,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,1199-Commercial, +5266,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,1199-Commercial, +5267,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,1199-Commercial, +5268,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,1199-Commercial, +5269,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,1199-Commercial, +5270,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,1199-Commercial, +5271,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,1199-Commercial, +5272,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,1199-Commercial, +5273,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,1199-Commercial, +5274,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,1199-Commercial, +5275,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,1199-Commercial, +5276,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,1199-Commercial, +5277,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,1199-Commercial, +5278,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,1199-Commercial, +5279,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,1199-Commercial, +5280,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,1199-Commercial, +5281,3934,43301043,ALBUNEX,,357.0,357.0,,,1199-Commercial, +5282,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,1199-Commercial, +5283,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5284,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5285,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5286,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5287,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5288,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,1199-Commercial, +5289,3934,43450022,REC RM .5HR,,541.0,541.0,,,1199-Commercial, +5290,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,1199-Commercial, +5291,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,1199-Commercial, +5292,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,1199-Commercial, +5293,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,1199-Commercial, +5294,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,1199-Commercial, +5295,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,1199-Commercial, +5296,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,1199-Commercial, +5297,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,1199-Commercial, +5298,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,1199-Commercial, +5299,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,1199-Commercial, +5300,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,1199-Commercial, +5301,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,1199-Commercial, +5302,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,1199-Commercial, +5303,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,1199-Commercial, +5304,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,1199-Commercial, +5305,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,1199-Commercial, +5306,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,1199-Commercial, +5307,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5308,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5309,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5310,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5311,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5312,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,1199-Commercial, +5313,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5314,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,1199-Commercial, +5315,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5316,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5317,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5318,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5319,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,1199-Commercial, +5320,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,1199-Commercial, +5321,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5322,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5323,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5324,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5325,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5326,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,1199-Commercial, +5327,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5328,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5329,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5330,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5331,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5332,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,1199-Commercial, +5333,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,1199-Commercial, +5334,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,1199-Commercial, +5335,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,1199-Commercial, +5336,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,1199-Commercial, +5337,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,1199-Commercial, +5338,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,1199-Commercial, +5339,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,1199-Commercial, +5340,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,1199-Commercial, +5341,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5342,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5343,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5344,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5345,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5346,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,1199-Commercial, +5347,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,1199-Commercial, +5348,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,1199-Commercial, +5349,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,1199-Commercial, +5350,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,1199-Commercial, +5351,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,1199-Commercial, +5352,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,1199-Commercial, +5353,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,1199-Commercial, +5354,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,1199-Commercial, +5355,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,1199-Commercial, +5356,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,1199-Commercial, +5357,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,1199-Commercial, +5358,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,1199-Commercial, +5359,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,1199-Commercial, +5360,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,1199-Commercial, +5361,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,1199-Commercial, +5362,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,1199-Commercial, +5363,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,1199-Commercial, +5364,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,1199-Commercial, +5365,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,1199-Commercial, +5366,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,1199-Commercial, +5367,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,1199-Commercial, +5368,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,1199-Commercial, +5369,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,1199-Commercial, +5370,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,1199-Commercial, +5371,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,1199-Commercial, +5372,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,1199-Commercial, +5373,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,1199-Commercial, +5374,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,1199-Commercial, +5375,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,1199-Commercial, +5376,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,1199-Commercial, +5377,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,1199-Commercial, +5378,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,1199-Commercial, +5379,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,1199-Commercial, +5380,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,1199-Commercial, +5381,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,1199-Commercial, +5382,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,1199-Commercial, +5383,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,1199-Commercial, +5384,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,1199-Commercial, +5385,3934,45924552,ENDO REC RM,,30.0,30.0,,,1199-Commercial, +5386,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,1199-Commercial, +5387,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,1199-Commercial, +5388,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,1199-Commercial, +5389,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,1199-Commercial, +5390,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,1199-Commercial, +5391,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,1199-Commercial, +5392,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,1199-Commercial, +5393,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,1199-Commercial, +5394,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,1199-Commercial, +5395,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,1199-Commercial, +5396,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,1199-Commercial, +5397,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,1199-Commercial, +5398,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,1199-Commercial, +5399,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,1199-Commercial, +5400,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,1199-Commercial, +5401,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,1199-Commercial, +5402,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,1199-Commercial, +5403,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,1199-Commercial, +5404,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,1199-Commercial, +5405,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,1199-Commercial, +5406,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,1199-Commercial, +5407,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,1199-Commercial, +5408,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,1199-Commercial, +5409,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,1199-Commercial, +5410,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,1199-Commercial, +5411,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,1199-Commercial, +5412,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,1199-Commercial, +5413,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,1199-Commercial, +5414,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,1199-Commercial, +5415,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,1199-Commercial, +5416,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,1199-Commercial, +5417,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,1199-Commercial, +5418,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,1199-Commercial, +5419,3934,53200010,GUEST TRAY,,24.0,24.0,,,1199-Commercial, +5420,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,1199-Commercial, +5421,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,1199-Commercial, +5422,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,1199-Commercial, +5423,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,1199-Commercial, +5424,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,1199-Commercial, +5425,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,1199-Commercial, +5426,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,1199-Commercial, +5427,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,1199-Commercial, +5428,3934,53329876,HIV MONITORING,,416.0,416.0,,,1199-Commercial, +5429,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,1199-Commercial, +5430,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,1199-Commercial, +5431,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,1199-Commercial, +5432,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,1199-Commercial, +5433,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,1199-Commercial, +5434,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,1199-Commercial, +5435,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,1199-Commercial, +5436,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,1199-Commercial, +5437,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,1199-Commercial, +5438,3934,76010107,COPY X-RAY,,22.0,22.0,,,1199-Commercial, +5439,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,1199-Commercial, +5440,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,1199-Commercial, +5441,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,1199-Commercial, +5442,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,1199-Commercial, +5443,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,1199-Commercial, +5444,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,1199-Commercial, +5445,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,1199-Commercial, +5446,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,1199-Commercial, +5447,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,1199-Commercial, +5448,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,1199-Commercial, +5449,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,1199-Commercial, +5450,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,1199-Commercial, +5451,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,Aetna-Commercial,237069.0 +5452,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,Aetna-Commercial, +5453,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,Aetna-Commercial,153038.5 +5454,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,Aetna-Commercial,90000.0 +5455,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,Aetna-Commercial, +5456,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,Aetna-Commercial, +5457,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,Aetna-Commercial, +5458,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,Aetna-Commercial,3827.9 +5459,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,Aetna-Commercial, +5460,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,Aetna-Commercial,86896.38 +5461,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,Aetna-Commercial, +5462,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,Aetna-Commercial, +5463,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,Aetna-Commercial,52416.21 +5464,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,Aetna-Commercial,60009.85 +5465,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,Aetna-Commercial,64813.2 +5466,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,Aetna-Commercial,45749.77 +5467,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,Aetna-Commercial,48710.83 +5468,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,Aetna-Commercial, +5469,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,Aetna-Commercial,29771.33 +5470,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,Aetna-Commercial,52348.16 +5471,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,Aetna-Commercial, +5472,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,Aetna-Commercial,34093.85 +5473,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,Aetna-Commercial,15550.76 +5474,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,Aetna-Commercial,39271.12 +5475,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,Aetna-Commercial,38052.65 +5476,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,Aetna-Commercial, +5477,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,Aetna-Commercial,41558.69 +5478,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,Aetna-Commercial,57760.06 +5479,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,Aetna-Commercial,35397.17 +5480,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,Aetna-Commercial,29584.98 +5481,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,Aetna-Commercial,24795.93 +5482,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,Aetna-Commercial,23996.7 +5483,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,Aetna-Commercial, +5484,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,Aetna-Commercial, +5485,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,Aetna-Commercial,19156.11 +5486,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,Aetna-Commercial, +5487,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,Aetna-Commercial,29021.62 +5488,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,Aetna-Commercial, +5489,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,Aetna-Commercial, +5490,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,Aetna-Commercial,9397.27 +5491,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,Aetna-Commercial,7698.21 +5492,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,Aetna-Commercial, +5493,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,Aetna-Commercial,19495.98 +5494,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,Aetna-Commercial,39721.29 +5495,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,Aetna-Commercial,37016.88 +5496,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,Aetna-Commercial,13802.01 +5497,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,Aetna-Commercial,6713.68 +5498,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,Aetna-Commercial, +5499,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,Aetna-Commercial,10864.34 +5500,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,Aetna-Commercial, +5501,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,Aetna-Commercial, +5502,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,Aetna-Commercial, +5503,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,Aetna-Commercial, +5504,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,Aetna-Commercial, +5505,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,Aetna-Commercial, +5506,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,Aetna-Commercial, +5507,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,Aetna-Commercial, +5508,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,Aetna-Commercial,31554.23 +5509,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,Aetna-Commercial,11099.48 +5510,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,Aetna-Commercial, +5511,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,Aetna-Commercial,65316.12 +5512,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,Aetna-Commercial,14519.42 +5513,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,Aetna-Commercial,12117.51 +5514,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,Aetna-Commercial, +5515,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,Aetna-Commercial,29061.14 +5516,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,Aetna-Commercial,12638.52 +5517,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,Aetna-Commercial,9958.02 +5518,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,Aetna-Commercial, +5519,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,Aetna-Commercial, +5520,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,Aetna-Commercial, +5521,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,Aetna-Commercial, +5522,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,Aetna-Commercial, +5523,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,Aetna-Commercial,19380.75 +5524,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,Aetna-Commercial,24641.27 +5525,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,Aetna-Commercial,12742.71 +5526,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,Aetna-Commercial, +5527,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,Aetna-Commercial, +5528,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,Aetna-Commercial, +5529,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,Aetna-Commercial,13929.0 +5530,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,Aetna-Commercial, +5531,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,Aetna-Commercial, +5532,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,Aetna-Commercial, +5533,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,Aetna-Commercial, +5534,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,Aetna-Commercial, +5535,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,Aetna-Commercial, +5536,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,Aetna-Commercial, +5537,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,Aetna-Commercial, +5538,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,Aetna-Commercial, +5539,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,Aetna-Commercial,23830.04 +5540,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,Aetna-Commercial, +5541,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,Aetna-Commercial,15939.22 +5542,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,Aetna-Commercial, +5543,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,Aetna-Commercial,291.41 +5544,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,Aetna-Commercial, +5545,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,Aetna-Commercial, +5546,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,Aetna-Commercial, +5547,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,Aetna-Commercial,33146.06 +5548,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,Aetna-Commercial, +5549,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,Aetna-Commercial, +5550,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,Aetna-Commercial, +5551,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,Aetna-Commercial,17996.02 +5552,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,Aetna-Commercial, +5553,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,Aetna-Commercial,9648.43 +5554,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,Aetna-Commercial, +5555,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,Aetna-Commercial,4807.65 +5556,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,Aetna-Commercial, +5557,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,Aetna-Commercial,9952.1 +5558,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,Aetna-Commercial, +5559,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,Aetna-Commercial,12776.49 +5560,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,Aetna-Commercial,8900.56 +5561,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,Aetna-Commercial, +5562,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,Aetna-Commercial,12651.22 +5563,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,Aetna-Commercial, +5564,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,Aetna-Commercial,39536.85 +5565,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,Aetna-Commercial,21762.9 +5566,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,Aetna-Commercial,50067.57 +5567,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,Aetna-Commercial,31385.81 +5568,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,Aetna-Commercial,16088.76 +5569,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,Aetna-Commercial,17849.68 +5570,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,Aetna-Commercial,21206.39 +5571,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,Aetna-Commercial,6921.93 +5572,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,Aetna-Commercial,81223.09 +5573,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,Aetna-Commercial,11834.65 +5574,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,Aetna-Commercial,11672.31 +5575,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,Aetna-Commercial,23584.05 +5576,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,Aetna-Commercial,15622.19 +5577,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,Aetna-Commercial, +5578,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,Aetna-Commercial,8759.09 +5579,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,Aetna-Commercial, +5580,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,Aetna-Commercial,14627.7 +5581,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,Aetna-Commercial, +5582,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,Aetna-Commercial,17328.58 +5583,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,Aetna-Commercial,15585.12 +5584,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,Aetna-Commercial, +5585,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,Aetna-Commercial, +5586,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,Aetna-Commercial,18064.19 +5587,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,Aetna-Commercial,14030.1 +5588,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,Aetna-Commercial,7355.7 +5589,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,Aetna-Commercial, +5590,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,Aetna-Commercial, +5591,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,Aetna-Commercial,25232.19 +5592,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,Aetna-Commercial,10410.42 +5593,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,Aetna-Commercial,9901.56 +5594,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,Aetna-Commercial,12443.97 +5595,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,Aetna-Commercial,9163.7 +5596,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,Aetna-Commercial, +5597,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,Aetna-Commercial,13837.73 +5598,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,Aetna-Commercial,7718.53 +5599,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,Aetna-Commercial,79787.25 +5600,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,Aetna-Commercial,34409.37 +5601,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,Aetna-Commercial,112932.04 +5602,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,Aetna-Commercial,35786.03 +5603,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,Aetna-Commercial,90355.96 +5604,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,Aetna-Commercial, +5605,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,Aetna-Commercial,44840.48 +5606,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,Aetna-Commercial,38092.81 +5607,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,Aetna-Commercial,95555.28 +5608,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,Aetna-Commercial,51306.3 +5609,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,Aetna-Commercial,47274.95 +5610,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,Aetna-Commercial, +5611,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,Aetna-Commercial,58075.8 +5612,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,Aetna-Commercial,43662.26 +5613,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,Aetna-Commercial,51271.4 +5614,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,Aetna-Commercial,34872.06 +5615,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,Aetna-Commercial,50327.4 +5616,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,Aetna-Commercial, +5617,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,Aetna-Commercial,38192.94 +5618,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,Aetna-Commercial,71006.58 +5619,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,Aetna-Commercial,47587.82 +5620,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,Aetna-Commercial,54577.2 +5621,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,Aetna-Commercial,80400.57 +5622,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,Aetna-Commercial,33457.89 +5623,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,Aetna-Commercial, +5624,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,Aetna-Commercial,34620.66 +5625,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,Aetna-Commercial,18954.3 +5626,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,Aetna-Commercial, +5627,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,Aetna-Commercial,51359.08 +5628,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,Aetna-Commercial,36480.13 +5629,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,Aetna-Commercial, +5630,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,Aetna-Commercial,21936.2 +5631,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,Aetna-Commercial,29119.81 +5632,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,Aetna-Commercial, +5633,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,Aetna-Commercial,33363.66 +5634,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,Aetna-Commercial,23312.49 +5635,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,Aetna-Commercial, +5636,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,Aetna-Commercial, +5637,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,Aetna-Commercial, +5638,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,Aetna-Commercial, +5639,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,Aetna-Commercial, +5640,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,Aetna-Commercial,31011.02 +5641,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,Aetna-Commercial, +5642,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,Aetna-Commercial,14078.4 +5643,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,Aetna-Commercial, +5644,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,Aetna-Commercial, +5645,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,Aetna-Commercial, +5646,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,Aetna-Commercial,42797.7 +5647,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,Aetna-Commercial,59872.45 +5648,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,Aetna-Commercial,99137.0 +5649,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,Aetna-Commercial,60602.46 +5650,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,Aetna-Commercial,79428.91 +5651,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,Aetna-Commercial,50501.52 +5652,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,Aetna-Commercial,27365.35 +5653,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,Aetna-Commercial, +5654,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,Aetna-Commercial,56717.55 +5655,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,Aetna-Commercial,23339.04 +5656,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,Aetna-Commercial,9272.83 +5657,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,Aetna-Commercial,10784.18 +5658,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,Aetna-Commercial,20086.96 +5659,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,Aetna-Commercial, +5660,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,Aetna-Commercial,31661.25 +5661,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,Aetna-Commercial,16555.34 +5662,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,Aetna-Commercial,38912.79 +5663,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,Aetna-Commercial,13808.47 +5664,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,Aetna-Commercial,24015.84 +5665,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,Aetna-Commercial,8446.24 +5666,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,Aetna-Commercial, +5667,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,Aetna-Commercial,23877.99 +5668,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,Aetna-Commercial,19088.88 +5669,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,Aetna-Commercial,13750.34 +5670,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,Aetna-Commercial, +5671,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,Aetna-Commercial, +5672,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,Aetna-Commercial,9384.03 +5673,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,Aetna-Commercial, +5674,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,Aetna-Commercial, +5675,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,Aetna-Commercial, +5676,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,Aetna-Commercial, +5677,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,Aetna-Commercial,11337.19 +5678,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,Aetna-Commercial,10442.77 +5679,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,Aetna-Commercial,8129.78 +5680,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,Aetna-Commercial, +5681,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,Aetna-Commercial,10971.25 +5682,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,Aetna-Commercial,11672.73 +5683,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,Aetna-Commercial,29189.0 +5684,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,Aetna-Commercial,14700.74 +5685,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,Aetna-Commercial, +5686,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,Aetna-Commercial, +5687,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,Aetna-Commercial, +5688,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,Aetna-Commercial,69127.53 +5689,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,Aetna-Commercial,34535.3 +5690,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,Aetna-Commercial,1874.42 +5691,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,Aetna-Commercial,87343.08 +5692,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,Aetna-Commercial,40877.83 +5693,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,Aetna-Commercial,26791.1 +5694,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,Aetna-Commercial, +5695,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,Aetna-Commercial, +5696,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,Aetna-Commercial, +5697,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,Aetna-Commercial,55846.36 +5698,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,Aetna-Commercial,28542.97 +5699,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,Aetna-Commercial, +5700,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,Aetna-Commercial,14242.26 +5701,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,Aetna-Commercial,16521.65 +5702,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,Aetna-Commercial, +5703,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,Aetna-Commercial,15210.31 +5704,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,Aetna-Commercial,16341.08 +5705,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,Aetna-Commercial, +5706,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,Aetna-Commercial, +5707,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,Aetna-Commercial, +5708,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,Aetna-Commercial,18470.84 +5709,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,Aetna-Commercial, +5710,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,Aetna-Commercial, +5711,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,Aetna-Commercial,14768.61 +5712,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,Aetna-Commercial, +5713,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,Aetna-Commercial,17705.43 +5714,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,Aetna-Commercial, +5715,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,Aetna-Commercial,1839.0 +5716,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,Aetna-Commercial, +5717,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,Aetna-Commercial, +5718,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,Aetna-Commercial, +5719,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,Aetna-Commercial, +5720,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,Aetna-Commercial,14336.11 +5721,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,Aetna-Commercial,10484.66 +5722,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,Aetna-Commercial,44352.6 +5723,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,Aetna-Commercial,16785.55 +5724,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,Aetna-Commercial, +5725,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,Aetna-Commercial,23662.83 +5726,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,Aetna-Commercial,15372.56 +5727,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,Aetna-Commercial,8919.75 +5728,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,Aetna-Commercial, +5729,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,Aetna-Commercial,14246.75 +5730,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,Aetna-Commercial, +5731,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,Aetna-Commercial,12078.16 +5732,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,Aetna-Commercial,15256.19 +5733,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,Aetna-Commercial,13998.4 +5734,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,Aetna-Commercial, +5735,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,Aetna-Commercial, +5736,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,Aetna-Commercial, +5737,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,Aetna-Commercial,7582.33 +5738,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,Aetna-Commercial,16450.39 +5739,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,Aetna-Commercial,7937.77 +5740,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,Aetna-Commercial,10584.54 +5741,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,Aetna-Commercial,12610.94 +5742,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,Aetna-Commercial,9582.31 +5743,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,Aetna-Commercial,49610.52 +5744,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,Aetna-Commercial, +5745,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,Aetna-Commercial,19370.81 +5746,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,Aetna-Commercial, +5747,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,Aetna-Commercial, +5748,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,Aetna-Commercial, +5749,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,Aetna-Commercial,47032.32 +5750,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,Aetna-Commercial, +5751,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,Aetna-Commercial, +5752,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,Aetna-Commercial,22394.02 +5753,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,Aetna-Commercial,17095.56 +5754,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,Aetna-Commercial, +5755,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,Aetna-Commercial, +5756,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,Aetna-Commercial, +5757,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,Aetna-Commercial, +5758,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,Aetna-Commercial,24615.37 +5759,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,Aetna-Commercial,16146.07 +5760,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,Aetna-Commercial,20723.06 +5761,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,Aetna-Commercial,9677.5 +5762,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,Aetna-Commercial,46240.11 +5763,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,Aetna-Commercial,12392.4 +5764,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,Aetna-Commercial,8172.98 +5765,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,Aetna-Commercial,16848.38 +5766,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,Aetna-Commercial,12962.42 +5767,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,Aetna-Commercial,5427.26 +5768,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,Aetna-Commercial, +5769,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,Aetna-Commercial, +5770,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,Aetna-Commercial,11837.28 +5771,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,Aetna-Commercial,50332.13 +5772,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,Aetna-Commercial, +5773,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,Aetna-Commercial, +5774,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,Aetna-Commercial, +5775,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,Aetna-Commercial, +5776,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,Aetna-Commercial, +5777,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,Aetna-Commercial, +5778,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,Aetna-Commercial, +5779,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,Aetna-Commercial, +5780,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,Aetna-Commercial,41405.87 +5781,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,Aetna-Commercial, +5782,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,Aetna-Commercial, +5783,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,Aetna-Commercial, +5784,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,Aetna-Commercial, +5785,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,Aetna-Commercial, +5786,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,Aetna-Commercial,16357.38 +5787,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,Aetna-Commercial, +5788,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,Aetna-Commercial,37618.31 +5789,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,Aetna-Commercial, +5790,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,Aetna-Commercial, +5791,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,Aetna-Commercial, +5792,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,Aetna-Commercial, +5793,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,Aetna-Commercial,32198.97 +5794,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,Aetna-Commercial,25055.01 +5795,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,Aetna-Commercial,17357.13 +5796,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,Aetna-Commercial, +5797,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,Aetna-Commercial, +5798,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,Aetna-Commercial, +5799,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,Aetna-Commercial, +5800,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,Aetna-Commercial, +5801,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,Aetna-Commercial, +5802,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,Aetna-Commercial, +5803,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,Aetna-Commercial,22332.54 +5804,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,Aetna-Commercial, +5805,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,Aetna-Commercial, +5806,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,Aetna-Commercial, +5807,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,Aetna-Commercial, +5808,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,Aetna-Commercial, +5809,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,Aetna-Commercial,24099.01 +5810,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,Aetna-Commercial,17169.42 +5811,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,Aetna-Commercial, +5812,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,Aetna-Commercial, +5813,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,Aetna-Commercial, +5814,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,Aetna-Commercial, +5815,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,Aetna-Commercial,21638.92 +5816,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,Aetna-Commercial, +5817,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,Aetna-Commercial, +5818,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,Aetna-Commercial, +5819,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,Aetna-Commercial,50926.85 +5820,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,Aetna-Commercial, +5821,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,Aetna-Commercial, +5822,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,Aetna-Commercial,15775.71 +5823,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,Aetna-Commercial, +5824,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,Aetna-Commercial, +5825,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,Aetna-Commercial, +5826,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,Aetna-Commercial, +5827,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,Aetna-Commercial,9607.05 +5828,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,Aetna-Commercial,8245.84 +5829,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,Aetna-Commercial, +5830,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,Aetna-Commercial,11066.15 +5831,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,Aetna-Commercial, +5832,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,Aetna-Commercial,13920.29 +5833,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,Aetna-Commercial, +5834,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,Aetna-Commercial, +5835,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,Aetna-Commercial,47521.79 +5836,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,Aetna-Commercial,11980.77 +5837,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,Aetna-Commercial, +5838,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,Aetna-Commercial, +5839,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,Aetna-Commercial,1949.0 +5840,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,Aetna-Commercial,12157.12 +5841,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,Aetna-Commercial, +5842,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,Aetna-Commercial,7310.05 +5843,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,Aetna-Commercial, +5844,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,Aetna-Commercial,10763.04 +5845,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,Aetna-Commercial,12235.44 +5846,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,Aetna-Commercial,12558.62 +5847,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,Aetna-Commercial,13945.36 +5848,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,Aetna-Commercial, +5849,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,Aetna-Commercial, +5850,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,Aetna-Commercial, +5851,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,Aetna-Commercial, +5852,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,Aetna-Commercial,8586.15 +5853,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,Aetna-Commercial, +5854,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,Aetna-Commercial, +5855,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,Aetna-Commercial,14797.15 +5856,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,Aetna-Commercial,24649.35 +5857,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,Aetna-Commercial, +5858,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,Aetna-Commercial, +5859,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,Aetna-Commercial,21583.78 +5860,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,Aetna-Commercial,23584.86 +5861,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,Aetna-Commercial, +5862,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,Aetna-Commercial, +5863,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,Aetna-Commercial, +5864,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,Aetna-Commercial, +5865,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,Aetna-Commercial, +5866,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,Aetna-Commercial, +5867,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,Aetna-Commercial, +5868,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,Aetna-Commercial,8534.76 +5869,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,Aetna-Commercial, +5870,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,Aetna-Commercial, +5871,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,Aetna-Commercial, +5872,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,Aetna-Commercial,12232.69 +5873,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,Aetna-Commercial,13487.28 +5874,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,Aetna-Commercial, +5875,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,Aetna-Commercial, +5876,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,Aetna-Commercial, +5877,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,Aetna-Commercial,11847.11 +5878,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,Aetna-Commercial,31838.88 +5879,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,Aetna-Commercial, +5880,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,Aetna-Commercial, +5881,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,Aetna-Commercial, +5882,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,Aetna-Commercial, +5883,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,Aetna-Commercial,22701.56 +5884,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,Aetna-Commercial,23439.56 +5885,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,Aetna-Commercial, +5886,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,Aetna-Commercial, +5887,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,Aetna-Commercial, +5888,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,Aetna-Commercial, +5889,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,Aetna-Commercial, +5890,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,Aetna-Commercial,21008.56 +5891,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,Aetna-Commercial,35722.59 +5892,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,Aetna-Commercial,11812.01 +5893,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,Aetna-Commercial,13141.8 +5894,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,Aetna-Commercial,8778.3 +5895,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,Aetna-Commercial,26244.56 +5896,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,Aetna-Commercial,10965.82 +5897,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,Aetna-Commercial, +5898,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,Aetna-Commercial,15093.82 +5899,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,Aetna-Commercial,14877.94 +5900,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,Aetna-Commercial, +5901,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,Aetna-Commercial, +5902,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,Aetna-Commercial,90013.18 +5903,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,Aetna-Commercial,99999.0 +5904,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,Aetna-Commercial, +5905,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,Aetna-Commercial,26267.91 +5906,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,Aetna-Commercial, +5907,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,Aetna-Commercial, +5908,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,Aetna-Commercial,26745.0 +5909,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,Aetna-Commercial,26236.81 +5910,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,Aetna-Commercial,76089.07 +5911,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,Aetna-Commercial,20027.79 +5912,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,Aetna-Commercial,7262.04 +5913,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,Aetna-Commercial, +5914,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,Aetna-Commercial, +5915,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,Aetna-Commercial, +5916,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,Aetna-Commercial, +5917,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,Aetna-Commercial, +5918,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,Aetna-Commercial, +5919,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,Aetna-Commercial,21986.71 +5920,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,Aetna-Commercial, +5921,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,Aetna-Commercial, +5922,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,Aetna-Commercial, +5923,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,Aetna-Commercial,83540.93 +5924,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,Aetna-Commercial,12176.61 +5925,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,Aetna-Commercial,8517.18 +5926,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,Aetna-Commercial, +5927,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,Aetna-Commercial, +5928,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,Aetna-Commercial,9544.46 +5929,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,Aetna-Commercial,11069.36 +5930,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,Aetna-Commercial, +5931,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,Aetna-Commercial,11709.02 +5932,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,Aetna-Commercial, +5933,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,Aetna-Commercial, +5934,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,Aetna-Commercial,23680.81 +5935,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,Aetna-Commercial,15019.52 +5936,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,Aetna-Commercial, +5937,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,Aetna-Commercial, +5938,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,Aetna-Commercial,21844.18 +5939,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,Aetna-Commercial,29719.75 +5940,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,Aetna-Commercial, +5941,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,Aetna-Commercial,20762.62 +5942,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,Aetna-Commercial,13250.29 +5943,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,Aetna-Commercial, +5944,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,Aetna-Commercial, +5945,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,Aetna-Commercial, +5946,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,Aetna-Commercial, +5947,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,Aetna-Commercial,7769.79 +5948,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,Aetna-Commercial, +5949,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,Aetna-Commercial,10745.52 +5950,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,Aetna-Commercial,1468.15 +5951,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,Aetna-Commercial, +5952,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,Aetna-Commercial, +5953,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,Aetna-Commercial,27069.32 +5954,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,Aetna-Commercial,17193.87 +5955,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,Aetna-Commercial,22747.09 +5956,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,Aetna-Commercial, +5957,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,Aetna-Commercial,15818.59 +5958,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,Aetna-Commercial,15629.5 +5959,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,Aetna-Commercial, +5960,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,Aetna-Commercial, +5961,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,Aetna-Commercial, +5962,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,Aetna-Commercial, +5963,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,Aetna-Commercial, +5964,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,Aetna-Commercial, +5965,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,Aetna-Commercial,23049.18 +5966,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,Aetna-Commercial, +5967,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,Aetna-Commercial, +5968,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,Aetna-Commercial, +5969,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,Aetna-Commercial, +5970,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,Aetna-Commercial, +5971,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,Aetna-Commercial, +5972,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,Aetna-Commercial,9487.31 +5973,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,Aetna-Commercial,1957.79 +5974,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,Aetna-Commercial, +5975,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,Aetna-Commercial, +5976,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,Aetna-Commercial, +5977,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,Aetna-Commercial, +5978,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,Aetna-Commercial, +5979,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,Aetna-Commercial, +5980,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,Aetna-Commercial, +5981,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,Aetna-Commercial, +5982,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,Aetna-Commercial, +5983,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,Aetna-Commercial, +5984,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,Aetna-Commercial, +5985,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,Aetna-Commercial, +5986,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,Aetna-Commercial, +5987,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,Aetna-Commercial, +5988,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,Aetna-Commercial, +5989,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,Aetna-Commercial, +5990,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,Aetna-Commercial, +5991,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,Aetna-Commercial, +5992,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,Aetna-Commercial, +5993,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,Aetna-Commercial, +5994,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,Aetna-Commercial, +5995,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,Aetna-Commercial, +5996,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,Aetna-Commercial, +5997,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,Aetna-Commercial, +5998,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,Aetna-Commercial, +5999,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,Aetna-Commercial,18442.38 +6000,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,Aetna-Commercial, +6001,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,Aetna-Commercial, +6002,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,Aetna-Commercial,12374.76 +6003,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,Aetna-Commercial,53997.79 +6004,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,Aetna-Commercial, +6005,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,Aetna-Commercial,14484.15 +6006,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,Aetna-Commercial, +6007,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,Aetna-Commercial,39690.01 +6008,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,Aetna-Commercial, +6009,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,Aetna-Commercial, +6010,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,Aetna-Commercial, +6011,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,Aetna-Commercial, +6012,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,Aetna-Commercial,11816.32 +6013,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,Aetna-Commercial,70952.84 +6014,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,Aetna-Commercial, +6015,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,Aetna-Commercial, +6016,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,Aetna-Commercial, +6017,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,Aetna-Commercial, +6018,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,Aetna-Commercial,15208.46 +6019,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,Aetna-Commercial,22472.02 +6020,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,Aetna-Commercial, +6021,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,Aetna-Commercial, +6022,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,Aetna-Commercial,10104.48 +6023,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,Aetna-Commercial,7603.11 +6024,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,Aetna-Commercial,114155.03 +6025,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,Aetna-Commercial,26975.41 +6026,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,Aetna-Commercial, +6027,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,Aetna-Commercial, +6028,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,Aetna-Commercial,32572.46 +6029,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,Aetna-Commercial,25284.32 +6030,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,Aetna-Commercial,50036.02 +6031,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,Aetna-Commercial, +6032,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,Aetna-Commercial,33182.39 +6033,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,Aetna-Commercial, +6034,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,Aetna-Commercial, +6035,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,Aetna-Commercial,42356.27 +6036,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,Aetna-Commercial,28355.2 +6037,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,Aetna-Commercial, +6038,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,Aetna-Commercial,38051.95 +6039,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,Aetna-Commercial,30192.27 +6040,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,Aetna-Commercial, +6041,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,Aetna-Commercial,29896.41 +6042,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,Aetna-Commercial, +6043,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,Aetna-Commercial, +6044,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,Aetna-Commercial,13806.56 +6045,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,Aetna-Commercial,12331.23 +6046,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,Aetna-Commercial,18386.77 +6047,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,Aetna-Commercial,1874.42 +6048,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,Aetna-Commercial,26020.1 +6049,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,Aetna-Commercial,15269.05 +6050,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,Aetna-Commercial, +6051,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,Aetna-Commercial,64969.64 +6052,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,Aetna-Commercial,68249.46 +6053,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,Aetna-Commercial,15397.99 +6054,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,Aetna-Commercial, +6055,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,Aetna-Commercial, +6056,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,Aetna-Commercial, +6057,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,Aetna-Commercial,10332.16 +6058,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,Aetna-Commercial,21952.17 +6059,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,Aetna-Commercial, +6060,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,Aetna-Commercial,17188.66 +6061,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,Aetna-Commercial, +6062,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,Aetna-Commercial, +6063,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,Aetna-Commercial, +6064,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,Aetna-Commercial, +6065,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,Aetna-Commercial,23454.33 +6066,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,Aetna-Commercial,11589.3 +6067,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,Aetna-Commercial,27929.48 +6068,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,Aetna-Commercial, +6069,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,Aetna-Commercial, +6070,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,Aetna-Commercial, +6071,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,Aetna-Commercial, +6072,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,Aetna-Commercial,28573.82 +6073,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,Aetna-Commercial,18286.41 +6074,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,Aetna-Commercial, +6075,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,Aetna-Commercial, +6076,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,Aetna-Commercial, +6077,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,Aetna-Commercial,9202.55 +6078,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,Aetna-Commercial,63371.65 +6079,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,Aetna-Commercial,11882.44 +6080,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,Aetna-Commercial, +6081,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,Aetna-Commercial,14726.28 +6082,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,Aetna-Commercial, +6083,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,Aetna-Commercial,22555.05 +6084,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,Aetna-Commercial,12589.35 +6085,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,Aetna-Commercial, +6086,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,Aetna-Commercial, +6087,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,Aetna-Commercial, +6088,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,Aetna-Commercial, +6089,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,Aetna-Commercial, +6090,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,Aetna-Commercial,17070.34 +6091,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,Aetna-Commercial,58895.07 +6092,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,Aetna-Commercial, +6093,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,Aetna-Commercial, +6094,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,Aetna-Commercial,5331.08 +6095,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,Aetna-Commercial, +6096,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,Aetna-Commercial, +6097,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,Aetna-Commercial, +6098,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,Aetna-Commercial, +6099,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,Aetna-Commercial, +6100,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,Aetna-Commercial, +6101,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,Aetna-Commercial,42361.21 +6102,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,Aetna-Commercial, +6103,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,Aetna-Commercial, +6104,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,Aetna-Commercial,22908.49 +6105,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,Aetna-Commercial, +6106,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,Aetna-Commercial, +6107,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,Aetna-Commercial, +6108,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,Aetna-Commercial, +6109,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,Aetna-Commercial,4544.0 +6110,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,Aetna-Commercial,3701.0 +6111,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,Aetna-Commercial,4050.4 +6112,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,Aetna-Commercial, +6113,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,Aetna-Commercial,15806.32 +6114,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,Aetna-Commercial,4544.0 +6115,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,Aetna-Commercial,4544.0 +6116,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,Aetna-Commercial,1949.0 +6117,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,Aetna-Commercial, +6118,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,Aetna-Commercial,4544.0 +6119,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,Aetna-Commercial,4544.0 +6120,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,Aetna-Commercial, +6121,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,Aetna-Commercial,4287.0 +6122,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,Aetna-Commercial,1949.0 +6123,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,Aetna-Commercial, +6124,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,Aetna-Commercial, +6125,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,Aetna-Commercial,2272.0 +6126,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,Aetna-Commercial, +6127,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,Aetna-Commercial, +6128,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,Aetna-Commercial, +6129,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,Aetna-Commercial, +6130,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,Aetna-Commercial, +6131,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,Aetna-Commercial, +6132,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,Aetna-Commercial, +6133,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,Aetna-Commercial, +6134,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,Aetna-Commercial, +6135,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,Aetna-Commercial, +6136,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,Aetna-Commercial,4544.0 +6137,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,Aetna-Commercial, +6138,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,Aetna-Commercial,1691.0 +6139,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,Aetna-Commercial,4068.7 +6140,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,Aetna-Commercial,3408.0 +6141,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,Aetna-Commercial,2779.2 +6142,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,Aetna-Commercial,4544.0 +6143,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,Aetna-Commercial, +6144,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,Aetna-Commercial,2679.38 +6145,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,Aetna-Commercial,3470.33 +6146,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,Aetna-Commercial,2143.5 +6147,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,Aetna-Commercial, +6148,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,Aetna-Commercial,4079.1 +6149,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,Aetna-Commercial, +6150,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,Aetna-Commercial,4476.1 +6151,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,Aetna-Commercial, +6152,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,Aetna-Commercial, +6153,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,Aetna-Commercial,4544.0 +6154,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,Aetna-Commercial, +6155,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,Aetna-Commercial,4544.0 +6156,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,Aetna-Commercial, +6157,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,Aetna-Commercial, +6158,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,Aetna-Commercial, +6159,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,Aetna-Commercial, +6160,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,Aetna-Commercial, +6161,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,Aetna-Commercial,2272.0 +6162,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,Aetna-Commercial,3963.0 +6163,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,Aetna-Commercial, +6164,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,Aetna-Commercial, +6165,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,Aetna-Commercial,4287.0 +6166,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,Aetna-Commercial, +6167,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,Aetna-Commercial, +6168,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,Aetna-Commercial, +6169,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,Aetna-Commercial, +6170,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,Aetna-Commercial, +6171,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,Aetna-Commercial, +6172,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,Aetna-Commercial, +6173,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,Aetna-Commercial, +6174,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,Aetna-Commercial, +6175,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,Aetna-Commercial, +6176,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,Aetna-Commercial, +6177,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,Aetna-Commercial,3408.0 +6178,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,Aetna-Commercial, +6179,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,Aetna-Commercial, +6180,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,Aetna-Commercial,4544.0 +6181,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,Aetna-Commercial,4544.0 +6182,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,Aetna-Commercial, +6183,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,Aetna-Commercial, +6184,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,Aetna-Commercial, +6185,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,Aetna-Commercial, +6186,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,Aetna-Commercial,4456.0 +6187,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,Aetna-Commercial,7335.88 +6188,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,Aetna-Commercial,2743.63 +6189,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,Aetna-Commercial, +6190,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,Aetna-Commercial, +6191,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,Aetna-Commercial, +6192,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,Aetna-Commercial, +6193,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,Aetna-Commercial,1949.0 +6194,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,Aetna-Commercial,1894.0 +6195,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,Aetna-Commercial, +6196,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,Aetna-Commercial,1839.0 +6197,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,Aetna-Commercial,1949.0 +6198,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,Aetna-Commercial,1949.0 +6199,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,Aetna-Commercial, +6200,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,Aetna-Commercial, +6201,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,Aetna-Commercial, +6202,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,Aetna-Commercial, +6203,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,Aetna-Commercial, +6204,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,Aetna-Commercial, +6205,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,Aetna-Commercial,2272.0 +6206,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,Aetna-Commercial, +6207,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,Aetna-Commercial,2143.5 +6208,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,Aetna-Commercial,9998.95 +6209,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,Aetna-Commercial, +6210,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,Aetna-Commercial,2143.5 +6211,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,Aetna-Commercial,4227.5 +6212,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,Aetna-Commercial,3054.0 +6213,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,Aetna-Commercial, +6214,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,Aetna-Commercial, +6215,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,Aetna-Commercial,2272.0 +6216,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,Aetna-Commercial,1949.0 +6217,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,Aetna-Commercial, +6218,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,Aetna-Commercial, +6219,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,Aetna-Commercial,4544.0 +6220,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,Aetna-Commercial,2272.0 +6221,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,Aetna-Commercial, +6222,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,Aetna-Commercial,2207.75 +6223,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,Aetna-Commercial,2743.63 +6224,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,Aetna-Commercial, +6225,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,Aetna-Commercial,289.95 +6226,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,Aetna-Commercial, +6227,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,Aetna-Commercial, +6228,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,Aetna-Commercial, +6229,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,Aetna-Commercial, +6230,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,Aetna-Commercial, +6231,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,Aetna-Commercial, +6232,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,Aetna-Commercial, +6233,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,Aetna-Commercial,4897.27 +6234,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,Aetna-Commercial, +6235,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,Aetna-Commercial,4544.0 +6236,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,Aetna-Commercial, +6237,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,Aetna-Commercial,4544.0 +6238,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,Aetna-Commercial,2272.0 +6239,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,Aetna-Commercial,2143.5 +6240,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,Aetna-Commercial,3215.25 +6241,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,Aetna-Commercial, +6242,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,Aetna-Commercial,2143.5 +6243,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,Aetna-Commercial,2143.5 +6244,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,Aetna-Commercial, +6245,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,Aetna-Commercial, +6246,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,Aetna-Commercial, +6247,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,Aetna-Commercial,4063.7 +6248,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,Aetna-Commercial, +6249,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,Aetna-Commercial, +6250,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,Aetna-Commercial, +6251,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,Aetna-Commercial, +6252,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,Aetna-Commercial, +6253,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,Aetna-Commercial,4544.0 +6254,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,Aetna-Commercial,2272.0 +6255,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,Aetna-Commercial, +6256,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,Aetna-Commercial, +6257,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,Aetna-Commercial, +6258,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,Aetna-Commercial, +6259,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,Aetna-Commercial,4438.3 +6260,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,Aetna-Commercial,2272.0 +6261,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,Aetna-Commercial, +6262,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,Aetna-Commercial, +6263,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,Aetna-Commercial, +6264,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,Aetna-Commercial, +6265,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,Aetna-Commercial,3280.25 +6266,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,Aetna-Commercial,4544.0 +6267,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,Aetna-Commercial, +6268,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,Aetna-Commercial, +6269,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,Aetna-Commercial,2272.0 +6270,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,Aetna-Commercial, +6271,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,Aetna-Commercial, +6272,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,Aetna-Commercial,4332.6 +6273,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,Aetna-Commercial, +6274,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,Aetna-Commercial,1949.0 +6275,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,Aetna-Commercial,1894.0 +6276,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,Aetna-Commercial, +6277,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,Aetna-Commercial, +6278,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,Aetna-Commercial, +6279,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,Aetna-Commercial,4287.0 +6280,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,Aetna-Commercial, +6281,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,Aetna-Commercial,4544.0 +6282,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,Aetna-Commercial,3408.0 +6283,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,Aetna-Commercial,5043.08 +6284,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,Aetna-Commercial,4544.0 +6285,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,Aetna-Commercial,4680.92 +6286,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,Aetna-Commercial,4544.0 +6287,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,Aetna-Commercial, +6288,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,Aetna-Commercial,4544.0 +6289,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,Aetna-Commercial,4287.0 +6290,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,Aetna-Commercial,4544.0 +6291,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,Aetna-Commercial,4305.3 +6292,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,Aetna-Commercial, +6293,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,Aetna-Commercial,4448.1 +6294,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,Aetna-Commercial, +6295,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,Aetna-Commercial, +6296,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,Aetna-Commercial,2272.0 +6297,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,Aetna-Commercial,6344.98 +6298,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,Aetna-Commercial,2272.0 +6299,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,Aetna-Commercial, +6300,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,Aetna-Commercial,4287.0 +6301,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,Aetna-Commercial,3539.63 +6302,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,Aetna-Commercial,7507.0 +6303,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,Aetna-Commercial,3408.0 +6304,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,Aetna-Commercial,4287.0 +6305,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,Aetna-Commercial,4415.5 +6306,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,Aetna-Commercial,4287.0 +6307,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,Aetna-Commercial,3246.3 +6308,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,Aetna-Commercial,4544.0 +6309,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,Aetna-Commercial, +6310,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,Aetna-Commercial, +6311,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,Aetna-Commercial,2272.0 +6312,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,Aetna-Commercial,4415.5 +6313,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,Aetna-Commercial, +6314,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,Aetna-Commercial, +6315,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,Aetna-Commercial, +6316,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,Aetna-Commercial, +6317,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,Aetna-Commercial, +6318,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,Aetna-Commercial,4336.1 +6319,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,Aetna-Commercial, +6320,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,Aetna-Commercial,4415.5 +6321,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,Aetna-Commercial,4544.0 +6322,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,Aetna-Commercial,9585.5 +6323,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,Aetna-Commercial, +6324,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,Aetna-Commercial, +6325,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,Aetna-Commercial,497.0 +6326,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,Aetna-Commercial, +6327,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,Aetna-Commercial, +6328,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,Aetna-Commercial, +6329,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,Aetna-Commercial, +6330,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,Aetna-Commercial, +6331,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,Aetna-Commercial,7445.46 +6332,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,Aetna-Commercial, +6333,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,Aetna-Commercial,1949.0 +6334,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,Aetna-Commercial, +6335,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,Aetna-Commercial, +6336,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,Aetna-Commercial, +6337,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,Aetna-Commercial, +6338,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,Aetna-Commercial,4544.0 +6339,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,Aetna-Commercial,23055.41 +6340,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,Aetna-Commercial,4544.0 +6341,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,Aetna-Commercial, +6342,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,Aetna-Commercial, +6343,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,Aetna-Commercial, +6344,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,Aetna-Commercial,2143.5 +6345,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,Aetna-Commercial, +6346,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,Aetna-Commercial, +6347,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,Aetna-Commercial, +6348,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,Aetna-Commercial, +6349,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,Aetna-Commercial, +6350,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,Aetna-Commercial,4287.0 +6351,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,Aetna-Commercial, +6352,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,Aetna-Commercial, +6353,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,Aetna-Commercial, +6354,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,Aetna-Commercial, +6355,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,Aetna-Commercial, +6356,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,Aetna-Commercial, +6357,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,Aetna-Commercial, +6358,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,Aetna-Commercial, +6359,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,Aetna-Commercial, +6360,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,Aetna-Commercial,4459.2 +6361,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,Aetna-Commercial, +6362,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,Aetna-Commercial, +6363,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,Aetna-Commercial, +6364,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,Aetna-Commercial,4287.0 +6365,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,Aetna-Commercial, +6366,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,Aetna-Commercial, +6367,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,Aetna-Commercial, +6368,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,Aetna-Commercial,2272.0 +6369,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,Aetna-Commercial,4064.75 +6370,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,Aetna-Commercial, +6371,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,Aetna-Commercial, +6372,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,Aetna-Commercial,4287.0 +6373,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,Aetna-Commercial, +6374,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,Aetna-Commercial, +6375,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,Aetna-Commercial, +6376,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,Aetna-Commercial, +6377,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,Aetna-Commercial, +6378,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,Aetna-Commercial, +6379,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,Aetna-Commercial, +6380,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,Aetna-Commercial, +6381,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,Aetna-Commercial, +6382,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,Aetna-Commercial, +6383,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,Aetna-Commercial, +6384,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,Aetna-Commercial, +6385,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,Aetna-Commercial,4287.0 +6386,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,Aetna-Commercial,4287.0 +6387,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,Aetna-Commercial,4116.3 +6388,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,Aetna-Commercial,4287.0 +6389,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,Aetna-Commercial,3949.7 +6390,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,Aetna-Commercial,4544.0 +6391,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,Aetna-Commercial, +6392,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,Aetna-Commercial, +6393,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,Aetna-Commercial, +6394,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,Aetna-Commercial,4116.3 +6395,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,Aetna-Commercial, +6396,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,Aetna-Commercial, +6397,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,Aetna-Commercial, +6398,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,Aetna-Commercial, +6399,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,Aetna-Commercial,4957.7 +6400,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,Aetna-Commercial, +6401,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,Aetna-Commercial, +6402,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,Aetna-Commercial,12467.0 +6403,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,Aetna-Commercial, +6404,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,Aetna-Commercial,2143.5 +6405,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,Aetna-Commercial,2143.5 +6406,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,Aetna-Commercial, +6407,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,Aetna-Commercial, +6408,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,Aetna-Commercial, +6409,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,Aetna-Commercial,4134.5 +6410,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,Aetna-Commercial, +6411,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,Aetna-Commercial, +6412,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,Aetna-Commercial, +6413,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,Aetna-Commercial, +6414,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,Aetna-Commercial, +6415,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,Aetna-Commercial, +6416,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,Aetna-Commercial, +6417,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,Aetna-Commercial, +6418,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,Aetna-Commercial, +6419,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,Aetna-Commercial,2431.0 +6420,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,Aetna-Commercial, +6421,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,Aetna-Commercial, +6422,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,Aetna-Commercial,5776.6 +6423,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,Aetna-Commercial, +6424,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,Aetna-Commercial, +6425,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,Aetna-Commercial, +6426,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,Aetna-Commercial,265.78 +6427,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,Aetna-Commercial,1949.0 +6428,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,Aetna-Commercial, +6429,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,Aetna-Commercial, +6430,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,Aetna-Commercial,3343.75 +6431,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,Aetna-Commercial, +6432,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,Aetna-Commercial,4544.0 +6433,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,Aetna-Commercial, +6434,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,Aetna-Commercial, +6435,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,Aetna-Commercial, +6436,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,Aetna-Commercial, +6437,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,Aetna-Commercial, +6438,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,Aetna-Commercial, +6439,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,Aetna-Commercial, +6440,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,Aetna-Commercial,4631.5 +6441,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,Aetna-Commercial,5266.0 +6442,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,Aetna-Commercial, +6443,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,Aetna-Commercial,4879.5 +6444,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,Aetna-Commercial, +6445,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,Aetna-Commercial,4452.9 +6446,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,Aetna-Commercial, +6447,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,Aetna-Commercial, +6448,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,Aetna-Commercial, +6449,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,Aetna-Commercial, +6450,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,Aetna-Commercial,5865.1 +6451,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,Aetna-Commercial, +6452,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,Aetna-Commercial,4544.0 +6453,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,Aetna-Commercial, +6454,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,Aetna-Commercial, +6455,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,Aetna-Commercial,4770.5 +6456,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,Aetna-Commercial,7269.6 +6457,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,Aetna-Commercial, +6458,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,Aetna-Commercial, +6459,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,Aetna-Commercial,4741.6 +6460,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,Aetna-Commercial, +6461,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,Aetna-Commercial, +6462,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,Aetna-Commercial, +6463,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,Aetna-Commercial, +6464,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,Aetna-Commercial, +6465,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,Aetna-Commercial, +6466,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,Aetna-Commercial, +6467,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,Aetna-Commercial, +6468,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,Aetna-Commercial, +6469,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,Aetna-Commercial, +6470,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,Aetna-Commercial,4544.0 +6471,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,Aetna-Commercial, +6472,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,Aetna-Commercial, +6473,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,Aetna-Commercial, +6474,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,Aetna-Commercial, +6475,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,Aetna-Commercial, +6476,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,Aetna-Commercial, +6477,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,Aetna-Commercial, +6478,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,Aetna-Commercial, +6479,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,Aetna-Commercial,4372.67 +6480,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,Aetna-Commercial, +6481,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,Aetna-Commercial, +6482,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,Aetna-Commercial, +6483,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,Aetna-Commercial, +6484,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,Aetna-Commercial, +6485,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,Aetna-Commercial, +6486,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,Aetna-Commercial, +6487,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,Aetna-Commercial, +6488,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,Aetna-Commercial, +6489,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,Aetna-Commercial, +6490,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,Aetna-Commercial, +6491,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,Aetna-Commercial, +6492,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,Aetna-Commercial, +6493,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,Aetna-Commercial,2629.5 +6494,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,Aetna-Commercial, +6495,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,Aetna-Commercial, +6496,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,Aetna-Commercial,3408.0 +6497,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,Aetna-Commercial, +6498,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,Aetna-Commercial, +6499,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,Aetna-Commercial, +6500,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,Aetna-Commercial, +6501,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,Aetna-Commercial, +6502,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,Aetna-Commercial,1949.0 +6503,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,Aetna-Commercial, +6504,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,Aetna-Commercial, +6505,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,Aetna-Commercial,1949.0 +6506,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,Aetna-Commercial,4444.5 +6507,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,Aetna-Commercial,6195.5 +6508,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,Aetna-Commercial, +6509,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,Aetna-Commercial,6461.0 +6510,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,Aetna-Commercial,1949.0 +6511,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,Aetna-Commercial, +6512,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,Aetna-Commercial, +6513,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,Aetna-Commercial, +6514,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,Aetna-Commercial,7247.13 +6515,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,Aetna-Commercial, +6516,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,Aetna-Commercial, +6517,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,Aetna-Commercial,4544.0 +6518,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,Aetna-Commercial,4544.0 +6519,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,Aetna-Commercial, +6520,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,Aetna-Commercial, +6521,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,Aetna-Commercial, +6522,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,Aetna-Commercial,4544.0 +6523,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,Aetna-Commercial, +6524,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,Aetna-Commercial, +6525,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,Aetna-Commercial,4287.0 +6526,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,Aetna-Commercial, +6527,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,Aetna-Commercial, +6528,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,Aetna-Commercial,4544.0 +6529,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,Aetna-Commercial, +6530,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,Aetna-Commercial,4287.0 +6531,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,Aetna-Commercial, +6532,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,Aetna-Commercial, +6533,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,Aetna-Commercial, +6534,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,Aetna-Commercial,1025.85 +6535,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,Aetna-Commercial, +6536,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,Aetna-Commercial,2638.65 +6537,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,Aetna-Commercial, +6538,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,Aetna-Commercial,2272.0 +6539,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,Aetna-Commercial, +6540,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,Aetna-Commercial, +6541,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,Aetna-Commercial, +6542,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,Aetna-Commercial, +6543,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,Aetna-Commercial,6816.0 +6544,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,Aetna-Commercial, +6545,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,Aetna-Commercial, +6546,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,Aetna-Commercial, +6547,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,Aetna-Commercial, +6548,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,Aetna-Commercial, +6549,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,Aetna-Commercial, +6550,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,Aetna-Commercial, +6551,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,Aetna-Commercial, +6552,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,Aetna-Commercial, +6553,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,Aetna-Commercial, +6554,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,Aetna-Commercial, +6555,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,Aetna-Commercial, +6556,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,Aetna-Commercial,1949.0 +6557,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,Aetna-Commercial, +6558,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,Aetna-Commercial, +6559,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,Aetna-Commercial,4421.1 +6560,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,Aetna-Commercial, +6561,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,Aetna-Commercial,1949.0 +6562,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,Aetna-Commercial, +6563,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,Aetna-Commercial, +6564,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,Aetna-Commercial, +6565,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,Aetna-Commercial,1839.0 +6566,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,Aetna-Commercial,4561.0 +6567,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,Aetna-Commercial,4435.5 +6568,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,Aetna-Commercial, +6569,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,Aetna-Commercial, +6570,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,Aetna-Commercial, +6571,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,Aetna-Commercial,1949.0 +6572,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,Aetna-Commercial, +6573,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,Aetna-Commercial, +6574,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,Aetna-Commercial, +6575,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,Aetna-Commercial,4287.0 +6576,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,Aetna-Commercial, +6577,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,Aetna-Commercial, +6578,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,Aetna-Commercial, +6579,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,Aetna-Commercial, +6580,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,Aetna-Commercial, +6581,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,Aetna-Commercial,16715.57 +6582,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,Aetna-Commercial, +6583,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,Aetna-Commercial,4495.78 +6584,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,Aetna-Commercial, +6585,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,Aetna-Commercial, +6586,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,Aetna-Commercial, +6587,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,Aetna-Commercial, +6588,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,Aetna-Commercial, +6589,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,Aetna-Commercial, +6590,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,Aetna-Commercial,872.46 +6591,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,Aetna-Commercial, +6592,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,Aetna-Commercial, +6593,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,Aetna-Commercial, +6594,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,Aetna-Commercial, +6595,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,Aetna-Commercial, +6596,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,Aetna-Commercial, +6597,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,Aetna-Commercial, +6598,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,Aetna-Commercial,3949.7 +6599,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,Aetna-Commercial, +6600,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,Aetna-Commercial, +6601,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,Aetna-Commercial, +6602,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,Aetna-Commercial,3768.4 +6603,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,Aetna-Commercial, +6604,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,Aetna-Commercial, +6605,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,Aetna-Commercial, +6606,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,Aetna-Commercial, +6607,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,Aetna-Commercial, +6608,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,Aetna-Commercial, +6609,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,Aetna-Commercial, +6610,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,Aetna-Commercial, +6611,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,Aetna-Commercial,2336.2 +6612,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,Aetna-Commercial, +6613,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,Aetna-Commercial,14519.0 +6614,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,Aetna-Commercial,16739.87 +6615,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,Aetna-Commercial, +6616,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,Aetna-Commercial, +6617,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,Aetna-Commercial, +6618,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,Aetna-Commercial, +6619,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,Aetna-Commercial, +6620,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,Aetna-Commercial, +6621,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,Aetna-Commercial, +6622,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,Aetna-Commercial, +6623,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,Aetna-Commercial,3802.06 +6624,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,Aetna-Commercial, +6625,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,Aetna-Commercial, +6626,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,Aetna-Commercial, +6627,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,Aetna-Commercial, +6628,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,Aetna-Commercial, +6629,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,Aetna-Commercial, +6630,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,Aetna-Commercial,8246.2 +6631,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,Aetna-Commercial, +6632,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,Aetna-Commercial, +6633,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,Aetna-Commercial, +6634,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,Aetna-Commercial, +6635,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,Aetna-Commercial, +6636,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,Aetna-Commercial,4287.0 +6637,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,Aetna-Commercial,4544.0 +6638,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,Aetna-Commercial, +6639,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,Aetna-Commercial,2272.0 +6640,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,Aetna-Commercial,4544.0 +6641,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,Aetna-Commercial,3161.5 +6642,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,Aetna-Commercial,4287.0 +6643,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,Aetna-Commercial,4544.0 +6644,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,Aetna-Commercial, +6645,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,Aetna-Commercial, +6646,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,Aetna-Commercial, +6647,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,Aetna-Commercial, +6648,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,Aetna-Commercial, +6649,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,Aetna-Commercial,1839.0 +6650,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,Aetna-Commercial, +6651,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,Aetna-Commercial, +6652,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,Aetna-Commercial,4817.9 +6653,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,Aetna-Commercial, +6654,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,Aetna-Commercial,4544.0 +6655,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,Aetna-Commercial,1949.0 +6656,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,Aetna-Commercial,5529.0 +6657,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,Aetna-Commercial, +6658,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,Aetna-Commercial,5341.5 +6659,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,Aetna-Commercial, +6660,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,Aetna-Commercial,6261.0 +6661,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,Aetna-Commercial, +6662,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,Aetna-Commercial, +6663,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,Aetna-Commercial, +6664,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,Aetna-Commercial, +6665,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,Aetna-Commercial, +6666,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,Aetna-Commercial,2272.0 +6667,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,Aetna-Commercial, +6668,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,Aetna-Commercial, +6669,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,Aetna-Commercial,4287.0 +6670,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,Aetna-Commercial,2809.34 +6671,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,Aetna-Commercial, +6672,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,Aetna-Commercial, +6673,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,Aetna-Commercial,4544.0 +6674,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,Aetna-Commercial,2272.0 +6675,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,Aetna-Commercial,2272.0 +6676,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,Aetna-Commercial, +6677,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,Aetna-Commercial,4544.0 +6678,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,Aetna-Commercial, +6679,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,Aetna-Commercial, +6680,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,Aetna-Commercial, +6681,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,Aetna-Commercial, +6682,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,Aetna-Commercial, +6683,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,Aetna-Commercial, +6684,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,Aetna-Commercial, +6685,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,Aetna-Commercial,4287.0 +6686,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,Aetna-Commercial, +6687,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,Aetna-Commercial, +6688,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,Aetna-Commercial,2272.0 +6689,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,Aetna-Commercial,3279.5 +6690,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,Aetna-Commercial,4193.3 +6691,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,Aetna-Commercial,2272.0 +6692,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,Aetna-Commercial,4471.9 +6693,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,Aetna-Commercial, +6694,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,Aetna-Commercial, +6695,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,Aetna-Commercial,4555.5 +6696,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,Aetna-Commercial,6039.0 +6697,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,Aetna-Commercial,4544.0 +6698,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,Aetna-Commercial,4544.0 +6699,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,Aetna-Commercial,2272.0 +6700,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,Aetna-Commercial,2143.5 +6701,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,Aetna-Commercial, +6702,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,Aetna-Commercial, +6703,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,Aetna-Commercial,2272.0 +6704,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,Aetna-Commercial, +6705,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,Aetna-Commercial,5253.0 +6706,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,Aetna-Commercial, +6707,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,Aetna-Commercial, +6708,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,Aetna-Commercial, +6709,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,Aetna-Commercial,4544.0 +6710,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,Aetna-Commercial, +6711,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,Aetna-Commercial, +6712,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,Aetna-Commercial, +6713,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,Aetna-Commercial, +6714,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,Aetna-Commercial, +6715,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,Aetna-Commercial, +6716,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,Aetna-Commercial,6835.0 +6717,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,Aetna-Commercial, +6718,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,Aetna-Commercial, +6719,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,Aetna-Commercial, +6720,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,Aetna-Commercial, +6721,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,Aetna-Commercial, +6722,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,Aetna-Commercial, +6723,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,Aetna-Commercial, +6724,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,Aetna-Commercial,5545.5 +6725,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,Aetna-Commercial,4544.0 +6726,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,Aetna-Commercial,34146.11 +6727,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,Aetna-Commercial, +6728,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,Aetna-Commercial, +6729,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,Aetna-Commercial, +6730,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,Aetna-Commercial, +6731,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,Aetna-Commercial,1949.0 +6732,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,Aetna-Commercial, +6733,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,Aetna-Commercial,1949.0 +6734,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,Aetna-Commercial,1866.5 +6735,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,Aetna-Commercial,1949.0 +6736,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,Aetna-Commercial,162.03 +6737,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,Aetna-Commercial, +6738,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,Aetna-Commercial,1949.0 +6739,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,Aetna-Commercial, +6740,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,Aetna-Commercial,1949.0 +6741,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,Aetna-Commercial,1949.0 +6742,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,Aetna-Commercial,4091.33 +6743,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,Aetna-Commercial, +6744,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,Aetna-Commercial, +6745,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,Aetna-Commercial,5301.26 +6746,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,Aetna-Commercial,5411.0 +6747,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,Aetna-Commercial, +6748,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,Aetna-Commercial,4544.0 +6749,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,Aetna-Commercial, +6750,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,Aetna-Commercial, +6751,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,Aetna-Commercial,3408.0 +6752,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,Aetna-Commercial,2272.0 +6753,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,Aetna-Commercial,4332.6 +6754,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,Aetna-Commercial,4544.0 +6755,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,Aetna-Commercial,7566.0 +6756,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,Aetna-Commercial,6299.4 +6757,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,Aetna-Commercial, +6758,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,Aetna-Commercial,4062.4 +6759,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,Aetna-Commercial,3925.8 +6760,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,Aetna-Commercial,4525.98 +6761,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,Aetna-Commercial, +6762,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,Aetna-Commercial, +6763,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,Aetna-Commercial,6879.0 +6764,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,Aetna-Commercial, +6765,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,Aetna-Commercial, +6766,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,Aetna-Commercial,4233.2 +6767,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,Aetna-Commercial, +6768,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,Aetna-Commercial, +6769,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,Aetna-Commercial,4157.6 +6770,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,Aetna-Commercial, +6771,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,Aetna-Commercial, +6772,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,Aetna-Commercial,2272.0 +6773,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,Aetna-Commercial,4507.95 +6774,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,Aetna-Commercial, +6775,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,Aetna-Commercial,7366.0 +6776,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,Aetna-Commercial,4544.0 +6777,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,Aetna-Commercial,5013.9 +6778,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,Aetna-Commercial,5387.0 +6779,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,Aetna-Commercial, +6780,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,Aetna-Commercial, +6781,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,Aetna-Commercial,4287.0 +6782,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,Aetna-Commercial, +6783,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,Aetna-Commercial,1740.0 +6784,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,Aetna-Commercial,4544.0 +6785,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,Aetna-Commercial, +6786,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,Aetna-Commercial, +6787,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,Aetna-Commercial,1949.0 +6788,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,Aetna-Commercial,4544.0 +6789,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,Aetna-Commercial, +6790,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,Aetna-Commercial,4399.8 +6791,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,Aetna-Commercial,4471.9 +6792,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,Aetna-Commercial, +6793,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,Aetna-Commercial, +6794,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,Aetna-Commercial, +6795,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,Aetna-Commercial,1839.0 +6796,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,Aetna-Commercial, +6797,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,Aetna-Commercial, +6798,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,Aetna-Commercial,2272.0 +6799,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,Aetna-Commercial, +6800,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,Aetna-Commercial, +6801,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,Aetna-Commercial,2143.5 +6802,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,Aetna-Commercial,2272.0 +6803,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,Aetna-Commercial, +6804,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,Aetna-Commercial,4053.9 +6805,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,Aetna-Commercial, +6806,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,Aetna-Commercial, +6807,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,Aetna-Commercial, +6808,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,Aetna-Commercial, +6809,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,Aetna-Commercial, +6810,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,Aetna-Commercial, +6811,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,Aetna-Commercial, +6812,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,Aetna-Commercial,6591.0 +6813,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,Aetna-Commercial, +6814,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,Aetna-Commercial, +6815,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,Aetna-Commercial, +6816,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,Aetna-Commercial, +6817,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,Aetna-Commercial,13224.52 +6818,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,Aetna-Commercial, +6819,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,Aetna-Commercial, +6820,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,Aetna-Commercial, +6821,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,Aetna-Commercial, +6822,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,Aetna-Commercial, +6823,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,Aetna-Commercial, +6824,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,Aetna-Commercial, +6825,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,Aetna-Commercial, +6826,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,Aetna-Commercial,4390.0 +6827,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,Aetna-Commercial,3558.07 +6828,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,Aetna-Commercial,3627.6 +6829,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,Aetna-Commercial, +6830,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,Aetna-Commercial,193.29 +6831,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,Aetna-Commercial, +6832,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,Aetna-Commercial,7810.0 +6833,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,Aetna-Commercial, +6834,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,Aetna-Commercial, +6835,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,Aetna-Commercial, +6836,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,Aetna-Commercial, +6837,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,Aetna-Commercial,5251.0 +6838,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,Aetna-Commercial, +6839,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,Aetna-Commercial,4287.0 +6840,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,Aetna-Commercial, +6841,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,Aetna-Commercial, +6842,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,Aetna-Commercial,2143.5 +6843,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,Aetna-Commercial, +6844,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,Aetna-Commercial, +6845,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,Aetna-Commercial, +6846,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,Aetna-Commercial, +6847,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,Aetna-Commercial, +6848,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,Aetna-Commercial, +6849,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,Aetna-Commercial, +6850,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,Aetna-Commercial, +6851,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,Aetna-Commercial, +6852,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,Aetna-Commercial,4287.0 +6853,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,Aetna-Commercial,4544.0 +6854,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,Aetna-Commercial, +6855,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,Aetna-Commercial, +6856,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,Aetna-Commercial, +6857,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,Aetna-Commercial, +6858,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,Aetna-Commercial,4399.8 +6859,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,Aetna-Commercial, +6860,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,Aetna-Commercial,4287.0 +6861,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,Aetna-Commercial, +6862,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,Aetna-Commercial, +6863,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,Aetna-Commercial, +6864,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,Aetna-Commercial, +6865,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,Aetna-Commercial,4287.0 +6866,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,Aetna-Commercial, +6867,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,Aetna-Commercial, +6868,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,Aetna-Commercial,8586.15 +6869,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,Aetna-Commercial, +6870,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,Aetna-Commercial, +6871,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,Aetna-Commercial,46112.6 +6872,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,Aetna-Commercial,4045.3 +6873,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,Aetna-Commercial, +6874,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,Aetna-Commercial, +6875,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,Aetna-Commercial, +6876,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,Aetna-Commercial, +6877,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,Aetna-Commercial, +6878,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,Aetna-Commercial, +6879,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,Aetna-Commercial,4544.0 +6880,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,Aetna-Commercial, +6881,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,Aetna-Commercial,8229.2 +6882,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,Aetna-Commercial,21230.37 +6883,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,Aetna-Commercial,2713.5 +6884,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,Aetna-Commercial, +6885,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,Aetna-Commercial, +6886,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,Aetna-Commercial, +6887,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,Aetna-Commercial, +6888,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,Aetna-Commercial,39110.42 +6889,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,Aetna-Commercial,4287.0 +6890,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,Aetna-Commercial,4188.4 +6891,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,Aetna-Commercial,4544.0 +6892,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,Aetna-Commercial, +6893,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,Aetna-Commercial, +6894,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,Aetna-Commercial, +6895,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,Aetna-Commercial,13335.01 +6896,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,Aetna-Commercial,4544.0 +6897,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,Aetna-Commercial, +6898,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,Aetna-Commercial, +6899,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,Aetna-Commercial, +6900,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,Aetna-Commercial, +6901,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,Aetna-Commercial, +6902,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,Aetna-Commercial, +6903,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,Aetna-Commercial, +6904,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,Aetna-Commercial,4544.0 +6905,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,Aetna-Commercial, +6906,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,Aetna-Commercial, +6907,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,Aetna-Commercial,3651.5 +6908,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,Aetna-Commercial, +6909,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,Aetna-Commercial, +6910,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,Aetna-Commercial, +6911,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,Aetna-Commercial,8584.79 +6912,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,Aetna-Commercial, +6913,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,Aetna-Commercial,1340.55 +6914,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,Aetna-Commercial, +6915,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,Aetna-Commercial,3215.25 +6916,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,Aetna-Commercial, +6917,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,Aetna-Commercial, +6918,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,Aetna-Commercial, +6919,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,Aetna-Commercial,9705.52 +6920,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,Aetna-Commercial, +6921,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,Aetna-Commercial,3622.38 +6922,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,Aetna-Commercial,5568.28 +6923,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,Aetna-Commercial,5358.75 +6924,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,Aetna-Commercial,5255.68 +6925,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,Aetna-Commercial,2229.17 +6926,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,Aetna-Commercial, +6927,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,Aetna-Commercial,4287.0 +6928,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,Aetna-Commercial,2272.0 +6929,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,Aetna-Commercial,2272.0 +6930,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,Aetna-Commercial,2477.0 +6931,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,Aetna-Commercial,8469.0 +6932,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,Aetna-Commercial, +6933,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,Aetna-Commercial,60.0 +6934,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,Aetna-Commercial,226.4 +6935,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,Aetna-Commercial, +6936,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,Aetna-Commercial,2063.7 +6937,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,Aetna-Commercial, +6938,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,Aetna-Commercial, +6939,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,Aetna-Commercial, +6940,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,Aetna-Commercial, +6941,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,Aetna-Commercial,8395.53 +6942,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,Aetna-Commercial,6780.52 +6943,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,Aetna-Commercial,3357.41 +6944,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,Aetna-Commercial,8010.0 +6945,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,Aetna-Commercial, +6946,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,Aetna-Commercial,5737.84 +6947,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,Aetna-Commercial, +6948,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,Aetna-Commercial, +6949,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,Aetna-Commercial,4458.33 +6950,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,Aetna-Commercial,4105.5 +6951,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,Aetna-Commercial, +6952,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,Aetna-Commercial, +6953,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,Aetna-Commercial, +6954,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,Aetna-Commercial,4336.1 +6955,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,Aetna-Commercial,4544.0 +6956,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,Aetna-Commercial,406.17 +6957,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,Aetna-Commercial,372.49 +6958,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,Aetna-Commercial, +6959,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,Aetna-Commercial, +6960,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,Aetna-Commercial,4287.0 +6961,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,Aetna-Commercial,131.09 +6962,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,Aetna-Commercial, +6963,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,Aetna-Commercial, +6964,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,Aetna-Commercial, +6965,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,Aetna-Commercial, +6966,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,Aetna-Commercial,16020.0 +6967,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,Aetna-Commercial, +6968,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,Aetna-Commercial, +6969,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,Aetna-Commercial, +6970,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,Aetna-Commercial,4592.0 +6971,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,Aetna-Commercial, +6972,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,Aetna-Commercial, +6973,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,Aetna-Commercial, +6974,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,Aetna-Commercial, +6975,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,Aetna-Commercial, +6976,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,Aetna-Commercial, +6977,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,Aetna-Commercial,30997.51 +6978,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,Aetna-Commercial, +6979,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,Aetna-Commercial,5568.28 +6980,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,Aetna-Commercial, +6981,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,Aetna-Commercial, +6982,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,Aetna-Commercial, +6983,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,Aetna-Commercial, +6984,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,Aetna-Commercial, +6985,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,Aetna-Commercial,2903.75 +6986,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,Aetna-Commercial, +6987,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,Aetna-Commercial,2143.5 +6988,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,Aetna-Commercial,30799.29 +6989,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,Aetna-Commercial, +6990,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,Aetna-Commercial,12004.12 +6991,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,Aetna-Commercial, +6992,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,Aetna-Commercial, +6993,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,Aetna-Commercial, +6994,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,Aetna-Commercial, +6995,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,Aetna-Commercial, +6996,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,Aetna-Commercial,4544.0 +6997,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,Aetna-Commercial,8331.6 +6998,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,Aetna-Commercial, +6999,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,Aetna-Commercial, +7000,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,Aetna-Commercial, +7001,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,Aetna-Commercial,4601.5 +7002,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,Aetna-Commercial,5182.0 +7003,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,Aetna-Commercial, +7004,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,Aetna-Commercial, +7005,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,Aetna-Commercial, +7006,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,Aetna-Commercial,4544.0 +7007,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,Aetna-Commercial, +7008,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,Aetna-Commercial, +7009,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,Aetna-Commercial, +7010,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,Aetna-Commercial, +7011,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,Aetna-Commercial, +7012,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,Aetna-Commercial,15719.54 +7013,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,Aetna-Commercial,15478.55 +7014,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,Aetna-Commercial,15478.55 +7015,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,Aetna-Commercial,15478.55 +7016,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,Aetna-Commercial,10321.63 +7017,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,Aetna-Commercial,57908.97 +7018,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,Aetna-Commercial,11054.03 +7019,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,Aetna-Commercial,11363.16 +7020,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,Aetna-Commercial,4544.0 +7021,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,Aetna-Commercial,4363.05 +7022,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,Aetna-Commercial,5902.58 +7023,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,Aetna-Commercial,2272.0 +7024,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,Aetna-Commercial,9070.4 +7025,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,Aetna-Commercial,40512.65 +7026,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,Aetna-Commercial, +7027,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,Aetna-Commercial, +7028,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,Aetna-Commercial, +7029,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,Aetna-Commercial,3818.8 +7030,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,Aetna-Commercial, +7031,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,Aetna-Commercial, +7032,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,Aetna-Commercial, +7033,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,Aetna-Commercial,4544.0 +7034,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,Aetna-Commercial, +7035,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,Aetna-Commercial, +7036,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,Aetna-Commercial, +7037,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,Aetna-Commercial, +7038,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,Aetna-Commercial, +7039,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,Aetna-Commercial, +7040,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,Aetna-Commercial, +7041,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,Aetna-Commercial, +7042,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,Aetna-Commercial,2272.0 +7043,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,Aetna-Commercial, +7044,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,Aetna-Commercial, +7045,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,Aetna-Commercial, +7046,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,Aetna-Commercial, +7047,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,Aetna-Commercial, +7048,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,Aetna-Commercial,1949.0 +7049,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,Aetna-Commercial,2272.0 +7050,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,Aetna-Commercial, +7051,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,Aetna-Commercial, +7052,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,Aetna-Commercial, +7053,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,Aetna-Commercial, +7054,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,Aetna-Commercial, +7055,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,Aetna-Commercial, +7056,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,Aetna-Commercial,2272.0 +7057,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,Aetna-Commercial, +7058,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,Aetna-Commercial, +7059,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,Aetna-Commercial,4544.0 +7060,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,Aetna-Commercial,1949.0 +7061,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,Aetna-Commercial, +7062,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,Aetna-Commercial, +7063,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,Aetna-Commercial,4287.0 +7064,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,Aetna-Commercial, +7065,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,Aetna-Commercial, +7066,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,Aetna-Commercial, +7067,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,Aetna-Commercial, +7068,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,Aetna-Commercial, +7069,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,Aetna-Commercial, +7070,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,Aetna-Commercial,3875.8 +7071,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,Aetna-Commercial, +7072,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,Aetna-Commercial, +7073,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,Aetna-Commercial, +7074,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,Aetna-Commercial, +7075,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,Aetna-Commercial, +7076,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,Aetna-Commercial, +7077,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,Aetna-Commercial, +7078,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,Aetna-Commercial, +7079,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,Aetna-Commercial, +7080,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,Aetna-Commercial, +7081,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,Aetna-Commercial, +7082,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,Aetna-Commercial,9447.0 +7083,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,Aetna-Commercial, +7084,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,Aetna-Commercial, +7085,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,Aetna-Commercial, +7086,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,Aetna-Commercial, +7087,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,Aetna-Commercial, +7088,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,Aetna-Commercial, +7089,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,Aetna-Commercial,7860.0 +7090,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,Aetna-Commercial,7631.0 +7091,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,Aetna-Commercial, +7092,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,Aetna-Commercial, +7093,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,Aetna-Commercial,4332.8 +7094,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,Aetna-Commercial, +7095,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,Aetna-Commercial, +7096,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,Aetna-Commercial, +7097,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,Aetna-Commercial,4544.0 +7098,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,Aetna-Commercial, +7099,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,Aetna-Commercial, +7100,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,Aetna-Commercial, +7101,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,Aetna-Commercial, +7102,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,Aetna-Commercial, +7103,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,Aetna-Commercial, +7104,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,Aetna-Commercial, +7105,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,Aetna-Commercial, +7106,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,Aetna-Commercial, +7107,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,Aetna-Commercial,4544.0 +7108,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,Aetna-Commercial, +7109,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,Aetna-Commercial, +7110,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,Aetna-Commercial,4544.0 +7111,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,Aetna-Commercial,4544.0 +7112,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,Aetna-Commercial, +7113,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,Aetna-Commercial,4287.0 +7114,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,Aetna-Commercial,5666.78 +7115,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,Aetna-Commercial, +7116,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,Aetna-Commercial,1886.79 +7117,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,Aetna-Commercial,4544.0 +7118,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,Aetna-Commercial,914.53 +7119,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,Aetna-Commercial,4544.0 +7120,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,Aetna-Commercial,4199.5 +7121,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,Aetna-Commercial,1902.8 +7122,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,Aetna-Commercial,2943.67 +7123,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,Aetna-Commercial,5034.0 +7124,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,Aetna-Commercial,4544.0 +7125,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,Aetna-Commercial, +7126,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,Aetna-Commercial, +7127,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,Aetna-Commercial,3392.11 +7128,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,Aetna-Commercial,3633.39 +7129,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,Aetna-Commercial, +7130,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,Aetna-Commercial, +7131,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,Aetna-Commercial,4415.5 +7132,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,Aetna-Commercial,5791.98 +7133,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,Aetna-Commercial,4544.0 +7134,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,Aetna-Commercial,5791.98 +7135,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,Aetna-Commercial, +7136,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,Aetna-Commercial, +7137,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,Aetna-Commercial, +7138,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,Aetna-Commercial, +7139,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,Aetna-Commercial,8089.0 +7140,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,Aetna-Commercial,7397.4 +7141,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,Aetna-Commercial, +7142,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,Aetna-Commercial, +7143,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,Aetna-Commercial,3851.0 +7144,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,Aetna-Commercial,3815.5 +7145,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,Aetna-Commercial, +7146,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,Aetna-Commercial,2954.8 +7147,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,Aetna-Commercial, +7148,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,Aetna-Commercial, +7149,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,Aetna-Commercial,8736.57 +7150,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,Aetna-Commercial,6796.6 +7151,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,Aetna-Commercial,7658.2 +7152,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,Aetna-Commercial,2272.0 +7153,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,Aetna-Commercial,4287.0 +7154,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,Aetna-Commercial,952.14 +7155,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,Aetna-Commercial,7631.0 +7156,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,Aetna-Commercial, +7157,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,Aetna-Commercial, +7158,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,Aetna-Commercial,4287.0 +7159,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,Aetna-Commercial, +7160,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,Aetna-Commercial, +7161,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,Aetna-Commercial, +7162,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,Aetna-Commercial, +7163,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,Aetna-Commercial, +7164,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,Aetna-Commercial, +7165,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,Aetna-Commercial, +7166,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,Aetna-Commercial, +7167,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,Aetna-Commercial, +7168,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,Aetna-Commercial, +7169,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,Aetna-Commercial, +7170,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,Aetna-Commercial, +7171,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,Aetna-Commercial, +7172,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,Aetna-Commercial, +7173,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,Aetna-Commercial, +7174,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,Aetna-Commercial, +7175,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,Aetna-Commercial, +7176,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,Aetna-Commercial, +7177,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,Aetna-Commercial,16249.25 +7178,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,Aetna-Commercial, +7179,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,Aetna-Commercial, +7180,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,Aetna-Commercial,4287.0 +7181,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,Aetna-Commercial, +7182,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,Aetna-Commercial, +7183,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,Aetna-Commercial,2428.65 +7184,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,Aetna-Commercial,2143.5 +7185,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,Aetna-Commercial,4544.0 +7186,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,Aetna-Commercial, +7187,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,Aetna-Commercial, +7188,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,Aetna-Commercial, +7189,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,Aetna-Commercial, +7190,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,Aetna-Commercial,4544.0 +7191,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,Aetna-Commercial, +7192,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,Aetna-Commercial, +7193,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,Aetna-Commercial, +7194,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,Aetna-Commercial, +7195,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,Aetna-Commercial,4544.0 +7196,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,Aetna-Commercial, +7197,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,Aetna-Commercial,4544.0 +7198,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,Aetna-Commercial,7556.9 +7199,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,Aetna-Commercial, +7200,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,Aetna-Commercial, +7201,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,Aetna-Commercial,4544.0 +7202,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,Aetna-Commercial, +7203,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,Aetna-Commercial,4287.0 +7204,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,Aetna-Commercial, +7205,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,Aetna-Commercial,4287.0 +7206,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,Aetna-Commercial, +7207,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,Aetna-Commercial, +7208,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,Aetna-Commercial,3698.67 +7209,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,Aetna-Commercial, +7210,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,Aetna-Commercial, +7211,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,Aetna-Commercial, +7212,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,Aetna-Commercial, +7213,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,Aetna-Commercial, +7214,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,Aetna-Commercial, +7215,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,Aetna-Commercial,4287.0 +7216,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,Aetna-Commercial,4544.0 +7217,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,Aetna-Commercial,3215.25 +7218,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,Aetna-Commercial, +7219,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,Aetna-Commercial, +7220,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,Aetna-Commercial, +7221,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,Aetna-Commercial, +7222,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,Aetna-Commercial, +7223,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,Aetna-Commercial, +7224,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,Aetna-Commercial, +7225,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,Aetna-Commercial,4544.0 +7226,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,Aetna-Commercial, +7227,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,Aetna-Commercial, +7228,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,Aetna-Commercial,4319.27 +7229,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,Aetna-Commercial, +7230,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,Aetna-Commercial,4544.0 +7231,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,Aetna-Commercial,3987.4 +7232,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,Aetna-Commercial,4544.0 +7233,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,Aetna-Commercial, +7234,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,Aetna-Commercial, +7235,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,Aetna-Commercial, +7236,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,Aetna-Commercial, +7237,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,Aetna-Commercial, +7238,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,Aetna-Commercial, +7239,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,Aetna-Commercial,4390.0 +7240,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,Aetna-Commercial,4332.6 +7241,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,Aetna-Commercial,4347.65 +7242,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,Aetna-Commercial, +7243,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,Aetna-Commercial, +7244,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,Aetna-Commercial, +7245,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,Aetna-Commercial,4544.0 +7246,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,Aetna-Commercial, +7247,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,Aetna-Commercial, +7248,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,Aetna-Commercial, +7249,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,Aetna-Commercial, +7250,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,Aetna-Commercial, +7251,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,Aetna-Commercial, +7252,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,Aetna-Commercial,3766.97 +7253,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,Aetna-Commercial,11505.0 +7254,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,Aetna-Commercial,8089.0 +7255,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,Aetna-Commercial,7140.06 +7256,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,Aetna-Commercial, +7257,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,Aetna-Commercial, +7258,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,Aetna-Commercial, +7259,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,Aetna-Commercial,952.14 +7260,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,Aetna-Commercial,952.14 +7261,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,Aetna-Commercial, +7262,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,Aetna-Commercial,4291.82 +7263,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,Aetna-Commercial, +7264,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,Aetna-Commercial, +7265,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,Aetna-Commercial,15550.76 +7266,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,Aetna-Commercial, +7267,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,Aetna-Commercial,8089.0 +7268,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,Aetna-Commercial, +7269,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,Aetna-Commercial, +7270,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,Aetna-Commercial,4287.0 +7271,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,Aetna-Commercial,17318.88 +7272,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,Aetna-Commercial, +7273,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,Aetna-Commercial,4336.1 +7274,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,Aetna-Commercial, +7275,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,Aetna-Commercial,3071.5 +7276,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,Aetna-Commercial, +7277,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,Aetna-Commercial,4544.0 +7278,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,Aetna-Commercial, +7279,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,Aetna-Commercial,4399.8 +7280,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,Aetna-Commercial,4544.0 +7281,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,Aetna-Commercial, +7282,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,Aetna-Commercial, +7283,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,Aetna-Commercial, +7284,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,Aetna-Commercial, +7285,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,Aetna-Commercial, +7286,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,Aetna-Commercial,8089.0 +7287,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,Aetna-Commercial,7597.84 +7288,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,Aetna-Commercial,7796.9 +7289,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,Aetna-Commercial,7748.35 +7290,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,Aetna-Commercial, +7291,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,Aetna-Commercial,4044.5 +7292,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,Aetna-Commercial,4044.5 +7293,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,Aetna-Commercial, +7294,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,Aetna-Commercial, +7295,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,Aetna-Commercial,8089.0 +7296,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,Aetna-Commercial, +7297,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,Aetna-Commercial,8089.0 +7298,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,Aetna-Commercial,8016.9 +7299,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,Aetna-Commercial,7688.63 +7300,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,Aetna-Commercial, +7301,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,Aetna-Commercial, +7302,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,Aetna-Commercial, +7303,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,Aetna-Commercial,9774.0 +7304,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,Aetna-Commercial,9467.65 +7305,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,Aetna-Commercial,8089.0 +7306,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,Aetna-Commercial,10192.48 +7307,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,Aetna-Commercial,7631.0 +7308,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,Aetna-Commercial, +7309,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,Aetna-Commercial, +7310,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,Aetna-Commercial,952.14 +7311,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,Aetna-Commercial, +7312,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,Aetna-Commercial,4287.0 +7313,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,Aetna-Commercial, +7314,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,Aetna-Commercial,4544.0 +7315,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,Aetna-Commercial, +7316,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,Aetna-Commercial, +7317,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,Aetna-Commercial,4287.0 +7318,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,Aetna-Commercial,4544.0 +7319,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,Aetna-Commercial, +7320,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,Aetna-Commercial,8544.88 +7321,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,Aetna-Commercial,4287.0 +7322,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,Aetna-Commercial, +7323,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,Aetna-Commercial, +7324,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,Aetna-Commercial, +7325,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,Aetna-Commercial,9774.3 +7326,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,Aetna-Commercial, +7327,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,Aetna-Commercial,8806.9 +7328,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,Aetna-Commercial,3738.0 +7329,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,Aetna-Commercial, +7330,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,Aetna-Commercial, +7331,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,Aetna-Commercial, +7332,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,Aetna-Commercial, +7333,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,Aetna-Commercial, +7334,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,Aetna-Commercial, +7335,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,Aetna-Commercial, +7336,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,Aetna-Commercial, +7337,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,Aetna-Commercial, +7338,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,Aetna-Commercial, +7339,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,Aetna-Commercial, +7340,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,Aetna-Commercial,1949.0 +7341,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,Aetna-Commercial, +7342,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,Aetna-Commercial, +7343,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,Aetna-Commercial, +7344,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,Aetna-Commercial, +7345,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,Aetna-Commercial,2834.12 +7346,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,Aetna-Commercial,1677.2 +7347,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,Aetna-Commercial,2310.24 +7348,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,Aetna-Commercial, +7349,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,Aetna-Commercial,388.5 +7350,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,Aetna-Commercial,669.67 +7351,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,Aetna-Commercial,349.3 +7352,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,Aetna-Commercial,141.4 +7353,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,Aetna-Commercial, +7354,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,Aetna-Commercial,4544.0 +7355,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,Aetna-Commercial, +7356,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,Aetna-Commercial,3791.5 +7357,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,Aetna-Commercial,3840.5 +7358,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,Aetna-Commercial, +7359,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,Aetna-Commercial, +7360,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,Aetna-Commercial,4287.0 +7361,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,Aetna-Commercial,5702.83 +7362,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,Aetna-Commercial,4249.25 +7363,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,Aetna-Commercial, +7364,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,Aetna-Commercial, +7365,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,Aetna-Commercial, +7366,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,Aetna-Commercial,4096.0 +7367,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,Aetna-Commercial, +7368,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,Aetna-Commercial, +7369,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,Aetna-Commercial, +7370,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,Aetna-Commercial, +7371,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,Aetna-Commercial,4544.0 +7372,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,Aetna-Commercial, +7373,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,Aetna-Commercial,2143.5 +7374,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,Aetna-Commercial, +7375,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,Aetna-Commercial,3629.7 +7376,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,Aetna-Commercial, +7377,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,Aetna-Commercial,12607.75 +7378,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,Aetna-Commercial,21607.12 +7379,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,Aetna-Commercial,6570.0 +7380,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,Aetna-Commercial,3602.21 +7381,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,Aetna-Commercial,4439.7 +7382,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,Aetna-Commercial,6278.4 +7383,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,Aetna-Commercial, +7384,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,Aetna-Commercial,5126.61 +7385,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,Aetna-Commercial,4342.45 +7386,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,Aetna-Commercial,2272.0 +7387,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,Aetna-Commercial,3408.0 +7388,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,Aetna-Commercial, +7389,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,Aetna-Commercial,3970.0 +7390,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,Aetna-Commercial,4065.2 +7391,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,Aetna-Commercial, +7392,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,Aetna-Commercial, +7393,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,Aetna-Commercial, +7394,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,Aetna-Commercial, +7395,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,Aetna-Commercial, +7396,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,Aetna-Commercial, +7397,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,Aetna-Commercial, +7398,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,Aetna-Commercial, +7399,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,Aetna-Commercial, +7400,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,Aetna-Commercial,5004.5 +7401,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,Aetna-Commercial, +7402,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,Aetna-Commercial, +7403,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,Aetna-Commercial, +7404,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,Aetna-Commercial, +7405,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,Aetna-Commercial, +7406,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,Aetna-Commercial,4287.0 +7407,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,Aetna-Commercial, +7408,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,Aetna-Commercial,5315.5 +7409,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,Aetna-Commercial, +7410,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,Aetna-Commercial, +7411,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,Aetna-Commercial,6192.0 +7412,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,Aetna-Commercial,4544.0 +7413,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,Aetna-Commercial,4471.9 +7414,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,Aetna-Commercial, +7415,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,Aetna-Commercial,2272.0 +7416,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,Aetna-Commercial, +7417,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,Aetna-Commercial,4287.0 +7418,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,Aetna-Commercial, +7419,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,Aetna-Commercial, +7420,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,Aetna-Commercial, +7421,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,Aetna-Commercial,4544.0 +7422,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,Aetna-Commercial, +7423,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,Aetna-Commercial, +7424,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,Aetna-Commercial, +7425,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,Aetna-Commercial, +7426,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,Aetna-Commercial, +7427,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,Aetna-Commercial, +7428,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,Aetna-Commercial,14560.8 +7429,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,Aetna-Commercial, +7430,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,Aetna-Commercial, +7431,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,Aetna-Commercial,4287.0 +7432,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,Aetna-Commercial, +7433,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,Aetna-Commercial,2272.0 +7434,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,Aetna-Commercial,2143.5 +7435,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,Aetna-Commercial, +7436,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,Aetna-Commercial,7204.42 +7437,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,Aetna-Commercial, +7438,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,Aetna-Commercial,4544.0 +7439,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,Aetna-Commercial, +7440,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,Aetna-Commercial, +7441,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,Aetna-Commercial, +7442,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,Aetna-Commercial,4544.0 +7443,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,Aetna-Commercial, +7444,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,Aetna-Commercial,4544.0 +7445,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,Aetna-Commercial, +7446,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,Aetna-Commercial, +7447,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,Aetna-Commercial, +7448,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,Aetna-Commercial,4544.0 +7449,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,Aetna-Commercial, +7450,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,Aetna-Commercial,4544.0 +7451,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,Aetna-Commercial, +7452,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,Aetna-Commercial, +7453,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,Aetna-Commercial,4079.2 +7454,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,Aetna-Commercial,6294.0 +7455,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,Aetna-Commercial, +7456,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,Aetna-Commercial, +7457,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,Aetna-Commercial, +7458,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,Aetna-Commercial, +7459,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,Aetna-Commercial, +7460,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,Aetna-Commercial, +7461,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,Aetna-Commercial,1839.0 +7462,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,Aetna-Commercial, +7463,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,Aetna-Commercial, +7464,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,Aetna-Commercial, +7465,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,Aetna-Commercial,1949.0 +7466,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,Aetna-Commercial,4287.0 +7467,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,Aetna-Commercial, +7468,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,Aetna-Commercial, +7469,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,Aetna-Commercial,4038.6 +7470,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,Aetna-Commercial, +7471,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,Aetna-Commercial, +7472,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,Aetna-Commercial, +7473,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,Aetna-Commercial,4544.0 +7474,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,Aetna-Commercial, +7475,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,Aetna-Commercial,10391.0 +7476,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,Aetna-Commercial, +7477,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,Aetna-Commercial, +7478,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,Aetna-Commercial,4544.0 +7479,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,Aetna-Commercial, +7480,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,Aetna-Commercial, +7481,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,Aetna-Commercial,2811.4 +7482,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,Aetna-Commercial, +7483,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,Aetna-Commercial,8009.0 +7484,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,Aetna-Commercial, +7485,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,Aetna-Commercial,4544.0 +7486,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,Aetna-Commercial,8726.08 +7487,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,Aetna-Commercial,3279.5 +7488,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,Aetna-Commercial, +7489,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,Aetna-Commercial, +7490,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,Aetna-Commercial,2207.75 +7491,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,Aetna-Commercial, +7492,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,Aetna-Commercial, +7493,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,Aetna-Commercial, +7494,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,Aetna-Commercial,12409.42 +7495,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,Aetna-Commercial, +7496,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,Aetna-Commercial, +7497,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,Aetna-Commercial,7655.7 +7498,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,Aetna-Commercial, +7499,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,Aetna-Commercial, +7500,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,Aetna-Commercial, +7501,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,Aetna-Commercial, +7502,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,Aetna-Commercial, +7503,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,Aetna-Commercial, +7504,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,Aetna-Commercial, +7505,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,Aetna-Commercial, +7506,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,Aetna-Commercial, +7507,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,Aetna-Commercial, +7508,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,Aetna-Commercial, +7509,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,Aetna-Commercial,3896.6 +7510,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,Aetna-Commercial,4287.0 +7511,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,Aetna-Commercial,2272.0 +7512,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,Aetna-Commercial, +7513,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,Aetna-Commercial,2272.0 +7514,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,Aetna-Commercial, +7515,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,Aetna-Commercial, +7516,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,Aetna-Commercial,5174.97 +7517,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,Aetna-Commercial,2143.5 +7518,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,Aetna-Commercial, +7519,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,Aetna-Commercial, +7520,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,Aetna-Commercial,2143.5 +7521,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,Aetna-Commercial,2143.5 +7522,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,Aetna-Commercial,4287.0 +7523,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,Aetna-Commercial,1581.8 +7524,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,Aetna-Commercial, +7525,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,Aetna-Commercial, +7526,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,Aetna-Commercial,8089.0 +7527,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,Aetna-Commercial, +7528,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,Aetna-Commercial,8228.8 +7529,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,Aetna-Commercial, +7530,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,Aetna-Commercial,12796.5 +7531,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,Aetna-Commercial,7631.0 +7532,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,Aetna-Commercial,7983.1 +7533,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,Aetna-Commercial, +7534,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,Aetna-Commercial,7671.11 +7535,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,Aetna-Commercial, +7536,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,Aetna-Commercial,3815.5 +7537,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,Aetna-Commercial,7050.0 +7538,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,Aetna-Commercial,7631.0 +7539,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,Aetna-Commercial,7261.4 +7540,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,Aetna-Commercial,7024.8 +7541,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,Aetna-Commercial,29081.65 +7542,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,Aetna-Commercial, +7543,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,Aetna-Commercial, +7544,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,Aetna-Commercial,3815.5 +7545,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,Aetna-Commercial,7647.43 +7546,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,Aetna-Commercial,7631.0 +7547,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,Aetna-Commercial, +7548,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,Aetna-Commercial,2785.09 +7549,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,Aetna-Commercial, +7550,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,Aetna-Commercial,4287.0 +7551,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,Aetna-Commercial, +7552,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,Aetna-Commercial,4544.0 +7553,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,Aetna-Commercial, +7554,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,Aetna-Commercial, +7555,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,Aetna-Commercial,1894.0 +7556,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,Aetna-Commercial,7786.13 +7557,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,Aetna-Commercial, +7558,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,Aetna-Commercial,4287.0 +7559,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,Aetna-Commercial, +7560,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,Aetna-Commercial,4287.0 +7561,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,Aetna-Commercial, +7562,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,Aetna-Commercial, +7563,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,Aetna-Commercial, +7564,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,Aetna-Commercial, +7565,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,Aetna-Commercial, +7566,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,Aetna-Commercial, +7567,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,Aetna-Commercial, +7568,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,Aetna-Commercial,4287.0 +7569,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,Aetna-Commercial,4544.0 +7570,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,Aetna-Commercial, +7571,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,Aetna-Commercial,4544.0 +7572,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,Aetna-Commercial,4544.0 +7573,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,Aetna-Commercial,5757.0 +7574,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,Aetna-Commercial, +7575,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,Aetna-Commercial,4038.6 +7576,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,Aetna-Commercial, +7577,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,Aetna-Commercial,4544.0 +7578,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,Aetna-Commercial, +7579,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,Aetna-Commercial,5519.06 +7580,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,Aetna-Commercial,4287.0 +7581,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,Aetna-Commercial,2143.5 +7582,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,Aetna-Commercial,5955.46 +7583,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,Aetna-Commercial,4544.0 +7584,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,Aetna-Commercial,4287.0 +7585,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,Aetna-Commercial,3931.4 +7586,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,Aetna-Commercial, +7587,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,Aetna-Commercial, +7588,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,Aetna-Commercial,45347.55 +7589,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,Aetna-Commercial, +7590,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,Aetna-Commercial, +7591,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,Aetna-Commercial, +7592,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,Aetna-Commercial,20747.4 +7593,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,Aetna-Commercial, +7594,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,Aetna-Commercial,18524.37 +7595,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,Aetna-Commercial, +7596,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,Aetna-Commercial, +7597,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,Aetna-Commercial,3932.9 +7598,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,Aetna-Commercial, +7599,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,Aetna-Commercial, +7600,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,Aetna-Commercial,4544.0 +7601,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,Aetna-Commercial, +7602,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,Aetna-Commercial,4544.0 +7603,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,Aetna-Commercial, +7604,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,Aetna-Commercial, +7605,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,Aetna-Commercial, +7606,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,Aetna-Commercial, +7607,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,Aetna-Commercial, +7608,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,Aetna-Commercial, +7609,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,Aetna-Commercial,15671.9 +7610,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,Aetna-Commercial, +7611,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,Aetna-Commercial, +7612,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,Aetna-Commercial, +7613,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,Aetna-Commercial, +7614,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,Aetna-Commercial,31328.0 +7615,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,Aetna-Commercial, +7616,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,Aetna-Commercial, +7617,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,Aetna-Commercial, +7618,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,Aetna-Commercial, +7619,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,Aetna-Commercial, +7620,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,Aetna-Commercial, +7621,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,Aetna-Commercial, +7622,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,Aetna-Commercial, +7623,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,Aetna-Commercial, +7624,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,Aetna-Commercial, +7625,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,Aetna-Commercial, +7626,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,Aetna-Commercial, +7627,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,Aetna-Commercial, +7628,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,Aetna-Commercial,459.24 +7629,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,Aetna-Commercial, +7630,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,Aetna-Commercial, +7631,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,Aetna-Commercial, +7632,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,Aetna-Commercial, +7633,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,Aetna-Commercial, +7634,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,Aetna-Commercial,6430.5 +7635,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,Aetna-Commercial,2272.0 +7636,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,Aetna-Commercial, +7637,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,Aetna-Commercial, +7638,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,Aetna-Commercial,5680.0 +7639,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,Aetna-Commercial,3408.0 +7640,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,Aetna-Commercial, +7641,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,Aetna-Commercial, +7642,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,Aetna-Commercial, +7643,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,Aetna-Commercial, +7644,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,Aetna-Commercial,963.05 +7645,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,Aetna-Commercial, +7646,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,Aetna-Commercial, +7647,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,Aetna-Commercial, +7648,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,Aetna-Commercial, +7649,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,Aetna-Commercial,8754.0 +7650,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,Aetna-Commercial, +7651,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,Aetna-Commercial,3560.0 +7652,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,Aetna-Commercial, +7653,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,Aetna-Commercial,4071.89 +7654,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,Aetna-Commercial,3963.7 +7655,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,Aetna-Commercial, +7656,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,Aetna-Commercial,918.48 +7657,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,Aetna-Commercial, +7658,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,Aetna-Commercial, +7659,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,Aetna-Commercial,6430.5 +7660,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,Aetna-Commercial,2143.5 +7661,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,Aetna-Commercial,6816.0 +7662,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,Aetna-Commercial,3408.0 +7663,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,Aetna-Commercial, +7664,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,Aetna-Commercial, +7665,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,Aetna-Commercial, +7666,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,Aetna-Commercial, +7667,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,Aetna-Commercial, +7668,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,Aetna-Commercial,4287.0 +7669,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,Aetna-Commercial, +7670,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,Aetna-Commercial, +7671,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,Aetna-Commercial, +7672,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,Aetna-Commercial, +7673,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,Aetna-Commercial,4471.9 +7674,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,Aetna-Commercial,2143.5 +7675,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,Aetna-Commercial,4544.0 +7676,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,Aetna-Commercial, +7677,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,Aetna-Commercial,2272.0 +7678,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,Aetna-Commercial, +7679,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,Aetna-Commercial, +7680,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,Aetna-Commercial, +7681,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,Aetna-Commercial, +7682,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,Aetna-Commercial,4287.0 +7683,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,Aetna-Commercial,2143.5 +7684,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,Aetna-Commercial, +7685,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,Aetna-Commercial, +7686,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,Aetna-Commercial, +7687,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,Aetna-Commercial, +7688,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,Aetna-Commercial, +7689,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,Aetna-Commercial,6674.17 +7690,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,Aetna-Commercial, +7691,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,Aetna-Commercial,1530.0 +7692,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,Aetna-Commercial,3572.94 +7693,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,Aetna-Commercial,3788.43 +7694,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,Aetna-Commercial, +7695,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,Aetna-Commercial, +7696,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,Aetna-Commercial, +7697,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,Aetna-Commercial, +7698,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,Aetna-Commercial, +7699,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,Aetna-Commercial, +7700,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,Aetna-Commercial, +7701,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,Aetna-Commercial, +7702,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,Aetna-Commercial, +7703,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,Aetna-Commercial, +7704,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,Aetna-Commercial, +7705,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,Aetna-Commercial, +7706,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,Aetna-Commercial, +7707,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,Aetna-Commercial, +7708,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,Aetna-Commercial, +7709,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,Aetna-Commercial, +7710,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,Aetna-Commercial,4625.91 +7711,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,Aetna-Commercial, +7712,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,Aetna-Commercial, +7713,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,Aetna-Commercial, +7714,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,Aetna-Commercial, +7715,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,Aetna-Commercial, +7716,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,Aetna-Commercial,4704.0 +7717,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,Aetna-Commercial, +7718,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,Aetna-Commercial, +7719,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,Aetna-Commercial, +7720,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,Aetna-Commercial, +7721,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,Aetna-Commercial, +7722,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,Aetna-Commercial,4157.6 +7723,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,Aetna-Commercial,4587.44 +7724,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,Aetna-Commercial, +7725,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,Aetna-Commercial, +7726,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,Aetna-Commercial, +7727,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,Aetna-Commercial, +7728,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,Aetna-Commercial, +7729,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,Aetna-Commercial, +7730,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,Aetna-Commercial, +7731,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,Aetna-Commercial, +7732,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,Aetna-Commercial, +7733,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,Aetna-Commercial, +7734,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,Aetna-Commercial, +7735,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,Aetna-Commercial, +7736,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,Aetna-Commercial, +7737,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,Aetna-Commercial, +7738,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,Aetna-Commercial,4704.0 +7739,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,Aetna-Commercial,8263.26 +7740,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,Aetna-Commercial,2272.0 +7741,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,Aetna-Commercial,4544.0 +7742,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,Aetna-Commercial, +7743,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,Aetna-Commercial,4544.0 +7744,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,Aetna-Commercial, +7745,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,Aetna-Commercial, +7746,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,Aetna-Commercial, +7747,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,Aetna-Commercial,5131.0 +7748,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,Aetna-Commercial, +7749,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,Aetna-Commercial, +7750,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,Aetna-Commercial,5131.0 +7751,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,Aetna-Commercial, +7752,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,Aetna-Commercial, +7753,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,Aetna-Commercial, +7754,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,Aetna-Commercial, +7755,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,Aetna-Commercial, +7756,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,Aetna-Commercial, +7757,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,Aetna-Commercial, +7758,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,Aetna-Commercial, +7759,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,Aetna-Commercial,4544.0 +7760,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,Aetna-Commercial, +7761,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,Aetna-Commercial,6816.0 +7762,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,Aetna-Commercial, +7763,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,Aetna-Commercial, +7764,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,Aetna-Commercial, +7765,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,Aetna-Commercial, +7766,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,Aetna-Commercial, +7767,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,Aetna-Commercial, +7768,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,Aetna-Commercial, +7769,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,Aetna-Commercial, +7770,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,Aetna-Commercial, +7771,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,Aetna-Commercial, +7772,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,Aetna-Commercial, +7773,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,Aetna-Commercial, +7774,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,Aetna-Commercial,4089.6 +7775,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,Aetna-Commercial,4544.0 +7776,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,Aetna-Commercial,2143.5 +7777,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,Aetna-Commercial, +7778,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,Aetna-Commercial,4093.9 +7779,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,Aetna-Commercial, +7780,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,Aetna-Commercial,4287.0 +7781,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,Aetna-Commercial,4544.0 +7782,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,Aetna-Commercial, +7783,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,Aetna-Commercial, +7784,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,Aetna-Commercial,4544.0 +7785,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,Aetna-Commercial, +7786,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,Aetna-Commercial, +7787,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,Aetna-Commercial,2344.49 +7788,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,Aetna-Commercial, +7789,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,Aetna-Commercial, +7790,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,Aetna-Commercial, +7791,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,Aetna-Commercial,8487.75 +7792,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,Aetna-Commercial, +7793,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,Aetna-Commercial,4287.0 +7794,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,Aetna-Commercial, +7795,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,Aetna-Commercial,2344.63 +7796,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,Aetna-Commercial, +7797,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,Aetna-Commercial, +7798,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,Aetna-Commercial, +7799,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,Aetna-Commercial, +7800,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,Aetna-Commercial, +7801,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,Aetna-Commercial, +7802,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,Aetna-Commercial, +7803,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,Aetna-Commercial,4287.0 +7804,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,Aetna-Commercial, +7805,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,Aetna-Commercial, +7806,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,Aetna-Commercial, +7807,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,Aetna-Commercial, +7808,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,Aetna-Commercial, +7809,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,Aetna-Commercial, +7810,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,Aetna-Commercial, +7811,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,Aetna-Commercial,4544.0 +7812,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,Aetna-Commercial, +7813,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,Aetna-Commercial,2272.0 +7814,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,Aetna-Commercial, +7815,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,Aetna-Commercial, +7816,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,Aetna-Commercial, +7817,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,Aetna-Commercial,4471.9 +7818,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,Aetna-Commercial,3590.5 +7819,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,Aetna-Commercial, +7820,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,Aetna-Commercial, +7821,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,Aetna-Commercial, +7822,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,Aetna-Commercial,4544.0 +7823,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,Aetna-Commercial, +7824,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,Aetna-Commercial, +7825,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,Aetna-Commercial, +7826,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,Aetna-Commercial, +7827,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,Aetna-Commercial, +7828,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,Aetna-Commercial, +7829,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,Aetna-Commercial, +7830,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,Aetna-Commercial, +7831,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,Aetna-Commercial, +7832,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,Aetna-Commercial, +7833,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,Aetna-Commercial, +7834,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,Aetna-Commercial,942.0 +7835,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,Aetna-Commercial, +7836,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,Aetna-Commercial,560.0 +7837,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,Aetna-Commercial,2259.6 +7838,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,Aetna-Commercial, +7839,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,Aetna-Commercial,2136.0 +7840,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,Aetna-Commercial,2664.0 +7841,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,Aetna-Commercial, +7842,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,Aetna-Commercial,1573.6 +7843,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,Aetna-Commercial, +7844,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,Aetna-Commercial, +7845,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,Aetna-Commercial,2023.7 +7846,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,Aetna-Commercial, +7847,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,Aetna-Commercial, +7848,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,Aetna-Commercial,135.78 +7849,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,Aetna-Commercial,2240.7 +7850,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,Aetna-Commercial,2243.5 +7851,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,Aetna-Commercial,8551.0 +7852,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,Aetna-Commercial,8551.0 +7853,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,Aetna-Commercial, +7854,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,Aetna-Commercial,3870.3 +7855,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,Aetna-Commercial,3916.38 +7856,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,Aetna-Commercial,1855.0 +7857,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,Aetna-Commercial,4078.9 +7858,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,Aetna-Commercial, +7859,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,Aetna-Commercial,3488.8 +7860,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,Aetna-Commercial,3801.56 +7861,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,Aetna-Commercial, +7862,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,Aetna-Commercial,5195.72 +7863,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,Aetna-Commercial,1495.2 +7864,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,Aetna-Commercial,4065.48 +7865,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,Aetna-Commercial,4065.48 +7866,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,Aetna-Commercial, +7867,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,Aetna-Commercial, +7868,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,Aetna-Commercial, +7869,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,Aetna-Commercial, +7870,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,Aetna-Commercial, +7871,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,Aetna-Commercial, +7872,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,Aetna-Commercial,2538.0 +7873,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,Aetna-Commercial,10148.31 +7874,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,Aetna-Commercial, +7875,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,Aetna-Commercial,591.5 +7876,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,Aetna-Commercial,3674.63 +7877,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,Aetna-Commercial, +7878,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,Aetna-Commercial,3798.2 +7879,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,Aetna-Commercial, +7880,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,Aetna-Commercial,262.5 +7881,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,Aetna-Commercial,412.3 +7882,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,Aetna-Commercial,597.1 +7883,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,Aetna-Commercial,949.0 +7884,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,Aetna-Commercial,417.0 +7885,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,Aetna-Commercial, +7886,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,Aetna-Commercial, +7887,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,Aetna-Commercial,279.3 +7888,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,Aetna-Commercial,467.6 +7889,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,Aetna-Commercial,567.0 +7890,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,Aetna-Commercial,451.5 +7891,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,Aetna-Commercial,459.9 +7892,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,Aetna-Commercial,840.0 +7893,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,Aetna-Commercial,673.75 +7894,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,Aetna-Commercial,4348.0 +7895,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,Aetna-Commercial, +7896,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,Aetna-Commercial,318.17 +7897,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,Aetna-Commercial, +7898,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,Aetna-Commercial,135.78 +7899,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,Aetna-Commercial,431.05 +7900,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,Aetna-Commercial, +7901,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,Aetna-Commercial,4744.0 +7902,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,Aetna-Commercial,8798.83 +7903,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,Aetna-Commercial,3980.0 +7904,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,Aetna-Commercial,4215.4 +7905,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,Aetna-Commercial,4684.0 +7906,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,Aetna-Commercial,2216.2 +7907,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,Aetna-Commercial,4067.0 +7908,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,Aetna-Commercial,4133.5 +7909,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,Aetna-Commercial,4312.7 +7910,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,Aetna-Commercial,441.0 +7911,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,Aetna-Commercial,343.0 +7912,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,Aetna-Commercial, +7913,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,Aetna-Commercial,1556.1 +7914,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,Aetna-Commercial, +7915,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,Aetna-Commercial,3025.4 +7916,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,Aetna-Commercial, +7917,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,Aetna-Commercial,3840.2 +7918,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,Aetna-Commercial, +7919,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,Aetna-Commercial,426.0 +7920,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,Aetna-Commercial,361.9 +7921,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,Aetna-Commercial,133.05 +7922,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,Aetna-Commercial, +7923,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,Aetna-Commercial,438.62 +7924,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,Aetna-Commercial, +7925,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,Aetna-Commercial,504.0 +7926,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,Aetna-Commercial,319.03 +7927,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,Aetna-Commercial,511.0 +7928,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,Aetna-Commercial,425.0 +7929,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,Aetna-Commercial,384.3 +7930,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,Aetna-Commercial,484.99 +7931,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,Aetna-Commercial, +7932,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,Aetna-Commercial,609.0 +7933,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,Aetna-Commercial,405.3 +7934,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,Aetna-Commercial,1715.0 +7935,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,Aetna-Commercial, +7936,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,Aetna-Commercial, +7937,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,Aetna-Commercial,2711.1 +7938,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,Aetna-Commercial,3541.3 +7939,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,Aetna-Commercial,3826.0 +7940,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,Aetna-Commercial,2923.2 +7941,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,Aetna-Commercial,326.9 +7942,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,Aetna-Commercial,423.27 +7943,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,Aetna-Commercial,462.7 +7944,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,Aetna-Commercial,419.3 +7945,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,Aetna-Commercial,456.4 +7946,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,Aetna-Commercial,600.6 +7947,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,Aetna-Commercial, +7948,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,Aetna-Commercial,365.0 +7949,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,Aetna-Commercial,332.73 +7950,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,Aetna-Commercial,376.78 +7951,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,Aetna-Commercial,876.0 +7952,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,Aetna-Commercial,96.69 +7953,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,Aetna-Commercial,460.05 +7954,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,Aetna-Commercial, +7955,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,Aetna-Commercial,368.2 +7956,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,Aetna-Commercial,484.9 +7957,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,Aetna-Commercial, +7958,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,Aetna-Commercial,491.4 +7959,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,Aetna-Commercial,348.6 +7960,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,Aetna-Commercial,410.9 +7961,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,Aetna-Commercial,1790.0 +7962,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,Aetna-Commercial,7700.0 +7963,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,Aetna-Commercial, +7964,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,Aetna-Commercial, +7965,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,Aetna-Commercial, +7966,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,Aetna-Commercial,3986.0 +7967,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,Aetna-Commercial,4050.9 +7968,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,Aetna-Commercial, +7969,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,Aetna-Commercial,96.69 +7970,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,Aetna-Commercial,127.6 +7971,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,Aetna-Commercial,2381.0 +7972,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,Aetna-Commercial, +7973,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,Aetna-Commercial,2893.8 +7974,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,Aetna-Commercial,3997.6 +7975,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,Aetna-Commercial,2797.2 +7976,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,Aetna-Commercial,3941.0 +7977,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,Aetna-Commercial,4822.63 +7978,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,Aetna-Commercial,4408.37 +7979,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,Aetna-Commercial,1488.9 +7980,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,Aetna-Commercial,5151.3 +7981,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,Aetna-Commercial,2772.7 +7982,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,Aetna-Commercial, +7983,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,Aetna-Commercial, +7984,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,Aetna-Commercial, +7985,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,Aetna-Commercial,608.3 +7986,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,Aetna-Commercial,596.4 +7987,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,Aetna-Commercial,569.8 +7988,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,Aetna-Commercial,60.2 +7989,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,Aetna-Commercial, +7990,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,Aetna-Commercial, +7991,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,Aetna-Commercial, +7992,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,Aetna-Commercial,905.8 +7993,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,Aetna-Commercial, +7994,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,Aetna-Commercial, +7995,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,Aetna-Commercial, +7996,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,Aetna-Commercial, +7997,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,Aetna-Commercial, +7998,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,Aetna-Commercial, +7999,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,Aetna-Commercial,1068.2 +8000,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,Aetna-Commercial,2354.1 +8001,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,Aetna-Commercial,612.5 +8002,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,Aetna-Commercial, +8003,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,Aetna-Commercial,1625.4 +8004,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,Aetna-Commercial,5439.81 +8005,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,Aetna-Commercial,512.05 +8006,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,Aetna-Commercial,951.58 +8007,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,Aetna-Commercial,2726.96 +8008,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,Aetna-Commercial, +8009,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,Aetna-Commercial,2023.0 +8010,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,Aetna-Commercial, +8011,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,Aetna-Commercial, +8012,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,Aetna-Commercial, +8013,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,Aetna-Commercial, +8014,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,Aetna-Commercial, +8015,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,Aetna-Commercial,576.1 +8016,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,Aetna-Commercial, +8017,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,Aetna-Commercial, +8018,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,Aetna-Commercial, +8019,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,Aetna-Commercial, +8020,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,Aetna-Commercial, +8021,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,Aetna-Commercial, +8022,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,Aetna-Commercial, +8023,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,Aetna-Commercial, +8024,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,Aetna-Commercial, +8025,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,Aetna-Commercial,3370.33 +8026,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,Aetna-Commercial, +8027,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,Aetna-Commercial,583.43 +8028,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,Aetna-Commercial,909.3 +8029,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,Aetna-Commercial, +8030,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,Aetna-Commercial,565.31 +8031,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,Aetna-Commercial, +8032,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,Aetna-Commercial, +8033,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,Aetna-Commercial, +8034,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,Aetna-Commercial, +8035,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,Aetna-Commercial, +8036,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,Aetna-Commercial, +8037,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,Aetna-Commercial, +8038,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,Aetna-Commercial, +8039,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,Aetna-Commercial,786.1 +8040,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,Aetna-Commercial,1055.47 +8041,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,Aetna-Commercial,606.67 +8042,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,Aetna-Commercial,1050.0 +8043,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,Aetna-Commercial,849.8 +8044,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,Aetna-Commercial,808.1 +8045,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,Aetna-Commercial,676.2 +8046,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,Aetna-Commercial,862.4 +8047,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,Aetna-Commercial,990.0 +8048,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,Aetna-Commercial, +8049,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,Aetna-Commercial,395.5 +8050,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,Aetna-Commercial, +8051,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,Aetna-Commercial, +8052,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,Aetna-Commercial, +8053,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,Aetna-Commercial, +8054,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,Aetna-Commercial, +8055,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,Aetna-Commercial, +8056,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,Aetna-Commercial,502.0 +8057,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,Aetna-Commercial,480.9 +8058,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,Aetna-Commercial, +8059,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,Aetna-Commercial, +8060,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,Aetna-Commercial, +8061,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,Aetna-Commercial, +8062,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,Aetna-Commercial,2767.18 +8063,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,Aetna-Commercial,2767.18 +8064,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,Aetna-Commercial,4081.0 +8065,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,Aetna-Commercial,2582.3 +8066,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,Aetna-Commercial,135.78 +8067,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,Aetna-Commercial,2192.87 +8068,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,Aetna-Commercial,6540.0 +8069,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Aetna-Commercial, +8070,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,Aetna-Commercial, +8071,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,Aetna-Commercial, +8072,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,Aetna-Commercial,347.9 +8073,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,Aetna-Commercial, +8074,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,Aetna-Commercial,491.35 +8075,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,Aetna-Commercial,2194.0 +8076,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,Aetna-Commercial, +8077,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,Aetna-Commercial, +8078,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,Aetna-Commercial, +8079,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,Aetna-Commercial,457.5 +8080,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,Aetna-Commercial, +8081,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,Aetna-Commercial, +8082,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,Aetna-Commercial, +8083,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,Aetna-Commercial, +8084,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,Aetna-Commercial,2221.1 +8085,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,Aetna-Commercial,2376.5 +8086,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,Aetna-Commercial,3456.87 +8087,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,Aetna-Commercial,2966.6 +8088,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,Aetna-Commercial, +8089,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,Aetna-Commercial,114.72 +8090,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,Aetna-Commercial,183.91 +8091,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,Aetna-Commercial,146.3 +8092,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,Aetna-Commercial,498.82 +8093,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,Aetna-Commercial,629.38 +8094,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,Aetna-Commercial,872.0 +8095,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,Aetna-Commercial,394.1 +8096,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,Aetna-Commercial,628.25 +8097,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,Aetna-Commercial, +8098,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,Aetna-Commercial, +8099,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,Aetna-Commercial,671.65 +8100,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,Aetna-Commercial,196.4 +8101,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,Aetna-Commercial,1003.0 +8102,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,Aetna-Commercial,2766.0 +8103,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,Aetna-Commercial,268.0 +8104,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,Aetna-Commercial,15313.37 +8105,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,Aetna-Commercial,5055.05 +8106,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,Aetna-Commercial,14470.0 +8107,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,Aetna-Commercial,11642.4 +8108,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,Aetna-Commercial,8009.0 +8109,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,Aetna-Commercial, +8110,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Aetna-Commercial, +8111,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,Aetna-Commercial,3662.4 +8112,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,Aetna-Commercial,3759.91 +8113,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,Aetna-Commercial, +8114,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,Aetna-Commercial,5660.2 +8115,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,Aetna-Commercial,1372.0 +8116,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,Aetna-Commercial,14470.0 +8117,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,Aetna-Commercial,1854.0 +8118,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,Aetna-Commercial,19694.5 +8119,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,Aetna-Commercial,6545.0 +8120,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,Aetna-Commercial,12319.0 +8121,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,Aetna-Commercial,8694.0 +8122,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,Aetna-Commercial,447.0 +8123,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,Aetna-Commercial, +8124,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,Aetna-Commercial, +8125,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,Aetna-Commercial,1470.0 +8126,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,Aetna-Commercial,511.0 +8127,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,Aetna-Commercial,8118.17 +8128,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,Aetna-Commercial, +8129,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,Aetna-Commercial,8009.0 +8130,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,Aetna-Commercial, +8131,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Aetna-Commercial, +8132,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,Aetna-Commercial, +8133,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,Aetna-Commercial, +8134,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,Aetna-Commercial,1404.9 +8135,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,Aetna-Commercial,1004.5 +8136,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,Aetna-Commercial, +8137,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,Aetna-Commercial,1310.4 +8138,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,Aetna-Commercial, +8139,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,Aetna-Commercial, +8140,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,Aetna-Commercial,1355.2 +8141,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,Aetna-Commercial,2593.5 +8142,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,Aetna-Commercial, +8143,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,Aetna-Commercial,1992.2 +8144,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,Aetna-Commercial,441.58 +8145,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,Aetna-Commercial, +8146,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,Aetna-Commercial,6100.62 +8147,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,Aetna-Commercial, +8148,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,Aetna-Commercial, +8149,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,Aetna-Commercial,1082.9 +8150,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,Aetna-Commercial, +8151,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,Aetna-Commercial,1050.7 +8152,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,Aetna-Commercial,1656.9 +8153,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,Aetna-Commercial,6180.3 +8154,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,Aetna-Commercial, +8155,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,Aetna-Commercial,547.02 +8156,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,Aetna-Commercial,1479.1 +8157,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,Aetna-Commercial,1344.0 +8158,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,Aetna-Commercial,1628.2 +8159,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,Aetna-Commercial, +8160,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,Aetna-Commercial, +8161,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,Aetna-Commercial,1949.97 +8162,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,Aetna-Commercial, +8163,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,Aetna-Commercial,7844.2 +8164,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,Aetna-Commercial, +8165,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,Aetna-Commercial, +8166,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,Aetna-Commercial,8208.87 +8167,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,Aetna-Commercial,8142.4 +8168,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,Aetna-Commercial,2900.07 +8169,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,Aetna-Commercial, +8170,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,Aetna-Commercial,3401.3 +8171,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,Aetna-Commercial,287.61 +8172,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,Aetna-Commercial, +8173,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,Aetna-Commercial, +8174,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,Aetna-Commercial,321.34 +8175,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,Aetna-Commercial, +8176,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,Aetna-Commercial,340.55 +8177,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,Aetna-Commercial, +8178,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,Aetna-Commercial,306.99 +8179,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,Aetna-Commercial,157.5 +8180,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,Aetna-Commercial,1844.15 +8181,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,Aetna-Commercial,329.47 +8182,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,Aetna-Commercial,377.3 +8183,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,Aetna-Commercial, +8184,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,Aetna-Commercial, +8185,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,Aetna-Commercial, +8186,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,Aetna-Commercial,381.13 +8187,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,Aetna-Commercial, +8188,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,Aetna-Commercial,14.75 +8189,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,Aetna-Commercial,133.0 +8190,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,Aetna-Commercial,42.0 +8191,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,Aetna-Commercial, +8192,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,Aetna-Commercial,57.4 +8193,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,Aetna-Commercial, +8194,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,Aetna-Commercial,14.0 +8195,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,Aetna-Commercial,13.25 +8196,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,Aetna-Commercial,99.0 +8197,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,Aetna-Commercial,239.0 +8198,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,Aetna-Commercial,15.4 +8199,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,Aetna-Commercial, +8200,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,Aetna-Commercial, +8201,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,Aetna-Commercial, +8202,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,Aetna-Commercial,149.8 +8203,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,Aetna-Commercial,271.54 +8204,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,Aetna-Commercial, +8205,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,Aetna-Commercial, +8206,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,Aetna-Commercial, +8207,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,Aetna-Commercial,539.0 +8208,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,Aetna-Commercial, +8209,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,Aetna-Commercial, +8210,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,Aetna-Commercial, +8211,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,Aetna-Commercial,62.3 +8212,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,Aetna-Commercial, +8213,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,Aetna-Commercial,1839.0 +8214,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,Aetna-Commercial,232.0 +8215,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,Aetna-Commercial,25.9 +8216,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,Aetna-Commercial, +8217,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,Aetna-Commercial,232.0 +8218,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,Aetna-Commercial, +8219,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,Aetna-Commercial, +8220,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,Aetna-Commercial, +8221,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,Aetna-Commercial, +8222,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,Aetna-Commercial,36.0 +8223,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,Aetna-Commercial, +8224,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,Aetna-Commercial, +8225,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,Aetna-Commercial, +8226,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,Aetna-Commercial, +8227,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,Aetna-Commercial, +8228,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,Aetna-Commercial, +8229,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,Aetna-Commercial, +8230,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,Aetna-Commercial,622.97 +8231,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,Aetna-Commercial, +8232,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,Aetna-Commercial,72.0 +8233,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,Aetna-Commercial, +8234,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,Aetna-Commercial,18.9 +8235,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,Aetna-Commercial, +8236,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Aetna-Commercial, +8237,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Aetna-Commercial, +8238,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Aetna-Commercial, +8239,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,Aetna-Commercial, +8240,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,Aetna-Commercial, +8241,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,Aetna-Commercial, +8242,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,Aetna-Commercial, +8243,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,Aetna-Commercial, +8244,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,Aetna-Commercial, +8245,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,Aetna-Commercial, +8246,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,Aetna-Commercial, +8247,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,Aetna-Commercial, +8248,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,Aetna-Commercial, +8249,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,Aetna-Commercial,1262.1 +8250,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,Aetna-Commercial, +8251,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,Aetna-Commercial, +8252,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,Aetna-Commercial, +8253,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,Aetna-Commercial, +8254,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,Aetna-Commercial,140.0 +8255,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,Aetna-Commercial, +8256,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,Aetna-Commercial, +8257,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,Aetna-Commercial, +8258,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,Aetna-Commercial, +8259,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,Aetna-Commercial, +8260,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,Aetna-Commercial,221.9 +8261,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,Aetna-Commercial,277.2 +8262,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,Aetna-Commercial, +8263,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,Aetna-Commercial, +8264,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,Aetna-Commercial, +8265,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,Aetna-Commercial, +8266,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,Aetna-Commercial, +8267,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,Aetna-Commercial,95.0 +8268,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,Aetna-Commercial, +8269,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,Aetna-Commercial, +8270,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,Aetna-Commercial, +8271,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,Aetna-Commercial, +8272,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,Aetna-Commercial, +8273,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,Aetna-Commercial,178.0 +8274,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,Aetna-Commercial,803.99 +8275,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,Aetna-Commercial, +8276,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,Aetna-Commercial,112.0 +8277,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,Aetna-Commercial, +8278,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,Aetna-Commercial, +8279,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,Aetna-Commercial, +8280,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,Aetna-Commercial,48.3 +8281,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,Aetna-Commercial, +8282,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,Aetna-Commercial, +8283,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,Aetna-Commercial,155.4 +8284,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,Aetna-Commercial,246.52 +8285,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,Aetna-Commercial, +8286,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,Aetna-Commercial, +8287,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,Aetna-Commercial,230.35 +8288,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,Aetna-Commercial, +8289,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,Aetna-Commercial, +8290,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,Aetna-Commercial, +8291,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,Aetna-Commercial, +8292,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,Aetna-Commercial, +8293,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,Aetna-Commercial,93.1 +8294,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,Aetna-Commercial,150.33 +8295,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,Aetna-Commercial,953.4 +8296,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,Aetna-Commercial, +8297,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,Aetna-Commercial,826.0 +8298,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,Aetna-Commercial, +8299,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,Aetna-Commercial,593.6 +8300,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,Aetna-Commercial, +8301,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,Aetna-Commercial, +8302,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,Aetna-Commercial, +8303,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,Aetna-Commercial, +8304,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,Aetna-Commercial, +8305,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,Aetna-Commercial, +8306,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,Aetna-Commercial, +8307,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,Aetna-Commercial,137.0 +8308,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,Aetna-Commercial,235.9 +8309,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,Aetna-Commercial, +8310,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,Aetna-Commercial, +8311,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,Aetna-Commercial, +8312,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,Aetna-Commercial,970.0 +8313,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,Aetna-Commercial, +8314,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,Aetna-Commercial,1270.0 +8315,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,Aetna-Commercial, +8316,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,Aetna-Commercial, +8317,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,Aetna-Commercial, +8318,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,Aetna-Commercial,1520.0 +8319,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,Aetna-Commercial, +8320,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,Aetna-Commercial, +8321,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,Aetna-Commercial, +8322,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,Aetna-Commercial, +8323,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,Aetna-Commercial,17.0 +8324,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,Aetna-Commercial,39.9 +8325,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,Aetna-Commercial,42.28 +8326,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,Aetna-Commercial,91.7 +8327,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,Aetna-Commercial,6.0 +8328,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,Aetna-Commercial, +8329,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,Aetna-Commercial,13.44 +8330,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,Aetna-Commercial, +8331,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,Aetna-Commercial,194.6 +8332,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,Aetna-Commercial, +8333,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,Aetna-Commercial, +8334,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,Aetna-Commercial, +8335,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,Aetna-Commercial, +8336,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,Aetna-Commercial, +8337,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,Aetna-Commercial,88.9 +8338,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,Aetna-Commercial,1686.0 +8339,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,Aetna-Commercial, +8340,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,Aetna-Commercial,10.73 +8341,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,Aetna-Commercial, +8342,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,Aetna-Commercial, +8343,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,Aetna-Commercial,16.1 +8344,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,Aetna-Commercial,166.6 +8345,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,Aetna-Commercial,9.8 +8346,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,Aetna-Commercial,89.25 +8347,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,Aetna-Commercial,78.4 +8348,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,Aetna-Commercial,56.0 +8349,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,Aetna-Commercial, +8350,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,Aetna-Commercial, +8351,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,Aetna-Commercial, +8352,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,Aetna-Commercial,488.0 +8353,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,Aetna-Commercial, +8354,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,Aetna-Commercial,85.0 +8355,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,Aetna-Commercial, +8356,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,Aetna-Commercial,3.5 +8357,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,Aetna-Commercial,9.8 +8358,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,Aetna-Commercial,116.0 +8359,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,Aetna-Commercial, +8360,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,Aetna-Commercial,209.3 +8361,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,Aetna-Commercial, +8362,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,Aetna-Commercial, +8363,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,Aetna-Commercial, +8364,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,Aetna-Commercial,93.8 +8365,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,Aetna-Commercial, +8366,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,Aetna-Commercial,72.0 +8367,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,Aetna-Commercial,44.8 +8368,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,Aetna-Commercial,27.3 +8369,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,Aetna-Commercial,104.0 +8370,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,Aetna-Commercial,16.1 +8371,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,Aetna-Commercial, +8372,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,Aetna-Commercial,8.4 +8373,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,Aetna-Commercial, +8374,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,Aetna-Commercial,560.0 +8375,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,Aetna-Commercial,166.88 +8376,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,Aetna-Commercial,712.5 +8377,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,Aetna-Commercial, +8378,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,Aetna-Commercial, +8379,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,Aetna-Commercial,79.9 +8380,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,Aetna-Commercial,83.0 +8381,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,Aetna-Commercial,160.3 +8382,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,Aetna-Commercial, +8383,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,Aetna-Commercial,61.6 +8384,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,Aetna-Commercial,167.0 +8385,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,Aetna-Commercial,32.2 +8386,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,Aetna-Commercial, +8387,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,Aetna-Commercial, +8388,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,Aetna-Commercial, +8389,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,Aetna-Commercial,20.0 +8390,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,Aetna-Commercial,56.7 +8391,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,Aetna-Commercial, +8392,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,Aetna-Commercial, +8393,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,Aetna-Commercial,7.0 +8394,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,Aetna-Commercial,311.5 +8395,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,Aetna-Commercial, +8396,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,Aetna-Commercial, +8397,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,Aetna-Commercial, +8398,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,Aetna-Commercial,13.3 +8399,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,Aetna-Commercial, +8400,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,Aetna-Commercial, +8401,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,Aetna-Commercial, +8402,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,Aetna-Commercial,134.15 +8403,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,Aetna-Commercial, +8404,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,Aetna-Commercial,183.0 +8405,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,Aetna-Commercial, +8406,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,Aetna-Commercial,400.7 +8407,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,Aetna-Commercial,200.9 +8408,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,Aetna-Commercial,32.08 +8409,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,Aetna-Commercial, +8410,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,Aetna-Commercial,468.0 +8411,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,Aetna-Commercial, +8412,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,Aetna-Commercial,49.0 +8413,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,Aetna-Commercial,58.0 +8414,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,Aetna-Commercial, +8415,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,Aetna-Commercial, +8416,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,Aetna-Commercial, +8417,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,Aetna-Commercial, +8418,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,Aetna-Commercial, +8419,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,Aetna-Commercial, +8420,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,Aetna-Commercial,58.8 +8421,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,Aetna-Commercial,87.06 +8422,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,Aetna-Commercial,209.3 +8423,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,Aetna-Commercial,224.7 +8424,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,Aetna-Commercial,49.0 +8425,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,Aetna-Commercial, +8426,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,Aetna-Commercial,126.0 +8427,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,Aetna-Commercial, +8428,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,Aetna-Commercial, +8429,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,Aetna-Commercial,132.1 +8430,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,Aetna-Commercial, +8431,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,Aetna-Commercial,212.0 +8432,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,Aetna-Commercial, +8433,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,Aetna-Commercial, +8434,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,Aetna-Commercial, +8435,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,Aetna-Commercial,224.0 +8436,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,Aetna-Commercial,11.9 +8437,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,Aetna-Commercial, +8438,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,Aetna-Commercial, +8439,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,Aetna-Commercial,46.69 +8440,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,Aetna-Commercial,148.05 +8441,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,Aetna-Commercial,65.8 +8442,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,Aetna-Commercial,5.6 +8443,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,Aetna-Commercial,92.46 +8444,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,Aetna-Commercial,252.0 +8445,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,Aetna-Commercial,67.42 +8446,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,Aetna-Commercial, +8447,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,Aetna-Commercial, +8448,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,Aetna-Commercial,4.2 +8449,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,Aetna-Commercial,175.55 +8450,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,Aetna-Commercial, +8451,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,Aetna-Commercial, +8452,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,Aetna-Commercial, +8453,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,Aetna-Commercial, +8454,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,Aetna-Commercial,1014.94 +8455,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,Aetna-Commercial, +8456,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,Aetna-Commercial,34.3 +8457,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,Aetna-Commercial, +8458,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,Aetna-Commercial, +8459,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,Aetna-Commercial, +8460,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,Aetna-Commercial,17.5 +8461,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,Aetna-Commercial, +8462,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,Aetna-Commercial, +8463,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,Aetna-Commercial,320.0 +8464,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,Aetna-Commercial,283.15 +8465,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,Aetna-Commercial,22.4 +8466,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,Aetna-Commercial, +8467,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,Aetna-Commercial,12.6 +8468,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,Aetna-Commercial,74.0 +8469,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,Aetna-Commercial,60.9 +8470,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,Aetna-Commercial,7.7 +8471,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,Aetna-Commercial, +8472,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,Aetna-Commercial,444.6 +8473,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,Aetna-Commercial, +8474,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,Aetna-Commercial, +8475,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,Aetna-Commercial, +8476,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,Aetna-Commercial, +8477,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,Aetna-Commercial,70.7 +8478,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,Aetna-Commercial,14.78 +8479,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,Aetna-Commercial,69.4 +8480,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,Aetna-Commercial, +8481,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,Aetna-Commercial,210.0 +8482,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,Aetna-Commercial, +8483,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,Aetna-Commercial,88.9 +8484,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,Aetna-Commercial,120.0 +8485,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,Aetna-Commercial,45.5 +8486,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,Aetna-Commercial,102.2 +8487,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,Aetna-Commercial, +8488,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,Aetna-Commercial,215.08 +8489,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,Aetna-Commercial,204.11 +8490,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,Aetna-Commercial,294.7 +8491,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,Aetna-Commercial, +8492,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,Aetna-Commercial,181.51 +8493,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,Aetna-Commercial, +8494,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,Aetna-Commercial, +8495,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,Aetna-Commercial,62.0 +8496,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,Aetna-Commercial,58.1 +8497,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,Aetna-Commercial,137.9 +8498,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,Aetna-Commercial,120.4 +8499,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,Aetna-Commercial, +8500,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,Aetna-Commercial, +8501,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,Aetna-Commercial,43.4 +8502,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,Aetna-Commercial,10.0 +8503,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,Aetna-Commercial, +8504,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,Aetna-Commercial, +8505,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,Aetna-Commercial, +8506,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,Aetna-Commercial, +8507,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,Aetna-Commercial,10.5 +8508,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,Aetna-Commercial, +8509,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,Aetna-Commercial,9.1 +8510,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,Aetna-Commercial,65.0 +8511,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,Aetna-Commercial,45.5 +8512,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,Aetna-Commercial, +8513,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,Aetna-Commercial, +8514,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,Aetna-Commercial,14.0 +8515,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,Aetna-Commercial, +8516,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,Aetna-Commercial, +8517,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,Aetna-Commercial,41.3 +8518,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,Aetna-Commercial, +8519,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,Aetna-Commercial,6.0 +8520,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,Aetna-Commercial,15.4 +8521,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,Aetna-Commercial,11.0 +8522,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,Aetna-Commercial,24.03 +8523,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,Aetna-Commercial,107.8 +8524,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,Aetna-Commercial,201.0 +8525,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,Aetna-Commercial,16.43 +8526,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,Aetna-Commercial,2457.33 +8527,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,Aetna-Commercial, +8528,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,Aetna-Commercial,21.0 +8529,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,Aetna-Commercial,56.56 +8530,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,Aetna-Commercial,65.1 +8531,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,Aetna-Commercial,127.81 +8532,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,Aetna-Commercial,121.0 +8533,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,Aetna-Commercial,95.9 +8534,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,Aetna-Commercial,98.0 +8535,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,Aetna-Commercial,10.0 +8536,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,Aetna-Commercial, +8537,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,Aetna-Commercial,1728.0 +8538,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,Aetna-Commercial, +8539,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,Aetna-Commercial,82.0 +8540,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,Aetna-Commercial, +8541,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,Aetna-Commercial,63.7 +8542,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,Aetna-Commercial,2.1 +8543,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,Aetna-Commercial,11.9 +8544,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,Aetna-Commercial, +8545,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,Aetna-Commercial, +8546,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,Aetna-Commercial,9.8 +8547,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,Aetna-Commercial,42.0 +8548,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,Aetna-Commercial,7.7 +8549,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,Aetna-Commercial, +8550,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,Aetna-Commercial,314.0 +8551,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,Aetna-Commercial,189.7 +8552,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,Aetna-Commercial,9.1 +8553,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,Aetna-Commercial,1630.36 +8554,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,Aetna-Commercial,113.0 +8555,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,Aetna-Commercial, +8556,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,Aetna-Commercial,42.0 +8557,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,Aetna-Commercial,41.0 +8558,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,Aetna-Commercial,132.24 +8559,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,Aetna-Commercial,235.62 +8560,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,Aetna-Commercial,21.7 +8561,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,Aetna-Commercial,96.75 +8562,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,Aetna-Commercial,55.44 +8563,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,Aetna-Commercial, +8564,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,Aetna-Commercial,9917.59 +8565,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,Aetna-Commercial,182.0 +8566,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,Aetna-Commercial,154.7 +8567,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,Aetna-Commercial,342.3 +8568,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,Aetna-Commercial,288.17 +8569,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,Aetna-Commercial,233.98 +8570,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,Aetna-Commercial,212.28 +8571,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,Aetna-Commercial,117.25 +8572,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,Aetna-Commercial,485.8 +8573,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,Aetna-Commercial, +8574,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,Aetna-Commercial,238.0 +8575,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,Aetna-Commercial,168.7 +8576,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,Aetna-Commercial, +8577,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,Aetna-Commercial,199.5 +8578,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,Aetna-Commercial, +8579,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,Aetna-Commercial,196.7 +8580,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,Aetna-Commercial,285.6 +8581,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,Aetna-Commercial,499.8 +8582,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,Aetna-Commercial, +8583,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,Aetna-Commercial, +8584,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,Aetna-Commercial, +8585,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,Aetna-Commercial,402.0 +8586,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,Aetna-Commercial,114.38 +8587,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,Aetna-Commercial, +8588,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,Aetna-Commercial, +8589,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,Aetna-Commercial, +8590,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,Aetna-Commercial, +8591,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,Aetna-Commercial, +8592,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,Aetna-Commercial,535.73 +8593,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,Aetna-Commercial,639.45 +8594,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,Aetna-Commercial,89.0 +8595,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,Aetna-Commercial, +8596,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,Aetna-Commercial,199.85 +8597,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,Aetna-Commercial, +8598,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,Aetna-Commercial,80.0 +8599,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,Aetna-Commercial, +8600,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,Aetna-Commercial,50.4 +8601,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,Aetna-Commercial,117.0 +8602,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,Aetna-Commercial,134.87 +8603,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,Aetna-Commercial, +8604,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,Aetna-Commercial,218.0 +8605,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,Aetna-Commercial, +8606,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,Aetna-Commercial, +8607,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,Aetna-Commercial, +8608,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,Aetna-Commercial,51.1 +8609,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,Aetna-Commercial, +8610,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,Aetna-Commercial,126.7 +8611,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,Aetna-Commercial,90.16 +8612,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,Aetna-Commercial,105.0 +8613,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,Aetna-Commercial,214.54 +8614,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,Aetna-Commercial, +8615,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,Aetna-Commercial,21.0 +8616,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,Aetna-Commercial,374.5 +8617,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,Aetna-Commercial,29.4 +8618,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,Aetna-Commercial, +8619,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,Aetna-Commercial, +8620,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,Aetna-Commercial,366.8 +8621,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,Aetna-Commercial, +8622,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,Aetna-Commercial, +8623,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,Aetna-Commercial,111.07 +8624,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,Aetna-Commercial,7.7 +8625,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,Aetna-Commercial,158.9 +8626,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,Aetna-Commercial,994.0 +8627,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,Aetna-Commercial,105.0 +8628,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,Aetna-Commercial,108.5 +8629,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,Aetna-Commercial,252.0 +8630,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,Aetna-Commercial,234.5 +8631,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,Aetna-Commercial,279.3 +8632,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,Aetna-Commercial,59.5 +8633,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,Aetna-Commercial, +8634,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,Aetna-Commercial,21.97 +8635,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,Aetna-Commercial,50.4 +8636,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,Aetna-Commercial, +8637,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,Aetna-Commercial, +8638,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,Aetna-Commercial,202.21 +8639,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,Aetna-Commercial,189.0 +8640,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,Aetna-Commercial,15.59 +8641,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,Aetna-Commercial, +8642,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,Aetna-Commercial,16.8 +8643,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,Aetna-Commercial, +8644,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,Aetna-Commercial,168.0 +8645,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,Aetna-Commercial, +8646,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,Aetna-Commercial,189.7 +8647,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,Aetna-Commercial, +8648,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,Aetna-Commercial,221.55 +8649,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,Aetna-Commercial,207.2 +8650,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,Aetna-Commercial,305.9 +8651,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,Aetna-Commercial,554.4 +8652,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,Aetna-Commercial,7.35 +8653,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,Aetna-Commercial,64.75 +8654,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,Aetna-Commercial,247.1 +8655,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,Aetna-Commercial, +8656,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,Aetna-Commercial,67.2 +8657,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,Aetna-Commercial, +8658,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,Aetna-Commercial, +8659,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,Aetna-Commercial, +8660,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,Aetna-Commercial, +8661,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,Aetna-Commercial, +8662,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,Aetna-Commercial, +8663,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,Aetna-Commercial,404.6 +8664,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,Aetna-Commercial,277.2 +8665,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,Aetna-Commercial, +8666,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,Aetna-Commercial, +8667,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,Aetna-Commercial, +8668,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,Aetna-Commercial, +8669,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,Aetna-Commercial, +8670,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,Aetna-Commercial, +8671,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,Aetna-Commercial,167.07 +8672,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,Aetna-Commercial,7.2 +8673,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,Aetna-Commercial,57.4 +8674,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,Aetna-Commercial,3.2 +8675,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,Aetna-Commercial,4.0 +8676,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,Aetna-Commercial,11.2 +8677,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,Aetna-Commercial,10.5 +8678,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,Aetna-Commercial, +8679,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,Aetna-Commercial, +8680,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,Aetna-Commercial, +8681,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,Aetna-Commercial, +8682,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,Aetna-Commercial,20.0 +8683,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,Aetna-Commercial, +8684,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,Aetna-Commercial, +8685,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,Aetna-Commercial, +8686,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,Aetna-Commercial, +8687,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,Aetna-Commercial, +8688,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,Aetna-Commercial, +8689,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,Aetna-Commercial,74.9 +8690,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,Aetna-Commercial,121.8 +8691,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,Aetna-Commercial,88.2 +8692,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,Aetna-Commercial, +8693,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,Aetna-Commercial,6.3 +8694,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,Aetna-Commercial, +8695,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,Aetna-Commercial, +8696,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,Aetna-Commercial, +8697,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,Aetna-Commercial,144.9 +8698,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,Aetna-Commercial, +8699,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,Aetna-Commercial, +8700,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,Aetna-Commercial, +8701,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,Aetna-Commercial,20.0 +8702,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,Aetna-Commercial,22.4 +8703,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,Aetna-Commercial,98.0 +8704,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,Aetna-Commercial,111.3 +8705,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,Aetna-Commercial,58.8 +8706,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,Aetna-Commercial,116.7 +8707,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,Aetna-Commercial,102.2 +8708,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,Aetna-Commercial, +8709,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,Aetna-Commercial,175.0 +8710,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,Aetna-Commercial, +8711,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,Aetna-Commercial, +8712,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,Aetna-Commercial, +8713,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,Aetna-Commercial,8.0 +8714,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,Aetna-Commercial,178.43 +8715,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,Aetna-Commercial,595.0 +8716,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,Aetna-Commercial, +8717,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,Aetna-Commercial,166.6 +8718,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,Aetna-Commercial,559.75 +8719,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,Aetna-Commercial,551.75 +8720,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,Aetna-Commercial,754.07 +8721,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,Aetna-Commercial,926.1 +8722,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,Aetna-Commercial,909.4 +8723,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,Aetna-Commercial,644.8 +8724,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,Aetna-Commercial,303.9 +8725,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,Aetna-Commercial, +8726,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,Aetna-Commercial,579.63 +8727,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,Aetna-Commercial,579.63 +8728,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,Aetna-Commercial,866.6 +8729,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,Aetna-Commercial,1685.6 +8730,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,Aetna-Commercial,257.0 +8731,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,Aetna-Commercial,875.42 +8732,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,Aetna-Commercial,699.3 +8733,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,Aetna-Commercial,223.0 +8734,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,Aetna-Commercial,1238.88 +8735,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,Aetna-Commercial,180.0 +8736,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,Aetna-Commercial,251.1 +8737,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,Aetna-Commercial,294.53 +8738,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,Aetna-Commercial,269.93 +8739,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,Aetna-Commercial,81.0 +8740,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,Aetna-Commercial,146.58 +8741,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,Aetna-Commercial,134.91 +8742,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,Aetna-Commercial,157.82 +8743,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,Aetna-Commercial,68.6 +8744,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,Aetna-Commercial, +8745,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,Aetna-Commercial, +8746,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,Aetna-Commercial,59.5 +8747,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,Aetna-Commercial, +8748,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,Aetna-Commercial,33.6 +8749,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,Aetna-Commercial, +8750,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,Aetna-Commercial, +8751,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,Aetna-Commercial, +8752,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,Aetna-Commercial,35.0 +8753,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,Aetna-Commercial, +8754,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,Aetna-Commercial, +8755,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,Aetna-Commercial, +8756,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,Aetna-Commercial, +8757,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,Aetna-Commercial, +8758,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,Aetna-Commercial,165.75 +8759,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,Aetna-Commercial,2143.5 +8760,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,Aetna-Commercial,216.2 +8761,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,Aetna-Commercial, +8762,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,Aetna-Commercial,96.6 +8763,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,Aetna-Commercial, +8764,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,Aetna-Commercial,105.6 +8765,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,Aetna-Commercial,87.5 +8766,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,Aetna-Commercial,94.0 +8767,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,Aetna-Commercial,57.8 +8768,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,Aetna-Commercial,10.5 +8769,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,Aetna-Commercial,82.25 +8770,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,Aetna-Commercial, +8771,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,Aetna-Commercial,74.18 +8772,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,Aetna-Commercial,48.0 +8773,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,Aetna-Commercial, +8774,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,Aetna-Commercial,11.2 +8775,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,Aetna-Commercial, +8776,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,Aetna-Commercial,88.9 +8777,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,Aetna-Commercial, +8778,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,Aetna-Commercial, +8779,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,Aetna-Commercial, +8780,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,Aetna-Commercial,106.0 +8781,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,Aetna-Commercial, +8782,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,Aetna-Commercial, +8783,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,Aetna-Commercial, +8784,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,Aetna-Commercial,71.4 +8785,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,Aetna-Commercial, +8786,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,Aetna-Commercial, +8787,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,Aetna-Commercial, +8788,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,Aetna-Commercial,72.0 +8789,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,Aetna-Commercial, +8790,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,Aetna-Commercial, +8791,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,Aetna-Commercial, +8792,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,Aetna-Commercial, +8793,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,Aetna-Commercial,280.5 +8794,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,Aetna-Commercial,241.4 +8795,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,Aetna-Commercial,49.0 +8796,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,Aetna-Commercial,111.75 +8797,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,Aetna-Commercial, +8798,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,Aetna-Commercial, +8799,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,Aetna-Commercial, +8800,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,Aetna-Commercial, +8801,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,Aetna-Commercial, +8802,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,Aetna-Commercial,35.09 +8803,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,Aetna-Commercial,85.0 +8804,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,Aetna-Commercial,35.09 +8805,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,Aetna-Commercial,489.3 +8806,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,Aetna-Commercial,35.0 +8807,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,Aetna-Commercial,124.6 +8808,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,Aetna-Commercial,178.0 +8809,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,Aetna-Commercial,35.09 +8810,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,Aetna-Commercial,96.0 +8811,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,Aetna-Commercial, +8812,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,Aetna-Commercial, +8813,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,Aetna-Commercial, +8814,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,Aetna-Commercial, +8815,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,Aetna-Commercial,272.85 +8816,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,Aetna-Commercial,172.2 +8817,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,Aetna-Commercial, +8818,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,Aetna-Commercial, +8819,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,Aetna-Commercial,1924.0 +8820,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,Aetna-Commercial,545.18 +8821,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,Aetna-Commercial, +8822,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,Aetna-Commercial, +8823,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,Aetna-Commercial,50.4 +8824,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,Aetna-Commercial,269.73 +8825,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,Aetna-Commercial,135.42 +8826,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,Aetna-Commercial, +8827,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,Aetna-Commercial, +8828,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,Aetna-Commercial,111.0 +8829,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,Aetna-Commercial, +8830,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,Aetna-Commercial, +8831,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,Aetna-Commercial, +8832,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,Aetna-Commercial, +8833,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,Aetna-Commercial, +8834,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,Aetna-Commercial, +8835,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,Aetna-Commercial, +8836,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,Aetna-Commercial, +8837,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,Aetna-Commercial,114.8 +8838,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,Aetna-Commercial,180.95 +8839,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,Aetna-Commercial, +8840,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,Aetna-Commercial,140.7 +8841,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,Aetna-Commercial,7388.25 +8842,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,Aetna-Commercial,5575.5 +8843,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,Aetna-Commercial,35.7 +8844,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,Aetna-Commercial,128.28 +8845,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,Aetna-Commercial,326.2 +8846,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,Aetna-Commercial,244.3 +8847,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,Aetna-Commercial,495.6 +8848,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,Aetna-Commercial,1061.0 +8849,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,Aetna-Commercial, +8850,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,Aetna-Commercial, +8851,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,Aetna-Commercial, +8852,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,Aetna-Commercial,905.3 +8853,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,Aetna-Commercial, +8854,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,Aetna-Commercial,1572.4 +8855,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,Aetna-Commercial,210.0 +8856,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,Aetna-Commercial,2881.4 +8857,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,Aetna-Commercial,358.2 +8858,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,Aetna-Commercial, +8859,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,Aetna-Commercial,1722.7 +8860,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,Aetna-Commercial,323.4 +8861,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,Aetna-Commercial,2725.0 +8862,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,Aetna-Commercial,4953.0 +8863,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,Aetna-Commercial,3049.0 +8864,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,Aetna-Commercial,955.0 +8865,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,Aetna-Commercial,134.4 +8866,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,Aetna-Commercial,1816.0 +8867,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,Aetna-Commercial,2032.8 +8868,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,Aetna-Commercial, +8869,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,Aetna-Commercial, +8870,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,Aetna-Commercial, +8871,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,Aetna-Commercial,322.0 +8872,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,Aetna-Commercial, +8873,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,Aetna-Commercial, +8874,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,Aetna-Commercial, +8875,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,Aetna-Commercial,829.5 +8876,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,Aetna-Commercial,941.63 +8877,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,Aetna-Commercial,750.4 +8878,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,Aetna-Commercial, +8879,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,Aetna-Commercial, +8880,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,Aetna-Commercial, +8881,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,Aetna-Commercial,1456.0 +8882,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,Aetna-Commercial, +8883,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,Aetna-Commercial, +8884,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,Aetna-Commercial, +8885,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,Aetna-Commercial,280.0 +8886,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,Aetna-Commercial, +8887,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,Aetna-Commercial,39.74 +8888,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,Aetna-Commercial,54.13 +8889,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,Aetna-Commercial,121.1 +8890,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,Aetna-Commercial, +8891,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,Aetna-Commercial, +8892,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,Aetna-Commercial, +8893,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,Aetna-Commercial, +8894,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,Aetna-Commercial,1949.0 +8895,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,Aetna-Commercial,1949.0 +8896,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,Aetna-Commercial, +8897,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,Aetna-Commercial, +8898,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,Aetna-Commercial, +8899,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,Aetna-Commercial, +8900,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,Aetna-Commercial,48.54 +8901,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,Aetna-Commercial, +8902,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,Aetna-Commercial,412.4 +8903,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,Aetna-Commercial, +8904,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,Aetna-Commercial,36.52 +8905,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,Aetna-Commercial, +8906,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,Aetna-Commercial, +8907,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,Aetna-Commercial,38.29 +8908,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,Aetna-Commercial,125.13 +8909,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,Aetna-Commercial,110.9 +8910,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,Aetna-Commercial, +8911,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,Aetna-Commercial, +8912,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,Aetna-Commercial, +8913,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,Aetna-Commercial, +8914,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,Aetna-Commercial, +8915,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,Aetna-Commercial, +8916,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,Aetna-Commercial, +8917,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,Aetna-Commercial, +8918,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,Aetna-Commercial, +8919,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,Aetna-Commercial, +8920,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,Aetna-Commercial, +8921,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,Aetna-Commercial, +8922,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,Aetna-Commercial,149.14 +8923,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,Aetna-Commercial, +8924,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,Aetna-Commercial, +8925,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,Aetna-Commercial, +8926,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,Aetna-Commercial, +8927,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,Aetna-Commercial,1294.0 +8928,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,Aetna-Commercial, +8929,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,Aetna-Commercial, +8930,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,Aetna-Commercial, +8931,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,Aetna-Commercial, +8932,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,Aetna-Commercial,3514.0 +8933,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,Aetna-Commercial,868.0 +8934,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,Aetna-Commercial,3514.0 +8935,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,Aetna-Commercial,851.2 +8936,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,Aetna-Commercial, +8937,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,Aetna-Commercial,269.5 +8938,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,Aetna-Commercial, +8939,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,Aetna-Commercial, +8940,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,Aetna-Commercial,877.1 +8941,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,Aetna-Commercial,877.1 +8942,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,Aetna-Commercial, +8943,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,Aetna-Commercial, +8944,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,Aetna-Commercial, +8945,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,Aetna-Commercial, +8946,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,Aetna-Commercial, +8947,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,Aetna-Commercial, +8948,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,Aetna-Commercial, +8949,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,Aetna-Commercial, +8950,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,Aetna-Commercial, +8951,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,Aetna-Commercial, +8952,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,Aetna-Commercial, +8953,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,Aetna-Commercial, +8954,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,Aetna-Commercial, +8955,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,Aetna-Commercial, +8956,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,Aetna-Commercial, +8957,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,Aetna-Commercial, +8958,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,Aetna-Commercial, +8959,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,Aetna-Commercial, +8960,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,Aetna-Commercial,282.0 +8961,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,Aetna-Commercial, +8962,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,Aetna-Commercial, +8963,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,Aetna-Commercial,362.4 +8964,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,Aetna-Commercial,588.7 +8965,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,Aetna-Commercial,610.4 +8966,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,Aetna-Commercial,102.62 +8967,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,Aetna-Commercial,1327.2 +8968,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,Aetna-Commercial, +8969,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,Aetna-Commercial,1327.2 +8970,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,Aetna-Commercial, +8971,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,Aetna-Commercial,346.5 +8972,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,Aetna-Commercial,308.0 +8973,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,Aetna-Commercial, +8974,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,Aetna-Commercial,171.79 +8975,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,Aetna-Commercial,436.8 +8976,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,Aetna-Commercial,127.62 +8977,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,Aetna-Commercial,1165.5 +8978,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,Aetna-Commercial,385.0 +8979,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,Aetna-Commercial, +8980,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,Aetna-Commercial, +8981,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,Aetna-Commercial, +8982,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,Aetna-Commercial,134.0 +8983,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,Aetna-Commercial,342.3 +8984,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,Aetna-Commercial,498.4 +8985,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,Aetna-Commercial,399.0 +8986,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,Aetna-Commercial,125.3 +8987,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,Aetna-Commercial,703.5 +8988,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,Aetna-Commercial,1243.2 +8989,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,Aetna-Commercial,484.68 +8990,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,Aetna-Commercial,230.3 +8991,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,Aetna-Commercial, +8992,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,Aetna-Commercial, +8993,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,Aetna-Commercial, +8994,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,Aetna-Commercial,646.1 +8995,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,Aetna-Commercial,583.8 +8996,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,Aetna-Commercial,160.3 +8997,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,Aetna-Commercial,630.0 +8998,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,Aetna-Commercial,672.7 +8999,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,Aetna-Commercial, +9000,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,Aetna-Commercial,560.0 +9001,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,Aetna-Commercial, +9002,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,Aetna-Commercial, +9003,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,Aetna-Commercial, +9004,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,Aetna-Commercial, +9005,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,Aetna-Commercial,1085.7 +9006,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,Aetna-Commercial, +9007,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,Aetna-Commercial,1327.2 +9008,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,Aetna-Commercial,22060.86 +9009,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,Aetna-Commercial,9741.5 +9010,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,Aetna-Commercial, +9011,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,Aetna-Commercial,27603.0 +9012,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,Aetna-Commercial,13016.38 +9013,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,Aetna-Commercial, +9014,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,Aetna-Commercial, +9015,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,Aetna-Commercial, +9016,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,Aetna-Commercial,19483.0 +9017,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,Aetna-Commercial,22166.63 +9018,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,Aetna-Commercial,309.66 +9019,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,Aetna-Commercial,20652.0 +9020,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,Aetna-Commercial,10376.0 +9021,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,Aetna-Commercial,10376.0 +9022,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,Aetna-Commercial, +9023,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,Aetna-Commercial, +9024,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,Aetna-Commercial,451.2 +9025,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,Aetna-Commercial,988.27 +9026,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,Aetna-Commercial,1246.0 +9027,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,Aetna-Commercial,1246.0 +9028,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,Aetna-Commercial, +9029,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,Aetna-Commercial,98.7 +9030,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,Aetna-Commercial, +9031,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,Aetna-Commercial, +9032,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,Aetna-Commercial, +9033,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,Aetna-Commercial, +9034,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,Aetna-Commercial,3370.22 +9035,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,Aetna-Commercial, +9036,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,Aetna-Commercial,4163.0 +9037,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,Aetna-Commercial,1469.84 +9038,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,Aetna-Commercial,3277.05 +9039,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,Aetna-Commercial, +9040,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,Aetna-Commercial,884.38 +9041,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,Aetna-Commercial,966.7 +9042,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,Aetna-Commercial,732.42 +9043,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,Aetna-Commercial,4480.35 +9044,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,Aetna-Commercial, +9045,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,Aetna-Commercial,92.4 +9046,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,Aetna-Commercial,8137.9 +9047,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,Aetna-Commercial, +9048,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,Aetna-Commercial, +9049,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,Aetna-Commercial,9613.87 +9050,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,Aetna-Commercial, +9051,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,Aetna-Commercial,11759.68 +9052,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,Aetna-Commercial, +9053,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,Aetna-Commercial,9591.9 +9054,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,Aetna-Commercial,6004.3 +9055,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,Aetna-Commercial,11941.87 +9056,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,Aetna-Commercial,7145.8 +9057,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,Aetna-Commercial, +9058,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,Aetna-Commercial, +9059,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,Aetna-Commercial, +9060,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,Aetna-Commercial, +9061,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,Aetna-Commercial, +9062,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,Aetna-Commercial,8545.8 +9063,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,Aetna-Commercial, +9064,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,Aetna-Commercial,6396.0 +9065,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,Aetna-Commercial,6121.35 +9066,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,Aetna-Commercial,6396.0 +9067,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,Aetna-Commercial,6396.0 +9068,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,Aetna-Commercial, +9069,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,Aetna-Commercial, +9070,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,Aetna-Commercial, +9071,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,Aetna-Commercial,30833.83 +9072,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,Aetna-Commercial,25778.5 +9073,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,Aetna-Commercial, +9074,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,Aetna-Commercial,30587.0 +9075,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,Aetna-Commercial, +9076,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,Aetna-Commercial,1223.0 +9077,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,Aetna-Commercial,2272.0 +9078,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,Aetna-Commercial, +9079,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,Aetna-Commercial,575.1 +9080,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,Aetna-Commercial,227.98 +9081,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,Aetna-Commercial,11651.25 +9082,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,Aetna-Commercial,1544.9 +9083,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,Aetna-Commercial, +9084,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,Aetna-Commercial, +9085,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,Aetna-Commercial,588.7 +9086,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,Aetna-Commercial, +9087,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,Aetna-Commercial,1484.0 +9088,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,Aetna-Commercial,127.6 +9089,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,Aetna-Commercial,1371.3 +9090,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,Aetna-Commercial, +9091,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,Aetna-Commercial,1559.6 +9092,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,Aetna-Commercial,1341.35 +9093,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,Aetna-Commercial,2173.0 +9094,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,Aetna-Commercial, +9095,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,Aetna-Commercial,337.4 +9096,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,Aetna-Commercial,427.0 +9097,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,Aetna-Commercial, +9098,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,Aetna-Commercial,22091.44 +9099,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,Aetna-Commercial,300.05 +9100,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,Aetna-Commercial,733.6 +9101,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,Aetna-Commercial,791.7 +9102,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,Aetna-Commercial, +9103,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,Aetna-Commercial, +9104,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,Aetna-Commercial,421.4 +9105,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,Aetna-Commercial,781.9 +9106,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,Aetna-Commercial,1894.0 +9107,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,Aetna-Commercial, +9108,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,Aetna-Commercial, +9109,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,Aetna-Commercial,1383.2 +9110,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,Aetna-Commercial,735.04 +9111,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,Aetna-Commercial,276.8 +9112,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,Aetna-Commercial,216.0 +9113,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,Aetna-Commercial,1172.0 +9114,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,Aetna-Commercial, +9115,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,Aetna-Commercial, +9116,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,Aetna-Commercial, +9117,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,Aetna-Commercial,490.0 +9118,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,Aetna-Commercial, +9119,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,Aetna-Commercial,613.26 +9120,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,Aetna-Commercial, +9121,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,Aetna-Commercial, +9122,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,Aetna-Commercial,3780.0 +9123,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,Aetna-Commercial, +9124,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,Aetna-Commercial,3986.5 +9125,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,Aetna-Commercial,6965.7 +9126,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,Aetna-Commercial,4116.76 +9127,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,Aetna-Commercial,4039.12 +9128,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,Aetna-Commercial, +9129,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,Aetna-Commercial,3034.5 +9130,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,Aetna-Commercial,632.8 +9131,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,Aetna-Commercial,1045.0 +9132,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,Aetna-Commercial, +9133,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,Aetna-Commercial,145.6 +9134,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,Aetna-Commercial,169.15 +9135,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,Aetna-Commercial, +9136,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,Aetna-Commercial, +9137,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,Aetna-Commercial, +9138,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,Aetna-Commercial, +9139,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,Aetna-Commercial, +9140,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,Aetna-Commercial, +9141,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,Aetna-Commercial, +9142,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,Aetna-Commercial, +9143,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,Aetna-Commercial,546.72 +9144,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,Aetna-Commercial,1526.7 +9145,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,Aetna-Commercial,1526.7 +9146,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,Aetna-Commercial,907.9 +9147,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,Aetna-Commercial, +9148,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,Aetna-Commercial, +9149,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,Aetna-Commercial, +9150,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,Aetna-Commercial, +9151,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,Aetna-Commercial, +9152,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,Aetna-Commercial,501.2 +9153,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,Aetna-Commercial,501.2 +9154,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,Aetna-Commercial, +9155,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,Aetna-Commercial, +9156,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,Aetna-Commercial, +9157,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,Aetna-Commercial,501.2 +9158,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,Aetna-Commercial,936.6 +9159,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,Aetna-Commercial,2017.4 +9160,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,Aetna-Commercial,1263.5 +9161,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,Aetna-Commercial, +9162,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,Aetna-Commercial, +9163,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,Aetna-Commercial,1949.0 +9164,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,Aetna-Commercial,4689.25 +9165,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,Aetna-Commercial,1949.0 +9166,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,Aetna-Commercial,2553.0 +9167,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,Aetna-Commercial,1530.5 +9168,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,Aetna-Commercial,1203.4 +9169,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,Aetna-Commercial,975.58 +9170,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,Aetna-Commercial,1949.0 +9171,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,Aetna-Commercial,2512.67 +9172,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,Aetna-Commercial,2012.0 +9173,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,Aetna-Commercial,2739.39 +9174,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,Aetna-Commercial,738.5 +9175,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,Aetna-Commercial,859.0 +9176,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,Aetna-Commercial,761.03 +9177,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,Aetna-Commercial,4011.0 +9178,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,Aetna-Commercial,15085.0 +9179,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,Aetna-Commercial,2513.75 +9180,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,Aetna-Commercial,3486.13 +9181,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,Aetna-Commercial,2252.27 +9182,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,Aetna-Commercial, +9183,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,Aetna-Commercial,25053.38 +9184,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,Aetna-Commercial,280.0 +9185,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,Aetna-Commercial, +9186,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,Aetna-Commercial,92.85 +9187,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,Aetna-Commercial,68.6 +9188,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,Aetna-Commercial,78.4 +9189,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,Aetna-Commercial,74.4 +9190,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,Aetna-Commercial, +9191,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,Aetna-Commercial,110.6 +9192,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,Aetna-Commercial,81.39 +9193,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,Aetna-Commercial,429.07 +9194,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,Aetna-Commercial,230.86 +9195,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,Aetna-Commercial, +9196,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,Aetna-Commercial,156.1 +9197,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,Aetna-Commercial,51.94 +9198,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,Aetna-Commercial,89.04 +9199,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,Aetna-Commercial,135.0 +9200,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,Aetna-Commercial,217.67 +9201,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,Aetna-Commercial,21.21 +9202,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,Aetna-Commercial,177.1 +9203,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,Aetna-Commercial,304.5 +9204,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,Aetna-Commercial,101.29 +9205,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,Aetna-Commercial, +9206,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,Aetna-Commercial,295.0 +9207,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,Aetna-Commercial,280.7 +9208,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,Aetna-Commercial,107.42 +9209,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,Aetna-Commercial, +9210,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,Aetna-Commercial,228.98 +9211,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,Aetna-Commercial,169.97 +9212,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,Aetna-Commercial,193.2 +9213,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,Aetna-Commercial, +9214,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,Aetna-Commercial,263.73 +9215,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,Aetna-Commercial,316.4 +9216,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,Aetna-Commercial,277.2 +9217,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,Aetna-Commercial, +9218,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,Aetna-Commercial, +9219,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,Aetna-Commercial,3628.33 +9220,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,Aetna-Commercial,957.9 +9221,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,Aetna-Commercial, +9222,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,Aetna-Commercial, +9223,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,Aetna-Commercial, +9224,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,Aetna-Commercial, +9225,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,Aetna-Commercial,168.7 +9226,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,Aetna-Commercial,171.97 +9227,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,Aetna-Commercial, +9228,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,Aetna-Commercial, +9229,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,Aetna-Commercial, +9230,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,Aetna-Commercial, +9231,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,Aetna-Commercial, +9232,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,Aetna-Commercial,207.9 +9233,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,Aetna-Commercial,224.7 +9234,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,Aetna-Commercial,277.2 +9235,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,Aetna-Commercial,259.0 +9236,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,Aetna-Commercial,287.05 +9237,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,Aetna-Commercial, +9238,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,Aetna-Commercial, +9239,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,Aetna-Commercial, +9240,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,Aetna-Commercial, +9241,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,Aetna-Commercial, +9242,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,Aetna-Commercial,1912.33 +9243,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,Aetna-Commercial,5705.11 +9244,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,Aetna-Commercial,1949.0 +9245,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,Aetna-Commercial,2940.0 +9246,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,Aetna-Commercial,4962.7 +9247,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,Aetna-Commercial,807.66 +9248,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,Aetna-Commercial, +9249,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,Aetna-Commercial, +9250,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,Aetna-Commercial, +9251,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,Aetna-Commercial, +9252,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,Aetna-Commercial, +9253,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,Aetna-Commercial, +9254,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,Aetna-Commercial, +9255,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,Aetna-Commercial, +9256,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,Aetna-Commercial, +9257,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,Aetna-Commercial, +9258,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,Aetna-Commercial, +9259,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,Aetna-Commercial, +9260,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,Aetna-Commercial, +9261,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,Aetna-Commercial, +9262,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,Aetna-Commercial, +9263,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,Aetna-Commercial, +9264,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,Aetna-Commercial, +9265,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,Aetna-Commercial, +9266,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,Aetna-Commercial, +9267,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,Aetna-Commercial,1949.0 +9268,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,Aetna-Commercial,1949.0 +9269,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,Aetna-Commercial, +9270,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,Aetna-Commercial, +9271,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,Aetna-Commercial,2822.0 +9272,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,Aetna-Commercial, +9273,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,Aetna-Commercial, +9274,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,Aetna-Commercial, +9275,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,Aetna-Commercial, +9276,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,Aetna-Commercial, +9277,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,Aetna-Commercial, +9278,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,Aetna-Commercial,298.6 +9279,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,Aetna-Commercial, +9280,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,Aetna-Commercial, +9281,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,Aetna-Commercial, +9282,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,Aetna-Commercial, +9283,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,Aetna-Commercial, +9284,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,Aetna-Commercial,6340.8 +9285,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,Aetna-Commercial, +9286,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,Aetna-Commercial, +9287,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,Aetna-Commercial, +9288,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,Aetna-Commercial, +9289,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,Aetna-Commercial, +9290,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,Aetna-Commercial, +9291,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,Aetna-Commercial, +9292,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,Aetna-Commercial, +9293,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,Aetna-Commercial, +9294,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,Aetna-Commercial, +9295,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,Aetna-Commercial, +9296,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,Aetna-Commercial, +9297,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,Aetna-Commercial, +9298,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,Aetna-Commercial, +9299,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,Aetna-Commercial, +9300,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,Aetna-Commercial, +9301,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,Aetna-Commercial, +9302,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,Aetna-Commercial, +9303,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,Aetna-Commercial, +9304,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,Aetna-Commercial, +9305,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,Aetna-Commercial, +9306,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,Aetna-Commercial, +9307,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,Aetna-Commercial, +9308,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,Aetna-Commercial, +9309,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,Aetna-Commercial, +9310,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,Aetna-Commercial, +9311,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,Aetna-Commercial, +9312,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,Aetna-Commercial, +9313,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,Aetna-Commercial, +9314,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,Aetna-Commercial, +9315,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,Aetna-Commercial, +9316,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,Aetna-Commercial, +9317,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,Aetna-Commercial, +9318,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,Aetna-Commercial, +9319,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,Aetna-Commercial, +9320,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,Aetna-Commercial, +9321,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,Aetna-Commercial, +9322,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,Aetna-Commercial, +9323,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,Aetna-Commercial, +9324,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,Aetna-Commercial, +9325,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,Aetna-Commercial, +9326,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,Aetna-Commercial, +9327,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,Aetna-Commercial, +9328,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,Aetna-Commercial, +9329,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,Aetna-Commercial, +9330,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,Aetna-Commercial, +9331,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,Aetna-Commercial, +9332,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,Aetna-Commercial, +9333,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,Aetna-Commercial, +9334,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,Aetna-Commercial, +9335,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,Aetna-Commercial, +9336,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,Aetna-Commercial, +9337,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,Aetna-Commercial, +9338,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,Aetna-Commercial, +9339,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,Aetna-Commercial, +9340,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,Aetna-Commercial, +9341,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,Aetna-Commercial, +9342,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,Aetna-Commercial, +9343,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,Aetna-Commercial, +9344,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,Aetna-Commercial, +9345,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,Aetna-Commercial, +9346,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,Aetna-Commercial, +9347,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,Aetna-Commercial, +9348,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,Aetna-Commercial, +9349,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,Aetna-Commercial, +9350,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,Aetna-Commercial, +9351,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,Aetna-Commercial, +9352,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,Aetna-Commercial, +9353,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,Aetna-Commercial, +9354,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,Aetna-Commercial, +9355,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,Aetna-Commercial, +9356,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,Aetna-Commercial, +9357,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,Aetna-Commercial, +9358,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,Aetna-Commercial, +9359,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,Aetna-Commercial, +9360,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,Aetna-Commercial, +9361,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,Aetna-Commercial, +9362,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,Aetna-Commercial, +9363,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,Aetna-Commercial, +9364,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,Aetna-Commercial, +9365,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,Aetna-Commercial, +9366,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,Aetna-Commercial, +9367,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,Aetna-Commercial, +9368,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,Aetna-Commercial, +9369,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,Aetna-Commercial, +9370,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,Aetna-Commercial, +9371,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,Aetna-Commercial, +9372,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,Aetna-Commercial, +9373,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,Aetna-Commercial, +9374,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,Aetna-Commercial, +9375,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,Aetna-Commercial, +9376,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,Aetna-Commercial, +9377,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,Aetna-Commercial, +9378,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,Aetna-Commercial, +9379,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,Aetna-Commercial, +9380,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,Aetna-Commercial, +9381,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,Aetna-Commercial, +9382,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,Aetna-Commercial, +9383,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,Aetna-Commercial, +9384,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,Aetna-Commercial, +9385,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,Aetna-Commercial, +9386,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,Aetna-Commercial, +9387,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,Aetna-Commercial, +9388,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,Aetna-Commercial, +9389,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,Aetna-Commercial, +9390,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,Aetna-Commercial, +9391,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,Aetna-Commercial, +9392,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,Aetna-Commercial, +9393,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,Aetna-Commercial, +9394,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,Aetna-Commercial, +9395,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,Aetna-Commercial, +9396,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,Aetna-Commercial, +9397,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,Aetna-Commercial, +9398,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,Aetna-Commercial, +9399,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,Aetna-Commercial, +9400,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,Aetna-Commercial, +9401,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,Aetna-Commercial, +9402,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,Aetna-Commercial, +9403,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,Aetna-Commercial, +9404,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,Aetna-Commercial, +9405,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,Aetna-Commercial, +9406,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,Aetna-Commercial, +9407,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,Aetna-Commercial, +9408,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,Aetna-Commercial, +9409,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,Aetna-Commercial, +9410,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,Aetna-Commercial, +9411,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,Aetna-Commercial, +9412,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,Aetna-Commercial, +9413,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,Aetna-Commercial, +9414,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,Aetna-Commercial, +9415,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,Aetna-Commercial, +9416,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,Aetna-Commercial, +9417,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,Aetna-Commercial, +9418,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,Aetna-Commercial, +9419,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,Aetna-Commercial, +9420,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,Aetna-Commercial, +9421,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,Aetna-Commercial, +9422,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,Aetna-Commercial, +9423,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,Aetna-Commercial, +9424,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,Aetna-Commercial, +9425,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,Aetna-Commercial, +9426,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,Aetna-Commercial, +9427,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,Aetna-Commercial, +9428,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,Aetna-Commercial, +9429,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,Aetna-Commercial, +9430,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,Aetna-Commercial, +9431,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,Aetna-Commercial, +9432,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,Aetna-Commercial, +9433,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,Aetna-Commercial, +9434,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,Aetna-Commercial, +9435,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,Aetna-Commercial, +9436,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,Aetna-Commercial, +9437,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,Aetna-Commercial, +9438,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,Aetna-Commercial, +9439,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,Aetna-Commercial, +9440,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,Aetna-Commercial, +9441,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,Aetna-Commercial, +9442,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,Aetna-Commercial, +9443,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,Aetna-Commercial, +9444,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,Aetna-Commercial, +9445,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,Aetna-Commercial, +9446,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,Aetna-Commercial, +9447,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,Aetna-Commercial, +9448,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,Aetna-Commercial, +9449,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,Aetna-Commercial, +9450,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,Aetna-Commercial, +9451,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,Aetna-Commercial, +9452,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,Aetna-Commercial, +9453,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,Aetna-Commercial, +9454,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,Aetna-Commercial, +9455,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,Aetna-Commercial, +9456,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,Aetna-Commercial, +9457,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,Aetna-Commercial, +9458,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,Aetna-Commercial, +9459,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,Aetna-Commercial, +9460,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,Aetna-Commercial, +9461,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,Aetna-Commercial, +9462,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,Aetna-Commercial, +9463,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,Aetna-Commercial, +9464,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,Aetna-Commercial, +9465,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,Aetna-Commercial, +9466,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,Aetna-Commercial, +9467,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,Aetna-Commercial, +9468,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,Aetna-Commercial, +9469,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,Aetna-Commercial, +9470,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,Aetna-Commercial, +9471,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,Aetna-Commercial, +9472,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,Aetna-Commercial, +9473,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,Aetna-Commercial, +9474,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,Aetna-Commercial, +9475,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,Aetna-Commercial, +9476,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,Aetna-Commercial, +9477,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,Aetna-Commercial, +9478,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,Aetna-Commercial, +9479,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,Aetna-Commercial, +9480,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,Aetna-Commercial, +9481,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,Aetna-Commercial, +9482,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,Aetna-Commercial, +9483,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,Aetna-Commercial, +9484,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,Aetna-Commercial, +9485,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,Aetna-Commercial, +9486,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,Aetna-Commercial, +9487,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,Aetna-Commercial, +9488,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,Aetna-Commercial, +9489,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,Aetna-Commercial, +9490,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,Aetna-Commercial, +9491,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,Aetna-Commercial, +9492,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,Aetna-Commercial, +9493,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,Aetna-Commercial, +9494,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,Aetna-Commercial, +9495,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,Aetna-Commercial, +9496,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,Aetna-Commercial, +9497,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,Aetna-Commercial, +9498,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,Aetna-Commercial, +9499,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,Aetna-Commercial, +9500,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,Aetna-Commercial, +9501,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,Aetna-Commercial, +9502,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,Aetna-Commercial, +9503,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,Aetna-Commercial, +9504,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,Aetna-Commercial, +9505,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,Aetna-Commercial, +9506,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,Aetna-Commercial, +9507,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,Aetna-Commercial, +9508,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,Aetna-Commercial, +9509,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,Aetna-Commercial, +9510,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,Aetna-Commercial, +9511,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,Aetna-Commercial, +9512,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,Aetna-Commercial, +9513,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,Aetna-Commercial, +9514,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,Aetna-Commercial, +9515,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,Aetna-Commercial, +9516,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,Aetna-Commercial, +9517,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,Aetna-Commercial, +9518,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,Aetna-Commercial, +9519,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,Aetna-Commercial, +9520,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,Aetna-Commercial, +9521,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,Aetna-Commercial, +9522,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,Aetna-Commercial, +9523,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,Aetna-Commercial, +9524,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,Aetna-Commercial, +9525,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,Aetna-Commercial, +9526,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,Aetna-Commercial, +9527,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,Aetna-Commercial, +9528,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,Aetna-Commercial, +9529,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,Aetna-Commercial, +9530,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,Aetna-Commercial, +9531,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,Aetna-Commercial, +9532,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,Aetna-Commercial, +9533,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,Aetna-Commercial, +9534,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,Aetna-Commercial, +9535,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,Aetna-Commercial, +9536,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,Aetna-Commercial, +9537,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,Aetna-Commercial, +9538,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,Aetna-Commercial, +9539,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,Aetna-Commercial, +9540,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,Aetna-Commercial, +9541,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,Aetna-Commercial, +9542,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,Aetna-Commercial, +9543,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,Aetna-Commercial, +9544,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,Aetna-Commercial, +9545,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,Aetna-Commercial, +9546,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,Aetna-Commercial, +9547,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,Aetna-Commercial, +9548,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,Aetna-Commercial, +9549,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,Aetna-Commercial, +9550,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,Aetna-Commercial, +9551,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,Aetna-Commercial, +9552,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,Aetna-Commercial,1014.0 +9553,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,Aetna-Commercial,1016.8 +9554,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,Aetna-Commercial,1440.6 +9555,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,Aetna-Commercial,1137.0 +9556,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,Aetna-Commercial,438.56 +9557,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,Aetna-Commercial, +9558,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,Aetna-Commercial,3443.0 +9559,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,Aetna-Commercial, +9560,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,Aetna-Commercial, +9561,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,Aetna-Commercial, +9562,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,Aetna-Commercial, +9563,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,Aetna-Commercial,238.71 +9564,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,Aetna-Commercial,155.0 +9565,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,Aetna-Commercial, +9566,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,Aetna-Commercial,956.0 +9567,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,Aetna-Commercial,102.0 +9568,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,Aetna-Commercial,174.0 +9569,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,Aetna-Commercial,270.2 +9570,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,Aetna-Commercial,95.9 +9571,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,Aetna-Commercial, +9572,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,Aetna-Commercial, +9573,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,Aetna-Commercial,35342.43 +9574,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,Aetna-Commercial,67.2 +9575,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,Aetna-Commercial,1680.0 +9576,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,Aetna-Commercial, +9577,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,Aetna-Commercial,2121.0 +9578,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,Aetna-Commercial,95.2 +9579,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,Aetna-Commercial, +9580,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,Aetna-Commercial,111.3 +9581,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,Aetna-Commercial,42.0 +9582,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,Aetna-Commercial,109.62 +9583,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,Aetna-Commercial, +9584,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,Aetna-Commercial,640.5 +9585,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,Aetna-Commercial,242.86 +9586,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,Aetna-Commercial, +9587,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,Aetna-Commercial, +9588,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,Aetna-Commercial,308.0 +9589,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,Aetna-Commercial, +9590,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,Aetna-Commercial, +9591,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,Aetna-Commercial,589.0 +9592,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,Aetna-Commercial,2772.0 +9593,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,Aetna-Commercial, +9594,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,Aetna-Commercial, +9595,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,Aetna-Commercial,720.3 +9596,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,Aetna-Commercial, +9597,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,Aetna-Commercial, +9598,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,Aetna-Commercial,2244.0 +9599,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,Aetna-Commercial, +9600,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,Aetna-Commercial,1763.0 +9601,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,Aetna-Commercial,18900.0 +9602,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,Aetna-Commercial,13000.0 +9603,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,Aetna-Commercial,3850.0 +9604,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,Aetna-Commercial,1450.25 +9605,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,Aetna-Commercial,610.0 +9606,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,Aetna-Commercial,995.0 +9607,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,Aetna-Commercial, +9608,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,Aetna-Commercial, +9609,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,Aetna-Commercial,1224.5 +9610,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,Aetna-Commercial,2166.75 +9611,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,Aetna-Commercial,6176.0 +9612,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,Aetna-Commercial,5000.0 +9613,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,Aetna-Commercial,150.0 +9614,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,Aetna-Commercial,397.5 +9615,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,Aetna-Commercial, +9616,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,Aetna-Commercial,1520.0 +9617,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,Aetna-Commercial, +9618,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,Aetna-Commercial,77.5 +9619,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,Aetna-Commercial,3076.0 +9620,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,Aetna-Commercial,308.0 +9621,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,Aetna-Commercial,111.0 +9622,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,Aetna-Commercial,931.0 +9623,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,Aetna-Commercial,6079.33 +9624,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,Aetna-Commercial,292.5 +9625,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,Aetna-Commercial,1160.29 +9626,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,Aetna-Commercial,19240.0 +9627,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,Aetna-Commercial, +9628,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,Aetna-Commercial,693.67 +9629,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,Aetna-Commercial,1182.39 +9630,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,Aetna-Commercial,11127.9 +9631,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,Aetna-Commercial, +9632,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,Aetna-Commercial,4300.0 +9633,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,Aetna-Commercial,4200.0 +9634,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,Aetna-Commercial,5840.0 +9635,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,Aetna-Commercial, +9636,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,Aetna-Commercial,334.5 +9637,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,Aetna-Commercial, +9638,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,Aetna-Commercial,8800.0 +9639,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,Aetna-Commercial, +9640,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,Aetna-Commercial, +9641,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,Aetna-Commercial,385.5 +9642,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,Aetna-Commercial,1860.0 +9643,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,Aetna-Commercial,9823.8 +9644,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,Aetna-Commercial, +9645,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,Aetna-Commercial,5000.0 +9646,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,Aetna-Commercial,146.5 +9647,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,Aetna-Commercial, +9648,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,Aetna-Commercial, +9649,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,Aetna-Commercial, +9650,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,Aetna-Commercial,2625.0 +9651,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,Aetna-Commercial,900.0 +9652,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,Aetna-Commercial, +9653,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,Aetna-Commercial, +9654,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,Aetna-Commercial,20000.0 +9655,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,Aetna-Commercial, +9656,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,Aetna-Commercial, +9657,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,Aetna-Commercial, +9658,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,Aetna-Commercial,1133.0 +9659,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,Aetna-Commercial,1449.0 +9660,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,Aetna-Commercial, +9661,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,Aetna-Commercial,260.0 +9662,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,Aetna-Commercial,280.0 +9663,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,Aetna-Commercial,232.0 +9664,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,Aetna-Commercial, +9665,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,Aetna-Commercial, +9666,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,Aetna-Commercial, +9667,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,Aetna-Commercial,1140.0 +9668,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,Aetna-Commercial,2150.0 +9669,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,Aetna-Commercial, +9670,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,Aetna-Commercial,144.94 +9671,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,Aetna-Commercial, +9672,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,Aetna-Commercial, +9673,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,Aetna-Commercial, +9674,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,Aetna-Commercial,115.0 +9675,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,Aetna-Commercial, +9676,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,Aetna-Commercial, +9677,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,Aetna-Commercial, +9678,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,Aetna-Commercial, +9679,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,Aetna-Commercial, +9680,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,Aetna-Commercial,462.61 +9681,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,Aetna-Commercial, +9682,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,Aetna-Commercial, +9683,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,Aetna-Commercial, +9684,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,Aetna-Commercial,463.4 +9685,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,Aetna-Commercial,824.81 +9686,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,Aetna-Commercial,4725.0 +9687,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,Aetna-Commercial, +9688,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,Aetna-Commercial,18.0 +9689,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,Aetna-Commercial, +9690,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,Aetna-Commercial, +9691,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,Aetna-Commercial, +9692,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,Aetna-Commercial,150.0 +9693,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,Aetna-Commercial, +9694,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,Aetna-Commercial,19188.0 +9695,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,Aetna-Commercial, +9696,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,Aetna-Commercial,26504.97 +9697,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,Aetna-Commercial, +9698,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,Aetna-Commercial,48531.57 +9699,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,Aetna-Commercial, +9700,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,Aetna-Commercial, +9701,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,Aetna-Commercial, +9702,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,Aetna-Commercial, +9703,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,Aetna-Commercial, +9704,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,Aetna-Commercial, +9705,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,Aetna-Commercial, +9706,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,Aetna-Commercial, +9707,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,Aetna-Commercial, +9708,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,Aetna-Commercial,1949.0 +9709,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,Aetna-Commercial, +9710,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,Aetna-Commercial, +9711,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,Aetna-Commercial, +9712,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,Aetna-Commercial, +9713,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,Aetna-Commercial, +9714,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,Aetna-Commercial, +9715,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,Aetna-Commercial, +9716,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,Aetna-Commercial, +9717,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,Aetna-Commercial, +9718,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,Aetna-Commercial, +9719,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,Aetna-Commercial, +9720,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,Aetna-Commercial, +9721,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,Aetna-Commercial, +9722,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,Aetna-Commercial, +9723,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,Aetna-Commercial, +9724,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,Aetna-Commercial, +9725,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,Aetna-Commercial, +9726,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,Aetna-Commercial, +9727,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,Aetna-Commercial, +9728,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,Aetna-Commercial, +9729,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,Aetna-Commercial, +9730,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,Aetna-Commercial, +9731,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,Aetna-Commercial, +9732,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,Aetna-Commercial, +9733,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,Aetna-Commercial, +9734,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,Aetna-Commercial, +9735,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,Aetna-Commercial, +9736,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,Aetna-Commercial, +9737,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,Aetna-Commercial, +9738,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,Aetna-Commercial, +9739,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,Aetna-Commercial, +9740,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,Aetna-Commercial, +9741,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,Aetna-Commercial, +9742,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,Aetna-Commercial, +9743,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,Aetna-Commercial,46.17 +9744,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,Aetna-Commercial,74.72 +9745,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,Aetna-Commercial, +9746,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,Aetna-Commercial, +9747,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,Aetna-Commercial, +9748,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,Aetna-Commercial,894.52 +9749,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,Aetna-Commercial,233.8 +9750,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,Aetna-Commercial, +9751,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,Aetna-Commercial,925.44 +9752,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,Aetna-Commercial,135.8 +9753,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,Aetna-Commercial, +9754,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,Aetna-Commercial,31.15 +9755,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,Aetna-Commercial,78.4 +9756,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,Aetna-Commercial,553.0 +9757,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,Aetna-Commercial,6213.0 +9758,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,Aetna-Commercial, +9759,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,Aetna-Commercial, +9760,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,Aetna-Commercial,1949.0 +9761,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,Aetna-Commercial,95.15 +9762,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,Aetna-Commercial, +9763,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,Aetna-Commercial,160.5 +9764,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,Aetna-Commercial,89.88 +9765,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,Aetna-Commercial,802.07 +9766,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,Aetna-Commercial, +9767,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,Aetna-Commercial,1397.9 +9768,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,Aetna-Commercial, +9769,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,Aetna-Commercial, +9770,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,Aetna-Commercial, +9771,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,Aetna-Commercial, +9772,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,Aetna-Commercial,127.44 +9773,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,Aetna-Commercial, +9774,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,Aetna-Commercial, +9775,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,Aetna-Commercial,220.75 +9776,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,Aetna-Commercial,45.0 +9777,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,Aetna-Commercial, +9778,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,Aetna-Commercial,12.44 +9779,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,Aetna-Commercial, +9780,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,Aetna-Commercial, +9781,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,Aetna-Commercial,18.52 +9782,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,Aetna-Commercial, +9783,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,Aetna-Commercial,69.05 +9784,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,Aetna-Commercial,94.45 +9785,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,Aetna-Commercial,18.06 +9786,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,Aetna-Commercial,32.4 +9787,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,Aetna-Commercial,2167.2 +9788,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,Aetna-Commercial, +9789,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,Aetna-Commercial,5035.49 +9790,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,Aetna-Commercial, +9791,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,Aetna-Commercial, +9792,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,Aetna-Commercial, +9793,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,Aetna-Commercial,4.35 +9794,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,Aetna-Commercial,3657.6 +9795,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,Aetna-Commercial,20968.16 +9796,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,Aetna-Commercial,35.14 +9797,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,Aetna-Commercial, +9798,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,Aetna-Commercial,126.36 +9799,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,Aetna-Commercial, +9800,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,Aetna-Commercial,378.0 +9801,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,Aetna-Commercial,426.19 +9802,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,Aetna-Commercial,61.52 +9803,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,Aetna-Commercial,73.84 +9804,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,Aetna-Commercial,312.9 +9805,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,Aetna-Commercial,74.16 +9806,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,Aetna-Commercial, +9807,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,Aetna-Commercial,268.72 +9808,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,Aetna-Commercial, +9809,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,Aetna-Commercial,11.52 +9810,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,Aetna-Commercial, +9811,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,Aetna-Commercial, +9812,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,Aetna-Commercial,268.58 +9813,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,Aetna-Commercial, +9814,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,Aetna-Commercial,5572.8 +9815,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,Aetna-Commercial, +9816,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,Aetna-Commercial,1235.81 +9817,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,Aetna-Commercial,3276.91 +9818,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,Aetna-Commercial, +9819,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,Aetna-Commercial, +9820,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,Aetna-Commercial,3973.03 +9821,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,Aetna-Commercial, +9822,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,Aetna-Commercial,234.49 +9823,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,Aetna-Commercial, +9824,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,Aetna-Commercial,1697.95 +9825,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,Aetna-Commercial,472.86 +9826,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,Aetna-Commercial, +9827,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,Aetna-Commercial, +9828,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,Aetna-Commercial,19.61 +9829,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,Aetna-Commercial,2.76 +9830,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,Aetna-Commercial,125.61 +9831,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,Aetna-Commercial, +9832,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,Aetna-Commercial, +9833,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,Aetna-Commercial, +9834,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,Aetna-Commercial, +9835,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,Aetna-Commercial,136.71 +9836,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,Aetna-Commercial, +9837,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,Aetna-Commercial,2788.34 +9838,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,Aetna-Commercial,1811.39 +9839,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,Aetna-Commercial, +9840,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,Aetna-Commercial,738.95 +9841,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,Aetna-Commercial,1411.2 +9842,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,Aetna-Commercial,5004.0 +9843,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,Aetna-Commercial, +9844,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,Aetna-Commercial,17136.0 +9845,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,Aetna-Commercial,2502.0 +9846,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,Aetna-Commercial,13.01 +9847,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,Aetna-Commercial, +9848,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,Aetna-Commercial,432.43 +9849,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,Aetna-Commercial,21.56 +9850,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,Aetna-Commercial, +9851,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,Aetna-Commercial,2.1 +9852,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,Aetna-Commercial,102.1 +9853,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,Aetna-Commercial,139.11 +9854,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,Aetna-Commercial, +9855,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,Aetna-Commercial,30.0 +9856,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,Aetna-Commercial, +9857,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,Aetna-Commercial, +9858,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,Aetna-Commercial,21337.28 +9859,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,Aetna-Commercial,252.0 +9860,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,Aetna-Commercial, +9861,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,Aetna-Commercial,155.94 +9862,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,Aetna-Commercial,18.0 +9863,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,Aetna-Commercial,6022.37 +9864,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,Aetna-Commercial,31.15 +9865,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,Aetna-Commercial,7700.76 +9866,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,Aetna-Commercial,86.13 +9867,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,Aetna-Commercial, +9868,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,Aetna-Commercial,7.53 +9869,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,Aetna-Commercial, +9870,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,Aetna-Commercial,5.37 +9871,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,Aetna-Commercial,3.02 +9872,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,Aetna-Commercial, +9873,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,Aetna-Commercial, +9874,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,Aetna-Commercial, +9875,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,Aetna-Commercial, +9876,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,Aetna-Commercial,235.62 +9877,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,Aetna-Commercial,2.32 +9878,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,Aetna-Commercial, +9879,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,Aetna-Commercial,6.39 +9880,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,Aetna-Commercial,11.6 +9881,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,Aetna-Commercial, +9882,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,Aetna-Commercial, +9883,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,Aetna-Commercial,68314.33 +9884,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,Aetna-Commercial, +9885,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,Aetna-Commercial,8502.95 +9886,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,Aetna-Commercial,178.88 +9887,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,Aetna-Commercial, +9888,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,Aetna-Commercial, +9889,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,Aetna-Commercial, +9890,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,Aetna-Commercial,6.78 +9891,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,Aetna-Commercial,753.98 +9892,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,Aetna-Commercial,22431.81 +9893,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,Aetna-Commercial,86.59 +9894,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,Aetna-Commercial,208.86 +9895,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,Aetna-Commercial, +9896,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,Aetna-Commercial, +9897,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,Aetna-Commercial,30332.73 +9898,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,Aetna-Commercial, +9899,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,Aetna-Commercial, +9900,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,Aetna-Commercial, +9901,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,Aetna-Commercial, +9902,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,Aetna-Commercial,112.5 +9903,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,Aetna-Commercial,29.48 +9904,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,Aetna-Commercial,3.76 +9905,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,Aetna-Commercial, +9906,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,Aetna-Commercial,518.7 +9907,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,Aetna-Commercial,294.0 +9908,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,Aetna-Commercial, +9909,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,Aetna-Commercial, +9910,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,Aetna-Commercial, +9911,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,Aetna-Commercial,192.63 +9912,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,Aetna-Commercial, +9913,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,Aetna-Commercial,29.47 +9914,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,Aetna-Commercial,23.39 +9915,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,Aetna-Commercial,713.2 +9916,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,Aetna-Commercial,18.74 +9917,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,Aetna-Commercial, +9918,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,Aetna-Commercial, +9919,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,Aetna-Commercial,83.44 +9920,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,Aetna-Commercial,4460.84 +9921,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,Aetna-Commercial,3048.15 +9922,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,Aetna-Commercial, +9923,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,Aetna-Commercial, +9924,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,Aetna-Commercial,89.96 +9925,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,Aetna-Commercial,35.97 +9926,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,Aetna-Commercial,11131.89 +9927,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,Aetna-Commercial, +9928,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,Aetna-Commercial,6.53 +9929,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,Aetna-Commercial,15.46 +9930,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,Aetna-Commercial, +9931,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,Aetna-Commercial, +9932,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,Aetna-Commercial,73.49 +9933,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,Aetna-Commercial,21.74 +9934,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,Aetna-Commercial,1581.96 +9935,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,Aetna-Commercial,239.4 +9936,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,Aetna-Commercial,94.5 +9937,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,Aetna-Commercial,19.24 +9938,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,Aetna-Commercial,309.6 +9939,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,Aetna-Commercial,11.75 +9940,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,Aetna-Commercial,9.65 +9941,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,Aetna-Commercial,9.83 +9942,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,Aetna-Commercial,29.7 +9943,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,Aetna-Commercial,16.86 +9944,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,Aetna-Commercial, +9945,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,Aetna-Commercial, +9946,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,Aetna-Commercial,18000.0 +9947,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,Aetna-Commercial, +9948,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,Aetna-Commercial, +9949,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,Aetna-Commercial, +9950,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,Aetna-Commercial,10.14 +9951,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,Aetna-Commercial,24.12 +9952,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,Aetna-Commercial, +9953,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,Aetna-Commercial, +9954,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,Aetna-Commercial, +9955,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,Aetna-Commercial, +9956,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,Aetna-Commercial, +9957,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,Aetna-Commercial,1.64 +9958,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,Aetna-Commercial, +9959,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,Aetna-Commercial, +9960,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,Aetna-Commercial,52.73 +9961,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,Aetna-Commercial, +9962,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,Aetna-Commercial, +9963,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,Aetna-Commercial,1.68 +9964,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,Aetna-Commercial, +9965,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,Aetna-Commercial,133.56 +9966,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,Aetna-Commercial,7.87 +9967,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,Aetna-Commercial,135.32 +9968,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,Aetna-Commercial, +9969,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,Aetna-Commercial,14.27 +9970,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,Aetna-Commercial,2.01 +9971,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,Aetna-Commercial, +9972,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,Aetna-Commercial, +9973,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,Aetna-Commercial,211.68 +9974,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,Aetna-Commercial, +9975,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,Aetna-Commercial,6858.94 +9976,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,Aetna-Commercial, +9977,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,Aetna-Commercial, +9978,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,Aetna-Commercial,283.04 +9979,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,Aetna-Commercial,4793.54 +9980,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,Aetna-Commercial,9037.04 +9981,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,Aetna-Commercial, +9982,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,Aetna-Commercial,192.19 +9983,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,Aetna-Commercial,4039.56 +9984,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,Aetna-Commercial,33138.0 +9985,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,Aetna-Commercial, +9986,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,Aetna-Commercial,208.17 +9987,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,Aetna-Commercial,6458.63 +9988,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,Aetna-Commercial, +9989,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,Aetna-Commercial,136.46 +9990,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,Aetna-Commercial,2768.85 +9991,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,Aetna-Commercial,4.18 +9992,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,Aetna-Commercial, +9993,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,Aetna-Commercial, +9994,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,Aetna-Commercial, +9995,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,Aetna-Commercial,19819.14 +9996,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,Aetna-Commercial,507.06 +9997,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,Aetna-Commercial, +9998,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,Aetna-Commercial,3287.04 +9999,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,Aetna-Commercial, +10000,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,Aetna-Commercial, +10001,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,Aetna-Commercial, +10002,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,Aetna-Commercial,34.47 +10003,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,Aetna-Commercial,68.65 +10004,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,Aetna-Commercial,154.18 +10005,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,Aetna-Commercial,2286.9 +10006,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,Aetna-Commercial,6246.07 +10007,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,Aetna-Commercial,113.87 +10008,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,Aetna-Commercial, +10009,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,Aetna-Commercial, +10010,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,Aetna-Commercial,3292.81 +10011,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,Aetna-Commercial, +10012,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,Aetna-Commercial,37807.1 +10013,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,Aetna-Commercial, +10014,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,Aetna-Commercial,8.36 +10015,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,Aetna-Commercial, +10016,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,Aetna-Commercial,756.0 +10017,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,Aetna-Commercial,7520.63 +10018,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,Aetna-Commercial,51897.86 +10019,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,Aetna-Commercial,144.24 +10020,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,Aetna-Commercial,35531.7 +10021,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,Aetna-Commercial,1486.42 +10022,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,Aetna-Commercial,20037.46 +10023,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,Aetna-Commercial, +10024,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,Aetna-Commercial, +10025,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,Aetna-Commercial,22815.16 +10026,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,Aetna-Commercial,24215.44 +10027,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,Aetna-Commercial,10205.6 +10028,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,Aetna-Commercial, +10029,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,Aetna-Commercial, +10030,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,Aetna-Commercial,16809.89 +10031,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,Aetna-Commercial,22129.7 +10032,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,Aetna-Commercial, +10033,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,Aetna-Commercial,21613.13 +10034,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,Aetna-Commercial,8022.16 +10035,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,Aetna-Commercial, +10036,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,Aetna-Commercial, +10037,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,Aetna-Commercial, +10038,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,Aetna-Commercial,88.3 +10039,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,Aetna-Commercial,212.63 +10040,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,Aetna-Commercial,5267.63 +10041,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,Aetna-Commercial,23084.97 +10042,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,Aetna-Commercial, +10043,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,Aetna-Commercial, +10044,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,Aetna-Commercial, +10045,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,Aetna-Commercial, +10046,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,Aetna-Commercial,334.0 +10047,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,Aetna-Commercial,374.28 +10048,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,Aetna-Commercial,241.5 +10049,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,Aetna-Commercial, +10050,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,Aetna-Commercial,42.0 +10051,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,Aetna-Commercial, +10052,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,Aetna-Commercial, +10053,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,Aetna-Commercial,1583.65 +10054,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,Aetna-Commercial, +10055,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,Aetna-Commercial, +10056,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,Aetna-Commercial, +10057,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,Aetna-Commercial, +10058,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,Aetna-Commercial, +10059,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,Aetna-Commercial,800.0 +10060,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,Aetna-Commercial, +10061,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,Aetna-Commercial, +10062,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,Aetna-Commercial,3042.5 +10063,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,Aetna-Commercial,527.1 +10064,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,Aetna-Commercial, +10065,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,Aetna-Commercial, +10066,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,Aetna-Commercial,727.7 +10067,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,Aetna-Commercial,2723.0 +10068,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,Aetna-Commercial,2722.0 +10069,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,Aetna-Commercial, +10070,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,Aetna-Commercial,499.61 +10071,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,Aetna-Commercial,8456.35 +10072,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,Aetna-Commercial,4186.98 +10073,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,Aetna-Commercial, +10074,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,Aetna-Commercial,1610.0 +10075,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,Aetna-Commercial,2701.32 +10076,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,Aetna-Commercial,294.03 +10077,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,Aetna-Commercial, +10078,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,Aetna-Commercial,2515.0 +10079,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,Aetna-Commercial,6093.85 +10080,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,Aetna-Commercial, +10081,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,Aetna-Commercial,235.65 +10082,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,Aetna-Commercial,0.75 +10083,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,Aetna-Commercial,0.62 +10084,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,Aetna-Commercial,300.95 +10085,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,Aetna-Commercial, +10086,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,Aetna-Commercial, +10087,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,Aetna-Commercial, +10088,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,Aetna-Commercial,0.7 +10089,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,Aetna-Commercial, +10090,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,Aetna-Commercial, +10091,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,Aetna-Commercial,1100.0 +10092,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,Aetna-Commercial, +10093,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,Aetna-Commercial,15.0 +10094,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,Aetna-Commercial, +10095,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,Aetna-Commercial,11938.82 +10096,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,Aetna-Commercial, +10097,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,Aetna-Commercial,5050.0 +10098,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,Aetna-Commercial, +10099,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,Aetna-Commercial, +10100,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,Aetna-Commercial, +10101,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,Aetna-Commercial, +10102,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,Aetna-Commercial, +10103,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,Aetna-Commercial, +10104,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,Aetna-Commercial, +10105,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,Aetna-Commercial, +10106,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,Aetna-Commercial,10521.0 +10107,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,Aetna-Commercial, +10108,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,Aetna-Commercial, +10109,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,Aetna-Commercial,364.0 +10110,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,Aetna-Commercial, +10111,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,Aetna-Commercial, +10112,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,Aetna-Commercial,476.54 +10113,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,Aetna-Commercial, +10114,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,Aetna-Commercial,50.08 +10115,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,Aetna-Commercial, +10116,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,Aetna-Commercial, +10117,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,Aetna-Commercial,2272.0 +10118,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,Aetna-Commercial,1896.53 +10119,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,Aetna-Commercial,103.0 +10120,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,Aetna-Commercial, +10121,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,Aetna-Commercial, +10122,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,Aetna-Commercial,138.75 +10123,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,Aetna-Commercial,38.75 +10124,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,Aetna-Commercial, +10125,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,Aetna-Commercial,220.67 +10126,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,Aetna-Commercial,1498.2 +10127,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,Aetna-Commercial,414.0 +10128,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,Aetna-Commercial,1014.0 +10129,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,Aetna-Commercial, +10130,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,Aetna-Commercial, +10131,3934,30000012,PRIVATE,,8380.0,8380.0,,,Aetna-Commercial, +10132,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,Aetna-Commercial, +10133,3934,30000038,ICU,,12700.0,12700.0,,,Aetna-Commercial, +10134,3934,30000046,BURN UNIT,,12700.0,12700.0,,,Aetna-Commercial, +10135,3934,30000053,NICU,,12700.0,12700.0,,,Aetna-Commercial, +10136,3934,30000061,ICR ROOM,,7630.0,7630.0,,,Aetna-Commercial, +10137,3934,30000079,PSYCH,,7630.0,7630.0,,,Aetna-Commercial, +10138,3934,30000087,NEWBORN,,4140.0,4140.0,,,Aetna-Commercial, +10139,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,Aetna-Commercial, +10140,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10141,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,Aetna-Commercial, +10142,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10143,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10144,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10145,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10146,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10147,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10148,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10149,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10150,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10151,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10152,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10153,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,Aetna-Commercial, 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PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10167,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,Aetna-Commercial, +10168,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10169,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10170,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10171,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10172,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10173,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10174,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10175,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10176,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10177,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10178,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, 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PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10193,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10194,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10195,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10196,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10197,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10198,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10199,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10200,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10201,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10202,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10203,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10204,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10205,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10206,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10207,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10208,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10209,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,Aetna-Commercial, +10210,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10211,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10212,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10213,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10214,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10215,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10216,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10217,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10218,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10219,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10220,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10221,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10222,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10223,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10224,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10225,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10226,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10227,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10228,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10229,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10230,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10231,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10232,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10233,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10234,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10235,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10236,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10237,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10238,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10239,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10240,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10241,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10242,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10243,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10244,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10245,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,Aetna-Commercial, +10246,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,Aetna-Commercial, +10247,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,Aetna-Commercial, +10248,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10249,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10250,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10251,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10252,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10253,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10254,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10255,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10256,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10257,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10258,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10259,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10260,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10261,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10262,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10263,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10264,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10265,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10266,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,Aetna-Commercial, 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PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10468,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10469,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10470,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10471,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10472,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10473,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10474,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10475,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10476,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10477,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10478,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10479,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10480,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10481,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10482,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10483,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10484,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10485,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10486,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10487,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10488,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10489,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10490,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10491,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10492,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10493,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10494,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10495,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10496,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10497,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10498,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10499,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10500,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10501,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10502,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10503,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,Aetna-Commercial, +10504,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10505,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10506,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10507,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,Aetna-Commercial, +10508,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10509,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10510,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10511,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10512,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10513,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10514,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10515,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10516,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10517,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10518,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,Aetna-Commercial, 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PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10532,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,Aetna-Commercial, +10533,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10534,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10535,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10536,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10537,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10538,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10539,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10540,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,Aetna-Commercial, +10541,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10542,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,Aetna-Commercial, +10543,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10544,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10545,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10546,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,Aetna-Commercial, +10547,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,Aetna-Commercial, +10548,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,Aetna-Commercial, +10549,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10550,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,Aetna-Commercial, +10551,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10552,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10553,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10554,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10555,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,Aetna-Commercial, +10556,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10557,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10558,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10559,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10560,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10561,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10562,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10563,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,Aetna-Commercial, +10564,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10565,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10566,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10567,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10568,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10569,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10570,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10571,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,Aetna-Commercial, +10572,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Commercial, +10573,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,Aetna-Commercial, +10574,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,Aetna-Commercial, +10575,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,Aetna-Commercial, +10576,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,Aetna-Commercial, +10577,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,Aetna-Commercial, +10578,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,Aetna-Commercial, +10579,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,Aetna-Commercial, +10580,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,Aetna-Commercial, +10581,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,Aetna-Commercial, +10582,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,Aetna-Commercial, +10583,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,Aetna-Commercial, +10584,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,Aetna-Commercial, +10585,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,Aetna-Commercial, +10586,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,Aetna-Commercial, +10587,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,Aetna-Commercial, +10588,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,Aetna-Commercial, +10589,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,Aetna-Commercial, +10590,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,Aetna-Commercial, +10591,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,Aetna-Commercial, +10592,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,Aetna-Commercial, +10593,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,Aetna-Commercial, +10594,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,Aetna-Commercial, +10595,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,Aetna-Commercial, +10596,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,Aetna-Commercial, +10597,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,Aetna-Commercial, +10598,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,Aetna-Commercial, +10599,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,Aetna-Commercial, +10600,3934,37112000,ACUTE ED,,1580.0,1580.0,,,Aetna-Commercial, +10601,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,Aetna-Commercial, +10602,3934,37112034,TRIAGE,,277.0,277.0,,,Aetna-Commercial, +10603,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,Aetna-Commercial, +10604,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,Aetna-Commercial, +10605,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,Aetna-Commercial, +10606,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,Aetna-Commercial, +10607,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,Aetna-Commercial, +10608,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,Aetna-Commercial, +10609,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,Aetna-Commercial, +10610,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,Aetna-Commercial, +10611,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,Aetna-Commercial, +10612,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,Aetna-Commercial, +10613,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,Aetna-Commercial, +10614,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,Aetna-Commercial, +10615,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,Aetna-Commercial, +10616,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,Aetna-Commercial, +10617,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,Aetna-Commercial, +10618,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,Aetna-Commercial, +10619,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,Aetna-Commercial, +10620,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,Aetna-Commercial, +10621,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,Aetna-Commercial, +10622,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,Aetna-Commercial, +10623,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,Aetna-Commercial, +10624,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,Aetna-Commercial, +10625,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,Aetna-Commercial, +10626,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,Aetna-Commercial, +10627,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,Aetna-Commercial, +10628,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,Aetna-Commercial, +10629,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,Aetna-Commercial, +10630,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,Aetna-Commercial, +10631,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,Aetna-Commercial, +10632,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,Aetna-Commercial, +10633,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,Aetna-Commercial, +10634,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,Aetna-Commercial, +10635,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,Aetna-Commercial, +10636,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,Aetna-Commercial, +10637,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,Aetna-Commercial, +10638,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,Aetna-Commercial, +10639,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,Aetna-Commercial, +10640,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,Aetna-Commercial, +10641,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,Aetna-Commercial, +10642,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,Aetna-Commercial, +10643,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,Aetna-Commercial, +10644,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,Aetna-Commercial, +10645,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,Aetna-Commercial, +10646,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,Aetna-Commercial, +10647,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,Aetna-Commercial, +10648,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,Aetna-Commercial, +10649,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,Aetna-Commercial, +10650,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,Aetna-Commercial, +10651,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,Aetna-Commercial, +10652,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,Aetna-Commercial, +10653,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,Aetna-Commercial, +10654,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,Aetna-Commercial, +10655,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,Aetna-Commercial, +10656,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,Aetna-Commercial, +10657,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,Aetna-Commercial, +10658,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,Aetna-Commercial, +10659,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,Aetna-Commercial, +10660,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,Aetna-Commercial, +10661,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,Aetna-Commercial, +10662,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,Aetna-Commercial, +10663,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,Aetna-Commercial, +10664,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,Aetna-Commercial, +10665,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,Aetna-Commercial, +10666,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,Aetna-Commercial, +10667,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,Aetna-Commercial, +10668,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,Aetna-Commercial, +10669,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,Aetna-Commercial, +10670,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,Aetna-Commercial, +10671,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,Aetna-Commercial, +10672,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,Aetna-Commercial, +10673,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,Aetna-Commercial, +10674,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,Aetna-Commercial, +10675,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,Aetna-Commercial, +10676,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,Aetna-Commercial, +10677,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,Aetna-Commercial, +10678,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,Aetna-Commercial, +10679,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,Aetna-Commercial, +10680,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,Aetna-Commercial, +10681,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,Aetna-Commercial, +10682,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,Aetna-Commercial, +10683,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,Aetna-Commercial, +10684,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,Aetna-Commercial, +10685,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,Aetna-Commercial, +10686,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,Aetna-Commercial, +10687,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,Aetna-Commercial, +10688,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,Aetna-Commercial, +10689,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,Aetna-Commercial, +10690,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,Aetna-Commercial, +10691,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,Aetna-Commercial, +10692,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,Aetna-Commercial, +10693,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,Aetna-Commercial, +10694,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,Aetna-Commercial, +10695,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,Aetna-Commercial, +10696,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,Aetna-Commercial, +10697,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,Aetna-Commercial, +10698,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,Aetna-Commercial, +10699,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,Aetna-Commercial, +10700,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,Aetna-Commercial, +10701,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,Aetna-Commercial, +10702,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Commercial, +10703,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10704,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10705,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10706,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10707,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10708,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,Aetna-Commercial, +10709,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,Aetna-Commercial, +10710,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,Aetna-Commercial, +10711,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10712,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10713,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10714,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,Aetna-Commercial, +10715,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,Aetna-Commercial, +10716,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,Aetna-Commercial, +10717,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,Aetna-Commercial, +10718,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,Aetna-Commercial, +10719,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,Aetna-Commercial, +10720,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,Aetna-Commercial, +10721,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,Aetna-Commercial, +10722,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,Aetna-Commercial, +10723,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,Aetna-Commercial, +10724,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,Aetna-Commercial, +10725,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,Aetna-Commercial, +10726,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,Aetna-Commercial, +10727,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,Aetna-Commercial, +10728,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,Aetna-Commercial, +10729,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,Aetna-Commercial, +10730,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,Aetna-Commercial, +10731,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,Aetna-Commercial, +10732,3934,43301043,ALBUNEX,,357.0,357.0,,,Aetna-Commercial, +10733,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,Aetna-Commercial, +10734,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10735,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10736,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10737,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10738,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10739,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,Aetna-Commercial, +10740,3934,43450022,REC RM .5HR,,541.0,541.0,,,Aetna-Commercial, +10741,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,Aetna-Commercial, +10742,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,Aetna-Commercial, +10743,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,Aetna-Commercial, +10744,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,Aetna-Commercial, +10745,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,Aetna-Commercial, +10746,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,Aetna-Commercial, +10747,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,Aetna-Commercial, +10748,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,Aetna-Commercial, +10749,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,Aetna-Commercial, +10750,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,Aetna-Commercial, +10751,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,Aetna-Commercial, +10752,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,Aetna-Commercial, +10753,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,Aetna-Commercial, +10754,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,Aetna-Commercial, +10755,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,Aetna-Commercial, +10756,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,Aetna-Commercial, +10757,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Commercial, +10758,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10759,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10760,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10761,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10762,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10763,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,Aetna-Commercial, +10764,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10765,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Commercial, +10766,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10767,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10768,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10769,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10770,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,Aetna-Commercial, +10771,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Commercial, +10772,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10773,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10774,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10775,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10776,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10777,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Commercial, +10778,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10779,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10780,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10781,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10782,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10783,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,Aetna-Commercial, +10784,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,Aetna-Commercial, +10785,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,Aetna-Commercial, +10786,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,Aetna-Commercial, +10787,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,Aetna-Commercial, +10788,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,Aetna-Commercial, +10789,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,Aetna-Commercial, +10790,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,Aetna-Commercial, +10791,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Commercial, +10792,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10793,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10794,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10795,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10796,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10797,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,Aetna-Commercial, +10798,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,Aetna-Commercial, +10799,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,Aetna-Commercial, +10800,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,Aetna-Commercial, +10801,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,Aetna-Commercial, +10802,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,Aetna-Commercial, +10803,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,Aetna-Commercial, +10804,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,Aetna-Commercial, +10805,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,Aetna-Commercial, +10806,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,Aetna-Commercial, +10807,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,Aetna-Commercial, +10808,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,Aetna-Commercial, +10809,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,Aetna-Commercial, +10810,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,Aetna-Commercial, +10811,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,Aetna-Commercial, +10812,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,Aetna-Commercial, +10813,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,Aetna-Commercial, +10814,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,Aetna-Commercial, +10815,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,Aetna-Commercial, +10816,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,Aetna-Commercial, +10817,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,Aetna-Commercial, +10818,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,Aetna-Commercial, +10819,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,Aetna-Commercial, +10820,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,Aetna-Commercial, +10821,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,Aetna-Commercial, +10822,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,Aetna-Commercial, +10823,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,Aetna-Commercial, +10824,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,Aetna-Commercial, +10825,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,Aetna-Commercial, +10826,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,Aetna-Commercial, +10827,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,Aetna-Commercial, +10828,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,Aetna-Commercial, +10829,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,Aetna-Commercial, +10830,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,Aetna-Commercial, +10831,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,Aetna-Commercial, +10832,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,Aetna-Commercial, +10833,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,Aetna-Commercial, +10834,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,Aetna-Commercial, +10835,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,Aetna-Commercial, +10836,3934,45924552,ENDO REC RM,,30.0,30.0,,,Aetna-Commercial, +10837,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,Aetna-Commercial, +10838,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,Aetna-Commercial, +10839,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,Aetna-Commercial, +10840,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,Aetna-Commercial, +10841,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,Aetna-Commercial, +10842,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,Aetna-Commercial, +10843,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,Aetna-Commercial, +10844,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,Aetna-Commercial, +10845,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,Aetna-Commercial, +10846,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,Aetna-Commercial, +10847,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,Aetna-Commercial, +10848,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,Aetna-Commercial, +10849,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,Aetna-Commercial, +10850,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,Aetna-Commercial, +10851,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,Aetna-Commercial, +10852,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,Aetna-Commercial, +10853,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,Aetna-Commercial, +10854,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,Aetna-Commercial, +10855,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,Aetna-Commercial, +10856,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,Aetna-Commercial, +10857,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,Aetna-Commercial, +10858,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,Aetna-Commercial, +10859,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,Aetna-Commercial, +10860,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,Aetna-Commercial, +10861,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,Aetna-Commercial, +10862,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,Aetna-Commercial, +10863,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Commercial, +10864,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Commercial, +10865,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Commercial, +10866,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Commercial, +10867,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Commercial, +10868,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Commercial, +10869,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,Aetna-Commercial, +10870,3934,53200010,GUEST TRAY,,24.0,24.0,,,Aetna-Commercial, +10871,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,Aetna-Commercial, +10872,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,Aetna-Commercial, +10873,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,Aetna-Commercial, +10874,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,Aetna-Commercial, +10875,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,Aetna-Commercial, +10876,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,Aetna-Commercial, +10877,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,Aetna-Commercial, +10878,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,Aetna-Commercial, +10879,3934,53329876,HIV MONITORING,,416.0,416.0,,,Aetna-Commercial, +10880,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,Aetna-Commercial, +10881,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,Aetna-Commercial, +10882,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,Aetna-Commercial, +10883,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,Aetna-Commercial, +10884,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,Aetna-Commercial, +10885,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,Aetna-Commercial, +10886,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,Aetna-Commercial, +10887,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,Aetna-Commercial, +10888,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,Aetna-Commercial, +10889,3934,76010107,COPY X-RAY,,22.0,22.0,,,Aetna-Commercial, +10890,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,Aetna-Commercial, +10891,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,Aetna-Commercial, +10892,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,Aetna-Commercial, +10893,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,Aetna-Commercial, +10894,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,Aetna-Commercial, +10895,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,Aetna-Commercial, +10896,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,Aetna-Commercial, +10897,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,Aetna-Commercial, +10898,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,Aetna-Commercial, +10899,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,Aetna-Commercial, +10900,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,Aetna-Commercial, +10901,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,Aetna-Commercial, +10902,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,Aetna-Medicare Advantage, +10903,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,Aetna-Medicare Advantage, +10904,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,Aetna-Medicare Advantage,153038.5 +10905,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,Aetna-Medicare Advantage, +10906,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,Aetna-Medicare Advantage, +10907,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,Aetna-Medicare Advantage, +10908,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,Aetna-Medicare Advantage, +10909,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,Aetna-Medicare Advantage, +10910,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,Aetna-Medicare Advantage, +10911,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,Aetna-Medicare Advantage,141686.64 +10912,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,Aetna-Medicare Advantage, +10913,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,Aetna-Medicare Advantage, +10914,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,Aetna-Medicare Advantage,69583.21 +10915,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,Aetna-Medicare Advantage, +10916,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,Aetna-Medicare Advantage, +10917,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,Aetna-Medicare Advantage, +10918,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,Aetna-Medicare Advantage, +10919,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,Aetna-Medicare Advantage, +10920,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,Aetna-Medicare Advantage, +10921,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,Aetna-Medicare Advantage, +10922,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,Aetna-Medicare Advantage, +10923,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,Aetna-Medicare Advantage,17985.86 +10924,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,Aetna-Medicare Advantage, +10925,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,Aetna-Medicare Advantage, +10926,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,Aetna-Medicare Advantage,18845.11 +10927,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,Aetna-Medicare Advantage,17191.24 +10928,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,Aetna-Medicare Advantage, +10929,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,Aetna-Medicare Advantage, +10930,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,Aetna-Medicare Advantage, +10931,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,Aetna-Medicare Advantage, +10932,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,Aetna-Medicare Advantage, +10933,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,Aetna-Medicare Advantage, +10934,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,Aetna-Medicare Advantage, +10935,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,Aetna-Medicare Advantage, +10936,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,Aetna-Medicare Advantage,11262.18 +10937,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,Aetna-Medicare Advantage, +10938,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,Aetna-Medicare Advantage, +10939,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,Aetna-Medicare Advantage,12317.41 +10940,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,Aetna-Medicare Advantage, +10941,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,Aetna-Medicare Advantage, +10942,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,Aetna-Medicare Advantage, +10943,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,Aetna-Medicare Advantage, +10944,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,Aetna-Medicare Advantage, +10945,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,Aetna-Medicare Advantage, +10946,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,Aetna-Medicare Advantage,31256.11 +10947,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,Aetna-Medicare Advantage, +10948,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,Aetna-Medicare Advantage,7735.76 +10949,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,Aetna-Medicare Advantage, +10950,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,Aetna-Medicare Advantage, +10951,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,Aetna-Medicare Advantage, +10952,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,Aetna-Medicare Advantage,8621.08 +10953,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,Aetna-Medicare Advantage, +10954,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,Aetna-Medicare Advantage, +10955,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,Aetna-Medicare Advantage,9959.83 +10956,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,Aetna-Medicare Advantage, +10957,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,Aetna-Medicare Advantage, +10958,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,Aetna-Medicare Advantage, +10959,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,Aetna-Medicare Advantage, +10960,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,Aetna-Medicare Advantage,36823.12 +10961,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,Aetna-Medicare Advantage, +10962,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,Aetna-Medicare Advantage,18751.09 +10963,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,Aetna-Medicare Advantage, +10964,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,Aetna-Medicare Advantage, +10965,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,Aetna-Medicare Advantage, +10966,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,Aetna-Medicare Advantage, +10967,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,Aetna-Medicare Advantage, +10968,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,Aetna-Medicare Advantage,6824.39 +10969,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,Aetna-Medicare Advantage, +10970,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,Aetna-Medicare Advantage, +10971,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,Aetna-Medicare Advantage, +10972,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,Aetna-Medicare Advantage, +10973,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,Aetna-Medicare Advantage, +10974,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,Aetna-Medicare Advantage, +10975,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,Aetna-Medicare Advantage,15326.97 +10976,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,Aetna-Medicare Advantage, +10977,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,Aetna-Medicare Advantage, +10978,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,Aetna-Medicare Advantage, +10979,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,Aetna-Medicare Advantage, +10980,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,Aetna-Medicare Advantage, +10981,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,Aetna-Medicare Advantage, +10982,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,Aetna-Medicare Advantage, +10983,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,Aetna-Medicare Advantage, +10984,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,Aetna-Medicare Advantage, +10985,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,Aetna-Medicare Advantage, +10986,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,Aetna-Medicare Advantage, +10987,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,Aetna-Medicare Advantage, +10988,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,Aetna-Medicare Advantage, +10989,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,Aetna-Medicare Advantage, +10990,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,Aetna-Medicare Advantage, +10991,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,Aetna-Medicare Advantage, +10992,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,Aetna-Medicare Advantage, +10993,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,Aetna-Medicare Advantage, +10994,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,Aetna-Medicare Advantage, +10995,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,Aetna-Medicare Advantage, +10996,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,Aetna-Medicare Advantage, +10997,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,Aetna-Medicare Advantage, +10998,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,Aetna-Medicare Advantage, +10999,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,Aetna-Medicare Advantage, +11000,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,Aetna-Medicare Advantage, +11001,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,Aetna-Medicare Advantage, +11002,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,Aetna-Medicare Advantage, +11003,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,Aetna-Medicare Advantage, +11004,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,Aetna-Medicare Advantage, +11005,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,Aetna-Medicare Advantage, +11006,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,Aetna-Medicare Advantage, +11007,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,Aetna-Medicare Advantage, +11008,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,Aetna-Medicare Advantage, +11009,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,Aetna-Medicare Advantage, +11010,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,Aetna-Medicare Advantage, +11011,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,Aetna-Medicare Advantage, +11012,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,Aetna-Medicare Advantage, +11013,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,Aetna-Medicare Advantage, +11014,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,Aetna-Medicare Advantage, +11015,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,Aetna-Medicare Advantage, +11016,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,Aetna-Medicare Advantage, +11017,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,Aetna-Medicare Advantage, +11018,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,Aetna-Medicare Advantage, +11019,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,Aetna-Medicare Advantage, +11020,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,Aetna-Medicare Advantage,11220.08 +11021,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,Aetna-Medicare Advantage,11241.56 +11022,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,Aetna-Medicare Advantage, +11023,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,Aetna-Medicare Advantage,43986.58 +11024,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,Aetna-Medicare Advantage,11834.65 +11025,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,Aetna-Medicare Advantage, +11026,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,Aetna-Medicare Advantage,14566.39 +11027,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,Aetna-Medicare Advantage, +11028,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,Aetna-Medicare Advantage, +11029,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,Aetna-Medicare Advantage, +11030,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,Aetna-Medicare Advantage,8011.01 +11031,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,Aetna-Medicare Advantage, +11032,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,Aetna-Medicare Advantage, +11033,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,Aetna-Medicare Advantage,10385.65 +11034,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,Aetna-Medicare Advantage,9809.69 +11035,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,Aetna-Medicare Advantage, +11036,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,Aetna-Medicare Advantage, +11037,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,Aetna-Medicare Advantage,12908.11 +11038,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,Aetna-Medicare Advantage,8995.26 +11039,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,Aetna-Medicare Advantage, +11040,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,Aetna-Medicare Advantage, +11041,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,Aetna-Medicare Advantage, +11042,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,Aetna-Medicare Advantage, +11043,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,Aetna-Medicare Advantage, +11044,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,Aetna-Medicare Advantage, +11045,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,Aetna-Medicare Advantage,8249.29 +11046,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,Aetna-Medicare Advantage, +11047,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,Aetna-Medicare Advantage, +11048,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,Aetna-Medicare Advantage, +11049,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,Aetna-Medicare Advantage, +11050,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,Aetna-Medicare Advantage, +11051,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,Aetna-Medicare Advantage, +11052,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,Aetna-Medicare Advantage,104231.31 +11053,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,Aetna-Medicare Advantage, +11054,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,Aetna-Medicare Advantage, +11055,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,Aetna-Medicare Advantage, +11056,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,Aetna-Medicare Advantage,46563.39 +11057,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,Aetna-Medicare Advantage, +11058,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,Aetna-Medicare Advantage,68891.9 +11059,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,Aetna-Medicare Advantage, +11060,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,Aetna-Medicare Advantage,60127.49 +11061,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,Aetna-Medicare Advantage, +11062,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,Aetna-Medicare Advantage, +11063,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,Aetna-Medicare Advantage,42759.37 +11064,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,Aetna-Medicare Advantage,52461.49 +11065,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,Aetna-Medicare Advantage,33686.42 +11066,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,Aetna-Medicare Advantage, +11067,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,Aetna-Medicare Advantage, +11068,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,Aetna-Medicare Advantage, +11069,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,Aetna-Medicare Advantage, +11070,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,Aetna-Medicare Advantage, +11071,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,Aetna-Medicare Advantage, +11072,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,Aetna-Medicare Advantage,42935.49 +11073,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,Aetna-Medicare Advantage, +11074,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,Aetna-Medicare Advantage, +11075,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,Aetna-Medicare Advantage,21110.16 +11076,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,Aetna-Medicare Advantage,18954.3 +11077,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,Aetna-Medicare Advantage, +11078,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,Aetna-Medicare Advantage,100293.36 +11079,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,Aetna-Medicare Advantage,17680.31 +11080,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,Aetna-Medicare Advantage, +11081,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,Aetna-Medicare Advantage, +11082,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,Aetna-Medicare Advantage, +11083,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,Aetna-Medicare Advantage,27062.7 +11084,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,Aetna-Medicare Advantage,22638.56 +11085,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,Aetna-Medicare Advantage,16257.69 +11086,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,Aetna-Medicare Advantage, +11087,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,Aetna-Medicare Advantage, +11088,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,Aetna-Medicare Advantage, +11089,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,Aetna-Medicare Advantage,25053.1 +11090,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,Aetna-Medicare Advantage, +11091,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,Aetna-Medicare Advantage, +11092,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,Aetna-Medicare Advantage, +11093,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,Aetna-Medicare Advantage, +11094,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,Aetna-Medicare Advantage, +11095,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,Aetna-Medicare Advantage, +11096,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,Aetna-Medicare Advantage, +11097,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,Aetna-Medicare Advantage,58352.48 +11098,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,Aetna-Medicare Advantage,46440.61 +11099,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,Aetna-Medicare Advantage, +11100,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,Aetna-Medicare Advantage, +11101,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,Aetna-Medicare Advantage,43102.61 +11102,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,Aetna-Medicare Advantage,29589.2 +11103,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,Aetna-Medicare Advantage, +11104,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,Aetna-Medicare Advantage, +11105,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,Aetna-Medicare Advantage, +11106,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,Aetna-Medicare Advantage,15082.1 +11107,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,Aetna-Medicare Advantage, +11108,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,Aetna-Medicare Advantage, +11109,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,Aetna-Medicare Advantage,14879.58 +11110,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,Aetna-Medicare Advantage, +11111,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,Aetna-Medicare Advantage,18362.28 +11112,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,Aetna-Medicare Advantage,11007.48 +11113,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,Aetna-Medicare Advantage, +11114,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,Aetna-Medicare Advantage, +11115,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,Aetna-Medicare Advantage,11900.91 +11116,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,Aetna-Medicare Advantage,8978.26 +11117,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,Aetna-Medicare Advantage, +11118,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,Aetna-Medicare Advantage, +11119,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,Aetna-Medicare Advantage,12249.56 +11120,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,Aetna-Medicare Advantage, +11121,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,Aetna-Medicare Advantage, +11122,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,Aetna-Medicare Advantage, +11123,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,Aetna-Medicare Advantage, +11124,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,Aetna-Medicare Advantage, +11125,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,Aetna-Medicare Advantage, +11126,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,Aetna-Medicare Advantage, +11127,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,Aetna-Medicare Advantage, +11128,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,Aetna-Medicare Advantage,10250.72 +11129,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,Aetna-Medicare Advantage,6785.02 +11130,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,Aetna-Medicare Advantage, +11131,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,Aetna-Medicare Advantage, +11132,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,Aetna-Medicare Advantage,7131.15 +11133,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,Aetna-Medicare Advantage,250.0 +11134,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,Aetna-Medicare Advantage,17013.44 +11135,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,Aetna-Medicare Advantage, +11136,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,Aetna-Medicare Advantage, +11137,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,Aetna-Medicare Advantage, +11138,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,Aetna-Medicare Advantage, +11139,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,Aetna-Medicare Advantage, +11140,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,Aetna-Medicare Advantage, +11141,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,Aetna-Medicare Advantage, +11142,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,Aetna-Medicare Advantage,62768.81 +11143,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,Aetna-Medicare Advantage,22065.16 +11144,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,Aetna-Medicare Advantage, +11145,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,Aetna-Medicare Advantage, +11146,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,Aetna-Medicare Advantage, +11147,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,Aetna-Medicare Advantage,33335.09 +11148,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,Aetna-Medicare Advantage, +11149,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,Aetna-Medicare Advantage, +11150,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,Aetna-Medicare Advantage, +11151,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,Aetna-Medicare Advantage, +11152,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,Aetna-Medicare Advantage, +11153,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,Aetna-Medicare Advantage, +11154,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,Aetna-Medicare Advantage, +11155,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,Aetna-Medicare Advantage, +11156,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,Aetna-Medicare Advantage, +11157,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,Aetna-Medicare Advantage, +11158,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,Aetna-Medicare Advantage,21476.15 +11159,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,Aetna-Medicare Advantage, +11160,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,Aetna-Medicare Advantage, +11161,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,Aetna-Medicare Advantage, +11162,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,Aetna-Medicare Advantage, +11163,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,Aetna-Medicare Advantage, +11164,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,Aetna-Medicare Advantage, +11165,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,Aetna-Medicare Advantage, +11166,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,Aetna-Medicare Advantage,37512.81 +11167,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,Aetna-Medicare Advantage, +11168,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,Aetna-Medicare Advantage, +11169,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,Aetna-Medicare Advantage, +11170,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,Aetna-Medicare Advantage, +11171,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,Aetna-Medicare Advantage, +11172,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,Aetna-Medicare Advantage, +11173,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,Aetna-Medicare Advantage,19036.15 +11174,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,Aetna-Medicare Advantage, +11175,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,Aetna-Medicare Advantage, +11176,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,Aetna-Medicare Advantage,14644.72 +11177,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,Aetna-Medicare Advantage,9759.23 +11178,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,Aetna-Medicare Advantage, +11179,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,Aetna-Medicare Advantage, +11180,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,Aetna-Medicare Advantage, +11181,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,Aetna-Medicare Advantage, +11182,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,Aetna-Medicare Advantage, +11183,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,Aetna-Medicare Advantage, +11184,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,Aetna-Medicare Advantage, +11185,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,Aetna-Medicare Advantage, +11186,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,Aetna-Medicare Advantage,13887.74 +11187,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,Aetna-Medicare Advantage,456.88 +11188,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,Aetna-Medicare Advantage,5316.36 +11189,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,Aetna-Medicare Advantage,17383.79 +11190,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,Aetna-Medicare Advantage,6826.8 +11191,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,Aetna-Medicare Advantage, +11192,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,Aetna-Medicare Advantage, +11193,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,Aetna-Medicare Advantage, +11194,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,Aetna-Medicare Advantage, +11195,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,Aetna-Medicare Advantage, +11196,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,Aetna-Medicare Advantage, +11197,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,Aetna-Medicare Advantage, +11198,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,Aetna-Medicare Advantage, +11199,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,Aetna-Medicare Advantage, +11200,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,Aetna-Medicare Advantage, +11201,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,Aetna-Medicare Advantage, +11202,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,Aetna-Medicare Advantage, +11203,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,Aetna-Medicare Advantage, +11204,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,Aetna-Medicare Advantage, +11205,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,Aetna-Medicare Advantage, +11206,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,Aetna-Medicare Advantage, +11207,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,Aetna-Medicare Advantage, +11208,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,Aetna-Medicare Advantage, +11209,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,Aetna-Medicare Advantage, +11210,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,Aetna-Medicare Advantage, +11211,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,Aetna-Medicare Advantage, +11212,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,Aetna-Medicare Advantage, +11213,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,Aetna-Medicare Advantage,154810.12 +11214,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,Aetna-Medicare Advantage, +11215,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,Aetna-Medicare Advantage, +11216,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,Aetna-Medicare Advantage, +11217,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,Aetna-Medicare Advantage, +11218,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,Aetna-Medicare Advantage, +11219,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,Aetna-Medicare Advantage,13765.55 +11220,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,Aetna-Medicare Advantage, +11221,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,Aetna-Medicare Advantage, +11222,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,Aetna-Medicare Advantage,48970.06 +11223,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,Aetna-Medicare Advantage, +11224,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,Aetna-Medicare Advantage, +11225,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,Aetna-Medicare Advantage, +11226,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,Aetna-Medicare Advantage, +11227,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,Aetna-Medicare Advantage, +11228,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,Aetna-Medicare Advantage, +11229,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,Aetna-Medicare Advantage, +11230,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,Aetna-Medicare Advantage, +11231,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,Aetna-Medicare Advantage, +11232,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,Aetna-Medicare Advantage, +11233,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,Aetna-Medicare Advantage, +11234,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,Aetna-Medicare Advantage, +11235,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,Aetna-Medicare Advantage, +11236,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,Aetna-Medicare Advantage, +11237,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,Aetna-Medicare Advantage,17581.36 +11238,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,Aetna-Medicare Advantage, +11239,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,Aetna-Medicare Advantage, +11240,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,Aetna-Medicare Advantage, +11241,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,Aetna-Medicare Advantage, +11242,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,Aetna-Medicare Advantage, +11243,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,Aetna-Medicare Advantage, +11244,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,Aetna-Medicare Advantage, +11245,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,Aetna-Medicare Advantage,25055.01 +11246,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,Aetna-Medicare Advantage,19201.05 +11247,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,Aetna-Medicare Advantage, +11248,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,Aetna-Medicare Advantage, +11249,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,Aetna-Medicare Advantage, +11250,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,Aetna-Medicare Advantage, +11251,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,Aetna-Medicare Advantage, +11252,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,Aetna-Medicare Advantage, +11253,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,Aetna-Medicare Advantage, +11254,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,Aetna-Medicare Advantage, +11255,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,Aetna-Medicare Advantage, +11256,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,Aetna-Medicare Advantage, +11257,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,Aetna-Medicare Advantage, +11258,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,Aetna-Medicare Advantage, +11259,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,Aetna-Medicare Advantage, +11260,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,Aetna-Medicare Advantage, +11261,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,Aetna-Medicare Advantage, +11262,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,Aetna-Medicare Advantage,14659.58 +11263,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,Aetna-Medicare Advantage,14217.73 +11264,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,Aetna-Medicare Advantage, +11265,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,Aetna-Medicare Advantage, +11266,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,Aetna-Medicare Advantage, +11267,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,Aetna-Medicare Advantage, +11268,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,Aetna-Medicare Advantage, +11269,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,Aetna-Medicare Advantage, +11270,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,Aetna-Medicare Advantage, +11271,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,Aetna-Medicare Advantage, +11272,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,Aetna-Medicare Advantage, +11273,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,Aetna-Medicare Advantage, +11274,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,Aetna-Medicare Advantage, +11275,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,Aetna-Medicare Advantage, +11276,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,Aetna-Medicare Advantage, +11277,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,Aetna-Medicare Advantage, +11278,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,Aetna-Medicare Advantage, +11279,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,Aetna-Medicare Advantage,6740.63 +11280,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,Aetna-Medicare Advantage, +11281,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,Aetna-Medicare Advantage, +11282,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,Aetna-Medicare Advantage,15080.32 +11283,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,Aetna-Medicare Advantage, +11284,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,Aetna-Medicare Advantage, +11285,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,Aetna-Medicare Advantage, +11286,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,Aetna-Medicare Advantage, +11287,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,Aetna-Medicare Advantage, +11288,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,Aetna-Medicare Advantage, +11289,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,Aetna-Medicare Advantage, +11290,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,Aetna-Medicare Advantage, +11291,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,Aetna-Medicare Advantage,7882.28 +11292,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,Aetna-Medicare Advantage, +11293,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,Aetna-Medicare Advantage, +11294,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,Aetna-Medicare Advantage, +11295,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,Aetna-Medicare Advantage, +11296,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,Aetna-Medicare Advantage, +11297,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,Aetna-Medicare Advantage, +11298,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,Aetna-Medicare Advantage, +11299,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,Aetna-Medicare Advantage,6585.75 +11300,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,Aetna-Medicare Advantage, +11301,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,Aetna-Medicare Advantage, +11302,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,Aetna-Medicare Advantage, +11303,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,Aetna-Medicare Advantage, +11304,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,Aetna-Medicare Advantage, +11305,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,Aetna-Medicare Advantage, +11306,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,Aetna-Medicare Advantage, +11307,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,Aetna-Medicare Advantage, +11308,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,Aetna-Medicare Advantage, +11309,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,Aetna-Medicare Advantage, +11310,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,Aetna-Medicare Advantage, +11311,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,Aetna-Medicare Advantage, +11312,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,Aetna-Medicare Advantage, +11313,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,Aetna-Medicare Advantage, +11314,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,Aetna-Medicare Advantage, +11315,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,Aetna-Medicare Advantage, +11316,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,Aetna-Medicare Advantage, +11317,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,Aetna-Medicare Advantage, +11318,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,Aetna-Medicare Advantage, +11319,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,Aetna-Medicare Advantage, +11320,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,Aetna-Medicare Advantage, +11321,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,Aetna-Medicare Advantage, +11322,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,Aetna-Medicare Advantage, +11323,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,Aetna-Medicare Advantage, +11324,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,Aetna-Medicare Advantage, +11325,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,Aetna-Medicare Advantage,12361.29 +11326,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,Aetna-Medicare Advantage,7677.39 +11327,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,Aetna-Medicare Advantage, +11328,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,Aetna-Medicare Advantage, +11329,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,Aetna-Medicare Advantage, +11330,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,Aetna-Medicare Advantage, +11331,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,Aetna-Medicare Advantage, +11332,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,Aetna-Medicare Advantage, +11333,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,Aetna-Medicare Advantage, +11334,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,Aetna-Medicare Advantage, +11335,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,Aetna-Medicare Advantage, +11336,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,Aetna-Medicare Advantage, +11337,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,Aetna-Medicare Advantage, +11338,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,Aetna-Medicare Advantage, +11339,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,Aetna-Medicare Advantage, +11340,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,Aetna-Medicare Advantage, +11341,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,Aetna-Medicare Advantage, +11342,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,Aetna-Medicare Advantage, +11343,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,Aetna-Medicare Advantage,13232.43 +11344,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,Aetna-Medicare Advantage, +11345,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,Aetna-Medicare Advantage, +11346,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,Aetna-Medicare Advantage, +11347,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,Aetna-Medicare Advantage,6728.7 +11348,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,Aetna-Medicare Advantage, +11349,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,Aetna-Medicare Advantage, +11350,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,Aetna-Medicare Advantage,8968.56 +11351,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,Aetna-Medicare Advantage, +11352,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,Aetna-Medicare Advantage, +11353,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,Aetna-Medicare Advantage, +11354,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,Aetna-Medicare Advantage,27183.22 +11355,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,Aetna-Medicare Advantage,30108.95 +11356,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,Aetna-Medicare Advantage, +11357,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,Aetna-Medicare Advantage, +11358,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,Aetna-Medicare Advantage, +11359,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,Aetna-Medicare Advantage, +11360,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,Aetna-Medicare Advantage, +11361,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,Aetna-Medicare Advantage,22323.21 +11362,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,Aetna-Medicare Advantage, +11363,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,Aetna-Medicare Advantage, +11364,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,Aetna-Medicare Advantage, +11365,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,Aetna-Medicare Advantage,12830.19 +11366,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,Aetna-Medicare Advantage, +11367,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,Aetna-Medicare Advantage, +11368,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,Aetna-Medicare Advantage, +11369,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,Aetna-Medicare Advantage, +11370,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,Aetna-Medicare Advantage,46412.97 +11371,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,Aetna-Medicare Advantage, +11372,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,Aetna-Medicare Advantage,29421.83 +11373,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,Aetna-Medicare Advantage, +11374,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,Aetna-Medicare Advantage, +11375,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,Aetna-Medicare Advantage,7946.39 +11376,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,Aetna-Medicare Advantage, +11377,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,Aetna-Medicare Advantage, +11378,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,Aetna-Medicare Advantage, +11379,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,Aetna-Medicare Advantage, +11380,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,Aetna-Medicare Advantage, +11381,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,Aetna-Medicare Advantage, +11382,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,Aetna-Medicare Advantage, +11383,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,Aetna-Medicare Advantage, +11384,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,Aetna-Medicare Advantage, +11385,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,Aetna-Medicare Advantage, +11386,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,Aetna-Medicare Advantage,8927.98 +11387,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,Aetna-Medicare Advantage, +11388,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,Aetna-Medicare Advantage, +11389,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,Aetna-Medicare Advantage, +11390,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,Aetna-Medicare Advantage, +11391,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,Aetna-Medicare Advantage, +11392,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,Aetna-Medicare Advantage, +11393,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,Aetna-Medicare Advantage, +11394,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,Aetna-Medicare Advantage, +11395,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,Aetna-Medicare Advantage,15209.07 +11396,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,Aetna-Medicare Advantage, +11397,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,Aetna-Medicare Advantage, +11398,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,Aetna-Medicare Advantage, +11399,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,Aetna-Medicare Advantage, +11400,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,Aetna-Medicare Advantage, +11401,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,Aetna-Medicare Advantage, +11402,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,Aetna-Medicare Advantage, +11403,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,Aetna-Medicare Advantage, +11404,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,Aetna-Medicare Advantage, +11405,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,Aetna-Medicare Advantage, +11406,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,Aetna-Medicare Advantage, +11407,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,Aetna-Medicare Advantage, +11408,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,Aetna-Medicare Advantage, +11409,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,Aetna-Medicare Advantage, +11410,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,Aetna-Medicare Advantage, +11411,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,Aetna-Medicare Advantage, +11412,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,Aetna-Medicare Advantage, +11413,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,Aetna-Medicare Advantage, +11414,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,Aetna-Medicare Advantage, +11415,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,Aetna-Medicare Advantage, +11416,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,Aetna-Medicare Advantage, +11417,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,Aetna-Medicare Advantage, +11418,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,Aetna-Medicare Advantage, +11419,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,Aetna-Medicare Advantage, +11420,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,Aetna-Medicare Advantage, +11421,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,Aetna-Medicare Advantage, +11422,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,Aetna-Medicare Advantage, +11423,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,Aetna-Medicare Advantage, +11424,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,Aetna-Medicare Advantage, +11425,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,Aetna-Medicare Advantage, +11426,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,Aetna-Medicare Advantage, +11427,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,Aetna-Medicare Advantage, +11428,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,Aetna-Medicare Advantage, +11429,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,Aetna-Medicare Advantage, +11430,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,Aetna-Medicare Advantage, +11431,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,Aetna-Medicare Advantage, +11432,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,Aetna-Medicare Advantage, +11433,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,Aetna-Medicare Advantage, +11434,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,Aetna-Medicare Advantage, +11435,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,Aetna-Medicare Advantage, +11436,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,Aetna-Medicare Advantage, +11437,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,Aetna-Medicare Advantage, +11438,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,Aetna-Medicare Advantage, +11439,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,Aetna-Medicare Advantage, +11440,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,Aetna-Medicare Advantage, +11441,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,Aetna-Medicare Advantage, +11442,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,Aetna-Medicare Advantage, +11443,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,Aetna-Medicare Advantage, +11444,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,Aetna-Medicare Advantage, +11445,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,Aetna-Medicare Advantage, +11446,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,Aetna-Medicare Advantage, +11447,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,Aetna-Medicare Advantage, +11448,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,Aetna-Medicare Advantage, +11449,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,Aetna-Medicare Advantage, +11450,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,Aetna-Medicare Advantage, +11451,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,Aetna-Medicare Advantage, +11452,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,Aetna-Medicare Advantage, +11453,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,Aetna-Medicare Advantage,8855.67 +11454,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,Aetna-Medicare Advantage,13444.08 +11455,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,Aetna-Medicare Advantage, +11456,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,Aetna-Medicare Advantage, +11457,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,Aetna-Medicare Advantage, +11458,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,Aetna-Medicare Advantage, +11459,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,Aetna-Medicare Advantage, +11460,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,Aetna-Medicare Advantage, +11461,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,Aetna-Medicare Advantage, +11462,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,Aetna-Medicare Advantage, +11463,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,Aetna-Medicare Advantage, +11464,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,Aetna-Medicare Advantage, +11465,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,Aetna-Medicare Advantage, +11466,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,Aetna-Medicare Advantage, +11467,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,Aetna-Medicare Advantage, +11468,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,Aetna-Medicare Advantage,19316.67 +11469,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,Aetna-Medicare Advantage, +11470,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,Aetna-Medicare Advantage, +11471,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,Aetna-Medicare Advantage, +11472,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,Aetna-Medicare Advantage, +11473,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,Aetna-Medicare Advantage, +11474,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,Aetna-Medicare Advantage, +11475,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,Aetna-Medicare Advantage,46875.45 +11476,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,Aetna-Medicare Advantage, +11477,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,Aetna-Medicare Advantage, +11478,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,Aetna-Medicare Advantage, +11479,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,Aetna-Medicare Advantage, +11480,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,Aetna-Medicare Advantage, +11481,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,Aetna-Medicare Advantage, +11482,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,Aetna-Medicare Advantage, +11483,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,Aetna-Medicare Advantage, +11484,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,Aetna-Medicare Advantage, +11485,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,Aetna-Medicare Advantage, +11486,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,Aetna-Medicare Advantage, +11487,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,Aetna-Medicare Advantage, +11488,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,Aetna-Medicare Advantage, +11489,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,Aetna-Medicare Advantage,41669.45 +11490,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,Aetna-Medicare Advantage, +11491,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,Aetna-Medicare Advantage, +11492,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,Aetna-Medicare Advantage, +11493,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,Aetna-Medicare Advantage, +11494,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,Aetna-Medicare Advantage,17460.26 +11495,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,Aetna-Medicare Advantage, +11496,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,Aetna-Medicare Advantage, +11497,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,Aetna-Medicare Advantage,13625.83 +11498,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,Aetna-Medicare Advantage, +11499,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,Aetna-Medicare Advantage, +11500,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,Aetna-Medicare Advantage, +11501,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,Aetna-Medicare Advantage,7632.07 +11502,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,Aetna-Medicare Advantage,84523.03 +11503,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,Aetna-Medicare Advantage,28697.93 +11504,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,Aetna-Medicare Advantage,10308.53 +11505,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,Aetna-Medicare Advantage, +11506,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,Aetna-Medicare Advantage, +11507,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,Aetna-Medicare Advantage, +11508,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,Aetna-Medicare Advantage, +11509,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,Aetna-Medicare Advantage, +11510,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,Aetna-Medicare Advantage,12150.29 +11511,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,Aetna-Medicare Advantage, +11512,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,Aetna-Medicare Advantage, +11513,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,Aetna-Medicare Advantage, +11514,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,Aetna-Medicare Advantage, +11515,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,Aetna-Medicare Advantage, +11516,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,Aetna-Medicare Advantage, +11517,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,Aetna-Medicare Advantage, +11518,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,Aetna-Medicare Advantage, +11519,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,Aetna-Medicare Advantage, +11520,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,Aetna-Medicare Advantage, +11521,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,Aetna-Medicare Advantage, +11522,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,Aetna-Medicare Advantage, +11523,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,Aetna-Medicare Advantage,16955.62 +11524,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,Aetna-Medicare Advantage, +11525,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,Aetna-Medicare Advantage, +11526,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,Aetna-Medicare Advantage, +11527,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,Aetna-Medicare Advantage, +11528,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,Aetna-Medicare Advantage, +11529,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,Aetna-Medicare Advantage, +11530,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,Aetna-Medicare Advantage, +11531,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,Aetna-Medicare Advantage, +11532,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,Aetna-Medicare Advantage,10355.75 +11533,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,Aetna-Medicare Advantage, +11534,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,Aetna-Medicare Advantage, +11535,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,Aetna-Medicare Advantage, +11536,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,Aetna-Medicare Advantage, +11537,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,Aetna-Medicare Advantage, +11538,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,Aetna-Medicare Advantage, +11539,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,Aetna-Medicare Advantage, +11540,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,Aetna-Medicare Advantage, +11541,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,Aetna-Medicare Advantage, +11542,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,Aetna-Medicare Advantage,6972.21 +11543,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,Aetna-Medicare Advantage, +11544,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,Aetna-Medicare Advantage, +11545,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,Aetna-Medicare Advantage, +11546,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,Aetna-Medicare Advantage, +11547,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,Aetna-Medicare Advantage,33719.38 +11548,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,Aetna-Medicare Advantage, +11549,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,Aetna-Medicare Advantage, +11550,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,Aetna-Medicare Advantage, +11551,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,Aetna-Medicare Advantage, +11552,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,Aetna-Medicare Advantage, +11553,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,Aetna-Medicare Advantage, +11554,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,Aetna-Medicare Advantage,38534.66 +11555,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,Aetna-Medicare Advantage, +11556,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,Aetna-Medicare Advantage, +11557,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,Aetna-Medicare Advantage,26970.03 +11558,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,Aetna-Medicare Advantage, +11559,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,Aetna-Medicare Advantage, +11560,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,Aetna-Medicare Advantage,728.29 +11561,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,Aetna-Medicare Advantage, +11562,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,Aetna-Medicare Advantage, +11563,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,Aetna-Medicare Advantage, +11564,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,Aetna-Medicare Advantage, +11565,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,Aetna-Medicare Advantage, +11566,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,Aetna-Medicare Advantage,739.03 +11567,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,Aetna-Medicare Advantage,211.69 +11568,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,Aetna-Medicare Advantage, +11569,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,Aetna-Medicare Advantage, +11570,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,Aetna-Medicare Advantage, +11571,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,Aetna-Medicare Advantage, +11572,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,Aetna-Medicare Advantage, +11573,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,Aetna-Medicare Advantage, +11574,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,Aetna-Medicare Advantage, +11575,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,Aetna-Medicare Advantage, +11576,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,Aetna-Medicare Advantage,14659.58 +11577,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,Aetna-Medicare Advantage, +11578,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,Aetna-Medicare Advantage, +11579,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,Aetna-Medicare Advantage, +11580,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,Aetna-Medicare Advantage, +11581,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,Aetna-Medicare Advantage, +11582,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,Aetna-Medicare Advantage, +11583,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,Aetna-Medicare Advantage, +11584,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,Aetna-Medicare Advantage, +11585,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,Aetna-Medicare Advantage, +11586,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,Aetna-Medicare Advantage, +11587,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,Aetna-Medicare Advantage, +11588,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,Aetna-Medicare Advantage, +11589,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,Aetna-Medicare Advantage, +11590,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,Aetna-Medicare Advantage, +11591,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,Aetna-Medicare Advantage, +11592,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,Aetna-Medicare Advantage, +11593,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,Aetna-Medicare Advantage, +11594,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,Aetna-Medicare Advantage, +11595,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,Aetna-Medicare Advantage, +11596,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,Aetna-Medicare Advantage, +11597,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,Aetna-Medicare Advantage, +11598,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,Aetna-Medicare Advantage, +11599,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,Aetna-Medicare Advantage, +11600,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,Aetna-Medicare Advantage, +11601,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,Aetna-Medicare Advantage, +11602,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,Aetna-Medicare Advantage, +11603,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,Aetna-Medicare Advantage, +11604,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,Aetna-Medicare Advantage, +11605,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,Aetna-Medicare Advantage, +11606,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,Aetna-Medicare Advantage, +11607,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,Aetna-Medicare Advantage, +11608,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,Aetna-Medicare Advantage, +11609,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,Aetna-Medicare Advantage, +11610,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,Aetna-Medicare Advantage, +11611,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,Aetna-Medicare Advantage, +11612,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,Aetna-Medicare Advantage, +11613,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,Aetna-Medicare Advantage, +11614,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,Aetna-Medicare Advantage, +11615,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,Aetna-Medicare Advantage, +11616,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,Aetna-Medicare Advantage, +11617,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,Aetna-Medicare Advantage, +11618,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,Aetna-Medicare Advantage, +11619,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,Aetna-Medicare Advantage, +11620,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,Aetna-Medicare Advantage, +11621,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,Aetna-Medicare Advantage, +11622,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,Aetna-Medicare Advantage, +11623,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,Aetna-Medicare Advantage, +11624,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,Aetna-Medicare Advantage, +11625,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,Aetna-Medicare Advantage, +11626,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,Aetna-Medicare Advantage, +11627,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,Aetna-Medicare Advantage, +11628,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,Aetna-Medicare Advantage, +11629,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,Aetna-Medicare Advantage, +11630,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,Aetna-Medicare Advantage, +11631,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,Aetna-Medicare Advantage, +11632,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,Aetna-Medicare Advantage, +11633,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,Aetna-Medicare Advantage, +11634,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,Aetna-Medicare Advantage, +11635,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,Aetna-Medicare Advantage, +11636,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,Aetna-Medicare Advantage, +11637,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,Aetna-Medicare Advantage, +11638,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,Aetna-Medicare Advantage, +11639,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,Aetna-Medicare Advantage, +11640,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,Aetna-Medicare Advantage, +11641,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,Aetna-Medicare Advantage, +11642,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,Aetna-Medicare Advantage, +11643,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,Aetna-Medicare Advantage, +11644,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,Aetna-Medicare Advantage, +11645,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,Aetna-Medicare Advantage, +11646,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,Aetna-Medicare Advantage, +11647,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,Aetna-Medicare Advantage, +11648,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,Aetna-Medicare Advantage, +11649,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,Aetna-Medicare Advantage, +11650,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,Aetna-Medicare Advantage, +11651,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,Aetna-Medicare Advantage, +11652,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,Aetna-Medicare Advantage, +11653,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,Aetna-Medicare Advantage, +11654,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,Aetna-Medicare Advantage, +11655,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,Aetna-Medicare Advantage, +11656,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,Aetna-Medicare Advantage, +11657,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,Aetna-Medicare Advantage, +11658,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,Aetna-Medicare Advantage, +11659,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,Aetna-Medicare Advantage, +11660,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,Aetna-Medicare Advantage, +11661,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,Aetna-Medicare Advantage, +11662,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,Aetna-Medicare Advantage, +11663,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,Aetna-Medicare Advantage, +11664,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,Aetna-Medicare Advantage, +11665,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,Aetna-Medicare Advantage, +11666,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,Aetna-Medicare Advantage, +11667,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,Aetna-Medicare Advantage,404.96 +11668,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,Aetna-Medicare Advantage, +11669,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,Aetna-Medicare Advantage, +11670,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,Aetna-Medicare Advantage, +11671,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,Aetna-Medicare Advantage, +11672,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,Aetna-Medicare Advantage, +11673,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,Aetna-Medicare Advantage, +11674,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,Aetna-Medicare Advantage, +11675,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,Aetna-Medicare Advantage, +11676,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,Aetna-Medicare Advantage, +11677,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,Aetna-Medicare Advantage, +11678,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,Aetna-Medicare Advantage, +11679,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,Aetna-Medicare Advantage, +11680,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,Aetna-Medicare Advantage, +11681,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,Aetna-Medicare Advantage, +11682,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,Aetna-Medicare Advantage, +11683,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,Aetna-Medicare Advantage, +11684,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,Aetna-Medicare Advantage, +11685,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,Aetna-Medicare Advantage, +11686,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,Aetna-Medicare Advantage, +11687,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,Aetna-Medicare Advantage, +11688,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,Aetna-Medicare Advantage, +11689,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,Aetna-Medicare Advantage, +11690,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,Aetna-Medicare Advantage, +11691,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,Aetna-Medicare Advantage, +11692,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,Aetna-Medicare Advantage, +11693,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,Aetna-Medicare Advantage, +11694,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,Aetna-Medicare Advantage, +11695,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,Aetna-Medicare Advantage, +11696,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,Aetna-Medicare Advantage, +11697,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,Aetna-Medicare Advantage, +11698,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,Aetna-Medicare Advantage, +11699,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,Aetna-Medicare Advantage, +11700,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,Aetna-Medicare Advantage, +11701,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,Aetna-Medicare Advantage, +11702,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,Aetna-Medicare Advantage, +11703,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,Aetna-Medicare Advantage, +11704,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,Aetna-Medicare Advantage, +11705,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,Aetna-Medicare Advantage, +11706,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,Aetna-Medicare Advantage, +11707,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,Aetna-Medicare Advantage, +11708,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,Aetna-Medicare Advantage, +11709,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,Aetna-Medicare Advantage, +11710,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,Aetna-Medicare Advantage, +11711,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,Aetna-Medicare Advantage, +11712,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,Aetna-Medicare Advantage, +11713,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,Aetna-Medicare Advantage, +11714,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,Aetna-Medicare Advantage, +11715,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,Aetna-Medicare Advantage, +11716,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,Aetna-Medicare Advantage, +11717,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,Aetna-Medicare Advantage, +11718,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,Aetna-Medicare Advantage, +11719,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,Aetna-Medicare Advantage, +11720,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,Aetna-Medicare Advantage, +11721,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,Aetna-Medicare Advantage, +11722,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,Aetna-Medicare Advantage, +11723,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,Aetna-Medicare Advantage, +11724,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,Aetna-Medicare Advantage, +11725,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,Aetna-Medicare Advantage, +11726,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,Aetna-Medicare Advantage, +11727,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,Aetna-Medicare Advantage, +11728,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,Aetna-Medicare Advantage, +11729,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,Aetna-Medicare Advantage, +11730,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,Aetna-Medicare Advantage, +11731,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,Aetna-Medicare Advantage, +11732,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,Aetna-Medicare Advantage,1662.9 +11733,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,Aetna-Medicare Advantage, +11734,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,Aetna-Medicare Advantage,1662.9 +11735,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,Aetna-Medicare Advantage, +11736,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,Aetna-Medicare Advantage,1662.9 +11737,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,Aetna-Medicare Advantage, +11738,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,Aetna-Medicare Advantage, +11739,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,Aetna-Medicare Advantage, +11740,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,Aetna-Medicare Advantage, +11741,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,Aetna-Medicare Advantage, +11742,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,Aetna-Medicare Advantage, +11743,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,Aetna-Medicare Advantage, +11744,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,Aetna-Medicare Advantage, +11745,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,Aetna-Medicare Advantage, +11746,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,Aetna-Medicare Advantage, +11747,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,Aetna-Medicare Advantage, +11748,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,Aetna-Medicare Advantage,4570.93 +11749,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,Aetna-Medicare Advantage, +11750,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,Aetna-Medicare Advantage, +11751,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,Aetna-Medicare Advantage, +11752,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,Aetna-Medicare Advantage, +11753,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,Aetna-Medicare Advantage, +11754,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,Aetna-Medicare Advantage, +11755,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,Aetna-Medicare Advantage, +11756,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,Aetna-Medicare Advantage, +11757,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,Aetna-Medicare Advantage, +11758,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,Aetna-Medicare Advantage, +11759,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,Aetna-Medicare Advantage, +11760,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,Aetna-Medicare Advantage, +11761,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,Aetna-Medicare Advantage, +11762,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,Aetna-Medicare Advantage, +11763,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,Aetna-Medicare Advantage, +11764,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,Aetna-Medicare Advantage, +11765,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,Aetna-Medicare Advantage, +11766,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,Aetna-Medicare Advantage, +11767,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,Aetna-Medicare Advantage, +11768,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,Aetna-Medicare Advantage, +11769,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,Aetna-Medicare Advantage, +11770,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,Aetna-Medicare Advantage, +11771,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,Aetna-Medicare Advantage, +11772,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,Aetna-Medicare Advantage, +11773,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,Aetna-Medicare Advantage, +11774,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,Aetna-Medicare Advantage, +11775,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,Aetna-Medicare Advantage, +11776,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,Aetna-Medicare Advantage,305.81 +11777,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,Aetna-Medicare Advantage, +11778,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,Aetna-Medicare Advantage, +11779,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,Aetna-Medicare Advantage, +11780,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,Aetna-Medicare Advantage, +11781,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,Aetna-Medicare Advantage, +11782,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,Aetna-Medicare Advantage, +11783,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,Aetna-Medicare Advantage, +11784,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,Aetna-Medicare Advantage,154.8 +11785,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,Aetna-Medicare Advantage, +11786,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,Aetna-Medicare Advantage, +11787,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,Aetna-Medicare Advantage, +11788,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,Aetna-Medicare Advantage, +11789,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,Aetna-Medicare Advantage, +11790,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,Aetna-Medicare Advantage, +11791,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,Aetna-Medicare Advantage, +11792,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,Aetna-Medicare Advantage, +11793,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,Aetna-Medicare Advantage, +11794,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,Aetna-Medicare Advantage, +11795,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,Aetna-Medicare Advantage, +11796,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,Aetna-Medicare Advantage, +11797,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,Aetna-Medicare Advantage, +11798,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,Aetna-Medicare Advantage, +11799,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,Aetna-Medicare Advantage, +11800,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,Aetna-Medicare Advantage, +11801,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,Aetna-Medicare Advantage, +11802,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,Aetna-Medicare Advantage, +11803,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,Aetna-Medicare Advantage, +11804,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,Aetna-Medicare Advantage, +11805,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,Aetna-Medicare Advantage, +11806,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,Aetna-Medicare Advantage, +11807,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,Aetna-Medicare Advantage, +11808,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,Aetna-Medicare Advantage, +11809,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,Aetna-Medicare Advantage, +11810,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,Aetna-Medicare Advantage, +11811,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,Aetna-Medicare Advantage, +11812,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,Aetna-Medicare Advantage, +11813,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,Aetna-Medicare Advantage, +11814,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,Aetna-Medicare Advantage, +11815,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,Aetna-Medicare Advantage, +11816,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,Aetna-Medicare Advantage, +11817,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,Aetna-Medicare Advantage, +11818,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,Aetna-Medicare Advantage, +11819,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,Aetna-Medicare Advantage, +11820,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,Aetna-Medicare Advantage, +11821,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,Aetna-Medicare Advantage, +11822,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,Aetna-Medicare Advantage, +11823,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,Aetna-Medicare Advantage, +11824,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,Aetna-Medicare Advantage, +11825,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,Aetna-Medicare Advantage, +11826,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,Aetna-Medicare Advantage, +11827,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,Aetna-Medicare Advantage, +11828,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,Aetna-Medicare Advantage, +11829,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,Aetna-Medicare Advantage, +11830,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,Aetna-Medicare Advantage, +11831,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,Aetna-Medicare Advantage, +11832,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,Aetna-Medicare Advantage, +11833,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,Aetna-Medicare Advantage, +11834,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,Aetna-Medicare Advantage, +11835,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,Aetna-Medicare Advantage, +11836,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,Aetna-Medicare Advantage, +11837,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,Aetna-Medicare Advantage, +11838,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,Aetna-Medicare Advantage, +11839,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,Aetna-Medicare Advantage, +11840,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,Aetna-Medicare Advantage, +11841,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,Aetna-Medicare Advantage, +11842,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,Aetna-Medicare Advantage, +11843,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,Aetna-Medicare Advantage, +11844,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,Aetna-Medicare Advantage, +11845,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,Aetna-Medicare Advantage, +11846,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,Aetna-Medicare Advantage, +11847,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,Aetna-Medicare Advantage, +11848,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,Aetna-Medicare Advantage, +11849,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,Aetna-Medicare Advantage, +11850,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,Aetna-Medicare Advantage, +11851,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,Aetna-Medicare Advantage, +11852,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,Aetna-Medicare Advantage, +11853,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,Aetna-Medicare Advantage, +11854,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,Aetna-Medicare Advantage, +11855,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,Aetna-Medicare Advantage, +11856,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,Aetna-Medicare Advantage, +11857,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,Aetna-Medicare Advantage, +11858,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,Aetna-Medicare Advantage, +11859,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,Aetna-Medicare Advantage, +11860,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,Aetna-Medicare Advantage, +11861,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,Aetna-Medicare Advantage, +11862,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,Aetna-Medicare Advantage, +11863,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,Aetna-Medicare Advantage, +11864,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,Aetna-Medicare Advantage, +11865,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,Aetna-Medicare Advantage, +11866,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,Aetna-Medicare Advantage, +11867,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,Aetna-Medicare Advantage, +11868,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,Aetna-Medicare Advantage, +11869,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,Aetna-Medicare Advantage, +11870,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,Aetna-Medicare Advantage, +11871,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,Aetna-Medicare Advantage, +11872,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,Aetna-Medicare Advantage, +11873,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,Aetna-Medicare Advantage, +11874,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,Aetna-Medicare Advantage, +11875,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,Aetna-Medicare Advantage, +11876,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,Aetna-Medicare Advantage, +11877,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,Aetna-Medicare Advantage,261.25 +11878,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,Aetna-Medicare Advantage, +11879,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,Aetna-Medicare Advantage, +11880,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,Aetna-Medicare Advantage, +11881,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,Aetna-Medicare Advantage, +11882,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,Aetna-Medicare Advantage, +11883,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,Aetna-Medicare Advantage, +11884,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,Aetna-Medicare Advantage, +11885,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,Aetna-Medicare Advantage, +11886,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,Aetna-Medicare Advantage, +11887,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,Aetna-Medicare Advantage, +11888,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,Aetna-Medicare Advantage, +11889,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,Aetna-Medicare Advantage, +11890,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,Aetna-Medicare Advantage, +11891,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,Aetna-Medicare Advantage, +11892,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,Aetna-Medicare Advantage, +11893,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,Aetna-Medicare Advantage, +11894,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,Aetna-Medicare Advantage, +11895,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,Aetna-Medicare Advantage, +11896,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,Aetna-Medicare Advantage, +11897,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,Aetna-Medicare Advantage, +11898,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,Aetna-Medicare Advantage, +11899,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,Aetna-Medicare Advantage, +11900,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,Aetna-Medicare Advantage, +11901,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,Aetna-Medicare Advantage, +11902,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,Aetna-Medicare Advantage, +11903,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,Aetna-Medicare Advantage, +11904,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,Aetna-Medicare Advantage, +11905,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,Aetna-Medicare Advantage, +11906,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,Aetna-Medicare Advantage, +11907,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,Aetna-Medicare Advantage, +11908,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,Aetna-Medicare Advantage, +11909,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,Aetna-Medicare Advantage, +11910,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,Aetna-Medicare Advantage, +11911,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,Aetna-Medicare Advantage, +11912,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,Aetna-Medicare Advantage, +11913,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,Aetna-Medicare Advantage, +11914,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,Aetna-Medicare Advantage, +11915,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,Aetna-Medicare Advantage, +11916,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,Aetna-Medicare Advantage, +11917,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,Aetna-Medicare Advantage, +11918,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,Aetna-Medicare Advantage, +11919,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,Aetna-Medicare Advantage,1577.16 +11920,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,Aetna-Medicare Advantage,12866.08 +11921,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,Aetna-Medicare Advantage, +11922,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,Aetna-Medicare Advantage, +11923,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,Aetna-Medicare Advantage, +11924,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,Aetna-Medicare Advantage, +11925,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,Aetna-Medicare Advantage, +11926,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,Aetna-Medicare Advantage, +11927,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,Aetna-Medicare Advantage, +11928,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,Aetna-Medicare Advantage, +11929,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,Aetna-Medicare Advantage, +11930,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,Aetna-Medicare Advantage,1630.36 +11931,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,Aetna-Medicare Advantage, +11932,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,Aetna-Medicare Advantage, +11933,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,Aetna-Medicare Advantage, +11934,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,Aetna-Medicare Advantage, +11935,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,Aetna-Medicare Advantage, +11936,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,Aetna-Medicare Advantage, +11937,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,Aetna-Medicare Advantage, +11938,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,Aetna-Medicare Advantage, +11939,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,Aetna-Medicare Advantage, +11940,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,Aetna-Medicare Advantage, +11941,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,Aetna-Medicare Advantage, +11942,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,Aetna-Medicare Advantage, +11943,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,Aetna-Medicare Advantage, +11944,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,Aetna-Medicare Advantage, +11945,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,Aetna-Medicare Advantage, +11946,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,Aetna-Medicare Advantage,7247.13 +11947,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,Aetna-Medicare Advantage, +11948,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,Aetna-Medicare Advantage, +11949,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,Aetna-Medicare Advantage, +11950,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,Aetna-Medicare Advantage, +11951,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,Aetna-Medicare Advantage, +11952,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,Aetna-Medicare Advantage, +11953,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,Aetna-Medicare Advantage, +11954,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,Aetna-Medicare Advantage, +11955,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,Aetna-Medicare Advantage, +11956,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,Aetna-Medicare Advantage, +11957,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,Aetna-Medicare Advantage, +11958,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,Aetna-Medicare Advantage, +11959,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,Aetna-Medicare Advantage, +11960,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,Aetna-Medicare Advantage, +11961,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,Aetna-Medicare Advantage, +11962,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,Aetna-Medicare Advantage, +11963,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,Aetna-Medicare Advantage, +11964,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,Aetna-Medicare Advantage, +11965,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,Aetna-Medicare Advantage, +11966,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,Aetna-Medicare Advantage, +11967,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,Aetna-Medicare Advantage, +11968,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,Aetna-Medicare Advantage, +11969,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,Aetna-Medicare Advantage, +11970,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,Aetna-Medicare Advantage, +11971,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,Aetna-Medicare Advantage, +11972,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,Aetna-Medicare Advantage, +11973,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,Aetna-Medicare Advantage, +11974,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,Aetna-Medicare Advantage, +11975,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,Aetna-Medicare Advantage, +11976,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,Aetna-Medicare Advantage, +11977,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,Aetna-Medicare Advantage, +11978,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,Aetna-Medicare Advantage, +11979,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,Aetna-Medicare Advantage, +11980,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,Aetna-Medicare Advantage, +11981,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,Aetna-Medicare Advantage, +11982,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,Aetna-Medicare Advantage, +11983,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,Aetna-Medicare Advantage, +11984,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,Aetna-Medicare Advantage, +11985,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,Aetna-Medicare Advantage,241.44 +11986,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,Aetna-Medicare Advantage, +11987,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,Aetna-Medicare Advantage, +11988,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,Aetna-Medicare Advantage, +11989,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,Aetna-Medicare Advantage, +11990,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,Aetna-Medicare Advantage, +11991,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,Aetna-Medicare Advantage, +11992,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,Aetna-Medicare Advantage, +11993,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,Aetna-Medicare Advantage, +11994,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,Aetna-Medicare Advantage, +11995,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,Aetna-Medicare Advantage, +11996,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,Aetna-Medicare Advantage, +11997,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,Aetna-Medicare Advantage, +11998,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,Aetna-Medicare Advantage, +11999,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,Aetna-Medicare Advantage, +12000,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,Aetna-Medicare Advantage, +12001,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,Aetna-Medicare Advantage, +12002,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,Aetna-Medicare Advantage, +12003,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,Aetna-Medicare Advantage, +12004,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,Aetna-Medicare Advantage, +12005,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,Aetna-Medicare Advantage, +12006,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,Aetna-Medicare Advantage, +12007,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,Aetna-Medicare Advantage, +12008,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,Aetna-Medicare Advantage, +12009,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,Aetna-Medicare Advantage, +12010,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,Aetna-Medicare Advantage, +12011,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,Aetna-Medicare Advantage, +12012,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,Aetna-Medicare Advantage, +12013,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,Aetna-Medicare Advantage, +12014,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,Aetna-Medicare Advantage, +12015,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,Aetna-Medicare Advantage, +12016,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,Aetna-Medicare Advantage, +12017,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,Aetna-Medicare Advantage, +12018,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,Aetna-Medicare Advantage, +12019,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,Aetna-Medicare Advantage, +12020,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,Aetna-Medicare Advantage, +12021,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,Aetna-Medicare Advantage, +12022,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,Aetna-Medicare Advantage, +12023,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,Aetna-Medicare Advantage, +12024,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,Aetna-Medicare Advantage, +12025,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,Aetna-Medicare Advantage, +12026,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,Aetna-Medicare Advantage, +12027,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,Aetna-Medicare Advantage, +12028,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,Aetna-Medicare Advantage, +12029,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,Aetna-Medicare Advantage, +12030,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,Aetna-Medicare Advantage, +12031,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,Aetna-Medicare Advantage, +12032,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,Aetna-Medicare Advantage,17581.36 +12033,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,Aetna-Medicare Advantage,16977.35 +12034,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,Aetna-Medicare Advantage, +12035,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,Aetna-Medicare Advantage, +12036,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,Aetna-Medicare Advantage, +12037,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,Aetna-Medicare Advantage, +12038,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,Aetna-Medicare Advantage,19201.05 +12039,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,Aetna-Medicare Advantage, +12040,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,Aetna-Medicare Advantage, +12041,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,Aetna-Medicare Advantage, +12042,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,Aetna-Medicare Advantage, +12043,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,Aetna-Medicare Advantage, +12044,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,Aetna-Medicare Advantage, +12045,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,Aetna-Medicare Advantage, +12046,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,Aetna-Medicare Advantage, +12047,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,Aetna-Medicare Advantage, +12048,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,Aetna-Medicare Advantage, +12049,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,Aetna-Medicare Advantage, +12050,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,Aetna-Medicare Advantage, +12051,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,Aetna-Medicare Advantage, +12052,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,Aetna-Medicare Advantage, +12053,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,Aetna-Medicare Advantage, +12054,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,Aetna-Medicare Advantage, +12055,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,Aetna-Medicare Advantage, +12056,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,Aetna-Medicare Advantage, +12057,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,Aetna-Medicare Advantage, +12058,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,Aetna-Medicare Advantage, +12059,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,Aetna-Medicare Advantage, +12060,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,Aetna-Medicare Advantage, +12061,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,Aetna-Medicare Advantage, +12062,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,Aetna-Medicare Advantage, +12063,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,Aetna-Medicare Advantage, +12064,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,Aetna-Medicare Advantage, +12065,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,Aetna-Medicare Advantage,17503.85 +12066,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,Aetna-Medicare Advantage, +12067,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,Aetna-Medicare Advantage, +12068,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,Aetna-Medicare Advantage, +12069,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,Aetna-Medicare Advantage, +12070,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,Aetna-Medicare Advantage, +12071,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,Aetna-Medicare Advantage, +12072,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,Aetna-Medicare Advantage, +12073,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,Aetna-Medicare Advantage, +12074,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,Aetna-Medicare Advantage, +12075,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,Aetna-Medicare Advantage, +12076,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,Aetna-Medicare Advantage, +12077,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,Aetna-Medicare Advantage, +12078,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,Aetna-Medicare Advantage, +12079,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,Aetna-Medicare Advantage, +12080,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,Aetna-Medicare Advantage, +12081,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,Aetna-Medicare Advantage, +12082,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,Aetna-Medicare Advantage, +12083,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,Aetna-Medicare Advantage, +12084,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,Aetna-Medicare Advantage, +12085,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,Aetna-Medicare Advantage, +12086,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,Aetna-Medicare Advantage, +12087,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,Aetna-Medicare Advantage, +12088,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,Aetna-Medicare Advantage, +12089,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,Aetna-Medicare Advantage, +12090,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,Aetna-Medicare Advantage, +12091,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,Aetna-Medicare Advantage, +12092,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,Aetna-Medicare Advantage, +12093,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,Aetna-Medicare Advantage, +12094,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,Aetna-Medicare Advantage, +12095,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,Aetna-Medicare Advantage, +12096,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,Aetna-Medicare Advantage, +12097,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,Aetna-Medicare Advantage, +12098,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,Aetna-Medicare Advantage, +12099,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,Aetna-Medicare Advantage, +12100,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,Aetna-Medicare Advantage, +12101,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,Aetna-Medicare Advantage, +12102,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,Aetna-Medicare Advantage, +12103,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,Aetna-Medicare Advantage, +12104,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,Aetna-Medicare Advantage, +12105,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,Aetna-Medicare Advantage, +12106,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,Aetna-Medicare Advantage, +12107,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,Aetna-Medicare Advantage, +12108,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,Aetna-Medicare Advantage, +12109,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,Aetna-Medicare Advantage, +12110,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,Aetna-Medicare Advantage, +12111,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,Aetna-Medicare Advantage, +12112,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,Aetna-Medicare Advantage, +12113,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,Aetna-Medicare Advantage, +12114,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,Aetna-Medicare Advantage, +12115,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,Aetna-Medicare Advantage, +12116,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,Aetna-Medicare Advantage, +12117,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,Aetna-Medicare Advantage, +12118,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,Aetna-Medicare Advantage, +12119,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,Aetna-Medicare Advantage, +12120,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,Aetna-Medicare Advantage, +12121,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,Aetna-Medicare Advantage, +12122,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,Aetna-Medicare Advantage, +12123,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,Aetna-Medicare Advantage, +12124,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,Aetna-Medicare Advantage, +12125,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,Aetna-Medicare Advantage, +12126,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,Aetna-Medicare Advantage, +12127,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,Aetna-Medicare Advantage, +12128,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,Aetna-Medicare Advantage, +12129,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,Aetna-Medicare Advantage, +12130,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,Aetna-Medicare Advantage, +12131,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,Aetna-Medicare Advantage, +12132,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,Aetna-Medicare Advantage, +12133,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,Aetna-Medicare Advantage, +12134,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,Aetna-Medicare Advantage, +12135,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,Aetna-Medicare Advantage, +12136,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,Aetna-Medicare Advantage, +12137,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,Aetna-Medicare Advantage, +12138,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,Aetna-Medicare Advantage, +12139,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,Aetna-Medicare Advantage, +12140,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,Aetna-Medicare Advantage, +12141,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,Aetna-Medicare Advantage, +12142,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,Aetna-Medicare Advantage, +12143,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,Aetna-Medicare Advantage, +12144,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,Aetna-Medicare Advantage, +12145,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,Aetna-Medicare Advantage, +12146,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,Aetna-Medicare Advantage, +12147,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,Aetna-Medicare Advantage, +12148,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,Aetna-Medicare Advantage, +12149,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,Aetna-Medicare Advantage, +12150,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,Aetna-Medicare Advantage,14217.73 +12151,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,Aetna-Medicare Advantage, +12152,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,Aetna-Medicare Advantage, +12153,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,Aetna-Medicare Advantage, +12154,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,Aetna-Medicare Advantage, +12155,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,Aetna-Medicare Advantage, +12156,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,Aetna-Medicare Advantage, +12157,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,Aetna-Medicare Advantage, +12158,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,Aetna-Medicare Advantage, +12159,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,Aetna-Medicare Advantage, +12160,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,Aetna-Medicare Advantage, +12161,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,Aetna-Medicare Advantage, +12162,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,Aetna-Medicare Advantage, +12163,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,Aetna-Medicare Advantage, +12164,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,Aetna-Medicare Advantage, +12165,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,Aetna-Medicare Advantage, +12166,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,Aetna-Medicare Advantage, +12167,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,Aetna-Medicare Advantage, +12168,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,Aetna-Medicare Advantage, +12169,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,Aetna-Medicare Advantage, +12170,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,Aetna-Medicare Advantage, +12171,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,Aetna-Medicare Advantage, +12172,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,Aetna-Medicare Advantage, +12173,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,Aetna-Medicare Advantage, +12174,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,Aetna-Medicare Advantage, +12175,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,Aetna-Medicare Advantage, +12176,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,Aetna-Medicare Advantage, +12177,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,Aetna-Medicare Advantage, +12178,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,Aetna-Medicare Advantage, +12179,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,Aetna-Medicare Advantage, +12180,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,Aetna-Medicare Advantage, +12181,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,Aetna-Medicare Advantage, +12182,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,Aetna-Medicare Advantage, +12183,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,Aetna-Medicare Advantage, +12184,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,Aetna-Medicare Advantage, +12185,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,Aetna-Medicare Advantage, +12186,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,Aetna-Medicare Advantage, +12187,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,Aetna-Medicare Advantage, +12188,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,Aetna-Medicare Advantage, +12189,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,Aetna-Medicare Advantage, +12190,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,Aetna-Medicare Advantage, +12191,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,Aetna-Medicare Advantage, +12192,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,Aetna-Medicare Advantage, +12193,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,Aetna-Medicare Advantage,162.03 +12194,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,Aetna-Medicare Advantage, +12195,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,Aetna-Medicare Advantage, +12196,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,Aetna-Medicare Advantage, +12197,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,Aetna-Medicare Advantage, +12198,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,Aetna-Medicare Advantage, +12199,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,Aetna-Medicare Advantage, +12200,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,Aetna-Medicare Advantage, +12201,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,Aetna-Medicare Advantage, +12202,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,Aetna-Medicare Advantage, +12203,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,Aetna-Medicare Advantage, +12204,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,Aetna-Medicare Advantage, +12205,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,Aetna-Medicare Advantage, +12206,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,Aetna-Medicare Advantage, +12207,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,Aetna-Medicare Advantage, +12208,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,Aetna-Medicare Advantage, +12209,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,Aetna-Medicare Advantage, +12210,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,Aetna-Medicare Advantage, +12211,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,Aetna-Medicare Advantage, +12212,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,Aetna-Medicare Advantage, +12213,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,Aetna-Medicare Advantage, +12214,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,Aetna-Medicare Advantage, +12215,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,Aetna-Medicare Advantage, +12216,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,Aetna-Medicare Advantage, +12217,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,Aetna-Medicare Advantage, +12218,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,Aetna-Medicare Advantage, +12219,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,Aetna-Medicare Advantage, +12220,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,Aetna-Medicare Advantage, +12221,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,Aetna-Medicare Advantage, +12222,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,Aetna-Medicare Advantage, +12223,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,Aetna-Medicare Advantage, +12224,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,Aetna-Medicare Advantage, +12225,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,Aetna-Medicare Advantage, +12226,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,Aetna-Medicare Advantage, +12227,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,Aetna-Medicare Advantage, +12228,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,Aetna-Medicare Advantage, +12229,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,Aetna-Medicare Advantage, +12230,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,Aetna-Medicare Advantage, +12231,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,Aetna-Medicare Advantage, +12232,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,Aetna-Medicare Advantage, +12233,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,Aetna-Medicare Advantage, +12234,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,Aetna-Medicare Advantage, +12235,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,Aetna-Medicare Advantage, +12236,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,Aetna-Medicare Advantage, +12237,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,Aetna-Medicare Advantage, +12238,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,Aetna-Medicare Advantage, +12239,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,Aetna-Medicare Advantage, +12240,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,Aetna-Medicare Advantage, +12241,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,Aetna-Medicare Advantage, +12242,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,Aetna-Medicare Advantage, +12243,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,Aetna-Medicare Advantage, +12244,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,Aetna-Medicare Advantage, +12245,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,Aetna-Medicare Advantage, +12246,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,Aetna-Medicare Advantage, +12247,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,Aetna-Medicare Advantage, +12248,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,Aetna-Medicare Advantage, +12249,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,Aetna-Medicare Advantage, +12250,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,Aetna-Medicare Advantage, +12251,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,Aetna-Medicare Advantage, +12252,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,Aetna-Medicare Advantage, +12253,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,Aetna-Medicare Advantage, +12254,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,Aetna-Medicare Advantage, +12255,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,Aetna-Medicare Advantage, +12256,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,Aetna-Medicare Advantage, +12257,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,Aetna-Medicare Advantage, +12258,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,Aetna-Medicare Advantage, +12259,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,Aetna-Medicare Advantage, +12260,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,Aetna-Medicare Advantage, +12261,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,Aetna-Medicare Advantage, +12262,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,Aetna-Medicare Advantage, +12263,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,Aetna-Medicare Advantage, +12264,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,Aetna-Medicare Advantage, +12265,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,Aetna-Medicare Advantage, +12266,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,Aetna-Medicare Advantage, +12267,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,Aetna-Medicare Advantage, +12268,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,Aetna-Medicare Advantage, +12269,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,Aetna-Medicare Advantage, +12270,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,Aetna-Medicare Advantage, +12271,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,Aetna-Medicare Advantage, +12272,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,Aetna-Medicare Advantage, +12273,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,Aetna-Medicare Advantage, +12274,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,Aetna-Medicare Advantage, +12275,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,Aetna-Medicare Advantage, +12276,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,Aetna-Medicare Advantage, +12277,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,Aetna-Medicare Advantage, +12278,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,Aetna-Medicare Advantage, +12279,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,Aetna-Medicare Advantage, +12280,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,Aetna-Medicare Advantage, +12281,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,Aetna-Medicare Advantage, +12282,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,Aetna-Medicare Advantage, +12283,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,Aetna-Medicare Advantage, +12284,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,Aetna-Medicare Advantage, +12285,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,Aetna-Medicare Advantage, +12286,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,Aetna-Medicare Advantage, +12287,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,Aetna-Medicare Advantage, +12288,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,Aetna-Medicare Advantage, +12289,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,Aetna-Medicare Advantage, +12290,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,Aetna-Medicare Advantage, +12291,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,Aetna-Medicare Advantage, +12292,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,Aetna-Medicare Advantage, +12293,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,Aetna-Medicare Advantage, +12294,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,Aetna-Medicare Advantage, +12295,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,Aetna-Medicare Advantage, +12296,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,Aetna-Medicare Advantage, +12297,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,Aetna-Medicare Advantage, +12298,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,Aetna-Medicare Advantage, +12299,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,Aetna-Medicare Advantage, +12300,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,Aetna-Medicare Advantage, +12301,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,Aetna-Medicare Advantage, +12302,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,Aetna-Medicare Advantage, +12303,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,Aetna-Medicare Advantage,3558.07 +12304,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,Aetna-Medicare Advantage,3558.07 +12305,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,Aetna-Medicare Advantage, +12306,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,Aetna-Medicare Advantage, +12307,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,Aetna-Medicare Advantage, +12308,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,Aetna-Medicare Advantage, +12309,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,Aetna-Medicare Advantage,5343.81 +12310,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,Aetna-Medicare Advantage, +12311,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,Aetna-Medicare Advantage, +12312,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,Aetna-Medicare Advantage, +12313,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,Aetna-Medicare Advantage, +12314,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,Aetna-Medicare Advantage, +12315,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,Aetna-Medicare Advantage, +12316,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,Aetna-Medicare Advantage, +12317,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,Aetna-Medicare Advantage, +12318,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,Aetna-Medicare Advantage, +12319,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,Aetna-Medicare Advantage, +12320,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,Aetna-Medicare Advantage, +12321,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,Aetna-Medicare Advantage, +12322,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,Aetna-Medicare Advantage,12420.23 +12323,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,Aetna-Medicare Advantage, +12324,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,Aetna-Medicare Advantage, +12325,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,Aetna-Medicare Advantage, +12326,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,Aetna-Medicare Advantage, +12327,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,Aetna-Medicare Advantage, +12328,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,Aetna-Medicare Advantage, +12329,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,Aetna-Medicare Advantage, +12330,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,Aetna-Medicare Advantage, +12331,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,Aetna-Medicare Advantage, +12332,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,Aetna-Medicare Advantage,12420.23 +12333,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,Aetna-Medicare Advantage, +12334,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,Aetna-Medicare Advantage, +12335,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,Aetna-Medicare Advantage, +12336,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,Aetna-Medicare Advantage, +12337,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,Aetna-Medicare Advantage, +12338,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,Aetna-Medicare Advantage, +12339,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,Aetna-Medicare Advantage,39110.42 +12340,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,Aetna-Medicare Advantage, +12341,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,Aetna-Medicare Advantage, +12342,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,Aetna-Medicare Advantage, +12343,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,Aetna-Medicare Advantage, +12344,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,Aetna-Medicare Advantage, +12345,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,Aetna-Medicare Advantage, +12346,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,Aetna-Medicare Advantage,9258.1 +12347,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,Aetna-Medicare Advantage,522.88 +12348,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,Aetna-Medicare Advantage, +12349,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,Aetna-Medicare Advantage, +12350,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,Aetna-Medicare Advantage, +12351,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,Aetna-Medicare Advantage, +12352,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,Aetna-Medicare Advantage, +12353,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,Aetna-Medicare Advantage, +12354,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,Aetna-Medicare Advantage, +12355,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,Aetna-Medicare Advantage, +12356,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,Aetna-Medicare Advantage, +12357,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,Aetna-Medicare Advantage, +12358,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,Aetna-Medicare Advantage, +12359,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,Aetna-Medicare Advantage, +12360,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,Aetna-Medicare Advantage, +12361,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,Aetna-Medicare Advantage, +12362,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,Aetna-Medicare Advantage,11382.5 +12363,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,Aetna-Medicare Advantage, +12364,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,Aetna-Medicare Advantage, +12365,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,Aetna-Medicare Advantage, +12366,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,Aetna-Medicare Advantage, +12367,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,Aetna-Medicare Advantage, +12368,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,Aetna-Medicare Advantage, +12369,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,Aetna-Medicare Advantage, +12370,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,Aetna-Medicare Advantage, +12371,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,Aetna-Medicare Advantage, +12372,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,Aetna-Medicare Advantage,5585.82 +12373,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,Aetna-Medicare Advantage, +12374,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,Aetna-Medicare Advantage, +12375,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,Aetna-Medicare Advantage, +12376,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,Aetna-Medicare Advantage, +12377,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,Aetna-Medicare Advantage, +12378,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,Aetna-Medicare Advantage, +12379,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,Aetna-Medicare Advantage, +12380,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,Aetna-Medicare Advantage, +12381,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,Aetna-Medicare Advantage, +12382,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,Aetna-Medicare Advantage, +12383,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,Aetna-Medicare Advantage, +12384,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,Aetna-Medicare Advantage, +12385,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,Aetna-Medicare Advantage,13.0 +12386,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,Aetna-Medicare Advantage, +12387,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,Aetna-Medicare Advantage,464.93 +12388,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,Aetna-Medicare Advantage, +12389,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,Aetna-Medicare Advantage, +12390,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,Aetna-Medicare Advantage, +12391,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,Aetna-Medicare Advantage, +12392,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,Aetna-Medicare Advantage, +12393,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,Aetna-Medicare Advantage, +12394,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,Aetna-Medicare Advantage,1976.11 +12395,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,Aetna-Medicare Advantage, +12396,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,Aetna-Medicare Advantage, +12397,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,Aetna-Medicare Advantage,3350.83 +12398,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,Aetna-Medicare Advantage, +12399,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,Aetna-Medicare Advantage, +12400,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,Aetna-Medicare Advantage, +12401,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,Aetna-Medicare Advantage, +12402,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,Aetna-Medicare Advantage,3357.41 +12403,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,Aetna-Medicare Advantage, +12404,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,Aetna-Medicare Advantage, +12405,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,Aetna-Medicare Advantage, +12406,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,Aetna-Medicare Advantage, +12407,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,Aetna-Medicare Advantage, +12408,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,Aetna-Medicare Advantage, +12409,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,Aetna-Medicare Advantage, +12410,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,Aetna-Medicare Advantage, +12411,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,Aetna-Medicare Advantage, +12412,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,Aetna-Medicare Advantage, +12413,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,Aetna-Medicare Advantage, +12414,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,Aetna-Medicare Advantage, +12415,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,Aetna-Medicare Advantage, +12416,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,Aetna-Medicare Advantage, +12417,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,Aetna-Medicare Advantage, +12418,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,Aetna-Medicare Advantage, +12419,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,Aetna-Medicare Advantage, +12420,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,Aetna-Medicare Advantage, +12421,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,Aetna-Medicare Advantage, +12422,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,Aetna-Medicare Advantage, +12423,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,Aetna-Medicare Advantage, +12424,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,Aetna-Medicare Advantage, +12425,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,Aetna-Medicare Advantage, +12426,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,Aetna-Medicare Advantage, +12427,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,Aetna-Medicare Advantage, +12428,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,Aetna-Medicare Advantage, +12429,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,Aetna-Medicare Advantage, +12430,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,Aetna-Medicare Advantage, +12431,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,Aetna-Medicare Advantage, +12432,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,Aetna-Medicare Advantage, +12433,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,Aetna-Medicare Advantage, +12434,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,Aetna-Medicare Advantage,17191.24 +12435,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,Aetna-Medicare Advantage, +12436,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,Aetna-Medicare Advantage,12004.12 +12437,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,Aetna-Medicare Advantage, +12438,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,Aetna-Medicare Advantage, +12439,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,Aetna-Medicare Advantage, +12440,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,Aetna-Medicare Advantage, +12441,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,Aetna-Medicare Advantage, +12442,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,Aetna-Medicare Advantage, +12443,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,Aetna-Medicare Advantage, +12444,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,Aetna-Medicare Advantage, +12445,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,Aetna-Medicare Advantage, +12446,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,Aetna-Medicare Advantage, +12447,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,Aetna-Medicare Advantage, +12448,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,Aetna-Medicare Advantage, +12449,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,Aetna-Medicare Advantage, +12450,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,Aetna-Medicare Advantage, +12451,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,Aetna-Medicare Advantage, +12452,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,Aetna-Medicare Advantage, +12453,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,Aetna-Medicare Advantage, +12454,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,Aetna-Medicare Advantage, +12455,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,Aetna-Medicare Advantage, +12456,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,Aetna-Medicare Advantage, +12457,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,Aetna-Medicare Advantage, +12458,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,Aetna-Medicare Advantage, +12459,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,Aetna-Medicare Advantage, +12460,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,Aetna-Medicare Advantage, +12461,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,Aetna-Medicare Advantage, +12462,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,Aetna-Medicare Advantage, +12463,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,Aetna-Medicare Advantage, +12464,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,Aetna-Medicare Advantage, +12465,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,Aetna-Medicare Advantage, +12466,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,Aetna-Medicare Advantage, +12467,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,Aetna-Medicare Advantage, +12468,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,Aetna-Medicare Advantage,10293.23 +12469,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,Aetna-Medicare Advantage, +12470,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,Aetna-Medicare Advantage,3670.3 +12471,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,Aetna-Medicare Advantage,1647.51 +12472,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,Aetna-Medicare Advantage, +12473,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,Aetna-Medicare Advantage, +12474,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,Aetna-Medicare Advantage, +12475,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,Aetna-Medicare Advantage, +12476,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,Aetna-Medicare Advantage,10192.48 +12477,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,Aetna-Medicare Advantage, +12478,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,Aetna-Medicare Advantage, +12479,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,Aetna-Medicare Advantage, +12480,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,Aetna-Medicare Advantage, +12481,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,Aetna-Medicare Advantage, +12482,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,Aetna-Medicare Advantage, +12483,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,Aetna-Medicare Advantage, +12484,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,Aetna-Medicare Advantage, +12485,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,Aetna-Medicare Advantage, +12486,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,Aetna-Medicare Advantage, +12487,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,Aetna-Medicare Advantage, +12488,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,Aetna-Medicare Advantage, +12489,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,Aetna-Medicare Advantage, +12490,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,Aetna-Medicare Advantage, +12491,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,Aetna-Medicare Advantage, +12492,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,Aetna-Medicare Advantage, +12493,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,Aetna-Medicare Advantage, +12494,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,Aetna-Medicare Advantage, +12495,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,Aetna-Medicare Advantage, +12496,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,Aetna-Medicare Advantage, +12497,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,Aetna-Medicare Advantage, +12498,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,Aetna-Medicare Advantage, +12499,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,Aetna-Medicare Advantage, +12500,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,Aetna-Medicare Advantage, +12501,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,Aetna-Medicare Advantage, +12502,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,Aetna-Medicare Advantage, +12503,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,Aetna-Medicare Advantage, +12504,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,Aetna-Medicare Advantage, +12505,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,Aetna-Medicare Advantage, +12506,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,Aetna-Medicare Advantage, +12507,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,Aetna-Medicare Advantage, +12508,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,Aetna-Medicare Advantage, +12509,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,Aetna-Medicare Advantage, +12510,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,Aetna-Medicare Advantage, +12511,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,Aetna-Medicare Advantage, +12512,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,Aetna-Medicare Advantage, +12513,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,Aetna-Medicare Advantage, +12514,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,Aetna-Medicare Advantage, +12515,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,Aetna-Medicare Advantage, +12516,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,Aetna-Medicare Advantage, +12517,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,Aetna-Medicare Advantage, +12518,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,Aetna-Medicare Advantage, +12519,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,Aetna-Medicare Advantage, +12520,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,Aetna-Medicare Advantage, +12521,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,Aetna-Medicare Advantage, +12522,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,Aetna-Medicare Advantage, +12523,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,Aetna-Medicare Advantage, +12524,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,Aetna-Medicare Advantage, +12525,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,Aetna-Medicare Advantage, +12526,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,Aetna-Medicare Advantage, +12527,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,Aetna-Medicare Advantage, +12528,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,Aetna-Medicare Advantage, +12529,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,Aetna-Medicare Advantage, +12530,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,Aetna-Medicare Advantage, +12531,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,Aetna-Medicare Advantage, +12532,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,Aetna-Medicare Advantage, +12533,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,Aetna-Medicare Advantage, +12534,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,Aetna-Medicare Advantage, +12535,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,Aetna-Medicare Advantage, +12536,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,Aetna-Medicare Advantage, +12537,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,Aetna-Medicare Advantage, +12538,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,Aetna-Medicare Advantage, +12539,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,Aetna-Medicare Advantage, +12540,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,Aetna-Medicare Advantage, +12541,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,Aetna-Medicare Advantage, +12542,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,Aetna-Medicare Advantage, +12543,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,Aetna-Medicare Advantage, +12544,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,Aetna-Medicare Advantage, +12545,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,Aetna-Medicare Advantage, +12546,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,Aetna-Medicare Advantage, +12547,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,Aetna-Medicare Advantage, +12548,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,Aetna-Medicare Advantage, +12549,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,Aetna-Medicare Advantage, +12550,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,Aetna-Medicare Advantage, +12551,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,Aetna-Medicare Advantage, +12552,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,Aetna-Medicare Advantage, +12553,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,Aetna-Medicare Advantage, +12554,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,Aetna-Medicare Advantage, +12555,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,Aetna-Medicare Advantage, +12556,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,Aetna-Medicare Advantage, +12557,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,Aetna-Medicare Advantage, +12558,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,Aetna-Medicare Advantage,952.14 +12559,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,Aetna-Medicare Advantage, +12560,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,Aetna-Medicare Advantage, +12561,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,Aetna-Medicare Advantage, +12562,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,Aetna-Medicare Advantage,952.14 +12563,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,Aetna-Medicare Advantage, +12564,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,Aetna-Medicare Advantage,1886.79 +12565,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,Aetna-Medicare Advantage, +12566,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,Aetna-Medicare Advantage, +12567,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,Aetna-Medicare Advantage, +12568,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,Aetna-Medicare Advantage,476.07 +12569,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,Aetna-Medicare Advantage, +12570,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,Aetna-Medicare Advantage,1886.79 +12571,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,Aetna-Medicare Advantage, +12572,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,Aetna-Medicare Advantage, +12573,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,Aetna-Medicare Advantage,1886.79 +12574,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,Aetna-Medicare Advantage, +12575,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,Aetna-Medicare Advantage,1886.79 +12576,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,Aetna-Medicare Advantage, +12577,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,Aetna-Medicare Advantage, +12578,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,Aetna-Medicare Advantage, +12579,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,Aetna-Medicare Advantage,3633.39 +12580,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,Aetna-Medicare Advantage, +12581,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,Aetna-Medicare Advantage, +12582,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,Aetna-Medicare Advantage,1781.33 +12583,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,Aetna-Medicare Advantage,5791.98 +12584,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,Aetna-Medicare Advantage, +12585,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,Aetna-Medicare Advantage, +12586,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,Aetna-Medicare Advantage, +12587,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,Aetna-Medicare Advantage, +12588,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,Aetna-Medicare Advantage, +12589,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,Aetna-Medicare Advantage, +12590,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,Aetna-Medicare Advantage, +12591,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,Aetna-Medicare Advantage, +12592,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,Aetna-Medicare Advantage, +12593,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,Aetna-Medicare Advantage, +12594,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,Aetna-Medicare Advantage, +12595,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,Aetna-Medicare Advantage, +12596,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,Aetna-Medicare Advantage, +12597,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,Aetna-Medicare Advantage, +12598,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,Aetna-Medicare Advantage, +12599,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,Aetna-Medicare Advantage, +12600,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,Aetna-Medicare Advantage, +12601,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,Aetna-Medicare Advantage, +12602,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,Aetna-Medicare Advantage, +12603,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,Aetna-Medicare Advantage, +12604,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,Aetna-Medicare Advantage, +12605,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,Aetna-Medicare Advantage, +12606,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,Aetna-Medicare Advantage, +12607,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,Aetna-Medicare Advantage, +12608,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,Aetna-Medicare Advantage,1886.79 +12609,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,Aetna-Medicare Advantage, +12610,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,Aetna-Medicare Advantage, +12611,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,Aetna-Medicare Advantage, +12612,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,Aetna-Medicare Advantage, +12613,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,Aetna-Medicare Advantage, +12614,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,Aetna-Medicare Advantage, +12615,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,Aetna-Medicare Advantage, +12616,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,Aetna-Medicare Advantage, +12617,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,Aetna-Medicare Advantage, +12618,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,Aetna-Medicare Advantage, +12619,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,Aetna-Medicare Advantage, +12620,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,Aetna-Medicare Advantage, +12621,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,Aetna-Medicare Advantage, +12622,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,Aetna-Medicare Advantage, +12623,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,Aetna-Medicare Advantage, +12624,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,Aetna-Medicare Advantage, +12625,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,Aetna-Medicare Advantage, +12626,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,Aetna-Medicare Advantage, +12627,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,Aetna-Medicare Advantage, +12628,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,Aetna-Medicare Advantage,5856.04 +12629,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,Aetna-Medicare Advantage, +12630,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,Aetna-Medicare Advantage, +12631,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,Aetna-Medicare Advantage, +12632,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,Aetna-Medicare Advantage, +12633,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,Aetna-Medicare Advantage, +12634,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,Aetna-Medicare Advantage, +12635,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,Aetna-Medicare Advantage, +12636,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,Aetna-Medicare Advantage, +12637,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,Aetna-Medicare Advantage, +12638,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,Aetna-Medicare Advantage, +12639,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,Aetna-Medicare Advantage, +12640,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,Aetna-Medicare Advantage, +12641,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,Aetna-Medicare Advantage, +12642,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,Aetna-Medicare Advantage, +12643,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,Aetna-Medicare Advantage, +12644,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,Aetna-Medicare Advantage, +12645,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,Aetna-Medicare Advantage, +12646,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,Aetna-Medicare Advantage, +12647,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,Aetna-Medicare Advantage, +12648,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,Aetna-Medicare Advantage,1216.61 +12649,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,Aetna-Medicare Advantage, +12650,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,Aetna-Medicare Advantage, +12651,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,Aetna-Medicare Advantage, +12652,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,Aetna-Medicare Advantage,1216.61 +12653,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,Aetna-Medicare Advantage, +12654,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,Aetna-Medicare Advantage, +12655,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,Aetna-Medicare Advantage, +12656,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,Aetna-Medicare Advantage, +12657,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +12658,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,Aetna-Medicare Advantage, +12659,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,Aetna-Medicare Advantage, +12660,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,Aetna-Medicare Advantage, +12661,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,Aetna-Medicare Advantage, +12662,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,Aetna-Medicare Advantage,5731.46 +12663,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,Aetna-Medicare Advantage, +12664,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,Aetna-Medicare Advantage,2824.33 +12665,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,Aetna-Medicare Advantage, +12666,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,Aetna-Medicare Advantage,4756.03 +12667,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,Aetna-Medicare Advantage,1759.56 +12668,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,Aetna-Medicare Advantage,5731.46 +12669,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,Aetna-Medicare Advantage, +12670,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,Aetna-Medicare Advantage, +12671,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,Aetna-Medicare Advantage, +12672,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,Aetna-Medicare Advantage, +12673,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,Aetna-Medicare Advantage, +12674,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,Aetna-Medicare Advantage, +12675,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,Aetna-Medicare Advantage, +12676,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,Aetna-Medicare Advantage, +12677,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,Aetna-Medicare Advantage, +12678,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,Aetna-Medicare Advantage,1822.3 +12679,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,Aetna-Medicare Advantage,6028.0 +12680,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,Aetna-Medicare Advantage, +12681,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,Aetna-Medicare Advantage,5840.0 +12682,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,Aetna-Medicare Advantage,7746.0 +12683,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,Aetna-Medicare Advantage, +12684,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,Aetna-Medicare Advantage, +12685,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,Aetna-Medicare Advantage, +12686,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,Aetna-Medicare Advantage,397.29 +12687,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,Aetna-Medicare Advantage,4642.0 +12688,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,Aetna-Medicare Advantage, +12689,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,Aetna-Medicare Advantage,3071.99 +12690,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,Aetna-Medicare Advantage, +12691,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,Aetna-Medicare Advantage,4379.0 +12692,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,Aetna-Medicare Advantage,5511.1 +12693,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,Aetna-Medicare Advantage, +12694,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,Aetna-Medicare Advantage, +12695,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,Aetna-Medicare Advantage, +12696,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,Aetna-Medicare Advantage,5858.63 +12697,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,Aetna-Medicare Advantage, +12698,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,Aetna-Medicare Advantage,9095.0 +12699,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,Aetna-Medicare Advantage, +12700,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,Aetna-Medicare Advantage,3802.13 +12701,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,Aetna-Medicare Advantage,3780.83 +12702,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,Aetna-Medicare Advantage, +12703,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,Aetna-Medicare Advantage,3936.96 +12704,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,Aetna-Medicare Advantage,10058.55 +12705,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,Aetna-Medicare Advantage,11003.99 +12706,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,Aetna-Medicare Advantage,10528.47 +12707,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,Aetna-Medicare Advantage, +12708,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,Aetna-Medicare Advantage, +12709,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,Aetna-Medicare Advantage, +12710,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,Aetna-Medicare Advantage,5299.51 +12711,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,Aetna-Medicare Advantage,3892.0 +12712,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,Aetna-Medicare Advantage, +12713,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,Aetna-Medicare Advantage,4870.75 +12714,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,Aetna-Medicare Advantage, +12715,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,Aetna-Medicare Advantage,3037.35 +12716,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,Aetna-Medicare Advantage,4995.41 +12717,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,Aetna-Medicare Advantage,8756.17 +12718,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,Aetna-Medicare Advantage,2032.44 +12719,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,Aetna-Medicare Advantage,2696.68 +12720,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,Aetna-Medicare Advantage, +12721,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,Aetna-Medicare Advantage, +12722,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,Aetna-Medicare Advantage,759.17 +12723,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,Aetna-Medicare Advantage, +12724,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,Aetna-Medicare Advantage, +12725,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,Aetna-Medicare Advantage, +12726,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,Aetna-Medicare Advantage, +12727,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,Aetna-Medicare Advantage,759.17 +12728,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,Aetna-Medicare Advantage,5511.1 +12729,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,Aetna-Medicare Advantage,510.51 +12730,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,Aetna-Medicare Advantage,1886.79 +12731,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,Aetna-Medicare Advantage, +12732,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,Aetna-Medicare Advantage,627.73 +12733,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,Aetna-Medicare Advantage, +12734,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,Aetna-Medicare Advantage,136.23 +12735,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,Aetna-Medicare Advantage, +12736,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,Aetna-Medicare Advantage,4568.42 +12737,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,Aetna-Medicare Advantage,6912.0 +12738,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,Aetna-Medicare Advantage,7164.32 +12739,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,Aetna-Medicare Advantage,8439.0 +12740,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,Aetna-Medicare Advantage,5858.63 +12741,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,Aetna-Medicare Advantage, +12742,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,Aetna-Medicare Advantage,5511.1 +12743,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,Aetna-Medicare Advantage,5907.82 +12744,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,Aetna-Medicare Advantage,4394.24 +12745,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,Aetna-Medicare Advantage,5285.03 +12746,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,Aetna-Medicare Advantage,2755.55 +12747,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,Aetna-Medicare Advantage,3802.13 +12748,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,Aetna-Medicare Advantage, +12749,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,Aetna-Medicare Advantage,5299.51 +12750,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,Aetna-Medicare Advantage,8298.9 +12751,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,Aetna-Medicare Advantage,5511.1 +12752,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,Aetna-Medicare Advantage, +12753,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,Aetna-Medicare Advantage, +12754,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,Aetna-Medicare Advantage,10073.67 +12755,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,Aetna-Medicare Advantage,18689.0 +12756,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,Aetna-Medicare Advantage,10058.55 +12757,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,Aetna-Medicare Advantage,10058.55 +12758,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,Aetna-Medicare Advantage,10359.75 +12759,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,Aetna-Medicare Advantage, +12760,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,Aetna-Medicare Advantage, +12761,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,Aetna-Medicare Advantage, +12762,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,Aetna-Medicare Advantage,6891.25 +12763,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,Aetna-Medicare Advantage,5731.46 +12764,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,Aetna-Medicare Advantage, +12765,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,Aetna-Medicare Advantage, +12766,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,Aetna-Medicare Advantage, +12767,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,Aetna-Medicare Advantage,741.75 +12768,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,Aetna-Medicare Advantage,5731.46 +12769,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,Aetna-Medicare Advantage,2141.47 +12770,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,Aetna-Medicare Advantage, +12771,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,Aetna-Medicare Advantage, +12772,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,Aetna-Medicare Advantage,2315.13 +12773,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,Aetna-Medicare Advantage, +12774,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,Aetna-Medicare Advantage, +12775,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,Aetna-Medicare Advantage, +12776,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,Aetna-Medicare Advantage, +12777,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,Aetna-Medicare Advantage, +12778,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,Aetna-Medicare Advantage,12172.22 +12779,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,Aetna-Medicare Advantage, +12780,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,Aetna-Medicare Advantage, +12781,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,Aetna-Medicare Advantage, +12782,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,Aetna-Medicare Advantage,3674.25 +12783,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,Aetna-Medicare Advantage,2271.38 +12784,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,Aetna-Medicare Advantage, +12785,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,Aetna-Medicare Advantage, +12786,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,Aetna-Medicare Advantage, +12787,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,Aetna-Medicare Advantage, +12788,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,Aetna-Medicare Advantage, +12789,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,Aetna-Medicare Advantage,532.37 +12790,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,Aetna-Medicare Advantage,190.0 +12791,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,Aetna-Medicare Advantage,4176.0 +12792,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,Aetna-Medicare Advantage, +12793,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,Aetna-Medicare Advantage,1025.55 +12794,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,Aetna-Medicare Advantage, +12795,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,Aetna-Medicare Advantage, +12796,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,Aetna-Medicare Advantage,3216.36 +12797,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,Aetna-Medicare Advantage,1619.7 +12798,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,Aetna-Medicare Advantage,2210.66 +12799,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,Aetna-Medicare Advantage, +12800,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,Aetna-Medicare Advantage,438.84 +12801,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,Aetna-Medicare Advantage,694.58 +12802,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,Aetna-Medicare Advantage,447.29 +12803,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,Aetna-Medicare Advantage,182.18 +12804,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,Aetna-Medicare Advantage, +12805,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,Aetna-Medicare Advantage,3095.0 +12806,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,Aetna-Medicare Advantage, +12807,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,Aetna-Medicare Advantage,4476.62 +12808,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,Aetna-Medicare Advantage,3662.13 +12809,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,Aetna-Medicare Advantage, +12810,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,Aetna-Medicare Advantage, +12811,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,Aetna-Medicare Advantage,3826.73 +12812,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,Aetna-Medicare Advantage,5027.0 +12813,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,Aetna-Medicare Advantage,7920.0 +12814,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,Aetna-Medicare Advantage,2189.15 +12815,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,Aetna-Medicare Advantage, +12816,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,Aetna-Medicare Advantage, +12817,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,Aetna-Medicare Advantage,5511.1 +12818,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,Aetna-Medicare Advantage, +12819,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,Aetna-Medicare Advantage, +12820,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,Aetna-Medicare Advantage,6053.63 +12821,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,Aetna-Medicare Advantage,5511.1 +12822,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,Aetna-Medicare Advantage,5731.46 +12823,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,Aetna-Medicare Advantage, +12824,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,Aetna-Medicare Advantage,5511.1 +12825,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,Aetna-Medicare Advantage,8625.0 +12826,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,Aetna-Medicare Advantage, +12827,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,Aetna-Medicare Advantage,5229.14 +12828,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,Aetna-Medicare Advantage,7245.81 +12829,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,Aetna-Medicare Advantage,6721.0 +12830,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,Aetna-Medicare Advantage,2804.1 +12831,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,Aetna-Medicare Advantage, +12832,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,Aetna-Medicare Advantage,1778.6 +12833,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,Aetna-Medicare Advantage,9259.0 +12834,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,Aetna-Medicare Advantage, +12835,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,Aetna-Medicare Advantage,5229.14 +12836,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,Aetna-Medicare Advantage,15644.0 +12837,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,Aetna-Medicare Advantage,5511.1 +12838,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,Aetna-Medicare Advantage,1653.33 +12839,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,Aetna-Medicare Advantage, +12840,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,Aetna-Medicare Advantage,7920.0 +12841,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,Aetna-Medicare Advantage,5229.14 +12842,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,Aetna-Medicare Advantage,4486.09 +12843,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,Aetna-Medicare Advantage, +12844,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,Aetna-Medicare Advantage, +12845,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,Aetna-Medicare Advantage,2088.39 +12846,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,Aetna-Medicare Advantage, +12847,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,Aetna-Medicare Advantage, +12848,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,Aetna-Medicare Advantage,5731.46 +12849,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,Aetna-Medicare Advantage, +12850,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,Aetna-Medicare Advantage, +12851,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,Aetna-Medicare Advantage, +12852,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,Aetna-Medicare Advantage, +12853,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,Aetna-Medicare Advantage, +12854,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,Aetna-Medicare Advantage,1866.96 +12855,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,Aetna-Medicare Advantage, +12856,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,Aetna-Medicare Advantage,4123.75 +12857,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,Aetna-Medicare Advantage, +12858,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,Aetna-Medicare Advantage, +12859,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,Aetna-Medicare Advantage, +12860,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,Aetna-Medicare Advantage, +12861,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,Aetna-Medicare Advantage, +12862,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,Aetna-Medicare Advantage,5731.46 +12863,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,Aetna-Medicare Advantage,2848.0 +12864,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,Aetna-Medicare Advantage,3920.0 +12865,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,Aetna-Medicare Advantage,317.86 +12866,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,Aetna-Medicare Advantage,2865.73 +12867,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,Aetna-Medicare Advantage, +12868,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,Aetna-Medicare Advantage, +12869,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,Aetna-Medicare Advantage, +12870,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,Aetna-Medicare Advantage,1204.5 +12871,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,Aetna-Medicare Advantage, +12872,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,Aetna-Medicare Advantage, +12873,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,Aetna-Medicare Advantage, +12874,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,Aetna-Medicare Advantage, +12875,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,Aetna-Medicare Advantage,4287.0 +12876,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,Aetna-Medicare Advantage, +12877,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,Aetna-Medicare Advantage,12229.78 +12878,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,Aetna-Medicare Advantage, +12879,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,Aetna-Medicare Advantage, +12880,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,Aetna-Medicare Advantage, +12881,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,Aetna-Medicare Advantage, +12882,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,Aetna-Medicare Advantage, +12883,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,Aetna-Medicare Advantage,3805.0 +12884,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,Aetna-Medicare Advantage, +12885,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,Aetna-Medicare Advantage, +12886,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,Aetna-Medicare Advantage,5299.51 +12887,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,Aetna-Medicare Advantage,1324.88 +12888,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,Aetna-Medicare Advantage, +12889,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,Aetna-Medicare Advantage,6972.67 +12890,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,Aetna-Medicare Advantage, +12891,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,Aetna-Medicare Advantage, +12892,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,Aetna-Medicare Advantage, +12893,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,Aetna-Medicare Advantage, +12894,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,Aetna-Medicare Advantage, +12895,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,Aetna-Medicare Advantage,1445.4 +12896,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,Aetna-Medicare Advantage,2649.76 +12897,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,Aetna-Medicare Advantage, +12898,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,Aetna-Medicare Advantage,1431.14 +12899,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,Aetna-Medicare Advantage, +12900,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,Aetna-Medicare Advantage, +12901,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,Aetna-Medicare Advantage,4773.76 +12902,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,Aetna-Medicare Advantage, +12903,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,Aetna-Medicare Advantage, +12904,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,Aetna-Medicare Advantage,1609.44 +12905,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,Aetna-Medicare Advantage,5511.1 +12906,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,Aetna-Medicare Advantage, +12907,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,Aetna-Medicare Advantage,9863.17 +12908,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,Aetna-Medicare Advantage,6646.35 +12909,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,Aetna-Medicare Advantage, +12910,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,Aetna-Medicare Advantage,3805.0 +12911,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,Aetna-Medicare Advantage, +12912,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,Aetna-Medicare Advantage,533.5 +12913,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,Aetna-Medicare Advantage,243.1 +12914,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,Aetna-Medicare Advantage,1443.37 +12915,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,Aetna-Medicare Advantage, +12916,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,Aetna-Medicare Advantage, +12917,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,Aetna-Medicare Advantage,4299.69 +12918,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,Aetna-Medicare Advantage,772.96 +12919,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,Aetna-Medicare Advantage, +12920,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,Aetna-Medicare Advantage,4432.07 +12921,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,Aetna-Medicare Advantage, +12922,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,Aetna-Medicare Advantage, +12923,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,Aetna-Medicare Advantage,5731.46 +12924,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,Aetna-Medicare Advantage,5461.0 +12925,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,Aetna-Medicare Advantage,8794.78 +12926,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,Aetna-Medicare Advantage, +12927,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,Aetna-Medicare Advantage, +12928,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,Aetna-Medicare Advantage, +12929,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,Aetna-Medicare Advantage, +12930,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,Aetna-Medicare Advantage, +12931,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,Aetna-Medicare Advantage, +12932,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,Aetna-Medicare Advantage, +12933,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,Aetna-Medicare Advantage,4641.03 +12934,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,Aetna-Medicare Advantage,5362.33 +12935,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,Aetna-Medicare Advantage, +12936,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,Aetna-Medicare Advantage, +12937,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,Aetna-Medicare Advantage,5266.58 +12938,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,Aetna-Medicare Advantage,2297.98 +12939,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,Aetna-Medicare Advantage, +12940,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,Aetna-Medicare Advantage, +12941,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,Aetna-Medicare Advantage, +12942,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,Aetna-Medicare Advantage, +12943,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,Aetna-Medicare Advantage, +12944,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,Aetna-Medicare Advantage,3436.0 +12945,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,Aetna-Medicare Advantage,8116.67 +12946,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,Aetna-Medicare Advantage, +12947,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,Aetna-Medicare Advantage, +12948,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,Aetna-Medicare Advantage,1765.59 +12949,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,Aetna-Medicare Advantage, +12950,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,Aetna-Medicare Advantage, +12951,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,Aetna-Medicare Advantage,408.46 +12952,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,Aetna-Medicare Advantage,817.26 +12953,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,Aetna-Medicare Advantage, +12954,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,Aetna-Medicare Advantage, +12955,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,Aetna-Medicare Advantage,4001.83 +12956,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,Aetna-Medicare Advantage,743.45 +12957,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,Aetna-Medicare Advantage, +12958,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,Aetna-Medicare Advantage, +12959,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,Aetna-Medicare Advantage, +12960,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,Aetna-Medicare Advantage,5731.46 +12961,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,Aetna-Medicare Advantage,1546.98 +12962,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,Aetna-Medicare Advantage,4375.02 +12963,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,Aetna-Medicare Advantage,612.94 +12964,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,Aetna-Medicare Advantage,5280.5 +12965,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,Aetna-Medicare Advantage, +12966,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,Aetna-Medicare Advantage, +12967,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,Aetna-Medicare Advantage,5511.1 +12968,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,Aetna-Medicare Advantage,3363.05 +12969,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,Aetna-Medicare Advantage, +12970,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,Aetna-Medicare Advantage, +12971,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,Aetna-Medicare Advantage,3436.0 +12972,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,Aetna-Medicare Advantage,362.94 +12973,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,Aetna-Medicare Advantage,1606.41 +12974,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,Aetna-Medicare Advantage,7116.43 +12975,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,Aetna-Medicare Advantage,4609.0 +12976,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,Aetna-Medicare Advantage, +12977,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,Aetna-Medicare Advantage, +12978,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,Aetna-Medicare Advantage, +12979,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,Aetna-Medicare Advantage, +12980,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,Aetna-Medicare Advantage,11453.0 +12981,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,Aetna-Medicare Advantage,12357.0 +12982,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,Aetna-Medicare Advantage,10058.55 +12983,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,Aetna-Medicare Advantage,9066.49 +12984,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,Aetna-Medicare Advantage,5461.0 +12985,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,Aetna-Medicare Advantage,6239.1 +12986,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,Aetna-Medicare Advantage, +12987,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,Aetna-Medicare Advantage,2755.55 +12988,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,Aetna-Medicare Advantage,5511.1 +12989,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,Aetna-Medicare Advantage,1547.55 +12990,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,Aetna-Medicare Advantage,5731.46 +12991,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,Aetna-Medicare Advantage, +12992,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,Aetna-Medicare Advantage,11877.05 +12993,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,Aetna-Medicare Advantage,10058.55 +12994,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,Aetna-Medicare Advantage, +12995,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,Aetna-Medicare Advantage, +12996,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,Aetna-Medicare Advantage,9961.8 +12997,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,Aetna-Medicare Advantage,12352.62 +12998,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,Aetna-Medicare Advantage, +12999,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,Aetna-Medicare Advantage, +13000,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,Aetna-Medicare Advantage,5511.1 +13001,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,Aetna-Medicare Advantage, +13002,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,Aetna-Medicare Advantage, +13003,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,Aetna-Medicare Advantage, +13004,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,Aetna-Medicare Advantage, +13005,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,Aetna-Medicare Advantage, +13006,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,Aetna-Medicare Advantage,1321.46 +13007,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,Aetna-Medicare Advantage,9642.56 +13008,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,Aetna-Medicare Advantage,5731.46 +13009,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,Aetna-Medicare Advantage,596.7 +13010,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,Aetna-Medicare Advantage, +13011,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,Aetna-Medicare Advantage,5731.46 +13012,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +13013,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,Aetna-Medicare Advantage, +13014,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,Aetna-Medicare Advantage,3988.53 +13015,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,Aetna-Medicare Advantage, +13016,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,Aetna-Medicare Advantage, +13017,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +13018,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +13019,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,Aetna-Medicare Advantage,1300.56 +13020,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,Aetna-Medicare Advantage,6158.33 +13021,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,Aetna-Medicare Advantage,3679.65 +13022,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,Aetna-Medicare Advantage,3219.02 +13023,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,Aetna-Medicare Advantage,5731.46 +13024,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,Aetna-Medicare Advantage, +13025,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,Aetna-Medicare Advantage,892.97 +13026,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,Aetna-Medicare Advantage, +13027,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,Aetna-Medicare Advantage,1215.78 +13028,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,Aetna-Medicare Advantage,2083.21 +13029,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,Aetna-Medicare Advantage, +13030,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,Aetna-Medicare Advantage,2929.31 +13031,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,Aetna-Medicare Advantage,3770.49 +13032,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,Aetna-Medicare Advantage,7920.0 +13033,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,Aetna-Medicare Advantage,5993.95 +13034,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,Aetna-Medicare Advantage, +13035,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,Aetna-Medicare Advantage,7920.0 +13036,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,Aetna-Medicare Advantage,5731.46 +13037,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,Aetna-Medicare Advantage, +13038,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,Aetna-Medicare Advantage,687.75 +13039,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,Aetna-Medicare Advantage, +13040,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,Aetna-Medicare Advantage, +13041,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,Aetna-Medicare Advantage,1324.88 +13042,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,Aetna-Medicare Advantage, +13043,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,Aetna-Medicare Advantage, +13044,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,Aetna-Medicare Advantage,20235.23 +13045,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,Aetna-Medicare Advantage, +13046,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,Aetna-Medicare Advantage,2913.0 +13047,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,Aetna-Medicare Advantage, +13048,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,Aetna-Medicare Advantage,2230.0 +13049,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,Aetna-Medicare Advantage,718.81 +13050,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,Aetna-Medicare Advantage,1560.74 +13051,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,Aetna-Medicare Advantage,3892.0 +13052,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,Aetna-Medicare Advantage, +13053,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,Aetna-Medicare Advantage,5731.46 +13054,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +13055,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,Aetna-Medicare Advantage,4393.97 +13056,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,Aetna-Medicare Advantage,5511.1 +13057,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,Aetna-Medicare Advantage, +13058,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,Aetna-Medicare Advantage, +13059,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,Aetna-Medicare Advantage, +13060,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,Aetna-Medicare Advantage,22057.47 +13061,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,Aetna-Medicare Advantage, +13062,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,Aetna-Medicare Advantage, +13063,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,Aetna-Medicare Advantage, +13064,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,Aetna-Medicare Advantage, +13065,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,Aetna-Medicare Advantage,7836.0 +13066,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,Aetna-Medicare Advantage, +13067,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,Aetna-Medicare Advantage, +13068,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,Aetna-Medicare Advantage, +13069,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,Aetna-Medicare Advantage,9285.0 +13070,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,Aetna-Medicare Advantage, +13071,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,Aetna-Medicare Advantage,7358.07 +13072,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,Aetna-Medicare Advantage, +13073,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,Aetna-Medicare Advantage,30600.08 +13074,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,Aetna-Medicare Advantage, +13075,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,Aetna-Medicare Advantage,1829.72 +13076,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,Aetna-Medicare Advantage, +13077,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,Aetna-Medicare Advantage, +13078,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,Aetna-Medicare Advantage, +13079,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,Aetna-Medicare Advantage, +13080,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,Aetna-Medicare Advantage, +13081,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,Aetna-Medicare Advantage, +13082,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,Aetna-Medicare Advantage,1157.99 +13083,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,Aetna-Medicare Advantage, +13084,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,Aetna-Medicare Advantage, +13085,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,Aetna-Medicare Advantage,8787.94 +13086,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,Aetna-Medicare Advantage,2929.31 +13087,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,Aetna-Medicare Advantage,2272.23 +13088,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,Aetna-Medicare Advantage,585.53 +13089,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,Aetna-Medicare Advantage,4099.68 +13090,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,Aetna-Medicare Advantage, +13091,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,Aetna-Medicare Advantage, +13092,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,Aetna-Medicare Advantage, +13093,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,Aetna-Medicare Advantage, +13094,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,Aetna-Medicare Advantage, +13095,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,Aetna-Medicare Advantage, +13096,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,Aetna-Medicare Advantage, +13097,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,Aetna-Medicare Advantage, +13098,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,Aetna-Medicare Advantage, +13099,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,Aetna-Medicare Advantage, +13100,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,Aetna-Medicare Advantage,10572.02 +13101,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,Aetna-Medicare Advantage, +13102,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,Aetna-Medicare Advantage,24460.2 +13103,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,Aetna-Medicare Advantage,3911.88 +13104,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,Aetna-Medicare Advantage, +13105,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,Aetna-Medicare Advantage, +13106,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,Aetna-Medicare Advantage, +13107,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,Aetna-Medicare Advantage, +13108,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,Aetna-Medicare Advantage,5228.0 +13109,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,Aetna-Medicare Advantage, +13110,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,Aetna-Medicare Advantage,2095.38 +13111,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,Aetna-Medicare Advantage, +13112,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,Aetna-Medicare Advantage,10333.32 +13113,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,Aetna-Medicare Advantage,2066.67 +13114,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,Aetna-Medicare Advantage,3726.29 +13115,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,Aetna-Medicare Advantage, +13116,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,Aetna-Medicare Advantage, +13117,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,Aetna-Medicare Advantage, +13118,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,Aetna-Medicare Advantage,788.17 +13119,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,Aetna-Medicare Advantage, +13120,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,Aetna-Medicare Advantage, +13121,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,Aetna-Medicare Advantage,5461.0 +13122,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,Aetna-Medicare Advantage, +13123,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,Aetna-Medicare Advantage, +13124,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,Aetna-Medicare Advantage,5731.46 +13125,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,Aetna-Medicare Advantage,2865.73 +13126,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,Aetna-Medicare Advantage,5731.46 +13127,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,Aetna-Medicare Advantage,3210.23 +13128,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,Aetna-Medicare Advantage, +13129,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,Aetna-Medicare Advantage, +13130,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,Aetna-Medicare Advantage, +13131,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,Aetna-Medicare Advantage, +13132,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,Aetna-Medicare Advantage,4662.28 +13133,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,Aetna-Medicare Advantage,682.24 +13134,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,Aetna-Medicare Advantage, +13135,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,Aetna-Medicare Advantage, +13136,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,Aetna-Medicare Advantage, +13137,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,Aetna-Medicare Advantage, +13138,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,Aetna-Medicare Advantage, +13139,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,Aetna-Medicare Advantage, +13140,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,Aetna-Medicare Advantage, +13141,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,Aetna-Medicare Advantage, +13142,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,Aetna-Medicare Advantage, +13143,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,Aetna-Medicare Advantage, +13144,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,Aetna-Medicare Advantage, +13145,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,Aetna-Medicare Advantage, +13146,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,Aetna-Medicare Advantage, +13147,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,Aetna-Medicare Advantage, +13148,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,Aetna-Medicare Advantage,1707.0 +13149,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,Aetna-Medicare Advantage, +13150,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,Aetna-Medicare Advantage, +13151,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,Aetna-Medicare Advantage, +13152,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,Aetna-Medicare Advantage, +13153,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,Aetna-Medicare Advantage, +13154,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,Aetna-Medicare Advantage, +13155,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,Aetna-Medicare Advantage,5461.0 +13156,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,Aetna-Medicare Advantage, +13157,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,Aetna-Medicare Advantage, +13158,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,Aetna-Medicare Advantage, +13159,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,Aetna-Medicare Advantage, +13160,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,Aetna-Medicare Advantage,4633.56 +13161,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,Aetna-Medicare Advantage,4305.03 +13162,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,Aetna-Medicare Advantage, +13163,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,Aetna-Medicare Advantage,1862.51 +13164,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,Aetna-Medicare Advantage, +13165,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,Aetna-Medicare Advantage,2348.33 +13166,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,Aetna-Medicare Advantage, +13167,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,Aetna-Medicare Advantage,4718.43 +13168,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,Aetna-Medicare Advantage, +13169,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,Aetna-Medicare Advantage, +13170,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,Aetna-Medicare Advantage, +13171,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,Aetna-Medicare Advantage, +13172,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,Aetna-Medicare Advantage,4104.91 +13173,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,Aetna-Medicare Advantage, +13174,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,Aetna-Medicare Advantage,4718.43 +13175,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,Aetna-Medicare Advantage, +13176,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,Aetna-Medicare Advantage, +13177,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,Aetna-Medicare Advantage, +13178,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,Aetna-Medicare Advantage, +13179,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,Aetna-Medicare Advantage, +13180,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,Aetna-Medicare Advantage, +13181,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,Aetna-Medicare Advantage, +13182,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,Aetna-Medicare Advantage, +13183,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,Aetna-Medicare Advantage, +13184,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,Aetna-Medicare Advantage, +13185,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,Aetna-Medicare Advantage, +13186,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,Aetna-Medicare Advantage, +13187,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,Aetna-Medicare Advantage, +13188,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,Aetna-Medicare Advantage, +13189,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,Aetna-Medicare Advantage,6631.88 +13190,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,Aetna-Medicare Advantage,5731.46 +13191,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,Aetna-Medicare Advantage,2483.26 +13192,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,Aetna-Medicare Advantage,2865.73 +13193,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,Aetna-Medicare Advantage, +13194,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,Aetna-Medicare Advantage, +13195,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,Aetna-Medicare Advantage, +13196,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,Aetna-Medicare Advantage, +13197,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,Aetna-Medicare Advantage, +13198,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,Aetna-Medicare Advantage,5731.46 +13199,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,Aetna-Medicare Advantage,2967.08 +13200,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,Aetna-Medicare Advantage, +13201,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,Aetna-Medicare Advantage,2865.73 +13202,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,Aetna-Medicare Advantage, +13203,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,Aetna-Medicare Advantage,5731.46 +13204,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,Aetna-Medicare Advantage, +13205,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,Aetna-Medicare Advantage, +13206,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,Aetna-Medicare Advantage, +13207,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,Aetna-Medicare Advantage, +13208,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,Aetna-Medicare Advantage, +13209,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,Aetna-Medicare Advantage, +13210,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,Aetna-Medicare Advantage,9242.44 +13211,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,Aetna-Medicare Advantage,8266.65 +13212,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,Aetna-Medicare Advantage, +13213,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,Aetna-Medicare Advantage, +13214,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,Aetna-Medicare Advantage, +13215,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,Aetna-Medicare Advantage,2073.14 +13216,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,Aetna-Medicare Advantage, +13217,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,Aetna-Medicare Advantage, +13218,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,Aetna-Medicare Advantage, +13219,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,Aetna-Medicare Advantage,2303.49 +13220,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,Aetna-Medicare Advantage,898.43 +13221,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,Aetna-Medicare Advantage, +13222,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,Aetna-Medicare Advantage,932.6 +13223,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,Aetna-Medicare Advantage, +13224,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,Aetna-Medicare Advantage, +13225,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,Aetna-Medicare Advantage,5731.46 +13226,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,Aetna-Medicare Advantage, +13227,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,Aetna-Medicare Advantage, +13228,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,Aetna-Medicare Advantage, +13229,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,Aetna-Medicare Advantage,6843.77 +13230,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,Aetna-Medicare Advantage,3170.13 +13231,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,Aetna-Medicare Advantage, +13232,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,Aetna-Medicare Advantage, +13233,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,Aetna-Medicare Advantage,5461.0 +13234,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,Aetna-Medicare Advantage,1197.91 +13235,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,Aetna-Medicare Advantage,9463.84 +13236,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,Aetna-Medicare Advantage, +13237,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,Aetna-Medicare Advantage,2391.52 +13238,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,Aetna-Medicare Advantage,5228.0 +13239,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,Aetna-Medicare Advantage,1071.0 +13240,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,Aetna-Medicare Advantage, +13241,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,Aetna-Medicare Advantage, +13242,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,Aetna-Medicare Advantage,8191.5 +13243,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,Aetna-Medicare Advantage, +13244,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,Aetna-Medicare Advantage, +13245,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,Aetna-Medicare Advantage, +13246,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,Aetna-Medicare Advantage, +13247,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,Aetna-Medicare Advantage, +13248,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,Aetna-Medicare Advantage,6449.53 +13249,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,Aetna-Medicare Advantage, +13250,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,Aetna-Medicare Advantage,7140.3 +13251,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,Aetna-Medicare Advantage,7708.58 +13252,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,Aetna-Medicare Advantage, +13253,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,Aetna-Medicare Advantage,932.6 +13254,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,Aetna-Medicare Advantage,5537.58 +13255,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,Aetna-Medicare Advantage, +13256,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,Aetna-Medicare Advantage, +13257,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,Aetna-Medicare Advantage,377.25 +13258,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,Aetna-Medicare Advantage, +13259,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,Aetna-Medicare Advantage, +13260,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,Aetna-Medicare Advantage, +13261,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,Aetna-Medicare Advantage,1829.72 +13262,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,Aetna-Medicare Advantage, +13263,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,Aetna-Medicare Advantage,246.92 +13264,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,Aetna-Medicare Advantage,1547.98 +13265,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,Aetna-Medicare Advantage,2650.21 +13266,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,Aetna-Medicare Advantage, +13267,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,Aetna-Medicare Advantage, +13268,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,Aetna-Medicare Advantage,2032.34 +13269,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,Aetna-Medicare Advantage,8314.78 +13270,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,Aetna-Medicare Advantage,5511.1 +13271,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,Aetna-Medicare Advantage, +13272,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,Aetna-Medicare Advantage, +13273,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,Aetna-Medicare Advantage,714.0 +13274,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,Aetna-Medicare Advantage, +13275,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,Aetna-Medicare Advantage,5511.1 +13276,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,Aetna-Medicare Advantage,8597.19 +13277,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,Aetna-Medicare Advantage, +13278,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,Aetna-Medicare Advantage,3626.77 +13279,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,Aetna-Medicare Advantage, +13280,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,Aetna-Medicare Advantage, +13281,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,Aetna-Medicare Advantage, +13282,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,Aetna-Medicare Advantage, +13283,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,Aetna-Medicare Advantage,623.76 +13284,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,Aetna-Medicare Advantage, +13285,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,Aetna-Medicare Advantage,971.93 +13286,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,Aetna-Medicare Advantage,17.43 +13287,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,Aetna-Medicare Advantage,29.44 +13288,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,Aetna-Medicare Advantage, +13289,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,Aetna-Medicare Advantage,136.98 +13290,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,Aetna-Medicare Advantage,2050.97 +13291,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,Aetna-Medicare Advantage, +13292,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,Aetna-Medicare Advantage,3026.67 +13293,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,Aetna-Medicare Advantage,1307.0 +13294,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,Aetna-Medicare Advantage,1501.53 +13295,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,Aetna-Medicare Advantage, +13296,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,Aetna-Medicare Advantage,4768.69 +13297,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,Aetna-Medicare Advantage,2207.73 +13298,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,Aetna-Medicare Advantage,3684.23 +13299,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,Aetna-Medicare Advantage,290.93 +13300,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,Aetna-Medicare Advantage,2885.49 +13301,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,Aetna-Medicare Advantage,225.18 +13302,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,Aetna-Medicare Advantage,7760.49 +13303,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,Aetna-Medicare Advantage,7745.85 +13304,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,Aetna-Medicare Advantage,535.2 +13305,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,Aetna-Medicare Advantage,4814.89 +13306,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,Aetna-Medicare Advantage,4780.28 +13307,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,Aetna-Medicare Advantage,1695.5 +13308,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,Aetna-Medicare Advantage,5930.13 +13309,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,Aetna-Medicare Advantage,8142.07 +13310,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,Aetna-Medicare Advantage,3892.5 +13311,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,Aetna-Medicare Advantage,5111.22 +13312,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,Aetna-Medicare Advantage, +13313,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,Aetna-Medicare Advantage,7359.78 +13314,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,Aetna-Medicare Advantage,1859.98 +13315,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,Aetna-Medicare Advantage,895.0 +13316,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,Aetna-Medicare Advantage,507.24 +13317,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,Aetna-Medicare Advantage,501.34 +13318,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,Aetna-Medicare Advantage,26.25 +13319,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,Aetna-Medicare Advantage, +13320,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,Aetna-Medicare Advantage, +13321,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,Aetna-Medicare Advantage,103.86 +13322,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,Aetna-Medicare Advantage, +13323,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,Aetna-Medicare Advantage,2413.14 +13324,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,Aetna-Medicare Advantage,8525.54 +13325,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,Aetna-Medicare Advantage,519.7 +13326,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,Aetna-Medicare Advantage,787.42 +13327,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,Aetna-Medicare Advantage,4329.4 +13328,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,Aetna-Medicare Advantage,2071.0 +13329,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,Aetna-Medicare Advantage, +13330,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,Aetna-Medicare Advantage, +13331,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,Aetna-Medicare Advantage,326.15 +13332,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,Aetna-Medicare Advantage,548.86 +13333,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,Aetna-Medicare Advantage,713.05 +13334,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,Aetna-Medicare Advantage,1011.99 +13335,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,Aetna-Medicare Advantage,415.61 +13336,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,Aetna-Medicare Advantage, +13337,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,Aetna-Medicare Advantage, +13338,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,Aetna-Medicare Advantage,371.81 +13339,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,Aetna-Medicare Advantage,601.98 +13340,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,Aetna-Medicare Advantage,807.92 +13341,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,Aetna-Medicare Advantage,322.5 +13342,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,Aetna-Medicare Advantage,601.87 +13343,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,Aetna-Medicare Advantage,577.49 +13344,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,Aetna-Medicare Advantage,809.78 +13345,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,Aetna-Medicare Advantage,4183.83 +13346,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,Aetna-Medicare Advantage, +13347,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,Aetna-Medicare Advantage,1814.32 +13348,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,Aetna-Medicare Advantage, +13349,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,Aetna-Medicare Advantage,1688.52 +13350,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,Aetna-Medicare Advantage,299.78 +13351,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,Aetna-Medicare Advantage, +13352,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,Aetna-Medicare Advantage,4784.36 +13353,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,Aetna-Medicare Advantage,7093.5 +13354,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,Aetna-Medicare Advantage,3222.2 +13355,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,Aetna-Medicare Advantage,3002.44 +13356,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,Aetna-Medicare Advantage,4500.4 +13357,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,Aetna-Medicare Advantage, +13358,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,Aetna-Medicare Advantage,4855.48 +13359,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,Aetna-Medicare Advantage,4550.37 +13360,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,Aetna-Medicare Advantage,4561.97 +13361,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,Aetna-Medicare Advantage,418.17 +13362,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,Aetna-Medicare Advantage,441.22 +13363,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,Aetna-Medicare Advantage, +13364,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,Aetna-Medicare Advantage,1307.0 +13365,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,Aetna-Medicare Advantage,1994.14 +13366,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,Aetna-Medicare Advantage,3375.48 +13367,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,Aetna-Medicare Advantage,574.74 +13368,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,Aetna-Medicare Advantage,5469.99 +13369,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,Aetna-Medicare Advantage,255.0 +13370,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,Aetna-Medicare Advantage,424.93 +13371,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,Aetna-Medicare Advantage,360.5 +13372,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,Aetna-Medicare Advantage,349.85 +13373,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,Aetna-Medicare Advantage,124.81 +13374,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,Aetna-Medicare Advantage,510.13 +13375,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,Aetna-Medicare Advantage,43.48 +13376,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,Aetna-Medicare Advantage,476.09 +13377,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,Aetna-Medicare Advantage,446.36 +13378,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,Aetna-Medicare Advantage,510.53 +13379,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,Aetna-Medicare Advantage,499.1 +13380,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,Aetna-Medicare Advantage,481.49 +13381,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,Aetna-Medicare Advantage,638.0 +13382,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,Aetna-Medicare Advantage,301.54 +13383,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,Aetna-Medicare Advantage,810.64 +13384,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,Aetna-Medicare Advantage,539.55 +13385,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,Aetna-Medicare Advantage,1709.95 +13386,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,Aetna-Medicare Advantage,354.09 +13387,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,Aetna-Medicare Advantage,349.55 +13388,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,Aetna-Medicare Advantage,3462.95 +13389,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,Aetna-Medicare Advantage,3115.61 +13390,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,Aetna-Medicare Advantage,3197.41 +13391,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,Aetna-Medicare Advantage,4163.82 +13392,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,Aetna-Medicare Advantage,454.75 +13393,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,Aetna-Medicare Advantage,479.44 +13394,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,Aetna-Medicare Advantage,615.96 +13395,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,Aetna-Medicare Advantage,306.22 +13396,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,Aetna-Medicare Advantage,509.21 +13397,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,Aetna-Medicare Advantage,780.3 +13398,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,Aetna-Medicare Advantage, +13399,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,Aetna-Medicare Advantage,379.46 +13400,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,Aetna-Medicare Advantage,435.84 +13401,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,Aetna-Medicare Advantage,499.83 +13402,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,Aetna-Medicare Advantage,873.15 +13403,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,Aetna-Medicare Advantage,76.31 +13404,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,Aetna-Medicare Advantage,841.47 +13405,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,Aetna-Medicare Advantage, +13406,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,Aetna-Medicare Advantage,346.26 +13407,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,Aetna-Medicare Advantage,637.39 +13408,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,Aetna-Medicare Advantage,403.49 +13409,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,Aetna-Medicare Advantage,654.16 +13410,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,Aetna-Medicare Advantage,464.06 +13411,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,Aetna-Medicare Advantage,547.4 +13412,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,Aetna-Medicare Advantage,1437.64 +13413,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,Aetna-Medicare Advantage,491.55 +13414,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,Aetna-Medicare Advantage,1379.16 +13415,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,Aetna-Medicare Advantage,1828.5 +13416,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,Aetna-Medicare Advantage,10153.49 +13417,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,Aetna-Medicare Advantage,3974.36 +13418,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,Aetna-Medicare Advantage,5392.64 +13419,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,Aetna-Medicare Advantage, +13420,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,Aetna-Medicare Advantage,373.13 +13421,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,Aetna-Medicare Advantage,579.31 +13422,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,Aetna-Medicare Advantage,149.86 +13423,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,Aetna-Medicare Advantage, +13424,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,Aetna-Medicare Advantage,1930.1 +13425,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,Aetna-Medicare Advantage,4819.56 +13426,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,Aetna-Medicare Advantage,360.73 +13427,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,Aetna-Medicare Advantage,3736.29 +13428,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,Aetna-Medicare Advantage,4773.58 +13429,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,Aetna-Medicare Advantage,4861.66 +13430,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,Aetna-Medicare Advantage,1852.53 +13431,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,Aetna-Medicare Advantage,6745.47 +13432,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,Aetna-Medicare Advantage,3449.73 +13433,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,Aetna-Medicare Advantage,515.97 +13434,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,Aetna-Medicare Advantage,408.84 +13435,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,Aetna-Medicare Advantage,630.04 +13436,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,Aetna-Medicare Advantage,783.23 +13437,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,Aetna-Medicare Advantage,643.06 +13438,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,Aetna-Medicare Advantage,213.25 +13439,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,Aetna-Medicare Advantage,43.0 +13440,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,Aetna-Medicare Advantage,811.65 +13441,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,Aetna-Medicare Advantage, +13442,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,Aetna-Medicare Advantage, +13443,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,Aetna-Medicare Advantage, +13444,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,Aetna-Medicare Advantage,390.82 +13445,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,Aetna-Medicare Advantage, +13446,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,Aetna-Medicare Advantage, +13447,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,Aetna-Medicare Advantage,4489.74 +13448,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,Aetna-Medicare Advantage,696.5 +13449,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,Aetna-Medicare Advantage, +13450,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,Aetna-Medicare Advantage,1181.12 +13451,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,Aetna-Medicare Advantage,1681.5 +13452,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,Aetna-Medicare Advantage, +13453,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,Aetna-Medicare Advantage,364.52 +13454,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,Aetna-Medicare Advantage,1797.23 +13455,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,Aetna-Medicare Advantage,6191.34 +13456,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,Aetna-Medicare Advantage,565.79 +13457,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,Aetna-Medicare Advantage,1201.0 +13458,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,Aetna-Medicare Advantage,14744.01 +13459,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,Aetna-Medicare Advantage,528.87 +13460,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,Aetna-Medicare Advantage,2881.3 +13461,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,Aetna-Medicare Advantage, +13462,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,Aetna-Medicare Advantage, +13463,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,Aetna-Medicare Advantage, +13464,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,Aetna-Medicare Advantage,13791.98 +13465,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,Aetna-Medicare Advantage,1181.64 +13466,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,Aetna-Medicare Advantage,1492.56 +13467,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,Aetna-Medicare Advantage, +13468,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,Aetna-Medicare Advantage, +13469,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,Aetna-Medicare Advantage, +13470,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,Aetna-Medicare Advantage, +13471,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,Aetna-Medicare Advantage, +13472,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,Aetna-Medicare Advantage, +13473,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,Aetna-Medicare Advantage, +13474,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,Aetna-Medicare Advantage, +13475,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,Aetna-Medicare Advantage, +13476,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,Aetna-Medicare Advantage,4254.0 +13477,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,Aetna-Medicare Advantage,275.54 +13478,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,Aetna-Medicare Advantage,877.54 +13479,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,Aetna-Medicare Advantage,3325.09 +13480,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,Aetna-Medicare Advantage, +13481,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,Aetna-Medicare Advantage,690.71 +13482,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,Aetna-Medicare Advantage, +13483,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,Aetna-Medicare Advantage, +13484,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,Aetna-Medicare Advantage, +13485,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,Aetna-Medicare Advantage, +13486,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,Aetna-Medicare Advantage, +13487,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,Aetna-Medicare Advantage, +13488,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,Aetna-Medicare Advantage, +13489,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,Aetna-Medicare Advantage,104.62 +13490,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,Aetna-Medicare Advantage,1011.04 +13491,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,Aetna-Medicare Advantage,418.95 +13492,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,Aetna-Medicare Advantage,807.61 +13493,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,Aetna-Medicare Advantage,835.45 +13494,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,Aetna-Medicare Advantage,1131.27 +13495,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,Aetna-Medicare Advantage,986.83 +13496,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,Aetna-Medicare Advantage,483.0 +13497,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,Aetna-Medicare Advantage,1072.57 +13498,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,Aetna-Medicare Advantage,697.36 +13499,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,Aetna-Medicare Advantage,181.53 +13500,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,Aetna-Medicare Advantage,140.33 +13501,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,Aetna-Medicare Advantage,886.82 +13502,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,Aetna-Medicare Advantage, +13503,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,Aetna-Medicare Advantage,132.27 +13504,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,Aetna-Medicare Advantage,163.97 +13505,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,Aetna-Medicare Advantage, +13506,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,Aetna-Medicare Advantage, +13507,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,Aetna-Medicare Advantage,268.5 +13508,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,Aetna-Medicare Advantage, +13509,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,Aetna-Medicare Advantage,478.24 +13510,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,Aetna-Medicare Advantage,1430.26 +13511,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,Aetna-Medicare Advantage,1515.0 +13512,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,Aetna-Medicare Advantage, +13513,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,Aetna-Medicare Advantage,3216.48 +13514,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,Aetna-Medicare Advantage,3216.48 +13515,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,Aetna-Medicare Advantage,3121.5 +13516,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,Aetna-Medicare Advantage,2100.45 +13517,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,Aetna-Medicare Advantage,519.03 +13518,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,Aetna-Medicare Advantage,2470.23 +13519,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,Aetna-Medicare Advantage,3327.41 +13520,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Aetna-Medicare Advantage, +13521,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,Aetna-Medicare Advantage,54.83 +13522,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,Aetna-Medicare Advantage,368.46 +13523,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,Aetna-Medicare Advantage,418.51 +13524,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,Aetna-Medicare Advantage, +13525,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,Aetna-Medicare Advantage,426.24 +13526,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,Aetna-Medicare Advantage,1285.96 +13527,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,Aetna-Medicare Advantage, +13528,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,Aetna-Medicare Advantage,945.05 +13529,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,Aetna-Medicare Advantage, +13530,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,Aetna-Medicare Advantage,559.25 +13531,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,Aetna-Medicare Advantage,454.07 +13532,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,Aetna-Medicare Advantage,758.27 +13533,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,Aetna-Medicare Advantage,703.16 +13534,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,Aetna-Medicare Advantage, +13535,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,Aetna-Medicare Advantage, +13536,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,Aetna-Medicare Advantage,2762.95 +13537,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,Aetna-Medicare Advantage,3065.81 +13538,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,Aetna-Medicare Advantage,3949.2 +13539,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,Aetna-Medicare Advantage,715.74 +13540,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,Aetna-Medicare Advantage,259.18 +13541,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,Aetna-Medicare Advantage,243.08 +13542,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,Aetna-Medicare Advantage,194.76 +13543,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,Aetna-Medicare Advantage,691.44 +13544,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,Aetna-Medicare Advantage,835.32 +13545,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,Aetna-Medicare Advantage,841.0 +13546,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,Aetna-Medicare Advantage,420.79 +13547,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,Aetna-Medicare Advantage,744.55 +13548,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,Aetna-Medicare Advantage,397.5 +13549,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,Aetna-Medicare Advantage,33.72 +13550,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,Aetna-Medicare Advantage,896.05 +13551,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,Aetna-Medicare Advantage,273.97 +13552,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,Aetna-Medicare Advantage,941.06 +13553,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,Aetna-Medicare Advantage,2425.89 +13554,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,Aetna-Medicare Advantage,638.84 +13555,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,Aetna-Medicare Advantage,12698.5 +13556,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,Aetna-Medicare Advantage,3547.19 +13557,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,Aetna-Medicare Advantage,13656.39 +13558,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,Aetna-Medicare Advantage,7825.74 +13559,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,Aetna-Medicare Advantage,5362.33 +13560,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,Aetna-Medicare Advantage,2293.57 +13561,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Aetna-Medicare Advantage, +13562,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,Aetna-Medicare Advantage, +13563,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,Aetna-Medicare Advantage,3224.66 +13564,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,Aetna-Medicare Advantage,400.77 +13565,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,Aetna-Medicare Advantage,2881.43 +13566,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,Aetna-Medicare Advantage,1282.0 +13567,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,Aetna-Medicare Advantage,13622.77 +13568,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,Aetna-Medicare Advantage,1740.05 +13569,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,Aetna-Medicare Advantage,13147.0 +13570,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,Aetna-Medicare Advantage,6320.6 +13571,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,Aetna-Medicare Advantage,1872.09 +13572,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,Aetna-Medicare Advantage,2844.53 +13573,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,Aetna-Medicare Advantage,519.84 +13574,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,Aetna-Medicare Advantage, +13575,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,Aetna-Medicare Advantage, +13576,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,Aetna-Medicare Advantage,1108.75 +13577,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,Aetna-Medicare Advantage,512.86 +13578,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,Aetna-Medicare Advantage,6288.38 +13579,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,Aetna-Medicare Advantage, +13580,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,Aetna-Medicare Advantage,5362.33 +13581,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,Aetna-Medicare Advantage,6672.01 +13582,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Aetna-Medicare Advantage, +13583,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,Aetna-Medicare Advantage,170.5 +13584,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,Aetna-Medicare Advantage,1722.99 +13585,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,Aetna-Medicare Advantage,1883.0 +13586,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,Aetna-Medicare Advantage,902.97 +13587,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,Aetna-Medicare Advantage, +13588,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,Aetna-Medicare Advantage,1824.57 +13589,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,Aetna-Medicare Advantage, +13590,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,Aetna-Medicare Advantage,1152.5 +13591,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,Aetna-Medicare Advantage,1239.92 +13592,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,Aetna-Medicare Advantage,2563.49 +13593,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,Aetna-Medicare Advantage, +13594,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,Aetna-Medicare Advantage,2115.73 +13595,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,Aetna-Medicare Advantage,102.76 +13596,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,Aetna-Medicare Advantage,2004.56 +13597,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,Aetna-Medicare Advantage,7186.91 +13598,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,Aetna-Medicare Advantage, +13599,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,Aetna-Medicare Advantage, +13600,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,Aetna-Medicare Advantage,881.19 +13601,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,Aetna-Medicare Advantage,1094.5 +13602,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,Aetna-Medicare Advantage, +13603,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,Aetna-Medicare Advantage, +13604,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,Aetna-Medicare Advantage,6138.59 +13605,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,Aetna-Medicare Advantage, +13606,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,Aetna-Medicare Advantage, +13607,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,Aetna-Medicare Advantage, +13608,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,Aetna-Medicare Advantage, +13609,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,Aetna-Medicare Advantage,2025.85 +13610,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,Aetna-Medicare Advantage, +13611,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,Aetna-Medicare Advantage,1446.81 +13612,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,Aetna-Medicare Advantage,2714.49 +13613,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,Aetna-Medicare Advantage, +13614,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,Aetna-Medicare Advantage,11172.94 +13615,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,Aetna-Medicare Advantage,10741.5 +13616,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,Aetna-Medicare Advantage, +13617,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,Aetna-Medicare Advantage,10198.68 +13618,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,Aetna-Medicare Advantage,11597.87 +13619,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,Aetna-Medicare Advantage,3285.39 +13620,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,Aetna-Medicare Advantage, +13621,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,Aetna-Medicare Advantage,8264.06 +13622,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,Aetna-Medicare Advantage,861.5 +13623,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,Aetna-Medicare Advantage, +13624,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,Aetna-Medicare Advantage,24.87 +13625,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,Aetna-Medicare Advantage,211.17 +13626,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,Aetna-Medicare Advantage,27.11 +13627,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,Aetna-Medicare Advantage,332.84 +13628,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +13629,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,Aetna-Medicare Advantage,222.41 +13630,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,Aetna-Medicare Advantage,166.29 +13631,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,Aetna-Medicare Advantage,529.28 +13632,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,Aetna-Medicare Advantage,986.0 +13633,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,Aetna-Medicare Advantage, +13634,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,Aetna-Medicare Advantage, +13635,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,Aetna-Medicare Advantage, +13636,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,Aetna-Medicare Advantage, +13637,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,Aetna-Medicare Advantage,251.5 +13638,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,Aetna-Medicare Advantage, +13639,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,Aetna-Medicare Advantage, +13640,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,Aetna-Medicare Advantage,178.0 +13641,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,Aetna-Medicare Advantage,26.31 +13642,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,Aetna-Medicare Advantage, +13643,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,Aetna-Medicare Advantage, +13644,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,Aetna-Medicare Advantage, +13645,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,Aetna-Medicare Advantage,15.75 +13646,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,Aetna-Medicare Advantage,17.0 +13647,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,Aetna-Medicare Advantage,56.5 +13648,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,Aetna-Medicare Advantage,202.6 +13649,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,Aetna-Medicare Advantage,15.0 +13650,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,Aetna-Medicare Advantage,84.5 +13651,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,Aetna-Medicare Advantage,15.75 +13652,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,Aetna-Medicare Advantage, +13653,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,Aetna-Medicare Advantage, +13654,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,Aetna-Medicare Advantage,254.93 +13655,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,Aetna-Medicare Advantage, +13656,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,Aetna-Medicare Advantage, +13657,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,Aetna-Medicare Advantage, +13658,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,Aetna-Medicare Advantage,472.72 +13659,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,Aetna-Medicare Advantage, +13660,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,Aetna-Medicare Advantage, +13661,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,Aetna-Medicare Advantage, +13662,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,Aetna-Medicare Advantage,69.55 +13663,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,Aetna-Medicare Advantage, +13664,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,Aetna-Medicare Advantage,748.2 +13665,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,Aetna-Medicare Advantage,7.5 +13666,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,Aetna-Medicare Advantage,18.5 +13667,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,Aetna-Medicare Advantage, +13668,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,Aetna-Medicare Advantage, +13669,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,Aetna-Medicare Advantage, +13670,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,Aetna-Medicare Advantage, +13671,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,Aetna-Medicare Advantage, +13672,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,Aetna-Medicare Advantage, +13673,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,Aetna-Medicare Advantage, +13674,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,Aetna-Medicare Advantage, +13675,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,Aetna-Medicare Advantage, +13676,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,Aetna-Medicare Advantage, +13677,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,Aetna-Medicare Advantage, +13678,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,Aetna-Medicare Advantage, +13679,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,Aetna-Medicare Advantage, +13680,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,Aetna-Medicare Advantage,55.69 +13681,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,Aetna-Medicare Advantage,139.87 +13682,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,Aetna-Medicare Advantage, +13683,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,Aetna-Medicare Advantage,61.86 +13684,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,Aetna-Medicare Advantage,15.79 +13685,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,Aetna-Medicare Advantage,25.43 +13686,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,Aetna-Medicare Advantage, +13687,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Aetna-Medicare Advantage, +13688,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Aetna-Medicare Advantage, +13689,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Aetna-Medicare Advantage, +13690,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,Aetna-Medicare Advantage, +13691,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,Aetna-Medicare Advantage, +13692,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,Aetna-Medicare Advantage, +13693,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,Aetna-Medicare Advantage, +13694,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,Aetna-Medicare Advantage, +13695,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,Aetna-Medicare Advantage, +13696,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,Aetna-Medicare Advantage, +13697,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,Aetna-Medicare Advantage,1223.56 +13698,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,Aetna-Medicare Advantage, +13699,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,Aetna-Medicare Advantage, +13700,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,Aetna-Medicare Advantage,1139.06 +13701,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,Aetna-Medicare Advantage,1149.8 +13702,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,Aetna-Medicare Advantage, +13703,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,Aetna-Medicare Advantage, +13704,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,Aetna-Medicare Advantage, +13705,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,Aetna-Medicare Advantage,219.26 +13706,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,Aetna-Medicare Advantage,487.5 +13707,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,Aetna-Medicare Advantage, +13708,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,Aetna-Medicare Advantage,542.13 +13709,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,Aetna-Medicare Advantage,1998.55 +13710,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,Aetna-Medicare Advantage, +13711,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,Aetna-Medicare Advantage,204.24 +13712,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,Aetna-Medicare Advantage,324.5 +13713,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,Aetna-Medicare Advantage,64.79 +13714,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,Aetna-Medicare Advantage, +13715,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,Aetna-Medicare Advantage, +13716,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,Aetna-Medicare Advantage, +13717,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,Aetna-Medicare Advantage, +13718,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,Aetna-Medicare Advantage, +13719,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,Aetna-Medicare Advantage, +13720,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,Aetna-Medicare Advantage,184.37 +13721,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,Aetna-Medicare Advantage, +13722,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,Aetna-Medicare Advantage, +13723,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,Aetna-Medicare Advantage,1212.29 +13724,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,Aetna-Medicare Advantage,734.16 +13725,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,Aetna-Medicare Advantage,2137.62 +13726,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,Aetna-Medicare Advantage, +13727,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,Aetna-Medicare Advantage,93.49 +13728,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,Aetna-Medicare Advantage, +13729,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,Aetna-Medicare Advantage,195.05 +13730,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,Aetna-Medicare Advantage,71.35 +13731,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,Aetna-Medicare Advantage,66.65 +13732,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,Aetna-Medicare Advantage, +13733,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,Aetna-Medicare Advantage,112.65 +13734,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,Aetna-Medicare Advantage, +13735,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,Aetna-Medicare Advantage, +13736,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,Aetna-Medicare Advantage, +13737,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,Aetna-Medicare Advantage, +13738,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,Aetna-Medicare Advantage, +13739,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,Aetna-Medicare Advantage, +13740,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,Aetna-Medicare Advantage, +13741,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,Aetna-Medicare Advantage,1017.37 +13742,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,Aetna-Medicare Advantage, +13743,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,Aetna-Medicare Advantage, +13744,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,Aetna-Medicare Advantage, +13745,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,Aetna-Medicare Advantage, +13746,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,Aetna-Medicare Advantage, +13747,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,Aetna-Medicare Advantage, +13748,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,Aetna-Medicare Advantage,1184.88 +13749,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,Aetna-Medicare Advantage, +13750,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,Aetna-Medicare Advantage,138.13 +13751,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,Aetna-Medicare Advantage, +13752,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,Aetna-Medicare Advantage,140.0 +13753,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,Aetna-Medicare Advantage,272.8 +13754,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,Aetna-Medicare Advantage, +13755,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,Aetna-Medicare Advantage,68.2 +13756,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,Aetna-Medicare Advantage, +13757,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,Aetna-Medicare Advantage, +13758,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,Aetna-Medicare Advantage, +13759,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,Aetna-Medicare Advantage,369.45 +13760,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,Aetna-Medicare Advantage,335.3 +13761,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,Aetna-Medicare Advantage,496.18 +13762,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,Aetna-Medicare Advantage,940.69 +13763,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,Aetna-Medicare Advantage,850.73 +13764,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,Aetna-Medicare Advantage, +13765,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,Aetna-Medicare Advantage,635.0 +13766,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,Aetna-Medicare Advantage,647.5 +13767,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,Aetna-Medicare Advantage, +13768,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,Aetna-Medicare Advantage, +13769,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,Aetna-Medicare Advantage,396.92 +13770,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,Aetna-Medicare Advantage, +13771,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,Aetna-Medicare Advantage, +13772,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,Aetna-Medicare Advantage,204.08 +13773,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,Aetna-Medicare Advantage,25.43 +13774,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,Aetna-Medicare Advantage,413.85 +13775,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,Aetna-Medicare Advantage,49.79 +13776,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,Aetna-Medicare Advantage,39.56 +13777,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,Aetna-Medicare Advantage,139.82 +13778,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,Aetna-Medicare Advantage,6.58 +13779,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,Aetna-Medicare Advantage,13.16 +13780,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,Aetna-Medicare Advantage,162.84 +13781,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,Aetna-Medicare Advantage, +13782,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,Aetna-Medicare Advantage,185.59 +13783,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,Aetna-Medicare Advantage, +13784,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,Aetna-Medicare Advantage, +13785,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,Aetna-Medicare Advantage,137.56 +13786,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,Aetna-Medicare Advantage, +13787,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,Aetna-Medicare Advantage,53.4 +13788,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,Aetna-Medicare Advantage,121.44 +13789,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,Aetna-Medicare Advantage,126.0 +13790,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,Aetna-Medicare Advantage,24.15 +13791,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,Aetna-Medicare Advantage,27.72 +13792,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,Aetna-Medicare Advantage,138.9 +13793,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,Aetna-Medicare Advantage,23.55 +13794,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,Aetna-Medicare Advantage,29.55 +13795,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,Aetna-Medicare Advantage,223.65 +13796,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,Aetna-Medicare Advantage,19.58 +13797,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,Aetna-Medicare Advantage,111.47 +13798,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,Aetna-Medicare Advantage,96.29 +13799,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,Aetna-Medicare Advantage,27.04 +13800,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,Aetna-Medicare Advantage,28.21 +13801,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,Aetna-Medicare Advantage,20.01 +13802,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,Aetna-Medicare Advantage,16.91 +13803,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,Aetna-Medicare Advantage,409.29 +13804,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,Aetna-Medicare Advantage,236.5 +13805,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,Aetna-Medicare Advantage,69.61 +13806,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,Aetna-Medicare Advantage,179.12 +13807,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,Aetna-Medicare Advantage,6.9 +13808,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,Aetna-Medicare Advantage,15.92 +13809,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,Aetna-Medicare Advantage,101.74 +13810,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,Aetna-Medicare Advantage, +13811,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,Aetna-Medicare Advantage,255.21 +13812,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,Aetna-Medicare Advantage,25.43 +13813,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,Aetna-Medicare Advantage, +13814,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,Aetna-Medicare Advantage,25.76 +13815,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,Aetna-Medicare Advantage,67.0 +13816,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,Aetna-Medicare Advantage,309.18 +13817,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,Aetna-Medicare Advantage,63.18 +13818,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,Aetna-Medicare Advantage,34.0 +13819,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,Aetna-Medicare Advantage,36.84 +13820,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,Aetna-Medicare Advantage,47.71 +13821,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,Aetna-Medicare Advantage,30.36 +13822,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,Aetna-Medicare Advantage, +13823,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,Aetna-Medicare Advantage,121.51 +13824,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,Aetna-Medicare Advantage,27.68 +13825,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,Aetna-Medicare Advantage,328.25 +13826,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,Aetna-Medicare Advantage,336.0 +13827,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,Aetna-Medicare Advantage,123.96 +13828,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,Aetna-Medicare Advantage,66.01 +13829,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,Aetna-Medicare Advantage, +13830,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,Aetna-Medicare Advantage,82.7 +13831,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,Aetna-Medicare Advantage,72.79 +13832,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,Aetna-Medicare Advantage,207.86 +13833,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,Aetna-Medicare Advantage,6.82 +13834,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,Aetna-Medicare Advantage,59.09 +13835,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,Aetna-Medicare Advantage,203.64 +13836,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,Aetna-Medicare Advantage,50.43 +13837,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,Aetna-Medicare Advantage,384.41 +13838,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,Aetna-Medicare Advantage,337.51 +13839,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,Aetna-Medicare Advantage, +13840,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,Aetna-Medicare Advantage,368.49 +13841,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,Aetna-Medicare Advantage,82.11 +13842,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,Aetna-Medicare Advantage, +13843,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,Aetna-Medicare Advantage, +13844,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,Aetna-Medicare Advantage,16.43 +13845,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,Aetna-Medicare Advantage,390.29 +13846,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,Aetna-Medicare Advantage,39.47 +13847,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,Aetna-Medicare Advantage,176.76 +13848,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,Aetna-Medicare Advantage,225.26 +13849,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,Aetna-Medicare Advantage,8.77 +13850,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,Aetna-Medicare Advantage, +13851,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,Aetna-Medicare Advantage,38.53 +13852,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,Aetna-Medicare Advantage, +13853,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,Aetna-Medicare Advantage,174.88 +13854,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,Aetna-Medicare Advantage,247.77 +13855,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,Aetna-Medicare Advantage,213.02 +13856,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,Aetna-Medicare Advantage,16.06 +13857,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,Aetna-Medicare Advantage,484.13 +13858,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,Aetna-Medicare Advantage,235.12 +13859,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,Aetna-Medicare Advantage,32.72 +13860,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,Aetna-Medicare Advantage,58.29 +13861,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,Aetna-Medicare Advantage,269.97 +13862,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,Aetna-Medicare Advantage,27.1 +13863,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,Aetna-Medicare Advantage,54.93 +13864,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,Aetna-Medicare Advantage,50.87 +13865,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,Aetna-Medicare Advantage,67.53 +13866,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,Aetna-Medicare Advantage,43.0 +13867,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,Aetna-Medicare Advantage,186.49 +13868,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,Aetna-Medicare Advantage,34.64 +13869,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,Aetna-Medicare Advantage,12.81 +13870,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,Aetna-Medicare Advantage, +13871,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,Aetna-Medicare Advantage,74.23 +13872,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,Aetna-Medicare Advantage,12.86 +13873,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,Aetna-Medicare Advantage,262.24 +13874,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,Aetna-Medicare Advantage,210.13 +13875,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,Aetna-Medicare Advantage,47.81 +13876,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,Aetna-Medicare Advantage, +13877,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,Aetna-Medicare Advantage,122.13 +13878,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,Aetna-Medicare Advantage,138.0 +13879,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,Aetna-Medicare Advantage, +13880,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,Aetna-Medicare Advantage,162.88 +13881,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,Aetna-Medicare Advantage,25.77 +13882,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,Aetna-Medicare Advantage,198.0 +13883,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,Aetna-Medicare Advantage, +13884,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,Aetna-Medicare Advantage, +13885,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,Aetna-Medicare Advantage, +13886,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,Aetna-Medicare Advantage,188.01 +13887,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,Aetna-Medicare Advantage, +13888,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,Aetna-Medicare Advantage,20.44 +13889,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,Aetna-Medicare Advantage,290.72 +13890,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,Aetna-Medicare Advantage,181.98 +13891,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,Aetna-Medicare Advantage,357.44 +13892,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,Aetna-Medicare Advantage,203.5 +13893,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,Aetna-Medicare Advantage,22.15 +13894,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,Aetna-Medicare Advantage,108.44 +13895,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,Aetna-Medicare Advantage,157.53 +13896,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,Aetna-Medicare Advantage,1439.0 +13897,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,Aetna-Medicare Advantage,16.44 +13898,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,Aetna-Medicare Advantage, +13899,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,Aetna-Medicare Advantage,20.2 +13900,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,Aetna-Medicare Advantage,131.0 +13901,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,Aetna-Medicare Advantage,106.74 +13902,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,Aetna-Medicare Advantage,117.74 +13903,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,Aetna-Medicare Advantage,41.91 +13904,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,Aetna-Medicare Advantage,10.5 +13905,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,Aetna-Medicare Advantage,102.28 +13906,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,Aetna-Medicare Advantage,27.43 +13907,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,Aetna-Medicare Advantage, +13908,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,Aetna-Medicare Advantage,109.14 +13909,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,Aetna-Medicare Advantage,31.38 +13910,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,Aetna-Medicare Advantage, +13911,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,Aetna-Medicare Advantage,27.41 +13912,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,Aetna-Medicare Advantage,28.63 +13913,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,Aetna-Medicare Advantage,157.74 +13914,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,Aetna-Medicare Advantage,342.0 +13915,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,Aetna-Medicare Advantage,342.92 +13916,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,Aetna-Medicare Advantage,35.08 +13917,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,Aetna-Medicare Advantage,47.5 +13918,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,Aetna-Medicare Advantage,81.27 +13919,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,Aetna-Medicare Advantage,50.02 +13920,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,Aetna-Medicare Advantage,50.52 +13921,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,Aetna-Medicare Advantage,14.49 +13922,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,Aetna-Medicare Advantage, +13923,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,Aetna-Medicare Advantage,416.42 +13924,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,Aetna-Medicare Advantage,41.94 +13925,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,Aetna-Medicare Advantage, +13926,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,Aetna-Medicare Advantage,349.57 +13927,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,Aetna-Medicare Advantage,12.41 +13928,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,Aetna-Medicare Advantage,68.28 +13929,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,Aetna-Medicare Advantage,16.44 +13930,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,Aetna-Medicare Advantage,64.0 +13931,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,Aetna-Medicare Advantage,6.21 +13932,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,Aetna-Medicare Advantage,50.06 +13933,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,Aetna-Medicare Advantage, +13934,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,Aetna-Medicare Advantage, +13935,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,Aetna-Medicare Advantage,70.16 +13936,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,Aetna-Medicare Advantage,35.0 +13937,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,Aetna-Medicare Advantage,73.0 +13938,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,Aetna-Medicare Advantage, +13939,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,Aetna-Medicare Advantage,205.31 +13940,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,Aetna-Medicare Advantage,80.5 +13941,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,Aetna-Medicare Advantage,321.53 +13942,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,Aetna-Medicare Advantage,150.04 +13943,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,Aetna-Medicare Advantage,278.71 +13944,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,Aetna-Medicare Advantage,70.29 +13945,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,Aetna-Medicare Advantage,59.68 +13946,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,Aetna-Medicare Advantage,54.38 +13947,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,Aetna-Medicare Advantage,64.8 +13948,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,Aetna-Medicare Advantage,172.78 +13949,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,Aetna-Medicare Advantage,169.27 +13950,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,Aetna-Medicare Advantage,113.74 +13951,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,Aetna-Medicare Advantage,127.53 +13952,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,Aetna-Medicare Advantage, +13953,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,Aetna-Medicare Advantage,102.62 +13954,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,Aetna-Medicare Advantage, +13955,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,Aetna-Medicare Advantage, +13956,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,Aetna-Medicare Advantage,207.87 +13957,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,Aetna-Medicare Advantage,22.5 +13958,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,Aetna-Medicare Advantage,216.91 +13959,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,Aetna-Medicare Advantage,17.0 +13960,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,Aetna-Medicare Advantage,89.98 +13961,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,Aetna-Medicare Advantage,57.13 +13962,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,Aetna-Medicare Advantage,42.76 +13963,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,Aetna-Medicare Advantage,23.81 +13964,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,Aetna-Medicare Advantage,152.07 +13965,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,Aetna-Medicare Advantage,10.0 +13966,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,Aetna-Medicare Advantage, +13967,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,Aetna-Medicare Advantage, +13968,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,Aetna-Medicare Advantage, +13969,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,Aetna-Medicare Advantage,4.83 +13970,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,Aetna-Medicare Advantage,246.74 +13971,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,Aetna-Medicare Advantage,257.53 +13972,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,Aetna-Medicare Advantage,98.04 +13973,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,Aetna-Medicare Advantage,17.54 +13974,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,Aetna-Medicare Advantage,106.63 +13975,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,Aetna-Medicare Advantage,212.09 +13976,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,Aetna-Medicare Advantage,145.19 +13977,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,Aetna-Medicare Advantage,268.85 +13978,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,Aetna-Medicare Advantage,68.19 +13979,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,Aetna-Medicare Advantage,50.22 +13980,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,Aetna-Medicare Advantage,70.3 +13981,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,Aetna-Medicare Advantage,81.43 +13982,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,Aetna-Medicare Advantage,149.01 +13983,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,Aetna-Medicare Advantage,81.8 +13984,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,Aetna-Medicare Advantage,95.48 +13985,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,Aetna-Medicare Advantage,214.87 +13986,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,Aetna-Medicare Advantage,306.97 +13987,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,Aetna-Medicare Advantage, +13988,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,Aetna-Medicare Advantage,145.4 +13989,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,Aetna-Medicare Advantage,60.91 +13990,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,Aetna-Medicare Advantage,67.53 +13991,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,Aetna-Medicare Advantage,35.33 +13992,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,Aetna-Medicare Advantage,74.55 +13993,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,Aetna-Medicare Advantage,5.52 +13994,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,Aetna-Medicare Advantage,28.7 +13995,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,Aetna-Medicare Advantage,26.6 +13996,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,Aetna-Medicare Advantage, +13997,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,Aetna-Medicare Advantage,62.38 +13998,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,Aetna-Medicare Advantage,41.4 +13999,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,Aetna-Medicare Advantage,71.3 +14000,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,Aetna-Medicare Advantage,123.46 +14001,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,Aetna-Medicare Advantage,403.28 +14002,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,Aetna-Medicare Advantage,227.15 +14003,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,Aetna-Medicare Advantage,12.44 +14004,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,Aetna-Medicare Advantage,718.75 +14005,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,Aetna-Medicare Advantage,99.11 +14006,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,Aetna-Medicare Advantage, +14007,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,Aetna-Medicare Advantage,147.34 +14008,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,Aetna-Medicare Advantage,143.83 +14009,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,Aetna-Medicare Advantage,136.0 +14010,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,Aetna-Medicare Advantage,112.61 +14011,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,Aetna-Medicare Advantage, +14012,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,Aetna-Medicare Advantage,63.15 +14013,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,Aetna-Medicare Advantage,31.5 +14014,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,Aetna-Medicare Advantage,60.16 +14015,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,Aetna-Medicare Advantage,2696.44 +14016,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,Aetna-Medicare Advantage, +14017,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,Aetna-Medicare Advantage, +14018,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,Aetna-Medicare Advantage,21.3 +14019,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,Aetna-Medicare Advantage,373.18 +14020,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,Aetna-Medicare Advantage,303.02 +14021,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,Aetna-Medicare Advantage,274.95 +14022,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,Aetna-Medicare Advantage,149.1 +14023,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,Aetna-Medicare Advantage,324.5 +14024,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,Aetna-Medicare Advantage, +14025,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,Aetna-Medicare Advantage,278.9 +14026,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,Aetna-Medicare Advantage,197.33 +14027,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,Aetna-Medicare Advantage, +14028,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,Aetna-Medicare Advantage,196.65 +14029,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,Aetna-Medicare Advantage, +14030,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,Aetna-Medicare Advantage, +14031,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,Aetna-Medicare Advantage,281.52 +14032,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,Aetna-Medicare Advantage,307.28 +14033,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,Aetna-Medicare Advantage,15.18 +14034,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,Aetna-Medicare Advantage, +14035,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,Aetna-Medicare Advantage, +14036,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,Aetna-Medicare Advantage,114.17 +14037,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,Aetna-Medicare Advantage,85.0 +14038,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,Aetna-Medicare Advantage,105.71 +14039,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,Aetna-Medicare Advantage,109.63 +14040,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,Aetna-Medicare Advantage,18.42 +14041,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,Aetna-Medicare Advantage,161.38 +14042,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,Aetna-Medicare Advantage,58.86 +14043,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,Aetna-Medicare Advantage,482.31 +14044,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,Aetna-Medicare Advantage,414.27 +14045,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,Aetna-Medicare Advantage,87.5 +14046,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,Aetna-Medicare Advantage, +14047,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,Aetna-Medicare Advantage,373.62 +14048,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,Aetna-Medicare Advantage, +14049,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,Aetna-Medicare Advantage,72.42 +14050,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,Aetna-Medicare Advantage, +14051,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,Aetna-Medicare Advantage,51.1 +14052,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,Aetna-Medicare Advantage,114.33 +14053,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,Aetna-Medicare Advantage,63.78 +14054,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,Aetna-Medicare Advantage,28.86 +14055,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,Aetna-Medicare Advantage,104.96 +14056,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,Aetna-Medicare Advantage,173.82 +14057,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,Aetna-Medicare Advantage, +14058,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,Aetna-Medicare Advantage,22.5 +14059,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,Aetna-Medicare Advantage,107.93 +14060,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,Aetna-Medicare Advantage,218.92 +14061,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,Aetna-Medicare Advantage,220.4 +14062,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,Aetna-Medicare Advantage,109.63 +14063,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,Aetna-Medicare Advantage,101.4 +14064,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,Aetna-Medicare Advantage,114.49 +14065,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,Aetna-Medicare Advantage,129.0 +14066,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,Aetna-Medicare Advantage,77.2 +14067,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,Aetna-Medicare Advantage,482.37 +14068,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,Aetna-Medicare Advantage,28.49 +14069,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,Aetna-Medicare Advantage, +14070,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,Aetna-Medicare Advantage, +14071,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,Aetna-Medicare Advantage,491.14 +14072,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,Aetna-Medicare Advantage, +14073,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,Aetna-Medicare Advantage,20.76 +14074,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,Aetna-Medicare Advantage,145.59 +14075,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,Aetna-Medicare Advantage,12.06 +14076,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,Aetna-Medicare Advantage,213.12 +14077,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,Aetna-Medicare Advantage,279.2 +14078,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,Aetna-Medicare Advantage,140.0 +14079,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,Aetna-Medicare Advantage,144.9 +14080,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,Aetna-Medicare Advantage,305.21 +14081,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,Aetna-Medicare Advantage,299.95 +14082,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,Aetna-Medicare Advantage,337.27 +14083,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,Aetna-Medicare Advantage,59.64 +14084,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,Aetna-Medicare Advantage,48.2 +14085,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,Aetna-Medicare Advantage,34.2 +14086,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,Aetna-Medicare Advantage,165.29 +14087,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,Aetna-Medicare Advantage,22.87 +14088,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,Aetna-Medicare Advantage,11.74 +14089,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,Aetna-Medicare Advantage,214.87 +14090,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,Aetna-Medicare Advantage,253.46 +14091,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,Aetna-Medicare Advantage,19.78 +14092,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,Aetna-Medicare Advantage, +14093,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,Aetna-Medicare Advantage,26.31 +14094,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,Aetna-Medicare Advantage,25.43 +14095,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,Aetna-Medicare Advantage,147.34 +14096,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,Aetna-Medicare Advantage, +14097,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,Aetna-Medicare Advantage,140.0 +14098,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,Aetna-Medicare Advantage, +14099,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,Aetna-Medicare Advantage,163.5 +14100,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,Aetna-Medicare Advantage,268.37 +14101,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,Aetna-Medicare Advantage,396.42 +14102,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,Aetna-Medicare Advantage,105.01 +14103,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,Aetna-Medicare Advantage,72.42 +14104,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,Aetna-Medicare Advantage,85.07 +14105,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,Aetna-Medicare Advantage,320.12 +14106,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,Aetna-Medicare Advantage,23.53 +14107,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,Aetna-Medicare Advantage,84.2 +14108,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,Aetna-Medicare Advantage,46.11 +14109,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,Aetna-Medicare Advantage, +14110,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,Aetna-Medicare Advantage,22.13 +14111,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,Aetna-Medicare Advantage,25.24 +14112,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,Aetna-Medicare Advantage,78.93 +14113,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,Aetna-Medicare Advantage,27.19 +14114,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,Aetna-Medicare Advantage,253.46 +14115,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,Aetna-Medicare Advantage,189.79 +14116,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,Aetna-Medicare Advantage,51.75 +14117,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,Aetna-Medicare Advantage, +14118,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,Aetna-Medicare Advantage, +14119,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,Aetna-Medicare Advantage, +14120,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,Aetna-Medicare Advantage, +14121,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,Aetna-Medicare Advantage, +14122,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,Aetna-Medicare Advantage,195.58 +14123,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,Aetna-Medicare Advantage,9.87 +14124,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,Aetna-Medicare Advantage,426.05 +14125,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,Aetna-Medicare Advantage,12.64 +14126,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,Aetna-Medicare Advantage,25.7 +14127,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,Aetna-Medicare Advantage,41.1 +14128,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,Aetna-Medicare Advantage,45.37 +14129,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,Aetna-Medicare Advantage,24.12 +14130,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,Aetna-Medicare Advantage,53.57 +14131,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,Aetna-Medicare Advantage, +14132,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,Aetna-Medicare Advantage, +14133,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,Aetna-Medicare Advantage,21.93 +14134,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,Aetna-Medicare Advantage,81.87 +14135,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,Aetna-Medicare Advantage,47.23 +14136,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,Aetna-Medicare Advantage, +14137,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,Aetna-Medicare Advantage, +14138,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,Aetna-Medicare Advantage, +14139,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,Aetna-Medicare Advantage,167.41 +14140,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,Aetna-Medicare Advantage,63.21 +14141,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,Aetna-Medicare Advantage,123.46 +14142,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,Aetna-Medicare Advantage,107.88 +14143,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,Aetna-Medicare Advantage,18.86 +14144,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,Aetna-Medicare Advantage,107.55 +14145,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,Aetna-Medicare Advantage,104.88 +14146,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,Aetna-Medicare Advantage, +14147,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,Aetna-Medicare Advantage, +14148,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,Aetna-Medicare Advantage,142.83 +14149,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,Aetna-Medicare Advantage, +14150,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,Aetna-Medicare Advantage, +14151,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,Aetna-Medicare Advantage,24.93 +14152,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,Aetna-Medicare Advantage,36.49 +14153,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,Aetna-Medicare Advantage,249.81 +14154,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,Aetna-Medicare Advantage,122.79 +14155,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,Aetna-Medicare Advantage,139.45 +14156,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,Aetna-Medicare Advantage,92.09 +14157,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,Aetna-Medicare Advantage,127.17 +14158,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,Aetna-Medicare Advantage,119.81 +14159,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,Aetna-Medicare Advantage,159.38 +14160,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,Aetna-Medicare Advantage,200.26 +14161,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,Aetna-Medicare Advantage, +14162,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,Aetna-Medicare Advantage,15.01 +14163,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,Aetna-Medicare Advantage, +14164,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,Aetna-Medicare Advantage,42.2 +14165,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,Aetna-Medicare Advantage,196.66 +14166,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,Aetna-Medicare Advantage,798.11 +14167,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,Aetna-Medicare Advantage,248.51 +14168,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,Aetna-Medicare Advantage,171.9 +14169,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,Aetna-Medicare Advantage,482.82 +14170,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,Aetna-Medicare Advantage,475.8 +14171,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,Aetna-Medicare Advantage,730.5 +14172,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,Aetna-Medicare Advantage,1462.02 +14173,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,Aetna-Medicare Advantage,927.02 +14174,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,Aetna-Medicare Advantage,425.74 +14175,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,Aetna-Medicare Advantage,41.08 +14176,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,Aetna-Medicare Advantage, +14177,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,Aetna-Medicare Advantage,519.5 +14178,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,Aetna-Medicare Advantage,519.5 +14179,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,Aetna-Medicare Advantage,702.04 +14180,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,Aetna-Medicare Advantage,1856.71 +14181,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,Aetna-Medicare Advantage,266.11 +14182,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,Aetna-Medicare Advantage,1526.75 +14183,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,Aetna-Medicare Advantage,642.72 +14184,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,Aetna-Medicare Advantage,65.39 +14185,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,Aetna-Medicare Advantage,273.11 +14186,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,Aetna-Medicare Advantage,105.74 +14187,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,Aetna-Medicare Advantage,147.68 +14188,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,Aetna-Medicare Advantage,255.0 +14189,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,Aetna-Medicare Advantage,362.24 +14190,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,Aetna-Medicare Advantage,159.84 +14191,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,Aetna-Medicare Advantage,243.47 +14192,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,Aetna-Medicare Advantage,134.79 +14193,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,Aetna-Medicare Advantage,179.88 +14194,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,Aetna-Medicare Advantage,80.69 +14195,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,Aetna-Medicare Advantage,641.99 +14196,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,Aetna-Medicare Advantage,5.17 +14197,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,Aetna-Medicare Advantage,69.29 +14198,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,Aetna-Medicare Advantage, +14199,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,Aetna-Medicare Advantage,32.74 +14200,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,Aetna-Medicare Advantage, +14201,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,Aetna-Medicare Advantage,102.61 +14202,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,Aetna-Medicare Advantage, +14203,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,Aetna-Medicare Advantage,30.7 +14204,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,Aetna-Medicare Advantage,33.58 +14205,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,Aetna-Medicare Advantage,63.36 +14206,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,Aetna-Medicare Advantage,64.9 +14207,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,Aetna-Medicare Advantage, +14208,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,Aetna-Medicare Advantage,3.0 +14209,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,Aetna-Medicare Advantage,112.72 +14210,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,Aetna-Medicare Advantage,63.58 +14211,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,Aetna-Medicare Advantage,101.74 +14212,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,Aetna-Medicare Advantage, +14213,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,Aetna-Medicare Advantage,82.44 +14214,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,Aetna-Medicare Advantage, +14215,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,Aetna-Medicare Advantage,95.27 +14216,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,Aetna-Medicare Advantage,82.52 +14217,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,Aetna-Medicare Advantage,44.33 +14218,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,Aetna-Medicare Advantage,39.34 +14219,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,Aetna-Medicare Advantage,38.29 +14220,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,Aetna-Medicare Advantage, +14221,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,Aetna-Medicare Advantage,1381.23 +14222,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,Aetna-Medicare Advantage,89.46 +14223,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,Aetna-Medicare Advantage,32.74 +14224,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,Aetna-Medicare Advantage, +14225,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,Aetna-Medicare Advantage,58.59 +14226,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,Aetna-Medicare Advantage,55.4 +14227,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,Aetna-Medicare Advantage,111.61 +14228,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,Aetna-Medicare Advantage, +14229,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,Aetna-Medicare Advantage,12.12 +14230,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,Aetna-Medicare Advantage, +14231,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,Aetna-Medicare Advantage,84.8 +14232,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,Aetna-Medicare Advantage, +14233,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,Aetna-Medicare Advantage, +14234,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,Aetna-Medicare Advantage,98.12 +14235,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,Aetna-Medicare Advantage,216.66 +14236,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,Aetna-Medicare Advantage, +14237,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,Aetna-Medicare Advantage,13.16 +14238,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,Aetna-Medicare Advantage, +14239,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,Aetna-Medicare Advantage,55.17 +14240,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,Aetna-Medicare Advantage,20.93 +14241,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,Aetna-Medicare Advantage, +14242,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,Aetna-Medicare Advantage, +14243,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,Aetna-Medicare Advantage,19.14 +14244,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,Aetna-Medicare Advantage,288.88 +14245,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,Aetna-Medicare Advantage,243.2 +14246,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,Aetna-Medicare Advantage,36.89 +14247,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,Aetna-Medicare Advantage,156.11 +14248,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,Aetna-Medicare Advantage,271.54 +14249,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,Aetna-Medicare Advantage,146.01 +14250,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,Aetna-Medicare Advantage, +14251,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,Aetna-Medicare Advantage,20.93 +14252,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,Aetna-Medicare Advantage, +14253,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,Aetna-Medicare Advantage, +14254,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,Aetna-Medicare Advantage,58.65 +14255,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,Aetna-Medicare Advantage,145.17 +14256,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,Aetna-Medicare Advantage,573.05 +14257,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,Aetna-Medicare Advantage,48.46 +14258,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,Aetna-Medicare Advantage,156.11 +14259,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,Aetna-Medicare Advantage,156.11 +14260,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,Aetna-Medicare Advantage, +14261,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,Aetna-Medicare Advantage,354.6 +14262,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,Aetna-Medicare Advantage, +14263,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,Aetna-Medicare Advantage, +14264,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,Aetna-Medicare Advantage, +14265,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,Aetna-Medicare Advantage,71.48 +14266,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,Aetna-Medicare Advantage,281.42 +14267,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,Aetna-Medicare Advantage,163.81 +14268,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,Aetna-Medicare Advantage,235.76 +14269,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,Aetna-Medicare Advantage, +14270,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,Aetna-Medicare Advantage,1798.0 +14271,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,Aetna-Medicare Advantage,100.0 +14272,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,Aetna-Medicare Advantage,241.0 +14273,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,Aetna-Medicare Advantage,20.93 +14274,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,Aetna-Medicare Advantage, +14275,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,Aetna-Medicare Advantage,794.6 +14276,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,Aetna-Medicare Advantage,133.66 +14277,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,Aetna-Medicare Advantage,440.08 +14278,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,Aetna-Medicare Advantage,156.35 +14279,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,Aetna-Medicare Advantage,106.93 +14280,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,Aetna-Medicare Advantage,118.0 +14281,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,Aetna-Medicare Advantage, +14282,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,Aetna-Medicare Advantage,262.6 +14283,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,Aetna-Medicare Advantage, +14284,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,Aetna-Medicare Advantage, +14285,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,Aetna-Medicare Advantage, +14286,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,Aetna-Medicare Advantage, +14287,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,Aetna-Medicare Advantage, +14288,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,Aetna-Medicare Advantage,113.16 +14289,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,Aetna-Medicare Advantage,245.98 +14290,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,Aetna-Medicare Advantage, +14291,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,Aetna-Medicare Advantage,215.63 +14292,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,Aetna-Medicare Advantage,6667.47 +14293,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,Aetna-Medicare Advantage,6396.3 +14294,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,Aetna-Medicare Advantage, +14295,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,Aetna-Medicare Advantage,118.68 +14296,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,Aetna-Medicare Advantage,111.09 +14297,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,Aetna-Medicare Advantage,290.78 +14298,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,Aetna-Medicare Advantage,341.81 +14299,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,Aetna-Medicare Advantage,408.61 +14300,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,Aetna-Medicare Advantage, +14301,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,Aetna-Medicare Advantage, +14302,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,Aetna-Medicare Advantage, +14303,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,Aetna-Medicare Advantage,602.49 +14304,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,Aetna-Medicare Advantage, +14305,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,Aetna-Medicare Advantage,806.94 +14306,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,Aetna-Medicare Advantage, +14307,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,Aetna-Medicare Advantage,1478.58 +14308,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,Aetna-Medicare Advantage,238.26 +14309,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,Aetna-Medicare Advantage, +14310,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,Aetna-Medicare Advantage,2914.42 +14311,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,Aetna-Medicare Advantage,3285.86 +14312,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,Aetna-Medicare Advantage,2841.13 +14313,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,Aetna-Medicare Advantage,1905.0 +14314,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,Aetna-Medicare Advantage,3153.6 +14315,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,Aetna-Medicare Advantage,2230.53 +14316,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,Aetna-Medicare Advantage,62.99 +14317,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,Aetna-Medicare Advantage,2088.65 +14318,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,Aetna-Medicare Advantage,993.19 +14319,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,Aetna-Medicare Advantage, +14320,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,Aetna-Medicare Advantage, +14321,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,Aetna-Medicare Advantage, +14322,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,Aetna-Medicare Advantage,792.79 +14323,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,Aetna-Medicare Advantage,33.33 +14324,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,Aetna-Medicare Advantage,1130.4 +14325,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,Aetna-Medicare Advantage,201.67 +14326,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,Aetna-Medicare Advantage,423.26 +14327,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,Aetna-Medicare Advantage,1326.99 +14328,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,Aetna-Medicare Advantage,1446.19 +14329,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,Aetna-Medicare Advantage,253.0 +14330,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,Aetna-Medicare Advantage,1379.21 +14331,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,Aetna-Medicare Advantage,46.28 +14332,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,Aetna-Medicare Advantage,1462.4 +14333,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,Aetna-Medicare Advantage, +14334,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,Aetna-Medicare Advantage,132.43 +14335,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,Aetna-Medicare Advantage, +14336,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,Aetna-Medicare Advantage,1737.31 +14337,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,Aetna-Medicare Advantage,70.87 +14338,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,Aetna-Medicare Advantage,45.07 +14339,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,Aetna-Medicare Advantage,55.03 +14340,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,Aetna-Medicare Advantage,162.26 +14341,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,Aetna-Medicare Advantage, +14342,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,Aetna-Medicare Advantage,4128.62 +14343,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,Aetna-Medicare Advantage,21.93 +14344,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,Aetna-Medicare Advantage, +14345,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,Aetna-Medicare Advantage,1001.56 +14346,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,Aetna-Medicare Advantage,250.8 +14347,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,Aetna-Medicare Advantage, +14348,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,Aetna-Medicare Advantage, +14349,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,Aetna-Medicare Advantage,27.64 +14350,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,Aetna-Medicare Advantage,0.01 +14351,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,Aetna-Medicare Advantage,43.72 +14352,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,Aetna-Medicare Advantage,84.64 +14353,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,Aetna-Medicare Advantage,380.58 +14354,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,Aetna-Medicare Advantage, +14355,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,Aetna-Medicare Advantage,56.9 +14356,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,Aetna-Medicare Advantage, +14357,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,Aetna-Medicare Advantage,54.42 +14358,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,Aetna-Medicare Advantage,15.35 +14359,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,Aetna-Medicare Advantage,43.31 +14360,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,Aetna-Medicare Advantage,46.66 +14361,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,Aetna-Medicare Advantage,31.84 +14362,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,Aetna-Medicare Advantage,40.54 +14363,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,Aetna-Medicare Advantage,347.76 +14364,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,Aetna-Medicare Advantage,28.9 +14365,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,Aetna-Medicare Advantage,1829.72 +14366,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,Aetna-Medicare Advantage,335.81 +14367,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,Aetna-Medicare Advantage, +14368,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,Aetna-Medicare Advantage,150.89 +14369,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,Aetna-Medicare Advantage,376.67 +14370,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,Aetna-Medicare Advantage,251.6 +14371,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,Aetna-Medicare Advantage,295.18 +14372,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,Aetna-Medicare Advantage,64.55 +14373,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,Aetna-Medicare Advantage,159.14 +14374,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,Aetna-Medicare Advantage, +14375,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,Aetna-Medicare Advantage, +14376,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,Aetna-Medicare Advantage, +14377,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +14378,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,Aetna-Medicare Advantage, +14379,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,Aetna-Medicare Advantage, +14380,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,Aetna-Medicare Advantage, +14381,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,Aetna-Medicare Advantage, +14382,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,Aetna-Medicare Advantage, +14383,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,Aetna-Medicare Advantage,4402.74 +14384,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,Aetna-Medicare Advantage,846.92 +14385,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,Aetna-Medicare Advantage,4402.74 +14386,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,Aetna-Medicare Advantage,1066.48 +14387,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,Aetna-Medicare Advantage, +14388,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,Aetna-Medicare Advantage,337.66 +14389,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,Aetna-Medicare Advantage, +14390,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,Aetna-Medicare Advantage,574.44 +14391,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,Aetna-Medicare Advantage,1098.93 +14392,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,Aetna-Medicare Advantage,1098.93 +14393,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,Aetna-Medicare Advantage, +14394,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,Aetna-Medicare Advantage, +14395,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,Aetna-Medicare Advantage, +14396,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,Aetna-Medicare Advantage,143.26 +14397,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,Aetna-Medicare Advantage, +14398,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,Aetna-Medicare Advantage,2063.62 +14399,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,Aetna-Medicare Advantage, +14400,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,Aetna-Medicare Advantage, +14401,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,Aetna-Medicare Advantage, +14402,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,Aetna-Medicare Advantage, +14403,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,Aetna-Medicare Advantage, +14404,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,Aetna-Medicare Advantage, +14405,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,Aetna-Medicare Advantage, +14406,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,Aetna-Medicare Advantage,103.68 +14407,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,Aetna-Medicare Advantage, +14408,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,Aetna-Medicare Advantage, +14409,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,Aetna-Medicare Advantage,51.84 +14410,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,Aetna-Medicare Advantage, +14411,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,Aetna-Medicare Advantage,283.94 +14412,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,Aetna-Medicare Advantage, +14413,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,Aetna-Medicare Advantage, +14414,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,Aetna-Medicare Advantage,319.86 +14415,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,Aetna-Medicare Advantage,278.46 +14416,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,Aetna-Medicare Advantage,578.53 +14417,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,Aetna-Medicare Advantage,309.12 +14418,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,Aetna-Medicare Advantage,1221.99 +14419,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,Aetna-Medicare Advantage, +14420,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,Aetna-Medicare Advantage,1221.99 +14421,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,Aetna-Medicare Advantage,821.0 +14422,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,Aetna-Medicare Advantage, +14423,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,Aetna-Medicare Advantage,368.95 +14424,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,Aetna-Medicare Advantage,77.96 +14425,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,Aetna-Medicare Advantage,291.53 +14426,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,Aetna-Medicare Advantage,428.93 +14427,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,Aetna-Medicare Advantage,294.9 +14428,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,Aetna-Medicare Advantage,1135.52 +14429,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,Aetna-Medicare Advantage,461.19 +14430,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,Aetna-Medicare Advantage, +14431,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,Aetna-Medicare Advantage, +14432,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,Aetna-Medicare Advantage, +14433,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,Aetna-Medicare Advantage,124.52 +14434,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,Aetna-Medicare Advantage,67.97 +14435,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,Aetna-Medicare Advantage,571.5 +14436,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,Aetna-Medicare Advantage,388.74 +14437,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,Aetna-Medicare Advantage,519.68 +14438,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,Aetna-Medicare Advantage,57.96 +14439,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,Aetna-Medicare Advantage,1000.27 +14440,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,Aetna-Medicare Advantage,606.91 +14441,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,Aetna-Medicare Advantage,444.81 +14442,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,Aetna-Medicare Advantage,240.69 +14443,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,Aetna-Medicare Advantage, +14444,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,Aetna-Medicare Advantage,149.31 +14445,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,Aetna-Medicare Advantage,169.69 +14446,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,Aetna-Medicare Advantage, +14447,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,Aetna-Medicare Advantage, +14448,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,Aetna-Medicare Advantage,630.0 +14449,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,Aetna-Medicare Advantage,493.58 +14450,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,Aetna-Medicare Advantage, +14451,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,Aetna-Medicare Advantage,540.8 +14452,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,Aetna-Medicare Advantage,17.54 +14453,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,Aetna-Medicare Advantage, +14454,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,Aetna-Medicare Advantage, +14455,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,Aetna-Medicare Advantage, +14456,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,Aetna-Medicare Advantage, +14457,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,Aetna-Medicare Advantage, +14458,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,Aetna-Medicare Advantage,1221.99 +14459,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,Aetna-Medicare Advantage,23133.0 +14460,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,Aetna-Medicare Advantage,8771.5 +14461,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,Aetna-Medicare Advantage, +14462,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,Aetna-Medicare Advantage,23662.0 +14463,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,Aetna-Medicare Advantage,17337.6 +14464,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,Aetna-Medicare Advantage,24900.21 +14465,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,Aetna-Medicare Advantage,13322.68 +14466,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,Aetna-Medicare Advantage,23133.0 +14467,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,Aetna-Medicare Advantage, +14468,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,Aetna-Medicare Advantage,22011.5 +14469,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,Aetna-Medicare Advantage,648.05 +14470,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,Aetna-Medicare Advantage,2684.0 +14471,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,Aetna-Medicare Advantage,4706.72 +14472,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,Aetna-Medicare Advantage, +14473,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,Aetna-Medicare Advantage, +14474,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +14475,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,Aetna-Medicare Advantage,396.0 +14476,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,Aetna-Medicare Advantage,1214.35 +14477,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,Aetna-Medicare Advantage,831.5 +14478,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,Aetna-Medicare Advantage,831.5 +14479,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,Aetna-Medicare Advantage, +14480,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,Aetna-Medicare Advantage, +14481,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,Aetna-Medicare Advantage,66.93 +14482,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,Aetna-Medicare Advantage,10492.0 +14483,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,Aetna-Medicare Advantage, +14484,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,Aetna-Medicare Advantage, +14485,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,Aetna-Medicare Advantage,4398.36 +14486,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,Aetna-Medicare Advantage,543.77 +14487,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,Aetna-Medicare Advantage,3879.3 +14488,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,Aetna-Medicare Advantage,1605.48 +14489,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,Aetna-Medicare Advantage,4881.0 +14490,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,Aetna-Medicare Advantage,406.56 +14491,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,Aetna-Medicare Advantage,1229.0 +14492,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,Aetna-Medicare Advantage,1208.56 +14493,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,Aetna-Medicare Advantage,970.0 +14494,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,Aetna-Medicare Advantage,5485.01 +14495,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,Aetna-Medicare Advantage, +14496,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,Aetna-Medicare Advantage,121.0 +14497,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,Aetna-Medicare Advantage,3373.62 +14498,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,Aetna-Medicare Advantage, +14499,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,Aetna-Medicare Advantage, +14500,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,Aetna-Medicare Advantage,5464.5 +14501,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,Aetna-Medicare Advantage, +14502,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,Aetna-Medicare Advantage,11079.0 +14503,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,Aetna-Medicare Advantage, +14504,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,Aetna-Medicare Advantage,11079.0 +14505,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,Aetna-Medicare Advantage,11079.0 +14506,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,Aetna-Medicare Advantage,8837.16 +14507,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,Aetna-Medicare Advantage,7732.2 +14508,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,Aetna-Medicare Advantage, +14509,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,Aetna-Medicare Advantage, +14510,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,Aetna-Medicare Advantage, +14511,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,Aetna-Medicare Advantage,3535.87 +14512,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,Aetna-Medicare Advantage, +14513,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,Aetna-Medicare Advantage, +14514,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,Aetna-Medicare Advantage,11083.15 +14515,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,Aetna-Medicare Advantage,62194.0 +14516,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,Aetna-Medicare Advantage, +14517,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,Aetna-Medicare Advantage,54909.0 +14518,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,Aetna-Medicare Advantage,11859.33 +14519,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,Aetna-Medicare Advantage, +14520,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,Aetna-Medicare Advantage, +14521,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,Aetna-Medicare Advantage, +14522,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,Aetna-Medicare Advantage,62016.4 +14523,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,Aetna-Medicare Advantage,23073.4 +14524,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,Aetna-Medicare Advantage, +14525,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,Aetna-Medicare Advantage,88229.41 +14526,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,Aetna-Medicare Advantage, +14527,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,Aetna-Medicare Advantage,130.44 +14528,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,Aetna-Medicare Advantage,10168.0 +14529,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,Aetna-Medicare Advantage, +14530,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,Aetna-Medicare Advantage, +14531,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,Aetna-Medicare Advantage,299.95 +14532,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,Aetna-Medicare Advantage, +14533,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,Aetna-Medicare Advantage,1872.48 +14534,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,Aetna-Medicare Advantage, +14535,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,Aetna-Medicare Advantage,115.6 +14536,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,Aetna-Medicare Advantage,427.84 +14537,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,Aetna-Medicare Advantage,148.41 +14538,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,Aetna-Medicare Advantage,1859.32 +14539,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,Aetna-Medicare Advantage,638.92 +14540,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,Aetna-Medicare Advantage,1605.86 +14541,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,Aetna-Medicare Advantage,949.69 +14542,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,Aetna-Medicare Advantage,980.54 +14543,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,Aetna-Medicare Advantage,1345.71 +14544,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,Aetna-Medicare Advantage,1529.34 +14545,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,Aetna-Medicare Advantage,62.08 +14546,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,Aetna-Medicare Advantage,254.72 +14547,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,Aetna-Medicare Advantage, +14548,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,Aetna-Medicare Advantage, +14549,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,Aetna-Medicare Advantage,562.78 +14550,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,Aetna-Medicare Advantage,332.62 +14551,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,Aetna-Medicare Advantage,919.14 +14552,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,Aetna-Medicare Advantage,991.93 +14553,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,Aetna-Medicare Advantage, +14554,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,Aetna-Medicare Advantage,295.74 +14555,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,Aetna-Medicare Advantage,332.18 +14556,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,Aetna-Medicare Advantage,1026.09 +14557,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,Aetna-Medicare Advantage,1911.67 +14558,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,Aetna-Medicare Advantage,1648.89 +14559,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,Aetna-Medicare Advantage, +14560,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,Aetna-Medicare Advantage,1733.04 +14561,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,Aetna-Medicare Advantage,929.67 +14562,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,Aetna-Medicare Advantage,318.37 +14563,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,Aetna-Medicare Advantage,202.6 +14564,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,Aetna-Medicare Advantage,627.0 +14565,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,Aetna-Medicare Advantage,390.74 +14566,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,Aetna-Medicare Advantage, +14567,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,Aetna-Medicare Advantage, +14568,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,Aetna-Medicare Advantage,6544.13 +14569,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,Aetna-Medicare Advantage,6945.84 +14570,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,Aetna-Medicare Advantage,3661.66 +14571,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,Aetna-Medicare Advantage, +14572,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,Aetna-Medicare Advantage,620.11 +14573,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,Aetna-Medicare Advantage,13479.8 +14574,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,Aetna-Medicare Advantage, +14575,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,Aetna-Medicare Advantage,4831.18 +14576,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,Aetna-Medicare Advantage, +14577,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,Aetna-Medicare Advantage,5109.94 +14578,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,Aetna-Medicare Advantage,5188.19 +14579,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,Aetna-Medicare Advantage,831.34 +14580,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,Aetna-Medicare Advantage,3584.46 +14581,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,Aetna-Medicare Advantage,758.35 +14582,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,Aetna-Medicare Advantage,762.48 +14583,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,Aetna-Medicare Advantage,178.28 +14584,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,Aetna-Medicare Advantage,294.9 +14585,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,Aetna-Medicare Advantage,294.9 +14586,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,Aetna-Medicare Advantage, +14587,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,Aetna-Medicare Advantage, +14588,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,Aetna-Medicare Advantage, +14589,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,Aetna-Medicare Advantage,1052.45 +14590,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,Aetna-Medicare Advantage, +14591,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,Aetna-Medicare Advantage, +14592,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,Aetna-Medicare Advantage, +14593,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,Aetna-Medicare Advantage,1117.57 +14594,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,Aetna-Medicare Advantage, +14595,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,Aetna-Medicare Advantage,1474.36 +14596,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,Aetna-Medicare Advantage,1474.36 +14597,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,Aetna-Medicare Advantage,606.0 +14598,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,Aetna-Medicare Advantage,223.52 +14599,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,Aetna-Medicare Advantage, +14600,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,Aetna-Medicare Advantage, +14601,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,Aetna-Medicare Advantage,223.46 +14602,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,Aetna-Medicare Advantage, +14603,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,Aetna-Medicare Advantage,627.96 +14604,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,Aetna-Medicare Advantage,627.96 +14605,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,Aetna-Medicare Advantage,50.15 +14606,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,Aetna-Medicare Advantage, +14607,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,Aetna-Medicare Advantage, +14608,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,Aetna-Medicare Advantage,627.96 +14609,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,Aetna-Medicare Advantage,627.96 +14610,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,Aetna-Medicare Advantage,2527.63 +14611,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,Aetna-Medicare Advantage,1583.06 +14612,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,Aetna-Medicare Advantage,216.6 +14613,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,Aetna-Medicare Advantage,649.8 +14614,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,Aetna-Medicare Advantage,2324.63 +14615,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,Aetna-Medicare Advantage,4170.35 +14616,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,Aetna-Medicare Advantage,5370.05 +14617,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,Aetna-Medicare Advantage,9126.68 +14618,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,Aetna-Medicare Advantage,2321.0 +14619,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,Aetna-Medicare Advantage,600.48 +14620,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,Aetna-Medicare Advantage,3397.42 +14621,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,Aetna-Medicare Advantage,5246.81 +14622,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,Aetna-Medicare Advantage,9741.35 +14623,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,Aetna-Medicare Advantage,9622.25 +14624,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,Aetna-Medicare Advantage,2965.31 +14625,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,Aetna-Medicare Advantage,680.34 +14626,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,Aetna-Medicare Advantage,3874.37 +14627,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,Aetna-Medicare Advantage,5850.72 +14628,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,Aetna-Medicare Advantage,3658.4 +14629,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,Aetna-Medicare Advantage,6528.46 +14630,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,Aetna-Medicare Advantage,6939.0 +14631,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,Aetna-Medicare Advantage,3744.34 +14632,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,Aetna-Medicare Advantage,3035.99 +14633,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,Aetna-Medicare Advantage, +14634,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,Aetna-Medicare Advantage,9049.1 +14635,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,Aetna-Medicare Advantage,250.67 +14636,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,Aetna-Medicare Advantage,1391.04 +14637,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,Aetna-Medicare Advantage,294.9 +14638,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,Aetna-Medicare Advantage, +14639,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,Aetna-Medicare Advantage,76.07 +14640,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,Aetna-Medicare Advantage,24.38 +14641,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,Aetna-Medicare Advantage,132.31 +14642,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,Aetna-Medicare Advantage, +14643,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,Aetna-Medicare Advantage,52.5 +14644,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,Aetna-Medicare Advantage,428.21 +14645,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,Aetna-Medicare Advantage,283.94 +14646,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,Aetna-Medicare Advantage, +14647,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,Aetna-Medicare Advantage,111.5 +14648,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,Aetna-Medicare Advantage,29.0 +14649,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,Aetna-Medicare Advantage,58.0 +14650,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,Aetna-Medicare Advantage, +14651,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,Aetna-Medicare Advantage,294.9 +14652,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,Aetna-Medicare Advantage, +14653,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,Aetna-Medicare Advantage,294.9 +14654,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,Aetna-Medicare Advantage,221.45 +14655,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,Aetna-Medicare Advantage,298.55 +14656,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,Aetna-Medicare Advantage, +14657,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,Aetna-Medicare Advantage,194.19 +14658,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,Aetna-Medicare Advantage,232.22 +14659,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,Aetna-Medicare Advantage,283.94 +14660,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,Aetna-Medicare Advantage, +14661,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,Aetna-Medicare Advantage,468.46 +14662,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,Aetna-Medicare Advantage,294.9 +14663,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,Aetna-Medicare Advantage,518.99 +14664,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,Aetna-Medicare Advantage, +14665,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,Aetna-Medicare Advantage,189.69 +14666,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,Aetna-Medicare Advantage,346.87 +14667,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,Aetna-Medicare Advantage,157.78 +14668,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,Aetna-Medicare Advantage, +14669,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,Aetna-Medicare Advantage,34.36 +14670,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,Aetna-Medicare Advantage,1233.12 +14671,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,Aetna-Medicare Advantage,1192.78 +14672,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,Aetna-Medicare Advantage,217.25 +14673,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,Aetna-Medicare Advantage, +14674,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,Aetna-Medicare Advantage, +14675,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,Aetna-Medicare Advantage, +14676,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,Aetna-Medicare Advantage,195.97 +14677,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,Aetna-Medicare Advantage,171.0 +14678,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,Aetna-Medicare Advantage,256.21 +14679,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,Aetna-Medicare Advantage,254.09 +14680,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,Aetna-Medicare Advantage,387.65 +14681,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,Aetna-Medicare Advantage,411.33 +14682,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,Aetna-Medicare Advantage,261.15 +14683,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,Aetna-Medicare Advantage,59.26 +14684,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,Aetna-Medicare Advantage,281.53 +14685,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,Aetna-Medicare Advantage,330.37 +14686,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,Aetna-Medicare Advantage,372.57 +14687,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,Aetna-Medicare Advantage,407.53 +14688,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,Aetna-Medicare Advantage,177.16 +14689,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,Aetna-Medicare Advantage,138.18 +14690,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,Aetna-Medicare Advantage,185.47 +14691,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,Aetna-Medicare Advantage,317.49 +14692,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,Aetna-Medicare Advantage,256.21 +14693,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,Aetna-Medicare Advantage,1829.72 +14694,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,Aetna-Medicare Advantage,1839.0 +14695,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,Aetna-Medicare Advantage,2100.0 +14696,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,Aetna-Medicare Advantage,3489.98 +14697,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,Aetna-Medicare Advantage,6821.14 +14698,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,Aetna-Medicare Advantage,1076.65 +14699,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,Aetna-Medicare Advantage,213.51 +14700,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,Aetna-Medicare Advantage,198.21 +14701,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,Aetna-Medicare Advantage,213.51 +14702,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,Aetna-Medicare Advantage,192.16 +14703,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,Aetna-Medicare Advantage,261.58 +14704,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,Aetna-Medicare Advantage,256.21 +14705,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,Aetna-Medicare Advantage, +14706,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,Aetna-Medicare Advantage,205.23 +14707,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,Aetna-Medicare Advantage,200.37 +14708,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,Aetna-Medicare Advantage,367.09 +14709,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,Aetna-Medicare Advantage,201.75 +14710,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,Aetna-Medicare Advantage,251.28 +14711,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,Aetna-Medicare Advantage,256.21 +14712,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,Aetna-Medicare Advantage, +14713,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,Aetna-Medicare Advantage, +14714,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,Aetna-Medicare Advantage,54.87 +14715,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,Aetna-Medicare Advantage,79.24 +14716,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,Aetna-Medicare Advantage,191.79 +14717,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,Aetna-Medicare Advantage, +14718,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,Aetna-Medicare Advantage,74.98 +14719,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,Aetna-Medicare Advantage,97.69 +14720,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,Aetna-Medicare Advantage, +14721,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,Aetna-Medicare Advantage,47635.34 +14722,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,Aetna-Medicare Advantage,2814.2 +14723,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,Aetna-Medicare Advantage,127994.08 +14724,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,Aetna-Medicare Advantage, +14725,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,Aetna-Medicare Advantage,4679.19 +14726,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,Aetna-Medicare Advantage,544.53 +14727,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,Aetna-Medicare Advantage,71290.2 +14728,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,Aetna-Medicare Advantage,37857.67 +14729,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,Aetna-Medicare Advantage,416.78 +14730,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,Aetna-Medicare Advantage,200209.44 +14731,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,Aetna-Medicare Advantage, +14732,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,Aetna-Medicare Advantage,137.62 +14733,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,Aetna-Medicare Advantage,92896.18 +14734,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,Aetna-Medicare Advantage, +14735,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,Aetna-Medicare Advantage, +14736,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,Aetna-Medicare Advantage, +14737,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,Aetna-Medicare Advantage, +14738,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,Aetna-Medicare Advantage,41576.4 +14739,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,Aetna-Medicare Advantage, +14740,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,Aetna-Medicare Advantage,10852.8 +14741,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,Aetna-Medicare Advantage, +14742,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,Aetna-Medicare Advantage, +14743,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,Aetna-Medicare Advantage,14388.08 +14744,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,Aetna-Medicare Advantage,138419.36 +14745,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,Aetna-Medicare Advantage,64137.98 +14746,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,Aetna-Medicare Advantage, +14747,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,Aetna-Medicare Advantage,50002.16 +14748,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,Aetna-Medicare Advantage, +14749,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,Aetna-Medicare Advantage,57372.63 +14750,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,Aetna-Medicare Advantage, +14751,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,Aetna-Medicare Advantage,12648.3 +14752,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,Aetna-Medicare Advantage,34355.75 +14753,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,Aetna-Medicare Advantage,30549.57 +14754,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,Aetna-Medicare Advantage,17776.56 +14755,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,Aetna-Medicare Advantage,3926.88 +14756,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,Aetna-Medicare Advantage,27833.62 +14757,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,Aetna-Medicare Advantage,49092.15 +14758,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,Aetna-Medicare Advantage,9871.84 +14759,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,Aetna-Medicare Advantage,96215.1 +14760,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,Aetna-Medicare Advantage,16287.96 +14761,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,Aetna-Medicare Advantage,33287.81 +14762,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,Aetna-Medicare Advantage,24550.26 +14763,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,Aetna-Medicare Advantage,18581.87 +14764,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,Aetna-Medicare Advantage,58009.66 +14765,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,Aetna-Medicare Advantage,28154.82 +14766,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,Aetna-Medicare Advantage, +14767,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,Aetna-Medicare Advantage, +14768,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,Aetna-Medicare Advantage,5208.64 +14769,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,Aetna-Medicare Advantage,4500.9 +14770,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,Aetna-Medicare Advantage, +14771,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,Aetna-Medicare Advantage,15955.88 +14772,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,Aetna-Medicare Advantage, +14773,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,Aetna-Medicare Advantage,67626.2 +14774,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,Aetna-Medicare Advantage,10388.38 +14775,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,Aetna-Medicare Advantage,12889.39 +14776,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,Aetna-Medicare Advantage,18624.31 +14777,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,Aetna-Medicare Advantage,19352.02 +14778,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,Aetna-Medicare Advantage, +14779,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,Aetna-Medicare Advantage,12252.96 +14780,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,Aetna-Medicare Advantage,10841.83 +14781,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,Aetna-Medicare Advantage,11139.03 +14782,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,Aetna-Medicare Advantage,8416.61 +14783,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,Aetna-Medicare Advantage,6211.57 +14784,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,Aetna-Medicare Advantage,10739.52 +14785,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,Aetna-Medicare Advantage,5852.19 +14786,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,Aetna-Medicare Advantage,5395.16 +14787,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,Aetna-Medicare Advantage,57316.91 +14788,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,Aetna-Medicare Advantage, +14789,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,Aetna-Medicare Advantage, +14790,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,Aetna-Medicare Advantage,42316.44 +14791,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,Aetna-Medicare Advantage,24283.15 +14792,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,Aetna-Medicare Advantage,21107.41 +14793,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,Aetna-Medicare Advantage,27288.75 +14794,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,Aetna-Medicare Advantage, +14795,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,Aetna-Medicare Advantage,15639.91 +14796,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,Aetna-Medicare Advantage,14505.53 +14797,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,Aetna-Medicare Advantage,22276.83 +14798,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,Aetna-Medicare Advantage, +14799,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,Aetna-Medicare Advantage,29918.49 +14800,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,Aetna-Medicare Advantage,19962.79 +14801,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,Aetna-Medicare Advantage,6304.33 +14802,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,Aetna-Medicare Advantage,11153.27 +14803,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,Aetna-Medicare Advantage, +14804,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,Aetna-Medicare Advantage,10832.6 +14805,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,Aetna-Medicare Advantage,10345.96 +14806,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,Aetna-Medicare Advantage, +14807,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,Aetna-Medicare Advantage,8485.58 +14808,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,Aetna-Medicare Advantage,4891.06 +14809,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,Aetna-Medicare Advantage,16540.43 +14810,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,Aetna-Medicare Advantage,6395.7 +14811,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,Aetna-Medicare Advantage,8837.06 +14812,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,Aetna-Medicare Advantage,4761.69 +14813,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,Aetna-Medicare Advantage,5176.66 +14814,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,Aetna-Medicare Advantage, +14815,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,Aetna-Medicare Advantage,25107.94 +14816,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,Aetna-Medicare Advantage,8008.09 +14817,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,Aetna-Medicare Advantage,15914.75 +14818,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,Aetna-Medicare Advantage,17282.77 +14819,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,Aetna-Medicare Advantage,11294.95 +14820,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,Aetna-Medicare Advantage,16000.45 +14821,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,Aetna-Medicare Advantage, +14822,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,Aetna-Medicare Advantage,9186.07 +14823,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,Aetna-Medicare Advantage, +14824,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,Aetna-Medicare Advantage,10617.85 +14825,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,Aetna-Medicare Advantage, +14826,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,Aetna-Medicare Advantage,11787.49 +14827,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,Aetna-Medicare Advantage,22087.48 +14828,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,Aetna-Medicare Advantage,10121.54 +14829,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,Aetna-Medicare Advantage, +14830,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,Aetna-Medicare Advantage,16107.78 +14831,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,Aetna-Medicare Advantage,19273.49 +14832,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,Aetna-Medicare Advantage,7910.2 +14833,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,Aetna-Medicare Advantage,5307.71 +14834,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,Aetna-Medicare Advantage,6702.68 +14835,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,Aetna-Medicare Advantage,8884.05 +14836,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,Aetna-Medicare Advantage, +14837,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,Aetna-Medicare Advantage,5874.09 +14838,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,Aetna-Medicare Advantage, +14839,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,Aetna-Medicare Advantage,7447.31 +14840,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,Aetna-Medicare Advantage,15202.03 +14841,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,Aetna-Medicare Advantage, +14842,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,Aetna-Medicare Advantage,9995.16 +14843,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,Aetna-Medicare Advantage, +14844,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,Aetna-Medicare Advantage, +14845,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,Aetna-Medicare Advantage,13077.74 +14846,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,Aetna-Medicare Advantage,18112.99 +14847,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,Aetna-Medicare Advantage,7119.92 +14848,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,Aetna-Medicare Advantage,9594.03 +14849,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,Aetna-Medicare Advantage,5278.6 +14850,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,Aetna-Medicare Advantage,17048.19 +14851,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,Aetna-Medicare Advantage,49007.24 +14852,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,Aetna-Medicare Advantage,32156.65 +14853,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,Aetna-Medicare Advantage,30665.89 +14854,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,Aetna-Medicare Advantage,22386.09 +14855,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,Aetna-Medicare Advantage,14045.08 +14856,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,Aetna-Medicare Advantage,9881.04 +14857,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,Aetna-Medicare Advantage,11670.07 +14858,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,Aetna-Medicare Advantage, +14859,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,Aetna-Medicare Advantage,13541.7 +14860,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,Aetna-Medicare Advantage,15405.03 +14861,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,Aetna-Medicare Advantage,17878.68 +14862,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,Aetna-Medicare Advantage, +14863,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,Aetna-Medicare Advantage,7455.87 +14864,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,Aetna-Medicare Advantage,19358.03 +14865,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,Aetna-Medicare Advantage,15120.04 +14866,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,Aetna-Medicare Advantage, +14867,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,Aetna-Medicare Advantage, +14868,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,Aetna-Medicare Advantage,20708.75 +14869,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,Aetna-Medicare Advantage, +14870,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,Aetna-Medicare Advantage,8543.19 +14871,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,Aetna-Medicare Advantage,7893.75 +14872,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,Aetna-Medicare Advantage, +14873,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,Aetna-Medicare Advantage, +14874,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,Aetna-Medicare Advantage, +14875,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,Aetna-Medicare Advantage,24578.0 +14876,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,Aetna-Medicare Advantage,13810.0 +14877,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,Aetna-Medicare Advantage, +14878,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,Aetna-Medicare Advantage,10060.95 +14879,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,Aetna-Medicare Advantage,10286.54 +14880,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,Aetna-Medicare Advantage,5942.94 +14881,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,Aetna-Medicare Advantage,5289.82 +14882,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,Aetna-Medicare Advantage, +14883,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,Aetna-Medicare Advantage,10810.01 +14884,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,Aetna-Medicare Advantage,10908.1 +14885,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,Aetna-Medicare Advantage,6510.71 +14886,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,Aetna-Medicare Advantage,60065.49 +14887,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,Aetna-Medicare Advantage,6686.79 +14888,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,Aetna-Medicare Advantage,16377.54 +14889,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,Aetna-Medicare Advantage,38056.98 +14890,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,Aetna-Medicare Advantage, +14891,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,Aetna-Medicare Advantage,6444.13 +14892,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,Aetna-Medicare Advantage, +14893,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,Aetna-Medicare Advantage,33739.75 +14894,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,Aetna-Medicare Advantage, +14895,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,Aetna-Medicare Advantage,11929.38 +14896,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,Aetna-Medicare Advantage,14363.83 +14897,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,Aetna-Medicare Advantage, +14898,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,Aetna-Medicare Advantage,12512.2 +14899,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,Aetna-Medicare Advantage, +14900,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,Aetna-Medicare Advantage,10098.97 +14901,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,Aetna-Medicare Advantage,8133.33 +14902,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,Aetna-Medicare Advantage,9306.32 +14903,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,Aetna-Medicare Advantage,4759.52 +14904,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,Aetna-Medicare Advantage,8690.52 +14905,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,Aetna-Medicare Advantage,26001.38 +14906,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,Aetna-Medicare Advantage,16359.43 +14907,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,Aetna-Medicare Advantage, +14908,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,Aetna-Medicare Advantage, +14909,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,Aetna-Medicare Advantage,5286.08 +14910,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,Aetna-Medicare Advantage,12027.96 +14911,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,Aetna-Medicare Advantage,7526.17 +14912,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,Aetna-Medicare Advantage, +14913,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,Aetna-Medicare Advantage, +14914,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,Aetna-Medicare Advantage,8768.32 +14915,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,Aetna-Medicare Advantage, +14916,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,Aetna-Medicare Advantage, +14917,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,Aetna-Medicare Advantage, +14918,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,Aetna-Medicare Advantage,8887.25 +14919,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,Aetna-Medicare Advantage,22356.87 +14920,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,Aetna-Medicare Advantage,5984.26 +14921,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,Aetna-Medicare Advantage, +14922,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,Aetna-Medicare Advantage,8869.85 +14923,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,Aetna-Medicare Advantage, +14924,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,Aetna-Medicare Advantage,5554.8 +14925,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,Aetna-Medicare Advantage,6676.77 +14926,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,Aetna-Medicare Advantage,4906.54 +14927,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,Aetna-Medicare Advantage, +14928,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,Aetna-Medicare Advantage, +14929,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,Aetna-Medicare Advantage,14050.92 +14930,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,Aetna-Medicare Advantage, +14931,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,Aetna-Medicare Advantage, +14932,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,Aetna-Medicare Advantage,91283.53 +14933,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,Aetna-Medicare Advantage,93499.55 +14934,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,Aetna-Medicare Advantage,58809.08 +14935,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,Aetna-Medicare Advantage, +14936,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,Aetna-Medicare Advantage,39484.35 +14937,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,Aetna-Medicare Advantage,19879.38 +14938,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,Aetna-Medicare Advantage, +14939,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,Aetna-Medicare Advantage,26519.96 +14940,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,Aetna-Medicare Advantage,19336.59 +14941,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,Aetna-Medicare Advantage,15244.82 +14942,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,Aetna-Medicare Advantage, +14943,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,Aetna-Medicare Advantage,39781.72 +14944,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,Aetna-Medicare Advantage,94927.16 +14945,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,Aetna-Medicare Advantage, +14946,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,Aetna-Medicare Advantage,9557.63 +14947,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,Aetna-Medicare Advantage,3064.28 +14948,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,Aetna-Medicare Advantage, +14949,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,Aetna-Medicare Advantage,9638.24 +14950,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,Aetna-Medicare Advantage,14866.1 +14951,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,Aetna-Medicare Advantage,8410.19 +14952,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,Aetna-Medicare Advantage,8933.7 +14953,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,Aetna-Medicare Advantage, +14954,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,Aetna-Medicare Advantage,27980.17 +14955,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,Aetna-Medicare Advantage,43755.33 +14956,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,Aetna-Medicare Advantage,45648.55 +14957,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,Aetna-Medicare Advantage, +14958,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,Aetna-Medicare Advantage,115461.11 +14959,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,Aetna-Medicare Advantage,8838.22 +14960,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,Aetna-Medicare Advantage,29689.21 +14961,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,Aetna-Medicare Advantage,21393.05 +14962,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,Aetna-Medicare Advantage,14150.19 +14963,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,Aetna-Medicare Advantage,22979.66 +14964,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,Aetna-Medicare Advantage,5919.42 +14965,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,Aetna-Medicare Advantage,10003.84 +14966,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,Aetna-Medicare Advantage,9359.76 +14967,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,Aetna-Medicare Advantage, +14968,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,Aetna-Medicare Advantage, +14969,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,Aetna-Medicare Advantage, +14970,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,Aetna-Medicare Advantage, +14971,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,Aetna-Medicare Advantage, +14972,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,Aetna-Medicare Advantage, +14973,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,Aetna-Medicare Advantage,4806.52 +14974,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,Aetna-Medicare Advantage,5364.87 +14975,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,Aetna-Medicare Advantage, +14976,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,Aetna-Medicare Advantage, +14977,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,Aetna-Medicare Advantage, +14978,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,Aetna-Medicare Advantage,3239.89 +14979,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,Aetna-Medicare Advantage, +14980,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,Aetna-Medicare Advantage,6583.66 +14981,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,Aetna-Medicare Advantage,6816.59 +14982,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,Aetna-Medicare Advantage,9789.81 +14983,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,Aetna-Medicare Advantage,5025.79 +14984,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,Aetna-Medicare Advantage,13144.87 +14985,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,Aetna-Medicare Advantage, +14986,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,Aetna-Medicare Advantage,6431.45 +14987,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,Aetna-Medicare Advantage,7586.76 +14988,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,Aetna-Medicare Advantage,4930.56 +14989,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,Aetna-Medicare Advantage,16167.69 +14990,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,Aetna-Medicare Advantage, +14991,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,Aetna-Medicare Advantage,8027.28 +14992,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,Aetna-Medicare Advantage,412184.56 +14993,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,Aetna-Medicare Advantage,4562.54 +14994,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,Aetna-Medicare Advantage, +14995,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,Aetna-Medicare Advantage, +14996,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,Aetna-Medicare Advantage,10330.84 +14997,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,Aetna-Medicare Advantage,19205.92 +14998,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,Aetna-Medicare Advantage, +14999,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,Aetna-Medicare Advantage, +15000,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,Aetna-Medicare Advantage,58081.95 +15001,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,Aetna-Medicare Advantage,34662.68 +15002,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,Aetna-Medicare Advantage, +15003,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,Aetna-Medicare Advantage,791.09 +15004,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,Aetna-Medicare Advantage,1134.23 +15005,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,Aetna-Medicare Advantage,1763.73 +15006,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,Aetna-Medicare Advantage,997.19 +15007,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,Aetna-Medicare Advantage,1145.14 +15008,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,Aetna-Medicare Advantage, +15009,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,Aetna-Medicare Advantage,2375.67 +15010,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,Aetna-Medicare Advantage, +15011,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,Aetna-Medicare Advantage, +15012,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,Aetna-Medicare Advantage, +15013,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,Aetna-Medicare Advantage, +15014,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,Aetna-Medicare Advantage,283.55 +15015,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,Aetna-Medicare Advantage, +15016,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,Aetna-Medicare Advantage, +15017,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,Aetna-Medicare Advantage, +15018,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,Aetna-Medicare Advantage, +15019,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,Aetna-Medicare Advantage, +15020,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,Aetna-Medicare Advantage,397.34 +15021,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,Aetna-Medicare Advantage,119.28 +15022,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,Aetna-Medicare Advantage, +15023,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,Aetna-Medicare Advantage,10.0 +15024,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,Aetna-Medicare Advantage,13868.01 +15025,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,Aetna-Medicare Advantage,87.27 +15026,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,Aetna-Medicare Advantage,6226.1 +15027,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,Aetna-Medicare Advantage, +15028,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,Aetna-Medicare Advantage, +15029,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,Aetna-Medicare Advantage,126.73 +15030,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,Aetna-Medicare Advantage, +15031,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,Aetna-Medicare Advantage,79.5 +15032,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,Aetna-Medicare Advantage,50.87 +15033,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,Aetna-Medicare Advantage,150.03 +15034,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,Aetna-Medicare Advantage, +15035,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,Aetna-Medicare Advantage, +15036,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,Aetna-Medicare Advantage,310.02 +15037,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,Aetna-Medicare Advantage, +15038,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,Aetna-Medicare Advantage, +15039,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,Aetna-Medicare Advantage,382.99 +15040,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,Aetna-Medicare Advantage, +15041,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,Aetna-Medicare Advantage, +15042,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,Aetna-Medicare Advantage, +15043,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,Aetna-Medicare Advantage,2170.67 +15044,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,Aetna-Medicare Advantage,5100.0 +15045,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,Aetna-Medicare Advantage,818.5 +15046,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,Aetna-Medicare Advantage,1018.71 +15047,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,Aetna-Medicare Advantage,19092.0 +15048,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,Aetna-Medicare Advantage, +15049,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,Aetna-Medicare Advantage,4333.54 +15050,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,Aetna-Medicare Advantage, +15051,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,Aetna-Medicare Advantage,1202.37 +15052,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,Aetna-Medicare Advantage, +15053,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,Aetna-Medicare Advantage,22474.15 +15054,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,Aetna-Medicare Advantage,1572.09 +15055,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,Aetna-Medicare Advantage,758.91 +15056,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,Aetna-Medicare Advantage,221.01 +15057,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,Aetna-Medicare Advantage,477.6 +15058,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,Aetna-Medicare Advantage, +15059,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,Aetna-Medicare Advantage, +15060,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,Aetna-Medicare Advantage,1407.65 +15061,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,Aetna-Medicare Advantage,3861.61 +15062,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,Aetna-Medicare Advantage,9470.0 +15063,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,Aetna-Medicare Advantage, +15064,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,Aetna-Medicare Advantage,461.54 +15065,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,Aetna-Medicare Advantage,117.6 +15066,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,Aetna-Medicare Advantage, +15067,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,Aetna-Medicare Advantage, +15068,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,Aetna-Medicare Advantage,433.04 +15069,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,Aetna-Medicare Advantage,16.0 +15070,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,Aetna-Medicare Advantage,5152.0 +15071,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,Aetna-Medicare Advantage,293.43 +15072,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,Aetna-Medicare Advantage,3151.5 +15073,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,Aetna-Medicare Advantage, +15074,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,Aetna-Medicare Advantage,5968.2 +15075,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,Aetna-Medicare Advantage, +15076,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,Aetna-Medicare Advantage,2236.46 +15077,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,Aetna-Medicare Advantage,9235.2 +15078,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,Aetna-Medicare Advantage, +15079,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,Aetna-Medicare Advantage,316.04 +15080,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,Aetna-Medicare Advantage,1677.89 +15081,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,Aetna-Medicare Advantage,16698.84 +15082,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,Aetna-Medicare Advantage, +15083,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,Aetna-Medicare Advantage,8347.97 +15084,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,Aetna-Medicare Advantage, +15085,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,Aetna-Medicare Advantage,2803.2 +15086,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,Aetna-Medicare Advantage, +15087,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,Aetna-Medicare Advantage,1380.43 +15088,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,Aetna-Medicare Advantage,2494.08 +15089,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,Aetna-Medicare Advantage,6366.75 +15090,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,Aetna-Medicare Advantage, +15091,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,Aetna-Medicare Advantage,1534.82 +15092,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,Aetna-Medicare Advantage,438.52 +15093,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,Aetna-Medicare Advantage,2813.11 +15094,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,Aetna-Medicare Advantage,5736.39 +15095,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,Aetna-Medicare Advantage, +15096,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,Aetna-Medicare Advantage, +15097,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,Aetna-Medicare Advantage,139.18 +15098,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,Aetna-Medicare Advantage,20555.63 +15099,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,Aetna-Medicare Advantage,1151.12 +15100,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,Aetna-Medicare Advantage, +15101,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,Aetna-Medicare Advantage,2718.8 +15102,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,Aetna-Medicare Advantage,2818.04 +15103,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,Aetna-Medicare Advantage, +15104,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,Aetna-Medicare Advantage,274.08 +15105,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,Aetna-Medicare Advantage, +15106,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,Aetna-Medicare Advantage,328.89 +15107,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,Aetna-Medicare Advantage,1419.71 +15108,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,Aetna-Medicare Advantage, +15109,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,Aetna-Medicare Advantage, +15110,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,Aetna-Medicare Advantage,609.8 +15111,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,Aetna-Medicare Advantage, +15112,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,Aetna-Medicare Advantage, +15113,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,Aetna-Medicare Advantage,280.0 +15114,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,Aetna-Medicare Advantage,96.27 +15115,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,Aetna-Medicare Advantage, +15116,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,Aetna-Medicare Advantage,4000.0 +15117,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,Aetna-Medicare Advantage, +15118,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,Aetna-Medicare Advantage,522.5 +15119,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,Aetna-Medicare Advantage, +15120,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,Aetna-Medicare Advantage, +15121,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,Aetna-Medicare Advantage,568.0 +15122,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,Aetna-Medicare Advantage, +15123,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,Aetna-Medicare Advantage, +15124,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,Aetna-Medicare Advantage, +15125,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,Aetna-Medicare Advantage, +15126,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,Aetna-Medicare Advantage, +15127,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,Aetna-Medicare Advantage, +15128,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,Aetna-Medicare Advantage, +15129,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,Aetna-Medicare Advantage, +15130,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,Aetna-Medicare Advantage,465.11 +15131,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,Aetna-Medicare Advantage,2924.58 +15132,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,Aetna-Medicare Advantage, +15133,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,Aetna-Medicare Advantage, +15134,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,Aetna-Medicare Advantage, +15135,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,Aetna-Medicare Advantage, +15136,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,Aetna-Medicare Advantage,911.04 +15137,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,Aetna-Medicare Advantage,3203.8 +15138,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,Aetna-Medicare Advantage,348.61 +15139,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,Aetna-Medicare Advantage,50.52 +15140,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,Aetna-Medicare Advantage, +15141,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,Aetna-Medicare Advantage, +15142,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,Aetna-Medicare Advantage, +15143,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,Aetna-Medicare Advantage, +15144,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,Aetna-Medicare Advantage,2940.82 +15145,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,Aetna-Medicare Advantage,204.52 +15146,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,Aetna-Medicare Advantage, +15147,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,Aetna-Medicare Advantage,15221.52 +15148,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,Aetna-Medicare Advantage, +15149,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,Aetna-Medicare Advantage,18506.77 +15150,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,Aetna-Medicare Advantage, +15151,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,Aetna-Medicare Advantage, +15152,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,Aetna-Medicare Advantage,23662.0 +15153,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,Aetna-Medicare Advantage, +15154,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,Aetna-Medicare Advantage, +15155,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,Aetna-Medicare Advantage, +15156,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,Aetna-Medicare Advantage, +15157,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,Aetna-Medicare Advantage,5920.24 +15158,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,Aetna-Medicare Advantage, +15159,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,Aetna-Medicare Advantage,187.71 +15160,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,Aetna-Medicare Advantage,61.48 +15161,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,Aetna-Medicare Advantage, +15162,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,Aetna-Medicare Advantage, +15163,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,Aetna-Medicare Advantage, +15164,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,Aetna-Medicare Advantage, +15165,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,Aetna-Medicare Advantage, +15166,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,Aetna-Medicare Advantage,103.02 +15167,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,Aetna-Medicare Advantage, +15168,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,Aetna-Medicare Advantage, +15169,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,Aetna-Medicare Advantage, +15170,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,Aetna-Medicare Advantage,858.09 +15171,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,Aetna-Medicare Advantage,2711.16 +15172,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,Aetna-Medicare Advantage,2069.55 +15173,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,Aetna-Medicare Advantage, +15174,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,Aetna-Medicare Advantage, +15175,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,Aetna-Medicare Advantage,1858.96 +15176,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,Aetna-Medicare Advantage, +15177,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,Aetna-Medicare Advantage,855.66 +15178,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,Aetna-Medicare Advantage, +15179,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,Aetna-Medicare Advantage,1007.32 +15180,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,Aetna-Medicare Advantage,3154.19 +15181,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,Aetna-Medicare Advantage,171.87 +15182,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,Aetna-Medicare Advantage, +15183,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,Aetna-Medicare Advantage,252.61 +15184,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,Aetna-Medicare Advantage, +15185,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,Aetna-Medicare Advantage, +15186,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,Aetna-Medicare Advantage, +15187,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,Aetna-Medicare Advantage, +15188,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,Aetna-Medicare Advantage,98.01 +15189,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,Aetna-Medicare Advantage, +15190,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,Aetna-Medicare Advantage, +15191,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,Aetna-Medicare Advantage, +15192,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,Aetna-Medicare Advantage,262.02 +15193,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,Aetna-Medicare Advantage, +15194,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,Aetna-Medicare Advantage,97.38 +15195,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,Aetna-Medicare Advantage,108.49 +15196,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,Aetna-Medicare Advantage,87.95 +15197,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,Aetna-Medicare Advantage,19.38 +15198,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,Aetna-Medicare Advantage,925.07 +15199,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,Aetna-Medicare Advantage,3872.0 +15200,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,Aetna-Medicare Advantage,230.46 +15201,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,Aetna-Medicare Advantage, +15202,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,Aetna-Medicare Advantage,2614.03 +15203,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,Aetna-Medicare Advantage,156.23 +15204,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,Aetna-Medicare Advantage,757.93 +15205,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,Aetna-Medicare Advantage,132.77 +15206,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,Aetna-Medicare Advantage,77.28 +15207,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,Aetna-Medicare Advantage,583.02 +15208,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,Aetna-Medicare Advantage,17370.19 +15209,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,Aetna-Medicare Advantage, +15210,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,Aetna-Medicare Advantage, +15211,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,Aetna-Medicare Advantage,130.44 +15212,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,Aetna-Medicare Advantage,93.59 +15213,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,Aetna-Medicare Advantage,344.62 +15214,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,Aetna-Medicare Advantage,218.28 +15215,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,Aetna-Medicare Advantage,87.65 +15216,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,Aetna-Medicare Advantage, +15217,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,Aetna-Medicare Advantage,0.69 +15218,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,Aetna-Medicare Advantage, +15219,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,Aetna-Medicare Advantage,57.66 +15220,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,Aetna-Medicare Advantage,53.31 +15221,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,Aetna-Medicare Advantage,3180.65 +15222,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,Aetna-Medicare Advantage, +15223,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,Aetna-Medicare Advantage,127.44 +15224,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,Aetna-Medicare Advantage,437.21 +15225,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,Aetna-Medicare Advantage,8.74 +15226,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,Aetna-Medicare Advantage,345.73 +15227,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,Aetna-Medicare Advantage,491.67 +15228,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,Aetna-Medicare Advantage,14.25 +15229,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,Aetna-Medicare Advantage, +15230,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,Aetna-Medicare Advantage,386.36 +15231,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,Aetna-Medicare Advantage, +15232,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,Aetna-Medicare Advantage,14.89 +15233,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,Aetna-Medicare Advantage, +15234,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,Aetna-Medicare Advantage, +15235,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,Aetna-Medicare Advantage,21.34 +15236,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,Aetna-Medicare Advantage,11.43 +15237,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,Aetna-Medicare Advantage,18.09 +15238,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,Aetna-Medicare Advantage,457.71 +15239,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,Aetna-Medicare Advantage, +15240,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,Aetna-Medicare Advantage,2524.63 +15241,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,Aetna-Medicare Advantage, +15242,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,Aetna-Medicare Advantage, +15243,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,Aetna-Medicare Advantage,98.63 +15244,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,Aetna-Medicare Advantage,22.55 +15245,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,Aetna-Medicare Advantage,1670.75 +15246,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,Aetna-Medicare Advantage,1142.56 +15247,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,Aetna-Medicare Advantage,5.73 +15248,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,Aetna-Medicare Advantage, +15249,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,Aetna-Medicare Advantage,50.04 +15250,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,Aetna-Medicare Advantage, +15251,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,Aetna-Medicare Advantage,378.88 +15252,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,Aetna-Medicare Advantage,24.97 +15253,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,Aetna-Medicare Advantage,13.3 +15254,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,Aetna-Medicare Advantage,354.65 +15255,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,Aetna-Medicare Advantage,302.96 +15256,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,Aetna-Medicare Advantage,184.5 +15257,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,Aetna-Medicare Advantage,61.48 +15258,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,Aetna-Medicare Advantage, +15259,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,Aetna-Medicare Advantage,402.63 +15260,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,Aetna-Medicare Advantage,13.0 +15261,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,Aetna-Medicare Advantage, +15262,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,Aetna-Medicare Advantage,33.85 +15263,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,Aetna-Medicare Advantage, +15264,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,Aetna-Medicare Advantage, +15265,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,Aetna-Medicare Advantage,3767.21 +15266,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,Aetna-Medicare Advantage, +15267,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,Aetna-Medicare Advantage,1204.91 +15268,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,Aetna-Medicare Advantage,4037.62 +15269,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,Aetna-Medicare Advantage, +15270,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,Aetna-Medicare Advantage, +15271,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,Aetna-Medicare Advantage,4875.73 +15272,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,Aetna-Medicare Advantage,36.09 +15273,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,Aetna-Medicare Advantage,177.0 +15274,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,Aetna-Medicare Advantage, +15275,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,Aetna-Medicare Advantage,9.36 +15276,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,Aetna-Medicare Advantage, +15277,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,Aetna-Medicare Advantage, +15278,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,Aetna-Medicare Advantage, +15279,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,Aetna-Medicare Advantage,8.15 +15280,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,Aetna-Medicare Advantage,4.62 +15281,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,Aetna-Medicare Advantage,125.61 +15282,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,Aetna-Medicare Advantage, +15283,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,Aetna-Medicare Advantage,31864.75 +15284,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,Aetna-Medicare Advantage, +15285,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,Aetna-Medicare Advantage,500.7 +15286,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,Aetna-Medicare Advantage,139.08 +15287,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,Aetna-Medicare Advantage, +15288,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,Aetna-Medicare Advantage,2819.72 +15289,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,Aetna-Medicare Advantage,1115.91 +15290,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,Aetna-Medicare Advantage, +15291,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,Aetna-Medicare Advantage,738.61 +15292,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,Aetna-Medicare Advantage, +15293,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,Aetna-Medicare Advantage,20915.62 +15294,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,Aetna-Medicare Advantage, +15295,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,Aetna-Medicare Advantage,15028.96 +15296,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,Aetna-Medicare Advantage,7332.35 +15297,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,Aetna-Medicare Advantage,11.51 +15298,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,Aetna-Medicare Advantage, +15299,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,Aetna-Medicare Advantage,677.25 +15300,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,Aetna-Medicare Advantage,7.21 +15301,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,Aetna-Medicare Advantage, +15302,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,Aetna-Medicare Advantage,1.46 +15303,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,Aetna-Medicare Advantage,229.08 +15304,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,Aetna-Medicare Advantage,298.1 +15305,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,Aetna-Medicare Advantage, +15306,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,Aetna-Medicare Advantage,29.1 +15307,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,Aetna-Medicare Advantage,36.99 +15308,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,Aetna-Medicare Advantage,1074.59 +15309,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,Aetna-Medicare Advantage,22433.37 +15310,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,Aetna-Medicare Advantage,243.36 +15311,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,Aetna-Medicare Advantage,3.99 +15312,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,Aetna-Medicare Advantage,452.54 +15313,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,Aetna-Medicare Advantage,8.27 +15314,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,Aetna-Medicare Advantage,6301.64 +15315,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,Aetna-Medicare Advantage,17.16 +15316,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,Aetna-Medicare Advantage, +15317,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,Aetna-Medicare Advantage,28.08 +15318,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,Aetna-Medicare Advantage,37.04 +15319,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,Aetna-Medicare Advantage,12.78 +15320,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,Aetna-Medicare Advantage, +15321,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,Aetna-Medicare Advantage,3.35 +15322,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,Aetna-Medicare Advantage,2.98 +15323,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,Aetna-Medicare Advantage, +15324,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,Aetna-Medicare Advantage, +15325,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,Aetna-Medicare Advantage,16.42 +15326,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,Aetna-Medicare Advantage, +15327,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,Aetna-Medicare Advantage,99.64 +15328,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,Aetna-Medicare Advantage,11.94 +15329,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,Aetna-Medicare Advantage, +15330,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,Aetna-Medicare Advantage,5.68 +15331,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,Aetna-Medicare Advantage,5.94 +15332,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,Aetna-Medicare Advantage,13.8 +15333,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,Aetna-Medicare Advantage, +15334,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,Aetna-Medicare Advantage, +15335,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,Aetna-Medicare Advantage, +15336,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,Aetna-Medicare Advantage,13042.29 +15337,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,Aetna-Medicare Advantage, +15338,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,Aetna-Medicare Advantage, +15339,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,Aetna-Medicare Advantage,61.52 +15340,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,Aetna-Medicare Advantage, +15341,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,Aetna-Medicare Advantage,5.02 +15342,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,Aetna-Medicare Advantage,1000.86 +15343,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,Aetna-Medicare Advantage,14704.66 +15344,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,Aetna-Medicare Advantage,55.12 +15345,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,Aetna-Medicare Advantage,145.76 +15346,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,Aetna-Medicare Advantage, +15347,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,Aetna-Medicare Advantage, +15348,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,Aetna-Medicare Advantage,16626.89 +15349,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,Aetna-Medicare Advantage,12.12 +15350,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,Aetna-Medicare Advantage, +15351,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,Aetna-Medicare Advantage, +15352,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,Aetna-Medicare Advantage, +15353,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,Aetna-Medicare Advantage,225.0 +15354,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,Aetna-Medicare Advantage,84.24 +15355,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,Aetna-Medicare Advantage,4.37 +15356,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,Aetna-Medicare Advantage, +15357,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,Aetna-Medicare Advantage,477.14 +15358,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,Aetna-Medicare Advantage,97.02 +15359,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,Aetna-Medicare Advantage, +15360,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,Aetna-Medicare Advantage,90.35 +15361,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,Aetna-Medicare Advantage,6108.39 +15362,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,Aetna-Medicare Advantage,351.68 +15363,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,Aetna-Medicare Advantage,610.47 +15364,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,Aetna-Medicare Advantage,33.48 +15365,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,Aetna-Medicare Advantage,51.92 +15366,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,Aetna-Medicare Advantage,279.25 +15367,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,Aetna-Medicare Advantage,6.03 +15368,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,Aetna-Medicare Advantage,130.92 +15369,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,Aetna-Medicare Advantage,15.63 +15370,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,Aetna-Medicare Advantage, +15371,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,Aetna-Medicare Advantage,3214.2 +15372,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,Aetna-Medicare Advantage,540.3 +15373,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,Aetna-Medicare Advantage,21.52 +15374,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,Aetna-Medicare Advantage,12629.38 +15375,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,Aetna-Medicare Advantage,17.02 +15376,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,Aetna-Medicare Advantage,19.82 +15377,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,Aetna-Medicare Advantage,11910.0 +15378,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,Aetna-Medicare Advantage, +15379,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,Aetna-Medicare Advantage,6.16 +15380,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,Aetna-Medicare Advantage,11.82 +15381,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,Aetna-Medicare Advantage, +15382,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,Aetna-Medicare Advantage,151.7 +15383,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,Aetna-Medicare Advantage,15.8 +15384,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,Aetna-Medicare Advantage,10.53 +15385,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,Aetna-Medicare Advantage,1003.46 +15386,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,Aetna-Medicare Advantage,342.0 +15387,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,Aetna-Medicare Advantage,22.28 +15388,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,Aetna-Medicare Advantage,11.35 +15389,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,Aetna-Medicare Advantage,6.35 +15390,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,Aetna-Medicare Advantage,14.34 +15391,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,Aetna-Medicare Advantage,10.26 +15392,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,Aetna-Medicare Advantage,8.9 +15393,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,Aetna-Medicare Advantage,5.1 +15394,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,Aetna-Medicare Advantage,14.04 +15395,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,Aetna-Medicare Advantage, +15396,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,Aetna-Medicare Advantage, +15397,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,Aetna-Medicare Advantage, +15398,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,Aetna-Medicare Advantage, +15399,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,Aetna-Medicare Advantage,1469.71 +15400,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,Aetna-Medicare Advantage, +15401,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,Aetna-Medicare Advantage, +15402,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,Aetna-Medicare Advantage, +15403,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,Aetna-Medicare Advantage, +15404,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,Aetna-Medicare Advantage, +15405,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,Aetna-Medicare Advantage, +15406,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,Aetna-Medicare Advantage,13.1 +15407,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,Aetna-Medicare Advantage,1.48 +15408,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,Aetna-Medicare Advantage,2.01 +15409,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,Aetna-Medicare Advantage, +15410,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,Aetna-Medicare Advantage, +15411,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,Aetna-Medicare Advantage, +15412,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,Aetna-Medicare Advantage,1.69 +15413,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,Aetna-Medicare Advantage,5.32 +15414,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,Aetna-Medicare Advantage,356.19 +15415,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,Aetna-Medicare Advantage,5.31 +15416,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,Aetna-Medicare Advantage,167.34 +15417,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,Aetna-Medicare Advantage,12.41 +15418,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,Aetna-Medicare Advantage,405.66 +15419,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,Aetna-Medicare Advantage,224.92 +15420,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,Aetna-Medicare Advantage,10.24 +15421,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,Aetna-Medicare Advantage,5.03 +15422,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,Aetna-Medicare Advantage, +15423,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,Aetna-Medicare Advantage, +15424,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,Aetna-Medicare Advantage,220.85 +15425,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,Aetna-Medicare Advantage, +15426,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,Aetna-Medicare Advantage,21412.08 +15427,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,Aetna-Medicare Advantage,12980.89 +15428,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,Aetna-Medicare Advantage, +15429,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,Aetna-Medicare Advantage,172.44 +15430,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,Aetna-Medicare Advantage,9665.75 +15431,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,Aetna-Medicare Advantage,17986.66 +15432,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,Aetna-Medicare Advantage, +15433,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,Aetna-Medicare Advantage, +15434,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,Aetna-Medicare Advantage,3566.35 +15435,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,Aetna-Medicare Advantage, +15436,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,Aetna-Medicare Advantage,1848.5 +15437,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,Aetna-Medicare Advantage,260.81 +15438,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,Aetna-Medicare Advantage,2532.07 +15439,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,Aetna-Medicare Advantage, +15440,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,Aetna-Medicare Advantage,90.05 +15441,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,Aetna-Medicare Advantage,3162.03 +15442,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,Aetna-Medicare Advantage, +15443,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,Aetna-Medicare Advantage, +15444,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,Aetna-Medicare Advantage, +15445,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,Aetna-Medicare Advantage,17.84 +15446,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,Aetna-Medicare Advantage,5037.13 +15447,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,Aetna-Medicare Advantage, +15448,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,Aetna-Medicare Advantage, +15449,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,Aetna-Medicare Advantage,5377.03 +15450,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,Aetna-Medicare Advantage,13272.24 +15451,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,Aetna-Medicare Advantage, +15452,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,Aetna-Medicare Advantage,4144.01 +15453,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,Aetna-Medicare Advantage,26.26 +15454,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,Aetna-Medicare Advantage,100.96 +15455,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,Aetna-Medicare Advantage,219.45 +15456,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,Aetna-Medicare Advantage,4508.46 +15457,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,Aetna-Medicare Advantage, +15458,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,Aetna-Medicare Advantage,320.43 +15459,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,Aetna-Medicare Advantage,94.72 +15460,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,Aetna-Medicare Advantage, +15461,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,Aetna-Medicare Advantage,3336.72 +15462,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,Aetna-Medicare Advantage,4178.88 +15463,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,Aetna-Medicare Advantage, +15464,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,Aetna-Medicare Advantage, +15465,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,Aetna-Medicare Advantage,3.95 +15466,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,Aetna-Medicare Advantage, +15467,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,Aetna-Medicare Advantage,789.34 +15468,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,Aetna-Medicare Advantage,1866.4 +15469,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,Aetna-Medicare Advantage, +15470,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,Aetna-Medicare Advantage,145.69 +15471,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,Aetna-Medicare Advantage,19476.7 +15472,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,Aetna-Medicare Advantage,2152.67 +15473,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,Aetna-Medicare Advantage,16296.2 +15474,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,Aetna-Medicare Advantage,13121.26 +15475,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,Aetna-Medicare Advantage, +15476,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,Aetna-Medicare Advantage, +15477,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,Aetna-Medicare Advantage,3233.97 +15478,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,Aetna-Medicare Advantage,12656.07 +15479,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,Aetna-Medicare Advantage,12988.87 +15480,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,Aetna-Medicare Advantage, +15481,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,Aetna-Medicare Advantage,16685.94 +15482,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,Aetna-Medicare Advantage,8749.03 +15483,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,Aetna-Medicare Advantage, +15484,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,Aetna-Medicare Advantage,13779.08 +15485,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,Aetna-Medicare Advantage,15730.03 +15486,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,Aetna-Medicare Advantage, +15487,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,Aetna-Medicare Advantage, +15488,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,Aetna-Medicare Advantage,15.92 +15489,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,Aetna-Medicare Advantage,112.15 +15490,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,Aetna-Medicare Advantage,219.02 +15491,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,Aetna-Medicare Advantage,3402.51 +15492,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,Aetna-Medicare Advantage, +15493,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,Aetna-Medicare Advantage,64.13 +15494,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,Aetna-Medicare Advantage, +15495,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,Aetna-Medicare Advantage,149.6 +15496,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,Aetna-Medicare Advantage,124.95 +15497,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,Aetna-Medicare Advantage, +15498,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,Aetna-Medicare Advantage, +15499,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,Aetna-Medicare Advantage,223.0 +15500,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,Aetna-Medicare Advantage,289.97 +15501,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,Aetna-Medicare Advantage, +15502,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,Aetna-Medicare Advantage, +15503,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,Aetna-Medicare Advantage, +15504,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,Aetna-Medicare Advantage,2930.0 +15505,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,Aetna-Medicare Advantage, +15506,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,Aetna-Medicare Advantage, +15507,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,Aetna-Medicare Advantage, +15508,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,Aetna-Medicare Advantage,796.46 +15509,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,Aetna-Medicare Advantage, +15510,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,Aetna-Medicare Advantage, +15511,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,Aetna-Medicare Advantage, +15512,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,Aetna-Medicare Advantage, +15513,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,Aetna-Medicare Advantage, +15514,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,Aetna-Medicare Advantage,753.0 +15515,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,Aetna-Medicare Advantage,660.41 +15516,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,Aetna-Medicare Advantage, +15517,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,Aetna-Medicare Advantage, +15518,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,Aetna-Medicare Advantage, +15519,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,Aetna-Medicare Advantage,6245.54 +15520,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,Aetna-Medicare Advantage, +15521,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,Aetna-Medicare Advantage, +15522,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,Aetna-Medicare Advantage,6843.12 +15523,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,Aetna-Medicare Advantage,4111.74 +15524,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,Aetna-Medicare Advantage, +15525,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,Aetna-Medicare Advantage,371.76 +15526,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,Aetna-Medicare Advantage,594.0 +15527,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,Aetna-Medicare Advantage,425.39 +15528,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,Aetna-Medicare Advantage,309.83 +15529,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,Aetna-Medicare Advantage,1367.0 +15530,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,Aetna-Medicare Advantage,9256.72 +15531,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,Aetna-Medicare Advantage, +15532,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,Aetna-Medicare Advantage,277.42 +15533,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,Aetna-Medicare Advantage,2.73 +15534,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,Aetna-Medicare Advantage,0.59 +15535,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,Aetna-Medicare Advantage,256.34 +15536,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,Aetna-Medicare Advantage, +15537,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,Aetna-Medicare Advantage,7.69 +15538,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,Aetna-Medicare Advantage,2.72 +15539,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,Aetna-Medicare Advantage, +15540,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,Aetna-Medicare Advantage, +15541,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,Aetna-Medicare Advantage, +15542,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,Aetna-Medicare Advantage, +15543,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,Aetna-Medicare Advantage, +15544,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,Aetna-Medicare Advantage, +15545,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,Aetna-Medicare Advantage, +15546,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,Aetna-Medicare Advantage,8325.37 +15547,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,Aetna-Medicare Advantage,1105.88 +15548,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,Aetna-Medicare Advantage,995.3 +15549,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,Aetna-Medicare Advantage, +15550,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,Aetna-Medicare Advantage,10125.43 +15551,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,Aetna-Medicare Advantage, +15552,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,Aetna-Medicare Advantage, +15553,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,Aetna-Medicare Advantage, +15554,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,Aetna-Medicare Advantage,256.3 +15555,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,Aetna-Medicare Advantage,2106.02 +15556,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,Aetna-Medicare Advantage,791.29 +15557,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,Aetna-Medicare Advantage,3205.54 +15558,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,Aetna-Medicare Advantage, +15559,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,Aetna-Medicare Advantage, +15560,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,Aetna-Medicare Advantage,319.24 +15561,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,Aetna-Medicare Advantage, +15562,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,Aetna-Medicare Advantage, +15563,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,Aetna-Medicare Advantage,3410.97 +15564,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,Aetna-Medicare Advantage, +15565,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,Aetna-Medicare Advantage,110.13 +15566,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,Aetna-Medicare Advantage,5055.58 +15567,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,Aetna-Medicare Advantage, +15568,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,Aetna-Medicare Advantage, +15569,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,Aetna-Medicare Advantage,1751.45 +15570,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,Aetna-Medicare Advantage,103.0 +15571,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,Aetna-Medicare Advantage,387.4 +15572,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,Aetna-Medicare Advantage,137.04 +15573,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,Aetna-Medicare Advantage,150.0 +15574,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,Aetna-Medicare Advantage,75.0 +15575,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,Aetna-Medicare Advantage, +15576,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,Aetna-Medicare Advantage,161.84 +15577,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,Aetna-Medicare Advantage,1559.31 +15578,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,Aetna-Medicare Advantage, +15579,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,Aetna-Medicare Advantage, +15580,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,Aetna-Medicare Advantage, +15581,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15582,3934,30000012,PRIVATE,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15583,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15584,3934,30000038,ICU,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15585,3934,30000046,BURN UNIT,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15586,3934,30000053,NICU,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15587,3934,30000061,ICR ROOM,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15588,3934,30000079,PSYCH,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15589,3934,30000087,NEWBORN,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15590,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15591,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15592,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15593,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15594,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15595,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15596,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15597,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15598,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15599,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15600,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15601,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15602,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15603,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15604,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15605,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15606,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15607,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15608,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15609,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15610,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15611,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15612,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15613,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15614,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15615,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15616,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15617,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15618,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15619,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15620,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15621,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15622,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15623,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15624,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15625,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15626,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15627,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15628,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15629,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15630,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15631,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15632,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15633,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15634,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15635,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15636,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15637,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15638,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15639,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15640,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15641,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15642,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15643,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15644,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15645,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15646,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15647,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15648,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15649,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15650,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15651,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15652,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15653,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15654,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15655,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15656,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15657,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15658,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15659,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15660,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15661,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15662,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15663,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15664,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15665,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15666,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15667,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15668,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15669,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15670,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15671,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15672,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15673,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15674,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15675,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15676,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15677,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15678,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15679,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15680,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15681,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15682,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15683,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15684,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15685,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15686,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15687,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15688,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15689,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15690,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15691,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15692,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15693,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15694,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15695,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15696,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15697,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15698,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15699,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15700,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15701,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15702,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15703,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15704,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15705,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15706,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15707,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15708,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15709,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15710,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15711,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15712,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15713,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15714,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15715,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15716,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15717,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15718,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15719,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15720,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15721,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15722,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15723,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15724,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15725,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15726,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15727,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15728,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15729,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15730,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15731,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15732,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15733,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15734,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15735,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15736,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15737,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15738,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15739,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15740,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15741,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15742,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15743,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15744,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15745,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15746,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15747,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15748,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15749,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15750,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15751,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15752,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15753,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15754,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15755,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15756,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15757,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15758,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15759,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15760,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15761,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15762,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15763,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15764,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15765,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15766,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15767,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15768,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15769,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15770,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15771,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15772,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15773,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15774,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15775,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15776,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15777,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15778,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15779,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15780,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15781,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15782,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15783,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15784,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15785,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15786,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15787,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15788,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15789,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15790,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15791,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15792,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15793,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15794,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15795,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15796,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15797,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15798,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15799,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15800,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15801,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15802,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15803,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15804,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15805,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15806,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15807,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15808,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15809,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15810,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15811,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15812,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15813,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15814,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15815,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15816,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15817,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15818,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15819,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15820,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15821,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15822,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15823,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15824,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15825,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15826,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15827,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15828,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15829,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15830,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15831,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15832,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15833,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15834,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15835,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15836,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15837,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15838,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15839,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15840,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15841,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15842,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15843,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15844,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15845,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15846,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15847,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15848,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15849,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15850,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15851,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15852,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15853,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15854,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15855,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15856,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15857,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15858,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15859,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15860,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15861,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15862,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15863,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15864,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15865,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15866,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15867,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15868,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15869,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15870,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15871,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15872,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15873,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15874,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15875,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15876,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15877,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15878,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15879,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15880,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15881,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15882,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15883,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15884,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15885,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15886,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15887,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15888,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15889,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15890,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15891,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15892,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15893,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15894,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15895,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15896,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15897,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15898,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15899,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15900,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15901,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15902,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15903,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15904,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15905,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15906,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15907,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15908,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15909,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15910,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15911,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15912,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15913,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15914,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15915,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15916,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15917,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15918,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15919,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15920,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15921,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15922,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15923,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15924,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15925,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15926,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15927,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15928,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15929,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15930,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15931,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15932,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15933,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15934,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15935,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15936,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15937,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15938,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15939,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15940,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15941,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15942,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15943,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15944,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15945,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15946,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15947,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15948,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15949,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15950,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15951,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15952,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15953,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15954,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15955,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15956,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15957,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15958,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15959,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15960,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15961,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15962,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15963,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15964,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15965,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15966,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15967,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15968,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15969,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15970,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15971,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15972,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15973,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15974,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15975,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15976,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15977,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15978,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15979,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15980,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +15981,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15982,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15983,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15984,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15985,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15986,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15987,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +15988,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15989,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +15990,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15991,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15992,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15993,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15994,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15995,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15996,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +15997,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15998,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +15999,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,Aetna-Medicare Advantage, +16000,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16001,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16002,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16003,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16004,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16005,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +16006,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,Aetna-Medicare Advantage, +16007,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +16008,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16009,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16010,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16011,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +16012,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16013,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +16014,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16015,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16016,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16017,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +16018,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16019,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +16020,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16021,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16022,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16023,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16024,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,Aetna-Medicare Advantage, +16025,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,Aetna-Medicare Advantage, +16026,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,Aetna-Medicare Advantage, +16027,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,Aetna-Medicare Advantage, +16028,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,Aetna-Medicare Advantage, +16029,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,Aetna-Medicare Advantage, +16030,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,Aetna-Medicare Advantage, +16031,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,Aetna-Medicare Advantage, +16032,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,Aetna-Medicare Advantage, +16033,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,Aetna-Medicare Advantage, +16034,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,Aetna-Medicare Advantage, +16035,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,Aetna-Medicare Advantage, +16036,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,Aetna-Medicare Advantage, +16037,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,Aetna-Medicare Advantage, +16038,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,Aetna-Medicare Advantage, +16039,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,Aetna-Medicare Advantage, +16040,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,Aetna-Medicare Advantage, +16041,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,Aetna-Medicare Advantage, +16042,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,Aetna-Medicare Advantage, +16043,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,Aetna-Medicare Advantage, +16044,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,Aetna-Medicare Advantage, +16045,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,Aetna-Medicare Advantage, +16046,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,Aetna-Medicare Advantage, +16047,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,Aetna-Medicare Advantage, +16048,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,Aetna-Medicare Advantage, +16049,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,Aetna-Medicare Advantage, +16050,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,Aetna-Medicare Advantage, +16051,3934,37112000,ACUTE ED,,1580.0,1580.0,,,Aetna-Medicare Advantage, +16052,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,Aetna-Medicare Advantage, +16053,3934,37112034,TRIAGE,,277.0,277.0,,,Aetna-Medicare Advantage, +16054,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,Aetna-Medicare Advantage, +16055,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,Aetna-Medicare Advantage, +16056,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,Aetna-Medicare Advantage, +16057,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,Aetna-Medicare Advantage, +16058,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,Aetna-Medicare Advantage, +16059,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,Aetna-Medicare Advantage, +16060,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,Aetna-Medicare Advantage, +16061,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,Aetna-Medicare Advantage, +16062,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,Aetna-Medicare Advantage, +16063,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,Aetna-Medicare Advantage, +16064,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,Aetna-Medicare Advantage, +16065,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,Aetna-Medicare Advantage, +16066,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,Aetna-Medicare Advantage, +16067,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,Aetna-Medicare Advantage, +16068,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,Aetna-Medicare Advantage, +16069,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,Aetna-Medicare Advantage, +16070,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,Aetna-Medicare Advantage, +16071,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,Aetna-Medicare Advantage, +16072,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,Aetna-Medicare Advantage, +16073,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,Aetna-Medicare Advantage, +16074,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,Aetna-Medicare Advantage, +16075,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,Aetna-Medicare Advantage, +16076,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,Aetna-Medicare Advantage, +16077,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,Aetna-Medicare Advantage, +16078,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,Aetna-Medicare Advantage, +16079,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,Aetna-Medicare Advantage, +16080,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,Aetna-Medicare Advantage, +16081,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,Aetna-Medicare Advantage, +16082,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,Aetna-Medicare Advantage, +16083,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,Aetna-Medicare Advantage, +16084,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,Aetna-Medicare Advantage, +16085,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,Aetna-Medicare Advantage, +16086,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,Aetna-Medicare Advantage, +16087,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,Aetna-Medicare Advantage, +16088,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,Aetna-Medicare Advantage, +16089,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,Aetna-Medicare Advantage, +16090,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,Aetna-Medicare Advantage, +16091,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,Aetna-Medicare Advantage, +16092,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,Aetna-Medicare Advantage, +16093,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,Aetna-Medicare Advantage, +16094,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,Aetna-Medicare Advantage, +16095,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,Aetna-Medicare Advantage, +16096,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,Aetna-Medicare Advantage, +16097,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,Aetna-Medicare Advantage, +16098,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,Aetna-Medicare Advantage, +16099,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,Aetna-Medicare Advantage, +16100,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,Aetna-Medicare Advantage, +16101,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,Aetna-Medicare Advantage, +16102,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,Aetna-Medicare Advantage, +16103,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,Aetna-Medicare Advantage, +16104,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,Aetna-Medicare Advantage, +16105,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,Aetna-Medicare Advantage, +16106,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,Aetna-Medicare Advantage, +16107,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,Aetna-Medicare Advantage, +16108,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,Aetna-Medicare Advantage, +16109,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,Aetna-Medicare Advantage, +16110,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,Aetna-Medicare Advantage, +16111,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,Aetna-Medicare Advantage, +16112,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,Aetna-Medicare Advantage, +16113,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,Aetna-Medicare Advantage, +16114,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,Aetna-Medicare Advantage, +16115,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,Aetna-Medicare Advantage, +16116,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,Aetna-Medicare Advantage, +16117,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,Aetna-Medicare Advantage, +16118,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,Aetna-Medicare Advantage, +16119,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,Aetna-Medicare Advantage, +16120,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,Aetna-Medicare Advantage, +16121,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,Aetna-Medicare Advantage, +16122,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,Aetna-Medicare Advantage, +16123,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,Aetna-Medicare Advantage, +16124,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,Aetna-Medicare Advantage, +16125,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,Aetna-Medicare Advantage, +16126,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,Aetna-Medicare Advantage, +16127,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,Aetna-Medicare Advantage, +16128,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,Aetna-Medicare Advantage, +16129,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,Aetna-Medicare Advantage, +16130,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,Aetna-Medicare Advantage, +16131,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,Aetna-Medicare Advantage, +16132,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,Aetna-Medicare Advantage, +16133,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,Aetna-Medicare Advantage, +16134,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,Aetna-Medicare Advantage, +16135,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,Aetna-Medicare Advantage, +16136,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,Aetna-Medicare Advantage, +16137,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,Aetna-Medicare Advantage, +16138,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,Aetna-Medicare Advantage, +16139,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,Aetna-Medicare Advantage, +16140,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,Aetna-Medicare Advantage, +16141,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,Aetna-Medicare Advantage, +16142,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,Aetna-Medicare Advantage, +16143,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,Aetna-Medicare Advantage, +16144,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,Aetna-Medicare Advantage, +16145,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,Aetna-Medicare Advantage, +16146,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,Aetna-Medicare Advantage, +16147,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,Aetna-Medicare Advantage, +16148,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,Aetna-Medicare Advantage, +16149,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,Aetna-Medicare Advantage, +16150,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,Aetna-Medicare Advantage, +16151,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,Aetna-Medicare Advantage, +16152,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,Aetna-Medicare Advantage, +16153,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Medicare Advantage, +16154,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16155,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16156,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16157,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16158,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16159,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,Aetna-Medicare Advantage, +16160,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,Aetna-Medicare Advantage, +16161,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,Aetna-Medicare Advantage, +16162,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16163,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16164,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16165,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,Aetna-Medicare Advantage, +16166,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,Aetna-Medicare Advantage, +16167,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,Aetna-Medicare Advantage, +16168,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,Aetna-Medicare Advantage, +16169,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,Aetna-Medicare Advantage, +16170,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,Aetna-Medicare Advantage, +16171,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,Aetna-Medicare Advantage, +16172,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,Aetna-Medicare Advantage, +16173,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,Aetna-Medicare Advantage, +16174,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,Aetna-Medicare Advantage, +16175,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,Aetna-Medicare Advantage, +16176,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,Aetna-Medicare Advantage, +16177,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,Aetna-Medicare Advantage, +16178,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,Aetna-Medicare Advantage, +16179,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,Aetna-Medicare Advantage, +16180,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,Aetna-Medicare Advantage, +16181,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,Aetna-Medicare Advantage, +16182,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,Aetna-Medicare Advantage, +16183,3934,43301043,ALBUNEX,,357.0,357.0,,,Aetna-Medicare Advantage, +16184,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,Aetna-Medicare Advantage, +16185,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16186,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16187,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16188,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16189,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16190,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,Aetna-Medicare Advantage, +16191,3934,43450022,REC RM .5HR,,541.0,541.0,,,Aetna-Medicare Advantage, +16192,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,Aetna-Medicare Advantage, +16193,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,Aetna-Medicare Advantage, +16194,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,Aetna-Medicare Advantage, +16195,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,Aetna-Medicare Advantage, +16196,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,Aetna-Medicare Advantage, +16197,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,Aetna-Medicare Advantage, +16198,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,Aetna-Medicare Advantage, +16199,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,Aetna-Medicare Advantage, +16200,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,Aetna-Medicare Advantage, +16201,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,Aetna-Medicare Advantage, +16202,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,Aetna-Medicare Advantage, +16203,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,Aetna-Medicare Advantage, +16204,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,Aetna-Medicare Advantage, +16205,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,Aetna-Medicare Advantage, +16206,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,Aetna-Medicare Advantage, +16207,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,Aetna-Medicare Advantage, +16208,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Medicare Advantage, +16209,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16210,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16211,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16212,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16213,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16214,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,Aetna-Medicare Advantage, +16215,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16216,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Medicare Advantage, +16217,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16218,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16219,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16220,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16221,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,Aetna-Medicare Advantage, +16222,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Medicare Advantage, +16223,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16224,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16225,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16226,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16227,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16228,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Medicare Advantage, +16229,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16230,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16231,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16232,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16233,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16234,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,Aetna-Medicare Advantage, +16235,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,Aetna-Medicare Advantage, +16236,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,Aetna-Medicare Advantage, +16237,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,Aetna-Medicare Advantage, +16238,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,Aetna-Medicare Advantage, +16239,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,Aetna-Medicare Advantage, +16240,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,Aetna-Medicare Advantage, +16241,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,Aetna-Medicare Advantage, +16242,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Medicare Advantage, +16243,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16244,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16245,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16246,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16247,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16248,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16249,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,Aetna-Medicare Advantage, +16250,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,Aetna-Medicare Advantage, +16251,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,Aetna-Medicare Advantage, +16252,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,Aetna-Medicare Advantage, +16253,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,Aetna-Medicare Advantage, +16254,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,Aetna-Medicare Advantage, +16255,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,Aetna-Medicare Advantage, +16256,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,Aetna-Medicare Advantage, +16257,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,Aetna-Medicare Advantage, +16258,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,Aetna-Medicare Advantage, +16259,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,Aetna-Medicare Advantage, +16260,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,Aetna-Medicare Advantage, +16261,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,Aetna-Medicare Advantage, +16262,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,Aetna-Medicare Advantage, +16263,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,Aetna-Medicare Advantage, +16264,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,Aetna-Medicare Advantage, +16265,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,Aetna-Medicare Advantage, +16266,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,Aetna-Medicare Advantage, +16267,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,Aetna-Medicare Advantage, +16268,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,Aetna-Medicare Advantage, +16269,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,Aetna-Medicare Advantage, +16270,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,Aetna-Medicare Advantage, +16271,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,Aetna-Medicare Advantage, +16272,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,Aetna-Medicare Advantage, +16273,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,Aetna-Medicare Advantage, +16274,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,Aetna-Medicare Advantage, +16275,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,Aetna-Medicare Advantage, +16276,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,Aetna-Medicare Advantage, +16277,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,Aetna-Medicare Advantage, +16278,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,Aetna-Medicare Advantage, +16279,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,Aetna-Medicare Advantage, +16280,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,Aetna-Medicare Advantage, +16281,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,Aetna-Medicare Advantage, +16282,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,Aetna-Medicare Advantage, +16283,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,Aetna-Medicare Advantage, +16284,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,Aetna-Medicare Advantage, +16285,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,Aetna-Medicare Advantage, +16286,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,Aetna-Medicare Advantage, +16287,3934,45924552,ENDO REC RM,,30.0,30.0,,,Aetna-Medicare Advantage, +16288,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,Aetna-Medicare Advantage, +16289,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,Aetna-Medicare Advantage, +16290,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,Aetna-Medicare Advantage, +16291,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,Aetna-Medicare Advantage, +16292,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,Aetna-Medicare Advantage, +16293,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,Aetna-Medicare Advantage, +16294,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,Aetna-Medicare Advantage, +16295,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,Aetna-Medicare Advantage, +16296,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,Aetna-Medicare Advantage, +16297,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,Aetna-Medicare Advantage, +16298,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,Aetna-Medicare Advantage, +16299,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,Aetna-Medicare Advantage, +16300,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,Aetna-Medicare Advantage, +16301,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,Aetna-Medicare Advantage, +16302,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,Aetna-Medicare Advantage, +16303,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,Aetna-Medicare Advantage, +16304,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,Aetna-Medicare Advantage, +16305,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,Aetna-Medicare Advantage, +16306,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,Aetna-Medicare Advantage, +16307,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,Aetna-Medicare Advantage, +16308,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,Aetna-Medicare Advantage, +16309,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,Aetna-Medicare Advantage, +16310,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,Aetna-Medicare Advantage, +16311,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,Aetna-Medicare Advantage, +16312,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,Aetna-Medicare Advantage, +16313,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,Aetna-Medicare Advantage, +16314,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,Aetna-Medicare Advantage, +16315,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,Aetna-Medicare Advantage, +16316,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,Aetna-Medicare Advantage, +16317,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,Aetna-Medicare Advantage, +16318,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,Aetna-Medicare Advantage, +16319,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,Aetna-Medicare Advantage, +16320,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,Aetna-Medicare Advantage, +16321,3934,53200010,GUEST TRAY,,24.0,24.0,,,Aetna-Medicare Advantage, +16322,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,Aetna-Medicare Advantage, +16323,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,Aetna-Medicare Advantage, +16324,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,Aetna-Medicare Advantage, +16325,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,Aetna-Medicare Advantage, +16326,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,Aetna-Medicare Advantage, +16327,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,Aetna-Medicare Advantage, +16328,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,Aetna-Medicare Advantage, +16329,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,Aetna-Medicare Advantage, +16330,3934,53329876,HIV MONITORING,,416.0,416.0,,,Aetna-Medicare Advantage, +16331,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,Aetna-Medicare Advantage, +16332,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,Aetna-Medicare Advantage, +16333,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,Aetna-Medicare Advantage, +16334,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,Aetna-Medicare Advantage, +16335,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,Aetna-Medicare Advantage, +16336,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,Aetna-Medicare Advantage, +16337,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,Aetna-Medicare Advantage, +16338,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,Aetna-Medicare Advantage, +16339,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,Aetna-Medicare Advantage, +16340,3934,76010107,COPY X-RAY,,22.0,22.0,,,Aetna-Medicare Advantage, +16341,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,Aetna-Medicare Advantage, +16342,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,Aetna-Medicare Advantage, +16343,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,Aetna-Medicare Advantage, +16344,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,Aetna-Medicare Advantage, +16345,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,Aetna-Medicare Advantage, +16346,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,Aetna-Medicare Advantage, +16347,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,Aetna-Medicare Advantage, +16348,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,Aetna-Medicare Advantage, +16349,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,Aetna-Medicare Advantage, +16350,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,Aetna-Medicare Advantage, +16351,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,Aetna-Medicare Advantage, +16352,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,Aetna-Medicare Advantage, +16353,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,Cigna-Commercial, +16354,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,Cigna-Commercial, +16355,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,Cigna-Commercial, +16356,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,Cigna-Commercial, +16357,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,Cigna-Commercial, +16358,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,Cigna-Commercial, +16359,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,Cigna-Commercial, +16360,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,Cigna-Commercial, +16361,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,Cigna-Commercial, +16362,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,Cigna-Commercial, +16363,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,Cigna-Commercial,216762.23 +16364,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,Cigna-Commercial, +16365,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,Cigna-Commercial, +16366,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,Cigna-Commercial, +16367,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,Cigna-Commercial,511169.46 +16368,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,Cigna-Commercial,72667.64 +16369,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,Cigna-Commercial, +16370,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,Cigna-Commercial, +16371,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,Cigna-Commercial, +16372,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,Cigna-Commercial, +16373,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,Cigna-Commercial, +16374,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,Cigna-Commercial, +16375,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,Cigna-Commercial, +16376,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,Cigna-Commercial, +16377,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,Cigna-Commercial, +16378,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,Cigna-Commercial, +16379,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,Cigna-Commercial, +16380,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,Cigna-Commercial, +16381,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,Cigna-Commercial, +16382,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,Cigna-Commercial, +16383,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,Cigna-Commercial, +16384,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,Cigna-Commercial, +16385,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,Cigna-Commercial, +16386,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,Cigna-Commercial, +16387,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,Cigna-Commercial,24385.53 +16388,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,Cigna-Commercial, +16389,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,Cigna-Commercial, +16390,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,Cigna-Commercial, +16391,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,Cigna-Commercial, +16392,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,Cigna-Commercial, +16393,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,Cigna-Commercial, +16394,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,Cigna-Commercial, +16395,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,Cigna-Commercial, +16396,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,Cigna-Commercial, +16397,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,Cigna-Commercial, +16398,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,Cigna-Commercial, +16399,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,Cigna-Commercial, +16400,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,Cigna-Commercial, +16401,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,Cigna-Commercial, +16402,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,Cigna-Commercial, +16403,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,Cigna-Commercial, +16404,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,Cigna-Commercial, +16405,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,Cigna-Commercial, +16406,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,Cigna-Commercial, +16407,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,Cigna-Commercial, +16408,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,Cigna-Commercial, +16409,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,Cigna-Commercial, +16410,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,Cigna-Commercial, +16411,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,Cigna-Commercial, +16412,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,Cigna-Commercial, +16413,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,Cigna-Commercial, +16414,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,Cigna-Commercial, +16415,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,Cigna-Commercial,15556.45 +16416,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,Cigna-Commercial, +16417,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,Cigna-Commercial, +16418,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,Cigna-Commercial, +16419,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,Cigna-Commercial,13394.13 +16420,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,Cigna-Commercial, +16421,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,Cigna-Commercial, +16422,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,Cigna-Commercial, +16423,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,Cigna-Commercial, +16424,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,Cigna-Commercial, +16425,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,Cigna-Commercial, +16426,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,Cigna-Commercial, +16427,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,Cigna-Commercial,15610.22 +16428,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,Cigna-Commercial, +16429,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,Cigna-Commercial,14111.33 +16430,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,Cigna-Commercial, +16431,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,Cigna-Commercial, +16432,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,Cigna-Commercial, +16433,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,Cigna-Commercial, +16434,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,Cigna-Commercial, +16435,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,Cigna-Commercial, +16436,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,Cigna-Commercial, +16437,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,Cigna-Commercial, +16438,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,Cigna-Commercial, +16439,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,Cigna-Commercial, +16440,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,Cigna-Commercial, +16441,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,Cigna-Commercial, +16442,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,Cigna-Commercial, +16443,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,Cigna-Commercial, +16444,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,Cigna-Commercial, +16445,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,Cigna-Commercial, +16446,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,Cigna-Commercial, +16447,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,Cigna-Commercial, +16448,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,Cigna-Commercial, +16449,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,Cigna-Commercial, +16450,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,Cigna-Commercial, +16451,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,Cigna-Commercial, +16452,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,Cigna-Commercial, +16453,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,Cigna-Commercial, +16454,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,Cigna-Commercial, +16455,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,Cigna-Commercial, +16456,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,Cigna-Commercial, +16457,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,Cigna-Commercial, +16458,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,Cigna-Commercial, +16459,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,Cigna-Commercial, +16460,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,Cigna-Commercial, +16461,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,Cigna-Commercial, +16462,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,Cigna-Commercial, +16463,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,Cigna-Commercial, +16464,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,Cigna-Commercial,14599.24 +16465,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,Cigna-Commercial, +16466,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,Cigna-Commercial, +16467,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,Cigna-Commercial, +16468,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,Cigna-Commercial, +16469,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,Cigna-Commercial, +16470,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,Cigna-Commercial, +16471,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,Cigna-Commercial, +16472,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,Cigna-Commercial, +16473,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,Cigna-Commercial, +16474,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,Cigna-Commercial,32704.46 +16475,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,Cigna-Commercial, +16476,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,Cigna-Commercial, +16477,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,Cigna-Commercial, +16478,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,Cigna-Commercial,19722.24 +16479,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,Cigna-Commercial,25661.8 +16480,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,Cigna-Commercial, +16481,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,Cigna-Commercial, +16482,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,Cigna-Commercial, +16483,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,Cigna-Commercial, +16484,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,Cigna-Commercial,20317.11 +16485,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,Cigna-Commercial,20441.37 +16486,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,Cigna-Commercial, +16487,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,Cigna-Commercial, +16488,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,Cigna-Commercial, +16489,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,Cigna-Commercial, +16490,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,Cigna-Commercial, +16491,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,Cigna-Commercial, +16492,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,Cigna-Commercial, +16493,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,Cigna-Commercial, +16494,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,Cigna-Commercial,19039.67 +16495,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,Cigna-Commercial, +16496,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,Cigna-Commercial, +16497,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,Cigna-Commercial,12419.22 +16498,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,Cigna-Commercial, +16499,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,Cigna-Commercial, +16500,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,Cigna-Commercial, +16501,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,Cigna-Commercial,431777.68 +16502,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,Cigna-Commercial,159011.41 +16503,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,Cigna-Commercial, +16504,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,Cigna-Commercial, +16505,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,Cigna-Commercial, +16506,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,Cigna-Commercial, +16507,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,Cigna-Commercial, +16508,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,Cigna-Commercial, +16509,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,Cigna-Commercial, +16510,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,Cigna-Commercial, +16511,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,Cigna-Commercial, +16512,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,Cigna-Commercial, +16513,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,Cigna-Commercial, +16514,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,Cigna-Commercial, +16515,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,Cigna-Commercial, +16516,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,Cigna-Commercial, +16517,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,Cigna-Commercial, +16518,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,Cigna-Commercial, +16519,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,Cigna-Commercial, +16520,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,Cigna-Commercial, +16521,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,Cigna-Commercial, +16522,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,Cigna-Commercial,69427.3 +16523,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,Cigna-Commercial, +16524,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,Cigna-Commercial, +16525,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,Cigna-Commercial, +16526,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,Cigna-Commercial, +16527,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,Cigna-Commercial, +16528,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,Cigna-Commercial, +16529,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,Cigna-Commercial,57697.92 +16530,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,Cigna-Commercial,39595.38 +16531,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,Cigna-Commercial, +16532,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,Cigna-Commercial, +16533,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,Cigna-Commercial, +16534,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,Cigna-Commercial, +16535,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,Cigna-Commercial, +16536,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,Cigna-Commercial, +16537,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,Cigna-Commercial, +16538,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,Cigna-Commercial, +16539,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,Cigna-Commercial, +16540,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,Cigna-Commercial, +16541,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,Cigna-Commercial, +16542,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,Cigna-Commercial, +16543,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,Cigna-Commercial, +16544,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,Cigna-Commercial, +16545,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,Cigna-Commercial, +16546,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,Cigna-Commercial, +16547,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,Cigna-Commercial, +16548,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,Cigna-Commercial, +16549,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,Cigna-Commercial, +16550,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,Cigna-Commercial, +16551,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,Cigna-Commercial, +16552,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,Cigna-Commercial, +16553,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,Cigna-Commercial, +16554,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,Cigna-Commercial, +16555,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,Cigna-Commercial, +16556,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,Cigna-Commercial, +16557,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,Cigna-Commercial,28659.12 +16558,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,Cigna-Commercial,17912.94 +16559,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,Cigna-Commercial, +16560,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,Cigna-Commercial, +16561,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,Cigna-Commercial, +16562,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,Cigna-Commercial, +16563,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,Cigna-Commercial, +16564,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,Cigna-Commercial, +16565,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,Cigna-Commercial,30617.4 +16566,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,Cigna-Commercial, +16567,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,Cigna-Commercial, +16568,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,Cigna-Commercial, +16569,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,Cigna-Commercial, +16570,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,Cigna-Commercial, +16571,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,Cigna-Commercial, +16572,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,Cigna-Commercial, +16573,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,Cigna-Commercial, +16574,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,Cigna-Commercial,11639.85 +16575,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,Cigna-Commercial, +16576,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,Cigna-Commercial,14144.53 +16577,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,Cigna-Commercial, +16578,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,Cigna-Commercial, +16579,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,Cigna-Commercial, +16580,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,Cigna-Commercial, +16581,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,Cigna-Commercial, +16582,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,Cigna-Commercial, +16583,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,Cigna-Commercial,14772.1 +16584,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,Cigna-Commercial, +16585,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,Cigna-Commercial, +16586,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,Cigna-Commercial,16860.32 +16587,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,Cigna-Commercial, +16588,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,Cigna-Commercial, +16589,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,Cigna-Commercial, +16590,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,Cigna-Commercial, +16591,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,Cigna-Commercial, +16592,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,Cigna-Commercial, +16593,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,Cigna-Commercial, +16594,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,Cigna-Commercial, +16595,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,Cigna-Commercial,35977.58 +16596,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,Cigna-Commercial, +16597,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,Cigna-Commercial, +16598,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,Cigna-Commercial, +16599,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,Cigna-Commercial, +16600,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,Cigna-Commercial, +16601,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,Cigna-Commercial, +16602,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,Cigna-Commercial,29837.64 +16603,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,Cigna-Commercial,22436.73 +16604,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,Cigna-Commercial, +16605,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,Cigna-Commercial, +16606,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,Cigna-Commercial, +16607,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,Cigna-Commercial, +16608,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,Cigna-Commercial, +16609,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,Cigna-Commercial, +16610,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,Cigna-Commercial, +16611,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,Cigna-Commercial, +16612,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,Cigna-Commercial, +16613,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,Cigna-Commercial, +16614,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,Cigna-Commercial, +16615,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,Cigna-Commercial, +16616,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,Cigna-Commercial, +16617,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,Cigna-Commercial, +16618,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,Cigna-Commercial, +16619,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,Cigna-Commercial, +16620,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,Cigna-Commercial, +16621,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,Cigna-Commercial, +16622,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,Cigna-Commercial,19881.8 +16623,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,Cigna-Commercial,13197.23 +16624,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,Cigna-Commercial, +16625,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,Cigna-Commercial, +16626,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,Cigna-Commercial, +16627,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,Cigna-Commercial, +16628,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,Cigna-Commercial,17881.88 +16629,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,Cigna-Commercial, +16630,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,Cigna-Commercial, +16631,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,Cigna-Commercial, +16632,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,Cigna-Commercial, +16633,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,Cigna-Commercial, +16634,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,Cigna-Commercial, +16635,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,Cigna-Commercial, +16636,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,Cigna-Commercial, +16637,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,Cigna-Commercial, +16638,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,Cigna-Commercial, +16639,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,Cigna-Commercial, +16640,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,Cigna-Commercial, +16641,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,Cigna-Commercial, +16642,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,Cigna-Commercial, +16643,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,Cigna-Commercial, +16644,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,Cigna-Commercial, +16645,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,Cigna-Commercial, +16646,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,Cigna-Commercial, +16647,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,Cigna-Commercial, +16648,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,Cigna-Commercial, +16649,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,Cigna-Commercial, +16650,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,Cigna-Commercial, +16651,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,Cigna-Commercial, +16652,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,Cigna-Commercial, +16653,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,Cigna-Commercial, +16654,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,Cigna-Commercial,30887.74 +16655,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,Cigna-Commercial, +16656,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,Cigna-Commercial, +16657,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,Cigna-Commercial, +16658,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,Cigna-Commercial, +16659,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,Cigna-Commercial, +16660,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,Cigna-Commercial, +16661,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,Cigna-Commercial,18453.16 +16662,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,Cigna-Commercial, +16663,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,Cigna-Commercial, +16664,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,Cigna-Commercial, +16665,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,Cigna-Commercial, +16666,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,Cigna-Commercial, +16667,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,Cigna-Commercial, +16668,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,Cigna-Commercial, +16669,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,Cigna-Commercial, +16670,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,Cigna-Commercial,29671.06 +16671,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,Cigna-Commercial, +16672,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,Cigna-Commercial, +16673,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,Cigna-Commercial, +16674,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,Cigna-Commercial,109893.41 +16675,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,Cigna-Commercial, +16676,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,Cigna-Commercial, +16677,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,Cigna-Commercial, +16678,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,Cigna-Commercial, +16679,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,Cigna-Commercial, +16680,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,Cigna-Commercial, +16681,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,Cigna-Commercial, +16682,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,Cigna-Commercial,49541.32 +16683,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,Cigna-Commercial, +16684,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,Cigna-Commercial, +16685,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,Cigna-Commercial, +16686,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,Cigna-Commercial,63668.82 +16687,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,Cigna-Commercial, +16688,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,Cigna-Commercial,41584.81 +16689,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,Cigna-Commercial,56883.43 +16690,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,Cigna-Commercial, +16691,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,Cigna-Commercial, +16692,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,Cigna-Commercial, +16693,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,Cigna-Commercial, +16694,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,Cigna-Commercial, +16695,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,Cigna-Commercial, +16696,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,Cigna-Commercial, +16697,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,Cigna-Commercial,38837.13 +16698,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,Cigna-Commercial, +16699,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,Cigna-Commercial, +16700,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,Cigna-Commercial, +16701,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,Cigna-Commercial, +16702,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,Cigna-Commercial, +16703,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,Cigna-Commercial, +16704,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,Cigna-Commercial,123403.67 +16705,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,Cigna-Commercial,40139.98 +16706,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,Cigna-Commercial,32723.28 +16707,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,Cigna-Commercial, +16708,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,Cigna-Commercial, +16709,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,Cigna-Commercial, +16710,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,Cigna-Commercial, +16711,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,Cigna-Commercial, +16712,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,Cigna-Commercial, +16713,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,Cigna-Commercial, +16714,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,Cigna-Commercial, +16715,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,Cigna-Commercial, +16716,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,Cigna-Commercial, +16717,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,Cigna-Commercial, +16718,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,Cigna-Commercial, +16719,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,Cigna-Commercial, +16720,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,Cigna-Commercial, +16721,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,Cigna-Commercial, +16722,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,Cigna-Commercial, +16723,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,Cigna-Commercial, +16724,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,Cigna-Commercial, +16725,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,Cigna-Commercial, +16726,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,Cigna-Commercial, +16727,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,Cigna-Commercial, +16728,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,Cigna-Commercial, +16729,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,Cigna-Commercial, +16730,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,Cigna-Commercial, +16731,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,Cigna-Commercial, +16732,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,Cigna-Commercial, +16733,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,Cigna-Commercial, +16734,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,Cigna-Commercial, +16735,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,Cigna-Commercial, +16736,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,Cigna-Commercial,44410.43 +16737,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,Cigna-Commercial, +16738,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,Cigna-Commercial, +16739,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,Cigna-Commercial, +16740,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,Cigna-Commercial, +16741,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,Cigna-Commercial, +16742,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,Cigna-Commercial, +16743,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,Cigna-Commercial, +16744,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,Cigna-Commercial, +16745,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,Cigna-Commercial, +16746,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,Cigna-Commercial, +16747,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,Cigna-Commercial, +16748,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,Cigna-Commercial, +16749,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,Cigna-Commercial, +16750,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,Cigna-Commercial, +16751,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,Cigna-Commercial, +16752,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,Cigna-Commercial, +16753,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,Cigna-Commercial, +16754,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,Cigna-Commercial,18497.12 +16755,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,Cigna-Commercial, +16756,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,Cigna-Commercial, +16757,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,Cigna-Commercial, +16758,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,Cigna-Commercial, +16759,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,Cigna-Commercial, +16760,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,Cigna-Commercial, +16761,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,Cigna-Commercial, +16762,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,Cigna-Commercial, +16763,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,Cigna-Commercial, +16764,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,Cigna-Commercial, +16765,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,Cigna-Commercial, +16766,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,Cigna-Commercial, +16767,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,Cigna-Commercial, +16768,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,Cigna-Commercial, +16769,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,Cigna-Commercial, +16770,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,Cigna-Commercial, +16771,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,Cigna-Commercial, +16772,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,Cigna-Commercial, +16773,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,Cigna-Commercial, +16774,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,Cigna-Commercial, +16775,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,Cigna-Commercial,14621.56 +16776,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,Cigna-Commercial, +16777,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,Cigna-Commercial, +16778,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,Cigna-Commercial, +16779,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,Cigna-Commercial, +16780,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,Cigna-Commercial, +16781,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,Cigna-Commercial, +16782,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,Cigna-Commercial,72301.99 +16783,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,Cigna-Commercial, +16784,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,Cigna-Commercial, +16785,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,Cigna-Commercial, +16786,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,Cigna-Commercial, +16787,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,Cigna-Commercial, +16788,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,Cigna-Commercial, +16789,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,Cigna-Commercial, +16790,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,Cigna-Commercial, +16791,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,Cigna-Commercial, +16792,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,Cigna-Commercial, +16793,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,Cigna-Commercial, +16794,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,Cigna-Commercial, +16795,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,Cigna-Commercial, +16796,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,Cigna-Commercial,11264.93 +16797,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,Cigna-Commercial, +16798,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,Cigna-Commercial, +16799,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,Cigna-Commercial, +16800,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,Cigna-Commercial, +16801,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,Cigna-Commercial, +16802,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,Cigna-Commercial, +16803,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,Cigna-Commercial, +16804,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,Cigna-Commercial, +16805,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,Cigna-Commercial, +16806,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,Cigna-Commercial, +16807,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,Cigna-Commercial, +16808,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,Cigna-Commercial, +16809,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,Cigna-Commercial, +16810,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,Cigna-Commercial,34901.47 +16811,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,Cigna-Commercial, +16812,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,Cigna-Commercial, +16813,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,Cigna-Commercial, +16814,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,Cigna-Commercial, +16815,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,Cigna-Commercial, +16816,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,Cigna-Commercial, +16817,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,Cigna-Commercial, +16818,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,Cigna-Commercial, +16819,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,Cigna-Commercial, +16820,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,Cigna-Commercial, +16821,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,Cigna-Commercial, +16822,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,Cigna-Commercial, +16823,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,Cigna-Commercial, +16824,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,Cigna-Commercial, +16825,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,Cigna-Commercial,26562.05 +16826,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,Cigna-Commercial, +16827,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,Cigna-Commercial, +16828,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,Cigna-Commercial, +16829,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,Cigna-Commercial, +16830,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,Cigna-Commercial, +16831,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,Cigna-Commercial,13938.07 +16832,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,Cigna-Commercial, +16833,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,Cigna-Commercial, +16834,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,Cigna-Commercial, +16835,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,Cigna-Commercial, +16836,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,Cigna-Commercial, +16837,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,Cigna-Commercial, +16838,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,Cigna-Commercial, +16839,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,Cigna-Commercial, +16840,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,Cigna-Commercial, +16841,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,Cigna-Commercial, +16842,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,Cigna-Commercial, +16843,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,Cigna-Commercial, +16844,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,Cigna-Commercial, +16845,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,Cigna-Commercial, +16846,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,Cigna-Commercial, +16847,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,Cigna-Commercial, +16848,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,Cigna-Commercial, +16849,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,Cigna-Commercial, +16850,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,Cigna-Commercial, +16851,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,Cigna-Commercial, +16852,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,Cigna-Commercial, +16853,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,Cigna-Commercial, +16854,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,Cigna-Commercial, +16855,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,Cigna-Commercial, +16856,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,Cigna-Commercial, +16857,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,Cigna-Commercial, +16858,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,Cigna-Commercial, +16859,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,Cigna-Commercial, +16860,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,Cigna-Commercial,20315.54 +16861,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,Cigna-Commercial, +16862,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,Cigna-Commercial, +16863,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,Cigna-Commercial, +16864,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,Cigna-Commercial, +16865,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,Cigna-Commercial, +16866,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,Cigna-Commercial, +16867,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,Cigna-Commercial, +16868,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,Cigna-Commercial, +16869,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,Cigna-Commercial, +16870,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,Cigna-Commercial, +16871,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,Cigna-Commercial, +16872,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,Cigna-Commercial,10559.84 +16873,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,Cigna-Commercial, +16874,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,Cigna-Commercial,12822.37 +16875,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,Cigna-Commercial, +16876,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,Cigna-Commercial, +16877,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,Cigna-Commercial,8799.16 +16878,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,Cigna-Commercial, +16879,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,Cigna-Commercial,45586.78 +16880,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,Cigna-Commercial,13681.55 +16881,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,Cigna-Commercial,11048.12 +16882,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,Cigna-Commercial, +16883,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,Cigna-Commercial, +16884,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,Cigna-Commercial,198505.54 +16885,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,Cigna-Commercial, +16886,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,Cigna-Commercial,3953.37 +16887,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,Cigna-Commercial,3150.78 +16888,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,Cigna-Commercial,2768.06 +16889,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,Cigna-Commercial, +16890,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,Cigna-Commercial, +16891,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,Cigna-Commercial, +16892,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,Cigna-Commercial, +16893,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,Cigna-Commercial, +16894,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,Cigna-Commercial, +16895,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,Cigna-Commercial, +16896,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,Cigna-Commercial, +16897,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,Cigna-Commercial,11774.0 +16898,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,Cigna-Commercial,11396.78 +16899,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,Cigna-Commercial,8994.44 +16900,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,Cigna-Commercial, +16901,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,Cigna-Commercial, +16902,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,Cigna-Commercial, +16903,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,Cigna-Commercial, +16904,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,Cigna-Commercial, +16905,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,Cigna-Commercial,58626.02 +16906,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,Cigna-Commercial, +16907,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,Cigna-Commercial, +16908,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,Cigna-Commercial, +16909,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,Cigna-Commercial, +16910,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,Cigna-Commercial, +16911,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,Cigna-Commercial, +16912,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,Cigna-Commercial, +16913,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,Cigna-Commercial, +16914,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,Cigna-Commercial, +16915,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,Cigna-Commercial, +16916,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,Cigna-Commercial, +16917,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,Cigna-Commercial,26128.31 +16918,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,Cigna-Commercial, +16919,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,Cigna-Commercial, +16920,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,Cigna-Commercial, +16921,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,Cigna-Commercial, +16922,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,Cigna-Commercial, +16923,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,Cigna-Commercial, +16924,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,Cigna-Commercial,12939.29 +16925,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,Cigna-Commercial,9410.96 +16926,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,Cigna-Commercial, +16927,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,Cigna-Commercial, +16928,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,Cigna-Commercial, +16929,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,Cigna-Commercial, +16930,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,Cigna-Commercial, +16931,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,Cigna-Commercial, +16932,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,Cigna-Commercial, +16933,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,Cigna-Commercial, +16934,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,Cigna-Commercial, +16935,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,Cigna-Commercial, +16936,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,Cigna-Commercial, +16937,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,Cigna-Commercial, +16938,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,Cigna-Commercial, +16939,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,Cigna-Commercial, +16940,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,Cigna-Commercial, +16941,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,Cigna-Commercial,37305.93 +16942,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,Cigna-Commercial, +16943,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,Cigna-Commercial,35249.17 +16944,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,Cigna-Commercial, +16945,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,Cigna-Commercial, +16946,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,Cigna-Commercial, +16947,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,Cigna-Commercial, +16948,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,Cigna-Commercial, +16949,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,Cigna-Commercial, +16950,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,Cigna-Commercial, +16951,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,Cigna-Commercial, +16952,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,Cigna-Commercial, +16953,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,Cigna-Commercial,237536.47 +16954,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,Cigna-Commercial,33363.24 +16955,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,Cigna-Commercial,17720.92 +16956,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,Cigna-Commercial, +16957,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,Cigna-Commercial, +16958,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,Cigna-Commercial, +16959,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,Cigna-Commercial, +16960,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,Cigna-Commercial, +16961,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,Cigna-Commercial, +16962,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,Cigna-Commercial, +16963,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,Cigna-Commercial, +16964,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,Cigna-Commercial, +16965,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,Cigna-Commercial, +16966,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,Cigna-Commercial, +16967,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,Cigna-Commercial, +16968,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,Cigna-Commercial,8178.0 +16969,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,Cigna-Commercial, +16970,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,Cigna-Commercial, +16971,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,Cigna-Commercial, +16972,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,Cigna-Commercial, +16973,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,Cigna-Commercial, +16974,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,Cigna-Commercial, +16975,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,Cigna-Commercial, +16976,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,Cigna-Commercial, +16977,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,Cigna-Commercial, +16978,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,Cigna-Commercial, +16979,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,Cigna-Commercial, +16980,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,Cigna-Commercial, +16981,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,Cigna-Commercial,14531.07 +16982,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,Cigna-Commercial,137349.33 +16983,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,Cigna-Commercial, +16984,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,Cigna-Commercial, +16985,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,Cigna-Commercial, +16986,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,Cigna-Commercial, +16987,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,Cigna-Commercial,109687.9 +16988,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,Cigna-Commercial, +16989,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,Cigna-Commercial, +16990,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,Cigna-Commercial, +16991,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,Cigna-Commercial, +16992,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,Cigna-Commercial, +16993,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,Cigna-Commercial, +16994,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,Cigna-Commercial, +16995,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,Cigna-Commercial, +16996,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,Cigna-Commercial, +16997,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,Cigna-Commercial, +16998,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,Cigna-Commercial, +16999,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,Cigna-Commercial, +17000,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,Cigna-Commercial, +17001,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,Cigna-Commercial, +17002,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,Cigna-Commercial, +17003,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,Cigna-Commercial, +17004,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,Cigna-Commercial, +17005,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,Cigna-Commercial, +17006,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,Cigna-Commercial, +17007,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,Cigna-Commercial, +17008,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,Cigna-Commercial, +17009,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,Cigna-Commercial, +17010,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,Cigna-Commercial, +17011,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,Cigna-Commercial,4238.0 +17012,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,Cigna-Commercial, +17013,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,Cigna-Commercial,4802.34 +17014,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,Cigna-Commercial,2400.35 +17015,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,Cigna-Commercial, +17016,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,Cigna-Commercial, +17017,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,Cigna-Commercial,1724.0 +17018,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,Cigna-Commercial,398.01 +17019,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,Cigna-Commercial, +17020,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,Cigna-Commercial, +17021,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,Cigna-Commercial, +17022,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,Cigna-Commercial,4800.7 +17023,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,Cigna-Commercial, +17024,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,Cigna-Commercial,180.2 +17025,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,Cigna-Commercial, +17026,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,Cigna-Commercial, +17027,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,Cigna-Commercial, +17028,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,Cigna-Commercial, +17029,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,Cigna-Commercial, +17030,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,Cigna-Commercial, +17031,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,Cigna-Commercial, +17032,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,Cigna-Commercial, +17033,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,Cigna-Commercial, +17034,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,Cigna-Commercial, +17035,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,Cigna-Commercial,2154.29 +17036,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,Cigna-Commercial, +17037,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,Cigna-Commercial, +17038,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,Cigna-Commercial,4451.7 +17039,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,Cigna-Commercial,3560.05 +17040,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,Cigna-Commercial,5136.0 +17041,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,Cigna-Commercial,4800.7 +17042,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,Cigna-Commercial, +17043,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,Cigna-Commercial,4800.7 +17044,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,Cigna-Commercial,2400.35 +17045,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,Cigna-Commercial,4329.58 +17046,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,Cigna-Commercial, +17047,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,Cigna-Commercial,4800.7 +17048,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,Cigna-Commercial, +17049,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,Cigna-Commercial, +17050,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,Cigna-Commercial,3600.53 +17051,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,Cigna-Commercial,5024.0 +17052,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,Cigna-Commercial,4642.0 +17053,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,Cigna-Commercial, +17054,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,Cigna-Commercial,4986.0 +17055,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,Cigna-Commercial, +17056,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,Cigna-Commercial,4800.7 +17057,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,Cigna-Commercial, +17058,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,Cigna-Commercial, +17059,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,Cigna-Commercial, +17060,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,Cigna-Commercial, +17061,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,Cigna-Commercial, +17062,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,Cigna-Commercial, +17063,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,Cigna-Commercial, +17064,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,Cigna-Commercial,3992.14 +17065,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,Cigna-Commercial, +17066,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,Cigna-Commercial, +17067,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,Cigna-Commercial, +17068,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,Cigna-Commercial, +17069,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,Cigna-Commercial, +17070,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,Cigna-Commercial, +17071,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,Cigna-Commercial, +17072,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,Cigna-Commercial, +17073,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,Cigna-Commercial, +17074,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,Cigna-Commercial, +17075,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,Cigna-Commercial, +17076,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,Cigna-Commercial, +17077,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,Cigna-Commercial, +17078,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,Cigna-Commercial,1174.02 +17079,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,Cigna-Commercial, +17080,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,Cigna-Commercial,323.74 +17081,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,Cigna-Commercial, +17082,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,Cigna-Commercial,4379.0 +17083,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,Cigna-Commercial,4429.89 +17084,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,Cigna-Commercial, +17085,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,Cigna-Commercial, +17086,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,Cigna-Commercial, +17087,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,Cigna-Commercial, +17088,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,Cigna-Commercial, +17089,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,Cigna-Commercial,5090.59 +17090,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,Cigna-Commercial, +17091,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,Cigna-Commercial, +17092,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,Cigna-Commercial, +17093,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,Cigna-Commercial, +17094,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,Cigna-Commercial, +17095,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,Cigna-Commercial,383.12 +17096,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,Cigna-Commercial,420.23 +17097,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,Cigna-Commercial,480.08 +17098,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,Cigna-Commercial, +17099,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,Cigna-Commercial,479.19 +17100,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,Cigna-Commercial,397.82 +17101,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,Cigna-Commercial, +17102,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,Cigna-Commercial,110.46 +17103,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,Cigna-Commercial, +17104,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,Cigna-Commercial, +17105,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,Cigna-Commercial, +17106,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,Cigna-Commercial, +17107,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,Cigna-Commercial, +17108,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,Cigna-Commercial, +17109,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,Cigna-Commercial, +17110,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,Cigna-Commercial, +17111,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,Cigna-Commercial, +17112,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,Cigna-Commercial, +17113,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,Cigna-Commercial, +17114,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,Cigna-Commercial, +17115,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,Cigna-Commercial, +17116,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,Cigna-Commercial, +17117,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,Cigna-Commercial,414.21 +17118,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,Cigna-Commercial,257.7 +17119,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,Cigna-Commercial, +17120,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,Cigna-Commercial, +17121,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,Cigna-Commercial,4820.58 +17122,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,Cigna-Commercial, +17123,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,Cigna-Commercial,2400.35 +17124,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,Cigna-Commercial,3744.69 +17125,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,Cigna-Commercial, +17126,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,Cigna-Commercial,2400.35 +17127,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,Cigna-Commercial,2021.49 +17128,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,Cigna-Commercial, +17129,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,Cigna-Commercial,2544.51 +17130,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,Cigna-Commercial, +17131,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,Cigna-Commercial, +17132,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,Cigna-Commercial, +17133,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,Cigna-Commercial,4624.0 +17134,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,Cigna-Commercial, +17135,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,Cigna-Commercial, +17136,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,Cigna-Commercial, +17137,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,Cigna-Commercial,4800.7 +17138,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,Cigna-Commercial, +17139,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,Cigna-Commercial, +17140,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,Cigna-Commercial, +17141,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,Cigna-Commercial,2321.0 +17142,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,Cigna-Commercial, +17143,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,Cigna-Commercial, +17144,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,Cigna-Commercial,4642.0 +17145,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,Cigna-Commercial, +17146,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,Cigna-Commercial, +17147,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,Cigna-Commercial, +17148,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,Cigna-Commercial, +17149,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,Cigna-Commercial, +17150,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,Cigna-Commercial, +17151,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,Cigna-Commercial, +17152,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,Cigna-Commercial, +17153,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,Cigna-Commercial, +17154,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,Cigna-Commercial, +17155,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,Cigna-Commercial, +17156,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,Cigna-Commercial, +17157,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,Cigna-Commercial, +17158,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,Cigna-Commercial, +17159,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,Cigna-Commercial, +17160,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,Cigna-Commercial, +17161,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,Cigna-Commercial, +17162,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,Cigna-Commercial, +17163,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,Cigna-Commercial,4642.0 +17164,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,Cigna-Commercial,984.28 +17165,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,Cigna-Commercial,3681.73 +17166,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,Cigna-Commercial,6487.46 +17167,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,Cigna-Commercial,5831.81 +17168,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,Cigna-Commercial, +17169,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,Cigna-Commercial, +17170,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,Cigna-Commercial, +17171,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,Cigna-Commercial, +17172,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,Cigna-Commercial,5089.02 +17173,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,Cigna-Commercial, +17174,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,Cigna-Commercial,3017.87 +17175,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,Cigna-Commercial, +17176,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,Cigna-Commercial, +17177,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,Cigna-Commercial,345.0 +17178,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,Cigna-Commercial, +17179,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,Cigna-Commercial, +17180,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,Cigna-Commercial, +17181,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,Cigna-Commercial,1980.5 +17182,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,Cigna-Commercial, +17183,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,Cigna-Commercial,5523.08 +17184,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,Cigna-Commercial, +17185,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,Cigna-Commercial,4853.85 +17186,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,Cigna-Commercial,601.25 +17187,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,Cigna-Commercial,4344.7 +17188,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,Cigna-Commercial, +17189,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,Cigna-Commercial, +17190,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,Cigna-Commercial,3592.25 +17191,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,Cigna-Commercial,5426.64 +17192,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,Cigna-Commercial,4292.16 +17193,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,Cigna-Commercial, +17194,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,Cigna-Commercial, +17195,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,Cigna-Commercial,2750.52 +17196,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,Cigna-Commercial, +17197,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,Cigna-Commercial,3998.75 +17198,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,Cigna-Commercial, +17199,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,Cigna-Commercial,5746.01 +17200,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,Cigna-Commercial,3628.81 +17201,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,Cigna-Commercial, +17202,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,Cigna-Commercial,2546.08 +17203,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,Cigna-Commercial,7857.25 +17204,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,Cigna-Commercial, +17205,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,Cigna-Commercial, +17206,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,Cigna-Commercial, +17207,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,Cigna-Commercial,4421.81 +17208,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,Cigna-Commercial, +17209,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,Cigna-Commercial,3706.17 +17210,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,Cigna-Commercial,2644.53 +17211,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,Cigna-Commercial,7201.05 +17212,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,Cigna-Commercial,2546.08 +17213,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,Cigna-Commercial, +17214,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,Cigna-Commercial,6604.31 +17215,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,Cigna-Commercial, +17216,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,Cigna-Commercial, +17217,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,Cigna-Commercial, +17218,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,Cigna-Commercial, +17219,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,Cigna-Commercial,4642.0 +17220,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,Cigna-Commercial,3341.63 +17221,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,Cigna-Commercial, +17222,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,Cigna-Commercial,2422.43 +17223,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,Cigna-Commercial, +17224,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,Cigna-Commercial, +17225,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,Cigna-Commercial, +17226,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,Cigna-Commercial, +17227,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,Cigna-Commercial,486.97 +17228,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,Cigna-Commercial, +17229,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,Cigna-Commercial, +17230,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,Cigna-Commercial, +17231,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,Cigna-Commercial, +17232,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,Cigna-Commercial, +17233,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,Cigna-Commercial,4800.7 +17234,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,Cigna-Commercial, +17235,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,Cigna-Commercial, +17236,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,Cigna-Commercial, +17237,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,Cigna-Commercial, +17238,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,Cigna-Commercial, +17239,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,Cigna-Commercial, +17240,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,Cigna-Commercial,4832.64 +17241,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,Cigna-Commercial, +17242,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,Cigna-Commercial, +17243,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,Cigna-Commercial, +17244,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,Cigna-Commercial, +17245,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,Cigna-Commercial, +17246,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,Cigna-Commercial, +17247,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,Cigna-Commercial, +17248,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,Cigna-Commercial,4924.0 +17249,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,Cigna-Commercial, +17250,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,Cigna-Commercial, +17251,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,Cigna-Commercial, +17252,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,Cigna-Commercial, +17253,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,Cigna-Commercial, +17254,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,Cigna-Commercial, +17255,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,Cigna-Commercial, +17256,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,Cigna-Commercial, +17257,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,Cigna-Commercial, +17258,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,Cigna-Commercial, +17259,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,Cigna-Commercial, +17260,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,Cigna-Commercial, +17261,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,Cigna-Commercial, +17262,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,Cigna-Commercial, +17263,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,Cigna-Commercial,5265.98 +17264,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,Cigna-Commercial, +17265,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,Cigna-Commercial, +17266,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,Cigna-Commercial, +17267,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,Cigna-Commercial, +17268,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,Cigna-Commercial, +17269,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,Cigna-Commercial, +17270,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,Cigna-Commercial,4379.0 +17271,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,Cigna-Commercial, +17272,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,Cigna-Commercial, +17273,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,Cigna-Commercial, +17274,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,Cigna-Commercial, +17275,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,Cigna-Commercial, +17276,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,Cigna-Commercial, +17277,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,Cigna-Commercial, +17278,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,Cigna-Commercial, +17279,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,Cigna-Commercial, +17280,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,Cigna-Commercial, +17281,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,Cigna-Commercial, +17282,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,Cigna-Commercial, +17283,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,Cigna-Commercial, +17284,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,Cigna-Commercial, +17285,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,Cigna-Commercial, +17286,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,Cigna-Commercial, +17287,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,Cigna-Commercial, +17288,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,Cigna-Commercial, +17289,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,Cigna-Commercial, +17290,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,Cigna-Commercial, +17291,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,Cigna-Commercial, +17292,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,Cigna-Commercial, +17293,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,Cigna-Commercial, +17294,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,Cigna-Commercial, +17295,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,Cigna-Commercial,4216.77 +17296,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,Cigna-Commercial, +17297,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,Cigna-Commercial, +17298,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,Cigna-Commercial,4123.79 +17299,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,Cigna-Commercial, +17300,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,Cigna-Commercial, +17301,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,Cigna-Commercial, +17302,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,Cigna-Commercial, +17303,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,Cigna-Commercial, +17304,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,Cigna-Commercial,7325.1 +17305,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,Cigna-Commercial, +17306,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,Cigna-Commercial, +17307,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,Cigna-Commercial, +17308,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,Cigna-Commercial, +17309,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,Cigna-Commercial, +17310,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,Cigna-Commercial, +17311,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,Cigna-Commercial, +17312,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,Cigna-Commercial,4233.07 +17313,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,Cigna-Commercial,4642.0 +17314,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,Cigna-Commercial,4312.56 +17315,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,Cigna-Commercial, +17316,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,Cigna-Commercial, +17317,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,Cigna-Commercial, +17318,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,Cigna-Commercial, +17319,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,Cigna-Commercial, +17320,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,Cigna-Commercial,4950.07 +17321,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,Cigna-Commercial,3354.15 +17322,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,Cigna-Commercial, +17323,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,Cigna-Commercial, +17324,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,Cigna-Commercial,5323.64 +17325,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,Cigna-Commercial, +17326,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,Cigna-Commercial, +17327,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,Cigna-Commercial, +17328,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,Cigna-Commercial,756.31 +17329,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,Cigna-Commercial, +17330,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,Cigna-Commercial, +17331,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,Cigna-Commercial, +17332,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,Cigna-Commercial, +17333,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,Cigna-Commercial, +17334,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,Cigna-Commercial, +17335,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,Cigna-Commercial, +17336,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,Cigna-Commercial,4642.0 +17337,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,Cigna-Commercial, +17338,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,Cigna-Commercial, +17339,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,Cigna-Commercial, +17340,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,Cigna-Commercial, +17341,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,Cigna-Commercial, +17342,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,Cigna-Commercial, +17343,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,Cigna-Commercial,5560.57 +17344,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,Cigna-Commercial,4373.03 +17345,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,Cigna-Commercial, +17346,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,Cigna-Commercial, +17347,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,Cigna-Commercial,4652.81 +17348,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,Cigna-Commercial, +17349,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,Cigna-Commercial, +17350,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,Cigna-Commercial, +17351,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,Cigna-Commercial, +17352,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,Cigna-Commercial, +17353,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,Cigna-Commercial, +17354,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,Cigna-Commercial,4642.0 +17355,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,Cigna-Commercial, +17356,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,Cigna-Commercial, +17357,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,Cigna-Commercial, +17358,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,Cigna-Commercial, +17359,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,Cigna-Commercial, +17360,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,Cigna-Commercial, +17361,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,Cigna-Commercial, +17362,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,Cigna-Commercial, +17363,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,Cigna-Commercial,1127.9 +17364,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,Cigna-Commercial,836.11 +17365,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,Cigna-Commercial,6631.42 +17366,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,Cigna-Commercial, +17367,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,Cigna-Commercial, +17368,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,Cigna-Commercial,1856.8 +17369,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,Cigna-Commercial, +17370,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,Cigna-Commercial, +17371,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,Cigna-Commercial,6510.22 +17372,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,Cigna-Commercial,5134.32 +17373,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,Cigna-Commercial, +17374,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,Cigna-Commercial, +17375,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,Cigna-Commercial, +17376,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,Cigna-Commercial,4378.31 +17377,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,Cigna-Commercial,3886.0 +17378,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,Cigna-Commercial,4460.72 +17379,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,Cigna-Commercial, +17380,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,Cigna-Commercial, +17381,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,Cigna-Commercial,4443.38 +17382,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,Cigna-Commercial, +17383,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,Cigna-Commercial, +17384,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,Cigna-Commercial, +17385,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,Cigna-Commercial, +17386,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,Cigna-Commercial, +17387,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,Cigna-Commercial,5554.04 +17388,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,Cigna-Commercial, +17389,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,Cigna-Commercial, +17390,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,Cigna-Commercial, +17391,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,Cigna-Commercial, +17392,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,Cigna-Commercial, +17393,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,Cigna-Commercial, +17394,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,Cigna-Commercial, +17395,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,Cigna-Commercial, +17396,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,Cigna-Commercial, +17397,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,Cigna-Commercial, +17398,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,Cigna-Commercial, +17399,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,Cigna-Commercial, +17400,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,Cigna-Commercial, +17401,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,Cigna-Commercial, +17402,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,Cigna-Commercial, +17403,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,Cigna-Commercial, +17404,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,Cigna-Commercial, +17405,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,Cigna-Commercial, +17406,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,Cigna-Commercial, +17407,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,Cigna-Commercial,2321.0 +17408,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,Cigna-Commercial, +17409,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,Cigna-Commercial,7322.92 +17410,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,Cigna-Commercial, +17411,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,Cigna-Commercial, +17412,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,Cigna-Commercial, +17413,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,Cigna-Commercial,5798.71 +17414,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,Cigna-Commercial, +17415,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,Cigna-Commercial, +17416,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,Cigna-Commercial, +17417,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,Cigna-Commercial, +17418,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,Cigna-Commercial, +17419,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,Cigna-Commercial,4252.16 +17420,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,Cigna-Commercial,4652.81 +17421,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,Cigna-Commercial, +17422,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,Cigna-Commercial, +17423,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,Cigna-Commercial,5446.36 +17424,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,Cigna-Commercial, +17425,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,Cigna-Commercial, +17426,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,Cigna-Commercial,4806.48 +17427,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,Cigna-Commercial,4732.16 +17428,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,Cigna-Commercial, +17429,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,Cigna-Commercial, +17430,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,Cigna-Commercial,4652.81 +17431,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,Cigna-Commercial, +17432,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,Cigna-Commercial, +17433,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,Cigna-Commercial, +17434,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,Cigna-Commercial, +17435,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,Cigna-Commercial, +17436,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,Cigna-Commercial,1005.14 +17437,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,Cigna-Commercial, +17438,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,Cigna-Commercial, +17439,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,Cigna-Commercial, +17440,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,Cigna-Commercial, +17441,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,Cigna-Commercial, +17442,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,Cigna-Commercial, +17443,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,Cigna-Commercial, +17444,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,Cigna-Commercial, +17445,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,Cigna-Commercial, +17446,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,Cigna-Commercial, +17447,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,Cigna-Commercial,4231.86 +17448,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,Cigna-Commercial,2400.35 +17449,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,Cigna-Commercial, +17450,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,Cigna-Commercial, +17451,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,Cigna-Commercial, +17452,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,Cigna-Commercial, +17453,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,Cigna-Commercial, +17454,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,Cigna-Commercial, +17455,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,Cigna-Commercial, +17456,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,Cigna-Commercial, +17457,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,Cigna-Commercial, +17458,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,Cigna-Commercial, +17459,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,Cigna-Commercial, +17460,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,Cigna-Commercial, +17461,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,Cigna-Commercial, +17462,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,Cigna-Commercial, +17463,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,Cigna-Commercial, +17464,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,Cigna-Commercial, +17465,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,Cigna-Commercial, +17466,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,Cigna-Commercial, +17467,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,Cigna-Commercial, +17468,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,Cigna-Commercial,4396.29 +17469,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,Cigna-Commercial, +17470,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,Cigna-Commercial, +17471,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,Cigna-Commercial, +17472,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,Cigna-Commercial, +17473,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,Cigna-Commercial,451.94 +17474,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,Cigna-Commercial, +17475,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,Cigna-Commercial,5134.32 +17476,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,Cigna-Commercial, +17477,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,Cigna-Commercial, +17478,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,Cigna-Commercial, +17479,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,Cigna-Commercial, +17480,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,Cigna-Commercial, +17481,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,Cigna-Commercial, +17482,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,Cigna-Commercial, +17483,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,Cigna-Commercial,14847.38 +17484,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,Cigna-Commercial, +17485,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,Cigna-Commercial, +17486,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,Cigna-Commercial, +17487,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,Cigna-Commercial, +17488,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,Cigna-Commercial, +17489,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,Cigna-Commercial, +17490,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,Cigna-Commercial, +17491,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,Cigna-Commercial, +17492,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,Cigna-Commercial, +17493,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,Cigna-Commercial, +17494,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,Cigna-Commercial, +17495,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,Cigna-Commercial, +17496,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,Cigna-Commercial, +17497,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,Cigna-Commercial, +17498,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,Cigna-Commercial,3667.5 +17499,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,Cigna-Commercial, +17500,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,Cigna-Commercial, +17501,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,Cigna-Commercial, +17502,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,Cigna-Commercial, +17503,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,Cigna-Commercial, +17504,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,Cigna-Commercial, +17505,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,Cigna-Commercial, +17506,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,Cigna-Commercial, +17507,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,Cigna-Commercial, +17508,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,Cigna-Commercial, +17509,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,Cigna-Commercial, +17510,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,Cigna-Commercial, +17511,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,Cigna-Commercial, +17512,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,Cigna-Commercial, +17513,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,Cigna-Commercial, +17514,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,Cigna-Commercial, +17515,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,Cigna-Commercial,9421.65 +17516,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,Cigna-Commercial, +17517,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,Cigna-Commercial, +17518,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,Cigna-Commercial, +17519,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,Cigna-Commercial, +17520,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,Cigna-Commercial, +17521,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,Cigna-Commercial, +17522,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,Cigna-Commercial, +17523,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,Cigna-Commercial,4800.7 +17524,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,Cigna-Commercial, +17525,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,Cigna-Commercial, +17526,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,Cigna-Commercial,946.04 +17527,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,Cigna-Commercial, +17528,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,Cigna-Commercial, +17529,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,Cigna-Commercial, +17530,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,Cigna-Commercial, +17531,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,Cigna-Commercial, +17532,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,Cigna-Commercial, +17533,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,Cigna-Commercial,3816.77 +17534,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,Cigna-Commercial, +17535,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,Cigna-Commercial, +17536,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,Cigna-Commercial, +17537,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,Cigna-Commercial, +17538,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,Cigna-Commercial,2400.35 +17539,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,Cigna-Commercial, +17540,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,Cigna-Commercial, +17541,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,Cigna-Commercial, +17542,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,Cigna-Commercial, +17543,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,Cigna-Commercial, +17544,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,Cigna-Commercial, +17545,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,Cigna-Commercial, +17546,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,Cigna-Commercial, +17547,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,Cigna-Commercial, +17548,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,Cigna-Commercial,4642.0 +17549,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,Cigna-Commercial, +17550,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,Cigna-Commercial, +17551,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,Cigna-Commercial, +17552,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,Cigna-Commercial, +17553,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,Cigna-Commercial, +17554,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,Cigna-Commercial, +17555,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,Cigna-Commercial, +17556,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,Cigna-Commercial, +17557,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,Cigna-Commercial, +17558,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,Cigna-Commercial,5628.42 +17559,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,Cigna-Commercial, +17560,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,Cigna-Commercial, +17561,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,Cigna-Commercial, +17562,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,Cigna-Commercial,3379.41 +17563,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,Cigna-Commercial,4772.63 +17564,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,Cigna-Commercial, +17565,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,Cigna-Commercial, +17566,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,Cigna-Commercial, +17567,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,Cigna-Commercial, +17568,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,Cigna-Commercial, +17569,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,Cigna-Commercial, +17570,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,Cigna-Commercial, +17571,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,Cigna-Commercial, +17572,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,Cigna-Commercial, +17573,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,Cigna-Commercial, +17574,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,Cigna-Commercial, +17575,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,Cigna-Commercial,4024.23 +17576,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,Cigna-Commercial, +17577,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,Cigna-Commercial, +17578,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,Cigna-Commercial, +17579,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,Cigna-Commercial,5062.74 +17580,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,Cigna-Commercial, +17581,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,Cigna-Commercial, +17582,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,Cigna-Commercial, +17583,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,Cigna-Commercial, +17584,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,Cigna-Commercial, +17585,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,Cigna-Commercial, +17586,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,Cigna-Commercial, +17587,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,Cigna-Commercial, +17588,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,Cigna-Commercial, +17589,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,Cigna-Commercial, +17590,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,Cigna-Commercial, +17591,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,Cigna-Commercial,4632.39 +17592,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,Cigna-Commercial, +17593,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,Cigna-Commercial,4607.24 +17594,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,Cigna-Commercial, +17595,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,Cigna-Commercial, +17596,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,Cigna-Commercial, +17597,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,Cigna-Commercial, +17598,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,Cigna-Commercial,7088.7 +17599,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,Cigna-Commercial, +17600,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,Cigna-Commercial, +17601,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,Cigna-Commercial, +17602,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,Cigna-Commercial, +17603,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,Cigna-Commercial, +17604,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,Cigna-Commercial, +17605,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,Cigna-Commercial, +17606,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,Cigna-Commercial, +17607,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,Cigna-Commercial, +17608,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,Cigna-Commercial, +17609,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,Cigna-Commercial, +17610,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,Cigna-Commercial, +17611,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,Cigna-Commercial, +17612,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,Cigna-Commercial, +17613,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,Cigna-Commercial,6691.23 +17614,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,Cigna-Commercial, +17615,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,Cigna-Commercial, +17616,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,Cigna-Commercial,6062.25 +17617,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,Cigna-Commercial,496.01 +17618,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,Cigna-Commercial, +17619,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,Cigna-Commercial,5035.31 +17620,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,Cigna-Commercial, +17621,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,Cigna-Commercial,461.95 +17622,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,Cigna-Commercial,3081.34 +17623,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,Cigna-Commercial, +17624,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,Cigna-Commercial, +17625,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,Cigna-Commercial, +17626,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,Cigna-Commercial, +17627,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,Cigna-Commercial,5363.19 +17628,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,Cigna-Commercial, +17629,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,Cigna-Commercial,4327.25 +17630,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,Cigna-Commercial, +17631,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,Cigna-Commercial, +17632,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,Cigna-Commercial, +17633,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,Cigna-Commercial, +17634,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,Cigna-Commercial, +17635,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,Cigna-Commercial,157.87 +17636,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,Cigna-Commercial,193.84 +17637,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,Cigna-Commercial,207.07 +17638,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,Cigna-Commercial, +17639,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,Cigna-Commercial,171.55 +17640,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,Cigna-Commercial, +17641,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,Cigna-Commercial, +17642,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,Cigna-Commercial,451.58 +17643,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,Cigna-Commercial,313.51 +17644,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,Cigna-Commercial,1372.58 +17645,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,Cigna-Commercial, +17646,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,Cigna-Commercial, +17647,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,Cigna-Commercial, +17648,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,Cigna-Commercial,5782.0 +17649,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,Cigna-Commercial, +17650,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,Cigna-Commercial, +17651,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,Cigna-Commercial, +17652,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,Cigna-Commercial, +17653,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,Cigna-Commercial,4056.0 +17654,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,Cigna-Commercial, +17655,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,Cigna-Commercial, +17656,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,Cigna-Commercial,2400.35 +17657,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,Cigna-Commercial,7263.14 +17658,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,Cigna-Commercial,4999.2 +17659,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,Cigna-Commercial, +17660,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,Cigna-Commercial, +17661,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,Cigna-Commercial, +17662,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,Cigna-Commercial,5212.84 +17663,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,Cigna-Commercial, +17664,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,Cigna-Commercial,9417.75 +17665,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,Cigna-Commercial, +17666,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,Cigna-Commercial, +17667,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,Cigna-Commercial, +17668,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,Cigna-Commercial, +17669,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,Cigna-Commercial, +17670,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,Cigna-Commercial, +17671,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,Cigna-Commercial,4378.17 +17672,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,Cigna-Commercial, +17673,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,Cigna-Commercial, +17674,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,Cigna-Commercial,4800.7 +17675,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,Cigna-Commercial,4896.81 +17676,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,Cigna-Commercial,4640.87 +17677,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,Cigna-Commercial, +17678,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,Cigna-Commercial, +17679,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,Cigna-Commercial, +17680,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,Cigna-Commercial,5801.18 +17681,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,Cigna-Commercial, +17682,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,Cigna-Commercial,4642.0 +17683,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,Cigna-Commercial, +17684,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,Cigna-Commercial,4800.7 +17685,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,Cigna-Commercial, +17686,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,Cigna-Commercial, +17687,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,Cigna-Commercial, +17688,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,Cigna-Commercial, +17689,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,Cigna-Commercial,143.86 +17690,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,Cigna-Commercial, +17691,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,Cigna-Commercial, +17692,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,Cigna-Commercial, +17693,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,Cigna-Commercial, +17694,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,Cigna-Commercial, +17695,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,Cigna-Commercial, +17696,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,Cigna-Commercial,4642.0 +17697,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,Cigna-Commercial,291.94 +17698,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,Cigna-Commercial, +17699,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,Cigna-Commercial, +17700,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,Cigna-Commercial,4863.02 +17701,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,Cigna-Commercial, +17702,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,Cigna-Commercial, +17703,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,Cigna-Commercial, +17704,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,Cigna-Commercial, +17705,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,Cigna-Commercial, +17706,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,Cigna-Commercial, +17707,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,Cigna-Commercial, +17708,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,Cigna-Commercial, +17709,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,Cigna-Commercial, +17710,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,Cigna-Commercial, +17711,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,Cigna-Commercial, +17712,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,Cigna-Commercial, +17713,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,Cigna-Commercial,4638.49 +17714,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,Cigna-Commercial, +17715,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,Cigna-Commercial, +17716,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,Cigna-Commercial, +17717,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,Cigna-Commercial, +17718,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,Cigna-Commercial, +17719,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,Cigna-Commercial,247.88 +17720,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,Cigna-Commercial, +17721,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,Cigna-Commercial, +17722,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,Cigna-Commercial, +17723,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,Cigna-Commercial, +17724,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,Cigna-Commercial, +17725,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,Cigna-Commercial, +17726,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,Cigna-Commercial, +17727,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,Cigna-Commercial, +17728,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,Cigna-Commercial, +17729,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,Cigna-Commercial, +17730,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,Cigna-Commercial, +17731,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,Cigna-Commercial, +17732,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,Cigna-Commercial,357.45 +17733,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,Cigna-Commercial, +17734,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,Cigna-Commercial, +17735,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,Cigna-Commercial, +17736,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,Cigna-Commercial, +17737,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,Cigna-Commercial, +17738,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,Cigna-Commercial, +17739,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,Cigna-Commercial, +17740,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,Cigna-Commercial,2544.51 +17741,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,Cigna-Commercial, +17742,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,Cigna-Commercial, +17743,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,Cigna-Commercial, +17744,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,Cigna-Commercial, +17745,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,Cigna-Commercial, +17746,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,Cigna-Commercial,3906.41 +17747,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,Cigna-Commercial, +17748,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,Cigna-Commercial, +17749,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,Cigna-Commercial, +17750,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,Cigna-Commercial, +17751,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,Cigna-Commercial, +17752,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,Cigna-Commercial, +17753,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,Cigna-Commercial, +17754,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,Cigna-Commercial, +17755,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,Cigna-Commercial,5089.02 +17756,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,Cigna-Commercial, +17757,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,Cigna-Commercial, +17758,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,Cigna-Commercial, +17759,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,Cigna-Commercial, +17760,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,Cigna-Commercial,4803.18 +17761,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,Cigna-Commercial,5089.02 +17762,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,Cigna-Commercial, +17763,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,Cigna-Commercial, +17764,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,Cigna-Commercial, +17765,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,Cigna-Commercial, +17766,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,Cigna-Commercial, +17767,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,Cigna-Commercial, +17768,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,Cigna-Commercial, +17769,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,Cigna-Commercial, +17770,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,Cigna-Commercial, +17771,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,Cigna-Commercial, +17772,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,Cigna-Commercial, +17773,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,Cigna-Commercial,13355.67 +17774,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,Cigna-Commercial, +17775,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,Cigna-Commercial, +17776,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,Cigna-Commercial, +17777,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,Cigna-Commercial, +17778,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,Cigna-Commercial, +17779,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,Cigna-Commercial, +17780,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,Cigna-Commercial, +17781,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,Cigna-Commercial, +17782,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,Cigna-Commercial, +17783,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,Cigna-Commercial,10197.21 +17784,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,Cigna-Commercial, +17785,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,Cigna-Commercial, +17786,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,Cigna-Commercial, +17787,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,Cigna-Commercial, +17788,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,Cigna-Commercial, +17789,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,Cigna-Commercial, +17790,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,Cigna-Commercial, +17791,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,Cigna-Commercial, +17792,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,Cigna-Commercial,22179.11 +17793,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,Cigna-Commercial, +17794,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,Cigna-Commercial, +17795,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,Cigna-Commercial, +17796,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,Cigna-Commercial, +17797,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,Cigna-Commercial,8182.04 +17798,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,Cigna-Commercial,1502.55 +17799,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,Cigna-Commercial, +17800,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,Cigna-Commercial, +17801,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,Cigna-Commercial, +17802,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,Cigna-Commercial, +17803,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,Cigna-Commercial, +17804,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,Cigna-Commercial, +17805,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,Cigna-Commercial, +17806,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,Cigna-Commercial, +17807,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,Cigna-Commercial, +17808,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,Cigna-Commercial, +17809,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,Cigna-Commercial, +17810,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,Cigna-Commercial, +17811,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,Cigna-Commercial, +17812,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,Cigna-Commercial, +17813,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,Cigna-Commercial, +17814,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,Cigna-Commercial, +17815,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,Cigna-Commercial, +17816,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,Cigna-Commercial, +17817,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,Cigna-Commercial, +17818,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,Cigna-Commercial, +17819,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,Cigna-Commercial, +17820,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,Cigna-Commercial, +17821,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,Cigna-Commercial, +17822,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,Cigna-Commercial, +17823,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,Cigna-Commercial,3557.49 +17824,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,Cigna-Commercial,4175.27 +17825,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,Cigna-Commercial, +17826,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,Cigna-Commercial,3142.17 +17827,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,Cigna-Commercial,612.0 +17828,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,Cigna-Commercial, +17829,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,Cigna-Commercial, +17830,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,Cigna-Commercial, +17831,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,Cigna-Commercial, +17832,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,Cigna-Commercial, +17833,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,Cigna-Commercial, +17834,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,Cigna-Commercial, +17835,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,Cigna-Commercial, +17836,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,Cigna-Commercial,50.75 +17837,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,Cigna-Commercial, +17838,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,Cigna-Commercial,2083.51 +17839,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,Cigna-Commercial, +17840,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,Cigna-Commercial, +17841,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,Cigna-Commercial, +17842,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,Cigna-Commercial, +17843,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,Cigna-Commercial,5240.46 +17844,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,Cigna-Commercial, +17845,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,Cigna-Commercial, +17846,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,Cigna-Commercial, +17847,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,Cigna-Commercial, +17848,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,Cigna-Commercial,4644.93 +17849,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,Cigna-Commercial,2604.44 +17850,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,Cigna-Commercial, +17851,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,Cigna-Commercial,2687.0 +17852,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,Cigna-Commercial,3441.48 +17853,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,Cigna-Commercial, +17854,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,Cigna-Commercial,4642.0 +17855,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,Cigna-Commercial, +17856,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,Cigna-Commercial,3951.24 +17857,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,Cigna-Commercial,4379.0 +17858,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,Cigna-Commercial,359.48 +17859,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,Cigna-Commercial,359.41 +17860,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,Cigna-Commercial, +17861,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,Cigna-Commercial, +17862,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,Cigna-Commercial, +17863,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,Cigna-Commercial, +17864,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,Cigna-Commercial, +17865,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,Cigna-Commercial, +17866,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,Cigna-Commercial, +17867,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,Cigna-Commercial, +17868,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,Cigna-Commercial, +17869,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,Cigna-Commercial, +17870,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,Cigna-Commercial,4019.13 +17871,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,Cigna-Commercial, +17872,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,Cigna-Commercial, +17873,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,Cigna-Commercial, +17874,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,Cigna-Commercial, +17875,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,Cigna-Commercial, +17876,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,Cigna-Commercial, +17877,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,Cigna-Commercial, +17878,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,Cigna-Commercial, +17879,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,Cigna-Commercial, +17880,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,Cigna-Commercial,8327.55 +17881,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,Cigna-Commercial, +17882,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,Cigna-Commercial, +17883,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,Cigna-Commercial, +17884,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,Cigna-Commercial, +17885,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,Cigna-Commercial, +17886,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,Cigna-Commercial, +17887,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,Cigna-Commercial, +17888,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,Cigna-Commercial, +17889,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,Cigna-Commercial, +17890,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,Cigna-Commercial,2916.61 +17891,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,Cigna-Commercial, +17892,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,Cigna-Commercial, +17893,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,Cigna-Commercial, +17894,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,Cigna-Commercial, +17895,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,Cigna-Commercial, +17896,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,Cigna-Commercial, +17897,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,Cigna-Commercial, +17898,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,Cigna-Commercial, +17899,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,Cigna-Commercial, +17900,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,Cigna-Commercial, +17901,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,Cigna-Commercial, +17902,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,Cigna-Commercial, +17903,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,Cigna-Commercial,1435.15 +17904,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,Cigna-Commercial, +17905,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,Cigna-Commercial, +17906,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,Cigna-Commercial, +17907,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,Cigna-Commercial, +17908,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,Cigna-Commercial, +17909,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,Cigna-Commercial, +17910,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,Cigna-Commercial, +17911,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,Cigna-Commercial, +17912,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,Cigna-Commercial, +17913,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,Cigna-Commercial, +17914,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,Cigna-Commercial, +17915,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,Cigna-Commercial, +17916,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,Cigna-Commercial, +17917,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,Cigna-Commercial, +17918,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,Cigna-Commercial,3763.83 +17919,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,Cigna-Commercial, +17920,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,Cigna-Commercial,3299.03 +17921,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,Cigna-Commercial,5643.29 +17922,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,Cigna-Commercial,3172.56 +17923,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,Cigna-Commercial, +17924,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,Cigna-Commercial,6586.66 +17925,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,Cigna-Commercial, +17926,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,Cigna-Commercial, +17927,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,Cigna-Commercial,12674.03 +17928,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,Cigna-Commercial, +17929,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,Cigna-Commercial, +17930,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,Cigna-Commercial, +17931,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,Cigna-Commercial, +17932,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,Cigna-Commercial,6964.42 +17933,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,Cigna-Commercial, +17934,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,Cigna-Commercial, +17935,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,Cigna-Commercial,984.28 +17936,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,Cigna-Commercial, +17937,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,Cigna-Commercial, +17938,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,Cigna-Commercial,924.8 +17939,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,Cigna-Commercial, +17940,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,Cigna-Commercial, +17941,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,Cigna-Commercial, +17942,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,Cigna-Commercial, +17943,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,Cigna-Commercial, +17944,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,Cigna-Commercial, +17945,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,Cigna-Commercial, +17946,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,Cigna-Commercial, +17947,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,Cigna-Commercial,4379.0 +17948,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,Cigna-Commercial, +17949,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,Cigna-Commercial, +17950,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,Cigna-Commercial, +17951,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,Cigna-Commercial, +17952,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,Cigna-Commercial, +17953,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,Cigna-Commercial, +17954,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,Cigna-Commercial, +17955,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,Cigna-Commercial, +17956,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,Cigna-Commercial, +17957,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,Cigna-Commercial, +17958,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,Cigna-Commercial,5770.28 +17959,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,Cigna-Commercial, +17960,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,Cigna-Commercial, +17961,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,Cigna-Commercial, +17962,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,Cigna-Commercial,494.67 +17963,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,Cigna-Commercial, +17964,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,Cigna-Commercial, +17965,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,Cigna-Commercial, +17966,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,Cigna-Commercial, +17967,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,Cigna-Commercial, +17968,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,Cigna-Commercial, +17969,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,Cigna-Commercial,4708.47 +17970,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,Cigna-Commercial, +17971,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,Cigna-Commercial, +17972,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,Cigna-Commercial, +17973,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,Cigna-Commercial, +17974,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,Cigna-Commercial, +17975,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,Cigna-Commercial, +17976,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,Cigna-Commercial, +17977,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,Cigna-Commercial, +17978,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,Cigna-Commercial, +17979,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,Cigna-Commercial, +17980,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,Cigna-Commercial, +17981,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,Cigna-Commercial, +17982,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,Cigna-Commercial, +17983,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,Cigna-Commercial, +17984,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,Cigna-Commercial, +17985,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,Cigna-Commercial,817.04 +17986,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,Cigna-Commercial, +17987,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,Cigna-Commercial, +17988,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,Cigna-Commercial, +17989,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,Cigna-Commercial, +17990,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,Cigna-Commercial, +17991,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,Cigna-Commercial,5558.47 +17992,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,Cigna-Commercial, +17993,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,Cigna-Commercial, +17994,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,Cigna-Commercial, +17995,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,Cigna-Commercial, +17996,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,Cigna-Commercial, +17997,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,Cigna-Commercial,4031.34 +17998,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,Cigna-Commercial, +17999,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,Cigna-Commercial, +18000,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,Cigna-Commercial, +18001,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,Cigna-Commercial, +18002,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,Cigna-Commercial, +18003,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,Cigna-Commercial, +18004,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,Cigna-Commercial, +18005,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,Cigna-Commercial, +18006,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,Cigna-Commercial, +18007,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,Cigna-Commercial, +18008,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,Cigna-Commercial, +18009,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,Cigna-Commercial,3037.46 +18010,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,Cigna-Commercial, +18011,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,Cigna-Commercial, +18012,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,Cigna-Commercial, +18013,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,Cigna-Commercial,3858.7 +18014,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,Cigna-Commercial, +18015,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,Cigna-Commercial,4642.0 +18016,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,Cigna-Commercial,5089.02 +18017,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,Cigna-Commercial, +18018,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,Cigna-Commercial, +18019,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,Cigna-Commercial,2989.13 +18020,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,Cigna-Commercial, +18021,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,Cigna-Commercial,4260.28 +18022,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,Cigna-Commercial,4169.6 +18023,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,Cigna-Commercial, +18024,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,Cigna-Commercial,2321.0 +18025,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,Cigna-Commercial, +18026,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,Cigna-Commercial,4721.35 +18027,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,Cigna-Commercial, +18028,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,Cigna-Commercial, +18029,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,Cigna-Commercial,5197.85 +18030,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,Cigna-Commercial,4800.7 +18031,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,Cigna-Commercial, +18032,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,Cigna-Commercial, +18033,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,Cigna-Commercial, +18034,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,Cigna-Commercial,4626.25 +18035,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,Cigna-Commercial,2400.35 +18036,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,Cigna-Commercial, +18037,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,Cigna-Commercial, +18038,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,Cigna-Commercial, +18039,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,Cigna-Commercial, +18040,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,Cigna-Commercial, +18041,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,Cigna-Commercial,6806.12 +18042,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,Cigna-Commercial, +18043,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,Cigna-Commercial, +18044,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,Cigna-Commercial, +18045,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,Cigna-Commercial, +18046,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,Cigna-Commercial, +18047,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,Cigna-Commercial, +18048,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,Cigna-Commercial, +18049,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,Cigna-Commercial, +18050,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,Cigna-Commercial,118.01 +18051,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,Cigna-Commercial, +18052,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,Cigna-Commercial, +18053,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,Cigna-Commercial,4208.97 +18054,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,Cigna-Commercial, +18055,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,Cigna-Commercial, +18056,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,Cigna-Commercial, +18057,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,Cigna-Commercial, +18058,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,Cigna-Commercial, +18059,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,Cigna-Commercial,4642.01 +18060,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,Cigna-Commercial, +18061,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,Cigna-Commercial, +18062,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,Cigna-Commercial, +18063,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,Cigna-Commercial, +18064,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,Cigna-Commercial, +18065,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,Cigna-Commercial, +18066,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,Cigna-Commercial, +18067,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,Cigna-Commercial, +18068,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,Cigna-Commercial, +18069,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,Cigna-Commercial, +18070,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,Cigna-Commercial, +18071,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,Cigna-Commercial, +18072,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,Cigna-Commercial, +18073,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,Cigna-Commercial, +18074,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,Cigna-Commercial, +18075,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,Cigna-Commercial, +18076,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,Cigna-Commercial, +18077,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,Cigna-Commercial, +18078,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,Cigna-Commercial, +18079,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,Cigna-Commercial,11000.36 +18080,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,Cigna-Commercial, +18081,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,Cigna-Commercial,1525.4 +18082,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,Cigna-Commercial, +18083,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,Cigna-Commercial,4800.7 +18084,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,Cigna-Commercial,3745.25 +18085,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,Cigna-Commercial,4800.7 +18086,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,Cigna-Commercial, +18087,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,Cigna-Commercial, +18088,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,Cigna-Commercial, +18089,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,Cigna-Commercial, +18090,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,Cigna-Commercial,4587.84 +18091,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,Cigna-Commercial, +18092,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,Cigna-Commercial,2531.33 +18093,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,Cigna-Commercial, +18094,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,Cigna-Commercial, +18095,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,Cigna-Commercial, +18096,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,Cigna-Commercial, +18097,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,Cigna-Commercial,4965.45 +18098,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,Cigna-Commercial,2400.16 +18099,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,Cigna-Commercial,4294.97 +18100,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,Cigna-Commercial,7426.95 +18101,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,Cigna-Commercial,4040.43 +18102,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,Cigna-Commercial,5089.02 +18103,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,Cigna-Commercial,4804.46 +18104,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,Cigna-Commercial,1788.35 +18105,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,Cigna-Commercial, +18106,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,Cigna-Commercial, +18107,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,Cigna-Commercial,5090.86 +18108,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,Cigna-Commercial, +18109,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,Cigna-Commercial, +18110,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,Cigna-Commercial, +18111,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,Cigna-Commercial, +18112,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,Cigna-Commercial, +18113,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,Cigna-Commercial, +18114,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,Cigna-Commercial, +18115,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,Cigna-Commercial, +18116,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,Cigna-Commercial, +18117,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,Cigna-Commercial, +18118,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,Cigna-Commercial, +18119,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,Cigna-Commercial, +18120,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,Cigna-Commercial, +18121,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,Cigna-Commercial, +18122,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,Cigna-Commercial, +18123,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,Cigna-Commercial, +18124,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,Cigna-Commercial, +18125,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,Cigna-Commercial, +18126,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,Cigna-Commercial, +18127,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,Cigna-Commercial, +18128,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,Cigna-Commercial, +18129,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,Cigna-Commercial, +18130,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,Cigna-Commercial, +18131,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,Cigna-Commercial, +18132,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,Cigna-Commercial, +18133,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,Cigna-Commercial, +18134,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,Cigna-Commercial, +18135,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,Cigna-Commercial, +18136,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,Cigna-Commercial, +18137,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,Cigna-Commercial, +18138,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,Cigna-Commercial, +18139,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,Cigna-Commercial, +18140,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,Cigna-Commercial, +18141,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,Cigna-Commercial, +18142,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,Cigna-Commercial, +18143,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,Cigna-Commercial, +18144,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,Cigna-Commercial, +18145,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,Cigna-Commercial, +18146,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,Cigna-Commercial, +18147,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,Cigna-Commercial, +18148,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,Cigna-Commercial, +18149,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,Cigna-Commercial, +18150,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,Cigna-Commercial, +18151,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,Cigna-Commercial, +18152,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,Cigna-Commercial, +18153,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,Cigna-Commercial, +18154,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,Cigna-Commercial, +18155,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,Cigna-Commercial, +18156,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,Cigna-Commercial, +18157,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,Cigna-Commercial, +18158,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,Cigna-Commercial, +18159,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,Cigna-Commercial, +18160,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,Cigna-Commercial, +18161,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,Cigna-Commercial, +18162,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,Cigna-Commercial, +18163,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,Cigna-Commercial, +18164,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,Cigna-Commercial, +18165,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,Cigna-Commercial, +18166,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,Cigna-Commercial, +18167,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,Cigna-Commercial, +18168,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,Cigna-Commercial, +18169,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,Cigna-Commercial, +18170,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,Cigna-Commercial, +18171,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,Cigna-Commercial, +18172,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,Cigna-Commercial, +18173,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,Cigna-Commercial, +18174,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,Cigna-Commercial, +18175,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,Cigna-Commercial, +18176,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,Cigna-Commercial, +18177,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,Cigna-Commercial, +18178,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,Cigna-Commercial, +18179,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,Cigna-Commercial, +18180,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,Cigna-Commercial, +18181,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,Cigna-Commercial, +18182,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,Cigna-Commercial, +18183,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,Cigna-Commercial, +18184,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,Cigna-Commercial, +18185,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,Cigna-Commercial, +18186,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,Cigna-Commercial, +18187,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,Cigna-Commercial, +18188,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,Cigna-Commercial, +18189,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,Cigna-Commercial, +18190,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,Cigna-Commercial, +18191,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,Cigna-Commercial, +18192,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,Cigna-Commercial, +18193,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,Cigna-Commercial, +18194,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,Cigna-Commercial, +18195,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,Cigna-Commercial, +18196,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,Cigna-Commercial, +18197,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,Cigna-Commercial, +18198,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,Cigna-Commercial, +18199,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,Cigna-Commercial, +18200,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,Cigna-Commercial, +18201,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,Cigna-Commercial, +18202,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,Cigna-Commercial, +18203,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,Cigna-Commercial, +18204,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,Cigna-Commercial, +18205,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,Cigna-Commercial, +18206,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,Cigna-Commercial, +18207,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,Cigna-Commercial, +18208,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,Cigna-Commercial, +18209,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,Cigna-Commercial, +18210,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,Cigna-Commercial, +18211,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,Cigna-Commercial, +18212,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,Cigna-Commercial, +18213,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,Cigna-Commercial, +18214,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,Cigna-Commercial, +18215,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,Cigna-Commercial, +18216,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,Cigna-Commercial, +18217,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,Cigna-Commercial, +18218,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,Cigna-Commercial, +18219,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,Cigna-Commercial, +18220,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,Cigna-Commercial, +18221,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,Cigna-Commercial, +18222,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,Cigna-Commercial, +18223,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,Cigna-Commercial, +18224,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,Cigna-Commercial, +18225,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,Cigna-Commercial, +18226,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,Cigna-Commercial, +18227,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,Cigna-Commercial, +18228,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,Cigna-Commercial, +18229,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,Cigna-Commercial, +18230,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,Cigna-Commercial, +18231,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,Cigna-Commercial, +18232,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,Cigna-Commercial, +18233,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,Cigna-Commercial, +18234,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,Cigna-Commercial, +18235,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,Cigna-Commercial, +18236,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,Cigna-Commercial, +18237,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,Cigna-Commercial, +18238,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,Cigna-Commercial, +18239,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,Cigna-Commercial, +18240,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,Cigna-Commercial, +18241,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,Cigna-Commercial, +18242,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,Cigna-Commercial, +18243,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,Cigna-Commercial, +18244,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,Cigna-Commercial, +18245,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,Cigna-Commercial, +18246,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,Cigna-Commercial, +18247,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,Cigna-Commercial, +18248,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,Cigna-Commercial, +18249,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,Cigna-Commercial, +18250,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,Cigna-Commercial, +18251,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,Cigna-Commercial, +18252,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,Cigna-Commercial, +18253,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,Cigna-Commercial, +18254,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,Cigna-Commercial, +18255,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,Cigna-Commercial, +18256,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,Cigna-Commercial, +18257,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,Cigna-Commercial, +18258,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,Cigna-Commercial, +18259,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,Cigna-Commercial, +18260,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,Cigna-Commercial, +18261,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,Cigna-Commercial, +18262,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,Cigna-Commercial, +18263,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,Cigna-Commercial, +18264,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,Cigna-Commercial, +18265,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,Cigna-Commercial, +18266,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,Cigna-Commercial, +18267,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,Cigna-Commercial, +18268,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,Cigna-Commercial, +18269,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,Cigna-Commercial, +18270,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,Cigna-Commercial, +18271,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,Cigna-Commercial, +18272,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,Cigna-Commercial, +18273,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,Cigna-Commercial, +18274,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,Cigna-Commercial, +18275,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,Cigna-Commercial, +18276,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,Cigna-Commercial, +18277,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,Cigna-Commercial, +18278,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,Cigna-Commercial, +18279,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,Cigna-Commercial, +18280,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,Cigna-Commercial, +18281,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,Cigna-Commercial, +18282,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,Cigna-Commercial, +18283,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,Cigna-Commercial, +18284,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,Cigna-Commercial, +18285,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,Cigna-Commercial, +18286,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,Cigna-Commercial, +18287,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,Cigna-Commercial, +18288,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,Cigna-Commercial, +18289,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,Cigna-Commercial, +18290,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,Cigna-Commercial, +18291,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,Cigna-Commercial, +18292,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,Cigna-Commercial, +18293,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,Cigna-Commercial, +18294,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,Cigna-Commercial, +18295,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,Cigna-Commercial, +18296,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,Cigna-Commercial, +18297,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,Cigna-Commercial, +18298,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,Cigna-Commercial, +18299,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,Cigna-Commercial, +18300,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,Cigna-Commercial, +18301,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,Cigna-Commercial, +18302,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,Cigna-Commercial, +18303,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,Cigna-Commercial, +18304,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,Cigna-Commercial, +18305,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,Cigna-Commercial, +18306,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,Cigna-Commercial, +18307,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,Cigna-Commercial, +18308,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,Cigna-Commercial, +18309,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,Cigna-Commercial, +18310,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,Cigna-Commercial, +18311,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,Cigna-Commercial, +18312,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,Cigna-Commercial, +18313,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,Cigna-Commercial, +18314,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,Cigna-Commercial, +18315,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,Cigna-Commercial, +18316,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,Cigna-Commercial, +18317,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,Cigna-Commercial, +18318,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,Cigna-Commercial, +18319,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,Cigna-Commercial, +18320,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,Cigna-Commercial, +18321,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,Cigna-Commercial, +18322,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,Cigna-Commercial, +18323,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,Cigna-Commercial, +18324,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,Cigna-Commercial, +18325,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,Cigna-Commercial, +18326,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,Cigna-Commercial, +18327,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,Cigna-Commercial, +18328,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,Cigna-Commercial, +18329,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,Cigna-Commercial, +18330,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,Cigna-Commercial, +18331,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,Cigna-Commercial, +18332,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,Cigna-Commercial, +18333,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,Cigna-Commercial, +18334,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,Cigna-Commercial, +18335,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,Cigna-Commercial, +18336,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,Cigna-Commercial, +18337,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,Cigna-Commercial, +18338,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,Cigna-Commercial, +18339,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,Cigna-Commercial, +18340,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,Cigna-Commercial, +18341,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,Cigna-Commercial, +18342,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,Cigna-Commercial, +18343,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,Cigna-Commercial, +18344,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,Cigna-Commercial, +18345,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,Cigna-Commercial, +18346,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,Cigna-Commercial, +18347,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,Cigna-Commercial, +18348,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,Cigna-Commercial, +18349,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,Cigna-Commercial, +18350,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,Cigna-Commercial, +18351,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,Cigna-Commercial, +18352,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,Cigna-Commercial, +18353,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,Cigna-Commercial, +18354,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,Cigna-Commercial, +18355,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,Cigna-Commercial, +18356,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,Cigna-Commercial, +18357,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,Cigna-Commercial, +18358,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,Cigna-Commercial, +18359,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,Cigna-Commercial, +18360,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,Cigna-Commercial, +18361,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,Cigna-Commercial, +18362,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,Cigna-Commercial, +18363,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,Cigna-Commercial, +18364,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,Cigna-Commercial, +18365,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,Cigna-Commercial, +18366,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,Cigna-Commercial, +18367,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,Cigna-Commercial, +18368,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,Cigna-Commercial, +18369,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,Cigna-Commercial, +18370,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,Cigna-Commercial, +18371,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,Cigna-Commercial, +18372,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,Cigna-Commercial, +18373,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,Cigna-Commercial, +18374,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,Cigna-Commercial, +18375,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,Cigna-Commercial, +18376,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,Cigna-Commercial, +18377,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,Cigna-Commercial, +18378,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,Cigna-Commercial, +18379,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,Cigna-Commercial, +18380,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,Cigna-Commercial, +18381,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,Cigna-Commercial, +18382,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,Cigna-Commercial, +18383,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,Cigna-Commercial, +18384,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,Cigna-Commercial, +18385,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,Cigna-Commercial, +18386,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,Cigna-Commercial, +18387,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,Cigna-Commercial, +18388,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,Cigna-Commercial, +18389,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,Cigna-Commercial, +18390,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,Cigna-Commercial, +18391,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,Cigna-Commercial, +18392,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,Cigna-Commercial, +18393,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,Cigna-Commercial, +18394,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,Cigna-Commercial, +18395,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,Cigna-Commercial, +18396,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,Cigna-Commercial, +18397,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,Cigna-Commercial, +18398,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,Cigna-Commercial, +18399,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,Cigna-Commercial, +18400,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,Cigna-Commercial, +18401,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,Cigna-Commercial, +18402,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,Cigna-Commercial, +18403,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,Cigna-Commercial, +18404,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,Cigna-Commercial, +18405,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,Cigna-Commercial, +18406,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,Cigna-Commercial, +18407,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,Cigna-Commercial, +18408,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,Cigna-Commercial, +18409,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,Cigna-Commercial, +18410,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,Cigna-Commercial, +18411,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,Cigna-Commercial, +18412,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,Cigna-Commercial, +18413,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,Cigna-Commercial, +18414,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,Cigna-Commercial, +18415,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,Cigna-Commercial, +18416,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,Cigna-Commercial, +18417,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,Cigna-Commercial, +18418,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,Cigna-Commercial, +18419,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,Cigna-Commercial, +18420,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,Cigna-Commercial, +18421,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,Cigna-Commercial, +18422,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,Cigna-Commercial, +18423,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,Cigna-Commercial, +18424,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,Cigna-Commercial, +18425,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,Cigna-Commercial, +18426,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,Cigna-Commercial, +18427,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,Cigna-Commercial, +18428,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,Cigna-Commercial, +18429,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,Cigna-Commercial, +18430,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,Cigna-Commercial, +18431,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,Cigna-Commercial, +18432,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,Cigna-Commercial, +18433,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,Cigna-Commercial, +18434,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,Cigna-Commercial, +18435,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,Cigna-Commercial, +18436,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,Cigna-Commercial, +18437,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,Cigna-Commercial, +18438,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,Cigna-Commercial, +18439,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,Cigna-Commercial, +18440,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,Cigna-Commercial, +18441,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,Cigna-Commercial, +18442,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,Cigna-Commercial, +18443,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,Cigna-Commercial,7599.23 +18444,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,Cigna-Commercial, +18445,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,Cigna-Commercial, +18446,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,Cigna-Commercial, +18447,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,Cigna-Commercial, +18448,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,Cigna-Commercial, +18449,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,Cigna-Commercial, +18450,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,Cigna-Commercial, +18451,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,Cigna-Commercial, +18452,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,Cigna-Commercial, +18453,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,Cigna-Commercial, +18454,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,Cigna-Commercial, +18455,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,Cigna-Commercial, +18456,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,Cigna-Commercial, +18457,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,Cigna-Commercial, +18458,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,Cigna-Commercial, +18459,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,Cigna-Commercial, +18460,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,Cigna-Commercial, +18461,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,Cigna-Commercial, +18462,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,Cigna-Commercial, +18463,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,Cigna-Commercial, +18464,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,Cigna-Commercial, +18465,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,Cigna-Commercial, +18466,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,Cigna-Commercial, +18467,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,Cigna-Commercial, +18468,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,Cigna-Commercial, +18469,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,Cigna-Commercial, +18470,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,Cigna-Commercial, +18471,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,Cigna-Commercial, +18472,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,Cigna-Commercial, +18473,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,Cigna-Commercial, +18474,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,Cigna-Commercial, +18475,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,Cigna-Commercial, +18476,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,Cigna-Commercial, +18477,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,Cigna-Commercial, +18478,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,Cigna-Commercial, +18479,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,Cigna-Commercial, +18480,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,Cigna-Commercial, +18481,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,Cigna-Commercial, +18482,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,Cigna-Commercial, +18483,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,Cigna-Commercial, +18484,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,Cigna-Commercial, +18485,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,Cigna-Commercial, +18486,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,Cigna-Commercial, +18487,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,Cigna-Commercial, +18488,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,Cigna-Commercial, +18489,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,Cigna-Commercial, +18490,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,Cigna-Commercial, +18491,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,Cigna-Commercial, +18492,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,Cigna-Commercial, +18493,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,Cigna-Commercial, +18494,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,Cigna-Commercial, +18495,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,Cigna-Commercial, +18496,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,Cigna-Commercial, +18497,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,Cigna-Commercial, +18498,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,Cigna-Commercial, +18499,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,Cigna-Commercial, +18500,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,Cigna-Commercial, +18501,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,Cigna-Commercial, +18502,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,Cigna-Commercial, +18503,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,Cigna-Commercial, +18504,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,Cigna-Commercial, +18505,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,Cigna-Commercial, +18506,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,Cigna-Commercial, +18507,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,Cigna-Commercial, +18508,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,Cigna-Commercial, +18509,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,Cigna-Commercial, +18510,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,Cigna-Commercial, +18511,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,Cigna-Commercial, +18512,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,Cigna-Commercial, +18513,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,Cigna-Commercial, +18514,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,Cigna-Commercial, +18515,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,Cigna-Commercial, +18516,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,Cigna-Commercial, +18517,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,Cigna-Commercial, +18518,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,Cigna-Commercial, +18519,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,Cigna-Commercial, +18520,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,Cigna-Commercial, +18521,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,Cigna-Commercial, +18522,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,Cigna-Commercial, +18523,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,Cigna-Commercial, +18524,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,Cigna-Commercial, +18525,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,Cigna-Commercial, +18526,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,Cigna-Commercial, +18527,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,Cigna-Commercial, +18528,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,Cigna-Commercial, +18529,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,Cigna-Commercial, +18530,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,Cigna-Commercial, +18531,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,Cigna-Commercial, +18532,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,Cigna-Commercial, +18533,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,Cigna-Commercial, +18534,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,Cigna-Commercial, +18535,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,Cigna-Commercial, +18536,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,Cigna-Commercial, +18537,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,Cigna-Commercial, +18538,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,Cigna-Commercial, +18539,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,Cigna-Commercial, +18540,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,Cigna-Commercial, +18541,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,Cigna-Commercial, +18542,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,Cigna-Commercial, +18543,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,Cigna-Commercial, +18544,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,Cigna-Commercial, +18545,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,Cigna-Commercial, +18546,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,Cigna-Commercial, +18547,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,Cigna-Commercial, +18548,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,Cigna-Commercial, +18549,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,Cigna-Commercial, +18550,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,Cigna-Commercial, +18551,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,Cigna-Commercial, +18552,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,Cigna-Commercial, +18553,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,Cigna-Commercial, +18554,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,Cigna-Commercial, +18555,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,Cigna-Commercial, +18556,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,Cigna-Commercial, +18557,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,Cigna-Commercial, +18558,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,Cigna-Commercial, +18559,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,Cigna-Commercial, +18560,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,Cigna-Commercial, +18561,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,Cigna-Commercial, +18562,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,Cigna-Commercial, +18563,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,Cigna-Commercial, +18564,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,Cigna-Commercial, +18565,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,Cigna-Commercial, +18566,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,Cigna-Commercial, +18567,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,Cigna-Commercial, +18568,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,Cigna-Commercial, +18569,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,Cigna-Commercial, +18570,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,Cigna-Commercial, +18571,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,Cigna-Commercial, +18572,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,Cigna-Commercial, +18573,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,Cigna-Commercial, +18574,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,Cigna-Commercial, +18575,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,Cigna-Commercial, +18576,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,Cigna-Commercial, +18577,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,Cigna-Commercial, +18578,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,Cigna-Commercial, +18579,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,Cigna-Commercial, +18580,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,Cigna-Commercial, +18581,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,Cigna-Commercial, +18582,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,Cigna-Commercial, +18583,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,Cigna-Commercial, +18584,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,Cigna-Commercial, +18585,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,Cigna-Commercial, +18586,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,Cigna-Commercial, +18587,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,Cigna-Commercial, +18588,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,Cigna-Commercial, +18589,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,Cigna-Commercial, +18590,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,Cigna-Commercial, +18591,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,Cigna-Commercial, +18592,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,Cigna-Commercial, +18593,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,Cigna-Commercial, +18594,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,Cigna-Commercial, +18595,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,Cigna-Commercial, +18596,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,Cigna-Commercial, +18597,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,Cigna-Commercial, +18598,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,Cigna-Commercial, +18599,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,Cigna-Commercial, +18600,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,Cigna-Commercial, +18601,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,Cigna-Commercial, +18602,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,Cigna-Commercial, +18603,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,Cigna-Commercial, +18604,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,Cigna-Commercial, +18605,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,Cigna-Commercial, +18606,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,Cigna-Commercial, +18607,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,Cigna-Commercial, +18608,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,Cigna-Commercial, +18609,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,Cigna-Commercial, +18610,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,Cigna-Commercial, +18611,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,Cigna-Commercial, +18612,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,Cigna-Commercial, +18613,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,Cigna-Commercial, +18614,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,Cigna-Commercial, +18615,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,Cigna-Commercial, +18616,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,Cigna-Commercial, +18617,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,Cigna-Commercial, +18618,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,Cigna-Commercial, +18619,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,Cigna-Commercial, +18620,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,Cigna-Commercial, +18621,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,Cigna-Commercial, +18622,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,Cigna-Commercial, +18623,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,Cigna-Commercial, +18624,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,Cigna-Commercial, +18625,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,Cigna-Commercial, +18626,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,Cigna-Commercial, +18627,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,Cigna-Commercial, +18628,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,Cigna-Commercial, +18629,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,Cigna-Commercial, +18630,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,Cigna-Commercial, +18631,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,Cigna-Commercial, +18632,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,Cigna-Commercial, +18633,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,Cigna-Commercial, +18634,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,Cigna-Commercial, +18635,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,Cigna-Commercial, +18636,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,Cigna-Commercial, +18637,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,Cigna-Commercial,4687.83 +18638,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,Cigna-Commercial, +18639,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,Cigna-Commercial, +18640,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,Cigna-Commercial, +18641,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,Cigna-Commercial, +18642,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,Cigna-Commercial, +18643,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,Cigna-Commercial, +18644,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,Cigna-Commercial, +18645,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,Cigna-Commercial, +18646,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,Cigna-Commercial, +18647,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,Cigna-Commercial, +18648,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,Cigna-Commercial, +18649,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,Cigna-Commercial, +18650,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,Cigna-Commercial, +18651,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,Cigna-Commercial, +18652,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,Cigna-Commercial, +18653,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,Cigna-Commercial, +18654,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,Cigna-Commercial, +18655,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,Cigna-Commercial, +18656,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,Cigna-Commercial, +18657,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,Cigna-Commercial, +18658,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,Cigna-Commercial, +18659,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,Cigna-Commercial, +18660,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,Cigna-Commercial, +18661,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,Cigna-Commercial, +18662,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,Cigna-Commercial, +18663,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,Cigna-Commercial, +18664,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,Cigna-Commercial, +18665,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,Cigna-Commercial, +18666,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,Cigna-Commercial, +18667,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,Cigna-Commercial, +18668,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,Cigna-Commercial, +18669,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,Cigna-Commercial, +18670,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,Cigna-Commercial, +18671,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,Cigna-Commercial, +18672,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,Cigna-Commercial, +18673,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,Cigna-Commercial, +18674,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,Cigna-Commercial, +18675,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,Cigna-Commercial, +18676,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,Cigna-Commercial, +18677,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,Cigna-Commercial, +18678,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,Cigna-Commercial, +18679,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,Cigna-Commercial, +18680,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,Cigna-Commercial, +18681,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,Cigna-Commercial, +18682,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,Cigna-Commercial, +18683,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,Cigna-Commercial, +18684,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,Cigna-Commercial, +18685,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,Cigna-Commercial, +18686,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,Cigna-Commercial, +18687,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,Cigna-Commercial, +18688,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,Cigna-Commercial, +18689,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,Cigna-Commercial, +18690,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,Cigna-Commercial, +18691,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,Cigna-Commercial, +18692,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,Cigna-Commercial, +18693,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,Cigna-Commercial, +18694,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,Cigna-Commercial, +18695,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,Cigna-Commercial, +18696,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,Cigna-Commercial, +18697,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,Cigna-Commercial, +18698,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,Cigna-Commercial, +18699,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,Cigna-Commercial, +18700,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,Cigna-Commercial, +18701,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,Cigna-Commercial, +18702,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,Cigna-Commercial, +18703,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,Cigna-Commercial, +18704,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,Cigna-Commercial, +18705,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,Cigna-Commercial, +18706,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,Cigna-Commercial, +18707,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,Cigna-Commercial, +18708,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,Cigna-Commercial, +18709,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,Cigna-Commercial, +18710,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,Cigna-Commercial, +18711,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,Cigna-Commercial, +18712,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,Cigna-Commercial, +18713,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,Cigna-Commercial, +18714,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,Cigna-Commercial, +18715,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,Cigna-Commercial, +18716,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,Cigna-Commercial, +18717,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,Cigna-Commercial, +18718,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,Cigna-Commercial, +18719,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,Cigna-Commercial, +18720,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,Cigna-Commercial, +18721,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,Cigna-Commercial, +18722,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,Cigna-Commercial, +18723,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,Cigna-Commercial, +18724,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,Cigna-Commercial, +18725,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,Cigna-Commercial, +18726,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,Cigna-Commercial, +18727,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,Cigna-Commercial, +18728,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,Cigna-Commercial, +18729,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,Cigna-Commercial, +18730,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,Cigna-Commercial, +18731,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,Cigna-Commercial, +18732,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,Cigna-Commercial, +18733,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,Cigna-Commercial, +18734,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,Cigna-Commercial, +18735,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,Cigna-Commercial, +18736,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,Cigna-Commercial, +18737,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,Cigna-Commercial, +18738,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,Cigna-Commercial, +18739,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,Cigna-Commercial, +18740,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,Cigna-Commercial, +18741,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,Cigna-Commercial,2136.0 +18742,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,Cigna-Commercial, +18743,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,Cigna-Commercial, +18744,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,Cigna-Commercial, +18745,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,Cigna-Commercial, +18746,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,Cigna-Commercial, +18747,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,Cigna-Commercial,5027.0 +18748,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,Cigna-Commercial, +18749,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,Cigna-Commercial, +18750,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,Cigna-Commercial, +18751,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,Cigna-Commercial, +18752,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,Cigna-Commercial, +18753,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,Cigna-Commercial, +18754,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,Cigna-Commercial, +18755,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,Cigna-Commercial, +18756,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,Cigna-Commercial, +18757,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,Cigna-Commercial, +18758,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,Cigna-Commercial, +18759,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,Cigna-Commercial, +18760,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,Cigna-Commercial, +18761,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,Cigna-Commercial, +18762,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,Cigna-Commercial, +18763,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,Cigna-Commercial, +18764,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,Cigna-Commercial, +18765,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,Cigna-Commercial, +18766,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,Cigna-Commercial, +18767,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,Cigna-Commercial, +18768,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,Cigna-Commercial, +18769,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,Cigna-Commercial, +18770,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,Cigna-Commercial, +18771,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,Cigna-Commercial, +18772,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,Cigna-Commercial, +18773,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,Cigna-Commercial, +18774,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,Cigna-Commercial,127.6 +18775,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,Cigna-Commercial, +18776,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,Cigna-Commercial, +18777,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,Cigna-Commercial, +18778,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,Cigna-Commercial, +18779,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,Cigna-Commercial, +18780,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,Cigna-Commercial, +18781,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,Cigna-Commercial, +18782,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,Cigna-Commercial, +18783,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,Cigna-Commercial, +18784,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,Cigna-Commercial, +18785,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,Cigna-Commercial, +18786,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,Cigna-Commercial, +18787,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,Cigna-Commercial, +18788,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,Cigna-Commercial, +18789,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,Cigna-Commercial, +18790,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,Cigna-Commercial, +18791,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,Cigna-Commercial, +18792,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,Cigna-Commercial, +18793,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,Cigna-Commercial, +18794,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,Cigna-Commercial, +18795,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,Cigna-Commercial, +18796,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,Cigna-Commercial,4348.0 +18797,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,Cigna-Commercial, +18798,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,Cigna-Commercial, +18799,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,Cigna-Commercial, +18800,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,Cigna-Commercial, +18801,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,Cigna-Commercial, +18802,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,Cigna-Commercial, +18803,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,Cigna-Commercial, +18804,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,Cigna-Commercial, +18805,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,Cigna-Commercial, +18806,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,Cigna-Commercial, +18807,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,Cigna-Commercial, +18808,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,Cigna-Commercial, +18809,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,Cigna-Commercial, +18810,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,Cigna-Commercial, +18811,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,Cigna-Commercial, +18812,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,Cigna-Commercial, +18813,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,Cigna-Commercial, +18814,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,Cigna-Commercial, +18815,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,Cigna-Commercial, +18816,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,Cigna-Commercial, +18817,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,Cigna-Commercial, +18818,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,Cigna-Commercial, +18819,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,Cigna-Commercial, +18820,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,Cigna-Commercial, +18821,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,Cigna-Commercial, +18822,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,Cigna-Commercial, +18823,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,Cigna-Commercial, +18824,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,Cigna-Commercial, +18825,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,Cigna-Commercial, +18826,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,Cigna-Commercial, +18827,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,Cigna-Commercial, +18828,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,Cigna-Commercial, +18829,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,Cigna-Commercial, +18830,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,Cigna-Commercial, +18831,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,Cigna-Commercial, +18832,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,Cigna-Commercial, +18833,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,Cigna-Commercial, +18834,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,Cigna-Commercial,536.0 +18835,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,Cigna-Commercial, +18836,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,Cigna-Commercial, +18837,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,Cigna-Commercial, +18838,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,Cigna-Commercial, +18839,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,Cigna-Commercial, +18840,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,Cigna-Commercial, +18841,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,Cigna-Commercial, +18842,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,Cigna-Commercial, +18843,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,Cigna-Commercial, +18844,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,Cigna-Commercial, +18845,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,Cigna-Commercial, +18846,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,Cigna-Commercial, +18847,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,Cigna-Commercial, +18848,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,Cigna-Commercial, +18849,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,Cigna-Commercial, +18850,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,Cigna-Commercial, +18851,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,Cigna-Commercial, +18852,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,Cigna-Commercial,524.0 +18853,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,Cigna-Commercial, +18854,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,Cigna-Commercial, +18855,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,Cigna-Commercial, +18856,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,Cigna-Commercial, +18857,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,Cigna-Commercial, +18858,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,Cigna-Commercial, +18859,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,Cigna-Commercial, +18860,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,Cigna-Commercial, +18861,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,Cigna-Commercial, +18862,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,Cigna-Commercial, +18863,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,Cigna-Commercial, +18864,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,Cigna-Commercial, +18865,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,Cigna-Commercial, +18866,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,Cigna-Commercial, +18867,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,Cigna-Commercial, +18868,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,Cigna-Commercial, +18869,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,Cigna-Commercial, +18870,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,Cigna-Commercial, +18871,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,Cigna-Commercial, +18872,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,Cigna-Commercial, +18873,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,Cigna-Commercial, +18874,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,Cigna-Commercial, +18875,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,Cigna-Commercial, +18876,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,Cigna-Commercial, +18877,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,Cigna-Commercial, +18878,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,Cigna-Commercial, +18879,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,Cigna-Commercial, +18880,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,Cigna-Commercial, +18881,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,Cigna-Commercial, +18882,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,Cigna-Commercial, +18883,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,Cigna-Commercial, +18884,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,Cigna-Commercial, +18885,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,Cigna-Commercial, +18886,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,Cigna-Commercial, +18887,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,Cigna-Commercial, +18888,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,Cigna-Commercial, +18889,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,Cigna-Commercial, +18890,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,Cigna-Commercial, +18891,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,Cigna-Commercial, +18892,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,Cigna-Commercial, +18893,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,Cigna-Commercial, +18894,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,Cigna-Commercial, +18895,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,Cigna-Commercial, +18896,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,Cigna-Commercial, +18897,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,Cigna-Commercial, +18898,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,Cigna-Commercial, +18899,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,Cigna-Commercial, +18900,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,Cigna-Commercial, +18901,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,Cigna-Commercial, +18902,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,Cigna-Commercial, +18903,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,Cigna-Commercial, +18904,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,Cigna-Commercial, +18905,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,Cigna-Commercial, +18906,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,Cigna-Commercial, +18907,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,Cigna-Commercial, +18908,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,Cigna-Commercial, +18909,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,Cigna-Commercial,1461.38 +18910,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,Cigna-Commercial, +18911,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,Cigna-Commercial, +18912,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,Cigna-Commercial, +18913,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,Cigna-Commercial, +18914,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,Cigna-Commercial, +18915,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,Cigna-Commercial, +18916,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,Cigna-Commercial, +18917,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,Cigna-Commercial, +18918,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,Cigna-Commercial, +18919,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,Cigna-Commercial, +18920,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,Cigna-Commercial, +18921,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,Cigna-Commercial, +18922,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,Cigna-Commercial, +18923,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,Cigna-Commercial, +18924,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,Cigna-Commercial, +18925,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,Cigna-Commercial, +18926,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,Cigna-Commercial, +18927,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,Cigna-Commercial, +18928,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,Cigna-Commercial, +18929,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,Cigna-Commercial, +18930,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,Cigna-Commercial, +18931,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,Cigna-Commercial, +18932,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,Cigna-Commercial, +18933,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,Cigna-Commercial, +18934,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,Cigna-Commercial, +18935,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,Cigna-Commercial, +18936,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,Cigna-Commercial, +18937,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,Cigna-Commercial, +18938,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,Cigna-Commercial, +18939,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,Cigna-Commercial, +18940,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,Cigna-Commercial, +18941,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,Cigna-Commercial, +18942,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,Cigna-Commercial, +18943,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,Cigna-Commercial, +18944,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,Cigna-Commercial, +18945,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,Cigna-Commercial, +18946,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,Cigna-Commercial, +18947,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,Cigna-Commercial, +18948,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,Cigna-Commercial, +18949,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,Cigna-Commercial, +18950,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,Cigna-Commercial, +18951,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,Cigna-Commercial, +18952,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,Cigna-Commercial, +18953,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,Cigna-Commercial, +18954,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,Cigna-Commercial, +18955,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,Cigna-Commercial, +18956,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,Cigna-Commercial, +18957,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,Cigna-Commercial, +18958,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,Cigna-Commercial,63.03 +18959,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,Cigna-Commercial, +18960,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,Cigna-Commercial, +18961,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,Cigna-Commercial, +18962,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,Cigna-Commercial, +18963,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,Cigna-Commercial, +18964,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,Cigna-Commercial, +18965,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,Cigna-Commercial, +18966,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,Cigna-Commercial, +18967,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,Cigna-Commercial, +18968,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,Cigna-Commercial, +18969,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,Cigna-Commercial, +18970,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,Cigna-Commercial, +18971,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Cigna-Commercial, +18972,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,Cigna-Commercial, +18973,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,Cigna-Commercial, +18974,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,Cigna-Commercial, +18975,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,Cigna-Commercial, +18976,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,Cigna-Commercial, +18977,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,Cigna-Commercial, +18978,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,Cigna-Commercial, +18979,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,Cigna-Commercial, +18980,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,Cigna-Commercial, +18981,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,Cigna-Commercial, +18982,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,Cigna-Commercial, +18983,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,Cigna-Commercial, +18984,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,Cigna-Commercial, +18985,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,Cigna-Commercial, +18986,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,Cigna-Commercial, +18987,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,Cigna-Commercial, +18988,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,Cigna-Commercial, +18989,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,Cigna-Commercial,2119.0 +18990,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,Cigna-Commercial, +18991,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,Cigna-Commercial, +18992,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,Cigna-Commercial, +18993,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,Cigna-Commercial,571.0 +18994,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,Cigna-Commercial, +18995,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,Cigna-Commercial, +18996,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,Cigna-Commercial, +18997,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,Cigna-Commercial, +18998,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,Cigna-Commercial, +18999,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,Cigna-Commercial, +19000,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,Cigna-Commercial, +19001,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,Cigna-Commercial, +19002,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,Cigna-Commercial, +19003,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,Cigna-Commercial, +19004,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,Cigna-Commercial, +19005,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,Cigna-Commercial, +19006,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,Cigna-Commercial, +19007,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,Cigna-Commercial, +19008,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,Cigna-Commercial, +19009,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,Cigna-Commercial, +19010,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,Cigna-Commercial, +19011,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,Cigna-Commercial, +19012,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Cigna-Commercial, +19013,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,Cigna-Commercial, +19014,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,Cigna-Commercial, +19015,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,Cigna-Commercial, +19016,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,Cigna-Commercial, +19017,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,Cigna-Commercial, +19018,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,Cigna-Commercial, +19019,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,Cigna-Commercial, +19020,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,Cigna-Commercial, +19021,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,Cigna-Commercial, +19022,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,Cigna-Commercial, +19023,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,Cigna-Commercial, +19024,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,Cigna-Commercial, +19025,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,Cigna-Commercial, +19026,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,Cigna-Commercial, +19027,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,Cigna-Commercial, +19028,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,Cigna-Commercial, +19029,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,Cigna-Commercial, +19030,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,Cigna-Commercial, +19031,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,Cigna-Commercial, +19032,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,Cigna-Commercial, +19033,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,Cigna-Commercial, +19034,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,Cigna-Commercial, +19035,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,Cigna-Commercial, +19036,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,Cigna-Commercial, +19037,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,Cigna-Commercial, +19038,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,Cigna-Commercial, +19039,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,Cigna-Commercial, +19040,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,Cigna-Commercial, +19041,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,Cigna-Commercial, +19042,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,Cigna-Commercial, +19043,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,Cigna-Commercial, +19044,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,Cigna-Commercial, +19045,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,Cigna-Commercial, +19046,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,Cigna-Commercial, +19047,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,Cigna-Commercial, +19048,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,Cigna-Commercial,6298.5 +19049,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,Cigna-Commercial, +19050,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,Cigna-Commercial, +19051,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,Cigna-Commercial, +19052,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,Cigna-Commercial, +19053,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,Cigna-Commercial, +19054,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,Cigna-Commercial, +19055,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,Cigna-Commercial, +19056,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,Cigna-Commercial, +19057,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,Cigna-Commercial, +19058,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,Cigna-Commercial, +19059,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,Cigna-Commercial, +19060,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,Cigna-Commercial, +19061,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,Cigna-Commercial, +19062,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,Cigna-Commercial, +19063,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,Cigna-Commercial, +19064,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,Cigna-Commercial, +19065,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,Cigna-Commercial, +19066,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,Cigna-Commercial, +19067,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,Cigna-Commercial, +19068,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,Cigna-Commercial, +19069,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,Cigna-Commercial, +19070,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,Cigna-Commercial, +19071,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,Cigna-Commercial, +19072,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,Cigna-Commercial, +19073,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,Cigna-Commercial, +19074,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,Cigna-Commercial, +19075,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,Cigna-Commercial, +19076,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,Cigna-Commercial,135.88 +19077,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,Cigna-Commercial, +19078,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,Cigna-Commercial,251.5 +19079,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,Cigna-Commercial, +19080,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,Cigna-Commercial,116.5 +19081,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,Cigna-Commercial, +19082,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,Cigna-Commercial, +19083,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,Cigna-Commercial,149.5 +19084,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,Cigna-Commercial, +19085,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,Cigna-Commercial, +19086,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,Cigna-Commercial, +19087,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,Cigna-Commercial, +19088,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,Cigna-Commercial, +19089,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,Cigna-Commercial, +19090,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,Cigna-Commercial, +19091,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,Cigna-Commercial, +19092,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,Cigna-Commercial, +19093,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,Cigna-Commercial, +19094,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,Cigna-Commercial, +19095,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,Cigna-Commercial, +19096,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,Cigna-Commercial, +19097,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,Cigna-Commercial, +19098,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,Cigna-Commercial, +19099,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,Cigna-Commercial,23.9 +19100,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,Cigna-Commercial, +19101,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,Cigna-Commercial, +19102,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,Cigna-Commercial, +19103,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,Cigna-Commercial, +19104,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,Cigna-Commercial, +19105,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,Cigna-Commercial,148.5 +19106,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,Cigna-Commercial, +19107,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,Cigna-Commercial, +19108,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,Cigna-Commercial, +19109,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,Cigna-Commercial, +19110,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,Cigna-Commercial, +19111,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,Cigna-Commercial, +19112,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,Cigna-Commercial, +19113,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,Cigna-Commercial, +19114,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,Cigna-Commercial, +19115,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,Cigna-Commercial, +19116,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,Cigna-Commercial, +19117,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,Cigna-Commercial, +19118,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,Cigna-Commercial, +19119,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,Cigna-Commercial, +19120,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,Cigna-Commercial, +19121,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,Cigna-Commercial, +19122,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,Cigna-Commercial, +19123,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,Cigna-Commercial, +19124,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,Cigna-Commercial, +19125,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,Cigna-Commercial, +19126,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,Cigna-Commercial, +19127,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,Cigna-Commercial, +19128,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,Cigna-Commercial, +19129,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,Cigna-Commercial, +19130,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,Cigna-Commercial, +19131,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,Cigna-Commercial, +19132,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,Cigna-Commercial,50.83 +19133,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,Cigna-Commercial, +19134,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,Cigna-Commercial, +19135,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,Cigna-Commercial, +19136,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,Cigna-Commercial, +19137,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,Cigna-Commercial, +19138,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Cigna-Commercial, +19139,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Cigna-Commercial, +19140,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,Cigna-Commercial, +19141,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,Cigna-Commercial, +19142,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,Cigna-Commercial, +19143,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,Cigna-Commercial, +19144,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,Cigna-Commercial, +19145,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,Cigna-Commercial, +19146,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,Cigna-Commercial, +19147,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,Cigna-Commercial, +19148,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,Cigna-Commercial, +19149,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,Cigna-Commercial, +19150,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,Cigna-Commercial, +19151,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,Cigna-Commercial, +19152,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,Cigna-Commercial, +19153,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,Cigna-Commercial, +19154,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,Cigna-Commercial, +19155,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,Cigna-Commercial, +19156,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,Cigna-Commercial, +19157,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,Cigna-Commercial, +19158,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,Cigna-Commercial, +19159,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,Cigna-Commercial, +19160,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,Cigna-Commercial, +19161,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,Cigna-Commercial, +19162,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,Cigna-Commercial, +19163,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,Cigna-Commercial, +19164,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,Cigna-Commercial, +19165,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,Cigna-Commercial, +19166,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,Cigna-Commercial, +19167,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,Cigna-Commercial, +19168,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,Cigna-Commercial, +19169,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,Cigna-Commercial, +19170,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,Cigna-Commercial, +19171,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,Cigna-Commercial, +19172,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,Cigna-Commercial, +19173,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,Cigna-Commercial, +19174,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,Cigna-Commercial, +19175,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,Cigna-Commercial, +19176,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,Cigna-Commercial, +19177,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,Cigna-Commercial, +19178,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,Cigna-Commercial, +19179,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,Cigna-Commercial, +19180,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,Cigna-Commercial, +19181,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,Cigna-Commercial, +19182,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,Cigna-Commercial, +19183,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,Cigna-Commercial, +19184,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,Cigna-Commercial, +19185,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,Cigna-Commercial, +19186,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,Cigna-Commercial, +19187,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,Cigna-Commercial, +19188,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,Cigna-Commercial, +19189,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,Cigna-Commercial, +19190,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,Cigna-Commercial, +19191,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,Cigna-Commercial, +19192,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,Cigna-Commercial, +19193,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,Cigna-Commercial, +19194,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,Cigna-Commercial, +19195,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,Cigna-Commercial, +19196,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,Cigna-Commercial, +19197,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,Cigna-Commercial, +19198,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,Cigna-Commercial, +19199,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,Cigna-Commercial, +19200,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,Cigna-Commercial, +19201,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,Cigna-Commercial, +19202,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,Cigna-Commercial, +19203,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,Cigna-Commercial, +19204,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,Cigna-Commercial, +19205,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,Cigna-Commercial, +19206,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,Cigna-Commercial, +19207,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,Cigna-Commercial, +19208,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,Cigna-Commercial, +19209,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,Cigna-Commercial, +19210,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,Cigna-Commercial, +19211,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,Cigna-Commercial, +19212,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,Cigna-Commercial, +19213,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,Cigna-Commercial, +19214,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,Cigna-Commercial, +19215,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,Cigna-Commercial, +19216,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,Cigna-Commercial, +19217,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,Cigna-Commercial, +19218,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,Cigna-Commercial, +19219,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,Cigna-Commercial, +19220,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,Cigna-Commercial, +19221,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,Cigna-Commercial, +19222,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,Cigna-Commercial, +19223,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,Cigna-Commercial, +19224,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,Cigna-Commercial, +19225,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,Cigna-Commercial, +19226,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,Cigna-Commercial, +19227,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,Cigna-Commercial, +19228,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,Cigna-Commercial, +19229,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,Cigna-Commercial, +19230,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,Cigna-Commercial, +19231,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,Cigna-Commercial, +19232,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,Cigna-Commercial, +19233,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,Cigna-Commercial, +19234,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,Cigna-Commercial, +19235,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,Cigna-Commercial, +19236,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,Cigna-Commercial, +19237,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,Cigna-Commercial, +19238,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,Cigna-Commercial, +19239,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,Cigna-Commercial, +19240,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,Cigna-Commercial, +19241,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,Cigna-Commercial, +19242,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,Cigna-Commercial, +19243,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,Cigna-Commercial, +19244,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,Cigna-Commercial, +19245,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,Cigna-Commercial, +19246,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,Cigna-Commercial, +19247,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,Cigna-Commercial, +19248,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,Cigna-Commercial, +19249,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,Cigna-Commercial, +19250,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,Cigna-Commercial, +19251,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,Cigna-Commercial, +19252,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,Cigna-Commercial, +19253,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,Cigna-Commercial, +19254,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,Cigna-Commercial,134.13 +19255,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,Cigna-Commercial, +19256,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,Cigna-Commercial, +19257,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,Cigna-Commercial, +19258,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,Cigna-Commercial, +19259,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,Cigna-Commercial, +19260,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,Cigna-Commercial, +19261,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,Cigna-Commercial, +19262,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,Cigna-Commercial, +19263,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,Cigna-Commercial, +19264,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,Cigna-Commercial, +19265,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,Cigna-Commercial, +19266,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,Cigna-Commercial, +19267,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,Cigna-Commercial, +19268,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,Cigna-Commercial, +19269,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,Cigna-Commercial, +19270,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,Cigna-Commercial, +19271,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,Cigna-Commercial, +19272,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,Cigna-Commercial, +19273,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,Cigna-Commercial, +19274,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,Cigna-Commercial, +19275,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,Cigna-Commercial, +19276,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,Cigna-Commercial, +19277,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,Cigna-Commercial, +19278,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,Cigna-Commercial, +19279,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,Cigna-Commercial, +19280,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,Cigna-Commercial, +19281,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,Cigna-Commercial, +19282,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,Cigna-Commercial,41.5 +19283,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,Cigna-Commercial, +19284,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,Cigna-Commercial, +19285,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,Cigna-Commercial, +19286,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,Cigna-Commercial, +19287,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,Cigna-Commercial, +19288,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,Cigna-Commercial, +19289,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,Cigna-Commercial, +19290,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,Cigna-Commercial, +19291,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,Cigna-Commercial, +19292,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,Cigna-Commercial, +19293,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,Cigna-Commercial, +19294,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,Cigna-Commercial, +19295,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,Cigna-Commercial, +19296,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,Cigna-Commercial, +19297,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,Cigna-Commercial, +19298,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,Cigna-Commercial, +19299,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,Cigna-Commercial, +19300,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,Cigna-Commercial, +19301,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,Cigna-Commercial, +19302,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,Cigna-Commercial, +19303,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,Cigna-Commercial, +19304,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,Cigna-Commercial, +19305,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,Cigna-Commercial, +19306,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,Cigna-Commercial, +19307,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,Cigna-Commercial, +19308,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,Cigna-Commercial, +19309,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,Cigna-Commercial, +19310,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,Cigna-Commercial, +19311,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,Cigna-Commercial, +19312,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,Cigna-Commercial, +19313,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,Cigna-Commercial, +19314,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,Cigna-Commercial, +19315,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,Cigna-Commercial, +19316,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,Cigna-Commercial, +19317,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,Cigna-Commercial, +19318,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,Cigna-Commercial, +19319,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,Cigna-Commercial, +19320,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,Cigna-Commercial, +19321,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,Cigna-Commercial, +19322,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,Cigna-Commercial, +19323,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,Cigna-Commercial, +19324,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,Cigna-Commercial, +19325,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,Cigna-Commercial, +19326,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,Cigna-Commercial, +19327,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,Cigna-Commercial, +19328,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,Cigna-Commercial, +19329,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,Cigna-Commercial, +19330,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,Cigna-Commercial, +19331,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,Cigna-Commercial, +19332,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,Cigna-Commercial, +19333,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,Cigna-Commercial,21.2 +19334,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,Cigna-Commercial, +19335,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,Cigna-Commercial, +19336,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,Cigna-Commercial, +19337,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,Cigna-Commercial, +19338,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,Cigna-Commercial, +19339,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,Cigna-Commercial, +19340,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,Cigna-Commercial, +19341,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,Cigna-Commercial,6.5 +19342,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,Cigna-Commercial, +19343,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,Cigna-Commercial, +19344,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,Cigna-Commercial, +19345,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,Cigna-Commercial, +19346,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,Cigna-Commercial, +19347,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,Cigna-Commercial, +19348,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,Cigna-Commercial, +19349,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,Cigna-Commercial, +19350,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,Cigna-Commercial, +19351,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,Cigna-Commercial, +19352,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,Cigna-Commercial, +19353,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,Cigna-Commercial, +19354,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,Cigna-Commercial, +19355,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,Cigna-Commercial, +19356,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,Cigna-Commercial,9.68 +19357,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,Cigna-Commercial, +19358,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,Cigna-Commercial, +19359,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,Cigna-Commercial, +19360,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,Cigna-Commercial, +19361,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,Cigna-Commercial, +19362,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,Cigna-Commercial, +19363,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,Cigna-Commercial, +19364,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,Cigna-Commercial, +19365,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,Cigna-Commercial, +19366,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,Cigna-Commercial, +19367,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,Cigna-Commercial, +19368,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,Cigna-Commercial, +19369,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,Cigna-Commercial, +19370,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,Cigna-Commercial, +19371,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,Cigna-Commercial, +19372,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,Cigna-Commercial, +19373,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,Cigna-Commercial, +19374,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,Cigna-Commercial,49.4 +19375,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,Cigna-Commercial, +19376,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,Cigna-Commercial, +19377,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,Cigna-Commercial, +19378,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,Cigna-Commercial, +19379,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,Cigna-Commercial, +19380,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,Cigna-Commercial, +19381,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,Cigna-Commercial,6.4 +19382,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,Cigna-Commercial, +19383,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,Cigna-Commercial, +19384,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,Cigna-Commercial, +19385,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,Cigna-Commercial, +19386,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,Cigna-Commercial, +19387,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,Cigna-Commercial, +19388,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,Cigna-Commercial, +19389,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,Cigna-Commercial, +19390,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,Cigna-Commercial, +19391,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,Cigna-Commercial, +19392,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,Cigna-Commercial, +19393,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,Cigna-Commercial, +19394,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,Cigna-Commercial, +19395,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,Cigna-Commercial, +19396,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,Cigna-Commercial, +19397,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,Cigna-Commercial,18.6 +19398,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,Cigna-Commercial, +19399,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,Cigna-Commercial, +19400,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,Cigna-Commercial, +19401,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,Cigna-Commercial, +19402,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,Cigna-Commercial, +19403,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,Cigna-Commercial, +19404,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,Cigna-Commercial, +19405,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,Cigna-Commercial, +19406,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,Cigna-Commercial, +19407,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,Cigna-Commercial, +19408,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,Cigna-Commercial, +19409,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,Cigna-Commercial, +19410,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,Cigna-Commercial, +19411,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,Cigna-Commercial, +19412,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,Cigna-Commercial, +19413,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,Cigna-Commercial, +19414,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,Cigna-Commercial, +19415,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,Cigna-Commercial, +19416,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,Cigna-Commercial, +19417,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,Cigna-Commercial, +19418,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,Cigna-Commercial, +19419,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,Cigna-Commercial, +19420,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,Cigna-Commercial, +19421,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,Cigna-Commercial, +19422,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,Cigna-Commercial, +19423,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,Cigna-Commercial, +19424,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,Cigna-Commercial, +19425,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,Cigna-Commercial, +19426,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,Cigna-Commercial, +19427,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,Cigna-Commercial, +19428,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,Cigna-Commercial, +19429,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,Cigna-Commercial, +19430,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,Cigna-Commercial, +19431,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,Cigna-Commercial, +19432,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,Cigna-Commercial, +19433,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,Cigna-Commercial, +19434,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,Cigna-Commercial, +19435,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,Cigna-Commercial, +19436,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,Cigna-Commercial, +19437,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,Cigna-Commercial, +19438,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,Cigna-Commercial, +19439,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,Cigna-Commercial, +19440,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,Cigna-Commercial, +19441,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,Cigna-Commercial, +19442,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,Cigna-Commercial, +19443,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,Cigna-Commercial,9.1 +19444,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,Cigna-Commercial, +19445,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,Cigna-Commercial, +19446,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,Cigna-Commercial, +19447,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,Cigna-Commercial, +19448,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,Cigna-Commercial, +19449,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,Cigna-Commercial, +19450,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,Cigna-Commercial, +19451,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,Cigna-Commercial, +19452,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,Cigna-Commercial, +19453,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,Cigna-Commercial, +19454,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,Cigna-Commercial, +19455,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,Cigna-Commercial, +19456,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,Cigna-Commercial, +19457,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,Cigna-Commercial, +19458,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,Cigna-Commercial, +19459,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,Cigna-Commercial, +19460,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,Cigna-Commercial,40.8 +19461,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,Cigna-Commercial,30.32 +19462,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,Cigna-Commercial, +19463,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,Cigna-Commercial, +19464,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,Cigna-Commercial, +19465,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,Cigna-Commercial, +19466,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,Cigna-Commercial, +19467,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,Cigna-Commercial, +19468,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,Cigna-Commercial, +19469,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,Cigna-Commercial, +19470,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,Cigna-Commercial, +19471,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,Cigna-Commercial, +19472,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,Cigna-Commercial, +19473,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,Cigna-Commercial, +19474,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,Cigna-Commercial, +19475,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,Cigna-Commercial, +19476,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,Cigna-Commercial, +19477,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,Cigna-Commercial, +19478,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,Cigna-Commercial, +19479,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,Cigna-Commercial, +19480,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,Cigna-Commercial, +19481,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,Cigna-Commercial, +19482,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,Cigna-Commercial, +19483,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,Cigna-Commercial, +19484,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,Cigna-Commercial, +19485,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,Cigna-Commercial, +19486,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,Cigna-Commercial, +19487,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,Cigna-Commercial, +19488,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,Cigna-Commercial, +19489,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,Cigna-Commercial, +19490,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,Cigna-Commercial, +19491,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,Cigna-Commercial, +19492,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,Cigna-Commercial, +19493,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,Cigna-Commercial, +19494,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,Cigna-Commercial, +19495,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,Cigna-Commercial, +19496,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,Cigna-Commercial, +19497,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,Cigna-Commercial, +19498,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,Cigna-Commercial, +19499,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,Cigna-Commercial, +19500,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,Cigna-Commercial, +19501,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,Cigna-Commercial, +19502,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,Cigna-Commercial, +19503,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,Cigna-Commercial, +19504,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,Cigna-Commercial, +19505,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,Cigna-Commercial, +19506,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,Cigna-Commercial, +19507,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,Cigna-Commercial, +19508,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,Cigna-Commercial, +19509,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,Cigna-Commercial, +19510,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,Cigna-Commercial, +19511,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,Cigna-Commercial, +19512,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,Cigna-Commercial, +19513,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,Cigna-Commercial, +19514,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,Cigna-Commercial, +19515,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,Cigna-Commercial, +19516,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,Cigna-Commercial, +19517,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,Cigna-Commercial, +19518,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,Cigna-Commercial, +19519,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,Cigna-Commercial, +19520,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,Cigna-Commercial, +19521,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,Cigna-Commercial, +19522,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,Cigna-Commercial,280.0 +19523,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,Cigna-Commercial, +19524,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,Cigna-Commercial, +19525,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,Cigna-Commercial, +19526,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,Cigna-Commercial, +19527,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,Cigna-Commercial,121.5 +19528,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,Cigna-Commercial, +19529,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,Cigna-Commercial, +19530,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,Cigna-Commercial, +19531,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,Cigna-Commercial, +19532,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,Cigna-Commercial, +19533,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,Cigna-Commercial, +19534,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,Cigna-Commercial, +19535,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,Cigna-Commercial, +19536,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,Cigna-Commercial, +19537,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,Cigna-Commercial, +19538,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,Cigna-Commercial, +19539,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,Cigna-Commercial, +19540,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,Cigna-Commercial, +19541,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,Cigna-Commercial, +19542,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,Cigna-Commercial, +19543,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,Cigna-Commercial, +19544,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,Cigna-Commercial, +19545,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,Cigna-Commercial, +19546,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,Cigna-Commercial, +19547,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,Cigna-Commercial, +19548,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,Cigna-Commercial, +19549,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,Cigna-Commercial, +19550,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,Cigna-Commercial, +19551,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,Cigna-Commercial, +19552,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,Cigna-Commercial, +19553,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,Cigna-Commercial, +19554,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,Cigna-Commercial, +19555,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,Cigna-Commercial, +19556,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,Cigna-Commercial, +19557,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,Cigna-Commercial, +19558,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,Cigna-Commercial, +19559,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,Cigna-Commercial, +19560,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,Cigna-Commercial, +19561,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,Cigna-Commercial, +19562,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,Cigna-Commercial, +19563,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,Cigna-Commercial, +19564,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,Cigna-Commercial, +19565,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,Cigna-Commercial, +19566,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,Cigna-Commercial, +19567,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,Cigna-Commercial, +19568,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,Cigna-Commercial, +19569,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,Cigna-Commercial, +19570,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,Cigna-Commercial, +19571,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,Cigna-Commercial, +19572,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,Cigna-Commercial, +19573,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,Cigna-Commercial, +19574,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,Cigna-Commercial, +19575,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,Cigna-Commercial, +19576,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,Cigna-Commercial, +19577,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,Cigna-Commercial, +19578,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,Cigna-Commercial, +19579,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,Cigna-Commercial, +19580,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,Cigna-Commercial, +19581,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,Cigna-Commercial, +19582,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,Cigna-Commercial, +19583,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,Cigna-Commercial, +19584,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,Cigna-Commercial, +19585,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,Cigna-Commercial, +19586,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,Cigna-Commercial, +19587,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,Cigna-Commercial, +19588,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,Cigna-Commercial, +19589,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,Cigna-Commercial, +19590,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,Cigna-Commercial, +19591,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,Cigna-Commercial, +19592,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,Cigna-Commercial, +19593,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,Cigna-Commercial, +19594,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,Cigna-Commercial, +19595,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,Cigna-Commercial, +19596,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,Cigna-Commercial, +19597,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,Cigna-Commercial, +19598,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,Cigna-Commercial, +19599,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,Cigna-Commercial, +19600,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,Cigna-Commercial, +19601,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,Cigna-Commercial, +19602,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,Cigna-Commercial, +19603,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,Cigna-Commercial, +19604,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,Cigna-Commercial, +19605,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,Cigna-Commercial, +19606,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,Cigna-Commercial, +19607,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,Cigna-Commercial, +19608,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,Cigna-Commercial, +19609,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,Cigna-Commercial, +19610,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,Cigna-Commercial, +19611,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,Cigna-Commercial, +19612,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,Cigna-Commercial, +19613,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,Cigna-Commercial, +19614,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,Cigna-Commercial, +19615,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,Cigna-Commercial, +19616,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,Cigna-Commercial, +19617,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,Cigna-Commercial, +19618,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,Cigna-Commercial, +19619,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,Cigna-Commercial,19.6 +19620,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,Cigna-Commercial, +19621,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,Cigna-Commercial, +19622,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,Cigna-Commercial, +19623,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,Cigna-Commercial, +19624,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,Cigna-Commercial, +19625,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,Cigna-Commercial, +19626,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,Cigna-Commercial, +19627,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,Cigna-Commercial, +19628,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,Cigna-Commercial,13.31 +19629,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,Cigna-Commercial, +19630,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,Cigna-Commercial, +19631,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,Cigna-Commercial, +19632,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,Cigna-Commercial, +19633,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,Cigna-Commercial, +19634,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,Cigna-Commercial, +19635,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,Cigna-Commercial, +19636,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,Cigna-Commercial, +19637,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,Cigna-Commercial, +19638,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,Cigna-Commercial, +19639,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,Cigna-Commercial, +19640,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,Cigna-Commercial, +19641,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,Cigna-Commercial, +19642,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,Cigna-Commercial, +19643,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,Cigna-Commercial,48.09 +19644,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,Cigna-Commercial, +19645,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,Cigna-Commercial, +19646,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,Cigna-Commercial, +19647,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,Cigna-Commercial, +19648,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,Cigna-Commercial, +19649,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,Cigna-Commercial, +19650,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,Cigna-Commercial, +19651,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,Cigna-Commercial, +19652,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,Cigna-Commercial, +19653,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,Cigna-Commercial, +19654,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,Cigna-Commercial, +19655,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,Cigna-Commercial, +19656,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,Cigna-Commercial, +19657,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,Cigna-Commercial, +19658,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,Cigna-Commercial, +19659,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,Cigna-Commercial, +19660,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,Cigna-Commercial, +19661,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,Cigna-Commercial, +19662,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,Cigna-Commercial, +19663,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,Cigna-Commercial, +19664,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,Cigna-Commercial, +19665,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,Cigna-Commercial, +19666,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,Cigna-Commercial, +19667,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,Cigna-Commercial, +19668,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,Cigna-Commercial, +19669,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,Cigna-Commercial, +19670,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,Cigna-Commercial, +19671,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,Cigna-Commercial, +19672,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,Cigna-Commercial, +19673,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,Cigna-Commercial, +19674,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,Cigna-Commercial, +19675,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,Cigna-Commercial, +19676,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,Cigna-Commercial, +19677,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,Cigna-Commercial, +19678,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,Cigna-Commercial, +19679,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,Cigna-Commercial, +19680,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,Cigna-Commercial, +19681,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,Cigna-Commercial, +19682,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,Cigna-Commercial, +19683,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,Cigna-Commercial, +19684,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,Cigna-Commercial, +19685,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,Cigna-Commercial, +19686,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,Cigna-Commercial, +19687,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,Cigna-Commercial, +19688,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,Cigna-Commercial, +19689,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,Cigna-Commercial, +19690,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,Cigna-Commercial, +19691,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,Cigna-Commercial, +19692,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,Cigna-Commercial, +19693,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,Cigna-Commercial, +19694,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,Cigna-Commercial, +19695,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,Cigna-Commercial, +19696,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,Cigna-Commercial, +19697,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,Cigna-Commercial, +19698,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,Cigna-Commercial,6.5 +19699,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,Cigna-Commercial, +19700,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,Cigna-Commercial, +19701,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,Cigna-Commercial, +19702,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,Cigna-Commercial, +19703,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,Cigna-Commercial, +19704,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,Cigna-Commercial, +19705,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,Cigna-Commercial, +19706,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,Cigna-Commercial, +19707,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,Cigna-Commercial, +19708,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,Cigna-Commercial, +19709,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,Cigna-Commercial, +19710,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,Cigna-Commercial, +19711,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,Cigna-Commercial, +19712,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,Cigna-Commercial, +19713,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,Cigna-Commercial, +19714,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,Cigna-Commercial, +19715,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,Cigna-Commercial, +19716,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,Cigna-Commercial, +19717,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,Cigna-Commercial, +19718,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,Cigna-Commercial, +19719,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,Cigna-Commercial, +19720,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,Cigna-Commercial, +19721,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,Cigna-Commercial, +19722,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,Cigna-Commercial,12.0 +19723,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,Cigna-Commercial, +19724,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,Cigna-Commercial, +19725,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,Cigna-Commercial, +19726,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,Cigna-Commercial, +19727,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,Cigna-Commercial,7.5 +19728,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,Cigna-Commercial, +19729,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,Cigna-Commercial, +19730,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,Cigna-Commercial, +19731,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,Cigna-Commercial, +19732,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,Cigna-Commercial, +19733,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,Cigna-Commercial, +19734,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,Cigna-Commercial, +19735,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,Cigna-Commercial, +19736,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,Cigna-Commercial, +19737,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,Cigna-Commercial, +19738,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,Cigna-Commercial, +19739,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,Cigna-Commercial, +19740,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,Cigna-Commercial,19.17 +19741,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,Cigna-Commercial, +19742,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,Cigna-Commercial, +19743,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,Cigna-Commercial, +19744,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,Cigna-Commercial, +19745,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,Cigna-Commercial, +19746,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,Cigna-Commercial, +19747,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,Cigna-Commercial, +19748,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,Cigna-Commercial, +19749,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,Cigna-Commercial, +19750,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,Cigna-Commercial, +19751,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,Cigna-Commercial, +19752,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,Cigna-Commercial, +19753,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,Cigna-Commercial, +19754,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,Cigna-Commercial, +19755,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,Cigna-Commercial, +19756,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,Cigna-Commercial, +19757,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,Cigna-Commercial, +19758,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,Cigna-Commercial, +19759,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,Cigna-Commercial, +19760,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,Cigna-Commercial, +19761,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,Cigna-Commercial, +19762,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,Cigna-Commercial, +19763,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,Cigna-Commercial, +19764,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,Cigna-Commercial, +19765,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,Cigna-Commercial,276.37 +19766,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,Cigna-Commercial, +19767,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,Cigna-Commercial, +19768,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,Cigna-Commercial, +19769,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,Cigna-Commercial, +19770,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,Cigna-Commercial, +19771,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,Cigna-Commercial, +19772,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,Cigna-Commercial, +19773,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,Cigna-Commercial, +19774,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,Cigna-Commercial, +19775,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,Cigna-Commercial, +19776,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,Cigna-Commercial, +19777,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,Cigna-Commercial, +19778,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,Cigna-Commercial, +19779,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,Cigna-Commercial, +19780,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,Cigna-Commercial, +19781,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,Cigna-Commercial, +19782,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,Cigna-Commercial, +19783,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,Cigna-Commercial, +19784,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,Cigna-Commercial, +19785,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,Cigna-Commercial, +19786,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,Cigna-Commercial, +19787,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,Cigna-Commercial, +19788,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,Cigna-Commercial, +19789,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,Cigna-Commercial, +19790,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,Cigna-Commercial, +19791,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,Cigna-Commercial, +19792,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,Cigna-Commercial, +19793,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,Cigna-Commercial, +19794,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,Cigna-Commercial, +19795,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,Cigna-Commercial, +19796,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,Cigna-Commercial, +19797,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,Cigna-Commercial, +19798,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,Cigna-Commercial, +19799,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,Cigna-Commercial, +19800,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,Cigna-Commercial, +19801,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,Cigna-Commercial, +19802,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,Cigna-Commercial, +19803,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,Cigna-Commercial, +19804,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,Cigna-Commercial, +19805,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,Cigna-Commercial, +19806,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,Cigna-Commercial, +19807,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,Cigna-Commercial, +19808,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,Cigna-Commercial, +19809,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,Cigna-Commercial, +19810,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,Cigna-Commercial, +19811,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,Cigna-Commercial, +19812,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,Cigna-Commercial, +19813,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,Cigna-Commercial, +19814,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,Cigna-Commercial, +19815,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,Cigna-Commercial, +19816,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,Cigna-Commercial, +19817,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,Cigna-Commercial, +19818,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,Cigna-Commercial, +19819,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,Cigna-Commercial, +19820,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,Cigna-Commercial, +19821,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,Cigna-Commercial, +19822,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,Cigna-Commercial, +19823,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,Cigna-Commercial, +19824,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,Cigna-Commercial, +19825,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,Cigna-Commercial, +19826,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,Cigna-Commercial, +19827,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,Cigna-Commercial, +19828,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,Cigna-Commercial, +19829,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,Cigna-Commercial, +19830,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,Cigna-Commercial, +19831,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,Cigna-Commercial, +19832,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,Cigna-Commercial, +19833,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,Cigna-Commercial, +19834,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,Cigna-Commercial, +19835,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,Cigna-Commercial, +19836,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,Cigna-Commercial, +19837,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,Cigna-Commercial, +19838,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,Cigna-Commercial, +19839,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,Cigna-Commercial, +19840,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,Cigna-Commercial, +19841,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,Cigna-Commercial, +19842,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,Cigna-Commercial, +19843,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,Cigna-Commercial, +19844,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,Cigna-Commercial, +19845,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,Cigna-Commercial, +19846,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,Cigna-Commercial, +19847,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,Cigna-Commercial, +19848,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,Cigna-Commercial, +19849,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,Cigna-Commercial, +19850,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,Cigna-Commercial, +19851,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,Cigna-Commercial, +19852,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,Cigna-Commercial, +19853,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,Cigna-Commercial, +19854,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,Cigna-Commercial, +19855,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,Cigna-Commercial, +19856,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,Cigna-Commercial, +19857,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,Cigna-Commercial, +19858,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,Cigna-Commercial, +19859,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,Cigna-Commercial, +19860,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,Cigna-Commercial, +19861,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,Cigna-Commercial, +19862,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,Cigna-Commercial, +19863,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,Cigna-Commercial, +19864,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,Cigna-Commercial, +19865,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,Cigna-Commercial, +19866,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,Cigna-Commercial, +19867,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,Cigna-Commercial, +19868,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,Cigna-Commercial, +19869,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,Cigna-Commercial, +19870,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,Cigna-Commercial, +19871,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,Cigna-Commercial, +19872,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,Cigna-Commercial, +19873,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,Cigna-Commercial, +19874,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,Cigna-Commercial, +19875,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,Cigna-Commercial, +19876,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,Cigna-Commercial,647.5 +19877,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,Cigna-Commercial, +19878,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,Cigna-Commercial, +19879,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,Cigna-Commercial, +19880,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,Cigna-Commercial, +19881,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,Cigna-Commercial, +19882,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,Cigna-Commercial, +19883,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,Cigna-Commercial, +19884,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,Cigna-Commercial, +19885,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,Cigna-Commercial, +19886,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,Cigna-Commercial, +19887,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,Cigna-Commercial, +19888,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,Cigna-Commercial, +19889,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,Cigna-Commercial, +19890,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,Cigna-Commercial, +19891,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,Cigna-Commercial, +19892,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,Cigna-Commercial, +19893,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,Cigna-Commercial, +19894,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,Cigna-Commercial, +19895,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,Cigna-Commercial, +19896,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,Cigna-Commercial, +19897,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,Cigna-Commercial, +19898,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,Cigna-Commercial, +19899,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,Cigna-Commercial, +19900,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,Cigna-Commercial, +19901,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,Cigna-Commercial, +19902,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,Cigna-Commercial, +19903,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,Cigna-Commercial, +19904,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,Cigna-Commercial, +19905,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,Cigna-Commercial, +19906,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,Cigna-Commercial, +19907,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,Cigna-Commercial, +19908,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,Cigna-Commercial, +19909,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,Cigna-Commercial, +19910,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,Cigna-Commercial, +19911,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,Cigna-Commercial, +19912,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,Cigna-Commercial, +19913,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,Cigna-Commercial,2488.09 +19914,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,Cigna-Commercial, +19915,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,Cigna-Commercial, +19916,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,Cigna-Commercial, +19917,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,Cigna-Commercial, +19918,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,Cigna-Commercial, +19919,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,Cigna-Commercial, +19920,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,Cigna-Commercial, +19921,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,Cigna-Commercial, +19922,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,Cigna-Commercial, +19923,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,Cigna-Commercial, +19924,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,Cigna-Commercial, +19925,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,Cigna-Commercial, +19926,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,Cigna-Commercial,775.35 +19927,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,Cigna-Commercial, +19928,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,Cigna-Commercial, +19929,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,Cigna-Commercial, +19930,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,Cigna-Commercial, +19931,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,Cigna-Commercial, +19932,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,Cigna-Commercial, +19933,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,Cigna-Commercial, +19934,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,Cigna-Commercial, +19935,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,Cigna-Commercial, +19936,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,Cigna-Commercial,2507.51 +19937,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,Cigna-Commercial, +19938,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,Cigna-Commercial, +19939,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,Cigna-Commercial, +19940,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,Cigna-Commercial, +19941,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,Cigna-Commercial, +19942,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,Cigna-Commercial,156.02 +19943,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,Cigna-Commercial, +19944,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,Cigna-Commercial,123.15 +19945,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,Cigna-Commercial, +19946,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,Cigna-Commercial, +19947,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,Cigna-Commercial, +19948,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,Cigna-Commercial, +19949,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,Cigna-Commercial, +19950,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,Cigna-Commercial, +19951,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,Cigna-Commercial, +19952,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,Cigna-Commercial, +19953,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,Cigna-Commercial, +19954,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,Cigna-Commercial, +19955,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,Cigna-Commercial,3452.71 +19956,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,Cigna-Commercial,19249.48 +19957,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,Cigna-Commercial, +19958,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,Cigna-Commercial, +19959,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,Cigna-Commercial, +19960,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,Cigna-Commercial, +19961,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,Cigna-Commercial, +19962,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,Cigna-Commercial,103.43 +19963,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,Cigna-Commercial, +19964,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,Cigna-Commercial, +19965,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,Cigna-Commercial, +19966,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,Cigna-Commercial, +19967,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,Cigna-Commercial, +19968,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,Cigna-Commercial, +19969,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,Cigna-Commercial, +19970,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,Cigna-Commercial, +19971,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,Cigna-Commercial, +19972,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,Cigna-Commercial, +19973,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,Cigna-Commercial, +19974,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,Cigna-Commercial, +19975,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,Cigna-Commercial, +19976,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,Cigna-Commercial, +19977,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,Cigna-Commercial, +19978,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,Cigna-Commercial, +19979,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,Cigna-Commercial, +19980,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,Cigna-Commercial, +19981,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,Cigna-Commercial, +19982,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,Cigna-Commercial, +19983,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,Cigna-Commercial, +19984,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,Cigna-Commercial, +19985,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,Cigna-Commercial, +19986,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,Cigna-Commercial, +19987,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,Cigna-Commercial, +19988,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,Cigna-Commercial, +19989,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,Cigna-Commercial, +19990,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,Cigna-Commercial, +19991,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,Cigna-Commercial, +19992,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,Cigna-Commercial, +19993,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,Cigna-Commercial, +19994,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,Cigna-Commercial, +19995,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,Cigna-Commercial, +19996,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,Cigna-Commercial, +19997,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,Cigna-Commercial, +19998,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,Cigna-Commercial, +19999,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,Cigna-Commercial, +20000,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,Cigna-Commercial, +20001,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,Cigna-Commercial, +20002,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,Cigna-Commercial, +20003,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,Cigna-Commercial, +20004,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,Cigna-Commercial, +20005,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,Cigna-Commercial, +20006,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,Cigna-Commercial, +20007,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,Cigna-Commercial, +20008,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,Cigna-Commercial, +20009,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,Cigna-Commercial, +20010,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,Cigna-Commercial, +20011,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,Cigna-Commercial, +20012,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,Cigna-Commercial, +20013,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,Cigna-Commercial, +20014,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,Cigna-Commercial, +20015,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,Cigna-Commercial, +20016,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,Cigna-Commercial, +20017,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,Cigna-Commercial, +20018,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,Cigna-Commercial, +20019,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,Cigna-Commercial, +20020,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,Cigna-Commercial, +20021,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,Cigna-Commercial, +20022,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,Cigna-Commercial, +20023,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,Cigna-Commercial, +20024,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,Cigna-Commercial, +20025,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,Cigna-Commercial, +20026,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,Cigna-Commercial, +20027,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,Cigna-Commercial, +20028,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,Cigna-Commercial, +20029,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,Cigna-Commercial, +20030,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,Cigna-Commercial, +20031,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,Cigna-Commercial, +20032,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,Cigna-Commercial, +20033,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,Cigna-Commercial, +20034,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,Cigna-Commercial, +20035,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,Cigna-Commercial, +20036,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,Cigna-Commercial, +20037,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,Cigna-Commercial, +20038,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,Cigna-Commercial, +20039,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,Cigna-Commercial, +20040,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,Cigna-Commercial, +20041,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,Cigna-Commercial, +20042,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,Cigna-Commercial, +20043,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,Cigna-Commercial, +20044,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,Cigna-Commercial, +20045,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,Cigna-Commercial, +20046,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,Cigna-Commercial, +20047,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,Cigna-Commercial, +20048,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,Cigna-Commercial, +20049,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,Cigna-Commercial, +20050,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,Cigna-Commercial, +20051,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,Cigna-Commercial, +20052,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,Cigna-Commercial, +20053,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,Cigna-Commercial, +20054,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,Cigna-Commercial,429.6 +20055,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,Cigna-Commercial,429.6 +20056,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,Cigna-Commercial, +20057,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,Cigna-Commercial, +20058,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,Cigna-Commercial, +20059,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,Cigna-Commercial, +20060,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,Cigna-Commercial, +20061,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,Cigna-Commercial,1299.6 +20062,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,Cigna-Commercial,1083.0 +20063,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,Cigna-Commercial, +20064,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,Cigna-Commercial, +20065,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,Cigna-Commercial, +20066,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,Cigna-Commercial, +20067,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,Cigna-Commercial, +20068,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,Cigna-Commercial, +20069,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,Cigna-Commercial, +20070,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,Cigna-Commercial, +20071,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,Cigna-Commercial, +20072,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,Cigna-Commercial,100.0 +20073,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,Cigna-Commercial,150.0 +20074,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,Cigna-Commercial, +20075,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,Cigna-Commercial, +20076,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,Cigna-Commercial, +20077,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,Cigna-Commercial, +20078,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,Cigna-Commercial,3557.88 +20079,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,Cigna-Commercial, +20080,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,Cigna-Commercial,3806.69 +20081,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,Cigna-Commercial, +20082,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,Cigna-Commercial, +20083,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,Cigna-Commercial,6405.0 +20084,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,Cigna-Commercial, +20085,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,Cigna-Commercial,6405.0 +20086,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,Cigna-Commercial, +20087,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,Cigna-Commercial, +20088,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,Cigna-Commercial, +20089,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,Cigna-Commercial, +20090,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,Cigna-Commercial, +20091,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,Cigna-Commercial, +20092,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,Cigna-Commercial, +20093,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,Cigna-Commercial, +20094,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,Cigna-Commercial, +20095,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,Cigna-Commercial, +20096,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,Cigna-Commercial, +20097,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,Cigna-Commercial, +20098,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,Cigna-Commercial, +20099,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,Cigna-Commercial, +20100,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,Cigna-Commercial, +20101,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,Cigna-Commercial, +20102,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,Cigna-Commercial, +20103,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,Cigna-Commercial, +20104,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,Cigna-Commercial, +20105,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,Cigna-Commercial, +20106,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,Cigna-Commercial, +20107,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,Cigna-Commercial, +20108,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,Cigna-Commercial, +20109,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,Cigna-Commercial, +20110,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,Cigna-Commercial, +20111,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,Cigna-Commercial, +20112,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,Cigna-Commercial, +20113,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,Cigna-Commercial, +20114,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,Cigna-Commercial, +20115,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,Cigna-Commercial, +20116,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,Cigna-Commercial, +20117,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,Cigna-Commercial, +20118,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,Cigna-Commercial, +20119,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,Cigna-Commercial, +20120,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,Cigna-Commercial, +20121,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,Cigna-Commercial, +20122,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,Cigna-Commercial, +20123,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,Cigna-Commercial, +20124,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,Cigna-Commercial, +20125,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,Cigna-Commercial, +20126,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,Cigna-Commercial, +20127,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,Cigna-Commercial, +20128,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,Cigna-Commercial, +20129,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,Cigna-Commercial, +20130,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,Cigna-Commercial, +20131,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,Cigna-Commercial, +20132,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,Cigna-Commercial, +20133,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,Cigna-Commercial, +20134,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,Cigna-Commercial, +20135,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,Cigna-Commercial, +20136,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,Cigna-Commercial, +20137,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,Cigna-Commercial, +20138,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,Cigna-Commercial, +20139,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,Cigna-Commercial, +20140,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,Cigna-Commercial, +20141,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,Cigna-Commercial, +20142,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,Cigna-Commercial, +20143,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,Cigna-Commercial, +20144,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,Cigna-Commercial, +20145,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,Cigna-Commercial,945.0 +20146,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,Cigna-Commercial,1707.0 +20147,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,Cigna-Commercial,2942.67 +20148,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,Cigna-Commercial, +20149,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,Cigna-Commercial, +20150,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,Cigna-Commercial, +20151,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,Cigna-Commercial, +20152,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,Cigna-Commercial, +20153,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,Cigna-Commercial, +20154,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,Cigna-Commercial, +20155,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,Cigna-Commercial, +20156,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,Cigna-Commercial, +20157,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,Cigna-Commercial, +20158,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,Cigna-Commercial, +20159,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,Cigna-Commercial, +20160,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,Cigna-Commercial, +20161,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,Cigna-Commercial, +20162,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,Cigna-Commercial, +20163,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,Cigna-Commercial, +20164,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,Cigna-Commercial, +20165,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,Cigna-Commercial, +20166,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,Cigna-Commercial, +20167,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,Cigna-Commercial, +20168,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,Cigna-Commercial, +20169,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,Cigna-Commercial, +20170,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,Cigna-Commercial, +20171,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,Cigna-Commercial, +20172,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,Cigna-Commercial,53404.94 +20173,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,Cigna-Commercial, +20174,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,Cigna-Commercial, +20175,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,Cigna-Commercial, +20176,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,Cigna-Commercial, +20177,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,Cigna-Commercial, +20178,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,Cigna-Commercial,124225.44 +20179,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,Cigna-Commercial, +20180,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,Cigna-Commercial, +20181,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,Cigna-Commercial,118339.0 +20182,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,Cigna-Commercial,116544.18 +20183,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,Cigna-Commercial, +20184,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,Cigna-Commercial,43595.0 +20185,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,Cigna-Commercial,107685.44 +20186,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,Cigna-Commercial, +20187,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,Cigna-Commercial, +20188,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,Cigna-Commercial,125584.0 +20189,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,Cigna-Commercial, +20190,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,Cigna-Commercial, +20191,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,Cigna-Commercial,41246.0 +20192,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,Cigna-Commercial, +20193,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,Cigna-Commercial, +20194,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,Cigna-Commercial,36572.0 +20195,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,Cigna-Commercial, +20196,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,Cigna-Commercial,40402.0 +20197,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,Cigna-Commercial, +20198,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,Cigna-Commercial,73566.0 +20199,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,Cigna-Commercial, +20200,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,Cigna-Commercial, +20201,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,Cigna-Commercial, +20202,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,Cigna-Commercial,31083.96 +20203,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,Cigna-Commercial, +20204,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,Cigna-Commercial,23139.09 +20205,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,Cigna-Commercial, +20206,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,Cigna-Commercial, +20207,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,Cigna-Commercial,35132.0 +20208,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,Cigna-Commercial, +20209,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,Cigna-Commercial, +20210,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,Cigna-Commercial, +20211,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,Cigna-Commercial,18178.11 +20212,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,Cigna-Commercial,19532.3 +20213,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,Cigna-Commercial,32379.0 +20214,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,Cigna-Commercial, +20215,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,Cigna-Commercial, +20216,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,Cigna-Commercial, +20217,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,Cigna-Commercial, +20218,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,Cigna-Commercial, +20219,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,Cigna-Commercial, +20220,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,Cigna-Commercial, +20221,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,Cigna-Commercial, +20222,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,Cigna-Commercial, +20223,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,Cigna-Commercial, +20224,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,Cigna-Commercial, +20225,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,Cigna-Commercial, +20226,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,Cigna-Commercial, +20227,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,Cigna-Commercial, +20228,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,Cigna-Commercial, +20229,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,Cigna-Commercial, +20230,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,Cigna-Commercial, +20231,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,Cigna-Commercial, +20232,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,Cigna-Commercial, +20233,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,Cigna-Commercial, +20234,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,Cigna-Commercial, +20235,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,Cigna-Commercial, +20236,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,Cigna-Commercial, +20237,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,Cigna-Commercial, +20238,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,Cigna-Commercial, +20239,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,Cigna-Commercial, +20240,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,Cigna-Commercial, +20241,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,Cigna-Commercial, +20242,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,Cigna-Commercial, +20243,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,Cigna-Commercial, +20244,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,Cigna-Commercial, +20245,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,Cigna-Commercial, +20246,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,Cigna-Commercial, +20247,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,Cigna-Commercial, +20248,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,Cigna-Commercial, +20249,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,Cigna-Commercial, +20250,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,Cigna-Commercial, +20251,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,Cigna-Commercial, +20252,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,Cigna-Commercial, +20253,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,Cigna-Commercial, +20254,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,Cigna-Commercial, +20255,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,Cigna-Commercial, +20256,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,Cigna-Commercial, +20257,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,Cigna-Commercial, +20258,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,Cigna-Commercial, +20259,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,Cigna-Commercial, +20260,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,Cigna-Commercial, +20261,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,Cigna-Commercial, +20262,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,Cigna-Commercial, +20263,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,Cigna-Commercial, +20264,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,Cigna-Commercial, +20265,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,Cigna-Commercial, +20266,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,Cigna-Commercial, +20267,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,Cigna-Commercial, +20268,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,Cigna-Commercial, +20269,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,Cigna-Commercial, +20270,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,Cigna-Commercial, +20271,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,Cigna-Commercial, +20272,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,Cigna-Commercial, +20273,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,Cigna-Commercial, +20274,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,Cigna-Commercial, +20275,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,Cigna-Commercial, +20276,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,Cigna-Commercial, +20277,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,Cigna-Commercial, +20278,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,Cigna-Commercial, +20279,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,Cigna-Commercial, +20280,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,Cigna-Commercial, +20281,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,Cigna-Commercial, +20282,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,Cigna-Commercial, +20283,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,Cigna-Commercial, +20284,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,Cigna-Commercial, +20285,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,Cigna-Commercial, +20286,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,Cigna-Commercial, +20287,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,Cigna-Commercial, +20288,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,Cigna-Commercial, +20289,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,Cigna-Commercial, +20290,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,Cigna-Commercial, +20291,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,Cigna-Commercial, +20292,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,Cigna-Commercial, +20293,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,Cigna-Commercial, +20294,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,Cigna-Commercial, +20295,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,Cigna-Commercial, +20296,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,Cigna-Commercial, +20297,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,Cigna-Commercial, +20298,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,Cigna-Commercial, +20299,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,Cigna-Commercial, +20300,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,Cigna-Commercial, +20301,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,Cigna-Commercial, +20302,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,Cigna-Commercial, +20303,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,Cigna-Commercial, +20304,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,Cigna-Commercial, +20305,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,Cigna-Commercial, +20306,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,Cigna-Commercial, +20307,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,Cigna-Commercial, +20308,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,Cigna-Commercial, +20309,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,Cigna-Commercial, +20310,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,Cigna-Commercial, +20311,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,Cigna-Commercial, +20312,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,Cigna-Commercial, +20313,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,Cigna-Commercial, +20314,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,Cigna-Commercial, +20315,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,Cigna-Commercial, +20316,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,Cigna-Commercial, +20317,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,Cigna-Commercial, +20318,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,Cigna-Commercial, +20319,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,Cigna-Commercial, +20320,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,Cigna-Commercial, +20321,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,Cigna-Commercial, +20322,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,Cigna-Commercial, +20323,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,Cigna-Commercial, +20324,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,Cigna-Commercial, +20325,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,Cigna-Commercial, +20326,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,Cigna-Commercial, +20327,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,Cigna-Commercial, +20328,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,Cigna-Commercial, +20329,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,Cigna-Commercial, +20330,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,Cigna-Commercial, +20331,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,Cigna-Commercial, +20332,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,Cigna-Commercial, +20333,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,Cigna-Commercial, +20334,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,Cigna-Commercial, +20335,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,Cigna-Commercial, +20336,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,Cigna-Commercial, +20337,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,Cigna-Commercial, +20338,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,Cigna-Commercial, +20339,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,Cigna-Commercial, +20340,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,Cigna-Commercial, +20341,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,Cigna-Commercial, +20342,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,Cigna-Commercial, +20343,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,Cigna-Commercial, +20344,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,Cigna-Commercial, +20345,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,Cigna-Commercial, +20346,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,Cigna-Commercial, +20347,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,Cigna-Commercial, +20348,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,Cigna-Commercial, +20349,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,Cigna-Commercial, +20350,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,Cigna-Commercial, +20351,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,Cigna-Commercial, +20352,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,Cigna-Commercial, +20353,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,Cigna-Commercial, +20354,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,Cigna-Commercial, +20355,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,Cigna-Commercial, +20356,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,Cigna-Commercial, +20357,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,Cigna-Commercial, +20358,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,Cigna-Commercial, +20359,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,Cigna-Commercial, +20360,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,Cigna-Commercial, +20361,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,Cigna-Commercial, +20362,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,Cigna-Commercial, +20363,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,Cigna-Commercial, +20364,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,Cigna-Commercial, +20365,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,Cigna-Commercial, +20366,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,Cigna-Commercial, +20367,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,Cigna-Commercial, +20368,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,Cigna-Commercial, +20369,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,Cigna-Commercial, +20370,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,Cigna-Commercial, +20371,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,Cigna-Commercial, +20372,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,Cigna-Commercial, +20373,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,Cigna-Commercial, +20374,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,Cigna-Commercial, +20375,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,Cigna-Commercial, +20376,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,Cigna-Commercial, +20377,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,Cigna-Commercial, +20378,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,Cigna-Commercial, +20379,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,Cigna-Commercial, +20380,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,Cigna-Commercial, +20381,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,Cigna-Commercial, +20382,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,Cigna-Commercial, +20383,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,Cigna-Commercial, +20384,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,Cigna-Commercial, +20385,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,Cigna-Commercial, +20386,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,Cigna-Commercial, +20387,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,Cigna-Commercial, +20388,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,Cigna-Commercial, +20389,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,Cigna-Commercial, +20390,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,Cigna-Commercial, +20391,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,Cigna-Commercial, +20392,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,Cigna-Commercial, +20393,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,Cigna-Commercial, +20394,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,Cigna-Commercial, +20395,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,Cigna-Commercial, +20396,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,Cigna-Commercial, +20397,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,Cigna-Commercial, +20398,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,Cigna-Commercial, +20399,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,Cigna-Commercial, +20400,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,Cigna-Commercial, +20401,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,Cigna-Commercial, +20402,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,Cigna-Commercial, +20403,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,Cigna-Commercial, +20404,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,Cigna-Commercial, +20405,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,Cigna-Commercial, +20406,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,Cigna-Commercial, +20407,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,Cigna-Commercial, +20408,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,Cigna-Commercial, +20409,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,Cigna-Commercial, +20410,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,Cigna-Commercial, +20411,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,Cigna-Commercial, +20412,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,Cigna-Commercial, +20413,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,Cigna-Commercial, +20414,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,Cigna-Commercial, +20415,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,Cigna-Commercial, +20416,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,Cigna-Commercial, +20417,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,Cigna-Commercial, +20418,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,Cigna-Commercial, +20419,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,Cigna-Commercial, +20420,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,Cigna-Commercial, +20421,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,Cigna-Commercial, +20422,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,Cigna-Commercial, +20423,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,Cigna-Commercial, +20424,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,Cigna-Commercial, +20425,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,Cigna-Commercial, +20426,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,Cigna-Commercial, +20427,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,Cigna-Commercial, +20428,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,Cigna-Commercial, +20429,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,Cigna-Commercial, +20430,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,Cigna-Commercial, +20431,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,Cigna-Commercial, +20432,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,Cigna-Commercial, +20433,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,Cigna-Commercial, +20434,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,Cigna-Commercial, +20435,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,Cigna-Commercial, +20436,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,Cigna-Commercial, +20437,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,Cigna-Commercial, +20438,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,Cigna-Commercial, +20439,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,Cigna-Commercial, +20440,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,Cigna-Commercial, +20441,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,Cigna-Commercial, +20442,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,Cigna-Commercial, +20443,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,Cigna-Commercial, +20444,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,Cigna-Commercial, +20445,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,Cigna-Commercial, +20446,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,Cigna-Commercial, +20447,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,Cigna-Commercial, +20448,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,Cigna-Commercial, +20449,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,Cigna-Commercial, +20450,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,Cigna-Commercial, +20451,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,Cigna-Commercial, +20452,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,Cigna-Commercial, +20453,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,Cigna-Commercial, +20454,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,Cigna-Commercial, +20455,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,Cigna-Commercial, +20456,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,Cigna-Commercial, +20457,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,Cigna-Commercial, +20458,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,Cigna-Commercial, +20459,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,Cigna-Commercial, +20460,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,Cigna-Commercial, +20461,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,Cigna-Commercial, +20462,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,Cigna-Commercial, +20463,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,Cigna-Commercial, +20464,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,Cigna-Commercial, +20465,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,Cigna-Commercial, +20466,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,Cigna-Commercial, +20467,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,Cigna-Commercial, +20468,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,Cigna-Commercial, +20469,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,Cigna-Commercial, +20470,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,Cigna-Commercial, +20471,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,Cigna-Commercial, +20472,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,Cigna-Commercial, +20473,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,Cigna-Commercial, +20474,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,Cigna-Commercial, +20475,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,Cigna-Commercial, +20476,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,Cigna-Commercial, +20477,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,Cigna-Commercial, +20478,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,Cigna-Commercial, +20479,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,Cigna-Commercial, +20480,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,Cigna-Commercial, +20481,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,Cigna-Commercial, +20482,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,Cigna-Commercial, +20483,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,Cigna-Commercial, +20484,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,Cigna-Commercial, +20485,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,Cigna-Commercial, +20486,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,Cigna-Commercial, +20487,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,Cigna-Commercial, +20488,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,Cigna-Commercial, +20489,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,Cigna-Commercial, +20490,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,Cigna-Commercial, +20491,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,Cigna-Commercial, +20492,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,Cigna-Commercial, +20493,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,Cigna-Commercial, +20494,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,Cigna-Commercial, +20495,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,Cigna-Commercial, +20496,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,Cigna-Commercial, +20497,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,Cigna-Commercial, +20498,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,Cigna-Commercial, +20499,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,Cigna-Commercial, +20500,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,Cigna-Commercial, +20501,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,Cigna-Commercial, +20502,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,Cigna-Commercial, +20503,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,Cigna-Commercial, +20504,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,Cigna-Commercial, +20505,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,Cigna-Commercial, +20506,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,Cigna-Commercial, +20507,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,Cigna-Commercial, +20508,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,Cigna-Commercial, +20509,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,Cigna-Commercial, +20510,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,Cigna-Commercial, +20511,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,Cigna-Commercial, +20512,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,Cigna-Commercial, +20513,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,Cigna-Commercial, +20514,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,Cigna-Commercial, +20515,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,Cigna-Commercial, +20516,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,Cigna-Commercial, +20517,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,Cigna-Commercial, +20518,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,Cigna-Commercial, +20519,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,Cigna-Commercial, +20520,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,Cigna-Commercial, +20521,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,Cigna-Commercial, +20522,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,Cigna-Commercial, +20523,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,Cigna-Commercial, +20524,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,Cigna-Commercial, +20525,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,Cigna-Commercial, +20526,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,Cigna-Commercial, +20527,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,Cigna-Commercial, +20528,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,Cigna-Commercial, +20529,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,Cigna-Commercial, +20530,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,Cigna-Commercial, +20531,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,Cigna-Commercial, +20532,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,Cigna-Commercial, +20533,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,Cigna-Commercial, +20534,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,Cigna-Commercial, +20535,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,Cigna-Commercial, +20536,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,Cigna-Commercial, +20537,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,Cigna-Commercial, +20538,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,Cigna-Commercial, +20539,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,Cigna-Commercial, +20540,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,Cigna-Commercial, +20541,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,Cigna-Commercial, +20542,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,Cigna-Commercial, +20543,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,Cigna-Commercial, +20544,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,Cigna-Commercial, +20545,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,Cigna-Commercial, +20546,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,Cigna-Commercial, +20547,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,Cigna-Commercial, +20548,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,Cigna-Commercial, +20549,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,Cigna-Commercial, +20550,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,Cigna-Commercial, +20551,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,Cigna-Commercial, +20552,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,Cigna-Commercial, +20553,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,Cigna-Commercial, +20554,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,Cigna-Commercial, +20555,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,Cigna-Commercial, +20556,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,Cigna-Commercial, +20557,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,Cigna-Commercial, +20558,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,Cigna-Commercial, +20559,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,Cigna-Commercial, +20560,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,Cigna-Commercial, +20561,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,Cigna-Commercial, +20562,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,Cigna-Commercial, +20563,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,Cigna-Commercial, +20564,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,Cigna-Commercial, +20565,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,Cigna-Commercial, +20566,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,Cigna-Commercial, +20567,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,Cigna-Commercial, +20568,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,Cigna-Commercial, +20569,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,Cigna-Commercial, +20570,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,Cigna-Commercial, +20571,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,Cigna-Commercial, +20572,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,Cigna-Commercial, +20573,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,Cigna-Commercial, +20574,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,Cigna-Commercial, +20575,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,Cigna-Commercial, +20576,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,Cigna-Commercial, +20577,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,Cigna-Commercial, +20578,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,Cigna-Commercial, +20579,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,Cigna-Commercial, +20580,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,Cigna-Commercial, +20581,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,Cigna-Commercial, +20582,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,Cigna-Commercial, +20583,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,Cigna-Commercial, +20584,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,Cigna-Commercial, +20585,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,Cigna-Commercial, +20586,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,Cigna-Commercial, +20587,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,Cigna-Commercial, +20588,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,Cigna-Commercial, +20589,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,Cigna-Commercial, +20590,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,Cigna-Commercial, +20591,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,Cigna-Commercial, +20592,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,Cigna-Commercial, +20593,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,Cigna-Commercial, +20594,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,Cigna-Commercial, +20595,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,Cigna-Commercial, +20596,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,Cigna-Commercial, +20597,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,Cigna-Commercial, +20598,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,Cigna-Commercial, +20599,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,Cigna-Commercial, +20600,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,Cigna-Commercial, +20601,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,Cigna-Commercial, +20602,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,Cigna-Commercial, +20603,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,Cigna-Commercial, +20604,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,Cigna-Commercial, +20605,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,Cigna-Commercial, +20606,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,Cigna-Commercial, +20607,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,Cigna-Commercial, +20608,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,Cigna-Commercial, +20609,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,Cigna-Commercial, +20610,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,Cigna-Commercial, +20611,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,Cigna-Commercial, +20612,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,Cigna-Commercial, +20613,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,Cigna-Commercial, +20614,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,Cigna-Commercial, +20615,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,Cigna-Commercial, +20616,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,Cigna-Commercial, +20617,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,Cigna-Commercial, +20618,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,Cigna-Commercial, +20619,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,Cigna-Commercial, +20620,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,Cigna-Commercial, +20621,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,Cigna-Commercial, +20622,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,Cigna-Commercial, +20623,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,Cigna-Commercial, +20624,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,Cigna-Commercial, +20625,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,Cigna-Commercial, +20626,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,Cigna-Commercial, +20627,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,Cigna-Commercial, +20628,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,Cigna-Commercial, +20629,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,Cigna-Commercial, +20630,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,Cigna-Commercial, +20631,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,Cigna-Commercial, +20632,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,Cigna-Commercial, +20633,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,Cigna-Commercial, +20634,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,Cigna-Commercial, +20635,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,Cigna-Commercial, +20636,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,Cigna-Commercial, +20637,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,Cigna-Commercial, +20638,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,Cigna-Commercial, +20639,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,Cigna-Commercial, +20640,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,Cigna-Commercial, +20641,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,Cigna-Commercial, +20642,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,Cigna-Commercial, +20643,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,Cigna-Commercial, +20644,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,Cigna-Commercial, +20645,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,Cigna-Commercial, +20646,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,Cigna-Commercial, +20647,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,Cigna-Commercial, +20648,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,Cigna-Commercial, +20649,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,Cigna-Commercial, +20650,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,Cigna-Commercial, +20651,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,Cigna-Commercial, +20652,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,Cigna-Commercial, +20653,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,Cigna-Commercial, +20654,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,Cigna-Commercial, +20655,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,Cigna-Commercial, +20656,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,Cigna-Commercial, +20657,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,Cigna-Commercial, +20658,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,Cigna-Commercial, +20659,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,Cigna-Commercial, +20660,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,Cigna-Commercial, +20661,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,Cigna-Commercial, +20662,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,Cigna-Commercial, +20663,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,Cigna-Commercial, +20664,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,Cigna-Commercial, +20665,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,Cigna-Commercial, +20666,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,Cigna-Commercial, +20667,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,Cigna-Commercial, +20668,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,Cigna-Commercial, +20669,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,Cigna-Commercial, +20670,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,Cigna-Commercial, +20671,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,Cigna-Commercial, +20672,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,Cigna-Commercial, +20673,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,Cigna-Commercial, +20674,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,Cigna-Commercial, +20675,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,Cigna-Commercial, +20676,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,Cigna-Commercial, +20677,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,Cigna-Commercial, +20678,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,Cigna-Commercial, +20679,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,Cigna-Commercial, +20680,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,Cigna-Commercial, +20681,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,Cigna-Commercial, +20682,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,Cigna-Commercial, +20683,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,Cigna-Commercial, +20684,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,Cigna-Commercial, +20685,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,Cigna-Commercial, +20686,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,Cigna-Commercial, +20687,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,Cigna-Commercial, +20688,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,Cigna-Commercial, +20689,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,Cigna-Commercial, +20690,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,Cigna-Commercial, +20691,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,Cigna-Commercial, +20692,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,Cigna-Commercial, +20693,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,Cigna-Commercial, +20694,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,Cigna-Commercial, +20695,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,Cigna-Commercial, +20696,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,Cigna-Commercial, +20697,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,Cigna-Commercial, +20698,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,Cigna-Commercial, +20699,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,Cigna-Commercial, +20700,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,Cigna-Commercial, +20701,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,Cigna-Commercial, +20702,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,Cigna-Commercial, +20703,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,Cigna-Commercial, +20704,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,Cigna-Commercial, +20705,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,Cigna-Commercial, +20706,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,Cigna-Commercial, +20707,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,Cigna-Commercial, +20708,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,Cigna-Commercial, +20709,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,Cigna-Commercial, +20710,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,Cigna-Commercial, +20711,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,Cigna-Commercial, +20712,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,Cigna-Commercial, +20713,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,Cigna-Commercial, +20714,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,Cigna-Commercial, +20715,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,Cigna-Commercial, +20716,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,Cigna-Commercial, +20717,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,Cigna-Commercial, +20718,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,Cigna-Commercial, +20719,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,Cigna-Commercial, +20720,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,Cigna-Commercial, +20721,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,Cigna-Commercial, +20722,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,Cigna-Commercial, +20723,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,Cigna-Commercial, +20724,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,Cigna-Commercial, +20725,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,Cigna-Commercial, +20726,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,Cigna-Commercial, +20727,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,Cigna-Commercial, +20728,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,Cigna-Commercial, +20729,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,Cigna-Commercial, +20730,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,Cigna-Commercial, +20731,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,Cigna-Commercial, +20732,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,Cigna-Commercial, +20733,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,Cigna-Commercial, +20734,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,Cigna-Commercial, +20735,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,Cigna-Commercial, +20736,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,Cigna-Commercial, +20737,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,Cigna-Commercial, +20738,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,Cigna-Commercial, +20739,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,Cigna-Commercial, +20740,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,Cigna-Commercial, +20741,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,Cigna-Commercial, +20742,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,Cigna-Commercial, +20743,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,Cigna-Commercial, +20744,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,Cigna-Commercial, +20745,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,Cigna-Commercial, +20746,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,Cigna-Commercial, +20747,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,Cigna-Commercial, +20748,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,Cigna-Commercial, +20749,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,Cigna-Commercial, +20750,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,Cigna-Commercial, +20751,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,Cigna-Commercial, +20752,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,Cigna-Commercial, +20753,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,Cigna-Commercial, +20754,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,Cigna-Commercial,0.78 +20755,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,Cigna-Commercial, +20756,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,Cigna-Commercial, +20757,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,Cigna-Commercial, +20758,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,Cigna-Commercial, +20759,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,Cigna-Commercial, +20760,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,Cigna-Commercial, +20761,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,Cigna-Commercial, +20762,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,Cigna-Commercial, +20763,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,Cigna-Commercial, +20764,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,Cigna-Commercial, +20765,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,Cigna-Commercial, +20766,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,Cigna-Commercial, +20767,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,Cigna-Commercial, +20768,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,Cigna-Commercial, +20769,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,Cigna-Commercial, +20770,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,Cigna-Commercial, +20771,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,Cigna-Commercial, +20772,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,Cigna-Commercial, +20773,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,Cigna-Commercial, +20774,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,Cigna-Commercial, +20775,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,Cigna-Commercial, +20776,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,Cigna-Commercial, +20777,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,Cigna-Commercial, +20778,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,Cigna-Commercial, +20779,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,Cigna-Commercial, +20780,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,Cigna-Commercial, +20781,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,Cigna-Commercial, +20782,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,Cigna-Commercial, +20783,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,Cigna-Commercial, +20784,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,Cigna-Commercial, +20785,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,Cigna-Commercial, +20786,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,Cigna-Commercial, +20787,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,Cigna-Commercial, +20788,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,Cigna-Commercial, +20789,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,Cigna-Commercial, +20790,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,Cigna-Commercial, +20791,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,Cigna-Commercial, +20792,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,Cigna-Commercial, +20793,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,Cigna-Commercial, +20794,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,Cigna-Commercial, +20795,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,Cigna-Commercial, +20796,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,Cigna-Commercial, +20797,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,Cigna-Commercial, +20798,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,Cigna-Commercial, +20799,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,Cigna-Commercial, +20800,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,Cigna-Commercial, +20801,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,Cigna-Commercial, +20802,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,Cigna-Commercial, +20803,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,Cigna-Commercial, +20804,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,Cigna-Commercial, +20805,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,Cigna-Commercial, +20806,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,Cigna-Commercial, +20807,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,Cigna-Commercial, +20808,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,Cigna-Commercial, +20809,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,Cigna-Commercial, +20810,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,Cigna-Commercial, +20811,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,Cigna-Commercial, +20812,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,Cigna-Commercial, +20813,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,Cigna-Commercial, +20814,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,Cigna-Commercial, +20815,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,Cigna-Commercial, +20816,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,Cigna-Commercial, +20817,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,Cigna-Commercial, +20818,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,Cigna-Commercial,1.5 +20819,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,Cigna-Commercial, +20820,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,Cigna-Commercial, +20821,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,Cigna-Commercial, +20822,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,Cigna-Commercial, +20823,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,Cigna-Commercial, +20824,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,Cigna-Commercial, +20825,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,Cigna-Commercial, +20826,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,Cigna-Commercial, +20827,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,Cigna-Commercial, +20828,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,Cigna-Commercial, +20829,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,Cigna-Commercial, +20830,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,Cigna-Commercial, +20831,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,Cigna-Commercial, +20832,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,Cigna-Commercial, +20833,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,Cigna-Commercial, +20834,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,Cigna-Commercial, +20835,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,Cigna-Commercial, +20836,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,Cigna-Commercial, +20837,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,Cigna-Commercial, +20838,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,Cigna-Commercial, +20839,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,Cigna-Commercial, +20840,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,Cigna-Commercial, +20841,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,Cigna-Commercial, +20842,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,Cigna-Commercial, +20843,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,Cigna-Commercial, +20844,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,Cigna-Commercial, +20845,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,Cigna-Commercial,0.58 +20846,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,Cigna-Commercial, +20847,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,Cigna-Commercial, +20848,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,Cigna-Commercial, +20849,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,Cigna-Commercial, +20850,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,Cigna-Commercial, +20851,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,Cigna-Commercial, +20852,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,Cigna-Commercial, +20853,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,Cigna-Commercial, +20854,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,Cigna-Commercial, +20855,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,Cigna-Commercial, +20856,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,Cigna-Commercial, +20857,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,Cigna-Commercial, +20858,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,Cigna-Commercial, +20859,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,Cigna-Commercial, +20860,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,Cigna-Commercial, +20861,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,Cigna-Commercial, +20862,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,Cigna-Commercial, +20863,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,Cigna-Commercial, +20864,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,Cigna-Commercial, +20865,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,Cigna-Commercial, +20866,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,Cigna-Commercial, +20867,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,Cigna-Commercial, +20868,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,Cigna-Commercial, +20869,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,Cigna-Commercial,27.25 +20870,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,Cigna-Commercial, +20871,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,Cigna-Commercial, +20872,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,Cigna-Commercial, +20873,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,Cigna-Commercial, +20874,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,Cigna-Commercial, +20875,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,Cigna-Commercial, +20876,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,Cigna-Commercial, +20877,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,Cigna-Commercial, +20878,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,Cigna-Commercial, +20879,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,Cigna-Commercial, +20880,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,Cigna-Commercial, +20881,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,Cigna-Commercial, +20882,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,Cigna-Commercial, +20883,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,Cigna-Commercial, +20884,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,Cigna-Commercial, +20885,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,Cigna-Commercial, +20886,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,Cigna-Commercial, +20887,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,Cigna-Commercial, +20888,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,Cigna-Commercial, +20889,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,Cigna-Commercial, +20890,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,Cigna-Commercial, +20891,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,Cigna-Commercial, +20892,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,Cigna-Commercial, +20893,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,Cigna-Commercial, +20894,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,Cigna-Commercial, +20895,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,Cigna-Commercial, +20896,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,Cigna-Commercial, +20897,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,Cigna-Commercial, +20898,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,Cigna-Commercial, +20899,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,Cigna-Commercial, +20900,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,Cigna-Commercial, +20901,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,Cigna-Commercial, +20902,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,Cigna-Commercial, +20903,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,Cigna-Commercial, +20904,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,Cigna-Commercial, +20905,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,Cigna-Commercial, +20906,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,Cigna-Commercial, +20907,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,Cigna-Commercial, +20908,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,Cigna-Commercial, +20909,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,Cigna-Commercial, +20910,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,Cigna-Commercial, +20911,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,Cigna-Commercial, +20912,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,Cigna-Commercial, +20913,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,Cigna-Commercial, +20914,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,Cigna-Commercial, +20915,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,Cigna-Commercial, +20916,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,Cigna-Commercial, +20917,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,Cigna-Commercial, +20918,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,Cigna-Commercial, +20919,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,Cigna-Commercial, +20920,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,Cigna-Commercial, +20921,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,Cigna-Commercial, +20922,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,Cigna-Commercial, +20923,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,Cigna-Commercial, +20924,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,Cigna-Commercial, +20925,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,Cigna-Commercial, +20926,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,Cigna-Commercial, +20927,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,Cigna-Commercial, +20928,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,Cigna-Commercial, +20929,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,Cigna-Commercial, +20930,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,Cigna-Commercial, +20931,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,Cigna-Commercial, +20932,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,Cigna-Commercial, +20933,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,Cigna-Commercial, +20934,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,Cigna-Commercial, +20935,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,Cigna-Commercial, +20936,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,Cigna-Commercial, +20937,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,Cigna-Commercial, +20938,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,Cigna-Commercial, +20939,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,Cigna-Commercial, +20940,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,Cigna-Commercial, +20941,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,Cigna-Commercial, +20942,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,Cigna-Commercial, +20943,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,Cigna-Commercial, +20944,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,Cigna-Commercial, +20945,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,Cigna-Commercial, +20946,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,Cigna-Commercial, +20947,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,Cigna-Commercial, +20948,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,Cigna-Commercial, +20949,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,Cigna-Commercial, +20950,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,Cigna-Commercial, +20951,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,Cigna-Commercial, +20952,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,Cigna-Commercial, +20953,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,Cigna-Commercial, +20954,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,Cigna-Commercial, +20955,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,Cigna-Commercial, +20956,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,Cigna-Commercial, +20957,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,Cigna-Commercial, +20958,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,Cigna-Commercial, +20959,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,Cigna-Commercial, +20960,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,Cigna-Commercial, +20961,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,Cigna-Commercial, +20962,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,Cigna-Commercial, +20963,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,Cigna-Commercial, +20964,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,Cigna-Commercial, +20965,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,Cigna-Commercial, +20966,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,Cigna-Commercial, +20967,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,Cigna-Commercial, +20968,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,Cigna-Commercial, +20969,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,Cigna-Commercial, +20970,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,Cigna-Commercial, +20971,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,Cigna-Commercial, +20972,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,Cigna-Commercial, +20973,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,Cigna-Commercial, +20974,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,Cigna-Commercial, +20975,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,Cigna-Commercial, +20976,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,Cigna-Commercial, +20977,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,Cigna-Commercial, +20978,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,Cigna-Commercial, +20979,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,Cigna-Commercial, +20980,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,Cigna-Commercial, +20981,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,Cigna-Commercial, +20982,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,Cigna-Commercial, +20983,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,Cigna-Commercial, +20984,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,Cigna-Commercial, +20985,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,Cigna-Commercial, +20986,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,Cigna-Commercial, +20987,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,Cigna-Commercial, +20988,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,Cigna-Commercial, +20989,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,Cigna-Commercial, +20990,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,Cigna-Commercial, +20991,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,Cigna-Commercial, +20992,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,Cigna-Commercial, +20993,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,Cigna-Commercial, +20994,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,Cigna-Commercial, +20995,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,Cigna-Commercial, +20996,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,Cigna-Commercial, +20997,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,Cigna-Commercial, +20998,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,Cigna-Commercial, +20999,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,Cigna-Commercial, +21000,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,Cigna-Commercial, +21001,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,Cigna-Commercial, +21002,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,Cigna-Commercial, +21003,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,Cigna-Commercial, +21004,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,Cigna-Commercial, +21005,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,Cigna-Commercial, +21006,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,Cigna-Commercial, +21007,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,Cigna-Commercial, +21008,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,Cigna-Commercial, +21009,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,Cigna-Commercial, +21010,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,Cigna-Commercial, +21011,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,Cigna-Commercial, +21012,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,Cigna-Commercial, +21013,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,Cigna-Commercial, +21014,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,Cigna-Commercial, +21015,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,Cigna-Commercial, +21016,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,Cigna-Commercial, +21017,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,Cigna-Commercial, +21018,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,Cigna-Commercial, +21019,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,Cigna-Commercial,1162.26 +21020,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,Cigna-Commercial,1198.2 +21021,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,Cigna-Commercial, +21022,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,Cigna-Commercial, +21023,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,Cigna-Commercial, +21024,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,Cigna-Commercial, +21025,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,Cigna-Commercial, +21026,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,Cigna-Commercial, +21027,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,Cigna-Commercial, +21028,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,Cigna-Commercial, +21029,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,Cigna-Commercial, +21030,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,Cigna-Commercial, +21031,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,Cigna-Commercial, +21032,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,Cigna-Commercial, +21033,3934,30000012,PRIVATE,,8380.0,8380.0,,,Cigna-Commercial, +21034,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,Cigna-Commercial, +21035,3934,30000038,ICU,,12700.0,12700.0,,,Cigna-Commercial, +21036,3934,30000046,BURN UNIT,,12700.0,12700.0,,,Cigna-Commercial, +21037,3934,30000053,NICU,,12700.0,12700.0,,,Cigna-Commercial, +21038,3934,30000061,ICR ROOM,,7630.0,7630.0,,,Cigna-Commercial, +21039,3934,30000079,PSYCH,,7630.0,7630.0,,,Cigna-Commercial, +21040,3934,30000087,NEWBORN,,4140.0,4140.0,,,Cigna-Commercial, +21041,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,Cigna-Commercial, +21042,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21043,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,Cigna-Commercial, +21044,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21045,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21046,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21047,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21048,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21049,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21050,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21051,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21052,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21053,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21054,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21055,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21056,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21057,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21058,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21059,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21060,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21061,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21062,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21063,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21064,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21065,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21066,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21067,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21068,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21069,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,Cigna-Commercial, +21070,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21071,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21072,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21073,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21074,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21075,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21076,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21077,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21078,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21079,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21080,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21081,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21082,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21083,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21084,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,Cigna-Commercial, +21085,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21086,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21087,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21088,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21089,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21090,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21091,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21092,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21093,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21094,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21095,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21096,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21097,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21098,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21099,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21100,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21101,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21102,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21103,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21104,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21105,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21106,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21107,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21108,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21109,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21110,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21111,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,Cigna-Commercial, +21112,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21113,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21114,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21115,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21116,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21117,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21118,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21119,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21120,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21121,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21122,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21123,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21124,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21125,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21126,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21127,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21128,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21129,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21130,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21131,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21132,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21133,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21134,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21135,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21136,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21137,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21138,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21139,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21140,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21141,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21142,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21143,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21144,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21145,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21146,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21147,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,Cigna-Commercial, +21148,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,Cigna-Commercial, +21149,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,Cigna-Commercial, +21150,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21151,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21152,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21153,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21154,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21155,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21156,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21157,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21158,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21159,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21160,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21161,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21162,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21163,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21164,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21165,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21166,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21167,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21168,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21169,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21170,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21171,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21172,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21173,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21174,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21175,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21176,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21177,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21178,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21179,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21180,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21181,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21182,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21183,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21184,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21185,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21186,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21187,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21188,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21189,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21190,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21191,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21192,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21193,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21194,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21195,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21196,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21197,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21198,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, 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PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21337,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21338,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21339,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21340,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21341,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21342,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21343,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21344,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21345,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21346,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21347,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21348,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21349,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,Cigna-Commercial, +21350,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21351,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,Cigna-Commercial, +21352,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21353,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21354,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21355,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21356,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21357,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21358,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21359,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21360,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21361,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,Cigna-Commercial, +21362,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21363,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21364,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21365,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21366,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21367,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21368,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21369,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21370,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21371,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21372,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21373,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21374,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21375,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21376,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21377,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21378,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21379,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21380,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21381,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21382,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21383,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21384,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21385,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21386,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21387,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21388,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21389,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21390,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21391,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21392,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21393,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21394,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21395,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21396,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21397,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21398,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21399,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21400,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21401,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21402,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21403,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21404,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21405,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,Cigna-Commercial, +21406,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21407,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21408,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21409,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,Cigna-Commercial, +21410,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21411,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21412,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21413,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21414,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21415,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21416,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21417,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21418,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21419,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21420,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21421,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21422,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21423,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21424,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21425,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21426,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21427,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21428,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21429,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21430,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21431,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21432,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21433,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21434,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,Cigna-Commercial, +21435,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21436,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21437,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21438,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21439,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21440,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21441,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21442,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,Cigna-Commercial, +21443,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21444,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,Cigna-Commercial, +21445,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21446,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21447,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21448,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,Cigna-Commercial, +21449,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,Cigna-Commercial, +21450,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,Cigna-Commercial, +21451,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21452,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,Cigna-Commercial, +21453,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21454,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21455,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21456,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21457,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,Cigna-Commercial, +21458,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21459,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21460,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21461,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21462,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21463,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21464,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21465,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,Cigna-Commercial, +21466,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21467,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21468,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21469,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21470,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21471,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21472,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21473,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,Cigna-Commercial, +21474,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,Cigna-Commercial, +21475,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,Cigna-Commercial, +21476,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,Cigna-Commercial, +21477,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,Cigna-Commercial, +21478,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,Cigna-Commercial, +21479,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,Cigna-Commercial, +21480,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,Cigna-Commercial, +21481,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,Cigna-Commercial, +21482,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,Cigna-Commercial, +21483,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,Cigna-Commercial, +21484,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,Cigna-Commercial, +21485,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,Cigna-Commercial, +21486,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,Cigna-Commercial, +21487,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,Cigna-Commercial, +21488,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,Cigna-Commercial, +21489,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,Cigna-Commercial, +21490,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,Cigna-Commercial, +21491,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,Cigna-Commercial, +21492,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,Cigna-Commercial, +21493,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,Cigna-Commercial, +21494,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,Cigna-Commercial, +21495,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,Cigna-Commercial, +21496,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,Cigna-Commercial, +21497,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,Cigna-Commercial, +21498,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,Cigna-Commercial, +21499,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,Cigna-Commercial, +21500,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,Cigna-Commercial, +21501,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,Cigna-Commercial, +21502,3934,37112000,ACUTE ED,,1580.0,1580.0,,,Cigna-Commercial, +21503,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,Cigna-Commercial, +21504,3934,37112034,TRIAGE,,277.0,277.0,,,Cigna-Commercial, +21505,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,Cigna-Commercial, +21506,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,Cigna-Commercial, +21507,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,Cigna-Commercial, +21508,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,Cigna-Commercial, +21509,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,Cigna-Commercial, +21510,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,Cigna-Commercial, +21511,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,Cigna-Commercial, +21512,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,Cigna-Commercial, +21513,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,Cigna-Commercial, +21514,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,Cigna-Commercial, +21515,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,Cigna-Commercial, +21516,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,Cigna-Commercial, +21517,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,Cigna-Commercial, +21518,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,Cigna-Commercial, +21519,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,Cigna-Commercial, +21520,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,Cigna-Commercial, +21521,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,Cigna-Commercial, +21522,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,Cigna-Commercial, +21523,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,Cigna-Commercial, +21524,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,Cigna-Commercial, +21525,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,Cigna-Commercial, +21526,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,Cigna-Commercial, +21527,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,Cigna-Commercial, +21528,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,Cigna-Commercial, +21529,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,Cigna-Commercial, +21530,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,Cigna-Commercial, +21531,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,Cigna-Commercial, +21532,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,Cigna-Commercial, +21533,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,Cigna-Commercial, +21534,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,Cigna-Commercial, +21535,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,Cigna-Commercial, +21536,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,Cigna-Commercial, +21537,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,Cigna-Commercial, +21538,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,Cigna-Commercial, +21539,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,Cigna-Commercial, +21540,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,Cigna-Commercial, +21541,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,Cigna-Commercial, +21542,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,Cigna-Commercial, +21543,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,Cigna-Commercial, +21544,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,Cigna-Commercial, +21545,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,Cigna-Commercial, +21546,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,Cigna-Commercial, +21547,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,Cigna-Commercial, +21548,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,Cigna-Commercial, +21549,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,Cigna-Commercial, +21550,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,Cigna-Commercial, +21551,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,Cigna-Commercial, +21552,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,Cigna-Commercial, +21553,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,Cigna-Commercial, +21554,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,Cigna-Commercial, +21555,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,Cigna-Commercial, +21556,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,Cigna-Commercial, +21557,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,Cigna-Commercial, +21558,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,Cigna-Commercial, +21559,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,Cigna-Commercial, +21560,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,Cigna-Commercial, +21561,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,Cigna-Commercial, +21562,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,Cigna-Commercial, +21563,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,Cigna-Commercial, +21564,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,Cigna-Commercial, +21565,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,Cigna-Commercial, +21566,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,Cigna-Commercial, +21567,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,Cigna-Commercial, +21568,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,Cigna-Commercial, +21569,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,Cigna-Commercial, +21570,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,Cigna-Commercial, +21571,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,Cigna-Commercial, +21572,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,Cigna-Commercial, +21573,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,Cigna-Commercial, +21574,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,Cigna-Commercial, +21575,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,Cigna-Commercial, +21576,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,Cigna-Commercial, +21577,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,Cigna-Commercial, +21578,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,Cigna-Commercial, +21579,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,Cigna-Commercial, +21580,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,Cigna-Commercial, +21581,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,Cigna-Commercial, +21582,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,Cigna-Commercial, +21583,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,Cigna-Commercial, +21584,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,Cigna-Commercial, +21585,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,Cigna-Commercial, +21586,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,Cigna-Commercial, +21587,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,Cigna-Commercial, +21588,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,Cigna-Commercial, +21589,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,Cigna-Commercial, +21590,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,Cigna-Commercial, +21591,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,Cigna-Commercial, +21592,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,Cigna-Commercial, +21593,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,Cigna-Commercial, +21594,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,Cigna-Commercial, +21595,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,Cigna-Commercial, +21596,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,Cigna-Commercial, +21597,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,Cigna-Commercial, +21598,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,Cigna-Commercial, +21599,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,Cigna-Commercial, +21600,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,Cigna-Commercial, +21601,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,Cigna-Commercial, +21602,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,Cigna-Commercial, +21603,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,Cigna-Commercial, +21604,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,Cigna-Commercial, +21605,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21606,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21607,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21608,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21609,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21610,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,Cigna-Commercial, +21611,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,Cigna-Commercial, +21612,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,Cigna-Commercial, +21613,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21614,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21615,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21616,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,Cigna-Commercial, +21617,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,Cigna-Commercial, +21618,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,Cigna-Commercial, +21619,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,Cigna-Commercial, +21620,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,Cigna-Commercial, +21621,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,Cigna-Commercial, +21622,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,Cigna-Commercial, +21623,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,Cigna-Commercial, +21624,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,Cigna-Commercial, +21625,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,Cigna-Commercial, +21626,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,Cigna-Commercial, +21627,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,Cigna-Commercial, +21628,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,Cigna-Commercial, +21629,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,Cigna-Commercial, +21630,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,Cigna-Commercial, +21631,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,Cigna-Commercial, +21632,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,Cigna-Commercial, +21633,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,Cigna-Commercial, +21634,3934,43301043,ALBUNEX,,357.0,357.0,,,Cigna-Commercial, +21635,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,Cigna-Commercial, +21636,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21637,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21638,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21639,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21640,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21641,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,Cigna-Commercial, +21642,3934,43450022,REC RM .5HR,,541.0,541.0,,,Cigna-Commercial, +21643,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,Cigna-Commercial, +21644,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,Cigna-Commercial, +21645,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,Cigna-Commercial, +21646,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,Cigna-Commercial, +21647,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,Cigna-Commercial, +21648,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,Cigna-Commercial, +21649,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,Cigna-Commercial, +21650,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,Cigna-Commercial, +21651,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,Cigna-Commercial, +21652,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,Cigna-Commercial, +21653,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,Cigna-Commercial, +21654,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,Cigna-Commercial, +21655,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,Cigna-Commercial, +21656,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,Cigna-Commercial, +21657,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,Cigna-Commercial, +21658,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,Cigna-Commercial, +21659,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,Cigna-Commercial, +21660,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21661,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21662,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21663,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21664,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21665,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,Cigna-Commercial, +21666,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21667,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,Cigna-Commercial, +21668,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21669,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21670,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21671,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21672,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,Cigna-Commercial, +21673,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,Cigna-Commercial, +21674,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21675,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21676,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21677,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21678,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21679,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,Cigna-Commercial, +21680,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21681,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21682,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21683,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21684,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21685,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,Cigna-Commercial, +21686,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,Cigna-Commercial, +21687,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,Cigna-Commercial, +21688,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,Cigna-Commercial, +21689,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,Cigna-Commercial, +21690,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,Cigna-Commercial, +21691,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,Cigna-Commercial, +21692,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,Cigna-Commercial, +21693,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,Cigna-Commercial, +21694,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21695,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21696,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21697,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21698,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21699,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,Cigna-Commercial, +21700,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,Cigna-Commercial, +21701,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,Cigna-Commercial, +21702,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,Cigna-Commercial, +21703,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,Cigna-Commercial, +21704,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,Cigna-Commercial, +21705,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,Cigna-Commercial, +21706,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,Cigna-Commercial, +21707,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,Cigna-Commercial, +21708,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,Cigna-Commercial, +21709,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,Cigna-Commercial, +21710,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,Cigna-Commercial, +21711,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,Cigna-Commercial, +21712,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,Cigna-Commercial, +21713,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,Cigna-Commercial, +21714,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,Cigna-Commercial, +21715,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,Cigna-Commercial, +21716,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,Cigna-Commercial, +21717,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,Cigna-Commercial, +21718,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,Cigna-Commercial, +21719,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,Cigna-Commercial, +21720,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,Cigna-Commercial, +21721,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,Cigna-Commercial, +21722,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,Cigna-Commercial, +21723,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,Cigna-Commercial, +21724,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,Cigna-Commercial, +21725,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,Cigna-Commercial, +21726,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,Cigna-Commercial, +21727,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,Cigna-Commercial, +21728,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,Cigna-Commercial, +21729,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,Cigna-Commercial, +21730,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,Cigna-Commercial, +21731,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,Cigna-Commercial, +21732,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,Cigna-Commercial, +21733,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,Cigna-Commercial, +21734,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,Cigna-Commercial, +21735,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,Cigna-Commercial, +21736,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,Cigna-Commercial, +21737,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,Cigna-Commercial, +21738,3934,45924552,ENDO REC RM,,30.0,30.0,,,Cigna-Commercial, +21739,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,Cigna-Commercial, +21740,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,Cigna-Commercial, +21741,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,Cigna-Commercial, +21742,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,Cigna-Commercial, +21743,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,Cigna-Commercial, +21744,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,Cigna-Commercial, +21745,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,Cigna-Commercial, +21746,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,Cigna-Commercial, +21747,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,Cigna-Commercial, +21748,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,Cigna-Commercial, +21749,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,Cigna-Commercial, +21750,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,Cigna-Commercial, +21751,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,Cigna-Commercial, +21752,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,Cigna-Commercial, +21753,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,Cigna-Commercial, +21754,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,Cigna-Commercial, +21755,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,Cigna-Commercial, +21756,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,Cigna-Commercial, +21757,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,Cigna-Commercial, +21758,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,Cigna-Commercial, +21759,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,Cigna-Commercial, +21760,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,Cigna-Commercial, +21761,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,Cigna-Commercial, +21762,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,Cigna-Commercial, +21763,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,Cigna-Commercial, +21764,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,Cigna-Commercial, +21765,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,Cigna-Commercial, +21766,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,Cigna-Commercial, +21767,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,Cigna-Commercial, +21768,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,Cigna-Commercial, +21769,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,Cigna-Commercial, +21770,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,Cigna-Commercial, +21771,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,Cigna-Commercial, +21772,3934,53200010,GUEST TRAY,,24.0,24.0,,,Cigna-Commercial, +21773,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,Cigna-Commercial, +21774,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,Cigna-Commercial, +21775,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,Cigna-Commercial, +21776,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,Cigna-Commercial, +21777,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,Cigna-Commercial, +21778,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,Cigna-Commercial, +21779,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,Cigna-Commercial, +21780,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,Cigna-Commercial, +21781,3934,53329876,HIV MONITORING,,416.0,416.0,,,Cigna-Commercial, +21782,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,Cigna-Commercial, +21783,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,Cigna-Commercial, +21784,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,Cigna-Commercial, +21785,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,Cigna-Commercial, +21786,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,Cigna-Commercial, +21787,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,Cigna-Commercial, +21788,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,Cigna-Commercial, +21789,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,Cigna-Commercial, +21790,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,Cigna-Commercial, +21791,3934,76010107,COPY X-RAY,,22.0,22.0,,,Cigna-Commercial, +21792,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,Cigna-Commercial, +21793,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,Cigna-Commercial, +21794,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,Cigna-Commercial, +21795,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,Cigna-Commercial, +21796,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,Cigna-Commercial, +21797,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,Cigna-Commercial, +21798,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,Cigna-Commercial, +21799,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,Cigna-Commercial, +21800,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,Cigna-Commercial, +21801,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,Cigna-Commercial, +21802,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,Cigna-Commercial, +21803,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,Cigna-Commercial, +21804,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMBLEMHEALTH/GHI-Commercial, +21805,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMBLEMHEALTH/GHI-Commercial, +21806,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMBLEMHEALTH/GHI-Commercial, +21807,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMBLEMHEALTH/GHI-Commercial, +21808,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMBLEMHEALTH/GHI-Commercial, +21809,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMBLEMHEALTH/GHI-Commercial, +21810,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMBLEMHEALTH/GHI-Commercial, +21811,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMBLEMHEALTH/GHI-Commercial, +21812,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMBLEMHEALTH/GHI-Commercial, +21813,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMBLEMHEALTH/GHI-Commercial, +21814,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMBLEMHEALTH/GHI-Commercial, +21815,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMBLEMHEALTH/GHI-Commercial, +21816,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMBLEMHEALTH/GHI-Commercial, +21817,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMBLEMHEALTH/GHI-Commercial, +21818,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMBLEMHEALTH/GHI-Commercial, +21819,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMBLEMHEALTH/GHI-Commercial, +21820,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMBLEMHEALTH/GHI-Commercial, +21821,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMBLEMHEALTH/GHI-Commercial, +21822,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMBLEMHEALTH/GHI-Commercial, +21823,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMBLEMHEALTH/GHI-Commercial, +21824,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMBLEMHEALTH/GHI-Commercial, +21825,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMBLEMHEALTH/GHI-Commercial, +21826,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMBLEMHEALTH/GHI-Commercial, +21827,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMBLEMHEALTH/GHI-Commercial, +21828,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMBLEMHEALTH/GHI-Commercial, +21829,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMBLEMHEALTH/GHI-Commercial, +21830,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMBLEMHEALTH/GHI-Commercial, +21831,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMBLEMHEALTH/GHI-Commercial, +21832,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMBLEMHEALTH/GHI-Commercial, +21833,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMBLEMHEALTH/GHI-Commercial, +21834,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMBLEMHEALTH/GHI-Commercial, +21835,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMBLEMHEALTH/GHI-Commercial, +21836,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMBLEMHEALTH/GHI-Commercial, +21837,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMBLEMHEALTH/GHI-Commercial, +21838,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMBLEMHEALTH/GHI-Commercial, +21839,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMBLEMHEALTH/GHI-Commercial, +21840,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMBLEMHEALTH/GHI-Commercial, +21841,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMBLEMHEALTH/GHI-Commercial, +21842,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMBLEMHEALTH/GHI-Commercial, +21843,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMBLEMHEALTH/GHI-Commercial, +21844,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMBLEMHEALTH/GHI-Commercial, +21845,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMBLEMHEALTH/GHI-Commercial, +21846,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMBLEMHEALTH/GHI-Commercial, +21847,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMBLEMHEALTH/GHI-Commercial, +21848,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMBLEMHEALTH/GHI-Commercial, +21849,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMBLEMHEALTH/GHI-Commercial, +21850,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMBLEMHEALTH/GHI-Commercial, +21851,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMBLEMHEALTH/GHI-Commercial, +21852,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMBLEMHEALTH/GHI-Commercial, +21853,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMBLEMHEALTH/GHI-Commercial, +21854,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMBLEMHEALTH/GHI-Commercial, +21855,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMBLEMHEALTH/GHI-Commercial, +21856,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMBLEMHEALTH/GHI-Commercial, +21857,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMBLEMHEALTH/GHI-Commercial, +21858,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMBLEMHEALTH/GHI-Commercial, +21859,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMBLEMHEALTH/GHI-Commercial, +21860,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMBLEMHEALTH/GHI-Commercial, +21861,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMBLEMHEALTH/GHI-Commercial, +21862,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMBLEMHEALTH/GHI-Commercial, +21863,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMBLEMHEALTH/GHI-Commercial, +21864,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMBLEMHEALTH/GHI-Commercial, +21865,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMBLEMHEALTH/GHI-Commercial, +21866,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMBLEMHEALTH/GHI-Commercial, +21867,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMBLEMHEALTH/GHI-Commercial, +21868,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMBLEMHEALTH/GHI-Commercial, +21869,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMBLEMHEALTH/GHI-Commercial, +21870,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMBLEMHEALTH/GHI-Commercial, +21871,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMBLEMHEALTH/GHI-Commercial, +21872,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMBLEMHEALTH/GHI-Commercial, +21873,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMBLEMHEALTH/GHI-Commercial, +21874,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMBLEMHEALTH/GHI-Commercial, +21875,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMBLEMHEALTH/GHI-Commercial, +21876,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMBLEMHEALTH/GHI-Commercial, +21877,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMBLEMHEALTH/GHI-Commercial, +21878,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMBLEMHEALTH/GHI-Commercial,18826.08 +21879,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMBLEMHEALTH/GHI-Commercial, +21880,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMBLEMHEALTH/GHI-Commercial, +21881,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMBLEMHEALTH/GHI-Commercial, +21882,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMBLEMHEALTH/GHI-Commercial, +21883,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMBLEMHEALTH/GHI-Commercial, +21884,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMBLEMHEALTH/GHI-Commercial, +21885,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMBLEMHEALTH/GHI-Commercial, +21886,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMBLEMHEALTH/GHI-Commercial, +21887,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMBLEMHEALTH/GHI-Commercial, +21888,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMBLEMHEALTH/GHI-Commercial, +21889,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMBLEMHEALTH/GHI-Commercial, +21890,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMBLEMHEALTH/GHI-Commercial,30370.81 +21891,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMBLEMHEALTH/GHI-Commercial, +21892,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMBLEMHEALTH/GHI-Commercial, +21893,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMBLEMHEALTH/GHI-Commercial, +21894,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMBLEMHEALTH/GHI-Commercial, +21895,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMBLEMHEALTH/GHI-Commercial, +21896,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMBLEMHEALTH/GHI-Commercial, +21897,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMBLEMHEALTH/GHI-Commercial, +21898,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMBLEMHEALTH/GHI-Commercial, +21899,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMBLEMHEALTH/GHI-Commercial, +21900,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMBLEMHEALTH/GHI-Commercial, +21901,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMBLEMHEALTH/GHI-Commercial, +21902,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMBLEMHEALTH/GHI-Commercial, +21903,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMBLEMHEALTH/GHI-Commercial, +21904,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMBLEMHEALTH/GHI-Commercial, +21905,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMBLEMHEALTH/GHI-Commercial, +21906,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMBLEMHEALTH/GHI-Commercial, +21907,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMBLEMHEALTH/GHI-Commercial, +21908,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMBLEMHEALTH/GHI-Commercial, +21909,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMBLEMHEALTH/GHI-Commercial, +21910,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMBLEMHEALTH/GHI-Commercial, +21911,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMBLEMHEALTH/GHI-Commercial, +21912,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMBLEMHEALTH/GHI-Commercial, +21913,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMBLEMHEALTH/GHI-Commercial, +21914,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMBLEMHEALTH/GHI-Commercial, +21915,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMBLEMHEALTH/GHI-Commercial, +21916,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMBLEMHEALTH/GHI-Commercial, +21917,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMBLEMHEALTH/GHI-Commercial, +21918,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMBLEMHEALTH/GHI-Commercial, +21919,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMBLEMHEALTH/GHI-Commercial, +21920,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMBLEMHEALTH/GHI-Commercial, +21921,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMBLEMHEALTH/GHI-Commercial, +21922,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMBLEMHEALTH/GHI-Commercial, +21923,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMBLEMHEALTH/GHI-Commercial, +21924,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMBLEMHEALTH/GHI-Commercial, +21925,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMBLEMHEALTH/GHI-Commercial, +21926,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMBLEMHEALTH/GHI-Commercial,26110.13 +21927,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMBLEMHEALTH/GHI-Commercial, +21928,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMBLEMHEALTH/GHI-Commercial, +21929,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMBLEMHEALTH/GHI-Commercial, +21930,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMBLEMHEALTH/GHI-Commercial, +21931,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMBLEMHEALTH/GHI-Commercial, +21932,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMBLEMHEALTH/GHI-Commercial, +21933,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMBLEMHEALTH/GHI-Commercial, +21934,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMBLEMHEALTH/GHI-Commercial, +21935,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMBLEMHEALTH/GHI-Commercial, +21936,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMBLEMHEALTH/GHI-Commercial, +21937,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMBLEMHEALTH/GHI-Commercial, +21938,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMBLEMHEALTH/GHI-Commercial, +21939,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMBLEMHEALTH/GHI-Commercial, +21940,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMBLEMHEALTH/GHI-Commercial, +21941,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMBLEMHEALTH/GHI-Commercial, +21942,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMBLEMHEALTH/GHI-Commercial, +21943,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMBLEMHEALTH/GHI-Commercial, +21944,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMBLEMHEALTH/GHI-Commercial, +21945,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMBLEMHEALTH/GHI-Commercial, +21946,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMBLEMHEALTH/GHI-Commercial, +21947,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMBLEMHEALTH/GHI-Commercial, +21948,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMBLEMHEALTH/GHI-Commercial, +21949,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMBLEMHEALTH/GHI-Commercial, +21950,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMBLEMHEALTH/GHI-Commercial, +21951,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMBLEMHEALTH/GHI-Commercial, +21952,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMBLEMHEALTH/GHI-Commercial, +21953,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMBLEMHEALTH/GHI-Commercial, +21954,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMBLEMHEALTH/GHI-Commercial, +21955,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMBLEMHEALTH/GHI-Commercial, +21956,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMBLEMHEALTH/GHI-Commercial, +21957,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMBLEMHEALTH/GHI-Commercial, +21958,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMBLEMHEALTH/GHI-Commercial, +21959,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMBLEMHEALTH/GHI-Commercial, +21960,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMBLEMHEALTH/GHI-Commercial, +21961,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMBLEMHEALTH/GHI-Commercial, +21962,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMBLEMHEALTH/GHI-Commercial, +21963,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMBLEMHEALTH/GHI-Commercial, +21964,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMBLEMHEALTH/GHI-Commercial, +21965,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMBLEMHEALTH/GHI-Commercial, +21966,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMBLEMHEALTH/GHI-Commercial, +21967,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMBLEMHEALTH/GHI-Commercial, +21968,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMBLEMHEALTH/GHI-Commercial, +21969,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMBLEMHEALTH/GHI-Commercial, +21970,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMBLEMHEALTH/GHI-Commercial, +21971,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMBLEMHEALTH/GHI-Commercial, +21972,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMBLEMHEALTH/GHI-Commercial, +21973,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMBLEMHEALTH/GHI-Commercial, +21974,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMBLEMHEALTH/GHI-Commercial, +21975,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMBLEMHEALTH/GHI-Commercial, +21976,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMBLEMHEALTH/GHI-Commercial, +21977,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMBLEMHEALTH/GHI-Commercial, +21978,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMBLEMHEALTH/GHI-Commercial, +21979,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMBLEMHEALTH/GHI-Commercial, +21980,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMBLEMHEALTH/GHI-Commercial, +21981,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMBLEMHEALTH/GHI-Commercial, +21982,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMBLEMHEALTH/GHI-Commercial, +21983,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMBLEMHEALTH/GHI-Commercial, +21984,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMBLEMHEALTH/GHI-Commercial, +21985,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMBLEMHEALTH/GHI-Commercial, +21986,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMBLEMHEALTH/GHI-Commercial, +21987,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMBLEMHEALTH/GHI-Commercial, +21988,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMBLEMHEALTH/GHI-Commercial, +21989,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMBLEMHEALTH/GHI-Commercial, +21990,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMBLEMHEALTH/GHI-Commercial, +21991,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMBLEMHEALTH/GHI-Commercial, +21992,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMBLEMHEALTH/GHI-Commercial, +21993,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMBLEMHEALTH/GHI-Commercial, +21994,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMBLEMHEALTH/GHI-Commercial, +21995,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMBLEMHEALTH/GHI-Commercial, +21996,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMBLEMHEALTH/GHI-Commercial, +21997,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMBLEMHEALTH/GHI-Commercial, +21998,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMBLEMHEALTH/GHI-Commercial, +21999,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMBLEMHEALTH/GHI-Commercial, +22000,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMBLEMHEALTH/GHI-Commercial,117926.27 +22001,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMBLEMHEALTH/GHI-Commercial, +22002,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMBLEMHEALTH/GHI-Commercial, +22003,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMBLEMHEALTH/GHI-Commercial, +22004,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMBLEMHEALTH/GHI-Commercial, +22005,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMBLEMHEALTH/GHI-Commercial, +22006,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMBLEMHEALTH/GHI-Commercial, +22007,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMBLEMHEALTH/GHI-Commercial, +22008,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMBLEMHEALTH/GHI-Commercial, +22009,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMBLEMHEALTH/GHI-Commercial, +22010,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMBLEMHEALTH/GHI-Commercial, +22011,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMBLEMHEALTH/GHI-Commercial, +22012,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMBLEMHEALTH/GHI-Commercial, +22013,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMBLEMHEALTH/GHI-Commercial, +22014,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMBLEMHEALTH/GHI-Commercial, +22015,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMBLEMHEALTH/GHI-Commercial, +22016,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMBLEMHEALTH/GHI-Commercial, +22017,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMBLEMHEALTH/GHI-Commercial, +22018,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMBLEMHEALTH/GHI-Commercial, +22019,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMBLEMHEALTH/GHI-Commercial, +22020,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMBLEMHEALTH/GHI-Commercial, +22021,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMBLEMHEALTH/GHI-Commercial, +22022,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMBLEMHEALTH/GHI-Commercial, +22023,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMBLEMHEALTH/GHI-Commercial, +22024,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMBLEMHEALTH/GHI-Commercial, +22025,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMBLEMHEALTH/GHI-Commercial, +22026,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMBLEMHEALTH/GHI-Commercial, +22027,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMBLEMHEALTH/GHI-Commercial, +22028,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMBLEMHEALTH/GHI-Commercial, +22029,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMBLEMHEALTH/GHI-Commercial, +22030,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMBLEMHEALTH/GHI-Commercial, +22031,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMBLEMHEALTH/GHI-Commercial, +22032,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMBLEMHEALTH/GHI-Commercial, +22033,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMBLEMHEALTH/GHI-Commercial, +22034,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMBLEMHEALTH/GHI-Commercial, +22035,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMBLEMHEALTH/GHI-Commercial, +22036,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMBLEMHEALTH/GHI-Commercial, +22037,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMBLEMHEALTH/GHI-Commercial, +22038,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMBLEMHEALTH/GHI-Commercial, +22039,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMBLEMHEALTH/GHI-Commercial, +22040,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMBLEMHEALTH/GHI-Commercial, +22041,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMBLEMHEALTH/GHI-Commercial, +22042,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMBLEMHEALTH/GHI-Commercial, +22043,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMBLEMHEALTH/GHI-Commercial, +22044,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMBLEMHEALTH/GHI-Commercial, +22045,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMBLEMHEALTH/GHI-Commercial, +22046,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMBLEMHEALTH/GHI-Commercial, +22047,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMBLEMHEALTH/GHI-Commercial, +22048,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMBLEMHEALTH/GHI-Commercial, +22049,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMBLEMHEALTH/GHI-Commercial, +22050,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMBLEMHEALTH/GHI-Commercial, +22051,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMBLEMHEALTH/GHI-Commercial, +22052,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMBLEMHEALTH/GHI-Commercial, +22053,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMBLEMHEALTH/GHI-Commercial, +22054,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMBLEMHEALTH/GHI-Commercial, +22055,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMBLEMHEALTH/GHI-Commercial, +22056,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMBLEMHEALTH/GHI-Commercial, +22057,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMBLEMHEALTH/GHI-Commercial, +22058,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMBLEMHEALTH/GHI-Commercial, +22059,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMBLEMHEALTH/GHI-Commercial, +22060,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMBLEMHEALTH/GHI-Commercial, +22061,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMBLEMHEALTH/GHI-Commercial, +22062,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMBLEMHEALTH/GHI-Commercial, +22063,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMBLEMHEALTH/GHI-Commercial, +22064,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMBLEMHEALTH/GHI-Commercial, +22065,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMBLEMHEALTH/GHI-Commercial, +22066,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMBLEMHEALTH/GHI-Commercial, +22067,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMBLEMHEALTH/GHI-Commercial, +22068,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMBLEMHEALTH/GHI-Commercial, +22069,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMBLEMHEALTH/GHI-Commercial, +22070,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMBLEMHEALTH/GHI-Commercial, +22071,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMBLEMHEALTH/GHI-Commercial, +22072,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMBLEMHEALTH/GHI-Commercial, +22073,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMBLEMHEALTH/GHI-Commercial, +22074,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMBLEMHEALTH/GHI-Commercial, +22075,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMBLEMHEALTH/GHI-Commercial, +22076,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMBLEMHEALTH/GHI-Commercial, +22077,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMBLEMHEALTH/GHI-Commercial, +22078,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMBLEMHEALTH/GHI-Commercial, +22079,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMBLEMHEALTH/GHI-Commercial, +22080,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMBLEMHEALTH/GHI-Commercial, +22081,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMBLEMHEALTH/GHI-Commercial, +22082,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMBLEMHEALTH/GHI-Commercial, +22083,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMBLEMHEALTH/GHI-Commercial, +22084,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMBLEMHEALTH/GHI-Commercial, +22085,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMBLEMHEALTH/GHI-Commercial, +22086,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMBLEMHEALTH/GHI-Commercial, +22087,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMBLEMHEALTH/GHI-Commercial, +22088,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMBLEMHEALTH/GHI-Commercial, +22089,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMBLEMHEALTH/GHI-Commercial, +22090,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMBLEMHEALTH/GHI-Commercial, +22091,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMBLEMHEALTH/GHI-Commercial, +22092,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMBLEMHEALTH/GHI-Commercial, +22093,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMBLEMHEALTH/GHI-Commercial, +22094,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMBLEMHEALTH/GHI-Commercial, +22095,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMBLEMHEALTH/GHI-Commercial, +22096,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMBLEMHEALTH/GHI-Commercial, +22097,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMBLEMHEALTH/GHI-Commercial, +22098,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMBLEMHEALTH/GHI-Commercial, +22099,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMBLEMHEALTH/GHI-Commercial, +22100,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMBLEMHEALTH/GHI-Commercial, +22101,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMBLEMHEALTH/GHI-Commercial, +22102,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMBLEMHEALTH/GHI-Commercial, +22103,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMBLEMHEALTH/GHI-Commercial, +22104,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMBLEMHEALTH/GHI-Commercial, +22105,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMBLEMHEALTH/GHI-Commercial, +22106,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMBLEMHEALTH/GHI-Commercial, +22107,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMBLEMHEALTH/GHI-Commercial, +22108,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMBLEMHEALTH/GHI-Commercial, +22109,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMBLEMHEALTH/GHI-Commercial, +22110,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMBLEMHEALTH/GHI-Commercial, +22111,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMBLEMHEALTH/GHI-Commercial, +22112,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMBLEMHEALTH/GHI-Commercial, +22113,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMBLEMHEALTH/GHI-Commercial, +22114,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMBLEMHEALTH/GHI-Commercial, +22115,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMBLEMHEALTH/GHI-Commercial, +22116,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMBLEMHEALTH/GHI-Commercial, +22117,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMBLEMHEALTH/GHI-Commercial, +22118,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMBLEMHEALTH/GHI-Commercial, +22119,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMBLEMHEALTH/GHI-Commercial, +22120,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMBLEMHEALTH/GHI-Commercial, +22121,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMBLEMHEALTH/GHI-Commercial, +22122,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMBLEMHEALTH/GHI-Commercial, +22123,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMBLEMHEALTH/GHI-Commercial, +22124,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMBLEMHEALTH/GHI-Commercial, +22125,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMBLEMHEALTH/GHI-Commercial, +22126,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMBLEMHEALTH/GHI-Commercial, +22127,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMBLEMHEALTH/GHI-Commercial, +22128,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMBLEMHEALTH/GHI-Commercial, +22129,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMBLEMHEALTH/GHI-Commercial, +22130,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMBLEMHEALTH/GHI-Commercial, +22131,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMBLEMHEALTH/GHI-Commercial, +22132,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMBLEMHEALTH/GHI-Commercial, +22133,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMBLEMHEALTH/GHI-Commercial, +22134,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMBLEMHEALTH/GHI-Commercial, +22135,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMBLEMHEALTH/GHI-Commercial, +22136,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMBLEMHEALTH/GHI-Commercial, +22137,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMBLEMHEALTH/GHI-Commercial, +22138,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMBLEMHEALTH/GHI-Commercial, +22139,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMBLEMHEALTH/GHI-Commercial, +22140,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMBLEMHEALTH/GHI-Commercial, +22141,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMBLEMHEALTH/GHI-Commercial, +22142,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMBLEMHEALTH/GHI-Commercial, +22143,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMBLEMHEALTH/GHI-Commercial, +22144,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMBLEMHEALTH/GHI-Commercial, +22145,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMBLEMHEALTH/GHI-Commercial, +22146,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMBLEMHEALTH/GHI-Commercial, +22147,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMBLEMHEALTH/GHI-Commercial, +22148,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMBLEMHEALTH/GHI-Commercial, +22149,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMBLEMHEALTH/GHI-Commercial, +22150,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMBLEMHEALTH/GHI-Commercial, +22151,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMBLEMHEALTH/GHI-Commercial, +22152,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMBLEMHEALTH/GHI-Commercial, +22153,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMBLEMHEALTH/GHI-Commercial, +22154,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMBLEMHEALTH/GHI-Commercial, +22155,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMBLEMHEALTH/GHI-Commercial, +22156,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMBLEMHEALTH/GHI-Commercial, +22157,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMBLEMHEALTH/GHI-Commercial,39992.1 +22158,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMBLEMHEALTH/GHI-Commercial, +22159,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMBLEMHEALTH/GHI-Commercial, +22160,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMBLEMHEALTH/GHI-Commercial, +22161,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMBLEMHEALTH/GHI-Commercial, +22162,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMBLEMHEALTH/GHI-Commercial, +22163,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMBLEMHEALTH/GHI-Commercial, +22164,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMBLEMHEALTH/GHI-Commercial, +22165,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMBLEMHEALTH/GHI-Commercial, +22166,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMBLEMHEALTH/GHI-Commercial, +22167,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMBLEMHEALTH/GHI-Commercial, +22168,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMBLEMHEALTH/GHI-Commercial, +22169,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMBLEMHEALTH/GHI-Commercial, +22170,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMBLEMHEALTH/GHI-Commercial, +22171,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMBLEMHEALTH/GHI-Commercial, +22172,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMBLEMHEALTH/GHI-Commercial, +22173,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMBLEMHEALTH/GHI-Commercial, +22174,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMBLEMHEALTH/GHI-Commercial, +22175,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMBLEMHEALTH/GHI-Commercial, +22176,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMBLEMHEALTH/GHI-Commercial, +22177,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMBLEMHEALTH/GHI-Commercial, +22178,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMBLEMHEALTH/GHI-Commercial, +22179,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMBLEMHEALTH/GHI-Commercial, +22180,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMBLEMHEALTH/GHI-Commercial, +22181,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMBLEMHEALTH/GHI-Commercial, +22182,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMBLEMHEALTH/GHI-Commercial, +22183,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMBLEMHEALTH/GHI-Commercial, +22184,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMBLEMHEALTH/GHI-Commercial, +22185,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMBLEMHEALTH/GHI-Commercial, +22186,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMBLEMHEALTH/GHI-Commercial, +22187,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMBLEMHEALTH/GHI-Commercial, +22188,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMBLEMHEALTH/GHI-Commercial, +22189,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMBLEMHEALTH/GHI-Commercial, +22190,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMBLEMHEALTH/GHI-Commercial, +22191,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMBLEMHEALTH/GHI-Commercial, +22192,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMBLEMHEALTH/GHI-Commercial, +22193,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMBLEMHEALTH/GHI-Commercial, +22194,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMBLEMHEALTH/GHI-Commercial, +22195,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMBLEMHEALTH/GHI-Commercial, +22196,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMBLEMHEALTH/GHI-Commercial, +22197,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMBLEMHEALTH/GHI-Commercial, +22198,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMBLEMHEALTH/GHI-Commercial, +22199,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMBLEMHEALTH/GHI-Commercial, +22200,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMBLEMHEALTH/GHI-Commercial, +22201,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMBLEMHEALTH/GHI-Commercial, +22202,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMBLEMHEALTH/GHI-Commercial, +22203,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMBLEMHEALTH/GHI-Commercial, +22204,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMBLEMHEALTH/GHI-Commercial, +22205,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMBLEMHEALTH/GHI-Commercial, +22206,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMBLEMHEALTH/GHI-Commercial, +22207,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMBLEMHEALTH/GHI-Commercial, +22208,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMBLEMHEALTH/GHI-Commercial, +22209,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMBLEMHEALTH/GHI-Commercial, +22210,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMBLEMHEALTH/GHI-Commercial, +22211,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMBLEMHEALTH/GHI-Commercial, +22212,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMBLEMHEALTH/GHI-Commercial, +22213,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMBLEMHEALTH/GHI-Commercial, +22214,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMBLEMHEALTH/GHI-Commercial, +22215,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMBLEMHEALTH/GHI-Commercial, +22216,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMBLEMHEALTH/GHI-Commercial, +22217,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMBLEMHEALTH/GHI-Commercial, +22218,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMBLEMHEALTH/GHI-Commercial, +22219,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMBLEMHEALTH/GHI-Commercial, +22220,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMBLEMHEALTH/GHI-Commercial, +22221,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMBLEMHEALTH/GHI-Commercial, +22222,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMBLEMHEALTH/GHI-Commercial, +22223,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMBLEMHEALTH/GHI-Commercial, +22224,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMBLEMHEALTH/GHI-Commercial, +22225,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMBLEMHEALTH/GHI-Commercial, +22226,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMBLEMHEALTH/GHI-Commercial,18131.35 +22227,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMBLEMHEALTH/GHI-Commercial, +22228,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMBLEMHEALTH/GHI-Commercial, +22229,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMBLEMHEALTH/GHI-Commercial, +22230,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMBLEMHEALTH/GHI-Commercial, +22231,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMBLEMHEALTH/GHI-Commercial, +22232,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMBLEMHEALTH/GHI-Commercial, +22233,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMBLEMHEALTH/GHI-Commercial, +22234,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMBLEMHEALTH/GHI-Commercial, +22235,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMBLEMHEALTH/GHI-Commercial, +22236,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMBLEMHEALTH/GHI-Commercial, +22237,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMBLEMHEALTH/GHI-Commercial, +22238,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMBLEMHEALTH/GHI-Commercial, +22239,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMBLEMHEALTH/GHI-Commercial, +22240,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMBLEMHEALTH/GHI-Commercial, +22241,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMBLEMHEALTH/GHI-Commercial, +22242,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMBLEMHEALTH/GHI-Commercial, +22243,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMBLEMHEALTH/GHI-Commercial, +22244,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMBLEMHEALTH/GHI-Commercial, +22245,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMBLEMHEALTH/GHI-Commercial, +22246,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMBLEMHEALTH/GHI-Commercial, +22247,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMBLEMHEALTH/GHI-Commercial, +22248,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMBLEMHEALTH/GHI-Commercial, +22249,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMBLEMHEALTH/GHI-Commercial, +22250,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMBLEMHEALTH/GHI-Commercial, +22251,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMBLEMHEALTH/GHI-Commercial, +22252,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMBLEMHEALTH/GHI-Commercial, +22253,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMBLEMHEALTH/GHI-Commercial, +22254,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMBLEMHEALTH/GHI-Commercial, +22255,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMBLEMHEALTH/GHI-Commercial, +22256,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMBLEMHEALTH/GHI-Commercial, +22257,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMBLEMHEALTH/GHI-Commercial, +22258,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMBLEMHEALTH/GHI-Commercial, +22259,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMBLEMHEALTH/GHI-Commercial, +22260,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMBLEMHEALTH/GHI-Commercial, +22261,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMBLEMHEALTH/GHI-Commercial, +22262,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMBLEMHEALTH/GHI-Commercial, +22263,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMBLEMHEALTH/GHI-Commercial, +22264,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMBLEMHEALTH/GHI-Commercial, +22265,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMBLEMHEALTH/GHI-Commercial, +22266,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMBLEMHEALTH/GHI-Commercial, +22267,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMBLEMHEALTH/GHI-Commercial, +22268,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMBLEMHEALTH/GHI-Commercial, +22269,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMBLEMHEALTH/GHI-Commercial, +22270,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMBLEMHEALTH/GHI-Commercial, +22271,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMBLEMHEALTH/GHI-Commercial, +22272,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMBLEMHEALTH/GHI-Commercial, +22273,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMBLEMHEALTH/GHI-Commercial, +22274,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMBLEMHEALTH/GHI-Commercial, +22275,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMBLEMHEALTH/GHI-Commercial, +22276,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMBLEMHEALTH/GHI-Commercial, +22277,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMBLEMHEALTH/GHI-Commercial, +22278,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMBLEMHEALTH/GHI-Commercial, +22279,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMBLEMHEALTH/GHI-Commercial, +22280,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMBLEMHEALTH/GHI-Commercial, +22281,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMBLEMHEALTH/GHI-Commercial, +22282,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMBLEMHEALTH/GHI-Commercial, +22283,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMBLEMHEALTH/GHI-Commercial, +22284,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMBLEMHEALTH/GHI-Commercial, +22285,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMBLEMHEALTH/GHI-Commercial, +22286,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMBLEMHEALTH/GHI-Commercial, +22287,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMBLEMHEALTH/GHI-Commercial, +22288,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMBLEMHEALTH/GHI-Commercial, +22289,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMBLEMHEALTH/GHI-Commercial, +22290,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMBLEMHEALTH/GHI-Commercial, +22291,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMBLEMHEALTH/GHI-Commercial, +22292,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMBLEMHEALTH/GHI-Commercial, +22293,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMBLEMHEALTH/GHI-Commercial, +22294,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMBLEMHEALTH/GHI-Commercial, +22295,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMBLEMHEALTH/GHI-Commercial, +22296,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMBLEMHEALTH/GHI-Commercial, +22297,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMBLEMHEALTH/GHI-Commercial, +22298,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMBLEMHEALTH/GHI-Commercial, +22299,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMBLEMHEALTH/GHI-Commercial, +22300,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMBLEMHEALTH/GHI-Commercial, +22301,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMBLEMHEALTH/GHI-Commercial, +22302,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMBLEMHEALTH/GHI-Commercial, +22303,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMBLEMHEALTH/GHI-Commercial, +22304,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMBLEMHEALTH/GHI-Commercial, +22305,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMBLEMHEALTH/GHI-Commercial, +22306,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMBLEMHEALTH/GHI-Commercial, +22307,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMBLEMHEALTH/GHI-Commercial, +22308,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMBLEMHEALTH/GHI-Commercial, +22309,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMBLEMHEALTH/GHI-Commercial, +22310,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMBLEMHEALTH/GHI-Commercial, +22311,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMBLEMHEALTH/GHI-Commercial, +22312,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMBLEMHEALTH/GHI-Commercial, +22313,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMBLEMHEALTH/GHI-Commercial, +22314,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMBLEMHEALTH/GHI-Commercial, +22315,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMBLEMHEALTH/GHI-Commercial, +22316,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMBLEMHEALTH/GHI-Commercial, +22317,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMBLEMHEALTH/GHI-Commercial, +22318,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMBLEMHEALTH/GHI-Commercial, +22319,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMBLEMHEALTH/GHI-Commercial, +22320,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMBLEMHEALTH/GHI-Commercial, +22321,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMBLEMHEALTH/GHI-Commercial, +22322,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMBLEMHEALTH/GHI-Commercial, +22323,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMBLEMHEALTH/GHI-Commercial, +22324,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMBLEMHEALTH/GHI-Commercial, +22325,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMBLEMHEALTH/GHI-Commercial, +22326,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMBLEMHEALTH/GHI-Commercial, +22327,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMBLEMHEALTH/GHI-Commercial, +22328,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMBLEMHEALTH/GHI-Commercial, +22329,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMBLEMHEALTH/GHI-Commercial, +22330,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMBLEMHEALTH/GHI-Commercial,36275.03 +22331,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMBLEMHEALTH/GHI-Commercial, +22332,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMBLEMHEALTH/GHI-Commercial,18892.35 +22333,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMBLEMHEALTH/GHI-Commercial, +22334,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMBLEMHEALTH/GHI-Commercial, +22335,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMBLEMHEALTH/GHI-Commercial, +22336,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMBLEMHEALTH/GHI-Commercial, +22337,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMBLEMHEALTH/GHI-Commercial,81034.88 +22338,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMBLEMHEALTH/GHI-Commercial, +22339,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMBLEMHEALTH/GHI-Commercial,4082.25 +22340,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMBLEMHEALTH/GHI-Commercial, +22341,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMBLEMHEALTH/GHI-Commercial, +22342,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMBLEMHEALTH/GHI-Commercial, +22343,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMBLEMHEALTH/GHI-Commercial, +22344,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMBLEMHEALTH/GHI-Commercial, +22345,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMBLEMHEALTH/GHI-Commercial, +22346,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMBLEMHEALTH/GHI-Commercial, +22347,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMBLEMHEALTH/GHI-Commercial, +22348,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMBLEMHEALTH/GHI-Commercial, +22349,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMBLEMHEALTH/GHI-Commercial,14882.4 +22350,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMBLEMHEALTH/GHI-Commercial,13493.96 +22351,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMBLEMHEALTH/GHI-Commercial, +22352,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMBLEMHEALTH/GHI-Commercial, +22353,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMBLEMHEALTH/GHI-Commercial, +22354,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMBLEMHEALTH/GHI-Commercial, +22355,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMBLEMHEALTH/GHI-Commercial, +22356,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMBLEMHEALTH/GHI-Commercial, +22357,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMBLEMHEALTH/GHI-Commercial, +22358,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMBLEMHEALTH/GHI-Commercial, +22359,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMBLEMHEALTH/GHI-Commercial, +22360,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMBLEMHEALTH/GHI-Commercial, +22361,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMBLEMHEALTH/GHI-Commercial, +22362,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMBLEMHEALTH/GHI-Commercial, +22363,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMBLEMHEALTH/GHI-Commercial, +22364,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMBLEMHEALTH/GHI-Commercial, +22365,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMBLEMHEALTH/GHI-Commercial, +22366,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMBLEMHEALTH/GHI-Commercial, +22367,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMBLEMHEALTH/GHI-Commercial, +22368,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMBLEMHEALTH/GHI-Commercial, +22369,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMBLEMHEALTH/GHI-Commercial, +22370,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMBLEMHEALTH/GHI-Commercial, +22371,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMBLEMHEALTH/GHI-Commercial, +22372,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMBLEMHEALTH/GHI-Commercial, +22373,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMBLEMHEALTH/GHI-Commercial, +22374,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMBLEMHEALTH/GHI-Commercial, +22375,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMBLEMHEALTH/GHI-Commercial, +22376,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMBLEMHEALTH/GHI-Commercial, +22377,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMBLEMHEALTH/GHI-Commercial, +22378,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMBLEMHEALTH/GHI-Commercial, +22379,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMBLEMHEALTH/GHI-Commercial, +22380,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMBLEMHEALTH/GHI-Commercial, +22381,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMBLEMHEALTH/GHI-Commercial, +22382,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMBLEMHEALTH/GHI-Commercial, +22383,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMBLEMHEALTH/GHI-Commercial, +22384,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMBLEMHEALTH/GHI-Commercial, +22385,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMBLEMHEALTH/GHI-Commercial, +22386,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMBLEMHEALTH/GHI-Commercial, +22387,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMBLEMHEALTH/GHI-Commercial, +22388,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMBLEMHEALTH/GHI-Commercial, +22389,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMBLEMHEALTH/GHI-Commercial, +22390,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMBLEMHEALTH/GHI-Commercial, +22391,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMBLEMHEALTH/GHI-Commercial, +22392,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMBLEMHEALTH/GHI-Commercial, +22393,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMBLEMHEALTH/GHI-Commercial, +22394,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMBLEMHEALTH/GHI-Commercial, +22395,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMBLEMHEALTH/GHI-Commercial, +22396,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMBLEMHEALTH/GHI-Commercial, +22397,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMBLEMHEALTH/GHI-Commercial, +22398,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMBLEMHEALTH/GHI-Commercial,18913.63 +22399,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMBLEMHEALTH/GHI-Commercial, +22400,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMBLEMHEALTH/GHI-Commercial, +22401,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMBLEMHEALTH/GHI-Commercial, +22402,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMBLEMHEALTH/GHI-Commercial, +22403,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMBLEMHEALTH/GHI-Commercial, +22404,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMBLEMHEALTH/GHI-Commercial,408187.05 +22405,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMBLEMHEALTH/GHI-Commercial, +22406,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMBLEMHEALTH/GHI-Commercial, +22407,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMBLEMHEALTH/GHI-Commercial, +22408,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMBLEMHEALTH/GHI-Commercial, +22409,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMBLEMHEALTH/GHI-Commercial, +22410,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMBLEMHEALTH/GHI-Commercial, +22411,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMBLEMHEALTH/GHI-Commercial, +22412,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMBLEMHEALTH/GHI-Commercial, +22413,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMBLEMHEALTH/GHI-Commercial, +22414,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMBLEMHEALTH/GHI-Commercial, +22415,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMBLEMHEALTH/GHI-Commercial, +22416,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMBLEMHEALTH/GHI-Commercial, +22417,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMBLEMHEALTH/GHI-Commercial, +22418,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMBLEMHEALTH/GHI-Commercial, +22419,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMBLEMHEALTH/GHI-Commercial, +22420,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMBLEMHEALTH/GHI-Commercial, +22421,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMBLEMHEALTH/GHI-Commercial, +22422,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMBLEMHEALTH/GHI-Commercial, +22423,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMBLEMHEALTH/GHI-Commercial, +22424,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMBLEMHEALTH/GHI-Commercial, +22425,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMBLEMHEALTH/GHI-Commercial, +22426,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMBLEMHEALTH/GHI-Commercial, +22427,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMBLEMHEALTH/GHI-Commercial, +22428,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMBLEMHEALTH/GHI-Commercial, +22429,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMBLEMHEALTH/GHI-Commercial, +22430,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMBLEMHEALTH/GHI-Commercial, +22431,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMBLEMHEALTH/GHI-Commercial, +22432,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMBLEMHEALTH/GHI-Commercial, +22433,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMBLEMHEALTH/GHI-Commercial, +22434,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMBLEMHEALTH/GHI-Commercial, +22435,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMBLEMHEALTH/GHI-Commercial, +22436,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMBLEMHEALTH/GHI-Commercial, +22437,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMBLEMHEALTH/GHI-Commercial, +22438,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMBLEMHEALTH/GHI-Commercial, +22439,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMBLEMHEALTH/GHI-Commercial, +22440,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMBLEMHEALTH/GHI-Commercial, +22441,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMBLEMHEALTH/GHI-Commercial, +22442,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMBLEMHEALTH/GHI-Commercial, +22443,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMBLEMHEALTH/GHI-Commercial, +22444,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMBLEMHEALTH/GHI-Commercial, +22445,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMBLEMHEALTH/GHI-Commercial, +22446,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMBLEMHEALTH/GHI-Commercial, +22447,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMBLEMHEALTH/GHI-Commercial, +22448,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMBLEMHEALTH/GHI-Commercial, +22449,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMBLEMHEALTH/GHI-Commercial, +22450,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMBLEMHEALTH/GHI-Commercial, +22451,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMBLEMHEALTH/GHI-Commercial, +22452,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMBLEMHEALTH/GHI-Commercial, +22453,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMBLEMHEALTH/GHI-Commercial, +22454,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMBLEMHEALTH/GHI-Commercial, +22455,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMBLEMHEALTH/GHI-Commercial, +22456,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMBLEMHEALTH/GHI-Commercial,169201.3 +22457,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMBLEMHEALTH/GHI-Commercial, +22458,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMBLEMHEALTH/GHI-Commercial, +22459,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMBLEMHEALTH/GHI-Commercial, +22460,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMBLEMHEALTH/GHI-Commercial, +22461,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMBLEMHEALTH/GHI-Commercial, +22462,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMBLEMHEALTH/GHI-Commercial, +22463,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMBLEMHEALTH/GHI-Commercial, +22464,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMBLEMHEALTH/GHI-Commercial, +22465,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMBLEMHEALTH/GHI-Commercial, +22466,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMBLEMHEALTH/GHI-Commercial, +22467,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMBLEMHEALTH/GHI-Commercial, +22468,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMBLEMHEALTH/GHI-Commercial,922.26 +22469,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMBLEMHEALTH/GHI-Commercial, +22470,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMBLEMHEALTH/GHI-Commercial, +22471,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +22472,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMBLEMHEALTH/GHI-Commercial, +22473,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMBLEMHEALTH/GHI-Commercial, +22474,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMBLEMHEALTH/GHI-Commercial, +22475,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +22476,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMBLEMHEALTH/GHI-Commercial, +22477,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMBLEMHEALTH/GHI-Commercial, +22478,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMBLEMHEALTH/GHI-Commercial, +22479,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMBLEMHEALTH/GHI-Commercial,77.43 +22480,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMBLEMHEALTH/GHI-Commercial, +22481,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMBLEMHEALTH/GHI-Commercial, +22482,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +22483,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMBLEMHEALTH/GHI-Commercial, +22484,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMBLEMHEALTH/GHI-Commercial, +22485,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMBLEMHEALTH/GHI-Commercial, +22486,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMBLEMHEALTH/GHI-Commercial, +22487,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMBLEMHEALTH/GHI-Commercial, +22488,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMBLEMHEALTH/GHI-Commercial, +22489,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMBLEMHEALTH/GHI-Commercial, +22490,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMBLEMHEALTH/GHI-Commercial, +22491,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMBLEMHEALTH/GHI-Commercial, +22492,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMBLEMHEALTH/GHI-Commercial, +22493,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMBLEMHEALTH/GHI-Commercial, +22494,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMBLEMHEALTH/GHI-Commercial, +22495,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMBLEMHEALTH/GHI-Commercial, +22496,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMBLEMHEALTH/GHI-Commercial, +22497,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMBLEMHEALTH/GHI-Commercial, +22498,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMBLEMHEALTH/GHI-Commercial, +22499,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMBLEMHEALTH/GHI-Commercial, +22500,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMBLEMHEALTH/GHI-Commercial, +22501,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMBLEMHEALTH/GHI-Commercial, +22502,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMBLEMHEALTH/GHI-Commercial, +22503,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMBLEMHEALTH/GHI-Commercial, +22504,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMBLEMHEALTH/GHI-Commercial, +22505,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMBLEMHEALTH/GHI-Commercial, +22506,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMBLEMHEALTH/GHI-Commercial, +22507,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMBLEMHEALTH/GHI-Commercial, +22508,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMBLEMHEALTH/GHI-Commercial, +22509,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMBLEMHEALTH/GHI-Commercial, +22510,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +22511,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMBLEMHEALTH/GHI-Commercial, +22512,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMBLEMHEALTH/GHI-Commercial, +22513,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMBLEMHEALTH/GHI-Commercial, +22514,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMBLEMHEALTH/GHI-Commercial, +22515,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMBLEMHEALTH/GHI-Commercial, +22516,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMBLEMHEALTH/GHI-Commercial, +22517,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMBLEMHEALTH/GHI-Commercial, +22518,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMBLEMHEALTH/GHI-Commercial, +22519,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMBLEMHEALTH/GHI-Commercial, +22520,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMBLEMHEALTH/GHI-Commercial, +22521,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMBLEMHEALTH/GHI-Commercial, +22522,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMBLEMHEALTH/GHI-Commercial, +22523,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMBLEMHEALTH/GHI-Commercial, +22524,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMBLEMHEALTH/GHI-Commercial, +22525,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMBLEMHEALTH/GHI-Commercial, +22526,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMBLEMHEALTH/GHI-Commercial, +22527,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMBLEMHEALTH/GHI-Commercial, +22528,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMBLEMHEALTH/GHI-Commercial, +22529,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMBLEMHEALTH/GHI-Commercial, +22530,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMBLEMHEALTH/GHI-Commercial, +22531,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMBLEMHEALTH/GHI-Commercial, +22532,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMBLEMHEALTH/GHI-Commercial, +22533,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMBLEMHEALTH/GHI-Commercial, +22534,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMBLEMHEALTH/GHI-Commercial, +22535,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMBLEMHEALTH/GHI-Commercial, +22536,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMBLEMHEALTH/GHI-Commercial, +22537,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMBLEMHEALTH/GHI-Commercial, +22538,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMBLEMHEALTH/GHI-Commercial, +22539,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMBLEMHEALTH/GHI-Commercial, +22540,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMBLEMHEALTH/GHI-Commercial, +22541,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMBLEMHEALTH/GHI-Commercial, +22542,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMBLEMHEALTH/GHI-Commercial, +22543,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMBLEMHEALTH/GHI-Commercial, +22544,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMBLEMHEALTH/GHI-Commercial, +22545,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMBLEMHEALTH/GHI-Commercial, +22546,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMBLEMHEALTH/GHI-Commercial, +22547,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMBLEMHEALTH/GHI-Commercial,1568.03 +22548,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMBLEMHEALTH/GHI-Commercial, +22549,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMBLEMHEALTH/GHI-Commercial, +22550,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMBLEMHEALTH/GHI-Commercial, +22551,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMBLEMHEALTH/GHI-Commercial, +22552,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMBLEMHEALTH/GHI-Commercial, +22553,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMBLEMHEALTH/GHI-Commercial, +22554,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMBLEMHEALTH/GHI-Commercial, +22555,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMBLEMHEALTH/GHI-Commercial, +22556,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMBLEMHEALTH/GHI-Commercial, +22557,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMBLEMHEALTH/GHI-Commercial, +22558,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMBLEMHEALTH/GHI-Commercial, +22559,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMBLEMHEALTH/GHI-Commercial, +22560,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMBLEMHEALTH/GHI-Commercial, +22561,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMBLEMHEALTH/GHI-Commercial, +22562,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMBLEMHEALTH/GHI-Commercial, +22563,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMBLEMHEALTH/GHI-Commercial, +22564,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMBLEMHEALTH/GHI-Commercial, +22565,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMBLEMHEALTH/GHI-Commercial, +22566,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMBLEMHEALTH/GHI-Commercial, +22567,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMBLEMHEALTH/GHI-Commercial, +22568,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMBLEMHEALTH/GHI-Commercial, +22569,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMBLEMHEALTH/GHI-Commercial, +22570,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMBLEMHEALTH/GHI-Commercial, +22571,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMBLEMHEALTH/GHI-Commercial, +22572,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMBLEMHEALTH/GHI-Commercial, +22573,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMBLEMHEALTH/GHI-Commercial, +22574,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMBLEMHEALTH/GHI-Commercial, +22575,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMBLEMHEALTH/GHI-Commercial, +22576,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMBLEMHEALTH/GHI-Commercial, +22577,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMBLEMHEALTH/GHI-Commercial, +22578,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMBLEMHEALTH/GHI-Commercial, +22579,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMBLEMHEALTH/GHI-Commercial, +22580,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMBLEMHEALTH/GHI-Commercial, +22581,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMBLEMHEALTH/GHI-Commercial, +22582,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMBLEMHEALTH/GHI-Commercial, +22583,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMBLEMHEALTH/GHI-Commercial, +22584,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMBLEMHEALTH/GHI-Commercial, +22585,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMBLEMHEALTH/GHI-Commercial, +22586,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMBLEMHEALTH/GHI-Commercial, +22587,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMBLEMHEALTH/GHI-Commercial, +22588,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMBLEMHEALTH/GHI-Commercial, +22589,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMBLEMHEALTH/GHI-Commercial, +22590,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMBLEMHEALTH/GHI-Commercial, +22591,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMBLEMHEALTH/GHI-Commercial, +22592,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMBLEMHEALTH/GHI-Commercial, +22593,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMBLEMHEALTH/GHI-Commercial, +22594,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMBLEMHEALTH/GHI-Commercial, +22595,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMBLEMHEALTH/GHI-Commercial, +22596,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMBLEMHEALTH/GHI-Commercial, +22597,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMBLEMHEALTH/GHI-Commercial, +22598,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMBLEMHEALTH/GHI-Commercial, +22599,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMBLEMHEALTH/GHI-Commercial, +22600,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMBLEMHEALTH/GHI-Commercial, +22601,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMBLEMHEALTH/GHI-Commercial, +22602,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMBLEMHEALTH/GHI-Commercial, +22603,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMBLEMHEALTH/GHI-Commercial, +22604,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMBLEMHEALTH/GHI-Commercial, +22605,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMBLEMHEALTH/GHI-Commercial, +22606,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMBLEMHEALTH/GHI-Commercial, +22607,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMBLEMHEALTH/GHI-Commercial, +22608,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMBLEMHEALTH/GHI-Commercial, +22609,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMBLEMHEALTH/GHI-Commercial, +22610,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMBLEMHEALTH/GHI-Commercial, +22611,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMBLEMHEALTH/GHI-Commercial, +22612,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMBLEMHEALTH/GHI-Commercial, +22613,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMBLEMHEALTH/GHI-Commercial, +22614,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMBLEMHEALTH/GHI-Commercial, +22615,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMBLEMHEALTH/GHI-Commercial, +22616,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMBLEMHEALTH/GHI-Commercial, +22617,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMBLEMHEALTH/GHI-Commercial, +22618,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMBLEMHEALTH/GHI-Commercial, +22619,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMBLEMHEALTH/GHI-Commercial, +22620,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMBLEMHEALTH/GHI-Commercial, +22621,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMBLEMHEALTH/GHI-Commercial, +22622,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMBLEMHEALTH/GHI-Commercial, +22623,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMBLEMHEALTH/GHI-Commercial, +22624,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMBLEMHEALTH/GHI-Commercial, +22625,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMBLEMHEALTH/GHI-Commercial, +22626,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMBLEMHEALTH/GHI-Commercial, +22627,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMBLEMHEALTH/GHI-Commercial, +22628,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMBLEMHEALTH/GHI-Commercial, +22629,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMBLEMHEALTH/GHI-Commercial, +22630,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMBLEMHEALTH/GHI-Commercial, +22631,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMBLEMHEALTH/GHI-Commercial, +22632,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMBLEMHEALTH/GHI-Commercial, +22633,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMBLEMHEALTH/GHI-Commercial, +22634,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMBLEMHEALTH/GHI-Commercial,5858.63 +22635,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMBLEMHEALTH/GHI-Commercial, +22636,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMBLEMHEALTH/GHI-Commercial, +22637,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMBLEMHEALTH/GHI-Commercial, +22638,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMBLEMHEALTH/GHI-Commercial, +22639,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMBLEMHEALTH/GHI-Commercial, +22640,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMBLEMHEALTH/GHI-Commercial, +22641,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMBLEMHEALTH/GHI-Commercial, +22642,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMBLEMHEALTH/GHI-Commercial, +22643,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMBLEMHEALTH/GHI-Commercial, +22644,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMBLEMHEALTH/GHI-Commercial, +22645,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMBLEMHEALTH/GHI-Commercial, +22646,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMBLEMHEALTH/GHI-Commercial, +22647,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMBLEMHEALTH/GHI-Commercial, +22648,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMBLEMHEALTH/GHI-Commercial, +22649,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMBLEMHEALTH/GHI-Commercial, +22650,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMBLEMHEALTH/GHI-Commercial, +22651,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMBLEMHEALTH/GHI-Commercial, +22652,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMBLEMHEALTH/GHI-Commercial, +22653,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMBLEMHEALTH/GHI-Commercial, +22654,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMBLEMHEALTH/GHI-Commercial,8020.3 +22655,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMBLEMHEALTH/GHI-Commercial, +22656,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMBLEMHEALTH/GHI-Commercial, +22657,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +22658,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMBLEMHEALTH/GHI-Commercial, +22659,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMBLEMHEALTH/GHI-Commercial, +22660,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMBLEMHEALTH/GHI-Commercial,5858.63 +22661,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMBLEMHEALTH/GHI-Commercial, +22662,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMBLEMHEALTH/GHI-Commercial, +22663,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMBLEMHEALTH/GHI-Commercial, +22664,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMBLEMHEALTH/GHI-Commercial, +22665,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMBLEMHEALTH/GHI-Commercial, +22666,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMBLEMHEALTH/GHI-Commercial, +22667,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMBLEMHEALTH/GHI-Commercial, +22668,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMBLEMHEALTH/GHI-Commercial, +22669,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMBLEMHEALTH/GHI-Commercial, +22670,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMBLEMHEALTH/GHI-Commercial, +22671,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMBLEMHEALTH/GHI-Commercial, +22672,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMBLEMHEALTH/GHI-Commercial, +22673,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMBLEMHEALTH/GHI-Commercial, +22674,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMBLEMHEALTH/GHI-Commercial, +22675,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMBLEMHEALTH/GHI-Commercial, +22676,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +22677,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMBLEMHEALTH/GHI-Commercial, +22678,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMBLEMHEALTH/GHI-Commercial,63.43 +22679,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMBLEMHEALTH/GHI-Commercial, +22680,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMBLEMHEALTH/GHI-Commercial, +22681,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMBLEMHEALTH/GHI-Commercial, +22682,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMBLEMHEALTH/GHI-Commercial, +22683,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMBLEMHEALTH/GHI-Commercial, +22684,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMBLEMHEALTH/GHI-Commercial, +22685,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMBLEMHEALTH/GHI-Commercial, +22686,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMBLEMHEALTH/GHI-Commercial, +22687,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMBLEMHEALTH/GHI-Commercial, +22688,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMBLEMHEALTH/GHI-Commercial, +22689,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMBLEMHEALTH/GHI-Commercial, +22690,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMBLEMHEALTH/GHI-Commercial, +22691,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMBLEMHEALTH/GHI-Commercial, +22692,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMBLEMHEALTH/GHI-Commercial, +22693,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMBLEMHEALTH/GHI-Commercial, +22694,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMBLEMHEALTH/GHI-Commercial, +22695,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMBLEMHEALTH/GHI-Commercial, +22696,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMBLEMHEALTH/GHI-Commercial, +22697,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMBLEMHEALTH/GHI-Commercial, +22698,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMBLEMHEALTH/GHI-Commercial, +22699,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMBLEMHEALTH/GHI-Commercial, +22700,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMBLEMHEALTH/GHI-Commercial, +22701,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMBLEMHEALTH/GHI-Commercial, +22702,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMBLEMHEALTH/GHI-Commercial, +22703,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMBLEMHEALTH/GHI-Commercial, +22704,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMBLEMHEALTH/GHI-Commercial, +22705,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMBLEMHEALTH/GHI-Commercial, +22706,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMBLEMHEALTH/GHI-Commercial, +22707,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMBLEMHEALTH/GHI-Commercial, +22708,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMBLEMHEALTH/GHI-Commercial, +22709,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMBLEMHEALTH/GHI-Commercial, +22710,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMBLEMHEALTH/GHI-Commercial, +22711,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMBLEMHEALTH/GHI-Commercial, +22712,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMBLEMHEALTH/GHI-Commercial, +22713,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMBLEMHEALTH/GHI-Commercial,2672.0 +22714,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMBLEMHEALTH/GHI-Commercial, +22715,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +22716,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +22717,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +22718,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMBLEMHEALTH/GHI-Commercial, +22719,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMBLEMHEALTH/GHI-Commercial, +22720,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMBLEMHEALTH/GHI-Commercial, +22721,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMBLEMHEALTH/GHI-Commercial, +22722,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMBLEMHEALTH/GHI-Commercial, +22723,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMBLEMHEALTH/GHI-Commercial, +22724,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMBLEMHEALTH/GHI-Commercial, +22725,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMBLEMHEALTH/GHI-Commercial, +22726,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMBLEMHEALTH/GHI-Commercial, +22727,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMBLEMHEALTH/GHI-Commercial, +22728,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMBLEMHEALTH/GHI-Commercial, +22729,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMBLEMHEALTH/GHI-Commercial, +22730,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMBLEMHEALTH/GHI-Commercial, +22731,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMBLEMHEALTH/GHI-Commercial, +22732,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMBLEMHEALTH/GHI-Commercial, +22733,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMBLEMHEALTH/GHI-Commercial, +22734,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMBLEMHEALTH/GHI-Commercial, +22735,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMBLEMHEALTH/GHI-Commercial, +22736,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMBLEMHEALTH/GHI-Commercial, +22737,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMBLEMHEALTH/GHI-Commercial, +22738,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +22739,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMBLEMHEALTH/GHI-Commercial, +22740,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMBLEMHEALTH/GHI-Commercial, +22741,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMBLEMHEALTH/GHI-Commercial, +22742,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMBLEMHEALTH/GHI-Commercial, +22743,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMBLEMHEALTH/GHI-Commercial,1464.65 +22744,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/GHI-Commercial, +22745,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMBLEMHEALTH/GHI-Commercial, +22746,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMBLEMHEALTH/GHI-Commercial, +22747,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMBLEMHEALTH/GHI-Commercial, +22748,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMBLEMHEALTH/GHI-Commercial, +22749,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMBLEMHEALTH/GHI-Commercial, +22750,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMBLEMHEALTH/GHI-Commercial, +22751,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMBLEMHEALTH/GHI-Commercial, +22752,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMBLEMHEALTH/GHI-Commercial, +22753,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMBLEMHEALTH/GHI-Commercial, +22754,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMBLEMHEALTH/GHI-Commercial, +22755,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMBLEMHEALTH/GHI-Commercial, +22756,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMBLEMHEALTH/GHI-Commercial, +22757,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMBLEMHEALTH/GHI-Commercial, +22758,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMBLEMHEALTH/GHI-Commercial, +22759,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMBLEMHEALTH/GHI-Commercial, +22760,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMBLEMHEALTH/GHI-Commercial, +22761,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMBLEMHEALTH/GHI-Commercial, +22762,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMBLEMHEALTH/GHI-Commercial, +22763,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMBLEMHEALTH/GHI-Commercial, +22764,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMBLEMHEALTH/GHI-Commercial, +22765,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMBLEMHEALTH/GHI-Commercial, +22766,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMBLEMHEALTH/GHI-Commercial, +22767,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMBLEMHEALTH/GHI-Commercial, +22768,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMBLEMHEALTH/GHI-Commercial, +22769,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMBLEMHEALTH/GHI-Commercial, +22770,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMBLEMHEALTH/GHI-Commercial, +22771,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMBLEMHEALTH/GHI-Commercial, +22772,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMBLEMHEALTH/GHI-Commercial, +22773,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMBLEMHEALTH/GHI-Commercial, +22774,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMBLEMHEALTH/GHI-Commercial, +22775,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMBLEMHEALTH/GHI-Commercial, +22776,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMBLEMHEALTH/GHI-Commercial, +22777,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMBLEMHEALTH/GHI-Commercial, +22778,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMBLEMHEALTH/GHI-Commercial, +22779,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMBLEMHEALTH/GHI-Commercial, +22780,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMBLEMHEALTH/GHI-Commercial, +22781,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMBLEMHEALTH/GHI-Commercial, +22782,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMBLEMHEALTH/GHI-Commercial, +22783,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMBLEMHEALTH/GHI-Commercial, +22784,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMBLEMHEALTH/GHI-Commercial, +22785,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMBLEMHEALTH/GHI-Commercial, +22786,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMBLEMHEALTH/GHI-Commercial, +22787,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMBLEMHEALTH/GHI-Commercial, +22788,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMBLEMHEALTH/GHI-Commercial, +22789,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMBLEMHEALTH/GHI-Commercial, +22790,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMBLEMHEALTH/GHI-Commercial, +22791,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMBLEMHEALTH/GHI-Commercial, +22792,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMBLEMHEALTH/GHI-Commercial, +22793,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMBLEMHEALTH/GHI-Commercial, +22794,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMBLEMHEALTH/GHI-Commercial, +22795,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMBLEMHEALTH/GHI-Commercial, +22796,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMBLEMHEALTH/GHI-Commercial, +22797,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +22798,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMBLEMHEALTH/GHI-Commercial, +22799,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMBLEMHEALTH/GHI-Commercial, +22800,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMBLEMHEALTH/GHI-Commercial, +22801,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMBLEMHEALTH/GHI-Commercial, +22802,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMBLEMHEALTH/GHI-Commercial, +22803,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMBLEMHEALTH/GHI-Commercial, +22804,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMBLEMHEALTH/GHI-Commercial, +22805,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMBLEMHEALTH/GHI-Commercial, +22806,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMBLEMHEALTH/GHI-Commercial, +22807,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMBLEMHEALTH/GHI-Commercial, +22808,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMBLEMHEALTH/GHI-Commercial, +22809,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMBLEMHEALTH/GHI-Commercial, +22810,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMBLEMHEALTH/GHI-Commercial, +22811,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMBLEMHEALTH/GHI-Commercial, +22812,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMBLEMHEALTH/GHI-Commercial, +22813,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMBLEMHEALTH/GHI-Commercial, +22814,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMBLEMHEALTH/GHI-Commercial, +22815,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMBLEMHEALTH/GHI-Commercial, +22816,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMBLEMHEALTH/GHI-Commercial, +22817,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMBLEMHEALTH/GHI-Commercial, +22818,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMBLEMHEALTH/GHI-Commercial, +22819,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMBLEMHEALTH/GHI-Commercial, +22820,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMBLEMHEALTH/GHI-Commercial, +22821,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMBLEMHEALTH/GHI-Commercial, +22822,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMBLEMHEALTH/GHI-Commercial, +22823,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMBLEMHEALTH/GHI-Commercial, +22824,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMBLEMHEALTH/GHI-Commercial, +22825,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMBLEMHEALTH/GHI-Commercial, +22826,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMBLEMHEALTH/GHI-Commercial, +22827,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMBLEMHEALTH/GHI-Commercial, +22828,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMBLEMHEALTH/GHI-Commercial, +22829,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMBLEMHEALTH/GHI-Commercial, +22830,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMBLEMHEALTH/GHI-Commercial, +22831,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMBLEMHEALTH/GHI-Commercial, +22832,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMBLEMHEALTH/GHI-Commercial, +22833,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMBLEMHEALTH/GHI-Commercial, +22834,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMBLEMHEALTH/GHI-Commercial, +22835,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMBLEMHEALTH/GHI-Commercial, +22836,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMBLEMHEALTH/GHI-Commercial, +22837,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMBLEMHEALTH/GHI-Commercial, +22838,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMBLEMHEALTH/GHI-Commercial, +22839,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMBLEMHEALTH/GHI-Commercial, +22840,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMBLEMHEALTH/GHI-Commercial, +22841,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMBLEMHEALTH/GHI-Commercial, +22842,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMBLEMHEALTH/GHI-Commercial, +22843,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMBLEMHEALTH/GHI-Commercial, +22844,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMBLEMHEALTH/GHI-Commercial, +22845,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMBLEMHEALTH/GHI-Commercial, +22846,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMBLEMHEALTH/GHI-Commercial, +22847,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMBLEMHEALTH/GHI-Commercial, +22848,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMBLEMHEALTH/GHI-Commercial, +22849,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMBLEMHEALTH/GHI-Commercial, +22850,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMBLEMHEALTH/GHI-Commercial, +22851,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +22852,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMBLEMHEALTH/GHI-Commercial, +22853,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMBLEMHEALTH/GHI-Commercial, +22854,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMBLEMHEALTH/GHI-Commercial, +22855,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMBLEMHEALTH/GHI-Commercial,1640.06 +22856,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMBLEMHEALTH/GHI-Commercial, +22857,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMBLEMHEALTH/GHI-Commercial, +22858,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMBLEMHEALTH/GHI-Commercial,1640.06 +22859,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMBLEMHEALTH/GHI-Commercial,2929.31 +22860,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMBLEMHEALTH/GHI-Commercial, +22861,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMBLEMHEALTH/GHI-Commercial, +22862,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMBLEMHEALTH/GHI-Commercial, +22863,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMBLEMHEALTH/GHI-Commercial, +22864,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMBLEMHEALTH/GHI-Commercial, +22865,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMBLEMHEALTH/GHI-Commercial, +22866,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMBLEMHEALTH/GHI-Commercial, +22867,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMBLEMHEALTH/GHI-Commercial, +22868,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMBLEMHEALTH/GHI-Commercial, +22869,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMBLEMHEALTH/GHI-Commercial, +22870,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMBLEMHEALTH/GHI-Commercial, +22871,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMBLEMHEALTH/GHI-Commercial, +22872,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMBLEMHEALTH/GHI-Commercial, +22873,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMBLEMHEALTH/GHI-Commercial, +22874,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMBLEMHEALTH/GHI-Commercial, +22875,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMBLEMHEALTH/GHI-Commercial, +22876,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMBLEMHEALTH/GHI-Commercial, +22877,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMBLEMHEALTH/GHI-Commercial, +22878,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMBLEMHEALTH/GHI-Commercial,5858.63 +22879,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMBLEMHEALTH/GHI-Commercial,2929.31 +22880,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMBLEMHEALTH/GHI-Commercial, +22881,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMBLEMHEALTH/GHI-Commercial, +22882,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMBLEMHEALTH/GHI-Commercial, +22883,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMBLEMHEALTH/GHI-Commercial, +22884,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMBLEMHEALTH/GHI-Commercial, +22885,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMBLEMHEALTH/GHI-Commercial, +22886,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMBLEMHEALTH/GHI-Commercial,2843.8 +22887,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMBLEMHEALTH/GHI-Commercial,52.25 +22888,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMBLEMHEALTH/GHI-Commercial, +22889,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMBLEMHEALTH/GHI-Commercial, +22890,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMBLEMHEALTH/GHI-Commercial, +22891,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMBLEMHEALTH/GHI-Commercial, +22892,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMBLEMHEALTH/GHI-Commercial, +22893,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMBLEMHEALTH/GHI-Commercial, +22894,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMBLEMHEALTH/GHI-Commercial, +22895,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMBLEMHEALTH/GHI-Commercial, +22896,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMBLEMHEALTH/GHI-Commercial, +22897,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMBLEMHEALTH/GHI-Commercial, +22898,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMBLEMHEALTH/GHI-Commercial, +22899,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMBLEMHEALTH/GHI-Commercial, +22900,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMBLEMHEALTH/GHI-Commercial, +22901,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMBLEMHEALTH/GHI-Commercial, +22902,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMBLEMHEALTH/GHI-Commercial, +22903,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMBLEMHEALTH/GHI-Commercial, +22904,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +22905,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMBLEMHEALTH/GHI-Commercial, +22906,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMBLEMHEALTH/GHI-Commercial, +22907,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMBLEMHEALTH/GHI-Commercial, +22908,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMBLEMHEALTH/GHI-Commercial, +22909,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMBLEMHEALTH/GHI-Commercial, +22910,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMBLEMHEALTH/GHI-Commercial, +22911,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMBLEMHEALTH/GHI-Commercial, +22912,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMBLEMHEALTH/GHI-Commercial, +22913,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMBLEMHEALTH/GHI-Commercial, +22914,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMBLEMHEALTH/GHI-Commercial, +22915,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMBLEMHEALTH/GHI-Commercial, +22916,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMBLEMHEALTH/GHI-Commercial, +22917,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMBLEMHEALTH/GHI-Commercial, +22918,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMBLEMHEALTH/GHI-Commercial, +22919,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMBLEMHEALTH/GHI-Commercial, +22920,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMBLEMHEALTH/GHI-Commercial, +22921,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMBLEMHEALTH/GHI-Commercial, +22922,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMBLEMHEALTH/GHI-Commercial, +22923,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMBLEMHEALTH/GHI-Commercial, +22924,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMBLEMHEALTH/GHI-Commercial, +22925,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMBLEMHEALTH/GHI-Commercial, +22926,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMBLEMHEALTH/GHI-Commercial, +22927,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMBLEMHEALTH/GHI-Commercial, +22928,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +22929,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMBLEMHEALTH/GHI-Commercial, +22930,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMBLEMHEALTH/GHI-Commercial, +22931,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMBLEMHEALTH/GHI-Commercial, +22932,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMBLEMHEALTH/GHI-Commercial, +22933,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMBLEMHEALTH/GHI-Commercial, +22934,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMBLEMHEALTH/GHI-Commercial, +22935,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMBLEMHEALTH/GHI-Commercial, +22936,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMBLEMHEALTH/GHI-Commercial, +22937,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMBLEMHEALTH/GHI-Commercial, +22938,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMBLEMHEALTH/GHI-Commercial, +22939,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMBLEMHEALTH/GHI-Commercial, +22940,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMBLEMHEALTH/GHI-Commercial, +22941,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMBLEMHEALTH/GHI-Commercial, +22942,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMBLEMHEALTH/GHI-Commercial, +22943,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMBLEMHEALTH/GHI-Commercial, +22944,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMBLEMHEALTH/GHI-Commercial, +22945,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMBLEMHEALTH/GHI-Commercial, +22946,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMBLEMHEALTH/GHI-Commercial, +22947,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMBLEMHEALTH/GHI-Commercial, +22948,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMBLEMHEALTH/GHI-Commercial, +22949,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMBLEMHEALTH/GHI-Commercial, +22950,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMBLEMHEALTH/GHI-Commercial, +22951,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMBLEMHEALTH/GHI-Commercial, +22952,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMBLEMHEALTH/GHI-Commercial, +22953,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMBLEMHEALTH/GHI-Commercial, +22954,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMBLEMHEALTH/GHI-Commercial, +22955,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMBLEMHEALTH/GHI-Commercial, +22956,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMBLEMHEALTH/GHI-Commercial, +22957,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +22958,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMBLEMHEALTH/GHI-Commercial, +22959,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMBLEMHEALTH/GHI-Commercial, +22960,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMBLEMHEALTH/GHI-Commercial, +22961,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMBLEMHEALTH/GHI-Commercial, +22962,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMBLEMHEALTH/GHI-Commercial, +22963,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMBLEMHEALTH/GHI-Commercial, +22964,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMBLEMHEALTH/GHI-Commercial, +22965,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMBLEMHEALTH/GHI-Commercial, +22966,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMBLEMHEALTH/GHI-Commercial, +22967,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMBLEMHEALTH/GHI-Commercial, +22968,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMBLEMHEALTH/GHI-Commercial, +22969,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMBLEMHEALTH/GHI-Commercial, +22970,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMBLEMHEALTH/GHI-Commercial, +22971,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMBLEMHEALTH/GHI-Commercial, +22972,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMBLEMHEALTH/GHI-Commercial, +22973,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMBLEMHEALTH/GHI-Commercial, +22974,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMBLEMHEALTH/GHI-Commercial, +22975,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMBLEMHEALTH/GHI-Commercial, +22976,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMBLEMHEALTH/GHI-Commercial, +22977,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMBLEMHEALTH/GHI-Commercial, +22978,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMBLEMHEALTH/GHI-Commercial, +22979,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMBLEMHEALTH/GHI-Commercial, +22980,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMBLEMHEALTH/GHI-Commercial, +22981,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMBLEMHEALTH/GHI-Commercial, +22982,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMBLEMHEALTH/GHI-Commercial, +22983,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMBLEMHEALTH/GHI-Commercial, +22984,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMBLEMHEALTH/GHI-Commercial, +22985,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMBLEMHEALTH/GHI-Commercial, +22986,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMBLEMHEALTH/GHI-Commercial, +22987,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMBLEMHEALTH/GHI-Commercial, +22988,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMBLEMHEALTH/GHI-Commercial, +22989,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMBLEMHEALTH/GHI-Commercial, +22990,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMBLEMHEALTH/GHI-Commercial, +22991,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMBLEMHEALTH/GHI-Commercial, +22992,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMBLEMHEALTH/GHI-Commercial, +22993,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMBLEMHEALTH/GHI-Commercial, +22994,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMBLEMHEALTH/GHI-Commercial, +22995,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMBLEMHEALTH/GHI-Commercial, +22996,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMBLEMHEALTH/GHI-Commercial, +22997,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMBLEMHEALTH/GHI-Commercial, +22998,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMBLEMHEALTH/GHI-Commercial, +22999,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMBLEMHEALTH/GHI-Commercial, +23000,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMBLEMHEALTH/GHI-Commercial, +23001,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMBLEMHEALTH/GHI-Commercial, +23002,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23003,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMBLEMHEALTH/GHI-Commercial, +23004,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMBLEMHEALTH/GHI-Commercial, +23005,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMBLEMHEALTH/GHI-Commercial, +23006,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMBLEMHEALTH/GHI-Commercial, +23007,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMBLEMHEALTH/GHI-Commercial, +23008,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMBLEMHEALTH/GHI-Commercial, +23009,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMBLEMHEALTH/GHI-Commercial, +23010,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMBLEMHEALTH/GHI-Commercial, +23011,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMBLEMHEALTH/GHI-Commercial, +23012,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMBLEMHEALTH/GHI-Commercial, +23013,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMBLEMHEALTH/GHI-Commercial, +23014,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMBLEMHEALTH/GHI-Commercial, +23015,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMBLEMHEALTH/GHI-Commercial, +23016,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMBLEMHEALTH/GHI-Commercial, +23017,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMBLEMHEALTH/GHI-Commercial, +23018,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMBLEMHEALTH/GHI-Commercial, +23019,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMBLEMHEALTH/GHI-Commercial, +23020,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMBLEMHEALTH/GHI-Commercial, +23021,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMBLEMHEALTH/GHI-Commercial, +23022,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMBLEMHEALTH/GHI-Commercial, +23023,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMBLEMHEALTH/GHI-Commercial, +23024,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMBLEMHEALTH/GHI-Commercial, +23025,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMBLEMHEALTH/GHI-Commercial, +23026,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMBLEMHEALTH/GHI-Commercial, +23027,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMBLEMHEALTH/GHI-Commercial, +23028,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMBLEMHEALTH/GHI-Commercial, +23029,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMBLEMHEALTH/GHI-Commercial, +23030,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMBLEMHEALTH/GHI-Commercial, +23031,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMBLEMHEALTH/GHI-Commercial, +23032,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMBLEMHEALTH/GHI-Commercial, +23033,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMBLEMHEALTH/GHI-Commercial, +23034,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMBLEMHEALTH/GHI-Commercial, +23035,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMBLEMHEALTH/GHI-Commercial, +23036,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23037,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMBLEMHEALTH/GHI-Commercial, +23038,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMBLEMHEALTH/GHI-Commercial, +23039,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMBLEMHEALTH/GHI-Commercial, +23040,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +23041,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMBLEMHEALTH/GHI-Commercial, +23042,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMBLEMHEALTH/GHI-Commercial, +23043,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMBLEMHEALTH/GHI-Commercial, +23044,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMBLEMHEALTH/GHI-Commercial, +23045,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMBLEMHEALTH/GHI-Commercial, +23046,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMBLEMHEALTH/GHI-Commercial, +23047,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMBLEMHEALTH/GHI-Commercial, +23048,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMBLEMHEALTH/GHI-Commercial, +23049,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMBLEMHEALTH/GHI-Commercial, +23050,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMBLEMHEALTH/GHI-Commercial, +23051,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMBLEMHEALTH/GHI-Commercial, +23052,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMBLEMHEALTH/GHI-Commercial, +23053,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMBLEMHEALTH/GHI-Commercial, +23054,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMBLEMHEALTH/GHI-Commercial, +23055,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23056,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMBLEMHEALTH/GHI-Commercial, +23057,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMBLEMHEALTH/GHI-Commercial, +23058,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMBLEMHEALTH/GHI-Commercial, +23059,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMBLEMHEALTH/GHI-Commercial, +23060,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMBLEMHEALTH/GHI-Commercial, +23061,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMBLEMHEALTH/GHI-Commercial, +23062,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMBLEMHEALTH/GHI-Commercial, +23063,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMBLEMHEALTH/GHI-Commercial, +23064,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMBLEMHEALTH/GHI-Commercial, +23065,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMBLEMHEALTH/GHI-Commercial, +23066,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMBLEMHEALTH/GHI-Commercial, +23067,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMBLEMHEALTH/GHI-Commercial, +23068,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMBLEMHEALTH/GHI-Commercial, +23069,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMBLEMHEALTH/GHI-Commercial, +23070,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMBLEMHEALTH/GHI-Commercial, +23071,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMBLEMHEALTH/GHI-Commercial, +23072,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMBLEMHEALTH/GHI-Commercial, +23073,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMBLEMHEALTH/GHI-Commercial, +23074,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMBLEMHEALTH/GHI-Commercial, +23075,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMBLEMHEALTH/GHI-Commercial, +23076,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMBLEMHEALTH/GHI-Commercial, +23077,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMBLEMHEALTH/GHI-Commercial, +23078,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMBLEMHEALTH/GHI-Commercial, +23079,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMBLEMHEALTH/GHI-Commercial, +23080,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMBLEMHEALTH/GHI-Commercial, +23081,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMBLEMHEALTH/GHI-Commercial, +23082,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMBLEMHEALTH/GHI-Commercial, +23083,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMBLEMHEALTH/GHI-Commercial, +23084,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMBLEMHEALTH/GHI-Commercial, +23085,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMBLEMHEALTH/GHI-Commercial, +23086,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMBLEMHEALTH/GHI-Commercial, +23087,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMBLEMHEALTH/GHI-Commercial,1640.06 +23088,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMBLEMHEALTH/GHI-Commercial, +23089,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMBLEMHEALTH/GHI-Commercial, +23090,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMBLEMHEALTH/GHI-Commercial, +23091,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMBLEMHEALTH/GHI-Commercial, +23092,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMBLEMHEALTH/GHI-Commercial, +23093,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMBLEMHEALTH/GHI-Commercial, +23094,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMBLEMHEALTH/GHI-Commercial, +23095,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMBLEMHEALTH/GHI-Commercial, +23096,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMBLEMHEALTH/GHI-Commercial, +23097,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMBLEMHEALTH/GHI-Commercial, +23098,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMBLEMHEALTH/GHI-Commercial, +23099,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMBLEMHEALTH/GHI-Commercial, +23100,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMBLEMHEALTH/GHI-Commercial, +23101,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23102,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23103,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMBLEMHEALTH/GHI-Commercial, +23104,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMBLEMHEALTH/GHI-Commercial, +23105,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMBLEMHEALTH/GHI-Commercial, +23106,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMBLEMHEALTH/GHI-Commercial, +23107,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMBLEMHEALTH/GHI-Commercial, +23108,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMBLEMHEALTH/GHI-Commercial, +23109,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMBLEMHEALTH/GHI-Commercial, +23110,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMBLEMHEALTH/GHI-Commercial, +23111,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMBLEMHEALTH/GHI-Commercial, +23112,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMBLEMHEALTH/GHI-Commercial, +23113,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMBLEMHEALTH/GHI-Commercial,2929.31 +23114,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMBLEMHEALTH/GHI-Commercial, +23115,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMBLEMHEALTH/GHI-Commercial, +23116,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMBLEMHEALTH/GHI-Commercial, +23117,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMBLEMHEALTH/GHI-Commercial, +23118,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMBLEMHEALTH/GHI-Commercial, +23119,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMBLEMHEALTH/GHI-Commercial, +23120,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23121,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMBLEMHEALTH/GHI-Commercial, +23122,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMBLEMHEALTH/GHI-Commercial, +23123,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMBLEMHEALTH/GHI-Commercial, +23124,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23125,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMBLEMHEALTH/GHI-Commercial, +23126,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMBLEMHEALTH/GHI-Commercial, +23127,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMBLEMHEALTH/GHI-Commercial, +23128,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMBLEMHEALTH/GHI-Commercial, +23129,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23130,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMBLEMHEALTH/GHI-Commercial, +23131,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMBLEMHEALTH/GHI-Commercial, +23132,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMBLEMHEALTH/GHI-Commercial, +23133,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMBLEMHEALTH/GHI-Commercial, +23134,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +23135,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMBLEMHEALTH/GHI-Commercial, +23136,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMBLEMHEALTH/GHI-Commercial, +23137,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMBLEMHEALTH/GHI-Commercial, +23138,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMBLEMHEALTH/GHI-Commercial, +23139,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMBLEMHEALTH/GHI-Commercial, +23140,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMBLEMHEALTH/GHI-Commercial, +23141,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23142,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMBLEMHEALTH/GHI-Commercial, +23143,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMBLEMHEALTH/GHI-Commercial, +23144,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMBLEMHEALTH/GHI-Commercial, +23145,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMBLEMHEALTH/GHI-Commercial, +23146,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMBLEMHEALTH/GHI-Commercial, +23147,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMBLEMHEALTH/GHI-Commercial, +23148,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMBLEMHEALTH/GHI-Commercial, +23149,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMBLEMHEALTH/GHI-Commercial, +23150,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMBLEMHEALTH/GHI-Commercial, +23151,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMBLEMHEALTH/GHI-Commercial, +23152,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMBLEMHEALTH/GHI-Commercial, +23153,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMBLEMHEALTH/GHI-Commercial, +23154,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMBLEMHEALTH/GHI-Commercial, +23155,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMBLEMHEALTH/GHI-Commercial, +23156,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMBLEMHEALTH/GHI-Commercial, +23157,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMBLEMHEALTH/GHI-Commercial, +23158,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMBLEMHEALTH/GHI-Commercial, +23159,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMBLEMHEALTH/GHI-Commercial, +23160,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMBLEMHEALTH/GHI-Commercial, +23161,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMBLEMHEALTH/GHI-Commercial, +23162,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMBLEMHEALTH/GHI-Commercial, +23163,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMBLEMHEALTH/GHI-Commercial, +23164,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMBLEMHEALTH/GHI-Commercial, +23165,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMBLEMHEALTH/GHI-Commercial, +23166,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMBLEMHEALTH/GHI-Commercial, +23167,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMBLEMHEALTH/GHI-Commercial, +23168,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMBLEMHEALTH/GHI-Commercial, +23169,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMBLEMHEALTH/GHI-Commercial, +23170,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMBLEMHEALTH/GHI-Commercial, +23171,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMBLEMHEALTH/GHI-Commercial, +23172,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMBLEMHEALTH/GHI-Commercial, +23173,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMBLEMHEALTH/GHI-Commercial, +23174,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMBLEMHEALTH/GHI-Commercial, +23175,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMBLEMHEALTH/GHI-Commercial, +23176,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMBLEMHEALTH/GHI-Commercial, +23177,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMBLEMHEALTH/GHI-Commercial, +23178,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMBLEMHEALTH/GHI-Commercial, +23179,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMBLEMHEALTH/GHI-Commercial, +23180,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMBLEMHEALTH/GHI-Commercial, +23181,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMBLEMHEALTH/GHI-Commercial, +23182,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMBLEMHEALTH/GHI-Commercial, +23183,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMBLEMHEALTH/GHI-Commercial, +23184,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMBLEMHEALTH/GHI-Commercial, +23185,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMBLEMHEALTH/GHI-Commercial, +23186,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMBLEMHEALTH/GHI-Commercial, +23187,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23188,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMBLEMHEALTH/GHI-Commercial, +23189,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMBLEMHEALTH/GHI-Commercial, +23190,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMBLEMHEALTH/GHI-Commercial, +23191,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMBLEMHEALTH/GHI-Commercial, +23192,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMBLEMHEALTH/GHI-Commercial, +23193,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMBLEMHEALTH/GHI-Commercial, +23194,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23195,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMBLEMHEALTH/GHI-Commercial, +23196,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMBLEMHEALTH/GHI-Commercial, +23197,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMBLEMHEALTH/GHI-Commercial, +23198,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMBLEMHEALTH/GHI-Commercial, +23199,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMBLEMHEALTH/GHI-Commercial, +23200,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMBLEMHEALTH/GHI-Commercial, +23201,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMBLEMHEALTH/GHI-Commercial, +23202,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMBLEMHEALTH/GHI-Commercial, +23203,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMBLEMHEALTH/GHI-Commercial, +23204,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMBLEMHEALTH/GHI-Commercial, +23205,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMBLEMHEALTH/GHI-Commercial, +23206,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMBLEMHEALTH/GHI-Commercial, +23207,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMBLEMHEALTH/GHI-Commercial, +23208,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMBLEMHEALTH/GHI-Commercial, +23209,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMBLEMHEALTH/GHI-Commercial, +23210,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMBLEMHEALTH/GHI-Commercial, +23211,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMBLEMHEALTH/GHI-Commercial,2929.31 +23212,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMBLEMHEALTH/GHI-Commercial, +23213,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMBLEMHEALTH/GHI-Commercial, +23214,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMBLEMHEALTH/GHI-Commercial, +23215,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMBLEMHEALTH/GHI-Commercial, +23216,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMBLEMHEALTH/GHI-Commercial, +23217,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMBLEMHEALTH/GHI-Commercial, +23218,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMBLEMHEALTH/GHI-Commercial, +23219,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMBLEMHEALTH/GHI-Commercial, +23220,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMBLEMHEALTH/GHI-Commercial, +23221,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMBLEMHEALTH/GHI-Commercial, +23222,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMBLEMHEALTH/GHI-Commercial, +23223,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMBLEMHEALTH/GHI-Commercial, +23224,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMBLEMHEALTH/GHI-Commercial, +23225,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMBLEMHEALTH/GHI-Commercial, +23226,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMBLEMHEALTH/GHI-Commercial, +23227,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMBLEMHEALTH/GHI-Commercial, +23228,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMBLEMHEALTH/GHI-Commercial, +23229,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMBLEMHEALTH/GHI-Commercial, +23230,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMBLEMHEALTH/GHI-Commercial, +23231,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMBLEMHEALTH/GHI-Commercial, +23232,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMBLEMHEALTH/GHI-Commercial, +23233,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMBLEMHEALTH/GHI-Commercial, +23234,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMBLEMHEALTH/GHI-Commercial, +23235,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMBLEMHEALTH/GHI-Commercial, +23236,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMBLEMHEALTH/GHI-Commercial, +23237,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMBLEMHEALTH/GHI-Commercial, +23238,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMBLEMHEALTH/GHI-Commercial, +23239,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMBLEMHEALTH/GHI-Commercial, +23240,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMBLEMHEALTH/GHI-Commercial, +23241,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMBLEMHEALTH/GHI-Commercial, +23242,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMBLEMHEALTH/GHI-Commercial, +23243,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMBLEMHEALTH/GHI-Commercial, +23244,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMBLEMHEALTH/GHI-Commercial, +23245,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMBLEMHEALTH/GHI-Commercial, +23246,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMBLEMHEALTH/GHI-Commercial, +23247,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMBLEMHEALTH/GHI-Commercial, +23248,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMBLEMHEALTH/GHI-Commercial, +23249,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMBLEMHEALTH/GHI-Commercial, +23250,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMBLEMHEALTH/GHI-Commercial, +23251,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMBLEMHEALTH/GHI-Commercial, +23252,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMBLEMHEALTH/GHI-Commercial, +23253,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +23254,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMBLEMHEALTH/GHI-Commercial, +23255,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMBLEMHEALTH/GHI-Commercial, +23256,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMBLEMHEALTH/GHI-Commercial, +23257,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMBLEMHEALTH/GHI-Commercial, +23258,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMBLEMHEALTH/GHI-Commercial, +23259,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMBLEMHEALTH/GHI-Commercial, +23260,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMBLEMHEALTH/GHI-Commercial, +23261,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMBLEMHEALTH/GHI-Commercial, +23262,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMBLEMHEALTH/GHI-Commercial, +23263,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMBLEMHEALTH/GHI-Commercial, +23264,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMBLEMHEALTH/GHI-Commercial, +23265,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMBLEMHEALTH/GHI-Commercial, +23266,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMBLEMHEALTH/GHI-Commercial, +23267,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMBLEMHEALTH/GHI-Commercial, +23268,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMBLEMHEALTH/GHI-Commercial, +23269,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMBLEMHEALTH/GHI-Commercial, +23270,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMBLEMHEALTH/GHI-Commercial, +23271,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMBLEMHEALTH/GHI-Commercial, +23272,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMBLEMHEALTH/GHI-Commercial, +23273,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMBLEMHEALTH/GHI-Commercial, +23274,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMBLEMHEALTH/GHI-Commercial, +23275,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMBLEMHEALTH/GHI-Commercial,5858.63 +23276,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMBLEMHEALTH/GHI-Commercial, +23277,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMBLEMHEALTH/GHI-Commercial, +23278,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMBLEMHEALTH/GHI-Commercial, +23279,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMBLEMHEALTH/GHI-Commercial, +23280,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMBLEMHEALTH/GHI-Commercial, +23281,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMBLEMHEALTH/GHI-Commercial, +23282,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMBLEMHEALTH/GHI-Commercial, +23283,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMBLEMHEALTH/GHI-Commercial, +23284,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMBLEMHEALTH/GHI-Commercial, +23285,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMBLEMHEALTH/GHI-Commercial, +23286,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMBLEMHEALTH/GHI-Commercial,1640.06 +23287,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMBLEMHEALTH/GHI-Commercial,56.2 +23288,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMBLEMHEALTH/GHI-Commercial, +23289,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMBLEMHEALTH/GHI-Commercial,94.02 +23290,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMBLEMHEALTH/GHI-Commercial, +23291,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23292,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMBLEMHEALTH/GHI-Commercial, +23293,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMBLEMHEALTH/GHI-Commercial, +23294,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMBLEMHEALTH/GHI-Commercial, +23295,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMBLEMHEALTH/GHI-Commercial, +23296,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +23297,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMBLEMHEALTH/GHI-Commercial,5858.63 +23298,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMBLEMHEALTH/GHI-Commercial, +23299,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMBLEMHEALTH/GHI-Commercial, +23300,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMBLEMHEALTH/GHI-Commercial, +23301,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMBLEMHEALTH/GHI-Commercial, +23302,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMBLEMHEALTH/GHI-Commercial, +23303,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMBLEMHEALTH/GHI-Commercial, +23304,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMBLEMHEALTH/GHI-Commercial, +23305,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMBLEMHEALTH/GHI-Commercial, +23306,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMBLEMHEALTH/GHI-Commercial, +23307,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMBLEMHEALTH/GHI-Commercial, +23308,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMBLEMHEALTH/GHI-Commercial, +23309,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMBLEMHEALTH/GHI-Commercial,462.2 +23310,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMBLEMHEALTH/GHI-Commercial, +23311,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMBLEMHEALTH/GHI-Commercial, +23312,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMBLEMHEALTH/GHI-Commercial, +23313,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMBLEMHEALTH/GHI-Commercial, +23314,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMBLEMHEALTH/GHI-Commercial, +23315,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMBLEMHEALTH/GHI-Commercial, +23316,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMBLEMHEALTH/GHI-Commercial, +23317,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23318,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMBLEMHEALTH/GHI-Commercial, +23319,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMBLEMHEALTH/GHI-Commercial, +23320,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMBLEMHEALTH/GHI-Commercial, +23321,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMBLEMHEALTH/GHI-Commercial, +23322,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMBLEMHEALTH/GHI-Commercial, +23323,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMBLEMHEALTH/GHI-Commercial, +23324,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMBLEMHEALTH/GHI-Commercial, +23325,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMBLEMHEALTH/GHI-Commercial, +23326,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMBLEMHEALTH/GHI-Commercial, +23327,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMBLEMHEALTH/GHI-Commercial, +23328,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMBLEMHEALTH/GHI-Commercial, +23329,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMBLEMHEALTH/GHI-Commercial, +23330,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMBLEMHEALTH/GHI-Commercial, +23331,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMBLEMHEALTH/GHI-Commercial, +23332,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMBLEMHEALTH/GHI-Commercial, +23333,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMBLEMHEALTH/GHI-Commercial, +23334,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMBLEMHEALTH/GHI-Commercial, +23335,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMBLEMHEALTH/GHI-Commercial, +23336,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMBLEMHEALTH/GHI-Commercial, +23337,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMBLEMHEALTH/GHI-Commercial, +23338,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMBLEMHEALTH/GHI-Commercial, +23339,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMBLEMHEALTH/GHI-Commercial, +23340,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMBLEMHEALTH/GHI-Commercial, +23341,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMBLEMHEALTH/GHI-Commercial, +23342,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMBLEMHEALTH/GHI-Commercial, +23343,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMBLEMHEALTH/GHI-Commercial, +23344,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMBLEMHEALTH/GHI-Commercial, +23345,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMBLEMHEALTH/GHI-Commercial, +23346,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMBLEMHEALTH/GHI-Commercial, +23347,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMBLEMHEALTH/GHI-Commercial, +23348,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMBLEMHEALTH/GHI-Commercial, +23349,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMBLEMHEALTH/GHI-Commercial, +23350,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMBLEMHEALTH/GHI-Commercial, +23351,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMBLEMHEALTH/GHI-Commercial, +23352,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMBLEMHEALTH/GHI-Commercial, +23353,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMBLEMHEALTH/GHI-Commercial, +23354,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMBLEMHEALTH/GHI-Commercial, +23355,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMBLEMHEALTH/GHI-Commercial, +23356,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMBLEMHEALTH/GHI-Commercial, +23357,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMBLEMHEALTH/GHI-Commercial, +23358,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMBLEMHEALTH/GHI-Commercial, +23359,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMBLEMHEALTH/GHI-Commercial, +23360,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMBLEMHEALTH/GHI-Commercial, +23361,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMBLEMHEALTH/GHI-Commercial, +23362,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMBLEMHEALTH/GHI-Commercial, +23363,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMBLEMHEALTH/GHI-Commercial, +23364,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMBLEMHEALTH/GHI-Commercial, +23365,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMBLEMHEALTH/GHI-Commercial,5858.63 +23366,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMBLEMHEALTH/GHI-Commercial, +23367,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/GHI-Commercial, +23368,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/GHI-Commercial, +23369,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMBLEMHEALTH/GHI-Commercial,22649.46 +23370,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMBLEMHEALTH/GHI-Commercial, +23371,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMBLEMHEALTH/GHI-Commercial, +23372,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMBLEMHEALTH/GHI-Commercial, +23373,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMBLEMHEALTH/GHI-Commercial,2929.31 +23374,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMBLEMHEALTH/GHI-Commercial, +23375,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMBLEMHEALTH/GHI-Commercial, +23376,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMBLEMHEALTH/GHI-Commercial, +23377,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMBLEMHEALTH/GHI-Commercial, +23378,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMBLEMHEALTH/GHI-Commercial, +23379,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMBLEMHEALTH/GHI-Commercial, +23380,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMBLEMHEALTH/GHI-Commercial, +23381,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMBLEMHEALTH/GHI-Commercial, +23382,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMBLEMHEALTH/GHI-Commercial, +23383,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMBLEMHEALTH/GHI-Commercial, +23384,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMBLEMHEALTH/GHI-Commercial, +23385,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMBLEMHEALTH/GHI-Commercial, +23386,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMBLEMHEALTH/GHI-Commercial, +23387,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMBLEMHEALTH/GHI-Commercial, +23388,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMBLEMHEALTH/GHI-Commercial, +23389,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMBLEMHEALTH/GHI-Commercial, +23390,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMBLEMHEALTH/GHI-Commercial, +23391,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMBLEMHEALTH/GHI-Commercial, +23392,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMBLEMHEALTH/GHI-Commercial, +23393,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMBLEMHEALTH/GHI-Commercial, +23394,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMBLEMHEALTH/GHI-Commercial, +23395,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMBLEMHEALTH/GHI-Commercial, +23396,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMBLEMHEALTH/GHI-Commercial, +23397,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMBLEMHEALTH/GHI-Commercial,5344.0 +23398,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMBLEMHEALTH/GHI-Commercial, +23399,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMBLEMHEALTH/GHI-Commercial, +23400,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMBLEMHEALTH/GHI-Commercial, +23401,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMBLEMHEALTH/GHI-Commercial, +23402,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMBLEMHEALTH/GHI-Commercial, +23403,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMBLEMHEALTH/GHI-Commercial, +23404,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMBLEMHEALTH/GHI-Commercial, +23405,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMBLEMHEALTH/GHI-Commercial, +23406,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMBLEMHEALTH/GHI-Commercial, +23407,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +23408,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMBLEMHEALTH/GHI-Commercial, +23409,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMBLEMHEALTH/GHI-Commercial, +23410,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMBLEMHEALTH/GHI-Commercial, +23411,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMBLEMHEALTH/GHI-Commercial, +23412,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23413,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMBLEMHEALTH/GHI-Commercial, +23414,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMBLEMHEALTH/GHI-Commercial, +23415,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMBLEMHEALTH/GHI-Commercial, +23416,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMBLEMHEALTH/GHI-Commercial, +23417,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMBLEMHEALTH/GHI-Commercial, +23418,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMBLEMHEALTH/GHI-Commercial, +23419,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMBLEMHEALTH/GHI-Commercial, +23420,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMBLEMHEALTH/GHI-Commercial, +23421,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMBLEMHEALTH/GHI-Commercial, +23422,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMBLEMHEALTH/GHI-Commercial, +23423,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMBLEMHEALTH/GHI-Commercial, +23424,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMBLEMHEALTH/GHI-Commercial, +23425,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMBLEMHEALTH/GHI-Commercial, +23426,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMBLEMHEALTH/GHI-Commercial, +23427,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMBLEMHEALTH/GHI-Commercial, +23428,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMBLEMHEALTH/GHI-Commercial, +23429,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMBLEMHEALTH/GHI-Commercial, +23430,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMBLEMHEALTH/GHI-Commercial, +23431,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMBLEMHEALTH/GHI-Commercial, +23432,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMBLEMHEALTH/GHI-Commercial, +23433,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMBLEMHEALTH/GHI-Commercial, +23434,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMBLEMHEALTH/GHI-Commercial, +23435,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMBLEMHEALTH/GHI-Commercial, +23436,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMBLEMHEALTH/GHI-Commercial, +23437,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23438,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMBLEMHEALTH/GHI-Commercial, +23439,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMBLEMHEALTH/GHI-Commercial, +23440,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMBLEMHEALTH/GHI-Commercial, +23441,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMBLEMHEALTH/GHI-Commercial, +23442,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMBLEMHEALTH/GHI-Commercial, +23443,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMBLEMHEALTH/GHI-Commercial, +23444,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMBLEMHEALTH/GHI-Commercial, +23445,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMBLEMHEALTH/GHI-Commercial, +23446,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMBLEMHEALTH/GHI-Commercial, +23447,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMBLEMHEALTH/GHI-Commercial, +23448,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMBLEMHEALTH/GHI-Commercial, +23449,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMBLEMHEALTH/GHI-Commercial, +23450,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMBLEMHEALTH/GHI-Commercial, +23451,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMBLEMHEALTH/GHI-Commercial, +23452,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMBLEMHEALTH/GHI-Commercial, +23453,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMBLEMHEALTH/GHI-Commercial, +23454,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMBLEMHEALTH/GHI-Commercial, +23455,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMBLEMHEALTH/GHI-Commercial, +23456,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMBLEMHEALTH/GHI-Commercial, +23457,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMBLEMHEALTH/GHI-Commercial, +23458,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMBLEMHEALTH/GHI-Commercial, +23459,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMBLEMHEALTH/GHI-Commercial, +23460,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMBLEMHEALTH/GHI-Commercial, +23461,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMBLEMHEALTH/GHI-Commercial, +23462,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMBLEMHEALTH/GHI-Commercial, +23463,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMBLEMHEALTH/GHI-Commercial, +23464,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMBLEMHEALTH/GHI-Commercial,2929.31 +23465,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMBLEMHEALTH/GHI-Commercial, +23466,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMBLEMHEALTH/GHI-Commercial, +23467,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMBLEMHEALTH/GHI-Commercial, +23468,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMBLEMHEALTH/GHI-Commercial, +23469,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMBLEMHEALTH/GHI-Commercial, +23470,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMBLEMHEALTH/GHI-Commercial, +23471,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMBLEMHEALTH/GHI-Commercial, +23472,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMBLEMHEALTH/GHI-Commercial, +23473,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMBLEMHEALTH/GHI-Commercial, +23474,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMBLEMHEALTH/GHI-Commercial, +23475,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMBLEMHEALTH/GHI-Commercial, +23476,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMBLEMHEALTH/GHI-Commercial, +23477,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMBLEMHEALTH/GHI-Commercial,5858.63 +23478,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMBLEMHEALTH/GHI-Commercial, +23479,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMBLEMHEALTH/GHI-Commercial, +23480,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMBLEMHEALTH/GHI-Commercial, +23481,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMBLEMHEALTH/GHI-Commercial, +23482,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMBLEMHEALTH/GHI-Commercial, +23483,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMBLEMHEALTH/GHI-Commercial, +23484,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMBLEMHEALTH/GHI-Commercial, +23485,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMBLEMHEALTH/GHI-Commercial, +23486,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMBLEMHEALTH/GHI-Commercial, +23487,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMBLEMHEALTH/GHI-Commercial, +23488,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMBLEMHEALTH/GHI-Commercial, +23489,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMBLEMHEALTH/GHI-Commercial, +23490,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMBLEMHEALTH/GHI-Commercial, +23491,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMBLEMHEALTH/GHI-Commercial, +23492,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMBLEMHEALTH/GHI-Commercial, +23493,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMBLEMHEALTH/GHI-Commercial, +23494,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMBLEMHEALTH/GHI-Commercial, +23495,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMBLEMHEALTH/GHI-Commercial, +23496,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMBLEMHEALTH/GHI-Commercial, +23497,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMBLEMHEALTH/GHI-Commercial, +23498,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMBLEMHEALTH/GHI-Commercial, +23499,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMBLEMHEALTH/GHI-Commercial, +23500,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMBLEMHEALTH/GHI-Commercial, +23501,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMBLEMHEALTH/GHI-Commercial, +23502,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMBLEMHEALTH/GHI-Commercial, +23503,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMBLEMHEALTH/GHI-Commercial,5687.6 +23504,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMBLEMHEALTH/GHI-Commercial, +23505,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23506,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +23507,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMBLEMHEALTH/GHI-Commercial, +23508,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMBLEMHEALTH/GHI-Commercial, +23509,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMBLEMHEALTH/GHI-Commercial, +23510,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMBLEMHEALTH/GHI-Commercial, +23511,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMBLEMHEALTH/GHI-Commercial, +23512,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMBLEMHEALTH/GHI-Commercial, +23513,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMBLEMHEALTH/GHI-Commercial, +23514,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMBLEMHEALTH/GHI-Commercial, +23515,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMBLEMHEALTH/GHI-Commercial, +23516,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMBLEMHEALTH/GHI-Commercial, +23517,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMBLEMHEALTH/GHI-Commercial, +23518,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMBLEMHEALTH/GHI-Commercial, +23519,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMBLEMHEALTH/GHI-Commercial, +23520,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMBLEMHEALTH/GHI-Commercial, +23521,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMBLEMHEALTH/GHI-Commercial, +23522,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMBLEMHEALTH/GHI-Commercial,5188.0 +23523,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMBLEMHEALTH/GHI-Commercial, +23524,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMBLEMHEALTH/GHI-Commercial, +23525,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMBLEMHEALTH/GHI-Commercial, +23526,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMBLEMHEALTH/GHI-Commercial, +23527,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMBLEMHEALTH/GHI-Commercial, +23528,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMBLEMHEALTH/GHI-Commercial, +23529,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMBLEMHEALTH/GHI-Commercial, +23530,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMBLEMHEALTH/GHI-Commercial, +23531,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMBLEMHEALTH/GHI-Commercial, +23532,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMBLEMHEALTH/GHI-Commercial, +23533,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMBLEMHEALTH/GHI-Commercial,5358.63 +23534,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMBLEMHEALTH/GHI-Commercial, +23535,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMBLEMHEALTH/GHI-Commercial, +23536,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMBLEMHEALTH/GHI-Commercial, +23537,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMBLEMHEALTH/GHI-Commercial, +23538,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMBLEMHEALTH/GHI-Commercial, +23539,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMBLEMHEALTH/GHI-Commercial, +23540,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMBLEMHEALTH/GHI-Commercial, +23541,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMBLEMHEALTH/GHI-Commercial, +23542,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMBLEMHEALTH/GHI-Commercial, +23543,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMBLEMHEALTH/GHI-Commercial, +23544,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMBLEMHEALTH/GHI-Commercial, +23545,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMBLEMHEALTH/GHI-Commercial, +23546,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMBLEMHEALTH/GHI-Commercial, +23547,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMBLEMHEALTH/GHI-Commercial, +23548,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMBLEMHEALTH/GHI-Commercial,5858.63 +23549,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMBLEMHEALTH/GHI-Commercial, +23550,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMBLEMHEALTH/GHI-Commercial,4393.97 +23551,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMBLEMHEALTH/GHI-Commercial, +23552,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMBLEMHEALTH/GHI-Commercial, +23553,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMBLEMHEALTH/GHI-Commercial,2594.0 +23554,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMBLEMHEALTH/GHI-Commercial,5858.63 +23555,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMBLEMHEALTH/GHI-Commercial, +23556,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMBLEMHEALTH/GHI-Commercial, +23557,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMBLEMHEALTH/GHI-Commercial, +23558,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMBLEMHEALTH/GHI-Commercial,5858.63 +23559,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +23560,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMBLEMHEALTH/GHI-Commercial, +23561,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMBLEMHEALTH/GHI-Commercial, +23562,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMBLEMHEALTH/GHI-Commercial, +23563,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMBLEMHEALTH/GHI-Commercial, +23564,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +23565,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMBLEMHEALTH/GHI-Commercial, +23566,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMBLEMHEALTH/GHI-Commercial, +23567,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMBLEMHEALTH/GHI-Commercial, +23568,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMBLEMHEALTH/GHI-Commercial,5461.0 +23569,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMBLEMHEALTH/GHI-Commercial,5139.02 +23570,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMBLEMHEALTH/GHI-Commercial, +23571,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMBLEMHEALTH/GHI-Commercial, +23572,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMBLEMHEALTH/GHI-Commercial, +23573,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMBLEMHEALTH/GHI-Commercial, +23574,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMBLEMHEALTH/GHI-Commercial, +23575,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23576,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMBLEMHEALTH/GHI-Commercial, +23577,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMBLEMHEALTH/GHI-Commercial, +23578,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMBLEMHEALTH/GHI-Commercial, +23579,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMBLEMHEALTH/GHI-Commercial, +23580,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMBLEMHEALTH/GHI-Commercial, +23581,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23582,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMBLEMHEALTH/GHI-Commercial, +23583,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMBLEMHEALTH/GHI-Commercial, +23584,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMBLEMHEALTH/GHI-Commercial, +23585,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23586,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMBLEMHEALTH/GHI-Commercial, +23587,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMBLEMHEALTH/GHI-Commercial, +23588,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMBLEMHEALTH/GHI-Commercial, +23589,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMBLEMHEALTH/GHI-Commercial, +23590,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMBLEMHEALTH/GHI-Commercial, +23591,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMBLEMHEALTH/GHI-Commercial, +23592,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMBLEMHEALTH/GHI-Commercial, +23593,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMBLEMHEALTH/GHI-Commercial, +23594,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMBLEMHEALTH/GHI-Commercial, +23595,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMBLEMHEALTH/GHI-Commercial, +23596,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMBLEMHEALTH/GHI-Commercial, +23597,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMBLEMHEALTH/GHI-Commercial, +23598,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMBLEMHEALTH/GHI-Commercial, +23599,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMBLEMHEALTH/GHI-Commercial, +23600,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMBLEMHEALTH/GHI-Commercial, +23601,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMBLEMHEALTH/GHI-Commercial, +23602,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMBLEMHEALTH/GHI-Commercial, +23603,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMBLEMHEALTH/GHI-Commercial, +23604,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMBLEMHEALTH/GHI-Commercial, +23605,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMBLEMHEALTH/GHI-Commercial, +23606,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMBLEMHEALTH/GHI-Commercial,8876.0 +23607,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMBLEMHEALTH/GHI-Commercial,8776.0 +23608,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMBLEMHEALTH/GHI-Commercial, +23609,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMBLEMHEALTH/GHI-Commercial, +23610,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMBLEMHEALTH/GHI-Commercial, +23611,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMBLEMHEALTH/GHI-Commercial, +23612,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMBLEMHEALTH/GHI-Commercial, +23613,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMBLEMHEALTH/GHI-Commercial,3892.0 +23614,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMBLEMHEALTH/GHI-Commercial, +23615,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMBLEMHEALTH/GHI-Commercial, +23616,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMBLEMHEALTH/GHI-Commercial, +23617,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMBLEMHEALTH/GHI-Commercial, +23618,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMBLEMHEALTH/GHI-Commercial, +23619,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMBLEMHEALTH/GHI-Commercial, +23620,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMBLEMHEALTH/GHI-Commercial, +23621,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMBLEMHEALTH/GHI-Commercial, +23622,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMBLEMHEALTH/GHI-Commercial, +23623,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +23624,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMBLEMHEALTH/GHI-Commercial, +23625,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMBLEMHEALTH/GHI-Commercial, +23626,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMBLEMHEALTH/GHI-Commercial, +23627,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMBLEMHEALTH/GHI-Commercial, +23628,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMBLEMHEALTH/GHI-Commercial, +23629,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMBLEMHEALTH/GHI-Commercial, +23630,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMBLEMHEALTH/GHI-Commercial, +23631,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMBLEMHEALTH/GHI-Commercial, +23632,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMBLEMHEALTH/GHI-Commercial, +23633,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMBLEMHEALTH/GHI-Commercial, +23634,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMBLEMHEALTH/GHI-Commercial, +23635,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMBLEMHEALTH/GHI-Commercial, +23636,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMBLEMHEALTH/GHI-Commercial, +23637,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMBLEMHEALTH/GHI-Commercial, +23638,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMBLEMHEALTH/GHI-Commercial, +23639,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMBLEMHEALTH/GHI-Commercial, +23640,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMBLEMHEALTH/GHI-Commercial,7134.67 +23641,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMBLEMHEALTH/GHI-Commercial,6828.0 +23642,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMBLEMHEALTH/GHI-Commercial, +23643,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMBLEMHEALTH/GHI-Commercial, +23644,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMBLEMHEALTH/GHI-Commercial,12319.0 +23645,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMBLEMHEALTH/GHI-Commercial,1707.0 +23646,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMBLEMHEALTH/GHI-Commercial, +23647,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMBLEMHEALTH/GHI-Commercial, +23648,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMBLEMHEALTH/GHI-Commercial,13835.81 +23649,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMBLEMHEALTH/GHI-Commercial, +23650,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMBLEMHEALTH/GHI-Commercial,1707.0 +23651,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMBLEMHEALTH/GHI-Commercial, +23652,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMBLEMHEALTH/GHI-Commercial, +23653,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMBLEMHEALTH/GHI-Commercial, +23654,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23655,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMBLEMHEALTH/GHI-Commercial, +23656,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMBLEMHEALTH/GHI-Commercial, +23657,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMBLEMHEALTH/GHI-Commercial,8876.0 +23658,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMBLEMHEALTH/GHI-Commercial,8676.0 +23659,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMBLEMHEALTH/GHI-Commercial, +23660,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMBLEMHEALTH/GHI-Commercial, +23661,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMBLEMHEALTH/GHI-Commercial,9558.0 +23662,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMBLEMHEALTH/GHI-Commercial, +23663,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23664,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMBLEMHEALTH/GHI-Commercial, +23665,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMBLEMHEALTH/GHI-Commercial, +23666,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMBLEMHEALTH/GHI-Commercial, +23667,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMBLEMHEALTH/GHI-Commercial, +23668,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMBLEMHEALTH/GHI-Commercial, +23669,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMBLEMHEALTH/GHI-Commercial, +23670,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMBLEMHEALTH/GHI-Commercial,2597.33 +23671,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMBLEMHEALTH/GHI-Commercial, +23672,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMBLEMHEALTH/GHI-Commercial, +23673,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMBLEMHEALTH/GHI-Commercial,5461.0 +23674,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMBLEMHEALTH/GHI-Commercial, +23675,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMBLEMHEALTH/GHI-Commercial, +23676,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMBLEMHEALTH/GHI-Commercial, +23677,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMBLEMHEALTH/GHI-Commercial, +23678,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMBLEMHEALTH/GHI-Commercial, +23679,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMBLEMHEALTH/GHI-Commercial, +23680,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMBLEMHEALTH/GHI-Commercial,12029.0 +23681,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMBLEMHEALTH/GHI-Commercial, +23682,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMBLEMHEALTH/GHI-Commercial, +23683,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMBLEMHEALTH/GHI-Commercial, +23684,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMBLEMHEALTH/GHI-Commercial, +23685,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMBLEMHEALTH/GHI-Commercial, +23686,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMBLEMHEALTH/GHI-Commercial, +23687,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMBLEMHEALTH/GHI-Commercial, +23688,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMBLEMHEALTH/GHI-Commercial, +23689,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMBLEMHEALTH/GHI-Commercial, +23690,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMBLEMHEALTH/GHI-Commercial, +23691,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMBLEMHEALTH/GHI-Commercial, +23692,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMBLEMHEALTH/GHI-Commercial, +23693,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMBLEMHEALTH/GHI-Commercial, +23694,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMBLEMHEALTH/GHI-Commercial, +23695,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMBLEMHEALTH/GHI-Commercial, +23696,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMBLEMHEALTH/GHI-Commercial, +23697,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMBLEMHEALTH/GHI-Commercial, +23698,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMBLEMHEALTH/GHI-Commercial,1946.0 +23699,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMBLEMHEALTH/GHI-Commercial, +23700,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMBLEMHEALTH/GHI-Commercial, +23701,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMBLEMHEALTH/GHI-Commercial, +23702,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMBLEMHEALTH/GHI-Commercial, +23703,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMBLEMHEALTH/GHI-Commercial, +23704,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMBLEMHEALTH/GHI-Commercial, +23705,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMBLEMHEALTH/GHI-Commercial, +23706,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMBLEMHEALTH/GHI-Commercial, +23707,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMBLEMHEALTH/GHI-Commercial,3581.0 +23708,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMBLEMHEALTH/GHI-Commercial, +23709,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMBLEMHEALTH/GHI-Commercial, +23710,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMBLEMHEALTH/GHI-Commercial, +23711,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMBLEMHEALTH/GHI-Commercial, +23712,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMBLEMHEALTH/GHI-Commercial, +23713,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMBLEMHEALTH/GHI-Commercial, +23714,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMBLEMHEALTH/GHI-Commercial, +23715,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMBLEMHEALTH/GHI-Commercial,7920.0 +23716,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMBLEMHEALTH/GHI-Commercial, +23717,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMBLEMHEALTH/GHI-Commercial, +23718,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMBLEMHEALTH/GHI-Commercial, +23719,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMBLEMHEALTH/GHI-Commercial, +23720,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMBLEMHEALTH/GHI-Commercial, +23721,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMBLEMHEALTH/GHI-Commercial, +23722,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMBLEMHEALTH/GHI-Commercial, +23723,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMBLEMHEALTH/GHI-Commercial, +23724,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMBLEMHEALTH/GHI-Commercial,3411.26 +23725,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMBLEMHEALTH/GHI-Commercial, +23726,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMBLEMHEALTH/GHI-Commercial, +23727,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMBLEMHEALTH/GHI-Commercial, +23728,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMBLEMHEALTH/GHI-Commercial, +23729,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMBLEMHEALTH/GHI-Commercial, +23730,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMBLEMHEALTH/GHI-Commercial,3414.0 +23731,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMBLEMHEALTH/GHI-Commercial, +23732,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMBLEMHEALTH/GHI-Commercial, +23733,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMBLEMHEALTH/GHI-Commercial, +23734,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMBLEMHEALTH/GHI-Commercial, +23735,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMBLEMHEALTH/GHI-Commercial,10162.01 +23736,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMBLEMHEALTH/GHI-Commercial, +23737,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMBLEMHEALTH/GHI-Commercial, +23738,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMBLEMHEALTH/GHI-Commercial,7920.0 +23739,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMBLEMHEALTH/GHI-Commercial, +23740,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMBLEMHEALTH/GHI-Commercial, +23741,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMBLEMHEALTH/GHI-Commercial, +23742,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMBLEMHEALTH/GHI-Commercial, +23743,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMBLEMHEALTH/GHI-Commercial, +23744,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMBLEMHEALTH/GHI-Commercial, +23745,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMBLEMHEALTH/GHI-Commercial,3162.0 +23746,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +23747,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMBLEMHEALTH/GHI-Commercial, +23748,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +23749,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMBLEMHEALTH/GHI-Commercial, +23750,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMBLEMHEALTH/GHI-Commercial,4776.0 +23751,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMBLEMHEALTH/GHI-Commercial, +23752,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMBLEMHEALTH/GHI-Commercial, +23753,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMBLEMHEALTH/GHI-Commercial, +23754,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMBLEMHEALTH/GHI-Commercial, +23755,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMBLEMHEALTH/GHI-Commercial, +23756,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMBLEMHEALTH/GHI-Commercial, +23757,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMBLEMHEALTH/GHI-Commercial, +23758,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMBLEMHEALTH/GHI-Commercial, +23759,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +23760,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMBLEMHEALTH/GHI-Commercial, +23761,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMBLEMHEALTH/GHI-Commercial, +23762,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMBLEMHEALTH/GHI-Commercial, +23763,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMBLEMHEALTH/GHI-Commercial, +23764,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23765,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMBLEMHEALTH/GHI-Commercial, +23766,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMBLEMHEALTH/GHI-Commercial, +23767,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMBLEMHEALTH/GHI-Commercial, +23768,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMBLEMHEALTH/GHI-Commercial,1946.0 +23769,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMBLEMHEALTH/GHI-Commercial, +23770,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMBLEMHEALTH/GHI-Commercial, +23771,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMBLEMHEALTH/GHI-Commercial, +23772,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMBLEMHEALTH/GHI-Commercial, +23773,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMBLEMHEALTH/GHI-Commercial, +23774,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23775,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMBLEMHEALTH/GHI-Commercial, +23776,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMBLEMHEALTH/GHI-Commercial, +23777,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMBLEMHEALTH/GHI-Commercial, +23778,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMBLEMHEALTH/GHI-Commercial, +23779,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMBLEMHEALTH/GHI-Commercial,9558.0 +23780,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMBLEMHEALTH/GHI-Commercial, +23781,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMBLEMHEALTH/GHI-Commercial, +23782,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMBLEMHEALTH/GHI-Commercial, +23783,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMBLEMHEALTH/GHI-Commercial, +23784,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMBLEMHEALTH/GHI-Commercial,3892.0 +23785,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMBLEMHEALTH/GHI-Commercial, +23786,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMBLEMHEALTH/GHI-Commercial, +23787,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23788,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMBLEMHEALTH/GHI-Commercial, +23789,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMBLEMHEALTH/GHI-Commercial, +23790,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMBLEMHEALTH/GHI-Commercial, +23791,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMBLEMHEALTH/GHI-Commercial, +23792,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMBLEMHEALTH/GHI-Commercial, +23793,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMBLEMHEALTH/GHI-Commercial, +23794,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMBLEMHEALTH/GHI-Commercial, +23795,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMBLEMHEALTH/GHI-Commercial, +23796,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMBLEMHEALTH/GHI-Commercial, +23797,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMBLEMHEALTH/GHI-Commercial, +23798,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMBLEMHEALTH/GHI-Commercial, +23799,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMBLEMHEALTH/GHI-Commercial, +23800,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMBLEMHEALTH/GHI-Commercial, +23801,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMBLEMHEALTH/GHI-Commercial, +23802,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMBLEMHEALTH/GHI-Commercial, +23803,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMBLEMHEALTH/GHI-Commercial,5409.0 +23804,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23805,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMBLEMHEALTH/GHI-Commercial, +23806,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMBLEMHEALTH/GHI-Commercial, +23807,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23808,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMBLEMHEALTH/GHI-Commercial, +23809,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMBLEMHEALTH/GHI-Commercial, +23810,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMBLEMHEALTH/GHI-Commercial, +23811,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMBLEMHEALTH/GHI-Commercial, +23812,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMBLEMHEALTH/GHI-Commercial, +23813,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMBLEMHEALTH/GHI-Commercial, +23814,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMBLEMHEALTH/GHI-Commercial, +23815,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMBLEMHEALTH/GHI-Commercial, +23816,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMBLEMHEALTH/GHI-Commercial, +23817,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMBLEMHEALTH/GHI-Commercial, +23818,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMBLEMHEALTH/GHI-Commercial, +23819,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMBLEMHEALTH/GHI-Commercial, +23820,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMBLEMHEALTH/GHI-Commercial, +23821,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMBLEMHEALTH/GHI-Commercial, +23822,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMBLEMHEALTH/GHI-Commercial, +23823,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMBLEMHEALTH/GHI-Commercial, +23824,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMBLEMHEALTH/GHI-Commercial, +23825,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +23826,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMBLEMHEALTH/GHI-Commercial, +23827,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMBLEMHEALTH/GHI-Commercial, +23828,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMBLEMHEALTH/GHI-Commercial, +23829,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMBLEMHEALTH/GHI-Commercial, +23830,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMBLEMHEALTH/GHI-Commercial, +23831,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23832,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMBLEMHEALTH/GHI-Commercial, +23833,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23834,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMBLEMHEALTH/GHI-Commercial, +23835,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMBLEMHEALTH/GHI-Commercial, +23836,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMBLEMHEALTH/GHI-Commercial, +23837,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMBLEMHEALTH/GHI-Commercial,1946.0 +23838,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +23839,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMBLEMHEALTH/GHI-Commercial,6018.07 +23840,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMBLEMHEALTH/GHI-Commercial, +23841,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMBLEMHEALTH/GHI-Commercial, +23842,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMBLEMHEALTH/GHI-Commercial, +23843,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMBLEMHEALTH/GHI-Commercial, +23844,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMBLEMHEALTH/GHI-Commercial, +23845,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMBLEMHEALTH/GHI-Commercial,3337.5 +23846,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMBLEMHEALTH/GHI-Commercial, +23847,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMBLEMHEALTH/GHI-Commercial,7920.0 +23848,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMBLEMHEALTH/GHI-Commercial, +23849,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMBLEMHEALTH/GHI-Commercial, +23850,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMBLEMHEALTH/GHI-Commercial, +23851,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMBLEMHEALTH/GHI-Commercial, +23852,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMBLEMHEALTH/GHI-Commercial, +23853,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMBLEMHEALTH/GHI-Commercial, +23854,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMBLEMHEALTH/GHI-Commercial, +23855,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMBLEMHEALTH/GHI-Commercial, +23856,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMBLEMHEALTH/GHI-Commercial, +23857,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMBLEMHEALTH/GHI-Commercial, +23858,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMBLEMHEALTH/GHI-Commercial, +23859,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMBLEMHEALTH/GHI-Commercial, +23860,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMBLEMHEALTH/GHI-Commercial, +23861,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMBLEMHEALTH/GHI-Commercial, +23862,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMBLEMHEALTH/GHI-Commercial, +23863,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23864,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMBLEMHEALTH/GHI-Commercial, +23865,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMBLEMHEALTH/GHI-Commercial, +23866,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMBLEMHEALTH/GHI-Commercial, +23867,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMBLEMHEALTH/GHI-Commercial, +23868,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23869,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMBLEMHEALTH/GHI-Commercial, +23870,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMBLEMHEALTH/GHI-Commercial,5261.35 +23871,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMBLEMHEALTH/GHI-Commercial, +23872,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMBLEMHEALTH/GHI-Commercial, +23873,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMBLEMHEALTH/GHI-Commercial, +23874,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMBLEMHEALTH/GHI-Commercial, +23875,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMBLEMHEALTH/GHI-Commercial, +23876,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMBLEMHEALTH/GHI-Commercial, +23877,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMBLEMHEALTH/GHI-Commercial,4115.84 +23878,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMBLEMHEALTH/GHI-Commercial, +23879,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMBLEMHEALTH/GHI-Commercial, +23880,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMBLEMHEALTH/GHI-Commercial, +23881,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMBLEMHEALTH/GHI-Commercial,9558.0 +23882,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMBLEMHEALTH/GHI-Commercial,6557.0 +23883,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMBLEMHEALTH/GHI-Commercial, +23884,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMBLEMHEALTH/GHI-Commercial, +23885,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMBLEMHEALTH/GHI-Commercial, +23886,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMBLEMHEALTH/GHI-Commercial, +23887,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMBLEMHEALTH/GHI-Commercial,6922.0 +23888,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMBLEMHEALTH/GHI-Commercial, +23889,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMBLEMHEALTH/GHI-Commercial,3104.62 +23890,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMBLEMHEALTH/GHI-Commercial, +23891,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMBLEMHEALTH/GHI-Commercial, +23892,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMBLEMHEALTH/GHI-Commercial,7920.0 +23893,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMBLEMHEALTH/GHI-Commercial, +23894,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMBLEMHEALTH/GHI-Commercial,9558.0 +23895,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMBLEMHEALTH/GHI-Commercial,8876.0 +23896,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMBLEMHEALTH/GHI-Commercial, +23897,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMBLEMHEALTH/GHI-Commercial, +23898,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMBLEMHEALTH/GHI-Commercial, +23899,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMBLEMHEALTH/GHI-Commercial,8876.0 +23900,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMBLEMHEALTH/GHI-Commercial, +23901,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMBLEMHEALTH/GHI-Commercial, +23902,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMBLEMHEALTH/GHI-Commercial, +23903,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMBLEMHEALTH/GHI-Commercial, +23904,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMBLEMHEALTH/GHI-Commercial, +23905,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMBLEMHEALTH/GHI-Commercial,7857.51 +23906,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMBLEMHEALTH/GHI-Commercial, +23907,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMBLEMHEALTH/GHI-Commercial, +23908,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMBLEMHEALTH/GHI-Commercial, +23909,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMBLEMHEALTH/GHI-Commercial,8876.0 +23910,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMBLEMHEALTH/GHI-Commercial, +23911,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMBLEMHEALTH/GHI-Commercial,892.45 +23912,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMBLEMHEALTH/GHI-Commercial, +23913,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMBLEMHEALTH/GHI-Commercial, +23914,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +23915,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMBLEMHEALTH/GHI-Commercial, +23916,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMBLEMHEALTH/GHI-Commercial, +23917,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23918,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMBLEMHEALTH/GHI-Commercial, +23919,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +23920,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +23921,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMBLEMHEALTH/GHI-Commercial, +23922,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMBLEMHEALTH/GHI-Commercial,6532.67 +23923,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMBLEMHEALTH/GHI-Commercial, +23924,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMBLEMHEALTH/GHI-Commercial,5337.07 +23925,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMBLEMHEALTH/GHI-Commercial,5824.0 +23926,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +23927,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMBLEMHEALTH/GHI-Commercial, +23928,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMBLEMHEALTH/GHI-Commercial, +23929,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMBLEMHEALTH/GHI-Commercial, +23930,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMBLEMHEALTH/GHI-Commercial, +23931,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMBLEMHEALTH/GHI-Commercial, +23932,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMBLEMHEALTH/GHI-Commercial,8876.0 +23933,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMBLEMHEALTH/GHI-Commercial,8876.0 +23934,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMBLEMHEALTH/GHI-Commercial, +23935,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMBLEMHEALTH/GHI-Commercial, +23936,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMBLEMHEALTH/GHI-Commercial, +23937,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMBLEMHEALTH/GHI-Commercial, +23938,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMBLEMHEALTH/GHI-Commercial, +23939,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMBLEMHEALTH/GHI-Commercial, +23940,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMBLEMHEALTH/GHI-Commercial, +23941,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMBLEMHEALTH/GHI-Commercial, +23942,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMBLEMHEALTH/GHI-Commercial, +23943,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMBLEMHEALTH/GHI-Commercial,19186.91 +23944,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMBLEMHEALTH/GHI-Commercial, +23945,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMBLEMHEALTH/GHI-Commercial, +23946,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMBLEMHEALTH/GHI-Commercial, +23947,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMBLEMHEALTH/GHI-Commercial, +23948,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMBLEMHEALTH/GHI-Commercial, +23949,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23950,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMBLEMHEALTH/GHI-Commercial, +23951,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMBLEMHEALTH/GHI-Commercial, +23952,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMBLEMHEALTH/GHI-Commercial, +23953,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMBLEMHEALTH/GHI-Commercial,3845.13 +23954,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMBLEMHEALTH/GHI-Commercial, +23955,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMBLEMHEALTH/GHI-Commercial,2771.65 +23956,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +23957,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMBLEMHEALTH/GHI-Commercial, +23958,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMBLEMHEALTH/GHI-Commercial, +23959,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMBLEMHEALTH/GHI-Commercial, +23960,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMBLEMHEALTH/GHI-Commercial, +23961,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMBLEMHEALTH/GHI-Commercial, +23962,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMBLEMHEALTH/GHI-Commercial, +23963,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMBLEMHEALTH/GHI-Commercial, +23964,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMBLEMHEALTH/GHI-Commercial, +23965,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMBLEMHEALTH/GHI-Commercial, +23966,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMBLEMHEALTH/GHI-Commercial, +23967,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMBLEMHEALTH/GHI-Commercial,8678.0 +23968,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMBLEMHEALTH/GHI-Commercial, +23969,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMBLEMHEALTH/GHI-Commercial, +23970,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMBLEMHEALTH/GHI-Commercial, +23971,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMBLEMHEALTH/GHI-Commercial, +23972,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMBLEMHEALTH/GHI-Commercial, +23973,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMBLEMHEALTH/GHI-Commercial,7168.5 +23974,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMBLEMHEALTH/GHI-Commercial, +23975,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMBLEMHEALTH/GHI-Commercial, +23976,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMBLEMHEALTH/GHI-Commercial, +23977,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMBLEMHEALTH/GHI-Commercial,1707.0 +23978,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMBLEMHEALTH/GHI-Commercial, +23979,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMBLEMHEALTH/GHI-Commercial, +23980,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMBLEMHEALTH/GHI-Commercial, +23981,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMBLEMHEALTH/GHI-Commercial, +23982,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMBLEMHEALTH/GHI-Commercial, +23983,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMBLEMHEALTH/GHI-Commercial, +23984,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMBLEMHEALTH/GHI-Commercial, +23985,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMBLEMHEALTH/GHI-Commercial, +23986,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMBLEMHEALTH/GHI-Commercial,3892.0 +23987,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMBLEMHEALTH/GHI-Commercial, +23988,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMBLEMHEALTH/GHI-Commercial, +23989,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMBLEMHEALTH/GHI-Commercial, +23990,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMBLEMHEALTH/GHI-Commercial, +23991,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMBLEMHEALTH/GHI-Commercial, +23992,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMBLEMHEALTH/GHI-Commercial, +23993,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMBLEMHEALTH/GHI-Commercial, +23994,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +23995,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMBLEMHEALTH/GHI-Commercial, +23996,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMBLEMHEALTH/GHI-Commercial, +23997,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMBLEMHEALTH/GHI-Commercial,2919.0 +23998,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMBLEMHEALTH/GHI-Commercial, +23999,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMBLEMHEALTH/GHI-Commercial, +24000,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMBLEMHEALTH/GHI-Commercial, +24001,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMBLEMHEALTH/GHI-Commercial, +24002,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMBLEMHEALTH/GHI-Commercial, +24003,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMBLEMHEALTH/GHI-Commercial, +24004,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMBLEMHEALTH/GHI-Commercial, +24005,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMBLEMHEALTH/GHI-Commercial, +24006,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMBLEMHEALTH/GHI-Commercial, +24007,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMBLEMHEALTH/GHI-Commercial, +24008,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMBLEMHEALTH/GHI-Commercial, +24009,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMBLEMHEALTH/GHI-Commercial, +24010,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMBLEMHEALTH/GHI-Commercial, +24011,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMBLEMHEALTH/GHI-Commercial, +24012,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMBLEMHEALTH/GHI-Commercial,4188.0 +24013,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMBLEMHEALTH/GHI-Commercial,2385.45 +24014,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMBLEMHEALTH/GHI-Commercial,5377.93 +24015,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMBLEMHEALTH/GHI-Commercial,5263.61 +24016,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMBLEMHEALTH/GHI-Commercial, +24017,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMBLEMHEALTH/GHI-Commercial, +24018,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMBLEMHEALTH/GHI-Commercial, +24019,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMBLEMHEALTH/GHI-Commercial, +24020,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMBLEMHEALTH/GHI-Commercial, +24021,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMBLEMHEALTH/GHI-Commercial, +24022,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMBLEMHEALTH/GHI-Commercial, +24023,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMBLEMHEALTH/GHI-Commercial,1365.25 +24024,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMBLEMHEALTH/GHI-Commercial, +24025,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMBLEMHEALTH/GHI-Commercial,2730.5 +24026,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMBLEMHEALTH/GHI-Commercial,5461.0 +24027,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMBLEMHEALTH/GHI-Commercial,1365.25 +24028,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMBLEMHEALTH/GHI-Commercial,5461.0 +24029,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMBLEMHEALTH/GHI-Commercial,973.0 +24030,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMBLEMHEALTH/GHI-Commercial, +24031,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/GHI-Commercial, +24032,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +24033,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMBLEMHEALTH/GHI-Commercial, +24034,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMBLEMHEALTH/GHI-Commercial, +24035,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMBLEMHEALTH/GHI-Commercial, +24036,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMBLEMHEALTH/GHI-Commercial, +24037,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMBLEMHEALTH/GHI-Commercial, +24038,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMBLEMHEALTH/GHI-Commercial,1980.0 +24039,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMBLEMHEALTH/GHI-Commercial, +24040,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMBLEMHEALTH/GHI-Commercial,20294.0 +24041,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMBLEMHEALTH/GHI-Commercial,1365.25 +24042,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMBLEMHEALTH/GHI-Commercial,7920.0 +24043,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMBLEMHEALTH/GHI-Commercial, +24044,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMBLEMHEALTH/GHI-Commercial, +24045,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMBLEMHEALTH/GHI-Commercial, +24046,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMBLEMHEALTH/GHI-Commercial, +24047,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMBLEMHEALTH/GHI-Commercial, +24048,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMBLEMHEALTH/GHI-Commercial, +24049,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMBLEMHEALTH/GHI-Commercial, +24050,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMBLEMHEALTH/GHI-Commercial, +24051,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMBLEMHEALTH/GHI-Commercial, +24052,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMBLEMHEALTH/GHI-Commercial, +24053,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMBLEMHEALTH/GHI-Commercial, +24054,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMBLEMHEALTH/GHI-Commercial, +24055,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMBLEMHEALTH/GHI-Commercial, +24056,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMBLEMHEALTH/GHI-Commercial, +24057,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMBLEMHEALTH/GHI-Commercial, +24058,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMBLEMHEALTH/GHI-Commercial, +24059,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMBLEMHEALTH/GHI-Commercial, +24060,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMBLEMHEALTH/GHI-Commercial, +24061,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMBLEMHEALTH/GHI-Commercial, +24062,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMBLEMHEALTH/GHI-Commercial, +24063,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMBLEMHEALTH/GHI-Commercial, +24064,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/GHI-Commercial, +24065,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMBLEMHEALTH/GHI-Commercial, +24066,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMBLEMHEALTH/GHI-Commercial, +24067,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMBLEMHEALTH/GHI-Commercial, +24068,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMBLEMHEALTH/GHI-Commercial, +24069,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMBLEMHEALTH/GHI-Commercial, +24070,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMBLEMHEALTH/GHI-Commercial, +24071,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMBLEMHEALTH/GHI-Commercial, +24072,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMBLEMHEALTH/GHI-Commercial, +24073,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMBLEMHEALTH/GHI-Commercial, +24074,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMBLEMHEALTH/GHI-Commercial, +24075,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMBLEMHEALTH/GHI-Commercial, +24076,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMBLEMHEALTH/GHI-Commercial, +24077,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMBLEMHEALTH/GHI-Commercial, +24078,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMBLEMHEALTH/GHI-Commercial, +24079,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMBLEMHEALTH/GHI-Commercial, +24080,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMBLEMHEALTH/GHI-Commercial, +24081,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/GHI-Commercial, +24082,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMBLEMHEALTH/GHI-Commercial, +24083,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMBLEMHEALTH/GHI-Commercial, +24084,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMBLEMHEALTH/GHI-Commercial, +24085,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMBLEMHEALTH/GHI-Commercial, +24086,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMBLEMHEALTH/GHI-Commercial, +24087,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMBLEMHEALTH/GHI-Commercial, +24088,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMBLEMHEALTH/GHI-Commercial, +24089,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMBLEMHEALTH/GHI-Commercial, +24090,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMBLEMHEALTH/GHI-Commercial, +24091,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMBLEMHEALTH/GHI-Commercial, +24092,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMBLEMHEALTH/GHI-Commercial,5461.0 +24093,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMBLEMHEALTH/GHI-Commercial, +24094,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMBLEMHEALTH/GHI-Commercial, +24095,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMBLEMHEALTH/GHI-Commercial, +24096,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMBLEMHEALTH/GHI-Commercial, +24097,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMBLEMHEALTH/GHI-Commercial, +24098,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMBLEMHEALTH/GHI-Commercial, +24099,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMBLEMHEALTH/GHI-Commercial, +24100,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMBLEMHEALTH/GHI-Commercial, +24101,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMBLEMHEALTH/GHI-Commercial, +24102,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMBLEMHEALTH/GHI-Commercial, +24103,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMBLEMHEALTH/GHI-Commercial, +24104,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMBLEMHEALTH/GHI-Commercial, +24105,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMBLEMHEALTH/GHI-Commercial,7920.0 +24106,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMBLEMHEALTH/GHI-Commercial, +24107,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMBLEMHEALTH/GHI-Commercial, +24108,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMBLEMHEALTH/GHI-Commercial, +24109,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMBLEMHEALTH/GHI-Commercial, +24110,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMBLEMHEALTH/GHI-Commercial, +24111,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMBLEMHEALTH/GHI-Commercial, +24112,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMBLEMHEALTH/GHI-Commercial, +24113,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMBLEMHEALTH/GHI-Commercial, +24114,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMBLEMHEALTH/GHI-Commercial, +24115,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMBLEMHEALTH/GHI-Commercial, +24116,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMBLEMHEALTH/GHI-Commercial, +24117,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMBLEMHEALTH/GHI-Commercial, +24118,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMBLEMHEALTH/GHI-Commercial, +24119,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMBLEMHEALTH/GHI-Commercial, +24120,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMBLEMHEALTH/GHI-Commercial, +24121,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMBLEMHEALTH/GHI-Commercial, +24122,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMBLEMHEALTH/GHI-Commercial, +24123,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMBLEMHEALTH/GHI-Commercial, +24124,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMBLEMHEALTH/GHI-Commercial, +24125,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMBLEMHEALTH/GHI-Commercial, +24126,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMBLEMHEALTH/GHI-Commercial, +24127,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMBLEMHEALTH/GHI-Commercial, +24128,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMBLEMHEALTH/GHI-Commercial, +24129,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMBLEMHEALTH/GHI-Commercial, +24130,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMBLEMHEALTH/GHI-Commercial, +24131,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMBLEMHEALTH/GHI-Commercial, +24132,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMBLEMHEALTH/GHI-Commercial, +24133,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMBLEMHEALTH/GHI-Commercial, +24134,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMBLEMHEALTH/GHI-Commercial, +24135,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMBLEMHEALTH/GHI-Commercial, +24136,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMBLEMHEALTH/GHI-Commercial, +24137,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMBLEMHEALTH/GHI-Commercial,5446.65 +24138,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMBLEMHEALTH/GHI-Commercial, +24139,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMBLEMHEALTH/GHI-Commercial, +24140,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMBLEMHEALTH/GHI-Commercial, +24141,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMBLEMHEALTH/GHI-Commercial, +24142,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMBLEMHEALTH/GHI-Commercial, +24143,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMBLEMHEALTH/GHI-Commercial, +24144,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMBLEMHEALTH/GHI-Commercial,4748.98 +24145,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMBLEMHEALTH/GHI-Commercial, +24146,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMBLEMHEALTH/GHI-Commercial, +24147,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMBLEMHEALTH/GHI-Commercial, +24148,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMBLEMHEALTH/GHI-Commercial, +24149,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMBLEMHEALTH/GHI-Commercial, +24150,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMBLEMHEALTH/GHI-Commercial, +24151,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMBLEMHEALTH/GHI-Commercial, +24152,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMBLEMHEALTH/GHI-Commercial, +24153,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMBLEMHEALTH/GHI-Commercial, +24154,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMBLEMHEALTH/GHI-Commercial, +24155,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMBLEMHEALTH/GHI-Commercial, +24156,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMBLEMHEALTH/GHI-Commercial,5461.0 +24157,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMBLEMHEALTH/GHI-Commercial, +24158,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMBLEMHEALTH/GHI-Commercial, +24159,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMBLEMHEALTH/GHI-Commercial, +24160,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMBLEMHEALTH/GHI-Commercial, +24161,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMBLEMHEALTH/GHI-Commercial, +24162,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMBLEMHEALTH/GHI-Commercial, +24163,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMBLEMHEALTH/GHI-Commercial, +24164,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMBLEMHEALTH/GHI-Commercial, +24165,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMBLEMHEALTH/GHI-Commercial, +24166,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMBLEMHEALTH/GHI-Commercial, +24167,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMBLEMHEALTH/GHI-Commercial, +24168,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMBLEMHEALTH/GHI-Commercial, +24169,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMBLEMHEALTH/GHI-Commercial, +24170,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMBLEMHEALTH/GHI-Commercial, +24171,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMBLEMHEALTH/GHI-Commercial,1948.5 +24172,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMBLEMHEALTH/GHI-Commercial, +24173,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMBLEMHEALTH/GHI-Commercial, +24174,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMBLEMHEALTH/GHI-Commercial, +24175,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMBLEMHEALTH/GHI-Commercial,5233.61 +24176,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMBLEMHEALTH/GHI-Commercial,3324.45 +24177,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMBLEMHEALTH/GHI-Commercial,7920.0 +24178,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMBLEMHEALTH/GHI-Commercial, +24179,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMBLEMHEALTH/GHI-Commercial, +24180,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMBLEMHEALTH/GHI-Commercial, +24181,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMBLEMHEALTH/GHI-Commercial, +24182,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMBLEMHEALTH/GHI-Commercial, +24183,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMBLEMHEALTH/GHI-Commercial, +24184,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMBLEMHEALTH/GHI-Commercial, +24185,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMBLEMHEALTH/GHI-Commercial, +24186,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMBLEMHEALTH/GHI-Commercial, +24187,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMBLEMHEALTH/GHI-Commercial,254.5 +24188,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMBLEMHEALTH/GHI-Commercial, +24189,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMBLEMHEALTH/GHI-Commercial, +24190,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMBLEMHEALTH/GHI-Commercial, +24191,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMBLEMHEALTH/GHI-Commercial, +24192,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMBLEMHEALTH/GHI-Commercial, +24193,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMBLEMHEALTH/GHI-Commercial, +24194,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMBLEMHEALTH/GHI-Commercial, +24195,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMBLEMHEALTH/GHI-Commercial, +24196,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMBLEMHEALTH/GHI-Commercial, +24197,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMBLEMHEALTH/GHI-Commercial, +24198,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMBLEMHEALTH/GHI-Commercial, +24199,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMBLEMHEALTH/GHI-Commercial, +24200,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMBLEMHEALTH/GHI-Commercial, +24201,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMBLEMHEALTH/GHI-Commercial, +24202,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMBLEMHEALTH/GHI-Commercial, +24203,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMBLEMHEALTH/GHI-Commercial, +24204,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMBLEMHEALTH/GHI-Commercial, +24205,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMBLEMHEALTH/GHI-Commercial, +24206,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMBLEMHEALTH/GHI-Commercial, +24207,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMBLEMHEALTH/GHI-Commercial, +24208,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMBLEMHEALTH/GHI-Commercial, +24209,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMBLEMHEALTH/GHI-Commercial, +24210,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMBLEMHEALTH/GHI-Commercial, +24211,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMBLEMHEALTH/GHI-Commercial, +24212,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMBLEMHEALTH/GHI-Commercial, +24213,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMBLEMHEALTH/GHI-Commercial,2733.08 +24214,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMBLEMHEALTH/GHI-Commercial, +24215,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMBLEMHEALTH/GHI-Commercial, +24216,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMBLEMHEALTH/GHI-Commercial, +24217,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMBLEMHEALTH/GHI-Commercial,22.33 +24218,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMBLEMHEALTH/GHI-Commercial,532.0 +24219,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMBLEMHEALTH/GHI-Commercial,269.0 +24220,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMBLEMHEALTH/GHI-Commercial, +24221,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMBLEMHEALTH/GHI-Commercial, +24222,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMBLEMHEALTH/GHI-Commercial, +24223,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMBLEMHEALTH/GHI-Commercial, +24224,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMBLEMHEALTH/GHI-Commercial, +24225,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMBLEMHEALTH/GHI-Commercial,1358.0 +24226,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMBLEMHEALTH/GHI-Commercial, +24227,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMBLEMHEALTH/GHI-Commercial, +24228,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMBLEMHEALTH/GHI-Commercial,422.5 +24229,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMBLEMHEALTH/GHI-Commercial,4618.0 +24230,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMBLEMHEALTH/GHI-Commercial, +24231,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMBLEMHEALTH/GHI-Commercial, +24232,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMBLEMHEALTH/GHI-Commercial, +24233,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMBLEMHEALTH/GHI-Commercial, +24234,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMBLEMHEALTH/GHI-Commercial,583.0 +24235,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMBLEMHEALTH/GHI-Commercial, +24236,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMBLEMHEALTH/GHI-Commercial, +24237,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMBLEMHEALTH/GHI-Commercial, +24238,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMBLEMHEALTH/GHI-Commercial, +24239,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMBLEMHEALTH/GHI-Commercial, +24240,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMBLEMHEALTH/GHI-Commercial,735.5 +24241,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMBLEMHEALTH/GHI-Commercial,381.2 +24242,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMBLEMHEALTH/GHI-Commercial, +24243,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMBLEMHEALTH/GHI-Commercial, +24244,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMBLEMHEALTH/GHI-Commercial,339.5 +24245,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMBLEMHEALTH/GHI-Commercial, +24246,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMBLEMHEALTH/GHI-Commercial, +24247,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMBLEMHEALTH/GHI-Commercial, +24248,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMBLEMHEALTH/GHI-Commercial, +24249,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMBLEMHEALTH/GHI-Commercial, +24250,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMBLEMHEALTH/GHI-Commercial, +24251,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMBLEMHEALTH/GHI-Commercial, +24252,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMBLEMHEALTH/GHI-Commercial, +24253,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMBLEMHEALTH/GHI-Commercial, +24254,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMBLEMHEALTH/GHI-Commercial, +24255,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMBLEMHEALTH/GHI-Commercial, +24256,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMBLEMHEALTH/GHI-Commercial, +24257,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMBLEMHEALTH/GHI-Commercial, +24258,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMBLEMHEALTH/GHI-Commercial, +24259,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMBLEMHEALTH/GHI-Commercial, +24260,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMBLEMHEALTH/GHI-Commercial, +24261,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMBLEMHEALTH/GHI-Commercial, +24262,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMBLEMHEALTH/GHI-Commercial, +24263,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMBLEMHEALTH/GHI-Commercial, +24264,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMBLEMHEALTH/GHI-Commercial, +24265,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMBLEMHEALTH/GHI-Commercial, +24266,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMBLEMHEALTH/GHI-Commercial, +24267,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMBLEMHEALTH/GHI-Commercial, +24268,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMBLEMHEALTH/GHI-Commercial, +24269,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMBLEMHEALTH/GHI-Commercial, +24270,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMBLEMHEALTH/GHI-Commercial,2935.0 +24271,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMBLEMHEALTH/GHI-Commercial, +24272,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMBLEMHEALTH/GHI-Commercial, +24273,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMBLEMHEALTH/GHI-Commercial, +24274,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMBLEMHEALTH/GHI-Commercial, +24275,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMBLEMHEALTH/GHI-Commercial, +24276,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMBLEMHEALTH/GHI-Commercial,288.5 +24277,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMBLEMHEALTH/GHI-Commercial, +24278,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMBLEMHEALTH/GHI-Commercial, +24279,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMBLEMHEALTH/GHI-Commercial, +24280,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMBLEMHEALTH/GHI-Commercial,284.5 +24281,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMBLEMHEALTH/GHI-Commercial, +24282,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMBLEMHEALTH/GHI-Commercial,635.0 +24283,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMBLEMHEALTH/GHI-Commercial,341.5 +24284,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMBLEMHEALTH/GHI-Commercial, +24285,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMBLEMHEALTH/GHI-Commercial,536.0 +24286,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMBLEMHEALTH/GHI-Commercial,296.0 +24287,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMBLEMHEALTH/GHI-Commercial, +24288,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMBLEMHEALTH/GHI-Commercial, +24289,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMBLEMHEALTH/GHI-Commercial, +24290,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMBLEMHEALTH/GHI-Commercial, +24291,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMBLEMHEALTH/GHI-Commercial, +24292,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMBLEMHEALTH/GHI-Commercial, +24293,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMBLEMHEALTH/GHI-Commercial, +24294,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMBLEMHEALTH/GHI-Commercial, +24295,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMBLEMHEALTH/GHI-Commercial,267.5 +24296,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMBLEMHEALTH/GHI-Commercial, +24297,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMBLEMHEALTH/GHI-Commercial, +24298,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMBLEMHEALTH/GHI-Commercial, +24299,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMBLEMHEALTH/GHI-Commercial, +24300,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMBLEMHEALTH/GHI-Commercial, +24301,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMBLEMHEALTH/GHI-Commercial, +24302,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMBLEMHEALTH/GHI-Commercial,237.67 +24303,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMBLEMHEALTH/GHI-Commercial,280.5 +24304,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMBLEMHEALTH/GHI-Commercial,424.38 +24305,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMBLEMHEALTH/GHI-Commercial, +24306,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMBLEMHEALTH/GHI-Commercial, +24307,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMBLEMHEALTH/GHI-Commercial, +24308,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMBLEMHEALTH/GHI-Commercial, +24309,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMBLEMHEALTH/GHI-Commercial,639.0 +24310,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMBLEMHEALTH/GHI-Commercial,433.0 +24311,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMBLEMHEALTH/GHI-Commercial,656.0 +24312,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMBLEMHEALTH/GHI-Commercial, +24313,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMBLEMHEALTH/GHI-Commercial, +24314,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMBLEMHEALTH/GHI-Commercial, +24315,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMBLEMHEALTH/GHI-Commercial, +24316,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMBLEMHEALTH/GHI-Commercial, +24317,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMBLEMHEALTH/GHI-Commercial, +24318,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMBLEMHEALTH/GHI-Commercial, +24319,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMBLEMHEALTH/GHI-Commercial, +24320,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMBLEMHEALTH/GHI-Commercial, +24321,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMBLEMHEALTH/GHI-Commercial, +24322,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMBLEMHEALTH/GHI-Commercial, +24323,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMBLEMHEALTH/GHI-Commercial, +24324,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMBLEMHEALTH/GHI-Commercial, +24325,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMBLEMHEALTH/GHI-Commercial, +24326,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMBLEMHEALTH/GHI-Commercial, +24327,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMBLEMHEALTH/GHI-Commercial, +24328,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMBLEMHEALTH/GHI-Commercial, +24329,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMBLEMHEALTH/GHI-Commercial, +24330,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMBLEMHEALTH/GHI-Commercial,7956.0 +24331,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMBLEMHEALTH/GHI-Commercial, +24332,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMBLEMHEALTH/GHI-Commercial, +24333,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMBLEMHEALTH/GHI-Commercial, +24334,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMBLEMHEALTH/GHI-Commercial, +24335,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMBLEMHEALTH/GHI-Commercial, +24336,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMBLEMHEALTH/GHI-Commercial, +24337,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMBLEMHEALTH/GHI-Commercial, +24338,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMBLEMHEALTH/GHI-Commercial, +24339,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMBLEMHEALTH/GHI-Commercial,435.5 +24340,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMBLEMHEALTH/GHI-Commercial, +24341,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMBLEMHEALTH/GHI-Commercial, +24342,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMBLEMHEALTH/GHI-Commercial, +24343,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMBLEMHEALTH/GHI-Commercial, +24344,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMBLEMHEALTH/GHI-Commercial, +24345,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMBLEMHEALTH/GHI-Commercial, +24346,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMBLEMHEALTH/GHI-Commercial, +24347,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMBLEMHEALTH/GHI-Commercial, +24348,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMBLEMHEALTH/GHI-Commercial, +24349,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMBLEMHEALTH/GHI-Commercial, +24350,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMBLEMHEALTH/GHI-Commercial, +24351,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMBLEMHEALTH/GHI-Commercial, +24352,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMBLEMHEALTH/GHI-Commercial, +24353,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMBLEMHEALTH/GHI-Commercial, +24354,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMBLEMHEALTH/GHI-Commercial, +24355,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMBLEMHEALTH/GHI-Commercial, +24356,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMBLEMHEALTH/GHI-Commercial, +24357,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMBLEMHEALTH/GHI-Commercial, +24358,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMBLEMHEALTH/GHI-Commercial, +24359,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMBLEMHEALTH/GHI-Commercial, +24360,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMBLEMHEALTH/GHI-Commercial, +24361,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMBLEMHEALTH/GHI-Commercial, +24362,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMBLEMHEALTH/GHI-Commercial, +24363,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMBLEMHEALTH/GHI-Commercial, +24364,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMBLEMHEALTH/GHI-Commercial, +24365,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMBLEMHEALTH/GHI-Commercial, +24366,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMBLEMHEALTH/GHI-Commercial,9193.25 +24367,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMBLEMHEALTH/GHI-Commercial, +24368,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMBLEMHEALTH/GHI-Commercial, +24369,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMBLEMHEALTH/GHI-Commercial, +24370,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMBLEMHEALTH/GHI-Commercial, +24371,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMBLEMHEALTH/GHI-Commercial, +24372,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMBLEMHEALTH/GHI-Commercial, +24373,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMBLEMHEALTH/GHI-Commercial, +24374,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMBLEMHEALTH/GHI-Commercial, +24375,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMBLEMHEALTH/GHI-Commercial, +24376,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMBLEMHEALTH/GHI-Commercial, +24377,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMBLEMHEALTH/GHI-Commercial, +24378,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMBLEMHEALTH/GHI-Commercial, +24379,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMBLEMHEALTH/GHI-Commercial, +24380,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMBLEMHEALTH/GHI-Commercial, +24381,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMBLEMHEALTH/GHI-Commercial, +24382,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMBLEMHEALTH/GHI-Commercial, +24383,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMBLEMHEALTH/GHI-Commercial, +24384,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMBLEMHEALTH/GHI-Commercial, +24385,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMBLEMHEALTH/GHI-Commercial, +24386,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMBLEMHEALTH/GHI-Commercial, +24387,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMBLEMHEALTH/GHI-Commercial, +24388,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMBLEMHEALTH/GHI-Commercial, +24389,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMBLEMHEALTH/GHI-Commercial, +24390,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMBLEMHEALTH/GHI-Commercial, +24391,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMBLEMHEALTH/GHI-Commercial, +24392,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMBLEMHEALTH/GHI-Commercial,406.35 +24393,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMBLEMHEALTH/GHI-Commercial, +24394,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMBLEMHEALTH/GHI-Commercial,1421.59 +24395,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMBLEMHEALTH/GHI-Commercial,482.14 +24396,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMBLEMHEALTH/GHI-Commercial, +24397,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMBLEMHEALTH/GHI-Commercial,815.0 +24398,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMBLEMHEALTH/GHI-Commercial, +24399,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMBLEMHEALTH/GHI-Commercial, +24400,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMBLEMHEALTH/GHI-Commercial, +24401,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMBLEMHEALTH/GHI-Commercial, +24402,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMBLEMHEALTH/GHI-Commercial, +24403,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMBLEMHEALTH/GHI-Commercial, +24404,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMBLEMHEALTH/GHI-Commercial, +24405,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMBLEMHEALTH/GHI-Commercial, +24406,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMBLEMHEALTH/GHI-Commercial, +24407,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMBLEMHEALTH/GHI-Commercial, +24408,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMBLEMHEALTH/GHI-Commercial, +24409,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMBLEMHEALTH/GHI-Commercial,27.22 +24410,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMBLEMHEALTH/GHI-Commercial, +24411,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMBLEMHEALTH/GHI-Commercial,21.35 +24412,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMBLEMHEALTH/GHI-Commercial, +24413,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMBLEMHEALTH/GHI-Commercial, +24414,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMBLEMHEALTH/GHI-Commercial, +24415,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMBLEMHEALTH/GHI-Commercial,1901.53 +24416,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMBLEMHEALTH/GHI-Commercial,1880.51 +24417,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMBLEMHEALTH/GHI-Commercial, +24418,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMBLEMHEALTH/GHI-Commercial,66.58 +24419,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMBLEMHEALTH/GHI-Commercial, +24420,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMBLEMHEALTH/GHI-Commercial, +24421,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMBLEMHEALTH/GHI-Commercial, +24422,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/GHI-Commercial, +24423,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMBLEMHEALTH/GHI-Commercial, +24424,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMBLEMHEALTH/GHI-Commercial, +24425,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMBLEMHEALTH/GHI-Commercial, +24426,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMBLEMHEALTH/GHI-Commercial, +24427,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMBLEMHEALTH/GHI-Commercial, +24428,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMBLEMHEALTH/GHI-Commercial, +24429,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMBLEMHEALTH/GHI-Commercial, +24430,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMBLEMHEALTH/GHI-Commercial, +24431,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMBLEMHEALTH/GHI-Commercial, +24432,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMBLEMHEALTH/GHI-Commercial, +24433,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMBLEMHEALTH/GHI-Commercial, +24434,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMBLEMHEALTH/GHI-Commercial, +24435,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMBLEMHEALTH/GHI-Commercial, +24436,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMBLEMHEALTH/GHI-Commercial, +24437,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMBLEMHEALTH/GHI-Commercial, +24438,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMBLEMHEALTH/GHI-Commercial, +24439,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMBLEMHEALTH/GHI-Commercial, +24440,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMBLEMHEALTH/GHI-Commercial,2119.0 +24441,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMBLEMHEALTH/GHI-Commercial, +24442,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMBLEMHEALTH/GHI-Commercial,1229.5 +24443,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMBLEMHEALTH/GHI-Commercial,966.06 +24444,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMBLEMHEALTH/GHI-Commercial,560.29 +24445,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMBLEMHEALTH/GHI-Commercial,667.8 +24446,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMBLEMHEALTH/GHI-Commercial,1352.5 +24447,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMBLEMHEALTH/GHI-Commercial,493.3 +24448,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMBLEMHEALTH/GHI-Commercial, +24449,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMBLEMHEALTH/GHI-Commercial,636.5 +24450,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMBLEMHEALTH/GHI-Commercial, +24451,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMBLEMHEALTH/GHI-Commercial, +24452,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMBLEMHEALTH/GHI-Commercial,992.0 +24453,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMBLEMHEALTH/GHI-Commercial,2062.43 +24454,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMBLEMHEALTH/GHI-Commercial, +24455,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMBLEMHEALTH/GHI-Commercial, +24456,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMBLEMHEALTH/GHI-Commercial, +24457,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMBLEMHEALTH/GHI-Commercial, +24458,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMBLEMHEALTH/GHI-Commercial, +24459,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMBLEMHEALTH/GHI-Commercial, +24460,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMBLEMHEALTH/GHI-Commercial, +24461,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMBLEMHEALTH/GHI-Commercial, +24462,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMBLEMHEALTH/GHI-Commercial, +24463,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/GHI-Commercial, +24464,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMBLEMHEALTH/GHI-Commercial, +24465,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMBLEMHEALTH/GHI-Commercial, +24466,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMBLEMHEALTH/GHI-Commercial, +24467,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMBLEMHEALTH/GHI-Commercial, +24468,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMBLEMHEALTH/GHI-Commercial, +24469,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMBLEMHEALTH/GHI-Commercial, +24470,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMBLEMHEALTH/GHI-Commercial, +24471,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMBLEMHEALTH/GHI-Commercial, +24472,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMBLEMHEALTH/GHI-Commercial, +24473,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMBLEMHEALTH/GHI-Commercial, +24474,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMBLEMHEALTH/GHI-Commercial, +24475,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMBLEMHEALTH/GHI-Commercial, +24476,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMBLEMHEALTH/GHI-Commercial, +24477,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMBLEMHEALTH/GHI-Commercial, +24478,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMBLEMHEALTH/GHI-Commercial, +24479,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMBLEMHEALTH/GHI-Commercial, +24480,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMBLEMHEALTH/GHI-Commercial, +24481,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMBLEMHEALTH/GHI-Commercial, +24482,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMBLEMHEALTH/GHI-Commercial, +24483,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMBLEMHEALTH/GHI-Commercial, +24484,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/GHI-Commercial, +24485,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMBLEMHEALTH/GHI-Commercial, +24486,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMBLEMHEALTH/GHI-Commercial, +24487,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMBLEMHEALTH/GHI-Commercial, +24488,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMBLEMHEALTH/GHI-Commercial, +24489,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMBLEMHEALTH/GHI-Commercial, +24490,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMBLEMHEALTH/GHI-Commercial,979.0 +24491,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMBLEMHEALTH/GHI-Commercial, +24492,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMBLEMHEALTH/GHI-Commercial, +24493,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMBLEMHEALTH/GHI-Commercial, +24494,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMBLEMHEALTH/GHI-Commercial, +24495,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMBLEMHEALTH/GHI-Commercial, +24496,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMBLEMHEALTH/GHI-Commercial, +24497,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMBLEMHEALTH/GHI-Commercial, +24498,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMBLEMHEALTH/GHI-Commercial, +24499,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMBLEMHEALTH/GHI-Commercial,2781.0 +24500,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMBLEMHEALTH/GHI-Commercial, +24501,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMBLEMHEALTH/GHI-Commercial, +24502,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMBLEMHEALTH/GHI-Commercial, +24503,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMBLEMHEALTH/GHI-Commercial, +24504,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMBLEMHEALTH/GHI-Commercial, +24505,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMBLEMHEALTH/GHI-Commercial, +24506,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMBLEMHEALTH/GHI-Commercial, +24507,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMBLEMHEALTH/GHI-Commercial, +24508,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMBLEMHEALTH/GHI-Commercial, +24509,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMBLEMHEALTH/GHI-Commercial, +24510,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMBLEMHEALTH/GHI-Commercial, +24511,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMBLEMHEALTH/GHI-Commercial, +24512,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMBLEMHEALTH/GHI-Commercial, +24513,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMBLEMHEALTH/GHI-Commercial, +24514,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMBLEMHEALTH/GHI-Commercial, +24515,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMBLEMHEALTH/GHI-Commercial, +24516,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMBLEMHEALTH/GHI-Commercial, +24517,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMBLEMHEALTH/GHI-Commercial, +24518,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMBLEMHEALTH/GHI-Commercial, +24519,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMBLEMHEALTH/GHI-Commercial,5908.0 +24520,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMBLEMHEALTH/GHI-Commercial, +24521,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMBLEMHEALTH/GHI-Commercial, +24522,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMBLEMHEALTH/GHI-Commercial, +24523,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMBLEMHEALTH/GHI-Commercial, +24524,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMBLEMHEALTH/GHI-Commercial, +24525,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMBLEMHEALTH/GHI-Commercial, +24526,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMBLEMHEALTH/GHI-Commercial, +24527,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMBLEMHEALTH/GHI-Commercial,508.19 +24528,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMBLEMHEALTH/GHI-Commercial, +24529,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMBLEMHEALTH/GHI-Commercial,494.75 +24530,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +24531,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMBLEMHEALTH/GHI-Commercial,228.0 +24532,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMBLEMHEALTH/GHI-Commercial, +24533,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMBLEMHEALTH/GHI-Commercial,641.0 +24534,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMBLEMHEALTH/GHI-Commercial,120.14 +24535,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMBLEMHEALTH/GHI-Commercial, +24536,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMBLEMHEALTH/GHI-Commercial, +24537,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMBLEMHEALTH/GHI-Commercial, +24538,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMBLEMHEALTH/GHI-Commercial, +24539,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMBLEMHEALTH/GHI-Commercial, +24540,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMBLEMHEALTH/GHI-Commercial, +24541,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMBLEMHEALTH/GHI-Commercial, +24542,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMBLEMHEALTH/GHI-Commercial, +24543,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMBLEMHEALTH/GHI-Commercial, +24544,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMBLEMHEALTH/GHI-Commercial, +24545,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMBLEMHEALTH/GHI-Commercial, +24546,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMBLEMHEALTH/GHI-Commercial, +24547,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMBLEMHEALTH/GHI-Commercial, +24548,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMBLEMHEALTH/GHI-Commercial, +24549,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMBLEMHEALTH/GHI-Commercial, +24550,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMBLEMHEALTH/GHI-Commercial, +24551,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMBLEMHEALTH/GHI-Commercial, +24552,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMBLEMHEALTH/GHI-Commercial, +24553,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMBLEMHEALTH/GHI-Commercial, +24554,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMBLEMHEALTH/GHI-Commercial, +24555,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMBLEMHEALTH/GHI-Commercial,214.0 +24556,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMBLEMHEALTH/GHI-Commercial, +24557,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMBLEMHEALTH/GHI-Commercial, +24558,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMBLEMHEALTH/GHI-Commercial, +24559,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMBLEMHEALTH/GHI-Commercial, +24560,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMBLEMHEALTH/GHI-Commercial,539.0 +24561,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMBLEMHEALTH/GHI-Commercial, +24562,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMBLEMHEALTH/GHI-Commercial, +24563,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMBLEMHEALTH/GHI-Commercial, +24564,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMBLEMHEALTH/GHI-Commercial, +24565,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMBLEMHEALTH/GHI-Commercial, +24566,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMBLEMHEALTH/GHI-Commercial, +24567,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMBLEMHEALTH/GHI-Commercial, +24568,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMBLEMHEALTH/GHI-Commercial, +24569,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMBLEMHEALTH/GHI-Commercial, +24570,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMBLEMHEALTH/GHI-Commercial, +24571,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMBLEMHEALTH/GHI-Commercial, +24572,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMBLEMHEALTH/GHI-Commercial, +24573,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMBLEMHEALTH/GHI-Commercial, +24574,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMBLEMHEALTH/GHI-Commercial, +24575,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMBLEMHEALTH/GHI-Commercial, +24576,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMBLEMHEALTH/GHI-Commercial, +24577,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMBLEMHEALTH/GHI-Commercial, +24578,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMBLEMHEALTH/GHI-Commercial, +24579,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMBLEMHEALTH/GHI-Commercial, +24580,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMBLEMHEALTH/GHI-Commercial, +24581,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMBLEMHEALTH/GHI-Commercial, +24582,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMBLEMHEALTH/GHI-Commercial, +24583,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMBLEMHEALTH/GHI-Commercial,160.4 +24584,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +24585,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMBLEMHEALTH/GHI-Commercial, +24586,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMBLEMHEALTH/GHI-Commercial, +24587,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMBLEMHEALTH/GHI-Commercial, +24588,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMBLEMHEALTH/GHI-Commercial, +24589,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/GHI-Commercial, +24590,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/GHI-Commercial, +24591,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/GHI-Commercial, +24592,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/GHI-Commercial, +24593,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/GHI-Commercial, +24594,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMBLEMHEALTH/GHI-Commercial, +24595,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMBLEMHEALTH/GHI-Commercial, +24596,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMBLEMHEALTH/GHI-Commercial, +24597,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMBLEMHEALTH/GHI-Commercial, +24598,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMBLEMHEALTH/GHI-Commercial, +24599,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMBLEMHEALTH/GHI-Commercial, +24600,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMBLEMHEALTH/GHI-Commercial, +24601,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMBLEMHEALTH/GHI-Commercial, +24602,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMBLEMHEALTH/GHI-Commercial, +24603,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMBLEMHEALTH/GHI-Commercial, +24604,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMBLEMHEALTH/GHI-Commercial, +24605,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMBLEMHEALTH/GHI-Commercial, +24606,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMBLEMHEALTH/GHI-Commercial, +24607,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMBLEMHEALTH/GHI-Commercial, +24608,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMBLEMHEALTH/GHI-Commercial, +24609,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMBLEMHEALTH/GHI-Commercial, +24610,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMBLEMHEALTH/GHI-Commercial, +24611,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMBLEMHEALTH/GHI-Commercial, +24612,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMBLEMHEALTH/GHI-Commercial, +24613,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMBLEMHEALTH/GHI-Commercial,16.95 +24614,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMBLEMHEALTH/GHI-Commercial,424.0 +24615,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMBLEMHEALTH/GHI-Commercial,47.5 +24616,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMBLEMHEALTH/GHI-Commercial, +24617,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMBLEMHEALTH/GHI-Commercial, +24618,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMBLEMHEALTH/GHI-Commercial, +24619,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMBLEMHEALTH/GHI-Commercial, +24620,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMBLEMHEALTH/GHI-Commercial, +24621,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMBLEMHEALTH/GHI-Commercial, +24622,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMBLEMHEALTH/GHI-Commercial, +24623,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMBLEMHEALTH/GHI-Commercial, +24624,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMBLEMHEALTH/GHI-Commercial, +24625,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMBLEMHEALTH/GHI-Commercial, +24626,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMBLEMHEALTH/GHI-Commercial, +24627,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMBLEMHEALTH/GHI-Commercial, +24628,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMBLEMHEALTH/GHI-Commercial, +24629,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMBLEMHEALTH/GHI-Commercial, +24630,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMBLEMHEALTH/GHI-Commercial, +24631,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMBLEMHEALTH/GHI-Commercial, +24632,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMBLEMHEALTH/GHI-Commercial, +24633,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMBLEMHEALTH/GHI-Commercial, +24634,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMBLEMHEALTH/GHI-Commercial, +24635,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMBLEMHEALTH/GHI-Commercial, +24636,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMBLEMHEALTH/GHI-Commercial, +24637,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMBLEMHEALTH/GHI-Commercial, +24638,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMBLEMHEALTH/GHI-Commercial, +24639,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMBLEMHEALTH/GHI-Commercial, +24640,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMBLEMHEALTH/GHI-Commercial, +24641,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMBLEMHEALTH/GHI-Commercial, +24642,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMBLEMHEALTH/GHI-Commercial, +24643,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMBLEMHEALTH/GHI-Commercial, +24644,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMBLEMHEALTH/GHI-Commercial, +24645,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMBLEMHEALTH/GHI-Commercial, +24646,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMBLEMHEALTH/GHI-Commercial, +24647,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMBLEMHEALTH/GHI-Commercial, +24648,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMBLEMHEALTH/GHI-Commercial, +24649,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMBLEMHEALTH/GHI-Commercial, +24650,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMBLEMHEALTH/GHI-Commercial, +24651,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMBLEMHEALTH/GHI-Commercial, +24652,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMBLEMHEALTH/GHI-Commercial, +24653,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMBLEMHEALTH/GHI-Commercial, +24654,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMBLEMHEALTH/GHI-Commercial, +24655,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMBLEMHEALTH/GHI-Commercial, +24656,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMBLEMHEALTH/GHI-Commercial, +24657,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMBLEMHEALTH/GHI-Commercial, +24658,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMBLEMHEALTH/GHI-Commercial, +24659,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMBLEMHEALTH/GHI-Commercial, +24660,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMBLEMHEALTH/GHI-Commercial, +24661,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMBLEMHEALTH/GHI-Commercial, +24662,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMBLEMHEALTH/GHI-Commercial, +24663,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMBLEMHEALTH/GHI-Commercial, +24664,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMBLEMHEALTH/GHI-Commercial, +24665,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMBLEMHEALTH/GHI-Commercial, +24666,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMBLEMHEALTH/GHI-Commercial, +24667,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMBLEMHEALTH/GHI-Commercial, +24668,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMBLEMHEALTH/GHI-Commercial, +24669,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMBLEMHEALTH/GHI-Commercial, +24670,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMBLEMHEALTH/GHI-Commercial, +24671,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMBLEMHEALTH/GHI-Commercial, +24672,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMBLEMHEALTH/GHI-Commercial, +24673,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMBLEMHEALTH/GHI-Commercial, +24674,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMBLEMHEALTH/GHI-Commercial, +24675,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMBLEMHEALTH/GHI-Commercial, +24676,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMBLEMHEALTH/GHI-Commercial, +24677,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMBLEMHEALTH/GHI-Commercial,61.0 +24678,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMBLEMHEALTH/GHI-Commercial, +24679,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMBLEMHEALTH/GHI-Commercial, +24680,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMBLEMHEALTH/GHI-Commercial, +24681,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMBLEMHEALTH/GHI-Commercial, +24682,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMBLEMHEALTH/GHI-Commercial, +24683,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMBLEMHEALTH/GHI-Commercial, +24684,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMBLEMHEALTH/GHI-Commercial, +24685,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMBLEMHEALTH/GHI-Commercial, +24686,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMBLEMHEALTH/GHI-Commercial, +24687,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMBLEMHEALTH/GHI-Commercial, +24688,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMBLEMHEALTH/GHI-Commercial, +24689,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMBLEMHEALTH/GHI-Commercial, +24690,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMBLEMHEALTH/GHI-Commercial, +24691,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMBLEMHEALTH/GHI-Commercial,135.0 +24692,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMBLEMHEALTH/GHI-Commercial, +24693,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMBLEMHEALTH/GHI-Commercial,0.16 +24694,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMBLEMHEALTH/GHI-Commercial, +24695,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMBLEMHEALTH/GHI-Commercial, +24696,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMBLEMHEALTH/GHI-Commercial, +24697,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMBLEMHEALTH/GHI-Commercial,255.0 +24698,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMBLEMHEALTH/GHI-Commercial, +24699,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMBLEMHEALTH/GHI-Commercial,132.0 +24700,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMBLEMHEALTH/GHI-Commercial,116.0 +24701,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMBLEMHEALTH/GHI-Commercial, +24702,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMBLEMHEALTH/GHI-Commercial, +24703,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMBLEMHEALTH/GHI-Commercial, +24704,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMBLEMHEALTH/GHI-Commercial, +24705,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMBLEMHEALTH/GHI-Commercial,456.0 +24706,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMBLEMHEALTH/GHI-Commercial, +24707,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMBLEMHEALTH/GHI-Commercial, +24708,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMBLEMHEALTH/GHI-Commercial, +24709,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMBLEMHEALTH/GHI-Commercial, +24710,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMBLEMHEALTH/GHI-Commercial,14.0 +24711,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMBLEMHEALTH/GHI-Commercial,124.0 +24712,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMBLEMHEALTH/GHI-Commercial, +24713,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMBLEMHEALTH/GHI-Commercial,89.7 +24714,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMBLEMHEALTH/GHI-Commercial, +24715,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMBLEMHEALTH/GHI-Commercial, +24716,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMBLEMHEALTH/GHI-Commercial, +24717,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMBLEMHEALTH/GHI-Commercial, +24718,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMBLEMHEALTH/GHI-Commercial, +24719,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMBLEMHEALTH/GHI-Commercial, +24720,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMBLEMHEALTH/GHI-Commercial, +24721,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMBLEMHEALTH/GHI-Commercial,21.0 +24722,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMBLEMHEALTH/GHI-Commercial,104.0 +24723,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMBLEMHEALTH/GHI-Commercial, +24724,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMBLEMHEALTH/GHI-Commercial, +24725,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMBLEMHEALTH/GHI-Commercial,12.0 +24726,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMBLEMHEALTH/GHI-Commercial, +24727,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMBLEMHEALTH/GHI-Commercial, +24728,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMBLEMHEALTH/GHI-Commercial,68.84 +24729,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMBLEMHEALTH/GHI-Commercial,44.02 +24730,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMBLEMHEALTH/GHI-Commercial, +24731,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMBLEMHEALTH/GHI-Commercial, +24732,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMBLEMHEALTH/GHI-Commercial,101.0 +24733,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMBLEMHEALTH/GHI-Commercial, +24734,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMBLEMHEALTH/GHI-Commercial, +24735,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMBLEMHEALTH/GHI-Commercial, +24736,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMBLEMHEALTH/GHI-Commercial,94.0 +24737,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMBLEMHEALTH/GHI-Commercial,116.66 +24738,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMBLEMHEALTH/GHI-Commercial, +24739,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMBLEMHEALTH/GHI-Commercial, +24740,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMBLEMHEALTH/GHI-Commercial, +24741,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMBLEMHEALTH/GHI-Commercial, +24742,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMBLEMHEALTH/GHI-Commercial, +24743,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMBLEMHEALTH/GHI-Commercial, +24744,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMBLEMHEALTH/GHI-Commercial, +24745,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMBLEMHEALTH/GHI-Commercial, +24746,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMBLEMHEALTH/GHI-Commercial, +24747,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMBLEMHEALTH/GHI-Commercial, +24748,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMBLEMHEALTH/GHI-Commercial, +24749,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMBLEMHEALTH/GHI-Commercial, +24750,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMBLEMHEALTH/GHI-Commercial, +24751,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMBLEMHEALTH/GHI-Commercial, +24752,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMBLEMHEALTH/GHI-Commercial, +24753,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMBLEMHEALTH/GHI-Commercial, +24754,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMBLEMHEALTH/GHI-Commercial, +24755,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMBLEMHEALTH/GHI-Commercial,182.0 +24756,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMBLEMHEALTH/GHI-Commercial,30.95 +24757,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMBLEMHEALTH/GHI-Commercial,93.68 +24758,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMBLEMHEALTH/GHI-Commercial, +24759,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMBLEMHEALTH/GHI-Commercial,12.28 +24760,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMBLEMHEALTH/GHI-Commercial, +24761,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMBLEMHEALTH/GHI-Commercial, +24762,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMBLEMHEALTH/GHI-Commercial, +24763,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMBLEMHEALTH/GHI-Commercial, +24764,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMBLEMHEALTH/GHI-Commercial, +24765,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMBLEMHEALTH/GHI-Commercial, +24766,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMBLEMHEALTH/GHI-Commercial,62.0 +24767,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMBLEMHEALTH/GHI-Commercial, +24768,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMBLEMHEALTH/GHI-Commercial, +24769,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMBLEMHEALTH/GHI-Commercial, +24770,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMBLEMHEALTH/GHI-Commercial, +24771,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMBLEMHEALTH/GHI-Commercial, +24772,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMBLEMHEALTH/GHI-Commercial, +24773,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMBLEMHEALTH/GHI-Commercial,93.0 +24774,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMBLEMHEALTH/GHI-Commercial, +24775,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMBLEMHEALTH/GHI-Commercial, +24776,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMBLEMHEALTH/GHI-Commercial, +24777,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMBLEMHEALTH/GHI-Commercial, +24778,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMBLEMHEALTH/GHI-Commercial, +24779,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMBLEMHEALTH/GHI-Commercial, +24780,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMBLEMHEALTH/GHI-Commercial, +24781,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMBLEMHEALTH/GHI-Commercial, +24782,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMBLEMHEALTH/GHI-Commercial,150.0 +24783,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMBLEMHEALTH/GHI-Commercial, +24784,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMBLEMHEALTH/GHI-Commercial,198.0 +24785,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMBLEMHEALTH/GHI-Commercial, +24786,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMBLEMHEALTH/GHI-Commercial, +24787,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMBLEMHEALTH/GHI-Commercial, +24788,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMBLEMHEALTH/GHI-Commercial, +24789,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMBLEMHEALTH/GHI-Commercial, +24790,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMBLEMHEALTH/GHI-Commercial, +24791,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMBLEMHEALTH/GHI-Commercial, +24792,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMBLEMHEALTH/GHI-Commercial, +24793,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMBLEMHEALTH/GHI-Commercial, +24794,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMBLEMHEALTH/GHI-Commercial, +24795,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMBLEMHEALTH/GHI-Commercial,8.0 +24796,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMBLEMHEALTH/GHI-Commercial,123.0 +24797,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMBLEMHEALTH/GHI-Commercial,114.5 +24798,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMBLEMHEALTH/GHI-Commercial,4.7 +24799,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMBLEMHEALTH/GHI-Commercial, +24800,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMBLEMHEALTH/GHI-Commercial, +24801,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMBLEMHEALTH/GHI-Commercial, +24802,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMBLEMHEALTH/GHI-Commercial,140.0 +24803,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMBLEMHEALTH/GHI-Commercial, +24804,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMBLEMHEALTH/GHI-Commercial, +24805,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMBLEMHEALTH/GHI-Commercial, +24806,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMBLEMHEALTH/GHI-Commercial, +24807,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMBLEMHEALTH/GHI-Commercial,63.5 +24808,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMBLEMHEALTH/GHI-Commercial, +24809,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMBLEMHEALTH/GHI-Commercial, +24810,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMBLEMHEALTH/GHI-Commercial, +24811,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMBLEMHEALTH/GHI-Commercial, +24812,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMBLEMHEALTH/GHI-Commercial, +24813,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMBLEMHEALTH/GHI-Commercial, +24814,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMBLEMHEALTH/GHI-Commercial, +24815,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMBLEMHEALTH/GHI-Commercial, +24816,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMBLEMHEALTH/GHI-Commercial, +24817,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMBLEMHEALTH/GHI-Commercial, +24818,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMBLEMHEALTH/GHI-Commercial, +24819,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMBLEMHEALTH/GHI-Commercial, +24820,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMBLEMHEALTH/GHI-Commercial,0.4 +24821,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMBLEMHEALTH/GHI-Commercial, +24822,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMBLEMHEALTH/GHI-Commercial, +24823,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMBLEMHEALTH/GHI-Commercial, +24824,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMBLEMHEALTH/GHI-Commercial, +24825,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMBLEMHEALTH/GHI-Commercial, +24826,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMBLEMHEALTH/GHI-Commercial, +24827,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMBLEMHEALTH/GHI-Commercial, +24828,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMBLEMHEALTH/GHI-Commercial, +24829,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMBLEMHEALTH/GHI-Commercial, +24830,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMBLEMHEALTH/GHI-Commercial,108.0 +24831,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMBLEMHEALTH/GHI-Commercial, +24832,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMBLEMHEALTH/GHI-Commercial,44.75 +24833,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMBLEMHEALTH/GHI-Commercial, +24834,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMBLEMHEALTH/GHI-Commercial, +24835,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMBLEMHEALTH/GHI-Commercial, +24836,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMBLEMHEALTH/GHI-Commercial, +24837,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMBLEMHEALTH/GHI-Commercial,86.0 +24838,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMBLEMHEALTH/GHI-Commercial, +24839,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMBLEMHEALTH/GHI-Commercial, +24840,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMBLEMHEALTH/GHI-Commercial, +24841,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMBLEMHEALTH/GHI-Commercial, +24842,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMBLEMHEALTH/GHI-Commercial,3.58 +24843,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMBLEMHEALTH/GHI-Commercial, +24844,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMBLEMHEALTH/GHI-Commercial, +24845,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMBLEMHEALTH/GHI-Commercial, +24846,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMBLEMHEALTH/GHI-Commercial, +24847,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMBLEMHEALTH/GHI-Commercial, +24848,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMBLEMHEALTH/GHI-Commercial, +24849,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMBLEMHEALTH/GHI-Commercial, +24850,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMBLEMHEALTH/GHI-Commercial,4.38 +24851,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMBLEMHEALTH/GHI-Commercial, +24852,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMBLEMHEALTH/GHI-Commercial, +24853,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMBLEMHEALTH/GHI-Commercial, +24854,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMBLEMHEALTH/GHI-Commercial, +24855,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMBLEMHEALTH/GHI-Commercial, +24856,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMBLEMHEALTH/GHI-Commercial, +24857,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMBLEMHEALTH/GHI-Commercial, +24858,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMBLEMHEALTH/GHI-Commercial, +24859,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMBLEMHEALTH/GHI-Commercial, +24860,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMBLEMHEALTH/GHI-Commercial, +24861,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMBLEMHEALTH/GHI-Commercial, +24862,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMBLEMHEALTH/GHI-Commercial, +24863,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMBLEMHEALTH/GHI-Commercial,70.0 +24864,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMBLEMHEALTH/GHI-Commercial, +24865,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMBLEMHEALTH/GHI-Commercial, +24866,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMBLEMHEALTH/GHI-Commercial, +24867,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMBLEMHEALTH/GHI-Commercial, +24868,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMBLEMHEALTH/GHI-Commercial, +24869,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMBLEMHEALTH/GHI-Commercial, +24870,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMBLEMHEALTH/GHI-Commercial, +24871,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMBLEMHEALTH/GHI-Commercial, +24872,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMBLEMHEALTH/GHI-Commercial, +24873,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMBLEMHEALTH/GHI-Commercial,0.7 +24874,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMBLEMHEALTH/GHI-Commercial, +24875,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMBLEMHEALTH/GHI-Commercial, +24876,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMBLEMHEALTH/GHI-Commercial,216.0 +24877,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMBLEMHEALTH/GHI-Commercial,215.0 +24878,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMBLEMHEALTH/GHI-Commercial, +24879,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMBLEMHEALTH/GHI-Commercial,275.4 +24880,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMBLEMHEALTH/GHI-Commercial, +24881,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMBLEMHEALTH/GHI-Commercial, +24882,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMBLEMHEALTH/GHI-Commercial,83.0 +24883,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMBLEMHEALTH/GHI-Commercial,97.0 +24884,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMBLEMHEALTH/GHI-Commercial,164.0 +24885,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMBLEMHEALTH/GHI-Commercial, +24886,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMBLEMHEALTH/GHI-Commercial, +24887,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMBLEMHEALTH/GHI-Commercial,140.0 +24888,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMBLEMHEALTH/GHI-Commercial, +24889,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMBLEMHEALTH/GHI-Commercial, +24890,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMBLEMHEALTH/GHI-Commercial,148.0 +24891,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMBLEMHEALTH/GHI-Commercial, +24892,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMBLEMHEALTH/GHI-Commercial,82.0 +24893,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMBLEMHEALTH/GHI-Commercial, +24894,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMBLEMHEALTH/GHI-Commercial,91.0 +24895,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMBLEMHEALTH/GHI-Commercial, +24896,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMBLEMHEALTH/GHI-Commercial, +24897,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMBLEMHEALTH/GHI-Commercial, +24898,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMBLEMHEALTH/GHI-Commercial, +24899,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMBLEMHEALTH/GHI-Commercial, +24900,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMBLEMHEALTH/GHI-Commercial, +24901,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMBLEMHEALTH/GHI-Commercial,11.0 +24902,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMBLEMHEALTH/GHI-Commercial, +24903,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMBLEMHEALTH/GHI-Commercial,179.64 +24904,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMBLEMHEALTH/GHI-Commercial,381.5 +24905,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMBLEMHEALTH/GHI-Commercial, +24906,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMBLEMHEALTH/GHI-Commercial, +24907,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMBLEMHEALTH/GHI-Commercial, +24908,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMBLEMHEALTH/GHI-Commercial, +24909,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMBLEMHEALTH/GHI-Commercial, +24910,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMBLEMHEALTH/GHI-Commercial, +24911,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMBLEMHEALTH/GHI-Commercial,92.18 +24912,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMBLEMHEALTH/GHI-Commercial,95.83 +24913,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMBLEMHEALTH/GHI-Commercial, +24914,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMBLEMHEALTH/GHI-Commercial,19.8 +24915,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMBLEMHEALTH/GHI-Commercial, +24916,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMBLEMHEALTH/GHI-Commercial, +24917,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMBLEMHEALTH/GHI-Commercial, +24918,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMBLEMHEALTH/GHI-Commercial, +24919,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMBLEMHEALTH/GHI-Commercial, +24920,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMBLEMHEALTH/GHI-Commercial, +24921,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMBLEMHEALTH/GHI-Commercial,22.0 +24922,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMBLEMHEALTH/GHI-Commercial,17.85 +24923,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMBLEMHEALTH/GHI-Commercial,16.2 +24924,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMBLEMHEALTH/GHI-Commercial, +24925,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMBLEMHEALTH/GHI-Commercial, +24926,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMBLEMHEALTH/GHI-Commercial, +24927,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMBLEMHEALTH/GHI-Commercial, +24928,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMBLEMHEALTH/GHI-Commercial, +24929,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMBLEMHEALTH/GHI-Commercial, +24930,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMBLEMHEALTH/GHI-Commercial, +24931,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMBLEMHEALTH/GHI-Commercial, +24932,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMBLEMHEALTH/GHI-Commercial, +24933,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMBLEMHEALTH/GHI-Commercial, +24934,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMBLEMHEALTH/GHI-Commercial, +24935,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMBLEMHEALTH/GHI-Commercial, +24936,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMBLEMHEALTH/GHI-Commercial, +24937,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMBLEMHEALTH/GHI-Commercial, +24938,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMBLEMHEALTH/GHI-Commercial, +24939,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMBLEMHEALTH/GHI-Commercial,8.5 +24940,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMBLEMHEALTH/GHI-Commercial, +24941,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMBLEMHEALTH/GHI-Commercial, +24942,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMBLEMHEALTH/GHI-Commercial, +24943,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMBLEMHEALTH/GHI-Commercial, +24944,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMBLEMHEALTH/GHI-Commercial, +24945,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMBLEMHEALTH/GHI-Commercial, +24946,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMBLEMHEALTH/GHI-Commercial, +24947,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMBLEMHEALTH/GHI-Commercial,91.0 +24948,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMBLEMHEALTH/GHI-Commercial, +24949,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMBLEMHEALTH/GHI-Commercial,108.87 +24950,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMBLEMHEALTH/GHI-Commercial, +24951,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMBLEMHEALTH/GHI-Commercial,39.57 +24952,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMBLEMHEALTH/GHI-Commercial, +24953,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMBLEMHEALTH/GHI-Commercial, +24954,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMBLEMHEALTH/GHI-Commercial,112.33 +24955,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMBLEMHEALTH/GHI-Commercial, +24956,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMBLEMHEALTH/GHI-Commercial, +24957,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMBLEMHEALTH/GHI-Commercial, +24958,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMBLEMHEALTH/GHI-Commercial, +24959,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMBLEMHEALTH/GHI-Commercial, +24960,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMBLEMHEALTH/GHI-Commercial, +24961,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMBLEMHEALTH/GHI-Commercial, +24962,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMBLEMHEALTH/GHI-Commercial, +24963,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMBLEMHEALTH/GHI-Commercial, +24964,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMBLEMHEALTH/GHI-Commercial, +24965,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMBLEMHEALTH/GHI-Commercial, +24966,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMBLEMHEALTH/GHI-Commercial,47.01 +24967,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMBLEMHEALTH/GHI-Commercial, +24968,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMBLEMHEALTH/GHI-Commercial,24.33 +24969,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMBLEMHEALTH/GHI-Commercial,293.25 +24970,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMBLEMHEALTH/GHI-Commercial, +24971,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMBLEMHEALTH/GHI-Commercial, +24972,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMBLEMHEALTH/GHI-Commercial, +24973,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMBLEMHEALTH/GHI-Commercial,286.23 +24974,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMBLEMHEALTH/GHI-Commercial, +24975,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMBLEMHEALTH/GHI-Commercial, +24976,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMBLEMHEALTH/GHI-Commercial, +24977,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMBLEMHEALTH/GHI-Commercial, +24978,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMBLEMHEALTH/GHI-Commercial, +24979,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMBLEMHEALTH/GHI-Commercial,155.38 +24980,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMBLEMHEALTH/GHI-Commercial, +24981,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMBLEMHEALTH/GHI-Commercial,166.0 +24982,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMBLEMHEALTH/GHI-Commercial, +24983,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMBLEMHEALTH/GHI-Commercial, +24984,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMBLEMHEALTH/GHI-Commercial, +24985,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMBLEMHEALTH/GHI-Commercial, +24986,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMBLEMHEALTH/GHI-Commercial, +24987,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMBLEMHEALTH/GHI-Commercial, +24988,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMBLEMHEALTH/GHI-Commercial, +24989,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMBLEMHEALTH/GHI-Commercial, +24990,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMBLEMHEALTH/GHI-Commercial, +24991,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMBLEMHEALTH/GHI-Commercial,5.45 +24992,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMBLEMHEALTH/GHI-Commercial, +24993,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMBLEMHEALTH/GHI-Commercial, +24994,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMBLEMHEALTH/GHI-Commercial, +24995,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMBLEMHEALTH/GHI-Commercial, +24996,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMBLEMHEALTH/GHI-Commercial, +24997,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMBLEMHEALTH/GHI-Commercial, +24998,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMBLEMHEALTH/GHI-Commercial, +24999,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMBLEMHEALTH/GHI-Commercial, +25000,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMBLEMHEALTH/GHI-Commercial, +25001,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMBLEMHEALTH/GHI-Commercial, +25002,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMBLEMHEALTH/GHI-Commercial, +25003,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMBLEMHEALTH/GHI-Commercial, +25004,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMBLEMHEALTH/GHI-Commercial, +25005,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMBLEMHEALTH/GHI-Commercial,8.0 +25006,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMBLEMHEALTH/GHI-Commercial,49.58 +25007,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMBLEMHEALTH/GHI-Commercial, +25008,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMBLEMHEALTH/GHI-Commercial, +25009,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMBLEMHEALTH/GHI-Commercial,93.0 +25010,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMBLEMHEALTH/GHI-Commercial, +25011,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMBLEMHEALTH/GHI-Commercial, +25012,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMBLEMHEALTH/GHI-Commercial, +25013,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMBLEMHEALTH/GHI-Commercial, +25014,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMBLEMHEALTH/GHI-Commercial, +25015,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMBLEMHEALTH/GHI-Commercial, +25016,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMBLEMHEALTH/GHI-Commercial,273.88 +25017,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMBLEMHEALTH/GHI-Commercial,6.75 +25018,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMBLEMHEALTH/GHI-Commercial, +25019,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMBLEMHEALTH/GHI-Commercial, +25020,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMBLEMHEALTH/GHI-Commercial, +25021,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMBLEMHEALTH/GHI-Commercial, +25022,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMBLEMHEALTH/GHI-Commercial, +25023,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMBLEMHEALTH/GHI-Commercial, +25024,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMBLEMHEALTH/GHI-Commercial, +25025,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMBLEMHEALTH/GHI-Commercial, +25026,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMBLEMHEALTH/GHI-Commercial, +25027,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMBLEMHEALTH/GHI-Commercial, +25028,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMBLEMHEALTH/GHI-Commercial, +25029,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMBLEMHEALTH/GHI-Commercial, +25030,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMBLEMHEALTH/GHI-Commercial, +25031,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMBLEMHEALTH/GHI-Commercial, +25032,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMBLEMHEALTH/GHI-Commercial, +25033,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMBLEMHEALTH/GHI-Commercial, +25034,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMBLEMHEALTH/GHI-Commercial, +25035,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMBLEMHEALTH/GHI-Commercial, +25036,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMBLEMHEALTH/GHI-Commercial, +25037,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMBLEMHEALTH/GHI-Commercial, +25038,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMBLEMHEALTH/GHI-Commercial, +25039,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMBLEMHEALTH/GHI-Commercial, +25040,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMBLEMHEALTH/GHI-Commercial, +25041,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMBLEMHEALTH/GHI-Commercial, +25042,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMBLEMHEALTH/GHI-Commercial,2.53 +25043,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMBLEMHEALTH/GHI-Commercial, +25044,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMBLEMHEALTH/GHI-Commercial,2.94 +25045,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMBLEMHEALTH/GHI-Commercial, +25046,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMBLEMHEALTH/GHI-Commercial, +25047,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMBLEMHEALTH/GHI-Commercial,3.63 +25048,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMBLEMHEALTH/GHI-Commercial, +25049,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMBLEMHEALTH/GHI-Commercial, +25050,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMBLEMHEALTH/GHI-Commercial, +25051,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMBLEMHEALTH/GHI-Commercial, +25052,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMBLEMHEALTH/GHI-Commercial, +25053,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMBLEMHEALTH/GHI-Commercial, +25054,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMBLEMHEALTH/GHI-Commercial, +25055,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMBLEMHEALTH/GHI-Commercial, +25056,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMBLEMHEALTH/GHI-Commercial, +25057,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMBLEMHEALTH/GHI-Commercial, +25058,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMBLEMHEALTH/GHI-Commercial,42.0 +25059,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMBLEMHEALTH/GHI-Commercial, +25060,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMBLEMHEALTH/GHI-Commercial, +25061,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMBLEMHEALTH/GHI-Commercial, +25062,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMBLEMHEALTH/GHI-Commercial, +25063,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMBLEMHEALTH/GHI-Commercial, +25064,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMBLEMHEALTH/GHI-Commercial, +25065,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMBLEMHEALTH/GHI-Commercial, +25066,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMBLEMHEALTH/GHI-Commercial,8.0 +25067,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMBLEMHEALTH/GHI-Commercial,155.77 +25068,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMBLEMHEALTH/GHI-Commercial, +25069,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMBLEMHEALTH/GHI-Commercial, +25070,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMBLEMHEALTH/GHI-Commercial, +25071,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMBLEMHEALTH/GHI-Commercial, +25072,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMBLEMHEALTH/GHI-Commercial, +25073,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMBLEMHEALTH/GHI-Commercial,1090.48 +25074,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMBLEMHEALTH/GHI-Commercial,83.68 +25075,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMBLEMHEALTH/GHI-Commercial,1735.49 +25076,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMBLEMHEALTH/GHI-Commercial, +25077,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMBLEMHEALTH/GHI-Commercial, +25078,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMBLEMHEALTH/GHI-Commercial, +25079,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMBLEMHEALTH/GHI-Commercial,750.2 +25080,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMBLEMHEALTH/GHI-Commercial,790.84 +25081,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMBLEMHEALTH/GHI-Commercial, +25082,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMBLEMHEALTH/GHI-Commercial, +25083,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMBLEMHEALTH/GHI-Commercial,1254.0 +25084,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMBLEMHEALTH/GHI-Commercial,3000.0 +25085,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMBLEMHEALTH/GHI-Commercial,2821.0 +25086,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMBLEMHEALTH/GHI-Commercial, +25087,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMBLEMHEALTH/GHI-Commercial,173.0 +25088,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMBLEMHEALTH/GHI-Commercial, +25089,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMBLEMHEALTH/GHI-Commercial, +25090,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMBLEMHEALTH/GHI-Commercial, +25091,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMBLEMHEALTH/GHI-Commercial, +25092,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMBLEMHEALTH/GHI-Commercial, +25093,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMBLEMHEALTH/GHI-Commercial,111.0 +25094,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMBLEMHEALTH/GHI-Commercial,151.33 +25095,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMBLEMHEALTH/GHI-Commercial, +25096,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMBLEMHEALTH/GHI-Commercial, +25097,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMBLEMHEALTH/GHI-Commercial, +25098,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMBLEMHEALTH/GHI-Commercial, +25099,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMBLEMHEALTH/GHI-Commercial, +25100,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMBLEMHEALTH/GHI-Commercial, +25101,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMBLEMHEALTH/GHI-Commercial, +25102,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMBLEMHEALTH/GHI-Commercial, +25103,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMBLEMHEALTH/GHI-Commercial, +25104,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMBLEMHEALTH/GHI-Commercial, +25105,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMBLEMHEALTH/GHI-Commercial, +25106,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMBLEMHEALTH/GHI-Commercial, +25107,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMBLEMHEALTH/GHI-Commercial, +25108,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMBLEMHEALTH/GHI-Commercial, +25109,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMBLEMHEALTH/GHI-Commercial, +25110,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMBLEMHEALTH/GHI-Commercial, +25111,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMBLEMHEALTH/GHI-Commercial, +25112,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMBLEMHEALTH/GHI-Commercial, +25113,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMBLEMHEALTH/GHI-Commercial, +25114,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMBLEMHEALTH/GHI-Commercial, +25115,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMBLEMHEALTH/GHI-Commercial, +25116,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMBLEMHEALTH/GHI-Commercial, +25117,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMBLEMHEALTH/GHI-Commercial, +25118,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMBLEMHEALTH/GHI-Commercial, +25119,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMBLEMHEALTH/GHI-Commercial, +25120,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMBLEMHEALTH/GHI-Commercial, +25121,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMBLEMHEALTH/GHI-Commercial, +25122,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMBLEMHEALTH/GHI-Commercial, +25123,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMBLEMHEALTH/GHI-Commercial, +25124,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMBLEMHEALTH/GHI-Commercial, +25125,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMBLEMHEALTH/GHI-Commercial, +25126,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMBLEMHEALTH/GHI-Commercial, +25127,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMBLEMHEALTH/GHI-Commercial, +25128,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMBLEMHEALTH/GHI-Commercial, +25129,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMBLEMHEALTH/GHI-Commercial,3.03 +25130,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMBLEMHEALTH/GHI-Commercial, +25131,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMBLEMHEALTH/GHI-Commercial, +25132,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMBLEMHEALTH/GHI-Commercial, +25133,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMBLEMHEALTH/GHI-Commercial, +25134,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMBLEMHEALTH/GHI-Commercial, +25135,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMBLEMHEALTH/GHI-Commercial, +25136,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMBLEMHEALTH/GHI-Commercial, +25137,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMBLEMHEALTH/GHI-Commercial, +25138,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMBLEMHEALTH/GHI-Commercial, +25139,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMBLEMHEALTH/GHI-Commercial, +25140,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMBLEMHEALTH/GHI-Commercial, +25141,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMBLEMHEALTH/GHI-Commercial, +25142,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/GHI-Commercial, +25143,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMBLEMHEALTH/GHI-Commercial, +25144,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMBLEMHEALTH/GHI-Commercial, +25145,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMBLEMHEALTH/GHI-Commercial, +25146,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMBLEMHEALTH/GHI-Commercial,18.18 +25147,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMBLEMHEALTH/GHI-Commercial, +25148,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMBLEMHEALTH/GHI-Commercial, +25149,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMBLEMHEALTH/GHI-Commercial, +25150,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMBLEMHEALTH/GHI-Commercial, +25151,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMBLEMHEALTH/GHI-Commercial, +25152,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMBLEMHEALTH/GHI-Commercial, +25153,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/GHI-Commercial, +25154,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMBLEMHEALTH/GHI-Commercial, +25155,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMBLEMHEALTH/GHI-Commercial, +25156,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMBLEMHEALTH/GHI-Commercial, +25157,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMBLEMHEALTH/GHI-Commercial, +25158,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMBLEMHEALTH/GHI-Commercial,16.64 +25159,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMBLEMHEALTH/GHI-Commercial, +25160,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMBLEMHEALTH/GHI-Commercial, +25161,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMBLEMHEALTH/GHI-Commercial, +25162,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMBLEMHEALTH/GHI-Commercial, +25163,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMBLEMHEALTH/GHI-Commercial, +25164,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMBLEMHEALTH/GHI-Commercial, +25165,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMBLEMHEALTH/GHI-Commercial, +25166,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMBLEMHEALTH/GHI-Commercial, +25167,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMBLEMHEALTH/GHI-Commercial, +25168,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMBLEMHEALTH/GHI-Commercial,17.67 +25169,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMBLEMHEALTH/GHI-Commercial,203.5 +25170,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMBLEMHEALTH/GHI-Commercial, +25171,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMBLEMHEALTH/GHI-Commercial, +25172,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMBLEMHEALTH/GHI-Commercial,1798.0 +25173,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMBLEMHEALTH/GHI-Commercial,50.75 +25174,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMBLEMHEALTH/GHI-Commercial, +25175,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/GHI-Commercial, +25176,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMBLEMHEALTH/GHI-Commercial, +25177,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMBLEMHEALTH/GHI-Commercial, +25178,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMBLEMHEALTH/GHI-Commercial, +25179,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMBLEMHEALTH/GHI-Commercial, +25180,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMBLEMHEALTH/GHI-Commercial, +25181,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMBLEMHEALTH/GHI-Commercial, +25182,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMBLEMHEALTH/GHI-Commercial, +25183,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMBLEMHEALTH/GHI-Commercial, +25184,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMBLEMHEALTH/GHI-Commercial, +25185,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMBLEMHEALTH/GHI-Commercial, +25186,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMBLEMHEALTH/GHI-Commercial, +25187,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMBLEMHEALTH/GHI-Commercial, +25188,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMBLEMHEALTH/GHI-Commercial, +25189,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMBLEMHEALTH/GHI-Commercial, +25190,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMBLEMHEALTH/GHI-Commercial, +25191,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMBLEMHEALTH/GHI-Commercial,81.2 +25192,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMBLEMHEALTH/GHI-Commercial, +25193,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMBLEMHEALTH/GHI-Commercial, +25194,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMBLEMHEALTH/GHI-Commercial, +25195,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMBLEMHEALTH/GHI-Commercial, +25196,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMBLEMHEALTH/GHI-Commercial, +25197,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMBLEMHEALTH/GHI-Commercial, +25198,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMBLEMHEALTH/GHI-Commercial, +25199,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMBLEMHEALTH/GHI-Commercial, +25200,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMBLEMHEALTH/GHI-Commercial, +25201,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMBLEMHEALTH/GHI-Commercial, +25202,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMBLEMHEALTH/GHI-Commercial, +25203,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMBLEMHEALTH/GHI-Commercial, +25204,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMBLEMHEALTH/GHI-Commercial, +25205,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMBLEMHEALTH/GHI-Commercial, +25206,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMBLEMHEALTH/GHI-Commercial, +25207,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMBLEMHEALTH/GHI-Commercial, +25208,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMBLEMHEALTH/GHI-Commercial, +25209,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMBLEMHEALTH/GHI-Commercial, +25210,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMBLEMHEALTH/GHI-Commercial, +25211,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMBLEMHEALTH/GHI-Commercial, +25212,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMBLEMHEALTH/GHI-Commercial, +25213,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMBLEMHEALTH/GHI-Commercial, +25214,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMBLEMHEALTH/GHI-Commercial,2094.0 +25215,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMBLEMHEALTH/GHI-Commercial,81.6 +25216,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMBLEMHEALTH/GHI-Commercial, +25217,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMBLEMHEALTH/GHI-Commercial, +25218,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMBLEMHEALTH/GHI-Commercial, +25219,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMBLEMHEALTH/GHI-Commercial, +25220,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMBLEMHEALTH/GHI-Commercial, +25221,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMBLEMHEALTH/GHI-Commercial, +25222,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMBLEMHEALTH/GHI-Commercial, +25223,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMBLEMHEALTH/GHI-Commercial, +25224,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMBLEMHEALTH/GHI-Commercial, +25225,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMBLEMHEALTH/GHI-Commercial, +25226,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMBLEMHEALTH/GHI-Commercial, +25227,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMBLEMHEALTH/GHI-Commercial, +25228,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMBLEMHEALTH/GHI-Commercial, +25229,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMBLEMHEALTH/GHI-Commercial, +25230,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMBLEMHEALTH/GHI-Commercial, +25231,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMBLEMHEALTH/GHI-Commercial, +25232,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMBLEMHEALTH/GHI-Commercial, +25233,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMBLEMHEALTH/GHI-Commercial, +25234,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMBLEMHEALTH/GHI-Commercial, +25235,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMBLEMHEALTH/GHI-Commercial, +25236,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMBLEMHEALTH/GHI-Commercial, +25237,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMBLEMHEALTH/GHI-Commercial, +25238,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMBLEMHEALTH/GHI-Commercial, +25239,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMBLEMHEALTH/GHI-Commercial, +25240,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMBLEMHEALTH/GHI-Commercial, +25241,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMBLEMHEALTH/GHI-Commercial, +25242,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMBLEMHEALTH/GHI-Commercial,92.5 +25243,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMBLEMHEALTH/GHI-Commercial, +25244,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMBLEMHEALTH/GHI-Commercial, +25245,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMBLEMHEALTH/GHI-Commercial, +25246,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMBLEMHEALTH/GHI-Commercial, +25247,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMBLEMHEALTH/GHI-Commercial, +25248,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMBLEMHEALTH/GHI-Commercial, +25249,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMBLEMHEALTH/GHI-Commercial, +25250,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMBLEMHEALTH/GHI-Commercial, +25251,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMBLEMHEALTH/GHI-Commercial, +25252,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMBLEMHEALTH/GHI-Commercial, +25253,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMBLEMHEALTH/GHI-Commercial, +25254,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMBLEMHEALTH/GHI-Commercial, +25255,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMBLEMHEALTH/GHI-Commercial, +25256,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMBLEMHEALTH/GHI-Commercial, +25257,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMBLEMHEALTH/GHI-Commercial, +25258,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMBLEMHEALTH/GHI-Commercial, +25259,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMBLEMHEALTH/GHI-Commercial, +25260,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMBLEMHEALTH/GHI-Commercial, +25261,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMBLEMHEALTH/GHI-Commercial, +25262,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMBLEMHEALTH/GHI-Commercial, +25263,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMBLEMHEALTH/GHI-Commercial, +25264,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMBLEMHEALTH/GHI-Commercial, +25265,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMBLEMHEALTH/GHI-Commercial, +25266,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMBLEMHEALTH/GHI-Commercial, +25267,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMBLEMHEALTH/GHI-Commercial, +25268,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMBLEMHEALTH/GHI-Commercial, +25269,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMBLEMHEALTH/GHI-Commercial, +25270,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMBLEMHEALTH/GHI-Commercial, +25271,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMBLEMHEALTH/GHI-Commercial, +25272,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMBLEMHEALTH/GHI-Commercial, +25273,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMBLEMHEALTH/GHI-Commercial, +25274,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMBLEMHEALTH/GHI-Commercial, +25275,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMBLEMHEALTH/GHI-Commercial, +25276,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMBLEMHEALTH/GHI-Commercial, +25277,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +25278,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +25279,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +25280,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMBLEMHEALTH/GHI-Commercial, +25281,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMBLEMHEALTH/GHI-Commercial, +25282,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMBLEMHEALTH/GHI-Commercial, +25283,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMBLEMHEALTH/GHI-Commercial, +25284,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMBLEMHEALTH/GHI-Commercial, +25285,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMBLEMHEALTH/GHI-Commercial, +25286,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMBLEMHEALTH/GHI-Commercial, +25287,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMBLEMHEALTH/GHI-Commercial, +25288,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMBLEMHEALTH/GHI-Commercial, +25289,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMBLEMHEALTH/GHI-Commercial, +25290,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMBLEMHEALTH/GHI-Commercial, +25291,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMBLEMHEALTH/GHI-Commercial, +25292,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMBLEMHEALTH/GHI-Commercial, +25293,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMBLEMHEALTH/GHI-Commercial, +25294,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMBLEMHEALTH/GHI-Commercial, +25295,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMBLEMHEALTH/GHI-Commercial, +25296,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMBLEMHEALTH/GHI-Commercial, +25297,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMBLEMHEALTH/GHI-Commercial, +25298,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMBLEMHEALTH/GHI-Commercial, +25299,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMBLEMHEALTH/GHI-Commercial, +25300,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMBLEMHEALTH/GHI-Commercial, +25301,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMBLEMHEALTH/GHI-Commercial, +25302,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMBLEMHEALTH/GHI-Commercial, +25303,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMBLEMHEALTH/GHI-Commercial, +25304,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMBLEMHEALTH/GHI-Commercial, +25305,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMBLEMHEALTH/GHI-Commercial, +25306,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMBLEMHEALTH/GHI-Commercial, +25307,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMBLEMHEALTH/GHI-Commercial, +25308,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMBLEMHEALTH/GHI-Commercial, +25309,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMBLEMHEALTH/GHI-Commercial, +25310,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMBLEMHEALTH/GHI-Commercial, +25311,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMBLEMHEALTH/GHI-Commercial, +25312,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMBLEMHEALTH/GHI-Commercial, +25313,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMBLEMHEALTH/GHI-Commercial,132.0 +25314,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMBLEMHEALTH/GHI-Commercial, +25315,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMBLEMHEALTH/GHI-Commercial, +25316,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMBLEMHEALTH/GHI-Commercial, +25317,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMBLEMHEALTH/GHI-Commercial, +25318,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMBLEMHEALTH/GHI-Commercial, +25319,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMBLEMHEALTH/GHI-Commercial, +25320,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMBLEMHEALTH/GHI-Commercial, +25321,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMBLEMHEALTH/GHI-Commercial, +25322,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMBLEMHEALTH/GHI-Commercial, +25323,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMBLEMHEALTH/GHI-Commercial, +25324,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMBLEMHEALTH/GHI-Commercial, +25325,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMBLEMHEALTH/GHI-Commercial, +25326,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMBLEMHEALTH/GHI-Commercial, +25327,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMBLEMHEALTH/GHI-Commercial, +25328,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMBLEMHEALTH/GHI-Commercial, +25329,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMBLEMHEALTH/GHI-Commercial, +25330,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMBLEMHEALTH/GHI-Commercial, +25331,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMBLEMHEALTH/GHI-Commercial, +25332,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMBLEMHEALTH/GHI-Commercial, +25333,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMBLEMHEALTH/GHI-Commercial, +25334,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMBLEMHEALTH/GHI-Commercial, +25335,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMBLEMHEALTH/GHI-Commercial, +25336,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMBLEMHEALTH/GHI-Commercial, +25337,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMBLEMHEALTH/GHI-Commercial, +25338,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMBLEMHEALTH/GHI-Commercial, +25339,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMBLEMHEALTH/GHI-Commercial, +25340,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMBLEMHEALTH/GHI-Commercial, +25341,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMBLEMHEALTH/GHI-Commercial, +25342,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMBLEMHEALTH/GHI-Commercial, +25343,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMBLEMHEALTH/GHI-Commercial, +25344,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMBLEMHEALTH/GHI-Commercial, +25345,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMBLEMHEALTH/GHI-Commercial, +25346,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMBLEMHEALTH/GHI-Commercial, +25347,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMBLEMHEALTH/GHI-Commercial, +25348,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMBLEMHEALTH/GHI-Commercial, +25349,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMBLEMHEALTH/GHI-Commercial, +25350,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMBLEMHEALTH/GHI-Commercial, +25351,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMBLEMHEALTH/GHI-Commercial, +25352,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMBLEMHEALTH/GHI-Commercial, +25353,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMBLEMHEALTH/GHI-Commercial, +25354,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMBLEMHEALTH/GHI-Commercial, +25355,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMBLEMHEALTH/GHI-Commercial, +25356,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMBLEMHEALTH/GHI-Commercial, +25357,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMBLEMHEALTH/GHI-Commercial, +25358,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMBLEMHEALTH/GHI-Commercial, +25359,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMBLEMHEALTH/GHI-Commercial, +25360,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMBLEMHEALTH/GHI-Commercial, +25361,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMBLEMHEALTH/GHI-Commercial, +25362,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMBLEMHEALTH/GHI-Commercial, +25363,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMBLEMHEALTH/GHI-Commercial, +25364,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMBLEMHEALTH/GHI-Commercial,23662.0 +25365,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMBLEMHEALTH/GHI-Commercial, +25366,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMBLEMHEALTH/GHI-Commercial, +25367,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMBLEMHEALTH/GHI-Commercial, +25368,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMBLEMHEALTH/GHI-Commercial, +25369,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMBLEMHEALTH/GHI-Commercial, +25370,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMBLEMHEALTH/GHI-Commercial, +25371,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMBLEMHEALTH/GHI-Commercial, +25372,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMBLEMHEALTH/GHI-Commercial,1917.0 +25373,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMBLEMHEALTH/GHI-Commercial, +25374,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMBLEMHEALTH/GHI-Commercial, +25375,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMBLEMHEALTH/GHI-Commercial, +25376,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +25377,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMBLEMHEALTH/GHI-Commercial,612.38 +25378,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMBLEMHEALTH/GHI-Commercial,1441.0 +25379,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMBLEMHEALTH/GHI-Commercial, +25380,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMBLEMHEALTH/GHI-Commercial, +25381,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMBLEMHEALTH/GHI-Commercial, +25382,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMBLEMHEALTH/GHI-Commercial, +25383,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMBLEMHEALTH/GHI-Commercial, +25384,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMBLEMHEALTH/GHI-Commercial,43.49 +25385,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMBLEMHEALTH/GHI-Commercial, +25386,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMBLEMHEALTH/GHI-Commercial, +25387,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMBLEMHEALTH/GHI-Commercial,2567.93 +25388,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMBLEMHEALTH/GHI-Commercial, +25389,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMBLEMHEALTH/GHI-Commercial,2036.17 +25390,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMBLEMHEALTH/GHI-Commercial, +25391,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMBLEMHEALTH/GHI-Commercial, +25392,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMBLEMHEALTH/GHI-Commercial, +25393,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMBLEMHEALTH/GHI-Commercial,97.84 +25394,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMBLEMHEALTH/GHI-Commercial, +25395,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMBLEMHEALTH/GHI-Commercial,71.15 +25396,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMBLEMHEALTH/GHI-Commercial, +25397,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMBLEMHEALTH/GHI-Commercial, +25398,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMBLEMHEALTH/GHI-Commercial,13.13 +25399,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMBLEMHEALTH/GHI-Commercial, +25400,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMBLEMHEALTH/GHI-Commercial, +25401,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMBLEMHEALTH/GHI-Commercial, +25402,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMBLEMHEALTH/GHI-Commercial,11079.0 +25403,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMBLEMHEALTH/GHI-Commercial, +25404,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMBLEMHEALTH/GHI-Commercial, +25405,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMBLEMHEALTH/GHI-Commercial, +25406,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMBLEMHEALTH/GHI-Commercial,11079.0 +25407,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMBLEMHEALTH/GHI-Commercial,11079.0 +25408,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMBLEMHEALTH/GHI-Commercial,11079.0 +25409,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMBLEMHEALTH/GHI-Commercial, +25410,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMBLEMHEALTH/GHI-Commercial, +25411,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMBLEMHEALTH/GHI-Commercial, +25412,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMBLEMHEALTH/GHI-Commercial, +25413,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMBLEMHEALTH/GHI-Commercial, +25414,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMBLEMHEALTH/GHI-Commercial, +25415,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMBLEMHEALTH/GHI-Commercial, +25416,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMBLEMHEALTH/GHI-Commercial, +25417,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMBLEMHEALTH/GHI-Commercial, +25418,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMBLEMHEALTH/GHI-Commercial, +25419,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMBLEMHEALTH/GHI-Commercial, +25420,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMBLEMHEALTH/GHI-Commercial, +25421,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMBLEMHEALTH/GHI-Commercial, +25422,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMBLEMHEALTH/GHI-Commercial, +25423,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMBLEMHEALTH/GHI-Commercial, +25424,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMBLEMHEALTH/GHI-Commercial,62194.0 +25425,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMBLEMHEALTH/GHI-Commercial, +25426,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMBLEMHEALTH/GHI-Commercial, +25427,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMBLEMHEALTH/GHI-Commercial,62194.0 +25428,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMBLEMHEALTH/GHI-Commercial, +25429,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMBLEMHEALTH/GHI-Commercial, +25430,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMBLEMHEALTH/GHI-Commercial, +25431,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMBLEMHEALTH/GHI-Commercial, +25432,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMBLEMHEALTH/GHI-Commercial, +25433,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMBLEMHEALTH/GHI-Commercial,169.86 +25434,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMBLEMHEALTH/GHI-Commercial, +25435,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMBLEMHEALTH/GHI-Commercial, +25436,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMBLEMHEALTH/GHI-Commercial, +25437,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMBLEMHEALTH/GHI-Commercial, +25438,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMBLEMHEALTH/GHI-Commercial, +25439,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMBLEMHEALTH/GHI-Commercial, +25440,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMBLEMHEALTH/GHI-Commercial, +25441,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMBLEMHEALTH/GHI-Commercial, +25442,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMBLEMHEALTH/GHI-Commercial, +25443,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMBLEMHEALTH/GHI-Commercial, +25444,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMBLEMHEALTH/GHI-Commercial,668.4 +25445,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMBLEMHEALTH/GHI-Commercial, +25446,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMBLEMHEALTH/GHI-Commercial,41.96 +25447,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMBLEMHEALTH/GHI-Commercial, +25448,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMBLEMHEALTH/GHI-Commercial, +25449,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMBLEMHEALTH/GHI-Commercial, +25450,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMBLEMHEALTH/GHI-Commercial, +25451,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMBLEMHEALTH/GHI-Commercial, +25452,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMBLEMHEALTH/GHI-Commercial, +25453,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMBLEMHEALTH/GHI-Commercial,831.33 +25454,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMBLEMHEALTH/GHI-Commercial, +25455,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMBLEMHEALTH/GHI-Commercial, +25456,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMBLEMHEALTH/GHI-Commercial, +25457,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMBLEMHEALTH/GHI-Commercial, +25458,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMBLEMHEALTH/GHI-Commercial,1074.5 +25459,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMBLEMHEALTH/GHI-Commercial,10439.54 +25460,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMBLEMHEALTH/GHI-Commercial, +25461,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMBLEMHEALTH/GHI-Commercial, +25462,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMBLEMHEALTH/GHI-Commercial,988.0 +25463,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMBLEMHEALTH/GHI-Commercial,53.0 +25464,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMBLEMHEALTH/GHI-Commercial,17.4 +25465,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMBLEMHEALTH/GHI-Commercial,10.6 +25466,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMBLEMHEALTH/GHI-Commercial, +25467,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMBLEMHEALTH/GHI-Commercial, +25468,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMBLEMHEALTH/GHI-Commercial, +25469,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMBLEMHEALTH/GHI-Commercial, +25470,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMBLEMHEALTH/GHI-Commercial,11676.0 +25471,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMBLEMHEALTH/GHI-Commercial, +25472,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMBLEMHEALTH/GHI-Commercial,15635.0 +25473,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMBLEMHEALTH/GHI-Commercial, +25474,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMBLEMHEALTH/GHI-Commercial, +25475,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMBLEMHEALTH/GHI-Commercial,16406.0 +25476,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMBLEMHEALTH/GHI-Commercial, +25477,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMBLEMHEALTH/GHI-Commercial, +25478,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMBLEMHEALTH/GHI-Commercial, +25479,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMBLEMHEALTH/GHI-Commercial, +25480,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMBLEMHEALTH/GHI-Commercial, +25481,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMBLEMHEALTH/GHI-Commercial, +25482,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMBLEMHEALTH/GHI-Commercial,2043.5 +25483,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMBLEMHEALTH/GHI-Commercial, +25484,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMBLEMHEALTH/GHI-Commercial, +25485,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMBLEMHEALTH/GHI-Commercial, +25486,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMBLEMHEALTH/GHI-Commercial, +25487,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMBLEMHEALTH/GHI-Commercial, +25488,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/GHI-Commercial, +25489,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/GHI-Commercial, +25490,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMBLEMHEALTH/GHI-Commercial, +25491,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMBLEMHEALTH/GHI-Commercial, +25492,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMBLEMHEALTH/GHI-Commercial, +25493,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMBLEMHEALTH/GHI-Commercial, +25494,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMBLEMHEALTH/GHI-Commercial, +25495,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMBLEMHEALTH/GHI-Commercial, +25496,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMBLEMHEALTH/GHI-Commercial, +25497,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMBLEMHEALTH/GHI-Commercial, +25498,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMBLEMHEALTH/GHI-Commercial, +25499,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMBLEMHEALTH/GHI-Commercial, +25500,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMBLEMHEALTH/GHI-Commercial, +25501,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMBLEMHEALTH/GHI-Commercial, +25502,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMBLEMHEALTH/GHI-Commercial, +25503,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMBLEMHEALTH/GHI-Commercial, +25504,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMBLEMHEALTH/GHI-Commercial, +25505,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMBLEMHEALTH/GHI-Commercial,388.48 +25506,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMBLEMHEALTH/GHI-Commercial, +25507,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMBLEMHEALTH/GHI-Commercial, +25508,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMBLEMHEALTH/GHI-Commercial, +25509,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMBLEMHEALTH/GHI-Commercial, +25510,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMBLEMHEALTH/GHI-Commercial,329.93 +25511,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMBLEMHEALTH/GHI-Commercial,943.88 +25512,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMBLEMHEALTH/GHI-Commercial,1167.77 +25513,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMBLEMHEALTH/GHI-Commercial,777.89 +25514,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMBLEMHEALTH/GHI-Commercial, +25515,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMBLEMHEALTH/GHI-Commercial, +25516,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMBLEMHEALTH/GHI-Commercial,200.0 +25517,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMBLEMHEALTH/GHI-Commercial,5636.17 +25518,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMBLEMHEALTH/GHI-Commercial,3543.07 +25519,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMBLEMHEALTH/GHI-Commercial,5028.81 +25520,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMBLEMHEALTH/GHI-Commercial,150.0 +25521,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMBLEMHEALTH/GHI-Commercial,25.19 +25522,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMBLEMHEALTH/GHI-Commercial,2721.63 +25523,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMBLEMHEALTH/GHI-Commercial,2777.98 +25524,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMBLEMHEALTH/GHI-Commercial,3949.82 +25525,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMBLEMHEALTH/GHI-Commercial,10492.0 +25526,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMBLEMHEALTH/GHI-Commercial, +25527,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMBLEMHEALTH/GHI-Commercial, +25528,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMBLEMHEALTH/GHI-Commercial,5797.24 +25529,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMBLEMHEALTH/GHI-Commercial,4116.34 +25530,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMBLEMHEALTH/GHI-Commercial,7011.65 +25531,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMBLEMHEALTH/GHI-Commercial,5676.16 +25532,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMBLEMHEALTH/GHI-Commercial,8606.71 +25533,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMBLEMHEALTH/GHI-Commercial, +25534,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMBLEMHEALTH/GHI-Commercial,9762.3 +25535,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMBLEMHEALTH/GHI-Commercial, +25536,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMBLEMHEALTH/GHI-Commercial,6939.0 +25537,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMBLEMHEALTH/GHI-Commercial,1367.5 +25538,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMBLEMHEALTH/GHI-Commercial, +25539,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMBLEMHEALTH/GHI-Commercial,418.5 +25540,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMBLEMHEALTH/GHI-Commercial, +25541,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMBLEMHEALTH/GHI-Commercial, +25542,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMBLEMHEALTH/GHI-Commercial, +25543,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMBLEMHEALTH/GHI-Commercial,20.0 +25544,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMBLEMHEALTH/GHI-Commercial, +25545,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMBLEMHEALTH/GHI-Commercial, +25546,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMBLEMHEALTH/GHI-Commercial,317.63 +25547,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMBLEMHEALTH/GHI-Commercial, +25548,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMBLEMHEALTH/GHI-Commercial, +25549,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMBLEMHEALTH/GHI-Commercial,377.0 +25550,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMBLEMHEALTH/GHI-Commercial, +25551,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMBLEMHEALTH/GHI-Commercial, +25552,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMBLEMHEALTH/GHI-Commercial, +25553,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMBLEMHEALTH/GHI-Commercial, +25554,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMBLEMHEALTH/GHI-Commercial, +25555,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMBLEMHEALTH/GHI-Commercial,116.0 +25556,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMBLEMHEALTH/GHI-Commercial,342.33 +25557,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMBLEMHEALTH/GHI-Commercial,468.0 +25558,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMBLEMHEALTH/GHI-Commercial, +25559,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMBLEMHEALTH/GHI-Commercial,218.5 +25560,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMBLEMHEALTH/GHI-Commercial,339.0 +25561,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMBLEMHEALTH/GHI-Commercial, +25562,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMBLEMHEALTH/GHI-Commercial, +25563,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMBLEMHEALTH/GHI-Commercial, +25564,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMBLEMHEALTH/GHI-Commercial,324.0 +25565,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMBLEMHEALTH/GHI-Commercial, +25566,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMBLEMHEALTH/GHI-Commercial, +25567,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMBLEMHEALTH/GHI-Commercial, +25568,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMBLEMHEALTH/GHI-Commercial, +25569,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMBLEMHEALTH/GHI-Commercial, +25570,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMBLEMHEALTH/GHI-Commercial, +25571,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMBLEMHEALTH/GHI-Commercial, +25572,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMBLEMHEALTH/GHI-Commercial,1406.0 +25573,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMBLEMHEALTH/GHI-Commercial,20.0 +25574,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMBLEMHEALTH/GHI-Commercial, +25575,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMBLEMHEALTH/GHI-Commercial, +25576,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMBLEMHEALTH/GHI-Commercial, +25577,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMBLEMHEALTH/GHI-Commercial, +25578,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMBLEMHEALTH/GHI-Commercial, +25579,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMBLEMHEALTH/GHI-Commercial, +25580,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMBLEMHEALTH/GHI-Commercial, +25581,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMBLEMHEALTH/GHI-Commercial, +25582,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMBLEMHEALTH/GHI-Commercial, +25583,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMBLEMHEALTH/GHI-Commercial, +25584,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMBLEMHEALTH/GHI-Commercial, +25585,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMBLEMHEALTH/GHI-Commercial, +25586,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMBLEMHEALTH/GHI-Commercial, +25587,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMBLEMHEALTH/GHI-Commercial, +25588,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMBLEMHEALTH/GHI-Commercial, +25589,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMBLEMHEALTH/GHI-Commercial, +25590,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMBLEMHEALTH/GHI-Commercial, +25591,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMBLEMHEALTH/GHI-Commercial, +25592,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMBLEMHEALTH/GHI-Commercial, +25593,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMBLEMHEALTH/GHI-Commercial, +25594,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMBLEMHEALTH/GHI-Commercial, +25595,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMBLEMHEALTH/GHI-Commercial,614.0 +25596,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMBLEMHEALTH/GHI-Commercial,1018.05 +25597,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMBLEMHEALTH/GHI-Commercial,1679.87 +25598,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMBLEMHEALTH/GHI-Commercial,3104.85 +25599,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMBLEMHEALTH/GHI-Commercial,6726.04 +25600,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMBLEMHEALTH/GHI-Commercial, +25601,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMBLEMHEALTH/GHI-Commercial, +25602,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMBLEMHEALTH/GHI-Commercial, +25603,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMBLEMHEALTH/GHI-Commercial, +25604,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMBLEMHEALTH/GHI-Commercial, +25605,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMBLEMHEALTH/GHI-Commercial, +25606,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMBLEMHEALTH/GHI-Commercial, +25607,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMBLEMHEALTH/GHI-Commercial, +25608,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMBLEMHEALTH/GHI-Commercial, +25609,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMBLEMHEALTH/GHI-Commercial, +25610,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMBLEMHEALTH/GHI-Commercial, +25611,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMBLEMHEALTH/GHI-Commercial, +25612,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMBLEMHEALTH/GHI-Commercial, +25613,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMBLEMHEALTH/GHI-Commercial, +25614,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMBLEMHEALTH/GHI-Commercial, +25615,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMBLEMHEALTH/GHI-Commercial, +25616,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMBLEMHEALTH/GHI-Commercial, +25617,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMBLEMHEALTH/GHI-Commercial, +25618,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMBLEMHEALTH/GHI-Commercial, +25619,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMBLEMHEALTH/GHI-Commercial, +25620,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMBLEMHEALTH/GHI-Commercial, +25621,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMBLEMHEALTH/GHI-Commercial, +25622,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMBLEMHEALTH/GHI-Commercial, +25623,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMBLEMHEALTH/GHI-Commercial, +25624,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMBLEMHEALTH/GHI-Commercial, +25625,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMBLEMHEALTH/GHI-Commercial, +25626,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMBLEMHEALTH/GHI-Commercial, +25627,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMBLEMHEALTH/GHI-Commercial, +25628,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMBLEMHEALTH/GHI-Commercial, +25629,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMBLEMHEALTH/GHI-Commercial, +25630,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMBLEMHEALTH/GHI-Commercial, +25631,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMBLEMHEALTH/GHI-Commercial, +25632,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMBLEMHEALTH/GHI-Commercial, +25633,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMBLEMHEALTH/GHI-Commercial, +25634,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMBLEMHEALTH/GHI-Commercial, +25635,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMBLEMHEALTH/GHI-Commercial, +25636,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMBLEMHEALTH/GHI-Commercial, +25637,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMBLEMHEALTH/GHI-Commercial, +25638,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMBLEMHEALTH/GHI-Commercial, +25639,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMBLEMHEALTH/GHI-Commercial, +25640,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMBLEMHEALTH/GHI-Commercial, +25641,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMBLEMHEALTH/GHI-Commercial, +25642,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMBLEMHEALTH/GHI-Commercial, +25643,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMBLEMHEALTH/GHI-Commercial, +25644,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMBLEMHEALTH/GHI-Commercial, +25645,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMBLEMHEALTH/GHI-Commercial, +25646,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMBLEMHEALTH/GHI-Commercial, +25647,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMBLEMHEALTH/GHI-Commercial, +25648,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMBLEMHEALTH/GHI-Commercial, +25649,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMBLEMHEALTH/GHI-Commercial, +25650,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMBLEMHEALTH/GHI-Commercial, +25651,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMBLEMHEALTH/GHI-Commercial, +25652,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMBLEMHEALTH/GHI-Commercial, +25653,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMBLEMHEALTH/GHI-Commercial,31062.0 +25654,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMBLEMHEALTH/GHI-Commercial, +25655,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMBLEMHEALTH/GHI-Commercial, +25656,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMBLEMHEALTH/GHI-Commercial, +25657,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMBLEMHEALTH/GHI-Commercial, +25658,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMBLEMHEALTH/GHI-Commercial, +25659,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMBLEMHEALTH/GHI-Commercial, +25660,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMBLEMHEALTH/GHI-Commercial, +25661,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMBLEMHEALTH/GHI-Commercial, +25662,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMBLEMHEALTH/GHI-Commercial, +25663,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMBLEMHEALTH/GHI-Commercial, +25664,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMBLEMHEALTH/GHI-Commercial, +25665,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMBLEMHEALTH/GHI-Commercial, +25666,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMBLEMHEALTH/GHI-Commercial, +25667,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMBLEMHEALTH/GHI-Commercial, +25668,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMBLEMHEALTH/GHI-Commercial, +25669,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMBLEMHEALTH/GHI-Commercial, +25670,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMBLEMHEALTH/GHI-Commercial, +25671,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMBLEMHEALTH/GHI-Commercial, +25672,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMBLEMHEALTH/GHI-Commercial, +25673,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMBLEMHEALTH/GHI-Commercial, +25674,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMBLEMHEALTH/GHI-Commercial, +25675,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMBLEMHEALTH/GHI-Commercial, +25676,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMBLEMHEALTH/GHI-Commercial, +25677,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMBLEMHEALTH/GHI-Commercial, +25678,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMBLEMHEALTH/GHI-Commercial, +25679,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMBLEMHEALTH/GHI-Commercial, +25680,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMBLEMHEALTH/GHI-Commercial, +25681,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMBLEMHEALTH/GHI-Commercial, +25682,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMBLEMHEALTH/GHI-Commercial, +25683,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMBLEMHEALTH/GHI-Commercial, +25684,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMBLEMHEALTH/GHI-Commercial, +25685,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMBLEMHEALTH/GHI-Commercial, +25686,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMBLEMHEALTH/GHI-Commercial, +25687,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMBLEMHEALTH/GHI-Commercial, +25688,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMBLEMHEALTH/GHI-Commercial, +25689,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMBLEMHEALTH/GHI-Commercial, +25690,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMBLEMHEALTH/GHI-Commercial, +25691,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMBLEMHEALTH/GHI-Commercial, +25692,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMBLEMHEALTH/GHI-Commercial, +25693,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMBLEMHEALTH/GHI-Commercial, +25694,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMBLEMHEALTH/GHI-Commercial, +25695,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMBLEMHEALTH/GHI-Commercial, +25696,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMBLEMHEALTH/GHI-Commercial, +25697,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMBLEMHEALTH/GHI-Commercial, +25698,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMBLEMHEALTH/GHI-Commercial, +25699,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMBLEMHEALTH/GHI-Commercial, +25700,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMBLEMHEALTH/GHI-Commercial, +25701,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMBLEMHEALTH/GHI-Commercial, +25702,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMBLEMHEALTH/GHI-Commercial, +25703,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMBLEMHEALTH/GHI-Commercial, +25704,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMBLEMHEALTH/GHI-Commercial, +25705,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMBLEMHEALTH/GHI-Commercial, +25706,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMBLEMHEALTH/GHI-Commercial, +25707,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMBLEMHEALTH/GHI-Commercial, +25708,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMBLEMHEALTH/GHI-Commercial, +25709,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMBLEMHEALTH/GHI-Commercial, +25710,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMBLEMHEALTH/GHI-Commercial, +25711,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMBLEMHEALTH/GHI-Commercial, +25712,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMBLEMHEALTH/GHI-Commercial, +25713,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMBLEMHEALTH/GHI-Commercial, +25714,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMBLEMHEALTH/GHI-Commercial, +25715,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMBLEMHEALTH/GHI-Commercial, +25716,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMBLEMHEALTH/GHI-Commercial, +25717,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMBLEMHEALTH/GHI-Commercial, +25718,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMBLEMHEALTH/GHI-Commercial, +25719,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMBLEMHEALTH/GHI-Commercial, +25720,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMBLEMHEALTH/GHI-Commercial, +25721,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMBLEMHEALTH/GHI-Commercial, +25722,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMBLEMHEALTH/GHI-Commercial, +25723,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMBLEMHEALTH/GHI-Commercial, +25724,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMBLEMHEALTH/GHI-Commercial, +25725,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMBLEMHEALTH/GHI-Commercial, +25726,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMBLEMHEALTH/GHI-Commercial, +25727,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMBLEMHEALTH/GHI-Commercial, +25728,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMBLEMHEALTH/GHI-Commercial, +25729,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMBLEMHEALTH/GHI-Commercial, +25730,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMBLEMHEALTH/GHI-Commercial, +25731,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMBLEMHEALTH/GHI-Commercial, +25732,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMBLEMHEALTH/GHI-Commercial, +25733,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMBLEMHEALTH/GHI-Commercial, +25734,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMBLEMHEALTH/GHI-Commercial, +25735,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMBLEMHEALTH/GHI-Commercial, +25736,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMBLEMHEALTH/GHI-Commercial, +25737,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMBLEMHEALTH/GHI-Commercial, +25738,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMBLEMHEALTH/GHI-Commercial, +25739,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMBLEMHEALTH/GHI-Commercial, +25740,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMBLEMHEALTH/GHI-Commercial, +25741,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMBLEMHEALTH/GHI-Commercial, +25742,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMBLEMHEALTH/GHI-Commercial, +25743,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMBLEMHEALTH/GHI-Commercial, +25744,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMBLEMHEALTH/GHI-Commercial, +25745,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMBLEMHEALTH/GHI-Commercial, +25746,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMBLEMHEALTH/GHI-Commercial, +25747,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMBLEMHEALTH/GHI-Commercial, +25748,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMBLEMHEALTH/GHI-Commercial, +25749,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMBLEMHEALTH/GHI-Commercial, +25750,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMBLEMHEALTH/GHI-Commercial, +25751,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMBLEMHEALTH/GHI-Commercial, +25752,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMBLEMHEALTH/GHI-Commercial, +25753,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMBLEMHEALTH/GHI-Commercial, +25754,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMBLEMHEALTH/GHI-Commercial, +25755,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMBLEMHEALTH/GHI-Commercial, +25756,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMBLEMHEALTH/GHI-Commercial, +25757,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMBLEMHEALTH/GHI-Commercial, +25758,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMBLEMHEALTH/GHI-Commercial, +25759,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMBLEMHEALTH/GHI-Commercial, +25760,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMBLEMHEALTH/GHI-Commercial, +25761,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMBLEMHEALTH/GHI-Commercial, +25762,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMBLEMHEALTH/GHI-Commercial, +25763,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMBLEMHEALTH/GHI-Commercial, +25764,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMBLEMHEALTH/GHI-Commercial, +25765,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMBLEMHEALTH/GHI-Commercial, +25766,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMBLEMHEALTH/GHI-Commercial, +25767,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMBLEMHEALTH/GHI-Commercial, +25768,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMBLEMHEALTH/GHI-Commercial, +25769,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMBLEMHEALTH/GHI-Commercial, +25770,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMBLEMHEALTH/GHI-Commercial, +25771,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMBLEMHEALTH/GHI-Commercial, +25772,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMBLEMHEALTH/GHI-Commercial, +25773,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMBLEMHEALTH/GHI-Commercial, +25774,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMBLEMHEALTH/GHI-Commercial, +25775,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMBLEMHEALTH/GHI-Commercial, +25776,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMBLEMHEALTH/GHI-Commercial, +25777,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMBLEMHEALTH/GHI-Commercial, +25778,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMBLEMHEALTH/GHI-Commercial, +25779,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMBLEMHEALTH/GHI-Commercial, +25780,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMBLEMHEALTH/GHI-Commercial, +25781,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMBLEMHEALTH/GHI-Commercial, +25782,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMBLEMHEALTH/GHI-Commercial, +25783,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMBLEMHEALTH/GHI-Commercial, +25784,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMBLEMHEALTH/GHI-Commercial, +25785,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMBLEMHEALTH/GHI-Commercial, +25786,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMBLEMHEALTH/GHI-Commercial, +25787,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMBLEMHEALTH/GHI-Commercial, +25788,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMBLEMHEALTH/GHI-Commercial, +25789,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMBLEMHEALTH/GHI-Commercial, +25790,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMBLEMHEALTH/GHI-Commercial, +25791,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMBLEMHEALTH/GHI-Commercial, +25792,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMBLEMHEALTH/GHI-Commercial, +25793,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMBLEMHEALTH/GHI-Commercial, +25794,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMBLEMHEALTH/GHI-Commercial, +25795,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMBLEMHEALTH/GHI-Commercial, +25796,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMBLEMHEALTH/GHI-Commercial, +25797,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMBLEMHEALTH/GHI-Commercial, +25798,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMBLEMHEALTH/GHI-Commercial, +25799,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMBLEMHEALTH/GHI-Commercial, +25800,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMBLEMHEALTH/GHI-Commercial, +25801,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMBLEMHEALTH/GHI-Commercial, +25802,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMBLEMHEALTH/GHI-Commercial, +25803,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMBLEMHEALTH/GHI-Commercial, +25804,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMBLEMHEALTH/GHI-Commercial, +25805,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMBLEMHEALTH/GHI-Commercial, +25806,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMBLEMHEALTH/GHI-Commercial, +25807,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMBLEMHEALTH/GHI-Commercial, +25808,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMBLEMHEALTH/GHI-Commercial, +25809,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMBLEMHEALTH/GHI-Commercial, +25810,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMBLEMHEALTH/GHI-Commercial, +25811,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMBLEMHEALTH/GHI-Commercial, +25812,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMBLEMHEALTH/GHI-Commercial, +25813,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMBLEMHEALTH/GHI-Commercial, +25814,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMBLEMHEALTH/GHI-Commercial, +25815,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMBLEMHEALTH/GHI-Commercial, +25816,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMBLEMHEALTH/GHI-Commercial, +25817,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMBLEMHEALTH/GHI-Commercial, +25818,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMBLEMHEALTH/GHI-Commercial, +25819,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMBLEMHEALTH/GHI-Commercial, +25820,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMBLEMHEALTH/GHI-Commercial, +25821,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMBLEMHEALTH/GHI-Commercial, +25822,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMBLEMHEALTH/GHI-Commercial, +25823,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMBLEMHEALTH/GHI-Commercial, +25824,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMBLEMHEALTH/GHI-Commercial, +25825,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMBLEMHEALTH/GHI-Commercial, +25826,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMBLEMHEALTH/GHI-Commercial, +25827,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMBLEMHEALTH/GHI-Commercial, +25828,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMBLEMHEALTH/GHI-Commercial, +25829,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMBLEMHEALTH/GHI-Commercial, +25830,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMBLEMHEALTH/GHI-Commercial, +25831,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMBLEMHEALTH/GHI-Commercial, +25832,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMBLEMHEALTH/GHI-Commercial, +25833,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMBLEMHEALTH/GHI-Commercial, +25834,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMBLEMHEALTH/GHI-Commercial, +25835,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMBLEMHEALTH/GHI-Commercial, +25836,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMBLEMHEALTH/GHI-Commercial, +25837,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMBLEMHEALTH/GHI-Commercial, +25838,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMBLEMHEALTH/GHI-Commercial, +25839,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMBLEMHEALTH/GHI-Commercial, +25840,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMBLEMHEALTH/GHI-Commercial, +25841,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMBLEMHEALTH/GHI-Commercial, +25842,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMBLEMHEALTH/GHI-Commercial, +25843,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMBLEMHEALTH/GHI-Commercial, +25844,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMBLEMHEALTH/GHI-Commercial, +25845,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMBLEMHEALTH/GHI-Commercial, +25846,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMBLEMHEALTH/GHI-Commercial, +25847,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMBLEMHEALTH/GHI-Commercial, +25848,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMBLEMHEALTH/GHI-Commercial, +25849,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMBLEMHEALTH/GHI-Commercial, +25850,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMBLEMHEALTH/GHI-Commercial, +25851,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMBLEMHEALTH/GHI-Commercial, +25852,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMBLEMHEALTH/GHI-Commercial, +25853,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMBLEMHEALTH/GHI-Commercial, +25854,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMBLEMHEALTH/GHI-Commercial, +25855,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMBLEMHEALTH/GHI-Commercial, +25856,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMBLEMHEALTH/GHI-Commercial, +25857,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMBLEMHEALTH/GHI-Commercial, +25858,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMBLEMHEALTH/GHI-Commercial, +25859,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMBLEMHEALTH/GHI-Commercial, +25860,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMBLEMHEALTH/GHI-Commercial, +25861,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMBLEMHEALTH/GHI-Commercial, +25862,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMBLEMHEALTH/GHI-Commercial, +25863,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMBLEMHEALTH/GHI-Commercial, +25864,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMBLEMHEALTH/GHI-Commercial, +25865,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMBLEMHEALTH/GHI-Commercial, +25866,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMBLEMHEALTH/GHI-Commercial, +25867,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMBLEMHEALTH/GHI-Commercial, +25868,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMBLEMHEALTH/GHI-Commercial, +25869,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMBLEMHEALTH/GHI-Commercial, +25870,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMBLEMHEALTH/GHI-Commercial, +25871,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMBLEMHEALTH/GHI-Commercial, +25872,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMBLEMHEALTH/GHI-Commercial, +25873,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMBLEMHEALTH/GHI-Commercial, +25874,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMBLEMHEALTH/GHI-Commercial, +25875,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMBLEMHEALTH/GHI-Commercial, +25876,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMBLEMHEALTH/GHI-Commercial, +25877,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMBLEMHEALTH/GHI-Commercial, +25878,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMBLEMHEALTH/GHI-Commercial, +25879,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMBLEMHEALTH/GHI-Commercial, +25880,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMBLEMHEALTH/GHI-Commercial, +25881,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMBLEMHEALTH/GHI-Commercial, +25882,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMBLEMHEALTH/GHI-Commercial, +25883,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMBLEMHEALTH/GHI-Commercial, +25884,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMBLEMHEALTH/GHI-Commercial, +25885,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMBLEMHEALTH/GHI-Commercial, +25886,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMBLEMHEALTH/GHI-Commercial, +25887,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMBLEMHEALTH/GHI-Commercial, +25888,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMBLEMHEALTH/GHI-Commercial, +25889,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMBLEMHEALTH/GHI-Commercial, +25890,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMBLEMHEALTH/GHI-Commercial, +25891,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMBLEMHEALTH/GHI-Commercial, +25892,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMBLEMHEALTH/GHI-Commercial, +25893,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMBLEMHEALTH/GHI-Commercial, +25894,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMBLEMHEALTH/GHI-Commercial, +25895,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMBLEMHEALTH/GHI-Commercial, +25896,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMBLEMHEALTH/GHI-Commercial, +25897,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMBLEMHEALTH/GHI-Commercial, +25898,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMBLEMHEALTH/GHI-Commercial, +25899,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMBLEMHEALTH/GHI-Commercial, +25900,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMBLEMHEALTH/GHI-Commercial, +25901,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMBLEMHEALTH/GHI-Commercial, +25902,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMBLEMHEALTH/GHI-Commercial, +25903,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMBLEMHEALTH/GHI-Commercial, +25904,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMBLEMHEALTH/GHI-Commercial, +25905,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMBLEMHEALTH/GHI-Commercial,1260.33 +25906,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMBLEMHEALTH/GHI-Commercial, +25907,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMBLEMHEALTH/GHI-Commercial, +25908,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMBLEMHEALTH/GHI-Commercial, +25909,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMBLEMHEALTH/GHI-Commercial, +25910,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMBLEMHEALTH/GHI-Commercial, +25911,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMBLEMHEALTH/GHI-Commercial, +25912,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMBLEMHEALTH/GHI-Commercial, +25913,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMBLEMHEALTH/GHI-Commercial, +25914,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMBLEMHEALTH/GHI-Commercial, +25915,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMBLEMHEALTH/GHI-Commercial, +25916,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMBLEMHEALTH/GHI-Commercial, +25917,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMBLEMHEALTH/GHI-Commercial, +25918,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMBLEMHEALTH/GHI-Commercial, +25919,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMBLEMHEALTH/GHI-Commercial, +25920,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMBLEMHEALTH/GHI-Commercial, +25921,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMBLEMHEALTH/GHI-Commercial, +25922,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMBLEMHEALTH/GHI-Commercial,399.0 +25923,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMBLEMHEALTH/GHI-Commercial, +25924,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMBLEMHEALTH/GHI-Commercial, +25925,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMBLEMHEALTH/GHI-Commercial, +25926,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMBLEMHEALTH/GHI-Commercial, +25927,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMBLEMHEALTH/GHI-Commercial, +25928,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMBLEMHEALTH/GHI-Commercial, +25929,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMBLEMHEALTH/GHI-Commercial, +25930,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMBLEMHEALTH/GHI-Commercial, +25931,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMBLEMHEALTH/GHI-Commercial, +25932,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMBLEMHEALTH/GHI-Commercial, +25933,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMBLEMHEALTH/GHI-Commercial, +25934,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMBLEMHEALTH/GHI-Commercial, +25935,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMBLEMHEALTH/GHI-Commercial, +25936,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMBLEMHEALTH/GHI-Commercial, +25937,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMBLEMHEALTH/GHI-Commercial, +25938,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMBLEMHEALTH/GHI-Commercial, +25939,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMBLEMHEALTH/GHI-Commercial, +25940,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMBLEMHEALTH/GHI-Commercial, +25941,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMBLEMHEALTH/GHI-Commercial, +25942,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMBLEMHEALTH/GHI-Commercial, +25943,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMBLEMHEALTH/GHI-Commercial, +25944,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMBLEMHEALTH/GHI-Commercial, +25945,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMBLEMHEALTH/GHI-Commercial, +25946,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMBLEMHEALTH/GHI-Commercial, +25947,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMBLEMHEALTH/GHI-Commercial, +25948,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMBLEMHEALTH/GHI-Commercial, +25949,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMBLEMHEALTH/GHI-Commercial, +25950,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMBLEMHEALTH/GHI-Commercial, +25951,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMBLEMHEALTH/GHI-Commercial, +25952,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMBLEMHEALTH/GHI-Commercial, +25953,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMBLEMHEALTH/GHI-Commercial, +25954,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMBLEMHEALTH/GHI-Commercial, +25955,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMBLEMHEALTH/GHI-Commercial, +25956,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMBLEMHEALTH/GHI-Commercial, +25957,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMBLEMHEALTH/GHI-Commercial,2.77 +25958,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMBLEMHEALTH/GHI-Commercial, +25959,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMBLEMHEALTH/GHI-Commercial, +25960,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMBLEMHEALTH/GHI-Commercial, +25961,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMBLEMHEALTH/GHI-Commercial, +25962,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMBLEMHEALTH/GHI-Commercial, +25963,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMBLEMHEALTH/GHI-Commercial, +25964,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMBLEMHEALTH/GHI-Commercial, +25965,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMBLEMHEALTH/GHI-Commercial, +25966,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMBLEMHEALTH/GHI-Commercial, +25967,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMBLEMHEALTH/GHI-Commercial, +25968,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMBLEMHEALTH/GHI-Commercial, +25969,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMBLEMHEALTH/GHI-Commercial, +25970,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMBLEMHEALTH/GHI-Commercial, +25971,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMBLEMHEALTH/GHI-Commercial, +25972,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMBLEMHEALTH/GHI-Commercial, +25973,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMBLEMHEALTH/GHI-Commercial, +25974,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMBLEMHEALTH/GHI-Commercial, +25975,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMBLEMHEALTH/GHI-Commercial, +25976,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMBLEMHEALTH/GHI-Commercial,587.72 +25977,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMBLEMHEALTH/GHI-Commercial, +25978,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMBLEMHEALTH/GHI-Commercial, +25979,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMBLEMHEALTH/GHI-Commercial, +25980,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMBLEMHEALTH/GHI-Commercial, +25981,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMBLEMHEALTH/GHI-Commercial,1.65 +25982,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMBLEMHEALTH/GHI-Commercial,261.27 +25983,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMBLEMHEALTH/GHI-Commercial, +25984,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMBLEMHEALTH/GHI-Commercial, +25985,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMBLEMHEALTH/GHI-Commercial, +25986,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMBLEMHEALTH/GHI-Commercial, +25987,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMBLEMHEALTH/GHI-Commercial, +25988,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMBLEMHEALTH/GHI-Commercial, +25989,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMBLEMHEALTH/GHI-Commercial, +25990,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMBLEMHEALTH/GHI-Commercial, +25991,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMBLEMHEALTH/GHI-Commercial, +25992,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMBLEMHEALTH/GHI-Commercial, +25993,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMBLEMHEALTH/GHI-Commercial, +25994,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMBLEMHEALTH/GHI-Commercial, +25995,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMBLEMHEALTH/GHI-Commercial, +25996,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMBLEMHEALTH/GHI-Commercial, +25997,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMBLEMHEALTH/GHI-Commercial, +25998,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMBLEMHEALTH/GHI-Commercial, +25999,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMBLEMHEALTH/GHI-Commercial, +26000,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMBLEMHEALTH/GHI-Commercial, +26001,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMBLEMHEALTH/GHI-Commercial, +26002,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMBLEMHEALTH/GHI-Commercial, +26003,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMBLEMHEALTH/GHI-Commercial, +26004,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMBLEMHEALTH/GHI-Commercial, +26005,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMBLEMHEALTH/GHI-Commercial, +26006,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMBLEMHEALTH/GHI-Commercial, +26007,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMBLEMHEALTH/GHI-Commercial, +26008,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMBLEMHEALTH/GHI-Commercial, +26009,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMBLEMHEALTH/GHI-Commercial, +26010,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMBLEMHEALTH/GHI-Commercial, +26011,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMBLEMHEALTH/GHI-Commercial, +26012,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMBLEMHEALTH/GHI-Commercial, +26013,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMBLEMHEALTH/GHI-Commercial, +26014,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMBLEMHEALTH/GHI-Commercial, +26015,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMBLEMHEALTH/GHI-Commercial,1.23 +26016,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMBLEMHEALTH/GHI-Commercial, +26017,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMBLEMHEALTH/GHI-Commercial, +26018,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMBLEMHEALTH/GHI-Commercial, +26019,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMBLEMHEALTH/GHI-Commercial, +26020,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMBLEMHEALTH/GHI-Commercial, +26021,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMBLEMHEALTH/GHI-Commercial, +26022,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMBLEMHEALTH/GHI-Commercial, +26023,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMBLEMHEALTH/GHI-Commercial, +26024,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMBLEMHEALTH/GHI-Commercial, +26025,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMBLEMHEALTH/GHI-Commercial, +26026,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMBLEMHEALTH/GHI-Commercial, +26027,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMBLEMHEALTH/GHI-Commercial, +26028,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMBLEMHEALTH/GHI-Commercial, +26029,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMBLEMHEALTH/GHI-Commercial, +26030,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMBLEMHEALTH/GHI-Commercial, +26031,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMBLEMHEALTH/GHI-Commercial, +26032,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMBLEMHEALTH/GHI-Commercial, +26033,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMBLEMHEALTH/GHI-Commercial, +26034,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMBLEMHEALTH/GHI-Commercial, +26035,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMBLEMHEALTH/GHI-Commercial, +26036,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMBLEMHEALTH/GHI-Commercial, +26037,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMBLEMHEALTH/GHI-Commercial, +26038,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMBLEMHEALTH/GHI-Commercial, +26039,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMBLEMHEALTH/GHI-Commercial, +26040,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMBLEMHEALTH/GHI-Commercial, +26041,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMBLEMHEALTH/GHI-Commercial,25.5 +26042,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMBLEMHEALTH/GHI-Commercial, +26043,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMBLEMHEALTH/GHI-Commercial, +26044,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMBLEMHEALTH/GHI-Commercial, +26045,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMBLEMHEALTH/GHI-Commercial, +26046,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMBLEMHEALTH/GHI-Commercial, +26047,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMBLEMHEALTH/GHI-Commercial,626.4 +26048,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMBLEMHEALTH/GHI-Commercial, +26049,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMBLEMHEALTH/GHI-Commercial, +26050,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMBLEMHEALTH/GHI-Commercial, +26051,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMBLEMHEALTH/GHI-Commercial, +26052,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMBLEMHEALTH/GHI-Commercial, +26053,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMBLEMHEALTH/GHI-Commercial, +26054,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMBLEMHEALTH/GHI-Commercial,18809.98 +26055,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMBLEMHEALTH/GHI-Commercial, +26056,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMBLEMHEALTH/GHI-Commercial, +26057,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMBLEMHEALTH/GHI-Commercial, +26058,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMBLEMHEALTH/GHI-Commercial, +26059,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMBLEMHEALTH/GHI-Commercial, +26060,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMBLEMHEALTH/GHI-Commercial, +26061,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMBLEMHEALTH/GHI-Commercial, +26062,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMBLEMHEALTH/GHI-Commercial, +26063,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMBLEMHEALTH/GHI-Commercial, +26064,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMBLEMHEALTH/GHI-Commercial, +26065,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMBLEMHEALTH/GHI-Commercial, +26066,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMBLEMHEALTH/GHI-Commercial, +26067,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMBLEMHEALTH/GHI-Commercial, +26068,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMBLEMHEALTH/GHI-Commercial, +26069,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMBLEMHEALTH/GHI-Commercial, +26070,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMBLEMHEALTH/GHI-Commercial, +26071,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMBLEMHEALTH/GHI-Commercial, +26072,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMBLEMHEALTH/GHI-Commercial, +26073,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMBLEMHEALTH/GHI-Commercial, +26074,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMBLEMHEALTH/GHI-Commercial, +26075,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMBLEMHEALTH/GHI-Commercial, +26076,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMBLEMHEALTH/GHI-Commercial, +26077,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMBLEMHEALTH/GHI-Commercial, +26078,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMBLEMHEALTH/GHI-Commercial, +26079,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMBLEMHEALTH/GHI-Commercial, +26080,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMBLEMHEALTH/GHI-Commercial, +26081,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMBLEMHEALTH/GHI-Commercial,150.0 +26082,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMBLEMHEALTH/GHI-Commercial, +26083,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMBLEMHEALTH/GHI-Commercial, +26084,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMBLEMHEALTH/GHI-Commercial, +26085,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMBLEMHEALTH/GHI-Commercial, +26086,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMBLEMHEALTH/GHI-Commercial, +26087,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMBLEMHEALTH/GHI-Commercial, +26088,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMBLEMHEALTH/GHI-Commercial, +26089,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMBLEMHEALTH/GHI-Commercial, +26090,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMBLEMHEALTH/GHI-Commercial, +26091,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMBLEMHEALTH/GHI-Commercial,58.78 +26092,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMBLEMHEALTH/GHI-Commercial,100.0 +26093,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMBLEMHEALTH/GHI-Commercial, +26094,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMBLEMHEALTH/GHI-Commercial, +26095,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMBLEMHEALTH/GHI-Commercial, +26096,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMBLEMHEALTH/GHI-Commercial, +26097,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMBLEMHEALTH/GHI-Commercial, +26098,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMBLEMHEALTH/GHI-Commercial, +26099,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMBLEMHEALTH/GHI-Commercial, +26100,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMBLEMHEALTH/GHI-Commercial, +26101,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMBLEMHEALTH/GHI-Commercial, +26102,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMBLEMHEALTH/GHI-Commercial, +26103,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMBLEMHEALTH/GHI-Commercial, +26104,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMBLEMHEALTH/GHI-Commercial, +26105,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMBLEMHEALTH/GHI-Commercial, +26106,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMBLEMHEALTH/GHI-Commercial, +26107,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMBLEMHEALTH/GHI-Commercial, +26108,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMBLEMHEALTH/GHI-Commercial, +26109,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMBLEMHEALTH/GHI-Commercial, +26110,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMBLEMHEALTH/GHI-Commercial,248.77 +26111,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMBLEMHEALTH/GHI-Commercial, +26112,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMBLEMHEALTH/GHI-Commercial, +26113,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMBLEMHEALTH/GHI-Commercial, +26114,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMBLEMHEALTH/GHI-Commercial, +26115,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMBLEMHEALTH/GHI-Commercial, +26116,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMBLEMHEALTH/GHI-Commercial, +26117,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMBLEMHEALTH/GHI-Commercial, +26118,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMBLEMHEALTH/GHI-Commercial, +26119,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMBLEMHEALTH/GHI-Commercial, +26120,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMBLEMHEALTH/GHI-Commercial, +26121,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMBLEMHEALTH/GHI-Commercial, +26122,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMBLEMHEALTH/GHI-Commercial, +26123,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMBLEMHEALTH/GHI-Commercial, +26124,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMBLEMHEALTH/GHI-Commercial, +26125,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMBLEMHEALTH/GHI-Commercial,67.01 +26126,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMBLEMHEALTH/GHI-Commercial, +26127,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMBLEMHEALTH/GHI-Commercial, +26128,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMBLEMHEALTH/GHI-Commercial, +26129,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMBLEMHEALTH/GHI-Commercial, +26130,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMBLEMHEALTH/GHI-Commercial, +26131,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMBLEMHEALTH/GHI-Commercial, +26132,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMBLEMHEALTH/GHI-Commercial, +26133,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMBLEMHEALTH/GHI-Commercial, +26134,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMBLEMHEALTH/GHI-Commercial, +26135,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMBLEMHEALTH/GHI-Commercial, +26136,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMBLEMHEALTH/GHI-Commercial, +26137,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMBLEMHEALTH/GHI-Commercial, +26138,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMBLEMHEALTH/GHI-Commercial, +26139,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMBLEMHEALTH/GHI-Commercial, +26140,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMBLEMHEALTH/GHI-Commercial, +26141,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMBLEMHEALTH/GHI-Commercial, +26142,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMBLEMHEALTH/GHI-Commercial,93.93 +26143,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMBLEMHEALTH/GHI-Commercial, +26144,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMBLEMHEALTH/GHI-Commercial, +26145,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMBLEMHEALTH/GHI-Commercial, +26146,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMBLEMHEALTH/GHI-Commercial,46.98 +26147,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMBLEMHEALTH/GHI-Commercial, +26148,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMBLEMHEALTH/GHI-Commercial, +26149,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMBLEMHEALTH/GHI-Commercial, +26150,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMBLEMHEALTH/GHI-Commercial, +26151,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMBLEMHEALTH/GHI-Commercial, +26152,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMBLEMHEALTH/GHI-Commercial, +26153,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMBLEMHEALTH/GHI-Commercial, +26154,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMBLEMHEALTH/GHI-Commercial,36.6 +26155,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMBLEMHEALTH/GHI-Commercial, +26156,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMBLEMHEALTH/GHI-Commercial, +26157,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMBLEMHEALTH/GHI-Commercial,20.88 +26158,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMBLEMHEALTH/GHI-Commercial, +26159,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMBLEMHEALTH/GHI-Commercial, +26160,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMBLEMHEALTH/GHI-Commercial, +26161,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMBLEMHEALTH/GHI-Commercial, +26162,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMBLEMHEALTH/GHI-Commercial,10.62 +26163,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMBLEMHEALTH/GHI-Commercial, +26164,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMBLEMHEALTH/GHI-Commercial, +26165,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMBLEMHEALTH/GHI-Commercial, +26166,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMBLEMHEALTH/GHI-Commercial, +26167,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMBLEMHEALTH/GHI-Commercial, +26168,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMBLEMHEALTH/GHI-Commercial, +26169,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMBLEMHEALTH/GHI-Commercial, +26170,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMBLEMHEALTH/GHI-Commercial, +26171,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMBLEMHEALTH/GHI-Commercial, +26172,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMBLEMHEALTH/GHI-Commercial, +26173,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMBLEMHEALTH/GHI-Commercial, +26174,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMBLEMHEALTH/GHI-Commercial, +26175,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMBLEMHEALTH/GHI-Commercial, +26176,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMBLEMHEALTH/GHI-Commercial, +26177,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMBLEMHEALTH/GHI-Commercial,1.87 +26178,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMBLEMHEALTH/GHI-Commercial, +26179,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMBLEMHEALTH/GHI-Commercial, +26180,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMBLEMHEALTH/GHI-Commercial, +26181,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMBLEMHEALTH/GHI-Commercial, +26182,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMBLEMHEALTH/GHI-Commercial,2.95 +26183,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMBLEMHEALTH/GHI-Commercial, +26184,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMBLEMHEALTH/GHI-Commercial, +26185,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMBLEMHEALTH/GHI-Commercial, +26186,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMBLEMHEALTH/GHI-Commercial, +26187,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMBLEMHEALTH/GHI-Commercial, +26188,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMBLEMHEALTH/GHI-Commercial,390.6 +26189,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMBLEMHEALTH/GHI-Commercial, +26190,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMBLEMHEALTH/GHI-Commercial,67.1 +26191,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMBLEMHEALTH/GHI-Commercial, +26192,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMBLEMHEALTH/GHI-Commercial, +26193,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMBLEMHEALTH/GHI-Commercial, +26194,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMBLEMHEALTH/GHI-Commercial, +26195,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMBLEMHEALTH/GHI-Commercial,10842.0 +26196,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMBLEMHEALTH/GHI-Commercial, +26197,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMBLEMHEALTH/GHI-Commercial, +26198,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMBLEMHEALTH/GHI-Commercial, +26199,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMBLEMHEALTH/GHI-Commercial, +26200,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMBLEMHEALTH/GHI-Commercial, +26201,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMBLEMHEALTH/GHI-Commercial, +26202,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMBLEMHEALTH/GHI-Commercial, +26203,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMBLEMHEALTH/GHI-Commercial, +26204,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMBLEMHEALTH/GHI-Commercial, +26205,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMBLEMHEALTH/GHI-Commercial,10.98 +26206,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMBLEMHEALTH/GHI-Commercial,2.28 +26207,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMBLEMHEALTH/GHI-Commercial, +26208,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMBLEMHEALTH/GHI-Commercial, +26209,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMBLEMHEALTH/GHI-Commercial, +26210,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMBLEMHEALTH/GHI-Commercial, +26211,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMBLEMHEALTH/GHI-Commercial,12632.33 +26212,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMBLEMHEALTH/GHI-Commercial, +26213,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMBLEMHEALTH/GHI-Commercial, +26214,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMBLEMHEALTH/GHI-Commercial,1.47 +26215,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMBLEMHEALTH/GHI-Commercial,18.0 +26216,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMBLEMHEALTH/GHI-Commercial, +26217,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMBLEMHEALTH/GHI-Commercial, +26218,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMBLEMHEALTH/GHI-Commercial, +26219,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMBLEMHEALTH/GHI-Commercial, +26220,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMBLEMHEALTH/GHI-Commercial, +26221,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMBLEMHEALTH/GHI-Commercial,1.84 +26222,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMBLEMHEALTH/GHI-Commercial, +26223,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMBLEMHEALTH/GHI-Commercial,2.7 +26224,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMBLEMHEALTH/GHI-Commercial, +26225,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMBLEMHEALTH/GHI-Commercial, +26226,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMBLEMHEALTH/GHI-Commercial, +26227,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMBLEMHEALTH/GHI-Commercial, +26228,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMBLEMHEALTH/GHI-Commercial, +26229,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMBLEMHEALTH/GHI-Commercial, +26230,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMBLEMHEALTH/GHI-Commercial,0.09 +26231,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMBLEMHEALTH/GHI-Commercial, +26232,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMBLEMHEALTH/GHI-Commercial,7.19 +26233,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMBLEMHEALTH/GHI-Commercial,1.23 +26234,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMBLEMHEALTH/GHI-Commercial, +26235,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMBLEMHEALTH/GHI-Commercial, +26236,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMBLEMHEALTH/GHI-Commercial, +26237,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMBLEMHEALTH/GHI-Commercial, +26238,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMBLEMHEALTH/GHI-Commercial, +26239,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMBLEMHEALTH/GHI-Commercial, +26240,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMBLEMHEALTH/GHI-Commercial, +26241,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMBLEMHEALTH/GHI-Commercial, +26242,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMBLEMHEALTH/GHI-Commercial, +26243,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMBLEMHEALTH/GHI-Commercial,2.16 +26244,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMBLEMHEALTH/GHI-Commercial, +26245,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMBLEMHEALTH/GHI-Commercial, +26246,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMBLEMHEALTH/GHI-Commercial, +26247,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMBLEMHEALTH/GHI-Commercial,182.75 +26248,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMBLEMHEALTH/GHI-Commercial, +26249,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMBLEMHEALTH/GHI-Commercial, +26250,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMBLEMHEALTH/GHI-Commercial, +26251,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMBLEMHEALTH/GHI-Commercial, +26252,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMBLEMHEALTH/GHI-Commercial, +26253,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMBLEMHEALTH/GHI-Commercial, +26254,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMBLEMHEALTH/GHI-Commercial, +26255,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMBLEMHEALTH/GHI-Commercial,49.55 +26256,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMBLEMHEALTH/GHI-Commercial, +26257,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMBLEMHEALTH/GHI-Commercial, +26258,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMBLEMHEALTH/GHI-Commercial, +26259,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMBLEMHEALTH/GHI-Commercial,741.0 +26260,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMBLEMHEALTH/GHI-Commercial, +26261,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMBLEMHEALTH/GHI-Commercial, +26262,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMBLEMHEALTH/GHI-Commercial, +26263,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMBLEMHEALTH/GHI-Commercial, +26264,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMBLEMHEALTH/GHI-Commercial,427.72 +26265,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMBLEMHEALTH/GHI-Commercial, +26266,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMBLEMHEALTH/GHI-Commercial, +26267,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMBLEMHEALTH/GHI-Commercial, +26268,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMBLEMHEALTH/GHI-Commercial,50.94 +26269,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMBLEMHEALTH/GHI-Commercial,0.33 +26270,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMBLEMHEALTH/GHI-Commercial, +26271,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMBLEMHEALTH/GHI-Commercial, +26272,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMBLEMHEALTH/GHI-Commercial, +26273,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMBLEMHEALTH/GHI-Commercial, +26274,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMBLEMHEALTH/GHI-Commercial, +26275,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMBLEMHEALTH/GHI-Commercial, +26276,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMBLEMHEALTH/GHI-Commercial,71.05 +26277,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMBLEMHEALTH/GHI-Commercial, +26278,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMBLEMHEALTH/GHI-Commercial, +26279,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMBLEMHEALTH/GHI-Commercial,17348.4 +26280,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMBLEMHEALTH/GHI-Commercial, +26281,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMBLEMHEALTH/GHI-Commercial, +26282,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMBLEMHEALTH/GHI-Commercial, +26283,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMBLEMHEALTH/GHI-Commercial, +26284,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMBLEMHEALTH/GHI-Commercial, +26285,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMBLEMHEALTH/GHI-Commercial,1.88 +26286,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMBLEMHEALTH/GHI-Commercial, +26287,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMBLEMHEALTH/GHI-Commercial,75.8 +26288,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMBLEMHEALTH/GHI-Commercial,100.59 +26289,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMBLEMHEALTH/GHI-Commercial, +26290,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMBLEMHEALTH/GHI-Commercial, +26291,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMBLEMHEALTH/GHI-Commercial, +26292,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMBLEMHEALTH/GHI-Commercial,7.02 +26293,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMBLEMHEALTH/GHI-Commercial,2.19 +26294,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMBLEMHEALTH/GHI-Commercial, +26295,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMBLEMHEALTH/GHI-Commercial,14.85 +26296,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMBLEMHEALTH/GHI-Commercial,7.09 +26297,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMBLEMHEALTH/GHI-Commercial, +26298,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMBLEMHEALTH/GHI-Commercial, +26299,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMBLEMHEALTH/GHI-Commercial, +26300,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMBLEMHEALTH/GHI-Commercial, +26301,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMBLEMHEALTH/GHI-Commercial, +26302,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMBLEMHEALTH/GHI-Commercial, +26303,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMBLEMHEALTH/GHI-Commercial, +26304,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMBLEMHEALTH/GHI-Commercial, +26305,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMBLEMHEALTH/GHI-Commercial, +26306,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMBLEMHEALTH/GHI-Commercial, +26307,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMBLEMHEALTH/GHI-Commercial, +26308,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMBLEMHEALTH/GHI-Commercial, +26309,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMBLEMHEALTH/GHI-Commercial, +26310,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMBLEMHEALTH/GHI-Commercial, +26311,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMBLEMHEALTH/GHI-Commercial, +26312,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMBLEMHEALTH/GHI-Commercial, +26313,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMBLEMHEALTH/GHI-Commercial, +26314,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMBLEMHEALTH/GHI-Commercial, +26315,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMBLEMHEALTH/GHI-Commercial, +26316,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMBLEMHEALTH/GHI-Commercial, +26317,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMBLEMHEALTH/GHI-Commercial, +26318,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMBLEMHEALTH/GHI-Commercial, +26319,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMBLEMHEALTH/GHI-Commercial, +26320,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMBLEMHEALTH/GHI-Commercial, +26321,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMBLEMHEALTH/GHI-Commercial, +26322,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMBLEMHEALTH/GHI-Commercial, +26323,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMBLEMHEALTH/GHI-Commercial, +26324,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMBLEMHEALTH/GHI-Commercial, +26325,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMBLEMHEALTH/GHI-Commercial, +26326,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMBLEMHEALTH/GHI-Commercial, +26327,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMBLEMHEALTH/GHI-Commercial, +26328,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMBLEMHEALTH/GHI-Commercial, +26329,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMBLEMHEALTH/GHI-Commercial, +26330,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMBLEMHEALTH/GHI-Commercial, +26331,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMBLEMHEALTH/GHI-Commercial, +26332,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMBLEMHEALTH/GHI-Commercial, +26333,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMBLEMHEALTH/GHI-Commercial, +26334,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMBLEMHEALTH/GHI-Commercial, +26335,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMBLEMHEALTH/GHI-Commercial, +26336,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMBLEMHEALTH/GHI-Commercial, +26337,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMBLEMHEALTH/GHI-Commercial, +26338,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMBLEMHEALTH/GHI-Commercial, +26339,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMBLEMHEALTH/GHI-Commercial, +26340,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMBLEMHEALTH/GHI-Commercial, +26341,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMBLEMHEALTH/GHI-Commercial, +26342,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMBLEMHEALTH/GHI-Commercial, +26343,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMBLEMHEALTH/GHI-Commercial, +26344,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMBLEMHEALTH/GHI-Commercial, +26345,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMBLEMHEALTH/GHI-Commercial, +26346,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMBLEMHEALTH/GHI-Commercial, +26347,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMBLEMHEALTH/GHI-Commercial, +26348,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMBLEMHEALTH/GHI-Commercial, +26349,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMBLEMHEALTH/GHI-Commercial, +26350,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMBLEMHEALTH/GHI-Commercial, +26351,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMBLEMHEALTH/GHI-Commercial, +26352,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMBLEMHEALTH/GHI-Commercial, +26353,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMBLEMHEALTH/GHI-Commercial, +26354,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMBLEMHEALTH/GHI-Commercial, +26355,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMBLEMHEALTH/GHI-Commercial, +26356,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMBLEMHEALTH/GHI-Commercial, +26357,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMBLEMHEALTH/GHI-Commercial, +26358,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMBLEMHEALTH/GHI-Commercial,2286.9 +26359,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMBLEMHEALTH/GHI-Commercial, +26360,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMBLEMHEALTH/GHI-Commercial, +26361,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMBLEMHEALTH/GHI-Commercial, +26362,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMBLEMHEALTH/GHI-Commercial, +26363,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMBLEMHEALTH/GHI-Commercial,16.2 +26364,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMBLEMHEALTH/GHI-Commercial, +26365,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMBLEMHEALTH/GHI-Commercial, +26366,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMBLEMHEALTH/GHI-Commercial, +26367,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMBLEMHEALTH/GHI-Commercial, +26368,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMBLEMHEALTH/GHI-Commercial, +26369,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMBLEMHEALTH/GHI-Commercial, +26370,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMBLEMHEALTH/GHI-Commercial, +26371,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMBLEMHEALTH/GHI-Commercial,133929.96 +26372,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMBLEMHEALTH/GHI-Commercial,8.66 +26373,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMBLEMHEALTH/GHI-Commercial,71063.4 +26374,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMBLEMHEALTH/GHI-Commercial, +26375,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMBLEMHEALTH/GHI-Commercial, +26376,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMBLEMHEALTH/GHI-Commercial, +26377,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMBLEMHEALTH/GHI-Commercial, +26378,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMBLEMHEALTH/GHI-Commercial, +26379,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMBLEMHEALTH/GHI-Commercial, +26380,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMBLEMHEALTH/GHI-Commercial,257.35 +26381,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMBLEMHEALTH/GHI-Commercial, +26382,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMBLEMHEALTH/GHI-Commercial, +26383,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMBLEMHEALTH/GHI-Commercial, +26384,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMBLEMHEALTH/GHI-Commercial, +26385,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMBLEMHEALTH/GHI-Commercial, +26386,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMBLEMHEALTH/GHI-Commercial, +26387,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMBLEMHEALTH/GHI-Commercial,339.52 +26388,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMBLEMHEALTH/GHI-Commercial, +26389,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMBLEMHEALTH/GHI-Commercial, +26390,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMBLEMHEALTH/GHI-Commercial, +26391,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMBLEMHEALTH/GHI-Commercial, +26392,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMBLEMHEALTH/GHI-Commercial, +26393,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMBLEMHEALTH/GHI-Commercial, +26394,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMBLEMHEALTH/GHI-Commercial, +26395,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMBLEMHEALTH/GHI-Commercial, +26396,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMBLEMHEALTH/GHI-Commercial, +26397,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMBLEMHEALTH/GHI-Commercial, +26398,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMBLEMHEALTH/GHI-Commercial, +26399,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMBLEMHEALTH/GHI-Commercial, +26400,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMBLEMHEALTH/GHI-Commercial, +26401,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMBLEMHEALTH/GHI-Commercial, +26402,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMBLEMHEALTH/GHI-Commercial, +26403,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMBLEMHEALTH/GHI-Commercial, +26404,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMBLEMHEALTH/GHI-Commercial, +26405,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMBLEMHEALTH/GHI-Commercial, +26406,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMBLEMHEALTH/GHI-Commercial, +26407,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMBLEMHEALTH/GHI-Commercial, +26408,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMBLEMHEALTH/GHI-Commercial, +26409,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMBLEMHEALTH/GHI-Commercial, +26410,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMBLEMHEALTH/GHI-Commercial, +26411,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMBLEMHEALTH/GHI-Commercial, +26412,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMBLEMHEALTH/GHI-Commercial, +26413,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMBLEMHEALTH/GHI-Commercial, +26414,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMBLEMHEALTH/GHI-Commercial, +26415,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMBLEMHEALTH/GHI-Commercial, +26416,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMBLEMHEALTH/GHI-Commercial,753.5 +26417,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMBLEMHEALTH/GHI-Commercial, +26418,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMBLEMHEALTH/GHI-Commercial, +26419,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMBLEMHEALTH/GHI-Commercial, +26420,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMBLEMHEALTH/GHI-Commercial, +26421,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMBLEMHEALTH/GHI-Commercial, +26422,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMBLEMHEALTH/GHI-Commercial, +26423,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMBLEMHEALTH/GHI-Commercial, +26424,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMBLEMHEALTH/GHI-Commercial, +26425,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMBLEMHEALTH/GHI-Commercial,3634.5 +26426,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMBLEMHEALTH/GHI-Commercial, +26427,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMBLEMHEALTH/GHI-Commercial, +26428,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMBLEMHEALTH/GHI-Commercial, +26429,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMBLEMHEALTH/GHI-Commercial, +26430,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMBLEMHEALTH/GHI-Commercial, +26431,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMBLEMHEALTH/GHI-Commercial, +26432,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMBLEMHEALTH/GHI-Commercial,7134.9 +26433,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMBLEMHEALTH/GHI-Commercial, +26434,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMBLEMHEALTH/GHI-Commercial,69.34 +26435,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMBLEMHEALTH/GHI-Commercial, +26436,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMBLEMHEALTH/GHI-Commercial, +26437,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMBLEMHEALTH/GHI-Commercial, +26438,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMBLEMHEALTH/GHI-Commercial, +26439,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMBLEMHEALTH/GHI-Commercial, +26440,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMBLEMHEALTH/GHI-Commercial,8.23 +26441,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMBLEMHEALTH/GHI-Commercial, +26442,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMBLEMHEALTH/GHI-Commercial, +26443,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMBLEMHEALTH/GHI-Commercial, +26444,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMBLEMHEALTH/GHI-Commercial, +26445,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMBLEMHEALTH/GHI-Commercial, +26446,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMBLEMHEALTH/GHI-Commercial, +26447,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMBLEMHEALTH/GHI-Commercial, +26448,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMBLEMHEALTH/GHI-Commercial, +26449,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMBLEMHEALTH/GHI-Commercial, +26450,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMBLEMHEALTH/GHI-Commercial, +26451,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMBLEMHEALTH/GHI-Commercial, +26452,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMBLEMHEALTH/GHI-Commercial, +26453,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMBLEMHEALTH/GHI-Commercial, +26454,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMBLEMHEALTH/GHI-Commercial, +26455,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMBLEMHEALTH/GHI-Commercial, +26456,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMBLEMHEALTH/GHI-Commercial, +26457,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMBLEMHEALTH/GHI-Commercial, +26458,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMBLEMHEALTH/GHI-Commercial, +26459,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMBLEMHEALTH/GHI-Commercial, +26460,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMBLEMHEALTH/GHI-Commercial, +26461,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMBLEMHEALTH/GHI-Commercial, +26462,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMBLEMHEALTH/GHI-Commercial, +26463,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMBLEMHEALTH/GHI-Commercial, +26464,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMBLEMHEALTH/GHI-Commercial, +26465,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMBLEMHEALTH/GHI-Commercial, +26466,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMBLEMHEALTH/GHI-Commercial, +26467,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMBLEMHEALTH/GHI-Commercial, +26468,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMBLEMHEALTH/GHI-Commercial, +26469,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMBLEMHEALTH/GHI-Commercial, +26470,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMBLEMHEALTH/GHI-Commercial,200.0 +26471,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMBLEMHEALTH/GHI-Commercial,1997.0 +26472,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMBLEMHEALTH/GHI-Commercial,51.5 +26473,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMBLEMHEALTH/GHI-Commercial, +26474,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMBLEMHEALTH/GHI-Commercial, +26475,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMBLEMHEALTH/GHI-Commercial,191.25 +26476,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMBLEMHEALTH/GHI-Commercial, +26477,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMBLEMHEALTH/GHI-Commercial, +26478,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMBLEMHEALTH/GHI-Commercial, +26479,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMBLEMHEALTH/GHI-Commercial, +26480,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMBLEMHEALTH/GHI-Commercial, +26481,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMBLEMHEALTH/GHI-Commercial,1002.0 +26482,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMBLEMHEALTH/GHI-Commercial, +26483,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26484,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26485,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26486,3934,30000038,ICU,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26487,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26488,3934,30000053,NICU,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26489,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26490,3934,30000079,PSYCH,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26491,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26492,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26493,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26494,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26495,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26496,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26497,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26498,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26499,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26500,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26501,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26502,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26503,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26504,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26505,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26506,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26507,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26508,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26509,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26510,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26511,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26512,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26513,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26514,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26515,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26516,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26517,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26518,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26519,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26520,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26521,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26522,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26523,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26524,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26525,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26526,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26527,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26528,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26529,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26530,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26531,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26532,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26533,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26534,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26535,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26536,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26537,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26538,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26539,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26540,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26541,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26542,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26543,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26544,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26545,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26546,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26547,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26548,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26549,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26550,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26551,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26552,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26553,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26554,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26555,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26556,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26557,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26558,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26559,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26560,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26561,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26562,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26563,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26564,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26565,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26566,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26567,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26568,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26569,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26570,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26571,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26572,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26573,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26574,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26575,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26576,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26577,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26578,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26579,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26580,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26581,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26582,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26583,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26584,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26585,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26586,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26587,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26588,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26589,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26590,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26591,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26592,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26593,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26594,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26595,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26596,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26597,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26598,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26599,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26600,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26601,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26602,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26603,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26604,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26605,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26606,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26607,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26608,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26609,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26610,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26611,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26612,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26613,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26614,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26615,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26616,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26617,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26618,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26619,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26620,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26621,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26622,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26623,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26624,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26625,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26626,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26627,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26628,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26629,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26630,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26631,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26632,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26633,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26634,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26635,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26636,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26637,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26638,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26639,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26640,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26641,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26642,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26643,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26644,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26645,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26646,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26647,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26648,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26649,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26650,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26651,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26652,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26653,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26654,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26655,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26656,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26657,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26658,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26659,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26660,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26661,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26662,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26663,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26664,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26665,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26666,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26667,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26668,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26669,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26670,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26671,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26672,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26673,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26674,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26675,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26676,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26677,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26678,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26679,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26680,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26681,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26682,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26683,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26684,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26685,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26686,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26687,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26688,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26689,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26690,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26691,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26692,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26693,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26694,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26695,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26696,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26697,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26698,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26699,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26700,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26701,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26702,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26703,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26704,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26705,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26706,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26707,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26708,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26709,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26710,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26711,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26712,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26713,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26714,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26715,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26716,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26717,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26718,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26719,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26720,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26721,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26722,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26723,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26724,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26725,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26726,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26727,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26728,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26729,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26730,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26731,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26732,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26733,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26734,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26735,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26736,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26737,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26738,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26739,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26740,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26741,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26742,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26743,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26744,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26745,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26746,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26747,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26748,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26749,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26750,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26751,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26752,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26753,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26754,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26755,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26756,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26757,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26758,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26759,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26760,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26761,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26762,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26763,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26764,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26765,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26766,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26767,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26768,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26769,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26770,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26771,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26772,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26773,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26774,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26775,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26776,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26777,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26778,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26779,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26780,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26781,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26782,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26783,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26784,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26785,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26786,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26787,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26788,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26789,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26790,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26791,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26792,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26793,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26794,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26795,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26796,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26797,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26798,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26799,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26800,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26801,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26802,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26803,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26804,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26805,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26806,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26807,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26808,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26809,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26810,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26811,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26812,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26813,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26814,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26815,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26816,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26817,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26818,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26819,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26820,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26821,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26822,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26823,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26824,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26825,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26826,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26827,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26828,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26829,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26830,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26831,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26832,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26833,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26834,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26835,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26836,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26837,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26838,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26839,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26840,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26841,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26842,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26843,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26844,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26845,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26846,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26847,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26848,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26849,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26850,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26851,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26852,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26853,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26854,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26855,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26856,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26857,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26858,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26859,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26860,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26861,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26862,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26863,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26864,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26865,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26866,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26867,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26868,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26869,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26870,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26871,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26872,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26873,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26874,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26875,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26876,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26877,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26878,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26879,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26880,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26881,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26882,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26883,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26884,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26885,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26886,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26887,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26888,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26889,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26890,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26891,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26892,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26893,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26894,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26895,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26896,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26897,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26898,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26899,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26900,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26901,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/GHI-Commercial, +26902,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26903,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26904,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26905,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26906,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26907,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26908,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/GHI-Commercial, +26909,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26910,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26911,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26912,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26913,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26914,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26915,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26916,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26917,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26918,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26919,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26920,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26921,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26922,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26923,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26924,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26925,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26926,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/GHI-Commercial, +26927,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/GHI-Commercial, +26928,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/GHI-Commercial, +26929,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMBLEMHEALTH/GHI-Commercial, +26930,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMBLEMHEALTH/GHI-Commercial, +26931,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMBLEMHEALTH/GHI-Commercial, +26932,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMBLEMHEALTH/GHI-Commercial, +26933,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26934,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26935,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26936,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26937,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26938,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26939,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26940,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26941,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26942,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26943,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26944,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26945,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMBLEMHEALTH/GHI-Commercial, +26946,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMBLEMHEALTH/GHI-Commercial, +26947,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMBLEMHEALTH/GHI-Commercial, +26948,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMBLEMHEALTH/GHI-Commercial, +26949,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMBLEMHEALTH/GHI-Commercial, +26950,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMBLEMHEALTH/GHI-Commercial, +26951,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMBLEMHEALTH/GHI-Commercial, +26952,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMBLEMHEALTH/GHI-Commercial, +26953,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMBLEMHEALTH/GHI-Commercial, +26954,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMBLEMHEALTH/GHI-Commercial, +26955,3934,37112034,TRIAGE,,277.0,277.0,,,EMBLEMHEALTH/GHI-Commercial, +26956,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMBLEMHEALTH/GHI-Commercial, +26957,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMBLEMHEALTH/GHI-Commercial, +26958,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMBLEMHEALTH/GHI-Commercial, +26959,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMBLEMHEALTH/GHI-Commercial, +26960,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMBLEMHEALTH/GHI-Commercial, +26961,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/GHI-Commercial, +26962,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/GHI-Commercial, +26963,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMBLEMHEALTH/GHI-Commercial, +26964,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMBLEMHEALTH/GHI-Commercial, +26965,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMBLEMHEALTH/GHI-Commercial, +26966,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMBLEMHEALTH/GHI-Commercial, +26967,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMBLEMHEALTH/GHI-Commercial, +26968,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMBLEMHEALTH/GHI-Commercial, +26969,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMBLEMHEALTH/GHI-Commercial, +26970,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMBLEMHEALTH/GHI-Commercial, +26971,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMBLEMHEALTH/GHI-Commercial, +26972,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMBLEMHEALTH/GHI-Commercial, +26973,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMBLEMHEALTH/GHI-Commercial, +26974,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMBLEMHEALTH/GHI-Commercial, +26975,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMBLEMHEALTH/GHI-Commercial, +26976,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMBLEMHEALTH/GHI-Commercial, +26977,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMBLEMHEALTH/GHI-Commercial, +26978,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMBLEMHEALTH/GHI-Commercial, +26979,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMBLEMHEALTH/GHI-Commercial, +26980,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMBLEMHEALTH/GHI-Commercial, +26981,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMBLEMHEALTH/GHI-Commercial, +26982,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMBLEMHEALTH/GHI-Commercial, +26983,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMBLEMHEALTH/GHI-Commercial, +26984,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMBLEMHEALTH/GHI-Commercial, +26985,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMBLEMHEALTH/GHI-Commercial, +26986,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMBLEMHEALTH/GHI-Commercial, +26987,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMBLEMHEALTH/GHI-Commercial, +26988,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,EMBLEMHEALTH/GHI-Commercial, +26989,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,EMBLEMHEALTH/GHI-Commercial, +26990,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,EMBLEMHEALTH/GHI-Commercial, +26991,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,EMBLEMHEALTH/GHI-Commercial, +26992,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,EMBLEMHEALTH/GHI-Commercial, +26993,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,EMBLEMHEALTH/GHI-Commercial, +26994,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,EMBLEMHEALTH/GHI-Commercial, +26995,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,EMBLEMHEALTH/GHI-Commercial, +26996,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,EMBLEMHEALTH/GHI-Commercial, +26997,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,EMBLEMHEALTH/GHI-Commercial, +26998,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,EMBLEMHEALTH/GHI-Commercial, +26999,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMBLEMHEALTH/GHI-Commercial, +27000,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMBLEMHEALTH/GHI-Commercial, +27001,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMBLEMHEALTH/GHI-Commercial, +27002,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMBLEMHEALTH/GHI-Commercial, +27003,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMBLEMHEALTH/GHI-Commercial, +27004,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMBLEMHEALTH/GHI-Commercial, +27005,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMBLEMHEALTH/GHI-Commercial, +27006,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMBLEMHEALTH/GHI-Commercial, +27007,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMBLEMHEALTH/GHI-Commercial, +27008,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMBLEMHEALTH/GHI-Commercial, +27009,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMBLEMHEALTH/GHI-Commercial, +27010,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMBLEMHEALTH/GHI-Commercial, +27011,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMBLEMHEALTH/GHI-Commercial, +27012,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMBLEMHEALTH/GHI-Commercial, +27013,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/GHI-Commercial, +27014,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/GHI-Commercial, +27015,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/GHI-Commercial, +27016,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/GHI-Commercial, +27017,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/GHI-Commercial, +27018,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/GHI-Commercial, +27019,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/GHI-Commercial, +27020,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/GHI-Commercial, +27021,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/GHI-Commercial, +27022,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/GHI-Commercial, +27023,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/GHI-Commercial, +27024,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/GHI-Commercial, +27025,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/GHI-Commercial, +27026,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/GHI-Commercial, +27027,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/GHI-Commercial, +27028,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/GHI-Commercial, +27029,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/GHI-Commercial, +27030,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/GHI-Commercial, +27031,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/GHI-Commercial, +27032,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/GHI-Commercial, +27033,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/GHI-Commercial, +27034,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/GHI-Commercial, +27035,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/GHI-Commercial, +27036,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/GHI-Commercial, +27037,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/GHI-Commercial, +27038,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/GHI-Commercial, +27039,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/GHI-Commercial, +27040,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/GHI-Commercial, +27041,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/GHI-Commercial, +27042,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/GHI-Commercial, +27043,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/GHI-Commercial, +27044,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/GHI-Commercial, +27045,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/GHI-Commercial, +27046,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/GHI-Commercial, +27047,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/GHI-Commercial, +27048,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/GHI-Commercial, +27049,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/GHI-Commercial, +27050,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/GHI-Commercial, +27051,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/GHI-Commercial, +27052,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/GHI-Commercial, +27053,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/GHI-Commercial, +27054,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/GHI-Commercial, +27055,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/GHI-Commercial, +27056,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27057,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27058,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27059,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27060,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27061,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMBLEMHEALTH/GHI-Commercial, +27062,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMBLEMHEALTH/GHI-Commercial, +27063,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMBLEMHEALTH/GHI-Commercial, +27064,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27065,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27066,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27067,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMBLEMHEALTH/GHI-Commercial, +27068,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMBLEMHEALTH/GHI-Commercial, +27069,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMBLEMHEALTH/GHI-Commercial, +27070,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMBLEMHEALTH/GHI-Commercial, +27071,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMBLEMHEALTH/GHI-Commercial, +27072,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMBLEMHEALTH/GHI-Commercial, +27073,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMBLEMHEALTH/GHI-Commercial, +27074,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMBLEMHEALTH/GHI-Commercial, +27075,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMBLEMHEALTH/GHI-Commercial, +27076,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMBLEMHEALTH/GHI-Commercial, +27077,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMBLEMHEALTH/GHI-Commercial, +27078,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMBLEMHEALTH/GHI-Commercial, +27079,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMBLEMHEALTH/GHI-Commercial, +27080,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMBLEMHEALTH/GHI-Commercial, +27081,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMBLEMHEALTH/GHI-Commercial, +27082,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMBLEMHEALTH/GHI-Commercial, +27083,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMBLEMHEALTH/GHI-Commercial, +27084,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMBLEMHEALTH/GHI-Commercial, +27085,3934,43301043,ALBUNEX,,357.0,357.0,,,EMBLEMHEALTH/GHI-Commercial, +27086,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMBLEMHEALTH/GHI-Commercial, +27087,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27088,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27089,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27090,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27091,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27092,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMBLEMHEALTH/GHI-Commercial, +27093,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMBLEMHEALTH/GHI-Commercial, +27094,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMBLEMHEALTH/GHI-Commercial, +27095,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMBLEMHEALTH/GHI-Commercial, +27096,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMBLEMHEALTH/GHI-Commercial, +27097,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMBLEMHEALTH/GHI-Commercial, +27098,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMBLEMHEALTH/GHI-Commercial, +27099,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMBLEMHEALTH/GHI-Commercial, +27100,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMBLEMHEALTH/GHI-Commercial, +27101,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMBLEMHEALTH/GHI-Commercial, +27102,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMBLEMHEALTH/GHI-Commercial, +27103,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMBLEMHEALTH/GHI-Commercial, +27104,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMBLEMHEALTH/GHI-Commercial, +27105,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMBLEMHEALTH/GHI-Commercial, +27106,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMBLEMHEALTH/GHI-Commercial, +27107,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMBLEMHEALTH/GHI-Commercial, +27108,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMBLEMHEALTH/GHI-Commercial, +27109,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMBLEMHEALTH/GHI-Commercial, +27110,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/GHI-Commercial, +27111,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27112,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27113,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27114,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27115,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27116,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMBLEMHEALTH/GHI-Commercial, +27117,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27118,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/GHI-Commercial, +27119,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27120,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27121,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27122,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27123,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMBLEMHEALTH/GHI-Commercial, +27124,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/GHI-Commercial, +27125,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27126,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27127,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27128,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27129,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27130,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/GHI-Commercial, +27131,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27132,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27133,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27134,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27135,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27136,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMBLEMHEALTH/GHI-Commercial, +27137,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMBLEMHEALTH/GHI-Commercial, +27138,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMBLEMHEALTH/GHI-Commercial, +27139,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMBLEMHEALTH/GHI-Commercial, +27140,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMBLEMHEALTH/GHI-Commercial, +27141,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMBLEMHEALTH/GHI-Commercial, +27142,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMBLEMHEALTH/GHI-Commercial, +27143,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMBLEMHEALTH/GHI-Commercial, +27144,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/GHI-Commercial, +27145,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27146,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27147,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27148,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27149,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27150,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27151,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMBLEMHEALTH/GHI-Commercial, +27152,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMBLEMHEALTH/GHI-Commercial, +27153,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMBLEMHEALTH/GHI-Commercial, +27154,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMBLEMHEALTH/GHI-Commercial, +27155,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMBLEMHEALTH/GHI-Commercial, +27156,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/GHI-Commercial, +27157,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/GHI-Commercial, +27158,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/GHI-Commercial, +27159,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMBLEMHEALTH/GHI-Commercial, +27160,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMBLEMHEALTH/GHI-Commercial, +27161,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMBLEMHEALTH/GHI-Commercial, +27162,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMBLEMHEALTH/GHI-Commercial, +27163,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMBLEMHEALTH/GHI-Commercial, +27164,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMBLEMHEALTH/GHI-Commercial, +27165,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMBLEMHEALTH/GHI-Commercial, +27166,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMBLEMHEALTH/GHI-Commercial, +27167,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMBLEMHEALTH/GHI-Commercial, +27168,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMBLEMHEALTH/GHI-Commercial, +27169,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMBLEMHEALTH/GHI-Commercial, +27170,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMBLEMHEALTH/GHI-Commercial, +27171,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMBLEMHEALTH/GHI-Commercial, +27172,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMBLEMHEALTH/GHI-Commercial, +27173,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMBLEMHEALTH/GHI-Commercial, +27174,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMBLEMHEALTH/GHI-Commercial, +27175,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMBLEMHEALTH/GHI-Commercial, +27176,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMBLEMHEALTH/GHI-Commercial, +27177,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMBLEMHEALTH/GHI-Commercial, +27178,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMBLEMHEALTH/GHI-Commercial, +27179,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMBLEMHEALTH/GHI-Commercial, +27180,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/GHI-Commercial, +27181,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMBLEMHEALTH/GHI-Commercial, +27182,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/GHI-Commercial, +27183,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMBLEMHEALTH/GHI-Commercial, +27184,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMBLEMHEALTH/GHI-Commercial, +27185,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMBLEMHEALTH/GHI-Commercial, +27186,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMBLEMHEALTH/GHI-Commercial, +27187,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMBLEMHEALTH/GHI-Commercial, +27188,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMBLEMHEALTH/GHI-Commercial, +27189,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/GHI-Commercial, +27190,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMBLEMHEALTH/GHI-Commercial, +27191,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMBLEMHEALTH/GHI-Commercial, +27192,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMBLEMHEALTH/GHI-Commercial, +27193,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMBLEMHEALTH/GHI-Commercial, +27194,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMBLEMHEALTH/GHI-Commercial, +27195,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMBLEMHEALTH/GHI-Commercial, +27196,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMBLEMHEALTH/GHI-Commercial, +27197,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMBLEMHEALTH/GHI-Commercial, +27198,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMBLEMHEALTH/GHI-Commercial, +27199,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMBLEMHEALTH/GHI-Commercial, +27200,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMBLEMHEALTH/GHI-Commercial, +27201,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMBLEMHEALTH/GHI-Commercial, +27202,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMBLEMHEALTH/GHI-Commercial, +27203,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMBLEMHEALTH/GHI-Commercial, +27204,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMBLEMHEALTH/GHI-Commercial, +27205,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMBLEMHEALTH/GHI-Commercial, +27206,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMBLEMHEALTH/GHI-Commercial, +27207,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMBLEMHEALTH/GHI-Commercial, +27208,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/GHI-Commercial, +27209,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/GHI-Commercial, +27210,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMBLEMHEALTH/GHI-Commercial, +27211,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMBLEMHEALTH/GHI-Commercial, +27212,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMBLEMHEALTH/GHI-Commercial, +27213,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMBLEMHEALTH/GHI-Commercial, +27214,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMBLEMHEALTH/GHI-Commercial, +27215,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMBLEMHEALTH/GHI-Commercial, +27216,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/GHI-Commercial, +27217,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/GHI-Commercial, +27218,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/GHI-Commercial, +27219,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/GHI-Commercial, +27220,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/GHI-Commercial, +27221,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/GHI-Commercial, +27222,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMBLEMHEALTH/GHI-Commercial, +27223,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMBLEMHEALTH/GHI-Commercial, +27224,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMBLEMHEALTH/GHI-Commercial, +27225,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMBLEMHEALTH/GHI-Commercial, +27226,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMBLEMHEALTH/GHI-Commercial, +27227,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMBLEMHEALTH/GHI-Commercial, +27228,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMBLEMHEALTH/GHI-Commercial, +27229,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMBLEMHEALTH/GHI-Commercial, +27230,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMBLEMHEALTH/GHI-Commercial, +27231,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMBLEMHEALTH/GHI-Commercial, +27232,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMBLEMHEALTH/GHI-Commercial, +27233,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMBLEMHEALTH/GHI-Commercial, +27234,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMBLEMHEALTH/GHI-Commercial, +27235,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMBLEMHEALTH/GHI-Commercial, +27236,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMBLEMHEALTH/GHI-Commercial, +27237,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMBLEMHEALTH/GHI-Commercial, +27238,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMBLEMHEALTH/GHI-Commercial, +27239,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMBLEMHEALTH/GHI-Commercial, +27240,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMBLEMHEALTH/GHI-Commercial, +27241,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMBLEMHEALTH/GHI-Commercial, +27242,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMBLEMHEALTH/GHI-Commercial, +27243,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMBLEMHEALTH/GHI-Commercial, +27244,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMBLEMHEALTH/GHI-Commercial, +27245,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMBLEMHEALTH/GHI-Commercial, +27246,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMBLEMHEALTH/GHI-Commercial, +27247,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMBLEMHEALTH/GHI-Commercial, +27248,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMBLEMHEALTH/GHI-Commercial, +27249,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMBLEMHEALTH/GHI-Commercial, +27250,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMBLEMHEALTH/GHI-Commercial, +27251,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMBLEMHEALTH/GHI-Commercial, +27252,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMBLEMHEALTH/GHI-Commercial, +27253,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMBLEMHEALTH/GHI-Commercial, +27254,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMBLEMHEALTH/GHI-Commercial, +27255,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMBLEMHEALTH/HIP-CHP, +27256,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMBLEMHEALTH/HIP-CHP, +27257,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMBLEMHEALTH/HIP-CHP, +27258,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMBLEMHEALTH/HIP-CHP, +27259,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMBLEMHEALTH/HIP-CHP, +27260,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMBLEMHEALTH/HIP-CHP, +27261,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMBLEMHEALTH/HIP-CHP, +27262,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMBLEMHEALTH/HIP-CHP, +27263,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMBLEMHEALTH/HIP-CHP, +27264,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMBLEMHEALTH/HIP-CHP, +27265,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMBLEMHEALTH/HIP-CHP, +27266,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMBLEMHEALTH/HIP-CHP, +27267,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMBLEMHEALTH/HIP-CHP, +27268,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMBLEMHEALTH/HIP-CHP, +27269,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMBLEMHEALTH/HIP-CHP, +27270,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMBLEMHEALTH/HIP-CHP, +27271,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMBLEMHEALTH/HIP-CHP, +27272,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMBLEMHEALTH/HIP-CHP, +27273,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMBLEMHEALTH/HIP-CHP, +27274,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMBLEMHEALTH/HIP-CHP, +27275,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMBLEMHEALTH/HIP-CHP, +27276,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMBLEMHEALTH/HIP-CHP, +27277,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMBLEMHEALTH/HIP-CHP, +27278,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMBLEMHEALTH/HIP-CHP, +27279,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMBLEMHEALTH/HIP-CHP, +27280,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMBLEMHEALTH/HIP-CHP, +27281,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMBLEMHEALTH/HIP-CHP, +27282,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMBLEMHEALTH/HIP-CHP, +27283,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMBLEMHEALTH/HIP-CHP, +27284,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMBLEMHEALTH/HIP-CHP, +27285,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMBLEMHEALTH/HIP-CHP, +27286,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMBLEMHEALTH/HIP-CHP, +27287,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMBLEMHEALTH/HIP-CHP, +27288,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMBLEMHEALTH/HIP-CHP, +27289,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMBLEMHEALTH/HIP-CHP, +27290,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMBLEMHEALTH/HIP-CHP, +27291,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMBLEMHEALTH/HIP-CHP, +27292,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMBLEMHEALTH/HIP-CHP, +27293,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMBLEMHEALTH/HIP-CHP, +27294,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMBLEMHEALTH/HIP-CHP, +27295,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMBLEMHEALTH/HIP-CHP, +27296,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMBLEMHEALTH/HIP-CHP, +27297,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMBLEMHEALTH/HIP-CHP, +27298,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMBLEMHEALTH/HIP-CHP, +27299,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMBLEMHEALTH/HIP-CHP, +27300,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMBLEMHEALTH/HIP-CHP, +27301,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMBLEMHEALTH/HIP-CHP, +27302,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMBLEMHEALTH/HIP-CHP, +27303,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMBLEMHEALTH/HIP-CHP, +27304,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMBLEMHEALTH/HIP-CHP, +27305,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMBLEMHEALTH/HIP-CHP, +27306,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMBLEMHEALTH/HIP-CHP, +27307,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMBLEMHEALTH/HIP-CHP, +27308,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMBLEMHEALTH/HIP-CHP, +27309,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMBLEMHEALTH/HIP-CHP, +27310,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMBLEMHEALTH/HIP-CHP, +27311,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMBLEMHEALTH/HIP-CHP, +27312,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMBLEMHEALTH/HIP-CHP, +27313,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMBLEMHEALTH/HIP-CHP, +27314,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMBLEMHEALTH/HIP-CHP, +27315,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMBLEMHEALTH/HIP-CHP, +27316,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMBLEMHEALTH/HIP-CHP, +27317,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMBLEMHEALTH/HIP-CHP, +27318,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMBLEMHEALTH/HIP-CHP, +27319,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMBLEMHEALTH/HIP-CHP, +27320,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMBLEMHEALTH/HIP-CHP, +27321,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMBLEMHEALTH/HIP-CHP, +27322,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMBLEMHEALTH/HIP-CHP, +27323,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMBLEMHEALTH/HIP-CHP, +27324,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMBLEMHEALTH/HIP-CHP, +27325,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMBLEMHEALTH/HIP-CHP, +27326,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMBLEMHEALTH/HIP-CHP, +27327,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMBLEMHEALTH/HIP-CHP, +27328,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMBLEMHEALTH/HIP-CHP, +27329,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMBLEMHEALTH/HIP-CHP, +27330,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMBLEMHEALTH/HIP-CHP, +27331,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMBLEMHEALTH/HIP-CHP, +27332,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMBLEMHEALTH/HIP-CHP, +27333,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMBLEMHEALTH/HIP-CHP, +27334,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMBLEMHEALTH/HIP-CHP, +27335,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMBLEMHEALTH/HIP-CHP, +27336,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMBLEMHEALTH/HIP-CHP, +27337,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMBLEMHEALTH/HIP-CHP, +27338,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMBLEMHEALTH/HIP-CHP, +27339,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMBLEMHEALTH/HIP-CHP, +27340,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMBLEMHEALTH/HIP-CHP, +27341,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMBLEMHEALTH/HIP-CHP, +27342,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMBLEMHEALTH/HIP-CHP, +27343,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMBLEMHEALTH/HIP-CHP, +27344,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMBLEMHEALTH/HIP-CHP, +27345,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMBLEMHEALTH/HIP-CHP, +27346,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMBLEMHEALTH/HIP-CHP, +27347,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMBLEMHEALTH/HIP-CHP, +27348,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMBLEMHEALTH/HIP-CHP, +27349,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMBLEMHEALTH/HIP-CHP, +27350,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMBLEMHEALTH/HIP-CHP, +27351,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMBLEMHEALTH/HIP-CHP, +27352,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMBLEMHEALTH/HIP-CHP, +27353,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMBLEMHEALTH/HIP-CHP, +27354,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMBLEMHEALTH/HIP-CHP, +27355,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMBLEMHEALTH/HIP-CHP, +27356,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMBLEMHEALTH/HIP-CHP, +27357,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMBLEMHEALTH/HIP-CHP, +27358,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMBLEMHEALTH/HIP-CHP, +27359,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMBLEMHEALTH/HIP-CHP, +27360,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMBLEMHEALTH/HIP-CHP, +27361,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMBLEMHEALTH/HIP-CHP, +27362,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMBLEMHEALTH/HIP-CHP, +27363,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMBLEMHEALTH/HIP-CHP, +27364,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMBLEMHEALTH/HIP-CHP, +27365,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMBLEMHEALTH/HIP-CHP, +27366,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMBLEMHEALTH/HIP-CHP, +27367,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMBLEMHEALTH/HIP-CHP, +27368,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMBLEMHEALTH/HIP-CHP, +27369,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMBLEMHEALTH/HIP-CHP, +27370,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMBLEMHEALTH/HIP-CHP, +27371,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMBLEMHEALTH/HIP-CHP, +27372,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMBLEMHEALTH/HIP-CHP, +27373,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMBLEMHEALTH/HIP-CHP, +27374,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMBLEMHEALTH/HIP-CHP, +27375,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMBLEMHEALTH/HIP-CHP, +27376,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMBLEMHEALTH/HIP-CHP, +27377,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMBLEMHEALTH/HIP-CHP, +27378,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMBLEMHEALTH/HIP-CHP, +27379,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMBLEMHEALTH/HIP-CHP, +27380,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMBLEMHEALTH/HIP-CHP, +27381,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMBLEMHEALTH/HIP-CHP, +27382,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMBLEMHEALTH/HIP-CHP, +27383,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMBLEMHEALTH/HIP-CHP, +27384,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMBLEMHEALTH/HIP-CHP, +27385,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMBLEMHEALTH/HIP-CHP, +27386,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMBLEMHEALTH/HIP-CHP, +27387,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMBLEMHEALTH/HIP-CHP, +27388,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMBLEMHEALTH/HIP-CHP, +27389,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMBLEMHEALTH/HIP-CHP, +27390,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMBLEMHEALTH/HIP-CHP, +27391,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMBLEMHEALTH/HIP-CHP, +27392,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMBLEMHEALTH/HIP-CHP, +27393,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMBLEMHEALTH/HIP-CHP, +27394,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMBLEMHEALTH/HIP-CHP, +27395,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMBLEMHEALTH/HIP-CHP, +27396,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMBLEMHEALTH/HIP-CHP, +27397,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMBLEMHEALTH/HIP-CHP, +27398,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMBLEMHEALTH/HIP-CHP, +27399,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMBLEMHEALTH/HIP-CHP, +27400,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMBLEMHEALTH/HIP-CHP, +27401,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMBLEMHEALTH/HIP-CHP, +27402,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMBLEMHEALTH/HIP-CHP, +27403,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMBLEMHEALTH/HIP-CHP, +27404,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMBLEMHEALTH/HIP-CHP, +27405,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMBLEMHEALTH/HIP-CHP, +27406,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMBLEMHEALTH/HIP-CHP, +27407,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMBLEMHEALTH/HIP-CHP, +27408,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMBLEMHEALTH/HIP-CHP, +27409,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMBLEMHEALTH/HIP-CHP, +27410,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMBLEMHEALTH/HIP-CHP, +27411,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMBLEMHEALTH/HIP-CHP, +27412,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMBLEMHEALTH/HIP-CHP, +27413,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMBLEMHEALTH/HIP-CHP, +27414,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMBLEMHEALTH/HIP-CHP, +27415,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMBLEMHEALTH/HIP-CHP, +27416,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMBLEMHEALTH/HIP-CHP, +27417,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMBLEMHEALTH/HIP-CHP, +27418,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMBLEMHEALTH/HIP-CHP, +27419,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMBLEMHEALTH/HIP-CHP, +27420,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMBLEMHEALTH/HIP-CHP, +27421,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMBLEMHEALTH/HIP-CHP, +27422,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMBLEMHEALTH/HIP-CHP, +27423,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMBLEMHEALTH/HIP-CHP, +27424,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMBLEMHEALTH/HIP-CHP, +27425,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMBLEMHEALTH/HIP-CHP, +27426,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMBLEMHEALTH/HIP-CHP, +27427,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMBLEMHEALTH/HIP-CHP, +27428,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMBLEMHEALTH/HIP-CHP, +27429,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMBLEMHEALTH/HIP-CHP, +27430,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMBLEMHEALTH/HIP-CHP, +27431,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMBLEMHEALTH/HIP-CHP, +27432,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMBLEMHEALTH/HIP-CHP, +27433,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMBLEMHEALTH/HIP-CHP, +27434,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMBLEMHEALTH/HIP-CHP, +27435,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMBLEMHEALTH/HIP-CHP, +27436,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMBLEMHEALTH/HIP-CHP, +27437,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMBLEMHEALTH/HIP-CHP, +27438,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMBLEMHEALTH/HIP-CHP, +27439,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMBLEMHEALTH/HIP-CHP, +27440,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMBLEMHEALTH/HIP-CHP, +27441,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMBLEMHEALTH/HIP-CHP, +27442,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMBLEMHEALTH/HIP-CHP, +27443,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMBLEMHEALTH/HIP-CHP, +27444,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMBLEMHEALTH/HIP-CHP, +27445,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMBLEMHEALTH/HIP-CHP, +27446,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMBLEMHEALTH/HIP-CHP, +27447,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMBLEMHEALTH/HIP-CHP, +27448,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMBLEMHEALTH/HIP-CHP, +27449,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMBLEMHEALTH/HIP-CHP, +27450,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMBLEMHEALTH/HIP-CHP, +27451,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMBLEMHEALTH/HIP-CHP, +27452,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMBLEMHEALTH/HIP-CHP, +27453,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMBLEMHEALTH/HIP-CHP, +27454,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMBLEMHEALTH/HIP-CHP, +27455,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMBLEMHEALTH/HIP-CHP, +27456,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMBLEMHEALTH/HIP-CHP, +27457,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMBLEMHEALTH/HIP-CHP, +27458,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMBLEMHEALTH/HIP-CHP, +27459,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMBLEMHEALTH/HIP-CHP, +27460,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMBLEMHEALTH/HIP-CHP, +27461,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMBLEMHEALTH/HIP-CHP, +27462,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMBLEMHEALTH/HIP-CHP, +27463,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMBLEMHEALTH/HIP-CHP, +27464,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMBLEMHEALTH/HIP-CHP, +27465,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMBLEMHEALTH/HIP-CHP, +27466,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMBLEMHEALTH/HIP-CHP, +27467,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMBLEMHEALTH/HIP-CHP, +27468,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMBLEMHEALTH/HIP-CHP, +27469,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMBLEMHEALTH/HIP-CHP, +27470,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMBLEMHEALTH/HIP-CHP, +27471,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMBLEMHEALTH/HIP-CHP, +27472,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMBLEMHEALTH/HIP-CHP, +27473,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMBLEMHEALTH/HIP-CHP, +27474,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMBLEMHEALTH/HIP-CHP, +27475,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMBLEMHEALTH/HIP-CHP, +27476,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMBLEMHEALTH/HIP-CHP, +27477,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMBLEMHEALTH/HIP-CHP, +27478,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMBLEMHEALTH/HIP-CHP, +27479,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMBLEMHEALTH/HIP-CHP, +27480,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMBLEMHEALTH/HIP-CHP, +27481,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMBLEMHEALTH/HIP-CHP, +27482,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMBLEMHEALTH/HIP-CHP, +27483,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMBLEMHEALTH/HIP-CHP, +27484,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMBLEMHEALTH/HIP-CHP, +27485,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMBLEMHEALTH/HIP-CHP, +27486,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMBLEMHEALTH/HIP-CHP, +27487,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMBLEMHEALTH/HIP-CHP, +27488,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMBLEMHEALTH/HIP-CHP, +27489,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMBLEMHEALTH/HIP-CHP, +27490,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMBLEMHEALTH/HIP-CHP, +27491,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMBLEMHEALTH/HIP-CHP, +27492,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMBLEMHEALTH/HIP-CHP, +27493,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMBLEMHEALTH/HIP-CHP, +27494,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMBLEMHEALTH/HIP-CHP, +27495,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMBLEMHEALTH/HIP-CHP, +27496,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMBLEMHEALTH/HIP-CHP, +27497,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMBLEMHEALTH/HIP-CHP, +27498,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMBLEMHEALTH/HIP-CHP, +27499,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMBLEMHEALTH/HIP-CHP, +27500,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMBLEMHEALTH/HIP-CHP, +27501,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMBLEMHEALTH/HIP-CHP, +27502,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMBLEMHEALTH/HIP-CHP, +27503,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMBLEMHEALTH/HIP-CHP, +27504,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMBLEMHEALTH/HIP-CHP, +27505,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMBLEMHEALTH/HIP-CHP, +27506,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMBLEMHEALTH/HIP-CHP, +27507,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMBLEMHEALTH/HIP-CHP, +27508,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMBLEMHEALTH/HIP-CHP, +27509,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMBLEMHEALTH/HIP-CHP, +27510,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMBLEMHEALTH/HIP-CHP, +27511,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMBLEMHEALTH/HIP-CHP, +27512,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMBLEMHEALTH/HIP-CHP, +27513,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMBLEMHEALTH/HIP-CHP, +27514,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMBLEMHEALTH/HIP-CHP, +27515,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMBLEMHEALTH/HIP-CHP, +27516,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMBLEMHEALTH/HIP-CHP, +27517,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMBLEMHEALTH/HIP-CHP, +27518,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMBLEMHEALTH/HIP-CHP, +27519,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMBLEMHEALTH/HIP-CHP, +27520,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMBLEMHEALTH/HIP-CHP, +27521,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMBLEMHEALTH/HIP-CHP, +27522,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMBLEMHEALTH/HIP-CHP, +27523,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMBLEMHEALTH/HIP-CHP, +27524,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMBLEMHEALTH/HIP-CHP, +27525,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMBLEMHEALTH/HIP-CHP, +27526,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMBLEMHEALTH/HIP-CHP, +27527,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMBLEMHEALTH/HIP-CHP, +27528,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMBLEMHEALTH/HIP-CHP, +27529,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMBLEMHEALTH/HIP-CHP, +27530,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMBLEMHEALTH/HIP-CHP, +27531,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMBLEMHEALTH/HIP-CHP, +27532,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMBLEMHEALTH/HIP-CHP, +27533,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMBLEMHEALTH/HIP-CHP, +27534,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMBLEMHEALTH/HIP-CHP, +27535,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMBLEMHEALTH/HIP-CHP, +27536,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMBLEMHEALTH/HIP-CHP, +27537,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMBLEMHEALTH/HIP-CHP, +27538,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMBLEMHEALTH/HIP-CHP, +27539,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMBLEMHEALTH/HIP-CHP, +27540,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMBLEMHEALTH/HIP-CHP, +27541,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMBLEMHEALTH/HIP-CHP, +27542,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMBLEMHEALTH/HIP-CHP, +27543,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMBLEMHEALTH/HIP-CHP, +27544,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMBLEMHEALTH/HIP-CHP, +27545,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMBLEMHEALTH/HIP-CHP, +27546,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMBLEMHEALTH/HIP-CHP, +27547,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMBLEMHEALTH/HIP-CHP, +27548,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMBLEMHEALTH/HIP-CHP, +27549,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMBLEMHEALTH/HIP-CHP, +27550,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMBLEMHEALTH/HIP-CHP, +27551,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMBLEMHEALTH/HIP-CHP, +27552,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMBLEMHEALTH/HIP-CHP, +27553,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMBLEMHEALTH/HIP-CHP, +27554,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMBLEMHEALTH/HIP-CHP, +27555,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMBLEMHEALTH/HIP-CHP, +27556,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMBLEMHEALTH/HIP-CHP, +27557,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMBLEMHEALTH/HIP-CHP, +27558,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMBLEMHEALTH/HIP-CHP, +27559,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMBLEMHEALTH/HIP-CHP, +27560,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMBLEMHEALTH/HIP-CHP, +27561,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMBLEMHEALTH/HIP-CHP, +27562,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMBLEMHEALTH/HIP-CHP, +27563,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMBLEMHEALTH/HIP-CHP, +27564,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMBLEMHEALTH/HIP-CHP, +27565,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMBLEMHEALTH/HIP-CHP, +27566,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMBLEMHEALTH/HIP-CHP, +27567,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMBLEMHEALTH/HIP-CHP, +27568,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMBLEMHEALTH/HIP-CHP, +27569,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMBLEMHEALTH/HIP-CHP, +27570,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMBLEMHEALTH/HIP-CHP, +27571,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMBLEMHEALTH/HIP-CHP, +27572,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMBLEMHEALTH/HIP-CHP, +27573,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMBLEMHEALTH/HIP-CHP, +27574,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMBLEMHEALTH/HIP-CHP, +27575,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMBLEMHEALTH/HIP-CHP, +27576,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMBLEMHEALTH/HIP-CHP, +27577,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMBLEMHEALTH/HIP-CHP, +27578,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMBLEMHEALTH/HIP-CHP, +27579,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMBLEMHEALTH/HIP-CHP, +27580,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMBLEMHEALTH/HIP-CHP, +27581,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMBLEMHEALTH/HIP-CHP, +27582,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMBLEMHEALTH/HIP-CHP, +27583,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMBLEMHEALTH/HIP-CHP, +27584,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMBLEMHEALTH/HIP-CHP, +27585,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMBLEMHEALTH/HIP-CHP, +27586,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMBLEMHEALTH/HIP-CHP, +27587,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMBLEMHEALTH/HIP-CHP, +27588,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMBLEMHEALTH/HIP-CHP, +27589,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMBLEMHEALTH/HIP-CHP, +27590,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMBLEMHEALTH/HIP-CHP, +27591,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMBLEMHEALTH/HIP-CHP, +27592,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMBLEMHEALTH/HIP-CHP, +27593,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMBLEMHEALTH/HIP-CHP, +27594,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMBLEMHEALTH/HIP-CHP, +27595,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMBLEMHEALTH/HIP-CHP, +27596,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMBLEMHEALTH/HIP-CHP, +27597,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMBLEMHEALTH/HIP-CHP, +27598,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMBLEMHEALTH/HIP-CHP, +27599,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMBLEMHEALTH/HIP-CHP, +27600,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMBLEMHEALTH/HIP-CHP, +27601,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMBLEMHEALTH/HIP-CHP, +27602,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMBLEMHEALTH/HIP-CHP, +27603,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMBLEMHEALTH/HIP-CHP, +27604,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMBLEMHEALTH/HIP-CHP, +27605,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMBLEMHEALTH/HIP-CHP, +27606,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMBLEMHEALTH/HIP-CHP, +27607,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMBLEMHEALTH/HIP-CHP, +27608,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMBLEMHEALTH/HIP-CHP, +27609,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMBLEMHEALTH/HIP-CHP, +27610,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMBLEMHEALTH/HIP-CHP, +27611,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMBLEMHEALTH/HIP-CHP, +27612,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMBLEMHEALTH/HIP-CHP, +27613,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMBLEMHEALTH/HIP-CHP, +27614,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMBLEMHEALTH/HIP-CHP, +27615,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMBLEMHEALTH/HIP-CHP, +27616,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMBLEMHEALTH/HIP-CHP, +27617,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMBLEMHEALTH/HIP-CHP, +27618,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMBLEMHEALTH/HIP-CHP, +27619,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMBLEMHEALTH/HIP-CHP, +27620,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMBLEMHEALTH/HIP-CHP, +27621,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMBLEMHEALTH/HIP-CHP, +27622,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMBLEMHEALTH/HIP-CHP, +27623,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMBLEMHEALTH/HIP-CHP, +27624,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMBLEMHEALTH/HIP-CHP, +27625,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMBLEMHEALTH/HIP-CHP, +27626,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMBLEMHEALTH/HIP-CHP, +27627,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMBLEMHEALTH/HIP-CHP, +27628,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMBLEMHEALTH/HIP-CHP, +27629,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMBLEMHEALTH/HIP-CHP, +27630,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMBLEMHEALTH/HIP-CHP, +27631,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMBLEMHEALTH/HIP-CHP, +27632,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMBLEMHEALTH/HIP-CHP, +27633,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMBLEMHEALTH/HIP-CHP, +27634,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMBLEMHEALTH/HIP-CHP, +27635,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMBLEMHEALTH/HIP-CHP, +27636,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMBLEMHEALTH/HIP-CHP, +27637,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMBLEMHEALTH/HIP-CHP, +27638,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMBLEMHEALTH/HIP-CHP, +27639,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMBLEMHEALTH/HIP-CHP, +27640,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMBLEMHEALTH/HIP-CHP, +27641,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMBLEMHEALTH/HIP-CHP, +27642,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMBLEMHEALTH/HIP-CHP, +27643,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMBLEMHEALTH/HIP-CHP, +27644,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMBLEMHEALTH/HIP-CHP, +27645,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMBLEMHEALTH/HIP-CHP, +27646,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMBLEMHEALTH/HIP-CHP, +27647,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMBLEMHEALTH/HIP-CHP, +27648,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMBLEMHEALTH/HIP-CHP, +27649,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMBLEMHEALTH/HIP-CHP, +27650,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMBLEMHEALTH/HIP-CHP, +27651,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMBLEMHEALTH/HIP-CHP, +27652,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMBLEMHEALTH/HIP-CHP, +27653,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMBLEMHEALTH/HIP-CHP, +27654,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMBLEMHEALTH/HIP-CHP, +27655,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMBLEMHEALTH/HIP-CHP, +27656,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMBLEMHEALTH/HIP-CHP, +27657,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMBLEMHEALTH/HIP-CHP, +27658,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMBLEMHEALTH/HIP-CHP, +27659,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMBLEMHEALTH/HIP-CHP, +27660,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMBLEMHEALTH/HIP-CHP, +27661,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMBLEMHEALTH/HIP-CHP, +27662,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMBLEMHEALTH/HIP-CHP, +27663,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMBLEMHEALTH/HIP-CHP, +27664,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMBLEMHEALTH/HIP-CHP, +27665,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMBLEMHEALTH/HIP-CHP, +27666,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMBLEMHEALTH/HIP-CHP, +27667,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMBLEMHEALTH/HIP-CHP, +27668,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMBLEMHEALTH/HIP-CHP, +27669,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMBLEMHEALTH/HIP-CHP, +27670,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMBLEMHEALTH/HIP-CHP, +27671,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMBLEMHEALTH/HIP-CHP, +27672,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMBLEMHEALTH/HIP-CHP, +27673,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMBLEMHEALTH/HIP-CHP, +27674,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMBLEMHEALTH/HIP-CHP, +27675,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMBLEMHEALTH/HIP-CHP, +27676,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMBLEMHEALTH/HIP-CHP, +27677,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMBLEMHEALTH/HIP-CHP, +27678,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMBLEMHEALTH/HIP-CHP, +27679,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMBLEMHEALTH/HIP-CHP, +27680,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMBLEMHEALTH/HIP-CHP, +27681,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMBLEMHEALTH/HIP-CHP, +27682,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMBLEMHEALTH/HIP-CHP, +27683,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMBLEMHEALTH/HIP-CHP, +27684,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMBLEMHEALTH/HIP-CHP, +27685,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMBLEMHEALTH/HIP-CHP, +27686,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMBLEMHEALTH/HIP-CHP, +27687,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMBLEMHEALTH/HIP-CHP, +27688,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMBLEMHEALTH/HIP-CHP, +27689,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMBLEMHEALTH/HIP-CHP, +27690,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMBLEMHEALTH/HIP-CHP, +27691,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMBLEMHEALTH/HIP-CHP, +27692,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMBLEMHEALTH/HIP-CHP, +27693,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMBLEMHEALTH/HIP-CHP, +27694,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMBLEMHEALTH/HIP-CHP, +27695,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMBLEMHEALTH/HIP-CHP, +27696,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMBLEMHEALTH/HIP-CHP, +27697,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMBLEMHEALTH/HIP-CHP, +27698,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMBLEMHEALTH/HIP-CHP, +27699,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMBLEMHEALTH/HIP-CHP, +27700,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMBLEMHEALTH/HIP-CHP, +27701,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMBLEMHEALTH/HIP-CHP, +27702,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMBLEMHEALTH/HIP-CHP, +27703,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMBLEMHEALTH/HIP-CHP, +27704,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMBLEMHEALTH/HIP-CHP, +27705,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMBLEMHEALTH/HIP-CHP, +27706,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMBLEMHEALTH/HIP-CHP, +27707,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMBLEMHEALTH/HIP-CHP, +27708,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMBLEMHEALTH/HIP-CHP, +27709,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMBLEMHEALTH/HIP-CHP, +27710,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMBLEMHEALTH/HIP-CHP, +27711,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMBLEMHEALTH/HIP-CHP, +27712,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMBLEMHEALTH/HIP-CHP, +27713,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMBLEMHEALTH/HIP-CHP, +27714,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMBLEMHEALTH/HIP-CHP, +27715,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMBLEMHEALTH/HIP-CHP, +27716,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMBLEMHEALTH/HIP-CHP, +27717,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMBLEMHEALTH/HIP-CHP, +27718,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMBLEMHEALTH/HIP-CHP, +27719,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMBLEMHEALTH/HIP-CHP, +27720,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMBLEMHEALTH/HIP-CHP, +27721,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMBLEMHEALTH/HIP-CHP, +27722,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMBLEMHEALTH/HIP-CHP, +27723,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMBLEMHEALTH/HIP-CHP, +27724,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMBLEMHEALTH/HIP-CHP, +27725,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMBLEMHEALTH/HIP-CHP, +27726,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMBLEMHEALTH/HIP-CHP, +27727,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMBLEMHEALTH/HIP-CHP, +27728,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMBLEMHEALTH/HIP-CHP, +27729,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMBLEMHEALTH/HIP-CHP, +27730,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMBLEMHEALTH/HIP-CHP, +27731,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMBLEMHEALTH/HIP-CHP, +27732,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMBLEMHEALTH/HIP-CHP, +27733,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMBLEMHEALTH/HIP-CHP, +27734,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMBLEMHEALTH/HIP-CHP, +27735,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMBLEMHEALTH/HIP-CHP, +27736,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMBLEMHEALTH/HIP-CHP, +27737,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMBLEMHEALTH/HIP-CHP, +27738,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMBLEMHEALTH/HIP-CHP, +27739,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMBLEMHEALTH/HIP-CHP, +27740,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMBLEMHEALTH/HIP-CHP, +27741,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMBLEMHEALTH/HIP-CHP, +27742,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMBLEMHEALTH/HIP-CHP, +27743,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMBLEMHEALTH/HIP-CHP, +27744,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMBLEMHEALTH/HIP-CHP, +27745,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMBLEMHEALTH/HIP-CHP, +27746,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMBLEMHEALTH/HIP-CHP, +27747,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMBLEMHEALTH/HIP-CHP, +27748,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMBLEMHEALTH/HIP-CHP, +27749,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMBLEMHEALTH/HIP-CHP, +27750,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMBLEMHEALTH/HIP-CHP, +27751,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMBLEMHEALTH/HIP-CHP, +27752,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMBLEMHEALTH/HIP-CHP, +27753,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMBLEMHEALTH/HIP-CHP, +27754,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMBLEMHEALTH/HIP-CHP, +27755,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMBLEMHEALTH/HIP-CHP, +27756,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMBLEMHEALTH/HIP-CHP, +27757,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMBLEMHEALTH/HIP-CHP, +27758,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMBLEMHEALTH/HIP-CHP, +27759,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMBLEMHEALTH/HIP-CHP, +27760,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMBLEMHEALTH/HIP-CHP, +27761,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMBLEMHEALTH/HIP-CHP, +27762,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMBLEMHEALTH/HIP-CHP, +27763,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMBLEMHEALTH/HIP-CHP, +27764,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMBLEMHEALTH/HIP-CHP, +27765,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMBLEMHEALTH/HIP-CHP, +27766,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMBLEMHEALTH/HIP-CHP, +27767,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMBLEMHEALTH/HIP-CHP, +27768,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMBLEMHEALTH/HIP-CHP, +27769,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMBLEMHEALTH/HIP-CHP, +27770,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMBLEMHEALTH/HIP-CHP, +27771,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMBLEMHEALTH/HIP-CHP, +27772,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMBLEMHEALTH/HIP-CHP, +27773,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMBLEMHEALTH/HIP-CHP, +27774,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMBLEMHEALTH/HIP-CHP, +27775,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMBLEMHEALTH/HIP-CHP, +27776,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMBLEMHEALTH/HIP-CHP, +27777,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMBLEMHEALTH/HIP-CHP, +27778,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMBLEMHEALTH/HIP-CHP, +27779,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMBLEMHEALTH/HIP-CHP, +27780,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMBLEMHEALTH/HIP-CHP, +27781,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMBLEMHEALTH/HIP-CHP, +27782,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMBLEMHEALTH/HIP-CHP, +27783,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMBLEMHEALTH/HIP-CHP, +27784,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMBLEMHEALTH/HIP-CHP, +27785,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMBLEMHEALTH/HIP-CHP, +27786,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMBLEMHEALTH/HIP-CHP, +27787,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMBLEMHEALTH/HIP-CHP, +27788,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMBLEMHEALTH/HIP-CHP, +27789,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMBLEMHEALTH/HIP-CHP, +27790,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMBLEMHEALTH/HIP-CHP, +27791,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMBLEMHEALTH/HIP-CHP, +27792,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMBLEMHEALTH/HIP-CHP, +27793,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMBLEMHEALTH/HIP-CHP, +27794,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMBLEMHEALTH/HIP-CHP, +27795,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMBLEMHEALTH/HIP-CHP, +27796,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMBLEMHEALTH/HIP-CHP, +27797,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMBLEMHEALTH/HIP-CHP, +27798,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMBLEMHEALTH/HIP-CHP, +27799,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMBLEMHEALTH/HIP-CHP, +27800,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMBLEMHEALTH/HIP-CHP, +27801,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMBLEMHEALTH/HIP-CHP, +27802,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMBLEMHEALTH/HIP-CHP, +27803,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMBLEMHEALTH/HIP-CHP, +27804,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMBLEMHEALTH/HIP-CHP, +27805,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMBLEMHEALTH/HIP-CHP, +27806,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMBLEMHEALTH/HIP-CHP, +27807,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMBLEMHEALTH/HIP-CHP, +27808,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMBLEMHEALTH/HIP-CHP, +27809,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMBLEMHEALTH/HIP-CHP, +27810,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMBLEMHEALTH/HIP-CHP, +27811,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMBLEMHEALTH/HIP-CHP, +27812,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMBLEMHEALTH/HIP-CHP, +27813,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMBLEMHEALTH/HIP-CHP, +27814,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMBLEMHEALTH/HIP-CHP, +27815,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMBLEMHEALTH/HIP-CHP, +27816,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMBLEMHEALTH/HIP-CHP, +27817,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMBLEMHEALTH/HIP-CHP, +27818,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMBLEMHEALTH/HIP-CHP, +27819,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMBLEMHEALTH/HIP-CHP, +27820,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMBLEMHEALTH/HIP-CHP, +27821,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMBLEMHEALTH/HIP-CHP, +27822,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMBLEMHEALTH/HIP-CHP, +27823,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMBLEMHEALTH/HIP-CHP, +27824,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMBLEMHEALTH/HIP-CHP, +27825,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMBLEMHEALTH/HIP-CHP, +27826,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMBLEMHEALTH/HIP-CHP, +27827,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMBLEMHEALTH/HIP-CHP, +27828,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMBLEMHEALTH/HIP-CHP, +27829,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMBLEMHEALTH/HIP-CHP, +27830,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMBLEMHEALTH/HIP-CHP, +27831,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMBLEMHEALTH/HIP-CHP, +27832,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMBLEMHEALTH/HIP-CHP, +27833,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMBLEMHEALTH/HIP-CHP, +27834,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMBLEMHEALTH/HIP-CHP, +27835,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMBLEMHEALTH/HIP-CHP, +27836,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMBLEMHEALTH/HIP-CHP, +27837,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMBLEMHEALTH/HIP-CHP, +27838,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMBLEMHEALTH/HIP-CHP, +27839,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMBLEMHEALTH/HIP-CHP, +27840,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMBLEMHEALTH/HIP-CHP, +27841,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMBLEMHEALTH/HIP-CHP, +27842,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMBLEMHEALTH/HIP-CHP, +27843,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMBLEMHEALTH/HIP-CHP, +27844,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMBLEMHEALTH/HIP-CHP, +27845,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMBLEMHEALTH/HIP-CHP, +27846,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMBLEMHEALTH/HIP-CHP, +27847,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMBLEMHEALTH/HIP-CHP, +27848,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMBLEMHEALTH/HIP-CHP, +27849,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMBLEMHEALTH/HIP-CHP, +27850,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMBLEMHEALTH/HIP-CHP, +27851,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMBLEMHEALTH/HIP-CHP, +27852,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMBLEMHEALTH/HIP-CHP, +27853,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMBLEMHEALTH/HIP-CHP, +27854,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMBLEMHEALTH/HIP-CHP, +27855,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMBLEMHEALTH/HIP-CHP, +27856,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMBLEMHEALTH/HIP-CHP, +27857,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMBLEMHEALTH/HIP-CHP, +27858,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMBLEMHEALTH/HIP-CHP, +27859,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMBLEMHEALTH/HIP-CHP, +27860,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMBLEMHEALTH/HIP-CHP, +27861,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMBLEMHEALTH/HIP-CHP, +27862,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMBLEMHEALTH/HIP-CHP, +27863,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMBLEMHEALTH/HIP-CHP, +27864,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMBLEMHEALTH/HIP-CHP, +27865,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMBLEMHEALTH/HIP-CHP, +27866,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMBLEMHEALTH/HIP-CHP, +27867,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMBLEMHEALTH/HIP-CHP, +27868,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMBLEMHEALTH/HIP-CHP, +27869,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMBLEMHEALTH/HIP-CHP, +27870,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMBLEMHEALTH/HIP-CHP, +27871,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMBLEMHEALTH/HIP-CHP, +27872,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMBLEMHEALTH/HIP-CHP, +27873,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMBLEMHEALTH/HIP-CHP, +27874,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMBLEMHEALTH/HIP-CHP, +27875,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMBLEMHEALTH/HIP-CHP, +27876,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMBLEMHEALTH/HIP-CHP, +27877,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMBLEMHEALTH/HIP-CHP, +27878,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMBLEMHEALTH/HIP-CHP, +27879,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMBLEMHEALTH/HIP-CHP, +27880,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMBLEMHEALTH/HIP-CHP, +27881,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMBLEMHEALTH/HIP-CHP, +27882,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMBLEMHEALTH/HIP-CHP, +27883,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMBLEMHEALTH/HIP-CHP, +27884,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMBLEMHEALTH/HIP-CHP, +27885,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMBLEMHEALTH/HIP-CHP, +27886,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMBLEMHEALTH/HIP-CHP, +27887,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMBLEMHEALTH/HIP-CHP, +27888,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMBLEMHEALTH/HIP-CHP, +27889,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMBLEMHEALTH/HIP-CHP, +27890,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMBLEMHEALTH/HIP-CHP, +27891,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMBLEMHEALTH/HIP-CHP, +27892,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMBLEMHEALTH/HIP-CHP, +27893,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMBLEMHEALTH/HIP-CHP, +27894,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMBLEMHEALTH/HIP-CHP, +27895,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMBLEMHEALTH/HIP-CHP, +27896,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMBLEMHEALTH/HIP-CHP, +27897,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMBLEMHEALTH/HIP-CHP, +27898,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMBLEMHEALTH/HIP-CHP, +27899,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMBLEMHEALTH/HIP-CHP, +27900,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMBLEMHEALTH/HIP-CHP, +27901,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMBLEMHEALTH/HIP-CHP, +27902,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMBLEMHEALTH/HIP-CHP, +27903,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMBLEMHEALTH/HIP-CHP, +27904,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMBLEMHEALTH/HIP-CHP, +27905,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMBLEMHEALTH/HIP-CHP, +27906,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMBLEMHEALTH/HIP-CHP, +27907,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMBLEMHEALTH/HIP-CHP, +27908,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMBLEMHEALTH/HIP-CHP, +27909,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMBLEMHEALTH/HIP-CHP, +27910,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMBLEMHEALTH/HIP-CHP, +27911,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMBLEMHEALTH/HIP-CHP, +27912,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMBLEMHEALTH/HIP-CHP, +27913,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMBLEMHEALTH/HIP-CHP, +27914,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMBLEMHEALTH/HIP-CHP, +27915,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMBLEMHEALTH/HIP-CHP, +27916,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMBLEMHEALTH/HIP-CHP, +27917,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMBLEMHEALTH/HIP-CHP, +27918,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMBLEMHEALTH/HIP-CHP, +27919,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMBLEMHEALTH/HIP-CHP, +27920,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMBLEMHEALTH/HIP-CHP, +27921,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMBLEMHEALTH/HIP-CHP, +27922,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMBLEMHEALTH/HIP-CHP, +27923,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMBLEMHEALTH/HIP-CHP, +27924,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMBLEMHEALTH/HIP-CHP, +27925,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMBLEMHEALTH/HIP-CHP, +27926,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMBLEMHEALTH/HIP-CHP, +27927,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMBLEMHEALTH/HIP-CHP, +27928,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMBLEMHEALTH/HIP-CHP, +27929,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMBLEMHEALTH/HIP-CHP, +27930,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMBLEMHEALTH/HIP-CHP, +27931,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMBLEMHEALTH/HIP-CHP, +27932,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMBLEMHEALTH/HIP-CHP, +27933,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMBLEMHEALTH/HIP-CHP, +27934,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMBLEMHEALTH/HIP-CHP, +27935,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMBLEMHEALTH/HIP-CHP, +27936,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMBLEMHEALTH/HIP-CHP, +27937,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMBLEMHEALTH/HIP-CHP, +27938,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMBLEMHEALTH/HIP-CHP, +27939,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMBLEMHEALTH/HIP-CHP, +27940,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMBLEMHEALTH/HIP-CHP, +27941,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMBLEMHEALTH/HIP-CHP, +27942,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMBLEMHEALTH/HIP-CHP, +27943,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMBLEMHEALTH/HIP-CHP, +27944,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMBLEMHEALTH/HIP-CHP, +27945,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMBLEMHEALTH/HIP-CHP, +27946,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMBLEMHEALTH/HIP-CHP, +27947,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMBLEMHEALTH/HIP-CHP, +27948,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMBLEMHEALTH/HIP-CHP, +27949,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMBLEMHEALTH/HIP-CHP, +27950,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMBLEMHEALTH/HIP-CHP, +27951,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMBLEMHEALTH/HIP-CHP, +27952,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMBLEMHEALTH/HIP-CHP,5731.46 +27953,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMBLEMHEALTH/HIP-CHP, +27954,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMBLEMHEALTH/HIP-CHP, +27955,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMBLEMHEALTH/HIP-CHP, +27956,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMBLEMHEALTH/HIP-CHP, +27957,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMBLEMHEALTH/HIP-CHP, +27958,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMBLEMHEALTH/HIP-CHP, +27959,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMBLEMHEALTH/HIP-CHP, +27960,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMBLEMHEALTH/HIP-CHP, +27961,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +27962,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMBLEMHEALTH/HIP-CHP, +27963,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMBLEMHEALTH/HIP-CHP, +27964,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMBLEMHEALTH/HIP-CHP, +27965,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMBLEMHEALTH/HIP-CHP, +27966,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMBLEMHEALTH/HIP-CHP, +27967,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMBLEMHEALTH/HIP-CHP, +27968,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMBLEMHEALTH/HIP-CHP, +27969,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMBLEMHEALTH/HIP-CHP, +27970,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMBLEMHEALTH/HIP-CHP, +27971,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMBLEMHEALTH/HIP-CHP, +27972,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMBLEMHEALTH/HIP-CHP, +27973,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMBLEMHEALTH/HIP-CHP, +27974,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMBLEMHEALTH/HIP-CHP, +27975,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMBLEMHEALTH/HIP-CHP, +27976,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMBLEMHEALTH/HIP-CHP, +27977,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMBLEMHEALTH/HIP-CHP, +27978,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMBLEMHEALTH/HIP-CHP, +27979,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMBLEMHEALTH/HIP-CHP, +27980,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMBLEMHEALTH/HIP-CHP, +27981,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMBLEMHEALTH/HIP-CHP, +27982,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMBLEMHEALTH/HIP-CHP, +27983,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMBLEMHEALTH/HIP-CHP, +27984,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMBLEMHEALTH/HIP-CHP, +27985,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMBLEMHEALTH/HIP-CHP, +27986,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMBLEMHEALTH/HIP-CHP, +27987,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMBLEMHEALTH/HIP-CHP, +27988,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMBLEMHEALTH/HIP-CHP, +27989,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMBLEMHEALTH/HIP-CHP, +27990,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMBLEMHEALTH/HIP-CHP, +27991,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMBLEMHEALTH/HIP-CHP, +27992,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMBLEMHEALTH/HIP-CHP, +27993,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMBLEMHEALTH/HIP-CHP, +27994,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMBLEMHEALTH/HIP-CHP, +27995,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMBLEMHEALTH/HIP-CHP, +27996,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMBLEMHEALTH/HIP-CHP, +27997,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMBLEMHEALTH/HIP-CHP, +27998,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMBLEMHEALTH/HIP-CHP, +27999,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMBLEMHEALTH/HIP-CHP, +28000,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMBLEMHEALTH/HIP-CHP, +28001,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMBLEMHEALTH/HIP-CHP,1829.72 +28002,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMBLEMHEALTH/HIP-CHP, +28003,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMBLEMHEALTH/HIP-CHP, +28004,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMBLEMHEALTH/HIP-CHP, +28005,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMBLEMHEALTH/HIP-CHP, +28006,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMBLEMHEALTH/HIP-CHP, +28007,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMBLEMHEALTH/HIP-CHP, +28008,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMBLEMHEALTH/HIP-CHP, +28009,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMBLEMHEALTH/HIP-CHP, +28010,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMBLEMHEALTH/HIP-CHP, +28011,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMBLEMHEALTH/HIP-CHP, +28012,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMBLEMHEALTH/HIP-CHP, +28013,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMBLEMHEALTH/HIP-CHP, +28014,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMBLEMHEALTH/HIP-CHP, +28015,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMBLEMHEALTH/HIP-CHP, +28016,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMBLEMHEALTH/HIP-CHP, +28017,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMBLEMHEALTH/HIP-CHP, +28018,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMBLEMHEALTH/HIP-CHP, +28019,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMBLEMHEALTH/HIP-CHP, +28020,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMBLEMHEALTH/HIP-CHP, +28021,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMBLEMHEALTH/HIP-CHP, +28022,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMBLEMHEALTH/HIP-CHP, +28023,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMBLEMHEALTH/HIP-CHP, +28024,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMBLEMHEALTH/HIP-CHP, +28025,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMBLEMHEALTH/HIP-CHP, +28026,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMBLEMHEALTH/HIP-CHP, +28027,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMBLEMHEALTH/HIP-CHP, +28028,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMBLEMHEALTH/HIP-CHP, +28029,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMBLEMHEALTH/HIP-CHP, +28030,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMBLEMHEALTH/HIP-CHP, +28031,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMBLEMHEALTH/HIP-CHP, +28032,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMBLEMHEALTH/HIP-CHP, +28033,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMBLEMHEALTH/HIP-CHP, +28034,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMBLEMHEALTH/HIP-CHP, +28035,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMBLEMHEALTH/HIP-CHP, +28036,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMBLEMHEALTH/HIP-CHP, +28037,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMBLEMHEALTH/HIP-CHP, +28038,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMBLEMHEALTH/HIP-CHP, +28039,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMBLEMHEALTH/HIP-CHP, +28040,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMBLEMHEALTH/HIP-CHP, +28041,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMBLEMHEALTH/HIP-CHP, +28042,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMBLEMHEALTH/HIP-CHP, +28043,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMBLEMHEALTH/HIP-CHP, +28044,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMBLEMHEALTH/HIP-CHP, +28045,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMBLEMHEALTH/HIP-CHP, +28046,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMBLEMHEALTH/HIP-CHP, +28047,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMBLEMHEALTH/HIP-CHP, +28048,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMBLEMHEALTH/HIP-CHP, +28049,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMBLEMHEALTH/HIP-CHP, +28050,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMBLEMHEALTH/HIP-CHP, +28051,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMBLEMHEALTH/HIP-CHP, +28052,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMBLEMHEALTH/HIP-CHP, +28053,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMBLEMHEALTH/HIP-CHP, +28054,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMBLEMHEALTH/HIP-CHP, +28055,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMBLEMHEALTH/HIP-CHP, +28056,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMBLEMHEALTH/HIP-CHP, +28057,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMBLEMHEALTH/HIP-CHP, +28058,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMBLEMHEALTH/HIP-CHP, +28059,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMBLEMHEALTH/HIP-CHP, +28060,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMBLEMHEALTH/HIP-CHP, +28061,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMBLEMHEALTH/HIP-CHP, +28062,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMBLEMHEALTH/HIP-CHP, +28063,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMBLEMHEALTH/HIP-CHP, +28064,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMBLEMHEALTH/HIP-CHP, +28065,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMBLEMHEALTH/HIP-CHP, +28066,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMBLEMHEALTH/HIP-CHP, +28067,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMBLEMHEALTH/HIP-CHP, +28068,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMBLEMHEALTH/HIP-CHP, +28069,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMBLEMHEALTH/HIP-CHP, +28070,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMBLEMHEALTH/HIP-CHP, +28071,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMBLEMHEALTH/HIP-CHP, +28072,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMBLEMHEALTH/HIP-CHP, +28073,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMBLEMHEALTH/HIP-CHP, +28074,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMBLEMHEALTH/HIP-CHP, +28075,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMBLEMHEALTH/HIP-CHP, +28076,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMBLEMHEALTH/HIP-CHP, +28077,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMBLEMHEALTH/HIP-CHP, +28078,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMBLEMHEALTH/HIP-CHP, +28079,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMBLEMHEALTH/HIP-CHP, +28080,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMBLEMHEALTH/HIP-CHP, +28081,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMBLEMHEALTH/HIP-CHP, +28082,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMBLEMHEALTH/HIP-CHP, +28083,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMBLEMHEALTH/HIP-CHP, +28084,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMBLEMHEALTH/HIP-CHP, +28085,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMBLEMHEALTH/HIP-CHP, +28086,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMBLEMHEALTH/HIP-CHP, +28087,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMBLEMHEALTH/HIP-CHP, +28088,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMBLEMHEALTH/HIP-CHP, +28089,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMBLEMHEALTH/HIP-CHP, +28090,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMBLEMHEALTH/HIP-CHP, +28091,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMBLEMHEALTH/HIP-CHP, +28092,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMBLEMHEALTH/HIP-CHP, +28093,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMBLEMHEALTH/HIP-CHP, +28094,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMBLEMHEALTH/HIP-CHP, +28095,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMBLEMHEALTH/HIP-CHP, +28096,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMBLEMHEALTH/HIP-CHP, +28097,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMBLEMHEALTH/HIP-CHP, +28098,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMBLEMHEALTH/HIP-CHP, +28099,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMBLEMHEALTH/HIP-CHP, +28100,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMBLEMHEALTH/HIP-CHP, +28101,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMBLEMHEALTH/HIP-CHP, +28102,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMBLEMHEALTH/HIP-CHP, +28103,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMBLEMHEALTH/HIP-CHP, +28104,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMBLEMHEALTH/HIP-CHP, +28105,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMBLEMHEALTH/HIP-CHP, +28106,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMBLEMHEALTH/HIP-CHP, +28107,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMBLEMHEALTH/HIP-CHP, +28108,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMBLEMHEALTH/HIP-CHP, +28109,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMBLEMHEALTH/HIP-CHP, +28110,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMBLEMHEALTH/HIP-CHP, +28111,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMBLEMHEALTH/HIP-CHP, +28112,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMBLEMHEALTH/HIP-CHP, +28113,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMBLEMHEALTH/HIP-CHP, +28114,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMBLEMHEALTH/HIP-CHP, +28115,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMBLEMHEALTH/HIP-CHP, +28116,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMBLEMHEALTH/HIP-CHP, +28117,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMBLEMHEALTH/HIP-CHP, +28118,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMBLEMHEALTH/HIP-CHP, +28119,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMBLEMHEALTH/HIP-CHP, +28120,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMBLEMHEALTH/HIP-CHP, +28121,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMBLEMHEALTH/HIP-CHP, +28122,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMBLEMHEALTH/HIP-CHP,4298.6 +28123,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMBLEMHEALTH/HIP-CHP, +28124,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMBLEMHEALTH/HIP-CHP, +28125,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMBLEMHEALTH/HIP-CHP, +28126,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMBLEMHEALTH/HIP-CHP, +28127,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +28128,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMBLEMHEALTH/HIP-CHP, +28129,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMBLEMHEALTH/HIP-CHP, +28130,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMBLEMHEALTH/HIP-CHP, +28131,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMBLEMHEALTH/HIP-CHP, +28132,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMBLEMHEALTH/HIP-CHP, +28133,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMBLEMHEALTH/HIP-CHP, +28134,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMBLEMHEALTH/HIP-CHP, +28135,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMBLEMHEALTH/HIP-CHP, +28136,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMBLEMHEALTH/HIP-CHP, +28137,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMBLEMHEALTH/HIP-CHP, +28138,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMBLEMHEALTH/HIP-CHP, +28139,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMBLEMHEALTH/HIP-CHP, +28140,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMBLEMHEALTH/HIP-CHP, +28141,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMBLEMHEALTH/HIP-CHP, +28142,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMBLEMHEALTH/HIP-CHP, +28143,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMBLEMHEALTH/HIP-CHP, +28144,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMBLEMHEALTH/HIP-CHP, +28145,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMBLEMHEALTH/HIP-CHP, +28146,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMBLEMHEALTH/HIP-CHP, +28147,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMBLEMHEALTH/HIP-CHP, +28148,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMBLEMHEALTH/HIP-CHP, +28149,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMBLEMHEALTH/HIP-CHP, +28150,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMBLEMHEALTH/HIP-CHP, +28151,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMBLEMHEALTH/HIP-CHP, +28152,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMBLEMHEALTH/HIP-CHP, +28153,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMBLEMHEALTH/HIP-CHP, +28154,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMBLEMHEALTH/HIP-CHP, +28155,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMBLEMHEALTH/HIP-CHP, +28156,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMBLEMHEALTH/HIP-CHP, +28157,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMBLEMHEALTH/HIP-CHP, +28158,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMBLEMHEALTH/HIP-CHP, +28159,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMBLEMHEALTH/HIP-CHP, +28160,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMBLEMHEALTH/HIP-CHP, +28161,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMBLEMHEALTH/HIP-CHP, +28162,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMBLEMHEALTH/HIP-CHP, +28163,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMBLEMHEALTH/HIP-CHP, +28164,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMBLEMHEALTH/HIP-CHP, +28165,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMBLEMHEALTH/HIP-CHP, +28166,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMBLEMHEALTH/HIP-CHP,5731.46 +28167,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28168,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMBLEMHEALTH/HIP-CHP, +28169,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMBLEMHEALTH/HIP-CHP, +28170,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMBLEMHEALTH/HIP-CHP, +28171,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMBLEMHEALTH/HIP-CHP, +28172,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMBLEMHEALTH/HIP-CHP, +28173,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMBLEMHEALTH/HIP-CHP, +28174,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMBLEMHEALTH/HIP-CHP, +28175,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMBLEMHEALTH/HIP-CHP, +28176,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMBLEMHEALTH/HIP-CHP, +28177,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMBLEMHEALTH/HIP-CHP, +28178,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMBLEMHEALTH/HIP-CHP, +28179,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMBLEMHEALTH/HIP-CHP, +28180,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMBLEMHEALTH/HIP-CHP, +28181,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMBLEMHEALTH/HIP-CHP, +28182,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMBLEMHEALTH/HIP-CHP, +28183,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMBLEMHEALTH/HIP-CHP, +28184,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMBLEMHEALTH/HIP-CHP, +28185,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMBLEMHEALTH/HIP-CHP, +28186,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMBLEMHEALTH/HIP-CHP, +28187,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMBLEMHEALTH/HIP-CHP, +28188,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMBLEMHEALTH/HIP-CHP, +28189,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMBLEMHEALTH/HIP-CHP, +28190,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMBLEMHEALTH/HIP-CHP, +28191,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMBLEMHEALTH/HIP-CHP, +28192,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMBLEMHEALTH/HIP-CHP, +28193,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMBLEMHEALTH/HIP-CHP, +28194,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMBLEMHEALTH/HIP-CHP, +28195,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-CHP, +28196,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMBLEMHEALTH/HIP-CHP, +28197,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMBLEMHEALTH/HIP-CHP, +28198,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMBLEMHEALTH/HIP-CHP, +28199,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMBLEMHEALTH/HIP-CHP, +28200,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMBLEMHEALTH/HIP-CHP, +28201,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMBLEMHEALTH/HIP-CHP, +28202,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMBLEMHEALTH/HIP-CHP, +28203,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMBLEMHEALTH/HIP-CHP, +28204,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMBLEMHEALTH/HIP-CHP, +28205,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMBLEMHEALTH/HIP-CHP, +28206,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMBLEMHEALTH/HIP-CHP, +28207,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMBLEMHEALTH/HIP-CHP, +28208,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMBLEMHEALTH/HIP-CHP, +28209,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMBLEMHEALTH/HIP-CHP, +28210,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMBLEMHEALTH/HIP-CHP, +28211,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMBLEMHEALTH/HIP-CHP, +28212,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMBLEMHEALTH/HIP-CHP, +28213,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMBLEMHEALTH/HIP-CHP, +28214,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMBLEMHEALTH/HIP-CHP, +28215,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMBLEMHEALTH/HIP-CHP, +28216,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMBLEMHEALTH/HIP-CHP, +28217,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMBLEMHEALTH/HIP-CHP, +28218,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMBLEMHEALTH/HIP-CHP, +28219,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMBLEMHEALTH/HIP-CHP, +28220,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMBLEMHEALTH/HIP-CHP, +28221,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMBLEMHEALTH/HIP-CHP, +28222,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMBLEMHEALTH/HIP-CHP, +28223,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMBLEMHEALTH/HIP-CHP, +28224,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMBLEMHEALTH/HIP-CHP, +28225,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMBLEMHEALTH/HIP-CHP, +28226,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMBLEMHEALTH/HIP-CHP, +28227,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMBLEMHEALTH/HIP-CHP, +28228,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMBLEMHEALTH/HIP-CHP, +28229,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMBLEMHEALTH/HIP-CHP, +28230,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMBLEMHEALTH/HIP-CHP, +28231,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMBLEMHEALTH/HIP-CHP, +28232,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMBLEMHEALTH/HIP-CHP, +28233,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMBLEMHEALTH/HIP-CHP, +28234,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMBLEMHEALTH/HIP-CHP, +28235,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMBLEMHEALTH/HIP-CHP, +28236,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMBLEMHEALTH/HIP-CHP, +28237,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMBLEMHEALTH/HIP-CHP, +28238,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMBLEMHEALTH/HIP-CHP, +28239,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMBLEMHEALTH/HIP-CHP, +28240,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMBLEMHEALTH/HIP-CHP, +28241,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMBLEMHEALTH/HIP-CHP, +28242,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMBLEMHEALTH/HIP-CHP, +28243,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMBLEMHEALTH/HIP-CHP, +28244,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMBLEMHEALTH/HIP-CHP, +28245,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMBLEMHEALTH/HIP-CHP, +28246,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMBLEMHEALTH/HIP-CHP, +28247,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMBLEMHEALTH/HIP-CHP, +28248,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +28249,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMBLEMHEALTH/HIP-CHP, +28250,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMBLEMHEALTH/HIP-CHP, +28251,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMBLEMHEALTH/HIP-CHP, +28252,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMBLEMHEALTH/HIP-CHP, +28253,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMBLEMHEALTH/HIP-CHP, +28254,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMBLEMHEALTH/HIP-CHP, +28255,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMBLEMHEALTH/HIP-CHP, +28256,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMBLEMHEALTH/HIP-CHP, +28257,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMBLEMHEALTH/HIP-CHP, +28258,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMBLEMHEALTH/HIP-CHP, +28259,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMBLEMHEALTH/HIP-CHP, +28260,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMBLEMHEALTH/HIP-CHP, +28261,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMBLEMHEALTH/HIP-CHP, +28262,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMBLEMHEALTH/HIP-CHP, +28263,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMBLEMHEALTH/HIP-CHP, +28264,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMBLEMHEALTH/HIP-CHP, +28265,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMBLEMHEALTH/HIP-CHP, +28266,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMBLEMHEALTH/HIP-CHP, +28267,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMBLEMHEALTH/HIP-CHP, +28268,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMBLEMHEALTH/HIP-CHP, +28269,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMBLEMHEALTH/HIP-CHP, +28270,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMBLEMHEALTH/HIP-CHP, +28271,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMBLEMHEALTH/HIP-CHP, +28272,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMBLEMHEALTH/HIP-CHP, +28273,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMBLEMHEALTH/HIP-CHP, +28274,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMBLEMHEALTH/HIP-CHP, +28275,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMBLEMHEALTH/HIP-CHP, +28276,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMBLEMHEALTH/HIP-CHP, +28277,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMBLEMHEALTH/HIP-CHP, +28278,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMBLEMHEALTH/HIP-CHP, +28279,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMBLEMHEALTH/HIP-CHP, +28280,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMBLEMHEALTH/HIP-CHP, +28281,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMBLEMHEALTH/HIP-CHP, +28282,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMBLEMHEALTH/HIP-CHP, +28283,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMBLEMHEALTH/HIP-CHP, +28284,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMBLEMHEALTH/HIP-CHP, +28285,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMBLEMHEALTH/HIP-CHP, +28286,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMBLEMHEALTH/HIP-CHP, +28287,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMBLEMHEALTH/HIP-CHP, +28288,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMBLEMHEALTH/HIP-CHP, +28289,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMBLEMHEALTH/HIP-CHP, +28290,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMBLEMHEALTH/HIP-CHP, +28291,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMBLEMHEALTH/HIP-CHP, +28292,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMBLEMHEALTH/HIP-CHP, +28293,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMBLEMHEALTH/HIP-CHP, +28294,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMBLEMHEALTH/HIP-CHP, +28295,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMBLEMHEALTH/HIP-CHP, +28296,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMBLEMHEALTH/HIP-CHP, +28297,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMBLEMHEALTH/HIP-CHP, +28298,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMBLEMHEALTH/HIP-CHP, +28299,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMBLEMHEALTH/HIP-CHP, +28300,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMBLEMHEALTH/HIP-CHP, +28301,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMBLEMHEALTH/HIP-CHP, +28302,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMBLEMHEALTH/HIP-CHP, +28303,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMBLEMHEALTH/HIP-CHP, +28304,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMBLEMHEALTH/HIP-CHP, +28305,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMBLEMHEALTH/HIP-CHP, +28306,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMBLEMHEALTH/HIP-CHP, +28307,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMBLEMHEALTH/HIP-CHP, +28308,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMBLEMHEALTH/HIP-CHP,631.49 +28309,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMBLEMHEALTH/HIP-CHP,1829.72 +28310,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMBLEMHEALTH/HIP-CHP, +28311,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMBLEMHEALTH/HIP-CHP, +28312,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMBLEMHEALTH/HIP-CHP, +28313,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMBLEMHEALTH/HIP-CHP, +28314,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMBLEMHEALTH/HIP-CHP, +28315,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMBLEMHEALTH/HIP-CHP, +28316,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMBLEMHEALTH/HIP-CHP, +28317,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMBLEMHEALTH/HIP-CHP, +28318,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMBLEMHEALTH/HIP-CHP, +28319,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMBLEMHEALTH/HIP-CHP, +28320,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMBLEMHEALTH/HIP-CHP, +28321,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMBLEMHEALTH/HIP-CHP, +28322,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMBLEMHEALTH/HIP-CHP, +28323,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMBLEMHEALTH/HIP-CHP, +28324,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMBLEMHEALTH/HIP-CHP, +28325,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMBLEMHEALTH/HIP-CHP, +28326,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMBLEMHEALTH/HIP-CHP, +28327,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMBLEMHEALTH/HIP-CHP, +28328,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMBLEMHEALTH/HIP-CHP, +28329,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMBLEMHEALTH/HIP-CHP, +28330,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMBLEMHEALTH/HIP-CHP, +28331,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMBLEMHEALTH/HIP-CHP, +28332,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMBLEMHEALTH/HIP-CHP, +28333,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMBLEMHEALTH/HIP-CHP, +28334,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMBLEMHEALTH/HIP-CHP, +28335,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMBLEMHEALTH/HIP-CHP, +28336,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMBLEMHEALTH/HIP-CHP, +28337,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMBLEMHEALTH/HIP-CHP, +28338,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMBLEMHEALTH/HIP-CHP, +28339,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMBLEMHEALTH/HIP-CHP, +28340,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMBLEMHEALTH/HIP-CHP, +28341,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMBLEMHEALTH/HIP-CHP, +28342,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMBLEMHEALTH/HIP-CHP, +28343,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMBLEMHEALTH/HIP-CHP, +28344,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMBLEMHEALTH/HIP-CHP, +28345,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMBLEMHEALTH/HIP-CHP, +28346,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMBLEMHEALTH/HIP-CHP, +28347,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMBLEMHEALTH/HIP-CHP, +28348,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMBLEMHEALTH/HIP-CHP, +28349,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMBLEMHEALTH/HIP-CHP, +28350,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMBLEMHEALTH/HIP-CHP, +28351,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMBLEMHEALTH/HIP-CHP, +28352,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMBLEMHEALTH/HIP-CHP, +28353,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMBLEMHEALTH/HIP-CHP, +28354,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMBLEMHEALTH/HIP-CHP, +28355,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +28356,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMBLEMHEALTH/HIP-CHP, +28357,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMBLEMHEALTH/HIP-CHP, +28358,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMBLEMHEALTH/HIP-CHP, +28359,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMBLEMHEALTH/HIP-CHP, +28360,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMBLEMHEALTH/HIP-CHP, +28361,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMBLEMHEALTH/HIP-CHP, +28362,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMBLEMHEALTH/HIP-CHP, +28363,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMBLEMHEALTH/HIP-CHP, +28364,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMBLEMHEALTH/HIP-CHP, +28365,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMBLEMHEALTH/HIP-CHP, +28366,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMBLEMHEALTH/HIP-CHP, +28367,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMBLEMHEALTH/HIP-CHP, +28368,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMBLEMHEALTH/HIP-CHP, +28369,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMBLEMHEALTH/HIP-CHP, +28370,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMBLEMHEALTH/HIP-CHP, +28371,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMBLEMHEALTH/HIP-CHP, +28372,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMBLEMHEALTH/HIP-CHP, +28373,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMBLEMHEALTH/HIP-CHP, +28374,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMBLEMHEALTH/HIP-CHP, +28375,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMBLEMHEALTH/HIP-CHP, +28376,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMBLEMHEALTH/HIP-CHP, +28377,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMBLEMHEALTH/HIP-CHP, +28378,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMBLEMHEALTH/HIP-CHP, +28379,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMBLEMHEALTH/HIP-CHP, +28380,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMBLEMHEALTH/HIP-CHP, +28381,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMBLEMHEALTH/HIP-CHP, +28382,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMBLEMHEALTH/HIP-CHP, +28383,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMBLEMHEALTH/HIP-CHP, +28384,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMBLEMHEALTH/HIP-CHP, +28385,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMBLEMHEALTH/HIP-CHP, +28386,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMBLEMHEALTH/HIP-CHP, +28387,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMBLEMHEALTH/HIP-CHP, +28388,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMBLEMHEALTH/HIP-CHP, +28389,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMBLEMHEALTH/HIP-CHP, +28390,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMBLEMHEALTH/HIP-CHP, +28391,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMBLEMHEALTH/HIP-CHP, +28392,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMBLEMHEALTH/HIP-CHP, +28393,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMBLEMHEALTH/HIP-CHP, +28394,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMBLEMHEALTH/HIP-CHP, +28395,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMBLEMHEALTH/HIP-CHP, +28396,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMBLEMHEALTH/HIP-CHP, +28397,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMBLEMHEALTH/HIP-CHP, +28398,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMBLEMHEALTH/HIP-CHP, +28399,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMBLEMHEALTH/HIP-CHP, +28400,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMBLEMHEALTH/HIP-CHP, +28401,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMBLEMHEALTH/HIP-CHP, +28402,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMBLEMHEALTH/HIP-CHP, +28403,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMBLEMHEALTH/HIP-CHP, +28404,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMBLEMHEALTH/HIP-CHP, +28405,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMBLEMHEALTH/HIP-CHP, +28406,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMBLEMHEALTH/HIP-CHP, +28407,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMBLEMHEALTH/HIP-CHP, +28408,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMBLEMHEALTH/HIP-CHP, +28409,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMBLEMHEALTH/HIP-CHP, +28410,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMBLEMHEALTH/HIP-CHP, +28411,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMBLEMHEALTH/HIP-CHP, +28412,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMBLEMHEALTH/HIP-CHP, +28413,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMBLEMHEALTH/HIP-CHP, +28414,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMBLEMHEALTH/HIP-CHP, +28415,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMBLEMHEALTH/HIP-CHP, +28416,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMBLEMHEALTH/HIP-CHP, +28417,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMBLEMHEALTH/HIP-CHP, +28418,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMBLEMHEALTH/HIP-CHP, +28419,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMBLEMHEALTH/HIP-CHP, +28420,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMBLEMHEALTH/HIP-CHP, +28421,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMBLEMHEALTH/HIP-CHP, +28422,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMBLEMHEALTH/HIP-CHP, +28423,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMBLEMHEALTH/HIP-CHP, +28424,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMBLEMHEALTH/HIP-CHP, +28425,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMBLEMHEALTH/HIP-CHP, +28426,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMBLEMHEALTH/HIP-CHP, +28427,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMBLEMHEALTH/HIP-CHP, +28428,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMBLEMHEALTH/HIP-CHP, +28429,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMBLEMHEALTH/HIP-CHP, +28430,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMBLEMHEALTH/HIP-CHP, +28431,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMBLEMHEALTH/HIP-CHP, +28432,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMBLEMHEALTH/HIP-CHP, +28433,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMBLEMHEALTH/HIP-CHP, +28434,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMBLEMHEALTH/HIP-CHP, +28435,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMBLEMHEALTH/HIP-CHP, +28436,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMBLEMHEALTH/HIP-CHP, +28437,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMBLEMHEALTH/HIP-CHP, +28438,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMBLEMHEALTH/HIP-CHP, +28439,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMBLEMHEALTH/HIP-CHP, +28440,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMBLEMHEALTH/HIP-CHP, +28441,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMBLEMHEALTH/HIP-CHP, +28442,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMBLEMHEALTH/HIP-CHP, +28443,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMBLEMHEALTH/HIP-CHP, +28444,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMBLEMHEALTH/HIP-CHP, +28445,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMBLEMHEALTH/HIP-CHP, +28446,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMBLEMHEALTH/HIP-CHP, +28447,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMBLEMHEALTH/HIP-CHP, +28448,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMBLEMHEALTH/HIP-CHP, +28449,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMBLEMHEALTH/HIP-CHP, +28450,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMBLEMHEALTH/HIP-CHP, +28451,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMBLEMHEALTH/HIP-CHP, +28452,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMBLEMHEALTH/HIP-CHP, +28453,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28454,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMBLEMHEALTH/HIP-CHP, +28455,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMBLEMHEALTH/HIP-CHP, +28456,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMBLEMHEALTH/HIP-CHP, +28457,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMBLEMHEALTH/HIP-CHP, +28458,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMBLEMHEALTH/HIP-CHP, +28459,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMBLEMHEALTH/HIP-CHP, +28460,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMBLEMHEALTH/HIP-CHP, +28461,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMBLEMHEALTH/HIP-CHP, +28462,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMBLEMHEALTH/HIP-CHP, +28463,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMBLEMHEALTH/HIP-CHP, +28464,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMBLEMHEALTH/HIP-CHP, +28465,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMBLEMHEALTH/HIP-CHP, +28466,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMBLEMHEALTH/HIP-CHP, +28467,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMBLEMHEALTH/HIP-CHP, +28468,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMBLEMHEALTH/HIP-CHP, +28469,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMBLEMHEALTH/HIP-CHP, +28470,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMBLEMHEALTH/HIP-CHP, +28471,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMBLEMHEALTH/HIP-CHP, +28472,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMBLEMHEALTH/HIP-CHP, +28473,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMBLEMHEALTH/HIP-CHP, +28474,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMBLEMHEALTH/HIP-CHP, +28475,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMBLEMHEALTH/HIP-CHP, +28476,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMBLEMHEALTH/HIP-CHP, +28477,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMBLEMHEALTH/HIP-CHP, +28478,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMBLEMHEALTH/HIP-CHP, +28479,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMBLEMHEALTH/HIP-CHP, +28480,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMBLEMHEALTH/HIP-CHP, +28481,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMBLEMHEALTH/HIP-CHP, +28482,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMBLEMHEALTH/HIP-CHP, +28483,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMBLEMHEALTH/HIP-CHP, +28484,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMBLEMHEALTH/HIP-CHP, +28485,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMBLEMHEALTH/HIP-CHP, +28486,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMBLEMHEALTH/HIP-CHP, +28487,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28488,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMBLEMHEALTH/HIP-CHP, +28489,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMBLEMHEALTH/HIP-CHP, +28490,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMBLEMHEALTH/HIP-CHP, +28491,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +28492,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMBLEMHEALTH/HIP-CHP, +28493,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMBLEMHEALTH/HIP-CHP,5731.46 +28494,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMBLEMHEALTH/HIP-CHP, +28495,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMBLEMHEALTH/HIP-CHP, +28496,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMBLEMHEALTH/HIP-CHP, +28497,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMBLEMHEALTH/HIP-CHP, +28498,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMBLEMHEALTH/HIP-CHP, +28499,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMBLEMHEALTH/HIP-CHP, +28500,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMBLEMHEALTH/HIP-CHP, +28501,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMBLEMHEALTH/HIP-CHP, +28502,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMBLEMHEALTH/HIP-CHP, +28503,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMBLEMHEALTH/HIP-CHP, +28504,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMBLEMHEALTH/HIP-CHP, +28505,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMBLEMHEALTH/HIP-CHP, +28506,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +28507,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMBLEMHEALTH/HIP-CHP, +28508,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMBLEMHEALTH/HIP-CHP, +28509,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMBLEMHEALTH/HIP-CHP, +28510,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMBLEMHEALTH/HIP-CHP, +28511,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMBLEMHEALTH/HIP-CHP, +28512,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMBLEMHEALTH/HIP-CHP, +28513,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMBLEMHEALTH/HIP-CHP, +28514,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMBLEMHEALTH/HIP-CHP, +28515,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMBLEMHEALTH/HIP-CHP, +28516,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMBLEMHEALTH/HIP-CHP, +28517,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMBLEMHEALTH/HIP-CHP, +28518,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMBLEMHEALTH/HIP-CHP, +28519,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMBLEMHEALTH/HIP-CHP, +28520,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMBLEMHEALTH/HIP-CHP, +28521,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMBLEMHEALTH/HIP-CHP, +28522,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMBLEMHEALTH/HIP-CHP, +28523,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMBLEMHEALTH/HIP-CHP, +28524,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMBLEMHEALTH/HIP-CHP, +28525,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMBLEMHEALTH/HIP-CHP, +28526,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMBLEMHEALTH/HIP-CHP, +28527,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMBLEMHEALTH/HIP-CHP, +28528,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMBLEMHEALTH/HIP-CHP, +28529,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMBLEMHEALTH/HIP-CHP, +28530,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMBLEMHEALTH/HIP-CHP, +28531,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMBLEMHEALTH/HIP-CHP, +28532,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMBLEMHEALTH/HIP-CHP, +28533,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMBLEMHEALTH/HIP-CHP, +28534,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMBLEMHEALTH/HIP-CHP, +28535,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMBLEMHEALTH/HIP-CHP, +28536,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMBLEMHEALTH/HIP-CHP, +28537,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMBLEMHEALTH/HIP-CHP, +28538,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMBLEMHEALTH/HIP-CHP,1829.72 +28539,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMBLEMHEALTH/HIP-CHP,4578.15 +28540,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMBLEMHEALTH/HIP-CHP, +28541,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMBLEMHEALTH/HIP-CHP, +28542,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMBLEMHEALTH/HIP-CHP, +28543,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMBLEMHEALTH/HIP-CHP, +28544,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMBLEMHEALTH/HIP-CHP, +28545,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMBLEMHEALTH/HIP-CHP, +28546,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMBLEMHEALTH/HIP-CHP, +28547,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMBLEMHEALTH/HIP-CHP, +28548,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMBLEMHEALTH/HIP-CHP, +28549,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMBLEMHEALTH/HIP-CHP, +28550,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMBLEMHEALTH/HIP-CHP, +28551,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMBLEMHEALTH/HIP-CHP, +28552,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +28553,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28554,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMBLEMHEALTH/HIP-CHP, +28555,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMBLEMHEALTH/HIP-CHP, +28556,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMBLEMHEALTH/HIP-CHP, +28557,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMBLEMHEALTH/HIP-CHP, +28558,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMBLEMHEALTH/HIP-CHP, +28559,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMBLEMHEALTH/HIP-CHP, +28560,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMBLEMHEALTH/HIP-CHP, +28561,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMBLEMHEALTH/HIP-CHP, +28562,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMBLEMHEALTH/HIP-CHP, +28563,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMBLEMHEALTH/HIP-CHP, +28564,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMBLEMHEALTH/HIP-CHP, +28565,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMBLEMHEALTH/HIP-CHP, +28566,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMBLEMHEALTH/HIP-CHP, +28567,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMBLEMHEALTH/HIP-CHP, +28568,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMBLEMHEALTH/HIP-CHP, +28569,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMBLEMHEALTH/HIP-CHP, +28570,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMBLEMHEALTH/HIP-CHP, +28571,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28572,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMBLEMHEALTH/HIP-CHP, +28573,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMBLEMHEALTH/HIP-CHP, +28574,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMBLEMHEALTH/HIP-CHP, +28575,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28576,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMBLEMHEALTH/HIP-CHP, +28577,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMBLEMHEALTH/HIP-CHP, +28578,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMBLEMHEALTH/HIP-CHP, +28579,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMBLEMHEALTH/HIP-CHP, +28580,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMBLEMHEALTH/HIP-CHP, +28581,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMBLEMHEALTH/HIP-CHP, +28582,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMBLEMHEALTH/HIP-CHP, +28583,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMBLEMHEALTH/HIP-CHP, +28584,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMBLEMHEALTH/HIP-CHP, +28585,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMBLEMHEALTH/HIP-CHP, +28586,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMBLEMHEALTH/HIP-CHP, +28587,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMBLEMHEALTH/HIP-CHP, +28588,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMBLEMHEALTH/HIP-CHP, +28589,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMBLEMHEALTH/HIP-CHP, +28590,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMBLEMHEALTH/HIP-CHP, +28591,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMBLEMHEALTH/HIP-CHP, +28592,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +28593,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMBLEMHEALTH/HIP-CHP, +28594,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMBLEMHEALTH/HIP-CHP, +28595,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMBLEMHEALTH/HIP-CHP, +28596,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMBLEMHEALTH/HIP-CHP, +28597,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMBLEMHEALTH/HIP-CHP, +28598,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMBLEMHEALTH/HIP-CHP, +28599,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMBLEMHEALTH/HIP-CHP, +28600,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMBLEMHEALTH/HIP-CHP, +28601,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMBLEMHEALTH/HIP-CHP, +28602,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMBLEMHEALTH/HIP-CHP, +28603,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMBLEMHEALTH/HIP-CHP, +28604,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMBLEMHEALTH/HIP-CHP, +28605,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMBLEMHEALTH/HIP-CHP, +28606,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMBLEMHEALTH/HIP-CHP, +28607,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMBLEMHEALTH/HIP-CHP, +28608,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMBLEMHEALTH/HIP-CHP, +28609,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMBLEMHEALTH/HIP-CHP, +28610,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMBLEMHEALTH/HIP-CHP, +28611,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMBLEMHEALTH/HIP-CHP, +28612,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMBLEMHEALTH/HIP-CHP, +28613,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMBLEMHEALTH/HIP-CHP, +28614,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMBLEMHEALTH/HIP-CHP, +28615,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMBLEMHEALTH/HIP-CHP, +28616,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMBLEMHEALTH/HIP-CHP, +28617,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMBLEMHEALTH/HIP-CHP, +28618,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMBLEMHEALTH/HIP-CHP, +28619,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMBLEMHEALTH/HIP-CHP, +28620,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMBLEMHEALTH/HIP-CHP, +28621,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMBLEMHEALTH/HIP-CHP, +28622,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMBLEMHEALTH/HIP-CHP, +28623,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMBLEMHEALTH/HIP-CHP, +28624,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMBLEMHEALTH/HIP-CHP, +28625,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMBLEMHEALTH/HIP-CHP, +28626,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMBLEMHEALTH/HIP-CHP, +28627,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMBLEMHEALTH/HIP-CHP, +28628,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMBLEMHEALTH/HIP-CHP, +28629,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMBLEMHEALTH/HIP-CHP, +28630,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMBLEMHEALTH/HIP-CHP, +28631,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMBLEMHEALTH/HIP-CHP, +28632,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMBLEMHEALTH/HIP-CHP, +28633,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMBLEMHEALTH/HIP-CHP, +28634,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMBLEMHEALTH/HIP-CHP, +28635,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMBLEMHEALTH/HIP-CHP, +28636,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMBLEMHEALTH/HIP-CHP, +28637,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMBLEMHEALTH/HIP-CHP, +28638,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28639,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMBLEMHEALTH/HIP-CHP, +28640,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMBLEMHEALTH/HIP-CHP, +28641,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMBLEMHEALTH/HIP-CHP, +28642,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMBLEMHEALTH/HIP-CHP, +28643,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMBLEMHEALTH/HIP-CHP, +28644,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMBLEMHEALTH/HIP-CHP, +28645,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28646,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMBLEMHEALTH/HIP-CHP, +28647,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMBLEMHEALTH/HIP-CHP, +28648,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMBLEMHEALTH/HIP-CHP, +28649,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMBLEMHEALTH/HIP-CHP, +28650,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMBLEMHEALTH/HIP-CHP, +28651,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMBLEMHEALTH/HIP-CHP, +28652,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMBLEMHEALTH/HIP-CHP, +28653,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMBLEMHEALTH/HIP-CHP, +28654,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMBLEMHEALTH/HIP-CHP, +28655,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMBLEMHEALTH/HIP-CHP, +28656,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMBLEMHEALTH/HIP-CHP, +28657,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMBLEMHEALTH/HIP-CHP, +28658,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMBLEMHEALTH/HIP-CHP, +28659,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMBLEMHEALTH/HIP-CHP, +28660,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMBLEMHEALTH/HIP-CHP, +28661,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMBLEMHEALTH/HIP-CHP, +28662,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMBLEMHEALTH/HIP-CHP, +28663,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMBLEMHEALTH/HIP-CHP, +28664,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMBLEMHEALTH/HIP-CHP, +28665,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMBLEMHEALTH/HIP-CHP, +28666,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMBLEMHEALTH/HIP-CHP, +28667,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMBLEMHEALTH/HIP-CHP, +28668,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMBLEMHEALTH/HIP-CHP, +28669,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMBLEMHEALTH/HIP-CHP, +28670,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMBLEMHEALTH/HIP-CHP, +28671,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMBLEMHEALTH/HIP-CHP, +28672,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMBLEMHEALTH/HIP-CHP, +28673,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMBLEMHEALTH/HIP-CHP, +28674,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMBLEMHEALTH/HIP-CHP, +28675,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMBLEMHEALTH/HIP-CHP, +28676,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMBLEMHEALTH/HIP-CHP, +28677,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMBLEMHEALTH/HIP-CHP, +28678,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMBLEMHEALTH/HIP-CHP, +28679,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMBLEMHEALTH/HIP-CHP, +28680,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMBLEMHEALTH/HIP-CHP, +28681,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMBLEMHEALTH/HIP-CHP, +28682,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMBLEMHEALTH/HIP-CHP, +28683,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMBLEMHEALTH/HIP-CHP, +28684,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMBLEMHEALTH/HIP-CHP, +28685,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMBLEMHEALTH/HIP-CHP, +28686,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMBLEMHEALTH/HIP-CHP, +28687,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMBLEMHEALTH/HIP-CHP, +28688,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMBLEMHEALTH/HIP-CHP, +28689,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMBLEMHEALTH/HIP-CHP, +28690,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMBLEMHEALTH/HIP-CHP, +28691,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMBLEMHEALTH/HIP-CHP, +28692,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMBLEMHEALTH/HIP-CHP, +28693,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMBLEMHEALTH/HIP-CHP, +28694,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMBLEMHEALTH/HIP-CHP, +28695,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMBLEMHEALTH/HIP-CHP, +28696,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMBLEMHEALTH/HIP-CHP, +28697,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMBLEMHEALTH/HIP-CHP, +28698,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMBLEMHEALTH/HIP-CHP, +28699,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMBLEMHEALTH/HIP-CHP, +28700,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMBLEMHEALTH/HIP-CHP, +28701,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMBLEMHEALTH/HIP-CHP, +28702,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMBLEMHEALTH/HIP-CHP, +28703,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMBLEMHEALTH/HIP-CHP, +28704,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +28705,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMBLEMHEALTH/HIP-CHP, +28706,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMBLEMHEALTH/HIP-CHP, +28707,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMBLEMHEALTH/HIP-CHP,5731.46 +28708,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMBLEMHEALTH/HIP-CHP, +28709,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMBLEMHEALTH/HIP-CHP, +28710,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMBLEMHEALTH/HIP-CHP, +28711,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMBLEMHEALTH/HIP-CHP, +28712,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMBLEMHEALTH/HIP-CHP, +28713,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMBLEMHEALTH/HIP-CHP, +28714,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMBLEMHEALTH/HIP-CHP, +28715,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMBLEMHEALTH/HIP-CHP, +28716,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMBLEMHEALTH/HIP-CHP, +28717,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMBLEMHEALTH/HIP-CHP, +28718,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMBLEMHEALTH/HIP-CHP, +28719,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMBLEMHEALTH/HIP-CHP, +28720,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMBLEMHEALTH/HIP-CHP, +28721,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMBLEMHEALTH/HIP-CHP, +28722,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMBLEMHEALTH/HIP-CHP, +28723,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMBLEMHEALTH/HIP-CHP, +28724,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMBLEMHEALTH/HIP-CHP, +28725,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMBLEMHEALTH/HIP-CHP, +28726,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMBLEMHEALTH/HIP-CHP, +28727,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMBLEMHEALTH/HIP-CHP, +28728,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMBLEMHEALTH/HIP-CHP, +28729,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMBLEMHEALTH/HIP-CHP, +28730,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMBLEMHEALTH/HIP-CHP, +28731,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMBLEMHEALTH/HIP-CHP, +28732,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMBLEMHEALTH/HIP-CHP, +28733,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMBLEMHEALTH/HIP-CHP, +28734,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMBLEMHEALTH/HIP-CHP, +28735,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMBLEMHEALTH/HIP-CHP, +28736,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMBLEMHEALTH/HIP-CHP, +28737,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMBLEMHEALTH/HIP-CHP, +28738,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMBLEMHEALTH/HIP-CHP,48.74 +28739,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMBLEMHEALTH/HIP-CHP, +28740,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMBLEMHEALTH/HIP-CHP, +28741,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMBLEMHEALTH/HIP-CHP, +28742,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28743,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMBLEMHEALTH/HIP-CHP, +28744,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMBLEMHEALTH/HIP-CHP, +28745,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMBLEMHEALTH/HIP-CHP, +28746,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMBLEMHEALTH/HIP-CHP, +28747,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMBLEMHEALTH/HIP-CHP, +28748,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMBLEMHEALTH/HIP-CHP, +28749,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMBLEMHEALTH/HIP-CHP, +28750,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMBLEMHEALTH/HIP-CHP, +28751,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMBLEMHEALTH/HIP-CHP, +28752,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMBLEMHEALTH/HIP-CHP, +28753,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMBLEMHEALTH/HIP-CHP, +28754,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMBLEMHEALTH/HIP-CHP, +28755,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMBLEMHEALTH/HIP-CHP, +28756,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMBLEMHEALTH/HIP-CHP, +28757,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMBLEMHEALTH/HIP-CHP, +28758,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMBLEMHEALTH/HIP-CHP, +28759,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMBLEMHEALTH/HIP-CHP, +28760,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMBLEMHEALTH/HIP-CHP, +28761,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMBLEMHEALTH/HIP-CHP, +28762,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMBLEMHEALTH/HIP-CHP, +28763,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMBLEMHEALTH/HIP-CHP, +28764,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMBLEMHEALTH/HIP-CHP, +28765,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMBLEMHEALTH/HIP-CHP, +28766,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMBLEMHEALTH/HIP-CHP, +28767,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMBLEMHEALTH/HIP-CHP, +28768,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28769,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMBLEMHEALTH/HIP-CHP, +28770,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMBLEMHEALTH/HIP-CHP, +28771,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMBLEMHEALTH/HIP-CHP, +28772,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMBLEMHEALTH/HIP-CHP, +28773,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMBLEMHEALTH/HIP-CHP, +28774,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMBLEMHEALTH/HIP-CHP, +28775,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMBLEMHEALTH/HIP-CHP, +28776,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMBLEMHEALTH/HIP-CHP, +28777,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMBLEMHEALTH/HIP-CHP, +28778,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMBLEMHEALTH/HIP-CHP, +28779,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMBLEMHEALTH/HIP-CHP, +28780,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMBLEMHEALTH/HIP-CHP, +28781,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMBLEMHEALTH/HIP-CHP, +28782,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMBLEMHEALTH/HIP-CHP, +28783,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMBLEMHEALTH/HIP-CHP, +28784,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMBLEMHEALTH/HIP-CHP, +28785,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMBLEMHEALTH/HIP-CHP, +28786,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMBLEMHEALTH/HIP-CHP, +28787,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMBLEMHEALTH/HIP-CHP, +28788,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMBLEMHEALTH/HIP-CHP, +28789,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMBLEMHEALTH/HIP-CHP, +28790,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMBLEMHEALTH/HIP-CHP, +28791,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMBLEMHEALTH/HIP-CHP, +28792,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMBLEMHEALTH/HIP-CHP, +28793,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMBLEMHEALTH/HIP-CHP, +28794,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMBLEMHEALTH/HIP-CHP, +28795,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMBLEMHEALTH/HIP-CHP, +28796,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMBLEMHEALTH/HIP-CHP, +28797,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMBLEMHEALTH/HIP-CHP, +28798,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMBLEMHEALTH/HIP-CHP, +28799,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMBLEMHEALTH/HIP-CHP, +28800,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMBLEMHEALTH/HIP-CHP, +28801,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMBLEMHEALTH/HIP-CHP, +28802,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMBLEMHEALTH/HIP-CHP, +28803,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMBLEMHEALTH/HIP-CHP, +28804,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMBLEMHEALTH/HIP-CHP, +28805,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMBLEMHEALTH/HIP-CHP, +28806,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMBLEMHEALTH/HIP-CHP, +28807,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMBLEMHEALTH/HIP-CHP, +28808,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMBLEMHEALTH/HIP-CHP, +28809,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMBLEMHEALTH/HIP-CHP, +28810,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMBLEMHEALTH/HIP-CHP, +28811,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMBLEMHEALTH/HIP-CHP, +28812,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMBLEMHEALTH/HIP-CHP, +28813,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMBLEMHEALTH/HIP-CHP, +28814,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMBLEMHEALTH/HIP-CHP, +28815,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMBLEMHEALTH/HIP-CHP, +28816,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMBLEMHEALTH/HIP-CHP, +28817,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMBLEMHEALTH/HIP-CHP, +28818,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-CHP, +28819,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-CHP, +28820,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMBLEMHEALTH/HIP-CHP, +28821,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMBLEMHEALTH/HIP-CHP, +28822,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMBLEMHEALTH/HIP-CHP, +28823,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMBLEMHEALTH/HIP-CHP, +28824,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMBLEMHEALTH/HIP-CHP, +28825,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMBLEMHEALTH/HIP-CHP, +28826,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMBLEMHEALTH/HIP-CHP, +28827,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMBLEMHEALTH/HIP-CHP, +28828,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMBLEMHEALTH/HIP-CHP, +28829,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMBLEMHEALTH/HIP-CHP, +28830,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMBLEMHEALTH/HIP-CHP, +28831,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMBLEMHEALTH/HIP-CHP, +28832,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMBLEMHEALTH/HIP-CHP, +28833,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMBLEMHEALTH/HIP-CHP, +28834,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMBLEMHEALTH/HIP-CHP, +28835,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMBLEMHEALTH/HIP-CHP, +28836,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMBLEMHEALTH/HIP-CHP, +28837,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMBLEMHEALTH/HIP-CHP, +28838,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMBLEMHEALTH/HIP-CHP, +28839,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMBLEMHEALTH/HIP-CHP, +28840,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMBLEMHEALTH/HIP-CHP, +28841,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMBLEMHEALTH/HIP-CHP, +28842,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMBLEMHEALTH/HIP-CHP, +28843,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMBLEMHEALTH/HIP-CHP, +28844,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMBLEMHEALTH/HIP-CHP, +28845,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMBLEMHEALTH/HIP-CHP, +28846,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMBLEMHEALTH/HIP-CHP, +28847,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMBLEMHEALTH/HIP-CHP, +28848,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMBLEMHEALTH/HIP-CHP, +28849,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMBLEMHEALTH/HIP-CHP, +28850,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMBLEMHEALTH/HIP-CHP, +28851,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMBLEMHEALTH/HIP-CHP, +28852,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMBLEMHEALTH/HIP-CHP, +28853,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMBLEMHEALTH/HIP-CHP, +28854,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMBLEMHEALTH/HIP-CHP, +28855,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMBLEMHEALTH/HIP-CHP, +28856,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMBLEMHEALTH/HIP-CHP, +28857,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMBLEMHEALTH/HIP-CHP, +28858,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMBLEMHEALTH/HIP-CHP, +28859,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMBLEMHEALTH/HIP-CHP, +28860,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMBLEMHEALTH/HIP-CHP, +28861,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMBLEMHEALTH/HIP-CHP, +28862,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMBLEMHEALTH/HIP-CHP, +28863,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +28864,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMBLEMHEALTH/HIP-CHP, +28865,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMBLEMHEALTH/HIP-CHP, +28866,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMBLEMHEALTH/HIP-CHP, +28867,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMBLEMHEALTH/HIP-CHP, +28868,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMBLEMHEALTH/HIP-CHP, +28869,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMBLEMHEALTH/HIP-CHP, +28870,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMBLEMHEALTH/HIP-CHP, +28871,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMBLEMHEALTH/HIP-CHP, +28872,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMBLEMHEALTH/HIP-CHP, +28873,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMBLEMHEALTH/HIP-CHP, +28874,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMBLEMHEALTH/HIP-CHP, +28875,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMBLEMHEALTH/HIP-CHP, +28876,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMBLEMHEALTH/HIP-CHP, +28877,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMBLEMHEALTH/HIP-CHP, +28878,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMBLEMHEALTH/HIP-CHP, +28879,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMBLEMHEALTH/HIP-CHP, +28880,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMBLEMHEALTH/HIP-CHP, +28881,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMBLEMHEALTH/HIP-CHP, +28882,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMBLEMHEALTH/HIP-CHP, +28883,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMBLEMHEALTH/HIP-CHP, +28884,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMBLEMHEALTH/HIP-CHP, +28885,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMBLEMHEALTH/HIP-CHP, +28886,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMBLEMHEALTH/HIP-CHP, +28887,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMBLEMHEALTH/HIP-CHP, +28888,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28889,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMBLEMHEALTH/HIP-CHP, +28890,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMBLEMHEALTH/HIP-CHP, +28891,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMBLEMHEALTH/HIP-CHP, +28892,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMBLEMHEALTH/HIP-CHP, +28893,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMBLEMHEALTH/HIP-CHP, +28894,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMBLEMHEALTH/HIP-CHP, +28895,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMBLEMHEALTH/HIP-CHP, +28896,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMBLEMHEALTH/HIP-CHP, +28897,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMBLEMHEALTH/HIP-CHP, +28898,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMBLEMHEALTH/HIP-CHP, +28899,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMBLEMHEALTH/HIP-CHP, +28900,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMBLEMHEALTH/HIP-CHP, +28901,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMBLEMHEALTH/HIP-CHP, +28902,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMBLEMHEALTH/HIP-CHP, +28903,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMBLEMHEALTH/HIP-CHP, +28904,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMBLEMHEALTH/HIP-CHP, +28905,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMBLEMHEALTH/HIP-CHP, +28906,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMBLEMHEALTH/HIP-CHP, +28907,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMBLEMHEALTH/HIP-CHP, +28908,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMBLEMHEALTH/HIP-CHP, +28909,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMBLEMHEALTH/HIP-CHP, +28910,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMBLEMHEALTH/HIP-CHP, +28911,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMBLEMHEALTH/HIP-CHP, +28912,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMBLEMHEALTH/HIP-CHP, +28913,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMBLEMHEALTH/HIP-CHP, +28914,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMBLEMHEALTH/HIP-CHP, +28915,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMBLEMHEALTH/HIP-CHP,2026.33 +28916,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMBLEMHEALTH/HIP-CHP, +28917,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMBLEMHEALTH/HIP-CHP, +28918,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMBLEMHEALTH/HIP-CHP, +28919,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMBLEMHEALTH/HIP-CHP, +28920,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMBLEMHEALTH/HIP-CHP, +28921,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMBLEMHEALTH/HIP-CHP, +28922,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMBLEMHEALTH/HIP-CHP, +28923,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMBLEMHEALTH/HIP-CHP, +28924,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMBLEMHEALTH/HIP-CHP, +28925,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMBLEMHEALTH/HIP-CHP, +28926,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMBLEMHEALTH/HIP-CHP, +28927,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMBLEMHEALTH/HIP-CHP, +28928,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMBLEMHEALTH/HIP-CHP, +28929,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMBLEMHEALTH/HIP-CHP, +28930,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMBLEMHEALTH/HIP-CHP, +28931,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMBLEMHEALTH/HIP-CHP, +28932,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMBLEMHEALTH/HIP-CHP, +28933,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMBLEMHEALTH/HIP-CHP, +28934,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMBLEMHEALTH/HIP-CHP, +28935,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMBLEMHEALTH/HIP-CHP, +28936,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMBLEMHEALTH/HIP-CHP, +28937,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMBLEMHEALTH/HIP-CHP, +28938,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMBLEMHEALTH/HIP-CHP, +28939,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMBLEMHEALTH/HIP-CHP, +28940,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMBLEMHEALTH/HIP-CHP, +28941,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMBLEMHEALTH/HIP-CHP, +28942,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMBLEMHEALTH/HIP-CHP, +28943,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMBLEMHEALTH/HIP-CHP, +28944,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMBLEMHEALTH/HIP-CHP, +28945,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMBLEMHEALTH/HIP-CHP, +28946,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMBLEMHEALTH/HIP-CHP, +28947,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMBLEMHEALTH/HIP-CHP, +28948,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMBLEMHEALTH/HIP-CHP, +28949,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMBLEMHEALTH/HIP-CHP, +28950,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMBLEMHEALTH/HIP-CHP, +28951,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMBLEMHEALTH/HIP-CHP, +28952,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMBLEMHEALTH/HIP-CHP, +28953,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMBLEMHEALTH/HIP-CHP, +28954,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMBLEMHEALTH/HIP-CHP, +28955,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMBLEMHEALTH/HIP-CHP, +28956,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMBLEMHEALTH/HIP-CHP, +28957,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMBLEMHEALTH/HIP-CHP, +28958,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMBLEMHEALTH/HIP-CHP, +28959,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMBLEMHEALTH/HIP-CHP, +28960,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMBLEMHEALTH/HIP-CHP, +28961,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMBLEMHEALTH/HIP-CHP, +28962,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMBLEMHEALTH/HIP-CHP, +28963,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMBLEMHEALTH/HIP-CHP, +28964,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMBLEMHEALTH/HIP-CHP, +28965,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMBLEMHEALTH/HIP-CHP, +28966,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMBLEMHEALTH/HIP-CHP, +28967,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMBLEMHEALTH/HIP-CHP, +28968,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMBLEMHEALTH/HIP-CHP, +28969,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMBLEMHEALTH/HIP-CHP, +28970,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMBLEMHEALTH/HIP-CHP, +28971,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMBLEMHEALTH/HIP-CHP, +28972,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMBLEMHEALTH/HIP-CHP, +28973,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMBLEMHEALTH/HIP-CHP, +28974,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMBLEMHEALTH/HIP-CHP, +28975,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMBLEMHEALTH/HIP-CHP, +28976,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMBLEMHEALTH/HIP-CHP, +28977,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMBLEMHEALTH/HIP-CHP, +28978,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMBLEMHEALTH/HIP-CHP, +28979,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMBLEMHEALTH/HIP-CHP, +28980,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMBLEMHEALTH/HIP-CHP, +28981,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMBLEMHEALTH/HIP-CHP, +28982,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMBLEMHEALTH/HIP-CHP, +28983,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMBLEMHEALTH/HIP-CHP, +28984,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMBLEMHEALTH/HIP-CHP, +28985,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMBLEMHEALTH/HIP-CHP, +28986,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMBLEMHEALTH/HIP-CHP, +28987,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMBLEMHEALTH/HIP-CHP, +28988,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMBLEMHEALTH/HIP-CHP, +28989,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMBLEMHEALTH/HIP-CHP, +28990,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMBLEMHEALTH/HIP-CHP, +28991,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMBLEMHEALTH/HIP-CHP, +28992,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMBLEMHEALTH/HIP-CHP, +28993,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMBLEMHEALTH/HIP-CHP, +28994,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMBLEMHEALTH/HIP-CHP, +28995,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMBLEMHEALTH/HIP-CHP, +28996,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMBLEMHEALTH/HIP-CHP, +28997,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMBLEMHEALTH/HIP-CHP, +28998,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMBLEMHEALTH/HIP-CHP, +28999,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMBLEMHEALTH/HIP-CHP,2431.59 +29000,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMBLEMHEALTH/HIP-CHP, +29001,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMBLEMHEALTH/HIP-CHP, +29002,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMBLEMHEALTH/HIP-CHP, +29003,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMBLEMHEALTH/HIP-CHP, +29004,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMBLEMHEALTH/HIP-CHP, +29005,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMBLEMHEALTH/HIP-CHP, +29006,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMBLEMHEALTH/HIP-CHP, +29007,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMBLEMHEALTH/HIP-CHP, +29008,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMBLEMHEALTH/HIP-CHP, +29009,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMBLEMHEALTH/HIP-CHP, +29010,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +29011,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMBLEMHEALTH/HIP-CHP, +29012,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMBLEMHEALTH/HIP-CHP, +29013,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMBLEMHEALTH/HIP-CHP, +29014,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMBLEMHEALTH/HIP-CHP, +29015,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMBLEMHEALTH/HIP-CHP, +29016,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMBLEMHEALTH/HIP-CHP, +29017,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMBLEMHEALTH/HIP-CHP, +29018,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMBLEMHEALTH/HIP-CHP, +29019,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMBLEMHEALTH/HIP-CHP, +29020,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMBLEMHEALTH/HIP-CHP, +29021,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMBLEMHEALTH/HIP-CHP, +29022,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMBLEMHEALTH/HIP-CHP, +29023,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMBLEMHEALTH/HIP-CHP, +29024,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMBLEMHEALTH/HIP-CHP, +29025,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMBLEMHEALTH/HIP-CHP, +29026,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMBLEMHEALTH/HIP-CHP, +29027,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMBLEMHEALTH/HIP-CHP, +29028,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMBLEMHEALTH/HIP-CHP, +29029,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMBLEMHEALTH/HIP-CHP, +29030,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMBLEMHEALTH/HIP-CHP, +29031,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMBLEMHEALTH/HIP-CHP, +29032,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMBLEMHEALTH/HIP-CHP, +29033,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMBLEMHEALTH/HIP-CHP, +29034,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMBLEMHEALTH/HIP-CHP, +29035,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMBLEMHEALTH/HIP-CHP, +29036,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMBLEMHEALTH/HIP-CHP, +29037,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMBLEMHEALTH/HIP-CHP, +29038,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMBLEMHEALTH/HIP-CHP, +29039,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMBLEMHEALTH/HIP-CHP, +29040,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMBLEMHEALTH/HIP-CHP, +29041,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMBLEMHEALTH/HIP-CHP, +29042,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMBLEMHEALTH/HIP-CHP, +29043,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMBLEMHEALTH/HIP-CHP, +29044,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMBLEMHEALTH/HIP-CHP, +29045,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMBLEMHEALTH/HIP-CHP, +29046,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMBLEMHEALTH/HIP-CHP, +29047,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMBLEMHEALTH/HIP-CHP, +29048,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMBLEMHEALTH/HIP-CHP, +29049,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMBLEMHEALTH/HIP-CHP, +29050,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMBLEMHEALTH/HIP-CHP, +29051,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMBLEMHEALTH/HIP-CHP, +29052,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMBLEMHEALTH/HIP-CHP, +29053,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMBLEMHEALTH/HIP-CHP, +29054,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMBLEMHEALTH/HIP-CHP, +29055,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMBLEMHEALTH/HIP-CHP, +29056,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMBLEMHEALTH/HIP-CHP, +29057,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMBLEMHEALTH/HIP-CHP, +29058,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMBLEMHEALTH/HIP-CHP, +29059,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMBLEMHEALTH/HIP-CHP, +29060,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMBLEMHEALTH/HIP-CHP, +29061,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMBLEMHEALTH/HIP-CHP, +29062,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMBLEMHEALTH/HIP-CHP, +29063,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMBLEMHEALTH/HIP-CHP, +29064,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMBLEMHEALTH/HIP-CHP, +29065,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMBLEMHEALTH/HIP-CHP, +29066,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMBLEMHEALTH/HIP-CHP, +29067,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMBLEMHEALTH/HIP-CHP, +29068,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMBLEMHEALTH/HIP-CHP, +29069,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMBLEMHEALTH/HIP-CHP, +29070,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMBLEMHEALTH/HIP-CHP, +29071,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMBLEMHEALTH/HIP-CHP, +29072,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMBLEMHEALTH/HIP-CHP, +29073,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMBLEMHEALTH/HIP-CHP, +29074,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMBLEMHEALTH/HIP-CHP, +29075,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMBLEMHEALTH/HIP-CHP, +29076,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMBLEMHEALTH/HIP-CHP, +29077,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMBLEMHEALTH/HIP-CHP, +29078,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMBLEMHEALTH/HIP-CHP, +29079,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMBLEMHEALTH/HIP-CHP, +29080,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMBLEMHEALTH/HIP-CHP, +29081,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMBLEMHEALTH/HIP-CHP, +29082,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMBLEMHEALTH/HIP-CHP, +29083,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMBLEMHEALTH/HIP-CHP, +29084,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMBLEMHEALTH/HIP-CHP, +29085,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMBLEMHEALTH/HIP-CHP, +29086,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMBLEMHEALTH/HIP-CHP, +29087,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMBLEMHEALTH/HIP-CHP, +29088,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMBLEMHEALTH/HIP-CHP, +29089,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMBLEMHEALTH/HIP-CHP, +29090,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMBLEMHEALTH/HIP-CHP, +29091,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMBLEMHEALTH/HIP-CHP, +29092,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMBLEMHEALTH/HIP-CHP, +29093,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMBLEMHEALTH/HIP-CHP, +29094,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMBLEMHEALTH/HIP-CHP, +29095,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMBLEMHEALTH/HIP-CHP, +29096,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMBLEMHEALTH/HIP-CHP, +29097,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMBLEMHEALTH/HIP-CHP, +29098,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMBLEMHEALTH/HIP-CHP, +29099,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMBLEMHEALTH/HIP-CHP, +29100,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMBLEMHEALTH/HIP-CHP, +29101,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMBLEMHEALTH/HIP-CHP, +29102,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMBLEMHEALTH/HIP-CHP, +29103,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMBLEMHEALTH/HIP-CHP, +29104,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMBLEMHEALTH/HIP-CHP, +29105,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29106,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMBLEMHEALTH/HIP-CHP, +29107,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMBLEMHEALTH/HIP-CHP, +29108,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMBLEMHEALTH/HIP-CHP, +29109,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMBLEMHEALTH/HIP-CHP, +29110,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMBLEMHEALTH/HIP-CHP, +29111,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMBLEMHEALTH/HIP-CHP, +29112,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMBLEMHEALTH/HIP-CHP, +29113,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMBLEMHEALTH/HIP-CHP, +29114,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29115,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMBLEMHEALTH/HIP-CHP, +29116,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMBLEMHEALTH/HIP-CHP, +29117,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMBLEMHEALTH/HIP-CHP, +29118,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMBLEMHEALTH/HIP-CHP, +29119,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMBLEMHEALTH/HIP-CHP, +29120,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMBLEMHEALTH/HIP-CHP, +29121,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMBLEMHEALTH/HIP-CHP, +29122,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMBLEMHEALTH/HIP-CHP, +29123,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMBLEMHEALTH/HIP-CHP, +29124,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMBLEMHEALTH/HIP-CHP, +29125,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMBLEMHEALTH/HIP-CHP, +29126,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMBLEMHEALTH/HIP-CHP, +29127,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMBLEMHEALTH/HIP-CHP, +29128,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMBLEMHEALTH/HIP-CHP, +29129,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMBLEMHEALTH/HIP-CHP, +29130,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMBLEMHEALTH/HIP-CHP, +29131,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMBLEMHEALTH/HIP-CHP, +29132,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMBLEMHEALTH/HIP-CHP, +29133,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMBLEMHEALTH/HIP-CHP, +29134,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMBLEMHEALTH/HIP-CHP, +29135,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMBLEMHEALTH/HIP-CHP, +29136,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMBLEMHEALTH/HIP-CHP, +29137,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMBLEMHEALTH/HIP-CHP, +29138,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMBLEMHEALTH/HIP-CHP, +29139,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMBLEMHEALTH/HIP-CHP, +29140,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMBLEMHEALTH/HIP-CHP, +29141,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMBLEMHEALTH/HIP-CHP, +29142,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMBLEMHEALTH/HIP-CHP, +29143,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMBLEMHEALTH/HIP-CHP, +29144,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMBLEMHEALTH/HIP-CHP, +29145,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMBLEMHEALTH/HIP-CHP, +29146,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMBLEMHEALTH/HIP-CHP, +29147,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMBLEMHEALTH/HIP-CHP, +29148,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMBLEMHEALTH/HIP-CHP, +29149,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMBLEMHEALTH/HIP-CHP, +29150,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMBLEMHEALTH/HIP-CHP, +29151,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMBLEMHEALTH/HIP-CHP, +29152,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMBLEMHEALTH/HIP-CHP, +29153,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMBLEMHEALTH/HIP-CHP, +29154,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMBLEMHEALTH/HIP-CHP, +29155,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMBLEMHEALTH/HIP-CHP, +29156,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMBLEMHEALTH/HIP-CHP, +29157,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMBLEMHEALTH/HIP-CHP, +29158,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMBLEMHEALTH/HIP-CHP, +29159,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMBLEMHEALTH/HIP-CHP, +29160,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMBLEMHEALTH/HIP-CHP, +29161,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMBLEMHEALTH/HIP-CHP, +29162,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMBLEMHEALTH/HIP-CHP, +29163,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMBLEMHEALTH/HIP-CHP, +29164,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMBLEMHEALTH/HIP-CHP, +29165,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMBLEMHEALTH/HIP-CHP, +29166,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMBLEMHEALTH/HIP-CHP, +29167,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMBLEMHEALTH/HIP-CHP, +29168,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMBLEMHEALTH/HIP-CHP, +29169,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMBLEMHEALTH/HIP-CHP, +29170,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMBLEMHEALTH/HIP-CHP, +29171,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMBLEMHEALTH/HIP-CHP, +29172,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMBLEMHEALTH/HIP-CHP, +29173,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMBLEMHEALTH/HIP-CHP, +29174,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMBLEMHEALTH/HIP-CHP, +29175,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMBLEMHEALTH/HIP-CHP, +29176,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMBLEMHEALTH/HIP-CHP, +29177,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMBLEMHEALTH/HIP-CHP, +29178,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMBLEMHEALTH/HIP-CHP, +29179,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMBLEMHEALTH/HIP-CHP, +29180,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMBLEMHEALTH/HIP-CHP, +29181,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMBLEMHEALTH/HIP-CHP, +29182,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMBLEMHEALTH/HIP-CHP, +29183,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMBLEMHEALTH/HIP-CHP, +29184,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMBLEMHEALTH/HIP-CHP, +29185,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMBLEMHEALTH/HIP-CHP, +29186,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMBLEMHEALTH/HIP-CHP, +29187,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMBLEMHEALTH/HIP-CHP, +29188,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMBLEMHEALTH/HIP-CHP, +29189,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMBLEMHEALTH/HIP-CHP, +29190,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMBLEMHEALTH/HIP-CHP, +29191,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMBLEMHEALTH/HIP-CHP, +29192,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMBLEMHEALTH/HIP-CHP, +29193,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMBLEMHEALTH/HIP-CHP, +29194,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMBLEMHEALTH/HIP-CHP, +29195,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMBLEMHEALTH/HIP-CHP, +29196,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMBLEMHEALTH/HIP-CHP, +29197,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +29198,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMBLEMHEALTH/HIP-CHP, +29199,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +29200,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMBLEMHEALTH/HIP-CHP, +29201,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMBLEMHEALTH/HIP-CHP, +29202,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMBLEMHEALTH/HIP-CHP, +29203,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMBLEMHEALTH/HIP-CHP, +29204,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMBLEMHEALTH/HIP-CHP, +29205,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMBLEMHEALTH/HIP-CHP, +29206,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMBLEMHEALTH/HIP-CHP, +29207,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMBLEMHEALTH/HIP-CHP, +29208,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMBLEMHEALTH/HIP-CHP, +29209,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMBLEMHEALTH/HIP-CHP, +29210,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMBLEMHEALTH/HIP-CHP, +29211,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMBLEMHEALTH/HIP-CHP, +29212,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMBLEMHEALTH/HIP-CHP, +29213,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMBLEMHEALTH/HIP-CHP, +29214,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMBLEMHEALTH/HIP-CHP, +29215,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMBLEMHEALTH/HIP-CHP, +29216,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMBLEMHEALTH/HIP-CHP, +29217,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMBLEMHEALTH/HIP-CHP, +29218,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMBLEMHEALTH/HIP-CHP, +29219,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMBLEMHEALTH/HIP-CHP, +29220,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMBLEMHEALTH/HIP-CHP, +29221,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMBLEMHEALTH/HIP-CHP, +29222,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMBLEMHEALTH/HIP-CHP, +29223,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMBLEMHEALTH/HIP-CHP, +29224,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMBLEMHEALTH/HIP-CHP, +29225,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +29226,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMBLEMHEALTH/HIP-CHP, +29227,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMBLEMHEALTH/HIP-CHP, +29228,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMBLEMHEALTH/HIP-CHP, +29229,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMBLEMHEALTH/HIP-CHP, +29230,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMBLEMHEALTH/HIP-CHP, +29231,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMBLEMHEALTH/HIP-CHP, +29232,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMBLEMHEALTH/HIP-CHP, +29233,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMBLEMHEALTH/HIP-CHP, +29234,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMBLEMHEALTH/HIP-CHP, +29235,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMBLEMHEALTH/HIP-CHP, +29236,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMBLEMHEALTH/HIP-CHP, +29237,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMBLEMHEALTH/HIP-CHP, +29238,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMBLEMHEALTH/HIP-CHP, +29239,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMBLEMHEALTH/HIP-CHP, +29240,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMBLEMHEALTH/HIP-CHP, +29241,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMBLEMHEALTH/HIP-CHP, +29242,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMBLEMHEALTH/HIP-CHP, +29243,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMBLEMHEALTH/HIP-CHP, +29244,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMBLEMHEALTH/HIP-CHP, +29245,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMBLEMHEALTH/HIP-CHP, +29246,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMBLEMHEALTH/HIP-CHP, +29247,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMBLEMHEALTH/HIP-CHP, +29248,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMBLEMHEALTH/HIP-CHP, +29249,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMBLEMHEALTH/HIP-CHP, +29250,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMBLEMHEALTH/HIP-CHP, +29251,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMBLEMHEALTH/HIP-CHP, +29252,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMBLEMHEALTH/HIP-CHP, +29253,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMBLEMHEALTH/HIP-CHP, +29254,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMBLEMHEALTH/HIP-CHP, +29255,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29256,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMBLEMHEALTH/HIP-CHP, +29257,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMBLEMHEALTH/HIP-CHP, +29258,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMBLEMHEALTH/HIP-CHP, +29259,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMBLEMHEALTH/HIP-CHP, +29260,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMBLEMHEALTH/HIP-CHP, +29261,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMBLEMHEALTH/HIP-CHP, +29262,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMBLEMHEALTH/HIP-CHP, +29263,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMBLEMHEALTH/HIP-CHP, +29264,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMBLEMHEALTH/HIP-CHP, +29265,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMBLEMHEALTH/HIP-CHP, +29266,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMBLEMHEALTH/HIP-CHP, +29267,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMBLEMHEALTH/HIP-CHP, +29268,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMBLEMHEALTH/HIP-CHP, +29269,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMBLEMHEALTH/HIP-CHP, +29270,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMBLEMHEALTH/HIP-CHP, +29271,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMBLEMHEALTH/HIP-CHP, +29272,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMBLEMHEALTH/HIP-CHP, +29273,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMBLEMHEALTH/HIP-CHP, +29274,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMBLEMHEALTH/HIP-CHP, +29275,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMBLEMHEALTH/HIP-CHP, +29276,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMBLEMHEALTH/HIP-CHP, +29277,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMBLEMHEALTH/HIP-CHP, +29278,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMBLEMHEALTH/HIP-CHP, +29279,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMBLEMHEALTH/HIP-CHP, +29280,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMBLEMHEALTH/HIP-CHP, +29281,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMBLEMHEALTH/HIP-CHP, +29282,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +29283,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMBLEMHEALTH/HIP-CHP, +29284,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29285,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMBLEMHEALTH/HIP-CHP, +29286,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMBLEMHEALTH/HIP-CHP, +29287,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMBLEMHEALTH/HIP-CHP, +29288,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMBLEMHEALTH/HIP-CHP, +29289,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMBLEMHEALTH/HIP-CHP, +29290,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMBLEMHEALTH/HIP-CHP, +29291,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMBLEMHEALTH/HIP-CHP, +29292,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMBLEMHEALTH/HIP-CHP, +29293,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMBLEMHEALTH/HIP-CHP, +29294,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMBLEMHEALTH/HIP-CHP, +29295,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMBLEMHEALTH/HIP-CHP, +29296,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMBLEMHEALTH/HIP-CHP, +29297,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMBLEMHEALTH/HIP-CHP, +29298,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMBLEMHEALTH/HIP-CHP, +29299,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMBLEMHEALTH/HIP-CHP, +29300,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMBLEMHEALTH/HIP-CHP, +29301,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMBLEMHEALTH/HIP-CHP, +29302,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMBLEMHEALTH/HIP-CHP, +29303,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMBLEMHEALTH/HIP-CHP, +29304,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMBLEMHEALTH/HIP-CHP, +29305,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMBLEMHEALTH/HIP-CHP, +29306,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMBLEMHEALTH/HIP-CHP, +29307,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMBLEMHEALTH/HIP-CHP, +29308,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMBLEMHEALTH/HIP-CHP, +29309,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMBLEMHEALTH/HIP-CHP, +29310,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMBLEMHEALTH/HIP-CHP, +29311,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMBLEMHEALTH/HIP-CHP, +29312,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMBLEMHEALTH/HIP-CHP, +29313,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMBLEMHEALTH/HIP-CHP, +29314,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMBLEMHEALTH/HIP-CHP, +29315,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMBLEMHEALTH/HIP-CHP, +29316,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMBLEMHEALTH/HIP-CHP, +29317,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMBLEMHEALTH/HIP-CHP, +29318,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMBLEMHEALTH/HIP-CHP, +29319,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29320,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMBLEMHEALTH/HIP-CHP, +29321,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMBLEMHEALTH/HIP-CHP, +29322,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMBLEMHEALTH/HIP-CHP, +29323,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMBLEMHEALTH/HIP-CHP, +29324,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMBLEMHEALTH/HIP-CHP, +29325,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMBLEMHEALTH/HIP-CHP, +29326,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMBLEMHEALTH/HIP-CHP, +29327,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMBLEMHEALTH/HIP-CHP, +29328,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMBLEMHEALTH/HIP-CHP, +29329,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMBLEMHEALTH/HIP-CHP, +29330,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMBLEMHEALTH/HIP-CHP, +29331,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMBLEMHEALTH/HIP-CHP, +29332,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMBLEMHEALTH/HIP-CHP, +29333,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMBLEMHEALTH/HIP-CHP, +29334,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMBLEMHEALTH/HIP-CHP, +29335,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMBLEMHEALTH/HIP-CHP, +29336,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMBLEMHEALTH/HIP-CHP, +29337,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMBLEMHEALTH/HIP-CHP, +29338,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMBLEMHEALTH/HIP-CHP, +29339,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMBLEMHEALTH/HIP-CHP, +29340,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMBLEMHEALTH/HIP-CHP, +29341,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMBLEMHEALTH/HIP-CHP, +29342,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMBLEMHEALTH/HIP-CHP, +29343,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMBLEMHEALTH/HIP-CHP, +29344,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMBLEMHEALTH/HIP-CHP, +29345,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMBLEMHEALTH/HIP-CHP, +29346,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMBLEMHEALTH/HIP-CHP, +29347,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMBLEMHEALTH/HIP-CHP, +29348,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMBLEMHEALTH/HIP-CHP, +29349,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMBLEMHEALTH/HIP-CHP, +29350,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMBLEMHEALTH/HIP-CHP, +29351,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMBLEMHEALTH/HIP-CHP, +29352,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMBLEMHEALTH/HIP-CHP, +29353,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMBLEMHEALTH/HIP-CHP, +29354,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMBLEMHEALTH/HIP-CHP, +29355,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMBLEMHEALTH/HIP-CHP, +29356,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMBLEMHEALTH/HIP-CHP, +29357,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMBLEMHEALTH/HIP-CHP, +29358,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMBLEMHEALTH/HIP-CHP, +29359,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMBLEMHEALTH/HIP-CHP, +29360,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMBLEMHEALTH/HIP-CHP, +29361,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMBLEMHEALTH/HIP-CHP, +29362,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMBLEMHEALTH/HIP-CHP, +29363,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMBLEMHEALTH/HIP-CHP, +29364,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMBLEMHEALTH/HIP-CHP, +29365,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +29366,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMBLEMHEALTH/HIP-CHP, +29367,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMBLEMHEALTH/HIP-CHP, +29368,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29369,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMBLEMHEALTH/HIP-CHP, +29370,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +29371,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +29372,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMBLEMHEALTH/HIP-CHP, +29373,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMBLEMHEALTH/HIP-CHP, +29374,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMBLEMHEALTH/HIP-CHP, +29375,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMBLEMHEALTH/HIP-CHP, +29376,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMBLEMHEALTH/HIP-CHP, +29377,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMBLEMHEALTH/HIP-CHP, +29378,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMBLEMHEALTH/HIP-CHP, +29379,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMBLEMHEALTH/HIP-CHP, +29380,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMBLEMHEALTH/HIP-CHP, +29381,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMBLEMHEALTH/HIP-CHP, +29382,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMBLEMHEALTH/HIP-CHP, +29383,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMBLEMHEALTH/HIP-CHP, +29384,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMBLEMHEALTH/HIP-CHP, +29385,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMBLEMHEALTH/HIP-CHP, +29386,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMBLEMHEALTH/HIP-CHP, +29387,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMBLEMHEALTH/HIP-CHP, +29388,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMBLEMHEALTH/HIP-CHP, +29389,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMBLEMHEALTH/HIP-CHP, +29390,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMBLEMHEALTH/HIP-CHP, +29391,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMBLEMHEALTH/HIP-CHP, +29392,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMBLEMHEALTH/HIP-CHP, +29393,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMBLEMHEALTH/HIP-CHP, +29394,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMBLEMHEALTH/HIP-CHP, +29395,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMBLEMHEALTH/HIP-CHP, +29396,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMBLEMHEALTH/HIP-CHP, +29397,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMBLEMHEALTH/HIP-CHP, +29398,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMBLEMHEALTH/HIP-CHP, +29399,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMBLEMHEALTH/HIP-CHP, +29400,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29401,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMBLEMHEALTH/HIP-CHP, +29402,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMBLEMHEALTH/HIP-CHP, +29403,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMBLEMHEALTH/HIP-CHP, +29404,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMBLEMHEALTH/HIP-CHP, +29405,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMBLEMHEALTH/HIP-CHP, +29406,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMBLEMHEALTH/HIP-CHP, +29407,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +29408,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMBLEMHEALTH/HIP-CHP, +29409,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMBLEMHEALTH/HIP-CHP, +29410,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMBLEMHEALTH/HIP-CHP, +29411,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMBLEMHEALTH/HIP-CHP, +29412,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMBLEMHEALTH/HIP-CHP, +29413,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMBLEMHEALTH/HIP-CHP, +29414,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMBLEMHEALTH/HIP-CHP, +29415,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMBLEMHEALTH/HIP-CHP, +29416,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMBLEMHEALTH/HIP-CHP, +29417,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMBLEMHEALTH/HIP-CHP, +29418,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMBLEMHEALTH/HIP-CHP, +29419,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMBLEMHEALTH/HIP-CHP, +29420,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMBLEMHEALTH/HIP-CHP, +29421,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMBLEMHEALTH/HIP-CHP, +29422,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMBLEMHEALTH/HIP-CHP, +29423,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMBLEMHEALTH/HIP-CHP, +29424,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMBLEMHEALTH/HIP-CHP, +29425,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMBLEMHEALTH/HIP-CHP, +29426,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMBLEMHEALTH/HIP-CHP, +29427,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMBLEMHEALTH/HIP-CHP, +29428,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMBLEMHEALTH/HIP-CHP, +29429,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMBLEMHEALTH/HIP-CHP, +29430,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMBLEMHEALTH/HIP-CHP, +29431,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMBLEMHEALTH/HIP-CHP, +29432,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMBLEMHEALTH/HIP-CHP, +29433,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMBLEMHEALTH/HIP-CHP, +29434,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMBLEMHEALTH/HIP-CHP, +29435,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMBLEMHEALTH/HIP-CHP, +29436,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMBLEMHEALTH/HIP-CHP, +29437,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMBLEMHEALTH/HIP-CHP, +29438,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMBLEMHEALTH/HIP-CHP, +29439,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMBLEMHEALTH/HIP-CHP, +29440,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMBLEMHEALTH/HIP-CHP, +29441,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMBLEMHEALTH/HIP-CHP, +29442,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMBLEMHEALTH/HIP-CHP, +29443,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMBLEMHEALTH/HIP-CHP, +29444,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMBLEMHEALTH/HIP-CHP, +29445,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMBLEMHEALTH/HIP-CHP, +29446,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMBLEMHEALTH/HIP-CHP, +29447,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMBLEMHEALTH/HIP-CHP, +29448,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMBLEMHEALTH/HIP-CHP, +29449,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMBLEMHEALTH/HIP-CHP, +29450,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMBLEMHEALTH/HIP-CHP, +29451,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMBLEMHEALTH/HIP-CHP, +29452,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMBLEMHEALTH/HIP-CHP, +29453,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMBLEMHEALTH/HIP-CHP, +29454,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMBLEMHEALTH/HIP-CHP, +29455,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMBLEMHEALTH/HIP-CHP, +29456,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMBLEMHEALTH/HIP-CHP, +29457,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMBLEMHEALTH/HIP-CHP, +29458,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMBLEMHEALTH/HIP-CHP, +29459,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMBLEMHEALTH/HIP-CHP, +29460,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMBLEMHEALTH/HIP-CHP, +29461,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMBLEMHEALTH/HIP-CHP, +29462,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMBLEMHEALTH/HIP-CHP, +29463,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMBLEMHEALTH/HIP-CHP, +29464,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMBLEMHEALTH/HIP-CHP, +29465,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMBLEMHEALTH/HIP-CHP, +29466,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMBLEMHEALTH/HIP-CHP, +29467,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMBLEMHEALTH/HIP-CHP, +29468,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMBLEMHEALTH/HIP-CHP, +29469,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMBLEMHEALTH/HIP-CHP, +29470,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMBLEMHEALTH/HIP-CHP, +29471,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMBLEMHEALTH/HIP-CHP, +29472,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMBLEMHEALTH/HIP-CHP, +29473,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMBLEMHEALTH/HIP-CHP, +29474,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMBLEMHEALTH/HIP-CHP, +29475,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMBLEMHEALTH/HIP-CHP, +29476,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMBLEMHEALTH/HIP-CHP, +29477,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMBLEMHEALTH/HIP-CHP, +29478,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMBLEMHEALTH/HIP-CHP, +29479,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMBLEMHEALTH/HIP-CHP, +29480,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMBLEMHEALTH/HIP-CHP, +29481,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMBLEMHEALTH/HIP-CHP, +29482,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-CHP, +29483,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +29484,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMBLEMHEALTH/HIP-CHP, +29485,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMBLEMHEALTH/HIP-CHP, +29486,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMBLEMHEALTH/HIP-CHP, +29487,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMBLEMHEALTH/HIP-CHP, +29488,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMBLEMHEALTH/HIP-CHP, +29489,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMBLEMHEALTH/HIP-CHP, +29490,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMBLEMHEALTH/HIP-CHP, +29491,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMBLEMHEALTH/HIP-CHP, +29492,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMBLEMHEALTH/HIP-CHP, +29493,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMBLEMHEALTH/HIP-CHP, +29494,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMBLEMHEALTH/HIP-CHP, +29495,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMBLEMHEALTH/HIP-CHP, +29496,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMBLEMHEALTH/HIP-CHP, +29497,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMBLEMHEALTH/HIP-CHP, +29498,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMBLEMHEALTH/HIP-CHP, +29499,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMBLEMHEALTH/HIP-CHP, +29500,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMBLEMHEALTH/HIP-CHP, +29501,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMBLEMHEALTH/HIP-CHP, +29502,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMBLEMHEALTH/HIP-CHP, +29503,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMBLEMHEALTH/HIP-CHP, +29504,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMBLEMHEALTH/HIP-CHP, +29505,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMBLEMHEALTH/HIP-CHP, +29506,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMBLEMHEALTH/HIP-CHP, +29507,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMBLEMHEALTH/HIP-CHP, +29508,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMBLEMHEALTH/HIP-CHP, +29509,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMBLEMHEALTH/HIP-CHP, +29510,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMBLEMHEALTH/HIP-CHP, +29511,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMBLEMHEALTH/HIP-CHP, +29512,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMBLEMHEALTH/HIP-CHP, +29513,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMBLEMHEALTH/HIP-CHP, +29514,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMBLEMHEALTH/HIP-CHP, +29515,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-CHP, +29516,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMBLEMHEALTH/HIP-CHP, +29517,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMBLEMHEALTH/HIP-CHP, +29518,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMBLEMHEALTH/HIP-CHP, +29519,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMBLEMHEALTH/HIP-CHP, +29520,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMBLEMHEALTH/HIP-CHP, +29521,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMBLEMHEALTH/HIP-CHP, +29522,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMBLEMHEALTH/HIP-CHP, +29523,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMBLEMHEALTH/HIP-CHP, +29524,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMBLEMHEALTH/HIP-CHP, +29525,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMBLEMHEALTH/HIP-CHP, +29526,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMBLEMHEALTH/HIP-CHP, +29527,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMBLEMHEALTH/HIP-CHP, +29528,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMBLEMHEALTH/HIP-CHP, +29529,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMBLEMHEALTH/HIP-CHP, +29530,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMBLEMHEALTH/HIP-CHP, +29531,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMBLEMHEALTH/HIP-CHP, +29532,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-CHP, +29533,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMBLEMHEALTH/HIP-CHP, +29534,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMBLEMHEALTH/HIP-CHP, +29535,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMBLEMHEALTH/HIP-CHP, +29536,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMBLEMHEALTH/HIP-CHP, +29537,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMBLEMHEALTH/HIP-CHP, +29538,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMBLEMHEALTH/HIP-CHP, +29539,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMBLEMHEALTH/HIP-CHP, +29540,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMBLEMHEALTH/HIP-CHP, +29541,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMBLEMHEALTH/HIP-CHP, +29542,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMBLEMHEALTH/HIP-CHP, +29543,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMBLEMHEALTH/HIP-CHP, +29544,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMBLEMHEALTH/HIP-CHP, +29545,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMBLEMHEALTH/HIP-CHP, +29546,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMBLEMHEALTH/HIP-CHP, +29547,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMBLEMHEALTH/HIP-CHP, +29548,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMBLEMHEALTH/HIP-CHP, +29549,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMBLEMHEALTH/HIP-CHP, +29550,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMBLEMHEALTH/HIP-CHP, +29551,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMBLEMHEALTH/HIP-CHP, +29552,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMBLEMHEALTH/HIP-CHP, +29553,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMBLEMHEALTH/HIP-CHP, +29554,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMBLEMHEALTH/HIP-CHP, +29555,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMBLEMHEALTH/HIP-CHP, +29556,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMBLEMHEALTH/HIP-CHP, +29557,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMBLEMHEALTH/HIP-CHP, +29558,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMBLEMHEALTH/HIP-CHP, +29559,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMBLEMHEALTH/HIP-CHP, +29560,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMBLEMHEALTH/HIP-CHP, +29561,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMBLEMHEALTH/HIP-CHP, +29562,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMBLEMHEALTH/HIP-CHP, +29563,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMBLEMHEALTH/HIP-CHP, +29564,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMBLEMHEALTH/HIP-CHP, +29565,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMBLEMHEALTH/HIP-CHP, +29566,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMBLEMHEALTH/HIP-CHP, +29567,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMBLEMHEALTH/HIP-CHP, +29568,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMBLEMHEALTH/HIP-CHP, +29569,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMBLEMHEALTH/HIP-CHP, +29570,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMBLEMHEALTH/HIP-CHP, +29571,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMBLEMHEALTH/HIP-CHP, +29572,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMBLEMHEALTH/HIP-CHP, +29573,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMBLEMHEALTH/HIP-CHP, +29574,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMBLEMHEALTH/HIP-CHP, +29575,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMBLEMHEALTH/HIP-CHP, +29576,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMBLEMHEALTH/HIP-CHP, +29577,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMBLEMHEALTH/HIP-CHP, +29578,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMBLEMHEALTH/HIP-CHP, +29579,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMBLEMHEALTH/HIP-CHP, +29580,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMBLEMHEALTH/HIP-CHP, +29581,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMBLEMHEALTH/HIP-CHP, +29582,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMBLEMHEALTH/HIP-CHP, +29583,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMBLEMHEALTH/HIP-CHP, +29584,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMBLEMHEALTH/HIP-CHP, +29585,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMBLEMHEALTH/HIP-CHP, +29586,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMBLEMHEALTH/HIP-CHP, +29587,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMBLEMHEALTH/HIP-CHP, +29588,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMBLEMHEALTH/HIP-CHP, +29589,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMBLEMHEALTH/HIP-CHP, +29590,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMBLEMHEALTH/HIP-CHP, +29591,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMBLEMHEALTH/HIP-CHP, +29592,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMBLEMHEALTH/HIP-CHP, +29593,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMBLEMHEALTH/HIP-CHP, +29594,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMBLEMHEALTH/HIP-CHP, +29595,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMBLEMHEALTH/HIP-CHP, +29596,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMBLEMHEALTH/HIP-CHP, +29597,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMBLEMHEALTH/HIP-CHP, +29598,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMBLEMHEALTH/HIP-CHP, +29599,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMBLEMHEALTH/HIP-CHP, +29600,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMBLEMHEALTH/HIP-CHP, +29601,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMBLEMHEALTH/HIP-CHP, +29602,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMBLEMHEALTH/HIP-CHP, +29603,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMBLEMHEALTH/HIP-CHP, +29604,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMBLEMHEALTH/HIP-CHP, +29605,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMBLEMHEALTH/HIP-CHP, +29606,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMBLEMHEALTH/HIP-CHP, +29607,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMBLEMHEALTH/HIP-CHP, +29608,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMBLEMHEALTH/HIP-CHP, +29609,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMBLEMHEALTH/HIP-CHP, +29610,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMBLEMHEALTH/HIP-CHP, +29611,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMBLEMHEALTH/HIP-CHP, +29612,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMBLEMHEALTH/HIP-CHP, +29613,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMBLEMHEALTH/HIP-CHP, +29614,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMBLEMHEALTH/HIP-CHP, +29615,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMBLEMHEALTH/HIP-CHP, +29616,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMBLEMHEALTH/HIP-CHP, +29617,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMBLEMHEALTH/HIP-CHP, +29618,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMBLEMHEALTH/HIP-CHP, +29619,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMBLEMHEALTH/HIP-CHP, +29620,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMBLEMHEALTH/HIP-CHP, +29621,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMBLEMHEALTH/HIP-CHP, +29622,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMBLEMHEALTH/HIP-CHP, +29623,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMBLEMHEALTH/HIP-CHP, +29624,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMBLEMHEALTH/HIP-CHP, +29625,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMBLEMHEALTH/HIP-CHP, +29626,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMBLEMHEALTH/HIP-CHP, +29627,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMBLEMHEALTH/HIP-CHP, +29628,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMBLEMHEALTH/HIP-CHP, +29629,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMBLEMHEALTH/HIP-CHP, +29630,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMBLEMHEALTH/HIP-CHP, +29631,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMBLEMHEALTH/HIP-CHP, +29632,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMBLEMHEALTH/HIP-CHP, +29633,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMBLEMHEALTH/HIP-CHP, +29634,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMBLEMHEALTH/HIP-CHP, +29635,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMBLEMHEALTH/HIP-CHP, +29636,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMBLEMHEALTH/HIP-CHP, +29637,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMBLEMHEALTH/HIP-CHP, +29638,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMBLEMHEALTH/HIP-CHP, +29639,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMBLEMHEALTH/HIP-CHP, +29640,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMBLEMHEALTH/HIP-CHP, +29641,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMBLEMHEALTH/HIP-CHP, +29642,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMBLEMHEALTH/HIP-CHP, +29643,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMBLEMHEALTH/HIP-CHP, +29644,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMBLEMHEALTH/HIP-CHP, +29645,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMBLEMHEALTH/HIP-CHP, +29646,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMBLEMHEALTH/HIP-CHP, +29647,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMBLEMHEALTH/HIP-CHP, +29648,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMBLEMHEALTH/HIP-CHP, +29649,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMBLEMHEALTH/HIP-CHP, +29650,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMBLEMHEALTH/HIP-CHP, +29651,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMBLEMHEALTH/HIP-CHP, +29652,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMBLEMHEALTH/HIP-CHP, +29653,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMBLEMHEALTH/HIP-CHP, +29654,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMBLEMHEALTH/HIP-CHP, +29655,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMBLEMHEALTH/HIP-CHP, +29656,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMBLEMHEALTH/HIP-CHP, +29657,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMBLEMHEALTH/HIP-CHP, +29658,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMBLEMHEALTH/HIP-CHP, +29659,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMBLEMHEALTH/HIP-CHP, +29660,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMBLEMHEALTH/HIP-CHP, +29661,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMBLEMHEALTH/HIP-CHP, +29662,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMBLEMHEALTH/HIP-CHP, +29663,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMBLEMHEALTH/HIP-CHP, +29664,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMBLEMHEALTH/HIP-CHP, +29665,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMBLEMHEALTH/HIP-CHP, +29666,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMBLEMHEALTH/HIP-CHP, +29667,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMBLEMHEALTH/HIP-CHP, +29668,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMBLEMHEALTH/HIP-CHP, +29669,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMBLEMHEALTH/HIP-CHP, +29670,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMBLEMHEALTH/HIP-CHP, +29671,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMBLEMHEALTH/HIP-CHP, +29672,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMBLEMHEALTH/HIP-CHP, +29673,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMBLEMHEALTH/HIP-CHP, +29674,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMBLEMHEALTH/HIP-CHP, +29675,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMBLEMHEALTH/HIP-CHP, +29676,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMBLEMHEALTH/HIP-CHP, +29677,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMBLEMHEALTH/HIP-CHP, +29678,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMBLEMHEALTH/HIP-CHP, +29679,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMBLEMHEALTH/HIP-CHP, +29680,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMBLEMHEALTH/HIP-CHP, +29681,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMBLEMHEALTH/HIP-CHP, +29682,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMBLEMHEALTH/HIP-CHP, +29683,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMBLEMHEALTH/HIP-CHP, +29684,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMBLEMHEALTH/HIP-CHP, +29685,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMBLEMHEALTH/HIP-CHP, +29686,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMBLEMHEALTH/HIP-CHP, +29687,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMBLEMHEALTH/HIP-CHP, +29688,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMBLEMHEALTH/HIP-CHP, +29689,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMBLEMHEALTH/HIP-CHP, +29690,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMBLEMHEALTH/HIP-CHP, +29691,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMBLEMHEALTH/HIP-CHP, +29692,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMBLEMHEALTH/HIP-CHP, +29693,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMBLEMHEALTH/HIP-CHP, +29694,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMBLEMHEALTH/HIP-CHP, +29695,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMBLEMHEALTH/HIP-CHP, +29696,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMBLEMHEALTH/HIP-CHP, +29697,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMBLEMHEALTH/HIP-CHP, +29698,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMBLEMHEALTH/HIP-CHP, +29699,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMBLEMHEALTH/HIP-CHP, +29700,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMBLEMHEALTH/HIP-CHP, +29701,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMBLEMHEALTH/HIP-CHP, +29702,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMBLEMHEALTH/HIP-CHP, +29703,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMBLEMHEALTH/HIP-CHP, +29704,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMBLEMHEALTH/HIP-CHP, +29705,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMBLEMHEALTH/HIP-CHP, +29706,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMBLEMHEALTH/HIP-CHP, +29707,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMBLEMHEALTH/HIP-CHP, +29708,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMBLEMHEALTH/HIP-CHP, +29709,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMBLEMHEALTH/HIP-CHP, +29710,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMBLEMHEALTH/HIP-CHP, +29711,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMBLEMHEALTH/HIP-CHP, +29712,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMBLEMHEALTH/HIP-CHP, +29713,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMBLEMHEALTH/HIP-CHP, +29714,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMBLEMHEALTH/HIP-CHP, +29715,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMBLEMHEALTH/HIP-CHP, +29716,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMBLEMHEALTH/HIP-CHP, +29717,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMBLEMHEALTH/HIP-CHP, +29718,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMBLEMHEALTH/HIP-CHP, +29719,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMBLEMHEALTH/HIP-CHP, +29720,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMBLEMHEALTH/HIP-CHP, +29721,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMBLEMHEALTH/HIP-CHP, +29722,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMBLEMHEALTH/HIP-CHP, +29723,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMBLEMHEALTH/HIP-CHP, +29724,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMBLEMHEALTH/HIP-CHP, +29725,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMBLEMHEALTH/HIP-CHP, +29726,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMBLEMHEALTH/HIP-CHP, +29727,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMBLEMHEALTH/HIP-CHP, +29728,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMBLEMHEALTH/HIP-CHP, +29729,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMBLEMHEALTH/HIP-CHP, +29730,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMBLEMHEALTH/HIP-CHP, +29731,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMBLEMHEALTH/HIP-CHP, +29732,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMBLEMHEALTH/HIP-CHP, +29733,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMBLEMHEALTH/HIP-CHP, +29734,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMBLEMHEALTH/HIP-CHP, +29735,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMBLEMHEALTH/HIP-CHP, +29736,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMBLEMHEALTH/HIP-CHP, +29737,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMBLEMHEALTH/HIP-CHP, +29738,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMBLEMHEALTH/HIP-CHP, +29739,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMBLEMHEALTH/HIP-CHP, +29740,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMBLEMHEALTH/HIP-CHP, +29741,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMBLEMHEALTH/HIP-CHP, +29742,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMBLEMHEALTH/HIP-CHP, +29743,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMBLEMHEALTH/HIP-CHP, +29744,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMBLEMHEALTH/HIP-CHP, +29745,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMBLEMHEALTH/HIP-CHP, +29746,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMBLEMHEALTH/HIP-CHP, +29747,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMBLEMHEALTH/HIP-CHP, +29748,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMBLEMHEALTH/HIP-CHP, +29749,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMBLEMHEALTH/HIP-CHP, +29750,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMBLEMHEALTH/HIP-CHP, +29751,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMBLEMHEALTH/HIP-CHP, +29752,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMBLEMHEALTH/HIP-CHP, +29753,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMBLEMHEALTH/HIP-CHP, +29754,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMBLEMHEALTH/HIP-CHP, +29755,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMBLEMHEALTH/HIP-CHP, +29756,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMBLEMHEALTH/HIP-CHP, +29757,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMBLEMHEALTH/HIP-CHP, +29758,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMBLEMHEALTH/HIP-CHP, +29759,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMBLEMHEALTH/HIP-CHP, +29760,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMBLEMHEALTH/HIP-CHP, +29761,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMBLEMHEALTH/HIP-CHP, +29762,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMBLEMHEALTH/HIP-CHP,328.0 +29763,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMBLEMHEALTH/HIP-CHP, +29764,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMBLEMHEALTH/HIP-CHP, +29765,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMBLEMHEALTH/HIP-CHP, +29766,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMBLEMHEALTH/HIP-CHP, +29767,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMBLEMHEALTH/HIP-CHP, +29768,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMBLEMHEALTH/HIP-CHP, +29769,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMBLEMHEALTH/HIP-CHP, +29770,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMBLEMHEALTH/HIP-CHP, +29771,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMBLEMHEALTH/HIP-CHP, +29772,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMBLEMHEALTH/HIP-CHP, +29773,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMBLEMHEALTH/HIP-CHP, +29774,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMBLEMHEALTH/HIP-CHP, +29775,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMBLEMHEALTH/HIP-CHP, +29776,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMBLEMHEALTH/HIP-CHP, +29777,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMBLEMHEALTH/HIP-CHP, +29778,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMBLEMHEALTH/HIP-CHP, +29779,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMBLEMHEALTH/HIP-CHP, +29780,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMBLEMHEALTH/HIP-CHP, +29781,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMBLEMHEALTH/HIP-CHP, +29782,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMBLEMHEALTH/HIP-CHP, +29783,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMBLEMHEALTH/HIP-CHP, +29784,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMBLEMHEALTH/HIP-CHP, +29785,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMBLEMHEALTH/HIP-CHP, +29786,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMBLEMHEALTH/HIP-CHP, +29787,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMBLEMHEALTH/HIP-CHP, +29788,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMBLEMHEALTH/HIP-CHP, +29789,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMBLEMHEALTH/HIP-CHP, +29790,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMBLEMHEALTH/HIP-CHP, +29791,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMBLEMHEALTH/HIP-CHP, +29792,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMBLEMHEALTH/HIP-CHP, +29793,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMBLEMHEALTH/HIP-CHP, +29794,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMBLEMHEALTH/HIP-CHP, +29795,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMBLEMHEALTH/HIP-CHP, +29796,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMBLEMHEALTH/HIP-CHP, +29797,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMBLEMHEALTH/HIP-CHP, +29798,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMBLEMHEALTH/HIP-CHP, +29799,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMBLEMHEALTH/HIP-CHP, +29800,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMBLEMHEALTH/HIP-CHP, +29801,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMBLEMHEALTH/HIP-CHP, +29802,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMBLEMHEALTH/HIP-CHP, +29803,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMBLEMHEALTH/HIP-CHP, +29804,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMBLEMHEALTH/HIP-CHP, +29805,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMBLEMHEALTH/HIP-CHP, +29806,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMBLEMHEALTH/HIP-CHP, +29807,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMBLEMHEALTH/HIP-CHP, +29808,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMBLEMHEALTH/HIP-CHP, +29809,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMBLEMHEALTH/HIP-CHP, +29810,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMBLEMHEALTH/HIP-CHP, +29811,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMBLEMHEALTH/HIP-CHP, +29812,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMBLEMHEALTH/HIP-CHP, +29813,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMBLEMHEALTH/HIP-CHP, +29814,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMBLEMHEALTH/HIP-CHP, +29815,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMBLEMHEALTH/HIP-CHP, +29816,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMBLEMHEALTH/HIP-CHP, +29817,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMBLEMHEALTH/HIP-CHP, +29818,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMBLEMHEALTH/HIP-CHP, +29819,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMBLEMHEALTH/HIP-CHP, +29820,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMBLEMHEALTH/HIP-CHP, +29821,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMBLEMHEALTH/HIP-CHP, +29822,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMBLEMHEALTH/HIP-CHP, +29823,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMBLEMHEALTH/HIP-CHP, +29824,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMBLEMHEALTH/HIP-CHP, +29825,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMBLEMHEALTH/HIP-CHP, +29826,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMBLEMHEALTH/HIP-CHP, +29827,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMBLEMHEALTH/HIP-CHP, +29828,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMBLEMHEALTH/HIP-CHP, +29829,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMBLEMHEALTH/HIP-CHP, +29830,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMBLEMHEALTH/HIP-CHP, +29831,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMBLEMHEALTH/HIP-CHP, +29832,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMBLEMHEALTH/HIP-CHP, +29833,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMBLEMHEALTH/HIP-CHP, +29834,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMBLEMHEALTH/HIP-CHP, +29835,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMBLEMHEALTH/HIP-CHP, +29836,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMBLEMHEALTH/HIP-CHP, +29837,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMBLEMHEALTH/HIP-CHP, +29838,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMBLEMHEALTH/HIP-CHP, +29839,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMBLEMHEALTH/HIP-CHP, +29840,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMBLEMHEALTH/HIP-CHP, +29841,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMBLEMHEALTH/HIP-CHP, +29842,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMBLEMHEALTH/HIP-CHP, +29843,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMBLEMHEALTH/HIP-CHP, +29844,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMBLEMHEALTH/HIP-CHP, +29845,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMBLEMHEALTH/HIP-CHP, +29846,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMBLEMHEALTH/HIP-CHP, +29847,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMBLEMHEALTH/HIP-CHP, +29848,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMBLEMHEALTH/HIP-CHP, +29849,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMBLEMHEALTH/HIP-CHP, +29850,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMBLEMHEALTH/HIP-CHP, +29851,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMBLEMHEALTH/HIP-CHP, +29852,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMBLEMHEALTH/HIP-CHP, +29853,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMBLEMHEALTH/HIP-CHP, +29854,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMBLEMHEALTH/HIP-CHP, +29855,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMBLEMHEALTH/HIP-CHP, +29856,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMBLEMHEALTH/HIP-CHP, +29857,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMBLEMHEALTH/HIP-CHP, +29858,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMBLEMHEALTH/HIP-CHP, +29859,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMBLEMHEALTH/HIP-CHP, +29860,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMBLEMHEALTH/HIP-CHP, +29861,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMBLEMHEALTH/HIP-CHP, +29862,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMBLEMHEALTH/HIP-CHP, +29863,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMBLEMHEALTH/HIP-CHP, +29864,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMBLEMHEALTH/HIP-CHP, +29865,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMBLEMHEALTH/HIP-CHP, +29866,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMBLEMHEALTH/HIP-CHP, +29867,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMBLEMHEALTH/HIP-CHP, +29868,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMBLEMHEALTH/HIP-CHP, +29869,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMBLEMHEALTH/HIP-CHP, +29870,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMBLEMHEALTH/HIP-CHP, +29871,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMBLEMHEALTH/HIP-CHP, +29872,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMBLEMHEALTH/HIP-CHP, +29873,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-CHP, +29874,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMBLEMHEALTH/HIP-CHP, +29875,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMBLEMHEALTH/HIP-CHP, +29876,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMBLEMHEALTH/HIP-CHP, +29877,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMBLEMHEALTH/HIP-CHP, +29878,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMBLEMHEALTH/HIP-CHP, +29879,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMBLEMHEALTH/HIP-CHP, +29880,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMBLEMHEALTH/HIP-CHP, +29881,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMBLEMHEALTH/HIP-CHP, +29882,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMBLEMHEALTH/HIP-CHP, +29883,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMBLEMHEALTH/HIP-CHP, +29884,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMBLEMHEALTH/HIP-CHP, +29885,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMBLEMHEALTH/HIP-CHP, +29886,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMBLEMHEALTH/HIP-CHP, +29887,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMBLEMHEALTH/HIP-CHP, +29888,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMBLEMHEALTH/HIP-CHP, +29889,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMBLEMHEALTH/HIP-CHP, +29890,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMBLEMHEALTH/HIP-CHP, +29891,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMBLEMHEALTH/HIP-CHP, +29892,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMBLEMHEALTH/HIP-CHP, +29893,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMBLEMHEALTH/HIP-CHP, +29894,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMBLEMHEALTH/HIP-CHP, +29895,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMBLEMHEALTH/HIP-CHP, +29896,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMBLEMHEALTH/HIP-CHP, +29897,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMBLEMHEALTH/HIP-CHP, +29898,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMBLEMHEALTH/HIP-CHP, +29899,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMBLEMHEALTH/HIP-CHP, +29900,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMBLEMHEALTH/HIP-CHP, +29901,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMBLEMHEALTH/HIP-CHP, +29902,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMBLEMHEALTH/HIP-CHP, +29903,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMBLEMHEALTH/HIP-CHP, +29904,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMBLEMHEALTH/HIP-CHP, +29905,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMBLEMHEALTH/HIP-CHP, +29906,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMBLEMHEALTH/HIP-CHP, +29907,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMBLEMHEALTH/HIP-CHP, +29908,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMBLEMHEALTH/HIP-CHP, +29909,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMBLEMHEALTH/HIP-CHP, +29910,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMBLEMHEALTH/HIP-CHP, +29911,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMBLEMHEALTH/HIP-CHP, +29912,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMBLEMHEALTH/HIP-CHP, +29913,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMBLEMHEALTH/HIP-CHP, +29914,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-CHP, +29915,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMBLEMHEALTH/HIP-CHP, +29916,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMBLEMHEALTH/HIP-CHP, +29917,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMBLEMHEALTH/HIP-CHP, +29918,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMBLEMHEALTH/HIP-CHP, +29919,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMBLEMHEALTH/HIP-CHP, +29920,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMBLEMHEALTH/HIP-CHP, +29921,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMBLEMHEALTH/HIP-CHP, +29922,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMBLEMHEALTH/HIP-CHP, +29923,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMBLEMHEALTH/HIP-CHP, +29924,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMBLEMHEALTH/HIP-CHP, +29925,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMBLEMHEALTH/HIP-CHP, +29926,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMBLEMHEALTH/HIP-CHP, +29927,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMBLEMHEALTH/HIP-CHP, +29928,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMBLEMHEALTH/HIP-CHP, +29929,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMBLEMHEALTH/HIP-CHP, +29930,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMBLEMHEALTH/HIP-CHP, +29931,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMBLEMHEALTH/HIP-CHP, +29932,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMBLEMHEALTH/HIP-CHP, +29933,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMBLEMHEALTH/HIP-CHP, +29934,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMBLEMHEALTH/HIP-CHP, +29935,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-CHP, +29936,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMBLEMHEALTH/HIP-CHP, +29937,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMBLEMHEALTH/HIP-CHP, +29938,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMBLEMHEALTH/HIP-CHP, +29939,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMBLEMHEALTH/HIP-CHP, +29940,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMBLEMHEALTH/HIP-CHP, +29941,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMBLEMHEALTH/HIP-CHP, +29942,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMBLEMHEALTH/HIP-CHP, +29943,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMBLEMHEALTH/HIP-CHP, +29944,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMBLEMHEALTH/HIP-CHP, +29945,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMBLEMHEALTH/HIP-CHP, +29946,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMBLEMHEALTH/HIP-CHP, +29947,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMBLEMHEALTH/HIP-CHP, +29948,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMBLEMHEALTH/HIP-CHP, +29949,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMBLEMHEALTH/HIP-CHP, +29950,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMBLEMHEALTH/HIP-CHP, +29951,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMBLEMHEALTH/HIP-CHP, +29952,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMBLEMHEALTH/HIP-CHP, +29953,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMBLEMHEALTH/HIP-CHP, +29954,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMBLEMHEALTH/HIP-CHP, +29955,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMBLEMHEALTH/HIP-CHP, +29956,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMBLEMHEALTH/HIP-CHP, +29957,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMBLEMHEALTH/HIP-CHP, +29958,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMBLEMHEALTH/HIP-CHP, +29959,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMBLEMHEALTH/HIP-CHP, +29960,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMBLEMHEALTH/HIP-CHP, +29961,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMBLEMHEALTH/HIP-CHP, +29962,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMBLEMHEALTH/HIP-CHP, +29963,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMBLEMHEALTH/HIP-CHP, +29964,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMBLEMHEALTH/HIP-CHP, +29965,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMBLEMHEALTH/HIP-CHP, +29966,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMBLEMHEALTH/HIP-CHP, +29967,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMBLEMHEALTH/HIP-CHP, +29968,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMBLEMHEALTH/HIP-CHP, +29969,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMBLEMHEALTH/HIP-CHP, +29970,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMBLEMHEALTH/HIP-CHP, +29971,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMBLEMHEALTH/HIP-CHP, +29972,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMBLEMHEALTH/HIP-CHP, +29973,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMBLEMHEALTH/HIP-CHP, +29974,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMBLEMHEALTH/HIP-CHP, +29975,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMBLEMHEALTH/HIP-CHP, +29976,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMBLEMHEALTH/HIP-CHP, +29977,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMBLEMHEALTH/HIP-CHP, +29978,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMBLEMHEALTH/HIP-CHP, +29979,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMBLEMHEALTH/HIP-CHP, +29980,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMBLEMHEALTH/HIP-CHP, +29981,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +29982,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMBLEMHEALTH/HIP-CHP, +29983,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMBLEMHEALTH/HIP-CHP, +29984,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMBLEMHEALTH/HIP-CHP, +29985,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMBLEMHEALTH/HIP-CHP, +29986,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMBLEMHEALTH/HIP-CHP, +29987,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMBLEMHEALTH/HIP-CHP, +29988,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMBLEMHEALTH/HIP-CHP, +29989,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMBLEMHEALTH/HIP-CHP, +29990,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMBLEMHEALTH/HIP-CHP, +29991,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMBLEMHEALTH/HIP-CHP, +29992,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMBLEMHEALTH/HIP-CHP, +29993,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMBLEMHEALTH/HIP-CHP, +29994,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMBLEMHEALTH/HIP-CHP, +29995,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMBLEMHEALTH/HIP-CHP, +29996,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMBLEMHEALTH/HIP-CHP, +29997,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMBLEMHEALTH/HIP-CHP, +29998,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMBLEMHEALTH/HIP-CHP, +29999,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMBLEMHEALTH/HIP-CHP, +30000,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMBLEMHEALTH/HIP-CHP, +30001,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMBLEMHEALTH/HIP-CHP, +30002,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMBLEMHEALTH/HIP-CHP, +30003,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMBLEMHEALTH/HIP-CHP, +30004,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMBLEMHEALTH/HIP-CHP, +30005,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMBLEMHEALTH/HIP-CHP, +30006,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMBLEMHEALTH/HIP-CHP, +30007,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMBLEMHEALTH/HIP-CHP, +30008,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMBLEMHEALTH/HIP-CHP, +30009,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMBLEMHEALTH/HIP-CHP, +30010,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMBLEMHEALTH/HIP-CHP, +30011,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMBLEMHEALTH/HIP-CHP, +30012,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMBLEMHEALTH/HIP-CHP, +30013,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMBLEMHEALTH/HIP-CHP, +30014,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMBLEMHEALTH/HIP-CHP, +30015,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMBLEMHEALTH/HIP-CHP, +30016,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMBLEMHEALTH/HIP-CHP, +30017,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMBLEMHEALTH/HIP-CHP, +30018,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMBLEMHEALTH/HIP-CHP, +30019,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMBLEMHEALTH/HIP-CHP, +30020,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMBLEMHEALTH/HIP-CHP, +30021,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMBLEMHEALTH/HIP-CHP, +30022,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMBLEMHEALTH/HIP-CHP, +30023,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMBLEMHEALTH/HIP-CHP, +30024,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMBLEMHEALTH/HIP-CHP, +30025,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMBLEMHEALTH/HIP-CHP, +30026,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMBLEMHEALTH/HIP-CHP, +30027,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMBLEMHEALTH/HIP-CHP, +30028,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMBLEMHEALTH/HIP-CHP, +30029,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMBLEMHEALTH/HIP-CHP, +30030,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMBLEMHEALTH/HIP-CHP, +30031,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMBLEMHEALTH/HIP-CHP, +30032,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMBLEMHEALTH/HIP-CHP, +30033,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMBLEMHEALTH/HIP-CHP, +30034,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMBLEMHEALTH/HIP-CHP, +30035,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +30036,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMBLEMHEALTH/HIP-CHP, +30037,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMBLEMHEALTH/HIP-CHP, +30038,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMBLEMHEALTH/HIP-CHP, +30039,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMBLEMHEALTH/HIP-CHP, +30040,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-CHP, +30041,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-CHP, +30042,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-CHP, +30043,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-CHP, +30044,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-CHP, +30045,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMBLEMHEALTH/HIP-CHP, +30046,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMBLEMHEALTH/HIP-CHP, +30047,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMBLEMHEALTH/HIP-CHP, +30048,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMBLEMHEALTH/HIP-CHP, +30049,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMBLEMHEALTH/HIP-CHP, +30050,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMBLEMHEALTH/HIP-CHP, +30051,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMBLEMHEALTH/HIP-CHP, +30052,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMBLEMHEALTH/HIP-CHP, +30053,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMBLEMHEALTH/HIP-CHP, +30054,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMBLEMHEALTH/HIP-CHP, +30055,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMBLEMHEALTH/HIP-CHP, +30056,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMBLEMHEALTH/HIP-CHP, +30057,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMBLEMHEALTH/HIP-CHP, +30058,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMBLEMHEALTH/HIP-CHP, +30059,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMBLEMHEALTH/HIP-CHP, +30060,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMBLEMHEALTH/HIP-CHP, +30061,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMBLEMHEALTH/HIP-CHP, +30062,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMBLEMHEALTH/HIP-CHP, +30063,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMBLEMHEALTH/HIP-CHP, +30064,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMBLEMHEALTH/HIP-CHP, +30065,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMBLEMHEALTH/HIP-CHP, +30066,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMBLEMHEALTH/HIP-CHP, +30067,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMBLEMHEALTH/HIP-CHP, +30068,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMBLEMHEALTH/HIP-CHP, +30069,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMBLEMHEALTH/HIP-CHP, +30070,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMBLEMHEALTH/HIP-CHP, +30071,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMBLEMHEALTH/HIP-CHP, +30072,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMBLEMHEALTH/HIP-CHP, +30073,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMBLEMHEALTH/HIP-CHP, +30074,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMBLEMHEALTH/HIP-CHP, +30075,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMBLEMHEALTH/HIP-CHP, +30076,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMBLEMHEALTH/HIP-CHP, +30077,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMBLEMHEALTH/HIP-CHP, +30078,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMBLEMHEALTH/HIP-CHP, +30079,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMBLEMHEALTH/HIP-CHP, +30080,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMBLEMHEALTH/HIP-CHP, +30081,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMBLEMHEALTH/HIP-CHP, +30082,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMBLEMHEALTH/HIP-CHP, +30083,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMBLEMHEALTH/HIP-CHP, +30084,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMBLEMHEALTH/HIP-CHP, +30085,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMBLEMHEALTH/HIP-CHP, +30086,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMBLEMHEALTH/HIP-CHP, +30087,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMBLEMHEALTH/HIP-CHP, +30088,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMBLEMHEALTH/HIP-CHP, +30089,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMBLEMHEALTH/HIP-CHP, +30090,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMBLEMHEALTH/HIP-CHP, +30091,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMBLEMHEALTH/HIP-CHP, +30092,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMBLEMHEALTH/HIP-CHP, +30093,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMBLEMHEALTH/HIP-CHP, +30094,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMBLEMHEALTH/HIP-CHP, +30095,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMBLEMHEALTH/HIP-CHP, +30096,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMBLEMHEALTH/HIP-CHP, +30097,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMBLEMHEALTH/HIP-CHP, +30098,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMBLEMHEALTH/HIP-CHP, +30099,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMBLEMHEALTH/HIP-CHP, +30100,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMBLEMHEALTH/HIP-CHP, +30101,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMBLEMHEALTH/HIP-CHP, +30102,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMBLEMHEALTH/HIP-CHP, +30103,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMBLEMHEALTH/HIP-CHP, +30104,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMBLEMHEALTH/HIP-CHP, +30105,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMBLEMHEALTH/HIP-CHP, +30106,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMBLEMHEALTH/HIP-CHP, +30107,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMBLEMHEALTH/HIP-CHP, +30108,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMBLEMHEALTH/HIP-CHP, +30109,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMBLEMHEALTH/HIP-CHP, +30110,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMBLEMHEALTH/HIP-CHP, +30111,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMBLEMHEALTH/HIP-CHP, +30112,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMBLEMHEALTH/HIP-CHP, +30113,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMBLEMHEALTH/HIP-CHP, +30114,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMBLEMHEALTH/HIP-CHP, +30115,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMBLEMHEALTH/HIP-CHP, +30116,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMBLEMHEALTH/HIP-CHP, +30117,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMBLEMHEALTH/HIP-CHP, +30118,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMBLEMHEALTH/HIP-CHP, +30119,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMBLEMHEALTH/HIP-CHP, +30120,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMBLEMHEALTH/HIP-CHP, +30121,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMBLEMHEALTH/HIP-CHP, +30122,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMBLEMHEALTH/HIP-CHP, +30123,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMBLEMHEALTH/HIP-CHP, +30124,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMBLEMHEALTH/HIP-CHP, +30125,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMBLEMHEALTH/HIP-CHP, +30126,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMBLEMHEALTH/HIP-CHP, +30127,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMBLEMHEALTH/HIP-CHP, +30128,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMBLEMHEALTH/HIP-CHP, +30129,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMBLEMHEALTH/HIP-CHP, +30130,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMBLEMHEALTH/HIP-CHP, +30131,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMBLEMHEALTH/HIP-CHP, +30132,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMBLEMHEALTH/HIP-CHP, +30133,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMBLEMHEALTH/HIP-CHP, +30134,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMBLEMHEALTH/HIP-CHP, +30135,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMBLEMHEALTH/HIP-CHP, +30136,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMBLEMHEALTH/HIP-CHP, +30137,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMBLEMHEALTH/HIP-CHP, +30138,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMBLEMHEALTH/HIP-CHP, +30139,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMBLEMHEALTH/HIP-CHP, +30140,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMBLEMHEALTH/HIP-CHP, +30141,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMBLEMHEALTH/HIP-CHP, +30142,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMBLEMHEALTH/HIP-CHP, +30143,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMBLEMHEALTH/HIP-CHP, +30144,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMBLEMHEALTH/HIP-CHP, +30145,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMBLEMHEALTH/HIP-CHP, +30146,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMBLEMHEALTH/HIP-CHP, +30147,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMBLEMHEALTH/HIP-CHP, +30148,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMBLEMHEALTH/HIP-CHP, +30149,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMBLEMHEALTH/HIP-CHP, +30150,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMBLEMHEALTH/HIP-CHP, +30151,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMBLEMHEALTH/HIP-CHP, +30152,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMBLEMHEALTH/HIP-CHP, +30153,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMBLEMHEALTH/HIP-CHP, +30154,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMBLEMHEALTH/HIP-CHP, +30155,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMBLEMHEALTH/HIP-CHP, +30156,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMBLEMHEALTH/HIP-CHP, +30157,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMBLEMHEALTH/HIP-CHP, +30158,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMBLEMHEALTH/HIP-CHP, +30159,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMBLEMHEALTH/HIP-CHP, +30160,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMBLEMHEALTH/HIP-CHP, +30161,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMBLEMHEALTH/HIP-CHP, +30162,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMBLEMHEALTH/HIP-CHP, +30163,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMBLEMHEALTH/HIP-CHP, +30164,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMBLEMHEALTH/HIP-CHP, +30165,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMBLEMHEALTH/HIP-CHP, +30166,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMBLEMHEALTH/HIP-CHP, +30167,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMBLEMHEALTH/HIP-CHP, +30168,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMBLEMHEALTH/HIP-CHP, +30169,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMBLEMHEALTH/HIP-CHP, +30170,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMBLEMHEALTH/HIP-CHP, +30171,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMBLEMHEALTH/HIP-CHP, +30172,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMBLEMHEALTH/HIP-CHP, +30173,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMBLEMHEALTH/HIP-CHP, +30174,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMBLEMHEALTH/HIP-CHP, +30175,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMBLEMHEALTH/HIP-CHP, +30176,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMBLEMHEALTH/HIP-CHP, +30177,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMBLEMHEALTH/HIP-CHP, +30178,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMBLEMHEALTH/HIP-CHP, +30179,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMBLEMHEALTH/HIP-CHP, +30180,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMBLEMHEALTH/HIP-CHP, +30181,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMBLEMHEALTH/HIP-CHP, +30182,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMBLEMHEALTH/HIP-CHP, +30183,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMBLEMHEALTH/HIP-CHP, +30184,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMBLEMHEALTH/HIP-CHP, +30185,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMBLEMHEALTH/HIP-CHP, +30186,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMBLEMHEALTH/HIP-CHP, +30187,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMBLEMHEALTH/HIP-CHP, +30188,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMBLEMHEALTH/HIP-CHP, +30189,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMBLEMHEALTH/HIP-CHP, +30190,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMBLEMHEALTH/HIP-CHP, +30191,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMBLEMHEALTH/HIP-CHP, +30192,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMBLEMHEALTH/HIP-CHP, +30193,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMBLEMHEALTH/HIP-CHP, +30194,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMBLEMHEALTH/HIP-CHP, +30195,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMBLEMHEALTH/HIP-CHP, +30196,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMBLEMHEALTH/HIP-CHP, +30197,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMBLEMHEALTH/HIP-CHP, +30198,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMBLEMHEALTH/HIP-CHP, +30199,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMBLEMHEALTH/HIP-CHP, +30200,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMBLEMHEALTH/HIP-CHP, +30201,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMBLEMHEALTH/HIP-CHP, +30202,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMBLEMHEALTH/HIP-CHP, +30203,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMBLEMHEALTH/HIP-CHP, +30204,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMBLEMHEALTH/HIP-CHP, +30205,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMBLEMHEALTH/HIP-CHP, +30206,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMBLEMHEALTH/HIP-CHP, +30207,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMBLEMHEALTH/HIP-CHP, +30208,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMBLEMHEALTH/HIP-CHP, +30209,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMBLEMHEALTH/HIP-CHP, +30210,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMBLEMHEALTH/HIP-CHP, +30211,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMBLEMHEALTH/HIP-CHP, +30212,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMBLEMHEALTH/HIP-CHP, +30213,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMBLEMHEALTH/HIP-CHP, +30214,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMBLEMHEALTH/HIP-CHP, +30215,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMBLEMHEALTH/HIP-CHP, +30216,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMBLEMHEALTH/HIP-CHP, +30217,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMBLEMHEALTH/HIP-CHP, +30218,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMBLEMHEALTH/HIP-CHP, +30219,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMBLEMHEALTH/HIP-CHP, +30220,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMBLEMHEALTH/HIP-CHP, +30221,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMBLEMHEALTH/HIP-CHP, +30222,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMBLEMHEALTH/HIP-CHP, +30223,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMBLEMHEALTH/HIP-CHP, +30224,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMBLEMHEALTH/HIP-CHP, +30225,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMBLEMHEALTH/HIP-CHP, +30226,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMBLEMHEALTH/HIP-CHP, +30227,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMBLEMHEALTH/HIP-CHP, +30228,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMBLEMHEALTH/HIP-CHP, +30229,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMBLEMHEALTH/HIP-CHP, +30230,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMBLEMHEALTH/HIP-CHP, +30231,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMBLEMHEALTH/HIP-CHP, +30232,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMBLEMHEALTH/HIP-CHP, +30233,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMBLEMHEALTH/HIP-CHP, +30234,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMBLEMHEALTH/HIP-CHP, +30235,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMBLEMHEALTH/HIP-CHP, +30236,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMBLEMHEALTH/HIP-CHP, +30237,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMBLEMHEALTH/HIP-CHP, +30238,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMBLEMHEALTH/HIP-CHP, +30239,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMBLEMHEALTH/HIP-CHP, +30240,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMBLEMHEALTH/HIP-CHP, +30241,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMBLEMHEALTH/HIP-CHP, +30242,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMBLEMHEALTH/HIP-CHP, +30243,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMBLEMHEALTH/HIP-CHP, +30244,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMBLEMHEALTH/HIP-CHP, +30245,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMBLEMHEALTH/HIP-CHP, +30246,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMBLEMHEALTH/HIP-CHP, +30247,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMBLEMHEALTH/HIP-CHP, +30248,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMBLEMHEALTH/HIP-CHP, +30249,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMBLEMHEALTH/HIP-CHP, +30250,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMBLEMHEALTH/HIP-CHP, +30251,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMBLEMHEALTH/HIP-CHP, +30252,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMBLEMHEALTH/HIP-CHP, +30253,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMBLEMHEALTH/HIP-CHP, +30254,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMBLEMHEALTH/HIP-CHP, +30255,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMBLEMHEALTH/HIP-CHP, +30256,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMBLEMHEALTH/HIP-CHP, +30257,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMBLEMHEALTH/HIP-CHP, +30258,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMBLEMHEALTH/HIP-CHP, +30259,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMBLEMHEALTH/HIP-CHP, +30260,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMBLEMHEALTH/HIP-CHP, +30261,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMBLEMHEALTH/HIP-CHP, +30262,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMBLEMHEALTH/HIP-CHP, +30263,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMBLEMHEALTH/HIP-CHP, +30264,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMBLEMHEALTH/HIP-CHP, +30265,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMBLEMHEALTH/HIP-CHP, +30266,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMBLEMHEALTH/HIP-CHP, +30267,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMBLEMHEALTH/HIP-CHP, +30268,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMBLEMHEALTH/HIP-CHP, +30269,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMBLEMHEALTH/HIP-CHP, +30270,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMBLEMHEALTH/HIP-CHP, +30271,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMBLEMHEALTH/HIP-CHP, +30272,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMBLEMHEALTH/HIP-CHP, +30273,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMBLEMHEALTH/HIP-CHP, +30274,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMBLEMHEALTH/HIP-CHP, +30275,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMBLEMHEALTH/HIP-CHP, +30276,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMBLEMHEALTH/HIP-CHP, +30277,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMBLEMHEALTH/HIP-CHP, +30278,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMBLEMHEALTH/HIP-CHP, +30279,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMBLEMHEALTH/HIP-CHP, +30280,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMBLEMHEALTH/HIP-CHP, +30281,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMBLEMHEALTH/HIP-CHP, +30282,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMBLEMHEALTH/HIP-CHP, +30283,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMBLEMHEALTH/HIP-CHP, +30284,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMBLEMHEALTH/HIP-CHP, +30285,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMBLEMHEALTH/HIP-CHP, +30286,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMBLEMHEALTH/HIP-CHP, +30287,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMBLEMHEALTH/HIP-CHP, +30288,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMBLEMHEALTH/HIP-CHP, +30289,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMBLEMHEALTH/HIP-CHP, +30290,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMBLEMHEALTH/HIP-CHP, +30291,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMBLEMHEALTH/HIP-CHP, +30292,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMBLEMHEALTH/HIP-CHP, +30293,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMBLEMHEALTH/HIP-CHP, +30294,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMBLEMHEALTH/HIP-CHP, +30295,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMBLEMHEALTH/HIP-CHP, +30296,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMBLEMHEALTH/HIP-CHP, +30297,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMBLEMHEALTH/HIP-CHP, +30298,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMBLEMHEALTH/HIP-CHP, +30299,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMBLEMHEALTH/HIP-CHP, +30300,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMBLEMHEALTH/HIP-CHP, +30301,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMBLEMHEALTH/HIP-CHP, +30302,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMBLEMHEALTH/HIP-CHP, +30303,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMBLEMHEALTH/HIP-CHP, +30304,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMBLEMHEALTH/HIP-CHP, +30305,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMBLEMHEALTH/HIP-CHP, +30306,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMBLEMHEALTH/HIP-CHP, +30307,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMBLEMHEALTH/HIP-CHP, +30308,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMBLEMHEALTH/HIP-CHP, +30309,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMBLEMHEALTH/HIP-CHP, +30310,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMBLEMHEALTH/HIP-CHP, +30311,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMBLEMHEALTH/HIP-CHP, +30312,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMBLEMHEALTH/HIP-CHP, +30313,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMBLEMHEALTH/HIP-CHP, +30314,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMBLEMHEALTH/HIP-CHP, +30315,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMBLEMHEALTH/HIP-CHP, +30316,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMBLEMHEALTH/HIP-CHP, +30317,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMBLEMHEALTH/HIP-CHP, +30318,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMBLEMHEALTH/HIP-CHP, +30319,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMBLEMHEALTH/HIP-CHP, +30320,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMBLEMHEALTH/HIP-CHP, +30321,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMBLEMHEALTH/HIP-CHP, +30322,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMBLEMHEALTH/HIP-CHP, +30323,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMBLEMHEALTH/HIP-CHP, +30324,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMBLEMHEALTH/HIP-CHP, +30325,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMBLEMHEALTH/HIP-CHP, +30326,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMBLEMHEALTH/HIP-CHP, +30327,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMBLEMHEALTH/HIP-CHP, +30328,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMBLEMHEALTH/HIP-CHP, +30329,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMBLEMHEALTH/HIP-CHP, +30330,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMBLEMHEALTH/HIP-CHP, +30331,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMBLEMHEALTH/HIP-CHP, +30332,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMBLEMHEALTH/HIP-CHP, +30333,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMBLEMHEALTH/HIP-CHP, +30334,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMBLEMHEALTH/HIP-CHP, +30335,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMBLEMHEALTH/HIP-CHP, +30336,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMBLEMHEALTH/HIP-CHP, +30337,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMBLEMHEALTH/HIP-CHP, +30338,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMBLEMHEALTH/HIP-CHP, +30339,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMBLEMHEALTH/HIP-CHP, +30340,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMBLEMHEALTH/HIP-CHP, +30341,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMBLEMHEALTH/HIP-CHP, +30342,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMBLEMHEALTH/HIP-CHP, +30343,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMBLEMHEALTH/HIP-CHP, +30344,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMBLEMHEALTH/HIP-CHP, +30345,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMBLEMHEALTH/HIP-CHP, +30346,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMBLEMHEALTH/HIP-CHP, +30347,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMBLEMHEALTH/HIP-CHP, +30348,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMBLEMHEALTH/HIP-CHP, +30349,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMBLEMHEALTH/HIP-CHP, +30350,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMBLEMHEALTH/HIP-CHP, +30351,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMBLEMHEALTH/HIP-CHP, +30352,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMBLEMHEALTH/HIP-CHP, +30353,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMBLEMHEALTH/HIP-CHP, +30354,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMBLEMHEALTH/HIP-CHP, +30355,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMBLEMHEALTH/HIP-CHP, +30356,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMBLEMHEALTH/HIP-CHP, +30357,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMBLEMHEALTH/HIP-CHP, +30358,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMBLEMHEALTH/HIP-CHP, +30359,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMBLEMHEALTH/HIP-CHP, +30360,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMBLEMHEALTH/HIP-CHP, +30361,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMBLEMHEALTH/HIP-CHP, +30362,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMBLEMHEALTH/HIP-CHP, +30363,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMBLEMHEALTH/HIP-CHP, +30364,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMBLEMHEALTH/HIP-CHP, +30365,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMBLEMHEALTH/HIP-CHP, +30366,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMBLEMHEALTH/HIP-CHP, +30367,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMBLEMHEALTH/HIP-CHP, +30368,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMBLEMHEALTH/HIP-CHP, +30369,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMBLEMHEALTH/HIP-CHP, +30370,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMBLEMHEALTH/HIP-CHP, +30371,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMBLEMHEALTH/HIP-CHP, +30372,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMBLEMHEALTH/HIP-CHP, +30373,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMBLEMHEALTH/HIP-CHP, +30374,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMBLEMHEALTH/HIP-CHP, +30375,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMBLEMHEALTH/HIP-CHP, +30376,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMBLEMHEALTH/HIP-CHP, +30377,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMBLEMHEALTH/HIP-CHP, +30378,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMBLEMHEALTH/HIP-CHP, +30379,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMBLEMHEALTH/HIP-CHP, +30380,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMBLEMHEALTH/HIP-CHP, +30381,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMBLEMHEALTH/HIP-CHP, +30382,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMBLEMHEALTH/HIP-CHP, +30383,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMBLEMHEALTH/HIP-CHP, +30384,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMBLEMHEALTH/HIP-CHP, +30385,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMBLEMHEALTH/HIP-CHP, +30386,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMBLEMHEALTH/HIP-CHP, +30387,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMBLEMHEALTH/HIP-CHP, +30388,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMBLEMHEALTH/HIP-CHP, +30389,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMBLEMHEALTH/HIP-CHP, +30390,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMBLEMHEALTH/HIP-CHP, +30391,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMBLEMHEALTH/HIP-CHP, +30392,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMBLEMHEALTH/HIP-CHP, +30393,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMBLEMHEALTH/HIP-CHP, +30394,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMBLEMHEALTH/HIP-CHP, +30395,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMBLEMHEALTH/HIP-CHP, +30396,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMBLEMHEALTH/HIP-CHP, +30397,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMBLEMHEALTH/HIP-CHP, +30398,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMBLEMHEALTH/HIP-CHP, +30399,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMBLEMHEALTH/HIP-CHP, +30400,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMBLEMHEALTH/HIP-CHP, +30401,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMBLEMHEALTH/HIP-CHP, +30402,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMBLEMHEALTH/HIP-CHP, +30403,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMBLEMHEALTH/HIP-CHP, +30404,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMBLEMHEALTH/HIP-CHP, +30405,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMBLEMHEALTH/HIP-CHP, +30406,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMBLEMHEALTH/HIP-CHP, +30407,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMBLEMHEALTH/HIP-CHP, +30408,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMBLEMHEALTH/HIP-CHP, +30409,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMBLEMHEALTH/HIP-CHP, +30410,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMBLEMHEALTH/HIP-CHP, +30411,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMBLEMHEALTH/HIP-CHP, +30412,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMBLEMHEALTH/HIP-CHP, +30413,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMBLEMHEALTH/HIP-CHP, +30414,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMBLEMHEALTH/HIP-CHP, +30415,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMBLEMHEALTH/HIP-CHP, +30416,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMBLEMHEALTH/HIP-CHP, +30417,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMBLEMHEALTH/HIP-CHP, +30418,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMBLEMHEALTH/HIP-CHP, +30419,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMBLEMHEALTH/HIP-CHP, +30420,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMBLEMHEALTH/HIP-CHP, +30421,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMBLEMHEALTH/HIP-CHP, +30422,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMBLEMHEALTH/HIP-CHP, +30423,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMBLEMHEALTH/HIP-CHP, +30424,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMBLEMHEALTH/HIP-CHP, +30425,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMBLEMHEALTH/HIP-CHP, +30426,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMBLEMHEALTH/HIP-CHP, +30427,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMBLEMHEALTH/HIP-CHP, +30428,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMBLEMHEALTH/HIP-CHP, +30429,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMBLEMHEALTH/HIP-CHP, +30430,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMBLEMHEALTH/HIP-CHP, +30431,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMBLEMHEALTH/HIP-CHP, +30432,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMBLEMHEALTH/HIP-CHP, +30433,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMBLEMHEALTH/HIP-CHP, +30434,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMBLEMHEALTH/HIP-CHP, +30435,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMBLEMHEALTH/HIP-CHP, +30436,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMBLEMHEALTH/HIP-CHP, +30437,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMBLEMHEALTH/HIP-CHP, +30438,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMBLEMHEALTH/HIP-CHP, +30439,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMBLEMHEALTH/HIP-CHP, +30440,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMBLEMHEALTH/HIP-CHP, +30441,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMBLEMHEALTH/HIP-CHP, +30442,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMBLEMHEALTH/HIP-CHP, +30443,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMBLEMHEALTH/HIP-CHP, +30444,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMBLEMHEALTH/HIP-CHP, +30445,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMBLEMHEALTH/HIP-CHP, +30446,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMBLEMHEALTH/HIP-CHP, +30447,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMBLEMHEALTH/HIP-CHP, +30448,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMBLEMHEALTH/HIP-CHP, +30449,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMBLEMHEALTH/HIP-CHP, +30450,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMBLEMHEALTH/HIP-CHP, +30451,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMBLEMHEALTH/HIP-CHP, +30452,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMBLEMHEALTH/HIP-CHP, +30453,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMBLEMHEALTH/HIP-CHP, +30454,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMBLEMHEALTH/HIP-CHP, +30455,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMBLEMHEALTH/HIP-CHP, +30456,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMBLEMHEALTH/HIP-CHP, +30457,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMBLEMHEALTH/HIP-CHP, +30458,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMBLEMHEALTH/HIP-CHP, +30459,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMBLEMHEALTH/HIP-CHP, +30460,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMBLEMHEALTH/HIP-CHP, +30461,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMBLEMHEALTH/HIP-CHP, +30462,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMBLEMHEALTH/HIP-CHP, +30463,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMBLEMHEALTH/HIP-CHP, +30464,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMBLEMHEALTH/HIP-CHP, +30465,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMBLEMHEALTH/HIP-CHP, +30466,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMBLEMHEALTH/HIP-CHP, +30467,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMBLEMHEALTH/HIP-CHP, +30468,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMBLEMHEALTH/HIP-CHP, +30469,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMBLEMHEALTH/HIP-CHP, +30470,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMBLEMHEALTH/HIP-CHP, +30471,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMBLEMHEALTH/HIP-CHP, +30472,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMBLEMHEALTH/HIP-CHP, +30473,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMBLEMHEALTH/HIP-CHP, +30474,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMBLEMHEALTH/HIP-CHP, +30475,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMBLEMHEALTH/HIP-CHP, +30476,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMBLEMHEALTH/HIP-CHP, +30477,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMBLEMHEALTH/HIP-CHP, +30478,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMBLEMHEALTH/HIP-CHP, +30479,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMBLEMHEALTH/HIP-CHP, +30480,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMBLEMHEALTH/HIP-CHP, +30481,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMBLEMHEALTH/HIP-CHP, +30482,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMBLEMHEALTH/HIP-CHP, +30483,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMBLEMHEALTH/HIP-CHP, +30484,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMBLEMHEALTH/HIP-CHP, +30485,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMBLEMHEALTH/HIP-CHP, +30486,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMBLEMHEALTH/HIP-CHP, +30487,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMBLEMHEALTH/HIP-CHP, +30488,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMBLEMHEALTH/HIP-CHP, +30489,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMBLEMHEALTH/HIP-CHP, +30490,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMBLEMHEALTH/HIP-CHP, +30491,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMBLEMHEALTH/HIP-CHP, +30492,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMBLEMHEALTH/HIP-CHP, +30493,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMBLEMHEALTH/HIP-CHP, +30494,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMBLEMHEALTH/HIP-CHP, +30495,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMBLEMHEALTH/HIP-CHP, +30496,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMBLEMHEALTH/HIP-CHP, +30497,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMBLEMHEALTH/HIP-CHP, +30498,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMBLEMHEALTH/HIP-CHP, +30499,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMBLEMHEALTH/HIP-CHP, +30500,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMBLEMHEALTH/HIP-CHP, +30501,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMBLEMHEALTH/HIP-CHP, +30502,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMBLEMHEALTH/HIP-CHP, +30503,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMBLEMHEALTH/HIP-CHP, +30504,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMBLEMHEALTH/HIP-CHP, +30505,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMBLEMHEALTH/HIP-CHP, +30506,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMBLEMHEALTH/HIP-CHP, +30507,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMBLEMHEALTH/HIP-CHP, +30508,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMBLEMHEALTH/HIP-CHP, +30509,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMBLEMHEALTH/HIP-CHP, +30510,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMBLEMHEALTH/HIP-CHP, +30511,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMBLEMHEALTH/HIP-CHP, +30512,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMBLEMHEALTH/HIP-CHP, +30513,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMBLEMHEALTH/HIP-CHP, +30514,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMBLEMHEALTH/HIP-CHP, +30515,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMBLEMHEALTH/HIP-CHP, +30516,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMBLEMHEALTH/HIP-CHP, +30517,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMBLEMHEALTH/HIP-CHP, +30518,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMBLEMHEALTH/HIP-CHP, +30519,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMBLEMHEALTH/HIP-CHP, +30520,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMBLEMHEALTH/HIP-CHP, +30521,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMBLEMHEALTH/HIP-CHP, +30522,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMBLEMHEALTH/HIP-CHP, +30523,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMBLEMHEALTH/HIP-CHP, +30524,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMBLEMHEALTH/HIP-CHP, +30525,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMBLEMHEALTH/HIP-CHP, +30526,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMBLEMHEALTH/HIP-CHP, +30527,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMBLEMHEALTH/HIP-CHP, +30528,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMBLEMHEALTH/HIP-CHP, +30529,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMBLEMHEALTH/HIP-CHP, +30530,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMBLEMHEALTH/HIP-CHP, +30531,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMBLEMHEALTH/HIP-CHP, +30532,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMBLEMHEALTH/HIP-CHP, +30533,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMBLEMHEALTH/HIP-CHP, +30534,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMBLEMHEALTH/HIP-CHP, +30535,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMBLEMHEALTH/HIP-CHP, +30536,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMBLEMHEALTH/HIP-CHP, +30537,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMBLEMHEALTH/HIP-CHP, +30538,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMBLEMHEALTH/HIP-CHP, +30539,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMBLEMHEALTH/HIP-CHP, +30540,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMBLEMHEALTH/HIP-CHP, +30541,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMBLEMHEALTH/HIP-CHP, +30542,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMBLEMHEALTH/HIP-CHP, +30543,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMBLEMHEALTH/HIP-CHP, +30544,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMBLEMHEALTH/HIP-CHP, +30545,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMBLEMHEALTH/HIP-CHP, +30546,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMBLEMHEALTH/HIP-CHP, +30547,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMBLEMHEALTH/HIP-CHP, +30548,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMBLEMHEALTH/HIP-CHP, +30549,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMBLEMHEALTH/HIP-CHP, +30550,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMBLEMHEALTH/HIP-CHP, +30551,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMBLEMHEALTH/HIP-CHP, +30552,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMBLEMHEALTH/HIP-CHP, +30553,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMBLEMHEALTH/HIP-CHP, +30554,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMBLEMHEALTH/HIP-CHP, +30555,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMBLEMHEALTH/HIP-CHP, +30556,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMBLEMHEALTH/HIP-CHP, +30557,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMBLEMHEALTH/HIP-CHP, +30558,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMBLEMHEALTH/HIP-CHP, +30559,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMBLEMHEALTH/HIP-CHP, +30560,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMBLEMHEALTH/HIP-CHP, +30561,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMBLEMHEALTH/HIP-CHP, +30562,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMBLEMHEALTH/HIP-CHP, +30563,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMBLEMHEALTH/HIP-CHP, +30564,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMBLEMHEALTH/HIP-CHP, +30565,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMBLEMHEALTH/HIP-CHP, +30566,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMBLEMHEALTH/HIP-CHP, +30567,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMBLEMHEALTH/HIP-CHP, +30568,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMBLEMHEALTH/HIP-CHP, +30569,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMBLEMHEALTH/HIP-CHP, +30570,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMBLEMHEALTH/HIP-CHP, +30571,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMBLEMHEALTH/HIP-CHP, +30572,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMBLEMHEALTH/HIP-CHP, +30573,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMBLEMHEALTH/HIP-CHP, +30574,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMBLEMHEALTH/HIP-CHP, +30575,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMBLEMHEALTH/HIP-CHP, +30576,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMBLEMHEALTH/HIP-CHP, +30577,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMBLEMHEALTH/HIP-CHP, +30578,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMBLEMHEALTH/HIP-CHP, +30579,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMBLEMHEALTH/HIP-CHP, +30580,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMBLEMHEALTH/HIP-CHP, +30581,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMBLEMHEALTH/HIP-CHP, +30582,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMBLEMHEALTH/HIP-CHP, +30583,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMBLEMHEALTH/HIP-CHP, +30584,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMBLEMHEALTH/HIP-CHP, +30585,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMBLEMHEALTH/HIP-CHP, +30586,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMBLEMHEALTH/HIP-CHP, +30587,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMBLEMHEALTH/HIP-CHP, +30588,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMBLEMHEALTH/HIP-CHP, +30589,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMBLEMHEALTH/HIP-CHP, +30590,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMBLEMHEALTH/HIP-CHP, +30591,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMBLEMHEALTH/HIP-CHP, +30592,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMBLEMHEALTH/HIP-CHP, +30593,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-CHP, +30594,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMBLEMHEALTH/HIP-CHP, +30595,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMBLEMHEALTH/HIP-CHP, +30596,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMBLEMHEALTH/HIP-CHP, +30597,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMBLEMHEALTH/HIP-CHP, +30598,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMBLEMHEALTH/HIP-CHP, +30599,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMBLEMHEALTH/HIP-CHP, +30600,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMBLEMHEALTH/HIP-CHP, +30601,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMBLEMHEALTH/HIP-CHP, +30602,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMBLEMHEALTH/HIP-CHP, +30603,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMBLEMHEALTH/HIP-CHP, +30604,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-CHP, +30605,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMBLEMHEALTH/HIP-CHP, +30606,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMBLEMHEALTH/HIP-CHP, +30607,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMBLEMHEALTH/HIP-CHP, +30608,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMBLEMHEALTH/HIP-CHP, +30609,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMBLEMHEALTH/HIP-CHP, +30610,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMBLEMHEALTH/HIP-CHP, +30611,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMBLEMHEALTH/HIP-CHP, +30612,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMBLEMHEALTH/HIP-CHP, +30613,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMBLEMHEALTH/HIP-CHP, +30614,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMBLEMHEALTH/HIP-CHP, +30615,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMBLEMHEALTH/HIP-CHP, +30616,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMBLEMHEALTH/HIP-CHP, +30617,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMBLEMHEALTH/HIP-CHP, +30618,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMBLEMHEALTH/HIP-CHP, +30619,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMBLEMHEALTH/HIP-CHP, +30620,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMBLEMHEALTH/HIP-CHP, +30621,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMBLEMHEALTH/HIP-CHP, +30622,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMBLEMHEALTH/HIP-CHP, +30623,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMBLEMHEALTH/HIP-CHP, +30624,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMBLEMHEALTH/HIP-CHP, +30625,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMBLEMHEALTH/HIP-CHP, +30626,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-CHP, +30627,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMBLEMHEALTH/HIP-CHP, +30628,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMBLEMHEALTH/HIP-CHP, +30629,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMBLEMHEALTH/HIP-CHP, +30630,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMBLEMHEALTH/HIP-CHP, +30631,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMBLEMHEALTH/HIP-CHP, +30632,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMBLEMHEALTH/HIP-CHP, +30633,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMBLEMHEALTH/HIP-CHP, +30634,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMBLEMHEALTH/HIP-CHP, +30635,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMBLEMHEALTH/HIP-CHP, +30636,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMBLEMHEALTH/HIP-CHP, +30637,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMBLEMHEALTH/HIP-CHP, +30638,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMBLEMHEALTH/HIP-CHP, +30639,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMBLEMHEALTH/HIP-CHP, +30640,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMBLEMHEALTH/HIP-CHP, +30641,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMBLEMHEALTH/HIP-CHP, +30642,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMBLEMHEALTH/HIP-CHP, +30643,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMBLEMHEALTH/HIP-CHP, +30644,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMBLEMHEALTH/HIP-CHP, +30645,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMBLEMHEALTH/HIP-CHP, +30646,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMBLEMHEALTH/HIP-CHP, +30647,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMBLEMHEALTH/HIP-CHP, +30648,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMBLEMHEALTH/HIP-CHP, +30649,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMBLEMHEALTH/HIP-CHP, +30650,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMBLEMHEALTH/HIP-CHP, +30651,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMBLEMHEALTH/HIP-CHP, +30652,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMBLEMHEALTH/HIP-CHP, +30653,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMBLEMHEALTH/HIP-CHP, +30654,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMBLEMHEALTH/HIP-CHP, +30655,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMBLEMHEALTH/HIP-CHP, +30656,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMBLEMHEALTH/HIP-CHP, +30657,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMBLEMHEALTH/HIP-CHP, +30658,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMBLEMHEALTH/HIP-CHP, +30659,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMBLEMHEALTH/HIP-CHP, +30660,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMBLEMHEALTH/HIP-CHP, +30661,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMBLEMHEALTH/HIP-CHP, +30662,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMBLEMHEALTH/HIP-CHP, +30663,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMBLEMHEALTH/HIP-CHP, +30664,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMBLEMHEALTH/HIP-CHP, +30665,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMBLEMHEALTH/HIP-CHP, +30666,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMBLEMHEALTH/HIP-CHP, +30667,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMBLEMHEALTH/HIP-CHP, +30668,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMBLEMHEALTH/HIP-CHP, +30669,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMBLEMHEALTH/HIP-CHP, +30670,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMBLEMHEALTH/HIP-CHP, +30671,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMBLEMHEALTH/HIP-CHP, +30672,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMBLEMHEALTH/HIP-CHP, +30673,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMBLEMHEALTH/HIP-CHP, +30674,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMBLEMHEALTH/HIP-CHP, +30675,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMBLEMHEALTH/HIP-CHP, +30676,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMBLEMHEALTH/HIP-CHP, +30677,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMBLEMHEALTH/HIP-CHP, +30678,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMBLEMHEALTH/HIP-CHP, +30679,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMBLEMHEALTH/HIP-CHP, +30680,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMBLEMHEALTH/HIP-CHP, +30681,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMBLEMHEALTH/HIP-CHP, +30682,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMBLEMHEALTH/HIP-CHP, +30683,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMBLEMHEALTH/HIP-CHP, +30684,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMBLEMHEALTH/HIP-CHP, +30685,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMBLEMHEALTH/HIP-CHP, +30686,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMBLEMHEALTH/HIP-CHP, +30687,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMBLEMHEALTH/HIP-CHP, +30688,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMBLEMHEALTH/HIP-CHP, +30689,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMBLEMHEALTH/HIP-CHP, +30690,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMBLEMHEALTH/HIP-CHP, +30691,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMBLEMHEALTH/HIP-CHP, +30692,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMBLEMHEALTH/HIP-CHP, +30693,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMBLEMHEALTH/HIP-CHP, +30694,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMBLEMHEALTH/HIP-CHP, +30695,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMBLEMHEALTH/HIP-CHP, +30696,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMBLEMHEALTH/HIP-CHP, +30697,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMBLEMHEALTH/HIP-CHP, +30698,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMBLEMHEALTH/HIP-CHP, +30699,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMBLEMHEALTH/HIP-CHP, +30700,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMBLEMHEALTH/HIP-CHP, +30701,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMBLEMHEALTH/HIP-CHP, +30702,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMBLEMHEALTH/HIP-CHP, +30703,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMBLEMHEALTH/HIP-CHP, +30704,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMBLEMHEALTH/HIP-CHP, +30705,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMBLEMHEALTH/HIP-CHP, +30706,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMBLEMHEALTH/HIP-CHP, +30707,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMBLEMHEALTH/HIP-CHP, +30708,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMBLEMHEALTH/HIP-CHP, +30709,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMBLEMHEALTH/HIP-CHP, +30710,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMBLEMHEALTH/HIP-CHP, +30711,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMBLEMHEALTH/HIP-CHP, +30712,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMBLEMHEALTH/HIP-CHP, +30713,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMBLEMHEALTH/HIP-CHP, +30714,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMBLEMHEALTH/HIP-CHP, +30715,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMBLEMHEALTH/HIP-CHP, +30716,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMBLEMHEALTH/HIP-CHP, +30717,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMBLEMHEALTH/HIP-CHP, +30718,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMBLEMHEALTH/HIP-CHP, +30719,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMBLEMHEALTH/HIP-CHP, +30720,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMBLEMHEALTH/HIP-CHP, +30721,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMBLEMHEALTH/HIP-CHP, +30722,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMBLEMHEALTH/HIP-CHP, +30723,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMBLEMHEALTH/HIP-CHP, +30724,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMBLEMHEALTH/HIP-CHP, +30725,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMBLEMHEALTH/HIP-CHP, +30726,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMBLEMHEALTH/HIP-CHP, +30727,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMBLEMHEALTH/HIP-CHP, +30728,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +30729,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +30730,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +30731,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMBLEMHEALTH/HIP-CHP, +30732,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMBLEMHEALTH/HIP-CHP, +30733,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMBLEMHEALTH/HIP-CHP, +30734,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMBLEMHEALTH/HIP-CHP, +30735,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMBLEMHEALTH/HIP-CHP, +30736,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMBLEMHEALTH/HIP-CHP, +30737,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMBLEMHEALTH/HIP-CHP, +30738,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMBLEMHEALTH/HIP-CHP, +30739,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMBLEMHEALTH/HIP-CHP, +30740,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMBLEMHEALTH/HIP-CHP, +30741,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMBLEMHEALTH/HIP-CHP, +30742,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMBLEMHEALTH/HIP-CHP, +30743,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMBLEMHEALTH/HIP-CHP, +30744,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMBLEMHEALTH/HIP-CHP, +30745,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMBLEMHEALTH/HIP-CHP, +30746,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMBLEMHEALTH/HIP-CHP, +30747,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMBLEMHEALTH/HIP-CHP, +30748,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMBLEMHEALTH/HIP-CHP, +30749,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMBLEMHEALTH/HIP-CHP, +30750,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMBLEMHEALTH/HIP-CHP, +30751,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMBLEMHEALTH/HIP-CHP, +30752,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMBLEMHEALTH/HIP-CHP, +30753,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMBLEMHEALTH/HIP-CHP, +30754,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMBLEMHEALTH/HIP-CHP, +30755,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMBLEMHEALTH/HIP-CHP, +30756,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMBLEMHEALTH/HIP-CHP, +30757,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMBLEMHEALTH/HIP-CHP, +30758,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMBLEMHEALTH/HIP-CHP, +30759,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMBLEMHEALTH/HIP-CHP, +30760,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMBLEMHEALTH/HIP-CHP, +30761,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMBLEMHEALTH/HIP-CHP, +30762,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMBLEMHEALTH/HIP-CHP, +30763,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMBLEMHEALTH/HIP-CHP, +30764,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMBLEMHEALTH/HIP-CHP, +30765,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMBLEMHEALTH/HIP-CHP, +30766,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMBLEMHEALTH/HIP-CHP, +30767,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMBLEMHEALTH/HIP-CHP, +30768,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMBLEMHEALTH/HIP-CHP, +30769,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMBLEMHEALTH/HIP-CHP, +30770,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMBLEMHEALTH/HIP-CHP, +30771,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMBLEMHEALTH/HIP-CHP, +30772,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMBLEMHEALTH/HIP-CHP, +30773,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMBLEMHEALTH/HIP-CHP, +30774,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMBLEMHEALTH/HIP-CHP, +30775,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMBLEMHEALTH/HIP-CHP, +30776,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMBLEMHEALTH/HIP-CHP, +30777,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMBLEMHEALTH/HIP-CHP, +30778,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMBLEMHEALTH/HIP-CHP, +30779,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMBLEMHEALTH/HIP-CHP, +30780,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMBLEMHEALTH/HIP-CHP, +30781,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMBLEMHEALTH/HIP-CHP, +30782,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMBLEMHEALTH/HIP-CHP, +30783,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMBLEMHEALTH/HIP-CHP, +30784,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMBLEMHEALTH/HIP-CHP, +30785,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMBLEMHEALTH/HIP-CHP, +30786,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMBLEMHEALTH/HIP-CHP, +30787,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMBLEMHEALTH/HIP-CHP, +30788,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMBLEMHEALTH/HIP-CHP, +30789,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMBLEMHEALTH/HIP-CHP, +30790,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMBLEMHEALTH/HIP-CHP, +30791,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMBLEMHEALTH/HIP-CHP, +30792,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMBLEMHEALTH/HIP-CHP, +30793,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMBLEMHEALTH/HIP-CHP, +30794,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMBLEMHEALTH/HIP-CHP, +30795,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMBLEMHEALTH/HIP-CHP, +30796,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMBLEMHEALTH/HIP-CHP, +30797,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMBLEMHEALTH/HIP-CHP, +30798,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMBLEMHEALTH/HIP-CHP, +30799,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMBLEMHEALTH/HIP-CHP, +30800,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMBLEMHEALTH/HIP-CHP, +30801,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMBLEMHEALTH/HIP-CHP, +30802,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMBLEMHEALTH/HIP-CHP, +30803,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMBLEMHEALTH/HIP-CHP, +30804,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMBLEMHEALTH/HIP-CHP, +30805,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMBLEMHEALTH/HIP-CHP, +30806,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMBLEMHEALTH/HIP-CHP, +30807,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMBLEMHEALTH/HIP-CHP, +30808,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMBLEMHEALTH/HIP-CHP, +30809,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMBLEMHEALTH/HIP-CHP, +30810,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMBLEMHEALTH/HIP-CHP, +30811,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMBLEMHEALTH/HIP-CHP, +30812,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMBLEMHEALTH/HIP-CHP, +30813,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMBLEMHEALTH/HIP-CHP, +30814,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMBLEMHEALTH/HIP-CHP, +30815,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMBLEMHEALTH/HIP-CHP, +30816,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMBLEMHEALTH/HIP-CHP, +30817,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMBLEMHEALTH/HIP-CHP, +30818,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMBLEMHEALTH/HIP-CHP, +30819,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMBLEMHEALTH/HIP-CHP, +30820,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMBLEMHEALTH/HIP-CHP, +30821,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMBLEMHEALTH/HIP-CHP, +30822,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMBLEMHEALTH/HIP-CHP, +30823,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMBLEMHEALTH/HIP-CHP, +30824,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMBLEMHEALTH/HIP-CHP, +30825,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMBLEMHEALTH/HIP-CHP, +30826,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMBLEMHEALTH/HIP-CHP, +30827,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +30828,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMBLEMHEALTH/HIP-CHP, +30829,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMBLEMHEALTH/HIP-CHP, +30830,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMBLEMHEALTH/HIP-CHP, +30831,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMBLEMHEALTH/HIP-CHP, +30832,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMBLEMHEALTH/HIP-CHP, +30833,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMBLEMHEALTH/HIP-CHP, +30834,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMBLEMHEALTH/HIP-CHP, +30835,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMBLEMHEALTH/HIP-CHP, +30836,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMBLEMHEALTH/HIP-CHP, +30837,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMBLEMHEALTH/HIP-CHP, +30838,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMBLEMHEALTH/HIP-CHP, +30839,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMBLEMHEALTH/HIP-CHP, +30840,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMBLEMHEALTH/HIP-CHP, +30841,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMBLEMHEALTH/HIP-CHP, +30842,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMBLEMHEALTH/HIP-CHP, +30843,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMBLEMHEALTH/HIP-CHP, +30844,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMBLEMHEALTH/HIP-CHP, +30845,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMBLEMHEALTH/HIP-CHP, +30846,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMBLEMHEALTH/HIP-CHP, +30847,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMBLEMHEALTH/HIP-CHP, +30848,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMBLEMHEALTH/HIP-CHP, +30849,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMBLEMHEALTH/HIP-CHP, +30850,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMBLEMHEALTH/HIP-CHP, +30851,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-CHP, +30852,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMBLEMHEALTH/HIP-CHP, +30853,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMBLEMHEALTH/HIP-CHP, +30854,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMBLEMHEALTH/HIP-CHP, +30855,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMBLEMHEALTH/HIP-CHP, +30856,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMBLEMHEALTH/HIP-CHP, +30857,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMBLEMHEALTH/HIP-CHP, +30858,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMBLEMHEALTH/HIP-CHP, +30859,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMBLEMHEALTH/HIP-CHP, +30860,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMBLEMHEALTH/HIP-CHP, +30861,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMBLEMHEALTH/HIP-CHP, +30862,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMBLEMHEALTH/HIP-CHP, +30863,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMBLEMHEALTH/HIP-CHP, +30864,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMBLEMHEALTH/HIP-CHP, +30865,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMBLEMHEALTH/HIP-CHP, +30866,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMBLEMHEALTH/HIP-CHP, +30867,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMBLEMHEALTH/HIP-CHP, +30868,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMBLEMHEALTH/HIP-CHP, +30869,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMBLEMHEALTH/HIP-CHP, +30870,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMBLEMHEALTH/HIP-CHP, +30871,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMBLEMHEALTH/HIP-CHP, +30872,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMBLEMHEALTH/HIP-CHP, +30873,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMBLEMHEALTH/HIP-CHP, +30874,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMBLEMHEALTH/HIP-CHP, +30875,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMBLEMHEALTH/HIP-CHP, +30876,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMBLEMHEALTH/HIP-CHP, +30877,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMBLEMHEALTH/HIP-CHP, +30878,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMBLEMHEALTH/HIP-CHP, +30879,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMBLEMHEALTH/HIP-CHP, +30880,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMBLEMHEALTH/HIP-CHP, +30881,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMBLEMHEALTH/HIP-CHP, +30882,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMBLEMHEALTH/HIP-CHP, +30883,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMBLEMHEALTH/HIP-CHP, +30884,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMBLEMHEALTH/HIP-CHP, +30885,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMBLEMHEALTH/HIP-CHP, +30886,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMBLEMHEALTH/HIP-CHP, +30887,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMBLEMHEALTH/HIP-CHP, +30888,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMBLEMHEALTH/HIP-CHP, +30889,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMBLEMHEALTH/HIP-CHP, +30890,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMBLEMHEALTH/HIP-CHP, +30891,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMBLEMHEALTH/HIP-CHP, +30892,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMBLEMHEALTH/HIP-CHP, +30893,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMBLEMHEALTH/HIP-CHP, +30894,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMBLEMHEALTH/HIP-CHP, +30895,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMBLEMHEALTH/HIP-CHP, +30896,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMBLEMHEALTH/HIP-CHP, +30897,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMBLEMHEALTH/HIP-CHP, +30898,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMBLEMHEALTH/HIP-CHP, +30899,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMBLEMHEALTH/HIP-CHP, +30900,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMBLEMHEALTH/HIP-CHP, +30901,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMBLEMHEALTH/HIP-CHP, +30902,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMBLEMHEALTH/HIP-CHP, +30903,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMBLEMHEALTH/HIP-CHP, +30904,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMBLEMHEALTH/HIP-CHP, +30905,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMBLEMHEALTH/HIP-CHP, +30906,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMBLEMHEALTH/HIP-CHP, +30907,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMBLEMHEALTH/HIP-CHP, +30908,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMBLEMHEALTH/HIP-CHP, +30909,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMBLEMHEALTH/HIP-CHP, +30910,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMBLEMHEALTH/HIP-CHP, +30911,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMBLEMHEALTH/HIP-CHP, +30912,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMBLEMHEALTH/HIP-CHP, +30913,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMBLEMHEALTH/HIP-CHP, +30914,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMBLEMHEALTH/HIP-CHP, +30915,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMBLEMHEALTH/HIP-CHP, +30916,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMBLEMHEALTH/HIP-CHP, +30917,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMBLEMHEALTH/HIP-CHP, +30918,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMBLEMHEALTH/HIP-CHP, +30919,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMBLEMHEALTH/HIP-CHP, +30920,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMBLEMHEALTH/HIP-CHP, +30921,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMBLEMHEALTH/HIP-CHP, +30922,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMBLEMHEALTH/HIP-CHP, +30923,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMBLEMHEALTH/HIP-CHP, +30924,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMBLEMHEALTH/HIP-CHP, +30925,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMBLEMHEALTH/HIP-CHP, +30926,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMBLEMHEALTH/HIP-CHP, +30927,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMBLEMHEALTH/HIP-CHP, +30928,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMBLEMHEALTH/HIP-CHP, +30929,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMBLEMHEALTH/HIP-CHP, +30930,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMBLEMHEALTH/HIP-CHP, +30931,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMBLEMHEALTH/HIP-CHP, +30932,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMBLEMHEALTH/HIP-CHP, +30933,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMBLEMHEALTH/HIP-CHP, +30934,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMBLEMHEALTH/HIP-CHP, +30935,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMBLEMHEALTH/HIP-CHP, +30936,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMBLEMHEALTH/HIP-CHP, +30937,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMBLEMHEALTH/HIP-CHP, +30938,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMBLEMHEALTH/HIP-CHP, +30939,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-CHP, +30940,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-CHP, +30941,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMBLEMHEALTH/HIP-CHP, +30942,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMBLEMHEALTH/HIP-CHP, +30943,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMBLEMHEALTH/HIP-CHP, +30944,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMBLEMHEALTH/HIP-CHP, +30945,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMBLEMHEALTH/HIP-CHP, +30946,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMBLEMHEALTH/HIP-CHP, +30947,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMBLEMHEALTH/HIP-CHP, +30948,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMBLEMHEALTH/HIP-CHP, +30949,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMBLEMHEALTH/HIP-CHP, +30950,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMBLEMHEALTH/HIP-CHP, +30951,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMBLEMHEALTH/HIP-CHP, +30952,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMBLEMHEALTH/HIP-CHP, +30953,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMBLEMHEALTH/HIP-CHP, +30954,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMBLEMHEALTH/HIP-CHP, +30955,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMBLEMHEALTH/HIP-CHP, +30956,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMBLEMHEALTH/HIP-CHP, +30957,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMBLEMHEALTH/HIP-CHP, +30958,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMBLEMHEALTH/HIP-CHP, +30959,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMBLEMHEALTH/HIP-CHP, +30960,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMBLEMHEALTH/HIP-CHP, +30961,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMBLEMHEALTH/HIP-CHP, +30962,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMBLEMHEALTH/HIP-CHP, +30963,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMBLEMHEALTH/HIP-CHP, +30964,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMBLEMHEALTH/HIP-CHP, +30965,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMBLEMHEALTH/HIP-CHP, +30966,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMBLEMHEALTH/HIP-CHP, +30967,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMBLEMHEALTH/HIP-CHP, +30968,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMBLEMHEALTH/HIP-CHP, +30969,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMBLEMHEALTH/HIP-CHP, +30970,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMBLEMHEALTH/HIP-CHP, +30971,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMBLEMHEALTH/HIP-CHP, +30972,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMBLEMHEALTH/HIP-CHP, +30973,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMBLEMHEALTH/HIP-CHP, +30974,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMBLEMHEALTH/HIP-CHP, +30975,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMBLEMHEALTH/HIP-CHP, +30976,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMBLEMHEALTH/HIP-CHP, +30977,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMBLEMHEALTH/HIP-CHP, +30978,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMBLEMHEALTH/HIP-CHP, +30979,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMBLEMHEALTH/HIP-CHP, +30980,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMBLEMHEALTH/HIP-CHP, +30981,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMBLEMHEALTH/HIP-CHP, +30982,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMBLEMHEALTH/HIP-CHP, +30983,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMBLEMHEALTH/HIP-CHP, +30984,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMBLEMHEALTH/HIP-CHP, +30985,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMBLEMHEALTH/HIP-CHP, +30986,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMBLEMHEALTH/HIP-CHP, +30987,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMBLEMHEALTH/HIP-CHP, +30988,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMBLEMHEALTH/HIP-CHP, +30989,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMBLEMHEALTH/HIP-CHP, +30990,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMBLEMHEALTH/HIP-CHP, +30991,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMBLEMHEALTH/HIP-CHP, +30992,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMBLEMHEALTH/HIP-CHP, +30993,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMBLEMHEALTH/HIP-CHP, +30994,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMBLEMHEALTH/HIP-CHP, +30995,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMBLEMHEALTH/HIP-CHP, +30996,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMBLEMHEALTH/HIP-CHP, +30997,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMBLEMHEALTH/HIP-CHP, +30998,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMBLEMHEALTH/HIP-CHP, +30999,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMBLEMHEALTH/HIP-CHP, +31000,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMBLEMHEALTH/HIP-CHP, +31001,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMBLEMHEALTH/HIP-CHP, +31002,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMBLEMHEALTH/HIP-CHP, +31003,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMBLEMHEALTH/HIP-CHP, +31004,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMBLEMHEALTH/HIP-CHP, +31005,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMBLEMHEALTH/HIP-CHP, +31006,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMBLEMHEALTH/HIP-CHP, +31007,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMBLEMHEALTH/HIP-CHP, +31008,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMBLEMHEALTH/HIP-CHP, +31009,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMBLEMHEALTH/HIP-CHP, +31010,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMBLEMHEALTH/HIP-CHP, +31011,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMBLEMHEALTH/HIP-CHP, +31012,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMBLEMHEALTH/HIP-CHP, +31013,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMBLEMHEALTH/HIP-CHP, +31014,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMBLEMHEALTH/HIP-CHP, +31015,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMBLEMHEALTH/HIP-CHP, +31016,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMBLEMHEALTH/HIP-CHP, +31017,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMBLEMHEALTH/HIP-CHP, +31018,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMBLEMHEALTH/HIP-CHP, +31019,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMBLEMHEALTH/HIP-CHP, +31020,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMBLEMHEALTH/HIP-CHP, +31021,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMBLEMHEALTH/HIP-CHP, +31022,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMBLEMHEALTH/HIP-CHP, +31023,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMBLEMHEALTH/HIP-CHP, +31024,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMBLEMHEALTH/HIP-CHP, +31025,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMBLEMHEALTH/HIP-CHP, +31026,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMBLEMHEALTH/HIP-CHP, +31027,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMBLEMHEALTH/HIP-CHP, +31028,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMBLEMHEALTH/HIP-CHP, +31029,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMBLEMHEALTH/HIP-CHP, +31030,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMBLEMHEALTH/HIP-CHP, +31031,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMBLEMHEALTH/HIP-CHP, +31032,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMBLEMHEALTH/HIP-CHP, +31033,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMBLEMHEALTH/HIP-CHP, +31034,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMBLEMHEALTH/HIP-CHP, +31035,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMBLEMHEALTH/HIP-CHP, +31036,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMBLEMHEALTH/HIP-CHP, +31037,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMBLEMHEALTH/HIP-CHP, +31038,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMBLEMHEALTH/HIP-CHP, +31039,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMBLEMHEALTH/HIP-CHP, +31040,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMBLEMHEALTH/HIP-CHP, +31041,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMBLEMHEALTH/HIP-CHP, +31042,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMBLEMHEALTH/HIP-CHP, +31043,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMBLEMHEALTH/HIP-CHP, +31044,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMBLEMHEALTH/HIP-CHP, +31045,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMBLEMHEALTH/HIP-CHP, +31046,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMBLEMHEALTH/HIP-CHP, +31047,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMBLEMHEALTH/HIP-CHP, +31048,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMBLEMHEALTH/HIP-CHP, +31049,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMBLEMHEALTH/HIP-CHP, +31050,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMBLEMHEALTH/HIP-CHP, +31051,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMBLEMHEALTH/HIP-CHP, +31052,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMBLEMHEALTH/HIP-CHP, +31053,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMBLEMHEALTH/HIP-CHP, +31054,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMBLEMHEALTH/HIP-CHP, +31055,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMBLEMHEALTH/HIP-CHP, +31056,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMBLEMHEALTH/HIP-CHP, +31057,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMBLEMHEALTH/HIP-CHP, +31058,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMBLEMHEALTH/HIP-CHP, +31059,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMBLEMHEALTH/HIP-CHP, +31060,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMBLEMHEALTH/HIP-CHP, +31061,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMBLEMHEALTH/HIP-CHP, +31062,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMBLEMHEALTH/HIP-CHP, +31063,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMBLEMHEALTH/HIP-CHP, +31064,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMBLEMHEALTH/HIP-CHP, +31065,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMBLEMHEALTH/HIP-CHP, +31066,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMBLEMHEALTH/HIP-CHP, +31067,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMBLEMHEALTH/HIP-CHP, +31068,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMBLEMHEALTH/HIP-CHP, +31069,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMBLEMHEALTH/HIP-CHP, +31070,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMBLEMHEALTH/HIP-CHP, +31071,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMBLEMHEALTH/HIP-CHP, +31072,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMBLEMHEALTH/HIP-CHP, +31073,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMBLEMHEALTH/HIP-CHP, +31074,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMBLEMHEALTH/HIP-CHP, +31075,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMBLEMHEALTH/HIP-CHP, +31076,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMBLEMHEALTH/HIP-CHP, +31077,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMBLEMHEALTH/HIP-CHP, +31078,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMBLEMHEALTH/HIP-CHP, +31079,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMBLEMHEALTH/HIP-CHP, +31080,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMBLEMHEALTH/HIP-CHP, +31081,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMBLEMHEALTH/HIP-CHP, +31082,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMBLEMHEALTH/HIP-CHP, +31083,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMBLEMHEALTH/HIP-CHP, +31084,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMBLEMHEALTH/HIP-CHP, +31085,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMBLEMHEALTH/HIP-CHP, +31086,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMBLEMHEALTH/HIP-CHP, +31087,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMBLEMHEALTH/HIP-CHP, +31088,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMBLEMHEALTH/HIP-CHP, +31089,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMBLEMHEALTH/HIP-CHP, +31090,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMBLEMHEALTH/HIP-CHP, +31091,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMBLEMHEALTH/HIP-CHP, +31092,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMBLEMHEALTH/HIP-CHP, +31093,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMBLEMHEALTH/HIP-CHP, +31094,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMBLEMHEALTH/HIP-CHP, +31095,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMBLEMHEALTH/HIP-CHP, +31096,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMBLEMHEALTH/HIP-CHP, +31097,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMBLEMHEALTH/HIP-CHP, +31098,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMBLEMHEALTH/HIP-CHP, +31099,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMBLEMHEALTH/HIP-CHP, +31100,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMBLEMHEALTH/HIP-CHP, +31101,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMBLEMHEALTH/HIP-CHP, +31102,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMBLEMHEALTH/HIP-CHP, +31103,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMBLEMHEALTH/HIP-CHP, +31104,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMBLEMHEALTH/HIP-CHP, +31105,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMBLEMHEALTH/HIP-CHP, +31106,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMBLEMHEALTH/HIP-CHP, +31107,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMBLEMHEALTH/HIP-CHP, +31108,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMBLEMHEALTH/HIP-CHP, +31109,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMBLEMHEALTH/HIP-CHP, +31110,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMBLEMHEALTH/HIP-CHP, +31111,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMBLEMHEALTH/HIP-CHP, +31112,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMBLEMHEALTH/HIP-CHP, +31113,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMBLEMHEALTH/HIP-CHP, +31114,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMBLEMHEALTH/HIP-CHP, +31115,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMBLEMHEALTH/HIP-CHP, +31116,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMBLEMHEALTH/HIP-CHP, +31117,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMBLEMHEALTH/HIP-CHP, +31118,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMBLEMHEALTH/HIP-CHP, +31119,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMBLEMHEALTH/HIP-CHP, +31120,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMBLEMHEALTH/HIP-CHP, +31121,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMBLEMHEALTH/HIP-CHP, +31122,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMBLEMHEALTH/HIP-CHP, +31123,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMBLEMHEALTH/HIP-CHP, +31124,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMBLEMHEALTH/HIP-CHP, +31125,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMBLEMHEALTH/HIP-CHP, +31126,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMBLEMHEALTH/HIP-CHP, +31127,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMBLEMHEALTH/HIP-CHP, +31128,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMBLEMHEALTH/HIP-CHP, +31129,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMBLEMHEALTH/HIP-CHP, +31130,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMBLEMHEALTH/HIP-CHP, +31131,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMBLEMHEALTH/HIP-CHP, +31132,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMBLEMHEALTH/HIP-CHP, +31133,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMBLEMHEALTH/HIP-CHP, +31134,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMBLEMHEALTH/HIP-CHP, +31135,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMBLEMHEALTH/HIP-CHP, +31136,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMBLEMHEALTH/HIP-CHP, +31137,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMBLEMHEALTH/HIP-CHP, +31138,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMBLEMHEALTH/HIP-CHP, +31139,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMBLEMHEALTH/HIP-CHP, +31140,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMBLEMHEALTH/HIP-CHP, +31141,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMBLEMHEALTH/HIP-CHP, +31142,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMBLEMHEALTH/HIP-CHP, +31143,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMBLEMHEALTH/HIP-CHP, +31144,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMBLEMHEALTH/HIP-CHP, +31145,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMBLEMHEALTH/HIP-CHP, +31146,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMBLEMHEALTH/HIP-CHP, +31147,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMBLEMHEALTH/HIP-CHP, +31148,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMBLEMHEALTH/HIP-CHP, +31149,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMBLEMHEALTH/HIP-CHP, +31150,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMBLEMHEALTH/HIP-CHP, +31151,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMBLEMHEALTH/HIP-CHP, +31152,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMBLEMHEALTH/HIP-CHP, +31153,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMBLEMHEALTH/HIP-CHP, +31154,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMBLEMHEALTH/HIP-CHP, +31155,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMBLEMHEALTH/HIP-CHP, +31156,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMBLEMHEALTH/HIP-CHP, +31157,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMBLEMHEALTH/HIP-CHP, +31158,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMBLEMHEALTH/HIP-CHP, +31159,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMBLEMHEALTH/HIP-CHP, +31160,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMBLEMHEALTH/HIP-CHP, +31161,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMBLEMHEALTH/HIP-CHP, +31162,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMBLEMHEALTH/HIP-CHP, +31163,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMBLEMHEALTH/HIP-CHP, +31164,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMBLEMHEALTH/HIP-CHP, +31165,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMBLEMHEALTH/HIP-CHP, +31166,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMBLEMHEALTH/HIP-CHP, +31167,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMBLEMHEALTH/HIP-CHP, +31168,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMBLEMHEALTH/HIP-CHP, +31169,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMBLEMHEALTH/HIP-CHP, +31170,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMBLEMHEALTH/HIP-CHP, +31171,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMBLEMHEALTH/HIP-CHP, +31172,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMBLEMHEALTH/HIP-CHP, +31173,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMBLEMHEALTH/HIP-CHP, +31174,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMBLEMHEALTH/HIP-CHP, +31175,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMBLEMHEALTH/HIP-CHP, +31176,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMBLEMHEALTH/HIP-CHP, +31177,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMBLEMHEALTH/HIP-CHP, +31178,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMBLEMHEALTH/HIP-CHP, +31179,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMBLEMHEALTH/HIP-CHP, +31180,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMBLEMHEALTH/HIP-CHP, +31181,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMBLEMHEALTH/HIP-CHP, +31182,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMBLEMHEALTH/HIP-CHP, +31183,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMBLEMHEALTH/HIP-CHP, +31184,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMBLEMHEALTH/HIP-CHP, +31185,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMBLEMHEALTH/HIP-CHP, +31186,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMBLEMHEALTH/HIP-CHP, +31187,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMBLEMHEALTH/HIP-CHP, +31188,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMBLEMHEALTH/HIP-CHP, +31189,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMBLEMHEALTH/HIP-CHP, +31190,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMBLEMHEALTH/HIP-CHP, +31191,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMBLEMHEALTH/HIP-CHP, +31192,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMBLEMHEALTH/HIP-CHP, +31193,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMBLEMHEALTH/HIP-CHP, +31194,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMBLEMHEALTH/HIP-CHP, +31195,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMBLEMHEALTH/HIP-CHP, +31196,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMBLEMHEALTH/HIP-CHP, +31197,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMBLEMHEALTH/HIP-CHP, +31198,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMBLEMHEALTH/HIP-CHP, +31199,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMBLEMHEALTH/HIP-CHP, +31200,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMBLEMHEALTH/HIP-CHP, +31201,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMBLEMHEALTH/HIP-CHP, +31202,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMBLEMHEALTH/HIP-CHP, +31203,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMBLEMHEALTH/HIP-CHP, +31204,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMBLEMHEALTH/HIP-CHP, +31205,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMBLEMHEALTH/HIP-CHP, +31206,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMBLEMHEALTH/HIP-CHP, +31207,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMBLEMHEALTH/HIP-CHP, +31208,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMBLEMHEALTH/HIP-CHP, +31209,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMBLEMHEALTH/HIP-CHP, +31210,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMBLEMHEALTH/HIP-CHP, +31211,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMBLEMHEALTH/HIP-CHP, +31212,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMBLEMHEALTH/HIP-CHP, +31213,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMBLEMHEALTH/HIP-CHP, +31214,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMBLEMHEALTH/HIP-CHP, +31215,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMBLEMHEALTH/HIP-CHP, +31216,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMBLEMHEALTH/HIP-CHP, +31217,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMBLEMHEALTH/HIP-CHP, +31218,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMBLEMHEALTH/HIP-CHP, +31219,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMBLEMHEALTH/HIP-CHP, +31220,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMBLEMHEALTH/HIP-CHP, +31221,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMBLEMHEALTH/HIP-CHP, +31222,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMBLEMHEALTH/HIP-CHP, +31223,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMBLEMHEALTH/HIP-CHP, +31224,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMBLEMHEALTH/HIP-CHP, +31225,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMBLEMHEALTH/HIP-CHP, +31226,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMBLEMHEALTH/HIP-CHP, +31227,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMBLEMHEALTH/HIP-CHP, +31228,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMBLEMHEALTH/HIP-CHP, +31229,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMBLEMHEALTH/HIP-CHP, +31230,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMBLEMHEALTH/HIP-CHP, +31231,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMBLEMHEALTH/HIP-CHP, +31232,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMBLEMHEALTH/HIP-CHP, +31233,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMBLEMHEALTH/HIP-CHP, +31234,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMBLEMHEALTH/HIP-CHP, +31235,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMBLEMHEALTH/HIP-CHP, +31236,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMBLEMHEALTH/HIP-CHP, +31237,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMBLEMHEALTH/HIP-CHP, +31238,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMBLEMHEALTH/HIP-CHP, +31239,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMBLEMHEALTH/HIP-CHP, +31240,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMBLEMHEALTH/HIP-CHP, +31241,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMBLEMHEALTH/HIP-CHP, +31242,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMBLEMHEALTH/HIP-CHP, +31243,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMBLEMHEALTH/HIP-CHP, +31244,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMBLEMHEALTH/HIP-CHP, +31245,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMBLEMHEALTH/HIP-CHP, +31246,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMBLEMHEALTH/HIP-CHP, +31247,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMBLEMHEALTH/HIP-CHP, +31248,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMBLEMHEALTH/HIP-CHP, +31249,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMBLEMHEALTH/HIP-CHP, +31250,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMBLEMHEALTH/HIP-CHP, +31251,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMBLEMHEALTH/HIP-CHP, +31252,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMBLEMHEALTH/HIP-CHP, +31253,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMBLEMHEALTH/HIP-CHP, +31254,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMBLEMHEALTH/HIP-CHP, +31255,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMBLEMHEALTH/HIP-CHP, +31256,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMBLEMHEALTH/HIP-CHP, +31257,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMBLEMHEALTH/HIP-CHP, +31258,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMBLEMHEALTH/HIP-CHP, +31259,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMBLEMHEALTH/HIP-CHP, +31260,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMBLEMHEALTH/HIP-CHP, +31261,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMBLEMHEALTH/HIP-CHP, +31262,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMBLEMHEALTH/HIP-CHP, +31263,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMBLEMHEALTH/HIP-CHP, +31264,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMBLEMHEALTH/HIP-CHP, +31265,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMBLEMHEALTH/HIP-CHP, +31266,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMBLEMHEALTH/HIP-CHP, +31267,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMBLEMHEALTH/HIP-CHP, +31268,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMBLEMHEALTH/HIP-CHP, +31269,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMBLEMHEALTH/HIP-CHP, +31270,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMBLEMHEALTH/HIP-CHP, +31271,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMBLEMHEALTH/HIP-CHP, +31272,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMBLEMHEALTH/HIP-CHP, +31273,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMBLEMHEALTH/HIP-CHP, +31274,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMBLEMHEALTH/HIP-CHP, +31275,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMBLEMHEALTH/HIP-CHP, +31276,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMBLEMHEALTH/HIP-CHP, +31277,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMBLEMHEALTH/HIP-CHP, +31278,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMBLEMHEALTH/HIP-CHP, +31279,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMBLEMHEALTH/HIP-CHP, +31280,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMBLEMHEALTH/HIP-CHP, +31281,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMBLEMHEALTH/HIP-CHP, +31282,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMBLEMHEALTH/HIP-CHP, +31283,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMBLEMHEALTH/HIP-CHP, +31284,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMBLEMHEALTH/HIP-CHP, +31285,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMBLEMHEALTH/HIP-CHP, +31286,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMBLEMHEALTH/HIP-CHP, +31287,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMBLEMHEALTH/HIP-CHP, +31288,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMBLEMHEALTH/HIP-CHP, +31289,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMBLEMHEALTH/HIP-CHP, +31290,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMBLEMHEALTH/HIP-CHP, +31291,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMBLEMHEALTH/HIP-CHP, +31292,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMBLEMHEALTH/HIP-CHP, +31293,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMBLEMHEALTH/HIP-CHP, +31294,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMBLEMHEALTH/HIP-CHP, +31295,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMBLEMHEALTH/HIP-CHP, +31296,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMBLEMHEALTH/HIP-CHP, +31297,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMBLEMHEALTH/HIP-CHP, +31298,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMBLEMHEALTH/HIP-CHP, +31299,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMBLEMHEALTH/HIP-CHP, +31300,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMBLEMHEALTH/HIP-CHP, +31301,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMBLEMHEALTH/HIP-CHP, +31302,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMBLEMHEALTH/HIP-CHP, +31303,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMBLEMHEALTH/HIP-CHP, +31304,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMBLEMHEALTH/HIP-CHP, +31305,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMBLEMHEALTH/HIP-CHP, +31306,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMBLEMHEALTH/HIP-CHP, +31307,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMBLEMHEALTH/HIP-CHP, +31308,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMBLEMHEALTH/HIP-CHP, +31309,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMBLEMHEALTH/HIP-CHP, +31310,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMBLEMHEALTH/HIP-CHP, +31311,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMBLEMHEALTH/HIP-CHP, +31312,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMBLEMHEALTH/HIP-CHP, +31313,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMBLEMHEALTH/HIP-CHP, +31314,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMBLEMHEALTH/HIP-CHP, +31315,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMBLEMHEALTH/HIP-CHP, +31316,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMBLEMHEALTH/HIP-CHP, +31317,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMBLEMHEALTH/HIP-CHP, +31318,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMBLEMHEALTH/HIP-CHP, +31319,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMBLEMHEALTH/HIP-CHP, +31320,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMBLEMHEALTH/HIP-CHP, +31321,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMBLEMHEALTH/HIP-CHP, +31322,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMBLEMHEALTH/HIP-CHP, +31323,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMBLEMHEALTH/HIP-CHP, +31324,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMBLEMHEALTH/HIP-CHP, +31325,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMBLEMHEALTH/HIP-CHP, +31326,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMBLEMHEALTH/HIP-CHP, +31327,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMBLEMHEALTH/HIP-CHP, +31328,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMBLEMHEALTH/HIP-CHP, +31329,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMBLEMHEALTH/HIP-CHP, +31330,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMBLEMHEALTH/HIP-CHP, +31331,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMBLEMHEALTH/HIP-CHP, +31332,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMBLEMHEALTH/HIP-CHP, +31333,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMBLEMHEALTH/HIP-CHP, +31334,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMBLEMHEALTH/HIP-CHP, +31335,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMBLEMHEALTH/HIP-CHP, +31336,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMBLEMHEALTH/HIP-CHP, +31337,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMBLEMHEALTH/HIP-CHP, +31338,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMBLEMHEALTH/HIP-CHP, +31339,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMBLEMHEALTH/HIP-CHP, +31340,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMBLEMHEALTH/HIP-CHP, +31341,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMBLEMHEALTH/HIP-CHP, +31342,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMBLEMHEALTH/HIP-CHP, +31343,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMBLEMHEALTH/HIP-CHP, +31344,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMBLEMHEALTH/HIP-CHP, +31345,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMBLEMHEALTH/HIP-CHP, +31346,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMBLEMHEALTH/HIP-CHP, +31347,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMBLEMHEALTH/HIP-CHP, +31348,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMBLEMHEALTH/HIP-CHP, +31349,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMBLEMHEALTH/HIP-CHP, +31350,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMBLEMHEALTH/HIP-CHP, +31351,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMBLEMHEALTH/HIP-CHP, +31352,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMBLEMHEALTH/HIP-CHP, +31353,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMBLEMHEALTH/HIP-CHP, +31354,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMBLEMHEALTH/HIP-CHP, +31355,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMBLEMHEALTH/HIP-CHP, +31356,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMBLEMHEALTH/HIP-CHP, +31357,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMBLEMHEALTH/HIP-CHP, +31358,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMBLEMHEALTH/HIP-CHP, +31359,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMBLEMHEALTH/HIP-CHP, +31360,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMBLEMHEALTH/HIP-CHP, +31361,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMBLEMHEALTH/HIP-CHP, +31362,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMBLEMHEALTH/HIP-CHP, +31363,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMBLEMHEALTH/HIP-CHP, +31364,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMBLEMHEALTH/HIP-CHP, +31365,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMBLEMHEALTH/HIP-CHP, +31366,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMBLEMHEALTH/HIP-CHP, +31367,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMBLEMHEALTH/HIP-CHP, +31368,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMBLEMHEALTH/HIP-CHP, +31369,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMBLEMHEALTH/HIP-CHP, +31370,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMBLEMHEALTH/HIP-CHP, +31371,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMBLEMHEALTH/HIP-CHP, +31372,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMBLEMHEALTH/HIP-CHP, +31373,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMBLEMHEALTH/HIP-CHP, +31374,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMBLEMHEALTH/HIP-CHP, +31375,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMBLEMHEALTH/HIP-CHP, +31376,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMBLEMHEALTH/HIP-CHP, +31377,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMBLEMHEALTH/HIP-CHP, +31378,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMBLEMHEALTH/HIP-CHP, +31379,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMBLEMHEALTH/HIP-CHP, +31380,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMBLEMHEALTH/HIP-CHP, +31381,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMBLEMHEALTH/HIP-CHP, +31382,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMBLEMHEALTH/HIP-CHP, +31383,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMBLEMHEALTH/HIP-CHP, +31384,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMBLEMHEALTH/HIP-CHP, +31385,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMBLEMHEALTH/HIP-CHP, +31386,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMBLEMHEALTH/HIP-CHP, +31387,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMBLEMHEALTH/HIP-CHP, +31388,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMBLEMHEALTH/HIP-CHP, +31389,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMBLEMHEALTH/HIP-CHP, +31390,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMBLEMHEALTH/HIP-CHP, +31391,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMBLEMHEALTH/HIP-CHP, +31392,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMBLEMHEALTH/HIP-CHP, +31393,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMBLEMHEALTH/HIP-CHP, +31394,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMBLEMHEALTH/HIP-CHP, +31395,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMBLEMHEALTH/HIP-CHP, +31396,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMBLEMHEALTH/HIP-CHP, +31397,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMBLEMHEALTH/HIP-CHP, +31398,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMBLEMHEALTH/HIP-CHP, +31399,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMBLEMHEALTH/HIP-CHP, +31400,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMBLEMHEALTH/HIP-CHP, +31401,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMBLEMHEALTH/HIP-CHP, +31402,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMBLEMHEALTH/HIP-CHP, +31403,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMBLEMHEALTH/HIP-CHP, +31404,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMBLEMHEALTH/HIP-CHP, +31405,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMBLEMHEALTH/HIP-CHP, +31406,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMBLEMHEALTH/HIP-CHP, +31407,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMBLEMHEALTH/HIP-CHP, +31408,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMBLEMHEALTH/HIP-CHP, +31409,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMBLEMHEALTH/HIP-CHP, +31410,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMBLEMHEALTH/HIP-CHP, +31411,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMBLEMHEALTH/HIP-CHP, +31412,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMBLEMHEALTH/HIP-CHP, +31413,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMBLEMHEALTH/HIP-CHP, +31414,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMBLEMHEALTH/HIP-CHP, +31415,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMBLEMHEALTH/HIP-CHP, +31416,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMBLEMHEALTH/HIP-CHP, +31417,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMBLEMHEALTH/HIP-CHP, +31418,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMBLEMHEALTH/HIP-CHP, +31419,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMBLEMHEALTH/HIP-CHP, +31420,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMBLEMHEALTH/HIP-CHP, +31421,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMBLEMHEALTH/HIP-CHP, +31422,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMBLEMHEALTH/HIP-CHP, +31423,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMBLEMHEALTH/HIP-CHP, +31424,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMBLEMHEALTH/HIP-CHP, +31425,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMBLEMHEALTH/HIP-CHP, +31426,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMBLEMHEALTH/HIP-CHP, +31427,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMBLEMHEALTH/HIP-CHP, +31428,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMBLEMHEALTH/HIP-CHP, +31429,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMBLEMHEALTH/HIP-CHP, +31430,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMBLEMHEALTH/HIP-CHP, +31431,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMBLEMHEALTH/HIP-CHP, +31432,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMBLEMHEALTH/HIP-CHP, +31433,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMBLEMHEALTH/HIP-CHP, +31434,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMBLEMHEALTH/HIP-CHP, +31435,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMBLEMHEALTH/HIP-CHP, +31436,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMBLEMHEALTH/HIP-CHP, +31437,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMBLEMHEALTH/HIP-CHP, +31438,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMBLEMHEALTH/HIP-CHP, +31439,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMBLEMHEALTH/HIP-CHP, +31440,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMBLEMHEALTH/HIP-CHP, +31441,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMBLEMHEALTH/HIP-CHP, +31442,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMBLEMHEALTH/HIP-CHP, +31443,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMBLEMHEALTH/HIP-CHP, +31444,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMBLEMHEALTH/HIP-CHP, +31445,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMBLEMHEALTH/HIP-CHP, +31446,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMBLEMHEALTH/HIP-CHP, +31447,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMBLEMHEALTH/HIP-CHP, +31448,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMBLEMHEALTH/HIP-CHP, +31449,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMBLEMHEALTH/HIP-CHP, +31450,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMBLEMHEALTH/HIP-CHP, +31451,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMBLEMHEALTH/HIP-CHP, +31452,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMBLEMHEALTH/HIP-CHP, +31453,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMBLEMHEALTH/HIP-CHP, +31454,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMBLEMHEALTH/HIP-CHP, +31455,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMBLEMHEALTH/HIP-CHP, +31456,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMBLEMHEALTH/HIP-CHP, +31457,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMBLEMHEALTH/HIP-CHP, +31458,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMBLEMHEALTH/HIP-CHP, +31459,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMBLEMHEALTH/HIP-CHP, +31460,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMBLEMHEALTH/HIP-CHP, +31461,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMBLEMHEALTH/HIP-CHP, +31462,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMBLEMHEALTH/HIP-CHP, +31463,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMBLEMHEALTH/HIP-CHP, +31464,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMBLEMHEALTH/HIP-CHP, +31465,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMBLEMHEALTH/HIP-CHP, +31466,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMBLEMHEALTH/HIP-CHP, +31467,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMBLEMHEALTH/HIP-CHP, +31468,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMBLEMHEALTH/HIP-CHP, +31469,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMBLEMHEALTH/HIP-CHP, +31470,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMBLEMHEALTH/HIP-CHP, +31471,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMBLEMHEALTH/HIP-CHP, +31472,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMBLEMHEALTH/HIP-CHP, +31473,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMBLEMHEALTH/HIP-CHP, +31474,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMBLEMHEALTH/HIP-CHP, +31475,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMBLEMHEALTH/HIP-CHP, +31476,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMBLEMHEALTH/HIP-CHP, +31477,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMBLEMHEALTH/HIP-CHP, +31478,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMBLEMHEALTH/HIP-CHP, +31479,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMBLEMHEALTH/HIP-CHP, +31480,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMBLEMHEALTH/HIP-CHP, +31481,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMBLEMHEALTH/HIP-CHP, +31482,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMBLEMHEALTH/HIP-CHP, +31483,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMBLEMHEALTH/HIP-CHP, +31484,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMBLEMHEALTH/HIP-CHP, +31485,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMBLEMHEALTH/HIP-CHP, +31486,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMBLEMHEALTH/HIP-CHP, +31487,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMBLEMHEALTH/HIP-CHP, +31488,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMBLEMHEALTH/HIP-CHP, +31489,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMBLEMHEALTH/HIP-CHP, +31490,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMBLEMHEALTH/HIP-CHP, +31491,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMBLEMHEALTH/HIP-CHP, +31492,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMBLEMHEALTH/HIP-CHP, +31493,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMBLEMHEALTH/HIP-CHP, +31494,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMBLEMHEALTH/HIP-CHP, +31495,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMBLEMHEALTH/HIP-CHP, +31496,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMBLEMHEALTH/HIP-CHP, +31497,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMBLEMHEALTH/HIP-CHP, +31498,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMBLEMHEALTH/HIP-CHP, +31499,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMBLEMHEALTH/HIP-CHP, +31500,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMBLEMHEALTH/HIP-CHP, +31501,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMBLEMHEALTH/HIP-CHP, +31502,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMBLEMHEALTH/HIP-CHP, +31503,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMBLEMHEALTH/HIP-CHP, +31504,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMBLEMHEALTH/HIP-CHP, +31505,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMBLEMHEALTH/HIP-CHP, +31506,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMBLEMHEALTH/HIP-CHP, +31507,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMBLEMHEALTH/HIP-CHP, +31508,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMBLEMHEALTH/HIP-CHP, +31509,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMBLEMHEALTH/HIP-CHP, +31510,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMBLEMHEALTH/HIP-CHP, +31511,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMBLEMHEALTH/HIP-CHP, +31512,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMBLEMHEALTH/HIP-CHP, +31513,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMBLEMHEALTH/HIP-CHP, +31514,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMBLEMHEALTH/HIP-CHP, +31515,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMBLEMHEALTH/HIP-CHP, +31516,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMBLEMHEALTH/HIP-CHP, +31517,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMBLEMHEALTH/HIP-CHP, +31518,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMBLEMHEALTH/HIP-CHP, +31519,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMBLEMHEALTH/HIP-CHP, +31520,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMBLEMHEALTH/HIP-CHP, +31521,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMBLEMHEALTH/HIP-CHP, +31522,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMBLEMHEALTH/HIP-CHP, +31523,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMBLEMHEALTH/HIP-CHP, +31524,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMBLEMHEALTH/HIP-CHP, +31525,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMBLEMHEALTH/HIP-CHP, +31526,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMBLEMHEALTH/HIP-CHP, +31527,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMBLEMHEALTH/HIP-CHP, +31528,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMBLEMHEALTH/HIP-CHP, +31529,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMBLEMHEALTH/HIP-CHP, +31530,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMBLEMHEALTH/HIP-CHP, +31531,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMBLEMHEALTH/HIP-CHP, +31532,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMBLEMHEALTH/HIP-CHP, +31533,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMBLEMHEALTH/HIP-CHP, +31534,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMBLEMHEALTH/HIP-CHP, +31535,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMBLEMHEALTH/HIP-CHP, +31536,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMBLEMHEALTH/HIP-CHP, +31537,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMBLEMHEALTH/HIP-CHP, +31538,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMBLEMHEALTH/HIP-CHP, +31539,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMBLEMHEALTH/HIP-CHP, +31540,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMBLEMHEALTH/HIP-CHP, +31541,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMBLEMHEALTH/HIP-CHP, +31542,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMBLEMHEALTH/HIP-CHP, +31543,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMBLEMHEALTH/HIP-CHP, +31544,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMBLEMHEALTH/HIP-CHP, +31545,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMBLEMHEALTH/HIP-CHP, +31546,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMBLEMHEALTH/HIP-CHP, +31547,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMBLEMHEALTH/HIP-CHP, +31548,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMBLEMHEALTH/HIP-CHP, +31549,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMBLEMHEALTH/HIP-CHP, +31550,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMBLEMHEALTH/HIP-CHP, +31551,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMBLEMHEALTH/HIP-CHP, +31552,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMBLEMHEALTH/HIP-CHP, +31553,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMBLEMHEALTH/HIP-CHP, +31554,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMBLEMHEALTH/HIP-CHP, +31555,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMBLEMHEALTH/HIP-CHP, +31556,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMBLEMHEALTH/HIP-CHP, +31557,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMBLEMHEALTH/HIP-CHP, +31558,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMBLEMHEALTH/HIP-CHP, +31559,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMBLEMHEALTH/HIP-CHP, +31560,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMBLEMHEALTH/HIP-CHP, +31561,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMBLEMHEALTH/HIP-CHP, +31562,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMBLEMHEALTH/HIP-CHP, +31563,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMBLEMHEALTH/HIP-CHP, +31564,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMBLEMHEALTH/HIP-CHP, +31565,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMBLEMHEALTH/HIP-CHP, +31566,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMBLEMHEALTH/HIP-CHP, +31567,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMBLEMHEALTH/HIP-CHP, +31568,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMBLEMHEALTH/HIP-CHP, +31569,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMBLEMHEALTH/HIP-CHP, +31570,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMBLEMHEALTH/HIP-CHP, +31571,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMBLEMHEALTH/HIP-CHP, +31572,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMBLEMHEALTH/HIP-CHP, +31573,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMBLEMHEALTH/HIP-CHP, +31574,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMBLEMHEALTH/HIP-CHP, +31575,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMBLEMHEALTH/HIP-CHP, +31576,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMBLEMHEALTH/HIP-CHP, +31577,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMBLEMHEALTH/HIP-CHP, +31578,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMBLEMHEALTH/HIP-CHP, +31579,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMBLEMHEALTH/HIP-CHP, +31580,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMBLEMHEALTH/HIP-CHP, +31581,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMBLEMHEALTH/HIP-CHP, +31582,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMBLEMHEALTH/HIP-CHP, +31583,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMBLEMHEALTH/HIP-CHP, +31584,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMBLEMHEALTH/HIP-CHP, +31585,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMBLEMHEALTH/HIP-CHP, +31586,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMBLEMHEALTH/HIP-CHP, +31587,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMBLEMHEALTH/HIP-CHP, +31588,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMBLEMHEALTH/HIP-CHP, +31589,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMBLEMHEALTH/HIP-CHP, +31590,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMBLEMHEALTH/HIP-CHP, +31591,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMBLEMHEALTH/HIP-CHP, +31592,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMBLEMHEALTH/HIP-CHP, +31593,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMBLEMHEALTH/HIP-CHP, +31594,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMBLEMHEALTH/HIP-CHP, +31595,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMBLEMHEALTH/HIP-CHP, +31596,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMBLEMHEALTH/HIP-CHP, +31597,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMBLEMHEALTH/HIP-CHP, +31598,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMBLEMHEALTH/HIP-CHP, +31599,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMBLEMHEALTH/HIP-CHP, +31600,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMBLEMHEALTH/HIP-CHP, +31601,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMBLEMHEALTH/HIP-CHP, +31602,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMBLEMHEALTH/HIP-CHP, +31603,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMBLEMHEALTH/HIP-CHP, +31604,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMBLEMHEALTH/HIP-CHP, +31605,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMBLEMHEALTH/HIP-CHP, +31606,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMBLEMHEALTH/HIP-CHP, +31607,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMBLEMHEALTH/HIP-CHP, +31608,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMBLEMHEALTH/HIP-CHP, +31609,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMBLEMHEALTH/HIP-CHP, +31610,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMBLEMHEALTH/HIP-CHP, +31611,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMBLEMHEALTH/HIP-CHP, +31612,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMBLEMHEALTH/HIP-CHP, +31613,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMBLEMHEALTH/HIP-CHP, +31614,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMBLEMHEALTH/HIP-CHP, +31615,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMBLEMHEALTH/HIP-CHP, +31616,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMBLEMHEALTH/HIP-CHP, +31617,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMBLEMHEALTH/HIP-CHP, +31618,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMBLEMHEALTH/HIP-CHP, +31619,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMBLEMHEALTH/HIP-CHP, +31620,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMBLEMHEALTH/HIP-CHP, +31621,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMBLEMHEALTH/HIP-CHP, +31622,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMBLEMHEALTH/HIP-CHP, +31623,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMBLEMHEALTH/HIP-CHP, +31624,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMBLEMHEALTH/HIP-CHP, +31625,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMBLEMHEALTH/HIP-CHP, +31626,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMBLEMHEALTH/HIP-CHP, +31627,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMBLEMHEALTH/HIP-CHP, +31628,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMBLEMHEALTH/HIP-CHP, +31629,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMBLEMHEALTH/HIP-CHP, +31630,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMBLEMHEALTH/HIP-CHP, +31631,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMBLEMHEALTH/HIP-CHP, +31632,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMBLEMHEALTH/HIP-CHP, +31633,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMBLEMHEALTH/HIP-CHP, +31634,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMBLEMHEALTH/HIP-CHP, +31635,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMBLEMHEALTH/HIP-CHP, +31636,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMBLEMHEALTH/HIP-CHP, +31637,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMBLEMHEALTH/HIP-CHP, +31638,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMBLEMHEALTH/HIP-CHP, +31639,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMBLEMHEALTH/HIP-CHP, +31640,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMBLEMHEALTH/HIP-CHP, +31641,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMBLEMHEALTH/HIP-CHP, +31642,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMBLEMHEALTH/HIP-CHP, +31643,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMBLEMHEALTH/HIP-CHP, +31644,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMBLEMHEALTH/HIP-CHP, +31645,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMBLEMHEALTH/HIP-CHP, +31646,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMBLEMHEALTH/HIP-CHP, +31647,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMBLEMHEALTH/HIP-CHP, +31648,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMBLEMHEALTH/HIP-CHP, +31649,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMBLEMHEALTH/HIP-CHP, +31650,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMBLEMHEALTH/HIP-CHP, +31651,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMBLEMHEALTH/HIP-CHP, +31652,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMBLEMHEALTH/HIP-CHP, +31653,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMBLEMHEALTH/HIP-CHP, +31654,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMBLEMHEALTH/HIP-CHP, +31655,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMBLEMHEALTH/HIP-CHP, +31656,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMBLEMHEALTH/HIP-CHP, +31657,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMBLEMHEALTH/HIP-CHP, +31658,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMBLEMHEALTH/HIP-CHP, +31659,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMBLEMHEALTH/HIP-CHP, +31660,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMBLEMHEALTH/HIP-CHP, +31661,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMBLEMHEALTH/HIP-CHP, +31662,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMBLEMHEALTH/HIP-CHP, +31663,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMBLEMHEALTH/HIP-CHP, +31664,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMBLEMHEALTH/HIP-CHP, +31665,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMBLEMHEALTH/HIP-CHP, +31666,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMBLEMHEALTH/HIP-CHP, +31667,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMBLEMHEALTH/HIP-CHP, +31668,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMBLEMHEALTH/HIP-CHP, +31669,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMBLEMHEALTH/HIP-CHP, +31670,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMBLEMHEALTH/HIP-CHP, +31671,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMBLEMHEALTH/HIP-CHP, +31672,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMBLEMHEALTH/HIP-CHP, +31673,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMBLEMHEALTH/HIP-CHP, +31674,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMBLEMHEALTH/HIP-CHP, +31675,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMBLEMHEALTH/HIP-CHP, +31676,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMBLEMHEALTH/HIP-CHP, +31677,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMBLEMHEALTH/HIP-CHP, +31678,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMBLEMHEALTH/HIP-CHP, +31679,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMBLEMHEALTH/HIP-CHP, +31680,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMBLEMHEALTH/HIP-CHP, +31681,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMBLEMHEALTH/HIP-CHP, +31682,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMBLEMHEALTH/HIP-CHP, +31683,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMBLEMHEALTH/HIP-CHP, +31684,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMBLEMHEALTH/HIP-CHP, +31685,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMBLEMHEALTH/HIP-CHP, +31686,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMBLEMHEALTH/HIP-CHP, +31687,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMBLEMHEALTH/HIP-CHP, +31688,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMBLEMHEALTH/HIP-CHP, +31689,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMBLEMHEALTH/HIP-CHP, +31690,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMBLEMHEALTH/HIP-CHP, +31691,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMBLEMHEALTH/HIP-CHP, +31692,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMBLEMHEALTH/HIP-CHP, +31693,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMBLEMHEALTH/HIP-CHP, +31694,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMBLEMHEALTH/HIP-CHP, +31695,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMBLEMHEALTH/HIP-CHP, +31696,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMBLEMHEALTH/HIP-CHP, +31697,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMBLEMHEALTH/HIP-CHP, +31698,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMBLEMHEALTH/HIP-CHP, +31699,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMBLEMHEALTH/HIP-CHP, +31700,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMBLEMHEALTH/HIP-CHP, +31701,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMBLEMHEALTH/HIP-CHP, +31702,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMBLEMHEALTH/HIP-CHP, +31703,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMBLEMHEALTH/HIP-CHP, +31704,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMBLEMHEALTH/HIP-CHP, +31705,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMBLEMHEALTH/HIP-CHP, +31706,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMBLEMHEALTH/HIP-CHP, +31707,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMBLEMHEALTH/HIP-CHP, +31708,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMBLEMHEALTH/HIP-CHP, +31709,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMBLEMHEALTH/HIP-CHP, +31710,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMBLEMHEALTH/HIP-CHP, +31711,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMBLEMHEALTH/HIP-CHP, +31712,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMBLEMHEALTH/HIP-CHP, +31713,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMBLEMHEALTH/HIP-CHP, +31714,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMBLEMHEALTH/HIP-CHP, +31715,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMBLEMHEALTH/HIP-CHP, +31716,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMBLEMHEALTH/HIP-CHP, +31717,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMBLEMHEALTH/HIP-CHP, +31718,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMBLEMHEALTH/HIP-CHP, +31719,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMBLEMHEALTH/HIP-CHP, +31720,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMBLEMHEALTH/HIP-CHP, +31721,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMBLEMHEALTH/HIP-CHP, +31722,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMBLEMHEALTH/HIP-CHP, +31723,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMBLEMHEALTH/HIP-CHP, +31724,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMBLEMHEALTH/HIP-CHP, +31725,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMBLEMHEALTH/HIP-CHP, +31726,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMBLEMHEALTH/HIP-CHP, +31727,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMBLEMHEALTH/HIP-CHP, +31728,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMBLEMHEALTH/HIP-CHP, +31729,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMBLEMHEALTH/HIP-CHP, +31730,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMBLEMHEALTH/HIP-CHP, +31731,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMBLEMHEALTH/HIP-CHP, +31732,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMBLEMHEALTH/HIP-CHP, +31733,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMBLEMHEALTH/HIP-CHP, +31734,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMBLEMHEALTH/HIP-CHP, +31735,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMBLEMHEALTH/HIP-CHP, +31736,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMBLEMHEALTH/HIP-CHP, +31737,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMBLEMHEALTH/HIP-CHP, +31738,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMBLEMHEALTH/HIP-CHP, +31739,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMBLEMHEALTH/HIP-CHP, +31740,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMBLEMHEALTH/HIP-CHP, +31741,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMBLEMHEALTH/HIP-CHP, +31742,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMBLEMHEALTH/HIP-CHP, +31743,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMBLEMHEALTH/HIP-CHP, +31744,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMBLEMHEALTH/HIP-CHP, +31745,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMBLEMHEALTH/HIP-CHP, +31746,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMBLEMHEALTH/HIP-CHP, +31747,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMBLEMHEALTH/HIP-CHP, +31748,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMBLEMHEALTH/HIP-CHP, +31749,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMBLEMHEALTH/HIP-CHP, +31750,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMBLEMHEALTH/HIP-CHP, +31751,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMBLEMHEALTH/HIP-CHP, +31752,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMBLEMHEALTH/HIP-CHP, +31753,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMBLEMHEALTH/HIP-CHP, +31754,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMBLEMHEALTH/HIP-CHP, +31755,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMBLEMHEALTH/HIP-CHP, +31756,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMBLEMHEALTH/HIP-CHP, +31757,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMBLEMHEALTH/HIP-CHP, +31758,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMBLEMHEALTH/HIP-CHP, +31759,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMBLEMHEALTH/HIP-CHP, +31760,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMBLEMHEALTH/HIP-CHP, +31761,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMBLEMHEALTH/HIP-CHP, +31762,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMBLEMHEALTH/HIP-CHP, +31763,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMBLEMHEALTH/HIP-CHP, +31764,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMBLEMHEALTH/HIP-CHP, +31765,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMBLEMHEALTH/HIP-CHP, +31766,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMBLEMHEALTH/HIP-CHP, +31767,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMBLEMHEALTH/HIP-CHP, +31768,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMBLEMHEALTH/HIP-CHP, +31769,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMBLEMHEALTH/HIP-CHP, +31770,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMBLEMHEALTH/HIP-CHP, +31771,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMBLEMHEALTH/HIP-CHP, +31772,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMBLEMHEALTH/HIP-CHP, +31773,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMBLEMHEALTH/HIP-CHP, +31774,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMBLEMHEALTH/HIP-CHP, +31775,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMBLEMHEALTH/HIP-CHP, +31776,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMBLEMHEALTH/HIP-CHP, +31777,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMBLEMHEALTH/HIP-CHP, +31778,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMBLEMHEALTH/HIP-CHP, +31779,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMBLEMHEALTH/HIP-CHP, +31780,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMBLEMHEALTH/HIP-CHP, +31781,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMBLEMHEALTH/HIP-CHP, +31782,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMBLEMHEALTH/HIP-CHP, +31783,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMBLEMHEALTH/HIP-CHP, +31784,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMBLEMHEALTH/HIP-CHP, +31785,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMBLEMHEALTH/HIP-CHP, +31786,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMBLEMHEALTH/HIP-CHP, +31787,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMBLEMHEALTH/HIP-CHP, +31788,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMBLEMHEALTH/HIP-CHP, +31789,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMBLEMHEALTH/HIP-CHP, +31790,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMBLEMHEALTH/HIP-CHP, +31791,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMBLEMHEALTH/HIP-CHP, +31792,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMBLEMHEALTH/HIP-CHP, +31793,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMBLEMHEALTH/HIP-CHP, +31794,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMBLEMHEALTH/HIP-CHP, +31795,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMBLEMHEALTH/HIP-CHP, +31796,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMBLEMHEALTH/HIP-CHP, +31797,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMBLEMHEALTH/HIP-CHP, +31798,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMBLEMHEALTH/HIP-CHP, +31799,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMBLEMHEALTH/HIP-CHP, +31800,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMBLEMHEALTH/HIP-CHP, +31801,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMBLEMHEALTH/HIP-CHP, +31802,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMBLEMHEALTH/HIP-CHP, +31803,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMBLEMHEALTH/HIP-CHP, +31804,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMBLEMHEALTH/HIP-CHP, +31805,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMBLEMHEALTH/HIP-CHP, +31806,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMBLEMHEALTH/HIP-CHP, +31807,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMBLEMHEALTH/HIP-CHP, +31808,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMBLEMHEALTH/HIP-CHP, +31809,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMBLEMHEALTH/HIP-CHP, +31810,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMBLEMHEALTH/HIP-CHP, +31811,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMBLEMHEALTH/HIP-CHP, +31812,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMBLEMHEALTH/HIP-CHP, +31813,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMBLEMHEALTH/HIP-CHP, +31814,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMBLEMHEALTH/HIP-CHP, +31815,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMBLEMHEALTH/HIP-CHP, +31816,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMBLEMHEALTH/HIP-CHP, +31817,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMBLEMHEALTH/HIP-CHP, +31818,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMBLEMHEALTH/HIP-CHP, +31819,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMBLEMHEALTH/HIP-CHP, +31820,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMBLEMHEALTH/HIP-CHP, +31821,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMBLEMHEALTH/HIP-CHP, +31822,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMBLEMHEALTH/HIP-CHP, +31823,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMBLEMHEALTH/HIP-CHP, +31824,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMBLEMHEALTH/HIP-CHP, +31825,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMBLEMHEALTH/HIP-CHP, +31826,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMBLEMHEALTH/HIP-CHP, +31827,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMBLEMHEALTH/HIP-CHP, +31828,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMBLEMHEALTH/HIP-CHP, +31829,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMBLEMHEALTH/HIP-CHP, +31830,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMBLEMHEALTH/HIP-CHP, +31831,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMBLEMHEALTH/HIP-CHP, +31832,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMBLEMHEALTH/HIP-CHP, +31833,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMBLEMHEALTH/HIP-CHP, +31834,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMBLEMHEALTH/HIP-CHP, +31835,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMBLEMHEALTH/HIP-CHP, +31836,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMBLEMHEALTH/HIP-CHP, +31837,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMBLEMHEALTH/HIP-CHP, +31838,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMBLEMHEALTH/HIP-CHP, +31839,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMBLEMHEALTH/HIP-CHP, +31840,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMBLEMHEALTH/HIP-CHP, +31841,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMBLEMHEALTH/HIP-CHP, +31842,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMBLEMHEALTH/HIP-CHP, +31843,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMBLEMHEALTH/HIP-CHP, +31844,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMBLEMHEALTH/HIP-CHP, +31845,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMBLEMHEALTH/HIP-CHP, +31846,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMBLEMHEALTH/HIP-CHP, +31847,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMBLEMHEALTH/HIP-CHP, +31848,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMBLEMHEALTH/HIP-CHP, +31849,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMBLEMHEALTH/HIP-CHP, +31850,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMBLEMHEALTH/HIP-CHP, +31851,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMBLEMHEALTH/HIP-CHP, +31852,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMBLEMHEALTH/HIP-CHP, +31853,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMBLEMHEALTH/HIP-CHP, +31854,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMBLEMHEALTH/HIP-CHP, +31855,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMBLEMHEALTH/HIP-CHP, +31856,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMBLEMHEALTH/HIP-CHP, +31857,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMBLEMHEALTH/HIP-CHP, +31858,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMBLEMHEALTH/HIP-CHP, +31859,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMBLEMHEALTH/HIP-CHP, +31860,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMBLEMHEALTH/HIP-CHP, +31861,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMBLEMHEALTH/HIP-CHP, +31862,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMBLEMHEALTH/HIP-CHP, +31863,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMBLEMHEALTH/HIP-CHP, +31864,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMBLEMHEALTH/HIP-CHP, +31865,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMBLEMHEALTH/HIP-CHP, +31866,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMBLEMHEALTH/HIP-CHP, +31867,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMBLEMHEALTH/HIP-CHP, +31868,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMBLEMHEALTH/HIP-CHP, +31869,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMBLEMHEALTH/HIP-CHP, +31870,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMBLEMHEALTH/HIP-CHP, +31871,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMBLEMHEALTH/HIP-CHP, +31872,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMBLEMHEALTH/HIP-CHP, +31873,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMBLEMHEALTH/HIP-CHP, +31874,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMBLEMHEALTH/HIP-CHP, +31875,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMBLEMHEALTH/HIP-CHP, +31876,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMBLEMHEALTH/HIP-CHP, +31877,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMBLEMHEALTH/HIP-CHP, +31878,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMBLEMHEALTH/HIP-CHP, +31879,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMBLEMHEALTH/HIP-CHP, +31880,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMBLEMHEALTH/HIP-CHP, +31881,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMBLEMHEALTH/HIP-CHP, +31882,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMBLEMHEALTH/HIP-CHP, +31883,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMBLEMHEALTH/HIP-CHP, +31884,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMBLEMHEALTH/HIP-CHP, +31885,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMBLEMHEALTH/HIP-CHP, +31886,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMBLEMHEALTH/HIP-CHP, +31887,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMBLEMHEALTH/HIP-CHP, +31888,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMBLEMHEALTH/HIP-CHP, +31889,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMBLEMHEALTH/HIP-CHP, +31890,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMBLEMHEALTH/HIP-CHP, +31891,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMBLEMHEALTH/HIP-CHP, +31892,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMBLEMHEALTH/HIP-CHP, +31893,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMBLEMHEALTH/HIP-CHP, +31894,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMBLEMHEALTH/HIP-CHP, +31895,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMBLEMHEALTH/HIP-CHP, +31896,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMBLEMHEALTH/HIP-CHP, +31897,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMBLEMHEALTH/HIP-CHP, +31898,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMBLEMHEALTH/HIP-CHP, +31899,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMBLEMHEALTH/HIP-CHP, +31900,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMBLEMHEALTH/HIP-CHP, +31901,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMBLEMHEALTH/HIP-CHP, +31902,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMBLEMHEALTH/HIP-CHP, +31903,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMBLEMHEALTH/HIP-CHP, +31904,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMBLEMHEALTH/HIP-CHP, +31905,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMBLEMHEALTH/HIP-CHP, +31906,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMBLEMHEALTH/HIP-CHP, +31907,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMBLEMHEALTH/HIP-CHP, +31908,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMBLEMHEALTH/HIP-CHP, +31909,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMBLEMHEALTH/HIP-CHP, +31910,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMBLEMHEALTH/HIP-CHP, +31911,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMBLEMHEALTH/HIP-CHP, +31912,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMBLEMHEALTH/HIP-CHP, +31913,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMBLEMHEALTH/HIP-CHP, +31914,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMBLEMHEALTH/HIP-CHP, +31915,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMBLEMHEALTH/HIP-CHP, +31916,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMBLEMHEALTH/HIP-CHP, +31917,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMBLEMHEALTH/HIP-CHP, +31918,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMBLEMHEALTH/HIP-CHP, +31919,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMBLEMHEALTH/HIP-CHP, +31920,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMBLEMHEALTH/HIP-CHP, +31921,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMBLEMHEALTH/HIP-CHP, +31922,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMBLEMHEALTH/HIP-CHP, +31923,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMBLEMHEALTH/HIP-CHP, +31924,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMBLEMHEALTH/HIP-CHP, +31925,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMBLEMHEALTH/HIP-CHP, +31926,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMBLEMHEALTH/HIP-CHP, +31927,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMBLEMHEALTH/HIP-CHP, +31928,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMBLEMHEALTH/HIP-CHP, +31929,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMBLEMHEALTH/HIP-CHP, +31930,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMBLEMHEALTH/HIP-CHP, +31931,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMBLEMHEALTH/HIP-CHP, +31932,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMBLEMHEALTH/HIP-CHP, +31933,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMBLEMHEALTH/HIP-CHP, +31934,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31935,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31936,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31937,3934,30000038,ICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31938,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31939,3934,30000053,NICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31940,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31941,3934,30000079,PSYCH,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31942,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +31943,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31944,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31945,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31946,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31947,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31948,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31949,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31950,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31951,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31952,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31953,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31954,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31955,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31956,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31957,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31958,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31959,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31960,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31961,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31962,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31963,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31964,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31965,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31966,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31967,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31968,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31969,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31970,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31971,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31972,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31973,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31974,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31975,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31976,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31977,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31978,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31979,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31980,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31981,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31982,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31983,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31984,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31985,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31986,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31987,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31988,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +31989,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31990,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31991,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31992,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31993,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31994,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +31995,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31996,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31997,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +31998,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +31999,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32000,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32001,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32002,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32003,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32004,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32005,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32006,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32007,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32008,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32009,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32010,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32011,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32012,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32013,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32014,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32015,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32016,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32017,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32018,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32019,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32020,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32021,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32022,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32023,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32024,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32025,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32026,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32027,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32028,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32029,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32030,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32031,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32032,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32033,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32034,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32035,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32036,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32037,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32038,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32039,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32040,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32041,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32042,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32043,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32044,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32045,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32046,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32047,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32048,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32049,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32050,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32051,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32052,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32053,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32054,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32055,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32056,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32057,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32058,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32059,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32060,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32061,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32062,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32063,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32064,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32065,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32066,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32067,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32068,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32069,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32070,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32071,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32072,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32073,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32074,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32075,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32076,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32077,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32078,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32079,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32080,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32081,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32082,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32083,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32084,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32085,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32086,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32087,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32088,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32089,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32090,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32091,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32092,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32093,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32094,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32095,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32096,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32097,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32098,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32099,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32100,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32101,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32102,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32103,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32104,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32105,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32106,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32107,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32108,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32109,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32110,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32111,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32112,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32113,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32114,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32115,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32116,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32117,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32118,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32119,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32120,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32121,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32122,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32123,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32124,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32125,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32126,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32127,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32128,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32129,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32130,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32131,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32132,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32133,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32134,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32135,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32136,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32137,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32138,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32139,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32140,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32141,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32142,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32143,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32144,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32145,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32146,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32147,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32148,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32149,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32150,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32151,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32152,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32153,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32154,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32155,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32156,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32157,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32158,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32159,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32160,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32161,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32162,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32163,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32164,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32165,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32166,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32167,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32168,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32169,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32170,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32171,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32172,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32173,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32174,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32175,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32176,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32177,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32178,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32179,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32180,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32181,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32182,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32183,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32184,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32185,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32186,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32187,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32188,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32189,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32190,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32191,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32192,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32193,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32194,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32195,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32196,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32197,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32198,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32199,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32200,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32201,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32202,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32203,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32204,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32205,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32206,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32207,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32208,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32209,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32210,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32211,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32212,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32213,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32214,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32215,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32216,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32217,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32218,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32219,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32220,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32221,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32222,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32223,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32224,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32225,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32226,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32227,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32228,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32229,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32230,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32231,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32232,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32233,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32234,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32235,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32236,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32237,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32238,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32239,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32240,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32241,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32242,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32243,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32244,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32245,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32246,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32247,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32248,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32249,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32250,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32251,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32252,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32253,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32254,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32255,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32256,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32257,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32258,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32259,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32260,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32261,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32262,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32263,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32264,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32265,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32266,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32267,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32268,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32269,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32270,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32271,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32272,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32273,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32274,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32275,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32276,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32277,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32278,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32279,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32280,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32281,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32282,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32283,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32284,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32285,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32286,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32287,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32288,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32289,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32290,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32291,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32292,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32293,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32294,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32295,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32296,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32297,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32298,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32299,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32300,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32301,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32302,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32303,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32304,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32305,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32306,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32307,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32308,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32309,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32310,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32311,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32312,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32313,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32314,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32315,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32316,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32317,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32318,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32319,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32320,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32321,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32322,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32323,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32324,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32325,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32326,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32327,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32328,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32329,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32330,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32331,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32332,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32333,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32334,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32335,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32336,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32337,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32338,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32339,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32340,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32341,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32342,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32343,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32344,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32345,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32346,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32347,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32348,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32349,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32350,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32351,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32352,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-CHP, +32353,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32354,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32355,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32356,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32357,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32358,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32359,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-CHP, +32360,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32361,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32362,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32363,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32364,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32365,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32366,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32367,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32368,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32369,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32370,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32371,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32372,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32373,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32374,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32375,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32376,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32377,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-CHP, +32378,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-CHP, +32379,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-CHP, +32380,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMBLEMHEALTH/HIP-CHP, +32381,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMBLEMHEALTH/HIP-CHP, +32382,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMBLEMHEALTH/HIP-CHP, +32383,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMBLEMHEALTH/HIP-CHP, +32384,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32385,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32386,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32387,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32388,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32389,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32390,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32391,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32392,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32393,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32394,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32395,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32396,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMBLEMHEALTH/HIP-CHP, +32397,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMBLEMHEALTH/HIP-CHP, +32398,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMBLEMHEALTH/HIP-CHP, +32399,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMBLEMHEALTH/HIP-CHP, +32400,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMBLEMHEALTH/HIP-CHP, +32401,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMBLEMHEALTH/HIP-CHP, +32402,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMBLEMHEALTH/HIP-CHP, +32403,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMBLEMHEALTH/HIP-CHP, +32404,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMBLEMHEALTH/HIP-CHP, +32405,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMBLEMHEALTH/HIP-CHP, +32406,3934,37112034,TRIAGE,,277.0,277.0,,,EMBLEMHEALTH/HIP-CHP, +32407,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMBLEMHEALTH/HIP-CHP, +32408,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMBLEMHEALTH/HIP-CHP, +32409,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMBLEMHEALTH/HIP-CHP, +32410,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMBLEMHEALTH/HIP-CHP, +32411,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMBLEMHEALTH/HIP-CHP, +32412,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-CHP, +32413,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-CHP, +32414,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-CHP, +32415,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-CHP, +32416,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMBLEMHEALTH/HIP-CHP, +32417,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMBLEMHEALTH/HIP-CHP, +32418,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMBLEMHEALTH/HIP-CHP, +32419,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMBLEMHEALTH/HIP-CHP, +32420,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMBLEMHEALTH/HIP-CHP, +32421,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMBLEMHEALTH/HIP-CHP, +32422,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-CHP, +32423,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMBLEMHEALTH/HIP-CHP, +32424,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMBLEMHEALTH/HIP-CHP, +32425,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMBLEMHEALTH/HIP-CHP, +32426,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMBLEMHEALTH/HIP-CHP, +32427,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMBLEMHEALTH/HIP-CHP, +32428,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMBLEMHEALTH/HIP-CHP, +32429,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMBLEMHEALTH/HIP-CHP, +32430,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMBLEMHEALTH/HIP-CHP, +32431,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMBLEMHEALTH/HIP-CHP, +32432,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMBLEMHEALTH/HIP-CHP, +32433,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMBLEMHEALTH/HIP-CHP, +32434,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMBLEMHEALTH/HIP-CHP, +32435,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMBLEMHEALTH/HIP-CHP, +32436,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMBLEMHEALTH/HIP-CHP, +32437,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMBLEMHEALTH/HIP-CHP, +32438,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMBLEMHEALTH/HIP-CHP, +32439,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,EMBLEMHEALTH/HIP-CHP, +32440,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,EMBLEMHEALTH/HIP-CHP, +32441,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,EMBLEMHEALTH/HIP-CHP, +32442,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,EMBLEMHEALTH/HIP-CHP, +32443,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,EMBLEMHEALTH/HIP-CHP, +32444,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,EMBLEMHEALTH/HIP-CHP, +32445,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-CHP, +32446,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,EMBLEMHEALTH/HIP-CHP, +32447,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-CHP, +32448,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-CHP, +32449,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-CHP, +32450,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMBLEMHEALTH/HIP-CHP, +32451,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMBLEMHEALTH/HIP-CHP, +32452,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMBLEMHEALTH/HIP-CHP, +32453,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMBLEMHEALTH/HIP-CHP, +32454,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMBLEMHEALTH/HIP-CHP, +32455,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMBLEMHEALTH/HIP-CHP, +32456,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMBLEMHEALTH/HIP-CHP, +32457,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMBLEMHEALTH/HIP-CHP, +32458,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMBLEMHEALTH/HIP-CHP, +32459,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMBLEMHEALTH/HIP-CHP, +32460,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMBLEMHEALTH/HIP-CHP, +32461,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMBLEMHEALTH/HIP-CHP, +32462,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMBLEMHEALTH/HIP-CHP, +32463,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMBLEMHEALTH/HIP-CHP, +32464,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-CHP, +32465,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-CHP, +32466,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-CHP, +32467,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-CHP, +32468,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-CHP, +32469,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-CHP, +32470,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-CHP, +32471,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-CHP, +32472,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-CHP, +32473,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-CHP, +32474,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-CHP, +32475,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-CHP, +32476,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-CHP, +32477,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-CHP, +32478,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-CHP, +32479,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-CHP, +32480,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-CHP, +32481,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-CHP, +32482,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-CHP, +32483,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-CHP, +32484,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-CHP, +32485,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-CHP, +32486,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-CHP, +32487,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-CHP, +32488,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-CHP, +32489,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-CHP, +32490,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-CHP, +32491,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-CHP, +32492,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-CHP, +32493,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-CHP, +32494,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-CHP, +32495,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-CHP, +32496,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-CHP, +32497,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-CHP, +32498,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-CHP, +32499,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-CHP, +32500,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-CHP, +32501,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-CHP, +32502,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-CHP, +32503,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-CHP, +32504,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-CHP, +32505,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-CHP, +32506,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-CHP, +32507,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32508,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32509,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32510,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32511,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32512,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-CHP, +32513,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMBLEMHEALTH/HIP-CHP, +32514,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMBLEMHEALTH/HIP-CHP, +32515,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32516,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32517,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32518,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMBLEMHEALTH/HIP-CHP, +32519,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMBLEMHEALTH/HIP-CHP, +32520,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMBLEMHEALTH/HIP-CHP, +32521,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMBLEMHEALTH/HIP-CHP, +32522,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMBLEMHEALTH/HIP-CHP, +32523,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMBLEMHEALTH/HIP-CHP, +32524,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMBLEMHEALTH/HIP-CHP, +32525,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMBLEMHEALTH/HIP-CHP, +32526,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMBLEMHEALTH/HIP-CHP, +32527,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMBLEMHEALTH/HIP-CHP, +32528,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMBLEMHEALTH/HIP-CHP, +32529,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMBLEMHEALTH/HIP-CHP, +32530,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMBLEMHEALTH/HIP-CHP, +32531,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMBLEMHEALTH/HIP-CHP, +32532,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMBLEMHEALTH/HIP-CHP, +32533,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMBLEMHEALTH/HIP-CHP, +32534,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMBLEMHEALTH/HIP-CHP, +32535,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMBLEMHEALTH/HIP-CHP, +32536,3934,43301043,ALBUNEX,,357.0,357.0,,,EMBLEMHEALTH/HIP-CHP, +32537,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-CHP, +32538,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32539,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32540,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32541,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32542,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32543,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMBLEMHEALTH/HIP-CHP, +32544,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMBLEMHEALTH/HIP-CHP, +32545,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMBLEMHEALTH/HIP-CHP, +32546,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMBLEMHEALTH/HIP-CHP, +32547,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMBLEMHEALTH/HIP-CHP, +32548,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMBLEMHEALTH/HIP-CHP, +32549,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMBLEMHEALTH/HIP-CHP, +32550,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMBLEMHEALTH/HIP-CHP, +32551,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMBLEMHEALTH/HIP-CHP, +32552,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMBLEMHEALTH/HIP-CHP, +32553,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMBLEMHEALTH/HIP-CHP, +32554,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMBLEMHEALTH/HIP-CHP, +32555,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMBLEMHEALTH/HIP-CHP, +32556,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMBLEMHEALTH/HIP-CHP, +32557,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMBLEMHEALTH/HIP-CHP, +32558,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMBLEMHEALTH/HIP-CHP, +32559,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMBLEMHEALTH/HIP-CHP, +32560,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMBLEMHEALTH/HIP-CHP, +32561,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-CHP, +32562,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32563,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32564,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32565,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32566,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32567,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMBLEMHEALTH/HIP-CHP, +32568,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32569,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-CHP, +32570,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32571,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32572,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32573,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32574,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMBLEMHEALTH/HIP-CHP, +32575,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-CHP, +32576,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32577,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32578,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32579,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32580,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32581,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-CHP, +32582,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32583,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32584,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32585,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32586,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32587,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMBLEMHEALTH/HIP-CHP, +32588,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMBLEMHEALTH/HIP-CHP, +32589,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMBLEMHEALTH/HIP-CHP, +32590,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMBLEMHEALTH/HIP-CHP, +32591,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMBLEMHEALTH/HIP-CHP, +32592,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMBLEMHEALTH/HIP-CHP, +32593,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMBLEMHEALTH/HIP-CHP, +32594,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMBLEMHEALTH/HIP-CHP, +32595,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-CHP, +32596,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32597,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32598,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32599,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32600,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32601,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32602,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMBLEMHEALTH/HIP-CHP, +32603,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMBLEMHEALTH/HIP-CHP, +32604,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMBLEMHEALTH/HIP-CHP, +32605,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMBLEMHEALTH/HIP-CHP, +32606,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMBLEMHEALTH/HIP-CHP, +32607,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-CHP, +32608,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-CHP, +32609,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-CHP, +32610,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMBLEMHEALTH/HIP-CHP, +32611,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMBLEMHEALTH/HIP-CHP, +32612,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMBLEMHEALTH/HIP-CHP, +32613,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMBLEMHEALTH/HIP-CHP, +32614,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMBLEMHEALTH/HIP-CHP, +32615,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMBLEMHEALTH/HIP-CHP, +32616,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMBLEMHEALTH/HIP-CHP, +32617,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMBLEMHEALTH/HIP-CHP, +32618,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMBLEMHEALTH/HIP-CHP, +32619,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMBLEMHEALTH/HIP-CHP, +32620,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMBLEMHEALTH/HIP-CHP, +32621,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMBLEMHEALTH/HIP-CHP, +32622,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMBLEMHEALTH/HIP-CHP, +32623,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMBLEMHEALTH/HIP-CHP, +32624,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMBLEMHEALTH/HIP-CHP, +32625,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMBLEMHEALTH/HIP-CHP, +32626,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMBLEMHEALTH/HIP-CHP, +32627,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMBLEMHEALTH/HIP-CHP, +32628,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMBLEMHEALTH/HIP-CHP, +32629,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMBLEMHEALTH/HIP-CHP, +32630,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMBLEMHEALTH/HIP-CHP, +32631,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-CHP, +32632,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMBLEMHEALTH/HIP-CHP, +32633,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-CHP, +32634,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMBLEMHEALTH/HIP-CHP, +32635,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMBLEMHEALTH/HIP-CHP, +32636,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMBLEMHEALTH/HIP-CHP, +32637,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMBLEMHEALTH/HIP-CHP, +32638,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMBLEMHEALTH/HIP-CHP, +32639,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMBLEMHEALTH/HIP-CHP, +32640,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-CHP, +32641,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMBLEMHEALTH/HIP-CHP, +32642,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMBLEMHEALTH/HIP-CHP, +32643,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMBLEMHEALTH/HIP-CHP, +32644,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMBLEMHEALTH/HIP-CHP, +32645,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMBLEMHEALTH/HIP-CHP, +32646,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMBLEMHEALTH/HIP-CHP, +32647,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMBLEMHEALTH/HIP-CHP, +32648,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMBLEMHEALTH/HIP-CHP, +32649,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMBLEMHEALTH/HIP-CHP, +32650,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMBLEMHEALTH/HIP-CHP, +32651,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMBLEMHEALTH/HIP-CHP, +32652,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMBLEMHEALTH/HIP-CHP, +32653,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMBLEMHEALTH/HIP-CHP, +32654,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMBLEMHEALTH/HIP-CHP, +32655,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMBLEMHEALTH/HIP-CHP, +32656,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMBLEMHEALTH/HIP-CHP, +32657,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMBLEMHEALTH/HIP-CHP, +32658,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-CHP, +32659,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-CHP, +32660,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-CHP, +32661,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMBLEMHEALTH/HIP-CHP, +32662,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMBLEMHEALTH/HIP-CHP, +32663,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMBLEMHEALTH/HIP-CHP, +32664,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMBLEMHEALTH/HIP-CHP, +32665,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-CHP, +32666,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMBLEMHEALTH/HIP-CHP, +32667,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-CHP, +32668,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-CHP, +32669,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-CHP, +32670,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-CHP, +32671,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-CHP, +32672,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-CHP, +32673,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMBLEMHEALTH/HIP-CHP, +32674,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMBLEMHEALTH/HIP-CHP, +32675,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMBLEMHEALTH/HIP-CHP, +32676,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMBLEMHEALTH/HIP-CHP, +32677,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMBLEMHEALTH/HIP-CHP, +32678,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMBLEMHEALTH/HIP-CHP, +32679,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMBLEMHEALTH/HIP-CHP, +32680,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMBLEMHEALTH/HIP-CHP, +32681,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMBLEMHEALTH/HIP-CHP, +32682,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMBLEMHEALTH/HIP-CHP, +32683,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMBLEMHEALTH/HIP-CHP, +32684,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMBLEMHEALTH/HIP-CHP, +32685,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMBLEMHEALTH/HIP-CHP, +32686,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMBLEMHEALTH/HIP-CHP, +32687,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMBLEMHEALTH/HIP-CHP, +32688,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMBLEMHEALTH/HIP-CHP, +32689,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMBLEMHEALTH/HIP-CHP, +32690,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMBLEMHEALTH/HIP-CHP, +32691,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMBLEMHEALTH/HIP-CHP, +32692,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMBLEMHEALTH/HIP-CHP, +32693,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMBLEMHEALTH/HIP-CHP, +32694,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMBLEMHEALTH/HIP-CHP, +32695,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMBLEMHEALTH/HIP-CHP, +32696,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMBLEMHEALTH/HIP-CHP, +32697,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMBLEMHEALTH/HIP-CHP, +32698,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMBLEMHEALTH/HIP-CHP, +32699,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMBLEMHEALTH/HIP-CHP, +32700,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMBLEMHEALTH/HIP-CHP, +32701,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMBLEMHEALTH/HIP-CHP, +32702,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMBLEMHEALTH/HIP-CHP, +32703,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMBLEMHEALTH/HIP-CHP, +32704,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMBLEMHEALTH/HIP-CHP, +32705,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMBLEMHEALTH/HIP-CHP, +32706,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMBLEMHEALTH/HIP-Commercial,222904.69 +32707,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMBLEMHEALTH/HIP-Commercial, +32708,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMBLEMHEALTH/HIP-Commercial,242897.29 +32709,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMBLEMHEALTH/HIP-Commercial,669759.47 +32710,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMBLEMHEALTH/HIP-Commercial, +32711,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMBLEMHEALTH/HIP-Commercial, +32712,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMBLEMHEALTH/HIP-Commercial, +32713,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMBLEMHEALTH/HIP-Commercial, +32714,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMBLEMHEALTH/HIP-Commercial, +32715,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMBLEMHEALTH/HIP-Commercial, +32716,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMBLEMHEALTH/HIP-Commercial, +32717,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMBLEMHEALTH/HIP-Commercial, +32718,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMBLEMHEALTH/HIP-Commercial,50432.91 +32719,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMBLEMHEALTH/HIP-Commercial, +32720,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMBLEMHEALTH/HIP-Commercial, +32721,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMBLEMHEALTH/HIP-Commercial, +32722,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMBLEMHEALTH/HIP-Commercial, +32723,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMBLEMHEALTH/HIP-Commercial, +32724,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMBLEMHEALTH/HIP-Commercial, +32725,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMBLEMHEALTH/HIP-Commercial,19003.75 +32726,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMBLEMHEALTH/HIP-Commercial,122053.97 +32727,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMBLEMHEALTH/HIP-Commercial, +32728,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMBLEMHEALTH/HIP-Commercial, +32729,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMBLEMHEALTH/HIP-Commercial, +32730,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMBLEMHEALTH/HIP-Commercial, +32731,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMBLEMHEALTH/HIP-Commercial, +32732,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMBLEMHEALTH/HIP-Commercial, +32733,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMBLEMHEALTH/HIP-Commercial, +32734,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMBLEMHEALTH/HIP-Commercial, +32735,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMBLEMHEALTH/HIP-Commercial, +32736,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMBLEMHEALTH/HIP-Commercial,19973.13 +32737,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMBLEMHEALTH/HIP-Commercial, +32738,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMBLEMHEALTH/HIP-Commercial, +32739,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMBLEMHEALTH/HIP-Commercial, +32740,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMBLEMHEALTH/HIP-Commercial,20676.2 +32741,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMBLEMHEALTH/HIP-Commercial, +32742,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMBLEMHEALTH/HIP-Commercial, +32743,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMBLEMHEALTH/HIP-Commercial,16660.93 +32744,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMBLEMHEALTH/HIP-Commercial, +32745,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMBLEMHEALTH/HIP-Commercial, +32746,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMBLEMHEALTH/HIP-Commercial, +32747,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMBLEMHEALTH/HIP-Commercial, +32748,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMBLEMHEALTH/HIP-Commercial,46348.1 +32749,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMBLEMHEALTH/HIP-Commercial,40292.51 +32750,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMBLEMHEALTH/HIP-Commercial,15825.25 +32751,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMBLEMHEALTH/HIP-Commercial,14287.93 +32752,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMBLEMHEALTH/HIP-Commercial,11710.29 +32753,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMBLEMHEALTH/HIP-Commercial, +32754,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMBLEMHEALTH/HIP-Commercial, +32755,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMBLEMHEALTH/HIP-Commercial, +32756,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMBLEMHEALTH/HIP-Commercial,8722.97 +32757,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMBLEMHEALTH/HIP-Commercial, +32758,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMBLEMHEALTH/HIP-Commercial, +32759,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMBLEMHEALTH/HIP-Commercial, +32760,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMBLEMHEALTH/HIP-Commercial, +32761,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMBLEMHEALTH/HIP-Commercial, +32762,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMBLEMHEALTH/HIP-Commercial, +32763,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMBLEMHEALTH/HIP-Commercial, +32764,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMBLEMHEALTH/HIP-Commercial, +32765,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMBLEMHEALTH/HIP-Commercial,12393.88 +32766,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMBLEMHEALTH/HIP-Commercial, +32767,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMBLEMHEALTH/HIP-Commercial, +32768,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMBLEMHEALTH/HIP-Commercial,19339.36 +32769,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMBLEMHEALTH/HIP-Commercial, +32770,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMBLEMHEALTH/HIP-Commercial,13599.21 +32771,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMBLEMHEALTH/HIP-Commercial, +32772,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMBLEMHEALTH/HIP-Commercial, +32773,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMBLEMHEALTH/HIP-Commercial, +32774,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMBLEMHEALTH/HIP-Commercial, +32775,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMBLEMHEALTH/HIP-Commercial,114726.43 +32776,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMBLEMHEALTH/HIP-Commercial, +32777,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMBLEMHEALTH/HIP-Commercial, +32778,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMBLEMHEALTH/HIP-Commercial,30735.28 +32779,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMBLEMHEALTH/HIP-Commercial,52872.41 +32780,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMBLEMHEALTH/HIP-Commercial,20346.43 +32781,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMBLEMHEALTH/HIP-Commercial, +32782,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMBLEMHEALTH/HIP-Commercial, +32783,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMBLEMHEALTH/HIP-Commercial, +32784,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMBLEMHEALTH/HIP-Commercial, +32785,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMBLEMHEALTH/HIP-Commercial, +32786,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMBLEMHEALTH/HIP-Commercial, +32787,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMBLEMHEALTH/HIP-Commercial, +32788,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMBLEMHEALTH/HIP-Commercial, +32789,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMBLEMHEALTH/HIP-Commercial, +32790,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMBLEMHEALTH/HIP-Commercial, +32791,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMBLEMHEALTH/HIP-Commercial, +32792,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMBLEMHEALTH/HIP-Commercial, +32793,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMBLEMHEALTH/HIP-Commercial, +32794,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMBLEMHEALTH/HIP-Commercial,26131.94 +32795,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMBLEMHEALTH/HIP-Commercial, +32796,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMBLEMHEALTH/HIP-Commercial, +32797,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMBLEMHEALTH/HIP-Commercial, +32798,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMBLEMHEALTH/HIP-Commercial,11648.83 +32799,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMBLEMHEALTH/HIP-Commercial, +32800,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMBLEMHEALTH/HIP-Commercial,10638.98 +32801,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMBLEMHEALTH/HIP-Commercial, +32802,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMBLEMHEALTH/HIP-Commercial, +32803,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMBLEMHEALTH/HIP-Commercial, +32804,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMBLEMHEALTH/HIP-Commercial, +32805,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMBLEMHEALTH/HIP-Commercial, +32806,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMBLEMHEALTH/HIP-Commercial, +32807,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMBLEMHEALTH/HIP-Commercial, +32808,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMBLEMHEALTH/HIP-Commercial, +32809,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMBLEMHEALTH/HIP-Commercial, +32810,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMBLEMHEALTH/HIP-Commercial,6329.15 +32811,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMBLEMHEALTH/HIP-Commercial, +32812,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMBLEMHEALTH/HIP-Commercial,13298.5 +32813,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMBLEMHEALTH/HIP-Commercial, +32814,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMBLEMHEALTH/HIP-Commercial, +32815,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMBLEMHEALTH/HIP-Commercial, +32816,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMBLEMHEALTH/HIP-Commercial, +32817,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMBLEMHEALTH/HIP-Commercial,15836.16 +32818,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMBLEMHEALTH/HIP-Commercial, +32819,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMBLEMHEALTH/HIP-Commercial, +32820,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMBLEMHEALTH/HIP-Commercial,18815.01 +32821,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMBLEMHEALTH/HIP-Commercial, +32822,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMBLEMHEALTH/HIP-Commercial, +32823,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMBLEMHEALTH/HIP-Commercial, +32824,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMBLEMHEALTH/HIP-Commercial,23847.43 +32825,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMBLEMHEALTH/HIP-Commercial, +32826,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMBLEMHEALTH/HIP-Commercial,13955.6 +32827,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMBLEMHEALTH/HIP-Commercial,22915.35 +32828,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMBLEMHEALTH/HIP-Commercial,17811.29 +32829,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMBLEMHEALTH/HIP-Commercial, +32830,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMBLEMHEALTH/HIP-Commercial,14605.84 +32831,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMBLEMHEALTH/HIP-Commercial,27618.76 +32832,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMBLEMHEALTH/HIP-Commercial, +32833,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMBLEMHEALTH/HIP-Commercial,21587.37 +32834,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMBLEMHEALTH/HIP-Commercial, +32835,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMBLEMHEALTH/HIP-Commercial, +32836,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMBLEMHEALTH/HIP-Commercial, +32837,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMBLEMHEALTH/HIP-Commercial,10521.56 +32838,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMBLEMHEALTH/HIP-Commercial,17588.84 +32839,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMBLEMHEALTH/HIP-Commercial,7906.05 +32840,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMBLEMHEALTH/HIP-Commercial,17006.18 +32841,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMBLEMHEALTH/HIP-Commercial,18216.37 +32842,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMBLEMHEALTH/HIP-Commercial,16957.22 +32843,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMBLEMHEALTH/HIP-Commercial, +32844,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMBLEMHEALTH/HIP-Commercial, +32845,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMBLEMHEALTH/HIP-Commercial, +32846,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMBLEMHEALTH/HIP-Commercial, +32847,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMBLEMHEALTH/HIP-Commercial,26066.45 +32848,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMBLEMHEALTH/HIP-Commercial,17383.99 +32849,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMBLEMHEALTH/HIP-Commercial,22729.51 +32850,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMBLEMHEALTH/HIP-Commercial,16054.5 +32851,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMBLEMHEALTH/HIP-Commercial,7250.8 +32852,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMBLEMHEALTH/HIP-Commercial, +32853,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMBLEMHEALTH/HIP-Commercial, +32854,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMBLEMHEALTH/HIP-Commercial,46846.25 +32855,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMBLEMHEALTH/HIP-Commercial,49541.13 +32856,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMBLEMHEALTH/HIP-Commercial,104343.13 +32857,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMBLEMHEALTH/HIP-Commercial, +32858,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMBLEMHEALTH/HIP-Commercial, +32859,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMBLEMHEALTH/HIP-Commercial, +32860,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMBLEMHEALTH/HIP-Commercial, +32861,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMBLEMHEALTH/HIP-Commercial, +32862,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMBLEMHEALTH/HIP-Commercial, +32863,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMBLEMHEALTH/HIP-Commercial, +32864,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMBLEMHEALTH/HIP-Commercial, +32865,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMBLEMHEALTH/HIP-Commercial,46135.54 +32866,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMBLEMHEALTH/HIP-Commercial,54008.7 +32867,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMBLEMHEALTH/HIP-Commercial,42556.47 +32868,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMBLEMHEALTH/HIP-Commercial, +32869,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMBLEMHEALTH/HIP-Commercial, +32870,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMBLEMHEALTH/HIP-Commercial, +32871,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMBLEMHEALTH/HIP-Commercial, +32872,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMBLEMHEALTH/HIP-Commercial, +32873,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMBLEMHEALTH/HIP-Commercial,42796.51 +32874,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMBLEMHEALTH/HIP-Commercial, +32875,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMBLEMHEALTH/HIP-Commercial,118558.08 +32876,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMBLEMHEALTH/HIP-Commercial,38712.59 +32877,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMBLEMHEALTH/HIP-Commercial, +32878,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMBLEMHEALTH/HIP-Commercial, +32879,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMBLEMHEALTH/HIP-Commercial,21063.44 +32880,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMBLEMHEALTH/HIP-Commercial, +32881,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMBLEMHEALTH/HIP-Commercial, +32882,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMBLEMHEALTH/HIP-Commercial,42475.3 +32883,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMBLEMHEALTH/HIP-Commercial,46410.85 +32884,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMBLEMHEALTH/HIP-Commercial, +32885,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMBLEMHEALTH/HIP-Commercial, +32886,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMBLEMHEALTH/HIP-Commercial, +32887,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMBLEMHEALTH/HIP-Commercial, +32888,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMBLEMHEALTH/HIP-Commercial, +32889,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMBLEMHEALTH/HIP-Commercial,42882.09 +32890,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMBLEMHEALTH/HIP-Commercial, +32891,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMBLEMHEALTH/HIP-Commercial, +32892,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMBLEMHEALTH/HIP-Commercial, +32893,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMBLEMHEALTH/HIP-Commercial, +32894,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMBLEMHEALTH/HIP-Commercial, +32895,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMBLEMHEALTH/HIP-Commercial, +32896,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMBLEMHEALTH/HIP-Commercial, +32897,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMBLEMHEALTH/HIP-Commercial, +32898,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMBLEMHEALTH/HIP-Commercial, +32899,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMBLEMHEALTH/HIP-Commercial, +32900,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMBLEMHEALTH/HIP-Commercial, +32901,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMBLEMHEALTH/HIP-Commercial,57974.79 +32902,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMBLEMHEALTH/HIP-Commercial,57483.8 +32903,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMBLEMHEALTH/HIP-Commercial, +32904,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMBLEMHEALTH/HIP-Commercial,35008.67 +32905,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMBLEMHEALTH/HIP-Commercial,82364.2 +32906,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMBLEMHEALTH/HIP-Commercial,63797.26 +32907,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMBLEMHEALTH/HIP-Commercial,22039.21 +32908,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMBLEMHEALTH/HIP-Commercial, +32909,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMBLEMHEALTH/HIP-Commercial,66474.04 +32910,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMBLEMHEALTH/HIP-Commercial,21960.75 +32911,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMBLEMHEALTH/HIP-Commercial,15446.89 +32912,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMBLEMHEALTH/HIP-Commercial, +32913,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMBLEMHEALTH/HIP-Commercial,15066.89 +32914,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMBLEMHEALTH/HIP-Commercial, +32915,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMBLEMHEALTH/HIP-Commercial,18403.22 +32916,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMBLEMHEALTH/HIP-Commercial,10121.69 +32917,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMBLEMHEALTH/HIP-Commercial, +32918,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMBLEMHEALTH/HIP-Commercial, +32919,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMBLEMHEALTH/HIP-Commercial,21075.0 +32920,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMBLEMHEALTH/HIP-Commercial,8027.82 +32921,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMBLEMHEALTH/HIP-Commercial, +32922,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMBLEMHEALTH/HIP-Commercial, +32923,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMBLEMHEALTH/HIP-Commercial,34832.8 +32924,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMBLEMHEALTH/HIP-Commercial,24637.27 +32925,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMBLEMHEALTH/HIP-Commercial, +32926,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMBLEMHEALTH/HIP-Commercial, +32927,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMBLEMHEALTH/HIP-Commercial,12858.13 +32928,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMBLEMHEALTH/HIP-Commercial, +32929,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMBLEMHEALTH/HIP-Commercial,6668.36 +32930,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMBLEMHEALTH/HIP-Commercial,12327.01 +32931,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMBLEMHEALTH/HIP-Commercial,7757.96 +32932,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMBLEMHEALTH/HIP-Commercial,10455.73 +32933,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMBLEMHEALTH/HIP-Commercial,8464.57 +32934,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMBLEMHEALTH/HIP-Commercial,5281.4 +32935,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMBLEMHEALTH/HIP-Commercial, +32936,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMBLEMHEALTH/HIP-Commercial,7273.77 +32937,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMBLEMHEALTH/HIP-Commercial,6557.93 +32938,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMBLEMHEALTH/HIP-Commercial,37503.7 +32939,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMBLEMHEALTH/HIP-Commercial,8695.29 +32940,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMBLEMHEALTH/HIP-Commercial, +32941,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMBLEMHEALTH/HIP-Commercial, +32942,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMBLEMHEALTH/HIP-Commercial, +32943,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMBLEMHEALTH/HIP-Commercial,149926.43 +32944,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMBLEMHEALTH/HIP-Commercial, +32945,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMBLEMHEALTH/HIP-Commercial, +32946,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMBLEMHEALTH/HIP-Commercial,66012.02 +32947,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMBLEMHEALTH/HIP-Commercial,131151.62 +32948,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMBLEMHEALTH/HIP-Commercial,40657.81 +32949,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMBLEMHEALTH/HIP-Commercial, +32950,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMBLEMHEALTH/HIP-Commercial, +32951,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMBLEMHEALTH/HIP-Commercial, +32952,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMBLEMHEALTH/HIP-Commercial, +32953,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMBLEMHEALTH/HIP-Commercial,26628.54 +32954,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMBLEMHEALTH/HIP-Commercial, +32955,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMBLEMHEALTH/HIP-Commercial,41138.56 +32956,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMBLEMHEALTH/HIP-Commercial,29751.4 +32957,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMBLEMHEALTH/HIP-Commercial,21768.47 +32958,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMBLEMHEALTH/HIP-Commercial, +32959,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMBLEMHEALTH/HIP-Commercial, +32960,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMBLEMHEALTH/HIP-Commercial, +32961,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMBLEMHEALTH/HIP-Commercial, +32962,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMBLEMHEALTH/HIP-Commercial, +32963,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMBLEMHEALTH/HIP-Commercial, +32964,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMBLEMHEALTH/HIP-Commercial, +32965,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMBLEMHEALTH/HIP-Commercial, +32966,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMBLEMHEALTH/HIP-Commercial, +32967,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMBLEMHEALTH/HIP-Commercial, +32968,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMBLEMHEALTH/HIP-Commercial, +32969,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMBLEMHEALTH/HIP-Commercial,11773.44 +32970,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMBLEMHEALTH/HIP-Commercial, +32971,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMBLEMHEALTH/HIP-Commercial, +32972,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMBLEMHEALTH/HIP-Commercial, +32973,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMBLEMHEALTH/HIP-Commercial, +32974,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMBLEMHEALTH/HIP-Commercial, +32975,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMBLEMHEALTH/HIP-Commercial,9135.32 +32976,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMBLEMHEALTH/HIP-Commercial, +32977,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMBLEMHEALTH/HIP-Commercial,17156.49 +32978,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMBLEMHEALTH/HIP-Commercial, +32979,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMBLEMHEALTH/HIP-Commercial, +32980,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMBLEMHEALTH/HIP-Commercial,21179.46 +32981,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMBLEMHEALTH/HIP-Commercial,10776.14 +32982,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMBLEMHEALTH/HIP-Commercial,5836.11 +32983,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMBLEMHEALTH/HIP-Commercial, +32984,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMBLEMHEALTH/HIP-Commercial, +32985,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMBLEMHEALTH/HIP-Commercial, +32986,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMBLEMHEALTH/HIP-Commercial,7726.25 +32987,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMBLEMHEALTH/HIP-Commercial, +32988,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMBLEMHEALTH/HIP-Commercial,8564.61 +32989,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMBLEMHEALTH/HIP-Commercial, +32990,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMBLEMHEALTH/HIP-Commercial, +32991,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMBLEMHEALTH/HIP-Commercial,13805.69 +32992,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMBLEMHEALTH/HIP-Commercial,5388.46 +32993,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMBLEMHEALTH/HIP-Commercial,10651.79 +32994,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMBLEMHEALTH/HIP-Commercial,15400.98 +32995,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMBLEMHEALTH/HIP-Commercial,13845.42 +32996,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMBLEMHEALTH/HIP-Commercial,8250.79 +32997,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMBLEMHEALTH/HIP-Commercial, +32998,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMBLEMHEALTH/HIP-Commercial, +32999,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMBLEMHEALTH/HIP-Commercial, +33000,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMBLEMHEALTH/HIP-Commercial, +33001,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMBLEMHEALTH/HIP-Commercial,29102.44 +33002,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMBLEMHEALTH/HIP-Commercial, +33003,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMBLEMHEALTH/HIP-Commercial, +33004,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMBLEMHEALTH/HIP-Commercial, +33005,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMBLEMHEALTH/HIP-Commercial,49181.88 +33006,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMBLEMHEALTH/HIP-Commercial, +33007,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMBLEMHEALTH/HIP-Commercial,27095.78 +33008,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMBLEMHEALTH/HIP-Commercial,31495.76 +33009,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMBLEMHEALTH/HIP-Commercial, +33010,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMBLEMHEALTH/HIP-Commercial, +33011,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMBLEMHEALTH/HIP-Commercial, +33012,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMBLEMHEALTH/HIP-Commercial, +33013,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMBLEMHEALTH/HIP-Commercial,15487.16 +33014,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMBLEMHEALTH/HIP-Commercial,24733.94 +33015,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMBLEMHEALTH/HIP-Commercial,26712.89 +33016,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMBLEMHEALTH/HIP-Commercial, +33017,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMBLEMHEALTH/HIP-Commercial,14174.75 +33018,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMBLEMHEALTH/HIP-Commercial, +33019,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMBLEMHEALTH/HIP-Commercial, +33020,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMBLEMHEALTH/HIP-Commercial, +33021,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMBLEMHEALTH/HIP-Commercial,22414.72 +33022,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMBLEMHEALTH/HIP-Commercial, +33023,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMBLEMHEALTH/HIP-Commercial,13808.37 +33024,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMBLEMHEALTH/HIP-Commercial,9563.12 +33025,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMBLEMHEALTH/HIP-Commercial, +33026,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMBLEMHEALTH/HIP-Commercial, +33027,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMBLEMHEALTH/HIP-Commercial,115425.27 +33028,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMBLEMHEALTH/HIP-Commercial, +33029,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMBLEMHEALTH/HIP-Commercial, +33030,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMBLEMHEALTH/HIP-Commercial,112542.62 +33031,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMBLEMHEALTH/HIP-Commercial, +33032,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMBLEMHEALTH/HIP-Commercial, +33033,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMBLEMHEALTH/HIP-Commercial, +33034,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMBLEMHEALTH/HIP-Commercial, +33035,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMBLEMHEALTH/HIP-Commercial,70811.28 +33036,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMBLEMHEALTH/HIP-Commercial, +33037,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMBLEMHEALTH/HIP-Commercial,20311.5 +33038,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMBLEMHEALTH/HIP-Commercial,64749.08 +33039,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMBLEMHEALTH/HIP-Commercial,23323.34 +33040,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMBLEMHEALTH/HIP-Commercial,75253.98 +33041,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMBLEMHEALTH/HIP-Commercial,29628.54 +33042,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMBLEMHEALTH/HIP-Commercial,47225.85 +33043,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMBLEMHEALTH/HIP-Commercial, +33044,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMBLEMHEALTH/HIP-Commercial, +33045,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMBLEMHEALTH/HIP-Commercial, +33046,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMBLEMHEALTH/HIP-Commercial, +33047,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMBLEMHEALTH/HIP-Commercial,41693.79 +33048,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMBLEMHEALTH/HIP-Commercial, +33049,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMBLEMHEALTH/HIP-Commercial, +33050,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMBLEMHEALTH/HIP-Commercial,17524.69 +33051,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMBLEMHEALTH/HIP-Commercial, +33052,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMBLEMHEALTH/HIP-Commercial,29512.06 +33053,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMBLEMHEALTH/HIP-Commercial, +33054,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMBLEMHEALTH/HIP-Commercial, +33055,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMBLEMHEALTH/HIP-Commercial, +33056,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMBLEMHEALTH/HIP-Commercial, +33057,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMBLEMHEALTH/HIP-Commercial, +33058,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMBLEMHEALTH/HIP-Commercial,19586.65 +33059,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMBLEMHEALTH/HIP-Commercial, +33060,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMBLEMHEALTH/HIP-Commercial, +33061,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMBLEMHEALTH/HIP-Commercial, +33062,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMBLEMHEALTH/HIP-Commercial, +33063,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMBLEMHEALTH/HIP-Commercial, +33064,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMBLEMHEALTH/HIP-Commercial, +33065,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMBLEMHEALTH/HIP-Commercial, +33066,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMBLEMHEALTH/HIP-Commercial, +33067,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMBLEMHEALTH/HIP-Commercial, +33068,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMBLEMHEALTH/HIP-Commercial, +33069,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMBLEMHEALTH/HIP-Commercial,15895.81 +33070,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMBLEMHEALTH/HIP-Commercial,36290.02 +33071,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMBLEMHEALTH/HIP-Commercial, +33072,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMBLEMHEALTH/HIP-Commercial, +33073,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMBLEMHEALTH/HIP-Commercial,41593.4 +33074,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMBLEMHEALTH/HIP-Commercial, +33075,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMBLEMHEALTH/HIP-Commercial, +33076,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMBLEMHEALTH/HIP-Commercial, +33077,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMBLEMHEALTH/HIP-Commercial, +33078,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMBLEMHEALTH/HIP-Commercial,11730.88 +33079,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMBLEMHEALTH/HIP-Commercial, +33080,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMBLEMHEALTH/HIP-Commercial, +33081,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMBLEMHEALTH/HIP-Commercial, +33082,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMBLEMHEALTH/HIP-Commercial,10597.47 +33083,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMBLEMHEALTH/HIP-Commercial, +33084,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMBLEMHEALTH/HIP-Commercial, +33085,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMBLEMHEALTH/HIP-Commercial, +33086,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMBLEMHEALTH/HIP-Commercial, +33087,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMBLEMHEALTH/HIP-Commercial,91973.71 +33088,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMBLEMHEALTH/HIP-Commercial, +33089,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMBLEMHEALTH/HIP-Commercial, +33090,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMBLEMHEALTH/HIP-Commercial, +33091,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMBLEMHEALTH/HIP-Commercial, +33092,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMBLEMHEALTH/HIP-Commercial, +33093,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMBLEMHEALTH/HIP-Commercial,27494.99 +33094,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMBLEMHEALTH/HIP-Commercial, +33095,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMBLEMHEALTH/HIP-Commercial,8195.75 +33096,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMBLEMHEALTH/HIP-Commercial, +33097,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMBLEMHEALTH/HIP-Commercial, +33098,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMBLEMHEALTH/HIP-Commercial, +33099,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMBLEMHEALTH/HIP-Commercial,7211.6 +33100,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMBLEMHEALTH/HIP-Commercial, +33101,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMBLEMHEALTH/HIP-Commercial,14163.59 +33102,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMBLEMHEALTH/HIP-Commercial, +33103,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMBLEMHEALTH/HIP-Commercial, +33104,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMBLEMHEALTH/HIP-Commercial, +33105,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMBLEMHEALTH/HIP-Commercial,6469.38 +33106,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMBLEMHEALTH/HIP-Commercial,12638.85 +33107,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMBLEMHEALTH/HIP-Commercial,23499.64 +33108,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMBLEMHEALTH/HIP-Commercial, +33109,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMBLEMHEALTH/HIP-Commercial, +33110,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMBLEMHEALTH/HIP-Commercial, +33111,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMBLEMHEALTH/HIP-Commercial, +33112,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMBLEMHEALTH/HIP-Commercial, +33113,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMBLEMHEALTH/HIP-Commercial, +33114,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMBLEMHEALTH/HIP-Commercial,19860.97 +33115,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMBLEMHEALTH/HIP-Commercial,25404.8 +33116,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMBLEMHEALTH/HIP-Commercial, +33117,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMBLEMHEALTH/HIP-Commercial, +33118,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMBLEMHEALTH/HIP-Commercial, +33119,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMBLEMHEALTH/HIP-Commercial,26791.44 +33120,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMBLEMHEALTH/HIP-Commercial, +33121,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMBLEMHEALTH/HIP-Commercial, +33122,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMBLEMHEALTH/HIP-Commercial, +33123,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMBLEMHEALTH/HIP-Commercial,8705.45 +33124,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMBLEMHEALTH/HIP-Commercial, +33125,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMBLEMHEALTH/HIP-Commercial, +33126,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMBLEMHEALTH/HIP-Commercial, +33127,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMBLEMHEALTH/HIP-Commercial, +33128,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMBLEMHEALTH/HIP-Commercial,7505.74 +33129,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMBLEMHEALTH/HIP-Commercial, +33130,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMBLEMHEALTH/HIP-Commercial,19246.16 +33131,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMBLEMHEALTH/HIP-Commercial, +33132,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMBLEMHEALTH/HIP-Commercial, +33133,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMBLEMHEALTH/HIP-Commercial,20294.06 +33134,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMBLEMHEALTH/HIP-Commercial, +33135,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMBLEMHEALTH/HIP-Commercial, +33136,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMBLEMHEALTH/HIP-Commercial,37875.56 +33137,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMBLEMHEALTH/HIP-Commercial, +33138,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMBLEMHEALTH/HIP-Commercial, +33139,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMBLEMHEALTH/HIP-Commercial,25640.47 +33140,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMBLEMHEALTH/HIP-Commercial, +33141,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMBLEMHEALTH/HIP-Commercial, +33142,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMBLEMHEALTH/HIP-Commercial, +33143,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMBLEMHEALTH/HIP-Commercial, +33144,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMBLEMHEALTH/HIP-Commercial, +33145,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMBLEMHEALTH/HIP-Commercial, +33146,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMBLEMHEALTH/HIP-Commercial, +33147,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMBLEMHEALTH/HIP-Commercial,11927.98 +33148,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMBLEMHEALTH/HIP-Commercial,14536.81 +33149,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMBLEMHEALTH/HIP-Commercial, +33150,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMBLEMHEALTH/HIP-Commercial,14983.31 +33151,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMBLEMHEALTH/HIP-Commercial,6830.71 +33152,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMBLEMHEALTH/HIP-Commercial, +33153,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMBLEMHEALTH/HIP-Commercial, +33154,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMBLEMHEALTH/HIP-Commercial, +33155,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMBLEMHEALTH/HIP-Commercial, +33156,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMBLEMHEALTH/HIP-Commercial, +33157,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMBLEMHEALTH/HIP-Commercial, +33158,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMBLEMHEALTH/HIP-Commercial, +33159,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMBLEMHEALTH/HIP-Commercial, +33160,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMBLEMHEALTH/HIP-Commercial,23356.25 +33161,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMBLEMHEALTH/HIP-Commercial, +33162,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMBLEMHEALTH/HIP-Commercial, +33163,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMBLEMHEALTH/HIP-Commercial,16270.07 +33164,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMBLEMHEALTH/HIP-Commercial,13638.7 +33165,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMBLEMHEALTH/HIP-Commercial, +33166,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMBLEMHEALTH/HIP-Commercial, +33167,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMBLEMHEALTH/HIP-Commercial,17814.48 +33168,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMBLEMHEALTH/HIP-Commercial, +33169,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMBLEMHEALTH/HIP-Commercial, +33170,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMBLEMHEALTH/HIP-Commercial,9623.77 +33171,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMBLEMHEALTH/HIP-Commercial, +33172,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMBLEMHEALTH/HIP-Commercial, +33173,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMBLEMHEALTH/HIP-Commercial, +33174,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMBLEMHEALTH/HIP-Commercial, +33175,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMBLEMHEALTH/HIP-Commercial, +33176,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMBLEMHEALTH/HIP-Commercial, +33177,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMBLEMHEALTH/HIP-Commercial, +33178,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMBLEMHEALTH/HIP-Commercial,12602.55 +33179,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMBLEMHEALTH/HIP-Commercial,14391.8 +33180,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMBLEMHEALTH/HIP-Commercial, +33181,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMBLEMHEALTH/HIP-Commercial, +33182,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMBLEMHEALTH/HIP-Commercial, +33183,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMBLEMHEALTH/HIP-Commercial,10621.95 +33184,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMBLEMHEALTH/HIP-Commercial,10082.54 +33185,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMBLEMHEALTH/HIP-Commercial, +33186,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMBLEMHEALTH/HIP-Commercial,6790.42 +33187,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMBLEMHEALTH/HIP-Commercial, +33188,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMBLEMHEALTH/HIP-Commercial,6182.39 +33189,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMBLEMHEALTH/HIP-Commercial,62139.0 +33190,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMBLEMHEALTH/HIP-Commercial, +33191,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMBLEMHEALTH/HIP-Commercial, +33192,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMBLEMHEALTH/HIP-Commercial,15765.12 +33193,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMBLEMHEALTH/HIP-Commercial, +33194,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMBLEMHEALTH/HIP-Commercial, +33195,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMBLEMHEALTH/HIP-Commercial, +33196,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMBLEMHEALTH/HIP-Commercial,12467.33 +33197,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMBLEMHEALTH/HIP-Commercial, +33198,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMBLEMHEALTH/HIP-Commercial, +33199,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMBLEMHEALTH/HIP-Commercial, +33200,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMBLEMHEALTH/HIP-Commercial, +33201,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMBLEMHEALTH/HIP-Commercial, +33202,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMBLEMHEALTH/HIP-Commercial, +33203,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMBLEMHEALTH/HIP-Commercial, +33204,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMBLEMHEALTH/HIP-Commercial, +33205,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMBLEMHEALTH/HIP-Commercial, +33206,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMBLEMHEALTH/HIP-Commercial, +33207,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMBLEMHEALTH/HIP-Commercial, +33208,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMBLEMHEALTH/HIP-Commercial,36722.02 +33209,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMBLEMHEALTH/HIP-Commercial, +33210,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMBLEMHEALTH/HIP-Commercial, +33211,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMBLEMHEALTH/HIP-Commercial, +33212,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMBLEMHEALTH/HIP-Commercial,26751.09 +33213,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMBLEMHEALTH/HIP-Commercial,27613.94 +33214,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMBLEMHEALTH/HIP-Commercial, +33215,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMBLEMHEALTH/HIP-Commercial, +33216,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMBLEMHEALTH/HIP-Commercial, +33217,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMBLEMHEALTH/HIP-Commercial, +33218,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMBLEMHEALTH/HIP-Commercial, +33219,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMBLEMHEALTH/HIP-Commercial, +33220,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMBLEMHEALTH/HIP-Commercial, +33221,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMBLEMHEALTH/HIP-Commercial, +33222,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMBLEMHEALTH/HIP-Commercial, +33223,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMBLEMHEALTH/HIP-Commercial, +33224,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMBLEMHEALTH/HIP-Commercial, +33225,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMBLEMHEALTH/HIP-Commercial,17346.8 +33226,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMBLEMHEALTH/HIP-Commercial, +33227,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMBLEMHEALTH/HIP-Commercial,17014.17 +33228,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMBLEMHEALTH/HIP-Commercial, +33229,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMBLEMHEALTH/HIP-Commercial, +33230,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMBLEMHEALTH/HIP-Commercial, +33231,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMBLEMHEALTH/HIP-Commercial,20384.92 +33232,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMBLEMHEALTH/HIP-Commercial,41267.1 +33233,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMBLEMHEALTH/HIP-Commercial,22481.38 +33234,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMBLEMHEALTH/HIP-Commercial,21269.08 +33235,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMBLEMHEALTH/HIP-Commercial, +33236,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMBLEMHEALTH/HIP-Commercial,243862.8 +33237,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMBLEMHEALTH/HIP-Commercial,70171.1 +33238,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMBLEMHEALTH/HIP-Commercial, +33239,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMBLEMHEALTH/HIP-Commercial,87847.05 +33240,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMBLEMHEALTH/HIP-Commercial,32173.35 +33241,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMBLEMHEALTH/HIP-Commercial,4402.69 +33242,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMBLEMHEALTH/HIP-Commercial, +33243,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMBLEMHEALTH/HIP-Commercial, +33244,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMBLEMHEALTH/HIP-Commercial,20687.51 +33245,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMBLEMHEALTH/HIP-Commercial, +33246,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMBLEMHEALTH/HIP-Commercial, +33247,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMBLEMHEALTH/HIP-Commercial, +33248,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMBLEMHEALTH/HIP-Commercial, +33249,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMBLEMHEALTH/HIP-Commercial, +33250,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMBLEMHEALTH/HIP-Commercial,22196.17 +33251,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMBLEMHEALTH/HIP-Commercial,16441.14 +33252,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMBLEMHEALTH/HIP-Commercial,14831.78 +33253,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMBLEMHEALTH/HIP-Commercial, +33254,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMBLEMHEALTH/HIP-Commercial,28580.95 +33255,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMBLEMHEALTH/HIP-Commercial, +33256,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMBLEMHEALTH/HIP-Commercial, +33257,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMBLEMHEALTH/HIP-Commercial,7717.4 +33258,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMBLEMHEALTH/HIP-Commercial,19677.1 +33259,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMBLEMHEALTH/HIP-Commercial, +33260,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMBLEMHEALTH/HIP-Commercial, +33261,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMBLEMHEALTH/HIP-Commercial, +33262,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMBLEMHEALTH/HIP-Commercial, +33263,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMBLEMHEALTH/HIP-Commercial, +33264,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMBLEMHEALTH/HIP-Commercial, +33265,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMBLEMHEALTH/HIP-Commercial, +33266,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMBLEMHEALTH/HIP-Commercial, +33267,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMBLEMHEALTH/HIP-Commercial, +33268,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMBLEMHEALTH/HIP-Commercial,43504.39 +33269,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMBLEMHEALTH/HIP-Commercial, +33270,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMBLEMHEALTH/HIP-Commercial,32463.3 +33271,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMBLEMHEALTH/HIP-Commercial, +33272,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMBLEMHEALTH/HIP-Commercial, +33273,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMBLEMHEALTH/HIP-Commercial, +33274,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMBLEMHEALTH/HIP-Commercial,75253.98 +33275,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMBLEMHEALTH/HIP-Commercial, +33276,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMBLEMHEALTH/HIP-Commercial, +33277,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMBLEMHEALTH/HIP-Commercial, +33278,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMBLEMHEALTH/HIP-Commercial, +33279,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMBLEMHEALTH/HIP-Commercial,47717.67 +33280,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMBLEMHEALTH/HIP-Commercial, +33281,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMBLEMHEALTH/HIP-Commercial, +33282,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMBLEMHEALTH/HIP-Commercial, +33283,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMBLEMHEALTH/HIP-Commercial, +33284,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMBLEMHEALTH/HIP-Commercial, +33285,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMBLEMHEALTH/HIP-Commercial, +33286,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMBLEMHEALTH/HIP-Commercial,13930.12 +33287,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMBLEMHEALTH/HIP-Commercial, +33288,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMBLEMHEALTH/HIP-Commercial, +33289,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMBLEMHEALTH/HIP-Commercial, +33290,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMBLEMHEALTH/HIP-Commercial, +33291,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMBLEMHEALTH/HIP-Commercial,31538.18 +33292,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMBLEMHEALTH/HIP-Commercial, +33293,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMBLEMHEALTH/HIP-Commercial,50279.67 +33294,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMBLEMHEALTH/HIP-Commercial,17150.24 +33295,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMBLEMHEALTH/HIP-Commercial, +33296,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMBLEMHEALTH/HIP-Commercial, +33297,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMBLEMHEALTH/HIP-Commercial, +33298,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMBLEMHEALTH/HIP-Commercial, +33299,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMBLEMHEALTH/HIP-Commercial, +33300,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMBLEMHEALTH/HIP-Commercial, +33301,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMBLEMHEALTH/HIP-Commercial,25214.33 +33302,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMBLEMHEALTH/HIP-Commercial, +33303,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMBLEMHEALTH/HIP-Commercial, +33304,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMBLEMHEALTH/HIP-Commercial,26423.56 +33305,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMBLEMHEALTH/HIP-Commercial, +33306,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMBLEMHEALTH/HIP-Commercial,52752.4 +33307,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMBLEMHEALTH/HIP-Commercial,22889.96 +33308,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMBLEMHEALTH/HIP-Commercial,12462.48 +33309,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMBLEMHEALTH/HIP-Commercial, +33310,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMBLEMHEALTH/HIP-Commercial, +33311,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMBLEMHEALTH/HIP-Commercial, +33312,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMBLEMHEALTH/HIP-Commercial, +33313,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMBLEMHEALTH/HIP-Commercial, +33314,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMBLEMHEALTH/HIP-Commercial, +33315,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMBLEMHEALTH/HIP-Commercial,10722.28 +33316,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMBLEMHEALTH/HIP-Commercial, +33317,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMBLEMHEALTH/HIP-Commercial, +33318,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMBLEMHEALTH/HIP-Commercial, +33319,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMBLEMHEALTH/HIP-Commercial, +33320,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMBLEMHEALTH/HIP-Commercial,41216.05 +33321,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMBLEMHEALTH/HIP-Commercial,13211.29 +33322,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMBLEMHEALTH/HIP-Commercial, +33323,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMBLEMHEALTH/HIP-Commercial, +33324,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMBLEMHEALTH/HIP-Commercial, +33325,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMBLEMHEALTH/HIP-Commercial, +33326,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMBLEMHEALTH/HIP-Commercial, +33327,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMBLEMHEALTH/HIP-Commercial, +33328,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMBLEMHEALTH/HIP-Commercial, +33329,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMBLEMHEALTH/HIP-Commercial, +33330,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMBLEMHEALTH/HIP-Commercial, +33331,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMBLEMHEALTH/HIP-Commercial,40731.11 +33332,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMBLEMHEALTH/HIP-Commercial,11761.53 +33333,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMBLEMHEALTH/HIP-Commercial,12545.03 +33334,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMBLEMHEALTH/HIP-Commercial,18790.13 +33335,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMBLEMHEALTH/HIP-Commercial,15409.78 +33336,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMBLEMHEALTH/HIP-Commercial, +33337,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMBLEMHEALTH/HIP-Commercial, +33338,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMBLEMHEALTH/HIP-Commercial, +33339,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMBLEMHEALTH/HIP-Commercial, +33340,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMBLEMHEALTH/HIP-Commercial, +33341,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMBLEMHEALTH/HIP-Commercial, +33342,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMBLEMHEALTH/HIP-Commercial, +33343,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMBLEMHEALTH/HIP-Commercial,46320.21 +33344,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMBLEMHEALTH/HIP-Commercial, +33345,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMBLEMHEALTH/HIP-Commercial, +33346,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMBLEMHEALTH/HIP-Commercial,18684.67 +33347,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMBLEMHEALTH/HIP-Commercial, +33348,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMBLEMHEALTH/HIP-Commercial, +33349,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMBLEMHEALTH/HIP-Commercial, +33350,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMBLEMHEALTH/HIP-Commercial, +33351,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMBLEMHEALTH/HIP-Commercial,31732.14 +33352,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMBLEMHEALTH/HIP-Commercial, +33353,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMBLEMHEALTH/HIP-Commercial, +33354,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMBLEMHEALTH/HIP-Commercial,60087.49 +33355,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMBLEMHEALTH/HIP-Commercial, +33356,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMBLEMHEALTH/HIP-Commercial, +33357,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMBLEMHEALTH/HIP-Commercial, +33358,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMBLEMHEALTH/HIP-Commercial,64786.62 +33359,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMBLEMHEALTH/HIP-Commercial,20309.44 +33360,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMBLEMHEALTH/HIP-Commercial,29558.63 +33361,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMBLEMHEALTH/HIP-Commercial, +33362,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMBLEMHEALTH/HIP-Commercial, +33363,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMBLEMHEALTH/HIP-Commercial, +33364,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMBLEMHEALTH/HIP-Commercial,2067.07 +33365,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMBLEMHEALTH/HIP-Commercial, +33366,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMBLEMHEALTH/HIP-Commercial, +33367,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMBLEMHEALTH/HIP-Commercial, +33368,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMBLEMHEALTH/HIP-Commercial, +33369,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33370,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMBLEMHEALTH/HIP-Commercial, +33371,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +33372,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMBLEMHEALTH/HIP-Commercial, +33373,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +33374,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMBLEMHEALTH/HIP-Commercial,2957.46 +33375,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMBLEMHEALTH/HIP-Commercial, +33376,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMBLEMHEALTH/HIP-Commercial, +33377,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMBLEMHEALTH/HIP-Commercial,386.93 +33378,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMBLEMHEALTH/HIP-Commercial, +33379,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMBLEMHEALTH/HIP-Commercial,2865.73 +33380,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMBLEMHEALTH/HIP-Commercial, +33381,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMBLEMHEALTH/HIP-Commercial, +33382,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMBLEMHEALTH/HIP-Commercial, +33383,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMBLEMHEALTH/HIP-Commercial, +33384,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +33385,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMBLEMHEALTH/HIP-Commercial, +33386,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMBLEMHEALTH/HIP-Commercial, +33387,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMBLEMHEALTH/HIP-Commercial, +33388,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMBLEMHEALTH/HIP-Commercial,374.73 +33389,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMBLEMHEALTH/HIP-Commercial, +33390,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMBLEMHEALTH/HIP-Commercial, +33391,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMBLEMHEALTH/HIP-Commercial, +33392,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMBLEMHEALTH/HIP-Commercial, +33393,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMBLEMHEALTH/HIP-Commercial,2642.7 +33394,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMBLEMHEALTH/HIP-Commercial,2417.0 +33395,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMBLEMHEALTH/HIP-Commercial, +33396,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMBLEMHEALTH/HIP-Commercial,2990.67 +33397,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMBLEMHEALTH/HIP-Commercial, +33398,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMBLEMHEALTH/HIP-Commercial, +33399,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMBLEMHEALTH/HIP-Commercial,5731.46 +33400,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMBLEMHEALTH/HIP-Commercial, +33401,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMBLEMHEALTH/HIP-Commercial, +33402,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMBLEMHEALTH/HIP-Commercial, +33403,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMBLEMHEALTH/HIP-Commercial, +33404,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMBLEMHEALTH/HIP-Commercial, +33405,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33406,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMBLEMHEALTH/HIP-Commercial, +33407,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMBLEMHEALTH/HIP-Commercial, +33408,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMBLEMHEALTH/HIP-Commercial,8266.65 +33409,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMBLEMHEALTH/HIP-Commercial, +33410,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMBLEMHEALTH/HIP-Commercial, +33411,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMBLEMHEALTH/HIP-Commercial, +33412,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +33413,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMBLEMHEALTH/HIP-Commercial, +33414,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMBLEMHEALTH/HIP-Commercial, +33415,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMBLEMHEALTH/HIP-Commercial, +33416,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMBLEMHEALTH/HIP-Commercial, +33417,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMBLEMHEALTH/HIP-Commercial,5027.0 +33418,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMBLEMHEALTH/HIP-Commercial, +33419,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMBLEMHEALTH/HIP-Commercial, +33420,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMBLEMHEALTH/HIP-Commercial, +33421,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMBLEMHEALTH/HIP-Commercial, +33422,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMBLEMHEALTH/HIP-Commercial, +33423,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMBLEMHEALTH/HIP-Commercial, +33424,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMBLEMHEALTH/HIP-Commercial,405.23 +33425,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMBLEMHEALTH/HIP-Commercial,729.08 +33426,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMBLEMHEALTH/HIP-Commercial, +33427,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMBLEMHEALTH/HIP-Commercial, +33428,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMBLEMHEALTH/HIP-Commercial, +33429,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMBLEMHEALTH/HIP-Commercial, +33430,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMBLEMHEALTH/HIP-Commercial, +33431,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMBLEMHEALTH/HIP-Commercial, +33432,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMBLEMHEALTH/HIP-Commercial, +33433,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMBLEMHEALTH/HIP-Commercial,124.68 +33434,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMBLEMHEALTH/HIP-Commercial, +33435,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMBLEMHEALTH/HIP-Commercial, +33436,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMBLEMHEALTH/HIP-Commercial, +33437,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMBLEMHEALTH/HIP-Commercial, +33438,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMBLEMHEALTH/HIP-Commercial, +33439,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMBLEMHEALTH/HIP-Commercial, +33440,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMBLEMHEALTH/HIP-Commercial, +33441,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMBLEMHEALTH/HIP-Commercial, +33442,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMBLEMHEALTH/HIP-Commercial,8266.65 +33443,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMBLEMHEALTH/HIP-Commercial, +33444,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMBLEMHEALTH/HIP-Commercial, +33445,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMBLEMHEALTH/HIP-Commercial,2149.84 +33446,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMBLEMHEALTH/HIP-Commercial,379.52 +33447,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMBLEMHEALTH/HIP-Commercial,875.68 +33448,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMBLEMHEALTH/HIP-Commercial,1829.72 +33449,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMBLEMHEALTH/HIP-Commercial,1806.33 +33450,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +33451,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMBLEMHEALTH/HIP-Commercial, +33452,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +33453,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMBLEMHEALTH/HIP-Commercial,391.68 +33454,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMBLEMHEALTH/HIP-Commercial, +33455,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMBLEMHEALTH/HIP-Commercial, +33456,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMBLEMHEALTH/HIP-Commercial, +33457,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMBLEMHEALTH/HIP-Commercial, +33458,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMBLEMHEALTH/HIP-Commercial, +33459,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMBLEMHEALTH/HIP-Commercial, +33460,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMBLEMHEALTH/HIP-Commercial, +33461,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMBLEMHEALTH/HIP-Commercial,907.13 +33462,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMBLEMHEALTH/HIP-Commercial, +33463,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMBLEMHEALTH/HIP-Commercial, +33464,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMBLEMHEALTH/HIP-Commercial, +33465,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMBLEMHEALTH/HIP-Commercial,2755.55 +33466,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMBLEMHEALTH/HIP-Commercial,1759.56 +33467,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMBLEMHEALTH/HIP-Commercial, +33468,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMBLEMHEALTH/HIP-Commercial, +33469,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMBLEMHEALTH/HIP-Commercial, +33470,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMBLEMHEALTH/HIP-Commercial,1573.62 +33471,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMBLEMHEALTH/HIP-Commercial,316.51 +33472,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMBLEMHEALTH/HIP-Commercial, +33473,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMBLEMHEALTH/HIP-Commercial, +33474,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMBLEMHEALTH/HIP-Commercial,4298.59 +33475,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMBLEMHEALTH/HIP-Commercial,1432.86 +33476,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMBLEMHEALTH/HIP-Commercial, +33477,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMBLEMHEALTH/HIP-Commercial,431.63 +33478,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMBLEMHEALTH/HIP-Commercial,431.63 +33479,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMBLEMHEALTH/HIP-Commercial, +33480,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMBLEMHEALTH/HIP-Commercial,614.18 +33481,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMBLEMHEALTH/HIP-Commercial, +33482,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMBLEMHEALTH/HIP-Commercial, +33483,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMBLEMHEALTH/HIP-Commercial, +33484,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33485,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33486,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMBLEMHEALTH/HIP-Commercial, +33487,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMBLEMHEALTH/HIP-Commercial, +33488,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMBLEMHEALTH/HIP-Commercial, +33489,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMBLEMHEALTH/HIP-Commercial,1802.66 +33490,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMBLEMHEALTH/HIP-Commercial,1931.86 +33491,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMBLEMHEALTH/HIP-Commercial, +33492,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMBLEMHEALTH/HIP-Commercial,3607.05 +33493,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMBLEMHEALTH/HIP-Commercial, +33494,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMBLEMHEALTH/HIP-Commercial,1536.52 +33495,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMBLEMHEALTH/HIP-Commercial, +33496,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMBLEMHEALTH/HIP-Commercial,2149.84 +33497,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMBLEMHEALTH/HIP-Commercial, +33498,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMBLEMHEALTH/HIP-Commercial, +33499,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMBLEMHEALTH/HIP-Commercial,5027.0 +33500,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMBLEMHEALTH/HIP-Commercial, +33501,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMBLEMHEALTH/HIP-Commercial,1759.56 +33502,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMBLEMHEALTH/HIP-Commercial,2048.75 +33503,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMBLEMHEALTH/HIP-Commercial, +33504,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMBLEMHEALTH/HIP-Commercial, +33505,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMBLEMHEALTH/HIP-Commercial, +33506,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMBLEMHEALTH/HIP-Commercial,2865.73 +33507,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMBLEMHEALTH/HIP-Commercial, +33508,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMBLEMHEALTH/HIP-Commercial, +33509,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMBLEMHEALTH/HIP-Commercial, +33510,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMBLEMHEALTH/HIP-Commercial, +33511,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMBLEMHEALTH/HIP-Commercial,4299.69 +33512,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMBLEMHEALTH/HIP-Commercial, +33513,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMBLEMHEALTH/HIP-Commercial, +33514,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMBLEMHEALTH/HIP-Commercial, +33515,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMBLEMHEALTH/HIP-Commercial, +33516,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMBLEMHEALTH/HIP-Commercial,5731.46 +33517,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMBLEMHEALTH/HIP-Commercial,2149.3 +33518,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMBLEMHEALTH/HIP-Commercial, +33519,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMBLEMHEALTH/HIP-Commercial, +33520,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMBLEMHEALTH/HIP-Commercial,7842.0 +33521,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMBLEMHEALTH/HIP-Commercial,1399.41 +33522,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMBLEMHEALTH/HIP-Commercial, +33523,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMBLEMHEALTH/HIP-Commercial, +33524,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMBLEMHEALTH/HIP-Commercial, +33525,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMBLEMHEALTH/HIP-Commercial, +33526,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMBLEMHEALTH/HIP-Commercial, +33527,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMBLEMHEALTH/HIP-Commercial,2755.55 +33528,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMBLEMHEALTH/HIP-Commercial,5299.51 +33529,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMBLEMHEALTH/HIP-Commercial, +33530,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +33531,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMBLEMHEALTH/HIP-Commercial, +33532,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMBLEMHEALTH/HIP-Commercial, +33533,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMBLEMHEALTH/HIP-Commercial,331.97 +33534,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMBLEMHEALTH/HIP-Commercial, +33535,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMBLEMHEALTH/HIP-Commercial, +33536,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMBLEMHEALTH/HIP-Commercial,5731.46 +33537,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33538,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMBLEMHEALTH/HIP-Commercial,5731.46 +33539,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMBLEMHEALTH/HIP-Commercial,2649.76 +33540,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMBLEMHEALTH/HIP-Commercial,1696.16 +33541,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMBLEMHEALTH/HIP-Commercial, +33542,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMBLEMHEALTH/HIP-Commercial, +33543,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMBLEMHEALTH/HIP-Commercial,6686.7 +33544,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMBLEMHEALTH/HIP-Commercial,3771.47 +33545,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMBLEMHEALTH/HIP-Commercial,1203.57 +33546,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMBLEMHEALTH/HIP-Commercial, +33547,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMBLEMHEALTH/HIP-Commercial, +33548,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMBLEMHEALTH/HIP-Commercial,1526.09 +33549,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMBLEMHEALTH/HIP-Commercial, +33550,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMBLEMHEALTH/HIP-Commercial, +33551,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMBLEMHEALTH/HIP-Commercial,5511.1 +33552,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMBLEMHEALTH/HIP-Commercial,5731.46 +33553,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMBLEMHEALTH/HIP-Commercial,8597.18 +33554,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMBLEMHEALTH/HIP-Commercial, +33555,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMBLEMHEALTH/HIP-Commercial,2614.0 +33556,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMBLEMHEALTH/HIP-Commercial,8597.18 +33557,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMBLEMHEALTH/HIP-Commercial, +33558,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMBLEMHEALTH/HIP-Commercial,2066.67 +33559,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33560,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMBLEMHEALTH/HIP-Commercial,4133.33 +33561,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMBLEMHEALTH/HIP-Commercial,6637.82 +33562,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMBLEMHEALTH/HIP-Commercial, +33563,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMBLEMHEALTH/HIP-Commercial,5511.1 +33564,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMBLEMHEALTH/HIP-Commercial, +33565,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMBLEMHEALTH/HIP-Commercial,4710.2 +33566,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMBLEMHEALTH/HIP-Commercial, +33567,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMBLEMHEALTH/HIP-Commercial,8597.18 +33568,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMBLEMHEALTH/HIP-Commercial, +33569,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMBLEMHEALTH/HIP-Commercial, +33570,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMBLEMHEALTH/HIP-Commercial,2704.87 +33571,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMBLEMHEALTH/HIP-Commercial, +33572,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMBLEMHEALTH/HIP-Commercial,1034.7 +33573,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMBLEMHEALTH/HIP-Commercial,842.92 +33574,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMBLEMHEALTH/HIP-Commercial,5731.46 +33575,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33576,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMBLEMHEALTH/HIP-Commercial, +33577,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMBLEMHEALTH/HIP-Commercial, +33578,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +33579,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMBLEMHEALTH/HIP-Commercial, +33580,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMBLEMHEALTH/HIP-Commercial, +33581,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMBLEMHEALTH/HIP-Commercial, +33582,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMBLEMHEALTH/HIP-Commercial, +33583,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMBLEMHEALTH/HIP-Commercial, +33584,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMBLEMHEALTH/HIP-Commercial,1260.18 +33585,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMBLEMHEALTH/HIP-Commercial,2755.55 +33586,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMBLEMHEALTH/HIP-Commercial, +33587,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMBLEMHEALTH/HIP-Commercial, +33588,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMBLEMHEALTH/HIP-Commercial,2311.92 +33589,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMBLEMHEALTH/HIP-Commercial,582.2 +33590,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMBLEMHEALTH/HIP-Commercial, +33591,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMBLEMHEALTH/HIP-Commercial, +33592,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMBLEMHEALTH/HIP-Commercial, +33593,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMBLEMHEALTH/HIP-Commercial,5731.46 +33594,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMBLEMHEALTH/HIP-Commercial, +33595,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMBLEMHEALTH/HIP-Commercial, +33596,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMBLEMHEALTH/HIP-Commercial, +33597,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMBLEMHEALTH/HIP-Commercial, +33598,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMBLEMHEALTH/HIP-Commercial, +33599,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMBLEMHEALTH/HIP-Commercial,1377.78 +33600,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMBLEMHEALTH/HIP-Commercial, +33601,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMBLEMHEALTH/HIP-Commercial, +33602,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMBLEMHEALTH/HIP-Commercial,3974.64 +33603,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMBLEMHEALTH/HIP-Commercial, +33604,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMBLEMHEALTH/HIP-Commercial, +33605,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMBLEMHEALTH/HIP-Commercial,2480.0 +33606,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMBLEMHEALTH/HIP-Commercial, +33607,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMBLEMHEALTH/HIP-Commercial, +33608,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMBLEMHEALTH/HIP-Commercial, +33609,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMBLEMHEALTH/HIP-Commercial, +33610,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33611,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMBLEMHEALTH/HIP-Commercial, +33612,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMBLEMHEALTH/HIP-Commercial, +33613,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMBLEMHEALTH/HIP-Commercial, +33614,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMBLEMHEALTH/HIP-Commercial, +33615,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMBLEMHEALTH/HIP-Commercial, +33616,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMBLEMHEALTH/HIP-Commercial, +33617,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMBLEMHEALTH/HIP-Commercial, +33618,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +33619,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +33620,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMBLEMHEALTH/HIP-Commercial, +33621,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMBLEMHEALTH/HIP-Commercial, +33622,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMBLEMHEALTH/HIP-Commercial,2865.73 +33623,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMBLEMHEALTH/HIP-Commercial, +33624,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMBLEMHEALTH/HIP-Commercial, +33625,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMBLEMHEALTH/HIP-Commercial, +33626,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMBLEMHEALTH/HIP-Commercial, +33627,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMBLEMHEALTH/HIP-Commercial,1033.54 +33628,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMBLEMHEALTH/HIP-Commercial,2067.07 +33629,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMBLEMHEALTH/HIP-Commercial, +33630,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMBLEMHEALTH/HIP-Commercial, +33631,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMBLEMHEALTH/HIP-Commercial,6188.62 +33632,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMBLEMHEALTH/HIP-Commercial, +33633,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMBLEMHEALTH/HIP-Commercial, +33634,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMBLEMHEALTH/HIP-Commercial, +33635,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMBLEMHEALTH/HIP-Commercial, +33636,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMBLEMHEALTH/HIP-Commercial, +33637,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMBLEMHEALTH/HIP-Commercial,4943.16 +33638,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMBLEMHEALTH/HIP-Commercial, +33639,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMBLEMHEALTH/HIP-Commercial, +33640,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +33641,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMBLEMHEALTH/HIP-Commercial, +33642,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMBLEMHEALTH/HIP-Commercial, +33643,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMBLEMHEALTH/HIP-Commercial, +33644,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMBLEMHEALTH/HIP-Commercial, +33645,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMBLEMHEALTH/HIP-Commercial, +33646,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-Commercial, +33647,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMBLEMHEALTH/HIP-Commercial, +33648,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMBLEMHEALTH/HIP-Commercial, +33649,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMBLEMHEALTH/HIP-Commercial, +33650,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMBLEMHEALTH/HIP-Commercial, +33651,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMBLEMHEALTH/HIP-Commercial,5731.46 +33652,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMBLEMHEALTH/HIP-Commercial, +33653,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMBLEMHEALTH/HIP-Commercial, +33654,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMBLEMHEALTH/HIP-Commercial, +33655,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMBLEMHEALTH/HIP-Commercial, +33656,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMBLEMHEALTH/HIP-Commercial, +33657,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMBLEMHEALTH/HIP-Commercial,13878.07 +33658,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMBLEMHEALTH/HIP-Commercial,1910.48 +33659,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMBLEMHEALTH/HIP-Commercial,1377.78 +33660,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMBLEMHEALTH/HIP-Commercial,2755.55 +33661,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMBLEMHEALTH/HIP-Commercial, +33662,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMBLEMHEALTH/HIP-Commercial, +33663,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMBLEMHEALTH/HIP-Commercial, +33664,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMBLEMHEALTH/HIP-Commercial, +33665,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMBLEMHEALTH/HIP-Commercial,5511.1 +33666,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMBLEMHEALTH/HIP-Commercial, +33667,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMBLEMHEALTH/HIP-Commercial,5731.46 +33668,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMBLEMHEALTH/HIP-Commercial, +33669,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMBLEMHEALTH/HIP-Commercial, +33670,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMBLEMHEALTH/HIP-Commercial, +33671,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMBLEMHEALTH/HIP-Commercial, +33672,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMBLEMHEALTH/HIP-Commercial, +33673,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMBLEMHEALTH/HIP-Commercial, +33674,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMBLEMHEALTH/HIP-Commercial, +33675,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMBLEMHEALTH/HIP-Commercial, +33676,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMBLEMHEALTH/HIP-Commercial, +33677,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMBLEMHEALTH/HIP-Commercial, +33678,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMBLEMHEALTH/HIP-Commercial, +33679,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMBLEMHEALTH/HIP-Commercial, +33680,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMBLEMHEALTH/HIP-Commercial, +33681,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMBLEMHEALTH/HIP-Commercial,1372.57 +33682,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMBLEMHEALTH/HIP-Commercial,1674.89 +33683,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMBLEMHEALTH/HIP-Commercial, +33684,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33685,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMBLEMHEALTH/HIP-Commercial,5027.0 +33686,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMBLEMHEALTH/HIP-Commercial, +33687,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMBLEMHEALTH/HIP-Commercial, +33688,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMBLEMHEALTH/HIP-Commercial, +33689,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMBLEMHEALTH/HIP-Commercial,4330.08 +33690,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMBLEMHEALTH/HIP-Commercial, +33691,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMBLEMHEALTH/HIP-Commercial, +33692,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMBLEMHEALTH/HIP-Commercial, +33693,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMBLEMHEALTH/HIP-Commercial, +33694,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMBLEMHEALTH/HIP-Commercial, +33695,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMBLEMHEALTH/HIP-Commercial, +33696,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMBLEMHEALTH/HIP-Commercial, +33697,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMBLEMHEALTH/HIP-Commercial, +33698,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMBLEMHEALTH/HIP-Commercial, +33699,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +33700,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMBLEMHEALTH/HIP-Commercial,2872.53 +33701,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMBLEMHEALTH/HIP-Commercial, +33702,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMBLEMHEALTH/HIP-Commercial, +33703,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMBLEMHEALTH/HIP-Commercial, +33704,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMBLEMHEALTH/HIP-Commercial, +33705,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMBLEMHEALTH/HIP-Commercial, +33706,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMBLEMHEALTH/HIP-Commercial, +33707,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMBLEMHEALTH/HIP-Commercial, +33708,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMBLEMHEALTH/HIP-Commercial, +33709,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMBLEMHEALTH/HIP-Commercial, +33710,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMBLEMHEALTH/HIP-Commercial, +33711,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMBLEMHEALTH/HIP-Commercial, +33712,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMBLEMHEALTH/HIP-Commercial, +33713,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMBLEMHEALTH/HIP-Commercial, +33714,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMBLEMHEALTH/HIP-Commercial, +33715,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMBLEMHEALTH/HIP-Commercial, +33716,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMBLEMHEALTH/HIP-Commercial, +33717,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMBLEMHEALTH/HIP-Commercial, +33718,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMBLEMHEALTH/HIP-Commercial, +33719,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMBLEMHEALTH/HIP-Commercial,572.04 +33720,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMBLEMHEALTH/HIP-Commercial, +33721,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMBLEMHEALTH/HIP-Commercial, +33722,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMBLEMHEALTH/HIP-Commercial, +33723,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMBLEMHEALTH/HIP-Commercial, +33724,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMBLEMHEALTH/HIP-Commercial,13372.95 +33725,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMBLEMHEALTH/HIP-Commercial,3832.75 +33726,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMBLEMHEALTH/HIP-Commercial, +33727,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMBLEMHEALTH/HIP-Commercial, +33728,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33729,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMBLEMHEALTH/HIP-Commercial, +33730,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMBLEMHEALTH/HIP-Commercial, +33731,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMBLEMHEALTH/HIP-Commercial, +33732,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMBLEMHEALTH/HIP-Commercial, +33733,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMBLEMHEALTH/HIP-Commercial, +33734,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMBLEMHEALTH/HIP-Commercial,3614.43 +33735,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMBLEMHEALTH/HIP-Commercial, +33736,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMBLEMHEALTH/HIP-Commercial, +33737,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMBLEMHEALTH/HIP-Commercial, +33738,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMBLEMHEALTH/HIP-Commercial, +33739,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMBLEMHEALTH/HIP-Commercial, +33740,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMBLEMHEALTH/HIP-Commercial,5511.1 +33741,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMBLEMHEALTH/HIP-Commercial, +33742,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMBLEMHEALTH/HIP-Commercial, +33743,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33744,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMBLEMHEALTH/HIP-Commercial, +33745,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMBLEMHEALTH/HIP-Commercial, +33746,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMBLEMHEALTH/HIP-Commercial, +33747,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMBLEMHEALTH/HIP-Commercial, +33748,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMBLEMHEALTH/HIP-Commercial, +33749,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMBLEMHEALTH/HIP-Commercial, +33750,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMBLEMHEALTH/HIP-Commercial, +33751,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMBLEMHEALTH/HIP-Commercial,5511.1 +33752,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMBLEMHEALTH/HIP-Commercial, +33753,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +33754,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMBLEMHEALTH/HIP-Commercial,6026.91 +33755,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMBLEMHEALTH/HIP-Commercial, +33756,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMBLEMHEALTH/HIP-Commercial,2865.73 +33757,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMBLEMHEALTH/HIP-Commercial,612.31 +33758,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMBLEMHEALTH/HIP-Commercial,3802.49 +33759,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMBLEMHEALTH/HIP-Commercial, +33760,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMBLEMHEALTH/HIP-Commercial,4578.15 +33761,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMBLEMHEALTH/HIP-Commercial, +33762,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMBLEMHEALTH/HIP-Commercial,7482.6 +33763,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMBLEMHEALTH/HIP-Commercial,7517.33 +33764,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMBLEMHEALTH/HIP-Commercial,3159.77 +33765,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMBLEMHEALTH/HIP-Commercial, +33766,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMBLEMHEALTH/HIP-Commercial, +33767,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMBLEMHEALTH/HIP-Commercial, +33768,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMBLEMHEALTH/HIP-Commercial, +33769,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMBLEMHEALTH/HIP-Commercial,2515.17 +33770,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMBLEMHEALTH/HIP-Commercial,408.07 +33771,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMBLEMHEALTH/HIP-Commercial, +33772,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMBLEMHEALTH/HIP-Commercial,5228.0 +33773,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMBLEMHEALTH/HIP-Commercial, +33774,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMBLEMHEALTH/HIP-Commercial, +33775,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMBLEMHEALTH/HIP-Commercial, +33776,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMBLEMHEALTH/HIP-Commercial, +33777,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMBLEMHEALTH/HIP-Commercial,1536.52 +33778,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMBLEMHEALTH/HIP-Commercial, +33779,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMBLEMHEALTH/HIP-Commercial,5511.1 +33780,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMBLEMHEALTH/HIP-Commercial,5511.1 +33781,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMBLEMHEALTH/HIP-Commercial, +33782,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMBLEMHEALTH/HIP-Commercial, +33783,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMBLEMHEALTH/HIP-Commercial,5228.0 +33784,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMBLEMHEALTH/HIP-Commercial,1569.62 +33785,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33786,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMBLEMHEALTH/HIP-Commercial, +33787,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMBLEMHEALTH/HIP-Commercial, +33788,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMBLEMHEALTH/HIP-Commercial, +33789,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMBLEMHEALTH/HIP-Commercial, +33790,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33791,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMBLEMHEALTH/HIP-Commercial, +33792,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMBLEMHEALTH/HIP-Commercial, +33793,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMBLEMHEALTH/HIP-Commercial,5511.1 +33794,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMBLEMHEALTH/HIP-Commercial,5511.1 +33795,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMBLEMHEALTH/HIP-Commercial, +33796,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMBLEMHEALTH/HIP-Commercial, +33797,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMBLEMHEALTH/HIP-Commercial, +33798,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMBLEMHEALTH/HIP-Commercial,8266.65 +33799,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMBLEMHEALTH/HIP-Commercial, +33800,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMBLEMHEALTH/HIP-Commercial, +33801,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMBLEMHEALTH/HIP-Commercial, +33802,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMBLEMHEALTH/HIP-Commercial, +33803,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMBLEMHEALTH/HIP-Commercial, +33804,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMBLEMHEALTH/HIP-Commercial, +33805,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMBLEMHEALTH/HIP-Commercial,5731.46 +33806,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +33807,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMBLEMHEALTH/HIP-Commercial, +33808,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMBLEMHEALTH/HIP-Commercial, +33809,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMBLEMHEALTH/HIP-Commercial, +33810,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMBLEMHEALTH/HIP-Commercial, +33811,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMBLEMHEALTH/HIP-Commercial,673.55 +33812,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMBLEMHEALTH/HIP-Commercial, +33813,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMBLEMHEALTH/HIP-Commercial,4213.02 +33814,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33815,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMBLEMHEALTH/HIP-Commercial, +33816,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMBLEMHEALTH/HIP-Commercial, +33817,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMBLEMHEALTH/HIP-Commercial, +33818,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMBLEMHEALTH/HIP-Commercial, +33819,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMBLEMHEALTH/HIP-Commercial, +33820,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMBLEMHEALTH/HIP-Commercial, +33821,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMBLEMHEALTH/HIP-Commercial,5511.1 +33822,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMBLEMHEALTH/HIP-Commercial,3380.51 +33823,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMBLEMHEALTH/HIP-Commercial, +33824,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMBLEMHEALTH/HIP-Commercial, +33825,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMBLEMHEALTH/HIP-Commercial, +33826,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMBLEMHEALTH/HIP-Commercial, +33827,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMBLEMHEALTH/HIP-Commercial, +33828,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMBLEMHEALTH/HIP-Commercial,1466.39 +33829,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMBLEMHEALTH/HIP-Commercial,3150.06 +33830,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +33831,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMBLEMHEALTH/HIP-Commercial, +33832,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMBLEMHEALTH/HIP-Commercial, +33833,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMBLEMHEALTH/HIP-Commercial, +33834,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMBLEMHEALTH/HIP-Commercial, +33835,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMBLEMHEALTH/HIP-Commercial,8597.18 +33836,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMBLEMHEALTH/HIP-Commercial, +33837,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMBLEMHEALTH/HIP-Commercial, +33838,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMBLEMHEALTH/HIP-Commercial, +33839,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMBLEMHEALTH/HIP-Commercial, +33840,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMBLEMHEALTH/HIP-Commercial, +33841,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMBLEMHEALTH/HIP-Commercial, +33842,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMBLEMHEALTH/HIP-Commercial, +33843,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMBLEMHEALTH/HIP-Commercial, +33844,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMBLEMHEALTH/HIP-Commercial, +33845,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMBLEMHEALTH/HIP-Commercial, +33846,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMBLEMHEALTH/HIP-Commercial, +33847,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMBLEMHEALTH/HIP-Commercial, +33848,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMBLEMHEALTH/HIP-Commercial, +33849,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMBLEMHEALTH/HIP-Commercial, +33850,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMBLEMHEALTH/HIP-Commercial, +33851,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33852,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMBLEMHEALTH/HIP-Commercial, +33853,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMBLEMHEALTH/HIP-Commercial,2861.38 +33854,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMBLEMHEALTH/HIP-Commercial, +33855,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMBLEMHEALTH/HIP-Commercial, +33856,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMBLEMHEALTH/HIP-Commercial, +33857,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMBLEMHEALTH/HIP-Commercial, +33858,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMBLEMHEALTH/HIP-Commercial, +33859,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33860,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMBLEMHEALTH/HIP-Commercial, +33861,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMBLEMHEALTH/HIP-Commercial, +33862,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMBLEMHEALTH/HIP-Commercial,2628.01 +33863,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMBLEMHEALTH/HIP-Commercial, +33864,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMBLEMHEALTH/HIP-Commercial,2168.37 +33865,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMBLEMHEALTH/HIP-Commercial,2891.16 +33866,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMBLEMHEALTH/HIP-Commercial, +33867,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMBLEMHEALTH/HIP-Commercial, +33868,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMBLEMHEALTH/HIP-Commercial, +33869,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMBLEMHEALTH/HIP-Commercial, +33870,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMBLEMHEALTH/HIP-Commercial, +33871,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMBLEMHEALTH/HIP-Commercial, +33872,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMBLEMHEALTH/HIP-Commercial, +33873,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMBLEMHEALTH/HIP-Commercial, +33874,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMBLEMHEALTH/HIP-Commercial, +33875,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMBLEMHEALTH/HIP-Commercial, +33876,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMBLEMHEALTH/HIP-Commercial, +33877,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMBLEMHEALTH/HIP-Commercial, +33878,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMBLEMHEALTH/HIP-Commercial, +33879,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMBLEMHEALTH/HIP-Commercial, +33880,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMBLEMHEALTH/HIP-Commercial, +33881,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMBLEMHEALTH/HIP-Commercial, +33882,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMBLEMHEALTH/HIP-Commercial, +33883,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33884,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMBLEMHEALTH/HIP-Commercial,2925.57 +33885,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMBLEMHEALTH/HIP-Commercial, +33886,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMBLEMHEALTH/HIP-Commercial, +33887,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMBLEMHEALTH/HIP-Commercial, +33888,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMBLEMHEALTH/HIP-Commercial, +33889,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMBLEMHEALTH/HIP-Commercial, +33890,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMBLEMHEALTH/HIP-Commercial, +33891,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMBLEMHEALTH/HIP-Commercial, +33892,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMBLEMHEALTH/HIP-Commercial,5511.1 +33893,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMBLEMHEALTH/HIP-Commercial, +33894,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMBLEMHEALTH/HIP-Commercial,2128.96 +33895,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMBLEMHEALTH/HIP-Commercial,8597.18 +33896,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMBLEMHEALTH/HIP-Commercial, +33897,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMBLEMHEALTH/HIP-Commercial, +33898,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMBLEMHEALTH/HIP-Commercial,4298.59 +33899,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMBLEMHEALTH/HIP-Commercial, +33900,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMBLEMHEALTH/HIP-Commercial, +33901,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMBLEMHEALTH/HIP-Commercial, +33902,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMBLEMHEALTH/HIP-Commercial, +33903,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMBLEMHEALTH/HIP-Commercial, +33904,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMBLEMHEALTH/HIP-Commercial,1759.56 +33905,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMBLEMHEALTH/HIP-Commercial, +33906,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMBLEMHEALTH/HIP-Commercial, +33907,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMBLEMHEALTH/HIP-Commercial, +33908,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMBLEMHEALTH/HIP-Commercial, +33909,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMBLEMHEALTH/HIP-Commercial, +33910,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMBLEMHEALTH/HIP-Commercial, +33911,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMBLEMHEALTH/HIP-Commercial,7482.6 +33912,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMBLEMHEALTH/HIP-Commercial, +33913,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMBLEMHEALTH/HIP-Commercial, +33914,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMBLEMHEALTH/HIP-Commercial, +33915,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMBLEMHEALTH/HIP-Commercial, +33916,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMBLEMHEALTH/HIP-Commercial, +33917,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMBLEMHEALTH/HIP-Commercial, +33918,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMBLEMHEALTH/HIP-Commercial, +33919,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMBLEMHEALTH/HIP-Commercial, +33920,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMBLEMHEALTH/HIP-Commercial, +33921,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMBLEMHEALTH/HIP-Commercial, +33922,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMBLEMHEALTH/HIP-Commercial, +33923,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMBLEMHEALTH/HIP-Commercial, +33924,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMBLEMHEALTH/HIP-Commercial, +33925,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMBLEMHEALTH/HIP-Commercial, +33926,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMBLEMHEALTH/HIP-Commercial, +33927,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMBLEMHEALTH/HIP-Commercial, +33928,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMBLEMHEALTH/HIP-Commercial, +33929,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMBLEMHEALTH/HIP-Commercial, +33930,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMBLEMHEALTH/HIP-Commercial, +33931,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMBLEMHEALTH/HIP-Commercial, +33932,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMBLEMHEALTH/HIP-Commercial, +33933,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMBLEMHEALTH/HIP-Commercial, +33934,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMBLEMHEALTH/HIP-Commercial, +33935,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMBLEMHEALTH/HIP-Commercial, +33936,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMBLEMHEALTH/HIP-Commercial, +33937,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMBLEMHEALTH/HIP-Commercial, +33938,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +33939,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMBLEMHEALTH/HIP-Commercial, +33940,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +33941,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMBLEMHEALTH/HIP-Commercial, +33942,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +33943,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMBLEMHEALTH/HIP-Commercial, +33944,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMBLEMHEALTH/HIP-Commercial,5731.46 +33945,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMBLEMHEALTH/HIP-Commercial, +33946,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMBLEMHEALTH/HIP-Commercial, +33947,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMBLEMHEALTH/HIP-Commercial, +33948,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMBLEMHEALTH/HIP-Commercial, +33949,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMBLEMHEALTH/HIP-Commercial, +33950,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMBLEMHEALTH/HIP-Commercial, +33951,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMBLEMHEALTH/HIP-Commercial,4168.67 +33952,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMBLEMHEALTH/HIP-Commercial, +33953,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMBLEMHEALTH/HIP-Commercial, +33954,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMBLEMHEALTH/HIP-Commercial, +33955,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMBLEMHEALTH/HIP-Commercial, +33956,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMBLEMHEALTH/HIP-Commercial, +33957,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +33958,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMBLEMHEALTH/HIP-Commercial,2383.44 +33959,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMBLEMHEALTH/HIP-Commercial, +33960,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMBLEMHEALTH/HIP-Commercial, +33961,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMBLEMHEALTH/HIP-Commercial, +33962,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMBLEMHEALTH/HIP-Commercial, +33963,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMBLEMHEALTH/HIP-Commercial, +33964,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +33965,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMBLEMHEALTH/HIP-Commercial,1074.92 +33966,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMBLEMHEALTH/HIP-Commercial,4213.02 +33967,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMBLEMHEALTH/HIP-Commercial, +33968,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMBLEMHEALTH/HIP-Commercial, +33969,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMBLEMHEALTH/HIP-Commercial, +33970,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMBLEMHEALTH/HIP-Commercial, +33971,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMBLEMHEALTH/HIP-Commercial, +33972,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMBLEMHEALTH/HIP-Commercial, +33973,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMBLEMHEALTH/HIP-Commercial,612.31 +33974,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMBLEMHEALTH/HIP-Commercial, +33975,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMBLEMHEALTH/HIP-Commercial,5511.1 +33976,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMBLEMHEALTH/HIP-Commercial, +33977,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMBLEMHEALTH/HIP-Commercial, +33978,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMBLEMHEALTH/HIP-Commercial, +33979,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMBLEMHEALTH/HIP-Commercial, +33980,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMBLEMHEALTH/HIP-Commercial, +33981,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMBLEMHEALTH/HIP-Commercial, +33982,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMBLEMHEALTH/HIP-Commercial,5731.46 +33983,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMBLEMHEALTH/HIP-Commercial, +33984,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMBLEMHEALTH/HIP-Commercial,3315.09 +33985,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMBLEMHEALTH/HIP-Commercial, +33986,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMBLEMHEALTH/HIP-Commercial, +33987,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMBLEMHEALTH/HIP-Commercial,1334.64 +33988,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +33989,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +33990,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMBLEMHEALTH/HIP-Commercial,281.45 +33991,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMBLEMHEALTH/HIP-Commercial, +33992,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMBLEMHEALTH/HIP-Commercial, +33993,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMBLEMHEALTH/HIP-Commercial,330.15 +33994,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMBLEMHEALTH/HIP-Commercial, +33995,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMBLEMHEALTH/HIP-Commercial, +33996,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +33997,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMBLEMHEALTH/HIP-Commercial,463.12 +33998,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMBLEMHEALTH/HIP-Commercial, +33999,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMBLEMHEALTH/HIP-Commercial, +34000,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMBLEMHEALTH/HIP-Commercial, +34001,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMBLEMHEALTH/HIP-Commercial,5827.93 +34002,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMBLEMHEALTH/HIP-Commercial, +34003,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +34004,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34005,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMBLEMHEALTH/HIP-Commercial, +34006,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMBLEMHEALTH/HIP-Commercial, +34007,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMBLEMHEALTH/HIP-Commercial,1033.54 +34008,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMBLEMHEALTH/HIP-Commercial, +34009,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMBLEMHEALTH/HIP-Commercial,2067.07 +34010,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMBLEMHEALTH/HIP-Commercial,13922.19 +34011,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMBLEMHEALTH/HIP-Commercial,8754.51 +34012,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMBLEMHEALTH/HIP-Commercial, +34013,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMBLEMHEALTH/HIP-Commercial, +34014,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMBLEMHEALTH/HIP-Commercial, +34015,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMBLEMHEALTH/HIP-Commercial,2969.47 +34016,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMBLEMHEALTH/HIP-Commercial, +34017,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMBLEMHEALTH/HIP-Commercial, +34018,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMBLEMHEALTH/HIP-Commercial, +34019,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMBLEMHEALTH/HIP-Commercial, +34020,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMBLEMHEALTH/HIP-Commercial, +34021,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMBLEMHEALTH/HIP-Commercial,5511.1 +34022,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34023,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMBLEMHEALTH/HIP-Commercial, +34024,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMBLEMHEALTH/HIP-Commercial,3455.62 +34025,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMBLEMHEALTH/HIP-Commercial, +34026,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34027,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMBLEMHEALTH/HIP-Commercial, +34028,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMBLEMHEALTH/HIP-Commercial,3639.72 +34029,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMBLEMHEALTH/HIP-Commercial, +34030,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMBLEMHEALTH/HIP-Commercial, +34031,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +34032,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMBLEMHEALTH/HIP-Commercial, +34033,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMBLEMHEALTH/HIP-Commercial,5925.86 +34034,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMBLEMHEALTH/HIP-Commercial, +34035,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMBLEMHEALTH/HIP-Commercial, +34036,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +34037,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMBLEMHEALTH/HIP-Commercial, +34038,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMBLEMHEALTH/HIP-Commercial, +34039,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMBLEMHEALTH/HIP-Commercial, +34040,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMBLEMHEALTH/HIP-Commercial,3049.08 +34041,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMBLEMHEALTH/HIP-Commercial, +34042,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMBLEMHEALTH/HIP-Commercial,146.69 +34043,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +34044,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMBLEMHEALTH/HIP-Commercial,4029.75 +34045,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMBLEMHEALTH/HIP-Commercial, +34046,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMBLEMHEALTH/HIP-Commercial,4738.25 +34047,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMBLEMHEALTH/HIP-Commercial, +34048,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMBLEMHEALTH/HIP-Commercial, +34049,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMBLEMHEALTH/HIP-Commercial, +34050,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMBLEMHEALTH/HIP-Commercial, +34051,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMBLEMHEALTH/HIP-Commercial, +34052,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMBLEMHEALTH/HIP-Commercial, +34053,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMBLEMHEALTH/HIP-Commercial,4134.15 +34054,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMBLEMHEALTH/HIP-Commercial, +34055,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMBLEMHEALTH/HIP-Commercial,2445.52 +34056,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMBLEMHEALTH/HIP-Commercial, +34057,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMBLEMHEALTH/HIP-Commercial, +34058,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMBLEMHEALTH/HIP-Commercial, +34059,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMBLEMHEALTH/HIP-Commercial, +34060,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMBLEMHEALTH/HIP-Commercial,3459.56 +34061,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMBLEMHEALTH/HIP-Commercial, +34062,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMBLEMHEALTH/HIP-Commercial, +34063,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMBLEMHEALTH/HIP-Commercial, +34064,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMBLEMHEALTH/HIP-Commercial, +34065,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMBLEMHEALTH/HIP-Commercial, +34066,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMBLEMHEALTH/HIP-Commercial,1991.42 +34067,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMBLEMHEALTH/HIP-Commercial, +34068,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMBLEMHEALTH/HIP-Commercial, +34069,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMBLEMHEALTH/HIP-Commercial,2146.79 +34070,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMBLEMHEALTH/HIP-Commercial, +34071,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMBLEMHEALTH/HIP-Commercial, +34072,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMBLEMHEALTH/HIP-Commercial,241.78 +34073,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMBLEMHEALTH/HIP-Commercial, +34074,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMBLEMHEALTH/HIP-Commercial, +34075,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMBLEMHEALTH/HIP-Commercial, +34076,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMBLEMHEALTH/HIP-Commercial, +34077,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMBLEMHEALTH/HIP-Commercial, +34078,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMBLEMHEALTH/HIP-Commercial, +34079,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMBLEMHEALTH/HIP-Commercial, +34080,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMBLEMHEALTH/HIP-Commercial,3629.23 +34081,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMBLEMHEALTH/HIP-Commercial, +34082,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMBLEMHEALTH/HIP-Commercial,2123.42 +34083,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMBLEMHEALTH/HIP-Commercial,3614.21 +34084,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMBLEMHEALTH/HIP-Commercial, +34085,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMBLEMHEALTH/HIP-Commercial,582.83 +34086,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMBLEMHEALTH/HIP-Commercial, +34087,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMBLEMHEALTH/HIP-Commercial, +34088,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMBLEMHEALTH/HIP-Commercial, +34089,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34090,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMBLEMHEALTH/HIP-Commercial, +34091,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMBLEMHEALTH/HIP-Commercial,1829.72 +34092,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMBLEMHEALTH/HIP-Commercial,1643.7 +34093,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMBLEMHEALTH/HIP-Commercial, +34094,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMBLEMHEALTH/HIP-Commercial,5191.13 +34095,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMBLEMHEALTH/HIP-Commercial,11716.78 +34096,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34097,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMBLEMHEALTH/HIP-Commercial,9200.96 +34098,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMBLEMHEALTH/HIP-Commercial, +34099,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMBLEMHEALTH/HIP-Commercial, +34100,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMBLEMHEALTH/HIP-Commercial, +34101,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMBLEMHEALTH/HIP-Commercial, +34102,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMBLEMHEALTH/HIP-Commercial, +34103,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMBLEMHEALTH/HIP-Commercial, +34104,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMBLEMHEALTH/HIP-Commercial, +34105,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMBLEMHEALTH/HIP-Commercial, +34106,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMBLEMHEALTH/HIP-Commercial, +34107,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMBLEMHEALTH/HIP-Commercial,11329.63 +34108,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMBLEMHEALTH/HIP-Commercial,6954.46 +34109,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMBLEMHEALTH/HIP-Commercial, +34110,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMBLEMHEALTH/HIP-Commercial, +34111,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMBLEMHEALTH/HIP-Commercial, +34112,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMBLEMHEALTH/HIP-Commercial,886.69 +34113,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMBLEMHEALTH/HIP-Commercial,2661.8 +34114,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMBLEMHEALTH/HIP-Commercial, +34115,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMBLEMHEALTH/HIP-Commercial, +34116,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMBLEMHEALTH/HIP-Commercial, +34117,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMBLEMHEALTH/HIP-Commercial,5511.1 +34118,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMBLEMHEALTH/HIP-Commercial, +34119,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMBLEMHEALTH/HIP-Commercial, +34120,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMBLEMHEALTH/HIP-Commercial,4310.6 +34121,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMBLEMHEALTH/HIP-Commercial,1816.96 +34122,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMBLEMHEALTH/HIP-Commercial,2649.76 +34123,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMBLEMHEALTH/HIP-Commercial, +34124,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMBLEMHEALTH/HIP-Commercial, +34125,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMBLEMHEALTH/HIP-Commercial, +34126,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMBLEMHEALTH/HIP-Commercial,12668.63 +34127,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMBLEMHEALTH/HIP-Commercial, +34128,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMBLEMHEALTH/HIP-Commercial, +34129,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMBLEMHEALTH/HIP-Commercial, +34130,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMBLEMHEALTH/HIP-Commercial, +34131,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMBLEMHEALTH/HIP-Commercial, +34132,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMBLEMHEALTH/HIP-Commercial, +34133,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMBLEMHEALTH/HIP-Commercial, +34134,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMBLEMHEALTH/HIP-Commercial, +34135,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMBLEMHEALTH/HIP-Commercial, +34136,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMBLEMHEALTH/HIP-Commercial,12423.16 +34137,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMBLEMHEALTH/HIP-Commercial, +34138,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMBLEMHEALTH/HIP-Commercial, +34139,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMBLEMHEALTH/HIP-Commercial, +34140,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMBLEMHEALTH/HIP-Commercial, +34141,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMBLEMHEALTH/HIP-Commercial, +34142,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMBLEMHEALTH/HIP-Commercial, +34143,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMBLEMHEALTH/HIP-Commercial,14231.58 +34144,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMBLEMHEALTH/HIP-Commercial,27985.25 +34145,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMBLEMHEALTH/HIP-Commercial, +34146,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMBLEMHEALTH/HIP-Commercial,37998.3 +34147,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMBLEMHEALTH/HIP-Commercial,37951.29 +34148,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMBLEMHEALTH/HIP-Commercial, +34149,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMBLEMHEALTH/HIP-Commercial, +34150,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMBLEMHEALTH/HIP-Commercial,14607.59 +34151,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMBLEMHEALTH/HIP-Commercial,4299.69 +34152,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMBLEMHEALTH/HIP-Commercial, +34153,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMBLEMHEALTH/HIP-Commercial,5406.22 +34154,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMBLEMHEALTH/HIP-Commercial, +34155,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +34156,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMBLEMHEALTH/HIP-Commercial, +34157,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMBLEMHEALTH/HIP-Commercial, +34158,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMBLEMHEALTH/HIP-Commercial, +34159,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMBLEMHEALTH/HIP-Commercial, +34160,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMBLEMHEALTH/HIP-Commercial, +34161,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMBLEMHEALTH/HIP-Commercial, +34162,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMBLEMHEALTH/HIP-Commercial, +34163,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMBLEMHEALTH/HIP-Commercial, +34164,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMBLEMHEALTH/HIP-Commercial, +34165,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMBLEMHEALTH/HIP-Commercial, +34166,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMBLEMHEALTH/HIP-Commercial,4578.15 +34167,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMBLEMHEALTH/HIP-Commercial, +34168,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMBLEMHEALTH/HIP-Commercial, +34169,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMBLEMHEALTH/HIP-Commercial, +34170,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMBLEMHEALTH/HIP-Commercial, +34171,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMBLEMHEALTH/HIP-Commercial,2755.55 +34172,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMBLEMHEALTH/HIP-Commercial, +34173,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMBLEMHEALTH/HIP-Commercial, +34174,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMBLEMHEALTH/HIP-Commercial, +34175,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMBLEMHEALTH/HIP-Commercial, +34176,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMBLEMHEALTH/HIP-Commercial,7164.32 +34177,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMBLEMHEALTH/HIP-Commercial,5587.22 +34178,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMBLEMHEALTH/HIP-Commercial, +34179,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMBLEMHEALTH/HIP-Commercial,2865.73 +34180,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMBLEMHEALTH/HIP-Commercial,2066.67 +34181,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMBLEMHEALTH/HIP-Commercial, +34182,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMBLEMHEALTH/HIP-Commercial, +34183,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMBLEMHEALTH/HIP-Commercial, +34184,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMBLEMHEALTH/HIP-Commercial, +34185,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMBLEMHEALTH/HIP-Commercial, +34186,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMBLEMHEALTH/HIP-Commercial, +34187,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMBLEMHEALTH/HIP-Commercial, +34188,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMBLEMHEALTH/HIP-Commercial,1829.72 +34189,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMBLEMHEALTH/HIP-Commercial,61.0 +34190,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMBLEMHEALTH/HIP-Commercial,51.2 +34191,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMBLEMHEALTH/HIP-Commercial,2493.55 +34192,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMBLEMHEALTH/HIP-Commercial, +34193,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34194,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMBLEMHEALTH/HIP-Commercial,2267.84 +34195,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMBLEMHEALTH/HIP-Commercial, +34196,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMBLEMHEALTH/HIP-Commercial,2823.64 +34197,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMBLEMHEALTH/HIP-Commercial,3121.55 +34198,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +34199,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMBLEMHEALTH/HIP-Commercial,5731.46 +34200,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMBLEMHEALTH/HIP-Commercial, +34201,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMBLEMHEALTH/HIP-Commercial,5228.0 +34202,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMBLEMHEALTH/HIP-Commercial,4134.15 +34203,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMBLEMHEALTH/HIP-Commercial, +34204,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMBLEMHEALTH/HIP-Commercial,2865.73 +34205,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMBLEMHEALTH/HIP-Commercial, +34206,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMBLEMHEALTH/HIP-Commercial, +34207,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMBLEMHEALTH/HIP-Commercial, +34208,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMBLEMHEALTH/HIP-Commercial, +34209,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMBLEMHEALTH/HIP-Commercial,1062.01 +34210,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMBLEMHEALTH/HIP-Commercial,4298.6 +34211,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMBLEMHEALTH/HIP-Commercial,486.84 +34212,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMBLEMHEALTH/HIP-Commercial,494.65 +34213,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMBLEMHEALTH/HIP-Commercial, +34214,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMBLEMHEALTH/HIP-Commercial, +34215,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMBLEMHEALTH/HIP-Commercial, +34216,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMBLEMHEALTH/HIP-Commercial, +34217,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMBLEMHEALTH/HIP-Commercial, +34218,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMBLEMHEALTH/HIP-Commercial, +34219,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34220,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMBLEMHEALTH/HIP-Commercial,4611.42 +34221,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMBLEMHEALTH/HIP-Commercial,5697.54 +34222,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMBLEMHEALTH/HIP-Commercial, +34223,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMBLEMHEALTH/HIP-Commercial,3628.74 +34224,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMBLEMHEALTH/HIP-Commercial,3628.74 +34225,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMBLEMHEALTH/HIP-Commercial,4647.63 +34226,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMBLEMHEALTH/HIP-Commercial, +34227,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMBLEMHEALTH/HIP-Commercial, +34228,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMBLEMHEALTH/HIP-Commercial, +34229,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMBLEMHEALTH/HIP-Commercial,3808.28 +34230,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMBLEMHEALTH/HIP-Commercial,3173.56 +34231,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMBLEMHEALTH/HIP-Commercial, +34232,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMBLEMHEALTH/HIP-Commercial, +34233,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMBLEMHEALTH/HIP-Commercial, +34234,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMBLEMHEALTH/HIP-Commercial, +34235,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMBLEMHEALTH/HIP-Commercial, +34236,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMBLEMHEALTH/HIP-Commercial,5511.1 +34237,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMBLEMHEALTH/HIP-Commercial, +34238,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMBLEMHEALTH/HIP-Commercial,4299.69 +34239,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMBLEMHEALTH/HIP-Commercial,11614.62 +34240,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMBLEMHEALTH/HIP-Commercial, +34241,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMBLEMHEALTH/HIP-Commercial, +34242,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMBLEMHEALTH/HIP-Commercial,3808.28 +34243,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMBLEMHEALTH/HIP-Commercial,3173.56 +34244,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMBLEMHEALTH/HIP-Commercial,3173.56 +34245,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMBLEMHEALTH/HIP-Commercial,4183.66 +34246,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMBLEMHEALTH/HIP-Commercial,3808.28 +34247,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMBLEMHEALTH/HIP-Commercial,6053.77 +34248,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMBLEMHEALTH/HIP-Commercial, +34249,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMBLEMHEALTH/HIP-Commercial, +34250,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMBLEMHEALTH/HIP-Commercial, +34251,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMBLEMHEALTH/HIP-Commercial,2964.84 +34252,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMBLEMHEALTH/HIP-Commercial, +34253,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMBLEMHEALTH/HIP-Commercial, +34254,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMBLEMHEALTH/HIP-Commercial,5511.1 +34255,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMBLEMHEALTH/HIP-Commercial, +34256,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMBLEMHEALTH/HIP-Commercial, +34257,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMBLEMHEALTH/HIP-Commercial, +34258,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMBLEMHEALTH/HIP-Commercial, +34259,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMBLEMHEALTH/HIP-Commercial, +34260,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMBLEMHEALTH/HIP-Commercial, +34261,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMBLEMHEALTH/HIP-Commercial,486.04 +34262,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMBLEMHEALTH/HIP-Commercial,243.01 +34263,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMBLEMHEALTH/HIP-Commercial,3424.56 +34264,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMBLEMHEALTH/HIP-Commercial, +34265,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMBLEMHEALTH/HIP-Commercial, +34266,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMBLEMHEALTH/HIP-Commercial, +34267,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMBLEMHEALTH/HIP-Commercial,5511.1 +34268,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMBLEMHEALTH/HIP-Commercial,5731.46 +34269,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-Commercial, +34270,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-Commercial, +34271,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMBLEMHEALTH/HIP-Commercial,5731.46 +34272,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMBLEMHEALTH/HIP-Commercial, +34273,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMBLEMHEALTH/HIP-Commercial,5563.64 +34274,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMBLEMHEALTH/HIP-Commercial,3224.76 +34275,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMBLEMHEALTH/HIP-Commercial,3525.31 +34276,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMBLEMHEALTH/HIP-Commercial,5228.0 +34277,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMBLEMHEALTH/HIP-Commercial,8597.19 +34278,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMBLEMHEALTH/HIP-Commercial,3169.48 +34279,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMBLEMHEALTH/HIP-Commercial, +34280,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMBLEMHEALTH/HIP-Commercial,3059.54 +34281,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMBLEMHEALTH/HIP-Commercial, +34282,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMBLEMHEALTH/HIP-Commercial, +34283,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMBLEMHEALTH/HIP-Commercial, +34284,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMBLEMHEALTH/HIP-Commercial, +34285,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMBLEMHEALTH/HIP-Commercial, +34286,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMBLEMHEALTH/HIP-Commercial, +34287,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMBLEMHEALTH/HIP-Commercial, +34288,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMBLEMHEALTH/HIP-Commercial,5731.46 +34289,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMBLEMHEALTH/HIP-Commercial, +34290,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMBLEMHEALTH/HIP-Commercial,2483.11 +34291,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMBLEMHEALTH/HIP-Commercial, +34292,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMBLEMHEALTH/HIP-Commercial, +34293,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMBLEMHEALTH/HIP-Commercial, +34294,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMBLEMHEALTH/HIP-Commercial, +34295,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMBLEMHEALTH/HIP-Commercial, +34296,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMBLEMHEALTH/HIP-Commercial, +34297,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMBLEMHEALTH/HIP-Commercial, +34298,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMBLEMHEALTH/HIP-Commercial, +34299,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMBLEMHEALTH/HIP-Commercial, +34300,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMBLEMHEALTH/HIP-Commercial, +34301,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMBLEMHEALTH/HIP-Commercial, +34302,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMBLEMHEALTH/HIP-Commercial, +34303,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMBLEMHEALTH/HIP-Commercial, +34304,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMBLEMHEALTH/HIP-Commercial,1444.99 +34305,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMBLEMHEALTH/HIP-Commercial, +34306,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMBLEMHEALTH/HIP-Commercial, +34307,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMBLEMHEALTH/HIP-Commercial, +34308,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMBLEMHEALTH/HIP-Commercial, +34309,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +34310,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMBLEMHEALTH/HIP-Commercial,4299.69 +34311,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMBLEMHEALTH/HIP-Commercial, +34312,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMBLEMHEALTH/HIP-Commercial, +34313,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMBLEMHEALTH/HIP-Commercial, +34314,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +34315,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMBLEMHEALTH/HIP-Commercial,2745.86 +34316,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMBLEMHEALTH/HIP-Commercial,3669.91 +34317,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMBLEMHEALTH/HIP-Commercial, +34318,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMBLEMHEALTH/HIP-Commercial, +34319,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMBLEMHEALTH/HIP-Commercial,5731.46 +34320,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMBLEMHEALTH/HIP-Commercial, +34321,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMBLEMHEALTH/HIP-Commercial, +34322,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMBLEMHEALTH/HIP-Commercial, +34323,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMBLEMHEALTH/HIP-Commercial, +34324,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMBLEMHEALTH/HIP-Commercial, +34325,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMBLEMHEALTH/HIP-Commercial, +34326,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMBLEMHEALTH/HIP-Commercial, +34327,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMBLEMHEALTH/HIP-Commercial, +34328,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMBLEMHEALTH/HIP-Commercial, +34329,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMBLEMHEALTH/HIP-Commercial,2445.52 +34330,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMBLEMHEALTH/HIP-Commercial, +34331,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMBLEMHEALTH/HIP-Commercial, +34332,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMBLEMHEALTH/HIP-Commercial, +34333,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMBLEMHEALTH/HIP-Commercial, +34334,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMBLEMHEALTH/HIP-Commercial, +34335,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMBLEMHEALTH/HIP-Commercial, +34336,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMBLEMHEALTH/HIP-Commercial, +34337,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMBLEMHEALTH/HIP-Commercial, +34338,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMBLEMHEALTH/HIP-Commercial, +34339,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34340,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMBLEMHEALTH/HIP-Commercial, +34341,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMBLEMHEALTH/HIP-Commercial, +34342,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMBLEMHEALTH/HIP-Commercial, +34343,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMBLEMHEALTH/HIP-Commercial, +34344,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMBLEMHEALTH/HIP-Commercial,2520.34 +34345,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMBLEMHEALTH/HIP-Commercial, +34346,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMBLEMHEALTH/HIP-Commercial, +34347,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMBLEMHEALTH/HIP-Commercial, +34348,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMBLEMHEALTH/HIP-Commercial, +34349,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMBLEMHEALTH/HIP-Commercial, +34350,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMBLEMHEALTH/HIP-Commercial, +34351,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMBLEMHEALTH/HIP-Commercial, +34352,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMBLEMHEALTH/HIP-Commercial, +34353,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMBLEMHEALTH/HIP-Commercial, +34354,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMBLEMHEALTH/HIP-Commercial, +34355,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMBLEMHEALTH/HIP-Commercial, +34356,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMBLEMHEALTH/HIP-Commercial, +34357,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMBLEMHEALTH/HIP-Commercial, +34358,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMBLEMHEALTH/HIP-Commercial, +34359,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMBLEMHEALTH/HIP-Commercial, +34360,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMBLEMHEALTH/HIP-Commercial, +34361,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMBLEMHEALTH/HIP-Commercial, +34362,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMBLEMHEALTH/HIP-Commercial,2431.59 +34363,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMBLEMHEALTH/HIP-Commercial, +34364,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMBLEMHEALTH/HIP-Commercial,2338.41 +34365,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMBLEMHEALTH/HIP-Commercial,1893.94 +34366,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMBLEMHEALTH/HIP-Commercial,1824.24 +34367,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMBLEMHEALTH/HIP-Commercial, +34368,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMBLEMHEALTH/HIP-Commercial,2431.59 +34369,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMBLEMHEALTH/HIP-Commercial,1044.09 +34370,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMBLEMHEALTH/HIP-Commercial,2431.59 +34371,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMBLEMHEALTH/HIP-Commercial, +34372,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMBLEMHEALTH/HIP-Commercial,1106.65 +34373,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMBLEMHEALTH/HIP-Commercial,1799.03 +34374,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMBLEMHEALTH/HIP-Commercial,939.68 +34375,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMBLEMHEALTH/HIP-Commercial,1793.46 +34376,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMBLEMHEALTH/HIP-Commercial, +34377,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMBLEMHEALTH/HIP-Commercial, +34378,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMBLEMHEALTH/HIP-Commercial, +34379,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMBLEMHEALTH/HIP-Commercial,2431.59 +34380,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMBLEMHEALTH/HIP-Commercial,1610.84 +34381,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMBLEMHEALTH/HIP-Commercial, +34382,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMBLEMHEALTH/HIP-Commercial,3631.94 +34383,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMBLEMHEALTH/HIP-Commercial,2952.12 +34384,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMBLEMHEALTH/HIP-Commercial, +34385,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMBLEMHEALTH/HIP-Commercial,1240.07 +34386,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMBLEMHEALTH/HIP-Commercial,1940.86 +34387,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMBLEMHEALTH/HIP-Commercial,1759.56 +34388,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMBLEMHEALTH/HIP-Commercial,8781.52 +34389,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMBLEMHEALTH/HIP-Commercial, +34390,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMBLEMHEALTH/HIP-Commercial, +34391,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMBLEMHEALTH/HIP-Commercial, +34392,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMBLEMHEALTH/HIP-Commercial, +34393,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMBLEMHEALTH/HIP-Commercial, +34394,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMBLEMHEALTH/HIP-Commercial,4669.6 +34395,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMBLEMHEALTH/HIP-Commercial, +34396,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMBLEMHEALTH/HIP-Commercial, +34397,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMBLEMHEALTH/HIP-Commercial, +34398,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMBLEMHEALTH/HIP-Commercial, +34399,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMBLEMHEALTH/HIP-Commercial, +34400,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMBLEMHEALTH/HIP-Commercial, +34401,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMBLEMHEALTH/HIP-Commercial, +34402,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMBLEMHEALTH/HIP-Commercial, +34403,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMBLEMHEALTH/HIP-Commercial,281.72 +34404,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMBLEMHEALTH/HIP-Commercial, +34405,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMBLEMHEALTH/HIP-Commercial, +34406,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMBLEMHEALTH/HIP-Commercial,9671.56 +34407,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34408,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +34409,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMBLEMHEALTH/HIP-Commercial, +34410,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMBLEMHEALTH/HIP-Commercial, +34411,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMBLEMHEALTH/HIP-Commercial, +34412,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMBLEMHEALTH/HIP-Commercial, +34413,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMBLEMHEALTH/HIP-Commercial,1746.7 +34414,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMBLEMHEALTH/HIP-Commercial, +34415,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMBLEMHEALTH/HIP-Commercial, +34416,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMBLEMHEALTH/HIP-Commercial, +34417,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMBLEMHEALTH/HIP-Commercial, +34418,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMBLEMHEALTH/HIP-Commercial, +34419,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMBLEMHEALTH/HIP-Commercial, +34420,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMBLEMHEALTH/HIP-Commercial,1349.46 +34421,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMBLEMHEALTH/HIP-Commercial, +34422,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMBLEMHEALTH/HIP-Commercial, +34423,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMBLEMHEALTH/HIP-Commercial,1754.08 +34424,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMBLEMHEALTH/HIP-Commercial, +34425,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMBLEMHEALTH/HIP-Commercial,1007.85 +34426,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMBLEMHEALTH/HIP-Commercial, +34427,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMBLEMHEALTH/HIP-Commercial, +34428,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMBLEMHEALTH/HIP-Commercial, +34429,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMBLEMHEALTH/HIP-Commercial, +34430,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMBLEMHEALTH/HIP-Commercial, +34431,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMBLEMHEALTH/HIP-Commercial, +34432,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMBLEMHEALTH/HIP-Commercial,9616.78 +34433,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMBLEMHEALTH/HIP-Commercial, +34434,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMBLEMHEALTH/HIP-Commercial, +34435,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMBLEMHEALTH/HIP-Commercial, +34436,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMBLEMHEALTH/HIP-Commercial, +34437,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMBLEMHEALTH/HIP-Commercial, +34438,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMBLEMHEALTH/HIP-Commercial,629.83 +34439,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMBLEMHEALTH/HIP-Commercial,2431.59 +34440,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMBLEMHEALTH/HIP-Commercial, +34441,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMBLEMHEALTH/HIP-Commercial, +34442,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMBLEMHEALTH/HIP-Commercial, +34443,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMBLEMHEALTH/HIP-Commercial,2431.59 +34444,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMBLEMHEALTH/HIP-Commercial, +34445,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMBLEMHEALTH/HIP-Commercial, +34446,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMBLEMHEALTH/HIP-Commercial, +34447,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMBLEMHEALTH/HIP-Commercial, +34448,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMBLEMHEALTH/HIP-Commercial, +34449,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMBLEMHEALTH/HIP-Commercial, +34450,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMBLEMHEALTH/HIP-Commercial,2431.59 +34451,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMBLEMHEALTH/HIP-Commercial, +34452,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMBLEMHEALTH/HIP-Commercial,3450.87 +34453,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMBLEMHEALTH/HIP-Commercial,2467.21 +34454,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMBLEMHEALTH/HIP-Commercial, +34455,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMBLEMHEALTH/HIP-Commercial,2338.41 +34456,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMBLEMHEALTH/HIP-Commercial,2431.59 +34457,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMBLEMHEALTH/HIP-Commercial, +34458,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMBLEMHEALTH/HIP-Commercial, +34459,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMBLEMHEALTH/HIP-Commercial, +34460,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMBLEMHEALTH/HIP-Commercial,3341.82 +34461,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +34462,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMBLEMHEALTH/HIP-Commercial, +34463,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMBLEMHEALTH/HIP-Commercial, +34464,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMBLEMHEALTH/HIP-Commercial,2861.06 +34465,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMBLEMHEALTH/HIP-Commercial, +34466,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMBLEMHEALTH/HIP-Commercial, +34467,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMBLEMHEALTH/HIP-Commercial, +34468,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMBLEMHEALTH/HIP-Commercial, +34469,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMBLEMHEALTH/HIP-Commercial, +34470,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMBLEMHEALTH/HIP-Commercial, +34471,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMBLEMHEALTH/HIP-Commercial, +34472,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMBLEMHEALTH/HIP-Commercial, +34473,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMBLEMHEALTH/HIP-Commercial, +34474,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMBLEMHEALTH/HIP-Commercial, +34475,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMBLEMHEALTH/HIP-Commercial, +34476,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMBLEMHEALTH/HIP-Commercial, +34477,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMBLEMHEALTH/HIP-Commercial, +34478,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMBLEMHEALTH/HIP-Commercial, +34479,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMBLEMHEALTH/HIP-Commercial, +34480,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMBLEMHEALTH/HIP-Commercial, +34481,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMBLEMHEALTH/HIP-Commercial, +34482,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMBLEMHEALTH/HIP-Commercial, +34483,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMBLEMHEALTH/HIP-Commercial, +34484,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMBLEMHEALTH/HIP-Commercial, +34485,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMBLEMHEALTH/HIP-Commercial, +34486,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMBLEMHEALTH/HIP-Commercial, +34487,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMBLEMHEALTH/HIP-Commercial, +34488,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMBLEMHEALTH/HIP-Commercial, +34489,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMBLEMHEALTH/HIP-Commercial, +34490,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMBLEMHEALTH/HIP-Commercial, +34491,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMBLEMHEALTH/HIP-Commercial, +34492,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMBLEMHEALTH/HIP-Commercial, +34493,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMBLEMHEALTH/HIP-Commercial, +34494,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMBLEMHEALTH/HIP-Commercial, +34495,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMBLEMHEALTH/HIP-Commercial, +34496,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMBLEMHEALTH/HIP-Commercial, +34497,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMBLEMHEALTH/HIP-Commercial, +34498,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMBLEMHEALTH/HIP-Commercial, +34499,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMBLEMHEALTH/HIP-Commercial, +34500,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMBLEMHEALTH/HIP-Commercial, +34501,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMBLEMHEALTH/HIP-Commercial, +34502,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMBLEMHEALTH/HIP-Commercial, +34503,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMBLEMHEALTH/HIP-Commercial, +34504,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMBLEMHEALTH/HIP-Commercial, +34505,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMBLEMHEALTH/HIP-Commercial, +34506,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMBLEMHEALTH/HIP-Commercial, +34507,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMBLEMHEALTH/HIP-Commercial, +34508,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMBLEMHEALTH/HIP-Commercial,6753.72 +34509,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMBLEMHEALTH/HIP-Commercial, +34510,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMBLEMHEALTH/HIP-Commercial, +34511,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMBLEMHEALTH/HIP-Commercial, +34512,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMBLEMHEALTH/HIP-Commercial, +34513,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMBLEMHEALTH/HIP-Commercial, +34514,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMBLEMHEALTH/HIP-Commercial, +34515,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMBLEMHEALTH/HIP-Commercial, +34516,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMBLEMHEALTH/HIP-Commercial, +34517,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMBLEMHEALTH/HIP-Commercial, +34518,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMBLEMHEALTH/HIP-Commercial, +34519,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMBLEMHEALTH/HIP-Commercial, +34520,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMBLEMHEALTH/HIP-Commercial, +34521,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMBLEMHEALTH/HIP-Commercial, +34522,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMBLEMHEALTH/HIP-Commercial, +34523,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMBLEMHEALTH/HIP-Commercial, +34524,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMBLEMHEALTH/HIP-Commercial, +34525,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +34526,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMBLEMHEALTH/HIP-Commercial, +34527,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMBLEMHEALTH/HIP-Commercial, +34528,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMBLEMHEALTH/HIP-Commercial, +34529,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMBLEMHEALTH/HIP-Commercial, +34530,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMBLEMHEALTH/HIP-Commercial, +34531,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMBLEMHEALTH/HIP-Commercial, +34532,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMBLEMHEALTH/HIP-Commercial, +34533,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMBLEMHEALTH/HIP-Commercial, +34534,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMBLEMHEALTH/HIP-Commercial, +34535,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMBLEMHEALTH/HIP-Commercial, +34536,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMBLEMHEALTH/HIP-Commercial, +34537,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMBLEMHEALTH/HIP-Commercial, +34538,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMBLEMHEALTH/HIP-Commercial, +34539,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMBLEMHEALTH/HIP-Commercial, +34540,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMBLEMHEALTH/HIP-Commercial, +34541,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMBLEMHEALTH/HIP-Commercial, +34542,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMBLEMHEALTH/HIP-Commercial, +34543,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMBLEMHEALTH/HIP-Commercial, +34544,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMBLEMHEALTH/HIP-Commercial, +34545,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMBLEMHEALTH/HIP-Commercial, +34546,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMBLEMHEALTH/HIP-Commercial, +34547,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMBLEMHEALTH/HIP-Commercial, +34548,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMBLEMHEALTH/HIP-Commercial, +34549,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMBLEMHEALTH/HIP-Commercial, +34550,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMBLEMHEALTH/HIP-Commercial, +34551,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMBLEMHEALTH/HIP-Commercial, +34552,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMBLEMHEALTH/HIP-Commercial, +34553,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMBLEMHEALTH/HIP-Commercial, +34554,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMBLEMHEALTH/HIP-Commercial, +34555,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMBLEMHEALTH/HIP-Commercial, +34556,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34557,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMBLEMHEALTH/HIP-Commercial, +34558,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMBLEMHEALTH/HIP-Commercial, +34559,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMBLEMHEALTH/HIP-Commercial, +34560,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMBLEMHEALTH/HIP-Commercial, +34561,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMBLEMHEALTH/HIP-Commercial, +34562,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMBLEMHEALTH/HIP-Commercial, +34563,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMBLEMHEALTH/HIP-Commercial, +34564,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMBLEMHEALTH/HIP-Commercial, +34565,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMBLEMHEALTH/HIP-Commercial,952.14 +34566,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMBLEMHEALTH/HIP-Commercial, +34567,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMBLEMHEALTH/HIP-Commercial,2775.14 +34568,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMBLEMHEALTH/HIP-Commercial, +34569,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMBLEMHEALTH/HIP-Commercial, +34570,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMBLEMHEALTH/HIP-Commercial, +34571,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMBLEMHEALTH/HIP-Commercial, +34572,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMBLEMHEALTH/HIP-Commercial, +34573,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMBLEMHEALTH/HIP-Commercial, +34574,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMBLEMHEALTH/HIP-Commercial, +34575,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMBLEMHEALTH/HIP-Commercial, +34576,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMBLEMHEALTH/HIP-Commercial,2146.23 +34577,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMBLEMHEALTH/HIP-Commercial, +34578,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMBLEMHEALTH/HIP-Commercial, +34579,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMBLEMHEALTH/HIP-Commercial, +34580,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMBLEMHEALTH/HIP-Commercial, +34581,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMBLEMHEALTH/HIP-Commercial, +34582,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMBLEMHEALTH/HIP-Commercial, +34583,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMBLEMHEALTH/HIP-Commercial, +34584,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMBLEMHEALTH/HIP-Commercial, +34585,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMBLEMHEALTH/HIP-Commercial, +34586,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMBLEMHEALTH/HIP-Commercial, +34587,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMBLEMHEALTH/HIP-Commercial, +34588,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMBLEMHEALTH/HIP-Commercial, +34589,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMBLEMHEALTH/HIP-Commercial, +34590,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMBLEMHEALTH/HIP-Commercial, +34591,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMBLEMHEALTH/HIP-Commercial, +34592,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMBLEMHEALTH/HIP-Commercial, +34593,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMBLEMHEALTH/HIP-Commercial, +34594,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMBLEMHEALTH/HIP-Commercial, +34595,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMBLEMHEALTH/HIP-Commercial, +34596,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMBLEMHEALTH/HIP-Commercial, +34597,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMBLEMHEALTH/HIP-Commercial, +34598,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMBLEMHEALTH/HIP-Commercial, +34599,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMBLEMHEALTH/HIP-Commercial,6303.0 +34600,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMBLEMHEALTH/HIP-Commercial, +34601,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMBLEMHEALTH/HIP-Commercial, +34602,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMBLEMHEALTH/HIP-Commercial, +34603,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMBLEMHEALTH/HIP-Commercial, +34604,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMBLEMHEALTH/HIP-Commercial, +34605,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMBLEMHEALTH/HIP-Commercial, +34606,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMBLEMHEALTH/HIP-Commercial, +34607,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMBLEMHEALTH/HIP-Commercial, +34608,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMBLEMHEALTH/HIP-Commercial, +34609,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMBLEMHEALTH/HIP-Commercial,680.98 +34610,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMBLEMHEALTH/HIP-Commercial, +34611,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMBLEMHEALTH/HIP-Commercial,2099.48 +34612,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMBLEMHEALTH/HIP-Commercial, +34613,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMBLEMHEALTH/HIP-Commercial, +34614,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMBLEMHEALTH/HIP-Commercial, +34615,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMBLEMHEALTH/HIP-Commercial, +34616,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMBLEMHEALTH/HIP-Commercial,3602.21 +34617,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMBLEMHEALTH/HIP-Commercial, +34618,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMBLEMHEALTH/HIP-Commercial, +34619,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMBLEMHEALTH/HIP-Commercial, +34620,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMBLEMHEALTH/HIP-Commercial, +34621,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMBLEMHEALTH/HIP-Commercial, +34622,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMBLEMHEALTH/HIP-Commercial, +34623,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMBLEMHEALTH/HIP-Commercial, +34624,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMBLEMHEALTH/HIP-Commercial, +34625,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMBLEMHEALTH/HIP-Commercial, +34626,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMBLEMHEALTH/HIP-Commercial, +34627,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMBLEMHEALTH/HIP-Commercial, +34628,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMBLEMHEALTH/HIP-Commercial, +34629,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMBLEMHEALTH/HIP-Commercial, +34630,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMBLEMHEALTH/HIP-Commercial, +34631,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMBLEMHEALTH/HIP-Commercial, +34632,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMBLEMHEALTH/HIP-Commercial,3656.96 +34633,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMBLEMHEALTH/HIP-Commercial, +34634,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMBLEMHEALTH/HIP-Commercial, +34635,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMBLEMHEALTH/HIP-Commercial, +34636,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMBLEMHEALTH/HIP-Commercial, +34637,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMBLEMHEALTH/HIP-Commercial, +34638,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMBLEMHEALTH/HIP-Commercial, +34639,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMBLEMHEALTH/HIP-Commercial,5168.41 +34640,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMBLEMHEALTH/HIP-Commercial,5260.05 +34641,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMBLEMHEALTH/HIP-Commercial, +34642,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMBLEMHEALTH/HIP-Commercial, +34643,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMBLEMHEALTH/HIP-Commercial, +34644,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMBLEMHEALTH/HIP-Commercial, +34645,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMBLEMHEALTH/HIP-Commercial,5168.41 +34646,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMBLEMHEALTH/HIP-Commercial, +34647,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMBLEMHEALTH/HIP-Commercial, +34648,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +34649,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMBLEMHEALTH/HIP-Commercial, +34650,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +34651,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMBLEMHEALTH/HIP-Commercial, +34652,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMBLEMHEALTH/HIP-Commercial, +34653,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMBLEMHEALTH/HIP-Commercial, +34654,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMBLEMHEALTH/HIP-Commercial, +34655,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMBLEMHEALTH/HIP-Commercial, +34656,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMBLEMHEALTH/HIP-Commercial, +34657,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMBLEMHEALTH/HIP-Commercial, +34658,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMBLEMHEALTH/HIP-Commercial, +34659,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMBLEMHEALTH/HIP-Commercial, +34660,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMBLEMHEALTH/HIP-Commercial, +34661,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +34662,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMBLEMHEALTH/HIP-Commercial, +34663,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMBLEMHEALTH/HIP-Commercial, +34664,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMBLEMHEALTH/HIP-Commercial, +34665,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMBLEMHEALTH/HIP-Commercial, +34666,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMBLEMHEALTH/HIP-Commercial, +34667,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMBLEMHEALTH/HIP-Commercial, +34668,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMBLEMHEALTH/HIP-Commercial, +34669,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMBLEMHEALTH/HIP-Commercial, +34670,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMBLEMHEALTH/HIP-Commercial, +34671,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMBLEMHEALTH/HIP-Commercial, +34672,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMBLEMHEALTH/HIP-Commercial, +34673,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMBLEMHEALTH/HIP-Commercial, +34674,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMBLEMHEALTH/HIP-Commercial, +34675,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMBLEMHEALTH/HIP-Commercial, +34676,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +34677,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMBLEMHEALTH/HIP-Commercial, +34678,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMBLEMHEALTH/HIP-Commercial, +34679,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +34680,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMBLEMHEALTH/HIP-Commercial, +34681,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMBLEMHEALTH/HIP-Commercial, +34682,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMBLEMHEALTH/HIP-Commercial, +34683,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMBLEMHEALTH/HIP-Commercial, +34684,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMBLEMHEALTH/HIP-Commercial, +34685,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMBLEMHEALTH/HIP-Commercial, +34686,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMBLEMHEALTH/HIP-Commercial, +34687,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMBLEMHEALTH/HIP-Commercial, +34688,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMBLEMHEALTH/HIP-Commercial, +34689,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMBLEMHEALTH/HIP-Commercial, +34690,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMBLEMHEALTH/HIP-Commercial, +34691,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMBLEMHEALTH/HIP-Commercial, +34692,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMBLEMHEALTH/HIP-Commercial, +34693,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMBLEMHEALTH/HIP-Commercial, +34694,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMBLEMHEALTH/HIP-Commercial, +34695,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMBLEMHEALTH/HIP-Commercial, +34696,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMBLEMHEALTH/HIP-Commercial, +34697,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMBLEMHEALTH/HIP-Commercial, +34698,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMBLEMHEALTH/HIP-Commercial, +34699,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMBLEMHEALTH/HIP-Commercial, +34700,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMBLEMHEALTH/HIP-Commercial, +34701,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMBLEMHEALTH/HIP-Commercial, +34702,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMBLEMHEALTH/HIP-Commercial, +34703,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMBLEMHEALTH/HIP-Commercial, +34704,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMBLEMHEALTH/HIP-Commercial, +34705,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMBLEMHEALTH/HIP-Commercial, +34706,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34707,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMBLEMHEALTH/HIP-Commercial, +34708,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMBLEMHEALTH/HIP-Commercial, +34709,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMBLEMHEALTH/HIP-Commercial,2099.48 +34710,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMBLEMHEALTH/HIP-Commercial, +34711,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMBLEMHEALTH/HIP-Commercial, +34712,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMBLEMHEALTH/HIP-Commercial,6646.35 +34713,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMBLEMHEALTH/HIP-Commercial,5126.61 +34714,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMBLEMHEALTH/HIP-Commercial,1477.94 +34715,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMBLEMHEALTH/HIP-Commercial, +34716,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMBLEMHEALTH/HIP-Commercial, +34717,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMBLEMHEALTH/HIP-Commercial, +34718,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMBLEMHEALTH/HIP-Commercial, +34719,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMBLEMHEALTH/HIP-Commercial, +34720,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMBLEMHEALTH/HIP-Commercial, +34721,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMBLEMHEALTH/HIP-Commercial, +34722,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMBLEMHEALTH/HIP-Commercial, +34723,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMBLEMHEALTH/HIP-Commercial, +34724,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMBLEMHEALTH/HIP-Commercial, +34725,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMBLEMHEALTH/HIP-Commercial, +34726,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMBLEMHEALTH/HIP-Commercial,5346.39 +34727,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMBLEMHEALTH/HIP-Commercial, +34728,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMBLEMHEALTH/HIP-Commercial, +34729,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMBLEMHEALTH/HIP-Commercial, +34730,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMBLEMHEALTH/HIP-Commercial, +34731,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMBLEMHEALTH/HIP-Commercial, +34732,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMBLEMHEALTH/HIP-Commercial, +34733,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +34734,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMBLEMHEALTH/HIP-Commercial, +34735,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34736,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMBLEMHEALTH/HIP-Commercial, +34737,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMBLEMHEALTH/HIP-Commercial, +34738,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMBLEMHEALTH/HIP-Commercial,2101.31 +34739,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMBLEMHEALTH/HIP-Commercial, +34740,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +34741,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMBLEMHEALTH/HIP-Commercial, +34742,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMBLEMHEALTH/HIP-Commercial, +34743,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMBLEMHEALTH/HIP-Commercial, +34744,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMBLEMHEALTH/HIP-Commercial, +34745,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMBLEMHEALTH/HIP-Commercial, +34746,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMBLEMHEALTH/HIP-Commercial, +34747,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMBLEMHEALTH/HIP-Commercial, +34748,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMBLEMHEALTH/HIP-Commercial, +34749,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMBLEMHEALTH/HIP-Commercial, +34750,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMBLEMHEALTH/HIP-Commercial, +34751,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMBLEMHEALTH/HIP-Commercial, +34752,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMBLEMHEALTH/HIP-Commercial, +34753,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMBLEMHEALTH/HIP-Commercial, +34754,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMBLEMHEALTH/HIP-Commercial, +34755,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMBLEMHEALTH/HIP-Commercial, +34756,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMBLEMHEALTH/HIP-Commercial, +34757,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMBLEMHEALTH/HIP-Commercial, +34758,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMBLEMHEALTH/HIP-Commercial, +34759,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMBLEMHEALTH/HIP-Commercial, +34760,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMBLEMHEALTH/HIP-Commercial, +34761,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMBLEMHEALTH/HIP-Commercial, +34762,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMBLEMHEALTH/HIP-Commercial, +34763,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMBLEMHEALTH/HIP-Commercial, +34764,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMBLEMHEALTH/HIP-Commercial, +34765,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMBLEMHEALTH/HIP-Commercial, +34766,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMBLEMHEALTH/HIP-Commercial, +34767,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMBLEMHEALTH/HIP-Commercial, +34768,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMBLEMHEALTH/HIP-Commercial, +34769,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMBLEMHEALTH/HIP-Commercial, +34770,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34771,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMBLEMHEALTH/HIP-Commercial, +34772,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMBLEMHEALTH/HIP-Commercial, +34773,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMBLEMHEALTH/HIP-Commercial, +34774,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMBLEMHEALTH/HIP-Commercial, +34775,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMBLEMHEALTH/HIP-Commercial, +34776,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMBLEMHEALTH/HIP-Commercial, +34777,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMBLEMHEALTH/HIP-Commercial, +34778,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMBLEMHEALTH/HIP-Commercial, +34779,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMBLEMHEALTH/HIP-Commercial, +34780,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMBLEMHEALTH/HIP-Commercial, +34781,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMBLEMHEALTH/HIP-Commercial, +34782,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMBLEMHEALTH/HIP-Commercial, +34783,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMBLEMHEALTH/HIP-Commercial, +34784,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMBLEMHEALTH/HIP-Commercial, +34785,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMBLEMHEALTH/HIP-Commercial, +34786,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMBLEMHEALTH/HIP-Commercial, +34787,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMBLEMHEALTH/HIP-Commercial, +34788,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMBLEMHEALTH/HIP-Commercial, +34789,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMBLEMHEALTH/HIP-Commercial, +34790,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMBLEMHEALTH/HIP-Commercial, +34791,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMBLEMHEALTH/HIP-Commercial, +34792,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMBLEMHEALTH/HIP-Commercial, +34793,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMBLEMHEALTH/HIP-Commercial, +34794,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMBLEMHEALTH/HIP-Commercial, +34795,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMBLEMHEALTH/HIP-Commercial, +34796,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMBLEMHEALTH/HIP-Commercial,10192.48 +34797,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMBLEMHEALTH/HIP-Commercial, +34798,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMBLEMHEALTH/HIP-Commercial, +34799,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMBLEMHEALTH/HIP-Commercial, +34800,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMBLEMHEALTH/HIP-Commercial, +34801,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMBLEMHEALTH/HIP-Commercial, +34802,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMBLEMHEALTH/HIP-Commercial, +34803,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMBLEMHEALTH/HIP-Commercial, +34804,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMBLEMHEALTH/HIP-Commercial, +34805,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMBLEMHEALTH/HIP-Commercial, +34806,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMBLEMHEALTH/HIP-Commercial, +34807,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMBLEMHEALTH/HIP-Commercial, +34808,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMBLEMHEALTH/HIP-Commercial, +34809,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMBLEMHEALTH/HIP-Commercial, +34810,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMBLEMHEALTH/HIP-Commercial, +34811,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMBLEMHEALTH/HIP-Commercial, +34812,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMBLEMHEALTH/HIP-Commercial, +34813,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMBLEMHEALTH/HIP-Commercial, +34814,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMBLEMHEALTH/HIP-Commercial, +34815,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMBLEMHEALTH/HIP-Commercial, +34816,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +34817,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMBLEMHEALTH/HIP-Commercial, +34818,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMBLEMHEALTH/HIP-Commercial, +34819,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34820,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMBLEMHEALTH/HIP-Commercial, +34821,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +34822,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +34823,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMBLEMHEALTH/HIP-Commercial, +34824,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMBLEMHEALTH/HIP-Commercial, +34825,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMBLEMHEALTH/HIP-Commercial, +34826,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMBLEMHEALTH/HIP-Commercial, +34827,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMBLEMHEALTH/HIP-Commercial, +34828,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMBLEMHEALTH/HIP-Commercial, +34829,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMBLEMHEALTH/HIP-Commercial, +34830,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMBLEMHEALTH/HIP-Commercial, +34831,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMBLEMHEALTH/HIP-Commercial, +34832,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMBLEMHEALTH/HIP-Commercial, +34833,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMBLEMHEALTH/HIP-Commercial, +34834,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMBLEMHEALTH/HIP-Commercial, +34835,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMBLEMHEALTH/HIP-Commercial,6135.58 +34836,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMBLEMHEALTH/HIP-Commercial, +34837,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMBLEMHEALTH/HIP-Commercial, +34838,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMBLEMHEALTH/HIP-Commercial, +34839,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMBLEMHEALTH/HIP-Commercial, +34840,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMBLEMHEALTH/HIP-Commercial, +34841,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMBLEMHEALTH/HIP-Commercial, +34842,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMBLEMHEALTH/HIP-Commercial, +34843,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMBLEMHEALTH/HIP-Commercial, +34844,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMBLEMHEALTH/HIP-Commercial, +34845,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMBLEMHEALTH/HIP-Commercial, +34846,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMBLEMHEALTH/HIP-Commercial, +34847,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMBLEMHEALTH/HIP-Commercial, +34848,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMBLEMHEALTH/HIP-Commercial, +34849,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMBLEMHEALTH/HIP-Commercial, +34850,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMBLEMHEALTH/HIP-Commercial, +34851,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34852,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMBLEMHEALTH/HIP-Commercial, +34853,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMBLEMHEALTH/HIP-Commercial, +34854,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMBLEMHEALTH/HIP-Commercial, +34855,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMBLEMHEALTH/HIP-Commercial, +34856,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMBLEMHEALTH/HIP-Commercial, +34857,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMBLEMHEALTH/HIP-Commercial,743.07 +34858,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +34859,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMBLEMHEALTH/HIP-Commercial, +34860,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMBLEMHEALTH/HIP-Commercial, +34861,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMBLEMHEALTH/HIP-Commercial, +34862,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMBLEMHEALTH/HIP-Commercial, +34863,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMBLEMHEALTH/HIP-Commercial, +34864,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMBLEMHEALTH/HIP-Commercial, +34865,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMBLEMHEALTH/HIP-Commercial, +34866,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMBLEMHEALTH/HIP-Commercial, +34867,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMBLEMHEALTH/HIP-Commercial, +34868,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMBLEMHEALTH/HIP-Commercial, +34869,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMBLEMHEALTH/HIP-Commercial, +34870,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMBLEMHEALTH/HIP-Commercial, +34871,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMBLEMHEALTH/HIP-Commercial, +34872,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMBLEMHEALTH/HIP-Commercial, +34873,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMBLEMHEALTH/HIP-Commercial, +34874,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMBLEMHEALTH/HIP-Commercial, +34875,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMBLEMHEALTH/HIP-Commercial,7213.79 +34876,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMBLEMHEALTH/HIP-Commercial, +34877,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMBLEMHEALTH/HIP-Commercial, +34878,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMBLEMHEALTH/HIP-Commercial, +34879,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMBLEMHEALTH/HIP-Commercial, +34880,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMBLEMHEALTH/HIP-Commercial, +34881,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMBLEMHEALTH/HIP-Commercial, +34882,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMBLEMHEALTH/HIP-Commercial, +34883,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMBLEMHEALTH/HIP-Commercial, +34884,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMBLEMHEALTH/HIP-Commercial, +34885,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMBLEMHEALTH/HIP-Commercial, +34886,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMBLEMHEALTH/HIP-Commercial, +34887,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMBLEMHEALTH/HIP-Commercial, +34888,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMBLEMHEALTH/HIP-Commercial, +34889,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMBLEMHEALTH/HIP-Commercial, +34890,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMBLEMHEALTH/HIP-Commercial, +34891,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMBLEMHEALTH/HIP-Commercial, +34892,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMBLEMHEALTH/HIP-Commercial, +34893,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMBLEMHEALTH/HIP-Commercial,974.43 +34894,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMBLEMHEALTH/HIP-Commercial, +34895,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMBLEMHEALTH/HIP-Commercial, +34896,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +34897,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMBLEMHEALTH/HIP-Commercial, +34898,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMBLEMHEALTH/HIP-Commercial, +34899,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMBLEMHEALTH/HIP-Commercial, +34900,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMBLEMHEALTH/HIP-Commercial, +34901,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMBLEMHEALTH/HIP-Commercial, +34902,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMBLEMHEALTH/HIP-Commercial, +34903,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMBLEMHEALTH/HIP-Commercial, +34904,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMBLEMHEALTH/HIP-Commercial, +34905,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMBLEMHEALTH/HIP-Commercial, +34906,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMBLEMHEALTH/HIP-Commercial,23980.59 +34907,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMBLEMHEALTH/HIP-Commercial, +34908,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMBLEMHEALTH/HIP-Commercial, +34909,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMBLEMHEALTH/HIP-Commercial, +34910,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMBLEMHEALTH/HIP-Commercial, +34911,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMBLEMHEALTH/HIP-Commercial, +34912,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMBLEMHEALTH/HIP-Commercial, +34913,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMBLEMHEALTH/HIP-Commercial, +34914,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMBLEMHEALTH/HIP-Commercial, +34915,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMBLEMHEALTH/HIP-Commercial, +34916,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMBLEMHEALTH/HIP-Commercial, +34917,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMBLEMHEALTH/HIP-Commercial, +34918,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMBLEMHEALTH/HIP-Commercial, +34919,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMBLEMHEALTH/HIP-Commercial, +34920,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMBLEMHEALTH/HIP-Commercial, +34921,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMBLEMHEALTH/HIP-Commercial, +34922,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMBLEMHEALTH/HIP-Commercial, +34923,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMBLEMHEALTH/HIP-Commercial, +34924,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMBLEMHEALTH/HIP-Commercial, +34925,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMBLEMHEALTH/HIP-Commercial, +34926,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMBLEMHEALTH/HIP-Commercial, +34927,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMBLEMHEALTH/HIP-Commercial, +34928,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMBLEMHEALTH/HIP-Commercial, +34929,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMBLEMHEALTH/HIP-Commercial, +34930,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMBLEMHEALTH/HIP-Commercial,2054.29 +34931,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMBLEMHEALTH/HIP-Commercial, +34932,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMBLEMHEALTH/HIP-Commercial, +34933,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-Commercial, +34934,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +34935,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMBLEMHEALTH/HIP-Commercial, +34936,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMBLEMHEALTH/HIP-Commercial, +34937,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMBLEMHEALTH/HIP-Commercial, +34938,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMBLEMHEALTH/HIP-Commercial, +34939,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMBLEMHEALTH/HIP-Commercial, +34940,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMBLEMHEALTH/HIP-Commercial, +34941,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMBLEMHEALTH/HIP-Commercial, +34942,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMBLEMHEALTH/HIP-Commercial, +34943,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMBLEMHEALTH/HIP-Commercial, +34944,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMBLEMHEALTH/HIP-Commercial, +34945,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMBLEMHEALTH/HIP-Commercial, +34946,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMBLEMHEALTH/HIP-Commercial, +34947,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMBLEMHEALTH/HIP-Commercial, +34948,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMBLEMHEALTH/HIP-Commercial, +34949,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMBLEMHEALTH/HIP-Commercial, +34950,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMBLEMHEALTH/HIP-Commercial, +34951,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMBLEMHEALTH/HIP-Commercial, +34952,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMBLEMHEALTH/HIP-Commercial, +34953,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMBLEMHEALTH/HIP-Commercial, +34954,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMBLEMHEALTH/HIP-Commercial, +34955,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMBLEMHEALTH/HIP-Commercial, +34956,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMBLEMHEALTH/HIP-Commercial, +34957,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMBLEMHEALTH/HIP-Commercial, +34958,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMBLEMHEALTH/HIP-Commercial, +34959,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMBLEMHEALTH/HIP-Commercial, +34960,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMBLEMHEALTH/HIP-Commercial, +34961,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMBLEMHEALTH/HIP-Commercial, +34962,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMBLEMHEALTH/HIP-Commercial, +34963,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMBLEMHEALTH/HIP-Commercial, +34964,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMBLEMHEALTH/HIP-Commercial, +34965,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMBLEMHEALTH/HIP-Commercial, +34966,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-Commercial, +34967,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMBLEMHEALTH/HIP-Commercial, +34968,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMBLEMHEALTH/HIP-Commercial, +34969,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMBLEMHEALTH/HIP-Commercial, +34970,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMBLEMHEALTH/HIP-Commercial, +34971,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMBLEMHEALTH/HIP-Commercial, +34972,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMBLEMHEALTH/HIP-Commercial, +34973,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMBLEMHEALTH/HIP-Commercial, +34974,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMBLEMHEALTH/HIP-Commercial, +34975,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMBLEMHEALTH/HIP-Commercial, +34976,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMBLEMHEALTH/HIP-Commercial, +34977,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMBLEMHEALTH/HIP-Commercial, +34978,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMBLEMHEALTH/HIP-Commercial, +34979,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMBLEMHEALTH/HIP-Commercial, +34980,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMBLEMHEALTH/HIP-Commercial, +34981,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMBLEMHEALTH/HIP-Commercial,2344.49 +34982,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMBLEMHEALTH/HIP-Commercial, +34983,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-Commercial, +34984,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMBLEMHEALTH/HIP-Commercial, +34985,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMBLEMHEALTH/HIP-Commercial,2344.63 +34986,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMBLEMHEALTH/HIP-Commercial, +34987,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMBLEMHEALTH/HIP-Commercial, +34988,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMBLEMHEALTH/HIP-Commercial, +34989,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMBLEMHEALTH/HIP-Commercial, +34990,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMBLEMHEALTH/HIP-Commercial, +34991,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMBLEMHEALTH/HIP-Commercial, +34992,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMBLEMHEALTH/HIP-Commercial, +34993,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMBLEMHEALTH/HIP-Commercial,2442.03 +34994,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMBLEMHEALTH/HIP-Commercial,2472.08 +34995,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMBLEMHEALTH/HIP-Commercial, +34996,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMBLEMHEALTH/HIP-Commercial, +34997,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMBLEMHEALTH/HIP-Commercial, +34998,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMBLEMHEALTH/HIP-Commercial, +34999,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMBLEMHEALTH/HIP-Commercial, +35000,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMBLEMHEALTH/HIP-Commercial, +35001,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMBLEMHEALTH/HIP-Commercial,4750.1 +35002,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMBLEMHEALTH/HIP-Commercial, +35003,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMBLEMHEALTH/HIP-Commercial, +35004,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMBLEMHEALTH/HIP-Commercial, +35005,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMBLEMHEALTH/HIP-Commercial, +35006,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMBLEMHEALTH/HIP-Commercial, +35007,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMBLEMHEALTH/HIP-Commercial, +35008,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMBLEMHEALTH/HIP-Commercial, +35009,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMBLEMHEALTH/HIP-Commercial, +35010,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMBLEMHEALTH/HIP-Commercial, +35011,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMBLEMHEALTH/HIP-Commercial, +35012,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMBLEMHEALTH/HIP-Commercial, +35013,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMBLEMHEALTH/HIP-Commercial, +35014,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMBLEMHEALTH/HIP-Commercial, +35015,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMBLEMHEALTH/HIP-Commercial, +35016,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMBLEMHEALTH/HIP-Commercial, +35017,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMBLEMHEALTH/HIP-Commercial, +35018,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMBLEMHEALTH/HIP-Commercial, +35019,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMBLEMHEALTH/HIP-Commercial, +35020,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMBLEMHEALTH/HIP-Commercial, +35021,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMBLEMHEALTH/HIP-Commercial, +35022,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMBLEMHEALTH/HIP-Commercial, +35023,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMBLEMHEALTH/HIP-Commercial, +35024,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMBLEMHEALTH/HIP-Commercial, +35025,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMBLEMHEALTH/HIP-Commercial, +35026,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMBLEMHEALTH/HIP-Commercial, +35027,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMBLEMHEALTH/HIP-Commercial, +35028,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMBLEMHEALTH/HIP-Commercial, +35029,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMBLEMHEALTH/HIP-Commercial, +35030,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMBLEMHEALTH/HIP-Commercial, +35031,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMBLEMHEALTH/HIP-Commercial, +35032,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMBLEMHEALTH/HIP-Commercial, +35033,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMBLEMHEALTH/HIP-Commercial, +35034,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMBLEMHEALTH/HIP-Commercial, +35035,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMBLEMHEALTH/HIP-Commercial, +35036,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMBLEMHEALTH/HIP-Commercial, +35037,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMBLEMHEALTH/HIP-Commercial, +35038,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMBLEMHEALTH/HIP-Commercial, +35039,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMBLEMHEALTH/HIP-Commercial,2427.77 +35040,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMBLEMHEALTH/HIP-Commercial, +35041,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMBLEMHEALTH/HIP-Commercial, +35042,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMBLEMHEALTH/HIP-Commercial, +35043,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMBLEMHEALTH/HIP-Commercial, +35044,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMBLEMHEALTH/HIP-Commercial, +35045,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMBLEMHEALTH/HIP-Commercial, +35046,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMBLEMHEALTH/HIP-Commercial,2427.77 +35047,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMBLEMHEALTH/HIP-Commercial, +35048,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMBLEMHEALTH/HIP-Commercial, +35049,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMBLEMHEALTH/HIP-Commercial, +35050,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMBLEMHEALTH/HIP-Commercial, +35051,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMBLEMHEALTH/HIP-Commercial, +35052,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMBLEMHEALTH/HIP-Commercial, +35053,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMBLEMHEALTH/HIP-Commercial, +35054,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMBLEMHEALTH/HIP-Commercial, +35055,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMBLEMHEALTH/HIP-Commercial, +35056,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMBLEMHEALTH/HIP-Commercial, +35057,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMBLEMHEALTH/HIP-Commercial, +35058,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMBLEMHEALTH/HIP-Commercial, +35059,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMBLEMHEALTH/HIP-Commercial, +35060,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMBLEMHEALTH/HIP-Commercial, +35061,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMBLEMHEALTH/HIP-Commercial, +35062,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMBLEMHEALTH/HIP-Commercial, +35063,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMBLEMHEALTH/HIP-Commercial, +35064,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMBLEMHEALTH/HIP-Commercial, +35065,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMBLEMHEALTH/HIP-Commercial, +35066,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMBLEMHEALTH/HIP-Commercial, +35067,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMBLEMHEALTH/HIP-Commercial, +35068,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMBLEMHEALTH/HIP-Commercial, +35069,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMBLEMHEALTH/HIP-Commercial, +35070,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMBLEMHEALTH/HIP-Commercial, +35071,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMBLEMHEALTH/HIP-Commercial, +35072,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMBLEMHEALTH/HIP-Commercial, +35073,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMBLEMHEALTH/HIP-Commercial, +35074,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMBLEMHEALTH/HIP-Commercial, +35075,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMBLEMHEALTH/HIP-Commercial, +35076,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMBLEMHEALTH/HIP-Commercial, +35077,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMBLEMHEALTH/HIP-Commercial, +35078,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMBLEMHEALTH/HIP-Commercial, +35079,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMBLEMHEALTH/HIP-Commercial, +35080,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMBLEMHEALTH/HIP-Commercial, +35081,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMBLEMHEALTH/HIP-Commercial, +35082,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMBLEMHEALTH/HIP-Commercial, +35083,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMBLEMHEALTH/HIP-Commercial, +35084,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMBLEMHEALTH/HIP-Commercial, +35085,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMBLEMHEALTH/HIP-Commercial, +35086,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMBLEMHEALTH/HIP-Commercial, +35087,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMBLEMHEALTH/HIP-Commercial, +35088,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMBLEMHEALTH/HIP-Commercial, +35089,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMBLEMHEALTH/HIP-Commercial, +35090,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMBLEMHEALTH/HIP-Commercial, +35091,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMBLEMHEALTH/HIP-Commercial, +35092,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMBLEMHEALTH/HIP-Commercial, +35093,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMBLEMHEALTH/HIP-Commercial, +35094,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMBLEMHEALTH/HIP-Commercial,276.15 +35095,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMBLEMHEALTH/HIP-Commercial, +35096,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMBLEMHEALTH/HIP-Commercial, +35097,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMBLEMHEALTH/HIP-Commercial, +35098,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMBLEMHEALTH/HIP-Commercial, +35099,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMBLEMHEALTH/HIP-Commercial, +35100,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMBLEMHEALTH/HIP-Commercial, +35101,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMBLEMHEALTH/HIP-Commercial,216.48 +35102,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMBLEMHEALTH/HIP-Commercial, +35103,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMBLEMHEALTH/HIP-Commercial, +35104,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMBLEMHEALTH/HIP-Commercial,334.42 +35105,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMBLEMHEALTH/HIP-Commercial, +35106,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMBLEMHEALTH/HIP-Commercial,509.51 +35107,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMBLEMHEALTH/HIP-Commercial, +35108,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMBLEMHEALTH/HIP-Commercial, +35109,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMBLEMHEALTH/HIP-Commercial,431.05 +35110,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMBLEMHEALTH/HIP-Commercial,269.47 +35111,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMBLEMHEALTH/HIP-Commercial, +35112,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMBLEMHEALTH/HIP-Commercial, +35113,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMBLEMHEALTH/HIP-Commercial, +35114,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMBLEMHEALTH/HIP-Commercial, +35115,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMBLEMHEALTH/HIP-Commercial,1056.79 +35116,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMBLEMHEALTH/HIP-Commercial, +35117,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMBLEMHEALTH/HIP-Commercial,431.05 +35118,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMBLEMHEALTH/HIP-Commercial, +35119,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMBLEMHEALTH/HIP-Commercial,98.09 +35120,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMBLEMHEALTH/HIP-Commercial,95.77 +35121,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMBLEMHEALTH/HIP-Commercial, +35122,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMBLEMHEALTH/HIP-Commercial, +35123,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMBLEMHEALTH/HIP-Commercial, +35124,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMBLEMHEALTH/HIP-Commercial, +35125,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMBLEMHEALTH/HIP-Commercial, +35126,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMBLEMHEALTH/HIP-Commercial, +35127,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMBLEMHEALTH/HIP-Commercial,2284.5 +35128,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMBLEMHEALTH/HIP-Commercial,384.39 +35129,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMBLEMHEALTH/HIP-Commercial, +35130,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMBLEMHEALTH/HIP-Commercial, +35131,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMBLEMHEALTH/HIP-Commercial,272.12 +35132,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMBLEMHEALTH/HIP-Commercial, +35133,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMBLEMHEALTH/HIP-Commercial, +35134,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMBLEMHEALTH/HIP-Commercial, +35135,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMBLEMHEALTH/HIP-Commercial, +35136,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMBLEMHEALTH/HIP-Commercial, +35137,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMBLEMHEALTH/HIP-Commercial, +35138,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMBLEMHEALTH/HIP-Commercial, +35139,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMBLEMHEALTH/HIP-Commercial, +35140,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMBLEMHEALTH/HIP-Commercial, +35141,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMBLEMHEALTH/HIP-Commercial, +35142,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMBLEMHEALTH/HIP-Commercial, +35143,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMBLEMHEALTH/HIP-Commercial,128.73 +35144,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMBLEMHEALTH/HIP-Commercial, +35145,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMBLEMHEALTH/HIP-Commercial, +35146,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMBLEMHEALTH/HIP-Commercial,128.73 +35147,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMBLEMHEALTH/HIP-Commercial, +35148,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMBLEMHEALTH/HIP-Commercial, +35149,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMBLEMHEALTH/HIP-Commercial, +35150,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMBLEMHEALTH/HIP-Commercial, +35151,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMBLEMHEALTH/HIP-Commercial, +35152,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMBLEMHEALTH/HIP-Commercial, +35153,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMBLEMHEALTH/HIP-Commercial, +35154,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMBLEMHEALTH/HIP-Commercial, +35155,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMBLEMHEALTH/HIP-Commercial, +35156,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMBLEMHEALTH/HIP-Commercial, +35157,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMBLEMHEALTH/HIP-Commercial, +35158,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMBLEMHEALTH/HIP-Commercial,612.16 +35159,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMBLEMHEALTH/HIP-Commercial, +35160,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMBLEMHEALTH/HIP-Commercial,269.47 +35161,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMBLEMHEALTH/HIP-Commercial, +35162,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMBLEMHEALTH/HIP-Commercial,446.33 +35163,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMBLEMHEALTH/HIP-Commercial,431.05 +35164,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMBLEMHEALTH/HIP-Commercial, +35165,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMBLEMHEALTH/HIP-Commercial,127.6 +35166,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMBLEMHEALTH/HIP-Commercial,135.78 +35167,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMBLEMHEALTH/HIP-Commercial, +35168,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMBLEMHEALTH/HIP-Commercial, +35169,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMBLEMHEALTH/HIP-Commercial, +35170,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMBLEMHEALTH/HIP-Commercial, +35171,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMBLEMHEALTH/HIP-Commercial, +35172,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMBLEMHEALTH/HIP-Commercial, +35173,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMBLEMHEALTH/HIP-Commercial, +35174,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMBLEMHEALTH/HIP-Commercial, +35175,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMBLEMHEALTH/HIP-Commercial, +35176,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMBLEMHEALTH/HIP-Commercial,133.95 +35177,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMBLEMHEALTH/HIP-Commercial, +35178,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMBLEMHEALTH/HIP-Commercial,96.41 +35179,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMBLEMHEALTH/HIP-Commercial, +35180,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMBLEMHEALTH/HIP-Commercial, +35181,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMBLEMHEALTH/HIP-Commercial, +35182,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMBLEMHEALTH/HIP-Commercial,94.73 +35183,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMBLEMHEALTH/HIP-Commercial, +35184,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMBLEMHEALTH/HIP-Commercial, +35185,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMBLEMHEALTH/HIP-Commercial,98.09 +35186,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMBLEMHEALTH/HIP-Commercial, +35187,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMBLEMHEALTH/HIP-Commercial, +35188,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMBLEMHEALTH/HIP-Commercial,94.73 +35189,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMBLEMHEALTH/HIP-Commercial, +35190,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMBLEMHEALTH/HIP-Commercial, +35191,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMBLEMHEALTH/HIP-Commercial, +35192,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMBLEMHEALTH/HIP-Commercial, +35193,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMBLEMHEALTH/HIP-Commercial, +35194,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMBLEMHEALTH/HIP-Commercial,612.16 +35195,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMBLEMHEALTH/HIP-Commercial, +35196,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMBLEMHEALTH/HIP-Commercial, +35197,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMBLEMHEALTH/HIP-Commercial,95.35 +35198,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMBLEMHEALTH/HIP-Commercial, +35199,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMBLEMHEALTH/HIP-Commercial, +35200,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMBLEMHEALTH/HIP-Commercial, +35201,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMBLEMHEALTH/HIP-Commercial, +35202,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMBLEMHEALTH/HIP-Commercial, +35203,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMBLEMHEALTH/HIP-Commercial,94.73 +35204,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMBLEMHEALTH/HIP-Commercial,94.73 +35205,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMBLEMHEALTH/HIP-Commercial, +35206,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMBLEMHEALTH/HIP-Commercial,129.89 +35207,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMBLEMHEALTH/HIP-Commercial, +35208,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMBLEMHEALTH/HIP-Commercial,95.85 +35209,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMBLEMHEALTH/HIP-Commercial, +35210,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMBLEMHEALTH/HIP-Commercial, +35211,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMBLEMHEALTH/HIP-Commercial, +35212,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMBLEMHEALTH/HIP-Commercial, +35213,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMBLEMHEALTH/HIP-Commercial,813.5 +35214,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMBLEMHEALTH/HIP-Commercial,94.73 +35215,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMBLEMHEALTH/HIP-Commercial, +35216,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMBLEMHEALTH/HIP-Commercial, +35217,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMBLEMHEALTH/HIP-Commercial, +35218,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMBLEMHEALTH/HIP-Commercial, +35219,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMBLEMHEALTH/HIP-Commercial, +35220,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMBLEMHEALTH/HIP-Commercial, +35221,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMBLEMHEALTH/HIP-Commercial,612.16 +35222,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMBLEMHEALTH/HIP-Commercial, +35223,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMBLEMHEALTH/HIP-Commercial, +35224,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMBLEMHEALTH/HIP-Commercial, +35225,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMBLEMHEALTH/HIP-Commercial, +35226,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMBLEMHEALTH/HIP-Commercial, +35227,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMBLEMHEALTH/HIP-Commercial,212.78 +35228,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMBLEMHEALTH/HIP-Commercial, +35229,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMBLEMHEALTH/HIP-Commercial,438.69 +35230,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMBLEMHEALTH/HIP-Commercial, +35231,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMBLEMHEALTH/HIP-Commercial,269.47 +35232,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMBLEMHEALTH/HIP-Commercial,438.69 +35233,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMBLEMHEALTH/HIP-Commercial,431.05 +35234,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMBLEMHEALTH/HIP-Commercial, +35235,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMBLEMHEALTH/HIP-Commercial,431.05 +35236,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMBLEMHEALTH/HIP-Commercial, +35237,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMBLEMHEALTH/HIP-Commercial, +35238,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMBLEMHEALTH/HIP-Commercial, +35239,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMBLEMHEALTH/HIP-Commercial, +35240,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMBLEMHEALTH/HIP-Commercial,216.48 +35241,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMBLEMHEALTH/HIP-Commercial, +35242,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMBLEMHEALTH/HIP-Commercial, +35243,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMBLEMHEALTH/HIP-Commercial, +35244,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMBLEMHEALTH/HIP-Commercial, +35245,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMBLEMHEALTH/HIP-Commercial, +35246,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMBLEMHEALTH/HIP-Commercial, +35247,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMBLEMHEALTH/HIP-Commercial, +35248,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMBLEMHEALTH/HIP-Commercial, +35249,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMBLEMHEALTH/HIP-Commercial, +35250,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMBLEMHEALTH/HIP-Commercial, +35251,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMBLEMHEALTH/HIP-Commercial, +35252,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMBLEMHEALTH/HIP-Commercial,431.05 +35253,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMBLEMHEALTH/HIP-Commercial, +35254,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMBLEMHEALTH/HIP-Commercial, +35255,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMBLEMHEALTH/HIP-Commercial, +35256,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMBLEMHEALTH/HIP-Commercial, +35257,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMBLEMHEALTH/HIP-Commercial, +35258,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMBLEMHEALTH/HIP-Commercial, +35259,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMBLEMHEALTH/HIP-Commercial,431.05 +35260,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMBLEMHEALTH/HIP-Commercial, +35261,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMBLEMHEALTH/HIP-Commercial,216.48 +35262,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMBLEMHEALTH/HIP-Commercial,209.07 +35263,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMBLEMHEALTH/HIP-Commercial, +35264,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMBLEMHEALTH/HIP-Commercial, +35265,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMBLEMHEALTH/HIP-Commercial, +35266,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMBLEMHEALTH/HIP-Commercial, +35267,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMBLEMHEALTH/HIP-Commercial, +35268,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMBLEMHEALTH/HIP-Commercial, +35269,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMBLEMHEALTH/HIP-Commercial, +35270,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMBLEMHEALTH/HIP-Commercial, +35271,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMBLEMHEALTH/HIP-Commercial, +35272,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMBLEMHEALTH/HIP-Commercial, +35273,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMBLEMHEALTH/HIP-Commercial, +35274,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMBLEMHEALTH/HIP-Commercial, +35275,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMBLEMHEALTH/HIP-Commercial, +35276,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMBLEMHEALTH/HIP-Commercial, +35277,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMBLEMHEALTH/HIP-Commercial, +35278,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMBLEMHEALTH/HIP-Commercial, +35279,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMBLEMHEALTH/HIP-Commercial, +35280,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMBLEMHEALTH/HIP-Commercial, +35281,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMBLEMHEALTH/HIP-Commercial, +35282,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMBLEMHEALTH/HIP-Commercial, +35283,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMBLEMHEALTH/HIP-Commercial, +35284,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMBLEMHEALTH/HIP-Commercial, +35285,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMBLEMHEALTH/HIP-Commercial, +35286,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMBLEMHEALTH/HIP-Commercial, +35287,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMBLEMHEALTH/HIP-Commercial, +35288,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMBLEMHEALTH/HIP-Commercial, +35289,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMBLEMHEALTH/HIP-Commercial, +35290,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMBLEMHEALTH/HIP-Commercial, +35291,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMBLEMHEALTH/HIP-Commercial, +35292,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMBLEMHEALTH/HIP-Commercial, +35293,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMBLEMHEALTH/HIP-Commercial, +35294,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMBLEMHEALTH/HIP-Commercial,127.6 +35295,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMBLEMHEALTH/HIP-Commercial, +35296,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMBLEMHEALTH/HIP-Commercial,132.12 +35297,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMBLEMHEALTH/HIP-Commercial,96.41 +35298,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMBLEMHEALTH/HIP-Commercial,127.6 +35299,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMBLEMHEALTH/HIP-Commercial,186.13 +35300,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMBLEMHEALTH/HIP-Commercial, +35301,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMBLEMHEALTH/HIP-Commercial,131.83 +35302,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMBLEMHEALTH/HIP-Commercial, +35303,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMBLEMHEALTH/HIP-Commercial, +35304,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMBLEMHEALTH/HIP-Commercial, +35305,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMBLEMHEALTH/HIP-Commercial, +35306,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMBLEMHEALTH/HIP-Commercial, +35307,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMBLEMHEALTH/HIP-Commercial, +35308,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMBLEMHEALTH/HIP-Commercial, +35309,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMBLEMHEALTH/HIP-Commercial, +35310,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMBLEMHEALTH/HIP-Commercial, +35311,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMBLEMHEALTH/HIP-Commercial, +35312,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMBLEMHEALTH/HIP-Commercial, +35313,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMBLEMHEALTH/HIP-Commercial, +35314,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMBLEMHEALTH/HIP-Commercial, +35315,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMBLEMHEALTH/HIP-Commercial, +35316,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMBLEMHEALTH/HIP-Commercial, +35317,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMBLEMHEALTH/HIP-Commercial, +35318,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMBLEMHEALTH/HIP-Commercial, +35319,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMBLEMHEALTH/HIP-Commercial,264.24 +35320,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMBLEMHEALTH/HIP-Commercial,132.12 +35321,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMBLEMHEALTH/HIP-Commercial, +35322,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMBLEMHEALTH/HIP-Commercial, +35323,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMBLEMHEALTH/HIP-Commercial, +35324,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Commercial, +35325,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMBLEMHEALTH/HIP-Commercial, +35326,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMBLEMHEALTH/HIP-Commercial, +35327,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMBLEMHEALTH/HIP-Commercial, +35328,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMBLEMHEALTH/HIP-Commercial, +35329,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMBLEMHEALTH/HIP-Commercial, +35330,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMBLEMHEALTH/HIP-Commercial, +35331,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMBLEMHEALTH/HIP-Commercial, +35332,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMBLEMHEALTH/HIP-Commercial, +35333,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMBLEMHEALTH/HIP-Commercial, +35334,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMBLEMHEALTH/HIP-Commercial, +35335,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMBLEMHEALTH/HIP-Commercial, +35336,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMBLEMHEALTH/HIP-Commercial, +35337,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMBLEMHEALTH/HIP-Commercial, +35338,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMBLEMHEALTH/HIP-Commercial, +35339,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMBLEMHEALTH/HIP-Commercial, +35340,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMBLEMHEALTH/HIP-Commercial, +35341,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMBLEMHEALTH/HIP-Commercial, +35342,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMBLEMHEALTH/HIP-Commercial, +35343,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMBLEMHEALTH/HIP-Commercial, +35344,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMBLEMHEALTH/HIP-Commercial, +35345,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMBLEMHEALTH/HIP-Commercial, +35346,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMBLEMHEALTH/HIP-Commercial,31.15 +35347,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMBLEMHEALTH/HIP-Commercial,113.05 +35348,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMBLEMHEALTH/HIP-Commercial,143.47 +35349,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMBLEMHEALTH/HIP-Commercial,118.91 +35350,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMBLEMHEALTH/HIP-Commercial, +35351,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMBLEMHEALTH/HIP-Commercial, +35352,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMBLEMHEALTH/HIP-Commercial, +35353,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMBLEMHEALTH/HIP-Commercial, +35354,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMBLEMHEALTH/HIP-Commercial,130.99 +35355,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMBLEMHEALTH/HIP-Commercial, +35356,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMBLEMHEALTH/HIP-Commercial,153.82 +35357,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMBLEMHEALTH/HIP-Commercial,406.05 +35358,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMBLEMHEALTH/HIP-Commercial, +35359,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMBLEMHEALTH/HIP-Commercial,2023.07 +35360,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMBLEMHEALTH/HIP-Commercial,148.56 +35361,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMBLEMHEALTH/HIP-Commercial,2023.07 +35362,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMBLEMHEALTH/HIP-Commercial,793.14 +35363,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMBLEMHEALTH/HIP-Commercial,2101.31 +35364,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMBLEMHEALTH/HIP-Commercial,1028.03 +35365,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Commercial, +35366,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMBLEMHEALTH/HIP-Commercial, +35367,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMBLEMHEALTH/HIP-Commercial,439.71 +35368,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMBLEMHEALTH/HIP-Commercial, +35369,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMBLEMHEALTH/HIP-Commercial,397.76 +35370,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMBLEMHEALTH/HIP-Commercial,148.83 +35371,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMBLEMHEALTH/HIP-Commercial,2023.07 +35372,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMBLEMHEALTH/HIP-Commercial,153.36 +35373,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMBLEMHEALTH/HIP-Commercial,9622.23 +35374,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMBLEMHEALTH/HIP-Commercial,2102.35 +35375,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMBLEMHEALTH/HIP-Commercial, +35376,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMBLEMHEALTH/HIP-Commercial,652.79 +35377,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMBLEMHEALTH/HIP-Commercial, +35378,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMBLEMHEALTH/HIP-Commercial, +35379,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMBLEMHEALTH/HIP-Commercial, +35380,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMBLEMHEALTH/HIP-Commercial,283.15 +35381,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMBLEMHEALTH/HIP-Commercial, +35382,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMBLEMHEALTH/HIP-Commercial,1031.86 +35383,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMBLEMHEALTH/HIP-Commercial,1028.03 +35384,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMBLEMHEALTH/HIP-Commercial,2101.31 +35385,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMBLEMHEALTH/HIP-Commercial, +35386,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Commercial, +35387,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMBLEMHEALTH/HIP-Commercial, +35388,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMBLEMHEALTH/HIP-Commercial, +35389,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMBLEMHEALTH/HIP-Commercial, +35390,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMBLEMHEALTH/HIP-Commercial, +35391,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMBLEMHEALTH/HIP-Commercial, +35392,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMBLEMHEALTH/HIP-Commercial,573.06 +35393,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMBLEMHEALTH/HIP-Commercial, +35394,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMBLEMHEALTH/HIP-Commercial, +35395,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMBLEMHEALTH/HIP-Commercial, +35396,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMBLEMHEALTH/HIP-Commercial, +35397,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMBLEMHEALTH/HIP-Commercial, +35398,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMBLEMHEALTH/HIP-Commercial,441.58 +35399,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMBLEMHEALTH/HIP-Commercial, +35400,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMBLEMHEALTH/HIP-Commercial, +35401,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMBLEMHEALTH/HIP-Commercial,1541.26 +35402,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMBLEMHEALTH/HIP-Commercial, +35403,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMBLEMHEALTH/HIP-Commercial, +35404,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMBLEMHEALTH/HIP-Commercial, +35405,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMBLEMHEALTH/HIP-Commercial, +35406,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMBLEMHEALTH/HIP-Commercial,457.24 +35407,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMBLEMHEALTH/HIP-Commercial, +35408,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMBLEMHEALTH/HIP-Commercial,1764.12 +35409,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMBLEMHEALTH/HIP-Commercial, +35410,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMBLEMHEALTH/HIP-Commercial,583.22 +35411,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMBLEMHEALTH/HIP-Commercial, +35412,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMBLEMHEALTH/HIP-Commercial, +35413,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMBLEMHEALTH/HIP-Commercial, +35414,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMBLEMHEALTH/HIP-Commercial, +35415,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMBLEMHEALTH/HIP-Commercial, +35416,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMBLEMHEALTH/HIP-Commercial, +35417,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMBLEMHEALTH/HIP-Commercial, +35418,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMBLEMHEALTH/HIP-Commercial,1733.39 +35419,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMBLEMHEALTH/HIP-Commercial,1733.39 +35420,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMBLEMHEALTH/HIP-Commercial, +35421,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMBLEMHEALTH/HIP-Commercial,1748.76 +35422,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMBLEMHEALTH/HIP-Commercial, +35423,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMBLEMHEALTH/HIP-Commercial,1542.74 +35424,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMBLEMHEALTH/HIP-Commercial, +35425,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMBLEMHEALTH/HIP-Commercial, +35426,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMBLEMHEALTH/HIP-Commercial,292.29 +35427,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMBLEMHEALTH/HIP-Commercial, +35428,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMBLEMHEALTH/HIP-Commercial, +35429,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMBLEMHEALTH/HIP-Commercial,211.0 +35430,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMBLEMHEALTH/HIP-Commercial, +35431,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMBLEMHEALTH/HIP-Commercial,10.56 +35432,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +35433,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMBLEMHEALTH/HIP-Commercial,13.39 +35434,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMBLEMHEALTH/HIP-Commercial, +35435,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMBLEMHEALTH/HIP-Commercial, +35436,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMBLEMHEALTH/HIP-Commercial,8.17 +35437,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMBLEMHEALTH/HIP-Commercial, +35438,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMBLEMHEALTH/HIP-Commercial, +35439,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMBLEMHEALTH/HIP-Commercial, +35440,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMBLEMHEALTH/HIP-Commercial, +35441,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMBLEMHEALTH/HIP-Commercial, +35442,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMBLEMHEALTH/HIP-Commercial, +35443,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMBLEMHEALTH/HIP-Commercial, +35444,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMBLEMHEALTH/HIP-Commercial, +35445,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMBLEMHEALTH/HIP-Commercial, +35446,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMBLEMHEALTH/HIP-Commercial, +35447,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMBLEMHEALTH/HIP-Commercial, +35448,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMBLEMHEALTH/HIP-Commercial, +35449,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMBLEMHEALTH/HIP-Commercial, +35450,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMBLEMHEALTH/HIP-Commercial, +35451,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMBLEMHEALTH/HIP-Commercial, +35452,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMBLEMHEALTH/HIP-Commercial,18.05 +35453,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMBLEMHEALTH/HIP-Commercial, +35454,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMBLEMHEALTH/HIP-Commercial, +35455,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMBLEMHEALTH/HIP-Commercial, +35456,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMBLEMHEALTH/HIP-Commercial, +35457,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMBLEMHEALTH/HIP-Commercial, +35458,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMBLEMHEALTH/HIP-Commercial,13.73 +35459,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMBLEMHEALTH/HIP-Commercial, +35460,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMBLEMHEALTH/HIP-Commercial, +35461,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMBLEMHEALTH/HIP-Commercial, +35462,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMBLEMHEALTH/HIP-Commercial, +35463,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMBLEMHEALTH/HIP-Commercial, +35464,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMBLEMHEALTH/HIP-Commercial, +35465,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMBLEMHEALTH/HIP-Commercial, +35466,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMBLEMHEALTH/HIP-Commercial, +35467,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMBLEMHEALTH/HIP-Commercial, +35468,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMBLEMHEALTH/HIP-Commercial, +35469,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMBLEMHEALTH/HIP-Commercial, +35470,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMBLEMHEALTH/HIP-Commercial, +35471,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMBLEMHEALTH/HIP-Commercial, +35472,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMBLEMHEALTH/HIP-Commercial, +35473,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMBLEMHEALTH/HIP-Commercial, +35474,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMBLEMHEALTH/HIP-Commercial, +35475,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMBLEMHEALTH/HIP-Commercial, +35476,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMBLEMHEALTH/HIP-Commercial, +35477,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMBLEMHEALTH/HIP-Commercial, +35478,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMBLEMHEALTH/HIP-Commercial, +35479,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMBLEMHEALTH/HIP-Commercial, +35480,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMBLEMHEALTH/HIP-Commercial, +35481,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMBLEMHEALTH/HIP-Commercial, +35482,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMBLEMHEALTH/HIP-Commercial, +35483,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMBLEMHEALTH/HIP-Commercial, +35484,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMBLEMHEALTH/HIP-Commercial, +35485,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMBLEMHEALTH/HIP-Commercial,3.17 +35486,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +35487,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMBLEMHEALTH/HIP-Commercial, +35488,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMBLEMHEALTH/HIP-Commercial, +35489,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMBLEMHEALTH/HIP-Commercial, +35490,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMBLEMHEALTH/HIP-Commercial, +35491,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Commercial, +35492,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Commercial, +35493,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Commercial, +35494,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-Commercial, +35495,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-Commercial, +35496,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMBLEMHEALTH/HIP-Commercial, +35497,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMBLEMHEALTH/HIP-Commercial, +35498,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMBLEMHEALTH/HIP-Commercial, +35499,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMBLEMHEALTH/HIP-Commercial, +35500,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMBLEMHEALTH/HIP-Commercial, +35501,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMBLEMHEALTH/HIP-Commercial, +35502,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMBLEMHEALTH/HIP-Commercial, +35503,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMBLEMHEALTH/HIP-Commercial, +35504,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMBLEMHEALTH/HIP-Commercial,163.96 +35505,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMBLEMHEALTH/HIP-Commercial, +35506,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMBLEMHEALTH/HIP-Commercial, +35507,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMBLEMHEALTH/HIP-Commercial, +35508,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMBLEMHEALTH/HIP-Commercial, +35509,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMBLEMHEALTH/HIP-Commercial, +35510,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMBLEMHEALTH/HIP-Commercial, +35511,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMBLEMHEALTH/HIP-Commercial, +35512,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMBLEMHEALTH/HIP-Commercial, +35513,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMBLEMHEALTH/HIP-Commercial, +35514,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMBLEMHEALTH/HIP-Commercial, +35515,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMBLEMHEALTH/HIP-Commercial, +35516,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMBLEMHEALTH/HIP-Commercial, +35517,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMBLEMHEALTH/HIP-Commercial, +35518,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMBLEMHEALTH/HIP-Commercial, +35519,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMBLEMHEALTH/HIP-Commercial, +35520,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMBLEMHEALTH/HIP-Commercial, +35521,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMBLEMHEALTH/HIP-Commercial, +35522,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMBLEMHEALTH/HIP-Commercial, +35523,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMBLEMHEALTH/HIP-Commercial, +35524,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMBLEMHEALTH/HIP-Commercial, +35525,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMBLEMHEALTH/HIP-Commercial, +35526,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMBLEMHEALTH/HIP-Commercial, +35527,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMBLEMHEALTH/HIP-Commercial, +35528,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMBLEMHEALTH/HIP-Commercial, +35529,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMBLEMHEALTH/HIP-Commercial,260.79 +35530,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMBLEMHEALTH/HIP-Commercial, +35531,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMBLEMHEALTH/HIP-Commercial, +35532,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMBLEMHEALTH/HIP-Commercial, +35533,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMBLEMHEALTH/HIP-Commercial, +35534,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMBLEMHEALTH/HIP-Commercial, +35535,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMBLEMHEALTH/HIP-Commercial, +35536,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMBLEMHEALTH/HIP-Commercial, +35537,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMBLEMHEALTH/HIP-Commercial, +35538,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMBLEMHEALTH/HIP-Commercial, +35539,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMBLEMHEALTH/HIP-Commercial, +35540,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMBLEMHEALTH/HIP-Commercial, +35541,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMBLEMHEALTH/HIP-Commercial, +35542,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMBLEMHEALTH/HIP-Commercial, +35543,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMBLEMHEALTH/HIP-Commercial, +35544,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMBLEMHEALTH/HIP-Commercial, +35545,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMBLEMHEALTH/HIP-Commercial, +35546,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMBLEMHEALTH/HIP-Commercial, +35547,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMBLEMHEALTH/HIP-Commercial, +35548,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMBLEMHEALTH/HIP-Commercial, +35549,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMBLEMHEALTH/HIP-Commercial, +35550,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMBLEMHEALTH/HIP-Commercial, +35551,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMBLEMHEALTH/HIP-Commercial, +35552,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMBLEMHEALTH/HIP-Commercial, +35553,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMBLEMHEALTH/HIP-Commercial, +35554,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMBLEMHEALTH/HIP-Commercial, +35555,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMBLEMHEALTH/HIP-Commercial, +35556,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMBLEMHEALTH/HIP-Commercial, +35557,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMBLEMHEALTH/HIP-Commercial, +35558,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMBLEMHEALTH/HIP-Commercial, +35559,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMBLEMHEALTH/HIP-Commercial, +35560,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMBLEMHEALTH/HIP-Commercial, +35561,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMBLEMHEALTH/HIP-Commercial, +35562,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMBLEMHEALTH/HIP-Commercial, +35563,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMBLEMHEALTH/HIP-Commercial, +35564,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMBLEMHEALTH/HIP-Commercial, +35565,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMBLEMHEALTH/HIP-Commercial, +35566,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMBLEMHEALTH/HIP-Commercial, +35567,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMBLEMHEALTH/HIP-Commercial, +35568,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMBLEMHEALTH/HIP-Commercial, +35569,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMBLEMHEALTH/HIP-Commercial, +35570,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMBLEMHEALTH/HIP-Commercial, +35571,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMBLEMHEALTH/HIP-Commercial, +35572,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMBLEMHEALTH/HIP-Commercial, +35573,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMBLEMHEALTH/HIP-Commercial, +35574,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMBLEMHEALTH/HIP-Commercial, +35575,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMBLEMHEALTH/HIP-Commercial, +35576,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMBLEMHEALTH/HIP-Commercial, +35577,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMBLEMHEALTH/HIP-Commercial, +35578,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMBLEMHEALTH/HIP-Commercial, +35579,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMBLEMHEALTH/HIP-Commercial, +35580,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMBLEMHEALTH/HIP-Commercial, +35581,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMBLEMHEALTH/HIP-Commercial,5.78 +35582,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMBLEMHEALTH/HIP-Commercial,6.0 +35583,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMBLEMHEALTH/HIP-Commercial, +35584,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMBLEMHEALTH/HIP-Commercial, +35585,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMBLEMHEALTH/HIP-Commercial, +35586,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMBLEMHEALTH/HIP-Commercial, +35587,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMBLEMHEALTH/HIP-Commercial, +35588,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMBLEMHEALTH/HIP-Commercial, +35589,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMBLEMHEALTH/HIP-Commercial, +35590,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMBLEMHEALTH/HIP-Commercial, +35591,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMBLEMHEALTH/HIP-Commercial, +35592,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMBLEMHEALTH/HIP-Commercial, +35593,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMBLEMHEALTH/HIP-Commercial,6.48 +35594,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMBLEMHEALTH/HIP-Commercial, +35595,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMBLEMHEALTH/HIP-Commercial,7.0 +35596,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMBLEMHEALTH/HIP-Commercial, +35597,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMBLEMHEALTH/HIP-Commercial, +35598,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMBLEMHEALTH/HIP-Commercial, +35599,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMBLEMHEALTH/HIP-Commercial,16.18 +35600,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMBLEMHEALTH/HIP-Commercial, +35601,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMBLEMHEALTH/HIP-Commercial, +35602,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMBLEMHEALTH/HIP-Commercial, +35603,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMBLEMHEALTH/HIP-Commercial, +35604,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMBLEMHEALTH/HIP-Commercial, +35605,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMBLEMHEALTH/HIP-Commercial, +35606,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMBLEMHEALTH/HIP-Commercial, +35607,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMBLEMHEALTH/HIP-Commercial,29.6 +35608,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMBLEMHEALTH/HIP-Commercial, +35609,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMBLEMHEALTH/HIP-Commercial, +35610,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMBLEMHEALTH/HIP-Commercial, +35611,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMBLEMHEALTH/HIP-Commercial, +35612,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMBLEMHEALTH/HIP-Commercial, +35613,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMBLEMHEALTH/HIP-Commercial, +35614,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMBLEMHEALTH/HIP-Commercial, +35615,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMBLEMHEALTH/HIP-Commercial,18.96 +35616,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMBLEMHEALTH/HIP-Commercial, +35617,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMBLEMHEALTH/HIP-Commercial, +35618,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMBLEMHEALTH/HIP-Commercial, +35619,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMBLEMHEALTH/HIP-Commercial, +35620,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMBLEMHEALTH/HIP-Commercial, +35621,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMBLEMHEALTH/HIP-Commercial, +35622,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMBLEMHEALTH/HIP-Commercial, +35623,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMBLEMHEALTH/HIP-Commercial, +35624,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMBLEMHEALTH/HIP-Commercial,4.35 +35625,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMBLEMHEALTH/HIP-Commercial, +35626,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMBLEMHEALTH/HIP-Commercial, +35627,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMBLEMHEALTH/HIP-Commercial, +35628,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMBLEMHEALTH/HIP-Commercial, +35629,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMBLEMHEALTH/HIP-Commercial, +35630,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMBLEMHEALTH/HIP-Commercial, +35631,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMBLEMHEALTH/HIP-Commercial,6.51 +35632,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMBLEMHEALTH/HIP-Commercial, +35633,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMBLEMHEALTH/HIP-Commercial, +35634,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMBLEMHEALTH/HIP-Commercial, +35635,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMBLEMHEALTH/HIP-Commercial,5.18 +35636,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMBLEMHEALTH/HIP-Commercial, +35637,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMBLEMHEALTH/HIP-Commercial, +35638,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMBLEMHEALTH/HIP-Commercial, +35639,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMBLEMHEALTH/HIP-Commercial,15.08 +35640,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMBLEMHEALTH/HIP-Commercial, +35641,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMBLEMHEALTH/HIP-Commercial, +35642,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMBLEMHEALTH/HIP-Commercial, +35643,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMBLEMHEALTH/HIP-Commercial, +35644,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMBLEMHEALTH/HIP-Commercial, +35645,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMBLEMHEALTH/HIP-Commercial, +35646,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMBLEMHEALTH/HIP-Commercial, +35647,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMBLEMHEALTH/HIP-Commercial, +35648,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMBLEMHEALTH/HIP-Commercial, +35649,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMBLEMHEALTH/HIP-Commercial, +35650,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMBLEMHEALTH/HIP-Commercial, +35651,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMBLEMHEALTH/HIP-Commercial, +35652,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMBLEMHEALTH/HIP-Commercial, +35653,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMBLEMHEALTH/HIP-Commercial, +35654,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMBLEMHEALTH/HIP-Commercial, +35655,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMBLEMHEALTH/HIP-Commercial, +35656,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMBLEMHEALTH/HIP-Commercial, +35657,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMBLEMHEALTH/HIP-Commercial,13.63 +35658,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMBLEMHEALTH/HIP-Commercial, +35659,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMBLEMHEALTH/HIP-Commercial,14.7 +35660,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMBLEMHEALTH/HIP-Commercial, +35661,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMBLEMHEALTH/HIP-Commercial,27.9 +35662,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMBLEMHEALTH/HIP-Commercial, +35663,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMBLEMHEALTH/HIP-Commercial, +35664,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMBLEMHEALTH/HIP-Commercial, +35665,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMBLEMHEALTH/HIP-Commercial, +35666,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMBLEMHEALTH/HIP-Commercial, +35667,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMBLEMHEALTH/HIP-Commercial, +35668,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMBLEMHEALTH/HIP-Commercial,3.93 +35669,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMBLEMHEALTH/HIP-Commercial, +35670,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMBLEMHEALTH/HIP-Commercial, +35671,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMBLEMHEALTH/HIP-Commercial, +35672,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMBLEMHEALTH/HIP-Commercial, +35673,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMBLEMHEALTH/HIP-Commercial, +35674,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMBLEMHEALTH/HIP-Commercial, +35675,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMBLEMHEALTH/HIP-Commercial,7.2 +35676,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMBLEMHEALTH/HIP-Commercial, +35677,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMBLEMHEALTH/HIP-Commercial, +35678,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMBLEMHEALTH/HIP-Commercial, +35679,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMBLEMHEALTH/HIP-Commercial, +35680,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMBLEMHEALTH/HIP-Commercial, +35681,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMBLEMHEALTH/HIP-Commercial,12.58 +35682,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMBLEMHEALTH/HIP-Commercial, +35683,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMBLEMHEALTH/HIP-Commercial, +35684,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMBLEMHEALTH/HIP-Commercial, +35685,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMBLEMHEALTH/HIP-Commercial, +35686,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMBLEMHEALTH/HIP-Commercial,9.71 +35687,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMBLEMHEALTH/HIP-Commercial, +35688,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMBLEMHEALTH/HIP-Commercial, +35689,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMBLEMHEALTH/HIP-Commercial, +35690,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMBLEMHEALTH/HIP-Commercial, +35691,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMBLEMHEALTH/HIP-Commercial, +35692,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMBLEMHEALTH/HIP-Commercial, +35693,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMBLEMHEALTH/HIP-Commercial, +35694,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMBLEMHEALTH/HIP-Commercial, +35695,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMBLEMHEALTH/HIP-Commercial, +35696,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMBLEMHEALTH/HIP-Commercial, +35697,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMBLEMHEALTH/HIP-Commercial, +35698,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMBLEMHEALTH/HIP-Commercial,6.47 +35699,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMBLEMHEALTH/HIP-Commercial, +35700,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMBLEMHEALTH/HIP-Commercial,6.04 +35701,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMBLEMHEALTH/HIP-Commercial, +35702,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMBLEMHEALTH/HIP-Commercial, +35703,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMBLEMHEALTH/HIP-Commercial, +35704,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMBLEMHEALTH/HIP-Commercial,6.89 +35705,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMBLEMHEALTH/HIP-Commercial, +35706,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMBLEMHEALTH/HIP-Commercial, +35707,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMBLEMHEALTH/HIP-Commercial, +35708,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMBLEMHEALTH/HIP-Commercial, +35709,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMBLEMHEALTH/HIP-Commercial,6.7 +35710,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMBLEMHEALTH/HIP-Commercial, +35711,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMBLEMHEALTH/HIP-Commercial, +35712,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMBLEMHEALTH/HIP-Commercial, +35713,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMBLEMHEALTH/HIP-Commercial, +35714,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMBLEMHEALTH/HIP-Commercial, +35715,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMBLEMHEALTH/HIP-Commercial, +35716,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMBLEMHEALTH/HIP-Commercial, +35717,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMBLEMHEALTH/HIP-Commercial, +35718,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMBLEMHEALTH/HIP-Commercial, +35719,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMBLEMHEALTH/HIP-Commercial,27.2 +35720,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMBLEMHEALTH/HIP-Commercial, +35721,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMBLEMHEALTH/HIP-Commercial, +35722,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMBLEMHEALTH/HIP-Commercial, +35723,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMBLEMHEALTH/HIP-Commercial, +35724,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMBLEMHEALTH/HIP-Commercial, +35725,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMBLEMHEALTH/HIP-Commercial, +35726,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMBLEMHEALTH/HIP-Commercial, +35727,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMBLEMHEALTH/HIP-Commercial,41.28 +35728,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMBLEMHEALTH/HIP-Commercial, +35729,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMBLEMHEALTH/HIP-Commercial, +35730,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMBLEMHEALTH/HIP-Commercial, +35731,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMBLEMHEALTH/HIP-Commercial, +35732,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMBLEMHEALTH/HIP-Commercial, +35733,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMBLEMHEALTH/HIP-Commercial, +35734,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMBLEMHEALTH/HIP-Commercial,4.74 +35735,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMBLEMHEALTH/HIP-Commercial, +35736,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMBLEMHEALTH/HIP-Commercial, +35737,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMBLEMHEALTH/HIP-Commercial, +35738,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMBLEMHEALTH/HIP-Commercial, +35739,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMBLEMHEALTH/HIP-Commercial, +35740,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMBLEMHEALTH/HIP-Commercial, +35741,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMBLEMHEALTH/HIP-Commercial, +35742,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMBLEMHEALTH/HIP-Commercial, +35743,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMBLEMHEALTH/HIP-Commercial, +35744,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMBLEMHEALTH/HIP-Commercial, +35745,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMBLEMHEALTH/HIP-Commercial, +35746,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMBLEMHEALTH/HIP-Commercial, +35747,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMBLEMHEALTH/HIP-Commercial,18.39 +35748,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMBLEMHEALTH/HIP-Commercial, +35749,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMBLEMHEALTH/HIP-Commercial, +35750,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMBLEMHEALTH/HIP-Commercial,3.67 +35751,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMBLEMHEALTH/HIP-Commercial, +35752,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMBLEMHEALTH/HIP-Commercial,10.74 +35753,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMBLEMHEALTH/HIP-Commercial,17.83 +35754,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMBLEMHEALTH/HIP-Commercial, +35755,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMBLEMHEALTH/HIP-Commercial, +35756,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMBLEMHEALTH/HIP-Commercial, +35757,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMBLEMHEALTH/HIP-Commercial,10.0 +35758,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMBLEMHEALTH/HIP-Commercial, +35759,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMBLEMHEALTH/HIP-Commercial, +35760,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMBLEMHEALTH/HIP-Commercial, +35761,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMBLEMHEALTH/HIP-Commercial, +35762,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMBLEMHEALTH/HIP-Commercial, +35763,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMBLEMHEALTH/HIP-Commercial, +35764,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMBLEMHEALTH/HIP-Commercial, +35765,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMBLEMHEALTH/HIP-Commercial, +35766,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMBLEMHEALTH/HIP-Commercial, +35767,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMBLEMHEALTH/HIP-Commercial, +35768,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMBLEMHEALTH/HIP-Commercial, +35769,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMBLEMHEALTH/HIP-Commercial, +35770,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMBLEMHEALTH/HIP-Commercial, +35771,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMBLEMHEALTH/HIP-Commercial, +35772,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMBLEMHEALTH/HIP-Commercial, +35773,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMBLEMHEALTH/HIP-Commercial, +35774,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMBLEMHEALTH/HIP-Commercial, +35775,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMBLEMHEALTH/HIP-Commercial,14.0 +35776,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMBLEMHEALTH/HIP-Commercial,11.0 +35777,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMBLEMHEALTH/HIP-Commercial, +35778,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMBLEMHEALTH/HIP-Commercial,6.87 +35779,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMBLEMHEALTH/HIP-Commercial,9.02 +35780,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMBLEMHEALTH/HIP-Commercial, +35781,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMBLEMHEALTH/HIP-Commercial,16.8 +35782,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMBLEMHEALTH/HIP-Commercial, +35783,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMBLEMHEALTH/HIP-Commercial, +35784,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMBLEMHEALTH/HIP-Commercial, +35785,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMBLEMHEALTH/HIP-Commercial, +35786,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMBLEMHEALTH/HIP-Commercial,12.76 +35787,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMBLEMHEALTH/HIP-Commercial, +35788,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMBLEMHEALTH/HIP-Commercial, +35789,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMBLEMHEALTH/HIP-Commercial,14.18 +35790,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMBLEMHEALTH/HIP-Commercial, +35791,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMBLEMHEALTH/HIP-Commercial, +35792,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMBLEMHEALTH/HIP-Commercial, +35793,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMBLEMHEALTH/HIP-Commercial, +35794,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMBLEMHEALTH/HIP-Commercial, +35795,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMBLEMHEALTH/HIP-Commercial, +35796,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMBLEMHEALTH/HIP-Commercial,4.52 +35797,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMBLEMHEALTH/HIP-Commercial, +35798,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMBLEMHEALTH/HIP-Commercial, +35799,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMBLEMHEALTH/HIP-Commercial, +35800,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMBLEMHEALTH/HIP-Commercial, +35801,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMBLEMHEALTH/HIP-Commercial, +35802,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMBLEMHEALTH/HIP-Commercial, +35803,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMBLEMHEALTH/HIP-Commercial, +35804,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMBLEMHEALTH/HIP-Commercial, +35805,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMBLEMHEALTH/HIP-Commercial, +35806,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMBLEMHEALTH/HIP-Commercial, +35807,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMBLEMHEALTH/HIP-Commercial, +35808,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMBLEMHEALTH/HIP-Commercial, +35809,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMBLEMHEALTH/HIP-Commercial,3.8 +35810,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMBLEMHEALTH/HIP-Commercial, +35811,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMBLEMHEALTH/HIP-Commercial,2.37 +35812,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMBLEMHEALTH/HIP-Commercial,2.37 +35813,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMBLEMHEALTH/HIP-Commercial,7.77 +35814,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMBLEMHEALTH/HIP-Commercial,6.47 +35815,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMBLEMHEALTH/HIP-Commercial, +35816,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMBLEMHEALTH/HIP-Commercial,3.99 +35817,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMBLEMHEALTH/HIP-Commercial, +35818,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMBLEMHEALTH/HIP-Commercial, +35819,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMBLEMHEALTH/HIP-Commercial, +35820,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMBLEMHEALTH/HIP-Commercial, +35821,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMBLEMHEALTH/HIP-Commercial, +35822,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMBLEMHEALTH/HIP-Commercial, +35823,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMBLEMHEALTH/HIP-Commercial, +35824,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMBLEMHEALTH/HIP-Commercial, +35825,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMBLEMHEALTH/HIP-Commercial, +35826,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMBLEMHEALTH/HIP-Commercial, +35827,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMBLEMHEALTH/HIP-Commercial, +35828,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMBLEMHEALTH/HIP-Commercial, +35829,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMBLEMHEALTH/HIP-Commercial, +35830,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMBLEMHEALTH/HIP-Commercial, +35831,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMBLEMHEALTH/HIP-Commercial, +35832,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMBLEMHEALTH/HIP-Commercial, +35833,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMBLEMHEALTH/HIP-Commercial, +35834,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMBLEMHEALTH/HIP-Commercial, +35835,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMBLEMHEALTH/HIP-Commercial, +35836,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMBLEMHEALTH/HIP-Commercial,30.64 +35837,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMBLEMHEALTH/HIP-Commercial, +35838,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMBLEMHEALTH/HIP-Commercial, +35839,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMBLEMHEALTH/HIP-Commercial, +35840,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMBLEMHEALTH/HIP-Commercial, +35841,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMBLEMHEALTH/HIP-Commercial, +35842,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMBLEMHEALTH/HIP-Commercial, +35843,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMBLEMHEALTH/HIP-Commercial, +35844,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMBLEMHEALTH/HIP-Commercial, +35845,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMBLEMHEALTH/HIP-Commercial, +35846,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMBLEMHEALTH/HIP-Commercial, +35847,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMBLEMHEALTH/HIP-Commercial, +35848,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMBLEMHEALTH/HIP-Commercial, +35849,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMBLEMHEALTH/HIP-Commercial,4.29 +35850,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMBLEMHEALTH/HIP-Commercial, +35851,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMBLEMHEALTH/HIP-Commercial, +35852,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMBLEMHEALTH/HIP-Commercial, +35853,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMBLEMHEALTH/HIP-Commercial,2.7 +35854,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMBLEMHEALTH/HIP-Commercial, +35855,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMBLEMHEALTH/HIP-Commercial, +35856,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMBLEMHEALTH/HIP-Commercial,6.01 +35857,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMBLEMHEALTH/HIP-Commercial, +35858,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMBLEMHEALTH/HIP-Commercial, +35859,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMBLEMHEALTH/HIP-Commercial, +35860,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMBLEMHEALTH/HIP-Commercial, +35861,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMBLEMHEALTH/HIP-Commercial, +35862,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMBLEMHEALTH/HIP-Commercial, +35863,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMBLEMHEALTH/HIP-Commercial, +35864,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMBLEMHEALTH/HIP-Commercial, +35865,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMBLEMHEALTH/HIP-Commercial,12.09 +35866,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMBLEMHEALTH/HIP-Commercial,11.16 +35867,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMBLEMHEALTH/HIP-Commercial, +35868,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMBLEMHEALTH/HIP-Commercial,5.18 +35869,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMBLEMHEALTH/HIP-Commercial, +35870,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMBLEMHEALTH/HIP-Commercial, +35871,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMBLEMHEALTH/HIP-Commercial, +35872,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMBLEMHEALTH/HIP-Commercial, +35873,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMBLEMHEALTH/HIP-Commercial, +35874,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMBLEMHEALTH/HIP-Commercial, +35875,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMBLEMHEALTH/HIP-Commercial, +35876,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMBLEMHEALTH/HIP-Commercial, +35877,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMBLEMHEALTH/HIP-Commercial, +35878,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMBLEMHEALTH/HIP-Commercial,12.95 +35879,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMBLEMHEALTH/HIP-Commercial, +35880,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMBLEMHEALTH/HIP-Commercial,13.74 +35881,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMBLEMHEALTH/HIP-Commercial,17.93 +35882,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMBLEMHEALTH/HIP-Commercial, +35883,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMBLEMHEALTH/HIP-Commercial, +35884,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMBLEMHEALTH/HIP-Commercial,36.42 +35885,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMBLEMHEALTH/HIP-Commercial, +35886,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMBLEMHEALTH/HIP-Commercial,20.81 +35887,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMBLEMHEALTH/HIP-Commercial, +35888,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMBLEMHEALTH/HIP-Commercial, +35889,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMBLEMHEALTH/HIP-Commercial,20.81 +35890,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMBLEMHEALTH/HIP-Commercial, +35891,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMBLEMHEALTH/HIP-Commercial, +35892,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMBLEMHEALTH/HIP-Commercial, +35893,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMBLEMHEALTH/HIP-Commercial,22.34 +35894,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMBLEMHEALTH/HIP-Commercial,29.35 +35895,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMBLEMHEALTH/HIP-Commercial, +35896,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMBLEMHEALTH/HIP-Commercial, +35897,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMBLEMHEALTH/HIP-Commercial, +35898,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMBLEMHEALTH/HIP-Commercial, +35899,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMBLEMHEALTH/HIP-Commercial, +35900,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMBLEMHEALTH/HIP-Commercial, +35901,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMBLEMHEALTH/HIP-Commercial, +35902,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMBLEMHEALTH/HIP-Commercial, +35903,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMBLEMHEALTH/HIP-Commercial, +35904,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMBLEMHEALTH/HIP-Commercial,37.73 +35905,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMBLEMHEALTH/HIP-Commercial,46.98 +35906,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMBLEMHEALTH/HIP-Commercial, +35907,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMBLEMHEALTH/HIP-Commercial, +35908,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMBLEMHEALTH/HIP-Commercial,5.67 +35909,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMBLEMHEALTH/HIP-Commercial, +35910,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMBLEMHEALTH/HIP-Commercial, +35911,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMBLEMHEALTH/HIP-Commercial, +35912,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMBLEMHEALTH/HIP-Commercial, +35913,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMBLEMHEALTH/HIP-Commercial, +35914,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMBLEMHEALTH/HIP-Commercial, +35915,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMBLEMHEALTH/HIP-Commercial, +35916,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMBLEMHEALTH/HIP-Commercial, +35917,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMBLEMHEALTH/HIP-Commercial, +35918,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMBLEMHEALTH/HIP-Commercial, +35919,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMBLEMHEALTH/HIP-Commercial, +35920,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMBLEMHEALTH/HIP-Commercial, +35921,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMBLEMHEALTH/HIP-Commercial, +35922,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMBLEMHEALTH/HIP-Commercial, +35923,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMBLEMHEALTH/HIP-Commercial, +35924,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMBLEMHEALTH/HIP-Commercial, +35925,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMBLEMHEALTH/HIP-Commercial, +35926,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMBLEMHEALTH/HIP-Commercial, +35927,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMBLEMHEALTH/HIP-Commercial, +35928,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMBLEMHEALTH/HIP-Commercial, +35929,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMBLEMHEALTH/HIP-Commercial, +35930,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMBLEMHEALTH/HIP-Commercial, +35931,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMBLEMHEALTH/HIP-Commercial, +35932,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMBLEMHEALTH/HIP-Commercial, +35933,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMBLEMHEALTH/HIP-Commercial, +35934,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMBLEMHEALTH/HIP-Commercial, +35935,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMBLEMHEALTH/HIP-Commercial, +35936,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMBLEMHEALTH/HIP-Commercial, +35937,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMBLEMHEALTH/HIP-Commercial, +35938,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMBLEMHEALTH/HIP-Commercial, +35939,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMBLEMHEALTH/HIP-Commercial, +35940,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMBLEMHEALTH/HIP-Commercial, +35941,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMBLEMHEALTH/HIP-Commercial, +35942,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMBLEMHEALTH/HIP-Commercial, +35943,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMBLEMHEALTH/HIP-Commercial, +35944,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMBLEMHEALTH/HIP-Commercial, +35945,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMBLEMHEALTH/HIP-Commercial, +35946,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMBLEMHEALTH/HIP-Commercial, +35947,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMBLEMHEALTH/HIP-Commercial, +35948,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMBLEMHEALTH/HIP-Commercial, +35949,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMBLEMHEALTH/HIP-Commercial, +35950,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMBLEMHEALTH/HIP-Commercial, +35951,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMBLEMHEALTH/HIP-Commercial, +35952,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMBLEMHEALTH/HIP-Commercial, +35953,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMBLEMHEALTH/HIP-Commercial, +35954,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMBLEMHEALTH/HIP-Commercial, +35955,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMBLEMHEALTH/HIP-Commercial, +35956,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMBLEMHEALTH/HIP-Commercial, +35957,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMBLEMHEALTH/HIP-Commercial, +35958,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMBLEMHEALTH/HIP-Commercial, +35959,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMBLEMHEALTH/HIP-Commercial, +35960,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMBLEMHEALTH/HIP-Commercial,42.13 +35961,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMBLEMHEALTH/HIP-Commercial, +35962,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMBLEMHEALTH/HIP-Commercial, +35963,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMBLEMHEALTH/HIP-Commercial, +35964,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMBLEMHEALTH/HIP-Commercial, +35965,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMBLEMHEALTH/HIP-Commercial, +35966,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMBLEMHEALTH/HIP-Commercial, +35967,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMBLEMHEALTH/HIP-Commercial, +35968,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMBLEMHEALTH/HIP-Commercial, +35969,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMBLEMHEALTH/HIP-Commercial, +35970,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMBLEMHEALTH/HIP-Commercial, +35971,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMBLEMHEALTH/HIP-Commercial, +35972,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMBLEMHEALTH/HIP-Commercial,64.19 +35973,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMBLEMHEALTH/HIP-Commercial,323.75 +35974,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMBLEMHEALTH/HIP-Commercial,325.8 +35975,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMBLEMHEALTH/HIP-Commercial, +35976,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMBLEMHEALTH/HIP-Commercial, +35977,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMBLEMHEALTH/HIP-Commercial,353.14 +35978,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMBLEMHEALTH/HIP-Commercial, +35979,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMBLEMHEALTH/HIP-Commercial, +35980,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMBLEMHEALTH/HIP-Commercial, +35981,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMBLEMHEALTH/HIP-Commercial,132.22 +35982,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMBLEMHEALTH/HIP-Commercial, +35983,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMBLEMHEALTH/HIP-Commercial, +35984,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMBLEMHEALTH/HIP-Commercial, +35985,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMBLEMHEALTH/HIP-Commercial, +35986,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMBLEMHEALTH/HIP-Commercial, +35987,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMBLEMHEALTH/HIP-Commercial,180.85 +35988,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMBLEMHEALTH/HIP-Commercial, +35989,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMBLEMHEALTH/HIP-Commercial, +35990,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMBLEMHEALTH/HIP-Commercial, +35991,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMBLEMHEALTH/HIP-Commercial, +35992,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMBLEMHEALTH/HIP-Commercial,8.62 +35993,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMBLEMHEALTH/HIP-Commercial,8.08 +35994,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMBLEMHEALTH/HIP-Commercial,9.09 +35995,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMBLEMHEALTH/HIP-Commercial,19.89 +35996,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMBLEMHEALTH/HIP-Commercial,8.07 +35997,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMBLEMHEALTH/HIP-Commercial,8.09 +35998,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMBLEMHEALTH/HIP-Commercial,7.71 +35999,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMBLEMHEALTH/HIP-Commercial,8.41 +36000,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMBLEMHEALTH/HIP-Commercial, +36001,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMBLEMHEALTH/HIP-Commercial, +36002,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMBLEMHEALTH/HIP-Commercial, +36003,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMBLEMHEALTH/HIP-Commercial, +36004,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMBLEMHEALTH/HIP-Commercial, +36005,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMBLEMHEALTH/HIP-Commercial, +36006,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMBLEMHEALTH/HIP-Commercial, +36007,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMBLEMHEALTH/HIP-Commercial, +36008,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMBLEMHEALTH/HIP-Commercial, +36009,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMBLEMHEALTH/HIP-Commercial, +36010,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMBLEMHEALTH/HIP-Commercial, +36011,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMBLEMHEALTH/HIP-Commercial, +36012,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMBLEMHEALTH/HIP-Commercial, +36013,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMBLEMHEALTH/HIP-Commercial, +36014,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMBLEMHEALTH/HIP-Commercial, +36015,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMBLEMHEALTH/HIP-Commercial,7.48 +36016,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMBLEMHEALTH/HIP-Commercial, +36017,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMBLEMHEALTH/HIP-Commercial,13.59 +36018,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMBLEMHEALTH/HIP-Commercial, +36019,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMBLEMHEALTH/HIP-Commercial,4.27 +36020,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMBLEMHEALTH/HIP-Commercial,5.39 +36021,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMBLEMHEALTH/HIP-Commercial, +36022,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMBLEMHEALTH/HIP-Commercial, +36023,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMBLEMHEALTH/HIP-Commercial, +36024,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMBLEMHEALTH/HIP-Commercial, +36025,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMBLEMHEALTH/HIP-Commercial, +36026,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMBLEMHEALTH/HIP-Commercial, +36027,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMBLEMHEALTH/HIP-Commercial, +36028,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMBLEMHEALTH/HIP-Commercial, +36029,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMBLEMHEALTH/HIP-Commercial, +36030,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMBLEMHEALTH/HIP-Commercial, +36031,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMBLEMHEALTH/HIP-Commercial, +36032,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMBLEMHEALTH/HIP-Commercial, +36033,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMBLEMHEALTH/HIP-Commercial, +36034,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMBLEMHEALTH/HIP-Commercial, +36035,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMBLEMHEALTH/HIP-Commercial, +36036,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMBLEMHEALTH/HIP-Commercial, +36037,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMBLEMHEALTH/HIP-Commercial, +36038,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMBLEMHEALTH/HIP-Commercial, +36039,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMBLEMHEALTH/HIP-Commercial, +36040,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMBLEMHEALTH/HIP-Commercial, +36041,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMBLEMHEALTH/HIP-Commercial, +36042,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMBLEMHEALTH/HIP-Commercial, +36043,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMBLEMHEALTH/HIP-Commercial, +36044,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Commercial, +36045,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMBLEMHEALTH/HIP-Commercial, +36046,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMBLEMHEALTH/HIP-Commercial, +36047,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMBLEMHEALTH/HIP-Commercial, +36048,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMBLEMHEALTH/HIP-Commercial, +36049,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMBLEMHEALTH/HIP-Commercial, +36050,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMBLEMHEALTH/HIP-Commercial, +36051,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMBLEMHEALTH/HIP-Commercial,42.84 +36052,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMBLEMHEALTH/HIP-Commercial, +36053,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMBLEMHEALTH/HIP-Commercial, +36054,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMBLEMHEALTH/HIP-Commercial, +36055,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Commercial, +36056,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMBLEMHEALTH/HIP-Commercial, +36057,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMBLEMHEALTH/HIP-Commercial, +36058,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMBLEMHEALTH/HIP-Commercial, +36059,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMBLEMHEALTH/HIP-Commercial, +36060,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMBLEMHEALTH/HIP-Commercial, +36061,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMBLEMHEALTH/HIP-Commercial, +36062,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMBLEMHEALTH/HIP-Commercial, +36063,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMBLEMHEALTH/HIP-Commercial, +36064,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMBLEMHEALTH/HIP-Commercial, +36065,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMBLEMHEALTH/HIP-Commercial,85.1 +36066,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMBLEMHEALTH/HIP-Commercial, +36067,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMBLEMHEALTH/HIP-Commercial, +36068,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMBLEMHEALTH/HIP-Commercial, +36069,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMBLEMHEALTH/HIP-Commercial, +36070,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMBLEMHEALTH/HIP-Commercial, +36071,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMBLEMHEALTH/HIP-Commercial, +36072,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMBLEMHEALTH/HIP-Commercial,142.63 +36073,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMBLEMHEALTH/HIP-Commercial, +36074,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMBLEMHEALTH/HIP-Commercial, +36075,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMBLEMHEALTH/HIP-Commercial,51.31 +36076,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMBLEMHEALTH/HIP-Commercial, +36077,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Commercial, +36078,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMBLEMHEALTH/HIP-Commercial, +36079,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMBLEMHEALTH/HIP-Commercial, +36080,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMBLEMHEALTH/HIP-Commercial,42.84 +36081,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMBLEMHEALTH/HIP-Commercial, +36082,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMBLEMHEALTH/HIP-Commercial, +36083,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMBLEMHEALTH/HIP-Commercial, +36084,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMBLEMHEALTH/HIP-Commercial, +36085,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMBLEMHEALTH/HIP-Commercial,257.45 +36086,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMBLEMHEALTH/HIP-Commercial, +36087,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMBLEMHEALTH/HIP-Commercial,488.66 +36088,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMBLEMHEALTH/HIP-Commercial,57.0 +36089,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMBLEMHEALTH/HIP-Commercial,128.73 +36090,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMBLEMHEALTH/HIP-Commercial, +36091,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMBLEMHEALTH/HIP-Commercial, +36092,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMBLEMHEALTH/HIP-Commercial, +36093,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMBLEMHEALTH/HIP-Commercial,40.33 +36094,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMBLEMHEALTH/HIP-Commercial, +36095,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMBLEMHEALTH/HIP-Commercial, +36096,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMBLEMHEALTH/HIP-Commercial,341.05 +36097,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMBLEMHEALTH/HIP-Commercial, +36098,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMBLEMHEALTH/HIP-Commercial, +36099,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMBLEMHEALTH/HIP-Commercial, +36100,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMBLEMHEALTH/HIP-Commercial, +36101,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMBLEMHEALTH/HIP-Commercial, +36102,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMBLEMHEALTH/HIP-Commercial, +36103,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMBLEMHEALTH/HIP-Commercial, +36104,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMBLEMHEALTH/HIP-Commercial, +36105,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMBLEMHEALTH/HIP-Commercial, +36106,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMBLEMHEALTH/HIP-Commercial, +36107,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMBLEMHEALTH/HIP-Commercial, +36108,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMBLEMHEALTH/HIP-Commercial, +36109,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMBLEMHEALTH/HIP-Commercial, +36110,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMBLEMHEALTH/HIP-Commercial, +36111,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMBLEMHEALTH/HIP-Commercial, +36112,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMBLEMHEALTH/HIP-Commercial, +36113,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMBLEMHEALTH/HIP-Commercial, +36114,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMBLEMHEALTH/HIP-Commercial, +36115,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMBLEMHEALTH/HIP-Commercial, +36116,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMBLEMHEALTH/HIP-Commercial,60.33 +36117,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMBLEMHEALTH/HIP-Commercial,77.69 +36118,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMBLEMHEALTH/HIP-Commercial, +36119,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMBLEMHEALTH/HIP-Commercial, +36120,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMBLEMHEALTH/HIP-Commercial, +36121,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMBLEMHEALTH/HIP-Commercial,116.54 +36122,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMBLEMHEALTH/HIP-Commercial, +36123,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMBLEMHEALTH/HIP-Commercial, +36124,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMBLEMHEALTH/HIP-Commercial, +36125,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMBLEMHEALTH/HIP-Commercial, +36126,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMBLEMHEALTH/HIP-Commercial, +36127,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMBLEMHEALTH/HIP-Commercial, +36128,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMBLEMHEALTH/HIP-Commercial, +36129,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMBLEMHEALTH/HIP-Commercial, +36130,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMBLEMHEALTH/HIP-Commercial, +36131,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMBLEMHEALTH/HIP-Commercial, +36132,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMBLEMHEALTH/HIP-Commercial, +36133,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMBLEMHEALTH/HIP-Commercial, +36134,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMBLEMHEALTH/HIP-Commercial, +36135,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMBLEMHEALTH/HIP-Commercial, +36136,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMBLEMHEALTH/HIP-Commercial, +36137,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMBLEMHEALTH/HIP-Commercial, +36138,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMBLEMHEALTH/HIP-Commercial, +36139,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMBLEMHEALTH/HIP-Commercial, +36140,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMBLEMHEALTH/HIP-Commercial, +36141,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMBLEMHEALTH/HIP-Commercial, +36142,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMBLEMHEALTH/HIP-Commercial, +36143,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMBLEMHEALTH/HIP-Commercial, +36144,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMBLEMHEALTH/HIP-Commercial, +36145,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMBLEMHEALTH/HIP-Commercial, +36146,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMBLEMHEALTH/HIP-Commercial, +36147,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMBLEMHEALTH/HIP-Commercial, +36148,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMBLEMHEALTH/HIP-Commercial, +36149,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMBLEMHEALTH/HIP-Commercial, +36150,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMBLEMHEALTH/HIP-Commercial, +36151,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMBLEMHEALTH/HIP-Commercial, +36152,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMBLEMHEALTH/HIP-Commercial, +36153,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMBLEMHEALTH/HIP-Commercial, +36154,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMBLEMHEALTH/HIP-Commercial, +36155,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMBLEMHEALTH/HIP-Commercial, +36156,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMBLEMHEALTH/HIP-Commercial, +36157,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMBLEMHEALTH/HIP-Commercial, +36158,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMBLEMHEALTH/HIP-Commercial, +36159,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMBLEMHEALTH/HIP-Commercial, +36160,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMBLEMHEALTH/HIP-Commercial, +36161,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMBLEMHEALTH/HIP-Commercial, +36162,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMBLEMHEALTH/HIP-Commercial, +36163,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMBLEMHEALTH/HIP-Commercial, +36164,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMBLEMHEALTH/HIP-Commercial, +36165,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMBLEMHEALTH/HIP-Commercial, +36166,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMBLEMHEALTH/HIP-Commercial, +36167,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMBLEMHEALTH/HIP-Commercial, +36168,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMBLEMHEALTH/HIP-Commercial, +36169,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMBLEMHEALTH/HIP-Commercial, +36170,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMBLEMHEALTH/HIP-Commercial, +36171,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMBLEMHEALTH/HIP-Commercial, +36172,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMBLEMHEALTH/HIP-Commercial, +36173,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMBLEMHEALTH/HIP-Commercial, +36174,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMBLEMHEALTH/HIP-Commercial, +36175,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMBLEMHEALTH/HIP-Commercial, +36176,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMBLEMHEALTH/HIP-Commercial, +36177,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMBLEMHEALTH/HIP-Commercial, +36178,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMBLEMHEALTH/HIP-Commercial, +36179,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +36180,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +36181,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +36182,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMBLEMHEALTH/HIP-Commercial, +36183,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMBLEMHEALTH/HIP-Commercial, +36184,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMBLEMHEALTH/HIP-Commercial, +36185,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMBLEMHEALTH/HIP-Commercial, +36186,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMBLEMHEALTH/HIP-Commercial, +36187,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMBLEMHEALTH/HIP-Commercial, +36188,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMBLEMHEALTH/HIP-Commercial, +36189,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMBLEMHEALTH/HIP-Commercial, +36190,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMBLEMHEALTH/HIP-Commercial, +36191,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMBLEMHEALTH/HIP-Commercial, +36192,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMBLEMHEALTH/HIP-Commercial, +36193,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMBLEMHEALTH/HIP-Commercial, +36194,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMBLEMHEALTH/HIP-Commercial, +36195,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMBLEMHEALTH/HIP-Commercial, +36196,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMBLEMHEALTH/HIP-Commercial, +36197,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMBLEMHEALTH/HIP-Commercial, +36198,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMBLEMHEALTH/HIP-Commercial, +36199,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMBLEMHEALTH/HIP-Commercial, +36200,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMBLEMHEALTH/HIP-Commercial, +36201,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMBLEMHEALTH/HIP-Commercial, +36202,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMBLEMHEALTH/HIP-Commercial, +36203,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMBLEMHEALTH/HIP-Commercial, +36204,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMBLEMHEALTH/HIP-Commercial, +36205,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMBLEMHEALTH/HIP-Commercial, +36206,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMBLEMHEALTH/HIP-Commercial, +36207,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMBLEMHEALTH/HIP-Commercial, +36208,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMBLEMHEALTH/HIP-Commercial, +36209,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMBLEMHEALTH/HIP-Commercial, +36210,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMBLEMHEALTH/HIP-Commercial, +36211,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMBLEMHEALTH/HIP-Commercial, +36212,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMBLEMHEALTH/HIP-Commercial, +36213,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMBLEMHEALTH/HIP-Commercial, +36214,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMBLEMHEALTH/HIP-Commercial, +36215,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMBLEMHEALTH/HIP-Commercial,90.73 +36216,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMBLEMHEALTH/HIP-Commercial, +36217,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMBLEMHEALTH/HIP-Commercial, +36218,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMBLEMHEALTH/HIP-Commercial,133.27 +36219,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMBLEMHEALTH/HIP-Commercial, +36220,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMBLEMHEALTH/HIP-Commercial,106.45 +36221,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMBLEMHEALTH/HIP-Commercial, +36222,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMBLEMHEALTH/HIP-Commercial,326.8 +36223,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMBLEMHEALTH/HIP-Commercial, +36224,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMBLEMHEALTH/HIP-Commercial,326.8 +36225,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMBLEMHEALTH/HIP-Commercial, +36226,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMBLEMHEALTH/HIP-Commercial, +36227,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMBLEMHEALTH/HIP-Commercial,169.2 +36228,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMBLEMHEALTH/HIP-Commercial, +36229,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMBLEMHEALTH/HIP-Commercial, +36230,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMBLEMHEALTH/HIP-Commercial, +36231,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMBLEMHEALTH/HIP-Commercial, +36232,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMBLEMHEALTH/HIP-Commercial, +36233,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMBLEMHEALTH/HIP-Commercial, +36234,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMBLEMHEALTH/HIP-Commercial, +36235,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMBLEMHEALTH/HIP-Commercial, +36236,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMBLEMHEALTH/HIP-Commercial, +36237,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMBLEMHEALTH/HIP-Commercial, +36238,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMBLEMHEALTH/HIP-Commercial, +36239,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMBLEMHEALTH/HIP-Commercial, +36240,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMBLEMHEALTH/HIP-Commercial, +36241,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMBLEMHEALTH/HIP-Commercial, +36242,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMBLEMHEALTH/HIP-Commercial, +36243,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMBLEMHEALTH/HIP-Commercial, +36244,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMBLEMHEALTH/HIP-Commercial, +36245,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMBLEMHEALTH/HIP-Commercial, +36246,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMBLEMHEALTH/HIP-Commercial,86.02 +36247,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMBLEMHEALTH/HIP-Commercial, +36248,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMBLEMHEALTH/HIP-Commercial, +36249,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMBLEMHEALTH/HIP-Commercial, +36250,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMBLEMHEALTH/HIP-Commercial, +36251,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMBLEMHEALTH/HIP-Commercial, +36252,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMBLEMHEALTH/HIP-Commercial,102.86 +36253,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMBLEMHEALTH/HIP-Commercial,111.16 +36254,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMBLEMHEALTH/HIP-Commercial, +36255,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMBLEMHEALTH/HIP-Commercial, +36256,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMBLEMHEALTH/HIP-Commercial, +36257,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMBLEMHEALTH/HIP-Commercial,169.2 +36258,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMBLEMHEALTH/HIP-Commercial, +36259,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMBLEMHEALTH/HIP-Commercial,163.4 +36260,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMBLEMHEALTH/HIP-Commercial, +36261,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMBLEMHEALTH/HIP-Commercial, +36262,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMBLEMHEALTH/HIP-Commercial, +36263,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMBLEMHEALTH/HIP-Commercial, +36264,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMBLEMHEALTH/HIP-Commercial, +36265,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMBLEMHEALTH/HIP-Commercial, +36266,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMBLEMHEALTH/HIP-Commercial,11759.68 +36267,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMBLEMHEALTH/HIP-Commercial, +36268,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMBLEMHEALTH/HIP-Commercial, +36269,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMBLEMHEALTH/HIP-Commercial, +36270,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMBLEMHEALTH/HIP-Commercial, +36271,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMBLEMHEALTH/HIP-Commercial, +36272,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMBLEMHEALTH/HIP-Commercial, +36273,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMBLEMHEALTH/HIP-Commercial,309.66 +36274,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMBLEMHEALTH/HIP-Commercial,663.79 +36275,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMBLEMHEALTH/HIP-Commercial, +36276,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMBLEMHEALTH/HIP-Commercial, +36277,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMBLEMHEALTH/HIP-Commercial, +36278,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +36279,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMBLEMHEALTH/HIP-Commercial,67.49 +36280,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMBLEMHEALTH/HIP-Commercial, +36281,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMBLEMHEALTH/HIP-Commercial, +36282,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMBLEMHEALTH/HIP-Commercial, +36283,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMBLEMHEALTH/HIP-Commercial, +36284,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMBLEMHEALTH/HIP-Commercial, +36285,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMBLEMHEALTH/HIP-Commercial, +36286,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMBLEMHEALTH/HIP-Commercial, +36287,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMBLEMHEALTH/HIP-Commercial, +36288,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMBLEMHEALTH/HIP-Commercial, +36289,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMBLEMHEALTH/HIP-Commercial, +36290,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMBLEMHEALTH/HIP-Commercial, +36291,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMBLEMHEALTH/HIP-Commercial,577.43 +36292,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMBLEMHEALTH/HIP-Commercial,279.02 +36293,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMBLEMHEALTH/HIP-Commercial,575.46 +36294,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMBLEMHEALTH/HIP-Commercial, +36295,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMBLEMHEALTH/HIP-Commercial, +36296,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMBLEMHEALTH/HIP-Commercial, +36297,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMBLEMHEALTH/HIP-Commercial, +36298,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMBLEMHEALTH/HIP-Commercial, +36299,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMBLEMHEALTH/HIP-Commercial, +36300,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMBLEMHEALTH/HIP-Commercial, +36301,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMBLEMHEALTH/HIP-Commercial, +36302,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Commercial, +36303,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMBLEMHEALTH/HIP-Commercial, +36304,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMBLEMHEALTH/HIP-Commercial, +36305,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMBLEMHEALTH/HIP-Commercial, +36306,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMBLEMHEALTH/HIP-Commercial, +36307,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMBLEMHEALTH/HIP-Commercial, +36308,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMBLEMHEALTH/HIP-Commercial,3394.58 +36309,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMBLEMHEALTH/HIP-Commercial, +36310,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMBLEMHEALTH/HIP-Commercial,3514.95 +36311,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMBLEMHEALTH/HIP-Commercial,3394.58 +36312,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMBLEMHEALTH/HIP-Commercial, +36313,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMBLEMHEALTH/HIP-Commercial, +36314,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMBLEMHEALTH/HIP-Commercial, +36315,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMBLEMHEALTH/HIP-Commercial, +36316,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMBLEMHEALTH/HIP-Commercial, +36317,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMBLEMHEALTH/HIP-Commercial, +36318,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMBLEMHEALTH/HIP-Commercial, +36319,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMBLEMHEALTH/HIP-Commercial, +36320,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMBLEMHEALTH/HIP-Commercial, +36321,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMBLEMHEALTH/HIP-Commercial, +36322,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMBLEMHEALTH/HIP-Commercial, +36323,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMBLEMHEALTH/HIP-Commercial, +36324,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMBLEMHEALTH/HIP-Commercial, +36325,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMBLEMHEALTH/HIP-Commercial, +36326,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMBLEMHEALTH/HIP-Commercial, +36327,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMBLEMHEALTH/HIP-Commercial, +36328,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMBLEMHEALTH/HIP-Commercial, +36329,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMBLEMHEALTH/HIP-Commercial,26024.74 +36330,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMBLEMHEALTH/HIP-Commercial, +36331,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMBLEMHEALTH/HIP-Commercial, +36332,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMBLEMHEALTH/HIP-Commercial, +36333,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMBLEMHEALTH/HIP-Commercial, +36334,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMBLEMHEALTH/HIP-Commercial,117.46 +36335,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMBLEMHEALTH/HIP-Commercial, +36336,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMBLEMHEALTH/HIP-Commercial, +36337,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMBLEMHEALTH/HIP-Commercial,269.47 +36338,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMBLEMHEALTH/HIP-Commercial, +36339,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMBLEMHEALTH/HIP-Commercial, +36340,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMBLEMHEALTH/HIP-Commercial,131.09 +36341,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMBLEMHEALTH/HIP-Commercial, +36342,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMBLEMHEALTH/HIP-Commercial,274.25 +36343,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMBLEMHEALTH/HIP-Commercial, +36344,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMBLEMHEALTH/HIP-Commercial, +36345,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMBLEMHEALTH/HIP-Commercial, +36346,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMBLEMHEALTH/HIP-Commercial,271.06 +36347,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMBLEMHEALTH/HIP-Commercial,129.86 +36348,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMBLEMHEALTH/HIP-Commercial,269.47 +36349,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMBLEMHEALTH/HIP-Commercial, +36350,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMBLEMHEALTH/HIP-Commercial,269.47 +36351,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMBLEMHEALTH/HIP-Commercial, +36352,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMBLEMHEALTH/HIP-Commercial, +36353,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMBLEMHEALTH/HIP-Commercial, +36354,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMBLEMHEALTH/HIP-Commercial, +36355,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMBLEMHEALTH/HIP-Commercial, +36356,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMBLEMHEALTH/HIP-Commercial, +36357,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMBLEMHEALTH/HIP-Commercial, +36358,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMBLEMHEALTH/HIP-Commercial, +36359,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMBLEMHEALTH/HIP-Commercial, +36360,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMBLEMHEALTH/HIP-Commercial, +36361,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMBLEMHEALTH/HIP-Commercial, +36362,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMBLEMHEALTH/HIP-Commercial, +36363,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMBLEMHEALTH/HIP-Commercial, +36364,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMBLEMHEALTH/HIP-Commercial, +36365,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMBLEMHEALTH/HIP-Commercial, +36366,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMBLEMHEALTH/HIP-Commercial, +36367,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMBLEMHEALTH/HIP-Commercial, +36368,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMBLEMHEALTH/HIP-Commercial, +36369,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMBLEMHEALTH/HIP-Commercial, +36370,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMBLEMHEALTH/HIP-Commercial, +36371,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMBLEMHEALTH/HIP-Commercial, +36372,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMBLEMHEALTH/HIP-Commercial, +36373,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMBLEMHEALTH/HIP-Commercial, +36374,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMBLEMHEALTH/HIP-Commercial, +36375,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMBLEMHEALTH/HIP-Commercial, +36376,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMBLEMHEALTH/HIP-Commercial, +36377,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMBLEMHEALTH/HIP-Commercial, +36378,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMBLEMHEALTH/HIP-Commercial, +36379,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMBLEMHEALTH/HIP-Commercial, +36380,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMBLEMHEALTH/HIP-Commercial, +36381,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMBLEMHEALTH/HIP-Commercial,1077.05 +36382,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMBLEMHEALTH/HIP-Commercial,1077.05 +36383,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMBLEMHEALTH/HIP-Commercial, +36384,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMBLEMHEALTH/HIP-Commercial, +36385,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMBLEMHEALTH/HIP-Commercial, +36386,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMBLEMHEALTH/HIP-Commercial, +36387,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMBLEMHEALTH/HIP-Commercial, +36388,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMBLEMHEALTH/HIP-Commercial, +36389,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMBLEMHEALTH/HIP-Commercial, +36390,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-Commercial, +36391,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-Commercial, +36392,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMBLEMHEALTH/HIP-Commercial, +36393,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMBLEMHEALTH/HIP-Commercial, +36394,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMBLEMHEALTH/HIP-Commercial, +36395,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMBLEMHEALTH/HIP-Commercial, +36396,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMBLEMHEALTH/HIP-Commercial, +36397,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMBLEMHEALTH/HIP-Commercial, +36398,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMBLEMHEALTH/HIP-Commercial, +36399,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMBLEMHEALTH/HIP-Commercial, +36400,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMBLEMHEALTH/HIP-Commercial, +36401,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMBLEMHEALTH/HIP-Commercial, +36402,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMBLEMHEALTH/HIP-Commercial, +36403,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMBLEMHEALTH/HIP-Commercial, +36404,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMBLEMHEALTH/HIP-Commercial, +36405,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMBLEMHEALTH/HIP-Commercial, +36406,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMBLEMHEALTH/HIP-Commercial, +36407,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMBLEMHEALTH/HIP-Commercial,305.02 +36408,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMBLEMHEALTH/HIP-Commercial, +36409,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMBLEMHEALTH/HIP-Commercial, +36410,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMBLEMHEALTH/HIP-Commercial, +36411,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMBLEMHEALTH/HIP-Commercial, +36412,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMBLEMHEALTH/HIP-Commercial,262.82 +36413,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMBLEMHEALTH/HIP-Commercial, +36414,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMBLEMHEALTH/HIP-Commercial,195.46 +36415,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMBLEMHEALTH/HIP-Commercial, +36416,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMBLEMHEALTH/HIP-Commercial, +36417,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMBLEMHEALTH/HIP-Commercial, +36418,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMBLEMHEALTH/HIP-Commercial,238.29 +36419,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMBLEMHEALTH/HIP-Commercial,62.01 +36420,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMBLEMHEALTH/HIP-Commercial,246.74 +36421,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMBLEMHEALTH/HIP-Commercial,285.13 +36422,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMBLEMHEALTH/HIP-Commercial,73.26 +36423,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMBLEMHEALTH/HIP-Commercial, +36424,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMBLEMHEALTH/HIP-Commercial,73.26 +36425,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMBLEMHEALTH/HIP-Commercial,239.31 +36426,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMBLEMHEALTH/HIP-Commercial,69.42 +36427,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMBLEMHEALTH/HIP-Commercial, +36428,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMBLEMHEALTH/HIP-Commercial, +36429,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMBLEMHEALTH/HIP-Commercial,73.0 +36430,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMBLEMHEALTH/HIP-Commercial,73.03 +36431,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMBLEMHEALTH/HIP-Commercial,229.32 +36432,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMBLEMHEALTH/HIP-Commercial,395.6 +36433,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMBLEMHEALTH/HIP-Commercial,372.02 +36434,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMBLEMHEALTH/HIP-Commercial,438.81 +36435,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMBLEMHEALTH/HIP-Commercial, +36436,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMBLEMHEALTH/HIP-Commercial,444.39 +36437,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMBLEMHEALTH/HIP-Commercial, +36438,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMBLEMHEALTH/HIP-Commercial, +36439,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMBLEMHEALTH/HIP-Commercial,65.59 +36440,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMBLEMHEALTH/HIP-Commercial, +36441,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMBLEMHEALTH/HIP-Commercial, +36442,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMBLEMHEALTH/HIP-Commercial,14.02 +36443,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMBLEMHEALTH/HIP-Commercial, +36444,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMBLEMHEALTH/HIP-Commercial, +36445,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMBLEMHEALTH/HIP-Commercial, +36446,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMBLEMHEALTH/HIP-Commercial, +36447,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMBLEMHEALTH/HIP-Commercial, +36448,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMBLEMHEALTH/HIP-Commercial,86.44 +36449,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMBLEMHEALTH/HIP-Commercial,61.54 +36450,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMBLEMHEALTH/HIP-Commercial, +36451,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMBLEMHEALTH/HIP-Commercial,26.84 +36452,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMBLEMHEALTH/HIP-Commercial, +36453,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMBLEMHEALTH/HIP-Commercial, +36454,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMBLEMHEALTH/HIP-Commercial, +36455,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMBLEMHEALTH/HIP-Commercial,98.07 +36456,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMBLEMHEALTH/HIP-Commercial, +36457,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMBLEMHEALTH/HIP-Commercial,114.95 +36458,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMBLEMHEALTH/HIP-Commercial,117.68 +36459,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMBLEMHEALTH/HIP-Commercial,117.68 +36460,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMBLEMHEALTH/HIP-Commercial, +36461,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMBLEMHEALTH/HIP-Commercial, +36462,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMBLEMHEALTH/HIP-Commercial,113.84 +36463,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMBLEMHEALTH/HIP-Commercial, +36464,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMBLEMHEALTH/HIP-Commercial, +36465,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMBLEMHEALTH/HIP-Commercial,111.02 +36466,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMBLEMHEALTH/HIP-Commercial,42.7 +36467,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMBLEMHEALTH/HIP-Commercial, +36468,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMBLEMHEALTH/HIP-Commercial, +36469,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMBLEMHEALTH/HIP-Commercial, +36470,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMBLEMHEALTH/HIP-Commercial, +36471,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMBLEMHEALTH/HIP-Commercial,134.4 +36472,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMBLEMHEALTH/HIP-Commercial, +36473,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMBLEMHEALTH/HIP-Commercial, +36474,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMBLEMHEALTH/HIP-Commercial, +36475,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMBLEMHEALTH/HIP-Commercial, +36476,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMBLEMHEALTH/HIP-Commercial, +36477,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMBLEMHEALTH/HIP-Commercial, +36478,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMBLEMHEALTH/HIP-Commercial, +36479,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMBLEMHEALTH/HIP-Commercial, +36480,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMBLEMHEALTH/HIP-Commercial, +36481,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMBLEMHEALTH/HIP-Commercial,131.09 +36482,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMBLEMHEALTH/HIP-Commercial, +36483,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMBLEMHEALTH/HIP-Commercial, +36484,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMBLEMHEALTH/HIP-Commercial, +36485,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMBLEMHEALTH/HIP-Commercial, +36486,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMBLEMHEALTH/HIP-Commercial, +36487,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMBLEMHEALTH/HIP-Commercial, +36488,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMBLEMHEALTH/HIP-Commercial, +36489,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMBLEMHEALTH/HIP-Commercial, +36490,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMBLEMHEALTH/HIP-Commercial, +36491,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMBLEMHEALTH/HIP-Commercial, +36492,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMBLEMHEALTH/HIP-Commercial, +36493,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMBLEMHEALTH/HIP-Commercial, +36494,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMBLEMHEALTH/HIP-Commercial, +36495,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMBLEMHEALTH/HIP-Commercial, +36496,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMBLEMHEALTH/HIP-Commercial, +36497,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMBLEMHEALTH/HIP-Commercial, +36498,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMBLEMHEALTH/HIP-Commercial,155.82 +36499,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMBLEMHEALTH/HIP-Commercial,1576.0 +36500,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMBLEMHEALTH/HIP-Commercial,2321.0 +36501,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMBLEMHEALTH/HIP-Commercial,3214.92 +36502,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMBLEMHEALTH/HIP-Commercial, +36503,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMBLEMHEALTH/HIP-Commercial, +36504,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMBLEMHEALTH/HIP-Commercial, +36505,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMBLEMHEALTH/HIP-Commercial, +36506,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMBLEMHEALTH/HIP-Commercial, +36507,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMBLEMHEALTH/HIP-Commercial, +36508,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMBLEMHEALTH/HIP-Commercial, +36509,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMBLEMHEALTH/HIP-Commercial, +36510,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMBLEMHEALTH/HIP-Commercial, +36511,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMBLEMHEALTH/HIP-Commercial, +36512,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMBLEMHEALTH/HIP-Commercial, +36513,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMBLEMHEALTH/HIP-Commercial, +36514,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMBLEMHEALTH/HIP-Commercial, +36515,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMBLEMHEALTH/HIP-Commercial, +36516,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMBLEMHEALTH/HIP-Commercial, +36517,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMBLEMHEALTH/HIP-Commercial, +36518,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMBLEMHEALTH/HIP-Commercial, +36519,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMBLEMHEALTH/HIP-Commercial, +36520,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMBLEMHEALTH/HIP-Commercial, +36521,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMBLEMHEALTH/HIP-Commercial, +36522,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMBLEMHEALTH/HIP-Commercial, +36523,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMBLEMHEALTH/HIP-Commercial, +36524,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMBLEMHEALTH/HIP-Commercial, +36525,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMBLEMHEALTH/HIP-Commercial, +36526,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMBLEMHEALTH/HIP-Commercial, +36527,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMBLEMHEALTH/HIP-Commercial, +36528,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMBLEMHEALTH/HIP-Commercial, +36529,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMBLEMHEALTH/HIP-Commercial,4625.91 +36530,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMBLEMHEALTH/HIP-Commercial,416.78 +36531,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMBLEMHEALTH/HIP-Commercial,199845.82 +36532,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMBLEMHEALTH/HIP-Commercial, +36533,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMBLEMHEALTH/HIP-Commercial, +36534,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMBLEMHEALTH/HIP-Commercial,109229.0 +36535,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMBLEMHEALTH/HIP-Commercial, +36536,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMBLEMHEALTH/HIP-Commercial, +36537,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMBLEMHEALTH/HIP-Commercial, +36538,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMBLEMHEALTH/HIP-Commercial, +36539,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMBLEMHEALTH/HIP-Commercial, +36540,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMBLEMHEALTH/HIP-Commercial, +36541,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMBLEMHEALTH/HIP-Commercial, +36542,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMBLEMHEALTH/HIP-Commercial, +36543,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMBLEMHEALTH/HIP-Commercial, +36544,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMBLEMHEALTH/HIP-Commercial,18505.0 +36545,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMBLEMHEALTH/HIP-Commercial, +36546,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMBLEMHEALTH/HIP-Commercial, +36547,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMBLEMHEALTH/HIP-Commercial, +36548,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMBLEMHEALTH/HIP-Commercial, +36549,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMBLEMHEALTH/HIP-Commercial, +36550,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMBLEMHEALTH/HIP-Commercial, +36551,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMBLEMHEALTH/HIP-Commercial,38010.62 +36552,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMBLEMHEALTH/HIP-Commercial, +36553,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMBLEMHEALTH/HIP-Commercial, +36554,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMBLEMHEALTH/HIP-Commercial,35324.35 +36555,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMBLEMHEALTH/HIP-Commercial, +36556,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMBLEMHEALTH/HIP-Commercial, +36557,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMBLEMHEALTH/HIP-Commercial, +36558,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMBLEMHEALTH/HIP-Commercial, +36559,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMBLEMHEALTH/HIP-Commercial,33346.06 +36560,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMBLEMHEALTH/HIP-Commercial, +36561,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMBLEMHEALTH/HIP-Commercial, +36562,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMBLEMHEALTH/HIP-Commercial, +36563,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMBLEMHEALTH/HIP-Commercial, +36564,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMBLEMHEALTH/HIP-Commercial, +36565,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMBLEMHEALTH/HIP-Commercial, +36566,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMBLEMHEALTH/HIP-Commercial, +36567,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMBLEMHEALTH/HIP-Commercial,22513.0 +36568,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMBLEMHEALTH/HIP-Commercial, +36569,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMBLEMHEALTH/HIP-Commercial,93215.78 +36570,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMBLEMHEALTH/HIP-Commercial, +36571,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMBLEMHEALTH/HIP-Commercial, +36572,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMBLEMHEALTH/HIP-Commercial, +36573,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMBLEMHEALTH/HIP-Commercial, +36574,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMBLEMHEALTH/HIP-Commercial, +36575,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMBLEMHEALTH/HIP-Commercial, +36576,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMBLEMHEALTH/HIP-Commercial, +36577,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMBLEMHEALTH/HIP-Commercial, +36578,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMBLEMHEALTH/HIP-Commercial, +36579,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMBLEMHEALTH/HIP-Commercial, +36580,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMBLEMHEALTH/HIP-Commercial, +36581,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMBLEMHEALTH/HIP-Commercial, +36582,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMBLEMHEALTH/HIP-Commercial, +36583,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMBLEMHEALTH/HIP-Commercial, +36584,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMBLEMHEALTH/HIP-Commercial, +36585,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMBLEMHEALTH/HIP-Commercial, +36586,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMBLEMHEALTH/HIP-Commercial, +36587,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMBLEMHEALTH/HIP-Commercial, +36588,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMBLEMHEALTH/HIP-Commercial, +36589,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMBLEMHEALTH/HIP-Commercial, +36590,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMBLEMHEALTH/HIP-Commercial, +36591,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMBLEMHEALTH/HIP-Commercial, +36592,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMBLEMHEALTH/HIP-Commercial, +36593,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMBLEMHEALTH/HIP-Commercial, +36594,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMBLEMHEALTH/HIP-Commercial, +36595,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMBLEMHEALTH/HIP-Commercial, +36596,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMBLEMHEALTH/HIP-Commercial, +36597,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMBLEMHEALTH/HIP-Commercial, +36598,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMBLEMHEALTH/HIP-Commercial, +36599,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMBLEMHEALTH/HIP-Commercial, +36600,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMBLEMHEALTH/HIP-Commercial, +36601,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMBLEMHEALTH/HIP-Commercial, +36602,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMBLEMHEALTH/HIP-Commercial, +36603,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMBLEMHEALTH/HIP-Commercial, +36604,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMBLEMHEALTH/HIP-Commercial, +36605,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMBLEMHEALTH/HIP-Commercial, +36606,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMBLEMHEALTH/HIP-Commercial, +36607,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMBLEMHEALTH/HIP-Commercial, +36608,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMBLEMHEALTH/HIP-Commercial, +36609,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMBLEMHEALTH/HIP-Commercial, +36610,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMBLEMHEALTH/HIP-Commercial, +36611,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMBLEMHEALTH/HIP-Commercial, +36612,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMBLEMHEALTH/HIP-Commercial, +36613,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMBLEMHEALTH/HIP-Commercial, +36614,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMBLEMHEALTH/HIP-Commercial, +36615,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMBLEMHEALTH/HIP-Commercial, +36616,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMBLEMHEALTH/HIP-Commercial, +36617,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMBLEMHEALTH/HIP-Commercial, +36618,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMBLEMHEALTH/HIP-Commercial, +36619,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMBLEMHEALTH/HIP-Commercial, +36620,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMBLEMHEALTH/HIP-Commercial, +36621,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMBLEMHEALTH/HIP-Commercial, +36622,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMBLEMHEALTH/HIP-Commercial, +36623,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMBLEMHEALTH/HIP-Commercial, +36624,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMBLEMHEALTH/HIP-Commercial, +36625,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMBLEMHEALTH/HIP-Commercial, +36626,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMBLEMHEALTH/HIP-Commercial, +36627,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMBLEMHEALTH/HIP-Commercial, +36628,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMBLEMHEALTH/HIP-Commercial, +36629,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMBLEMHEALTH/HIP-Commercial, +36630,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMBLEMHEALTH/HIP-Commercial, +36631,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMBLEMHEALTH/HIP-Commercial, +36632,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMBLEMHEALTH/HIP-Commercial, +36633,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMBLEMHEALTH/HIP-Commercial, +36634,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMBLEMHEALTH/HIP-Commercial, +36635,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMBLEMHEALTH/HIP-Commercial, +36636,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMBLEMHEALTH/HIP-Commercial, +36637,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMBLEMHEALTH/HIP-Commercial, +36638,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMBLEMHEALTH/HIP-Commercial, +36639,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMBLEMHEALTH/HIP-Commercial, +36640,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMBLEMHEALTH/HIP-Commercial, +36641,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMBLEMHEALTH/HIP-Commercial, +36642,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMBLEMHEALTH/HIP-Commercial, +36643,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMBLEMHEALTH/HIP-Commercial, +36644,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMBLEMHEALTH/HIP-Commercial, +36645,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMBLEMHEALTH/HIP-Commercial, +36646,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMBLEMHEALTH/HIP-Commercial, +36647,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMBLEMHEALTH/HIP-Commercial, +36648,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMBLEMHEALTH/HIP-Commercial, +36649,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMBLEMHEALTH/HIP-Commercial, +36650,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMBLEMHEALTH/HIP-Commercial, +36651,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMBLEMHEALTH/HIP-Commercial, +36652,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMBLEMHEALTH/HIP-Commercial, +36653,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMBLEMHEALTH/HIP-Commercial, +36654,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMBLEMHEALTH/HIP-Commercial, +36655,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMBLEMHEALTH/HIP-Commercial, +36656,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMBLEMHEALTH/HIP-Commercial, +36657,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMBLEMHEALTH/HIP-Commercial, +36658,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMBLEMHEALTH/HIP-Commercial, +36659,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMBLEMHEALTH/HIP-Commercial, +36660,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMBLEMHEALTH/HIP-Commercial, +36661,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMBLEMHEALTH/HIP-Commercial, +36662,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMBLEMHEALTH/HIP-Commercial, +36663,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMBLEMHEALTH/HIP-Commercial, +36664,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMBLEMHEALTH/HIP-Commercial, +36665,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMBLEMHEALTH/HIP-Commercial, +36666,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMBLEMHEALTH/HIP-Commercial, +36667,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMBLEMHEALTH/HIP-Commercial, +36668,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMBLEMHEALTH/HIP-Commercial, +36669,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMBLEMHEALTH/HIP-Commercial, +36670,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMBLEMHEALTH/HIP-Commercial, +36671,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMBLEMHEALTH/HIP-Commercial, +36672,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMBLEMHEALTH/HIP-Commercial, +36673,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMBLEMHEALTH/HIP-Commercial, +36674,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMBLEMHEALTH/HIP-Commercial, +36675,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMBLEMHEALTH/HIP-Commercial, +36676,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMBLEMHEALTH/HIP-Commercial, +36677,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMBLEMHEALTH/HIP-Commercial, +36678,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMBLEMHEALTH/HIP-Commercial, +36679,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMBLEMHEALTH/HIP-Commercial, +36680,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMBLEMHEALTH/HIP-Commercial, +36681,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMBLEMHEALTH/HIP-Commercial, +36682,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMBLEMHEALTH/HIP-Commercial, +36683,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMBLEMHEALTH/HIP-Commercial, +36684,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMBLEMHEALTH/HIP-Commercial, +36685,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMBLEMHEALTH/HIP-Commercial, +36686,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMBLEMHEALTH/HIP-Commercial, +36687,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMBLEMHEALTH/HIP-Commercial, +36688,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMBLEMHEALTH/HIP-Commercial, +36689,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMBLEMHEALTH/HIP-Commercial, +36690,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMBLEMHEALTH/HIP-Commercial, +36691,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMBLEMHEALTH/HIP-Commercial, +36692,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMBLEMHEALTH/HIP-Commercial, +36693,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMBLEMHEALTH/HIP-Commercial, +36694,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMBLEMHEALTH/HIP-Commercial, +36695,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMBLEMHEALTH/HIP-Commercial, +36696,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMBLEMHEALTH/HIP-Commercial, +36697,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMBLEMHEALTH/HIP-Commercial, +36698,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMBLEMHEALTH/HIP-Commercial, +36699,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMBLEMHEALTH/HIP-Commercial, +36700,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMBLEMHEALTH/HIP-Commercial, +36701,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMBLEMHEALTH/HIP-Commercial, +36702,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMBLEMHEALTH/HIP-Commercial, +36703,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMBLEMHEALTH/HIP-Commercial, +36704,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMBLEMHEALTH/HIP-Commercial, +36705,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMBLEMHEALTH/HIP-Commercial, +36706,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMBLEMHEALTH/HIP-Commercial, +36707,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMBLEMHEALTH/HIP-Commercial, +36708,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMBLEMHEALTH/HIP-Commercial, +36709,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMBLEMHEALTH/HIP-Commercial, +36710,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMBLEMHEALTH/HIP-Commercial, +36711,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMBLEMHEALTH/HIP-Commercial, +36712,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMBLEMHEALTH/HIP-Commercial, +36713,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMBLEMHEALTH/HIP-Commercial, +36714,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMBLEMHEALTH/HIP-Commercial, +36715,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMBLEMHEALTH/HIP-Commercial, +36716,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMBLEMHEALTH/HIP-Commercial, +36717,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMBLEMHEALTH/HIP-Commercial, +36718,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMBLEMHEALTH/HIP-Commercial, +36719,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMBLEMHEALTH/HIP-Commercial, +36720,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMBLEMHEALTH/HIP-Commercial, +36721,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMBLEMHEALTH/HIP-Commercial, +36722,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMBLEMHEALTH/HIP-Commercial, +36723,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMBLEMHEALTH/HIP-Commercial, +36724,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMBLEMHEALTH/HIP-Commercial, +36725,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMBLEMHEALTH/HIP-Commercial, +36726,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMBLEMHEALTH/HIP-Commercial, +36727,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMBLEMHEALTH/HIP-Commercial, +36728,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMBLEMHEALTH/HIP-Commercial, +36729,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMBLEMHEALTH/HIP-Commercial, +36730,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMBLEMHEALTH/HIP-Commercial, +36731,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMBLEMHEALTH/HIP-Commercial, +36732,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMBLEMHEALTH/HIP-Commercial, +36733,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMBLEMHEALTH/HIP-Commercial, +36734,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMBLEMHEALTH/HIP-Commercial, +36735,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMBLEMHEALTH/HIP-Commercial, +36736,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMBLEMHEALTH/HIP-Commercial, +36737,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMBLEMHEALTH/HIP-Commercial, +36738,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMBLEMHEALTH/HIP-Commercial, +36739,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMBLEMHEALTH/HIP-Commercial, +36740,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMBLEMHEALTH/HIP-Commercial, +36741,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMBLEMHEALTH/HIP-Commercial, +36742,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMBLEMHEALTH/HIP-Commercial, +36743,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMBLEMHEALTH/HIP-Commercial, +36744,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMBLEMHEALTH/HIP-Commercial, +36745,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMBLEMHEALTH/HIP-Commercial, +36746,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMBLEMHEALTH/HIP-Commercial, +36747,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMBLEMHEALTH/HIP-Commercial, +36748,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMBLEMHEALTH/HIP-Commercial, +36749,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMBLEMHEALTH/HIP-Commercial, +36750,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMBLEMHEALTH/HIP-Commercial, +36751,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMBLEMHEALTH/HIP-Commercial, +36752,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMBLEMHEALTH/HIP-Commercial, +36753,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMBLEMHEALTH/HIP-Commercial, +36754,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMBLEMHEALTH/HIP-Commercial, +36755,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMBLEMHEALTH/HIP-Commercial, +36756,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMBLEMHEALTH/HIP-Commercial, +36757,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMBLEMHEALTH/HIP-Commercial, +36758,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMBLEMHEALTH/HIP-Commercial, +36759,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMBLEMHEALTH/HIP-Commercial, +36760,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMBLEMHEALTH/HIP-Commercial, +36761,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMBLEMHEALTH/HIP-Commercial, +36762,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMBLEMHEALTH/HIP-Commercial, +36763,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMBLEMHEALTH/HIP-Commercial, +36764,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMBLEMHEALTH/HIP-Commercial, +36765,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMBLEMHEALTH/HIP-Commercial, +36766,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMBLEMHEALTH/HIP-Commercial, +36767,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMBLEMHEALTH/HIP-Commercial, +36768,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMBLEMHEALTH/HIP-Commercial, +36769,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMBLEMHEALTH/HIP-Commercial, +36770,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMBLEMHEALTH/HIP-Commercial, +36771,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMBLEMHEALTH/HIP-Commercial, +36772,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMBLEMHEALTH/HIP-Commercial, +36773,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMBLEMHEALTH/HIP-Commercial, +36774,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMBLEMHEALTH/HIP-Commercial, +36775,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMBLEMHEALTH/HIP-Commercial, +36776,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMBLEMHEALTH/HIP-Commercial, +36777,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMBLEMHEALTH/HIP-Commercial, +36778,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMBLEMHEALTH/HIP-Commercial, +36779,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMBLEMHEALTH/HIP-Commercial, +36780,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMBLEMHEALTH/HIP-Commercial, +36781,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMBLEMHEALTH/HIP-Commercial, +36782,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMBLEMHEALTH/HIP-Commercial, +36783,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMBLEMHEALTH/HIP-Commercial, +36784,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMBLEMHEALTH/HIP-Commercial, +36785,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMBLEMHEALTH/HIP-Commercial, +36786,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMBLEMHEALTH/HIP-Commercial, +36787,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMBLEMHEALTH/HIP-Commercial, +36788,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMBLEMHEALTH/HIP-Commercial, +36789,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMBLEMHEALTH/HIP-Commercial, +36790,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMBLEMHEALTH/HIP-Commercial, +36791,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMBLEMHEALTH/HIP-Commercial, +36792,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMBLEMHEALTH/HIP-Commercial, +36793,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMBLEMHEALTH/HIP-Commercial, +36794,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMBLEMHEALTH/HIP-Commercial, +36795,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMBLEMHEALTH/HIP-Commercial, +36796,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMBLEMHEALTH/HIP-Commercial, +36797,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMBLEMHEALTH/HIP-Commercial, +36798,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMBLEMHEALTH/HIP-Commercial, +36799,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMBLEMHEALTH/HIP-Commercial, +36800,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMBLEMHEALTH/HIP-Commercial, +36801,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMBLEMHEALTH/HIP-Commercial, +36802,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMBLEMHEALTH/HIP-Commercial, +36803,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMBLEMHEALTH/HIP-Commercial, +36804,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMBLEMHEALTH/HIP-Commercial, +36805,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMBLEMHEALTH/HIP-Commercial, +36806,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMBLEMHEALTH/HIP-Commercial, +36807,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMBLEMHEALTH/HIP-Commercial,180.17 +36808,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMBLEMHEALTH/HIP-Commercial,680.0 +36809,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMBLEMHEALTH/HIP-Commercial,1076.0 +36810,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMBLEMHEALTH/HIP-Commercial,568.5 +36811,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMBLEMHEALTH/HIP-Commercial,906.5 +36812,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMBLEMHEALTH/HIP-Commercial, +36813,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMBLEMHEALTH/HIP-Commercial,1842.0 +36814,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMBLEMHEALTH/HIP-Commercial, +36815,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMBLEMHEALTH/HIP-Commercial, +36816,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMBLEMHEALTH/HIP-Commercial, +36817,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMBLEMHEALTH/HIP-Commercial, +36818,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMBLEMHEALTH/HIP-Commercial, +36819,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMBLEMHEALTH/HIP-Commercial, +36820,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMBLEMHEALTH/HIP-Commercial, +36821,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMBLEMHEALTH/HIP-Commercial, +36822,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMBLEMHEALTH/HIP-Commercial, +36823,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMBLEMHEALTH/HIP-Commercial, +36824,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMBLEMHEALTH/HIP-Commercial, +36825,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMBLEMHEALTH/HIP-Commercial, +36826,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMBLEMHEALTH/HIP-Commercial, +36827,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMBLEMHEALTH/HIP-Commercial, +36828,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMBLEMHEALTH/HIP-Commercial, +36829,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMBLEMHEALTH/HIP-Commercial, +36830,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMBLEMHEALTH/HIP-Commercial, +36831,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMBLEMHEALTH/HIP-Commercial, +36832,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMBLEMHEALTH/HIP-Commercial, +36833,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMBLEMHEALTH/HIP-Commercial, +36834,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMBLEMHEALTH/HIP-Commercial, +36835,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMBLEMHEALTH/HIP-Commercial, +36836,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMBLEMHEALTH/HIP-Commercial, +36837,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMBLEMHEALTH/HIP-Commercial, +36838,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMBLEMHEALTH/HIP-Commercial, +36839,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMBLEMHEALTH/HIP-Commercial, +36840,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMBLEMHEALTH/HIP-Commercial, +36841,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMBLEMHEALTH/HIP-Commercial, +36842,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMBLEMHEALTH/HIP-Commercial, +36843,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMBLEMHEALTH/HIP-Commercial, +36844,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMBLEMHEALTH/HIP-Commercial, +36845,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMBLEMHEALTH/HIP-Commercial, +36846,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMBLEMHEALTH/HIP-Commercial, +36847,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMBLEMHEALTH/HIP-Commercial, +36848,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMBLEMHEALTH/HIP-Commercial, +36849,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMBLEMHEALTH/HIP-Commercial, +36850,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMBLEMHEALTH/HIP-Commercial, +36851,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMBLEMHEALTH/HIP-Commercial,17015.26 +36852,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMBLEMHEALTH/HIP-Commercial, +36853,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMBLEMHEALTH/HIP-Commercial, +36854,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMBLEMHEALTH/HIP-Commercial, +36855,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMBLEMHEALTH/HIP-Commercial,333.63 +36856,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMBLEMHEALTH/HIP-Commercial, +36857,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMBLEMHEALTH/HIP-Commercial, +36858,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMBLEMHEALTH/HIP-Commercial, +36859,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMBLEMHEALTH/HIP-Commercial, +36860,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMBLEMHEALTH/HIP-Commercial, +36861,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMBLEMHEALTH/HIP-Commercial, +36862,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMBLEMHEALTH/HIP-Commercial, +36863,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMBLEMHEALTH/HIP-Commercial, +36864,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMBLEMHEALTH/HIP-Commercial, +36865,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMBLEMHEALTH/HIP-Commercial, +36866,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMBLEMHEALTH/HIP-Commercial, +36867,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMBLEMHEALTH/HIP-Commercial, +36868,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMBLEMHEALTH/HIP-Commercial, +36869,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMBLEMHEALTH/HIP-Commercial, +36870,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMBLEMHEALTH/HIP-Commercial, +36871,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMBLEMHEALTH/HIP-Commercial, +36872,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMBLEMHEALTH/HIP-Commercial, +36873,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMBLEMHEALTH/HIP-Commercial, +36874,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMBLEMHEALTH/HIP-Commercial, +36875,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMBLEMHEALTH/HIP-Commercial, +36876,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMBLEMHEALTH/HIP-Commercial, +36877,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMBLEMHEALTH/HIP-Commercial, +36878,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMBLEMHEALTH/HIP-Commercial, +36879,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMBLEMHEALTH/HIP-Commercial, +36880,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMBLEMHEALTH/HIP-Commercial, +36881,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMBLEMHEALTH/HIP-Commercial, +36882,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMBLEMHEALTH/HIP-Commercial, +36883,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMBLEMHEALTH/HIP-Commercial, +36884,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMBLEMHEALTH/HIP-Commercial, +36885,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMBLEMHEALTH/HIP-Commercial, +36886,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMBLEMHEALTH/HIP-Commercial, +36887,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMBLEMHEALTH/HIP-Commercial, +36888,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMBLEMHEALTH/HIP-Commercial, +36889,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMBLEMHEALTH/HIP-Commercial, +36890,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMBLEMHEALTH/HIP-Commercial, +36891,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMBLEMHEALTH/HIP-Commercial, +36892,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMBLEMHEALTH/HIP-Commercial, +36893,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMBLEMHEALTH/HIP-Commercial, +36894,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMBLEMHEALTH/HIP-Commercial, +36895,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMBLEMHEALTH/HIP-Commercial, +36896,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMBLEMHEALTH/HIP-Commercial, +36897,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMBLEMHEALTH/HIP-Commercial, +36898,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMBLEMHEALTH/HIP-Commercial, +36899,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMBLEMHEALTH/HIP-Commercial, +36900,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMBLEMHEALTH/HIP-Commercial, +36901,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMBLEMHEALTH/HIP-Commercial, +36902,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMBLEMHEALTH/HIP-Commercial, +36903,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMBLEMHEALTH/HIP-Commercial, +36904,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMBLEMHEALTH/HIP-Commercial, +36905,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMBLEMHEALTH/HIP-Commercial, +36906,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMBLEMHEALTH/HIP-Commercial, +36907,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMBLEMHEALTH/HIP-Commercial, +36908,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMBLEMHEALTH/HIP-Commercial, +36909,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMBLEMHEALTH/HIP-Commercial, +36910,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMBLEMHEALTH/HIP-Commercial, +36911,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMBLEMHEALTH/HIP-Commercial, +36912,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMBLEMHEALTH/HIP-Commercial, +36913,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMBLEMHEALTH/HIP-Commercial, +36914,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMBLEMHEALTH/HIP-Commercial, +36915,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMBLEMHEALTH/HIP-Commercial, +36916,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMBLEMHEALTH/HIP-Commercial, +36917,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMBLEMHEALTH/HIP-Commercial, +36918,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMBLEMHEALTH/HIP-Commercial, +36919,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMBLEMHEALTH/HIP-Commercial, +36920,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMBLEMHEALTH/HIP-Commercial, +36921,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMBLEMHEALTH/HIP-Commercial, +36922,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMBLEMHEALTH/HIP-Commercial, +36923,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMBLEMHEALTH/HIP-Commercial, +36924,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMBLEMHEALTH/HIP-Commercial, +36925,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMBLEMHEALTH/HIP-Commercial, +36926,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMBLEMHEALTH/HIP-Commercial, +36927,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMBLEMHEALTH/HIP-Commercial, +36928,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMBLEMHEALTH/HIP-Commercial, +36929,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMBLEMHEALTH/HIP-Commercial, +36930,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMBLEMHEALTH/HIP-Commercial, +36931,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMBLEMHEALTH/HIP-Commercial, +36932,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMBLEMHEALTH/HIP-Commercial, +36933,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMBLEMHEALTH/HIP-Commercial, +36934,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMBLEMHEALTH/HIP-Commercial, +36935,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMBLEMHEALTH/HIP-Commercial,446.33 +36936,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMBLEMHEALTH/HIP-Commercial, +36937,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMBLEMHEALTH/HIP-Commercial, +36938,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMBLEMHEALTH/HIP-Commercial, +36939,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMBLEMHEALTH/HIP-Commercial, +36940,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMBLEMHEALTH/HIP-Commercial, +36941,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMBLEMHEALTH/HIP-Commercial,846.34 +36942,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMBLEMHEALTH/HIP-Commercial, +36943,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMBLEMHEALTH/HIP-Commercial, +36944,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMBLEMHEALTH/HIP-Commercial, +36945,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMBLEMHEALTH/HIP-Commercial, +36946,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMBLEMHEALTH/HIP-Commercial, +36947,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMBLEMHEALTH/HIP-Commercial, +36948,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMBLEMHEALTH/HIP-Commercial, +36949,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMBLEMHEALTH/HIP-Commercial, +36950,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMBLEMHEALTH/HIP-Commercial, +36951,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMBLEMHEALTH/HIP-Commercial,11968.17 +36952,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMBLEMHEALTH/HIP-Commercial, +36953,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMBLEMHEALTH/HIP-Commercial, +36954,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMBLEMHEALTH/HIP-Commercial, +36955,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMBLEMHEALTH/HIP-Commercial, +36956,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMBLEMHEALTH/HIP-Commercial, +36957,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMBLEMHEALTH/HIP-Commercial, +36958,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMBLEMHEALTH/HIP-Commercial, +36959,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMBLEMHEALTH/HIP-Commercial, +36960,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMBLEMHEALTH/HIP-Commercial, +36961,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMBLEMHEALTH/HIP-Commercial, +36962,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMBLEMHEALTH/HIP-Commercial,11759.68 +36963,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMBLEMHEALTH/HIP-Commercial, +36964,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMBLEMHEALTH/HIP-Commercial, +36965,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMBLEMHEALTH/HIP-Commercial, +36966,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMBLEMHEALTH/HIP-Commercial, +36967,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMBLEMHEALTH/HIP-Commercial, +36968,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMBLEMHEALTH/HIP-Commercial, +36969,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMBLEMHEALTH/HIP-Commercial, +36970,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMBLEMHEALTH/HIP-Commercial, +36971,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMBLEMHEALTH/HIP-Commercial, +36972,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMBLEMHEALTH/HIP-Commercial, +36973,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMBLEMHEALTH/HIP-Commercial, +36974,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMBLEMHEALTH/HIP-Commercial, +36975,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMBLEMHEALTH/HIP-Commercial, +36976,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMBLEMHEALTH/HIP-Commercial, +36977,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMBLEMHEALTH/HIP-Commercial, +36978,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMBLEMHEALTH/HIP-Commercial, +36979,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMBLEMHEALTH/HIP-Commercial, +36980,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMBLEMHEALTH/HIP-Commercial, +36981,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMBLEMHEALTH/HIP-Commercial, +36982,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMBLEMHEALTH/HIP-Commercial, +36983,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMBLEMHEALTH/HIP-Commercial, +36984,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMBLEMHEALTH/HIP-Commercial, +36985,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMBLEMHEALTH/HIP-Commercial, +36986,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMBLEMHEALTH/HIP-Commercial, +36987,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMBLEMHEALTH/HIP-Commercial, +36988,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMBLEMHEALTH/HIP-Commercial, +36989,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMBLEMHEALTH/HIP-Commercial, +36990,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMBLEMHEALTH/HIP-Commercial, +36991,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMBLEMHEALTH/HIP-Commercial, +36992,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMBLEMHEALTH/HIP-Commercial, +36993,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMBLEMHEALTH/HIP-Commercial, +36994,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMBLEMHEALTH/HIP-Commercial, +36995,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMBLEMHEALTH/HIP-Commercial, +36996,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMBLEMHEALTH/HIP-Commercial, +36997,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMBLEMHEALTH/HIP-Commercial, +36998,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMBLEMHEALTH/HIP-Commercial, +36999,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMBLEMHEALTH/HIP-Commercial, +37000,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMBLEMHEALTH/HIP-Commercial, +37001,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMBLEMHEALTH/HIP-Commercial, +37002,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMBLEMHEALTH/HIP-Commercial, +37003,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMBLEMHEALTH/HIP-Commercial, +37004,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMBLEMHEALTH/HIP-Commercial,131.46 +37005,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMBLEMHEALTH/HIP-Commercial, +37006,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMBLEMHEALTH/HIP-Commercial, +37007,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMBLEMHEALTH/HIP-Commercial, +37008,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMBLEMHEALTH/HIP-Commercial, +37009,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMBLEMHEALTH/HIP-Commercial,31.15 +37010,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMBLEMHEALTH/HIP-Commercial,11.69 +37011,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMBLEMHEALTH/HIP-Commercial,96.69 +37012,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMBLEMHEALTH/HIP-Commercial, +37013,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMBLEMHEALTH/HIP-Commercial, +37014,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMBLEMHEALTH/HIP-Commercial, +37015,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMBLEMHEALTH/HIP-Commercial,30.71 +37016,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMBLEMHEALTH/HIP-Commercial, +37017,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMBLEMHEALTH/HIP-Commercial, +37018,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMBLEMHEALTH/HIP-Commercial,140.9 +37019,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMBLEMHEALTH/HIP-Commercial, +37020,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMBLEMHEALTH/HIP-Commercial, +37021,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMBLEMHEALTH/HIP-Commercial, +37022,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMBLEMHEALTH/HIP-Commercial, +37023,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMBLEMHEALTH/HIP-Commercial, +37024,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMBLEMHEALTH/HIP-Commercial, +37025,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMBLEMHEALTH/HIP-Commercial,4357.73 +37026,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMBLEMHEALTH/HIP-Commercial, +37027,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMBLEMHEALTH/HIP-Commercial, +37028,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMBLEMHEALTH/HIP-Commercial, +37029,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMBLEMHEALTH/HIP-Commercial, +37030,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMBLEMHEALTH/HIP-Commercial, +37031,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMBLEMHEALTH/HIP-Commercial, +37032,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMBLEMHEALTH/HIP-Commercial, +37033,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMBLEMHEALTH/HIP-Commercial, +37034,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMBLEMHEALTH/HIP-Commercial, +37035,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMBLEMHEALTH/HIP-Commercial, +37036,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMBLEMHEALTH/HIP-Commercial, +37037,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMBLEMHEALTH/HIP-Commercial, +37038,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMBLEMHEALTH/HIP-Commercial, +37039,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMBLEMHEALTH/HIP-Commercial, +37040,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMBLEMHEALTH/HIP-Commercial, +37041,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMBLEMHEALTH/HIP-Commercial, +37042,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMBLEMHEALTH/HIP-Commercial, +37043,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMBLEMHEALTH/HIP-Commercial, +37044,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMBLEMHEALTH/HIP-Commercial, +37045,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMBLEMHEALTH/HIP-Commercial, +37046,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMBLEMHEALTH/HIP-Commercial, +37047,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMBLEMHEALTH/HIP-Commercial, +37048,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMBLEMHEALTH/HIP-Commercial, +37049,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMBLEMHEALTH/HIP-Commercial, +37050,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMBLEMHEALTH/HIP-Commercial,6.06 +37051,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMBLEMHEALTH/HIP-Commercial, +37052,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMBLEMHEALTH/HIP-Commercial, +37053,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMBLEMHEALTH/HIP-Commercial, +37054,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMBLEMHEALTH/HIP-Commercial, +37055,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMBLEMHEALTH/HIP-Commercial, +37056,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMBLEMHEALTH/HIP-Commercial, +37057,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMBLEMHEALTH/HIP-Commercial, +37058,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMBLEMHEALTH/HIP-Commercial, +37059,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMBLEMHEALTH/HIP-Commercial, +37060,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMBLEMHEALTH/HIP-Commercial, +37061,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMBLEMHEALTH/HIP-Commercial, +37062,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMBLEMHEALTH/HIP-Commercial, +37063,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMBLEMHEALTH/HIP-Commercial, +37064,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMBLEMHEALTH/HIP-Commercial, +37065,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMBLEMHEALTH/HIP-Commercial, +37066,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMBLEMHEALTH/HIP-Commercial, +37067,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMBLEMHEALTH/HIP-Commercial, +37068,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMBLEMHEALTH/HIP-Commercial, +37069,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMBLEMHEALTH/HIP-Commercial,520.2 +37070,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMBLEMHEALTH/HIP-Commercial, +37071,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMBLEMHEALTH/HIP-Commercial, +37072,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMBLEMHEALTH/HIP-Commercial,3.48 +37073,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMBLEMHEALTH/HIP-Commercial, +37074,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMBLEMHEALTH/HIP-Commercial, +37075,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMBLEMHEALTH/HIP-Commercial,1470.1 +37076,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMBLEMHEALTH/HIP-Commercial, +37077,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMBLEMHEALTH/HIP-Commercial, +37078,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMBLEMHEALTH/HIP-Commercial, +37079,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMBLEMHEALTH/HIP-Commercial, +37080,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMBLEMHEALTH/HIP-Commercial, +37081,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMBLEMHEALTH/HIP-Commercial, +37082,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMBLEMHEALTH/HIP-Commercial, +37083,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMBLEMHEALTH/HIP-Commercial, +37084,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMBLEMHEALTH/HIP-Commercial, +37085,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMBLEMHEALTH/HIP-Commercial, +37086,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMBLEMHEALTH/HIP-Commercial, +37087,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMBLEMHEALTH/HIP-Commercial, +37088,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMBLEMHEALTH/HIP-Commercial, +37089,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMBLEMHEALTH/HIP-Commercial, +37090,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMBLEMHEALTH/HIP-Commercial, +37091,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMBLEMHEALTH/HIP-Commercial, +37092,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMBLEMHEALTH/HIP-Commercial,1.13 +37093,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMBLEMHEALTH/HIP-Commercial,326.88 +37094,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMBLEMHEALTH/HIP-Commercial, +37095,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMBLEMHEALTH/HIP-Commercial,0.79 +37096,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMBLEMHEALTH/HIP-Commercial, +37097,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMBLEMHEALTH/HIP-Commercial, +37098,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMBLEMHEALTH/HIP-Commercial, +37099,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMBLEMHEALTH/HIP-Commercial, +37100,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMBLEMHEALTH/HIP-Commercial, +37101,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMBLEMHEALTH/HIP-Commercial, +37102,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMBLEMHEALTH/HIP-Commercial, +37103,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMBLEMHEALTH/HIP-Commercial, +37104,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMBLEMHEALTH/HIP-Commercial, +37105,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMBLEMHEALTH/HIP-Commercial, +37106,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMBLEMHEALTH/HIP-Commercial, +37107,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMBLEMHEALTH/HIP-Commercial, +37108,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMBLEMHEALTH/HIP-Commercial, +37109,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMBLEMHEALTH/HIP-Commercial, +37110,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMBLEMHEALTH/HIP-Commercial, +37111,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMBLEMHEALTH/HIP-Commercial, +37112,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMBLEMHEALTH/HIP-Commercial, +37113,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMBLEMHEALTH/HIP-Commercial, +37114,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMBLEMHEALTH/HIP-Commercial, +37115,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMBLEMHEALTH/HIP-Commercial, +37116,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMBLEMHEALTH/HIP-Commercial, +37117,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMBLEMHEALTH/HIP-Commercial, +37118,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMBLEMHEALTH/HIP-Commercial, +37119,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMBLEMHEALTH/HIP-Commercial, +37120,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMBLEMHEALTH/HIP-Commercial, +37121,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMBLEMHEALTH/HIP-Commercial, +37122,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMBLEMHEALTH/HIP-Commercial, +37123,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMBLEMHEALTH/HIP-Commercial, +37124,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMBLEMHEALTH/HIP-Commercial, +37125,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMBLEMHEALTH/HIP-Commercial, +37126,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMBLEMHEALTH/HIP-Commercial, +37127,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMBLEMHEALTH/HIP-Commercial, +37128,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMBLEMHEALTH/HIP-Commercial, +37129,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMBLEMHEALTH/HIP-Commercial, +37130,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMBLEMHEALTH/HIP-Commercial, +37131,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMBLEMHEALTH/HIP-Commercial, +37132,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMBLEMHEALTH/HIP-Commercial, +37133,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMBLEMHEALTH/HIP-Commercial, +37134,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMBLEMHEALTH/HIP-Commercial, +37135,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMBLEMHEALTH/HIP-Commercial, +37136,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMBLEMHEALTH/HIP-Commercial, +37137,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMBLEMHEALTH/HIP-Commercial, +37138,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMBLEMHEALTH/HIP-Commercial, +37139,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMBLEMHEALTH/HIP-Commercial, +37140,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMBLEMHEALTH/HIP-Commercial, +37141,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMBLEMHEALTH/HIP-Commercial, +37142,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMBLEMHEALTH/HIP-Commercial, +37143,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMBLEMHEALTH/HIP-Commercial, +37144,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMBLEMHEALTH/HIP-Commercial, +37145,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMBLEMHEALTH/HIP-Commercial, +37146,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMBLEMHEALTH/HIP-Commercial, +37147,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMBLEMHEALTH/HIP-Commercial,2611.37 +37148,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMBLEMHEALTH/HIP-Commercial, +37149,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMBLEMHEALTH/HIP-Commercial, +37150,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMBLEMHEALTH/HIP-Commercial, +37151,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMBLEMHEALTH/HIP-Commercial, +37152,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMBLEMHEALTH/HIP-Commercial, +37153,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMBLEMHEALTH/HIP-Commercial, +37154,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMBLEMHEALTH/HIP-Commercial, +37155,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMBLEMHEALTH/HIP-Commercial, +37156,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMBLEMHEALTH/HIP-Commercial, +37157,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMBLEMHEALTH/HIP-Commercial, +37158,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMBLEMHEALTH/HIP-Commercial, +37159,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMBLEMHEALTH/HIP-Commercial, +37160,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMBLEMHEALTH/HIP-Commercial, +37161,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMBLEMHEALTH/HIP-Commercial, +37162,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMBLEMHEALTH/HIP-Commercial, +37163,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMBLEMHEALTH/HIP-Commercial, +37164,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMBLEMHEALTH/HIP-Commercial, +37165,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMBLEMHEALTH/HIP-Commercial, +37166,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMBLEMHEALTH/HIP-Commercial, +37167,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMBLEMHEALTH/HIP-Commercial, +37168,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMBLEMHEALTH/HIP-Commercial, +37169,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMBLEMHEALTH/HIP-Commercial, +37170,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMBLEMHEALTH/HIP-Commercial,87.36 +37171,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMBLEMHEALTH/HIP-Commercial, +37172,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMBLEMHEALTH/HIP-Commercial, +37173,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMBLEMHEALTH/HIP-Commercial, +37174,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMBLEMHEALTH/HIP-Commercial, +37175,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMBLEMHEALTH/HIP-Commercial, +37176,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMBLEMHEALTH/HIP-Commercial, +37177,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMBLEMHEALTH/HIP-Commercial, +37178,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMBLEMHEALTH/HIP-Commercial, +37179,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMBLEMHEALTH/HIP-Commercial, +37180,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMBLEMHEALTH/HIP-Commercial, +37181,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMBLEMHEALTH/HIP-Commercial,20.35 +37182,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMBLEMHEALTH/HIP-Commercial, +37183,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMBLEMHEALTH/HIP-Commercial, +37184,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMBLEMHEALTH/HIP-Commercial, +37185,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMBLEMHEALTH/HIP-Commercial, +37186,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMBLEMHEALTH/HIP-Commercial, +37187,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMBLEMHEALTH/HIP-Commercial, +37188,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMBLEMHEALTH/HIP-Commercial, +37189,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMBLEMHEALTH/HIP-Commercial, +37190,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMBLEMHEALTH/HIP-Commercial, +37191,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMBLEMHEALTH/HIP-Commercial, +37192,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMBLEMHEALTH/HIP-Commercial, +37193,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMBLEMHEALTH/HIP-Commercial, +37194,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMBLEMHEALTH/HIP-Commercial, +37195,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMBLEMHEALTH/HIP-Commercial, +37196,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMBLEMHEALTH/HIP-Commercial, +37197,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMBLEMHEALTH/HIP-Commercial, +37198,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMBLEMHEALTH/HIP-Commercial, +37199,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMBLEMHEALTH/HIP-Commercial, +37200,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMBLEMHEALTH/HIP-Commercial, +37201,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMBLEMHEALTH/HIP-Commercial, +37202,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMBLEMHEALTH/HIP-Commercial, +37203,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMBLEMHEALTH/HIP-Commercial, +37204,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMBLEMHEALTH/HIP-Commercial, +37205,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMBLEMHEALTH/HIP-Commercial, +37206,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMBLEMHEALTH/HIP-Commercial, +37207,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMBLEMHEALTH/HIP-Commercial, +37208,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMBLEMHEALTH/HIP-Commercial, +37209,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMBLEMHEALTH/HIP-Commercial, +37210,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMBLEMHEALTH/HIP-Commercial, +37211,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMBLEMHEALTH/HIP-Commercial, +37212,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMBLEMHEALTH/HIP-Commercial, +37213,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMBLEMHEALTH/HIP-Commercial, +37214,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMBLEMHEALTH/HIP-Commercial, +37215,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMBLEMHEALTH/HIP-Commercial, +37216,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMBLEMHEALTH/HIP-Commercial, +37217,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMBLEMHEALTH/HIP-Commercial, +37218,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMBLEMHEALTH/HIP-Commercial, +37219,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMBLEMHEALTH/HIP-Commercial, +37220,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMBLEMHEALTH/HIP-Commercial, +37221,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMBLEMHEALTH/HIP-Commercial, +37222,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMBLEMHEALTH/HIP-Commercial, +37223,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMBLEMHEALTH/HIP-Commercial, +37224,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMBLEMHEALTH/HIP-Commercial, +37225,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMBLEMHEALTH/HIP-Commercial, +37226,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMBLEMHEALTH/HIP-Commercial, +37227,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMBLEMHEALTH/HIP-Commercial, +37228,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMBLEMHEALTH/HIP-Commercial, +37229,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMBLEMHEALTH/HIP-Commercial, +37230,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMBLEMHEALTH/HIP-Commercial,78.2 +37231,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMBLEMHEALTH/HIP-Commercial, +37232,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMBLEMHEALTH/HIP-Commercial, +37233,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMBLEMHEALTH/HIP-Commercial, +37234,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMBLEMHEALTH/HIP-Commercial, +37235,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMBLEMHEALTH/HIP-Commercial, +37236,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMBLEMHEALTH/HIP-Commercial, +37237,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMBLEMHEALTH/HIP-Commercial, +37238,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMBLEMHEALTH/HIP-Commercial,43.87 +37239,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMBLEMHEALTH/HIP-Commercial, +37240,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMBLEMHEALTH/HIP-Commercial, +37241,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMBLEMHEALTH/HIP-Commercial, +37242,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMBLEMHEALTH/HIP-Commercial,39.35 +37243,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMBLEMHEALTH/HIP-Commercial, +37244,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMBLEMHEALTH/HIP-Commercial, +37245,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMBLEMHEALTH/HIP-Commercial,29.19 +37246,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMBLEMHEALTH/HIP-Commercial, +37247,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMBLEMHEALTH/HIP-Commercial, +37248,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMBLEMHEALTH/HIP-Commercial, +37249,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMBLEMHEALTH/HIP-Commercial, +37250,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMBLEMHEALTH/HIP-Commercial, +37251,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMBLEMHEALTH/HIP-Commercial, +37252,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMBLEMHEALTH/HIP-Commercial, +37253,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMBLEMHEALTH/HIP-Commercial,99.52 +37254,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMBLEMHEALTH/HIP-Commercial, +37255,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMBLEMHEALTH/HIP-Commercial,27.96 +37256,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMBLEMHEALTH/HIP-Commercial, +37257,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMBLEMHEALTH/HIP-Commercial, +37258,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMBLEMHEALTH/HIP-Commercial, +37259,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMBLEMHEALTH/HIP-Commercial, +37260,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMBLEMHEALTH/HIP-Commercial, +37261,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMBLEMHEALTH/HIP-Commercial, +37262,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMBLEMHEALTH/HIP-Commercial, +37263,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMBLEMHEALTH/HIP-Commercial, +37264,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMBLEMHEALTH/HIP-Commercial, +37265,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMBLEMHEALTH/HIP-Commercial,560.4 +37266,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMBLEMHEALTH/HIP-Commercial, +37267,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMBLEMHEALTH/HIP-Commercial, +37268,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMBLEMHEALTH/HIP-Commercial, +37269,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMBLEMHEALTH/HIP-Commercial, +37270,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMBLEMHEALTH/HIP-Commercial, +37271,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMBLEMHEALTH/HIP-Commercial, +37272,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMBLEMHEALTH/HIP-Commercial,1956.24 +37273,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMBLEMHEALTH/HIP-Commercial, +37274,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMBLEMHEALTH/HIP-Commercial, +37275,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMBLEMHEALTH/HIP-Commercial,50.73 +37276,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMBLEMHEALTH/HIP-Commercial, +37277,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMBLEMHEALTH/HIP-Commercial, +37278,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMBLEMHEALTH/HIP-Commercial, +37279,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMBLEMHEALTH/HIP-Commercial, +37280,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMBLEMHEALTH/HIP-Commercial, +37281,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMBLEMHEALTH/HIP-Commercial,71.95 +37282,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMBLEMHEALTH/HIP-Commercial,397.72 +37283,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMBLEMHEALTH/HIP-Commercial, +37284,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMBLEMHEALTH/HIP-Commercial, +37285,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMBLEMHEALTH/HIP-Commercial,91.26 +37286,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMBLEMHEALTH/HIP-Commercial, +37287,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMBLEMHEALTH/HIP-Commercial, +37288,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMBLEMHEALTH/HIP-Commercial, +37289,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMBLEMHEALTH/HIP-Commercial,91.15 +37290,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMBLEMHEALTH/HIP-Commercial, +37291,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMBLEMHEALTH/HIP-Commercial, +37292,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMBLEMHEALTH/HIP-Commercial, +37293,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMBLEMHEALTH/HIP-Commercial, +37294,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMBLEMHEALTH/HIP-Commercial, +37295,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMBLEMHEALTH/HIP-Commercial,732.36 +37296,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMBLEMHEALTH/HIP-Commercial, +37297,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMBLEMHEALTH/HIP-Commercial, +37298,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMBLEMHEALTH/HIP-Commercial, +37299,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMBLEMHEALTH/HIP-Commercial, +37300,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMBLEMHEALTH/HIP-Commercial, +37301,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMBLEMHEALTH/HIP-Commercial, +37302,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMBLEMHEALTH/HIP-Commercial, +37303,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMBLEMHEALTH/HIP-Commercial, +37304,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMBLEMHEALTH/HIP-Commercial, +37305,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMBLEMHEALTH/HIP-Commercial, +37306,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMBLEMHEALTH/HIP-Commercial, +37307,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMBLEMHEALTH/HIP-Commercial,106.99 +37308,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMBLEMHEALTH/HIP-Commercial, +37309,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMBLEMHEALTH/HIP-Commercial, +37310,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMBLEMHEALTH/HIP-Commercial, +37311,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMBLEMHEALTH/HIP-Commercial, +37312,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMBLEMHEALTH/HIP-Commercial, +37313,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMBLEMHEALTH/HIP-Commercial, +37314,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMBLEMHEALTH/HIP-Commercial, +37315,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMBLEMHEALTH/HIP-Commercial, +37316,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMBLEMHEALTH/HIP-Commercial, +37317,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMBLEMHEALTH/HIP-Commercial, +37318,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMBLEMHEALTH/HIP-Commercial, +37319,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMBLEMHEALTH/HIP-Commercial, +37320,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMBLEMHEALTH/HIP-Commercial, +37321,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMBLEMHEALTH/HIP-Commercial, +37322,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMBLEMHEALTH/HIP-Commercial, +37323,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMBLEMHEALTH/HIP-Commercial,188.35 +37324,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMBLEMHEALTH/HIP-Commercial, +37325,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMBLEMHEALTH/HIP-Commercial, +37326,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMBLEMHEALTH/HIP-Commercial, +37327,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMBLEMHEALTH/HIP-Commercial, +37328,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMBLEMHEALTH/HIP-Commercial, +37329,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMBLEMHEALTH/HIP-Commercial, +37330,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMBLEMHEALTH/HIP-Commercial,38.35 +37331,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMBLEMHEALTH/HIP-Commercial, +37332,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMBLEMHEALTH/HIP-Commercial, +37333,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMBLEMHEALTH/HIP-Commercial, +37334,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMBLEMHEALTH/HIP-Commercial, +37335,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMBLEMHEALTH/HIP-Commercial, +37336,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMBLEMHEALTH/HIP-Commercial, +37337,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMBLEMHEALTH/HIP-Commercial, +37338,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMBLEMHEALTH/HIP-Commercial, +37339,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMBLEMHEALTH/HIP-Commercial, +37340,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMBLEMHEALTH/HIP-Commercial, +37341,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMBLEMHEALTH/HIP-Commercial, +37342,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMBLEMHEALTH/HIP-Commercial, +37343,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMBLEMHEALTH/HIP-Commercial, +37344,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMBLEMHEALTH/HIP-Commercial, +37345,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMBLEMHEALTH/HIP-Commercial, +37346,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMBLEMHEALTH/HIP-Commercial, +37347,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMBLEMHEALTH/HIP-Commercial, +37348,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMBLEMHEALTH/HIP-Commercial, +37349,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMBLEMHEALTH/HIP-Commercial, +37350,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMBLEMHEALTH/HIP-Commercial, +37351,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMBLEMHEALTH/HIP-Commercial, +37352,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMBLEMHEALTH/HIP-Commercial, +37353,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMBLEMHEALTH/HIP-Commercial, +37354,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMBLEMHEALTH/HIP-Commercial, +37355,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMBLEMHEALTH/HIP-Commercial, +37356,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMBLEMHEALTH/HIP-Commercial, +37357,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMBLEMHEALTH/HIP-Commercial, +37358,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMBLEMHEALTH/HIP-Commercial,118.35 +37359,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMBLEMHEALTH/HIP-Commercial, +37360,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMBLEMHEALTH/HIP-Commercial, +37361,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMBLEMHEALTH/HIP-Commercial, +37362,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMBLEMHEALTH/HIP-Commercial, +37363,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMBLEMHEALTH/HIP-Commercial, +37364,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMBLEMHEALTH/HIP-Commercial, +37365,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMBLEMHEALTH/HIP-Commercial, +37366,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMBLEMHEALTH/HIP-Commercial, +37367,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMBLEMHEALTH/HIP-Commercial, +37368,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMBLEMHEALTH/HIP-Commercial, +37369,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMBLEMHEALTH/HIP-Commercial, +37370,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMBLEMHEALTH/HIP-Commercial, +37371,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMBLEMHEALTH/HIP-Commercial, +37372,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMBLEMHEALTH/HIP-Commercial, +37373,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMBLEMHEALTH/HIP-Commercial, +37374,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMBLEMHEALTH/HIP-Commercial,35.91 +37375,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMBLEMHEALTH/HIP-Commercial, +37376,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMBLEMHEALTH/HIP-Commercial, +37377,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMBLEMHEALTH/HIP-Commercial,75.0 +37378,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMBLEMHEALTH/HIP-Commercial,25.0 +37379,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMBLEMHEALTH/HIP-Commercial, +37380,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMBLEMHEALTH/HIP-Commercial, +37381,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMBLEMHEALTH/HIP-Commercial, +37382,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMBLEMHEALTH/HIP-Commercial, +37383,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMBLEMHEALTH/HIP-Commercial, +37384,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMBLEMHEALTH/HIP-Commercial, +37385,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37386,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37387,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37388,3934,30000038,ICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37389,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37390,3934,30000053,NICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37391,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37392,3934,30000079,PSYCH,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37393,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37394,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37395,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37396,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37397,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37398,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37399,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37400,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37401,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37402,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37403,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37404,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37405,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37406,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37407,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37408,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37409,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37410,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37411,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37412,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37413,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37414,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37415,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37416,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37417,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37418,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37419,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37420,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37421,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37422,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37423,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37424,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37425,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37426,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37427,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37428,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37429,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37430,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37431,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37432,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37433,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37434,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37435,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37436,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37437,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37438,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37439,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37440,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37441,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37442,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37443,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37444,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37445,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37446,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37447,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37448,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37449,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37450,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37451,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37452,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37453,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37454,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37455,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37456,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37457,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37458,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37459,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37460,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37461,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37462,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37463,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37464,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37465,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37466,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37467,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37468,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37469,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37470,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37471,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37472,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37473,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37474,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37475,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37476,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37477,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37478,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37479,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37480,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37481,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37482,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37483,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37484,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37485,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37486,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37487,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37488,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37489,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37490,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37491,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37492,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37493,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37494,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37495,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37496,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37497,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37498,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37499,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37500,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37501,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37502,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37503,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37504,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37505,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37506,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37507,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37508,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37509,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37510,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37511,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37512,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37513,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37514,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37515,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37516,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37517,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37518,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37519,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37520,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37521,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37522,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37523,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37524,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37525,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37526,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37527,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37528,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37529,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37530,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37531,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37532,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37533,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37534,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37535,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37536,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37537,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37538,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37539,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37540,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37541,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37542,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37543,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37544,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37545,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37546,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37547,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37548,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37549,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37550,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37551,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37552,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37553,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37554,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37555,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37556,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37557,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37558,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37559,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37560,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37561,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37562,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37563,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37564,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37565,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37566,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37567,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37568,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37569,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37570,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37571,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37572,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37573,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37574,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37575,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37576,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37577,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37578,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37579,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37580,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37581,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37582,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37583,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37584,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37585,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37586,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37587,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37588,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37589,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37590,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37591,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37592,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37593,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37594,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37595,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37596,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37597,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37598,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37599,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37600,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37601,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37602,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37603,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37604,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37605,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37606,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37607,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37608,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37609,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37610,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37611,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37612,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37613,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37614,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37615,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37616,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37617,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37618,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37619,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37620,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37621,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37622,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37623,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37624,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37625,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37626,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37627,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37628,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37629,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37630,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37631,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37632,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37633,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37634,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37635,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37636,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37637,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37638,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37639,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37640,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37641,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37642,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37643,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37644,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37645,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37646,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37647,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37648,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37649,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37650,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37651,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37652,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37653,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37654,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37655,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37656,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37657,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37658,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37659,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37660,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37661,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37662,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37663,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37664,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37665,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37666,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37667,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37668,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37669,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37670,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37671,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37672,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37673,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37674,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37675,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37676,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37677,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37678,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37679,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37680,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37681,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37682,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37683,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37684,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37685,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37686,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37687,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37688,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37689,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37690,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37691,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37692,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37693,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37694,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37695,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37696,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37697,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37698,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37699,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37700,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37701,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37702,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37703,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37704,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37705,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37706,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37707,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37708,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37709,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37710,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37711,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37712,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37713,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37714,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37715,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37716,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37717,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37718,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37719,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37720,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37721,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37722,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37723,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37724,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37725,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37726,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37727,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37728,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37729,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37730,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37731,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37732,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37733,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37734,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37735,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37736,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37737,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37738,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37739,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37740,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37741,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37742,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37743,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37744,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37745,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37746,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37747,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37748,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37749,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37750,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37751,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37752,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37753,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37754,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37755,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37756,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37757,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37758,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37759,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37760,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37761,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37762,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37763,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37764,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37765,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37766,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37767,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37768,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37769,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37770,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37771,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37772,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37773,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37774,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37775,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37776,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37777,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37778,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37779,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37780,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37781,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37782,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37783,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37784,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37785,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37786,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37787,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37788,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37789,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37790,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37791,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37792,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37793,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37794,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37795,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37796,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37797,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37798,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37799,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37800,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37801,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37802,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37803,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Commercial, +37804,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37805,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37806,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37807,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37808,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37809,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37810,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Commercial, +37811,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37812,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37813,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37814,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37815,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37816,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37817,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37818,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37819,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37820,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37821,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37822,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37823,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37824,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37825,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37826,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37827,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37828,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Commercial, +37829,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Commercial, +37830,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Commercial, +37831,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMBLEMHEALTH/HIP-Commercial, +37832,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMBLEMHEALTH/HIP-Commercial, +37833,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMBLEMHEALTH/HIP-Commercial, +37834,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMBLEMHEALTH/HIP-Commercial, +37835,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37836,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37837,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37838,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37839,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37840,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37841,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37842,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37843,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37844,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37845,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37846,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37847,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMBLEMHEALTH/HIP-Commercial, +37848,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Commercial, +37849,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMBLEMHEALTH/HIP-Commercial, +37850,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMBLEMHEALTH/HIP-Commercial, +37851,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMBLEMHEALTH/HIP-Commercial, +37852,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMBLEMHEALTH/HIP-Commercial, +37853,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMBLEMHEALTH/HIP-Commercial, +37854,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMBLEMHEALTH/HIP-Commercial, +37855,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMBLEMHEALTH/HIP-Commercial, +37856,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMBLEMHEALTH/HIP-Commercial, +37857,3934,37112034,TRIAGE,,277.0,277.0,,,EMBLEMHEALTH/HIP-Commercial, +37858,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMBLEMHEALTH/HIP-Commercial, +37859,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMBLEMHEALTH/HIP-Commercial, +37860,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMBLEMHEALTH/HIP-Commercial, +37861,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMBLEMHEALTH/HIP-Commercial, +37862,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMBLEMHEALTH/HIP-Commercial, +37863,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Commercial, +37864,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Commercial, +37865,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Commercial, +37866,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Commercial, +37867,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMBLEMHEALTH/HIP-Commercial, +37868,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMBLEMHEALTH/HIP-Commercial, +37869,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMBLEMHEALTH/HIP-Commercial, +37870,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMBLEMHEALTH/HIP-Commercial, +37871,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMBLEMHEALTH/HIP-Commercial, +37872,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMBLEMHEALTH/HIP-Commercial, +37873,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-Commercial, +37874,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMBLEMHEALTH/HIP-Commercial, +37875,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMBLEMHEALTH/HIP-Commercial, +37876,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMBLEMHEALTH/HIP-Commercial, +37877,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMBLEMHEALTH/HIP-Commercial, +37878,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMBLEMHEALTH/HIP-Commercial, +37879,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMBLEMHEALTH/HIP-Commercial, +37880,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMBLEMHEALTH/HIP-Commercial, +37881,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMBLEMHEALTH/HIP-Commercial, +37882,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMBLEMHEALTH/HIP-Commercial, +37883,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMBLEMHEALTH/HIP-Commercial, +37884,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMBLEMHEALTH/HIP-Commercial, +37885,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMBLEMHEALTH/HIP-Commercial, +37886,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMBLEMHEALTH/HIP-Commercial, +37887,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMBLEMHEALTH/HIP-Commercial, +37888,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMBLEMHEALTH/HIP-Commercial, +37889,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMBLEMHEALTH/HIP-Commercial, +37890,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,EMBLEMHEALTH/HIP-Commercial, +37891,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,EMBLEMHEALTH/HIP-Commercial, +37892,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,EMBLEMHEALTH/HIP-Commercial, +37893,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,EMBLEMHEALTH/HIP-Commercial, +37894,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,EMBLEMHEALTH/HIP-Commercial, +37895,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,EMBLEMHEALTH/HIP-Commercial, +37896,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-Commercial, +37897,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,EMBLEMHEALTH/HIP-Commercial, +37898,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-Commercial, +37899,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-Commercial, +37900,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-Commercial, +37901,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMBLEMHEALTH/HIP-Commercial, +37902,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMBLEMHEALTH/HIP-Commercial, +37903,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMBLEMHEALTH/HIP-Commercial, +37904,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMBLEMHEALTH/HIP-Commercial, +37905,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMBLEMHEALTH/HIP-Commercial, +37906,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMBLEMHEALTH/HIP-Commercial, +37907,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMBLEMHEALTH/HIP-Commercial, +37908,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMBLEMHEALTH/HIP-Commercial, +37909,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMBLEMHEALTH/HIP-Commercial, +37910,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMBLEMHEALTH/HIP-Commercial, +37911,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMBLEMHEALTH/HIP-Commercial, +37912,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMBLEMHEALTH/HIP-Commercial, +37913,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMBLEMHEALTH/HIP-Commercial, +37914,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMBLEMHEALTH/HIP-Commercial, +37915,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-Commercial, +37916,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-Commercial, +37917,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-Commercial, +37918,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-Commercial, +37919,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-Commercial, +37920,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-Commercial, +37921,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-Commercial, +37922,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-Commercial, +37923,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-Commercial, +37924,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-Commercial, +37925,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-Commercial, +37926,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-Commercial, +37927,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-Commercial, +37928,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-Commercial, +37929,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-Commercial, +37930,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-Commercial, +37931,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-Commercial, +37932,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-Commercial, +37933,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-Commercial, +37934,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-Commercial, +37935,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-Commercial, +37936,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-Commercial, +37937,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-Commercial, +37938,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-Commercial, +37939,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-Commercial, +37940,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-Commercial, +37941,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-Commercial, +37942,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-Commercial, +37943,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-Commercial, +37944,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-Commercial, +37945,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-Commercial, +37946,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-Commercial, +37947,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-Commercial, +37948,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-Commercial, +37949,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-Commercial, +37950,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-Commercial, +37951,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-Commercial, +37952,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-Commercial, +37953,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-Commercial, +37954,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-Commercial, +37955,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-Commercial, +37956,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-Commercial, +37957,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Commercial, +37958,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +37959,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +37960,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +37961,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +37962,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +37963,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-Commercial, +37964,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMBLEMHEALTH/HIP-Commercial, +37965,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMBLEMHEALTH/HIP-Commercial, +37966,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +37967,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +37968,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +37969,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMBLEMHEALTH/HIP-Commercial, +37970,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMBLEMHEALTH/HIP-Commercial, +37971,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMBLEMHEALTH/HIP-Commercial, +37972,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMBLEMHEALTH/HIP-Commercial, +37973,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMBLEMHEALTH/HIP-Commercial, +37974,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMBLEMHEALTH/HIP-Commercial, +37975,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMBLEMHEALTH/HIP-Commercial, +37976,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMBLEMHEALTH/HIP-Commercial, +37977,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMBLEMHEALTH/HIP-Commercial, +37978,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMBLEMHEALTH/HIP-Commercial, +37979,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMBLEMHEALTH/HIP-Commercial, +37980,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMBLEMHEALTH/HIP-Commercial, +37981,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMBLEMHEALTH/HIP-Commercial, +37982,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMBLEMHEALTH/HIP-Commercial, +37983,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMBLEMHEALTH/HIP-Commercial, +37984,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMBLEMHEALTH/HIP-Commercial, +37985,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMBLEMHEALTH/HIP-Commercial, +37986,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMBLEMHEALTH/HIP-Commercial, +37987,3934,43301043,ALBUNEX,,357.0,357.0,,,EMBLEMHEALTH/HIP-Commercial, +37988,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-Commercial, +37989,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +37990,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +37991,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +37992,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +37993,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +37994,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMBLEMHEALTH/HIP-Commercial, +37995,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMBLEMHEALTH/HIP-Commercial, +37996,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMBLEMHEALTH/HIP-Commercial, +37997,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMBLEMHEALTH/HIP-Commercial, +37998,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMBLEMHEALTH/HIP-Commercial, +37999,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMBLEMHEALTH/HIP-Commercial, +38000,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMBLEMHEALTH/HIP-Commercial, +38001,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMBLEMHEALTH/HIP-Commercial, +38002,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMBLEMHEALTH/HIP-Commercial, +38003,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMBLEMHEALTH/HIP-Commercial, +38004,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMBLEMHEALTH/HIP-Commercial, +38005,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMBLEMHEALTH/HIP-Commercial, +38006,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMBLEMHEALTH/HIP-Commercial, +38007,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMBLEMHEALTH/HIP-Commercial, +38008,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMBLEMHEALTH/HIP-Commercial, +38009,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMBLEMHEALTH/HIP-Commercial, +38010,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMBLEMHEALTH/HIP-Commercial, +38011,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMBLEMHEALTH/HIP-Commercial, +38012,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Commercial, +38013,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +38014,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +38015,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +38016,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +38017,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +38018,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMBLEMHEALTH/HIP-Commercial, +38019,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +38020,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Commercial, +38021,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +38022,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +38023,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +38024,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +38025,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMBLEMHEALTH/HIP-Commercial, +38026,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Commercial, +38027,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +38028,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +38029,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +38030,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +38031,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +38032,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Commercial, +38033,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +38034,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +38035,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +38036,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +38037,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +38038,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMBLEMHEALTH/HIP-Commercial, +38039,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMBLEMHEALTH/HIP-Commercial, +38040,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMBLEMHEALTH/HIP-Commercial, +38041,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMBLEMHEALTH/HIP-Commercial, +38042,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMBLEMHEALTH/HIP-Commercial, +38043,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMBLEMHEALTH/HIP-Commercial, +38044,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMBLEMHEALTH/HIP-Commercial, +38045,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMBLEMHEALTH/HIP-Commercial, +38046,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Commercial, +38047,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +38048,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +38049,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +38050,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +38051,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +38052,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +38053,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMBLEMHEALTH/HIP-Commercial, +38054,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMBLEMHEALTH/HIP-Commercial, +38055,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMBLEMHEALTH/HIP-Commercial, +38056,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMBLEMHEALTH/HIP-Commercial, +38057,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMBLEMHEALTH/HIP-Commercial, +38058,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-Commercial, +38059,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-Commercial, +38060,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-Commercial, +38061,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMBLEMHEALTH/HIP-Commercial, +38062,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMBLEMHEALTH/HIP-Commercial, +38063,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMBLEMHEALTH/HIP-Commercial, +38064,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMBLEMHEALTH/HIP-Commercial, +38065,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMBLEMHEALTH/HIP-Commercial, +38066,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMBLEMHEALTH/HIP-Commercial, +38067,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMBLEMHEALTH/HIP-Commercial, +38068,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMBLEMHEALTH/HIP-Commercial, +38069,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMBLEMHEALTH/HIP-Commercial, +38070,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMBLEMHEALTH/HIP-Commercial, +38071,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMBLEMHEALTH/HIP-Commercial, +38072,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMBLEMHEALTH/HIP-Commercial, +38073,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMBLEMHEALTH/HIP-Commercial, +38074,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMBLEMHEALTH/HIP-Commercial, +38075,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMBLEMHEALTH/HIP-Commercial, +38076,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMBLEMHEALTH/HIP-Commercial, +38077,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMBLEMHEALTH/HIP-Commercial, +38078,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMBLEMHEALTH/HIP-Commercial, +38079,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMBLEMHEALTH/HIP-Commercial, +38080,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMBLEMHEALTH/HIP-Commercial, +38081,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMBLEMHEALTH/HIP-Commercial, +38082,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-Commercial, +38083,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMBLEMHEALTH/HIP-Commercial, +38084,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-Commercial, +38085,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMBLEMHEALTH/HIP-Commercial, +38086,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMBLEMHEALTH/HIP-Commercial, +38087,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMBLEMHEALTH/HIP-Commercial, +38088,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMBLEMHEALTH/HIP-Commercial, +38089,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMBLEMHEALTH/HIP-Commercial, +38090,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMBLEMHEALTH/HIP-Commercial, +38091,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-Commercial, +38092,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMBLEMHEALTH/HIP-Commercial, +38093,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMBLEMHEALTH/HIP-Commercial, +38094,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMBLEMHEALTH/HIP-Commercial, +38095,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMBLEMHEALTH/HIP-Commercial, +38096,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMBLEMHEALTH/HIP-Commercial, +38097,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMBLEMHEALTH/HIP-Commercial, +38098,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMBLEMHEALTH/HIP-Commercial, +38099,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMBLEMHEALTH/HIP-Commercial, +38100,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMBLEMHEALTH/HIP-Commercial, +38101,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMBLEMHEALTH/HIP-Commercial, +38102,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMBLEMHEALTH/HIP-Commercial, +38103,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMBLEMHEALTH/HIP-Commercial, +38104,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMBLEMHEALTH/HIP-Commercial, +38105,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMBLEMHEALTH/HIP-Commercial, +38106,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMBLEMHEALTH/HIP-Commercial, +38107,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMBLEMHEALTH/HIP-Commercial, +38108,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMBLEMHEALTH/HIP-Commercial, +38109,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Commercial, +38110,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Commercial, +38111,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Commercial, +38112,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMBLEMHEALTH/HIP-Commercial, +38113,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMBLEMHEALTH/HIP-Commercial, +38114,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMBLEMHEALTH/HIP-Commercial, +38115,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMBLEMHEALTH/HIP-Commercial, +38116,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-Commercial, +38117,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMBLEMHEALTH/HIP-Commercial, +38118,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Commercial, +38119,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Commercial, +38120,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Commercial, +38121,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Commercial, +38122,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Commercial, +38123,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Commercial, +38124,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMBLEMHEALTH/HIP-Commercial, +38125,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMBLEMHEALTH/HIP-Commercial, +38126,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMBLEMHEALTH/HIP-Commercial, +38127,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMBLEMHEALTH/HIP-Commercial, +38128,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMBLEMHEALTH/HIP-Commercial, +38129,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMBLEMHEALTH/HIP-Commercial, +38130,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMBLEMHEALTH/HIP-Commercial, +38131,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMBLEMHEALTH/HIP-Commercial, +38132,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMBLEMHEALTH/HIP-Commercial, +38133,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMBLEMHEALTH/HIP-Commercial, +38134,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMBLEMHEALTH/HIP-Commercial, +38135,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMBLEMHEALTH/HIP-Commercial, +38136,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMBLEMHEALTH/HIP-Commercial, +38137,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMBLEMHEALTH/HIP-Commercial, +38138,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMBLEMHEALTH/HIP-Commercial, +38139,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMBLEMHEALTH/HIP-Commercial, +38140,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMBLEMHEALTH/HIP-Commercial, +38141,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMBLEMHEALTH/HIP-Commercial, +38142,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMBLEMHEALTH/HIP-Commercial, +38143,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMBLEMHEALTH/HIP-Commercial, +38144,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMBLEMHEALTH/HIP-Commercial, +38145,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMBLEMHEALTH/HIP-Commercial, +38146,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMBLEMHEALTH/HIP-Commercial, +38147,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMBLEMHEALTH/HIP-Commercial, +38148,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMBLEMHEALTH/HIP-Commercial, +38149,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMBLEMHEALTH/HIP-Commercial, +38150,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMBLEMHEALTH/HIP-Commercial, +38151,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMBLEMHEALTH/HIP-Commercial, +38152,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMBLEMHEALTH/HIP-Commercial, +38153,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMBLEMHEALTH/HIP-Commercial, +38154,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMBLEMHEALTH/HIP-Commercial, +38155,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMBLEMHEALTH/HIP-Commercial, +38156,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMBLEMHEALTH/HIP-Commercial, +38157,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMBLEMHEALTH/HIP-Medicaid, +38158,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMBLEMHEALTH/HIP-Medicaid, +38159,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMBLEMHEALTH/HIP-Medicaid, +38160,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMBLEMHEALTH/HIP-Medicaid, +38161,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMBLEMHEALTH/HIP-Medicaid, +38162,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMBLEMHEALTH/HIP-Medicaid, +38163,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMBLEMHEALTH/HIP-Medicaid, +38164,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMBLEMHEALTH/HIP-Medicaid, +38165,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMBLEMHEALTH/HIP-Medicaid, +38166,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMBLEMHEALTH/HIP-Medicaid, +38167,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMBLEMHEALTH/HIP-Medicaid, +38168,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMBLEMHEALTH/HIP-Medicaid, +38169,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMBLEMHEALTH/HIP-Medicaid, +38170,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMBLEMHEALTH/HIP-Medicaid, +38171,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMBLEMHEALTH/HIP-Medicaid, +38172,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMBLEMHEALTH/HIP-Medicaid, +38173,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMBLEMHEALTH/HIP-Medicaid, +38174,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMBLEMHEALTH/HIP-Medicaid, +38175,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMBLEMHEALTH/HIP-Medicaid, +38176,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMBLEMHEALTH/HIP-Medicaid, +38177,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMBLEMHEALTH/HIP-Medicaid, +38178,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMBLEMHEALTH/HIP-Medicaid, +38179,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMBLEMHEALTH/HIP-Medicaid, +38180,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMBLEMHEALTH/HIP-Medicaid, +38181,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMBLEMHEALTH/HIP-Medicaid, +38182,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMBLEMHEALTH/HIP-Medicaid, +38183,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMBLEMHEALTH/HIP-Medicaid, +38184,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMBLEMHEALTH/HIP-Medicaid, +38185,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMBLEMHEALTH/HIP-Medicaid, +38186,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMBLEMHEALTH/HIP-Medicaid, +38187,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMBLEMHEALTH/HIP-Medicaid, +38188,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMBLEMHEALTH/HIP-Medicaid, +38189,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMBLEMHEALTH/HIP-Medicaid, +38190,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMBLEMHEALTH/HIP-Medicaid, +38191,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMBLEMHEALTH/HIP-Medicaid, +38192,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMBLEMHEALTH/HIP-Medicaid, +38193,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMBLEMHEALTH/HIP-Medicaid, +38194,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMBLEMHEALTH/HIP-Medicaid, +38195,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMBLEMHEALTH/HIP-Medicaid, +38196,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMBLEMHEALTH/HIP-Medicaid, +38197,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMBLEMHEALTH/HIP-Medicaid, +38198,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMBLEMHEALTH/HIP-Medicaid, +38199,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMBLEMHEALTH/HIP-Medicaid, +38200,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMBLEMHEALTH/HIP-Medicaid, +38201,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMBLEMHEALTH/HIP-Medicaid, +38202,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMBLEMHEALTH/HIP-Medicaid, +38203,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMBLEMHEALTH/HIP-Medicaid, +38204,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMBLEMHEALTH/HIP-Medicaid, +38205,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMBLEMHEALTH/HIP-Medicaid, +38206,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMBLEMHEALTH/HIP-Medicaid, +38207,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMBLEMHEALTH/HIP-Medicaid, +38208,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMBLEMHEALTH/HIP-Medicaid, +38209,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMBLEMHEALTH/HIP-Medicaid, +38210,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMBLEMHEALTH/HIP-Medicaid, +38211,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMBLEMHEALTH/HIP-Medicaid, +38212,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMBLEMHEALTH/HIP-Medicaid, +38213,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMBLEMHEALTH/HIP-Medicaid, +38214,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMBLEMHEALTH/HIP-Medicaid, +38215,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMBLEMHEALTH/HIP-Medicaid, +38216,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMBLEMHEALTH/HIP-Medicaid, +38217,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMBLEMHEALTH/HIP-Medicaid, +38218,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMBLEMHEALTH/HIP-Medicaid, +38219,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMBLEMHEALTH/HIP-Medicaid, +38220,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMBLEMHEALTH/HIP-Medicaid, +38221,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMBLEMHEALTH/HIP-Medicaid, +38222,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMBLEMHEALTH/HIP-Medicaid, +38223,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMBLEMHEALTH/HIP-Medicaid, +38224,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMBLEMHEALTH/HIP-Medicaid, +38225,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMBLEMHEALTH/HIP-Medicaid, +38226,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMBLEMHEALTH/HIP-Medicaid, +38227,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMBLEMHEALTH/HIP-Medicaid, +38228,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMBLEMHEALTH/HIP-Medicaid, +38229,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMBLEMHEALTH/HIP-Medicaid, +38230,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMBLEMHEALTH/HIP-Medicaid, +38231,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMBLEMHEALTH/HIP-Medicaid, +38232,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMBLEMHEALTH/HIP-Medicaid, +38233,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMBLEMHEALTH/HIP-Medicaid, +38234,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMBLEMHEALTH/HIP-Medicaid, +38235,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMBLEMHEALTH/HIP-Medicaid, +38236,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMBLEMHEALTH/HIP-Medicaid, +38237,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMBLEMHEALTH/HIP-Medicaid, +38238,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMBLEMHEALTH/HIP-Medicaid, +38239,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMBLEMHEALTH/HIP-Medicaid, +38240,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMBLEMHEALTH/HIP-Medicaid, +38241,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMBLEMHEALTH/HIP-Medicaid, +38242,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMBLEMHEALTH/HIP-Medicaid, +38243,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMBLEMHEALTH/HIP-Medicaid, +38244,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMBLEMHEALTH/HIP-Medicaid, +38245,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMBLEMHEALTH/HIP-Medicaid, +38246,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMBLEMHEALTH/HIP-Medicaid, +38247,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMBLEMHEALTH/HIP-Medicaid, +38248,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMBLEMHEALTH/HIP-Medicaid, +38249,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMBLEMHEALTH/HIP-Medicaid, +38250,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMBLEMHEALTH/HIP-Medicaid, +38251,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMBLEMHEALTH/HIP-Medicaid, +38252,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMBLEMHEALTH/HIP-Medicaid, +38253,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMBLEMHEALTH/HIP-Medicaid, +38254,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMBLEMHEALTH/HIP-Medicaid, +38255,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMBLEMHEALTH/HIP-Medicaid, +38256,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMBLEMHEALTH/HIP-Medicaid, +38257,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMBLEMHEALTH/HIP-Medicaid, +38258,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMBLEMHEALTH/HIP-Medicaid, +38259,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMBLEMHEALTH/HIP-Medicaid, +38260,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMBLEMHEALTH/HIP-Medicaid, +38261,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMBLEMHEALTH/HIP-Medicaid, +38262,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMBLEMHEALTH/HIP-Medicaid, +38263,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMBLEMHEALTH/HIP-Medicaid, +38264,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMBLEMHEALTH/HIP-Medicaid, +38265,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMBLEMHEALTH/HIP-Medicaid, +38266,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMBLEMHEALTH/HIP-Medicaid, +38267,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMBLEMHEALTH/HIP-Medicaid, +38268,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMBLEMHEALTH/HIP-Medicaid, +38269,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMBLEMHEALTH/HIP-Medicaid, +38270,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMBLEMHEALTH/HIP-Medicaid, +38271,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMBLEMHEALTH/HIP-Medicaid, +38272,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMBLEMHEALTH/HIP-Medicaid, +38273,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMBLEMHEALTH/HIP-Medicaid, +38274,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMBLEMHEALTH/HIP-Medicaid, +38275,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMBLEMHEALTH/HIP-Medicaid, +38276,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMBLEMHEALTH/HIP-Medicaid, +38277,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMBLEMHEALTH/HIP-Medicaid, +38278,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMBLEMHEALTH/HIP-Medicaid, +38279,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMBLEMHEALTH/HIP-Medicaid, +38280,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMBLEMHEALTH/HIP-Medicaid, +38281,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMBLEMHEALTH/HIP-Medicaid, +38282,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMBLEMHEALTH/HIP-Medicaid, +38283,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMBLEMHEALTH/HIP-Medicaid, +38284,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMBLEMHEALTH/HIP-Medicaid, +38285,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMBLEMHEALTH/HIP-Medicaid, +38286,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMBLEMHEALTH/HIP-Medicaid, +38287,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMBLEMHEALTH/HIP-Medicaid, +38288,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMBLEMHEALTH/HIP-Medicaid, +38289,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMBLEMHEALTH/HIP-Medicaid, +38290,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMBLEMHEALTH/HIP-Medicaid, +38291,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMBLEMHEALTH/HIP-Medicaid, +38292,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMBLEMHEALTH/HIP-Medicaid, +38293,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMBLEMHEALTH/HIP-Medicaid, +38294,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMBLEMHEALTH/HIP-Medicaid, +38295,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMBLEMHEALTH/HIP-Medicaid, +38296,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMBLEMHEALTH/HIP-Medicaid, +38297,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMBLEMHEALTH/HIP-Medicaid, +38298,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMBLEMHEALTH/HIP-Medicaid, +38299,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMBLEMHEALTH/HIP-Medicaid, +38300,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMBLEMHEALTH/HIP-Medicaid, +38301,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMBLEMHEALTH/HIP-Medicaid, +38302,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMBLEMHEALTH/HIP-Medicaid, +38303,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMBLEMHEALTH/HIP-Medicaid, +38304,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMBLEMHEALTH/HIP-Medicaid, +38305,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMBLEMHEALTH/HIP-Medicaid, +38306,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMBLEMHEALTH/HIP-Medicaid, +38307,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMBLEMHEALTH/HIP-Medicaid, +38308,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMBLEMHEALTH/HIP-Medicaid, +38309,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMBLEMHEALTH/HIP-Medicaid, +38310,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMBLEMHEALTH/HIP-Medicaid, +38311,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMBLEMHEALTH/HIP-Medicaid, +38312,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMBLEMHEALTH/HIP-Medicaid, +38313,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMBLEMHEALTH/HIP-Medicaid, +38314,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMBLEMHEALTH/HIP-Medicaid, +38315,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMBLEMHEALTH/HIP-Medicaid, +38316,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMBLEMHEALTH/HIP-Medicaid, +38317,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMBLEMHEALTH/HIP-Medicaid, +38318,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMBLEMHEALTH/HIP-Medicaid, +38319,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMBLEMHEALTH/HIP-Medicaid, +38320,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMBLEMHEALTH/HIP-Medicaid, +38321,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMBLEMHEALTH/HIP-Medicaid, +38322,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMBLEMHEALTH/HIP-Medicaid, +38323,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMBLEMHEALTH/HIP-Medicaid, +38324,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMBLEMHEALTH/HIP-Medicaid, +38325,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMBLEMHEALTH/HIP-Medicaid, +38326,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMBLEMHEALTH/HIP-Medicaid, +38327,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMBLEMHEALTH/HIP-Medicaid, +38328,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMBLEMHEALTH/HIP-Medicaid, +38329,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMBLEMHEALTH/HIP-Medicaid, +38330,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMBLEMHEALTH/HIP-Medicaid, +38331,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMBLEMHEALTH/HIP-Medicaid, +38332,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMBLEMHEALTH/HIP-Medicaid, +38333,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMBLEMHEALTH/HIP-Medicaid, +38334,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMBLEMHEALTH/HIP-Medicaid, +38335,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMBLEMHEALTH/HIP-Medicaid, +38336,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMBLEMHEALTH/HIP-Medicaid, +38337,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMBLEMHEALTH/HIP-Medicaid, +38338,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMBLEMHEALTH/HIP-Medicaid, +38339,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMBLEMHEALTH/HIP-Medicaid, +38340,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMBLEMHEALTH/HIP-Medicaid, +38341,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMBLEMHEALTH/HIP-Medicaid, +38342,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMBLEMHEALTH/HIP-Medicaid, +38343,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMBLEMHEALTH/HIP-Medicaid, +38344,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMBLEMHEALTH/HIP-Medicaid, +38345,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMBLEMHEALTH/HIP-Medicaid, +38346,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMBLEMHEALTH/HIP-Medicaid, +38347,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMBLEMHEALTH/HIP-Medicaid, +38348,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMBLEMHEALTH/HIP-Medicaid, +38349,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMBLEMHEALTH/HIP-Medicaid, +38350,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMBLEMHEALTH/HIP-Medicaid, +38351,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMBLEMHEALTH/HIP-Medicaid, +38352,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMBLEMHEALTH/HIP-Medicaid, +38353,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMBLEMHEALTH/HIP-Medicaid, +38354,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMBLEMHEALTH/HIP-Medicaid, +38355,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMBLEMHEALTH/HIP-Medicaid, +38356,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMBLEMHEALTH/HIP-Medicaid, +38357,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMBLEMHEALTH/HIP-Medicaid, +38358,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMBLEMHEALTH/HIP-Medicaid, +38359,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMBLEMHEALTH/HIP-Medicaid, +38360,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMBLEMHEALTH/HIP-Medicaid, +38361,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMBLEMHEALTH/HIP-Medicaid, +38362,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMBLEMHEALTH/HIP-Medicaid, +38363,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMBLEMHEALTH/HIP-Medicaid, +38364,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMBLEMHEALTH/HIP-Medicaid, +38365,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMBLEMHEALTH/HIP-Medicaid, +38366,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMBLEMHEALTH/HIP-Medicaid, +38367,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMBLEMHEALTH/HIP-Medicaid, +38368,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMBLEMHEALTH/HIP-Medicaid, +38369,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMBLEMHEALTH/HIP-Medicaid, +38370,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMBLEMHEALTH/HIP-Medicaid, +38371,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMBLEMHEALTH/HIP-Medicaid, +38372,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMBLEMHEALTH/HIP-Medicaid, +38373,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMBLEMHEALTH/HIP-Medicaid, +38374,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMBLEMHEALTH/HIP-Medicaid, +38375,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMBLEMHEALTH/HIP-Medicaid, +38376,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMBLEMHEALTH/HIP-Medicaid, +38377,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMBLEMHEALTH/HIP-Medicaid, +38378,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMBLEMHEALTH/HIP-Medicaid, +38379,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMBLEMHEALTH/HIP-Medicaid, +38380,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMBLEMHEALTH/HIP-Medicaid, +38381,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMBLEMHEALTH/HIP-Medicaid, +38382,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMBLEMHEALTH/HIP-Medicaid, +38383,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMBLEMHEALTH/HIP-Medicaid, +38384,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMBLEMHEALTH/HIP-Medicaid, +38385,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMBLEMHEALTH/HIP-Medicaid, +38386,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMBLEMHEALTH/HIP-Medicaid, +38387,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMBLEMHEALTH/HIP-Medicaid, +38388,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMBLEMHEALTH/HIP-Medicaid, +38389,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMBLEMHEALTH/HIP-Medicaid, +38390,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMBLEMHEALTH/HIP-Medicaid, +38391,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMBLEMHEALTH/HIP-Medicaid, +38392,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMBLEMHEALTH/HIP-Medicaid, +38393,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMBLEMHEALTH/HIP-Medicaid, +38394,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMBLEMHEALTH/HIP-Medicaid, +38395,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMBLEMHEALTH/HIP-Medicaid, +38396,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMBLEMHEALTH/HIP-Medicaid, +38397,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMBLEMHEALTH/HIP-Medicaid, +38398,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMBLEMHEALTH/HIP-Medicaid, +38399,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMBLEMHEALTH/HIP-Medicaid, +38400,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMBLEMHEALTH/HIP-Medicaid, +38401,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMBLEMHEALTH/HIP-Medicaid, +38402,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMBLEMHEALTH/HIP-Medicaid, +38403,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMBLEMHEALTH/HIP-Medicaid, +38404,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMBLEMHEALTH/HIP-Medicaid, +38405,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMBLEMHEALTH/HIP-Medicaid, +38406,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMBLEMHEALTH/HIP-Medicaid, +38407,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMBLEMHEALTH/HIP-Medicaid, +38408,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMBLEMHEALTH/HIP-Medicaid, +38409,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMBLEMHEALTH/HIP-Medicaid, +38410,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMBLEMHEALTH/HIP-Medicaid, +38411,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMBLEMHEALTH/HIP-Medicaid, +38412,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMBLEMHEALTH/HIP-Medicaid, +38413,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMBLEMHEALTH/HIP-Medicaid, +38414,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMBLEMHEALTH/HIP-Medicaid, +38415,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMBLEMHEALTH/HIP-Medicaid, +38416,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMBLEMHEALTH/HIP-Medicaid, +38417,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMBLEMHEALTH/HIP-Medicaid, +38418,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMBLEMHEALTH/HIP-Medicaid, +38419,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMBLEMHEALTH/HIP-Medicaid, +38420,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMBLEMHEALTH/HIP-Medicaid, +38421,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMBLEMHEALTH/HIP-Medicaid, +38422,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMBLEMHEALTH/HIP-Medicaid, +38423,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMBLEMHEALTH/HIP-Medicaid, +38424,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMBLEMHEALTH/HIP-Medicaid, +38425,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMBLEMHEALTH/HIP-Medicaid, +38426,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMBLEMHEALTH/HIP-Medicaid, +38427,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMBLEMHEALTH/HIP-Medicaid, +38428,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMBLEMHEALTH/HIP-Medicaid, +38429,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMBLEMHEALTH/HIP-Medicaid, +38430,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMBLEMHEALTH/HIP-Medicaid, +38431,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMBLEMHEALTH/HIP-Medicaid, +38432,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMBLEMHEALTH/HIP-Medicaid, +38433,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMBLEMHEALTH/HIP-Medicaid, +38434,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMBLEMHEALTH/HIP-Medicaid, +38435,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMBLEMHEALTH/HIP-Medicaid, +38436,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMBLEMHEALTH/HIP-Medicaid, +38437,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMBLEMHEALTH/HIP-Medicaid, +38438,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMBLEMHEALTH/HIP-Medicaid, +38439,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMBLEMHEALTH/HIP-Medicaid, +38440,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMBLEMHEALTH/HIP-Medicaid, +38441,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMBLEMHEALTH/HIP-Medicaid, +38442,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMBLEMHEALTH/HIP-Medicaid, +38443,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMBLEMHEALTH/HIP-Medicaid, +38444,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMBLEMHEALTH/HIP-Medicaid, +38445,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMBLEMHEALTH/HIP-Medicaid, +38446,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMBLEMHEALTH/HIP-Medicaid, +38447,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMBLEMHEALTH/HIP-Medicaid, +38448,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMBLEMHEALTH/HIP-Medicaid, +38449,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMBLEMHEALTH/HIP-Medicaid, +38450,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMBLEMHEALTH/HIP-Medicaid, +38451,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMBLEMHEALTH/HIP-Medicaid, +38452,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMBLEMHEALTH/HIP-Medicaid, +38453,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMBLEMHEALTH/HIP-Medicaid, +38454,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMBLEMHEALTH/HIP-Medicaid, +38455,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMBLEMHEALTH/HIP-Medicaid, +38456,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMBLEMHEALTH/HIP-Medicaid, +38457,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMBLEMHEALTH/HIP-Medicaid, +38458,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMBLEMHEALTH/HIP-Medicaid, +38459,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMBLEMHEALTH/HIP-Medicaid, +38460,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMBLEMHEALTH/HIP-Medicaid, +38461,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMBLEMHEALTH/HIP-Medicaid, +38462,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMBLEMHEALTH/HIP-Medicaid, +38463,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMBLEMHEALTH/HIP-Medicaid, +38464,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMBLEMHEALTH/HIP-Medicaid, +38465,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMBLEMHEALTH/HIP-Medicaid, +38466,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMBLEMHEALTH/HIP-Medicaid, +38467,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMBLEMHEALTH/HIP-Medicaid, +38468,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMBLEMHEALTH/HIP-Medicaid, +38469,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMBLEMHEALTH/HIP-Medicaid, +38470,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMBLEMHEALTH/HIP-Medicaid, +38471,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMBLEMHEALTH/HIP-Medicaid, +38472,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMBLEMHEALTH/HIP-Medicaid, +38473,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMBLEMHEALTH/HIP-Medicaid, +38474,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMBLEMHEALTH/HIP-Medicaid, +38475,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMBLEMHEALTH/HIP-Medicaid, +38476,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMBLEMHEALTH/HIP-Medicaid, +38477,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMBLEMHEALTH/HIP-Medicaid, +38478,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMBLEMHEALTH/HIP-Medicaid, +38479,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMBLEMHEALTH/HIP-Medicaid, +38480,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMBLEMHEALTH/HIP-Medicaid, +38481,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMBLEMHEALTH/HIP-Medicaid, +38482,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMBLEMHEALTH/HIP-Medicaid, +38483,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMBLEMHEALTH/HIP-Medicaid, +38484,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMBLEMHEALTH/HIP-Medicaid, +38485,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMBLEMHEALTH/HIP-Medicaid, +38486,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMBLEMHEALTH/HIP-Medicaid, +38487,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMBLEMHEALTH/HIP-Medicaid, +38488,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMBLEMHEALTH/HIP-Medicaid, +38489,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMBLEMHEALTH/HIP-Medicaid, +38490,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMBLEMHEALTH/HIP-Medicaid, +38491,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMBLEMHEALTH/HIP-Medicaid, +38492,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMBLEMHEALTH/HIP-Medicaid, +38493,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMBLEMHEALTH/HIP-Medicaid, +38494,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMBLEMHEALTH/HIP-Medicaid, +38495,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMBLEMHEALTH/HIP-Medicaid, +38496,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMBLEMHEALTH/HIP-Medicaid, +38497,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMBLEMHEALTH/HIP-Medicaid, +38498,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMBLEMHEALTH/HIP-Medicaid, +38499,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMBLEMHEALTH/HIP-Medicaid, +38500,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMBLEMHEALTH/HIP-Medicaid, +38501,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMBLEMHEALTH/HIP-Medicaid, +38502,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMBLEMHEALTH/HIP-Medicaid, +38503,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMBLEMHEALTH/HIP-Medicaid, +38504,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMBLEMHEALTH/HIP-Medicaid, +38505,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMBLEMHEALTH/HIP-Medicaid, +38506,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMBLEMHEALTH/HIP-Medicaid, +38507,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMBLEMHEALTH/HIP-Medicaid, +38508,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMBLEMHEALTH/HIP-Medicaid, +38509,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMBLEMHEALTH/HIP-Medicaid, +38510,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMBLEMHEALTH/HIP-Medicaid, +38511,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMBLEMHEALTH/HIP-Medicaid, +38512,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMBLEMHEALTH/HIP-Medicaid, +38513,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMBLEMHEALTH/HIP-Medicaid, +38514,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMBLEMHEALTH/HIP-Medicaid, +38515,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMBLEMHEALTH/HIP-Medicaid, +38516,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMBLEMHEALTH/HIP-Medicaid, +38517,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMBLEMHEALTH/HIP-Medicaid, +38518,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMBLEMHEALTH/HIP-Medicaid, +38519,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMBLEMHEALTH/HIP-Medicaid, +38520,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMBLEMHEALTH/HIP-Medicaid, +38521,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMBLEMHEALTH/HIP-Medicaid, +38522,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMBLEMHEALTH/HIP-Medicaid, +38523,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMBLEMHEALTH/HIP-Medicaid, +38524,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMBLEMHEALTH/HIP-Medicaid, +38525,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMBLEMHEALTH/HIP-Medicaid, +38526,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMBLEMHEALTH/HIP-Medicaid, +38527,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMBLEMHEALTH/HIP-Medicaid, +38528,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMBLEMHEALTH/HIP-Medicaid, +38529,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMBLEMHEALTH/HIP-Medicaid, +38530,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMBLEMHEALTH/HIP-Medicaid, +38531,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMBLEMHEALTH/HIP-Medicaid, +38532,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMBLEMHEALTH/HIP-Medicaid, +38533,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMBLEMHEALTH/HIP-Medicaid, +38534,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMBLEMHEALTH/HIP-Medicaid, +38535,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMBLEMHEALTH/HIP-Medicaid, +38536,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMBLEMHEALTH/HIP-Medicaid, +38537,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMBLEMHEALTH/HIP-Medicaid, +38538,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMBLEMHEALTH/HIP-Medicaid, +38539,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMBLEMHEALTH/HIP-Medicaid, +38540,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMBLEMHEALTH/HIP-Medicaid, +38541,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMBLEMHEALTH/HIP-Medicaid, +38542,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMBLEMHEALTH/HIP-Medicaid, +38543,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMBLEMHEALTH/HIP-Medicaid, +38544,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMBLEMHEALTH/HIP-Medicaid, +38545,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMBLEMHEALTH/HIP-Medicaid, +38546,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMBLEMHEALTH/HIP-Medicaid, +38547,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMBLEMHEALTH/HIP-Medicaid, +38548,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMBLEMHEALTH/HIP-Medicaid, +38549,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMBLEMHEALTH/HIP-Medicaid, +38550,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMBLEMHEALTH/HIP-Medicaid, +38551,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMBLEMHEALTH/HIP-Medicaid, +38552,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMBLEMHEALTH/HIP-Medicaid, +38553,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMBLEMHEALTH/HIP-Medicaid, +38554,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMBLEMHEALTH/HIP-Medicaid, +38555,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMBLEMHEALTH/HIP-Medicaid, +38556,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMBLEMHEALTH/HIP-Medicaid, +38557,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMBLEMHEALTH/HIP-Medicaid, +38558,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMBLEMHEALTH/HIP-Medicaid, +38559,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMBLEMHEALTH/HIP-Medicaid, +38560,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMBLEMHEALTH/HIP-Medicaid, +38561,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMBLEMHEALTH/HIP-Medicaid, +38562,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMBLEMHEALTH/HIP-Medicaid, +38563,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMBLEMHEALTH/HIP-Medicaid, +38564,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMBLEMHEALTH/HIP-Medicaid, +38565,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMBLEMHEALTH/HIP-Medicaid, +38566,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMBLEMHEALTH/HIP-Medicaid, +38567,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMBLEMHEALTH/HIP-Medicaid, +38568,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMBLEMHEALTH/HIP-Medicaid, +38569,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMBLEMHEALTH/HIP-Medicaid, +38570,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMBLEMHEALTH/HIP-Medicaid, +38571,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMBLEMHEALTH/HIP-Medicaid, +38572,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMBLEMHEALTH/HIP-Medicaid, +38573,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMBLEMHEALTH/HIP-Medicaid, +38574,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMBLEMHEALTH/HIP-Medicaid, +38575,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMBLEMHEALTH/HIP-Medicaid, +38576,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMBLEMHEALTH/HIP-Medicaid, +38577,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMBLEMHEALTH/HIP-Medicaid, +38578,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMBLEMHEALTH/HIP-Medicaid, +38579,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMBLEMHEALTH/HIP-Medicaid, +38580,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMBLEMHEALTH/HIP-Medicaid, +38581,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMBLEMHEALTH/HIP-Medicaid, +38582,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMBLEMHEALTH/HIP-Medicaid, +38583,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMBLEMHEALTH/HIP-Medicaid, +38584,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMBLEMHEALTH/HIP-Medicaid, +38585,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMBLEMHEALTH/HIP-Medicaid, +38586,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMBLEMHEALTH/HIP-Medicaid, +38587,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMBLEMHEALTH/HIP-Medicaid, +38588,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMBLEMHEALTH/HIP-Medicaid, +38589,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMBLEMHEALTH/HIP-Medicaid, +38590,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMBLEMHEALTH/HIP-Medicaid, +38591,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMBLEMHEALTH/HIP-Medicaid, +38592,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMBLEMHEALTH/HIP-Medicaid, +38593,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMBLEMHEALTH/HIP-Medicaid, +38594,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMBLEMHEALTH/HIP-Medicaid, +38595,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMBLEMHEALTH/HIP-Medicaid, +38596,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMBLEMHEALTH/HIP-Medicaid, +38597,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMBLEMHEALTH/HIP-Medicaid, +38598,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMBLEMHEALTH/HIP-Medicaid, +38599,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMBLEMHEALTH/HIP-Medicaid, +38600,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMBLEMHEALTH/HIP-Medicaid, +38601,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMBLEMHEALTH/HIP-Medicaid, +38602,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMBLEMHEALTH/HIP-Medicaid, +38603,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMBLEMHEALTH/HIP-Medicaid, +38604,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMBLEMHEALTH/HIP-Medicaid, +38605,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMBLEMHEALTH/HIP-Medicaid, +38606,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMBLEMHEALTH/HIP-Medicaid, +38607,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMBLEMHEALTH/HIP-Medicaid, +38608,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMBLEMHEALTH/HIP-Medicaid, +38609,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMBLEMHEALTH/HIP-Medicaid, +38610,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMBLEMHEALTH/HIP-Medicaid, +38611,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMBLEMHEALTH/HIP-Medicaid, +38612,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMBLEMHEALTH/HIP-Medicaid, +38613,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMBLEMHEALTH/HIP-Medicaid, +38614,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMBLEMHEALTH/HIP-Medicaid, +38615,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMBLEMHEALTH/HIP-Medicaid, +38616,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMBLEMHEALTH/HIP-Medicaid, +38617,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMBLEMHEALTH/HIP-Medicaid, +38618,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMBLEMHEALTH/HIP-Medicaid, +38619,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMBLEMHEALTH/HIP-Medicaid, +38620,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMBLEMHEALTH/HIP-Medicaid, +38621,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMBLEMHEALTH/HIP-Medicaid, +38622,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMBLEMHEALTH/HIP-Medicaid, +38623,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMBLEMHEALTH/HIP-Medicaid, +38624,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMBLEMHEALTH/HIP-Medicaid, +38625,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMBLEMHEALTH/HIP-Medicaid, +38626,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMBLEMHEALTH/HIP-Medicaid, +38627,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMBLEMHEALTH/HIP-Medicaid, +38628,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMBLEMHEALTH/HIP-Medicaid, +38629,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMBLEMHEALTH/HIP-Medicaid, +38630,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMBLEMHEALTH/HIP-Medicaid, +38631,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMBLEMHEALTH/HIP-Medicaid, +38632,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMBLEMHEALTH/HIP-Medicaid, +38633,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMBLEMHEALTH/HIP-Medicaid, +38634,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMBLEMHEALTH/HIP-Medicaid, +38635,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMBLEMHEALTH/HIP-Medicaid, +38636,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMBLEMHEALTH/HIP-Medicaid, +38637,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMBLEMHEALTH/HIP-Medicaid, +38638,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMBLEMHEALTH/HIP-Medicaid, +38639,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMBLEMHEALTH/HIP-Medicaid, +38640,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMBLEMHEALTH/HIP-Medicaid, +38641,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMBLEMHEALTH/HIP-Medicaid, +38642,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMBLEMHEALTH/HIP-Medicaid, +38643,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMBLEMHEALTH/HIP-Medicaid, +38644,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMBLEMHEALTH/HIP-Medicaid, +38645,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMBLEMHEALTH/HIP-Medicaid, +38646,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMBLEMHEALTH/HIP-Medicaid, +38647,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMBLEMHEALTH/HIP-Medicaid, +38648,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMBLEMHEALTH/HIP-Medicaid, +38649,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMBLEMHEALTH/HIP-Medicaid, +38650,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMBLEMHEALTH/HIP-Medicaid, +38651,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMBLEMHEALTH/HIP-Medicaid, +38652,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMBLEMHEALTH/HIP-Medicaid, +38653,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMBLEMHEALTH/HIP-Medicaid, +38654,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMBLEMHEALTH/HIP-Medicaid, +38655,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMBLEMHEALTH/HIP-Medicaid, +38656,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMBLEMHEALTH/HIP-Medicaid, +38657,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMBLEMHEALTH/HIP-Medicaid, +38658,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMBLEMHEALTH/HIP-Medicaid, +38659,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMBLEMHEALTH/HIP-Medicaid, +38660,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMBLEMHEALTH/HIP-Medicaid, +38661,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMBLEMHEALTH/HIP-Medicaid, +38662,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMBLEMHEALTH/HIP-Medicaid, +38663,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMBLEMHEALTH/HIP-Medicaid, +38664,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMBLEMHEALTH/HIP-Medicaid, +38665,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMBLEMHEALTH/HIP-Medicaid, +38666,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMBLEMHEALTH/HIP-Medicaid, +38667,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMBLEMHEALTH/HIP-Medicaid, +38668,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMBLEMHEALTH/HIP-Medicaid, +38669,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMBLEMHEALTH/HIP-Medicaid, +38670,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMBLEMHEALTH/HIP-Medicaid, +38671,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMBLEMHEALTH/HIP-Medicaid, +38672,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMBLEMHEALTH/HIP-Medicaid, +38673,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMBLEMHEALTH/HIP-Medicaid, +38674,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMBLEMHEALTH/HIP-Medicaid, +38675,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMBLEMHEALTH/HIP-Medicaid, +38676,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMBLEMHEALTH/HIP-Medicaid, +38677,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMBLEMHEALTH/HIP-Medicaid, +38678,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMBLEMHEALTH/HIP-Medicaid, +38679,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMBLEMHEALTH/HIP-Medicaid, +38680,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMBLEMHEALTH/HIP-Medicaid, +38681,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMBLEMHEALTH/HIP-Medicaid, +38682,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMBLEMHEALTH/HIP-Medicaid, +38683,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMBLEMHEALTH/HIP-Medicaid, +38684,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMBLEMHEALTH/HIP-Medicaid, +38685,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMBLEMHEALTH/HIP-Medicaid, +38686,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMBLEMHEALTH/HIP-Medicaid, +38687,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMBLEMHEALTH/HIP-Medicaid, +38688,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMBLEMHEALTH/HIP-Medicaid, +38689,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMBLEMHEALTH/HIP-Medicaid, +38690,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMBLEMHEALTH/HIP-Medicaid, +38691,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMBLEMHEALTH/HIP-Medicaid, +38692,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMBLEMHEALTH/HIP-Medicaid, +38693,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMBLEMHEALTH/HIP-Medicaid, +38694,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMBLEMHEALTH/HIP-Medicaid, +38695,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMBLEMHEALTH/HIP-Medicaid, +38696,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMBLEMHEALTH/HIP-Medicaid, +38697,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMBLEMHEALTH/HIP-Medicaid, +38698,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMBLEMHEALTH/HIP-Medicaid, +38699,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMBLEMHEALTH/HIP-Medicaid, +38700,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMBLEMHEALTH/HIP-Medicaid, +38701,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMBLEMHEALTH/HIP-Medicaid, +38702,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMBLEMHEALTH/HIP-Medicaid, +38703,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMBLEMHEALTH/HIP-Medicaid, +38704,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMBLEMHEALTH/HIP-Medicaid, +38705,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMBLEMHEALTH/HIP-Medicaid, +38706,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMBLEMHEALTH/HIP-Medicaid, +38707,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMBLEMHEALTH/HIP-Medicaid, +38708,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMBLEMHEALTH/HIP-Medicaid, +38709,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMBLEMHEALTH/HIP-Medicaid, +38710,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMBLEMHEALTH/HIP-Medicaid, +38711,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMBLEMHEALTH/HIP-Medicaid, +38712,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMBLEMHEALTH/HIP-Medicaid, +38713,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMBLEMHEALTH/HIP-Medicaid, +38714,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMBLEMHEALTH/HIP-Medicaid, +38715,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMBLEMHEALTH/HIP-Medicaid, +38716,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMBLEMHEALTH/HIP-Medicaid, +38717,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMBLEMHEALTH/HIP-Medicaid, +38718,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMBLEMHEALTH/HIP-Medicaid, +38719,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMBLEMHEALTH/HIP-Medicaid, +38720,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMBLEMHEALTH/HIP-Medicaid, +38721,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMBLEMHEALTH/HIP-Medicaid, +38722,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMBLEMHEALTH/HIP-Medicaid, +38723,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMBLEMHEALTH/HIP-Medicaid, +38724,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMBLEMHEALTH/HIP-Medicaid, +38725,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMBLEMHEALTH/HIP-Medicaid, +38726,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMBLEMHEALTH/HIP-Medicaid, +38727,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMBLEMHEALTH/HIP-Medicaid, +38728,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMBLEMHEALTH/HIP-Medicaid, +38729,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMBLEMHEALTH/HIP-Medicaid, +38730,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMBLEMHEALTH/HIP-Medicaid, +38731,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMBLEMHEALTH/HIP-Medicaid, +38732,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMBLEMHEALTH/HIP-Medicaid, +38733,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMBLEMHEALTH/HIP-Medicaid, +38734,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMBLEMHEALTH/HIP-Medicaid, +38735,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMBLEMHEALTH/HIP-Medicaid, +38736,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMBLEMHEALTH/HIP-Medicaid, +38737,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMBLEMHEALTH/HIP-Medicaid, +38738,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMBLEMHEALTH/HIP-Medicaid, +38739,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMBLEMHEALTH/HIP-Medicaid, +38740,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMBLEMHEALTH/HIP-Medicaid, +38741,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMBLEMHEALTH/HIP-Medicaid, +38742,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMBLEMHEALTH/HIP-Medicaid, +38743,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMBLEMHEALTH/HIP-Medicaid, +38744,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMBLEMHEALTH/HIP-Medicaid, +38745,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMBLEMHEALTH/HIP-Medicaid, +38746,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMBLEMHEALTH/HIP-Medicaid, +38747,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMBLEMHEALTH/HIP-Medicaid, +38748,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMBLEMHEALTH/HIP-Medicaid, +38749,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMBLEMHEALTH/HIP-Medicaid, +38750,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMBLEMHEALTH/HIP-Medicaid, +38751,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMBLEMHEALTH/HIP-Medicaid, +38752,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMBLEMHEALTH/HIP-Medicaid, +38753,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMBLEMHEALTH/HIP-Medicaid, +38754,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMBLEMHEALTH/HIP-Medicaid, +38755,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMBLEMHEALTH/HIP-Medicaid, +38756,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMBLEMHEALTH/HIP-Medicaid, +38757,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMBLEMHEALTH/HIP-Medicaid, +38758,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMBLEMHEALTH/HIP-Medicaid, +38759,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMBLEMHEALTH/HIP-Medicaid, +38760,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMBLEMHEALTH/HIP-Medicaid, +38761,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMBLEMHEALTH/HIP-Medicaid, +38762,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMBLEMHEALTH/HIP-Medicaid, +38763,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMBLEMHEALTH/HIP-Medicaid, +38764,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMBLEMHEALTH/HIP-Medicaid, +38765,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMBLEMHEALTH/HIP-Medicaid, +38766,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMBLEMHEALTH/HIP-Medicaid, +38767,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMBLEMHEALTH/HIP-Medicaid, +38768,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMBLEMHEALTH/HIP-Medicaid, +38769,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMBLEMHEALTH/HIP-Medicaid, +38770,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMBLEMHEALTH/HIP-Medicaid, +38771,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMBLEMHEALTH/HIP-Medicaid, +38772,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMBLEMHEALTH/HIP-Medicaid, +38773,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMBLEMHEALTH/HIP-Medicaid, +38774,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMBLEMHEALTH/HIP-Medicaid, +38775,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMBLEMHEALTH/HIP-Medicaid, +38776,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMBLEMHEALTH/HIP-Medicaid, +38777,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMBLEMHEALTH/HIP-Medicaid, +38778,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMBLEMHEALTH/HIP-Medicaid, +38779,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMBLEMHEALTH/HIP-Medicaid, +38780,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMBLEMHEALTH/HIP-Medicaid, +38781,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMBLEMHEALTH/HIP-Medicaid, +38782,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMBLEMHEALTH/HIP-Medicaid, +38783,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMBLEMHEALTH/HIP-Medicaid, +38784,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMBLEMHEALTH/HIP-Medicaid, +38785,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMBLEMHEALTH/HIP-Medicaid, +38786,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMBLEMHEALTH/HIP-Medicaid, +38787,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMBLEMHEALTH/HIP-Medicaid, +38788,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMBLEMHEALTH/HIP-Medicaid, +38789,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMBLEMHEALTH/HIP-Medicaid, +38790,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMBLEMHEALTH/HIP-Medicaid, +38791,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMBLEMHEALTH/HIP-Medicaid, +38792,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMBLEMHEALTH/HIP-Medicaid, +38793,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMBLEMHEALTH/HIP-Medicaid, +38794,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMBLEMHEALTH/HIP-Medicaid, +38795,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMBLEMHEALTH/HIP-Medicaid, +38796,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMBLEMHEALTH/HIP-Medicaid, +38797,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMBLEMHEALTH/HIP-Medicaid, +38798,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMBLEMHEALTH/HIP-Medicaid, +38799,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMBLEMHEALTH/HIP-Medicaid, +38800,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMBLEMHEALTH/HIP-Medicaid, +38801,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMBLEMHEALTH/HIP-Medicaid, +38802,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMBLEMHEALTH/HIP-Medicaid, +38803,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMBLEMHEALTH/HIP-Medicaid, +38804,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMBLEMHEALTH/HIP-Medicaid, +38805,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMBLEMHEALTH/HIP-Medicaid, +38806,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMBLEMHEALTH/HIP-Medicaid, +38807,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMBLEMHEALTH/HIP-Medicaid, +38808,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMBLEMHEALTH/HIP-Medicaid, +38809,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMBLEMHEALTH/HIP-Medicaid, +38810,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMBLEMHEALTH/HIP-Medicaid, +38811,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMBLEMHEALTH/HIP-Medicaid, +38812,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMBLEMHEALTH/HIP-Medicaid, +38813,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMBLEMHEALTH/HIP-Medicaid, +38814,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMBLEMHEALTH/HIP-Medicaid, +38815,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMBLEMHEALTH/HIP-Medicaid, +38816,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMBLEMHEALTH/HIP-Medicaid, +38817,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMBLEMHEALTH/HIP-Medicaid, +38818,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMBLEMHEALTH/HIP-Medicaid, +38819,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMBLEMHEALTH/HIP-Medicaid, +38820,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMBLEMHEALTH/HIP-Medicaid,737.88 +38821,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMBLEMHEALTH/HIP-Medicaid, +38822,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMBLEMHEALTH/HIP-Medicaid,363.43 +38823,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMBLEMHEALTH/HIP-Medicaid,348.72 +38824,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +38825,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMBLEMHEALTH/HIP-Medicaid, +38826,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMBLEMHEALTH/HIP-Medicaid,1382.86 +38827,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMBLEMHEALTH/HIP-Medicaid, +38828,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +38829,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMBLEMHEALTH/HIP-Medicaid, +38830,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMBLEMHEALTH/HIP-Medicaid, +38831,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMBLEMHEALTH/HIP-Medicaid, +38832,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMBLEMHEALTH/HIP-Medicaid, +38833,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMBLEMHEALTH/HIP-Medicaid, +38834,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMBLEMHEALTH/HIP-Medicaid, +38835,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +38836,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMBLEMHEALTH/HIP-Medicaid, +38837,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMBLEMHEALTH/HIP-Medicaid, +38838,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMBLEMHEALTH/HIP-Medicaid, +38839,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMBLEMHEALTH/HIP-Medicaid, +38840,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMBLEMHEALTH/HIP-Medicaid, +38841,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMBLEMHEALTH/HIP-Medicaid, +38842,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMBLEMHEALTH/HIP-Medicaid, +38843,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMBLEMHEALTH/HIP-Medicaid, +38844,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMBLEMHEALTH/HIP-Medicaid,323.72 +38845,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMBLEMHEALTH/HIP-Medicaid,323.72 +38846,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMBLEMHEALTH/HIP-Medicaid, +38847,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMBLEMHEALTH/HIP-Medicaid, +38848,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMBLEMHEALTH/HIP-Medicaid, +38849,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMBLEMHEALTH/HIP-Medicaid, +38850,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMBLEMHEALTH/HIP-Medicaid, +38851,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMBLEMHEALTH/HIP-Medicaid, +38852,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMBLEMHEALTH/HIP-Medicaid, +38853,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMBLEMHEALTH/HIP-Medicaid, +38854,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMBLEMHEALTH/HIP-Medicaid, +38855,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMBLEMHEALTH/HIP-Medicaid, +38856,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMBLEMHEALTH/HIP-Medicaid, +38857,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMBLEMHEALTH/HIP-Medicaid, +38858,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMBLEMHEALTH/HIP-Medicaid, +38859,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMBLEMHEALTH/HIP-Medicaid,3342.11 +38860,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMBLEMHEALTH/HIP-Medicaid, +38861,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMBLEMHEALTH/HIP-Medicaid, +38862,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMBLEMHEALTH/HIP-Medicaid, +38863,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +38864,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMBLEMHEALTH/HIP-Medicaid, +38865,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMBLEMHEALTH/HIP-Medicaid, +38866,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMBLEMHEALTH/HIP-Medicaid, +38867,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMBLEMHEALTH/HIP-Medicaid, +38868,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMBLEMHEALTH/HIP-Medicaid, +38869,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMBLEMHEALTH/HIP-Medicaid, +38870,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMBLEMHEALTH/HIP-Medicaid, +38871,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMBLEMHEALTH/HIP-Medicaid, +38872,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMBLEMHEALTH/HIP-Medicaid, +38873,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMBLEMHEALTH/HIP-Medicaid, +38874,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMBLEMHEALTH/HIP-Medicaid, +38875,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMBLEMHEALTH/HIP-Medicaid, +38876,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMBLEMHEALTH/HIP-Medicaid, +38877,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMBLEMHEALTH/HIP-Medicaid, +38878,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMBLEMHEALTH/HIP-Medicaid, +38879,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMBLEMHEALTH/HIP-Medicaid, +38880,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMBLEMHEALTH/HIP-Medicaid, +38881,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMBLEMHEALTH/HIP-Medicaid, +38882,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMBLEMHEALTH/HIP-Medicaid, +38883,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMBLEMHEALTH/HIP-Medicaid, +38884,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMBLEMHEALTH/HIP-Medicaid, +38885,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMBLEMHEALTH/HIP-Medicaid, +38886,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMBLEMHEALTH/HIP-Medicaid, +38887,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMBLEMHEALTH/HIP-Medicaid, +38888,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMBLEMHEALTH/HIP-Medicaid, +38889,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMBLEMHEALTH/HIP-Medicaid, +38890,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMBLEMHEALTH/HIP-Medicaid, +38891,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMBLEMHEALTH/HIP-Medicaid, +38892,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMBLEMHEALTH/HIP-Medicaid, +38893,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMBLEMHEALTH/HIP-Medicaid,1321.13 +38894,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMBLEMHEALTH/HIP-Medicaid, +38895,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMBLEMHEALTH/HIP-Medicaid, +38896,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMBLEMHEALTH/HIP-Medicaid, +38897,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMBLEMHEALTH/HIP-Medicaid, +38898,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMBLEMHEALTH/HIP-Medicaid, +38899,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMBLEMHEALTH/HIP-Medicaid,504.7 +38900,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMBLEMHEALTH/HIP-Medicaid,504.7 +38901,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMBLEMHEALTH/HIP-Medicaid,504.7 +38902,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMBLEMHEALTH/HIP-Medicaid, +38903,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMBLEMHEALTH/HIP-Medicaid,489.85 +38904,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMBLEMHEALTH/HIP-Medicaid, +38905,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMBLEMHEALTH/HIP-Medicaid, +38906,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMBLEMHEALTH/HIP-Medicaid, +38907,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMBLEMHEALTH/HIP-Medicaid, +38908,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMBLEMHEALTH/HIP-Medicaid, +38909,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMBLEMHEALTH/HIP-Medicaid, +38910,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMBLEMHEALTH/HIP-Medicaid, +38911,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMBLEMHEALTH/HIP-Medicaid,753.06 +38912,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMBLEMHEALTH/HIP-Medicaid,358.53 +38913,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMBLEMHEALTH/HIP-Medicaid, +38914,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMBLEMHEALTH/HIP-Medicaid, +38915,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMBLEMHEALTH/HIP-Medicaid, +38916,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMBLEMHEALTH/HIP-Medicaid, +38917,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMBLEMHEALTH/HIP-Medicaid, +38918,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMBLEMHEALTH/HIP-Medicaid, +38919,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMBLEMHEALTH/HIP-Medicaid, +38920,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMBLEMHEALTH/HIP-Medicaid,794.86 +38921,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMBLEMHEALTH/HIP-Medicaid,753.06 +38922,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMBLEMHEALTH/HIP-Medicaid,753.06 +38923,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMBLEMHEALTH/HIP-Medicaid, +38924,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMBLEMHEALTH/HIP-Medicaid, +38925,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMBLEMHEALTH/HIP-Medicaid, +38926,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMBLEMHEALTH/HIP-Medicaid, +38927,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMBLEMHEALTH/HIP-Medicaid, +38928,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMBLEMHEALTH/HIP-Medicaid, +38929,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMBLEMHEALTH/HIP-Medicaid, +38930,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMBLEMHEALTH/HIP-Medicaid, +38931,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMBLEMHEALTH/HIP-Medicaid, +38932,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMBLEMHEALTH/HIP-Medicaid, +38933,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMBLEMHEALTH/HIP-Medicaid,682.8 +38934,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMBLEMHEALTH/HIP-Medicaid, +38935,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMBLEMHEALTH/HIP-Medicaid, +38936,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicaid, +38937,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMBLEMHEALTH/HIP-Medicaid, +38938,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMBLEMHEALTH/HIP-Medicaid, +38939,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMBLEMHEALTH/HIP-Medicaid, +38940,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMBLEMHEALTH/HIP-Medicaid, +38941,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMBLEMHEALTH/HIP-Medicaid, +38942,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMBLEMHEALTH/HIP-Medicaid, +38943,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMBLEMHEALTH/HIP-Medicaid,1602.08 +38944,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMBLEMHEALTH/HIP-Medicaid, +38945,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMBLEMHEALTH/HIP-Medicaid, +38946,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMBLEMHEALTH/HIP-Medicaid, +38947,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMBLEMHEALTH/HIP-Medicaid,1539.31 +38948,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMBLEMHEALTH/HIP-Medicaid, +38949,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMBLEMHEALTH/HIP-Medicaid, +38950,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMBLEMHEALTH/HIP-Medicaid, +38951,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMBLEMHEALTH/HIP-Medicaid, +38952,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMBLEMHEALTH/HIP-Medicaid, +38953,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMBLEMHEALTH/HIP-Medicaid, +38954,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMBLEMHEALTH/HIP-Medicaid, +38955,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMBLEMHEALTH/HIP-Medicaid, +38956,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMBLEMHEALTH/HIP-Medicaid, +38957,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMBLEMHEALTH/HIP-Medicaid, +38958,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMBLEMHEALTH/HIP-Medicaid, +38959,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMBLEMHEALTH/HIP-Medicaid, +38960,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMBLEMHEALTH/HIP-Medicaid, +38961,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMBLEMHEALTH/HIP-Medicaid, +38962,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMBLEMHEALTH/HIP-Medicaid, +38963,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMBLEMHEALTH/HIP-Medicaid, +38964,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMBLEMHEALTH/HIP-Medicaid, +38965,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMBLEMHEALTH/HIP-Medicaid, +38966,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMBLEMHEALTH/HIP-Medicaid, +38967,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMBLEMHEALTH/HIP-Medicaid, +38968,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMBLEMHEALTH/HIP-Medicaid, +38969,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMBLEMHEALTH/HIP-Medicaid, +38970,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMBLEMHEALTH/HIP-Medicaid, +38971,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMBLEMHEALTH/HIP-Medicaid,3308.78 +38972,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMBLEMHEALTH/HIP-Medicaid, +38973,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMBLEMHEALTH/HIP-Medicaid, +38974,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMBLEMHEALTH/HIP-Medicaid, +38975,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMBLEMHEALTH/HIP-Medicaid, +38976,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMBLEMHEALTH/HIP-Medicaid, +38977,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMBLEMHEALTH/HIP-Medicaid, +38978,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMBLEMHEALTH/HIP-Medicaid, +38979,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMBLEMHEALTH/HIP-Medicaid, +38980,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMBLEMHEALTH/HIP-Medicaid, +38981,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMBLEMHEALTH/HIP-Medicaid,504.7 +38982,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMBLEMHEALTH/HIP-Medicaid, +38983,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMBLEMHEALTH/HIP-Medicaid, +38984,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMBLEMHEALTH/HIP-Medicaid,379.52 +38985,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMBLEMHEALTH/HIP-Medicaid, +38986,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMBLEMHEALTH/HIP-Medicaid, +38987,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMBLEMHEALTH/HIP-Medicaid,1793.31 +38988,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMBLEMHEALTH/HIP-Medicaid, +38989,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMBLEMHEALTH/HIP-Medicaid, +38990,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMBLEMHEALTH/HIP-Medicaid, +38991,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMBLEMHEALTH/HIP-Medicaid,1793.31 +38992,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMBLEMHEALTH/HIP-Medicaid, +38993,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMBLEMHEALTH/HIP-Medicaid, +38994,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMBLEMHEALTH/HIP-Medicaid,1726.65 +38995,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMBLEMHEALTH/HIP-Medicaid, +38996,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMBLEMHEALTH/HIP-Medicaid, +38997,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMBLEMHEALTH/HIP-Medicaid, +38998,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMBLEMHEALTH/HIP-Medicaid, +38999,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMBLEMHEALTH/HIP-Medicaid,964.86 +39000,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMBLEMHEALTH/HIP-Medicaid, +39001,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMBLEMHEALTH/HIP-Medicaid, +39002,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMBLEMHEALTH/HIP-Medicaid,3599.31 +39003,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMBLEMHEALTH/HIP-Medicaid,2775.76 +39004,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMBLEMHEALTH/HIP-Medicaid, +39005,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMBLEMHEALTH/HIP-Medicaid, +39006,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMBLEMHEALTH/HIP-Medicaid, +39007,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMBLEMHEALTH/HIP-Medicaid,5078.01 +39008,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMBLEMHEALTH/HIP-Medicaid, +39009,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMBLEMHEALTH/HIP-Medicaid, +39010,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39011,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMBLEMHEALTH/HIP-Medicaid, +39012,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMBLEMHEALTH/HIP-Medicaid, +39013,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMBLEMHEALTH/HIP-Medicaid, +39014,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMBLEMHEALTH/HIP-Medicaid,5011.35 +39015,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMBLEMHEALTH/HIP-Medicaid, +39016,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMBLEMHEALTH/HIP-Medicaid,3532.65 +39017,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMBLEMHEALTH/HIP-Medicaid, +39018,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMBLEMHEALTH/HIP-Medicaid, +39019,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMBLEMHEALTH/HIP-Medicaid, +39020,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMBLEMHEALTH/HIP-Medicaid,2720.35 +39021,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMBLEMHEALTH/HIP-Medicaid, +39022,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMBLEMHEALTH/HIP-Medicaid, +39023,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMBLEMHEALTH/HIP-Medicaid, +39024,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39025,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMBLEMHEALTH/HIP-Medicaid, +39026,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMBLEMHEALTH/HIP-Medicaid, +39027,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMBLEMHEALTH/HIP-Medicaid, +39028,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMBLEMHEALTH/HIP-Medicaid, +39029,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39030,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicaid, +39031,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMBLEMHEALTH/HIP-Medicaid, +39032,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMBLEMHEALTH/HIP-Medicaid, +39033,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMBLEMHEALTH/HIP-Medicaid, +39034,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMBLEMHEALTH/HIP-Medicaid,412.86 +39035,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMBLEMHEALTH/HIP-Medicaid,351.78 +39036,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMBLEMHEALTH/HIP-Medicaid, +39037,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMBLEMHEALTH/HIP-Medicaid, +39038,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMBLEMHEALTH/HIP-Medicaid, +39039,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMBLEMHEALTH/HIP-Medicaid,317.3 +39040,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMBLEMHEALTH/HIP-Medicaid, +39041,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMBLEMHEALTH/HIP-Medicaid, +39042,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMBLEMHEALTH/HIP-Medicaid, +39043,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39044,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMBLEMHEALTH/HIP-Medicaid,1872.98 +39045,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMBLEMHEALTH/HIP-Medicaid, +39046,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMBLEMHEALTH/HIP-Medicaid, +39047,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMBLEMHEALTH/HIP-Medicaid, +39048,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMBLEMHEALTH/HIP-Medicaid, +39049,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMBLEMHEALTH/HIP-Medicaid, +39050,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMBLEMHEALTH/HIP-Medicaid, +39051,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMBLEMHEALTH/HIP-Medicaid, +39052,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMBLEMHEALTH/HIP-Medicaid, +39053,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMBLEMHEALTH/HIP-Medicaid, +39054,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMBLEMHEALTH/HIP-Medicaid, +39055,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMBLEMHEALTH/HIP-Medicaid, +39056,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMBLEMHEALTH/HIP-Medicaid, +39057,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMBLEMHEALTH/HIP-Medicaid, +39058,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMBLEMHEALTH/HIP-Medicaid, +39059,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMBLEMHEALTH/HIP-Medicaid, +39060,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMBLEMHEALTH/HIP-Medicaid, +39061,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39062,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMBLEMHEALTH/HIP-Medicaid, +39063,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMBLEMHEALTH/HIP-Medicaid, +39064,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMBLEMHEALTH/HIP-Medicaid, +39065,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMBLEMHEALTH/HIP-Medicaid, +39066,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMBLEMHEALTH/HIP-Medicaid, +39067,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMBLEMHEALTH/HIP-Medicaid, +39068,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39069,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39070,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39071,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMBLEMHEALTH/HIP-Medicaid, +39072,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMBLEMHEALTH/HIP-Medicaid, +39073,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMBLEMHEALTH/HIP-Medicaid, +39074,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMBLEMHEALTH/HIP-Medicaid, +39075,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMBLEMHEALTH/HIP-Medicaid, +39076,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMBLEMHEALTH/HIP-Medicaid, +39077,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMBLEMHEALTH/HIP-Medicaid, +39078,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMBLEMHEALTH/HIP-Medicaid, +39079,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMBLEMHEALTH/HIP-Medicaid, +39080,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMBLEMHEALTH/HIP-Medicaid, +39081,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMBLEMHEALTH/HIP-Medicaid, +39082,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMBLEMHEALTH/HIP-Medicaid, +39083,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMBLEMHEALTH/HIP-Medicaid, +39084,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMBLEMHEALTH/HIP-Medicaid, +39085,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMBLEMHEALTH/HIP-Medicaid, +39086,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMBLEMHEALTH/HIP-Medicaid, +39087,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMBLEMHEALTH/HIP-Medicaid, +39088,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMBLEMHEALTH/HIP-Medicaid, +39089,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMBLEMHEALTH/HIP-Medicaid, +39090,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMBLEMHEALTH/HIP-Medicaid, +39091,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39092,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMBLEMHEALTH/HIP-Medicaid, +39093,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMBLEMHEALTH/HIP-Medicaid, +39094,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMBLEMHEALTH/HIP-Medicaid, +39095,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMBLEMHEALTH/HIP-Medicaid, +39096,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMBLEMHEALTH/HIP-Medicaid, +39097,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-Medicaid, +39098,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMBLEMHEALTH/HIP-Medicaid, +39099,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMBLEMHEALTH/HIP-Medicaid, +39100,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMBLEMHEALTH/HIP-Medicaid, +39101,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMBLEMHEALTH/HIP-Medicaid, +39102,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMBLEMHEALTH/HIP-Medicaid, +39103,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMBLEMHEALTH/HIP-Medicaid, +39104,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMBLEMHEALTH/HIP-Medicaid, +39105,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMBLEMHEALTH/HIP-Medicaid, +39106,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMBLEMHEALTH/HIP-Medicaid,3429.64 +39107,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMBLEMHEALTH/HIP-Medicaid, +39108,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMBLEMHEALTH/HIP-Medicaid, +39109,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMBLEMHEALTH/HIP-Medicaid, +39110,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMBLEMHEALTH/HIP-Medicaid, +39111,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMBLEMHEALTH/HIP-Medicaid, +39112,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMBLEMHEALTH/HIP-Medicaid, +39113,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMBLEMHEALTH/HIP-Medicaid, +39114,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMBLEMHEALTH/HIP-Medicaid, +39115,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMBLEMHEALTH/HIP-Medicaid, +39116,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMBLEMHEALTH/HIP-Medicaid, +39117,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMBLEMHEALTH/HIP-Medicaid, +39118,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMBLEMHEALTH/HIP-Medicaid, +39119,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMBLEMHEALTH/HIP-Medicaid, +39120,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMBLEMHEALTH/HIP-Medicaid, +39121,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMBLEMHEALTH/HIP-Medicaid, +39122,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMBLEMHEALTH/HIP-Medicaid, +39123,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMBLEMHEALTH/HIP-Medicaid, +39124,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMBLEMHEALTH/HIP-Medicaid, +39125,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMBLEMHEALTH/HIP-Medicaid, +39126,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMBLEMHEALTH/HIP-Medicaid, +39127,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMBLEMHEALTH/HIP-Medicaid, +39128,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMBLEMHEALTH/HIP-Medicaid, +39129,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMBLEMHEALTH/HIP-Medicaid, +39130,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMBLEMHEALTH/HIP-Medicaid, +39131,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMBLEMHEALTH/HIP-Medicaid, +39132,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMBLEMHEALTH/HIP-Medicaid, +39133,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMBLEMHEALTH/HIP-Medicaid, +39134,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMBLEMHEALTH/HIP-Medicaid, +39135,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMBLEMHEALTH/HIP-Medicaid, +39136,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMBLEMHEALTH/HIP-Medicaid, +39137,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMBLEMHEALTH/HIP-Medicaid, +39138,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMBLEMHEALTH/HIP-Medicaid, +39139,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMBLEMHEALTH/HIP-Medicaid, +39140,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMBLEMHEALTH/HIP-Medicaid, +39141,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMBLEMHEALTH/HIP-Medicaid, +39142,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMBLEMHEALTH/HIP-Medicaid, +39143,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMBLEMHEALTH/HIP-Medicaid, +39144,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMBLEMHEALTH/HIP-Medicaid, +39145,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMBLEMHEALTH/HIP-Medicaid, +39146,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMBLEMHEALTH/HIP-Medicaid, +39147,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMBLEMHEALTH/HIP-Medicaid, +39148,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMBLEMHEALTH/HIP-Medicaid, +39149,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMBLEMHEALTH/HIP-Medicaid, +39150,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39151,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMBLEMHEALTH/HIP-Medicaid, +39152,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMBLEMHEALTH/HIP-Medicaid, +39153,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMBLEMHEALTH/HIP-Medicaid, +39154,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMBLEMHEALTH/HIP-Medicaid, +39155,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMBLEMHEALTH/HIP-Medicaid, +39156,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMBLEMHEALTH/HIP-Medicaid, +39157,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMBLEMHEALTH/HIP-Medicaid, +39158,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMBLEMHEALTH/HIP-Medicaid, +39159,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMBLEMHEALTH/HIP-Medicaid, +39160,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMBLEMHEALTH/HIP-Medicaid, +39161,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMBLEMHEALTH/HIP-Medicaid, +39162,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMBLEMHEALTH/HIP-Medicaid, +39163,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMBLEMHEALTH/HIP-Medicaid, +39164,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMBLEMHEALTH/HIP-Medicaid, +39165,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMBLEMHEALTH/HIP-Medicaid, +39166,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMBLEMHEALTH/HIP-Medicaid, +39167,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMBLEMHEALTH/HIP-Medicaid, +39168,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMBLEMHEALTH/HIP-Medicaid, +39169,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMBLEMHEALTH/HIP-Medicaid, +39170,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMBLEMHEALTH/HIP-Medicaid, +39171,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMBLEMHEALTH/HIP-Medicaid, +39172,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMBLEMHEALTH/HIP-Medicaid, +39173,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMBLEMHEALTH/HIP-Medicaid, +39174,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMBLEMHEALTH/HIP-Medicaid, +39175,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMBLEMHEALTH/HIP-Medicaid, +39176,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMBLEMHEALTH/HIP-Medicaid,2154.39 +39177,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMBLEMHEALTH/HIP-Medicaid, +39178,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMBLEMHEALTH/HIP-Medicaid, +39179,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMBLEMHEALTH/HIP-Medicaid, +39180,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMBLEMHEALTH/HIP-Medicaid, +39181,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMBLEMHEALTH/HIP-Medicaid, +39182,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMBLEMHEALTH/HIP-Medicaid, +39183,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMBLEMHEALTH/HIP-Medicaid, +39184,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMBLEMHEALTH/HIP-Medicaid, +39185,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMBLEMHEALTH/HIP-Medicaid, +39186,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMBLEMHEALTH/HIP-Medicaid, +39187,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMBLEMHEALTH/HIP-Medicaid, +39188,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMBLEMHEALTH/HIP-Medicaid, +39189,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMBLEMHEALTH/HIP-Medicaid, +39190,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39191,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMBLEMHEALTH/HIP-Medicaid, +39192,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMBLEMHEALTH/HIP-Medicaid, +39193,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMBLEMHEALTH/HIP-Medicaid, +39194,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMBLEMHEALTH/HIP-Medicaid, +39195,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMBLEMHEALTH/HIP-Medicaid, +39196,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMBLEMHEALTH/HIP-Medicaid, +39197,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMBLEMHEALTH/HIP-Medicaid, +39198,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMBLEMHEALTH/HIP-Medicaid, +39199,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMBLEMHEALTH/HIP-Medicaid, +39200,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMBLEMHEALTH/HIP-Medicaid, +39201,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMBLEMHEALTH/HIP-Medicaid, +39202,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMBLEMHEALTH/HIP-Medicaid, +39203,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMBLEMHEALTH/HIP-Medicaid, +39204,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39205,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMBLEMHEALTH/HIP-Medicaid,3159.77 +39206,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMBLEMHEALTH/HIP-Medicaid, +39207,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMBLEMHEALTH/HIP-Medicaid, +39208,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMBLEMHEALTH/HIP-Medicaid,551.08 +39209,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMBLEMHEALTH/HIP-Medicaid, +39210,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMBLEMHEALTH/HIP-Medicaid, +39211,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMBLEMHEALTH/HIP-Medicaid, +39212,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMBLEMHEALTH/HIP-Medicaid, +39213,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMBLEMHEALTH/HIP-Medicaid, +39214,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMBLEMHEALTH/HIP-Medicaid,3159.77 +39215,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMBLEMHEALTH/HIP-Medicaid, +39216,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMBLEMHEALTH/HIP-Medicaid, +39217,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMBLEMHEALTH/HIP-Medicaid, +39218,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMBLEMHEALTH/HIP-Medicaid, +39219,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMBLEMHEALTH/HIP-Medicaid,2439.62 +39220,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMBLEMHEALTH/HIP-Medicaid, +39221,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMBLEMHEALTH/HIP-Medicaid,363.43 +39222,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMBLEMHEALTH/HIP-Medicaid, +39223,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMBLEMHEALTH/HIP-Medicaid,1412.66 +39224,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMBLEMHEALTH/HIP-Medicaid, +39225,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMBLEMHEALTH/HIP-Medicaid, +39226,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMBLEMHEALTH/HIP-Medicaid, +39227,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMBLEMHEALTH/HIP-Medicaid, +39228,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMBLEMHEALTH/HIP-Medicaid, +39229,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39230,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMBLEMHEALTH/HIP-Medicaid, +39231,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMBLEMHEALTH/HIP-Medicaid, +39232,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMBLEMHEALTH/HIP-Medicaid, +39233,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMBLEMHEALTH/HIP-Medicaid, +39234,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMBLEMHEALTH/HIP-Medicaid,1158.64 +39235,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMBLEMHEALTH/HIP-Medicaid, +39236,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMBLEMHEALTH/HIP-Medicaid, +39237,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMBLEMHEALTH/HIP-Medicaid, +39238,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMBLEMHEALTH/HIP-Medicaid,1412.66 +39239,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMBLEMHEALTH/HIP-Medicaid, +39240,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMBLEMHEALTH/HIP-Medicaid, +39241,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39242,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMBLEMHEALTH/HIP-Medicaid,2263.66 +39243,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMBLEMHEALTH/HIP-Medicaid, +39244,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMBLEMHEALTH/HIP-Medicaid, +39245,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMBLEMHEALTH/HIP-Medicaid, +39246,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMBLEMHEALTH/HIP-Medicaid, +39247,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMBLEMHEALTH/HIP-Medicaid, +39248,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMBLEMHEALTH/HIP-Medicaid, +39249,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMBLEMHEALTH/HIP-Medicaid, +39250,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMBLEMHEALTH/HIP-Medicaid, +39251,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMBLEMHEALTH/HIP-Medicaid, +39252,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMBLEMHEALTH/HIP-Medicaid,1412.66 +39253,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMBLEMHEALTH/HIP-Medicaid, +39254,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMBLEMHEALTH/HIP-Medicaid, +39255,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMBLEMHEALTH/HIP-Medicaid, +39256,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMBLEMHEALTH/HIP-Medicaid, +39257,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39258,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMBLEMHEALTH/HIP-Medicaid, +39259,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMBLEMHEALTH/HIP-Medicaid, +39260,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39261,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMBLEMHEALTH/HIP-Medicaid, +39262,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMBLEMHEALTH/HIP-Medicaid, +39263,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMBLEMHEALTH/HIP-Medicaid, +39264,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMBLEMHEALTH/HIP-Medicaid,3159.77 +39265,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39266,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMBLEMHEALTH/HIP-Medicaid, +39267,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMBLEMHEALTH/HIP-Medicaid, +39268,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMBLEMHEALTH/HIP-Medicaid, +39269,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMBLEMHEALTH/HIP-Medicaid, +39270,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMBLEMHEALTH/HIP-Medicaid, +39271,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMBLEMHEALTH/HIP-Medicaid, +39272,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMBLEMHEALTH/HIP-Medicaid, +39273,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMBLEMHEALTH/HIP-Medicaid, +39274,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMBLEMHEALTH/HIP-Medicaid, +39275,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMBLEMHEALTH/HIP-Medicaid, +39276,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMBLEMHEALTH/HIP-Medicaid, +39277,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMBLEMHEALTH/HIP-Medicaid, +39278,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMBLEMHEALTH/HIP-Medicaid, +39279,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMBLEMHEALTH/HIP-Medicaid, +39280,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMBLEMHEALTH/HIP-Medicaid, +39281,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39282,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMBLEMHEALTH/HIP-Medicaid, +39283,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMBLEMHEALTH/HIP-Medicaid,1303.02 +39284,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMBLEMHEALTH/HIP-Medicaid, +39285,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMBLEMHEALTH/HIP-Medicaid, +39286,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMBLEMHEALTH/HIP-Medicaid,496.21 +39287,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMBLEMHEALTH/HIP-Medicaid, +39288,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMBLEMHEALTH/HIP-Medicaid, +39289,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMBLEMHEALTH/HIP-Medicaid, +39290,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMBLEMHEALTH/HIP-Medicaid, +39291,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMBLEMHEALTH/HIP-Medicaid, +39292,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMBLEMHEALTH/HIP-Medicaid, +39293,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMBLEMHEALTH/HIP-Medicaid, +39294,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMBLEMHEALTH/HIP-Medicaid, +39295,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMBLEMHEALTH/HIP-Medicaid, +39296,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMBLEMHEALTH/HIP-Medicaid, +39297,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMBLEMHEALTH/HIP-Medicaid, +39298,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMBLEMHEALTH/HIP-Medicaid, +39299,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMBLEMHEALTH/HIP-Medicaid, +39300,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMBLEMHEALTH/HIP-Medicaid, +39301,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMBLEMHEALTH/HIP-Medicaid, +39302,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMBLEMHEALTH/HIP-Medicaid, +39303,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMBLEMHEALTH/HIP-Medicaid, +39304,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMBLEMHEALTH/HIP-Medicaid, +39305,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMBLEMHEALTH/HIP-Medicaid, +39306,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMBLEMHEALTH/HIP-Medicaid,1916.07 +39307,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMBLEMHEALTH/HIP-Medicaid, +39308,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMBLEMHEALTH/HIP-Medicaid, +39309,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMBLEMHEALTH/HIP-Medicaid, +39310,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39311,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMBLEMHEALTH/HIP-Medicaid, +39312,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMBLEMHEALTH/HIP-Medicaid, +39313,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMBLEMHEALTH/HIP-Medicaid, +39314,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMBLEMHEALTH/HIP-Medicaid, +39315,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMBLEMHEALTH/HIP-Medicaid,2168.37 +39316,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMBLEMHEALTH/HIP-Medicaid, +39317,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMBLEMHEALTH/HIP-Medicaid,2168.37 +39318,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMBLEMHEALTH/HIP-Medicaid,2168.37 +39319,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMBLEMHEALTH/HIP-Medicaid,3840.11 +39320,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMBLEMHEALTH/HIP-Medicaid, +39321,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMBLEMHEALTH/HIP-Medicaid, +39322,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMBLEMHEALTH/HIP-Medicaid, +39323,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMBLEMHEALTH/HIP-Medicaid, +39324,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMBLEMHEALTH/HIP-Medicaid, +39325,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMBLEMHEALTH/HIP-Medicaid, +39326,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMBLEMHEALTH/HIP-Medicaid, +39327,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMBLEMHEALTH/HIP-Medicaid, +39328,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMBLEMHEALTH/HIP-Medicaid, +39329,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMBLEMHEALTH/HIP-Medicaid, +39330,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMBLEMHEALTH/HIP-Medicaid, +39331,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMBLEMHEALTH/HIP-Medicaid, +39332,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMBLEMHEALTH/HIP-Medicaid, +39333,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMBLEMHEALTH/HIP-Medicaid, +39334,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39335,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39336,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMBLEMHEALTH/HIP-Medicaid, +39337,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMBLEMHEALTH/HIP-Medicaid, +39338,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMBLEMHEALTH/HIP-Medicaid, +39339,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMBLEMHEALTH/HIP-Medicaid, +39340,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMBLEMHEALTH/HIP-Medicaid, +39341,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMBLEMHEALTH/HIP-Medicaid, +39342,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMBLEMHEALTH/HIP-Medicaid, +39343,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMBLEMHEALTH/HIP-Medicaid, +39344,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMBLEMHEALTH/HIP-Medicaid,2168.37 +39345,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMBLEMHEALTH/HIP-Medicaid, +39346,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMBLEMHEALTH/HIP-Medicaid, +39347,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMBLEMHEALTH/HIP-Medicaid, +39348,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39349,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMBLEMHEALTH/HIP-Medicaid, +39350,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMBLEMHEALTH/HIP-Medicaid, +39351,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMBLEMHEALTH/HIP-Medicaid, +39352,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMBLEMHEALTH/HIP-Medicaid, +39353,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMBLEMHEALTH/HIP-Medicaid, +39354,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMBLEMHEALTH/HIP-Medicaid, +39355,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39356,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMBLEMHEALTH/HIP-Medicaid, +39357,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMBLEMHEALTH/HIP-Medicaid, +39358,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMBLEMHEALTH/HIP-Medicaid, +39359,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMBLEMHEALTH/HIP-Medicaid, +39360,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMBLEMHEALTH/HIP-Medicaid, +39361,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMBLEMHEALTH/HIP-Medicaid, +39362,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMBLEMHEALTH/HIP-Medicaid, +39363,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMBLEMHEALTH/HIP-Medicaid, +39364,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMBLEMHEALTH/HIP-Medicaid, +39365,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMBLEMHEALTH/HIP-Medicaid, +39366,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMBLEMHEALTH/HIP-Medicaid, +39367,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMBLEMHEALTH/HIP-Medicaid, +39368,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMBLEMHEALTH/HIP-Medicaid, +39369,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMBLEMHEALTH/HIP-Medicaid, +39370,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMBLEMHEALTH/HIP-Medicaid, +39371,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMBLEMHEALTH/HIP-Medicaid, +39372,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMBLEMHEALTH/HIP-Medicaid, +39373,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMBLEMHEALTH/HIP-Medicaid,1916.07 +39374,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMBLEMHEALTH/HIP-Medicaid, +39375,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMBLEMHEALTH/HIP-Medicaid, +39376,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMBLEMHEALTH/HIP-Medicaid, +39377,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMBLEMHEALTH/HIP-Medicaid, +39378,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMBLEMHEALTH/HIP-Medicaid, +39379,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMBLEMHEALTH/HIP-Medicaid, +39380,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMBLEMHEALTH/HIP-Medicaid, +39381,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMBLEMHEALTH/HIP-Medicaid, +39382,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMBLEMHEALTH/HIP-Medicaid, +39383,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMBLEMHEALTH/HIP-Medicaid, +39384,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMBLEMHEALTH/HIP-Medicaid, +39385,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMBLEMHEALTH/HIP-Medicaid, +39386,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMBLEMHEALTH/HIP-Medicaid, +39387,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMBLEMHEALTH/HIP-Medicaid, +39388,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMBLEMHEALTH/HIP-Medicaid,1787.58 +39389,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39390,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMBLEMHEALTH/HIP-Medicaid, +39391,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39392,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMBLEMHEALTH/HIP-Medicaid, +39393,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39394,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMBLEMHEALTH/HIP-Medicaid, +39395,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMBLEMHEALTH/HIP-Medicaid, +39396,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMBLEMHEALTH/HIP-Medicaid, +39397,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMBLEMHEALTH/HIP-Medicaid, +39398,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMBLEMHEALTH/HIP-Medicaid, +39399,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMBLEMHEALTH/HIP-Medicaid, +39400,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMBLEMHEALTH/HIP-Medicaid,2256.15 +39401,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMBLEMHEALTH/HIP-Medicaid, +39402,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMBLEMHEALTH/HIP-Medicaid,2256.15 +39403,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMBLEMHEALTH/HIP-Medicaid, +39404,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMBLEMHEALTH/HIP-Medicaid,2256.15 +39405,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMBLEMHEALTH/HIP-Medicaid, +39406,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMBLEMHEALTH/HIP-Medicaid, +39407,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMBLEMHEALTH/HIP-Medicaid, +39408,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +39409,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMBLEMHEALTH/HIP-Medicaid, +39410,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMBLEMHEALTH/HIP-Medicaid, +39411,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMBLEMHEALTH/HIP-Medicaid, +39412,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMBLEMHEALTH/HIP-Medicaid, +39413,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMBLEMHEALTH/HIP-Medicaid, +39414,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMBLEMHEALTH/HIP-Medicaid, +39415,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMBLEMHEALTH/HIP-Medicaid, +39416,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMBLEMHEALTH/HIP-Medicaid, +39417,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMBLEMHEALTH/HIP-Medicaid, +39418,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMBLEMHEALTH/HIP-Medicaid, +39419,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMBLEMHEALTH/HIP-Medicaid, +39420,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMBLEMHEALTH/HIP-Medicaid, +39421,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMBLEMHEALTH/HIP-Medicaid, +39422,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMBLEMHEALTH/HIP-Medicaid, +39423,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMBLEMHEALTH/HIP-Medicaid, +39424,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMBLEMHEALTH/HIP-Medicaid, +39425,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMBLEMHEALTH/HIP-Medicaid, +39426,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMBLEMHEALTH/HIP-Medicaid, +39427,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMBLEMHEALTH/HIP-Medicaid, +39428,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMBLEMHEALTH/HIP-Medicaid,2256.15 +39429,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMBLEMHEALTH/HIP-Medicaid, +39430,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMBLEMHEALTH/HIP-Medicaid, +39431,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMBLEMHEALTH/HIP-Medicaid, +39432,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMBLEMHEALTH/HIP-Medicaid, +39433,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMBLEMHEALTH/HIP-Medicaid, +39434,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMBLEMHEALTH/HIP-Medicaid, +39435,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMBLEMHEALTH/HIP-Medicaid, +39436,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMBLEMHEALTH/HIP-Medicaid, +39437,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMBLEMHEALTH/HIP-Medicaid, +39438,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMBLEMHEALTH/HIP-Medicaid, +39439,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMBLEMHEALTH/HIP-Medicaid, +39440,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMBLEMHEALTH/HIP-Medicaid,234.76 +39441,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMBLEMHEALTH/HIP-Medicaid, +39442,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMBLEMHEALTH/HIP-Medicaid, +39443,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMBLEMHEALTH/HIP-Medicaid, +39444,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMBLEMHEALTH/HIP-Medicaid, +39445,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMBLEMHEALTH/HIP-Medicaid, +39446,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMBLEMHEALTH/HIP-Medicaid, +39447,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMBLEMHEALTH/HIP-Medicaid,281.45 +39448,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMBLEMHEALTH/HIP-Medicaid, +39449,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMBLEMHEALTH/HIP-Medicaid, +39450,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMBLEMHEALTH/HIP-Medicaid, +39451,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMBLEMHEALTH/HIP-Medicaid, +39452,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMBLEMHEALTH/HIP-Medicaid, +39453,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMBLEMHEALTH/HIP-Medicaid, +39454,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +39455,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39456,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMBLEMHEALTH/HIP-Medicaid, +39457,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMBLEMHEALTH/HIP-Medicaid, +39458,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMBLEMHEALTH/HIP-Medicaid, +39459,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMBLEMHEALTH/HIP-Medicaid, +39460,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMBLEMHEALTH/HIP-Medicaid, +39461,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMBLEMHEALTH/HIP-Medicaid,3810.76 +39462,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMBLEMHEALTH/HIP-Medicaid, +39463,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMBLEMHEALTH/HIP-Medicaid, +39464,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMBLEMHEALTH/HIP-Medicaid, +39465,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMBLEMHEALTH/HIP-Medicaid, +39466,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMBLEMHEALTH/HIP-Medicaid,1986.45 +39467,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMBLEMHEALTH/HIP-Medicaid, +39468,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMBLEMHEALTH/HIP-Medicaid, +39469,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMBLEMHEALTH/HIP-Medicaid, +39470,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMBLEMHEALTH/HIP-Medicaid, +39471,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMBLEMHEALTH/HIP-Medicaid, +39472,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMBLEMHEALTH/HIP-Medicaid,937.5 +39473,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39474,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMBLEMHEALTH/HIP-Medicaid, +39475,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMBLEMHEALTH/HIP-Medicaid, +39476,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMBLEMHEALTH/HIP-Medicaid, +39477,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39478,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMBLEMHEALTH/HIP-Medicaid,1986.45 +39479,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMBLEMHEALTH/HIP-Medicaid,1986.45 +39480,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMBLEMHEALTH/HIP-Medicaid,1986.45 +39481,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMBLEMHEALTH/HIP-Medicaid, +39482,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +39483,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMBLEMHEALTH/HIP-Medicaid, +39484,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMBLEMHEALTH/HIP-Medicaid,3674.66 +39485,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMBLEMHEALTH/HIP-Medicaid, +39486,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMBLEMHEALTH/HIP-Medicaid, +39487,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39488,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMBLEMHEALTH/HIP-Medicaid, +39489,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMBLEMHEALTH/HIP-Medicaid, +39490,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMBLEMHEALTH/HIP-Medicaid, +39491,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMBLEMHEALTH/HIP-Medicaid, +39492,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMBLEMHEALTH/HIP-Medicaid,2695.48 +39493,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMBLEMHEALTH/HIP-Medicaid, +39494,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +39495,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMBLEMHEALTH/HIP-Medicaid, +39496,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMBLEMHEALTH/HIP-Medicaid, +39497,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMBLEMHEALTH/HIP-Medicaid, +39498,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMBLEMHEALTH/HIP-Medicaid, +39499,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMBLEMHEALTH/HIP-Medicaid,3626.77 +39500,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMBLEMHEALTH/HIP-Medicaid, +39501,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMBLEMHEALTH/HIP-Medicaid, +39502,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMBLEMHEALTH/HIP-Medicaid, +39503,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMBLEMHEALTH/HIP-Medicaid, +39504,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMBLEMHEALTH/HIP-Medicaid, +39505,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMBLEMHEALTH/HIP-Medicaid, +39506,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMBLEMHEALTH/HIP-Medicaid, +39507,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMBLEMHEALTH/HIP-Medicaid, +39508,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMBLEMHEALTH/HIP-Medicaid, +39509,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMBLEMHEALTH/HIP-Medicaid, +39510,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMBLEMHEALTH/HIP-Medicaid, +39511,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMBLEMHEALTH/HIP-Medicaid, +39512,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMBLEMHEALTH/HIP-Medicaid, +39513,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMBLEMHEALTH/HIP-Medicaid, +39514,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMBLEMHEALTH/HIP-Medicaid, +39515,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMBLEMHEALTH/HIP-Medicaid, +39516,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMBLEMHEALTH/HIP-Medicaid, +39517,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMBLEMHEALTH/HIP-Medicaid, +39518,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMBLEMHEALTH/HIP-Medicaid, +39519,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMBLEMHEALTH/HIP-Medicaid, +39520,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMBLEMHEALTH/HIP-Medicaid, +39521,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMBLEMHEALTH/HIP-Medicaid, +39522,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMBLEMHEALTH/HIP-Medicaid, +39523,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMBLEMHEALTH/HIP-Medicaid,624.31 +39524,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMBLEMHEALTH/HIP-Medicaid, +39525,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMBLEMHEALTH/HIP-Medicaid, +39526,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMBLEMHEALTH/HIP-Medicaid, +39527,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMBLEMHEALTH/HIP-Medicaid, +39528,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMBLEMHEALTH/HIP-Medicaid, +39529,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMBLEMHEALTH/HIP-Medicaid, +39530,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMBLEMHEALTH/HIP-Medicaid, +39531,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMBLEMHEALTH/HIP-Medicaid, +39532,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMBLEMHEALTH/HIP-Medicaid, +39533,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMBLEMHEALTH/HIP-Medicaid, +39534,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMBLEMHEALTH/HIP-Medicaid, +39535,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMBLEMHEALTH/HIP-Medicaid, +39536,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMBLEMHEALTH/HIP-Medicaid,138.97 +39537,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMBLEMHEALTH/HIP-Medicaid, +39538,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMBLEMHEALTH/HIP-Medicaid, +39539,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMBLEMHEALTH/HIP-Medicaid, +39540,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39541,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMBLEMHEALTH/HIP-Medicaid, +39542,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMBLEMHEALTH/HIP-Medicaid, +39543,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMBLEMHEALTH/HIP-Medicaid,602.44 +39544,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMBLEMHEALTH/HIP-Medicaid, +39545,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMBLEMHEALTH/HIP-Medicaid, +39546,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMBLEMHEALTH/HIP-Medicaid, +39547,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39548,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMBLEMHEALTH/HIP-Medicaid, +39549,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMBLEMHEALTH/HIP-Medicaid, +39550,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMBLEMHEALTH/HIP-Medicaid, +39551,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMBLEMHEALTH/HIP-Medicaid, +39552,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMBLEMHEALTH/HIP-Medicaid, +39553,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMBLEMHEALTH/HIP-Medicaid, +39554,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMBLEMHEALTH/HIP-Medicaid, +39555,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMBLEMHEALTH/HIP-Medicaid, +39556,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMBLEMHEALTH/HIP-Medicaid, +39557,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMBLEMHEALTH/HIP-Medicaid, +39558,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMBLEMHEALTH/HIP-Medicaid, +39559,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMBLEMHEALTH/HIP-Medicaid, +39560,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMBLEMHEALTH/HIP-Medicaid, +39561,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMBLEMHEALTH/HIP-Medicaid, +39562,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMBLEMHEALTH/HIP-Medicaid, +39563,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMBLEMHEALTH/HIP-Medicaid, +39564,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMBLEMHEALTH/HIP-Medicaid, +39565,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMBLEMHEALTH/HIP-Medicaid, +39566,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMBLEMHEALTH/HIP-Medicaid, +39567,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMBLEMHEALTH/HIP-Medicaid, +39568,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMBLEMHEALTH/HIP-Medicaid, +39569,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMBLEMHEALTH/HIP-Medicaid, +39570,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMBLEMHEALTH/HIP-Medicaid, +39571,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMBLEMHEALTH/HIP-Medicaid, +39572,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMBLEMHEALTH/HIP-Medicaid, +39573,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMBLEMHEALTH/HIP-Medicaid, +39574,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMBLEMHEALTH/HIP-Medicaid, +39575,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMBLEMHEALTH/HIP-Medicaid, +39576,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMBLEMHEALTH/HIP-Medicaid, +39577,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMBLEMHEALTH/HIP-Medicaid, +39578,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMBLEMHEALTH/HIP-Medicaid, +39579,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMBLEMHEALTH/HIP-Medicaid, +39580,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMBLEMHEALTH/HIP-Medicaid, +39581,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMBLEMHEALTH/HIP-Medicaid, +39582,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMBLEMHEALTH/HIP-Medicaid, +39583,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMBLEMHEALTH/HIP-Medicaid, +39584,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMBLEMHEALTH/HIP-Medicaid, +39585,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMBLEMHEALTH/HIP-Medicaid, +39586,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMBLEMHEALTH/HIP-Medicaid, +39587,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMBLEMHEALTH/HIP-Medicaid, +39588,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMBLEMHEALTH/HIP-Medicaid, +39589,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMBLEMHEALTH/HIP-Medicaid, +39590,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMBLEMHEALTH/HIP-Medicaid, +39591,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMBLEMHEALTH/HIP-Medicaid, +39592,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMBLEMHEALTH/HIP-Medicaid, +39593,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMBLEMHEALTH/HIP-Medicaid, +39594,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMBLEMHEALTH/HIP-Medicaid, +39595,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMBLEMHEALTH/HIP-Medicaid, +39596,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMBLEMHEALTH/HIP-Medicaid, +39597,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMBLEMHEALTH/HIP-Medicaid, +39598,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMBLEMHEALTH/HIP-Medicaid, +39599,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMBLEMHEALTH/HIP-Medicaid, +39600,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMBLEMHEALTH/HIP-Medicaid, +39601,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMBLEMHEALTH/HIP-Medicaid, +39602,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMBLEMHEALTH/HIP-Medicaid, +39603,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMBLEMHEALTH/HIP-Medicaid, +39604,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMBLEMHEALTH/HIP-Medicaid, +39605,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMBLEMHEALTH/HIP-Medicaid, +39606,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39607,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMBLEMHEALTH/HIP-Medicaid, +39608,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMBLEMHEALTH/HIP-Medicaid, +39609,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMBLEMHEALTH/HIP-Medicaid, +39610,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMBLEMHEALTH/HIP-Medicaid, +39611,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMBLEMHEALTH/HIP-Medicaid, +39612,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMBLEMHEALTH/HIP-Medicaid, +39613,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMBLEMHEALTH/HIP-Medicaid, +39614,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMBLEMHEALTH/HIP-Medicaid, +39615,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMBLEMHEALTH/HIP-Medicaid, +39616,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMBLEMHEALTH/HIP-Medicaid, +39617,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMBLEMHEALTH/HIP-Medicaid,33.16 +39618,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMBLEMHEALTH/HIP-Medicaid, +39619,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMBLEMHEALTH/HIP-Medicaid, +39620,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMBLEMHEALTH/HIP-Medicaid, +39621,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39622,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMBLEMHEALTH/HIP-Medicaid, +39623,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMBLEMHEALTH/HIP-Medicaid, +39624,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMBLEMHEALTH/HIP-Medicaid, +39625,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMBLEMHEALTH/HIP-Medicaid, +39626,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMBLEMHEALTH/HIP-Medicaid, +39627,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMBLEMHEALTH/HIP-Medicaid,1539.48 +39628,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMBLEMHEALTH/HIP-Medicaid, +39629,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMBLEMHEALTH/HIP-Medicaid, +39630,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMBLEMHEALTH/HIP-Medicaid, +39631,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMBLEMHEALTH/HIP-Medicaid, +39632,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMBLEMHEALTH/HIP-Medicaid, +39633,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMBLEMHEALTH/HIP-Medicaid, +39634,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMBLEMHEALTH/HIP-Medicaid, +39635,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMBLEMHEALTH/HIP-Medicaid, +39636,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMBLEMHEALTH/HIP-Medicaid, +39637,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMBLEMHEALTH/HIP-Medicaid, +39638,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMBLEMHEALTH/HIP-Medicaid, +39639,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMBLEMHEALTH/HIP-Medicaid,33.16 +39640,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMBLEMHEALTH/HIP-Medicaid,12.91 +39641,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMBLEMHEALTH/HIP-Medicaid,38.4 +39642,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMBLEMHEALTH/HIP-Medicaid,366.39 +39643,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMBLEMHEALTH/HIP-Medicaid, +39644,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39645,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMBLEMHEALTH/HIP-Medicaid, +39646,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMBLEMHEALTH/HIP-Medicaid, +39647,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMBLEMHEALTH/HIP-Medicaid, +39648,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMBLEMHEALTH/HIP-Medicaid,2041.05 +39649,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39650,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMBLEMHEALTH/HIP-Medicaid,1537.64 +39651,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMBLEMHEALTH/HIP-Medicaid, +39652,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMBLEMHEALTH/HIP-Medicaid,2119.88 +39653,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMBLEMHEALTH/HIP-Medicaid, +39654,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMBLEMHEALTH/HIP-Medicaid,2704.33 +39655,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMBLEMHEALTH/HIP-Medicaid,351.16 +39656,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMBLEMHEALTH/HIP-Medicaid, +39657,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMBLEMHEALTH/HIP-Medicaid, +39658,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMBLEMHEALTH/HIP-Medicaid, +39659,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMBLEMHEALTH/HIP-Medicaid, +39660,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMBLEMHEALTH/HIP-Medicaid,861.25 +39661,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMBLEMHEALTH/HIP-Medicaid, +39662,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMBLEMHEALTH/HIP-Medicaid,100.11 +39663,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMBLEMHEALTH/HIP-Medicaid,116.54 +39664,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMBLEMHEALTH/HIP-Medicaid, +39665,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMBLEMHEALTH/HIP-Medicaid, +39666,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMBLEMHEALTH/HIP-Medicaid,588.17 +39667,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMBLEMHEALTH/HIP-Medicaid,49.32 +39668,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMBLEMHEALTH/HIP-Medicaid, +39669,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMBLEMHEALTH/HIP-Medicaid, +39670,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39671,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMBLEMHEALTH/HIP-Medicaid, +39672,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMBLEMHEALTH/HIP-Medicaid, +39673,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMBLEMHEALTH/HIP-Medicaid, +39674,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMBLEMHEALTH/HIP-Medicaid, +39675,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMBLEMHEALTH/HIP-Medicaid, +39676,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMBLEMHEALTH/HIP-Medicaid, +39677,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMBLEMHEALTH/HIP-Medicaid, +39678,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMBLEMHEALTH/HIP-Medicaid, +39679,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMBLEMHEALTH/HIP-Medicaid, +39680,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMBLEMHEALTH/HIP-Medicaid, +39681,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMBLEMHEALTH/HIP-Medicaid, +39682,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMBLEMHEALTH/HIP-Medicaid, +39683,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMBLEMHEALTH/HIP-Medicaid, +39684,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMBLEMHEALTH/HIP-Medicaid, +39685,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMBLEMHEALTH/HIP-Medicaid, +39686,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMBLEMHEALTH/HIP-Medicaid, +39687,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMBLEMHEALTH/HIP-Medicaid, +39688,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMBLEMHEALTH/HIP-Medicaid, +39689,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMBLEMHEALTH/HIP-Medicaid, +39690,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMBLEMHEALTH/HIP-Medicaid, +39691,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMBLEMHEALTH/HIP-Medicaid, +39692,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMBLEMHEALTH/HIP-Medicaid, +39693,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMBLEMHEALTH/HIP-Medicaid, +39694,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMBLEMHEALTH/HIP-Medicaid, +39695,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMBLEMHEALTH/HIP-Medicaid, +39696,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMBLEMHEALTH/HIP-Medicaid, +39697,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMBLEMHEALTH/HIP-Medicaid, +39698,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMBLEMHEALTH/HIP-Medicaid, +39699,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMBLEMHEALTH/HIP-Medicaid, +39700,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMBLEMHEALTH/HIP-Medicaid, +39701,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMBLEMHEALTH/HIP-Medicaid, +39702,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMBLEMHEALTH/HIP-Medicaid, +39703,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMBLEMHEALTH/HIP-Medicaid,2856.21 +39704,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMBLEMHEALTH/HIP-Medicaid, +39705,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMBLEMHEALTH/HIP-Medicaid, +39706,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMBLEMHEALTH/HIP-Medicaid, +39707,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMBLEMHEALTH/HIP-Medicaid, +39708,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMBLEMHEALTH/HIP-Medicaid, +39709,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMBLEMHEALTH/HIP-Medicaid, +39710,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMBLEMHEALTH/HIP-Medicaid, +39711,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMBLEMHEALTH/HIP-Medicaid, +39712,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMBLEMHEALTH/HIP-Medicaid, +39713,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMBLEMHEALTH/HIP-Medicaid, +39714,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMBLEMHEALTH/HIP-Medicaid, +39715,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMBLEMHEALTH/HIP-Medicaid, +39716,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMBLEMHEALTH/HIP-Medicaid, +39717,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMBLEMHEALTH/HIP-Medicaid, +39718,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMBLEMHEALTH/HIP-Medicaid, +39719,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMBLEMHEALTH/HIP-Medicaid, +39720,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-Medicaid, +39721,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-Medicaid, +39722,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMBLEMHEALTH/HIP-Medicaid,631.96 +39723,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMBLEMHEALTH/HIP-Medicaid, +39724,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMBLEMHEALTH/HIP-Medicaid,808.77 +39725,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMBLEMHEALTH/HIP-Medicaid, +39726,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMBLEMHEALTH/HIP-Medicaid, +39727,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMBLEMHEALTH/HIP-Medicaid, +39728,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMBLEMHEALTH/HIP-Medicaid, +39729,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMBLEMHEALTH/HIP-Medicaid, +39730,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMBLEMHEALTH/HIP-Medicaid, +39731,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMBLEMHEALTH/HIP-Medicaid, +39732,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMBLEMHEALTH/HIP-Medicaid, +39733,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMBLEMHEALTH/HIP-Medicaid, +39734,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMBLEMHEALTH/HIP-Medicaid, +39735,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMBLEMHEALTH/HIP-Medicaid, +39736,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMBLEMHEALTH/HIP-Medicaid, +39737,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMBLEMHEALTH/HIP-Medicaid, +39738,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMBLEMHEALTH/HIP-Medicaid, +39739,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMBLEMHEALTH/HIP-Medicaid, +39740,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMBLEMHEALTH/HIP-Medicaid, +39741,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMBLEMHEALTH/HIP-Medicaid, +39742,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMBLEMHEALTH/HIP-Medicaid, +39743,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMBLEMHEALTH/HIP-Medicaid, +39744,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMBLEMHEALTH/HIP-Medicaid, +39745,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMBLEMHEALTH/HIP-Medicaid, +39746,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMBLEMHEALTH/HIP-Medicaid, +39747,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMBLEMHEALTH/HIP-Medicaid, +39748,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMBLEMHEALTH/HIP-Medicaid, +39749,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMBLEMHEALTH/HIP-Medicaid, +39750,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMBLEMHEALTH/HIP-Medicaid, +39751,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMBLEMHEALTH/HIP-Medicaid, +39752,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMBLEMHEALTH/HIP-Medicaid, +39753,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMBLEMHEALTH/HIP-Medicaid, +39754,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMBLEMHEALTH/HIP-Medicaid, +39755,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMBLEMHEALTH/HIP-Medicaid,1392.04 +39756,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMBLEMHEALTH/HIP-Medicaid, +39757,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMBLEMHEALTH/HIP-Medicaid, +39758,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMBLEMHEALTH/HIP-Medicaid, +39759,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMBLEMHEALTH/HIP-Medicaid, +39760,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39761,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMBLEMHEALTH/HIP-Medicaid, +39762,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMBLEMHEALTH/HIP-Medicaid, +39763,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMBLEMHEALTH/HIP-Medicaid, +39764,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMBLEMHEALTH/HIP-Medicaid, +39765,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +39766,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMBLEMHEALTH/HIP-Medicaid,157.08 +39767,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMBLEMHEALTH/HIP-Medicaid, +39768,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMBLEMHEALTH/HIP-Medicaid, +39769,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMBLEMHEALTH/HIP-Medicaid, +39770,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39771,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMBLEMHEALTH/HIP-Medicaid, +39772,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMBLEMHEALTH/HIP-Medicaid, +39773,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMBLEMHEALTH/HIP-Medicaid, +39774,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMBLEMHEALTH/HIP-Medicaid, +39775,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMBLEMHEALTH/HIP-Medicaid, +39776,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMBLEMHEALTH/HIP-Medicaid, +39777,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMBLEMHEALTH/HIP-Medicaid, +39778,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMBLEMHEALTH/HIP-Medicaid, +39779,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMBLEMHEALTH/HIP-Medicaid, +39780,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMBLEMHEALTH/HIP-Medicaid, +39781,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMBLEMHEALTH/HIP-Medicaid, +39782,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMBLEMHEALTH/HIP-Medicaid, +39783,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMBLEMHEALTH/HIP-Medicaid, +39784,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMBLEMHEALTH/HIP-Medicaid, +39785,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMBLEMHEALTH/HIP-Medicaid, +39786,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMBLEMHEALTH/HIP-Medicaid, +39787,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicaid, +39788,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMBLEMHEALTH/HIP-Medicaid, +39789,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMBLEMHEALTH/HIP-Medicaid, +39790,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39791,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMBLEMHEALTH/HIP-Medicaid, +39792,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMBLEMHEALTH/HIP-Medicaid, +39793,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMBLEMHEALTH/HIP-Medicaid, +39794,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMBLEMHEALTH/HIP-Medicaid, +39795,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMBLEMHEALTH/HIP-Medicaid,1661.3 +39796,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMBLEMHEALTH/HIP-Medicaid, +39797,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMBLEMHEALTH/HIP-Medicaid, +39798,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMBLEMHEALTH/HIP-Medicaid, +39799,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMBLEMHEALTH/HIP-Medicaid, +39800,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMBLEMHEALTH/HIP-Medicaid, +39801,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMBLEMHEALTH/HIP-Medicaid, +39802,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMBLEMHEALTH/HIP-Medicaid, +39803,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMBLEMHEALTH/HIP-Medicaid, +39804,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMBLEMHEALTH/HIP-Medicaid, +39805,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMBLEMHEALTH/HIP-Medicaid,473.64 +39806,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMBLEMHEALTH/HIP-Medicaid, +39807,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMBLEMHEALTH/HIP-Medicaid, +39808,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMBLEMHEALTH/HIP-Medicaid, +39809,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMBLEMHEALTH/HIP-Medicaid, +39810,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMBLEMHEALTH/HIP-Medicaid, +39811,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMBLEMHEALTH/HIP-Medicaid, +39812,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMBLEMHEALTH/HIP-Medicaid, +39813,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMBLEMHEALTH/HIP-Medicaid,939.68 +39814,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMBLEMHEALTH/HIP-Medicaid, +39815,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMBLEMHEALTH/HIP-Medicaid, +39816,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMBLEMHEALTH/HIP-Medicaid, +39817,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMBLEMHEALTH/HIP-Medicaid,978.68 +39818,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMBLEMHEALTH/HIP-Medicaid, +39819,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMBLEMHEALTH/HIP-Medicaid,939.68 +39820,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMBLEMHEALTH/HIP-Medicaid, +39821,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMBLEMHEALTH/HIP-Medicaid, +39822,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMBLEMHEALTH/HIP-Medicaid, +39823,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMBLEMHEALTH/HIP-Medicaid,991.89 +39824,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMBLEMHEALTH/HIP-Medicaid, +39825,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMBLEMHEALTH/HIP-Medicaid, +39826,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMBLEMHEALTH/HIP-Medicaid, +39827,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMBLEMHEALTH/HIP-Medicaid,939.68 +39828,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMBLEMHEALTH/HIP-Medicaid, +39829,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMBLEMHEALTH/HIP-Medicaid, +39830,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMBLEMHEALTH/HIP-Medicaid,939.68 +39831,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMBLEMHEALTH/HIP-Medicaid, +39832,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMBLEMHEALTH/HIP-Medicaid, +39833,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMBLEMHEALTH/HIP-Medicaid, +39834,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMBLEMHEALTH/HIP-Medicaid, +39835,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMBLEMHEALTH/HIP-Medicaid, +39836,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMBLEMHEALTH/HIP-Medicaid, +39837,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMBLEMHEALTH/HIP-Medicaid, +39838,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMBLEMHEALTH/HIP-Medicaid, +39839,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMBLEMHEALTH/HIP-Medicaid, +39840,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMBLEMHEALTH/HIP-Medicaid, +39841,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMBLEMHEALTH/HIP-Medicaid, +39842,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMBLEMHEALTH/HIP-Medicaid, +39843,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMBLEMHEALTH/HIP-Medicaid, +39844,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMBLEMHEALTH/HIP-Medicaid, +39845,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMBLEMHEALTH/HIP-Medicaid, +39846,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMBLEMHEALTH/HIP-Medicaid, +39847,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMBLEMHEALTH/HIP-Medicaid, +39848,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMBLEMHEALTH/HIP-Medicaid, +39849,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMBLEMHEALTH/HIP-Medicaid, +39850,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMBLEMHEALTH/HIP-Medicaid, +39851,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMBLEMHEALTH/HIP-Medicaid, +39852,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMBLEMHEALTH/HIP-Medicaid, +39853,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMBLEMHEALTH/HIP-Medicaid, +39854,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMBLEMHEALTH/HIP-Medicaid, +39855,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMBLEMHEALTH/HIP-Medicaid, +39856,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMBLEMHEALTH/HIP-Medicaid,2701.45 +39857,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMBLEMHEALTH/HIP-Medicaid,3428.46 +39858,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +39859,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39860,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMBLEMHEALTH/HIP-Medicaid, +39861,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMBLEMHEALTH/HIP-Medicaid, +39862,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMBLEMHEALTH/HIP-Medicaid, +39863,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMBLEMHEALTH/HIP-Medicaid, +39864,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMBLEMHEALTH/HIP-Medicaid, +39865,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMBLEMHEALTH/HIP-Medicaid, +39866,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMBLEMHEALTH/HIP-Medicaid, +39867,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMBLEMHEALTH/HIP-Medicaid, +39868,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMBLEMHEALTH/HIP-Medicaid,939.68 +39869,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMBLEMHEALTH/HIP-Medicaid, +39870,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMBLEMHEALTH/HIP-Medicaid, +39871,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMBLEMHEALTH/HIP-Medicaid, +39872,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMBLEMHEALTH/HIP-Medicaid, +39873,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMBLEMHEALTH/HIP-Medicaid, +39874,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMBLEMHEALTH/HIP-Medicaid, +39875,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMBLEMHEALTH/HIP-Medicaid, +39876,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMBLEMHEALTH/HIP-Medicaid, +39877,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMBLEMHEALTH/HIP-Medicaid, +39878,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMBLEMHEALTH/HIP-Medicaid, +39879,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMBLEMHEALTH/HIP-Medicaid, +39880,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMBLEMHEALTH/HIP-Medicaid, +39881,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMBLEMHEALTH/HIP-Medicaid, +39882,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMBLEMHEALTH/HIP-Medicaid, +39883,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMBLEMHEALTH/HIP-Medicaid,2939.45 +39884,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMBLEMHEALTH/HIP-Medicaid, +39885,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMBLEMHEALTH/HIP-Medicaid, +39886,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMBLEMHEALTH/HIP-Medicaid, +39887,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMBLEMHEALTH/HIP-Medicaid, +39888,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMBLEMHEALTH/HIP-Medicaid, +39889,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMBLEMHEALTH/HIP-Medicaid,907.06 +39890,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMBLEMHEALTH/HIP-Medicaid, +39891,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMBLEMHEALTH/HIP-Medicaid, +39892,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMBLEMHEALTH/HIP-Medicaid, +39893,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMBLEMHEALTH/HIP-Medicaid, +39894,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMBLEMHEALTH/HIP-Medicaid, +39895,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMBLEMHEALTH/HIP-Medicaid, +39896,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMBLEMHEALTH/HIP-Medicaid, +39897,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMBLEMHEALTH/HIP-Medicaid, +39898,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMBLEMHEALTH/HIP-Medicaid, +39899,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMBLEMHEALTH/HIP-Medicaid, +39900,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMBLEMHEALTH/HIP-Medicaid, +39901,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMBLEMHEALTH/HIP-Medicaid,907.06 +39902,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMBLEMHEALTH/HIP-Medicaid, +39903,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMBLEMHEALTH/HIP-Medicaid,634.21 +39904,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMBLEMHEALTH/HIP-Medicaid, +39905,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMBLEMHEALTH/HIP-Medicaid, +39906,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMBLEMHEALTH/HIP-Medicaid, +39907,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMBLEMHEALTH/HIP-Medicaid,985.74 +39908,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMBLEMHEALTH/HIP-Medicaid, +39909,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMBLEMHEALTH/HIP-Medicaid, +39910,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMBLEMHEALTH/HIP-Medicaid, +39911,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMBLEMHEALTH/HIP-Medicaid, +39912,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +39913,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMBLEMHEALTH/HIP-Medicaid, +39914,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMBLEMHEALTH/HIP-Medicaid, +39915,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMBLEMHEALTH/HIP-Medicaid, +39916,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMBLEMHEALTH/HIP-Medicaid, +39917,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +39918,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMBLEMHEALTH/HIP-Medicaid, +39919,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMBLEMHEALTH/HIP-Medicaid, +39920,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMBLEMHEALTH/HIP-Medicaid,24411.75 +39921,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMBLEMHEALTH/HIP-Medicaid, +39922,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMBLEMHEALTH/HIP-Medicaid, +39923,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMBLEMHEALTH/HIP-Medicaid, +39924,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMBLEMHEALTH/HIP-Medicaid, +39925,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMBLEMHEALTH/HIP-Medicaid, +39926,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMBLEMHEALTH/HIP-Medicaid, +39927,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMBLEMHEALTH/HIP-Medicaid, +39928,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMBLEMHEALTH/HIP-Medicaid, +39929,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMBLEMHEALTH/HIP-Medicaid, +39930,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMBLEMHEALTH/HIP-Medicaid, +39931,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMBLEMHEALTH/HIP-Medicaid, +39932,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMBLEMHEALTH/HIP-Medicaid, +39933,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMBLEMHEALTH/HIP-Medicaid, +39934,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +39935,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMBLEMHEALTH/HIP-Medicaid, +39936,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMBLEMHEALTH/HIP-Medicaid, +39937,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +39938,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMBLEMHEALTH/HIP-Medicaid, +39939,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMBLEMHEALTH/HIP-Medicaid, +39940,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicaid, +39941,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMBLEMHEALTH/HIP-Medicaid, +39942,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMBLEMHEALTH/HIP-Medicaid, +39943,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +39944,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMBLEMHEALTH/HIP-Medicaid, +39945,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMBLEMHEALTH/HIP-Medicaid, +39946,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMBLEMHEALTH/HIP-Medicaid,5041.0 +39947,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMBLEMHEALTH/HIP-Medicaid, +39948,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMBLEMHEALTH/HIP-Medicaid, +39949,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMBLEMHEALTH/HIP-Medicaid, +39950,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMBLEMHEALTH/HIP-Medicaid, +39951,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMBLEMHEALTH/HIP-Medicaid, +39952,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMBLEMHEALTH/HIP-Medicaid, +39953,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMBLEMHEALTH/HIP-Medicaid, +39954,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMBLEMHEALTH/HIP-Medicaid, +39955,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMBLEMHEALTH/HIP-Medicaid, +39956,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMBLEMHEALTH/HIP-Medicaid, +39957,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMBLEMHEALTH/HIP-Medicaid, +39958,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMBLEMHEALTH/HIP-Medicaid, +39959,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMBLEMHEALTH/HIP-Medicaid,8192.0 +39960,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMBLEMHEALTH/HIP-Medicaid,8207.47 +39961,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMBLEMHEALTH/HIP-Medicaid, +39962,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMBLEMHEALTH/HIP-Medicaid, +39963,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMBLEMHEALTH/HIP-Medicaid, +39964,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMBLEMHEALTH/HIP-Medicaid, +39965,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMBLEMHEALTH/HIP-Medicaid, +39966,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMBLEMHEALTH/HIP-Medicaid,3071.08 +39967,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMBLEMHEALTH/HIP-Medicaid, +39968,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMBLEMHEALTH/HIP-Medicaid,5041.0 +39969,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMBLEMHEALTH/HIP-Medicaid, +39970,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMBLEMHEALTH/HIP-Medicaid, +39971,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMBLEMHEALTH/HIP-Medicaid, +39972,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMBLEMHEALTH/HIP-Medicaid, +39973,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMBLEMHEALTH/HIP-Medicaid, +39974,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMBLEMHEALTH/HIP-Medicaid, +39975,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMBLEMHEALTH/HIP-Medicaid, +39976,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +39977,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMBLEMHEALTH/HIP-Medicaid, +39978,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMBLEMHEALTH/HIP-Medicaid, +39979,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMBLEMHEALTH/HIP-Medicaid, +39980,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMBLEMHEALTH/HIP-Medicaid, +39981,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMBLEMHEALTH/HIP-Medicaid, +39982,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMBLEMHEALTH/HIP-Medicaid, +39983,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMBLEMHEALTH/HIP-Medicaid, +39984,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMBLEMHEALTH/HIP-Medicaid, +39985,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +39986,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMBLEMHEALTH/HIP-Medicaid, +39987,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMBLEMHEALTH/HIP-Medicaid, +39988,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMBLEMHEALTH/HIP-Medicaid, +39989,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMBLEMHEALTH/HIP-Medicaid, +39990,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMBLEMHEALTH/HIP-Medicaid, +39991,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMBLEMHEALTH/HIP-Medicaid, +39992,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMBLEMHEALTH/HIP-Medicaid, +39993,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMBLEMHEALTH/HIP-Medicaid, +39994,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMBLEMHEALTH/HIP-Medicaid, +39995,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMBLEMHEALTH/HIP-Medicaid, +39996,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMBLEMHEALTH/HIP-Medicaid, +39997,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMBLEMHEALTH/HIP-Medicaid,6002.56 +39998,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMBLEMHEALTH/HIP-Medicaid,8671.78 +39999,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMBLEMHEALTH/HIP-Medicaid, +40000,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMBLEMHEALTH/HIP-Medicaid, +40001,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMBLEMHEALTH/HIP-Medicaid,17645.0 +40002,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMBLEMHEALTH/HIP-Medicaid, +40003,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMBLEMHEALTH/HIP-Medicaid,6240.0 +40004,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMBLEMHEALTH/HIP-Medicaid, +40005,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMBLEMHEALTH/HIP-Medicaid,2621.73 +40006,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMBLEMHEALTH/HIP-Medicaid, +40007,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40008,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMBLEMHEALTH/HIP-Medicaid, +40009,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMBLEMHEALTH/HIP-Medicaid,6907.67 +40010,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMBLEMHEALTH/HIP-Medicaid,8192.0 +40011,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMBLEMHEALTH/HIP-Medicaid, +40012,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMBLEMHEALTH/HIP-Medicaid, +40013,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMBLEMHEALTH/HIP-Medicaid, +40014,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMBLEMHEALTH/HIP-Medicaid, +40015,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMBLEMHEALTH/HIP-Medicaid, +40016,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40017,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMBLEMHEALTH/HIP-Medicaid,8823.0 +40018,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMBLEMHEALTH/HIP-Medicaid, +40019,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMBLEMHEALTH/HIP-Medicaid, +40020,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMBLEMHEALTH/HIP-Medicaid, +40021,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMBLEMHEALTH/HIP-Medicaid, +40022,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40023,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMBLEMHEALTH/HIP-Medicaid,2552.67 +40024,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMBLEMHEALTH/HIP-Medicaid, +40025,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMBLEMHEALTH/HIP-Medicaid, +40026,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMBLEMHEALTH/HIP-Medicaid, +40027,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMBLEMHEALTH/HIP-Medicaid,2520.5 +40028,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMBLEMHEALTH/HIP-Medicaid, +40029,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMBLEMHEALTH/HIP-Medicaid, +40030,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMBLEMHEALTH/HIP-Medicaid, +40031,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMBLEMHEALTH/HIP-Medicaid, +40032,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMBLEMHEALTH/HIP-Medicaid, +40033,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMBLEMHEALTH/HIP-Medicaid,11103.0 +40034,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMBLEMHEALTH/HIP-Medicaid, +40035,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMBLEMHEALTH/HIP-Medicaid, +40036,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMBLEMHEALTH/HIP-Medicaid, +40037,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMBLEMHEALTH/HIP-Medicaid, +40038,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMBLEMHEALTH/HIP-Medicaid, +40039,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMBLEMHEALTH/HIP-Medicaid, +40040,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMBLEMHEALTH/HIP-Medicaid, +40041,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMBLEMHEALTH/HIP-Medicaid, +40042,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMBLEMHEALTH/HIP-Medicaid, +40043,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMBLEMHEALTH/HIP-Medicaid, +40044,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMBLEMHEALTH/HIP-Medicaid, +40045,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMBLEMHEALTH/HIP-Medicaid, +40046,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMBLEMHEALTH/HIP-Medicaid, +40047,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMBLEMHEALTH/HIP-Medicaid, +40048,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMBLEMHEALTH/HIP-Medicaid, +40049,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMBLEMHEALTH/HIP-Medicaid, +40050,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMBLEMHEALTH/HIP-Medicaid, +40051,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMBLEMHEALTH/HIP-Medicaid,2634.88 +40052,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMBLEMHEALTH/HIP-Medicaid, +40053,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMBLEMHEALTH/HIP-Medicaid, +40054,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMBLEMHEALTH/HIP-Medicaid, +40055,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMBLEMHEALTH/HIP-Medicaid, +40056,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMBLEMHEALTH/HIP-Medicaid, +40057,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMBLEMHEALTH/HIP-Medicaid, +40058,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMBLEMHEALTH/HIP-Medicaid, +40059,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMBLEMHEALTH/HIP-Medicaid,3655.0 +40060,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMBLEMHEALTH/HIP-Medicaid,2688.0 +40061,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMBLEMHEALTH/HIP-Medicaid, +40062,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMBLEMHEALTH/HIP-Medicaid, +40063,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMBLEMHEALTH/HIP-Medicaid,3796.0 +40064,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMBLEMHEALTH/HIP-Medicaid, +40065,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMBLEMHEALTH/HIP-Medicaid, +40066,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMBLEMHEALTH/HIP-Medicaid, +40067,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMBLEMHEALTH/HIP-Medicaid,6326.07 +40068,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMBLEMHEALTH/HIP-Medicaid,7310.0 +40069,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40070,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMBLEMHEALTH/HIP-Medicaid, +40071,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMBLEMHEALTH/HIP-Medicaid, +40072,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMBLEMHEALTH/HIP-Medicaid,3734.96 +40073,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMBLEMHEALTH/HIP-Medicaid, +40074,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMBLEMHEALTH/HIP-Medicaid, +40075,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMBLEMHEALTH/HIP-Medicaid, +40076,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMBLEMHEALTH/HIP-Medicaid, +40077,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMBLEMHEALTH/HIP-Medicaid, +40078,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMBLEMHEALTH/HIP-Medicaid, +40079,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMBLEMHEALTH/HIP-Medicaid, +40080,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMBLEMHEALTH/HIP-Medicaid, +40081,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMBLEMHEALTH/HIP-Medicaid, +40082,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMBLEMHEALTH/HIP-Medicaid, +40083,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMBLEMHEALTH/HIP-Medicaid,5244.17 +40084,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMBLEMHEALTH/HIP-Medicaid, +40085,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMBLEMHEALTH/HIP-Medicaid, +40086,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMBLEMHEALTH/HIP-Medicaid, +40087,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMBLEMHEALTH/HIP-Medicaid, +40088,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMBLEMHEALTH/HIP-Medicaid,9859.25 +40089,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMBLEMHEALTH/HIP-Medicaid, +40090,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMBLEMHEALTH/HIP-Medicaid, +40091,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMBLEMHEALTH/HIP-Medicaid,7310.0 +40092,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMBLEMHEALTH/HIP-Medicaid, +40093,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40094,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMBLEMHEALTH/HIP-Medicaid, +40095,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMBLEMHEALTH/HIP-Medicaid,7310.0 +40096,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMBLEMHEALTH/HIP-Medicaid, +40097,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMBLEMHEALTH/HIP-Medicaid, +40098,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMBLEMHEALTH/HIP-Medicaid, +40099,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +40100,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMBLEMHEALTH/HIP-Medicaid, +40101,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +40102,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMBLEMHEALTH/HIP-Medicaid, +40103,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMBLEMHEALTH/HIP-Medicaid, +40104,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMBLEMHEALTH/HIP-Medicaid, +40105,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMBLEMHEALTH/HIP-Medicaid, +40106,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMBLEMHEALTH/HIP-Medicaid, +40107,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMBLEMHEALTH/HIP-Medicaid, +40108,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMBLEMHEALTH/HIP-Medicaid, +40109,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMBLEMHEALTH/HIP-Medicaid, +40110,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMBLEMHEALTH/HIP-Medicaid, +40111,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMBLEMHEALTH/HIP-Medicaid, +40112,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +40113,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMBLEMHEALTH/HIP-Medicaid, +40114,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMBLEMHEALTH/HIP-Medicaid, +40115,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMBLEMHEALTH/HIP-Medicaid, +40116,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMBLEMHEALTH/HIP-Medicaid, +40117,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMBLEMHEALTH/HIP-Medicaid, +40118,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMBLEMHEALTH/HIP-Medicaid, +40119,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMBLEMHEALTH/HIP-Medicaid, +40120,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMBLEMHEALTH/HIP-Medicaid, +40121,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMBLEMHEALTH/HIP-Medicaid, +40122,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMBLEMHEALTH/HIP-Medicaid, +40123,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMBLEMHEALTH/HIP-Medicaid, +40124,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMBLEMHEALTH/HIP-Medicaid, +40125,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMBLEMHEALTH/HIP-Medicaid, +40126,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMBLEMHEALTH/HIP-Medicaid, +40127,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40128,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMBLEMHEALTH/HIP-Medicaid, +40129,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMBLEMHEALTH/HIP-Medicaid, +40130,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +40131,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMBLEMHEALTH/HIP-Medicaid, +40132,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMBLEMHEALTH/HIP-Medicaid, +40133,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMBLEMHEALTH/HIP-Medicaid, +40134,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMBLEMHEALTH/HIP-Medicaid, +40135,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMBLEMHEALTH/HIP-Medicaid,6303.0 +40136,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMBLEMHEALTH/HIP-Medicaid, +40137,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMBLEMHEALTH/HIP-Medicaid, +40138,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMBLEMHEALTH/HIP-Medicaid, +40139,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMBLEMHEALTH/HIP-Medicaid, +40140,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +40141,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMBLEMHEALTH/HIP-Medicaid, +40142,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMBLEMHEALTH/HIP-Medicaid, +40143,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMBLEMHEALTH/HIP-Medicaid, +40144,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMBLEMHEALTH/HIP-Medicaid, +40145,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMBLEMHEALTH/HIP-Medicaid, +40146,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMBLEMHEALTH/HIP-Medicaid, +40147,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMBLEMHEALTH/HIP-Medicaid, +40148,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +40149,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMBLEMHEALTH/HIP-Medicaid,5041.0 +40150,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMBLEMHEALTH/HIP-Medicaid, +40151,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMBLEMHEALTH/HIP-Medicaid, +40152,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMBLEMHEALTH/HIP-Medicaid, +40153,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMBLEMHEALTH/HIP-Medicaid, +40154,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40155,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMBLEMHEALTH/HIP-Medicaid, +40156,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMBLEMHEALTH/HIP-Medicaid,4848.5 +40157,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40158,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMBLEMHEALTH/HIP-Medicaid, +40159,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMBLEMHEALTH/HIP-Medicaid, +40160,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMBLEMHEALTH/HIP-Medicaid,5028.5 +40161,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMBLEMHEALTH/HIP-Medicaid, +40162,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMBLEMHEALTH/HIP-Medicaid, +40163,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMBLEMHEALTH/HIP-Medicaid, +40164,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMBLEMHEALTH/HIP-Medicaid, +40165,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMBLEMHEALTH/HIP-Medicaid, +40166,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMBLEMHEALTH/HIP-Medicaid, +40167,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMBLEMHEALTH/HIP-Medicaid, +40168,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMBLEMHEALTH/HIP-Medicaid, +40169,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMBLEMHEALTH/HIP-Medicaid, +40170,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMBLEMHEALTH/HIP-Medicaid, +40171,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMBLEMHEALTH/HIP-Medicaid, +40172,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMBLEMHEALTH/HIP-Medicaid, +40173,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMBLEMHEALTH/HIP-Medicaid, +40174,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMBLEMHEALTH/HIP-Medicaid, +40175,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMBLEMHEALTH/HIP-Medicaid, +40176,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMBLEMHEALTH/HIP-Medicaid, +40177,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMBLEMHEALTH/HIP-Medicaid, +40178,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +40179,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMBLEMHEALTH/HIP-Medicaid, +40180,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMBLEMHEALTH/HIP-Medicaid, +40181,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMBLEMHEALTH/HIP-Medicaid, +40182,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMBLEMHEALTH/HIP-Medicaid, +40183,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMBLEMHEALTH/HIP-Medicaid, +40184,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40185,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMBLEMHEALTH/HIP-Medicaid, +40186,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40187,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMBLEMHEALTH/HIP-Medicaid, +40188,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMBLEMHEALTH/HIP-Medicaid, +40189,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMBLEMHEALTH/HIP-Medicaid, +40190,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMBLEMHEALTH/HIP-Medicaid, +40191,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40192,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMBLEMHEALTH/HIP-Medicaid, +40193,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMBLEMHEALTH/HIP-Medicaid, +40194,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMBLEMHEALTH/HIP-Medicaid, +40195,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMBLEMHEALTH/HIP-Medicaid, +40196,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMBLEMHEALTH/HIP-Medicaid, +40197,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMBLEMHEALTH/HIP-Medicaid, +40198,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMBLEMHEALTH/HIP-Medicaid, +40199,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMBLEMHEALTH/HIP-Medicaid, +40200,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMBLEMHEALTH/HIP-Medicaid,7310.0 +40201,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMBLEMHEALTH/HIP-Medicaid, +40202,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMBLEMHEALTH/HIP-Medicaid, +40203,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMBLEMHEALTH/HIP-Medicaid, +40204,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMBLEMHEALTH/HIP-Medicaid, +40205,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMBLEMHEALTH/HIP-Medicaid, +40206,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMBLEMHEALTH/HIP-Medicaid, +40207,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMBLEMHEALTH/HIP-Medicaid, +40208,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMBLEMHEALTH/HIP-Medicaid, +40209,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMBLEMHEALTH/HIP-Medicaid, +40210,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +40211,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMBLEMHEALTH/HIP-Medicaid, +40212,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMBLEMHEALTH/HIP-Medicaid, +40213,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMBLEMHEALTH/HIP-Medicaid, +40214,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMBLEMHEALTH/HIP-Medicaid, +40215,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMBLEMHEALTH/HIP-Medicaid, +40216,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMBLEMHEALTH/HIP-Medicaid, +40217,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMBLEMHEALTH/HIP-Medicaid, +40218,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMBLEMHEALTH/HIP-Medicaid, +40219,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMBLEMHEALTH/HIP-Medicaid,2520.5 +40220,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMBLEMHEALTH/HIP-Medicaid, +40221,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40222,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMBLEMHEALTH/HIP-Medicaid, +40223,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMBLEMHEALTH/HIP-Medicaid, +40224,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMBLEMHEALTH/HIP-Medicaid, +40225,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMBLEMHEALTH/HIP-Medicaid, +40226,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMBLEMHEALTH/HIP-Medicaid,4575.0 +40227,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMBLEMHEALTH/HIP-Medicaid,3497.0 +40228,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMBLEMHEALTH/HIP-Medicaid, +40229,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMBLEMHEALTH/HIP-Medicaid, +40230,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMBLEMHEALTH/HIP-Medicaid, +40231,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMBLEMHEALTH/HIP-Medicaid, +40232,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMBLEMHEALTH/HIP-Medicaid,8823.0 +40233,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMBLEMHEALTH/HIP-Medicaid, +40234,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMBLEMHEALTH/HIP-Medicaid, +40235,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMBLEMHEALTH/HIP-Medicaid, +40236,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMBLEMHEALTH/HIP-Medicaid, +40237,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMBLEMHEALTH/HIP-Medicaid, +40238,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMBLEMHEALTH/HIP-Medicaid, +40239,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMBLEMHEALTH/HIP-Medicaid, +40240,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMBLEMHEALTH/HIP-Medicaid,4410.88 +40241,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMBLEMHEALTH/HIP-Medicaid, +40242,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMBLEMHEALTH/HIP-Medicaid, +40243,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMBLEMHEALTH/HIP-Medicaid,5193.0 +40244,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMBLEMHEALTH/HIP-Medicaid, +40245,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMBLEMHEALTH/HIP-Medicaid, +40246,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMBLEMHEALTH/HIP-Medicaid, +40247,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMBLEMHEALTH/HIP-Medicaid,7587.13 +40248,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMBLEMHEALTH/HIP-Medicaid,8823.0 +40249,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMBLEMHEALTH/HIP-Medicaid, +40250,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMBLEMHEALTH/HIP-Medicaid, +40251,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMBLEMHEALTH/HIP-Medicaid,8192.0 +40252,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMBLEMHEALTH/HIP-Medicaid,8192.0 +40253,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMBLEMHEALTH/HIP-Medicaid, +40254,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMBLEMHEALTH/HIP-Medicaid, +40255,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMBLEMHEALTH/HIP-Medicaid, +40256,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMBLEMHEALTH/HIP-Medicaid, +40257,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMBLEMHEALTH/HIP-Medicaid, +40258,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMBLEMHEALTH/HIP-Medicaid, +40259,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMBLEMHEALTH/HIP-Medicaid, +40260,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMBLEMHEALTH/HIP-Medicaid, +40261,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMBLEMHEALTH/HIP-Medicaid,3216.0 +40262,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMBLEMHEALTH/HIP-Medicaid, +40263,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMBLEMHEALTH/HIP-Medicaid, +40264,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMBLEMHEALTH/HIP-Medicaid,1350.99 +40265,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMBLEMHEALTH/HIP-Medicaid, +40266,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMBLEMHEALTH/HIP-Medicaid, +40267,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +40268,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMBLEMHEALTH/HIP-Medicaid, +40269,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMBLEMHEALTH/HIP-Medicaid, +40270,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40271,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMBLEMHEALTH/HIP-Medicaid, +40272,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +40273,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +40274,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMBLEMHEALTH/HIP-Medicaid, +40275,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMBLEMHEALTH/HIP-Medicaid,5016.0 +40276,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMBLEMHEALTH/HIP-Medicaid, +40277,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMBLEMHEALTH/HIP-Medicaid,5041.0 +40278,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMBLEMHEALTH/HIP-Medicaid, +40279,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMBLEMHEALTH/HIP-Medicaid, +40280,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +40281,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMBLEMHEALTH/HIP-Medicaid, +40282,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMBLEMHEALTH/HIP-Medicaid, +40283,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMBLEMHEALTH/HIP-Medicaid,2573.0 +40284,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMBLEMHEALTH/HIP-Medicaid, +40285,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMBLEMHEALTH/HIP-Medicaid,8192.0 +40286,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMBLEMHEALTH/HIP-Medicaid, +40287,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMBLEMHEALTH/HIP-Medicaid, +40288,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMBLEMHEALTH/HIP-Medicaid, +40289,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMBLEMHEALTH/HIP-Medicaid, +40290,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMBLEMHEALTH/HIP-Medicaid, +40291,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMBLEMHEALTH/HIP-Medicaid, +40292,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMBLEMHEALTH/HIP-Medicaid, +40293,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMBLEMHEALTH/HIP-Medicaid, +40294,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMBLEMHEALTH/HIP-Medicaid, +40295,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMBLEMHEALTH/HIP-Medicaid, +40296,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMBLEMHEALTH/HIP-Medicaid, +40297,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMBLEMHEALTH/HIP-Medicaid, +40298,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMBLEMHEALTH/HIP-Medicaid, +40299,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMBLEMHEALTH/HIP-Medicaid, +40300,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMBLEMHEALTH/HIP-Medicaid, +40301,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMBLEMHEALTH/HIP-Medicaid, +40302,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40303,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMBLEMHEALTH/HIP-Medicaid,9079.56 +40304,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMBLEMHEALTH/HIP-Medicaid,1277.0 +40305,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMBLEMHEALTH/HIP-Medicaid, +40306,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40307,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMBLEMHEALTH/HIP-Medicaid, +40308,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMBLEMHEALTH/HIP-Medicaid, +40309,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +40310,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMBLEMHEALTH/HIP-Medicaid, +40311,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMBLEMHEALTH/HIP-Medicaid, +40312,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMBLEMHEALTH/HIP-Medicaid, +40313,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMBLEMHEALTH/HIP-Medicaid, +40314,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMBLEMHEALTH/HIP-Medicaid, +40315,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMBLEMHEALTH/HIP-Medicaid, +40316,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMBLEMHEALTH/HIP-Medicaid, +40317,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMBLEMHEALTH/HIP-Medicaid, +40318,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMBLEMHEALTH/HIP-Medicaid, +40319,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMBLEMHEALTH/HIP-Medicaid, +40320,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMBLEMHEALTH/HIP-Medicaid, +40321,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicaid, +40322,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMBLEMHEALTH/HIP-Medicaid,8571.0 +40323,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMBLEMHEALTH/HIP-Medicaid, +40324,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMBLEMHEALTH/HIP-Medicaid, +40325,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMBLEMHEALTH/HIP-Medicaid, +40326,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMBLEMHEALTH/HIP-Medicaid, +40327,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMBLEMHEALTH/HIP-Medicaid, +40328,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMBLEMHEALTH/HIP-Medicaid, +40329,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMBLEMHEALTH/HIP-Medicaid, +40330,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMBLEMHEALTH/HIP-Medicaid, +40331,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMBLEMHEALTH/HIP-Medicaid, +40332,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMBLEMHEALTH/HIP-Medicaid, +40333,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMBLEMHEALTH/HIP-Medicaid, +40334,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMBLEMHEALTH/HIP-Medicaid, +40335,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMBLEMHEALTH/HIP-Medicaid, +40336,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMBLEMHEALTH/HIP-Medicaid, +40337,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMBLEMHEALTH/HIP-Medicaid,100.0 +40338,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMBLEMHEALTH/HIP-Medicaid, +40339,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMBLEMHEALTH/HIP-Medicaid, +40340,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMBLEMHEALTH/HIP-Medicaid,3592.0 +40341,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMBLEMHEALTH/HIP-Medicaid, +40342,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMBLEMHEALTH/HIP-Medicaid, +40343,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMBLEMHEALTH/HIP-Medicaid, +40344,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMBLEMHEALTH/HIP-Medicaid,3074.04 +40345,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40346,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMBLEMHEALTH/HIP-Medicaid, +40347,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40348,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMBLEMHEALTH/HIP-Medicaid, +40349,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMBLEMHEALTH/HIP-Medicaid, +40350,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMBLEMHEALTH/HIP-Medicaid, +40351,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMBLEMHEALTH/HIP-Medicaid, +40352,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMBLEMHEALTH/HIP-Medicaid,6617.25 +40353,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMBLEMHEALTH/HIP-Medicaid, +40354,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMBLEMHEALTH/HIP-Medicaid, +40355,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMBLEMHEALTH/HIP-Medicaid,6261.0 +40356,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMBLEMHEALTH/HIP-Medicaid, +40357,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMBLEMHEALTH/HIP-Medicaid,5663.5 +40358,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMBLEMHEALTH/HIP-Medicaid, +40359,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMBLEMHEALTH/HIP-Medicaid,1796.0 +40360,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMBLEMHEALTH/HIP-Medicaid,898.0 +40361,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMBLEMHEALTH/HIP-Medicaid, +40362,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMBLEMHEALTH/HIP-Medicaid, +40363,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMBLEMHEALTH/HIP-Medicaid, +40364,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMBLEMHEALTH/HIP-Medicaid, +40365,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMBLEMHEALTH/HIP-Medicaid, +40366,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMBLEMHEALTH/HIP-Medicaid, +40367,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMBLEMHEALTH/HIP-Medicaid, +40368,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMBLEMHEALTH/HIP-Medicaid, +40369,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMBLEMHEALTH/HIP-Medicaid, +40370,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMBLEMHEALTH/HIP-Medicaid, +40371,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMBLEMHEALTH/HIP-Medicaid, +40372,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMBLEMHEALTH/HIP-Medicaid, +40373,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMBLEMHEALTH/HIP-Medicaid, +40374,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40375,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMBLEMHEALTH/HIP-Medicaid, +40376,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMBLEMHEALTH/HIP-Medicaid, +40377,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMBLEMHEALTH/HIP-Medicaid, +40378,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMBLEMHEALTH/HIP-Medicaid, +40379,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMBLEMHEALTH/HIP-Medicaid, +40380,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMBLEMHEALTH/HIP-Medicaid, +40381,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMBLEMHEALTH/HIP-Medicaid,4410.88 +40382,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMBLEMHEALTH/HIP-Medicaid, +40383,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMBLEMHEALTH/HIP-Medicaid, +40384,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-Medicaid, +40385,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +40386,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMBLEMHEALTH/HIP-Medicaid, +40387,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMBLEMHEALTH/HIP-Medicaid, +40388,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMBLEMHEALTH/HIP-Medicaid, +40389,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMBLEMHEALTH/HIP-Medicaid, +40390,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMBLEMHEALTH/HIP-Medicaid, +40391,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMBLEMHEALTH/HIP-Medicaid, +40392,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicaid, +40393,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMBLEMHEALTH/HIP-Medicaid, +40394,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMBLEMHEALTH/HIP-Medicaid, +40395,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMBLEMHEALTH/HIP-Medicaid, +40396,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMBLEMHEALTH/HIP-Medicaid, +40397,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMBLEMHEALTH/HIP-Medicaid, +40398,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMBLEMHEALTH/HIP-Medicaid, +40399,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMBLEMHEALTH/HIP-Medicaid, +40400,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMBLEMHEALTH/HIP-Medicaid, +40401,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMBLEMHEALTH/HIP-Medicaid, +40402,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMBLEMHEALTH/HIP-Medicaid,200.0 +40403,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMBLEMHEALTH/HIP-Medicaid, +40404,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMBLEMHEALTH/HIP-Medicaid, +40405,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMBLEMHEALTH/HIP-Medicaid, +40406,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMBLEMHEALTH/HIP-Medicaid, +40407,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMBLEMHEALTH/HIP-Medicaid, +40408,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMBLEMHEALTH/HIP-Medicaid, +40409,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMBLEMHEALTH/HIP-Medicaid, +40410,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMBLEMHEALTH/HIP-Medicaid, +40411,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMBLEMHEALTH/HIP-Medicaid, +40412,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMBLEMHEALTH/HIP-Medicaid, +40413,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMBLEMHEALTH/HIP-Medicaid, +40414,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMBLEMHEALTH/HIP-Medicaid, +40415,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMBLEMHEALTH/HIP-Medicaid, +40416,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMBLEMHEALTH/HIP-Medicaid, +40417,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-Medicaid, +40418,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMBLEMHEALTH/HIP-Medicaid, +40419,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMBLEMHEALTH/HIP-Medicaid, +40420,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMBLEMHEALTH/HIP-Medicaid, +40421,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMBLEMHEALTH/HIP-Medicaid, +40422,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMBLEMHEALTH/HIP-Medicaid, +40423,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMBLEMHEALTH/HIP-Medicaid, +40424,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMBLEMHEALTH/HIP-Medicaid, +40425,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMBLEMHEALTH/HIP-Medicaid, +40426,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMBLEMHEALTH/HIP-Medicaid, +40427,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMBLEMHEALTH/HIP-Medicaid, +40428,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMBLEMHEALTH/HIP-Medicaid, +40429,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMBLEMHEALTH/HIP-Medicaid,7310.0 +40430,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicaid,5041.0 +40431,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMBLEMHEALTH/HIP-Medicaid, +40432,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMBLEMHEALTH/HIP-Medicaid, +40433,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMBLEMHEALTH/HIP-Medicaid, +40434,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-Medicaid, +40435,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMBLEMHEALTH/HIP-Medicaid, +40436,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMBLEMHEALTH/HIP-Medicaid, +40437,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMBLEMHEALTH/HIP-Medicaid, +40438,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMBLEMHEALTH/HIP-Medicaid, +40439,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMBLEMHEALTH/HIP-Medicaid, +40440,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMBLEMHEALTH/HIP-Medicaid, +40441,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMBLEMHEALTH/HIP-Medicaid, +40442,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMBLEMHEALTH/HIP-Medicaid, +40443,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMBLEMHEALTH/HIP-Medicaid, +40444,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMBLEMHEALTH/HIP-Medicaid, +40445,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMBLEMHEALTH/HIP-Medicaid,4410.88 +40446,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMBLEMHEALTH/HIP-Medicaid, +40447,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMBLEMHEALTH/HIP-Medicaid, +40448,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMBLEMHEALTH/HIP-Medicaid, +40449,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMBLEMHEALTH/HIP-Medicaid, +40450,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMBLEMHEALTH/HIP-Medicaid, +40451,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMBLEMHEALTH/HIP-Medicaid, +40452,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMBLEMHEALTH/HIP-Medicaid, +40453,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMBLEMHEALTH/HIP-Medicaid, +40454,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMBLEMHEALTH/HIP-Medicaid, +40455,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMBLEMHEALTH/HIP-Medicaid, +40456,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMBLEMHEALTH/HIP-Medicaid, +40457,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMBLEMHEALTH/HIP-Medicaid, +40458,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMBLEMHEALTH/HIP-Medicaid, +40459,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMBLEMHEALTH/HIP-Medicaid, +40460,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicaid, +40461,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMBLEMHEALTH/HIP-Medicaid, +40462,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMBLEMHEALTH/HIP-Medicaid, +40463,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMBLEMHEALTH/HIP-Medicaid, +40464,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMBLEMHEALTH/HIP-Medicaid, +40465,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMBLEMHEALTH/HIP-Medicaid, +40466,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMBLEMHEALTH/HIP-Medicaid, +40467,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMBLEMHEALTH/HIP-Medicaid,9726.05 +40468,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMBLEMHEALTH/HIP-Medicaid, +40469,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMBLEMHEALTH/HIP-Medicaid, +40470,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMBLEMHEALTH/HIP-Medicaid, +40471,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMBLEMHEALTH/HIP-Medicaid, +40472,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMBLEMHEALTH/HIP-Medicaid, +40473,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMBLEMHEALTH/HIP-Medicaid, +40474,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMBLEMHEALTH/HIP-Medicaid, +40475,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMBLEMHEALTH/HIP-Medicaid, +40476,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMBLEMHEALTH/HIP-Medicaid, +40477,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMBLEMHEALTH/HIP-Medicaid, +40478,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMBLEMHEALTH/HIP-Medicaid, +40479,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMBLEMHEALTH/HIP-Medicaid, +40480,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMBLEMHEALTH/HIP-Medicaid, +40481,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40482,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMBLEMHEALTH/HIP-Medicaid, +40483,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicaid, +40484,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMBLEMHEALTH/HIP-Medicaid, +40485,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40486,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMBLEMHEALTH/HIP-Medicaid, +40487,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMBLEMHEALTH/HIP-Medicaid, +40488,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMBLEMHEALTH/HIP-Medicaid, +40489,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMBLEMHEALTH/HIP-Medicaid, +40490,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMBLEMHEALTH/HIP-Medicaid, +40491,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMBLEMHEALTH/HIP-Medicaid, +40492,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMBLEMHEALTH/HIP-Medicaid, +40493,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMBLEMHEALTH/HIP-Medicaid, +40494,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMBLEMHEALTH/HIP-Medicaid, +40495,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMBLEMHEALTH/HIP-Medicaid, +40496,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMBLEMHEALTH/HIP-Medicaid, +40497,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMBLEMHEALTH/HIP-Medicaid,2495.5 +40498,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMBLEMHEALTH/HIP-Medicaid, +40499,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMBLEMHEALTH/HIP-Medicaid, +40500,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMBLEMHEALTH/HIP-Medicaid, +40501,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMBLEMHEALTH/HIP-Medicaid, +40502,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMBLEMHEALTH/HIP-Medicaid, +40503,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMBLEMHEALTH/HIP-Medicaid, +40504,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMBLEMHEALTH/HIP-Medicaid, +40505,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMBLEMHEALTH/HIP-Medicaid, +40506,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMBLEMHEALTH/HIP-Medicaid, +40507,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMBLEMHEALTH/HIP-Medicaid, +40508,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMBLEMHEALTH/HIP-Medicaid, +40509,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMBLEMHEALTH/HIP-Medicaid, +40510,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMBLEMHEALTH/HIP-Medicaid, +40511,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMBLEMHEALTH/HIP-Medicaid, +40512,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMBLEMHEALTH/HIP-Medicaid, +40513,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMBLEMHEALTH/HIP-Medicaid, +40514,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMBLEMHEALTH/HIP-Medicaid, +40515,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMBLEMHEALTH/HIP-Medicaid, +40516,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMBLEMHEALTH/HIP-Medicaid, +40517,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMBLEMHEALTH/HIP-Medicaid, +40518,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMBLEMHEALTH/HIP-Medicaid, +40519,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMBLEMHEALTH/HIP-Medicaid, +40520,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMBLEMHEALTH/HIP-Medicaid, +40521,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMBLEMHEALTH/HIP-Medicaid, +40522,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMBLEMHEALTH/HIP-Medicaid, +40523,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMBLEMHEALTH/HIP-Medicaid, +40524,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMBLEMHEALTH/HIP-Medicaid, +40525,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMBLEMHEALTH/HIP-Medicaid, +40526,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMBLEMHEALTH/HIP-Medicaid, +40527,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMBLEMHEALTH/HIP-Medicaid, +40528,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMBLEMHEALTH/HIP-Medicaid, +40529,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMBLEMHEALTH/HIP-Medicaid, +40530,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMBLEMHEALTH/HIP-Medicaid,7310.0 +40531,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMBLEMHEALTH/HIP-Medicaid, +40532,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMBLEMHEALTH/HIP-Medicaid, +40533,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMBLEMHEALTH/HIP-Medicaid, +40534,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMBLEMHEALTH/HIP-Medicaid, +40535,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMBLEMHEALTH/HIP-Medicaid, +40536,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMBLEMHEALTH/HIP-Medicaid, +40537,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMBLEMHEALTH/HIP-Medicaid, +40538,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMBLEMHEALTH/HIP-Medicaid, +40539,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMBLEMHEALTH/HIP-Medicaid, +40540,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMBLEMHEALTH/HIP-Medicaid,504.0 +40541,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMBLEMHEALTH/HIP-Medicaid, +40542,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMBLEMHEALTH/HIP-Medicaid, +40543,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMBLEMHEALTH/HIP-Medicaid, +40544,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMBLEMHEALTH/HIP-Medicaid, +40545,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMBLEMHEALTH/HIP-Medicaid,1614.5 +40546,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMBLEMHEALTH/HIP-Medicaid, +40547,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMBLEMHEALTH/HIP-Medicaid, +40548,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMBLEMHEALTH/HIP-Medicaid, +40549,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMBLEMHEALTH/HIP-Medicaid, +40550,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMBLEMHEALTH/HIP-Medicaid, +40551,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMBLEMHEALTH/HIP-Medicaid, +40552,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMBLEMHEALTH/HIP-Medicaid, +40553,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMBLEMHEALTH/HIP-Medicaid, +40554,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMBLEMHEALTH/HIP-Medicaid, +40555,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMBLEMHEALTH/HIP-Medicaid,6175.0 +40556,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMBLEMHEALTH/HIP-Medicaid, +40557,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMBLEMHEALTH/HIP-Medicaid,3237.0 +40558,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMBLEMHEALTH/HIP-Medicaid, +40559,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMBLEMHEALTH/HIP-Medicaid, +40560,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMBLEMHEALTH/HIP-Medicaid, +40561,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMBLEMHEALTH/HIP-Medicaid, +40562,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMBLEMHEALTH/HIP-Medicaid, +40563,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMBLEMHEALTH/HIP-Medicaid, +40564,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMBLEMHEALTH/HIP-Medicaid, +40565,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMBLEMHEALTH/HIP-Medicaid, +40566,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMBLEMHEALTH/HIP-Medicaid,4349.3 +40567,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMBLEMHEALTH/HIP-Medicaid, +40568,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMBLEMHEALTH/HIP-Medicaid,4245.89 +40569,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMBLEMHEALTH/HIP-Medicaid, +40570,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMBLEMHEALTH/HIP-Medicaid,589.37 +40571,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMBLEMHEALTH/HIP-Medicaid,548.71 +40572,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMBLEMHEALTH/HIP-Medicaid, +40573,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMBLEMHEALTH/HIP-Medicaid, +40574,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMBLEMHEALTH/HIP-Medicaid, +40575,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMBLEMHEALTH/HIP-Medicaid, +40576,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMBLEMHEALTH/HIP-Medicaid, +40577,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMBLEMHEALTH/HIP-Medicaid, +40578,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMBLEMHEALTH/HIP-Medicaid,1739.72 +40579,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMBLEMHEALTH/HIP-Medicaid,4050.1 +40580,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMBLEMHEALTH/HIP-Medicaid, +40581,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMBLEMHEALTH/HIP-Medicaid,422.5 +40582,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMBLEMHEALTH/HIP-Medicaid,4512.67 +40583,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMBLEMHEALTH/HIP-Medicaid, +40584,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMBLEMHEALTH/HIP-Medicaid, +40585,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMBLEMHEALTH/HIP-Medicaid, +40586,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMBLEMHEALTH/HIP-Medicaid, +40587,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMBLEMHEALTH/HIP-Medicaid,512.13 +40588,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMBLEMHEALTH/HIP-Medicaid,456.5 +40589,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMBLEMHEALTH/HIP-Medicaid, +40590,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMBLEMHEALTH/HIP-Medicaid,572.5 +40591,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMBLEMHEALTH/HIP-Medicaid, +40592,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMBLEMHEALTH/HIP-Medicaid, +40593,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMBLEMHEALTH/HIP-Medicaid,196.9 +40594,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMBLEMHEALTH/HIP-Medicaid,437.2 +40595,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMBLEMHEALTH/HIP-Medicaid, +40596,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMBLEMHEALTH/HIP-Medicaid, +40597,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMBLEMHEALTH/HIP-Medicaid,440.92 +40598,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMBLEMHEALTH/HIP-Medicaid, +40599,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMBLEMHEALTH/HIP-Medicaid, +40600,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMBLEMHEALTH/HIP-Medicaid,4348.0 +40601,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMBLEMHEALTH/HIP-Medicaid, +40602,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMBLEMHEALTH/HIP-Medicaid, +40603,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMBLEMHEALTH/HIP-Medicaid, +40604,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMBLEMHEALTH/HIP-Medicaid, +40605,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMBLEMHEALTH/HIP-Medicaid, +40606,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMBLEMHEALTH/HIP-Medicaid, +40607,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMBLEMHEALTH/HIP-Medicaid, +40608,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMBLEMHEALTH/HIP-Medicaid, +40609,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMBLEMHEALTH/HIP-Medicaid,83.86 +40610,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMBLEMHEALTH/HIP-Medicaid, +40611,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMBLEMHEALTH/HIP-Medicaid,2597.4 +40612,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMBLEMHEALTH/HIP-Medicaid, +40613,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMBLEMHEALTH/HIP-Medicaid, +40614,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMBLEMHEALTH/HIP-Medicaid, +40615,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMBLEMHEALTH/HIP-Medicaid, +40616,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMBLEMHEALTH/HIP-Medicaid,219.91 +40617,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMBLEMHEALTH/HIP-Medicaid, +40618,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMBLEMHEALTH/HIP-Medicaid, +40619,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMBLEMHEALTH/HIP-Medicaid,1189.5 +40620,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMBLEMHEALTH/HIP-Medicaid, +40621,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMBLEMHEALTH/HIP-Medicaid, +40622,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMBLEMHEALTH/HIP-Medicaid, +40623,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMBLEMHEALTH/HIP-Medicaid,2935.0 +40624,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMBLEMHEALTH/HIP-Medicaid, +40625,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMBLEMHEALTH/HIP-Medicaid, +40626,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMBLEMHEALTH/HIP-Medicaid,360.5 +40627,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMBLEMHEALTH/HIP-Medicaid, +40628,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMBLEMHEALTH/HIP-Medicaid, +40629,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMBLEMHEALTH/HIP-Medicaid,328.87 +40630,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMBLEMHEALTH/HIP-Medicaid, +40631,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMBLEMHEALTH/HIP-Medicaid,269.5 +40632,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMBLEMHEALTH/HIP-Medicaid, +40633,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMBLEMHEALTH/HIP-Medicaid,284.5 +40634,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMBLEMHEALTH/HIP-Medicaid,275.0 +40635,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMBLEMHEALTH/HIP-Medicaid, +40636,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMBLEMHEALTH/HIP-Medicaid,395.1 +40637,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMBLEMHEALTH/HIP-Medicaid, +40638,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMBLEMHEALTH/HIP-Medicaid,502.33 +40639,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMBLEMHEALTH/HIP-Medicaid,294.23 +40640,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMBLEMHEALTH/HIP-Medicaid, +40641,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMBLEMHEALTH/HIP-Medicaid, +40642,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMBLEMHEALTH/HIP-Medicaid, +40643,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMBLEMHEALTH/HIP-Medicaid, +40644,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMBLEMHEALTH/HIP-Medicaid, +40645,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMBLEMHEALTH/HIP-Medicaid,2047.0 +40646,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMBLEMHEALTH/HIP-Medicaid, +40647,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMBLEMHEALTH/HIP-Medicaid,1026.5 +40648,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMBLEMHEALTH/HIP-Medicaid,401.57 +40649,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMBLEMHEALTH/HIP-Medicaid, +40650,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMBLEMHEALTH/HIP-Medicaid, +40651,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMBLEMHEALTH/HIP-Medicaid,326.0 +40652,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMBLEMHEALTH/HIP-Medicaid, +40653,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMBLEMHEALTH/HIP-Medicaid, +40654,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMBLEMHEALTH/HIP-Medicaid,296.25 +40655,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMBLEMHEALTH/HIP-Medicaid,389.38 +40656,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMBLEMHEALTH/HIP-Medicaid,323.5 +40657,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMBLEMHEALTH/HIP-Medicaid,590.35 +40658,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMBLEMHEALTH/HIP-Medicaid, +40659,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMBLEMHEALTH/HIP-Medicaid,380.9 +40660,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMBLEMHEALTH/HIP-Medicaid, +40661,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMBLEMHEALTH/HIP-Medicaid,434.0 +40662,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMBLEMHEALTH/HIP-Medicaid,382.67 +40663,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMBLEMHEALTH/HIP-Medicaid, +40664,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMBLEMHEALTH/HIP-Medicaid,394.78 +40665,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMBLEMHEALTH/HIP-Medicaid,332.0 +40666,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMBLEMHEALTH/HIP-Medicaid,314.0 +40667,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMBLEMHEALTH/HIP-Medicaid, +40668,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMBLEMHEALTH/HIP-Medicaid, +40669,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMBLEMHEALTH/HIP-Medicaid, +40670,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMBLEMHEALTH/HIP-Medicaid,4281.25 +40671,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMBLEMHEALTH/HIP-Medicaid, +40672,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMBLEMHEALTH/HIP-Medicaid,3622.75 +40673,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMBLEMHEALTH/HIP-Medicaid,3096.0 +40674,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMBLEMHEALTH/HIP-Medicaid, +40675,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMBLEMHEALTH/HIP-Medicaid, +40676,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMBLEMHEALTH/HIP-Medicaid,41.67 +40677,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMBLEMHEALTH/HIP-Medicaid, +40678,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMBLEMHEALTH/HIP-Medicaid, +40679,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMBLEMHEALTH/HIP-Medicaid, +40680,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMBLEMHEALTH/HIP-Medicaid,2673.5 +40681,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMBLEMHEALTH/HIP-Medicaid, +40682,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMBLEMHEALTH/HIP-Medicaid,3916.5 +40683,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMBLEMHEALTH/HIP-Medicaid,4066.92 +40684,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMBLEMHEALTH/HIP-Medicaid,3564.0 +40685,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMBLEMHEALTH/HIP-Medicaid, +40686,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMBLEMHEALTH/HIP-Medicaid,3679.5 +40687,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMBLEMHEALTH/HIP-Medicaid, +40688,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMBLEMHEALTH/HIP-Medicaid, +40689,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMBLEMHEALTH/HIP-Medicaid, +40690,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMBLEMHEALTH/HIP-Medicaid, +40691,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMBLEMHEALTH/HIP-Medicaid,576.75 +40692,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMBLEMHEALTH/HIP-Medicaid,435.5 +40693,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMBLEMHEALTH/HIP-Medicaid, +40694,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMBLEMHEALTH/HIP-Medicaid, +40695,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMBLEMHEALTH/HIP-Medicaid, +40696,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMBLEMHEALTH/HIP-Medicaid, +40697,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMBLEMHEALTH/HIP-Medicaid,486.0 +40698,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMBLEMHEALTH/HIP-Medicaid, +40699,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMBLEMHEALTH/HIP-Medicaid, +40700,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMBLEMHEALTH/HIP-Medicaid, +40701,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMBLEMHEALTH/HIP-Medicaid, +40702,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMBLEMHEALTH/HIP-Medicaid, +40703,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMBLEMHEALTH/HIP-Medicaid, +40704,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMBLEMHEALTH/HIP-Medicaid, +40705,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMBLEMHEALTH/HIP-Medicaid,816.5 +40706,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMBLEMHEALTH/HIP-Medicaid,1799.0 +40707,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMBLEMHEALTH/HIP-Medicaid, +40708,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMBLEMHEALTH/HIP-Medicaid, +40709,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMBLEMHEALTH/HIP-Medicaid, +40710,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMBLEMHEALTH/HIP-Medicaid,3332.8 +40711,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMBLEMHEALTH/HIP-Medicaid, +40712,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMBLEMHEALTH/HIP-Medicaid,642.91 +40713,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMBLEMHEALTH/HIP-Medicaid,2003.89 +40714,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMBLEMHEALTH/HIP-Medicaid, +40715,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMBLEMHEALTH/HIP-Medicaid, +40716,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMBLEMHEALTH/HIP-Medicaid, +40717,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMBLEMHEALTH/HIP-Medicaid, +40718,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMBLEMHEALTH/HIP-Medicaid, +40719,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMBLEMHEALTH/HIP-Medicaid, +40720,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMBLEMHEALTH/HIP-Medicaid, +40721,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMBLEMHEALTH/HIP-Medicaid, +40722,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMBLEMHEALTH/HIP-Medicaid, +40723,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMBLEMHEALTH/HIP-Medicaid, +40724,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMBLEMHEALTH/HIP-Medicaid, +40725,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMBLEMHEALTH/HIP-Medicaid, +40726,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMBLEMHEALTH/HIP-Medicaid, +40727,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMBLEMHEALTH/HIP-Medicaid, +40728,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMBLEMHEALTH/HIP-Medicaid, +40729,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMBLEMHEALTH/HIP-Medicaid, +40730,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMBLEMHEALTH/HIP-Medicaid, +40731,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMBLEMHEALTH/HIP-Medicaid, +40732,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMBLEMHEALTH/HIP-Medicaid, +40733,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMBLEMHEALTH/HIP-Medicaid, +40734,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMBLEMHEALTH/HIP-Medicaid,482.31 +40735,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMBLEMHEALTH/HIP-Medicaid,1435.0 +40736,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMBLEMHEALTH/HIP-Medicaid,802.33 +40737,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMBLEMHEALTH/HIP-Medicaid, +40738,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMBLEMHEALTH/HIP-Medicaid, +40739,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMBLEMHEALTH/HIP-Medicaid, +40740,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMBLEMHEALTH/HIP-Medicaid, +40741,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMBLEMHEALTH/HIP-Medicaid, +40742,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMBLEMHEALTH/HIP-Medicaid, +40743,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMBLEMHEALTH/HIP-Medicaid, +40744,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMBLEMHEALTH/HIP-Medicaid, +40745,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMBLEMHEALTH/HIP-Medicaid,888.5 +40746,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMBLEMHEALTH/HIP-Medicaid, +40747,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMBLEMHEALTH/HIP-Medicaid,1260.0 +40748,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMBLEMHEALTH/HIP-Medicaid,447.77 +40749,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMBLEMHEALTH/HIP-Medicaid,607.0 +40750,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMBLEMHEALTH/HIP-Medicaid,848.03 +40751,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMBLEMHEALTH/HIP-Medicaid, +40752,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMBLEMHEALTH/HIP-Medicaid,616.0 +40753,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMBLEMHEALTH/HIP-Medicaid, +40754,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMBLEMHEALTH/HIP-Medicaid, +40755,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMBLEMHEALTH/HIP-Medicaid, +40756,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMBLEMHEALTH/HIP-Medicaid, +40757,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMBLEMHEALTH/HIP-Medicaid, +40758,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMBLEMHEALTH/HIP-Medicaid, +40759,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMBLEMHEALTH/HIP-Medicaid, +40760,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMBLEMHEALTH/HIP-Medicaid, +40761,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMBLEMHEALTH/HIP-Medicaid, +40762,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMBLEMHEALTH/HIP-Medicaid,140.4 +40763,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMBLEMHEALTH/HIP-Medicaid, +40764,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMBLEMHEALTH/HIP-Medicaid, +40765,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMBLEMHEALTH/HIP-Medicaid, +40766,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMBLEMHEALTH/HIP-Medicaid, +40767,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMBLEMHEALTH/HIP-Medicaid, +40768,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMBLEMHEALTH/HIP-Medicaid,1883.88 +40769,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMBLEMHEALTH/HIP-Medicaid, +40770,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMBLEMHEALTH/HIP-Medicaid,2483.0 +40771,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMBLEMHEALTH/HIP-Medicaid, +40772,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMBLEMHEALTH/HIP-Medicaid, +40773,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMBLEMHEALTH/HIP-Medicaid,1833.0 +40774,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMBLEMHEALTH/HIP-Medicaid, +40775,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Medicaid, +40776,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMBLEMHEALTH/HIP-Medicaid, +40777,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMBLEMHEALTH/HIP-Medicaid, +40778,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMBLEMHEALTH/HIP-Medicaid,569.0 +40779,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMBLEMHEALTH/HIP-Medicaid, +40780,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMBLEMHEALTH/HIP-Medicaid, +40781,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMBLEMHEALTH/HIP-Medicaid, +40782,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMBLEMHEALTH/HIP-Medicaid, +40783,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMBLEMHEALTH/HIP-Medicaid,348.5 +40784,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMBLEMHEALTH/HIP-Medicaid,351.0 +40785,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMBLEMHEALTH/HIP-Medicaid, +40786,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMBLEMHEALTH/HIP-Medicaid, +40787,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMBLEMHEALTH/HIP-Medicaid, +40788,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMBLEMHEALTH/HIP-Medicaid, +40789,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMBLEMHEALTH/HIP-Medicaid, +40790,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMBLEMHEALTH/HIP-Medicaid, +40791,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMBLEMHEALTH/HIP-Medicaid, +40792,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMBLEMHEALTH/HIP-Medicaid, +40793,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMBLEMHEALTH/HIP-Medicaid,2102.7 +40794,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMBLEMHEALTH/HIP-Medicaid, +40795,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMBLEMHEALTH/HIP-Medicaid,792.49 +40796,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMBLEMHEALTH/HIP-Medicaid,1306.07 +40797,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMBLEMHEALTH/HIP-Medicaid,584.18 +40798,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMBLEMHEALTH/HIP-Medicaid,617.36 +40799,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMBLEMHEALTH/HIP-Medicaid,1352.5 +40800,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMBLEMHEALTH/HIP-Medicaid,461.42 +40801,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMBLEMHEALTH/HIP-Medicaid,681.0 +40802,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMBLEMHEALTH/HIP-Medicaid,390.83 +40803,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMBLEMHEALTH/HIP-Medicaid, +40804,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMBLEMHEALTH/HIP-Medicaid, +40805,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMBLEMHEALTH/HIP-Medicaid,1315.79 +40806,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMBLEMHEALTH/HIP-Medicaid, +40807,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMBLEMHEALTH/HIP-Medicaid,1150.75 +40808,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMBLEMHEALTH/HIP-Medicaid,1833.83 +40809,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMBLEMHEALTH/HIP-Medicaid, +40810,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMBLEMHEALTH/HIP-Medicaid,9268.5 +40811,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMBLEMHEALTH/HIP-Medicaid,8038.75 +40812,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMBLEMHEALTH/HIP-Medicaid,11137.0 +40813,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMBLEMHEALTH/HIP-Medicaid,4715.5 +40814,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMBLEMHEALTH/HIP-Medicaid, +40815,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMBLEMHEALTH/HIP-Medicaid, +40816,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Medicaid, +40817,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMBLEMHEALTH/HIP-Medicaid, +40818,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMBLEMHEALTH/HIP-Medicaid,1566.5 +40819,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMBLEMHEALTH/HIP-Medicaid, +40820,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMBLEMHEALTH/HIP-Medicaid,2830.83 +40821,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMBLEMHEALTH/HIP-Medicaid,2128.22 +40822,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMBLEMHEALTH/HIP-Medicaid,10955.75 +40823,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMBLEMHEALTH/HIP-Medicaid, +40824,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMBLEMHEALTH/HIP-Medicaid, +40825,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMBLEMHEALTH/HIP-Medicaid,6034.75 +40826,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMBLEMHEALTH/HIP-Medicaid,1433.11 +40827,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMBLEMHEALTH/HIP-Medicaid,1749.54 +40828,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMBLEMHEALTH/HIP-Medicaid,543.0 +40829,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMBLEMHEALTH/HIP-Medicaid, +40830,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMBLEMHEALTH/HIP-Medicaid, +40831,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMBLEMHEALTH/HIP-Medicaid,864.31 +40832,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMBLEMHEALTH/HIP-Medicaid, +40833,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMBLEMHEALTH/HIP-Medicaid, +40834,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMBLEMHEALTH/HIP-Medicaid, +40835,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMBLEMHEALTH/HIP-Medicaid, +40836,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMBLEMHEALTH/HIP-Medicaid, +40837,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Medicaid, +40838,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMBLEMHEALTH/HIP-Medicaid, +40839,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMBLEMHEALTH/HIP-Medicaid, +40840,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMBLEMHEALTH/HIP-Medicaid,696.61 +40841,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMBLEMHEALTH/HIP-Medicaid, +40842,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMBLEMHEALTH/HIP-Medicaid, +40843,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMBLEMHEALTH/HIP-Medicaid,979.0 +40844,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMBLEMHEALTH/HIP-Medicaid, +40845,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMBLEMHEALTH/HIP-Medicaid, +40846,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMBLEMHEALTH/HIP-Medicaid, +40847,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMBLEMHEALTH/HIP-Medicaid,1852.5 +40848,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMBLEMHEALTH/HIP-Medicaid, +40849,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMBLEMHEALTH/HIP-Medicaid, +40850,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMBLEMHEALTH/HIP-Medicaid, +40851,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMBLEMHEALTH/HIP-Medicaid, +40852,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMBLEMHEALTH/HIP-Medicaid,4736.94 +40853,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMBLEMHEALTH/HIP-Medicaid, +40854,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMBLEMHEALTH/HIP-Medicaid, +40855,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMBLEMHEALTH/HIP-Medicaid, +40856,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMBLEMHEALTH/HIP-Medicaid, +40857,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMBLEMHEALTH/HIP-Medicaid, +40858,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMBLEMHEALTH/HIP-Medicaid, +40859,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMBLEMHEALTH/HIP-Medicaid, +40860,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMBLEMHEALTH/HIP-Medicaid, +40861,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMBLEMHEALTH/HIP-Medicaid, +40862,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMBLEMHEALTH/HIP-Medicaid, +40863,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMBLEMHEALTH/HIP-Medicaid, +40864,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMBLEMHEALTH/HIP-Medicaid,1292.5 +40865,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMBLEMHEALTH/HIP-Medicaid, +40866,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMBLEMHEALTH/HIP-Medicaid, +40867,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMBLEMHEALTH/HIP-Medicaid, +40868,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMBLEMHEALTH/HIP-Medicaid, +40869,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMBLEMHEALTH/HIP-Medicaid,11077.5 +40870,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMBLEMHEALTH/HIP-Medicaid,6166.5 +40871,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMBLEMHEALTH/HIP-Medicaid,6530.0 +40872,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMBLEMHEALTH/HIP-Medicaid,5714.75 +40873,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMBLEMHEALTH/HIP-Medicaid,5816.0 +40874,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMBLEMHEALTH/HIP-Medicaid,2946.5 +40875,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMBLEMHEALTH/HIP-Medicaid, +40876,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMBLEMHEALTH/HIP-Medicaid, +40877,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMBLEMHEALTH/HIP-Medicaid, +40878,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMBLEMHEALTH/HIP-Medicaid, +40879,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMBLEMHEALTH/HIP-Medicaid, +40880,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMBLEMHEALTH/HIP-Medicaid,285.18 +40881,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMBLEMHEALTH/HIP-Medicaid, +40882,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMBLEMHEALTH/HIP-Medicaid,1215.5 +40883,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +40884,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMBLEMHEALTH/HIP-Medicaid,300.33 +40885,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMBLEMHEALTH/HIP-Medicaid, +40886,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMBLEMHEALTH/HIP-Medicaid, +40887,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMBLEMHEALTH/HIP-Medicaid,48.13 +40888,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMBLEMHEALTH/HIP-Medicaid, +40889,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMBLEMHEALTH/HIP-Medicaid, +40890,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMBLEMHEALTH/HIP-Medicaid, +40891,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMBLEMHEALTH/HIP-Medicaid, +40892,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMBLEMHEALTH/HIP-Medicaid, +40893,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMBLEMHEALTH/HIP-Medicaid, +40894,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMBLEMHEALTH/HIP-Medicaid, +40895,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMBLEMHEALTH/HIP-Medicaid, +40896,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMBLEMHEALTH/HIP-Medicaid, +40897,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMBLEMHEALTH/HIP-Medicaid, +40898,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMBLEMHEALTH/HIP-Medicaid, +40899,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMBLEMHEALTH/HIP-Medicaid, +40900,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMBLEMHEALTH/HIP-Medicaid, +40901,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMBLEMHEALTH/HIP-Medicaid, +40902,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMBLEMHEALTH/HIP-Medicaid,25.0 +40903,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMBLEMHEALTH/HIP-Medicaid, +40904,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMBLEMHEALTH/HIP-Medicaid, +40905,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMBLEMHEALTH/HIP-Medicaid, +40906,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMBLEMHEALTH/HIP-Medicaid, +40907,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMBLEMHEALTH/HIP-Medicaid, +40908,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMBLEMHEALTH/HIP-Medicaid, +40909,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMBLEMHEALTH/HIP-Medicaid,20.5 +40910,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMBLEMHEALTH/HIP-Medicaid, +40911,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMBLEMHEALTH/HIP-Medicaid, +40912,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMBLEMHEALTH/HIP-Medicaid, +40913,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMBLEMHEALTH/HIP-Medicaid,13.22 +40914,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMBLEMHEALTH/HIP-Medicaid, +40915,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMBLEMHEALTH/HIP-Medicaid, +40916,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMBLEMHEALTH/HIP-Medicaid, +40917,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMBLEMHEALTH/HIP-Medicaid, +40918,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMBLEMHEALTH/HIP-Medicaid, +40919,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMBLEMHEALTH/HIP-Medicaid,209.0 +40920,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMBLEMHEALTH/HIP-Medicaid,11.37 +40921,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMBLEMHEALTH/HIP-Medicaid, +40922,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicaid, +40923,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMBLEMHEALTH/HIP-Medicaid,11.37 +40924,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMBLEMHEALTH/HIP-Medicaid, +40925,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMBLEMHEALTH/HIP-Medicaid, +40926,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMBLEMHEALTH/HIP-Medicaid, +40927,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicaid, +40928,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMBLEMHEALTH/HIP-Medicaid, +40929,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicaid, +40930,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMBLEMHEALTH/HIP-Medicaid, +40931,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicaid, +40932,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicaid, +40933,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicaid, +40934,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMBLEMHEALTH/HIP-Medicaid, +40935,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMBLEMHEALTH/HIP-Medicaid, +40936,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMBLEMHEALTH/HIP-Medicaid,49.1 +40937,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +40938,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMBLEMHEALTH/HIP-Medicaid,97.37 +40939,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMBLEMHEALTH/HIP-Medicaid, +40940,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMBLEMHEALTH/HIP-Medicaid, +40941,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMBLEMHEALTH/HIP-Medicaid, +40942,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Medicaid, +40943,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Medicaid, +40944,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Medicaid, +40945,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-Medicaid, +40946,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-Medicaid, +40947,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMBLEMHEALTH/HIP-Medicaid, +40948,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMBLEMHEALTH/HIP-Medicaid, +40949,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMBLEMHEALTH/HIP-Medicaid, +40950,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMBLEMHEALTH/HIP-Medicaid, +40951,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMBLEMHEALTH/HIP-Medicaid, +40952,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMBLEMHEALTH/HIP-Medicaid, +40953,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMBLEMHEALTH/HIP-Medicaid, +40954,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMBLEMHEALTH/HIP-Medicaid, +40955,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMBLEMHEALTH/HIP-Medicaid, +40956,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMBLEMHEALTH/HIP-Medicaid, +40957,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMBLEMHEALTH/HIP-Medicaid, +40958,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMBLEMHEALTH/HIP-Medicaid, +40959,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMBLEMHEALTH/HIP-Medicaid, +40960,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMBLEMHEALTH/HIP-Medicaid, +40961,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMBLEMHEALTH/HIP-Medicaid, +40962,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMBLEMHEALTH/HIP-Medicaid, +40963,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMBLEMHEALTH/HIP-Medicaid, +40964,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMBLEMHEALTH/HIP-Medicaid, +40965,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMBLEMHEALTH/HIP-Medicaid, +40966,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMBLEMHEALTH/HIP-Medicaid, +40967,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMBLEMHEALTH/HIP-Medicaid,25.0 +40968,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMBLEMHEALTH/HIP-Medicaid, +40969,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMBLEMHEALTH/HIP-Medicaid, +40970,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMBLEMHEALTH/HIP-Medicaid, +40971,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMBLEMHEALTH/HIP-Medicaid, +40972,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMBLEMHEALTH/HIP-Medicaid, +40973,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMBLEMHEALTH/HIP-Medicaid, +40974,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMBLEMHEALTH/HIP-Medicaid, +40975,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMBLEMHEALTH/HIP-Medicaid, +40976,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMBLEMHEALTH/HIP-Medicaid, +40977,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMBLEMHEALTH/HIP-Medicaid, +40978,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMBLEMHEALTH/HIP-Medicaid, +40979,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMBLEMHEALTH/HIP-Medicaid, +40980,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMBLEMHEALTH/HIP-Medicaid, +40981,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMBLEMHEALTH/HIP-Medicaid, +40982,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMBLEMHEALTH/HIP-Medicaid,1923.5 +40983,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMBLEMHEALTH/HIP-Medicaid, +40984,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMBLEMHEALTH/HIP-Medicaid, +40985,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMBLEMHEALTH/HIP-Medicaid, +40986,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMBLEMHEALTH/HIP-Medicaid, +40987,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMBLEMHEALTH/HIP-Medicaid, +40988,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMBLEMHEALTH/HIP-Medicaid, +40989,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMBLEMHEALTH/HIP-Medicaid, +40990,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMBLEMHEALTH/HIP-Medicaid, +40991,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMBLEMHEALTH/HIP-Medicaid, +40992,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMBLEMHEALTH/HIP-Medicaid, +40993,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMBLEMHEALTH/HIP-Medicaid, +40994,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMBLEMHEALTH/HIP-Medicaid, +40995,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMBLEMHEALTH/HIP-Medicaid, +40996,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMBLEMHEALTH/HIP-Medicaid, +40997,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMBLEMHEALTH/HIP-Medicaid, +40998,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMBLEMHEALTH/HIP-Medicaid, +40999,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMBLEMHEALTH/HIP-Medicaid, +41000,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMBLEMHEALTH/HIP-Medicaid, +41001,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMBLEMHEALTH/HIP-Medicaid, +41002,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMBLEMHEALTH/HIP-Medicaid, +41003,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMBLEMHEALTH/HIP-Medicaid, +41004,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMBLEMHEALTH/HIP-Medicaid, +41005,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMBLEMHEALTH/HIP-Medicaid, +41006,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMBLEMHEALTH/HIP-Medicaid, +41007,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMBLEMHEALTH/HIP-Medicaid, +41008,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMBLEMHEALTH/HIP-Medicaid, +41009,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMBLEMHEALTH/HIP-Medicaid, +41010,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMBLEMHEALTH/HIP-Medicaid, +41011,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMBLEMHEALTH/HIP-Medicaid, +41012,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMBLEMHEALTH/HIP-Medicaid, +41013,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMBLEMHEALTH/HIP-Medicaid, +41014,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMBLEMHEALTH/HIP-Medicaid, +41015,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMBLEMHEALTH/HIP-Medicaid, +41016,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMBLEMHEALTH/HIP-Medicaid, +41017,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMBLEMHEALTH/HIP-Medicaid, +41018,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMBLEMHEALTH/HIP-Medicaid, +41019,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMBLEMHEALTH/HIP-Medicaid, +41020,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMBLEMHEALTH/HIP-Medicaid,635.0 +41021,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMBLEMHEALTH/HIP-Medicaid, +41022,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMBLEMHEALTH/HIP-Medicaid, +41023,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMBLEMHEALTH/HIP-Medicaid, +41024,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMBLEMHEALTH/HIP-Medicaid, +41025,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMBLEMHEALTH/HIP-Medicaid, +41026,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMBLEMHEALTH/HIP-Medicaid, +41027,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMBLEMHEALTH/HIP-Medicaid, +41028,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMBLEMHEALTH/HIP-Medicaid, +41029,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMBLEMHEALTH/HIP-Medicaid,292.0 +41030,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMBLEMHEALTH/HIP-Medicaid, +41031,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMBLEMHEALTH/HIP-Medicaid, +41032,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMBLEMHEALTH/HIP-Medicaid,193.5 +41033,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMBLEMHEALTH/HIP-Medicaid, +41034,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMBLEMHEALTH/HIP-Medicaid, +41035,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMBLEMHEALTH/HIP-Medicaid, +41036,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMBLEMHEALTH/HIP-Medicaid, +41037,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMBLEMHEALTH/HIP-Medicaid, +41038,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMBLEMHEALTH/HIP-Medicaid, +41039,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMBLEMHEALTH/HIP-Medicaid, +41040,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMBLEMHEALTH/HIP-Medicaid, +41041,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMBLEMHEALTH/HIP-Medicaid, +41042,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMBLEMHEALTH/HIP-Medicaid, +41043,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMBLEMHEALTH/HIP-Medicaid, +41044,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMBLEMHEALTH/HIP-Medicaid,18.18 +41045,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMBLEMHEALTH/HIP-Medicaid, +41046,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMBLEMHEALTH/HIP-Medicaid, +41047,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMBLEMHEALTH/HIP-Medicaid, +41048,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMBLEMHEALTH/HIP-Medicaid, +41049,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMBLEMHEALTH/HIP-Medicaid, +41050,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMBLEMHEALTH/HIP-Medicaid, +41051,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMBLEMHEALTH/HIP-Medicaid, +41052,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMBLEMHEALTH/HIP-Medicaid,25.0 +41053,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMBLEMHEALTH/HIP-Medicaid, +41054,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMBLEMHEALTH/HIP-Medicaid, +41055,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMBLEMHEALTH/HIP-Medicaid, +41056,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMBLEMHEALTH/HIP-Medicaid,46.5 +41057,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMBLEMHEALTH/HIP-Medicaid, +41058,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMBLEMHEALTH/HIP-Medicaid,25.0 +41059,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMBLEMHEALTH/HIP-Medicaid, +41060,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMBLEMHEALTH/HIP-Medicaid, +41061,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMBLEMHEALTH/HIP-Medicaid, +41062,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMBLEMHEALTH/HIP-Medicaid, +41063,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMBLEMHEALTH/HIP-Medicaid, +41064,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMBLEMHEALTH/HIP-Medicaid, +41065,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMBLEMHEALTH/HIP-Medicaid, +41066,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMBLEMHEALTH/HIP-Medicaid,20.47 +41067,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMBLEMHEALTH/HIP-Medicaid, +41068,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMBLEMHEALTH/HIP-Medicaid, +41069,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMBLEMHEALTH/HIP-Medicaid, +41070,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMBLEMHEALTH/HIP-Medicaid, +41071,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMBLEMHEALTH/HIP-Medicaid, +41072,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMBLEMHEALTH/HIP-Medicaid, +41073,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMBLEMHEALTH/HIP-Medicaid, +41074,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMBLEMHEALTH/HIP-Medicaid, +41075,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMBLEMHEALTH/HIP-Medicaid, +41076,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMBLEMHEALTH/HIP-Medicaid, +41077,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMBLEMHEALTH/HIP-Medicaid, +41078,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMBLEMHEALTH/HIP-Medicaid, +41079,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMBLEMHEALTH/HIP-Medicaid, +41080,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMBLEMHEALTH/HIP-Medicaid,19.25 +41081,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMBLEMHEALTH/HIP-Medicaid,25.0 +41082,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMBLEMHEALTH/HIP-Medicaid,25.0 +41083,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMBLEMHEALTH/HIP-Medicaid, +41084,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMBLEMHEALTH/HIP-Medicaid, +41085,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMBLEMHEALTH/HIP-Medicaid, +41086,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMBLEMHEALTH/HIP-Medicaid,47.59 +41087,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMBLEMHEALTH/HIP-Medicaid, +41088,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMBLEMHEALTH/HIP-Medicaid, +41089,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMBLEMHEALTH/HIP-Medicaid, +41090,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMBLEMHEALTH/HIP-Medicaid,416.23 +41091,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMBLEMHEALTH/HIP-Medicaid, +41092,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMBLEMHEALTH/HIP-Medicaid, +41093,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMBLEMHEALTH/HIP-Medicaid, +41094,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMBLEMHEALTH/HIP-Medicaid, +41095,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMBLEMHEALTH/HIP-Medicaid, +41096,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMBLEMHEALTH/HIP-Medicaid, +41097,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMBLEMHEALTH/HIP-Medicaid, +41098,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMBLEMHEALTH/HIP-Medicaid, +41099,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMBLEMHEALTH/HIP-Medicaid, +41100,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMBLEMHEALTH/HIP-Medicaid,384.5 +41101,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMBLEMHEALTH/HIP-Medicaid, +41102,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMBLEMHEALTH/HIP-Medicaid, +41103,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMBLEMHEALTH/HIP-Medicaid, +41104,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMBLEMHEALTH/HIP-Medicaid, +41105,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMBLEMHEALTH/HIP-Medicaid, +41106,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMBLEMHEALTH/HIP-Medicaid, +41107,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMBLEMHEALTH/HIP-Medicaid, +41108,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMBLEMHEALTH/HIP-Medicaid,66.89 +41109,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMBLEMHEALTH/HIP-Medicaid, +41110,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMBLEMHEALTH/HIP-Medicaid,29.9 +41111,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMBLEMHEALTH/HIP-Medicaid, +41112,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMBLEMHEALTH/HIP-Medicaid,175.17 +41113,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMBLEMHEALTH/HIP-Medicaid, +41114,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMBLEMHEALTH/HIP-Medicaid, +41115,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMBLEMHEALTH/HIP-Medicaid, +41116,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMBLEMHEALTH/HIP-Medicaid, +41117,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMBLEMHEALTH/HIP-Medicaid, +41118,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMBLEMHEALTH/HIP-Medicaid,34.16 +41119,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMBLEMHEALTH/HIP-Medicaid, +41120,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMBLEMHEALTH/HIP-Medicaid, +41121,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMBLEMHEALTH/HIP-Medicaid, +41122,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMBLEMHEALTH/HIP-Medicaid, +41123,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMBLEMHEALTH/HIP-Medicaid, +41124,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMBLEMHEALTH/HIP-Medicaid, +41125,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMBLEMHEALTH/HIP-Medicaid, +41126,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMBLEMHEALTH/HIP-Medicaid, +41127,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMBLEMHEALTH/HIP-Medicaid, +41128,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMBLEMHEALTH/HIP-Medicaid, +41129,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMBLEMHEALTH/HIP-Medicaid, +41130,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMBLEMHEALTH/HIP-Medicaid, +41131,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMBLEMHEALTH/HIP-Medicaid, +41132,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMBLEMHEALTH/HIP-Medicaid, +41133,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMBLEMHEALTH/HIP-Medicaid, +41134,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMBLEMHEALTH/HIP-Medicaid, +41135,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMBLEMHEALTH/HIP-Medicaid, +41136,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMBLEMHEALTH/HIP-Medicaid, +41137,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMBLEMHEALTH/HIP-Medicaid, +41138,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMBLEMHEALTH/HIP-Medicaid, +41139,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMBLEMHEALTH/HIP-Medicaid, +41140,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMBLEMHEALTH/HIP-Medicaid, +41141,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMBLEMHEALTH/HIP-Medicaid, +41142,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMBLEMHEALTH/HIP-Medicaid, +41143,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMBLEMHEALTH/HIP-Medicaid, +41144,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMBLEMHEALTH/HIP-Medicaid, +41145,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMBLEMHEALTH/HIP-Medicaid, +41146,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMBLEMHEALTH/HIP-Medicaid, +41147,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMBLEMHEALTH/HIP-Medicaid, +41148,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMBLEMHEALTH/HIP-Medicaid, +41149,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMBLEMHEALTH/HIP-Medicaid,6.32 +41150,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMBLEMHEALTH/HIP-Medicaid,81.76 +41151,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMBLEMHEALTH/HIP-Medicaid,18.98 +41152,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMBLEMHEALTH/HIP-Medicaid, +41153,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMBLEMHEALTH/HIP-Medicaid, +41154,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMBLEMHEALTH/HIP-Medicaid, +41155,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMBLEMHEALTH/HIP-Medicaid,74.49 +41156,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMBLEMHEALTH/HIP-Medicaid, +41157,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMBLEMHEALTH/HIP-Medicaid, +41158,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMBLEMHEALTH/HIP-Medicaid, +41159,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMBLEMHEALTH/HIP-Medicaid, +41160,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMBLEMHEALTH/HIP-Medicaid,60.85 +41161,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMBLEMHEALTH/HIP-Medicaid, +41162,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMBLEMHEALTH/HIP-Medicaid, +41163,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMBLEMHEALTH/HIP-Medicaid, +41164,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMBLEMHEALTH/HIP-Medicaid, +41165,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMBLEMHEALTH/HIP-Medicaid, +41166,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMBLEMHEALTH/HIP-Medicaid, +41167,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMBLEMHEALTH/HIP-Medicaid, +41168,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMBLEMHEALTH/HIP-Medicaid, +41169,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMBLEMHEALTH/HIP-Medicaid,16.37 +41170,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMBLEMHEALTH/HIP-Medicaid, +41171,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMBLEMHEALTH/HIP-Medicaid, +41172,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMBLEMHEALTH/HIP-Medicaid, +41173,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMBLEMHEALTH/HIP-Medicaid, +41174,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMBLEMHEALTH/HIP-Medicaid, +41175,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMBLEMHEALTH/HIP-Medicaid,153.15 +41176,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMBLEMHEALTH/HIP-Medicaid, +41177,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMBLEMHEALTH/HIP-Medicaid, +41178,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMBLEMHEALTH/HIP-Medicaid, +41179,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMBLEMHEALTH/HIP-Medicaid, +41180,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMBLEMHEALTH/HIP-Medicaid, +41181,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMBLEMHEALTH/HIP-Medicaid,26.5 +41182,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMBLEMHEALTH/HIP-Medicaid, +41183,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMBLEMHEALTH/HIP-Medicaid, +41184,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMBLEMHEALTH/HIP-Medicaid, +41185,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMBLEMHEALTH/HIP-Medicaid,14.13 +41186,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMBLEMHEALTH/HIP-Medicaid, +41187,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMBLEMHEALTH/HIP-Medicaid, +41188,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMBLEMHEALTH/HIP-Medicaid, +41189,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMBLEMHEALTH/HIP-Medicaid, +41190,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMBLEMHEALTH/HIP-Medicaid, +41191,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMBLEMHEALTH/HIP-Medicaid, +41192,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMBLEMHEALTH/HIP-Medicaid, +41193,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMBLEMHEALTH/HIP-Medicaid, +41194,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMBLEMHEALTH/HIP-Medicaid, +41195,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMBLEMHEALTH/HIP-Medicaid,150.0 +41196,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMBLEMHEALTH/HIP-Medicaid, +41197,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMBLEMHEALTH/HIP-Medicaid, +41198,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMBLEMHEALTH/HIP-Medicaid, +41199,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMBLEMHEALTH/HIP-Medicaid, +41200,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMBLEMHEALTH/HIP-Medicaid, +41201,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMBLEMHEALTH/HIP-Medicaid, +41202,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMBLEMHEALTH/HIP-Medicaid,40.29 +41203,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMBLEMHEALTH/HIP-Medicaid,9.85 +41204,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMBLEMHEALTH/HIP-Medicaid, +41205,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMBLEMHEALTH/HIP-Medicaid, +41206,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMBLEMHEALTH/HIP-Medicaid, +41207,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMBLEMHEALTH/HIP-Medicaid, +41208,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMBLEMHEALTH/HIP-Medicaid, +41209,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMBLEMHEALTH/HIP-Medicaid, +41210,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMBLEMHEALTH/HIP-Medicaid, +41211,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMBLEMHEALTH/HIP-Medicaid, +41212,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMBLEMHEALTH/HIP-Medicaid, +41213,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMBLEMHEALTH/HIP-Medicaid, +41214,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMBLEMHEALTH/HIP-Medicaid, +41215,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMBLEMHEALTH/HIP-Medicaid, +41216,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMBLEMHEALTH/HIP-Medicaid, +41217,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMBLEMHEALTH/HIP-Medicaid,3.5 +41218,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMBLEMHEALTH/HIP-Medicaid, +41219,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMBLEMHEALTH/HIP-Medicaid, +41220,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMBLEMHEALTH/HIP-Medicaid, +41221,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMBLEMHEALTH/HIP-Medicaid, +41222,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMBLEMHEALTH/HIP-Medicaid, +41223,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMBLEMHEALTH/HIP-Medicaid, +41224,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMBLEMHEALTH/HIP-Medicaid, +41225,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMBLEMHEALTH/HIP-Medicaid, +41226,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMBLEMHEALTH/HIP-Medicaid, +41227,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMBLEMHEALTH/HIP-Medicaid, +41228,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMBLEMHEALTH/HIP-Medicaid, +41229,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMBLEMHEALTH/HIP-Medicaid,18.5 +41230,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMBLEMHEALTH/HIP-Medicaid,138.43 +41231,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMBLEMHEALTH/HIP-Medicaid, +41232,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMBLEMHEALTH/HIP-Medicaid,17.9 +41233,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMBLEMHEALTH/HIP-Medicaid, +41234,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMBLEMHEALTH/HIP-Medicaid, +41235,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMBLEMHEALTH/HIP-Medicaid, +41236,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMBLEMHEALTH/HIP-Medicaid, +41237,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMBLEMHEALTH/HIP-Medicaid,8.4 +41238,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMBLEMHEALTH/HIP-Medicaid, +41239,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMBLEMHEALTH/HIP-Medicaid, +41240,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMBLEMHEALTH/HIP-Medicaid, +41241,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMBLEMHEALTH/HIP-Medicaid, +41242,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMBLEMHEALTH/HIP-Medicaid, +41243,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMBLEMHEALTH/HIP-Medicaid,122.69 +41244,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMBLEMHEALTH/HIP-Medicaid, +41245,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMBLEMHEALTH/HIP-Medicaid, +41246,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMBLEMHEALTH/HIP-Medicaid, +41247,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMBLEMHEALTH/HIP-Medicaid,6.59 +41248,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMBLEMHEALTH/HIP-Medicaid, +41249,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMBLEMHEALTH/HIP-Medicaid, +41250,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMBLEMHEALTH/HIP-Medicaid, +41251,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMBLEMHEALTH/HIP-Medicaid, +41252,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMBLEMHEALTH/HIP-Medicaid, +41253,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMBLEMHEALTH/HIP-Medicaid, +41254,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMBLEMHEALTH/HIP-Medicaid, +41255,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMBLEMHEALTH/HIP-Medicaid, +41256,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMBLEMHEALTH/HIP-Medicaid, +41257,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMBLEMHEALTH/HIP-Medicaid,147.56 +41258,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMBLEMHEALTH/HIP-Medicaid, +41259,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMBLEMHEALTH/HIP-Medicaid,6.68 +41260,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMBLEMHEALTH/HIP-Medicaid, +41261,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMBLEMHEALTH/HIP-Medicaid, +41262,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMBLEMHEALTH/HIP-Medicaid,45.0 +41263,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMBLEMHEALTH/HIP-Medicaid,44.0 +41264,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMBLEMHEALTH/HIP-Medicaid,90.01 +41265,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMBLEMHEALTH/HIP-Medicaid,49.04 +41266,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMBLEMHEALTH/HIP-Medicaid, +41267,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMBLEMHEALTH/HIP-Medicaid,3.6 +41268,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMBLEMHEALTH/HIP-Medicaid, +41269,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMBLEMHEALTH/HIP-Medicaid, +41270,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMBLEMHEALTH/HIP-Medicaid, +41271,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMBLEMHEALTH/HIP-Medicaid, +41272,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMBLEMHEALTH/HIP-Medicaid, +41273,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMBLEMHEALTH/HIP-Medicaid, +41274,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMBLEMHEALTH/HIP-Medicaid, +41275,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMBLEMHEALTH/HIP-Medicaid, +41276,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMBLEMHEALTH/HIP-Medicaid, +41277,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMBLEMHEALTH/HIP-Medicaid, +41278,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMBLEMHEALTH/HIP-Medicaid, +41279,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMBLEMHEALTH/HIP-Medicaid, +41280,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMBLEMHEALTH/HIP-Medicaid, +41281,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMBLEMHEALTH/HIP-Medicaid, +41282,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMBLEMHEALTH/HIP-Medicaid, +41283,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMBLEMHEALTH/HIP-Medicaid, +41284,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMBLEMHEALTH/HIP-Medicaid, +41285,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMBLEMHEALTH/HIP-Medicaid, +41286,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMBLEMHEALTH/HIP-Medicaid, +41287,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMBLEMHEALTH/HIP-Medicaid, +41288,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMBLEMHEALTH/HIP-Medicaid, +41289,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMBLEMHEALTH/HIP-Medicaid, +41290,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMBLEMHEALTH/HIP-Medicaid, +41291,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMBLEMHEALTH/HIP-Medicaid,215.0 +41292,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMBLEMHEALTH/HIP-Medicaid, +41293,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMBLEMHEALTH/HIP-Medicaid, +41294,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMBLEMHEALTH/HIP-Medicaid, +41295,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMBLEMHEALTH/HIP-Medicaid, +41296,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMBLEMHEALTH/HIP-Medicaid, +41297,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMBLEMHEALTH/HIP-Medicaid, +41298,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMBLEMHEALTH/HIP-Medicaid, +41299,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMBLEMHEALTH/HIP-Medicaid, +41300,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMBLEMHEALTH/HIP-Medicaid,46.87 +41301,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMBLEMHEALTH/HIP-Medicaid, +41302,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMBLEMHEALTH/HIP-Medicaid, +41303,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMBLEMHEALTH/HIP-Medicaid, +41304,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMBLEMHEALTH/HIP-Medicaid,29.53 +41305,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMBLEMHEALTH/HIP-Medicaid, +41306,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMBLEMHEALTH/HIP-Medicaid, +41307,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMBLEMHEALTH/HIP-Medicaid,61.86 +41308,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMBLEMHEALTH/HIP-Medicaid, +41309,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMBLEMHEALTH/HIP-Medicaid, +41310,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMBLEMHEALTH/HIP-Medicaid, +41311,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMBLEMHEALTH/HIP-Medicaid, +41312,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMBLEMHEALTH/HIP-Medicaid, +41313,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMBLEMHEALTH/HIP-Medicaid, +41314,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMBLEMHEALTH/HIP-Medicaid, +41315,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMBLEMHEALTH/HIP-Medicaid, +41316,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMBLEMHEALTH/HIP-Medicaid,17.03 +41317,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMBLEMHEALTH/HIP-Medicaid, +41318,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMBLEMHEALTH/HIP-Medicaid, +41319,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMBLEMHEALTH/HIP-Medicaid,6.35 +41320,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMBLEMHEALTH/HIP-Medicaid, +41321,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMBLEMHEALTH/HIP-Medicaid, +41322,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMBLEMHEALTH/HIP-Medicaid, +41323,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMBLEMHEALTH/HIP-Medicaid, +41324,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMBLEMHEALTH/HIP-Medicaid, +41325,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMBLEMHEALTH/HIP-Medicaid, +41326,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMBLEMHEALTH/HIP-Medicaid, +41327,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMBLEMHEALTH/HIP-Medicaid, +41328,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMBLEMHEALTH/HIP-Medicaid, +41329,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMBLEMHEALTH/HIP-Medicaid, +41330,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMBLEMHEALTH/HIP-Medicaid, +41331,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMBLEMHEALTH/HIP-Medicaid, +41332,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMBLEMHEALTH/HIP-Medicaid, +41333,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMBLEMHEALTH/HIP-Medicaid,2677.0 +41334,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMBLEMHEALTH/HIP-Medicaid, +41335,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMBLEMHEALTH/HIP-Medicaid, +41336,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMBLEMHEALTH/HIP-Medicaid, +41337,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMBLEMHEALTH/HIP-Medicaid, +41338,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMBLEMHEALTH/HIP-Medicaid, +41339,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMBLEMHEALTH/HIP-Medicaid, +41340,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMBLEMHEALTH/HIP-Medicaid, +41341,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMBLEMHEALTH/HIP-Medicaid, +41342,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMBLEMHEALTH/HIP-Medicaid, +41343,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMBLEMHEALTH/HIP-Medicaid, +41344,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMBLEMHEALTH/HIP-Medicaid,12.25 +41345,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMBLEMHEALTH/HIP-Medicaid, +41346,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMBLEMHEALTH/HIP-Medicaid, +41347,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMBLEMHEALTH/HIP-Medicaid, +41348,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMBLEMHEALTH/HIP-Medicaid, +41349,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMBLEMHEALTH/HIP-Medicaid, +41350,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMBLEMHEALTH/HIP-Medicaid, +41351,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMBLEMHEALTH/HIP-Medicaid, +41352,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMBLEMHEALTH/HIP-Medicaid, +41353,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMBLEMHEALTH/HIP-Medicaid, +41354,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMBLEMHEALTH/HIP-Medicaid, +41355,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMBLEMHEALTH/HIP-Medicaid, +41356,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMBLEMHEALTH/HIP-Medicaid, +41357,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMBLEMHEALTH/HIP-Medicaid, +41358,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMBLEMHEALTH/HIP-Medicaid, +41359,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMBLEMHEALTH/HIP-Medicaid,4.85 +41360,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMBLEMHEALTH/HIP-Medicaid, +41361,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMBLEMHEALTH/HIP-Medicaid, +41362,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMBLEMHEALTH/HIP-Medicaid,4.8 +41363,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMBLEMHEALTH/HIP-Medicaid, +41364,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMBLEMHEALTH/HIP-Medicaid, +41365,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMBLEMHEALTH/HIP-Medicaid, +41366,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMBLEMHEALTH/HIP-Medicaid, +41367,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMBLEMHEALTH/HIP-Medicaid, +41368,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMBLEMHEALTH/HIP-Medicaid, +41369,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMBLEMHEALTH/HIP-Medicaid, +41370,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMBLEMHEALTH/HIP-Medicaid,137.49 +41371,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMBLEMHEALTH/HIP-Medicaid, +41372,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMBLEMHEALTH/HIP-Medicaid, +41373,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMBLEMHEALTH/HIP-Medicaid, +41374,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMBLEMHEALTH/HIP-Medicaid, +41375,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMBLEMHEALTH/HIP-Medicaid, +41376,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMBLEMHEALTH/HIP-Medicaid, +41377,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMBLEMHEALTH/HIP-Medicaid, +41378,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMBLEMHEALTH/HIP-Medicaid, +41379,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMBLEMHEALTH/HIP-Medicaid, +41380,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMBLEMHEALTH/HIP-Medicaid, +41381,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMBLEMHEALTH/HIP-Medicaid, +41382,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMBLEMHEALTH/HIP-Medicaid, +41383,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMBLEMHEALTH/HIP-Medicaid, +41384,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMBLEMHEALTH/HIP-Medicaid, +41385,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMBLEMHEALTH/HIP-Medicaid, +41386,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMBLEMHEALTH/HIP-Medicaid, +41387,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMBLEMHEALTH/HIP-Medicaid, +41388,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMBLEMHEALTH/HIP-Medicaid, +41389,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMBLEMHEALTH/HIP-Medicaid, +41390,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMBLEMHEALTH/HIP-Medicaid, +41391,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMBLEMHEALTH/HIP-Medicaid, +41392,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMBLEMHEALTH/HIP-Medicaid, +41393,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMBLEMHEALTH/HIP-Medicaid, +41394,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMBLEMHEALTH/HIP-Medicaid, +41395,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMBLEMHEALTH/HIP-Medicaid, +41396,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMBLEMHEALTH/HIP-Medicaid, +41397,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMBLEMHEALTH/HIP-Medicaid, +41398,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMBLEMHEALTH/HIP-Medicaid, +41399,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMBLEMHEALTH/HIP-Medicaid, +41400,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMBLEMHEALTH/HIP-Medicaid, +41401,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMBLEMHEALTH/HIP-Medicaid, +41402,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMBLEMHEALTH/HIP-Medicaid, +41403,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMBLEMHEALTH/HIP-Medicaid, +41404,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMBLEMHEALTH/HIP-Medicaid, +41405,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMBLEMHEALTH/HIP-Medicaid, +41406,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMBLEMHEALTH/HIP-Medicaid,14.5 +41407,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMBLEMHEALTH/HIP-Medicaid, +41408,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMBLEMHEALTH/HIP-Medicaid, +41409,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMBLEMHEALTH/HIP-Medicaid,37.0 +41410,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMBLEMHEALTH/HIP-Medicaid, +41411,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMBLEMHEALTH/HIP-Medicaid, +41412,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMBLEMHEALTH/HIP-Medicaid, +41413,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMBLEMHEALTH/HIP-Medicaid, +41414,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMBLEMHEALTH/HIP-Medicaid, +41415,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMBLEMHEALTH/HIP-Medicaid, +41416,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMBLEMHEALTH/HIP-Medicaid, +41417,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMBLEMHEALTH/HIP-Medicaid, +41418,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMBLEMHEALTH/HIP-Medicaid, +41419,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMBLEMHEALTH/HIP-Medicaid, +41420,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMBLEMHEALTH/HIP-Medicaid, +41421,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMBLEMHEALTH/HIP-Medicaid, +41422,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMBLEMHEALTH/HIP-Medicaid, +41423,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMBLEMHEALTH/HIP-Medicaid, +41424,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMBLEMHEALTH/HIP-Medicaid, +41425,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMBLEMHEALTH/HIP-Medicaid, +41426,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMBLEMHEALTH/HIP-Medicaid,758.81 +41427,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMBLEMHEALTH/HIP-Medicaid, +41428,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMBLEMHEALTH/HIP-Medicaid, +41429,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMBLEMHEALTH/HIP-Medicaid, +41430,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMBLEMHEALTH/HIP-Medicaid, +41431,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMBLEMHEALTH/HIP-Medicaid, +41432,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMBLEMHEALTH/HIP-Medicaid,413.41 +41433,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMBLEMHEALTH/HIP-Medicaid,556.05 +41434,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMBLEMHEALTH/HIP-Medicaid, +41435,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMBLEMHEALTH/HIP-Medicaid, +41436,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMBLEMHEALTH/HIP-Medicaid, +41437,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMBLEMHEALTH/HIP-Medicaid, +41438,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMBLEMHEALTH/HIP-Medicaid,1118.33 +41439,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMBLEMHEALTH/HIP-Medicaid,208.0 +41440,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMBLEMHEALTH/HIP-Medicaid,90.74 +41441,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMBLEMHEALTH/HIP-Medicaid, +41442,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMBLEMHEALTH/HIP-Medicaid, +41443,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMBLEMHEALTH/HIP-Medicaid,196.06 +41444,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMBLEMHEALTH/HIP-Medicaid, +41445,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMBLEMHEALTH/HIP-Medicaid,358.68 +41446,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMBLEMHEALTH/HIP-Medicaid,59.5 +41447,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMBLEMHEALTH/HIP-Medicaid,189.9 +41448,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMBLEMHEALTH/HIP-Medicaid,10.6 +41449,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMBLEMHEALTH/HIP-Medicaid,111.5 +41450,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMBLEMHEALTH/HIP-Medicaid,171.75 +41451,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMBLEMHEALTH/HIP-Medicaid, +41452,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMBLEMHEALTH/HIP-Medicaid, +41453,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMBLEMHEALTH/HIP-Medicaid, +41454,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMBLEMHEALTH/HIP-Medicaid,24.0 +41455,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMBLEMHEALTH/HIP-Medicaid, +41456,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMBLEMHEALTH/HIP-Medicaid, +41457,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMBLEMHEALTH/HIP-Medicaid, +41458,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMBLEMHEALTH/HIP-Medicaid, +41459,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMBLEMHEALTH/HIP-Medicaid, +41460,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMBLEMHEALTH/HIP-Medicaid, +41461,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMBLEMHEALTH/HIP-Medicaid, +41462,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMBLEMHEALTH/HIP-Medicaid, +41463,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMBLEMHEALTH/HIP-Medicaid, +41464,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMBLEMHEALTH/HIP-Medicaid, +41465,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMBLEMHEALTH/HIP-Medicaid, +41466,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMBLEMHEALTH/HIP-Medicaid,5.8 +41467,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMBLEMHEALTH/HIP-Medicaid, +41468,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMBLEMHEALTH/HIP-Medicaid, +41469,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMBLEMHEALTH/HIP-Medicaid, +41470,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMBLEMHEALTH/HIP-Medicaid,72.0 +41471,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMBLEMHEALTH/HIP-Medicaid, +41472,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMBLEMHEALTH/HIP-Medicaid,88.0 +41473,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMBLEMHEALTH/HIP-Medicaid, +41474,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMBLEMHEALTH/HIP-Medicaid, +41475,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMBLEMHEALTH/HIP-Medicaid, +41476,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMBLEMHEALTH/HIP-Medicaid, +41477,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMBLEMHEALTH/HIP-Medicaid, +41478,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMBLEMHEALTH/HIP-Medicaid, +41479,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMBLEMHEALTH/HIP-Medicaid, +41480,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMBLEMHEALTH/HIP-Medicaid, +41481,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMBLEMHEALTH/HIP-Medicaid, +41482,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMBLEMHEALTH/HIP-Medicaid, +41483,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMBLEMHEALTH/HIP-Medicaid, +41484,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMBLEMHEALTH/HIP-Medicaid, +41485,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMBLEMHEALTH/HIP-Medicaid, +41486,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMBLEMHEALTH/HIP-Medicaid, +41487,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMBLEMHEALTH/HIP-Medicaid, +41488,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMBLEMHEALTH/HIP-Medicaid, +41489,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMBLEMHEALTH/HIP-Medicaid, +41490,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMBLEMHEALTH/HIP-Medicaid, +41491,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMBLEMHEALTH/HIP-Medicaid, +41492,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMBLEMHEALTH/HIP-Medicaid,32.0 +41493,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMBLEMHEALTH/HIP-Medicaid, +41494,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMBLEMHEALTH/HIP-Medicaid, +41495,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Medicaid, +41496,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMBLEMHEALTH/HIP-Medicaid, +41497,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMBLEMHEALTH/HIP-Medicaid,6.08 +41498,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMBLEMHEALTH/HIP-Medicaid, +41499,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMBLEMHEALTH/HIP-Medicaid,348.0 +41500,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMBLEMHEALTH/HIP-Medicaid, +41501,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMBLEMHEALTH/HIP-Medicaid, +41502,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMBLEMHEALTH/HIP-Medicaid, +41503,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMBLEMHEALTH/HIP-Medicaid, +41504,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMBLEMHEALTH/HIP-Medicaid, +41505,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMBLEMHEALTH/HIP-Medicaid, +41506,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Medicaid, +41507,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMBLEMHEALTH/HIP-Medicaid, +41508,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMBLEMHEALTH/HIP-Medicaid, +41509,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMBLEMHEALTH/HIP-Medicaid, +41510,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMBLEMHEALTH/HIP-Medicaid, +41511,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMBLEMHEALTH/HIP-Medicaid, +41512,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMBLEMHEALTH/HIP-Medicaid,50.0 +41513,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMBLEMHEALTH/HIP-Medicaid, +41514,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMBLEMHEALTH/HIP-Medicaid, +41515,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMBLEMHEALTH/HIP-Medicaid, +41516,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMBLEMHEALTH/HIP-Medicaid, +41517,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMBLEMHEALTH/HIP-Medicaid, +41518,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMBLEMHEALTH/HIP-Medicaid, +41519,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMBLEMHEALTH/HIP-Medicaid, +41520,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMBLEMHEALTH/HIP-Medicaid, +41521,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMBLEMHEALTH/HIP-Medicaid, +41522,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMBLEMHEALTH/HIP-Medicaid,203.5 +41523,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMBLEMHEALTH/HIP-Medicaid, +41524,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMBLEMHEALTH/HIP-Medicaid, +41525,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMBLEMHEALTH/HIP-Medicaid,619.47 +41526,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMBLEMHEALTH/HIP-Medicaid,60.42 +41527,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMBLEMHEALTH/HIP-Medicaid, +41528,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Medicaid, +41529,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMBLEMHEALTH/HIP-Medicaid, +41530,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMBLEMHEALTH/HIP-Medicaid,62.5 +41531,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMBLEMHEALTH/HIP-Medicaid, +41532,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMBLEMHEALTH/HIP-Medicaid, +41533,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMBLEMHEALTH/HIP-Medicaid, +41534,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMBLEMHEALTH/HIP-Medicaid, +41535,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMBLEMHEALTH/HIP-Medicaid, +41536,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMBLEMHEALTH/HIP-Medicaid, +41537,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMBLEMHEALTH/HIP-Medicaid, +41538,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMBLEMHEALTH/HIP-Medicaid, +41539,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMBLEMHEALTH/HIP-Medicaid, +41540,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMBLEMHEALTH/HIP-Medicaid, +41541,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMBLEMHEALTH/HIP-Medicaid, +41542,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMBLEMHEALTH/HIP-Medicaid, +41543,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMBLEMHEALTH/HIP-Medicaid, +41544,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMBLEMHEALTH/HIP-Medicaid,116.0 +41545,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMBLEMHEALTH/HIP-Medicaid, +41546,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMBLEMHEALTH/HIP-Medicaid,100.5 +41547,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMBLEMHEALTH/HIP-Medicaid,79.94 +41548,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMBLEMHEALTH/HIP-Medicaid,71.66 +41549,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMBLEMHEALTH/HIP-Medicaid, +41550,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMBLEMHEALTH/HIP-Medicaid, +41551,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMBLEMHEALTH/HIP-Medicaid, +41552,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMBLEMHEALTH/HIP-Medicaid, +41553,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMBLEMHEALTH/HIP-Medicaid,625.5 +41554,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMBLEMHEALTH/HIP-Medicaid, +41555,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMBLEMHEALTH/HIP-Medicaid, +41556,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMBLEMHEALTH/HIP-Medicaid, +41557,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMBLEMHEALTH/HIP-Medicaid, +41558,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMBLEMHEALTH/HIP-Medicaid, +41559,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMBLEMHEALTH/HIP-Medicaid, +41560,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMBLEMHEALTH/HIP-Medicaid, +41561,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMBLEMHEALTH/HIP-Medicaid, +41562,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMBLEMHEALTH/HIP-Medicaid, +41563,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMBLEMHEALTH/HIP-Medicaid, +41564,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMBLEMHEALTH/HIP-Medicaid, +41565,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMBLEMHEALTH/HIP-Medicaid, +41566,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMBLEMHEALTH/HIP-Medicaid, +41567,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMBLEMHEALTH/HIP-Medicaid,148.0 +41568,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMBLEMHEALTH/HIP-Medicaid,480.52 +41569,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMBLEMHEALTH/HIP-Medicaid,300.66 +41570,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMBLEMHEALTH/HIP-Medicaid, +41571,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMBLEMHEALTH/HIP-Medicaid,96.0 +41572,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMBLEMHEALTH/HIP-Medicaid, +41573,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMBLEMHEALTH/HIP-Medicaid, +41574,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMBLEMHEALTH/HIP-Medicaid, +41575,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMBLEMHEALTH/HIP-Medicaid, +41576,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMBLEMHEALTH/HIP-Medicaid, +41577,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMBLEMHEALTH/HIP-Medicaid, +41578,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMBLEMHEALTH/HIP-Medicaid, +41579,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMBLEMHEALTH/HIP-Medicaid, +41580,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMBLEMHEALTH/HIP-Medicaid, +41581,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMBLEMHEALTH/HIP-Medicaid,147.49 +41582,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMBLEMHEALTH/HIP-Medicaid,444.34 +41583,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMBLEMHEALTH/HIP-Medicaid, +41584,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMBLEMHEALTH/HIP-Medicaid, +41585,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMBLEMHEALTH/HIP-Medicaid, +41586,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMBLEMHEALTH/HIP-Medicaid, +41587,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMBLEMHEALTH/HIP-Medicaid,436.66 +41588,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMBLEMHEALTH/HIP-Medicaid, +41589,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMBLEMHEALTH/HIP-Medicaid, +41590,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMBLEMHEALTH/HIP-Medicaid, +41591,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMBLEMHEALTH/HIP-Medicaid, +41592,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMBLEMHEALTH/HIP-Medicaid, +41593,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMBLEMHEALTH/HIP-Medicaid,53.69 +41594,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMBLEMHEALTH/HIP-Medicaid, +41595,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMBLEMHEALTH/HIP-Medicaid,92.5 +41596,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMBLEMHEALTH/HIP-Medicaid, +41597,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMBLEMHEALTH/HIP-Medicaid, +41598,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMBLEMHEALTH/HIP-Medicaid, +41599,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMBLEMHEALTH/HIP-Medicaid, +41600,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMBLEMHEALTH/HIP-Medicaid, +41601,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMBLEMHEALTH/HIP-Medicaid, +41602,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMBLEMHEALTH/HIP-Medicaid, +41603,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMBLEMHEALTH/HIP-Medicaid, +41604,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMBLEMHEALTH/HIP-Medicaid, +41605,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMBLEMHEALTH/HIP-Medicaid, +41606,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMBLEMHEALTH/HIP-Medicaid, +41607,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMBLEMHEALTH/HIP-Medicaid, +41608,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMBLEMHEALTH/HIP-Medicaid, +41609,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMBLEMHEALTH/HIP-Medicaid, +41610,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMBLEMHEALTH/HIP-Medicaid, +41611,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMBLEMHEALTH/HIP-Medicaid, +41612,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMBLEMHEALTH/HIP-Medicaid, +41613,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMBLEMHEALTH/HIP-Medicaid, +41614,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMBLEMHEALTH/HIP-Medicaid, +41615,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMBLEMHEALTH/HIP-Medicaid, +41616,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMBLEMHEALTH/HIP-Medicaid, +41617,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMBLEMHEALTH/HIP-Medicaid, +41618,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMBLEMHEALTH/HIP-Medicaid, +41619,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMBLEMHEALTH/HIP-Medicaid, +41620,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMBLEMHEALTH/HIP-Medicaid, +41621,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMBLEMHEALTH/HIP-Medicaid, +41622,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMBLEMHEALTH/HIP-Medicaid, +41623,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMBLEMHEALTH/HIP-Medicaid, +41624,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMBLEMHEALTH/HIP-Medicaid, +41625,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMBLEMHEALTH/HIP-Medicaid, +41626,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMBLEMHEALTH/HIP-Medicaid, +41627,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMBLEMHEALTH/HIP-Medicaid, +41628,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMBLEMHEALTH/HIP-Medicaid, +41629,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMBLEMHEALTH/HIP-Medicaid, +41630,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +41631,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +41632,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +41633,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMBLEMHEALTH/HIP-Medicaid, +41634,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMBLEMHEALTH/HIP-Medicaid, +41635,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMBLEMHEALTH/HIP-Medicaid, +41636,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMBLEMHEALTH/HIP-Medicaid, +41637,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMBLEMHEALTH/HIP-Medicaid, +41638,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMBLEMHEALTH/HIP-Medicaid, +41639,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMBLEMHEALTH/HIP-Medicaid, +41640,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMBLEMHEALTH/HIP-Medicaid, +41641,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMBLEMHEALTH/HIP-Medicaid, +41642,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMBLEMHEALTH/HIP-Medicaid, +41643,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMBLEMHEALTH/HIP-Medicaid,192.5 +41644,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMBLEMHEALTH/HIP-Medicaid, +41645,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMBLEMHEALTH/HIP-Medicaid, +41646,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMBLEMHEALTH/HIP-Medicaid, +41647,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMBLEMHEALTH/HIP-Medicaid, +41648,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMBLEMHEALTH/HIP-Medicaid, +41649,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMBLEMHEALTH/HIP-Medicaid, +41650,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMBLEMHEALTH/HIP-Medicaid, +41651,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMBLEMHEALTH/HIP-Medicaid, +41652,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMBLEMHEALTH/HIP-Medicaid, +41653,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMBLEMHEALTH/HIP-Medicaid, +41654,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMBLEMHEALTH/HIP-Medicaid, +41655,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMBLEMHEALTH/HIP-Medicaid, +41656,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMBLEMHEALTH/HIP-Medicaid, +41657,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMBLEMHEALTH/HIP-Medicaid, +41658,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMBLEMHEALTH/HIP-Medicaid, +41659,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMBLEMHEALTH/HIP-Medicaid, +41660,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMBLEMHEALTH/HIP-Medicaid, +41661,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMBLEMHEALTH/HIP-Medicaid, +41662,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMBLEMHEALTH/HIP-Medicaid, +41663,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMBLEMHEALTH/HIP-Medicaid, +41664,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMBLEMHEALTH/HIP-Medicaid, +41665,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMBLEMHEALTH/HIP-Medicaid, +41666,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMBLEMHEALTH/HIP-Medicaid,189.57 +41667,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMBLEMHEALTH/HIP-Medicaid, +41668,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMBLEMHEALTH/HIP-Medicaid, +41669,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMBLEMHEALTH/HIP-Medicaid, +41670,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMBLEMHEALTH/HIP-Medicaid,420.5 +41671,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMBLEMHEALTH/HIP-Medicaid,436.0 +41672,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMBLEMHEALTH/HIP-Medicaid, +41673,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMBLEMHEALTH/HIP-Medicaid,1677.5 +41674,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMBLEMHEALTH/HIP-Medicaid, +41675,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMBLEMHEALTH/HIP-Medicaid, +41676,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMBLEMHEALTH/HIP-Medicaid, +41677,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMBLEMHEALTH/HIP-Medicaid, +41678,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMBLEMHEALTH/HIP-Medicaid,1064.13 +41679,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMBLEMHEALTH/HIP-Medicaid, +41680,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMBLEMHEALTH/HIP-Medicaid,497.0 +41681,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMBLEMHEALTH/HIP-Medicaid, +41682,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMBLEMHEALTH/HIP-Medicaid,96.0 +41683,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMBLEMHEALTH/HIP-Medicaid, +41684,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMBLEMHEALTH/HIP-Medicaid,1462.5 +41685,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMBLEMHEALTH/HIP-Medicaid, +41686,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMBLEMHEALTH/HIP-Medicaid, +41687,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMBLEMHEALTH/HIP-Medicaid, +41688,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMBLEMHEALTH/HIP-Medicaid,23.0 +41689,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMBLEMHEALTH/HIP-Medicaid, +41690,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMBLEMHEALTH/HIP-Medicaid, +41691,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMBLEMHEALTH/HIP-Medicaid, +41692,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMBLEMHEALTH/HIP-Medicaid, +41693,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMBLEMHEALTH/HIP-Medicaid, +41694,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMBLEMHEALTH/HIP-Medicaid, +41695,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMBLEMHEALTH/HIP-Medicaid,682.5 +41696,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMBLEMHEALTH/HIP-Medicaid, +41697,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMBLEMHEALTH/HIP-Medicaid, +41698,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMBLEMHEALTH/HIP-Medicaid, +41699,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMBLEMHEALTH/HIP-Medicaid, +41700,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMBLEMHEALTH/HIP-Medicaid, +41701,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMBLEMHEALTH/HIP-Medicaid, +41702,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMBLEMHEALTH/HIP-Medicaid, +41703,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMBLEMHEALTH/HIP-Medicaid,309.1 +41704,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMBLEMHEALTH/HIP-Medicaid,594.0 +41705,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMBLEMHEALTH/HIP-Medicaid, +41706,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMBLEMHEALTH/HIP-Medicaid, +41707,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMBLEMHEALTH/HIP-Medicaid, +41708,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMBLEMHEALTH/HIP-Medicaid, +41709,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMBLEMHEALTH/HIP-Medicaid, +41710,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMBLEMHEALTH/HIP-Medicaid, +41711,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMBLEMHEALTH/HIP-Medicaid, +41712,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMBLEMHEALTH/HIP-Medicaid, +41713,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMBLEMHEALTH/HIP-Medicaid, +41714,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMBLEMHEALTH/HIP-Medicaid, +41715,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMBLEMHEALTH/HIP-Medicaid, +41716,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMBLEMHEALTH/HIP-Medicaid, +41717,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMBLEMHEALTH/HIP-Medicaid,21816.0 +41718,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMBLEMHEALTH/HIP-Medicaid, +41719,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMBLEMHEALTH/HIP-Medicaid, +41720,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMBLEMHEALTH/HIP-Medicaid, +41721,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMBLEMHEALTH/HIP-Medicaid, +41722,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMBLEMHEALTH/HIP-Medicaid, +41723,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMBLEMHEALTH/HIP-Medicaid, +41724,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMBLEMHEALTH/HIP-Medicaid,55.95 +41725,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMBLEMHEALTH/HIP-Medicaid,2643.26 +41726,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMBLEMHEALTH/HIP-Medicaid, +41727,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMBLEMHEALTH/HIP-Medicaid, +41728,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMBLEMHEALTH/HIP-Medicaid, +41729,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +41730,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMBLEMHEALTH/HIP-Medicaid,931.49 +41731,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMBLEMHEALTH/HIP-Medicaid,870.22 +41732,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMBLEMHEALTH/HIP-Medicaid, +41733,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMBLEMHEALTH/HIP-Medicaid, +41734,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMBLEMHEALTH/HIP-Medicaid, +41735,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMBLEMHEALTH/HIP-Medicaid, +41736,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMBLEMHEALTH/HIP-Medicaid,52.0 +41737,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMBLEMHEALTH/HIP-Medicaid, +41738,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMBLEMHEALTH/HIP-Medicaid, +41739,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMBLEMHEALTH/HIP-Medicaid, +41740,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMBLEMHEALTH/HIP-Medicaid,3452.33 +41741,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMBLEMHEALTH/HIP-Medicaid, +41742,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMBLEMHEALTH/HIP-Medicaid,2081.5 +41743,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMBLEMHEALTH/HIP-Medicaid, +41744,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMBLEMHEALTH/HIP-Medicaid, +41745,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMBLEMHEALTH/HIP-Medicaid, +41746,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMBLEMHEALTH/HIP-Medicaid,61.45 +41747,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMBLEMHEALTH/HIP-Medicaid, +41748,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMBLEMHEALTH/HIP-Medicaid,36.75 +41749,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMBLEMHEALTH/HIP-Medicaid, +41750,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMBLEMHEALTH/HIP-Medicaid, +41751,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMBLEMHEALTH/HIP-Medicaid, +41752,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMBLEMHEALTH/HIP-Medicaid,10227.0 +41753,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicaid, +41754,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMBLEMHEALTH/HIP-Medicaid, +41755,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMBLEMHEALTH/HIP-Medicaid, +41756,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMBLEMHEALTH/HIP-Medicaid, +41757,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMBLEMHEALTH/HIP-Medicaid,10227.0 +41758,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMBLEMHEALTH/HIP-Medicaid, +41759,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMBLEMHEALTH/HIP-Medicaid,6849.67 +41760,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMBLEMHEALTH/HIP-Medicaid,5161.0 +41761,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMBLEMHEALTH/HIP-Medicaid, +41762,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMBLEMHEALTH/HIP-Medicaid, +41763,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMBLEMHEALTH/HIP-Medicaid, +41764,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMBLEMHEALTH/HIP-Medicaid, +41765,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMBLEMHEALTH/HIP-Medicaid, +41766,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMBLEMHEALTH/HIP-Medicaid, +41767,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMBLEMHEALTH/HIP-Medicaid, +41768,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMBLEMHEALTH/HIP-Medicaid, +41769,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMBLEMHEALTH/HIP-Medicaid, +41770,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMBLEMHEALTH/HIP-Medicaid, +41771,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMBLEMHEALTH/HIP-Medicaid, +41772,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMBLEMHEALTH/HIP-Medicaid, +41773,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMBLEMHEALTH/HIP-Medicaid, +41774,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMBLEMHEALTH/HIP-Medicaid, +41775,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMBLEMHEALTH/HIP-Medicaid, +41776,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMBLEMHEALTH/HIP-Medicaid, +41777,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMBLEMHEALTH/HIP-Medicaid,57407.0 +41778,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMBLEMHEALTH/HIP-Medicaid, +41779,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMBLEMHEALTH/HIP-Medicaid, +41780,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMBLEMHEALTH/HIP-Medicaid,57402.83 +41781,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMBLEMHEALTH/HIP-Medicaid, +41782,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMBLEMHEALTH/HIP-Medicaid, +41783,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMBLEMHEALTH/HIP-Medicaid, +41784,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMBLEMHEALTH/HIP-Medicaid,156.0 +41785,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMBLEMHEALTH/HIP-Medicaid,1264.33 +41786,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMBLEMHEALTH/HIP-Medicaid, +41787,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMBLEMHEALTH/HIP-Medicaid, +41788,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMBLEMHEALTH/HIP-Medicaid,1361.5 +41789,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMBLEMHEALTH/HIP-Medicaid, +41790,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMBLEMHEALTH/HIP-Medicaid, +41791,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMBLEMHEALTH/HIP-Medicaid, +41792,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMBLEMHEALTH/HIP-Medicaid, +41793,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMBLEMHEALTH/HIP-Medicaid, +41794,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMBLEMHEALTH/HIP-Medicaid, +41795,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMBLEMHEALTH/HIP-Medicaid, +41796,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMBLEMHEALTH/HIP-Medicaid, +41797,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMBLEMHEALTH/HIP-Medicaid, +41798,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMBLEMHEALTH/HIP-Medicaid,1534.0 +41799,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMBLEMHEALTH/HIP-Medicaid,25.0 +41800,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMBLEMHEALTH/HIP-Medicaid, +41801,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMBLEMHEALTH/HIP-Medicaid, +41802,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMBLEMHEALTH/HIP-Medicaid, +41803,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMBLEMHEALTH/HIP-Medicaid, +41804,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMBLEMHEALTH/HIP-Medicaid, +41805,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMBLEMHEALTH/HIP-Medicaid, +41806,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMBLEMHEALTH/HIP-Medicaid,929.13 +41807,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMBLEMHEALTH/HIP-Medicaid, +41808,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMBLEMHEALTH/HIP-Medicaid, +41809,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMBLEMHEALTH/HIP-Medicaid, +41810,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMBLEMHEALTH/HIP-Medicaid, +41811,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMBLEMHEALTH/HIP-Medicaid,597.5 +41812,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMBLEMHEALTH/HIP-Medicaid,3861.61 +41813,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMBLEMHEALTH/HIP-Medicaid,2539.18 +41814,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMBLEMHEALTH/HIP-Medicaid, +41815,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMBLEMHEALTH/HIP-Medicaid, +41816,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMBLEMHEALTH/HIP-Medicaid, +41817,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMBLEMHEALTH/HIP-Medicaid, +41818,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMBLEMHEALTH/HIP-Medicaid, +41819,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMBLEMHEALTH/HIP-Medicaid, +41820,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMBLEMHEALTH/HIP-Medicaid, +41821,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMBLEMHEALTH/HIP-Medicaid, +41822,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMBLEMHEALTH/HIP-Medicaid, +41823,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMBLEMHEALTH/HIP-Medicaid, +41824,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMBLEMHEALTH/HIP-Medicaid, +41825,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMBLEMHEALTH/HIP-Medicaid, +41826,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMBLEMHEALTH/HIP-Medicaid, +41827,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMBLEMHEALTH/HIP-Medicaid, +41828,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMBLEMHEALTH/HIP-Medicaid, +41829,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMBLEMHEALTH/HIP-Medicaid, +41830,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMBLEMHEALTH/HIP-Medicaid,3047.0 +41831,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMBLEMHEALTH/HIP-Medicaid, +41832,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMBLEMHEALTH/HIP-Medicaid,3022.06 +41833,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMBLEMHEALTH/HIP-Medicaid,3047.0 +41834,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMBLEMHEALTH/HIP-Medicaid, +41835,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMBLEMHEALTH/HIP-Medicaid,1551.43 +41836,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMBLEMHEALTH/HIP-Medicaid,517.5 +41837,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMBLEMHEALTH/HIP-Medicaid, +41838,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMBLEMHEALTH/HIP-Medicaid, +41839,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMBLEMHEALTH/HIP-Medicaid, +41840,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMBLEMHEALTH/HIP-Medicaid, +41841,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-Medicaid, +41842,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-Medicaid, +41843,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMBLEMHEALTH/HIP-Medicaid, +41844,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMBLEMHEALTH/HIP-Medicaid, +41845,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMBLEMHEALTH/HIP-Medicaid, +41846,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMBLEMHEALTH/HIP-Medicaid, +41847,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMBLEMHEALTH/HIP-Medicaid, +41848,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMBLEMHEALTH/HIP-Medicaid, +41849,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMBLEMHEALTH/HIP-Medicaid, +41850,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMBLEMHEALTH/HIP-Medicaid, +41851,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMBLEMHEALTH/HIP-Medicaid, +41852,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMBLEMHEALTH/HIP-Medicaid, +41853,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMBLEMHEALTH/HIP-Medicaid, +41854,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMBLEMHEALTH/HIP-Medicaid, +41855,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMBLEMHEALTH/HIP-Medicaid, +41856,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMBLEMHEALTH/HIP-Medicaid, +41857,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMBLEMHEALTH/HIP-Medicaid, +41858,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMBLEMHEALTH/HIP-Medicaid,427.72 +41859,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMBLEMHEALTH/HIP-Medicaid,429.6 +41860,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMBLEMHEALTH/HIP-Medicaid, +41861,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMBLEMHEALTH/HIP-Medicaid, +41862,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMBLEMHEALTH/HIP-Medicaid, +41863,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMBLEMHEALTH/HIP-Medicaid,429.6 +41864,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMBLEMHEALTH/HIP-Medicaid,515.52 +41865,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMBLEMHEALTH/HIP-Medicaid,1620.9 +41866,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMBLEMHEALTH/HIP-Medicaid,983.03 +41867,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMBLEMHEALTH/HIP-Medicaid,216.6 +41868,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMBLEMHEALTH/HIP-Medicaid,649.8 +41869,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMBLEMHEALTH/HIP-Medicaid,2924.67 +41870,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMBLEMHEALTH/HIP-Medicaid,1953.72 +41871,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMBLEMHEALTH/HIP-Medicaid,2773.98 +41872,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMBLEMHEALTH/HIP-Medicaid,6363.0 +41873,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMBLEMHEALTH/HIP-Medicaid,2751.52 +41874,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMBLEMHEALTH/HIP-Medicaid, +41875,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMBLEMHEALTH/HIP-Medicaid,3660.33 +41876,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMBLEMHEALTH/HIP-Medicaid,4270.35 +41877,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMBLEMHEALTH/HIP-Medicaid,1725.73 +41878,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMBLEMHEALTH/HIP-Medicaid,3437.83 +41879,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMBLEMHEALTH/HIP-Medicaid,6776.0 +41880,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMBLEMHEALTH/HIP-Medicaid,6380.0 +41881,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMBLEMHEALTH/HIP-Medicaid,4160.63 +41882,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMBLEMHEALTH/HIP-Medicaid,3467.27 +41883,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMBLEMHEALTH/HIP-Medicaid,6379.85 +41884,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMBLEMHEALTH/HIP-Medicaid,5989.14 +41885,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMBLEMHEALTH/HIP-Medicaid,6377.88 +41886,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMBLEMHEALTH/HIP-Medicaid,5162.91 +41887,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMBLEMHEALTH/HIP-Medicaid,6381.0 +41888,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMBLEMHEALTH/HIP-Medicaid, +41889,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMBLEMHEALTH/HIP-Medicaid,6271.62 +41890,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMBLEMHEALTH/HIP-Medicaid,372.0 +41891,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMBLEMHEALTH/HIP-Medicaid, +41892,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMBLEMHEALTH/HIP-Medicaid,356.1 +41893,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMBLEMHEALTH/HIP-Medicaid, +41894,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMBLEMHEALTH/HIP-Medicaid, +41895,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMBLEMHEALTH/HIP-Medicaid, +41896,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMBLEMHEALTH/HIP-Medicaid, +41897,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMBLEMHEALTH/HIP-Medicaid, +41898,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMBLEMHEALTH/HIP-Medicaid, +41899,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMBLEMHEALTH/HIP-Medicaid,291.22 +41900,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMBLEMHEALTH/HIP-Medicaid, +41901,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMBLEMHEALTH/HIP-Medicaid, +41902,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMBLEMHEALTH/HIP-Medicaid,181.0 +41903,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMBLEMHEALTH/HIP-Medicaid, +41904,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMBLEMHEALTH/HIP-Medicaid, +41905,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMBLEMHEALTH/HIP-Medicaid, +41906,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMBLEMHEALTH/HIP-Medicaid,176.11 +41907,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMBLEMHEALTH/HIP-Medicaid, +41908,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMBLEMHEALTH/HIP-Medicaid,203.5 +41909,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMBLEMHEALTH/HIP-Medicaid,149.25 +41910,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMBLEMHEALTH/HIP-Medicaid, +41911,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMBLEMHEALTH/HIP-Medicaid, +41912,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMBLEMHEALTH/HIP-Medicaid, +41913,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMBLEMHEALTH/HIP-Medicaid,218.67 +41914,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMBLEMHEALTH/HIP-Medicaid, +41915,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMBLEMHEALTH/HIP-Medicaid, +41916,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMBLEMHEALTH/HIP-Medicaid, +41917,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMBLEMHEALTH/HIP-Medicaid,211.0 +41918,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMBLEMHEALTH/HIP-Medicaid, +41919,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMBLEMHEALTH/HIP-Medicaid, +41920,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMBLEMHEALTH/HIP-Medicaid, +41921,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMBLEMHEALTH/HIP-Medicaid,226.0 +41922,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMBLEMHEALTH/HIP-Medicaid, +41923,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMBLEMHEALTH/HIP-Medicaid, +41924,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMBLEMHEALTH/HIP-Medicaid, +41925,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMBLEMHEALTH/HIP-Medicaid,25.88 +41926,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMBLEMHEALTH/HIP-Medicaid,4832.0 +41927,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMBLEMHEALTH/HIP-Medicaid, +41928,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMBLEMHEALTH/HIP-Medicaid, +41929,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMBLEMHEALTH/HIP-Medicaid, +41930,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMBLEMHEALTH/HIP-Medicaid, +41931,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMBLEMHEALTH/HIP-Medicaid, +41932,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMBLEMHEALTH/HIP-Medicaid,525.25 +41933,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMBLEMHEALTH/HIP-Medicaid, +41934,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMBLEMHEALTH/HIP-Medicaid, +41935,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMBLEMHEALTH/HIP-Medicaid, +41936,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMBLEMHEALTH/HIP-Medicaid, +41937,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMBLEMHEALTH/HIP-Medicaid, +41938,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMBLEMHEALTH/HIP-Medicaid,284.67 +41939,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMBLEMHEALTH/HIP-Medicaid, +41940,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMBLEMHEALTH/HIP-Medicaid,325.5 +41941,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMBLEMHEALTH/HIP-Medicaid,1589.0 +41942,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMBLEMHEALTH/HIP-Medicaid, +41943,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMBLEMHEALTH/HIP-Medicaid, +41944,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMBLEMHEALTH/HIP-Medicaid, +41945,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMBLEMHEALTH/HIP-Medicaid, +41946,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMBLEMHEALTH/HIP-Medicaid, +41947,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMBLEMHEALTH/HIP-Medicaid, +41948,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMBLEMHEALTH/HIP-Medicaid,566.0 +41949,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMBLEMHEALTH/HIP-Medicaid,933.15 +41950,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMBLEMHEALTH/HIP-Medicaid,1544.35 +41951,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMBLEMHEALTH/HIP-Medicaid,2640.92 +41952,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMBLEMHEALTH/HIP-Medicaid,5413.28 +41953,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMBLEMHEALTH/HIP-Medicaid,9648.0 +41954,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMBLEMHEALTH/HIP-Medicaid, +41955,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMBLEMHEALTH/HIP-Medicaid, +41956,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMBLEMHEALTH/HIP-Medicaid, +41957,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMBLEMHEALTH/HIP-Medicaid, +41958,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMBLEMHEALTH/HIP-Medicaid, +41959,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMBLEMHEALTH/HIP-Medicaid, +41960,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMBLEMHEALTH/HIP-Medicaid, +41961,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMBLEMHEALTH/HIP-Medicaid, +41962,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMBLEMHEALTH/HIP-Medicaid, +41963,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMBLEMHEALTH/HIP-Medicaid, +41964,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMBLEMHEALTH/HIP-Medicaid, +41965,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMBLEMHEALTH/HIP-Medicaid, +41966,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMBLEMHEALTH/HIP-Medicaid, +41967,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMBLEMHEALTH/HIP-Medicaid, +41968,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMBLEMHEALTH/HIP-Medicaid, +41969,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMBLEMHEALTH/HIP-Medicaid, +41970,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMBLEMHEALTH/HIP-Medicaid, +41971,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMBLEMHEALTH/HIP-Medicaid, +41972,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMBLEMHEALTH/HIP-Medicaid, +41973,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMBLEMHEALTH/HIP-Medicaid,9373.71 +41974,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMBLEMHEALTH/HIP-Medicaid, +41975,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMBLEMHEALTH/HIP-Medicaid, +41976,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMBLEMHEALTH/HIP-Medicaid, +41977,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMBLEMHEALTH/HIP-Medicaid, +41978,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMBLEMHEALTH/HIP-Medicaid, +41979,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMBLEMHEALTH/HIP-Medicaid, +41980,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMBLEMHEALTH/HIP-Medicaid, +41981,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMBLEMHEALTH/HIP-Medicaid, +41982,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMBLEMHEALTH/HIP-Medicaid, +41983,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMBLEMHEALTH/HIP-Medicaid, +41984,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMBLEMHEALTH/HIP-Medicaid, +41985,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMBLEMHEALTH/HIP-Medicaid, +41986,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMBLEMHEALTH/HIP-Medicaid, +41987,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMBLEMHEALTH/HIP-Medicaid, +41988,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMBLEMHEALTH/HIP-Medicaid, +41989,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMBLEMHEALTH/HIP-Medicaid, +41990,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMBLEMHEALTH/HIP-Medicaid, +41991,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMBLEMHEALTH/HIP-Medicaid, +41992,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMBLEMHEALTH/HIP-Medicaid, +41993,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMBLEMHEALTH/HIP-Medicaid, +41994,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMBLEMHEALTH/HIP-Medicaid, +41995,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMBLEMHEALTH/HIP-Medicaid, +41996,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMBLEMHEALTH/HIP-Medicaid, +41997,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMBLEMHEALTH/HIP-Medicaid, +41998,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMBLEMHEALTH/HIP-Medicaid, +41999,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMBLEMHEALTH/HIP-Medicaid, +42000,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMBLEMHEALTH/HIP-Medicaid, +42001,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMBLEMHEALTH/HIP-Medicaid, +42002,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMBLEMHEALTH/HIP-Medicaid, +42003,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMBLEMHEALTH/HIP-Medicaid, +42004,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMBLEMHEALTH/HIP-Medicaid, +42005,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMBLEMHEALTH/HIP-Medicaid, +42006,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMBLEMHEALTH/HIP-Medicaid, +42007,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMBLEMHEALTH/HIP-Medicaid, +42008,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMBLEMHEALTH/HIP-Medicaid, +42009,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMBLEMHEALTH/HIP-Medicaid, +42010,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMBLEMHEALTH/HIP-Medicaid, +42011,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMBLEMHEALTH/HIP-Medicaid, +42012,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMBLEMHEALTH/HIP-Medicaid, +42013,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMBLEMHEALTH/HIP-Medicaid, +42014,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMBLEMHEALTH/HIP-Medicaid, +42015,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMBLEMHEALTH/HIP-Medicaid, +42016,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMBLEMHEALTH/HIP-Medicaid, +42017,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMBLEMHEALTH/HIP-Medicaid, +42018,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMBLEMHEALTH/HIP-Medicaid, +42019,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMBLEMHEALTH/HIP-Medicaid, +42020,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMBLEMHEALTH/HIP-Medicaid, +42021,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMBLEMHEALTH/HIP-Medicaid, +42022,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMBLEMHEALTH/HIP-Medicaid, +42023,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMBLEMHEALTH/HIP-Medicaid, +42024,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMBLEMHEALTH/HIP-Medicaid, +42025,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMBLEMHEALTH/HIP-Medicaid, +42026,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMBLEMHEALTH/HIP-Medicaid, +42027,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMBLEMHEALTH/HIP-Medicaid, +42028,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMBLEMHEALTH/HIP-Medicaid, +42029,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMBLEMHEALTH/HIP-Medicaid, +42030,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMBLEMHEALTH/HIP-Medicaid, +42031,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMBLEMHEALTH/HIP-Medicaid, +42032,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMBLEMHEALTH/HIP-Medicaid, +42033,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMBLEMHEALTH/HIP-Medicaid, +42034,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMBLEMHEALTH/HIP-Medicaid, +42035,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMBLEMHEALTH/HIP-Medicaid, +42036,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMBLEMHEALTH/HIP-Medicaid, +42037,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMBLEMHEALTH/HIP-Medicaid, +42038,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMBLEMHEALTH/HIP-Medicaid, +42039,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMBLEMHEALTH/HIP-Medicaid, +42040,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMBLEMHEALTH/HIP-Medicaid, +42041,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMBLEMHEALTH/HIP-Medicaid, +42042,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMBLEMHEALTH/HIP-Medicaid, +42043,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMBLEMHEALTH/HIP-Medicaid, +42044,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMBLEMHEALTH/HIP-Medicaid, +42045,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMBLEMHEALTH/HIP-Medicaid, +42046,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMBLEMHEALTH/HIP-Medicaid, +42047,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMBLEMHEALTH/HIP-Medicaid, +42048,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMBLEMHEALTH/HIP-Medicaid, +42049,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMBLEMHEALTH/HIP-Medicaid, +42050,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMBLEMHEALTH/HIP-Medicaid, +42051,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMBLEMHEALTH/HIP-Medicaid, +42052,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMBLEMHEALTH/HIP-Medicaid, +42053,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMBLEMHEALTH/HIP-Medicaid, +42054,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMBLEMHEALTH/HIP-Medicaid, +42055,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMBLEMHEALTH/HIP-Medicaid, +42056,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMBLEMHEALTH/HIP-Medicaid, +42057,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMBLEMHEALTH/HIP-Medicaid, +42058,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMBLEMHEALTH/HIP-Medicaid, +42059,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMBLEMHEALTH/HIP-Medicaid, +42060,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMBLEMHEALTH/HIP-Medicaid, +42061,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMBLEMHEALTH/HIP-Medicaid, +42062,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMBLEMHEALTH/HIP-Medicaid, +42063,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMBLEMHEALTH/HIP-Medicaid, +42064,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMBLEMHEALTH/HIP-Medicaid, +42065,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMBLEMHEALTH/HIP-Medicaid, +42066,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMBLEMHEALTH/HIP-Medicaid, +42067,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMBLEMHEALTH/HIP-Medicaid, +42068,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMBLEMHEALTH/HIP-Medicaid, +42069,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMBLEMHEALTH/HIP-Medicaid, +42070,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMBLEMHEALTH/HIP-Medicaid, +42071,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMBLEMHEALTH/HIP-Medicaid, +42072,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMBLEMHEALTH/HIP-Medicaid, +42073,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMBLEMHEALTH/HIP-Medicaid, +42074,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMBLEMHEALTH/HIP-Medicaid, +42075,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMBLEMHEALTH/HIP-Medicaid, +42076,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMBLEMHEALTH/HIP-Medicaid, +42077,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMBLEMHEALTH/HIP-Medicaid, +42078,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMBLEMHEALTH/HIP-Medicaid, +42079,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMBLEMHEALTH/HIP-Medicaid, +42080,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMBLEMHEALTH/HIP-Medicaid, +42081,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMBLEMHEALTH/HIP-Medicaid, +42082,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMBLEMHEALTH/HIP-Medicaid, +42083,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMBLEMHEALTH/HIP-Medicaid, +42084,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMBLEMHEALTH/HIP-Medicaid, +42085,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMBLEMHEALTH/HIP-Medicaid, +42086,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMBLEMHEALTH/HIP-Medicaid, +42087,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMBLEMHEALTH/HIP-Medicaid, +42088,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMBLEMHEALTH/HIP-Medicaid, +42089,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMBLEMHEALTH/HIP-Medicaid, +42090,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMBLEMHEALTH/HIP-Medicaid, +42091,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMBLEMHEALTH/HIP-Medicaid, +42092,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMBLEMHEALTH/HIP-Medicaid, +42093,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMBLEMHEALTH/HIP-Medicaid, +42094,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMBLEMHEALTH/HIP-Medicaid, +42095,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMBLEMHEALTH/HIP-Medicaid, +42096,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMBLEMHEALTH/HIP-Medicaid, +42097,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMBLEMHEALTH/HIP-Medicaid, +42098,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMBLEMHEALTH/HIP-Medicaid, +42099,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMBLEMHEALTH/HIP-Medicaid, +42100,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMBLEMHEALTH/HIP-Medicaid, +42101,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMBLEMHEALTH/HIP-Medicaid, +42102,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMBLEMHEALTH/HIP-Medicaid, +42103,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMBLEMHEALTH/HIP-Medicaid, +42104,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMBLEMHEALTH/HIP-Medicaid, +42105,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMBLEMHEALTH/HIP-Medicaid, +42106,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMBLEMHEALTH/HIP-Medicaid, +42107,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMBLEMHEALTH/HIP-Medicaid, +42108,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMBLEMHEALTH/HIP-Medicaid, +42109,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMBLEMHEALTH/HIP-Medicaid, +42110,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMBLEMHEALTH/HIP-Medicaid, +42111,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMBLEMHEALTH/HIP-Medicaid, +42112,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMBLEMHEALTH/HIP-Medicaid, +42113,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMBLEMHEALTH/HIP-Medicaid, +42114,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMBLEMHEALTH/HIP-Medicaid, +42115,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMBLEMHEALTH/HIP-Medicaid, +42116,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMBLEMHEALTH/HIP-Medicaid, +42117,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMBLEMHEALTH/HIP-Medicaid, +42118,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMBLEMHEALTH/HIP-Medicaid, +42119,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMBLEMHEALTH/HIP-Medicaid, +42120,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMBLEMHEALTH/HIP-Medicaid, +42121,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMBLEMHEALTH/HIP-Medicaid, +42122,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMBLEMHEALTH/HIP-Medicaid, +42123,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMBLEMHEALTH/HIP-Medicaid, +42124,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMBLEMHEALTH/HIP-Medicaid, +42125,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMBLEMHEALTH/HIP-Medicaid, +42126,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMBLEMHEALTH/HIP-Medicaid, +42127,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMBLEMHEALTH/HIP-Medicaid, +42128,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMBLEMHEALTH/HIP-Medicaid, +42129,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMBLEMHEALTH/HIP-Medicaid, +42130,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMBLEMHEALTH/HIP-Medicaid, +42131,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMBLEMHEALTH/HIP-Medicaid, +42132,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMBLEMHEALTH/HIP-Medicaid, +42133,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMBLEMHEALTH/HIP-Medicaid, +42134,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMBLEMHEALTH/HIP-Medicaid, +42135,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMBLEMHEALTH/HIP-Medicaid, +42136,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMBLEMHEALTH/HIP-Medicaid, +42137,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMBLEMHEALTH/HIP-Medicaid, +42138,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMBLEMHEALTH/HIP-Medicaid, +42139,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMBLEMHEALTH/HIP-Medicaid, +42140,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMBLEMHEALTH/HIP-Medicaid, +42141,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMBLEMHEALTH/HIP-Medicaid, +42142,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMBLEMHEALTH/HIP-Medicaid, +42143,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMBLEMHEALTH/HIP-Medicaid, +42144,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMBLEMHEALTH/HIP-Medicaid, +42145,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMBLEMHEALTH/HIP-Medicaid, +42146,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMBLEMHEALTH/HIP-Medicaid, +42147,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMBLEMHEALTH/HIP-Medicaid, +42148,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMBLEMHEALTH/HIP-Medicaid, +42149,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMBLEMHEALTH/HIP-Medicaid, +42150,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMBLEMHEALTH/HIP-Medicaid, +42151,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMBLEMHEALTH/HIP-Medicaid, +42152,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMBLEMHEALTH/HIP-Medicaid, +42153,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMBLEMHEALTH/HIP-Medicaid, +42154,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMBLEMHEALTH/HIP-Medicaid, +42155,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMBLEMHEALTH/HIP-Medicaid, +42156,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMBLEMHEALTH/HIP-Medicaid, +42157,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMBLEMHEALTH/HIP-Medicaid, +42158,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMBLEMHEALTH/HIP-Medicaid, +42159,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMBLEMHEALTH/HIP-Medicaid, +42160,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMBLEMHEALTH/HIP-Medicaid, +42161,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMBLEMHEALTH/HIP-Medicaid, +42162,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMBLEMHEALTH/HIP-Medicaid, +42163,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMBLEMHEALTH/HIP-Medicaid, +42164,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMBLEMHEALTH/HIP-Medicaid, +42165,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMBLEMHEALTH/HIP-Medicaid, +42166,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMBLEMHEALTH/HIP-Medicaid, +42167,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMBLEMHEALTH/HIP-Medicaid, +42168,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMBLEMHEALTH/HIP-Medicaid, +42169,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMBLEMHEALTH/HIP-Medicaid, +42170,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMBLEMHEALTH/HIP-Medicaid, +42171,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMBLEMHEALTH/HIP-Medicaid, +42172,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMBLEMHEALTH/HIP-Medicaid, +42173,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMBLEMHEALTH/HIP-Medicaid, +42174,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMBLEMHEALTH/HIP-Medicaid, +42175,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMBLEMHEALTH/HIP-Medicaid, +42176,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMBLEMHEALTH/HIP-Medicaid, +42177,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMBLEMHEALTH/HIP-Medicaid, +42178,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMBLEMHEALTH/HIP-Medicaid, +42179,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMBLEMHEALTH/HIP-Medicaid, +42180,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMBLEMHEALTH/HIP-Medicaid, +42181,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMBLEMHEALTH/HIP-Medicaid, +42182,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMBLEMHEALTH/HIP-Medicaid, +42183,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMBLEMHEALTH/HIP-Medicaid, +42184,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMBLEMHEALTH/HIP-Medicaid, +42185,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMBLEMHEALTH/HIP-Medicaid, +42186,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMBLEMHEALTH/HIP-Medicaid, +42187,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMBLEMHEALTH/HIP-Medicaid, +42188,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMBLEMHEALTH/HIP-Medicaid, +42189,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMBLEMHEALTH/HIP-Medicaid, +42190,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMBLEMHEALTH/HIP-Medicaid, +42191,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMBLEMHEALTH/HIP-Medicaid, +42192,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMBLEMHEALTH/HIP-Medicaid, +42193,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMBLEMHEALTH/HIP-Medicaid, +42194,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMBLEMHEALTH/HIP-Medicaid, +42195,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMBLEMHEALTH/HIP-Medicaid, +42196,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMBLEMHEALTH/HIP-Medicaid, +42197,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMBLEMHEALTH/HIP-Medicaid, +42198,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMBLEMHEALTH/HIP-Medicaid, +42199,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMBLEMHEALTH/HIP-Medicaid, +42200,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMBLEMHEALTH/HIP-Medicaid, +42201,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMBLEMHEALTH/HIP-Medicaid, +42202,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMBLEMHEALTH/HIP-Medicaid, +42203,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMBLEMHEALTH/HIP-Medicaid, +42204,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMBLEMHEALTH/HIP-Medicaid, +42205,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMBLEMHEALTH/HIP-Medicaid, +42206,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMBLEMHEALTH/HIP-Medicaid, +42207,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMBLEMHEALTH/HIP-Medicaid, +42208,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMBLEMHEALTH/HIP-Medicaid, +42209,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMBLEMHEALTH/HIP-Medicaid, +42210,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMBLEMHEALTH/HIP-Medicaid, +42211,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMBLEMHEALTH/HIP-Medicaid, +42212,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMBLEMHEALTH/HIP-Medicaid, +42213,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMBLEMHEALTH/HIP-Medicaid, +42214,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMBLEMHEALTH/HIP-Medicaid, +42215,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMBLEMHEALTH/HIP-Medicaid, +42216,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMBLEMHEALTH/HIP-Medicaid, +42217,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMBLEMHEALTH/HIP-Medicaid, +42218,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMBLEMHEALTH/HIP-Medicaid, +42219,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMBLEMHEALTH/HIP-Medicaid, +42220,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMBLEMHEALTH/HIP-Medicaid, +42221,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMBLEMHEALTH/HIP-Medicaid, +42222,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMBLEMHEALTH/HIP-Medicaid, +42223,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMBLEMHEALTH/HIP-Medicaid, +42224,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMBLEMHEALTH/HIP-Medicaid, +42225,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMBLEMHEALTH/HIP-Medicaid, +42226,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMBLEMHEALTH/HIP-Medicaid, +42227,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMBLEMHEALTH/HIP-Medicaid, +42228,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMBLEMHEALTH/HIP-Medicaid, +42229,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMBLEMHEALTH/HIP-Medicaid, +42230,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMBLEMHEALTH/HIP-Medicaid, +42231,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMBLEMHEALTH/HIP-Medicaid, +42232,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMBLEMHEALTH/HIP-Medicaid, +42233,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMBLEMHEALTH/HIP-Medicaid, +42234,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMBLEMHEALTH/HIP-Medicaid, +42235,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMBLEMHEALTH/HIP-Medicaid, +42236,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMBLEMHEALTH/HIP-Medicaid, +42237,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMBLEMHEALTH/HIP-Medicaid, +42238,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMBLEMHEALTH/HIP-Medicaid, +42239,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMBLEMHEALTH/HIP-Medicaid, +42240,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMBLEMHEALTH/HIP-Medicaid, +42241,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMBLEMHEALTH/HIP-Medicaid, +42242,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMBLEMHEALTH/HIP-Medicaid, +42243,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMBLEMHEALTH/HIP-Medicaid, +42244,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMBLEMHEALTH/HIP-Medicaid, +42245,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMBLEMHEALTH/HIP-Medicaid, +42246,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMBLEMHEALTH/HIP-Medicaid, +42247,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMBLEMHEALTH/HIP-Medicaid, +42248,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMBLEMHEALTH/HIP-Medicaid, +42249,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMBLEMHEALTH/HIP-Medicaid, +42250,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMBLEMHEALTH/HIP-Medicaid, +42251,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMBLEMHEALTH/HIP-Medicaid, +42252,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMBLEMHEALTH/HIP-Medicaid, +42253,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMBLEMHEALTH/HIP-Medicaid, +42254,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMBLEMHEALTH/HIP-Medicaid, +42255,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMBLEMHEALTH/HIP-Medicaid, +42256,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMBLEMHEALTH/HIP-Medicaid, +42257,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMBLEMHEALTH/HIP-Medicaid, +42258,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMBLEMHEALTH/HIP-Medicaid,873.9 +42259,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMBLEMHEALTH/HIP-Medicaid,42.5 +42260,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMBLEMHEALTH/HIP-Medicaid, +42261,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMBLEMHEALTH/HIP-Medicaid,56.85 +42262,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMBLEMHEALTH/HIP-Medicaid, +42263,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMBLEMHEALTH/HIP-Medicaid, +42264,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMBLEMHEALTH/HIP-Medicaid, +42265,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMBLEMHEALTH/HIP-Medicaid, +42266,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMBLEMHEALTH/HIP-Medicaid, +42267,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMBLEMHEALTH/HIP-Medicaid, +42268,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMBLEMHEALTH/HIP-Medicaid, +42269,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMBLEMHEALTH/HIP-Medicaid,18.0 +42270,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMBLEMHEALTH/HIP-Medicaid, +42271,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMBLEMHEALTH/HIP-Medicaid, +42272,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMBLEMHEALTH/HIP-Medicaid, +42273,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMBLEMHEALTH/HIP-Medicaid, +42274,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMBLEMHEALTH/HIP-Medicaid, +42275,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMBLEMHEALTH/HIP-Medicaid,255.32 +42276,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMBLEMHEALTH/HIP-Medicaid, +42277,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMBLEMHEALTH/HIP-Medicaid, +42278,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMBLEMHEALTH/HIP-Medicaid, +42279,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMBLEMHEALTH/HIP-Medicaid, +42280,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMBLEMHEALTH/HIP-Medicaid,8.64 +42281,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMBLEMHEALTH/HIP-Medicaid, +42282,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMBLEMHEALTH/HIP-Medicaid, +42283,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMBLEMHEALTH/HIP-Medicaid, +42284,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMBLEMHEALTH/HIP-Medicaid, +42285,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMBLEMHEALTH/HIP-Medicaid, +42286,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMBLEMHEALTH/HIP-Medicaid, +42287,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMBLEMHEALTH/HIP-Medicaid, +42288,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMBLEMHEALTH/HIP-Medicaid, +42289,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMBLEMHEALTH/HIP-Medicaid, +42290,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMBLEMHEALTH/HIP-Medicaid, +42291,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMBLEMHEALTH/HIP-Medicaid, +42292,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMBLEMHEALTH/HIP-Medicaid, +42293,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMBLEMHEALTH/HIP-Medicaid, +42294,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMBLEMHEALTH/HIP-Medicaid, +42295,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMBLEMHEALTH/HIP-Medicaid, +42296,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMBLEMHEALTH/HIP-Medicaid, +42297,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMBLEMHEALTH/HIP-Medicaid, +42298,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMBLEMHEALTH/HIP-Medicaid, +42299,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMBLEMHEALTH/HIP-Medicaid, +42300,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMBLEMHEALTH/HIP-Medicaid, +42301,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMBLEMHEALTH/HIP-Medicaid,147.86 +42302,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMBLEMHEALTH/HIP-Medicaid, +42303,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMBLEMHEALTH/HIP-Medicaid, +42304,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMBLEMHEALTH/HIP-Medicaid,482.5 +42305,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMBLEMHEALTH/HIP-Medicaid, +42306,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMBLEMHEALTH/HIP-Medicaid, +42307,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMBLEMHEALTH/HIP-Medicaid, +42308,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMBLEMHEALTH/HIP-Medicaid, +42309,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMBLEMHEALTH/HIP-Medicaid, +42310,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMBLEMHEALTH/HIP-Medicaid, +42311,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMBLEMHEALTH/HIP-Medicaid, +42312,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMBLEMHEALTH/HIP-Medicaid, +42313,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMBLEMHEALTH/HIP-Medicaid, +42314,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMBLEMHEALTH/HIP-Medicaid, +42315,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMBLEMHEALTH/HIP-Medicaid, +42316,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMBLEMHEALTH/HIP-Medicaid, +42317,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMBLEMHEALTH/HIP-Medicaid, +42318,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMBLEMHEALTH/HIP-Medicaid, +42319,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMBLEMHEALTH/HIP-Medicaid, +42320,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMBLEMHEALTH/HIP-Medicaid, +42321,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMBLEMHEALTH/HIP-Medicaid, +42322,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMBLEMHEALTH/HIP-Medicaid, +42323,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMBLEMHEALTH/HIP-Medicaid, +42324,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMBLEMHEALTH/HIP-Medicaid, +42325,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMBLEMHEALTH/HIP-Medicaid, +42326,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMBLEMHEALTH/HIP-Medicaid, +42327,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMBLEMHEALTH/HIP-Medicaid, +42328,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMBLEMHEALTH/HIP-Medicaid, +42329,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMBLEMHEALTH/HIP-Medicaid, +42330,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMBLEMHEALTH/HIP-Medicaid, +42331,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMBLEMHEALTH/HIP-Medicaid, +42332,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMBLEMHEALTH/HIP-Medicaid, +42333,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMBLEMHEALTH/HIP-Medicaid, +42334,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMBLEMHEALTH/HIP-Medicaid, +42335,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMBLEMHEALTH/HIP-Medicaid, +42336,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMBLEMHEALTH/HIP-Medicaid, +42337,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMBLEMHEALTH/HIP-Medicaid, +42338,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMBLEMHEALTH/HIP-Medicaid,5433.5 +42339,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMBLEMHEALTH/HIP-Medicaid, +42340,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMBLEMHEALTH/HIP-Medicaid, +42341,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMBLEMHEALTH/HIP-Medicaid, +42342,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMBLEMHEALTH/HIP-Medicaid, +42343,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMBLEMHEALTH/HIP-Medicaid, +42344,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMBLEMHEALTH/HIP-Medicaid, +42345,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMBLEMHEALTH/HIP-Medicaid, +42346,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMBLEMHEALTH/HIP-Medicaid, +42347,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMBLEMHEALTH/HIP-Medicaid, +42348,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMBLEMHEALTH/HIP-Medicaid, +42349,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMBLEMHEALTH/HIP-Medicaid, +42350,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMBLEMHEALTH/HIP-Medicaid, +42351,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMBLEMHEALTH/HIP-Medicaid, +42352,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMBLEMHEALTH/HIP-Medicaid, +42353,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMBLEMHEALTH/HIP-Medicaid, +42354,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMBLEMHEALTH/HIP-Medicaid, +42355,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMBLEMHEALTH/HIP-Medicaid, +42356,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMBLEMHEALTH/HIP-Medicaid, +42357,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMBLEMHEALTH/HIP-Medicaid, +42358,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMBLEMHEALTH/HIP-Medicaid, +42359,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMBLEMHEALTH/HIP-Medicaid, +42360,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMBLEMHEALTH/HIP-Medicaid, +42361,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMBLEMHEALTH/HIP-Medicaid, +42362,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMBLEMHEALTH/HIP-Medicaid, +42363,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMBLEMHEALTH/HIP-Medicaid, +42364,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMBLEMHEALTH/HIP-Medicaid, +42365,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMBLEMHEALTH/HIP-Medicaid, +42366,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMBLEMHEALTH/HIP-Medicaid, +42367,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMBLEMHEALTH/HIP-Medicaid, +42368,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMBLEMHEALTH/HIP-Medicaid, +42369,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMBLEMHEALTH/HIP-Medicaid, +42370,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMBLEMHEALTH/HIP-Medicaid, +42371,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMBLEMHEALTH/HIP-Medicaid, +42372,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMBLEMHEALTH/HIP-Medicaid, +42373,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMBLEMHEALTH/HIP-Medicaid, +42374,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMBLEMHEALTH/HIP-Medicaid, +42375,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMBLEMHEALTH/HIP-Medicaid, +42376,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMBLEMHEALTH/HIP-Medicaid, +42377,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMBLEMHEALTH/HIP-Medicaid, +42378,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMBLEMHEALTH/HIP-Medicaid, +42379,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMBLEMHEALTH/HIP-Medicaid, +42380,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMBLEMHEALTH/HIP-Medicaid, +42381,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMBLEMHEALTH/HIP-Medicaid, +42382,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMBLEMHEALTH/HIP-Medicaid, +42383,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMBLEMHEALTH/HIP-Medicaid, +42384,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMBLEMHEALTH/HIP-Medicaid, +42385,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMBLEMHEALTH/HIP-Medicaid, +42386,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMBLEMHEALTH/HIP-Medicaid, +42387,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMBLEMHEALTH/HIP-Medicaid, +42388,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMBLEMHEALTH/HIP-Medicaid, +42389,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMBLEMHEALTH/HIP-Medicaid, +42390,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMBLEMHEALTH/HIP-Medicaid, +42391,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMBLEMHEALTH/HIP-Medicaid, +42392,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMBLEMHEALTH/HIP-Medicaid, +42393,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMBLEMHEALTH/HIP-Medicaid, +42394,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMBLEMHEALTH/HIP-Medicaid, +42395,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMBLEMHEALTH/HIP-Medicaid, +42396,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMBLEMHEALTH/HIP-Medicaid, +42397,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMBLEMHEALTH/HIP-Medicaid, +42398,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMBLEMHEALTH/HIP-Medicaid, +42399,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMBLEMHEALTH/HIP-Medicaid, +42400,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMBLEMHEALTH/HIP-Medicaid, +42401,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMBLEMHEALTH/HIP-Medicaid, +42402,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMBLEMHEALTH/HIP-Medicaid, +42403,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMBLEMHEALTH/HIP-Medicaid, +42404,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMBLEMHEALTH/HIP-Medicaid, +42405,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMBLEMHEALTH/HIP-Medicaid, +42406,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMBLEMHEALTH/HIP-Medicaid, +42407,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMBLEMHEALTH/HIP-Medicaid, +42408,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMBLEMHEALTH/HIP-Medicaid, +42409,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMBLEMHEALTH/HIP-Medicaid, +42410,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMBLEMHEALTH/HIP-Medicaid,3592.0 +42411,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMBLEMHEALTH/HIP-Medicaid, +42412,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMBLEMHEALTH/HIP-Medicaid, +42413,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMBLEMHEALTH/HIP-Medicaid, +42414,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMBLEMHEALTH/HIP-Medicaid,2629.39 +42415,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMBLEMHEALTH/HIP-Medicaid, +42416,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMBLEMHEALTH/HIP-Medicaid, +42417,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMBLEMHEALTH/HIP-Medicaid, +42418,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMBLEMHEALTH/HIP-Medicaid, +42419,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMBLEMHEALTH/HIP-Medicaid, +42420,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMBLEMHEALTH/HIP-Medicaid, +42421,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMBLEMHEALTH/HIP-Medicaid, +42422,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMBLEMHEALTH/HIP-Medicaid, +42423,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMBLEMHEALTH/HIP-Medicaid, +42424,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMBLEMHEALTH/HIP-Medicaid, +42425,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMBLEMHEALTH/HIP-Medicaid, +42426,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMBLEMHEALTH/HIP-Medicaid, +42427,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMBLEMHEALTH/HIP-Medicaid, +42428,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMBLEMHEALTH/HIP-Medicaid, +42429,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMBLEMHEALTH/HIP-Medicaid, +42430,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMBLEMHEALTH/HIP-Medicaid, +42431,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMBLEMHEALTH/HIP-Medicaid, +42432,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMBLEMHEALTH/HIP-Medicaid, +42433,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMBLEMHEALTH/HIP-Medicaid, +42434,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMBLEMHEALTH/HIP-Medicaid,100.0 +42435,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMBLEMHEALTH/HIP-Medicaid,1796.0 +42436,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMBLEMHEALTH/HIP-Medicaid,50.0 +42437,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMBLEMHEALTH/HIP-Medicaid, +42438,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMBLEMHEALTH/HIP-Medicaid, +42439,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMBLEMHEALTH/HIP-Medicaid, +42440,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMBLEMHEALTH/HIP-Medicaid, +42441,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMBLEMHEALTH/HIP-Medicaid, +42442,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMBLEMHEALTH/HIP-Medicaid, +42443,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMBLEMHEALTH/HIP-Medicaid, +42444,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMBLEMHEALTH/HIP-Medicaid, +42445,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMBLEMHEALTH/HIP-Medicaid,96.78 +42446,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMBLEMHEALTH/HIP-Medicaid, +42447,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMBLEMHEALTH/HIP-Medicaid, +42448,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMBLEMHEALTH/HIP-Medicaid, +42449,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMBLEMHEALTH/HIP-Medicaid, +42450,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMBLEMHEALTH/HIP-Medicaid, +42451,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMBLEMHEALTH/HIP-Medicaid, +42452,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMBLEMHEALTH/HIP-Medicaid, +42453,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMBLEMHEALTH/HIP-Medicaid, +42454,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMBLEMHEALTH/HIP-Medicaid, +42455,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMBLEMHEALTH/HIP-Medicaid, +42456,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMBLEMHEALTH/HIP-Medicaid, +42457,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMBLEMHEALTH/HIP-Medicaid, +42458,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMBLEMHEALTH/HIP-Medicaid,97.0 +42459,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMBLEMHEALTH/HIP-Medicaid, +42460,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMBLEMHEALTH/HIP-Medicaid, +42461,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMBLEMHEALTH/HIP-Medicaid, +42462,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMBLEMHEALTH/HIP-Medicaid,395.0 +42463,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMBLEMHEALTH/HIP-Medicaid,940.67 +42464,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMBLEMHEALTH/HIP-Medicaid, +42465,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMBLEMHEALTH/HIP-Medicaid, +42466,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMBLEMHEALTH/HIP-Medicaid, +42467,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMBLEMHEALTH/HIP-Medicaid, +42468,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMBLEMHEALTH/HIP-Medicaid, +42469,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMBLEMHEALTH/HIP-Medicaid, +42470,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMBLEMHEALTH/HIP-Medicaid, +42471,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMBLEMHEALTH/HIP-Medicaid, +42472,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMBLEMHEALTH/HIP-Medicaid, +42473,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMBLEMHEALTH/HIP-Medicaid, +42474,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMBLEMHEALTH/HIP-Medicaid, +42475,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMBLEMHEALTH/HIP-Medicaid, +42476,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMBLEMHEALTH/HIP-Medicaid, +42477,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMBLEMHEALTH/HIP-Medicaid, +42478,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMBLEMHEALTH/HIP-Medicaid,127.44 +42479,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMBLEMHEALTH/HIP-Medicaid, +42480,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMBLEMHEALTH/HIP-Medicaid, +42481,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMBLEMHEALTH/HIP-Medicaid, +42482,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMBLEMHEALTH/HIP-Medicaid, +42483,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMBLEMHEALTH/HIP-Medicaid, +42484,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMBLEMHEALTH/HIP-Medicaid, +42485,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMBLEMHEALTH/HIP-Medicaid, +42486,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMBLEMHEALTH/HIP-Medicaid, +42487,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMBLEMHEALTH/HIP-Medicaid, +42488,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMBLEMHEALTH/HIP-Medicaid, +42489,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMBLEMHEALTH/HIP-Medicaid, +42490,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMBLEMHEALTH/HIP-Medicaid, +42491,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMBLEMHEALTH/HIP-Medicaid, +42492,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMBLEMHEALTH/HIP-Medicaid, +42493,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMBLEMHEALTH/HIP-Medicaid, +42494,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMBLEMHEALTH/HIP-Medicaid, +42495,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMBLEMHEALTH/HIP-Medicaid, +42496,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMBLEMHEALTH/HIP-Medicaid, +42497,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMBLEMHEALTH/HIP-Medicaid, +42498,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMBLEMHEALTH/HIP-Medicaid, +42499,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMBLEMHEALTH/HIP-Medicaid, +42500,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMBLEMHEALTH/HIP-Medicaid, +42501,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMBLEMHEALTH/HIP-Medicaid, +42502,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMBLEMHEALTH/HIP-Medicaid, +42503,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMBLEMHEALTH/HIP-Medicaid, +42504,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMBLEMHEALTH/HIP-Medicaid, +42505,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMBLEMHEALTH/HIP-Medicaid, +42506,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMBLEMHEALTH/HIP-Medicaid,16.19 +42507,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMBLEMHEALTH/HIP-Medicaid,43.48 +42508,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMBLEMHEALTH/HIP-Medicaid, +42509,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMBLEMHEALTH/HIP-Medicaid, +42510,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMBLEMHEALTH/HIP-Medicaid,20.88 +42511,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMBLEMHEALTH/HIP-Medicaid, +42512,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMBLEMHEALTH/HIP-Medicaid, +42513,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMBLEMHEALTH/HIP-Medicaid, +42514,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMBLEMHEALTH/HIP-Medicaid, +42515,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMBLEMHEALTH/HIP-Medicaid,3.91 +42516,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMBLEMHEALTH/HIP-Medicaid, +42517,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMBLEMHEALTH/HIP-Medicaid, +42518,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMBLEMHEALTH/HIP-Medicaid, +42519,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMBLEMHEALTH/HIP-Medicaid, +42520,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMBLEMHEALTH/HIP-Medicaid,5572.8 +42521,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMBLEMHEALTH/HIP-Medicaid, +42522,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMBLEMHEALTH/HIP-Medicaid, +42523,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMBLEMHEALTH/HIP-Medicaid, +42524,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMBLEMHEALTH/HIP-Medicaid, +42525,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMBLEMHEALTH/HIP-Medicaid, +42526,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMBLEMHEALTH/HIP-Medicaid, +42527,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMBLEMHEALTH/HIP-Medicaid, +42528,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMBLEMHEALTH/HIP-Medicaid, +42529,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMBLEMHEALTH/HIP-Medicaid, +42530,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMBLEMHEALTH/HIP-Medicaid,0.32 +42531,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMBLEMHEALTH/HIP-Medicaid, +42532,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMBLEMHEALTH/HIP-Medicaid, +42533,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMBLEMHEALTH/HIP-Medicaid, +42534,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMBLEMHEALTH/HIP-Medicaid, +42535,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMBLEMHEALTH/HIP-Medicaid, +42536,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMBLEMHEALTH/HIP-Medicaid, +42537,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMBLEMHEALTH/HIP-Medicaid, +42538,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMBLEMHEALTH/HIP-Medicaid, +42539,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMBLEMHEALTH/HIP-Medicaid, +42540,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMBLEMHEALTH/HIP-Medicaid, +42541,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMBLEMHEALTH/HIP-Medicaid, +42542,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMBLEMHEALTH/HIP-Medicaid, +42543,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMBLEMHEALTH/HIP-Medicaid, +42544,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMBLEMHEALTH/HIP-Medicaid, +42545,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMBLEMHEALTH/HIP-Medicaid, +42546,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMBLEMHEALTH/HIP-Medicaid, +42547,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMBLEMHEALTH/HIP-Medicaid, +42548,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMBLEMHEALTH/HIP-Medicaid, +42549,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMBLEMHEALTH/HIP-Medicaid, +42550,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMBLEMHEALTH/HIP-Medicaid, +42551,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMBLEMHEALTH/HIP-Medicaid, +42552,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMBLEMHEALTH/HIP-Medicaid, +42553,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMBLEMHEALTH/HIP-Medicaid, +42554,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMBLEMHEALTH/HIP-Medicaid, +42555,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMBLEMHEALTH/HIP-Medicaid, +42556,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMBLEMHEALTH/HIP-Medicaid, +42557,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMBLEMHEALTH/HIP-Medicaid,1.66 +42558,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMBLEMHEALTH/HIP-Medicaid,9.36 +42559,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMBLEMHEALTH/HIP-Medicaid, +42560,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMBLEMHEALTH/HIP-Medicaid, +42561,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMBLEMHEALTH/HIP-Medicaid, +42562,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMBLEMHEALTH/HIP-Medicaid, +42563,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMBLEMHEALTH/HIP-Medicaid, +42564,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMBLEMHEALTH/HIP-Medicaid, +42565,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMBLEMHEALTH/HIP-Medicaid, +42566,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMBLEMHEALTH/HIP-Medicaid, +42567,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMBLEMHEALTH/HIP-Medicaid, +42568,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMBLEMHEALTH/HIP-Medicaid, +42569,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMBLEMHEALTH/HIP-Medicaid, +42570,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMBLEMHEALTH/HIP-Medicaid, +42571,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMBLEMHEALTH/HIP-Medicaid, +42572,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMBLEMHEALTH/HIP-Medicaid, +42573,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMBLEMHEALTH/HIP-Medicaid, +42574,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMBLEMHEALTH/HIP-Medicaid, +42575,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMBLEMHEALTH/HIP-Medicaid, +42576,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMBLEMHEALTH/HIP-Medicaid, +42577,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMBLEMHEALTH/HIP-Medicaid, +42578,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMBLEMHEALTH/HIP-Medicaid, +42579,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMBLEMHEALTH/HIP-Medicaid, +42580,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMBLEMHEALTH/HIP-Medicaid, +42581,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMBLEMHEALTH/HIP-Medicaid, +42582,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMBLEMHEALTH/HIP-Medicaid, +42583,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMBLEMHEALTH/HIP-Medicaid,3.31 +42584,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMBLEMHEALTH/HIP-Medicaid, +42585,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMBLEMHEALTH/HIP-Medicaid, +42586,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMBLEMHEALTH/HIP-Medicaid, +42587,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMBLEMHEALTH/HIP-Medicaid, +42588,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMBLEMHEALTH/HIP-Medicaid, +42589,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMBLEMHEALTH/HIP-Medicaid, +42590,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMBLEMHEALTH/HIP-Medicaid, +42591,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMBLEMHEALTH/HIP-Medicaid, +42592,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMBLEMHEALTH/HIP-Medicaid, +42593,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMBLEMHEALTH/HIP-Medicaid, +42594,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMBLEMHEALTH/HIP-Medicaid, +42595,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMBLEMHEALTH/HIP-Medicaid, +42596,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMBLEMHEALTH/HIP-Medicaid,2.12 +42597,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMBLEMHEALTH/HIP-Medicaid,20.24 +42598,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMBLEMHEALTH/HIP-Medicaid,21427.94 +42599,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMBLEMHEALTH/HIP-Medicaid, +42600,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMBLEMHEALTH/HIP-Medicaid, +42601,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMBLEMHEALTH/HIP-Medicaid, +42602,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMBLEMHEALTH/HIP-Medicaid, +42603,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMBLEMHEALTH/HIP-Medicaid, +42604,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMBLEMHEALTH/HIP-Medicaid, +42605,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMBLEMHEALTH/HIP-Medicaid, +42606,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMBLEMHEALTH/HIP-Medicaid, +42607,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMBLEMHEALTH/HIP-Medicaid, +42608,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMBLEMHEALTH/HIP-Medicaid, +42609,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMBLEMHEALTH/HIP-Medicaid, +42610,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMBLEMHEALTH/HIP-Medicaid, +42611,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMBLEMHEALTH/HIP-Medicaid, +42612,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMBLEMHEALTH/HIP-Medicaid,37.05 +42613,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMBLEMHEALTH/HIP-Medicaid, +42614,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMBLEMHEALTH/HIP-Medicaid, +42615,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMBLEMHEALTH/HIP-Medicaid,245.16 +42616,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMBLEMHEALTH/HIP-Medicaid, +42617,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMBLEMHEALTH/HIP-Medicaid,213.86 +42618,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMBLEMHEALTH/HIP-Medicaid, +42619,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMBLEMHEALTH/HIP-Medicaid, +42620,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMBLEMHEALTH/HIP-Medicaid, +42621,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMBLEMHEALTH/HIP-Medicaid, +42622,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMBLEMHEALTH/HIP-Medicaid, +42623,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMBLEMHEALTH/HIP-Medicaid, +42624,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMBLEMHEALTH/HIP-Medicaid, +42625,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMBLEMHEALTH/HIP-Medicaid, +42626,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMBLEMHEALTH/HIP-Medicaid,401.47 +42627,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMBLEMHEALTH/HIP-Medicaid, +42628,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMBLEMHEALTH/HIP-Medicaid, +42629,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMBLEMHEALTH/HIP-Medicaid, +42630,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMBLEMHEALTH/HIP-Medicaid, +42631,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMBLEMHEALTH/HIP-Medicaid, +42632,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMBLEMHEALTH/HIP-Medicaid, +42633,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMBLEMHEALTH/HIP-Medicaid, +42634,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMBLEMHEALTH/HIP-Medicaid, +42635,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMBLEMHEALTH/HIP-Medicaid, +42636,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMBLEMHEALTH/HIP-Medicaid, +42637,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMBLEMHEALTH/HIP-Medicaid, +42638,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMBLEMHEALTH/HIP-Medicaid, +42639,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMBLEMHEALTH/HIP-Medicaid, +42640,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMBLEMHEALTH/HIP-Medicaid, +42641,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMBLEMHEALTH/HIP-Medicaid,0.41 +42642,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMBLEMHEALTH/HIP-Medicaid, +42643,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMBLEMHEALTH/HIP-Medicaid,6.49 +42644,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMBLEMHEALTH/HIP-Medicaid, +42645,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMBLEMHEALTH/HIP-Medicaid,0.15 +42646,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMBLEMHEALTH/HIP-Medicaid,14.04 +42647,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMBLEMHEALTH/HIP-Medicaid,0.29 +42648,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMBLEMHEALTH/HIP-Medicaid, +42649,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMBLEMHEALTH/HIP-Medicaid,12.41 +42650,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMBLEMHEALTH/HIP-Medicaid, +42651,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMBLEMHEALTH/HIP-Medicaid, +42652,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMBLEMHEALTH/HIP-Medicaid, +42653,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMBLEMHEALTH/HIP-Medicaid, +42654,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMBLEMHEALTH/HIP-Medicaid, +42655,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMBLEMHEALTH/HIP-Medicaid, +42656,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMBLEMHEALTH/HIP-Medicaid, +42657,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMBLEMHEALTH/HIP-Medicaid, +42658,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMBLEMHEALTH/HIP-Medicaid, +42659,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMBLEMHEALTH/HIP-Medicaid, +42660,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMBLEMHEALTH/HIP-Medicaid, +42661,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMBLEMHEALTH/HIP-Medicaid, +42662,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMBLEMHEALTH/HIP-Medicaid, +42663,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMBLEMHEALTH/HIP-Medicaid, +42664,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMBLEMHEALTH/HIP-Medicaid, +42665,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMBLEMHEALTH/HIP-Medicaid, +42666,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMBLEMHEALTH/HIP-Medicaid, +42667,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMBLEMHEALTH/HIP-Medicaid, +42668,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMBLEMHEALTH/HIP-Medicaid, +42669,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMBLEMHEALTH/HIP-Medicaid, +42670,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMBLEMHEALTH/HIP-Medicaid, +42671,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMBLEMHEALTH/HIP-Medicaid, +42672,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMBLEMHEALTH/HIP-Medicaid, +42673,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMBLEMHEALTH/HIP-Medicaid, +42674,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMBLEMHEALTH/HIP-Medicaid, +42675,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMBLEMHEALTH/HIP-Medicaid, +42676,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMBLEMHEALTH/HIP-Medicaid, +42677,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMBLEMHEALTH/HIP-Medicaid, +42678,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMBLEMHEALTH/HIP-Medicaid, +42679,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMBLEMHEALTH/HIP-Medicaid, +42680,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMBLEMHEALTH/HIP-Medicaid, +42681,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMBLEMHEALTH/HIP-Medicaid, +42682,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMBLEMHEALTH/HIP-Medicaid, +42683,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMBLEMHEALTH/HIP-Medicaid, +42684,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMBLEMHEALTH/HIP-Medicaid, +42685,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMBLEMHEALTH/HIP-Medicaid, +42686,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMBLEMHEALTH/HIP-Medicaid,345.65 +42687,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMBLEMHEALTH/HIP-Medicaid, +42688,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMBLEMHEALTH/HIP-Medicaid, +42689,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMBLEMHEALTH/HIP-Medicaid, +42690,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMBLEMHEALTH/HIP-Medicaid, +42691,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMBLEMHEALTH/HIP-Medicaid, +42692,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMBLEMHEALTH/HIP-Medicaid, +42693,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMBLEMHEALTH/HIP-Medicaid, +42694,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMBLEMHEALTH/HIP-Medicaid, +42695,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMBLEMHEALTH/HIP-Medicaid, +42696,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMBLEMHEALTH/HIP-Medicaid, +42697,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMBLEMHEALTH/HIP-Medicaid, +42698,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMBLEMHEALTH/HIP-Medicaid, +42699,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMBLEMHEALTH/HIP-Medicaid, +42700,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMBLEMHEALTH/HIP-Medicaid, +42701,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMBLEMHEALTH/HIP-Medicaid, +42702,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMBLEMHEALTH/HIP-Medicaid, +42703,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMBLEMHEALTH/HIP-Medicaid, +42704,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMBLEMHEALTH/HIP-Medicaid, +42705,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMBLEMHEALTH/HIP-Medicaid, +42706,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMBLEMHEALTH/HIP-Medicaid, +42707,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMBLEMHEALTH/HIP-Medicaid, +42708,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMBLEMHEALTH/HIP-Medicaid, +42709,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMBLEMHEALTH/HIP-Medicaid,2.94 +42710,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMBLEMHEALTH/HIP-Medicaid, +42711,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMBLEMHEALTH/HIP-Medicaid, +42712,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMBLEMHEALTH/HIP-Medicaid, +42713,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMBLEMHEALTH/HIP-Medicaid, +42714,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMBLEMHEALTH/HIP-Medicaid, +42715,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMBLEMHEALTH/HIP-Medicaid, +42716,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMBLEMHEALTH/HIP-Medicaid, +42717,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMBLEMHEALTH/HIP-Medicaid, +42718,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMBLEMHEALTH/HIP-Medicaid, +42719,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMBLEMHEALTH/HIP-Medicaid, +42720,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMBLEMHEALTH/HIP-Medicaid, +42721,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMBLEMHEALTH/HIP-Medicaid, +42722,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMBLEMHEALTH/HIP-Medicaid, +42723,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMBLEMHEALTH/HIP-Medicaid, +42724,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMBLEMHEALTH/HIP-Medicaid, +42725,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMBLEMHEALTH/HIP-Medicaid, +42726,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMBLEMHEALTH/HIP-Medicaid, +42727,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMBLEMHEALTH/HIP-Medicaid, +42728,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMBLEMHEALTH/HIP-Medicaid, +42729,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMBLEMHEALTH/HIP-Medicaid, +42730,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMBLEMHEALTH/HIP-Medicaid, +42731,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMBLEMHEALTH/HIP-Medicaid, +42732,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMBLEMHEALTH/HIP-Medicaid, +42733,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMBLEMHEALTH/HIP-Medicaid, +42734,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMBLEMHEALTH/HIP-Medicaid, +42735,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMBLEMHEALTH/HIP-Medicaid, +42736,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMBLEMHEALTH/HIP-Medicaid, +42737,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMBLEMHEALTH/HIP-Medicaid, +42738,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMBLEMHEALTH/HIP-Medicaid, +42739,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMBLEMHEALTH/HIP-Medicaid, +42740,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMBLEMHEALTH/HIP-Medicaid, +42741,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMBLEMHEALTH/HIP-Medicaid, +42742,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMBLEMHEALTH/HIP-Medicaid, +42743,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMBLEMHEALTH/HIP-Medicaid, +42744,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMBLEMHEALTH/HIP-Medicaid, +42745,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMBLEMHEALTH/HIP-Medicaid, +42746,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMBLEMHEALTH/HIP-Medicaid, +42747,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMBLEMHEALTH/HIP-Medicaid, +42748,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMBLEMHEALTH/HIP-Medicaid, +42749,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMBLEMHEALTH/HIP-Medicaid, +42750,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMBLEMHEALTH/HIP-Medicaid, +42751,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMBLEMHEALTH/HIP-Medicaid, +42752,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMBLEMHEALTH/HIP-Medicaid, +42753,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMBLEMHEALTH/HIP-Medicaid, +42754,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMBLEMHEALTH/HIP-Medicaid, +42755,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMBLEMHEALTH/HIP-Medicaid, +42756,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMBLEMHEALTH/HIP-Medicaid, +42757,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMBLEMHEALTH/HIP-Medicaid, +42758,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMBLEMHEALTH/HIP-Medicaid, +42759,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMBLEMHEALTH/HIP-Medicaid, +42760,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMBLEMHEALTH/HIP-Medicaid, +42761,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMBLEMHEALTH/HIP-Medicaid, +42762,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMBLEMHEALTH/HIP-Medicaid, +42763,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMBLEMHEALTH/HIP-Medicaid, +42764,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMBLEMHEALTH/HIP-Medicaid, +42765,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMBLEMHEALTH/HIP-Medicaid, +42766,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMBLEMHEALTH/HIP-Medicaid, +42767,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMBLEMHEALTH/HIP-Medicaid, +42768,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMBLEMHEALTH/HIP-Medicaid, +42769,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMBLEMHEALTH/HIP-Medicaid,753.0 +42770,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMBLEMHEALTH/HIP-Medicaid, +42771,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMBLEMHEALTH/HIP-Medicaid, +42772,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMBLEMHEALTH/HIP-Medicaid, +42773,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMBLEMHEALTH/HIP-Medicaid, +42774,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMBLEMHEALTH/HIP-Medicaid, +42775,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMBLEMHEALTH/HIP-Medicaid, +42776,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMBLEMHEALTH/HIP-Medicaid, +42777,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMBLEMHEALTH/HIP-Medicaid, +42778,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMBLEMHEALTH/HIP-Medicaid,3734.0 +42779,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMBLEMHEALTH/HIP-Medicaid, +42780,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMBLEMHEALTH/HIP-Medicaid, +42781,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMBLEMHEALTH/HIP-Medicaid, +42782,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMBLEMHEALTH/HIP-Medicaid, +42783,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMBLEMHEALTH/HIP-Medicaid, +42784,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMBLEMHEALTH/HIP-Medicaid, +42785,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMBLEMHEALTH/HIP-Medicaid, +42786,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMBLEMHEALTH/HIP-Medicaid, +42787,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMBLEMHEALTH/HIP-Medicaid,138.68 +42788,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMBLEMHEALTH/HIP-Medicaid, +42789,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMBLEMHEALTH/HIP-Medicaid, +42790,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMBLEMHEALTH/HIP-Medicaid, +42791,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMBLEMHEALTH/HIP-Medicaid, +42792,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMBLEMHEALTH/HIP-Medicaid, +42793,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMBLEMHEALTH/HIP-Medicaid, +42794,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMBLEMHEALTH/HIP-Medicaid, +42795,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMBLEMHEALTH/HIP-Medicaid, +42796,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMBLEMHEALTH/HIP-Medicaid, +42797,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMBLEMHEALTH/HIP-Medicaid, +42798,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMBLEMHEALTH/HIP-Medicaid, +42799,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMBLEMHEALTH/HIP-Medicaid,20.0 +42800,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMBLEMHEALTH/HIP-Medicaid, +42801,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMBLEMHEALTH/HIP-Medicaid, +42802,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMBLEMHEALTH/HIP-Medicaid, +42803,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMBLEMHEALTH/HIP-Medicaid, +42804,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMBLEMHEALTH/HIP-Medicaid, +42805,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMBLEMHEALTH/HIP-Medicaid, +42806,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMBLEMHEALTH/HIP-Medicaid, +42807,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMBLEMHEALTH/HIP-Medicaid, +42808,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMBLEMHEALTH/HIP-Medicaid, +42809,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMBLEMHEALTH/HIP-Medicaid, +42810,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMBLEMHEALTH/HIP-Medicaid, +42811,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMBLEMHEALTH/HIP-Medicaid, +42812,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMBLEMHEALTH/HIP-Medicaid, +42813,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMBLEMHEALTH/HIP-Medicaid, +42814,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMBLEMHEALTH/HIP-Medicaid, +42815,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMBLEMHEALTH/HIP-Medicaid, +42816,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMBLEMHEALTH/HIP-Medicaid, +42817,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMBLEMHEALTH/HIP-Medicaid, +42818,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMBLEMHEALTH/HIP-Medicaid, +42819,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMBLEMHEALTH/HIP-Medicaid, +42820,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMBLEMHEALTH/HIP-Medicaid, +42821,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMBLEMHEALTH/HIP-Medicaid, +42822,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMBLEMHEALTH/HIP-Medicaid, +42823,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMBLEMHEALTH/HIP-Medicaid,4229.35 +42824,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMBLEMHEALTH/HIP-Medicaid,1198.2 +42825,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMBLEMHEALTH/HIP-Medicaid,51.5 +42826,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMBLEMHEALTH/HIP-Medicaid, +42827,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMBLEMHEALTH/HIP-Medicaid, +42828,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMBLEMHEALTH/HIP-Medicaid,111.41 +42829,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMBLEMHEALTH/HIP-Medicaid, +42830,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMBLEMHEALTH/HIP-Medicaid, +42831,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMBLEMHEALTH/HIP-Medicaid, +42832,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMBLEMHEALTH/HIP-Medicaid, +42833,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMBLEMHEALTH/HIP-Medicaid, +42834,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMBLEMHEALTH/HIP-Medicaid, +42835,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMBLEMHEALTH/HIP-Medicaid, +42836,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42837,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42838,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42839,3934,30000038,ICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42840,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42841,3934,30000053,NICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42842,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42843,3934,30000079,PSYCH,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42844,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +42845,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42846,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42847,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42848,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42849,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42850,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42851,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42852,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42853,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42854,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42855,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42856,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42857,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42858,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42859,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42860,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42861,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42862,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42863,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42864,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42865,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42866,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42867,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42868,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42869,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42870,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42871,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42872,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42873,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42874,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42875,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42876,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42877,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42878,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42879,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42880,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42881,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42882,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42883,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42884,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42885,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42886,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42887,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42888,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42889,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42890,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42891,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42892,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42893,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42894,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42895,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42896,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42897,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42898,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42899,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42900,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42901,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42902,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42903,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42904,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42905,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42906,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42907,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42908,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42909,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42910,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42911,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42912,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42913,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42914,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42915,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42916,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42917,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42918,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42919,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42920,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42921,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42922,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42923,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42924,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42925,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42926,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42927,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42928,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42929,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42930,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42931,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42932,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42933,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42934,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42935,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42936,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42937,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42938,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42939,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42940,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42941,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42942,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42943,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42944,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42945,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42946,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42947,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42948,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42949,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42950,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42951,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42952,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42953,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42954,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42955,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42956,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42957,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42958,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42959,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42960,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42961,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42962,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42963,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42964,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42965,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42966,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42967,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42968,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42969,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42970,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42971,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42972,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42973,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42974,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42975,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42976,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42977,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42978,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42979,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42980,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42981,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42982,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42983,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42984,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42985,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42986,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +42987,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42988,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42989,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42990,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42991,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42992,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42993,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42994,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42995,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42996,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +42997,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +42998,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +42999,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43000,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43001,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43002,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43003,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43004,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43005,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43006,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43007,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43008,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43009,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43010,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43011,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43012,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43013,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43014,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43015,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43016,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43017,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43018,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43019,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43020,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43021,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43022,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43023,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43024,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43025,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43026,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43027,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43028,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43029,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43030,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43031,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43032,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43033,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43034,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43035,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43036,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43037,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43038,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43039,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43040,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43041,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43042,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43043,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43044,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43045,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43046,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43047,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43048,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43049,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43050,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43051,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43052,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43053,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43054,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43055,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43056,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43057,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43058,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43059,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43060,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43061,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43062,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43063,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43064,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43065,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43066,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43067,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43068,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43069,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43070,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43071,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43072,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43073,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43074,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43075,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43076,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43077,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43078,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43079,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43080,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43081,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43082,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43083,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43084,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43085,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43086,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43087,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43088,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43089,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43090,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43091,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43092,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43093,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43094,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43095,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43096,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43097,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43098,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43099,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43100,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43101,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43102,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43103,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43104,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43105,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43106,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43107,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43108,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43109,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43110,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43111,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43112,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43113,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43114,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43115,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43116,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43117,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43118,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43119,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43120,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43121,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43122,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43123,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43124,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43125,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43126,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43127,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43128,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43129,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43130,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43131,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43132,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43133,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43134,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43135,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43136,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43137,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43138,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43139,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43140,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43141,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43142,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43143,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43144,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43145,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43146,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43147,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43148,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43149,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43150,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43151,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43152,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43153,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43154,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43155,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43156,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43157,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43158,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43159,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43160,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43161,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43162,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43163,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43164,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43165,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43166,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43167,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43168,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43169,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43170,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43171,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43172,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43173,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43174,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43175,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43176,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43177,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43178,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43179,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43180,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43181,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43182,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43183,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43184,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43185,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43186,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43187,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43188,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43189,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43190,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43191,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43192,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43193,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43194,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43195,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43196,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43197,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43198,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43199,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43200,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43201,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43202,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43203,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43204,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43205,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43206,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43207,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43208,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43209,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43210,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43211,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43212,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43213,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43214,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43215,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43216,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43217,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43218,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43219,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43220,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43221,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43222,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43223,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43224,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43225,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43226,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43227,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43228,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43229,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43230,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43231,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43232,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43233,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43234,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43235,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43236,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43237,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43238,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43239,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43240,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43241,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43242,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43243,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43244,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43245,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43246,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43247,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43248,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43249,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43250,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43251,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43252,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43253,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43254,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicaid, +43255,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43256,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43257,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43258,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43259,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43260,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43261,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicaid, +43262,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43263,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43264,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43265,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43266,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43267,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43268,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43269,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43270,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43271,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43272,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43273,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43274,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43275,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43276,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43277,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43278,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43279,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicaid, +43280,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43281,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicaid, +43282,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMBLEMHEALTH/HIP-Medicaid, +43283,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMBLEMHEALTH/HIP-Medicaid, +43284,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMBLEMHEALTH/HIP-Medicaid, +43285,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMBLEMHEALTH/HIP-Medicaid, +43286,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43287,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43288,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43289,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43290,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43291,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43292,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43293,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43294,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43295,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43296,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43297,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43298,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMBLEMHEALTH/HIP-Medicaid, +43299,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicaid, +43300,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMBLEMHEALTH/HIP-Medicaid, +43301,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMBLEMHEALTH/HIP-Medicaid, +43302,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMBLEMHEALTH/HIP-Medicaid, +43303,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMBLEMHEALTH/HIP-Medicaid, +43304,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMBLEMHEALTH/HIP-Medicaid, +43305,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMBLEMHEALTH/HIP-Medicaid, +43306,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMBLEMHEALTH/HIP-Medicaid, +43307,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMBLEMHEALTH/HIP-Medicaid, +43308,3934,37112034,TRIAGE,,277.0,277.0,,,EMBLEMHEALTH/HIP-Medicaid, +43309,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMBLEMHEALTH/HIP-Medicaid, +43310,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMBLEMHEALTH/HIP-Medicaid, +43311,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMBLEMHEALTH/HIP-Medicaid, +43312,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMBLEMHEALTH/HIP-Medicaid, +43313,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMBLEMHEALTH/HIP-Medicaid, +43314,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicaid, +43315,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicaid, +43316,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicaid, +43317,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicaid, +43318,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMBLEMHEALTH/HIP-Medicaid, +43319,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMBLEMHEALTH/HIP-Medicaid, +43320,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMBLEMHEALTH/HIP-Medicaid, +43321,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMBLEMHEALTH/HIP-Medicaid, +43322,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMBLEMHEALTH/HIP-Medicaid, +43323,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMBLEMHEALTH/HIP-Medicaid, +43324,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-Medicaid, +43325,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMBLEMHEALTH/HIP-Medicaid, +43326,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMBLEMHEALTH/HIP-Medicaid, +43327,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMBLEMHEALTH/HIP-Medicaid, +43328,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMBLEMHEALTH/HIP-Medicaid, +43329,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMBLEMHEALTH/HIP-Medicaid, +43330,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMBLEMHEALTH/HIP-Medicaid, +43331,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMBLEMHEALTH/HIP-Medicaid, +43332,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMBLEMHEALTH/HIP-Medicaid, +43333,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMBLEMHEALTH/HIP-Medicaid, +43334,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMBLEMHEALTH/HIP-Medicaid, +43335,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMBLEMHEALTH/HIP-Medicaid, +43336,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMBLEMHEALTH/HIP-Medicaid, +43337,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMBLEMHEALTH/HIP-Medicaid, +43338,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMBLEMHEALTH/HIP-Medicaid, +43339,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMBLEMHEALTH/HIP-Medicaid, +43340,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMBLEMHEALTH/HIP-Medicaid, +43341,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,EMBLEMHEALTH/HIP-Medicaid, +43342,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,EMBLEMHEALTH/HIP-Medicaid, +43343,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,EMBLEMHEALTH/HIP-Medicaid, +43344,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,EMBLEMHEALTH/HIP-Medicaid, +43345,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,EMBLEMHEALTH/HIP-Medicaid, +43346,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,EMBLEMHEALTH/HIP-Medicaid, +43347,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-Medicaid, +43348,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,EMBLEMHEALTH/HIP-Medicaid, +43349,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-Medicaid, +43350,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-Medicaid, +43351,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-Medicaid, +43352,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMBLEMHEALTH/HIP-Medicaid, +43353,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMBLEMHEALTH/HIP-Medicaid, +43354,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMBLEMHEALTH/HIP-Medicaid, +43355,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMBLEMHEALTH/HIP-Medicaid, +43356,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMBLEMHEALTH/HIP-Medicaid, +43357,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMBLEMHEALTH/HIP-Medicaid, +43358,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMBLEMHEALTH/HIP-Medicaid, +43359,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMBLEMHEALTH/HIP-Medicaid, +43360,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMBLEMHEALTH/HIP-Medicaid, +43361,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMBLEMHEALTH/HIP-Medicaid, +43362,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMBLEMHEALTH/HIP-Medicaid, +43363,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMBLEMHEALTH/HIP-Medicaid, +43364,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMBLEMHEALTH/HIP-Medicaid, +43365,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMBLEMHEALTH/HIP-Medicaid, +43366,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-Medicaid, +43367,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-Medicaid, +43368,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-Medicaid, +43369,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-Medicaid, +43370,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-Medicaid, +43371,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-Medicaid, +43372,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-Medicaid, +43373,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-Medicaid, +43374,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-Medicaid, +43375,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-Medicaid, +43376,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-Medicaid, +43377,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-Medicaid, +43378,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-Medicaid, +43379,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-Medicaid, +43380,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-Medicaid, +43381,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-Medicaid, +43382,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-Medicaid, +43383,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-Medicaid, +43384,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-Medicaid, +43385,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-Medicaid, +43386,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-Medicaid, +43387,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-Medicaid, +43388,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-Medicaid, +43389,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-Medicaid, +43390,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-Medicaid, +43391,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-Medicaid, +43392,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-Medicaid, +43393,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-Medicaid, +43394,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-Medicaid, +43395,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-Medicaid, +43396,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-Medicaid, +43397,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-Medicaid, +43398,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-Medicaid, +43399,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-Medicaid, +43400,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-Medicaid, +43401,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-Medicaid, +43402,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-Medicaid, +43403,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-Medicaid, +43404,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-Medicaid, +43405,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-Medicaid, +43406,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-Medicaid, +43407,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-Medicaid, +43408,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43409,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43410,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43411,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43412,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43413,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43414,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-Medicaid, +43415,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMBLEMHEALTH/HIP-Medicaid, +43416,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMBLEMHEALTH/HIP-Medicaid, +43417,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43418,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43419,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43420,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMBLEMHEALTH/HIP-Medicaid, +43421,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43422,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43423,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43424,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMBLEMHEALTH/HIP-Medicaid, +43425,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMBLEMHEALTH/HIP-Medicaid, +43426,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMBLEMHEALTH/HIP-Medicaid, +43427,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMBLEMHEALTH/HIP-Medicaid, +43428,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMBLEMHEALTH/HIP-Medicaid, +43429,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMBLEMHEALTH/HIP-Medicaid, +43430,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMBLEMHEALTH/HIP-Medicaid, +43431,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMBLEMHEALTH/HIP-Medicaid, +43432,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMBLEMHEALTH/HIP-Medicaid, +43433,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMBLEMHEALTH/HIP-Medicaid, +43434,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMBLEMHEALTH/HIP-Medicaid, +43435,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMBLEMHEALTH/HIP-Medicaid, +43436,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMBLEMHEALTH/HIP-Medicaid, +43437,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMBLEMHEALTH/HIP-Medicaid, +43438,3934,43301043,ALBUNEX,,357.0,357.0,,,EMBLEMHEALTH/HIP-Medicaid, +43439,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-Medicaid, +43440,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43441,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43442,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43443,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43444,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43445,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMBLEMHEALTH/HIP-Medicaid, +43446,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMBLEMHEALTH/HIP-Medicaid, +43447,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMBLEMHEALTH/HIP-Medicaid, +43448,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMBLEMHEALTH/HIP-Medicaid, +43449,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMBLEMHEALTH/HIP-Medicaid, +43450,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMBLEMHEALTH/HIP-Medicaid, +43451,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMBLEMHEALTH/HIP-Medicaid, +43452,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMBLEMHEALTH/HIP-Medicaid, +43453,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMBLEMHEALTH/HIP-Medicaid, +43454,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMBLEMHEALTH/HIP-Medicaid, +43455,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMBLEMHEALTH/HIP-Medicaid, +43456,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMBLEMHEALTH/HIP-Medicaid, +43457,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMBLEMHEALTH/HIP-Medicaid, +43458,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMBLEMHEALTH/HIP-Medicaid, +43459,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMBLEMHEALTH/HIP-Medicaid, +43460,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMBLEMHEALTH/HIP-Medicaid, +43461,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMBLEMHEALTH/HIP-Medicaid, +43462,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMBLEMHEALTH/HIP-Medicaid, +43463,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43464,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43465,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43466,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43467,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43468,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43469,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMBLEMHEALTH/HIP-Medicaid, +43470,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43471,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43472,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43473,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43474,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43475,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43476,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMBLEMHEALTH/HIP-Medicaid, +43477,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43478,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43479,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43480,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43481,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43482,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43483,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43484,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43485,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43486,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43487,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43488,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43489,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMBLEMHEALTH/HIP-Medicaid, +43490,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMBLEMHEALTH/HIP-Medicaid, +43491,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMBLEMHEALTH/HIP-Medicaid, +43492,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMBLEMHEALTH/HIP-Medicaid, +43493,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMBLEMHEALTH/HIP-Medicaid, +43494,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMBLEMHEALTH/HIP-Medicaid, +43495,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMBLEMHEALTH/HIP-Medicaid, +43496,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMBLEMHEALTH/HIP-Medicaid, +43497,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43498,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43499,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43500,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43501,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43502,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43503,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43504,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMBLEMHEALTH/HIP-Medicaid, +43505,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMBLEMHEALTH/HIP-Medicaid, +43506,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMBLEMHEALTH/HIP-Medicaid, +43507,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMBLEMHEALTH/HIP-Medicaid, +43508,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMBLEMHEALTH/HIP-Medicaid, +43509,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-Medicaid, +43510,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-Medicaid, +43511,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-Medicaid, +43512,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMBLEMHEALTH/HIP-Medicaid, +43513,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMBLEMHEALTH/HIP-Medicaid, +43514,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMBLEMHEALTH/HIP-Medicaid, +43515,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMBLEMHEALTH/HIP-Medicaid, +43516,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMBLEMHEALTH/HIP-Medicaid, +43517,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMBLEMHEALTH/HIP-Medicaid, +43518,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMBLEMHEALTH/HIP-Medicaid, +43519,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMBLEMHEALTH/HIP-Medicaid, +43520,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMBLEMHEALTH/HIP-Medicaid, +43521,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMBLEMHEALTH/HIP-Medicaid, +43522,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMBLEMHEALTH/HIP-Medicaid, +43523,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMBLEMHEALTH/HIP-Medicaid, +43524,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMBLEMHEALTH/HIP-Medicaid, +43525,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMBLEMHEALTH/HIP-Medicaid, +43526,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMBLEMHEALTH/HIP-Medicaid, +43527,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMBLEMHEALTH/HIP-Medicaid, +43528,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMBLEMHEALTH/HIP-Medicaid, +43529,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMBLEMHEALTH/HIP-Medicaid, +43530,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMBLEMHEALTH/HIP-Medicaid, +43531,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMBLEMHEALTH/HIP-Medicaid, +43532,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMBLEMHEALTH/HIP-Medicaid, +43533,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-Medicaid, +43534,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMBLEMHEALTH/HIP-Medicaid, +43535,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-Medicaid, +43536,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMBLEMHEALTH/HIP-Medicaid, +43537,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMBLEMHEALTH/HIP-Medicaid, +43538,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMBLEMHEALTH/HIP-Medicaid, +43539,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMBLEMHEALTH/HIP-Medicaid, +43540,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMBLEMHEALTH/HIP-Medicaid, +43541,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMBLEMHEALTH/HIP-Medicaid, +43542,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-Medicaid, +43543,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMBLEMHEALTH/HIP-Medicaid, +43544,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMBLEMHEALTH/HIP-Medicaid, +43545,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMBLEMHEALTH/HIP-Medicaid, +43546,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMBLEMHEALTH/HIP-Medicaid, +43547,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMBLEMHEALTH/HIP-Medicaid, +43548,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMBLEMHEALTH/HIP-Medicaid, +43549,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMBLEMHEALTH/HIP-Medicaid, +43550,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMBLEMHEALTH/HIP-Medicaid, +43551,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMBLEMHEALTH/HIP-Medicaid, +43552,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMBLEMHEALTH/HIP-Medicaid, +43553,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMBLEMHEALTH/HIP-Medicaid, +43554,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMBLEMHEALTH/HIP-Medicaid, +43555,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMBLEMHEALTH/HIP-Medicaid, +43556,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMBLEMHEALTH/HIP-Medicaid, +43557,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMBLEMHEALTH/HIP-Medicaid, +43558,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMBLEMHEALTH/HIP-Medicaid, +43559,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMBLEMHEALTH/HIP-Medicaid, +43560,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Medicaid, +43561,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Medicaid, +43562,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Medicaid, +43563,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMBLEMHEALTH/HIP-Medicaid, +43564,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMBLEMHEALTH/HIP-Medicaid, +43565,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMBLEMHEALTH/HIP-Medicaid, +43566,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMBLEMHEALTH/HIP-Medicaid, +43567,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-Medicaid, +43568,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMBLEMHEALTH/HIP-Medicaid, +43569,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicaid, +43570,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43571,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicaid, +43572,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicaid, +43573,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicaid, +43574,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicaid, +43575,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMBLEMHEALTH/HIP-Medicaid, +43576,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMBLEMHEALTH/HIP-Medicaid, +43577,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMBLEMHEALTH/HIP-Medicaid, +43578,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMBLEMHEALTH/HIP-Medicaid, +43579,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMBLEMHEALTH/HIP-Medicaid, +43580,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMBLEMHEALTH/HIP-Medicaid, +43581,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMBLEMHEALTH/HIP-Medicaid, +43582,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMBLEMHEALTH/HIP-Medicaid, +43583,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMBLEMHEALTH/HIP-Medicaid, +43584,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMBLEMHEALTH/HIP-Medicaid, +43585,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMBLEMHEALTH/HIP-Medicaid, +43586,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMBLEMHEALTH/HIP-Medicaid, +43587,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMBLEMHEALTH/HIP-Medicaid, +43588,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMBLEMHEALTH/HIP-Medicaid, +43589,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMBLEMHEALTH/HIP-Medicaid, +43590,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMBLEMHEALTH/HIP-Medicaid, +43591,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMBLEMHEALTH/HIP-Medicaid, +43592,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMBLEMHEALTH/HIP-Medicaid, +43593,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMBLEMHEALTH/HIP-Medicaid, +43594,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMBLEMHEALTH/HIP-Medicaid, +43595,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMBLEMHEALTH/HIP-Medicaid, +43596,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMBLEMHEALTH/HIP-Medicaid, +43597,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMBLEMHEALTH/HIP-Medicaid, +43598,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMBLEMHEALTH/HIP-Medicaid, +43599,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMBLEMHEALTH/HIP-Medicaid, +43600,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMBLEMHEALTH/HIP-Medicaid, +43601,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMBLEMHEALTH/HIP-Medicaid, +43602,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMBLEMHEALTH/HIP-Medicaid, +43603,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMBLEMHEALTH/HIP-Medicaid, +43604,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMBLEMHEALTH/HIP-Medicaid, +43605,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMBLEMHEALTH/HIP-Medicaid, +43606,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMBLEMHEALTH/HIP-Medicaid, +43607,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMBLEMHEALTH/HIP-Medicaid, +43608,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMBLEMHEALTH/HIP-Medicare Advantage, +43609,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMBLEMHEALTH/HIP-Medicare Advantage, +43610,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMBLEMHEALTH/HIP-Medicare Advantage, +43611,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMBLEMHEALTH/HIP-Medicare Advantage, +43612,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43613,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMBLEMHEALTH/HIP-Medicare Advantage, +43614,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMBLEMHEALTH/HIP-Medicare Advantage, +43615,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMBLEMHEALTH/HIP-Medicare Advantage, +43616,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43617,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMBLEMHEALTH/HIP-Medicare Advantage, +43618,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMBLEMHEALTH/HIP-Medicare Advantage, +43619,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMBLEMHEALTH/HIP-Medicare Advantage, +43620,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMBLEMHEALTH/HIP-Medicare Advantage, +43621,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMBLEMHEALTH/HIP-Medicare Advantage, +43622,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMBLEMHEALTH/HIP-Medicare Advantage, +43623,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMBLEMHEALTH/HIP-Medicare Advantage, +43624,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMBLEMHEALTH/HIP-Medicare Advantage, +43625,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMBLEMHEALTH/HIP-Medicare Advantage, +43626,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMBLEMHEALTH/HIP-Medicare Advantage, +43627,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMBLEMHEALTH/HIP-Medicare Advantage, +43628,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMBLEMHEALTH/HIP-Medicare Advantage, +43629,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMBLEMHEALTH/HIP-Medicare Advantage, +43630,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43631,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43632,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43633,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43634,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMBLEMHEALTH/HIP-Medicare Advantage, +43635,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMBLEMHEALTH/HIP-Medicare Advantage, +43636,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMBLEMHEALTH/HIP-Medicare Advantage, +43637,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMBLEMHEALTH/HIP-Medicare Advantage, +43638,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMBLEMHEALTH/HIP-Medicare Advantage, +43639,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMBLEMHEALTH/HIP-Medicare Advantage, +43640,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMBLEMHEALTH/HIP-Medicare Advantage, +43641,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMBLEMHEALTH/HIP-Medicare Advantage, +43642,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMBLEMHEALTH/HIP-Medicare Advantage, +43643,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43644,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMBLEMHEALTH/HIP-Medicare Advantage, +43645,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMBLEMHEALTH/HIP-Medicare Advantage, +43646,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43647,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43648,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43649,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMBLEMHEALTH/HIP-Medicare Advantage, +43650,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMBLEMHEALTH/HIP-Medicare Advantage, +43651,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMBLEMHEALTH/HIP-Medicare Advantage, +43652,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMBLEMHEALTH/HIP-Medicare Advantage, +43653,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMBLEMHEALTH/HIP-Medicare Advantage, +43654,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMBLEMHEALTH/HIP-Medicare Advantage, +43655,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMBLEMHEALTH/HIP-Medicare Advantage, +43656,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43657,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43658,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMBLEMHEALTH/HIP-Medicare Advantage, +43659,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43660,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43661,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMBLEMHEALTH/HIP-Medicare Advantage, +43662,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMBLEMHEALTH/HIP-Medicare Advantage, +43663,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMBLEMHEALTH/HIP-Medicare Advantage, +43664,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43665,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMBLEMHEALTH/HIP-Medicare Advantage, +43666,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMBLEMHEALTH/HIP-Medicare Advantage, +43667,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43668,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMBLEMHEALTH/HIP-Medicare Advantage, +43669,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMBLEMHEALTH/HIP-Medicare Advantage, +43670,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMBLEMHEALTH/HIP-Medicare Advantage, +43671,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMBLEMHEALTH/HIP-Medicare Advantage, +43672,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMBLEMHEALTH/HIP-Medicare Advantage, +43673,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMBLEMHEALTH/HIP-Medicare Advantage, +43674,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43675,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43676,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43677,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMBLEMHEALTH/HIP-Medicare Advantage, +43678,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMBLEMHEALTH/HIP-Medicare Advantage, +43679,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMBLEMHEALTH/HIP-Medicare Advantage, +43680,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMBLEMHEALTH/HIP-Medicare Advantage, +43681,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMBLEMHEALTH/HIP-Medicare Advantage, +43682,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMBLEMHEALTH/HIP-Medicare Advantage, +43683,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMBLEMHEALTH/HIP-Medicare Advantage, +43684,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43685,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43686,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMBLEMHEALTH/HIP-Medicare Advantage, +43687,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMBLEMHEALTH/HIP-Medicare Advantage, +43688,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMBLEMHEALTH/HIP-Medicare Advantage, +43689,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMBLEMHEALTH/HIP-Medicare Advantage, +43690,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMBLEMHEALTH/HIP-Medicare Advantage, +43691,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMBLEMHEALTH/HIP-Medicare Advantage, +43692,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43693,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMBLEMHEALTH/HIP-Medicare Advantage, +43694,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMBLEMHEALTH/HIP-Medicare Advantage, +43695,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMBLEMHEALTH/HIP-Medicare Advantage, +43696,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMBLEMHEALTH/HIP-Medicare Advantage, +43697,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMBLEMHEALTH/HIP-Medicare Advantage, +43698,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43699,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMBLEMHEALTH/HIP-Medicare Advantage, +43700,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMBLEMHEALTH/HIP-Medicare Advantage, +43701,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43702,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMBLEMHEALTH/HIP-Medicare Advantage, +43703,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMBLEMHEALTH/HIP-Medicare Advantage, +43704,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43705,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43706,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43707,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43708,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMBLEMHEALTH/HIP-Medicare Advantage, +43709,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMBLEMHEALTH/HIP-Medicare Advantage, +43710,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43711,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43712,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMBLEMHEALTH/HIP-Medicare Advantage, +43713,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43714,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMBLEMHEALTH/HIP-Medicare Advantage, +43715,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMBLEMHEALTH/HIP-Medicare Advantage, +43716,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMBLEMHEALTH/HIP-Medicare Advantage, +43717,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43718,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43719,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43720,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMBLEMHEALTH/HIP-Medicare Advantage, +43721,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMBLEMHEALTH/HIP-Medicare Advantage, +43722,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43723,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMBLEMHEALTH/HIP-Medicare Advantage, +43724,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43725,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43726,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMBLEMHEALTH/HIP-Medicare Advantage, +43727,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMBLEMHEALTH/HIP-Medicare Advantage, +43728,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMBLEMHEALTH/HIP-Medicare Advantage, +43729,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMBLEMHEALTH/HIP-Medicare Advantage, +43730,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMBLEMHEALTH/HIP-Medicare Advantage, +43731,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMBLEMHEALTH/HIP-Medicare Advantage, +43732,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMBLEMHEALTH/HIP-Medicare Advantage, +43733,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMBLEMHEALTH/HIP-Medicare Advantage, +43734,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMBLEMHEALTH/HIP-Medicare Advantage, +43735,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMBLEMHEALTH/HIP-Medicare Advantage, +43736,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43737,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMBLEMHEALTH/HIP-Medicare Advantage, +43738,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43739,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMBLEMHEALTH/HIP-Medicare Advantage, +43740,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMBLEMHEALTH/HIP-Medicare Advantage, +43741,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43742,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMBLEMHEALTH/HIP-Medicare Advantage, +43743,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMBLEMHEALTH/HIP-Medicare Advantage, +43744,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMBLEMHEALTH/HIP-Medicare Advantage, +43745,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43746,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMBLEMHEALTH/HIP-Medicare Advantage, +43747,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMBLEMHEALTH/HIP-Medicare Advantage, +43748,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMBLEMHEALTH/HIP-Medicare Advantage, +43749,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMBLEMHEALTH/HIP-Medicare Advantage, +43750,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMBLEMHEALTH/HIP-Medicare Advantage, +43751,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMBLEMHEALTH/HIP-Medicare Advantage, +43752,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMBLEMHEALTH/HIP-Medicare Advantage, +43753,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43754,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMBLEMHEALTH/HIP-Medicare Advantage, +43755,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43756,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMBLEMHEALTH/HIP-Medicare Advantage, +43757,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMBLEMHEALTH/HIP-Medicare Advantage, +43758,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMBLEMHEALTH/HIP-Medicare Advantage, +43759,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMBLEMHEALTH/HIP-Medicare Advantage, +43760,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMBLEMHEALTH/HIP-Medicare Advantage, +43761,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43762,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43763,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMBLEMHEALTH/HIP-Medicare Advantage, +43764,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMBLEMHEALTH/HIP-Medicare Advantage, +43765,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43766,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMBLEMHEALTH/HIP-Medicare Advantage, +43767,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMBLEMHEALTH/HIP-Medicare Advantage, +43768,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMBLEMHEALTH/HIP-Medicare Advantage, +43769,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMBLEMHEALTH/HIP-Medicare Advantage, +43770,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMBLEMHEALTH/HIP-Medicare Advantage, +43771,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43772,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMBLEMHEALTH/HIP-Medicare Advantage, +43773,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMBLEMHEALTH/HIP-Medicare Advantage, +43774,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMBLEMHEALTH/HIP-Medicare Advantage, +43775,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43776,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43777,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMBLEMHEALTH/HIP-Medicare Advantage, +43778,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMBLEMHEALTH/HIP-Medicare Advantage, +43779,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMBLEMHEALTH/HIP-Medicare Advantage, +43780,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMBLEMHEALTH/HIP-Medicare Advantage, +43781,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43782,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMBLEMHEALTH/HIP-Medicare Advantage, +43783,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMBLEMHEALTH/HIP-Medicare Advantage, +43784,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMBLEMHEALTH/HIP-Medicare Advantage, +43785,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMBLEMHEALTH/HIP-Medicare Advantage, +43786,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43787,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMBLEMHEALTH/HIP-Medicare Advantage, +43788,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMBLEMHEALTH/HIP-Medicare Advantage, +43789,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMBLEMHEALTH/HIP-Medicare Advantage, +43790,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMBLEMHEALTH/HIP-Medicare Advantage, +43791,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMBLEMHEALTH/HIP-Medicare Advantage, +43792,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43793,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMBLEMHEALTH/HIP-Medicare Advantage, +43794,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMBLEMHEALTH/HIP-Medicare Advantage, +43795,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMBLEMHEALTH/HIP-Medicare Advantage, +43796,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43797,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43798,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43799,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMBLEMHEALTH/HIP-Medicare Advantage, +43800,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMBLEMHEALTH/HIP-Medicare Advantage, +43801,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMBLEMHEALTH/HIP-Medicare Advantage, +43802,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMBLEMHEALTH/HIP-Medicare Advantage, +43803,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43804,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMBLEMHEALTH/HIP-Medicare Advantage, +43805,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43806,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMBLEMHEALTH/HIP-Medicare Advantage, +43807,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMBLEMHEALTH/HIP-Medicare Advantage, +43808,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMBLEMHEALTH/HIP-Medicare Advantage, +43809,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43810,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMBLEMHEALTH/HIP-Medicare Advantage, +43811,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMBLEMHEALTH/HIP-Medicare Advantage, +43812,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMBLEMHEALTH/HIP-Medicare Advantage, +43813,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMBLEMHEALTH/HIP-Medicare Advantage, +43814,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43815,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMBLEMHEALTH/HIP-Medicare Advantage, +43816,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMBLEMHEALTH/HIP-Medicare Advantage, +43817,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMBLEMHEALTH/HIP-Medicare Advantage, +43818,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43819,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMBLEMHEALTH/HIP-Medicare Advantage, +43820,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43821,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMBLEMHEALTH/HIP-Medicare Advantage, +43822,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43823,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43824,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMBLEMHEALTH/HIP-Medicare Advantage, +43825,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMBLEMHEALTH/HIP-Medicare Advantage, +43826,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMBLEMHEALTH/HIP-Medicare Advantage, +43827,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMBLEMHEALTH/HIP-Medicare Advantage, +43828,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43829,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMBLEMHEALTH/HIP-Medicare Advantage, +43830,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMBLEMHEALTH/HIP-Medicare Advantage, +43831,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43832,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMBLEMHEALTH/HIP-Medicare Advantage, +43833,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMBLEMHEALTH/HIP-Medicare Advantage, +43834,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMBLEMHEALTH/HIP-Medicare Advantage, +43835,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMBLEMHEALTH/HIP-Medicare Advantage, +43836,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43837,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43838,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMBLEMHEALTH/HIP-Medicare Advantage, +43839,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMBLEMHEALTH/HIP-Medicare Advantage, +43840,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMBLEMHEALTH/HIP-Medicare Advantage, +43841,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMBLEMHEALTH/HIP-Medicare Advantage, +43842,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMBLEMHEALTH/HIP-Medicare Advantage, +43843,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMBLEMHEALTH/HIP-Medicare Advantage, +43844,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMBLEMHEALTH/HIP-Medicare Advantage, +43845,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMBLEMHEALTH/HIP-Medicare Advantage, +43846,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43847,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43848,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMBLEMHEALTH/HIP-Medicare Advantage, +43849,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMBLEMHEALTH/HIP-Medicare Advantage, +43850,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMBLEMHEALTH/HIP-Medicare Advantage, +43851,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43852,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43853,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMBLEMHEALTH/HIP-Medicare Advantage, +43854,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMBLEMHEALTH/HIP-Medicare Advantage, +43855,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMBLEMHEALTH/HIP-Medicare Advantage, +43856,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43857,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMBLEMHEALTH/HIP-Medicare Advantage, +43858,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMBLEMHEALTH/HIP-Medicare Advantage, +43859,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43860,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMBLEMHEALTH/HIP-Medicare Advantage, +43861,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMBLEMHEALTH/HIP-Medicare Advantage, +43862,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMBLEMHEALTH/HIP-Medicare Advantage, +43863,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43864,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43865,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMBLEMHEALTH/HIP-Medicare Advantage, +43866,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMBLEMHEALTH/HIP-Medicare Advantage, +43867,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMBLEMHEALTH/HIP-Medicare Advantage, +43868,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43869,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMBLEMHEALTH/HIP-Medicare Advantage, +43870,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMBLEMHEALTH/HIP-Medicare Advantage, +43871,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43872,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43873,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43874,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43875,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMBLEMHEALTH/HIP-Medicare Advantage, +43876,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMBLEMHEALTH/HIP-Medicare Advantage, +43877,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43878,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMBLEMHEALTH/HIP-Medicare Advantage, +43879,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMBLEMHEALTH/HIP-Medicare Advantage, +43880,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43881,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43882,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMBLEMHEALTH/HIP-Medicare Advantage, +43883,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMBLEMHEALTH/HIP-Medicare Advantage, +43884,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMBLEMHEALTH/HIP-Medicare Advantage, +43885,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMBLEMHEALTH/HIP-Medicare Advantage, +43886,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43887,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMBLEMHEALTH/HIP-Medicare Advantage, +43888,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMBLEMHEALTH/HIP-Medicare Advantage, +43889,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMBLEMHEALTH/HIP-Medicare Advantage, +43890,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43891,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMBLEMHEALTH/HIP-Medicare Advantage, +43892,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMBLEMHEALTH/HIP-Medicare Advantage, +43893,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMBLEMHEALTH/HIP-Medicare Advantage, +43894,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43895,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMBLEMHEALTH/HIP-Medicare Advantage, +43896,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMBLEMHEALTH/HIP-Medicare Advantage, +43897,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMBLEMHEALTH/HIP-Medicare Advantage, +43898,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43899,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMBLEMHEALTH/HIP-Medicare Advantage, +43900,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMBLEMHEALTH/HIP-Medicare Advantage, +43901,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMBLEMHEALTH/HIP-Medicare Advantage, +43902,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43903,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMBLEMHEALTH/HIP-Medicare Advantage, +43904,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMBLEMHEALTH/HIP-Medicare Advantage, +43905,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMBLEMHEALTH/HIP-Medicare Advantage, +43906,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMBLEMHEALTH/HIP-Medicare Advantage, +43907,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMBLEMHEALTH/HIP-Medicare Advantage, +43908,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMBLEMHEALTH/HIP-Medicare Advantage, +43909,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMBLEMHEALTH/HIP-Medicare Advantage, +43910,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMBLEMHEALTH/HIP-Medicare Advantage, +43911,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43912,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43913,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMBLEMHEALTH/HIP-Medicare Advantage, +43914,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMBLEMHEALTH/HIP-Medicare Advantage, +43915,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMBLEMHEALTH/HIP-Medicare Advantage, +43916,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMBLEMHEALTH/HIP-Medicare Advantage, +43917,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMBLEMHEALTH/HIP-Medicare Advantage, +43918,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43919,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMBLEMHEALTH/HIP-Medicare Advantage, +43920,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMBLEMHEALTH/HIP-Medicare Advantage, +43921,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43922,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43923,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMBLEMHEALTH/HIP-Medicare Advantage, +43924,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMBLEMHEALTH/HIP-Medicare Advantage, +43925,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43926,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43927,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43928,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMBLEMHEALTH/HIP-Medicare Advantage, +43929,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMBLEMHEALTH/HIP-Medicare Advantage, +43930,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMBLEMHEALTH/HIP-Medicare Advantage, +43931,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43932,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMBLEMHEALTH/HIP-Medicare Advantage, +43933,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMBLEMHEALTH/HIP-Medicare Advantage, +43934,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMBLEMHEALTH/HIP-Medicare Advantage, +43935,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMBLEMHEALTH/HIP-Medicare Advantage, +43936,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMBLEMHEALTH/HIP-Medicare Advantage, +43937,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMBLEMHEALTH/HIP-Medicare Advantage, +43938,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMBLEMHEALTH/HIP-Medicare Advantage, +43939,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMBLEMHEALTH/HIP-Medicare Advantage, +43940,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43941,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMBLEMHEALTH/HIP-Medicare Advantage, +43942,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMBLEMHEALTH/HIP-Medicare Advantage, +43943,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMBLEMHEALTH/HIP-Medicare Advantage, +43944,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMBLEMHEALTH/HIP-Medicare Advantage, +43945,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43946,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMBLEMHEALTH/HIP-Medicare Advantage, +43947,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMBLEMHEALTH/HIP-Medicare Advantage, +43948,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43949,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43950,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMBLEMHEALTH/HIP-Medicare Advantage, +43951,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMBLEMHEALTH/HIP-Medicare Advantage, +43952,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMBLEMHEALTH/HIP-Medicare Advantage, +43953,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43954,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMBLEMHEALTH/HIP-Medicare Advantage, +43955,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43956,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43957,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43958,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43959,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMBLEMHEALTH/HIP-Medicare Advantage, +43960,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43961,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMBLEMHEALTH/HIP-Medicare Advantage, +43962,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMBLEMHEALTH/HIP-Medicare Advantage, +43963,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMBLEMHEALTH/HIP-Medicare Advantage, +43964,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMBLEMHEALTH/HIP-Medicare Advantage, +43965,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43966,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43967,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43968,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43969,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43970,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMBLEMHEALTH/HIP-Medicare Advantage, +43971,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMBLEMHEALTH/HIP-Medicare Advantage, +43972,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMBLEMHEALTH/HIP-Medicare Advantage, +43973,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMBLEMHEALTH/HIP-Medicare Advantage, +43974,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43975,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMBLEMHEALTH/HIP-Medicare Advantage, +43976,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43977,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43978,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMBLEMHEALTH/HIP-Medicare Advantage, +43979,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43980,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43981,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMBLEMHEALTH/HIP-Medicare Advantage, +43982,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMBLEMHEALTH/HIP-Medicare Advantage, +43983,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43984,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMBLEMHEALTH/HIP-Medicare Advantage, +43985,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMBLEMHEALTH/HIP-Medicare Advantage, +43986,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43987,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43988,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMBLEMHEALTH/HIP-Medicare Advantage, +43989,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMBLEMHEALTH/HIP-Medicare Advantage, +43990,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43991,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43992,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMBLEMHEALTH/HIP-Medicare Advantage, +43993,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43994,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMBLEMHEALTH/HIP-Medicare Advantage, +43995,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43996,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMBLEMHEALTH/HIP-Medicare Advantage, +43997,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMBLEMHEALTH/HIP-Medicare Advantage, +43998,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMBLEMHEALTH/HIP-Medicare Advantage, +43999,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMBLEMHEALTH/HIP-Medicare Advantage, +44000,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44001,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44002,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMBLEMHEALTH/HIP-Medicare Advantage, +44003,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMBLEMHEALTH/HIP-Medicare Advantage, +44004,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44005,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44006,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44007,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44008,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMBLEMHEALTH/HIP-Medicare Advantage, +44009,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMBLEMHEALTH/HIP-Medicare Advantage, +44010,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44011,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMBLEMHEALTH/HIP-Medicare Advantage, +44012,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMBLEMHEALTH/HIP-Medicare Advantage, +44013,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44014,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44015,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44016,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMBLEMHEALTH/HIP-Medicare Advantage, +44017,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMBLEMHEALTH/HIP-Medicare Advantage, +44018,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMBLEMHEALTH/HIP-Medicare Advantage, +44019,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44020,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44021,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMBLEMHEALTH/HIP-Medicare Advantage, +44022,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44023,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMBLEMHEALTH/HIP-Medicare Advantage, +44024,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMBLEMHEALTH/HIP-Medicare Advantage, +44025,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMBLEMHEALTH/HIP-Medicare Advantage, +44026,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44027,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMBLEMHEALTH/HIP-Medicare Advantage, +44028,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44029,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44030,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMBLEMHEALTH/HIP-Medicare Advantage, +44031,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMBLEMHEALTH/HIP-Medicare Advantage, +44032,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44033,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44034,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMBLEMHEALTH/HIP-Medicare Advantage, +44035,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44036,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44037,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44038,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44039,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMBLEMHEALTH/HIP-Medicare Advantage, +44040,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44041,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44042,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMBLEMHEALTH/HIP-Medicare Advantage, +44043,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44044,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMBLEMHEALTH/HIP-Medicare Advantage, +44045,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44046,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44047,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMBLEMHEALTH/HIP-Medicare Advantage, +44048,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44049,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44050,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMBLEMHEALTH/HIP-Medicare Advantage, +44051,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44052,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44053,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44054,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44055,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44056,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMBLEMHEALTH/HIP-Medicare Advantage, +44057,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44058,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMBLEMHEALTH/HIP-Medicare Advantage, +44059,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMBLEMHEALTH/HIP-Medicare Advantage, +44060,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44061,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44062,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44063,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44064,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44065,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44066,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMBLEMHEALTH/HIP-Medicare Advantage, +44067,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMBLEMHEALTH/HIP-Medicare Advantage, +44068,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44069,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44070,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMBLEMHEALTH/HIP-Medicare Advantage, +44071,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMBLEMHEALTH/HIP-Medicare Advantage, +44072,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMBLEMHEALTH/HIP-Medicare Advantage, +44073,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44074,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMBLEMHEALTH/HIP-Medicare Advantage, +44075,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44076,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMBLEMHEALTH/HIP-Medicare Advantage, +44077,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44078,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44079,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44080,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMBLEMHEALTH/HIP-Medicare Advantage, +44081,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMBLEMHEALTH/HIP-Medicare Advantage, +44082,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44083,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44084,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMBLEMHEALTH/HIP-Medicare Advantage, +44085,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMBLEMHEALTH/HIP-Medicare Advantage, +44086,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMBLEMHEALTH/HIP-Medicare Advantage, +44087,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMBLEMHEALTH/HIP-Medicare Advantage, +44088,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44089,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44090,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMBLEMHEALTH/HIP-Medicare Advantage, +44091,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMBLEMHEALTH/HIP-Medicare Advantage, +44092,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44093,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44094,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44095,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44096,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44097,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44098,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMBLEMHEALTH/HIP-Medicare Advantage, +44099,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMBLEMHEALTH/HIP-Medicare Advantage, +44100,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44101,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMBLEMHEALTH/HIP-Medicare Advantage, +44102,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMBLEMHEALTH/HIP-Medicare Advantage, +44103,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44104,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMBLEMHEALTH/HIP-Medicare Advantage, +44105,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMBLEMHEALTH/HIP-Medicare Advantage, +44106,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44107,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMBLEMHEALTH/HIP-Medicare Advantage, +44108,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMBLEMHEALTH/HIP-Medicare Advantage, +44109,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMBLEMHEALTH/HIP-Medicare Advantage, +44110,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMBLEMHEALTH/HIP-Medicare Advantage, +44111,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44112,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMBLEMHEALTH/HIP-Medicare Advantage, +44113,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44114,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMBLEMHEALTH/HIP-Medicare Advantage, +44115,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44116,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44117,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44118,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMBLEMHEALTH/HIP-Medicare Advantage, +44119,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44120,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMBLEMHEALTH/HIP-Medicare Advantage, +44121,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44122,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44123,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44124,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMBLEMHEALTH/HIP-Medicare Advantage, +44125,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44126,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44127,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44128,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44129,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMBLEMHEALTH/HIP-Medicare Advantage, +44130,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44131,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44132,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44133,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMBLEMHEALTH/HIP-Medicare Advantage, +44134,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44135,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44136,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44137,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMBLEMHEALTH/HIP-Medicare Advantage, +44138,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44139,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMBLEMHEALTH/HIP-Medicare Advantage, +44140,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44141,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44142,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44143,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44144,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44145,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44146,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMBLEMHEALTH/HIP-Medicare Advantage, +44147,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMBLEMHEALTH/HIP-Medicare Advantage, +44148,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMBLEMHEALTH/HIP-Medicare Advantage, +44149,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44150,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMBLEMHEALTH/HIP-Medicare Advantage, +44151,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44152,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44153,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44154,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44155,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44156,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMBLEMHEALTH/HIP-Medicare Advantage, +44157,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44158,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMBLEMHEALTH/HIP-Medicare Advantage, +44159,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44160,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMBLEMHEALTH/HIP-Medicare Advantage, +44161,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44162,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44163,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMBLEMHEALTH/HIP-Medicare Advantage, +44164,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMBLEMHEALTH/HIP-Medicare Advantage, +44165,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44166,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44167,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMBLEMHEALTH/HIP-Medicare Advantage, +44168,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44169,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMBLEMHEALTH/HIP-Medicare Advantage, +44170,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMBLEMHEALTH/HIP-Medicare Advantage, +44171,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44172,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44173,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44174,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMBLEMHEALTH/HIP-Medicare Advantage, +44175,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44176,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMBLEMHEALTH/HIP-Medicare Advantage, +44177,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMBLEMHEALTH/HIP-Medicare Advantage, +44178,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44179,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMBLEMHEALTH/HIP-Medicare Advantage, +44180,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44181,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44182,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMBLEMHEALTH/HIP-Medicare Advantage, +44183,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMBLEMHEALTH/HIP-Medicare Advantage, +44184,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMBLEMHEALTH/HIP-Medicare Advantage, +44185,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMBLEMHEALTH/HIP-Medicare Advantage, +44186,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44187,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMBLEMHEALTH/HIP-Medicare Advantage, +44188,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44189,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMBLEMHEALTH/HIP-Medicare Advantage, +44190,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44191,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44192,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44193,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44194,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMBLEMHEALTH/HIP-Medicare Advantage, +44195,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44196,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMBLEMHEALTH/HIP-Medicare Advantage, +44197,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMBLEMHEALTH/HIP-Medicare Advantage, +44198,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMBLEMHEALTH/HIP-Medicare Advantage, +44199,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44200,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMBLEMHEALTH/HIP-Medicare Advantage, +44201,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44202,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44203,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMBLEMHEALTH/HIP-Medicare Advantage, +44204,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44205,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMBLEMHEALTH/HIP-Medicare Advantage, +44206,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMBLEMHEALTH/HIP-Medicare Advantage, +44207,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44208,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMBLEMHEALTH/HIP-Medicare Advantage, +44209,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44210,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMBLEMHEALTH/HIP-Medicare Advantage, +44211,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44212,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44213,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44214,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMBLEMHEALTH/HIP-Medicare Advantage, +44215,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44216,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44217,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44218,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44219,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44220,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMBLEMHEALTH/HIP-Medicare Advantage, +44221,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMBLEMHEALTH/HIP-Medicare Advantage, +44222,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMBLEMHEALTH/HIP-Medicare Advantage, +44223,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44224,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMBLEMHEALTH/HIP-Medicare Advantage, +44225,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMBLEMHEALTH/HIP-Medicare Advantage, +44226,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMBLEMHEALTH/HIP-Medicare Advantage, +44227,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMBLEMHEALTH/HIP-Medicare Advantage, +44228,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44229,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44230,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44231,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMBLEMHEALTH/HIP-Medicare Advantage, +44232,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44233,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44234,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44235,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMBLEMHEALTH/HIP-Medicare Advantage, +44236,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44237,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44238,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMBLEMHEALTH/HIP-Medicare Advantage, +44239,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44240,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMBLEMHEALTH/HIP-Medicare Advantage, +44241,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44242,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44243,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44244,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMBLEMHEALTH/HIP-Medicare Advantage, +44245,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMBLEMHEALTH/HIP-Medicare Advantage, +44246,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMBLEMHEALTH/HIP-Medicare Advantage, +44247,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMBLEMHEALTH/HIP-Medicare Advantage, +44248,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMBLEMHEALTH/HIP-Medicare Advantage, +44249,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMBLEMHEALTH/HIP-Medicare Advantage, +44250,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44251,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44252,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMBLEMHEALTH/HIP-Medicare Advantage, +44253,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMBLEMHEALTH/HIP-Medicare Advantage, +44254,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44255,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMBLEMHEALTH/HIP-Medicare Advantage, +44256,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44257,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMBLEMHEALTH/HIP-Medicare Advantage, +44258,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMBLEMHEALTH/HIP-Medicare Advantage, +44259,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44260,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44261,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44262,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44263,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMBLEMHEALTH/HIP-Medicare Advantage, +44264,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44265,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44266,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMBLEMHEALTH/HIP-Medicare Advantage,753.81 +44267,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44268,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44269,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMBLEMHEALTH/HIP-Medicare Advantage, +44270,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44271,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44272,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44273,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44274,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44275,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44276,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44277,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44278,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44279,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44280,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMBLEMHEALTH/HIP-Medicare Advantage, +44281,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMBLEMHEALTH/HIP-Medicare Advantage, +44282,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMBLEMHEALTH/HIP-Medicare Advantage, +44283,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44284,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44285,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44286,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44287,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44288,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44289,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44290,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMBLEMHEALTH/HIP-Medicare Advantage, +44291,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44292,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44293,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44294,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMBLEMHEALTH/HIP-Medicare Advantage, +44295,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44296,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44297,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44298,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44299,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44300,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMBLEMHEALTH/HIP-Medicare Advantage,349.14 +44301,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44302,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44303,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44304,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44305,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44306,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMBLEMHEALTH/HIP-Medicare Advantage, +44307,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44308,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44309,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44310,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44311,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44312,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMBLEMHEALTH/HIP-Medicare Advantage, +44313,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44314,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44315,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44316,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44317,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44318,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44319,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44320,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44321,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44322,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44323,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMBLEMHEALTH/HIP-Medicare Advantage,2830.64 +44324,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44325,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMBLEMHEALTH/HIP-Medicare Advantage, +44326,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44327,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMBLEMHEALTH/HIP-Medicare Advantage,1680.46 +44328,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44329,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44330,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44331,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMBLEMHEALTH/HIP-Medicare Advantage, +44332,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44333,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44334,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44335,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44336,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44337,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMBLEMHEALTH/HIP-Medicare Advantage, +44338,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44339,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44340,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44341,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44342,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMBLEMHEALTH/HIP-Medicare Advantage, +44343,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44344,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMBLEMHEALTH/HIP-Medicare Advantage,7392.07 +44345,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44346,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMBLEMHEALTH/HIP-Medicare Advantage, +44347,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMBLEMHEALTH/HIP-Medicare Advantage, +44348,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44349,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44350,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44351,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMBLEMHEALTH/HIP-Medicare Advantage, +44352,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44353,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44354,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44355,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44356,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44357,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44358,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMBLEMHEALTH/HIP-Medicare Advantage, +44359,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44360,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44361,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMBLEMHEALTH/HIP-Medicare Advantage, +44362,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44363,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44364,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMBLEMHEALTH/HIP-Medicare Advantage, +44365,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44366,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44367,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMBLEMHEALTH/HIP-Medicare Advantage, +44368,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44369,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44370,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMBLEMHEALTH/HIP-Medicare Advantage, +44371,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44372,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44373,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44374,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44375,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44376,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44377,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMBLEMHEALTH/HIP-Medicare Advantage, +44378,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMBLEMHEALTH/HIP-Medicare Advantage, +44379,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMBLEMHEALTH/HIP-Medicare Advantage, +44380,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44381,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMBLEMHEALTH/HIP-Medicare Advantage, +44382,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44383,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44384,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44385,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44386,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44387,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44388,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMBLEMHEALTH/HIP-Medicare Advantage, +44389,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44390,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44391,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44392,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMBLEMHEALTH/HIP-Medicare Advantage,1862.37 +44393,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMBLEMHEALTH/HIP-Medicare Advantage, +44394,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44395,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44396,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44397,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44398,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMBLEMHEALTH/HIP-Medicare Advantage,313.03 +44399,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44400,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44401,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44402,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44403,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44404,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMBLEMHEALTH/HIP-Medicare Advantage, +44405,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44406,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44407,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMBLEMHEALTH/HIP-Medicare Advantage, +44408,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMBLEMHEALTH/HIP-Medicare Advantage,1957.01 +44409,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44410,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44411,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMBLEMHEALTH/HIP-Medicare Advantage,2048.75 +44412,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMBLEMHEALTH/HIP-Medicare Advantage,4206.71 +44413,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMBLEMHEALTH/HIP-Medicare Advantage, +44414,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44415,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44416,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMBLEMHEALTH/HIP-Medicare Advantage, +44417,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44418,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMBLEMHEALTH/HIP-Medicare Advantage, +44419,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44420,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44421,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44422,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMBLEMHEALTH/HIP-Medicare Advantage, +44423,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMBLEMHEALTH/HIP-Medicare Advantage, +44424,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44425,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMBLEMHEALTH/HIP-Medicare Advantage, +44426,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44427,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMBLEMHEALTH/HIP-Medicare Advantage, +44428,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44429,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44430,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMBLEMHEALTH/HIP-Medicare Advantage, +44431,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44432,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44433,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44434,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44435,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44436,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44437,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMBLEMHEALTH/HIP-Medicare Advantage, +44438,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44439,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44440,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMBLEMHEALTH/HIP-Medicare Advantage,1696.16 +44441,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44442,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMBLEMHEALTH/HIP-Medicare Advantage,1740.05 +44443,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44444,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMBLEMHEALTH/HIP-Medicare Advantage, +44445,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44446,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44447,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44448,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44449,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44450,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44451,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44452,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44453,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44454,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44455,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMBLEMHEALTH/HIP-Medicare Advantage, +44456,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMBLEMHEALTH/HIP-Medicare Advantage, +44457,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMBLEMHEALTH/HIP-Medicare Advantage, +44458,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMBLEMHEALTH/HIP-Medicare Advantage, +44459,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44460,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMBLEMHEALTH/HIP-Medicare Advantage, +44461,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44462,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44463,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMBLEMHEALTH/HIP-Medicare Advantage, +44464,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44465,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMBLEMHEALTH/HIP-Medicare Advantage, +44466,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMBLEMHEALTH/HIP-Medicare Advantage, +44467,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMBLEMHEALTH/HIP-Medicare Advantage, +44468,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMBLEMHEALTH/HIP-Medicare Advantage, +44469,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44470,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMBLEMHEALTH/HIP-Medicare Advantage, +44471,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44472,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44473,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44474,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44475,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44476,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44477,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44478,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMBLEMHEALTH/HIP-Medicare Advantage,2865.53 +44479,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44480,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44481,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44482,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMBLEMHEALTH/HIP-Medicare Advantage,323.47 +44483,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44484,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMBLEMHEALTH/HIP-Medicare Advantage, +44485,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44486,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44487,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMBLEMHEALTH/HIP-Medicare Advantage, +44488,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44489,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44490,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44491,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44492,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44493,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44494,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44495,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMBLEMHEALTH/HIP-Medicare Advantage,2830.64 +44496,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMBLEMHEALTH/HIP-Medicare Advantage, +44497,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44498,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44499,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44500,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMBLEMHEALTH/HIP-Medicare Advantage, +44501,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMBLEMHEALTH/HIP-Medicare Advantage, +44502,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44503,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44504,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMBLEMHEALTH/HIP-Medicare Advantage, +44505,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44506,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMBLEMHEALTH/HIP-Medicare Advantage, +44507,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44508,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44509,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMBLEMHEALTH/HIP-Medicare Advantage,5993.95 +44510,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44511,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44512,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44513,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44514,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44515,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMBLEMHEALTH/HIP-Medicare Advantage, +44516,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44517,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44518,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44519,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44520,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44521,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44522,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMBLEMHEALTH/HIP-Medicare Advantage, +44523,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMBLEMHEALTH/HIP-Medicare Advantage, +44524,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44525,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44526,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMBLEMHEALTH/HIP-Medicare Advantage, +44527,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMBLEMHEALTH/HIP-Medicare Advantage, +44528,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMBLEMHEALTH/HIP-Medicare Advantage, +44529,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44530,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMBLEMHEALTH/HIP-Medicare Advantage, +44531,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44532,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMBLEMHEALTH/HIP-Medicare Advantage, +44533,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMBLEMHEALTH/HIP-Medicare Advantage, +44534,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44535,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMBLEMHEALTH/HIP-Medicare Advantage, +44536,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMBLEMHEALTH/HIP-Medicare Advantage, +44537,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMBLEMHEALTH/HIP-Medicare Advantage, +44538,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44539,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMBLEMHEALTH/HIP-Medicare Advantage, +44540,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44541,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44542,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44543,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44544,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44545,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44546,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44547,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44548,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44549,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMBLEMHEALTH/HIP-Medicare Advantage, +44550,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMBLEMHEALTH/HIP-Medicare Advantage, +44551,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44552,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44553,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44554,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44555,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMBLEMHEALTH/HIP-Medicare Advantage, +44556,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMBLEMHEALTH/HIP-Medicare Advantage,7392.07 +44557,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMBLEMHEALTH/HIP-Medicare Advantage, +44558,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44559,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMBLEMHEALTH/HIP-Medicare Advantage, +44560,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMBLEMHEALTH/HIP-Medicare Advantage, +44561,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44562,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44563,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMBLEMHEALTH/HIP-Medicare Advantage, +44564,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44565,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMBLEMHEALTH/HIP-Medicare Advantage, +44566,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44567,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44568,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44569,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMBLEMHEALTH/HIP-Medicare Advantage, +44570,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMBLEMHEALTH/HIP-Medicare Advantage, +44571,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44572,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMBLEMHEALTH/HIP-Medicare Advantage, +44573,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44574,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44575,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMBLEMHEALTH/HIP-Medicare Advantage, +44576,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44577,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44578,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44579,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMBLEMHEALTH/HIP-Medicare Advantage, +44580,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44581,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMBLEMHEALTH/HIP-Medicare Advantage, +44582,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44583,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44584,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44585,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44586,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44587,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMBLEMHEALTH/HIP-Medicare Advantage, +44588,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44589,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44590,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44591,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMBLEMHEALTH/HIP-Medicare Advantage, +44592,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMBLEMHEALTH/HIP-Medicare Advantage, +44593,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44594,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44595,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMBLEMHEALTH/HIP-Medicare Advantage, +44596,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44597,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44598,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMBLEMHEALTH/HIP-Medicare Advantage, +44599,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMBLEMHEALTH/HIP-Medicare Advantage, +44600,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44601,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44602,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44603,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMBLEMHEALTH/HIP-Medicare Advantage, +44604,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMBLEMHEALTH/HIP-Medicare Advantage, +44605,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMBLEMHEALTH/HIP-Medicare Advantage, +44606,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44607,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMBLEMHEALTH/HIP-Medicare Advantage, +44608,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMBLEMHEALTH/HIP-Medicare Advantage, +44609,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44610,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44611,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMBLEMHEALTH/HIP-Medicare Advantage, +44612,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44613,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMBLEMHEALTH/HIP-Medicare Advantage, +44614,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44615,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44616,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMBLEMHEALTH/HIP-Medicare Advantage, +44617,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44618,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMBLEMHEALTH/HIP-Medicare Advantage, +44619,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMBLEMHEALTH/HIP-Medicare Advantage, +44620,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMBLEMHEALTH/HIP-Medicare Advantage, +44621,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44622,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44623,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44624,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44625,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMBLEMHEALTH/HIP-Medicare Advantage, +44626,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44627,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44628,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44629,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44630,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44631,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44632,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44633,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44634,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44635,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44636,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44637,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44638,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMBLEMHEALTH/HIP-Medicare Advantage, +44639,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44640,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44641,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44642,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44643,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44644,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44645,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44646,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMBLEMHEALTH/HIP-Medicare Advantage, +44647,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44648,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44649,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44650,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44651,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMBLEMHEALTH/HIP-Medicare Advantage, +44652,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMBLEMHEALTH/HIP-Medicare Advantage, +44653,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44654,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMBLEMHEALTH/HIP-Medicare Advantage, +44655,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44656,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMBLEMHEALTH/HIP-Medicare Advantage, +44657,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44658,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMBLEMHEALTH/HIP-Medicare Advantage, +44659,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44660,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMBLEMHEALTH/HIP-Medicare Advantage, +44661,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44662,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMBLEMHEALTH/HIP-Medicare Advantage,1674.89 +44663,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44664,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44665,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44666,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMBLEMHEALTH/HIP-Medicare Advantage,7083.09 +44667,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44668,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44669,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44670,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44671,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMBLEMHEALTH/HIP-Medicare Advantage, +44672,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44673,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44674,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44675,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMBLEMHEALTH/HIP-Medicare Advantage, +44676,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44677,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44678,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMBLEMHEALTH/HIP-Medicare Advantage, +44679,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44680,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44681,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMBLEMHEALTH/HIP-Medicare Advantage, +44682,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44683,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44684,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44685,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44686,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44687,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44688,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMBLEMHEALTH/HIP-Medicare Advantage, +44689,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44690,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMBLEMHEALTH/HIP-Medicare Advantage, +44691,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMBLEMHEALTH/HIP-Medicare Advantage,266.48 +44692,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44693,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44694,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMBLEMHEALTH/HIP-Medicare Advantage, +44695,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44696,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMBLEMHEALTH/HIP-Medicare Advantage, +44697,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44698,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44699,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMBLEMHEALTH/HIP-Medicare Advantage, +44700,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44701,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMBLEMHEALTH/HIP-Medicare Advantage, +44702,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMBLEMHEALTH/HIP-Medicare Advantage, +44703,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44704,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44705,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44706,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44707,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44708,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44709,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44710,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44711,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44712,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44713,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44714,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44715,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44716,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44717,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMBLEMHEALTH/HIP-Medicare Advantage, +44718,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44719,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44720,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMBLEMHEALTH/HIP-Medicare Advantage, +44721,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44722,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44723,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMBLEMHEALTH/HIP-Medicare Advantage, +44724,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44725,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44726,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMBLEMHEALTH/HIP-Medicare Advantage, +44727,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMBLEMHEALTH/HIP-Medicare Advantage, +44728,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44729,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMBLEMHEALTH/HIP-Medicare Advantage, +44730,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44731,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMBLEMHEALTH/HIP-Medicare Advantage, +44732,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44733,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44734,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMBLEMHEALTH/HIP-Medicare Advantage, +44735,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44736,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44737,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44738,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMBLEMHEALTH/HIP-Medicare Advantage, +44739,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMBLEMHEALTH/HIP-Medicare Advantage, +44740,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMBLEMHEALTH/HIP-Medicare Advantage, +44741,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44742,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44743,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44744,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMBLEMHEALTH/HIP-Medicare Advantage, +44745,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44746,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMBLEMHEALTH/HIP-Medicare Advantage, +44747,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44748,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44749,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44750,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMBLEMHEALTH/HIP-Medicare Advantage, +44751,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44752,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44753,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44754,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44755,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44756,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMBLEMHEALTH/HIP-Medicare Advantage, +44757,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44758,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44759,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44760,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44761,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44762,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMBLEMHEALTH/HIP-Medicare Advantage, +44763,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44764,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMBLEMHEALTH/HIP-Medicare Advantage, +44765,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44766,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMBLEMHEALTH/HIP-Medicare Advantage, +44767,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMBLEMHEALTH/HIP-Medicare Advantage, +44768,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44769,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44770,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMBLEMHEALTH/HIP-Medicare Advantage,14828.28 +44771,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMBLEMHEALTH/HIP-Medicare Advantage, +44772,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44773,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMBLEMHEALTH/HIP-Medicare Advantage, +44774,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMBLEMHEALTH/HIP-Medicare Advantage, +44775,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMBLEMHEALTH/HIP-Medicare Advantage, +44776,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44777,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44778,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMBLEMHEALTH/HIP-Medicare Advantage, +44779,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMBLEMHEALTH/HIP-Medicare Advantage, +44780,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMBLEMHEALTH/HIP-Medicare Advantage, +44781,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44782,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44783,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMBLEMHEALTH/HIP-Medicare Advantage, +44784,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMBLEMHEALTH/HIP-Medicare Advantage, +44785,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44786,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44787,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44788,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMBLEMHEALTH/HIP-Medicare Advantage, +44789,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMBLEMHEALTH/HIP-Medicare Advantage, +44790,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44791,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44792,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMBLEMHEALTH/HIP-Medicare Advantage, +44793,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44794,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44795,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44796,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44797,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44798,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44799,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44800,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44801,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMBLEMHEALTH/HIP-Medicare Advantage, +44802,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44803,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44804,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMBLEMHEALTH/HIP-Medicare Advantage, +44805,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44806,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44807,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMBLEMHEALTH/HIP-Medicare Advantage, +44808,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMBLEMHEALTH/HIP-Medicare Advantage, +44809,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44810,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44811,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44812,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMBLEMHEALTH/HIP-Medicare Advantage, +44813,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44814,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMBLEMHEALTH/HIP-Medicare Advantage, +44815,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44816,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMBLEMHEALTH/HIP-Medicare Advantage, +44817,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44818,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44819,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMBLEMHEALTH/HIP-Medicare Advantage, +44820,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMBLEMHEALTH/HIP-Medicare Advantage, +44821,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44822,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44823,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44824,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44825,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44826,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44827,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMBLEMHEALTH/HIP-Medicare Advantage, +44828,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44829,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44830,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44831,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44832,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44833,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44834,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44835,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44836,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMBLEMHEALTH/HIP-Medicare Advantage, +44837,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44838,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMBLEMHEALTH/HIP-Medicare Advantage, +44839,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44840,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44841,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44842,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +44843,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44844,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44845,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44846,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMBLEMHEALTH/HIP-Medicare Advantage, +44847,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44848,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44849,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44850,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44851,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44852,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44853,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMBLEMHEALTH/HIP-Medicare Advantage, +44854,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44855,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44856,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMBLEMHEALTH/HIP-Medicare Advantage, +44857,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44858,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44859,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44860,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMBLEMHEALTH/HIP-Medicare Advantage, +44861,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44862,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44863,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMBLEMHEALTH/HIP-Medicare Advantage, +44864,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMBLEMHEALTH/HIP-Medicare Advantage, +44865,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44866,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44867,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44868,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMBLEMHEALTH/HIP-Medicare Advantage, +44869,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMBLEMHEALTH/HIP-Medicare Advantage, +44870,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44871,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44872,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMBLEMHEALTH/HIP-Medicare Advantage, +44873,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44874,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44875,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMBLEMHEALTH/HIP-Medicare Advantage, +44876,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44877,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMBLEMHEALTH/HIP-Medicare Advantage, +44878,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44879,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMBLEMHEALTH/HIP-Medicare Advantage, +44880,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44881,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44882,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44883,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMBLEMHEALTH/HIP-Medicare Advantage, +44884,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44885,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMBLEMHEALTH/HIP-Medicare Advantage,3382.75 +44886,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMBLEMHEALTH/HIP-Medicare Advantage,3149.06 +44887,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44888,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMBLEMHEALTH/HIP-Medicare Advantage, +44889,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44890,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage,174.6 +44891,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44892,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMBLEMHEALTH/HIP-Medicare Advantage, +44893,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMBLEMHEALTH/HIP-Medicare Advantage, +44894,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44895,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44896,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMBLEMHEALTH/HIP-Medicare Advantage, +44897,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44898,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44899,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44900,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44901,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44902,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMBLEMHEALTH/HIP-Medicare Advantage, +44903,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMBLEMHEALTH/HIP-Medicare Advantage, +44904,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44905,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44906,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44907,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMBLEMHEALTH/HIP-Medicare Advantage, +44908,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44909,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44910,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44911,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44912,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMBLEMHEALTH/HIP-Medicare Advantage,7392.07 +44913,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMBLEMHEALTH/HIP-Medicare Advantage, +44914,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44915,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMBLEMHEALTH/HIP-Medicare Advantage, +44916,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44917,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44918,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44919,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44920,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44921,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44922,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44923,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMBLEMHEALTH/HIP-Medicare Advantage, +44924,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44925,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44926,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44927,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44928,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44929,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44930,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage, +44931,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMBLEMHEALTH/HIP-Medicare Advantage, +44932,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44933,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44934,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMBLEMHEALTH/HIP-Medicare Advantage, +44935,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMBLEMHEALTH/HIP-Medicare Advantage, +44936,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44937,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44938,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44939,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44940,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44941,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMBLEMHEALTH/HIP-Medicare Advantage, +44942,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMBLEMHEALTH/HIP-Medicare Advantage, +44943,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMBLEMHEALTH/HIP-Medicare Advantage, +44944,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44945,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44946,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44947,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMBLEMHEALTH/HIP-Medicare Advantage, +44948,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44949,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44950,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMBLEMHEALTH/HIP-Medicare Advantage, +44951,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44952,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44953,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMBLEMHEALTH/HIP-Medicare Advantage, +44954,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44955,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMBLEMHEALTH/HIP-Medicare Advantage, +44956,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMBLEMHEALTH/HIP-Medicare Advantage, +44957,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMBLEMHEALTH/HIP-Medicare Advantage, +44958,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMBLEMHEALTH/HIP-Medicare Advantage, +44959,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44960,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44961,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44962,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44963,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMBLEMHEALTH/HIP-Medicare Advantage, +44964,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMBLEMHEALTH/HIP-Medicare Advantage, +44965,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44966,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMBLEMHEALTH/HIP-Medicare Advantage, +44967,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMBLEMHEALTH/HIP-Medicare Advantage, +44968,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMBLEMHEALTH/HIP-Medicare Advantage,6722.82 +44969,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMBLEMHEALTH/HIP-Medicare Advantage, +44970,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44971,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMBLEMHEALTH/HIP-Medicare Advantage, +44972,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44973,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMBLEMHEALTH/HIP-Medicare Advantage, +44974,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMBLEMHEALTH/HIP-Medicare Advantage, +44975,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMBLEMHEALTH/HIP-Medicare Advantage, +44976,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44977,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMBLEMHEALTH/HIP-Medicare Advantage, +44978,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44979,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMBLEMHEALTH/HIP-Medicare Advantage, +44980,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMBLEMHEALTH/HIP-Medicare Advantage, +44981,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44982,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMBLEMHEALTH/HIP-Medicare Advantage, +44983,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMBLEMHEALTH/HIP-Medicare Advantage, +44984,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44985,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44986,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMBLEMHEALTH/HIP-Medicare Advantage, +44987,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44988,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMBLEMHEALTH/HIP-Medicare Advantage, +44989,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44990,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44991,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44992,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMBLEMHEALTH/HIP-Medicare Advantage, +44993,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMBLEMHEALTH/HIP-Medicare Advantage, +44994,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44995,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44996,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMBLEMHEALTH/HIP-Medicare Advantage, +44997,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMBLEMHEALTH/HIP-Medicare Advantage, +44998,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +44999,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMBLEMHEALTH/HIP-Medicare Advantage, +45000,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45001,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45002,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45003,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMBLEMHEALTH/HIP-Medicare Advantage,6722.82 +45004,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMBLEMHEALTH/HIP-Medicare Advantage, +45005,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45006,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45007,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45008,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMBLEMHEALTH/HIP-Medicare Advantage, +45009,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45010,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMBLEMHEALTH/HIP-Medicare Advantage,3700.15 +45011,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMBLEMHEALTH/HIP-Medicare Advantage, +45012,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45013,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45014,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45015,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMBLEMHEALTH/HIP-Medicare Advantage,1696.16 +45016,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMBLEMHEALTH/HIP-Medicare Advantage, +45017,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45018,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45019,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45020,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45021,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45022,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45023,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMBLEMHEALTH/HIP-Medicare Advantage, +45024,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMBLEMHEALTH/HIP-Medicare Advantage, +45025,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45026,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMBLEMHEALTH/HIP-Medicare Advantage, +45027,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMBLEMHEALTH/HIP-Medicare Advantage, +45028,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMBLEMHEALTH/HIP-Medicare Advantage, +45029,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45030,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMBLEMHEALTH/HIP-Medicare Advantage, +45031,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMBLEMHEALTH/HIP-Medicare Advantage, +45032,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMBLEMHEALTH/HIP-Medicare Advantage, +45033,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45034,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMBLEMHEALTH/HIP-Medicare Advantage, +45035,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMBLEMHEALTH/HIP-Medicare Advantage, +45036,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMBLEMHEALTH/HIP-Medicare Advantage, +45037,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45038,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMBLEMHEALTH/HIP-Medicare Advantage, +45039,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMBLEMHEALTH/HIP-Medicare Advantage, +45040,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45041,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMBLEMHEALTH/HIP-Medicare Advantage, +45042,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMBLEMHEALTH/HIP-Medicare Advantage, +45043,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMBLEMHEALTH/HIP-Medicare Advantage, +45044,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMBLEMHEALTH/HIP-Medicare Advantage, +45045,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMBLEMHEALTH/HIP-Medicare Advantage,39892.63 +45046,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMBLEMHEALTH/HIP-Medicare Advantage, +45047,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMBLEMHEALTH/HIP-Medicare Advantage, +45048,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMBLEMHEALTH/HIP-Medicare Advantage, +45049,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMBLEMHEALTH/HIP-Medicare Advantage, +45050,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMBLEMHEALTH/HIP-Medicare Advantage, +45051,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMBLEMHEALTH/HIP-Medicare Advantage, +45052,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMBLEMHEALTH/HIP-Medicare Advantage, +45053,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45054,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMBLEMHEALTH/HIP-Medicare Advantage, +45055,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45056,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45057,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45058,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45059,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45060,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45061,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45062,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMBLEMHEALTH/HIP-Medicare Advantage, +45063,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45064,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45065,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMBLEMHEALTH/HIP-Medicare Advantage, +45066,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45067,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45068,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45069,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45070,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45071,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45072,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45073,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45074,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45075,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45076,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMBLEMHEALTH/HIP-Medicare Advantage, +45077,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMBLEMHEALTH/HIP-Medicare Advantage, +45078,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMBLEMHEALTH/HIP-Medicare Advantage,5679.65 +45079,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMBLEMHEALTH/HIP-Medicare Advantage,5679.65 +45080,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45081,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMBLEMHEALTH/HIP-Medicare Advantage,5697.54 +45082,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMBLEMHEALTH/HIP-Medicare Advantage, +45083,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45084,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45085,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45086,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45087,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45088,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45089,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMBLEMHEALTH/HIP-Medicare Advantage, +45090,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45091,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMBLEMHEALTH/HIP-Medicare Advantage,3.06 +45092,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMBLEMHEALTH/HIP-Medicare Advantage, +45093,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMBLEMHEALTH/HIP-Medicare Advantage,472.83 +45094,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45095,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45096,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMBLEMHEALTH/HIP-Medicare Advantage,1635.64 +45097,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMBLEMHEALTH/HIP-Medicare Advantage, +45098,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45099,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45100,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage,2015.63 +45101,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45102,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMBLEMHEALTH/HIP-Medicare Advantage, +45103,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMBLEMHEALTH/HIP-Medicare Advantage,3298.32 +45104,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMBLEMHEALTH/HIP-Medicare Advantage, +45105,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45106,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage,2015.63 +45107,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45108,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45109,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45110,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45111,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45112,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMBLEMHEALTH/HIP-Medicare Advantage,779.14 +45113,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMBLEMHEALTH/HIP-Medicare Advantage,135.47 +45114,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45115,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMBLEMHEALTH/HIP-Medicare Advantage, +45116,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45117,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45118,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45119,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMBLEMHEALTH/HIP-Medicare Advantage, +45120,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45121,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45122,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45123,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45124,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45125,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45126,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45127,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMBLEMHEALTH/HIP-Medicare Advantage,6121.69 +45128,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45129,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45130,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMBLEMHEALTH/HIP-Medicare Advantage, +45131,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45132,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMBLEMHEALTH/HIP-Medicare Advantage, +45133,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMBLEMHEALTH/HIP-Medicare Advantage, +45134,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMBLEMHEALTH/HIP-Medicare Advantage, +45135,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMBLEMHEALTH/HIP-Medicare Advantage, +45136,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMBLEMHEALTH/HIP-Medicare Advantage, +45137,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45138,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45139,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMBLEMHEALTH/HIP-Medicare Advantage, +45140,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMBLEMHEALTH/HIP-Medicare Advantage, +45141,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45142,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMBLEMHEALTH/HIP-Medicare Advantage, +45143,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45144,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45145,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMBLEMHEALTH/HIP-Medicare Advantage, +45146,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45147,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45148,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMBLEMHEALTH/HIP-Medicare Advantage, +45149,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45150,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMBLEMHEALTH/HIP-Medicare Advantage, +45151,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMBLEMHEALTH/HIP-Medicare Advantage,19697.5 +45152,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45153,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMBLEMHEALTH/HIP-Medicare Advantage, +45154,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45155,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMBLEMHEALTH/HIP-Medicare Advantage, +45156,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45157,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45158,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMBLEMHEALTH/HIP-Medicare Advantage, +45159,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45160,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45161,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45162,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45163,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45164,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMBLEMHEALTH/HIP-Medicare Advantage, +45165,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45166,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMBLEMHEALTH/HIP-Medicare Advantage, +45167,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45168,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45169,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45170,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMBLEMHEALTH/HIP-Medicare Advantage, +45171,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45172,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45173,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMBLEMHEALTH/HIP-Medicare Advantage, +45174,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMBLEMHEALTH/HIP-Medicare Advantage, +45175,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMBLEMHEALTH/HIP-Medicare Advantage,2853.9 +45176,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMBLEMHEALTH/HIP-Medicare Advantage, +45177,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45178,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45179,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMBLEMHEALTH/HIP-Medicare Advantage,6843.87 +45180,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMBLEMHEALTH/HIP-Medicare Advantage,3743.71 +45181,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45182,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45183,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMBLEMHEALTH/HIP-Medicare Advantage, +45184,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMBLEMHEALTH/HIP-Medicare Advantage, +45185,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMBLEMHEALTH/HIP-Medicare Advantage, +45186,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45187,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45188,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMBLEMHEALTH/HIP-Medicare Advantage, +45189,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45190,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45191,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45192,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMBLEMHEALTH/HIP-Medicare Advantage, +45193,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMBLEMHEALTH/HIP-Medicare Advantage, +45194,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMBLEMHEALTH/HIP-Medicare Advantage, +45195,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45196,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMBLEMHEALTH/HIP-Medicare Advantage, +45197,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45198,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMBLEMHEALTH/HIP-Medicare Advantage, +45199,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45200,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMBLEMHEALTH/HIP-Medicare Advantage, +45201,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMBLEMHEALTH/HIP-Medicare Advantage, +45202,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMBLEMHEALTH/HIP-Medicare Advantage, +45203,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMBLEMHEALTH/HIP-Medicare Advantage, +45204,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMBLEMHEALTH/HIP-Medicare Advantage, +45205,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45206,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45207,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMBLEMHEALTH/HIP-Medicare Advantage, +45208,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45209,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45210,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMBLEMHEALTH/HIP-Medicare Advantage, +45211,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45212,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMBLEMHEALTH/HIP-Medicare Advantage, +45213,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMBLEMHEALTH/HIP-Medicare Advantage, +45214,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45215,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45216,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45217,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45218,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMBLEMHEALTH/HIP-Medicare Advantage, +45219,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45220,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45221,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45222,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMBLEMHEALTH/HIP-Medicare Advantage, +45223,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45224,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMBLEMHEALTH/HIP-Medicare Advantage, +45225,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMBLEMHEALTH/HIP-Medicare Advantage, +45226,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMBLEMHEALTH/HIP-Medicare Advantage, +45227,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMBLEMHEALTH/HIP-Medicare Advantage, +45228,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMBLEMHEALTH/HIP-Medicare Advantage, +45229,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45230,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45231,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMBLEMHEALTH/HIP-Medicare Advantage, +45232,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMBLEMHEALTH/HIP-Medicare Advantage, +45233,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45234,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45235,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45236,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMBLEMHEALTH/HIP-Medicare Advantage, +45237,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45238,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45239,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45240,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45241,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45242,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMBLEMHEALTH/HIP-Medicare Advantage, +45243,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45244,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMBLEMHEALTH/HIP-Medicare Advantage, +45245,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45246,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage, +45247,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMBLEMHEALTH/HIP-Medicare Advantage, +45248,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45249,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45250,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45251,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45252,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMBLEMHEALTH/HIP-Medicare Advantage, +45253,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45254,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMBLEMHEALTH/HIP-Medicare Advantage, +45255,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMBLEMHEALTH/HIP-Medicare Advantage, +45256,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMBLEMHEALTH/HIP-Medicare Advantage, +45257,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMBLEMHEALTH/HIP-Medicare Advantage, +45258,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45259,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45260,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45261,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45262,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45263,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45264,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage,971.18 +45265,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45266,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45267,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45268,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage,700.7 +45269,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45270,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMBLEMHEALTH/HIP-Medicare Advantage,1924.53 +45271,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45272,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45273,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45274,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45275,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45276,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45277,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45278,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45279,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45280,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45281,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMBLEMHEALTH/HIP-Medicare Advantage,1924.53 +45282,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45283,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45284,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45285,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMBLEMHEALTH/HIP-Medicare Advantage,3706.06 +45286,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45287,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45288,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45289,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45290,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMBLEMHEALTH/HIP-Medicare Advantage,3706.06 +45291,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMBLEMHEALTH/HIP-Medicare Advantage, +45292,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45293,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45294,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45295,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMBLEMHEALTH/HIP-Medicare Advantage, +45296,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMBLEMHEALTH/HIP-Medicare Advantage, +45297,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMBLEMHEALTH/HIP-Medicare Advantage, +45298,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45299,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45300,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45301,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45302,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMBLEMHEALTH/HIP-Medicare Advantage, +45303,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45304,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45305,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45306,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMBLEMHEALTH/HIP-Medicare Advantage, +45307,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMBLEMHEALTH/HIP-Medicare Advantage, +45308,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45309,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45310,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45311,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45312,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMBLEMHEALTH/HIP-Medicare Advantage, +45313,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45314,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45315,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45316,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45317,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45318,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45319,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMBLEMHEALTH/HIP-Medicare Advantage, +45320,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45321,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45322,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45323,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMBLEMHEALTH/HIP-Medicare Advantage, +45324,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45325,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMBLEMHEALTH/HIP-Medicare Advantage, +45326,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45327,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45328,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45329,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45330,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMBLEMHEALTH/HIP-Medicare Advantage, +45331,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45332,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45333,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMBLEMHEALTH/HIP-Medicare Advantage, +45334,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMBLEMHEALTH/HIP-Medicare Advantage,5973.16 +45335,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45336,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMBLEMHEALTH/HIP-Medicare Advantage, +45337,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMBLEMHEALTH/HIP-Medicare Advantage, +45338,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45339,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45340,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45341,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45342,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45343,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45344,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45345,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45346,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45347,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45348,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45349,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45350,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45351,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45352,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage,943.95 +45353,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45354,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage,1096.89 +45355,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45356,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45357,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45358,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMBLEMHEALTH/HIP-Medicare Advantage,1240.59 +45359,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45360,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45361,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45362,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45363,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +45364,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45365,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45366,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMBLEMHEALTH/HIP-Medicare Advantage, +45367,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMBLEMHEALTH/HIP-Medicare Advantage, +45368,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45369,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45370,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45371,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45372,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMBLEMHEALTH/HIP-Medicare Advantage, +45373,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45374,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45375,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMBLEMHEALTH/HIP-Medicare Advantage, +45376,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45377,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMBLEMHEALTH/HIP-Medicare Advantage, +45378,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45379,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45380,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45381,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMBLEMHEALTH/HIP-Medicare Advantage, +45382,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45383,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45384,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45385,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45386,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45387,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45388,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45389,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45390,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45391,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45392,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMBLEMHEALTH/HIP-Medicare Advantage, +45393,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMBLEMHEALTH/HIP-Medicare Advantage, +45394,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45395,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45396,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45397,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45398,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45399,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMBLEMHEALTH/HIP-Medicare Advantage, +45400,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45401,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45402,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45403,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45404,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45405,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMBLEMHEALTH/HIP-Medicare Advantage, +45406,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45407,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMBLEMHEALTH/HIP-Medicare Advantage, +45408,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45409,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45410,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMBLEMHEALTH/HIP-Medicare Advantage, +45411,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMBLEMHEALTH/HIP-Medicare Advantage, +45412,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMBLEMHEALTH/HIP-Medicare Advantage, +45413,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45414,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45415,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMBLEMHEALTH/HIP-Medicare Advantage, +45416,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMBLEMHEALTH/HIP-Medicare Advantage, +45417,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45418,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMBLEMHEALTH/HIP-Medicare Advantage, +45419,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMBLEMHEALTH/HIP-Medicare Advantage, +45420,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45421,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMBLEMHEALTH/HIP-Medicare Advantage, +45422,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMBLEMHEALTH/HIP-Medicare Advantage, +45423,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMBLEMHEALTH/HIP-Medicare Advantage, +45424,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45425,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45426,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMBLEMHEALTH/HIP-Medicare Advantage, +45427,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45428,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMBLEMHEALTH/HIP-Medicare Advantage, +45429,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45430,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45431,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMBLEMHEALTH/HIP-Medicare Advantage, +45432,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45433,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45434,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45435,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45436,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45437,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45438,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45439,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45440,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45441,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMBLEMHEALTH/HIP-Medicare Advantage, +45442,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45443,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45444,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45445,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45446,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45447,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45448,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45449,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45450,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMBLEMHEALTH/HIP-Medicare Advantage, +45451,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45452,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45453,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMBLEMHEALTH/HIP-Medicare Advantage, +45454,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMBLEMHEALTH/HIP-Medicare Advantage, +45455,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45456,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45457,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMBLEMHEALTH/HIP-Medicare Advantage, +45458,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45459,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45460,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45461,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMBLEMHEALTH/HIP-Medicare Advantage, +45462,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMBLEMHEALTH/HIP-Medicare Advantage, +45463,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMBLEMHEALTH/HIP-Medicare Advantage, +45464,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45465,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45466,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMBLEMHEALTH/HIP-Medicare Advantage, +45467,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45468,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMBLEMHEALTH/HIP-Medicare Advantage, +45469,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45470,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45471,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45472,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45473,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45474,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45475,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMBLEMHEALTH/HIP-Medicare Advantage, +45476,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45477,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMBLEMHEALTH/HIP-Medicare Advantage, +45478,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45479,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMBLEMHEALTH/HIP-Medicare Advantage, +45480,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45481,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMBLEMHEALTH/HIP-Medicare Advantage, +45482,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45483,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45484,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45485,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45486,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMBLEMHEALTH/HIP-Medicare Advantage, +45487,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45488,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMBLEMHEALTH/HIP-Medicare Advantage, +45489,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45490,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMBLEMHEALTH/HIP-Medicare Advantage, +45491,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45492,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMBLEMHEALTH/HIP-Medicare Advantage, +45493,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45494,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45495,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45496,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMBLEMHEALTH/HIP-Medicare Advantage, +45497,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45498,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45499,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45500,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45501,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45502,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMBLEMHEALTH/HIP-Medicare Advantage, +45503,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45504,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45505,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45506,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45507,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45508,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45509,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMBLEMHEALTH/HIP-Medicare Advantage, +45510,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMBLEMHEALTH/HIP-Medicare Advantage, +45511,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45512,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMBLEMHEALTH/HIP-Medicare Advantage, +45513,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45514,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45515,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45516,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45517,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45518,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45519,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45520,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45521,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45522,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45523,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45524,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45525,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMBLEMHEALTH/HIP-Medicare Advantage, +45526,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45527,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45528,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45529,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45530,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45531,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45532,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45533,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMBLEMHEALTH/HIP-Medicare Advantage, +45534,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45535,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMBLEMHEALTH/HIP-Medicare Advantage, +45536,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45537,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45538,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45539,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45540,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45541,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45542,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45543,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45544,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45545,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMBLEMHEALTH/HIP-Medicare Advantage, +45546,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45547,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45548,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45549,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMBLEMHEALTH/HIP-Medicare Advantage, +45550,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45551,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMBLEMHEALTH/HIP-Medicare Advantage, +45552,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45553,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMBLEMHEALTH/HIP-Medicare Advantage, +45554,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45555,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45556,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMBLEMHEALTH/HIP-Medicare Advantage, +45557,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45558,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45559,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45560,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMBLEMHEALTH/HIP-Medicare Advantage, +45561,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45562,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMBLEMHEALTH/HIP-Medicare Advantage, +45563,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45564,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45565,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45566,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45567,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45568,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45569,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45570,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45571,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45572,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45573,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMBLEMHEALTH/HIP-Medicare Advantage, +45574,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45575,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMBLEMHEALTH/HIP-Medicare Advantage, +45576,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45577,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45578,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45579,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMBLEMHEALTH/HIP-Medicare Advantage, +45580,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45581,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45582,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45583,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45584,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45585,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45586,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMBLEMHEALTH/HIP-Medicare Advantage, +45587,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMBLEMHEALTH/HIP-Medicare Advantage, +45588,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45589,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45590,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45591,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45592,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMBLEMHEALTH/HIP-Medicare Advantage, +45593,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMBLEMHEALTH/HIP-Medicare Advantage, +45594,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMBLEMHEALTH/HIP-Medicare Advantage, +45595,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMBLEMHEALTH/HIP-Medicare Advantage, +45596,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45597,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45598,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45599,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45600,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45601,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45602,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMBLEMHEALTH/HIP-Medicare Advantage, +45603,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45604,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45605,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45606,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMBLEMHEALTH/HIP-Medicare Advantage, +45607,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45608,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45609,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45610,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45611,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45612,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45613,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45614,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45615,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMBLEMHEALTH/HIP-Medicare Advantage, +45616,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45617,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45618,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45619,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMBLEMHEALTH/HIP-Medicare Advantage, +45620,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45621,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMBLEMHEALTH/HIP-Medicare Advantage, +45622,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45623,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45624,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45625,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45626,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMBLEMHEALTH/HIP-Medicare Advantage, +45627,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45628,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMBLEMHEALTH/HIP-Medicare Advantage, +45629,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45630,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45631,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMBLEMHEALTH/HIP-Medicare Advantage, +45632,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45633,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45634,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45635,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45636,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMBLEMHEALTH/HIP-Medicare Advantage, +45637,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45638,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMBLEMHEALTH/HIP-Medicare Advantage, +45639,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMBLEMHEALTH/HIP-Medicare Advantage, +45640,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45641,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45642,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45643,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMBLEMHEALTH/HIP-Medicare Advantage, +45644,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMBLEMHEALTH/HIP-Medicare Advantage, +45645,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45646,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45647,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMBLEMHEALTH/HIP-Medicare Advantage, +45648,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMBLEMHEALTH/HIP-Medicare Advantage, +45649,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45650,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMBLEMHEALTH/HIP-Medicare Advantage, +45651,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45652,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45653,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45654,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMBLEMHEALTH/HIP-Medicare Advantage, +45655,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45656,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMBLEMHEALTH/HIP-Medicare Advantage, +45657,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45658,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45659,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45660,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45661,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45662,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMBLEMHEALTH/HIP-Medicare Advantage, +45663,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMBLEMHEALTH/HIP-Medicare Advantage, +45664,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMBLEMHEALTH/HIP-Medicare Advantage, +45665,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMBLEMHEALTH/HIP-Medicare Advantage, +45666,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMBLEMHEALTH/HIP-Medicare Advantage, +45667,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45668,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMBLEMHEALTH/HIP-Medicare Advantage, +45669,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMBLEMHEALTH/HIP-Medicare Advantage, +45670,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45671,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45672,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45673,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMBLEMHEALTH/HIP-Medicare Advantage, +45674,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45675,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMBLEMHEALTH/HIP-Medicare Advantage, +45676,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMBLEMHEALTH/HIP-Medicare Advantage, +45677,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45678,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45679,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45680,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMBLEMHEALTH/HIP-Medicare Advantage, +45681,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMBLEMHEALTH/HIP-Medicare Advantage, +45682,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMBLEMHEALTH/HIP-Medicare Advantage, +45683,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMBLEMHEALTH/HIP-Medicare Advantage, +45684,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45685,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMBLEMHEALTH/HIP-Medicare Advantage, +45686,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45687,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45688,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMBLEMHEALTH/HIP-Medicare Advantage, +45689,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45690,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45691,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45692,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMBLEMHEALTH/HIP-Medicare Advantage, +45693,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45694,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45695,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45696,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45697,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMBLEMHEALTH/HIP-Medicare Advantage, +45698,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMBLEMHEALTH/HIP-Medicare Advantage, +45699,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMBLEMHEALTH/HIP-Medicare Advantage, +45700,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45701,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45702,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMBLEMHEALTH/HIP-Medicare Advantage, +45703,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMBLEMHEALTH/HIP-Medicare Advantage, +45704,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45705,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMBLEMHEALTH/HIP-Medicare Advantage, +45706,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45707,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMBLEMHEALTH/HIP-Medicare Advantage, +45708,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45709,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMBLEMHEALTH/HIP-Medicare Advantage, +45710,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMBLEMHEALTH/HIP-Medicare Advantage, +45711,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMBLEMHEALTH/HIP-Medicare Advantage, +45712,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45713,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMBLEMHEALTH/HIP-Medicare Advantage, +45714,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMBLEMHEALTH/HIP-Medicare Advantage, +45715,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45716,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMBLEMHEALTH/HIP-Medicare Advantage, +45717,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMBLEMHEALTH/HIP-Medicare Advantage, +45718,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +45719,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMBLEMHEALTH/HIP-Medicare Advantage, +45720,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45721,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45722,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45723,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +45724,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +45725,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMBLEMHEALTH/HIP-Medicare Advantage, +45726,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45727,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMBLEMHEALTH/HIP-Medicare Advantage, +45728,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMBLEMHEALTH/HIP-Medicare Advantage, +45729,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45730,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45731,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45732,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMBLEMHEALTH/HIP-Medicare Advantage, +45733,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMBLEMHEALTH/HIP-Medicare Advantage, +45734,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMBLEMHEALTH/HIP-Medicare Advantage, +45735,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45736,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45737,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45738,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMBLEMHEALTH/HIP-Medicare Advantage, +45739,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45740,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45741,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45742,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45743,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMBLEMHEALTH/HIP-Medicare Advantage, +45744,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45745,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMBLEMHEALTH/HIP-Medicare Advantage, +45746,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMBLEMHEALTH/HIP-Medicare Advantage, +45747,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMBLEMHEALTH/HIP-Medicare Advantage, +45748,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMBLEMHEALTH/HIP-Medicare Advantage, +45749,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMBLEMHEALTH/HIP-Medicare Advantage, +45750,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMBLEMHEALTH/HIP-Medicare Advantage, +45751,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMBLEMHEALTH/HIP-Medicare Advantage, +45752,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45753,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45754,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMBLEMHEALTH/HIP-Medicare Advantage, +45755,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45756,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMBLEMHEALTH/HIP-Medicare Advantage, +45757,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45758,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45759,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45760,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +45761,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMBLEMHEALTH/HIP-Medicare Advantage, +45762,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45763,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45764,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45765,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45766,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45767,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMBLEMHEALTH/HIP-Medicare Advantage, +45768,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMBLEMHEALTH/HIP-Medicare Advantage, +45769,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMBLEMHEALTH/HIP-Medicare Advantage, +45770,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMBLEMHEALTH/HIP-Medicare Advantage, +45771,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMBLEMHEALTH/HIP-Medicare Advantage, +45772,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45773,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMBLEMHEALTH/HIP-Medicare Advantage, +45774,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45775,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMBLEMHEALTH/HIP-Medicare Advantage, +45776,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45777,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45778,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45779,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMBLEMHEALTH/HIP-Medicare Advantage, +45780,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45781,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMBLEMHEALTH/HIP-Medicare Advantage, +45782,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMBLEMHEALTH/HIP-Medicare Advantage, +45783,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45784,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45785,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45786,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMBLEMHEALTH/HIP-Medicare Advantage, +45787,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45788,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMBLEMHEALTH/HIP-Medicare Advantage, +45789,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMBLEMHEALTH/HIP-Medicare Advantage, +45790,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45791,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMBLEMHEALTH/HIP-Medicare Advantage, +45792,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMBLEMHEALTH/HIP-Medicare Advantage, +45793,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45794,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45795,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMBLEMHEALTH/HIP-Medicare Advantage, +45796,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45797,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45798,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45799,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMBLEMHEALTH/HIP-Medicare Advantage, +45800,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45801,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45802,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45803,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45804,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMBLEMHEALTH/HIP-Medicare Advantage, +45805,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45806,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMBLEMHEALTH/HIP-Medicare Advantage, +45807,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45808,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45809,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45810,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45811,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45812,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMBLEMHEALTH/HIP-Medicare Advantage, +45813,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMBLEMHEALTH/HIP-Medicare Advantage, +45814,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMBLEMHEALTH/HIP-Medicare Advantage, +45815,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45816,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45817,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMBLEMHEALTH/HIP-Medicare Advantage, +45818,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMBLEMHEALTH/HIP-Medicare Advantage, +45819,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMBLEMHEALTH/HIP-Medicare Advantage, +45820,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMBLEMHEALTH/HIP-Medicare Advantage, +45821,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45822,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45823,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45824,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMBLEMHEALTH/HIP-Medicare Advantage, +45825,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45826,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45827,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45828,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMBLEMHEALTH/HIP-Medicare Advantage, +45829,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45830,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45831,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMBLEMHEALTH/HIP-Medicare Advantage, +45832,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45833,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMBLEMHEALTH/HIP-Medicare Advantage, +45834,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMBLEMHEALTH/HIP-Medicare Advantage, +45835,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45836,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45837,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45838,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45839,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMBLEMHEALTH/HIP-Medicare Advantage, +45840,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45841,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMBLEMHEALTH/HIP-Medicare Advantage, +45842,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45843,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45844,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45845,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMBLEMHEALTH/HIP-Medicare Advantage, +45846,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45847,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45848,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45849,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMBLEMHEALTH/HIP-Medicare Advantage, +45850,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45851,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMBLEMHEALTH/HIP-Medicare Advantage, +45852,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45853,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45854,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45855,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMBLEMHEALTH/HIP-Medicare Advantage, +45856,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45857,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45858,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45859,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45860,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45861,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMBLEMHEALTH/HIP-Medicare Advantage, +45862,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45863,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMBLEMHEALTH/HIP-Medicare Advantage, +45864,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMBLEMHEALTH/HIP-Medicare Advantage, +45865,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMBLEMHEALTH/HIP-Medicare Advantage, +45866,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45867,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMBLEMHEALTH/HIP-Medicare Advantage, +45868,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45869,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMBLEMHEALTH/HIP-Medicare Advantage, +45870,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45871,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMBLEMHEALTH/HIP-Medicare Advantage, +45872,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45873,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMBLEMHEALTH/HIP-Medicare Advantage, +45874,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMBLEMHEALTH/HIP-Medicare Advantage, +45875,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMBLEMHEALTH/HIP-Medicare Advantage, +45876,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45877,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMBLEMHEALTH/HIP-Medicare Advantage, +45878,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMBLEMHEALTH/HIP-Medicare Advantage, +45879,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMBLEMHEALTH/HIP-Medicare Advantage, +45880,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMBLEMHEALTH/HIP-Medicare Advantage, +45881,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45882,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMBLEMHEALTH/HIP-Medicare Advantage, +45883,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45884,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMBLEMHEALTH/HIP-Medicare Advantage, +45885,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMBLEMHEALTH/HIP-Medicare Advantage, +45886,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45887,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMBLEMHEALTH/HIP-Medicare Advantage, +45888,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45889,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45890,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45891,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMBLEMHEALTH/HIP-Medicare Advantage, +45892,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMBLEMHEALTH/HIP-Medicare Advantage, +45893,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45894,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMBLEMHEALTH/HIP-Medicare Advantage, +45895,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMBLEMHEALTH/HIP-Medicare Advantage, +45896,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45897,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45898,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMBLEMHEALTH/HIP-Medicare Advantage, +45899,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMBLEMHEALTH/HIP-Medicare Advantage, +45900,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMBLEMHEALTH/HIP-Medicare Advantage, +45901,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45902,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMBLEMHEALTH/HIP-Medicare Advantage, +45903,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMBLEMHEALTH/HIP-Medicare Advantage, +45904,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMBLEMHEALTH/HIP-Medicare Advantage, +45905,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMBLEMHEALTH/HIP-Medicare Advantage, +45906,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMBLEMHEALTH/HIP-Medicare Advantage, +45907,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMBLEMHEALTH/HIP-Medicare Advantage, +45908,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45909,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45910,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45911,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45912,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMBLEMHEALTH/HIP-Medicare Advantage, +45913,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45914,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMBLEMHEALTH/HIP-Medicare Advantage, +45915,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMBLEMHEALTH/HIP-Medicare Advantage, +45916,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMBLEMHEALTH/HIP-Medicare Advantage, +45917,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMBLEMHEALTH/HIP-Medicare Advantage, +45918,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMBLEMHEALTH/HIP-Medicare Advantage, +45919,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMBLEMHEALTH/HIP-Medicare Advantage, +45920,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45921,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMBLEMHEALTH/HIP-Medicare Advantage, +45922,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMBLEMHEALTH/HIP-Medicare Advantage, +45923,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45924,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMBLEMHEALTH/HIP-Medicare Advantage, +45925,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMBLEMHEALTH/HIP-Medicare Advantage, +45926,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45927,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMBLEMHEALTH/HIP-Medicare Advantage, +45928,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45929,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMBLEMHEALTH/HIP-Medicare Advantage, +45930,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMBLEMHEALTH/HIP-Medicare Advantage, +45931,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMBLEMHEALTH/HIP-Medicare Advantage, +45932,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45933,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45934,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45935,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMBLEMHEALTH/HIP-Medicare Advantage, +45936,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45937,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMBLEMHEALTH/HIP-Medicare Advantage, +45938,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMBLEMHEALTH/HIP-Medicare Advantage, +45939,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMBLEMHEALTH/HIP-Medicare Advantage, +45940,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMBLEMHEALTH/HIP-Medicare Advantage, +45941,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45942,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMBLEMHEALTH/HIP-Medicare Advantage, +45943,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45944,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMBLEMHEALTH/HIP-Medicare Advantage, +45945,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMBLEMHEALTH/HIP-Medicare Advantage, +45946,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMBLEMHEALTH/HIP-Medicare Advantage, +45947,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMBLEMHEALTH/HIP-Medicare Advantage, +45948,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMBLEMHEALTH/HIP-Medicare Advantage, +45949,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMBLEMHEALTH/HIP-Medicare Advantage, +45950,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMBLEMHEALTH/HIP-Medicare Advantage, +45951,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45952,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMBLEMHEALTH/HIP-Medicare Advantage, +45953,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45954,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMBLEMHEALTH/HIP-Medicare Advantage, +45955,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMBLEMHEALTH/HIP-Medicare Advantage, +45956,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMBLEMHEALTH/HIP-Medicare Advantage, +45957,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMBLEMHEALTH/HIP-Medicare Advantage, +45958,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45959,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMBLEMHEALTH/HIP-Medicare Advantage, +45960,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMBLEMHEALTH/HIP-Medicare Advantage, +45961,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMBLEMHEALTH/HIP-Medicare Advantage, +45962,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45963,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMBLEMHEALTH/HIP-Medicare Advantage, +45964,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMBLEMHEALTH/HIP-Medicare Advantage, +45965,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMBLEMHEALTH/HIP-Medicare Advantage, +45966,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45967,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMBLEMHEALTH/HIP-Medicare Advantage, +45968,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45969,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45970,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMBLEMHEALTH/HIP-Medicare Advantage, +45971,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMBLEMHEALTH/HIP-Medicare Advantage, +45972,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMBLEMHEALTH/HIP-Medicare Advantage, +45973,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45974,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMBLEMHEALTH/HIP-Medicare Advantage, +45975,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMBLEMHEALTH/HIP-Medicare Advantage, +45976,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMBLEMHEALTH/HIP-Medicare Advantage, +45977,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMBLEMHEALTH/HIP-Medicare Advantage, +45978,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMBLEMHEALTH/HIP-Medicare Advantage, +45979,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMBLEMHEALTH/HIP-Medicare Advantage, +45980,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMBLEMHEALTH/HIP-Medicare Advantage, +45981,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMBLEMHEALTH/HIP-Medicare Advantage, +45982,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMBLEMHEALTH/HIP-Medicare Advantage, +45983,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMBLEMHEALTH/HIP-Medicare Advantage, +45984,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMBLEMHEALTH/HIP-Medicare Advantage, +45985,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMBLEMHEALTH/HIP-Medicare Advantage, +45986,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMBLEMHEALTH/HIP-Medicare Advantage, +45987,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMBLEMHEALTH/HIP-Medicare Advantage, +45988,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45989,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45990,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMBLEMHEALTH/HIP-Medicare Advantage, +45991,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45992,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45993,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45994,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMBLEMHEALTH/HIP-Medicare Advantage, +45995,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45996,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMBLEMHEALTH/HIP-Medicare Advantage, +45997,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45998,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMBLEMHEALTH/HIP-Medicare Advantage, +45999,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46000,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46001,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMBLEMHEALTH/HIP-Medicare Advantage, +46002,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46003,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46004,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46005,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46006,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46007,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46008,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46009,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46010,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46011,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMBLEMHEALTH/HIP-Medicare Advantage, +46012,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46013,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46014,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46015,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46016,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46017,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46018,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46019,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46020,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46021,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMBLEMHEALTH/HIP-Medicare Advantage, +46022,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMBLEMHEALTH/HIP-Medicare Advantage, +46023,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46024,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46025,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46026,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46027,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46028,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMBLEMHEALTH/HIP-Medicare Advantage, +46029,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46030,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMBLEMHEALTH/HIP-Medicare Advantage, +46031,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46032,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46033,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46034,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46035,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46036,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMBLEMHEALTH/HIP-Medicare Advantage, +46037,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46038,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46039,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46040,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46041,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46042,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46043,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46044,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46045,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46046,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46047,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46048,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46049,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46050,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46051,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46052,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46053,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46054,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46055,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46056,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMBLEMHEALTH/HIP-Medicare Advantage, +46057,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46058,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46059,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46060,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46061,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46062,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46063,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46064,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46065,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46066,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46067,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46068,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46069,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46070,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46071,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46072,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46073,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46074,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46075,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46076,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46077,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46078,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46079,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46080,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46081,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMBLEMHEALTH/HIP-Medicare Advantage, +46082,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46083,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46084,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46085,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46086,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46087,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMBLEMHEALTH/HIP-Medicare Advantage, +46088,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46089,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46090,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46091,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46092,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46093,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46094,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46095,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46096,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46097,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46098,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46099,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46100,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46101,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46102,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46103,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46104,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46105,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46106,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46107,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46108,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46109,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46110,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46111,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46112,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46113,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46114,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46115,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46116,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46117,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46118,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46119,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46120,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46121,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46122,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMBLEMHEALTH/HIP-Medicare Advantage, +46123,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46124,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46125,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMBLEMHEALTH/HIP-Medicare Advantage, +46126,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46127,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46128,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46129,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46130,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46131,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46132,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46133,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMBLEMHEALTH/HIP-Medicare Advantage, +46134,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46135,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46136,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46137,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46138,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46139,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46140,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46141,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46142,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46143,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46144,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46145,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46146,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMBLEMHEALTH/HIP-Medicare Advantage, +46147,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMBLEMHEALTH/HIP-Medicare Advantage, +46148,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46149,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46150,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMBLEMHEALTH/HIP-Medicare Advantage, +46151,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMBLEMHEALTH/HIP-Medicare Advantage, +46152,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46153,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMBLEMHEALTH/HIP-Medicare Advantage, +46154,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46155,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMBLEMHEALTH/HIP-Medicare Advantage, +46156,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46157,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMBLEMHEALTH/HIP-Medicare Advantage, +46158,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46159,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMBLEMHEALTH/HIP-Medicare Advantage, +46160,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46161,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46162,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46163,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46164,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMBLEMHEALTH/HIP-Medicare Advantage, +46165,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMBLEMHEALTH/HIP-Medicare Advantage, +46166,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46167,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46168,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46169,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMBLEMHEALTH/HIP-Medicare Advantage, +46170,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMBLEMHEALTH/HIP-Medicare Advantage, +46171,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46172,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46173,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46174,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46175,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMBLEMHEALTH/HIP-Medicare Advantage, +46176,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMBLEMHEALTH/HIP-Medicare Advantage, +46177,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46178,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46179,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46180,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46181,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46182,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46183,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46184,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46185,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46186,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMBLEMHEALTH/HIP-Medicare Advantage, +46187,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46188,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMBLEMHEALTH/HIP-Medicare Advantage, +46189,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46190,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMBLEMHEALTH/HIP-Medicare Advantage, +46191,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMBLEMHEALTH/HIP-Medicare Advantage, +46192,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46193,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMBLEMHEALTH/HIP-Medicare Advantage, +46194,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMBLEMHEALTH/HIP-Medicare Advantage, +46195,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMBLEMHEALTH/HIP-Medicare Advantage, +46196,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46197,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46198,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46199,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46200,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46201,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46202,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46203,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46204,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46205,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46206,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46207,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46208,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMBLEMHEALTH/HIP-Medicare Advantage, +46209,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMBLEMHEALTH/HIP-Medicare Advantage, +46210,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46211,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMBLEMHEALTH/HIP-Medicare Advantage, +46212,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMBLEMHEALTH/HIP-Medicare Advantage, +46213,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMBLEMHEALTH/HIP-Medicare Advantage, +46214,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46215,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46216,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMBLEMHEALTH/HIP-Medicare Advantage, +46217,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46218,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMBLEMHEALTH/HIP-Medicare Advantage, +46219,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46220,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46221,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46222,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46223,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46224,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46225,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46226,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Medicare Advantage, +46227,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46228,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46229,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46230,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMBLEMHEALTH/HIP-Medicare Advantage, +46231,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46232,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46233,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMBLEMHEALTH/HIP-Medicare Advantage, +46234,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46235,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46236,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46237,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46238,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46239,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46240,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46241,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46242,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46243,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46244,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMBLEMHEALTH/HIP-Medicare Advantage, +46245,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMBLEMHEALTH/HIP-Medicare Advantage, +46246,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46247,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46248,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46249,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46250,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMBLEMHEALTH/HIP-Medicare Advantage, +46251,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46252,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46253,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46254,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46255,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46256,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46257,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMBLEMHEALTH/HIP-Medicare Advantage, +46258,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46259,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46260,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46261,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46262,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46263,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46264,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46265,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46266,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46267,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Medicare Advantage, +46268,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46269,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46270,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46271,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46272,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46273,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46274,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46275,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46276,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46277,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46278,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46279,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46280,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46281,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMBLEMHEALTH/HIP-Medicare Advantage, +46282,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46283,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46284,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46285,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46286,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46287,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMBLEMHEALTH/HIP-Medicare Advantage, +46288,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMBLEMHEALTH/HIP-Medicare Advantage, +46289,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46290,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46291,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46292,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46293,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46294,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46295,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46296,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46297,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46298,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46299,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMBLEMHEALTH/HIP-Medicare Advantage, +46300,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46301,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46302,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46303,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMBLEMHEALTH/HIP-Medicare Advantage, +46304,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMBLEMHEALTH/HIP-Medicare Advantage, +46305,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46306,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46307,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46308,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46309,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46310,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46311,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMBLEMHEALTH/HIP-Medicare Advantage, +46312,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46313,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46314,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46315,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46316,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46317,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46318,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46319,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMBLEMHEALTH/HIP-Medicare Advantage, +46320,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46321,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46322,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46323,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46324,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46325,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46326,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46327,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46328,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46329,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMBLEMHEALTH/HIP-Medicare Advantage, +46330,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46331,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMBLEMHEALTH/HIP-Medicare Advantage, +46332,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46333,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46334,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +46335,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46336,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46337,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46338,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46339,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46340,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46341,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46342,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46343,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46344,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46345,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46346,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46347,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46348,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMBLEMHEALTH/HIP-Medicare Advantage, +46349,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMBLEMHEALTH/HIP-Medicare Advantage, +46350,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46351,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMBLEMHEALTH/HIP-Medicare Advantage, +46352,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46353,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46354,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46355,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46356,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46357,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46358,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46359,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46360,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46361,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46362,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46363,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46364,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46365,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMBLEMHEALTH/HIP-Medicare Advantage, +46366,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMBLEMHEALTH/HIP-Medicare Advantage, +46367,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMBLEMHEALTH/HIP-Medicare Advantage, +46368,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46369,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46370,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46371,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMBLEMHEALTH/HIP-Medicare Advantage, +46372,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46373,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46374,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46375,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMBLEMHEALTH/HIP-Medicare Advantage, +46376,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMBLEMHEALTH/HIP-Medicare Advantage, +46377,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46378,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46379,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46380,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46381,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46382,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46383,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46384,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46385,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMBLEMHEALTH/HIP-Medicare Advantage, +46386,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46387,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46388,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +46389,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMBLEMHEALTH/HIP-Medicare Advantage, +46390,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMBLEMHEALTH/HIP-Medicare Advantage, +46391,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46392,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46393,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46394,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46395,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46396,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46397,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46398,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46399,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46400,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46401,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46402,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46403,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMBLEMHEALTH/HIP-Medicare Advantage, +46404,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46405,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMBLEMHEALTH/HIP-Medicare Advantage, +46406,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46407,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46408,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMBLEMHEALTH/HIP-Medicare Advantage, +46409,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46410,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46411,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMBLEMHEALTH/HIP-Medicare Advantage, +46412,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46413,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46414,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMBLEMHEALTH/HIP-Medicare Advantage, +46415,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMBLEMHEALTH/HIP-Medicare Advantage, +46416,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46417,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMBLEMHEALTH/HIP-Medicare Advantage, +46418,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46419,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMBLEMHEALTH/HIP-Medicare Advantage, +46420,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMBLEMHEALTH/HIP-Medicare Advantage, +46421,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46422,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46423,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46424,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46425,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46426,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46427,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMBLEMHEALTH/HIP-Medicare Advantage, +46428,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46429,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMBLEMHEALTH/HIP-Medicare Advantage, +46430,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46431,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46432,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMBLEMHEALTH/HIP-Medicare Advantage, +46433,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46434,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMBLEMHEALTH/HIP-Medicare Advantage, +46435,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMBLEMHEALTH/HIP-Medicare Advantage, +46436,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46437,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46438,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46439,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMBLEMHEALTH/HIP-Medicare Advantage, +46440,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46441,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46442,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46443,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46444,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46445,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46446,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMBLEMHEALTH/HIP-Medicare Advantage, +46447,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMBLEMHEALTH/HIP-Medicare Advantage, +46448,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMBLEMHEALTH/HIP-Medicare Advantage, +46449,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46450,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMBLEMHEALTH/HIP-Medicare Advantage, +46451,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46452,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46453,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMBLEMHEALTH/HIP-Medicare Advantage, +46454,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMBLEMHEALTH/HIP-Medicare Advantage, +46455,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMBLEMHEALTH/HIP-Medicare Advantage, +46456,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46457,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMBLEMHEALTH/HIP-Medicare Advantage, +46458,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46459,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46460,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMBLEMHEALTH/HIP-Medicare Advantage, +46461,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMBLEMHEALTH/HIP-Medicare Advantage, +46462,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMBLEMHEALTH/HIP-Medicare Advantage, +46463,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46464,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46465,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46466,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46467,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMBLEMHEALTH/HIP-Medicare Advantage, +46468,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMBLEMHEALTH/HIP-Medicare Advantage, +46469,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46470,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46471,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46472,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46473,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMBLEMHEALTH/HIP-Medicare Advantage, +46474,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46475,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46476,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMBLEMHEALTH/HIP-Medicare Advantage, +46477,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46478,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMBLEMHEALTH/HIP-Medicare Advantage, +46479,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMBLEMHEALTH/HIP-Medicare Advantage, +46480,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMBLEMHEALTH/HIP-Medicare Advantage, +46481,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46482,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46483,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46484,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46485,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMBLEMHEALTH/HIP-Medicare Advantage, +46486,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMBLEMHEALTH/HIP-Medicare Advantage, +46487,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46488,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46489,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMBLEMHEALTH/HIP-Medicare Advantage, +46490,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46491,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMBLEMHEALTH/HIP-Medicare Advantage, +46492,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMBLEMHEALTH/HIP-Medicare Advantage, +46493,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMBLEMHEALTH/HIP-Medicare Advantage, +46494,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46495,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46496,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46497,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMBLEMHEALTH/HIP-Medicare Advantage, +46498,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46499,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMBLEMHEALTH/HIP-Medicare Advantage, +46500,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMBLEMHEALTH/HIP-Medicare Advantage, +46501,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46502,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMBLEMHEALTH/HIP-Medicare Advantage, +46503,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46504,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46505,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46506,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46507,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46508,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMBLEMHEALTH/HIP-Medicare Advantage, +46509,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46510,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMBLEMHEALTH/HIP-Medicare Advantage, +46511,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46512,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMBLEMHEALTH/HIP-Medicare Advantage, +46513,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46514,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46515,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46516,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46517,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMBLEMHEALTH/HIP-Medicare Advantage, +46518,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMBLEMHEALTH/HIP-Medicare Advantage, +46519,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMBLEMHEALTH/HIP-Medicare Advantage, +46520,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMBLEMHEALTH/HIP-Medicare Advantage, +46521,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMBLEMHEALTH/HIP-Medicare Advantage, +46522,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMBLEMHEALTH/HIP-Medicare Advantage, +46523,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46524,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46525,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMBLEMHEALTH/HIP-Medicare Advantage, +46526,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46527,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMBLEMHEALTH/HIP-Medicare Advantage, +46528,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46529,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMBLEMHEALTH/HIP-Medicare Advantage, +46530,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMBLEMHEALTH/HIP-Medicare Advantage, +46531,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46532,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46533,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46534,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMBLEMHEALTH/HIP-Medicare Advantage, +46535,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMBLEMHEALTH/HIP-Medicare Advantage, +46536,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46537,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMBLEMHEALTH/HIP-Medicare Advantage, +46538,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46539,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46540,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46541,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46542,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMBLEMHEALTH/HIP-Medicare Advantage, +46543,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMBLEMHEALTH/HIP-Medicare Advantage, +46544,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMBLEMHEALTH/HIP-Medicare Advantage, +46545,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46546,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMBLEMHEALTH/HIP-Medicare Advantage, +46547,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46548,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMBLEMHEALTH/HIP-Medicare Advantage, +46549,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMBLEMHEALTH/HIP-Medicare Advantage, +46550,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMBLEMHEALTH/HIP-Medicare Advantage, +46551,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46552,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMBLEMHEALTH/HIP-Medicare Advantage, +46553,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMBLEMHEALTH/HIP-Medicare Advantage, +46554,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMBLEMHEALTH/HIP-Medicare Advantage, +46555,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46556,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMBLEMHEALTH/HIP-Medicare Advantage, +46557,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMBLEMHEALTH/HIP-Medicare Advantage, +46558,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMBLEMHEALTH/HIP-Medicare Advantage, +46559,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46560,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46561,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46562,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46563,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMBLEMHEALTH/HIP-Medicare Advantage, +46564,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46565,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMBLEMHEALTH/HIP-Medicare Advantage, +46566,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46567,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46568,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMBLEMHEALTH/HIP-Medicare Advantage, +46569,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46570,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46571,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46572,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMBLEMHEALTH/HIP-Medicare Advantage, +46573,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMBLEMHEALTH/HIP-Medicare Advantage, +46574,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMBLEMHEALTH/HIP-Medicare Advantage, +46575,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMBLEMHEALTH/HIP-Medicare Advantage, +46576,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMBLEMHEALTH/HIP-Medicare Advantage, +46577,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46578,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46579,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46580,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46581,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46582,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMBLEMHEALTH/HIP-Medicare Advantage, +46583,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46584,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46585,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46586,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMBLEMHEALTH/HIP-Medicare Advantage, +46587,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMBLEMHEALTH/HIP-Medicare Advantage, +46588,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46589,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46590,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46591,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46592,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46593,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46594,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMBLEMHEALTH/HIP-Medicare Advantage, +46595,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMBLEMHEALTH/HIP-Medicare Advantage, +46596,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46597,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMBLEMHEALTH/HIP-Medicare Advantage, +46598,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46599,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMBLEMHEALTH/HIP-Medicare Advantage, +46600,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46601,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46602,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMBLEMHEALTH/HIP-Medicare Advantage, +46603,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMBLEMHEALTH/HIP-Medicare Advantage, +46604,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMBLEMHEALTH/HIP-Medicare Advantage, +46605,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMBLEMHEALTH/HIP-Medicare Advantage, +46606,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMBLEMHEALTH/HIP-Medicare Advantage, +46607,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMBLEMHEALTH/HIP-Medicare Advantage, +46608,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMBLEMHEALTH/HIP-Medicare Advantage, +46609,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46610,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMBLEMHEALTH/HIP-Medicare Advantage, +46611,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46612,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMBLEMHEALTH/HIP-Medicare Advantage, +46613,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46614,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46615,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46616,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMBLEMHEALTH/HIP-Medicare Advantage, +46617,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMBLEMHEALTH/HIP-Medicare Advantage, +46618,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMBLEMHEALTH/HIP-Medicare Advantage, +46619,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46620,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46621,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46622,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMBLEMHEALTH/HIP-Medicare Advantage, +46623,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46624,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMBLEMHEALTH/HIP-Medicare Advantage, +46625,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46626,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46627,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMBLEMHEALTH/HIP-Medicare Advantage, +46628,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMBLEMHEALTH/HIP-Medicare Advantage, +46629,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46630,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46631,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMBLEMHEALTH/HIP-Medicare Advantage, +46632,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46633,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46634,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46635,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMBLEMHEALTH/HIP-Medicare Advantage, +46636,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46637,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46638,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46639,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46640,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46641,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46642,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46643,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46644,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMBLEMHEALTH/HIP-Medicare Advantage, +46645,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46646,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMBLEMHEALTH/HIP-Medicare Advantage, +46647,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46648,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMBLEMHEALTH/HIP-Medicare Advantage, +46649,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMBLEMHEALTH/HIP-Medicare Advantage, +46650,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMBLEMHEALTH/HIP-Medicare Advantage, +46651,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46652,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46653,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46654,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46655,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46656,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMBLEMHEALTH/HIP-Medicare Advantage, +46657,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMBLEMHEALTH/HIP-Medicare Advantage, +46658,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46659,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMBLEMHEALTH/HIP-Medicare Advantage, +46660,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46661,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMBLEMHEALTH/HIP-Medicare Advantage, +46662,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMBLEMHEALTH/HIP-Medicare Advantage, +46663,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMBLEMHEALTH/HIP-Medicare Advantage, +46664,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMBLEMHEALTH/HIP-Medicare Advantage, +46665,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46666,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMBLEMHEALTH/HIP-Medicare Advantage, +46667,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46668,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46669,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46670,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMBLEMHEALTH/HIP-Medicare Advantage, +46671,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46672,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46673,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMBLEMHEALTH/HIP-Medicare Advantage, +46674,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46675,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMBLEMHEALTH/HIP-Medicare Advantage, +46676,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46677,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMBLEMHEALTH/HIP-Medicare Advantage, +46678,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMBLEMHEALTH/HIP-Medicare Advantage, +46679,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMBLEMHEALTH/HIP-Medicare Advantage, +46680,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46681,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46682,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMBLEMHEALTH/HIP-Medicare Advantage, +46683,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46684,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMBLEMHEALTH/HIP-Medicare Advantage, +46685,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMBLEMHEALTH/HIP-Medicare Advantage, +46686,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMBLEMHEALTH/HIP-Medicare Advantage, +46687,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46688,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46689,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46690,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46691,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMBLEMHEALTH/HIP-Medicare Advantage, +46692,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMBLEMHEALTH/HIP-Medicare Advantage, +46693,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMBLEMHEALTH/HIP-Medicare Advantage, +46694,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46695,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMBLEMHEALTH/HIP-Medicare Advantage, +46696,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46697,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46698,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46699,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMBLEMHEALTH/HIP-Medicare Advantage, +46700,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMBLEMHEALTH/HIP-Medicare Advantage, +46701,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMBLEMHEALTH/HIP-Medicare Advantage, +46702,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46703,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMBLEMHEALTH/HIP-Medicare Advantage, +46704,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46705,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMBLEMHEALTH/HIP-Medicare Advantage, +46706,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMBLEMHEALTH/HIP-Medicare Advantage, +46707,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMBLEMHEALTH/HIP-Medicare Advantage, +46708,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46709,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMBLEMHEALTH/HIP-Medicare Advantage, +46710,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46711,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46712,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMBLEMHEALTH/HIP-Medicare Advantage, +46713,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMBLEMHEALTH/HIP-Medicare Advantage, +46714,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMBLEMHEALTH/HIP-Medicare Advantage, +46715,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46716,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46717,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMBLEMHEALTH/HIP-Medicare Advantage, +46718,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMBLEMHEALTH/HIP-Medicare Advantage, +46719,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46720,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46721,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMBLEMHEALTH/HIP-Medicare Advantage, +46722,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46723,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMBLEMHEALTH/HIP-Medicare Advantage, +46724,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46725,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46726,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46727,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46728,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46729,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMBLEMHEALTH/HIP-Medicare Advantage, +46730,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMBLEMHEALTH/HIP-Medicare Advantage, +46731,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46732,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMBLEMHEALTH/HIP-Medicare Advantage, +46733,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46734,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46735,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMBLEMHEALTH/HIP-Medicare Advantage, +46736,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46737,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46738,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46739,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46740,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMBLEMHEALTH/HIP-Medicare Advantage, +46741,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46742,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46743,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46744,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMBLEMHEALTH/HIP-Medicare Advantage, +46745,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMBLEMHEALTH/HIP-Medicare Advantage, +46746,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMBLEMHEALTH/HIP-Medicare Advantage, +46747,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMBLEMHEALTH/HIP-Medicare Advantage, +46748,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMBLEMHEALTH/HIP-Medicare Advantage, +46749,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46750,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46751,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMBLEMHEALTH/HIP-Medicare Advantage, +46752,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMBLEMHEALTH/HIP-Medicare Advantage, +46753,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46754,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMBLEMHEALTH/HIP-Medicare Advantage, +46755,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46756,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46757,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46758,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMBLEMHEALTH/HIP-Medicare Advantage, +46759,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46760,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46761,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46762,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMBLEMHEALTH/HIP-Medicare Advantage, +46763,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMBLEMHEALTH/HIP-Medicare Advantage, +46764,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMBLEMHEALTH/HIP-Medicare Advantage, +46765,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMBLEMHEALTH/HIP-Medicare Advantage, +46766,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46767,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMBLEMHEALTH/HIP-Medicare Advantage, +46768,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMBLEMHEALTH/HIP-Medicare Advantage, +46769,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46770,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46771,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46772,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMBLEMHEALTH/HIP-Medicare Advantage, +46773,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46774,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMBLEMHEALTH/HIP-Medicare Advantage, +46775,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46776,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46777,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46778,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46779,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMBLEMHEALTH/HIP-Medicare Advantage, +46780,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46781,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMBLEMHEALTH/HIP-Medicare Advantage, +46782,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46783,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46784,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46785,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46786,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46787,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46788,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46789,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46790,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMBLEMHEALTH/HIP-Medicare Advantage, +46791,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMBLEMHEALTH/HIP-Medicare Advantage, +46792,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMBLEMHEALTH/HIP-Medicare Advantage, +46793,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46794,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46795,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46796,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46797,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMBLEMHEALTH/HIP-Medicare Advantage, +46798,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46799,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMBLEMHEALTH/HIP-Medicare Advantage, +46800,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46801,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46802,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMBLEMHEALTH/HIP-Medicare Advantage, +46803,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46804,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMBLEMHEALTH/HIP-Medicare Advantage, +46805,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46806,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46807,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46808,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46809,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMBLEMHEALTH/HIP-Medicare Advantage, +46810,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46811,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMBLEMHEALTH/HIP-Medicare Advantage, +46812,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMBLEMHEALTH/HIP-Medicare Advantage, +46813,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46814,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMBLEMHEALTH/HIP-Medicare Advantage, +46815,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMBLEMHEALTH/HIP-Medicare Advantage, +46816,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMBLEMHEALTH/HIP-Medicare Advantage, +46817,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMBLEMHEALTH/HIP-Medicare Advantage, +46818,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMBLEMHEALTH/HIP-Medicare Advantage, +46819,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46820,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46821,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46822,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46823,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMBLEMHEALTH/HIP-Medicare Advantage, +46824,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46825,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMBLEMHEALTH/HIP-Medicare Advantage, +46826,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46827,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMBLEMHEALTH/HIP-Medicare Advantage, +46828,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46829,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMBLEMHEALTH/HIP-Medicare Advantage, +46830,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMBLEMHEALTH/HIP-Medicare Advantage, +46831,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMBLEMHEALTH/HIP-Medicare Advantage, +46832,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMBLEMHEALTH/HIP-Medicare Advantage, +46833,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMBLEMHEALTH/HIP-Medicare Advantage, +46834,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMBLEMHEALTH/HIP-Medicare Advantage, +46835,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMBLEMHEALTH/HIP-Medicare Advantage, +46836,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMBLEMHEALTH/HIP-Medicare Advantage, +46837,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46838,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMBLEMHEALTH/HIP-Medicare Advantage, +46839,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46840,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMBLEMHEALTH/HIP-Medicare Advantage, +46841,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMBLEMHEALTH/HIP-Medicare Advantage, +46842,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46843,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46844,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46845,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMBLEMHEALTH/HIP-Medicare Advantage, +46846,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMBLEMHEALTH/HIP-Medicare Advantage, +46847,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46848,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46849,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMBLEMHEALTH/HIP-Medicare Advantage, +46850,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMBLEMHEALTH/HIP-Medicare Advantage, +46851,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46852,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMBLEMHEALTH/HIP-Medicare Advantage, +46853,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMBLEMHEALTH/HIP-Medicare Advantage, +46854,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46855,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46856,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMBLEMHEALTH/HIP-Medicare Advantage, +46857,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMBLEMHEALTH/HIP-Medicare Advantage, +46858,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMBLEMHEALTH/HIP-Medicare Advantage, +46859,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMBLEMHEALTH/HIP-Medicare Advantage, +46860,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMBLEMHEALTH/HIP-Medicare Advantage, +46861,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46862,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMBLEMHEALTH/HIP-Medicare Advantage, +46863,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46864,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46865,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMBLEMHEALTH/HIP-Medicare Advantage, +46866,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46867,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46868,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMBLEMHEALTH/HIP-Medicare Advantage, +46869,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46870,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMBLEMHEALTH/HIP-Medicare Advantage, +46871,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46872,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46873,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46874,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46875,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46876,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46877,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46878,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMBLEMHEALTH/HIP-Medicare Advantage, +46879,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46880,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMBLEMHEALTH/HIP-Medicare Advantage, +46881,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMBLEMHEALTH/HIP-Medicare Advantage, +46882,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46883,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMBLEMHEALTH/HIP-Medicare Advantage, +46884,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMBLEMHEALTH/HIP-Medicare Advantage, +46885,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46886,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46887,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46888,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46889,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46890,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46891,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46892,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46893,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46894,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46895,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46896,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46897,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46898,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46899,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46900,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46901,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMBLEMHEALTH/HIP-Medicare Advantage, +46902,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46903,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46904,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46905,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMBLEMHEALTH/HIP-Medicare Advantage, +46906,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMBLEMHEALTH/HIP-Medicare Advantage, +46907,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46908,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMBLEMHEALTH/HIP-Medicare Advantage, +46909,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46910,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46911,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46912,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46913,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46914,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46915,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMBLEMHEALTH/HIP-Medicare Advantage, +46916,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46917,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMBLEMHEALTH/HIP-Medicare Advantage, +46918,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46919,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46920,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46921,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46922,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46923,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46924,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46925,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46926,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMBLEMHEALTH/HIP-Medicare Advantage, +46927,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMBLEMHEALTH/HIP-Medicare Advantage, +46928,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46929,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46930,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMBLEMHEALTH/HIP-Medicare Advantage, +46931,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMBLEMHEALTH/HIP-Medicare Advantage, +46932,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMBLEMHEALTH/HIP-Medicare Advantage, +46933,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46934,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46935,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMBLEMHEALTH/HIP-Medicare Advantage, +46936,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46937,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46938,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMBLEMHEALTH/HIP-Medicare Advantage, +46939,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMBLEMHEALTH/HIP-Medicare Advantage, +46940,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMBLEMHEALTH/HIP-Medicare Advantage, +46941,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46942,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46943,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46944,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMBLEMHEALTH/HIP-Medicare Advantage, +46945,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46946,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Medicare Advantage, +46947,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMBLEMHEALTH/HIP-Medicare Advantage, +46948,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46949,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46950,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46951,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46952,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46953,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46954,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMBLEMHEALTH/HIP-Medicare Advantage, +46955,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMBLEMHEALTH/HIP-Medicare Advantage, +46956,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46957,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Medicare Advantage, +46958,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMBLEMHEALTH/HIP-Medicare Advantage, +46959,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMBLEMHEALTH/HIP-Medicare Advantage, +46960,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46961,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMBLEMHEALTH/HIP-Medicare Advantage, +46962,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46963,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMBLEMHEALTH/HIP-Medicare Advantage, +46964,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46965,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46966,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46967,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46968,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46969,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46970,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46971,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46972,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMBLEMHEALTH/HIP-Medicare Advantage, +46973,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46974,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46975,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46976,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMBLEMHEALTH/HIP-Medicare Advantage, +46977,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMBLEMHEALTH/HIP-Medicare Advantage, +46978,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46979,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMBLEMHEALTH/HIP-Medicare Advantage, +46980,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMBLEMHEALTH/HIP-Medicare Advantage, +46981,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMBLEMHEALTH/HIP-Medicare Advantage, +46982,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46983,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMBLEMHEALTH/HIP-Medicare Advantage, +46984,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMBLEMHEALTH/HIP-Medicare Advantage, +46985,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46986,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46987,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMBLEMHEALTH/HIP-Medicare Advantage, +46988,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMBLEMHEALTH/HIP-Medicare Advantage, +46989,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMBLEMHEALTH/HIP-Medicare Advantage, +46990,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMBLEMHEALTH/HIP-Medicare Advantage, +46991,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMBLEMHEALTH/HIP-Medicare Advantage, +46992,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMBLEMHEALTH/HIP-Medicare Advantage, +46993,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46994,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46995,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMBLEMHEALTH/HIP-Medicare Advantage, +46996,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46997,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMBLEMHEALTH/HIP-Medicare Advantage, +46998,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMBLEMHEALTH/HIP-Medicare Advantage, +46999,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47000,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47001,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMBLEMHEALTH/HIP-Medicare Advantage, +47002,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47003,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47004,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47005,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47006,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47007,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47008,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47009,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47010,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47011,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47012,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47013,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47014,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47015,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47016,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47017,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47018,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47019,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47020,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47021,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47022,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47023,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47024,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47025,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47026,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47027,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47028,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47029,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47030,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47031,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47032,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47033,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47034,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47035,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47036,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47037,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47038,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47039,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47040,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMBLEMHEALTH/HIP-Medicare Advantage, +47041,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47042,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47043,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47044,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47045,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47046,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMBLEMHEALTH/HIP-Medicare Advantage, +47047,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMBLEMHEALTH/HIP-Medicare Advantage, +47048,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47049,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMBLEMHEALTH/HIP-Medicare Advantage, +47050,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMBLEMHEALTH/HIP-Medicare Advantage, +47051,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47052,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47053,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMBLEMHEALTH/HIP-Medicare Advantage, +47054,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMBLEMHEALTH/HIP-Medicare Advantage, +47055,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMBLEMHEALTH/HIP-Medicare Advantage, +47056,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMBLEMHEALTH/HIP-Medicare Advantage, +47057,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMBLEMHEALTH/HIP-Medicare Advantage, +47058,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMBLEMHEALTH/HIP-Medicare Advantage, +47059,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47060,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMBLEMHEALTH/HIP-Medicare Advantage, +47061,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47062,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMBLEMHEALTH/HIP-Medicare Advantage, +47063,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMBLEMHEALTH/HIP-Medicare Advantage, +47064,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMBLEMHEALTH/HIP-Medicare Advantage, +47065,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47066,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47067,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47068,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47069,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMBLEMHEALTH/HIP-Medicare Advantage, +47070,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47071,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47072,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMBLEMHEALTH/HIP-Medicare Advantage, +47073,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47074,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMBLEMHEALTH/HIP-Medicare Advantage, +47075,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47076,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMBLEMHEALTH/HIP-Medicare Advantage, +47077,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47078,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMBLEMHEALTH/HIP-Medicare Advantage, +47079,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47080,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47081,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +47082,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +47083,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +47084,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47085,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47086,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47087,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMBLEMHEALTH/HIP-Medicare Advantage, +47088,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47089,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47090,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47091,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47092,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47093,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47094,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47095,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47096,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47097,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47098,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47099,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47100,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47101,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMBLEMHEALTH/HIP-Medicare Advantage, +47102,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47103,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47104,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47105,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47106,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47107,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMBLEMHEALTH/HIP-Medicare Advantage, +47108,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47109,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47110,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47111,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47112,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47113,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMBLEMHEALTH/HIP-Medicare Advantage, +47114,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMBLEMHEALTH/HIP-Medicare Advantage, +47115,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47116,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMBLEMHEALTH/HIP-Medicare Advantage, +47117,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47118,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMBLEMHEALTH/HIP-Medicare Advantage, +47119,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMBLEMHEALTH/HIP-Medicare Advantage, +47120,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMBLEMHEALTH/HIP-Medicare Advantage, +47121,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47122,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47123,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47124,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47125,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47126,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47127,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47128,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47129,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47130,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMBLEMHEALTH/HIP-Medicare Advantage, +47131,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47132,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47133,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47134,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47135,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47136,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47137,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47138,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMBLEMHEALTH/HIP-Medicare Advantage, +47139,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47140,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47141,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47142,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47143,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMBLEMHEALTH/HIP-Medicare Advantage, +47144,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47145,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMBLEMHEALTH/HIP-Medicare Advantage, +47146,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47147,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMBLEMHEALTH/HIP-Medicare Advantage, +47148,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47149,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMBLEMHEALTH/HIP-Medicare Advantage, +47150,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47151,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47152,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47153,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47154,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47155,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47156,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47157,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47158,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47159,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47160,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMBLEMHEALTH/HIP-Medicare Advantage, +47161,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47162,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47163,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47164,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47165,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMBLEMHEALTH/HIP-Medicare Advantage, +47166,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47167,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMBLEMHEALTH/HIP-Medicare Advantage, +47168,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMBLEMHEALTH/HIP-Medicare Advantage, +47169,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47170,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMBLEMHEALTH/HIP-Medicare Advantage, +47171,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47172,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMBLEMHEALTH/HIP-Medicare Advantage, +47173,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47174,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMBLEMHEALTH/HIP-Medicare Advantage, +47175,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47176,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47177,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47178,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47179,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47180,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +47181,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47182,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47183,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47184,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47185,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47186,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47187,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47188,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47189,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47190,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47191,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47192,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMBLEMHEALTH/HIP-Medicare Advantage, +47193,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMBLEMHEALTH/HIP-Medicare Advantage, +47194,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMBLEMHEALTH/HIP-Medicare Advantage, +47195,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47196,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47197,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47198,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47199,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47200,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47201,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47202,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47203,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47204,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMBLEMHEALTH/HIP-Medicare Advantage, +47205,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47206,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47207,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMBLEMHEALTH/HIP-Medicare Advantage, +47208,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47209,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47210,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMBLEMHEALTH/HIP-Medicare Advantage, +47211,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMBLEMHEALTH/HIP-Medicare Advantage, +47212,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMBLEMHEALTH/HIP-Medicare Advantage, +47213,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMBLEMHEALTH/HIP-Medicare Advantage, +47214,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47215,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47216,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47217,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47218,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47219,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMBLEMHEALTH/HIP-Medicare Advantage, +47220,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47221,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47222,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47223,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47224,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47225,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47226,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47227,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMBLEMHEALTH/HIP-Medicare Advantage, +47228,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMBLEMHEALTH/HIP-Medicare Advantage, +47229,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47230,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47231,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47232,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47233,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMBLEMHEALTH/HIP-Medicare Advantage, +47234,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47235,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47236,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47237,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47238,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMBLEMHEALTH/HIP-Medicare Advantage, +47239,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47240,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47241,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMBLEMHEALTH/HIP-Medicare Advantage, +47242,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47243,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47244,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47245,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47246,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47247,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47248,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47249,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMBLEMHEALTH/HIP-Medicare Advantage, +47250,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47251,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47252,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47253,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47254,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47255,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47256,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47257,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47258,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47259,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47260,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMBLEMHEALTH/HIP-Medicare Advantage, +47261,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47262,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47263,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47264,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47265,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMBLEMHEALTH/HIP-Medicare Advantage, +47266,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47267,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47268,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47269,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47270,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47271,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47272,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMBLEMHEALTH/HIP-Medicare Advantage, +47273,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47274,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47275,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47276,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47277,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47278,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMBLEMHEALTH/HIP-Medicare Advantage, +47279,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47280,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47281,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMBLEMHEALTH/HIP-Medicare Advantage, +47282,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47283,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47284,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47285,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMBLEMHEALTH/HIP-Medicare Advantage, +47286,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47287,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47288,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47289,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47290,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47291,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47292,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47293,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47294,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMBLEMHEALTH/HIP-Medicare Advantage, +47295,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47296,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMBLEMHEALTH/HIP-Medicare Advantage, +47297,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMBLEMHEALTH/HIP-Medicare Advantage, +47298,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47299,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMBLEMHEALTH/HIP-Medicare Advantage, +47300,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47301,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47302,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47303,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47304,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47305,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47306,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47307,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMBLEMHEALTH/HIP-Medicare Advantage, +47308,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMBLEMHEALTH/HIP-Medicare Advantage, +47309,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47310,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47311,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47312,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMBLEMHEALTH/HIP-Medicare Advantage, +47313,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47314,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47315,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47316,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47317,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47318,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47319,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47320,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMBLEMHEALTH/HIP-Medicare Advantage, +47321,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMBLEMHEALTH/HIP-Medicare Advantage, +47322,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47323,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMBLEMHEALTH/HIP-Medicare Advantage, +47324,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMBLEMHEALTH/HIP-Medicare Advantage, +47325,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47326,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMBLEMHEALTH/HIP-Medicare Advantage, +47327,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMBLEMHEALTH/HIP-Medicare Advantage, +47328,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMBLEMHEALTH/HIP-Medicare Advantage, +47329,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47330,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47331,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47332,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47333,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47334,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47335,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47336,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMBLEMHEALTH/HIP-Medicare Advantage, +47337,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMBLEMHEALTH/HIP-Medicare Advantage, +47338,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMBLEMHEALTH/HIP-Medicare Advantage, +47339,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMBLEMHEALTH/HIP-Medicare Advantage, +47340,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47341,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMBLEMHEALTH/HIP-Medicare Advantage, +47342,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47343,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47344,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47345,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47346,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47347,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47348,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47349,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMBLEMHEALTH/HIP-Medicare Advantage, +47350,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47351,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47352,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47353,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMBLEMHEALTH/HIP-Medicare Advantage, +47354,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47355,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47356,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47357,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47358,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47359,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47360,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47361,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47362,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47363,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47364,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47365,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47366,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47367,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47368,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47369,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47370,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMBLEMHEALTH/HIP-Medicare Advantage, +47371,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47372,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47373,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47374,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47375,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47376,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47377,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47378,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47379,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47380,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47381,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47382,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47383,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47384,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMBLEMHEALTH/HIP-Medicare Advantage, +47385,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47386,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47387,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47388,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47389,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47390,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47391,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMBLEMHEALTH/HIP-Medicare Advantage, +47392,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47393,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47394,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMBLEMHEALTH/HIP-Medicare Advantage, +47395,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47396,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMBLEMHEALTH/HIP-Medicare Advantage, +47397,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMBLEMHEALTH/HIP-Medicare Advantage, +47398,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47399,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47400,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMBLEMHEALTH/HIP-Medicare Advantage, +47401,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47402,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47403,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMBLEMHEALTH/HIP-Medicare Advantage, +47404,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47405,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47406,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMBLEMHEALTH/HIP-Medicare Advantage, +47407,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMBLEMHEALTH/HIP-Medicare Advantage, +47408,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47409,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMBLEMHEALTH/HIP-Medicare Advantage, +47410,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMBLEMHEALTH/HIP-Medicare Advantage, +47411,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47412,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMBLEMHEALTH/HIP-Medicare Advantage, +47413,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMBLEMHEALTH/HIP-Medicare Advantage, +47414,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47415,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMBLEMHEALTH/HIP-Medicare Advantage, +47416,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMBLEMHEALTH/HIP-Medicare Advantage, +47417,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47418,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47419,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47420,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47421,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47422,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMBLEMHEALTH/HIP-Medicare Advantage, +47423,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMBLEMHEALTH/HIP-Medicare Advantage, +47424,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMBLEMHEALTH/HIP-Medicare Advantage, +47425,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47426,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47427,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMBLEMHEALTH/HIP-Medicare Advantage, +47428,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47429,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47430,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47431,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMBLEMHEALTH/HIP-Medicare Advantage, +47432,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47433,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47434,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47435,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47436,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47437,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47438,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMBLEMHEALTH/HIP-Medicare Advantage, +47439,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMBLEMHEALTH/HIP-Medicare Advantage, +47440,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47441,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47442,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47443,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47444,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47445,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47446,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47447,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47448,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMBLEMHEALTH/HIP-Medicare Advantage, +47449,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47450,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMBLEMHEALTH/HIP-Medicare Advantage, +47451,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMBLEMHEALTH/HIP-Medicare Advantage,37156.35 +47452,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47453,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47454,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47455,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMBLEMHEALTH/HIP-Medicare Advantage, +47456,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMBLEMHEALTH/HIP-Medicare Advantage, +47457,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMBLEMHEALTH/HIP-Medicare Advantage, +47458,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMBLEMHEALTH/HIP-Medicare Advantage, +47459,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMBLEMHEALTH/HIP-Medicare Advantage, +47460,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMBLEMHEALTH/HIP-Medicare Advantage, +47461,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47462,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47463,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMBLEMHEALTH/HIP-Medicare Advantage, +47464,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47465,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMBLEMHEALTH/HIP-Medicare Advantage, +47466,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMBLEMHEALTH/HIP-Medicare Advantage, +47467,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMBLEMHEALTH/HIP-Medicare Advantage, +47468,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47469,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47470,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMBLEMHEALTH/HIP-Medicare Advantage, +47471,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47472,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMBLEMHEALTH/HIP-Medicare Advantage, +47473,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47474,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMBLEMHEALTH/HIP-Medicare Advantage, +47475,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMBLEMHEALTH/HIP-Medicare Advantage, +47476,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMBLEMHEALTH/HIP-Medicare Advantage, +47477,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMBLEMHEALTH/HIP-Medicare Advantage, +47478,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMBLEMHEALTH/HIP-Medicare Advantage, +47479,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMBLEMHEALTH/HIP-Medicare Advantage, +47480,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47481,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMBLEMHEALTH/HIP-Medicare Advantage, +47482,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMBLEMHEALTH/HIP-Medicare Advantage, +47483,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMBLEMHEALTH/HIP-Medicare Advantage, +47484,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47485,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47486,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47487,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47488,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMBLEMHEALTH/HIP-Medicare Advantage, +47489,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47490,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47491,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMBLEMHEALTH/HIP-Medicare Advantage, +47492,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMBLEMHEALTH/HIP-Medicare Advantage, +47493,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMBLEMHEALTH/HIP-Medicare Advantage, +47494,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMBLEMHEALTH/HIP-Medicare Advantage, +47495,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47496,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMBLEMHEALTH/HIP-Medicare Advantage, +47497,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMBLEMHEALTH/HIP-Medicare Advantage, +47498,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMBLEMHEALTH/HIP-Medicare Advantage, +47499,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMBLEMHEALTH/HIP-Medicare Advantage, +47500,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMBLEMHEALTH/HIP-Medicare Advantage, +47501,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47502,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMBLEMHEALTH/HIP-Medicare Advantage, +47503,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMBLEMHEALTH/HIP-Medicare Advantage, +47504,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47505,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMBLEMHEALTH/HIP-Medicare Advantage, +47506,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47507,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMBLEMHEALTH/HIP-Medicare Advantage, +47508,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMBLEMHEALTH/HIP-Medicare Advantage, +47509,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMBLEMHEALTH/HIP-Medicare Advantage, +47510,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMBLEMHEALTH/HIP-Medicare Advantage, +47511,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMBLEMHEALTH/HIP-Medicare Advantage, +47512,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47513,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47514,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47515,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMBLEMHEALTH/HIP-Medicare Advantage, +47516,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMBLEMHEALTH/HIP-Medicare Advantage, +47517,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47518,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMBLEMHEALTH/HIP-Medicare Advantage, +47519,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47520,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMBLEMHEALTH/HIP-Medicare Advantage, +47521,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMBLEMHEALTH/HIP-Medicare Advantage, +47522,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47523,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47524,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47525,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47526,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47527,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47528,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47529,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47530,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47531,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47532,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMBLEMHEALTH/HIP-Medicare Advantage, +47533,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMBLEMHEALTH/HIP-Medicare Advantage, +47534,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMBLEMHEALTH/HIP-Medicare Advantage, +47535,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMBLEMHEALTH/HIP-Medicare Advantage, +47536,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47537,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMBLEMHEALTH/HIP-Medicare Advantage, +47538,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMBLEMHEALTH/HIP-Medicare Advantage, +47539,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47540,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47541,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47542,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMBLEMHEALTH/HIP-Medicare Advantage, +47543,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMBLEMHEALTH/HIP-Medicare Advantage, +47544,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47545,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMBLEMHEALTH/HIP-Medicare Advantage, +47546,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47547,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMBLEMHEALTH/HIP-Medicare Advantage, +47548,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47549,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMBLEMHEALTH/HIP-Medicare Advantage, +47550,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMBLEMHEALTH/HIP-Medicare Advantage, +47551,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMBLEMHEALTH/HIP-Medicare Advantage, +47552,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMBLEMHEALTH/HIP-Medicare Advantage, +47553,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMBLEMHEALTH/HIP-Medicare Advantage, +47554,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47555,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMBLEMHEALTH/HIP-Medicare Advantage, +47556,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47557,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47558,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMBLEMHEALTH/HIP-Medicare Advantage, +47559,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47560,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMBLEMHEALTH/HIP-Medicare Advantage, +47561,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47562,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47563,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47564,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMBLEMHEALTH/HIP-Medicare Advantage, +47565,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47566,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMBLEMHEALTH/HIP-Medicare Advantage, +47567,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMBLEMHEALTH/HIP-Medicare Advantage, +47568,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMBLEMHEALTH/HIP-Medicare Advantage, +47569,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47570,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47571,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47572,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47573,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47574,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47575,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47576,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47577,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47578,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMBLEMHEALTH/HIP-Medicare Advantage, +47579,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMBLEMHEALTH/HIP-Medicare Advantage, +47580,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMBLEMHEALTH/HIP-Medicare Advantage, +47581,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMBLEMHEALTH/HIP-Medicare Advantage, +47582,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47583,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47584,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMBLEMHEALTH/HIP-Medicare Advantage, +47585,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMBLEMHEALTH/HIP-Medicare Advantage, +47586,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47587,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47588,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMBLEMHEALTH/HIP-Medicare Advantage, +47589,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMBLEMHEALTH/HIP-Medicare Advantage, +47590,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMBLEMHEALTH/HIP-Medicare Advantage, +47591,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMBLEMHEALTH/HIP-Medicare Advantage, +47592,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMBLEMHEALTH/HIP-Medicare Advantage, +47593,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMBLEMHEALTH/HIP-Medicare Advantage, +47594,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47595,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47596,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMBLEMHEALTH/HIP-Medicare Advantage, +47597,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMBLEMHEALTH/HIP-Medicare Advantage, +47598,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47599,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47600,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47601,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMBLEMHEALTH/HIP-Medicare Advantage, +47602,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMBLEMHEALTH/HIP-Medicare Advantage, +47603,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47604,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMBLEMHEALTH/HIP-Medicare Advantage, +47605,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47606,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMBLEMHEALTH/HIP-Medicare Advantage, +47607,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMBLEMHEALTH/HIP-Medicare Advantage, +47608,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47609,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMBLEMHEALTH/HIP-Medicare Advantage, +47610,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47611,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47612,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47613,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMBLEMHEALTH/HIP-Medicare Advantage, +47614,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47615,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47616,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47617,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47618,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47619,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMBLEMHEALTH/HIP-Medicare Advantage, +47620,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMBLEMHEALTH/HIP-Medicare Advantage, +47621,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMBLEMHEALTH/HIP-Medicare Advantage, +47622,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47623,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47624,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47625,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMBLEMHEALTH/HIP-Medicare Advantage, +47626,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47627,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMBLEMHEALTH/HIP-Medicare Advantage, +47628,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMBLEMHEALTH/HIP-Medicare Advantage, +47629,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMBLEMHEALTH/HIP-Medicare Advantage, +47630,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47631,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMBLEMHEALTH/HIP-Medicare Advantage, +47632,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47633,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47634,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMBLEMHEALTH/HIP-Medicare Advantage, +47635,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMBLEMHEALTH/HIP-Medicare Advantage, +47636,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47637,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMBLEMHEALTH/HIP-Medicare Advantage, +47638,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMBLEMHEALTH/HIP-Medicare Advantage, +47639,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47640,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47641,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47642,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMBLEMHEALTH/HIP-Medicare Advantage, +47643,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47644,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMBLEMHEALTH/HIP-Medicare Advantage, +47645,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMBLEMHEALTH/HIP-Medicare Advantage, +47646,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMBLEMHEALTH/HIP-Medicare Advantage, +47647,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMBLEMHEALTH/HIP-Medicare Advantage, +47648,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47649,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47650,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47651,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMBLEMHEALTH/HIP-Medicare Advantage, +47652,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMBLEMHEALTH/HIP-Medicare Advantage, +47653,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMBLEMHEALTH/HIP-Medicare Advantage, +47654,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMBLEMHEALTH/HIP-Medicare Advantage, +47655,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47656,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47657,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMBLEMHEALTH/HIP-Medicare Advantage, +47658,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47659,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMBLEMHEALTH/HIP-Medicare Advantage, +47660,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMBLEMHEALTH/HIP-Medicare Advantage, +47661,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47662,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47663,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMBLEMHEALTH/HIP-Medicare Advantage, +47664,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMBLEMHEALTH/HIP-Medicare Advantage, +47665,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47666,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47667,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMBLEMHEALTH/HIP-Medicare Advantage, +47668,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47669,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMBLEMHEALTH/HIP-Medicare Advantage, +47670,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47671,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMBLEMHEALTH/HIP-Medicare Advantage, +47672,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47673,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMBLEMHEALTH/HIP-Medicare Advantage, +47674,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMBLEMHEALTH/HIP-Medicare Advantage, +47675,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMBLEMHEALTH/HIP-Medicare Advantage, +47676,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMBLEMHEALTH/HIP-Medicare Advantage, +47677,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMBLEMHEALTH/HIP-Medicare Advantage, +47678,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47679,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47680,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47681,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMBLEMHEALTH/HIP-Medicare Advantage, +47682,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47683,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMBLEMHEALTH/HIP-Medicare Advantage, +47684,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMBLEMHEALTH/HIP-Medicare Advantage, +47685,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47686,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47687,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMBLEMHEALTH/HIP-Medicare Advantage, +47688,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMBLEMHEALTH/HIP-Medicare Advantage, +47689,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMBLEMHEALTH/HIP-Medicare Advantage, +47690,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMBLEMHEALTH/HIP-Medicare Advantage, +47691,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47692,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMBLEMHEALTH/HIP-Medicare Advantage, +47693,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47694,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47695,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMBLEMHEALTH/HIP-Medicare Advantage, +47696,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMBLEMHEALTH/HIP-Medicare Advantage, +47697,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMBLEMHEALTH/HIP-Medicare Advantage, +47698,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47699,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47700,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47701,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47702,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMBLEMHEALTH/HIP-Medicare Advantage, +47703,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47704,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMBLEMHEALTH/HIP-Medicare Advantage, +47705,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47706,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMBLEMHEALTH/HIP-Medicare Advantage, +47707,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47708,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47709,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47710,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47711,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47712,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47713,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47714,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47715,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47716,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMBLEMHEALTH/HIP-Medicare Advantage, +47717,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47718,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47719,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMBLEMHEALTH/HIP-Medicare Advantage, +47720,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47721,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47722,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47723,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47724,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47725,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47726,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMBLEMHEALTH/HIP-Medicare Advantage, +47727,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47728,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47729,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47730,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47731,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47732,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47733,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47734,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47735,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47736,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47737,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47738,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47739,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47740,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47741,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47742,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47743,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47744,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47745,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47746,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47747,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47748,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47749,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47750,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47751,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47752,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47753,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47754,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47755,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47756,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47757,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47758,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47759,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47760,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47761,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47762,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47763,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47764,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47765,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47766,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47767,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47768,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47769,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47770,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47771,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47772,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMBLEMHEALTH/HIP-Medicare Advantage, +47773,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47774,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47775,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47776,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47777,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47778,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47779,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47780,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47781,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47782,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47783,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47784,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47785,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47786,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47787,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47788,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47789,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47790,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47791,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47792,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47793,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47794,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47795,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47796,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47797,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47798,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47799,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47800,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47801,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47802,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47803,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47804,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47805,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47806,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47807,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47808,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47809,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47810,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47811,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47812,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47813,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47814,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47815,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47816,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47817,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47818,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47819,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47820,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47821,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47822,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47823,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47824,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47825,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47826,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47827,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47828,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47829,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47830,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47831,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47832,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47833,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47834,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47835,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47836,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47837,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47838,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47839,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47840,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47841,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47842,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47843,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMBLEMHEALTH/HIP-Medicare Advantage, +47844,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMBLEMHEALTH/HIP-Medicare Advantage, +47845,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47846,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47847,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMBLEMHEALTH/HIP-Medicare Advantage, +47848,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMBLEMHEALTH/HIP-Medicare Advantage, +47849,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47850,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47851,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47852,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47853,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47854,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47855,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMBLEMHEALTH/HIP-Medicare Advantage, +47856,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47857,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMBLEMHEALTH/HIP-Medicare Advantage, +47858,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMBLEMHEALTH/HIP-Medicare Advantage, +47859,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMBLEMHEALTH/HIP-Medicare Advantage, +47860,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMBLEMHEALTH/HIP-Medicare Advantage, +47861,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47862,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47863,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47864,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMBLEMHEALTH/HIP-Medicare Advantage, +47865,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMBLEMHEALTH/HIP-Medicare Advantage, +47866,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMBLEMHEALTH/HIP-Medicare Advantage, +47867,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47868,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47869,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47870,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47871,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47872,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47873,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMBLEMHEALTH/HIP-Medicare Advantage, +47874,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMBLEMHEALTH/HIP-Medicare Advantage, +47875,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47876,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47877,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47878,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47879,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47880,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47881,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMBLEMHEALTH/HIP-Medicare Advantage, +47882,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMBLEMHEALTH/HIP-Medicare Advantage, +47883,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMBLEMHEALTH/HIP-Medicare Advantage, +47884,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMBLEMHEALTH/HIP-Medicare Advantage, +47885,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMBLEMHEALTH/HIP-Medicare Advantage, +47886,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47887,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47888,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMBLEMHEALTH/HIP-Medicare Advantage, +47889,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47890,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47891,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMBLEMHEALTH/HIP-Medicare Advantage, +47892,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47893,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMBLEMHEALTH/HIP-Medicare Advantage, +47894,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47895,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47896,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47897,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47898,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMBLEMHEALTH/HIP-Medicare Advantage, +47899,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMBLEMHEALTH/HIP-Medicare Advantage, +47900,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47901,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMBLEMHEALTH/HIP-Medicare Advantage, +47902,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47903,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMBLEMHEALTH/HIP-Medicare Advantage, +47904,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47905,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47906,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47907,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMBLEMHEALTH/HIP-Medicare Advantage, +47908,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47909,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMBLEMHEALTH/HIP-Medicare Advantage, +47910,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47911,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMBLEMHEALTH/HIP-Medicare Advantage, +47912,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47913,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47914,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMBLEMHEALTH/HIP-Medicare Advantage, +47915,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMBLEMHEALTH/HIP-Medicare Advantage, +47916,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47917,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47918,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47919,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47920,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47921,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47922,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47923,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMBLEMHEALTH/HIP-Medicare Advantage, +47924,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47925,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMBLEMHEALTH/HIP-Medicare Advantage, +47926,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMBLEMHEALTH/HIP-Medicare Advantage, +47927,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47928,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMBLEMHEALTH/HIP-Medicare Advantage, +47929,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47930,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMBLEMHEALTH/HIP-Medicare Advantage, +47931,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMBLEMHEALTH/HIP-Medicare Advantage, +47932,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMBLEMHEALTH/HIP-Medicare Advantage, +47933,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMBLEMHEALTH/HIP-Medicare Advantage, +47934,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMBLEMHEALTH/HIP-Medicare Advantage, +47935,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47936,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMBLEMHEALTH/HIP-Medicare Advantage, +47937,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMBLEMHEALTH/HIP-Medicare Advantage, +47938,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMBLEMHEALTH/HIP-Medicare Advantage, +47939,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMBLEMHEALTH/HIP-Medicare Advantage, +47940,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMBLEMHEALTH/HIP-Medicare Advantage, +47941,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMBLEMHEALTH/HIP-Medicare Advantage, +47942,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMBLEMHEALTH/HIP-Medicare Advantage, +47943,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47944,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47945,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47946,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47947,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMBLEMHEALTH/HIP-Medicare Advantage, +47948,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47949,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMBLEMHEALTH/HIP-Medicare Advantage, +47950,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMBLEMHEALTH/HIP-Medicare Advantage, +47951,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47952,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMBLEMHEALTH/HIP-Medicare Advantage, +47953,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMBLEMHEALTH/HIP-Medicare Advantage, +47954,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMBLEMHEALTH/HIP-Medicare Advantage, +47955,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMBLEMHEALTH/HIP-Medicare Advantage, +47956,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMBLEMHEALTH/HIP-Medicare Advantage, +47957,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47958,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMBLEMHEALTH/HIP-Medicare Advantage, +47959,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMBLEMHEALTH/HIP-Medicare Advantage, +47960,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMBLEMHEALTH/HIP-Medicare Advantage, +47961,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47962,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMBLEMHEALTH/HIP-Medicare Advantage, +47963,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMBLEMHEALTH/HIP-Medicare Advantage, +47964,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMBLEMHEALTH/HIP-Medicare Advantage, +47965,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMBLEMHEALTH/HIP-Medicare Advantage, +47966,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47967,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMBLEMHEALTH/HIP-Medicare Advantage, +47968,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47969,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMBLEMHEALTH/HIP-Medicare Advantage, +47970,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMBLEMHEALTH/HIP-Medicare Advantage, +47971,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47972,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMBLEMHEALTH/HIP-Medicare Advantage, +47973,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMBLEMHEALTH/HIP-Medicare Advantage, +47974,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMBLEMHEALTH/HIP-Medicare Advantage, +47975,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMBLEMHEALTH/HIP-Medicare Advantage, +47976,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMBLEMHEALTH/HIP-Medicare Advantage, +47977,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMBLEMHEALTH/HIP-Medicare Advantage, +47978,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMBLEMHEALTH/HIP-Medicare Advantage, +47979,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMBLEMHEALTH/HIP-Medicare Advantage, +47980,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47981,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMBLEMHEALTH/HIP-Medicare Advantage, +47982,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMBLEMHEALTH/HIP-Medicare Advantage, +47983,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47984,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMBLEMHEALTH/HIP-Medicare Advantage, +47985,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMBLEMHEALTH/HIP-Medicare Advantage, +47986,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMBLEMHEALTH/HIP-Medicare Advantage, +47987,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMBLEMHEALTH/HIP-Medicare Advantage, +47988,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMBLEMHEALTH/HIP-Medicare Advantage, +47989,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMBLEMHEALTH/HIP-Medicare Advantage, +47990,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47991,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMBLEMHEALTH/HIP-Medicare Advantage, +47992,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMBLEMHEALTH/HIP-Medicare Advantage, +47993,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMBLEMHEALTH/HIP-Medicare Advantage, +47994,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMBLEMHEALTH/HIP-Medicare Advantage, +47995,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMBLEMHEALTH/HIP-Medicare Advantage, +47996,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMBLEMHEALTH/HIP-Medicare Advantage, +47997,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47998,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMBLEMHEALTH/HIP-Medicare Advantage, +47999,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48000,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48001,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48002,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48003,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMBLEMHEALTH/HIP-Medicare Advantage, +48004,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMBLEMHEALTH/HIP-Medicare Advantage, +48005,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMBLEMHEALTH/HIP-Medicare Advantage, +48006,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMBLEMHEALTH/HIP-Medicare Advantage, +48007,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48008,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMBLEMHEALTH/HIP-Medicare Advantage, +48009,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMBLEMHEALTH/HIP-Medicare Advantage, +48010,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMBLEMHEALTH/HIP-Medicare Advantage, +48011,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMBLEMHEALTH/HIP-Medicare Advantage, +48012,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMBLEMHEALTH/HIP-Medicare Advantage, +48013,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMBLEMHEALTH/HIP-Medicare Advantage, +48014,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMBLEMHEALTH/HIP-Medicare Advantage, +48015,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMBLEMHEALTH/HIP-Medicare Advantage, +48016,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48017,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMBLEMHEALTH/HIP-Medicare Advantage, +48018,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMBLEMHEALTH/HIP-Medicare Advantage, +48019,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48020,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48021,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMBLEMHEALTH/HIP-Medicare Advantage, +48022,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMBLEMHEALTH/HIP-Medicare Advantage, +48023,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48024,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48025,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMBLEMHEALTH/HIP-Medicare Advantage, +48026,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMBLEMHEALTH/HIP-Medicare Advantage, +48027,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMBLEMHEALTH/HIP-Medicare Advantage, +48028,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMBLEMHEALTH/HIP-Medicare Advantage, +48029,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMBLEMHEALTH/HIP-Medicare Advantage, +48030,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMBLEMHEALTH/HIP-Medicare Advantage, +48031,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMBLEMHEALTH/HIP-Medicare Advantage, +48032,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48033,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMBLEMHEALTH/HIP-Medicare Advantage, +48034,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMBLEMHEALTH/HIP-Medicare Advantage, +48035,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMBLEMHEALTH/HIP-Medicare Advantage, +48036,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMBLEMHEALTH/HIP-Medicare Advantage, +48037,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48038,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMBLEMHEALTH/HIP-Medicare Advantage, +48039,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48040,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMBLEMHEALTH/HIP-Medicare Advantage, +48041,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48042,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMBLEMHEALTH/HIP-Medicare Advantage, +48043,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMBLEMHEALTH/HIP-Medicare Advantage, +48044,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMBLEMHEALTH/HIP-Medicare Advantage, +48045,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMBLEMHEALTH/HIP-Medicare Advantage, +48046,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMBLEMHEALTH/HIP-Medicare Advantage, +48047,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMBLEMHEALTH/HIP-Medicare Advantage, +48048,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMBLEMHEALTH/HIP-Medicare Advantage, +48049,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMBLEMHEALTH/HIP-Medicare Advantage, +48050,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMBLEMHEALTH/HIP-Medicare Advantage, +48051,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMBLEMHEALTH/HIP-Medicare Advantage, +48052,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMBLEMHEALTH/HIP-Medicare Advantage, +48053,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMBLEMHEALTH/HIP-Medicare Advantage, +48054,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMBLEMHEALTH/HIP-Medicare Advantage, +48055,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMBLEMHEALTH/HIP-Medicare Advantage, +48056,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMBLEMHEALTH/HIP-Medicare Advantage, +48057,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMBLEMHEALTH/HIP-Medicare Advantage, +48058,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMBLEMHEALTH/HIP-Medicare Advantage, +48059,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48060,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMBLEMHEALTH/HIP-Medicare Advantage, +48061,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMBLEMHEALTH/HIP-Medicare Advantage, +48062,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48063,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48064,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48065,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMBLEMHEALTH/HIP-Medicare Advantage, +48066,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMBLEMHEALTH/HIP-Medicare Advantage, +48067,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMBLEMHEALTH/HIP-Medicare Advantage, +48068,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMBLEMHEALTH/HIP-Medicare Advantage, +48069,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48070,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMBLEMHEALTH/HIP-Medicare Advantage, +48071,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMBLEMHEALTH/HIP-Medicare Advantage, +48072,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMBLEMHEALTH/HIP-Medicare Advantage, +48073,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMBLEMHEALTH/HIP-Medicare Advantage, +48074,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48075,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMBLEMHEALTH/HIP-Medicare Advantage, +48076,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMBLEMHEALTH/HIP-Medicare Advantage, +48077,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMBLEMHEALTH/HIP-Medicare Advantage, +48078,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMBLEMHEALTH/HIP-Medicare Advantage, +48079,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMBLEMHEALTH/HIP-Medicare Advantage, +48080,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMBLEMHEALTH/HIP-Medicare Advantage, +48081,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMBLEMHEALTH/HIP-Medicare Advantage, +48082,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48083,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48084,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMBLEMHEALTH/HIP-Medicare Advantage, +48085,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMBLEMHEALTH/HIP-Medicare Advantage, +48086,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMBLEMHEALTH/HIP-Medicare Advantage, +48087,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48088,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMBLEMHEALTH/HIP-Medicare Advantage, +48089,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMBLEMHEALTH/HIP-Medicare Advantage, +48090,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMBLEMHEALTH/HIP-Medicare Advantage, +48091,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMBLEMHEALTH/HIP-Medicare Advantage, +48092,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMBLEMHEALTH/HIP-Medicare Advantage, +48093,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48094,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMBLEMHEALTH/HIP-Medicare Advantage, +48095,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMBLEMHEALTH/HIP-Medicare Advantage, +48096,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMBLEMHEALTH/HIP-Medicare Advantage, +48097,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMBLEMHEALTH/HIP-Medicare Advantage, +48098,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMBLEMHEALTH/HIP-Medicare Advantage, +48099,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48100,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMBLEMHEALTH/HIP-Medicare Advantage, +48101,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48102,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMBLEMHEALTH/HIP-Medicare Advantage, +48103,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48104,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMBLEMHEALTH/HIP-Medicare Advantage, +48105,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMBLEMHEALTH/HIP-Medicare Advantage, +48106,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMBLEMHEALTH/HIP-Medicare Advantage, +48107,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMBLEMHEALTH/HIP-Medicare Advantage, +48108,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMBLEMHEALTH/HIP-Medicare Advantage, +48109,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMBLEMHEALTH/HIP-Medicare Advantage, +48110,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMBLEMHEALTH/HIP-Medicare Advantage, +48111,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMBLEMHEALTH/HIP-Medicare Advantage, +48112,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMBLEMHEALTH/HIP-Medicare Advantage, +48113,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMBLEMHEALTH/HIP-Medicare Advantage, +48114,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMBLEMHEALTH/HIP-Medicare Advantage, +48115,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMBLEMHEALTH/HIP-Medicare Advantage, +48116,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMBLEMHEALTH/HIP-Medicare Advantage, +48117,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMBLEMHEALTH/HIP-Medicare Advantage, +48118,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMBLEMHEALTH/HIP-Medicare Advantage, +48119,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMBLEMHEALTH/HIP-Medicare Advantage, +48120,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMBLEMHEALTH/HIP-Medicare Advantage, +48121,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48122,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMBLEMHEALTH/HIP-Medicare Advantage, +48123,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMBLEMHEALTH/HIP-Medicare Advantage, +48124,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMBLEMHEALTH/HIP-Medicare Advantage, +48125,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMBLEMHEALTH/HIP-Medicare Advantage, +48126,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48127,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMBLEMHEALTH/HIP-Medicare Advantage, +48128,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48129,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMBLEMHEALTH/HIP-Medicare Advantage, +48130,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMBLEMHEALTH/HIP-Medicare Advantage, +48131,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMBLEMHEALTH/HIP-Medicare Advantage, +48132,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMBLEMHEALTH/HIP-Medicare Advantage, +48133,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMBLEMHEALTH/HIP-Medicare Advantage, +48134,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48135,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMBLEMHEALTH/HIP-Medicare Advantage, +48136,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMBLEMHEALTH/HIP-Medicare Advantage, +48137,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMBLEMHEALTH/HIP-Medicare Advantage, +48138,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48139,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMBLEMHEALTH/HIP-Medicare Advantage, +48140,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMBLEMHEALTH/HIP-Medicare Advantage, +48141,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48142,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMBLEMHEALTH/HIP-Medicare Advantage, +48143,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMBLEMHEALTH/HIP-Medicare Advantage, +48144,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48145,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMBLEMHEALTH/HIP-Medicare Advantage, +48146,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMBLEMHEALTH/HIP-Medicare Advantage, +48147,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48148,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMBLEMHEALTH/HIP-Medicare Advantage, +48149,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48150,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMBLEMHEALTH/HIP-Medicare Advantage, +48151,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMBLEMHEALTH/HIP-Medicare Advantage, +48152,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMBLEMHEALTH/HIP-Medicare Advantage, +48153,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMBLEMHEALTH/HIP-Medicare Advantage, +48154,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMBLEMHEALTH/HIP-Medicare Advantage, +48155,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMBLEMHEALTH/HIP-Medicare Advantage, +48156,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48157,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMBLEMHEALTH/HIP-Medicare Advantage, +48158,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48159,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMBLEMHEALTH/HIP-Medicare Advantage, +48160,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMBLEMHEALTH/HIP-Medicare Advantage, +48161,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMBLEMHEALTH/HIP-Medicare Advantage, +48162,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48163,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMBLEMHEALTH/HIP-Medicare Advantage, +48164,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48165,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48166,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48167,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMBLEMHEALTH/HIP-Medicare Advantage, +48168,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48169,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMBLEMHEALTH/HIP-Medicare Advantage, +48170,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMBLEMHEALTH/HIP-Medicare Advantage, +48171,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMBLEMHEALTH/HIP-Medicare Advantage, +48172,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMBLEMHEALTH/HIP-Medicare Advantage, +48173,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48174,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMBLEMHEALTH/HIP-Medicare Advantage, +48175,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMBLEMHEALTH/HIP-Medicare Advantage, +48176,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMBLEMHEALTH/HIP-Medicare Advantage, +48177,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMBLEMHEALTH/HIP-Medicare Advantage, +48178,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMBLEMHEALTH/HIP-Medicare Advantage, +48179,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMBLEMHEALTH/HIP-Medicare Advantage, +48180,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMBLEMHEALTH/HIP-Medicare Advantage, +48181,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMBLEMHEALTH/HIP-Medicare Advantage, +48182,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMBLEMHEALTH/HIP-Medicare Advantage, +48183,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMBLEMHEALTH/HIP-Medicare Advantage, +48184,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMBLEMHEALTH/HIP-Medicare Advantage, +48185,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMBLEMHEALTH/HIP-Medicare Advantage, +48186,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMBLEMHEALTH/HIP-Medicare Advantage, +48187,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMBLEMHEALTH/HIP-Medicare Advantage, +48188,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMBLEMHEALTH/HIP-Medicare Advantage, +48189,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48190,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMBLEMHEALTH/HIP-Medicare Advantage, +48191,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMBLEMHEALTH/HIP-Medicare Advantage, +48192,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMBLEMHEALTH/HIP-Medicare Advantage, +48193,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMBLEMHEALTH/HIP-Medicare Advantage, +48194,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMBLEMHEALTH/HIP-Medicare Advantage, +48195,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMBLEMHEALTH/HIP-Medicare Advantage, +48196,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMBLEMHEALTH/HIP-Medicare Advantage, +48197,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMBLEMHEALTH/HIP-Medicare Advantage, +48198,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48199,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48200,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMBLEMHEALTH/HIP-Medicare Advantage, +48201,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMBLEMHEALTH/HIP-Medicare Advantage, +48202,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMBLEMHEALTH/HIP-Medicare Advantage, +48203,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMBLEMHEALTH/HIP-Medicare Advantage, +48204,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMBLEMHEALTH/HIP-Medicare Advantage, +48205,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMBLEMHEALTH/HIP-Medicare Advantage, +48206,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMBLEMHEALTH/HIP-Medicare Advantage, +48207,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMBLEMHEALTH/HIP-Medicare Advantage, +48208,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMBLEMHEALTH/HIP-Medicare Advantage, +48209,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48210,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48211,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48212,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48213,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48214,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMBLEMHEALTH/HIP-Medicare Advantage, +48215,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48216,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48217,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48218,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48219,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48220,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48221,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48222,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMBLEMHEALTH/HIP-Medicare Advantage, +48223,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48224,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48225,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48226,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48227,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48228,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48229,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48230,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48231,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMBLEMHEALTH/HIP-Medicare Advantage, +48232,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48233,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMBLEMHEALTH/HIP-Medicare Advantage, +48234,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMBLEMHEALTH/HIP-Medicare Advantage, +48235,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48236,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMBLEMHEALTH/HIP-Medicare Advantage, +48237,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMBLEMHEALTH/HIP-Medicare Advantage, +48238,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMBLEMHEALTH/HIP-Medicare Advantage, +48239,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMBLEMHEALTH/HIP-Medicare Advantage, +48240,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMBLEMHEALTH/HIP-Medicare Advantage, +48241,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMBLEMHEALTH/HIP-Medicare Advantage, +48242,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMBLEMHEALTH/HIP-Medicare Advantage, +48243,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMBLEMHEALTH/HIP-Medicare Advantage, +48244,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMBLEMHEALTH/HIP-Medicare Advantage, +48245,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMBLEMHEALTH/HIP-Medicare Advantage, +48246,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48247,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMBLEMHEALTH/HIP-Medicare Advantage, +48248,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48249,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMBLEMHEALTH/HIP-Medicare Advantage, +48250,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48251,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMBLEMHEALTH/HIP-Medicare Advantage, +48252,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMBLEMHEALTH/HIP-Medicare Advantage, +48253,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48254,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48255,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48256,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMBLEMHEALTH/HIP-Medicare Advantage, +48257,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48258,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48259,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48260,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMBLEMHEALTH/HIP-Medicare Advantage, +48261,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMBLEMHEALTH/HIP-Medicare Advantage, +48262,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMBLEMHEALTH/HIP-Medicare Advantage, +48263,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48264,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMBLEMHEALTH/HIP-Medicare Advantage, +48265,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48266,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48267,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48268,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48269,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMBLEMHEALTH/HIP-Medicare Advantage, +48270,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMBLEMHEALTH/HIP-Medicare Advantage, +48271,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMBLEMHEALTH/HIP-Medicare Advantage, +48272,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMBLEMHEALTH/HIP-Medicare Advantage, +48273,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMBLEMHEALTH/HIP-Medicare Advantage, +48274,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMBLEMHEALTH/HIP-Medicare Advantage, +48275,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMBLEMHEALTH/HIP-Medicare Advantage, +48276,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMBLEMHEALTH/HIP-Medicare Advantage, +48277,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMBLEMHEALTH/HIP-Medicare Advantage, +48278,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48279,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMBLEMHEALTH/HIP-Medicare Advantage, +48280,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48281,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48282,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48283,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48284,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48285,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48286,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMBLEMHEALTH/HIP-Medicare Advantage, +48287,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48288,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48289,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48290,3934,30000038,ICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48291,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48292,3934,30000053,NICU,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48293,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48294,3934,30000079,PSYCH,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48295,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48296,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48297,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48298,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48299,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48300,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48301,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48302,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48303,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48304,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48305,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48306,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48307,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48308,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48309,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48310,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48311,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48312,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48313,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48314,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48315,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48316,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48317,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48318,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48319,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48320,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48321,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48322,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48323,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48324,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48325,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48326,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48327,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48328,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48329,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48330,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48331,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48332,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48333,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48334,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48335,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48336,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48337,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48338,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48339,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48340,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48341,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48342,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48343,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48344,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48345,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48346,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48347,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48348,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48349,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48350,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48351,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48352,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48353,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48354,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48355,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48356,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48357,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48358,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48359,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48360,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48361,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48362,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48363,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48364,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48365,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48366,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48367,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48368,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48369,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48370,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48371,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48372,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48373,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48374,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48375,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48376,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48377,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48378,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48379,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48380,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48381,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48382,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48383,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48384,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48385,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48386,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48387,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48388,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48389,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48390,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48391,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48392,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48393,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48394,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48395,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48396,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48397,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48398,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48399,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48400,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48401,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48402,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48403,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48404,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48405,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48406,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48407,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48408,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48409,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48410,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48411,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48412,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48413,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48414,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48415,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48416,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48417,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48418,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48419,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48420,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48421,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48422,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48423,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48424,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48425,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48426,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48427,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48428,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48429,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48430,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48431,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48432,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48433,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48434,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48435,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48436,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48437,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48438,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48439,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48440,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48441,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48442,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48443,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48444,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48445,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48446,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48447,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48448,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48449,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48450,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48451,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48452,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48453,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48454,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48455,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48456,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48457,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48458,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48459,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48460,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48461,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48462,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48463,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48464,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48465,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48466,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48467,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48468,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48469,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48470,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48471,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48472,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48473,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48474,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48475,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48476,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48477,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48478,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48479,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48480,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48481,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48482,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48483,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48484,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48485,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48486,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48487,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48488,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48489,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48490,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48491,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48492,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48493,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48494,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48495,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48496,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48497,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48498,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48499,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48500,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48501,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48502,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48503,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48504,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48505,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48506,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48507,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48508,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48509,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48510,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48511,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48512,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48513,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48514,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48515,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48516,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48517,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48518,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48519,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48520,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48521,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48522,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48523,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48524,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48525,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48526,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48527,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48528,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48529,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48530,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48531,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48532,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48533,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48534,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48535,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48536,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48537,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48538,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48539,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48540,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48541,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48542,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48543,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48544,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48545,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48546,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48547,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48548,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48549,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48550,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48551,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48552,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48553,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48554,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48555,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48556,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48557,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48558,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48559,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48560,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48561,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48562,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48563,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48564,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48565,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48566,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48567,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48568,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48569,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48570,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48571,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48572,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48573,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48574,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48575,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48576,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48577,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48578,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48579,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48580,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48581,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48582,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48583,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48584,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48585,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48586,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48587,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48588,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48589,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48590,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48591,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48592,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48593,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48594,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48595,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48596,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48597,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48598,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48599,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48600,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48601,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48602,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48603,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48604,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48605,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48606,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48607,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48608,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48609,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48610,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48611,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48612,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48613,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48614,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48615,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48616,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48617,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48618,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48619,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48620,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48621,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48622,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48623,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48624,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48625,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48626,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48627,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48628,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48629,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48630,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48631,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48632,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48633,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48634,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48635,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48636,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48637,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48638,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48639,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48640,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48641,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48642,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48643,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48644,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48645,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48646,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48647,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48648,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48649,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48650,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48651,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48652,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48653,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48654,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48655,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48656,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48657,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48658,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48659,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48660,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48661,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48662,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48663,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48664,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48665,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48666,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48667,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48668,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48669,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48670,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48671,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48672,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48673,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48674,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48675,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48676,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48677,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48678,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48679,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48680,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48681,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48682,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48683,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48684,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48685,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48686,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48687,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48688,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48689,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48690,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48691,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48692,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48693,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48694,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48695,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48696,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48697,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48698,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48699,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48700,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48701,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48702,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48703,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48704,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48705,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48706,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48707,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48708,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48709,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48710,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48711,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48712,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48713,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48714,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48715,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48716,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48717,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48718,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48719,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48720,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48721,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48722,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48723,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48724,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48725,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48726,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48727,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48728,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48729,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48730,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48731,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48732,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48733,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48734,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48735,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48736,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48737,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48738,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48739,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48740,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48741,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48742,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48743,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48744,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48745,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48746,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48747,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48748,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48749,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48750,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48751,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48752,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48753,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48754,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48755,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48756,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48757,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48758,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48759,3934,37112034,TRIAGE,,277.0,277.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48760,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48761,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48762,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48763,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48764,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48765,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48766,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48767,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48768,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48769,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48770,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48771,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48772,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48773,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48774,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48775,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48776,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48777,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48778,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48779,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48780,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48781,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48782,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48783,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48784,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48785,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48786,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48787,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48788,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48789,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48790,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48791,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48792,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48793,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48794,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48795,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48796,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48797,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48798,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48799,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48800,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48801,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48802,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48803,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48804,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48805,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48806,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48807,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48808,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48809,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48810,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48811,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48812,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48813,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48814,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48815,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48816,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48817,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48818,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48819,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48820,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48821,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48822,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48823,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48824,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48825,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48826,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48827,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48828,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48829,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48830,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48831,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48832,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48833,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48834,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48835,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48836,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48837,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48838,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48839,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48840,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48841,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48842,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48843,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48844,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48845,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48846,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48847,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48848,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48849,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48850,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48851,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48852,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48853,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48854,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48855,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48856,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48857,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48858,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48859,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48860,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48861,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48862,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48863,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48864,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48865,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48866,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48867,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48868,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48869,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48870,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48871,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48872,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48873,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48874,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48875,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48876,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48877,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48878,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48879,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48880,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48881,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48882,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48883,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48884,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48885,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48886,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48887,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48888,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48889,3934,43301043,ALBUNEX,,357.0,357.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48890,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48891,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48892,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48893,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48894,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48895,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48896,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48897,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48898,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48899,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48900,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48901,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48902,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48903,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48904,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48905,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48906,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48907,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48908,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48909,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48910,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48911,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48912,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48913,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48914,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48915,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48916,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48917,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48918,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48919,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48920,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48921,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48922,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48923,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48924,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48925,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48926,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48927,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48928,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48929,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48930,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48931,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48932,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48933,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48934,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48935,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48936,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48937,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48938,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48939,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48940,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48941,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48942,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48943,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48944,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48945,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48946,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48947,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48948,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48949,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48950,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48951,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48952,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48953,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48954,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48955,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48956,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48957,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48958,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48959,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48960,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48961,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48962,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48963,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48964,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48965,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48966,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48967,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48968,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48969,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48970,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48971,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48972,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48973,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48974,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48975,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48976,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48977,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48978,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48979,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48980,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48981,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48982,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48983,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48984,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48985,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48986,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48987,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48988,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48989,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48990,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48991,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48992,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48993,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48994,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48995,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48996,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48997,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48998,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +48999,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49000,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49001,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49002,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49003,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49004,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49005,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49006,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49007,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49008,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49009,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49010,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49011,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49012,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49013,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49014,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49015,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49016,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49017,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49018,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49019,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49020,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49021,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49022,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49023,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49024,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49025,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49026,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49027,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49028,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49029,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49030,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49031,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49032,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49033,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49034,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49035,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49036,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49037,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49038,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49039,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49040,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49041,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49042,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49043,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49044,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49045,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49046,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49047,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49048,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49049,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49050,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49051,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49052,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49053,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49054,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49055,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49056,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49057,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49058,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMBLEMHEALTH/HIP-Medicare Advantage, +49059,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49060,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49061,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,372940.54 +49062,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49063,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49064,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49065,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49066,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49067,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49068,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49069,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49070,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49071,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49072,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,77711.0 +49073,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,88312.0 +49074,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49075,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,46371.0 +49076,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49077,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49078,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49079,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49080,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49081,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49082,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49083,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49084,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49085,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49086,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49087,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49088,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49089,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49090,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49091,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49092,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49093,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49094,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49095,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49096,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49097,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49098,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21915.0 +49099,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49100,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49101,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49102,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49103,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49104,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49105,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49106,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49107,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49108,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49109,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49110,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49111,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49112,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49113,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49114,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49115,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49116,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49117,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49118,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49119,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49120,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49121,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49122,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49123,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49124,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49125,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49126,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49127,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49128,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49129,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49130,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49131,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49132,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49133,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17082.0 +49134,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49135,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49136,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49137,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49138,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49139,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49140,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49141,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49142,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49143,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49144,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49145,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49146,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49147,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49148,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49149,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49150,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49151,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49152,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49153,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49154,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49155,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49156,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49157,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49158,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49159,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49160,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49161,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49162,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49163,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49164,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15385.26 +49165,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49166,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49167,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49168,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49169,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49170,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49171,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49172,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49173,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49174,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49175,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49176,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49177,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49178,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49179,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49180,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,36443.77 +49181,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,24055.0 +49182,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49183,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49184,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49185,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49186,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49187,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49188,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49189,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49190,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49191,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49192,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49193,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49194,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26798.0 +49195,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49196,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49197,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49198,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49199,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49200,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49201,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49202,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49203,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13424.0 +49204,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49205,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49206,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49207,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,115263.0 +49208,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49209,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49210,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49211,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49212,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49213,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49214,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49215,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49216,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49217,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49218,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49219,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49220,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49221,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49222,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49223,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49224,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49225,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49226,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49227,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49228,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49229,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49230,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49231,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49232,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49233,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49234,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49235,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,62664.0 +49236,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49237,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49238,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49239,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49240,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49241,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49242,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49243,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49244,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49245,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49246,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49247,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49248,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49249,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49250,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49251,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49252,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49253,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49254,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49255,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49256,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49257,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49258,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,104813.0 +49259,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,72105.0 +49260,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49261,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49262,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49263,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49264,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49265,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49266,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49267,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49268,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,42515.0 +49269,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49270,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49271,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49272,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26039.0 +49273,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49274,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49275,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49276,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49277,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49278,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49279,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49280,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49281,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49282,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49283,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49284,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49285,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49286,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14633.0 +49287,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10821.0 +49288,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49289,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49290,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49291,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49292,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49293,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49294,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49295,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49296,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49297,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49298,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49299,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49300,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49301,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32789.0 +49302,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49303,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49304,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49305,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49306,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49307,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49308,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49309,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49310,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49311,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49312,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49313,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49314,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49315,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49316,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49317,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49318,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49319,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49320,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49321,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49322,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49323,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49324,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49325,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49326,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49327,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49328,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49329,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49330,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49331,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49332,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49333,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49334,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49335,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49336,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49337,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49338,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49339,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49340,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49341,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19799.0 +49342,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49343,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,30648.0 +49344,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49345,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11648.0 +49346,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49347,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15303.0 +49348,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32646.0 +49349,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49350,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49351,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49352,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49353,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49354,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49355,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49356,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49357,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49358,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49359,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,46642.0 +49360,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49361,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49362,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49363,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49364,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49365,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49366,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49367,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49368,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49369,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49370,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49371,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49372,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49373,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49374,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49375,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49376,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49377,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49378,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49379,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49380,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49381,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49382,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49383,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49384,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49385,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49386,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49387,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49388,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49389,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49390,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49391,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49392,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49393,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49394,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,39557.0 +49395,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,58847.0 +49396,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49397,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49398,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49399,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49400,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49401,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49402,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49403,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49404,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49405,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49406,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49407,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49408,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49409,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49410,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49411,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,44539.0 +49412,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49413,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49414,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49415,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49416,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49417,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49418,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49419,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49420,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49421,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49422,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49423,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49424,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49425,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49426,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49427,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49428,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27383.0 +49429,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49430,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49431,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49432,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49433,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49434,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49435,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49436,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49437,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49438,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49439,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49440,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49441,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49442,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49443,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49444,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49445,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49446,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49447,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49448,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49449,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49450,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49451,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49452,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49453,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49454,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49455,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49456,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49457,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49458,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49459,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49460,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49461,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49462,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49463,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49464,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49465,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49466,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49467,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49468,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49469,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49470,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49471,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49472,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32839.0 +49473,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49474,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49475,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49476,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49477,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49478,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49479,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49480,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49481,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49482,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49483,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49484,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49485,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49486,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,47079.0 +49487,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49488,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49489,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49490,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49491,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49492,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,24565.86 +49493,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49494,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49495,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49496,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49497,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49498,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49499,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49500,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26811.0 +49501,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49502,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49503,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49504,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14639.0 +49505,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49506,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49507,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49508,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49509,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49510,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49511,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49512,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49513,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49514,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49515,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49516,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49517,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49518,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49519,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49520,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49521,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49522,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49523,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49524,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49525,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49526,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49527,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49528,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49529,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49530,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49531,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49532,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49533,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49534,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49535,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49536,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22479.0 +49537,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49538,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49539,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49540,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49541,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49542,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49543,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49544,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49545,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49546,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49547,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49548,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49549,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49550,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49551,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49552,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49553,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49554,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49555,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49556,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49557,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49558,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49559,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49560,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49561,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49562,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49563,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49564,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49565,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49566,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49567,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49568,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49569,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49570,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49571,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49572,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49573,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49574,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49575,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49576,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49577,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49578,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49579,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49580,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49581,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49582,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49583,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16470.0 +49584,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49585,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,73914.0 +49586,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49587,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22313.33 +49588,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,36084.0 +49589,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,389535.46 +49590,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12684.4 +49591,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49592,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27450.5 +49593,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18042.0 +49594,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6295.98 +49595,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49596,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49597,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49598,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49599,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49600,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49601,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49602,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49603,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16470.0 +49604,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9291.33 +49605,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15107.64 +49606,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49607,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23525.0 +49608,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49609,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25932.0 +49610,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49611,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49612,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49613,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49614,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49615,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49616,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49617,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49618,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49619,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,44860.0 +49620,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49621,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49622,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49623,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49624,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,97030.0 +49625,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49626,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49627,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49628,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49629,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49630,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49631,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10295.0 +49632,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49633,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49634,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49635,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49636,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49637,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49638,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49639,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49640,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49641,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49642,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49643,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49644,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49645,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49646,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49647,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,41815.0 +49648,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49649,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49650,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49651,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49652,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49653,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49654,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49655,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49656,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49657,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49658,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49659,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49660,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37505.0 +49661,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49662,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49663,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49664,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49665,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49666,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49667,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49668,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49669,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49670,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49671,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49672,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49673,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49674,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49675,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49676,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49677,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49678,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49679,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49680,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49681,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49682,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49683,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49684,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49685,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49686,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49687,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49688,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49689,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49690,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49691,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49692,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49693,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49694,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49695,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49696,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49697,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49698,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49699,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49700,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49701,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49702,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49703,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49704,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49705,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49706,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49707,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49708,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49709,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49710,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49711,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49712,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49713,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49714,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49715,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49716,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49717,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3452.0 +49718,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49719,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49720,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49721,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49722,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49723,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49724,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49725,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6620.0 +49726,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49727,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3482.67 +49728,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49729,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49730,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49731,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49732,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49733,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49734,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49735,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49736,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49737,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49738,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49739,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49740,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49741,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49742,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49743,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49744,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49745,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49746,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49747,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49748,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49749,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49750,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49751,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49752,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49753,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +49754,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6516.92 +49755,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49756,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4050.5 +49757,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49758,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49759,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49760,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49761,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49762,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49763,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5523.44 +49764,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49765,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49766,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49767,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49768,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49769,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49770,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49771,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49772,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49773,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49774,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49775,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49776,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49777,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49778,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49779,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2520.5 +49780,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +49781,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49782,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49783,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49784,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1576.0 +49785,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49786,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49787,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49788,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49789,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49790,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49791,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49792,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49793,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49794,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49795,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49796,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49797,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49798,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49799,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49800,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3338.0 +49801,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +49802,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,116.67 +49803,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49804,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +49805,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1293.5 +49806,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +49807,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49808,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49809,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49810,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49811,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49812,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49813,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49814,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49815,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49816,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49817,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49818,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49819,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49820,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49821,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49822,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49823,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49824,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,200.0 +49825,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,150.0 +49826,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49827,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49828,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49829,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49830,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49831,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49832,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49833,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49834,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49835,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49836,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49837,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49838,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49839,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49840,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49841,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49842,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49843,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2520.5 +49844,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49845,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49846,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49847,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49848,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49849,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1347.0 +49850,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49851,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49852,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49853,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49854,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49855,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1260.25 +49856,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49857,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49858,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49859,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3465.69 +49860,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49861,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49862,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49863,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +49864,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49865,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49866,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49867,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49868,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49869,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49870,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49871,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49872,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49873,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49874,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18818.68 +49875,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49876,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49877,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1977.82 +49878,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49879,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49880,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49881,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49882,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49883,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +49884,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49885,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49886,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49887,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49888,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49889,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +49890,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49891,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4953.55 +49892,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49893,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6270.5 +49894,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49895,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49896,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +49897,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +49898,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2299.72 +49899,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49900,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49901,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1796.0 +49902,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49903,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49904,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4727.25 +49905,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4813.06 +49906,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49907,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49908,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49909,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13313.85 +49910,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49911,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49912,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49913,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49914,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4695.75 +49915,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49916,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49917,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49918,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49919,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49920,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12108.68 +49921,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49922,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49923,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49924,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49925,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49926,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49927,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49928,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49929,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +49930,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49931,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49932,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49933,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49934,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49935,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49936,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49937,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49938,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49939,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49940,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49941,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1264.0 +49942,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49943,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49944,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49945,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49946,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4692.17 +49947,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49948,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49949,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49950,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49951,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49952,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49953,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49954,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49955,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49956,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49957,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49958,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49959,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49960,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49961,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49962,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49963,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49964,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49965,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7310.0 +49966,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49967,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49968,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49969,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49970,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49971,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49972,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49973,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49974,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49975,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7310.0 +49976,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7310.0 +49977,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8823.0 +49978,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49979,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49980,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49981,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49982,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49983,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3655.0 +49984,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7310.0 +49985,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49986,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49987,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49988,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49989,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49990,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49991,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9648.0 +49992,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49993,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49994,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49995,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49996,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49997,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49998,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +49999,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50000,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50001,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50002,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50003,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50004,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50005,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50006,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50007,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50008,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50009,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50010,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50011,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50012,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50013,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50014,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50015,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50016,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50017,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50018,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50019,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50020,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50021,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50022,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50023,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50024,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50025,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50026,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50027,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50028,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50029,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50030,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8571.0 +50031,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50032,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50033,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50034,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50035,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50036,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50037,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50038,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50039,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50040,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50041,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50042,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50043,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50044,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50045,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50046,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50047,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50048,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50049,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8571.0 +50050,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50051,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8571.0 +50052,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50053,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50054,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50055,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50056,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50057,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50058,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50059,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50060,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50061,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50062,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50063,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50064,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50065,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50066,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50067,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50068,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50069,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50070,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50071,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50072,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1576.0 +50073,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50074,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50075,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50076,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50077,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50078,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50079,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50080,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50081,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50082,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50083,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50084,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50085,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50086,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50087,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5751.0 +50088,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50089,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50090,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50091,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50092,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50093,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50094,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50095,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50096,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50097,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50098,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50099,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50100,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50101,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50102,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50103,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50104,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +50105,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50106,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50107,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50108,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50109,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50110,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50111,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50112,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50113,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +50114,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50115,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8571.0 +50116,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50117,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50118,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50119,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50120,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50121,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50122,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50123,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50124,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50125,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3952.34 +50126,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50127,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50128,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50129,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50130,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50131,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50132,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50133,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50134,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50135,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50136,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50137,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50138,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50139,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50140,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50141,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50142,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50143,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50144,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50145,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50146,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50147,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50148,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50149,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50150,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50151,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50152,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50153,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50154,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7089.62 +50155,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50156,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50157,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50158,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50159,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50160,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50161,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50162,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50163,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50164,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50165,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50166,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6146.0 +50167,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50168,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50169,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +50170,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50171,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50172,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50173,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50174,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50175,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50176,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50177,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50178,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50179,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,200.0 +50180,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50181,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50182,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50183,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50184,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50185,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50186,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50187,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50188,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2352.61 +50189,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26858.66 +50190,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8571.0 +50191,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50192,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50193,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50194,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50195,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50196,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50197,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50198,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2773.0 +50199,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50200,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50201,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50202,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50203,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50204,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50205,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50206,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50207,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50208,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50209,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50210,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6070.0 +50211,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50212,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50213,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50214,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50215,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50216,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50217,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50218,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50219,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50220,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50221,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13927.2 +50222,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50223,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50224,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50225,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50226,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50227,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50228,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50229,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50230,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50231,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50232,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50233,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50234,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50235,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50236,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50237,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50238,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50239,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50240,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50241,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50242,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50243,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50244,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50245,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50246,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50247,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50248,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50249,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50250,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50251,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50252,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50253,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50254,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50255,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50256,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50257,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50258,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50259,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50260,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50261,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50262,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50263,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50264,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50265,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50266,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50267,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50268,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8571.0 +50269,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50270,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50271,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50272,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50273,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50274,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4285.5 +50275,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50276,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50277,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50278,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50279,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50280,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50281,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50282,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50283,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50284,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50285,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50286,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50287,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50288,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50289,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50290,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50291,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50292,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +50293,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50294,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50295,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50296,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50297,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50298,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50299,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4727.25 +50300,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50301,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50302,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50303,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50304,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50305,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50306,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50307,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50308,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50309,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50310,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50311,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50312,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50313,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50314,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50315,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50316,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50317,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50318,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50319,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50320,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50321,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50322,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50323,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50324,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50325,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50326,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50327,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50328,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50329,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50330,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50331,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50332,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50333,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50334,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50335,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50336,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50337,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50338,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50339,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50340,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50341,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50342,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,116.05 +50343,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,75.0 +50344,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50345,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50346,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50347,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50348,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50349,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +50350,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +50351,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50352,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50353,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50354,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8571.0 +50355,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50356,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50357,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50358,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8088.36 +50359,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2363.63 +50360,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50361,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50362,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1575.75 +50363,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10146.75 +50364,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5714.0 +50365,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50366,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50367,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50368,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6759.0 +50369,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50370,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50371,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50372,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50373,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50374,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50375,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50376,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50377,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50378,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50379,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50380,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50381,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6616.0 +50382,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50383,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50384,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50385,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50386,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50387,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50388,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50389,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50390,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50391,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50392,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50393,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50394,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2520.5 +50395,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50396,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50397,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50398,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50399,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50400,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50401,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50402,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50403,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50404,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50405,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50406,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50407,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50408,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50409,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50410,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50411,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50412,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50413,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50414,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50415,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50416,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50417,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50418,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50419,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50420,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50421,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50422,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50423,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1575.75 +50424,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +50425,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50426,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50427,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50428,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50429,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50430,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50431,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50432,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50433,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50434,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50435,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50436,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50437,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50438,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50439,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50440,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50441,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50442,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50443,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50444,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50445,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50446,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50447,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50448,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1260.25 +50449,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50450,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3151.5 +50451,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50452,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50453,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50454,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50455,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50456,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50457,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50458,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50459,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50460,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +50461,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50462,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50463,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50464,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50465,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50466,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50467,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50468,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50469,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50470,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2707.54 +50471,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50472,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50473,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50474,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50475,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50476,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50477,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50478,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50479,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50480,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50481,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50482,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50483,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50484,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50485,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50486,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50487,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50488,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50489,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50490,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50491,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50492,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50493,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50494,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50495,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50496,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50497,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50498,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50499,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50500,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50501,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50502,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50503,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,41204.0 +50504,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1724.97 +50505,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50506,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50507,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50508,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50509,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50510,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50511,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50512,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50513,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50514,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6261.0 +50515,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50516,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50517,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50518,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50519,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50520,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50521,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50522,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50523,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50524,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50525,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50526,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50527,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50528,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50529,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5900.5 +50530,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6290.0 +50531,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50532,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12146.1 +50533,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50534,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50535,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50536,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50537,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50538,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50539,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50540,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50541,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50542,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,673.48 +50543,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50544,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3729.0 +50545,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50546,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50547,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50548,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50549,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50550,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50551,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50552,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50553,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50554,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8386.92 +50555,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50556,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50557,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1437.03 +50558,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50559,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50560,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50561,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50562,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50563,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3592.0 +50564,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,583.24 +50565,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,388.0 +50566,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50567,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50568,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50569,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50570,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50571,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50572,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50573,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6303.0 +50574,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50575,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50576,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50577,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50578,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50579,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50580,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50581,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50582,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50583,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50584,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50585,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50586,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50587,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50588,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50589,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50590,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50591,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50592,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50593,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50594,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50595,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50596,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50597,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50598,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50599,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50600,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50601,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50602,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50603,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50604,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50605,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50606,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50607,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50608,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50609,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8823.0 +50610,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50611,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50612,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50613,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50614,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50615,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50616,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50617,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50618,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50619,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50620,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7735.0 +50621,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7735.0 +50622,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7735.0 +50623,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7735.0 +50624,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50625,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50626,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50627,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4049.5 +50628,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50629,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50630,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50631,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50632,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8072.0 +50633,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12739.5 +50634,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50635,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50636,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50637,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8192.0 +50638,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50639,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50640,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50641,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,898.0 +50642,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50643,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50644,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50645,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50646,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50647,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50648,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50649,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50650,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2295.0 +50651,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50652,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50653,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50654,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50655,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50656,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50657,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50658,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50659,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50660,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50661,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50662,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50663,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50664,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50665,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50666,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50667,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50668,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +50669,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50670,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50671,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50672,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50673,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50674,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50675,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50676,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50677,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50678,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50679,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50680,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50681,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50682,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50683,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50684,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50685,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50686,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50687,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50688,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50689,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50690,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50691,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50692,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50693,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50694,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50695,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50696,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50697,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50698,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50699,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50700,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50701,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50702,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50703,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50704,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50705,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50706,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50707,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50708,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50709,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50710,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50711,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50712,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50713,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50714,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50715,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12340.16 +50716,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50717,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50718,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50719,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2560.72 +50720,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50721,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50722,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50723,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50724,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50725,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3592.0 +50726,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50727,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50728,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50729,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50730,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50731,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50732,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5448.67 +50733,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50734,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50735,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50736,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50737,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50738,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50739,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50740,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50741,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50742,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50743,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50744,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50745,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50746,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50747,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50748,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8823.0 +50749,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50750,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50751,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50752,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50753,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50754,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50755,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50756,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50757,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50758,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50759,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50760,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50761,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50762,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50763,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50764,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50765,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50766,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50767,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50768,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50769,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50770,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50771,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50772,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50773,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50774,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50775,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50776,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50777,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50778,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50779,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50780,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50781,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50782,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50783,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50784,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50785,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8194.5 +50786,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50787,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50788,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50789,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50790,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50791,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50792,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50793,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50794,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50795,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50796,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50797,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50798,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50799,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50800,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50801,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50802,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50803,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3443.57 +50804,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50805,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4769.14 +50806,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7561.5 +50807,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50808,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50809,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5060.0 +50810,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50811,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50812,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50813,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50814,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50815,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50816,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,482.13 +50817,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50818,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1279.07 +50819,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50820,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50821,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50822,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50823,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5376.0 +50824,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1279.07 +50825,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,109.18 +50826,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1753.1 +50827,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6261.0 +50828,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50829,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1279.07 +50830,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50831,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5269.0 +50832,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50833,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50834,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50835,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50836,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1822.3 +50837,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50838,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1753.1 +50839,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +50840,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +50841,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50842,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +50843,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50844,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50845,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50846,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3805.0 +50847,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50848,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50849,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1041.27 +50850,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2803.55 +50851,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50852,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50853,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +50854,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50855,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50856,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50857,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5140.0 +50858,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50859,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50860,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3766.97 +50861,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7788.01 +50862,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8606.08 +50863,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3238.14 +50864,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50865,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50866,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50867,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2360.56 +50868,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4356.82 +50869,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50870,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2800.56 +50871,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50872,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50873,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7560.14 +50874,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2168.63 +50875,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9215.0 +50876,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50877,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2424.0 +50878,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50879,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50880,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5016.0 +50881,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50882,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50883,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50884,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2694.86 +50885,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3036.29 +50886,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,489.89 +50887,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50888,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2979.38 +50889,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50890,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50891,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50892,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50893,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50894,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5203.0 +50895,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5782.99 +50896,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2540.61 +50897,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3539.38 +50898,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50899,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1692.67 +50900,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6111.38 +50901,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50902,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50903,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11275.95 +50904,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50905,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6864.0 +50906,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9312.0 +50907,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7489.2 +50908,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6828.0 +50909,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50910,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50911,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7074.87 +50912,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11366.52 +50913,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50914,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50915,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50916,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2804.2 +50917,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50918,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50919,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2711.88 +50920,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3351.95 +50921,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50922,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3484.12 +50923,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1077.36 +50924,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50925,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2602.37 +50926,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3708.5 +50927,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50928,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50929,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2510.92 +50930,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50931,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50932,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,893.59 +50933,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50934,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1784.5 +50935,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7718.71 +50936,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50937,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10192.48 +50938,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50939,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6123.0 +50940,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50941,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50942,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2225.94 +50943,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2364.65 +50944,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,494.84 +50945,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3805.0 +50946,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50947,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,322.8 +50948,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,284.74 +50949,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50950,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,419.8 +50951,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50952,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50953,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2675.18 +50954,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1432.0 +50955,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1321.02 +50956,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50957,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,166.16 +50958,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,494.92 +50959,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,392.0 +50960,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50961,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50962,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1557.91 +50963,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50964,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4496.9 +50965,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3740.07 +50966,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50967,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3743.12 +50968,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4259.19 +50969,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6828.0 +50970,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50971,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50972,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50973,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50974,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4331.0 +50975,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50976,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50977,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50978,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50979,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3807.13 +50980,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50981,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50982,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2036.09 +50983,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1846.24 +50984,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50985,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4010.32 +50986,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50987,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3514.81 +50988,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50989,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5801.55 +50990,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9010.78 +50991,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7117.0 +50992,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8242.93 +50993,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7636.56 +50994,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2332.58 +50995,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50996,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +50997,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5807.4 +50998,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3059.9 +50999,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5126.61 +51000,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3567.46 +51001,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51002,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2652.18 +51003,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51004,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51005,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1542.8 +51006,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51007,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51008,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51009,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51010,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51011,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51012,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3360.0 +51013,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51014,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3436.0 +51015,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51016,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51017,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9558.0 +51018,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51019,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +51020,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5340.0 +51021,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5081.0 +51022,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51023,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1946.0 +51024,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6751.16 +51025,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,504.79 +51026,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51027,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51028,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +51029,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51030,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1173.35 +51031,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51032,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51033,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51034,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5759.82 +51035,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51036,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51037,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51038,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51039,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51040,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51041,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2504.0 +51042,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3656.96 +51043,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7162.0 +51044,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51045,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3296.8 +51046,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7567.0 +51047,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1125.28 +51048,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1125.28 +51049,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51050,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51051,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51052,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6315.9 +51053,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8377.62 +51054,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51055,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1717.36 +51056,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51057,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1503.59 +51058,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5047.54 +51059,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51060,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51061,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6828.0 +51062,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3294.14 +51063,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21033.67 +51064,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51065,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51066,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51067,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1508.73 +51068,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51069,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51070,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,189.26 +51071,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +51072,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51073,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +51074,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4918.42 +51075,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,702.22 +51076,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51077,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8408.5 +51078,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51079,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51080,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51081,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51082,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51083,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51084,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51085,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51086,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51087,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51088,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51089,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3026.45 +51090,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51091,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2613.96 +51092,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +51093,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51094,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11545.84 +51095,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7920.0 +51096,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51097,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7920.0 +51098,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8121.41 +51099,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51100,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51101,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4240.53 +51102,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11849.45 +51103,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51104,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51105,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51106,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51107,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4779.0 +51108,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,973.0 +51109,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,627.41 +51110,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6903.0 +51111,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5340.0 +51112,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,541.43 +51113,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,636.26 +51114,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,636.26 +51115,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,639.45 +51116,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51117,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2411.0 +51118,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5056.67 +51119,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51120,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,556.67 +51121,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4908.0 +51122,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51123,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51124,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5174.97 +51125,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1396.99 +51126,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51127,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7619.88 +51128,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1946.0 +51129,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1902.5 +51130,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51131,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3960.0 +51132,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6539.69 +51133,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51134,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8823.0 +51135,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8823.0 +51136,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8823.0 +51137,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4438.0 +51138,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2377.33 +51139,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51140,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8823.0 +51141,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51142,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5203.22 +51143,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1862.24 +51144,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3648.0 +51145,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6877.92 +51146,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1734.33 +51147,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9371.43 +51148,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51149,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9876.59 +51150,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8139.0 +51151,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51152,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2804.2 +51153,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8808.26 +51154,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6686.52 +51155,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51156,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51157,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51158,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51159,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3960.0 +51160,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51161,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51162,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1780.02 +51163,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2321.0 +51164,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3755.81 +51165,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1211.36 +51166,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,925.36 +51167,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1215.78 +51168,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3440.92 +51169,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51170,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51171,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51172,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51173,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51174,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51175,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51176,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7940.0 +51177,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7292.16 +51178,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5041.0 +51179,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +51180,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,926.93 +51181,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51182,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51183,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51184,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51185,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,472.2 +51186,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51187,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5008.0 +51188,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4915.25 +51189,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3360.33 +51190,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3360.33 +51191,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7262.0 +51192,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7735.23 +51193,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7262.0 +51194,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1516.03 +51195,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,719.1 +51196,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3486.91 +51197,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51198,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1335.0 +51199,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13643.53 +51200,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51201,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51202,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51203,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51204,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51205,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9621.0 +51206,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +51207,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51208,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,610.54 +51209,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51210,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2265.36 +51211,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51212,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3664.6 +51213,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3658.16 +51214,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51215,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51216,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51217,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51218,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51219,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51220,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51221,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51222,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8623.59 +51223,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51224,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51225,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8198.0 +51226,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51227,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4099.0 +51228,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7180.7 +51229,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51230,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,33261.79 +51231,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6828.0 +51232,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1576.0 +51233,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,529.39 +51234,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51235,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51236,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51237,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51238,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51239,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51240,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51241,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3569.0 +51242,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4271.95 +51243,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2069.38 +51244,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3454.02 +51245,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51246,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1426.71 +51247,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51248,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51249,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51250,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,709.47 +51251,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,709.47 +51252,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51253,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51254,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51255,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51256,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51257,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16607.76 +51258,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4608.0 +51259,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16253.56 +51260,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3814.41 +51261,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51262,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1902.5 +51263,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51264,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51265,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51266,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4832.0 +51267,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4033.98 +51268,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3388.19 +51269,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4827.23 +51270,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2380.81 +51271,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51272,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51273,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51274,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51275,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,818.14 +51276,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51277,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51278,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2670.0 +51279,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51280,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51281,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5603.55 +51282,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51283,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +51284,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51285,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51286,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51287,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51288,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4416.0 +51289,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51290,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8357.34 +51291,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51292,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51293,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,714.67 +51294,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51295,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51296,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51297,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7310.0 +51298,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4989.51 +51299,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51300,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51301,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51302,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2243.02 +51303,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,332.1 +51304,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,97.74 +51305,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,332.1 +51306,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4195.82 +51307,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7561.5 +51308,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51309,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3489.0 +51310,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1710.7 +51311,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51312,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2525.7 +51313,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51314,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51315,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4371.52 +51316,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51317,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4625.91 +51318,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4541.11 +51319,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51320,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51321,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51322,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1862.51 +51323,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2520.5 +51324,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51325,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51326,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51327,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51328,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51329,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2456.5 +51330,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51331,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6327.71 +51332,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51333,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51334,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51335,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51336,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51337,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51338,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2949.41 +51339,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51340,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,613.17 +51341,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,613.17 +51342,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2290.99 +51343,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51344,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8953.0 +51345,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51346,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3162.61 +51347,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5237.56 +51348,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5461.0 +51349,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51350,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51351,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5158.38 +51352,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51353,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,274.63 +51354,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9783.1 +51355,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3079.93 +51356,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9078.0 +51357,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51358,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51359,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51360,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51361,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51362,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51363,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,653.51 +51364,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,613.17 +51365,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,613.17 +51366,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51367,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4393.38 +51368,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2562.44 +51369,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3165.45 +51370,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15393.47 +51371,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5244.0 +51372,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51373,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51374,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51375,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51376,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2809.09 +51377,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,327.7 +51378,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51379,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1212.38 +51380,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51381,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51382,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1001.8 +51383,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51384,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,618.92 +51385,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51386,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1527.22 +51387,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2344.49 +51388,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2176.81 +51389,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11645.02 +51390,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10985.91 +51391,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51392,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2344.49 +51393,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51394,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51395,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2151.99 +51396,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,932.6 +51397,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51398,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2344.49 +51399,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5959.72 +51400,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51401,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51402,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51403,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1069.08 +51404,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51405,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51406,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51407,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51408,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3788.43 +51409,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,268.08 +51410,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51411,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2151.99 +51412,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51413,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51414,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,695.72 +51415,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,377.25 +51416,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51417,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51418,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,352.54 +51419,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1662.9 +51420,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1817.76 +51421,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,192.31 +51422,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51423,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3764.71 +51424,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51425,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51426,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3345.07 +51427,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51428,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51429,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51430,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4476.8 +51431,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2201.93 +51432,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4894.62 +51433,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3764.71 +51434,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51435,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51436,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51437,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27065.52 +51438,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,74.81 +51439,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51440,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51441,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51442,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,85.75 +51443,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51444,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51445,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51446,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51447,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2136.0 +51448,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1809.5 +51449,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,248.66 +51450,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,275.66 +51451,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,313.38 +51452,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,367.55 +51453,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5027.0 +51454,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,441.06 +51455,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,220.76 +51456,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,435.29 +51457,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2966.36 +51458,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1602.5 +51459,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1035.05 +51460,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,654.99 +51461,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,282.33 +51462,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1169.57 +51463,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,438.07 +51464,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51465,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,622.23 +51466,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,802.2 +51467,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1027.47 +51468,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,941.79 +51469,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51470,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4129.0 +51471,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,282.33 +51472,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,870.0 +51473,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,464.67 +51474,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,384.5 +51475,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51476,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51477,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51478,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51479,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51480,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,748.78 +51481,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9162.33 +51482,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51483,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,422.5 +51484,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1119.13 +51485,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2141.0 +51486,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5242.5 +51487,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51488,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,165.69 +51489,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,298.57 +51490,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,644.67 +51491,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,819.5 +51492,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.78 +51493,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51494,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51495,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,186.5 +51496,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,360.4 +51497,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.26 +51498,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.78 +51499,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,798.75 +51500,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,449.5 +51501,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51502,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4348.0 +51503,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51504,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,130.19 +51505,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51506,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,290.93 +51507,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,462.61 +51508,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51509,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1848.73 +51510,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1048.49 +51511,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1393.78 +51512,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1736.81 +51513,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,997.13 +51514,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51515,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,775.92 +51516,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2651.49 +51517,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2879.0 +51518,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,183.98 +51519,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,324.95 +51520,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51521,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,290.93 +51522,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,341.73 +51523,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1527.13 +51524,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,462.61 +51525,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2175.27 +51526,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.11 +51527,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,228.0 +51528,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,197.22 +51529,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.78 +51530,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51531,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,288.5 +51532,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51533,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,178.92 +51534,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,239.5 +51535,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,299.36 +51536,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,260.45 +51537,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,316.5 +51538,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,512.25 +51539,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51540,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,536.0 +51541,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,216.68 +51542,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1194.68 +51543,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,462.61 +51544,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51545,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2572.0 +51546,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2529.5 +51547,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1975.74 +51548,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51549,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,85.75 +51550,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,231.83 +51551,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,403.01 +51552,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,299.5 +51553,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,326.0 +51554,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,253.07 +51555,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51556,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,209.0 +51557,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,336.7 +51558,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,280.5 +51559,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,515.82 +51560,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51561,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,324.36 +51562,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51563,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,246.0 +51564,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,427.5 +51565,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,152.67 +51566,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,424.43 +51567,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,348.75 +51568,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,293.5 +51569,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,349.11 +51570,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,359.8 +51571,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,371.28 +51572,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1061.33 +51573,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,761.14 +51574,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1777.86 +51575,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3096.0 +51576,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51577,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,126.05 +51578,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.78 +51579,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.78 +51580,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,231.52 +51581,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,216.48 +51582,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1079.34 +51583,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,165.09 +51584,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1245.7 +51585,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5232.0 +51586,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3292.5 +51587,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,522.0 +51588,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2789.88 +51589,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3548.5 +51590,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,274.95 +51591,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,231.52 +51592,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51593,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,423.44 +51594,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,358.25 +51595,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,407.0 +51596,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51597,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51598,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51599,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,242.27 +51600,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51601,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51602,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51603,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51604,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51605,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51606,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,278.69 +51607,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1184.75 +51608,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1681.51 +51609,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,437.5 +51610,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51611,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,904.73 +51612,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3371.66 +51613,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,71.47 +51614,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,444.96 +51615,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1458.97 +51616,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51617,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,290.75 +51618,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51619,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51620,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51621,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5719.3 +51622,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51623,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,740.01 +51624,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51625,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51626,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51627,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51628,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,458.22 +51629,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51630,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51631,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51632,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,378.39 +51633,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,715.99 +51634,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,67.01 +51635,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2401.55 +51636,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,358.94 +51637,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3880.59 +51638,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,914.67 +51639,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51640,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1538.5 +51641,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51642,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51643,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,234.1 +51644,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,79.52 +51645,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,435.62 +51646,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51647,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,355.1 +51648,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,159.79 +51649,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1020.61 +51650,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,321.89 +51651,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,791.74 +51652,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,585.13 +51653,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51654,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1443.67 +51655,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,332.64 +51656,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.11 +51657,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,282.5 +51658,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,959.91 +51659,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51660,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,137.3 +51661,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51662,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51663,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51664,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,124.32 +51665,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51666,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,112.05 +51667,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2321.0 +51668,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2054.7 +51669,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51670,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1910.83 +51671,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1880.5 +51672,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2734.1 +51673,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2334.68 +51674,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,162.18 +51675,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1703.3 +51676,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2015.67 +51677,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51678,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51679,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,418.81 +51680,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,266.0 +51681,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,98.09 +51682,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,228.04 +51683,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,226.0 +51684,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51685,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,610.5 +51686,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51687,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,378.39 +51688,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51689,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,378.39 +51690,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,208.13 +51691,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51692,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,276.87 +51693,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,934.42 +51694,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1980.5 +51695,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2119.0 +51696,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51697,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,525.0 +51698,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1437.5 +51699,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,571.0 +51700,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,413.9 +51701,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,633.16 +51702,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,466.5 +51703,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,281.5 +51704,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,434.7 +51705,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,397.5 +51706,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.78 +51707,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,524.65 +51708,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,561.24 +51709,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5601.5 +51710,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1480.0 +51711,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8796.0 +51712,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6836.99 +51713,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7741.5 +51714,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4459.71 +51715,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4348.5 +51716,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2613.96 +51717,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,946.8 +51718,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51719,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,812.1 +51720,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,970.08 +51721,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51722,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1322.5 +51723,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1520.5 +51724,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2517.64 +51725,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,191.51 +51726,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15052.0 +51727,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2497.68 +51728,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1282.5 +51729,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1220.5 +51730,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,618.18 +51731,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,148.66 +51732,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51733,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,889.78 +51734,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51735,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1571.28 +51736,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,946.8 +51737,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2672.46 +51738,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51739,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51740,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51741,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,445.99 +51742,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1073.5 +51743,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,717.5 +51744,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51745,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,803.46 +51746,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51747,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,380.28 +51748,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,968.0 +51749,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1516.83 +51750,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,451.62 +51751,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,818.71 +51752,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1600.0 +51753,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51754,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3038.4 +51755,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1541.26 +51756,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51757,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,424.5 +51758,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,833.83 +51759,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51760,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,571.8 +51761,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8829.0 +51762,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,593.38 +51763,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,547.02 +51764,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51765,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51766,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1229.5 +51767,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51768,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1345.08 +51769,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1541.26 +51770,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1476.34 +51771,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5821.26 +51772,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5763.5 +51773,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51774,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3055.8 +51775,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3782.15 +51776,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1558.32 +51777,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,833.83 +51778,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1611.77 +51779,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51780,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51781,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.82 +51782,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,144.01 +51783,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51784,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,251.5 +51785,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51786,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,116.5 +51787,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.76 +51788,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,495.32 +51789,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,70.36 +51790,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51791,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51792,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51793,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51794,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.06 +51795,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51796,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.28 +51797,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.96 +51798,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.48 +51799,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.48 +51800,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51801,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51802,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.5 +51803,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.5 +51804,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,106.0 +51805,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,40.45 +51806,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51807,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51808,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51809,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51810,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,200.0 +51811,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,43.01 +51812,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51813,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51814,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51815,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51816,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51817,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51818,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51819,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.96 +51820,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51821,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,400.73 +51822,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.0 +51823,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51824,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51825,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51826,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51827,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51828,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.0 +51829,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51830,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.0 +51831,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51832,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51833,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51834,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51835,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.0 +51836,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51837,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51838,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,48.18 +51839,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51840,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.42 +51841,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.61 +51842,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.54 +51843,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,369.0 +51844,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51845,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51846,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51847,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51848,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51849,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51850,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,193.25 +51851,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,282.0 +51852,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51853,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51854,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51855,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51856,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51857,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1379.5 +51858,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1221.5 +51859,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51860,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51861,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51862,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51863,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,130.0 +51864,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51865,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51866,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.04 +51867,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51868,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,65.69 +51869,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,299.95 +51870,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51871,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51872,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51873,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51874,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32.0 +51875,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51876,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51877,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51878,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51879,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51880,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51881,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51882,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51883,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,190.68 +51884,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51885,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,329.51 +51886,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51887,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51888,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,607.0 +51889,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51890,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51891,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51892,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51893,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51894,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51895,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,288.5 +51896,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51897,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51898,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51899,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51900,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51901,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51902,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51903,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51904,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51905,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,341.8 +51906,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51907,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51908,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51909,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51910,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51911,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51912,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51913,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51914,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51915,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51916,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1160.5 +51917,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,122.1 +51918,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,88.0 +51919,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,199.18 +51920,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,91.0 +51921,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,271.0 +51922,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,848.33 +51923,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51924,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51925,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2620.0 +51926,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,56.0 +51927,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51928,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51929,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,166.0 +51930,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.04 +51931,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.54 +51932,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,338.69 +51933,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.04 +51934,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,56.03 +51935,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51936,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,107.13 +51937,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.21 +51938,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.72 +51939,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.64 +51940,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,64.41 +51941,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.0 +51942,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,62.75 +51943,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.67 +51944,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.34 +51945,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.0 +51946,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.68 +51947,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,30.0 +51948,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.95 +51949,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51950,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.0 +51951,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.9 +51952,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.99 +51953,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.05 +51954,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,28.98 +51955,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29.41 +51956,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.72 +51957,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,51.0 +51958,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.4 +51959,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15.0 +51960,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,245.78 +51961,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51962,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,52.44 +51963,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,104.0 +51964,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.1 +51965,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.39 +51966,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,116.0 +51967,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51968,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.66 +51969,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.87 +51970,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51971,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.85 +51972,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.13 +51973,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,56.0 +51974,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,144.0 +51975,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.68 +51976,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.5 +51977,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.04 +51978,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,24.53 +51979,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51980,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.0 +51981,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51982,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,201.17 +51983,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1575.05 +51984,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,130.99 +51985,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51986,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51987,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,53.74 +51988,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.76 +51989,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.83 +51990,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51991,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.48 +51992,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,38.57 +51993,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51994,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51995,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.0 +51996,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +51997,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26.1 +51998,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.84 +51999,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52000,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52001,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.92 +52002,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,363.46 +52003,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52004,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52005,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52006,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.22 +52007,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52008,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52009,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52010,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,418.95 +52011,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,56.95 +52012,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,55.37 +52013,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.5 +52014,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,44.05 +52015,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,287.0 +52016,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27.27 +52017,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52018,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,53.22 +52019,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,96.82 +52020,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.37 +52021,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.88 +52022,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52023,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.69 +52024,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.94 +52025,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1.4 +52026,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.4 +52027,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52028,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,87.0 +52029,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.64 +52030,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.42 +52031,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.17 +52032,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.5 +52033,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.54 +52034,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.58 +52035,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52036,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52037,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.21 +52038,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52039,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,91.7 +52040,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52041,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52042,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52043,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.29 +52044,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.25 +52045,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52046,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.16 +52047,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,786.53 +52048,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52049,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1547.75 +52050,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.0 +52051,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29.7 +52052,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,115.53 +52053,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.3 +52054,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52055,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52056,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.0 +52057,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,76.14 +52058,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.75 +52059,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52060,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52061,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.0 +52062,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,33.16 +52063,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52064,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52065,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.0 +52066,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.0 +52067,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52068,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52069,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52070,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2331.0 +52071,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,153.54 +52072,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32.7 +52073,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52074,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22.75 +52075,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.74 +52076,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.04 +52077,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.04 +52078,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.45 +52079,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,64.41 +52080,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,88.26 +52081,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52082,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52083,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,622.0 +52084,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52085,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,102.73 +52086,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.91 +52087,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.16 +52088,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,57.0 +52089,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,39.77 +52090,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52091,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52092,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,80.0 +52093,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,65.0 +52094,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.21 +52095,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52096,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.09 +52097,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.0 +52098,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,30.76 +52099,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52100,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.42 +52101,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.0 +52102,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.53 +52103,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.3 +52104,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.09 +52105,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.3 +52106,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17.83 +52107,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52108,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52109,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.0 +52110,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.0 +52111,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.31 +52112,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52113,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.93 +52114,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.24 +52115,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52116,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,28.9 +52117,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.05 +52118,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,97.5 +52119,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,65.0 +52120,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52121,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.0 +52122,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52123,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.98 +52124,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52125,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52126,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52127,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.68 +52128,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.88 +52129,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.0 +52130,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.6 +52131,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,65.75 +52132,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,247.0 +52133,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52134,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,261.0 +52135,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.54 +52136,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.1 +52137,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.85 +52138,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.99 +52139,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,36.18 +52140,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.74 +52141,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,68.74 +52142,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,54.13 +52143,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.41 +52144,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.88 +52145,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,116.23 +52146,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.83 +52147,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,40.33 +52148,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52149,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.18 +52150,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.15 +52151,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17.0 +52152,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52153,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52154,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.56 +52155,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15.56 +52156,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.0 +52157,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.0 +52158,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,200.02 +52159,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,222.14 +52160,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.67 +52161,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,112.5 +52162,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.06 +52163,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52164,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.75 +52165,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.42 +52166,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,50.62 +52167,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,92.65 +52168,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2.8 +52169,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.79 +52170,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,63.0 +52171,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52172,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,408.48 +52173,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.48 +52174,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.3 +52175,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.89 +52176,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37.0 +52177,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,30.02 +52178,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27.23 +52179,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.77 +52180,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.69 +52181,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.05 +52182,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.02 +52183,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.9 +52184,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7.1 +52185,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.72 +52186,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52187,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52188,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.0 +52189,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.07 +52190,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52191,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.23 +52192,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52193,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,44.6 +52194,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.26 +52195,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52196,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52197,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52198,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52199,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.36 +52200,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.86 +52201,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,42.35 +52202,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,46.78 +52203,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52204,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.11 +52205,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52206,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15.62 +52207,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52208,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.77 +52209,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,63.27 +52210,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.38 +52211,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52212,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.45 +52213,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,243.94 +52214,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52215,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,44.11 +52216,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,36.5 +52217,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17.35 +52218,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,45.15 +52219,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,49.11 +52220,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.89 +52221,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,31.47 +52222,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52223,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,40.8 +52224,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,64.9 +52225,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.9 +52226,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52227,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52228,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,262.0 +52229,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.81 +52230,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.8 +52231,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.95 +52232,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.35 +52233,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.74 +52234,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,150.97 +52235,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.08 +52236,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.24 +52237,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26.37 +52238,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.07 +52239,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,31.32 +52240,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.81 +52241,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52242,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.38 +52243,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.62 +52244,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,45.23 +52245,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52246,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22.96 +52247,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,50.41 +52248,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.72 +52249,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.5 +52250,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52251,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,471.0 +52252,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,728.18 +52253,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52254,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32.07 +52255,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52256,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32.07 +52257,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37.73 +52258,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,55.39 +52259,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37.41 +52260,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.7 +52261,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,48.34 +52262,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,57.37 +52263,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,28.37 +52264,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,46.42 +52265,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.21 +52266,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52267,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.03 +52268,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52269,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.23 +52270,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,348.5 +52271,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,342.5 +52272,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,86.52 +52273,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29.58 +52274,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52275,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52276,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52277,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.03 +52278,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52279,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.7 +52280,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7.65 +52281,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,73.8 +52282,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.28 +52283,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.05 +52284,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.38 +52285,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.27 +52286,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52287,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52288,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52289,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.35 +52290,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.77 +52291,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52292,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52293,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52294,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52295,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52296,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52297,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.1 +52298,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.1 +52299,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,81.57 +52300,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.1 +52301,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.84 +52302,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.0 +52303,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.0 +52304,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52305,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.33 +52306,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22.0 +52307,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.38 +52308,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29.0 +52309,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17.0 +52310,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52311,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.46 +52312,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.65 +52313,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,50.56 +52314,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.37 +52315,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.16 +52316,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.7 +52317,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,426.0 +52318,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52319,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52320,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52321,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.15 +52322,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,117.53 +52323,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52324,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,64.28 +52325,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,64.19 +52326,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,41.07 +52327,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.54 +52328,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,973.95 +52329,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,825.1 +52330,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,470.11 +52331,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,814.3 +52332,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,653.9 +52333,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52334,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,499.51 +52335,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,530.92 +52336,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,652.63 +52337,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,876.75 +52338,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,173.8 +52339,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,162.64 +52340,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1250.46 +52341,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.13 +52342,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,134.52 +52343,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7.6 +52344,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,371.0 +52345,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,182.78 +52346,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.47 +52347,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,31.7 +52348,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,61.92 +52349,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,119.8 +52350,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,57.66 +52351,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,111.5 +52352,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,59.71 +52353,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.1 +52354,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.32 +52355,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.7 +52356,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52357,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52358,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.42 +52359,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52360,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.4 +52361,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52362,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52363,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52364,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52365,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52366,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,176.85 +52367,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.83 +52368,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.19 +52369,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52370,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27.31 +52371,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52372,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.08 +52373,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,50.19 +52374,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7.0 +52375,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.4 +52376,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,31.91 +52377,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52378,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52379,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.98 +52380,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52381,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.03 +52382,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.24 +52383,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.03 +52384,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.67 +52385,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52386,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.1 +52387,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.41 +52388,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.47 +52389,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52390,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52391,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52392,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.98 +52393,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.75 +52394,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52395,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,38.29 +52396,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,45.94 +52397,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.0 +52398,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,38.29 +52399,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52400,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,28.72 +52401,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,171.39 +52402,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,195.85 +52403,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26.94 +52404,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,47.6 +52405,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,49.78 +52406,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,48.63 +52407,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52408,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.0 +52409,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52410,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.43 +52411,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,38.29 +52412,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.09 +52413,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,53.77 +52414,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,34.46 +52415,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.14 +52416,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,43.31 +52417,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.43 +52418,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,101.42 +52419,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52420,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52421,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52422,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27.35 +52423,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.09 +52424,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,178.81 +52425,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,121.24 +52426,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52427,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,792.74 +52428,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,191.06 +52429,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.14 +52430,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.0 +52431,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.14 +52432,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,814.86 +52433,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,47.6 +52434,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,80.0 +52435,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52436,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52437,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.03 +52438,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,257.45 +52439,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,199.92 +52440,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52441,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52442,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,128.73 +52443,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52444,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52445,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,82.0 +52446,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,52.23 +52447,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52448,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,62.72 +52449,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1233.06 +52450,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2916.36 +52451,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52452,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27.31 +52453,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,30.0 +52454,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,99.02 +52455,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,141.6 +52456,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,122.19 +52457,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52458,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +52459,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +52460,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,211.4 +52461,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52462,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,204.77 +52463,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52464,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,375.73 +52465,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,83.6 +52466,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.0 +52467,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27.85 +52468,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,357.65 +52469,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1005.79 +52470,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,340.08 +52471,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,797.66 +52472,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,84.65 +52473,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1662.0 +52474,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1318.9 +52475,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,68.12 +52476,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52477,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52478,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52479,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,335.78 +52480,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,34.2 +52481,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,62.28 +52482,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,43.25 +52483,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,649.74 +52484,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,463.0 +52485,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,64.17 +52486,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,121.0 +52487,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,880.92 +52488,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,60.5 +52489,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,205.67 +52490,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,240.34 +52491,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52492,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52493,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,185.73 +52494,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,34.6 +52495,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3620.08 +52496,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26.8 +52497,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,103.0 +52498,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52499,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2413.56 +52500,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52501,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52502,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10256.54 +52503,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52504,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52505,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52506,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52507,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52508,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,34.15 +52509,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52510,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,412.4 +52511,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52512,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,43.09 +52513,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52514,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52515,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,34.42 +52516,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,43.8 +52517,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,42.51 +52518,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52519,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52520,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52521,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52522,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1070.37 +52523,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,261.43 +52524,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52525,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,68.35 +52526,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,223.46 +52527,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,106.32 +52528,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,223.46 +52529,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,106.32 +52530,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,159.14 +52531,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52532,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52533,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52534,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52535,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52536,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52537,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52538,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52539,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52540,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2497.09 +52541,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,620.0 +52542,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1702.48 +52543,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,608.0 +52544,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52545,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,185.32 +52546,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52547,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,574.44 +52548,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,539.35 +52549,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,630.67 +52550,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,208.59 +52551,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,204.54 +52552,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,197.92 +52553,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,204.66 +52554,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52555,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1971.11 +52556,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,86.34 +52557,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,84.39 +52558,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,87.63 +52559,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52560,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,91.13 +52561,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,74.09 +52562,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,80.78 +52563,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,71.41 +52564,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,395.96 +52565,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,268.08 +52566,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,90.88 +52567,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,90.88 +52568,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,193.09 +52569,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,196.91 +52570,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52571,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,236.69 +52572,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,227.37 +52573,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,236.69 +52574,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,227.37 +52575,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1029.1 +52576,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52577,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1029.1 +52578,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52579,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52580,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,860.8 +52581,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,82.11 +52582,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,234.25 +52583,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,211.13 +52584,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,791.5 +52585,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,679.01 +52586,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,322.86 +52587,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52588,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52589,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52590,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,437.0 +52591,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52592,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,568.0 +52593,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,788.0 +52594,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,40.46 +52595,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52596,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1011.76 +52597,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,798.48 +52598,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,306.63 +52599,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,140.43 +52600,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,154.99 +52601,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,163.26 +52602,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,209.42 +52603,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52604,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52605,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,450.0 +52606,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,740.0 +52607,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52608,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,948.5 +52609,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52610,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52611,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52612,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,77.28 +52613,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,77.28 +52614,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52615,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1029.1 +52616,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10959.0 +52617,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52618,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21698.0 +52619,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23662.0 +52620,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2745.05 +52621,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3311.09 +52622,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52623,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52624,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52625,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21673.0 +52626,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,648.05 +52627,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1675.72 +52628,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,359.73 +52629,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52630,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52631,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52632,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,799.1 +52633,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6126.0 +52634,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,384.73 +52635,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,278.85 +52636,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52637,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52638,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52639,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10461.23 +52640,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,98.86 +52641,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52642,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4078.09 +52643,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,470.07 +52644,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2710.0 +52645,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,351.02 +52646,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3310.57 +52647,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52648,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,390.25 +52649,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,162.3 +52650,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,144.07 +52651,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,736.23 +52652,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52653,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15.39 +52654,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8148.57 +52655,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52656,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52657,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7991.27 +52658,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3374.97 +52659,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10135.0 +52660,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3452.71 +52661,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7806.49 +52662,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4089.95 +52663,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7689.43 +52664,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10160.0 +52665,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52666,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9782.0 +52667,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52668,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,177.53 +52669,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52670,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52671,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52672,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,991.03 +52673,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52674,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52675,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,62194.0 +52676,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52677,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52678,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52679,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,45691.11 +52680,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,54909.0 +52681,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52682,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,39736.69 +52683,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52684,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4082.96 +52685,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52686,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52687,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,655.76 +52688,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,171.0 +52689,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52690,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1036.5 +52691,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,79.45 +52692,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,279.6 +52693,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,324.36 +52694,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52695,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,719.76 +52696,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,168.88 +52697,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52698,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52699,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,706.01 +52700,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,187.12 +52701,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,707.98 +52702,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52703,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,712.44 +52704,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52705,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52706,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,233.2 +52707,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,286.94 +52708,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,458.0 +52709,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52710,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52711,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,135.5 +52712,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,345.27 +52713,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,345.27 +52714,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3387.89 +52715,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2391.98 +52716,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52717,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,901.4 +52718,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,719.8 +52719,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,101.7 +52720,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52721,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,145.64 +52722,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1101.19 +52723,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52724,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,574.44 +52725,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,165.39 +52726,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52727,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,250.9 +52728,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52729,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52730,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,623.8 +52731,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52732,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1096.15 +52733,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52734,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2688.74 +52735,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3047.0 +52736,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52737,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2043.5 +52738,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,452.0 +52739,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,306.63 +52740,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,191.73 +52741,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.42 +52742,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.42 +52743,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52744,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52745,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52746,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,208.82 +52747,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52748,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52749,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52750,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,588.32 +52751,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52752,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52753,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52754,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,208.82 +52755,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52756,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,475.5 +52757,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52758,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,218.18 +52759,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,223.46 +52760,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,429.6 +52761,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,408.7 +52762,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,40.43 +52763,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52764,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52765,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,429.6 +52766,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,533.45 +52767,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1444.35 +52768,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,874.38 +52769,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,202.2 +52770,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,808.8 +52771,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1543.0 +52772,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2657.35 +52773,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3768.2 +52774,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5734.66 +52775,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1736.68 +52776,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,294.76 +52777,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2024.49 +52778,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1932.1 +52779,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2077.86 +52780,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10492.0 +52781,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3598.5 +52782,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2211.42 +52783,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5159.44 +52784,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2557.53 +52785,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4297.51 +52786,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6481.53 +52787,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6939.0 +52788,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3277.13 +52789,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1419.7 +52790,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4226.62 +52791,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6234.54 +52792,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,172.55 +52793,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52794,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,284.53 +52795,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.02 +52796,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.31 +52797,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.31 +52798,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,65.88 +52799,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52800,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.98 +52801,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,315.0 +52802,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,74.7 +52803,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,196.9 +52804,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,139.64 +52805,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,142.95 +52806,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35.68 +52807,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52808,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,61.89 +52809,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,125.01 +52810,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,164.78 +52811,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,334.4 +52812,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,212.57 +52813,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52814,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,151.29 +52815,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,150.41 +52816,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,160.69 +52817,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,73.45 +52818,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,366.0 +52819,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,229.0 +52820,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,122.96 +52821,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,56.3 +52822,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,92.59 +52823,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,128.35 +52824,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,115.08 +52825,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,30.06 +52826,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52827,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3163.0 +52828,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3884.91 +52829,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52830,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,95.0 +52831,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52832,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52833,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,90.88 +52834,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,211.48 +52835,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,195.88 +52836,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,194.09 +52837,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,197.98 +52838,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,198.0 +52839,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,196.16 +52840,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,260.0 +52841,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,208.06 +52842,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,201.13 +52843,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,575.9 +52844,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,809.36 +52845,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52846,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,137.98 +52847,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,183.15 +52848,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,201.06 +52849,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,191.38 +52850,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,614.0 +52851,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1005.5 +52852,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1684.83 +52853,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3868.77 +52854,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6799.69 +52855,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6388.72 +52856,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,195.14 +52857,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,176.38 +52858,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,197.16 +52859,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,199.47 +52860,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,202.3 +52861,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,194.54 +52862,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,199.47 +52863,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,191.43 +52864,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,171.15 +52865,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,198.72 +52866,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,199.01 +52867,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,200.01 +52868,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,200.27 +52869,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,199.47 +52870,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52871,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,128.54 +52872,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,82.26 +52873,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52874,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,51.44 +52875,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8715.07 +52876,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10258.0 +52877,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52878,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52879,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,171.16 +52880,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,130470.76 +52881,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52882,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4625.91 +52883,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,468.09 +52884,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,98050.85 +52885,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37516.45 +52886,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,0.01 +52887,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16683.82 +52888,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,124089.33 +52889,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52890,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,39367.0 +52891,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,41749.0 +52892,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52893,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52894,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,63049.0 +52895,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,36995.0 +52896,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17787.89 +52897,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22452.71 +52898,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52899,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52900,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23355.38 +52901,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,39563.88 +52902,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7178.13 +52903,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52904,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,46813.0 +52905,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52906,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35252.0 +52907,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14206.48 +52908,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9056.16 +52909,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7752.73 +52910,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4678.85 +52911,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8542.78 +52912,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4264.14 +52913,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,34468.0 +52914,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9881.52 +52915,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7896.48 +52916,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7094.06 +52917,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27952.32 +52918,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,101892.69 +52919,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32066.0 +52920,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9700.9 +52921,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6370.55 +52922,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9384.84 +52923,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52924,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4998.84 +52925,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7694.46 +52926,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13979.82 +52927,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8109.88 +52928,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21417.95 +52929,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18324.36 +52930,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,48612.47 +52931,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13633.72 +52932,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10951.4 +52933,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9800.51 +52934,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11034.88 +52935,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7526.04 +52936,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19135.68 +52937,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9048.32 +52938,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8076.22 +52939,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8259.2 +52940,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7312.68 +52941,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52942,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11424.53 +52943,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6342.06 +52944,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29385.39 +52945,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32666.78 +52946,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27181.43 +52947,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35327.39 +52948,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27279.77 +52949,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,33385.35 +52950,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21267.91 +52951,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13430.87 +52952,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17818.82 +52953,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21082.98 +52954,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,24828.06 +52955,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18376.23 +52956,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,24982.12 +52957,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14698.9 +52958,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13528.05 +52959,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7674.07 +52960,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9451.15 +52961,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52962,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11154.6 +52963,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25481.06 +52964,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23751.79 +52965,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9052.93 +52966,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5956.86 +52967,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52968,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11572.45 +52969,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4673.24 +52970,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5340.26 +52971,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6461.94 +52972,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9978.4 +52973,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10327.33 +52974,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25096.01 +52975,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,47513.94 +52976,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6999.26 +52977,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12191.12 +52978,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19842.14 +52979,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11304.43 +52980,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9945.84 +52981,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17727.98 +52982,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13510.23 +52983,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14192.98 +52984,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12524.7 +52985,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14065.28 +52986,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +52987,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6651.59 +52988,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6873.56 +52989,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29086.28 +52990,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9178.88 +52991,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12347.0 +52992,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9091.73 +52993,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9428.84 +52994,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5500.96 +52995,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11538.21 +52996,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8030.04 +52997,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23289.07 +52998,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12488.82 +52999,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20463.43 +53000,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53001,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10750.62 +53002,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14074.77 +53003,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17958.84 +53004,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19920.45 +53005,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9676.0 +53006,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13651.55 +53007,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15693.89 +53008,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53009,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,87319.45 +53010,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,35830.54 +53011,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,69926.19 +53012,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26962.52 +53013,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12170.36 +53014,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17655.98 +53015,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16953.74 +53016,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23933.41 +53017,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13206.87 +53018,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11087.79 +53019,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11223.08 +53020,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14644.35 +53021,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17645.07 +53022,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26075.28 +53023,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53024,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53025,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11484.5 +53026,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53027,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21754.83 +53028,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7528.1 +53029,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8496.33 +53030,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7443.38 +53031,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10155.88 +53032,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14399.57 +53033,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13075.46 +53034,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17327.43 +53035,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19714.47 +53036,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7892.03 +53037,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8179.48 +53038,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7170.22 +53039,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6620.68 +53040,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13060.88 +53041,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9637.51 +53042,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25907.59 +53043,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53044,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11536.2 +53045,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18059.11 +53046,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7761.01 +53047,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53048,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15923.93 +53049,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10849.8 +53050,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37414.21 +53051,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10126.64 +53052,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12029.74 +53053,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15413.73 +53054,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53055,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53056,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53057,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53058,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8845.23 +53059,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12083.14 +53060,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53061,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12162.24 +53062,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13644.55 +53063,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9021.96 +53064,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53065,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14979.78 +53066,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6017.42 +53067,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53068,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7735.55 +53069,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8200.84 +53070,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53071,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8768.32 +53072,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11411.39 +53073,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6755.2 +53074,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4058.77 +53075,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8302.5 +53076,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7270.16 +53077,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9213.11 +53078,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5657.1 +53079,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7880.21 +53080,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53081,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7168.9 +53082,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8157.58 +53083,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4522.18 +53084,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4105.12 +53085,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3207.91 +53086,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7085.57 +53087,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,178232.75 +53088,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,744798.13 +53089,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53090,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,79523.76 +53091,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,80351.47 +53092,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,52099.16 +53093,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,48199.64 +53094,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20740.58 +53095,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22548.66 +53096,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,24239.31 +53097,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16889.11 +53098,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7071.7 +53099,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19542.64 +53100,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,42720.91 +53101,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10810.32 +53102,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13230.31 +53103,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9635.44 +53104,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3615.51 +53105,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,257903.22 +53106,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,55063.59 +53107,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23044.13 +53108,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10668.29 +53109,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8324.43 +53110,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,341920.46 +53111,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,45477.96 +53112,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,67404.71 +53113,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53114,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,126259.37 +53115,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13676.77 +53116,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9203.75 +53117,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,53747.86 +53118,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,28761.12 +53119,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,43647.86 +53120,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8966.37 +53121,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5501.85 +53122,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6664.64 +53123,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6895.93 +53124,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2467.62 +53125,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14286.88 +53126,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20931.21 +53127,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13421.45 +53128,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14246.81 +53129,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14994.97 +53130,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6985.89 +53131,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8954.88 +53132,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22159.5 +53133,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16757.06 +53134,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5143.68 +53135,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6532.08 +53136,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53137,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5303.19 +53138,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6063.83 +53139,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8248.22 +53140,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9255.57 +53141,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15686.45 +53142,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53143,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14127.71 +53144,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7101.2 +53145,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3405.42 +53146,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9919.46 +53147,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32012.45 +53148,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9375.88 +53149,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53150,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12607.62 +53151,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8818.62 +53152,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,24613.65 +53153,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11901.49 +53154,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53155,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,33675.94 +53156,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15544.11 +53157,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,45572.66 +53158,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,69644.39 +53159,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,31291.5 +53160,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1030.75 +53161,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,711.8 +53162,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1045.2 +53163,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,688.5 +53164,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,866.5 +53165,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53166,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1684.58 +53167,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53168,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53169,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53170,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53171,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22.05 +53172,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53173,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32.67 +53174,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53175,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.07 +53176,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53177,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,115.33 +53178,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53179,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53180,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53181,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53182,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53183,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1324.16 +53184,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53185,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53186,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53187,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53188,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53189,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53190,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,55.0 +53191,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53192,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53193,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,343.0 +53194,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53195,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53196,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53197,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53198,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4013.0 +53199,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,57.31 +53200,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53201,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53202,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29.15 +53203,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,106.08 +53204,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53205,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53206,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,572.06 +53207,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53208,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1058.83 +53209,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53210,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53211,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53212,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,116.62 +53213,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,78.48 +53214,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53215,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53216,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,13.8 +53217,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53218,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53219,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3345.0 +53220,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53221,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53222,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53223,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53224,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53225,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53226,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2.9 +53227,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53228,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,53.75 +53229,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1033.15 +53230,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1033.15 +53231,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53232,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53233,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53234,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53235,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53236,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,74.25 +53237,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2915.0 +53238,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53239,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53240,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53241,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53242,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1400.0 +53243,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53244,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.26 +53245,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53246,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53247,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1022.03 +53248,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,400.0 +53249,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,91.53 +53250,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,952.42 +53251,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53252,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53253,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53254,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53255,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53256,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53257,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53258,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,241.43 +53259,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53260,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53261,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53262,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53263,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53264,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53265,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53266,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53267,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10.73 +53268,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53269,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53270,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.45 +53271,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19.25 +53272,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53273,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53274,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53275,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53276,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53277,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53278,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,111.5 +53279,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53280,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53281,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53282,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53283,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53284,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53285,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53286,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53287,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53288,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,462.87 +53289,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53290,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53291,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53292,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53293,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,826.78 +53294,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1336.49 +53295,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53296,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.11 +53297,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53298,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53299,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53300,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53301,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1033.15 +53302,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,123.61 +53303,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53304,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14202.34 +53305,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53306,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,19311.27 +53307,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53308,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15025.14 +53309,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53310,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53311,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53312,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53313,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2964.84 +53314,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53315,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53316,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,10209.87 +53317,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,63.82 +53318,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,82.97 +53319,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,693.07 +53320,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,859.0 +53321,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,859.0 +53322,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1718.0 +53323,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1982.09 +53324,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1933.08 +53325,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,125.11 +53326,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,187.72 +53327,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,125.11 +53328,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,147.35 +53329,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,294.22 +53330,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,96.24 +53331,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,192.06 +53332,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,400.71 +53333,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,308.24 +53334,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,91.7 +53335,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53336,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,300.0 +53337,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3263.83 +53338,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,300.0 +53339,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,109.89 +53340,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3436.0 +53341,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4802.0 +53342,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53343,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53344,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,147.86 +53345,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,91.56 +53346,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29.76 +53347,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,300.0 +53348,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,300.0 +53349,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1233.47 +53350,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,88.47 +53351,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,46.17 +53352,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,117.03 +53353,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53354,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.44 +53355,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53356,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,454.99 +53357,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,149.8 +53358,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53359,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,794.3 +53360,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,97.0 +53361,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53362,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,30.57 +53363,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.31 +53364,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,267.15 +53365,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4043.66 +53366,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53367,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53368,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,33.1 +53369,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53370,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,343.35 +53371,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,202.65 +53372,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,33.55 +53373,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53374,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53375,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53376,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,144.0 +53377,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,55.33 +53378,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4357.73 +53379,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53380,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,52.0 +53381,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53382,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53383,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,0.86 +53384,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15.75 +53385,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53386,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,38.08 +53387,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53388,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53389,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,129.13 +53390,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53391,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53392,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,15.24 +53393,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53394,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53395,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53396,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,873.36 +53397,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1954.32 +53398,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53399,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,67.63 +53400,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,67.63 +53401,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53402,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1395.9 +53403,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53404,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17.57 +53405,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53406,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53407,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53408,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,44.07 +53409,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14.41 +53410,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,16.77 +53411,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53412,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,26.2 +53413,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.96 +53414,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53415,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53416,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53417,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,0.73 +53418,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,38.3 +53419,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,23.31 +53420,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,139.22 +53421,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,80.22 +53422,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,555.91 +53423,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53424,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53425,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,677.38 +53426,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53427,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53428,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1373.29 +53429,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53430,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,21.2 +53431,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,67.63 +53432,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,7.02 +53433,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53434,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,28.52 +53435,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53436,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.4 +53437,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.05 +53438,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53439,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53440,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53441,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53442,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53443,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53444,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53445,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1394.17 +53446,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,0.67 +53447,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,50.4 +53448,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,146.88 +53449,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53450,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1617.0 +53451,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53452,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53453,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,980.0 +53454,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2.33 +53455,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53456,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,211.79 +53457,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1.61 +53458,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53459,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,0.58 +53460,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.15 +53461,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,32.4 +53462,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,234.19 +53463,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53464,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,29.61 +53465,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53466,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,14713.44 +53467,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,360.0 +53468,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.96 +53469,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,197.75 +53470,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,18.0 +53471,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53472,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.91 +53473,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53474,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53475,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53476,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.31 +53477,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53478,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.05 +53479,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53480,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53481,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,22.55 +53482,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53483,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53484,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53485,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1.59 +53486,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53487,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.03 +53488,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2.41 +53489,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,20.0 +53490,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53491,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53492,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53493,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4528.08 +53494,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53495,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1147.09 +53496,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53497,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53498,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.04 +53499,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,43.5 +53500,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4653.8 +53501,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,56.55 +53502,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,104.43 +53503,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53504,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53505,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53506,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53507,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53508,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53509,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,68.95 +53510,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,34.38 +53511,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53512,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.0 +53513,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53514,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,72.89 +53515,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,71.39 +53516,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53517,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53518,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53519,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,42.77 +53520,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53521,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.52 +53522,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,46.55 +53523,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,89.55 +53524,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.54 +53525,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53526,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53527,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53528,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,840.32 +53529,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,876.91 +53530,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53531,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3890.49 +53532,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53533,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,17.06 +53534,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2712.78 +53535,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53536,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53537,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.24 +53538,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53539,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53540,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,52.49 +53541,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.61 +53542,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,40.84 +53543,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,40.97 +53544,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53545,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.71 +53546,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2.9 +53547,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.78 +53548,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.28 +53549,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.84 +53550,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,5.2 +53551,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,9.65 +53552,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53553,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1279.8 +53554,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53555,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6853.28 +53556,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53557,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53558,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53559,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53560,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53561,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53562,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53563,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,25.84 +53564,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,6.53 +53565,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4.2 +53566,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53567,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53568,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53569,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53570,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3.65 +53571,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.46 +53572,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53573,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53574,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53575,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,54.29 +53576,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53577,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1.78 +53578,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1.84 +53579,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53580,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,0.52 +53581,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53582,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53583,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,78.28 +53584,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3981.41 +53585,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,161.14 +53586,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,103.21 +53587,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2466.95 +53588,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,58.17 +53589,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53590,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53591,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,770.83 +53592,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53593,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53594,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.57 +53595,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1008.61 +53596,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53597,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53598,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,278.69 +53599,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1.98 +53600,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53601,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53602,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53603,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53604,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,507.06 +53605,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53606,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,91.46 +53607,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3981.41 +53608,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,27.96 +53609,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53610,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53611,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53612,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,31.51 +53613,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53614,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,49.78 +53615,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53616,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53617,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53618,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,613.19 +53619,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53620,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53621,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53622,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,11.97 +53623,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53624,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,12.0 +53625,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2527.46 +53626,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53627,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53628,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2689.98 +53629,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53630,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53631,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53632,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53633,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53634,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1069.4 +53635,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3264.15 +53636,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53637,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53638,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8286.57 +53639,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53640,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53641,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4657.82 +53642,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,975.61 +53643,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4207.19 +53644,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53645,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53646,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37.93 +53647,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53648,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1076.18 +53649,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53650,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53651,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53652,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53653,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53654,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53655,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53656,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,239.95 +53657,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53658,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,45.25 +53659,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53660,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,349.73 +53661,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,4272.0 +53662,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53663,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53664,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53665,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53666,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53667,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53668,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53669,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53670,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53671,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,753.0 +53672,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,339.98 +53673,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53674,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53675,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,180.7 +53676,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,766.15 +53677,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53678,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53679,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,3507.0 +53680,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,995.63 +53681,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53682,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53683,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,39.69 +53684,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,92.64 +53685,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53686,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,614.8 +53687,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53688,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53689,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,37.73 +53690,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1.14 +53691,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53692,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,8.64 +53693,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53694,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2.98 +53695,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,0.03 +53696,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,161.94 +53697,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53698,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53699,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,458.65 +53700,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53701,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53702,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53703,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1307.76 +53704,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1033.15 +53705,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1033.15 +53706,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53707,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53708,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53709,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53710,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1033.15 +53711,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,251.36 +53712,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1950.61 +53713,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,271.52 +53714,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,2936.52 +53715,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53716,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53717,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,191.84 +53718,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53719,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53720,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53721,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53722,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,87.91 +53723,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53724,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53725,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,154.12 +53726,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1361.66 +53727,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,51.5 +53728,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,51.31 +53729,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53730,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,100.0 +53731,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,28.26 +53732,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53733,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,57.6 +53734,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,1520.36 +53735,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS,70.38 +53736,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53737,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53738,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53739,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53740,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53741,3934,30000038,ICU,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53742,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53743,3934,30000053,NICU,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53744,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53745,3934,30000079,PSYCH,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53746,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53747,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53748,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53749,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53750,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53751,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53752,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53753,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53754,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53755,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53756,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53757,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53758,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53759,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53760,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53761,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53762,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53763,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53764,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53765,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53766,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53767,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53768,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53769,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53770,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53771,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53772,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53773,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53774,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53775,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53776,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53777,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53778,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53779,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53780,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53781,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53782,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53783,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53784,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53785,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53786,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53787,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53788,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53789,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53790,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53791,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53792,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53793,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53794,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53795,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53796,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53797,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53798,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53799,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53800,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53801,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53802,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53803,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53804,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53805,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53806,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53807,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53808,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53809,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53810,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53811,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53812,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53813,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53814,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53815,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53816,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53817,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53818,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53819,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53820,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53821,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53822,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53823,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53824,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53825,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, 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ASSURANCE-HMO/POS, +53866,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53867,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53868,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53869,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53870,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53871,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53872,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53873,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53874,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53875,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE 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05NV PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53956,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53957,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53958,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53959,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53960,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53961,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53962,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53963,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53964,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53965,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53966,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53967,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53968,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53969,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53970,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53971,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53972,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53973,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53974,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53975,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53976,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53977,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53978,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53979,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53980,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53981,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53982,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53983,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53984,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53985,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53986,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53987,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53988,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53989,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53990,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53991,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53992,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53993,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53994,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53995,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53996,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53997,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53998,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +53999,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54000,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54001,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54002,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54003,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54004,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54005,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54006,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54007,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54008,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54009,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54010,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54011,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54012,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54013,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54014,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54015,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54016,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54017,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54018,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54019,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54020,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54021,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54022,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54023,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54024,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54025,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54026,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54027,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54028,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54029,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54030,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54031,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54032,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54033,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54034,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54035,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54036,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54037,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54038,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54039,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54040,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54041,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54042,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54043,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54044,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54045,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54046,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54047,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54048,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54049,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54050,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54051,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54052,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54053,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54054,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54055,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54056,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54057,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54058,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54059,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54060,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54061,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54062,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54063,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54064,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54065,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54066,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54067,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54068,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54069,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54070,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54071,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54072,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54073,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54074,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54075,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54076,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54077,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54078,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54079,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54080,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54081,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54082,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54083,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54084,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54085,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54086,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54087,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54088,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54089,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54090,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54091,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54092,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54093,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54094,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54095,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54096,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54097,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54098,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54099,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54100,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54101,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54102,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54103,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54104,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54105,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54106,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54107,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54108,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54109,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54110,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54111,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54112,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54113,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54114,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54115,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54116,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54117,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54118,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54119,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54120,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54121,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54122,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54123,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54124,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54125,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54126,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54127,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54128,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54129,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54130,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54131,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54132,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54133,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54134,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54135,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54136,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54137,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54138,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54139,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54140,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54141,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54142,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54143,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54144,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54145,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54146,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54147,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54148,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54149,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54150,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54151,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54152,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54153,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54154,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54155,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54156,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54157,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54158,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54159,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54160,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54161,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54162,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54163,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54164,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54165,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54166,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54167,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54168,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54169,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54170,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54171,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54172,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54173,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54174,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54175,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54176,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54177,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54178,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54179,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54180,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54181,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54182,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54183,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54184,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54185,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54186,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54187,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54188,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54189,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54190,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54191,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54192,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54193,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54194,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54195,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54196,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54197,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54198,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54199,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54200,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54201,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54202,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54203,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54204,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54205,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54206,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54207,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54208,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54209,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54210,3934,37112034,TRIAGE,,277.0,277.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54211,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54212,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54213,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54214,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54215,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54216,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54217,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54218,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54219,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54220,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54221,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54222,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54223,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54224,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54225,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54226,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54227,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54228,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54229,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54230,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54231,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54232,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54233,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54234,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54235,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54236,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54237,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54238,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54239,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54240,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54241,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54242,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54243,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54244,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54245,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54246,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54247,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54248,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54249,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54250,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54251,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54252,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54253,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54254,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54255,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54256,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54257,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54258,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54259,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54260,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54261,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54262,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54263,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54264,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54265,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54266,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54267,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54268,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54269,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54270,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54271,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54272,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54273,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54274,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54275,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54276,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54277,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54278,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54279,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54280,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54281,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54282,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54283,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54284,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54285,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54286,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54287,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54288,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54289,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54290,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54291,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54292,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54293,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54294,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54295,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54296,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54297,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54298,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54299,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54300,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54301,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54302,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54303,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54304,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54305,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54306,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54307,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54308,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54309,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54310,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54311,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54312,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54313,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54314,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54315,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54316,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54317,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54318,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54319,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54320,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54321,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54322,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54323,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54324,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54325,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54326,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54327,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54328,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54329,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54330,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54331,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54332,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54333,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54334,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54335,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54336,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54337,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54338,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54339,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54340,3934,43301043,ALBUNEX,,357.0,357.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54341,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54342,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54343,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54344,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54345,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54346,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54347,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54348,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54349,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54350,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54351,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54352,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54353,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54354,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54355,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54356,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54357,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54358,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54359,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54360,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54361,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54362,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54363,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54364,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54365,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54366,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54367,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54368,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54369,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54370,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54371,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54372,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54373,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54374,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54375,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54376,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54377,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54378,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54379,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54380,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54381,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54382,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54383,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54384,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54385,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54386,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54387,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54388,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54389,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54390,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54391,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54392,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54393,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54394,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54395,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54396,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54397,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54398,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54399,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54400,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54401,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54402,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54403,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54404,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54405,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54406,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54407,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54408,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54409,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54410,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54411,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54412,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54413,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54414,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54415,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54416,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54417,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54418,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54419,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54420,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54421,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54422,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54423,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54424,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54425,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54426,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54427,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54428,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54429,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54430,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54431,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54432,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54433,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54434,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54435,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54436,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54437,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54438,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54439,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54440,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54441,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54442,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54443,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54444,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54445,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54446,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54447,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54448,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54449,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54450,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54451,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54452,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54453,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54454,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54455,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54456,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54457,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54458,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54459,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54460,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54461,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54462,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54463,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54464,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54465,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54466,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54467,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54468,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54469,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54470,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54471,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54472,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54473,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54474,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54475,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54476,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54477,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54478,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54479,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54480,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54481,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54482,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54483,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54484,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54485,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54486,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54487,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54488,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54489,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54490,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54491,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54492,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54493,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54494,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54495,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54496,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54497,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54498,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54499,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54500,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54501,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54502,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54503,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54504,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54505,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54506,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54507,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54508,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54509,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMPIRE HEALTHCHOICE ASSURANCE-HMO/POS, +54510,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54511,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54512,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,153038.48 +54513,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54514,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54515,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54516,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54517,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54518,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54519,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,87606.29 +54520,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54521,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54522,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46929.4 +54523,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54524,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,37610.39 +54525,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,26196.86 +54526,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54527,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54528,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54529,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54530,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54531,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54532,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54533,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54534,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54535,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54536,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54537,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54538,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10919.91 +54539,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54540,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,120178.01 +54541,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54542,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54543,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54544,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54545,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54546,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54547,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14369.93 +54548,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54549,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54550,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54551,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54552,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54553,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54554,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21603.13 +54555,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9958.23 +54556,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7511.85 +54557,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54558,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54559,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54560,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54561,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54562,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54563,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54564,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54565,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54566,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54567,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54568,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12533.6 +54569,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9050.7 +54570,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54571,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54572,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8719.52 +54573,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54574,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54575,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54576,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54577,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54578,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54579,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54580,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54581,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54582,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54583,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54584,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9066.81 +54585,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54586,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54587,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54588,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54589,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54590,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54591,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54592,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54593,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54594,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54595,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54596,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54597,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54598,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54599,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54600,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54601,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54602,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54603,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54604,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54605,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54606,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54607,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54608,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54609,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54610,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54611,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54612,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54613,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12398.27 +54614,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54615,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54616,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54617,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54618,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54619,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54620,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54621,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54622,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54623,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54624,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54625,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54626,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54627,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54628,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54629,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14145.67 +54630,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8911.4 +54631,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19999.16 +54632,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15763.38 +54633,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54634,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15686.89 +54635,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54636,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54637,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54638,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54639,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14137.7 +54640,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54641,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11602.96 +54642,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10799.71 +54643,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54644,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54645,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12286.81 +54646,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8722.71 +54647,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54648,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54649,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54650,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54651,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54652,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54653,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54654,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54655,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54656,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15828.57 +54657,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54658,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,73544.38 +54659,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,35209.09 +54660,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,90679.26 +54661,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54662,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54663,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54664,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54665,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54666,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,68891.89 +54667,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54668,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54669,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,48606.25 +54670,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54671,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54672,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,51331.79 +54673,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54674,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54675,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54676,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54677,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54678,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54679,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,28923.72 +54680,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,73828.84 +54681,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54682,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54683,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54684,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54685,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54686,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,39965.36 +54687,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,17400.22 +54688,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54689,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54690,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54691,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54692,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22978.27 +54693,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54694,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54695,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54696,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54697,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54698,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54699,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54700,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54701,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54702,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20204.69 +54703,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54704,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54705,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,81053.82 +54706,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,47740.89 +54707,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54708,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,36200.52 +54709,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,44004.68 +54710,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54711,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54712,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54713,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54714,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14798.46 +54715,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9272.83 +54716,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54717,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,60299.99 +54718,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54719,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19478.67 +54720,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54721,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54722,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54723,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12805.37 +54724,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8978.26 +54725,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54726,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54727,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54728,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54729,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54730,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54731,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54732,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10574.42 +54733,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54734,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54735,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9065.26 +54736,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54737,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54738,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54739,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54740,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8806.02 +54741,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54742,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19161.59 +54743,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9952.77 +54744,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54745,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54746,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54747,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54748,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54749,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54750,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54751,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22947.5 +54752,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14228.88 +54753,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54754,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54755,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,32823.5 +54756,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54757,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54758,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54759,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54760,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54761,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54762,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54763,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54764,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54765,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54766,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54767,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54768,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54769,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54770,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54771,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54772,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54773,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54774,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54775,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54776,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54777,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54778,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14023.51 +54779,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54780,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54781,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,13825.51 +54782,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54783,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54784,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,25158.67 +54785,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9759.23 +54786,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54787,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54788,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54789,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54790,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54791,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14741.94 +54792,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54793,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54794,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,13887.74 +54795,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8394.71 +54796,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54797,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54798,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54799,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15016.59 +54800,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9648.62 +54801,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54802,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,50099.52 +54803,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54804,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54805,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54806,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54807,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54808,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54809,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54810,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21145.69 +54811,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15291.24 +54812,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54813,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54814,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54815,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54816,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54817,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54818,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54819,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15806.31 +54820,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54821,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54822,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54823,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54824,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54825,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54826,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54827,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54828,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54829,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54830,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54831,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54832,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54833,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54834,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54835,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54836,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54837,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54838,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54839,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54840,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54841,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54842,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54843,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54844,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54845,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,17636.75 +54846,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54847,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54848,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54849,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54850,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54851,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54852,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54853,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,43209.4 +54854,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18777.05 +54855,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54856,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20849.54 +54857,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54858,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54859,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54860,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54861,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54862,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54863,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54864,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54865,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54866,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54867,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54868,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54869,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54870,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54871,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54872,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54873,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54874,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54875,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54876,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54877,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54878,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54879,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54880,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54881,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54882,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54883,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54884,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19533.09 +54885,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54886,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54887,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7989.81 +54888,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54889,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54890,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54891,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54892,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54893,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54894,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54895,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54896,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54897,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54898,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54899,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54900,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54901,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54902,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54903,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54904,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54905,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54906,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20137.8 +54907,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54908,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54909,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54910,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54911,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54912,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54913,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54914,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54915,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54916,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54917,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54918,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11424.04 +54919,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11882.39 +54920,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54921,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54922,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54923,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54924,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54925,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54926,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54927,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54928,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54929,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54930,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54931,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54932,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8577.83 +54933,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54934,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54935,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54936,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8424.98 +54937,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20853.52 +54938,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54939,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54940,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54941,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54942,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54943,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54944,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54945,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54946,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54947,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54948,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54949,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54950,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54951,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14794.51 +54952,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8853.26 +54953,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54954,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54955,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54956,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54957,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15093.82 +54958,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54959,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54960,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54961,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54962,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54963,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54964,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54965,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54966,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,27977.72 +54967,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54968,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54969,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54970,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54971,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54972,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54973,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54974,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54975,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54976,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54977,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54978,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54979,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54980,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54981,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54982,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12786.02 +54983,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54984,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54985,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54986,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10374.97 +54987,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12314.74 +54988,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5191.04 +54989,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54990,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54991,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54992,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54993,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54994,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10368.23 +54995,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54996,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54997,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54998,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +54999,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55000,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55001,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55002,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55003,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55004,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55005,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55006,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55007,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55008,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55009,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55010,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55011,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55012,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55013,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55014,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55015,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55016,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55017,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55018,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55019,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55020,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55021,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55022,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55023,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55024,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55025,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10829.17 +55026,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55027,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55028,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55029,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55030,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55031,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55032,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55033,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55034,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55035,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55036,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55037,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55038,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55039,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55040,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55041,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55042,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55043,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55044,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55045,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55046,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55047,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55048,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55049,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55050,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55051,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55052,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55053,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55054,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55055,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55056,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55057,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55058,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55059,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55060,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55061,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55062,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14685.15 +55063,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55064,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55065,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55066,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55067,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55068,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55069,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55070,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19008.96 +55071,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55072,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55073,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,47825.98 +55074,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55075,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55076,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55077,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55078,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55079,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55080,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55081,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55082,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55083,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,50016.63 +55084,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55085,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55086,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55087,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55088,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55089,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,27452.31 +55090,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55091,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55092,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55093,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55094,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55095,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55096,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55097,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,41215.88 +55098,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55099,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,38040.26 +55100,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55101,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55102,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55103,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9633.43 +55104,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55105,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55106,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55107,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55108,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55109,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55110,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,121397.74 +55111,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,23982.79 +55112,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10121.63 +55113,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55114,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55115,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55116,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55117,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55118,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,13346.39 +55119,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12705.3 +55120,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55121,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55122,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55123,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55124,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55125,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8424.18 +55126,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55127,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55128,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55129,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55130,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55131,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55132,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55133,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55134,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55135,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55136,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55137,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55138,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55139,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46796.96 +55140,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10030.69 +55141,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55142,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55143,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55144,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55145,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55146,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55147,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55148,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55149,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55150,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55151,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55152,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55153,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55154,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55155,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,32492.33 +55156,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55157,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55158,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55159,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55160,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55161,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55162,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55163,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22082.68 +55164,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,13861.04 +55165,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55166,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55167,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55168,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55169,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55170,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55171,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55172,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55173,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55174,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55175,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55176,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55177,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55178,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,404.96 +55179,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55180,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6625.25 +55181,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55182,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55183,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55184,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55185,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55186,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55187,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55188,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55189,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55190,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55191,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55192,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55193,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55194,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55195,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55196,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55197,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55198,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55199,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55200,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55201,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55202,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55203,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55204,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55205,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55206,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55207,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55208,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55209,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55210,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55211,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55212,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55213,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55214,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55215,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55216,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55217,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55218,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55219,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55220,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55221,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55222,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55223,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55224,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55225,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55226,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55227,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55228,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55229,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55230,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55231,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55232,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55233,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55234,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55235,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55236,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55237,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55238,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55239,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55240,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55241,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55242,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55243,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55244,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55245,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55246,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55247,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55248,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55249,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55250,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55251,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55252,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55253,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55254,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55255,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55256,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55257,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55258,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55259,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55260,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55261,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55262,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55263,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55264,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55265,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55266,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55267,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55268,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55269,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55270,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55271,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55272,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55273,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55274,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55275,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55276,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55277,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55278,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55279,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55280,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55281,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55282,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55283,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55284,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55285,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55286,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55287,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55288,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55289,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55290,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55291,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55292,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55293,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55294,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2008.58 +55295,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55296,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55297,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55298,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55299,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55300,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,309.42 +55301,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55302,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55303,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4197.35 +55304,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55305,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55306,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55307,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55308,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55309,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55310,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2008.58 +55311,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55312,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55313,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55314,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55315,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55316,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55317,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55318,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55319,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55320,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55321,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55322,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55323,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55324,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55325,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55326,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55327,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55328,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55329,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55330,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55331,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55332,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55333,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55334,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55335,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55336,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55337,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55338,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55339,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55340,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1676.72 +55341,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55342,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1705.93 +55343,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55344,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1647.51 +55345,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55346,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55347,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55348,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55349,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55350,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55351,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55352,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55353,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55354,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55355,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55356,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3714.84 +55357,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55358,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55359,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6596.45 +55360,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55361,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55362,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55363,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55364,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55365,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10444.83 +55366,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55367,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55368,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55369,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55370,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55371,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55372,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55373,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55374,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55375,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55376,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55377,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1647.51 +55378,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55379,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1662.9 +55380,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55381,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55382,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55383,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55384,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,305.81 +55385,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55386,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55387,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55388,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55389,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55390,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,305.81 +55391,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55392,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,305.81 +55393,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55394,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55395,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55396,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55397,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55398,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55399,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55400,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55401,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55402,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55403,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55404,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55405,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55406,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55407,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55408,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55409,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55410,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55411,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55412,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55413,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55414,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55415,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55416,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55417,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55418,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55419,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55420,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55421,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55422,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55423,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55424,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55425,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55426,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55427,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55428,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55429,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55430,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55431,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55432,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55433,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55434,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55435,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55436,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55437,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55438,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55439,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55440,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55441,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55442,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55443,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55444,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55445,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55446,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55447,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55448,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55449,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55450,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55451,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55452,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55453,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55454,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55455,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55456,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55457,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55458,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55459,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55460,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55461,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55462,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55463,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55464,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55465,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55466,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55467,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55468,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55469,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55470,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55471,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55472,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55473,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55474,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55475,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55476,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55477,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55478,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55479,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55480,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55481,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55482,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55483,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55484,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55485,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,241.44 +55486,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1688.17 +55487,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55488,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55489,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55490,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55491,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55492,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55493,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55494,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55495,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55496,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55497,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55498,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55499,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55500,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55501,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55502,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55503,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55504,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55505,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55506,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55507,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55508,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55509,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55510,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55511,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55512,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55513,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55514,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55515,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55516,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55517,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55518,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55519,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55520,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55521,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55522,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55523,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55524,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55525,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55526,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55527,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55528,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55529,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1630.36 +55530,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55531,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55532,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55533,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55534,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55535,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55536,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55537,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55538,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55539,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55540,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55541,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55542,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55543,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55544,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55545,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55546,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55547,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55548,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55549,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55550,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55551,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55552,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55553,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55554,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55555,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55556,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55557,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55558,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55559,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55560,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55561,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55562,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55563,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55564,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55565,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55566,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55567,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55568,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55569,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55570,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55571,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55572,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55573,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55574,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55575,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55576,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55577,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55578,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55579,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55580,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55581,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55582,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55583,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55584,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55585,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55586,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55587,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55588,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55589,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55590,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55591,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55592,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55593,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,241.44 +55594,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55595,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55596,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55597,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55598,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55599,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55600,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55601,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55602,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55603,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55604,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55605,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55606,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55607,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55608,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55609,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55610,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55611,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55612,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55613,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55614,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55615,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55616,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55617,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55618,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55619,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55620,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55621,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55622,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55623,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55624,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55625,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55626,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55627,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55628,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55629,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55630,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55631,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55632,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55633,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55634,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55635,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55636,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55637,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55638,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55639,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55640,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14537.53 +55641,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55642,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55643,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55644,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55645,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55646,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55647,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55648,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55649,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55650,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55651,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55652,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55653,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55654,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55655,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55656,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55657,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55658,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55659,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55660,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55661,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55662,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55663,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55664,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55665,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55666,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55667,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55668,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55669,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55670,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55671,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55672,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14419.85 +55673,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55674,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55675,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55676,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55677,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55678,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55679,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55680,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55681,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55682,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55683,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55684,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55685,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55686,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55687,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55688,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55689,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55690,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55691,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55692,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55693,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55694,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55695,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55696,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55697,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55698,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55699,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55700,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55701,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55702,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55703,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55704,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55705,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55706,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55707,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55708,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55709,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55710,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55711,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55712,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55713,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55714,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55715,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55716,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55717,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55718,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55719,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55720,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55721,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55722,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55723,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55724,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55725,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55726,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55727,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55728,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55729,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55730,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55731,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55732,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55733,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55734,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55735,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55736,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55737,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55738,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55739,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55740,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55741,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55742,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55743,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55744,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55745,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55746,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55747,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55748,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55749,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55750,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3314.23 +55751,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55752,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55753,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55754,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55755,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55756,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55757,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55758,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55759,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55760,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55761,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55762,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55763,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55764,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55765,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55766,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55767,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55768,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55769,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55770,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55771,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55772,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55773,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55774,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55775,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55776,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55777,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55778,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55779,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55780,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55781,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55782,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55783,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55784,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55785,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55786,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55787,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55788,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55789,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55790,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55791,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55792,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55793,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55794,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55795,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55796,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55797,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55798,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55799,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55800,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55801,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55802,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55803,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55804,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55805,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55806,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55807,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55808,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55809,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55810,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55811,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55812,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55813,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55814,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7335.88 +55815,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55816,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55817,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55818,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55819,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1688.17 +55820,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55821,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55822,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55823,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55824,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55825,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55826,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55827,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55828,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55829,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55830,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55831,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55832,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55833,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55834,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55835,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55836,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55837,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55838,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55839,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55840,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55841,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55842,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55843,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55844,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55845,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55846,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55847,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55848,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55849,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55850,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55851,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55852,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55853,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55854,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55855,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55856,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55857,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55858,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55859,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55860,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55861,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55862,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55863,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55864,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55865,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55866,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55867,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55868,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55869,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55870,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55871,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55872,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55873,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55874,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55875,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55876,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55877,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55878,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55879,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55880,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55881,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1814.31 +55882,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55883,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55884,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55885,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55886,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3627.6 +55887,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55888,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4025.35 +55889,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,192.49 +55890,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55891,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55892,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55893,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55894,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55895,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55896,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55897,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55898,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55899,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55900,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55901,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55902,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55903,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55904,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55905,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55906,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55907,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55908,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55909,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55910,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55911,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55912,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55913,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55914,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55915,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55916,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55917,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1662.9 +55918,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55919,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3766.97 +55920,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55921,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55922,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55923,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55924,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,763.86 +55925,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55926,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55927,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55928,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55929,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55930,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55931,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55932,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55933,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55934,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22565.41 +55935,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55936,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55937,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55938,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55939,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55940,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55941,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22565.41 +55942,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55943,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55944,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55945,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55946,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55947,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55948,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55949,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55950,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,38452.37 +55951,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55952,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55953,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55954,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9546.18 +55955,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55956,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5637.13 +55957,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55958,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55959,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55960,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55961,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55962,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55963,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55964,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55965,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55966,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55967,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55968,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55969,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55970,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55971,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55972,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55973,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55974,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55975,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55976,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55977,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55978,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55979,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55980,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55981,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55982,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55983,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5585.82 +55984,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55985,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55986,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55987,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55988,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55989,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55990,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55991,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55992,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55993,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3.0 +55994,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55995,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,329.08 +55996,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55997,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55998,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +55999,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56000,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1589.88 +56001,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56002,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56003,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56004,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56005,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56006,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1646.51 +56007,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56008,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56009,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56010,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56011,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56012,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56013,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56014,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56015,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,132.03 +56016,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,131.09 +56017,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56018,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56019,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56020,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56021,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56022,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56023,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56024,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56025,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56026,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56027,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56028,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56029,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56030,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56031,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56032,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56033,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56034,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56035,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56036,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56037,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56038,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56039,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56040,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56041,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56042,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56043,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56044,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56045,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56046,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56047,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56048,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56049,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56050,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56051,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56052,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56053,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56054,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56055,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56056,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56057,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56058,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56059,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56060,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56061,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56062,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56063,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56064,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56065,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56066,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56067,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56068,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56069,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56070,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56071,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56072,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56073,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56074,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56075,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1647.51 +56076,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56077,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2775.14 +56078,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56079,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56080,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5088.72 +56081,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6479.91 +56082,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56083,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56084,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56085,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56086,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56087,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56088,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56089,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56090,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56091,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56092,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56093,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56094,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56095,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56096,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56097,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56098,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56099,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56100,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56101,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56102,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56103,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56104,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56105,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56106,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56107,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56108,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56109,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56110,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56111,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56112,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56113,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56114,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56115,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56116,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56117,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56118,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56119,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56120,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56121,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56122,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56123,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56124,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56125,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56126,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56127,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56128,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56129,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56130,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56131,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56132,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56133,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56134,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56135,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56136,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56137,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56138,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56139,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56140,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56141,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56142,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56143,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56144,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56145,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56146,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56147,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56148,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56149,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56150,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56151,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56152,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56153,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56154,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56155,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56156,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56157,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,247.77 +56158,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56159,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56160,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56161,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56162,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56163,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56164,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1902.8 +56165,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56166,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,829.49 +56167,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56168,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56169,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1970.27 +56170,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56171,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56172,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56173,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1902.8 +56174,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56175,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56176,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56177,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56178,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56179,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56180,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56181,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56182,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56183,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1902.8 +56184,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56185,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56186,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56187,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56188,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56189,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56190,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56191,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56192,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3735.33 +56193,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5888.1 +56194,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56195,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56196,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56197,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56198,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56199,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56200,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56201,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56202,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56203,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56204,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56205,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56206,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56207,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,311.63 +56208,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56209,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56210,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56211,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56212,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56213,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56214,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56215,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56216,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56217,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56218,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56219,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56220,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56221,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56222,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56223,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56224,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56225,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56226,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56227,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56228,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56229,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56230,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56231,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56232,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56233,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56234,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56235,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56236,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56237,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56238,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56239,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56240,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56241,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56242,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56243,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56244,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56245,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56246,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56247,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56248,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56249,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56250,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56251,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56252,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56253,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56254,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56255,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56256,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56257,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56258,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56259,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56260,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1214.22 +56261,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56262,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56263,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56264,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2861.06 +56265,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56266,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56267,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56268,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56269,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56270,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56271,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56272,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56273,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56274,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56275,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2107.99 +56276,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56277,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56278,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56279,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56280,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56281,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56282,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56283,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56284,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56285,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56286,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56287,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56288,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56289,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56290,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56291,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56292,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56293,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56294,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56295,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56296,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56297,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56298,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56299,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56300,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56301,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56302,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56303,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56304,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4803.18 +56305,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56306,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56307,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56308,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56309,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56310,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56311,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56312,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11394.46 +56313,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10981.56 +56314,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56315,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56316,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56317,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56318,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56319,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56320,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56321,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56322,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56323,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56324,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56325,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56326,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56327,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56328,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56329,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56330,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56331,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56332,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56333,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56334,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56335,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56336,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56337,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56338,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56339,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56340,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56341,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56342,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56343,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56344,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56345,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56346,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4694.9 +56347,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56348,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56349,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56350,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56351,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56352,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56353,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56354,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56355,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56356,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56357,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56358,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56359,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56360,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56361,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56362,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10959.0 +56363,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56364,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56365,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56366,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56367,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56368,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56369,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56370,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56371,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56372,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56373,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56374,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56375,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56376,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56377,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56378,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56379,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56380,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56381,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56382,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56383,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56384,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56385,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56386,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12298.0 +56387,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56388,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56389,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56390,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56391,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56392,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56393,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56394,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56395,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56396,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56397,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56398,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56399,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,205.34 +56400,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56401,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56402,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56403,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56404,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56405,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56406,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56407,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56408,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56409,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,408.0 +56410,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,132.0 +56411,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56412,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56413,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2400.35 +56414,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56415,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2400.35 +56416,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56417,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56418,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56419,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56420,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56421,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56422,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56423,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56424,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56425,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56426,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56427,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56428,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56429,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56430,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56431,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56432,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56433,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56434,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56435,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56436,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4903.12 +56437,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56438,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56439,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56440,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56441,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8787.94 +56442,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56443,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56444,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5774.21 +56445,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56446,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56447,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56448,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56449,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56450,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56451,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56452,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56453,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56454,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56455,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56456,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56457,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56458,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56459,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56460,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56461,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56462,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56463,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56464,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56465,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56466,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56467,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56468,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56469,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56470,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4944.86 +56471,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56472,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56473,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56474,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56475,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56476,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56477,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56478,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56479,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56480,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56481,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56482,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56483,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56484,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56485,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56486,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56487,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56488,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56489,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56490,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56491,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56492,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56493,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56494,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56495,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56496,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56497,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56498,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56499,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56500,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56501,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56502,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56503,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56504,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56505,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56506,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56507,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56508,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56509,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56510,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56511,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56512,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56513,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2400.35 +56514,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56515,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56516,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56517,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56518,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56519,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56520,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56521,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56522,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56523,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56524,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56525,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56526,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56527,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56528,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56529,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56530,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56531,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56532,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56533,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56534,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56535,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56536,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56537,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56538,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56539,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56540,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56541,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56542,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56543,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56544,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56545,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56546,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56547,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56548,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56549,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56550,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56551,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56552,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56553,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6316.23 +56554,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56555,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56556,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56557,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56558,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56559,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56560,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56561,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56562,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56563,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56564,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56565,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56566,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56567,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56568,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56569,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4642.0 +56570,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56571,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56572,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56573,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56574,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56575,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56576,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56577,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56578,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56579,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56580,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2321.0 +56581,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56582,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56583,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56584,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56585,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56586,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56587,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56588,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56589,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56590,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56591,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56592,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56593,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4763.14 +56594,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56595,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56596,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56597,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4642.0 +56598,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4642.0 +56599,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56600,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56601,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7140.2 +56602,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56603,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56604,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56605,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56606,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56607,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56608,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56609,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56610,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56611,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56612,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56613,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56614,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56615,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56616,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56617,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56618,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56619,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4644.27 +56620,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56621,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56622,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56623,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56624,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56625,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56626,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56627,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56628,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4884.29 +56629,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56630,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56631,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4642.0 +56632,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56633,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56634,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56635,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56636,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4571.57 +56637,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56638,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56639,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4736.0 +56640,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56641,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56642,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56643,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56644,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56645,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56646,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56647,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56648,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56649,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56650,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56651,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56652,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56653,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56654,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56655,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56656,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1044.64 +56657,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56658,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56659,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56660,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56661,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56662,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56663,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56664,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56665,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56666,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56667,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56668,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56669,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56670,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56671,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56672,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56673,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56674,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56675,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56676,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56677,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56678,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56679,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56680,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56681,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56682,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56683,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56684,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56685,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56686,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56687,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56688,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56689,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56690,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56691,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56692,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56693,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5089.02 +56694,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56695,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56696,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56697,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56698,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56699,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56700,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56701,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56702,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56703,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56704,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56705,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56706,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56707,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56708,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56709,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56710,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56711,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56712,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56713,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56714,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56715,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56716,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56717,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56718,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56719,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56720,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56721,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56722,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56723,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56724,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56725,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56726,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56727,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56728,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56729,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4944.86 +56730,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56731,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56732,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56733,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56734,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56735,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56736,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2597.1 +56737,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56738,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56739,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56740,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56741,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56742,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56743,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56744,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56745,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56746,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56747,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56748,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56749,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56750,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56751,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56752,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56753,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56754,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56755,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56756,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56757,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56758,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56759,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56760,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56761,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56762,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56763,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56764,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56765,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56766,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56767,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56768,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56769,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56770,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56771,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56772,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56773,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56774,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56775,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56776,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56777,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56778,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56779,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56780,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56781,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56782,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56783,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56784,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56785,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56786,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56787,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56788,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56789,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56790,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56791,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56792,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56793,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56794,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56795,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56796,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56797,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5267.11 +56798,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4792.4 +56799,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56800,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56801,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56802,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56803,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56804,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56805,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56806,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56807,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56808,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56809,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56810,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56811,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4778.3 +56812,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6108.21 +56813,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56814,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56815,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56816,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56817,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56818,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56819,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56820,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56821,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56822,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56823,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56824,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56825,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56826,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56827,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56828,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56829,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56830,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4800.7 +56831,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56832,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56833,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56834,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56835,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56836,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56837,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56838,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56839,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56840,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56841,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56842,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56843,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56844,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6984.77 +56845,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56846,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56847,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56848,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56849,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56850,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56851,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56852,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56853,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56854,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56855,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56856,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56857,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56858,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56859,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56860,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56861,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56862,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56863,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56864,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56865,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,305.9 +56866,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56867,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56868,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56869,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56870,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56871,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56872,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56873,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56874,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56875,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56876,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56877,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5579.09 +56878,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56879,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56880,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56881,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56882,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56883,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56884,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56885,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56886,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56887,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56888,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56889,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56890,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56891,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56892,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56893,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,380.92 +56894,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56895,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56896,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56897,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56898,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1873.36 +56899,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56900,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56901,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56902,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56903,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56904,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2724.71 +56905,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,643.22 +56906,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56907,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,509.12 +56908,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1886.65 +56909,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56910,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4330.52 +56911,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4330.52 +56912,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56913,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4444.81 +56914,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3807.58 +56915,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56916,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,536.04 +56917,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7344.34 +56918,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56919,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3996.86 +56920,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56921,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6734.3 +56922,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56923,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1660.89 +56924,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,456.36 +56925,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56926,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56927,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56928,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56929,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56930,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56931,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2225.93 +56932,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5479.22 +56933,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56934,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56935,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3473.6 +56936,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56937,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56938,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56939,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,288.19 +56940,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,47.23 +56941,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,66.52 +56942,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,79.94 +56943,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,39.02 +56944,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56945,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56946,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,328.23 +56947,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,516.34 +56948,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56949,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56950,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,556.92 +56951,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,63.96 +56952,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56953,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2762.24 +56954,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56955,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56956,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56957,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56958,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56959,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56960,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3405.45 +56961,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5236.3 +56962,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3446.99 +56963,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,403.64 +56964,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3879.29 +56965,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56966,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5323.06 +56967,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5409.54 +56968,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4865.9 +56969,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,393.51 +56970,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56971,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56972,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56973,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56974,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,347.34 +56975,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56976,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5025.95 +56977,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56978,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,39.18 +56979,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,393.79 +56980,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56981,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56982,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,472.72 +56983,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56984,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,436.27 +56985,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,389.0 +56986,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,441.24 +56987,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,421.74 +56988,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,502.6 +56989,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,540.15 +56990,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56991,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,774.51 +56992,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,460.88 +56993,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56994,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1432.86 +56995,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56996,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56997,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +56998,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3505.32 +56999,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,625.53 +57000,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57001,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,411.25 +57002,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57003,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57004,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,558.25 +57005,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,78.04 +57006,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,352.76 +57007,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,357.9 +57008,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,398.18 +57009,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,436.76 +57010,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,575.4 +57011,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57012,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,493.77 +57013,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,460.75 +57014,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,380.81 +57015,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,556.21 +57016,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,36.46 +57017,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,592.0 +57018,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,365.52 +57019,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,39.82 +57020,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1351.74 +57021,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57022,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,653.87 +57023,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,342.86 +57024,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4313.41 +57025,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2290.17 +57026,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57027,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57028,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57029,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57030,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57031,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57032,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57033,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1432.86 +57034,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57035,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3152.8 +57036,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4236.1 +57037,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,463.84 +57038,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1679.83 +57039,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5640.23 +57040,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57041,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,106.4 +57042,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57043,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57044,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,628.49 +57045,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,725.38 +57046,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57047,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57048,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57049,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57050,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57051,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57052,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57053,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57054,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57055,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57056,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57057,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57058,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,132.38 +57059,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,405.64 +57060,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57061,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57062,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57063,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5719.33 +57064,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57065,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1100.24 +57066,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2302.13 +57067,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57068,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57069,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57070,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57071,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57072,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57073,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57074,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57075,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57076,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57077,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57078,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57079,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57080,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57081,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57082,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57083,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57084,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2986.84 +57085,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57086,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1056.61 +57087,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,49.24 +57088,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57089,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,734.28 +57090,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57091,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57092,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57093,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57094,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57095,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57096,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57097,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57098,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,156.77 +57099,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,298.12 +57100,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,697.41 +57101,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,614.76 +57102,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,963.24 +57103,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,256.21 +57104,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57105,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1259.58 +57106,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,53.75 +57107,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57108,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57109,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57110,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57111,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57112,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57113,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57114,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57115,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1700.8 +57116,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57117,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1606.0 +57118,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1624.3 +57119,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57120,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57121,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2892.09 +57122,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2892.09 +57123,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3737.84 +57124,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2716.38 +57125,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57126,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,528.39 +57127,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57128,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57129,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57130,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,331.52 +57131,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,126.09 +57132,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57133,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57134,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57135,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57136,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57137,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57138,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57139,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57140,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57141,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57142,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57143,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57144,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,313.08 +57145,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57146,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3483.53 +57147,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57148,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,139.45 +57149,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,142.08 +57150,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,159.37 +57151,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,607.79 +57152,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,771.52 +57153,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,739.79 +57154,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,454.08 +57155,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,637.73 +57156,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57157,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57158,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,787.31 +57159,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57160,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,929.3 +57161,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2225.97 +57162,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,250.0 +57163,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,975.68 +57164,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2547.69 +57165,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11033.96 +57166,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57167,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57168,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57169,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57170,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57171,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5061.35 +57172,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57173,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3176.83 +57174,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1109.92 +57175,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11022.21 +57176,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,266.82 +57177,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57178,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7567.78 +57179,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2020.66 +57180,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2594.77 +57181,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57182,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57183,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57184,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1246.18 +57185,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,590.66 +57186,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3383.24 +57187,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57188,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57189,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57190,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57191,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57192,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1693.59 +57193,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,500.34 +57194,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,946.6 +57195,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57196,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1530.11 +57197,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57198,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57199,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1558.94 +57200,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,664.08 +57201,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57202,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2004.46 +57203,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57204,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57205,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9515.44 +57206,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57207,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57208,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57209,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57210,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,350.46 +57211,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57212,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6569.19 +57213,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57214,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57215,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57216,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57217,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1682.68 +57218,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57219,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57220,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,530.14 +57221,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57222,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9070.42 +57223,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57224,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57225,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9526.79 +57226,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2723.21 +57227,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57228,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57229,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1673.24 +57230,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57231,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57232,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57233,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,233.85 +57234,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15.0 +57235,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,334.24 +57236,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57237,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,222.41 +57238,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57239,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,525.35 +57240,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,260.77 +57241,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,61.58 +57242,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57243,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57244,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57245,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57246,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57247,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57248,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57249,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57250,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57251,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57252,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57253,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57254,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57255,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57256,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,32.0 +57257,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57258,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57259,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57260,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57261,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,30.0 +57262,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21.2 +57263,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19.2 +57264,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57265,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57266,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57267,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57268,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57269,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57270,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57271,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57272,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,58.71 +57273,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57274,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57275,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57276,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57277,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57278,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57279,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57280,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57281,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57282,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57283,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57284,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57285,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57286,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57287,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57288,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57289,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,177.91 +57290,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57291,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,72.08 +57292,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57293,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20.2 +57294,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57295,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57296,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57297,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57298,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57299,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57300,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57301,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57302,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57303,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57304,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57305,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57306,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57307,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57308,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57309,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57310,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57311,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57312,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57313,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57314,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57315,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57316,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57317,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57318,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57319,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,214.29 +57320,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,267.7 +57321,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57322,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57323,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57324,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57325,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57326,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57327,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57328,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57329,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57330,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57331,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57332,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57333,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57334,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,292.46 +57335,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57336,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57337,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57338,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57339,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57340,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57341,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57342,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57343,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57344,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57345,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57346,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57347,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57348,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57349,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57350,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57351,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57352,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57353,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57354,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57355,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57356,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57357,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57358,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57359,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,334.21 +57360,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57361,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57362,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,105.9 +57363,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57364,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57365,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57366,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57367,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57368,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57369,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57370,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57371,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57372,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57373,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57374,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57375,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57376,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57377,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57378,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57379,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57380,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57381,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,23.2 +57382,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,53.94 +57383,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,38.53 +57384,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57385,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,135.73 +57386,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57387,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15.0 +57388,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,189.17 +57389,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57390,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,192.38 +57391,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57392,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57393,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,152.05 +57394,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57395,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22.2 +57396,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57397,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,98.4 +57398,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57399,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7.0 +57400,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57401,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57402,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16.2 +57403,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,190.66 +57404,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57405,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,89.51 +57406,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,73.36 +57407,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3.0 +57408,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57409,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,29.0 +57410,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57411,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,400.22 +57412,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,44.07 +57413,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,63.55 +57414,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,24.2 +57415,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.0 +57416,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57417,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,49.74 +57418,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57419,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,228.91 +57420,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,25.43 +57421,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57422,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57423,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,98.75 +57424,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57425,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,57.57 +57426,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5.03 +57427,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,31.4 +57428,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6.67 +57429,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,23.0 +57430,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57431,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.0 +57432,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57433,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,32.48 +57434,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,26.2 +57435,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,60.69 +57436,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57437,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57438,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,82.44 +57439,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,125.75 +57440,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57441,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57442,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,62.03 +57443,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,192.21 +57444,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46.0 +57445,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,40.78 +57446,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57447,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57448,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20.0 +57449,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,26.2 +57450,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57451,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57452,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7.48 +57453,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,290.68 +57454,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57455,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57456,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,36.0 +57457,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57458,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57459,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57460,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57461,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,159.62 +57462,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57463,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,213.02 +57464,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57465,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,305.04 +57466,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,197.12 +57467,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,37.5 +57468,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57469,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,128.14 +57470,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57471,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57472,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46.35 +57473,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57474,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57475,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57476,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57477,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57478,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57479,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,53.07 +57480,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11.0 +57481,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,195.36 +57482,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,209.56 +57483,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,70.0 +57484,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57485,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,130.48 +57486,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57487,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57488,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,122.79 +57489,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57490,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,165.08 +57491,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57492,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57493,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57494,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,221.58 +57495,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57496,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57497,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57498,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,24.24 +57499,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,42.76 +57500,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,93.74 +57501,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.0 +57502,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,89.64 +57503,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18.0 +57504,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,194.24 +57505,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57506,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57507,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6.58 +57508,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,102.36 +57509,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57510,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57511,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57512,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.96 +57513,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,83.14 +57514,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57515,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57516,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57517,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,27.2 +57518,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57519,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57520,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57521,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,142.64 +57522,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,56.44 +57523,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,239.93 +57524,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57525,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,27.2 +57526,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,45.0 +57527,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57528,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57529,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.0 +57530,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57531,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,334.85 +57532,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57533,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57534,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57535,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57536,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.0 +57537,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11.22 +57538,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,52.62 +57539,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57540,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,101.41 +57541,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57542,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57543,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7.0 +57544,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5.03 +57545,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,91.94 +57546,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57547,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,204.15 +57548,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57549,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,36.4 +57550,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57551,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,272.59 +57552,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57553,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57554,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,39.21 +57555,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57556,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,139.65 +57557,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57558,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57559,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57560,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57561,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.96 +57562,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.2 +57563,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57564,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,13.0 +57565,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,33.11 +57566,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15.0 +57567,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57568,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.0 +57569,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,52.34 +57570,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46.14 +57571,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57572,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57573,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57574,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57575,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57576,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57577,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57578,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,49.55 +57579,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46.26 +57580,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.06 +57581,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16.0 +57582,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,115.14 +57583,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,212.09 +57584,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19.95 +57585,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,253.05 +57586,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57587,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,24.34 +57588,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,35.59 +57589,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,40.51 +57590,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,119.85 +57591,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.77 +57592,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9.87 +57593,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,93.31 +57594,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,306.97 +57595,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57596,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.08 +57597,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,67.32 +57598,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,35.05 +57599,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,51.44 +57600,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,74.55 +57601,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4.0 +57602,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57603,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,26.36 +57604,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,31.0 +57605,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57606,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,40.56 +57607,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11.0 +57608,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18.07 +57609,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,275.39 +57610,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,221.88 +57611,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57612,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57613,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4.0 +57614,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57615,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,39.47 +57616,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,38.59 +57617,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,116.34 +57618,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,94.98 +57619,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57620,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,49.97 +57621,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57622,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,60.16 +57623,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18777.32 +57624,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57625,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57626,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,30.2 +57627,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,277.84 +57628,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,33.2 +57629,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,33.2 +57630,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57631,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57632,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57633,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57634,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57635,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57636,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18.2 +57637,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57638,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57639,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,17.2 +57640,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18.2 +57641,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22.0 +57642,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57643,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57644,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,155.47 +57645,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,107.48 +57646,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57647,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57648,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57649,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57650,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,115.14 +57651,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57652,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,582.16 +57653,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,74.26 +57654,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57655,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,269.05 +57656,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57657,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,71.38 +57658,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57659,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,48.67 +57660,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,118.13 +57661,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57662,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57663,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57664,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,81.67 +57665,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6.08 +57666,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,56.28 +57667,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,55.22 +57668,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57669,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,122.53 +57670,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,89.65 +57671,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,101.4 +57672,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,86.17 +57673,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57674,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,39.0 +57675,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,376.74 +57676,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,42.0 +57677,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57678,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57679,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,263.26 +57680,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18.25 +57681,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.17 +57682,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,106.74 +57683,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7.44 +57684,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,164.82 +57685,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,323.76 +57686,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16.2 +57687,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,88.33 +57688,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,217.0 +57689,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,280.65 +57690,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,306.09 +57691,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57692,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1660.89 +57693,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,27.76 +57694,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,48.67 +57695,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,80.0 +57696,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57697,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,183.18 +57698,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57699,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57700,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57701,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16.22 +57702,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,25.43 +57703,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,64.22 +57704,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57705,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57706,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57707,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57708,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,268.37 +57709,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,396.42 +57710,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57711,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,24.34 +57712,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,62.63 +57713,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,251.84 +57714,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57715,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,78.93 +57716,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57717,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57718,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57719,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57720,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57721,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57722,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,207.03 +57723,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,133.59 +57724,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57725,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57726,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9.0 +57727,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9.33 +57728,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57729,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57730,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,190.32 +57731,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7.89 +57732,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,26.0 +57733,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4.0 +57734,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,17.76 +57735,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19.95 +57736,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,36.0 +57737,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,35.83 +57738,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,35.75 +57739,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57740,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57741,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21.93 +57742,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57743,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57744,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57745,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57746,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57747,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15.35 +57748,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,72.33 +57749,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,117.62 +57750,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,88.33 +57751,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57752,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20.2 +57753,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,112.32 +57754,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57755,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57756,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.25 +57757,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22.0 +57758,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57759,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21.68 +57760,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16.5 +57761,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21.63 +57762,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,30.43 +57763,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.25 +57764,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,92.28 +57765,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,123.66 +57766,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,116.65 +57767,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,23.24 +57768,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,195.58 +57769,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57770,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57771,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,26.0 +57772,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.0 +57773,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,156.34 +57774,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57775,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,254.94 +57776,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,64.0 +57777,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,154.0 +57778,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,140.0 +57779,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,772.51 +57780,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57781,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1009.98 +57782,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,449.32 +57783,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57784,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57785,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,452.98 +57786,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,483.5 +57787,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57788,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1500.78 +57789,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,295.01 +57790,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,956.14 +57791,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,889.32 +57792,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57793,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57794,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.0 +57795,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.0 +57796,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,191.41 +57797,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,490.18 +57798,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,73.94 +57799,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,117.2 +57800,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,223.28 +57801,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,158.4 +57802,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,65.19 +57803,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57804,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19.2 +57805,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,63.55 +57806,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46.69 +57807,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,35.89 +57808,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57809,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57810,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,113.82 +57811,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57812,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57813,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57814,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57815,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57816,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57817,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11.0 +57818,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57819,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,86.73 +57820,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57821,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,78.37 +57822,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57823,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,61.13 +57824,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,82.9 +57825,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57826,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.0 +57827,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15.0 +57828,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.0 +57829,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,80.4 +57830,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,76.26 +57831,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,38.13 +57832,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57833,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16.0 +57834,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19.2 +57835,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,85.85 +57836,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57837,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57838,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57839,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,74.89 +57840,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57841,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57842,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57843,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,76.26 +57844,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57845,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57846,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57847,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,33.51 +57848,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57849,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57850,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57851,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57852,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,422.95 +57853,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,227.3 +57854,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57855,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,54.2 +57856,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57857,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57858,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57859,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57860,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57861,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57862,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,57.46 +57863,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57864,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,503.59 +57865,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57866,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57867,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57868,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57869,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57870,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57871,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57872,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57873,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57874,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,181.34 +57875,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,161.19 +57876,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,115.09 +57877,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57878,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1576.92 +57879,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,112.5 +57880,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57881,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57882,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57883,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,250.0 +57884,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,67.0 +57885,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,142.52 +57886,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57887,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57888,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,17.2 +57889,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57890,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,82.0 +57891,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57892,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57893,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57894,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57895,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57896,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57897,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,173.6 +57898,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57899,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,53.4 +57900,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14672.88 +57901,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,13934.41 +57902,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57903,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,192.0 +57904,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57905,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57906,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57907,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,995.44 +57908,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57909,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57910,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57911,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57912,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57913,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57914,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57915,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57916,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57917,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57918,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57919,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57920,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,323.44 +57921,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1336.61 +57922,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2925.26 +57923,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57924,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,168.39 +57925,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,79.0 +57926,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2546.93 +57927,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57928,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57929,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57930,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1917.74 +57931,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,166.6 +57932,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57933,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57934,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,668.3 +57935,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1742.68 +57936,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,319.98 +57937,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57938,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57939,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57940,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1096.0 +57941,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57942,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57943,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57944,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1298.0 +57945,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57946,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.0 +57947,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57948,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,138.32 +57949,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57950,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2322.87 +57951,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57952,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57953,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.0 +57954,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57955,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57956,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57957,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57958,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57959,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57960,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57961,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57962,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57963,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20.61 +57964,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57965,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57966,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,50.2 +57967,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,90.68 +57968,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,75.68 +57969,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57970,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57971,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57972,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57973,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,848.25 +57974,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57975,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57976,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57977,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57978,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57979,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57980,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57981,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57982,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57983,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57984,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57985,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57986,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57987,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57988,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57989,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57990,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57991,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,282.0 +57992,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,680.0 +57993,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,282.0 +57994,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57995,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57996,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,276.12 +57997,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57998,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +57999,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,473.0 +58000,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,473.0 +58001,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58002,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58003,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58004,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58005,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58006,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58007,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58008,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58009,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58010,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58011,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58012,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58013,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58014,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58015,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58016,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58017,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58018,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58019,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58020,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58021,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58022,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,166.64 +58023,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58024,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,560.86 +58025,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58026,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1339.67 +58027,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58028,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1339.67 +58029,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58030,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58031,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,341.37 +58032,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58033,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,214.87 +58034,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,462.44 +58035,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,134.92 +58036,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1228.98 +58037,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,428.22 +58038,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58039,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,140.0 +58040,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58041,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,156.99 +58042,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,391.04 +58043,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,491.4 +58044,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,467.46 +58045,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,532.36 +58046,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58047,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1327.87 +58048,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,606.91 +58049,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58050,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58051,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,830.62 +58052,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58053,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,70.0 +58054,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58055,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58056,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,568.52 +58057,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,750.36 +58058,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58059,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,622.59 +58060,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,162.24 +58061,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58062,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58063,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58064,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58065,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58066,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1339.67 +58067,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18789.86 +58068,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58069,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58070,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20816.02 +58071,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58072,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58073,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58074,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58075,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58076,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18936.94 +58077,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58078,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2030.3 +58079,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,221.07 +58080,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58081,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58082,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58083,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,291.89 +58084,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,994.05 +58085,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58086,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58087,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58088,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58089,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58090,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58091,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58092,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58093,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3604.37 +58094,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58095,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3812.56 +58096,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58097,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4086.5 +58098,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58099,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,937.52 +58100,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,34.86 +58101,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,728.86 +58102,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,431.26 +58103,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58104,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1.0 +58105,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58106,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58107,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58108,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58109,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58110,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58111,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58112,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3557.01 +58113,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58114,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58115,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58116,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58117,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58118,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58119,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58120,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58121,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58122,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58123,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58124,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58125,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58126,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58127,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58128,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58129,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58130,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58131,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,51881.56 +58132,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58133,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,25747.14 +58134,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58135,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58136,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58137,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58138,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58139,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,227.86 +58140,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58141,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,289.76 +58142,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58143,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,402.34 +58144,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58145,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58146,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,389.56 +58147,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58148,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58149,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58150,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1259.58 +58151,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1760.66 +58152,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1663.07 +58153,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58154,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,269.94 +58155,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58156,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58157,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58158,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,274.83 +58159,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,722.66 +58160,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58161,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58162,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58163,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58164,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,98.0 +58165,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58166,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58167,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58168,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1477.41 +58169,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,736.89 +58170,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,257.11 +58171,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,172.71 +58172,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58173,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58174,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58175,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58176,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58177,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,235.54 +58178,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58179,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58180,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58181,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58182,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58183,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1076.0 +58184,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,680.0 +58185,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4432.16 +58186,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,476.0 +58187,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58188,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2104.18 +58189,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,639.2 +58190,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58191,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58192,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,157.34 +58193,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,152.36 +58194,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58195,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58196,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58197,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58198,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58199,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58200,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58201,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58202,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58203,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58204,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58205,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58206,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58207,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58208,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58209,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58210,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58211,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,531.34 +58212,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58213,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58214,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58215,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58216,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,477.56 +58217,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,610.58 +58218,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1145.33 +58219,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,565.8 +58220,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58221,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58222,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,949.34 +58223,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1009.89 +58224,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,544.64 +58225,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2041.9 +58226,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,701.25 +58227,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,483.88 +58228,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,362.22 +58229,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,753.35 +58230,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1131.81 +58231,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58232,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58233,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58234,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,753.38 +58235,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,799.56 +58236,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2888.12 +58237,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1159.22 +58238,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1685.43 +58239,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58240,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2047.93 +58241,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58242,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58243,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,245.57 +58244,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1525.0 +58245,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,81.3 +58246,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58247,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,79.43 +58248,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58249,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,54.0 +58250,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58251,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,79.43 +58252,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,343.14 +58253,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,167.17 +58254,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58255,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58256,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58257,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58258,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,102.12 +58259,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,177.32 +58260,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58261,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,209.67 +58262,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,277.8 +58263,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,343.14 +58264,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58265,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,193.68 +58266,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,223.91 +58267,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58268,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58269,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,179.28 +58270,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,154.32 +58271,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,195.16 +58272,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58273,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,296.96 +58274,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,266.97 +58275,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,138.0 +58276,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58277,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58278,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1458.43 +58279,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1051.23 +58280,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58281,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58282,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58283,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58284,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58285,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,74.0 +58286,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58287,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58288,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58289,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58290,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58291,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,50.0 +58292,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58293,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58294,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,70.0 +58295,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,70.0 +58296,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58297,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58298,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58299,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58300,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58301,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1660.89 +58302,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1656.39 +58303,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1963.0 +58304,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2221.69 +58305,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1847.68 +58306,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58307,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58308,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58309,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58310,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58311,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58312,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58313,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58314,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58315,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58316,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58317,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58318,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58319,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58320,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58321,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58322,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58323,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58324,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58325,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58326,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,96.82 +58327,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,96.82 +58328,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58329,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58330,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1607.27 +58331,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58332,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58333,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58334,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58335,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58336,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,55194.71 +58337,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58338,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58339,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58340,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58341,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58342,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58343,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58344,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58345,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58346,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58347,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58348,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58349,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58350,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58351,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58352,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15645.03 +58353,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58354,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58355,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58356,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58357,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8798.81 +58358,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58359,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14306.49 +58360,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9146.34 +58361,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58362,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58363,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58364,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58365,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58366,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58367,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58368,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58369,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58370,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58371,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58372,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58373,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,13974.93 +58374,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58375,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58376,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58377,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7876.57 +58378,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58379,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58380,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58381,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58382,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58383,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58384,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20533.79 +58385,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58386,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58387,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21002.9 +58388,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58389,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8306.38 +58390,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58391,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58392,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58393,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11318.71 +58394,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58395,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,51294.51 +58396,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58397,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58398,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58399,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,51312.93 +58400,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58401,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58402,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58403,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,32777.17 +58404,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58405,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58406,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58407,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58408,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58409,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58410,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58411,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58412,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58413,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58414,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58415,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,37167.35 +58416,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58417,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58418,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58419,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15320.84 +58420,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58421,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58422,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58423,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58424,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58425,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,89036.54 +58426,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,40083.9 +58427,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58428,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58429,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58430,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15560.3 +58431,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58432,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58433,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58434,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58435,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58436,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58437,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,17327.42 +58438,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58439,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,95964.19 +58440,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58441,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58442,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58443,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8559.35 +58444,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58445,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58446,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58447,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58448,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58449,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58450,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16386.76 +58451,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58452,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58453,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58454,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10190.16 +58455,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8776.71 +58456,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58457,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58458,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58459,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58460,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58461,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58462,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58463,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58464,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58465,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58466,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58467,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58468,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58469,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58470,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58471,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58472,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58473,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,47466.77 +58474,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58475,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58476,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58477,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58478,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58479,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58480,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58481,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58482,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58483,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,25059.05 +58484,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58485,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58486,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58487,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58488,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8200.77 +58489,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58490,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7883.94 +58491,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58492,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58493,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58494,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58495,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58496,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58497,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10766.11 +58498,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58499,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58500,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58501,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58502,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58503,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58504,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,29896.23 +58505,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58506,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58507,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,38098.93 +58508,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58509,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8100.07 +58510,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16286.06 +58511,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58512,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58513,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58514,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58515,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16973.75 +58516,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58517,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58518,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58519,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58520,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58521,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58522,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58523,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58524,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58525,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58526,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58527,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58528,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58529,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58530,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58531,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58532,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9184.41 +58533,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58534,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9299.85 +58535,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58536,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58537,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58538,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58539,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58540,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58541,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58542,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58543,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58544,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58545,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58546,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58547,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58548,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58549,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58550,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58551,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58552,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58553,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58554,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58555,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58556,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58557,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58558,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14396.14 +58559,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58560,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58561,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58562,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58563,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58564,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58565,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58566,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58567,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58568,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,79613.92 +58569,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58570,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,35038.76 +58571,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58572,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8320.39 +58573,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58574,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9932.28 +58575,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58576,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21764.88 +58577,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19281.61 +58578,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58579,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14602.44 +58580,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10506.99 +58581,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58582,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58583,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58584,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58585,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58586,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58587,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58588,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58589,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58590,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10831.84 +58591,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8420.58 +58592,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58593,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58594,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,28847.5 +58595,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,26688.77 +58596,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58597,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58598,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58599,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58600,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58601,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58602,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58603,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58604,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58605,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58606,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,50326.83 +58607,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21433.93 +58608,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58609,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,69910.03 +58610,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58611,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,520.89 +58612,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,926.19 +58613,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1521.21 +58614,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1000.31 +58615,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1499.63 +58616,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58617,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2327.47 +58618,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58619,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58620,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58621,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58622,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,78.93 +58623,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58624,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58625,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58626,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58627,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58628,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,180.8 +58629,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,102.4 +58630,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58631,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,28.8 +58632,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58633,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,76.8 +58634,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1568.0 +58635,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58636,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58637,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58638,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58639,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58640,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,46.4 +58641,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,120.0 +58642,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58643,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58644,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,256.8 +58645,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58646,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58647,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,411.0 +58648,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58649,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58650,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58651,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58652,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58653,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58654,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,557.14 +58655,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58656,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58657,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,447.48 +58658,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58659,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58660,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16450.0 +58661,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58662,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58663,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58664,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58665,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58666,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58667,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58668,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58669,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58670,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58671,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58672,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58673,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58674,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,84.42 +58675,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58676,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58677,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58678,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58679,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,199.05 +58680,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58681,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58682,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58683,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58684,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58685,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10124.55 +58686,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58687,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58688,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1515.53 +58689,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58690,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58691,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58692,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58693,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58694,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58695,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,48.41 +58696,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58697,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58698,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58699,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58700,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,415.95 +58701,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1442.89 +58702,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58703,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58704,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58705,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58706,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58707,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58708,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58709,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2839.06 +58710,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58711,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58712,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58713,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58714,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58715,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58716,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58717,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58718,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58719,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58720,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58721,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58722,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58723,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58724,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58725,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58726,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58727,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58728,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58729,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,143.89 +58730,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58731,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58732,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58733,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58734,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58735,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58736,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58737,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58738,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58739,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6261.22 +58740,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58741,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58742,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58743,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58744,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58745,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6570.37 +58746,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58747,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.06 +58748,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58749,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58750,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58751,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58752,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58753,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,221.81 +58754,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58755,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58756,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58757,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58758,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58759,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58760,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58761,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58762,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58763,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58764,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58765,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58766,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58767,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,40.34 +58768,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58769,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58770,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58771,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58772,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58773,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58774,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58775,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58776,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58777,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58778,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58779,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58780,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58781,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58782,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58783,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58784,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58785,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58786,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58787,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1660.89 +58788,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58789,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58790,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58791,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58792,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58793,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58794,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58795,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58796,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58797,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58798,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58799,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58800,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58801,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58802,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58803,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58804,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58805,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58806,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58807,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58808,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,252.65 +58809,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58810,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58811,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,135.87 +58812,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58813,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,136.44 +58814,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58815,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,692.86 +58816,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16290.52 +58817,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58818,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58819,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58820,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58821,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58822,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58823,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58824,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58825,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58826,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58827,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,96.82 +58828,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58829,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8547.48 +58830,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58831,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,104.0 +58832,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58833,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58834,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,133.8 +58835,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,16.08 +58836,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58837,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58838,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58839,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58840,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,18.68 +58841,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58842,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58843,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,19.57 +58844,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58845,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58846,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58847,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58848,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58849,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58850,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58851,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58852,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58853,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1268.61 +58854,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58855,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6.36 +58856,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58857,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58858,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58859,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58860,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.1 +58861,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58862,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58863,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,55.33 +58864,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58865,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58866,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58867,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58868,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3.81 +58869,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58870,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,23.9 +58871,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58872,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58873,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2083.32 +58874,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58875,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58876,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58877,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58878,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58879,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58880,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58881,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,261.42 +58882,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58883,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2.72 +58884,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58885,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58886,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58887,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4.24 +58888,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1.23 +58889,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58890,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58891,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58892,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58893,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58894,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58895,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58896,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1250.4 +58897,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1198.34 +58898,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58899,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,726.56 +58900,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58901,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4593.6 +58902,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58903,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58904,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58905,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.62 +58906,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58907,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,223.49 +58908,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,10.63 +58909,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58910,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1.26 +58911,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9.86 +58912,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,86.18 +58913,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58914,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22.43 +58915,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58916,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,624.74 +58917,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14236.18 +58918,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,272.32 +58919,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4.37 +58920,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,31.24 +58921,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6.36 +58922,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21444.26 +58923,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58924,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58925,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58926,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,12.79 +58927,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2.45 +58928,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58929,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2.0 +58930,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58931,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58932,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58933,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58934,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58935,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58936,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1.29 +58937,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58938,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4.36 +58939,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5.13 +58940,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58941,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58942,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58943,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58944,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58945,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58946,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58947,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58948,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58949,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3.68 +58950,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,340.7 +58951,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15163.9 +58952,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58953,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,69.59 +58954,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58955,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58956,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58957,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58958,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58959,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58960,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58961,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,103.34 +58962,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15.05 +58963,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1.51 +58964,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58965,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,411.87 +58966,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,219.82 +58967,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58968,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58969,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58970,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,94.17 +58971,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58972,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,6.17 +58973,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,14.07 +58974,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,344.37 +58975,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,2.9 +58976,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58977,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58978,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58979,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3335.26 +58980,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58981,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58982,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58983,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20.79 +58984,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,15.26 +58985,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,11910.0 +58986,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58987,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58988,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58989,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58990,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +58991,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,21.3 +58992,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,8.09 +58993,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1260.73 +58994,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,22.87 +58995,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,96.5 +58996,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9.43 +58997,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5.58 +58998,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3.23 +58999,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9.08 +59000,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59001,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59002,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,9.36 +59003,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59004,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59005,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59006,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59007,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59008,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59009,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59010,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59011,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59012,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59013,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59014,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59015,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59016,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,0.63 +59017,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59018,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59019,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59020,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59021,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59022,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59023,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59024,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59025,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59026,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,132.38 +59027,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59028,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5.12 +59029,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,0.62 +59030,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59031,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59032,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59033,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59034,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59035,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59036,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59037,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59038,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59039,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59040,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59041,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59042,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59043,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59044,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59045,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,53.61 +59046,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59047,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59048,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,56.32 +59049,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59050,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59051,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59052,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59053,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59054,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59055,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59056,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59057,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4146.94 +59058,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59059,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59060,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59061,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59062,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59063,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,292.9 +59064,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,835.71 +59065,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59066,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59067,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59068,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59069,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5296.19 +59070,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59071,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59072,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59073,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,5.15 +59074,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59075,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59076,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59077,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59078,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,62.79 +59079,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59080,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59081,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59082,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59083,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59084,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59085,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59086,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59087,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59088,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59089,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59090,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59091,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59092,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59093,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59094,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59095,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59096,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59097,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59098,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59099,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3392.8 +59100,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59101,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59102,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59103,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59104,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,313.93 +59105,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,451.57 +59106,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59107,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,337.38 +59108,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59109,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,63.54 +59110,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59111,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59112,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,3066.78 +59113,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59114,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59115,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59116,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59117,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59118,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59119,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59120,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59121,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59122,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,339.41 +59123,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59124,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59125,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59126,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59127,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59128,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59129,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59130,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59131,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,4595.17 +59132,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59133,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59134,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59135,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,126.91 +59136,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59137,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59138,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59139,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,20.75 +59140,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,68.46 +59141,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,0.36 +59142,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59143,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59144,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59145,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59146,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,0.99 +59147,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59148,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59149,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59150,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59151,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59152,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59153,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59154,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59155,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,985.15 +59156,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59157,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59158,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,7275.56 +59159,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59160,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59161,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59162,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59163,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59164,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59165,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59166,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59167,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59168,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,319.24 +59169,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59170,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59171,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59172,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59173,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,23.65 +59174,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59175,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59176,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59177,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,1493.11 +59178,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,59.7 +59179,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,51.31 +59180,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,200.0 +59181,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,82.22 +59182,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,27.41 +59183,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59184,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage,164.25 +59185,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59186,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59187,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59188,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59189,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59190,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59191,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59192,3934,30000038,ICU,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59193,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59194,3934,30000053,NICU,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59195,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59196,3934,30000079,PSYCH,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59197,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59198,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59199,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59200,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59201,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59202,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59203,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59204,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59205,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59206,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59207,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59208,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59209,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59210,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59211,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59212,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59213,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59214,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59215,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59216,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59217,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59218,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59219,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59220,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59221,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59222,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59223,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59224,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59225,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59226,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59227,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59228,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59229,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59230,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59231,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59232,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59233,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59234,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59235,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59236,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59237,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59238,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59239,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59240,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59241,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59242,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59253,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59254,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59255,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59256,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59257,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59258,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59259,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59260,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59261,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59262,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59263,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59264,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59265,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59266,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59267,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59268,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59269,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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Advantage, +59279,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59280,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59281,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59282,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59283,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59284,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59285,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59286,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59287,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59288,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59289,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59290,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59291,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59292,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59293,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59294,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59295,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59296,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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Advantage, +59306,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59307,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59308,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59309,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59310,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59311,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59312,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59313,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59314,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59315,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59316,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59317,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59318,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59319,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59320,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59321,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59322,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59323,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59324,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59325,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59326,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59327,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59328,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59329,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59330,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59331,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59332,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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+59342,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59343,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59344,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59345,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59346,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59347,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59348,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59349,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59350,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59351,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59352,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59353,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59354,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59355,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59356,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59357,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59358,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59359,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59360,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59361,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59362,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59363,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59364,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59365,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59366,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59367,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59368,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59414,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59415,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59416,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59417,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59418,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59419,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59420,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59421,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59422,3934,30802003,R&B 08BN 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PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59432,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59433,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59434,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59435,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59436,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59437,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59438,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59439,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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Advantage, +59458,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59459,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59460,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59461,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59462,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59463,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59464,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59465,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59466,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59467,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59468,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59469,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59470,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59471,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59472,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59473,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59474,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59475,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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ASSURANCE-Medicare Advantage, +59485,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59486,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59487,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59488,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59489,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59490,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59491,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59492,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59493,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59494,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59495,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59496,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59497,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59498,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59499,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59500,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59501,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59502,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59503,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59504,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59505,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59506,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59507,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59508,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59509,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59510,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59511,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59512,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59513,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59514,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59515,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59516,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59517,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59518,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59519,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59520,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59521,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59522,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59523,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59524,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59525,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59526,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59527,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59528,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59548,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59549,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59550,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59551,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59552,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59553,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59554,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59555,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59556,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59557,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59558,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59559,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59560,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59561,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59562,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59563,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59564,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59565,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59566,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59567,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59568,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59569,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59570,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59571,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59572,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59573,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59574,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59575,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59576,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59577,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59578,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59579,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59580,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59581,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59582,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, 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ASSURANCE-Medicare Advantage, +59610,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59611,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59612,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59613,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59614,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59615,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59616,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59617,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59618,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59619,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59620,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59621,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59622,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59623,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59624,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59625,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59626,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59627,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59628,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59629,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59630,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59631,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59632,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59633,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59634,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59635,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59636,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59637,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59638,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59639,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59640,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59641,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59642,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59643,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59644,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59645,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59646,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59647,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59648,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59649,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59650,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59651,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59652,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59653,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59654,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59655,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59656,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59657,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59658,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59659,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59660,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59661,3934,37112034,TRIAGE,,277.0,277.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59662,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59663,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59664,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59665,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59666,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59667,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59668,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59669,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59670,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59671,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59672,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59673,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59674,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59675,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59676,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59677,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59678,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59679,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59680,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59681,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59682,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59683,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59684,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59685,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59686,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59687,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59688,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59689,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59690,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59691,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59692,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59693,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59694,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59695,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59696,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59697,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59698,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59699,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59700,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59701,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59702,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59703,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59704,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59705,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59706,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59707,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59708,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59709,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59710,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59711,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59712,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59713,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59714,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59715,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59716,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59717,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59718,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59719,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59720,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59721,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59722,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59723,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59724,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59725,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59726,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59727,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59728,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59729,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59730,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59731,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59732,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59733,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59734,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59735,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59736,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59737,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59738,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59739,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59740,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59741,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59742,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59743,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59744,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59745,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59746,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59747,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59748,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59749,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59750,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59751,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59752,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59753,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59754,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59755,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59756,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59757,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59758,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59759,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59760,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59761,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59762,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59763,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59764,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59765,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59766,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59767,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59768,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59769,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59770,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59771,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59772,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59773,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59774,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59775,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59776,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59777,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59778,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59779,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59780,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59781,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59782,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59783,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59784,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59785,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59786,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59787,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59788,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59789,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59790,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59791,3934,43301043,ALBUNEX,,357.0,357.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59792,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59793,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59794,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59795,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59796,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59797,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59798,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59799,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59800,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59801,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59802,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59803,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59804,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59805,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59806,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59807,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59808,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59809,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59810,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59811,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59812,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59813,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59814,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59815,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59816,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59817,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59818,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59819,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59820,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59821,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59822,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59823,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59824,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59825,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59826,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59827,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59828,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59829,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59830,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59831,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59832,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59833,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59834,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59835,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59836,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59837,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59838,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59839,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59840,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59841,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59842,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59843,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59844,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59845,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59846,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59847,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59848,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59849,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59850,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59851,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59852,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59853,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59854,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59855,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59856,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59857,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59858,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59859,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59860,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59861,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59862,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59863,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59864,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59865,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59866,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59867,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59868,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59869,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59870,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59871,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59872,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59873,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59874,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59875,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59876,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59877,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59878,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59879,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59880,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59881,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59882,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59883,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59884,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59885,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59886,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59887,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59888,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59889,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59890,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59891,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59892,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59893,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59894,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59895,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59896,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59897,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59898,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59899,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59900,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59901,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59902,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59903,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59904,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59905,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59906,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59907,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59908,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59909,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59910,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59911,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59912,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59913,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59914,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59915,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59916,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59917,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59918,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59919,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59920,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59921,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59922,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59923,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59924,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59925,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59926,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59927,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59928,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59929,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59930,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59931,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59932,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59933,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59934,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59935,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59936,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59937,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59938,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59939,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59940,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59941,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59942,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59943,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59944,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59945,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59946,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59947,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59948,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59949,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59950,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59951,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59952,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59953,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59954,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59955,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59956,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59957,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59958,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59959,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59960,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMPIRE HEALTHCHOICE ASSURANCE-Medicare Advantage, +59961,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59962,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59963,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,154692.68 +59964,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,365765.53 +59965,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,95653.0 +59966,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33691.15 +59967,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,289921.04 +59968,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,142714.0 +59969,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90028.0 +59970,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,226165.0 +59971,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59972,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59973,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,117736.84 +59974,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,84394.83 +59975,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,110699.3 +59976,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62127.49 +59977,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47850.38 +59978,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59979,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,66491.67 +59980,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43961.0 +59981,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,66387.83 +59982,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46968.0 +59983,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36443.0 +59984,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,69649.0 +59985,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50272.5 +59986,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40569.0 +59987,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59988,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14181.97 +59989,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21910.0 +59990,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,86735.0 +59991,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49169.33 +59992,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39602.0 +59993,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59994,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +59995,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25362.94 +59996,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21996.0 +59997,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39461.02 +59998,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23570.67 +59999,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38060.0 +60000,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24687.0 +60001,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19020.0 +60002,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60003,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40898.0 +60004,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36013.0 +60005,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39777.58 +60006,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21957.33 +60007,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14809.8 +60008,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11687.47 +60009,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16162.0 +60010,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36738.0 +60011,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60012,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15823.0 +60013,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27389.0 +60014,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20144.5 +60015,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15468.0 +60016,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60017,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41059.0 +60018,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18845.21 +60019,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28083.0 +60020,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19521.0 +60021,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60022,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26521.0 +60023,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17250.1 +60024,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60025,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33209.0 +60026,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20151.0 +60027,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13900.5 +60028,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,76808.0 +60029,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46573.0 +60030,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44942.25 +60031,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,82238.0 +60032,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60033,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27575.67 +60034,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,68908.16 +60035,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17378.31 +60036,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60037,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17224.75 +60038,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45682.0 +60039,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60040,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60041,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60042,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60043,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60044,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60045,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15954.33 +60046,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60047,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60048,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60049,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60050,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60051,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24167.28 +60052,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19083.06 +60053,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60054,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17571.5 +60055,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60056,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60057,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48377.0 +60058,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35257.0 +60059,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32368.88 +60060,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26594.0 +60061,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60062,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60063,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14134.0 +60064,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29031.0 +60065,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60066,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20163.0 +60067,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14713.59 +60068,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33804.0 +60069,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13826.63 +60070,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14217.0 +60071,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33052.33 +60072,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19026.5 +60073,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60074,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,104424.0 +60075,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53001.2 +60076,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37982.86 +60077,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,67679.0 +60078,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33389.18 +60079,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60080,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28864.92 +60081,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17878.91 +60082,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37749.05 +60083,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25410.66 +60084,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18516.8 +60085,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36916.6 +60086,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24683.0 +60087,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60088,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21816.0 +60089,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16953.0 +60090,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60091,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21716.2 +60092,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22518.16 +60093,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24570.5 +60094,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19278.33 +60095,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14458.5 +60096,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27279.93 +60097,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17948.3 +60098,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13616.8 +60099,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14228.67 +60100,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60101,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38440.0 +60102,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19370.01 +60103,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14744.36 +60104,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17323.95 +60105,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13469.69 +60106,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16846.0 +60107,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28747.69 +60108,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17883.79 +60109,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,129334.0 +60110,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53201.5 +60111,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,95247.59 +60112,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60113,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54204.62 +60114,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,157517.68 +60115,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102659.0 +60116,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60117,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60118,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,116144.0 +60119,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60120,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60121,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,137146.0 +60122,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62976.73 +60123,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60124,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,87952.0 +60125,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60126,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60127,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,164340.02 +60128,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,108147.89 +60129,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128961.0 +60130,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,83693.0 +60131,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,105383.0 +60132,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22906.47 +60133,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,79514.0 +60134,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50851.67 +60135,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17400.57 +60136,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60137,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,66556.38 +60138,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41819.54 +60139,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41185.0 +60140,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38427.34 +60141,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14244.7 +60142,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70286.0 +60143,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53269.17 +60144,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37102.08 +60145,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51264.0 +60146,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60147,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60148,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60149,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44622.0 +60150,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,79268.0 +60151,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41749.0 +60152,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60153,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60154,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26825.4 +60155,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60156,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128379.07 +60157,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,108457.63 +60158,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60159,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34983.87 +60160,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,101463.16 +60161,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,66082.32 +60162,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53303.33 +60163,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30634.76 +60164,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63964.67 +60165,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34677.2 +60166,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20286.8 +60167,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15869.33 +60168,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60169,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60170,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47657.4 +60171,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24213.77 +60172,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22081.3 +60173,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35649.0 +60174,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32520.32 +60175,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19532.6 +60176,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14171.0 +60177,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60178,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28619.05 +60179,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21361.0 +60180,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13944.31 +60181,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23964.0 +60182,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13956.64 +60183,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6578.59 +60184,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15673.0 +60185,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27368.0 +60186,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60187,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25039.75 +60188,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15736.79 +60189,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11659.58 +60190,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14264.0 +60191,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13606.34 +60192,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15156.67 +60193,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42589.71 +60194,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19437.06 +60195,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15902.0 +60196,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33652.68 +60197,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60198,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60199,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37623.38 +60200,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31069.64 +60201,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97113.64 +60202,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51150.2 +60203,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35764.9 +60204,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48491.0 +60205,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30797.51 +60206,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59837.28 +60207,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48262.33 +60208,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35455.0 +60209,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,61336.0 +60210,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36894.67 +60211,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26000.6 +60212,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40949.89 +60213,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33536.58 +60214,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24275.17 +60215,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25308.35 +60216,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60217,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56488.0 +60218,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60219,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60220,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60221,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23072.0 +60222,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56874.7 +60223,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60224,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25221.97 +60225,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90702.0 +60226,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45490.67 +60227,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29344.0 +60228,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60229,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34916.39 +60230,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21736.78 +60231,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15608.5 +60232,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42798.0 +60233,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25868.0 +60234,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19373.0 +60235,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38922.67 +60236,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20979.22 +60237,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60238,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40444.0 +60239,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22323.33 +60240,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7074.02 +60241,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60242,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30052.98 +60243,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21185.13 +60244,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14735.33 +60245,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32677.0 +60246,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17344.13 +60247,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12017.33 +60248,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26168.33 +60249,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15747.63 +60250,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31500.06 +60251,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20143.89 +60252,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11954.75 +60253,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,87563.73 +60254,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59201.65 +60255,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44701.0 +60256,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60257,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60258,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60259,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60260,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17191.78 +60261,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43725.02 +60262,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34961.82 +60263,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26835.43 +60264,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,73594.0 +60265,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39450.0 +60266,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60267,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36821.85 +60268,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39775.51 +60269,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22112.0 +60270,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37045.67 +60271,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24549.0 +60272,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30986.05 +60273,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17918.46 +60274,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12895.0 +60275,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37126.61 +60276,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19265.4 +60277,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60278,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34841.0 +60279,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19142.06 +60280,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17650.0 +60281,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,117115.96 +60282,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,79932.48 +60283,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60284,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,135810.06 +60285,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,99352.75 +60286,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60287,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65482.91 +60288,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,61170.24 +60289,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60290,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60291,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41035.0 +60292,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60293,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70887.33 +60294,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60295,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,61414.0 +60296,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38569.38 +60297,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,58847.0 +60298,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,52115.95 +60299,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60300,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60301,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,69748.0 +60302,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48041.0 +60303,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18431.71 +60304,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,66282.0 +60305,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44913.36 +60306,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34792.35 +60307,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50676.0 +60308,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47082.0 +60309,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35191.5 +60310,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40255.25 +60311,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28081.25 +60312,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28387.44 +60313,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49070.33 +60314,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37224.5 +60315,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60316,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60317,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60318,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,64604.0 +60319,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35168.98 +60320,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28297.0 +60321,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37206.0 +60322,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36028.0 +60323,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60324,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60325,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12883.9 +60326,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60327,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22857.0 +60328,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60329,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37518.0 +60330,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28996.0 +60331,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,52773.82 +60332,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39904.5 +60333,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29865.0 +60334,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60335,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60336,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16665.0 +60337,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60338,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6809.41 +60339,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1420.17 +60340,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27610.23 +60341,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60342,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22632.0 +60343,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16249.0 +60344,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51844.5 +60345,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25948.75 +60346,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16531.0 +60347,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60348,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32067.0 +60349,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30752.0 +60350,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18098.13 +60351,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60352,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16867.0 +60353,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28182.0 +60354,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16965.0 +60355,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12436.75 +60356,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18195.75 +60357,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22973.5 +60358,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60359,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29859.5 +60360,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19084.0 +60361,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60362,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10289.46 +60363,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28853.23 +60364,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60365,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60366,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,119679.32 +60367,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34869.0 +60368,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57775.0 +60369,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34517.42 +60370,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26394.85 +60371,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35849.0 +60372,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29988.25 +60373,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39175.0 +60374,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33035.2 +60375,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60376,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11144.23 +60377,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60378,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60379,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36272.0 +60380,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60381,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11543.63 +60382,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23028.02 +60383,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17467.3 +60384,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60385,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60386,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31024.5 +60387,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17293.18 +60388,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,52193.0 +60389,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32040.0 +60390,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60391,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41820.0 +60392,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60393,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33107.29 +60394,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31895.43 +60395,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60396,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60397,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60398,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35220.25 +60399,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24462.0 +60400,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30465.37 +60401,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49768.0 +60402,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28079.28 +60403,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18440.33 +60404,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13044.22 +60405,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25189.94 +60406,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15463.61 +60407,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27494.0 +60408,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33139.0 +60409,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21566.0 +60410,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16395.0 +60411,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60412,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60413,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,69548.75 +60414,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,119419.0 +60415,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63558.0 +60416,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41832.92 +60417,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70547.33 +60418,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41137.57 +60419,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32710.83 +60420,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53243.22 +60421,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30738.0 +60422,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23045.45 +60423,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60424,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60425,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60426,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60427,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8250.35 +60428,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59742.0 +60429,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60430,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60431,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,76589.0 +60432,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,52267.5 +60433,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30827.67 +60434,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18178.19 +60435,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13248.0 +60436,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33977.0 +60437,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60438,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23192.33 +60439,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15859.97 +60440,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9445.64 +60441,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15864.0 +60442,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10137.41 +60443,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6173.25 +60444,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31899.2 +60445,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21755.38 +60446,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16322.0 +60447,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40570.5 +60448,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31129.29 +60449,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60450,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19739.0 +60451,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31327.89 +60452,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60453,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39414.0 +60454,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60455,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60456,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60457,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8084.91 +60458,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60459,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16915.0 +60460,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60461,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60462,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57444.37 +60463,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35664.5 +60464,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28241.0 +60465,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25129.87 +60466,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28486.0 +60467,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32254.27 +60468,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24175.83 +60469,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60470,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22825.0 +60471,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60472,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29548.0 +60473,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60474,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28522.0 +60475,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60476,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60477,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19887.78 +60478,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13461.5 +60479,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12522.0 +60480,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15657.77 +60481,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27919.0 +60482,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14433.41 +60483,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22092.0 +60484,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20748.36 +60485,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17314.76 +60486,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13571.64 +60487,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21844.97 +60488,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20008.18 +60489,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17918.09 +60490,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45940.37 +60491,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,183930.91 +60492,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75716.76 +60493,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13502.34 +60494,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36193.79 +60495,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7122.46 +60496,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6122.37 +60497,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60498,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15545.0 +60499,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11570.0 +60500,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60501,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38698.77 +60502,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50995.0 +60503,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60504,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29896.0 +60505,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15617.93 +60506,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13961.07 +60507,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12932.39 +60508,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47729.0 +60509,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23751.28 +60510,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21054.0 +60511,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28717.0 +60512,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18811.75 +60513,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33132.39 +60514,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37476.0 +60515,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21015.67 +60516,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14843.0 +60517,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60518,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27295.0 +60519,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17096.0 +60520,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60521,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60522,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60523,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,81846.0 +60524,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47402.0 +60525,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60526,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60527,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22603.47 +60528,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31947.0 +60529,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60530,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23762.65 +60531,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24088.06 +60532,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15416.86 +60533,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11233.38 +60534,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125181.0 +60535,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97393.42 +60536,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60537,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,92136.32 +60538,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31994.34 +60539,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27858.22 +60540,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59623.55 +60541,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32857.5 +60542,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22184.0 +60543,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16052.65 +60544,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26473.0 +60545,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54521.0 +60546,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27448.29 +60547,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20007.5 +60548,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,104445.6 +60549,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45013.39 +60550,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,73628.39 +60551,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41951.62 +60552,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29491.0 +60553,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36634.46 +60554,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20808.6 +60555,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18052.5 +60556,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29853.0 +60557,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15592.87 +60558,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60559,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22657.45 +60560,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15909.5 +60561,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,135078.83 +60562,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37454.84 +60563,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21683.71 +60564,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60565,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15946.13 +60566,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17563.0 +60567,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60568,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26860.0 +60569,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25044.94 +60570,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24794.04 +60571,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22556.83 +60572,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23314.0 +60573,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60574,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60575,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33273.0 +60576,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17225.08 +60577,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60578,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60579,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60580,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60581,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65773.89 +60582,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41519.84 +60583,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26884.0 +60584,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60585,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19474.0 +60586,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36405.0 +60587,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13567.0 +60588,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29412.85 +60589,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16326.78 +60590,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32844.54 +60591,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21895.67 +60592,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14437.0 +60593,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60594,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18544.0 +60595,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60596,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60597,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60598,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24446.04 +60599,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60600,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60601,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17113.6 +60602,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9466.67 +60603,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60604,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12566.0 +60605,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60606,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,85979.0 +60607,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60608,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36868.55 +60609,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60610,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28896.0 +60611,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60612,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28754.0 +60613,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,92391.75 +60614,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47015.1 +60615,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33970.0 +60616,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,71428.0 +60617,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35540.6 +60618,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24455.0 +60619,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3892.0 +60620,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1946.0 +60621,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60622,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60623,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60624,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2902.12 +60625,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3436.0 +60626,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +60627,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60628,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +60629,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.0 +60630,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60631,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1872.63 +60632,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1917.21 +60633,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60634,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60635,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60636,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60637,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60638,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60639,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60640,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60641,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,973.0 +60642,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60643,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60644,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60645,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60646,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60647,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1796.0 +60648,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5178.0 +60649,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,739.03 +60650,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2664.21 +60651,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4095.75 +60652,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60653,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60654,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +60655,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5142.62 +60656,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4822.0 +60657,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60658,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60659,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60660,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60661,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60662,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60663,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +60664,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60665,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60666,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60667,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60668,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60669,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60670,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60671,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60672,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12869.75 +60673,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60674,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60675,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60676,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2809.34 +60677,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60678,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60679,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60680,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60681,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60682,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4818.67 +60683,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60684,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60685,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60686,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1576.0 +60687,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60688,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,116.67 +60689,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60690,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6102.25 +60691,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6261.0 +60692,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60693,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60694,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60695,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60696,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60697,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10130.0 +60698,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60699,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60700,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60701,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3805.0 +60702,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60703,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +60704,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10441.41 +60705,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3004.0 +60706,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60707,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +60708,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +60709,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60710,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60711,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60712,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.99 +60713,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60714,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,469.0 +60715,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,193.55 +60716,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,973.0 +60717,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60718,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60719,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60720,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +60721,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8423.0 +60722,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60723,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,602.14 +60724,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60725,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +60726,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,225.72 +60727,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1946.0 +60728,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60729,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60730,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8638.23 +60731,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60732,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,951.25 +60733,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2670.0 +60734,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60735,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +60736,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60737,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +60738,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60739,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60740,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60741,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60742,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60743,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3930.25 +60744,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,982.98 +60745,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6081.09 +60746,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60747,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7262.0 +60748,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60749,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60750,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60751,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10203.31 +60752,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6540.0 +60753,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60754,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +60755,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60756,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1965.95 +60757,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5008.0 +60758,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2047.88 +60759,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,973.0 +60760,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60761,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60762,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60763,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60764,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60765,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3321.79 +60766,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60767,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60768,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60769,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5940.0 +60770,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60771,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60772,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1205.5 +60773,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60774,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60775,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2948.93 +60776,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17529.0 +60777,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60778,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60779,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60780,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60781,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60782,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +60783,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60784,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +60785,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +60786,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60787,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60788,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60789,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3436.0 +60790,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60791,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5809.5 +60792,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60793,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5595.33 +60794,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2520.5 +60795,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8191.5 +60796,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2730.5 +60797,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60798,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +60799,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8774.0 +60800,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3436.0 +60801,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,973.0 +60802,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10549.5 +60803,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1298.2 +60804,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60805,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60806,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60807,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11215.0 +60808,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20113.02 +60809,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60810,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3871.5 +60811,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19937.85 +60812,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60813,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11299.56 +60814,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60815,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5938.15 +60816,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6080.7 +60817,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60818,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16783.31 +60819,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60820,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3670.3 +60821,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8710.0 +60822,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23425.24 +60823,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60824,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60825,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60826,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60827,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2809.34 +60828,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60829,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3411.0 +60830,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60831,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2411.0 +60832,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6028.0 +60833,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60834,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60835,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,317.13 +60836,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60837,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60838,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60839,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60840,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60841,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60842,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,757.25 +60843,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,317.13 +60844,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3892.0 +60845,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3481.0 +60846,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3892.0 +60847,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60848,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7150.56 +60849,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60850,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60851,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60852,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60853,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26397.54 +60854,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20441.84 +60855,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60856,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60857,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60858,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60859,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60860,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6144.5 +60861,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60862,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7713.79 +60863,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60864,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60865,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5008.0 +60866,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60867,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60868,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60869,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60870,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60871,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7743.0 +60872,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60873,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60874,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60875,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5018.24 +60876,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60877,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60878,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60879,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7168.5 +60880,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60881,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60882,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5397.36 +60883,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60884,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7743.0 +60885,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60886,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7920.0 +60887,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60888,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60889,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60890,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60891,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60892,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60893,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60894,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,246.71 +60895,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60896,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60897,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6901.0 +60898,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +60899,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7028.0 +60900,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6212.32 +60901,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60902,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60903,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60904,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +60905,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60906,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5906.0 +60907,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60908,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60909,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60910,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10056.61 +60911,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60912,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24377.87 +60913,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60914,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9558.0 +60915,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31589.17 +60916,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60917,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60918,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60919,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60920,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60921,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2670.0 +60922,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60923,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4975.66 +60924,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60925,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7280.44 +60926,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60927,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11343.0 +60928,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60929,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60930,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60931,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60932,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6321.33 +60933,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8515.0 +60934,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60935,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60936,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.0 +60937,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60938,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60939,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60940,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5737.07 +60941,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60942,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +60943,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +60944,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60945,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60946,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60947,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60948,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60949,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60950,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6028.0 +60951,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9285.0 +60952,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60953,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5008.0 +60954,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60955,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60956,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60957,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60958,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1577.16 +60959,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9558.0 +60960,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9558.0 +60961,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60962,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4642.5 +60963,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60964,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9864.29 +60965,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6028.0 +60966,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60967,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9558.0 +60968,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60969,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60970,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60971,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3004.0 +60972,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60973,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60974,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +60975,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60976,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1834.5 +60977,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60978,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60979,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60980,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7797.96 +60981,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60982,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60983,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60984,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60985,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3413.13 +60986,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60987,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60988,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60989,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8054.33 +60990,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +60991,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6213.62 +60992,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60993,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60994,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60995,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60996,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3316.42 +60997,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60998,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +60999,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61000,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61001,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61002,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61003,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6028.0 +61004,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61005,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61006,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6303.0 +61007,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61008,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,200.0 +61009,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61010,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7495.07 +61011,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61012,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4524.5 +61013,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9285.0 +61014,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61015,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1042.25 +61016,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5871.12 +61017,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61018,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61019,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7247.13 +61020,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61021,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61022,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61023,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61024,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61025,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5276.0 +61026,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61027,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61028,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9004.79 +61029,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61030,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1784.5 +61031,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3569.0 +61032,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61033,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1662.9 +61034,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4682.71 +61035,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3414.0 +61036,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7920.0 +61037,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61038,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6856.51 +61039,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61040,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61041,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61042,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61043,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61044,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,261.25 +61045,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61046,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6992.0 +61047,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61048,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61049,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5694.79 +61050,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61051,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61052,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61053,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61054,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61055,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61056,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1365.25 +61057,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61058,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61059,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61060,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6992.0 +61061,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61062,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61063,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61064,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61065,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61066,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +61067,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61068,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5951.62 +61069,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61070,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61071,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61072,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61073,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1642.05 +61074,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9403.0 +61075,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61076,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7626.0 +61077,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61078,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61079,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61080,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61081,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,270.31 +61082,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61083,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +61084,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +61085,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61086,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61087,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61088,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61089,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61090,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3052.83 +61091,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28837.84 +61092,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61093,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61094,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61095,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61096,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6303.0 +61097,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61098,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61099,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61100,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1762.24 +61101,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61102,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61103,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61104,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7969.62 +61105,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61106,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5088.0 +61107,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +61108,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61109,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61110,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61111,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61112,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61113,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6765.0 +61114,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3436.0 +61115,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61116,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61117,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61118,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61119,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9552.54 +61120,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61121,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9078.0 +61122,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61123,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12208.36 +61124,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61125,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61126,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61127,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61128,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61129,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61130,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61131,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61132,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61133,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61134,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61135,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61136,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61137,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61138,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61139,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61140,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61141,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61142,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61143,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11645.5 +61144,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61145,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61146,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +61147,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61148,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61149,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61150,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61151,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61152,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61153,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7703.5 +61154,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61155,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61156,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61157,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61158,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10012.5 +61159,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1768.0 +61160,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61161,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61162,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8571.0 +61163,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61164,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61165,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +61166,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61167,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61168,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61169,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61170,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9285.0 +61171,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61172,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61173,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75.85 +61174,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61175,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61176,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8571.0 +61177,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6992.0 +61178,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61179,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61180,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61181,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61182,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6028.0 +61183,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3014.0 +61184,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61185,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61186,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61187,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4809.5 +61188,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61189,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61190,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61191,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61192,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61193,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61194,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61195,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61196,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3892.0 +61197,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61198,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61199,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61200,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7515.0 +61201,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11682.72 +61202,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61203,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61204,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6694.17 +61205,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61206,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +61207,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61208,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8876.0 +61209,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61210,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61211,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61212,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61213,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61214,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61215,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61216,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61217,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61218,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61219,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61220,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61221,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61222,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61223,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4822.0 +61224,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61225,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61226,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61227,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61228,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61229,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61230,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61231,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61232,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61233,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9285.0 +61234,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12115.0 +61235,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61236,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61237,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4822.0 +61238,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3316.42 +61239,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61240,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +61241,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61242,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61243,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +61244,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +61245,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.0 +61246,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61247,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61248,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61249,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61250,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61251,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +61252,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +61253,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61254,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61255,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +61256,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9285.0 +61257,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61258,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61259,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61260,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6350.0 +61261,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4946.26 +61262,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10580.18 +61263,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61264,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6211.74 +61265,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10127.55 +61266,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1335.0 +61267,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6261.0 +61268,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3014.0 +61269,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9026.0 +61270,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5647.0 +61271,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61272,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61273,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61274,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61275,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7319.0 +61276,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7048.09 +61277,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3337.5 +61278,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6048.0 +61279,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6958.62 +61280,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61281,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61282,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6992.0 +61283,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7633.48 +61284,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61285,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61286,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61287,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61288,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9310.5 +61289,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61290,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7680.0 +61291,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61292,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61293,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1718.0 +61294,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61295,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61296,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7197.58 +61297,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.0 +61298,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61299,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8139.0 +61300,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61301,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12231.5 +61302,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61303,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61304,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61305,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61306,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,132.09 +61307,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61308,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3631.0 +61309,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61310,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61311,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61312,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61313,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61314,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61315,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13550.25 +61316,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1335.0 +61317,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16275.0 +61318,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8010.0 +61319,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61320,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2503.13 +61321,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5006.25 +61322,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3003.75 +61323,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +61324,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61325,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61326,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61327,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,197.81 +61328,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61329,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2617.69 +61330,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61331,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61332,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +61333,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61334,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3558.07 +61335,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61336,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61337,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61338,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5081.0 +61339,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61340,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,189.66 +61341,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5876.42 +61342,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61343,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6118.66 +61344,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61345,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61346,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61347,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61348,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61349,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4822.0 +61350,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2730.5 +61351,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61352,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2411.0 +61353,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61354,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61355,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61356,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61357,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61358,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61359,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61360,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61361,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5984.56 +61362,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4822.0 +61363,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6591.0 +61364,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61365,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61366,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61367,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61368,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3805.0 +61369,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61370,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61371,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61372,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61373,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61374,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61375,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2674.0 +61376,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61377,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61378,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61379,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61380,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12420.23 +61381,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15085.49 +61382,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61383,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61384,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61385,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61386,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61387,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61388,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61389,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29885.59 +61390,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8470.05 +61391,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10880.42 +61392,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6675.0 +61393,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61394,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61395,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61396,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3267.96 +61397,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8607.96 +61398,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37579.89 +61399,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61400,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27516.67 +61401,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18064.81 +61402,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9558.0 +61403,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61404,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61405,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41144.75 +61406,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1659.7 +61407,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61408,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61409,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61410,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61411,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61412,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61413,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61414,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61415,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.0 +61416,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61417,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61418,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61419,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6236.0 +61420,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61421,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61422,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,879.67 +61423,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61424,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61425,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61426,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61427,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61428,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61429,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61430,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61431,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10734.09 +61432,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11880.0 +61433,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3756.98 +61434,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6695.25 +61435,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,129.8 +61436,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61437,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61438,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61439,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61440,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7152.46 +61441,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61442,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61443,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61444,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,568.41 +61445,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61446,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4222.18 +61447,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61448,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61449,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61450,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61451,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61452,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61453,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,100.0 +61454,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61455,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61456,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6903.0 +61457,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5469.61 +61458,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61459,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2403.7 +61460,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61461,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4182.71 +61462,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61463,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61464,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61465,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2879.45 +61466,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,920.19 +61467,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,263.5 +61468,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61469,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61470,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61471,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2516.75 +61472,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61473,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61474,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61475,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61476,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61477,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61478,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61479,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61480,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7262.0 +61481,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9358.0 +61482,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9195.0 +61483,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9703.06 +61484,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61485,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61486,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6001.66 +61487,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61488,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61489,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6998.71 +61490,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61491,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61492,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7920.0 +61493,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61494,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10277.5 +61495,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9558.0 +61496,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61497,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61498,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61499,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8139.0 +61500,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8257.0 +61501,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61502,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15853.5 +61503,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61504,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61505,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61506,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61507,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61508,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61509,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61510,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61511,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7622.66 +61512,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61513,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61514,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61515,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61516,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1160.06 +61517,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.81 +61518,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61519,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61520,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61521,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11974.5 +61522,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8380.0 +61523,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61524,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8380.0 +61525,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8380.0 +61526,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61527,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2853.75 +61528,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5056.54 +61529,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4387.0 +61530,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61531,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61532,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7801.0 +61533,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7233.0 +61534,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61535,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12357.0 +61536,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61537,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61538,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18213.84 +61539,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61540,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61541,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61542,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61543,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1096.35 +61544,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61545,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61546,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61547,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61548,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1707.0 +61549,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61550,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7407.0 +61551,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61552,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61553,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61554,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61555,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5008.0 +61556,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61557,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61558,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61559,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61560,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61561,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61562,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61563,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61564,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61565,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61566,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61567,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61568,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61569,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61570,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1024.0 +61571,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61572,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61573,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61574,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61575,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61576,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61577,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61578,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61579,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61580,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61581,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61582,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61583,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3569.0 +61584,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61585,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8413.86 +61586,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7920.0 +61587,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61588,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61589,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61590,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61591,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61592,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7899.0 +61593,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61594,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61595,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61596,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75.0 +61597,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6564.92 +61598,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8139.0 +61599,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8216.25 +61600,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61601,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7920.0 +61602,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6992.0 +61603,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61604,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7395.0 +61605,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6028.0 +61606,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61607,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61608,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61609,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61610,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3805.0 +61611,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61612,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61613,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61614,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61615,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61616,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61617,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2823.0 +61618,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3892.0 +61619,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4225.53 +61620,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4979.71 +61621,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4639.05 +61622,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61623,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6027.5 +61624,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3327.13 +61625,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61626,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61627,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2876.71 +61628,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3834.42 +61629,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6286.5 +61630,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5341.0 +61631,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2730.5 +61632,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61633,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +61634,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4892.79 +61635,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6828.0 +61636,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2670.0 +61637,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8439.0 +61638,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9363.2 +61639,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4869.67 +61640,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61641,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6725.48 +61642,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4487.32 +61643,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6027.5 +61644,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3191.3 +61645,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61646,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4660.46 +61647,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9558.0 +61648,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12549.5 +61649,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7920.0 +61650,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61651,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61652,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1925.33 +61653,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61654,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61655,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61656,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61657,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61658,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61659,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61660,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61661,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27507.0 +61662,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3436.0 +61663,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61664,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,914.53 +61665,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6680.83 +61666,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61667,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5340.0 +61668,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61669,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5008.0 +61670,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61671,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61672,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61673,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2599.0 +61674,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61675,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61676,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61677,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,952.14 +61678,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,462.72 +61679,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3892.0 +61680,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2306.22 +61681,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61682,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1216.61 +61683,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8961.25 +61684,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3858.0 +61685,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61686,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12365.39 +61687,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8906.0 +61688,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61689,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61690,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61691,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61692,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3805.0 +61693,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3692.0 +61694,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3892.0 +61695,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61696,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61697,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61698,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2842.81 +61699,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3569.0 +61700,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3569.0 +61701,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61702,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5461.0 +61703,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61704,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61705,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5453.13 +61706,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61707,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6109.67 +61708,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4141.2 +61709,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61710,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61711,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6695.35 +61712,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61713,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4822.0 +61714,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61715,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7233.0 +61716,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61717,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4328.33 +61718,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9147.55 +61719,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61720,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61721,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61722,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61723,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61724,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33164.5 +61725,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7495.0 +61726,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1682.94 +61727,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19236.0 +61728,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3651.89 +61729,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61730,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1208.55 +61731,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5568.0 +61732,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61733,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61734,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4482.06 +61735,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6219.5 +61736,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5221.0 +61737,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61738,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8292.42 +61739,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61740,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6814.0 +61741,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6432.0 +61742,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61743,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9317.36 +61744,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61745,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61746,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7109.83 +61747,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61748,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5808.0 +61749,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61750,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6151.83 +61751,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5930.17 +61752,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61753,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12106.67 +61754,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10554.29 +61755,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5041.08 +61756,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61757,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27367.37 +61758,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61759,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4482.33 +61760,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1304.0 +61761,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4434.0 +61762,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2445.63 +61763,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18608.65 +61764,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18518.91 +61765,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41840.59 +61766,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8884.0 +61767,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7988.17 +61768,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,975.92 +61769,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2913.0 +61770,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61771,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3551.53 +61772,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6224.83 +61773,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3800.0 +61774,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61775,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11206.32 +61776,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13996.34 +61777,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2032.44 +61778,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15440.0 +61779,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61780,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2279.0 +61781,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1512.85 +61782,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2913.78 +61783,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,679.91 +61784,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16760.78 +61785,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,759.17 +61786,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2488.63 +61787,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61788,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,610.73 +61789,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6068.35 +61790,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1661.21 +61791,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3274.2 +61792,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2572.42 +61793,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1067.56 +61794,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2364.31 +61795,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61796,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61797,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13720.3 +61798,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14664.22 +61799,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13117.11 +61800,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17894.0 +61801,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9945.6 +61802,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10038.11 +61803,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5954.5 +61804,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61805,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61806,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9846.16 +61807,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61808,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61809,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10593.75 +61810,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61811,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61812,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61813,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16383.87 +61814,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12260.27 +61815,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17252.11 +61816,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10124.46 +61817,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21929.0 +61818,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13444.0 +61819,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13414.22 +61820,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1598.67 +61821,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61822,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61823,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5172.5 +61824,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1634.0 +61825,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1579.75 +61826,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61827,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5265.0 +61828,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3440.0 +61829,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10635.42 +61830,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5587.73 +61831,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61832,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61833,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61834,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61835,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61836,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61837,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14200.73 +61838,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2772.0 +61839,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13395.78 +61840,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4718.33 +61841,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5226.31 +61842,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8703.64 +61843,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14134.92 +61844,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7022.09 +61845,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2614.22 +61846,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3085.33 +61847,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5795.0 +61848,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1701.33 +61849,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,337.7 +61850,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,463.59 +61851,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,378.0 +61852,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1041.58 +61853,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,417.02 +61854,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1186.77 +61855,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2678.54 +61856,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2396.0 +61857,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3385.66 +61858,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,347.0 +61859,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,889.36 +61860,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,980.2 +61861,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,510.73 +61862,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,445.69 +61863,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7269.98 +61864,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61865,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9499.48 +61866,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7122.52 +61867,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8057.63 +61868,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8732.67 +61869,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7169.0 +61870,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7527.69 +61871,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7506.64 +61872,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9917.94 +61873,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61874,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5973.42 +61875,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6449.2 +61876,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11446.5 +61877,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3934.67 +61878,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6975.27 +61879,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6633.15 +61880,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61881,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6438.69 +61882,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3554.67 +61883,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7405.47 +61884,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11515.22 +61885,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61886,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61887,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6739.57 +61888,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6588.51 +61889,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10268.4 +61890,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2192.67 +61891,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6566.01 +61892,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9092.22 +61893,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12733.67 +61894,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12425.0 +61895,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11999.55 +61896,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2178.0 +61897,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2541.0 +61898,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1938.0 +61899,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11772.37 +61900,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13813.86 +61901,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10836.65 +61902,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61903,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61904,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61905,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61906,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16752.19 +61907,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61908,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3598.5 +61909,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61910,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61911,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2601.0 +61912,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9659.0 +61913,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61914,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61915,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61916,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61917,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6273.0 +61918,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27963.0 +61919,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61920,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3478.42 +61921,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8543.0 +61922,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61923,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61924,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,661.0 +61925,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3797.33 +61926,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61927,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61928,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61929,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61930,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61931,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61932,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61933,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61934,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61935,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11939.34 +61936,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33336.13 +61937,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10932.33 +61938,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47829.5 +61939,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1311.0 +61940,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16278.11 +61941,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61942,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61943,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5008.0 +61944,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11828.0 +61945,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16469.92 +61946,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61947,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61948,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61949,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61950,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61951,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7176.0 +61952,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61953,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61954,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9683.13 +61955,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61956,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12021.0 +61957,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +61958,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61959,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61960,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61961,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61962,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,769.5 +61963,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61964,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6148.12 +61965,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61966,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24446.75 +61967,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20360.5 +61968,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6483.12 +61969,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4550.2 +61970,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4052.0 +61971,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1118.0 +61972,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,377.25 +61973,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61974,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61975,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4406.17 +61976,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61977,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2803.5 +61978,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1401.75 +61979,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61980,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14710.0 +61981,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61982,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61983,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61984,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61985,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61986,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4083.09 +61987,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9614.34 +61988,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61989,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28174.44 +61990,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +61991,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61992,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61993,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8521.37 +61994,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,691.29 +61995,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +61996,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13049.86 +61997,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12729.32 +61998,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15401.46 +61999,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62000,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12844.4 +62001,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62002,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6944.0 +62003,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5317.0 +62004,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14120.01 +62005,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62006,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3850.0 +62007,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5666.13 +62008,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5187.5 +62009,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16879.96 +62010,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,592.0 +62011,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2112.0 +62012,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62013,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6715.0 +62014,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11739.0 +62015,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62016,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62017,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,172.49 +62018,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6082.32 +62019,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7880.0 +62020,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2212.5 +62021,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62022,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,636.26 +62023,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8849.33 +62024,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2178.0 +62025,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62026,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62027,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19542.34 +62028,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28443.11 +62029,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17400.52 +62030,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2178.0 +62031,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,253.32 +62032,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62033,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62034,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62035,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38128.24 +62036,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28041.21 +62037,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62038,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9015.28 +62039,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62040,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62041,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9012.0 +62042,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2399.16 +62043,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62044,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8640.0 +62045,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62046,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62047,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9376.5 +62048,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62049,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9012.0 +62050,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62051,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22594.41 +62052,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24136.54 +62053,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9012.0 +62054,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62055,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14303.48 +62056,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18473.0 +62057,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62058,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62059,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62060,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62061,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62062,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62063,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1171.06 +62064,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62065,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3477.0 +62066,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5160.42 +62067,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62068,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62069,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62070,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4359.69 +62071,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62072,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62073,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4358.46 +62074,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62075,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47.64 +62076,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62077,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62078,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62079,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9645.0 +62080,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62081,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62082,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3996.0 +62083,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,433.43 +62084,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62085,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62086,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62087,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1062.65 +62088,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5160.0 +62089,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14604.33 +62090,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62091,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62092,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11944.67 +62093,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62094,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17608.89 +62095,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62096,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62097,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1632.0 +62098,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2337.5 +62099,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22142.19 +62100,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1728.0 +62101,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10346.0 +62102,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51187.75 +62103,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62104,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62105,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62106,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62107,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2009.0 +62108,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1277.0 +62109,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62110,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2601.63 +62111,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2769.0 +62112,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.26 +62113,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62114,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1412.48 +62115,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3009.25 +62116,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6915.0 +62117,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34372.67 +62118,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41351.0 +62119,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35011.37 +62120,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33246.4 +62121,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,83.4 +62122,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,83.4 +62123,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,131.13 +62124,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13052.84 +62125,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62126,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9447.54 +62127,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62128,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11406.26 +62129,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62130,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7017.3 +62131,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10971.0 +62132,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53740.89 +62133,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7518.67 +62134,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,529.39 +62135,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,767.35 +62136,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2162.0 +62137,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2495.0 +62138,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1478.12 +62139,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62140,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62141,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1231.0 +62142,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7233.87 +62143,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62144,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6534.0 +62145,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,362.19 +62146,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2472.0 +62147,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,868.33 +62148,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4288.74 +62149,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,451.55 +62150,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,394.0 +62151,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62152,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1672.12 +62153,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1152.0 +62154,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5479.61 +62155,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6294.0 +62156,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16375.0 +62157,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62158,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62159,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16912.92 +62160,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2981.92 +62161,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3044.69 +62162,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3966.5 +62163,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62164,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5298.0 +62165,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62166,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62167,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5757.34 +62168,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62169,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5520.67 +62170,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,661.11 +62171,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8712.0 +62172,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2178.0 +62173,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4636.36 +62174,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,628.75 +62175,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,535.43 +62176,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,628.75 +62177,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62178,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62179,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7392.0 +62180,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15696.3 +62181,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8919.64 +62182,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62183,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7555.67 +62184,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62185,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7017.48 +62186,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62187,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6011.0 +62188,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35282.0 +62189,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62190,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62191,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10222.0 +62192,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62193,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62194,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6565.2 +62195,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62196,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62197,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62198,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62199,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62200,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62201,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5952.0 +62202,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62203,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62204,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11654.29 +62205,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2271.0 +62206,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1264.0 +62207,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2712.0 +62208,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62209,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62210,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18048.0 +62211,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11006.0 +62212,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62213,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4988.0 +62214,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8823.0 +62215,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11520.3 +62216,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17746.96 +62217,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12111.21 +62218,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11577.58 +62219,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11550.32 +62220,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12045.76 +62221,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29345.85 +62222,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3609.06 +62223,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62224,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4751.91 +62225,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62226,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6373.94 +62227,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3418.03 +62228,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6703.48 +62229,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4934.17 +62230,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62231,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8442.15 +62232,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8105.4 +62233,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8418.03 +62234,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62235,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8406.84 +62236,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3507.91 +62237,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6514.03 +62238,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29345.85 +62239,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6354.0 +62240,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6604.45 +62241,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3258.0 +62242,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,613.17 +62243,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62244,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5447.6 +62245,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62246,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62247,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9795.58 +62248,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7852.18 +62249,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9239.76 +62250,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62251,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10413.73 +62252,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6308.39 +62253,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7061.91 +62254,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5994.33 +62255,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,268.08 +62256,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11087.58 +62257,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10478.38 +62258,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14750.31 +62259,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12130.69 +62260,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11377.01 +62261,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62262,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20496.41 +62263,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18538.0 +62264,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62265,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62266,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62267,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62268,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9917.33 +62269,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15710.0 +62270,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62271,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10890.0 +62272,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62273,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62274,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5179.31 +62275,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4786.11 +62276,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5030.11 +62277,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4816.4 +62278,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62279,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62280,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8490.39 +62281,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,932.6 +62282,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6604.06 +62283,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9042.83 +62284,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4926.81 +62285,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62286,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4963.73 +62287,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62288,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8381.85 +62289,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62290,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8250.86 +62291,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8282.29 +62292,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2178.0 +62293,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2846.8 +62294,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6324.44 +62295,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62296,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8078.98 +62297,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6951.46 +62298,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2344.49 +62299,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1209.58 +62300,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6703.7 +62301,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8072.16 +62302,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7358.09 +62303,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6906.53 +62304,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10772.0 +62305,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62306,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4356.0 +62307,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62308,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10004.98 +62309,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62310,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13346.27 +62311,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62312,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62313,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7526.94 +62314,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62315,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5622.28 +62316,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,144.25 +62317,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62318,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42298.02 +62319,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17380.0 +62320,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +62321,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62322,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,174.8 +62323,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,205.71 +62324,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62325,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62326,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62327,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62328,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6534.0 +62329,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62330,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25188.91 +62331,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62332,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62333,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62334,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62335,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62336,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62337,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62338,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62339,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26675.92 +62340,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62341,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,462.0 +62342,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,958.0 +62343,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24.84 +62344,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1017.68 +62345,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,773.33 +62346,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,299.2 +62347,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2517.84 +62348,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,412.0 +62349,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2249.65 +62350,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2983.33 +62351,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3329.93 +62352,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2133.67 +62353,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3862.24 +62354,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62355,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5267.31 +62356,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3953.97 +62357,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4046.33 +62358,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2319.77 +62359,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3058.0 +62360,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3264.73 +62361,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8656.1 +62362,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8657.32 +62363,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3514.0 +62364,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5235.38 +62365,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5003.49 +62366,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62367,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7223.78 +62368,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9307.39 +62369,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5033.86 +62370,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5476.31 +62371,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6382.67 +62372,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7878.86 +62373,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2024.0 +62374,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,867.63 +62375,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,541.67 +62376,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,513.29 +62377,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,818.18 +62378,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,677.0 +62379,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,988.0 +62380,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,415.0 +62381,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,191.08 +62382,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2586.8 +62383,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8724.95 +62384,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10704.0 +62385,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,845.0 +62386,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4796.77 +62387,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4282.0 +62388,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5711.0 +62389,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3878.16 +62390,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,357.93 +62391,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,558.7 +62392,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,878.71 +62393,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1015.0 +62394,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,454.86 +62395,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,585.0 +62396,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,396.5 +62397,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,373.0 +62398,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,645.22 +62399,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,819.5 +62400,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62401,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,656.29 +62402,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,907.48 +62403,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,944.44 +62404,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4554.65 +62405,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9926.0 +62406,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1853.87 +62407,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2416.0 +62408,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1866.21 +62409,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2700.0 +62410,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2700.0 +62411,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5197.87 +62412,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14683.5 +62413,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4369.88 +62414,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6303.33 +62415,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5126.56 +62416,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6670.0 +62417,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6027.07 +62418,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5993.5 +62419,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5866.5 +62420,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,452.29 +62421,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,468.06 +62422,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3116.0 +62423,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2268.34 +62424,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3116.0 +62425,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4082.54 +62426,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4686.5 +62427,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5659.18 +62428,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,477.0 +62429,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,474.29 +62430,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,545.62 +62431,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,529.71 +62432,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,409.5 +62433,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,562.66 +62434,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,247.52 +62435,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,526.93 +62436,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,453.47 +62437,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,549.74 +62438,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,534.76 +62439,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,588.14 +62440,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,704.43 +62441,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,705.91 +62442,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,849.21 +62443,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,578.08 +62444,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1785.4 +62445,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2619.0 +62446,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2672.0 +62447,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4289.0 +62448,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5213.36 +62449,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3943.25 +62450,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4607.11 +62451,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,544.54 +62452,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,519.84 +62453,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,628.24 +62454,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,605.46 +62455,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,632.01 +62456,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,866.4 +62457,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,385.0 +62458,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,400.04 +62459,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,465.06 +62460,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,550.53 +62461,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,754.84 +62462,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,380.67 +62463,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,595.3 +62464,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24.84 +62465,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,531.6 +62466,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,684.38 +62467,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,440.8 +62468,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,695.8 +62469,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,481.03 +62470,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,597.25 +62471,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2064.06 +62472,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3234.17 +62473,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3013.89 +62474,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4008.9 +62475,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5567.06 +62476,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4339.75 +62477,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5787.0 +62478,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,332.21 +62479,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,553.54 +62480,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,634.26 +62481,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2464.5 +62482,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3751.5 +62483,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4182.17 +62484,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5093.47 +62485,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4086.71 +62486,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4221.83 +62487,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5315.28 +62488,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6313.81 +62489,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2026.34 +62490,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7057.42 +62491,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62492,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1062.44 +62493,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,814.0 +62494,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,873.0 +62495,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,829.82 +62496,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,838.43 +62497,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,822.14 +62498,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,82.0 +62499,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62500,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62501,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,908.0 +62502,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62503,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62504,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,381.85 +62505,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3125.0 +62506,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62507,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1412.6 +62508,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62509,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1675.78 +62510,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2806.44 +62511,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62512,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62513,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2387.2 +62514,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7954.42 +62515,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,782.0 +62516,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1225.32 +62517,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2804.12 +62518,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22489.17 +62519,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3149.6 +62520,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6347.6 +62521,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8563.9 +62522,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9638.35 +62523,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13910.54 +62524,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2689.0 +62525,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2959.56 +62526,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4769.0 +62527,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18339.0 +62528,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62529,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4822.2 +62530,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5697.0 +62531,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7542.0 +62532,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2823.0 +62533,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,673.0 +62534,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1909.67 +62535,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4304.27 +62536,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,474.0 +62537,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2522.81 +62538,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7388.0 +62539,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1416.2 +62540,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,815.9 +62541,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,393.89 +62542,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1923.13 +62543,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,473.46 +62544,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,189.44 +62545,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,334.0 +62546,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90.88 +62547,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62548,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,122.18 +62549,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1111.09 +62550,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1214.11 +62551,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1303.77 +62552,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,770.94 +62553,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1160.48 +62554,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1317.26 +62555,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,966.0 +62556,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1172.59 +62557,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1085.12 +62558,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,997.49 +62559,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,471.9 +62560,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3085.0 +62561,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,68.65 +62562,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,715.26 +62563,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,127.66 +62564,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,123.02 +62565,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,127.66 +62566,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,505.5 +62567,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,123.67 +62568,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,862.0 +62569,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3842.0 +62570,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4371.0 +62571,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,95.75 +62572,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4781.99 +62573,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4781.99 +62574,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5477.9 +62575,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3900.37 +62576,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,672.33 +62577,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3501.58 +62578,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6344.18 +62579,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15923.2 +62580,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,752.0 +62581,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,541.93 +62582,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,415.74 +62583,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,414.96 +62584,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,611.28 +62585,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2247.35 +62586,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,212.07 +62587,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1251.35 +62588,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62589,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,570.35 +62590,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,801.0 +62591,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1032.71 +62592,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2443.75 +62593,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1131.18 +62594,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3247.0 +62595,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3284.0 +62596,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3305.64 +62597,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3233.62 +62598,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62599,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,132.6 +62600,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,132.6 +62601,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,163.02 +62602,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,578.76 +62603,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,727.74 +62604,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,727.74 +62605,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,357.68 +62606,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,761.86 +62607,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,813.67 +62608,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75.71 +62609,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,947.26 +62610,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,284.74 +62611,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1091.9 +62612,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2802.57 +62613,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,488.68 +62614,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19222.5 +62615,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3605.23 +62616,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15039.11 +62617,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9429.76 +62618,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8521.37 +62619,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6234.58 +62620,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15923.2 +62621,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6139.93 +62622,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3807.93 +62623,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18188.0 +62624,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4030.74 +62625,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1388.26 +62626,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15058.97 +62627,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1994.8 +62628,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27950.9 +62629,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9499.8 +62630,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2609.57 +62631,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3235.44 +62632,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,483.66 +62633,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,880.0 +62634,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7911.86 +62635,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1497.72 +62636,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,692.24 +62637,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7078.15 +62638,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6234.73 +62639,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8521.37 +62640,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62641,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15923.2 +62642,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,341.0 +62643,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2012.68 +62644,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2177.0 +62645,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1483.18 +62646,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4918.0 +62647,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1869.44 +62648,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6055.0 +62649,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2179.17 +62650,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1963.2 +62651,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3539.76 +62652,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62653,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2737.07 +62654,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3072.0 +62655,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2857.0 +62656,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8033.95 +62657,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62658,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3043.0 +62659,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1571.92 +62660,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2189.0 +62661,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1431.49 +62662,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2445.0 +62663,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8428.19 +62664,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62665,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4809.55 +62666,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62667,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2076.0 +62668,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2250.0 +62669,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1175.0 +62670,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2332.0 +62671,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2947.0 +62672,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62673,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11487.6 +62674,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11757.29 +62675,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62676,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11274.1 +62677,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11870.24 +62678,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3834.39 +62679,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2792.5 +62680,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5087.67 +62681,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1514.82 +62682,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57965.85 +62683,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,231.66 +62684,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,316.5 +62685,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.0 +62686,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,330.82 +62687,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62688,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,153.98 +62689,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,163.88 +62690,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,421.6 +62691,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,223.2 +62692,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,366.52 +62693,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.0 +62694,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,121.13 +62695,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.0 +62696,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,228.18 +62697,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21.16 +62698,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57.18 +62699,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,108.05 +62700,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33.16 +62701,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62.68 +62702,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62703,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.0 +62704,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.59 +62705,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.18 +62706,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75.74 +62707,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,162.52 +62708,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.06 +62709,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,122.33 +62710,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.16 +62711,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,60.46 +62712,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,136.0 +62713,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,201.96 +62714,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,148.0 +62715,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21.96 +62716,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32.5 +62717,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,539.0 +62718,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27.11 +62719,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62720,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27.11 +62721,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.7 +62722,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42.16 +62723,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,539.96 +62724,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6.5 +62725,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.16 +62726,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.0 +62727,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,248.0 +62728,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43.52 +62729,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62730,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62731,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.0 +62732,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.0 +62733,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.0 +62734,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.5 +62735,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.0 +62736,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.0 +62737,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.0 +62738,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33.79 +62739,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62740,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,156.0 +62741,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62742,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57.32 +62743,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30.0 +62744,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.36 +62745,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97.0 +62746,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97.0 +62747,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97.0 +62748,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97.0 +62749,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97.0 +62750,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97.0 +62751,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,97.0 +62752,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,251.9 +62753,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,281.57 +62754,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,760.0 +62755,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,300.0 +62756,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62757,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,523.0 +62758,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62759,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1145.8 +62760,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,648.13 +62761,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,214.62 +62762,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,152.0 +62763,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,428.0 +62764,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,166.84 +62765,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,325.0 +62766,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,153.5 +62767,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,176.25 +62768,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,440.56 +62769,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,365.0 +62770,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,215.56 +62771,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,269.28 +62772,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21.97 +62773,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62774,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,190.63 +62775,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,94.88 +62776,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62777,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,89.66 +62778,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80.48 +62779,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,502.57 +62780,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,305.43 +62781,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,185.0 +62782,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,233.07 +62783,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,406.86 +62784,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3206.0 +62785,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62786,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.74 +62787,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62788,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62789,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,148.0 +62790,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.88 +62791,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,116.25 +62792,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62793,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,222.0 +62794,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,285.35 +62795,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62796,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62797,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,231.63 +62798,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,578.67 +62799,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88.08 +62800,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62801,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,130.15 +62802,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,55.13 +62803,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,157.8 +62804,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.33 +62805,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,839.0 +62806,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,641.85 +62807,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,551.61 +62808,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,404.52 +62809,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,152.76 +62810,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62811,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62812,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,251.99 +62813,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,129.74 +62814,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,339.32 +62815,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,149.7 +62816,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.5 +62817,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,490.0 +62818,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.33 +62819,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,535.0 +62820,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,124.58 +62821,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1116.6 +62822,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,659.6 +62823,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,261.5 +62824,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,336.0 +62825,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62826,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2461.6 +62827,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1968.84 +62828,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,615.75 +62829,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42.87 +62830,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,760.0 +62831,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,127.92 +62832,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.83 +62833,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.0 +62834,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41.48 +62835,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51.85 +62836,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,93.16 +62837,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.07 +62838,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.54 +62839,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.55 +62840,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.72 +62841,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,176.8 +62842,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62843,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30.9 +62844,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,146.2 +62845,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62846,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53.04 +62847,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,99.66 +62848,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,116.77 +62849,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29.82 +62850,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.2 +62851,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62852,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.0 +62853,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.64 +62854,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,173.4 +62855,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.0 +62856,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,86.54 +62857,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,76.02 +62858,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.38 +62859,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50.06 +62860,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.4 +62861,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.8 +62862,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,310.08 +62863,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23.0 +62864,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,58.44 +62865,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,141.44 +62866,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70.04 +62867,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48.8 +62868,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.01 +62869,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,137.25 +62870,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,201.14 +62871,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.87 +62872,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9.67 +62873,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.25 +62874,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.87 +62875,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,191.76 +62876,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,64.08 +62877,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50.43 +62878,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27.54 +62879,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27.12 +62880,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62881,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.68 +62882,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.72 +62883,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65.49 +62884,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,190.74 +62885,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,228.48 +62886,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62.56 +62887,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.18 +62888,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.55 +62889,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,67.09 +62890,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.44 +62891,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,144.7 +62892,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.0 +62893,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,55.76 +62894,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,106.08 +62895,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31.28 +62896,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.27 +62897,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,115.45 +62898,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30.9 +62899,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,52.22 +62900,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.0 +62901,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.92 +62902,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31.09 +62903,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.18 +62904,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,312.8 +62905,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32.3 +62906,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.0 +62907,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24.95 +62908,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.22 +62909,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62910,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62911,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22.29 +62912,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,123.76 +62913,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,780.67 +62914,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128.86 +62915,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.0 +62916,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,400.44 +62917,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.76 +62918,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,96.04 +62919,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,307.39 +62920,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,275.71 +62921,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.23 +62922,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62.33 +62923,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40.8 +62924,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41.02 +62925,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54.4 +62926,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65.21 +62927,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.11 +62928,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.97 +62929,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26.52 +62930,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63.24 +62931,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.0 +62932,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,205.59 +62933,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,225.76 +62934,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70.0 +62935,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30.17 +62936,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,124.44 +62937,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7.86 +62938,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62939,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,118.99 +62940,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.61 +62941,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,139.82 +62942,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,135.0 +62943,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.75 +62944,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28.0 +62945,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,203.32 +62946,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6.25 +62947,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.9 +62948,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32.64 +62949,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,362.44 +62950,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,89.76 +62951,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,86.36 +62952,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.19 +62953,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,77.32 +62954,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,179.11 +62955,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.84 +62956,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62957,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.2 +62958,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.59 +62959,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,137.47 +62960,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.0 +62961,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62962,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62963,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38.96 +62964,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80.0 +62965,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62966,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62967,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.07 +62968,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,105.75 +62969,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.15 +62970,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23.54 +62971,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45.69 +62972,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,107.21 +62973,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,275.92 +62974,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,275.17 +62975,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31.23 +62976,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22.75 +62977,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.46 +62978,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51.0 +62979,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.16 +62980,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62981,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62982,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,325.04 +62983,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46.18 +62984,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.41 +62985,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30.98 +62986,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.83 +62987,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70.27 +62988,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.79 +62989,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,60.0 +62990,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.78 +62991,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,210.0 +62992,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29.0 +62993,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +62994,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,55.85 +62995,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53.06 +62996,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,99.28 +62997,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44.88 +62998,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,205.36 +62999,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,124.39 +63000,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,267.24 +63001,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63002,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,167.28 +63003,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.68 +63004,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44.29 +63005,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42.16 +63006,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,74.03 +63007,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,133.96 +63008,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,122.4 +63009,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.03 +63010,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,100.61 +63011,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62.0 +63012,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23.89 +63013,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.48 +63014,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9.44 +63015,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.0 +63016,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21.21 +63017,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.0 +63018,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32.49 +63019,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.0 +63020,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.76 +63021,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47.97 +63022,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37.31 +63023,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.0 +63024,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63025,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33.09 +63026,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40.71 +63027,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.53 +63028,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63029,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,112.54 +63030,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,109.77 +63031,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.75 +63032,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.11 +63033,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,79.34 +63034,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,139.85 +63035,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.34 +63036,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,183.04 +63037,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41.0 +63038,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.4 +63039,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54.55 +63040,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63.69 +63041,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,113.65 +63042,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36.3 +63043,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,55.13 +63044,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90.61 +63045,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,105.0 +63046,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.35 +63047,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,230.45 +63048,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,64.6 +63049,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54.63 +63050,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53.63 +63051,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.33 +63052,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63053,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.0 +63054,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.33 +63055,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63056,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.54 +63057,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40.8 +63058,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7.9 +63059,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,72.42 +63060,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,337.53 +63061,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,241.66 +63062,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.0 +63063,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1360.0 +63064,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,91.14 +63065,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63066,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32.88 +63067,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44.0 +63068,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,127.0 +63069,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63.37 +63070,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1.43 +63071,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48.96 +63072,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63.0 +63073,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.22 +63074,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12103.81 +63075,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,95.32 +63076,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39.87 +63077,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,332.52 +63078,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,167.25 +63079,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,227.12 +63080,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,206.04 +63081,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,115.6 +63082,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,113.28 +63083,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.89 +63084,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,98.43 +63085,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.9 +63086,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,144.84 +63087,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,193.8 +63088,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.81 +63089,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,103.0 +63090,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,103.65 +63091,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.77 +63092,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.66 +63093,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.53 +63094,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,93.19 +63095,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,172.68 +63096,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,115.6 +63097,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46.5 +63098,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.78 +63099,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6.53 +63100,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63101,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9.36 +63102,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,544.0 +63103,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,826.74 +63104,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,89.0 +63105,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63106,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,66.89 +63107,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.48 +63108,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80.0 +63109,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51.0 +63110,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45.56 +63111,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,117.0 +63112,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,180.88 +63113,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34.2 +63114,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,235.67 +63115,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,660.28 +63116,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7.77 +63117,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45.29 +63118,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.97 +63119,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,206.12 +63120,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,120.36 +63121,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88.06 +63122,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42.02 +63123,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,119.0 +63124,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,175.44 +63125,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33.88 +63126,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,365.84 +63127,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42.0 +63128,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,310.0 +63129,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.26 +63130,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,380.8 +63131,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.33 +63132,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.0 +63133,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,112.88 +63134,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.2 +63135,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,165.24 +63136,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,386.24 +63137,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88.92 +63138,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,109.14 +63139,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,227.47 +63140,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,251.02 +63141,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,271.32 +63142,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44.88 +63143,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54.45 +63144,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31.15 +63145,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57.42 +63146,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45.23 +63147,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37.5 +63148,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,166.6 +63149,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,183.6 +63150,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6.5 +63151,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.0 +63152,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.31 +63153,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,151.19 +63154,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,151.65 +63155,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51.37 +63156,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,178.16 +63157,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,72.89 +63158,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.08 +63159,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,194.48 +63160,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,286.96 +63161,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,419.86 +63162,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.0 +63163,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,61.88 +63164,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,240.04 +63165,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.24 +63166,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,61.2 +63167,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.4 +63168,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.03 +63169,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.02 +63170,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47.59 +63171,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.29 +63172,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.2 +63173,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,289.0 +63174,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,269.28 +63175,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,136.5 +63176,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.93 +63177,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63178,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63179,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.0 +63180,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63181,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,211.04 +63182,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9.0 +63183,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,73.08 +63184,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.0 +63185,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,58.64 +63186,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,69.55 +63187,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34.0 +63188,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28.32 +63189,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44.81 +63190,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38.67 +63191,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.35 +63192,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.54 +63193,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.19 +63194,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.35 +63195,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.0 +63196,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.0 +63197,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,189.0 +63198,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57.26 +63199,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,91.34 +63200,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,69.45 +63201,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.08 +63202,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.69 +63203,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9.07 +63204,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30.03 +63205,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.99 +63206,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63207,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,140.76 +63208,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.83 +63209,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.19 +63210,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.25 +63211,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.4 +63212,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,74.0 +63213,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,95.2 +63214,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,108.12 +63215,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,126.39 +63216,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,141.09 +63217,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,133.0 +63218,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54.52 +63219,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,164.77 +63220,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.0 +63221,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.91 +63222,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12.88 +63223,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.35 +63224,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,189.47 +63225,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,870.0 +63226,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,98.67 +63227,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,133.28 +63228,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,435.3 +63229,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,432.19 +63230,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,762.91 +63231,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1329.53 +63232,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1016.9 +63233,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,788.33 +63234,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,312.0 +63235,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2272.0 +63236,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,559.93 +63237,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,559.93 +63238,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4188.63 +63239,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1552.17 +63240,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,312.22 +63241,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1163.3 +63242,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,773.66 +63243,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,303.28 +63244,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,220.32 +63245,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,136.0 +63246,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,141.06 +63247,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,231.0 +63248,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,220.32 +63249,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62.28 +63250,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,318.24 +63251,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,148.0 +63252,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,139.4 +63253,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,64.6 +63254,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,266.56 +63255,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.96 +63256,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53.72 +63257,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45.56 +63258,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.39 +63259,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63260,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,209.44 +63261,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63262,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24.25 +63263,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128.23 +63264,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,275.0 +63265,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50.32 +63266,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,83.0 +63267,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63268,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,86.53 +63269,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49.85 +63270,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,137.36 +63271,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.5 +63272,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70.9 +63273,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,221.0 +63274,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,72.0 +63275,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,168.64 +63276,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88.0 +63277,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46.24 +63278,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32.72 +63279,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.33 +63280,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63281,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75.28 +63282,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26.99 +63283,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.42 +63284,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57.15 +63285,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,79.34 +63286,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,104.04 +63287,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47.55 +63288,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.65 +63289,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.25 +63290,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,89.13 +63291,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.98 +63292,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.08 +63293,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63294,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,177.17 +63295,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32.0 +63296,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63297,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,146.2 +63298,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48.96 +63299,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.0 +63300,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,87.73 +63301,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,330.0 +63302,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,174.71 +63303,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,330.0 +63304,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,193.12 +63305,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,60.03 +63306,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,121.04 +63307,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,421.08 +63308,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,226.42 +63309,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,178.0 +63310,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.0 +63311,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43.75 +63312,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.09 +63313,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.2 +63314,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.09 +63315,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,226.93 +63316,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44.76 +63317,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,140.09 +63318,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,162.11 +63319,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,146.39 +63320,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,165.67 +63321,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,96.0 +63322,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,67.0 +63323,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.5 +63324,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,166.46 +63325,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,321.0 +63326,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,141.67 +63327,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,512.87 +63328,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,613.0 +63329,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1702.49 +63330,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,153.96 +63331,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21.43 +63332,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.0 +63333,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38.29 +63334,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,196.39 +63335,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,104.04 +63336,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,272.26 +63337,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.5 +63338,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,112.79 +63339,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,85.68 +63340,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,317.84 +63341,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,235.2 +63342,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,545.97 +63343,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,286.77 +63344,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,158.92 +63345,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,257.45 +63346,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,448.0 +63347,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,164.0 +63348,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,231.96 +63349,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,452.0 +63350,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,133.73 +63351,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7596.06 +63352,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7157.6 +63353,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20.0 +63354,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,113.22 +63355,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,116.96 +63356,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40.0 +63357,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,143.9 +63358,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1096.77 +63359,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1369.8 +63360,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63361,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63362,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1055.42 +63363,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63364,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1481.58 +63365,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39.66 +63366,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2719.65 +63367,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,417.19 +63368,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63369,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3460.32 +63370,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3670.06 +63371,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4125.22 +63372,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1933.92 +63373,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4435.84 +63374,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4238.89 +63375,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.66 +63376,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5645.0 +63377,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1355.39 +63378,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,739.43 +63379,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,920.0 +63380,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2250.33 +63381,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3399.61 +63382,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,398.4 +63383,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2440.88 +63384,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,240.29 +63385,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,890.16 +63386,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1842.12 +63387,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,903.16 +63388,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1004.36 +63389,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1296.79 +63390,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,716.27 +63391,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2474.09 +63392,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2080.0 +63393,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6342.84 +63394,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,232.8 +63395,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4314.0 +63396,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,147.07 +63397,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,55.0 +63398,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,74.0 +63399,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,121.72 +63400,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2413.32 +63401,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13503.39 +63402,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,79.56 +63403,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,58.1 +63404,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +63405,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,117.0 +63406,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.76 +63407,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.53 +63408,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.25 +63409,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63410,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,181.8 +63411,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,647.42 +63412,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1178.28 +63413,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49.72 +63414,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,61.7 +63415,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,239.96 +63416,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,111.35 +63417,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42.34 +63418,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128.41 +63419,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,265.34 +63420,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,94.77 +63421,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,61.77 +63422,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,131.71 +63423,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.56 +63424,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1075.5 +63425,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,261.43 +63426,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,333.33 +63427,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,78.57 +63428,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,163.29 +63429,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,106.32 +63430,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,397.8 +63431,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63.0 +63432,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,320.22 +63433,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,159.0 +63434,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63435,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63436,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63437,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1800.87 +63438,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63439,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49.28 +63440,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36.62 +63441,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5462.0 +63442,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5050.09 +63443,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1240.0 +63444,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5050.09 +63445,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1216.0 +63446,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8631.6 +63447,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,385.0 +63448,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2816.0 +63449,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2082.9 +63450,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1253.0 +63451,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1253.0 +63452,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,206.22 +63453,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,200.62 +63454,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,205.98 +63455,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,202.24 +63456,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,74.36 +63457,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7533.5 +63458,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90.89 +63459,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90.89 +63460,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90.88 +63461,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,421.95 +63462,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63463,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,68.17 +63464,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90.89 +63465,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63466,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63467,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,268.08 +63468,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,90.89 +63469,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63470,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,352.92 +63471,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63472,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,150.19 +63473,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,359.72 +63474,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,231.0 +63475,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,592.96 +63476,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,298.2 +63477,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1834.31 +63478,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1443.0 +63479,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1834.22 +63480,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63481,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,530.0 +63482,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,449.1 +63483,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80.92 +63484,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,243.75 +63485,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,636.08 +63486,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,186.0 +63487,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1588.63 +63488,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,561.45 +63489,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,104.0 +63490,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63491,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63492,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,189.63 +63493,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,506.0 +63494,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,737.0 +63495,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,547.8 +63496,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,192.0 +63497,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1075.0 +63498,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1128.8 +63499,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,708.8 +63500,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.82 +63501,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,765.0 +63502,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,77.75 +63503,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1060.67 +63504,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,899.38 +63505,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63506,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63507,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,571.88 +63508,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,807.84 +63509,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,242.8 +63510,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,544.0 +63511,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63512,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,636.67 +63513,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,134.64 +63514,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,123.83 +63515,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,134.66 +63516,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128.44 +63517,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1840.88 +63518,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22362.72 +63519,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15746.73 +63520,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32386.05 +63521,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31334.66 +63522,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63523,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40532.44 +63524,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63525,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27188.81 +63526,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63527,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29986.24 +63528,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,938.51 +63529,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2930.63 +63530,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9902.86 +63531,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9866.75 +63532,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22173.55 +63533,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63534,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,369.93 +63535,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1371.99 +63536,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1780.0 +63537,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1780.0 +63538,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1926.78 +63539,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,162.0 +63540,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.25 +63541,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +63542,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1008.5 +63543,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,822.05 +63544,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4823.3 +63545,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63546,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3970.21 +63547,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2551.0 +63548,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5773.18 +63549,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,495.89 +63550,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2781.0 +63551,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1412.44 +63552,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2781.0 +63553,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6284.38 +63554,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5846.0 +63555,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2551.0 +63556,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12440.33 +63557,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63558,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13010.85 +63559,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12378.79 +63560,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12081.68 +63561,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12326.73 +63562,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13220.67 +63563,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12338.34 +63564,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12678.55 +63565,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12800.93 +63566,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12613.86 +63567,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11927.0 +63568,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,377.65 +63569,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2359.5 +63570,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9668.02 +63571,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3047.0 +63572,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,73790.67 +63573,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12858.25 +63574,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17088.98 +63575,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14548.1 +63576,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17060.57 +63577,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13033.72 +63578,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3871.0 +63579,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3675.0 +63580,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21144.54 +63581,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,67851.01 +63582,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,52785.16 +63583,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10113.67 +63584,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88812.07 +63585,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10229.0 +63586,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1223.0 +63587,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10356.9 +63588,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63589,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,814.87 +63590,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,324.41 +63591,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4362.37 +63592,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2105.68 +63593,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,852.0 +63594,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,933.64 +63595,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,861.82 +63596,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1369.2 +63597,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2034.46 +63598,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1308.71 +63599,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2001.0 +63600,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1112.23 +63601,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2115.32 +63602,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1565.89 +63603,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2226.08 +63604,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1929.0 +63605,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,712.44 +63606,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,653.0 +63607,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,407.0 +63608,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,233.2 +63609,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,359.68 +63610,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,993.92 +63611,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1112.5 +63612,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,809.59 +63613,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,73.62 +63614,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,574.47 +63615,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1163.8 +63616,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +63617,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2706.1 +63618,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.98 +63619,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,298.0 +63620,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1006.07 +63621,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,344.48 +63622,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,146.88 +63623,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1190.22 +63624,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,324.84 +63625,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63626,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63627,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10038.51 +63628,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17042.26 +63629,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5123.94 +63630,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9974.0 +63631,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20834.51 +63632,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19536.68 +63633,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63634,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3872.6 +63635,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10648.0 +63636,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5902.17 +63637,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6062.71 +63638,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,394.4 +63639,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3943.23 +63640,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,853.81 +63641,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1050.96 +63642,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,908.0 +63643,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,146.54 +63644,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,135.32 +63645,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,955.0 +63646,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,955.0 +63647,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,103.23 +63648,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1066.67 +63649,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.82 +63650,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.82 +63651,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2315.0 +63652,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.82 +63653,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1799.0 +63654,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2181.0 +63655,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2181.0 +63656,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.6 +63657,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63658,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,951.0 +63659,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,331.0 +63660,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,223.46 +63661,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,147.38 +63662,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,682.77 +63663,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,674.13 +63664,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6.42 +63665,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,346.17 +63666,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80.0 +63667,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,684.46 +63668,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,973.76 +63669,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2109.78 +63670,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1083.18 +63671,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,337.0 +63672,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,337.0 +63673,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2056.07 +63674,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1410.32 +63675,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1927.03 +63676,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2025.24 +63677,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1048.39 +63678,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,662.83 +63679,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1389.82 +63680,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +63681,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1525.44 +63682,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1592.14 +63683,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3551.97 +63684,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1671.36 +63685,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1728.0 +63686,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1709.35 +63687,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4530.4 +63688,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1974.16 +63689,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3090.8 +63690,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4164.14 +63691,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3910.74 +63692,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63693,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22730.72 +63694,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,284.97 +63695,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2016.0 +63696,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,268.58 +63697,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.65 +63698,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,100.0 +63699,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7.38 +63700,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.12 +63701,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.75 +63702,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,76.16 +63703,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,499.8 +63704,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,378.42 +63705,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,163.25 +63706,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,240.84 +63707,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39.44 +63708,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,78.88 +63709,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43.86 +63710,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,262.37 +63711,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21.31 +63712,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,193.51 +63713,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,310.88 +63714,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,370.6 +63715,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,345.0 +63716,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,214.88 +63717,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,267.92 +63718,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,101.32 +63719,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,236.64 +63720,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,331.84 +63721,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,198.97 +63722,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,133.87 +63723,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,EMPIRE HEALTHCHOICE ASSURANCE-PPO,78.83 +63724,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,274.99 +63725,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,292.19 +63726,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,133.55 +63727,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63728,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.5 +63729,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,893.52 +63730,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1321.35 +63731,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,540.5 +63732,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63733,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,393.33 +63734,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,804.0 +63735,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,95.1 +63736,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,330.02 +63737,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,213.77 +63738,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,195.69 +63739,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,209.5 +63740,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,318.92 +63741,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,204.28 +63742,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,183.85 +63743,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,212.93 +63744,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,204.96 +63745,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,239.87 +63746,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,240.38 +63747,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,206.65 +63748,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,210.3 +63749,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,204.26 +63750,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.97 +63751,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,263.75 +63752,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +63753,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2310.78 +63754,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +63755,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3000.02 +63756,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8008.98 +63757,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10558.67 +63758,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,199.81 +63759,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,199.47 +63760,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,199.47 +63761,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,199.47 +63762,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,201.95 +63763,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,199.47 +63764,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63765,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,205.45 +63766,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,EMPIRE HEALTHCHOICE ASSURANCE-PPO,191.05 +63767,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,200.12 +63768,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,199.47 +63769,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,197.68 +63770,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,199.89 +63771,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63772,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31.0 +63773,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40.0 +63774,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,153.85 +63775,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,79.0 +63776,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,87.24 +63777,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,144.0 +63778,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,55.33 +63779,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,68.0 +63780,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38098.53 +63781,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3083.15 +63782,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,261690.14 +63783,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,716.0 +63784,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10667.43 +63785,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,659.24 +63786,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35378.45 +63787,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,131197.99 +63788,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,387.83 +63789,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11826.55 +63790,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16000.9 +63791,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63792,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,93386.1 +63793,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13825.09 +63794,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63795,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,563.39 +63796,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4707.25 +63797,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11537.12 +63798,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43852.89 +63799,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25424.18 +63800,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12071.0 +63801,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5253.48 +63802,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18313.69 +63803,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35618.59 +63804,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8901.43 +63805,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5889.92 +63806,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63807,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3267.0 +63808,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7625.07 +63809,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10939.03 +63810,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6365.86 +63811,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32347.78 +63812,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5437.7 +63813,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32726.36 +63814,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13760.68 +63815,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8581.14 +63816,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9849.87 +63817,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9641.05 +63818,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25357.93 +63819,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13511.78 +63820,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24955.11 +63821,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21133.93 +63822,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10188.25 +63823,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4159.23 +63824,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22118.25 +63825,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11644.14 +63826,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2590.18 +63827,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5118.81 +63828,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10866.0 +63829,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6643.36 +63830,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10518.08 +63831,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38555.43 +63832,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43756.21 +63833,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17384.64 +63834,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10098.03 +63835,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18538.64 +63836,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6200.48 +63837,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14648.3 +63838,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48053.98 +63839,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8314.02 +63840,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9240.83 +63841,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8926.66 +63842,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9515.25 +63843,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7154.76 +63844,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8866.16 +63845,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12012.59 +63846,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53503.63 +63847,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12412.29 +63848,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8661.71 +63849,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36097.16 +63850,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,26675.47 +63851,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21146.14 +63852,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51546.08 +63853,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13492.93 +63854,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,158536.18 +63855,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20571.06 +63856,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14003.19 +63857,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57144.7 +63858,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29844.47 +63859,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21243.07 +63860,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8854.01 +63861,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20082.38 +63862,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17465.99 +63863,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9131.13 +63864,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33637.86 +63865,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15813.44 +63866,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27073.57 +63867,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4877.81 +63868,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50649.08 +63869,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44591.05 +63870,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30906.6 +63871,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5013.31 +63872,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4189.09 +63873,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +63874,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5002.3 +63875,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17505.53 +63876,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8753.35 +63877,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,109354.29 +63878,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,68900.44 +63879,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,67396.01 +63880,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9657.06 +63881,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27390.39 +63882,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5526.51 +63883,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8435.48 +63884,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6334.89 +63885,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19504.74 +63886,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49931.75 +63887,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8824.74 +63888,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8722.62 +63889,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6635.44 +63890,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12479.37 +63891,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35028.86 +63892,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9889.06 +63893,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28218.75 +63894,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17437.71 +63895,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5602.7 +63896,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,85798.14 +63897,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36623.77 +63898,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51771.46 +63899,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25621.92 +63900,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20603.34 +63901,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9953.74 +63902,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,44381.48 +63903,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11184.19 +63904,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13608.79 +63905,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11573.23 +63906,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,39984.23 +63907,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43895.7 +63908,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8096.08 +63909,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7098.17 +63910,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5744.47 +63911,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14853.5 +63912,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15120.63 +63913,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27445.14 +63914,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,105141.0 +63915,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11663.73 +63916,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42729.54 +63917,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7420.07 +63918,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128518.4 +63919,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59583.59 +63920,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12722.52 +63921,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9434.95 +63922,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35511.18 +63923,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14673.93 +63924,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19159.15 +63925,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4631.29 +63926,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17408.46 +63927,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22475.88 +63928,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24834.85 +63929,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,40599.28 +63930,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14697.36 +63931,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6109.62 +63932,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8522.39 +63933,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9244.57 +63934,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10147.98 +63935,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10711.18 +63936,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4644.81 +63937,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11054.72 +63938,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15289.01 +63939,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14827.58 +63940,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4737.75 +63941,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6067.23 +63942,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65262.53 +63943,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9658.73 +63944,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3605.35 +63945,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20050.26 +63946,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,52316.53 +63947,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38109.67 +63948,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12394.93 +63949,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12367.96 +63950,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15260.44 +63951,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11722.35 +63952,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33739.76 +63953,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13486.34 +63954,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20900.26 +63955,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11959.28 +63956,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,32843.45 +63957,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8290.72 +63958,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21630.85 +63959,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10017.17 +63960,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17314.23 +63961,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38161.6 +63962,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6168.49 +63963,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,124170.14 +63964,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11408.42 +63965,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9397.2 +63966,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7903.5 +63967,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5015.13 +63968,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15855.26 +63969,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14636.12 +63970,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65519.09 +63971,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8118.3 +63972,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11943.74 +63973,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7251.08 +63974,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22575.73 +63975,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9356.84 +63976,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6089.14 +63977,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8587.35 +63978,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6656.7 +63979,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7019.79 +63980,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6075.27 +63981,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9008.71 +63982,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23714.11 +63983,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7718.32 +63984,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23289.93 +63985,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9764.54 +63986,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2644.61 +63987,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2150.56 +63988,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3888.63 +63989,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,178224.87 +63990,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80851.85 +63991,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46539.48 +63992,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88781.78 +63993,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80314.35 +63994,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70267.47 +63995,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41864.78 +63996,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22800.16 +63997,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43510.98 +63998,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56409.34 +63999,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19453.01 +64000,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7485.22 +64001,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62925.19 +64002,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,104254.55 +64003,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47707.55 +64004,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9076.81 +64005,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19691.59 +64006,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16107.29 +64007,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7607.67 +64008,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18624.03 +64009,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12121.04 +64010,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9260.95 +64011,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10391.18 +64012,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28364.08 +64013,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27942.79 +64014,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,64596.23 +64015,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30788.45 +64016,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8730.1 +64017,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,168704.48 +64018,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16832.62 +64019,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,103582.97 +64020,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59906.1 +64021,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48837.77 +64022,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10142.15 +64023,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11858.84 +64024,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5514.89 +64025,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5888.04 +64026,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11624.5 +64027,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,155880.87 +64028,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12066.26 +64029,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13811.01 +64030,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15946.13 +64031,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24659.35 +64032,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6448.93 +64033,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,160617.4 +64034,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8616.1 +64035,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45951.73 +64036,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5742.87 +64037,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2921.7 +64038,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11440.77 +64039,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3787.5 +64040,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3777.19 +64041,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5088.89 +64042,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5918.5 +64043,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88889.91 +64044,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6700.31 +64045,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18720.47 +64046,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6754.5 +64047,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7010.27 +64048,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,60646.45 +64049,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18688.09 +64050,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,169297.62 +64051,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17208.47 +64052,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23429.64 +64053,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7717.17 +64054,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,91478.3 +64055,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19265.56 +64056,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46685.92 +64057,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,48329.72 +64058,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9845.72 +64059,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,43663.89 +64060,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,122199.57 +64061,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34333.5 +64062,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,721.6 +64063,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1088.0 +64064,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1479.88 +64065,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1063.0 +64066,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,438.56 +64067,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,748.18 +64068,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2754.4 +64069,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21.36 +64070,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,121.0 +64071,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,304.0 +64072,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.73 +64073,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,892.5 +64074,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,155.0 +64075,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64076,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64077,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.0 +64078,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64079,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,EMPIRE HEALTHCHOICE ASSURANCE-PPO,350.23 +64080,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,131.87 +64081,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,147.0 +64082,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.09 +64083,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,136960.0 +64084,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,104.01 +64085,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2400.0 +64086,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,900.0 +64087,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3242.0 +64088,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,137.82 +64089,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,95.78 +64090,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,161.2 +64091,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.04 +64092,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,155.5 +64093,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3092.91 +64094,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64095,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,327.45 +64096,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,212.67 +64097,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,173.6 +64098,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,430.33 +64099,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54.0 +64100,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64101,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64102,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4056.82 +64103,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10358.67 +64104,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1583.5 +64105,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1742.43 +64106,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50560.83 +64107,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,94.0 +64108,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5530.5 +64109,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,167.5 +64110,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1763.0 +64111,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35912.5 +64112,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35571.43 +64113,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4593.86 +64114,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1131.63 +64115,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1281.0 +64116,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1160.79 +64117,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2298.0 +64118,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,213.35 +64119,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1089.93 +64120,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3854.9 +64121,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9112.67 +64122,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7109.14 +64123,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,734.86 +64124,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,397.49 +64125,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.0 +64126,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1469.64 +64127,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1153.86 +64128,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70.0 +64129,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5494.36 +64130,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,472.0 +64131,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1608.67 +64132,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1300.0 +64133,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9933.01 +64134,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,429.67 +64135,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2015.82 +64136,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,20654.0 +64137,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2316.17 +64138,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,403.81 +64139,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3061.0 +64140,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22400.0 +64141,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,987.67 +64142,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9990.95 +64143,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9097.5 +64144,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7156.35 +64145,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,350.0 +64146,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,428.5 +64147,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3891.67 +64148,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8785.0 +64149,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16661.54 +64150,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1942.71 +64151,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,696.14 +64152,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3626.5 +64153,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16584.33 +64154,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10004.75 +64155,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18602.0 +64156,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3206.5 +64157,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29231.37 +64158,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11366.67 +64159,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53000.0 +64160,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5100.0 +64161,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5141.0 +64162,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,845.0 +64163,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1550.0 +64164,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,41279.84 +64165,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1790.0 +64166,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3072.0 +64167,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4323.33 +64168,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2674.0 +64169,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,741.84 +64170,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8400.0 +64171,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,142.45 +64172,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,213.02 +64173,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,140.0 +64174,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8328.0 +64175,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9428.57 +64176,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3474.14 +64177,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1686.77 +64178,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5344.19 +64179,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57965.85 +64180,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,304.24 +64181,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5812.5 +64182,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16509.52 +64183,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,42920.0 +64184,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1730.0 +64185,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,89.0 +64186,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1462.67 +64187,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1100.0 +64188,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3961.0 +64189,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4040.14 +64190,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4053.33 +64191,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2703.0 +64192,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4977.75 +64193,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5813.0 +64194,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2785.0 +64195,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6870.14 +64196,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5178.46 +64197,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,635.97 +64198,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28.65 +64199,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3465.5 +64200,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,98.57 +64201,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,EMPIRE HEALTHCHOICE ASSURANCE-PPO,178.35 +64202,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,312.0 +64203,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7225.49 +64204,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2982.29 +64205,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2696.4 +64206,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38453.87 +64207,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29792.42 +64208,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,46240.97 +64209,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27532.0 +64210,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,33917.52 +64211,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34465.97 +64212,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64213,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18833.29 +64214,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13056.0 +64215,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64216,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18799.42 +64217,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64218,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,329.64 +64219,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63.82 +64220,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3364.2 +64221,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1276.29 +64222,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,138.63 +64223,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,112.29 +64224,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64225,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,96.24 +64226,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,EMPIRE HEALTHCHOICE ASSURANCE-PPO,106.94 +64227,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,96.25 +64228,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,308.24 +64229,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2634.4 +64230,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1499.65 +64231,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2919.2 +64232,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,96.24 +64233,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64234,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2345.74 +64235,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64236,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64237,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,160.53 +64238,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2484.0 +64239,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11466.67 +64240,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3431.84 +64241,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,262.22 +64242,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,146.52 +64243,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64244,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64245,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64246,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64247,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,132.75 +64248,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22.25 +64249,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1986.0 +64250,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64251,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64252,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64253,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,117.0 +64254,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1333.33 +64255,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64256,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.31 +64257,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2965.33 +64258,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5052.14 +64259,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,227.12 +64260,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,109.08 +64261,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5384.44 +64262,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,128.61 +64263,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4113.46 +64264,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31.15 +64265,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,115.64 +64266,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,790.0 +64267,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10448.81 +64268,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13458.4 +64269,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1338.3 +64270,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,387.55 +64271,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,192.5 +64272,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1075.59 +64273,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,315.37 +64274,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,286.83 +64275,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,253.87 +64276,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64277,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1100.03 +64278,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,55.33 +64279,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64280,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12069.92 +64281,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,307.71 +64282,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,135.63 +64283,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64284,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,74.45 +64285,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,288.44 +64286,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80.45 +64287,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88.24 +64288,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19.03 +64289,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64290,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45.2 +64291,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,62.78 +64292,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2638.98 +64293,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64294,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75.38 +64295,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,27.44 +64296,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23.86 +64297,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4201.71 +64298,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6645.6 +64299,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8370.68 +64300,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64301,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64302,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,81.17 +64303,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.39 +64304,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2949.71 +64305,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2644.62 +64306,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6.12 +64307,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64308,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.94 +64309,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1121.47 +64310,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,540.66 +64311,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,57.67 +64312,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO,60.95 +64313,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,67.11 +64314,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.44 +64315,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64316,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64317,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64318,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64319,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.22 +64320,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,29921.19 +64321,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65.21 +64322,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,134.29 +64323,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,0.01 +64324,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6102.06 +64325,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,261.34 +64326,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2293.46 +64327,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1998.95 +64328,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,67.75 +64329,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49552.98 +64330,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6410.96 +64331,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64332,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,466.43 +64333,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1674.0 +64334,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.33 +64335,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64336,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,222.55 +64337,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3.66 +64338,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.84 +64339,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.56 +64340,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,129.42 +64341,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,EMPIRE HEALTHCHOICE ASSURANCE-PPO,64.11 +64342,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,91397.37 +64343,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,244452.96 +64344,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64345,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,EMPIRE HEALTHCHOICE ASSURANCE-PPO,401.82 +64346,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4617.12 +64347,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3911.89 +64348,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1427.85 +64349,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34.24 +64350,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1070.49 +64351,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2016.0 +64352,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19270.53 +64353,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9111.9 +64354,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11236.5 +64355,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14830.16 +64356,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16.6 +64357,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3048.19 +64358,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,637.07 +64359,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.43 +64360,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,214.54 +64361,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1.68 +64362,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22.91 +64363,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,146.17 +64364,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64365,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34.46 +64366,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,51.47 +64367,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64368,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17586.06 +64369,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,330.0 +64370,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14.75 +64371,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,103.79 +64372,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.27 +64373,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28681.2 +64374,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22.07 +64375,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4042.68 +64376,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,127.75 +64377,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37.56 +64378,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.09 +64379,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,237.73 +64380,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6.7 +64381,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.63 +64382,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9740.29 +64383,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,125.63 +64384,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.71 +64385,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,360.0 +64386,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64387,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3.61 +64388,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64389,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10.5 +64390,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22.54 +64391,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,59.38 +64392,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21600.0 +64393,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64394,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,106600.0 +64395,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16948.85 +64396,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,30.77 +64397,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7809.54 +64398,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,93.53 +64399,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,EMPIRE HEALTHCHOICE ASSURANCE-PPO,80.57 +64400,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.03 +64401,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,632.93 +64402,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21714.9 +64403,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,65.86 +64404,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,208.86 +64405,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.75 +64406,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,340.1 +64407,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23282.49 +64408,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.01 +64409,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,932.97 +64410,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,322.38 +64411,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,235.8 +64412,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,179.97 +64413,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.46 +64414,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.02 +64415,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21067.65 +64416,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,741.0 +64417,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.9 +64418,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1945.32 +64419,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,431.14 +64420,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10705.43 +64421,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,255.25 +64422,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1942.0 +64423,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34.65 +64424,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36.65 +64425,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1278.98 +64426,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,EMPIRE HEALTHCHOICE ASSURANCE-PPO,13.62 +64427,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,142.6 +64428,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.04 +64429,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,382.58 +64430,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4460.84 +64431,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1617.88 +64432,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,53.68 +64433,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25401.92 +64434,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.87 +64435,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,50.46 +64436,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17100.35 +64437,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.53 +64438,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.16 +64439,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,25.1 +64440,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,250.58 +64441,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64442,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,EMPIRE HEALTHCHOICE ASSURANCE-PPO,56.35 +64443,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18.68 +64444,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1761.06 +64445,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,EMPIRE HEALTHCHOICE ASSURANCE-PPO,72.38 +64446,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,94.5 +64447,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.64 +64448,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7.82 +64449,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.61 +64450,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9.84 +64451,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11.93 +64452,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15.96 +64453,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.2 +64454,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,12607.92 +64455,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64456,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4340.0 +64457,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,621.18 +64458,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1081.5 +64459,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64460,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.52 +64461,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,EMPIRE HEALTHCHOICE ASSURANCE-PPO,22.9 +64462,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,92.02 +64463,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,EMPIRE HEALTHCHOICE ASSURANCE-PPO,35.41 +64464,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,87.4 +64465,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,17.21 +64466,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,0.57 +64467,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1.83 +64468,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.25 +64469,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,EMPIRE HEALTHCHOICE ASSURANCE-PPO,47.75 +64470,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37.23 +64471,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64472,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64473,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,EMPIRE HEALTHCHOICE ASSURANCE-PPO,206.87 +64474,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64475,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,190.8 +64476,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3.56 +64477,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,353.36 +64478,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,554.09 +64479,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8.48 +64480,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2.39 +64481,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2.35 +64482,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64483,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,188.85 +64484,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3207.6 +64485,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31419.53 +64486,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18770.16 +64487,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2880.0 +64488,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,522.54 +64489,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4793.54 +64490,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11608.99 +64491,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,36018.0 +64492,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1.15 +64493,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3279.35 +64494,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,37545.52 +64495,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64496,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,126.95 +64497,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10468.16 +64498,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11750.13 +64499,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,EMPIRE HEALTHCHOICE ASSURANCE-PPO,88.98 +64500,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2710.36 +64501,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3.76 +64502,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4680.0 +64503,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8514.87 +64504,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,172.8 +64505,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,EMPIRE HEALTHCHOICE ASSURANCE-PPO,16832.2 +64506,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64507,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1868.09 +64508,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4528.22 +64509,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15791.71 +64510,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64511,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5802.86 +64512,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,EMPIRE HEALTHCHOICE ASSURANCE-PPO,49.82 +64513,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,EMPIRE HEALTHCHOICE ASSURANCE-PPO,68.57 +64514,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,346.79 +64515,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2447.66 +64516,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11827.56 +64517,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,444.08 +64518,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,151.2 +64519,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5531.4 +64520,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5347.87 +64521,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15003.53 +64522,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO,54010.14 +64523,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,EMPIRE HEALTHCHOICE ASSURANCE-PPO,107129.7 +64524,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4.19 +64525,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6058.23 +64526,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1493.33 +64527,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10694.55 +64528,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38669.56 +64529,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,EMPIRE HEALTHCHOICE ASSURANCE-PPO,123.94 +64530,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,EMPIRE HEALTHCHOICE ASSURANCE-PPO,38161.09 +64531,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3380.39 +64532,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,31883.65 +64533,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23937.36 +64534,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,678.78 +64535,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14509.59 +64536,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,EMPIRE HEALTHCHOICE ASSURANCE-PPO,14526.27 +64537,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,EMPIRE HEALTHCHOICE ASSURANCE-PPO,18046.49 +64538,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,21355.79 +64539,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23318.45 +64540,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19321.56 +64541,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64542,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64543,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,19452.47 +64544,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10055.27 +64545,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64546,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,EMPIRE HEALTHCHOICE ASSURANCE-PPO,24796.44 +64547,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,EMPIRE HEALTHCHOICE ASSURANCE-PPO,131.21 +64548,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,106.93 +64549,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,EMPIRE HEALTHCHOICE ASSURANCE-PPO,259.2 +64550,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4310.96 +64551,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8961.75 +64552,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,135.0 +64553,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,EMPIRE HEALTHCHOICE ASSURANCE-PPO,685.72 +64554,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,EMPIRE HEALTHCHOICE ASSURANCE-PPO,404.24 +64555,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64556,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,EMPIRE HEALTHCHOICE ASSURANCE-PPO,679.93 +64557,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,EMPIRE HEALTHCHOICE ASSURANCE-PPO,374.16 +64558,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,EMPIRE HEALTHCHOICE ASSURANCE-PPO,303.28 +64559,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,285.84 +64560,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,EMPIRE HEALTHCHOICE ASSURANCE-PPO,45.25 +64561,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,189.85 +64562,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,107.01 +64563,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2547.25 +64564,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10000.0 +64565,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1513.33 +64566,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2759.0 +64567,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64568,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,75770.0 +64569,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,800.0 +64570,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2200.0 +64571,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1000.0 +64572,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8741.0 +64573,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,746.63 +64574,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,753.0 +64575,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,EMPIRE HEALTHCHOICE ASSURANCE-PPO,28.92 +64576,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2901.0 +64577,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,536.0 +64578,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4014.03 +64579,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1066.0 +64580,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5150.0 +64581,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8492.26 +64582,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5318.81 +64583,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1592.0 +64584,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO,471.0 +64585,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3033.89 +64586,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,EMPIRE HEALTHCHOICE ASSURANCE-PPO,744.39 +64587,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,EMPIRE HEALTHCHOICE ASSURANCE-PPO,394.26 +64588,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1768.4 +64589,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8097.18 +64590,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,EMPIRE HEALTHCHOICE ASSURANCE-PPO,63.44 +64591,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,169.17 +64592,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1.03 +64593,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1.84 +64594,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,EMPIRE HEALTHCHOICE ASSURANCE-PPO,354.05 +64595,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,EMPIRE HEALTHCHOICE ASSURANCE-PPO,0.7 +64596,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,EMPIRE HEALTHCHOICE ASSURANCE-PPO,9.67 +64597,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,EMPIRE HEALTHCHOICE ASSURANCE-PPO,5.55 +64598,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64599,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,11000.0 +64600,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,EMPIRE HEALTHCHOICE ASSURANCE-PPO,4100.51 +64601,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64602,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1255.49 +64603,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64604,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1194.22 +64605,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10110.7 +64606,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2802.0 +64607,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7950.0 +64608,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,10395.0 +64609,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2863.75 +64610,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8748.0 +64611,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,2591.33 +64612,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,8065.5 +64613,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,EMPIRE HEALTHCHOICE ASSURANCE-PPO,987.69 +64614,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,EMPIRE HEALTHCHOICE ASSURANCE-PPO,6813.24 +64615,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64616,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,15030.0 +64617,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,EMPIRE HEALTHCHOICE ASSURANCE-PPO,202.3 +64618,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,366.0 +64619,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,364.0 +64620,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,87.0 +64621,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,93.0 +64622,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1182.17 +64623,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64624,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,EMPIRE HEALTHCHOICE ASSURANCE-PPO,23.82 +64625,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64626,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64627,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,EMPIRE HEALTHCHOICE ASSURANCE-PPO,3101.75 +64628,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1357.96 +64629,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,70.04 +64630,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,EMPIRE HEALTHCHOICE ASSURANCE-PPO,126.89 +64631,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,300.0 +64632,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,EMPIRE HEALTHCHOICE ASSURANCE-PPO,102.0 +64633,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,34.0 +64634,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,170.0 +64635,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,367.0 +64636,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,7298.13 +64637,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,367.0 +64638,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64639,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,EMPIRE HEALTHCHOICE ASSURANCE-PPO,1556.67 +64640,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64641,3934,30000012,PRIVATE,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64642,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64643,3934,30000038,ICU,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64644,3934,30000046,BURN UNIT,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64645,3934,30000053,NICU,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64646,3934,30000061,ICR ROOM,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64647,3934,30000079,PSYCH,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64648,3934,30000087,NEWBORN,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64649,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64650,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64651,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64652,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64653,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64654,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64655,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64656,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64657,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64658,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64659,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64660,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64661,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64662,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64663,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64664,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64665,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64666,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64667,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64668,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64669,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64670,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64671,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64672,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64673,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64674,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64675,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64676,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64677,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64678,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64679,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64680,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64681,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64682,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64683,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64684,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64685,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64686,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64687,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64688,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64689,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64690,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64691,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64692,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64693,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64694,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64695,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64696,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64697,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64698,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64699,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64700,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64701,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64702,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64703,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64704,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64705,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64706,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64707,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64708,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64709,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64710,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64711,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64712,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64713,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64714,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64715,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64716,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64717,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64718,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64719,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64720,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64721,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64722,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64723,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64724,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64725,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64726,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64727,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64728,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64729,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64730,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64731,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64732,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64733,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64734,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64735,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64736,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64737,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, 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PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64904,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64905,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64906,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64907,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64908,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64909,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64910,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64911,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64912,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64913,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64914,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64915,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64916,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64917,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64918,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64919,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64920,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64921,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64922,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64923,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, 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PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64945,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64946,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64947,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64948,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64949,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64950,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64951,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64952,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64953,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64954,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64955,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64956,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64957,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64958,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64959,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64960,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64961,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64962,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64963,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64964,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64965,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64966,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64967,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64968,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64969,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64970,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64971,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64972,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64973,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64974,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, 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SICU 18S1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64986,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64987,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64988,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64989,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64990,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64991,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64992,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64993,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64994,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +64995,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, 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PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65007,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65008,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65009,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65010,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65011,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65012,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65013,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65014,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65015,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65016,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, 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INPATIENT 04L1 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65028,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65029,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65030,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65031,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65032,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65033,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65034,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65035,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65036,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65037,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65038,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65039,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65040,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65041,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65042,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65043,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65044,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65045,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65046,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65047,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, 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PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65069,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65070,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65071,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65072,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65073,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65074,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65075,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65076,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65077,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65078,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65079,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65080,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65081,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65082,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65083,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65084,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65085,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65086,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65087,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65088,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65089,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65090,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65091,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65092,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65093,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65094,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65095,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65096,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65097,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65098,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65099,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65100,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65101,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65102,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65103,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65104,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65105,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65106,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65107,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65108,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65109,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65110,3934,37112000,ACUTE ED,,1580.0,1580.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65111,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65112,3934,37112034,TRIAGE,,277.0,277.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65113,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65114,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65115,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65116,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65117,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65118,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65119,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65120,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65121,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65122,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65123,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65124,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65125,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65126,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65127,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65128,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65129,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65130,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65131,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65132,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65133,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65134,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65135,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65136,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65137,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65138,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65139,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65140,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65141,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65142,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65143,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65144,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, 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HEALTHCHOICE ASSURANCE-PPO, +65156,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65157,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65158,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65159,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65160,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65161,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65162,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65163,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65164,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65165,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65166,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65167,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65168,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65169,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65170,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65171,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65172,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65173,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65174,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65175,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65176,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65177,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65178,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65179,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65180,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65181,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65182,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65183,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65184,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65185,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65186,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65187,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65188,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65189,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65190,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65191,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65192,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65193,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65194,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65195,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65196,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65197,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65198,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65199,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65200,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65201,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65202,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65203,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65204,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65205,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65206,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65207,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65208,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65209,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65210,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65211,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65212,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65213,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65214,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65215,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65216,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65217,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65218,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65219,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65220,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65221,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65222,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65223,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65224,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65225,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65226,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65227,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65228,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65229,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65230,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65231,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65232,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65233,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65234,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65235,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65236,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65237,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65238,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65239,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65240,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65241,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65242,3934,43301043,ALBUNEX,,357.0,357.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65243,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65244,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65245,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65246,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65247,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65248,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65249,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65250,3934,43450022,REC RM .5HR,,541.0,541.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65251,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65252,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65253,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65254,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65255,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65256,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65257,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65258,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65259,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65260,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65261,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65262,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65263,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65264,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65265,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65266,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65267,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65268,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65269,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65270,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65271,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65272,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65273,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65274,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65275,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65276,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65277,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65278,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65279,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65280,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65281,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65282,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65283,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65284,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65285,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65286,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65287,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65288,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65289,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65290,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65291,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65292,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65293,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65294,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65295,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65296,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65297,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65298,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65299,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65300,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65301,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65302,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65303,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65304,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65305,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65306,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65307,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65308,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65309,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65310,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65311,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65312,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65313,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65314,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65315,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65316,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65317,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65318,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65319,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65320,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65321,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65322,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65323,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65324,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65325,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65326,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65327,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65328,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65329,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65330,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65331,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65332,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65333,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65334,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65335,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65336,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65337,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65338,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65339,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65340,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65341,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65342,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65343,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65344,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65345,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65346,3934,45924552,ENDO REC RM,,30.0,30.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65347,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65348,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65349,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65350,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65351,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65352,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65353,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65354,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65355,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65356,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65357,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65358,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65359,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65360,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65361,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65362,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65363,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65364,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65365,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65366,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65367,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65368,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65369,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65370,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65371,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65372,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65373,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65374,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65375,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65376,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65377,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65378,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65379,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65380,3934,53200010,GUEST TRAY,,24.0,24.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65381,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65382,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65383,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65384,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65385,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65386,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65387,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65388,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65389,3934,53329876,HIV MONITORING,,416.0,416.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65390,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65391,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65392,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65393,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65394,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65395,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65396,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65397,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65398,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65399,3934,76010107,COPY X-RAY,,22.0,22.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65400,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65401,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65402,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65403,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65404,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65405,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65406,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65407,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65408,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65409,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65410,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65411,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,EMPIRE HEALTHCHOICE ASSURANCE-PPO, +65412,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,FIDELIS CARE NEW YORK-Medicaid, +65413,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,FIDELIS CARE NEW YORK-Medicaid, +65414,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,FIDELIS CARE NEW YORK-Medicaid, +65415,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,FIDELIS CARE NEW YORK-Medicaid, +65416,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,FIDELIS CARE NEW YORK-Medicaid, +65417,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,FIDELIS CARE NEW YORK-Medicaid, +65418,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,FIDELIS CARE NEW YORK-Medicaid, +65419,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,FIDELIS CARE NEW YORK-Medicaid, +65420,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,FIDELIS CARE NEW YORK-Medicaid, +65421,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,FIDELIS CARE NEW YORK-Medicaid, +65422,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,FIDELIS CARE NEW YORK-Medicaid, +65423,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,FIDELIS CARE NEW YORK-Medicaid, +65424,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,FIDELIS CARE NEW YORK-Medicaid, +65425,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,FIDELIS CARE NEW YORK-Medicaid, +65426,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,FIDELIS CARE NEW YORK-Medicaid, +65427,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,FIDELIS CARE NEW YORK-Medicaid, +65428,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,FIDELIS CARE NEW YORK-Medicaid, +65429,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,FIDELIS CARE NEW YORK-Medicaid, +65430,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,FIDELIS CARE NEW YORK-Medicaid, +65431,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,FIDELIS CARE NEW YORK-Medicaid, +65432,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,FIDELIS CARE NEW YORK-Medicaid, +65433,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,FIDELIS CARE NEW YORK-Medicaid, +65434,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,FIDELIS CARE NEW YORK-Medicaid, +65435,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,FIDELIS CARE NEW YORK-Medicaid, +65436,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,FIDELIS CARE NEW YORK-Medicaid, +65437,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,FIDELIS CARE NEW YORK-Medicaid, +65438,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,FIDELIS CARE NEW YORK-Medicaid, +65439,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,FIDELIS CARE NEW YORK-Medicaid, +65440,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,FIDELIS CARE NEW YORK-Medicaid, +65441,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,FIDELIS CARE NEW YORK-Medicaid, +65442,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,FIDELIS CARE NEW YORK-Medicaid, +65443,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,FIDELIS CARE NEW YORK-Medicaid, +65444,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,FIDELIS CARE NEW YORK-Medicaid, +65445,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,FIDELIS CARE NEW YORK-Medicaid, +65446,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,FIDELIS CARE NEW YORK-Medicaid, +65447,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,FIDELIS CARE NEW YORK-Medicaid, +65448,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,FIDELIS CARE NEW YORK-Medicaid, +65449,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,FIDELIS CARE NEW YORK-Medicaid, +65450,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,FIDELIS CARE NEW YORK-Medicaid, +65451,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,FIDELIS CARE NEW YORK-Medicaid, +65452,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,FIDELIS CARE NEW YORK-Medicaid, +65453,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,FIDELIS CARE NEW YORK-Medicaid, +65454,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,FIDELIS CARE NEW YORK-Medicaid, +65455,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,FIDELIS CARE NEW YORK-Medicaid, +65456,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,FIDELIS CARE NEW YORK-Medicaid, +65457,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,FIDELIS CARE NEW YORK-Medicaid, +65458,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,FIDELIS CARE NEW YORK-Medicaid, +65459,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,FIDELIS CARE NEW YORK-Medicaid, +65460,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,FIDELIS CARE NEW YORK-Medicaid, +65461,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,FIDELIS CARE NEW YORK-Medicaid, +65462,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,FIDELIS CARE NEW YORK-Medicaid, +65463,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,FIDELIS CARE NEW YORK-Medicaid, +65464,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,FIDELIS CARE NEW YORK-Medicaid, +65465,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,FIDELIS CARE NEW YORK-Medicaid, +65466,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,FIDELIS CARE NEW YORK-Medicaid, +65467,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,FIDELIS CARE NEW YORK-Medicaid, +65468,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,FIDELIS CARE NEW YORK-Medicaid, +65469,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,FIDELIS CARE NEW YORK-Medicaid, +65470,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,FIDELIS CARE NEW YORK-Medicaid, +65471,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,FIDELIS CARE NEW YORK-Medicaid, +65472,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,FIDELIS CARE NEW YORK-Medicaid, +65473,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,FIDELIS CARE NEW YORK-Medicaid, +65474,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,FIDELIS CARE NEW YORK-Medicaid, +65475,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,FIDELIS CARE NEW YORK-Medicaid, +65476,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,FIDELIS CARE NEW YORK-Medicaid, +65477,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,FIDELIS CARE NEW YORK-Medicaid, +65478,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,FIDELIS CARE NEW YORK-Medicaid, +65479,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,FIDELIS CARE NEW YORK-Medicaid, +65480,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,FIDELIS CARE NEW YORK-Medicaid, +65481,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,FIDELIS CARE NEW YORK-Medicaid, +65482,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,FIDELIS CARE NEW YORK-Medicaid, +65483,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,FIDELIS CARE NEW YORK-Medicaid, +65484,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,FIDELIS CARE NEW YORK-Medicaid, +65485,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,FIDELIS CARE NEW YORK-Medicaid, +65486,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,FIDELIS CARE NEW YORK-Medicaid, +65487,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,FIDELIS CARE NEW YORK-Medicaid, +65488,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,FIDELIS CARE NEW YORK-Medicaid, +65489,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,FIDELIS CARE NEW YORK-Medicaid, +65490,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,FIDELIS CARE NEW YORK-Medicaid, +65491,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,FIDELIS CARE NEW YORK-Medicaid, +65492,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,FIDELIS CARE NEW YORK-Medicaid, +65493,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,FIDELIS CARE NEW YORK-Medicaid, +65494,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,FIDELIS CARE NEW YORK-Medicaid, +65495,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,FIDELIS CARE NEW YORK-Medicaid, +65496,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,FIDELIS CARE NEW YORK-Medicaid, +65497,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,FIDELIS CARE NEW YORK-Medicaid, +65498,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,FIDELIS CARE NEW YORK-Medicaid, +65499,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,FIDELIS CARE NEW YORK-Medicaid, +65500,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,FIDELIS CARE NEW YORK-Medicaid, +65501,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,FIDELIS CARE NEW YORK-Medicaid, +65502,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,FIDELIS CARE NEW YORK-Medicaid, +65503,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,FIDELIS CARE NEW YORK-Medicaid, +65504,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,FIDELIS CARE NEW YORK-Medicaid, +65505,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,FIDELIS CARE NEW YORK-Medicaid, +65506,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,FIDELIS CARE NEW YORK-Medicaid, +65507,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,FIDELIS CARE NEW YORK-Medicaid, +65508,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,FIDELIS CARE NEW YORK-Medicaid, +65509,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,FIDELIS CARE NEW YORK-Medicaid, +65510,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,FIDELIS CARE NEW YORK-Medicaid, +65511,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,FIDELIS CARE NEW YORK-Medicaid, +65512,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,FIDELIS CARE NEW YORK-Medicaid, +65513,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,FIDELIS CARE NEW YORK-Medicaid, +65514,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,FIDELIS CARE NEW YORK-Medicaid, +65515,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,FIDELIS CARE NEW YORK-Medicaid, +65516,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,FIDELIS CARE NEW YORK-Medicaid, +65517,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,FIDELIS CARE NEW YORK-Medicaid, +65518,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,FIDELIS CARE NEW YORK-Medicaid, +65519,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,FIDELIS CARE NEW YORK-Medicaid, +65520,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,FIDELIS CARE NEW YORK-Medicaid, +65521,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,FIDELIS CARE NEW YORK-Medicaid, +65522,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,FIDELIS CARE NEW YORK-Medicaid, +65523,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,FIDELIS CARE NEW YORK-Medicaid, +65524,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,FIDELIS CARE NEW YORK-Medicaid, +65525,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,FIDELIS CARE NEW YORK-Medicaid, +65526,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,FIDELIS CARE NEW YORK-Medicaid, +65527,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,FIDELIS CARE NEW YORK-Medicaid, +65528,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,FIDELIS CARE NEW YORK-Medicaid, +65529,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,FIDELIS CARE NEW YORK-Medicaid, +65530,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,FIDELIS CARE NEW YORK-Medicaid, +65531,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,FIDELIS CARE NEW YORK-Medicaid, +65532,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,FIDELIS CARE NEW YORK-Medicaid, +65533,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,FIDELIS CARE NEW YORK-Medicaid, +65534,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,FIDELIS CARE NEW YORK-Medicaid, +65535,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,FIDELIS CARE NEW YORK-Medicaid, +65536,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,FIDELIS CARE NEW YORK-Medicaid, +65537,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,FIDELIS CARE NEW YORK-Medicaid, +65538,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,FIDELIS CARE NEW YORK-Medicaid, +65539,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,FIDELIS CARE NEW YORK-Medicaid, +65540,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,FIDELIS CARE NEW YORK-Medicaid, +65541,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,FIDELIS CARE NEW YORK-Medicaid, +65542,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,FIDELIS CARE NEW YORK-Medicaid, +65543,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,FIDELIS CARE NEW YORK-Medicaid, +65544,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,FIDELIS CARE NEW YORK-Medicaid, +65545,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,FIDELIS CARE NEW YORK-Medicaid, +65546,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,FIDELIS CARE NEW YORK-Medicaid, +65547,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,FIDELIS CARE NEW YORK-Medicaid, +65548,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,FIDELIS CARE NEW YORK-Medicaid, +65549,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,FIDELIS CARE NEW YORK-Medicaid, +65550,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,FIDELIS CARE NEW YORK-Medicaid, +65551,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,FIDELIS CARE NEW YORK-Medicaid, +65552,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,FIDELIS CARE NEW YORK-Medicaid, +65553,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,FIDELIS CARE NEW YORK-Medicaid, +65554,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,FIDELIS CARE NEW YORK-Medicaid, +65555,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,FIDELIS CARE NEW YORK-Medicaid, +65556,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,FIDELIS CARE NEW YORK-Medicaid, +65557,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,FIDELIS CARE NEW YORK-Medicaid, +65558,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,FIDELIS CARE NEW YORK-Medicaid, +65559,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,FIDELIS CARE NEW YORK-Medicaid, +65560,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,FIDELIS CARE NEW YORK-Medicaid, +65561,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,FIDELIS CARE NEW YORK-Medicaid, +65562,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,FIDELIS CARE NEW YORK-Medicaid, +65563,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,FIDELIS CARE NEW YORK-Medicaid, +65564,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,FIDELIS CARE NEW YORK-Medicaid, +65565,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,FIDELIS CARE NEW YORK-Medicaid, +65566,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,FIDELIS CARE NEW YORK-Medicaid, +65567,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,FIDELIS CARE NEW YORK-Medicaid, +65568,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,FIDELIS CARE NEW YORK-Medicaid, +65569,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,FIDELIS CARE NEW YORK-Medicaid, +65570,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,FIDELIS CARE NEW YORK-Medicaid, +65571,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,FIDELIS CARE NEW YORK-Medicaid, +65572,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,FIDELIS CARE NEW YORK-Medicaid, +65573,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,FIDELIS CARE NEW YORK-Medicaid, +65574,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,FIDELIS CARE NEW YORK-Medicaid, +65575,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,FIDELIS CARE NEW YORK-Medicaid, +65576,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,FIDELIS CARE NEW YORK-Medicaid, +65577,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,FIDELIS CARE NEW YORK-Medicaid, +65578,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,FIDELIS CARE NEW YORK-Medicaid, +65579,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,FIDELIS CARE NEW YORK-Medicaid, +65580,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,FIDELIS CARE NEW YORK-Medicaid, +65581,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,FIDELIS CARE NEW YORK-Medicaid, +65582,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,FIDELIS CARE NEW YORK-Medicaid, +65583,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,FIDELIS CARE NEW YORK-Medicaid, +65584,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,FIDELIS CARE NEW YORK-Medicaid, +65585,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,FIDELIS CARE NEW YORK-Medicaid, +65586,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,FIDELIS CARE NEW YORK-Medicaid, +65587,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,FIDELIS CARE NEW YORK-Medicaid, +65588,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,FIDELIS CARE NEW YORK-Medicaid, +65589,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,FIDELIS CARE NEW YORK-Medicaid, +65590,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,FIDELIS CARE NEW YORK-Medicaid, +65591,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,FIDELIS CARE NEW YORK-Medicaid, +65592,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,FIDELIS CARE NEW YORK-Medicaid, +65593,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,FIDELIS CARE NEW YORK-Medicaid, +65594,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,FIDELIS CARE NEW YORK-Medicaid, +65595,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,FIDELIS CARE NEW YORK-Medicaid, +65596,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,FIDELIS CARE NEW YORK-Medicaid, +65597,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,FIDELIS CARE NEW YORK-Medicaid, +65598,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,FIDELIS CARE NEW YORK-Medicaid, +65599,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,FIDELIS CARE NEW YORK-Medicaid, +65600,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,FIDELIS CARE NEW YORK-Medicaid, +65601,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,FIDELIS CARE NEW YORK-Medicaid, +65602,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,FIDELIS CARE NEW YORK-Medicaid, +65603,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,FIDELIS CARE NEW YORK-Medicaid, +65604,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,FIDELIS CARE NEW YORK-Medicaid, +65605,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,FIDELIS CARE NEW YORK-Medicaid, +65606,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,FIDELIS CARE NEW YORK-Medicaid, +65607,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,FIDELIS CARE NEW YORK-Medicaid, +65608,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,FIDELIS CARE NEW YORK-Medicaid, +65609,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,FIDELIS CARE NEW YORK-Medicaid, +65610,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,FIDELIS CARE NEW YORK-Medicaid, +65611,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,FIDELIS CARE NEW YORK-Medicaid, +65612,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,FIDELIS CARE NEW YORK-Medicaid, +65613,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,FIDELIS CARE NEW YORK-Medicaid, +65614,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,FIDELIS CARE NEW YORK-Medicaid, +65615,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,FIDELIS CARE NEW YORK-Medicaid, +65616,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,FIDELIS CARE NEW YORK-Medicaid, +65617,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,FIDELIS CARE NEW YORK-Medicaid, +65618,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,FIDELIS CARE NEW YORK-Medicaid, +65619,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,FIDELIS CARE NEW YORK-Medicaid, +65620,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,FIDELIS CARE NEW YORK-Medicaid, +65621,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,FIDELIS CARE NEW YORK-Medicaid, +65622,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,FIDELIS CARE NEW YORK-Medicaid, +65623,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,FIDELIS CARE NEW YORK-Medicaid, +65624,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,FIDELIS CARE NEW YORK-Medicaid, +65625,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,FIDELIS CARE NEW YORK-Medicaid, +65626,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,FIDELIS CARE NEW YORK-Medicaid, +65627,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,FIDELIS CARE NEW YORK-Medicaid, +65628,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,FIDELIS CARE NEW YORK-Medicaid, +65629,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,FIDELIS CARE NEW YORK-Medicaid, +65630,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,FIDELIS CARE NEW YORK-Medicaid, +65631,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,FIDELIS CARE NEW YORK-Medicaid, +65632,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,FIDELIS CARE NEW YORK-Medicaid, +65633,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,FIDELIS CARE NEW YORK-Medicaid, +65634,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,FIDELIS CARE NEW YORK-Medicaid, +65635,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,FIDELIS CARE NEW YORK-Medicaid, +65636,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,FIDELIS CARE NEW YORK-Medicaid, +65637,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,FIDELIS CARE NEW YORK-Medicaid, +65638,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,FIDELIS CARE NEW YORK-Medicaid, +65639,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,FIDELIS CARE NEW YORK-Medicaid, +65640,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,FIDELIS CARE NEW YORK-Medicaid, +65641,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,FIDELIS CARE NEW YORK-Medicaid, +65642,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,FIDELIS CARE NEW YORK-Medicaid, +65643,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,FIDELIS CARE NEW YORK-Medicaid, +65644,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,FIDELIS CARE NEW YORK-Medicaid, +65645,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,FIDELIS CARE NEW YORK-Medicaid, +65646,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,FIDELIS CARE NEW YORK-Medicaid, +65647,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,FIDELIS CARE NEW YORK-Medicaid, +65648,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,FIDELIS CARE NEW YORK-Medicaid, +65649,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,FIDELIS CARE NEW YORK-Medicaid, +65650,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,FIDELIS CARE NEW YORK-Medicaid, +65651,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,FIDELIS CARE NEW YORK-Medicaid, +65652,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,FIDELIS CARE NEW YORK-Medicaid, +65653,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,FIDELIS CARE NEW YORK-Medicaid, +65654,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,FIDELIS CARE NEW YORK-Medicaid, +65655,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,FIDELIS CARE NEW YORK-Medicaid, +65656,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,FIDELIS CARE NEW YORK-Medicaid, +65657,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,FIDELIS CARE NEW YORK-Medicaid, +65658,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,FIDELIS CARE NEW YORK-Medicaid, +65659,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,FIDELIS CARE NEW YORK-Medicaid, +65660,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,FIDELIS CARE NEW YORK-Medicaid, +65661,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,FIDELIS CARE NEW YORK-Medicaid, +65662,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,FIDELIS CARE NEW YORK-Medicaid, +65663,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,FIDELIS CARE NEW YORK-Medicaid, +65664,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,FIDELIS CARE NEW YORK-Medicaid, +65665,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,FIDELIS CARE NEW YORK-Medicaid, +65666,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,FIDELIS CARE NEW YORK-Medicaid, +65667,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,FIDELIS CARE NEW YORK-Medicaid, +65668,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,FIDELIS CARE NEW YORK-Medicaid, +65669,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,FIDELIS CARE NEW YORK-Medicaid, +65670,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,FIDELIS CARE NEW YORK-Medicaid, +65671,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,FIDELIS CARE NEW YORK-Medicaid, +65672,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,FIDELIS CARE NEW YORK-Medicaid, +65673,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,FIDELIS CARE NEW YORK-Medicaid, +65674,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,FIDELIS CARE NEW YORK-Medicaid, +65675,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,FIDELIS CARE NEW YORK-Medicaid, +65676,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,FIDELIS CARE NEW YORK-Medicaid, +65677,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,FIDELIS CARE NEW YORK-Medicaid, +65678,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,FIDELIS CARE NEW YORK-Medicaid, +65679,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,FIDELIS CARE NEW YORK-Medicaid, +65680,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,FIDELIS CARE NEW YORK-Medicaid, +65681,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,FIDELIS CARE NEW YORK-Medicaid, +65682,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,FIDELIS CARE NEW YORK-Medicaid, +65683,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,FIDELIS CARE NEW YORK-Medicaid, +65684,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,FIDELIS CARE NEW YORK-Medicaid, +65685,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,FIDELIS CARE NEW YORK-Medicaid, +65686,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,FIDELIS CARE NEW YORK-Medicaid, +65687,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,FIDELIS CARE NEW YORK-Medicaid, +65688,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,FIDELIS CARE NEW YORK-Medicaid, +65689,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,FIDELIS CARE NEW YORK-Medicaid, +65690,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,FIDELIS CARE NEW YORK-Medicaid, +65691,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,FIDELIS CARE NEW YORK-Medicaid, +65692,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,FIDELIS CARE NEW YORK-Medicaid, +65693,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,FIDELIS CARE NEW YORK-Medicaid, +65694,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,FIDELIS CARE NEW YORK-Medicaid, +65695,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,FIDELIS CARE NEW YORK-Medicaid, +65696,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,FIDELIS CARE NEW YORK-Medicaid, +65697,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,FIDELIS CARE NEW YORK-Medicaid, +65698,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,FIDELIS CARE NEW YORK-Medicaid, +65699,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,FIDELIS CARE NEW YORK-Medicaid, +65700,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,FIDELIS CARE NEW YORK-Medicaid, +65701,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,FIDELIS CARE NEW YORK-Medicaid, +65702,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,FIDELIS CARE NEW YORK-Medicaid, +65703,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,FIDELIS CARE NEW YORK-Medicaid, +65704,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,FIDELIS CARE NEW YORK-Medicaid, +65705,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,FIDELIS CARE NEW YORK-Medicaid, +65706,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,FIDELIS CARE NEW YORK-Medicaid, +65707,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,FIDELIS CARE NEW YORK-Medicaid, +65708,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,FIDELIS CARE NEW YORK-Medicaid, +65709,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,FIDELIS CARE NEW YORK-Medicaid, +65710,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,FIDELIS CARE NEW YORK-Medicaid, +65711,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,FIDELIS CARE NEW YORK-Medicaid, +65712,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,FIDELIS CARE NEW YORK-Medicaid, +65713,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,FIDELIS CARE NEW YORK-Medicaid, +65714,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,FIDELIS CARE NEW YORK-Medicaid, +65715,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,FIDELIS CARE NEW YORK-Medicaid, +65716,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,FIDELIS CARE NEW YORK-Medicaid, +65717,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,FIDELIS CARE NEW YORK-Medicaid, +65718,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,FIDELIS CARE NEW YORK-Medicaid, +65719,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,FIDELIS CARE NEW YORK-Medicaid, +65720,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,FIDELIS CARE NEW YORK-Medicaid, +65721,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,FIDELIS CARE NEW YORK-Medicaid, +65722,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,FIDELIS CARE NEW YORK-Medicaid, +65723,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,FIDELIS CARE NEW YORK-Medicaid, +65724,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,FIDELIS CARE NEW YORK-Medicaid, +65725,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,FIDELIS CARE NEW YORK-Medicaid, +65726,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,FIDELIS CARE NEW YORK-Medicaid, +65727,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,FIDELIS CARE NEW YORK-Medicaid, +65728,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,FIDELIS CARE NEW YORK-Medicaid, +65729,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,FIDELIS CARE NEW YORK-Medicaid, +65730,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,FIDELIS CARE NEW YORK-Medicaid, +65731,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,FIDELIS CARE NEW YORK-Medicaid, +65732,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,FIDELIS CARE NEW YORK-Medicaid, +65733,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,FIDELIS CARE NEW YORK-Medicaid, +65734,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,FIDELIS CARE NEW YORK-Medicaid, +65735,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,FIDELIS CARE NEW YORK-Medicaid, +65736,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,FIDELIS CARE NEW YORK-Medicaid, +65737,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,FIDELIS CARE NEW YORK-Medicaid, +65738,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,FIDELIS CARE NEW YORK-Medicaid, +65739,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,FIDELIS CARE NEW YORK-Medicaid, +65740,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,FIDELIS CARE NEW YORK-Medicaid, +65741,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,FIDELIS CARE NEW YORK-Medicaid, +65742,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,FIDELIS CARE NEW YORK-Medicaid, +65743,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,FIDELIS CARE NEW YORK-Medicaid, +65744,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,FIDELIS CARE NEW YORK-Medicaid, +65745,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,FIDELIS CARE NEW YORK-Medicaid, +65746,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,FIDELIS CARE NEW YORK-Medicaid, +65747,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,FIDELIS CARE NEW YORK-Medicaid, +65748,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,FIDELIS CARE NEW YORK-Medicaid, +65749,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,FIDELIS CARE NEW YORK-Medicaid, +65750,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,FIDELIS CARE NEW YORK-Medicaid, +65751,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,FIDELIS CARE NEW YORK-Medicaid, +65752,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,FIDELIS CARE NEW YORK-Medicaid, +65753,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,FIDELIS CARE NEW YORK-Medicaid, +65754,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,FIDELIS CARE NEW YORK-Medicaid, +65755,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,FIDELIS CARE NEW YORK-Medicaid, +65756,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,FIDELIS CARE NEW YORK-Medicaid, +65757,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,FIDELIS CARE NEW YORK-Medicaid, +65758,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,FIDELIS CARE NEW YORK-Medicaid, +65759,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,FIDELIS CARE NEW YORK-Medicaid, +65760,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,FIDELIS CARE NEW YORK-Medicaid, +65761,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,FIDELIS CARE NEW YORK-Medicaid, +65762,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,FIDELIS CARE NEW YORK-Medicaid, +65763,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,FIDELIS CARE NEW YORK-Medicaid, +65764,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,FIDELIS CARE NEW YORK-Medicaid, +65765,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,FIDELIS CARE NEW YORK-Medicaid, +65766,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,FIDELIS CARE NEW YORK-Medicaid, +65767,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,FIDELIS CARE NEW YORK-Medicaid, +65768,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,FIDELIS CARE NEW YORK-Medicaid, +65769,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,FIDELIS CARE NEW YORK-Medicaid, +65770,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,FIDELIS CARE NEW YORK-Medicaid, +65771,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,FIDELIS CARE NEW YORK-Medicaid, +65772,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,FIDELIS CARE NEW YORK-Medicaid, +65773,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,FIDELIS CARE NEW YORK-Medicaid, +65774,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,FIDELIS CARE NEW YORK-Medicaid, +65775,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,FIDELIS CARE NEW YORK-Medicaid, +65776,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,FIDELIS CARE NEW YORK-Medicaid, +65777,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,FIDELIS CARE NEW YORK-Medicaid, +65778,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,FIDELIS CARE NEW YORK-Medicaid, +65779,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,FIDELIS CARE NEW YORK-Medicaid, +65780,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,FIDELIS CARE NEW YORK-Medicaid, +65781,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,FIDELIS CARE NEW YORK-Medicaid, +65782,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,FIDELIS CARE NEW YORK-Medicaid, +65783,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,FIDELIS CARE NEW YORK-Medicaid, +65784,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,FIDELIS CARE NEW YORK-Medicaid, +65785,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,FIDELIS CARE NEW YORK-Medicaid, +65786,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,FIDELIS CARE NEW YORK-Medicaid, +65787,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,FIDELIS CARE NEW YORK-Medicaid, +65788,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,FIDELIS CARE NEW YORK-Medicaid, +65789,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,FIDELIS CARE NEW YORK-Medicaid, +65790,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,FIDELIS CARE NEW YORK-Medicaid, +65791,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,FIDELIS CARE NEW YORK-Medicaid, +65792,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,FIDELIS CARE NEW YORK-Medicaid, +65793,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,FIDELIS CARE NEW YORK-Medicaid, +65794,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,FIDELIS CARE NEW YORK-Medicaid, +65795,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,FIDELIS CARE NEW YORK-Medicaid, +65796,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,FIDELIS CARE NEW YORK-Medicaid, +65797,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,FIDELIS CARE NEW YORK-Medicaid, +65798,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,FIDELIS CARE NEW YORK-Medicaid, +65799,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,FIDELIS CARE NEW YORK-Medicaid, +65800,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,FIDELIS CARE NEW YORK-Medicaid, +65801,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,FIDELIS CARE NEW YORK-Medicaid, +65802,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,FIDELIS CARE NEW YORK-Medicaid, +65803,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,FIDELIS CARE NEW YORK-Medicaid, +65804,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,FIDELIS CARE NEW YORK-Medicaid, +65805,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,FIDELIS CARE NEW YORK-Medicaid, +65806,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,FIDELIS CARE NEW YORK-Medicaid, +65807,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,FIDELIS CARE NEW YORK-Medicaid, +65808,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,FIDELIS CARE NEW YORK-Medicaid, +65809,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,FIDELIS CARE NEW YORK-Medicaid, +65810,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,FIDELIS CARE NEW YORK-Medicaid, +65811,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,FIDELIS CARE NEW YORK-Medicaid, +65812,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,FIDELIS CARE NEW YORK-Medicaid, +65813,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,FIDELIS CARE NEW YORK-Medicaid, +65814,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,FIDELIS CARE NEW YORK-Medicaid, +65815,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,FIDELIS CARE NEW YORK-Medicaid, +65816,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,FIDELIS CARE NEW YORK-Medicaid, +65817,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,FIDELIS CARE NEW YORK-Medicaid, +65818,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,FIDELIS CARE NEW YORK-Medicaid, +65819,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,FIDELIS CARE NEW YORK-Medicaid, +65820,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,FIDELIS CARE NEW YORK-Medicaid, +65821,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,FIDELIS CARE NEW YORK-Medicaid, +65822,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,FIDELIS CARE NEW YORK-Medicaid, +65823,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,FIDELIS CARE NEW YORK-Medicaid, +65824,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,FIDELIS CARE NEW YORK-Medicaid, +65825,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,FIDELIS CARE NEW YORK-Medicaid, +65826,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,FIDELIS CARE NEW YORK-Medicaid, +65827,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,FIDELIS CARE NEW YORK-Medicaid, +65828,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,FIDELIS CARE NEW YORK-Medicaid, +65829,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,FIDELIS CARE NEW YORK-Medicaid, +65830,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,FIDELIS CARE NEW YORK-Medicaid, +65831,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,FIDELIS CARE NEW YORK-Medicaid, +65832,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,FIDELIS CARE NEW YORK-Medicaid, +65833,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,FIDELIS CARE NEW YORK-Medicaid, +65834,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,FIDELIS CARE NEW YORK-Medicaid, +65835,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,FIDELIS CARE NEW YORK-Medicaid, +65836,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,FIDELIS CARE NEW YORK-Medicaid, +65837,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,FIDELIS CARE NEW YORK-Medicaid, +65838,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,FIDELIS CARE NEW YORK-Medicaid, +65839,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,FIDELIS CARE NEW YORK-Medicaid, +65840,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,FIDELIS CARE NEW YORK-Medicaid, +65841,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,FIDELIS CARE NEW YORK-Medicaid, +65842,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,FIDELIS CARE NEW YORK-Medicaid, +65843,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,FIDELIS CARE NEW YORK-Medicaid, +65844,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,FIDELIS CARE NEW YORK-Medicaid, +65845,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,FIDELIS CARE NEW YORK-Medicaid, +65846,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,FIDELIS CARE NEW YORK-Medicaid, +65847,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,FIDELIS CARE NEW YORK-Medicaid, +65848,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,FIDELIS CARE NEW YORK-Medicaid, +65849,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,FIDELIS CARE NEW YORK-Medicaid, +65850,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,FIDELIS CARE NEW YORK-Medicaid, +65851,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,FIDELIS CARE NEW YORK-Medicaid, +65852,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,FIDELIS CARE NEW YORK-Medicaid, +65853,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,FIDELIS CARE NEW YORK-Medicaid, +65854,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,FIDELIS CARE NEW YORK-Medicaid, +65855,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,FIDELIS CARE NEW YORK-Medicaid, +65856,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,FIDELIS CARE NEW YORK-Medicaid, +65857,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,FIDELIS CARE NEW YORK-Medicaid, +65858,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,FIDELIS CARE NEW YORK-Medicaid, +65859,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,FIDELIS CARE NEW YORK-Medicaid, +65860,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,FIDELIS CARE NEW YORK-Medicaid, +65861,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,FIDELIS CARE NEW YORK-Medicaid, +65862,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,FIDELIS CARE NEW YORK-Medicaid, +65863,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,FIDELIS CARE NEW YORK-Medicaid, +65864,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,FIDELIS CARE NEW YORK-Medicaid, +65865,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,FIDELIS CARE NEW YORK-Medicaid, +65866,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,FIDELIS CARE NEW YORK-Medicaid, +65867,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,FIDELIS CARE NEW YORK-Medicaid, +65868,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,FIDELIS CARE NEW YORK-Medicaid, +65869,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,FIDELIS CARE NEW YORK-Medicaid, +65870,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,FIDELIS CARE NEW YORK-Medicaid, +65871,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,FIDELIS CARE NEW YORK-Medicaid, +65872,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,FIDELIS CARE NEW YORK-Medicaid, +65873,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,FIDELIS CARE NEW YORK-Medicaid, +65874,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,FIDELIS CARE NEW YORK-Medicaid, +65875,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,FIDELIS CARE NEW YORK-Medicaid, +65876,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,FIDELIS CARE NEW YORK-Medicaid, +65877,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,FIDELIS CARE NEW YORK-Medicaid, +65878,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,FIDELIS CARE NEW YORK-Medicaid, +65879,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,FIDELIS CARE NEW YORK-Medicaid, +65880,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,FIDELIS CARE NEW YORK-Medicaid, +65881,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,FIDELIS CARE NEW YORK-Medicaid, +65882,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,FIDELIS CARE NEW YORK-Medicaid, +65883,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,FIDELIS CARE NEW YORK-Medicaid, +65884,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,FIDELIS CARE NEW YORK-Medicaid, +65885,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,FIDELIS CARE NEW YORK-Medicaid, +65886,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,FIDELIS CARE NEW YORK-Medicaid, +65887,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,FIDELIS CARE NEW YORK-Medicaid, +65888,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,FIDELIS CARE NEW YORK-Medicaid, +65889,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,FIDELIS CARE NEW YORK-Medicaid, +65890,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,FIDELIS CARE NEW YORK-Medicaid, +65891,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,FIDELIS CARE NEW YORK-Medicaid, +65892,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,FIDELIS CARE NEW YORK-Medicaid, +65893,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,FIDELIS CARE NEW YORK-Medicaid, +65894,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,FIDELIS CARE NEW YORK-Medicaid, +65895,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,FIDELIS CARE NEW YORK-Medicaid, +65896,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,FIDELIS CARE NEW YORK-Medicaid, +65897,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,FIDELIS CARE NEW YORK-Medicaid, +65898,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,FIDELIS CARE NEW YORK-Medicaid, +65899,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,FIDELIS CARE NEW YORK-Medicaid, +65900,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,FIDELIS CARE NEW YORK-Medicaid, +65901,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,FIDELIS CARE NEW YORK-Medicaid, +65902,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,FIDELIS CARE NEW YORK-Medicaid, +65903,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,FIDELIS CARE NEW YORK-Medicaid, +65904,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,FIDELIS CARE NEW YORK-Medicaid, +65905,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,FIDELIS CARE NEW YORK-Medicaid, +65906,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,FIDELIS CARE NEW YORK-Medicaid, +65907,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,FIDELIS CARE NEW YORK-Medicaid, +65908,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,FIDELIS CARE NEW YORK-Medicaid, +65909,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,FIDELIS CARE NEW YORK-Medicaid, +65910,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,FIDELIS CARE NEW YORK-Medicaid, +65911,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,FIDELIS CARE NEW YORK-Medicaid, +65912,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,FIDELIS CARE NEW YORK-Medicaid, +65913,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,FIDELIS CARE NEW YORK-Medicaid, +65914,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,FIDELIS CARE NEW YORK-Medicaid, +65915,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,FIDELIS CARE NEW YORK-Medicaid, +65916,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,FIDELIS CARE NEW YORK-Medicaid, +65917,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,FIDELIS CARE NEW YORK-Medicaid, +65918,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,FIDELIS CARE NEW YORK-Medicaid, +65919,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,FIDELIS CARE NEW YORK-Medicaid, +65920,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,FIDELIS CARE NEW YORK-Medicaid, +65921,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,FIDELIS CARE NEW YORK-Medicaid, +65922,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,FIDELIS CARE NEW YORK-Medicaid, +65923,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,FIDELIS CARE NEW YORK-Medicaid, +65924,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,FIDELIS CARE NEW YORK-Medicaid, +65925,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,FIDELIS CARE NEW YORK-Medicaid, +65926,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,FIDELIS CARE NEW YORK-Medicaid, +65927,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,FIDELIS CARE NEW YORK-Medicaid, +65928,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,FIDELIS CARE NEW YORK-Medicaid, +65929,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,FIDELIS CARE NEW YORK-Medicaid, +65930,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,FIDELIS CARE NEW YORK-Medicaid, +65931,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,FIDELIS CARE NEW YORK-Medicaid, +65932,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,FIDELIS CARE NEW YORK-Medicaid, +65933,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,FIDELIS CARE NEW YORK-Medicaid, +65934,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,FIDELIS CARE NEW YORK-Medicaid, +65935,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,FIDELIS CARE NEW YORK-Medicaid, +65936,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,FIDELIS CARE NEW YORK-Medicaid, +65937,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,FIDELIS CARE NEW YORK-Medicaid, +65938,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,FIDELIS CARE NEW YORK-Medicaid, +65939,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,FIDELIS CARE NEW YORK-Medicaid, +65940,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,FIDELIS CARE NEW YORK-Medicaid, +65941,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,FIDELIS CARE NEW YORK-Medicaid, +65942,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,FIDELIS CARE NEW YORK-Medicaid, +65943,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,FIDELIS CARE NEW YORK-Medicaid, +65944,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,FIDELIS CARE NEW YORK-Medicaid, +65945,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,FIDELIS CARE NEW YORK-Medicaid, +65946,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,FIDELIS CARE NEW YORK-Medicaid, +65947,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,FIDELIS CARE NEW YORK-Medicaid, +65948,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,FIDELIS CARE NEW YORK-Medicaid, +65949,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,FIDELIS CARE NEW YORK-Medicaid, +65950,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,FIDELIS CARE NEW YORK-Medicaid, +65951,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,FIDELIS CARE NEW YORK-Medicaid, +65952,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,FIDELIS CARE NEW YORK-Medicaid, +65953,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,FIDELIS CARE NEW YORK-Medicaid, +65954,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,FIDELIS CARE NEW YORK-Medicaid, +65955,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,FIDELIS CARE NEW YORK-Medicaid, +65956,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,FIDELIS CARE NEW YORK-Medicaid, +65957,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,FIDELIS CARE NEW YORK-Medicaid, +65958,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,FIDELIS CARE NEW YORK-Medicaid, +65959,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,FIDELIS CARE NEW YORK-Medicaid, +65960,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,FIDELIS CARE NEW YORK-Medicaid, +65961,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,FIDELIS CARE NEW YORK-Medicaid, +65962,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,FIDELIS CARE NEW YORK-Medicaid, +65963,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,FIDELIS CARE NEW YORK-Medicaid, +65964,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,FIDELIS CARE NEW YORK-Medicaid, +65965,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,FIDELIS CARE NEW YORK-Medicaid, +65966,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,FIDELIS CARE NEW YORK-Medicaid, +65967,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,FIDELIS CARE NEW YORK-Medicaid, +65968,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,FIDELIS CARE NEW YORK-Medicaid, +65969,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,FIDELIS CARE NEW YORK-Medicaid, +65970,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,FIDELIS CARE NEW YORK-Medicaid, +65971,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,FIDELIS CARE NEW YORK-Medicaid, +65972,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,FIDELIS CARE NEW YORK-Medicaid, +65973,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,FIDELIS CARE NEW YORK-Medicaid, +65974,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,FIDELIS CARE NEW YORK-Medicaid, +65975,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,FIDELIS CARE NEW YORK-Medicaid, +65976,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,FIDELIS CARE NEW YORK-Medicaid, +65977,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,FIDELIS CARE NEW YORK-Medicaid, +65978,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,FIDELIS CARE NEW YORK-Medicaid, +65979,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,FIDELIS CARE NEW YORK-Medicaid, +65980,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,FIDELIS CARE NEW YORK-Medicaid, +65981,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,FIDELIS CARE NEW YORK-Medicaid, +65982,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,FIDELIS CARE NEW YORK-Medicaid, +65983,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,FIDELIS CARE NEW YORK-Medicaid, +65984,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,FIDELIS CARE NEW YORK-Medicaid, +65985,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,FIDELIS CARE NEW YORK-Medicaid, +65986,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,FIDELIS CARE NEW YORK-Medicaid, +65987,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,FIDELIS CARE NEW YORK-Medicaid, +65988,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,FIDELIS CARE NEW YORK-Medicaid, +65989,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,FIDELIS CARE NEW YORK-Medicaid, +65990,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,FIDELIS CARE NEW YORK-Medicaid, +65991,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,FIDELIS CARE NEW YORK-Medicaid, +65992,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,FIDELIS CARE NEW YORK-Medicaid, +65993,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,FIDELIS CARE NEW YORK-Medicaid, +65994,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,FIDELIS CARE NEW YORK-Medicaid, +65995,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,FIDELIS CARE NEW YORK-Medicaid, +65996,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,FIDELIS CARE NEW YORK-Medicaid, +65997,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,FIDELIS CARE NEW YORK-Medicaid, +65998,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,FIDELIS CARE NEW YORK-Medicaid, +65999,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,FIDELIS CARE NEW YORK-Medicaid, +66000,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,FIDELIS CARE NEW YORK-Medicaid, +66001,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,FIDELIS CARE NEW YORK-Medicaid, +66002,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,FIDELIS CARE NEW YORK-Medicaid, +66003,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,FIDELIS CARE NEW YORK-Medicaid, +66004,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,FIDELIS CARE NEW YORK-Medicaid, +66005,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,FIDELIS CARE NEW YORK-Medicaid, +66006,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,FIDELIS CARE NEW YORK-Medicaid, +66007,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,FIDELIS CARE NEW YORK-Medicaid, +66008,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,FIDELIS CARE NEW YORK-Medicaid, +66009,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,FIDELIS CARE NEW YORK-Medicaid, +66010,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,FIDELIS CARE NEW YORK-Medicaid, +66011,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,FIDELIS CARE NEW YORK-Medicaid, +66012,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,FIDELIS CARE NEW YORK-Medicaid, +66013,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,FIDELIS CARE NEW YORK-Medicaid, +66014,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,FIDELIS CARE NEW YORK-Medicaid, +66015,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,FIDELIS CARE NEW YORK-Medicaid, +66016,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,FIDELIS CARE NEW YORK-Medicaid, +66017,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,FIDELIS CARE NEW YORK-Medicaid, +66018,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,FIDELIS CARE NEW YORK-Medicaid, +66019,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,FIDELIS CARE NEW YORK-Medicaid, +66020,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,FIDELIS CARE NEW YORK-Medicaid, +66021,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,FIDELIS CARE NEW YORK-Medicaid, +66022,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,FIDELIS CARE NEW YORK-Medicaid, +66023,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,FIDELIS CARE NEW YORK-Medicaid, +66024,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,FIDELIS CARE NEW YORK-Medicaid, +66025,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,FIDELIS CARE NEW YORK-Medicaid, +66026,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,FIDELIS CARE NEW YORK-Medicaid, +66027,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,FIDELIS CARE NEW YORK-Medicaid, +66028,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,FIDELIS CARE NEW YORK-Medicaid, +66029,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,FIDELIS CARE NEW YORK-Medicaid, +66030,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,FIDELIS CARE NEW YORK-Medicaid, +66031,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,FIDELIS CARE NEW YORK-Medicaid, +66032,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,FIDELIS CARE NEW YORK-Medicaid, +66033,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,FIDELIS CARE NEW YORK-Medicaid, +66034,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,FIDELIS CARE NEW YORK-Medicaid, +66035,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,FIDELIS CARE NEW YORK-Medicaid, +66036,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,FIDELIS CARE NEW YORK-Medicaid, +66037,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,FIDELIS CARE NEW YORK-Medicaid, +66038,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,FIDELIS CARE NEW YORK-Medicaid, +66039,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,FIDELIS CARE NEW YORK-Medicaid, +66040,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,FIDELIS CARE NEW YORK-Medicaid, +66041,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,FIDELIS CARE NEW YORK-Medicaid, +66042,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,FIDELIS CARE NEW YORK-Medicaid, +66043,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,FIDELIS CARE NEW YORK-Medicaid, +66044,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,FIDELIS CARE NEW YORK-Medicaid, +66045,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,FIDELIS CARE NEW YORK-Medicaid, +66046,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,FIDELIS CARE NEW YORK-Medicaid, +66047,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,FIDELIS CARE NEW YORK-Medicaid, +66048,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,FIDELIS CARE NEW YORK-Medicaid, +66049,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,FIDELIS CARE NEW YORK-Medicaid, +66050,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,FIDELIS CARE NEW YORK-Medicaid, +66051,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,FIDELIS CARE NEW YORK-Medicaid, +66052,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,FIDELIS CARE NEW YORK-Medicaid, +66053,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,FIDELIS CARE NEW YORK-Medicaid, +66054,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,FIDELIS CARE NEW YORK-Medicaid, +66055,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,FIDELIS CARE NEW YORK-Medicaid, +66056,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,FIDELIS CARE NEW YORK-Medicaid, +66057,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,FIDELIS CARE NEW YORK-Medicaid, +66058,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,FIDELIS CARE NEW YORK-Medicaid, +66059,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,FIDELIS CARE NEW YORK-Medicaid, +66060,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,FIDELIS CARE NEW YORK-Medicaid, +66061,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,FIDELIS CARE NEW YORK-Medicaid, +66062,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,FIDELIS CARE NEW YORK-Medicaid, +66063,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,FIDELIS CARE NEW YORK-Medicaid, +66064,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,FIDELIS CARE NEW YORK-Medicaid, +66065,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,FIDELIS CARE NEW YORK-Medicaid, +66066,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,FIDELIS CARE NEW YORK-Medicaid, +66067,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,FIDELIS CARE NEW YORK-Medicaid, +66068,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,FIDELIS CARE NEW YORK-Medicaid, +66069,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,FIDELIS CARE NEW YORK-Medicaid, +66070,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,FIDELIS CARE NEW YORK-Medicaid,463.25 +66071,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66072,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,FIDELIS CARE NEW YORK-Medicaid, +66073,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,FIDELIS CARE NEW YORK-Medicaid, +66074,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,FIDELIS CARE NEW YORK-Medicaid, +66075,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66076,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,FIDELIS CARE NEW YORK-Medicaid,459.25 +66077,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,FIDELIS CARE NEW YORK-Medicaid,452.7 +66078,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,FIDELIS CARE NEW YORK-Medicaid, +66079,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,FIDELIS CARE NEW YORK-Medicaid,388.96 +66080,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,FIDELIS CARE NEW YORK-Medicaid,401.93 +66081,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,FIDELIS CARE NEW YORK-Medicaid,1435.46 +66082,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,FIDELIS CARE NEW YORK-Medicaid,765.94 +66083,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,FIDELIS CARE NEW YORK-Medicaid,377.25 +66084,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,FIDELIS CARE NEW YORK-Medicaid, +66085,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,FIDELIS CARE NEW YORK-Medicaid, +66086,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,FIDELIS CARE NEW YORK-Medicaid, +66087,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,FIDELIS CARE NEW YORK-Medicaid, +66088,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,FIDELIS CARE NEW YORK-Medicaid, +66089,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66090,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66091,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,FIDELIS CARE NEW YORK-Medicaid, +66092,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,FIDELIS CARE NEW YORK-Medicaid, +66093,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,FIDELIS CARE NEW YORK-Medicaid, +66094,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,FIDELIS CARE NEW YORK-Medicaid, +66095,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,FIDELIS CARE NEW YORK-Medicaid,459.25 +66096,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,FIDELIS CARE NEW YORK-Medicaid, +66097,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,FIDELIS CARE NEW YORK-Medicaid, +66098,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,FIDELIS CARE NEW YORK-Medicaid, +66099,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,FIDELIS CARE NEW YORK-Medicaid,787.77 +66100,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,FIDELIS CARE NEW YORK-Medicaid,787.77 +66101,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,FIDELIS CARE NEW YORK-Medicaid, +66102,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,FIDELIS CARE NEW YORK-Medicaid,1920.98 +66103,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,FIDELIS CARE NEW YORK-Medicaid,1435.46 +66104,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,FIDELIS CARE NEW YORK-Medicaid,336.03 +66105,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,FIDELIS CARE NEW YORK-Medicaid,1435.46 +66106,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,FIDELIS CARE NEW YORK-Medicaid, +66107,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,FIDELIS CARE NEW YORK-Medicaid, +66108,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,FIDELIS CARE NEW YORK-Medicaid, +66109,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,FIDELIS CARE NEW YORK-Medicaid,787.77 +66110,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,FIDELIS CARE NEW YORK-Medicaid,787.77 +66111,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,FIDELIS CARE NEW YORK-Medicaid,787.77 +66112,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,FIDELIS CARE NEW YORK-Medicaid,659.88 +66113,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,FIDELIS CARE NEW YORK-Medicaid,2328.31 +66114,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,FIDELIS CARE NEW YORK-Medicaid,2766.28 +66115,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,FIDELIS CARE NEW YORK-Medicaid, +66116,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,FIDELIS CARE NEW YORK-Medicaid, +66117,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,FIDELIS CARE NEW YORK-Medicaid, +66118,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66119,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,FIDELIS CARE NEW YORK-Medicaid, +66120,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,FIDELIS CARE NEW YORK-Medicaid, +66121,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,FIDELIS CARE NEW YORK-Medicaid, +66122,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,FIDELIS CARE NEW YORK-Medicaid, +66123,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,FIDELIS CARE NEW YORK-Medicaid,1504.66 +66124,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,FIDELIS CARE NEW YORK-Medicaid, +66125,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,FIDELIS CARE NEW YORK-Medicaid,822.37 +66126,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66127,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,FIDELIS CARE NEW YORK-Medicaid, +66128,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,FIDELIS CARE NEW YORK-Medicaid, +66129,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,FIDELIS CARE NEW YORK-Medicaid, +66130,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,FIDELIS CARE NEW YORK-Medicaid, +66131,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,FIDELIS CARE NEW YORK-Medicaid, +66132,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,FIDELIS CARE NEW YORK-Medicaid, +66133,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,FIDELIS CARE NEW YORK-Medicaid, +66134,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,FIDELIS CARE NEW YORK-Medicaid,129.42 +66135,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,FIDELIS CARE NEW YORK-Medicaid, +66136,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,FIDELIS CARE NEW YORK-Medicaid,208.25 +66137,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,FIDELIS CARE NEW YORK-Medicaid, +66138,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66139,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,FIDELIS CARE NEW YORK-Medicaid,439.1 +66140,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,FIDELIS CARE NEW YORK-Medicaid,287.1 +66141,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,FIDELIS CARE NEW YORK-Medicaid,1435.46 +66142,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,FIDELIS CARE NEW YORK-Medicaid, +66143,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,FIDELIS CARE NEW YORK-Medicaid,1435.46 +66144,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,FIDELIS CARE NEW YORK-Medicaid,293.18 +66145,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,FIDELIS CARE NEW YORK-Medicaid, +66146,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,FIDELIS CARE NEW YORK-Medicaid, +66147,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,FIDELIS CARE NEW YORK-Medicaid, +66148,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,FIDELIS CARE NEW YORK-Medicaid, +66149,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,FIDELIS CARE NEW YORK-Medicaid, +66150,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,FIDELIS CARE NEW YORK-Medicaid,702.22 +66151,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,FIDELIS CARE NEW YORK-Medicaid,393.96 +66152,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,FIDELIS CARE NEW YORK-Medicaid,391.18 +66153,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,FIDELIS CARE NEW YORK-Medicaid,681.74 +66154,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,FIDELIS CARE NEW YORK-Medicaid,593.75 +66155,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,FIDELIS CARE NEW YORK-Medicaid,446.7 +66156,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,FIDELIS CARE NEW YORK-Medicaid,497.3 +66157,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,FIDELIS CARE NEW YORK-Medicaid,523.9 +66158,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,FIDELIS CARE NEW YORK-Medicaid,593.75 +66159,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,FIDELIS CARE NEW YORK-Medicaid,430.75 +66160,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,FIDELIS CARE NEW YORK-Medicaid, +66161,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,FIDELIS CARE NEW YORK-Medicaid, +66162,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,FIDELIS CARE NEW YORK-Medicaid, +66163,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,FIDELIS CARE NEW YORK-Medicaid, +66164,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,FIDELIS CARE NEW YORK-Medicaid, +66165,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,FIDELIS CARE NEW YORK-Medicaid,645.19 +66166,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,FIDELIS CARE NEW YORK-Medicaid,504.51 +66167,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,FIDELIS CARE NEW YORK-Medicaid,1016.96 +66168,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,FIDELIS CARE NEW YORK-Medicaid,781.7 +66169,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,FIDELIS CARE NEW YORK-Medicaid, +66170,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,FIDELIS CARE NEW YORK-Medicaid, +66171,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,FIDELIS CARE NEW YORK-Medicaid,781.7 +66172,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,FIDELIS CARE NEW YORK-Medicaid,365.92 +66173,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,FIDELIS CARE NEW YORK-Medicaid, +66174,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,FIDELIS CARE NEW YORK-Medicaid, +66175,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,FIDELIS CARE NEW YORK-Medicaid, +66176,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,FIDELIS CARE NEW YORK-Medicaid,781.7 +66177,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,FIDELIS CARE NEW YORK-Medicaid,576.52 +66178,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,FIDELIS CARE NEW YORK-Medicaid,781.7 +66179,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,FIDELIS CARE NEW YORK-Medicaid, +66180,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,FIDELIS CARE NEW YORK-Medicaid, +66181,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,FIDELIS CARE NEW YORK-Medicaid, +66182,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,FIDELIS CARE NEW YORK-Medicaid,166.16 +66183,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,FIDELIS CARE NEW YORK-Medicaid, +66184,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66185,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,FIDELIS CARE NEW YORK-Medicaid, +66186,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,FIDELIS CARE NEW YORK-Medicaid,708.77 +66187,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,FIDELIS CARE NEW YORK-Medicaid, +66188,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,FIDELIS CARE NEW YORK-Medicaid, +66189,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,FIDELIS CARE NEW YORK-Medicaid, +66190,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66191,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66192,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,FIDELIS CARE NEW YORK-Medicaid, +66193,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,FIDELIS CARE NEW YORK-Medicaid, +66194,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,FIDELIS CARE NEW YORK-Medicaid, +66195,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,FIDELIS CARE NEW YORK-Medicaid, +66196,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,FIDELIS CARE NEW YORK-Medicaid,1732.84 +66197,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,FIDELIS CARE NEW YORK-Medicaid, +66198,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,FIDELIS CARE NEW YORK-Medicaid, +66199,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66200,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,FIDELIS CARE NEW YORK-Medicaid,1047.67 +66201,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66202,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,FIDELIS CARE NEW YORK-Medicaid, +66203,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,FIDELIS CARE NEW YORK-Medicaid,1663.01 +66204,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,FIDELIS CARE NEW YORK-Medicaid, +66205,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,FIDELIS CARE NEW YORK-Medicaid, +66206,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,FIDELIS CARE NEW YORK-Medicaid, +66207,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,FIDELIS CARE NEW YORK-Medicaid,1663.01 +66208,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,FIDELIS CARE NEW YORK-Medicaid, +66209,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,FIDELIS CARE NEW YORK-Medicaid, +66210,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,FIDELIS CARE NEW YORK-Medicaid, +66211,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,FIDELIS CARE NEW YORK-Medicaid, +66212,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,FIDELIS CARE NEW YORK-Medicaid,1605.82 +66213,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,FIDELIS CARE NEW YORK-Medicaid, +66214,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66215,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,FIDELIS CARE NEW YORK-Medicaid, +66216,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,FIDELIS CARE NEW YORK-Medicaid, +66217,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,FIDELIS CARE NEW YORK-Medicaid, +66218,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,FIDELIS CARE NEW YORK-Medicaid, +66219,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,FIDELIS CARE NEW YORK-Medicaid, +66220,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,FIDELIS CARE NEW YORK-Medicaid, +66221,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66222,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,FIDELIS CARE NEW YORK-Medicaid, +66223,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,FIDELIS CARE NEW YORK-Medicaid, +66224,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,FIDELIS CARE NEW YORK-Medicaid, +66225,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,FIDELIS CARE NEW YORK-Medicaid, +66226,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,FIDELIS CARE NEW YORK-Medicaid,3434.62 +66227,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,FIDELIS CARE NEW YORK-Medicaid,2328.31 +66228,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,FIDELIS CARE NEW YORK-Medicaid, +66229,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,FIDELIS CARE NEW YORK-Medicaid, +66230,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,FIDELIS CARE NEW YORK-Medicaid, +66231,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,FIDELIS CARE NEW YORK-Medicaid, +66232,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,FIDELIS CARE NEW YORK-Medicaid, +66233,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,FIDELIS CARE NEW YORK-Medicaid, +66234,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,FIDELIS CARE NEW YORK-Medicaid, +66235,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,FIDELIS CARE NEW YORK-Medicaid, +66236,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,FIDELIS CARE NEW YORK-Medicaid,523.9 +66237,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,FIDELIS CARE NEW YORK-Medicaid, +66238,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,FIDELIS CARE NEW YORK-Medicaid, +66239,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,FIDELIS CARE NEW YORK-Medicaid,373.56 +66240,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,FIDELIS CARE NEW YORK-Medicaid,656.23 +66241,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,FIDELIS CARE NEW YORK-Medicaid,1907.22 +66242,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,FIDELIS CARE NEW YORK-Medicaid,1856.58 +66243,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66244,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,FIDELIS CARE NEW YORK-Medicaid,1859.36 +66245,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66246,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,FIDELIS CARE NEW YORK-Medicaid,1849.99 +66247,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66248,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,FIDELIS CARE NEW YORK-Medicaid,2292.02 +66249,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,FIDELIS CARE NEW YORK-Medicaid,1792.32 +66250,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,FIDELIS CARE NEW YORK-Medicaid,2574.97 +66251,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,FIDELIS CARE NEW YORK-Medicaid,1287.91 +66252,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,FIDELIS CARE NEW YORK-Medicaid, +66253,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,FIDELIS CARE NEW YORK-Medicaid, +66254,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,FIDELIS CARE NEW YORK-Medicaid,1172.16 +66255,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,FIDELIS CARE NEW YORK-Medicaid, +66256,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,FIDELIS CARE NEW YORK-Medicaid, +66257,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,FIDELIS CARE NEW YORK-Medicaid, +66258,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,FIDELIS CARE NEW YORK-Medicaid,2909.43 +66259,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,FIDELIS CARE NEW YORK-Medicaid,3667.01 +66260,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,FIDELIS CARE NEW YORK-Medicaid, +66261,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,FIDELIS CARE NEW YORK-Medicaid, +66262,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,FIDELIS CARE NEW YORK-Medicaid,5271.14 +66263,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,FIDELIS CARE NEW YORK-Medicaid, +66264,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,FIDELIS CARE NEW YORK-Medicaid, +66265,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66266,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,FIDELIS CARE NEW YORK-Medicaid, +66267,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,FIDELIS CARE NEW YORK-Medicaid, +66268,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,FIDELIS CARE NEW YORK-Medicaid, +66269,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,FIDELIS CARE NEW YORK-Medicaid, +66270,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,FIDELIS CARE NEW YORK-Medicaid, +66271,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,FIDELIS CARE NEW YORK-Medicaid, +66272,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,FIDELIS CARE NEW YORK-Medicaid,3736.21 +66273,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,FIDELIS CARE NEW YORK-Medicaid,2483.24 +66274,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,FIDELIS CARE NEW YORK-Medicaid, +66275,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,FIDELIS CARE NEW YORK-Medicaid, +66276,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,FIDELIS CARE NEW YORK-Medicaid, +66277,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,FIDELIS CARE NEW YORK-Medicaid, +66278,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,FIDELIS CARE NEW YORK-Medicaid, +66279,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,FIDELIS CARE NEW YORK-Medicaid,656.23 +66280,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,FIDELIS CARE NEW YORK-Medicaid, +66281,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,FIDELIS CARE NEW YORK-Medicaid, +66282,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,FIDELIS CARE NEW YORK-Medicaid, +66283,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,FIDELIS CARE NEW YORK-Medicaid,936.41 +66284,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66285,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicaid, +66286,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,FIDELIS CARE NEW YORK-Medicaid,293.57 +66287,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,FIDELIS CARE NEW YORK-Medicaid, +66288,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,FIDELIS CARE NEW YORK-Medicaid, +66289,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,FIDELIS CARE NEW YORK-Medicaid,312.87 +66290,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,FIDELIS CARE NEW YORK-Medicaid,365.16 +66291,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,FIDELIS CARE NEW YORK-Medicaid,156.43 +66292,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,FIDELIS CARE NEW YORK-Medicaid, +66293,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,FIDELIS CARE NEW YORK-Medicaid, +66294,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,FIDELIS CARE NEW YORK-Medicaid,333.68 +66295,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,FIDELIS CARE NEW YORK-Medicaid,604.34 +66296,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,FIDELIS CARE NEW YORK-Medicaid, +66297,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,FIDELIS CARE NEW YORK-Medicaid, +66298,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66299,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,FIDELIS CARE NEW YORK-Medicaid,1831.15 +66300,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,FIDELIS CARE NEW YORK-Medicaid, +66301,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,FIDELIS CARE NEW YORK-Medicaid, +66302,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,FIDELIS CARE NEW YORK-Medicaid, +66303,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,FIDELIS CARE NEW YORK-Medicaid, +66304,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,FIDELIS CARE NEW YORK-Medicaid, +66305,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,FIDELIS CARE NEW YORK-Medicaid, +66306,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,FIDELIS CARE NEW YORK-Medicaid, +66307,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,FIDELIS CARE NEW YORK-Medicaid, +66308,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,FIDELIS CARE NEW YORK-Medicaid, +66309,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,FIDELIS CARE NEW YORK-Medicaid, +66310,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,FIDELIS CARE NEW YORK-Medicaid, +66311,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,FIDELIS CARE NEW YORK-Medicaid, +66312,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,FIDELIS CARE NEW YORK-Medicaid, +66313,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,FIDELIS CARE NEW YORK-Medicaid, +66314,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,FIDELIS CARE NEW YORK-Medicaid,2830.7 +66315,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,FIDELIS CARE NEW YORK-Medicaid, +66316,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66317,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,FIDELIS CARE NEW YORK-Medicaid, +66318,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,FIDELIS CARE NEW YORK-Medicaid, +66319,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,FIDELIS CARE NEW YORK-Medicaid, +66320,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,FIDELIS CARE NEW YORK-Medicaid, +66321,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,FIDELIS CARE NEW YORK-Medicaid, +66322,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,FIDELIS CARE NEW YORK-Medicaid, +66323,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66324,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66325,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66326,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,FIDELIS CARE NEW YORK-Medicaid, +66327,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,FIDELIS CARE NEW YORK-Medicaid, +66328,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,FIDELIS CARE NEW YORK-Medicaid, +66329,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,FIDELIS CARE NEW YORK-Medicaid, +66330,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,FIDELIS CARE NEW YORK-Medicaid, +66331,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,FIDELIS CARE NEW YORK-Medicaid, +66332,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,FIDELIS CARE NEW YORK-Medicaid, +66333,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,FIDELIS CARE NEW YORK-Medicaid, +66334,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,FIDELIS CARE NEW YORK-Medicaid, +66335,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,FIDELIS CARE NEW YORK-Medicaid, +66336,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,FIDELIS CARE NEW YORK-Medicaid, +66337,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,FIDELIS CARE NEW YORK-Medicaid, +66338,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,FIDELIS CARE NEW YORK-Medicaid, +66339,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,FIDELIS CARE NEW YORK-Medicaid, +66340,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,FIDELIS CARE NEW YORK-Medicaid, +66341,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,FIDELIS CARE NEW YORK-Medicaid, +66342,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,FIDELIS CARE NEW YORK-Medicaid, +66343,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,FIDELIS CARE NEW YORK-Medicaid, +66344,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,FIDELIS CARE NEW YORK-Medicaid, +66345,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,FIDELIS CARE NEW YORK-Medicaid, +66346,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66347,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,FIDELIS CARE NEW YORK-Medicaid, +66348,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,FIDELIS CARE NEW YORK-Medicaid,856.97 +66349,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,FIDELIS CARE NEW YORK-Medicaid,2032.46 +66350,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,FIDELIS CARE NEW YORK-Medicaid, +66351,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,FIDELIS CARE NEW YORK-Medicaid,1435.46 +66352,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,FIDELIS CARE NEW YORK-Medicaid, +66353,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,FIDELIS CARE NEW YORK-Medicaid, +66354,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,FIDELIS CARE NEW YORK-Medicaid, +66355,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,FIDELIS CARE NEW YORK-Medicaid, +66356,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,FIDELIS CARE NEW YORK-Medicaid, +66357,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,FIDELIS CARE NEW YORK-Medicaid,1435.46 +66358,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,FIDELIS CARE NEW YORK-Medicaid,1034.25 +66359,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,FIDELIS CARE NEW YORK-Medicaid, +66360,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,FIDELIS CARE NEW YORK-Medicaid, +66361,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,FIDELIS CARE NEW YORK-Medicaid, +66362,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,FIDELIS CARE NEW YORK-Medicaid, +66363,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,FIDELIS CARE NEW YORK-Medicaid,6381.79 +66364,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,FIDELIS CARE NEW YORK-Medicaid, +66365,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,FIDELIS CARE NEW YORK-Medicaid,2088.7 +66366,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,FIDELIS CARE NEW YORK-Medicaid, +66367,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,FIDELIS CARE NEW YORK-Medicaid, +66368,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,FIDELIS CARE NEW YORK-Medicaid, +66369,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,FIDELIS CARE NEW YORK-Medicaid, +66370,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,FIDELIS CARE NEW YORK-Medicaid,1004.19 +66371,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,FIDELIS CARE NEW YORK-Medicaid,1261.54 +66372,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,FIDELIS CARE NEW YORK-Medicaid, +66373,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,FIDELIS CARE NEW YORK-Medicaid, +66374,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,FIDELIS CARE NEW YORK-Medicaid, +66375,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,FIDELIS CARE NEW YORK-Medicaid, +66376,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,FIDELIS CARE NEW YORK-Medicaid, +66377,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,FIDELIS CARE NEW YORK-Medicaid, +66378,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,FIDELIS CARE NEW YORK-Medicaid, +66379,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,FIDELIS CARE NEW YORK-Medicaid, +66380,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,FIDELIS CARE NEW YORK-Medicaid, +66381,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,FIDELIS CARE NEW YORK-Medicaid, +66382,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,FIDELIS CARE NEW YORK-Medicaid, +66383,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66384,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,FIDELIS CARE NEW YORK-Medicaid, +66385,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,FIDELIS CARE NEW YORK-Medicaid, +66386,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,FIDELIS CARE NEW YORK-Medicaid, +66387,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,FIDELIS CARE NEW YORK-Medicaid,648.31 +66388,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,FIDELIS CARE NEW YORK-Medicaid, +66389,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,FIDELIS CARE NEW YORK-Medicaid,661.0 +66390,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66391,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,FIDELIS CARE NEW YORK-Medicaid, +66392,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,FIDELIS CARE NEW YORK-Medicaid, +66393,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,FIDELIS CARE NEW YORK-Medicaid, +66394,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,FIDELIS CARE NEW YORK-Medicaid, +66395,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,FIDELIS CARE NEW YORK-Medicaid, +66396,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,FIDELIS CARE NEW YORK-Medicaid, +66397,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,FIDELIS CARE NEW YORK-Medicaid, +66398,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,FIDELIS CARE NEW YORK-Medicaid, +66399,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,FIDELIS CARE NEW YORK-Medicaid,1208.36 +66400,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,FIDELIS CARE NEW YORK-Medicaid, +66401,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,FIDELIS CARE NEW YORK-Medicaid, +66402,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,FIDELIS CARE NEW YORK-Medicaid,2547.53 +66403,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,FIDELIS CARE NEW YORK-Medicaid, +66404,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,FIDELIS CARE NEW YORK-Medicaid,2532.41 +66405,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66406,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,FIDELIS CARE NEW YORK-Medicaid, +66407,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,FIDELIS CARE NEW YORK-Medicaid, +66408,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,FIDELIS CARE NEW YORK-Medicaid, +66409,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,FIDELIS CARE NEW YORK-Medicaid, +66410,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,FIDELIS CARE NEW YORK-Medicaid,3552.4 +66411,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,FIDELIS CARE NEW YORK-Medicaid, +66412,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,FIDELIS CARE NEW YORK-Medicaid,572.04 +66413,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,FIDELIS CARE NEW YORK-Medicaid,3552.4 +66414,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,FIDELIS CARE NEW YORK-Medicaid, +66415,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,FIDELIS CARE NEW YORK-Medicaid, +66416,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,FIDELIS CARE NEW YORK-Medicaid, +66417,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,FIDELIS CARE NEW YORK-Medicaid, +66418,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,FIDELIS CARE NEW YORK-Medicaid, +66419,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,FIDELIS CARE NEW YORK-Medicaid, +66420,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,FIDELIS CARE NEW YORK-Medicaid, +66421,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,FIDELIS CARE NEW YORK-Medicaid, +66422,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,FIDELIS CARE NEW YORK-Medicaid, +66423,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,FIDELIS CARE NEW YORK-Medicaid, +66424,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,FIDELIS CARE NEW YORK-Medicaid, +66425,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,FIDELIS CARE NEW YORK-Medicaid,572.04 +66426,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,FIDELIS CARE NEW YORK-Medicaid, +66427,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,FIDELIS CARE NEW YORK-Medicaid,572.04 +66428,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,FIDELIS CARE NEW YORK-Medicaid, +66429,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,FIDELIS CARE NEW YORK-Medicaid, +66430,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66431,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,FIDELIS CARE NEW YORK-Medicaid,2236.33 +66432,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,FIDELIS CARE NEW YORK-Medicaid,2054.7 +66433,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,FIDELIS CARE NEW YORK-Medicaid, +66434,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,FIDELIS CARE NEW YORK-Medicaid, +66435,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,FIDELIS CARE NEW YORK-Medicaid, +66436,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,FIDELIS CARE NEW YORK-Medicaid,2236.33 +66437,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,FIDELIS CARE NEW YORK-Medicaid, +66438,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,FIDELIS CARE NEW YORK-Medicaid, +66439,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,FIDELIS CARE NEW YORK-Medicaid,2236.33 +66440,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,FIDELIS CARE NEW YORK-Medicaid,1535.59 +66441,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,FIDELIS CARE NEW YORK-Medicaid, +66442,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,FIDELIS CARE NEW YORK-Medicaid, +66443,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,FIDELIS CARE NEW YORK-Medicaid, +66444,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,FIDELIS CARE NEW YORK-Medicaid, +66445,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66446,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,FIDELIS CARE NEW YORK-Medicaid, +66447,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,FIDELIS CARE NEW YORK-Medicaid, +66448,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,FIDELIS CARE NEW YORK-Medicaid,1070.02 +66449,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66450,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,FIDELIS CARE NEW YORK-Medicaid, +66451,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,FIDELIS CARE NEW YORK-Medicaid, +66452,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,FIDELIS CARE NEW YORK-Medicaid, +66453,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,FIDELIS CARE NEW YORK-Medicaid, +66454,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,FIDELIS CARE NEW YORK-Medicaid, +66455,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,FIDELIS CARE NEW YORK-Medicaid, +66456,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,FIDELIS CARE NEW YORK-Medicaid, +66457,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,FIDELIS CARE NEW YORK-Medicaid,3361.5 +66458,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,FIDELIS CARE NEW YORK-Medicaid, +66459,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,FIDELIS CARE NEW YORK-Medicaid,572.04 +66460,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66461,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,FIDELIS CARE NEW YORK-Medicaid, +66462,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,FIDELIS CARE NEW YORK-Medicaid, +66463,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,FIDELIS CARE NEW YORK-Medicaid, +66464,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,FIDELIS CARE NEW YORK-Medicaid, +66465,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,FIDELIS CARE NEW YORK-Medicaid, +66466,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,FIDELIS CARE NEW YORK-Medicaid,686.44 +66467,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66468,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,FIDELIS CARE NEW YORK-Medicaid, +66469,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66470,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66471,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,FIDELIS CARE NEW YORK-Medicaid, +66472,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,FIDELIS CARE NEW YORK-Medicaid, +66473,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,FIDELIS CARE NEW YORK-Medicaid, +66474,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,FIDELIS CARE NEW YORK-Medicaid, +66475,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,FIDELIS CARE NEW YORK-Medicaid, +66476,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,FIDELIS CARE NEW YORK-Medicaid, +66477,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,FIDELIS CARE NEW YORK-Medicaid, +66478,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,FIDELIS CARE NEW YORK-Medicaid,1202.71 +66479,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,FIDELIS CARE NEW YORK-Medicaid, +66480,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,FIDELIS CARE NEW YORK-Medicaid, +66481,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,FIDELIS CARE NEW YORK-Medicaid, +66482,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,FIDELIS CARE NEW YORK-Medicaid, +66483,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,FIDELIS CARE NEW YORK-Medicaid,1466.39 +66484,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,FIDELIS CARE NEW YORK-Medicaid,1466.39 +66485,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,FIDELIS CARE NEW YORK-Medicaid, +66486,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,FIDELIS CARE NEW YORK-Medicaid, +66487,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,FIDELIS CARE NEW YORK-Medicaid, +66488,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,FIDELIS CARE NEW YORK-Medicaid, +66489,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,FIDELIS CARE NEW YORK-Medicaid, +66490,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,FIDELIS CARE NEW YORK-Medicaid, +66491,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66492,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,FIDELIS CARE NEW YORK-Medicaid, +66493,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,FIDELIS CARE NEW YORK-Medicaid, +66494,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,FIDELIS CARE NEW YORK-Medicaid, +66495,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,FIDELIS CARE NEW YORK-Medicaid,575.09 +66496,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66497,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,FIDELIS CARE NEW YORK-Medicaid, +66498,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,FIDELIS CARE NEW YORK-Medicaid,1393.6 +66499,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,FIDELIS CARE NEW YORK-Medicaid, +66500,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,FIDELIS CARE NEW YORK-Medicaid, +66501,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,FIDELIS CARE NEW YORK-Medicaid, +66502,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,FIDELIS CARE NEW YORK-Medicaid, +66503,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,FIDELIS CARE NEW YORK-Medicaid, +66504,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,FIDELIS CARE NEW YORK-Medicaid,4478.52 +66505,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,FIDELIS CARE NEW YORK-Medicaid,1802.59 +66506,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,FIDELIS CARE NEW YORK-Medicaid, +66507,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,FIDELIS CARE NEW YORK-Medicaid, +66508,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,FIDELIS CARE NEW YORK-Medicaid, +66509,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,FIDELIS CARE NEW YORK-Medicaid,3361.5 +66510,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,FIDELIS CARE NEW YORK-Medicaid, +66511,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,FIDELIS CARE NEW YORK-Medicaid, +66512,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66513,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,FIDELIS CARE NEW YORK-Medicaid, +66514,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,FIDELIS CARE NEW YORK-Medicaid, +66515,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,FIDELIS CARE NEW YORK-Medicaid,2349.75 +66516,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,FIDELIS CARE NEW YORK-Medicaid, +66517,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,FIDELIS CARE NEW YORK-Medicaid,572.04 +66518,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,FIDELIS CARE NEW YORK-Medicaid, +66519,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66520,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66521,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,FIDELIS CARE NEW YORK-Medicaid, +66522,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,FIDELIS CARE NEW YORK-Medicaid, +66523,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,FIDELIS CARE NEW YORK-Medicaid, +66524,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,FIDELIS CARE NEW YORK-Medicaid, +66525,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,FIDELIS CARE NEW YORK-Medicaid, +66526,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,FIDELIS CARE NEW YORK-Medicaid,572.04 +66527,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,FIDELIS CARE NEW YORK-Medicaid, +66528,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,FIDELIS CARE NEW YORK-Medicaid, +66529,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,FIDELIS CARE NEW YORK-Medicaid,572.04 +66530,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,FIDELIS CARE NEW YORK-Medicaid,3223.74 +66531,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66532,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,FIDELIS CARE NEW YORK-Medicaid,572.04 +66533,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,FIDELIS CARE NEW YORK-Medicaid, +66534,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,FIDELIS CARE NEW YORK-Medicaid, +66535,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,FIDELIS CARE NEW YORK-Medicaid, +66536,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66537,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,FIDELIS CARE NEW YORK-Medicaid, +66538,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,FIDELIS CARE NEW YORK-Medicaid, +66539,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,FIDELIS CARE NEW YORK-Medicaid, +66540,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,FIDELIS CARE NEW YORK-Medicaid, +66541,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,FIDELIS CARE NEW YORK-Medicaid, +66542,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,FIDELIS CARE NEW YORK-Medicaid, +66543,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,FIDELIS CARE NEW YORK-Medicaid, +66544,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,FIDELIS CARE NEW YORK-Medicaid, +66545,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,FIDELIS CARE NEW YORK-Medicaid, +66546,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,FIDELIS CARE NEW YORK-Medicaid, +66547,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,FIDELIS CARE NEW YORK-Medicaid, +66548,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,FIDELIS CARE NEW YORK-Medicaid, +66549,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,FIDELIS CARE NEW YORK-Medicaid, +66550,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,FIDELIS CARE NEW YORK-Medicaid, +66551,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,FIDELIS CARE NEW YORK-Medicaid,584.95 +66552,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,FIDELIS CARE NEW YORK-Medicaid,1043.91 +66553,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,FIDELIS CARE NEW YORK-Medicaid, +66554,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,FIDELIS CARE NEW YORK-Medicaid, +66555,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,FIDELIS CARE NEW YORK-Medicaid, +66556,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,FIDELIS CARE NEW YORK-Medicaid, +66557,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,FIDELIS CARE NEW YORK-Medicaid, +66558,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,FIDELIS CARE NEW YORK-Medicaid, +66559,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,FIDELIS CARE NEW YORK-Medicaid, +66560,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,FIDELIS CARE NEW YORK-Medicaid, +66561,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66562,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,FIDELIS CARE NEW YORK-Medicaid, +66563,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,FIDELIS CARE NEW YORK-Medicaid, +66564,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,FIDELIS CARE NEW YORK-Medicaid, +66565,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66566,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,FIDELIS CARE NEW YORK-Medicaid, +66567,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,FIDELIS CARE NEW YORK-Medicaid, +66568,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,FIDELIS CARE NEW YORK-Medicaid, +66569,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,FIDELIS CARE NEW YORK-Medicaid, +66570,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,FIDELIS CARE NEW YORK-Medicaid,2250.84 +66571,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,FIDELIS CARE NEW YORK-Medicaid, +66572,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,FIDELIS CARE NEW YORK-Medicaid, +66573,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,FIDELIS CARE NEW YORK-Medicaid, +66574,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,FIDELIS CARE NEW YORK-Medicaid, +66575,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,FIDELIS CARE NEW YORK-Medicaid, +66576,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,FIDELIS CARE NEW YORK-Medicaid, +66577,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,FIDELIS CARE NEW YORK-Medicaid, +66578,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,FIDELIS CARE NEW YORK-Medicaid, +66579,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,FIDELIS CARE NEW YORK-Medicaid, +66580,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,FIDELIS CARE NEW YORK-Medicaid, +66581,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,FIDELIS CARE NEW YORK-Medicaid, +66582,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,FIDELIS CARE NEW YORK-Medicaid, +66583,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66584,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,FIDELIS CARE NEW YORK-Medicaid, +66585,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,FIDELIS CARE NEW YORK-Medicaid, +66586,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,FIDELIS CARE NEW YORK-Medicaid, +66587,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,FIDELIS CARE NEW YORK-Medicaid, +66588,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,FIDELIS CARE NEW YORK-Medicaid, +66589,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicaid, +66590,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,FIDELIS CARE NEW YORK-Medicaid,1988.94 +66591,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,FIDELIS CARE NEW YORK-Medicaid, +66592,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,FIDELIS CARE NEW YORK-Medicaid, +66593,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,FIDELIS CARE NEW YORK-Medicaid, +66594,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,FIDELIS CARE NEW YORK-Medicaid, +66595,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,FIDELIS CARE NEW YORK-Medicaid, +66596,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,FIDELIS CARE NEW YORK-Medicaid,1988.94 +66597,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,FIDELIS CARE NEW YORK-Medicaid,1988.94 +66598,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,FIDELIS CARE NEW YORK-Medicaid, +66599,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,FIDELIS CARE NEW YORK-Medicaid, +66600,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,FIDELIS CARE NEW YORK-Medicaid, +66601,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,FIDELIS CARE NEW YORK-Medicaid, +66602,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,FIDELIS CARE NEW YORK-Medicaid, +66603,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66604,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,FIDELIS CARE NEW YORK-Medicaid, +66605,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,FIDELIS CARE NEW YORK-Medicaid, +66606,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,FIDELIS CARE NEW YORK-Medicaid, +66607,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,FIDELIS CARE NEW YORK-Medicaid, +66608,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,FIDELIS CARE NEW YORK-Medicaid, +66609,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,FIDELIS CARE NEW YORK-Medicaid, +66610,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,FIDELIS CARE NEW YORK-Medicaid,572.04 +66611,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,FIDELIS CARE NEW YORK-Medicaid, +66612,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,FIDELIS CARE NEW YORK-Medicaid, +66613,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,FIDELIS CARE NEW YORK-Medicaid, +66614,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,FIDELIS CARE NEW YORK-Medicaid, +66615,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,FIDELIS CARE NEW YORK-Medicaid, +66616,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,FIDELIS CARE NEW YORK-Medicaid, +66617,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,FIDELIS CARE NEW YORK-Medicaid, +66618,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,FIDELIS CARE NEW YORK-Medicaid,572.04 +66619,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,FIDELIS CARE NEW YORK-Medicaid, +66620,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,FIDELIS CARE NEW YORK-Medicaid, +66621,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,FIDELIS CARE NEW YORK-Medicaid,3223.74 +66622,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,FIDELIS CARE NEW YORK-Medicaid, +66623,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,FIDELIS CARE NEW YORK-Medicaid,572.04 +66624,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,FIDELIS CARE NEW YORK-Medicaid,652.28 +66625,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,FIDELIS CARE NEW YORK-Medicaid,3552.4 +66626,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,FIDELIS CARE NEW YORK-Medicaid, +66627,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,FIDELIS CARE NEW YORK-Medicaid, +66628,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,FIDELIS CARE NEW YORK-Medicaid, +66629,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,FIDELIS CARE NEW YORK-Medicaid, +66630,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,FIDELIS CARE NEW YORK-Medicaid, +66631,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,FIDELIS CARE NEW YORK-Medicaid, +66632,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,FIDELIS CARE NEW YORK-Medicaid, +66633,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,FIDELIS CARE NEW YORK-Medicaid, +66634,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,FIDELIS CARE NEW YORK-Medicaid, +66635,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,FIDELIS CARE NEW YORK-Medicaid, +66636,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,FIDELIS CARE NEW YORK-Medicaid, +66637,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,FIDELIS CARE NEW YORK-Medicaid, +66638,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,FIDELIS CARE NEW YORK-Medicaid, +66639,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,FIDELIS CARE NEW YORK-Medicaid, +66640,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,FIDELIS CARE NEW YORK-Medicaid, +66641,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,FIDELIS CARE NEW YORK-Medicaid, +66642,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,FIDELIS CARE NEW YORK-Medicaid, +66643,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,FIDELIS CARE NEW YORK-Medicaid, +66644,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66645,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,FIDELIS CARE NEW YORK-Medicaid, +66646,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,FIDELIS CARE NEW YORK-Medicaid,1855.57 +66647,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,FIDELIS CARE NEW YORK-Medicaid, +66648,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66649,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,FIDELIS CARE NEW YORK-Medicaid, +66650,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,FIDELIS CARE NEW YORK-Medicaid, +66651,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,FIDELIS CARE NEW YORK-Medicaid, +66652,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,FIDELIS CARE NEW YORK-Medicaid, +66653,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,FIDELIS CARE NEW YORK-Medicaid, +66654,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,FIDELIS CARE NEW YORK-Medicaid, +66655,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,FIDELIS CARE NEW YORK-Medicaid,2341.96 +66656,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,FIDELIS CARE NEW YORK-Medicaid,2341.96 +66657,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,FIDELIS CARE NEW YORK-Medicaid, +66658,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66659,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,FIDELIS CARE NEW YORK-Medicaid,2341.96 +66660,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,FIDELIS CARE NEW YORK-Medicaid, +66661,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,FIDELIS CARE NEW YORK-Medicaid, +66662,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,FIDELIS CARE NEW YORK-Medicaid, +66663,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66664,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,FIDELIS CARE NEW YORK-Medicaid, +66665,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,FIDELIS CARE NEW YORK-Medicaid, +66666,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,FIDELIS CARE NEW YORK-Medicaid, +66667,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,FIDELIS CARE NEW YORK-Medicaid,4262.87 +66668,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,FIDELIS CARE NEW YORK-Medicaid, +66669,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,FIDELIS CARE NEW YORK-Medicaid, +66670,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66671,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,FIDELIS CARE NEW YORK-Medicaid, +66672,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66673,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,FIDELIS CARE NEW YORK-Medicaid,572.04 +66674,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,FIDELIS CARE NEW YORK-Medicaid, +66675,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,FIDELIS CARE NEW YORK-Medicaid, +66676,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,FIDELIS CARE NEW YORK-Medicaid, +66677,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,FIDELIS CARE NEW YORK-Medicaid, +66678,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,FIDELIS CARE NEW YORK-Medicaid,3279.94 +66679,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,FIDELIS CARE NEW YORK-Medicaid, +66680,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,FIDELIS CARE NEW YORK-Medicaid, +66681,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,FIDELIS CARE NEW YORK-Medicaid, +66682,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,FIDELIS CARE NEW YORK-Medicaid, +66683,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,FIDELIS CARE NEW YORK-Medicaid, +66684,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,FIDELIS CARE NEW YORK-Medicaid, +66685,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,FIDELIS CARE NEW YORK-Medicaid,2341.96 +66686,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,FIDELIS CARE NEW YORK-Medicaid, +66687,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,FIDELIS CARE NEW YORK-Medicaid, +66688,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,FIDELIS CARE NEW YORK-Medicaid, +66689,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,FIDELIS CARE NEW YORK-Medicaid, +66690,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,FIDELIS CARE NEW YORK-Medicaid, +66691,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,FIDELIS CARE NEW YORK-Medicaid, +66692,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,FIDELIS CARE NEW YORK-Medicaid, +66693,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,FIDELIS CARE NEW YORK-Medicaid, +66694,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,FIDELIS CARE NEW YORK-Medicaid,256.61 +66695,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,FIDELIS CARE NEW YORK-Medicaid,274.09 +66696,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,FIDELIS CARE NEW YORK-Medicaid,258.96 +66697,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,FIDELIS CARE NEW YORK-Medicaid, +66698,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,FIDELIS CARE NEW YORK-Medicaid, +66699,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,FIDELIS CARE NEW YORK-Medicaid,342.71 +66700,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,FIDELIS CARE NEW YORK-Medicaid,525.48 +66701,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,FIDELIS CARE NEW YORK-Medicaid,327.44 +66702,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,FIDELIS CARE NEW YORK-Medicaid,283.3 +66703,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,FIDELIS CARE NEW YORK-Medicaid,481.19 +66704,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,FIDELIS CARE NEW YORK-Medicaid, +66705,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,FIDELIS CARE NEW YORK-Medicaid, +66706,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,FIDELIS CARE NEW YORK-Medicaid, +66707,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,FIDELIS CARE NEW YORK-Medicaid, +66708,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,FIDELIS CARE NEW YORK-Medicaid,3814.42 +66709,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66710,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66711,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,FIDELIS CARE NEW YORK-Medicaid, +66712,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,FIDELIS CARE NEW YORK-Medicaid,2062.0 +66713,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,FIDELIS CARE NEW YORK-Medicaid, +66714,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,FIDELIS CARE NEW YORK-Medicaid, +66715,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,FIDELIS CARE NEW YORK-Medicaid, +66716,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,FIDELIS CARE NEW YORK-Medicaid,3814.42 +66717,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,FIDELIS CARE NEW YORK-Medicaid,3814.42 +66718,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,FIDELIS CARE NEW YORK-Medicaid, +66719,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,FIDELIS CARE NEW YORK-Medicaid, +66720,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,FIDELIS CARE NEW YORK-Medicaid, +66721,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,FIDELIS CARE NEW YORK-Medicaid,2062.0 +66722,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,FIDELIS CARE NEW YORK-Medicaid,2062.0 +66723,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,FIDELIS CARE NEW YORK-Medicaid, +66724,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,FIDELIS CARE NEW YORK-Medicaid, +66725,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,FIDELIS CARE NEW YORK-Medicaid, +66726,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,FIDELIS CARE NEW YORK-Medicaid, +66727,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,FIDELIS CARE NEW YORK-Medicaid, +66728,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66729,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,FIDELIS CARE NEW YORK-Medicaid, +66730,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,FIDELIS CARE NEW YORK-Medicaid, +66731,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,FIDELIS CARE NEW YORK-Medicaid, +66732,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66733,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,FIDELIS CARE NEW YORK-Medicaid, +66734,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,FIDELIS CARE NEW YORK-Medicaid,2062.0 +66735,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,FIDELIS CARE NEW YORK-Medicaid, +66736,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,FIDELIS CARE NEW YORK-Medicaid, +66737,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,FIDELIS CARE NEW YORK-Medicaid,2062.0 +66738,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,FIDELIS CARE NEW YORK-Medicaid, +66739,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,FIDELIS CARE NEW YORK-Medicaid,3814.42 +66740,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,FIDELIS CARE NEW YORK-Medicaid, +66741,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,FIDELIS CARE NEW YORK-Medicaid,1855.57 +66742,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66743,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,FIDELIS CARE NEW YORK-Medicaid, +66744,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,FIDELIS CARE NEW YORK-Medicaid, +66745,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,FIDELIS CARE NEW YORK-Medicaid, +66746,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,FIDELIS CARE NEW YORK-Medicaid, +66747,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,FIDELIS CARE NEW YORK-Medicaid,2453.82 +66748,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,FIDELIS CARE NEW YORK-Medicaid,144.25 +66749,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +66750,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,FIDELIS CARE NEW YORK-Medicaid, +66751,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,FIDELIS CARE NEW YORK-Medicaid, +66752,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,FIDELIS CARE NEW YORK-Medicaid,2650.21 +66753,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,FIDELIS CARE NEW YORK-Medicaid, +66754,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,FIDELIS CARE NEW YORK-Medicaid, +66755,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,FIDELIS CARE NEW YORK-Medicaid, +66756,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,FIDELIS CARE NEW YORK-Medicaid,174.8 +66757,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,FIDELIS CARE NEW YORK-Medicaid, +66758,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,FIDELIS CARE NEW YORK-Medicaid, +66759,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,FIDELIS CARE NEW YORK-Medicaid, +66760,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,FIDELIS CARE NEW YORK-Medicaid, +66761,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,FIDELIS CARE NEW YORK-Medicaid, +66762,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,FIDELIS CARE NEW YORK-Medicaid, +66763,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,FIDELIS CARE NEW YORK-Medicaid,174.8 +66764,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,FIDELIS CARE NEW YORK-Medicaid, +66765,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,FIDELIS CARE NEW YORK-Medicaid,871.95 +66766,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,FIDELIS CARE NEW YORK-Medicaid, +66767,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,FIDELIS CARE NEW YORK-Medicaid, +66768,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,FIDELIS CARE NEW YORK-Medicaid, +66769,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,FIDELIS CARE NEW YORK-Medicaid, +66770,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,FIDELIS CARE NEW YORK-Medicaid, +66771,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,FIDELIS CARE NEW YORK-Medicaid, +66772,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,FIDELIS CARE NEW YORK-Medicaid,2813.99 +66773,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,FIDELIS CARE NEW YORK-Medicaid, +66774,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,FIDELIS CARE NEW YORK-Medicaid, +66775,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,FIDELIS CARE NEW YORK-Medicaid, +66776,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,FIDELIS CARE NEW YORK-Medicaid, +66777,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,FIDELIS CARE NEW YORK-Medicaid, +66778,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,FIDELIS CARE NEW YORK-Medicaid, +66779,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,FIDELIS CARE NEW YORK-Medicaid,144.25 +66780,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,FIDELIS CARE NEW YORK-Medicaid,363.31 +66781,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,FIDELIS CARE NEW YORK-Medicaid, +66782,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,FIDELIS CARE NEW YORK-Medicaid, +66783,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,FIDELIS CARE NEW YORK-Medicaid, +66784,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,FIDELIS CARE NEW YORK-Medicaid,2018.36 +66785,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,FIDELIS CARE NEW YORK-Medicaid,1983.76 +66786,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,FIDELIS CARE NEW YORK-Medicaid, +66787,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,FIDELIS CARE NEW YORK-Medicaid, +66788,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,FIDELIS CARE NEW YORK-Medicaid, +66789,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,FIDELIS CARE NEW YORK-Medicaid,1914.56 +66790,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,FIDELIS CARE NEW YORK-Medicaid, +66791,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,FIDELIS CARE NEW YORK-Medicaid,447.65 +66792,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,FIDELIS CARE NEW YORK-Medicaid, +66793,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,FIDELIS CARE NEW YORK-Medicaid, +66794,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,FIDELIS CARE NEW YORK-Medicaid, +66795,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66796,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,FIDELIS CARE NEW YORK-Medicaid, +66797,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,FIDELIS CARE NEW YORK-Medicaid, +66798,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,FIDELIS CARE NEW YORK-Medicaid,995.89 +66799,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,FIDELIS CARE NEW YORK-Medicaid, +66800,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,FIDELIS CARE NEW YORK-Medicaid,1435.62 +66801,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,FIDELIS CARE NEW YORK-Medicaid, +66802,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66803,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,FIDELIS CARE NEW YORK-Medicaid,3576.79 +66804,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,FIDELIS CARE NEW YORK-Medicaid, +66805,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,FIDELIS CARE NEW YORK-Medicaid, +66806,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,FIDELIS CARE NEW YORK-Medicaid, +66807,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,FIDELIS CARE NEW YORK-Medicaid, +66808,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,FIDELIS CARE NEW YORK-Medicaid, +66809,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,FIDELIS CARE NEW YORK-Medicaid, +66810,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,FIDELIS CARE NEW YORK-Medicaid, +66811,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,FIDELIS CARE NEW YORK-Medicaid, +66812,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,FIDELIS CARE NEW YORK-Medicaid, +66813,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,FIDELIS CARE NEW YORK-Medicaid,1560.7 +66814,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,FIDELIS CARE NEW YORK-Medicaid,1560.7 +66815,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,FIDELIS CARE NEW YORK-Medicaid, +66816,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,FIDELIS CARE NEW YORK-Medicaid, +66817,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,FIDELIS CARE NEW YORK-Medicaid, +66818,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,FIDELIS CARE NEW YORK-Medicaid, +66819,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,FIDELIS CARE NEW YORK-Medicaid,1019.2 +66820,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,FIDELIS CARE NEW YORK-Medicaid, +66821,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,FIDELIS CARE NEW YORK-Medicaid, +66822,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,FIDELIS CARE NEW YORK-Medicaid, +66823,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,FIDELIS CARE NEW YORK-Medicaid, +66824,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,FIDELIS CARE NEW YORK-Medicaid, +66825,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,FIDELIS CARE NEW YORK-Medicaid, +66826,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,FIDELIS CARE NEW YORK-Medicaid, +66827,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,FIDELIS CARE NEW YORK-Medicaid, +66828,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,FIDELIS CARE NEW YORK-Medicaid, +66829,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,FIDELIS CARE NEW YORK-Medicaid, +66830,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,FIDELIS CARE NEW YORK-Medicaid, +66831,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,FIDELIS CARE NEW YORK-Medicaid, +66832,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,FIDELIS CARE NEW YORK-Medicaid, +66833,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,FIDELIS CARE NEW YORK-Medicaid, +66834,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,FIDELIS CARE NEW YORK-Medicaid, +66835,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,FIDELIS CARE NEW YORK-Medicaid, +66836,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,FIDELIS CARE NEW YORK-Medicaid, +66837,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,FIDELIS CARE NEW YORK-Medicaid, +66838,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,FIDELIS CARE NEW YORK-Medicaid, +66839,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,FIDELIS CARE NEW YORK-Medicaid, +66840,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,FIDELIS CARE NEW YORK-Medicaid, +66841,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,FIDELIS CARE NEW YORK-Medicaid, +66842,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,FIDELIS CARE NEW YORK-Medicaid,6897.65 +66843,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,FIDELIS CARE NEW YORK-Medicaid, +66844,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,FIDELIS CARE NEW YORK-Medicaid, +66845,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,FIDELIS CARE NEW YORK-Medicaid, +66846,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,FIDELIS CARE NEW YORK-Medicaid, +66847,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,FIDELIS CARE NEW YORK-Medicaid, +66848,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,FIDELIS CARE NEW YORK-Medicaid, +66849,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,FIDELIS CARE NEW YORK-Medicaid, +66850,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,FIDELIS CARE NEW YORK-Medicaid,13295.57 +66851,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,FIDELIS CARE NEW YORK-Medicaid, +66852,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,FIDELIS CARE NEW YORK-Medicaid, +66853,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,FIDELIS CARE NEW YORK-Medicaid, +66854,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,FIDELIS CARE NEW YORK-Medicaid, +66855,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,FIDELIS CARE NEW YORK-Medicaid, +66856,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,FIDELIS CARE NEW YORK-Medicaid,6897.65 +66857,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,FIDELIS CARE NEW YORK-Medicaid, +66858,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,FIDELIS CARE NEW YORK-Medicaid, +66859,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,FIDELIS CARE NEW YORK-Medicaid, +66860,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,FIDELIS CARE NEW YORK-Medicaid, +66861,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +66862,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,FIDELIS CARE NEW YORK-Medicaid, +66863,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,FIDELIS CARE NEW YORK-Medicaid, +66864,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,FIDELIS CARE NEW YORK-Medicaid,2783.55 +66865,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,FIDELIS CARE NEW YORK-Medicaid, +66866,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,FIDELIS CARE NEW YORK-Medicaid,3340.26 +66867,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,FIDELIS CARE NEW YORK-Medicaid, +66868,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,FIDELIS CARE NEW YORK-Medicaid, +66869,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,FIDELIS CARE NEW YORK-Medicaid, +66870,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,FIDELIS CARE NEW YORK-Medicaid, +66871,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,FIDELIS CARE NEW YORK-Medicaid, +66872,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,FIDELIS CARE NEW YORK-Medicaid, +66873,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,FIDELIS CARE NEW YORK-Medicaid, +66874,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,FIDELIS CARE NEW YORK-Medicaid, +66875,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,FIDELIS CARE NEW YORK-Medicaid, +66876,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,FIDELIS CARE NEW YORK-Medicaid, +66877,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,FIDELIS CARE NEW YORK-Medicaid, +66878,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,FIDELIS CARE NEW YORK-Medicaid,318.78 +66879,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,FIDELIS CARE NEW YORK-Medicaid, +66880,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,FIDELIS CARE NEW YORK-Medicaid, +66881,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,FIDELIS CARE NEW YORK-Medicaid, +66882,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,FIDELIS CARE NEW YORK-Medicaid,1230.06 +66883,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,FIDELIS CARE NEW YORK-Medicaid,1443.62 +66884,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,FIDELIS CARE NEW YORK-Medicaid, +66885,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,FIDELIS CARE NEW YORK-Medicaid,1103.92 +66886,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,FIDELIS CARE NEW YORK-Medicaid, +66887,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,FIDELIS CARE NEW YORK-Medicaid,369.55 +66888,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,FIDELIS CARE NEW YORK-Medicaid, +66889,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,FIDELIS CARE NEW YORK-Medicaid, +66890,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,FIDELIS CARE NEW YORK-Medicaid, +66891,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,FIDELIS CARE NEW YORK-Medicaid, +66892,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,FIDELIS CARE NEW YORK-Medicaid, +66893,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,FIDELIS CARE NEW YORK-Medicaid,42.87 +66894,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,FIDELIS CARE NEW YORK-Medicaid,34.42 +66895,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,FIDELIS CARE NEW YORK-Medicaid,8.59 +66896,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,FIDELIS CARE NEW YORK-Medicaid,39.86 +66897,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,FIDELIS CARE NEW YORK-Medicaid,641.09 +66898,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,FIDELIS CARE NEW YORK-Medicaid, +66899,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66900,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,FIDELIS CARE NEW YORK-Medicaid,2151.76 +66901,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,FIDELIS CARE NEW YORK-Medicaid, +66902,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,FIDELIS CARE NEW YORK-Medicaid,2118.68 +66903,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,FIDELIS CARE NEW YORK-Medicaid, +66904,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,FIDELIS CARE NEW YORK-Medicaid,298.32 +66905,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,FIDELIS CARE NEW YORK-Medicaid,1557.55 +66906,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,FIDELIS CARE NEW YORK-Medicaid, +66907,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,FIDELIS CARE NEW YORK-Medicaid,2200.51 +66908,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,FIDELIS CARE NEW YORK-Medicaid,251.09 +66909,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,FIDELIS CARE NEW YORK-Medicaid, +66910,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,FIDELIS CARE NEW YORK-Medicaid,284.85 +66911,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,FIDELIS CARE NEW YORK-Medicaid, +66912,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,FIDELIS CARE NEW YORK-Medicaid,1596.12 +66913,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,FIDELIS CARE NEW YORK-Medicaid, +66914,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,FIDELIS CARE NEW YORK-Medicaid, +66915,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,FIDELIS CARE NEW YORK-Medicaid,992.16 +66916,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,FIDELIS CARE NEW YORK-Medicaid,992.16 +66917,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,FIDELIS CARE NEW YORK-Medicaid,121.69 +66918,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,FIDELIS CARE NEW YORK-Medicaid,73.17 +66919,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,FIDELIS CARE NEW YORK-Medicaid, +66920,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,FIDELIS CARE NEW YORK-Medicaid, +66921,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,FIDELIS CARE NEW YORK-Medicaid,610.54 +66922,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,FIDELIS CARE NEW YORK-Medicaid,51.2 +66923,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,FIDELIS CARE NEW YORK-Medicaid, +66924,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,FIDELIS CARE NEW YORK-Medicaid, +66925,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +66926,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,FIDELIS CARE NEW YORK-Medicaid,2825.07 +66927,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,FIDELIS CARE NEW YORK-Medicaid,2825.07 +66928,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,FIDELIS CARE NEW YORK-Medicaid, +66929,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,FIDELIS CARE NEW YORK-Medicaid,2825.07 +66930,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,FIDELIS CARE NEW YORK-Medicaid, +66931,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,FIDELIS CARE NEW YORK-Medicaid, +66932,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,FIDELIS CARE NEW YORK-Medicaid,2964.84 +66933,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,FIDELIS CARE NEW YORK-Medicaid, +66934,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,FIDELIS CARE NEW YORK-Medicaid, +66935,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,FIDELIS CARE NEW YORK-Medicaid, +66936,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,FIDELIS CARE NEW YORK-Medicaid, +66937,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,FIDELIS CARE NEW YORK-Medicaid, +66938,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,FIDELIS CARE NEW YORK-Medicaid, +66939,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,FIDELIS CARE NEW YORK-Medicaid, +66940,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,FIDELIS CARE NEW YORK-Medicaid, +66941,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,FIDELIS CARE NEW YORK-Medicaid, +66942,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,FIDELIS CARE NEW YORK-Medicaid,2478.21 +66943,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,FIDELIS CARE NEW YORK-Medicaid, +66944,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,FIDELIS CARE NEW YORK-Medicaid, +66945,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,FIDELIS CARE NEW YORK-Medicaid, +66946,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,FIDELIS CARE NEW YORK-Medicaid,2964.84 +66947,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,FIDELIS CARE NEW YORK-Medicaid, +66948,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,FIDELIS CARE NEW YORK-Medicaid, +66949,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,FIDELIS CARE NEW YORK-Medicaid, +66950,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,FIDELIS CARE NEW YORK-Medicaid, +66951,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,FIDELIS CARE NEW YORK-Medicaid, +66952,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,FIDELIS CARE NEW YORK-Medicaid, +66953,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,FIDELIS CARE NEW YORK-Medicaid, +66954,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,FIDELIS CARE NEW YORK-Medicaid, +66955,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,FIDELIS CARE NEW YORK-Medicaid, +66956,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,FIDELIS CARE NEW YORK-Medicaid, +66957,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,FIDELIS CARE NEW YORK-Medicaid,2964.84 +66958,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,FIDELIS CARE NEW YORK-Medicaid, +66959,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,FIDELIS CARE NEW YORK-Medicaid, +66960,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,FIDELIS CARE NEW YORK-Medicaid, +66961,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,FIDELIS CARE NEW YORK-Medicaid, +66962,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,FIDELIS CARE NEW YORK-Medicaid, +66963,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,FIDELIS CARE NEW YORK-Medicaid, +66964,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,FIDELIS CARE NEW YORK-Medicaid, +66965,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,FIDELIS CARE NEW YORK-Medicaid, +66966,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,FIDELIS CARE NEW YORK-Medicaid, +66967,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,FIDELIS CARE NEW YORK-Medicaid, +66968,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,FIDELIS CARE NEW YORK-Medicaid, +66969,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,FIDELIS CARE NEW YORK-Medicaid,2843.73 +66970,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,FIDELIS CARE NEW YORK-Medicaid, +66971,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,FIDELIS CARE NEW YORK-Medicaid, +66972,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,FIDELIS CARE NEW YORK-Medicaid, +66973,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,FIDELIS CARE NEW YORK-Medicaid, +66974,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,FIDELIS CARE NEW YORK-Medicaid, +66975,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,FIDELIS CARE NEW YORK-Medicaid, +66976,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,FIDELIS CARE NEW YORK-Medicaid, +66977,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,FIDELIS CARE NEW YORK-Medicaid,839.37 +66978,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,FIDELIS CARE NEW YORK-Medicaid,816.46 +66979,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,FIDELIS CARE NEW YORK-Medicaid,826.48 +66980,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,FIDELIS CARE NEW YORK-Medicaid,1456.53 +66981,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,FIDELIS CARE NEW YORK-Medicaid,856.97 +66982,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,FIDELIS CARE NEW YORK-Medicaid, +66983,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,FIDELIS CARE NEW YORK-Medicaid,1412.83 +66984,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,FIDELIS CARE NEW YORK-Medicaid, +66985,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,FIDELIS CARE NEW YORK-Medicaid, +66986,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,FIDELIS CARE NEW YORK-Medicaid,4757.93 +66987,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,FIDELIS CARE NEW YORK-Medicaid, +66988,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,FIDELIS CARE NEW YORK-Medicaid, +66989,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,FIDELIS CARE NEW YORK-Medicaid, +66990,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,FIDELIS CARE NEW YORK-Medicaid, +66991,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,FIDELIS CARE NEW YORK-Medicaid, +66992,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,FIDELIS CARE NEW YORK-Medicaid, +66993,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,FIDELIS CARE NEW YORK-Medicaid, +66994,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,FIDELIS CARE NEW YORK-Medicaid,494.84 +66995,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,FIDELIS CARE NEW YORK-Medicaid, +66996,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,FIDELIS CARE NEW YORK-Medicaid, +66997,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,FIDELIS CARE NEW YORK-Medicaid, +66998,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,FIDELIS CARE NEW YORK-Medicaid, +66999,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,FIDELIS CARE NEW YORK-Medicaid, +67000,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,FIDELIS CARE NEW YORK-Medicaid, +67001,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,FIDELIS CARE NEW YORK-Medicaid,3392.79 +67002,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,FIDELIS CARE NEW YORK-Medicaid,170.07 +67003,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,FIDELIS CARE NEW YORK-Medicaid, +67004,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,FIDELIS CARE NEW YORK-Medicaid, +67005,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,FIDELIS CARE NEW YORK-Medicaid,1514.19 +67006,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,FIDELIS CARE NEW YORK-Medicaid, +67007,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,FIDELIS CARE NEW YORK-Medicaid, +67008,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,FIDELIS CARE NEW YORK-Medicaid,1171.78 +67009,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,FIDELIS CARE NEW YORK-Medicaid,1372.0 +67010,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67011,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,FIDELIS CARE NEW YORK-Medicaid, +67012,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,FIDELIS CARE NEW YORK-Medicaid,1580.7 +67013,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,FIDELIS CARE NEW YORK-Medicaid, +67014,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,FIDELIS CARE NEW YORK-Medicaid, +67015,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,FIDELIS CARE NEW YORK-Medicaid, +67016,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,FIDELIS CARE NEW YORK-Medicaid, +67017,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,FIDELIS CARE NEW YORK-Medicaid, +67018,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,FIDELIS CARE NEW YORK-Medicaid,2650.21 +67019,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,FIDELIS CARE NEW YORK-Medicaid, +67020,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67021,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,FIDELIS CARE NEW YORK-Medicaid,193.71 +67022,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,FIDELIS CARE NEW YORK-Medicaid, +67023,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,FIDELIS CARE NEW YORK-Medicaid, +67024,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,FIDELIS CARE NEW YORK-Medicaid,590.77 +67025,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicaid, +67026,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,FIDELIS CARE NEW YORK-Medicaid, +67027,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,FIDELIS CARE NEW YORK-Medicaid, +67028,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,FIDELIS CARE NEW YORK-Medicaid, +67029,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,FIDELIS CARE NEW YORK-Medicaid,3764.71 +67030,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,FIDELIS CARE NEW YORK-Medicaid,3392.79 +67031,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,FIDELIS CARE NEW YORK-Medicaid, +67032,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,FIDELIS CARE NEW YORK-Medicaid, +67033,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,FIDELIS CARE NEW YORK-Medicaid,1903.9 +67034,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,FIDELIS CARE NEW YORK-Medicaid, +67035,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,FIDELIS CARE NEW YORK-Medicaid, +67036,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,FIDELIS CARE NEW YORK-Medicaid, +67037,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,FIDELIS CARE NEW YORK-Medicaid, +67038,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,FIDELIS CARE NEW YORK-Medicaid, +67039,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,FIDELIS CARE NEW YORK-Medicaid, +67040,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,FIDELIS CARE NEW YORK-Medicaid, +67041,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,FIDELIS CARE NEW YORK-Medicaid, +67042,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicaid, +67043,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,FIDELIS CARE NEW YORK-Medicaid, +67044,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,FIDELIS CARE NEW YORK-Medicaid,221.92 +67045,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67046,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,FIDELIS CARE NEW YORK-Medicaid, +67047,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,FIDELIS CARE NEW YORK-Medicaid, +67048,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,FIDELIS CARE NEW YORK-Medicaid, +67049,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,FIDELIS CARE NEW YORK-Medicaid, +67050,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,FIDELIS CARE NEW YORK-Medicaid,1724.49 +67051,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,FIDELIS CARE NEW YORK-Medicaid,1724.49 +67052,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,FIDELIS CARE NEW YORK-Medicaid, +67053,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,FIDELIS CARE NEW YORK-Medicaid,1655.29 +67054,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,FIDELIS CARE NEW YORK-Medicaid,1655.29 +67055,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,FIDELIS CARE NEW YORK-Medicaid,769.79 +67056,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,FIDELIS CARE NEW YORK-Medicaid,1064.96 +67057,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,FIDELIS CARE NEW YORK-Medicaid, +67058,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,FIDELIS CARE NEW YORK-Medicaid, +67059,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,FIDELIS CARE NEW YORK-Medicaid, +67060,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,FIDELIS CARE NEW YORK-Medicaid,1099.01 +67061,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,FIDELIS CARE NEW YORK-Medicaid,1390.84 +67062,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,FIDELIS CARE NEW YORK-Medicaid, +67063,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,FIDELIS CARE NEW YORK-Medicaid, +67064,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,FIDELIS CARE NEW YORK-Medicaid,1331.36 +67065,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,FIDELIS CARE NEW YORK-Medicaid,975.42 +67066,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,FIDELIS CARE NEW YORK-Medicaid, +67067,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,FIDELIS CARE NEW YORK-Medicaid, +67068,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,FIDELIS CARE NEW YORK-Medicaid,963.85 +67069,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,FIDELIS CARE NEW YORK-Medicaid,611.71 +67070,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,FIDELIS CARE NEW YORK-Medicaid,975.42 +67071,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,FIDELIS CARE NEW YORK-Medicaid, +67072,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,FIDELIS CARE NEW YORK-Medicaid,1253.54 +67073,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,FIDELIS CARE NEW YORK-Medicaid, +67074,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,FIDELIS CARE NEW YORK-Medicaid,1307.04 +67075,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,FIDELIS CARE NEW YORK-Medicaid,898.13 +67076,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,FIDELIS CARE NEW YORK-Medicaid,975.42 +67077,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,FIDELIS CARE NEW YORK-Medicaid,975.42 +67078,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,FIDELIS CARE NEW YORK-Medicaid,975.42 +67079,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,FIDELIS CARE NEW YORK-Medicaid, +67080,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,FIDELIS CARE NEW YORK-Medicaid,975.42 +67081,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,FIDELIS CARE NEW YORK-Medicaid,1044.62 +67082,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,FIDELIS CARE NEW YORK-Medicaid, +67083,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,FIDELIS CARE NEW YORK-Medicaid, +67084,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,FIDELIS CARE NEW YORK-Medicaid, +67085,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,FIDELIS CARE NEW YORK-Medicaid,975.42 +67086,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,FIDELIS CARE NEW YORK-Medicaid, +67087,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,FIDELIS CARE NEW YORK-Medicaid, +67088,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,FIDELIS CARE NEW YORK-Medicaid, +67089,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,FIDELIS CARE NEW YORK-Medicaid,1643.83 +67090,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,FIDELIS CARE NEW YORK-Medicaid, +67091,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,FIDELIS CARE NEW YORK-Medicaid, +67092,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,FIDELIS CARE NEW YORK-Medicaid,1099.01 +67093,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,FIDELIS CARE NEW YORK-Medicaid, +67094,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,FIDELIS CARE NEW YORK-Medicaid,1504.9 +67095,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,FIDELIS CARE NEW YORK-Medicaid, +67096,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,FIDELIS CARE NEW YORK-Medicaid, +67097,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,FIDELIS CARE NEW YORK-Medicaid, +67098,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,FIDELIS CARE NEW YORK-Medicaid, +67099,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,FIDELIS CARE NEW YORK-Medicaid, +67100,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,FIDELIS CARE NEW YORK-Medicaid,2923.0 +67101,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,FIDELIS CARE NEW YORK-Medicaid, +67102,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,FIDELIS CARE NEW YORK-Medicaid, +67103,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,FIDELIS CARE NEW YORK-Medicaid, +67104,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,FIDELIS CARE NEW YORK-Medicaid, +67105,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,FIDELIS CARE NEW YORK-Medicaid, +67106,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,FIDELIS CARE NEW YORK-Medicaid, +67107,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,FIDELIS CARE NEW YORK-Medicaid, +67108,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,FIDELIS CARE NEW YORK-Medicaid, +67109,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,FIDELIS CARE NEW YORK-Medicaid,417.02 +67110,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,FIDELIS CARE NEW YORK-Medicaid, +67111,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,FIDELIS CARE NEW YORK-Medicaid, +67112,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,FIDELIS CARE NEW YORK-Medicaid,3320.41 +67113,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67114,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +67115,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,FIDELIS CARE NEW YORK-Medicaid, +67116,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,FIDELIS CARE NEW YORK-Medicaid, +67117,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,FIDELIS CARE NEW YORK-Medicaid, +67118,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,FIDELIS CARE NEW YORK-Medicaid, +67119,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,FIDELIS CARE NEW YORK-Medicaid,1044.62 +67120,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,FIDELIS CARE NEW YORK-Medicaid, +67121,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,FIDELIS CARE NEW YORK-Medicaid, +67122,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,FIDELIS CARE NEW YORK-Medicaid, +67123,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,FIDELIS CARE NEW YORK-Medicaid, +67124,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,FIDELIS CARE NEW YORK-Medicaid, +67125,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,FIDELIS CARE NEW YORK-Medicaid, +67126,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,FIDELIS CARE NEW YORK-Medicaid, +67127,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,FIDELIS CARE NEW YORK-Medicaid, +67128,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,FIDELIS CARE NEW YORK-Medicaid, +67129,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,FIDELIS CARE NEW YORK-Medicaid, +67130,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,FIDELIS CARE NEW YORK-Medicaid, +67131,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,FIDELIS CARE NEW YORK-Medicaid,941.56 +67132,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,FIDELIS CARE NEW YORK-Medicaid, +67133,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,FIDELIS CARE NEW YORK-Medicaid, +67134,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,FIDELIS CARE NEW YORK-Medicaid, +67135,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,FIDELIS CARE NEW YORK-Medicaid, +67136,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,FIDELIS CARE NEW YORK-Medicaid, +67137,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,FIDELIS CARE NEW YORK-Medicaid, +67138,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,FIDELIS CARE NEW YORK-Medicaid,3669.25 +67139,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,FIDELIS CARE NEW YORK-Medicaid, +67140,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,FIDELIS CARE NEW YORK-Medicaid, +67141,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,FIDELIS CARE NEW YORK-Medicaid, +67142,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,FIDELIS CARE NEW YORK-Medicaid, +67143,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,FIDELIS CARE NEW YORK-Medicaid, +67144,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,FIDELIS CARE NEW YORK-Medicaid, +67145,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,FIDELIS CARE NEW YORK-Medicaid,1010.76 +67146,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,FIDELIS CARE NEW YORK-Medicaid, +67147,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,FIDELIS CARE NEW YORK-Medicaid, +67148,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,FIDELIS CARE NEW YORK-Medicaid,941.56 +67149,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,FIDELIS CARE NEW YORK-Medicaid, +67150,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,FIDELIS CARE NEW YORK-Medicaid, +67151,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,FIDELIS CARE NEW YORK-Medicaid,941.56 +67152,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,FIDELIS CARE NEW YORK-Medicaid, +67153,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,FIDELIS CARE NEW YORK-Medicaid, +67154,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,FIDELIS CARE NEW YORK-Medicaid, +67155,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,FIDELIS CARE NEW YORK-Medicaid,537.04 +67156,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,FIDELIS CARE NEW YORK-Medicaid,683.12 +67157,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,FIDELIS CARE NEW YORK-Medicaid, +67158,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,FIDELIS CARE NEW YORK-Medicaid,700.16 +67159,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,FIDELIS CARE NEW YORK-Medicaid,1918.52 +67160,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,FIDELIS CARE NEW YORK-Medicaid, +67161,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,FIDELIS CARE NEW YORK-Medicaid, +67162,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,FIDELIS CARE NEW YORK-Medicaid,1025.01 +67163,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,FIDELIS CARE NEW YORK-Medicaid, +67164,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,FIDELIS CARE NEW YORK-Medicaid,1120.58 +67165,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,FIDELIS CARE NEW YORK-Medicaid, +67166,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,FIDELIS CARE NEW YORK-Medicaid,1120.58 +67167,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +67168,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,FIDELIS CARE NEW YORK-Medicaid, +67169,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,FIDELIS CARE NEW YORK-Medicaid, +67170,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,FIDELIS CARE NEW YORK-Medicaid, +67171,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,FIDELIS CARE NEW YORK-Medicaid, +67172,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,FIDELIS CARE NEW YORK-Medicaid, +67173,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,FIDELIS CARE NEW YORK-Medicaid, +67174,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,FIDELIS CARE NEW YORK-Medicaid, +67175,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,FIDELIS CARE NEW YORK-Medicaid, +67176,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,FIDELIS CARE NEW YORK-Medicaid, +67177,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67178,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,FIDELIS CARE NEW YORK-Medicaid, +67179,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,FIDELIS CARE NEW YORK-Medicaid, +67180,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,FIDELIS CARE NEW YORK-Medicaid, +67181,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,FIDELIS CARE NEW YORK-Medicaid, +67182,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,FIDELIS CARE NEW YORK-Medicaid, +67183,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67184,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,FIDELIS CARE NEW YORK-Medicaid, +67185,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,FIDELIS CARE NEW YORK-Medicaid, +67186,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,FIDELIS CARE NEW YORK-Medicaid, +67187,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,FIDELIS CARE NEW YORK-Medicaid, +67188,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,FIDELIS CARE NEW YORK-Medicaid, +67189,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,FIDELIS CARE NEW YORK-Medicaid, +67190,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,FIDELIS CARE NEW YORK-Medicaid, +67191,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,FIDELIS CARE NEW YORK-Medicaid, +67192,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,FIDELIS CARE NEW YORK-Medicaid, +67193,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67194,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,FIDELIS CARE NEW YORK-Medicaid, +67195,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicaid, +67196,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,FIDELIS CARE NEW YORK-Medicaid, +67197,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,FIDELIS CARE NEW YORK-Medicaid, +67198,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicaid, +67199,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,FIDELIS CARE NEW YORK-Medicaid, +67200,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,FIDELIS CARE NEW YORK-Medicaid, +67201,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,FIDELIS CARE NEW YORK-Medicaid, +67202,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,FIDELIS CARE NEW YORK-Medicaid, +67203,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,FIDELIS CARE NEW YORK-Medicaid, +67204,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,FIDELIS CARE NEW YORK-Medicaid, +67205,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,FIDELIS CARE NEW YORK-Medicaid, +67206,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,FIDELIS CARE NEW YORK-Medicaid, +67207,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,FIDELIS CARE NEW YORK-Medicaid, +67208,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,FIDELIS CARE NEW YORK-Medicaid, +67209,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,FIDELIS CARE NEW YORK-Medicaid, +67210,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,FIDELIS CARE NEW YORK-Medicaid, +67211,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,FIDELIS CARE NEW YORK-Medicaid, +67212,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,FIDELIS CARE NEW YORK-Medicaid, +67213,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,FIDELIS CARE NEW YORK-Medicaid, +67214,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,FIDELIS CARE NEW YORK-Medicaid, +67215,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,FIDELIS CARE NEW YORK-Medicaid, +67216,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,FIDELIS CARE NEW YORK-Medicaid, +67217,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,FIDELIS CARE NEW YORK-Medicaid, +67218,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,FIDELIS CARE NEW YORK-Medicaid, +67219,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,FIDELIS CARE NEW YORK-Medicaid, +67220,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,FIDELIS CARE NEW YORK-Medicaid, +67221,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,FIDELIS CARE NEW YORK-Medicaid, +67222,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,FIDELIS CARE NEW YORK-Medicaid, +67223,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,FIDELIS CARE NEW YORK-Medicaid, +67224,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,FIDELIS CARE NEW YORK-Medicaid, +67225,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,FIDELIS CARE NEW YORK-Medicaid, +67226,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,FIDELIS CARE NEW YORK-Medicaid, +67227,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,FIDELIS CARE NEW YORK-Medicaid, +67228,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,FIDELIS CARE NEW YORK-Medicaid, +67229,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,FIDELIS CARE NEW YORK-Medicaid, +67230,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,FIDELIS CARE NEW YORK-Medicaid, +67231,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +67232,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,FIDELIS CARE NEW YORK-Medicaid, +67233,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,FIDELIS CARE NEW YORK-Medicaid, +67234,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,FIDELIS CARE NEW YORK-Medicaid, +67235,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,FIDELIS CARE NEW YORK-Medicaid, +67236,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,FIDELIS CARE NEW YORK-Medicaid, +67237,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,FIDELIS CARE NEW YORK-Medicaid, +67238,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,FIDELIS CARE NEW YORK-Medicaid, +67239,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,FIDELIS CARE NEW YORK-Medicaid, +67240,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,FIDELIS CARE NEW YORK-Medicaid, +67241,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,FIDELIS CARE NEW YORK-Medicaid, +67242,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,FIDELIS CARE NEW YORK-Medicaid, +67243,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,FIDELIS CARE NEW YORK-Medicaid, +67244,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,FIDELIS CARE NEW YORK-Medicaid, +67245,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,FIDELIS CARE NEW YORK-Medicaid, +67246,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,FIDELIS CARE NEW YORK-Medicaid, +67247,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,FIDELIS CARE NEW YORK-Medicaid, +67248,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,FIDELIS CARE NEW YORK-Medicaid, +67249,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,FIDELIS CARE NEW YORK-Medicaid, +67250,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,FIDELIS CARE NEW YORK-Medicaid, +67251,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,FIDELIS CARE NEW YORK-Medicaid, +67252,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,FIDELIS CARE NEW YORK-Medicaid, +67253,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,FIDELIS CARE NEW YORK-Medicaid, +67254,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,FIDELIS CARE NEW YORK-Medicaid, +67255,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,FIDELIS CARE NEW YORK-Medicaid, +67256,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,FIDELIS CARE NEW YORK-Medicaid, +67257,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,FIDELIS CARE NEW YORK-Medicaid, +67258,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,FIDELIS CARE NEW YORK-Medicaid, +67259,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,FIDELIS CARE NEW YORK-Medicaid, +67260,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,FIDELIS CARE NEW YORK-Medicaid, +67261,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,FIDELIS CARE NEW YORK-Medicaid, +67262,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67263,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,FIDELIS CARE NEW YORK-Medicaid, +67264,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,FIDELIS CARE NEW YORK-Medicaid, +67265,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,FIDELIS CARE NEW YORK-Medicaid, +67266,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,FIDELIS CARE NEW YORK-Medicaid, +67267,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,FIDELIS CARE NEW YORK-Medicaid, +67268,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,FIDELIS CARE NEW YORK-Medicaid, +67269,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,FIDELIS CARE NEW YORK-Medicaid, +67270,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,FIDELIS CARE NEW YORK-Medicaid, +67271,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67272,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,FIDELIS CARE NEW YORK-Medicaid, +67273,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,FIDELIS CARE NEW YORK-Medicaid, +67274,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,FIDELIS CARE NEW YORK-Medicaid, +67275,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,FIDELIS CARE NEW YORK-Medicaid, +67276,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,FIDELIS CARE NEW YORK-Medicaid, +67277,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67278,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,FIDELIS CARE NEW YORK-Medicaid, +67279,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,FIDELIS CARE NEW YORK-Medicaid, +67280,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,FIDELIS CARE NEW YORK-Medicaid, +67281,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,FIDELIS CARE NEW YORK-Medicaid, +67282,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,FIDELIS CARE NEW YORK-Medicaid, +67283,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,FIDELIS CARE NEW YORK-Medicaid, +67284,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,FIDELIS CARE NEW YORK-Medicaid, +67285,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,FIDELIS CARE NEW YORK-Medicaid, +67286,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,FIDELIS CARE NEW YORK-Medicaid, +67287,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,FIDELIS CARE NEW YORK-Medicaid, +67288,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,FIDELIS CARE NEW YORK-Medicaid, +67289,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,FIDELIS CARE NEW YORK-Medicaid, +67290,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,FIDELIS CARE NEW YORK-Medicaid, +67291,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,FIDELIS CARE NEW YORK-Medicaid, +67292,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,FIDELIS CARE NEW YORK-Medicaid, +67293,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,FIDELIS CARE NEW YORK-Medicaid, +67294,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,FIDELIS CARE NEW YORK-Medicaid, +67295,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,FIDELIS CARE NEW YORK-Medicaid, +67296,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,FIDELIS CARE NEW YORK-Medicaid, +67297,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,FIDELIS CARE NEW YORK-Medicaid, +67298,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,FIDELIS CARE NEW YORK-Medicaid, +67299,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,FIDELIS CARE NEW YORK-Medicaid, +67300,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,FIDELIS CARE NEW YORK-Medicaid, +67301,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,FIDELIS CARE NEW YORK-Medicaid, +67302,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,FIDELIS CARE NEW YORK-Medicaid, +67303,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,FIDELIS CARE NEW YORK-Medicaid, +67304,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,FIDELIS CARE NEW YORK-Medicaid, +67305,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,FIDELIS CARE NEW YORK-Medicaid, +67306,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,FIDELIS CARE NEW YORK-Medicaid, +67307,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,FIDELIS CARE NEW YORK-Medicaid, +67308,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,FIDELIS CARE NEW YORK-Medicaid, +67309,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,FIDELIS CARE NEW YORK-Medicaid, +67310,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,FIDELIS CARE NEW YORK-Medicaid, +67311,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,FIDELIS CARE NEW YORK-Medicaid, +67312,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,FIDELIS CARE NEW YORK-Medicaid, +67313,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,FIDELIS CARE NEW YORK-Medicaid, +67314,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,FIDELIS CARE NEW YORK-Medicaid, +67315,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,FIDELIS CARE NEW YORK-Medicaid, +67316,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,FIDELIS CARE NEW YORK-Medicaid, +67317,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,FIDELIS CARE NEW YORK-Medicaid, +67318,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,FIDELIS CARE NEW YORK-Medicaid, +67319,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,FIDELIS CARE NEW YORK-Medicaid, +67320,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,FIDELIS CARE NEW YORK-Medicaid, +67321,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,FIDELIS CARE NEW YORK-Medicaid, +67322,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,FIDELIS CARE NEW YORK-Medicaid, +67323,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,FIDELIS CARE NEW YORK-Medicaid, +67324,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67325,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,FIDELIS CARE NEW YORK-Medicaid, +67326,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,FIDELIS CARE NEW YORK-Medicaid, +67327,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,FIDELIS CARE NEW YORK-Medicaid, +67328,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,FIDELIS CARE NEW YORK-Medicaid, +67329,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,FIDELIS CARE NEW YORK-Medicaid, +67330,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,FIDELIS CARE NEW YORK-Medicaid, +67331,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,FIDELIS CARE NEW YORK-Medicaid, +67332,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,FIDELIS CARE NEW YORK-Medicaid, +67333,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,FIDELIS CARE NEW YORK-Medicaid, +67334,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,FIDELIS CARE NEW YORK-Medicaid, +67335,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,FIDELIS CARE NEW YORK-Medicaid, +67336,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,FIDELIS CARE NEW YORK-Medicaid, +67337,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,FIDELIS CARE NEW YORK-Medicaid, +67338,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,FIDELIS CARE NEW YORK-Medicaid, +67339,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,FIDELIS CARE NEW YORK-Medicaid, +67340,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,FIDELIS CARE NEW YORK-Medicaid, +67341,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,FIDELIS CARE NEW YORK-Medicaid, +67342,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,FIDELIS CARE NEW YORK-Medicaid, +67343,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,FIDELIS CARE NEW YORK-Medicaid, +67344,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,FIDELIS CARE NEW YORK-Medicaid, +67345,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,FIDELIS CARE NEW YORK-Medicaid, +67346,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,FIDELIS CARE NEW YORK-Medicaid, +67347,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,FIDELIS CARE NEW YORK-Medicaid, +67348,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67349,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,FIDELIS CARE NEW YORK-Medicaid, +67350,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,FIDELIS CARE NEW YORK-Medicaid, +67351,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,FIDELIS CARE NEW YORK-Medicaid, +67352,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,FIDELIS CARE NEW YORK-Medicaid, +67353,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,FIDELIS CARE NEW YORK-Medicaid, +67354,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +67355,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,FIDELIS CARE NEW YORK-Medicaid, +67356,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +67357,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,FIDELIS CARE NEW YORK-Medicaid, +67358,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,FIDELIS CARE NEW YORK-Medicaid, +67359,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,FIDELIS CARE NEW YORK-Medicaid, +67360,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,FIDELIS CARE NEW YORK-Medicaid, +67361,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,FIDELIS CARE NEW YORK-Medicaid, +67362,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,FIDELIS CARE NEW YORK-Medicaid, +67363,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,FIDELIS CARE NEW YORK-Medicaid, +67364,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,FIDELIS CARE NEW YORK-Medicaid, +67365,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,FIDELIS CARE NEW YORK-Medicaid, +67366,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,FIDELIS CARE NEW YORK-Medicaid, +67367,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +67368,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,FIDELIS CARE NEW YORK-Medicaid, +67369,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,FIDELIS CARE NEW YORK-Medicaid, +67370,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,FIDELIS CARE NEW YORK-Medicaid, +67371,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,FIDELIS CARE NEW YORK-Medicaid, +67372,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,FIDELIS CARE NEW YORK-Medicaid, +67373,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,FIDELIS CARE NEW YORK-Medicaid, +67374,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,FIDELIS CARE NEW YORK-Medicaid, +67375,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,FIDELIS CARE NEW YORK-Medicaid, +67376,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,FIDELIS CARE NEW YORK-Medicaid, +67377,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,FIDELIS CARE NEW YORK-Medicaid, +67378,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,FIDELIS CARE NEW YORK-Medicaid, +67379,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,FIDELIS CARE NEW YORK-Medicaid, +67380,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,FIDELIS CARE NEW YORK-Medicaid, +67381,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67382,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67383,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,FIDELIS CARE NEW YORK-Medicaid, +67384,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,FIDELIS CARE NEW YORK-Medicaid, +67385,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +67386,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,FIDELIS CARE NEW YORK-Medicaid, +67387,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,FIDELIS CARE NEW YORK-Medicaid, +67388,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,FIDELIS CARE NEW YORK-Medicaid, +67389,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,FIDELIS CARE NEW YORK-Medicaid, +67390,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,FIDELIS CARE NEW YORK-Medicaid, +67391,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,FIDELIS CARE NEW YORK-Medicaid, +67392,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,FIDELIS CARE NEW YORK-Medicaid, +67393,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,FIDELIS CARE NEW YORK-Medicaid, +67394,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,FIDELIS CARE NEW YORK-Medicaid, +67395,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,FIDELIS CARE NEW YORK-Medicaid, +67396,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,FIDELIS CARE NEW YORK-Medicaid, +67397,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,FIDELIS CARE NEW YORK-Medicaid, +67398,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,FIDELIS CARE NEW YORK-Medicaid, +67399,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,FIDELIS CARE NEW YORK-Medicaid, +67400,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,FIDELIS CARE NEW YORK-Medicaid, +67401,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,FIDELIS CARE NEW YORK-Medicaid, +67402,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,FIDELIS CARE NEW YORK-Medicaid, +67403,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,FIDELIS CARE NEW YORK-Medicaid, +67404,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,FIDELIS CARE NEW YORK-Medicaid, +67405,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,FIDELIS CARE NEW YORK-Medicaid, +67406,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,FIDELIS CARE NEW YORK-Medicaid, +67407,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,FIDELIS CARE NEW YORK-Medicaid, +67408,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,FIDELIS CARE NEW YORK-Medicaid, +67409,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67410,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,FIDELIS CARE NEW YORK-Medicaid, +67411,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,FIDELIS CARE NEW YORK-Medicaid, +67412,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67413,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,FIDELIS CARE NEW YORK-Medicaid, +67414,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,FIDELIS CARE NEW YORK-Medicaid, +67415,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,FIDELIS CARE NEW YORK-Medicaid, +67416,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,FIDELIS CARE NEW YORK-Medicaid, +67417,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,FIDELIS CARE NEW YORK-Medicaid, +67418,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,FIDELIS CARE NEW YORK-Medicaid, +67419,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,FIDELIS CARE NEW YORK-Medicaid, +67420,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,FIDELIS CARE NEW YORK-Medicaid, +67421,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,FIDELIS CARE NEW YORK-Medicaid, +67422,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,FIDELIS CARE NEW YORK-Medicaid, +67423,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,FIDELIS CARE NEW YORK-Medicaid, +67424,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67425,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,FIDELIS CARE NEW YORK-Medicaid, +67426,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,FIDELIS CARE NEW YORK-Medicaid, +67427,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,FIDELIS CARE NEW YORK-Medicaid, +67428,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,FIDELIS CARE NEW YORK-Medicaid, +67429,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,FIDELIS CARE NEW YORK-Medicaid, +67430,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,FIDELIS CARE NEW YORK-Medicaid, +67431,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,FIDELIS CARE NEW YORK-Medicaid, +67432,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,FIDELIS CARE NEW YORK-Medicaid, +67433,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,FIDELIS CARE NEW YORK-Medicaid, +67434,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67435,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,FIDELIS CARE NEW YORK-Medicaid, +67436,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,FIDELIS CARE NEW YORK-Medicaid, +67437,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,FIDELIS CARE NEW YORK-Medicaid, +67438,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,FIDELIS CARE NEW YORK-Medicaid, +67439,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67440,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,FIDELIS CARE NEW YORK-Medicaid, +67441,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67442,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,FIDELIS CARE NEW YORK-Medicaid, +67443,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,FIDELIS CARE NEW YORK-Medicaid, +67444,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,FIDELIS CARE NEW YORK-Medicaid, +67445,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,FIDELIS CARE NEW YORK-Medicaid, +67446,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67447,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,FIDELIS CARE NEW YORK-Medicaid, +67448,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,FIDELIS CARE NEW YORK-Medicaid, +67449,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,FIDELIS CARE NEW YORK-Medicaid, +67450,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,FIDELIS CARE NEW YORK-Medicaid, +67451,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,FIDELIS CARE NEW YORK-Medicaid, +67452,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,FIDELIS CARE NEW YORK-Medicaid, +67453,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,FIDELIS CARE NEW YORK-Medicaid, +67454,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,FIDELIS CARE NEW YORK-Medicaid, +67455,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,FIDELIS CARE NEW YORK-Medicaid, +67456,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,FIDELIS CARE NEW YORK-Medicaid, +67457,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,FIDELIS CARE NEW YORK-Medicaid, +67458,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,FIDELIS CARE NEW YORK-Medicaid, +67459,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,FIDELIS CARE NEW YORK-Medicaid, +67460,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,FIDELIS CARE NEW YORK-Medicaid, +67461,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,FIDELIS CARE NEW YORK-Medicaid, +67462,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,FIDELIS CARE NEW YORK-Medicaid, +67463,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,FIDELIS CARE NEW YORK-Medicaid, +67464,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,FIDELIS CARE NEW YORK-Medicaid, +67465,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,FIDELIS CARE NEW YORK-Medicaid, +67466,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,FIDELIS CARE NEW YORK-Medicaid, +67467,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,FIDELIS CARE NEW YORK-Medicaid, +67468,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,FIDELIS CARE NEW YORK-Medicaid, +67469,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,FIDELIS CARE NEW YORK-Medicaid, +67470,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,FIDELIS CARE NEW YORK-Medicaid, +67471,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67472,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,FIDELIS CARE NEW YORK-Medicaid, +67473,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,FIDELIS CARE NEW YORK-Medicaid, +67474,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,FIDELIS CARE NEW YORK-Medicaid, +67475,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,FIDELIS CARE NEW YORK-Medicaid, +67476,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67477,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,FIDELIS CARE NEW YORK-Medicaid, +67478,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,FIDELIS CARE NEW YORK-Medicaid, +67479,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,FIDELIS CARE NEW YORK-Medicaid, +67480,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,FIDELIS CARE NEW YORK-Medicaid, +67481,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,FIDELIS CARE NEW YORK-Medicaid, +67482,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,FIDELIS CARE NEW YORK-Medicaid, +67483,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,FIDELIS CARE NEW YORK-Medicaid, +67484,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,FIDELIS CARE NEW YORK-Medicaid, +67485,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,FIDELIS CARE NEW YORK-Medicaid, +67486,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,FIDELIS CARE NEW YORK-Medicaid, +67487,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,FIDELIS CARE NEW YORK-Medicaid, +67488,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,FIDELIS CARE NEW YORK-Medicaid, +67489,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,FIDELIS CARE NEW YORK-Medicaid, +67490,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,FIDELIS CARE NEW YORK-Medicaid, +67491,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,FIDELIS CARE NEW YORK-Medicaid, +67492,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,FIDELIS CARE NEW YORK-Medicaid, +67493,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,FIDELIS CARE NEW YORK-Medicaid, +67494,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,FIDELIS CARE NEW YORK-Medicaid, +67495,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,FIDELIS CARE NEW YORK-Medicaid, +67496,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,FIDELIS CARE NEW YORK-Medicaid, +67497,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,FIDELIS CARE NEW YORK-Medicaid, +67498,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,FIDELIS CARE NEW YORK-Medicaid, +67499,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,FIDELIS CARE NEW YORK-Medicaid, +67500,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,FIDELIS CARE NEW YORK-Medicaid, +67501,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,FIDELIS CARE NEW YORK-Medicaid, +67502,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,FIDELIS CARE NEW YORK-Medicaid, +67503,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,FIDELIS CARE NEW YORK-Medicaid, +67504,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,FIDELIS CARE NEW YORK-Medicaid, +67505,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,FIDELIS CARE NEW YORK-Medicaid, +67506,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,FIDELIS CARE NEW YORK-Medicaid, +67507,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,FIDELIS CARE NEW YORK-Medicaid, +67508,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,FIDELIS CARE NEW YORK-Medicaid, +67509,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,FIDELIS CARE NEW YORK-Medicaid, +67510,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,FIDELIS CARE NEW YORK-Medicaid, +67511,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,FIDELIS CARE NEW YORK-Medicaid, +67512,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,FIDELIS CARE NEW YORK-Medicaid, +67513,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,FIDELIS CARE NEW YORK-Medicaid, +67514,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,FIDELIS CARE NEW YORK-Medicaid, +67515,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,FIDELIS CARE NEW YORK-Medicaid, +67516,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,FIDELIS CARE NEW YORK-Medicaid, +67517,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,FIDELIS CARE NEW YORK-Medicaid, +67518,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,FIDELIS CARE NEW YORK-Medicaid, +67519,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,FIDELIS CARE NEW YORK-Medicaid, +67520,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,FIDELIS CARE NEW YORK-Medicaid, +67521,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,FIDELIS CARE NEW YORK-Medicaid, +67522,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +67523,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,FIDELIS CARE NEW YORK-Medicaid, +67524,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,FIDELIS CARE NEW YORK-Medicaid, +67525,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67526,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,FIDELIS CARE NEW YORK-Medicaid, +67527,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +67528,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +67529,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,FIDELIS CARE NEW YORK-Medicaid, +67530,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,FIDELIS CARE NEW YORK-Medicaid, +67531,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,FIDELIS CARE NEW YORK-Medicaid, +67532,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,FIDELIS CARE NEW YORK-Medicaid, +67533,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,FIDELIS CARE NEW YORK-Medicaid, +67534,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,FIDELIS CARE NEW YORK-Medicaid, +67535,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,FIDELIS CARE NEW YORK-Medicaid, +67536,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,FIDELIS CARE NEW YORK-Medicaid, +67537,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,FIDELIS CARE NEW YORK-Medicaid, +67538,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,FIDELIS CARE NEW YORK-Medicaid, +67539,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,FIDELIS CARE NEW YORK-Medicaid, +67540,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,FIDELIS CARE NEW YORK-Medicaid, +67541,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,FIDELIS CARE NEW YORK-Medicaid, +67542,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,FIDELIS CARE NEW YORK-Medicaid, +67543,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,FIDELIS CARE NEW YORK-Medicaid, +67544,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,FIDELIS CARE NEW YORK-Medicaid, +67545,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,FIDELIS CARE NEW YORK-Medicaid, +67546,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,FIDELIS CARE NEW YORK-Medicaid, +67547,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,FIDELIS CARE NEW YORK-Medicaid, +67548,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,FIDELIS CARE NEW YORK-Medicaid, +67549,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,FIDELIS CARE NEW YORK-Medicaid, +67550,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,FIDELIS CARE NEW YORK-Medicaid, +67551,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,FIDELIS CARE NEW YORK-Medicaid, +67552,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,FIDELIS CARE NEW YORK-Medicaid, +67553,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,FIDELIS CARE NEW YORK-Medicaid, +67554,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,FIDELIS CARE NEW YORK-Medicaid, +67555,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,FIDELIS CARE NEW YORK-Medicaid, +67556,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,FIDELIS CARE NEW YORK-Medicaid, +67557,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67558,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,FIDELIS CARE NEW YORK-Medicaid, +67559,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,FIDELIS CARE NEW YORK-Medicaid, +67560,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,FIDELIS CARE NEW YORK-Medicaid, +67561,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67562,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,FIDELIS CARE NEW YORK-Medicaid, +67563,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,FIDELIS CARE NEW YORK-Medicaid, +67564,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +67565,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,FIDELIS CARE NEW YORK-Medicaid, +67566,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,FIDELIS CARE NEW YORK-Medicaid, +67567,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,FIDELIS CARE NEW YORK-Medicaid, +67568,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,FIDELIS CARE NEW YORK-Medicaid, +67569,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,FIDELIS CARE NEW YORK-Medicaid, +67570,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,FIDELIS CARE NEW YORK-Medicaid, +67571,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,FIDELIS CARE NEW YORK-Medicaid, +67572,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,FIDELIS CARE NEW YORK-Medicaid, +67573,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,FIDELIS CARE NEW YORK-Medicaid, +67574,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,FIDELIS CARE NEW YORK-Medicaid, +67575,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,FIDELIS CARE NEW YORK-Medicaid, +67576,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicaid, +67577,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,FIDELIS CARE NEW YORK-Medicaid, +67578,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,FIDELIS CARE NEW YORK-Medicaid, +67579,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,FIDELIS CARE NEW YORK-Medicaid, +67580,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,FIDELIS CARE NEW YORK-Medicaid, +67581,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,FIDELIS CARE NEW YORK-Medicaid, +67582,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,FIDELIS CARE NEW YORK-Medicaid, +67583,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,FIDELIS CARE NEW YORK-Medicaid, +67584,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,FIDELIS CARE NEW YORK-Medicaid, +67585,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,FIDELIS CARE NEW YORK-Medicaid, +67586,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,FIDELIS CARE NEW YORK-Medicaid, +67587,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,FIDELIS CARE NEW YORK-Medicaid, +67588,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,FIDELIS CARE NEW YORK-Medicaid, +67589,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,FIDELIS CARE NEW YORK-Medicaid, +67590,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,FIDELIS CARE NEW YORK-Medicaid, +67591,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,FIDELIS CARE NEW YORK-Medicaid, +67592,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,FIDELIS CARE NEW YORK-Medicaid, +67593,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,FIDELIS CARE NEW YORK-Medicaid, +67594,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,FIDELIS CARE NEW YORK-Medicaid, +67595,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,FIDELIS CARE NEW YORK-Medicaid, +67596,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,FIDELIS CARE NEW YORK-Medicaid, +67597,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,FIDELIS CARE NEW YORK-Medicaid, +67598,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,FIDELIS CARE NEW YORK-Medicaid, +67599,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,FIDELIS CARE NEW YORK-Medicaid, +67600,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67601,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,FIDELIS CARE NEW YORK-Medicaid, +67602,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67603,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,FIDELIS CARE NEW YORK-Medicaid, +67604,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,FIDELIS CARE NEW YORK-Medicaid, +67605,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,FIDELIS CARE NEW YORK-Medicaid, +67606,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,FIDELIS CARE NEW YORK-Medicaid, +67607,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,FIDELIS CARE NEW YORK-Medicaid, +67608,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,FIDELIS CARE NEW YORK-Medicaid, +67609,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,FIDELIS CARE NEW YORK-Medicaid, +67610,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,FIDELIS CARE NEW YORK-Medicaid, +67611,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,FIDELIS CARE NEW YORK-Medicaid, +67612,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,FIDELIS CARE NEW YORK-Medicaid, +67613,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,FIDELIS CARE NEW YORK-Medicaid, +67614,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,FIDELIS CARE NEW YORK-Medicaid, +67615,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,FIDELIS CARE NEW YORK-Medicaid, +67616,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,FIDELIS CARE NEW YORK-Medicaid, +67617,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,FIDELIS CARE NEW YORK-Medicaid, +67618,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,FIDELIS CARE NEW YORK-Medicaid, +67619,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,FIDELIS CARE NEW YORK-Medicaid, +67620,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,FIDELIS CARE NEW YORK-Medicaid, +67621,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,FIDELIS CARE NEW YORK-Medicaid, +67622,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,FIDELIS CARE NEW YORK-Medicaid, +67623,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,FIDELIS CARE NEW YORK-Medicaid, +67624,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,FIDELIS CARE NEW YORK-Medicaid, +67625,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,FIDELIS CARE NEW YORK-Medicaid, +67626,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,FIDELIS CARE NEW YORK-Medicaid, +67627,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,FIDELIS CARE NEW YORK-Medicaid, +67628,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,FIDELIS CARE NEW YORK-Medicaid, +67629,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67630,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,FIDELIS CARE NEW YORK-Medicaid, +67631,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,FIDELIS CARE NEW YORK-Medicaid, +67632,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,FIDELIS CARE NEW YORK-Medicaid, +67633,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,FIDELIS CARE NEW YORK-Medicaid, +67634,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,FIDELIS CARE NEW YORK-Medicaid, +67635,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,FIDELIS CARE NEW YORK-Medicaid, +67636,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,FIDELIS CARE NEW YORK-Medicaid, +67637,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,FIDELIS CARE NEW YORK-Medicaid, +67638,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,FIDELIS CARE NEW YORK-Medicaid, +67639,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,FIDELIS CARE NEW YORK-Medicaid, +67640,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +67641,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,FIDELIS CARE NEW YORK-Medicaid, +67642,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,FIDELIS CARE NEW YORK-Medicaid, +67643,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,FIDELIS CARE NEW YORK-Medicaid, +67644,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,FIDELIS CARE NEW YORK-Medicaid, +67645,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,FIDELIS CARE NEW YORK-Medicaid, +67646,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,FIDELIS CARE NEW YORK-Medicaid, +67647,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicaid, +67648,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,FIDELIS CARE NEW YORK-Medicaid, +67649,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,FIDELIS CARE NEW YORK-Medicaid, +67650,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,FIDELIS CARE NEW YORK-Medicaid, +67651,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,FIDELIS CARE NEW YORK-Medicaid, +67652,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,FIDELIS CARE NEW YORK-Medicaid, +67653,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,FIDELIS CARE NEW YORK-Medicaid, +67654,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,FIDELIS CARE NEW YORK-Medicaid, +67655,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,FIDELIS CARE NEW YORK-Medicaid, +67656,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,FIDELIS CARE NEW YORK-Medicaid, +67657,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,FIDELIS CARE NEW YORK-Medicaid, +67658,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,FIDELIS CARE NEW YORK-Medicaid, +67659,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,FIDELIS CARE NEW YORK-Medicaid, +67660,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,FIDELIS CARE NEW YORK-Medicaid, +67661,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,FIDELIS CARE NEW YORK-Medicaid, +67662,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,FIDELIS CARE NEW YORK-Medicaid, +67663,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,FIDELIS CARE NEW YORK-Medicaid, +67664,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,FIDELIS CARE NEW YORK-Medicaid, +67665,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,FIDELIS CARE NEW YORK-Medicaid, +67666,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,FIDELIS CARE NEW YORK-Medicaid, +67667,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,FIDELIS CARE NEW YORK-Medicaid, +67668,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,FIDELIS CARE NEW YORK-Medicaid, +67669,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,FIDELIS CARE NEW YORK-Medicaid, +67670,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,FIDELIS CARE NEW YORK-Medicaid, +67671,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,FIDELIS CARE NEW YORK-Medicaid, +67672,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,FIDELIS CARE NEW YORK-Medicaid, +67673,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,FIDELIS CARE NEW YORK-Medicaid, +67674,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,FIDELIS CARE NEW YORK-Medicaid, +67675,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,FIDELIS CARE NEW YORK-Medicaid, +67676,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,FIDELIS CARE NEW YORK-Medicaid, +67677,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,FIDELIS CARE NEW YORK-Medicaid, +67678,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,FIDELIS CARE NEW YORK-Medicaid, +67679,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,FIDELIS CARE NEW YORK-Medicaid, +67680,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,FIDELIS CARE NEW YORK-Medicaid, +67681,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,FIDELIS CARE NEW YORK-Medicaid, +67682,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,FIDELIS CARE NEW YORK-Medicaid, +67683,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,FIDELIS CARE NEW YORK-Medicaid, +67684,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,FIDELIS CARE NEW YORK-Medicaid, +67685,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicaid, +67686,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,FIDELIS CARE NEW YORK-Medicaid, +67687,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,FIDELIS CARE NEW YORK-Medicaid, +67688,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,FIDELIS CARE NEW YORK-Medicaid, +67689,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,FIDELIS CARE NEW YORK-Medicaid, +67690,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,FIDELIS CARE NEW YORK-Medicaid, +67691,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,FIDELIS CARE NEW YORK-Medicaid, +67692,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,FIDELIS CARE NEW YORK-Medicaid, +67693,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,FIDELIS CARE NEW YORK-Medicaid, +67694,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,FIDELIS CARE NEW YORK-Medicaid, +67695,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,FIDELIS CARE NEW YORK-Medicaid, +67696,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,FIDELIS CARE NEW YORK-Medicaid, +67697,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,FIDELIS CARE NEW YORK-Medicaid, +67698,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,FIDELIS CARE NEW YORK-Medicaid, +67699,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,FIDELIS CARE NEW YORK-Medicaid, +67700,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,FIDELIS CARE NEW YORK-Medicaid, +67701,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,FIDELIS CARE NEW YORK-Medicaid, +67702,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,FIDELIS CARE NEW YORK-Medicaid, +67703,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,FIDELIS CARE NEW YORK-Medicaid, +67704,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,FIDELIS CARE NEW YORK-Medicaid, +67705,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,FIDELIS CARE NEW YORK-Medicaid, +67706,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,FIDELIS CARE NEW YORK-Medicaid, +67707,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,FIDELIS CARE NEW YORK-Medicaid, +67708,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,FIDELIS CARE NEW YORK-Medicaid, +67709,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,FIDELIS CARE NEW YORK-Medicaid, +67710,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,FIDELIS CARE NEW YORK-Medicaid, +67711,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,FIDELIS CARE NEW YORK-Medicaid, +67712,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,FIDELIS CARE NEW YORK-Medicaid, +67713,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,FIDELIS CARE NEW YORK-Medicaid, +67714,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,FIDELIS CARE NEW YORK-Medicaid, +67715,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicaid, +67716,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,FIDELIS CARE NEW YORK-Medicaid, +67717,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,FIDELIS CARE NEW YORK-Medicaid, +67718,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,FIDELIS CARE NEW YORK-Medicaid, +67719,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,FIDELIS CARE NEW YORK-Medicaid, +67720,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,FIDELIS CARE NEW YORK-Medicaid, +67721,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,FIDELIS CARE NEW YORK-Medicaid, +67722,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,FIDELIS CARE NEW YORK-Medicaid, +67723,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,FIDELIS CARE NEW YORK-Medicaid, +67724,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,FIDELIS CARE NEW YORK-Medicaid, +67725,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,FIDELIS CARE NEW YORK-Medicaid, +67726,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,FIDELIS CARE NEW YORK-Medicaid, +67727,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,FIDELIS CARE NEW YORK-Medicaid, +67728,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,FIDELIS CARE NEW YORK-Medicaid, +67729,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,FIDELIS CARE NEW YORK-Medicaid, +67730,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,FIDELIS CARE NEW YORK-Medicaid, +67731,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,FIDELIS CARE NEW YORK-Medicaid, +67732,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,FIDELIS CARE NEW YORK-Medicaid, +67733,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,FIDELIS CARE NEW YORK-Medicaid, +67734,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,FIDELIS CARE NEW YORK-Medicaid, +67735,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,FIDELIS CARE NEW YORK-Medicaid, +67736,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67737,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,FIDELIS CARE NEW YORK-Medicaid, +67738,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicaid, +67739,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,FIDELIS CARE NEW YORK-Medicaid, +67740,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67741,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,FIDELIS CARE NEW YORK-Medicaid, +67742,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,FIDELIS CARE NEW YORK-Medicaid, +67743,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,FIDELIS CARE NEW YORK-Medicaid, +67744,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,FIDELIS CARE NEW YORK-Medicaid, +67745,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,FIDELIS CARE NEW YORK-Medicaid, +67746,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,FIDELIS CARE NEW YORK-Medicaid, +67747,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,FIDELIS CARE NEW YORK-Medicaid, +67748,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,FIDELIS CARE NEW YORK-Medicaid, +67749,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,FIDELIS CARE NEW YORK-Medicaid, +67750,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,FIDELIS CARE NEW YORK-Medicaid, +67751,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,FIDELIS CARE NEW YORK-Medicaid, +67752,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,FIDELIS CARE NEW YORK-Medicaid, +67753,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,FIDELIS CARE NEW YORK-Medicaid, +67754,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,FIDELIS CARE NEW YORK-Medicaid, +67755,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,FIDELIS CARE NEW YORK-Medicaid, +67756,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,FIDELIS CARE NEW YORK-Medicaid, +67757,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,FIDELIS CARE NEW YORK-Medicaid, +67758,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,FIDELIS CARE NEW YORK-Medicaid, +67759,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,FIDELIS CARE NEW YORK-Medicaid, +67760,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,FIDELIS CARE NEW YORK-Medicaid, +67761,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,FIDELIS CARE NEW YORK-Medicaid, +67762,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,FIDELIS CARE NEW YORK-Medicaid, +67763,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,FIDELIS CARE NEW YORK-Medicaid, +67764,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,FIDELIS CARE NEW YORK-Medicaid, +67765,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,FIDELIS CARE NEW YORK-Medicaid, +67766,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,FIDELIS CARE NEW YORK-Medicaid, +67767,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,FIDELIS CARE NEW YORK-Medicaid, +67768,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,FIDELIS CARE NEW YORK-Medicaid, +67769,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,FIDELIS CARE NEW YORK-Medicaid, +67770,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,FIDELIS CARE NEW YORK-Medicaid, +67771,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,FIDELIS CARE NEW YORK-Medicaid, +67772,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,FIDELIS CARE NEW YORK-Medicaid, +67773,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,FIDELIS CARE NEW YORK-Medicaid, +67774,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,FIDELIS CARE NEW YORK-Medicaid, +67775,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,FIDELIS CARE NEW YORK-Medicaid, +67776,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,FIDELIS CARE NEW YORK-Medicaid, +67777,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,FIDELIS CARE NEW YORK-Medicaid, +67778,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,FIDELIS CARE NEW YORK-Medicaid, +67779,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,FIDELIS CARE NEW YORK-Medicaid, +67780,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,FIDELIS CARE NEW YORK-Medicaid, +67781,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,FIDELIS CARE NEW YORK-Medicaid, +67782,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,FIDELIS CARE NEW YORK-Medicaid, +67783,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,FIDELIS CARE NEW YORK-Medicaid, +67784,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,FIDELIS CARE NEW YORK-Medicaid, +67785,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,FIDELIS CARE NEW YORK-Medicaid, +67786,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,FIDELIS CARE NEW YORK-Medicaid, +67787,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,FIDELIS CARE NEW YORK-Medicaid, +67788,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,FIDELIS CARE NEW YORK-Medicaid, +67789,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,FIDELIS CARE NEW YORK-Medicaid, +67790,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,FIDELIS CARE NEW YORK-Medicaid, +67791,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,FIDELIS CARE NEW YORK-Medicaid, +67792,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,FIDELIS CARE NEW YORK-Medicaid, +67793,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,FIDELIS CARE NEW YORK-Medicaid, +67794,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,FIDELIS CARE NEW YORK-Medicaid, +67795,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,FIDELIS CARE NEW YORK-Medicaid, +67796,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,FIDELIS CARE NEW YORK-Medicaid, +67797,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,FIDELIS CARE NEW YORK-Medicaid, +67798,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,FIDELIS CARE NEW YORK-Medicaid, +67799,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,FIDELIS CARE NEW YORK-Medicaid, +67800,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,FIDELIS CARE NEW YORK-Medicaid,558.72 +67801,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,FIDELIS CARE NEW YORK-Medicaid, +67802,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,FIDELIS CARE NEW YORK-Medicaid, +67803,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,FIDELIS CARE NEW YORK-Medicaid, +67804,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,FIDELIS CARE NEW YORK-Medicaid, +67805,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,FIDELIS CARE NEW YORK-Medicaid, +67806,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,FIDELIS CARE NEW YORK-Medicaid, +67807,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,FIDELIS CARE NEW YORK-Medicaid, +67808,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,FIDELIS CARE NEW YORK-Medicaid, +67809,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,FIDELIS CARE NEW YORK-Medicaid, +67810,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,FIDELIS CARE NEW YORK-Medicaid, +67811,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,FIDELIS CARE NEW YORK-Medicaid, +67812,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,FIDELIS CARE NEW YORK-Medicaid, +67813,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,FIDELIS CARE NEW YORK-Medicaid, +67814,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,FIDELIS CARE NEW YORK-Medicaid, +67815,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,FIDELIS CARE NEW YORK-Medicaid, +67816,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,FIDELIS CARE NEW YORK-Medicaid, +67817,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,FIDELIS CARE NEW YORK-Medicaid, +67818,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,FIDELIS CARE NEW YORK-Medicaid, +67819,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,FIDELIS CARE NEW YORK-Medicaid, +67820,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,FIDELIS CARE NEW YORK-Medicaid, +67821,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,FIDELIS CARE NEW YORK-Medicaid, +67822,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,FIDELIS CARE NEW YORK-Medicaid, +67823,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,FIDELIS CARE NEW YORK-Medicaid, +67824,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,FIDELIS CARE NEW YORK-Medicaid, +67825,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,FIDELIS CARE NEW YORK-Medicaid,96.69 +67826,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,FIDELIS CARE NEW YORK-Medicaid,96.69 +67827,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,FIDELIS CARE NEW YORK-Medicaid, +67828,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,FIDELIS CARE NEW YORK-Medicaid, +67829,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,FIDELIS CARE NEW YORK-Medicaid, +67830,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,FIDELIS CARE NEW YORK-Medicaid, +67831,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,FIDELIS CARE NEW YORK-Medicaid, +67832,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,FIDELIS CARE NEW YORK-Medicaid, +67833,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,FIDELIS CARE NEW YORK-Medicaid, +67834,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,FIDELIS CARE NEW YORK-Medicaid, +67835,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,FIDELIS CARE NEW YORK-Medicaid, +67836,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,FIDELIS CARE NEW YORK-Medicaid, +67837,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,FIDELIS CARE NEW YORK-Medicaid, +67838,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,FIDELIS CARE NEW YORK-Medicaid, +67839,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,FIDELIS CARE NEW YORK-Medicaid, +67840,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,FIDELIS CARE NEW YORK-Medicaid, +67841,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,FIDELIS CARE NEW YORK-Medicaid, +67842,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,FIDELIS CARE NEW YORK-Medicaid, +67843,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,FIDELIS CARE NEW YORK-Medicaid, +67844,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,FIDELIS CARE NEW YORK-Medicaid, +67845,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,FIDELIS CARE NEW YORK-Medicaid, +67846,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,FIDELIS CARE NEW YORK-Medicaid, +67847,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,FIDELIS CARE NEW YORK-Medicaid, +67848,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,FIDELIS CARE NEW YORK-Medicaid, +67849,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,FIDELIS CARE NEW YORK-Medicaid, +67850,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,FIDELIS CARE NEW YORK-Medicaid, +67851,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,FIDELIS CARE NEW YORK-Medicaid, +67852,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,FIDELIS CARE NEW YORK-Medicaid, +67853,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,FIDELIS CARE NEW YORK-Medicaid, +67854,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,FIDELIS CARE NEW YORK-Medicaid, +67855,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,FIDELIS CARE NEW YORK-Medicaid, +67856,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,FIDELIS CARE NEW YORK-Medicaid, +67857,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,FIDELIS CARE NEW YORK-Medicaid, +67858,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,FIDELIS CARE NEW YORK-Medicaid, +67859,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,FIDELIS CARE NEW YORK-Medicaid,135.78 +67860,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,FIDELIS CARE NEW YORK-Medicaid, +67861,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,FIDELIS CARE NEW YORK-Medicaid, +67862,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,FIDELIS CARE NEW YORK-Medicaid, +67863,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,FIDELIS CARE NEW YORK-Medicaid, +67864,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,FIDELIS CARE NEW YORK-Medicaid, +67865,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,FIDELIS CARE NEW YORK-Medicaid, +67866,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,FIDELIS CARE NEW YORK-Medicaid,282.33 +67867,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,FIDELIS CARE NEW YORK-Medicaid, +67868,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,FIDELIS CARE NEW YORK-Medicaid, +67869,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,FIDELIS CARE NEW YORK-Medicaid, +67870,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,FIDELIS CARE NEW YORK-Medicaid, +67871,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,FIDELIS CARE NEW YORK-Medicaid, +67872,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,FIDELIS CARE NEW YORK-Medicaid, +67873,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,FIDELIS CARE NEW YORK-Medicaid, +67874,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,FIDELIS CARE NEW YORK-Medicaid, +67875,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,FIDELIS CARE NEW YORK-Medicaid, +67876,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,FIDELIS CARE NEW YORK-Medicaid, +67877,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,FIDELIS CARE NEW YORK-Medicaid, +67878,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,FIDELIS CARE NEW YORK-Medicaid, +67879,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,FIDELIS CARE NEW YORK-Medicaid, +67880,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,FIDELIS CARE NEW YORK-Medicaid, +67881,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,FIDELIS CARE NEW YORK-Medicaid, +67882,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,FIDELIS CARE NEW YORK-Medicaid, +67883,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,FIDELIS CARE NEW YORK-Medicaid, +67884,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,FIDELIS CARE NEW YORK-Medicaid, +67885,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,FIDELIS CARE NEW YORK-Medicaid, +67886,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,FIDELIS CARE NEW YORK-Medicaid, +67887,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,FIDELIS CARE NEW YORK-Medicaid, +67888,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,FIDELIS CARE NEW YORK-Medicaid, +67889,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,FIDELIS CARE NEW YORK-Medicaid, +67890,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,FIDELIS CARE NEW YORK-Medicaid, +67891,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,FIDELIS CARE NEW YORK-Medicaid, +67892,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,FIDELIS CARE NEW YORK-Medicaid, +67893,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,FIDELIS CARE NEW YORK-Medicaid, +67894,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,FIDELIS CARE NEW YORK-Medicaid, +67895,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,FIDELIS CARE NEW YORK-Medicaid, +67896,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,FIDELIS CARE NEW YORK-Medicaid, +67897,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,FIDELIS CARE NEW YORK-Medicaid, +67898,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,FIDELIS CARE NEW YORK-Medicaid, +67899,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,FIDELIS CARE NEW YORK-Medicaid, +67900,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,FIDELIS CARE NEW YORK-Medicaid, +67901,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,FIDELIS CARE NEW YORK-Medicaid, +67902,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,FIDELIS CARE NEW YORK-Medicaid, +67903,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,FIDELIS CARE NEW YORK-Medicaid, +67904,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,FIDELIS CARE NEW YORK-Medicaid, +67905,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,FIDELIS CARE NEW YORK-Medicaid, +67906,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,FIDELIS CARE NEW YORK-Medicaid, +67907,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,FIDELIS CARE NEW YORK-Medicaid, +67908,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,FIDELIS CARE NEW YORK-Medicaid, +67909,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,FIDELIS CARE NEW YORK-Medicaid, +67910,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,FIDELIS CARE NEW YORK-Medicaid, +67911,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,FIDELIS CARE NEW YORK-Medicaid, +67912,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,FIDELIS CARE NEW YORK-Medicaid, +67913,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,FIDELIS CARE NEW YORK-Medicaid, +67914,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,FIDELIS CARE NEW YORK-Medicaid, +67915,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,FIDELIS CARE NEW YORK-Medicaid, +67916,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,FIDELIS CARE NEW YORK-Medicaid, +67917,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,FIDELIS CARE NEW YORK-Medicaid,96.69 +67918,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,FIDELIS CARE NEW YORK-Medicaid, +67919,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,FIDELIS CARE NEW YORK-Medicaid, +67920,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,FIDELIS CARE NEW YORK-Medicaid, +67921,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,FIDELIS CARE NEW YORK-Medicaid, +67922,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,FIDELIS CARE NEW YORK-Medicaid, +67923,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,FIDELIS CARE NEW YORK-Medicaid, +67924,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,FIDELIS CARE NEW YORK-Medicaid, +67925,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,FIDELIS CARE NEW YORK-Medicaid, +67926,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,FIDELIS CARE NEW YORK-Medicaid, +67927,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,FIDELIS CARE NEW YORK-Medicaid, +67928,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,FIDELIS CARE NEW YORK-Medicaid, +67929,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,FIDELIS CARE NEW YORK-Medicaid, +67930,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,FIDELIS CARE NEW YORK-Medicaid, +67931,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,FIDELIS CARE NEW YORK-Medicaid, +67932,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,FIDELIS CARE NEW YORK-Medicaid, +67933,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,FIDELIS CARE NEW YORK-Medicaid, +67934,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,FIDELIS CARE NEW YORK-Medicaid, +67935,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,FIDELIS CARE NEW YORK-Medicaid, +67936,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,FIDELIS CARE NEW YORK-Medicaid, +67937,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,FIDELIS CARE NEW YORK-Medicaid, +67938,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,FIDELIS CARE NEW YORK-Medicaid,462.61 +67939,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,FIDELIS CARE NEW YORK-Medicaid, +67940,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,FIDELIS CARE NEW YORK-Medicaid, +67941,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,FIDELIS CARE NEW YORK-Medicaid, +67942,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,FIDELIS CARE NEW YORK-Medicaid, +67943,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,FIDELIS CARE NEW YORK-Medicaid, +67944,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,FIDELIS CARE NEW YORK-Medicaid, +67945,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,FIDELIS CARE NEW YORK-Medicaid, +67946,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,FIDELIS CARE NEW YORK-Medicaid, +67947,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,FIDELIS CARE NEW YORK-Medicaid, +67948,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,FIDELIS CARE NEW YORK-Medicaid, +67949,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,FIDELIS CARE NEW YORK-Medicaid, +67950,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,FIDELIS CARE NEW YORK-Medicaid, +67951,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,FIDELIS CARE NEW YORK-Medicaid, +67952,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,FIDELIS CARE NEW YORK-Medicaid, +67953,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,FIDELIS CARE NEW YORK-Medicaid, +67954,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,FIDELIS CARE NEW YORK-Medicaid, +67955,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,FIDELIS CARE NEW YORK-Medicaid, +67956,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,FIDELIS CARE NEW YORK-Medicaid, +67957,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,FIDELIS CARE NEW YORK-Medicaid, +67958,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,FIDELIS CARE NEW YORK-Medicaid, +67959,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,FIDELIS CARE NEW YORK-Medicaid, +67960,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,FIDELIS CARE NEW YORK-Medicaid, +67961,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,FIDELIS CARE NEW YORK-Medicaid, +67962,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,FIDELIS CARE NEW YORK-Medicaid, +67963,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,FIDELIS CARE NEW YORK-Medicaid, +67964,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,FIDELIS CARE NEW YORK-Medicaid, +67965,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,FIDELIS CARE NEW YORK-Medicaid, +67966,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,FIDELIS CARE NEW YORK-Medicaid, +67967,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,FIDELIS CARE NEW YORK-Medicaid, +67968,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,FIDELIS CARE NEW YORK-Medicaid,220.76 +67969,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,FIDELIS CARE NEW YORK-Medicaid, +67970,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,FIDELIS CARE NEW YORK-Medicaid, +67971,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,FIDELIS CARE NEW YORK-Medicaid, +67972,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,FIDELIS CARE NEW YORK-Medicaid, +67973,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,FIDELIS CARE NEW YORK-Medicaid, +67974,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,FIDELIS CARE NEW YORK-Medicaid, +67975,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,FIDELIS CARE NEW YORK-Medicaid, +67976,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,FIDELIS CARE NEW YORK-Medicaid, +67977,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,FIDELIS CARE NEW YORK-Medicaid, +67978,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,FIDELIS CARE NEW YORK-Medicaid, +67979,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,FIDELIS CARE NEW YORK-Medicaid, +67980,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,FIDELIS CARE NEW YORK-Medicaid, +67981,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,FIDELIS CARE NEW YORK-Medicaid, +67982,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,FIDELIS CARE NEW YORK-Medicaid, +67983,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,FIDELIS CARE NEW YORK-Medicaid, +67984,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,FIDELIS CARE NEW YORK-Medicaid, +67985,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,FIDELIS CARE NEW YORK-Medicaid, +67986,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,FIDELIS CARE NEW YORK-Medicaid, +67987,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,FIDELIS CARE NEW YORK-Medicaid, +67988,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,FIDELIS CARE NEW YORK-Medicaid, +67989,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,FIDELIS CARE NEW YORK-Medicaid, +67990,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,FIDELIS CARE NEW YORK-Medicaid, +67991,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,FIDELIS CARE NEW YORK-Medicaid, +67992,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,FIDELIS CARE NEW YORK-Medicaid, +67993,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,FIDELIS CARE NEW YORK-Medicaid, +67994,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,FIDELIS CARE NEW YORK-Medicaid, +67995,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,FIDELIS CARE NEW YORK-Medicaid, +67996,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,FIDELIS CARE NEW YORK-Medicaid, +67997,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,FIDELIS CARE NEW YORK-Medicaid, +67998,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,FIDELIS CARE NEW YORK-Medicaid, +67999,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,FIDELIS CARE NEW YORK-Medicaid, +68000,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,FIDELIS CARE NEW YORK-Medicaid, +68001,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,FIDELIS CARE NEW YORK-Medicaid, +68002,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,FIDELIS CARE NEW YORK-Medicaid, +68003,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,FIDELIS CARE NEW YORK-Medicaid, +68004,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,FIDELIS CARE NEW YORK-Medicaid, +68005,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,FIDELIS CARE NEW YORK-Medicaid, +68006,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,FIDELIS CARE NEW YORK-Medicaid, +68007,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,FIDELIS CARE NEW YORK-Medicaid, +68008,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,FIDELIS CARE NEW YORK-Medicaid, +68009,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,FIDELIS CARE NEW YORK-Medicaid, +68010,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,FIDELIS CARE NEW YORK-Medicaid, +68011,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,FIDELIS CARE NEW YORK-Medicaid, +68012,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,FIDELIS CARE NEW YORK-Medicaid, +68013,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,FIDELIS CARE NEW YORK-Medicaid, +68014,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,FIDELIS CARE NEW YORK-Medicaid, +68015,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,FIDELIS CARE NEW YORK-Medicaid, +68016,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,FIDELIS CARE NEW YORK-Medicaid, +68017,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,FIDELIS CARE NEW YORK-Medicaid, +68018,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,FIDELIS CARE NEW YORK-Medicaid, +68019,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,FIDELIS CARE NEW YORK-Medicaid, +68020,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,FIDELIS CARE NEW YORK-Medicaid, +68021,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,FIDELIS CARE NEW YORK-Medicaid, +68022,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,FIDELIS CARE NEW YORK-Medicaid, +68023,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,FIDELIS CARE NEW YORK-Medicaid, +68024,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,FIDELIS CARE NEW YORK-Medicaid, +68025,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,FIDELIS CARE NEW YORK-Medicaid, +68026,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,FIDELIS CARE NEW YORK-Medicaid, +68027,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,FIDELIS CARE NEW YORK-Medicaid, +68028,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,FIDELIS CARE NEW YORK-Medicaid, +68029,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,FIDELIS CARE NEW YORK-Medicaid, +68030,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,FIDELIS CARE NEW YORK-Medicaid, +68031,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,FIDELIS CARE NEW YORK-Medicaid, +68032,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,FIDELIS CARE NEW YORK-Medicaid, +68033,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,FIDELIS CARE NEW YORK-Medicaid, +68034,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,FIDELIS CARE NEW YORK-Medicaid, +68035,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,FIDELIS CARE NEW YORK-Medicaid, +68036,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,FIDELIS CARE NEW YORK-Medicaid, +68037,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,FIDELIS CARE NEW YORK-Medicaid, +68038,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,FIDELIS CARE NEW YORK-Medicaid, +68039,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,FIDELIS CARE NEW YORK-Medicaid, +68040,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,FIDELIS CARE NEW YORK-Medicaid, +68041,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,FIDELIS CARE NEW YORK-Medicaid, +68042,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,FIDELIS CARE NEW YORK-Medicaid, +68043,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,FIDELIS CARE NEW YORK-Medicaid, +68044,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,FIDELIS CARE NEW YORK-Medicaid, +68045,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,FIDELIS CARE NEW YORK-Medicaid, +68046,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,FIDELIS CARE NEW YORK-Medicaid, +68047,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,FIDELIS CARE NEW YORK-Medicaid, +68048,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,FIDELIS CARE NEW YORK-Medicaid, +68049,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,FIDELIS CARE NEW YORK-Medicaid, +68050,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,FIDELIS CARE NEW YORK-Medicaid, +68051,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,FIDELIS CARE NEW YORK-Medicaid, +68052,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,FIDELIS CARE NEW YORK-Medicaid, +68053,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,FIDELIS CARE NEW YORK-Medicaid, +68054,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,FIDELIS CARE NEW YORK-Medicaid, +68055,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,FIDELIS CARE NEW YORK-Medicaid, +68056,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,FIDELIS CARE NEW YORK-Medicaid, +68057,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,FIDELIS CARE NEW YORK-Medicaid, +68058,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,FIDELIS CARE NEW YORK-Medicaid, +68059,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,FIDELIS CARE NEW YORK-Medicaid, +68060,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,FIDELIS CARE NEW YORK-Medicaid, +68061,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,FIDELIS CARE NEW YORK-Medicaid, +68062,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,FIDELIS CARE NEW YORK-Medicaid, +68063,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,FIDELIS CARE NEW YORK-Medicaid, +68064,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,FIDELIS CARE NEW YORK-Medicaid, +68065,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,FIDELIS CARE NEW YORK-Medicaid, +68066,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,FIDELIS CARE NEW YORK-Medicaid, +68067,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,FIDELIS CARE NEW YORK-Medicaid, +68068,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,FIDELIS CARE NEW YORK-Medicaid, +68069,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,FIDELIS CARE NEW YORK-Medicaid, +68070,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,FIDELIS CARE NEW YORK-Medicaid, +68071,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,FIDELIS CARE NEW YORK-Medicaid, +68072,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,FIDELIS CARE NEW YORK-Medicaid, +68073,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,FIDELIS CARE NEW YORK-Medicaid, +68074,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,FIDELIS CARE NEW YORK-Medicaid, +68075,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,FIDELIS CARE NEW YORK-Medicaid, +68076,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,FIDELIS CARE NEW YORK-Medicaid, +68077,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,FIDELIS CARE NEW YORK-Medicaid, +68078,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,FIDELIS CARE NEW YORK-Medicaid, +68079,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,FIDELIS CARE NEW YORK-Medicaid, +68080,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,FIDELIS CARE NEW YORK-Medicaid, +68081,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,FIDELIS CARE NEW YORK-Medicaid, +68082,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,FIDELIS CARE NEW YORK-Medicaid, +68083,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,FIDELIS CARE NEW YORK-Medicaid, +68084,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,FIDELIS CARE NEW YORK-Medicaid, +68085,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,FIDELIS CARE NEW YORK-Medicaid, +68086,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,FIDELIS CARE NEW YORK-Medicaid, +68087,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,FIDELIS CARE NEW YORK-Medicaid, +68088,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,FIDELIS CARE NEW YORK-Medicaid, +68089,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,FIDELIS CARE NEW YORK-Medicaid, +68090,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,FIDELIS CARE NEW YORK-Medicaid, +68091,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,FIDELIS CARE NEW YORK-Medicaid, +68092,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,FIDELIS CARE NEW YORK-Medicaid, +68093,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,FIDELIS CARE NEW YORK-Medicaid, +68094,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,FIDELIS CARE NEW YORK-Medicaid, +68095,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,FIDELIS CARE NEW YORK-Medicaid, +68096,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,FIDELIS CARE NEW YORK-Medicaid, +68097,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,FIDELIS CARE NEW YORK-Medicaid, +68098,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,FIDELIS CARE NEW YORK-Medicaid, +68099,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,FIDELIS CARE NEW YORK-Medicaid, +68100,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,FIDELIS CARE NEW YORK-Medicaid, +68101,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,FIDELIS CARE NEW YORK-Medicaid, +68102,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,FIDELIS CARE NEW YORK-Medicaid, +68103,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,FIDELIS CARE NEW YORK-Medicaid, +68104,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,FIDELIS CARE NEW YORK-Medicaid, +68105,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,FIDELIS CARE NEW YORK-Medicaid, +68106,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,FIDELIS CARE NEW YORK-Medicaid, +68107,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,FIDELIS CARE NEW YORK-Medicaid, +68108,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,FIDELIS CARE NEW YORK-Medicaid, +68109,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,FIDELIS CARE NEW YORK-Medicaid, +68110,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,FIDELIS CARE NEW YORK-Medicaid, +68111,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,FIDELIS CARE NEW YORK-Medicaid, +68112,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,FIDELIS CARE NEW YORK-Medicaid, +68113,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,FIDELIS CARE NEW YORK-Medicaid, +68114,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,FIDELIS CARE NEW YORK-Medicaid, +68115,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,FIDELIS CARE NEW YORK-Medicaid, +68116,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,FIDELIS CARE NEW YORK-Medicaid, +68117,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,FIDELIS CARE NEW YORK-Medicaid, +68118,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,FIDELIS CARE NEW YORK-Medicaid, +68119,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,FIDELIS CARE NEW YORK-Medicaid, +68120,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,FIDELIS CARE NEW YORK-Medicaid, +68121,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,FIDELIS CARE NEW YORK-Medicaid, +68122,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,FIDELIS CARE NEW YORK-Medicaid, +68123,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,FIDELIS CARE NEW YORK-Medicaid, +68124,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,FIDELIS CARE NEW YORK-Medicaid, +68125,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,FIDELIS CARE NEW YORK-Medicaid, +68126,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,FIDELIS CARE NEW YORK-Medicaid, +68127,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,FIDELIS CARE NEW YORK-Medicaid, +68128,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,FIDELIS CARE NEW YORK-Medicaid, +68129,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,FIDELIS CARE NEW YORK-Medicaid, +68130,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,FIDELIS CARE NEW YORK-Medicaid, +68131,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,FIDELIS CARE NEW YORK-Medicaid, +68132,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,FIDELIS CARE NEW YORK-Medicaid, +68133,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,FIDELIS CARE NEW YORK-Medicaid, +68134,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,FIDELIS CARE NEW YORK-Medicaid, +68135,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,FIDELIS CARE NEW YORK-Medicaid, +68136,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,FIDELIS CARE NEW YORK-Medicaid, +68137,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,FIDELIS CARE NEW YORK-Medicaid, +68138,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +68139,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,FIDELIS CARE NEW YORK-Medicaid,13.39 +68140,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,FIDELIS CARE NEW YORK-Medicaid, +68141,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,FIDELIS CARE NEW YORK-Medicaid, +68142,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,FIDELIS CARE NEW YORK-Medicaid, +68143,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,FIDELIS CARE NEW YORK-Medicaid, +68144,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,FIDELIS CARE NEW YORK-Medicaid, +68145,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,FIDELIS CARE NEW YORK-Medicaid, +68146,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,FIDELIS CARE NEW YORK-Medicaid, +68147,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,FIDELIS CARE NEW YORK-Medicaid, +68148,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,FIDELIS CARE NEW YORK-Medicaid, +68149,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,FIDELIS CARE NEW YORK-Medicaid, +68150,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,FIDELIS CARE NEW YORK-Medicaid, +68151,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,FIDELIS CARE NEW YORK-Medicaid, +68152,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,FIDELIS CARE NEW YORK-Medicaid, +68153,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,FIDELIS CARE NEW YORK-Medicaid, +68154,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,FIDELIS CARE NEW YORK-Medicaid, +68155,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,FIDELIS CARE NEW YORK-Medicaid, +68156,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,FIDELIS CARE NEW YORK-Medicaid, +68157,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,FIDELIS CARE NEW YORK-Medicaid, +68158,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,FIDELIS CARE NEW YORK-Medicaid, +68159,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,FIDELIS CARE NEW YORK-Medicaid, +68160,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,FIDELIS CARE NEW YORK-Medicaid, +68161,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,FIDELIS CARE NEW YORK-Medicaid, +68162,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,FIDELIS CARE NEW YORK-Medicaid, +68163,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,FIDELIS CARE NEW YORK-Medicaid, +68164,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,FIDELIS CARE NEW YORK-Medicaid, +68165,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,FIDELIS CARE NEW YORK-Medicaid, +68166,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,FIDELIS CARE NEW YORK-Medicaid, +68167,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,FIDELIS CARE NEW YORK-Medicaid, +68168,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,FIDELIS CARE NEW YORK-Medicaid, +68169,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,FIDELIS CARE NEW YORK-Medicaid, +68170,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,FIDELIS CARE NEW YORK-Medicaid, +68171,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,FIDELIS CARE NEW YORK-Medicaid, +68172,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,FIDELIS CARE NEW YORK-Medicaid, +68173,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,FIDELIS CARE NEW YORK-Medicaid, +68174,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,FIDELIS CARE NEW YORK-Medicaid, +68175,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,FIDELIS CARE NEW YORK-Medicaid, +68176,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,FIDELIS CARE NEW YORK-Medicaid, +68177,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicaid, +68178,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,FIDELIS CARE NEW YORK-Medicaid, +68179,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,FIDELIS CARE NEW YORK-Medicaid, +68180,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,FIDELIS CARE NEW YORK-Medicaid, +68181,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,FIDELIS CARE NEW YORK-Medicaid, +68182,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicaid, +68183,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,FIDELIS CARE NEW YORK-Medicaid, +68184,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicaid, +68185,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,FIDELIS CARE NEW YORK-Medicaid, +68186,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicaid, +68187,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicaid, +68188,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicaid, +68189,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,FIDELIS CARE NEW YORK-Medicaid, +68190,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,FIDELIS CARE NEW YORK-Medicaid, +68191,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,FIDELIS CARE NEW YORK-Medicaid, +68192,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +68193,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,FIDELIS CARE NEW YORK-Medicaid, +68194,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,FIDELIS CARE NEW YORK-Medicaid, +68195,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,FIDELIS CARE NEW YORK-Medicaid, +68196,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,FIDELIS CARE NEW YORK-Medicaid, +68197,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,FIDELIS CARE NEW YORK-Medicaid, +68198,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,FIDELIS CARE NEW YORK-Medicaid, +68199,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,FIDELIS CARE NEW YORK-Medicaid, +68200,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,FIDELIS CARE NEW YORK-Medicaid, +68201,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,FIDELIS CARE NEW YORK-Medicaid, +68202,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,FIDELIS CARE NEW YORK-Medicaid, +68203,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,FIDELIS CARE NEW YORK-Medicaid, +68204,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,FIDELIS CARE NEW YORK-Medicaid, +68205,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,FIDELIS CARE NEW YORK-Medicaid, +68206,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,FIDELIS CARE NEW YORK-Medicaid, +68207,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,FIDELIS CARE NEW YORK-Medicaid, +68208,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,FIDELIS CARE NEW YORK-Medicaid, +68209,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,FIDELIS CARE NEW YORK-Medicaid, +68210,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,FIDELIS CARE NEW YORK-Medicaid, +68211,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,FIDELIS CARE NEW YORK-Medicaid, +68212,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,FIDELIS CARE NEW YORK-Medicaid, +68213,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,FIDELIS CARE NEW YORK-Medicaid, +68214,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,FIDELIS CARE NEW YORK-Medicaid, +68215,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,FIDELIS CARE NEW YORK-Medicaid, +68216,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,FIDELIS CARE NEW YORK-Medicaid, +68217,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,FIDELIS CARE NEW YORK-Medicaid, +68218,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,FIDELIS CARE NEW YORK-Medicaid, +68219,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,FIDELIS CARE NEW YORK-Medicaid, +68220,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,FIDELIS CARE NEW YORK-Medicaid, +68221,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,FIDELIS CARE NEW YORK-Medicaid, +68222,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,FIDELIS CARE NEW YORK-Medicaid, +68223,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,FIDELIS CARE NEW YORK-Medicaid, +68224,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,FIDELIS CARE NEW YORK-Medicaid, +68225,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,FIDELIS CARE NEW YORK-Medicaid, +68226,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,FIDELIS CARE NEW YORK-Medicaid, +68227,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,FIDELIS CARE NEW YORK-Medicaid, +68228,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,FIDELIS CARE NEW YORK-Medicaid, +68229,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,FIDELIS CARE NEW YORK-Medicaid, +68230,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,FIDELIS CARE NEW YORK-Medicaid, +68231,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,FIDELIS CARE NEW YORK-Medicaid, +68232,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,FIDELIS CARE NEW YORK-Medicaid, +68233,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,FIDELIS CARE NEW YORK-Medicaid, +68234,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,FIDELIS CARE NEW YORK-Medicaid, +68235,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,FIDELIS CARE NEW YORK-Medicaid, +68236,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,FIDELIS CARE NEW YORK-Medicaid, +68237,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,FIDELIS CARE NEW YORK-Medicaid, +68238,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,FIDELIS CARE NEW YORK-Medicaid, +68239,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,FIDELIS CARE NEW YORK-Medicaid, +68240,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,FIDELIS CARE NEW YORK-Medicaid, +68241,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,FIDELIS CARE NEW YORK-Medicaid, +68242,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,FIDELIS CARE NEW YORK-Medicaid, +68243,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,FIDELIS CARE NEW YORK-Medicaid, +68244,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,FIDELIS CARE NEW YORK-Medicaid, +68245,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,FIDELIS CARE NEW YORK-Medicaid, +68246,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,FIDELIS CARE NEW YORK-Medicaid, +68247,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,FIDELIS CARE NEW YORK-Medicaid, +68248,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,FIDELIS CARE NEW YORK-Medicaid, +68249,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,FIDELIS CARE NEW YORK-Medicaid, +68250,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,FIDELIS CARE NEW YORK-Medicaid, +68251,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,FIDELIS CARE NEW YORK-Medicaid, +68252,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,FIDELIS CARE NEW YORK-Medicaid, +68253,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,FIDELIS CARE NEW YORK-Medicaid, +68254,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,FIDELIS CARE NEW YORK-Medicaid, +68255,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,FIDELIS CARE NEW YORK-Medicaid, +68256,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,FIDELIS CARE NEW YORK-Medicaid, +68257,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,FIDELIS CARE NEW YORK-Medicaid, +68258,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,FIDELIS CARE NEW YORK-Medicaid, +68259,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,FIDELIS CARE NEW YORK-Medicaid, +68260,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,FIDELIS CARE NEW YORK-Medicaid, +68261,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,FIDELIS CARE NEW YORK-Medicaid, +68262,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,FIDELIS CARE NEW YORK-Medicaid, +68263,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,FIDELIS CARE NEW YORK-Medicaid, +68264,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,FIDELIS CARE NEW YORK-Medicaid, +68265,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,FIDELIS CARE NEW YORK-Medicaid, +68266,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,FIDELIS CARE NEW YORK-Medicaid, +68267,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,FIDELIS CARE NEW YORK-Medicaid, +68268,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,FIDELIS CARE NEW YORK-Medicaid, +68269,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,FIDELIS CARE NEW YORK-Medicaid, +68270,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,FIDELIS CARE NEW YORK-Medicaid, +68271,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,FIDELIS CARE NEW YORK-Medicaid, +68272,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,FIDELIS CARE NEW YORK-Medicaid, +68273,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,FIDELIS CARE NEW YORK-Medicaid, +68274,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,FIDELIS CARE NEW YORK-Medicaid, +68275,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,FIDELIS CARE NEW YORK-Medicaid, +68276,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,FIDELIS CARE NEW YORK-Medicaid, +68277,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,FIDELIS CARE NEW YORK-Medicaid, +68278,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,FIDELIS CARE NEW YORK-Medicaid, +68279,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,FIDELIS CARE NEW YORK-Medicaid, +68280,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,FIDELIS CARE NEW YORK-Medicaid, +68281,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,FIDELIS CARE NEW YORK-Medicaid, +68282,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,FIDELIS CARE NEW YORK-Medicaid, +68283,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,FIDELIS CARE NEW YORK-Medicaid, +68284,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,FIDELIS CARE NEW YORK-Medicaid, +68285,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,FIDELIS CARE NEW YORK-Medicaid, +68286,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,FIDELIS CARE NEW YORK-Medicaid, +68287,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,FIDELIS CARE NEW YORK-Medicaid, +68288,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,FIDELIS CARE NEW YORK-Medicaid, +68289,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,FIDELIS CARE NEW YORK-Medicaid, +68290,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,FIDELIS CARE NEW YORK-Medicaid, +68291,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,FIDELIS CARE NEW YORK-Medicaid, +68292,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,FIDELIS CARE NEW YORK-Medicaid, +68293,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,FIDELIS CARE NEW YORK-Medicaid, +68294,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,FIDELIS CARE NEW YORK-Medicaid, +68295,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,FIDELIS CARE NEW YORK-Medicaid, +68296,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,FIDELIS CARE NEW YORK-Medicaid, +68297,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,FIDELIS CARE NEW YORK-Medicaid, +68298,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,FIDELIS CARE NEW YORK-Medicaid, +68299,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,FIDELIS CARE NEW YORK-Medicaid, +68300,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,FIDELIS CARE NEW YORK-Medicaid, +68301,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,FIDELIS CARE NEW YORK-Medicaid, +68302,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,FIDELIS CARE NEW YORK-Medicaid, +68303,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,FIDELIS CARE NEW YORK-Medicaid, +68304,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,FIDELIS CARE NEW YORK-Medicaid, +68305,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,FIDELIS CARE NEW YORK-Medicaid, +68306,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,FIDELIS CARE NEW YORK-Medicaid, +68307,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,FIDELIS CARE NEW YORK-Medicaid, +68308,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,FIDELIS CARE NEW YORK-Medicaid, +68309,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,FIDELIS CARE NEW YORK-Medicaid, +68310,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,FIDELIS CARE NEW YORK-Medicaid, +68311,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,FIDELIS CARE NEW YORK-Medicaid, +68312,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,FIDELIS CARE NEW YORK-Medicaid, +68313,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,FIDELIS CARE NEW YORK-Medicaid, +68314,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,FIDELIS CARE NEW YORK-Medicaid, +68315,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,FIDELIS CARE NEW YORK-Medicaid, +68316,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,FIDELIS CARE NEW YORK-Medicaid, +68317,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,FIDELIS CARE NEW YORK-Medicaid, +68318,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,FIDELIS CARE NEW YORK-Medicaid, +68319,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,FIDELIS CARE NEW YORK-Medicaid, +68320,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,FIDELIS CARE NEW YORK-Medicaid, +68321,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,FIDELIS CARE NEW YORK-Medicaid, +68322,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,FIDELIS CARE NEW YORK-Medicaid, +68323,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,FIDELIS CARE NEW YORK-Medicaid, +68324,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,FIDELIS CARE NEW YORK-Medicaid, +68325,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,FIDELIS CARE NEW YORK-Medicaid, +68326,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,FIDELIS CARE NEW YORK-Medicaid, +68327,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,FIDELIS CARE NEW YORK-Medicaid, +68328,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,FIDELIS CARE NEW YORK-Medicaid, +68329,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,FIDELIS CARE NEW YORK-Medicaid, +68330,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,FIDELIS CARE NEW YORK-Medicaid, +68331,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,FIDELIS CARE NEW YORK-Medicaid, +68332,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,FIDELIS CARE NEW YORK-Medicaid, +68333,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,FIDELIS CARE NEW YORK-Medicaid, +68334,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,FIDELIS CARE NEW YORK-Medicaid, +68335,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,FIDELIS CARE NEW YORK-Medicaid, +68336,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,FIDELIS CARE NEW YORK-Medicaid, +68337,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,FIDELIS CARE NEW YORK-Medicaid, +68338,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,FIDELIS CARE NEW YORK-Medicaid, +68339,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,FIDELIS CARE NEW YORK-Medicaid, +68340,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,FIDELIS CARE NEW YORK-Medicaid, +68341,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,FIDELIS CARE NEW YORK-Medicaid, +68342,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,FIDELIS CARE NEW YORK-Medicaid, +68343,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,FIDELIS CARE NEW YORK-Medicaid, +68344,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,FIDELIS CARE NEW YORK-Medicaid, +68345,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,FIDELIS CARE NEW YORK-Medicaid, +68346,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,FIDELIS CARE NEW YORK-Medicaid, +68347,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,FIDELIS CARE NEW YORK-Medicaid, +68348,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,FIDELIS CARE NEW YORK-Medicaid, +68349,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,FIDELIS CARE NEW YORK-Medicaid, +68350,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,FIDELIS CARE NEW YORK-Medicaid, +68351,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,FIDELIS CARE NEW YORK-Medicaid, +68352,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,FIDELIS CARE NEW YORK-Medicaid, +68353,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,FIDELIS CARE NEW YORK-Medicaid, +68354,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,FIDELIS CARE NEW YORK-Medicaid, +68355,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,FIDELIS CARE NEW YORK-Medicaid, +68356,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,FIDELIS CARE NEW YORK-Medicaid, +68357,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,FIDELIS CARE NEW YORK-Medicaid, +68358,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,FIDELIS CARE NEW YORK-Medicaid, +68359,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,FIDELIS CARE NEW YORK-Medicaid, +68360,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,FIDELIS CARE NEW YORK-Medicaid, +68361,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,FIDELIS CARE NEW YORK-Medicaid, +68362,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,FIDELIS CARE NEW YORK-Medicaid, +68363,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,FIDELIS CARE NEW YORK-Medicaid, +68364,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,FIDELIS CARE NEW YORK-Medicaid, +68365,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,FIDELIS CARE NEW YORK-Medicaid, +68366,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,FIDELIS CARE NEW YORK-Medicaid, +68367,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,FIDELIS CARE NEW YORK-Medicaid, +68368,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,FIDELIS CARE NEW YORK-Medicaid, +68369,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,FIDELIS CARE NEW YORK-Medicaid, +68370,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,FIDELIS CARE NEW YORK-Medicaid, +68371,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,FIDELIS CARE NEW YORK-Medicaid, +68372,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,FIDELIS CARE NEW YORK-Medicaid, +68373,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,FIDELIS CARE NEW YORK-Medicaid, +68374,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,FIDELIS CARE NEW YORK-Medicaid, +68375,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,FIDELIS CARE NEW YORK-Medicaid, +68376,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,FIDELIS CARE NEW YORK-Medicaid, +68377,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,FIDELIS CARE NEW YORK-Medicaid, +68378,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,FIDELIS CARE NEW YORK-Medicaid, +68379,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,FIDELIS CARE NEW YORK-Medicaid, +68380,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,FIDELIS CARE NEW YORK-Medicaid, +68381,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,FIDELIS CARE NEW YORK-Medicaid, +68382,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,FIDELIS CARE NEW YORK-Medicaid, +68383,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,FIDELIS CARE NEW YORK-Medicaid, +68384,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,FIDELIS CARE NEW YORK-Medicaid, +68385,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,FIDELIS CARE NEW YORK-Medicaid, +68386,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,FIDELIS CARE NEW YORK-Medicaid, +68387,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,FIDELIS CARE NEW YORK-Medicaid, +68388,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,FIDELIS CARE NEW YORK-Medicaid, +68389,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,FIDELIS CARE NEW YORK-Medicaid, +68390,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,FIDELIS CARE NEW YORK-Medicaid, +68391,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,FIDELIS CARE NEW YORK-Medicaid, +68392,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,FIDELIS CARE NEW YORK-Medicaid, +68393,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,FIDELIS CARE NEW YORK-Medicaid, +68394,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,FIDELIS CARE NEW YORK-Medicaid, +68395,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,FIDELIS CARE NEW YORK-Medicaid, +68396,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,FIDELIS CARE NEW YORK-Medicaid, +68397,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,FIDELIS CARE NEW YORK-Medicaid, +68398,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,FIDELIS CARE NEW YORK-Medicaid, +68399,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,FIDELIS CARE NEW YORK-Medicaid, +68400,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,FIDELIS CARE NEW YORK-Medicaid, +68401,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,FIDELIS CARE NEW YORK-Medicaid, +68402,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,FIDELIS CARE NEW YORK-Medicaid, +68403,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,FIDELIS CARE NEW YORK-Medicaid, +68404,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,FIDELIS CARE NEW YORK-Medicaid, +68405,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,FIDELIS CARE NEW YORK-Medicaid, +68406,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,FIDELIS CARE NEW YORK-Medicaid, +68407,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,FIDELIS CARE NEW YORK-Medicaid, +68408,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,FIDELIS CARE NEW YORK-Medicaid, +68409,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,FIDELIS CARE NEW YORK-Medicaid, +68410,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,FIDELIS CARE NEW YORK-Medicaid, +68411,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,FIDELIS CARE NEW YORK-Medicaid, +68412,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,FIDELIS CARE NEW YORK-Medicaid, +68413,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,FIDELIS CARE NEW YORK-Medicaid, +68414,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,FIDELIS CARE NEW YORK-Medicaid, +68415,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,FIDELIS CARE NEW YORK-Medicaid, +68416,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,FIDELIS CARE NEW YORK-Medicaid, +68417,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,FIDELIS CARE NEW YORK-Medicaid, +68418,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,FIDELIS CARE NEW YORK-Medicaid, +68419,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,FIDELIS CARE NEW YORK-Medicaid, +68420,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,FIDELIS CARE NEW YORK-Medicaid, +68421,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,FIDELIS CARE NEW YORK-Medicaid, +68422,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,FIDELIS CARE NEW YORK-Medicaid, +68423,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,FIDELIS CARE NEW YORK-Medicaid, +68424,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,FIDELIS CARE NEW YORK-Medicaid, +68425,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,FIDELIS CARE NEW YORK-Medicaid, +68426,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,FIDELIS CARE NEW YORK-Medicaid, +68427,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,FIDELIS CARE NEW YORK-Medicaid, +68428,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,FIDELIS CARE NEW YORK-Medicaid, +68429,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,FIDELIS CARE NEW YORK-Medicaid, +68430,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,FIDELIS CARE NEW YORK-Medicaid, +68431,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,FIDELIS CARE NEW YORK-Medicaid, +68432,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,FIDELIS CARE NEW YORK-Medicaid, +68433,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,FIDELIS CARE NEW YORK-Medicaid, +68434,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,FIDELIS CARE NEW YORK-Medicaid, +68435,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,FIDELIS CARE NEW YORK-Medicaid, +68436,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,FIDELIS CARE NEW YORK-Medicaid, +68437,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,FIDELIS CARE NEW YORK-Medicaid, +68438,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,FIDELIS CARE NEW YORK-Medicaid, +68439,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,FIDELIS CARE NEW YORK-Medicaid, +68440,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,FIDELIS CARE NEW YORK-Medicaid, +68441,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,FIDELIS CARE NEW YORK-Medicaid, +68442,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,FIDELIS CARE NEW YORK-Medicaid, +68443,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,FIDELIS CARE NEW YORK-Medicaid, +68444,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,FIDELIS CARE NEW YORK-Medicaid, +68445,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,FIDELIS CARE NEW YORK-Medicaid, +68446,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,FIDELIS CARE NEW YORK-Medicaid, +68447,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,FIDELIS CARE NEW YORK-Medicaid, +68448,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,FIDELIS CARE NEW YORK-Medicaid, +68449,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,FIDELIS CARE NEW YORK-Medicaid, +68450,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,FIDELIS CARE NEW YORK-Medicaid, +68451,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,FIDELIS CARE NEW YORK-Medicaid, +68452,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,FIDELIS CARE NEW YORK-Medicaid, +68453,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,FIDELIS CARE NEW YORK-Medicaid, +68454,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,FIDELIS CARE NEW YORK-Medicaid, +68455,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,FIDELIS CARE NEW YORK-Medicaid, +68456,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,FIDELIS CARE NEW YORK-Medicaid, +68457,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,FIDELIS CARE NEW YORK-Medicaid, +68458,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,FIDELIS CARE NEW YORK-Medicaid, +68459,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,FIDELIS CARE NEW YORK-Medicaid, +68460,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,FIDELIS CARE NEW YORK-Medicaid, +68461,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,FIDELIS CARE NEW YORK-Medicaid, +68462,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,FIDELIS CARE NEW YORK-Medicaid, +68463,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,FIDELIS CARE NEW YORK-Medicaid, +68464,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,FIDELIS CARE NEW YORK-Medicaid, +68465,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,FIDELIS CARE NEW YORK-Medicaid, +68466,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,FIDELIS CARE NEW YORK-Medicaid, +68467,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,FIDELIS CARE NEW YORK-Medicaid, +68468,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,FIDELIS CARE NEW YORK-Medicaid, +68469,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,FIDELIS CARE NEW YORK-Medicaid, +68470,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,FIDELIS CARE NEW YORK-Medicaid, +68471,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,FIDELIS CARE NEW YORK-Medicaid, +68472,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,FIDELIS CARE NEW YORK-Medicaid, +68473,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,FIDELIS CARE NEW YORK-Medicaid, +68474,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,FIDELIS CARE NEW YORK-Medicaid, +68475,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,FIDELIS CARE NEW YORK-Medicaid, +68476,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,FIDELIS CARE NEW YORK-Medicaid, +68477,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,FIDELIS CARE NEW YORK-Medicaid, +68478,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,FIDELIS CARE NEW YORK-Medicaid, +68479,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,FIDELIS CARE NEW YORK-Medicaid, +68480,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,FIDELIS CARE NEW YORK-Medicaid, +68481,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,FIDELIS CARE NEW YORK-Medicaid, +68482,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,FIDELIS CARE NEW YORK-Medicaid, +68483,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,FIDELIS CARE NEW YORK-Medicaid, +68484,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,FIDELIS CARE NEW YORK-Medicaid, +68485,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,FIDELIS CARE NEW YORK-Medicaid, +68486,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,FIDELIS CARE NEW YORK-Medicaid, +68487,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,FIDELIS CARE NEW YORK-Medicaid, +68488,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,FIDELIS CARE NEW YORK-Medicaid, +68489,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,FIDELIS CARE NEW YORK-Medicaid, +68490,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,FIDELIS CARE NEW YORK-Medicaid, +68491,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,FIDELIS CARE NEW YORK-Medicaid, +68492,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,FIDELIS CARE NEW YORK-Medicaid, +68493,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,FIDELIS CARE NEW YORK-Medicaid, +68494,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,FIDELIS CARE NEW YORK-Medicaid, +68495,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,FIDELIS CARE NEW YORK-Medicaid, +68496,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,FIDELIS CARE NEW YORK-Medicaid, +68497,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,FIDELIS CARE NEW YORK-Medicaid, +68498,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,FIDELIS CARE NEW YORK-Medicaid, +68499,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,FIDELIS CARE NEW YORK-Medicaid, +68500,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,FIDELIS CARE NEW YORK-Medicaid, +68501,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,FIDELIS CARE NEW YORK-Medicaid, +68502,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,FIDELIS CARE NEW YORK-Medicaid, +68503,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,FIDELIS CARE NEW YORK-Medicaid, +68504,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,FIDELIS CARE NEW YORK-Medicaid, +68505,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,FIDELIS CARE NEW YORK-Medicaid, +68506,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,FIDELIS CARE NEW YORK-Medicaid, +68507,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,FIDELIS CARE NEW YORK-Medicaid, +68508,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,FIDELIS CARE NEW YORK-Medicaid, +68509,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,FIDELIS CARE NEW YORK-Medicaid, +68510,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,FIDELIS CARE NEW YORK-Medicaid, +68511,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,FIDELIS CARE NEW YORK-Medicaid, +68512,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,FIDELIS CARE NEW YORK-Medicaid, +68513,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,FIDELIS CARE NEW YORK-Medicaid, +68514,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,FIDELIS CARE NEW YORK-Medicaid, +68515,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,FIDELIS CARE NEW YORK-Medicaid, +68516,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,FIDELIS CARE NEW YORK-Medicaid, +68517,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,FIDELIS CARE NEW YORK-Medicaid, +68518,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,FIDELIS CARE NEW YORK-Medicaid, +68519,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,FIDELIS CARE NEW YORK-Medicaid, +68520,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,FIDELIS CARE NEW YORK-Medicaid, +68521,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,FIDELIS CARE NEW YORK-Medicaid, +68522,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,FIDELIS CARE NEW YORK-Medicaid, +68523,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,FIDELIS CARE NEW YORK-Medicaid, +68524,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,FIDELIS CARE NEW YORK-Medicaid, +68525,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,FIDELIS CARE NEW YORK-Medicaid, +68526,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,FIDELIS CARE NEW YORK-Medicaid, +68527,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,FIDELIS CARE NEW YORK-Medicaid, +68528,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,FIDELIS CARE NEW YORK-Medicaid, +68529,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,FIDELIS CARE NEW YORK-Medicaid, +68530,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,FIDELIS CARE NEW YORK-Medicaid, +68531,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,FIDELIS CARE NEW YORK-Medicaid, +68532,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,FIDELIS CARE NEW YORK-Medicaid, +68533,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,FIDELIS CARE NEW YORK-Medicaid, +68534,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,FIDELIS CARE NEW YORK-Medicaid, +68535,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,FIDELIS CARE NEW YORK-Medicaid, +68536,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,FIDELIS CARE NEW YORK-Medicaid, +68537,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,FIDELIS CARE NEW YORK-Medicaid, +68538,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,FIDELIS CARE NEW YORK-Medicaid, +68539,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,FIDELIS CARE NEW YORK-Medicaid, +68540,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,FIDELIS CARE NEW YORK-Medicaid, +68541,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,FIDELIS CARE NEW YORK-Medicaid, +68542,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,FIDELIS CARE NEW YORK-Medicaid, +68543,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,FIDELIS CARE NEW YORK-Medicaid, +68544,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,FIDELIS CARE NEW YORK-Medicaid, +68545,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,FIDELIS CARE NEW YORK-Medicaid, +68546,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,FIDELIS CARE NEW YORK-Medicaid, +68547,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,FIDELIS CARE NEW YORK-Medicaid, +68548,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,FIDELIS CARE NEW YORK-Medicaid, +68549,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,FIDELIS CARE NEW YORK-Medicaid, +68550,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,FIDELIS CARE NEW YORK-Medicaid, +68551,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,FIDELIS CARE NEW YORK-Medicaid, +68552,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,FIDELIS CARE NEW YORK-Medicaid, +68553,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,FIDELIS CARE NEW YORK-Medicaid, +68554,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,FIDELIS CARE NEW YORK-Medicaid, +68555,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,FIDELIS CARE NEW YORK-Medicaid, +68556,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,FIDELIS CARE NEW YORK-Medicaid, +68557,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,FIDELIS CARE NEW YORK-Medicaid, +68558,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,FIDELIS CARE NEW YORK-Medicaid, +68559,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,FIDELIS CARE NEW YORK-Medicaid, +68560,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,FIDELIS CARE NEW YORK-Medicaid, +68561,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,FIDELIS CARE NEW YORK-Medicaid, +68562,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,FIDELIS CARE NEW YORK-Medicaid, +68563,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,FIDELIS CARE NEW YORK-Medicaid, +68564,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,FIDELIS CARE NEW YORK-Medicaid, +68565,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,FIDELIS CARE NEW YORK-Medicaid, +68566,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,FIDELIS CARE NEW YORK-Medicaid, +68567,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,FIDELIS CARE NEW YORK-Medicaid, +68568,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,FIDELIS CARE NEW YORK-Medicaid, +68569,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,FIDELIS CARE NEW YORK-Medicaid, +68570,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,FIDELIS CARE NEW YORK-Medicaid, +68571,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,FIDELIS CARE NEW YORK-Medicaid, +68572,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,FIDELIS CARE NEW YORK-Medicaid, +68573,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,FIDELIS CARE NEW YORK-Medicaid, +68574,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,FIDELIS CARE NEW YORK-Medicaid, +68575,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,FIDELIS CARE NEW YORK-Medicaid, +68576,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,FIDELIS CARE NEW YORK-Medicaid, +68577,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,FIDELIS CARE NEW YORK-Medicaid, +68578,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,FIDELIS CARE NEW YORK-Medicaid, +68579,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,FIDELIS CARE NEW YORK-Medicaid, +68580,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,FIDELIS CARE NEW YORK-Medicaid, +68581,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,FIDELIS CARE NEW YORK-Medicaid, +68582,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,FIDELIS CARE NEW YORK-Medicaid, +68583,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,FIDELIS CARE NEW YORK-Medicaid, +68584,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,FIDELIS CARE NEW YORK-Medicaid, +68585,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,FIDELIS CARE NEW YORK-Medicaid, +68586,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,FIDELIS CARE NEW YORK-Medicaid, +68587,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,FIDELIS CARE NEW YORK-Medicaid, +68588,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,FIDELIS CARE NEW YORK-Medicaid, +68589,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,FIDELIS CARE NEW YORK-Medicaid, +68590,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,FIDELIS CARE NEW YORK-Medicaid, +68591,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,FIDELIS CARE NEW YORK-Medicaid, +68592,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,FIDELIS CARE NEW YORK-Medicaid, +68593,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,FIDELIS CARE NEW YORK-Medicaid, +68594,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,FIDELIS CARE NEW YORK-Medicaid, +68595,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,FIDELIS CARE NEW YORK-Medicaid, +68596,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,FIDELIS CARE NEW YORK-Medicaid, +68597,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,FIDELIS CARE NEW YORK-Medicaid, +68598,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,FIDELIS CARE NEW YORK-Medicaid, +68599,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,FIDELIS CARE NEW YORK-Medicaid, +68600,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,FIDELIS CARE NEW YORK-Medicaid, +68601,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,FIDELIS CARE NEW YORK-Medicaid, +68602,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,FIDELIS CARE NEW YORK-Medicaid, +68603,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,FIDELIS CARE NEW YORK-Medicaid, +68604,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,FIDELIS CARE NEW YORK-Medicaid, +68605,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,FIDELIS CARE NEW YORK-Medicaid, +68606,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,FIDELIS CARE NEW YORK-Medicaid, +68607,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,FIDELIS CARE NEW YORK-Medicaid, +68608,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,FIDELIS CARE NEW YORK-Medicaid, +68609,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,FIDELIS CARE NEW YORK-Medicaid, +68610,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,FIDELIS CARE NEW YORK-Medicaid, +68611,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,FIDELIS CARE NEW YORK-Medicaid, +68612,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,FIDELIS CARE NEW YORK-Medicaid, +68613,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,FIDELIS CARE NEW YORK-Medicaid, +68614,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,FIDELIS CARE NEW YORK-Medicaid, +68615,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,FIDELIS CARE NEW YORK-Medicaid, +68616,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,FIDELIS CARE NEW YORK-Medicaid, +68617,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,FIDELIS CARE NEW YORK-Medicaid, +68618,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,FIDELIS CARE NEW YORK-Medicaid, +68619,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,FIDELIS CARE NEW YORK-Medicaid, +68620,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,FIDELIS CARE NEW YORK-Medicaid, +68621,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,FIDELIS CARE NEW YORK-Medicaid, +68622,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,FIDELIS CARE NEW YORK-Medicaid, +68623,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,FIDELIS CARE NEW YORK-Medicaid, +68624,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,FIDELIS CARE NEW YORK-Medicaid,15.49 +68625,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,FIDELIS CARE NEW YORK-Medicaid,17.03 +68626,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,FIDELIS CARE NEW YORK-Medicaid, +68627,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,FIDELIS CARE NEW YORK-Medicaid, +68628,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,FIDELIS CARE NEW YORK-Medicaid, +68629,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,FIDELIS CARE NEW YORK-Medicaid, +68630,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,FIDELIS CARE NEW YORK-Medicaid, +68631,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,FIDELIS CARE NEW YORK-Medicaid, +68632,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,FIDELIS CARE NEW YORK-Medicaid, +68633,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,FIDELIS CARE NEW YORK-Medicaid, +68634,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,FIDELIS CARE NEW YORK-Medicaid, +68635,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,FIDELIS CARE NEW YORK-Medicaid, +68636,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,FIDELIS CARE NEW YORK-Medicaid, +68637,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,FIDELIS CARE NEW YORK-Medicaid, +68638,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,FIDELIS CARE NEW YORK-Medicaid, +68639,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,FIDELIS CARE NEW YORK-Medicaid, +68640,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,FIDELIS CARE NEW YORK-Medicaid, +68641,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,FIDELIS CARE NEW YORK-Medicaid, +68642,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,FIDELIS CARE NEW YORK-Medicaid, +68643,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,FIDELIS CARE NEW YORK-Medicaid, +68644,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,FIDELIS CARE NEW YORK-Medicaid, +68645,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,FIDELIS CARE NEW YORK-Medicaid, +68646,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,FIDELIS CARE NEW YORK-Medicaid, +68647,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,FIDELIS CARE NEW YORK-Medicaid, +68648,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,FIDELIS CARE NEW YORK-Medicaid, +68649,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,FIDELIS CARE NEW YORK-Medicaid, +68650,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,FIDELIS CARE NEW YORK-Medicaid, +68651,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,FIDELIS CARE NEW YORK-Medicaid, +68652,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,FIDELIS CARE NEW YORK-Medicaid, +68653,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,FIDELIS CARE NEW YORK-Medicaid, +68654,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,FIDELIS CARE NEW YORK-Medicaid, +68655,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,FIDELIS CARE NEW YORK-Medicaid, +68656,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,FIDELIS CARE NEW YORK-Medicaid, +68657,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,FIDELIS CARE NEW YORK-Medicaid, +68658,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,FIDELIS CARE NEW YORK-Medicaid, +68659,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,FIDELIS CARE NEW YORK-Medicaid, +68660,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,FIDELIS CARE NEW YORK-Medicaid, +68661,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,FIDELIS CARE NEW YORK-Medicaid, +68662,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,FIDELIS CARE NEW YORK-Medicaid, +68663,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,FIDELIS CARE NEW YORK-Medicaid, +68664,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,FIDELIS CARE NEW YORK-Medicaid, +68665,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,FIDELIS CARE NEW YORK-Medicaid, +68666,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,FIDELIS CARE NEW YORK-Medicaid, +68667,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,FIDELIS CARE NEW YORK-Medicaid, +68668,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,FIDELIS CARE NEW YORK-Medicaid, +68669,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,FIDELIS CARE NEW YORK-Medicaid, +68670,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,FIDELIS CARE NEW YORK-Medicaid, +68671,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,FIDELIS CARE NEW YORK-Medicaid, +68672,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,FIDELIS CARE NEW YORK-Medicaid, +68673,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,FIDELIS CARE NEW YORK-Medicaid, +68674,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,FIDELIS CARE NEW YORK-Medicaid, +68675,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,FIDELIS CARE NEW YORK-Medicaid, +68676,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,FIDELIS CARE NEW YORK-Medicaid, +68677,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,FIDELIS CARE NEW YORK-Medicaid, +68678,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,FIDELIS CARE NEW YORK-Medicaid, +68679,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,FIDELIS CARE NEW YORK-Medicaid, +68680,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,FIDELIS CARE NEW YORK-Medicaid, +68681,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,FIDELIS CARE NEW YORK-Medicaid, +68682,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,FIDELIS CARE NEW YORK-Medicaid, +68683,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,FIDELIS CARE NEW YORK-Medicaid,343.35 +68684,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,FIDELIS CARE NEW YORK-Medicaid, +68685,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,FIDELIS CARE NEW YORK-Medicaid, +68686,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,FIDELIS CARE NEW YORK-Medicaid, +68687,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,FIDELIS CARE NEW YORK-Medicaid, +68688,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,FIDELIS CARE NEW YORK-Medicaid, +68689,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,FIDELIS CARE NEW YORK-Medicaid, +68690,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,FIDELIS CARE NEW YORK-Medicaid, +68691,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,FIDELIS CARE NEW YORK-Medicaid, +68692,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,FIDELIS CARE NEW YORK-Medicaid, +68693,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,FIDELIS CARE NEW YORK-Medicaid,174.66 +68694,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,FIDELIS CARE NEW YORK-Medicaid, +68695,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,FIDELIS CARE NEW YORK-Medicaid, +68696,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,FIDELIS CARE NEW YORK-Medicaid, +68697,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,FIDELIS CARE NEW YORK-Medicaid, +68698,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,FIDELIS CARE NEW YORK-Medicaid, +68699,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,FIDELIS CARE NEW YORK-Medicaid, +68700,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,FIDELIS CARE NEW YORK-Medicaid, +68701,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,FIDELIS CARE NEW YORK-Medicaid, +68702,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,FIDELIS CARE NEW YORK-Medicaid, +68703,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,FIDELIS CARE NEW YORK-Medicaid, +68704,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,FIDELIS CARE NEW YORK-Medicaid, +68705,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,FIDELIS CARE NEW YORK-Medicaid, +68706,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,FIDELIS CARE NEW YORK-Medicaid, +68707,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,FIDELIS CARE NEW YORK-Medicaid, +68708,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,FIDELIS CARE NEW YORK-Medicaid, +68709,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,FIDELIS CARE NEW YORK-Medicaid, +68710,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,FIDELIS CARE NEW YORK-Medicaid, +68711,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,FIDELIS CARE NEW YORK-Medicaid, +68712,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,FIDELIS CARE NEW YORK-Medicaid, +68713,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,FIDELIS CARE NEW YORK-Medicaid, +68714,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,FIDELIS CARE NEW YORK-Medicaid, +68715,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,FIDELIS CARE NEW YORK-Medicaid, +68716,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,FIDELIS CARE NEW YORK-Medicaid, +68717,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,FIDELIS CARE NEW YORK-Medicaid, +68718,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,FIDELIS CARE NEW YORK-Medicaid, +68719,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,FIDELIS CARE NEW YORK-Medicaid, +68720,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,FIDELIS CARE NEW YORK-Medicaid, +68721,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,FIDELIS CARE NEW YORK-Medicaid, +68722,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,FIDELIS CARE NEW YORK-Medicaid, +68723,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,FIDELIS CARE NEW YORK-Medicaid, +68724,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,FIDELIS CARE NEW YORK-Medicaid, +68725,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,FIDELIS CARE NEW YORK-Medicaid, +68726,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,FIDELIS CARE NEW YORK-Medicaid, +68727,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,FIDELIS CARE NEW YORK-Medicaid, +68728,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,FIDELIS CARE NEW YORK-Medicaid, +68729,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,FIDELIS CARE NEW YORK-Medicaid, +68730,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,FIDELIS CARE NEW YORK-Medicaid, +68731,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,FIDELIS CARE NEW YORK-Medicaid, +68732,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,FIDELIS CARE NEW YORK-Medicaid, +68733,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,FIDELIS CARE NEW YORK-Medicaid, +68734,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,FIDELIS CARE NEW YORK-Medicaid, +68735,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,FIDELIS CARE NEW YORK-Medicaid, +68736,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,FIDELIS CARE NEW YORK-Medicaid, +68737,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,FIDELIS CARE NEW YORK-Medicaid, +68738,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,FIDELIS CARE NEW YORK-Medicaid, +68739,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,FIDELIS CARE NEW YORK-Medicaid, +68740,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,FIDELIS CARE NEW YORK-Medicaid, +68741,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,FIDELIS CARE NEW YORK-Medicaid, +68742,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,FIDELIS CARE NEW YORK-Medicaid, +68743,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,FIDELIS CARE NEW YORK-Medicaid, +68744,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,FIDELIS CARE NEW YORK-Medicaid, +68745,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,FIDELIS CARE NEW YORK-Medicaid, +68746,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,FIDELIS CARE NEW YORK-Medicaid, +68747,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,FIDELIS CARE NEW YORK-Medicaid, +68748,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,FIDELIS CARE NEW YORK-Medicaid, +68749,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,FIDELIS CARE NEW YORK-Medicaid, +68750,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,FIDELIS CARE NEW YORK-Medicaid, +68751,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,FIDELIS CARE NEW YORK-Medicaid, +68752,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,FIDELIS CARE NEW YORK-Medicaid, +68753,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,FIDELIS CARE NEW YORK-Medicaid, +68754,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,FIDELIS CARE NEW YORK-Medicaid, +68755,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,FIDELIS CARE NEW YORK-Medicaid, +68756,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,FIDELIS CARE NEW YORK-Medicaid, +68757,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,FIDELIS CARE NEW YORK-Medicaid, +68758,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,FIDELIS CARE NEW YORK-Medicaid, +68759,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,FIDELIS CARE NEW YORK-Medicaid, +68760,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,FIDELIS CARE NEW YORK-Medicaid, +68761,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,FIDELIS CARE NEW YORK-Medicaid, +68762,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,FIDELIS CARE NEW YORK-Medicaid, +68763,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,FIDELIS CARE NEW YORK-Medicaid, +68764,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,FIDELIS CARE NEW YORK-Medicaid, +68765,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,FIDELIS CARE NEW YORK-Medicaid, +68766,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,FIDELIS CARE NEW YORK-Medicaid, +68767,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,FIDELIS CARE NEW YORK-Medicaid, +68768,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,FIDELIS CARE NEW YORK-Medicaid, +68769,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,FIDELIS CARE NEW YORK-Medicaid, +68770,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,FIDELIS CARE NEW YORK-Medicaid, +68771,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,FIDELIS CARE NEW YORK-Medicaid, +68772,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,FIDELIS CARE NEW YORK-Medicaid, +68773,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,FIDELIS CARE NEW YORK-Medicaid, +68774,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,FIDELIS CARE NEW YORK-Medicaid, +68775,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,FIDELIS CARE NEW YORK-Medicaid, +68776,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,FIDELIS CARE NEW YORK-Medicaid, +68777,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,FIDELIS CARE NEW YORK-Medicaid, +68778,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,FIDELIS CARE NEW YORK-Medicaid, +68779,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,FIDELIS CARE NEW YORK-Medicaid, +68780,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,FIDELIS CARE NEW YORK-Medicaid, +68781,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,FIDELIS CARE NEW YORK-Medicaid, +68782,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,FIDELIS CARE NEW YORK-Medicaid, +68783,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,FIDELIS CARE NEW YORK-Medicaid, +68784,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,FIDELIS CARE NEW YORK-Medicaid, +68785,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,FIDELIS CARE NEW YORK-Medicaid, +68786,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,FIDELIS CARE NEW YORK-Medicaid, +68787,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,FIDELIS CARE NEW YORK-Medicaid, +68788,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,FIDELIS CARE NEW YORK-Medicaid, +68789,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,FIDELIS CARE NEW YORK-Medicaid, +68790,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,FIDELIS CARE NEW YORK-Medicaid, +68791,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,FIDELIS CARE NEW YORK-Medicaid, +68792,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,FIDELIS CARE NEW YORK-Medicaid, +68793,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,FIDELIS CARE NEW YORK-Medicaid, +68794,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,FIDELIS CARE NEW YORK-Medicaid, +68795,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,FIDELIS CARE NEW YORK-Medicaid, +68796,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,FIDELIS CARE NEW YORK-Medicaid, +68797,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,FIDELIS CARE NEW YORK-Medicaid, +68798,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,FIDELIS CARE NEW YORK-Medicaid, +68799,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,FIDELIS CARE NEW YORK-Medicaid, +68800,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,FIDELIS CARE NEW YORK-Medicaid, +68801,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,FIDELIS CARE NEW YORK-Medicaid, +68802,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,FIDELIS CARE NEW YORK-Medicaid, +68803,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,FIDELIS CARE NEW YORK-Medicaid, +68804,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,FIDELIS CARE NEW YORK-Medicaid, +68805,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,FIDELIS CARE NEW YORK-Medicaid, +68806,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,FIDELIS CARE NEW YORK-Medicaid, +68807,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,FIDELIS CARE NEW YORK-Medicaid, +68808,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,FIDELIS CARE NEW YORK-Medicaid, +68809,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,FIDELIS CARE NEW YORK-Medicaid, +68810,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,FIDELIS CARE NEW YORK-Medicaid, +68811,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,FIDELIS CARE NEW YORK-Medicaid, +68812,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,FIDELIS CARE NEW YORK-Medicaid, +68813,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,FIDELIS CARE NEW YORK-Medicaid, +68814,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,FIDELIS CARE NEW YORK-Medicaid, +68815,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,FIDELIS CARE NEW YORK-Medicaid, +68816,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,FIDELIS CARE NEW YORK-Medicaid, +68817,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,FIDELIS CARE NEW YORK-Medicaid, +68818,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,FIDELIS CARE NEW YORK-Medicaid, +68819,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,FIDELIS CARE NEW YORK-Medicaid, +68820,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,FIDELIS CARE NEW YORK-Medicaid, +68821,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,FIDELIS CARE NEW YORK-Medicaid, +68822,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,FIDELIS CARE NEW YORK-Medicaid, +68823,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,FIDELIS CARE NEW YORK-Medicaid, +68824,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,FIDELIS CARE NEW YORK-Medicaid, +68825,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,FIDELIS CARE NEW YORK-Medicaid, +68826,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,FIDELIS CARE NEW YORK-Medicaid, +68827,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,FIDELIS CARE NEW YORK-Medicaid, +68828,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,FIDELIS CARE NEW YORK-Medicaid, +68829,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,FIDELIS CARE NEW YORK-Medicaid, +68830,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,FIDELIS CARE NEW YORK-Medicaid, +68831,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,FIDELIS CARE NEW YORK-Medicaid, +68832,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,FIDELIS CARE NEW YORK-Medicaid, +68833,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,FIDELIS CARE NEW YORK-Medicaid, +68834,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,FIDELIS CARE NEW YORK-Medicaid, +68835,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,FIDELIS CARE NEW YORK-Medicaid, +68836,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,FIDELIS CARE NEW YORK-Medicaid, +68837,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,FIDELIS CARE NEW YORK-Medicaid, +68838,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,FIDELIS CARE NEW YORK-Medicaid, +68839,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,FIDELIS CARE NEW YORK-Medicaid, +68840,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,FIDELIS CARE NEW YORK-Medicaid, +68841,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,FIDELIS CARE NEW YORK-Medicaid, +68842,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,FIDELIS CARE NEW YORK-Medicaid, +68843,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,FIDELIS CARE NEW YORK-Medicaid, +68844,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,FIDELIS CARE NEW YORK-Medicaid, +68845,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,FIDELIS CARE NEW YORK-Medicaid, +68846,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,FIDELIS CARE NEW YORK-Medicaid, +68847,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,FIDELIS CARE NEW YORK-Medicaid, +68848,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,FIDELIS CARE NEW YORK-Medicaid, +68849,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,FIDELIS CARE NEW YORK-Medicaid, +68850,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,FIDELIS CARE NEW YORK-Medicaid, +68851,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,FIDELIS CARE NEW YORK-Medicaid, +68852,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,FIDELIS CARE NEW YORK-Medicaid, +68853,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,FIDELIS CARE NEW YORK-Medicaid, +68854,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,FIDELIS CARE NEW YORK-Medicaid, +68855,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,FIDELIS CARE NEW YORK-Medicaid, +68856,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,FIDELIS CARE NEW YORK-Medicaid, +68857,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,FIDELIS CARE NEW YORK-Medicaid, +68858,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,FIDELIS CARE NEW YORK-Medicaid, +68859,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,FIDELIS CARE NEW YORK-Medicaid, +68860,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,FIDELIS CARE NEW YORK-Medicaid, +68861,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,FIDELIS CARE NEW YORK-Medicaid, +68862,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,FIDELIS CARE NEW YORK-Medicaid, +68863,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,FIDELIS CARE NEW YORK-Medicaid, +68864,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,FIDELIS CARE NEW YORK-Medicaid, +68865,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,FIDELIS CARE NEW YORK-Medicaid, +68866,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,FIDELIS CARE NEW YORK-Medicaid, +68867,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,FIDELIS CARE NEW YORK-Medicaid, +68868,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,FIDELIS CARE NEW YORK-Medicaid, +68869,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,FIDELIS CARE NEW YORK-Medicaid, +68870,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,FIDELIS CARE NEW YORK-Medicaid, +68871,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,FIDELIS CARE NEW YORK-Medicaid, +68872,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,FIDELIS CARE NEW YORK-Medicaid, +68873,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,FIDELIS CARE NEW YORK-Medicaid, +68874,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,FIDELIS CARE NEW YORK-Medicaid, +68875,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,FIDELIS CARE NEW YORK-Medicaid, +68876,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,FIDELIS CARE NEW YORK-Medicaid, +68877,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,FIDELIS CARE NEW YORK-Medicaid, +68878,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,FIDELIS CARE NEW YORK-Medicaid, +68879,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,FIDELIS CARE NEW YORK-Medicaid, +68880,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,FIDELIS CARE NEW YORK-Medicaid, +68881,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,FIDELIS CARE NEW YORK-Medicaid, +68882,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,FIDELIS CARE NEW YORK-Medicaid, +68883,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,FIDELIS CARE NEW YORK-Medicaid, +68884,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,FIDELIS CARE NEW YORK-Medicaid, +68885,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +68886,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +68887,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +68888,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,FIDELIS CARE NEW YORK-Medicaid, +68889,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,FIDELIS CARE NEW YORK-Medicaid, +68890,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,FIDELIS CARE NEW YORK-Medicaid, +68891,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,FIDELIS CARE NEW YORK-Medicaid, +68892,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,FIDELIS CARE NEW YORK-Medicaid, +68893,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,FIDELIS CARE NEW YORK-Medicaid, +68894,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,FIDELIS CARE NEW YORK-Medicaid, +68895,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,FIDELIS CARE NEW YORK-Medicaid, +68896,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,FIDELIS CARE NEW YORK-Medicaid, +68897,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,FIDELIS CARE NEW YORK-Medicaid, +68898,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,FIDELIS CARE NEW YORK-Medicaid, +68899,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,FIDELIS CARE NEW YORK-Medicaid, +68900,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,FIDELIS CARE NEW YORK-Medicaid, +68901,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,FIDELIS CARE NEW YORK-Medicaid, +68902,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,FIDELIS CARE NEW YORK-Medicaid, +68903,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,FIDELIS CARE NEW YORK-Medicaid, +68904,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,FIDELIS CARE NEW YORK-Medicaid, +68905,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,FIDELIS CARE NEW YORK-Medicaid, +68906,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,FIDELIS CARE NEW YORK-Medicaid, +68907,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,FIDELIS CARE NEW YORK-Medicaid, +68908,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,FIDELIS CARE NEW YORK-Medicaid, +68909,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,FIDELIS CARE NEW YORK-Medicaid, +68910,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,FIDELIS CARE NEW YORK-Medicaid, +68911,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,FIDELIS CARE NEW YORK-Medicaid, +68912,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,FIDELIS CARE NEW YORK-Medicaid, +68913,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,FIDELIS CARE NEW YORK-Medicaid, +68914,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,FIDELIS CARE NEW YORK-Medicaid, +68915,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,FIDELIS CARE NEW YORK-Medicaid, +68916,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,FIDELIS CARE NEW YORK-Medicaid, +68917,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,FIDELIS CARE NEW YORK-Medicaid, +68918,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,FIDELIS CARE NEW YORK-Medicaid, +68919,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,FIDELIS CARE NEW YORK-Medicaid, +68920,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,FIDELIS CARE NEW YORK-Medicaid, +68921,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,FIDELIS CARE NEW YORK-Medicaid, +68922,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,FIDELIS CARE NEW YORK-Medicaid, +68923,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,FIDELIS CARE NEW YORK-Medicaid, +68924,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,FIDELIS CARE NEW YORK-Medicaid, +68925,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,FIDELIS CARE NEW YORK-Medicaid, +68926,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,FIDELIS CARE NEW YORK-Medicaid, +68927,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,FIDELIS CARE NEW YORK-Medicaid, +68928,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,FIDELIS CARE NEW YORK-Medicaid, +68929,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,FIDELIS CARE NEW YORK-Medicaid, +68930,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,FIDELIS CARE NEW YORK-Medicaid, +68931,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,FIDELIS CARE NEW YORK-Medicaid, +68932,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,FIDELIS CARE NEW YORK-Medicaid, +68933,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,FIDELIS CARE NEW YORK-Medicaid, +68934,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,FIDELIS CARE NEW YORK-Medicaid, +68935,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,FIDELIS CARE NEW YORK-Medicaid, +68936,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,FIDELIS CARE NEW YORK-Medicaid, +68937,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,FIDELIS CARE NEW YORK-Medicaid, +68938,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,FIDELIS CARE NEW YORK-Medicaid, +68939,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,FIDELIS CARE NEW YORK-Medicaid, +68940,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,FIDELIS CARE NEW YORK-Medicaid, +68941,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,FIDELIS CARE NEW YORK-Medicaid, +68942,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,FIDELIS CARE NEW YORK-Medicaid, +68943,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,FIDELIS CARE NEW YORK-Medicaid, +68944,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,FIDELIS CARE NEW YORK-Medicaid, +68945,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,FIDELIS CARE NEW YORK-Medicaid, +68946,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,FIDELIS CARE NEW YORK-Medicaid, +68947,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,FIDELIS CARE NEW YORK-Medicaid, +68948,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,FIDELIS CARE NEW YORK-Medicaid, +68949,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,FIDELIS CARE NEW YORK-Medicaid, +68950,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,FIDELIS CARE NEW YORK-Medicaid, +68951,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,FIDELIS CARE NEW YORK-Medicaid, +68952,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,FIDELIS CARE NEW YORK-Medicaid, +68953,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,FIDELIS CARE NEW YORK-Medicaid, +68954,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,FIDELIS CARE NEW YORK-Medicaid, +68955,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,FIDELIS CARE NEW YORK-Medicaid, +68956,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,FIDELIS CARE NEW YORK-Medicaid, +68957,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,FIDELIS CARE NEW YORK-Medicaid, +68958,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,FIDELIS CARE NEW YORK-Medicaid, +68959,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,FIDELIS CARE NEW YORK-Medicaid, +68960,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,FIDELIS CARE NEW YORK-Medicaid, +68961,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,FIDELIS CARE NEW YORK-Medicaid, +68962,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,FIDELIS CARE NEW YORK-Medicaid, +68963,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,FIDELIS CARE NEW YORK-Medicaid, +68964,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,FIDELIS CARE NEW YORK-Medicaid, +68965,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,FIDELIS CARE NEW YORK-Medicaid, +68966,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,FIDELIS CARE NEW YORK-Medicaid, +68967,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,FIDELIS CARE NEW YORK-Medicaid, +68968,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,FIDELIS CARE NEW YORK-Medicaid, +68969,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,FIDELIS CARE NEW YORK-Medicaid, +68970,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,FIDELIS CARE NEW YORK-Medicaid, +68971,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,FIDELIS CARE NEW YORK-Medicaid, +68972,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,FIDELIS CARE NEW YORK-Medicaid, +68973,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,FIDELIS CARE NEW YORK-Medicaid, +68974,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,FIDELIS CARE NEW YORK-Medicaid, +68975,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,FIDELIS CARE NEW YORK-Medicaid, +68976,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,FIDELIS CARE NEW YORK-Medicaid, +68977,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,FIDELIS CARE NEW YORK-Medicaid, +68978,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,FIDELIS CARE NEW YORK-Medicaid, +68979,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,FIDELIS CARE NEW YORK-Medicaid, +68980,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,FIDELIS CARE NEW YORK-Medicaid, +68981,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,FIDELIS CARE NEW YORK-Medicaid, +68982,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,FIDELIS CARE NEW YORK-Medicaid, +68983,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,FIDELIS CARE NEW YORK-Medicaid, +68984,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +68985,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,FIDELIS CARE NEW YORK-Medicaid,66.64 +68986,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,FIDELIS CARE NEW YORK-Medicaid, +68987,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,FIDELIS CARE NEW YORK-Medicaid, +68988,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,FIDELIS CARE NEW YORK-Medicaid, +68989,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,FIDELIS CARE NEW YORK-Medicaid, +68990,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,FIDELIS CARE NEW YORK-Medicaid, +68991,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,FIDELIS CARE NEW YORK-Medicaid, +68992,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,FIDELIS CARE NEW YORK-Medicaid, +68993,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,FIDELIS CARE NEW YORK-Medicaid, +68994,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,FIDELIS CARE NEW YORK-Medicaid, +68995,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,FIDELIS CARE NEW YORK-Medicaid, +68996,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,FIDELIS CARE NEW YORK-Medicaid, +68997,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,FIDELIS CARE NEW YORK-Medicaid, +68998,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,FIDELIS CARE NEW YORK-Medicaid,282.33 +68999,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,FIDELIS CARE NEW YORK-Medicaid, +69000,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,FIDELIS CARE NEW YORK-Medicaid, +69001,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,FIDELIS CARE NEW YORK-Medicaid, +69002,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,FIDELIS CARE NEW YORK-Medicaid, +69003,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,FIDELIS CARE NEW YORK-Medicaid, +69004,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,FIDELIS CARE NEW YORK-Medicaid, +69005,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,FIDELIS CARE NEW YORK-Medicaid, +69006,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,FIDELIS CARE NEW YORK-Medicaid, +69007,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,FIDELIS CARE NEW YORK-Medicaid, +69008,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicaid, +69009,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,FIDELIS CARE NEW YORK-Medicaid, +69010,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,FIDELIS CARE NEW YORK-Medicaid, +69011,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,FIDELIS CARE NEW YORK-Medicaid, +69012,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,FIDELIS CARE NEW YORK-Medicaid, +69013,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,FIDELIS CARE NEW YORK-Medicaid, +69014,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,FIDELIS CARE NEW YORK-Medicaid, +69015,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,FIDELIS CARE NEW YORK-Medicaid, +69016,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,FIDELIS CARE NEW YORK-Medicaid, +69017,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,FIDELIS CARE NEW YORK-Medicaid, +69018,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,FIDELIS CARE NEW YORK-Medicaid, +69019,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,FIDELIS CARE NEW YORK-Medicaid, +69020,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,FIDELIS CARE NEW YORK-Medicaid, +69021,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,FIDELIS CARE NEW YORK-Medicaid, +69022,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,FIDELIS CARE NEW YORK-Medicaid, +69023,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,FIDELIS CARE NEW YORK-Medicaid, +69024,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,FIDELIS CARE NEW YORK-Medicaid, +69025,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,FIDELIS CARE NEW YORK-Medicaid, +69026,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,FIDELIS CARE NEW YORK-Medicaid, +69027,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,FIDELIS CARE NEW YORK-Medicaid, +69028,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,FIDELIS CARE NEW YORK-Medicaid, +69029,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,FIDELIS CARE NEW YORK-Medicaid, +69030,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,FIDELIS CARE NEW YORK-Medicaid, +69031,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,FIDELIS CARE NEW YORK-Medicaid, +69032,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,FIDELIS CARE NEW YORK-Medicaid, +69033,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,FIDELIS CARE NEW YORK-Medicaid, +69034,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,FIDELIS CARE NEW YORK-Medicaid, +69035,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,FIDELIS CARE NEW YORK-Medicaid, +69036,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,FIDELIS CARE NEW YORK-Medicaid, +69037,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,FIDELIS CARE NEW YORK-Medicaid, +69038,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,FIDELIS CARE NEW YORK-Medicaid, +69039,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,FIDELIS CARE NEW YORK-Medicaid, +69040,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,FIDELIS CARE NEW YORK-Medicaid, +69041,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,FIDELIS CARE NEW YORK-Medicaid, +69042,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,FIDELIS CARE NEW YORK-Medicaid, +69043,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,FIDELIS CARE NEW YORK-Medicaid, +69044,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,FIDELIS CARE NEW YORK-Medicaid, +69045,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,FIDELIS CARE NEW YORK-Medicaid, +69046,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,FIDELIS CARE NEW YORK-Medicaid, +69047,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,FIDELIS CARE NEW YORK-Medicaid, +69048,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,FIDELIS CARE NEW YORK-Medicaid, +69049,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,FIDELIS CARE NEW YORK-Medicaid, +69050,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,FIDELIS CARE NEW YORK-Medicaid, +69051,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,FIDELIS CARE NEW YORK-Medicaid, +69052,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,FIDELIS CARE NEW YORK-Medicaid,282.33 +69053,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,FIDELIS CARE NEW YORK-Medicaid, +69054,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,FIDELIS CARE NEW YORK-Medicaid, +69055,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,FIDELIS CARE NEW YORK-Medicaid, +69056,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,FIDELIS CARE NEW YORK-Medicaid, +69057,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,FIDELIS CARE NEW YORK-Medicaid, +69058,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,FIDELIS CARE NEW YORK-Medicaid, +69059,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,FIDELIS CARE NEW YORK-Medicaid, +69060,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,FIDELIS CARE NEW YORK-Medicaid, +69061,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,FIDELIS CARE NEW YORK-Medicaid, +69062,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,FIDELIS CARE NEW YORK-Medicaid, +69063,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,FIDELIS CARE NEW YORK-Medicaid, +69064,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,FIDELIS CARE NEW YORK-Medicaid, +69065,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,FIDELIS CARE NEW YORK-Medicaid, +69066,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,FIDELIS CARE NEW YORK-Medicaid, +69067,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,FIDELIS CARE NEW YORK-Medicaid, +69068,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,FIDELIS CARE NEW YORK-Medicaid, +69069,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,FIDELIS CARE NEW YORK-Medicaid, +69070,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,FIDELIS CARE NEW YORK-Medicaid, +69071,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,FIDELIS CARE NEW YORK-Medicaid, +69072,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,FIDELIS CARE NEW YORK-Medicaid, +69073,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,FIDELIS CARE NEW YORK-Medicaid, +69074,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,FIDELIS CARE NEW YORK-Medicaid, +69075,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,FIDELIS CARE NEW YORK-Medicaid, +69076,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,FIDELIS CARE NEW YORK-Medicaid, +69077,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,FIDELIS CARE NEW YORK-Medicaid, +69078,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,FIDELIS CARE NEW YORK-Medicaid, +69079,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,FIDELIS CARE NEW YORK-Medicaid, +69080,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,FIDELIS CARE NEW YORK-Medicaid, +69081,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,FIDELIS CARE NEW YORK-Medicaid, +69082,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,FIDELIS CARE NEW YORK-Medicaid, +69083,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,FIDELIS CARE NEW YORK-Medicaid, +69084,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,FIDELIS CARE NEW YORK-Medicaid, +69085,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,FIDELIS CARE NEW YORK-Medicaid, +69086,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,FIDELIS CARE NEW YORK-Medicaid, +69087,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,FIDELIS CARE NEW YORK-Medicaid, +69088,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,FIDELIS CARE NEW YORK-Medicaid, +69089,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,FIDELIS CARE NEW YORK-Medicaid, +69090,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,FIDELIS CARE NEW YORK-Medicaid, +69091,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,FIDELIS CARE NEW YORK-Medicaid, +69092,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,FIDELIS CARE NEW YORK-Medicaid, +69093,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,FIDELIS CARE NEW YORK-Medicaid, +69094,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,FIDELIS CARE NEW YORK-Medicaid, +69095,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,FIDELIS CARE NEW YORK-Medicaid, +69096,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,FIDELIS CARE NEW YORK-Medicaid, +69097,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,FIDELIS CARE NEW YORK-Medicaid, +69098,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,FIDELIS CARE NEW YORK-Medicaid, +69099,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,FIDELIS CARE NEW YORK-Medicaid, +69100,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,FIDELIS CARE NEW YORK-Medicaid, +69101,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,FIDELIS CARE NEW YORK-Medicaid, +69102,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,FIDELIS CARE NEW YORK-Medicaid, +69103,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,FIDELIS CARE NEW YORK-Medicaid, +69104,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,FIDELIS CARE NEW YORK-Medicaid, +69105,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,FIDELIS CARE NEW YORK-Medicaid, +69106,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,FIDELIS CARE NEW YORK-Medicaid, +69107,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,FIDELIS CARE NEW YORK-Medicaid, +69108,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,FIDELIS CARE NEW YORK-Medicaid, +69109,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,FIDELIS CARE NEW YORK-Medicaid, +69110,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,FIDELIS CARE NEW YORK-Medicaid, +69111,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,FIDELIS CARE NEW YORK-Medicaid, +69112,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,FIDELIS CARE NEW YORK-Medicaid, +69113,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,FIDELIS CARE NEW YORK-Medicaid, +69114,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,FIDELIS CARE NEW YORK-Medicaid, +69115,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,FIDELIS CARE NEW YORK-Medicaid, +69116,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,FIDELIS CARE NEW YORK-Medicaid, +69117,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,FIDELIS CARE NEW YORK-Medicaid, +69118,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,FIDELIS CARE NEW YORK-Medicaid, +69119,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,FIDELIS CARE NEW YORK-Medicaid, +69120,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,FIDELIS CARE NEW YORK-Medicaid, +69121,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,FIDELIS CARE NEW YORK-Medicaid, +69122,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,FIDELIS CARE NEW YORK-Medicaid, +69123,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,FIDELIS CARE NEW YORK-Medicaid, +69124,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,FIDELIS CARE NEW YORK-Medicaid, +69125,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,FIDELIS CARE NEW YORK-Medicaid, +69126,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,FIDELIS CARE NEW YORK-Medicaid, +69127,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,FIDELIS CARE NEW YORK-Medicaid, +69128,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,FIDELIS CARE NEW YORK-Medicaid, +69129,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,FIDELIS CARE NEW YORK-Medicaid, +69130,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,FIDELIS CARE NEW YORK-Medicaid, +69131,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,FIDELIS CARE NEW YORK-Medicaid,234.67 +69132,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,FIDELIS CARE NEW YORK-Medicaid, +69133,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,FIDELIS CARE NEW YORK-Medicaid, +69134,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,FIDELIS CARE NEW YORK-Medicaid, +69135,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,FIDELIS CARE NEW YORK-Medicaid, +69136,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,FIDELIS CARE NEW YORK-Medicaid, +69137,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,FIDELIS CARE NEW YORK-Medicaid, +69138,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,FIDELIS CARE NEW YORK-Medicaid, +69139,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,FIDELIS CARE NEW YORK-Medicaid, +69140,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,FIDELIS CARE NEW YORK-Medicaid, +69141,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,FIDELIS CARE NEW YORK-Medicaid, +69142,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,FIDELIS CARE NEW YORK-Medicaid, +69143,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,FIDELIS CARE NEW YORK-Medicaid, +69144,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,FIDELIS CARE NEW YORK-Medicaid, +69145,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,FIDELIS CARE NEW YORK-Medicaid, +69146,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,FIDELIS CARE NEW YORK-Medicaid, +69147,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,FIDELIS CARE NEW YORK-Medicaid, +69148,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,FIDELIS CARE NEW YORK-Medicaid, +69149,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,FIDELIS CARE NEW YORK-Medicaid, +69150,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,FIDELIS CARE NEW YORK-Medicaid, +69151,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,FIDELIS CARE NEW YORK-Medicaid, +69152,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,FIDELIS CARE NEW YORK-Medicaid, +69153,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,FIDELIS CARE NEW YORK-Medicaid, +69154,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,FIDELIS CARE NEW YORK-Medicaid, +69155,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,FIDELIS CARE NEW YORK-Medicaid, +69156,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,FIDELIS CARE NEW YORK-Medicaid, +69157,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,FIDELIS CARE NEW YORK-Medicaid, +69158,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,FIDELIS CARE NEW YORK-Medicaid, +69159,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,FIDELIS CARE NEW YORK-Medicaid, +69160,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,FIDELIS CARE NEW YORK-Medicaid, +69161,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,FIDELIS CARE NEW YORK-Medicaid, +69162,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,FIDELIS CARE NEW YORK-Medicaid, +69163,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,FIDELIS CARE NEW YORK-Medicaid, +69164,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,FIDELIS CARE NEW YORK-Medicaid, +69165,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,FIDELIS CARE NEW YORK-Medicaid, +69166,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,FIDELIS CARE NEW YORK-Medicaid, +69167,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,FIDELIS CARE NEW YORK-Medicaid, +69168,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,FIDELIS CARE NEW YORK-Medicaid, +69169,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,FIDELIS CARE NEW YORK-Medicaid, +69170,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,FIDELIS CARE NEW YORK-Medicaid, +69171,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,FIDELIS CARE NEW YORK-Medicaid, +69172,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,FIDELIS CARE NEW YORK-Medicaid, +69173,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,FIDELIS CARE NEW YORK-Medicaid, +69174,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,FIDELIS CARE NEW YORK-Medicaid, +69175,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,FIDELIS CARE NEW YORK-Medicaid, +69176,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,FIDELIS CARE NEW YORK-Medicaid, +69177,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,FIDELIS CARE NEW YORK-Medicaid, +69178,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,FIDELIS CARE NEW YORK-Medicaid, +69179,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,FIDELIS CARE NEW YORK-Medicaid, +69180,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,FIDELIS CARE NEW YORK-Medicaid, +69181,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,FIDELIS CARE NEW YORK-Medicaid, +69182,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,FIDELIS CARE NEW YORK-Medicaid, +69183,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,FIDELIS CARE NEW YORK-Medicaid, +69184,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,FIDELIS CARE NEW YORK-Medicaid, +69185,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,FIDELIS CARE NEW YORK-Medicaid, +69186,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,FIDELIS CARE NEW YORK-Medicaid, +69187,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,FIDELIS CARE NEW YORK-Medicaid, +69188,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,FIDELIS CARE NEW YORK-Medicaid, +69189,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,FIDELIS CARE NEW YORK-Medicaid, +69190,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,FIDELIS CARE NEW YORK-Medicaid, +69191,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,FIDELIS CARE NEW YORK-Medicaid, +69192,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,FIDELIS CARE NEW YORK-Medicaid, +69193,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,FIDELIS CARE NEW YORK-Medicaid, +69194,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,FIDELIS CARE NEW YORK-Medicaid, +69195,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,FIDELIS CARE NEW YORK-Medicaid, +69196,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,FIDELIS CARE NEW YORK-Medicaid, +69197,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,FIDELIS CARE NEW YORK-Medicaid, +69198,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,FIDELIS CARE NEW YORK-Medicaid, +69199,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,FIDELIS CARE NEW YORK-Medicaid, +69200,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,FIDELIS CARE NEW YORK-Medicaid, +69201,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,FIDELIS CARE NEW YORK-Medicaid, +69202,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,FIDELIS CARE NEW YORK-Medicaid, +69203,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,FIDELIS CARE NEW YORK-Medicaid, +69204,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,FIDELIS CARE NEW YORK-Medicaid, +69205,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,FIDELIS CARE NEW YORK-Medicaid,280.81 +69206,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,FIDELIS CARE NEW YORK-Medicaid,903.01 +69207,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,FIDELIS CARE NEW YORK-Medicaid, +69208,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,FIDELIS CARE NEW YORK-Medicaid, +69209,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,FIDELIS CARE NEW YORK-Medicaid, +69210,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,FIDELIS CARE NEW YORK-Medicaid, +69211,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,FIDELIS CARE NEW YORK-Medicaid, +69212,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,FIDELIS CARE NEW YORK-Medicaid, +69213,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,FIDELIS CARE NEW YORK-Medicaid, +69214,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,FIDELIS CARE NEW YORK-Medicaid, +69215,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,FIDELIS CARE NEW YORK-Medicaid, +69216,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,FIDELIS CARE NEW YORK-Medicaid, +69217,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,FIDELIS CARE NEW YORK-Medicaid, +69218,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,FIDELIS CARE NEW YORK-Medicaid, +69219,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,FIDELIS CARE NEW YORK-Medicaid, +69220,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,FIDELIS CARE NEW YORK-Medicaid, +69221,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,FIDELIS CARE NEW YORK-Medicaid, +69222,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,FIDELIS CARE NEW YORK-Medicaid, +69223,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,FIDELIS CARE NEW YORK-Medicaid, +69224,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,FIDELIS CARE NEW YORK-Medicaid, +69225,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,FIDELIS CARE NEW YORK-Medicaid, +69226,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,FIDELIS CARE NEW YORK-Medicaid, +69227,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,FIDELIS CARE NEW YORK-Medicaid, +69228,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,FIDELIS CARE NEW YORK-Medicaid, +69229,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,FIDELIS CARE NEW YORK-Medicaid, +69230,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,FIDELIS CARE NEW YORK-Medicaid, +69231,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,FIDELIS CARE NEW YORK-Medicaid, +69232,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,FIDELIS CARE NEW YORK-Medicaid, +69233,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,FIDELIS CARE NEW YORK-Medicaid, +69234,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,FIDELIS CARE NEW YORK-Medicaid, +69235,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,FIDELIS CARE NEW YORK-Medicaid, +69236,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,FIDELIS CARE NEW YORK-Medicaid, +69237,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,FIDELIS CARE NEW YORK-Medicaid, +69238,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,FIDELIS CARE NEW YORK-Medicaid, +69239,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,FIDELIS CARE NEW YORK-Medicaid, +69240,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,FIDELIS CARE NEW YORK-Medicaid, +69241,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,FIDELIS CARE NEW YORK-Medicaid, +69242,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,FIDELIS CARE NEW YORK-Medicaid, +69243,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,FIDELIS CARE NEW YORK-Medicaid, +69244,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,FIDELIS CARE NEW YORK-Medicaid, +69245,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,FIDELIS CARE NEW YORK-Medicaid, +69246,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,FIDELIS CARE NEW YORK-Medicaid, +69247,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,FIDELIS CARE NEW YORK-Medicaid, +69248,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,FIDELIS CARE NEW YORK-Medicaid, +69249,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,FIDELIS CARE NEW YORK-Medicaid, +69250,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,FIDELIS CARE NEW YORK-Medicaid, +69251,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,FIDELIS CARE NEW YORK-Medicaid, +69252,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,FIDELIS CARE NEW YORK-Medicaid, +69253,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,FIDELIS CARE NEW YORK-Medicaid, +69254,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,FIDELIS CARE NEW YORK-Medicaid, +69255,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,FIDELIS CARE NEW YORK-Medicaid, +69256,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,FIDELIS CARE NEW YORK-Medicaid, +69257,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,FIDELIS CARE NEW YORK-Medicaid, +69258,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,FIDELIS CARE NEW YORK-Medicaid, +69259,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,FIDELIS CARE NEW YORK-Medicaid, +69260,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,FIDELIS CARE NEW YORK-Medicaid, +69261,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,FIDELIS CARE NEW YORK-Medicaid, +69262,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,FIDELIS CARE NEW YORK-Medicaid, +69263,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,FIDELIS CARE NEW YORK-Medicaid, +69264,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,FIDELIS CARE NEW YORK-Medicaid, +69265,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,FIDELIS CARE NEW YORK-Medicaid, +69266,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,FIDELIS CARE NEW YORK-Medicaid, +69267,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,FIDELIS CARE NEW YORK-Medicaid, +69268,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,FIDELIS CARE NEW YORK-Medicaid, +69269,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,FIDELIS CARE NEW YORK-Medicaid, +69270,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,FIDELIS CARE NEW YORK-Medicaid, +69271,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,FIDELIS CARE NEW YORK-Medicaid, +69272,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,FIDELIS CARE NEW YORK-Medicaid, +69273,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,FIDELIS CARE NEW YORK-Medicaid, +69274,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,FIDELIS CARE NEW YORK-Medicaid, +69275,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,FIDELIS CARE NEW YORK-Medicaid, +69276,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,FIDELIS CARE NEW YORK-Medicaid, +69277,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,FIDELIS CARE NEW YORK-Medicaid, +69278,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,FIDELIS CARE NEW YORK-Medicaid, +69279,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,FIDELIS CARE NEW YORK-Medicaid, +69280,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,FIDELIS CARE NEW YORK-Medicaid, +69281,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,FIDELIS CARE NEW YORK-Medicaid, +69282,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,FIDELIS CARE NEW YORK-Medicaid, +69283,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,FIDELIS CARE NEW YORK-Medicaid, +69284,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,FIDELIS CARE NEW YORK-Medicaid, +69285,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,FIDELIS CARE NEW YORK-Medicaid, +69286,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,FIDELIS CARE NEW YORK-Medicaid, +69287,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,FIDELIS CARE NEW YORK-Medicaid, +69288,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,FIDELIS CARE NEW YORK-Medicaid, +69289,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,FIDELIS CARE NEW YORK-Medicaid, +69290,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,FIDELIS CARE NEW YORK-Medicaid, +69291,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,FIDELIS CARE NEW YORK-Medicaid, +69292,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,FIDELIS CARE NEW YORK-Medicaid, +69293,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,FIDELIS CARE NEW YORK-Medicaid, +69294,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,FIDELIS CARE NEW YORK-Medicaid, +69295,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,FIDELIS CARE NEW YORK-Medicaid, +69296,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,FIDELIS CARE NEW YORK-Medicaid, +69297,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,FIDELIS CARE NEW YORK-Medicaid, +69298,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,FIDELIS CARE NEW YORK-Medicaid, +69299,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,FIDELIS CARE NEW YORK-Medicaid, +69300,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,FIDELIS CARE NEW YORK-Medicaid, +69301,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,FIDELIS CARE NEW YORK-Medicaid, +69302,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,FIDELIS CARE NEW YORK-Medicaid, +69303,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,FIDELIS CARE NEW YORK-Medicaid, +69304,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,FIDELIS CARE NEW YORK-Medicaid, +69305,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,FIDELIS CARE NEW YORK-Medicaid, +69306,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,FIDELIS CARE NEW YORK-Medicaid, +69307,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,FIDELIS CARE NEW YORK-Medicaid, +69308,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,FIDELIS CARE NEW YORK-Medicaid, +69309,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,FIDELIS CARE NEW YORK-Medicaid, +69310,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,FIDELIS CARE NEW YORK-Medicaid, +69311,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,FIDELIS CARE NEW YORK-Medicaid, +69312,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,FIDELIS CARE NEW YORK-Medicaid, +69313,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,FIDELIS CARE NEW YORK-Medicaid, +69314,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,FIDELIS CARE NEW YORK-Medicaid, +69315,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,FIDELIS CARE NEW YORK-Medicaid, +69316,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,FIDELIS CARE NEW YORK-Medicaid, +69317,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,FIDELIS CARE NEW YORK-Medicaid, +69318,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,FIDELIS CARE NEW YORK-Medicaid, +69319,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,FIDELIS CARE NEW YORK-Medicaid, +69320,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,FIDELIS CARE NEW YORK-Medicaid, +69321,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,FIDELIS CARE NEW YORK-Medicaid, +69322,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,FIDELIS CARE NEW YORK-Medicaid, +69323,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,FIDELIS CARE NEW YORK-Medicaid, +69324,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,FIDELIS CARE NEW YORK-Medicaid, +69325,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,FIDELIS CARE NEW YORK-Medicaid, +69326,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,FIDELIS CARE NEW YORK-Medicaid, +69327,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,FIDELIS CARE NEW YORK-Medicaid, +69328,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,FIDELIS CARE NEW YORK-Medicaid, +69329,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,FIDELIS CARE NEW YORK-Medicaid, +69330,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,FIDELIS CARE NEW YORK-Medicaid, +69331,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,FIDELIS CARE NEW YORK-Medicaid, +69332,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,FIDELIS CARE NEW YORK-Medicaid, +69333,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,FIDELIS CARE NEW YORK-Medicaid, +69334,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,FIDELIS CARE NEW YORK-Medicaid, +69335,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,FIDELIS CARE NEW YORK-Medicaid, +69336,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,FIDELIS CARE NEW YORK-Medicaid, +69337,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,FIDELIS CARE NEW YORK-Medicaid, +69338,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,FIDELIS CARE NEW YORK-Medicaid, +69339,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,FIDELIS CARE NEW YORK-Medicaid, +69340,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,FIDELIS CARE NEW YORK-Medicaid, +69341,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,FIDELIS CARE NEW YORK-Medicaid, +69342,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,FIDELIS CARE NEW YORK-Medicaid, +69343,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,FIDELIS CARE NEW YORK-Medicaid, +69344,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,FIDELIS CARE NEW YORK-Medicaid, +69345,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,FIDELIS CARE NEW YORK-Medicaid, +69346,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,FIDELIS CARE NEW YORK-Medicaid, +69347,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,FIDELIS CARE NEW YORK-Medicaid, +69348,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,FIDELIS CARE NEW YORK-Medicaid, +69349,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,FIDELIS CARE NEW YORK-Medicaid, +69350,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,FIDELIS CARE NEW YORK-Medicaid, +69351,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,FIDELIS CARE NEW YORK-Medicaid, +69352,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,FIDELIS CARE NEW YORK-Medicaid, +69353,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,FIDELIS CARE NEW YORK-Medicaid, +69354,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,FIDELIS CARE NEW YORK-Medicaid, +69355,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,FIDELIS CARE NEW YORK-Medicaid, +69356,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,FIDELIS CARE NEW YORK-Medicaid, +69357,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,FIDELIS CARE NEW YORK-Medicaid, +69358,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,FIDELIS CARE NEW YORK-Medicaid, +69359,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,FIDELIS CARE NEW YORK-Medicaid, +69360,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,FIDELIS CARE NEW YORK-Medicaid, +69361,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,FIDELIS CARE NEW YORK-Medicaid, +69362,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,FIDELIS CARE NEW YORK-Medicaid, +69363,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,FIDELIS CARE NEW YORK-Medicaid, +69364,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,FIDELIS CARE NEW YORK-Medicaid, +69365,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,FIDELIS CARE NEW YORK-Medicaid, +69366,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,FIDELIS CARE NEW YORK-Medicaid, +69367,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,FIDELIS CARE NEW YORK-Medicaid, +69368,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,FIDELIS CARE NEW YORK-Medicaid, +69369,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,FIDELIS CARE NEW YORK-Medicaid, +69370,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,FIDELIS CARE NEW YORK-Medicaid, +69371,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,FIDELIS CARE NEW YORK-Medicaid, +69372,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,FIDELIS CARE NEW YORK-Medicaid, +69373,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,FIDELIS CARE NEW YORK-Medicaid, +69374,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,FIDELIS CARE NEW YORK-Medicaid, +69375,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,FIDELIS CARE NEW YORK-Medicaid, +69376,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,FIDELIS CARE NEW YORK-Medicaid, +69377,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,FIDELIS CARE NEW YORK-Medicaid, +69378,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,FIDELIS CARE NEW YORK-Medicaid, +69379,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,FIDELIS CARE NEW YORK-Medicaid, +69380,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,FIDELIS CARE NEW YORK-Medicaid, +69381,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,FIDELIS CARE NEW YORK-Medicaid, +69382,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,FIDELIS CARE NEW YORK-Medicaid, +69383,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,FIDELIS CARE NEW YORK-Medicaid, +69384,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,FIDELIS CARE NEW YORK-Medicaid, +69385,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,FIDELIS CARE NEW YORK-Medicaid, +69386,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,FIDELIS CARE NEW YORK-Medicaid, +69387,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,FIDELIS CARE NEW YORK-Medicaid, +69388,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,FIDELIS CARE NEW YORK-Medicaid, +69389,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,FIDELIS CARE NEW YORK-Medicaid, +69390,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,FIDELIS CARE NEW YORK-Medicaid, +69391,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,FIDELIS CARE NEW YORK-Medicaid, +69392,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,FIDELIS CARE NEW YORK-Medicaid, +69393,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,FIDELIS CARE NEW YORK-Medicaid, +69394,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,FIDELIS CARE NEW YORK-Medicaid, +69395,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,FIDELIS CARE NEW YORK-Medicaid, +69396,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,FIDELIS CARE NEW YORK-Medicaid, +69397,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,FIDELIS CARE NEW YORK-Medicaid, +69398,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,FIDELIS CARE NEW YORK-Medicaid, +69399,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,FIDELIS CARE NEW YORK-Medicaid, +69400,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,FIDELIS CARE NEW YORK-Medicaid, +69401,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,FIDELIS CARE NEW YORK-Medicaid, +69402,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,FIDELIS CARE NEW YORK-Medicaid, +69403,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,FIDELIS CARE NEW YORK-Medicaid, +69404,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,FIDELIS CARE NEW YORK-Medicaid, +69405,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,FIDELIS CARE NEW YORK-Medicaid, +69406,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,FIDELIS CARE NEW YORK-Medicaid, +69407,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,FIDELIS CARE NEW YORK-Medicaid, +69408,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,FIDELIS CARE NEW YORK-Medicaid, +69409,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,FIDELIS CARE NEW YORK-Medicaid, +69410,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,FIDELIS CARE NEW YORK-Medicaid, +69411,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,FIDELIS CARE NEW YORK-Medicaid, +69412,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,FIDELIS CARE NEW YORK-Medicaid, +69413,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,FIDELIS CARE NEW YORK-Medicaid, +69414,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,FIDELIS CARE NEW YORK-Medicaid, +69415,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,FIDELIS CARE NEW YORK-Medicaid, +69416,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,FIDELIS CARE NEW YORK-Medicaid, +69417,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,FIDELIS CARE NEW YORK-Medicaid, +69418,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,FIDELIS CARE NEW YORK-Medicaid, +69419,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,FIDELIS CARE NEW YORK-Medicaid, +69420,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,FIDELIS CARE NEW YORK-Medicaid, +69421,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,FIDELIS CARE NEW YORK-Medicaid, +69422,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,FIDELIS CARE NEW YORK-Medicaid, +69423,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,FIDELIS CARE NEW YORK-Medicaid, +69424,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,FIDELIS CARE NEW YORK-Medicaid, +69425,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,FIDELIS CARE NEW YORK-Medicaid, +69426,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,FIDELIS CARE NEW YORK-Medicaid, +69427,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,FIDELIS CARE NEW YORK-Medicaid, +69428,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,FIDELIS CARE NEW YORK-Medicaid, +69429,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,FIDELIS CARE NEW YORK-Medicaid, +69430,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,FIDELIS CARE NEW YORK-Medicaid, +69431,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,FIDELIS CARE NEW YORK-Medicaid, +69432,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,FIDELIS CARE NEW YORK-Medicaid, +69433,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,FIDELIS CARE NEW YORK-Medicaid, +69434,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,FIDELIS CARE NEW YORK-Medicaid, +69435,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,FIDELIS CARE NEW YORK-Medicaid, +69436,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,FIDELIS CARE NEW YORK-Medicaid, +69437,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,FIDELIS CARE NEW YORK-Medicaid, +69438,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,FIDELIS CARE NEW YORK-Medicaid, +69439,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,FIDELIS CARE NEW YORK-Medicaid, +69440,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,FIDELIS CARE NEW YORK-Medicaid, +69441,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,FIDELIS CARE NEW YORK-Medicaid, +69442,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,FIDELIS CARE NEW YORK-Medicaid, +69443,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,FIDELIS CARE NEW YORK-Medicaid, +69444,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,FIDELIS CARE NEW YORK-Medicaid, +69445,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,FIDELIS CARE NEW YORK-Medicaid, +69446,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,FIDELIS CARE NEW YORK-Medicaid, +69447,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,FIDELIS CARE NEW YORK-Medicaid, +69448,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,FIDELIS CARE NEW YORK-Medicaid, +69449,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,FIDELIS CARE NEW YORK-Medicaid, +69450,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,FIDELIS CARE NEW YORK-Medicaid, +69451,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,FIDELIS CARE NEW YORK-Medicaid, +69452,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,FIDELIS CARE NEW YORK-Medicaid, +69453,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,FIDELIS CARE NEW YORK-Medicaid, +69454,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,FIDELIS CARE NEW YORK-Medicaid, +69455,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,FIDELIS CARE NEW YORK-Medicaid, +69456,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,FIDELIS CARE NEW YORK-Medicaid, +69457,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,FIDELIS CARE NEW YORK-Medicaid, +69458,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,FIDELIS CARE NEW YORK-Medicaid, +69459,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,FIDELIS CARE NEW YORK-Medicaid, +69460,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,FIDELIS CARE NEW YORK-Medicaid, +69461,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,FIDELIS CARE NEW YORK-Medicaid, +69462,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,FIDELIS CARE NEW YORK-Medicaid, +69463,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,FIDELIS CARE NEW YORK-Medicaid, +69464,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,FIDELIS CARE NEW YORK-Medicaid, +69465,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,FIDELIS CARE NEW YORK-Medicaid, +69466,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,FIDELIS CARE NEW YORK-Medicaid, +69467,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,FIDELIS CARE NEW YORK-Medicaid, +69468,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,FIDELIS CARE NEW YORK-Medicaid, +69469,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,FIDELIS CARE NEW YORK-Medicaid, +69470,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,FIDELIS CARE NEW YORK-Medicaid, +69471,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,FIDELIS CARE NEW YORK-Medicaid, +69472,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,FIDELIS CARE NEW YORK-Medicaid, +69473,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,FIDELIS CARE NEW YORK-Medicaid, +69474,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,FIDELIS CARE NEW YORK-Medicaid, +69475,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,FIDELIS CARE NEW YORK-Medicaid, +69476,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,FIDELIS CARE NEW YORK-Medicaid, +69477,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,FIDELIS CARE NEW YORK-Medicaid, +69478,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,FIDELIS CARE NEW YORK-Medicaid, +69479,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,FIDELIS CARE NEW YORK-Medicaid, +69480,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,FIDELIS CARE NEW YORK-Medicaid, +69481,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,FIDELIS CARE NEW YORK-Medicaid, +69482,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,FIDELIS CARE NEW YORK-Medicaid, +69483,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,FIDELIS CARE NEW YORK-Medicaid, +69484,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,FIDELIS CARE NEW YORK-Medicaid, +69485,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,FIDELIS CARE NEW YORK-Medicaid, +69486,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,FIDELIS CARE NEW YORK-Medicaid, +69487,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,FIDELIS CARE NEW YORK-Medicaid, +69488,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,FIDELIS CARE NEW YORK-Medicaid, +69489,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,FIDELIS CARE NEW YORK-Medicaid, +69490,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,FIDELIS CARE NEW YORK-Medicaid, +69491,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,FIDELIS CARE NEW YORK-Medicaid, +69492,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,FIDELIS CARE NEW YORK-Medicaid, +69493,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,FIDELIS CARE NEW YORK-Medicaid, +69494,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,FIDELIS CARE NEW YORK-Medicaid, +69495,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,FIDELIS CARE NEW YORK-Medicaid, +69496,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,FIDELIS CARE NEW YORK-Medicaid, +69497,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,FIDELIS CARE NEW YORK-Medicaid, +69498,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,FIDELIS CARE NEW YORK-Medicaid, +69499,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,FIDELIS CARE NEW YORK-Medicaid, +69500,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,FIDELIS CARE NEW YORK-Medicaid, +69501,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,FIDELIS CARE NEW YORK-Medicaid, +69502,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,FIDELIS CARE NEW YORK-Medicaid, +69503,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,FIDELIS CARE NEW YORK-Medicaid, +69504,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,FIDELIS CARE NEW YORK-Medicaid, +69505,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,FIDELIS CARE NEW YORK-Medicaid, +69506,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,FIDELIS CARE NEW YORK-Medicaid, +69507,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,FIDELIS CARE NEW YORK-Medicaid, +69508,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,FIDELIS CARE NEW YORK-Medicaid, +69509,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,FIDELIS CARE NEW YORK-Medicaid, +69510,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,FIDELIS CARE NEW YORK-Medicaid, +69511,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,FIDELIS CARE NEW YORK-Medicaid, +69512,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,FIDELIS CARE NEW YORK-Medicaid, +69513,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,FIDELIS CARE NEW YORK-Medicaid, +69514,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,FIDELIS CARE NEW YORK-Medicaid,600.8 +69515,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,FIDELIS CARE NEW YORK-Medicaid, +69516,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,FIDELIS CARE NEW YORK-Medicaid, +69517,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,FIDELIS CARE NEW YORK-Medicaid, +69518,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,FIDELIS CARE NEW YORK-Medicaid, +69519,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,FIDELIS CARE NEW YORK-Medicaid, +69520,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,FIDELIS CARE NEW YORK-Medicaid, +69521,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,FIDELIS CARE NEW YORK-Medicaid, +69522,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,FIDELIS CARE NEW YORK-Medicaid, +69523,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,FIDELIS CARE NEW YORK-Medicaid, +69524,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,FIDELIS CARE NEW YORK-Medicaid, +69525,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,FIDELIS CARE NEW YORK-Medicaid, +69526,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,FIDELIS CARE NEW YORK-Medicaid, +69527,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,FIDELIS CARE NEW YORK-Medicaid, +69528,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,FIDELIS CARE NEW YORK-Medicaid, +69529,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,FIDELIS CARE NEW YORK-Medicaid, +69530,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,FIDELIS CARE NEW YORK-Medicaid, +69531,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,FIDELIS CARE NEW YORK-Medicaid, +69532,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,FIDELIS CARE NEW YORK-Medicaid, +69533,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,FIDELIS CARE NEW YORK-Medicaid, +69534,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,FIDELIS CARE NEW YORK-Medicaid, +69535,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,FIDELIS CARE NEW YORK-Medicaid, +69536,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,FIDELIS CARE NEW YORK-Medicaid, +69537,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,FIDELIS CARE NEW YORK-Medicaid, +69538,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,FIDELIS CARE NEW YORK-Medicaid, +69539,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,FIDELIS CARE NEW YORK-Medicaid, +69540,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,FIDELIS CARE NEW YORK-Medicaid, +69541,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,FIDELIS CARE NEW YORK-Medicaid, +69542,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,FIDELIS CARE NEW YORK-Medicaid, +69543,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,FIDELIS CARE NEW YORK-Medicaid, +69544,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,FIDELIS CARE NEW YORK-Medicaid, +69545,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,FIDELIS CARE NEW YORK-Medicaid, +69546,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,FIDELIS CARE NEW YORK-Medicaid, +69547,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,FIDELIS CARE NEW YORK-Medicaid, +69548,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,FIDELIS CARE NEW YORK-Medicaid, +69549,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,FIDELIS CARE NEW YORK-Medicaid, +69550,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,FIDELIS CARE NEW YORK-Medicaid, +69551,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,FIDELIS CARE NEW YORK-Medicaid, +69552,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,FIDELIS CARE NEW YORK-Medicaid, +69553,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,FIDELIS CARE NEW YORK-Medicaid, +69554,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,FIDELIS CARE NEW YORK-Medicaid, +69555,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,FIDELIS CARE NEW YORK-Medicaid, +69556,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,FIDELIS CARE NEW YORK-Medicaid, +69557,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,FIDELIS CARE NEW YORK-Medicaid, +69558,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,FIDELIS CARE NEW YORK-Medicaid, +69559,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,FIDELIS CARE NEW YORK-Medicaid, +69560,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,FIDELIS CARE NEW YORK-Medicaid, +69561,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,FIDELIS CARE NEW YORK-Medicaid, +69562,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,FIDELIS CARE NEW YORK-Medicaid, +69563,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,FIDELIS CARE NEW YORK-Medicaid, +69564,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,FIDELIS CARE NEW YORK-Medicaid, +69565,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,FIDELIS CARE NEW YORK-Medicaid, +69566,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,FIDELIS CARE NEW YORK-Medicaid, +69567,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,FIDELIS CARE NEW YORK-Medicaid, +69568,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,FIDELIS CARE NEW YORK-Medicaid, +69569,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,FIDELIS CARE NEW YORK-Medicaid, +69570,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,FIDELIS CARE NEW YORK-Medicaid, +69571,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,FIDELIS CARE NEW YORK-Medicaid, +69572,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,FIDELIS CARE NEW YORK-Medicaid, +69573,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,FIDELIS CARE NEW YORK-Medicaid, +69574,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,FIDELIS CARE NEW YORK-Medicaid, +69575,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,FIDELIS CARE NEW YORK-Medicaid, +69576,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,FIDELIS CARE NEW YORK-Medicaid, +69577,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,FIDELIS CARE NEW YORK-Medicaid, +69578,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,FIDELIS CARE NEW YORK-Medicaid, +69579,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,FIDELIS CARE NEW YORK-Medicaid, +69580,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,FIDELIS CARE NEW YORK-Medicaid, +69581,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,FIDELIS CARE NEW YORK-Medicaid, +69582,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,FIDELIS CARE NEW YORK-Medicaid, +69583,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,FIDELIS CARE NEW YORK-Medicaid, +69584,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,FIDELIS CARE NEW YORK-Medicaid, +69585,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,FIDELIS CARE NEW YORK-Medicaid, +69586,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,FIDELIS CARE NEW YORK-Medicaid, +69587,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,FIDELIS CARE NEW YORK-Medicaid, +69588,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,FIDELIS CARE NEW YORK-Medicaid, +69589,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,FIDELIS CARE NEW YORK-Medicaid, +69590,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,FIDELIS CARE NEW YORK-Medicaid, +69591,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,FIDELIS CARE NEW YORK-Medicaid, +69592,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,FIDELIS CARE NEW YORK-Medicaid, +69593,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,FIDELIS CARE NEW YORK-Medicaid, +69594,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,FIDELIS CARE NEW YORK-Medicaid, +69595,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,FIDELIS CARE NEW YORK-Medicaid, +69596,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,FIDELIS CARE NEW YORK-Medicaid, +69597,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,FIDELIS CARE NEW YORK-Medicaid, +69598,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,FIDELIS CARE NEW YORK-Medicaid, +69599,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,FIDELIS CARE NEW YORK-Medicaid, +69600,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,FIDELIS CARE NEW YORK-Medicaid, +69601,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,FIDELIS CARE NEW YORK-Medicaid, +69602,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,FIDELIS CARE NEW YORK-Medicaid, +69603,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,FIDELIS CARE NEW YORK-Medicaid, +69604,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,FIDELIS CARE NEW YORK-Medicaid, +69605,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,FIDELIS CARE NEW YORK-Medicaid, +69606,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,FIDELIS CARE NEW YORK-Medicaid, +69607,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,FIDELIS CARE NEW YORK-Medicaid, +69608,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,FIDELIS CARE NEW YORK-Medicaid, +69609,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,FIDELIS CARE NEW YORK-Medicaid, +69610,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,FIDELIS CARE NEW YORK-Medicaid, +69611,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,FIDELIS CARE NEW YORK-Medicaid, +69612,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,FIDELIS CARE NEW YORK-Medicaid, +69613,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,FIDELIS CARE NEW YORK-Medicaid, +69614,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,FIDELIS CARE NEW YORK-Medicaid, +69615,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,FIDELIS CARE NEW YORK-Medicaid, +69616,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,FIDELIS CARE NEW YORK-Medicaid, +69617,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,FIDELIS CARE NEW YORK-Medicaid, +69618,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,FIDELIS CARE NEW YORK-Medicaid, +69619,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,FIDELIS CARE NEW YORK-Medicaid, +69620,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,FIDELIS CARE NEW YORK-Medicaid, +69621,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,FIDELIS CARE NEW YORK-Medicaid, +69622,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,FIDELIS CARE NEW YORK-Medicaid, +69623,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,FIDELIS CARE NEW YORK-Medicaid, +69624,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,FIDELIS CARE NEW YORK-Medicaid, +69625,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,FIDELIS CARE NEW YORK-Medicaid, +69626,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,FIDELIS CARE NEW YORK-Medicaid, +69627,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,FIDELIS CARE NEW YORK-Medicaid, +69628,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,FIDELIS CARE NEW YORK-Medicaid, +69629,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,FIDELIS CARE NEW YORK-Medicaid, +69630,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,FIDELIS CARE NEW YORK-Medicaid, +69631,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,FIDELIS CARE NEW YORK-Medicaid, +69632,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,FIDELIS CARE NEW YORK-Medicaid, +69633,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,FIDELIS CARE NEW YORK-Medicaid, +69634,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,FIDELIS CARE NEW YORK-Medicaid, +69635,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,FIDELIS CARE NEW YORK-Medicaid, +69636,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,FIDELIS CARE NEW YORK-Medicaid, +69637,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,FIDELIS CARE NEW YORK-Medicaid, +69638,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,FIDELIS CARE NEW YORK-Medicaid, +69639,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,FIDELIS CARE NEW YORK-Medicaid, +69640,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,FIDELIS CARE NEW YORK-Medicaid, +69641,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,FIDELIS CARE NEW YORK-Medicaid, +69642,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,FIDELIS CARE NEW YORK-Medicaid, +69643,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,FIDELIS CARE NEW YORK-Medicaid, +69644,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,FIDELIS CARE NEW YORK-Medicaid, +69645,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,FIDELIS CARE NEW YORK-Medicaid, +69646,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,FIDELIS CARE NEW YORK-Medicaid, +69647,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,FIDELIS CARE NEW YORK-Medicaid, +69648,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,FIDELIS CARE NEW YORK-Medicaid, +69649,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,FIDELIS CARE NEW YORK-Medicaid, +69650,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,FIDELIS CARE NEW YORK-Medicaid, +69651,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,FIDELIS CARE NEW YORK-Medicaid, +69652,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,FIDELIS CARE NEW YORK-Medicaid, +69653,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,FIDELIS CARE NEW YORK-Medicaid, +69654,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,FIDELIS CARE NEW YORK-Medicaid, +69655,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,FIDELIS CARE NEW YORK-Medicaid, +69656,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,FIDELIS CARE NEW YORK-Medicaid, +69657,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,FIDELIS CARE NEW YORK-Medicaid, +69658,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,FIDELIS CARE NEW YORK-Medicaid, +69659,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,FIDELIS CARE NEW YORK-Medicaid, +69660,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,FIDELIS CARE NEW YORK-Medicaid, +69661,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,FIDELIS CARE NEW YORK-Medicaid, +69662,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,FIDELIS CARE NEW YORK-Medicaid, +69663,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,FIDELIS CARE NEW YORK-Medicaid, +69664,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,FIDELIS CARE NEW YORK-Medicaid, +69665,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,FIDELIS CARE NEW YORK-Medicaid, +69666,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,FIDELIS CARE NEW YORK-Medicaid, +69667,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,FIDELIS CARE NEW YORK-Medicaid, +69668,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,FIDELIS CARE NEW YORK-Medicaid, +69669,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,FIDELIS CARE NEW YORK-Medicaid, +69670,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,FIDELIS CARE NEW YORK-Medicaid, +69671,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,FIDELIS CARE NEW YORK-Medicaid, +69672,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,FIDELIS CARE NEW YORK-Medicaid, +69673,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,FIDELIS CARE NEW YORK-Medicaid, +69674,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,FIDELIS CARE NEW YORK-Medicaid, +69675,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,FIDELIS CARE NEW YORK-Medicaid, +69676,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,FIDELIS CARE NEW YORK-Medicaid, +69677,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,FIDELIS CARE NEW YORK-Medicaid, +69678,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,FIDELIS CARE NEW YORK-Medicaid, +69679,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,FIDELIS CARE NEW YORK-Medicaid, +69680,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,FIDELIS CARE NEW YORK-Medicaid, +69681,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,FIDELIS CARE NEW YORK-Medicaid, +69682,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,FIDELIS CARE NEW YORK-Medicaid, +69683,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,FIDELIS CARE NEW YORK-Medicaid, +69684,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,FIDELIS CARE NEW YORK-Medicaid, +69685,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,FIDELIS CARE NEW YORK-Medicaid, +69686,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,FIDELIS CARE NEW YORK-Medicaid, +69687,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,FIDELIS CARE NEW YORK-Medicaid, +69688,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,FIDELIS CARE NEW YORK-Medicaid, +69689,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,FIDELIS CARE NEW YORK-Medicaid, +69690,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,FIDELIS CARE NEW YORK-Medicaid, +69691,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,FIDELIS CARE NEW YORK-Medicaid, +69692,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,FIDELIS CARE NEW YORK-Medicaid, +69693,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,FIDELIS CARE NEW YORK-Medicaid, +69694,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,FIDELIS CARE NEW YORK-Medicaid, +69695,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,FIDELIS CARE NEW YORK-Medicaid, +69696,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,FIDELIS CARE NEW YORK-Medicaid, +69697,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,FIDELIS CARE NEW YORK-Medicaid, +69698,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,FIDELIS CARE NEW YORK-Medicaid, +69699,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,FIDELIS CARE NEW YORK-Medicaid, +69700,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,FIDELIS CARE NEW YORK-Medicaid, +69701,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,FIDELIS CARE NEW YORK-Medicaid, +69702,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,FIDELIS CARE NEW YORK-Medicaid, +69703,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,FIDELIS CARE NEW YORK-Medicaid, +69704,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,FIDELIS CARE NEW YORK-Medicaid, +69705,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,FIDELIS CARE NEW YORK-Medicaid, +69706,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,FIDELIS CARE NEW YORK-Medicaid, +69707,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,FIDELIS CARE NEW YORK-Medicaid, +69708,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,FIDELIS CARE NEW YORK-Medicaid, +69709,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,FIDELIS CARE NEW YORK-Medicaid, +69710,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,FIDELIS CARE NEW YORK-Medicaid, +69711,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,FIDELIS CARE NEW YORK-Medicaid, +69712,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,FIDELIS CARE NEW YORK-Medicaid, +69713,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,FIDELIS CARE NEW YORK-Medicaid, +69714,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,FIDELIS CARE NEW YORK-Medicaid, +69715,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,FIDELIS CARE NEW YORK-Medicaid, +69716,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,FIDELIS CARE NEW YORK-Medicaid, +69717,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,FIDELIS CARE NEW YORK-Medicaid, +69718,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,FIDELIS CARE NEW YORK-Medicaid, +69719,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,FIDELIS CARE NEW YORK-Medicaid, +69720,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,FIDELIS CARE NEW YORK-Medicaid, +69721,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,FIDELIS CARE NEW YORK-Medicaid, +69722,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,FIDELIS CARE NEW YORK-Medicaid, +69723,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,FIDELIS CARE NEW YORK-Medicaid, +69724,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,FIDELIS CARE NEW YORK-Medicaid, +69725,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,FIDELIS CARE NEW YORK-Medicaid, +69726,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,FIDELIS CARE NEW YORK-Medicaid, +69727,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,FIDELIS CARE NEW YORK-Medicaid, +69728,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,FIDELIS CARE NEW YORK-Medicaid, +69729,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,FIDELIS CARE NEW YORK-Medicaid, +69730,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,FIDELIS CARE NEW YORK-Medicaid, +69731,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,FIDELIS CARE NEW YORK-Medicaid, +69732,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,FIDELIS CARE NEW YORK-Medicaid, +69733,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,FIDELIS CARE NEW YORK-Medicaid, +69734,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,FIDELIS CARE NEW YORK-Medicaid, +69735,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,FIDELIS CARE NEW YORK-Medicaid, +69736,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,FIDELIS CARE NEW YORK-Medicaid, +69737,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,FIDELIS CARE NEW YORK-Medicaid, +69738,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,FIDELIS CARE NEW YORK-Medicaid, +69739,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,FIDELIS CARE NEW YORK-Medicaid, +69740,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,FIDELIS CARE NEW YORK-Medicaid, +69741,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,FIDELIS CARE NEW YORK-Medicaid, +69742,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,FIDELIS CARE NEW YORK-Medicaid, +69743,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,FIDELIS CARE NEW YORK-Medicaid, +69744,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,FIDELIS CARE NEW YORK-Medicaid, +69745,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,FIDELIS CARE NEW YORK-Medicaid, +69746,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,FIDELIS CARE NEW YORK-Medicaid, +69747,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,FIDELIS CARE NEW YORK-Medicaid, +69748,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,FIDELIS CARE NEW YORK-Medicaid, +69749,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,FIDELIS CARE NEW YORK-Medicaid, +69750,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,FIDELIS CARE NEW YORK-Medicaid, +69751,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,FIDELIS CARE NEW YORK-Medicaid, +69752,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,FIDELIS CARE NEW YORK-Medicaid, +69753,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,FIDELIS CARE NEW YORK-Medicaid, +69754,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,FIDELIS CARE NEW YORK-Medicaid, +69755,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,FIDELIS CARE NEW YORK-Medicaid, +69756,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,FIDELIS CARE NEW YORK-Medicaid, +69757,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,FIDELIS CARE NEW YORK-Medicaid, +69758,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,FIDELIS CARE NEW YORK-Medicaid, +69759,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,FIDELIS CARE NEW YORK-Medicaid, +69760,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,FIDELIS CARE NEW YORK-Medicaid, +69761,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,FIDELIS CARE NEW YORK-Medicaid, +69762,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,FIDELIS CARE NEW YORK-Medicaid, +69763,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,FIDELIS CARE NEW YORK-Medicaid, +69764,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,FIDELIS CARE NEW YORK-Medicaid, +69765,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,FIDELIS CARE NEW YORK-Medicaid, +69766,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,FIDELIS CARE NEW YORK-Medicaid, +69767,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,FIDELIS CARE NEW YORK-Medicaid, +69768,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,FIDELIS CARE NEW YORK-Medicaid, +69769,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,FIDELIS CARE NEW YORK-Medicaid, +69770,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,FIDELIS CARE NEW YORK-Medicaid, +69771,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,FIDELIS CARE NEW YORK-Medicaid, +69772,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,FIDELIS CARE NEW YORK-Medicaid, +69773,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,FIDELIS CARE NEW YORK-Medicaid, +69774,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,FIDELIS CARE NEW YORK-Medicaid, +69775,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,FIDELIS CARE NEW YORK-Medicaid, +69776,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,FIDELIS CARE NEW YORK-Medicaid, +69777,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,FIDELIS CARE NEW YORK-Medicaid, +69778,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,FIDELIS CARE NEW YORK-Medicaid, +69779,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,FIDELIS CARE NEW YORK-Medicaid, +69780,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,FIDELIS CARE NEW YORK-Medicaid, +69781,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,FIDELIS CARE NEW YORK-Medicaid, +69782,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,FIDELIS CARE NEW YORK-Medicaid, +69783,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,FIDELIS CARE NEW YORK-Medicaid, +69784,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,FIDELIS CARE NEW YORK-Medicaid, +69785,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,FIDELIS CARE NEW YORK-Medicaid, +69786,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,FIDELIS CARE NEW YORK-Medicaid, +69787,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,FIDELIS CARE NEW YORK-Medicaid, +69788,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,FIDELIS CARE NEW YORK-Medicaid, +69789,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,FIDELIS CARE NEW YORK-Medicaid, +69790,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,FIDELIS CARE NEW YORK-Medicaid, +69791,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,FIDELIS CARE NEW YORK-Medicaid, +69792,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,FIDELIS CARE NEW YORK-Medicaid, +69793,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,FIDELIS CARE NEW YORK-Medicaid, +69794,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,FIDELIS CARE NEW YORK-Medicaid, +69795,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,FIDELIS CARE NEW YORK-Medicaid, +69796,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,FIDELIS CARE NEW YORK-Medicaid, +69797,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,FIDELIS CARE NEW YORK-Medicaid, +69798,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,FIDELIS CARE NEW YORK-Medicaid, +69799,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,FIDELIS CARE NEW YORK-Medicaid, +69800,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,FIDELIS CARE NEW YORK-Medicaid, +69801,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,FIDELIS CARE NEW YORK-Medicaid, +69802,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,FIDELIS CARE NEW YORK-Medicaid, +69803,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,FIDELIS CARE NEW YORK-Medicaid, +69804,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,FIDELIS CARE NEW YORK-Medicaid, +69805,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,FIDELIS CARE NEW YORK-Medicaid, +69806,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,FIDELIS CARE NEW YORK-Medicaid, +69807,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,FIDELIS CARE NEW YORK-Medicaid, +69808,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,FIDELIS CARE NEW YORK-Medicaid, +69809,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,FIDELIS CARE NEW YORK-Medicaid, +69810,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,FIDELIS CARE NEW YORK-Medicaid, +69811,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,FIDELIS CARE NEW YORK-Medicaid, +69812,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,FIDELIS CARE NEW YORK-Medicaid, +69813,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,FIDELIS CARE NEW YORK-Medicaid, +69814,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,FIDELIS CARE NEW YORK-Medicaid, +69815,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,FIDELIS CARE NEW YORK-Medicaid, +69816,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,FIDELIS CARE NEW YORK-Medicaid, +69817,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,FIDELIS CARE NEW YORK-Medicaid, +69818,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,FIDELIS CARE NEW YORK-Medicaid, +69819,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,FIDELIS CARE NEW YORK-Medicaid, +69820,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,FIDELIS CARE NEW YORK-Medicaid, +69821,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,FIDELIS CARE NEW YORK-Medicaid, +69822,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,FIDELIS CARE NEW YORK-Medicaid,148.92 +69823,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,FIDELIS CARE NEW YORK-Medicaid, +69824,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,FIDELIS CARE NEW YORK-Medicaid, +69825,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,FIDELIS CARE NEW YORK-Medicaid, +69826,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,FIDELIS CARE NEW YORK-Medicaid, +69827,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,FIDELIS CARE NEW YORK-Medicaid, +69828,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,FIDELIS CARE NEW YORK-Medicaid, +69829,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,FIDELIS CARE NEW YORK-Medicaid, +69830,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,FIDELIS CARE NEW YORK-Medicaid, +69831,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,FIDELIS CARE NEW YORK-Medicaid, +69832,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,FIDELIS CARE NEW YORK-Medicaid, +69833,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,FIDELIS CARE NEW YORK-Medicaid, +69834,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,FIDELIS CARE NEW YORK-Medicaid, +69835,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,FIDELIS CARE NEW YORK-Medicaid, +69836,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,FIDELIS CARE NEW YORK-Medicaid, +69837,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,FIDELIS CARE NEW YORK-Medicaid, +69838,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,FIDELIS CARE NEW YORK-Medicaid, +69839,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,FIDELIS CARE NEW YORK-Medicaid, +69840,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,FIDELIS CARE NEW YORK-Medicaid, +69841,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,FIDELIS CARE NEW YORK-Medicaid, +69842,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,FIDELIS CARE NEW YORK-Medicaid, +69843,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,FIDELIS CARE NEW YORK-Medicaid, +69844,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,FIDELIS CARE NEW YORK-Medicaid, +69845,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,FIDELIS CARE NEW YORK-Medicaid, +69846,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,FIDELIS CARE NEW YORK-Medicaid, +69847,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,FIDELIS CARE NEW YORK-Medicaid, +69848,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,FIDELIS CARE NEW YORK-Medicaid, +69849,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,FIDELIS CARE NEW YORK-Medicaid, +69850,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,FIDELIS CARE NEW YORK-Medicaid, +69851,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,FIDELIS CARE NEW YORK-Medicaid, +69852,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,FIDELIS CARE NEW YORK-Medicaid, +69853,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,FIDELIS CARE NEW YORK-Medicaid, +69854,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,FIDELIS CARE NEW YORK-Medicaid, +69855,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,FIDELIS CARE NEW YORK-Medicaid, +69856,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,FIDELIS CARE NEW YORK-Medicaid, +69857,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,FIDELIS CARE NEW YORK-Medicaid, +69858,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,FIDELIS CARE NEW YORK-Medicaid, +69859,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,FIDELIS CARE NEW YORK-Medicaid, +69860,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,FIDELIS CARE NEW YORK-Medicaid, +69861,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,FIDELIS CARE NEW YORK-Medicaid, +69862,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,FIDELIS CARE NEW YORK-Medicaid, +69863,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,FIDELIS CARE NEW YORK-Medicaid, +69864,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,FIDELIS CARE NEW YORK-Medicaid, +69865,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,FIDELIS CARE NEW YORK-Medicaid, +69866,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,FIDELIS CARE NEW YORK-Medicaid, +69867,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,FIDELIS CARE NEW YORK-Medicaid, +69868,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,FIDELIS CARE NEW YORK-Medicaid, +69869,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,FIDELIS CARE NEW YORK-Medicaid, +69870,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,FIDELIS CARE NEW YORK-Medicaid, +69871,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,FIDELIS CARE NEW YORK-Medicaid, +69872,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,FIDELIS CARE NEW YORK-Medicaid, +69873,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,FIDELIS CARE NEW YORK-Medicaid, +69874,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,FIDELIS CARE NEW YORK-Medicaid, +69875,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,FIDELIS CARE NEW YORK-Medicaid, +69876,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,FIDELIS CARE NEW YORK-Medicaid, +69877,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,FIDELIS CARE NEW YORK-Medicaid, +69878,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,FIDELIS CARE NEW YORK-Medicaid, +69879,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,FIDELIS CARE NEW YORK-Medicaid, +69880,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,FIDELIS CARE NEW YORK-Medicaid, +69881,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,FIDELIS CARE NEW YORK-Medicaid, +69882,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,FIDELIS CARE NEW YORK-Medicaid, +69883,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,FIDELIS CARE NEW YORK-Medicaid, +69884,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,FIDELIS CARE NEW YORK-Medicaid, +69885,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,FIDELIS CARE NEW YORK-Medicaid, +69886,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,FIDELIS CARE NEW YORK-Medicaid, +69887,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,FIDELIS CARE NEW YORK-Medicaid, +69888,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,FIDELIS CARE NEW YORK-Medicaid, +69889,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,FIDELIS CARE NEW YORK-Medicaid, +69890,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,FIDELIS CARE NEW YORK-Medicaid, +69891,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,FIDELIS CARE NEW YORK-Medicaid, +69892,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,FIDELIS CARE NEW YORK-Medicaid, +69893,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,FIDELIS CARE NEW YORK-Medicaid, +69894,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,FIDELIS CARE NEW YORK-Medicaid, +69895,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,FIDELIS CARE NEW YORK-Medicaid, +69896,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,FIDELIS CARE NEW YORK-Medicaid, +69897,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,FIDELIS CARE NEW YORK-Medicaid, +69898,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,FIDELIS CARE NEW YORK-Medicaid, +69899,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,FIDELIS CARE NEW YORK-Medicaid, +69900,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,FIDELIS CARE NEW YORK-Medicaid, +69901,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,FIDELIS CARE NEW YORK-Medicaid, +69902,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,FIDELIS CARE NEW YORK-Medicaid, +69903,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,FIDELIS CARE NEW YORK-Medicaid, +69904,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,FIDELIS CARE NEW YORK-Medicaid, +69905,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,FIDELIS CARE NEW YORK-Medicaid, +69906,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,FIDELIS CARE NEW YORK-Medicaid, +69907,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,FIDELIS CARE NEW YORK-Medicaid, +69908,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,FIDELIS CARE NEW YORK-Medicaid, +69909,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,FIDELIS CARE NEW YORK-Medicaid, +69910,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,FIDELIS CARE NEW YORK-Medicaid, +69911,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,FIDELIS CARE NEW YORK-Medicaid, +69912,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,FIDELIS CARE NEW YORK-Medicaid, +69913,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,FIDELIS CARE NEW YORK-Medicaid, +69914,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,FIDELIS CARE NEW YORK-Medicaid, +69915,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,FIDELIS CARE NEW YORK-Medicaid, +69916,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,FIDELIS CARE NEW YORK-Medicaid, +69917,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,FIDELIS CARE NEW YORK-Medicaid, +69918,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,FIDELIS CARE NEW YORK-Medicaid, +69919,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,FIDELIS CARE NEW YORK-Medicaid, +69920,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,FIDELIS CARE NEW YORK-Medicaid, +69921,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,FIDELIS CARE NEW YORK-Medicaid, +69922,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,FIDELIS CARE NEW YORK-Medicaid, +69923,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,FIDELIS CARE NEW YORK-Medicaid, +69924,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,FIDELIS CARE NEW YORK-Medicaid, +69925,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,FIDELIS CARE NEW YORK-Medicaid, +69926,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,FIDELIS CARE NEW YORK-Medicaid, +69927,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,FIDELIS CARE NEW YORK-Medicaid, +69928,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,FIDELIS CARE NEW YORK-Medicaid, +69929,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,FIDELIS CARE NEW YORK-Medicaid, +69930,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,FIDELIS CARE NEW YORK-Medicaid, +69931,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,FIDELIS CARE NEW YORK-Medicaid, +69932,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,FIDELIS CARE NEW YORK-Medicaid, +69933,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,FIDELIS CARE NEW YORK-Medicaid, +69934,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,FIDELIS CARE NEW YORK-Medicaid, +69935,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,FIDELIS CARE NEW YORK-Medicaid, +69936,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,FIDELIS CARE NEW YORK-Medicaid, +69937,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,FIDELIS CARE NEW YORK-Medicaid, +69938,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,FIDELIS CARE NEW YORK-Medicaid, +69939,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,FIDELIS CARE NEW YORK-Medicaid, +69940,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,FIDELIS CARE NEW YORK-Medicaid, +69941,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,FIDELIS CARE NEW YORK-Medicaid, +69942,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,FIDELIS CARE NEW YORK-Medicaid, +69943,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,FIDELIS CARE NEW YORK-Medicaid, +69944,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,FIDELIS CARE NEW YORK-Medicaid, +69945,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,FIDELIS CARE NEW YORK-Medicaid, +69946,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,FIDELIS CARE NEW YORK-Medicaid, +69947,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,FIDELIS CARE NEW YORK-Medicaid, +69948,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,FIDELIS CARE NEW YORK-Medicaid, +69949,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,FIDELIS CARE NEW YORK-Medicaid, +69950,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,FIDELIS CARE NEW YORK-Medicaid, +69951,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,FIDELIS CARE NEW YORK-Medicaid, +69952,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,FIDELIS CARE NEW YORK-Medicaid, +69953,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,FIDELIS CARE NEW YORK-Medicaid, +69954,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,FIDELIS CARE NEW YORK-Medicaid, +69955,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,FIDELIS CARE NEW YORK-Medicaid, +69956,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,FIDELIS CARE NEW YORK-Medicaid, +69957,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,FIDELIS CARE NEW YORK-Medicaid, +69958,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,FIDELIS CARE NEW YORK-Medicaid, +69959,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,FIDELIS CARE NEW YORK-Medicaid, +69960,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,FIDELIS CARE NEW YORK-Medicaid, +69961,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,FIDELIS CARE NEW YORK-Medicaid, +69962,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,FIDELIS CARE NEW YORK-Medicaid, +69963,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,FIDELIS CARE NEW YORK-Medicaid, +69964,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,FIDELIS CARE NEW YORK-Medicaid, +69965,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,FIDELIS CARE NEW YORK-Medicaid, +69966,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,FIDELIS CARE NEW YORK-Medicaid, +69967,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,FIDELIS CARE NEW YORK-Medicaid, +69968,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,FIDELIS CARE NEW YORK-Medicaid, +69969,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,FIDELIS CARE NEW YORK-Medicaid, +69970,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,FIDELIS CARE NEW YORK-Medicaid, +69971,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,FIDELIS CARE NEW YORK-Medicaid, +69972,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,FIDELIS CARE NEW YORK-Medicaid, +69973,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,FIDELIS CARE NEW YORK-Medicaid, +69974,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,FIDELIS CARE NEW YORK-Medicaid, +69975,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,FIDELIS CARE NEW YORK-Medicaid, +69976,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,FIDELIS CARE NEW YORK-Medicaid, +69977,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,FIDELIS CARE NEW YORK-Medicaid, +69978,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,FIDELIS CARE NEW YORK-Medicaid, +69979,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,FIDELIS CARE NEW YORK-Medicaid, +69980,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,FIDELIS CARE NEW YORK-Medicaid, +69981,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,FIDELIS CARE NEW YORK-Medicaid, +69982,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,FIDELIS CARE NEW YORK-Medicaid, +69983,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,FIDELIS CARE NEW YORK-Medicaid, +69984,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,FIDELIS CARE NEW YORK-Medicaid, +69985,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,FIDELIS CARE NEW YORK-Medicaid, +69986,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,FIDELIS CARE NEW YORK-Medicaid, +69987,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,FIDELIS CARE NEW YORK-Medicaid, +69988,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,FIDELIS CARE NEW YORK-Medicaid, +69989,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,FIDELIS CARE NEW YORK-Medicaid, +69990,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,FIDELIS CARE NEW YORK-Medicaid, +69991,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,FIDELIS CARE NEW YORK-Medicaid, +69992,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,FIDELIS CARE NEW YORK-Medicaid, +69993,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,FIDELIS CARE NEW YORK-Medicaid, +69994,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,FIDELIS CARE NEW YORK-Medicaid, +69995,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,FIDELIS CARE NEW YORK-Medicaid, +69996,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,FIDELIS CARE NEW YORK-Medicaid, +69997,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,FIDELIS CARE NEW YORK-Medicaid, +69998,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,FIDELIS CARE NEW YORK-Medicaid, +69999,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,FIDELIS CARE NEW YORK-Medicaid, +70000,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,FIDELIS CARE NEW YORK-Medicaid, +70001,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,FIDELIS CARE NEW YORK-Medicaid, +70002,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,FIDELIS CARE NEW YORK-Medicaid, +70003,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,FIDELIS CARE NEW YORK-Medicaid, +70004,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,FIDELIS CARE NEW YORK-Medicaid, +70005,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,FIDELIS CARE NEW YORK-Medicaid, +70006,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,FIDELIS CARE NEW YORK-Medicaid, +70007,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,FIDELIS CARE NEW YORK-Medicaid, +70008,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,FIDELIS CARE NEW YORK-Medicaid, +70009,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,FIDELIS CARE NEW YORK-Medicaid, +70010,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,FIDELIS CARE NEW YORK-Medicaid, +70011,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,FIDELIS CARE NEW YORK-Medicaid, +70012,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,FIDELIS CARE NEW YORK-Medicaid, +70013,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,FIDELIS CARE NEW YORK-Medicaid, +70014,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,FIDELIS CARE NEW YORK-Medicaid, +70015,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,FIDELIS CARE NEW YORK-Medicaid, +70016,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,FIDELIS CARE NEW YORK-Medicaid, +70017,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,FIDELIS CARE NEW YORK-Medicaid, +70018,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,FIDELIS CARE NEW YORK-Medicaid, +70019,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,FIDELIS CARE NEW YORK-Medicaid, +70020,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,FIDELIS CARE NEW YORK-Medicaid, +70021,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,FIDELIS CARE NEW YORK-Medicaid, +70022,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,FIDELIS CARE NEW YORK-Medicaid, +70023,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,FIDELIS CARE NEW YORK-Medicaid, +70024,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,FIDELIS CARE NEW YORK-Medicaid, +70025,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,FIDELIS CARE NEW YORK-Medicaid, +70026,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,FIDELIS CARE NEW YORK-Medicaid, +70027,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,FIDELIS CARE NEW YORK-Medicaid, +70028,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,FIDELIS CARE NEW YORK-Medicaid, +70029,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,FIDELIS CARE NEW YORK-Medicaid, +70030,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,FIDELIS CARE NEW YORK-Medicaid, +70031,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,FIDELIS CARE NEW YORK-Medicaid, +70032,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,FIDELIS CARE NEW YORK-Medicaid, +70033,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,FIDELIS CARE NEW YORK-Medicaid, +70034,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,FIDELIS CARE NEW YORK-Medicaid, +70035,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,FIDELIS CARE NEW YORK-Medicaid, +70036,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,FIDELIS CARE NEW YORK-Medicaid, +70037,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,FIDELIS CARE NEW YORK-Medicaid, +70038,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,FIDELIS CARE NEW YORK-Medicaid, +70039,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,FIDELIS CARE NEW YORK-Medicaid, +70040,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,FIDELIS CARE NEW YORK-Medicaid, +70041,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,FIDELIS CARE NEW YORK-Medicaid, +70042,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,FIDELIS CARE NEW YORK-Medicaid, +70043,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,FIDELIS CARE NEW YORK-Medicaid, +70044,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,FIDELIS CARE NEW YORK-Medicaid, +70045,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,FIDELIS CARE NEW YORK-Medicaid, +70046,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,FIDELIS CARE NEW YORK-Medicaid, +70047,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,FIDELIS CARE NEW YORK-Medicaid, +70048,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,FIDELIS CARE NEW YORK-Medicaid, +70049,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,FIDELIS CARE NEW YORK-Medicaid, +70050,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,FIDELIS CARE NEW YORK-Medicaid, +70051,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,FIDELIS CARE NEW YORK-Medicaid, +70052,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,FIDELIS CARE NEW YORK-Medicaid, +70053,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,FIDELIS CARE NEW YORK-Medicaid, +70054,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,FIDELIS CARE NEW YORK-Medicaid, +70055,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,FIDELIS CARE NEW YORK-Medicaid, +70056,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,FIDELIS CARE NEW YORK-Medicaid, +70057,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,FIDELIS CARE NEW YORK-Medicaid, +70058,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,FIDELIS CARE NEW YORK-Medicaid, +70059,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,FIDELIS CARE NEW YORK-Medicaid, +70060,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,FIDELIS CARE NEW YORK-Medicaid, +70061,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,FIDELIS CARE NEW YORK-Medicaid, +70062,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,FIDELIS CARE NEW YORK-Medicaid, +70063,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,FIDELIS CARE NEW YORK-Medicaid, +70064,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,FIDELIS CARE NEW YORK-Medicaid, +70065,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,FIDELIS CARE NEW YORK-Medicaid, +70066,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,FIDELIS CARE NEW YORK-Medicaid, +70067,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,FIDELIS CARE NEW YORK-Medicaid, +70068,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,FIDELIS CARE NEW YORK-Medicaid, +70069,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,FIDELIS CARE NEW YORK-Medicaid, +70070,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,FIDELIS CARE NEW YORK-Medicaid, +70071,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,FIDELIS CARE NEW YORK-Medicaid, +70072,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,FIDELIS CARE NEW YORK-Medicaid, +70073,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,FIDELIS CARE NEW YORK-Medicaid, +70074,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,FIDELIS CARE NEW YORK-Medicaid, +70075,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,FIDELIS CARE NEW YORK-Medicaid, +70076,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,FIDELIS CARE NEW YORK-Medicaid, +70077,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,FIDELIS CARE NEW YORK-Medicaid, +70078,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,FIDELIS CARE NEW YORK-Medicaid, +70079,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,FIDELIS CARE NEW YORK-Medicaid, +70080,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,FIDELIS CARE NEW YORK-Medicaid, +70081,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,FIDELIS CARE NEW YORK-Medicaid, +70082,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,FIDELIS CARE NEW YORK-Medicaid, +70083,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,FIDELIS CARE NEW YORK-Medicaid, +70084,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,FIDELIS CARE NEW YORK-Medicaid, +70085,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,FIDELIS CARE NEW YORK-Medicaid, +70086,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,FIDELIS CARE NEW YORK-Medicaid, +70087,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,FIDELIS CARE NEW YORK-Medicaid, +70088,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,FIDELIS CARE NEW YORK-Medicaid, +70089,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,FIDELIS CARE NEW YORK-Medicaid, +70090,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,FIDELIS CARE NEW YORK-Medicaid, +70091,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70092,3934,30000012,PRIVATE,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70093,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70094,3934,30000038,ICU,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70095,3934,30000046,BURN UNIT,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70096,3934,30000053,NICU,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70097,3934,30000061,ICR ROOM,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70098,3934,30000079,PSYCH,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70099,3934,30000087,NEWBORN,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70100,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70101,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70102,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70103,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70104,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70105,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70106,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70107,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70108,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70109,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70110,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70111,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70112,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70113,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70114,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70115,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70116,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70117,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70118,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70119,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70120,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70121,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70122,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70123,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70124,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70125,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70126,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70127,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70128,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70129,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70130,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70131,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70132,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70133,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70134,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70135,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70136,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70137,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70138,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70139,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70140,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70141,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70142,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70143,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70144,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70145,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70146,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70147,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70148,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70149,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70150,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70151,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70152,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70153,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70154,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70155,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70156,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70157,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70158,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70159,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70160,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70161,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70162,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70163,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70164,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70165,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70166,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70167,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70168,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70169,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70170,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70171,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70172,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70173,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70174,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70175,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70176,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70177,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70178,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70179,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70180,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70181,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70182,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70183,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70184,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70185,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70186,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70187,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70188,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70189,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70190,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70191,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70192,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70193,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70194,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70195,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70196,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70197,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70198,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70199,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70200,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70201,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70202,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70203,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70204,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70205,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70206,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70207,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70208,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70209,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70210,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70211,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70212,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70213,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70214,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70215,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70216,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70217,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70218,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70219,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70220,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70221,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70222,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70223,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70224,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70225,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70226,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70227,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70228,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70229,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70230,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70231,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70232,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70233,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70234,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70235,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70236,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70237,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70238,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70239,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70240,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70241,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70242,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70243,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70244,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70245,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70246,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70247,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70248,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70249,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70250,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70251,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70252,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70253,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70254,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70255,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70256,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW 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PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70385,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70386,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70387,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70388,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70389,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70390,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70391,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70392,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70393,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70394,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, 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PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70406,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70407,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70408,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70409,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70410,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70411,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70412,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70413,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70414,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70415,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70416,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70417,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70418,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70419,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70420,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70421,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70422,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70423,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70424,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70425,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70426,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70427,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70428,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70429,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70430,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70431,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70432,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70433,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70434,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70435,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70436,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70437,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70438,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70439,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70440,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70441,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70442,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70443,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70444,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70445,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70446,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70447,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70448,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70449,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70450,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70451,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70452,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70453,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70454,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70455,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70456,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70457,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70458,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70459,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70460,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70461,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70462,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70463,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70464,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70465,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70466,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70467,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70468,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70469,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70470,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70471,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70472,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70473,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70474,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70475,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70476,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70477,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70478,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70479,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70480,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70481,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70482,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70483,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70484,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70485,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70486,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70487,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70488,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70489,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70490,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70491,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70492,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70493,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70494,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70495,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70496,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70497,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70498,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70499,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70500,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70501,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70502,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70503,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70504,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70505,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70506,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70507,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70508,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70509,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicaid, +70510,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70511,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70512,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70513,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70514,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70515,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70516,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicaid, +70517,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70518,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70519,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70520,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70521,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70522,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70523,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70524,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70525,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70526,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70527,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70528,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70529,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70530,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70531,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70532,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70533,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70534,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicaid, +70535,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70536,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicaid, +70537,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,FIDELIS CARE NEW YORK-Medicaid, +70538,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,FIDELIS CARE NEW YORK-Medicaid, +70539,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,FIDELIS CARE NEW YORK-Medicaid, +70540,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,FIDELIS CARE NEW YORK-Medicaid, +70541,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70542,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70543,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70544,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70545,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70546,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70547,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70548,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70549,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70550,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70551,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70552,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70553,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,FIDELIS CARE NEW YORK-Medicaid, +70554,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicaid, +70555,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,FIDELIS CARE NEW YORK-Medicaid, +70556,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,FIDELIS CARE NEW YORK-Medicaid, +70557,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,FIDELIS CARE NEW YORK-Medicaid, +70558,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,FIDELIS CARE NEW YORK-Medicaid, +70559,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,FIDELIS CARE NEW YORK-Medicaid, +70560,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,FIDELIS CARE NEW YORK-Medicaid, +70561,3934,37112000,ACUTE ED,,1580.0,1580.0,,,FIDELIS CARE NEW YORK-Medicaid, +70562,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,FIDELIS CARE NEW YORK-Medicaid, +70563,3934,37112034,TRIAGE,,277.0,277.0,,,FIDELIS CARE NEW YORK-Medicaid, +70564,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,FIDELIS CARE NEW YORK-Medicaid, +70565,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,FIDELIS CARE NEW YORK-Medicaid, +70566,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,FIDELIS CARE NEW YORK-Medicaid, +70567,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,FIDELIS CARE NEW YORK-Medicaid, +70568,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,FIDELIS CARE NEW YORK-Medicaid, +70569,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicaid, +70570,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicaid, +70571,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicaid, +70572,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicaid, +70573,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,FIDELIS CARE NEW YORK-Medicaid, +70574,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,FIDELIS CARE NEW YORK-Medicaid, +70575,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,FIDELIS CARE NEW YORK-Medicaid, +70576,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,FIDELIS CARE NEW YORK-Medicaid, +70577,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,FIDELIS CARE NEW YORK-Medicaid, +70578,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,FIDELIS CARE NEW YORK-Medicaid, +70579,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,FIDELIS CARE NEW YORK-Medicaid, +70580,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,FIDELIS CARE NEW YORK-Medicaid, +70581,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,FIDELIS CARE NEW YORK-Medicaid, +70582,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,FIDELIS CARE NEW YORK-Medicaid, +70583,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,FIDELIS CARE NEW YORK-Medicaid, +70584,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,FIDELIS CARE NEW YORK-Medicaid, +70585,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,FIDELIS CARE NEW YORK-Medicaid, +70586,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,FIDELIS CARE NEW YORK-Medicaid, +70587,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,FIDELIS CARE NEW YORK-Medicaid, +70588,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,FIDELIS CARE NEW YORK-Medicaid, +70589,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,FIDELIS CARE NEW YORK-Medicaid, +70590,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,FIDELIS CARE NEW YORK-Medicaid, +70591,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,FIDELIS CARE NEW YORK-Medicaid, +70592,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,FIDELIS CARE NEW YORK-Medicaid, +70593,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,FIDELIS CARE NEW YORK-Medicaid, +70594,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,FIDELIS CARE NEW YORK-Medicaid, +70595,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,FIDELIS CARE NEW YORK-Medicaid, +70596,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,FIDELIS CARE NEW YORK-Medicaid, +70597,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,FIDELIS CARE NEW YORK-Medicaid, +70598,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,FIDELIS CARE NEW YORK-Medicaid, +70599,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,FIDELIS CARE NEW YORK-Medicaid, +70600,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,FIDELIS CARE NEW YORK-Medicaid, +70601,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,FIDELIS CARE NEW YORK-Medicaid, +70602,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,FIDELIS CARE NEW YORK-Medicaid, +70603,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,FIDELIS CARE NEW YORK-Medicaid, +70604,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,FIDELIS CARE NEW YORK-Medicaid, +70605,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,FIDELIS CARE NEW YORK-Medicaid, +70606,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,FIDELIS CARE NEW YORK-Medicaid, +70607,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,FIDELIS CARE NEW YORK-Medicaid, +70608,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,FIDELIS CARE NEW YORK-Medicaid, +70609,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,FIDELIS CARE NEW YORK-Medicaid, +70610,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,FIDELIS CARE NEW YORK-Medicaid, +70611,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,FIDELIS CARE NEW YORK-Medicaid, +70612,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,FIDELIS CARE NEW YORK-Medicaid, +70613,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,FIDELIS CARE NEW YORK-Medicaid, +70614,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,FIDELIS CARE NEW YORK-Medicaid, +70615,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,FIDELIS CARE NEW YORK-Medicaid, +70616,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,FIDELIS CARE NEW YORK-Medicaid, +70617,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,FIDELIS CARE NEW YORK-Medicaid, +70618,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,FIDELIS CARE NEW YORK-Medicaid, +70619,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,FIDELIS CARE NEW YORK-Medicaid, +70620,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,FIDELIS CARE NEW YORK-Medicaid, +70621,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,FIDELIS CARE NEW YORK-Medicaid, +70622,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,FIDELIS CARE NEW YORK-Medicaid, +70623,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,FIDELIS CARE NEW YORK-Medicaid, +70624,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,FIDELIS CARE NEW YORK-Medicaid, +70625,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,FIDELIS CARE NEW YORK-Medicaid, +70626,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,FIDELIS CARE NEW YORK-Medicaid, +70627,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,FIDELIS CARE NEW YORK-Medicaid, +70628,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,FIDELIS CARE NEW YORK-Medicaid, +70629,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,FIDELIS CARE NEW YORK-Medicaid, +70630,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,FIDELIS CARE NEW YORK-Medicaid, +70631,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,FIDELIS CARE NEW YORK-Medicaid, +70632,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,FIDELIS CARE NEW YORK-Medicaid, +70633,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,FIDELIS CARE NEW YORK-Medicaid, +70634,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,FIDELIS CARE NEW YORK-Medicaid, +70635,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,FIDELIS CARE NEW YORK-Medicaid, +70636,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,FIDELIS CARE NEW YORK-Medicaid, +70637,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,FIDELIS CARE NEW YORK-Medicaid, +70638,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,FIDELIS CARE NEW YORK-Medicaid, +70639,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,FIDELIS CARE NEW YORK-Medicaid, +70640,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,FIDELIS CARE NEW YORK-Medicaid, +70641,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,FIDELIS CARE NEW YORK-Medicaid, +70642,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,FIDELIS CARE NEW YORK-Medicaid, +70643,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,FIDELIS CARE NEW YORK-Medicaid, +70644,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,FIDELIS CARE NEW YORK-Medicaid, +70645,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,FIDELIS CARE NEW YORK-Medicaid, +70646,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,FIDELIS CARE NEW YORK-Medicaid, +70647,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,FIDELIS CARE NEW YORK-Medicaid, +70648,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,FIDELIS CARE NEW YORK-Medicaid, +70649,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,FIDELIS CARE NEW YORK-Medicaid, +70650,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,FIDELIS CARE NEW YORK-Medicaid, +70651,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,FIDELIS CARE NEW YORK-Medicaid, +70652,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,FIDELIS CARE NEW YORK-Medicaid, +70653,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,FIDELIS CARE NEW YORK-Medicaid, +70654,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,FIDELIS CARE NEW YORK-Medicaid, +70655,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,FIDELIS CARE NEW YORK-Medicaid, +70656,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,FIDELIS CARE NEW YORK-Medicaid, +70657,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,FIDELIS CARE NEW YORK-Medicaid, +70658,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,FIDELIS CARE NEW YORK-Medicaid, +70659,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,FIDELIS CARE NEW YORK-Medicaid, +70660,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,FIDELIS CARE NEW YORK-Medicaid, +70661,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,FIDELIS CARE NEW YORK-Medicaid, +70662,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,FIDELIS CARE NEW YORK-Medicaid, +70663,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70664,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70665,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70666,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70667,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70668,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70669,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,FIDELIS CARE NEW YORK-Medicaid, +70670,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,FIDELIS CARE NEW YORK-Medicaid, +70671,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,FIDELIS CARE NEW YORK-Medicaid, +70672,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70673,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70674,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70675,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,FIDELIS CARE NEW YORK-Medicaid, +70676,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70677,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70678,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70679,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,FIDELIS CARE NEW YORK-Medicaid, +70680,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,FIDELIS CARE NEW YORK-Medicaid, +70681,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,FIDELIS CARE NEW YORK-Medicaid, +70682,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,FIDELIS CARE NEW YORK-Medicaid, +70683,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,FIDELIS CARE NEW YORK-Medicaid, +70684,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,FIDELIS CARE NEW YORK-Medicaid, +70685,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,FIDELIS CARE NEW YORK-Medicaid, +70686,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,FIDELIS CARE NEW YORK-Medicaid, +70687,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,FIDELIS CARE NEW YORK-Medicaid, +70688,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,FIDELIS CARE NEW YORK-Medicaid, +70689,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,FIDELIS CARE NEW YORK-Medicaid, +70690,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,FIDELIS CARE NEW YORK-Medicaid, +70691,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,FIDELIS CARE NEW YORK-Medicaid, +70692,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,FIDELIS CARE NEW YORK-Medicaid, +70693,3934,43301043,ALBUNEX,,357.0,357.0,,,FIDELIS CARE NEW YORK-Medicaid, +70694,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,FIDELIS CARE NEW YORK-Medicaid, +70695,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70696,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70697,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70698,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70699,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70700,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,FIDELIS CARE NEW YORK-Medicaid, +70701,3934,43450022,REC RM .5HR,,541.0,541.0,,,FIDELIS CARE NEW YORK-Medicaid, +70702,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,FIDELIS CARE NEW YORK-Medicaid, +70703,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,FIDELIS CARE NEW YORK-Medicaid, +70704,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,FIDELIS CARE NEW YORK-Medicaid, +70705,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,FIDELIS CARE NEW YORK-Medicaid, +70706,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,FIDELIS CARE NEW YORK-Medicaid, +70707,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,FIDELIS CARE NEW YORK-Medicaid, +70708,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,FIDELIS CARE NEW YORK-Medicaid, +70709,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,FIDELIS CARE NEW YORK-Medicaid, +70710,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,FIDELIS CARE NEW YORK-Medicaid, +70711,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,FIDELIS CARE NEW YORK-Medicaid, +70712,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,FIDELIS CARE NEW YORK-Medicaid, +70713,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,FIDELIS CARE NEW YORK-Medicaid, +70714,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,FIDELIS CARE NEW YORK-Medicaid, +70715,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,FIDELIS CARE NEW YORK-Medicaid, +70716,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,FIDELIS CARE NEW YORK-Medicaid, +70717,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,FIDELIS CARE NEW YORK-Medicaid, +70718,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70719,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70720,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70721,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70722,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70723,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70724,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,FIDELIS CARE NEW YORK-Medicaid, +70725,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70726,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70727,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70728,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70729,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70730,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70731,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,FIDELIS CARE NEW YORK-Medicaid, +70732,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70733,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70734,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70735,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70736,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70737,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70738,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70739,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70740,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70741,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70742,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70743,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70744,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,FIDELIS CARE NEW YORK-Medicaid, +70745,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,FIDELIS CARE NEW YORK-Medicaid, +70746,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,FIDELIS CARE NEW YORK-Medicaid, +70747,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,FIDELIS CARE NEW YORK-Medicaid, +70748,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,FIDELIS CARE NEW YORK-Medicaid, +70749,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,FIDELIS CARE NEW YORK-Medicaid, +70750,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,FIDELIS CARE NEW YORK-Medicaid, +70751,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,FIDELIS CARE NEW YORK-Medicaid, +70752,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70753,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70754,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70755,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70756,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70757,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70758,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70759,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,FIDELIS CARE NEW YORK-Medicaid, +70760,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,FIDELIS CARE NEW YORK-Medicaid, +70761,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,FIDELIS CARE NEW YORK-Medicaid, +70762,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,FIDELIS CARE NEW YORK-Medicaid, +70763,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,FIDELIS CARE NEW YORK-Medicaid, +70764,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,FIDELIS CARE NEW YORK-Medicaid, +70765,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,FIDELIS CARE NEW YORK-Medicaid, +70766,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,FIDELIS CARE NEW YORK-Medicaid, +70767,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,FIDELIS CARE NEW YORK-Medicaid, +70768,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,FIDELIS CARE NEW YORK-Medicaid, +70769,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,FIDELIS CARE NEW YORK-Medicaid, +70770,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,FIDELIS CARE NEW YORK-Medicaid, +70771,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,FIDELIS CARE NEW YORK-Medicaid, +70772,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,FIDELIS CARE NEW YORK-Medicaid, +70773,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,FIDELIS CARE NEW YORK-Medicaid, +70774,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,FIDELIS CARE NEW YORK-Medicaid, +70775,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,FIDELIS CARE NEW YORK-Medicaid, +70776,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,FIDELIS CARE NEW YORK-Medicaid, +70777,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,FIDELIS CARE NEW YORK-Medicaid, +70778,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,FIDELIS CARE NEW YORK-Medicaid, +70779,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,FIDELIS CARE NEW YORK-Medicaid, +70780,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,FIDELIS CARE NEW YORK-Medicaid, +70781,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,FIDELIS CARE NEW YORK-Medicaid, +70782,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,FIDELIS CARE NEW YORK-Medicaid, +70783,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,FIDELIS CARE NEW YORK-Medicaid, +70784,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,FIDELIS CARE NEW YORK-Medicaid, +70785,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,FIDELIS CARE NEW YORK-Medicaid, +70786,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,FIDELIS CARE NEW YORK-Medicaid, +70787,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,FIDELIS CARE NEW YORK-Medicaid, +70788,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,FIDELIS CARE NEW YORK-Medicaid, +70789,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,FIDELIS CARE NEW YORK-Medicaid, +70790,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,FIDELIS CARE NEW YORK-Medicaid, +70791,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,FIDELIS CARE NEW YORK-Medicaid, +70792,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,FIDELIS CARE NEW YORK-Medicaid, +70793,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,FIDELIS CARE NEW YORK-Medicaid, +70794,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,FIDELIS CARE NEW YORK-Medicaid, +70795,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,FIDELIS CARE NEW YORK-Medicaid, +70796,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,FIDELIS CARE NEW YORK-Medicaid, +70797,3934,45924552,ENDO REC RM,,30.0,30.0,,,FIDELIS CARE NEW YORK-Medicaid, +70798,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,FIDELIS CARE NEW YORK-Medicaid, +70799,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,FIDELIS CARE NEW YORK-Medicaid, +70800,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,FIDELIS CARE NEW YORK-Medicaid, +70801,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,FIDELIS CARE NEW YORK-Medicaid, +70802,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,FIDELIS CARE NEW YORK-Medicaid, +70803,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,FIDELIS CARE NEW YORK-Medicaid, +70804,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,FIDELIS CARE NEW YORK-Medicaid, +70805,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,FIDELIS CARE NEW YORK-Medicaid, +70806,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,FIDELIS CARE NEW YORK-Medicaid, +70807,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,FIDELIS CARE NEW YORK-Medicaid, +70808,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,FIDELIS CARE NEW YORK-Medicaid, +70809,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,FIDELIS CARE NEW YORK-Medicaid, +70810,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,FIDELIS CARE NEW YORK-Medicaid, +70811,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,FIDELIS CARE NEW YORK-Medicaid, +70812,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,FIDELIS CARE NEW YORK-Medicaid, +70813,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,FIDELIS CARE NEW YORK-Medicaid, +70814,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,FIDELIS CARE NEW YORK-Medicaid, +70815,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,FIDELIS CARE NEW YORK-Medicaid, +70816,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,FIDELIS CARE NEW YORK-Medicaid, +70817,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,FIDELIS CARE NEW YORK-Medicaid, +70818,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,FIDELIS CARE NEW YORK-Medicaid, +70819,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,FIDELIS CARE NEW YORK-Medicaid, +70820,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,FIDELIS CARE NEW YORK-Medicaid, +70821,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,FIDELIS CARE NEW YORK-Medicaid, +70822,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,FIDELIS CARE NEW YORK-Medicaid, +70823,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,FIDELIS CARE NEW YORK-Medicaid, +70824,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicaid, +70825,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70826,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicaid, +70827,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicaid, +70828,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicaid, +70829,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicaid, +70830,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,FIDELIS CARE NEW YORK-Medicaid, +70831,3934,53200010,GUEST TRAY,,24.0,24.0,,,FIDELIS CARE NEW YORK-Medicaid, +70832,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,FIDELIS CARE NEW YORK-Medicaid, +70833,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,FIDELIS CARE NEW YORK-Medicaid, +70834,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,FIDELIS CARE NEW YORK-Medicaid, +70835,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,FIDELIS CARE NEW YORK-Medicaid, +70836,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,FIDELIS CARE NEW YORK-Medicaid, +70837,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,FIDELIS CARE NEW YORK-Medicaid, +70838,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,FIDELIS CARE NEW YORK-Medicaid, +70839,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,FIDELIS CARE NEW YORK-Medicaid, +70840,3934,53329876,HIV MONITORING,,416.0,416.0,,,FIDELIS CARE NEW YORK-Medicaid, +70841,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,FIDELIS CARE NEW YORK-Medicaid, +70842,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,FIDELIS CARE NEW YORK-Medicaid, +70843,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,FIDELIS CARE NEW YORK-Medicaid, +70844,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,FIDELIS CARE NEW YORK-Medicaid, +70845,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,FIDELIS CARE NEW YORK-Medicaid, +70846,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,FIDELIS CARE NEW YORK-Medicaid, +70847,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,FIDELIS CARE NEW YORK-Medicaid, +70848,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,FIDELIS CARE NEW YORK-Medicaid, +70849,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,FIDELIS CARE NEW YORK-Medicaid, +70850,3934,76010107,COPY X-RAY,,22.0,22.0,,,FIDELIS CARE NEW YORK-Medicaid, +70851,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,FIDELIS CARE NEW YORK-Medicaid, +70852,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,FIDELIS CARE NEW YORK-Medicaid, +70853,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,FIDELIS CARE NEW YORK-Medicaid, +70854,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,FIDELIS CARE NEW YORK-Medicaid, +70855,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,FIDELIS CARE NEW YORK-Medicaid, +70856,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,FIDELIS CARE NEW YORK-Medicaid, +70857,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,FIDELIS CARE NEW YORK-Medicaid, +70858,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,FIDELIS CARE NEW YORK-Medicaid, +70859,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,FIDELIS CARE NEW YORK-Medicaid, +70860,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,FIDELIS CARE NEW YORK-Medicaid, +70861,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,FIDELIS CARE NEW YORK-Medicaid, +70862,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,FIDELIS CARE NEW YORK-Medicaid, +70863,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,FIDELIS CARE NEW YORK-Medicare Advantage, +70864,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,FIDELIS CARE NEW YORK-Medicare Advantage, +70865,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,FIDELIS CARE NEW YORK-Medicare Advantage, +70866,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,FIDELIS CARE NEW YORK-Medicare Advantage, +70867,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70868,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,FIDELIS CARE NEW YORK-Medicare Advantage, +70869,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,FIDELIS CARE NEW YORK-Medicare Advantage, +70870,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,FIDELIS CARE NEW YORK-Medicare Advantage, +70871,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70872,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,FIDELIS CARE NEW YORK-Medicare Advantage, +70873,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,FIDELIS CARE NEW YORK-Medicare Advantage, +70874,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,FIDELIS CARE NEW YORK-Medicare Advantage, +70875,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,FIDELIS CARE NEW YORK-Medicare Advantage, +70876,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,FIDELIS CARE NEW YORK-Medicare Advantage, +70877,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,FIDELIS CARE NEW YORK-Medicare Advantage, +70878,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,FIDELIS CARE NEW YORK-Medicare Advantage, +70879,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,FIDELIS CARE NEW YORK-Medicare Advantage, +70880,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,FIDELIS CARE NEW YORK-Medicare Advantage, +70881,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,FIDELIS CARE NEW YORK-Medicare Advantage, +70882,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,FIDELIS CARE NEW YORK-Medicare Advantage, +70883,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,FIDELIS CARE NEW YORK-Medicare Advantage, +70884,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,FIDELIS CARE NEW YORK-Medicare Advantage, +70885,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70886,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70887,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70888,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70889,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,FIDELIS CARE NEW YORK-Medicare Advantage, +70890,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,FIDELIS CARE NEW YORK-Medicare Advantage, +70891,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,FIDELIS CARE NEW YORK-Medicare Advantage, +70892,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,FIDELIS CARE NEW YORK-Medicare Advantage, +70893,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,FIDELIS CARE NEW YORK-Medicare Advantage, +70894,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,FIDELIS CARE NEW YORK-Medicare Advantage, +70895,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,FIDELIS CARE NEW YORK-Medicare Advantage, +70896,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,FIDELIS CARE NEW YORK-Medicare Advantage, +70897,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,FIDELIS CARE NEW YORK-Medicare Advantage, +70898,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70899,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,FIDELIS CARE NEW YORK-Medicare Advantage, +70900,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,FIDELIS CARE NEW YORK-Medicare Advantage, +70901,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70902,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70903,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70904,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,FIDELIS CARE NEW YORK-Medicare Advantage, +70905,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,FIDELIS CARE NEW YORK-Medicare Advantage, +70906,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,FIDELIS CARE NEW YORK-Medicare Advantage, +70907,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,FIDELIS CARE NEW YORK-Medicare Advantage, +70908,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,FIDELIS CARE NEW YORK-Medicare Advantage, +70909,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,FIDELIS CARE NEW YORK-Medicare Advantage, +70910,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,FIDELIS CARE NEW YORK-Medicare Advantage, +70911,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70912,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70913,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,FIDELIS CARE NEW YORK-Medicare Advantage, +70914,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70915,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70916,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,FIDELIS CARE NEW YORK-Medicare Advantage, +70917,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,FIDELIS CARE NEW YORK-Medicare Advantage, +70918,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,FIDELIS CARE NEW YORK-Medicare Advantage, +70919,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70920,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,FIDELIS CARE NEW YORK-Medicare Advantage, +70921,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,FIDELIS CARE NEW YORK-Medicare Advantage, +70922,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70923,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,FIDELIS CARE NEW YORK-Medicare Advantage, +70924,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,FIDELIS CARE NEW YORK-Medicare Advantage, +70925,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,FIDELIS CARE NEW YORK-Medicare Advantage, +70926,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,FIDELIS CARE NEW YORK-Medicare Advantage, +70927,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,FIDELIS CARE NEW YORK-Medicare Advantage, +70928,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,FIDELIS CARE NEW YORK-Medicare Advantage, +70929,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70930,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70931,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70932,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,FIDELIS CARE NEW YORK-Medicare Advantage, +70933,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,FIDELIS CARE NEW YORK-Medicare Advantage, +70934,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,FIDELIS CARE NEW YORK-Medicare Advantage, +70935,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,FIDELIS CARE NEW YORK-Medicare Advantage, +70936,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,FIDELIS CARE NEW YORK-Medicare Advantage, +70937,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,FIDELIS CARE NEW YORK-Medicare Advantage, +70938,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,FIDELIS CARE NEW YORK-Medicare Advantage, +70939,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70940,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70941,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,FIDELIS CARE NEW YORK-Medicare Advantage, +70942,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,FIDELIS CARE NEW YORK-Medicare Advantage, +70943,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,FIDELIS CARE NEW YORK-Medicare Advantage, +70944,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,FIDELIS CARE NEW YORK-Medicare Advantage, +70945,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,FIDELIS CARE NEW YORK-Medicare Advantage, +70946,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,FIDELIS CARE NEW YORK-Medicare Advantage, +70947,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70948,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,FIDELIS CARE NEW YORK-Medicare Advantage, +70949,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,FIDELIS CARE NEW YORK-Medicare Advantage, +70950,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,FIDELIS CARE NEW YORK-Medicare Advantage, +70951,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,FIDELIS CARE NEW YORK-Medicare Advantage, +70952,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,FIDELIS CARE NEW YORK-Medicare Advantage, +70953,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70954,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,FIDELIS CARE NEW YORK-Medicare Advantage, +70955,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,FIDELIS CARE NEW YORK-Medicare Advantage, +70956,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70957,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,FIDELIS CARE NEW YORK-Medicare Advantage, +70958,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,FIDELIS CARE NEW YORK-Medicare Advantage, +70959,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70960,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70961,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70962,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70963,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,FIDELIS CARE NEW YORK-Medicare Advantage, +70964,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,FIDELIS CARE NEW YORK-Medicare Advantage, +70965,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70966,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70967,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,FIDELIS CARE NEW YORK-Medicare Advantage, +70968,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70969,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,FIDELIS CARE NEW YORK-Medicare Advantage, +70970,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,FIDELIS CARE NEW YORK-Medicare Advantage, +70971,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,FIDELIS CARE NEW YORK-Medicare Advantage, +70972,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70973,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70974,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70975,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,FIDELIS CARE NEW YORK-Medicare Advantage, +70976,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,FIDELIS CARE NEW YORK-Medicare Advantage, +70977,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70978,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,FIDELIS CARE NEW YORK-Medicare Advantage, +70979,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70980,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70981,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,FIDELIS CARE NEW YORK-Medicare Advantage, +70982,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,FIDELIS CARE NEW YORK-Medicare Advantage, +70983,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,FIDELIS CARE NEW YORK-Medicare Advantage, +70984,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,FIDELIS CARE NEW YORK-Medicare Advantage, +70985,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,FIDELIS CARE NEW YORK-Medicare Advantage, +70986,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,FIDELIS CARE NEW YORK-Medicare Advantage, +70987,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,FIDELIS CARE NEW YORK-Medicare Advantage, +70988,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,FIDELIS CARE NEW YORK-Medicare Advantage, +70989,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,FIDELIS CARE NEW YORK-Medicare Advantage, +70990,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,FIDELIS CARE NEW YORK-Medicare Advantage, +70991,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70992,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,FIDELIS CARE NEW YORK-Medicare Advantage, +70993,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70994,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,FIDELIS CARE NEW YORK-Medicare Advantage, +70995,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,FIDELIS CARE NEW YORK-Medicare Advantage, +70996,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,FIDELIS CARE NEW YORK-Medicare Advantage, +70997,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,FIDELIS CARE NEW YORK-Medicare Advantage, +70998,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,FIDELIS CARE NEW YORK-Medicare Advantage, +70999,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,FIDELIS CARE NEW YORK-Medicare Advantage, +71000,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71001,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71002,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71003,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,FIDELIS CARE NEW YORK-Medicare Advantage, +71004,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,FIDELIS CARE NEW YORK-Medicare Advantage, +71005,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71006,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71007,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71008,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71009,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71010,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71011,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,FIDELIS CARE NEW YORK-Medicare Advantage, +71012,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71013,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71014,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,FIDELIS CARE NEW YORK-Medicare Advantage, +71015,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,FIDELIS CARE NEW YORK-Medicare Advantage, +71016,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71017,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71018,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,FIDELIS CARE NEW YORK-Medicare Advantage, +71019,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,FIDELIS CARE NEW YORK-Medicare Advantage, +71020,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71021,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71022,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,FIDELIS CARE NEW YORK-Medicare Advantage, +71023,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71024,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,FIDELIS CARE NEW YORK-Medicare Advantage, +71025,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,FIDELIS CARE NEW YORK-Medicare Advantage, +71026,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71027,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71028,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,FIDELIS CARE NEW YORK-Medicare Advantage, +71029,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,FIDELIS CARE NEW YORK-Medicare Advantage, +71030,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71031,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71032,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,FIDELIS CARE NEW YORK-Medicare Advantage, +71033,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,FIDELIS CARE NEW YORK-Medicare Advantage, +71034,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71035,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,FIDELIS CARE NEW YORK-Medicare Advantage, +71036,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71037,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,FIDELIS CARE NEW YORK-Medicare Advantage, +71038,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,FIDELIS CARE NEW YORK-Medicare Advantage, +71039,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71040,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71041,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71042,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71043,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71044,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71045,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71046,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,FIDELIS CARE NEW YORK-Medicare Advantage, +71047,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71048,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,FIDELIS CARE NEW YORK-Medicare Advantage, +71049,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,FIDELIS CARE NEW YORK-Medicare Advantage, +71050,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,FIDELIS CARE NEW YORK-Medicare Advantage, +71051,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71052,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71053,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71054,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,FIDELIS CARE NEW YORK-Medicare Advantage, +71055,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,FIDELIS CARE NEW YORK-Medicare Advantage, +71056,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,FIDELIS CARE NEW YORK-Medicare Advantage, +71057,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,FIDELIS CARE NEW YORK-Medicare Advantage, +71058,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71059,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,FIDELIS CARE NEW YORK-Medicare Advantage, +71060,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71061,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71062,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71063,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71064,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71065,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,FIDELIS CARE NEW YORK-Medicare Advantage, +71066,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,FIDELIS CARE NEW YORK-Medicare Advantage, +71067,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,FIDELIS CARE NEW YORK-Medicare Advantage, +71068,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,FIDELIS CARE NEW YORK-Medicare Advantage, +71069,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71070,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71071,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71072,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71073,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71074,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,FIDELIS CARE NEW YORK-Medicare Advantage, +71075,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71076,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71077,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71078,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71079,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,FIDELIS CARE NEW YORK-Medicare Advantage, +71080,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71081,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71082,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,FIDELIS CARE NEW YORK-Medicare Advantage, +71083,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71084,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,FIDELIS CARE NEW YORK-Medicare Advantage, +71085,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71086,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71087,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,FIDELIS CARE NEW YORK-Medicare Advantage, +71088,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,FIDELIS CARE NEW YORK-Medicare Advantage, +71089,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,FIDELIS CARE NEW YORK-Medicare Advantage, +71090,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71091,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71092,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71093,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71094,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,FIDELIS CARE NEW YORK-Medicare Advantage, +71095,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,FIDELIS CARE NEW YORK-Medicare Advantage, +71096,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,FIDELIS CARE NEW YORK-Medicare Advantage, +71097,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71098,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,FIDELIS CARE NEW YORK-Medicare Advantage, +71099,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71100,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,FIDELIS CARE NEW YORK-Medicare Advantage, +71101,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71102,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71103,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71104,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,FIDELIS CARE NEW YORK-Medicare Advantage, +71105,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71106,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71107,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71108,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,FIDELIS CARE NEW YORK-Medicare Advantage, +71109,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71110,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,FIDELIS CARE NEW YORK-Medicare Advantage, +71111,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71112,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,FIDELIS CARE NEW YORK-Medicare Advantage, +71113,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,FIDELIS CARE NEW YORK-Medicare Advantage, +71114,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71115,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,FIDELIS CARE NEW YORK-Medicare Advantage, +71116,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,FIDELIS CARE NEW YORK-Medicare Advantage, +71117,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,FIDELIS CARE NEW YORK-Medicare Advantage, +71118,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71119,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71120,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,FIDELIS CARE NEW YORK-Medicare Advantage, +71121,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,FIDELIS CARE NEW YORK-Medicare Advantage, +71122,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71123,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71124,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71125,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71126,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71127,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71128,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71129,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71130,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71131,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,FIDELIS CARE NEW YORK-Medicare Advantage, +71132,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71133,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,FIDELIS CARE NEW YORK-Medicare Advantage, +71134,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,FIDELIS CARE NEW YORK-Medicare Advantage, +71135,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71136,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71137,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,FIDELIS CARE NEW YORK-Medicare Advantage, +71138,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71139,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71140,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,FIDELIS CARE NEW YORK-Medicare Advantage, +71141,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71142,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,FIDELIS CARE NEW YORK-Medicare Advantage, +71143,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,FIDELIS CARE NEW YORK-Medicare Advantage, +71144,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,FIDELIS CARE NEW YORK-Medicare Advantage, +71145,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71146,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,FIDELIS CARE NEW YORK-Medicare Advantage, +71147,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71148,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,FIDELIS CARE NEW YORK-Medicare Advantage, +71149,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71150,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,FIDELIS CARE NEW YORK-Medicare Advantage, +71151,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,FIDELIS CARE NEW YORK-Medicare Advantage, +71152,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71153,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71154,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71155,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71156,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,FIDELIS CARE NEW YORK-Medicare Advantage, +71157,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71158,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,FIDELIS CARE NEW YORK-Medicare Advantage, +71159,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71160,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71161,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71162,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,FIDELIS CARE NEW YORK-Medicare Advantage, +71163,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,FIDELIS CARE NEW YORK-Medicare Advantage, +71164,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,FIDELIS CARE NEW YORK-Medicare Advantage, +71165,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,FIDELIS CARE NEW YORK-Medicare Advantage, +71166,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71167,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71168,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,FIDELIS CARE NEW YORK-Medicare Advantage, +71169,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,FIDELIS CARE NEW YORK-Medicare Advantage, +71170,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,FIDELIS CARE NEW YORK-Medicare Advantage, +71171,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,FIDELIS CARE NEW YORK-Medicare Advantage, +71172,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,FIDELIS CARE NEW YORK-Medicare Advantage, +71173,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71174,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,FIDELIS CARE NEW YORK-Medicare Advantage, +71175,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,FIDELIS CARE NEW YORK-Medicare Advantage, +71176,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71177,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71178,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,FIDELIS CARE NEW YORK-Medicare Advantage, +71179,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,FIDELIS CARE NEW YORK-Medicare Advantage, +71180,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71181,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71182,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71183,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,FIDELIS CARE NEW YORK-Medicare Advantage, +71184,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71185,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,FIDELIS CARE NEW YORK-Medicare Advantage, +71186,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71187,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71188,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71189,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,FIDELIS CARE NEW YORK-Medicare Advantage, +71190,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,FIDELIS CARE NEW YORK-Medicare Advantage, +71191,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,FIDELIS CARE NEW YORK-Medicare Advantage, +71192,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,FIDELIS CARE NEW YORK-Medicare Advantage, +71193,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,FIDELIS CARE NEW YORK-Medicare Advantage, +71194,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,FIDELIS CARE NEW YORK-Medicare Advantage, +71195,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71196,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,FIDELIS CARE NEW YORK-Medicare Advantage, +71197,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,FIDELIS CARE NEW YORK-Medicare Advantage, +71198,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,FIDELIS CARE NEW YORK-Medicare Advantage, +71199,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,FIDELIS CARE NEW YORK-Medicare Advantage, +71200,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71201,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,FIDELIS CARE NEW YORK-Medicare Advantage, +71202,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,FIDELIS CARE NEW YORK-Medicare Advantage, +71203,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71204,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71205,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,FIDELIS CARE NEW YORK-Medicare Advantage, +71206,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,FIDELIS CARE NEW YORK-Medicare Advantage, +71207,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,FIDELIS CARE NEW YORK-Medicare Advantage, +71208,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71209,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,FIDELIS CARE NEW YORK-Medicare Advantage, +71210,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71211,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71212,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71213,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71214,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,FIDELIS CARE NEW YORK-Medicare Advantage, +71215,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71216,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,FIDELIS CARE NEW YORK-Medicare Advantage, +71217,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71218,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,FIDELIS CARE NEW YORK-Medicare Advantage, +71219,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,FIDELIS CARE NEW YORK-Medicare Advantage, +71220,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71221,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71222,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71223,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71224,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71225,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,FIDELIS CARE NEW YORK-Medicare Advantage, +71226,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,FIDELIS CARE NEW YORK-Medicare Advantage, +71227,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,FIDELIS CARE NEW YORK-Medicare Advantage, +71228,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,FIDELIS CARE NEW YORK-Medicare Advantage, +71229,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71230,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,FIDELIS CARE NEW YORK-Medicare Advantage, +71231,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71232,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71233,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,FIDELIS CARE NEW YORK-Medicare Advantage, +71234,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71235,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71236,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,FIDELIS CARE NEW YORK-Medicare Advantage, +71237,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,FIDELIS CARE NEW YORK-Medicare Advantage, +71238,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71239,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,FIDELIS CARE NEW YORK-Medicare Advantage, +71240,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,FIDELIS CARE NEW YORK-Medicare Advantage, +71241,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71242,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71243,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,FIDELIS CARE NEW YORK-Medicare Advantage, +71244,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71245,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71246,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71247,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71248,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71249,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,FIDELIS CARE NEW YORK-Medicare Advantage, +71250,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71251,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,FIDELIS CARE NEW YORK-Medicare Advantage, +71252,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71253,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,FIDELIS CARE NEW YORK-Medicare Advantage, +71254,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,FIDELIS CARE NEW YORK-Medicare Advantage, +71255,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71256,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71257,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,FIDELIS CARE NEW YORK-Medicare Advantage, +71258,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,FIDELIS CARE NEW YORK-Medicare Advantage, +71259,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71260,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71261,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71262,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71263,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,FIDELIS CARE NEW YORK-Medicare Advantage, +71264,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,FIDELIS CARE NEW YORK-Medicare Advantage, +71265,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71266,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,FIDELIS CARE NEW YORK-Medicare Advantage, +71267,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71268,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71269,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71270,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71271,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,FIDELIS CARE NEW YORK-Medicare Advantage, +71272,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,FIDELIS CARE NEW YORK-Medicare Advantage, +71273,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71274,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71275,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71276,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,FIDELIS CARE NEW YORK-Medicare Advantage, +71277,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71278,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,FIDELIS CARE NEW YORK-Medicare Advantage, +71279,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,FIDELIS CARE NEW YORK-Medicare Advantage, +71280,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,FIDELIS CARE NEW YORK-Medicare Advantage, +71281,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71282,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,FIDELIS CARE NEW YORK-Medicare Advantage, +71283,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71284,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71285,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,FIDELIS CARE NEW YORK-Medicare Advantage, +71286,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71287,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71288,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71289,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,FIDELIS CARE NEW YORK-Medicare Advantage, +71290,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71291,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71292,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71293,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71294,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,FIDELIS CARE NEW YORK-Medicare Advantage, +71295,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71296,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71297,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,FIDELIS CARE NEW YORK-Medicare Advantage, +71298,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71299,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,FIDELIS CARE NEW YORK-Medicare Advantage, +71300,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71301,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71302,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,FIDELIS CARE NEW YORK-Medicare Advantage, +71303,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71304,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71305,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,FIDELIS CARE NEW YORK-Medicare Advantage, +71306,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71307,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71308,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71309,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71310,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71311,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71312,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71313,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,FIDELIS CARE NEW YORK-Medicare Advantage, +71314,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,FIDELIS CARE NEW YORK-Medicare Advantage, +71315,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71316,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71317,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71318,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,FIDELIS CARE NEW YORK-Medicare Advantage, +71319,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71320,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71321,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,FIDELIS CARE NEW YORK-Medicare Advantage, +71322,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,FIDELIS CARE NEW YORK-Medicare Advantage, +71323,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71324,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71325,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,FIDELIS CARE NEW YORK-Medicare Advantage, +71326,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,FIDELIS CARE NEW YORK-Medicare Advantage, +71327,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,FIDELIS CARE NEW YORK-Medicare Advantage, +71328,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71329,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,FIDELIS CARE NEW YORK-Medicare Advantage, +71330,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71331,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,FIDELIS CARE NEW YORK-Medicare Advantage, +71332,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71333,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71334,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71335,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,FIDELIS CARE NEW YORK-Medicare Advantage, +71336,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,FIDELIS CARE NEW YORK-Medicare Advantage, +71337,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71338,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71339,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,FIDELIS CARE NEW YORK-Medicare Advantage, +71340,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,FIDELIS CARE NEW YORK-Medicare Advantage, +71341,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,FIDELIS CARE NEW YORK-Medicare Advantage, +71342,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,FIDELIS CARE NEW YORK-Medicare Advantage, +71343,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71344,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71345,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,FIDELIS CARE NEW YORK-Medicare Advantage, +71346,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,FIDELIS CARE NEW YORK-Medicare Advantage, +71347,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71348,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71349,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,FIDELIS CARE NEW YORK-Medicare Advantage, +71350,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71351,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71352,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71353,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,FIDELIS CARE NEW YORK-Medicare Advantage, +71354,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,FIDELIS CARE NEW YORK-Medicare Advantage, +71355,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71356,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,FIDELIS CARE NEW YORK-Medicare Advantage, +71357,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71358,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,FIDELIS CARE NEW YORK-Medicare Advantage, +71359,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,FIDELIS CARE NEW YORK-Medicare Advantage, +71360,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,FIDELIS CARE NEW YORK-Medicare Advantage, +71361,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71362,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,FIDELIS CARE NEW YORK-Medicare Advantage, +71363,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,FIDELIS CARE NEW YORK-Medicare Advantage, +71364,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,FIDELIS CARE NEW YORK-Medicare Advantage, +71365,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,FIDELIS CARE NEW YORK-Medicare Advantage, +71366,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71367,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,FIDELIS CARE NEW YORK-Medicare Advantage, +71368,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71369,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,FIDELIS CARE NEW YORK-Medicare Advantage, +71370,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71371,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,FIDELIS CARE NEW YORK-Medicare Advantage, +71372,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71373,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,FIDELIS CARE NEW YORK-Medicare Advantage, +71374,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71375,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71376,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71377,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71378,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71379,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,FIDELIS CARE NEW YORK-Medicare Advantage, +71380,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71381,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71382,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71383,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71384,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,FIDELIS CARE NEW YORK-Medicare Advantage, +71385,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71386,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71387,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71388,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,FIDELIS CARE NEW YORK-Medicare Advantage, +71389,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71390,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71391,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71392,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,FIDELIS CARE NEW YORK-Medicare Advantage, +71393,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,FIDELIS CARE NEW YORK-Medicare Advantage, +71394,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,FIDELIS CARE NEW YORK-Medicare Advantage, +71395,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71396,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71397,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71398,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71399,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,FIDELIS CARE NEW YORK-Medicare Advantage, +71400,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71401,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71402,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,FIDELIS CARE NEW YORK-Medicare Advantage, +71403,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,FIDELIS CARE NEW YORK-Medicare Advantage, +71404,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71405,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,FIDELIS CARE NEW YORK-Medicare Advantage, +71406,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71407,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71408,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71409,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71410,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71411,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,FIDELIS CARE NEW YORK-Medicare Advantage, +71412,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71413,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,FIDELIS CARE NEW YORK-Medicare Advantage, +71414,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71415,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71416,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71417,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71418,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,FIDELIS CARE NEW YORK-Medicare Advantage, +71419,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,FIDELIS CARE NEW YORK-Medicare Advantage, +71420,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71421,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71422,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,FIDELIS CARE NEW YORK-Medicare Advantage, +71423,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71424,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,FIDELIS CARE NEW YORK-Medicare Advantage, +71425,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,FIDELIS CARE NEW YORK-Medicare Advantage, +71426,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71427,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71428,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71429,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,FIDELIS CARE NEW YORK-Medicare Advantage, +71430,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71431,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,FIDELIS CARE NEW YORK-Medicare Advantage, +71432,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,FIDELIS CARE NEW YORK-Medicare Advantage, +71433,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71434,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,FIDELIS CARE NEW YORK-Medicare Advantage, +71435,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71436,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71437,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,FIDELIS CARE NEW YORK-Medicare Advantage, +71438,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,FIDELIS CARE NEW YORK-Medicare Advantage, +71439,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,FIDELIS CARE NEW YORK-Medicare Advantage, +71440,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,FIDELIS CARE NEW YORK-Medicare Advantage, +71441,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71442,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,FIDELIS CARE NEW YORK-Medicare Advantage, +71443,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71444,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,FIDELIS CARE NEW YORK-Medicare Advantage, +71445,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71446,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71447,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71448,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71449,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,FIDELIS CARE NEW YORK-Medicare Advantage, +71450,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71451,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,FIDELIS CARE NEW YORK-Medicare Advantage, +71452,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,FIDELIS CARE NEW YORK-Medicare Advantage, +71453,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,FIDELIS CARE NEW YORK-Medicare Advantage, +71454,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71455,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,FIDELIS CARE NEW YORK-Medicare Advantage, +71456,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71457,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71458,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71459,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71460,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,FIDELIS CARE NEW YORK-Medicare Advantage, +71461,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,FIDELIS CARE NEW YORK-Medicare Advantage, +71462,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71463,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,FIDELIS CARE NEW YORK-Medicare Advantage, +71464,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71465,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,FIDELIS CARE NEW YORK-Medicare Advantage, +71466,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71467,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71468,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71469,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,FIDELIS CARE NEW YORK-Medicare Advantage, +71470,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71471,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71472,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71473,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71474,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71475,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,FIDELIS CARE NEW YORK-Medicare Advantage, +71476,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,FIDELIS CARE NEW YORK-Medicare Advantage, +71477,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,FIDELIS CARE NEW YORK-Medicare Advantage, +71478,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71479,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,FIDELIS CARE NEW YORK-Medicare Advantage, +71480,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,FIDELIS CARE NEW YORK-Medicare Advantage, +71481,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,FIDELIS CARE NEW YORK-Medicare Advantage, +71482,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71483,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,FIDELIS CARE NEW YORK-Medicare Advantage, +71484,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71485,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71486,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,FIDELIS CARE NEW YORK-Medicare Advantage, +71487,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71488,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71489,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71490,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,FIDELIS CARE NEW YORK-Medicare Advantage, +71491,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71492,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71493,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,FIDELIS CARE NEW YORK-Medicare Advantage, +71494,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71495,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,FIDELIS CARE NEW YORK-Medicare Advantage, +71496,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71497,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71498,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71499,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,FIDELIS CARE NEW YORK-Medicare Advantage, +71500,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,FIDELIS CARE NEW YORK-Medicare Advantage, +71501,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,FIDELIS CARE NEW YORK-Medicare Advantage, +71502,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,FIDELIS CARE NEW YORK-Medicare Advantage, +71503,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,FIDELIS CARE NEW YORK-Medicare Advantage, +71504,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,FIDELIS CARE NEW YORK-Medicare Advantage, +71505,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71506,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71507,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,FIDELIS CARE NEW YORK-Medicare Advantage, +71508,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,FIDELIS CARE NEW YORK-Medicare Advantage, +71509,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71510,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,FIDELIS CARE NEW YORK-Medicare Advantage, +71511,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71512,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,FIDELIS CARE NEW YORK-Medicare Advantage, +71513,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,FIDELIS CARE NEW YORK-Medicare Advantage, +71514,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71515,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71516,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71517,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71518,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,FIDELIS CARE NEW YORK-Medicare Advantage, +71519,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71520,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71521,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71522,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71523,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71524,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,FIDELIS CARE NEW YORK-Medicare Advantage, +71525,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71526,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71527,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71528,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,FIDELIS CARE NEW YORK-Medicare Advantage,211.69 +71529,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71530,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71531,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71532,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71533,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71534,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71535,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,FIDELIS CARE NEW YORK-Medicare Advantage, +71536,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,FIDELIS CARE NEW YORK-Medicare Advantage, +71537,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,FIDELIS CARE NEW YORK-Medicare Advantage, +71538,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71539,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71540,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71541,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71542,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71543,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71544,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71545,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,FIDELIS CARE NEW YORK-Medicare Advantage, +71546,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,FIDELIS CARE NEW YORK-Medicare Advantage, +71547,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,FIDELIS CARE NEW YORK-Medicare Advantage, +71548,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71549,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,FIDELIS CARE NEW YORK-Medicare Advantage, +71550,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71551,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71552,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71553,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71554,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71555,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,FIDELIS CARE NEW YORK-Medicare Advantage, +71556,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71557,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71558,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,FIDELIS CARE NEW YORK-Medicare Advantage, +71559,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,FIDELIS CARE NEW YORK-Medicare Advantage, +71560,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71561,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,FIDELIS CARE NEW YORK-Medicare Advantage, +71562,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71563,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71564,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71565,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71566,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71567,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,FIDELIS CARE NEW YORK-Medicare Advantage, +71568,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71569,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71570,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71571,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71572,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71573,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71574,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71575,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71576,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71577,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71578,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71579,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,FIDELIS CARE NEW YORK-Medicare Advantage, +71580,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,FIDELIS CARE NEW YORK-Medicare Advantage, +71581,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71582,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,FIDELIS CARE NEW YORK-Medicare Advantage, +71583,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71584,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71585,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71586,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,FIDELIS CARE NEW YORK-Medicare Advantage, +71587,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71588,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71589,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71590,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71591,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71592,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,FIDELIS CARE NEW YORK-Medicare Advantage, +71593,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71594,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71595,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71596,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71597,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,FIDELIS CARE NEW YORK-Medicare Advantage, +71598,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71599,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,FIDELIS CARE NEW YORK-Medicare Advantage, +71600,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71601,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,FIDELIS CARE NEW YORK-Medicare Advantage, +71602,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,FIDELIS CARE NEW YORK-Medicare Advantage, +71603,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71604,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71605,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71606,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71607,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71608,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71609,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71610,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71611,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71612,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71613,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,FIDELIS CARE NEW YORK-Medicare Advantage, +71614,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71615,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71616,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,FIDELIS CARE NEW YORK-Medicare Advantage, +71617,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71618,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71619,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,FIDELIS CARE NEW YORK-Medicare Advantage, +71620,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,FIDELIS CARE NEW YORK-Medicare Advantage,602.14 +71621,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71622,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,FIDELIS CARE NEW YORK-Medicare Advantage, +71623,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71624,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71625,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,FIDELIS CARE NEW YORK-Medicare Advantage, +71626,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,FIDELIS CARE NEW YORK-Medicare Advantage, +71627,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71628,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71629,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71630,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71631,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71632,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,FIDELIS CARE NEW YORK-Medicare Advantage, +71633,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,FIDELIS CARE NEW YORK-Medicare Advantage, +71634,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,FIDELIS CARE NEW YORK-Medicare Advantage, +71635,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71636,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71637,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71638,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71639,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71640,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71641,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71642,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71643,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,FIDELIS CARE NEW YORK-Medicare Advantage, +71644,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71645,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71646,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71647,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,FIDELIS CARE NEW YORK-Medicare Advantage, +71648,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,FIDELIS CARE NEW YORK-Medicare Advantage, +71649,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71650,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71651,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71652,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71653,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,FIDELIS CARE NEW YORK-Medicare Advantage, +71654,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71655,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71656,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71657,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71658,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71659,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,FIDELIS CARE NEW YORK-Medicare Advantage, +71660,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,FIDELIS CARE NEW YORK-Medicare Advantage, +71661,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71662,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,FIDELIS CARE NEW YORK-Medicare Advantage, +71663,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71664,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71665,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71666,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71667,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71668,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,FIDELIS CARE NEW YORK-Medicare Advantage, +71669,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71670,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71671,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,FIDELIS CARE NEW YORK-Medicare Advantage, +71672,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71673,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71674,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71675,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71676,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71677,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,FIDELIS CARE NEW YORK-Medicare Advantage, +71678,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,FIDELIS CARE NEW YORK-Medicare Advantage, +71679,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71680,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,FIDELIS CARE NEW YORK-Medicare Advantage, +71681,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71682,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,FIDELIS CARE NEW YORK-Medicare Advantage, +71683,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71684,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71685,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71686,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71687,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71688,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71689,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,FIDELIS CARE NEW YORK-Medicare Advantage, +71690,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,FIDELIS CARE NEW YORK-Medicare Advantage, +71691,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71692,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,FIDELIS CARE NEW YORK-Medicare Advantage, +71693,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71694,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71695,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,FIDELIS CARE NEW YORK-Medicare Advantage,194.75 +71696,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71697,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71698,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71699,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,FIDELIS CARE NEW YORK-Medicare Advantage, +71700,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71701,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,FIDELIS CARE NEW YORK-Medicare Advantage,3697.52 +71702,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71703,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71704,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71705,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71706,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71707,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71708,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71709,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71710,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71711,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71712,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,FIDELIS CARE NEW YORK-Medicare Advantage, +71713,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71714,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71715,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,FIDELIS CARE NEW YORK-Medicare Advantage, +71716,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71717,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,FIDELIS CARE NEW YORK-Medicare Advantage, +71718,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,FIDELIS CARE NEW YORK-Medicare Advantage, +71719,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71720,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,FIDELIS CARE NEW YORK-Medicare Advantage, +71721,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,FIDELIS CARE NEW YORK-Medicare Advantage, +71722,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,FIDELIS CARE NEW YORK-Medicare Advantage, +71723,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,FIDELIS CARE NEW YORK-Medicare Advantage, +71724,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71725,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,FIDELIS CARE NEW YORK-Medicare Advantage, +71726,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71727,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71728,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71729,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71730,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71731,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71732,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71733,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71734,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,FIDELIS CARE NEW YORK-Medicare Advantage, +71735,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71736,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71737,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71738,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71739,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,FIDELIS CARE NEW YORK-Medicare Advantage, +71740,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71741,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71742,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,FIDELIS CARE NEW YORK-Medicare Advantage, +71743,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71744,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71745,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71746,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71747,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71748,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71749,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71750,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71751,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71752,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71753,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71754,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71755,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,FIDELIS CARE NEW YORK-Medicare Advantage, +71756,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,FIDELIS CARE NEW YORK-Medicare Advantage, +71757,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71758,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,FIDELIS CARE NEW YORK-Medicare Advantage,7247.13 +71759,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,FIDELIS CARE NEW YORK-Medicare Advantage, +71760,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71761,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,FIDELIS CARE NEW YORK-Medicare Advantage, +71762,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71763,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71764,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,FIDELIS CARE NEW YORK-Medicare Advantage, +71765,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71766,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71767,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71768,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71769,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71770,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,FIDELIS CARE NEW YORK-Medicare Advantage, +71771,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71772,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,FIDELIS CARE NEW YORK-Medicare Advantage, +71773,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71774,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71775,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71776,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71777,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,FIDELIS CARE NEW YORK-Medicare Advantage, +71778,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,FIDELIS CARE NEW YORK-Medicare Advantage, +71779,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71780,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71781,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,FIDELIS CARE NEW YORK-Medicare Advantage, +71782,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,FIDELIS CARE NEW YORK-Medicare Advantage, +71783,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,FIDELIS CARE NEW YORK-Medicare Advantage, +71784,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71785,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,FIDELIS CARE NEW YORK-Medicare Advantage, +71786,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71787,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,FIDELIS CARE NEW YORK-Medicare Advantage, +71788,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,FIDELIS CARE NEW YORK-Medicare Advantage, +71789,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71790,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,FIDELIS CARE NEW YORK-Medicare Advantage, +71791,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,FIDELIS CARE NEW YORK-Medicare Advantage, +71792,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,FIDELIS CARE NEW YORK-Medicare Advantage, +71793,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71794,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,FIDELIS CARE NEW YORK-Medicare Advantage, +71795,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71796,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71797,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71798,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71799,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71800,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71801,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71802,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71803,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71804,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,FIDELIS CARE NEW YORK-Medicare Advantage, +71805,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,FIDELIS CARE NEW YORK-Medicare Advantage, +71806,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71807,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71808,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71809,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,FIDELIS CARE NEW YORK-Medicare Advantage, +71810,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,FIDELIS CARE NEW YORK-Medicare Advantage, +71811,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,FIDELIS CARE NEW YORK-Medicare Advantage, +71812,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,FIDELIS CARE NEW YORK-Medicare Advantage, +71813,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71814,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,FIDELIS CARE NEW YORK-Medicare Advantage, +71815,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,FIDELIS CARE NEW YORK-Medicare Advantage, +71816,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71817,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,FIDELIS CARE NEW YORK-Medicare Advantage, +71818,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,FIDELIS CARE NEW YORK-Medicare Advantage, +71819,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71820,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,FIDELIS CARE NEW YORK-Medicare Advantage, +71821,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71822,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71823,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71824,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,FIDELIS CARE NEW YORK-Medicare Advantage, +71825,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,FIDELIS CARE NEW YORK-Medicare Advantage, +71826,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,FIDELIS CARE NEW YORK-Medicare Advantage, +71827,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,FIDELIS CARE NEW YORK-Medicare Advantage, +71828,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71829,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71830,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,FIDELIS CARE NEW YORK-Medicare Advantage, +71831,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71832,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71833,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71834,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,FIDELIS CARE NEW YORK-Medicare Advantage, +71835,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71836,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,FIDELIS CARE NEW YORK-Medicare Advantage, +71837,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71838,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,FIDELIS CARE NEW YORK-Medicare Advantage,261.25 +71839,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71840,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71841,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71842,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,FIDELIS CARE NEW YORK-Medicare Advantage, +71843,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71844,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71845,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71846,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,FIDELIS CARE NEW YORK-Medicare Advantage, +71847,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,FIDELIS CARE NEW YORK-Medicare Advantage, +71848,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71849,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71850,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,FIDELIS CARE NEW YORK-Medicare Advantage, +71851,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71852,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71853,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,FIDELIS CARE NEW YORK-Medicare Advantage, +71854,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,FIDELIS CARE NEW YORK-Medicare Advantage, +71855,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71856,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71857,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71858,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,FIDELIS CARE NEW YORK-Medicare Advantage, +71859,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,FIDELIS CARE NEW YORK-Medicare Advantage, +71860,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,FIDELIS CARE NEW YORK-Medicare Advantage, +71861,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71862,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,FIDELIS CARE NEW YORK-Medicare Advantage, +71863,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,FIDELIS CARE NEW YORK-Medicare Advantage, +71864,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71865,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,FIDELIS CARE NEW YORK-Medicare Advantage, +71866,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,FIDELIS CARE NEW YORK-Medicare Advantage, +71867,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71868,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71869,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71870,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71871,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71872,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71873,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,FIDELIS CARE NEW YORK-Medicare Advantage, +71874,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,FIDELIS CARE NEW YORK-Medicare Advantage, +71875,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,FIDELIS CARE NEW YORK-Medicare Advantage, +71876,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71877,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71878,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71879,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71880,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,FIDELIS CARE NEW YORK-Medicare Advantage, +71881,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71882,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,FIDELIS CARE NEW YORK-Medicare Advantage, +71883,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,FIDELIS CARE NEW YORK-Medicare Advantage, +71884,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,FIDELIS CARE NEW YORK-Medicare Advantage, +71885,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71886,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71887,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71888,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71889,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71890,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,FIDELIS CARE NEW YORK-Medicare Advantage, +71891,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71892,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71893,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,FIDELIS CARE NEW YORK-Medicare Advantage, +71894,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71895,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71896,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71897,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71898,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71899,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71900,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71901,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,FIDELIS CARE NEW YORK-Medicare Advantage, +71902,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,FIDELIS CARE NEW YORK-Medicare Advantage, +71903,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,FIDELIS CARE NEW YORK-Medicare Advantage, +71904,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71905,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71906,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,FIDELIS CARE NEW YORK-Medicare Advantage, +71907,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,FIDELIS CARE NEW YORK-Medicare Advantage, +71908,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71909,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,FIDELIS CARE NEW YORK-Medicare Advantage, +71910,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71911,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,FIDELIS CARE NEW YORK-Medicare Advantage, +71912,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71913,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,FIDELIS CARE NEW YORK-Medicare Advantage, +71914,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71915,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,FIDELIS CARE NEW YORK-Medicare Advantage, +71916,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71917,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,FIDELIS CARE NEW YORK-Medicare Advantage,1642.05 +71918,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,FIDELIS CARE NEW YORK-Medicare Advantage, +71919,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,FIDELIS CARE NEW YORK-Medicare Advantage, +71920,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71921,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71922,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71923,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,FIDELIS CARE NEW YORK-Medicare Advantage, +71924,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71925,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71926,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,FIDELIS CARE NEW YORK-Medicare Advantage, +71927,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71928,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71929,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,FIDELIS CARE NEW YORK-Medicare Advantage, +71930,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,FIDELIS CARE NEW YORK-Medicare Advantage, +71931,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71932,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71933,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,FIDELIS CARE NEW YORK-Medicare Advantage, +71934,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71935,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71936,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,FIDELIS CARE NEW YORK-Medicare Advantage, +71937,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71938,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71939,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71940,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71941,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71942,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +71943,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,FIDELIS CARE NEW YORK-Medicare Advantage, +71944,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71945,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,FIDELIS CARE NEW YORK-Medicare Advantage, +71946,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71947,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71948,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71949,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,FIDELIS CARE NEW YORK-Medicare Advantage, +71950,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71951,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,FIDELIS CARE NEW YORK-Medicare Advantage, +71952,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71953,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71954,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,FIDELIS CARE NEW YORK-Medicare Advantage, +71955,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71956,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,FIDELIS CARE NEW YORK-Medicare Advantage, +71957,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,FIDELIS CARE NEW YORK-Medicare Advantage, +71958,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,FIDELIS CARE NEW YORK-Medicare Advantage, +71959,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71960,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,FIDELIS CARE NEW YORK-Medicare Advantage, +71961,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71962,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71963,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71964,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71965,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71966,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71967,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,FIDELIS CARE NEW YORK-Medicare Advantage, +71968,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71969,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,FIDELIS CARE NEW YORK-Medicare Advantage,3150.32 +71970,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71971,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +71972,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,FIDELIS CARE NEW YORK-Medicare Advantage, +71973,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71974,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71975,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,FIDELIS CARE NEW YORK-Medicare Advantage, +71976,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71977,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71978,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,FIDELIS CARE NEW YORK-Medicare Advantage, +71979,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71980,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71981,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,FIDELIS CARE NEW YORK-Medicare Advantage, +71982,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,FIDELIS CARE NEW YORK-Medicare Advantage, +71983,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71984,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,FIDELIS CARE NEW YORK-Medicare Advantage, +71985,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71986,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,FIDELIS CARE NEW YORK-Medicare Advantage, +71987,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71988,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71989,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,FIDELIS CARE NEW YORK-Medicare Advantage, +71990,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,FIDELIS CARE NEW YORK-Medicare Advantage, +71991,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,FIDELIS CARE NEW YORK-Medicare Advantage, +71992,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,FIDELIS CARE NEW YORK-Medicare Advantage, +71993,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,FIDELIS CARE NEW YORK-Medicare Advantage, +71994,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,FIDELIS CARE NEW YORK-Medicare Advantage, +71995,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,FIDELIS CARE NEW YORK-Medicare Advantage, +71996,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,FIDELIS CARE NEW YORK-Medicare Advantage, +71997,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,FIDELIS CARE NEW YORK-Medicare Advantage, +71998,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,FIDELIS CARE NEW YORK-Medicare Advantage, +71999,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,FIDELIS CARE NEW YORK-Medicare Advantage, +72000,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72001,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,FIDELIS CARE NEW YORK-Medicare Advantage, +72002,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72003,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72004,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72005,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72006,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72007,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72008,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72009,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72010,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72011,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,FIDELIS CARE NEW YORK-Medicare Advantage, +72012,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72013,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72014,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72015,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72016,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72017,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,FIDELIS CARE NEW YORK-Medicare Advantage, +72018,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72019,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,FIDELIS CARE NEW YORK-Medicare Advantage, +72020,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,FIDELIS CARE NEW YORK-Medicare Advantage, +72021,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,FIDELIS CARE NEW YORK-Medicare Advantage, +72022,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,FIDELIS CARE NEW YORK-Medicare Advantage, +72023,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72024,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72025,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,FIDELIS CARE NEW YORK-Medicare Advantage, +72026,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,FIDELIS CARE NEW YORK-Medicare Advantage, +72027,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,FIDELIS CARE NEW YORK-Medicare Advantage, +72028,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,FIDELIS CARE NEW YORK-Medicare Advantage, +72029,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,FIDELIS CARE NEW YORK-Medicare Advantage, +72030,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,FIDELIS CARE NEW YORK-Medicare Advantage, +72031,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72032,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72033,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,FIDELIS CARE NEW YORK-Medicare Advantage, +72034,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,FIDELIS CARE NEW YORK-Medicare Advantage, +72035,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72036,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72037,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72038,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,FIDELIS CARE NEW YORK-Medicare Advantage, +72039,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72040,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72041,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72042,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72043,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,FIDELIS CARE NEW YORK-Medicare Advantage, +72044,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,FIDELIS CARE NEW YORK-Medicare Advantage, +72045,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72046,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72047,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,FIDELIS CARE NEW YORK-Medicare Advantage, +72048,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72049,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72050,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72051,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72052,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72053,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72054,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72055,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72056,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72057,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72058,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72059,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,FIDELIS CARE NEW YORK-Medicare Advantage, +72060,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72061,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72062,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,FIDELIS CARE NEW YORK-Medicare Advantage, +72063,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,FIDELIS CARE NEW YORK-Medicare Advantage, +72064,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72065,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72066,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72067,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,FIDELIS CARE NEW YORK-Medicare Advantage, +72068,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72069,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,FIDELIS CARE NEW YORK-Medicare Advantage, +72070,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72071,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,FIDELIS CARE NEW YORK-Medicare Advantage, +72072,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72073,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72074,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,FIDELIS CARE NEW YORK-Medicare Advantage, +72075,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72076,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72077,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72078,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72079,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72080,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,FIDELIS CARE NEW YORK-Medicare Advantage, +72081,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72082,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,FIDELIS CARE NEW YORK-Medicare Advantage, +72083,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72084,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72085,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,FIDELIS CARE NEW YORK-Medicare Advantage, +72086,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72087,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72088,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72089,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,FIDELIS CARE NEW YORK-Medicare Advantage, +72090,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72091,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,FIDELIS CARE NEW YORK-Medicare Advantage, +72092,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,FIDELIS CARE NEW YORK-Medicare Advantage, +72093,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,FIDELIS CARE NEW YORK-Medicare Advantage, +72094,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72095,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72096,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72097,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72098,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72099,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72100,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72101,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,FIDELIS CARE NEW YORK-Medicare Advantage, +72102,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72103,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,FIDELIS CARE NEW YORK-Medicare Advantage, +72104,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72105,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72106,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,FIDELIS CARE NEW YORK-Medicare Advantage, +72107,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72108,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,FIDELIS CARE NEW YORK-Medicare Advantage, +72109,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72110,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72111,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,FIDELIS CARE NEW YORK-Medicare Advantage, +72112,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72113,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72114,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72115,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,FIDELIS CARE NEW YORK-Medicare Advantage, +72116,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72117,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72118,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,FIDELIS CARE NEW YORK-Medicare Advantage, +72119,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,FIDELIS CARE NEW YORK-Medicare Advantage, +72120,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72121,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72122,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,FIDELIS CARE NEW YORK-Medicare Advantage, +72123,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,FIDELIS CARE NEW YORK-Medicare Advantage, +72124,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,FIDELIS CARE NEW YORK-Medicare Advantage, +72125,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72126,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72127,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,FIDELIS CARE NEW YORK-Medicare Advantage, +72128,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72129,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72130,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,FIDELIS CARE NEW YORK-Medicare Advantage, +72131,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72132,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,FIDELIS CARE NEW YORK-Medicare Advantage, +72133,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72134,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,FIDELIS CARE NEW YORK-Medicare Advantage, +72135,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72136,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72137,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72138,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,FIDELIS CARE NEW YORK-Medicare Advantage, +72139,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,FIDELIS CARE NEW YORK-Medicare Advantage,3316.42 +72140,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72141,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72142,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72143,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,FIDELIS CARE NEW YORK-Medicare Advantage, +72144,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,FIDELIS CARE NEW YORK-Medicare Advantage, +72145,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage,162.03 +72146,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72147,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,FIDELIS CARE NEW YORK-Medicare Advantage, +72148,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,FIDELIS CARE NEW YORK-Medicare Advantage, +72149,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72150,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72151,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,FIDELIS CARE NEW YORK-Medicare Advantage, +72152,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72153,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72154,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72155,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72156,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72157,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,FIDELIS CARE NEW YORK-Medicare Advantage, +72158,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,FIDELIS CARE NEW YORK-Medicare Advantage, +72159,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72160,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72161,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72162,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,FIDELIS CARE NEW YORK-Medicare Advantage, +72163,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72164,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72165,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72166,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72167,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,FIDELIS CARE NEW YORK-Medicare Advantage, +72168,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,FIDELIS CARE NEW YORK-Medicare Advantage, +72169,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72170,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,FIDELIS CARE NEW YORK-Medicare Advantage, +72171,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72172,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72173,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72174,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72175,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72176,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72177,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72178,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72179,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72180,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72181,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72182,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72183,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72184,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72185,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72186,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,FIDELIS CARE NEW YORK-Medicare Advantage, +72187,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72188,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72189,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72190,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,FIDELIS CARE NEW YORK-Medicare Advantage, +72191,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72192,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72193,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72194,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72195,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72196,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72197,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,FIDELIS CARE NEW YORK-Medicare Advantage, +72198,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,FIDELIS CARE NEW YORK-Medicare Advantage, +72199,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72200,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72201,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72202,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,FIDELIS CARE NEW YORK-Medicare Advantage, +72203,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72204,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72205,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,FIDELIS CARE NEW YORK-Medicare Advantage, +72206,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72207,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72208,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72209,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72210,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,FIDELIS CARE NEW YORK-Medicare Advantage, +72211,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,FIDELIS CARE NEW YORK-Medicare Advantage, +72212,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72213,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72214,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72215,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72216,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72217,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72218,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72219,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72220,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72221,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,FIDELIS CARE NEW YORK-Medicare Advantage, +72222,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72223,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,FIDELIS CARE NEW YORK-Medicare Advantage, +72224,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72225,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72226,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72227,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,FIDELIS CARE NEW YORK-Medicare Advantage, +72228,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,FIDELIS CARE NEW YORK-Medicare Advantage, +72229,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,FIDELIS CARE NEW YORK-Medicare Advantage, +72230,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72231,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72232,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,FIDELIS CARE NEW YORK-Medicare Advantage, +72233,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72234,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,FIDELIS CARE NEW YORK-Medicare Advantage, +72235,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,FIDELIS CARE NEW YORK-Medicare Advantage, +72236,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72237,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72238,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72239,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72240,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72241,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,FIDELIS CARE NEW YORK-Medicare Advantage, +72242,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72243,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,FIDELIS CARE NEW YORK-Medicare Advantage, +72244,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72245,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72246,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72247,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72248,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,FIDELIS CARE NEW YORK-Medicare Advantage, +72249,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72250,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72251,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,FIDELIS CARE NEW YORK-Medicare Advantage, +72252,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,FIDELIS CARE NEW YORK-Medicare Advantage, +72253,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72254,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,FIDELIS CARE NEW YORK-Medicare Advantage, +72255,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72256,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,FIDELIS CARE NEW YORK-Medicare Advantage, +72257,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72258,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72259,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,FIDELIS CARE NEW YORK-Medicare Advantage, +72260,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72261,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72262,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72263,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,FIDELIS CARE NEW YORK-Medicare Advantage, +72264,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72265,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,FIDELIS CARE NEW YORK-Medicare Advantage, +72266,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,FIDELIS CARE NEW YORK-Medicare Advantage, +72267,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72268,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,FIDELIS CARE NEW YORK-Medicare Advantage, +72269,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,FIDELIS CARE NEW YORK-Medicare Advantage, +72270,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,FIDELIS CARE NEW YORK-Medicare Advantage, +72271,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,FIDELIS CARE NEW YORK-Medicare Advantage, +72272,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72273,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72274,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72275,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,FIDELIS CARE NEW YORK-Medicare Advantage, +72276,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72277,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72278,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72279,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,FIDELIS CARE NEW YORK-Medicare Advantage, +72280,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,FIDELIS CARE NEW YORK-Medicare Advantage, +72281,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,FIDELIS CARE NEW YORK-Medicare Advantage, +72282,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72283,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,FIDELIS CARE NEW YORK-Medicare Advantage, +72284,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72285,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,FIDELIS CARE NEW YORK-Medicare Advantage, +72286,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72287,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,FIDELIS CARE NEW YORK-Medicare Advantage, +72288,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72289,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,FIDELIS CARE NEW YORK-Medicare Advantage, +72290,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,FIDELIS CARE NEW YORK-Medicare Advantage, +72291,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72292,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72293,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,FIDELIS CARE NEW YORK-Medicare Advantage, +72294,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,FIDELIS CARE NEW YORK-Medicare Advantage, +72295,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,FIDELIS CARE NEW YORK-Medicare Advantage, +72296,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,FIDELIS CARE NEW YORK-Medicare Advantage, +72297,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72298,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,FIDELIS CARE NEW YORK-Medicare Advantage, +72299,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,FIDELIS CARE NEW YORK-Medicare Advantage, +72300,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,FIDELIS CARE NEW YORK-Medicare Advantage, +72301,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,FIDELIS CARE NEW YORK-Medicare Advantage, +72302,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,FIDELIS CARE NEW YORK-Medicare Advantage, +72303,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,FIDELIS CARE NEW YORK-Medicare Advantage, +72304,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,FIDELIS CARE NEW YORK-Medicare Advantage, +72305,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,FIDELIS CARE NEW YORK-Medicare Advantage, +72306,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,FIDELIS CARE NEW YORK-Medicare Advantage, +72307,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,FIDELIS CARE NEW YORK-Medicare Advantage, +72308,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,FIDELIS CARE NEW YORK-Medicare Advantage,739.03 +72309,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,FIDELIS CARE NEW YORK-Medicare Advantage, +72310,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,FIDELIS CARE NEW YORK-Medicare Advantage, +72311,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72312,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72313,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72314,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72315,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72316,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72317,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,FIDELIS CARE NEW YORK-Medicare Advantage, +72318,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72319,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72320,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,FIDELIS CARE NEW YORK-Medicare Advantage, +72321,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72322,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72323,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72324,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72325,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72326,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,FIDELIS CARE NEW YORK-Medicare Advantage, +72327,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72328,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72329,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72330,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72331,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,FIDELIS CARE NEW YORK-Medicare Advantage, +72332,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,FIDELIS CARE NEW YORK-Medicare Advantage, +72333,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,FIDELIS CARE NEW YORK-Medicare Advantage,5568.28 +72334,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,FIDELIS CARE NEW YORK-Medicare Advantage, +72335,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72336,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72337,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,FIDELIS CARE NEW YORK-Medicare Advantage, +72338,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72339,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72340,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72341,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72342,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72343,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72344,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,FIDELIS CARE NEW YORK-Medicare Advantage, +72345,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72346,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,FIDELIS CARE NEW YORK-Medicare Advantage,3.0 +72347,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,FIDELIS CARE NEW YORK-Medicare Advantage, +72348,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,FIDELIS CARE NEW YORK-Medicare Advantage,466.68 +72349,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72350,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72351,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72352,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,FIDELIS CARE NEW YORK-Medicare Advantage, +72353,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72354,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72355,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72356,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,FIDELIS CARE NEW YORK-Medicare Advantage, +72357,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,FIDELIS CARE NEW YORK-Medicare Advantage, +72358,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,FIDELIS CARE NEW YORK-Medicare Advantage, +72359,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,FIDELIS CARE NEW YORK-Medicare Advantage, +72360,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72361,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage,1976.11 +72362,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72363,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72364,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72365,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72366,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72367,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72368,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,FIDELIS CARE NEW YORK-Medicare Advantage, +72369,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72370,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,FIDELIS CARE NEW YORK-Medicare Advantage, +72371,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72372,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72373,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72374,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,FIDELIS CARE NEW YORK-Medicare Advantage, +72375,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72376,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72377,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72378,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72379,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72380,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72381,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72382,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,FIDELIS CARE NEW YORK-Medicare Advantage, +72383,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72384,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72385,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,FIDELIS CARE NEW YORK-Medicare Advantage, +72386,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72387,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,FIDELIS CARE NEW YORK-Medicare Advantage, +72388,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,FIDELIS CARE NEW YORK-Medicare Advantage, +72389,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,FIDELIS CARE NEW YORK-Medicare Advantage, +72390,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,FIDELIS CARE NEW YORK-Medicare Advantage, +72391,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,FIDELIS CARE NEW YORK-Medicare Advantage, +72392,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72393,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72394,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,FIDELIS CARE NEW YORK-Medicare Advantage, +72395,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,FIDELIS CARE NEW YORK-Medicare Advantage, +72396,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72397,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,FIDELIS CARE NEW YORK-Medicare Advantage, +72398,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72399,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72400,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,FIDELIS CARE NEW YORK-Medicare Advantage, +72401,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72402,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72403,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,FIDELIS CARE NEW YORK-Medicare Advantage, +72404,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72405,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,FIDELIS CARE NEW YORK-Medicare Advantage, +72406,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72407,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72408,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,FIDELIS CARE NEW YORK-Medicare Advantage, +72409,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72410,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72411,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72412,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72413,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,FIDELIS CARE NEW YORK-Medicare Advantage, +72414,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72415,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72416,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72417,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,FIDELIS CARE NEW YORK-Medicare Advantage, +72418,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72419,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72420,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72421,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,FIDELIS CARE NEW YORK-Medicare Advantage, +72422,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72423,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72424,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72425,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,FIDELIS CARE NEW YORK-Medicare Advantage, +72426,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72427,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72428,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,FIDELIS CARE NEW YORK-Medicare Advantage, +72429,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,FIDELIS CARE NEW YORK-Medicare Advantage, +72430,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,FIDELIS CARE NEW YORK-Medicare Advantage, +72431,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,FIDELIS CARE NEW YORK-Medicare Advantage, +72432,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72433,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72434,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,FIDELIS CARE NEW YORK-Medicare Advantage, +72435,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72436,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72437,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72438,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72439,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,FIDELIS CARE NEW YORK-Medicare Advantage, +72440,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,FIDELIS CARE NEW YORK-Medicare Advantage, +72441,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72442,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72443,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,FIDELIS CARE NEW YORK-Medicare Advantage, +72444,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72445,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72446,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72447,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,FIDELIS CARE NEW YORK-Medicare Advantage, +72448,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,FIDELIS CARE NEW YORK-Medicare Advantage, +72449,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,FIDELIS CARE NEW YORK-Medicare Advantage, +72450,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72451,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,FIDELIS CARE NEW YORK-Medicare Advantage, +72452,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72453,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72454,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72455,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,FIDELIS CARE NEW YORK-Medicare Advantage, +72456,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72457,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,FIDELIS CARE NEW YORK-Medicare Advantage, +72458,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72459,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,FIDELIS CARE NEW YORK-Medicare Advantage, +72460,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72461,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72462,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72463,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,FIDELIS CARE NEW YORK-Medicare Advantage, +72464,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72465,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,FIDELIS CARE NEW YORK-Medicare Advantage, +72466,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72467,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,FIDELIS CARE NEW YORK-Medicare Advantage, +72468,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72469,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72470,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72471,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72472,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,FIDELIS CARE NEW YORK-Medicare Advantage, +72473,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,FIDELIS CARE NEW YORK-Medicare Advantage, +72474,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72475,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72476,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72477,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,FIDELIS CARE NEW YORK-Medicare Advantage, +72478,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72479,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,FIDELIS CARE NEW YORK-Medicare Advantage, +72480,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,FIDELIS CARE NEW YORK-Medicare Advantage, +72481,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72482,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,FIDELIS CARE NEW YORK-Medicare Advantage, +72483,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,FIDELIS CARE NEW YORK-Medicare Advantage, +72484,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72485,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72486,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,FIDELIS CARE NEW YORK-Medicare Advantage, +72487,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,FIDELIS CARE NEW YORK-Medicare Advantage, +72488,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72489,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72490,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72491,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,FIDELIS CARE NEW YORK-Medicare Advantage, +72492,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,FIDELIS CARE NEW YORK-Medicare Advantage, +72493,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72494,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72495,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72496,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72497,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72498,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72499,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,FIDELIS CARE NEW YORK-Medicare Advantage, +72500,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72501,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72502,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72503,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72504,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72505,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72506,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72507,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,FIDELIS CARE NEW YORK-Medicare Advantage, +72508,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72509,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,FIDELIS CARE NEW YORK-Medicare Advantage, +72510,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,FIDELIS CARE NEW YORK-Medicare Advantage, +72511,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72512,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,FIDELIS CARE NEW YORK-Medicare Advantage, +72513,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72514,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72515,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,FIDELIS CARE NEW YORK-Medicare Advantage, +72516,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72517,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72518,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72519,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72520,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72521,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72522,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72523,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage,476.07 +72524,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72525,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72526,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72527,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72528,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72529,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72530,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72531,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72532,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72533,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72534,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72535,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72536,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72537,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72538,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72539,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72540,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72541,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72542,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72543,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72544,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72545,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72546,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,FIDELIS CARE NEW YORK-Medicare Advantage, +72547,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72548,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72549,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72550,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,FIDELIS CARE NEW YORK-Medicare Advantage, +72551,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,FIDELIS CARE NEW YORK-Medicare Advantage, +72552,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,FIDELIS CARE NEW YORK-Medicare Advantage, +72553,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72554,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72555,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72556,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72557,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72558,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72559,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72560,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72561,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,FIDELIS CARE NEW YORK-Medicare Advantage, +72562,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,FIDELIS CARE NEW YORK-Medicare Advantage, +72563,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72564,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72565,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72566,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72567,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,FIDELIS CARE NEW YORK-Medicare Advantage, +72568,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72569,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72570,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72571,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72572,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72573,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72574,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,FIDELIS CARE NEW YORK-Medicare Advantage, +72575,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72576,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72577,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72578,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,FIDELIS CARE NEW YORK-Medicare Advantage, +72579,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72580,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,FIDELIS CARE NEW YORK-Medicare Advantage, +72581,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72582,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72583,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72584,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72585,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72586,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72587,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,FIDELIS CARE NEW YORK-Medicare Advantage, +72588,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,FIDELIS CARE NEW YORK-Medicare Advantage, +72589,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,FIDELIS CARE NEW YORK-Medicare Advantage, +72590,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,FIDELIS CARE NEW YORK-Medicare Advantage, +72591,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,FIDELIS CARE NEW YORK-Medicare Advantage, +72592,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,FIDELIS CARE NEW YORK-Medicare Advantage, +72593,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,FIDELIS CARE NEW YORK-Medicare Advantage, +72594,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72595,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72596,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72597,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72598,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72599,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72600,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72601,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72602,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72603,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72604,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72605,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72606,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72607,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72608,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72609,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage,1216.61 +72610,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72611,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,FIDELIS CARE NEW YORK-Medicare Advantage, +72612,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72613,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72614,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72615,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72616,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72617,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72618,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +72619,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72620,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72621,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72622,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,FIDELIS CARE NEW YORK-Medicare Advantage, +72623,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72624,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72625,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72626,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72627,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,FIDELIS CARE NEW YORK-Medicare Advantage, +72628,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72629,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72630,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,FIDELIS CARE NEW YORK-Medicare Advantage, +72631,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72632,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,FIDELIS CARE NEW YORK-Medicare Advantage, +72633,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72634,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72635,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72636,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72637,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72638,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72639,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72640,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72641,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72642,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72643,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72644,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72645,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,FIDELIS CARE NEW YORK-Medicare Advantage, +72646,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72647,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,FIDELIS CARE NEW YORK-Medicare Advantage, +72648,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,FIDELIS CARE NEW YORK-Medicare Advantage, +72649,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72650,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72651,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72652,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72653,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72654,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,FIDELIS CARE NEW YORK-Medicare Advantage, +72655,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72656,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72657,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,FIDELIS CARE NEW YORK-Medicare Advantage, +72658,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72659,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72660,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,FIDELIS CARE NEW YORK-Medicare Advantage, +72661,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72662,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,FIDELIS CARE NEW YORK-Medicare Advantage, +72663,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72664,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,FIDELIS CARE NEW YORK-Medicare Advantage, +72665,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,FIDELIS CARE NEW YORK-Medicare Advantage, +72666,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,FIDELIS CARE NEW YORK-Medicare Advantage, +72667,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,FIDELIS CARE NEW YORK-Medicare Advantage, +72668,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72669,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72670,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,FIDELIS CARE NEW YORK-Medicare Advantage, +72671,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,FIDELIS CARE NEW YORK-Medicare Advantage, +72672,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72673,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,FIDELIS CARE NEW YORK-Medicare Advantage, +72674,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,FIDELIS CARE NEW YORK-Medicare Advantage, +72675,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72676,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,FIDELIS CARE NEW YORK-Medicare Advantage, +72677,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,FIDELIS CARE NEW YORK-Medicare Advantage, +72678,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,FIDELIS CARE NEW YORK-Medicare Advantage, +72679,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72680,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72681,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,FIDELIS CARE NEW YORK-Medicare Advantage, +72682,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72683,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,FIDELIS CARE NEW YORK-Medicare Advantage, +72684,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,FIDELIS CARE NEW YORK-Medicare Advantage, +72685,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72686,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,FIDELIS CARE NEW YORK-Medicare Advantage, +72687,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72688,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72689,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72690,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72691,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72692,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72693,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72694,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72695,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72696,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,FIDELIS CARE NEW YORK-Medicare Advantage, +72697,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72698,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72699,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72700,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72701,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72702,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72703,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72704,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72705,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,FIDELIS CARE NEW YORK-Medicare Advantage, +72706,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,FIDELIS CARE NEW YORK-Medicare Advantage, +72707,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72708,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,FIDELIS CARE NEW YORK-Medicare Advantage, +72709,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,FIDELIS CARE NEW YORK-Medicare Advantage, +72710,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72711,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72712,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,FIDELIS CARE NEW YORK-Medicare Advantage, +72713,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72714,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72715,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72716,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,FIDELIS CARE NEW YORK-Medicare Advantage, +72717,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,FIDELIS CARE NEW YORK-Medicare Advantage, +72718,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,FIDELIS CARE NEW YORK-Medicare Advantage, +72719,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72720,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72721,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,FIDELIS CARE NEW YORK-Medicare Advantage, +72722,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72723,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,FIDELIS CARE NEW YORK-Medicare Advantage, +72724,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72725,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72726,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72727,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,FIDELIS CARE NEW YORK-Medicare Advantage, +72728,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72729,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72730,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,FIDELIS CARE NEW YORK-Medicare Advantage, +72731,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72732,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,FIDELIS CARE NEW YORK-Medicare Advantage, +72733,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72734,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,FIDELIS CARE NEW YORK-Medicare Advantage, +72735,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72736,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,FIDELIS CARE NEW YORK-Medicare Advantage, +72737,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,FIDELIS CARE NEW YORK-Medicare Advantage, +72738,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72739,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72740,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72741,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,FIDELIS CARE NEW YORK-Medicare Advantage, +72742,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72743,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,FIDELIS CARE NEW YORK-Medicare Advantage, +72744,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72745,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,FIDELIS CARE NEW YORK-Medicare Advantage, +72746,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72747,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,FIDELIS CARE NEW YORK-Medicare Advantage, +72748,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72749,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72750,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72751,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,FIDELIS CARE NEW YORK-Medicare Advantage, +72752,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72753,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72754,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72755,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72756,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72757,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,FIDELIS CARE NEW YORK-Medicare Advantage, +72758,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72759,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72760,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72761,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,FIDELIS CARE NEW YORK-Medicare Advantage, +72762,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72763,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72764,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,FIDELIS CARE NEW YORK-Medicare Advantage, +72765,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,FIDELIS CARE NEW YORK-Medicare Advantage, +72766,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72767,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,FIDELIS CARE NEW YORK-Medicare Advantage, +72768,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72769,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72770,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72771,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72772,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72773,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72774,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72775,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72776,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72777,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72778,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72779,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72780,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,FIDELIS CARE NEW YORK-Medicare Advantage, +72781,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72782,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72783,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72784,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72785,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72786,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72787,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,FIDELIS CARE NEW YORK-Medicare Advantage, +72788,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,FIDELIS CARE NEW YORK-Medicare Advantage, +72789,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,FIDELIS CARE NEW YORK-Medicare Advantage, +72790,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,FIDELIS CARE NEW YORK-Medicare Advantage, +72791,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72792,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72793,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72794,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72795,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72796,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72797,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72798,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72799,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72800,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,FIDELIS CARE NEW YORK-Medicare Advantage, +72801,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72802,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72803,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72804,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,FIDELIS CARE NEW YORK-Medicare Advantage, +72805,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72806,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,FIDELIS CARE NEW YORK-Medicare Advantage, +72807,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72808,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,FIDELIS CARE NEW YORK-Medicare Advantage, +72809,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72810,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72811,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,FIDELIS CARE NEW YORK-Medicare Advantage, +72812,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72813,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72814,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72815,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,FIDELIS CARE NEW YORK-Medicare Advantage, +72816,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72817,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72818,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72819,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72820,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72821,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72822,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72823,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72824,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72825,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72826,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72827,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72828,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,FIDELIS CARE NEW YORK-Medicare Advantage, +72829,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72830,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,FIDELIS CARE NEW YORK-Medicare Advantage, +72831,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72832,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72833,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72834,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,FIDELIS CARE NEW YORK-Medicare Advantage, +72835,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72836,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72837,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72838,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72839,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72840,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72841,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,FIDELIS CARE NEW YORK-Medicare Advantage, +72842,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,FIDELIS CARE NEW YORK-Medicare Advantage, +72843,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72844,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72845,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72846,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72847,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72848,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,FIDELIS CARE NEW YORK-Medicare Advantage, +72849,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,FIDELIS CARE NEW YORK-Medicare Advantage, +72850,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,FIDELIS CARE NEW YORK-Medicare Advantage, +72851,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72852,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72853,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72854,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72855,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72856,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72857,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,FIDELIS CARE NEW YORK-Medicare Advantage, +72858,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72859,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72860,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72861,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,FIDELIS CARE NEW YORK-Medicare Advantage, +72862,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,FIDELIS CARE NEW YORK-Medicare Advantage, +72863,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72864,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72865,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72866,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72867,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72868,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72869,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72870,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,FIDELIS CARE NEW YORK-Medicare Advantage, +72871,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72872,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72873,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72874,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72875,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72876,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,FIDELIS CARE NEW YORK-Medicare Advantage, +72877,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72878,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,FIDELIS CARE NEW YORK-Medicare Advantage, +72879,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72880,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,FIDELIS CARE NEW YORK-Medicare Advantage, +72881,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,FIDELIS CARE NEW YORK-Medicare Advantage, +72882,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72883,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,FIDELIS CARE NEW YORK-Medicare Advantage, +72884,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72885,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72886,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,FIDELIS CARE NEW YORK-Medicare Advantage, +72887,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72888,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,FIDELIS CARE NEW YORK-Medicare Advantage, +72889,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72890,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72891,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,FIDELIS CARE NEW YORK-Medicare Advantage, +72892,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72893,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,FIDELIS CARE NEW YORK-Medicare Advantage, +72894,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,FIDELIS CARE NEW YORK-Medicare Advantage, +72895,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72896,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72897,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72898,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,FIDELIS CARE NEW YORK-Medicare Advantage, +72899,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,FIDELIS CARE NEW YORK-Medicare Advantage, +72900,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72901,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72902,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,FIDELIS CARE NEW YORK-Medicare Advantage, +72903,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,FIDELIS CARE NEW YORK-Medicare Advantage, +72904,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72905,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,FIDELIS CARE NEW YORK-Medicare Advantage, +72906,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,FIDELIS CARE NEW YORK-Medicare Advantage, +72907,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,FIDELIS CARE NEW YORK-Medicare Advantage, +72908,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72909,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,FIDELIS CARE NEW YORK-Medicare Advantage, +72910,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72911,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,FIDELIS CARE NEW YORK-Medicare Advantage, +72912,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72913,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72914,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72915,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72916,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72917,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,FIDELIS CARE NEW YORK-Medicare Advantage, +72918,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,FIDELIS CARE NEW YORK-Medicare Advantage, +72919,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,FIDELIS CARE NEW YORK-Medicare Advantage, +72920,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,FIDELIS CARE NEW YORK-Medicare Advantage, +72921,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,FIDELIS CARE NEW YORK-Medicare Advantage, +72922,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72923,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,FIDELIS CARE NEW YORK-Medicare Advantage, +72924,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,FIDELIS CARE NEW YORK-Medicare Advantage, +72925,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,FIDELIS CARE NEW YORK-Medicare Advantage, +72926,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72927,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72928,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,FIDELIS CARE NEW YORK-Medicare Advantage, +72929,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72930,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,FIDELIS CARE NEW YORK-Medicare Advantage, +72931,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,FIDELIS CARE NEW YORK-Medicare Advantage, +72932,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72933,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72934,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72935,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,FIDELIS CARE NEW YORK-Medicare Advantage, +72936,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,FIDELIS CARE NEW YORK-Medicare Advantage, +72937,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,FIDELIS CARE NEW YORK-Medicare Advantage, +72938,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,FIDELIS CARE NEW YORK-Medicare Advantage, +72939,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72940,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,FIDELIS CARE NEW YORK-Medicare Advantage, +72941,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72942,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,FIDELIS CARE NEW YORK-Medicare Advantage, +72943,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,FIDELIS CARE NEW YORK-Medicare Advantage, +72944,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,FIDELIS CARE NEW YORK-Medicare Advantage, +72945,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,FIDELIS CARE NEW YORK-Medicare Advantage, +72946,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72947,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,FIDELIS CARE NEW YORK-Medicare Advantage, +72948,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72949,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72950,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72951,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,FIDELIS CARE NEW YORK-Medicare Advantage, +72952,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,FIDELIS CARE NEW YORK-Medicare Advantage, +72953,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,FIDELIS CARE NEW YORK-Medicare Advantage, +72954,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,FIDELIS CARE NEW YORK-Medicare Advantage, +72955,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72956,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,FIDELIS CARE NEW YORK-Medicare Advantage, +72957,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,FIDELIS CARE NEW YORK-Medicare Advantage, +72958,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72959,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72960,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,FIDELIS CARE NEW YORK-Medicare Advantage, +72961,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +72962,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,FIDELIS CARE NEW YORK-Medicare Advantage, +72963,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72964,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,FIDELIS CARE NEW YORK-Medicare Advantage, +72965,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,FIDELIS CARE NEW YORK-Medicare Advantage, +72966,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,FIDELIS CARE NEW YORK-Medicare Advantage, +72967,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72968,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,FIDELIS CARE NEW YORK-Medicare Advantage, +72969,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,FIDELIS CARE NEW YORK-Medicare Advantage, +72970,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72971,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,FIDELIS CARE NEW YORK-Medicare Advantage, +72972,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,FIDELIS CARE NEW YORK-Medicare Advantage, +72973,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +72974,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,FIDELIS CARE NEW YORK-Medicare Advantage, +72975,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,FIDELIS CARE NEW YORK-Medicare Advantage, +72976,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72977,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72978,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +72979,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +72980,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,FIDELIS CARE NEW YORK-Medicare Advantage, +72981,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72982,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,FIDELIS CARE NEW YORK-Medicare Advantage, +72983,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,FIDELIS CARE NEW YORK-Medicare Advantage, +72984,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72985,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72986,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72987,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,FIDELIS CARE NEW YORK-Medicare Advantage, +72988,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,FIDELIS CARE NEW YORK-Medicare Advantage, +72989,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,FIDELIS CARE NEW YORK-Medicare Advantage, +72990,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72991,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72992,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,FIDELIS CARE NEW YORK-Medicare Advantage, +72993,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,FIDELIS CARE NEW YORK-Medicare Advantage, +72994,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,FIDELIS CARE NEW YORK-Medicare Advantage, +72995,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72996,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72997,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,FIDELIS CARE NEW YORK-Medicare Advantage, +72998,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,FIDELIS CARE NEW YORK-Medicare Advantage, +72999,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73000,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,FIDELIS CARE NEW YORK-Medicare Advantage, +73001,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,FIDELIS CARE NEW YORK-Medicare Advantage, +73002,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73003,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,FIDELIS CARE NEW YORK-Medicare Advantage, +73004,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,FIDELIS CARE NEW YORK-Medicare Advantage, +73005,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,FIDELIS CARE NEW YORK-Medicare Advantage, +73006,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,FIDELIS CARE NEW YORK-Medicare Advantage, +73007,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73008,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73009,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,FIDELIS CARE NEW YORK-Medicare Advantage, +73010,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73011,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73012,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73013,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73014,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,FIDELIS CARE NEW YORK-Medicare Advantage, +73015,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +73016,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,FIDELIS CARE NEW YORK-Medicare Advantage, +73017,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73018,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73019,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,FIDELIS CARE NEW YORK-Medicare Advantage, +73020,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73021,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73022,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,FIDELIS CARE NEW YORK-Medicare Advantage, +73023,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,FIDELIS CARE NEW YORK-Medicare Advantage, +73024,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,FIDELIS CARE NEW YORK-Medicare Advantage, +73025,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,FIDELIS CARE NEW YORK-Medicare Advantage, +73026,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,FIDELIS CARE NEW YORK-Medicare Advantage, +73027,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73028,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,FIDELIS CARE NEW YORK-Medicare Advantage, +73029,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73030,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73031,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73032,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73033,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73034,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,FIDELIS CARE NEW YORK-Medicare Advantage, +73035,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73036,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,FIDELIS CARE NEW YORK-Medicare Advantage, +73037,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,FIDELIS CARE NEW YORK-Medicare Advantage, +73038,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73039,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73040,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73041,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,FIDELIS CARE NEW YORK-Medicare Advantage, +73042,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73043,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,FIDELIS CARE NEW YORK-Medicare Advantage, +73044,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,FIDELIS CARE NEW YORK-Medicare Advantage, +73045,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73046,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,FIDELIS CARE NEW YORK-Medicare Advantage, +73047,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,FIDELIS CARE NEW YORK-Medicare Advantage, +73048,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,FIDELIS CARE NEW YORK-Medicare Advantage, +73049,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73050,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,FIDELIS CARE NEW YORK-Medicare Advantage, +73051,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73052,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73053,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73054,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,FIDELIS CARE NEW YORK-Medicare Advantage, +73055,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73056,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73057,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73058,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73059,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73060,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73061,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,FIDELIS CARE NEW YORK-Medicare Advantage, +73062,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73063,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73064,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73065,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,FIDELIS CARE NEW YORK-Medicare Advantage, +73066,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73067,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,FIDELIS CARE NEW YORK-Medicare Advantage, +73068,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,FIDELIS CARE NEW YORK-Medicare Advantage, +73069,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,FIDELIS CARE NEW YORK-Medicare Advantage, +73070,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73071,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73072,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,FIDELIS CARE NEW YORK-Medicare Advantage, +73073,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73074,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,FIDELIS CARE NEW YORK-Medicare Advantage, +73075,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73076,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73077,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73078,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73079,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,FIDELIS CARE NEW YORK-Medicare Advantage, +73080,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73081,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73082,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73083,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,FIDELIS CARE NEW YORK-Medicare Advantage, +73084,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73085,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73086,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,FIDELIS CARE NEW YORK-Medicare Advantage, +73087,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73088,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,FIDELIS CARE NEW YORK-Medicare Advantage, +73089,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,FIDELIS CARE NEW YORK-Medicare Advantage, +73090,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73091,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73092,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73093,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,FIDELIS CARE NEW YORK-Medicare Advantage, +73094,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,FIDELIS CARE NEW YORK-Medicare Advantage, +73095,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73096,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73097,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73098,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73099,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73100,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73101,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73102,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,FIDELIS CARE NEW YORK-Medicare Advantage, +73103,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73104,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,FIDELIS CARE NEW YORK-Medicare Advantage, +73105,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73106,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,FIDELIS CARE NEW YORK-Medicare Advantage, +73107,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73108,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73109,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73110,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,FIDELIS CARE NEW YORK-Medicare Advantage, +73111,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73112,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73113,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73114,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73115,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73116,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,FIDELIS CARE NEW YORK-Medicare Advantage, +73117,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73118,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,FIDELIS CARE NEW YORK-Medicare Advantage, +73119,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,FIDELIS CARE NEW YORK-Medicare Advantage, +73120,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,FIDELIS CARE NEW YORK-Medicare Advantage, +73121,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73122,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73123,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73124,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,FIDELIS CARE NEW YORK-Medicare Advantage, +73125,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73126,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73127,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73128,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,FIDELIS CARE NEW YORK-Medicare Advantage, +73129,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,FIDELIS CARE NEW YORK-Medicare Advantage, +73130,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,FIDELIS CARE NEW YORK-Medicare Advantage, +73131,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,FIDELIS CARE NEW YORK-Medicare Advantage, +73132,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,FIDELIS CARE NEW YORK-Medicare Advantage, +73133,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,FIDELIS CARE NEW YORK-Medicare Advantage, +73134,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,FIDELIS CARE NEW YORK-Medicare Advantage, +73135,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,FIDELIS CARE NEW YORK-Medicare Advantage, +73136,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73137,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,FIDELIS CARE NEW YORK-Medicare Advantage, +73138,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73139,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,FIDELIS CARE NEW YORK-Medicare Advantage, +73140,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73141,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73142,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,FIDELIS CARE NEW YORK-Medicare Advantage, +73143,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73144,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,FIDELIS CARE NEW YORK-Medicare Advantage, +73145,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,FIDELIS CARE NEW YORK-Medicare Advantage, +73146,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73147,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,FIDELIS CARE NEW YORK-Medicare Advantage, +73148,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73149,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,FIDELIS CARE NEW YORK-Medicare Advantage, +73150,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,FIDELIS CARE NEW YORK-Medicare Advantage, +73151,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,FIDELIS CARE NEW YORK-Medicare Advantage, +73152,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73153,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73154,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,FIDELIS CARE NEW YORK-Medicare Advantage, +73155,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,FIDELIS CARE NEW YORK-Medicare Advantage, +73156,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,FIDELIS CARE NEW YORK-Medicare Advantage, +73157,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,FIDELIS CARE NEW YORK-Medicare Advantage, +73158,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,FIDELIS CARE NEW YORK-Medicare Advantage, +73159,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73160,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,FIDELIS CARE NEW YORK-Medicare Advantage, +73161,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,FIDELIS CARE NEW YORK-Medicare Advantage, +73162,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,FIDELIS CARE NEW YORK-Medicare Advantage, +73163,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73164,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,FIDELIS CARE NEW YORK-Medicare Advantage, +73165,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73166,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73167,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,FIDELIS CARE NEW YORK-Medicare Advantage, +73168,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,FIDELIS CARE NEW YORK-Medicare Advantage, +73169,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,FIDELIS CARE NEW YORK-Medicare Advantage, +73170,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,FIDELIS CARE NEW YORK-Medicare Advantage, +73171,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73172,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,FIDELIS CARE NEW YORK-Medicare Advantage, +73173,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,FIDELIS CARE NEW YORK-Medicare Advantage, +73174,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,FIDELIS CARE NEW YORK-Medicare Advantage, +73175,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73176,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,FIDELIS CARE NEW YORK-Medicare Advantage, +73177,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,FIDELIS CARE NEW YORK-Medicare Advantage, +73178,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73179,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,FIDELIS CARE NEW YORK-Medicare Advantage, +73180,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,FIDELIS CARE NEW YORK-Medicare Advantage, +73181,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73182,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,FIDELIS CARE NEW YORK-Medicare Advantage, +73183,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73184,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,FIDELIS CARE NEW YORK-Medicare Advantage, +73185,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,FIDELIS CARE NEW YORK-Medicare Advantage, +73186,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,FIDELIS CARE NEW YORK-Medicare Advantage, +73187,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73188,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73189,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73190,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,FIDELIS CARE NEW YORK-Medicare Advantage, +73191,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73192,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,FIDELIS CARE NEW YORK-Medicare Advantage, +73193,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,FIDELIS CARE NEW YORK-Medicare Advantage, +73194,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73195,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73196,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73197,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,FIDELIS CARE NEW YORK-Medicare Advantage, +73198,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73199,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,FIDELIS CARE NEW YORK-Medicare Advantage, +73200,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,FIDELIS CARE NEW YORK-Medicare Advantage, +73201,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,FIDELIS CARE NEW YORK-Medicare Advantage, +73202,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73203,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,FIDELIS CARE NEW YORK-Medicare Advantage, +73204,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,FIDELIS CARE NEW YORK-Medicare Advantage, +73205,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,FIDELIS CARE NEW YORK-Medicare Advantage, +73206,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73207,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,FIDELIS CARE NEW YORK-Medicare Advantage, +73208,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73209,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,FIDELIS CARE NEW YORK-Medicare Advantage, +73210,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,FIDELIS CARE NEW YORK-Medicare Advantage, +73211,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73212,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,FIDELIS CARE NEW YORK-Medicare Advantage, +73213,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73214,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73215,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,FIDELIS CARE NEW YORK-Medicare Advantage, +73216,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73217,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73218,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,FIDELIS CARE NEW YORK-Medicare Advantage, +73219,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73220,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,FIDELIS CARE NEW YORK-Medicare Advantage, +73221,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73222,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,FIDELIS CARE NEW YORK-Medicare Advantage, +73223,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73224,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73225,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,FIDELIS CARE NEW YORK-Medicare Advantage, +73226,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,FIDELIS CARE NEW YORK-Medicare Advantage, +73227,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,FIDELIS CARE NEW YORK-Medicare Advantage, +73228,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73229,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73230,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,FIDELIS CARE NEW YORK-Medicare Advantage, +73231,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73232,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73233,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73234,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,FIDELIS CARE NEW YORK-Medicare Advantage, +73235,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,FIDELIS CARE NEW YORK-Medicare Advantage, +73236,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73237,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73238,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73239,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,FIDELIS CARE NEW YORK-Medicare Advantage, +73240,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,FIDELIS CARE NEW YORK-Medicare Advantage, +73241,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73242,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,FIDELIS CARE NEW YORK-Medicare Advantage, +73243,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73244,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73245,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,FIDELIS CARE NEW YORK-Medicare Advantage, +73246,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73247,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73248,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73249,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,FIDELIS CARE NEW YORK-Medicare Advantage, +73250,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73251,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,FIDELIS CARE NEW YORK-Medicare Advantage,293.23 +73252,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73253,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73254,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73255,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73256,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,FIDELIS CARE NEW YORK-Medicare Advantage, +73257,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73258,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73259,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73260,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73261,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73262,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73263,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73264,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73265,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73266,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,FIDELIS CARE NEW YORK-Medicare Advantage, +73267,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73268,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73269,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73270,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73271,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73272,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73273,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73274,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73275,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73276,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,FIDELIS CARE NEW YORK-Medicare Advantage, +73277,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,FIDELIS CARE NEW YORK-Medicare Advantage,96.69 +73278,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73279,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73280,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73281,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73282,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73283,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,FIDELIS CARE NEW YORK-Medicare Advantage, +73284,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73285,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,FIDELIS CARE NEW YORK-Medicare Advantage, +73286,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73287,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73288,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73289,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73290,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73291,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,FIDELIS CARE NEW YORK-Medicare Advantage, +73292,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73293,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73294,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73295,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73296,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73297,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73298,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73299,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73300,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73301,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73302,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73303,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73304,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73305,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73306,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73307,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73308,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73309,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73310,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73311,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,FIDELIS CARE NEW YORK-Medicare Advantage, +73312,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73313,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73314,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73315,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73316,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73317,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73318,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73319,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73320,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73321,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73322,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73323,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73324,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73325,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73326,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73327,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73328,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73329,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73330,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73331,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73332,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73333,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73334,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73335,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73336,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,FIDELIS CARE NEW YORK-Medicare Advantage, +73337,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73338,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73339,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73340,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73341,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73342,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73343,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73344,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73345,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73346,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73347,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73348,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73349,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73350,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73351,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73352,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73353,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73354,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73355,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73356,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73357,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73358,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73359,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73360,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73361,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73362,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73363,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73364,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73365,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73366,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73367,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73368,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73369,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73370,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73371,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73372,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73373,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73374,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73375,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73376,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73377,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,FIDELIS CARE NEW YORK-Medicare Advantage, +73378,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73379,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73380,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,FIDELIS CARE NEW YORK-Medicare Advantage, +73381,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73382,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73383,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73384,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73385,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73386,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73387,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73388,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,FIDELIS CARE NEW YORK-Medicare Advantage, +73389,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73390,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73391,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73392,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73393,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73394,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73395,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73396,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73397,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73398,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73399,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73400,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73401,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,FIDELIS CARE NEW YORK-Medicare Advantage, +73402,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,FIDELIS CARE NEW YORK-Medicare Advantage, +73403,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73404,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73405,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,FIDELIS CARE NEW YORK-Medicare Advantage, +73406,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73407,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73408,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,FIDELIS CARE NEW YORK-Medicare Advantage, +73409,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73410,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,FIDELIS CARE NEW YORK-Medicare Advantage, +73411,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73412,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,FIDELIS CARE NEW YORK-Medicare Advantage, +73413,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73414,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,FIDELIS CARE NEW YORK-Medicare Advantage, +73415,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73416,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73417,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73418,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73419,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,FIDELIS CARE NEW YORK-Medicare Advantage, +73420,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,FIDELIS CARE NEW YORK-Medicare Advantage, +73421,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73422,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73423,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73424,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73425,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73426,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73427,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73428,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73429,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73430,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,FIDELIS CARE NEW YORK-Medicare Advantage, +73431,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,FIDELIS CARE NEW YORK-Medicare Advantage, +73432,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73433,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73434,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73435,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73436,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73437,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73438,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73439,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73440,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73441,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,FIDELIS CARE NEW YORK-Medicare Advantage, +73442,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73443,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,FIDELIS CARE NEW YORK-Medicare Advantage, +73444,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73445,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,FIDELIS CARE NEW YORK-Medicare Advantage, +73446,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73447,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73448,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,FIDELIS CARE NEW YORK-Medicare Advantage, +73449,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,FIDELIS CARE NEW YORK-Medicare Advantage, +73450,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,FIDELIS CARE NEW YORK-Medicare Advantage, +73451,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73452,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73453,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73454,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73455,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73456,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73457,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73458,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73459,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73460,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73461,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73462,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73463,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,FIDELIS CARE NEW YORK-Medicare Advantage, +73464,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73465,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73466,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,FIDELIS CARE NEW YORK-Medicare Advantage, +73467,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,FIDELIS CARE NEW YORK-Medicare Advantage, +73468,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,FIDELIS CARE NEW YORK-Medicare Advantage, +73469,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73470,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73471,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,FIDELIS CARE NEW YORK-Medicare Advantage, +73472,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73473,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,FIDELIS CARE NEW YORK-Medicare Advantage, +73474,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73475,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73476,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73477,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73478,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73479,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73480,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73481,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73482,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73483,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73484,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73485,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,FIDELIS CARE NEW YORK-Medicare Advantage, +73486,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73487,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73488,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,FIDELIS CARE NEW YORK-Medicare Advantage, +73489,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73490,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73491,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73492,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73493,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73494,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73495,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73496,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73497,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73498,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73499,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,FIDELIS CARE NEW YORK-Medicare Advantage, +73500,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73501,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73502,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73503,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73504,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73505,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73506,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73507,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73508,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73509,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73510,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73511,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73512,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73513,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73514,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73515,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73516,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73517,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73518,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73519,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73520,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73521,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73522,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73523,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73524,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73525,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73526,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73527,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73528,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73529,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73530,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73531,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73532,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73533,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73534,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73535,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73536,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,FIDELIS CARE NEW YORK-Medicare Advantage, +73537,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73538,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73539,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73540,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73541,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73542,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,FIDELIS CARE NEW YORK-Medicare Advantage, +73543,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73544,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73545,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73546,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73547,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73548,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73549,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73550,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73551,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73552,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73553,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73554,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,FIDELIS CARE NEW YORK-Medicare Advantage, +73555,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73556,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73557,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73558,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,FIDELIS CARE NEW YORK-Medicare Advantage, +73559,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73560,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73561,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73562,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73563,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73564,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73565,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73566,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,FIDELIS CARE NEW YORK-Medicare Advantage, +73567,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73568,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73569,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73570,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73571,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73572,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73573,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73574,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,FIDELIS CARE NEW YORK-Medicare Advantage, +73575,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73576,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73577,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73578,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73579,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73580,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73581,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73582,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73583,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73584,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73585,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73586,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,FIDELIS CARE NEW YORK-Medicare Advantage, +73587,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73588,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73589,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +73590,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73591,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73592,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73593,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73594,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73595,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73596,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73597,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73598,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73599,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73600,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73601,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73602,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73603,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,FIDELIS CARE NEW YORK-Medicare Advantage, +73604,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,FIDELIS CARE NEW YORK-Medicare Advantage, +73605,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73606,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,FIDELIS CARE NEW YORK-Medicare Advantage, +73607,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73608,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73609,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73610,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73611,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73612,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73613,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73614,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73615,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73616,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73617,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73618,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73619,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73620,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,FIDELIS CARE NEW YORK-Medicare Advantage, +73621,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,FIDELIS CARE NEW YORK-Medicare Advantage, +73622,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,FIDELIS CARE NEW YORK-Medicare Advantage, +73623,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73624,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73625,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73626,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73627,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73628,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73629,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73630,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,FIDELIS CARE NEW YORK-Medicare Advantage, +73631,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73632,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73633,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73634,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73635,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73636,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73637,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73638,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73639,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73640,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,FIDELIS CARE NEW YORK-Medicare Advantage, +73641,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73642,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73643,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +73644,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,FIDELIS CARE NEW YORK-Medicare Advantage, +73645,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,FIDELIS CARE NEW YORK-Medicare Advantage, +73646,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73647,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73648,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73649,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73650,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73651,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73652,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73653,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73654,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73655,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73656,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73657,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73658,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,FIDELIS CARE NEW YORK-Medicare Advantage, +73659,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73660,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,FIDELIS CARE NEW YORK-Medicare Advantage, +73661,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73662,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73663,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,FIDELIS CARE NEW YORK-Medicare Advantage, +73664,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73665,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73666,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73667,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73668,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73669,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,FIDELIS CARE NEW YORK-Medicare Advantage, +73670,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,FIDELIS CARE NEW YORK-Medicare Advantage, +73671,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73672,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73673,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73674,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73675,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,FIDELIS CARE NEW YORK-Medicare Advantage, +73676,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73677,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73678,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73679,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73680,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73681,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73682,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,FIDELIS CARE NEW YORK-Medicare Advantage, +73683,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73684,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,FIDELIS CARE NEW YORK-Medicare Advantage, +73685,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73686,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73687,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,FIDELIS CARE NEW YORK-Medicare Advantage, +73688,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73689,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,FIDELIS CARE NEW YORK-Medicare Advantage, +73690,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,FIDELIS CARE NEW YORK-Medicare Advantage, +73691,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73692,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73693,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73694,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,FIDELIS CARE NEW YORK-Medicare Advantage, +73695,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73696,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73697,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73698,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73699,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73700,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73701,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,FIDELIS CARE NEW YORK-Medicare Advantage, +73702,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,FIDELIS CARE NEW YORK-Medicare Advantage, +73703,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,FIDELIS CARE NEW YORK-Medicare Advantage, +73704,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73705,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,FIDELIS CARE NEW YORK-Medicare Advantage, +73706,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73707,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73708,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73709,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,FIDELIS CARE NEW YORK-Medicare Advantage, +73710,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,FIDELIS CARE NEW YORK-Medicare Advantage, +73711,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73712,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,FIDELIS CARE NEW YORK-Medicare Advantage, +73713,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73714,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73715,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73716,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,FIDELIS CARE NEW YORK-Medicare Advantage, +73717,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73718,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73719,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73720,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73721,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73722,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,FIDELIS CARE NEW YORK-Medicare Advantage, +73723,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73724,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73725,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73726,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73727,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73728,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73729,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73730,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73731,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,FIDELIS CARE NEW YORK-Medicare Advantage, +73732,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73733,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,FIDELIS CARE NEW YORK-Medicare Advantage, +73734,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73735,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,FIDELIS CARE NEW YORK-Medicare Advantage, +73736,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73737,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73738,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73739,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73740,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,FIDELIS CARE NEW YORK-Medicare Advantage, +73741,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,FIDELIS CARE NEW YORK-Medicare Advantage, +73742,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73743,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73744,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,FIDELIS CARE NEW YORK-Medicare Advantage, +73745,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73746,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,FIDELIS CARE NEW YORK-Medicare Advantage, +73747,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,FIDELIS CARE NEW YORK-Medicare Advantage, +73748,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,FIDELIS CARE NEW YORK-Medicare Advantage, +73749,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73750,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73751,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73752,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,FIDELIS CARE NEW YORK-Medicare Advantage, +73753,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73754,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,FIDELIS CARE NEW YORK-Medicare Advantage, +73755,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,FIDELIS CARE NEW YORK-Medicare Advantage, +73756,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73757,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,FIDELIS CARE NEW YORK-Medicare Advantage, +73758,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73759,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73760,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73761,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73762,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73763,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73764,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73765,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,FIDELIS CARE NEW YORK-Medicare Advantage, +73766,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73767,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,FIDELIS CARE NEW YORK-Medicare Advantage, +73768,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73769,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73770,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73771,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73772,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73773,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73774,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,FIDELIS CARE NEW YORK-Medicare Advantage, +73775,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,FIDELIS CARE NEW YORK-Medicare Advantage, +73776,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,FIDELIS CARE NEW YORK-Medicare Advantage, +73777,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,FIDELIS CARE NEW YORK-Medicare Advantage, +73778,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73779,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73780,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,FIDELIS CARE NEW YORK-Medicare Advantage, +73781,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73782,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,FIDELIS CARE NEW YORK-Medicare Advantage, +73783,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73784,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,FIDELIS CARE NEW YORK-Medicare Advantage, +73785,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,FIDELIS CARE NEW YORK-Medicare Advantage, +73786,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73787,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73788,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73789,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,FIDELIS CARE NEW YORK-Medicare Advantage, +73790,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,FIDELIS CARE NEW YORK-Medicare Advantage, +73791,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73792,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,FIDELIS CARE NEW YORK-Medicare Advantage, +73793,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73794,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73795,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73796,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73797,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,FIDELIS CARE NEW YORK-Medicare Advantage, +73798,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,FIDELIS CARE NEW YORK-Medicare Advantage, +73799,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,FIDELIS CARE NEW YORK-Medicare Advantage, +73800,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73801,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,FIDELIS CARE NEW YORK-Medicare Advantage, +73802,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73803,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,FIDELIS CARE NEW YORK-Medicare Advantage, +73804,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,FIDELIS CARE NEW YORK-Medicare Advantage, +73805,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,FIDELIS CARE NEW YORK-Medicare Advantage, +73806,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73807,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,FIDELIS CARE NEW YORK-Medicare Advantage, +73808,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,FIDELIS CARE NEW YORK-Medicare Advantage, +73809,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,FIDELIS CARE NEW YORK-Medicare Advantage, +73810,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73811,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73812,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,FIDELIS CARE NEW YORK-Medicare Advantage, +73813,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,FIDELIS CARE NEW YORK-Medicare Advantage, +73814,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73815,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73816,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73817,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73818,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,FIDELIS CARE NEW YORK-Medicare Advantage, +73819,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73820,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,FIDELIS CARE NEW YORK-Medicare Advantage, +73821,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,FIDELIS CARE NEW YORK-Medicare Advantage, +73822,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73823,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,FIDELIS CARE NEW YORK-Medicare Advantage, +73824,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73825,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73826,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73827,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,FIDELIS CARE NEW YORK-Medicare Advantage, +73828,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,FIDELIS CARE NEW YORK-Medicare Advantage, +73829,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,FIDELIS CARE NEW YORK-Medicare Advantage, +73830,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,FIDELIS CARE NEW YORK-Medicare Advantage, +73831,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,FIDELIS CARE NEW YORK-Medicare Advantage, +73832,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73833,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73834,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73835,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73836,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73837,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,FIDELIS CARE NEW YORK-Medicare Advantage, +73838,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73839,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73840,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73841,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,FIDELIS CARE NEW YORK-Medicare Advantage, +73842,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,FIDELIS CARE NEW YORK-Medicare Advantage, +73843,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73844,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73845,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73846,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73847,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73848,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73849,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73850,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,FIDELIS CARE NEW YORK-Medicare Advantage, +73851,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73852,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,FIDELIS CARE NEW YORK-Medicare Advantage, +73853,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73854,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,FIDELIS CARE NEW YORK-Medicare Advantage, +73855,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73856,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73857,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,FIDELIS CARE NEW YORK-Medicare Advantage, +73858,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73859,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73860,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,FIDELIS CARE NEW YORK-Medicare Advantage, +73861,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,FIDELIS CARE NEW YORK-Medicare Advantage, +73862,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73863,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,FIDELIS CARE NEW YORK-Medicare Advantage, +73864,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73865,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,FIDELIS CARE NEW YORK-Medicare Advantage, +73866,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73867,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,FIDELIS CARE NEW YORK-Medicare Advantage, +73868,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73869,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,FIDELIS CARE NEW YORK-Medicare Advantage, +73870,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73871,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,FIDELIS CARE NEW YORK-Medicare Advantage, +73872,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,FIDELIS CARE NEW YORK-Medicare Advantage, +73873,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,FIDELIS CARE NEW YORK-Medicare Advantage, +73874,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73875,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73876,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73877,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,FIDELIS CARE NEW YORK-Medicare Advantage, +73878,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73879,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,FIDELIS CARE NEW YORK-Medicare Advantage, +73880,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73881,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73882,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,FIDELIS CARE NEW YORK-Medicare Advantage, +73883,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,FIDELIS CARE NEW YORK-Medicare Advantage, +73884,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73885,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73886,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,FIDELIS CARE NEW YORK-Medicare Advantage, +73887,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73888,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73889,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73890,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,FIDELIS CARE NEW YORK-Medicare Advantage, +73891,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73892,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73893,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73894,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73895,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,FIDELIS CARE NEW YORK-Medicare Advantage, +73896,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73897,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73898,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73899,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,FIDELIS CARE NEW YORK-Medicare Advantage, +73900,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73901,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,FIDELIS CARE NEW YORK-Medicare Advantage, +73902,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,FIDELIS CARE NEW YORK-Medicare Advantage, +73903,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,FIDELIS CARE NEW YORK-Medicare Advantage, +73904,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,FIDELIS CARE NEW YORK-Medicare Advantage, +73905,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,FIDELIS CARE NEW YORK-Medicare Advantage, +73906,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73907,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73908,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73909,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73910,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73911,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,FIDELIS CARE NEW YORK-Medicare Advantage, +73912,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,FIDELIS CARE NEW YORK-Medicare Advantage, +73913,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73914,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,FIDELIS CARE NEW YORK-Medicare Advantage, +73915,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73916,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,FIDELIS CARE NEW YORK-Medicare Advantage, +73917,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,FIDELIS CARE NEW YORK-Medicare Advantage, +73918,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,FIDELIS CARE NEW YORK-Medicare Advantage, +73919,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,FIDELIS CARE NEW YORK-Medicare Advantage, +73920,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73921,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,FIDELIS CARE NEW YORK-Medicare Advantage, +73922,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73923,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73924,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73925,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,FIDELIS CARE NEW YORK-Medicare Advantage, +73926,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73927,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73928,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,FIDELIS CARE NEW YORK-Medicare Advantage, +73929,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,FIDELIS CARE NEW YORK-Medicare Advantage, +73930,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,FIDELIS CARE NEW YORK-Medicare Advantage, +73931,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73932,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,FIDELIS CARE NEW YORK-Medicare Advantage, +73933,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,FIDELIS CARE NEW YORK-Medicare Advantage, +73934,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,FIDELIS CARE NEW YORK-Medicare Advantage, +73935,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73936,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73937,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,FIDELIS CARE NEW YORK-Medicare Advantage, +73938,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73939,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,FIDELIS CARE NEW YORK-Medicare Advantage, +73940,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,FIDELIS CARE NEW YORK-Medicare Advantage, +73941,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,FIDELIS CARE NEW YORK-Medicare Advantage, +73942,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73943,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73944,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73945,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73946,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,FIDELIS CARE NEW YORK-Medicare Advantage, +73947,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,FIDELIS CARE NEW YORK-Medicare Advantage, +73948,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,FIDELIS CARE NEW YORK-Medicare Advantage, +73949,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73950,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,FIDELIS CARE NEW YORK-Medicare Advantage, +73951,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73952,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73953,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73954,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,FIDELIS CARE NEW YORK-Medicare Advantage, +73955,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73956,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,FIDELIS CARE NEW YORK-Medicare Advantage, +73957,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73958,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73959,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73960,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,FIDELIS CARE NEW YORK-Medicare Advantage, +73961,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,FIDELIS CARE NEW YORK-Medicare Advantage, +73962,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,FIDELIS CARE NEW YORK-Medicare Advantage, +73963,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,FIDELIS CARE NEW YORK-Medicare Advantage, +73964,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,FIDELIS CARE NEW YORK-Medicare Advantage, +73965,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73966,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73967,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,FIDELIS CARE NEW YORK-Medicare Advantage, +73968,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,FIDELIS CARE NEW YORK-Medicare Advantage, +73969,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,FIDELIS CARE NEW YORK-Medicare Advantage, +73970,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73971,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73972,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,FIDELIS CARE NEW YORK-Medicare Advantage, +73973,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73974,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73975,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73976,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,FIDELIS CARE NEW YORK-Medicare Advantage, +73977,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73978,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,FIDELIS CARE NEW YORK-Medicare Advantage, +73979,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,FIDELIS CARE NEW YORK-Medicare Advantage, +73980,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73981,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73982,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73983,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73984,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,FIDELIS CARE NEW YORK-Medicare Advantage, +73985,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,FIDELIS CARE NEW YORK-Medicare Advantage, +73986,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73987,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,FIDELIS CARE NEW YORK-Medicare Advantage, +73988,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73989,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73990,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,FIDELIS CARE NEW YORK-Medicare Advantage, +73991,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73992,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73993,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73994,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73995,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,FIDELIS CARE NEW YORK-Medicare Advantage, +73996,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73997,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73998,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,FIDELIS CARE NEW YORK-Medicare Advantage, +73999,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,FIDELIS CARE NEW YORK-Medicare Advantage, +74000,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,FIDELIS CARE NEW YORK-Medicare Advantage, +74001,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74002,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,FIDELIS CARE NEW YORK-Medicare Advantage, +74003,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74004,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74005,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74006,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,FIDELIS CARE NEW YORK-Medicare Advantage, +74007,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,FIDELIS CARE NEW YORK-Medicare Advantage, +74008,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74009,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,FIDELIS CARE NEW YORK-Medicare Advantage, +74010,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74011,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74012,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74013,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,FIDELIS CARE NEW YORK-Medicare Advantage, +74014,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74015,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74016,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74017,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74018,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,FIDELIS CARE NEW YORK-Medicare Advantage, +74019,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74020,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74021,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74022,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74023,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74024,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74025,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74026,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,FIDELIS CARE NEW YORK-Medicare Advantage, +74027,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,FIDELIS CARE NEW YORK-Medicare Advantage, +74028,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74029,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74030,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74031,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74032,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74033,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74034,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,FIDELIS CARE NEW YORK-Medicare Advantage, +74035,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74036,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74037,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74038,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74039,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74040,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74041,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74042,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74043,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74044,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74045,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74046,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74047,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,FIDELIS CARE NEW YORK-Medicare Advantage, +74048,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74049,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74050,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74051,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74052,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74053,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74054,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,FIDELIS CARE NEW YORK-Medicare Advantage, +74055,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74056,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74057,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,FIDELIS CARE NEW YORK-Medicare Advantage, +74058,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74059,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74060,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74061,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74062,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74063,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74064,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74065,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74066,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,FIDELIS CARE NEW YORK-Medicare Advantage, +74067,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,FIDELIS CARE NEW YORK-Medicare Advantage, +74068,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74069,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74070,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,FIDELIS CARE NEW YORK-Medicare Advantage, +74071,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,FIDELIS CARE NEW YORK-Medicare Advantage, +74072,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,FIDELIS CARE NEW YORK-Medicare Advantage, +74073,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74074,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74075,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,FIDELIS CARE NEW YORK-Medicare Advantage,15.49 +74076,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74077,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74078,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74079,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74080,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,FIDELIS CARE NEW YORK-Medicare Advantage, +74081,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74082,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,FIDELIS CARE NEW YORK-Medicare Advantage, +74083,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74084,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,FIDELIS CARE NEW YORK-Medicare Advantage, +74085,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74086,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74087,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74088,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,FIDELIS CARE NEW YORK-Medicare Advantage, +74089,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74090,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,FIDELIS CARE NEW YORK-Medicare Advantage, +74091,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,FIDELIS CARE NEW YORK-Medicare Advantage, +74092,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74093,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,FIDELIS CARE NEW YORK-Medicare Advantage, +74094,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74095,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74096,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74097,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74098,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74099,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74100,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,FIDELIS CARE NEW YORK-Medicare Advantage, +74101,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74102,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74103,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74104,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,FIDELIS CARE NEW YORK-Medicare Advantage, +74105,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,FIDELIS CARE NEW YORK-Medicare Advantage, +74106,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74107,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74108,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,FIDELIS CARE NEW YORK-Medicare Advantage, +74109,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74110,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74111,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74112,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74113,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74114,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74115,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,FIDELIS CARE NEW YORK-Medicare Advantage, +74116,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74117,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,FIDELIS CARE NEW YORK-Medicare Advantage, +74118,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74119,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74120,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,FIDELIS CARE NEW YORK-Medicare Advantage, +74121,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74122,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74123,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74124,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74125,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74126,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74127,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74128,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74129,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74130,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74131,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74132,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74133,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,FIDELIS CARE NEW YORK-Medicare Advantage, +74134,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74135,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74136,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,FIDELIS CARE NEW YORK-Medicare Advantage, +74137,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74138,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,FIDELIS CARE NEW YORK-Medicare Advantage, +74139,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,FIDELIS CARE NEW YORK-Medicare Advantage, +74140,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74141,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74142,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74143,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74144,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74145,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74146,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74147,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74148,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74149,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74150,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74151,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74152,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74153,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74154,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74155,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74156,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74157,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74158,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74159,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74160,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74161,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74162,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74163,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,FIDELIS CARE NEW YORK-Medicare Advantage, +74164,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74165,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74166,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74167,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74168,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74169,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74170,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74171,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74172,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74173,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74174,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74175,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74176,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74177,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74178,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74179,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74180,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74181,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,FIDELIS CARE NEW YORK-Medicare Advantage, +74182,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,FIDELIS CARE NEW YORK-Medicare Advantage, +74183,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74184,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74185,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74186,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,FIDELIS CARE NEW YORK-Medicare Advantage, +74187,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74188,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74189,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74190,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,FIDELIS CARE NEW YORK-Medicare Advantage, +74191,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,FIDELIS CARE NEW YORK-Medicare Advantage, +74192,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74193,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,FIDELIS CARE NEW YORK-Medicare Advantage, +74194,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,FIDELIS CARE NEW YORK-Medicare Advantage, +74195,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,FIDELIS CARE NEW YORK-Medicare Advantage, +74196,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74197,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74198,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74199,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,FIDELIS CARE NEW YORK-Medicare Advantage, +74200,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74201,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,FIDELIS CARE NEW YORK-Medicare Advantage, +74202,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,FIDELIS CARE NEW YORK-Medicare Advantage, +74203,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74204,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74205,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74206,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74207,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74208,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74209,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74210,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74211,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74212,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,FIDELIS CARE NEW YORK-Medicare Advantage, +74213,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,FIDELIS CARE NEW YORK-Medicare Advantage, +74214,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74215,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74216,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74217,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74218,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,FIDELIS CARE NEW YORK-Medicare Advantage, +74219,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74220,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74221,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74222,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74223,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74224,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74225,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74226,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74227,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,FIDELIS CARE NEW YORK-Medicare Advantage, +74228,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74229,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74230,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74231,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,FIDELIS CARE NEW YORK-Medicare Advantage, +74232,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74233,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74234,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,FIDELIS CARE NEW YORK-Medicare Advantage, +74235,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74236,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74237,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74238,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,FIDELIS CARE NEW YORK-Medicare Advantage, +74239,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,FIDELIS CARE NEW YORK-Medicare Advantage, +74240,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74241,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74242,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74243,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74244,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74245,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74246,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,FIDELIS CARE NEW YORK-Medicare Advantage, +74247,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,FIDELIS CARE NEW YORK-Medicare Advantage, +74248,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74249,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74250,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,FIDELIS CARE NEW YORK-Medicare Advantage, +74251,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74252,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,FIDELIS CARE NEW YORK-Medicare Advantage, +74253,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74254,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74255,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74256,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,FIDELIS CARE NEW YORK-Medicare Advantage, +74257,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74258,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74259,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74260,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74261,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74262,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74263,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74264,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74265,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74266,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74267,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74268,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74269,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74270,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74271,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74272,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74273,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74274,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74275,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,FIDELIS CARE NEW YORK-Medicare Advantage, +74276,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74277,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74278,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74279,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74280,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74281,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74282,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74283,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74284,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74285,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74286,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74287,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74288,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74289,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74290,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74291,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74292,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74293,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74294,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74295,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74296,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,FIDELIS CARE NEW YORK-Medicare Advantage, +74297,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74298,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74299,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74300,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74301,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,FIDELIS CARE NEW YORK-Medicare Advantage, +74302,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,FIDELIS CARE NEW YORK-Medicare Advantage, +74303,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74304,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,FIDELIS CARE NEW YORK-Medicare Advantage, +74305,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,FIDELIS CARE NEW YORK-Medicare Advantage, +74306,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74307,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74308,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,FIDELIS CARE NEW YORK-Medicare Advantage, +74309,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,FIDELIS CARE NEW YORK-Medicare Advantage, +74310,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,FIDELIS CARE NEW YORK-Medicare Advantage, +74311,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,FIDELIS CARE NEW YORK-Medicare Advantage, +74312,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,FIDELIS CARE NEW YORK-Medicare Advantage, +74313,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74314,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74315,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,FIDELIS CARE NEW YORK-Medicare Advantage, +74316,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74317,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74318,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,FIDELIS CARE NEW YORK-Medicare Advantage, +74319,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,FIDELIS CARE NEW YORK-Medicare Advantage, +74320,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74321,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,FIDELIS CARE NEW YORK-Medicare Advantage, +74322,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74323,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74324,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,FIDELIS CARE NEW YORK-Medicare Advantage, +74325,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74326,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74327,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,FIDELIS CARE NEW YORK-Medicare Advantage, +74328,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74329,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74330,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,FIDELIS CARE NEW YORK-Medicare Advantage, +74331,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,FIDELIS CARE NEW YORK-Medicare Advantage, +74332,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74333,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,FIDELIS CARE NEW YORK-Medicare Advantage, +74334,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74335,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74336,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +74337,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +74338,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +74339,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74340,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74341,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74342,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74343,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74344,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74345,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74346,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74347,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74348,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,FIDELIS CARE NEW YORK-Medicare Advantage, +74349,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74350,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74351,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74352,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74353,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74354,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,FIDELIS CARE NEW YORK-Medicare Advantage, +74355,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74356,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,FIDELIS CARE NEW YORK-Medicare Advantage, +74357,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,FIDELIS CARE NEW YORK-Medicare Advantage, +74358,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74359,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74360,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74361,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74362,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,FIDELIS CARE NEW YORK-Medicare Advantage, +74363,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74364,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74365,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74366,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74367,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74368,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74369,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,FIDELIS CARE NEW YORK-Medicare Advantage, +74370,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74371,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,FIDELIS CARE NEW YORK-Medicare Advantage, +74372,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74373,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74374,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74375,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,FIDELIS CARE NEW YORK-Medicare Advantage, +74376,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74377,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74378,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74379,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74380,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74381,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74382,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74383,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74384,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74385,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74386,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74387,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74388,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74389,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74390,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74391,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74392,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74393,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,FIDELIS CARE NEW YORK-Medicare Advantage, +74394,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74395,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74396,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74397,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74398,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,FIDELIS CARE NEW YORK-Medicare Advantage, +74399,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74400,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,FIDELIS CARE NEW YORK-Medicare Advantage, +74401,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74402,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,FIDELIS CARE NEW YORK-Medicare Advantage, +74403,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74404,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,FIDELIS CARE NEW YORK-Medicare Advantage, +74405,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74406,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74407,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,FIDELIS CARE NEW YORK-Medicare Advantage, +74408,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74409,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74410,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74411,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74412,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74413,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,FIDELIS CARE NEW YORK-Medicare Advantage, +74414,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74415,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,FIDELIS CARE NEW YORK-Medicare Advantage, +74416,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74417,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74418,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74419,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74420,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74421,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74422,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,FIDELIS CARE NEW YORK-Medicare Advantage, +74423,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,FIDELIS CARE NEW YORK-Medicare Advantage, +74424,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74425,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,FIDELIS CARE NEW YORK-Medicare Advantage, +74426,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74427,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,FIDELIS CARE NEW YORK-Medicare Advantage, +74428,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74429,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,FIDELIS CARE NEW YORK-Medicare Advantage, +74430,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74431,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74432,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74433,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74434,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,FIDELIS CARE NEW YORK-Medicare Advantage, +74435,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +74436,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74437,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74438,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74439,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74440,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74441,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74442,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74443,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74444,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74445,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74446,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74447,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,FIDELIS CARE NEW YORK-Medicare Advantage, +74448,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74449,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,FIDELIS CARE NEW YORK-Medicare Advantage, +74450,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74451,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74452,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74453,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74454,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74455,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74456,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74457,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74458,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74459,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,FIDELIS CARE NEW YORK-Medicare Advantage, +74460,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74461,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74462,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,FIDELIS CARE NEW YORK-Medicare Advantage, +74463,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74464,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,FIDELIS CARE NEW YORK-Medicare Advantage, +74465,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74466,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74467,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,FIDELIS CARE NEW YORK-Medicare Advantage, +74468,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,FIDELIS CARE NEW YORK-Medicare Advantage, +74469,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74470,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74471,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74472,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74473,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74474,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74475,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74476,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74477,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74478,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74479,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74480,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74481,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74482,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74483,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,FIDELIS CARE NEW YORK-Medicare Advantage, +74484,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74485,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74486,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74487,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74488,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,FIDELIS CARE NEW YORK-Medicare Advantage, +74489,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74490,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74491,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74492,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74493,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,FIDELIS CARE NEW YORK-Medicare Advantage, +74494,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74495,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74496,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,FIDELIS CARE NEW YORK-Medicare Advantage, +74497,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74498,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74499,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74500,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74501,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74502,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74503,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74504,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,FIDELIS CARE NEW YORK-Medicare Advantage, +74505,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74506,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74507,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74508,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74509,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74510,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74511,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74512,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74513,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74514,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74515,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,FIDELIS CARE NEW YORK-Medicare Advantage, +74516,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74517,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74518,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74519,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,FIDELIS CARE NEW YORK-Medicare Advantage, +74520,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,FIDELIS CARE NEW YORK-Medicare Advantage, +74521,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74522,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74523,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74524,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74525,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74526,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74527,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,FIDELIS CARE NEW YORK-Medicare Advantage, +74528,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74529,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74530,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74531,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74532,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74533,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,FIDELIS CARE NEW YORK-Medicare Advantage, +74534,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74535,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74536,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,FIDELIS CARE NEW YORK-Medicare Advantage, +74537,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74538,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74539,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74540,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74541,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74542,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74543,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74544,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74545,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74546,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74547,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74548,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74549,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,FIDELIS CARE NEW YORK-Medicare Advantage, +74550,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74551,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,FIDELIS CARE NEW YORK-Medicare Advantage, +74552,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,FIDELIS CARE NEW YORK-Medicare Advantage, +74553,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74554,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,FIDELIS CARE NEW YORK-Medicare Advantage, +74555,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74556,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74557,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74558,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74559,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74560,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74561,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74562,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,FIDELIS CARE NEW YORK-Medicare Advantage, +74563,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,FIDELIS CARE NEW YORK-Medicare Advantage, +74564,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74565,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74566,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74567,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74568,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74569,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74570,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74571,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74572,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,FIDELIS CARE NEW YORK-Medicare Advantage, +74573,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74574,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,FIDELIS CARE NEW YORK-Medicare Advantage, +74575,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,FIDELIS CARE NEW YORK-Medicare Advantage, +74576,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,FIDELIS CARE NEW YORK-Medicare Advantage, +74577,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74578,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,FIDELIS CARE NEW YORK-Medicare Advantage, +74579,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,FIDELIS CARE NEW YORK-Medicare Advantage, +74580,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74581,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,FIDELIS CARE NEW YORK-Medicare Advantage, +74582,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,FIDELIS CARE NEW YORK-Medicare Advantage, +74583,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,FIDELIS CARE NEW YORK-Medicare Advantage, +74584,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74585,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74586,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74587,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74588,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74589,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74590,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,FIDELIS CARE NEW YORK-Medicare Advantage, +74591,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,FIDELIS CARE NEW YORK-Medicare Advantage, +74592,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,FIDELIS CARE NEW YORK-Medicare Advantage, +74593,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,FIDELIS CARE NEW YORK-Medicare Advantage, +74594,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,FIDELIS CARE NEW YORK-Medicare Advantage, +74595,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74596,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74597,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74598,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74599,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74600,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74601,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74602,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74603,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74604,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74605,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,FIDELIS CARE NEW YORK-Medicare Advantage, +74606,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74607,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74608,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,FIDELIS CARE NEW YORK-Medicare Advantage, +74609,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74610,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74611,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74612,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74613,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74614,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74615,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74616,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74617,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74618,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74619,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74620,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74621,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74622,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74623,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74624,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74625,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,FIDELIS CARE NEW YORK-Medicare Advantage, +74626,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74627,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74628,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74629,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74630,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74631,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74632,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74633,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74634,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74635,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74636,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74637,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74638,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74639,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,FIDELIS CARE NEW YORK-Medicare Advantage, +74640,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74641,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74642,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74643,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74644,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74645,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,FIDELIS CARE NEW YORK-Medicare Advantage, +74646,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74647,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,FIDELIS CARE NEW YORK-Medicare Advantage, +74648,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74649,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,FIDELIS CARE NEW YORK-Medicare Advantage, +74650,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74651,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,FIDELIS CARE NEW YORK-Medicare Advantage, +74652,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,FIDELIS CARE NEW YORK-Medicare Advantage, +74653,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74654,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74655,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,FIDELIS CARE NEW YORK-Medicare Advantage, +74656,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,FIDELIS CARE NEW YORK-Medicare Advantage,270.58 +74657,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74658,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,FIDELIS CARE NEW YORK-Medicare Advantage, +74659,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74660,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74661,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74662,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74663,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74664,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,FIDELIS CARE NEW YORK-Medicare Advantage, +74665,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,FIDELIS CARE NEW YORK-Medicare Advantage, +74666,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74667,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,FIDELIS CARE NEW YORK-Medicare Advantage, +74668,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,FIDELIS CARE NEW YORK-Medicare Advantage, +74669,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74670,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,FIDELIS CARE NEW YORK-Medicare Advantage, +74671,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,FIDELIS CARE NEW YORK-Medicare Advantage, +74672,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,FIDELIS CARE NEW YORK-Medicare Advantage, +74673,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74674,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74675,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74676,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74677,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,FIDELIS CARE NEW YORK-Medicare Advantage, +74678,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,FIDELIS CARE NEW YORK-Medicare Advantage, +74679,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,FIDELIS CARE NEW YORK-Medicare Advantage, +74680,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74681,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74682,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,FIDELIS CARE NEW YORK-Medicare Advantage, +74683,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74684,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74685,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74686,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,FIDELIS CARE NEW YORK-Medicare Advantage, +74687,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74688,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74689,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74690,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74691,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74692,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74693,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,FIDELIS CARE NEW YORK-Medicare Advantage, +74694,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,FIDELIS CARE NEW YORK-Medicare Advantage, +74695,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74696,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74697,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74698,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74699,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,FIDELIS CARE NEW YORK-Medicare Advantage, +74700,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74701,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74702,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74703,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,FIDELIS CARE NEW YORK-Medicare Advantage, +74704,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74705,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,FIDELIS CARE NEW YORK-Medicare Advantage, +74706,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,FIDELIS CARE NEW YORK-Medicare Advantage, +74707,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74708,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,FIDELIS CARE NEW YORK-Medicare Advantage, +74709,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74710,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,FIDELIS CARE NEW YORK-Medicare Advantage, +74711,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,FIDELIS CARE NEW YORK-Medicare Advantage, +74712,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74713,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74714,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,FIDELIS CARE NEW YORK-Medicare Advantage, +74715,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,FIDELIS CARE NEW YORK-Medicare Advantage, +74716,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74717,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74718,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,FIDELIS CARE NEW YORK-Medicare Advantage, +74719,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74720,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,FIDELIS CARE NEW YORK-Medicare Advantage, +74721,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,FIDELIS CARE NEW YORK-Medicare Advantage, +74722,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,FIDELIS CARE NEW YORK-Medicare Advantage, +74723,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74724,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74725,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,FIDELIS CARE NEW YORK-Medicare Advantage, +74726,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74727,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,FIDELIS CARE NEW YORK-Medicare Advantage, +74728,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74729,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,FIDELIS CARE NEW YORK-Medicare Advantage, +74730,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,FIDELIS CARE NEW YORK-Medicare Advantage, +74731,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,FIDELIS CARE NEW YORK-Medicare Advantage, +74732,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,FIDELIS CARE NEW YORK-Medicare Advantage, +74733,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,FIDELIS CARE NEW YORK-Medicare Advantage, +74734,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,FIDELIS CARE NEW YORK-Medicare Advantage, +74735,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,FIDELIS CARE NEW YORK-Medicare Advantage, +74736,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,FIDELIS CARE NEW YORK-Medicare Advantage, +74737,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,FIDELIS CARE NEW YORK-Medicare Advantage, +74738,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,FIDELIS CARE NEW YORK-Medicare Advantage, +74739,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74740,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,FIDELIS CARE NEW YORK-Medicare Advantage, +74741,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74742,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74743,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,FIDELIS CARE NEW YORK-Medicare Advantage, +74744,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74745,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74746,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,FIDELIS CARE NEW YORK-Medicare Advantage, +74747,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,FIDELIS CARE NEW YORK-Medicare Advantage, +74748,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,FIDELIS CARE NEW YORK-Medicare Advantage, +74749,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,FIDELIS CARE NEW YORK-Medicare Advantage, +74750,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74751,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,FIDELIS CARE NEW YORK-Medicare Advantage, +74752,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,FIDELIS CARE NEW YORK-Medicare Advantage, +74753,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,FIDELIS CARE NEW YORK-Medicare Advantage, +74754,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,FIDELIS CARE NEW YORK-Medicare Advantage, +74755,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,FIDELIS CARE NEW YORK-Medicare Advantage, +74756,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74757,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,FIDELIS CARE NEW YORK-Medicare Advantage, +74758,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,FIDELIS CARE NEW YORK-Medicare Advantage, +74759,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74760,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,FIDELIS CARE NEW YORK-Medicare Advantage, +74761,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74762,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,FIDELIS CARE NEW YORK-Medicare Advantage, +74763,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,FIDELIS CARE NEW YORK-Medicare Advantage, +74764,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,FIDELIS CARE NEW YORK-Medicare Advantage, +74765,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,FIDELIS CARE NEW YORK-Medicare Advantage, +74766,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,FIDELIS CARE NEW YORK-Medicare Advantage, +74767,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74768,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74769,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,FIDELIS CARE NEW YORK-Medicare Advantage, +74770,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74771,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,FIDELIS CARE NEW YORK-Medicare Advantage, +74772,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,FIDELIS CARE NEW YORK-Medicare Advantage, +74773,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,FIDELIS CARE NEW YORK-Medicare Advantage, +74774,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74775,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,FIDELIS CARE NEW YORK-Medicare Advantage, +74776,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,FIDELIS CARE NEW YORK-Medicare Advantage, +74777,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74778,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74779,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74780,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74781,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74782,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74783,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74784,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74785,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74786,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74787,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,FIDELIS CARE NEW YORK-Medicare Advantage, +74788,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74789,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,FIDELIS CARE NEW YORK-Medicare Advantage, +74790,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,FIDELIS CARE NEW YORK-Medicare Advantage, +74791,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74792,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,FIDELIS CARE NEW YORK-Medicare Advantage, +74793,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,FIDELIS CARE NEW YORK-Medicare Advantage, +74794,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74795,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74796,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74797,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,FIDELIS CARE NEW YORK-Medicare Advantage, +74798,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,FIDELIS CARE NEW YORK-Medicare Advantage, +74799,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74800,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,FIDELIS CARE NEW YORK-Medicare Advantage, +74801,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74802,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,FIDELIS CARE NEW YORK-Medicare Advantage, +74803,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74804,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,FIDELIS CARE NEW YORK-Medicare Advantage, +74805,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,FIDELIS CARE NEW YORK-Medicare Advantage, +74806,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,FIDELIS CARE NEW YORK-Medicare Advantage, +74807,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,FIDELIS CARE NEW YORK-Medicare Advantage, +74808,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,FIDELIS CARE NEW YORK-Medicare Advantage, +74809,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,FIDELIS CARE NEW YORK-Medicare Advantage, +74810,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,FIDELIS CARE NEW YORK-Medicare Advantage, +74811,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,FIDELIS CARE NEW YORK-Medicare Advantage, +74812,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74813,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,FIDELIS CARE NEW YORK-Medicare Advantage, +74814,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74815,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,FIDELIS CARE NEW YORK-Medicare Advantage, +74816,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74817,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74818,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74819,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,FIDELIS CARE NEW YORK-Medicare Advantage, +74820,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74821,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,FIDELIS CARE NEW YORK-Medicare Advantage, +74822,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,FIDELIS CARE NEW YORK-Medicare Advantage, +74823,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,FIDELIS CARE NEW YORK-Medicare Advantage, +74824,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74825,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74826,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74827,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74828,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,FIDELIS CARE NEW YORK-Medicare Advantage, +74829,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74830,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74831,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74832,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74833,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74834,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,FIDELIS CARE NEW YORK-Medicare Advantage, +74835,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,FIDELIS CARE NEW YORK-Medicare Advantage, +74836,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,FIDELIS CARE NEW YORK-Medicare Advantage, +74837,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,FIDELIS CARE NEW YORK-Medicare Advantage, +74838,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74839,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,FIDELIS CARE NEW YORK-Medicare Advantage, +74840,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,FIDELIS CARE NEW YORK-Medicare Advantage, +74841,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74842,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,FIDELIS CARE NEW YORK-Medicare Advantage, +74843,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,FIDELIS CARE NEW YORK-Medicare Advantage, +74844,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,FIDELIS CARE NEW YORK-Medicare Advantage, +74845,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,FIDELIS CARE NEW YORK-Medicare Advantage, +74846,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,FIDELIS CARE NEW YORK-Medicare Advantage, +74847,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,FIDELIS CARE NEW YORK-Medicare Advantage, +74848,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,FIDELIS CARE NEW YORK-Medicare Advantage, +74849,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,FIDELIS CARE NEW YORK-Medicare Advantage, +74850,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74851,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74852,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,FIDELIS CARE NEW YORK-Medicare Advantage, +74853,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74854,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,FIDELIS CARE NEW YORK-Medicare Advantage, +74855,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74856,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,FIDELIS CARE NEW YORK-Medicare Advantage, +74857,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,FIDELIS CARE NEW YORK-Medicare Advantage, +74858,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,FIDELIS CARE NEW YORK-Medicare Advantage, +74859,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,FIDELIS CARE NEW YORK-Medicare Advantage, +74860,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74861,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,FIDELIS CARE NEW YORK-Medicare Advantage, +74862,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,FIDELIS CARE NEW YORK-Medicare Advantage, +74863,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,FIDELIS CARE NEW YORK-Medicare Advantage, +74864,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,FIDELIS CARE NEW YORK-Medicare Advantage, +74865,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74866,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74867,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74868,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,FIDELIS CARE NEW YORK-Medicare Advantage, +74869,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74870,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,FIDELIS CARE NEW YORK-Medicare Advantage, +74871,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,FIDELIS CARE NEW YORK-Medicare Advantage, +74872,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,FIDELIS CARE NEW YORK-Medicare Advantage, +74873,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74874,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,FIDELIS CARE NEW YORK-Medicare Advantage, +74875,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,FIDELIS CARE NEW YORK-Medicare Advantage, +74876,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,FIDELIS CARE NEW YORK-Medicare Advantage, +74877,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74878,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74879,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74880,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,FIDELIS CARE NEW YORK-Medicare Advantage, +74881,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74882,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,FIDELIS CARE NEW YORK-Medicare Advantage, +74883,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,FIDELIS CARE NEW YORK-Medicare Advantage, +74884,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,FIDELIS CARE NEW YORK-Medicare Advantage, +74885,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74886,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,FIDELIS CARE NEW YORK-Medicare Advantage, +74887,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74888,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,FIDELIS CARE NEW YORK-Medicare Advantage, +74889,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74890,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,FIDELIS CARE NEW YORK-Medicare Advantage, +74891,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74892,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,FIDELIS CARE NEW YORK-Medicare Advantage, +74893,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,FIDELIS CARE NEW YORK-Medicare Advantage, +74894,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74895,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,FIDELIS CARE NEW YORK-Medicare Advantage, +74896,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74897,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,FIDELIS CARE NEW YORK-Medicare Advantage, +74898,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74899,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,FIDELIS CARE NEW YORK-Medicare Advantage, +74900,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,FIDELIS CARE NEW YORK-Medicare Advantage, +74901,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,FIDELIS CARE NEW YORK-Medicare Advantage, +74902,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,FIDELIS CARE NEW YORK-Medicare Advantage, +74903,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74904,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74905,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,FIDELIS CARE NEW YORK-Medicare Advantage, +74906,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,FIDELIS CARE NEW YORK-Medicare Advantage, +74907,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74908,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,FIDELIS CARE NEW YORK-Medicare Advantage, +74909,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,FIDELIS CARE NEW YORK-Medicare Advantage, +74910,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74911,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74912,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,FIDELIS CARE NEW YORK-Medicare Advantage, +74913,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,FIDELIS CARE NEW YORK-Medicare Advantage, +74914,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,FIDELIS CARE NEW YORK-Medicare Advantage, +74915,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,FIDELIS CARE NEW YORK-Medicare Advantage, +74916,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74917,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74918,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,FIDELIS CARE NEW YORK-Medicare Advantage, +74919,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,FIDELIS CARE NEW YORK-Medicare Advantage, +74920,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74921,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74922,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,FIDELIS CARE NEW YORK-Medicare Advantage, +74923,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,FIDELIS CARE NEW YORK-Medicare Advantage, +74924,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,FIDELIS CARE NEW YORK-Medicare Advantage, +74925,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,FIDELIS CARE NEW YORK-Medicare Advantage, +74926,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,FIDELIS CARE NEW YORK-Medicare Advantage, +74927,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,FIDELIS CARE NEW YORK-Medicare Advantage, +74928,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74929,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,FIDELIS CARE NEW YORK-Medicare Advantage, +74930,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,FIDELIS CARE NEW YORK-Medicare Advantage, +74931,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,FIDELIS CARE NEW YORK-Medicare Advantage, +74932,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,FIDELIS CARE NEW YORK-Medicare Advantage, +74933,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,FIDELIS CARE NEW YORK-Medicare Advantage, +74934,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74935,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,FIDELIS CARE NEW YORK-Medicare Advantage, +74936,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,FIDELIS CARE NEW YORK-Medicare Advantage, +74937,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74938,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,FIDELIS CARE NEW YORK-Medicare Advantage, +74939,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,FIDELIS CARE NEW YORK-Medicare Advantage, +74940,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,FIDELIS CARE NEW YORK-Medicare Advantage, +74941,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,FIDELIS CARE NEW YORK-Medicare Advantage, +74942,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,FIDELIS CARE NEW YORK-Medicare Advantage, +74943,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74944,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,FIDELIS CARE NEW YORK-Medicare Advantage, +74945,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,FIDELIS CARE NEW YORK-Medicare Advantage, +74946,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,FIDELIS CARE NEW YORK-Medicare Advantage, +74947,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,FIDELIS CARE NEW YORK-Medicare Advantage, +74948,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74949,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,FIDELIS CARE NEW YORK-Medicare Advantage, +74950,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,FIDELIS CARE NEW YORK-Medicare Advantage, +74951,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,FIDELIS CARE NEW YORK-Medicare Advantage, +74952,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,FIDELIS CARE NEW YORK-Medicare Advantage, +74953,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74954,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74955,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,FIDELIS CARE NEW YORK-Medicare Advantage, +74956,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,FIDELIS CARE NEW YORK-Medicare Advantage, +74957,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,FIDELIS CARE NEW YORK-Medicare Advantage, +74958,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,FIDELIS CARE NEW YORK-Medicare Advantage, +74959,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,FIDELIS CARE NEW YORK-Medicare Advantage, +74960,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,FIDELIS CARE NEW YORK-Medicare Advantage, +74961,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,FIDELIS CARE NEW YORK-Medicare Advantage, +74962,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,FIDELIS CARE NEW YORK-Medicare Advantage, +74963,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,FIDELIS CARE NEW YORK-Medicare Advantage, +74964,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74965,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74966,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74967,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74968,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74969,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,FIDELIS CARE NEW YORK-Medicare Advantage, +74970,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74971,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,FIDELIS CARE NEW YORK-Medicare Advantage, +74972,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74973,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74974,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,FIDELIS CARE NEW YORK-Medicare Advantage, +74975,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74976,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74977,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,FIDELIS CARE NEW YORK-Medicare Advantage, +74978,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74979,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74980,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74981,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,FIDELIS CARE NEW YORK-Medicare Advantage, +74982,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74983,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74984,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74985,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74986,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74987,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74988,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74989,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74990,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74991,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74992,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74993,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74994,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74995,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74996,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,FIDELIS CARE NEW YORK-Medicare Advantage, +74997,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74998,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,FIDELIS CARE NEW YORK-Medicare Advantage, +74999,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75000,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75001,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75002,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75003,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75004,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75005,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75006,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75007,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75008,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75009,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75010,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75011,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,FIDELIS CARE NEW YORK-Medicare Advantage, +75012,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75013,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75014,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75015,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75016,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75017,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75018,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75019,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75020,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75021,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75022,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75023,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75024,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75025,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75026,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75027,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,FIDELIS CARE NEW YORK-Medicare Advantage, +75028,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75029,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75030,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75031,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75032,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75033,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75034,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,FIDELIS CARE NEW YORK-Medicare Advantage, +75035,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75036,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75037,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75038,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75039,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75040,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,FIDELIS CARE NEW YORK-Medicare Advantage, +75041,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75042,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75043,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75044,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75045,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75046,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75047,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75048,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75049,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75050,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75051,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75052,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75053,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75054,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75055,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75056,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75057,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75058,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75059,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75060,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75061,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75062,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75063,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75064,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75065,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75066,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75067,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75068,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75069,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75070,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75071,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75072,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75073,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75074,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75075,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75076,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75077,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75078,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75079,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75080,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75081,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,FIDELIS CARE NEW YORK-Medicare Advantage, +75082,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75083,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75084,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75085,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75086,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75087,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75088,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75089,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75090,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75091,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75092,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,FIDELIS CARE NEW YORK-Medicare Advantage, +75093,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75094,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75095,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75096,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75097,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75098,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,FIDELIS CARE NEW YORK-Medicare Advantage, +75099,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,FIDELIS CARE NEW YORK-Medicare Advantage, +75100,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75101,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75102,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,FIDELIS CARE NEW YORK-Medicare Advantage, +75103,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,FIDELIS CARE NEW YORK-Medicare Advantage, +75104,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75105,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75106,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75107,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75108,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,FIDELIS CARE NEW YORK-Medicare Advantage, +75109,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75110,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,FIDELIS CARE NEW YORK-Medicare Advantage, +75111,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75112,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,FIDELIS CARE NEW YORK-Medicare Advantage, +75113,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,FIDELIS CARE NEW YORK-Medicare Advantage, +75114,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,FIDELIS CARE NEW YORK-Medicare Advantage, +75115,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,FIDELIS CARE NEW YORK-Medicare Advantage, +75116,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75117,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,FIDELIS CARE NEW YORK-Medicare Advantage, +75118,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75119,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,FIDELIS CARE NEW YORK-Medicare Advantage, +75120,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,FIDELIS CARE NEW YORK-Medicare Advantage, +75121,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,FIDELIS CARE NEW YORK-Medicare Advantage, +75122,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75123,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,FIDELIS CARE NEW YORK-Medicare Advantage, +75124,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75125,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75126,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75127,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,FIDELIS CARE NEW YORK-Medicare Advantage, +75128,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,FIDELIS CARE NEW YORK-Medicare Advantage, +75129,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,FIDELIS CARE NEW YORK-Medicare Advantage, +75130,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,FIDELIS CARE NEW YORK-Medicare Advantage, +75131,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75132,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,FIDELIS CARE NEW YORK-Medicare Advantage, +75133,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,FIDELIS CARE NEW YORK-Medicare Advantage, +75134,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,FIDELIS CARE NEW YORK-Medicare Advantage, +75135,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,FIDELIS CARE NEW YORK-Medicare Advantage, +75136,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,FIDELIS CARE NEW YORK-Medicare Advantage, +75137,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,FIDELIS CARE NEW YORK-Medicare Advantage, +75138,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,FIDELIS CARE NEW YORK-Medicare Advantage, +75139,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,FIDELIS CARE NEW YORK-Medicare Advantage, +75140,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,FIDELIS CARE NEW YORK-Medicare Advantage, +75141,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,FIDELIS CARE NEW YORK-Medicare Advantage, +75142,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,FIDELIS CARE NEW YORK-Medicare Advantage, +75143,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,FIDELIS CARE NEW YORK-Medicare Advantage, +75144,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75145,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75146,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,FIDELIS CARE NEW YORK-Medicare Advantage, +75147,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75148,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,FIDELIS CARE NEW YORK-Medicare Advantage, +75149,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75150,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75151,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75152,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75153,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,FIDELIS CARE NEW YORK-Medicare Advantage, +75154,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,FIDELIS CARE NEW YORK-Medicare Advantage, +75155,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75156,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,FIDELIS CARE NEW YORK-Medicare Advantage, +75157,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,FIDELIS CARE NEW YORK-Medicare Advantage, +75158,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,FIDELIS CARE NEW YORK-Medicare Advantage, +75159,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75160,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75161,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75162,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,FIDELIS CARE NEW YORK-Medicare Advantage, +75163,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,FIDELIS CARE NEW YORK-Medicare Advantage, +75164,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,FIDELIS CARE NEW YORK-Medicare Advantage, +75165,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75166,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,FIDELIS CARE NEW YORK-Medicare Advantage, +75167,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75168,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75169,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,FIDELIS CARE NEW YORK-Medicare Advantage, +75170,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,FIDELIS CARE NEW YORK-Medicare Advantage, +75171,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,FIDELIS CARE NEW YORK-Medicare Advantage, +75172,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75173,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75174,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75175,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75176,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75177,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75178,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,FIDELIS CARE NEW YORK-Medicare Advantage, +75179,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75180,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,FIDELIS CARE NEW YORK-Medicare Advantage, +75181,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,FIDELIS CARE NEW YORK-Medicare Advantage, +75182,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75183,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,FIDELIS CARE NEW YORK-Medicare Advantage, +75184,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75185,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,FIDELIS CARE NEW YORK-Medicare Advantage, +75186,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,FIDELIS CARE NEW YORK-Medicare Advantage, +75187,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,FIDELIS CARE NEW YORK-Medicare Advantage, +75188,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,FIDELIS CARE NEW YORK-Medicare Advantage, +75189,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,FIDELIS CARE NEW YORK-Medicare Advantage, +75190,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75191,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,FIDELIS CARE NEW YORK-Medicare Advantage, +75192,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,FIDELIS CARE NEW YORK-Medicare Advantage, +75193,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,FIDELIS CARE NEW YORK-Medicare Advantage, +75194,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,FIDELIS CARE NEW YORK-Medicare Advantage, +75195,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,FIDELIS CARE NEW YORK-Medicare Advantage, +75196,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,FIDELIS CARE NEW YORK-Medicare Advantage, +75197,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,FIDELIS CARE NEW YORK-Medicare Advantage, +75198,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75199,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75200,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75201,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,FIDELIS CARE NEW YORK-Medicare Advantage, +75202,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,FIDELIS CARE NEW YORK-Medicare Advantage, +75203,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,FIDELIS CARE NEW YORK-Medicare Advantage, +75204,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,FIDELIS CARE NEW YORK-Medicare Advantage, +75205,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,FIDELIS CARE NEW YORK-Medicare Advantage, +75206,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75207,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,FIDELIS CARE NEW YORK-Medicare Advantage, +75208,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,FIDELIS CARE NEW YORK-Medicare Advantage, +75209,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,FIDELIS CARE NEW YORK-Medicare Advantage, +75210,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,FIDELIS CARE NEW YORK-Medicare Advantage, +75211,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,FIDELIS CARE NEW YORK-Medicare Advantage, +75212,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75213,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,FIDELIS CARE NEW YORK-Medicare Advantage, +75214,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,FIDELIS CARE NEW YORK-Medicare Advantage, +75215,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,FIDELIS CARE NEW YORK-Medicare Advantage, +75216,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,FIDELIS CARE NEW YORK-Medicare Advantage, +75217,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,FIDELIS CARE NEW YORK-Medicare Advantage, +75218,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,FIDELIS CARE NEW YORK-Medicare Advantage, +75219,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,FIDELIS CARE NEW YORK-Medicare Advantage, +75220,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,FIDELIS CARE NEW YORK-Medicare Advantage, +75221,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75222,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,FIDELIS CARE NEW YORK-Medicare Advantage, +75223,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75224,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,FIDELIS CARE NEW YORK-Medicare Advantage, +75225,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,FIDELIS CARE NEW YORK-Medicare Advantage, +75226,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75227,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,FIDELIS CARE NEW YORK-Medicare Advantage, +75228,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,FIDELIS CARE NEW YORK-Medicare Advantage, +75229,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,FIDELIS CARE NEW YORK-Medicare Advantage, +75230,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,FIDELIS CARE NEW YORK-Medicare Advantage, +75231,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,FIDELIS CARE NEW YORK-Medicare Advantage, +75232,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75233,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,FIDELIS CARE NEW YORK-Medicare Advantage, +75234,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,FIDELIS CARE NEW YORK-Medicare Advantage, +75235,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75236,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,FIDELIS CARE NEW YORK-Medicare Advantage, +75237,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,FIDELIS CARE NEW YORK-Medicare Advantage, +75238,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75239,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,FIDELIS CARE NEW YORK-Medicare Advantage, +75240,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,FIDELIS CARE NEW YORK-Medicare Advantage, +75241,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75242,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,FIDELIS CARE NEW YORK-Medicare Advantage, +75243,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,FIDELIS CARE NEW YORK-Medicare Advantage, +75244,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75245,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75246,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,FIDELIS CARE NEW YORK-Medicare Advantage, +75247,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,FIDELIS CARE NEW YORK-Medicare Advantage, +75248,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,FIDELIS CARE NEW YORK-Medicare Advantage, +75249,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,FIDELIS CARE NEW YORK-Medicare Advantage, +75250,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75251,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,FIDELIS CARE NEW YORK-Medicare Advantage, +75252,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75253,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75254,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75255,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75256,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75257,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75258,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,FIDELIS CARE NEW YORK-Medicare Advantage, +75259,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,FIDELIS CARE NEW YORK-Medicare Advantage, +75260,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,FIDELIS CARE NEW YORK-Medicare Advantage, +75261,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,FIDELIS CARE NEW YORK-Medicare Advantage, +75262,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75263,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,FIDELIS CARE NEW YORK-Medicare Advantage, +75264,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,FIDELIS CARE NEW YORK-Medicare Advantage, +75265,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,FIDELIS CARE NEW YORK-Medicare Advantage, +75266,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,FIDELIS CARE NEW YORK-Medicare Advantage, +75267,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,FIDELIS CARE NEW YORK-Medicare Advantage, +75268,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,FIDELIS CARE NEW YORK-Medicare Advantage, +75269,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,FIDELIS CARE NEW YORK-Medicare Advantage, +75270,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75271,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75272,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,FIDELIS CARE NEW YORK-Medicare Advantage, +75273,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,FIDELIS CARE NEW YORK-Medicare Advantage, +75274,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75275,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75276,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,FIDELIS CARE NEW YORK-Medicare Advantage, +75277,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,FIDELIS CARE NEW YORK-Medicare Advantage, +75278,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75279,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75280,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,FIDELIS CARE NEW YORK-Medicare Advantage, +75281,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,FIDELIS CARE NEW YORK-Medicare Advantage, +75282,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,FIDELIS CARE NEW YORK-Medicare Advantage, +75283,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,FIDELIS CARE NEW YORK-Medicare Advantage, +75284,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,FIDELIS CARE NEW YORK-Medicare Advantage, +75285,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75286,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,FIDELIS CARE NEW YORK-Medicare Advantage, +75287,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75288,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,FIDELIS CARE NEW YORK-Medicare Advantage, +75289,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,FIDELIS CARE NEW YORK-Medicare Advantage, +75290,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,FIDELIS CARE NEW YORK-Medicare Advantage, +75291,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,FIDELIS CARE NEW YORK-Medicare Advantage, +75292,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75293,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,FIDELIS CARE NEW YORK-Medicare Advantage, +75294,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75295,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,FIDELIS CARE NEW YORK-Medicare Advantage, +75296,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75297,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,FIDELIS CARE NEW YORK-Medicare Advantage, +75298,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,FIDELIS CARE NEW YORK-Medicare Advantage, +75299,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,FIDELIS CARE NEW YORK-Medicare Advantage, +75300,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,FIDELIS CARE NEW YORK-Medicare Advantage, +75301,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,FIDELIS CARE NEW YORK-Medicare Advantage, +75302,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,FIDELIS CARE NEW YORK-Medicare Advantage, +75303,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,FIDELIS CARE NEW YORK-Medicare Advantage, +75304,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,FIDELIS CARE NEW YORK-Medicare Advantage, +75305,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,FIDELIS CARE NEW YORK-Medicare Advantage, +75306,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,FIDELIS CARE NEW YORK-Medicare Advantage, +75307,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,FIDELIS CARE NEW YORK-Medicare Advantage, +75308,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,FIDELIS CARE NEW YORK-Medicare Advantage, +75309,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,FIDELIS CARE NEW YORK-Medicare Advantage, +75310,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,FIDELIS CARE NEW YORK-Medicare Advantage, +75311,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,FIDELIS CARE NEW YORK-Medicare Advantage, +75312,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,FIDELIS CARE NEW YORK-Medicare Advantage, +75313,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75314,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75315,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,FIDELIS CARE NEW YORK-Medicare Advantage, +75316,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,FIDELIS CARE NEW YORK-Medicare Advantage, +75317,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75318,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75319,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75320,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,FIDELIS CARE NEW YORK-Medicare Advantage, +75321,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,FIDELIS CARE NEW YORK-Medicare Advantage, +75322,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,FIDELIS CARE NEW YORK-Medicare Advantage, +75323,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,FIDELIS CARE NEW YORK-Medicare Advantage, +75324,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75325,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,FIDELIS CARE NEW YORK-Medicare Advantage, +75326,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,FIDELIS CARE NEW YORK-Medicare Advantage, +75327,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,FIDELIS CARE NEW YORK-Medicare Advantage, +75328,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,FIDELIS CARE NEW YORK-Medicare Advantage, +75329,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75330,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,FIDELIS CARE NEW YORK-Medicare Advantage, +75331,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,FIDELIS CARE NEW YORK-Medicare Advantage, +75332,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,FIDELIS CARE NEW YORK-Medicare Advantage, +75333,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,FIDELIS CARE NEW YORK-Medicare Advantage, +75334,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,FIDELIS CARE NEW YORK-Medicare Advantage, +75335,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,FIDELIS CARE NEW YORK-Medicare Advantage, +75336,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,FIDELIS CARE NEW YORK-Medicare Advantage, +75337,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75338,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75339,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,FIDELIS CARE NEW YORK-Medicare Advantage, +75340,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,FIDELIS CARE NEW YORK-Medicare Advantage, +75341,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,FIDELIS CARE NEW YORK-Medicare Advantage, +75342,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75343,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,FIDELIS CARE NEW YORK-Medicare Advantage, +75344,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,FIDELIS CARE NEW YORK-Medicare Advantage, +75345,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,FIDELIS CARE NEW YORK-Medicare Advantage, +75346,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,FIDELIS CARE NEW YORK-Medicare Advantage, +75347,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,FIDELIS CARE NEW YORK-Medicare Advantage, +75348,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75349,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,FIDELIS CARE NEW YORK-Medicare Advantage, +75350,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75351,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,FIDELIS CARE NEW YORK-Medicare Advantage, +75352,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,FIDELIS CARE NEW YORK-Medicare Advantage, +75353,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75354,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75355,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,FIDELIS CARE NEW YORK-Medicare Advantage, +75356,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75357,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75358,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75359,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,FIDELIS CARE NEW YORK-Medicare Advantage, +75360,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,FIDELIS CARE NEW YORK-Medicare Advantage, +75361,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,FIDELIS CARE NEW YORK-Medicare Advantage, +75362,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,FIDELIS CARE NEW YORK-Medicare Advantage, +75363,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,FIDELIS CARE NEW YORK-Medicare Advantage, +75364,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,FIDELIS CARE NEW YORK-Medicare Advantage, +75365,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,FIDELIS CARE NEW YORK-Medicare Advantage, +75366,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,FIDELIS CARE NEW YORK-Medicare Advantage, +75367,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,FIDELIS CARE NEW YORK-Medicare Advantage, +75368,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,FIDELIS CARE NEW YORK-Medicare Advantage, +75369,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,FIDELIS CARE NEW YORK-Medicare Advantage, +75370,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,FIDELIS CARE NEW YORK-Medicare Advantage, +75371,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,FIDELIS CARE NEW YORK-Medicare Advantage, +75372,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,FIDELIS CARE NEW YORK-Medicare Advantage, +75373,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,FIDELIS CARE NEW YORK-Medicare Advantage, +75374,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,FIDELIS CARE NEW YORK-Medicare Advantage, +75375,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,FIDELIS CARE NEW YORK-Medicare Advantage, +75376,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75377,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75378,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,FIDELIS CARE NEW YORK-Medicare Advantage, +75379,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,FIDELIS CARE NEW YORK-Medicare Advantage, +75380,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,FIDELIS CARE NEW YORK-Medicare Advantage, +75381,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75382,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75383,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75384,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,FIDELIS CARE NEW YORK-Medicare Advantage, +75385,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75386,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,FIDELIS CARE NEW YORK-Medicare Advantage, +75387,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,FIDELIS CARE NEW YORK-Medicare Advantage, +75388,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,FIDELIS CARE NEW YORK-Medicare Advantage, +75389,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75390,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,FIDELIS CARE NEW YORK-Medicare Advantage, +75391,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,FIDELIS CARE NEW YORK-Medicare Advantage, +75392,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,FIDELIS CARE NEW YORK-Medicare Advantage, +75393,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75394,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,FIDELIS CARE NEW YORK-Medicare Advantage, +75395,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75396,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75397,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,FIDELIS CARE NEW YORK-Medicare Advantage, +75398,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,FIDELIS CARE NEW YORK-Medicare Advantage, +75399,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75400,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,FIDELIS CARE NEW YORK-Medicare Advantage, +75401,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,FIDELIS CARE NEW YORK-Medicare Advantage, +75402,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75403,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,FIDELIS CARE NEW YORK-Medicare Advantage, +75404,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75405,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,FIDELIS CARE NEW YORK-Medicare Advantage, +75406,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75407,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,FIDELIS CARE NEW YORK-Medicare Advantage, +75408,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,FIDELIS CARE NEW YORK-Medicare Advantage, +75409,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,FIDELIS CARE NEW YORK-Medicare Advantage, +75410,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,FIDELIS CARE NEW YORK-Medicare Advantage, +75411,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75412,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,FIDELIS CARE NEW YORK-Medicare Advantage, +75413,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75414,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,FIDELIS CARE NEW YORK-Medicare Advantage, +75415,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,FIDELIS CARE NEW YORK-Medicare Advantage, +75416,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75417,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75418,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,FIDELIS CARE NEW YORK-Medicare Advantage, +75419,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75420,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75421,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75422,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,FIDELIS CARE NEW YORK-Medicare Advantage, +75423,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75424,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,FIDELIS CARE NEW YORK-Medicare Advantage, +75425,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,FIDELIS CARE NEW YORK-Medicare Advantage, +75426,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,FIDELIS CARE NEW YORK-Medicare Advantage, +75427,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,FIDELIS CARE NEW YORK-Medicare Advantage, +75428,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75429,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,FIDELIS CARE NEW YORK-Medicare Advantage, +75430,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,FIDELIS CARE NEW YORK-Medicare Advantage, +75431,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,FIDELIS CARE NEW YORK-Medicare Advantage, +75432,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,FIDELIS CARE NEW YORK-Medicare Advantage, +75433,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,FIDELIS CARE NEW YORK-Medicare Advantage, +75434,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,FIDELIS CARE NEW YORK-Medicare Advantage, +75435,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,FIDELIS CARE NEW YORK-Medicare Advantage, +75436,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,FIDELIS CARE NEW YORK-Medicare Advantage, +75437,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,FIDELIS CARE NEW YORK-Medicare Advantage, +75438,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,FIDELIS CARE NEW YORK-Medicare Advantage, +75439,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,FIDELIS CARE NEW YORK-Medicare Advantage, +75440,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,FIDELIS CARE NEW YORK-Medicare Advantage, +75441,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,FIDELIS CARE NEW YORK-Medicare Advantage, +75442,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,FIDELIS CARE NEW YORK-Medicare Advantage, +75443,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,FIDELIS CARE NEW YORK-Medicare Advantage, +75444,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75445,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,FIDELIS CARE NEW YORK-Medicare Advantage, +75446,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,FIDELIS CARE NEW YORK-Medicare Advantage, +75447,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,FIDELIS CARE NEW YORK-Medicare Advantage, +75448,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,FIDELIS CARE NEW YORK-Medicare Advantage, +75449,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,FIDELIS CARE NEW YORK-Medicare Advantage, +75450,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,FIDELIS CARE NEW YORK-Medicare Advantage, +75451,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,FIDELIS CARE NEW YORK-Medicare Advantage, +75452,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,FIDELIS CARE NEW YORK-Medicare Advantage, +75453,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75454,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75455,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,FIDELIS CARE NEW YORK-Medicare Advantage, +75456,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,FIDELIS CARE NEW YORK-Medicare Advantage, +75457,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,FIDELIS CARE NEW YORK-Medicare Advantage, +75458,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,FIDELIS CARE NEW YORK-Medicare Advantage, +75459,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,FIDELIS CARE NEW YORK-Medicare Advantage, +75460,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,FIDELIS CARE NEW YORK-Medicare Advantage, +75461,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,FIDELIS CARE NEW YORK-Medicare Advantage, +75462,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,FIDELIS CARE NEW YORK-Medicare Advantage, +75463,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,FIDELIS CARE NEW YORK-Medicare Advantage, +75464,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75465,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75466,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75467,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75468,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75469,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,FIDELIS CARE NEW YORK-Medicare Advantage, +75470,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75471,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75472,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75473,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75474,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75475,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75476,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75477,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,FIDELIS CARE NEW YORK-Medicare Advantage, +75478,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75479,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75480,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75481,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75482,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75483,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75484,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75485,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75486,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,FIDELIS CARE NEW YORK-Medicare Advantage, +75487,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75488,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,FIDELIS CARE NEW YORK-Medicare Advantage, +75489,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,FIDELIS CARE NEW YORK-Medicare Advantage, +75490,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75491,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,FIDELIS CARE NEW YORK-Medicare Advantage, +75492,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,FIDELIS CARE NEW YORK-Medicare Advantage, +75493,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,FIDELIS CARE NEW YORK-Medicare Advantage, +75494,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,FIDELIS CARE NEW YORK-Medicare Advantage, +75495,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,FIDELIS CARE NEW YORK-Medicare Advantage, +75496,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,FIDELIS CARE NEW YORK-Medicare Advantage, +75497,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,FIDELIS CARE NEW YORK-Medicare Advantage, +75498,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,FIDELIS CARE NEW YORK-Medicare Advantage, +75499,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,FIDELIS CARE NEW YORK-Medicare Advantage, +75500,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,FIDELIS CARE NEW YORK-Medicare Advantage, +75501,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75502,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,FIDELIS CARE NEW YORK-Medicare Advantage, +75503,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75504,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,FIDELIS CARE NEW YORK-Medicare Advantage, +75505,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75506,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,FIDELIS CARE NEW YORK-Medicare Advantage, +75507,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,FIDELIS CARE NEW YORK-Medicare Advantage, +75508,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75509,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75510,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75511,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,FIDELIS CARE NEW YORK-Medicare Advantage, +75512,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75513,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75514,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75515,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,FIDELIS CARE NEW YORK-Medicare Advantage, +75516,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,FIDELIS CARE NEW YORK-Medicare Advantage, +75517,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,FIDELIS CARE NEW YORK-Medicare Advantage, +75518,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75519,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,FIDELIS CARE NEW YORK-Medicare Advantage, +75520,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75521,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75522,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75523,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75524,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,FIDELIS CARE NEW YORK-Medicare Advantage, +75525,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,FIDELIS CARE NEW YORK-Medicare Advantage, +75526,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,FIDELIS CARE NEW YORK-Medicare Advantage, +75527,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,FIDELIS CARE NEW YORK-Medicare Advantage, +75528,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,FIDELIS CARE NEW YORK-Medicare Advantage, +75529,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,FIDELIS CARE NEW YORK-Medicare Advantage, +75530,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,FIDELIS CARE NEW YORK-Medicare Advantage, +75531,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,FIDELIS CARE NEW YORK-Medicare Advantage, +75532,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,FIDELIS CARE NEW YORK-Medicare Advantage, +75533,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75534,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,FIDELIS CARE NEW YORK-Medicare Advantage, +75535,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75536,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75537,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75538,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75539,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75540,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75541,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,FIDELIS CARE NEW YORK-Medicare Advantage, +75542,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75543,3934,30000012,PRIVATE,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75544,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75545,3934,30000038,ICU,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75546,3934,30000046,BURN UNIT,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75547,3934,30000053,NICU,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75548,3934,30000061,ICR ROOM,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75549,3934,30000079,PSYCH,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75550,3934,30000087,NEWBORN,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75551,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75552,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75553,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75554,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75555,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75556,3934,30101000,R&B REV SURG 19N 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HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75606,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75607,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75608,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75609,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75610,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75611,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75612,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75613,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75614,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW 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PACKET FOR PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75625,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75626,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75627,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75628,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75629,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75630,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75631,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75632,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75633,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75828,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75829,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75830,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75831,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75832,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75833,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75834,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75835,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75836,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare 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PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75847,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75848,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75849,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75850,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75851,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75852,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75853,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75854,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75855,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare 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PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75866,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75867,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75868,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75869,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75870,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75871,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75872,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75873,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75874,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75885,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75886,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75887,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75888,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75889,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75890,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75891,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75892,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75893,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75894,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75895,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75896,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75897,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75898,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75899,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75900,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75901,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75902,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75903,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75904,3934,33162009,R&B INPATIENT 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PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75934,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75935,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75936,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75937,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75938,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75939,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75940,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75941,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75942,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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PT-U,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75963,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75964,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75965,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75966,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75967,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75968,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75969,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75970,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75971,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75972,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75973,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75974,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75975,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75976,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75977,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75978,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75979,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75980,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75981,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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Advantage, +75992,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75993,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75994,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75995,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75996,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75997,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75998,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +75999,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76000,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76001,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76002,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76003,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76004,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76005,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76006,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76007,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76008,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76009,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76010,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76011,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76012,3934,37112000,ACUTE ED,,1580.0,1580.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76013,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76014,3934,37112034,TRIAGE,,277.0,277.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76015,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76016,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76017,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76018,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76019,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76020,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76021,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76022,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76023,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76024,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76025,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76026,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76027,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76028,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76029,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76030,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76031,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76032,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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+76053,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76054,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76055,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76056,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76057,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76058,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76059,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76060,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76061,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76062,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76063,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76064,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76065,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76066,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76067,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76068,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76069,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76070,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76071,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76072,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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6HR,,32634.0,32634.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76084,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76085,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76086,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76087,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76088,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76089,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76090,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76091,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76092,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76093,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76094,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76095,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76096,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76097,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76098,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76099,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76100,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76101,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76102,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76103,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76104,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76105,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76106,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76107,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76108,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76109,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76110,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76111,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76112,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76113,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76114,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76115,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76116,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76117,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76118,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76119,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76120,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76121,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76122,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76123,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76124,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76125,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76126,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76127,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76128,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76129,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76130,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76131,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76132,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76133,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76134,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76135,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76136,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76137,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76138,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76139,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76140,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76141,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76142,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76143,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76144,3934,43301043,ALBUNEX,,357.0,357.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76145,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76146,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76147,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76148,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76149,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76150,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76151,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76152,3934,43450022,REC RM .5HR,,541.0,541.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76153,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76154,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76155,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76156,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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YORK-Medicare Advantage, +76168,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76169,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76170,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76171,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76172,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76173,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76174,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76175,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76176,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76177,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76178,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76179,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76180,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76181,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76182,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76183,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76184,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76185,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76186,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76187,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76188,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, 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2.5HR,,4273.0,4273.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76200,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76201,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76202,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76203,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76204,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76205,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76206,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76207,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76208,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76209,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76210,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76211,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76212,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76213,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76214,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76215,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76216,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76217,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76218,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76219,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76220,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76221,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76222,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76223,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76224,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76225,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76226,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76227,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76228,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76229,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76230,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76231,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76232,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76233,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76234,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76235,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76236,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76237,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76238,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76239,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76240,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76241,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76242,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76243,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76244,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76245,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76246,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76247,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76248,3934,45924552,ENDO REC RM,,30.0,30.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76249,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76250,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76251,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76252,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76253,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76254,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76255,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76256,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76257,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76258,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76259,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76260,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76261,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76262,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76263,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76264,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76265,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76266,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76267,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76268,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76269,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76270,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76271,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76272,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76273,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76274,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76275,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76276,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76277,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76278,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76279,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76280,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76281,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76282,3934,53200010,GUEST TRAY,,24.0,24.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76283,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76284,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76285,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76286,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76287,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76288,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76289,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76290,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76291,3934,53329876,HIV MONITORING,,416.0,416.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76292,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76293,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76294,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76295,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76296,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76297,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76298,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76299,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76300,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76301,3934,76010107,COPY X-RAY,,22.0,22.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76302,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76303,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76304,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76305,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76306,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76307,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76308,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76309,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76310,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76311,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76312,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76313,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,FIDELIS CARE NEW YORK-Medicare Advantage, +76314,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,HEALTHFIRST-Medicaid, +76315,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,HEALTHFIRST-Medicaid, +76316,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,HEALTHFIRST-Medicaid, +76317,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,HEALTHFIRST-Medicaid, +76318,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,HEALTHFIRST-Medicaid, +76319,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,HEALTHFIRST-Medicaid, +76320,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,HEALTHFIRST-Medicaid, +76321,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,HEALTHFIRST-Medicaid, +76322,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,HEALTHFIRST-Medicaid, +76323,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,HEALTHFIRST-Medicaid, +76324,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,HEALTHFIRST-Medicaid, +76325,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,HEALTHFIRST-Medicaid, +76326,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,HEALTHFIRST-Medicaid, +76327,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,HEALTHFIRST-Medicaid, +76328,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,HEALTHFIRST-Medicaid, +76329,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,HEALTHFIRST-Medicaid, +76330,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,HEALTHFIRST-Medicaid, +76331,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,HEALTHFIRST-Medicaid, +76332,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,HEALTHFIRST-Medicaid, +76333,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,HEALTHFIRST-Medicaid, +76334,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,HEALTHFIRST-Medicaid, +76335,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,HEALTHFIRST-Medicaid, +76336,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,HEALTHFIRST-Medicaid, +76337,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,HEALTHFIRST-Medicaid, +76338,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,HEALTHFIRST-Medicaid, +76339,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,HEALTHFIRST-Medicaid, +76340,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,HEALTHFIRST-Medicaid, +76341,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,HEALTHFIRST-Medicaid, +76342,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,HEALTHFIRST-Medicaid, +76343,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,HEALTHFIRST-Medicaid, +76344,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,HEALTHFIRST-Medicaid, +76345,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,HEALTHFIRST-Medicaid, +76346,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,HEALTHFIRST-Medicaid, +76347,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,HEALTHFIRST-Medicaid, +76348,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,HEALTHFIRST-Medicaid, +76349,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,HEALTHFIRST-Medicaid, +76350,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,HEALTHFIRST-Medicaid, +76351,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,HEALTHFIRST-Medicaid, +76352,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,HEALTHFIRST-Medicaid, +76353,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,HEALTHFIRST-Medicaid, +76354,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,HEALTHFIRST-Medicaid, +76355,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,HEALTHFIRST-Medicaid, +76356,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,HEALTHFIRST-Medicaid, +76357,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,HEALTHFIRST-Medicaid, +76358,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,HEALTHFIRST-Medicaid, +76359,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,HEALTHFIRST-Medicaid, +76360,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,HEALTHFIRST-Medicaid, +76361,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,HEALTHFIRST-Medicaid, +76362,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,HEALTHFIRST-Medicaid, +76363,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,HEALTHFIRST-Medicaid, +76364,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,HEALTHFIRST-Medicaid, +76365,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,HEALTHFIRST-Medicaid, +76366,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,HEALTHFIRST-Medicaid, +76367,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,HEALTHFIRST-Medicaid, +76368,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,HEALTHFIRST-Medicaid, +76369,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,HEALTHFIRST-Medicaid, +76370,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,HEALTHFIRST-Medicaid, +76371,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,HEALTHFIRST-Medicaid, +76372,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,HEALTHFIRST-Medicaid, +76373,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,HEALTHFIRST-Medicaid, +76374,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,HEALTHFIRST-Medicaid, +76375,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,HEALTHFIRST-Medicaid, +76376,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,HEALTHFIRST-Medicaid, +76377,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,HEALTHFIRST-Medicaid, +76378,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,HEALTHFIRST-Medicaid, +76379,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,HEALTHFIRST-Medicaid, +76380,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,HEALTHFIRST-Medicaid, +76381,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,HEALTHFIRST-Medicaid, +76382,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,HEALTHFIRST-Medicaid, +76383,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,HEALTHFIRST-Medicaid, +76384,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,HEALTHFIRST-Medicaid, +76385,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,HEALTHFIRST-Medicaid, +76386,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,HEALTHFIRST-Medicaid, +76387,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,HEALTHFIRST-Medicaid, +76388,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,HEALTHFIRST-Medicaid, +76389,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,HEALTHFIRST-Medicaid, +76390,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,HEALTHFIRST-Medicaid, +76391,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,HEALTHFIRST-Medicaid, +76392,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,HEALTHFIRST-Medicaid, +76393,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,HEALTHFIRST-Medicaid, +76394,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,HEALTHFIRST-Medicaid, +76395,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,HEALTHFIRST-Medicaid, +76396,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,HEALTHFIRST-Medicaid, +76397,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,HEALTHFIRST-Medicaid, +76398,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,HEALTHFIRST-Medicaid, +76399,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,HEALTHFIRST-Medicaid, +76400,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,HEALTHFIRST-Medicaid, +76401,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,HEALTHFIRST-Medicaid, +76402,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,HEALTHFIRST-Medicaid, +76403,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,HEALTHFIRST-Medicaid, +76404,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,HEALTHFIRST-Medicaid, +76405,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,HEALTHFIRST-Medicaid, +76406,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,HEALTHFIRST-Medicaid, +76407,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,HEALTHFIRST-Medicaid, +76408,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,HEALTHFIRST-Medicaid, +76409,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,HEALTHFIRST-Medicaid, +76410,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,HEALTHFIRST-Medicaid, +76411,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,HEALTHFIRST-Medicaid, +76412,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,HEALTHFIRST-Medicaid, +76413,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,HEALTHFIRST-Medicaid, +76414,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,HEALTHFIRST-Medicaid, +76415,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,HEALTHFIRST-Medicaid, +76416,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,HEALTHFIRST-Medicaid, +76417,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,HEALTHFIRST-Medicaid, +76418,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,HEALTHFIRST-Medicaid, +76419,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,HEALTHFIRST-Medicaid, +76420,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,HEALTHFIRST-Medicaid, +76421,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,HEALTHFIRST-Medicaid, +76422,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,HEALTHFIRST-Medicaid, +76423,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,HEALTHFIRST-Medicaid, +76424,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,HEALTHFIRST-Medicaid, +76425,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,HEALTHFIRST-Medicaid, +76426,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,HEALTHFIRST-Medicaid, +76427,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,HEALTHFIRST-Medicaid, +76428,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,HEALTHFIRST-Medicaid, +76429,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,HEALTHFIRST-Medicaid, +76430,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,HEALTHFIRST-Medicaid, +76431,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,HEALTHFIRST-Medicaid, +76432,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,HEALTHFIRST-Medicaid, +76433,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,HEALTHFIRST-Medicaid, +76434,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,HEALTHFIRST-Medicaid, +76435,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,HEALTHFIRST-Medicaid, +76436,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,HEALTHFIRST-Medicaid, +76437,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,HEALTHFIRST-Medicaid, +76438,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,HEALTHFIRST-Medicaid, +76439,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,HEALTHFIRST-Medicaid, +76440,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,HEALTHFIRST-Medicaid, +76441,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,HEALTHFIRST-Medicaid, +76442,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,HEALTHFIRST-Medicaid, +76443,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,HEALTHFIRST-Medicaid, +76444,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,HEALTHFIRST-Medicaid, +76445,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,HEALTHFIRST-Medicaid, +76446,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,HEALTHFIRST-Medicaid, +76447,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,HEALTHFIRST-Medicaid, +76448,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,HEALTHFIRST-Medicaid, +76449,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,HEALTHFIRST-Medicaid, +76450,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,HEALTHFIRST-Medicaid, +76451,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,HEALTHFIRST-Medicaid, +76452,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,HEALTHFIRST-Medicaid, +76453,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,HEALTHFIRST-Medicaid, +76454,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,HEALTHFIRST-Medicaid, +76455,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,HEALTHFIRST-Medicaid, +76456,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,HEALTHFIRST-Medicaid, +76457,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,HEALTHFIRST-Medicaid, +76458,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,HEALTHFIRST-Medicaid, +76459,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,HEALTHFIRST-Medicaid, +76460,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,HEALTHFIRST-Medicaid, +76461,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,HEALTHFIRST-Medicaid, +76462,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,HEALTHFIRST-Medicaid, +76463,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,HEALTHFIRST-Medicaid, +76464,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,HEALTHFIRST-Medicaid, +76465,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,HEALTHFIRST-Medicaid, +76466,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,HEALTHFIRST-Medicaid, +76467,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,HEALTHFIRST-Medicaid, +76468,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,HEALTHFIRST-Medicaid, +76469,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,HEALTHFIRST-Medicaid, +76470,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,HEALTHFIRST-Medicaid, +76471,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,HEALTHFIRST-Medicaid, +76472,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,HEALTHFIRST-Medicaid, +76473,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,HEALTHFIRST-Medicaid, +76474,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,HEALTHFIRST-Medicaid, +76475,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,HEALTHFIRST-Medicaid, +76476,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,HEALTHFIRST-Medicaid, +76477,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,HEALTHFIRST-Medicaid, +76478,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,HEALTHFIRST-Medicaid, +76479,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,HEALTHFIRST-Medicaid, +76480,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,HEALTHFIRST-Medicaid, +76481,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,HEALTHFIRST-Medicaid, +76482,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,HEALTHFIRST-Medicaid, +76483,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,HEALTHFIRST-Medicaid, +76484,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,HEALTHFIRST-Medicaid, +76485,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,HEALTHFIRST-Medicaid, +76486,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,HEALTHFIRST-Medicaid, +76487,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,HEALTHFIRST-Medicaid, +76488,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,HEALTHFIRST-Medicaid, +76489,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,HEALTHFIRST-Medicaid, +76490,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,HEALTHFIRST-Medicaid, +76491,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,HEALTHFIRST-Medicaid, +76492,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,HEALTHFIRST-Medicaid, +76493,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,HEALTHFIRST-Medicaid, +76494,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,HEALTHFIRST-Medicaid, +76495,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,HEALTHFIRST-Medicaid, +76496,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,HEALTHFIRST-Medicaid, +76497,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,HEALTHFIRST-Medicaid, +76498,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,HEALTHFIRST-Medicaid, +76499,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,HEALTHFIRST-Medicaid, +76500,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,HEALTHFIRST-Medicaid, +76501,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,HEALTHFIRST-Medicaid, +76502,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,HEALTHFIRST-Medicaid, +76503,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,HEALTHFIRST-Medicaid, +76504,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,HEALTHFIRST-Medicaid, +76505,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,HEALTHFIRST-Medicaid, +76506,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,HEALTHFIRST-Medicaid, +76507,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,HEALTHFIRST-Medicaid, +76508,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,HEALTHFIRST-Medicaid, +76509,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,HEALTHFIRST-Medicaid, +76510,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,HEALTHFIRST-Medicaid, +76511,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,HEALTHFIRST-Medicaid, +76512,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,HEALTHFIRST-Medicaid, +76513,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,HEALTHFIRST-Medicaid, +76514,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,HEALTHFIRST-Medicaid, +76515,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,HEALTHFIRST-Medicaid, +76516,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,HEALTHFIRST-Medicaid, +76517,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,HEALTHFIRST-Medicaid, +76518,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,HEALTHFIRST-Medicaid, +76519,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,HEALTHFIRST-Medicaid, +76520,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,HEALTHFIRST-Medicaid, +76521,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,HEALTHFIRST-Medicaid, +76522,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,HEALTHFIRST-Medicaid, +76523,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,HEALTHFIRST-Medicaid, +76524,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,HEALTHFIRST-Medicaid, +76525,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,HEALTHFIRST-Medicaid, +76526,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,HEALTHFIRST-Medicaid, +76527,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,HEALTHFIRST-Medicaid, +76528,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,HEALTHFIRST-Medicaid, +76529,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,HEALTHFIRST-Medicaid, +76530,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,HEALTHFIRST-Medicaid, +76531,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,HEALTHFIRST-Medicaid, +76532,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,HEALTHFIRST-Medicaid, +76533,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,HEALTHFIRST-Medicaid, +76534,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,HEALTHFIRST-Medicaid, +76535,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,HEALTHFIRST-Medicaid, +76536,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,HEALTHFIRST-Medicaid, +76537,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,HEALTHFIRST-Medicaid, +76538,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,HEALTHFIRST-Medicaid, +76539,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,HEALTHFIRST-Medicaid, +76540,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,HEALTHFIRST-Medicaid, +76541,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,HEALTHFIRST-Medicaid, +76542,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,HEALTHFIRST-Medicaid, +76543,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,HEALTHFIRST-Medicaid, +76544,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,HEALTHFIRST-Medicaid, +76545,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,HEALTHFIRST-Medicaid, +76546,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,HEALTHFIRST-Medicaid, +76547,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,HEALTHFIRST-Medicaid, +76548,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,HEALTHFIRST-Medicaid, +76549,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,HEALTHFIRST-Medicaid, +76550,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,HEALTHFIRST-Medicaid, +76551,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,HEALTHFIRST-Medicaid, +76552,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,HEALTHFIRST-Medicaid, +76553,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,HEALTHFIRST-Medicaid, +76554,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,HEALTHFIRST-Medicaid, +76555,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,HEALTHFIRST-Medicaid, +76556,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,HEALTHFIRST-Medicaid, +76557,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,HEALTHFIRST-Medicaid, +76558,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,HEALTHFIRST-Medicaid, +76559,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,HEALTHFIRST-Medicaid, +76560,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,HEALTHFIRST-Medicaid, +76561,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,HEALTHFIRST-Medicaid, +76562,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,HEALTHFIRST-Medicaid, +76563,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,HEALTHFIRST-Medicaid, +76564,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,HEALTHFIRST-Medicaid, +76565,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,HEALTHFIRST-Medicaid, +76566,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,HEALTHFIRST-Medicaid, +76567,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,HEALTHFIRST-Medicaid, +76568,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,HEALTHFIRST-Medicaid, +76569,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,HEALTHFIRST-Medicaid, +76570,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,HEALTHFIRST-Medicaid, +76571,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,HEALTHFIRST-Medicaid, +76572,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,HEALTHFIRST-Medicaid, +76573,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,HEALTHFIRST-Medicaid, +76574,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,HEALTHFIRST-Medicaid, +76575,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,HEALTHFIRST-Medicaid, +76576,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,HEALTHFIRST-Medicaid, +76577,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,HEALTHFIRST-Medicaid, +76578,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,HEALTHFIRST-Medicaid, +76579,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,HEALTHFIRST-Medicaid, +76580,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,HEALTHFIRST-Medicaid, +76581,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,HEALTHFIRST-Medicaid, +76582,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,HEALTHFIRST-Medicaid, +76583,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,HEALTHFIRST-Medicaid, +76584,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,HEALTHFIRST-Medicaid, +76585,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,HEALTHFIRST-Medicaid, +76586,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,HEALTHFIRST-Medicaid, +76587,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,HEALTHFIRST-Medicaid, +76588,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,HEALTHFIRST-Medicaid, +76589,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,HEALTHFIRST-Medicaid, +76590,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,HEALTHFIRST-Medicaid, +76591,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,HEALTHFIRST-Medicaid, +76592,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,HEALTHFIRST-Medicaid, +76593,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,HEALTHFIRST-Medicaid, +76594,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,HEALTHFIRST-Medicaid, +76595,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,HEALTHFIRST-Medicaid, +76596,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,HEALTHFIRST-Medicaid, +76597,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,HEALTHFIRST-Medicaid, +76598,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,HEALTHFIRST-Medicaid, +76599,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,HEALTHFIRST-Medicaid, +76600,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,HEALTHFIRST-Medicaid, +76601,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,HEALTHFIRST-Medicaid, +76602,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,HEALTHFIRST-Medicaid, +76603,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,HEALTHFIRST-Medicaid, +76604,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,HEALTHFIRST-Medicaid, +76605,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,HEALTHFIRST-Medicaid, +76606,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,HEALTHFIRST-Medicaid, +76607,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,HEALTHFIRST-Medicaid, +76608,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,HEALTHFIRST-Medicaid, +76609,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,HEALTHFIRST-Medicaid, +76610,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,HEALTHFIRST-Medicaid, +76611,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,HEALTHFIRST-Medicaid, +76612,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,HEALTHFIRST-Medicaid, +76613,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,HEALTHFIRST-Medicaid, +76614,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,HEALTHFIRST-Medicaid, +76615,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,HEALTHFIRST-Medicaid, +76616,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,HEALTHFIRST-Medicaid, +76617,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,HEALTHFIRST-Medicaid, +76618,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,HEALTHFIRST-Medicaid, +76619,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,HEALTHFIRST-Medicaid, +76620,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,HEALTHFIRST-Medicaid, +76621,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,HEALTHFIRST-Medicaid, +76622,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,HEALTHFIRST-Medicaid, +76623,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,HEALTHFIRST-Medicaid, +76624,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,HEALTHFIRST-Medicaid, +76625,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,HEALTHFIRST-Medicaid, +76626,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,HEALTHFIRST-Medicaid, +76627,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,HEALTHFIRST-Medicaid, +76628,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,HEALTHFIRST-Medicaid, +76629,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,HEALTHFIRST-Medicaid, +76630,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,HEALTHFIRST-Medicaid, +76631,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,HEALTHFIRST-Medicaid, +76632,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,HEALTHFIRST-Medicaid, +76633,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,HEALTHFIRST-Medicaid, +76634,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,HEALTHFIRST-Medicaid, +76635,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,HEALTHFIRST-Medicaid, +76636,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,HEALTHFIRST-Medicaid, +76637,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,HEALTHFIRST-Medicaid, +76638,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,HEALTHFIRST-Medicaid, +76639,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,HEALTHFIRST-Medicaid, +76640,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,HEALTHFIRST-Medicaid, +76641,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,HEALTHFIRST-Medicaid, +76642,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,HEALTHFIRST-Medicaid, +76643,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,HEALTHFIRST-Medicaid, +76644,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,HEALTHFIRST-Medicaid, +76645,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,HEALTHFIRST-Medicaid, +76646,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,HEALTHFIRST-Medicaid, +76647,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,HEALTHFIRST-Medicaid, +76648,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,HEALTHFIRST-Medicaid, +76649,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,HEALTHFIRST-Medicaid, +76650,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,HEALTHFIRST-Medicaid, +76651,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,HEALTHFIRST-Medicaid, +76652,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,HEALTHFIRST-Medicaid, +76653,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,HEALTHFIRST-Medicaid, +76654,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,HEALTHFIRST-Medicaid, +76655,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,HEALTHFIRST-Medicaid, +76656,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,HEALTHFIRST-Medicaid, +76657,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,HEALTHFIRST-Medicaid, +76658,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,HEALTHFIRST-Medicaid, +76659,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,HEALTHFIRST-Medicaid, +76660,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,HEALTHFIRST-Medicaid, +76661,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,HEALTHFIRST-Medicaid, +76662,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,HEALTHFIRST-Medicaid, +76663,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,HEALTHFIRST-Medicaid, +76664,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,HEALTHFIRST-Medicaid, +76665,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,HEALTHFIRST-Medicaid, +76666,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,HEALTHFIRST-Medicaid, +76667,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,HEALTHFIRST-Medicaid, +76668,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,HEALTHFIRST-Medicaid, +76669,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,HEALTHFIRST-Medicaid, +76670,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,HEALTHFIRST-Medicaid, +76671,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,HEALTHFIRST-Medicaid, +76672,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,HEALTHFIRST-Medicaid, +76673,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,HEALTHFIRST-Medicaid, +76674,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,HEALTHFIRST-Medicaid, +76675,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,HEALTHFIRST-Medicaid, +76676,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,HEALTHFIRST-Medicaid, +76677,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,HEALTHFIRST-Medicaid, +76678,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,HEALTHFIRST-Medicaid, +76679,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,HEALTHFIRST-Medicaid, +76680,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,HEALTHFIRST-Medicaid, +76681,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,HEALTHFIRST-Medicaid, +76682,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,HEALTHFIRST-Medicaid, +76683,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,HEALTHFIRST-Medicaid, +76684,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,HEALTHFIRST-Medicaid, +76685,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,HEALTHFIRST-Medicaid, +76686,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,HEALTHFIRST-Medicaid, +76687,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,HEALTHFIRST-Medicaid, +76688,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,HEALTHFIRST-Medicaid, +76689,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,HEALTHFIRST-Medicaid, +76690,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,HEALTHFIRST-Medicaid, +76691,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,HEALTHFIRST-Medicaid, +76692,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,HEALTHFIRST-Medicaid, +76693,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,HEALTHFIRST-Medicaid, +76694,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,HEALTHFIRST-Medicaid, +76695,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,HEALTHFIRST-Medicaid, +76696,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,HEALTHFIRST-Medicaid, +76697,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,HEALTHFIRST-Medicaid, +76698,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,HEALTHFIRST-Medicaid, +76699,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,HEALTHFIRST-Medicaid, +76700,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,HEALTHFIRST-Medicaid, +76701,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,HEALTHFIRST-Medicaid, +76702,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,HEALTHFIRST-Medicaid, +76703,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,HEALTHFIRST-Medicaid, +76704,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,HEALTHFIRST-Medicaid, +76705,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,HEALTHFIRST-Medicaid, +76706,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,HEALTHFIRST-Medicaid, +76707,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,HEALTHFIRST-Medicaid, +76708,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,HEALTHFIRST-Medicaid, +76709,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,HEALTHFIRST-Medicaid, +76710,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,HEALTHFIRST-Medicaid, +76711,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,HEALTHFIRST-Medicaid, +76712,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,HEALTHFIRST-Medicaid, +76713,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,HEALTHFIRST-Medicaid, +76714,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,HEALTHFIRST-Medicaid, +76715,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,HEALTHFIRST-Medicaid, +76716,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,HEALTHFIRST-Medicaid, +76717,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,HEALTHFIRST-Medicaid, +76718,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,HEALTHFIRST-Medicaid, +76719,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,HEALTHFIRST-Medicaid, +76720,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,HEALTHFIRST-Medicaid, +76721,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,HEALTHFIRST-Medicaid, +76722,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,HEALTHFIRST-Medicaid, +76723,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,HEALTHFIRST-Medicaid, +76724,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,HEALTHFIRST-Medicaid, +76725,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,HEALTHFIRST-Medicaid, +76726,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,HEALTHFIRST-Medicaid, +76727,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,HEALTHFIRST-Medicaid, +76728,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,HEALTHFIRST-Medicaid, +76729,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,HEALTHFIRST-Medicaid, +76730,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,HEALTHFIRST-Medicaid, +76731,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,HEALTHFIRST-Medicaid, +76732,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,HEALTHFIRST-Medicaid, +76733,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,HEALTHFIRST-Medicaid, +76734,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,HEALTHFIRST-Medicaid, +76735,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,HEALTHFIRST-Medicaid, +76736,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,HEALTHFIRST-Medicaid, +76737,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,HEALTHFIRST-Medicaid, +76738,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,HEALTHFIRST-Medicaid, +76739,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,HEALTHFIRST-Medicaid, +76740,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,HEALTHFIRST-Medicaid, +76741,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,HEALTHFIRST-Medicaid, +76742,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,HEALTHFIRST-Medicaid, +76743,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,HEALTHFIRST-Medicaid, +76744,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,HEALTHFIRST-Medicaid, +76745,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,HEALTHFIRST-Medicaid, +76746,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,HEALTHFIRST-Medicaid, +76747,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,HEALTHFIRST-Medicaid, +76748,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,HEALTHFIRST-Medicaid, +76749,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,HEALTHFIRST-Medicaid, +76750,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,HEALTHFIRST-Medicaid, +76751,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,HEALTHFIRST-Medicaid, +76752,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,HEALTHFIRST-Medicaid, +76753,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,HEALTHFIRST-Medicaid, +76754,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,HEALTHFIRST-Medicaid, +76755,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,HEALTHFIRST-Medicaid, +76756,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,HEALTHFIRST-Medicaid,19548.9 +76757,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,HEALTHFIRST-Medicaid, +76758,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,HEALTHFIRST-Medicaid, +76759,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,HEALTHFIRST-Medicaid, +76760,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,HEALTHFIRST-Medicaid, +76761,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,HEALTHFIRST-Medicaid, +76762,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,HEALTHFIRST-Medicaid, +76763,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,HEALTHFIRST-Medicaid, +76764,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,HEALTHFIRST-Medicaid, +76765,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,HEALTHFIRST-Medicaid, +76766,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,HEALTHFIRST-Medicaid, +76767,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,HEALTHFIRST-Medicaid, +76768,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,HEALTHFIRST-Medicaid, +76769,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,HEALTHFIRST-Medicaid, +76770,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,HEALTHFIRST-Medicaid, +76771,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,HEALTHFIRST-Medicaid, +76772,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,HEALTHFIRST-Medicaid, +76773,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,HEALTHFIRST-Medicaid, +76774,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,HEALTHFIRST-Medicaid, +76775,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,HEALTHFIRST-Medicaid, +76776,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,HEALTHFIRST-Medicaid, +76777,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,HEALTHFIRST-Medicaid, +76778,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,HEALTHFIRST-Medicaid, +76779,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,HEALTHFIRST-Medicaid, +76780,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,HEALTHFIRST-Medicaid, +76781,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,HEALTHFIRST-Medicaid, +76782,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,HEALTHFIRST-Medicaid, +76783,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,HEALTHFIRST-Medicaid, +76784,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,HEALTHFIRST-Medicaid, +76785,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,HEALTHFIRST-Medicaid, +76786,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,HEALTHFIRST-Medicaid, +76787,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,HEALTHFIRST-Medicaid, +76788,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,HEALTHFIRST-Medicaid, +76789,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,HEALTHFIRST-Medicaid, +76790,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,HEALTHFIRST-Medicaid, +76791,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,HEALTHFIRST-Medicaid, +76792,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,HEALTHFIRST-Medicaid, +76793,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,HEALTHFIRST-Medicaid, +76794,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,HEALTHFIRST-Medicaid, +76795,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,HEALTHFIRST-Medicaid, +76796,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,HEALTHFIRST-Medicaid, +76797,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,HEALTHFIRST-Medicaid, +76798,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,HEALTHFIRST-Medicaid, +76799,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,HEALTHFIRST-Medicaid, +76800,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,HEALTHFIRST-Medicaid, +76801,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,HEALTHFIRST-Medicaid, +76802,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,HEALTHFIRST-Medicaid, +76803,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,HEALTHFIRST-Medicaid, +76804,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,HEALTHFIRST-Medicaid, +76805,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,HEALTHFIRST-Medicaid, +76806,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,HEALTHFIRST-Medicaid, +76807,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,HEALTHFIRST-Medicaid, +76808,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,HEALTHFIRST-Medicaid, +76809,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,HEALTHFIRST-Medicaid, +76810,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,HEALTHFIRST-Medicaid, +76811,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,HEALTHFIRST-Medicaid, +76812,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,HEALTHFIRST-Medicaid, +76813,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,HEALTHFIRST-Medicaid, +76814,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,HEALTHFIRST-Medicaid, +76815,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,HEALTHFIRST-Medicaid, +76816,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,HEALTHFIRST-Medicaid, +76817,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,HEALTHFIRST-Medicaid, +76818,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,HEALTHFIRST-Medicaid, +76819,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,HEALTHFIRST-Medicaid, +76820,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,HEALTHFIRST-Medicaid, +76821,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,HEALTHFIRST-Medicaid, +76822,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,HEALTHFIRST-Medicaid, +76823,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,HEALTHFIRST-Medicaid, +76824,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,HEALTHFIRST-Medicaid, +76825,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,HEALTHFIRST-Medicaid, +76826,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,HEALTHFIRST-Medicaid, +76827,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,HEALTHFIRST-Medicaid, +76828,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,HEALTHFIRST-Medicaid, +76829,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,HEALTHFIRST-Medicaid, +76830,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,HEALTHFIRST-Medicaid, +76831,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,HEALTHFIRST-Medicaid, +76832,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,HEALTHFIRST-Medicaid, +76833,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,HEALTHFIRST-Medicaid, +76834,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,HEALTHFIRST-Medicaid, +76835,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,HEALTHFIRST-Medicaid, +76836,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,HEALTHFIRST-Medicaid, +76837,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,HEALTHFIRST-Medicaid, +76838,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,HEALTHFIRST-Medicaid, +76839,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,HEALTHFIRST-Medicaid, +76840,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,HEALTHFIRST-Medicaid, +76841,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,HEALTHFIRST-Medicaid, +76842,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,HEALTHFIRST-Medicaid, +76843,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,HEALTHFIRST-Medicaid, +76844,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,HEALTHFIRST-Medicaid, +76845,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,HEALTHFIRST-Medicaid, +76846,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,HEALTHFIRST-Medicaid, +76847,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,HEALTHFIRST-Medicaid, +76848,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,HEALTHFIRST-Medicaid, +76849,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,HEALTHFIRST-Medicaid, +76850,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,HEALTHFIRST-Medicaid, +76851,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,HEALTHFIRST-Medicaid, +76852,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,HEALTHFIRST-Medicaid, +76853,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,HEALTHFIRST-Medicaid, +76854,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,HEALTHFIRST-Medicaid, +76855,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,HEALTHFIRST-Medicaid, +76856,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,HEALTHFIRST-Medicaid, +76857,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,HEALTHFIRST-Medicaid, +76858,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,HEALTHFIRST-Medicaid, +76859,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,HEALTHFIRST-Medicaid, +76860,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,HEALTHFIRST-Medicaid, +76861,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,HEALTHFIRST-Medicaid, +76862,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,HEALTHFIRST-Medicaid, +76863,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,HEALTHFIRST-Medicaid, +76864,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,HEALTHFIRST-Medicaid, +76865,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,HEALTHFIRST-Medicaid, +76866,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,HEALTHFIRST-Medicaid, +76867,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,HEALTHFIRST-Medicaid, +76868,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,HEALTHFIRST-Medicaid, +76869,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,HEALTHFIRST-Medicaid, +76870,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,HEALTHFIRST-Medicaid, +76871,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,HEALTHFIRST-Medicaid, +76872,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,HEALTHFIRST-Medicaid, +76873,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,HEALTHFIRST-Medicaid, +76874,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,HEALTHFIRST-Medicaid, +76875,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,HEALTHFIRST-Medicaid, +76876,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,HEALTHFIRST-Medicaid, +76877,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,HEALTHFIRST-Medicaid, +76878,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,HEALTHFIRST-Medicaid, +76879,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,HEALTHFIRST-Medicaid, +76880,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,HEALTHFIRST-Medicaid, +76881,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,HEALTHFIRST-Medicaid, +76882,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,HEALTHFIRST-Medicaid, +76883,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,HEALTHFIRST-Medicaid, +76884,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,HEALTHFIRST-Medicaid, +76885,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,HEALTHFIRST-Medicaid, +76886,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,HEALTHFIRST-Medicaid, +76887,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,HEALTHFIRST-Medicaid, +76888,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,HEALTHFIRST-Medicaid, +76889,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,HEALTHFIRST-Medicaid, +76890,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,HEALTHFIRST-Medicaid, +76891,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,HEALTHFIRST-Medicaid, +76892,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,HEALTHFIRST-Medicaid, +76893,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,HEALTHFIRST-Medicaid, +76894,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,HEALTHFIRST-Medicaid, +76895,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,HEALTHFIRST-Medicaid, +76896,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,HEALTHFIRST-Medicaid, +76897,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,HEALTHFIRST-Medicaid, +76898,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,HEALTHFIRST-Medicaid, +76899,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,HEALTHFIRST-Medicaid, +76900,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,HEALTHFIRST-Medicaid, +76901,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,HEALTHFIRST-Medicaid, +76902,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,HEALTHFIRST-Medicaid, +76903,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,HEALTHFIRST-Medicaid, +76904,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,HEALTHFIRST-Medicaid, +76905,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,HEALTHFIRST-Medicaid, +76906,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,HEALTHFIRST-Medicaid, +76907,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,HEALTHFIRST-Medicaid, +76908,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,HEALTHFIRST-Medicaid, +76909,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,HEALTHFIRST-Medicaid, +76910,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,HEALTHFIRST-Medicaid, +76911,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,HEALTHFIRST-Medicaid, +76912,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,HEALTHFIRST-Medicaid, +76913,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,HEALTHFIRST-Medicaid, +76914,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,HEALTHFIRST-Medicaid, +76915,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,HEALTHFIRST-Medicaid, +76916,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,HEALTHFIRST-Medicaid,25845.8 +76917,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,HEALTHFIRST-Medicaid, +76918,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,HEALTHFIRST-Medicaid, +76919,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,HEALTHFIRST-Medicaid, +76920,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,HEALTHFIRST-Medicaid, +76921,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,HEALTHFIRST-Medicaid, +76922,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,HEALTHFIRST-Medicaid, +76923,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,HEALTHFIRST-Medicaid,12686.74 +76924,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,HEALTHFIRST-Medicaid, +76925,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,HEALTHFIRST-Medicaid, +76926,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,HEALTHFIRST-Medicaid, +76927,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,HEALTHFIRST-Medicaid,8807.54 +76928,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,HEALTHFIRST-Medicaid, +76929,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,HEALTHFIRST-Medicaid,1899.19 +76930,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,HEALTHFIRST-Medicaid, +76931,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,HEALTHFIRST-Medicaid, +76932,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,HEALTHFIRST-Medicaid, +76933,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,HEALTHFIRST-Medicaid, +76934,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,HEALTHFIRST-Medicaid, +76935,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,HEALTHFIRST-Medicaid, +76936,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,HEALTHFIRST-Medicaid, +76937,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,HEALTHFIRST-Medicaid, +76938,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,HEALTHFIRST-Medicaid, +76939,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,HEALTHFIRST-Medicaid, +76940,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,HEALTHFIRST-Medicaid, +76941,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,HEALTHFIRST-Medicaid, +76942,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,HEALTHFIRST-Medicaid, +76943,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,HEALTHFIRST-Medicaid, +76944,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,HEALTHFIRST-Medicaid, +76945,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,HEALTHFIRST-Medicaid, +76946,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,HEALTHFIRST-Medicaid, +76947,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,HEALTHFIRST-Medicaid, +76948,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,HEALTHFIRST-Medicaid, +76949,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,HEALTHFIRST-Medicaid, +76950,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,HEALTHFIRST-Medicaid, +76951,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,HEALTHFIRST-Medicaid, +76952,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,HEALTHFIRST-Medicaid, +76953,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,HEALTHFIRST-Medicaid, +76954,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,HEALTHFIRST-Medicaid, +76955,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,HEALTHFIRST-Medicaid,6212.46 +76956,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,HEALTHFIRST-Medicaid,2831.0 +76957,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,HEALTHFIRST-Medicaid, +76958,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,HEALTHFIRST-Medicaid, +76959,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,HEALTHFIRST-Medicaid, +76960,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,HEALTHFIRST-Medicaid, +76961,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,HEALTHFIRST-Medicaid, +76962,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,HEALTHFIRST-Medicaid, +76963,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,HEALTHFIRST-Medicaid, +76964,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,HEALTHFIRST-Medicaid, +76965,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,HEALTHFIRST-Medicaid, +76966,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,HEALTHFIRST-Medicaid, +76967,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,HEALTHFIRST-Medicaid, +76968,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,HEALTHFIRST-Medicaid, +76969,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,HEALTHFIRST-Medicaid, +76970,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,HEALTHFIRST-Medicaid, +76971,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,HEALTHFIRST-Medicaid, +76972,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,HEALTHFIRST-Medicaid,83.11 +76973,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,HEALTHFIRST-Medicaid, +76974,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,HEALTHFIRST-Medicaid, +76975,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,HEALTHFIRST-Medicaid, +76976,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,HEALTHFIRST-Medicaid, +76977,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,HEALTHFIRST-Medicaid, +76978,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,HEALTHFIRST-Medicaid,97.88 +76979,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,HEALTHFIRST-Medicaid,635.07 +76980,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,HEALTHFIRST-Medicaid, +76981,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,HEALTHFIRST-Medicaid, +76982,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,HEALTHFIRST-Medicaid,120.66 +76983,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,HEALTHFIRST-Medicaid, +76984,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,HEALTHFIRST-Medicaid, +76985,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,HEALTHFIRST-Medicaid,3961.0 +76986,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,HEALTHFIRST-Medicaid, +76987,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,HEALTHFIRST-Medicaid, +76988,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,HEALTHFIRST-Medicaid, +76989,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,HEALTHFIRST-Medicaid, +76990,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,HEALTHFIRST-Medicaid, +76991,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,HEALTHFIRST-Medicaid, +76992,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,HEALTHFIRST-Medicaid, +76993,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,HEALTHFIRST-Medicaid, +76994,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,HEALTHFIRST-Medicaid, +76995,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,HEALTHFIRST-Medicaid, +76996,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,HEALTHFIRST-Medicaid,86.29 +76997,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,HEALTHFIRST-Medicaid, +76998,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,HEALTHFIRST-Medicaid, +76999,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,HEALTHFIRST-Medicaid, +77000,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,HEALTHFIRST-Medicaid, +77001,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,HEALTHFIRST-Medicaid, +77002,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,HEALTHFIRST-Medicaid, +77003,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,HEALTHFIRST-Medicaid, +77004,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,HEALTHFIRST-Medicaid, +77005,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,HEALTHFIRST-Medicaid, +77006,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,HEALTHFIRST-Medicaid, +77007,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,HEALTHFIRST-Medicaid, +77008,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,HEALTHFIRST-Medicaid, +77009,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,HEALTHFIRST-Medicaid, +77010,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,HEALTHFIRST-Medicaid, +77011,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,HEALTHFIRST-Medicaid, +77012,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,HEALTHFIRST-Medicaid, +77013,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,HEALTHFIRST-Medicaid, +77014,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,HEALTHFIRST-Medicaid, +77015,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,HEALTHFIRST-Medicaid, +77016,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,HEALTHFIRST-Medicaid, +77017,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,HEALTHFIRST-Medicaid, +77018,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,HEALTHFIRST-Medicaid, +77019,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,HEALTHFIRST-Medicaid, +77020,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,HEALTHFIRST-Medicaid, +77021,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,HEALTHFIRST-Medicaid, +77022,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,HEALTHFIRST-Medicaid, +77023,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,HEALTHFIRST-Medicaid, +77024,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,HEALTHFIRST-Medicaid, +77025,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,HEALTHFIRST-Medicaid, +77026,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,HEALTHFIRST-Medicaid, +77027,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,HEALTHFIRST-Medicaid, +77028,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,HEALTHFIRST-Medicaid, +77029,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,HEALTHFIRST-Medicaid, +77030,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,HEALTHFIRST-Medicaid, +77031,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,HEALTHFIRST-Medicaid, +77032,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,HEALTHFIRST-Medicaid, +77033,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,HEALTHFIRST-Medicaid, +77034,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,HEALTHFIRST-Medicaid, +77035,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,HEALTHFIRST-Medicaid, +77036,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,HEALTHFIRST-Medicaid, +77037,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,HEALTHFIRST-Medicaid, +77038,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,HEALTHFIRST-Medicaid, +77039,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,HEALTHFIRST-Medicaid, +77040,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,HEALTHFIRST-Medicaid, +77041,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,HEALTHFIRST-Medicaid, +77042,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,HEALTHFIRST-Medicaid, +77043,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,HEALTHFIRST-Medicaid, +77044,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,HEALTHFIRST-Medicaid, +77045,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,HEALTHFIRST-Medicaid, +77046,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,HEALTHFIRST-Medicaid,5507.25 +77047,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,HEALTHFIRST-Medicaid, +77048,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,HEALTHFIRST-Medicaid, +77049,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,HEALTHFIRST-Medicaid, +77050,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,HEALTHFIRST-Medicaid, +77051,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,HEALTHFIRST-Medicaid, +77052,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,HEALTHFIRST-Medicaid,114.18 +77053,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,HEALTHFIRST-Medicaid,85.66 +77054,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,HEALTHFIRST-Medicaid,93.72 +77055,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,HEALTHFIRST-Medicaid,207.89 +77056,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,HEALTHFIRST-Medicaid,83.65 +77057,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,HEALTHFIRST-Medicaid,527.88 +77058,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,HEALTHFIRST-Medicaid, +77059,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,HEALTHFIRST-Medicaid, +77060,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,HEALTHFIRST-Medicaid,369.9 +77061,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,HEALTHFIRST-Medicaid, +77062,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,HEALTHFIRST-Medicaid, +77063,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,HEALTHFIRST-Medicaid, +77064,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,HEALTHFIRST-Medicaid, +77065,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,HEALTHFIRST-Medicaid, +77066,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,HEALTHFIRST-Medicaid, +77067,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,HEALTHFIRST-Medicaid, +77068,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,HEALTHFIRST-Medicaid, +77069,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,HEALTHFIRST-Medicaid, +77070,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,HEALTHFIRST-Medicaid, +77071,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,HEALTHFIRST-Medicaid, +77072,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,HEALTHFIRST-Medicaid, +77073,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,HEALTHFIRST-Medicaid, +77074,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,HEALTHFIRST-Medicaid, +77075,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,HEALTHFIRST-Medicaid, +77076,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,HEALTHFIRST-Medicaid, +77077,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,HEALTHFIRST-Medicaid, +77078,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,HEALTHFIRST-Medicaid, +77079,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,HEALTHFIRST-Medicaid, +77080,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,HEALTHFIRST-Medicaid, +77081,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,HEALTHFIRST-Medicaid, +77082,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,HEALTHFIRST-Medicaid, +77083,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,HEALTHFIRST-Medicaid, +77084,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,HEALTHFIRST-Medicaid, +77085,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,HEALTHFIRST-Medicaid, +77086,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,HEALTHFIRST-Medicaid, +77087,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,HEALTHFIRST-Medicaid, +77088,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,HEALTHFIRST-Medicaid, +77089,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,HEALTHFIRST-Medicaid, +77090,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,HEALTHFIRST-Medicaid, +77091,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,HEALTHFIRST-Medicaid, +77092,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,HEALTHFIRST-Medicaid, +77093,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,HEALTHFIRST-Medicaid, +77094,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,HEALTHFIRST-Medicaid, +77095,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,HEALTHFIRST-Medicaid, +77096,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,HEALTHFIRST-Medicaid, +77097,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,HEALTHFIRST-Medicaid, +77098,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,HEALTHFIRST-Medicaid, +77099,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,HEALTHFIRST-Medicaid, +77100,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,HEALTHFIRST-Medicaid, +77101,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,HEALTHFIRST-Medicaid, +77102,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,HEALTHFIRST-Medicaid, +77103,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,HEALTHFIRST-Medicaid, +77104,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,HEALTHFIRST-Medicaid, +77105,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,HEALTHFIRST-Medicaid, +77106,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,HEALTHFIRST-Medicaid, +77107,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,HEALTHFIRST-Medicaid, +77108,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,HEALTHFIRST-Medicaid, +77109,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,HEALTHFIRST-Medicaid, +77110,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,HEALTHFIRST-Medicaid, +77111,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,HEALTHFIRST-Medicaid, +77112,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,HEALTHFIRST-Medicaid, +77113,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,HEALTHFIRST-Medicaid, +77114,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,HEALTHFIRST-Medicaid, +77115,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,HEALTHFIRST-Medicaid, +77116,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,HEALTHFIRST-Medicaid, +77117,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,HEALTHFIRST-Medicaid, +77118,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,HEALTHFIRST-Medicaid, +77119,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,HEALTHFIRST-Medicaid, +77120,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,HEALTHFIRST-Medicaid, +77121,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,HEALTHFIRST-Medicaid, +77122,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,HEALTHFIRST-Medicaid, +77123,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,HEALTHFIRST-Medicaid, +77124,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,HEALTHFIRST-Medicaid, +77125,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,HEALTHFIRST-Medicaid, +77126,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,HEALTHFIRST-Medicaid, +77127,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,HEALTHFIRST-Medicaid, +77128,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,HEALTHFIRST-Medicaid, +77129,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,HEALTHFIRST-Medicaid, +77130,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,HEALTHFIRST-Medicaid, +77131,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,HEALTHFIRST-Medicaid, +77132,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,HEALTHFIRST-Medicaid, +77133,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,HEALTHFIRST-Medicaid, +77134,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,HEALTHFIRST-Medicaid, +77135,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,HEALTHFIRST-Medicaid, +77136,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,HEALTHFIRST-Medicaid, +77137,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,HEALTHFIRST-Medicaid, +77138,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,HEALTHFIRST-Medicaid,66.19 +77139,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,HEALTHFIRST-Medicaid, +77140,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,HEALTHFIRST-Medicaid, +77141,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,HEALTHFIRST-Medicaid,44.73 +77142,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,HEALTHFIRST-Medicaid, +77143,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,HEALTHFIRST-Medicaid, +77144,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,HEALTHFIRST-Medicaid, +77145,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,HEALTHFIRST-Medicaid, +77146,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,HEALTHFIRST-Medicaid, +77147,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,HEALTHFIRST-Medicaid, +77148,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,HEALTHFIRST-Medicaid, +77149,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,HEALTHFIRST-Medicaid, +77150,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,HEALTHFIRST-Medicaid, +77151,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,HEALTHFIRST-Medicaid, +77152,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,HEALTHFIRST-Medicaid, +77153,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,HEALTHFIRST-Medicaid, +77154,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,HEALTHFIRST-Medicaid, +77155,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,HEALTHFIRST-Medicaid, +77156,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,HEALTHFIRST-Medicaid, +77157,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,HEALTHFIRST-Medicaid, +77158,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,HEALTHFIRST-Medicaid, +77159,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,HEALTHFIRST-Medicaid, +77160,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,HEALTHFIRST-Medicaid, +77161,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,HEALTHFIRST-Medicaid, +77162,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,HEALTHFIRST-Medicaid, +77163,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,HEALTHFIRST-Medicaid, +77164,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,HEALTHFIRST-Medicaid,9350.45 +77165,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,HEALTHFIRST-Medicaid, +77166,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,HEALTHFIRST-Medicaid, +77167,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,HEALTHFIRST-Medicaid, +77168,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,HEALTHFIRST-Medicaid, +77169,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,HEALTHFIRST-Medicaid, +77170,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,HEALTHFIRST-Medicaid, +77171,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,HEALTHFIRST-Medicaid, +77172,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,HEALTHFIRST-Medicaid, +77173,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,HEALTHFIRST-Medicaid, +77174,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,HEALTHFIRST-Medicaid, +77175,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,HEALTHFIRST-Medicaid, +77176,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,HEALTHFIRST-Medicaid, +77177,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,HEALTHFIRST-Medicaid, +77178,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,HEALTHFIRST-Medicaid, +77179,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,HEALTHFIRST-Medicaid, +77180,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,HEALTHFIRST-Medicaid, +77181,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,HEALTHFIRST-Medicaid, +77182,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,HEALTHFIRST-Medicaid, +77183,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,HEALTHFIRST-Medicaid, +77184,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,HEALTHFIRST-Medicaid, +77185,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,HEALTHFIRST-Medicaid, +77186,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,HEALTHFIRST-Medicaid, +77187,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,HEALTHFIRST-Medicaid, +77188,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,HEALTHFIRST-Medicaid, +77189,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,HEALTHFIRST-Medicaid,46.4 +77190,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,HEALTHFIRST-Medicaid,2399.23 +77191,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,HEALTHFIRST-Medicaid,43.53 +77192,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,HEALTHFIRST-Medicaid,50.68 +77193,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,HEALTHFIRST-Medicaid, +77194,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,HEALTHFIRST-Medicaid,42.91 +77195,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,HEALTHFIRST-Medicaid,67.32 +77196,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,HEALTHFIRST-Medicaid,2365.0 +77197,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,HEALTHFIRST-Medicaid, +77198,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,HEALTHFIRST-Medicaid, +77199,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,HEALTHFIRST-Medicaid, +77200,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,HEALTHFIRST-Medicaid, +77201,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,HEALTHFIRST-Medicaid, +77202,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,HEALTHFIRST-Medicaid, +77203,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,HEALTHFIRST-Medicaid, +77204,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,HEALTHFIRST-Medicaid, +77205,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,HEALTHFIRST-Medicaid, +77206,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,HEALTHFIRST-Medicaid, +77207,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,HEALTHFIRST-Medicaid, +77208,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,HEALTHFIRST-Medicaid, +77209,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,HEALTHFIRST-Medicaid, +77210,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,HEALTHFIRST-Medicaid, +77211,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,HEALTHFIRST-Medicaid, +77212,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,HEALTHFIRST-Medicaid, +77213,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,HEALTHFIRST-Medicaid, +77214,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,HEALTHFIRST-Medicaid, +77215,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,HEALTHFIRST-Medicaid, +77216,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,HEALTHFIRST-Medicaid, +77217,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,HEALTHFIRST-Medicaid, +77218,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,HEALTHFIRST-Medicaid, +77219,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,HEALTHFIRST-Medicaid, +77220,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,HEALTHFIRST-Medicaid, +77221,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,HEALTHFIRST-Medicaid, +77222,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,HEALTHFIRST-Medicaid, +77223,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,HEALTHFIRST-Medicaid, +77224,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,HEALTHFIRST-Medicaid, +77225,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,HEALTHFIRST-Medicaid, +77226,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,HEALTHFIRST-Medicaid, +77227,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,HEALTHFIRST-Medicaid, +77228,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,HEALTHFIRST-Medicaid, +77229,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,HEALTHFIRST-Medicaid, +77230,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,HEALTHFIRST-Medicaid, +77231,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,HEALTHFIRST-Medicaid, +77232,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,HEALTHFIRST-Medicaid, +77233,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,HEALTHFIRST-Medicaid, +77234,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,HEALTHFIRST-Medicaid, +77235,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,HEALTHFIRST-Medicaid, +77236,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,HEALTHFIRST-Medicaid, +77237,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,HEALTHFIRST-Medicaid, +77238,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,HEALTHFIRST-Medicaid, +77239,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,HEALTHFIRST-Medicaid, +77240,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,HEALTHFIRST-Medicaid, +77241,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,HEALTHFIRST-Medicaid, +77242,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,HEALTHFIRST-Medicaid, +77243,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,HEALTHFIRST-Medicaid, +77244,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,HEALTHFIRST-Medicaid, +77245,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,HEALTHFIRST-Medicaid, +77246,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,HEALTHFIRST-Medicaid, +77247,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,HEALTHFIRST-Medicaid, +77248,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,HEALTHFIRST-Medicaid, +77249,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,HEALTHFIRST-Medicaid, +77250,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,HEALTHFIRST-Medicaid, +77251,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,HEALTHFIRST-Medicaid, +77252,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,HEALTHFIRST-Medicaid, +77253,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,HEALTHFIRST-Medicaid, +77254,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHFIRST-Medicaid, +77255,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,HEALTHFIRST-Medicaid, +77256,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,HEALTHFIRST-Medicaid, +77257,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,HEALTHFIRST-Medicaid, +77258,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,HEALTHFIRST-Medicaid, +77259,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,HEALTHFIRST-Medicaid, +77260,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,HEALTHFIRST-Medicaid, +77261,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,HEALTHFIRST-Medicaid, +77262,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,HEALTHFIRST-Medicaid, +77263,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,HEALTHFIRST-Medicaid, +77264,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,HEALTHFIRST-Medicaid, +77265,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,HEALTHFIRST-Medicaid, +77266,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,HEALTHFIRST-Medicaid, +77267,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,HEALTHFIRST-Medicaid, +77268,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,HEALTHFIRST-Medicaid, +77269,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,HEALTHFIRST-Medicaid, +77270,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,HEALTHFIRST-Medicaid, +77271,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,HEALTHFIRST-Medicaid, +77272,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,HEALTHFIRST-Medicaid, +77273,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,HEALTHFIRST-Medicaid, +77274,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,HEALTHFIRST-Medicaid, +77275,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,HEALTHFIRST-Medicaid, +77276,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,HEALTHFIRST-Medicaid, +77277,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,HEALTHFIRST-Medicaid, +77278,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,HEALTHFIRST-Medicaid, +77279,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,HEALTHFIRST-Medicaid, +77280,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,HEALTHFIRST-Medicaid, +77281,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,HEALTHFIRST-Medicaid, +77282,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,HEALTHFIRST-Medicaid, +77283,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,HEALTHFIRST-Medicaid, +77284,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,HEALTHFIRST-Medicaid,1808.38 +77285,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,HEALTHFIRST-Medicaid, +77286,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,HEALTHFIRST-Medicaid, +77287,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,HEALTHFIRST-Medicaid, +77288,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,HEALTHFIRST-Medicaid, +77289,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,HEALTHFIRST-Medicaid, +77290,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,HEALTHFIRST-Medicaid, +77291,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,HEALTHFIRST-Medicaid, +77292,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,HEALTHFIRST-Medicaid, +77293,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,HEALTHFIRST-Medicaid, +77294,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,HEALTHFIRST-Medicaid, +77295,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,HEALTHFIRST-Medicaid, +77296,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,HEALTHFIRST-Medicaid, +77297,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,HEALTHFIRST-Medicaid, +77298,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,HEALTHFIRST-Medicaid, +77299,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,HEALTHFIRST-Medicaid, +77300,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,HEALTHFIRST-Medicaid, +77301,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,HEALTHFIRST-Medicaid, +77302,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,HEALTHFIRST-Medicaid, +77303,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,HEALTHFIRST-Medicaid, +77304,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,HEALTHFIRST-Medicaid, +77305,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,HEALTHFIRST-Medicaid, +77306,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,HEALTHFIRST-Medicaid, +77307,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,HEALTHFIRST-Medicaid, +77308,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,HEALTHFIRST-Medicaid, +77309,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,HEALTHFIRST-Medicaid, +77310,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,HEALTHFIRST-Medicaid, +77311,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,HEALTHFIRST-Medicaid, +77312,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,HEALTHFIRST-Medicaid, +77313,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,HEALTHFIRST-Medicaid, +77314,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,HEALTHFIRST-Medicaid, +77315,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,HEALTHFIRST-Medicaid, +77316,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,HEALTHFIRST-Medicaid, +77317,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,HEALTHFIRST-Medicaid, +77318,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,HEALTHFIRST-Medicaid, +77319,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,HEALTHFIRST-Medicaid, +77320,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,HEALTHFIRST-Medicaid, +77321,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,HEALTHFIRST-Medicaid, +77322,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,HEALTHFIRST-Medicaid, +77323,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,HEALTHFIRST-Medicaid, +77324,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,HEALTHFIRST-Medicaid, +77325,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,HEALTHFIRST-Medicaid, +77326,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,HEALTHFIRST-Medicaid, +77327,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,HEALTHFIRST-Medicaid, +77328,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,HEALTHFIRST-Medicaid, +77329,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,HEALTHFIRST-Medicaid, +77330,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,HEALTHFIRST-Medicaid, +77331,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,HEALTHFIRST-Medicaid, +77332,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,HEALTHFIRST-Medicaid, +77333,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,HEALTHFIRST-Medicaid, +77334,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,HEALTHFIRST-Medicaid, +77335,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,HEALTHFIRST-Medicaid, +77336,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,HEALTHFIRST-Medicaid, +77337,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,HEALTHFIRST-Medicaid, +77338,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,HEALTHFIRST-Medicaid, +77339,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,HEALTHFIRST-Medicaid, +77340,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,HEALTHFIRST-Medicaid, +77341,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,HEALTHFIRST-Medicaid, +77342,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,HEALTHFIRST-Medicaid, +77343,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,HEALTHFIRST-Medicaid, +77344,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,HEALTHFIRST-Medicaid, +77345,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,HEALTHFIRST-Medicaid, +77346,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,HEALTHFIRST-Medicaid, +77347,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,HEALTHFIRST-Medicaid, +77348,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,HEALTHFIRST-Medicaid, +77349,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,HEALTHFIRST-Medicaid, +77350,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,HEALTHFIRST-Medicaid, +77351,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,HEALTHFIRST-Medicaid, +77352,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,HEALTHFIRST-Medicaid, +77353,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,HEALTHFIRST-Medicaid, +77354,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,HEALTHFIRST-Medicaid, +77355,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,HEALTHFIRST-Medicaid, +77356,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,HEALTHFIRST-Medicaid, +77357,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,HEALTHFIRST-Medicaid, +77358,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,HEALTHFIRST-Medicaid, +77359,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,HEALTHFIRST-Medicaid,5786.22 +77360,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,HEALTHFIRST-Medicaid, +77361,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,HEALTHFIRST-Medicaid, +77362,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,HEALTHFIRST-Medicaid, +77363,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,HEALTHFIRST-Medicaid, +77364,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,HEALTHFIRST-Medicaid, +77365,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,HEALTHFIRST-Medicaid, +77366,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,HEALTHFIRST-Medicaid, +77367,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,HEALTHFIRST-Medicaid, +77368,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,HEALTHFIRST-Medicaid, +77369,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,HEALTHFIRST-Medicaid, +77370,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,HEALTHFIRST-Medicaid, +77371,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,HEALTHFIRST-Medicaid, +77372,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,HEALTHFIRST-Medicaid, +77373,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,HEALTHFIRST-Medicaid, +77374,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,HEALTHFIRST-Medicaid, +77375,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,HEALTHFIRST-Medicaid, +77376,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,HEALTHFIRST-Medicaid, +77377,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,HEALTHFIRST-Medicaid, +77378,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,HEALTHFIRST-Medicaid, +77379,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,HEALTHFIRST-Medicaid, +77380,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,HEALTHFIRST-Medicaid,2438.01 +77381,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,HEALTHFIRST-Medicaid, +77382,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,HEALTHFIRST-Medicaid, +77383,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,HEALTHFIRST-Medicaid, +77384,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,HEALTHFIRST-Medicaid, +77385,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,HEALTHFIRST-Medicaid, +77386,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,HEALTHFIRST-Medicaid, +77387,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,HEALTHFIRST-Medicaid, +77388,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,HEALTHFIRST-Medicaid, +77389,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,HEALTHFIRST-Medicaid, +77390,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,HEALTHFIRST-Medicaid, +77391,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,HEALTHFIRST-Medicaid, +77392,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,HEALTHFIRST-Medicaid, +77393,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,HEALTHFIRST-Medicaid, +77394,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,HEALTHFIRST-Medicaid, +77395,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,HEALTHFIRST-Medicaid, +77396,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,HEALTHFIRST-Medicaid, +77397,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,HEALTHFIRST-Medicaid, +77398,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,HEALTHFIRST-Medicaid, +77399,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,HEALTHFIRST-Medicaid, +77400,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,HEALTHFIRST-Medicaid, +77401,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,HEALTHFIRST-Medicaid, +77402,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,HEALTHFIRST-Medicaid, +77403,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,HEALTHFIRST-Medicaid, +77404,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,HEALTHFIRST-Medicaid, +77405,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,HEALTHFIRST-Medicaid, +77406,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,HEALTHFIRST-Medicaid, +77407,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,HEALTHFIRST-Medicaid, +77408,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,HEALTHFIRST-Medicaid, +77409,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,HEALTHFIRST-Medicaid, +77410,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,HEALTHFIRST-Medicaid, +77411,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,HEALTHFIRST-Medicaid, +77412,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,HEALTHFIRST-Medicaid, +77413,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,HEALTHFIRST-Medicaid, +77414,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,HEALTHFIRST-Medicaid, +77415,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,HEALTHFIRST-Medicaid, +77416,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,HEALTHFIRST-Medicaid, +77417,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,HEALTHFIRST-Medicaid, +77418,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,HEALTHFIRST-Medicaid, +77419,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,HEALTHFIRST-Medicaid, +77420,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,HEALTHFIRST-Medicaid, +77421,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,HEALTHFIRST-Medicaid, +77422,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,HEALTHFIRST-Medicaid, +77423,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,HEALTHFIRST-Medicaid, +77424,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,HEALTHFIRST-Medicaid, +77425,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,HEALTHFIRST-Medicaid, +77426,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,HEALTHFIRST-Medicaid, +77427,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,HEALTHFIRST-Medicaid, +77428,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,HEALTHFIRST-Medicaid, +77429,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,HEALTHFIRST-Medicaid, +77430,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,HEALTHFIRST-Medicaid, +77431,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,HEALTHFIRST-Medicaid, +77432,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,HEALTHFIRST-Medicaid, +77433,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,HEALTHFIRST-Medicaid, +77434,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,HEALTHFIRST-Medicaid, +77435,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,HEALTHFIRST-Medicaid, +77436,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,HEALTHFIRST-Medicaid, +77437,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,HEALTHFIRST-Medicaid, +77438,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,HEALTHFIRST-Medicaid, +77439,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,HEALTHFIRST-Medicaid, +77440,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,HEALTHFIRST-Medicaid, +77441,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,HEALTHFIRST-Medicaid, +77442,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,HEALTHFIRST-Medicaid, +77443,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,HEALTHFIRST-Medicaid,64.27 +77444,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,HEALTHFIRST-Medicaid, +77445,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,HEALTHFIRST-Medicaid, +77446,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,HEALTHFIRST-Medicaid, +77447,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,HEALTHFIRST-Medicaid, +77448,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,HEALTHFIRST-Medicaid, +77449,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,HEALTHFIRST-Medicaid, +77450,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,HEALTHFIRST-Medicaid, +77451,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,HEALTHFIRST-Medicaid, +77452,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,HEALTHFIRST-Medicaid, +77453,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,HEALTHFIRST-Medicaid, +77454,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,HEALTHFIRST-Medicaid, +77455,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,HEALTHFIRST-Medicaid, +77456,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,HEALTHFIRST-Medicaid, +77457,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,HEALTHFIRST-Medicaid, +77458,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,HEALTHFIRST-Medicaid, +77459,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,HEALTHFIRST-Medicaid, +77460,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,HEALTHFIRST-Medicaid, +77461,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,HEALTHFIRST-Medicaid, +77462,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,HEALTHFIRST-Medicaid, +77463,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,HEALTHFIRST-Medicaid, +77464,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,HEALTHFIRST-Medicaid, +77465,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,HEALTHFIRST-Medicaid, +77466,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,HEALTHFIRST-Medicaid, +77467,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,HEALTHFIRST-Medicaid, +77468,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,HEALTHFIRST-Medicaid, +77469,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,HEALTHFIRST-Medicaid, +77470,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,HEALTHFIRST-Medicaid, +77471,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,HEALTHFIRST-Medicaid, +77472,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,HEALTHFIRST-Medicaid, +77473,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,HEALTHFIRST-Medicaid, +77474,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,HEALTHFIRST-Medicaid, +77475,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,HEALTHFIRST-Medicaid, +77476,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,HEALTHFIRST-Medicaid, +77477,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,HEALTHFIRST-Medicaid,1220.16 +77478,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,HEALTHFIRST-Medicaid, +77479,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,HEALTHFIRST-Medicaid,8285.36 +77480,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,HEALTHFIRST-Medicaid, +77481,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,HEALTHFIRST-Medicaid,3055.11 +77482,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,HEALTHFIRST-Medicaid, +77483,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,HEALTHFIRST-Medicaid, +77484,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,HEALTHFIRST-Medicaid, +77485,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,HEALTHFIRST-Medicaid, +77486,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,HEALTHFIRST-Medicaid, +77487,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,HEALTHFIRST-Medicaid, +77488,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,HEALTHFIRST-Medicaid, +77489,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,HEALTHFIRST-Medicaid, +77490,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,HEALTHFIRST-Medicaid, +77491,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,HEALTHFIRST-Medicaid, +77492,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,HEALTHFIRST-Medicaid, +77493,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,HEALTHFIRST-Medicaid, +77494,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,HEALTHFIRST-Medicaid, +77495,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,HEALTHFIRST-Medicaid, +77496,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,HEALTHFIRST-Medicaid, +77497,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,HEALTHFIRST-Medicaid, +77498,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,HEALTHFIRST-Medicaid, +77499,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,HEALTHFIRST-Medicaid, +77500,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,HEALTHFIRST-Medicaid, +77501,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,HEALTHFIRST-Medicaid, +77502,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,HEALTHFIRST-Medicaid, +77503,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,HEALTHFIRST-Medicaid, +77504,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,HEALTHFIRST-Medicaid, +77505,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,HEALTHFIRST-Medicaid, +77506,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,HEALTHFIRST-Medicaid, +77507,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,HEALTHFIRST-Medicaid, +77508,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,HEALTHFIRST-Medicaid, +77509,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,HEALTHFIRST-Medicaid, +77510,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,HEALTHFIRST-Medicaid, +77511,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,HEALTHFIRST-Medicaid, +77512,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,HEALTHFIRST-Medicaid, +77513,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,HEALTHFIRST-Medicaid,5141.38 +77514,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,HEALTHFIRST-Medicaid, +77515,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,HEALTHFIRST-Medicaid, +77516,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,HEALTHFIRST-Medicaid, +77517,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,HEALTHFIRST-Medicaid, +77518,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,HEALTHFIRST-Medicaid, +77519,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,HEALTHFIRST-Medicaid, +77520,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,HEALTHFIRST-Medicaid, +77521,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,HEALTHFIRST-Medicaid, +77522,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,HEALTHFIRST-Medicaid, +77523,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,HEALTHFIRST-Medicaid, +77524,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,HEALTHFIRST-Medicaid, +77525,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,HEALTHFIRST-Medicaid, +77526,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,HEALTHFIRST-Medicaid, +77527,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,HEALTHFIRST-Medicaid, +77528,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,HEALTHFIRST-Medicaid, +77529,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,HEALTHFIRST-Medicaid, +77530,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,HEALTHFIRST-Medicaid, +77531,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,HEALTHFIRST-Medicaid, +77532,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,HEALTHFIRST-Medicaid, +77533,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,HEALTHFIRST-Medicaid, +77534,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,HEALTHFIRST-Medicaid, +77535,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,HEALTHFIRST-Medicaid, +77536,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,HEALTHFIRST-Medicaid, +77537,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,HEALTHFIRST-Medicaid, +77538,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,HEALTHFIRST-Medicaid, +77539,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,HEALTHFIRST-Medicaid, +77540,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,HEALTHFIRST-Medicaid, +77541,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,HEALTHFIRST-Medicaid, +77542,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,HEALTHFIRST-Medicaid, +77543,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,HEALTHFIRST-Medicaid, +77544,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,HEALTHFIRST-Medicaid, +77545,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,HEALTHFIRST-Medicaid, +77546,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,HEALTHFIRST-Medicaid, +77547,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,HEALTHFIRST-Medicaid, +77548,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,HEALTHFIRST-Medicaid, +77549,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,HEALTHFIRST-Medicaid, +77550,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,HEALTHFIRST-Medicaid, +77551,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,HEALTHFIRST-Medicaid, +77552,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,HEALTHFIRST-Medicaid, +77553,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,HEALTHFIRST-Medicaid, +77554,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,HEALTHFIRST-Medicaid, +77555,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,HEALTHFIRST-Medicaid, +77556,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,HEALTHFIRST-Medicaid, +77557,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,HEALTHFIRST-Medicaid, +77558,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,HEALTHFIRST-Medicaid, +77559,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,HEALTHFIRST-Medicaid, +77560,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,HEALTHFIRST-Medicaid, +77561,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,HEALTHFIRST-Medicaid, +77562,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,HEALTHFIRST-Medicaid, +77563,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,HEALTHFIRST-Medicaid, +77564,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,HEALTHFIRST-Medicaid, +77565,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,HEALTHFIRST-Medicaid, +77566,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,HEALTHFIRST-Medicaid, +77567,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,HEALTHFIRST-Medicaid, +77568,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,HEALTHFIRST-Medicaid, +77569,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,HEALTHFIRST-Medicaid, +77570,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,HEALTHFIRST-Medicaid, +77571,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,HEALTHFIRST-Medicaid, +77572,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,HEALTHFIRST-Medicaid, +77573,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,HEALTHFIRST-Medicaid, +77574,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,HEALTHFIRST-Medicaid, +77575,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,HEALTHFIRST-Medicaid, +77576,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,HEALTHFIRST-Medicaid, +77577,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,HEALTHFIRST-Medicaid, +77578,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,HEALTHFIRST-Medicaid, +77579,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,HEALTHFIRST-Medicaid, +77580,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,HEALTHFIRST-Medicaid, +77581,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,HEALTHFIRST-Medicaid, +77582,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,HEALTHFIRST-Medicaid, +77583,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,HEALTHFIRST-Medicaid, +77584,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,HEALTHFIRST-Medicaid, +77585,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,HEALTHFIRST-Medicaid, +77586,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,HEALTHFIRST-Medicaid, +77587,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,HEALTHFIRST-Medicaid, +77588,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,HEALTHFIRST-Medicaid, +77589,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,HEALTHFIRST-Medicaid, +77590,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,HEALTHFIRST-Medicaid, +77591,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,HEALTHFIRST-Medicaid, +77592,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,HEALTHFIRST-Medicaid, +77593,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,HEALTHFIRST-Medicaid,1456.64 +77594,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,HEALTHFIRST-Medicaid, +77595,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,HEALTHFIRST-Medicaid, +77596,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,HEALTHFIRST-Medicaid, +77597,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,HEALTHFIRST-Medicaid,262.94 +77598,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,HEALTHFIRST-Medicaid, +77599,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,HEALTHFIRST-Medicaid, +77600,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,HEALTHFIRST-Medicaid, +77601,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,HEALTHFIRST-Medicaid, +77602,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,HEALTHFIRST-Medicaid, +77603,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,HEALTHFIRST-Medicaid, +77604,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,HEALTHFIRST-Medicaid, +77605,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,HEALTHFIRST-Medicaid,429.03 +77606,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,HEALTHFIRST-Medicaid, +77607,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,HEALTHFIRST-Medicaid, +77608,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,HEALTHFIRST-Medicaid, +77609,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,HEALTHFIRST-Medicaid, +77610,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,HEALTHFIRST-Medicaid, +77611,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,HEALTHFIRST-Medicaid, +77612,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,HEALTHFIRST-Medicaid, +77613,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,HEALTHFIRST-Medicaid, +77614,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,HEALTHFIRST-Medicaid, +77615,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,HEALTHFIRST-Medicaid, +77616,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,HEALTHFIRST-Medicaid, +77617,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,HEALTHFIRST-Medicaid, +77618,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,HEALTHFIRST-Medicaid, +77619,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,HEALTHFIRST-Medicaid, +77620,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,HEALTHFIRST-Medicaid, +77621,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,HEALTHFIRST-Medicaid, +77622,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,HEALTHFIRST-Medicaid, +77623,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,HEALTHFIRST-Medicaid, +77624,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,HEALTHFIRST-Medicaid, +77625,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,HEALTHFIRST-Medicaid, +77626,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,HEALTHFIRST-Medicaid, +77627,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,HEALTHFIRST-Medicaid, +77628,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,HEALTHFIRST-Medicaid, +77629,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,HEALTHFIRST-Medicaid, +77630,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,HEALTHFIRST-Medicaid, +77631,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,HEALTHFIRST-Medicaid, +77632,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,HEALTHFIRST-Medicaid, +77633,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,HEALTHFIRST-Medicaid, +77634,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,HEALTHFIRST-Medicaid, +77635,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,HEALTHFIRST-Medicaid, +77636,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,HEALTHFIRST-Medicaid, +77637,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,HEALTHFIRST-Medicaid, +77638,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,HEALTHFIRST-Medicaid, +77639,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,HEALTHFIRST-Medicaid, +77640,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,HEALTHFIRST-Medicaid, +77641,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,HEALTHFIRST-Medicaid, +77642,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,HEALTHFIRST-Medicaid, +77643,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,HEALTHFIRST-Medicaid, +77644,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,HEALTHFIRST-Medicaid, +77645,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,HEALTHFIRST-Medicaid, +77646,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,HEALTHFIRST-Medicaid, +77647,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,HEALTHFIRST-Medicaid, +77648,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,HEALTHFIRST-Medicaid, +77649,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,HEALTHFIRST-Medicaid, +77650,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,HEALTHFIRST-Medicaid, +77651,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,HEALTHFIRST-Medicaid, +77652,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,HEALTHFIRST-Medicaid, +77653,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,HEALTHFIRST-Medicaid, +77654,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,HEALTHFIRST-Medicaid, +77655,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,HEALTHFIRST-Medicaid, +77656,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,HEALTHFIRST-Medicaid, +77657,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,HEALTHFIRST-Medicaid, +77658,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,HEALTHFIRST-Medicaid, +77659,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,HEALTHFIRST-Medicaid, +77660,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,HEALTHFIRST-Medicaid, +77661,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,HEALTHFIRST-Medicaid, +77662,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,HEALTHFIRST-Medicaid, +77663,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,HEALTHFIRST-Medicaid, +77664,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,HEALTHFIRST-Medicaid, +77665,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,HEALTHFIRST-Medicaid, +77666,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,HEALTHFIRST-Medicaid, +77667,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,HEALTHFIRST-Medicaid, +77668,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,HEALTHFIRST-Medicaid, +77669,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,HEALTHFIRST-Medicaid, +77670,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,HEALTHFIRST-Medicaid, +77671,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,HEALTHFIRST-Medicaid, +77672,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,HEALTHFIRST-Medicaid, +77673,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,HEALTHFIRST-Medicaid, +77674,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,HEALTHFIRST-Medicaid, +77675,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,HEALTHFIRST-Medicaid, +77676,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,HEALTHFIRST-Medicaid, +77677,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,HEALTHFIRST-Medicaid, +77678,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,HEALTHFIRST-Medicaid, +77679,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,HEALTHFIRST-Medicaid, +77680,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,HEALTHFIRST-Medicaid, +77681,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,HEALTHFIRST-Medicaid, +77682,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,HEALTHFIRST-Medicaid, +77683,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,HEALTHFIRST-Medicaid, +77684,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,HEALTHFIRST-Medicaid, +77685,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,HEALTHFIRST-Medicaid, +77686,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,HEALTHFIRST-Medicaid, +77687,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,HEALTHFIRST-Medicaid, +77688,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,HEALTHFIRST-Medicaid, +77689,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,HEALTHFIRST-Medicaid, +77690,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,HEALTHFIRST-Medicaid, +77691,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,HEALTHFIRST-Medicaid, +77692,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,HEALTHFIRST-Medicaid, +77693,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,HEALTHFIRST-Medicaid, +77694,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,HEALTHFIRST-Medicaid, +77695,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,HEALTHFIRST-Medicaid, +77696,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,HEALTHFIRST-Medicaid, +77697,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,HEALTHFIRST-Medicaid, +77698,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,HEALTHFIRST-Medicaid, +77699,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,HEALTHFIRST-Medicaid, +77700,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,HEALTHFIRST-Medicaid, +77701,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,HEALTHFIRST-Medicaid, +77702,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,HEALTHFIRST-Medicaid, +77703,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,HEALTHFIRST-Medicaid, +77704,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,HEALTHFIRST-Medicaid, +77705,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,HEALTHFIRST-Medicaid, +77706,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,HEALTHFIRST-Medicaid, +77707,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,HEALTHFIRST-Medicaid, +77708,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,HEALTHFIRST-Medicaid, +77709,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,HEALTHFIRST-Medicaid, +77710,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,HEALTHFIRST-Medicaid, +77711,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,HEALTHFIRST-Medicaid, +77712,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,HEALTHFIRST-Medicaid, +77713,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,HEALTHFIRST-Medicaid, +77714,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,HEALTHFIRST-Medicaid, +77715,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,HEALTHFIRST-Medicaid, +77716,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,HEALTHFIRST-Medicaid, +77717,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,HEALTHFIRST-Medicaid, +77718,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,HEALTHFIRST-Medicaid, +77719,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,HEALTHFIRST-Medicaid,1001.36 +77720,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,HEALTHFIRST-Medicaid, +77721,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,HEALTHFIRST-Medicaid, +77722,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,HEALTHFIRST-Medicaid, +77723,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,HEALTHFIRST-Medicaid, +77724,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,HEALTHFIRST-Medicaid,410.06 +77725,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,HEALTHFIRST-Medicaid, +77726,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,HEALTHFIRST-Medicaid, +77727,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,HEALTHFIRST-Medicaid, +77728,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,HEALTHFIRST-Medicaid, +77729,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,HEALTHFIRST-Medicaid, +77730,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,HEALTHFIRST-Medicaid, +77731,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,HEALTHFIRST-Medicaid, +77732,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,HEALTHFIRST-Medicaid, +77733,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,HEALTHFIRST-Medicaid, +77734,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,HEALTHFIRST-Medicaid, +77735,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,HEALTHFIRST-Medicaid, +77736,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,HEALTHFIRST-Medicaid, +77737,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,HEALTHFIRST-Medicaid, +77738,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,HEALTHFIRST-Medicaid, +77739,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,HEALTHFIRST-Medicaid, +77740,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,HEALTHFIRST-Medicaid, +77741,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,HEALTHFIRST-Medicaid, +77742,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,HEALTHFIRST-Medicaid, +77743,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,HEALTHFIRST-Medicaid, +77744,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,HEALTHFIRST-Medicaid, +77745,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,HEALTHFIRST-Medicaid, +77746,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,HEALTHFIRST-Medicaid, +77747,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,HEALTHFIRST-Medicaid, +77748,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,HEALTHFIRST-Medicaid, +77749,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,HEALTHFIRST-Medicaid, +77750,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,HEALTHFIRST-Medicaid, +77751,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,HEALTHFIRST-Medicaid, +77752,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,HEALTHFIRST-Medicaid, +77753,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,HEALTHFIRST-Medicaid, +77754,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,HEALTHFIRST-Medicaid, +77755,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,HEALTHFIRST-Medicaid, +77756,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,HEALTHFIRST-Medicaid, +77757,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,HEALTHFIRST-Medicaid, +77758,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,HEALTHFIRST-Medicaid,4769.22 +77759,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,HEALTHFIRST-Medicaid,116.61 +77760,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,HEALTHFIRST-Medicaid, +77761,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,HEALTHFIRST-Medicaid, +77762,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,HEALTHFIRST-Medicaid, +77763,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,HEALTHFIRST-Medicaid, +77764,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,HEALTHFIRST-Medicaid, +77765,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,HEALTHFIRST-Medicaid, +77766,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,HEALTHFIRST-Medicaid, +77767,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,HEALTHFIRST-Medicaid, +77768,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,HEALTHFIRST-Medicaid, +77769,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,HEALTHFIRST-Medicaid, +77770,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,HEALTHFIRST-Medicaid, +77771,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,HEALTHFIRST-Medicaid, +77772,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,HEALTHFIRST-Medicaid, +77773,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,HEALTHFIRST-Medicaid, +77774,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,HEALTHFIRST-Medicaid, +77775,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,HEALTHFIRST-Medicaid, +77776,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,HEALTHFIRST-Medicaid, +77777,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,HEALTHFIRST-Medicaid, +77778,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,HEALTHFIRST-Medicaid, +77779,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,HEALTHFIRST-Medicaid, +77780,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,HEALTHFIRST-Medicaid, +77781,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,HEALTHFIRST-Medicaid, +77782,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,HEALTHFIRST-Medicaid, +77783,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,HEALTHFIRST-Medicaid, +77784,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,HEALTHFIRST-Medicaid, +77785,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,HEALTHFIRST-Medicaid, +77786,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,HEALTHFIRST-Medicaid, +77787,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,HEALTHFIRST-Medicaid, +77788,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,HEALTHFIRST-Medicaid, +77789,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,HEALTHFIRST-Medicaid, +77790,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,HEALTHFIRST-Medicaid, +77791,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,HEALTHFIRST-Medicaid,361.6 +77792,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,HEALTHFIRST-Medicaid,56.47 +77793,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,HEALTHFIRST-Medicaid, +77794,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,HEALTHFIRST-Medicaid, +77795,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,HEALTHFIRST-Medicaid, +77796,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,HEALTHFIRST-Medicaid,10.87 +77797,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,HEALTHFIRST-Medicaid,59.0 +77798,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,HEALTHFIRST-Medicaid,13.97 +77799,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,HEALTHFIRST-Medicaid,174.11 +77800,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,HEALTHFIRST-Medicaid,386.5 +77801,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,HEALTHFIRST-Medicaid,3268.0 +77802,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,HEALTHFIRST-Medicaid,139.9 +77803,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,HEALTHFIRST-Medicaid, +77804,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,HEALTHFIRST-Medicaid,308.68 +77805,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,HEALTHFIRST-Medicaid,111.74 +77806,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,HEALTHFIRST-Medicaid,101.33 +77807,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,HEALTHFIRST-Medicaid, +77808,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,HEALTHFIRST-Medicaid, +77809,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,HEALTHFIRST-Medicaid, +77810,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,HEALTHFIRST-Medicaid, +77811,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,HEALTHFIRST-Medicaid, +77812,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,HEALTHFIRST-Medicaid,99.96 +77813,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,HEALTHFIRST-Medicaid, +77814,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,HEALTHFIRST-Medicaid, +77815,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,HEALTHFIRST-Medicaid, +77816,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,HEALTHFIRST-Medicaid,69.58 +77817,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,HEALTHFIRST-Medicaid,3285.23 +77818,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,HEALTHFIRST-Medicaid, +77819,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,HEALTHFIRST-Medicaid,40.57 +77820,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,HEALTHFIRST-Medicaid,43.72 +77821,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,HEALTHFIRST-Medicaid,5630.9 +77822,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,HEALTHFIRST-Medicaid, +77823,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,HEALTHFIRST-Medicaid, +77824,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,HEALTHFIRST-Medicaid,50.16 +77825,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,HEALTHFIRST-Medicaid, +77826,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,HEALTHFIRST-Medicaid, +77827,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,HEALTHFIRST-Medicaid, +77828,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,HEALTHFIRST-Medicaid, +77829,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,HEALTHFIRST-Medicaid, +77830,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,HEALTHFIRST-Medicaid, +77831,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,HEALTHFIRST-Medicaid, +77832,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,HEALTHFIRST-Medicaid, +77833,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,HEALTHFIRST-Medicaid, +77834,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,HEALTHFIRST-Medicaid, +77835,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,HEALTHFIRST-Medicaid, +77836,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,HEALTHFIRST-Medicaid, +77837,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,HEALTHFIRST-Medicaid, +77838,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,HEALTHFIRST-Medicaid, +77839,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,HEALTHFIRST-Medicaid, +77840,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,HEALTHFIRST-Medicaid, +77841,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,HEALTHFIRST-Medicaid, +77842,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,HEALTHFIRST-Medicaid, +77843,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,HEALTHFIRST-Medicaid, +77844,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,HEALTHFIRST-Medicaid,559.94 +77845,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,HEALTHFIRST-Medicaid, +77846,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,HEALTHFIRST-Medicaid, +77847,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,HEALTHFIRST-Medicaid, +77848,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,HEALTHFIRST-Medicaid, +77849,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,HEALTHFIRST-Medicaid, +77850,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,HEALTHFIRST-Medicaid, +77851,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,HEALTHFIRST-Medicaid, +77852,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,HEALTHFIRST-Medicaid, +77853,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,HEALTHFIRST-Medicaid, +77854,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,HEALTHFIRST-Medicaid, +77855,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,HEALTHFIRST-Medicaid, +77856,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,HEALTHFIRST-Medicaid, +77857,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,HEALTHFIRST-Medicaid, +77858,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,HEALTHFIRST-Medicaid, +77859,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,HEALTHFIRST-Medicaid, +77860,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,HEALTHFIRST-Medicaid, +77861,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,HEALTHFIRST-Medicaid, +77862,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,HEALTHFIRST-Medicaid, +77863,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,HEALTHFIRST-Medicaid, +77864,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,HEALTHFIRST-Medicaid, +77865,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,HEALTHFIRST-Medicaid, +77866,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,HEALTHFIRST-Medicaid, +77867,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,HEALTHFIRST-Medicaid, +77868,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,HEALTHFIRST-Medicaid, +77869,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,HEALTHFIRST-Medicaid, +77870,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,HEALTHFIRST-Medicaid, +77871,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,HEALTHFIRST-Medicaid,475.79 +77872,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,HEALTHFIRST-Medicaid,2674.27 +77873,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,HEALTHFIRST-Medicaid, +77874,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,HEALTHFIRST-Medicaid, +77875,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,HEALTHFIRST-Medicaid, +77876,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,HEALTHFIRST-Medicaid, +77877,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHFIRST-Medicaid, +77878,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHFIRST-Medicaid, +77879,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,HEALTHFIRST-Medicaid,793.15 +77880,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,HEALTHFIRST-Medicaid, +77881,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,HEALTHFIRST-Medicaid,602.73 +77882,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,HEALTHFIRST-Medicaid, +77883,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,HEALTHFIRST-Medicaid, +77884,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,HEALTHFIRST-Medicaid, +77885,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,HEALTHFIRST-Medicaid, +77886,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,HEALTHFIRST-Medicaid, +77887,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,HEALTHFIRST-Medicaid, +77888,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,HEALTHFIRST-Medicaid, +77889,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,HEALTHFIRST-Medicaid, +77890,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,HEALTHFIRST-Medicaid, +77891,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,HEALTHFIRST-Medicaid, +77892,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,HEALTHFIRST-Medicaid, +77893,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,HEALTHFIRST-Medicaid, +77894,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,HEALTHFIRST-Medicaid, +77895,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,HEALTHFIRST-Medicaid, +77896,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,HEALTHFIRST-Medicaid, +77897,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,HEALTHFIRST-Medicaid, +77898,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,HEALTHFIRST-Medicaid, +77899,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,HEALTHFIRST-Medicaid, +77900,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,HEALTHFIRST-Medicaid, +77901,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,HEALTHFIRST-Medicaid, +77902,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,HEALTHFIRST-Medicaid, +77903,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,HEALTHFIRST-Medicaid, +77904,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,HEALTHFIRST-Medicaid, +77905,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,HEALTHFIRST-Medicaid, +77906,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,HEALTHFIRST-Medicaid, +77907,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,HEALTHFIRST-Medicaid, +77908,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,HEALTHFIRST-Medicaid, +77909,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,HEALTHFIRST-Medicaid, +77910,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,HEALTHFIRST-Medicaid, +77911,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,HEALTHFIRST-Medicaid, +77912,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,HEALTHFIRST-Medicaid, +77913,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,HEALTHFIRST-Medicaid, +77914,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,HEALTHFIRST-Medicaid, +77915,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,HEALTHFIRST-Medicaid, +77916,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,HEALTHFIRST-Medicaid, +77917,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,HEALTHFIRST-Medicaid, +77918,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,HEALTHFIRST-Medicaid, +77919,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,HEALTHFIRST-Medicaid, +77920,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,HEALTHFIRST-Medicaid, +77921,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,HEALTHFIRST-Medicaid, +77922,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,HEALTHFIRST-Medicaid, +77923,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,HEALTHFIRST-Medicaid,185.21 +77924,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,HEALTHFIRST-Medicaid, +77925,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,HEALTHFIRST-Medicaid, +77926,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,HEALTHFIRST-Medicaid,4099.79 +77927,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,HEALTHFIRST-Medicaid, +77928,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,HEALTHFIRST-Medicaid, +77929,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,HEALTHFIRST-Medicaid, +77930,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,HEALTHFIRST-Medicaid, +77931,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,HEALTHFIRST-Medicaid, +77932,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,HEALTHFIRST-Medicaid, +77933,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,HEALTHFIRST-Medicaid, +77934,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,HEALTHFIRST-Medicaid, +77935,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,HEALTHFIRST-Medicaid, +77936,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,HEALTHFIRST-Medicaid, +77937,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,HEALTHFIRST-Medicaid, +77938,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,HEALTHFIRST-Medicaid, +77939,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,HEALTHFIRST-Medicaid, +77940,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,HEALTHFIRST-Medicaid, +77941,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,HEALTHFIRST-Medicaid, +77942,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,HEALTHFIRST-Medicaid, +77943,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,HEALTHFIRST-Medicaid, +77944,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,HEALTHFIRST-Medicaid, +77945,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,HEALTHFIRST-Medicaid, +77946,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,HEALTHFIRST-Medicaid, +77947,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,HEALTHFIRST-Medicaid, +77948,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,HEALTHFIRST-Medicaid, +77949,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,HEALTHFIRST-Medicaid, +77950,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,HEALTHFIRST-Medicaid, +77951,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,HEALTHFIRST-Medicaid, +77952,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,HEALTHFIRST-Medicaid, +77953,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,HEALTHFIRST-Medicaid, +77954,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,HEALTHFIRST-Medicaid, +77955,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,HEALTHFIRST-Medicaid, +77956,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,HEALTHFIRST-Medicaid, +77957,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,HEALTHFIRST-Medicaid, +77958,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,HEALTHFIRST-Medicaid, +77959,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,HEALTHFIRST-Medicaid, +77960,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,HEALTHFIRST-Medicaid,3353.12 +77961,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,HEALTHFIRST-Medicaid, +77962,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,HEALTHFIRST-Medicaid, +77963,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,HEALTHFIRST-Medicaid, +77964,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,HEALTHFIRST-Medicaid, +77965,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,HEALTHFIRST-Medicaid, +77966,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,HEALTHFIRST-Medicaid, +77967,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,HEALTHFIRST-Medicaid, +77968,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,HEALTHFIRST-Medicaid, +77969,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,HEALTHFIRST-Medicaid, +77970,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,HEALTHFIRST-Medicaid, +77971,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,HEALTHFIRST-Medicaid, +77972,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,HEALTHFIRST-Medicaid, +77973,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,HEALTHFIRST-Medicaid, +77974,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,HEALTHFIRST-Medicaid,1376.93 +77975,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,HEALTHFIRST-Medicaid, +77976,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,HEALTHFIRST-Medicaid, +77977,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,HEALTHFIRST-Medicaid, +77978,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,HEALTHFIRST-Medicaid, +77979,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,HEALTHFIRST-Medicaid, +77980,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,HEALTHFIRST-Medicaid, +77981,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,HEALTHFIRST-Medicaid, +77982,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,HEALTHFIRST-Medicaid, +77983,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,HEALTHFIRST-Medicaid, +77984,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,HEALTHFIRST-Medicaid, +77985,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,HEALTHFIRST-Medicaid, +77986,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,HEALTHFIRST-Medicaid, +77987,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,HEALTHFIRST-Medicaid, +77988,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,HEALTHFIRST-Medicaid, +77989,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,HEALTHFIRST-Medicaid, +77990,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,HEALTHFIRST-Medicaid, +77991,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,HEALTHFIRST-Medicaid, +77992,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,HEALTHFIRST-Medicaid, +77993,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,HEALTHFIRST-Medicaid, +77994,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,HEALTHFIRST-Medicaid, +77995,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,HEALTHFIRST-Medicaid, +77996,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,HEALTHFIRST-Medicaid, +77997,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,HEALTHFIRST-Medicaid, +77998,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,HEALTHFIRST-Medicaid, +77999,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,HEALTHFIRST-Medicaid, +78000,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,HEALTHFIRST-Medicaid, +78001,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,HEALTHFIRST-Medicaid, +78002,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,HEALTHFIRST-Medicaid, +78003,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,HEALTHFIRST-Medicaid, +78004,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,HEALTHFIRST-Medicaid, +78005,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,HEALTHFIRST-Medicaid, +78006,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,HEALTHFIRST-Medicaid,866.28 +78007,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,HEALTHFIRST-Medicaid, +78008,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,HEALTHFIRST-Medicaid, +78009,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,HEALTHFIRST-Medicaid, +78010,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,HEALTHFIRST-Medicaid, +78011,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,HEALTHFIRST-Medicaid,46.4 +78012,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,HEALTHFIRST-Medicaid, +78013,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,HEALTHFIRST-Medicaid, +78014,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,HEALTHFIRST-Medicaid, +78015,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,HEALTHFIRST-Medicaid, +78016,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,HEALTHFIRST-Medicaid, +78017,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,HEALTHFIRST-Medicaid, +78018,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,HEALTHFIRST-Medicaid, +78019,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,HEALTHFIRST-Medicaid, +78020,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,HEALTHFIRST-Medicaid, +78021,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,HEALTHFIRST-Medicaid, +78022,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,HEALTHFIRST-Medicaid, +78023,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,HEALTHFIRST-Medicaid, +78024,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,HEALTHFIRST-Medicaid, +78025,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,HEALTHFIRST-Medicaid, +78026,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,HEALTHFIRST-Medicaid, +78027,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,HEALTHFIRST-Medicaid, +78028,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,HEALTHFIRST-Medicaid, +78029,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,HEALTHFIRST-Medicaid, +78030,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,HEALTHFIRST-Medicaid, +78031,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,HEALTHFIRST-Medicaid, +78032,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,HEALTHFIRST-Medicaid, +78033,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,HEALTHFIRST-Medicaid, +78034,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,HEALTHFIRST-Medicaid, +78035,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,HEALTHFIRST-Medicaid, +78036,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,HEALTHFIRST-Medicaid, +78037,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,HEALTHFIRST-Medicaid, +78038,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,HEALTHFIRST-Medicaid, +78039,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,HEALTHFIRST-Medicaid, +78040,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,HEALTHFIRST-Medicaid, +78041,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,HEALTHFIRST-Medicaid, +78042,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,HEALTHFIRST-Medicaid, +78043,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,HEALTHFIRST-Medicaid, +78044,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,HEALTHFIRST-Medicaid, +78045,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,HEALTHFIRST-Medicaid, +78046,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,HEALTHFIRST-Medicaid, +78047,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,HEALTHFIRST-Medicaid, +78048,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,HEALTHFIRST-Medicaid, +78049,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,HEALTHFIRST-Medicaid, +78050,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,HEALTHFIRST-Medicaid, +78051,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,HEALTHFIRST-Medicaid, +78052,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,HEALTHFIRST-Medicaid, +78053,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,HEALTHFIRST-Medicaid,822.2 +78054,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,HEALTHFIRST-Medicaid, +78055,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,HEALTHFIRST-Medicaid, +78056,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,HEALTHFIRST-Medicaid, +78057,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,HEALTHFIRST-Medicaid, +78058,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,HEALTHFIRST-Medicaid,1416.7 +78059,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,HEALTHFIRST-Medicaid, +78060,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,HEALTHFIRST-Medicaid,1430.14 +78061,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,HEALTHFIRST-Medicaid, +78062,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,HEALTHFIRST-Medicaid, +78063,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,HEALTHFIRST-Medicaid, +78064,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,HEALTHFIRST-Medicaid, +78065,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,HEALTHFIRST-Medicaid, +78066,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,HEALTHFIRST-Medicaid, +78067,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,HEALTHFIRST-Medicaid, +78068,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,HEALTHFIRST-Medicaid, +78069,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +78070,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,HEALTHFIRST-Medicaid, +78071,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,HEALTHFIRST-Medicaid, +78072,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,HEALTHFIRST-Medicaid, +78073,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,HEALTHFIRST-Medicaid, +78074,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,HEALTHFIRST-Medicaid, +78075,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,HEALTHFIRST-Medicaid, +78076,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,HEALTHFIRST-Medicaid, +78077,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,HEALTHFIRST-Medicaid, +78078,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,HEALTHFIRST-Medicaid, +78079,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,HEALTHFIRST-Medicaid, +78080,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,HEALTHFIRST-Medicaid, +78081,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,HEALTHFIRST-Medicaid, +78082,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,HEALTHFIRST-Medicaid, +78083,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,HEALTHFIRST-Medicaid, +78084,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,HEALTHFIRST-Medicaid, +78085,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,HEALTHFIRST-Medicaid, +78086,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,HEALTHFIRST-Medicaid, +78087,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,HEALTHFIRST-Medicaid, +78088,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,HEALTHFIRST-Medicaid, +78089,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,HEALTHFIRST-Medicaid, +78090,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,HEALTHFIRST-Medicaid, +78091,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,HEALTHFIRST-Medicaid, +78092,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,HEALTHFIRST-Medicaid, +78093,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,HEALTHFIRST-Medicaid, +78094,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,HEALTHFIRST-Medicaid, +78095,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,HEALTHFIRST-Medicaid, +78096,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,HEALTHFIRST-Medicaid, +78097,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,HEALTHFIRST-Medicaid, +78098,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,HEALTHFIRST-Medicaid, +78099,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,HEALTHFIRST-Medicaid, +78100,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,HEALTHFIRST-Medicaid, +78101,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,HEALTHFIRST-Medicaid, +78102,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,HEALTHFIRST-Medicaid, +78103,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,HEALTHFIRST-Medicaid, +78104,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,HEALTHFIRST-Medicaid, +78105,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,HEALTHFIRST-Medicaid, +78106,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,HEALTHFIRST-Medicaid, +78107,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,HEALTHFIRST-Medicaid, +78108,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,HEALTHFIRST-Medicaid, +78109,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,HEALTHFIRST-Medicaid, +78110,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,HEALTHFIRST-Medicaid, +78111,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,HEALTHFIRST-Medicaid, +78112,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,HEALTHFIRST-Medicaid, +78113,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,HEALTHFIRST-Medicaid, +78114,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,HEALTHFIRST-Medicaid, +78115,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,HEALTHFIRST-Medicaid, +78116,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,HEALTHFIRST-Medicaid, +78117,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,HEALTHFIRST-Medicaid, +78118,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,HEALTHFIRST-Medicaid, +78119,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,HEALTHFIRST-Medicaid, +78120,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,HEALTHFIRST-Medicaid, +78121,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,HEALTHFIRST-Medicaid, +78122,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,HEALTHFIRST-Medicaid, +78123,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,HEALTHFIRST-Medicaid, +78124,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,HEALTHFIRST-Medicaid, +78125,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,HEALTHFIRST-Medicaid, +78126,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,HEALTHFIRST-Medicaid, +78127,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,HEALTHFIRST-Medicaid, +78128,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,HEALTHFIRST-Medicaid, +78129,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,HEALTHFIRST-Medicaid, +78130,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,HEALTHFIRST-Medicaid, +78131,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,HEALTHFIRST-Medicaid, +78132,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,HEALTHFIRST-Medicaid, +78133,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,HEALTHFIRST-Medicaid, +78134,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,HEALTHFIRST-Medicaid, +78135,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,HEALTHFIRST-Medicaid, +78136,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,HEALTHFIRST-Medicaid, +78137,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,HEALTHFIRST-Medicaid, +78138,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,HEALTHFIRST-Medicaid, +78139,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,HEALTHFIRST-Medicaid, +78140,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,HEALTHFIRST-Medicaid, +78141,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,HEALTHFIRST-Medicaid, +78142,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,HEALTHFIRST-Medicaid, +78143,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,HEALTHFIRST-Medicaid, +78144,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,HEALTHFIRST-Medicaid, +78145,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,HEALTHFIRST-Medicaid, +78146,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,HEALTHFIRST-Medicaid, +78147,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,HEALTHFIRST-Medicaid, +78148,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,HEALTHFIRST-Medicaid, +78149,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,HEALTHFIRST-Medicaid, +78150,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,HEALTHFIRST-Medicaid, +78151,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,HEALTHFIRST-Medicaid, +78152,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,HEALTHFIRST-Medicaid, +78153,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,HEALTHFIRST-Medicaid, +78154,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,HEALTHFIRST-Medicaid, +78155,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,HEALTHFIRST-Medicaid, +78156,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,HEALTHFIRST-Medicaid, +78157,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,HEALTHFIRST-Medicaid, +78158,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,HEALTHFIRST-Medicaid, +78159,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,HEALTHFIRST-Medicaid, +78160,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,HEALTHFIRST-Medicaid, +78161,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,HEALTHFIRST-Medicaid, +78162,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,HEALTHFIRST-Medicaid, +78163,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,HEALTHFIRST-Medicaid, +78164,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,HEALTHFIRST-Medicaid, +78165,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,HEALTHFIRST-Medicaid, +78166,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,HEALTHFIRST-Medicaid, +78167,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,HEALTHFIRST-Medicaid, +78168,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,HEALTHFIRST-Medicaid, +78169,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,HEALTHFIRST-Medicaid, +78170,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,HEALTHFIRST-Medicaid, +78171,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,HEALTHFIRST-Medicaid, +78172,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,HEALTHFIRST-Medicaid, +78173,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,HEALTHFIRST-Medicaid, +78174,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,HEALTHFIRST-Medicaid, +78175,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,HEALTHFIRST-Medicaid, +78176,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,HEALTHFIRST-Medicaid, +78177,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,HEALTHFIRST-Medicaid, +78178,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,HEALTHFIRST-Medicaid, +78179,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,HEALTHFIRST-Medicaid, +78180,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,HEALTHFIRST-Medicaid, +78181,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,HEALTHFIRST-Medicaid, +78182,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,HEALTHFIRST-Medicaid, +78183,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,HEALTHFIRST-Medicaid, +78184,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,HEALTHFIRST-Medicaid, +78185,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,HEALTHFIRST-Medicaid, +78186,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,HEALTHFIRST-Medicaid, +78187,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,HEALTHFIRST-Medicaid, +78188,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,HEALTHFIRST-Medicaid, +78189,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,HEALTHFIRST-Medicaid, +78190,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,HEALTHFIRST-Medicaid, +78191,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,HEALTHFIRST-Medicaid, +78192,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,HEALTHFIRST-Medicaid, +78193,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,HEALTHFIRST-Medicaid, +78194,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,HEALTHFIRST-Medicaid, +78195,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,HEALTHFIRST-Medicaid, +78196,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,HEALTHFIRST-Medicaid, +78197,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,HEALTHFIRST-Medicaid, +78198,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,HEALTHFIRST-Medicaid, +78199,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,HEALTHFIRST-Medicaid, +78200,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,HEALTHFIRST-Medicaid, +78201,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,HEALTHFIRST-Medicaid, +78202,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,HEALTHFIRST-Medicaid, +78203,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,HEALTHFIRST-Medicaid, +78204,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,HEALTHFIRST-Medicaid, +78205,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,HEALTHFIRST-Medicaid, +78206,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,HEALTHFIRST-Medicaid, +78207,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,HEALTHFIRST-Medicaid, +78208,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,HEALTHFIRST-Medicaid, +78209,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,HEALTHFIRST-Medicaid, +78210,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,HEALTHFIRST-Medicaid, +78211,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,HEALTHFIRST-Medicaid, +78212,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,HEALTHFIRST-Medicaid, +78213,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,HEALTHFIRST-Medicaid, +78214,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,HEALTHFIRST-Medicaid, +78215,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,HEALTHFIRST-Medicaid, +78216,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,HEALTHFIRST-Medicaid, +78217,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,HEALTHFIRST-Medicaid, +78218,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,HEALTHFIRST-Medicaid, +78219,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,HEALTHFIRST-Medicaid, +78220,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,HEALTHFIRST-Medicaid, +78221,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,HEALTHFIRST-Medicaid, +78222,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,HEALTHFIRST-Medicaid, +78223,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,HEALTHFIRST-Medicaid, +78224,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,HEALTHFIRST-Medicaid, +78225,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,HEALTHFIRST-Medicaid, +78226,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,HEALTHFIRST-Medicaid, +78227,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,HEALTHFIRST-Medicaid, +78228,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,HEALTHFIRST-Medicaid, +78229,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,HEALTHFIRST-Medicaid, +78230,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,HEALTHFIRST-Medicaid, +78231,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,HEALTHFIRST-Medicaid, +78232,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,HEALTHFIRST-Medicaid, +78233,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,HEALTHFIRST-Medicaid, +78234,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,HEALTHFIRST-Medicaid, +78235,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,HEALTHFIRST-Medicaid, +78236,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,HEALTHFIRST-Medicaid, +78237,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,HEALTHFIRST-Medicaid, +78238,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,HEALTHFIRST-Medicaid, +78239,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,HEALTHFIRST-Medicaid, +78240,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,HEALTHFIRST-Medicaid, +78241,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,HEALTHFIRST-Medicaid, +78242,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,HEALTHFIRST-Medicaid, +78243,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,HEALTHFIRST-Medicaid, +78244,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,HEALTHFIRST-Medicaid, +78245,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,HEALTHFIRST-Medicaid, +78246,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,HEALTHFIRST-Medicaid, +78247,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,HEALTHFIRST-Medicaid, +78248,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,HEALTHFIRST-Medicaid, +78249,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,HEALTHFIRST-Medicaid, +78250,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,HEALTHFIRST-Medicaid, +78251,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,HEALTHFIRST-Medicaid, +78252,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,HEALTHFIRST-Medicaid, +78253,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,HEALTHFIRST-Medicaid, +78254,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,HEALTHFIRST-Medicaid, +78255,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,HEALTHFIRST-Medicaid, +78256,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,HEALTHFIRST-Medicaid, +78257,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,HEALTHFIRST-Medicaid, +78258,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,HEALTHFIRST-Medicaid, +78259,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,HEALTHFIRST-Medicaid, +78260,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,HEALTHFIRST-Medicaid, +78261,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,HEALTHFIRST-Medicaid, +78262,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,HEALTHFIRST-Medicaid, +78263,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,HEALTHFIRST-Medicaid, +78264,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,HEALTHFIRST-Medicaid, +78265,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,HEALTHFIRST-Medicaid, +78266,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,HEALTHFIRST-Medicaid, +78267,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,HEALTHFIRST-Medicaid, +78268,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,HEALTHFIRST-Medicaid, +78269,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,HEALTHFIRST-Medicaid, +78270,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,HEALTHFIRST-Medicaid, +78271,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,HEALTHFIRST-Medicaid, +78272,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,HEALTHFIRST-Medicaid, +78273,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,HEALTHFIRST-Medicaid, +78274,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,HEALTHFIRST-Medicaid, +78275,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,HEALTHFIRST-Medicaid, +78276,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,HEALTHFIRST-Medicaid, +78277,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,HEALTHFIRST-Medicaid, +78278,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,HEALTHFIRST-Medicaid, +78279,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,HEALTHFIRST-Medicaid, +78280,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,HEALTHFIRST-Medicaid, +78281,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,HEALTHFIRST-Medicaid, +78282,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,HEALTHFIRST-Medicaid, +78283,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,HEALTHFIRST-Medicaid, +78284,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,HEALTHFIRST-Medicaid, +78285,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,HEALTHFIRST-Medicaid, +78286,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,HEALTHFIRST-Medicaid, +78287,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,HEALTHFIRST-Medicaid, +78288,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,HEALTHFIRST-Medicaid, +78289,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,HEALTHFIRST-Medicaid, +78290,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,HEALTHFIRST-Medicaid, +78291,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,HEALTHFIRST-Medicaid, +78292,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,HEALTHFIRST-Medicaid, +78293,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,HEALTHFIRST-Medicaid, +78294,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,HEALTHFIRST-Medicaid, +78295,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,HEALTHFIRST-Medicaid, +78296,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,HEALTHFIRST-Medicaid, +78297,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,HEALTHFIRST-Medicaid, +78298,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,HEALTHFIRST-Medicaid, +78299,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,HEALTHFIRST-Medicaid, +78300,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,HEALTHFIRST-Medicaid, +78301,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,HEALTHFIRST-Medicaid, +78302,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,HEALTHFIRST-Medicaid, +78303,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,HEALTHFIRST-Medicaid, +78304,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,HEALTHFIRST-Medicaid, +78305,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,HEALTHFIRST-Medicaid, +78306,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,HEALTHFIRST-Medicaid, +78307,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,HEALTHFIRST-Medicaid, +78308,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,HEALTHFIRST-Medicaid, +78309,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,HEALTHFIRST-Medicaid, +78310,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,HEALTHFIRST-Medicaid, +78311,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,HEALTHFIRST-Medicaid, +78312,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,HEALTHFIRST-Medicaid, +78313,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,HEALTHFIRST-Medicaid, +78314,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,HEALTHFIRST-Medicaid, +78315,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,HEALTHFIRST-Medicaid, +78316,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,HEALTHFIRST-Medicaid, +78317,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,HEALTHFIRST-Medicaid, +78318,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,HEALTHFIRST-Medicaid, +78319,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,HEALTHFIRST-Medicaid, +78320,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,HEALTHFIRST-Medicaid, +78321,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,HEALTHFIRST-Medicaid, +78322,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,HEALTHFIRST-Medicaid, +78323,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,HEALTHFIRST-Medicaid, +78324,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,HEALTHFIRST-Medicaid, +78325,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,HEALTHFIRST-Medicaid, +78326,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,HEALTHFIRST-Medicaid, +78327,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,HEALTHFIRST-Medicaid, +78328,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,HEALTHFIRST-Medicaid, +78329,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,HEALTHFIRST-Medicaid, +78330,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,HEALTHFIRST-Medicaid, +78331,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,HEALTHFIRST-Medicaid, +78332,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,HEALTHFIRST-Medicaid, +78333,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,HEALTHFIRST-Medicaid, +78334,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,HEALTHFIRST-Medicaid, +78335,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,HEALTHFIRST-Medicaid, +78336,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,HEALTHFIRST-Medicaid, +78337,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,HEALTHFIRST-Medicaid, +78338,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,HEALTHFIRST-Medicaid, +78339,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,HEALTHFIRST-Medicaid, +78340,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,HEALTHFIRST-Medicaid, +78341,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,HEALTHFIRST-Medicaid, +78342,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,HEALTHFIRST-Medicaid, +78343,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,HEALTHFIRST-Medicaid, +78344,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,HEALTHFIRST-Medicaid, +78345,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,HEALTHFIRST-Medicaid, +78346,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,HEALTHFIRST-Medicaid, +78347,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,HEALTHFIRST-Medicaid, +78348,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,HEALTHFIRST-Medicaid, +78349,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,HEALTHFIRST-Medicaid, +78350,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,HEALTHFIRST-Medicaid, +78351,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,HEALTHFIRST-Medicaid, +78352,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,HEALTHFIRST-Medicaid, +78353,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,HEALTHFIRST-Medicaid, +78354,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,HEALTHFIRST-Medicaid, +78355,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,HEALTHFIRST-Medicaid, +78356,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,HEALTHFIRST-Medicaid, +78357,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,HEALTHFIRST-Medicaid, +78358,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,HEALTHFIRST-Medicaid, +78359,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,HEALTHFIRST-Medicaid, +78360,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,HEALTHFIRST-Medicaid, +78361,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,HEALTHFIRST-Medicaid, +78362,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,HEALTHFIRST-Medicaid, +78363,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,HEALTHFIRST-Medicaid, +78364,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,HEALTHFIRST-Medicaid, +78365,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,HEALTHFIRST-Medicaid, +78366,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,HEALTHFIRST-Medicaid, +78367,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,HEALTHFIRST-Medicaid, +78368,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,HEALTHFIRST-Medicaid, +78369,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,HEALTHFIRST-Medicaid, +78370,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,HEALTHFIRST-Medicaid, +78371,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,HEALTHFIRST-Medicaid, +78372,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,HEALTHFIRST-Medicaid, +78373,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,HEALTHFIRST-Medicaid, +78374,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,HEALTHFIRST-Medicaid, +78375,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,HEALTHFIRST-Medicaid, +78376,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,HEALTHFIRST-Medicaid, +78377,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,HEALTHFIRST-Medicaid, +78378,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,HEALTHFIRST-Medicaid, +78379,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,HEALTHFIRST-Medicaid, +78380,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,HEALTHFIRST-Medicaid, +78381,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,HEALTHFIRST-Medicaid, +78382,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,HEALTHFIRST-Medicaid, +78383,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,HEALTHFIRST-Medicaid, +78384,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,HEALTHFIRST-Medicaid, +78385,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,HEALTHFIRST-Medicaid, +78386,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,HEALTHFIRST-Medicaid, +78387,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,HEALTHFIRST-Medicaid, +78388,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,HEALTHFIRST-Medicaid, +78389,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,HEALTHFIRST-Medicaid, +78390,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,HEALTHFIRST-Medicaid, +78391,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,HEALTHFIRST-Medicaid, +78392,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,HEALTHFIRST-Medicaid, +78393,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,HEALTHFIRST-Medicaid, +78394,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,HEALTHFIRST-Medicaid, +78395,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,HEALTHFIRST-Medicaid, +78396,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,HEALTHFIRST-Medicaid, +78397,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,HEALTHFIRST-Medicaid, +78398,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,HEALTHFIRST-Medicaid, +78399,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,HEALTHFIRST-Medicaid, +78400,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,HEALTHFIRST-Medicaid, +78401,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,HEALTHFIRST-Medicaid, +78402,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,HEALTHFIRST-Medicaid, +78403,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,HEALTHFIRST-Medicaid, +78404,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,HEALTHFIRST-Medicaid, +78405,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,HEALTHFIRST-Medicaid, +78406,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,HEALTHFIRST-Medicaid, +78407,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,HEALTHFIRST-Medicaid, +78408,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,HEALTHFIRST-Medicaid, +78409,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,HEALTHFIRST-Medicaid, +78410,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,HEALTHFIRST-Medicaid, +78411,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,HEALTHFIRST-Medicaid, +78412,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,HEALTHFIRST-Medicaid, +78413,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,HEALTHFIRST-Medicaid, +78414,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,HEALTHFIRST-Medicaid, +78415,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,HEALTHFIRST-Medicaid, +78416,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,HEALTHFIRST-Medicaid, +78417,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,HEALTHFIRST-Medicaid, +78418,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,HEALTHFIRST-Medicaid, +78419,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,HEALTHFIRST-Medicaid, +78420,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,HEALTHFIRST-Medicaid, +78421,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,HEALTHFIRST-Medicaid, +78422,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,HEALTHFIRST-Medicaid, +78423,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,HEALTHFIRST-Medicaid, +78424,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +78425,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,HEALTHFIRST-Medicaid, +78426,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,HEALTHFIRST-Medicaid, +78427,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,HEALTHFIRST-Medicaid, +78428,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,HEALTHFIRST-Medicaid, +78429,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +78430,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +78431,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,HEALTHFIRST-Medicaid, +78432,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,HEALTHFIRST-Medicaid, +78433,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,HEALTHFIRST-Medicaid, +78434,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,HEALTHFIRST-Medicaid, +78435,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,HEALTHFIRST-Medicaid, +78436,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,HEALTHFIRST-Medicaid, +78437,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,HEALTHFIRST-Medicaid, +78438,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,HEALTHFIRST-Medicaid, +78439,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,HEALTHFIRST-Medicaid, +78440,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,HEALTHFIRST-Medicaid, +78441,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,HEALTHFIRST-Medicaid, +78442,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,HEALTHFIRST-Medicaid, +78443,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,HEALTHFIRST-Medicaid, +78444,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,HEALTHFIRST-Medicaid, +78445,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,HEALTHFIRST-Medicaid, +78446,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,HEALTHFIRST-Medicaid, +78447,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,HEALTHFIRST-Medicaid, +78448,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,HEALTHFIRST-Medicaid, +78449,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,HEALTHFIRST-Medicaid, +78450,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,HEALTHFIRST-Medicaid, +78451,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,HEALTHFIRST-Medicaid, +78452,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,HEALTHFIRST-Medicaid, +78453,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,HEALTHFIRST-Medicaid, +78454,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,HEALTHFIRST-Medicaid, +78455,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,HEALTHFIRST-Medicaid, +78456,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,HEALTHFIRST-Medicaid, +78457,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,HEALTHFIRST-Medicaid, +78458,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,HEALTHFIRST-Medicaid, +78459,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,HEALTHFIRST-Medicaid, +78460,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,HEALTHFIRST-Medicaid, +78461,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,HEALTHFIRST-Medicaid, +78462,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,HEALTHFIRST-Medicaid, +78463,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,HEALTHFIRST-Medicaid, +78464,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,HEALTHFIRST-Medicaid, +78465,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,HEALTHFIRST-Medicaid, +78466,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +78467,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,HEALTHFIRST-Medicaid, +78468,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,HEALTHFIRST-Medicaid, +78469,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,HEALTHFIRST-Medicaid, +78470,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,HEALTHFIRST-Medicaid, +78471,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,HEALTHFIRST-Medicaid, +78472,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,HEALTHFIRST-Medicaid, +78473,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,HEALTHFIRST-Medicaid, +78474,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,HEALTHFIRST-Medicaid, +78475,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,HEALTHFIRST-Medicaid, +78476,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,HEALTHFIRST-Medicaid, +78477,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,HEALTHFIRST-Medicaid, +78478,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,HEALTHFIRST-Medicaid, +78479,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,HEALTHFIRST-Medicaid, +78480,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,HEALTHFIRST-Medicaid, +78481,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,HEALTHFIRST-Medicaid, +78482,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,HEALTHFIRST-Medicaid, +78483,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,HEALTHFIRST-Medicaid, +78484,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,HEALTHFIRST-Medicaid, +78485,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,HEALTHFIRST-Medicaid, +78486,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,HEALTHFIRST-Medicaid, +78487,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,HEALTHFIRST-Medicaid, +78488,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,HEALTHFIRST-Medicaid, +78489,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,HEALTHFIRST-Medicaid, +78490,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,HEALTHFIRST-Medicaid, +78491,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,HEALTHFIRST-Medicaid, +78492,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,HEALTHFIRST-Medicaid, +78493,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,HEALTHFIRST-Medicaid, +78494,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,HEALTHFIRST-Medicaid, +78495,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,HEALTHFIRST-Medicaid, +78496,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,HEALTHFIRST-Medicaid, +78497,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,HEALTHFIRST-Medicaid, +78498,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,HEALTHFIRST-Medicaid, +78499,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,HEALTHFIRST-Medicaid, +78500,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,HEALTHFIRST-Medicaid, +78501,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,HEALTHFIRST-Medicaid, +78502,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,HEALTHFIRST-Medicaid, +78503,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,HEALTHFIRST-Medicaid, +78504,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,HEALTHFIRST-Medicaid, +78505,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,HEALTHFIRST-Medicaid, +78506,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,HEALTHFIRST-Medicaid, +78507,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,HEALTHFIRST-Medicaid, +78508,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,HEALTHFIRST-Medicaid, +78509,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,HEALTHFIRST-Medicaid, +78510,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,HEALTHFIRST-Medicaid, +78511,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,HEALTHFIRST-Medicaid, +78512,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,HEALTHFIRST-Medicaid, +78513,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,HEALTHFIRST-Medicaid, +78514,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,HEALTHFIRST-Medicaid, +78515,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,HEALTHFIRST-Medicaid, +78516,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,HEALTHFIRST-Medicaid, +78517,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,HEALTHFIRST-Medicaid, +78518,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,HEALTHFIRST-Medicaid, +78519,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,HEALTHFIRST-Medicaid, +78520,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,HEALTHFIRST-Medicaid, +78521,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,HEALTHFIRST-Medicaid, +78522,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,HEALTHFIRST-Medicaid, +78523,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,HEALTHFIRST-Medicaid, +78524,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,HEALTHFIRST-Medicaid, +78525,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,HEALTHFIRST-Medicaid, +78526,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,HEALTHFIRST-Medicaid, +78527,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,HEALTHFIRST-Medicaid, +78528,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,HEALTHFIRST-Medicaid, +78529,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,HEALTHFIRST-Medicaid, +78530,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,HEALTHFIRST-Medicaid, +78531,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,HEALTHFIRST-Medicaid, +78532,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,HEALTHFIRST-Medicaid, +78533,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,HEALTHFIRST-Medicaid, +78534,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,HEALTHFIRST-Medicaid, +78535,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,HEALTHFIRST-Medicaid, +78536,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,HEALTHFIRST-Medicaid, +78537,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,HEALTHFIRST-Medicaid, +78538,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,HEALTHFIRST-Medicaid, +78539,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,HEALTHFIRST-Medicaid, +78540,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,HEALTHFIRST-Medicaid, +78541,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHFIRST-Medicaid, +78542,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,HEALTHFIRST-Medicaid, +78543,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,HEALTHFIRST-Medicaid, +78544,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,HEALTHFIRST-Medicaid, +78545,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,HEALTHFIRST-Medicaid, +78546,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,HEALTHFIRST-Medicaid, +78547,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,HEALTHFIRST-Medicaid, +78548,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,HEALTHFIRST-Medicaid, +78549,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,HEALTHFIRST-Medicaid, +78550,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,HEALTHFIRST-Medicaid, +78551,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,HEALTHFIRST-Medicaid, +78552,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,HEALTHFIRST-Medicaid, +78553,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,HEALTHFIRST-Medicaid, +78554,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,HEALTHFIRST-Medicaid, +78555,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,HEALTHFIRST-Medicaid, +78556,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,HEALTHFIRST-Medicaid, +78557,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,HEALTHFIRST-Medicaid, +78558,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,HEALTHFIRST-Medicaid, +78559,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,HEALTHFIRST-Medicaid, +78560,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,HEALTHFIRST-Medicaid, +78561,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,HEALTHFIRST-Medicaid, +78562,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,HEALTHFIRST-Medicaid, +78563,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,HEALTHFIRST-Medicaid, +78564,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,HEALTHFIRST-Medicaid, +78565,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,HEALTHFIRST-Medicaid, +78566,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,HEALTHFIRST-Medicaid, +78567,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,HEALTHFIRST-Medicaid, +78568,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,HEALTHFIRST-Medicaid, +78569,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,HEALTHFIRST-Medicaid, +78570,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,HEALTHFIRST-Medicaid, +78571,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,HEALTHFIRST-Medicaid, +78572,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,HEALTHFIRST-Medicaid, +78573,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,HEALTHFIRST-Medicaid, +78574,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHFIRST-Medicaid, +78575,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,HEALTHFIRST-Medicaid, +78576,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,HEALTHFIRST-Medicaid, +78577,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,HEALTHFIRST-Medicaid, +78578,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,HEALTHFIRST-Medicaid, +78579,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,HEALTHFIRST-Medicaid, +78580,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,HEALTHFIRST-Medicaid, +78581,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,HEALTHFIRST-Medicaid, +78582,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,HEALTHFIRST-Medicaid, +78583,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,HEALTHFIRST-Medicaid, +78584,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,HEALTHFIRST-Medicaid, +78585,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,HEALTHFIRST-Medicaid, +78586,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,HEALTHFIRST-Medicaid, +78587,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,HEALTHFIRST-Medicaid, +78588,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,HEALTHFIRST-Medicaid, +78589,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,HEALTHFIRST-Medicaid, +78590,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,HEALTHFIRST-Medicaid, +78591,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHFIRST-Medicaid, +78592,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,HEALTHFIRST-Medicaid, +78593,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,HEALTHFIRST-Medicaid, +78594,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,HEALTHFIRST-Medicaid, +78595,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,HEALTHFIRST-Medicaid, +78596,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,HEALTHFIRST-Medicaid, +78597,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,HEALTHFIRST-Medicaid, +78598,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,HEALTHFIRST-Medicaid, +78599,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,HEALTHFIRST-Medicaid, +78600,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,HEALTHFIRST-Medicaid, +78601,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,HEALTHFIRST-Medicaid, +78602,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,HEALTHFIRST-Medicaid, +78603,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,HEALTHFIRST-Medicaid, +78604,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,HEALTHFIRST-Medicaid, +78605,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,HEALTHFIRST-Medicaid, +78606,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,HEALTHFIRST-Medicaid, +78607,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,HEALTHFIRST-Medicaid, +78608,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,HEALTHFIRST-Medicaid, +78609,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,HEALTHFIRST-Medicaid, +78610,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,HEALTHFIRST-Medicaid, +78611,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,HEALTHFIRST-Medicaid, +78612,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,HEALTHFIRST-Medicaid, +78613,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,HEALTHFIRST-Medicaid, +78614,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,HEALTHFIRST-Medicaid, +78615,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,HEALTHFIRST-Medicaid, +78616,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,HEALTHFIRST-Medicaid, +78617,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,HEALTHFIRST-Medicaid, +78618,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,HEALTHFIRST-Medicaid, +78619,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,HEALTHFIRST-Medicaid, +78620,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,HEALTHFIRST-Medicaid, +78621,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,HEALTHFIRST-Medicaid, +78622,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,HEALTHFIRST-Medicaid, +78623,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,HEALTHFIRST-Medicaid, +78624,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,HEALTHFIRST-Medicaid, +78625,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,HEALTHFIRST-Medicaid, +78626,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,HEALTHFIRST-Medicaid, +78627,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,HEALTHFIRST-Medicaid, +78628,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,HEALTHFIRST-Medicaid, +78629,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,HEALTHFIRST-Medicaid, +78630,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,HEALTHFIRST-Medicaid, +78631,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,HEALTHFIRST-Medicaid, +78632,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,HEALTHFIRST-Medicaid, +78633,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,HEALTHFIRST-Medicaid, +78634,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,HEALTHFIRST-Medicaid, +78635,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,HEALTHFIRST-Medicaid, +78636,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,HEALTHFIRST-Medicaid, +78637,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,HEALTHFIRST-Medicaid, +78638,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,HEALTHFIRST-Medicaid, +78639,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,HEALTHFIRST-Medicaid, +78640,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,HEALTHFIRST-Medicaid, +78641,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,HEALTHFIRST-Medicaid, +78642,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,HEALTHFIRST-Medicaid, +78643,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,HEALTHFIRST-Medicaid, +78644,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,HEALTHFIRST-Medicaid, +78645,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,HEALTHFIRST-Medicaid, +78646,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,HEALTHFIRST-Medicaid, +78647,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,HEALTHFIRST-Medicaid, +78648,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,HEALTHFIRST-Medicaid, +78649,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,HEALTHFIRST-Medicaid, +78650,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,HEALTHFIRST-Medicaid, +78651,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,HEALTHFIRST-Medicaid, +78652,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,HEALTHFIRST-Medicaid, +78653,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,HEALTHFIRST-Medicaid, +78654,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,HEALTHFIRST-Medicaid, +78655,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,HEALTHFIRST-Medicaid, +78656,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,HEALTHFIRST-Medicaid, +78657,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,HEALTHFIRST-Medicaid, +78658,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,HEALTHFIRST-Medicaid, +78659,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,HEALTHFIRST-Medicaid, +78660,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,HEALTHFIRST-Medicaid, +78661,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,HEALTHFIRST-Medicaid, +78662,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,HEALTHFIRST-Medicaid, +78663,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,HEALTHFIRST-Medicaid, +78664,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,HEALTHFIRST-Medicaid, +78665,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,HEALTHFIRST-Medicaid, +78666,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,HEALTHFIRST-Medicaid, +78667,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,HEALTHFIRST-Medicaid, +78668,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,HEALTHFIRST-Medicaid, +78669,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,HEALTHFIRST-Medicaid, +78670,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,HEALTHFIRST-Medicaid, +78671,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,HEALTHFIRST-Medicaid, +78672,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,HEALTHFIRST-Medicaid, +78673,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,HEALTHFIRST-Medicaid, +78674,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,HEALTHFIRST-Medicaid, +78675,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,HEALTHFIRST-Medicaid, +78676,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,HEALTHFIRST-Medicaid, +78677,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,HEALTHFIRST-Medicaid, +78678,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,HEALTHFIRST-Medicaid, +78679,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,HEALTHFIRST-Medicaid, +78680,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,HEALTHFIRST-Medicaid, +78681,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,HEALTHFIRST-Medicaid, +78682,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,HEALTHFIRST-Medicaid, +78683,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,HEALTHFIRST-Medicaid, +78684,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,HEALTHFIRST-Medicaid, +78685,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,HEALTHFIRST-Medicaid, +78686,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,HEALTHFIRST-Medicaid, +78687,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,HEALTHFIRST-Medicaid, +78688,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,HEALTHFIRST-Medicaid, +78689,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,HEALTHFIRST-Medicaid, +78690,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,HEALTHFIRST-Medicaid, +78691,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,HEALTHFIRST-Medicaid, +78692,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,HEALTHFIRST-Medicaid, +78693,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,HEALTHFIRST-Medicaid, +78694,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,HEALTHFIRST-Medicaid, +78695,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,HEALTHFIRST-Medicaid, +78696,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,HEALTHFIRST-Medicaid, +78697,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,HEALTHFIRST-Medicaid, +78698,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,HEALTHFIRST-Medicaid, +78699,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,HEALTHFIRST-Medicaid, +78700,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,HEALTHFIRST-Medicaid, +78701,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,HEALTHFIRST-Medicaid, +78702,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,HEALTHFIRST-Medicaid, +78703,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,HEALTHFIRST-Medicaid, +78704,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,HEALTHFIRST-Medicaid, +78705,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,HEALTHFIRST-Medicaid, +78706,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,HEALTHFIRST-Medicaid, +78707,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,HEALTHFIRST-Medicaid, +78708,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,HEALTHFIRST-Medicaid, +78709,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,HEALTHFIRST-Medicaid, +78710,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,HEALTHFIRST-Medicaid, +78711,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,HEALTHFIRST-Medicaid, +78712,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,HEALTHFIRST-Medicaid, +78713,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,HEALTHFIRST-Medicaid, +78714,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,HEALTHFIRST-Medicaid, +78715,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,HEALTHFIRST-Medicaid, +78716,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,HEALTHFIRST-Medicaid, +78717,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,HEALTHFIRST-Medicaid, +78718,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,HEALTHFIRST-Medicaid, +78719,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,HEALTHFIRST-Medicaid, +78720,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,HEALTHFIRST-Medicaid, +78721,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,HEALTHFIRST-Medicaid, +78722,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,HEALTHFIRST-Medicaid, +78723,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,HEALTHFIRST-Medicaid, +78724,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,HEALTHFIRST-Medicaid, +78725,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,HEALTHFIRST-Medicaid, +78726,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,HEALTHFIRST-Medicaid, +78727,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,HEALTHFIRST-Medicaid,497.0 +78728,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,HEALTHFIRST-Medicaid,74.81 +78729,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,HEALTHFIRST-Medicaid, +78730,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,HEALTHFIRST-Medicaid, +78731,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,HEALTHFIRST-Medicaid, +78732,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,HEALTHFIRST-Medicaid, +78733,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,HEALTHFIRST-Medicaid, +78734,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,HEALTHFIRST-Medicaid, +78735,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,HEALTHFIRST-Medicaid, +78736,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,HEALTHFIRST-Medicaid, +78737,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,HEALTHFIRST-Medicaid, +78738,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,HEALTHFIRST-Medicaid, +78739,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,HEALTHFIRST-Medicaid, +78740,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,HEALTHFIRST-Medicaid, +78741,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,HEALTHFIRST-Medicaid, +78742,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,HEALTHFIRST-Medicaid, +78743,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,HEALTHFIRST-Medicaid, +78744,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,HEALTHFIRST-Medicaid, +78745,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,HEALTHFIRST-Medicaid, +78746,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,HEALTHFIRST-Medicaid, +78747,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,HEALTHFIRST-Medicaid, +78748,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,HEALTHFIRST-Medicaid, +78749,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,HEALTHFIRST-Medicaid, +78750,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,HEALTHFIRST-Medicaid, +78751,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,HEALTHFIRST-Medicaid, +78752,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,HEALTHFIRST-Medicaid, +78753,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,HEALTHFIRST-Medicaid, +78754,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,HEALTHFIRST-Medicaid, +78755,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,HEALTHFIRST-Medicaid, +78756,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,HEALTHFIRST-Medicaid, +78757,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,HEALTHFIRST-Medicaid, +78758,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,HEALTHFIRST-Medicaid, +78759,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,HEALTHFIRST-Medicaid, +78760,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,HEALTHFIRST-Medicaid, +78761,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,HEALTHFIRST-Medicaid, +78762,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,HEALTHFIRST-Medicaid, +78763,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,HEALTHFIRST-Medicaid, +78764,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,HEALTHFIRST-Medicaid, +78765,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,HEALTHFIRST-Medicaid, +78766,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,HEALTHFIRST-Medicaid, +78767,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,HEALTHFIRST-Medicaid, +78768,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,HEALTHFIRST-Medicaid, +78769,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,HEALTHFIRST-Medicaid, +78770,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,HEALTHFIRST-Medicaid, +78771,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,HEALTHFIRST-Medicaid, +78772,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,HEALTHFIRST-Medicaid, +78773,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,HEALTHFIRST-Medicaid, +78774,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,HEALTHFIRST-Medicaid, +78775,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,HEALTHFIRST-Medicaid, +78776,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,HEALTHFIRST-Medicaid, +78777,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,HEALTHFIRST-Medicaid, +78778,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,HEALTHFIRST-Medicaid, +78779,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,HEALTHFIRST-Medicaid, +78780,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,HEALTHFIRST-Medicaid, +78781,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,HEALTHFIRST-Medicaid, +78782,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,HEALTHFIRST-Medicaid, +78783,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,HEALTHFIRST-Medicaid, +78784,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,HEALTHFIRST-Medicaid, +78785,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,HEALTHFIRST-Medicaid, +78786,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,HEALTHFIRST-Medicaid, +78787,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,HEALTHFIRST-Medicaid, +78788,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,HEALTHFIRST-Medicaid, +78789,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,HEALTHFIRST-Medicaid, +78790,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,HEALTHFIRST-Medicaid, +78791,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,HEALTHFIRST-Medicaid, +78792,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,HEALTHFIRST-Medicaid, +78793,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,HEALTHFIRST-Medicaid,2776.26 +78794,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,HEALTHFIRST-Medicaid, +78795,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,HEALTHFIRST-Medicaid, +78796,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,HEALTHFIRST-Medicaid, +78797,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,HEALTHFIRST-Medicaid, +78798,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,HEALTHFIRST-Medicaid, +78799,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,HEALTHFIRST-Medicaid, +78800,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,HEALTHFIRST-Medicaid, +78801,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,HEALTHFIRST-Medicaid, +78802,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,HEALTHFIRST-Medicaid, +78803,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,HEALTHFIRST-Medicaid, +78804,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,HEALTHFIRST-Medicaid, +78805,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,HEALTHFIRST-Medicaid, +78806,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,HEALTHFIRST-Medicaid, +78807,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,HEALTHFIRST-Medicaid, +78808,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,HEALTHFIRST-Medicaid, +78809,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,HEALTHFIRST-Medicaid, +78810,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,HEALTHFIRST-Medicaid, +78811,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,HEALTHFIRST-Medicaid, +78812,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,HEALTHFIRST-Medicaid, +78813,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,HEALTHFIRST-Medicaid, +78814,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,HEALTHFIRST-Medicaid, +78815,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,HEALTHFIRST-Medicaid, +78816,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,HEALTHFIRST-Medicaid, +78817,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,HEALTHFIRST-Medicaid, +78818,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,HEALTHFIRST-Medicaid, +78819,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,HEALTHFIRST-Medicaid, +78820,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,HEALTHFIRST-Medicaid, +78821,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,HEALTHFIRST-Medicaid, +78822,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,HEALTHFIRST-Medicaid, +78823,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,HEALTHFIRST-Medicaid, +78824,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,HEALTHFIRST-Medicaid, +78825,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,HEALTHFIRST-Medicaid, +78826,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,HEALTHFIRST-Medicaid, +78827,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,HEALTHFIRST-Medicaid, +78828,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,HEALTHFIRST-Medicaid, +78829,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,HEALTHFIRST-Medicaid, +78830,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,HEALTHFIRST-Medicaid, +78831,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,HEALTHFIRST-Medicaid, +78832,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,HEALTHFIRST-Medicaid, +78833,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,HEALTHFIRST-Medicaid, +78834,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,HEALTHFIRST-Medicaid, +78835,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,HEALTHFIRST-Medicaid, +78836,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,HEALTHFIRST-Medicaid, +78837,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,HEALTHFIRST-Medicaid,463.4 +78838,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,HEALTHFIRST-Medicaid, +78839,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,HEALTHFIRST-Medicaid, +78840,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,HEALTHFIRST-Medicaid, +78841,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,HEALTHFIRST-Medicaid, +78842,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,HEALTHFIRST-Medicaid, +78843,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,HEALTHFIRST-Medicaid, +78844,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,HEALTHFIRST-Medicaid, +78845,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,HEALTHFIRST-Medicaid, +78846,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,HEALTHFIRST-Medicaid, +78847,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,HEALTHFIRST-Medicaid, +78848,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,HEALTHFIRST-Medicaid, +78849,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,HEALTHFIRST-Medicaid, +78850,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,HEALTHFIRST-Medicaid, +78851,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,HEALTHFIRST-Medicaid, +78852,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,HEALTHFIRST-Medicaid, +78853,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,HEALTHFIRST-Medicaid, +78854,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,HEALTHFIRST-Medicaid, +78855,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,HEALTHFIRST-Medicaid, +78856,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,HEALTHFIRST-Medicaid, +78857,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,HEALTHFIRST-Medicaid, +78858,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,HEALTHFIRST-Medicaid, +78859,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,HEALTHFIRST-Medicaid, +78860,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,HEALTHFIRST-Medicaid, +78861,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,HEALTHFIRST-Medicaid, +78862,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,HEALTHFIRST-Medicaid, +78863,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,HEALTHFIRST-Medicaid, +78864,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,HEALTHFIRST-Medicaid, +78865,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,HEALTHFIRST-Medicaid, +78866,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,HEALTHFIRST-Medicaid, +78867,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,HEALTHFIRST-Medicaid, +78868,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,HEALTHFIRST-Medicaid, +78869,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,HEALTHFIRST-Medicaid, +78870,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,HEALTHFIRST-Medicaid, +78871,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,HEALTHFIRST-Medicaid, +78872,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,HEALTHFIRST-Medicaid, +78873,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,HEALTHFIRST-Medicaid, +78874,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,HEALTHFIRST-Medicaid, +78875,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,HEALTHFIRST-Medicaid, +78876,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,HEALTHFIRST-Medicaid, +78877,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,HEALTHFIRST-Medicaid, +78878,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,HEALTHFIRST-Medicaid, +78879,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,HEALTHFIRST-Medicaid, +78880,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,HEALTHFIRST-Medicaid, +78881,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,HEALTHFIRST-Medicaid, +78882,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,HEALTHFIRST-Medicaid, +78883,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,HEALTHFIRST-Medicaid, +78884,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,HEALTHFIRST-Medicaid, +78885,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,HEALTHFIRST-Medicaid, +78886,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,HEALTHFIRST-Medicaid, +78887,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,HEALTHFIRST-Medicaid, +78888,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,HEALTHFIRST-Medicaid, +78889,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,HEALTHFIRST-Medicaid, +78890,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,HEALTHFIRST-Medicaid, +78891,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,HEALTHFIRST-Medicaid, +78892,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,HEALTHFIRST-Medicaid, +78893,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,HEALTHFIRST-Medicaid, +78894,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,HEALTHFIRST-Medicaid, +78895,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,HEALTHFIRST-Medicaid, +78896,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,HEALTHFIRST-Medicaid, +78897,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,HEALTHFIRST-Medicaid, +78898,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,HEALTHFIRST-Medicaid, +78899,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,HEALTHFIRST-Medicaid, +78900,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,HEALTHFIRST-Medicaid, +78901,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,HEALTHFIRST-Medicaid, +78902,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,HEALTHFIRST-Medicaid, +78903,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,HEALTHFIRST-Medicaid, +78904,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,HEALTHFIRST-Medicaid, +78905,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,HEALTHFIRST-Medicaid, +78906,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,HEALTHFIRST-Medicaid, +78907,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,HEALTHFIRST-Medicaid, +78908,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,HEALTHFIRST-Medicaid, +78909,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,HEALTHFIRST-Medicaid, +78910,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,HEALTHFIRST-Medicaid, +78911,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,HEALTHFIRST-Medicaid, +78912,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,HEALTHFIRST-Medicaid, +78913,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,HEALTHFIRST-Medicaid, +78914,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,HEALTHFIRST-Medicaid, +78915,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,HEALTHFIRST-Medicaid, +78916,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,HEALTHFIRST-Medicaid, +78917,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,HEALTHFIRST-Medicaid, +78918,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,HEALTHFIRST-Medicaid, +78919,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,HEALTHFIRST-Medicaid, +78920,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,HEALTHFIRST-Medicaid, +78921,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,HEALTHFIRST-Medicaid, +78922,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,HEALTHFIRST-Medicaid, +78923,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,HEALTHFIRST-Medicaid, +78924,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,HEALTHFIRST-Medicaid, +78925,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,HEALTHFIRST-Medicaid, +78926,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,HEALTHFIRST-Medicaid, +78927,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,HEALTHFIRST-Medicaid, +78928,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,HEALTHFIRST-Medicaid, +78929,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,HEALTHFIRST-Medicaid, +78930,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,HEALTHFIRST-Medicaid, +78931,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,HEALTHFIRST-Medicaid, +78932,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHFIRST-Medicaid, +78933,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,HEALTHFIRST-Medicaid, +78934,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,HEALTHFIRST-Medicaid, +78935,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,HEALTHFIRST-Medicaid, +78936,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,HEALTHFIRST-Medicaid, +78937,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,HEALTHFIRST-Medicaid, +78938,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,HEALTHFIRST-Medicaid, +78939,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,HEALTHFIRST-Medicaid, +78940,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,HEALTHFIRST-Medicaid, +78941,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,HEALTHFIRST-Medicaid, +78942,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,HEALTHFIRST-Medicaid, +78943,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,HEALTHFIRST-Medicaid, +78944,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,HEALTHFIRST-Medicaid, +78945,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,HEALTHFIRST-Medicaid, +78946,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,HEALTHFIRST-Medicaid, +78947,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,HEALTHFIRST-Medicaid, +78948,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,HEALTHFIRST-Medicaid, +78949,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,HEALTHFIRST-Medicaid, +78950,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,HEALTHFIRST-Medicaid, +78951,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,HEALTHFIRST-Medicaid, +78952,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,HEALTHFIRST-Medicaid, +78953,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,HEALTHFIRST-Medicaid, +78954,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,HEALTHFIRST-Medicaid, +78955,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,HEALTHFIRST-Medicaid, +78956,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,HEALTHFIRST-Medicaid, +78957,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,HEALTHFIRST-Medicaid, +78958,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,HEALTHFIRST-Medicaid, +78959,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,HEALTHFIRST-Medicaid, +78960,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,HEALTHFIRST-Medicaid, +78961,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,HEALTHFIRST-Medicaid, +78962,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,HEALTHFIRST-Medicaid, +78963,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,HEALTHFIRST-Medicaid, +78964,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,HEALTHFIRST-Medicaid, +78965,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,HEALTHFIRST-Medicaid, +78966,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,HEALTHFIRST-Medicaid, +78967,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,HEALTHFIRST-Medicaid, +78968,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,HEALTHFIRST-Medicaid, +78969,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,HEALTHFIRST-Medicaid, +78970,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,HEALTHFIRST-Medicaid, +78971,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,HEALTHFIRST-Medicaid, +78972,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,HEALTHFIRST-Medicaid, +78973,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHFIRST-Medicaid, +78974,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,HEALTHFIRST-Medicaid, +78975,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,HEALTHFIRST-Medicaid, +78976,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,HEALTHFIRST-Medicaid, +78977,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,HEALTHFIRST-Medicaid, +78978,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,HEALTHFIRST-Medicaid, +78979,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,HEALTHFIRST-Medicaid, +78980,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,HEALTHFIRST-Medicaid, +78981,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,HEALTHFIRST-Medicaid, +78982,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,HEALTHFIRST-Medicaid, +78983,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,HEALTHFIRST-Medicaid, +78984,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,HEALTHFIRST-Medicaid, +78985,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,HEALTHFIRST-Medicaid, +78986,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,HEALTHFIRST-Medicaid, +78987,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,HEALTHFIRST-Medicaid, +78988,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,HEALTHFIRST-Medicaid, +78989,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,HEALTHFIRST-Medicaid, +78990,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,HEALTHFIRST-Medicaid, +78991,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,HEALTHFIRST-Medicaid, +78992,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,HEALTHFIRST-Medicaid, +78993,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,HEALTHFIRST-Medicaid, +78994,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHFIRST-Medicaid, +78995,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,HEALTHFIRST-Medicaid, +78996,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,HEALTHFIRST-Medicaid, +78997,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,HEALTHFIRST-Medicaid, +78998,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,HEALTHFIRST-Medicaid, +78999,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,HEALTHFIRST-Medicaid, +79000,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,HEALTHFIRST-Medicaid, +79001,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,HEALTHFIRST-Medicaid, +79002,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,HEALTHFIRST-Medicaid, +79003,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,HEALTHFIRST-Medicaid, +79004,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,HEALTHFIRST-Medicaid, +79005,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,HEALTHFIRST-Medicaid, +79006,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,HEALTHFIRST-Medicaid, +79007,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,HEALTHFIRST-Medicaid, +79008,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,HEALTHFIRST-Medicaid, +79009,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,HEALTHFIRST-Medicaid, +79010,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,HEALTHFIRST-Medicaid, +79011,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,HEALTHFIRST-Medicaid, +79012,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,HEALTHFIRST-Medicaid, +79013,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,HEALTHFIRST-Medicaid, +79014,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,HEALTHFIRST-Medicaid, +79015,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,HEALTHFIRST-Medicaid, +79016,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,HEALTHFIRST-Medicaid, +79017,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,HEALTHFIRST-Medicaid, +79018,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,HEALTHFIRST-Medicaid, +79019,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,HEALTHFIRST-Medicaid, +79020,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,HEALTHFIRST-Medicaid, +79021,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,HEALTHFIRST-Medicaid, +79022,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,HEALTHFIRST-Medicaid, +79023,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,HEALTHFIRST-Medicaid, +79024,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,HEALTHFIRST-Medicaid, +79025,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,HEALTHFIRST-Medicaid, +79026,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,HEALTHFIRST-Medicaid, +79027,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,HEALTHFIRST-Medicaid, +79028,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,HEALTHFIRST-Medicaid, +79029,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,HEALTHFIRST-Medicaid, +79030,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,HEALTHFIRST-Medicaid, +79031,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,HEALTHFIRST-Medicaid, +79032,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,HEALTHFIRST-Medicaid, +79033,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,HEALTHFIRST-Medicaid, +79034,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,HEALTHFIRST-Medicaid, +79035,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,HEALTHFIRST-Medicaid, +79036,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,HEALTHFIRST-Medicaid, +79037,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,HEALTHFIRST-Medicaid,0.92 +79038,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,HEALTHFIRST-Medicaid, +79039,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,HEALTHFIRST-Medicaid, +79040,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +79041,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,HEALTHFIRST-Medicaid, +79042,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,HEALTHFIRST-Medicaid, +79043,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,HEALTHFIRST-Medicaid, +79044,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,HEALTHFIRST-Medicaid,9.08 +79045,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,HEALTHFIRST-Medicaid, +79046,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,HEALTHFIRST-Medicaid, +79047,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,HEALTHFIRST-Medicaid, +79048,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,HEALTHFIRST-Medicaid, +79049,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,HEALTHFIRST-Medicaid, +79050,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,HEALTHFIRST-Medicaid, +79051,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,HEALTHFIRST-Medicaid, +79052,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,HEALTHFIRST-Medicaid, +79053,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,HEALTHFIRST-Medicaid, +79054,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,HEALTHFIRST-Medicaid, +79055,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,HEALTHFIRST-Medicaid, +79056,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,HEALTHFIRST-Medicaid, +79057,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,HEALTHFIRST-Medicaid, +79058,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,HEALTHFIRST-Medicaid, +79059,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,HEALTHFIRST-Medicaid, +79060,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,HEALTHFIRST-Medicaid, +79061,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,HEALTHFIRST-Medicaid, +79062,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,HEALTHFIRST-Medicaid, +79063,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,HEALTHFIRST-Medicaid, +79064,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,HEALTHFIRST-Medicaid, +79065,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,HEALTHFIRST-Medicaid, +79066,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,HEALTHFIRST-Medicaid, +79067,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,HEALTHFIRST-Medicaid, +79068,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,HEALTHFIRST-Medicaid, +79069,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,HEALTHFIRST-Medicaid, +79070,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,HEALTHFIRST-Medicaid, +79071,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,HEALTHFIRST-Medicaid, +79072,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,HEALTHFIRST-Medicaid, +79073,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,HEALTHFIRST-Medicaid, +79074,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,HEALTHFIRST-Medicaid, +79075,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,HEALTHFIRST-Medicaid, +79076,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,HEALTHFIRST-Medicaid, +79077,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,HEALTHFIRST-Medicaid, +79078,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,HEALTHFIRST-Medicaid, +79079,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,HEALTHFIRST-Medicaid, +79080,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,HEALTHFIRST-Medicaid, +79081,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,HEALTHFIRST-Medicaid, +79082,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,HEALTHFIRST-Medicaid, +79083,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,HEALTHFIRST-Medicaid, +79084,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,HEALTHFIRST-Medicaid, +79085,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,HEALTHFIRST-Medicaid, +79086,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,HEALTHFIRST-Medicaid, +79087,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,HEALTHFIRST-Medicaid, +79088,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,HEALTHFIRST-Medicaid, +79089,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,HEALTHFIRST-Medicaid, +79090,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,HEALTHFIRST-Medicaid, +79091,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,HEALTHFIRST-Medicaid, +79092,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,HEALTHFIRST-Medicaid, +79093,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,HEALTHFIRST-Medicaid, +79094,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +79095,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,HEALTHFIRST-Medicaid, +79096,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,HEALTHFIRST-Medicaid, +79097,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,HEALTHFIRST-Medicaid, +79098,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,HEALTHFIRST-Medicaid, +79099,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHFIRST-Medicaid, +79100,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHFIRST-Medicaid, +79101,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHFIRST-Medicaid, +79102,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHFIRST-Medicaid, +79103,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHFIRST-Medicaid, +79104,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,HEALTHFIRST-Medicaid, +79105,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,HEALTHFIRST-Medicaid, +79106,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,HEALTHFIRST-Medicaid, +79107,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,HEALTHFIRST-Medicaid, +79108,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,HEALTHFIRST-Medicaid, +79109,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,HEALTHFIRST-Medicaid, +79110,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,HEALTHFIRST-Medicaid, +79111,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,HEALTHFIRST-Medicaid, +79112,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,HEALTHFIRST-Medicaid, +79113,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,HEALTHFIRST-Medicaid, +79114,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,HEALTHFIRST-Medicaid, +79115,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,HEALTHFIRST-Medicaid, +79116,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,HEALTHFIRST-Medicaid, +79117,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,HEALTHFIRST-Medicaid, +79118,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,HEALTHFIRST-Medicaid, +79119,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,HEALTHFIRST-Medicaid, +79120,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,HEALTHFIRST-Medicaid, +79121,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,HEALTHFIRST-Medicaid, +79122,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,HEALTHFIRST-Medicaid, +79123,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,HEALTHFIRST-Medicaid, +79124,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,HEALTHFIRST-Medicaid, +79125,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,HEALTHFIRST-Medicaid, +79126,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,HEALTHFIRST-Medicaid, +79127,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,HEALTHFIRST-Medicaid, +79128,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,HEALTHFIRST-Medicaid, +79129,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,HEALTHFIRST-Medicaid, +79130,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,HEALTHFIRST-Medicaid, +79131,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,HEALTHFIRST-Medicaid, +79132,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,HEALTHFIRST-Medicaid, +79133,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,HEALTHFIRST-Medicaid, +79134,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,HEALTHFIRST-Medicaid, +79135,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,HEALTHFIRST-Medicaid, +79136,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,HEALTHFIRST-Medicaid, +79137,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,HEALTHFIRST-Medicaid, +79138,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,HEALTHFIRST-Medicaid, +79139,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,HEALTHFIRST-Medicaid, +79140,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,HEALTHFIRST-Medicaid, +79141,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,HEALTHFIRST-Medicaid, +79142,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,HEALTHFIRST-Medicaid, +79143,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,HEALTHFIRST-Medicaid, +79144,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,HEALTHFIRST-Medicaid, +79145,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,HEALTHFIRST-Medicaid, +79146,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,HEALTHFIRST-Medicaid, +79147,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,HEALTHFIRST-Medicaid, +79148,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,HEALTHFIRST-Medicaid, +79149,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,HEALTHFIRST-Medicaid, +79150,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,HEALTHFIRST-Medicaid, +79151,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,HEALTHFIRST-Medicaid, +79152,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,HEALTHFIRST-Medicaid, +79153,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,HEALTHFIRST-Medicaid, +79154,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,HEALTHFIRST-Medicaid, +79155,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,HEALTHFIRST-Medicaid, +79156,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,HEALTHFIRST-Medicaid, +79157,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,HEALTHFIRST-Medicaid, +79158,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,HEALTHFIRST-Medicaid, +79159,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,HEALTHFIRST-Medicaid, +79160,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,HEALTHFIRST-Medicaid, +79161,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,HEALTHFIRST-Medicaid, +79162,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,HEALTHFIRST-Medicaid, +79163,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,HEALTHFIRST-Medicaid, +79164,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,HEALTHFIRST-Medicaid, +79165,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,HEALTHFIRST-Medicaid, +79166,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,HEALTHFIRST-Medicaid, +79167,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,HEALTHFIRST-Medicaid, +79168,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,HEALTHFIRST-Medicaid, +79169,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,HEALTHFIRST-Medicaid, +79170,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,HEALTHFIRST-Medicaid, +79171,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,HEALTHFIRST-Medicaid, +79172,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,HEALTHFIRST-Medicaid, +79173,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,HEALTHFIRST-Medicaid, +79174,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,HEALTHFIRST-Medicaid, +79175,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,HEALTHFIRST-Medicaid, +79176,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,HEALTHFIRST-Medicaid, +79177,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,HEALTHFIRST-Medicaid, +79178,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,HEALTHFIRST-Medicaid, +79179,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,HEALTHFIRST-Medicaid, +79180,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,HEALTHFIRST-Medicaid, +79181,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,HEALTHFIRST-Medicaid, +79182,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,HEALTHFIRST-Medicaid, +79183,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,HEALTHFIRST-Medicaid, +79184,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,HEALTHFIRST-Medicaid, +79185,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,HEALTHFIRST-Medicaid, +79186,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,HEALTHFIRST-Medicaid, +79187,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,HEALTHFIRST-Medicaid, +79188,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,HEALTHFIRST-Medicaid, +79189,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,HEALTHFIRST-Medicaid, +79190,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,HEALTHFIRST-Medicaid, +79191,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,HEALTHFIRST-Medicaid, +79192,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,HEALTHFIRST-Medicaid, +79193,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,HEALTHFIRST-Medicaid, +79194,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,HEALTHFIRST-Medicaid, +79195,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,HEALTHFIRST-Medicaid, +79196,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,HEALTHFIRST-Medicaid, +79197,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,HEALTHFIRST-Medicaid, +79198,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,HEALTHFIRST-Medicaid, +79199,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,HEALTHFIRST-Medicaid, +79200,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,HEALTHFIRST-Medicaid, +79201,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,HEALTHFIRST-Medicaid, +79202,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,HEALTHFIRST-Medicaid, +79203,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,HEALTHFIRST-Medicaid, +79204,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,HEALTHFIRST-Medicaid, +79205,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,HEALTHFIRST-Medicaid, +79206,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,HEALTHFIRST-Medicaid, +79207,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,HEALTHFIRST-Medicaid, +79208,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,HEALTHFIRST-Medicaid, +79209,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,HEALTHFIRST-Medicaid, +79210,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,HEALTHFIRST-Medicaid, +79211,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,HEALTHFIRST-Medicaid, +79212,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,HEALTHFIRST-Medicaid, +79213,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,HEALTHFIRST-Medicaid, +79214,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,HEALTHFIRST-Medicaid, +79215,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,HEALTHFIRST-Medicaid, +79216,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,HEALTHFIRST-Medicaid, +79217,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,HEALTHFIRST-Medicaid, +79218,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,HEALTHFIRST-Medicaid, +79219,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,HEALTHFIRST-Medicaid, +79220,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,HEALTHFIRST-Medicaid, +79221,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,HEALTHFIRST-Medicaid, +79222,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,HEALTHFIRST-Medicaid, +79223,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,HEALTHFIRST-Medicaid, +79224,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,HEALTHFIRST-Medicaid, +79225,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,HEALTHFIRST-Medicaid, +79226,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,HEALTHFIRST-Medicaid, +79227,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,HEALTHFIRST-Medicaid, +79228,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,HEALTHFIRST-Medicaid, +79229,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,HEALTHFIRST-Medicaid, +79230,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,HEALTHFIRST-Medicaid, +79231,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,HEALTHFIRST-Medicaid, +79232,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,HEALTHFIRST-Medicaid, +79233,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,HEALTHFIRST-Medicaid, +79234,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,HEALTHFIRST-Medicaid, +79235,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,HEALTHFIRST-Medicaid, +79236,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,HEALTHFIRST-Medicaid, +79237,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,HEALTHFIRST-Medicaid, +79238,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,HEALTHFIRST-Medicaid, +79239,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,HEALTHFIRST-Medicaid, +79240,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,HEALTHFIRST-Medicaid, +79241,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,HEALTHFIRST-Medicaid, +79242,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,HEALTHFIRST-Medicaid, +79243,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,HEALTHFIRST-Medicaid, +79244,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,HEALTHFIRST-Medicaid, +79245,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,HEALTHFIRST-Medicaid, +79246,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,HEALTHFIRST-Medicaid, +79247,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,HEALTHFIRST-Medicaid, +79248,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,HEALTHFIRST-Medicaid, +79249,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,HEALTHFIRST-Medicaid, +79250,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,HEALTHFIRST-Medicaid, +79251,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,HEALTHFIRST-Medicaid, +79252,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,HEALTHFIRST-Medicaid, +79253,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,HEALTHFIRST-Medicaid, +79254,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,HEALTHFIRST-Medicaid, +79255,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,HEALTHFIRST-Medicaid, +79256,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,HEALTHFIRST-Medicaid, +79257,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,HEALTHFIRST-Medicaid, +79258,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,HEALTHFIRST-Medicaid, +79259,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,HEALTHFIRST-Medicaid, +79260,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,HEALTHFIRST-Medicaid, +79261,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,HEALTHFIRST-Medicaid, +79262,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,HEALTHFIRST-Medicaid, +79263,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,HEALTHFIRST-Medicaid, +79264,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,HEALTHFIRST-Medicaid, +79265,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,HEALTHFIRST-Medicaid, +79266,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,HEALTHFIRST-Medicaid, +79267,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,HEALTHFIRST-Medicaid, +79268,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,HEALTHFIRST-Medicaid, +79269,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,HEALTHFIRST-Medicaid, +79270,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,HEALTHFIRST-Medicaid, +79271,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,HEALTHFIRST-Medicaid, +79272,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,HEALTHFIRST-Medicaid, +79273,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,HEALTHFIRST-Medicaid, +79274,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,HEALTHFIRST-Medicaid, +79275,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,HEALTHFIRST-Medicaid, +79276,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,HEALTHFIRST-Medicaid, +79277,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,HEALTHFIRST-Medicaid, +79278,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,HEALTHFIRST-Medicaid, +79279,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,HEALTHFIRST-Medicaid, +79280,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,HEALTHFIRST-Medicaid, +79281,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,HEALTHFIRST-Medicaid, +79282,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,HEALTHFIRST-Medicaid, +79283,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,HEALTHFIRST-Medicaid, +79284,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,HEALTHFIRST-Medicaid, +79285,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,HEALTHFIRST-Medicaid, +79286,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,HEALTHFIRST-Medicaid, +79287,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,HEALTHFIRST-Medicaid, +79288,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,HEALTHFIRST-Medicaid, +79289,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,HEALTHFIRST-Medicaid, +79290,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,HEALTHFIRST-Medicaid, +79291,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,HEALTHFIRST-Medicaid, +79292,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,HEALTHFIRST-Medicaid, +79293,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,HEALTHFIRST-Medicaid, +79294,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,HEALTHFIRST-Medicaid, +79295,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,HEALTHFIRST-Medicaid, +79296,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,HEALTHFIRST-Medicaid, +79297,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,HEALTHFIRST-Medicaid, +79298,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,HEALTHFIRST-Medicaid, +79299,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,HEALTHFIRST-Medicaid, +79300,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,HEALTHFIRST-Medicaid, +79301,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,HEALTHFIRST-Medicaid, +79302,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,HEALTHFIRST-Medicaid, +79303,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,HEALTHFIRST-Medicaid, +79304,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,HEALTHFIRST-Medicaid, +79305,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,HEALTHFIRST-Medicaid, +79306,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,HEALTHFIRST-Medicaid, +79307,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,HEALTHFIRST-Medicaid, +79308,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,HEALTHFIRST-Medicaid, +79309,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,HEALTHFIRST-Medicaid, +79310,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,HEALTHFIRST-Medicaid, +79311,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,HEALTHFIRST-Medicaid, +79312,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,HEALTHFIRST-Medicaid, +79313,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,HEALTHFIRST-Medicaid, +79314,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,HEALTHFIRST-Medicaid, +79315,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,HEALTHFIRST-Medicaid, +79316,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,HEALTHFIRST-Medicaid, +79317,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,HEALTHFIRST-Medicaid, +79318,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,HEALTHFIRST-Medicaid, +79319,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,HEALTHFIRST-Medicaid, +79320,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,HEALTHFIRST-Medicaid, +79321,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,HEALTHFIRST-Medicaid, +79322,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,HEALTHFIRST-Medicaid, +79323,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,HEALTHFIRST-Medicaid, +79324,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,HEALTHFIRST-Medicaid, +79325,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,HEALTHFIRST-Medicaid, +79326,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,HEALTHFIRST-Medicaid,10.0 +79327,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,HEALTHFIRST-Medicaid, +79328,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,HEALTHFIRST-Medicaid, +79329,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,HEALTHFIRST-Medicaid, +79330,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,HEALTHFIRST-Medicaid, +79331,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,HEALTHFIRST-Medicaid, +79332,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,HEALTHFIRST-Medicaid, +79333,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,HEALTHFIRST-Medicaid, +79334,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,HEALTHFIRST-Medicaid, +79335,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,HEALTHFIRST-Medicaid, +79336,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,HEALTHFIRST-Medicaid, +79337,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,HEALTHFIRST-Medicaid, +79338,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,HEALTHFIRST-Medicaid, +79339,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,HEALTHFIRST-Medicaid, +79340,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,HEALTHFIRST-Medicaid, +79341,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,HEALTHFIRST-Medicaid, +79342,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,HEALTHFIRST-Medicaid, +79343,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,HEALTHFIRST-Medicaid, +79344,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,HEALTHFIRST-Medicaid, +79345,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,HEALTHFIRST-Medicaid, +79346,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,HEALTHFIRST-Medicaid, +79347,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,HEALTHFIRST-Medicaid, +79348,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,HEALTHFIRST-Medicaid, +79349,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,HEALTHFIRST-Medicaid, +79350,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,HEALTHFIRST-Medicaid, +79351,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,HEALTHFIRST-Medicaid, +79352,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,HEALTHFIRST-Medicaid, +79353,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,HEALTHFIRST-Medicaid, +79354,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,HEALTHFIRST-Medicaid, +79355,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,HEALTHFIRST-Medicaid, +79356,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,HEALTHFIRST-Medicaid, +79357,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,HEALTHFIRST-Medicaid, +79358,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,HEALTHFIRST-Medicaid, +79359,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,HEALTHFIRST-Medicaid, +79360,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,HEALTHFIRST-Medicaid, +79361,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,HEALTHFIRST-Medicaid, +79362,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,HEALTHFIRST-Medicaid, +79363,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,HEALTHFIRST-Medicaid, +79364,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,HEALTHFIRST-Medicaid, +79365,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,HEALTHFIRST-Medicaid, +79366,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,HEALTHFIRST-Medicaid, +79367,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,HEALTHFIRST-Medicaid, +79368,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,HEALTHFIRST-Medicaid, +79369,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,HEALTHFIRST-Medicaid, +79370,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,HEALTHFIRST-Medicaid, +79371,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,HEALTHFIRST-Medicaid, +79372,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,HEALTHFIRST-Medicaid, +79373,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,HEALTHFIRST-Medicaid, +79374,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,HEALTHFIRST-Medicaid, +79375,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,HEALTHFIRST-Medicaid, +79376,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,HEALTHFIRST-Medicaid, +79377,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,HEALTHFIRST-Medicaid, +79378,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,HEALTHFIRST-Medicaid, +79379,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,HEALTHFIRST-Medicaid, +79380,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,HEALTHFIRST-Medicaid, +79381,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,HEALTHFIRST-Medicaid, +79382,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,HEALTHFIRST-Medicaid, +79383,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,HEALTHFIRST-Medicaid, +79384,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,HEALTHFIRST-Medicaid, +79385,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,HEALTHFIRST-Medicaid, +79386,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,HEALTHFIRST-Medicaid, +79387,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,HEALTHFIRST-Medicaid, +79388,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,HEALTHFIRST-Medicaid, +79389,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,HEALTHFIRST-Medicaid, +79390,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,HEALTHFIRST-Medicaid, +79391,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,HEALTHFIRST-Medicaid, +79392,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,HEALTHFIRST-Medicaid, +79393,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,HEALTHFIRST-Medicaid, +79394,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,HEALTHFIRST-Medicaid, +79395,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,HEALTHFIRST-Medicaid, +79396,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,HEALTHFIRST-Medicaid, +79397,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,HEALTHFIRST-Medicaid, +79398,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,HEALTHFIRST-Medicaid, +79399,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,HEALTHFIRST-Medicaid, +79400,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,HEALTHFIRST-Medicaid, +79401,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,HEALTHFIRST-Medicaid, +79402,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,HEALTHFIRST-Medicaid, +79403,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,HEALTHFIRST-Medicaid, +79404,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,HEALTHFIRST-Medicaid, +79405,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,HEALTHFIRST-Medicaid, +79406,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,HEALTHFIRST-Medicaid, +79407,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,HEALTHFIRST-Medicaid, +79408,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,HEALTHFIRST-Medicaid, +79409,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,HEALTHFIRST-Medicaid, +79410,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,HEALTHFIRST-Medicaid, +79411,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,HEALTHFIRST-Medicaid, +79412,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,HEALTHFIRST-Medicaid, +79413,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,HEALTHFIRST-Medicaid, +79414,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,HEALTHFIRST-Medicaid, +79415,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,HEALTHFIRST-Medicaid, +79416,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,HEALTHFIRST-Medicaid, +79417,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,HEALTHFIRST-Medicaid, +79418,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,HEALTHFIRST-Medicaid, +79419,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,HEALTHFIRST-Medicaid, +79420,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,HEALTHFIRST-Medicaid, +79421,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,HEALTHFIRST-Medicaid, +79422,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,HEALTHFIRST-Medicaid, +79423,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,HEALTHFIRST-Medicaid, +79424,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,HEALTHFIRST-Medicaid, +79425,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,HEALTHFIRST-Medicaid, +79426,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,HEALTHFIRST-Medicaid, +79427,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,HEALTHFIRST-Medicaid, +79428,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,HEALTHFIRST-Medicaid, +79429,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,HEALTHFIRST-Medicaid, +79430,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,HEALTHFIRST-Medicaid, +79431,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,HEALTHFIRST-Medicaid, +79432,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,HEALTHFIRST-Medicaid, +79433,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,HEALTHFIRST-Medicaid, +79434,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,HEALTHFIRST-Medicaid, +79435,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,HEALTHFIRST-Medicaid, +79436,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,HEALTHFIRST-Medicaid, +79437,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,HEALTHFIRST-Medicaid, +79438,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,HEALTHFIRST-Medicaid, +79439,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,HEALTHFIRST-Medicaid, +79440,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,HEALTHFIRST-Medicaid, +79441,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,HEALTHFIRST-Medicaid, +79442,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,HEALTHFIRST-Medicaid, +79443,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,HEALTHFIRST-Medicaid, +79444,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,HEALTHFIRST-Medicaid, +79445,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,HEALTHFIRST-Medicaid, +79446,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,HEALTHFIRST-Medicaid, +79447,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,HEALTHFIRST-Medicaid, +79448,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,HEALTHFIRST-Medicaid, +79449,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,HEALTHFIRST-Medicaid, +79450,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,HEALTHFIRST-Medicaid, +79451,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,HEALTHFIRST-Medicaid, +79452,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,HEALTHFIRST-Medicaid, +79453,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,HEALTHFIRST-Medicaid, +79454,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,HEALTHFIRST-Medicaid, +79455,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,HEALTHFIRST-Medicaid, +79456,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,HEALTHFIRST-Medicaid, +79457,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,HEALTHFIRST-Medicaid, +79458,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,HEALTHFIRST-Medicaid, +79459,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,HEALTHFIRST-Medicaid, +79460,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,HEALTHFIRST-Medicaid, +79461,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,HEALTHFIRST-Medicaid, +79462,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,HEALTHFIRST-Medicaid, +79463,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,HEALTHFIRST-Medicaid, +79464,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,HEALTHFIRST-Medicaid, +79465,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,HEALTHFIRST-Medicaid, +79466,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,HEALTHFIRST-Medicaid, +79467,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,HEALTHFIRST-Medicaid, +79468,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,HEALTHFIRST-Medicaid, +79469,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,HEALTHFIRST-Medicaid, +79470,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,HEALTHFIRST-Medicaid, +79471,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,HEALTHFIRST-Medicaid, +79472,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,HEALTHFIRST-Medicaid, +79473,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,HEALTHFIRST-Medicaid, +79474,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,HEALTHFIRST-Medicaid, +79475,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,HEALTHFIRST-Medicaid, +79476,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,HEALTHFIRST-Medicaid, +79477,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,HEALTHFIRST-Medicaid, +79478,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,HEALTHFIRST-Medicaid, +79479,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,HEALTHFIRST-Medicaid, +79480,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,HEALTHFIRST-Medicaid, +79481,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,HEALTHFIRST-Medicaid, +79482,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,HEALTHFIRST-Medicaid, +79483,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,HEALTHFIRST-Medicaid, +79484,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,HEALTHFIRST-Medicaid, +79485,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,HEALTHFIRST-Medicaid, +79486,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,HEALTHFIRST-Medicaid, +79487,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,HEALTHFIRST-Medicaid, +79488,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,HEALTHFIRST-Medicaid, +79489,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,HEALTHFIRST-Medicaid, +79490,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,HEALTHFIRST-Medicaid, +79491,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,HEALTHFIRST-Medicaid, +79492,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,HEALTHFIRST-Medicaid, +79493,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,HEALTHFIRST-Medicaid, +79494,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,HEALTHFIRST-Medicaid, +79495,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,HEALTHFIRST-Medicaid, +79496,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,HEALTHFIRST-Medicaid, +79497,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,HEALTHFIRST-Medicaid, +79498,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,HEALTHFIRST-Medicaid, +79499,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,HEALTHFIRST-Medicaid, +79500,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,HEALTHFIRST-Medicaid, +79501,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,HEALTHFIRST-Medicaid, +79502,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,HEALTHFIRST-Medicaid, +79503,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,HEALTHFIRST-Medicaid, +79504,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,HEALTHFIRST-Medicaid, +79505,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,HEALTHFIRST-Medicaid, +79506,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,HEALTHFIRST-Medicaid, +79507,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,HEALTHFIRST-Medicaid, +79508,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,HEALTHFIRST-Medicaid, +79509,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,HEALTHFIRST-Medicaid, +79510,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,HEALTHFIRST-Medicaid, +79511,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,HEALTHFIRST-Medicaid, +79512,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,HEALTHFIRST-Medicaid, +79513,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,HEALTHFIRST-Medicaid, +79514,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,HEALTHFIRST-Medicaid, +79515,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,HEALTHFIRST-Medicaid, +79516,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,HEALTHFIRST-Medicaid, +79517,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,HEALTHFIRST-Medicaid, +79518,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,HEALTHFIRST-Medicaid, +79519,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,HEALTHFIRST-Medicaid,4.75 +79520,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,HEALTHFIRST-Medicaid, +79521,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,HEALTHFIRST-Medicaid, +79522,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,HEALTHFIRST-Medicaid, +79523,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,HEALTHFIRST-Medicaid, +79524,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,HEALTHFIRST-Medicaid, +79525,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,HEALTHFIRST-Medicaid, +79526,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,HEALTHFIRST-Medicaid, +79527,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,HEALTHFIRST-Medicaid, +79528,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,HEALTHFIRST-Medicaid, +79529,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,HEALTHFIRST-Medicaid, +79530,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,HEALTHFIRST-Medicaid, +79531,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,HEALTHFIRST-Medicaid, +79532,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,HEALTHFIRST-Medicaid, +79533,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,HEALTHFIRST-Medicaid, +79534,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,HEALTHFIRST-Medicaid, +79535,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,HEALTHFIRST-Medicaid, +79536,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,HEALTHFIRST-Medicaid, +79537,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,HEALTHFIRST-Medicaid, +79538,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,HEALTHFIRST-Medicaid, +79539,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,HEALTHFIRST-Medicaid, +79540,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,HEALTHFIRST-Medicaid, +79541,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,HEALTHFIRST-Medicaid, +79542,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,HEALTHFIRST-Medicaid, +79543,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,HEALTHFIRST-Medicaid, +79544,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,HEALTHFIRST-Medicaid, +79545,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,HEALTHFIRST-Medicaid, +79546,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,HEALTHFIRST-Medicaid, +79547,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,HEALTHFIRST-Medicaid, +79548,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,HEALTHFIRST-Medicaid, +79549,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,HEALTHFIRST-Medicaid, +79550,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,HEALTHFIRST-Medicaid, +79551,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,HEALTHFIRST-Medicaid, +79552,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,HEALTHFIRST-Medicaid, +79553,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,HEALTHFIRST-Medicaid, +79554,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,HEALTHFIRST-Medicaid, +79555,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,HEALTHFIRST-Medicaid, +79556,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,HEALTHFIRST-Medicaid, +79557,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,HEALTHFIRST-Medicaid, +79558,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,HEALTHFIRST-Medicaid, +79559,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,HEALTHFIRST-Medicaid, +79560,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,HEALTHFIRST-Medicaid, +79561,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,HEALTHFIRST-Medicaid, +79562,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,HEALTHFIRST-Medicaid, +79563,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,HEALTHFIRST-Medicaid, +79564,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,HEALTHFIRST-Medicaid, +79565,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,HEALTHFIRST-Medicaid, +79566,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,HEALTHFIRST-Medicaid, +79567,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,HEALTHFIRST-Medicaid, +79568,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,HEALTHFIRST-Medicaid, +79569,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,HEALTHFIRST-Medicaid, +79570,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,HEALTHFIRST-Medicaid, +79571,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,HEALTHFIRST-Medicaid, +79572,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,HEALTHFIRST-Medicaid, +79573,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,HEALTHFIRST-Medicaid, +79574,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,HEALTHFIRST-Medicaid, +79575,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,HEALTHFIRST-Medicaid, +79576,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,HEALTHFIRST-Medicaid, +79577,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,HEALTHFIRST-Medicaid, +79578,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,HEALTHFIRST-Medicaid, +79579,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,HEALTHFIRST-Medicaid, +79580,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,HEALTHFIRST-Medicaid, +79581,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,HEALTHFIRST-Medicaid, +79582,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,HEALTHFIRST-Medicaid, +79583,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,HEALTHFIRST-Medicaid, +79584,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,HEALTHFIRST-Medicaid, +79585,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,HEALTHFIRST-Medicaid, +79586,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,HEALTHFIRST-Medicaid, +79587,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,HEALTHFIRST-Medicaid, +79588,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,HEALTHFIRST-Medicaid, +79589,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,HEALTHFIRST-Medicaid, +79590,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,HEALTHFIRST-Medicaid, +79591,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,HEALTHFIRST-Medicaid, +79592,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,HEALTHFIRST-Medicaid, +79593,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,HEALTHFIRST-Medicaid, +79594,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,HEALTHFIRST-Medicaid, +79595,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,HEALTHFIRST-Medicaid, +79596,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,HEALTHFIRST-Medicaid, +79597,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,HEALTHFIRST-Medicaid, +79598,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,HEALTHFIRST-Medicaid, +79599,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,HEALTHFIRST-Medicaid, +79600,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,HEALTHFIRST-Medicaid, +79601,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,HEALTHFIRST-Medicaid, +79602,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,HEALTHFIRST-Medicaid, +79603,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,HEALTHFIRST-Medicaid, +79604,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,HEALTHFIRST-Medicaid, +79605,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,HEALTHFIRST-Medicaid, +79606,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,HEALTHFIRST-Medicaid, +79607,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,HEALTHFIRST-Medicaid, +79608,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,HEALTHFIRST-Medicaid, +79609,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,HEALTHFIRST-Medicaid, +79610,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,HEALTHFIRST-Medicaid, +79611,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,HEALTHFIRST-Medicaid, +79612,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,HEALTHFIRST-Medicaid, +79613,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,HEALTHFIRST-Medicaid, +79614,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,HEALTHFIRST-Medicaid, +79615,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,HEALTHFIRST-Medicaid, +79616,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,HEALTHFIRST-Medicaid, +79617,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,HEALTHFIRST-Medicaid, +79618,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,HEALTHFIRST-Medicaid, +79619,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,HEALTHFIRST-Medicaid, +79620,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,HEALTHFIRST-Medicaid, +79621,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,HEALTHFIRST-Medicaid, +79622,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,HEALTHFIRST-Medicaid, +79623,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,HEALTHFIRST-Medicaid, +79624,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,HEALTHFIRST-Medicaid, +79625,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,HEALTHFIRST-Medicaid, +79626,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,HEALTHFIRST-Medicaid, +79627,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,HEALTHFIRST-Medicaid, +79628,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,HEALTHFIRST-Medicaid, +79629,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,HEALTHFIRST-Medicaid, +79630,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,HEALTHFIRST-Medicaid, +79631,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,HEALTHFIRST-Medicaid, +79632,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,HEALTHFIRST-Medicaid, +79633,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,HEALTHFIRST-Medicaid, +79634,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,HEALTHFIRST-Medicaid, +79635,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,HEALTHFIRST-Medicaid, +79636,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,HEALTHFIRST-Medicaid, +79637,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,HEALTHFIRST-Medicaid, +79638,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,HEALTHFIRST-Medicaid, +79639,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,HEALTHFIRST-Medicaid, +79640,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,HEALTHFIRST-Medicaid, +79641,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,HEALTHFIRST-Medicaid, +79642,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,HEALTHFIRST-Medicaid, +79643,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,HEALTHFIRST-Medicaid, +79644,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,HEALTHFIRST-Medicaid, +79645,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,HEALTHFIRST-Medicaid, +79646,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,HEALTHFIRST-Medicaid, +79647,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,HEALTHFIRST-Medicaid, +79648,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,HEALTHFIRST-Medicaid, +79649,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,HEALTHFIRST-Medicaid, +79650,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,HEALTHFIRST-Medicaid, +79651,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,HEALTHFIRST-Medicaid, +79652,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHFIRST-Medicaid, +79653,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,HEALTHFIRST-Medicaid, +79654,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,HEALTHFIRST-Medicaid, +79655,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,HEALTHFIRST-Medicaid, +79656,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,HEALTHFIRST-Medicaid, +79657,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,HEALTHFIRST-Medicaid, +79658,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,HEALTHFIRST-Medicaid, +79659,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,HEALTHFIRST-Medicaid, +79660,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,HEALTHFIRST-Medicaid, +79661,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,HEALTHFIRST-Medicaid, +79662,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,HEALTHFIRST-Medicaid, +79663,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHFIRST-Medicaid, +79664,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,HEALTHFIRST-Medicaid, +79665,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,HEALTHFIRST-Medicaid, +79666,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,HEALTHFIRST-Medicaid, +79667,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,HEALTHFIRST-Medicaid, +79668,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,HEALTHFIRST-Medicaid, +79669,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,HEALTHFIRST-Medicaid, +79670,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,HEALTHFIRST-Medicaid, +79671,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,HEALTHFIRST-Medicaid, +79672,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,HEALTHFIRST-Medicaid, +79673,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,HEALTHFIRST-Medicaid, +79674,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,HEALTHFIRST-Medicaid, +79675,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,HEALTHFIRST-Medicaid, +79676,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,HEALTHFIRST-Medicaid, +79677,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,HEALTHFIRST-Medicaid, +79678,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,HEALTHFIRST-Medicaid, +79679,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,HEALTHFIRST-Medicaid, +79680,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,HEALTHFIRST-Medicaid, +79681,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,HEALTHFIRST-Medicaid, +79682,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,HEALTHFIRST-Medicaid, +79683,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,HEALTHFIRST-Medicaid, +79684,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,HEALTHFIRST-Medicaid, +79685,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHFIRST-Medicaid, +79686,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,HEALTHFIRST-Medicaid, +79687,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,HEALTHFIRST-Medicaid, +79688,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,HEALTHFIRST-Medicaid, +79689,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,HEALTHFIRST-Medicaid, +79690,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,HEALTHFIRST-Medicaid, +79691,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,HEALTHFIRST-Medicaid, +79692,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,HEALTHFIRST-Medicaid, +79693,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,HEALTHFIRST-Medicaid, +79694,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,HEALTHFIRST-Medicaid, +79695,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,HEALTHFIRST-Medicaid, +79696,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,HEALTHFIRST-Medicaid, +79697,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,HEALTHFIRST-Medicaid, +79698,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,HEALTHFIRST-Medicaid, +79699,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,HEALTHFIRST-Medicaid, +79700,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,HEALTHFIRST-Medicaid, +79701,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,HEALTHFIRST-Medicaid,38.57 +79702,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,HEALTHFIRST-Medicaid, +79703,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,HEALTHFIRST-Medicaid, +79704,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,HEALTHFIRST-Medicaid, +79705,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,HEALTHFIRST-Medicaid, +79706,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,HEALTHFIRST-Medicaid, +79707,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,HEALTHFIRST-Medicaid, +79708,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,HEALTHFIRST-Medicaid, +79709,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,HEALTHFIRST-Medicaid, +79710,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,HEALTHFIRST-Medicaid, +79711,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,HEALTHFIRST-Medicaid, +79712,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,HEALTHFIRST-Medicaid, +79713,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,HEALTHFIRST-Medicaid, +79714,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,HEALTHFIRST-Medicaid, +79715,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,HEALTHFIRST-Medicaid, +79716,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,HEALTHFIRST-Medicaid, +79717,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,HEALTHFIRST-Medicaid, +79718,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,HEALTHFIRST-Medicaid, +79719,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,HEALTHFIRST-Medicaid, +79720,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,HEALTHFIRST-Medicaid, +79721,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,HEALTHFIRST-Medicaid, +79722,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,HEALTHFIRST-Medicaid, +79723,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,HEALTHFIRST-Medicaid, +79724,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,HEALTHFIRST-Medicaid, +79725,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,HEALTHFIRST-Medicaid, +79726,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,HEALTHFIRST-Medicaid, +79727,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,HEALTHFIRST-Medicaid, +79728,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,HEALTHFIRST-Medicaid, +79729,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,HEALTHFIRST-Medicaid, +79730,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,HEALTHFIRST-Medicaid, +79731,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,HEALTHFIRST-Medicaid, +79732,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,HEALTHFIRST-Medicaid, +79733,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,HEALTHFIRST-Medicaid, +79734,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,HEALTHFIRST-Medicaid, +79735,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,HEALTHFIRST-Medicaid, +79736,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,HEALTHFIRST-Medicaid, +79737,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,HEALTHFIRST-Medicaid, +79738,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,HEALTHFIRST-Medicaid, +79739,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,HEALTHFIRST-Medicaid, +79740,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,HEALTHFIRST-Medicaid, +79741,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,HEALTHFIRST-Medicaid, +79742,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,HEALTHFIRST-Medicaid, +79743,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,HEALTHFIRST-Medicaid, +79744,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,HEALTHFIRST-Medicaid, +79745,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,HEALTHFIRST-Medicaid, +79746,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,HEALTHFIRST-Medicaid, +79747,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,HEALTHFIRST-Medicaid, +79748,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,HEALTHFIRST-Medicaid, +79749,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,HEALTHFIRST-Medicaid, +79750,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,HEALTHFIRST-Medicaid, +79751,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,HEALTHFIRST-Medicaid, +79752,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,HEALTHFIRST-Medicaid, +79753,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,HEALTHFIRST-Medicaid, +79754,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,HEALTHFIRST-Medicaid, +79755,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,HEALTHFIRST-Medicaid, +79756,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,HEALTHFIRST-Medicaid, +79757,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,HEALTHFIRST-Medicaid, +79758,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,HEALTHFIRST-Medicaid, +79759,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,HEALTHFIRST-Medicaid, +79760,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,HEALTHFIRST-Medicaid, +79761,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,HEALTHFIRST-Medicaid, +79762,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,HEALTHFIRST-Medicaid, +79763,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,HEALTHFIRST-Medicaid, +79764,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,HEALTHFIRST-Medicaid, +79765,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,HEALTHFIRST-Medicaid, +79766,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,HEALTHFIRST-Medicaid, +79767,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,HEALTHFIRST-Medicaid, +79768,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,HEALTHFIRST-Medicaid, +79769,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,HEALTHFIRST-Medicaid, +79770,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,HEALTHFIRST-Medicaid, +79771,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,HEALTHFIRST-Medicaid, +79772,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,HEALTHFIRST-Medicaid, +79773,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,HEALTHFIRST-Medicaid, +79774,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,HEALTHFIRST-Medicaid, +79775,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,HEALTHFIRST-Medicaid, +79776,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,HEALTHFIRST-Medicaid, +79777,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,HEALTHFIRST-Medicaid, +79778,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,HEALTHFIRST-Medicaid, +79779,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,HEALTHFIRST-Medicaid, +79780,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,HEALTHFIRST-Medicaid, +79781,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,HEALTHFIRST-Medicaid, +79782,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,HEALTHFIRST-Medicaid, +79783,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,HEALTHFIRST-Medicaid, +79784,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,HEALTHFIRST-Medicaid, +79785,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,HEALTHFIRST-Medicaid, +79786,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,HEALTHFIRST-Medicaid, +79787,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +79788,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +79789,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +79790,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,HEALTHFIRST-Medicaid, +79791,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,HEALTHFIRST-Medicaid, +79792,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,HEALTHFIRST-Medicaid, +79793,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,HEALTHFIRST-Medicaid, +79794,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,HEALTHFIRST-Medicaid, +79795,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,HEALTHFIRST-Medicaid, +79796,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,HEALTHFIRST-Medicaid, +79797,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,HEALTHFIRST-Medicaid, +79798,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,HEALTHFIRST-Medicaid, +79799,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,HEALTHFIRST-Medicaid, +79800,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,HEALTHFIRST-Medicaid, +79801,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,HEALTHFIRST-Medicaid, +79802,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,HEALTHFIRST-Medicaid, +79803,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,HEALTHFIRST-Medicaid, +79804,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,HEALTHFIRST-Medicaid, +79805,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,HEALTHFIRST-Medicaid, +79806,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,HEALTHFIRST-Medicaid, +79807,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,HEALTHFIRST-Medicaid, +79808,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,HEALTHFIRST-Medicaid, +79809,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,HEALTHFIRST-Medicaid, +79810,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,HEALTHFIRST-Medicaid, +79811,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,HEALTHFIRST-Medicaid, +79812,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,HEALTHFIRST-Medicaid, +79813,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,HEALTHFIRST-Medicaid, +79814,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,HEALTHFIRST-Medicaid, +79815,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,HEALTHFIRST-Medicaid, +79816,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,HEALTHFIRST-Medicaid, +79817,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,HEALTHFIRST-Medicaid, +79818,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,HEALTHFIRST-Medicaid, +79819,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,HEALTHFIRST-Medicaid, +79820,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,HEALTHFIRST-Medicaid, +79821,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,HEALTHFIRST-Medicaid, +79822,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,HEALTHFIRST-Medicaid, +79823,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,HEALTHFIRST-Medicaid, +79824,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,HEALTHFIRST-Medicaid, +79825,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,HEALTHFIRST-Medicaid, +79826,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,HEALTHFIRST-Medicaid, +79827,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,HEALTHFIRST-Medicaid, +79828,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,HEALTHFIRST-Medicaid, +79829,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,HEALTHFIRST-Medicaid, +79830,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,HEALTHFIRST-Medicaid, +79831,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,HEALTHFIRST-Medicaid, +79832,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,HEALTHFIRST-Medicaid, +79833,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,HEALTHFIRST-Medicaid, +79834,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,HEALTHFIRST-Medicaid, +79835,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,HEALTHFIRST-Medicaid, +79836,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,HEALTHFIRST-Medicaid, +79837,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,HEALTHFIRST-Medicaid, +79838,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,HEALTHFIRST-Medicaid, +79839,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,HEALTHFIRST-Medicaid, +79840,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,HEALTHFIRST-Medicaid, +79841,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,HEALTHFIRST-Medicaid, +79842,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,HEALTHFIRST-Medicaid, +79843,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,HEALTHFIRST-Medicaid, +79844,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,HEALTHFIRST-Medicaid, +79845,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,HEALTHFIRST-Medicaid, +79846,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,HEALTHFIRST-Medicaid, +79847,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,HEALTHFIRST-Medicaid, +79848,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,HEALTHFIRST-Medicaid, +79849,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,HEALTHFIRST-Medicaid, +79850,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,HEALTHFIRST-Medicaid, +79851,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,HEALTHFIRST-Medicaid, +79852,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,HEALTHFIRST-Medicaid, +79853,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,HEALTHFIRST-Medicaid, +79854,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,HEALTHFIRST-Medicaid, +79855,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,HEALTHFIRST-Medicaid, +79856,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,HEALTHFIRST-Medicaid, +79857,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,HEALTHFIRST-Medicaid, +79858,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,HEALTHFIRST-Medicaid, +79859,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,HEALTHFIRST-Medicaid, +79860,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,HEALTHFIRST-Medicaid, +79861,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,HEALTHFIRST-Medicaid, +79862,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,HEALTHFIRST-Medicaid, +79863,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,HEALTHFIRST-Medicaid, +79864,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,HEALTHFIRST-Medicaid, +79865,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,HEALTHFIRST-Medicaid, +79866,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,HEALTHFIRST-Medicaid, +79867,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,HEALTHFIRST-Medicaid, +79868,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,HEALTHFIRST-Medicaid, +79869,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,HEALTHFIRST-Medicaid, +79870,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,HEALTHFIRST-Medicaid, +79871,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,HEALTHFIRST-Medicaid, +79872,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,HEALTHFIRST-Medicaid, +79873,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,HEALTHFIRST-Medicaid, +79874,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,HEALTHFIRST-Medicaid, +79875,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,HEALTHFIRST-Medicaid, +79876,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,HEALTHFIRST-Medicaid, +79877,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,HEALTHFIRST-Medicaid, +79878,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,HEALTHFIRST-Medicaid, +79879,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,HEALTHFIRST-Medicaid, +79880,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,HEALTHFIRST-Medicaid, +79881,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,HEALTHFIRST-Medicaid, +79882,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,HEALTHFIRST-Medicaid, +79883,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,HEALTHFIRST-Medicaid, +79884,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,HEALTHFIRST-Medicaid, +79885,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,HEALTHFIRST-Medicaid, +79886,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +79887,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,HEALTHFIRST-Medicaid, +79888,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,HEALTHFIRST-Medicaid, +79889,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,HEALTHFIRST-Medicaid, +79890,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,HEALTHFIRST-Medicaid, +79891,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,HEALTHFIRST-Medicaid, +79892,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,HEALTHFIRST-Medicaid, +79893,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,HEALTHFIRST-Medicaid, +79894,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,HEALTHFIRST-Medicaid, +79895,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,HEALTHFIRST-Medicaid, +79896,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,HEALTHFIRST-Medicaid, +79897,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,HEALTHFIRST-Medicaid, +79898,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,HEALTHFIRST-Medicaid, +79899,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,HEALTHFIRST-Medicaid, +79900,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,HEALTHFIRST-Medicaid, +79901,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,HEALTHFIRST-Medicaid, +79902,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,HEALTHFIRST-Medicaid, +79903,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,HEALTHFIRST-Medicaid, +79904,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,HEALTHFIRST-Medicaid, +79905,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,HEALTHFIRST-Medicaid, +79906,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,HEALTHFIRST-Medicaid, +79907,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,HEALTHFIRST-Medicaid, +79908,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,HEALTHFIRST-Medicaid, +79909,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,HEALTHFIRST-Medicaid, +79910,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,HEALTHFIRST-Medicaid, +79911,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,HEALTHFIRST-Medicaid, +79912,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,HEALTHFIRST-Medicaid, +79913,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,HEALTHFIRST-Medicaid, +79914,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,HEALTHFIRST-Medicaid, +79915,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,HEALTHFIRST-Medicaid, +79916,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,HEALTHFIRST-Medicaid, +79917,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,HEALTHFIRST-Medicaid, +79918,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,HEALTHFIRST-Medicaid, +79919,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,HEALTHFIRST-Medicaid, +79920,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,HEALTHFIRST-Medicaid, +79921,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,HEALTHFIRST-Medicaid, +79922,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,HEALTHFIRST-Medicaid, +79923,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,HEALTHFIRST-Medicaid, +79924,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,HEALTHFIRST-Medicaid, +79925,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,HEALTHFIRST-Medicaid, +79926,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,HEALTHFIRST-Medicaid, +79927,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,HEALTHFIRST-Medicaid, +79928,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,HEALTHFIRST-Medicaid, +79929,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,HEALTHFIRST-Medicaid, +79930,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,HEALTHFIRST-Medicaid, +79931,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,HEALTHFIRST-Medicaid, +79932,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,HEALTHFIRST-Medicaid, +79933,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,HEALTHFIRST-Medicaid, +79934,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,HEALTHFIRST-Medicaid, +79935,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,HEALTHFIRST-Medicaid, +79936,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,HEALTHFIRST-Medicaid, +79937,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,HEALTHFIRST-Medicaid, +79938,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,HEALTHFIRST-Medicaid, +79939,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,HEALTHFIRST-Medicaid, +79940,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,HEALTHFIRST-Medicaid, +79941,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,HEALTHFIRST-Medicaid, +79942,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,HEALTHFIRST-Medicaid, +79943,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,HEALTHFIRST-Medicaid, +79944,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,HEALTHFIRST-Medicaid, +79945,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,HEALTHFIRST-Medicaid, +79946,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,HEALTHFIRST-Medicaid, +79947,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,HEALTHFIRST-Medicaid, +79948,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,HEALTHFIRST-Medicaid, +79949,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,HEALTHFIRST-Medicaid, +79950,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,HEALTHFIRST-Medicaid, +79951,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,HEALTHFIRST-Medicaid, +79952,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,HEALTHFIRST-Medicaid, +79953,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,HEALTHFIRST-Medicaid, +79954,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,HEALTHFIRST-Medicaid, +79955,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,HEALTHFIRST-Medicaid, +79956,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,HEALTHFIRST-Medicaid, +79957,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,HEALTHFIRST-Medicaid, +79958,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,HEALTHFIRST-Medicaid, +79959,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,HEALTHFIRST-Medicaid, +79960,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,HEALTHFIRST-Medicaid, +79961,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,HEALTHFIRST-Medicaid, +79962,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,HEALTHFIRST-Medicaid, +79963,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,HEALTHFIRST-Medicaid, +79964,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,HEALTHFIRST-Medicaid, +79965,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,HEALTHFIRST-Medicaid, +79966,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,HEALTHFIRST-Medicaid, +79967,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,HEALTHFIRST-Medicaid, +79968,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,HEALTHFIRST-Medicaid, +79969,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,HEALTHFIRST-Medicaid, +79970,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,HEALTHFIRST-Medicaid, +79971,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,HEALTHFIRST-Medicaid, +79972,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,HEALTHFIRST-Medicaid, +79973,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,HEALTHFIRST-Medicaid, +79974,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,HEALTHFIRST-Medicaid, +79975,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,HEALTHFIRST-Medicaid, +79976,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,HEALTHFIRST-Medicaid, +79977,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,HEALTHFIRST-Medicaid, +79978,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,HEALTHFIRST-Medicaid, +79979,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,HEALTHFIRST-Medicaid, +79980,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,HEALTHFIRST-Medicaid, +79981,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,HEALTHFIRST-Medicaid, +79982,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,HEALTHFIRST-Medicaid, +79983,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,HEALTHFIRST-Medicaid, +79984,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,HEALTHFIRST-Medicaid, +79985,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,HEALTHFIRST-Medicaid, +79986,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,HEALTHFIRST-Medicaid, +79987,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,HEALTHFIRST-Medicaid, +79988,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,HEALTHFIRST-Medicaid, +79989,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,HEALTHFIRST-Medicaid, +79990,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,HEALTHFIRST-Medicaid, +79991,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,HEALTHFIRST-Medicaid, +79992,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,HEALTHFIRST-Medicaid, +79993,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,HEALTHFIRST-Medicaid, +79994,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,HEALTHFIRST-Medicaid, +79995,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,HEALTHFIRST-Medicaid, +79996,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,HEALTHFIRST-Medicaid, +79997,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,HEALTHFIRST-Medicaid, +79998,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHFIRST-Medicaid, +79999,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHFIRST-Medicaid, +80000,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,HEALTHFIRST-Medicaid, +80001,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,HEALTHFIRST-Medicaid, +80002,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,HEALTHFIRST-Medicaid, +80003,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,HEALTHFIRST-Medicaid, +80004,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,HEALTHFIRST-Medicaid, +80005,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,HEALTHFIRST-Medicaid, +80006,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,HEALTHFIRST-Medicaid, +80007,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,HEALTHFIRST-Medicaid, +80008,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,HEALTHFIRST-Medicaid, +80009,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,HEALTHFIRST-Medicaid, +80010,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,HEALTHFIRST-Medicaid, +80011,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,HEALTHFIRST-Medicaid, +80012,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,HEALTHFIRST-Medicaid, +80013,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,HEALTHFIRST-Medicaid, +80014,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,HEALTHFIRST-Medicaid, +80015,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,HEALTHFIRST-Medicaid, +80016,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,HEALTHFIRST-Medicaid, +80017,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,HEALTHFIRST-Medicaid, +80018,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,HEALTHFIRST-Medicaid, +80019,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,HEALTHFIRST-Medicaid, +80020,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,HEALTHFIRST-Medicaid, +80021,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,HEALTHFIRST-Medicaid, +80022,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,HEALTHFIRST-Medicaid, +80023,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,HEALTHFIRST-Medicaid, +80024,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,HEALTHFIRST-Medicaid, +80025,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,HEALTHFIRST-Medicaid, +80026,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,HEALTHFIRST-Medicaid, +80027,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,HEALTHFIRST-Medicaid, +80028,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,HEALTHFIRST-Medicaid,224.78 +80029,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,HEALTHFIRST-Medicaid, +80030,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,HEALTHFIRST-Medicaid,71.75 +80031,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,HEALTHFIRST-Medicaid, +80032,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,HEALTHFIRST-Medicaid, +80033,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,HEALTHFIRST-Medicaid, +80034,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,HEALTHFIRST-Medicaid,136.47 +80035,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,HEALTHFIRST-Medicaid, +80036,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,HEALTHFIRST-Medicaid, +80037,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,HEALTHFIRST-Medicaid, +80038,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,HEALTHFIRST-Medicaid, +80039,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,HEALTHFIRST-Medicaid, +80040,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,HEALTHFIRST-Medicaid, +80041,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,HEALTHFIRST-Medicaid, +80042,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,HEALTHFIRST-Medicaid, +80043,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,HEALTHFIRST-Medicaid, +80044,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,HEALTHFIRST-Medicaid, +80045,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,HEALTHFIRST-Medicaid, +80046,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,HEALTHFIRST-Medicaid, +80047,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,HEALTHFIRST-Medicaid, +80048,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,HEALTHFIRST-Medicaid, +80049,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,HEALTHFIRST-Medicaid, +80050,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,HEALTHFIRST-Medicaid, +80051,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,HEALTHFIRST-Medicaid, +80052,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,HEALTHFIRST-Medicaid, +80053,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,HEALTHFIRST-Medicaid, +80054,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,HEALTHFIRST-Medicaid, +80055,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,HEALTHFIRST-Medicaid, +80056,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,HEALTHFIRST-Medicaid, +80057,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,HEALTHFIRST-Medicaid, +80058,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,HEALTHFIRST-Medicaid, +80059,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,HEALTHFIRST-Medicaid, +80060,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,HEALTHFIRST-Medicaid, +80061,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,HEALTHFIRST-Medicaid, +80062,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,HEALTHFIRST-Medicaid, +80063,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,HEALTHFIRST-Medicaid, +80064,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,HEALTHFIRST-Medicaid, +80065,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,HEALTHFIRST-Medicaid, +80066,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,HEALTHFIRST-Medicaid,98.83 +80067,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,HEALTHFIRST-Medicaid, +80068,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,HEALTHFIRST-Medicaid, +80069,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,HEALTHFIRST-Medicaid, +80070,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,HEALTHFIRST-Medicaid, +80071,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,HEALTHFIRST-Medicaid, +80072,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,HEALTHFIRST-Medicaid, +80073,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,HEALTHFIRST-Medicaid, +80074,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,HEALTHFIRST-Medicaid, +80075,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,HEALTHFIRST-Medicaid, +80076,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,HEALTHFIRST-Medicaid, +80077,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,HEALTHFIRST-Medicaid, +80078,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,HEALTHFIRST-Medicaid, +80079,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,HEALTHFIRST-Medicaid, +80080,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,HEALTHFIRST-Medicaid, +80081,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,HEALTHFIRST-Medicaid, +80082,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,HEALTHFIRST-Medicaid, +80083,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,HEALTHFIRST-Medicaid, +80084,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,HEALTHFIRST-Medicaid, +80085,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,HEALTHFIRST-Medicaid, +80086,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,HEALTHFIRST-Medicaid, +80087,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,HEALTHFIRST-Medicaid, +80088,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,HEALTHFIRST-Medicaid, +80089,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,HEALTHFIRST-Medicaid, +80090,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,HEALTHFIRST-Medicaid, +80091,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,HEALTHFIRST-Medicaid, +80092,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,HEALTHFIRST-Medicaid, +80093,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,HEALTHFIRST-Medicaid, +80094,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,HEALTHFIRST-Medicaid, +80095,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,HEALTHFIRST-Medicaid, +80096,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,HEALTHFIRST-Medicaid, +80097,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,HEALTHFIRST-Medicaid, +80098,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,HEALTHFIRST-Medicaid, +80099,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,HEALTHFIRST-Medicaid, +80100,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,HEALTHFIRST-Medicaid, +80101,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,HEALTHFIRST-Medicaid, +80102,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,HEALTHFIRST-Medicaid, +80103,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,HEALTHFIRST-Medicaid, +80104,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,HEALTHFIRST-Medicaid, +80105,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,HEALTHFIRST-Medicaid, +80106,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,HEALTHFIRST-Medicaid, +80107,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,HEALTHFIRST-Medicaid,267.78 +80108,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,HEALTHFIRST-Medicaid,261.38 +80109,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,HEALTHFIRST-Medicaid,2866.26 +80110,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,HEALTHFIRST-Medicaid, +80111,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,HEALTHFIRST-Medicaid, +80112,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,HEALTHFIRST-Medicaid, +80113,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,HEALTHFIRST-Medicaid, +80114,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,HEALTHFIRST-Medicaid, +80115,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,HEALTHFIRST-Medicaid, +80116,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,HEALTHFIRST-Medicaid, +80117,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,HEALTHFIRST-Medicaid, +80118,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,HEALTHFIRST-Medicaid, +80119,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,HEALTHFIRST-Medicaid, +80120,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,HEALTHFIRST-Medicaid, +80121,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,HEALTHFIRST-Medicaid, +80122,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,HEALTHFIRST-Medicaid, +80123,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,HEALTHFIRST-Medicaid, +80124,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,HEALTHFIRST-Medicaid, +80125,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,HEALTHFIRST-Medicaid, +80126,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,HEALTHFIRST-Medicaid, +80127,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,HEALTHFIRST-Medicaid, +80128,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,HEALTHFIRST-Medicaid, +80129,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,HEALTHFIRST-Medicaid, +80130,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,HEALTHFIRST-Medicaid, +80131,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,HEALTHFIRST-Medicaid, +80132,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,HEALTHFIRST-Medicaid, +80133,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,HEALTHFIRST-Medicaid, +80134,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,HEALTHFIRST-Medicaid, +80135,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,HEALTHFIRST-Medicaid, +80136,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,HEALTHFIRST-Medicaid, +80137,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,HEALTHFIRST-Medicaid, +80138,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,HEALTHFIRST-Medicaid, +80139,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,HEALTHFIRST-Medicaid, +80140,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,HEALTHFIRST-Medicaid, +80141,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,HEALTHFIRST-Medicaid, +80142,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,HEALTHFIRST-Medicaid, +80143,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,HEALTHFIRST-Medicaid, +80144,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,HEALTHFIRST-Medicaid, +80145,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,HEALTHFIRST-Medicaid, +80146,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,HEALTHFIRST-Medicaid, +80147,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,HEALTHFIRST-Medicaid, +80148,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,HEALTHFIRST-Medicaid, +80149,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,HEALTHFIRST-Medicaid, +80150,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,HEALTHFIRST-Medicaid, +80151,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,HEALTHFIRST-Medicaid, +80152,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,HEALTHFIRST-Medicaid, +80153,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,HEALTHFIRST-Medicaid, +80154,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,HEALTHFIRST-Medicaid, +80155,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,HEALTHFIRST-Medicaid, +80156,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,HEALTHFIRST-Medicaid, +80157,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,HEALTHFIRST-Medicaid, +80158,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,HEALTHFIRST-Medicaid, +80159,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,HEALTHFIRST-Medicaid, +80160,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,HEALTHFIRST-Medicaid, +80161,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,HEALTHFIRST-Medicaid, +80162,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,HEALTHFIRST-Medicaid, +80163,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,HEALTHFIRST-Medicaid, +80164,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,HEALTHFIRST-Medicaid, +80165,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,HEALTHFIRST-Medicaid, +80166,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,HEALTHFIRST-Medicaid, +80167,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,HEALTHFIRST-Medicaid, +80168,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,HEALTHFIRST-Medicaid, +80169,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,HEALTHFIRST-Medicaid, +80170,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,HEALTHFIRST-Medicaid, +80171,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,HEALTHFIRST-Medicaid, +80172,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,HEALTHFIRST-Medicaid, +80173,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,HEALTHFIRST-Medicaid, +80174,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,HEALTHFIRST-Medicaid, +80175,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,HEALTHFIRST-Medicaid, +80176,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,HEALTHFIRST-Medicaid, +80177,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,HEALTHFIRST-Medicaid, +80178,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,HEALTHFIRST-Medicaid, +80179,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,HEALTHFIRST-Medicaid, +80180,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,HEALTHFIRST-Medicaid, +80181,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,HEALTHFIRST-Medicaid, +80182,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,HEALTHFIRST-Medicaid, +80183,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,HEALTHFIRST-Medicaid, +80184,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,HEALTHFIRST-Medicaid, +80185,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,HEALTHFIRST-Medicaid, +80186,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,HEALTHFIRST-Medicaid, +80187,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,HEALTHFIRST-Medicaid, +80188,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,HEALTHFIRST-Medicaid, +80189,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,HEALTHFIRST-Medicaid, +80190,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,HEALTHFIRST-Medicaid, +80191,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,HEALTHFIRST-Medicaid, +80192,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,HEALTHFIRST-Medicaid, +80193,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,HEALTHFIRST-Medicaid, +80194,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,HEALTHFIRST-Medicaid, +80195,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,HEALTHFIRST-Medicaid, +80196,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,HEALTHFIRST-Medicaid, +80197,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,HEALTHFIRST-Medicaid, +80198,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,HEALTHFIRST-Medicaid, +80199,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,HEALTHFIRST-Medicaid, +80200,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,HEALTHFIRST-Medicaid, +80201,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,HEALTHFIRST-Medicaid, +80202,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,HEALTHFIRST-Medicaid, +80203,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,HEALTHFIRST-Medicaid, +80204,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,HEALTHFIRST-Medicaid, +80205,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,HEALTHFIRST-Medicaid, +80206,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,HEALTHFIRST-Medicaid, +80207,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,HEALTHFIRST-Medicaid, +80208,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,HEALTHFIRST-Medicaid, +80209,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,HEALTHFIRST-Medicaid, +80210,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,HEALTHFIRST-Medicaid, +80211,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,HEALTHFIRST-Medicaid, +80212,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,HEALTHFIRST-Medicaid, +80213,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,HEALTHFIRST-Medicaid, +80214,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,HEALTHFIRST-Medicaid, +80215,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,HEALTHFIRST-Medicaid, +80216,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,HEALTHFIRST-Medicaid, +80217,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,HEALTHFIRST-Medicaid, +80218,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,HEALTHFIRST-Medicaid, +80219,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,HEALTHFIRST-Medicaid, +80220,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,HEALTHFIRST-Medicaid, +80221,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,HEALTHFIRST-Medicaid, +80222,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,HEALTHFIRST-Medicaid, +80223,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,HEALTHFIRST-Medicaid, +80224,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,HEALTHFIRST-Medicaid, +80225,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,HEALTHFIRST-Medicaid, +80226,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,HEALTHFIRST-Medicaid, +80227,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,HEALTHFIRST-Medicaid, +80228,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,HEALTHFIRST-Medicaid, +80229,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,HEALTHFIRST-Medicaid, +80230,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,HEALTHFIRST-Medicaid, +80231,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,HEALTHFIRST-Medicaid, +80232,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,HEALTHFIRST-Medicaid, +80233,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,HEALTHFIRST-Medicaid, +80234,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,HEALTHFIRST-Medicaid, +80235,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,HEALTHFIRST-Medicaid, +80236,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,HEALTHFIRST-Medicaid, +80237,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,HEALTHFIRST-Medicaid, +80238,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,HEALTHFIRST-Medicaid, +80239,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,HEALTHFIRST-Medicaid, +80240,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,HEALTHFIRST-Medicaid, +80241,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,HEALTHFIRST-Medicaid, +80242,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,HEALTHFIRST-Medicaid, +80243,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,HEALTHFIRST-Medicaid, +80244,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,HEALTHFIRST-Medicaid, +80245,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,HEALTHFIRST-Medicaid, +80246,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,HEALTHFIRST-Medicaid, +80247,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,HEALTHFIRST-Medicaid, +80248,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,HEALTHFIRST-Medicaid, +80249,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,HEALTHFIRST-Medicaid, +80250,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,HEALTHFIRST-Medicaid, +80251,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,HEALTHFIRST-Medicaid, +80252,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,HEALTHFIRST-Medicaid, +80253,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,HEALTHFIRST-Medicaid, +80254,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,HEALTHFIRST-Medicaid, +80255,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,HEALTHFIRST-Medicaid, +80256,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,HEALTHFIRST-Medicaid, +80257,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,HEALTHFIRST-Medicaid, +80258,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,HEALTHFIRST-Medicaid, +80259,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,HEALTHFIRST-Medicaid, +80260,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,HEALTHFIRST-Medicaid, +80261,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,HEALTHFIRST-Medicaid, +80262,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,HEALTHFIRST-Medicaid, +80263,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,HEALTHFIRST-Medicaid, +80264,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,HEALTHFIRST-Medicaid, +80265,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,HEALTHFIRST-Medicaid, +80266,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,HEALTHFIRST-Medicaid, +80267,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,HEALTHFIRST-Medicaid, +80268,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,HEALTHFIRST-Medicaid, +80269,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,HEALTHFIRST-Medicaid, +80270,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,HEALTHFIRST-Medicaid, +80271,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,HEALTHFIRST-Medicaid, +80272,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,HEALTHFIRST-Medicaid, +80273,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,HEALTHFIRST-Medicaid, +80274,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,HEALTHFIRST-Medicaid, +80275,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,HEALTHFIRST-Medicaid, +80276,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,HEALTHFIRST-Medicaid, +80277,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,HEALTHFIRST-Medicaid, +80278,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,HEALTHFIRST-Medicaid, +80279,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,HEALTHFIRST-Medicaid, +80280,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,HEALTHFIRST-Medicaid, +80281,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,HEALTHFIRST-Medicaid, +80282,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,HEALTHFIRST-Medicaid, +80283,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,HEALTHFIRST-Medicaid, +80284,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,HEALTHFIRST-Medicaid, +80285,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,HEALTHFIRST-Medicaid, +80286,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,HEALTHFIRST-Medicaid, +80287,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,HEALTHFIRST-Medicaid, +80288,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,HEALTHFIRST-Medicaid, +80289,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,HEALTHFIRST-Medicaid, +80290,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,HEALTHFIRST-Medicaid, +80291,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,HEALTHFIRST-Medicaid, +80292,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,HEALTHFIRST-Medicaid, +80293,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,HEALTHFIRST-Medicaid, +80294,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,HEALTHFIRST-Medicaid, +80295,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,HEALTHFIRST-Medicaid, +80296,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,HEALTHFIRST-Medicaid, +80297,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,HEALTHFIRST-Medicaid, +80298,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,HEALTHFIRST-Medicaid, +80299,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,HEALTHFIRST-Medicaid, +80300,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,HEALTHFIRST-Medicaid, +80301,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,HEALTHFIRST-Medicaid, +80302,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,HEALTHFIRST-Medicaid, +80303,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,HEALTHFIRST-Medicaid, +80304,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,HEALTHFIRST-Medicaid, +80305,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,HEALTHFIRST-Medicaid, +80306,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,HEALTHFIRST-Medicaid, +80307,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,HEALTHFIRST-Medicaid, +80308,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,HEALTHFIRST-Medicaid, +80309,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,HEALTHFIRST-Medicaid, +80310,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,HEALTHFIRST-Medicaid, +80311,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,HEALTHFIRST-Medicaid, +80312,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,HEALTHFIRST-Medicaid, +80313,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,HEALTHFIRST-Medicaid, +80314,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,HEALTHFIRST-Medicaid, +80315,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,HEALTHFIRST-Medicaid, +80316,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,HEALTHFIRST-Medicaid, +80317,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,HEALTHFIRST-Medicaid, +80318,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,HEALTHFIRST-Medicaid, +80319,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,HEALTHFIRST-Medicaid, +80320,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,HEALTHFIRST-Medicaid, +80321,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,HEALTHFIRST-Medicaid, +80322,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,HEALTHFIRST-Medicaid, +80323,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,HEALTHFIRST-Medicaid, +80324,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,HEALTHFIRST-Medicaid, +80325,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,HEALTHFIRST-Medicaid, +80326,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,HEALTHFIRST-Medicaid, +80327,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,HEALTHFIRST-Medicaid, +80328,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,HEALTHFIRST-Medicaid, +80329,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,HEALTHFIRST-Medicaid, +80330,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,HEALTHFIRST-Medicaid, +80331,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,HEALTHFIRST-Medicaid, +80332,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,HEALTHFIRST-Medicaid, +80333,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,HEALTHFIRST-Medicaid, +80334,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,HEALTHFIRST-Medicaid, +80335,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,HEALTHFIRST-Medicaid, +80336,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,HEALTHFIRST-Medicaid, +80337,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,HEALTHFIRST-Medicaid, +80338,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,HEALTHFIRST-Medicaid, +80339,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,HEALTHFIRST-Medicaid, +80340,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,HEALTHFIRST-Medicaid, +80341,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,HEALTHFIRST-Medicaid, +80342,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,HEALTHFIRST-Medicaid, +80343,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,HEALTHFIRST-Medicaid, +80344,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,HEALTHFIRST-Medicaid, +80345,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,HEALTHFIRST-Medicaid, +80346,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,HEALTHFIRST-Medicaid, +80347,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,HEALTHFIRST-Medicaid, +80348,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,HEALTHFIRST-Medicaid, +80349,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,HEALTHFIRST-Medicaid, +80350,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,HEALTHFIRST-Medicaid, +80351,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,HEALTHFIRST-Medicaid, +80352,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,HEALTHFIRST-Medicaid, +80353,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,HEALTHFIRST-Medicaid, +80354,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,HEALTHFIRST-Medicaid, +80355,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,HEALTHFIRST-Medicaid, +80356,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,HEALTHFIRST-Medicaid, +80357,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,HEALTHFIRST-Medicaid, +80358,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,HEALTHFIRST-Medicaid, +80359,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,HEALTHFIRST-Medicaid, +80360,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,HEALTHFIRST-Medicaid, +80361,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,HEALTHFIRST-Medicaid, +80362,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,HEALTHFIRST-Medicaid, +80363,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,HEALTHFIRST-Medicaid, +80364,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,HEALTHFIRST-Medicaid, +80365,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,HEALTHFIRST-Medicaid, +80366,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,HEALTHFIRST-Medicaid, +80367,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,HEALTHFIRST-Medicaid, +80368,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,HEALTHFIRST-Medicaid, +80369,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,HEALTHFIRST-Medicaid, +80370,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,HEALTHFIRST-Medicaid, +80371,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,HEALTHFIRST-Medicaid, +80372,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,HEALTHFIRST-Medicaid, +80373,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,HEALTHFIRST-Medicaid, +80374,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,HEALTHFIRST-Medicaid, +80375,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,HEALTHFIRST-Medicaid, +80376,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,HEALTHFIRST-Medicaid, +80377,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,HEALTHFIRST-Medicaid, +80378,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,HEALTHFIRST-Medicaid, +80379,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,HEALTHFIRST-Medicaid, +80380,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,HEALTHFIRST-Medicaid, +80381,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,HEALTHFIRST-Medicaid, +80382,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,HEALTHFIRST-Medicaid, +80383,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,HEALTHFIRST-Medicaid, +80384,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,HEALTHFIRST-Medicaid, +80385,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,HEALTHFIRST-Medicaid, +80386,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,HEALTHFIRST-Medicaid, +80387,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,HEALTHFIRST-Medicaid, +80388,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,HEALTHFIRST-Medicaid, +80389,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,HEALTHFIRST-Medicaid, +80390,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,HEALTHFIRST-Medicaid, +80391,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,HEALTHFIRST-Medicaid, +80392,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,HEALTHFIRST-Medicaid, +80393,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,HEALTHFIRST-Medicaid, +80394,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,HEALTHFIRST-Medicaid, +80395,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,HEALTHFIRST-Medicaid, +80396,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,HEALTHFIRST-Medicaid, +80397,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,HEALTHFIRST-Medicaid, +80398,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,HEALTHFIRST-Medicaid, +80399,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,HEALTHFIRST-Medicaid, +80400,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,HEALTHFIRST-Medicaid, +80401,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,HEALTHFIRST-Medicaid, +80402,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,HEALTHFIRST-Medicaid, +80403,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,HEALTHFIRST-Medicaid, +80404,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,HEALTHFIRST-Medicaid, +80405,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,HEALTHFIRST-Medicaid, +80406,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,HEALTHFIRST-Medicaid, +80407,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,HEALTHFIRST-Medicaid, +80408,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,HEALTHFIRST-Medicaid, +80409,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,HEALTHFIRST-Medicaid, +80410,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,HEALTHFIRST-Medicaid, +80411,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,HEALTHFIRST-Medicaid, +80412,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,HEALTHFIRST-Medicaid, +80413,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,HEALTHFIRST-Medicaid, +80414,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,HEALTHFIRST-Medicaid, +80415,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,HEALTHFIRST-Medicaid, +80416,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,HEALTHFIRST-Medicaid,669.09 +80417,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,HEALTHFIRST-Medicaid, +80418,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,HEALTHFIRST-Medicaid, +80419,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,HEALTHFIRST-Medicaid, +80420,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,HEALTHFIRST-Medicaid, +80421,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,HEALTHFIRST-Medicaid, +80422,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,HEALTHFIRST-Medicaid, +80423,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,HEALTHFIRST-Medicaid, +80424,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,HEALTHFIRST-Medicaid, +80425,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,HEALTHFIRST-Medicaid, +80426,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,HEALTHFIRST-Medicaid, +80427,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,HEALTHFIRST-Medicaid, +80428,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,HEALTHFIRST-Medicaid, +80429,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,HEALTHFIRST-Medicaid, +80430,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,HEALTHFIRST-Medicaid, +80431,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,HEALTHFIRST-Medicaid, +80432,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,HEALTHFIRST-Medicaid, +80433,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,HEALTHFIRST-Medicaid, +80434,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,HEALTHFIRST-Medicaid, +80435,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,HEALTHFIRST-Medicaid, +80436,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,HEALTHFIRST-Medicaid, +80437,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,HEALTHFIRST-Medicaid, +80438,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,HEALTHFIRST-Medicaid, +80439,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,HEALTHFIRST-Medicaid, +80440,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,HEALTHFIRST-Medicaid, +80441,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,HEALTHFIRST-Medicaid, +80442,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,HEALTHFIRST-Medicaid, +80443,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,HEALTHFIRST-Medicaid, +80444,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,HEALTHFIRST-Medicaid, +80445,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,HEALTHFIRST-Medicaid, +80446,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,HEALTHFIRST-Medicaid, +80447,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,HEALTHFIRST-Medicaid, +80448,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,HEALTHFIRST-Medicaid, +80449,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,HEALTHFIRST-Medicaid, +80450,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,HEALTHFIRST-Medicaid, +80451,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,HEALTHFIRST-Medicaid, +80452,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,HEALTHFIRST-Medicaid, +80453,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,HEALTHFIRST-Medicaid, +80454,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,HEALTHFIRST-Medicaid, +80455,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,HEALTHFIRST-Medicaid, +80456,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,HEALTHFIRST-Medicaid, +80457,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,HEALTHFIRST-Medicaid, +80458,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,HEALTHFIRST-Medicaid, +80459,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,HEALTHFIRST-Medicaid, +80460,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,HEALTHFIRST-Medicaid, +80461,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,HEALTHFIRST-Medicaid, +80462,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,HEALTHFIRST-Medicaid, +80463,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,HEALTHFIRST-Medicaid, +80464,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,HEALTHFIRST-Medicaid, +80465,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,HEALTHFIRST-Medicaid, +80466,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,HEALTHFIRST-Medicaid, +80467,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,HEALTHFIRST-Medicaid, +80468,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,HEALTHFIRST-Medicaid, +80469,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,HEALTHFIRST-Medicaid, +80470,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,HEALTHFIRST-Medicaid, +80471,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,HEALTHFIRST-Medicaid, +80472,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,HEALTHFIRST-Medicaid, +80473,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,HEALTHFIRST-Medicaid, +80474,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,HEALTHFIRST-Medicaid, +80475,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,HEALTHFIRST-Medicaid, +80476,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,HEALTHFIRST-Medicaid, +80477,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,HEALTHFIRST-Medicaid, +80478,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,HEALTHFIRST-Medicaid, +80479,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,HEALTHFIRST-Medicaid, +80480,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,HEALTHFIRST-Medicaid, +80481,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,HEALTHFIRST-Medicaid, +80482,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,HEALTHFIRST-Medicaid, +80483,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,HEALTHFIRST-Medicaid, +80484,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,HEALTHFIRST-Medicaid, +80485,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,HEALTHFIRST-Medicaid, +80486,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,HEALTHFIRST-Medicaid, +80487,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,HEALTHFIRST-Medicaid, +80488,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,HEALTHFIRST-Medicaid, +80489,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,HEALTHFIRST-Medicaid, +80490,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,HEALTHFIRST-Medicaid, +80491,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,HEALTHFIRST-Medicaid, +80492,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,HEALTHFIRST-Medicaid, +80493,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,HEALTHFIRST-Medicaid, +80494,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,HEALTHFIRST-Medicaid, +80495,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,HEALTHFIRST-Medicaid, +80496,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,HEALTHFIRST-Medicaid, +80497,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,HEALTHFIRST-Medicaid, +80498,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,HEALTHFIRST-Medicaid, +80499,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,HEALTHFIRST-Medicaid, +80500,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,HEALTHFIRST-Medicaid, +80501,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,HEALTHFIRST-Medicaid, +80502,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,HEALTHFIRST-Medicaid, +80503,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,HEALTHFIRST-Medicaid, +80504,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,HEALTHFIRST-Medicaid, +80505,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,HEALTHFIRST-Medicaid, +80506,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,HEALTHFIRST-Medicaid, +80507,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,HEALTHFIRST-Medicaid, +80508,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,HEALTHFIRST-Medicaid, +80509,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,HEALTHFIRST-Medicaid, +80510,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,HEALTHFIRST-Medicaid, +80511,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,HEALTHFIRST-Medicaid, +80512,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,HEALTHFIRST-Medicaid, +80513,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,HEALTHFIRST-Medicaid, +80514,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,HEALTHFIRST-Medicaid, +80515,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,HEALTHFIRST-Medicaid, +80516,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,HEALTHFIRST-Medicaid, +80517,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,HEALTHFIRST-Medicaid, +80518,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,HEALTHFIRST-Medicaid, +80519,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,HEALTHFIRST-Medicaid, +80520,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,HEALTHFIRST-Medicaid, +80521,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,HEALTHFIRST-Medicaid, +80522,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,HEALTHFIRST-Medicaid, +80523,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,HEALTHFIRST-Medicaid, +80524,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,HEALTHFIRST-Medicaid, +80525,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,HEALTHFIRST-Medicaid, +80526,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,HEALTHFIRST-Medicaid, +80527,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,HEALTHFIRST-Medicaid, +80528,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,HEALTHFIRST-Medicaid, +80529,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,HEALTHFIRST-Medicaid, +80530,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,HEALTHFIRST-Medicaid, +80531,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,HEALTHFIRST-Medicaid, +80532,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,HEALTHFIRST-Medicaid, +80533,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,HEALTHFIRST-Medicaid, +80534,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,HEALTHFIRST-Medicaid, +80535,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,HEALTHFIRST-Medicaid, +80536,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,HEALTHFIRST-Medicaid, +80537,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,HEALTHFIRST-Medicaid, +80538,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,HEALTHFIRST-Medicaid, +80539,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,HEALTHFIRST-Medicaid, +80540,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,HEALTHFIRST-Medicaid, +80541,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,HEALTHFIRST-Medicaid, +80542,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,HEALTHFIRST-Medicaid, +80543,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,HEALTHFIRST-Medicaid, +80544,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,HEALTHFIRST-Medicaid, +80545,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,HEALTHFIRST-Medicaid, +80546,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,HEALTHFIRST-Medicaid, +80547,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,HEALTHFIRST-Medicaid, +80548,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,HEALTHFIRST-Medicaid, +80549,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,HEALTHFIRST-Medicaid, +80550,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,HEALTHFIRST-Medicaid, +80551,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,HEALTHFIRST-Medicaid, +80552,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,HEALTHFIRST-Medicaid, +80553,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,HEALTHFIRST-Medicaid, +80554,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,HEALTHFIRST-Medicaid, +80555,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,HEALTHFIRST-Medicaid, +80556,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,HEALTHFIRST-Medicaid, +80557,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,HEALTHFIRST-Medicaid, +80558,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,HEALTHFIRST-Medicaid, +80559,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,HEALTHFIRST-Medicaid, +80560,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,HEALTHFIRST-Medicaid, +80561,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,HEALTHFIRST-Medicaid, +80562,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,HEALTHFIRST-Medicaid, +80563,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,HEALTHFIRST-Medicaid, +80564,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,HEALTHFIRST-Medicaid, +80565,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,HEALTHFIRST-Medicaid, +80566,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,HEALTHFIRST-Medicaid, +80567,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,HEALTHFIRST-Medicaid, +80568,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,HEALTHFIRST-Medicaid, +80569,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,HEALTHFIRST-Medicaid, +80570,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,HEALTHFIRST-Medicaid, +80571,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,HEALTHFIRST-Medicaid, +80572,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,HEALTHFIRST-Medicaid, +80573,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,HEALTHFIRST-Medicaid, +80574,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,HEALTHFIRST-Medicaid, +80575,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,HEALTHFIRST-Medicaid, +80576,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,HEALTHFIRST-Medicaid, +80577,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,HEALTHFIRST-Medicaid, +80578,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,HEALTHFIRST-Medicaid, +80579,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,HEALTHFIRST-Medicaid, +80580,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,HEALTHFIRST-Medicaid, +80581,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,HEALTHFIRST-Medicaid, +80582,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,HEALTHFIRST-Medicaid, +80583,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,HEALTHFIRST-Medicaid, +80584,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,HEALTHFIRST-Medicaid, +80585,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,HEALTHFIRST-Medicaid, +80586,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,HEALTHFIRST-Medicaid, +80587,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,HEALTHFIRST-Medicaid, +80588,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,HEALTHFIRST-Medicaid, +80589,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,HEALTHFIRST-Medicaid, +80590,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,HEALTHFIRST-Medicaid, +80591,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,HEALTHFIRST-Medicaid, +80592,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,HEALTHFIRST-Medicaid, +80593,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,HEALTHFIRST-Medicaid, +80594,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,HEALTHFIRST-Medicaid, +80595,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,HEALTHFIRST-Medicaid, +80596,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,HEALTHFIRST-Medicaid, +80597,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,HEALTHFIRST-Medicaid, +80598,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,HEALTHFIRST-Medicaid, +80599,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,HEALTHFIRST-Medicaid, +80600,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,HEALTHFIRST-Medicaid, +80601,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,HEALTHFIRST-Medicaid, +80602,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,HEALTHFIRST-Medicaid, +80603,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,HEALTHFIRST-Medicaid, +80604,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,HEALTHFIRST-Medicaid, +80605,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,HEALTHFIRST-Medicaid, +80606,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,HEALTHFIRST-Medicaid, +80607,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,HEALTHFIRST-Medicaid, +80608,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,HEALTHFIRST-Medicaid, +80609,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,HEALTHFIRST-Medicaid, +80610,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,HEALTHFIRST-Medicaid, +80611,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,HEALTHFIRST-Medicaid, +80612,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,HEALTHFIRST-Medicaid, +80613,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,HEALTHFIRST-Medicaid, +80614,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,HEALTHFIRST-Medicaid, +80615,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,HEALTHFIRST-Medicaid, +80616,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,HEALTHFIRST-Medicaid, +80617,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,HEALTHFIRST-Medicaid, +80618,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,HEALTHFIRST-Medicaid, +80619,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,HEALTHFIRST-Medicaid, +80620,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,HEALTHFIRST-Medicaid, +80621,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,HEALTHFIRST-Medicaid, +80622,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,HEALTHFIRST-Medicaid, +80623,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,HEALTHFIRST-Medicaid, +80624,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,HEALTHFIRST-Medicaid, +80625,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,HEALTHFIRST-Medicaid, +80626,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,HEALTHFIRST-Medicaid, +80627,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,HEALTHFIRST-Medicaid, +80628,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,HEALTHFIRST-Medicaid, +80629,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,HEALTHFIRST-Medicaid, +80630,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,HEALTHFIRST-Medicaid, +80631,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,HEALTHFIRST-Medicaid, +80632,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,HEALTHFIRST-Medicaid, +80633,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,HEALTHFIRST-Medicaid, +80634,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,HEALTHFIRST-Medicaid, +80635,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,HEALTHFIRST-Medicaid, +80636,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,HEALTHFIRST-Medicaid, +80637,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,HEALTHFIRST-Medicaid, +80638,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,HEALTHFIRST-Medicaid, +80639,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,HEALTHFIRST-Medicaid, +80640,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,HEALTHFIRST-Medicaid, +80641,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,HEALTHFIRST-Medicaid, +80642,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,HEALTHFIRST-Medicaid, +80643,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,HEALTHFIRST-Medicaid, +80644,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,HEALTHFIRST-Medicaid, +80645,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,HEALTHFIRST-Medicaid, +80646,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,HEALTHFIRST-Medicaid, +80647,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,HEALTHFIRST-Medicaid, +80648,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,HEALTHFIRST-Medicaid, +80649,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,HEALTHFIRST-Medicaid, +80650,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,HEALTHFIRST-Medicaid, +80651,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,HEALTHFIRST-Medicaid, +80652,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,HEALTHFIRST-Medicaid, +80653,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,HEALTHFIRST-Medicaid, +80654,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,HEALTHFIRST-Medicaid, +80655,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,HEALTHFIRST-Medicaid, +80656,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,HEALTHFIRST-Medicaid, +80657,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,HEALTHFIRST-Medicaid, +80658,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,HEALTHFIRST-Medicaid, +80659,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,HEALTHFIRST-Medicaid, +80660,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,HEALTHFIRST-Medicaid, +80661,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,HEALTHFIRST-Medicaid, +80662,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,HEALTHFIRST-Medicaid, +80663,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,HEALTHFIRST-Medicaid, +80664,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,HEALTHFIRST-Medicaid, +80665,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,HEALTHFIRST-Medicaid, +80666,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,HEALTHFIRST-Medicaid, +80667,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,HEALTHFIRST-Medicaid, +80668,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,HEALTHFIRST-Medicaid, +80669,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,HEALTHFIRST-Medicaid, +80670,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,HEALTHFIRST-Medicaid, +80671,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,HEALTHFIRST-Medicaid, +80672,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,HEALTHFIRST-Medicaid, +80673,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,HEALTHFIRST-Medicaid, +80674,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,HEALTHFIRST-Medicaid, +80675,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,HEALTHFIRST-Medicaid, +80676,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,HEALTHFIRST-Medicaid, +80677,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,HEALTHFIRST-Medicaid, +80678,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,HEALTHFIRST-Medicaid, +80679,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,HEALTHFIRST-Medicaid, +80680,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,HEALTHFIRST-Medicaid, +80681,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,HEALTHFIRST-Medicaid, +80682,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,HEALTHFIRST-Medicaid, +80683,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,HEALTHFIRST-Medicaid, +80684,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,HEALTHFIRST-Medicaid, +80685,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,HEALTHFIRST-Medicaid, +80686,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,HEALTHFIRST-Medicaid, +80687,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,HEALTHFIRST-Medicaid, +80688,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,HEALTHFIRST-Medicaid, +80689,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,HEALTHFIRST-Medicaid, +80690,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,HEALTHFIRST-Medicaid, +80691,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,HEALTHFIRST-Medicaid, +80692,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,HEALTHFIRST-Medicaid, +80693,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,HEALTHFIRST-Medicaid, +80694,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,HEALTHFIRST-Medicaid, +80695,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,HEALTHFIRST-Medicaid, +80696,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,HEALTHFIRST-Medicaid, +80697,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,HEALTHFIRST-Medicaid, +80698,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,HEALTHFIRST-Medicaid, +80699,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,HEALTHFIRST-Medicaid, +80700,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,HEALTHFIRST-Medicaid, +80701,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,HEALTHFIRST-Medicaid, +80702,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,HEALTHFIRST-Medicaid, +80703,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,HEALTHFIRST-Medicaid, +80704,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,HEALTHFIRST-Medicaid, +80705,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,HEALTHFIRST-Medicaid, +80706,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,HEALTHFIRST-Medicaid, +80707,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,HEALTHFIRST-Medicaid, +80708,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,HEALTHFIRST-Medicaid, +80709,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,HEALTHFIRST-Medicaid, +80710,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,HEALTHFIRST-Medicaid, +80711,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,HEALTHFIRST-Medicaid, +80712,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,HEALTHFIRST-Medicaid, +80713,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,HEALTHFIRST-Medicaid, +80714,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,HEALTHFIRST-Medicaid, +80715,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,HEALTHFIRST-Medicaid, +80716,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,HEALTHFIRST-Medicaid, +80717,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,HEALTHFIRST-Medicaid, +80718,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,HEALTHFIRST-Medicaid, +80719,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,HEALTHFIRST-Medicaid, +80720,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,HEALTHFIRST-Medicaid, +80721,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,HEALTHFIRST-Medicaid, +80722,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,HEALTHFIRST-Medicaid, +80723,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,HEALTHFIRST-Medicaid, +80724,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,HEALTHFIRST-Medicaid, +80725,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,HEALTHFIRST-Medicaid, +80726,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,HEALTHFIRST-Medicaid, +80727,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,HEALTHFIRST-Medicaid, +80728,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,HEALTHFIRST-Medicaid, +80729,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,HEALTHFIRST-Medicaid, +80730,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,HEALTHFIRST-Medicaid, +80731,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,HEALTHFIRST-Medicaid, +80732,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,HEALTHFIRST-Medicaid, +80733,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,HEALTHFIRST-Medicaid, +80734,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,HEALTHFIRST-Medicaid, +80735,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,HEALTHFIRST-Medicaid, +80736,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,HEALTHFIRST-Medicaid, +80737,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,HEALTHFIRST-Medicaid, +80738,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,HEALTHFIRST-Medicaid, +80739,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,HEALTHFIRST-Medicaid, +80740,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,HEALTHFIRST-Medicaid, +80741,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,HEALTHFIRST-Medicaid, +80742,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,HEALTHFIRST-Medicaid, +80743,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,HEALTHFIRST-Medicaid, +80744,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,HEALTHFIRST-Medicaid, +80745,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,HEALTHFIRST-Medicaid, +80746,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,HEALTHFIRST-Medicaid, +80747,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,HEALTHFIRST-Medicaid, +80748,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,HEALTHFIRST-Medicaid, +80749,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,HEALTHFIRST-Medicaid, +80750,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,HEALTHFIRST-Medicaid, +80751,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,HEALTHFIRST-Medicaid, +80752,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,HEALTHFIRST-Medicaid, +80753,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,HEALTHFIRST-Medicaid, +80754,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,HEALTHFIRST-Medicaid, +80755,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,HEALTHFIRST-Medicaid, +80756,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,HEALTHFIRST-Medicaid, +80757,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,HEALTHFIRST-Medicaid, +80758,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,HEALTHFIRST-Medicaid, +80759,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,HEALTHFIRST-Medicaid, +80760,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,HEALTHFIRST-Medicaid, +80761,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,HEALTHFIRST-Medicaid, +80762,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,HEALTHFIRST-Medicaid, +80763,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,HEALTHFIRST-Medicaid, +80764,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,HEALTHFIRST-Medicaid, +80765,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,HEALTHFIRST-Medicaid, +80766,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,HEALTHFIRST-Medicaid, +80767,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,HEALTHFIRST-Medicaid, +80768,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,HEALTHFIRST-Medicaid, +80769,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,HEALTHFIRST-Medicaid, +80770,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,HEALTHFIRST-Medicaid, +80771,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,HEALTHFIRST-Medicaid, +80772,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,HEALTHFIRST-Medicaid, +80773,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,HEALTHFIRST-Medicaid, +80774,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,HEALTHFIRST-Medicaid, +80775,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,HEALTHFIRST-Medicaid, +80776,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,HEALTHFIRST-Medicaid, +80777,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,HEALTHFIRST-Medicaid, +80778,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,HEALTHFIRST-Medicaid, +80779,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,HEALTHFIRST-Medicaid, +80780,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,HEALTHFIRST-Medicaid, +80781,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,HEALTHFIRST-Medicaid, +80782,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,HEALTHFIRST-Medicaid, +80783,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,HEALTHFIRST-Medicaid, +80784,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,HEALTHFIRST-Medicaid, +80785,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,HEALTHFIRST-Medicaid, +80786,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,HEALTHFIRST-Medicaid, +80787,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,HEALTHFIRST-Medicaid, +80788,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,HEALTHFIRST-Medicaid, +80789,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,HEALTHFIRST-Medicaid, +80790,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,HEALTHFIRST-Medicaid, +80791,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,HEALTHFIRST-Medicaid, +80792,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,HEALTHFIRST-Medicaid, +80793,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,HEALTHFIRST-Medicaid, +80794,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,HEALTHFIRST-Medicaid, +80795,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,HEALTHFIRST-Medicaid, +80796,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,HEALTHFIRST-Medicaid, +80797,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,HEALTHFIRST-Medicaid, +80798,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,HEALTHFIRST-Medicaid, +80799,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,HEALTHFIRST-Medicaid, +80800,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,HEALTHFIRST-Medicaid, +80801,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,HEALTHFIRST-Medicaid, +80802,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,HEALTHFIRST-Medicaid, +80803,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,HEALTHFIRST-Medicaid, +80804,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,HEALTHFIRST-Medicaid, +80805,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,HEALTHFIRST-Medicaid, +80806,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,HEALTHFIRST-Medicaid, +80807,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,HEALTHFIRST-Medicaid, +80808,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,HEALTHFIRST-Medicaid, +80809,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,HEALTHFIRST-Medicaid, +80810,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,HEALTHFIRST-Medicaid, +80811,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,HEALTHFIRST-Medicaid, +80812,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,HEALTHFIRST-Medicaid, +80813,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,HEALTHFIRST-Medicaid, +80814,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,HEALTHFIRST-Medicaid, +80815,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,HEALTHFIRST-Medicaid, +80816,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,HEALTHFIRST-Medicaid, +80817,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,HEALTHFIRST-Medicaid, +80818,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,HEALTHFIRST-Medicaid, +80819,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,HEALTHFIRST-Medicaid, +80820,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,HEALTHFIRST-Medicaid, +80821,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,HEALTHFIRST-Medicaid, +80822,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,HEALTHFIRST-Medicaid, +80823,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,HEALTHFIRST-Medicaid, +80824,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,HEALTHFIRST-Medicaid, +80825,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,HEALTHFIRST-Medicaid, +80826,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,HEALTHFIRST-Medicaid, +80827,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,HEALTHFIRST-Medicaid, +80828,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,HEALTHFIRST-Medicaid, +80829,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,HEALTHFIRST-Medicaid, +80830,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,HEALTHFIRST-Medicaid, +80831,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,HEALTHFIRST-Medicaid, +80832,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,HEALTHFIRST-Medicaid, +80833,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,HEALTHFIRST-Medicaid, +80834,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,HEALTHFIRST-Medicaid, +80835,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,HEALTHFIRST-Medicaid, +80836,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,HEALTHFIRST-Medicaid, +80837,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,HEALTHFIRST-Medicaid, +80838,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,HEALTHFIRST-Medicaid, +80839,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,HEALTHFIRST-Medicaid, +80840,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,HEALTHFIRST-Medicaid, +80841,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,HEALTHFIRST-Medicaid, +80842,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,HEALTHFIRST-Medicaid, +80843,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,HEALTHFIRST-Medicaid, +80844,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,HEALTHFIRST-Medicaid, +80845,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,HEALTHFIRST-Medicaid, +80846,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,HEALTHFIRST-Medicaid, +80847,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,HEALTHFIRST-Medicaid, +80848,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,HEALTHFIRST-Medicaid, +80849,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,HEALTHFIRST-Medicaid, +80850,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,HEALTHFIRST-Medicaid, +80851,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,HEALTHFIRST-Medicaid, +80852,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,HEALTHFIRST-Medicaid, +80853,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,HEALTHFIRST-Medicaid, +80854,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,HEALTHFIRST-Medicaid, +80855,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,HEALTHFIRST-Medicaid, +80856,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,HEALTHFIRST-Medicaid, +80857,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,HEALTHFIRST-Medicaid, +80858,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,HEALTHFIRST-Medicaid, +80859,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,HEALTHFIRST-Medicaid, +80860,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,HEALTHFIRST-Medicaid, +80861,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,HEALTHFIRST-Medicaid, +80862,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,HEALTHFIRST-Medicaid, +80863,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,HEALTHFIRST-Medicaid, +80864,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,HEALTHFIRST-Medicaid, +80865,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,HEALTHFIRST-Medicaid, +80866,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,HEALTHFIRST-Medicaid, +80867,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,HEALTHFIRST-Medicaid, +80868,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,HEALTHFIRST-Medicaid, +80869,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,HEALTHFIRST-Medicaid, +80870,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,HEALTHFIRST-Medicaid, +80871,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,HEALTHFIRST-Medicaid, +80872,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,HEALTHFIRST-Medicaid, +80873,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,HEALTHFIRST-Medicaid, +80874,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,HEALTHFIRST-Medicaid, +80875,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,HEALTHFIRST-Medicaid, +80876,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,HEALTHFIRST-Medicaid, +80877,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,HEALTHFIRST-Medicaid, +80878,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,HEALTHFIRST-Medicaid, +80879,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,HEALTHFIRST-Medicaid, +80880,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,HEALTHFIRST-Medicaid, +80881,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,HEALTHFIRST-Medicaid, +80882,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,HEALTHFIRST-Medicaid, +80883,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,HEALTHFIRST-Medicaid, +80884,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,HEALTHFIRST-Medicaid, +80885,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,HEALTHFIRST-Medicaid, +80886,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,HEALTHFIRST-Medicaid, +80887,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,HEALTHFIRST-Medicaid, +80888,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,HEALTHFIRST-Medicaid, +80889,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,HEALTHFIRST-Medicaid, +80890,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,HEALTHFIRST-Medicaid, +80891,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,HEALTHFIRST-Medicaid, +80892,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,HEALTHFIRST-Medicaid, +80893,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,HEALTHFIRST-Medicaid, +80894,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,HEALTHFIRST-Medicaid, +80895,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,HEALTHFIRST-Medicaid, +80896,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,HEALTHFIRST-Medicaid, +80897,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,HEALTHFIRST-Medicaid, +80898,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,HEALTHFIRST-Medicaid, +80899,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,HEALTHFIRST-Medicaid, +80900,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,HEALTHFIRST-Medicaid, +80901,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,HEALTHFIRST-Medicaid, +80902,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,HEALTHFIRST-Medicaid, +80903,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,HEALTHFIRST-Medicaid, +80904,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,HEALTHFIRST-Medicaid, +80905,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,HEALTHFIRST-Medicaid, +80906,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,HEALTHFIRST-Medicaid, +80907,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,HEALTHFIRST-Medicaid, +80908,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,HEALTHFIRST-Medicaid, +80909,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,HEALTHFIRST-Medicaid, +80910,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,HEALTHFIRST-Medicaid, +80911,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,HEALTHFIRST-Medicaid, +80912,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,HEALTHFIRST-Medicaid, +80913,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,HEALTHFIRST-Medicaid, +80914,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,HEALTHFIRST-Medicaid, +80915,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,HEALTHFIRST-Medicaid, +80916,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,HEALTHFIRST-Medicaid, +80917,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,HEALTHFIRST-Medicaid, +80918,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,HEALTHFIRST-Medicaid, +80919,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,HEALTHFIRST-Medicaid, +80920,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,HEALTHFIRST-Medicaid, +80921,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,HEALTHFIRST-Medicaid, +80922,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,HEALTHFIRST-Medicaid, +80923,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,HEALTHFIRST-Medicaid, +80924,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,HEALTHFIRST-Medicaid, +80925,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,HEALTHFIRST-Medicaid, +80926,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,HEALTHFIRST-Medicaid, +80927,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,HEALTHFIRST-Medicaid, +80928,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,HEALTHFIRST-Medicaid, +80929,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,HEALTHFIRST-Medicaid, +80930,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,HEALTHFIRST-Medicaid, +80931,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,HEALTHFIRST-Medicaid, +80932,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,HEALTHFIRST-Medicaid, +80933,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,HEALTHFIRST-Medicaid, +80934,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,HEALTHFIRST-Medicaid, +80935,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,HEALTHFIRST-Medicaid, +80936,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,HEALTHFIRST-Medicaid, +80937,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,HEALTHFIRST-Medicaid, +80938,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,HEALTHFIRST-Medicaid, +80939,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,HEALTHFIRST-Medicaid, +80940,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,HEALTHFIRST-Medicaid, +80941,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,HEALTHFIRST-Medicaid, +80942,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,HEALTHFIRST-Medicaid, +80943,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,HEALTHFIRST-Medicaid, +80944,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,HEALTHFIRST-Medicaid, +80945,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,HEALTHFIRST-Medicaid, +80946,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,HEALTHFIRST-Medicaid, +80947,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,HEALTHFIRST-Medicaid, +80948,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,HEALTHFIRST-Medicaid, +80949,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,HEALTHFIRST-Medicaid, +80950,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,HEALTHFIRST-Medicaid, +80951,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,HEALTHFIRST-Medicaid, +80952,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,HEALTHFIRST-Medicaid, +80953,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,HEALTHFIRST-Medicaid, +80954,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,HEALTHFIRST-Medicaid, +80955,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,HEALTHFIRST-Medicaid, +80956,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,HEALTHFIRST-Medicaid, +80957,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,HEALTHFIRST-Medicaid, +80958,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,HEALTHFIRST-Medicaid, +80959,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,HEALTHFIRST-Medicaid, +80960,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,HEALTHFIRST-Medicaid, +80961,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,HEALTHFIRST-Medicaid, +80962,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,HEALTHFIRST-Medicaid, +80963,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,HEALTHFIRST-Medicaid, +80964,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,HEALTHFIRST-Medicaid, +80965,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,HEALTHFIRST-Medicaid, +80966,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,HEALTHFIRST-Medicaid, +80967,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,HEALTHFIRST-Medicaid, +80968,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,HEALTHFIRST-Medicaid, +80969,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,HEALTHFIRST-Medicaid, +80970,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,HEALTHFIRST-Medicaid, +80971,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,HEALTHFIRST-Medicaid, +80972,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,HEALTHFIRST-Medicaid, +80973,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,HEALTHFIRST-Medicaid, +80974,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,HEALTHFIRST-Medicaid, +80975,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,HEALTHFIRST-Medicaid, +80976,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,HEALTHFIRST-Medicaid, +80977,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,HEALTHFIRST-Medicaid, +80978,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,HEALTHFIRST-Medicaid, +80979,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,HEALTHFIRST-Medicaid, +80980,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,HEALTHFIRST-Medicaid, +80981,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,HEALTHFIRST-Medicaid, +80982,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,HEALTHFIRST-Medicaid, +80983,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,HEALTHFIRST-Medicaid, +80984,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,HEALTHFIRST-Medicaid, +80985,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,HEALTHFIRST-Medicaid, +80986,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,HEALTHFIRST-Medicaid, +80987,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,HEALTHFIRST-Medicaid, +80988,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,HEALTHFIRST-Medicaid, +80989,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,HEALTHFIRST-Medicaid, +80990,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,HEALTHFIRST-Medicaid, +80991,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,HEALTHFIRST-Medicaid, +80992,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,HEALTHFIRST-Medicaid, +80993,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +80994,3934,30000012,PRIVATE,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +80995,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +80996,3934,30000038,ICU,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +80997,3934,30000046,BURN UNIT,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +80998,3934,30000053,NICU,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +80999,3934,30000061,ICR ROOM,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81000,3934,30000079,PSYCH,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81001,3934,30000087,NEWBORN,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81002,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81003,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81004,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81005,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81006,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81007,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81008,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81009,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81010,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81011,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81012,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81013,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81014,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81015,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81016,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81017,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81018,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81019,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81020,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81021,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81022,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81023,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81024,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81025,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81026,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81027,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81028,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81029,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81030,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81031,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81032,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81033,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81034,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81035,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81036,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81037,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81038,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81039,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81040,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81041,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81042,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81043,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81044,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81045,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81046,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81047,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81048,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81049,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81050,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81051,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81052,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81053,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81054,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81055,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81056,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81057,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81058,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81059,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81060,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81061,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81062,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81063,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81064,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81065,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81066,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81067,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81068,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81069,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81070,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81071,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81072,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81073,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81074,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81075,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81076,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81077,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81078,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81079,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81080,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81081,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81082,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81083,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81084,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81085,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81086,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81087,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81088,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81089,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81090,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81091,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81092,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81093,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81094,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81095,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81096,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81097,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81098,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81099,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81100,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81101,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81102,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81103,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81104,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81105,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81106,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81107,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81108,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81109,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81110,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81111,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81112,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81113,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81114,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81115,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81116,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81117,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81118,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81119,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81120,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81121,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81122,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81123,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81124,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81125,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81126,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81127,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81128,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81129,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81130,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81131,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81132,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81133,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81134,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81135,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81136,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81137,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81138,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81139,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81140,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81141,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81142,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81143,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81144,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81145,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81146,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81147,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81148,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81149,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81150,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81151,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81152,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81153,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81154,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81155,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81156,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81157,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81158,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81159,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81160,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81161,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81162,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81163,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81164,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81165,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81166,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81167,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81168,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81169,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81170,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81171,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81172,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81173,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81174,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81175,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81176,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81177,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81178,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81179,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81180,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81181,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81182,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81183,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81184,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81185,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81186,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81187,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81188,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81189,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81190,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81191,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81192,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81193,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81194,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81195,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81196,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81197,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81198,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81199,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81200,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81201,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81202,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81203,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81204,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81205,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81206,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81207,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81208,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81209,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81210,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81211,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81212,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81213,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81214,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81215,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81216,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81217,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81218,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81219,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81220,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81221,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81222,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81223,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81224,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81225,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81226,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81227,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81228,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81229,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81230,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81231,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81232,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81233,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81234,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81235,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81236,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81237,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81238,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81239,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81240,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81241,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81242,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81243,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81244,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81245,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81246,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81247,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81248,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81249,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81250,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81251,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81252,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81253,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81254,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81255,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81256,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81257,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81258,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81259,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81260,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81261,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81262,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81263,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81264,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81265,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81266,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81267,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81268,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81269,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81270,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81271,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81272,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81273,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81274,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81275,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81276,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81277,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81278,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81279,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81280,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81281,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81282,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81283,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81284,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81285,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81286,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81287,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81288,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81289,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81290,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81291,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81292,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81293,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81294,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81295,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81296,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81297,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81298,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81299,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81300,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81301,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81302,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81303,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81304,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81305,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81306,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81307,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81308,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81309,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81310,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81311,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81312,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81313,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81314,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81315,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81316,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81317,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81318,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81319,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81320,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81321,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81322,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81323,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81324,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81325,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81326,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81327,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81328,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81329,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81330,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81331,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81332,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81333,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81334,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81335,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81336,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81337,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81338,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81339,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81340,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81341,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81342,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81343,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81344,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81345,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81346,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81347,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81348,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81349,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81350,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81351,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81352,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81353,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81354,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81355,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81356,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81357,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81358,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81359,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81360,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81361,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81362,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81363,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81364,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81365,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81366,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81367,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81368,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81369,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81370,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81371,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81372,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81373,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81374,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81375,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81376,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81377,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81378,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81379,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81380,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81381,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81382,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81383,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81384,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81385,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81386,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81387,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81388,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81389,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81390,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81391,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81392,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81393,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81394,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81395,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81396,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81397,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81398,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81399,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81400,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81401,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81402,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81403,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81404,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81405,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81406,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81407,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81408,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81409,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81410,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81411,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicaid, +81412,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81413,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81414,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81415,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81416,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81417,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81418,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicaid, +81419,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81420,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81421,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81422,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81423,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81424,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81425,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81426,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81427,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81428,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81429,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81430,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81431,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81432,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81433,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81434,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81435,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81436,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicaid, +81437,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicaid, +81438,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicaid, +81439,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,HEALTHFIRST-Medicaid, +81440,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,HEALTHFIRST-Medicaid, +81441,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,HEALTHFIRST-Medicaid, +81442,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,HEALTHFIRST-Medicaid, +81443,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81444,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81445,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81446,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81447,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81448,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81449,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81450,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81451,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81452,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81453,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81454,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81455,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,HEALTHFIRST-Medicaid, +81456,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,HEALTHFIRST-Medicaid, +81457,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,HEALTHFIRST-Medicaid, +81458,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,HEALTHFIRST-Medicaid, +81459,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,HEALTHFIRST-Medicaid, +81460,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,HEALTHFIRST-Medicaid, +81461,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,HEALTHFIRST-Medicaid, +81462,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,HEALTHFIRST-Medicaid, +81463,3934,37112000,ACUTE ED,,1580.0,1580.0,,,HEALTHFIRST-Medicaid, +81464,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,HEALTHFIRST-Medicaid, +81465,3934,37112034,TRIAGE,,277.0,277.0,,,HEALTHFIRST-Medicaid, +81466,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,HEALTHFIRST-Medicaid, +81467,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,HEALTHFIRST-Medicaid, +81468,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,HEALTHFIRST-Medicaid, +81469,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,HEALTHFIRST-Medicaid, +81470,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,HEALTHFIRST-Medicaid, +81471,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,HEALTHFIRST-Medicaid, +81472,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,HEALTHFIRST-Medicaid, +81473,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,HEALTHFIRST-Medicaid, +81474,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,HEALTHFIRST-Medicaid, +81475,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,HEALTHFIRST-Medicaid, +81476,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,HEALTHFIRST-Medicaid, +81477,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,HEALTHFIRST-Medicaid, +81478,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,HEALTHFIRST-Medicaid, +81479,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,HEALTHFIRST-Medicaid, +81480,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,HEALTHFIRST-Medicaid, +81481,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,HEALTHFIRST-Medicaid, +81482,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,HEALTHFIRST-Medicaid, +81483,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,HEALTHFIRST-Medicaid, +81484,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,HEALTHFIRST-Medicaid, +81485,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,HEALTHFIRST-Medicaid, +81486,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,HEALTHFIRST-Medicaid, +81487,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,HEALTHFIRST-Medicaid, +81488,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,HEALTHFIRST-Medicaid, +81489,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,HEALTHFIRST-Medicaid, +81490,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,HEALTHFIRST-Medicaid, +81491,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,HEALTHFIRST-Medicaid, +81492,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,HEALTHFIRST-Medicaid, +81493,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,HEALTHFIRST-Medicaid, +81494,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,HEALTHFIRST-Medicaid, +81495,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,HEALTHFIRST-Medicaid, +81496,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,HEALTHFIRST-Medicaid, +81497,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,HEALTHFIRST-Medicaid, +81498,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,HEALTHFIRST-Medicaid, +81499,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,HEALTHFIRST-Medicaid, +81500,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,HEALTHFIRST-Medicaid, +81501,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,HEALTHFIRST-Medicaid, +81502,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,HEALTHFIRST-Medicaid, +81503,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,HEALTHFIRST-Medicaid, +81504,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,HEALTHFIRST-Medicaid, +81505,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,HEALTHFIRST-Medicaid, +81506,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,HEALTHFIRST-Medicaid, +81507,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,HEALTHFIRST-Medicaid, +81508,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,HEALTHFIRST-Medicaid, +81509,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,HEALTHFIRST-Medicaid, +81510,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,HEALTHFIRST-Medicaid, +81511,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,HEALTHFIRST-Medicaid, +81512,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,HEALTHFIRST-Medicaid, +81513,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,HEALTHFIRST-Medicaid, +81514,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,HEALTHFIRST-Medicaid, +81515,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,HEALTHFIRST-Medicaid, +81516,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,HEALTHFIRST-Medicaid, +81517,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,HEALTHFIRST-Medicaid, +81518,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,HEALTHFIRST-Medicaid, +81519,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,HEALTHFIRST-Medicaid, +81520,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,HEALTHFIRST-Medicaid, +81521,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,HEALTHFIRST-Medicaid, +81522,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,HEALTHFIRST-Medicaid, +81523,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,HEALTHFIRST-Medicaid, +81524,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,HEALTHFIRST-Medicaid, +81525,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,HEALTHFIRST-Medicaid, +81526,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,HEALTHFIRST-Medicaid, +81527,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,HEALTHFIRST-Medicaid, +81528,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,HEALTHFIRST-Medicaid, +81529,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,HEALTHFIRST-Medicaid, +81530,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,HEALTHFIRST-Medicaid, +81531,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,HEALTHFIRST-Medicaid, +81532,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,HEALTHFIRST-Medicaid, +81533,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,HEALTHFIRST-Medicaid, +81534,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,HEALTHFIRST-Medicaid, +81535,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,HEALTHFIRST-Medicaid, +81536,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,HEALTHFIRST-Medicaid, +81537,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,HEALTHFIRST-Medicaid, +81538,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,HEALTHFIRST-Medicaid, +81539,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,HEALTHFIRST-Medicaid, +81540,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,HEALTHFIRST-Medicaid, +81541,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,HEALTHFIRST-Medicaid, +81542,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,HEALTHFIRST-Medicaid, +81543,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,HEALTHFIRST-Medicaid, +81544,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,HEALTHFIRST-Medicaid, +81545,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,HEALTHFIRST-Medicaid, +81546,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,HEALTHFIRST-Medicaid, +81547,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,HEALTHFIRST-Medicaid, +81548,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,HEALTHFIRST-Medicaid, +81549,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,HEALTHFIRST-Medicaid, +81550,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,HEALTHFIRST-Medicaid, +81551,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,HEALTHFIRST-Medicaid, +81552,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,HEALTHFIRST-Medicaid, +81553,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,HEALTHFIRST-Medicaid, +81554,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,HEALTHFIRST-Medicaid, +81555,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,HEALTHFIRST-Medicaid, +81556,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,HEALTHFIRST-Medicaid, +81557,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,HEALTHFIRST-Medicaid, +81558,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,HEALTHFIRST-Medicaid, +81559,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,HEALTHFIRST-Medicaid, +81560,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,HEALTHFIRST-Medicaid, +81561,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,HEALTHFIRST-Medicaid, +81562,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,HEALTHFIRST-Medicaid, +81563,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,HEALTHFIRST-Medicaid, +81564,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,HEALTHFIRST-Medicaid, +81565,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicaid, +81566,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81567,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81568,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81569,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81570,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81571,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,HEALTHFIRST-Medicaid, +81572,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,HEALTHFIRST-Medicaid, +81573,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,HEALTHFIRST-Medicaid, +81574,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81575,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81576,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81577,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,HEALTHFIRST-Medicaid, +81578,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,HEALTHFIRST-Medicaid, +81579,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,HEALTHFIRST-Medicaid, +81580,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,HEALTHFIRST-Medicaid, +81581,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,HEALTHFIRST-Medicaid, +81582,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,HEALTHFIRST-Medicaid, +81583,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,HEALTHFIRST-Medicaid, +81584,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,HEALTHFIRST-Medicaid, +81585,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,HEALTHFIRST-Medicaid, +81586,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,HEALTHFIRST-Medicaid, +81587,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,HEALTHFIRST-Medicaid, +81588,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,HEALTHFIRST-Medicaid, +81589,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,HEALTHFIRST-Medicaid, +81590,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,HEALTHFIRST-Medicaid, +81591,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,HEALTHFIRST-Medicaid, +81592,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,HEALTHFIRST-Medicaid, +81593,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,HEALTHFIRST-Medicaid, +81594,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,HEALTHFIRST-Medicaid, +81595,3934,43301043,ALBUNEX,,357.0,357.0,,,HEALTHFIRST-Medicaid, +81596,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,HEALTHFIRST-Medicaid, +81597,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81598,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81599,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81600,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81601,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81602,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,HEALTHFIRST-Medicaid, +81603,3934,43450022,REC RM .5HR,,541.0,541.0,,,HEALTHFIRST-Medicaid, +81604,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,HEALTHFIRST-Medicaid, +81605,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,HEALTHFIRST-Medicaid, +81606,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,HEALTHFIRST-Medicaid, +81607,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,HEALTHFIRST-Medicaid, +81608,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,HEALTHFIRST-Medicaid, +81609,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,HEALTHFIRST-Medicaid, +81610,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,HEALTHFIRST-Medicaid, +81611,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,HEALTHFIRST-Medicaid, +81612,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,HEALTHFIRST-Medicaid, +81613,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,HEALTHFIRST-Medicaid, +81614,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,HEALTHFIRST-Medicaid, +81615,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,HEALTHFIRST-Medicaid, +81616,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,HEALTHFIRST-Medicaid, +81617,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,HEALTHFIRST-Medicaid, +81618,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,HEALTHFIRST-Medicaid, +81619,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,HEALTHFIRST-Medicaid, +81620,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicaid, +81621,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81622,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81623,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81624,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81625,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81626,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,HEALTHFIRST-Medicaid, +81627,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81628,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicaid, +81629,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81630,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81631,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81632,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81633,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,HEALTHFIRST-Medicaid, +81634,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicaid, +81635,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81636,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81637,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81638,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81639,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81640,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicaid, +81641,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81642,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81643,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81644,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81645,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81646,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,HEALTHFIRST-Medicaid, +81647,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,HEALTHFIRST-Medicaid, +81648,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,HEALTHFIRST-Medicaid, +81649,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,HEALTHFIRST-Medicaid, +81650,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,HEALTHFIRST-Medicaid, +81651,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,HEALTHFIRST-Medicaid, +81652,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,HEALTHFIRST-Medicaid, +81653,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,HEALTHFIRST-Medicaid, +81654,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicaid, +81655,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81656,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81657,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81658,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81659,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81660,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81661,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,HEALTHFIRST-Medicaid, +81662,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,HEALTHFIRST-Medicaid, +81663,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,HEALTHFIRST-Medicaid, +81664,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,HEALTHFIRST-Medicaid, +81665,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,HEALTHFIRST-Medicaid, +81666,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,HEALTHFIRST-Medicaid, +81667,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,HEALTHFIRST-Medicaid, +81668,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,HEALTHFIRST-Medicaid, +81669,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,HEALTHFIRST-Medicaid, +81670,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,HEALTHFIRST-Medicaid, +81671,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,HEALTHFIRST-Medicaid, +81672,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,HEALTHFIRST-Medicaid, +81673,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,HEALTHFIRST-Medicaid, +81674,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,HEALTHFIRST-Medicaid, +81675,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,HEALTHFIRST-Medicaid, +81676,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,HEALTHFIRST-Medicaid, +81677,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,HEALTHFIRST-Medicaid, +81678,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,HEALTHFIRST-Medicaid, +81679,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,HEALTHFIRST-Medicaid, +81680,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,HEALTHFIRST-Medicaid, +81681,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,HEALTHFIRST-Medicaid, +81682,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,HEALTHFIRST-Medicaid, +81683,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,HEALTHFIRST-Medicaid, +81684,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,HEALTHFIRST-Medicaid, +81685,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,HEALTHFIRST-Medicaid, +81686,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,HEALTHFIRST-Medicaid, +81687,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,HEALTHFIRST-Medicaid, +81688,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,HEALTHFIRST-Medicaid, +81689,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,HEALTHFIRST-Medicaid, +81690,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,HEALTHFIRST-Medicaid, +81691,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,HEALTHFIRST-Medicaid, +81692,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,HEALTHFIRST-Medicaid, +81693,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,HEALTHFIRST-Medicaid, +81694,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,HEALTHFIRST-Medicaid, +81695,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,HEALTHFIRST-Medicaid, +81696,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,HEALTHFIRST-Medicaid, +81697,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,HEALTHFIRST-Medicaid, +81698,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,HEALTHFIRST-Medicaid, +81699,3934,45924552,ENDO REC RM,,30.0,30.0,,,HEALTHFIRST-Medicaid, +81700,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,HEALTHFIRST-Medicaid, +81701,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,HEALTHFIRST-Medicaid, +81702,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,HEALTHFIRST-Medicaid, +81703,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,HEALTHFIRST-Medicaid, +81704,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,HEALTHFIRST-Medicaid, +81705,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,HEALTHFIRST-Medicaid, +81706,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,HEALTHFIRST-Medicaid, +81707,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,HEALTHFIRST-Medicaid, +81708,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,HEALTHFIRST-Medicaid, +81709,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,HEALTHFIRST-Medicaid, +81710,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,HEALTHFIRST-Medicaid, +81711,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,HEALTHFIRST-Medicaid, +81712,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,HEALTHFIRST-Medicaid, +81713,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,HEALTHFIRST-Medicaid, +81714,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,HEALTHFIRST-Medicaid, +81715,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,HEALTHFIRST-Medicaid, +81716,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,HEALTHFIRST-Medicaid, +81717,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,HEALTHFIRST-Medicaid, +81718,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,HEALTHFIRST-Medicaid, +81719,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,HEALTHFIRST-Medicaid, +81720,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,HEALTHFIRST-Medicaid, +81721,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,HEALTHFIRST-Medicaid, +81722,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,HEALTHFIRST-Medicaid, +81723,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,HEALTHFIRST-Medicaid, +81724,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,HEALTHFIRST-Medicaid, +81725,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,HEALTHFIRST-Medicaid, +81726,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicaid, +81727,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicaid, +81728,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicaid, +81729,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicaid, +81730,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicaid, +81731,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicaid, +81732,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,HEALTHFIRST-Medicaid, +81733,3934,53200010,GUEST TRAY,,24.0,24.0,,,HEALTHFIRST-Medicaid, +81734,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,HEALTHFIRST-Medicaid, +81735,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,HEALTHFIRST-Medicaid, +81736,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,HEALTHFIRST-Medicaid, +81737,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,HEALTHFIRST-Medicaid, +81738,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,HEALTHFIRST-Medicaid, +81739,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,HEALTHFIRST-Medicaid, +81740,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,HEALTHFIRST-Medicaid, +81741,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,HEALTHFIRST-Medicaid, +81742,3934,53329876,HIV MONITORING,,416.0,416.0,,,HEALTHFIRST-Medicaid, +81743,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,HEALTHFIRST-Medicaid, +81744,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,HEALTHFIRST-Medicaid, +81745,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,HEALTHFIRST-Medicaid, +81746,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,HEALTHFIRST-Medicaid, +81747,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,HEALTHFIRST-Medicaid, +81748,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,HEALTHFIRST-Medicaid, +81749,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,HEALTHFIRST-Medicaid, +81750,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,HEALTHFIRST-Medicaid, +81751,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,HEALTHFIRST-Medicaid, +81752,3934,76010107,COPY X-RAY,,22.0,22.0,,,HEALTHFIRST-Medicaid, +81753,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,HEALTHFIRST-Medicaid, +81754,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,HEALTHFIRST-Medicaid, +81755,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,HEALTHFIRST-Medicaid, +81756,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,HEALTHFIRST-Medicaid, +81757,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,HEALTHFIRST-Medicaid, +81758,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,HEALTHFIRST-Medicaid, +81759,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,HEALTHFIRST-Medicaid, +81760,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,HEALTHFIRST-Medicaid, +81761,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,HEALTHFIRST-Medicaid, +81762,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,HEALTHFIRST-Medicaid, +81763,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,HEALTHFIRST-Medicaid, +81764,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,HEALTHFIRST-Medicaid, +81765,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,HEALTHFIRST-Medicare Advantage, +81766,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,HEALTHFIRST-Medicare Advantage, +81767,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,HEALTHFIRST-Medicare Advantage, +81768,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,HEALTHFIRST-Medicare Advantage, +81769,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,HEALTHFIRST-Medicare Advantage, +81770,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,HEALTHFIRST-Medicare Advantage, +81771,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,HEALTHFIRST-Medicare Advantage, +81772,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,HEALTHFIRST-Medicare Advantage, +81773,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,HEALTHFIRST-Medicare Advantage, +81774,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,HEALTHFIRST-Medicare Advantage, +81775,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,HEALTHFIRST-Medicare Advantage, +81776,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,HEALTHFIRST-Medicare Advantage, +81777,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,HEALTHFIRST-Medicare Advantage,46014.11 +81778,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,HEALTHFIRST-Medicare Advantage, +81779,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,HEALTHFIRST-Medicare Advantage, +81780,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,HEALTHFIRST-Medicare Advantage, +81781,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,HEALTHFIRST-Medicare Advantage, +81782,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,HEALTHFIRST-Medicare Advantage, +81783,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,HEALTHFIRST-Medicare Advantage, +81784,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,HEALTHFIRST-Medicare Advantage, +81785,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,HEALTHFIRST-Medicare Advantage, +81786,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,HEALTHFIRST-Medicare Advantage, +81787,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,HEALTHFIRST-Medicare Advantage, +81788,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,HEALTHFIRST-Medicare Advantage, +81789,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,HEALTHFIRST-Medicare Advantage, +81790,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,HEALTHFIRST-Medicare Advantage, +81791,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,HEALTHFIRST-Medicare Advantage, +81792,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,HEALTHFIRST-Medicare Advantage, +81793,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,HEALTHFIRST-Medicare Advantage, +81794,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,HEALTHFIRST-Medicare Advantage, +81795,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,HEALTHFIRST-Medicare Advantage, +81796,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,HEALTHFIRST-Medicare Advantage, +81797,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,HEALTHFIRST-Medicare Advantage, +81798,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,HEALTHFIRST-Medicare Advantage, +81799,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,HEALTHFIRST-Medicare Advantage,13142.03 +81800,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,HEALTHFIRST-Medicare Advantage, +81801,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,HEALTHFIRST-Medicare Advantage, +81802,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,HEALTHFIRST-Medicare Advantage,10447.04 +81803,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,HEALTHFIRST-Medicare Advantage, +81804,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,HEALTHFIRST-Medicare Advantage, +81805,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,HEALTHFIRST-Medicare Advantage, +81806,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,HEALTHFIRST-Medicare Advantage, +81807,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,HEALTHFIRST-Medicare Advantage, +81808,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,HEALTHFIRST-Medicare Advantage, +81809,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,HEALTHFIRST-Medicare Advantage, +81810,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,HEALTHFIRST-Medicare Advantage, +81811,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,HEALTHFIRST-Medicare Advantage, +81812,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,HEALTHFIRST-Medicare Advantage, +81813,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,HEALTHFIRST-Medicare Advantage, +81814,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,HEALTHFIRST-Medicare Advantage, +81815,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,HEALTHFIRST-Medicare Advantage, +81816,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,HEALTHFIRST-Medicare Advantage, +81817,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,HEALTHFIRST-Medicare Advantage, +81818,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,HEALTHFIRST-Medicare Advantage,9956.47 +81819,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,HEALTHFIRST-Medicare Advantage, +81820,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,HEALTHFIRST-Medicare Advantage, +81821,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,HEALTHFIRST-Medicare Advantage, +81822,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,HEALTHFIRST-Medicare Advantage, +81823,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,HEALTHFIRST-Medicare Advantage, +81824,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,HEALTHFIRST-Medicare Advantage, +81825,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,HEALTHFIRST-Medicare Advantage, +81826,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,HEALTHFIRST-Medicare Advantage, +81827,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,HEALTHFIRST-Medicare Advantage, +81828,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,HEALTHFIRST-Medicare Advantage, +81829,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,HEALTHFIRST-Medicare Advantage, +81830,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,HEALTHFIRST-Medicare Advantage, +81831,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,HEALTHFIRST-Medicare Advantage, +81832,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,HEALTHFIRST-Medicare Advantage, +81833,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,HEALTHFIRST-Medicare Advantage, +81834,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,HEALTHFIRST-Medicare Advantage, +81835,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,HEALTHFIRST-Medicare Advantage, +81836,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,HEALTHFIRST-Medicare Advantage, +81837,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,HEALTHFIRST-Medicare Advantage, +81838,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,HEALTHFIRST-Medicare Advantage, +81839,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,HEALTHFIRST-Medicare Advantage, +81840,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,HEALTHFIRST-Medicare Advantage, +81841,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,HEALTHFIRST-Medicare Advantage, +81842,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,HEALTHFIRST-Medicare Advantage, +81843,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,HEALTHFIRST-Medicare Advantage, +81844,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,HEALTHFIRST-Medicare Advantage, +81845,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,HEALTHFIRST-Medicare Advantage, +81846,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,HEALTHFIRST-Medicare Advantage, +81847,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,HEALTHFIRST-Medicare Advantage, +81848,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,HEALTHFIRST-Medicare Advantage, +81849,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,HEALTHFIRST-Medicare Advantage, +81850,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,HEALTHFIRST-Medicare Advantage, +81851,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,HEALTHFIRST-Medicare Advantage, +81852,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,HEALTHFIRST-Medicare Advantage, +81853,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,HEALTHFIRST-Medicare Advantage, +81854,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,HEALTHFIRST-Medicare Advantage, +81855,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,HEALTHFIRST-Medicare Advantage, +81856,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,HEALTHFIRST-Medicare Advantage, +81857,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,HEALTHFIRST-Medicare Advantage, +81858,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,HEALTHFIRST-Medicare Advantage, +81859,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,HEALTHFIRST-Medicare Advantage, +81860,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,HEALTHFIRST-Medicare Advantage, +81861,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,HEALTHFIRST-Medicare Advantage, +81862,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,HEALTHFIRST-Medicare Advantage, +81863,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,HEALTHFIRST-Medicare Advantage, +81864,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,HEALTHFIRST-Medicare Advantage, +81865,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,HEALTHFIRST-Medicare Advantage, +81866,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,HEALTHFIRST-Medicare Advantage, +81867,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,HEALTHFIRST-Medicare Advantage, +81868,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,HEALTHFIRST-Medicare Advantage, +81869,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,HEALTHFIRST-Medicare Advantage, +81870,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,HEALTHFIRST-Medicare Advantage, +81871,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,HEALTHFIRST-Medicare Advantage, +81872,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,HEALTHFIRST-Medicare Advantage, +81873,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,HEALTHFIRST-Medicare Advantage, +81874,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,HEALTHFIRST-Medicare Advantage, +81875,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,HEALTHFIRST-Medicare Advantage, +81876,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,HEALTHFIRST-Medicare Advantage, +81877,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,HEALTHFIRST-Medicare Advantage, +81878,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,HEALTHFIRST-Medicare Advantage, +81879,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,HEALTHFIRST-Medicare Advantage, +81880,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,HEALTHFIRST-Medicare Advantage, +81881,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,HEALTHFIRST-Medicare Advantage, +81882,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,HEALTHFIRST-Medicare Advantage, +81883,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,HEALTHFIRST-Medicare Advantage, +81884,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,HEALTHFIRST-Medicare Advantage, +81885,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,HEALTHFIRST-Medicare Advantage, +81886,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,HEALTHFIRST-Medicare Advantage,18730.16 +81887,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,HEALTHFIRST-Medicare Advantage, +81888,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,HEALTHFIRST-Medicare Advantage, +81889,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,HEALTHFIRST-Medicare Advantage, +81890,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,HEALTHFIRST-Medicare Advantage, +81891,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,HEALTHFIRST-Medicare Advantage, +81892,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,HEALTHFIRST-Medicare Advantage, +81893,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,HEALTHFIRST-Medicare Advantage, +81894,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,HEALTHFIRST-Medicare Advantage, +81895,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,HEALTHFIRST-Medicare Advantage, +81896,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,HEALTHFIRST-Medicare Advantage, +81897,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,HEALTHFIRST-Medicare Advantage, +81898,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,HEALTHFIRST-Medicare Advantage, +81899,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,HEALTHFIRST-Medicare Advantage, +81900,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,HEALTHFIRST-Medicare Advantage, +81901,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,HEALTHFIRST-Medicare Advantage, +81902,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,HEALTHFIRST-Medicare Advantage, +81903,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,HEALTHFIRST-Medicare Advantage, +81904,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,HEALTHFIRST-Medicare Advantage, +81905,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,HEALTHFIRST-Medicare Advantage, +81906,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,HEALTHFIRST-Medicare Advantage, +81907,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,HEALTHFIRST-Medicare Advantage, +81908,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,HEALTHFIRST-Medicare Advantage, +81909,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,HEALTHFIRST-Medicare Advantage, +81910,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,HEALTHFIRST-Medicare Advantage, +81911,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,HEALTHFIRST-Medicare Advantage, +81912,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,HEALTHFIRST-Medicare Advantage, +81913,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,HEALTHFIRST-Medicare Advantage, +81914,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,HEALTHFIRST-Medicare Advantage, +81915,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,HEALTHFIRST-Medicare Advantage,104231.31 +81916,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,HEALTHFIRST-Medicare Advantage, +81917,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,HEALTHFIRST-Medicare Advantage, +81918,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,HEALTHFIRST-Medicare Advantage, +81919,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,HEALTHFIRST-Medicare Advantage, +81920,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,HEALTHFIRST-Medicare Advantage, +81921,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,HEALTHFIRST-Medicare Advantage, +81922,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,HEALTHFIRST-Medicare Advantage, +81923,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,HEALTHFIRST-Medicare Advantage, +81924,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,HEALTHFIRST-Medicare Advantage, +81925,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,HEALTHFIRST-Medicare Advantage, +81926,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,HEALTHFIRST-Medicare Advantage, +81927,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,HEALTHFIRST-Medicare Advantage, +81928,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,HEALTHFIRST-Medicare Advantage, +81929,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,HEALTHFIRST-Medicare Advantage, +81930,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,HEALTHFIRST-Medicare Advantage, +81931,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,HEALTHFIRST-Medicare Advantage, +81932,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,HEALTHFIRST-Medicare Advantage, +81933,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,HEALTHFIRST-Medicare Advantage, +81934,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,HEALTHFIRST-Medicare Advantage, +81935,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,HEALTHFIRST-Medicare Advantage, +81936,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,HEALTHFIRST-Medicare Advantage, +81937,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,HEALTHFIRST-Medicare Advantage, +81938,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,HEALTHFIRST-Medicare Advantage,22789.57 +81939,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,HEALTHFIRST-Medicare Advantage, +81940,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,HEALTHFIRST-Medicare Advantage, +81941,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,HEALTHFIRST-Medicare Advantage, +81942,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,HEALTHFIRST-Medicare Advantage, +81943,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,HEALTHFIRST-Medicare Advantage, +81944,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,HEALTHFIRST-Medicare Advantage, +81945,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,HEALTHFIRST-Medicare Advantage, +81946,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,HEALTHFIRST-Medicare Advantage, +81947,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,HEALTHFIRST-Medicare Advantage, +81948,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,HEALTHFIRST-Medicare Advantage, +81949,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,HEALTHFIRST-Medicare Advantage, +81950,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,HEALTHFIRST-Medicare Advantage, +81951,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,HEALTHFIRST-Medicare Advantage, +81952,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,HEALTHFIRST-Medicare Advantage, +81953,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,HEALTHFIRST-Medicare Advantage, +81954,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,HEALTHFIRST-Medicare Advantage, +81955,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,HEALTHFIRST-Medicare Advantage, +81956,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,HEALTHFIRST-Medicare Advantage, +81957,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,HEALTHFIRST-Medicare Advantage, +81958,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,HEALTHFIRST-Medicare Advantage, +81959,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,HEALTHFIRST-Medicare Advantage, +81960,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,HEALTHFIRST-Medicare Advantage, +81961,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,HEALTHFIRST-Medicare Advantage, +81962,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,HEALTHFIRST-Medicare Advantage, +81963,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,HEALTHFIRST-Medicare Advantage, +81964,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,HEALTHFIRST-Medicare Advantage, +81965,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,HEALTHFIRST-Medicare Advantage, +81966,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,HEALTHFIRST-Medicare Advantage, +81967,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,HEALTHFIRST-Medicare Advantage, +81968,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,HEALTHFIRST-Medicare Advantage, +81969,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,HEALTHFIRST-Medicare Advantage, +81970,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,HEALTHFIRST-Medicare Advantage, +81971,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,HEALTHFIRST-Medicare Advantage, +81972,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,HEALTHFIRST-Medicare Advantage, +81973,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,HEALTHFIRST-Medicare Advantage, +81974,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,HEALTHFIRST-Medicare Advantage, +81975,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,HEALTHFIRST-Medicare Advantage, +81976,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,HEALTHFIRST-Medicare Advantage, +81977,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,HEALTHFIRST-Medicare Advantage, +81978,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,HEALTHFIRST-Medicare Advantage,14472.94 +81979,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,HEALTHFIRST-Medicare Advantage, +81980,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,HEALTHFIRST-Medicare Advantage, +81981,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,HEALTHFIRST-Medicare Advantage, +81982,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,HEALTHFIRST-Medicare Advantage, +81983,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,HEALTHFIRST-Medicare Advantage, +81984,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,HEALTHFIRST-Medicare Advantage, +81985,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,HEALTHFIRST-Medicare Advantage, +81986,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,HEALTHFIRST-Medicare Advantage, +81987,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,HEALTHFIRST-Medicare Advantage, +81988,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,HEALTHFIRST-Medicare Advantage,7955.29 +81989,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,HEALTHFIRST-Medicare Advantage, +81990,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,HEALTHFIRST-Medicare Advantage, +81991,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,HEALTHFIRST-Medicare Advantage,10261.24 +81992,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,HEALTHFIRST-Medicare Advantage, +81993,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,HEALTHFIRST-Medicare Advantage, +81994,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,HEALTHFIRST-Medicare Advantage, +81995,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,HEALTHFIRST-Medicare Advantage, +81996,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,HEALTHFIRST-Medicare Advantage,7808.94 +81997,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,HEALTHFIRST-Medicare Advantage, +81998,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,HEALTHFIRST-Medicare Advantage, +81999,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,HEALTHFIRST-Medicare Advantage, +82000,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,HEALTHFIRST-Medicare Advantage, +82001,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,HEALTHFIRST-Medicare Advantage, +82002,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,HEALTHFIRST-Medicare Advantage, +82003,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,HEALTHFIRST-Medicare Advantage, +82004,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,HEALTHFIRST-Medicare Advantage, +82005,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,HEALTHFIRST-Medicare Advantage, +82006,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,HEALTHFIRST-Medicare Advantage, +82007,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,HEALTHFIRST-Medicare Advantage, +82008,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,HEALTHFIRST-Medicare Advantage, +82009,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,HEALTHFIRST-Medicare Advantage, +82010,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,HEALTHFIRST-Medicare Advantage, +82011,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,HEALTHFIRST-Medicare Advantage, +82012,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,HEALTHFIRST-Medicare Advantage, +82013,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,HEALTHFIRST-Medicare Advantage, +82014,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,HEALTHFIRST-Medicare Advantage, +82015,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,HEALTHFIRST-Medicare Advantage, +82016,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,HEALTHFIRST-Medicare Advantage, +82017,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,HEALTHFIRST-Medicare Advantage, +82018,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,HEALTHFIRST-Medicare Advantage, +82019,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,HEALTHFIRST-Medicare Advantage, +82020,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,HEALTHFIRST-Medicare Advantage, +82021,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,HEALTHFIRST-Medicare Advantage, +82022,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,HEALTHFIRST-Medicare Advantage, +82023,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,HEALTHFIRST-Medicare Advantage, +82024,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,HEALTHFIRST-Medicare Advantage, +82025,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,HEALTHFIRST-Medicare Advantage, +82026,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,HEALTHFIRST-Medicare Advantage, +82027,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,HEALTHFIRST-Medicare Advantage, +82028,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,HEALTHFIRST-Medicare Advantage, +82029,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,HEALTHFIRST-Medicare Advantage, +82030,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,HEALTHFIRST-Medicare Advantage, +82031,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,HEALTHFIRST-Medicare Advantage, +82032,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,HEALTHFIRST-Medicare Advantage, +82033,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,HEALTHFIRST-Medicare Advantage, +82034,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,HEALTHFIRST-Medicare Advantage, +82035,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,HEALTHFIRST-Medicare Advantage, +82036,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,HEALTHFIRST-Medicare Advantage, +82037,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,HEALTHFIRST-Medicare Advantage, +82038,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,HEALTHFIRST-Medicare Advantage, +82039,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,HEALTHFIRST-Medicare Advantage, +82040,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,HEALTHFIRST-Medicare Advantage, +82041,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,HEALTHFIRST-Medicare Advantage, +82042,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,HEALTHFIRST-Medicare Advantage, +82043,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,HEALTHFIRST-Medicare Advantage, +82044,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,HEALTHFIRST-Medicare Advantage, +82045,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,HEALTHFIRST-Medicare Advantage, +82046,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,HEALTHFIRST-Medicare Advantage, +82047,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,HEALTHFIRST-Medicare Advantage, +82048,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,HEALTHFIRST-Medicare Advantage, +82049,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,HEALTHFIRST-Medicare Advantage, +82050,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,HEALTHFIRST-Medicare Advantage, +82051,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,HEALTHFIRST-Medicare Advantage, +82052,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,HEALTHFIRST-Medicare Advantage, +82053,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,HEALTHFIRST-Medicare Advantage, +82054,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,HEALTHFIRST-Medicare Advantage, +82055,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,HEALTHFIRST-Medicare Advantage, +82056,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,HEALTHFIRST-Medicare Advantage, +82057,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,HEALTHFIRST-Medicare Advantage, +82058,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,HEALTHFIRST-Medicare Advantage, +82059,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,HEALTHFIRST-Medicare Advantage, +82060,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,HEALTHFIRST-Medicare Advantage, +82061,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,HEALTHFIRST-Medicare Advantage, +82062,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,HEALTHFIRST-Medicare Advantage, +82063,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,HEALTHFIRST-Medicare Advantage, +82064,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,HEALTHFIRST-Medicare Advantage, +82065,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,HEALTHFIRST-Medicare Advantage, +82066,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,HEALTHFIRST-Medicare Advantage, +82067,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,HEALTHFIRST-Medicare Advantage,11219.12 +82068,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,HEALTHFIRST-Medicare Advantage, +82069,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,HEALTHFIRST-Medicare Advantage, +82070,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,HEALTHFIRST-Medicare Advantage, +82071,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,HEALTHFIRST-Medicare Advantage, +82072,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,HEALTHFIRST-Medicare Advantage, +82073,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,HEALTHFIRST-Medicare Advantage, +82074,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,HEALTHFIRST-Medicare Advantage, +82075,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,HEALTHFIRST-Medicare Advantage, +82076,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,HEALTHFIRST-Medicare Advantage, +82077,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,HEALTHFIRST-Medicare Advantage, +82078,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,HEALTHFIRST-Medicare Advantage, +82079,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,HEALTHFIRST-Medicare Advantage, +82080,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,HEALTHFIRST-Medicare Advantage, +82081,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,HEALTHFIRST-Medicare Advantage, +82082,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,HEALTHFIRST-Medicare Advantage, +82083,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,HEALTHFIRST-Medicare Advantage, +82084,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,HEALTHFIRST-Medicare Advantage, +82085,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,HEALTHFIRST-Medicare Advantage, +82086,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,HEALTHFIRST-Medicare Advantage, +82087,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,HEALTHFIRST-Medicare Advantage, +82088,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,HEALTHFIRST-Medicare Advantage, +82089,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,HEALTHFIRST-Medicare Advantage, +82090,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,HEALTHFIRST-Medicare Advantage, +82091,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,HEALTHFIRST-Medicare Advantage, +82092,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,HEALTHFIRST-Medicare Advantage, +82093,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,HEALTHFIRST-Medicare Advantage, +82094,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,HEALTHFIRST-Medicare Advantage, +82095,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,HEALTHFIRST-Medicare Advantage, +82096,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,HEALTHFIRST-Medicare Advantage, +82097,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,HEALTHFIRST-Medicare Advantage, +82098,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,HEALTHFIRST-Medicare Advantage, +82099,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,HEALTHFIRST-Medicare Advantage, +82100,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,HEALTHFIRST-Medicare Advantage, +82101,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,HEALTHFIRST-Medicare Advantage, +82102,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,HEALTHFIRST-Medicare Advantage, +82103,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,HEALTHFIRST-Medicare Advantage, +82104,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,HEALTHFIRST-Medicare Advantage, +82105,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,HEALTHFIRST-Medicare Advantage, +82106,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,HEALTHFIRST-Medicare Advantage, +82107,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,HEALTHFIRST-Medicare Advantage, +82108,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,HEALTHFIRST-Medicare Advantage, +82109,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,HEALTHFIRST-Medicare Advantage,19175.46 +82110,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,HEALTHFIRST-Medicare Advantage, +82111,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,HEALTHFIRST-Medicare Advantage, +82112,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,HEALTHFIRST-Medicare Advantage, +82113,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,HEALTHFIRST-Medicare Advantage, +82114,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,HEALTHFIRST-Medicare Advantage, +82115,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,HEALTHFIRST-Medicare Advantage, +82116,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,HEALTHFIRST-Medicare Advantage, +82117,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,HEALTHFIRST-Medicare Advantage, +82118,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,HEALTHFIRST-Medicare Advantage,15319.09 +82119,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,HEALTHFIRST-Medicare Advantage, +82120,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,HEALTHFIRST-Medicare Advantage, +82121,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,HEALTHFIRST-Medicare Advantage, +82122,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,HEALTHFIRST-Medicare Advantage, +82123,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,HEALTHFIRST-Medicare Advantage, +82124,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,HEALTHFIRST-Medicare Advantage, +82125,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,HEALTHFIRST-Medicare Advantage, +82126,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,HEALTHFIRST-Medicare Advantage, +82127,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,HEALTHFIRST-Medicare Advantage, +82128,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,HEALTHFIRST-Medicare Advantage,15846.14 +82129,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,HEALTHFIRST-Medicare Advantage, +82130,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,HEALTHFIRST-Medicare Advantage, +82131,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,HEALTHFIRST-Medicare Advantage, +82132,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,HEALTHFIRST-Medicare Advantage, +82133,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,HEALTHFIRST-Medicare Advantage, +82134,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,HEALTHFIRST-Medicare Advantage, +82135,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,HEALTHFIRST-Medicare Advantage, +82136,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,HEALTHFIRST-Medicare Advantage, +82137,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,HEALTHFIRST-Medicare Advantage, +82138,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,HEALTHFIRST-Medicare Advantage, +82139,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,HEALTHFIRST-Medicare Advantage, +82140,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,HEALTHFIRST-Medicare Advantage, +82141,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,HEALTHFIRST-Medicare Advantage, +82142,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,HEALTHFIRST-Medicare Advantage, +82143,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,HEALTHFIRST-Medicare Advantage, +82144,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,HEALTHFIRST-Medicare Advantage, +82145,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,HEALTHFIRST-Medicare Advantage, +82146,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,HEALTHFIRST-Medicare Advantage, +82147,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,HEALTHFIRST-Medicare Advantage, +82148,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,HEALTHFIRST-Medicare Advantage, +82149,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,HEALTHFIRST-Medicare Advantage, +82150,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,HEALTHFIRST-Medicare Advantage, +82151,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,HEALTHFIRST-Medicare Advantage, +82152,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,HEALTHFIRST-Medicare Advantage, +82153,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,HEALTHFIRST-Medicare Advantage, +82154,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,HEALTHFIRST-Medicare Advantage,9676.87 +82155,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,HEALTHFIRST-Medicare Advantage, +82156,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,HEALTHFIRST-Medicare Advantage, +82157,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,HEALTHFIRST-Medicare Advantage, +82158,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,HEALTHFIRST-Medicare Advantage, +82159,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,HEALTHFIRST-Medicare Advantage, +82160,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,HEALTHFIRST-Medicare Advantage, +82161,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,HEALTHFIRST-Medicare Advantage, +82162,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,HEALTHFIRST-Medicare Advantage, +82163,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,HEALTHFIRST-Medicare Advantage, +82164,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,HEALTHFIRST-Medicare Advantage, +82165,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,HEALTHFIRST-Medicare Advantage, +82166,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,HEALTHFIRST-Medicare Advantage, +82167,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,HEALTHFIRST-Medicare Advantage, +82168,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,HEALTHFIRST-Medicare Advantage, +82169,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,HEALTHFIRST-Medicare Advantage, +82170,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,HEALTHFIRST-Medicare Advantage, +82171,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,HEALTHFIRST-Medicare Advantage, +82172,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,HEALTHFIRST-Medicare Advantage, +82173,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,HEALTHFIRST-Medicare Advantage, +82174,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,HEALTHFIRST-Medicare Advantage, +82175,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,HEALTHFIRST-Medicare Advantage, +82176,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,HEALTHFIRST-Medicare Advantage, +82177,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,HEALTHFIRST-Medicare Advantage, +82178,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,HEALTHFIRST-Medicare Advantage, +82179,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,HEALTHFIRST-Medicare Advantage, +82180,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,HEALTHFIRST-Medicare Advantage, +82181,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,HEALTHFIRST-Medicare Advantage, +82182,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,HEALTHFIRST-Medicare Advantage, +82183,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,HEALTHFIRST-Medicare Advantage, +82184,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,HEALTHFIRST-Medicare Advantage, +82185,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,HEALTHFIRST-Medicare Advantage, +82186,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,HEALTHFIRST-Medicare Advantage, +82187,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,HEALTHFIRST-Medicare Advantage, +82188,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,HEALTHFIRST-Medicare Advantage, +82189,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,HEALTHFIRST-Medicare Advantage, +82190,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,HEALTHFIRST-Medicare Advantage, +82191,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,HEALTHFIRST-Medicare Advantage, +82192,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,HEALTHFIRST-Medicare Advantage, +82193,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,HEALTHFIRST-Medicare Advantage, +82194,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,HEALTHFIRST-Medicare Advantage, +82195,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,HEALTHFIRST-Medicare Advantage, +82196,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,HEALTHFIRST-Medicare Advantage, +82197,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,HEALTHFIRST-Medicare Advantage, +82198,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,HEALTHFIRST-Medicare Advantage, +82199,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,HEALTHFIRST-Medicare Advantage, +82200,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,HEALTHFIRST-Medicare Advantage, +82201,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,HEALTHFIRST-Medicare Advantage, +82202,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,HEALTHFIRST-Medicare Advantage, +82203,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,HEALTHFIRST-Medicare Advantage, +82204,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,HEALTHFIRST-Medicare Advantage, +82205,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,HEALTHFIRST-Medicare Advantage, +82206,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,HEALTHFIRST-Medicare Advantage,11853.67 +82207,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,HEALTHFIRST-Medicare Advantage, +82208,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,HEALTHFIRST-Medicare Advantage, +82209,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,HEALTHFIRST-Medicare Advantage, +82210,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,HEALTHFIRST-Medicare Advantage, +82211,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,HEALTHFIRST-Medicare Advantage, +82212,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,HEALTHFIRST-Medicare Advantage, +82213,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,HEALTHFIRST-Medicare Advantage, +82214,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,HEALTHFIRST-Medicare Advantage, +82215,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,HEALTHFIRST-Medicare Advantage, +82216,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,HEALTHFIRST-Medicare Advantage, +82217,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,HEALTHFIRST-Medicare Advantage,27179.87 +82218,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,HEALTHFIRST-Medicare Advantage, +82219,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,HEALTHFIRST-Medicare Advantage, +82220,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,HEALTHFIRST-Medicare Advantage, +82221,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,HEALTHFIRST-Medicare Advantage, +82222,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,HEALTHFIRST-Medicare Advantage, +82223,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,HEALTHFIRST-Medicare Advantage, +82224,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,HEALTHFIRST-Medicare Advantage, +82225,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,HEALTHFIRST-Medicare Advantage,12122.56 +82226,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,HEALTHFIRST-Medicare Advantage, +82227,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,HEALTHFIRST-Medicare Advantage, +82228,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,HEALTHFIRST-Medicare Advantage, +82229,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,HEALTHFIRST-Medicare Advantage, +82230,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,HEALTHFIRST-Medicare Advantage, +82231,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,HEALTHFIRST-Medicare Advantage, +82232,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,HEALTHFIRST-Medicare Advantage, +82233,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,HEALTHFIRST-Medicare Advantage, +82234,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,HEALTHFIRST-Medicare Advantage, +82235,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,HEALTHFIRST-Medicare Advantage, +82236,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,HEALTHFIRST-Medicare Advantage,20366.65 +82237,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,HEALTHFIRST-Medicare Advantage,12675.6 +82238,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,HEALTHFIRST-Medicare Advantage, +82239,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,HEALTHFIRST-Medicare Advantage, +82240,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,HEALTHFIRST-Medicare Advantage, +82241,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,HEALTHFIRST-Medicare Advantage, +82242,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,HEALTHFIRST-Medicare Advantage, +82243,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,HEALTHFIRST-Medicare Advantage, +82244,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,HEALTHFIRST-Medicare Advantage, +82245,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,HEALTHFIRST-Medicare Advantage, +82246,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,HEALTHFIRST-Medicare Advantage, +82247,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,HEALTHFIRST-Medicare Advantage, +82248,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,HEALTHFIRST-Medicare Advantage, +82249,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,HEALTHFIRST-Medicare Advantage, +82250,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,HEALTHFIRST-Medicare Advantage, +82251,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,HEALTHFIRST-Medicare Advantage, +82252,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,HEALTHFIRST-Medicare Advantage, +82253,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,HEALTHFIRST-Medicare Advantage, +82254,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,HEALTHFIRST-Medicare Advantage, +82255,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,HEALTHFIRST-Medicare Advantage, +82256,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,HEALTHFIRST-Medicare Advantage, +82257,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,HEALTHFIRST-Medicare Advantage, +82258,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,HEALTHFIRST-Medicare Advantage, +82259,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,HEALTHFIRST-Medicare Advantage, +82260,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,HEALTHFIRST-Medicare Advantage, +82261,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,HEALTHFIRST-Medicare Advantage, +82262,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,HEALTHFIRST-Medicare Advantage, +82263,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,HEALTHFIRST-Medicare Advantage, +82264,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,HEALTHFIRST-Medicare Advantage, +82265,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,HEALTHFIRST-Medicare Advantage, +82266,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,HEALTHFIRST-Medicare Advantage, +82267,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,HEALTHFIRST-Medicare Advantage, +82268,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,HEALTHFIRST-Medicare Advantage, +82269,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,HEALTHFIRST-Medicare Advantage, +82270,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,HEALTHFIRST-Medicare Advantage, +82271,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,HEALTHFIRST-Medicare Advantage, +82272,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,HEALTHFIRST-Medicare Advantage, +82273,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,HEALTHFIRST-Medicare Advantage, +82274,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,HEALTHFIRST-Medicare Advantage, +82275,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,HEALTHFIRST-Medicare Advantage, +82276,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,HEALTHFIRST-Medicare Advantage, +82277,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,HEALTHFIRST-Medicare Advantage, +82278,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,HEALTHFIRST-Medicare Advantage, +82279,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,HEALTHFIRST-Medicare Advantage, +82280,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,HEALTHFIRST-Medicare Advantage, +82281,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,HEALTHFIRST-Medicare Advantage, +82282,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,HEALTHFIRST-Medicare Advantage, +82283,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,HEALTHFIRST-Medicare Advantage, +82284,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,HEALTHFIRST-Medicare Advantage, +82285,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,HEALTHFIRST-Medicare Advantage, +82286,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,HEALTHFIRST-Medicare Advantage, +82287,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,HEALTHFIRST-Medicare Advantage, +82288,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,HEALTHFIRST-Medicare Advantage, +82289,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,HEALTHFIRST-Medicare Advantage, +82290,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,HEALTHFIRST-Medicare Advantage, +82291,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,HEALTHFIRST-Medicare Advantage, +82292,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,HEALTHFIRST-Medicare Advantage, +82293,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,HEALTHFIRST-Medicare Advantage, +82294,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,HEALTHFIRST-Medicare Advantage, +82295,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,HEALTHFIRST-Medicare Advantage, +82296,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,HEALTHFIRST-Medicare Advantage, +82297,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,HEALTHFIRST-Medicare Advantage, +82298,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,HEALTHFIRST-Medicare Advantage, +82299,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,HEALTHFIRST-Medicare Advantage, +82300,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,HEALTHFIRST-Medicare Advantage, +82301,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,HEALTHFIRST-Medicare Advantage, +82302,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,HEALTHFIRST-Medicare Advantage, +82303,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,HEALTHFIRST-Medicare Advantage, +82304,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,HEALTHFIRST-Medicare Advantage, +82305,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,HEALTHFIRST-Medicare Advantage, +82306,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,HEALTHFIRST-Medicare Advantage, +82307,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,HEALTHFIRST-Medicare Advantage,17433.32 +82308,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,HEALTHFIRST-Medicare Advantage, +82309,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,HEALTHFIRST-Medicare Advantage, +82310,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,HEALTHFIRST-Medicare Advantage, +82311,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,HEALTHFIRST-Medicare Advantage, +82312,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,HEALTHFIRST-Medicare Advantage, +82313,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,HEALTHFIRST-Medicare Advantage, +82314,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,HEALTHFIRST-Medicare Advantage, +82315,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,HEALTHFIRST-Medicare Advantage, +82316,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,HEALTHFIRST-Medicare Advantage, +82317,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,HEALTHFIRST-Medicare Advantage, +82318,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,HEALTHFIRST-Medicare Advantage, +82319,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,HEALTHFIRST-Medicare Advantage, +82320,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,HEALTHFIRST-Medicare Advantage, +82321,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,HEALTHFIRST-Medicare Advantage, +82322,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,HEALTHFIRST-Medicare Advantage, +82323,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,HEALTHFIRST-Medicare Advantage, +82324,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,HEALTHFIRST-Medicare Advantage, +82325,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,HEALTHFIRST-Medicare Advantage, +82326,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,HEALTHFIRST-Medicare Advantage, +82327,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,HEALTHFIRST-Medicare Advantage, +82328,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,HEALTHFIRST-Medicare Advantage, +82329,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,HEALTHFIRST-Medicare Advantage, +82330,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,HEALTHFIRST-Medicare Advantage, +82331,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,HEALTHFIRST-Medicare Advantage, +82332,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,HEALTHFIRST-Medicare Advantage, +82333,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,HEALTHFIRST-Medicare Advantage, +82334,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,HEALTHFIRST-Medicare Advantage, +82335,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,HEALTHFIRST-Medicare Advantage, +82336,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,HEALTHFIRST-Medicare Advantage, +82337,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,HEALTHFIRST-Medicare Advantage, +82338,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,HEALTHFIRST-Medicare Advantage, +82339,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,HEALTHFIRST-Medicare Advantage, +82340,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,HEALTHFIRST-Medicare Advantage, +82341,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,HEALTHFIRST-Medicare Advantage, +82342,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,HEALTHFIRST-Medicare Advantage, +82343,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,HEALTHFIRST-Medicare Advantage, +82344,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,HEALTHFIRST-Medicare Advantage, +82345,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,HEALTHFIRST-Medicare Advantage, +82346,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,HEALTHFIRST-Medicare Advantage, +82347,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,HEALTHFIRST-Medicare Advantage, +82348,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,HEALTHFIRST-Medicare Advantage, +82349,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,HEALTHFIRST-Medicare Advantage, +82350,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,HEALTHFIRST-Medicare Advantage, +82351,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,HEALTHFIRST-Medicare Advantage, +82352,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,HEALTHFIRST-Medicare Advantage, +82353,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,HEALTHFIRST-Medicare Advantage, +82354,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,HEALTHFIRST-Medicare Advantage, +82355,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,HEALTHFIRST-Medicare Advantage, +82356,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,HEALTHFIRST-Medicare Advantage, +82357,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,HEALTHFIRST-Medicare Advantage, +82358,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,HEALTHFIRST-Medicare Advantage, +82359,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,HEALTHFIRST-Medicare Advantage, +82360,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,HEALTHFIRST-Medicare Advantage, +82361,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,HEALTHFIRST-Medicare Advantage, +82362,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,HEALTHFIRST-Medicare Advantage, +82363,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,HEALTHFIRST-Medicare Advantage, +82364,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,HEALTHFIRST-Medicare Advantage, +82365,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,HEALTHFIRST-Medicare Advantage,60973.77 +82366,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,HEALTHFIRST-Medicare Advantage,16507.48 +82367,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,HEALTHFIRST-Medicare Advantage, +82368,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,HEALTHFIRST-Medicare Advantage, +82369,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,HEALTHFIRST-Medicare Advantage, +82370,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,HEALTHFIRST-Medicare Advantage, +82371,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,HEALTHFIRST-Medicare Advantage, +82372,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,HEALTHFIRST-Medicare Advantage, +82373,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,HEALTHFIRST-Medicare Advantage, +82374,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,HEALTHFIRST-Medicare Advantage,28378.23 +82375,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,HEALTHFIRST-Medicare Advantage, +82376,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,HEALTHFIRST-Medicare Advantage, +82377,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,HEALTHFIRST-Medicare Advantage, +82378,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,HEALTHFIRST-Medicare Advantage, +82379,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,HEALTHFIRST-Medicare Advantage, +82380,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,HEALTHFIRST-Medicare Advantage, +82381,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,HEALTHFIRST-Medicare Advantage, +82382,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,HEALTHFIRST-Medicare Advantage, +82383,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,HEALTHFIRST-Medicare Advantage, +82384,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,HEALTHFIRST-Medicare Advantage, +82385,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,HEALTHFIRST-Medicare Advantage, +82386,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,HEALTHFIRST-Medicare Advantage, +82387,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,HEALTHFIRST-Medicare Advantage, +82388,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,HEALTHFIRST-Medicare Advantage, +82389,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,HEALTHFIRST-Medicare Advantage, +82390,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,HEALTHFIRST-Medicare Advantage, +82391,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,HEALTHFIRST-Medicare Advantage, +82392,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,HEALTHFIRST-Medicare Advantage, +82393,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,HEALTHFIRST-Medicare Advantage, +82394,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,HEALTHFIRST-Medicare Advantage, +82395,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,HEALTHFIRST-Medicare Advantage, +82396,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,HEALTHFIRST-Medicare Advantage, +82397,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,HEALTHFIRST-Medicare Advantage, +82398,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,HEALTHFIRST-Medicare Advantage, +82399,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,HEALTHFIRST-Medicare Advantage, +82400,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,HEALTHFIRST-Medicare Advantage, +82401,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,HEALTHFIRST-Medicare Advantage, +82402,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,HEALTHFIRST-Medicare Advantage, +82403,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,HEALTHFIRST-Medicare Advantage, +82404,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,HEALTHFIRST-Medicare Advantage, +82405,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,HEALTHFIRST-Medicare Advantage, +82406,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,HEALTHFIRST-Medicare Advantage, +82407,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,HEALTHFIRST-Medicare Advantage, +82408,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,HEALTHFIRST-Medicare Advantage, +82409,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,HEALTHFIRST-Medicare Advantage, +82410,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,HEALTHFIRST-Medicare Advantage, +82411,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,HEALTHFIRST-Medicare Advantage, +82412,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,HEALTHFIRST-Medicare Advantage, +82413,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,HEALTHFIRST-Medicare Advantage, +82414,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,HEALTHFIRST-Medicare Advantage, +82415,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,HEALTHFIRST-Medicare Advantage, +82416,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,HEALTHFIRST-Medicare Advantage, +82417,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,HEALTHFIRST-Medicare Advantage,36785.22 +82418,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,HEALTHFIRST-Medicare Advantage, +82419,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,HEALTHFIRST-Medicare Advantage, +82420,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,HEALTHFIRST-Medicare Advantage, +82421,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,HEALTHFIRST-Medicare Advantage, +82422,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,HEALTHFIRST-Medicare Advantage, +82423,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,HEALTHFIRST-Medicare Advantage, +82424,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,HEALTHFIRST-Medicare Advantage, +82425,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,HEALTHFIRST-Medicare Advantage, +82426,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,HEALTHFIRST-Medicare Advantage, +82427,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,HEALTHFIRST-Medicare Advantage, +82428,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,HEALTHFIRST-Medicare Advantage, +82429,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,HEALTHFIRST-Medicare Advantage, +82430,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,HEALTHFIRST-Medicare Advantage, +82431,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,HEALTHFIRST-Medicare Advantage, +82432,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,HEALTHFIRST-Medicare Advantage, +82433,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,HEALTHFIRST-Medicare Advantage, +82434,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,HEALTHFIRST-Medicare Advantage, +82435,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,HEALTHFIRST-Medicare Advantage, +82436,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,HEALTHFIRST-Medicare Advantage, +82437,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,HEALTHFIRST-Medicare Advantage, +82438,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,HEALTHFIRST-Medicare Advantage, +82439,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,HEALTHFIRST-Medicare Advantage, +82440,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,HEALTHFIRST-Medicare Advantage, +82441,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,HEALTHFIRST-Medicare Advantage, +82442,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,HEALTHFIRST-Medicare Advantage, +82443,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,HEALTHFIRST-Medicare Advantage, +82444,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,HEALTHFIRST-Medicare Advantage, +82445,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,HEALTHFIRST-Medicare Advantage, +82446,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,HEALTHFIRST-Medicare Advantage, +82447,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,HEALTHFIRST-Medicare Advantage, +82448,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,HEALTHFIRST-Medicare Advantage, +82449,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,HEALTHFIRST-Medicare Advantage, +82450,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,HEALTHFIRST-Medicare Advantage, +82451,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,HEALTHFIRST-Medicare Advantage, +82452,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,HEALTHFIRST-Medicare Advantage, +82453,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,HEALTHFIRST-Medicare Advantage, +82454,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,HEALTHFIRST-Medicare Advantage, +82455,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,HEALTHFIRST-Medicare Advantage, +82456,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,HEALTHFIRST-Medicare Advantage, +82457,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,HEALTHFIRST-Medicare Advantage, +82458,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,HEALTHFIRST-Medicare Advantage, +82459,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,HEALTHFIRST-Medicare Advantage, +82460,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,HEALTHFIRST-Medicare Advantage, +82461,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,HEALTHFIRST-Medicare Advantage, +82462,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,HEALTHFIRST-Medicare Advantage, +82463,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,HEALTHFIRST-Medicare Advantage, +82464,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,HEALTHFIRST-Medicare Advantage, +82465,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,HEALTHFIRST-Medicare Advantage, +82466,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,HEALTHFIRST-Medicare Advantage, +82467,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,HEALTHFIRST-Medicare Advantage, +82468,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,HEALTHFIRST-Medicare Advantage, +82469,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,HEALTHFIRST-Medicare Advantage, +82470,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,HEALTHFIRST-Medicare Advantage, +82471,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +82472,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,HEALTHFIRST-Medicare Advantage, +82473,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,HEALTHFIRST-Medicare Advantage, +82474,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,HEALTHFIRST-Medicare Advantage, +82475,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,HEALTHFIRST-Medicare Advantage, +82476,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,HEALTHFIRST-Medicare Advantage, +82477,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,HEALTHFIRST-Medicare Advantage, +82478,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,HEALTHFIRST-Medicare Advantage, +82479,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,HEALTHFIRST-Medicare Advantage, +82480,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,HEALTHFIRST-Medicare Advantage, +82481,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,HEALTHFIRST-Medicare Advantage, +82482,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,HEALTHFIRST-Medicare Advantage, +82483,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,HEALTHFIRST-Medicare Advantage, +82484,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,HEALTHFIRST-Medicare Advantage, +82485,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,HEALTHFIRST-Medicare Advantage, +82486,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,HEALTHFIRST-Medicare Advantage, +82487,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,HEALTHFIRST-Medicare Advantage,287.61 +82488,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,HEALTHFIRST-Medicare Advantage, +82489,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,HEALTHFIRST-Medicare Advantage, +82490,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,HEALTHFIRST-Medicare Advantage, +82491,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,HEALTHFIRST-Medicare Advantage, +82492,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,HEALTHFIRST-Medicare Advantage, +82493,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,HEALTHFIRST-Medicare Advantage, +82494,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,HEALTHFIRST-Medicare Advantage, +82495,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,HEALTHFIRST-Medicare Advantage, +82496,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,HEALTHFIRST-Medicare Advantage, +82497,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,HEALTHFIRST-Medicare Advantage, +82498,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,HEALTHFIRST-Medicare Advantage, +82499,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,HEALTHFIRST-Medicare Advantage, +82500,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,HEALTHFIRST-Medicare Advantage, +82501,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,HEALTHFIRST-Medicare Advantage, +82502,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,HEALTHFIRST-Medicare Advantage, +82503,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,HEALTHFIRST-Medicare Advantage, +82504,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,HEALTHFIRST-Medicare Advantage, +82505,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,HEALTHFIRST-Medicare Advantage, +82506,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,HEALTHFIRST-Medicare Advantage, +82507,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,HEALTHFIRST-Medicare Advantage, +82508,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,HEALTHFIRST-Medicare Advantage, +82509,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,HEALTHFIRST-Medicare Advantage, +82510,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,HEALTHFIRST-Medicare Advantage, +82511,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,HEALTHFIRST-Medicare Advantage,67.55 +82512,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,HEALTHFIRST-Medicare Advantage, +82513,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,HEALTHFIRST-Medicare Advantage, +82514,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,HEALTHFIRST-Medicare Advantage, +82515,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,HEALTHFIRST-Medicare Advantage, +82516,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,HEALTHFIRST-Medicare Advantage, +82517,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,HEALTHFIRST-Medicare Advantage, +82518,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,HEALTHFIRST-Medicare Advantage, +82519,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,HEALTHFIRST-Medicare Advantage, +82520,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,HEALTHFIRST-Medicare Advantage, +82521,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,HEALTHFIRST-Medicare Advantage, +82522,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,HEALTHFIRST-Medicare Advantage, +82523,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,HEALTHFIRST-Medicare Advantage, +82524,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,HEALTHFIRST-Medicare Advantage, +82525,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,HEALTHFIRST-Medicare Advantage, +82526,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,HEALTHFIRST-Medicare Advantage, +82527,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,HEALTHFIRST-Medicare Advantage, +82528,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,HEALTHFIRST-Medicare Advantage, +82529,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,HEALTHFIRST-Medicare Advantage, +82530,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,HEALTHFIRST-Medicare Advantage, +82531,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,HEALTHFIRST-Medicare Advantage, +82532,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,HEALTHFIRST-Medicare Advantage, +82533,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,HEALTHFIRST-Medicare Advantage, +82534,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,HEALTHFIRST-Medicare Advantage, +82535,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,HEALTHFIRST-Medicare Advantage, +82536,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,HEALTHFIRST-Medicare Advantage, +82537,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,HEALTHFIRST-Medicare Advantage, +82538,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,HEALTHFIRST-Medicare Advantage, +82539,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,HEALTHFIRST-Medicare Advantage, +82540,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,HEALTHFIRST-Medicare Advantage, +82541,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,HEALTHFIRST-Medicare Advantage, +82542,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,HEALTHFIRST-Medicare Advantage, +82543,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,HEALTHFIRST-Medicare Advantage, +82544,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,HEALTHFIRST-Medicare Advantage, +82545,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,HEALTHFIRST-Medicare Advantage, +82546,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,HEALTHFIRST-Medicare Advantage, +82547,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,HEALTHFIRST-Medicare Advantage, +82548,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,HEALTHFIRST-Medicare Advantage, +82549,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,HEALTHFIRST-Medicare Advantage, +82550,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,HEALTHFIRST-Medicare Advantage, +82551,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,HEALTHFIRST-Medicare Advantage, +82552,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,HEALTHFIRST-Medicare Advantage, +82553,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,HEALTHFIRST-Medicare Advantage, +82554,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,HEALTHFIRST-Medicare Advantage, +82555,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,HEALTHFIRST-Medicare Advantage, +82556,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,HEALTHFIRST-Medicare Advantage, +82557,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,HEALTHFIRST-Medicare Advantage, +82558,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,HEALTHFIRST-Medicare Advantage, +82559,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,HEALTHFIRST-Medicare Advantage, +82560,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,HEALTHFIRST-Medicare Advantage, +82561,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,HEALTHFIRST-Medicare Advantage, +82562,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,HEALTHFIRST-Medicare Advantage, +82563,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,HEALTHFIRST-Medicare Advantage, +82564,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,HEALTHFIRST-Medicare Advantage, +82565,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,HEALTHFIRST-Medicare Advantage, +82566,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,HEALTHFIRST-Medicare Advantage, +82567,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,HEALTHFIRST-Medicare Advantage, +82568,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,HEALTHFIRST-Medicare Advantage, +82569,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,HEALTHFIRST-Medicare Advantage, +82570,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,HEALTHFIRST-Medicare Advantage, +82571,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,HEALTHFIRST-Medicare Advantage, +82572,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,HEALTHFIRST-Medicare Advantage, +82573,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,HEALTHFIRST-Medicare Advantage, +82574,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,HEALTHFIRST-Medicare Advantage, +82575,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,HEALTHFIRST-Medicare Advantage, +82576,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,HEALTHFIRST-Medicare Advantage, +82577,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,HEALTHFIRST-Medicare Advantage, +82578,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,HEALTHFIRST-Medicare Advantage, +82579,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,HEALTHFIRST-Medicare Advantage, +82580,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,HEALTHFIRST-Medicare Advantage, +82581,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,HEALTHFIRST-Medicare Advantage, +82582,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,HEALTHFIRST-Medicare Advantage, +82583,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,HEALTHFIRST-Medicare Advantage, +82584,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,HEALTHFIRST-Medicare Advantage, +82585,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,HEALTHFIRST-Medicare Advantage, +82586,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,HEALTHFIRST-Medicare Advantage, +82587,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,HEALTHFIRST-Medicare Advantage, +82588,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,HEALTHFIRST-Medicare Advantage, +82589,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,HEALTHFIRST-Medicare Advantage, +82590,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,HEALTHFIRST-Medicare Advantage, +82591,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,HEALTHFIRST-Medicare Advantage, +82592,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,HEALTHFIRST-Medicare Advantage, +82593,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,HEALTHFIRST-Medicare Advantage, +82594,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,HEALTHFIRST-Medicare Advantage, +82595,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,HEALTHFIRST-Medicare Advantage, +82596,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,HEALTHFIRST-Medicare Advantage, +82597,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,HEALTHFIRST-Medicare Advantage, +82598,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,HEALTHFIRST-Medicare Advantage, +82599,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,HEALTHFIRST-Medicare Advantage, +82600,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,HEALTHFIRST-Medicare Advantage, +82601,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,HEALTHFIRST-Medicare Advantage, +82602,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,HEALTHFIRST-Medicare Advantage, +82603,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,HEALTHFIRST-Medicare Advantage, +82604,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,HEALTHFIRST-Medicare Advantage, +82605,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,HEALTHFIRST-Medicare Advantage, +82606,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,HEALTHFIRST-Medicare Advantage, +82607,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,HEALTHFIRST-Medicare Advantage, +82608,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,HEALTHFIRST-Medicare Advantage, +82609,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,HEALTHFIRST-Medicare Advantage, +82610,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,HEALTHFIRST-Medicare Advantage, +82611,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,HEALTHFIRST-Medicare Advantage, +82612,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,HEALTHFIRST-Medicare Advantage, +82613,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,HEALTHFIRST-Medicare Advantage, +82614,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,HEALTHFIRST-Medicare Advantage, +82615,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,HEALTHFIRST-Medicare Advantage, +82616,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,HEALTHFIRST-Medicare Advantage, +82617,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,HEALTHFIRST-Medicare Advantage, +82618,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,HEALTHFIRST-Medicare Advantage, +82619,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,HEALTHFIRST-Medicare Advantage, +82620,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,HEALTHFIRST-Medicare Advantage, +82621,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,HEALTHFIRST-Medicare Advantage, +82622,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,HEALTHFIRST-Medicare Advantage, +82623,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,HEALTHFIRST-Medicare Advantage, +82624,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,HEALTHFIRST-Medicare Advantage, +82625,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,HEALTHFIRST-Medicare Advantage, +82626,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,HEALTHFIRST-Medicare Advantage, +82627,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,HEALTHFIRST-Medicare Advantage, +82628,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,HEALTHFIRST-Medicare Advantage, +82629,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,HEALTHFIRST-Medicare Advantage, +82630,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,HEALTHFIRST-Medicare Advantage, +82631,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,HEALTHFIRST-Medicare Advantage, +82632,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,HEALTHFIRST-Medicare Advantage, +82633,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,HEALTHFIRST-Medicare Advantage, +82634,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,HEALTHFIRST-Medicare Advantage, +82635,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,HEALTHFIRST-Medicare Advantage, +82636,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,HEALTHFIRST-Medicare Advantage, +82637,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +82638,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,HEALTHFIRST-Medicare Advantage, +82639,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,HEALTHFIRST-Medicare Advantage, +82640,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,HEALTHFIRST-Medicare Advantage, +82641,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,HEALTHFIRST-Medicare Advantage, +82642,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,HEALTHFIRST-Medicare Advantage, +82643,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,HEALTHFIRST-Medicare Advantage, +82644,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,HEALTHFIRST-Medicare Advantage, +82645,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,HEALTHFIRST-Medicare Advantage, +82646,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,HEALTHFIRST-Medicare Advantage, +82647,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,HEALTHFIRST-Medicare Advantage, +82648,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,HEALTHFIRST-Medicare Advantage, +82649,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,HEALTHFIRST-Medicare Advantage, +82650,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,HEALTHFIRST-Medicare Advantage, +82651,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,HEALTHFIRST-Medicare Advantage, +82652,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,HEALTHFIRST-Medicare Advantage, +82653,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,HEALTHFIRST-Medicare Advantage, +82654,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,HEALTHFIRST-Medicare Advantage, +82655,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,HEALTHFIRST-Medicare Advantage, +82656,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,HEALTHFIRST-Medicare Advantage, +82657,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,HEALTHFIRST-Medicare Advantage, +82658,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,HEALTHFIRST-Medicare Advantage, +82659,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,HEALTHFIRST-Medicare Advantage, +82660,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,HEALTHFIRST-Medicare Advantage, +82661,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,HEALTHFIRST-Medicare Advantage, +82662,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,HEALTHFIRST-Medicare Advantage, +82663,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,HEALTHFIRST-Medicare Advantage, +82664,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,HEALTHFIRST-Medicare Advantage, +82665,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,HEALTHFIRST-Medicare Advantage, +82666,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,HEALTHFIRST-Medicare Advantage, +82667,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,HEALTHFIRST-Medicare Advantage, +82668,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,HEALTHFIRST-Medicare Advantage, +82669,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,HEALTHFIRST-Medicare Advantage, +82670,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,HEALTHFIRST-Medicare Advantage, +82671,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,HEALTHFIRST-Medicare Advantage, +82672,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,HEALTHFIRST-Medicare Advantage, +82673,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,HEALTHFIRST-Medicare Advantage, +82674,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,HEALTHFIRST-Medicare Advantage, +82675,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,HEALTHFIRST-Medicare Advantage, +82676,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,HEALTHFIRST-Medicare Advantage, +82677,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +82678,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,HEALTHFIRST-Medicare Advantage, +82679,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,HEALTHFIRST-Medicare Advantage, +82680,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,HEALTHFIRST-Medicare Advantage, +82681,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,HEALTHFIRST-Medicare Advantage, +82682,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,HEALTHFIRST-Medicare Advantage, +82683,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,HEALTHFIRST-Medicare Advantage, +82684,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,HEALTHFIRST-Medicare Advantage, +82685,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,HEALTHFIRST-Medicare Advantage, +82686,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,HEALTHFIRST-Medicare Advantage, +82687,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,HEALTHFIRST-Medicare Advantage, +82688,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,HEALTHFIRST-Medicare Advantage, +82689,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,HEALTHFIRST-Medicare Advantage, +82690,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,HEALTHFIRST-Medicare Advantage, +82691,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,HEALTHFIRST-Medicare Advantage, +82692,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,HEALTHFIRST-Medicare Advantage, +82693,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,HEALTHFIRST-Medicare Advantage, +82694,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,HEALTHFIRST-Medicare Advantage, +82695,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,HEALTHFIRST-Medicare Advantage, +82696,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,HEALTHFIRST-Medicare Advantage, +82697,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,HEALTHFIRST-Medicare Advantage, +82698,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,HEALTHFIRST-Medicare Advantage, +82699,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,HEALTHFIRST-Medicare Advantage, +82700,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,HEALTHFIRST-Medicare Advantage, +82701,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,HEALTHFIRST-Medicare Advantage, +82702,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,HEALTHFIRST-Medicare Advantage, +82703,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,HEALTHFIRST-Medicare Advantage, +82704,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,HEALTHFIRST-Medicare Advantage, +82705,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHFIRST-Medicare Advantage, +82706,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,HEALTHFIRST-Medicare Advantage, +82707,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,HEALTHFIRST-Medicare Advantage, +82708,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,HEALTHFIRST-Medicare Advantage, +82709,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,HEALTHFIRST-Medicare Advantage, +82710,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,HEALTHFIRST-Medicare Advantage, +82711,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,HEALTHFIRST-Medicare Advantage, +82712,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,HEALTHFIRST-Medicare Advantage, +82713,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,HEALTHFIRST-Medicare Advantage, +82714,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,HEALTHFIRST-Medicare Advantage, +82715,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,HEALTHFIRST-Medicare Advantage, +82716,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,HEALTHFIRST-Medicare Advantage, +82717,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,HEALTHFIRST-Medicare Advantage, +82718,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,HEALTHFIRST-Medicare Advantage, +82719,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,HEALTHFIRST-Medicare Advantage, +82720,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,HEALTHFIRST-Medicare Advantage, +82721,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,HEALTHFIRST-Medicare Advantage, +82722,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,HEALTHFIRST-Medicare Advantage, +82723,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,HEALTHFIRST-Medicare Advantage, +82724,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,HEALTHFIRST-Medicare Advantage, +82725,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,HEALTHFIRST-Medicare Advantage, +82726,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,HEALTHFIRST-Medicare Advantage, +82727,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,HEALTHFIRST-Medicare Advantage, +82728,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,HEALTHFIRST-Medicare Advantage, +82729,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,HEALTHFIRST-Medicare Advantage, +82730,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,HEALTHFIRST-Medicare Advantage, +82731,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,HEALTHFIRST-Medicare Advantage, +82732,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,HEALTHFIRST-Medicare Advantage, +82733,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,HEALTHFIRST-Medicare Advantage, +82734,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,HEALTHFIRST-Medicare Advantage, +82735,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,HEALTHFIRST-Medicare Advantage, +82736,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,HEALTHFIRST-Medicare Advantage, +82737,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,HEALTHFIRST-Medicare Advantage, +82738,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,HEALTHFIRST-Medicare Advantage, +82739,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,HEALTHFIRST-Medicare Advantage, +82740,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,HEALTHFIRST-Medicare Advantage, +82741,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,HEALTHFIRST-Medicare Advantage, +82742,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,HEALTHFIRST-Medicare Advantage, +82743,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,HEALTHFIRST-Medicare Advantage, +82744,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,HEALTHFIRST-Medicare Advantage, +82745,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,HEALTHFIRST-Medicare Advantage, +82746,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,HEALTHFIRST-Medicare Advantage, +82747,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,HEALTHFIRST-Medicare Advantage, +82748,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,HEALTHFIRST-Medicare Advantage, +82749,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,HEALTHFIRST-Medicare Advantage, +82750,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,HEALTHFIRST-Medicare Advantage, +82751,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,HEALTHFIRST-Medicare Advantage, +82752,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,HEALTHFIRST-Medicare Advantage, +82753,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,HEALTHFIRST-Medicare Advantage, +82754,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,HEALTHFIRST-Medicare Advantage, +82755,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,HEALTHFIRST-Medicare Advantage, +82756,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,HEALTHFIRST-Medicare Advantage, +82757,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,HEALTHFIRST-Medicare Advantage, +82758,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +82759,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,HEALTHFIRST-Medicare Advantage, +82760,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,HEALTHFIRST-Medicare Advantage, +82761,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,HEALTHFIRST-Medicare Advantage, +82762,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,HEALTHFIRST-Medicare Advantage, +82763,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,HEALTHFIRST-Medicare Advantage, +82764,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,HEALTHFIRST-Medicare Advantage, +82765,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,HEALTHFIRST-Medicare Advantage, +82766,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,HEALTHFIRST-Medicare Advantage, +82767,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,HEALTHFIRST-Medicare Advantage, +82768,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,HEALTHFIRST-Medicare Advantage, +82769,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,HEALTHFIRST-Medicare Advantage, +82770,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,HEALTHFIRST-Medicare Advantage, +82771,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,HEALTHFIRST-Medicare Advantage, +82772,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,HEALTHFIRST-Medicare Advantage, +82773,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,HEALTHFIRST-Medicare Advantage, +82774,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,HEALTHFIRST-Medicare Advantage, +82775,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,HEALTHFIRST-Medicare Advantage, +82776,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,HEALTHFIRST-Medicare Advantage, +82777,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,HEALTHFIRST-Medicare Advantage, +82778,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,HEALTHFIRST-Medicare Advantage, +82779,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,HEALTHFIRST-Medicare Advantage, +82780,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,HEALTHFIRST-Medicare Advantage, +82781,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,HEALTHFIRST-Medicare Advantage, +82782,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,HEALTHFIRST-Medicare Advantage, +82783,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,HEALTHFIRST-Medicare Advantage, +82784,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,HEALTHFIRST-Medicare Advantage, +82785,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,HEALTHFIRST-Medicare Advantage, +82786,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,HEALTHFIRST-Medicare Advantage, +82787,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,HEALTHFIRST-Medicare Advantage, +82788,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,HEALTHFIRST-Medicare Advantage, +82789,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,HEALTHFIRST-Medicare Advantage, +82790,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,HEALTHFIRST-Medicare Advantage, +82791,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,HEALTHFIRST-Medicare Advantage, +82792,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,HEALTHFIRST-Medicare Advantage, +82793,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,HEALTHFIRST-Medicare Advantage, +82794,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,HEALTHFIRST-Medicare Advantage, +82795,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,HEALTHFIRST-Medicare Advantage, +82796,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,HEALTHFIRST-Medicare Advantage, +82797,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,HEALTHFIRST-Medicare Advantage, +82798,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,HEALTHFIRST-Medicare Advantage, +82799,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,HEALTHFIRST-Medicare Advantage, +82800,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,HEALTHFIRST-Medicare Advantage, +82801,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,HEALTHFIRST-Medicare Advantage, +82802,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,HEALTHFIRST-Medicare Advantage, +82803,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,HEALTHFIRST-Medicare Advantage, +82804,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,HEALTHFIRST-Medicare Advantage, +82805,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,HEALTHFIRST-Medicare Advantage, +82806,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,HEALTHFIRST-Medicare Advantage, +82807,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,HEALTHFIRST-Medicare Advantage, +82808,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,HEALTHFIRST-Medicare Advantage, +82809,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,HEALTHFIRST-Medicare Advantage, +82810,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,HEALTHFIRST-Medicare Advantage, +82811,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,HEALTHFIRST-Medicare Advantage, +82812,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,HEALTHFIRST-Medicare Advantage, +82813,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,HEALTHFIRST-Medicare Advantage, +82814,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,HEALTHFIRST-Medicare Advantage, +82815,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,HEALTHFIRST-Medicare Advantage, +82816,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,HEALTHFIRST-Medicare Advantage, +82817,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,HEALTHFIRST-Medicare Advantage, +82818,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,HEALTHFIRST-Medicare Advantage, +82819,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,HEALTHFIRST-Medicare Advantage, +82820,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,HEALTHFIRST-Medicare Advantage, +82821,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,HEALTHFIRST-Medicare Advantage, +82822,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,HEALTHFIRST-Medicare Advantage, +82823,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,HEALTHFIRST-Medicare Advantage, +82824,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,HEALTHFIRST-Medicare Advantage, +82825,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,HEALTHFIRST-Medicare Advantage, +82826,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,HEALTHFIRST-Medicare Advantage, +82827,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,HEALTHFIRST-Medicare Advantage, +82828,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,HEALTHFIRST-Medicare Advantage, +82829,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,HEALTHFIRST-Medicare Advantage, +82830,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,HEALTHFIRST-Medicare Advantage, +82831,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,HEALTHFIRST-Medicare Advantage, +82832,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,HEALTHFIRST-Medicare Advantage, +82833,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,HEALTHFIRST-Medicare Advantage, +82834,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,HEALTHFIRST-Medicare Advantage, +82835,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,HEALTHFIRST-Medicare Advantage, +82836,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,HEALTHFIRST-Medicare Advantage, +82837,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,HEALTHFIRST-Medicare Advantage, +82838,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,HEALTHFIRST-Medicare Advantage, +82839,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,HEALTHFIRST-Medicare Advantage, +82840,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,HEALTHFIRST-Medicare Advantage, +82841,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,HEALTHFIRST-Medicare Advantage, +82842,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,HEALTHFIRST-Medicare Advantage, +82843,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,HEALTHFIRST-Medicare Advantage, +82844,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,HEALTHFIRST-Medicare Advantage, +82845,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,HEALTHFIRST-Medicare Advantage, +82846,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,HEALTHFIRST-Medicare Advantage, +82847,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,HEALTHFIRST-Medicare Advantage, +82848,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,HEALTHFIRST-Medicare Advantage, +82849,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,HEALTHFIRST-Medicare Advantage, +82850,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,HEALTHFIRST-Medicare Advantage, +82851,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,HEALTHFIRST-Medicare Advantage, +82852,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,HEALTHFIRST-Medicare Advantage, +82853,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,HEALTHFIRST-Medicare Advantage, +82854,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,HEALTHFIRST-Medicare Advantage, +82855,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,HEALTHFIRST-Medicare Advantage, +82856,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,HEALTHFIRST-Medicare Advantage, +82857,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,HEALTHFIRST-Medicare Advantage, +82858,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,HEALTHFIRST-Medicare Advantage, +82859,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,HEALTHFIRST-Medicare Advantage, +82860,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,HEALTHFIRST-Medicare Advantage, +82861,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,HEALTHFIRST-Medicare Advantage, +82862,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,HEALTHFIRST-Medicare Advantage, +82863,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,HEALTHFIRST-Medicare Advantage, +82864,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,HEALTHFIRST-Medicare Advantage, +82865,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +82866,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,HEALTHFIRST-Medicare Advantage, +82867,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,HEALTHFIRST-Medicare Advantage, +82868,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,HEALTHFIRST-Medicare Advantage, +82869,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,HEALTHFIRST-Medicare Advantage, +82870,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,HEALTHFIRST-Medicare Advantage, +82871,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,HEALTHFIRST-Medicare Advantage, +82872,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,HEALTHFIRST-Medicare Advantage, +82873,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,HEALTHFIRST-Medicare Advantage, +82874,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,HEALTHFIRST-Medicare Advantage, +82875,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,HEALTHFIRST-Medicare Advantage, +82876,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,HEALTHFIRST-Medicare Advantage, +82877,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,HEALTHFIRST-Medicare Advantage, +82878,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,HEALTHFIRST-Medicare Advantage, +82879,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,HEALTHFIRST-Medicare Advantage, +82880,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,HEALTHFIRST-Medicare Advantage, +82881,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,HEALTHFIRST-Medicare Advantage, +82882,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,HEALTHFIRST-Medicare Advantage, +82883,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,HEALTHFIRST-Medicare Advantage, +82884,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,HEALTHFIRST-Medicare Advantage, +82885,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,HEALTHFIRST-Medicare Advantage, +82886,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,HEALTHFIRST-Medicare Advantage, +82887,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,HEALTHFIRST-Medicare Advantage, +82888,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,HEALTHFIRST-Medicare Advantage, +82889,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,HEALTHFIRST-Medicare Advantage, +82890,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,HEALTHFIRST-Medicare Advantage, +82891,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,HEALTHFIRST-Medicare Advantage, +82892,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,HEALTHFIRST-Medicare Advantage, +82893,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,HEALTHFIRST-Medicare Advantage, +82894,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,HEALTHFIRST-Medicare Advantage, +82895,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,HEALTHFIRST-Medicare Advantage, +82896,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,HEALTHFIRST-Medicare Advantage, +82897,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,HEALTHFIRST-Medicare Advantage, +82898,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,HEALTHFIRST-Medicare Advantage, +82899,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,HEALTHFIRST-Medicare Advantage, +82900,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,HEALTHFIRST-Medicare Advantage, +82901,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,HEALTHFIRST-Medicare Advantage, +82902,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,HEALTHFIRST-Medicare Advantage, +82903,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,HEALTHFIRST-Medicare Advantage, +82904,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,HEALTHFIRST-Medicare Advantage, +82905,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,HEALTHFIRST-Medicare Advantage, +82906,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,HEALTHFIRST-Medicare Advantage, +82907,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,HEALTHFIRST-Medicare Advantage, +82908,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,HEALTHFIRST-Medicare Advantage, +82909,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,HEALTHFIRST-Medicare Advantage, +82910,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,HEALTHFIRST-Medicare Advantage, +82911,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,HEALTHFIRST-Medicare Advantage, +82912,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,HEALTHFIRST-Medicare Advantage, +82913,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,HEALTHFIRST-Medicare Advantage, +82914,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,HEALTHFIRST-Medicare Advantage, +82915,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,HEALTHFIRST-Medicare Advantage, +82916,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,HEALTHFIRST-Medicare Advantage, +82917,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,HEALTHFIRST-Medicare Advantage, +82918,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,HEALTHFIRST-Medicare Advantage, +82919,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,HEALTHFIRST-Medicare Advantage, +82920,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,HEALTHFIRST-Medicare Advantage, +82921,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,HEALTHFIRST-Medicare Advantage, +82922,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,HEALTHFIRST-Medicare Advantage, +82923,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,HEALTHFIRST-Medicare Advantage, +82924,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,HEALTHFIRST-Medicare Advantage, +82925,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,HEALTHFIRST-Medicare Advantage, +82926,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,HEALTHFIRST-Medicare Advantage, +82927,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,HEALTHFIRST-Medicare Advantage, +82928,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,HEALTHFIRST-Medicare Advantage, +82929,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,HEALTHFIRST-Medicare Advantage, +82930,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,HEALTHFIRST-Medicare Advantage, +82931,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,HEALTHFIRST-Medicare Advantage, +82932,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,HEALTHFIRST-Medicare Advantage, +82933,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,HEALTHFIRST-Medicare Advantage, +82934,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,HEALTHFIRST-Medicare Advantage, +82935,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,HEALTHFIRST-Medicare Advantage, +82936,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,HEALTHFIRST-Medicare Advantage, +82937,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,HEALTHFIRST-Medicare Advantage, +82938,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,HEALTHFIRST-Medicare Advantage, +82939,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,HEALTHFIRST-Medicare Advantage, +82940,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,HEALTHFIRST-Medicare Advantage, +82941,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,HEALTHFIRST-Medicare Advantage, +82942,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,HEALTHFIRST-Medicare Advantage, +82943,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,HEALTHFIRST-Medicare Advantage, +82944,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,HEALTHFIRST-Medicare Advantage, +82945,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,HEALTHFIRST-Medicare Advantage, +82946,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,HEALTHFIRST-Medicare Advantage, +82947,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,HEALTHFIRST-Medicare Advantage, +82948,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,HEALTHFIRST-Medicare Advantage, +82949,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,HEALTHFIRST-Medicare Advantage, +82950,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,HEALTHFIRST-Medicare Advantage, +82951,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,HEALTHFIRST-Medicare Advantage, +82952,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,HEALTHFIRST-Medicare Advantage, +82953,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,HEALTHFIRST-Medicare Advantage, +82954,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,HEALTHFIRST-Medicare Advantage, +82955,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,HEALTHFIRST-Medicare Advantage, +82956,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,HEALTHFIRST-Medicare Advantage, +82957,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,HEALTHFIRST-Medicare Advantage, +82958,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,HEALTHFIRST-Medicare Advantage, +82959,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,HEALTHFIRST-Medicare Advantage, +82960,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,HEALTHFIRST-Medicare Advantage, +82961,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,HEALTHFIRST-Medicare Advantage, +82962,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,HEALTHFIRST-Medicare Advantage, +82963,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,HEALTHFIRST-Medicare Advantage, +82964,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,HEALTHFIRST-Medicare Advantage, +82965,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,HEALTHFIRST-Medicare Advantage, +82966,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,HEALTHFIRST-Medicare Advantage, +82967,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,HEALTHFIRST-Medicare Advantage, +82968,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,HEALTHFIRST-Medicare Advantage, +82969,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,HEALTHFIRST-Medicare Advantage, +82970,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,HEALTHFIRST-Medicare Advantage, +82971,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,HEALTHFIRST-Medicare Advantage, +82972,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,HEALTHFIRST-Medicare Advantage, +82973,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,HEALTHFIRST-Medicare Advantage, +82974,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,HEALTHFIRST-Medicare Advantage, +82975,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,HEALTHFIRST-Medicare Advantage, +82976,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,HEALTHFIRST-Medicare Advantage, +82977,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,HEALTHFIRST-Medicare Advantage, +82978,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,HEALTHFIRST-Medicare Advantage, +82979,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,HEALTHFIRST-Medicare Advantage, +82980,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,HEALTHFIRST-Medicare Advantage, +82981,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,HEALTHFIRST-Medicare Advantage, +82982,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,HEALTHFIRST-Medicare Advantage, +82983,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,HEALTHFIRST-Medicare Advantage, +82984,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,HEALTHFIRST-Medicare Advantage, +82985,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,HEALTHFIRST-Medicare Advantage, +82986,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,HEALTHFIRST-Medicare Advantage, +82987,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,HEALTHFIRST-Medicare Advantage, +82988,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,HEALTHFIRST-Medicare Advantage, +82989,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,HEALTHFIRST-Medicare Advantage, +82990,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,HEALTHFIRST-Medicare Advantage, +82991,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,HEALTHFIRST-Medicare Advantage, +82992,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,HEALTHFIRST-Medicare Advantage, +82993,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,HEALTHFIRST-Medicare Advantage, +82994,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,HEALTHFIRST-Medicare Advantage, +82995,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,HEALTHFIRST-Medicare Advantage, +82996,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,HEALTHFIRST-Medicare Advantage, +82997,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +82998,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,HEALTHFIRST-Medicare Advantage, +82999,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,HEALTHFIRST-Medicare Advantage, +83000,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,HEALTHFIRST-Medicare Advantage, +83001,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +83002,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,HEALTHFIRST-Medicare Advantage, +83003,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,HEALTHFIRST-Medicare Advantage, +83004,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,HEALTHFIRST-Medicare Advantage, +83005,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,HEALTHFIRST-Medicare Advantage, +83006,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,HEALTHFIRST-Medicare Advantage, +83007,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,HEALTHFIRST-Medicare Advantage, +83008,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,HEALTHFIRST-Medicare Advantage, +83009,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,HEALTHFIRST-Medicare Advantage, +83010,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,HEALTHFIRST-Medicare Advantage, +83011,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,HEALTHFIRST-Medicare Advantage, +83012,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,HEALTHFIRST-Medicare Advantage, +83013,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,HEALTHFIRST-Medicare Advantage, +83014,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,HEALTHFIRST-Medicare Advantage, +83015,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,HEALTHFIRST-Medicare Advantage, +83016,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +83017,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,HEALTHFIRST-Medicare Advantage, +83018,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,HEALTHFIRST-Medicare Advantage, +83019,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,HEALTHFIRST-Medicare Advantage, +83020,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,HEALTHFIRST-Medicare Advantage, +83021,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,HEALTHFIRST-Medicare Advantage, +83022,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,HEALTHFIRST-Medicare Advantage, +83023,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,HEALTHFIRST-Medicare Advantage, +83024,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,HEALTHFIRST-Medicare Advantage, +83025,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,HEALTHFIRST-Medicare Advantage, +83026,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,HEALTHFIRST-Medicare Advantage, +83027,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,HEALTHFIRST-Medicare Advantage, +83028,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,HEALTHFIRST-Medicare Advantage, +83029,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,HEALTHFIRST-Medicare Advantage, +83030,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,HEALTHFIRST-Medicare Advantage, +83031,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,HEALTHFIRST-Medicare Advantage, +83032,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,HEALTHFIRST-Medicare Advantage, +83033,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,HEALTHFIRST-Medicare Advantage, +83034,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,HEALTHFIRST-Medicare Advantage, +83035,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,HEALTHFIRST-Medicare Advantage, +83036,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,HEALTHFIRST-Medicare Advantage, +83037,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,HEALTHFIRST-Medicare Advantage, +83038,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,HEALTHFIRST-Medicare Advantage, +83039,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,HEALTHFIRST-Medicare Advantage, +83040,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,HEALTHFIRST-Medicare Advantage, +83041,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,HEALTHFIRST-Medicare Advantage, +83042,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,HEALTHFIRST-Medicare Advantage, +83043,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,HEALTHFIRST-Medicare Advantage, +83044,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,HEALTHFIRST-Medicare Advantage, +83045,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,HEALTHFIRST-Medicare Advantage, +83046,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,HEALTHFIRST-Medicare Advantage, +83047,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,HEALTHFIRST-Medicare Advantage, +83048,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,HEALTHFIRST-Medicare Advantage, +83049,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,HEALTHFIRST-Medicare Advantage, +83050,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,HEALTHFIRST-Medicare Advantage, +83051,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,HEALTHFIRST-Medicare Advantage, +83052,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,HEALTHFIRST-Medicare Advantage, +83053,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,HEALTHFIRST-Medicare Advantage, +83054,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,HEALTHFIRST-Medicare Advantage, +83055,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,HEALTHFIRST-Medicare Advantage, +83056,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,HEALTHFIRST-Medicare Advantage, +83057,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,HEALTHFIRST-Medicare Advantage, +83058,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,HEALTHFIRST-Medicare Advantage, +83059,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,HEALTHFIRST-Medicare Advantage, +83060,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,HEALTHFIRST-Medicare Advantage, +83061,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,HEALTHFIRST-Medicare Advantage, +83062,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +83063,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83064,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,HEALTHFIRST-Medicare Advantage, +83065,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,HEALTHFIRST-Medicare Advantage, +83066,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,HEALTHFIRST-Medicare Advantage, +83067,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,HEALTHFIRST-Medicare Advantage, +83068,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,HEALTHFIRST-Medicare Advantage, +83069,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,HEALTHFIRST-Medicare Advantage, +83070,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,HEALTHFIRST-Medicare Advantage, +83071,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,HEALTHFIRST-Medicare Advantage, +83072,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,HEALTHFIRST-Medicare Advantage, +83073,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,HEALTHFIRST-Medicare Advantage, +83074,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,HEALTHFIRST-Medicare Advantage, +83075,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,HEALTHFIRST-Medicare Advantage, +83076,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,HEALTHFIRST-Medicare Advantage, +83077,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,HEALTHFIRST-Medicare Advantage, +83078,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,HEALTHFIRST-Medicare Advantage, +83079,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,HEALTHFIRST-Medicare Advantage, +83080,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,HEALTHFIRST-Medicare Advantage, +83081,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,HEALTHFIRST-Medicare Advantage, +83082,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,HEALTHFIRST-Medicare Advantage, +83083,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,HEALTHFIRST-Medicare Advantage, +83084,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,HEALTHFIRST-Medicare Advantage, +83085,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,HEALTHFIRST-Medicare Advantage, +83086,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,HEALTHFIRST-Medicare Advantage, +83087,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,HEALTHFIRST-Medicare Advantage, +83088,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,HEALTHFIRST-Medicare Advantage, +83089,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,HEALTHFIRST-Medicare Advantage, +83090,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,HEALTHFIRST-Medicare Advantage, +83091,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,HEALTHFIRST-Medicare Advantage, +83092,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,HEALTHFIRST-Medicare Advantage, +83093,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,HEALTHFIRST-Medicare Advantage, +83094,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,HEALTHFIRST-Medicare Advantage, +83095,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,HEALTHFIRST-Medicare Advantage, +83096,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,HEALTHFIRST-Medicare Advantage, +83097,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,HEALTHFIRST-Medicare Advantage, +83098,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,HEALTHFIRST-Medicare Advantage, +83099,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,HEALTHFIRST-Medicare Advantage, +83100,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,HEALTHFIRST-Medicare Advantage, +83101,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,HEALTHFIRST-Medicare Advantage, +83102,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +83103,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,HEALTHFIRST-Medicare Advantage, +83104,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,HEALTHFIRST-Medicare Advantage, +83105,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,HEALTHFIRST-Medicare Advantage, +83106,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,HEALTHFIRST-Medicare Advantage, +83107,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,HEALTHFIRST-Medicare Advantage, +83108,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,HEALTHFIRST-Medicare Advantage, +83109,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,HEALTHFIRST-Medicare Advantage, +83110,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,HEALTHFIRST-Medicare Advantage, +83111,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,HEALTHFIRST-Medicare Advantage, +83112,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,HEALTHFIRST-Medicare Advantage, +83113,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,HEALTHFIRST-Medicare Advantage, +83114,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,HEALTHFIRST-Medicare Advantage, +83115,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,HEALTHFIRST-Medicare Advantage, +83116,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,HEALTHFIRST-Medicare Advantage, +83117,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,HEALTHFIRST-Medicare Advantage, +83118,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,HEALTHFIRST-Medicare Advantage, +83119,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,HEALTHFIRST-Medicare Advantage, +83120,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,HEALTHFIRST-Medicare Advantage, +83121,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,HEALTHFIRST-Medicare Advantage, +83122,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,HEALTHFIRST-Medicare Advantage, +83123,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,HEALTHFIRST-Medicare Advantage, +83124,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,HEALTHFIRST-Medicare Advantage, +83125,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,HEALTHFIRST-Medicare Advantage, +83126,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,HEALTHFIRST-Medicare Advantage, +83127,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,HEALTHFIRST-Medicare Advantage, +83128,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,HEALTHFIRST-Medicare Advantage, +83129,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,HEALTHFIRST-Medicare Advantage, +83130,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,HEALTHFIRST-Medicare Advantage, +83131,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,HEALTHFIRST-Medicare Advantage, +83132,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,HEALTHFIRST-Medicare Advantage, +83133,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,HEALTHFIRST-Medicare Advantage, +83134,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,HEALTHFIRST-Medicare Advantage, +83135,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,HEALTHFIRST-Medicare Advantage, +83136,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,HEALTHFIRST-Medicare Advantage, +83137,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,HEALTHFIRST-Medicare Advantage, +83138,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,HEALTHFIRST-Medicare Advantage, +83139,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,HEALTHFIRST-Medicare Advantage, +83140,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,HEALTHFIRST-Medicare Advantage, +83141,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,HEALTHFIRST-Medicare Advantage, +83142,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,HEALTHFIRST-Medicare Advantage, +83143,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,HEALTHFIRST-Medicare Advantage, +83144,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,HEALTHFIRST-Medicare Advantage, +83145,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,HEALTHFIRST-Medicare Advantage, +83146,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,HEALTHFIRST-Medicare Advantage, +83147,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,HEALTHFIRST-Medicare Advantage, +83148,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,HEALTHFIRST-Medicare Advantage, +83149,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,HEALTHFIRST-Medicare Advantage, +83150,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,HEALTHFIRST-Medicare Advantage, +83151,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,HEALTHFIRST-Medicare Advantage, +83152,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,HEALTHFIRST-Medicare Advantage, +83153,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,HEALTHFIRST-Medicare Advantage, +83154,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,HEALTHFIRST-Medicare Advantage, +83155,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,HEALTHFIRST-Medicare Advantage, +83156,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,HEALTHFIRST-Medicare Advantage, +83157,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,HEALTHFIRST-Medicare Advantage, +83158,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,HEALTHFIRST-Medicare Advantage, +83159,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,HEALTHFIRST-Medicare Advantage, +83160,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,HEALTHFIRST-Medicare Advantage, +83161,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,HEALTHFIRST-Medicare Advantage, +83162,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,HEALTHFIRST-Medicare Advantage, +83163,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,HEALTHFIRST-Medicare Advantage, +83164,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,HEALTHFIRST-Medicare Advantage, +83165,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,HEALTHFIRST-Medicare Advantage, +83166,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,HEALTHFIRST-Medicare Advantage, +83167,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,HEALTHFIRST-Medicare Advantage, +83168,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,HEALTHFIRST-Medicare Advantage, +83169,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,HEALTHFIRST-Medicare Advantage, +83170,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,HEALTHFIRST-Medicare Advantage, +83171,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,HEALTHFIRST-Medicare Advantage, +83172,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,HEALTHFIRST-Medicare Advantage, +83173,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,HEALTHFIRST-Medicare Advantage, +83174,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,HEALTHFIRST-Medicare Advantage, +83175,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,HEALTHFIRST-Medicare Advantage, +83176,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,HEALTHFIRST-Medicare Advantage, +83177,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,HEALTHFIRST-Medicare Advantage, +83178,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,HEALTHFIRST-Medicare Advantage, +83179,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,HEALTHFIRST-Medicare Advantage, +83180,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,HEALTHFIRST-Medicare Advantage, +83181,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,HEALTHFIRST-Medicare Advantage, +83182,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,HEALTHFIRST-Medicare Advantage, +83183,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,HEALTHFIRST-Medicare Advantage, +83184,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,HEALTHFIRST-Medicare Advantage, +83185,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,HEALTHFIRST-Medicare Advantage, +83186,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,HEALTHFIRST-Medicare Advantage, +83187,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,HEALTHFIRST-Medicare Advantage, +83188,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,HEALTHFIRST-Medicare Advantage, +83189,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,HEALTHFIRST-Medicare Advantage, +83190,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,HEALTHFIRST-Medicare Advantage, +83191,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,HEALTHFIRST-Medicare Advantage, +83192,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,HEALTHFIRST-Medicare Advantage, +83193,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,HEALTHFIRST-Medicare Advantage, +83194,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,HEALTHFIRST-Medicare Advantage, +83195,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,HEALTHFIRST-Medicare Advantage, +83196,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,HEALTHFIRST-Medicare Advantage, +83197,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,HEALTHFIRST-Medicare Advantage, +83198,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,HEALTHFIRST-Medicare Advantage, +83199,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,HEALTHFIRST-Medicare Advantage, +83200,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,HEALTHFIRST-Medicare Advantage, +83201,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,HEALTHFIRST-Medicare Advantage, +83202,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,HEALTHFIRST-Medicare Advantage, +83203,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,HEALTHFIRST-Medicare Advantage, +83204,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,HEALTHFIRST-Medicare Advantage, +83205,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,HEALTHFIRST-Medicare Advantage, +83206,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,HEALTHFIRST-Medicare Advantage, +83207,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,HEALTHFIRST-Medicare Advantage, +83208,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,HEALTHFIRST-Medicare Advantage, +83209,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,HEALTHFIRST-Medicare Advantage, +83210,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,HEALTHFIRST-Medicare Advantage, +83211,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,HEALTHFIRST-Medicare Advantage, +83212,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,HEALTHFIRST-Medicare Advantage, +83213,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,HEALTHFIRST-Medicare Advantage, +83214,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +83215,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,HEALTHFIRST-Medicare Advantage, +83216,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,HEALTHFIRST-Medicare Advantage, +83217,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,HEALTHFIRST-Medicare Advantage, +83218,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,HEALTHFIRST-Medicare Advantage, +83219,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,HEALTHFIRST-Medicare Advantage, +83220,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,HEALTHFIRST-Medicare Advantage, +83221,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,HEALTHFIRST-Medicare Advantage, +83222,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,HEALTHFIRST-Medicare Advantage, +83223,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,HEALTHFIRST-Medicare Advantage, +83224,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,HEALTHFIRST-Medicare Advantage, +83225,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,HEALTHFIRST-Medicare Advantage, +83226,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,HEALTHFIRST-Medicare Advantage, +83227,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,HEALTHFIRST-Medicare Advantage, +83228,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,HEALTHFIRST-Medicare Advantage, +83229,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,HEALTHFIRST-Medicare Advantage, +83230,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,HEALTHFIRST-Medicare Advantage, +83231,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,HEALTHFIRST-Medicare Advantage, +83232,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,HEALTHFIRST-Medicare Advantage, +83233,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,HEALTHFIRST-Medicare Advantage, +83234,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,HEALTHFIRST-Medicare Advantage, +83235,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,HEALTHFIRST-Medicare Advantage, +83236,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,HEALTHFIRST-Medicare Advantage, +83237,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,HEALTHFIRST-Medicare Advantage, +83238,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,HEALTHFIRST-Medicare Advantage, +83239,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,HEALTHFIRST-Medicare Advantage, +83240,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,HEALTHFIRST-Medicare Advantage, +83241,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,HEALTHFIRST-Medicare Advantage, +83242,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,HEALTHFIRST-Medicare Advantage, +83243,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,HEALTHFIRST-Medicare Advantage, +83244,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,HEALTHFIRST-Medicare Advantage, +83245,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,HEALTHFIRST-Medicare Advantage, +83246,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,HEALTHFIRST-Medicare Advantage, +83247,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,HEALTHFIRST-Medicare Advantage, +83248,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,HEALTHFIRST-Medicare Advantage, +83249,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,HEALTHFIRST-Medicare Advantage, +83250,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,HEALTHFIRST-Medicare Advantage, +83251,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,HEALTHFIRST-Medicare Advantage, +83252,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,HEALTHFIRST-Medicare Advantage, +83253,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,HEALTHFIRST-Medicare Advantage, +83254,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,HEALTHFIRST-Medicare Advantage, +83255,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,HEALTHFIRST-Medicare Advantage, +83256,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,HEALTHFIRST-Medicare Advantage, +83257,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,HEALTHFIRST-Medicare Advantage, +83258,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,HEALTHFIRST-Medicare Advantage, +83259,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,HEALTHFIRST-Medicare Advantage, +83260,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,HEALTHFIRST-Medicare Advantage, +83261,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,HEALTHFIRST-Medicare Advantage, +83262,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,HEALTHFIRST-Medicare Advantage, +83263,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,HEALTHFIRST-Medicare Advantage, +83264,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,HEALTHFIRST-Medicare Advantage, +83265,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,HEALTHFIRST-Medicare Advantage, +83266,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,HEALTHFIRST-Medicare Advantage, +83267,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,HEALTHFIRST-Medicare Advantage, +83268,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,HEALTHFIRST-Medicare Advantage, +83269,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,HEALTHFIRST-Medicare Advantage, +83270,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,HEALTHFIRST-Medicare Advantage, +83271,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,HEALTHFIRST-Medicare Advantage, +83272,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,HEALTHFIRST-Medicare Advantage, +83273,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,HEALTHFIRST-Medicare Advantage, +83274,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,HEALTHFIRST-Medicare Advantage, +83275,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,HEALTHFIRST-Medicare Advantage, +83276,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,HEALTHFIRST-Medicare Advantage, +83277,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,HEALTHFIRST-Medicare Advantage, +83278,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83279,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,HEALTHFIRST-Medicare Advantage, +83280,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,HEALTHFIRST-Medicare Advantage, +83281,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,HEALTHFIRST-Medicare Advantage, +83282,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,HEALTHFIRST-Medicare Advantage, +83283,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,HEALTHFIRST-Medicare Advantage, +83284,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,HEALTHFIRST-Medicare Advantage, +83285,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,HEALTHFIRST-Medicare Advantage, +83286,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,HEALTHFIRST-Medicare Advantage, +83287,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,HEALTHFIRST-Medicare Advantage, +83288,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,HEALTHFIRST-Medicare Advantage, +83289,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,HEALTHFIRST-Medicare Advantage, +83290,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,HEALTHFIRST-Medicare Advantage, +83291,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,HEALTHFIRST-Medicare Advantage, +83292,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,HEALTHFIRST-Medicare Advantage, +83293,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,HEALTHFIRST-Medicare Advantage, +83294,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,HEALTHFIRST-Medicare Advantage, +83295,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,HEALTHFIRST-Medicare Advantage, +83296,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,HEALTHFIRST-Medicare Advantage, +83297,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,HEALTHFIRST-Medicare Advantage, +83298,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,HEALTHFIRST-Medicare Advantage, +83299,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,HEALTHFIRST-Medicare Advantage, +83300,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,HEALTHFIRST-Medicare Advantage, +83301,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,HEALTHFIRST-Medicare Advantage, +83302,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,HEALTHFIRST-Medicare Advantage, +83303,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,HEALTHFIRST-Medicare Advantage, +83304,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,HEALTHFIRST-Medicare Advantage, +83305,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,HEALTHFIRST-Medicare Advantage, +83306,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,HEALTHFIRST-Medicare Advantage, +83307,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,HEALTHFIRST-Medicare Advantage, +83308,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,HEALTHFIRST-Medicare Advantage, +83309,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,HEALTHFIRST-Medicare Advantage, +83310,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,HEALTHFIRST-Medicare Advantage, +83311,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,HEALTHFIRST-Medicare Advantage, +83312,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,HEALTHFIRST-Medicare Advantage, +83313,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,HEALTHFIRST-Medicare Advantage, +83314,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,HEALTHFIRST-Medicare Advantage, +83315,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,HEALTHFIRST-Medicare Advantage, +83316,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,HEALTHFIRST-Medicare Advantage, +83317,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,HEALTHFIRST-Medicare Advantage, +83318,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,HEALTHFIRST-Medicare Advantage, +83319,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,HEALTHFIRST-Medicare Advantage, +83320,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,HEALTHFIRST-Medicare Advantage, +83321,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,HEALTHFIRST-Medicare Advantage, +83322,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,HEALTHFIRST-Medicare Advantage, +83323,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,HEALTHFIRST-Medicare Advantage, +83324,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,HEALTHFIRST-Medicare Advantage, +83325,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,HEALTHFIRST-Medicare Advantage, +83326,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,HEALTHFIRST-Medicare Advantage, +83327,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,HEALTHFIRST-Medicare Advantage, +83328,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHFIRST-Medicare Advantage, +83329,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHFIRST-Medicare Advantage, +83330,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,HEALTHFIRST-Medicare Advantage, +83331,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,HEALTHFIRST-Medicare Advantage, +83332,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,HEALTHFIRST-Medicare Advantage, +83333,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,HEALTHFIRST-Medicare Advantage, +83334,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,HEALTHFIRST-Medicare Advantage, +83335,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,HEALTHFIRST-Medicare Advantage, +83336,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,HEALTHFIRST-Medicare Advantage, +83337,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,HEALTHFIRST-Medicare Advantage, +83338,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,HEALTHFIRST-Medicare Advantage, +83339,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,HEALTHFIRST-Medicare Advantage, +83340,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,HEALTHFIRST-Medicare Advantage, +83341,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,HEALTHFIRST-Medicare Advantage, +83342,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,HEALTHFIRST-Medicare Advantage, +83343,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,HEALTHFIRST-Medicare Advantage, +83344,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,HEALTHFIRST-Medicare Advantage, +83345,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,HEALTHFIRST-Medicare Advantage, +83346,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,HEALTHFIRST-Medicare Advantage, +83347,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,HEALTHFIRST-Medicare Advantage, +83348,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,HEALTHFIRST-Medicare Advantage, +83349,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,HEALTHFIRST-Medicare Advantage, +83350,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,HEALTHFIRST-Medicare Advantage, +83351,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,HEALTHFIRST-Medicare Advantage, +83352,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,HEALTHFIRST-Medicare Advantage, +83353,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,HEALTHFIRST-Medicare Advantage, +83354,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,HEALTHFIRST-Medicare Advantage, +83355,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,HEALTHFIRST-Medicare Advantage, +83356,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,HEALTHFIRST-Medicare Advantage, +83357,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,HEALTHFIRST-Medicare Advantage, +83358,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,HEALTHFIRST-Medicare Advantage, +83359,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,HEALTHFIRST-Medicare Advantage, +83360,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,HEALTHFIRST-Medicare Advantage, +83361,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,HEALTHFIRST-Medicare Advantage, +83362,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,HEALTHFIRST-Medicare Advantage, +83363,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,HEALTHFIRST-Medicare Advantage, +83364,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,HEALTHFIRST-Medicare Advantage, +83365,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,HEALTHFIRST-Medicare Advantage, +83366,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,HEALTHFIRST-Medicare Advantage, +83367,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,HEALTHFIRST-Medicare Advantage, +83368,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,HEALTHFIRST-Medicare Advantage, +83369,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,HEALTHFIRST-Medicare Advantage, +83370,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,HEALTHFIRST-Medicare Advantage, +83371,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,HEALTHFIRST-Medicare Advantage, +83372,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,HEALTHFIRST-Medicare Advantage, +83373,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +83374,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,HEALTHFIRST-Medicare Advantage, +83375,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,HEALTHFIRST-Medicare Advantage, +83376,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,HEALTHFIRST-Medicare Advantage, +83377,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,HEALTHFIRST-Medicare Advantage, +83378,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,HEALTHFIRST-Medicare Advantage, +83379,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,HEALTHFIRST-Medicare Advantage, +83380,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,HEALTHFIRST-Medicare Advantage, +83381,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,HEALTHFIRST-Medicare Advantage, +83382,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,HEALTHFIRST-Medicare Advantage, +83383,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,HEALTHFIRST-Medicare Advantage, +83384,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,HEALTHFIRST-Medicare Advantage, +83385,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,HEALTHFIRST-Medicare Advantage, +83386,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,HEALTHFIRST-Medicare Advantage, +83387,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,HEALTHFIRST-Medicare Advantage, +83388,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,HEALTHFIRST-Medicare Advantage, +83389,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,HEALTHFIRST-Medicare Advantage, +83390,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,HEALTHFIRST-Medicare Advantage, +83391,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,HEALTHFIRST-Medicare Advantage, +83392,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,HEALTHFIRST-Medicare Advantage, +83393,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,HEALTHFIRST-Medicare Advantage, +83394,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,HEALTHFIRST-Medicare Advantage, +83395,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,HEALTHFIRST-Medicare Advantage, +83396,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,HEALTHFIRST-Medicare Advantage, +83397,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,HEALTHFIRST-Medicare Advantage, +83398,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83399,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,HEALTHFIRST-Medicare Advantage, +83400,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,HEALTHFIRST-Medicare Advantage, +83401,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,HEALTHFIRST-Medicare Advantage, +83402,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,HEALTHFIRST-Medicare Advantage, +83403,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,HEALTHFIRST-Medicare Advantage, +83404,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,HEALTHFIRST-Medicare Advantage, +83405,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,HEALTHFIRST-Medicare Advantage, +83406,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,HEALTHFIRST-Medicare Advantage, +83407,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,HEALTHFIRST-Medicare Advantage, +83408,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,HEALTHFIRST-Medicare Advantage, +83409,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,HEALTHFIRST-Medicare Advantage, +83410,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,HEALTHFIRST-Medicare Advantage, +83411,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,HEALTHFIRST-Medicare Advantage, +83412,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,HEALTHFIRST-Medicare Advantage, +83413,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,HEALTHFIRST-Medicare Advantage, +83414,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,HEALTHFIRST-Medicare Advantage, +83415,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,HEALTHFIRST-Medicare Advantage, +83416,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,HEALTHFIRST-Medicare Advantage, +83417,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,HEALTHFIRST-Medicare Advantage, +83418,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,HEALTHFIRST-Medicare Advantage, +83419,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,HEALTHFIRST-Medicare Advantage, +83420,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,HEALTHFIRST-Medicare Advantage, +83421,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,HEALTHFIRST-Medicare Advantage, +83422,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,HEALTHFIRST-Medicare Advantage, +83423,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,HEALTHFIRST-Medicare Advantage, +83424,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,HEALTHFIRST-Medicare Advantage, +83425,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,HEALTHFIRST-Medicare Advantage, +83426,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,HEALTHFIRST-Medicare Advantage, +83427,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,HEALTHFIRST-Medicare Advantage, +83428,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,HEALTHFIRST-Medicare Advantage, +83429,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,HEALTHFIRST-Medicare Advantage, +83430,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,HEALTHFIRST-Medicare Advantage, +83431,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,HEALTHFIRST-Medicare Advantage, +83432,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,HEALTHFIRST-Medicare Advantage, +83433,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,HEALTHFIRST-Medicare Advantage, +83434,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,HEALTHFIRST-Medicare Advantage, +83435,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,HEALTHFIRST-Medicare Advantage, +83436,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,HEALTHFIRST-Medicare Advantage, +83437,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,HEALTHFIRST-Medicare Advantage, +83438,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,HEALTHFIRST-Medicare Advantage, +83439,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,HEALTHFIRST-Medicare Advantage, +83440,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,HEALTHFIRST-Medicare Advantage, +83441,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,HEALTHFIRST-Medicare Advantage, +83442,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,HEALTHFIRST-Medicare Advantage, +83443,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,HEALTHFIRST-Medicare Advantage, +83444,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,HEALTHFIRST-Medicare Advantage, +83445,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,HEALTHFIRST-Medicare Advantage, +83446,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,HEALTHFIRST-Medicare Advantage, +83447,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,HEALTHFIRST-Medicare Advantage, +83448,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,HEALTHFIRST-Medicare Advantage, +83449,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,HEALTHFIRST-Medicare Advantage, +83450,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,HEALTHFIRST-Medicare Advantage, +83451,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,HEALTHFIRST-Medicare Advantage, +83452,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,HEALTHFIRST-Medicare Advantage, +83453,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,HEALTHFIRST-Medicare Advantage, +83454,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,HEALTHFIRST-Medicare Advantage, +83455,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,HEALTHFIRST-Medicare Advantage, +83456,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,HEALTHFIRST-Medicare Advantage, +83457,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,HEALTHFIRST-Medicare Advantage, +83458,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,HEALTHFIRST-Medicare Advantage, +83459,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,HEALTHFIRST-Medicare Advantage, +83460,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,HEALTHFIRST-Medicare Advantage, +83461,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,HEALTHFIRST-Medicare Advantage, +83462,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,HEALTHFIRST-Medicare Advantage, +83463,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,HEALTHFIRST-Medicare Advantage, +83464,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,HEALTHFIRST-Medicare Advantage, +83465,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,HEALTHFIRST-Medicare Advantage, +83466,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,HEALTHFIRST-Medicare Advantage, +83467,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,HEALTHFIRST-Medicare Advantage, +83468,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,HEALTHFIRST-Medicare Advantage, +83469,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,HEALTHFIRST-Medicare Advantage, +83470,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,HEALTHFIRST-Medicare Advantage, +83471,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,HEALTHFIRST-Medicare Advantage, +83472,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,HEALTHFIRST-Medicare Advantage, +83473,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,HEALTHFIRST-Medicare Advantage, +83474,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,HEALTHFIRST-Medicare Advantage, +83475,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,HEALTHFIRST-Medicare Advantage, +83476,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,HEALTHFIRST-Medicare Advantage, +83477,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,HEALTHFIRST-Medicare Advantage, +83478,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,HEALTHFIRST-Medicare Advantage, +83479,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,HEALTHFIRST-Medicare Advantage, +83480,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,HEALTHFIRST-Medicare Advantage, +83481,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,HEALTHFIRST-Medicare Advantage, +83482,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,HEALTHFIRST-Medicare Advantage, +83483,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,HEALTHFIRST-Medicare Advantage, +83484,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,HEALTHFIRST-Medicare Advantage, +83485,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,HEALTHFIRST-Medicare Advantage, +83486,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,HEALTHFIRST-Medicare Advantage, +83487,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,HEALTHFIRST-Medicare Advantage, +83488,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,HEALTHFIRST-Medicare Advantage, +83489,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,HEALTHFIRST-Medicare Advantage, +83490,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,HEALTHFIRST-Medicare Advantage, +83491,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,HEALTHFIRST-Medicare Advantage, +83492,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,HEALTHFIRST-Medicare Advantage, +83493,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,HEALTHFIRST-Medicare Advantage, +83494,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,HEALTHFIRST-Medicare Advantage, +83495,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,HEALTHFIRST-Medicare Advantage, +83496,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,HEALTHFIRST-Medicare Advantage, +83497,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,HEALTHFIRST-Medicare Advantage, +83498,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,HEALTHFIRST-Medicare Advantage, +83499,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,HEALTHFIRST-Medicare Advantage, +83500,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,HEALTHFIRST-Medicare Advantage, +83501,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,HEALTHFIRST-Medicare Advantage, +83502,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,HEALTHFIRST-Medicare Advantage, +83503,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,HEALTHFIRST-Medicare Advantage, +83504,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,HEALTHFIRST-Medicare Advantage, +83505,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,HEALTHFIRST-Medicare Advantage, +83506,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,HEALTHFIRST-Medicare Advantage, +83507,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,HEALTHFIRST-Medicare Advantage, +83508,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,HEALTHFIRST-Medicare Advantage, +83509,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,HEALTHFIRST-Medicare Advantage, +83510,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,HEALTHFIRST-Medicare Advantage, +83511,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,HEALTHFIRST-Medicare Advantage, +83512,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,HEALTHFIRST-Medicare Advantage, +83513,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,HEALTHFIRST-Medicare Advantage, +83514,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,HEALTHFIRST-Medicare Advantage, +83515,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,HEALTHFIRST-Medicare Advantage, +83516,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,HEALTHFIRST-Medicare Advantage, +83517,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,HEALTHFIRST-Medicare Advantage, +83518,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,HEALTHFIRST-Medicare Advantage, +83519,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,HEALTHFIRST-Medicare Advantage, +83520,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +83521,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,HEALTHFIRST-Medicare Advantage, +83522,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,HEALTHFIRST-Medicare Advantage, +83523,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,HEALTHFIRST-Medicare Advantage, +83524,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,HEALTHFIRST-Medicare Advantage, +83525,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,HEALTHFIRST-Medicare Advantage, +83526,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,HEALTHFIRST-Medicare Advantage, +83527,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,HEALTHFIRST-Medicare Advantage, +83528,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,HEALTHFIRST-Medicare Advantage, +83529,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,HEALTHFIRST-Medicare Advantage, +83530,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,HEALTHFIRST-Medicare Advantage, +83531,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,HEALTHFIRST-Medicare Advantage, +83532,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,HEALTHFIRST-Medicare Advantage, +83533,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,HEALTHFIRST-Medicare Advantage, +83534,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,HEALTHFIRST-Medicare Advantage, +83535,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,HEALTHFIRST-Medicare Advantage, +83536,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,HEALTHFIRST-Medicare Advantage, +83537,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,HEALTHFIRST-Medicare Advantage, +83538,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,HEALTHFIRST-Medicare Advantage, +83539,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,HEALTHFIRST-Medicare Advantage, +83540,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,HEALTHFIRST-Medicare Advantage, +83541,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,HEALTHFIRST-Medicare Advantage, +83542,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,HEALTHFIRST-Medicare Advantage, +83543,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,HEALTHFIRST-Medicare Advantage, +83544,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,HEALTHFIRST-Medicare Advantage, +83545,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,HEALTHFIRST-Medicare Advantage, +83546,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,HEALTHFIRST-Medicare Advantage, +83547,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,HEALTHFIRST-Medicare Advantage, +83548,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,HEALTHFIRST-Medicare Advantage, +83549,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,HEALTHFIRST-Medicare Advantage, +83550,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,HEALTHFIRST-Medicare Advantage, +83551,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,HEALTHFIRST-Medicare Advantage, +83552,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,HEALTHFIRST-Medicare Advantage, +83553,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,HEALTHFIRST-Medicare Advantage, +83554,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,HEALTHFIRST-Medicare Advantage, +83555,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,HEALTHFIRST-Medicare Advantage, +83556,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,HEALTHFIRST-Medicare Advantage, +83557,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,HEALTHFIRST-Medicare Advantage, +83558,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,HEALTHFIRST-Medicare Advantage, +83559,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,HEALTHFIRST-Medicare Advantage, +83560,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,HEALTHFIRST-Medicare Advantage, +83561,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,HEALTHFIRST-Medicare Advantage, +83562,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,HEALTHFIRST-Medicare Advantage, +83563,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,HEALTHFIRST-Medicare Advantage, +83564,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,HEALTHFIRST-Medicare Advantage, +83565,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,HEALTHFIRST-Medicare Advantage, +83566,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,HEALTHFIRST-Medicare Advantage, +83567,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,HEALTHFIRST-Medicare Advantage, +83568,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,HEALTHFIRST-Medicare Advantage, +83569,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,HEALTHFIRST-Medicare Advantage, +83570,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,HEALTHFIRST-Medicare Advantage, +83571,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,HEALTHFIRST-Medicare Advantage, +83572,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,HEALTHFIRST-Medicare Advantage, +83573,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,HEALTHFIRST-Medicare Advantage, +83574,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,HEALTHFIRST-Medicare Advantage, +83575,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,HEALTHFIRST-Medicare Advantage, +83576,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,HEALTHFIRST-Medicare Advantage, +83577,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,HEALTHFIRST-Medicare Advantage, +83578,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,HEALTHFIRST-Medicare Advantage, +83579,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,HEALTHFIRST-Medicare Advantage, +83580,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,HEALTHFIRST-Medicare Advantage, +83581,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,HEALTHFIRST-Medicare Advantage, +83582,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,HEALTHFIRST-Medicare Advantage, +83583,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,HEALTHFIRST-Medicare Advantage, +83584,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,HEALTHFIRST-Medicare Advantage, +83585,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,HEALTHFIRST-Medicare Advantage, +83586,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,HEALTHFIRST-Medicare Advantage, +83587,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,HEALTHFIRST-Medicare Advantage, +83588,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,HEALTHFIRST-Medicare Advantage, +83589,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,HEALTHFIRST-Medicare Advantage, +83590,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,HEALTHFIRST-Medicare Advantage, +83591,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,HEALTHFIRST-Medicare Advantage, +83592,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,HEALTHFIRST-Medicare Advantage, +83593,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,HEALTHFIRST-Medicare Advantage, +83594,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,HEALTHFIRST-Medicare Advantage, +83595,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,HEALTHFIRST-Medicare Advantage, +83596,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,HEALTHFIRST-Medicare Advantage, +83597,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,HEALTHFIRST-Medicare Advantage, +83598,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,HEALTHFIRST-Medicare Advantage, +83599,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,HEALTHFIRST-Medicare Advantage, +83600,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,HEALTHFIRST-Medicare Advantage, +83601,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,HEALTHFIRST-Medicare Advantage, +83602,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,HEALTHFIRST-Medicare Advantage, +83603,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,HEALTHFIRST-Medicare Advantage, +83604,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,HEALTHFIRST-Medicare Advantage, +83605,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,HEALTHFIRST-Medicare Advantage, +83606,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,HEALTHFIRST-Medicare Advantage, +83607,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,HEALTHFIRST-Medicare Advantage, +83608,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,HEALTHFIRST-Medicare Advantage, +83609,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,HEALTHFIRST-Medicare Advantage, +83610,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,HEALTHFIRST-Medicare Advantage, +83611,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,HEALTHFIRST-Medicare Advantage, +83612,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,HEALTHFIRST-Medicare Advantage, +83613,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,HEALTHFIRST-Medicare Advantage, +83614,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,HEALTHFIRST-Medicare Advantage, +83615,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83616,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,HEALTHFIRST-Medicare Advantage, +83617,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,HEALTHFIRST-Medicare Advantage, +83618,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,HEALTHFIRST-Medicare Advantage, +83619,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,HEALTHFIRST-Medicare Advantage, +83620,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,HEALTHFIRST-Medicare Advantage, +83621,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,HEALTHFIRST-Medicare Advantage, +83622,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,HEALTHFIRST-Medicare Advantage, +83623,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,HEALTHFIRST-Medicare Advantage, +83624,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,HEALTHFIRST-Medicare Advantage, +83625,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,HEALTHFIRST-Medicare Advantage, +83626,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,HEALTHFIRST-Medicare Advantage, +83627,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,HEALTHFIRST-Medicare Advantage, +83628,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,HEALTHFIRST-Medicare Advantage, +83629,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,HEALTHFIRST-Medicare Advantage, +83630,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,HEALTHFIRST-Medicare Advantage, +83631,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,HEALTHFIRST-Medicare Advantage, +83632,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,HEALTHFIRST-Medicare Advantage, +83633,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,HEALTHFIRST-Medicare Advantage, +83634,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,HEALTHFIRST-Medicare Advantage, +83635,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,HEALTHFIRST-Medicare Advantage, +83636,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,HEALTHFIRST-Medicare Advantage, +83637,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,HEALTHFIRST-Medicare Advantage, +83638,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,HEALTHFIRST-Medicare Advantage, +83639,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,HEALTHFIRST-Medicare Advantage, +83640,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,HEALTHFIRST-Medicare Advantage, +83641,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,HEALTHFIRST-Medicare Advantage, +83642,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,HEALTHFIRST-Medicare Advantage, +83643,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,HEALTHFIRST-Medicare Advantage, +83644,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,HEALTHFIRST-Medicare Advantage, +83645,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,HEALTHFIRST-Medicare Advantage, +83646,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,HEALTHFIRST-Medicare Advantage, +83647,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,HEALTHFIRST-Medicare Advantage, +83648,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,HEALTHFIRST-Medicare Advantage, +83649,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,HEALTHFIRST-Medicare Advantage, +83650,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,HEALTHFIRST-Medicare Advantage, +83651,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,HEALTHFIRST-Medicare Advantage, +83652,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,HEALTHFIRST-Medicare Advantage, +83653,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,HEALTHFIRST-Medicare Advantage, +83654,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,HEALTHFIRST-Medicare Advantage, +83655,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,HEALTHFIRST-Medicare Advantage, +83656,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,HEALTHFIRST-Medicare Advantage, +83657,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,HEALTHFIRST-Medicare Advantage, +83658,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,HEALTHFIRST-Medicare Advantage, +83659,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,HEALTHFIRST-Medicare Advantage, +83660,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,HEALTHFIRST-Medicare Advantage, +83661,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,HEALTHFIRST-Medicare Advantage, +83662,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,HEALTHFIRST-Medicare Advantage, +83663,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,HEALTHFIRST-Medicare Advantage, +83664,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,HEALTHFIRST-Medicare Advantage, +83665,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,HEALTHFIRST-Medicare Advantage, +83666,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,HEALTHFIRST-Medicare Advantage, +83667,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,HEALTHFIRST-Medicare Advantage, +83668,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,HEALTHFIRST-Medicare Advantage, +83669,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,HEALTHFIRST-Medicare Advantage, +83670,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,HEALTHFIRST-Medicare Advantage, +83671,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,HEALTHFIRST-Medicare Advantage, +83672,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,HEALTHFIRST-Medicare Advantage, +83673,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,HEALTHFIRST-Medicare Advantage, +83674,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,HEALTHFIRST-Medicare Advantage, +83675,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,HEALTHFIRST-Medicare Advantage, +83676,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,HEALTHFIRST-Medicare Advantage, +83677,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,HEALTHFIRST-Medicare Advantage, +83678,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,HEALTHFIRST-Medicare Advantage, +83679,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,HEALTHFIRST-Medicare Advantage, +83680,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,HEALTHFIRST-Medicare Advantage, +83681,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,HEALTHFIRST-Medicare Advantage, +83682,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,HEALTHFIRST-Medicare Advantage, +83683,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,HEALTHFIRST-Medicare Advantage, +83684,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,HEALTHFIRST-Medicare Advantage, +83685,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,HEALTHFIRST-Medicare Advantage, +83686,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,HEALTHFIRST-Medicare Advantage, +83687,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,HEALTHFIRST-Medicare Advantage, +83688,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,HEALTHFIRST-Medicare Advantage, +83689,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,HEALTHFIRST-Medicare Advantage, +83690,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,HEALTHFIRST-Medicare Advantage, +83691,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,HEALTHFIRST-Medicare Advantage, +83692,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,HEALTHFIRST-Medicare Advantage, +83693,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,HEALTHFIRST-Medicare Advantage, +83694,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,HEALTHFIRST-Medicare Advantage, +83695,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,HEALTHFIRST-Medicare Advantage, +83696,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,HEALTHFIRST-Medicare Advantage, +83697,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,HEALTHFIRST-Medicare Advantage, +83698,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,HEALTHFIRST-Medicare Advantage, +83699,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,HEALTHFIRST-Medicare Advantage, +83700,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,HEALTHFIRST-Medicare Advantage, +83701,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,HEALTHFIRST-Medicare Advantage, +83702,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,HEALTHFIRST-Medicare Advantage, +83703,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,HEALTHFIRST-Medicare Advantage, +83704,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,HEALTHFIRST-Medicare Advantage, +83705,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,HEALTHFIRST-Medicare Advantage, +83706,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,HEALTHFIRST-Medicare Advantage, +83707,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +83708,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,HEALTHFIRST-Medicare Advantage, +83709,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +83710,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,HEALTHFIRST-Medicare Advantage, +83711,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,HEALTHFIRST-Medicare Advantage, +83712,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,HEALTHFIRST-Medicare Advantage, +83713,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,HEALTHFIRST-Medicare Advantage, +83714,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,HEALTHFIRST-Medicare Advantage, +83715,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,HEALTHFIRST-Medicare Advantage, +83716,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,HEALTHFIRST-Medicare Advantage, +83717,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,HEALTHFIRST-Medicare Advantage, +83718,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,HEALTHFIRST-Medicare Advantage, +83719,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,HEALTHFIRST-Medicare Advantage, +83720,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,HEALTHFIRST-Medicare Advantage, +83721,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,HEALTHFIRST-Medicare Advantage, +83722,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,HEALTHFIRST-Medicare Advantage, +83723,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,HEALTHFIRST-Medicare Advantage, +83724,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,HEALTHFIRST-Medicare Advantage, +83725,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,HEALTHFIRST-Medicare Advantage, +83726,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,HEALTHFIRST-Medicare Advantage, +83727,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,HEALTHFIRST-Medicare Advantage, +83728,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,HEALTHFIRST-Medicare Advantage, +83729,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,HEALTHFIRST-Medicare Advantage, +83730,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,HEALTHFIRST-Medicare Advantage, +83731,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,HEALTHFIRST-Medicare Advantage, +83732,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,HEALTHFIRST-Medicare Advantage, +83733,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,HEALTHFIRST-Medicare Advantage, +83734,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,HEALTHFIRST-Medicare Advantage, +83735,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +83736,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,HEALTHFIRST-Medicare Advantage, +83737,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,HEALTHFIRST-Medicare Advantage, +83738,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,HEALTHFIRST-Medicare Advantage, +83739,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,HEALTHFIRST-Medicare Advantage, +83740,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,HEALTHFIRST-Medicare Advantage, +83741,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,HEALTHFIRST-Medicare Advantage, +83742,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,HEALTHFIRST-Medicare Advantage, +83743,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,HEALTHFIRST-Medicare Advantage, +83744,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,HEALTHFIRST-Medicare Advantage, +83745,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,HEALTHFIRST-Medicare Advantage, +83746,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,HEALTHFIRST-Medicare Advantage, +83747,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,HEALTHFIRST-Medicare Advantage, +83748,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,HEALTHFIRST-Medicare Advantage, +83749,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,HEALTHFIRST-Medicare Advantage, +83750,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,HEALTHFIRST-Medicare Advantage, +83751,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,HEALTHFIRST-Medicare Advantage, +83752,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,HEALTHFIRST-Medicare Advantage, +83753,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,HEALTHFIRST-Medicare Advantage, +83754,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,HEALTHFIRST-Medicare Advantage, +83755,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,HEALTHFIRST-Medicare Advantage, +83756,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,HEALTHFIRST-Medicare Advantage, +83757,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,HEALTHFIRST-Medicare Advantage, +83758,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,HEALTHFIRST-Medicare Advantage, +83759,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,HEALTHFIRST-Medicare Advantage, +83760,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,HEALTHFIRST-Medicare Advantage, +83761,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,HEALTHFIRST-Medicare Advantage, +83762,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,HEALTHFIRST-Medicare Advantage, +83763,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,HEALTHFIRST-Medicare Advantage, +83764,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,HEALTHFIRST-Medicare Advantage, +83765,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83766,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,HEALTHFIRST-Medicare Advantage, +83767,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,HEALTHFIRST-Medicare Advantage, +83768,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,HEALTHFIRST-Medicare Advantage, +83769,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,HEALTHFIRST-Medicare Advantage, +83770,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,HEALTHFIRST-Medicare Advantage, +83771,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,HEALTHFIRST-Medicare Advantage, +83772,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,HEALTHFIRST-Medicare Advantage, +83773,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,HEALTHFIRST-Medicare Advantage, +83774,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,HEALTHFIRST-Medicare Advantage, +83775,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,HEALTHFIRST-Medicare Advantage, +83776,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,HEALTHFIRST-Medicare Advantage, +83777,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,HEALTHFIRST-Medicare Advantage, +83778,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,HEALTHFIRST-Medicare Advantage, +83779,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,HEALTHFIRST-Medicare Advantage, +83780,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,HEALTHFIRST-Medicare Advantage, +83781,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,HEALTHFIRST-Medicare Advantage, +83782,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,HEALTHFIRST-Medicare Advantage, +83783,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,HEALTHFIRST-Medicare Advantage, +83784,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,HEALTHFIRST-Medicare Advantage, +83785,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,HEALTHFIRST-Medicare Advantage, +83786,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,HEALTHFIRST-Medicare Advantage, +83787,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,HEALTHFIRST-Medicare Advantage, +83788,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,HEALTHFIRST-Medicare Advantage, +83789,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,HEALTHFIRST-Medicare Advantage, +83790,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,HEALTHFIRST-Medicare Advantage, +83791,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,HEALTHFIRST-Medicare Advantage, +83792,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +83793,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,HEALTHFIRST-Medicare Advantage, +83794,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83795,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,HEALTHFIRST-Medicare Advantage, +83796,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,HEALTHFIRST-Medicare Advantage, +83797,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,HEALTHFIRST-Medicare Advantage, +83798,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,HEALTHFIRST-Medicare Advantage, +83799,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,HEALTHFIRST-Medicare Advantage, +83800,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,HEALTHFIRST-Medicare Advantage, +83801,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,HEALTHFIRST-Medicare Advantage, +83802,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,HEALTHFIRST-Medicare Advantage, +83803,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,HEALTHFIRST-Medicare Advantage, +83804,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,HEALTHFIRST-Medicare Advantage, +83805,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,HEALTHFIRST-Medicare Advantage, +83806,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,HEALTHFIRST-Medicare Advantage, +83807,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,HEALTHFIRST-Medicare Advantage, +83808,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,HEALTHFIRST-Medicare Advantage, +83809,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,HEALTHFIRST-Medicare Advantage, +83810,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,HEALTHFIRST-Medicare Advantage, +83811,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,HEALTHFIRST-Medicare Advantage, +83812,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,HEALTHFIRST-Medicare Advantage, +83813,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,HEALTHFIRST-Medicare Advantage, +83814,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,HEALTHFIRST-Medicare Advantage, +83815,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,HEALTHFIRST-Medicare Advantage, +83816,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,HEALTHFIRST-Medicare Advantage, +83817,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,HEALTHFIRST-Medicare Advantage, +83818,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,HEALTHFIRST-Medicare Advantage, +83819,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,HEALTHFIRST-Medicare Advantage, +83820,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,HEALTHFIRST-Medicare Advantage, +83821,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,HEALTHFIRST-Medicare Advantage, +83822,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,HEALTHFIRST-Medicare Advantage, +83823,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,HEALTHFIRST-Medicare Advantage, +83824,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,HEALTHFIRST-Medicare Advantage, +83825,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,HEALTHFIRST-Medicare Advantage, +83826,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,HEALTHFIRST-Medicare Advantage, +83827,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,HEALTHFIRST-Medicare Advantage, +83828,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,HEALTHFIRST-Medicare Advantage, +83829,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83830,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,HEALTHFIRST-Medicare Advantage, +83831,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,HEALTHFIRST-Medicare Advantage, +83832,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,HEALTHFIRST-Medicare Advantage, +83833,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,HEALTHFIRST-Medicare Advantage, +83834,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,HEALTHFIRST-Medicare Advantage, +83835,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,HEALTHFIRST-Medicare Advantage, +83836,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,HEALTHFIRST-Medicare Advantage, +83837,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,HEALTHFIRST-Medicare Advantage, +83838,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,HEALTHFIRST-Medicare Advantage, +83839,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,HEALTHFIRST-Medicare Advantage, +83840,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,HEALTHFIRST-Medicare Advantage, +83841,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,HEALTHFIRST-Medicare Advantage, +83842,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,HEALTHFIRST-Medicare Advantage, +83843,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,HEALTHFIRST-Medicare Advantage, +83844,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,HEALTHFIRST-Medicare Advantage, +83845,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,HEALTHFIRST-Medicare Advantage, +83846,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,HEALTHFIRST-Medicare Advantage, +83847,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,HEALTHFIRST-Medicare Advantage, +83848,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,HEALTHFIRST-Medicare Advantage, +83849,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,HEALTHFIRST-Medicare Advantage, +83850,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,HEALTHFIRST-Medicare Advantage, +83851,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,HEALTHFIRST-Medicare Advantage, +83852,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,HEALTHFIRST-Medicare Advantage, +83853,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,HEALTHFIRST-Medicare Advantage, +83854,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,HEALTHFIRST-Medicare Advantage, +83855,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,HEALTHFIRST-Medicare Advantage, +83856,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,HEALTHFIRST-Medicare Advantage, +83857,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,HEALTHFIRST-Medicare Advantage, +83858,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,HEALTHFIRST-Medicare Advantage, +83859,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,HEALTHFIRST-Medicare Advantage, +83860,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,HEALTHFIRST-Medicare Advantage, +83861,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,HEALTHFIRST-Medicare Advantage, +83862,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,HEALTHFIRST-Medicare Advantage, +83863,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,HEALTHFIRST-Medicare Advantage, +83864,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,HEALTHFIRST-Medicare Advantage, +83865,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,HEALTHFIRST-Medicare Advantage, +83866,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,HEALTHFIRST-Medicare Advantage, +83867,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,HEALTHFIRST-Medicare Advantage, +83868,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,HEALTHFIRST-Medicare Advantage, +83869,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,HEALTHFIRST-Medicare Advantage, +83870,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,HEALTHFIRST-Medicare Advantage, +83871,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,HEALTHFIRST-Medicare Advantage, +83872,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,HEALTHFIRST-Medicare Advantage, +83873,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,HEALTHFIRST-Medicare Advantage, +83874,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,HEALTHFIRST-Medicare Advantage, +83875,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +83876,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,HEALTHFIRST-Medicare Advantage, +83877,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,HEALTHFIRST-Medicare Advantage, +83878,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83879,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,HEALTHFIRST-Medicare Advantage, +83880,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +83881,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +83882,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,HEALTHFIRST-Medicare Advantage, +83883,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,HEALTHFIRST-Medicare Advantage, +83884,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,HEALTHFIRST-Medicare Advantage, +83885,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,HEALTHFIRST-Medicare Advantage, +83886,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,HEALTHFIRST-Medicare Advantage, +83887,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,HEALTHFIRST-Medicare Advantage, +83888,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,HEALTHFIRST-Medicare Advantage, +83889,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,HEALTHFIRST-Medicare Advantage, +83890,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,HEALTHFIRST-Medicare Advantage, +83891,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,HEALTHFIRST-Medicare Advantage, +83892,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,HEALTHFIRST-Medicare Advantage, +83893,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,HEALTHFIRST-Medicare Advantage, +83894,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,HEALTHFIRST-Medicare Advantage, +83895,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,HEALTHFIRST-Medicare Advantage, +83896,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,HEALTHFIRST-Medicare Advantage, +83897,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,HEALTHFIRST-Medicare Advantage, +83898,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,HEALTHFIRST-Medicare Advantage, +83899,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,HEALTHFIRST-Medicare Advantage, +83900,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,HEALTHFIRST-Medicare Advantage, +83901,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,HEALTHFIRST-Medicare Advantage, +83902,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,HEALTHFIRST-Medicare Advantage, +83903,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,HEALTHFIRST-Medicare Advantage, +83904,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,HEALTHFIRST-Medicare Advantage, +83905,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,HEALTHFIRST-Medicare Advantage, +83906,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,HEALTHFIRST-Medicare Advantage, +83907,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,HEALTHFIRST-Medicare Advantage, +83908,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,HEALTHFIRST-Medicare Advantage, +83909,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,HEALTHFIRST-Medicare Advantage, +83910,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83911,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,HEALTHFIRST-Medicare Advantage, +83912,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,HEALTHFIRST-Medicare Advantage, +83913,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,HEALTHFIRST-Medicare Advantage, +83914,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,HEALTHFIRST-Medicare Advantage, +83915,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,HEALTHFIRST-Medicare Advantage, +83916,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,HEALTHFIRST-Medicare Advantage, +83917,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +83918,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,HEALTHFIRST-Medicare Advantage, +83919,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,HEALTHFIRST-Medicare Advantage, +83920,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,HEALTHFIRST-Medicare Advantage, +83921,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,HEALTHFIRST-Medicare Advantage, +83922,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,HEALTHFIRST-Medicare Advantage, +83923,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,HEALTHFIRST-Medicare Advantage, +83924,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,HEALTHFIRST-Medicare Advantage, +83925,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,HEALTHFIRST-Medicare Advantage, +83926,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,HEALTHFIRST-Medicare Advantage, +83927,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,HEALTHFIRST-Medicare Advantage, +83928,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,HEALTHFIRST-Medicare Advantage, +83929,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,HEALTHFIRST-Medicare Advantage, +83930,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,HEALTHFIRST-Medicare Advantage, +83931,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,HEALTHFIRST-Medicare Advantage, +83932,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,HEALTHFIRST-Medicare Advantage, +83933,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,HEALTHFIRST-Medicare Advantage, +83934,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,HEALTHFIRST-Medicare Advantage, +83935,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,HEALTHFIRST-Medicare Advantage, +83936,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,HEALTHFIRST-Medicare Advantage, +83937,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,HEALTHFIRST-Medicare Advantage, +83938,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,HEALTHFIRST-Medicare Advantage, +83939,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,HEALTHFIRST-Medicare Advantage, +83940,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,HEALTHFIRST-Medicare Advantage, +83941,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,HEALTHFIRST-Medicare Advantage, +83942,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,HEALTHFIRST-Medicare Advantage, +83943,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,HEALTHFIRST-Medicare Advantage, +83944,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,HEALTHFIRST-Medicare Advantage, +83945,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,HEALTHFIRST-Medicare Advantage, +83946,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,HEALTHFIRST-Medicare Advantage, +83947,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,HEALTHFIRST-Medicare Advantage, +83948,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,HEALTHFIRST-Medicare Advantage, +83949,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,HEALTHFIRST-Medicare Advantage, +83950,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,HEALTHFIRST-Medicare Advantage, +83951,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,HEALTHFIRST-Medicare Advantage, +83952,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,HEALTHFIRST-Medicare Advantage, +83953,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,HEALTHFIRST-Medicare Advantage, +83954,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,HEALTHFIRST-Medicare Advantage, +83955,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,HEALTHFIRST-Medicare Advantage, +83956,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,HEALTHFIRST-Medicare Advantage, +83957,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,HEALTHFIRST-Medicare Advantage, +83958,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,HEALTHFIRST-Medicare Advantage, +83959,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,HEALTHFIRST-Medicare Advantage, +83960,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,HEALTHFIRST-Medicare Advantage, +83961,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,HEALTHFIRST-Medicare Advantage, +83962,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,HEALTHFIRST-Medicare Advantage, +83963,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,HEALTHFIRST-Medicare Advantage, +83964,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,HEALTHFIRST-Medicare Advantage, +83965,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,HEALTHFIRST-Medicare Advantage, +83966,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,HEALTHFIRST-Medicare Advantage, +83967,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,HEALTHFIRST-Medicare Advantage, +83968,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,HEALTHFIRST-Medicare Advantage, +83969,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,HEALTHFIRST-Medicare Advantage, +83970,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,HEALTHFIRST-Medicare Advantage, +83971,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,HEALTHFIRST-Medicare Advantage, +83972,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,HEALTHFIRST-Medicare Advantage, +83973,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,HEALTHFIRST-Medicare Advantage, +83974,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,HEALTHFIRST-Medicare Advantage, +83975,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,HEALTHFIRST-Medicare Advantage, +83976,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,HEALTHFIRST-Medicare Advantage, +83977,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,HEALTHFIRST-Medicare Advantage, +83978,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,HEALTHFIRST-Medicare Advantage, +83979,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,HEALTHFIRST-Medicare Advantage, +83980,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,HEALTHFIRST-Medicare Advantage, +83981,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,HEALTHFIRST-Medicare Advantage, +83982,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,HEALTHFIRST-Medicare Advantage, +83983,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,HEALTHFIRST-Medicare Advantage, +83984,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,HEALTHFIRST-Medicare Advantage, +83985,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,HEALTHFIRST-Medicare Advantage, +83986,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,HEALTHFIRST-Medicare Advantage, +83987,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,HEALTHFIRST-Medicare Advantage, +83988,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,HEALTHFIRST-Medicare Advantage, +83989,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,HEALTHFIRST-Medicare Advantage, +83990,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,HEALTHFIRST-Medicare Advantage, +83991,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,HEALTHFIRST-Medicare Advantage, +83992,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHFIRST-Medicare Advantage, +83993,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +83994,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,HEALTHFIRST-Medicare Advantage, +83995,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,HEALTHFIRST-Medicare Advantage, +83996,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,HEALTHFIRST-Medicare Advantage, +83997,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,HEALTHFIRST-Medicare Advantage, +83998,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,HEALTHFIRST-Medicare Advantage, +83999,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,HEALTHFIRST-Medicare Advantage, +84000,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,HEALTHFIRST-Medicare Advantage, +84001,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,HEALTHFIRST-Medicare Advantage, +84002,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,HEALTHFIRST-Medicare Advantage, +84003,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,HEALTHFIRST-Medicare Advantage, +84004,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,HEALTHFIRST-Medicare Advantage, +84005,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,HEALTHFIRST-Medicare Advantage, +84006,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,HEALTHFIRST-Medicare Advantage, +84007,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,HEALTHFIRST-Medicare Advantage, +84008,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,HEALTHFIRST-Medicare Advantage, +84009,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,HEALTHFIRST-Medicare Advantage, +84010,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,HEALTHFIRST-Medicare Advantage, +84011,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,HEALTHFIRST-Medicare Advantage, +84012,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,HEALTHFIRST-Medicare Advantage, +84013,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,HEALTHFIRST-Medicare Advantage, +84014,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,HEALTHFIRST-Medicare Advantage, +84015,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,HEALTHFIRST-Medicare Advantage, +84016,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,HEALTHFIRST-Medicare Advantage, +84017,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,HEALTHFIRST-Medicare Advantage, +84018,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,HEALTHFIRST-Medicare Advantage, +84019,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,HEALTHFIRST-Medicare Advantage, +84020,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,HEALTHFIRST-Medicare Advantage, +84021,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,HEALTHFIRST-Medicare Advantage, +84022,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,HEALTHFIRST-Medicare Advantage, +84023,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,HEALTHFIRST-Medicare Advantage, +84024,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,HEALTHFIRST-Medicare Advantage, +84025,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHFIRST-Medicare Advantage, +84026,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,HEALTHFIRST-Medicare Advantage, +84027,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,HEALTHFIRST-Medicare Advantage, +84028,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,HEALTHFIRST-Medicare Advantage, +84029,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,HEALTHFIRST-Medicare Advantage, +84030,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,HEALTHFIRST-Medicare Advantage, +84031,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,HEALTHFIRST-Medicare Advantage, +84032,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,HEALTHFIRST-Medicare Advantage, +84033,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,HEALTHFIRST-Medicare Advantage, +84034,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,HEALTHFIRST-Medicare Advantage, +84035,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,HEALTHFIRST-Medicare Advantage, +84036,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,HEALTHFIRST-Medicare Advantage, +84037,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,HEALTHFIRST-Medicare Advantage, +84038,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,HEALTHFIRST-Medicare Advantage, +84039,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,HEALTHFIRST-Medicare Advantage, +84040,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,HEALTHFIRST-Medicare Advantage, +84041,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,HEALTHFIRST-Medicare Advantage, +84042,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHFIRST-Medicare Advantage, +84043,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,HEALTHFIRST-Medicare Advantage, +84044,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,HEALTHFIRST-Medicare Advantage, +84045,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,HEALTHFIRST-Medicare Advantage, +84046,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,HEALTHFIRST-Medicare Advantage, +84047,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,HEALTHFIRST-Medicare Advantage, +84048,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,HEALTHFIRST-Medicare Advantage, +84049,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,HEALTHFIRST-Medicare Advantage, +84050,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,HEALTHFIRST-Medicare Advantage, +84051,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,HEALTHFIRST-Medicare Advantage, +84052,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,HEALTHFIRST-Medicare Advantage, +84053,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,HEALTHFIRST-Medicare Advantage, +84054,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,HEALTHFIRST-Medicare Advantage, +84055,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,HEALTHFIRST-Medicare Advantage, +84056,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,HEALTHFIRST-Medicare Advantage, +84057,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,HEALTHFIRST-Medicare Advantage, +84058,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,HEALTHFIRST-Medicare Advantage, +84059,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,HEALTHFIRST-Medicare Advantage, +84060,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,HEALTHFIRST-Medicare Advantage, +84061,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,HEALTHFIRST-Medicare Advantage, +84062,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,HEALTHFIRST-Medicare Advantage, +84063,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,HEALTHFIRST-Medicare Advantage, +84064,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,HEALTHFIRST-Medicare Advantage, +84065,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,HEALTHFIRST-Medicare Advantage, +84066,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,HEALTHFIRST-Medicare Advantage, +84067,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,HEALTHFIRST-Medicare Advantage, +84068,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,HEALTHFIRST-Medicare Advantage, +84069,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,HEALTHFIRST-Medicare Advantage, +84070,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,HEALTHFIRST-Medicare Advantage, +84071,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,HEALTHFIRST-Medicare Advantage, +84072,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,HEALTHFIRST-Medicare Advantage, +84073,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,HEALTHFIRST-Medicare Advantage, +84074,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,HEALTHFIRST-Medicare Advantage, +84075,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,HEALTHFIRST-Medicare Advantage, +84076,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,HEALTHFIRST-Medicare Advantage, +84077,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,HEALTHFIRST-Medicare Advantage, +84078,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,HEALTHFIRST-Medicare Advantage, +84079,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,HEALTHFIRST-Medicare Advantage, +84080,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,HEALTHFIRST-Medicare Advantage, +84081,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,HEALTHFIRST-Medicare Advantage, +84082,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,HEALTHFIRST-Medicare Advantage, +84083,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,HEALTHFIRST-Medicare Advantage, +84084,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,HEALTHFIRST-Medicare Advantage, +84085,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,HEALTHFIRST-Medicare Advantage, +84086,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,HEALTHFIRST-Medicare Advantage, +84087,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,HEALTHFIRST-Medicare Advantage, +84088,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,HEALTHFIRST-Medicare Advantage, +84089,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,HEALTHFIRST-Medicare Advantage, +84090,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,HEALTHFIRST-Medicare Advantage, +84091,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,HEALTHFIRST-Medicare Advantage, +84092,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,HEALTHFIRST-Medicare Advantage, +84093,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,HEALTHFIRST-Medicare Advantage, +84094,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,HEALTHFIRST-Medicare Advantage, +84095,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,HEALTHFIRST-Medicare Advantage, +84096,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,HEALTHFIRST-Medicare Advantage, +84097,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,HEALTHFIRST-Medicare Advantage, +84098,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,HEALTHFIRST-Medicare Advantage, +84099,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,HEALTHFIRST-Medicare Advantage, +84100,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,HEALTHFIRST-Medicare Advantage, +84101,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,HEALTHFIRST-Medicare Advantage, +84102,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,HEALTHFIRST-Medicare Advantage, +84103,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,HEALTHFIRST-Medicare Advantage, +84104,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,HEALTHFIRST-Medicare Advantage, +84105,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,HEALTHFIRST-Medicare Advantage, +84106,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,HEALTHFIRST-Medicare Advantage, +84107,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,HEALTHFIRST-Medicare Advantage, +84108,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,HEALTHFIRST-Medicare Advantage, +84109,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,HEALTHFIRST-Medicare Advantage, +84110,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,HEALTHFIRST-Medicare Advantage, +84111,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,HEALTHFIRST-Medicare Advantage, +84112,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,HEALTHFIRST-Medicare Advantage, +84113,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,HEALTHFIRST-Medicare Advantage, +84114,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,HEALTHFIRST-Medicare Advantage, +84115,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,HEALTHFIRST-Medicare Advantage, +84116,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,HEALTHFIRST-Medicare Advantage, +84117,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,HEALTHFIRST-Medicare Advantage, +84118,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,HEALTHFIRST-Medicare Advantage, +84119,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,HEALTHFIRST-Medicare Advantage, +84120,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,HEALTHFIRST-Medicare Advantage, +84121,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,HEALTHFIRST-Medicare Advantage, +84122,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,HEALTHFIRST-Medicare Advantage, +84123,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,HEALTHFIRST-Medicare Advantage, +84124,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,HEALTHFIRST-Medicare Advantage, +84125,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,HEALTHFIRST-Medicare Advantage, +84126,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,HEALTHFIRST-Medicare Advantage, +84127,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,HEALTHFIRST-Medicare Advantage, +84128,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,HEALTHFIRST-Medicare Advantage, +84129,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,HEALTHFIRST-Medicare Advantage, +84130,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,HEALTHFIRST-Medicare Advantage, +84131,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,HEALTHFIRST-Medicare Advantage, +84132,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,HEALTHFIRST-Medicare Advantage, +84133,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,HEALTHFIRST-Medicare Advantage, +84134,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,HEALTHFIRST-Medicare Advantage, +84135,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,HEALTHFIRST-Medicare Advantage, +84136,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,HEALTHFIRST-Medicare Advantage, +84137,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,HEALTHFIRST-Medicare Advantage, +84138,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,HEALTHFIRST-Medicare Advantage, +84139,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,HEALTHFIRST-Medicare Advantage, +84140,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,HEALTHFIRST-Medicare Advantage, +84141,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,HEALTHFIRST-Medicare Advantage, +84142,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,HEALTHFIRST-Medicare Advantage, +84143,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,HEALTHFIRST-Medicare Advantage, +84144,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,HEALTHFIRST-Medicare Advantage, +84145,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,HEALTHFIRST-Medicare Advantage, +84146,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,HEALTHFIRST-Medicare Advantage, +84147,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,HEALTHFIRST-Medicare Advantage, +84148,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,HEALTHFIRST-Medicare Advantage, +84149,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,HEALTHFIRST-Medicare Advantage, +84150,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,HEALTHFIRST-Medicare Advantage, +84151,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,HEALTHFIRST-Medicare Advantage, +84152,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,HEALTHFIRST-Medicare Advantage, +84153,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,HEALTHFIRST-Medicare Advantage, +84154,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,HEALTHFIRST-Medicare Advantage, +84155,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,HEALTHFIRST-Medicare Advantage, +84156,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,HEALTHFIRST-Medicare Advantage, +84157,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,HEALTHFIRST-Medicare Advantage, +84158,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,HEALTHFIRST-Medicare Advantage, +84159,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,HEALTHFIRST-Medicare Advantage, +84160,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,HEALTHFIRST-Medicare Advantage, +84161,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,HEALTHFIRST-Medicare Advantage, +84162,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,HEALTHFIRST-Medicare Advantage, +84163,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,HEALTHFIRST-Medicare Advantage, +84164,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,HEALTHFIRST-Medicare Advantage, +84165,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,HEALTHFIRST-Medicare Advantage, +84166,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,HEALTHFIRST-Medicare Advantage, +84167,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,HEALTHFIRST-Medicare Advantage, +84168,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,HEALTHFIRST-Medicare Advantage, +84169,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,HEALTHFIRST-Medicare Advantage, +84170,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,HEALTHFIRST-Medicare Advantage, +84171,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,HEALTHFIRST-Medicare Advantage, +84172,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,HEALTHFIRST-Medicare Advantage, +84173,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,HEALTHFIRST-Medicare Advantage, +84174,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,HEALTHFIRST-Medicare Advantage, +84175,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,HEALTHFIRST-Medicare Advantage, +84176,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,HEALTHFIRST-Medicare Advantage, +84177,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,HEALTHFIRST-Medicare Advantage, +84178,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,HEALTHFIRST-Medicare Advantage, +84179,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,HEALTHFIRST-Medicare Advantage, +84180,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,HEALTHFIRST-Medicare Advantage, +84181,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,HEALTHFIRST-Medicare Advantage, +84182,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,HEALTHFIRST-Medicare Advantage, +84183,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,HEALTHFIRST-Medicare Advantage, +84184,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,HEALTHFIRST-Medicare Advantage, +84185,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,HEALTHFIRST-Medicare Advantage, +84186,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,HEALTHFIRST-Medicare Advantage, +84187,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,HEALTHFIRST-Medicare Advantage, +84188,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,HEALTHFIRST-Medicare Advantage, +84189,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,HEALTHFIRST-Medicare Advantage, +84190,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,HEALTHFIRST-Medicare Advantage, +84191,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,HEALTHFIRST-Medicare Advantage, +84192,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,HEALTHFIRST-Medicare Advantage, +84193,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,HEALTHFIRST-Medicare Advantage, +84194,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,HEALTHFIRST-Medicare Advantage, +84195,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,HEALTHFIRST-Medicare Advantage, +84196,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,HEALTHFIRST-Medicare Advantage, +84197,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,HEALTHFIRST-Medicare Advantage, +84198,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,HEALTHFIRST-Medicare Advantage, +84199,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,HEALTHFIRST-Medicare Advantage, +84200,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,HEALTHFIRST-Medicare Advantage, +84201,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,HEALTHFIRST-Medicare Advantage, +84202,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,HEALTHFIRST-Medicare Advantage, +84203,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,HEALTHFIRST-Medicare Advantage, +84204,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,HEALTHFIRST-Medicare Advantage, +84205,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,HEALTHFIRST-Medicare Advantage, +84206,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,HEALTHFIRST-Medicare Advantage, +84207,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,HEALTHFIRST-Medicare Advantage, +84208,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,HEALTHFIRST-Medicare Advantage, +84209,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,HEALTHFIRST-Medicare Advantage, +84210,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,HEALTHFIRST-Medicare Advantage, +84211,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,HEALTHFIRST-Medicare Advantage, +84212,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,HEALTHFIRST-Medicare Advantage, +84213,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,HEALTHFIRST-Medicare Advantage, +84214,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,HEALTHFIRST-Medicare Advantage, +84215,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,HEALTHFIRST-Medicare Advantage, +84216,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,HEALTHFIRST-Medicare Advantage, +84217,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,HEALTHFIRST-Medicare Advantage, +84218,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,HEALTHFIRST-Medicare Advantage, +84219,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,HEALTHFIRST-Medicare Advantage, +84220,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,HEALTHFIRST-Medicare Advantage, +84221,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,HEALTHFIRST-Medicare Advantage, +84222,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,HEALTHFIRST-Medicare Advantage, +84223,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,HEALTHFIRST-Medicare Advantage, +84224,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,HEALTHFIRST-Medicare Advantage, +84225,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,HEALTHFIRST-Medicare Advantage, +84226,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,HEALTHFIRST-Medicare Advantage, +84227,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,HEALTHFIRST-Medicare Advantage, +84228,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,HEALTHFIRST-Medicare Advantage, +84229,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,HEALTHFIRST-Medicare Advantage, +84230,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,HEALTHFIRST-Medicare Advantage, +84231,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,HEALTHFIRST-Medicare Advantage, +84232,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,HEALTHFIRST-Medicare Advantage, +84233,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,HEALTHFIRST-Medicare Advantage, +84234,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,HEALTHFIRST-Medicare Advantage, +84235,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,HEALTHFIRST-Medicare Advantage, +84236,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,HEALTHFIRST-Medicare Advantage, +84237,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,HEALTHFIRST-Medicare Advantage, +84238,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,HEALTHFIRST-Medicare Advantage, +84239,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,HEALTHFIRST-Medicare Advantage, +84240,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,HEALTHFIRST-Medicare Advantage, +84241,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,HEALTHFIRST-Medicare Advantage, +84242,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,HEALTHFIRST-Medicare Advantage, +84243,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,HEALTHFIRST-Medicare Advantage, +84244,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,HEALTHFIRST-Medicare Advantage, +84245,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,HEALTHFIRST-Medicare Advantage, +84246,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,HEALTHFIRST-Medicare Advantage, +84247,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,HEALTHFIRST-Medicare Advantage, +84248,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,HEALTHFIRST-Medicare Advantage, +84249,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,HEALTHFIRST-Medicare Advantage, +84250,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,HEALTHFIRST-Medicare Advantage, +84251,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,HEALTHFIRST-Medicare Advantage, +84252,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,HEALTHFIRST-Medicare Advantage, +84253,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,HEALTHFIRST-Medicare Advantage, +84254,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,HEALTHFIRST-Medicare Advantage, +84255,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,HEALTHFIRST-Medicare Advantage, +84256,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,HEALTHFIRST-Medicare Advantage, +84257,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,HEALTHFIRST-Medicare Advantage, +84258,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,HEALTHFIRST-Medicare Advantage, +84259,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,HEALTHFIRST-Medicare Advantage, +84260,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,HEALTHFIRST-Medicare Advantage, +84261,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,HEALTHFIRST-Medicare Advantage, +84262,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,HEALTHFIRST-Medicare Advantage, +84263,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,HEALTHFIRST-Medicare Advantage, +84264,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,HEALTHFIRST-Medicare Advantage, +84265,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,HEALTHFIRST-Medicare Advantage, +84266,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,HEALTHFIRST-Medicare Advantage, +84267,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,HEALTHFIRST-Medicare Advantage, +84268,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,HEALTHFIRST-Medicare Advantage, +84269,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,HEALTHFIRST-Medicare Advantage, +84270,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,HEALTHFIRST-Medicare Advantage, +84271,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,HEALTHFIRST-Medicare Advantage, +84272,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,HEALTHFIRST-Medicare Advantage, +84273,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,HEALTHFIRST-Medicare Advantage, +84274,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,HEALTHFIRST-Medicare Advantage, +84275,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,HEALTHFIRST-Medicare Advantage, +84276,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,HEALTHFIRST-Medicare Advantage, +84277,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,HEALTHFIRST-Medicare Advantage, +84278,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,HEALTHFIRST-Medicare Advantage, +84279,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,HEALTHFIRST-Medicare Advantage, +84280,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,HEALTHFIRST-Medicare Advantage, +84281,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,HEALTHFIRST-Medicare Advantage, +84282,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,HEALTHFIRST-Medicare Advantage, +84283,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,HEALTHFIRST-Medicare Advantage, +84284,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,HEALTHFIRST-Medicare Advantage, +84285,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,HEALTHFIRST-Medicare Advantage, +84286,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,HEALTHFIRST-Medicare Advantage, +84287,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,HEALTHFIRST-Medicare Advantage, +84288,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,HEALTHFIRST-Medicare Advantage, +84289,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,HEALTHFIRST-Medicare Advantage, +84290,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,HEALTHFIRST-Medicare Advantage, +84291,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,HEALTHFIRST-Medicare Advantage, +84292,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,HEALTHFIRST-Medicare Advantage, +84293,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,HEALTHFIRST-Medicare Advantage, +84294,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,HEALTHFIRST-Medicare Advantage, +84295,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,HEALTHFIRST-Medicare Advantage, +84296,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,HEALTHFIRST-Medicare Advantage, +84297,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,HEALTHFIRST-Medicare Advantage, +84298,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,HEALTHFIRST-Medicare Advantage, +84299,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,HEALTHFIRST-Medicare Advantage, +84300,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,HEALTHFIRST-Medicare Advantage, +84301,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,HEALTHFIRST-Medicare Advantage, +84302,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,HEALTHFIRST-Medicare Advantage, +84303,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,HEALTHFIRST-Medicare Advantage, +84304,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,HEALTHFIRST-Medicare Advantage, +84305,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,HEALTHFIRST-Medicare Advantage, +84306,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,HEALTHFIRST-Medicare Advantage, +84307,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,HEALTHFIRST-Medicare Advantage, +84308,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,HEALTHFIRST-Medicare Advantage, +84309,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,HEALTHFIRST-Medicare Advantage, +84310,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,HEALTHFIRST-Medicare Advantage, +84311,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,HEALTHFIRST-Medicare Advantage, +84312,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,HEALTHFIRST-Medicare Advantage, +84313,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,HEALTHFIRST-Medicare Advantage, +84314,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,HEALTHFIRST-Medicare Advantage, +84315,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,HEALTHFIRST-Medicare Advantage, +84316,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,HEALTHFIRST-Medicare Advantage, +84317,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,HEALTHFIRST-Medicare Advantage, +84318,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,HEALTHFIRST-Medicare Advantage, +84319,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,HEALTHFIRST-Medicare Advantage, +84320,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,HEALTHFIRST-Medicare Advantage, +84321,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,HEALTHFIRST-Medicare Advantage, +84322,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,HEALTHFIRST-Medicare Advantage, +84323,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,HEALTHFIRST-Medicare Advantage, +84324,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,HEALTHFIRST-Medicare Advantage, +84325,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,HEALTHFIRST-Medicare Advantage, +84326,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,HEALTHFIRST-Medicare Advantage, +84327,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,HEALTHFIRST-Medicare Advantage, +84328,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,HEALTHFIRST-Medicare Advantage, +84329,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,HEALTHFIRST-Medicare Advantage, +84330,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,HEALTHFIRST-Medicare Advantage, +84331,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,HEALTHFIRST-Medicare Advantage, +84332,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,HEALTHFIRST-Medicare Advantage, +84333,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,HEALTHFIRST-Medicare Advantage, +84334,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,HEALTHFIRST-Medicare Advantage, +84335,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,HEALTHFIRST-Medicare Advantage, +84336,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,HEALTHFIRST-Medicare Advantage, +84337,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,HEALTHFIRST-Medicare Advantage, +84338,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,HEALTHFIRST-Medicare Advantage, +84339,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,HEALTHFIRST-Medicare Advantage, +84340,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,HEALTHFIRST-Medicare Advantage, +84341,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,HEALTHFIRST-Medicare Advantage, +84342,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,HEALTHFIRST-Medicare Advantage, +84343,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,HEALTHFIRST-Medicare Advantage, +84344,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,HEALTHFIRST-Medicare Advantage, +84345,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,HEALTHFIRST-Medicare Advantage, +84346,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,HEALTHFIRST-Medicare Advantage, +84347,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,HEALTHFIRST-Medicare Advantage, +84348,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,HEALTHFIRST-Medicare Advantage, +84349,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,HEALTHFIRST-Medicare Advantage, +84350,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,HEALTHFIRST-Medicare Advantage, +84351,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,HEALTHFIRST-Medicare Advantage, +84352,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,HEALTHFIRST-Medicare Advantage, +84353,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,HEALTHFIRST-Medicare Advantage, +84354,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,HEALTHFIRST-Medicare Advantage, +84355,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,HEALTHFIRST-Medicare Advantage, +84356,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,HEALTHFIRST-Medicare Advantage, +84357,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,HEALTHFIRST-Medicare Advantage, +84358,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,HEALTHFIRST-Medicare Advantage, +84359,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,HEALTHFIRST-Medicare Advantage, +84360,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,HEALTHFIRST-Medicare Advantage, +84361,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,HEALTHFIRST-Medicare Advantage, +84362,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,HEALTHFIRST-Medicare Advantage, +84363,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,HEALTHFIRST-Medicare Advantage, +84364,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,HEALTHFIRST-Medicare Advantage, +84365,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,HEALTHFIRST-Medicare Advantage, +84366,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,HEALTHFIRST-Medicare Advantage, +84367,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,HEALTHFIRST-Medicare Advantage, +84368,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,HEALTHFIRST-Medicare Advantage, +84369,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,HEALTHFIRST-Medicare Advantage, +84370,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,HEALTHFIRST-Medicare Advantage, +84371,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,HEALTHFIRST-Medicare Advantage, +84372,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,HEALTHFIRST-Medicare Advantage, +84373,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,HEALTHFIRST-Medicare Advantage, +84374,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,HEALTHFIRST-Medicare Advantage, +84375,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,HEALTHFIRST-Medicare Advantage, +84376,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,HEALTHFIRST-Medicare Advantage, +84377,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,HEALTHFIRST-Medicare Advantage, +84378,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,HEALTHFIRST-Medicare Advantage,1802.85 +84379,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,HEALTHFIRST-Medicare Advantage,1284.21 +84380,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,HEALTHFIRST-Medicare Advantage, +84381,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,HEALTHFIRST-Medicare Advantage, +84382,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,HEALTHFIRST-Medicare Advantage, +84383,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHFIRST-Medicare Advantage, +84384,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,HEALTHFIRST-Medicare Advantage, +84385,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,HEALTHFIRST-Medicare Advantage, +84386,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,HEALTHFIRST-Medicare Advantage, +84387,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,HEALTHFIRST-Medicare Advantage, +84388,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,HEALTHFIRST-Medicare Advantage, +84389,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,HEALTHFIRST-Medicare Advantage, +84390,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,HEALTHFIRST-Medicare Advantage, +84391,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,HEALTHFIRST-Medicare Advantage, +84392,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,HEALTHFIRST-Medicare Advantage, +84393,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,HEALTHFIRST-Medicare Advantage, +84394,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,HEALTHFIRST-Medicare Advantage, +84395,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,HEALTHFIRST-Medicare Advantage, +84396,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,HEALTHFIRST-Medicare Advantage, +84397,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,HEALTHFIRST-Medicare Advantage, +84398,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,HEALTHFIRST-Medicare Advantage, +84399,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,HEALTHFIRST-Medicare Advantage, +84400,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,HEALTHFIRST-Medicare Advantage, +84401,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,HEALTHFIRST-Medicare Advantage, +84402,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,HEALTHFIRST-Medicare Advantage, +84403,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,HEALTHFIRST-Medicare Advantage, +84404,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,HEALTHFIRST-Medicare Advantage, +84405,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,HEALTHFIRST-Medicare Advantage, +84406,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,HEALTHFIRST-Medicare Advantage, +84407,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,HEALTHFIRST-Medicare Advantage, +84408,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,HEALTHFIRST-Medicare Advantage, +84409,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,HEALTHFIRST-Medicare Advantage, +84410,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,HEALTHFIRST-Medicare Advantage, +84411,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,HEALTHFIRST-Medicare Advantage, +84412,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,HEALTHFIRST-Medicare Advantage, +84413,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,HEALTHFIRST-Medicare Advantage, +84414,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,HEALTHFIRST-Medicare Advantage, +84415,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,HEALTHFIRST-Medicare Advantage, +84416,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,HEALTHFIRST-Medicare Advantage, +84417,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,HEALTHFIRST-Medicare Advantage, +84418,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,HEALTHFIRST-Medicare Advantage, +84419,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,HEALTHFIRST-Medicare Advantage, +84420,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,HEALTHFIRST-Medicare Advantage, +84421,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,HEALTHFIRST-Medicare Advantage, +84422,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,HEALTHFIRST-Medicare Advantage, +84423,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,HEALTHFIRST-Medicare Advantage, +84424,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHFIRST-Medicare Advantage, +84425,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,HEALTHFIRST-Medicare Advantage, +84426,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,HEALTHFIRST-Medicare Advantage, +84427,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,HEALTHFIRST-Medicare Advantage, +84428,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,HEALTHFIRST-Medicare Advantage, +84429,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,HEALTHFIRST-Medicare Advantage, +84430,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,HEALTHFIRST-Medicare Advantage, +84431,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,HEALTHFIRST-Medicare Advantage, +84432,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,HEALTHFIRST-Medicare Advantage, +84433,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,HEALTHFIRST-Medicare Advantage, +84434,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,HEALTHFIRST-Medicare Advantage, +84435,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,HEALTHFIRST-Medicare Advantage, +84436,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,HEALTHFIRST-Medicare Advantage, +84437,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,HEALTHFIRST-Medicare Advantage, +84438,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,HEALTHFIRST-Medicare Advantage, +84439,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,HEALTHFIRST-Medicare Advantage, +84440,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,HEALTHFIRST-Medicare Advantage, +84441,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,HEALTHFIRST-Medicare Advantage, +84442,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,HEALTHFIRST-Medicare Advantage, +84443,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,HEALTHFIRST-Medicare Advantage, +84444,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,HEALTHFIRST-Medicare Advantage, +84445,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHFIRST-Medicare Advantage, +84446,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,HEALTHFIRST-Medicare Advantage, +84447,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,HEALTHFIRST-Medicare Advantage, +84448,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,HEALTHFIRST-Medicare Advantage, +84449,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,HEALTHFIRST-Medicare Advantage, +84450,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,HEALTHFIRST-Medicare Advantage, +84451,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,HEALTHFIRST-Medicare Advantage, +84452,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,HEALTHFIRST-Medicare Advantage, +84453,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,HEALTHFIRST-Medicare Advantage, +84454,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,HEALTHFIRST-Medicare Advantage, +84455,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,HEALTHFIRST-Medicare Advantage, +84456,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,HEALTHFIRST-Medicare Advantage, +84457,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,HEALTHFIRST-Medicare Advantage, +84458,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,HEALTHFIRST-Medicare Advantage, +84459,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,HEALTHFIRST-Medicare Advantage, +84460,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,HEALTHFIRST-Medicare Advantage, +84461,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,HEALTHFIRST-Medicare Advantage, +84462,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,HEALTHFIRST-Medicare Advantage, +84463,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,HEALTHFIRST-Medicare Advantage, +84464,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,HEALTHFIRST-Medicare Advantage, +84465,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,HEALTHFIRST-Medicare Advantage, +84466,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,HEALTHFIRST-Medicare Advantage, +84467,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,HEALTHFIRST-Medicare Advantage, +84468,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,HEALTHFIRST-Medicare Advantage, +84469,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,HEALTHFIRST-Medicare Advantage, +84470,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,HEALTHFIRST-Medicare Advantage, +84471,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,HEALTHFIRST-Medicare Advantage, +84472,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,HEALTHFIRST-Medicare Advantage, +84473,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,HEALTHFIRST-Medicare Advantage, +84474,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,HEALTHFIRST-Medicare Advantage, +84475,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,HEALTHFIRST-Medicare Advantage, +84476,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,HEALTHFIRST-Medicare Advantage, +84477,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,HEALTHFIRST-Medicare Advantage, +84478,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,HEALTHFIRST-Medicare Advantage, +84479,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,HEALTHFIRST-Medicare Advantage, +84480,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,HEALTHFIRST-Medicare Advantage, +84481,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,HEALTHFIRST-Medicare Advantage, +84482,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,HEALTHFIRST-Medicare Advantage, +84483,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,HEALTHFIRST-Medicare Advantage, +84484,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,HEALTHFIRST-Medicare Advantage, +84485,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,HEALTHFIRST-Medicare Advantage, +84486,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,HEALTHFIRST-Medicare Advantage, +84487,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,HEALTHFIRST-Medicare Advantage, +84488,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,HEALTHFIRST-Medicare Advantage,71.57 +84489,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,HEALTHFIRST-Medicare Advantage, +84490,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,HEALTHFIRST-Medicare Advantage, +84491,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +84492,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,HEALTHFIRST-Medicare Advantage, +84493,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,HEALTHFIRST-Medicare Advantage, +84494,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,HEALTHFIRST-Medicare Advantage, +84495,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,HEALTHFIRST-Medicare Advantage, +84496,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,HEALTHFIRST-Medicare Advantage, +84497,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,HEALTHFIRST-Medicare Advantage, +84498,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,HEALTHFIRST-Medicare Advantage, +84499,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,HEALTHFIRST-Medicare Advantage, +84500,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,HEALTHFIRST-Medicare Advantage, +84501,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,HEALTHFIRST-Medicare Advantage, +84502,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,HEALTHFIRST-Medicare Advantage, +84503,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,HEALTHFIRST-Medicare Advantage, +84504,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,HEALTHFIRST-Medicare Advantage, +84505,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,HEALTHFIRST-Medicare Advantage, +84506,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,HEALTHFIRST-Medicare Advantage, +84507,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,HEALTHFIRST-Medicare Advantage, +84508,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,HEALTHFIRST-Medicare Advantage, +84509,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,HEALTHFIRST-Medicare Advantage, +84510,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,HEALTHFIRST-Medicare Advantage, +84511,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,HEALTHFIRST-Medicare Advantage, +84512,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,HEALTHFIRST-Medicare Advantage, +84513,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,HEALTHFIRST-Medicare Advantage, +84514,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,HEALTHFIRST-Medicare Advantage, +84515,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,HEALTHFIRST-Medicare Advantage, +84516,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,HEALTHFIRST-Medicare Advantage, +84517,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,HEALTHFIRST-Medicare Advantage, +84518,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,HEALTHFIRST-Medicare Advantage, +84519,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,HEALTHFIRST-Medicare Advantage, +84520,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,HEALTHFIRST-Medicare Advantage, +84521,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,HEALTHFIRST-Medicare Advantage, +84522,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,HEALTHFIRST-Medicare Advantage, +84523,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,HEALTHFIRST-Medicare Advantage, +84524,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,HEALTHFIRST-Medicare Advantage, +84525,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,HEALTHFIRST-Medicare Advantage, +84526,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,HEALTHFIRST-Medicare Advantage, +84527,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,HEALTHFIRST-Medicare Advantage, +84528,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,HEALTHFIRST-Medicare Advantage, +84529,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,HEALTHFIRST-Medicare Advantage, +84530,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,HEALTHFIRST-Medicare Advantage, +84531,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,HEALTHFIRST-Medicare Advantage, +84532,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,HEALTHFIRST-Medicare Advantage, +84533,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,HEALTHFIRST-Medicare Advantage, +84534,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,HEALTHFIRST-Medicare Advantage, +84535,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,HEALTHFIRST-Medicare Advantage, +84536,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,HEALTHFIRST-Medicare Advantage, +84537,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,HEALTHFIRST-Medicare Advantage, +84538,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,HEALTHFIRST-Medicare Advantage, +84539,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,HEALTHFIRST-Medicare Advantage, +84540,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,HEALTHFIRST-Medicare Advantage, +84541,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,HEALTHFIRST-Medicare Advantage, +84542,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,HEALTHFIRST-Medicare Advantage, +84543,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,HEALTHFIRST-Medicare Advantage, +84544,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,HEALTHFIRST-Medicare Advantage, +84545,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +84546,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,HEALTHFIRST-Medicare Advantage, +84547,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,HEALTHFIRST-Medicare Advantage, +84548,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,HEALTHFIRST-Medicare Advantage, +84549,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,HEALTHFIRST-Medicare Advantage, +84550,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHFIRST-Medicare Advantage, +84551,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHFIRST-Medicare Advantage, +84552,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHFIRST-Medicare Advantage, +84553,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHFIRST-Medicare Advantage, +84554,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHFIRST-Medicare Advantage, +84555,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,HEALTHFIRST-Medicare Advantage, +84556,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,HEALTHFIRST-Medicare Advantage, +84557,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,HEALTHFIRST-Medicare Advantage, +84558,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,HEALTHFIRST-Medicare Advantage, +84559,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,HEALTHFIRST-Medicare Advantage, +84560,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,HEALTHFIRST-Medicare Advantage, +84561,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,HEALTHFIRST-Medicare Advantage, +84562,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,HEALTHFIRST-Medicare Advantage, +84563,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,HEALTHFIRST-Medicare Advantage, +84564,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,HEALTHFIRST-Medicare Advantage, +84565,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,HEALTHFIRST-Medicare Advantage, +84566,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,HEALTHFIRST-Medicare Advantage, +84567,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,HEALTHFIRST-Medicare Advantage, +84568,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,HEALTHFIRST-Medicare Advantage, +84569,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,HEALTHFIRST-Medicare Advantage, +84570,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,HEALTHFIRST-Medicare Advantage, +84571,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,HEALTHFIRST-Medicare Advantage, +84572,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,HEALTHFIRST-Medicare Advantage, +84573,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,HEALTHFIRST-Medicare Advantage, +84574,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,HEALTHFIRST-Medicare Advantage, +84575,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,HEALTHFIRST-Medicare Advantage, +84576,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,HEALTHFIRST-Medicare Advantage, +84577,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,HEALTHFIRST-Medicare Advantage, +84578,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,HEALTHFIRST-Medicare Advantage, +84579,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,HEALTHFIRST-Medicare Advantage, +84580,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,HEALTHFIRST-Medicare Advantage, +84581,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,HEALTHFIRST-Medicare Advantage, +84582,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,HEALTHFIRST-Medicare Advantage, +84583,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,HEALTHFIRST-Medicare Advantage, +84584,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,HEALTHFIRST-Medicare Advantage, +84585,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,HEALTHFIRST-Medicare Advantage, +84586,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,HEALTHFIRST-Medicare Advantage, +84587,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,HEALTHFIRST-Medicare Advantage, +84588,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,HEALTHFIRST-Medicare Advantage, +84589,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,HEALTHFIRST-Medicare Advantage, +84590,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,HEALTHFIRST-Medicare Advantage, +84591,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,HEALTHFIRST-Medicare Advantage, +84592,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,HEALTHFIRST-Medicare Advantage, +84593,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,HEALTHFIRST-Medicare Advantage, +84594,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,HEALTHFIRST-Medicare Advantage, +84595,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,HEALTHFIRST-Medicare Advantage, +84596,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,HEALTHFIRST-Medicare Advantage, +84597,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,HEALTHFIRST-Medicare Advantage, +84598,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,HEALTHFIRST-Medicare Advantage, +84599,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,HEALTHFIRST-Medicare Advantage, +84600,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,HEALTHFIRST-Medicare Advantage, +84601,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,HEALTHFIRST-Medicare Advantage, +84602,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,HEALTHFIRST-Medicare Advantage, +84603,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,HEALTHFIRST-Medicare Advantage, +84604,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,HEALTHFIRST-Medicare Advantage, +84605,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,HEALTHFIRST-Medicare Advantage, +84606,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,HEALTHFIRST-Medicare Advantage, +84607,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,HEALTHFIRST-Medicare Advantage, +84608,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,HEALTHFIRST-Medicare Advantage, +84609,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,HEALTHFIRST-Medicare Advantage, +84610,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,HEALTHFIRST-Medicare Advantage, +84611,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,HEALTHFIRST-Medicare Advantage, +84612,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,HEALTHFIRST-Medicare Advantage, +84613,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,HEALTHFIRST-Medicare Advantage, +84614,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,HEALTHFIRST-Medicare Advantage, +84615,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,HEALTHFIRST-Medicare Advantage, +84616,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,HEALTHFIRST-Medicare Advantage, +84617,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,HEALTHFIRST-Medicare Advantage, +84618,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,HEALTHFIRST-Medicare Advantage, +84619,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,HEALTHFIRST-Medicare Advantage, +84620,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,HEALTHFIRST-Medicare Advantage, +84621,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,HEALTHFIRST-Medicare Advantage, +84622,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,HEALTHFIRST-Medicare Advantage, +84623,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,HEALTHFIRST-Medicare Advantage, +84624,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,HEALTHFIRST-Medicare Advantage, +84625,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,HEALTHFIRST-Medicare Advantage, +84626,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,HEALTHFIRST-Medicare Advantage, +84627,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,HEALTHFIRST-Medicare Advantage, +84628,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,HEALTHFIRST-Medicare Advantage, +84629,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,HEALTHFIRST-Medicare Advantage, +84630,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,HEALTHFIRST-Medicare Advantage, +84631,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,HEALTHFIRST-Medicare Advantage, +84632,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,HEALTHFIRST-Medicare Advantage, +84633,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,HEALTHFIRST-Medicare Advantage, +84634,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,HEALTHFIRST-Medicare Advantage, +84635,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,HEALTHFIRST-Medicare Advantage, +84636,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,HEALTHFIRST-Medicare Advantage, +84637,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,HEALTHFIRST-Medicare Advantage, +84638,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,HEALTHFIRST-Medicare Advantage, +84639,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,HEALTHFIRST-Medicare Advantage, +84640,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,HEALTHFIRST-Medicare Advantage, +84641,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,HEALTHFIRST-Medicare Advantage, +84642,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,HEALTHFIRST-Medicare Advantage, +84643,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,HEALTHFIRST-Medicare Advantage, +84644,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,HEALTHFIRST-Medicare Advantage, +84645,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,HEALTHFIRST-Medicare Advantage, +84646,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,HEALTHFIRST-Medicare Advantage, +84647,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,HEALTHFIRST-Medicare Advantage, +84648,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,HEALTHFIRST-Medicare Advantage, +84649,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,HEALTHFIRST-Medicare Advantage, +84650,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,HEALTHFIRST-Medicare Advantage, +84651,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,HEALTHFIRST-Medicare Advantage, +84652,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,HEALTHFIRST-Medicare Advantage, +84653,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,HEALTHFIRST-Medicare Advantage, +84654,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,HEALTHFIRST-Medicare Advantage, +84655,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,HEALTHFIRST-Medicare Advantage, +84656,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,HEALTHFIRST-Medicare Advantage, +84657,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,HEALTHFIRST-Medicare Advantage, +84658,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,HEALTHFIRST-Medicare Advantage, +84659,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,HEALTHFIRST-Medicare Advantage, +84660,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,HEALTHFIRST-Medicare Advantage, +84661,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,HEALTHFIRST-Medicare Advantage, +84662,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,HEALTHFIRST-Medicare Advantage, +84663,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,HEALTHFIRST-Medicare Advantage, +84664,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,HEALTHFIRST-Medicare Advantage, +84665,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,HEALTHFIRST-Medicare Advantage, +84666,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,HEALTHFIRST-Medicare Advantage, +84667,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,HEALTHFIRST-Medicare Advantage, +84668,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,HEALTHFIRST-Medicare Advantage, +84669,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,HEALTHFIRST-Medicare Advantage, +84670,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,HEALTHFIRST-Medicare Advantage, +84671,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,HEALTHFIRST-Medicare Advantage, +84672,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,HEALTHFIRST-Medicare Advantage, +84673,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,HEALTHFIRST-Medicare Advantage, +84674,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,HEALTHFIRST-Medicare Advantage, +84675,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,HEALTHFIRST-Medicare Advantage, +84676,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,HEALTHFIRST-Medicare Advantage, +84677,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,HEALTHFIRST-Medicare Advantage, +84678,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,HEALTHFIRST-Medicare Advantage, +84679,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,HEALTHFIRST-Medicare Advantage, +84680,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,HEALTHFIRST-Medicare Advantage, +84681,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,HEALTHFIRST-Medicare Advantage, +84682,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,HEALTHFIRST-Medicare Advantage, +84683,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,HEALTHFIRST-Medicare Advantage, +84684,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,HEALTHFIRST-Medicare Advantage, +84685,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,HEALTHFIRST-Medicare Advantage, +84686,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,HEALTHFIRST-Medicare Advantage, +84687,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,HEALTHFIRST-Medicare Advantage, +84688,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,HEALTHFIRST-Medicare Advantage, +84689,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,HEALTHFIRST-Medicare Advantage, +84690,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,HEALTHFIRST-Medicare Advantage, +84691,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,HEALTHFIRST-Medicare Advantage, +84692,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,HEALTHFIRST-Medicare Advantage, +84693,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,HEALTHFIRST-Medicare Advantage, +84694,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,HEALTHFIRST-Medicare Advantage, +84695,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,HEALTHFIRST-Medicare Advantage, +84696,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,HEALTHFIRST-Medicare Advantage, +84697,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,HEALTHFIRST-Medicare Advantage, +84698,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,HEALTHFIRST-Medicare Advantage, +84699,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,HEALTHFIRST-Medicare Advantage, +84700,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,HEALTHFIRST-Medicare Advantage, +84701,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,HEALTHFIRST-Medicare Advantage, +84702,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,HEALTHFIRST-Medicare Advantage, +84703,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,HEALTHFIRST-Medicare Advantage, +84704,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,HEALTHFIRST-Medicare Advantage, +84705,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,HEALTHFIRST-Medicare Advantage, +84706,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,HEALTHFIRST-Medicare Advantage, +84707,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,HEALTHFIRST-Medicare Advantage, +84708,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,HEALTHFIRST-Medicare Advantage, +84709,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,HEALTHFIRST-Medicare Advantage, +84710,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,HEALTHFIRST-Medicare Advantage, +84711,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,HEALTHFIRST-Medicare Advantage, +84712,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,HEALTHFIRST-Medicare Advantage, +84713,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,HEALTHFIRST-Medicare Advantage, +84714,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,HEALTHFIRST-Medicare Advantage, +84715,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,HEALTHFIRST-Medicare Advantage, +84716,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,HEALTHFIRST-Medicare Advantage, +84717,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,HEALTHFIRST-Medicare Advantage, +84718,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,HEALTHFIRST-Medicare Advantage, +84719,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,HEALTHFIRST-Medicare Advantage, +84720,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,HEALTHFIRST-Medicare Advantage, +84721,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,HEALTHFIRST-Medicare Advantage, +84722,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,HEALTHFIRST-Medicare Advantage, +84723,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,HEALTHFIRST-Medicare Advantage, +84724,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,HEALTHFIRST-Medicare Advantage, +84725,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,HEALTHFIRST-Medicare Advantage, +84726,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,HEALTHFIRST-Medicare Advantage, +84727,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,HEALTHFIRST-Medicare Advantage, +84728,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,HEALTHFIRST-Medicare Advantage, +84729,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,HEALTHFIRST-Medicare Advantage, +84730,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,HEALTHFIRST-Medicare Advantage, +84731,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,HEALTHFIRST-Medicare Advantage, +84732,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,HEALTHFIRST-Medicare Advantage, +84733,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,HEALTHFIRST-Medicare Advantage, +84734,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,HEALTHFIRST-Medicare Advantage, +84735,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,HEALTHFIRST-Medicare Advantage, +84736,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,HEALTHFIRST-Medicare Advantage, +84737,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,HEALTHFIRST-Medicare Advantage, +84738,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,HEALTHFIRST-Medicare Advantage, +84739,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,HEALTHFIRST-Medicare Advantage, +84740,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,HEALTHFIRST-Medicare Advantage, +84741,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,HEALTHFIRST-Medicare Advantage, +84742,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,HEALTHFIRST-Medicare Advantage, +84743,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,HEALTHFIRST-Medicare Advantage, +84744,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,HEALTHFIRST-Medicare Advantage, +84745,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,HEALTHFIRST-Medicare Advantage, +84746,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,HEALTHFIRST-Medicare Advantage, +84747,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,HEALTHFIRST-Medicare Advantage, +84748,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,HEALTHFIRST-Medicare Advantage, +84749,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,HEALTHFIRST-Medicare Advantage, +84750,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,HEALTHFIRST-Medicare Advantage, +84751,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,HEALTHFIRST-Medicare Advantage, +84752,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,HEALTHFIRST-Medicare Advantage, +84753,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,HEALTHFIRST-Medicare Advantage, +84754,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,HEALTHFIRST-Medicare Advantage, +84755,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,HEALTHFIRST-Medicare Advantage, +84756,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,HEALTHFIRST-Medicare Advantage, +84757,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,HEALTHFIRST-Medicare Advantage, +84758,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,HEALTHFIRST-Medicare Advantage, +84759,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,HEALTHFIRST-Medicare Advantage, +84760,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,HEALTHFIRST-Medicare Advantage, +84761,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,HEALTHFIRST-Medicare Advantage, +84762,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,HEALTHFIRST-Medicare Advantage, +84763,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,HEALTHFIRST-Medicare Advantage, +84764,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,HEALTHFIRST-Medicare Advantage, +84765,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,HEALTHFIRST-Medicare Advantage, +84766,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,HEALTHFIRST-Medicare Advantage, +84767,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,HEALTHFIRST-Medicare Advantage, +84768,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,HEALTHFIRST-Medicare Advantage, +84769,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,HEALTHFIRST-Medicare Advantage, +84770,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,HEALTHFIRST-Medicare Advantage, +84771,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,HEALTHFIRST-Medicare Advantage, +84772,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,HEALTHFIRST-Medicare Advantage, +84773,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,HEALTHFIRST-Medicare Advantage, +84774,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,HEALTHFIRST-Medicare Advantage, +84775,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,HEALTHFIRST-Medicare Advantage, +84776,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,HEALTHFIRST-Medicare Advantage, +84777,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,HEALTHFIRST-Medicare Advantage, +84778,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,HEALTHFIRST-Medicare Advantage, +84779,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,HEALTHFIRST-Medicare Advantage, +84780,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,HEALTHFIRST-Medicare Advantage, +84781,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,HEALTHFIRST-Medicare Advantage, +84782,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,HEALTHFIRST-Medicare Advantage, +84783,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,HEALTHFIRST-Medicare Advantage, +84784,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,HEALTHFIRST-Medicare Advantage, +84785,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,HEALTHFIRST-Medicare Advantage, +84786,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,HEALTHFIRST-Medicare Advantage, +84787,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,HEALTHFIRST-Medicare Advantage, +84788,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,HEALTHFIRST-Medicare Advantage, +84789,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,HEALTHFIRST-Medicare Advantage, +84790,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,HEALTHFIRST-Medicare Advantage, +84791,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,HEALTHFIRST-Medicare Advantage, +84792,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,HEALTHFIRST-Medicare Advantage, +84793,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,HEALTHFIRST-Medicare Advantage, +84794,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,HEALTHFIRST-Medicare Advantage, +84795,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,HEALTHFIRST-Medicare Advantage, +84796,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,HEALTHFIRST-Medicare Advantage, +84797,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,HEALTHFIRST-Medicare Advantage, +84798,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,HEALTHFIRST-Medicare Advantage, +84799,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,HEALTHFIRST-Medicare Advantage, +84800,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,HEALTHFIRST-Medicare Advantage, +84801,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,HEALTHFIRST-Medicare Advantage, +84802,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,HEALTHFIRST-Medicare Advantage, +84803,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,HEALTHFIRST-Medicare Advantage, +84804,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,HEALTHFIRST-Medicare Advantage,133.31 +84805,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,HEALTHFIRST-Medicare Advantage, +84806,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,HEALTHFIRST-Medicare Advantage, +84807,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,HEALTHFIRST-Medicare Advantage, +84808,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,HEALTHFIRST-Medicare Advantage, +84809,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,HEALTHFIRST-Medicare Advantage, +84810,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,HEALTHFIRST-Medicare Advantage, +84811,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,HEALTHFIRST-Medicare Advantage, +84812,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,HEALTHFIRST-Medicare Advantage, +84813,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,HEALTHFIRST-Medicare Advantage, +84814,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,HEALTHFIRST-Medicare Advantage, +84815,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,HEALTHFIRST-Medicare Advantage, +84816,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,HEALTHFIRST-Medicare Advantage, +84817,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,HEALTHFIRST-Medicare Advantage, +84818,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,HEALTHFIRST-Medicare Advantage, +84819,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,HEALTHFIRST-Medicare Advantage, +84820,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,HEALTHFIRST-Medicare Advantage, +84821,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,HEALTHFIRST-Medicare Advantage, +84822,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,HEALTHFIRST-Medicare Advantage, +84823,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,HEALTHFIRST-Medicare Advantage, +84824,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,HEALTHFIRST-Medicare Advantage, +84825,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,HEALTHFIRST-Medicare Advantage, +84826,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,HEALTHFIRST-Medicare Advantage, +84827,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,HEALTHFIRST-Medicare Advantage, +84828,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,HEALTHFIRST-Medicare Advantage, +84829,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,HEALTHFIRST-Medicare Advantage, +84830,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,HEALTHFIRST-Medicare Advantage, +84831,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,HEALTHFIRST-Medicare Advantage, +84832,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,HEALTHFIRST-Medicare Advantage, +84833,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,HEALTHFIRST-Medicare Advantage, +84834,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,HEALTHFIRST-Medicare Advantage, +84835,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,HEALTHFIRST-Medicare Advantage, +84836,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,HEALTHFIRST-Medicare Advantage, +84837,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,HEALTHFIRST-Medicare Advantage, +84838,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,HEALTHFIRST-Medicare Advantage, +84839,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,HEALTHFIRST-Medicare Advantage, +84840,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,HEALTHFIRST-Medicare Advantage, +84841,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,HEALTHFIRST-Medicare Advantage, +84842,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,HEALTHFIRST-Medicare Advantage, +84843,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,HEALTHFIRST-Medicare Advantage, +84844,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,HEALTHFIRST-Medicare Advantage, +84845,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,HEALTHFIRST-Medicare Advantage, +84846,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,HEALTHFIRST-Medicare Advantage, +84847,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,HEALTHFIRST-Medicare Advantage, +84848,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,HEALTHFIRST-Medicare Advantage, +84849,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,HEALTHFIRST-Medicare Advantage, +84850,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,HEALTHFIRST-Medicare Advantage, +84851,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,HEALTHFIRST-Medicare Advantage, +84852,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,HEALTHFIRST-Medicare Advantage, +84853,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,HEALTHFIRST-Medicare Advantage, +84854,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,HEALTHFIRST-Medicare Advantage, +84855,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,HEALTHFIRST-Medicare Advantage, +84856,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,HEALTHFIRST-Medicare Advantage, +84857,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,HEALTHFIRST-Medicare Advantage, +84858,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,HEALTHFIRST-Medicare Advantage, +84859,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,HEALTHFIRST-Medicare Advantage, +84860,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,HEALTHFIRST-Medicare Advantage, +84861,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,HEALTHFIRST-Medicare Advantage, +84862,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,HEALTHFIRST-Medicare Advantage, +84863,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,HEALTHFIRST-Medicare Advantage, +84864,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,HEALTHFIRST-Medicare Advantage,113.97 +84865,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,HEALTHFIRST-Medicare Advantage, +84866,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,HEALTHFIRST-Medicare Advantage, +84867,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,HEALTHFIRST-Medicare Advantage, +84868,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,HEALTHFIRST-Medicare Advantage, +84869,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,HEALTHFIRST-Medicare Advantage, +84870,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,HEALTHFIRST-Medicare Advantage, +84871,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,HEALTHFIRST-Medicare Advantage, +84872,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,HEALTHFIRST-Medicare Advantage,43.08 +84873,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,HEALTHFIRST-Medicare Advantage, +84874,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,HEALTHFIRST-Medicare Advantage, +84875,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,HEALTHFIRST-Medicare Advantage, +84876,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,HEALTHFIRST-Medicare Advantage, +84877,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,HEALTHFIRST-Medicare Advantage, +84878,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,HEALTHFIRST-Medicare Advantage, +84879,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,HEALTHFIRST-Medicare Advantage, +84880,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,HEALTHFIRST-Medicare Advantage, +84881,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,HEALTHFIRST-Medicare Advantage, +84882,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,HEALTHFIRST-Medicare Advantage, +84883,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,HEALTHFIRST-Medicare Advantage, +84884,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,HEALTHFIRST-Medicare Advantage, +84885,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,HEALTHFIRST-Medicare Advantage, +84886,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,HEALTHFIRST-Medicare Advantage, +84887,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,HEALTHFIRST-Medicare Advantage, +84888,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,HEALTHFIRST-Medicare Advantage, +84889,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,HEALTHFIRST-Medicare Advantage, +84890,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,HEALTHFIRST-Medicare Advantage, +84891,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,HEALTHFIRST-Medicare Advantage, +84892,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,HEALTHFIRST-Medicare Advantage, +84893,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,HEALTHFIRST-Medicare Advantage, +84894,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,HEALTHFIRST-Medicare Advantage, +84895,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,HEALTHFIRST-Medicare Advantage, +84896,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,HEALTHFIRST-Medicare Advantage, +84897,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,HEALTHFIRST-Medicare Advantage, +84898,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,HEALTHFIRST-Medicare Advantage, +84899,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,HEALTHFIRST-Medicare Advantage, +84900,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,HEALTHFIRST-Medicare Advantage, +84901,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,HEALTHFIRST-Medicare Advantage, +84902,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,HEALTHFIRST-Medicare Advantage, +84903,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,HEALTHFIRST-Medicare Advantage, +84904,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,HEALTHFIRST-Medicare Advantage, +84905,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,HEALTHFIRST-Medicare Advantage, +84906,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,HEALTHFIRST-Medicare Advantage, +84907,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,HEALTHFIRST-Medicare Advantage, +84908,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,HEALTHFIRST-Medicare Advantage, +84909,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,HEALTHFIRST-Medicare Advantage, +84910,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,HEALTHFIRST-Medicare Advantage, +84911,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,HEALTHFIRST-Medicare Advantage, +84912,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,HEALTHFIRST-Medicare Advantage, +84913,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,HEALTHFIRST-Medicare Advantage, +84914,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,HEALTHFIRST-Medicare Advantage, +84915,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,HEALTHFIRST-Medicare Advantage, +84916,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,HEALTHFIRST-Medicare Advantage, +84917,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,HEALTHFIRST-Medicare Advantage, +84918,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,HEALTHFIRST-Medicare Advantage, +84919,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,HEALTHFIRST-Medicare Advantage, +84920,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,HEALTHFIRST-Medicare Advantage, +84921,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,HEALTHFIRST-Medicare Advantage, +84922,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,HEALTHFIRST-Medicare Advantage, +84923,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,HEALTHFIRST-Medicare Advantage, +84924,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,HEALTHFIRST-Medicare Advantage, +84925,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,HEALTHFIRST-Medicare Advantage, +84926,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,HEALTHFIRST-Medicare Advantage, +84927,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,HEALTHFIRST-Medicare Advantage, +84928,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,HEALTHFIRST-Medicare Advantage, +84929,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,HEALTHFIRST-Medicare Advantage, +84930,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,HEALTHFIRST-Medicare Advantage, +84931,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,HEALTHFIRST-Medicare Advantage, +84932,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,HEALTHFIRST-Medicare Advantage, +84933,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,HEALTHFIRST-Medicare Advantage, +84934,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,HEALTHFIRST-Medicare Advantage, +84935,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,HEALTHFIRST-Medicare Advantage, +84936,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,HEALTHFIRST-Medicare Advantage, +84937,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,HEALTHFIRST-Medicare Advantage, +84938,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,HEALTHFIRST-Medicare Advantage, +84939,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,HEALTHFIRST-Medicare Advantage, +84940,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,HEALTHFIRST-Medicare Advantage, +84941,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,HEALTHFIRST-Medicare Advantage, +84942,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,HEALTHFIRST-Medicare Advantage, +84943,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,HEALTHFIRST-Medicare Advantage, +84944,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,HEALTHFIRST-Medicare Advantage, +84945,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,HEALTHFIRST-Medicare Advantage, +84946,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,HEALTHFIRST-Medicare Advantage, +84947,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,HEALTHFIRST-Medicare Advantage, +84948,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,HEALTHFIRST-Medicare Advantage, +84949,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,HEALTHFIRST-Medicare Advantage, +84950,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,HEALTHFIRST-Medicare Advantage, +84951,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,HEALTHFIRST-Medicare Advantage, +84952,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,HEALTHFIRST-Medicare Advantage, +84953,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,HEALTHFIRST-Medicare Advantage, +84954,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,HEALTHFIRST-Medicare Advantage, +84955,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,HEALTHFIRST-Medicare Advantage, +84956,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,HEALTHFIRST-Medicare Advantage, +84957,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,HEALTHFIRST-Medicare Advantage, +84958,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,HEALTHFIRST-Medicare Advantage, +84959,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,HEALTHFIRST-Medicare Advantage, +84960,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,HEALTHFIRST-Medicare Advantage, +84961,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,HEALTHFIRST-Medicare Advantage, +84962,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,HEALTHFIRST-Medicare Advantage, +84963,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,HEALTHFIRST-Medicare Advantage, +84964,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,HEALTHFIRST-Medicare Advantage, +84965,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,HEALTHFIRST-Medicare Advantage, +84966,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,HEALTHFIRST-Medicare Advantage, +84967,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,HEALTHFIRST-Medicare Advantage, +84968,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,HEALTHFIRST-Medicare Advantage, +84969,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,HEALTHFIRST-Medicare Advantage, +84970,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,HEALTHFIRST-Medicare Advantage,30.53 +84971,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,HEALTHFIRST-Medicare Advantage, +84972,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,HEALTHFIRST-Medicare Advantage, +84973,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,HEALTHFIRST-Medicare Advantage, +84974,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,HEALTHFIRST-Medicare Advantage, +84975,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,HEALTHFIRST-Medicare Advantage, +84976,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,HEALTHFIRST-Medicare Advantage, +84977,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,HEALTHFIRST-Medicare Advantage, +84978,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,HEALTHFIRST-Medicare Advantage, +84979,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,HEALTHFIRST-Medicare Advantage, +84980,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,HEALTHFIRST-Medicare Advantage, +84981,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,HEALTHFIRST-Medicare Advantage, +84982,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,HEALTHFIRST-Medicare Advantage, +84983,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,HEALTHFIRST-Medicare Advantage, +84984,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,HEALTHFIRST-Medicare Advantage, +84985,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,HEALTHFIRST-Medicare Advantage, +84986,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,HEALTHFIRST-Medicare Advantage, +84987,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,HEALTHFIRST-Medicare Advantage, +84988,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,HEALTHFIRST-Medicare Advantage, +84989,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,HEALTHFIRST-Medicare Advantage, +84990,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,HEALTHFIRST-Medicare Advantage, +84991,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,HEALTHFIRST-Medicare Advantage, +84992,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,HEALTHFIRST-Medicare Advantage, +84993,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,HEALTHFIRST-Medicare Advantage, +84994,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,HEALTHFIRST-Medicare Advantage, +84995,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,HEALTHFIRST-Medicare Advantage, +84996,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,HEALTHFIRST-Medicare Advantage, +84997,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,HEALTHFIRST-Medicare Advantage, +84998,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,HEALTHFIRST-Medicare Advantage, +84999,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,HEALTHFIRST-Medicare Advantage, +85000,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,HEALTHFIRST-Medicare Advantage, +85001,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,HEALTHFIRST-Medicare Advantage, +85002,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,HEALTHFIRST-Medicare Advantage, +85003,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,HEALTHFIRST-Medicare Advantage, +85004,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,HEALTHFIRST-Medicare Advantage, +85005,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,HEALTHFIRST-Medicare Advantage, +85006,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,HEALTHFIRST-Medicare Advantage, +85007,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,HEALTHFIRST-Medicare Advantage, +85008,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,HEALTHFIRST-Medicare Advantage, +85009,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,HEALTHFIRST-Medicare Advantage, +85010,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,HEALTHFIRST-Medicare Advantage, +85011,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,HEALTHFIRST-Medicare Advantage, +85012,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,HEALTHFIRST-Medicare Advantage, +85013,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,HEALTHFIRST-Medicare Advantage, +85014,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,HEALTHFIRST-Medicare Advantage, +85015,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,HEALTHFIRST-Medicare Advantage, +85016,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,HEALTHFIRST-Medicare Advantage, +85017,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,HEALTHFIRST-Medicare Advantage, +85018,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,HEALTHFIRST-Medicare Advantage, +85019,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,HEALTHFIRST-Medicare Advantage, +85020,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,HEALTHFIRST-Medicare Advantage, +85021,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,HEALTHFIRST-Medicare Advantage, +85022,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,HEALTHFIRST-Medicare Advantage, +85023,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,HEALTHFIRST-Medicare Advantage, +85024,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,HEALTHFIRST-Medicare Advantage, +85025,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,HEALTHFIRST-Medicare Advantage, +85026,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,HEALTHFIRST-Medicare Advantage, +85027,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,HEALTHFIRST-Medicare Advantage, +85028,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,HEALTHFIRST-Medicare Advantage,75.64 +85029,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,HEALTHFIRST-Medicare Advantage, +85030,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,HEALTHFIRST-Medicare Advantage, +85031,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,HEALTHFIRST-Medicare Advantage, +85032,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,HEALTHFIRST-Medicare Advantage, +85033,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,HEALTHFIRST-Medicare Advantage, +85034,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,HEALTHFIRST-Medicare Advantage, +85035,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,HEALTHFIRST-Medicare Advantage, +85036,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,HEALTHFIRST-Medicare Advantage, +85037,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,HEALTHFIRST-Medicare Advantage, +85038,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,HEALTHFIRST-Medicare Advantage, +85039,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,HEALTHFIRST-Medicare Advantage, +85040,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,HEALTHFIRST-Medicare Advantage, +85041,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,HEALTHFIRST-Medicare Advantage, +85042,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,HEALTHFIRST-Medicare Advantage, +85043,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,HEALTHFIRST-Medicare Advantage, +85044,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,HEALTHFIRST-Medicare Advantage, +85045,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,HEALTHFIRST-Medicare Advantage, +85046,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,HEALTHFIRST-Medicare Advantage, +85047,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,HEALTHFIRST-Medicare Advantage, +85048,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,HEALTHFIRST-Medicare Advantage, +85049,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,HEALTHFIRST-Medicare Advantage, +85050,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,HEALTHFIRST-Medicare Advantage, +85051,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,HEALTHFIRST-Medicare Advantage, +85052,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,HEALTHFIRST-Medicare Advantage, +85053,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,HEALTHFIRST-Medicare Advantage, +85054,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,HEALTHFIRST-Medicare Advantage, +85055,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,HEALTHFIRST-Medicare Advantage,50.2 +85056,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,HEALTHFIRST-Medicare Advantage, +85057,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,HEALTHFIRST-Medicare Advantage, +85058,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,HEALTHFIRST-Medicare Advantage, +85059,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,HEALTHFIRST-Medicare Advantage, +85060,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,HEALTHFIRST-Medicare Advantage, +85061,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,HEALTHFIRST-Medicare Advantage, +85062,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,HEALTHFIRST-Medicare Advantage, +85063,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,HEALTHFIRST-Medicare Advantage, +85064,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,HEALTHFIRST-Medicare Advantage, +85065,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,HEALTHFIRST-Medicare Advantage, +85066,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,HEALTHFIRST-Medicare Advantage, +85067,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,HEALTHFIRST-Medicare Advantage, +85068,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,HEALTHFIRST-Medicare Advantage, +85069,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,HEALTHFIRST-Medicare Advantage, +85070,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,HEALTHFIRST-Medicare Advantage, +85071,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,HEALTHFIRST-Medicare Advantage, +85072,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,HEALTHFIRST-Medicare Advantage, +85073,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,HEALTHFIRST-Medicare Advantage, +85074,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,HEALTHFIRST-Medicare Advantage, +85075,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,HEALTHFIRST-Medicare Advantage, +85076,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,HEALTHFIRST-Medicare Advantage, +85077,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,HEALTHFIRST-Medicare Advantage, +85078,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,HEALTHFIRST-Medicare Advantage, +85079,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,HEALTHFIRST-Medicare Advantage, +85080,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,HEALTHFIRST-Medicare Advantage, +85081,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,HEALTHFIRST-Medicare Advantage, +85082,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,HEALTHFIRST-Medicare Advantage, +85083,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,HEALTHFIRST-Medicare Advantage, +85084,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,HEALTHFIRST-Medicare Advantage, +85085,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,HEALTHFIRST-Medicare Advantage, +85086,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,HEALTHFIRST-Medicare Advantage, +85087,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,HEALTHFIRST-Medicare Advantage, +85088,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,HEALTHFIRST-Medicare Advantage, +85089,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,HEALTHFIRST-Medicare Advantage, +85090,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,HEALTHFIRST-Medicare Advantage, +85091,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,HEALTHFIRST-Medicare Advantage, +85092,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,HEALTHFIRST-Medicare Advantage, +85093,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,HEALTHFIRST-Medicare Advantage, +85094,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,HEALTHFIRST-Medicare Advantage, +85095,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,HEALTHFIRST-Medicare Advantage, +85096,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,HEALTHFIRST-Medicare Advantage, +85097,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,HEALTHFIRST-Medicare Advantage, +85098,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,HEALTHFIRST-Medicare Advantage, +85099,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,HEALTHFIRST-Medicare Advantage, +85100,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,HEALTHFIRST-Medicare Advantage, +85101,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,HEALTHFIRST-Medicare Advantage, +85102,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,HEALTHFIRST-Medicare Advantage, +85103,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHFIRST-Medicare Advantage, +85104,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,HEALTHFIRST-Medicare Advantage, +85105,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,HEALTHFIRST-Medicare Advantage, +85106,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,HEALTHFIRST-Medicare Advantage, +85107,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,HEALTHFIRST-Medicare Advantage,111.94 +85108,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,HEALTHFIRST-Medicare Advantage, +85109,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,HEALTHFIRST-Medicare Advantage, +85110,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,HEALTHFIRST-Medicare Advantage, +85111,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,HEALTHFIRST-Medicare Advantage, +85112,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,HEALTHFIRST-Medicare Advantage, +85113,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,HEALTHFIRST-Medicare Advantage, +85114,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHFIRST-Medicare Advantage, +85115,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,HEALTHFIRST-Medicare Advantage, +85116,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,HEALTHFIRST-Medicare Advantage, +85117,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,HEALTHFIRST-Medicare Advantage, +85118,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,HEALTHFIRST-Medicare Advantage, +85119,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,HEALTHFIRST-Medicare Advantage, +85120,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,HEALTHFIRST-Medicare Advantage, +85121,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,HEALTHFIRST-Medicare Advantage, +85122,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,HEALTHFIRST-Medicare Advantage, +85123,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,HEALTHFIRST-Medicare Advantage, +85124,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,HEALTHFIRST-Medicare Advantage, +85125,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,HEALTHFIRST-Medicare Advantage, +85126,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,HEALTHFIRST-Medicare Advantage, +85127,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,HEALTHFIRST-Medicare Advantage, +85128,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,HEALTHFIRST-Medicare Advantage, +85129,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,HEALTHFIRST-Medicare Advantage,108.88 +85130,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,HEALTHFIRST-Medicare Advantage, +85131,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,HEALTHFIRST-Medicare Advantage, +85132,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,HEALTHFIRST-Medicare Advantage, +85133,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,HEALTHFIRST-Medicare Advantage, +85134,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,HEALTHFIRST-Medicare Advantage, +85135,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,HEALTHFIRST-Medicare Advantage, +85136,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHFIRST-Medicare Advantage, +85137,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,HEALTHFIRST-Medicare Advantage, +85138,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,HEALTHFIRST-Medicare Advantage, +85139,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,HEALTHFIRST-Medicare Advantage, +85140,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,HEALTHFIRST-Medicare Advantage, +85141,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,HEALTHFIRST-Medicare Advantage, +85142,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,HEALTHFIRST-Medicare Advantage, +85143,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,HEALTHFIRST-Medicare Advantage, +85144,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,HEALTHFIRST-Medicare Advantage, +85145,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,HEALTHFIRST-Medicare Advantage, +85146,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,HEALTHFIRST-Medicare Advantage, +85147,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,HEALTHFIRST-Medicare Advantage, +85148,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,HEALTHFIRST-Medicare Advantage, +85149,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,HEALTHFIRST-Medicare Advantage, +85150,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,HEALTHFIRST-Medicare Advantage, +85151,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,HEALTHFIRST-Medicare Advantage, +85152,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,HEALTHFIRST-Medicare Advantage, +85153,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,HEALTHFIRST-Medicare Advantage, +85154,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,HEALTHFIRST-Medicare Advantage, +85155,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,HEALTHFIRST-Medicare Advantage, +85156,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,HEALTHFIRST-Medicare Advantage, +85157,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,HEALTHFIRST-Medicare Advantage, +85158,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,HEALTHFIRST-Medicare Advantage, +85159,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,HEALTHFIRST-Medicare Advantage, +85160,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,HEALTHFIRST-Medicare Advantage, +85161,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,HEALTHFIRST-Medicare Advantage, +85162,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,HEALTHFIRST-Medicare Advantage, +85163,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,HEALTHFIRST-Medicare Advantage, +85164,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,HEALTHFIRST-Medicare Advantage, +85165,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,HEALTHFIRST-Medicare Advantage, +85166,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,HEALTHFIRST-Medicare Advantage, +85167,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,HEALTHFIRST-Medicare Advantage, +85168,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,HEALTHFIRST-Medicare Advantage, +85169,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,HEALTHFIRST-Medicare Advantage, +85170,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,HEALTHFIRST-Medicare Advantage, +85171,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,HEALTHFIRST-Medicare Advantage, +85172,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,HEALTHFIRST-Medicare Advantage, +85173,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,HEALTHFIRST-Medicare Advantage, +85174,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,HEALTHFIRST-Medicare Advantage, +85175,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,HEALTHFIRST-Medicare Advantage, +85176,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,HEALTHFIRST-Medicare Advantage, +85177,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,HEALTHFIRST-Medicare Advantage, +85178,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,HEALTHFIRST-Medicare Advantage, +85179,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,HEALTHFIRST-Medicare Advantage, +85180,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,HEALTHFIRST-Medicare Advantage, +85181,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,HEALTHFIRST-Medicare Advantage, +85182,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,HEALTHFIRST-Medicare Advantage, +85183,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,HEALTHFIRST-Medicare Advantage, +85184,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,HEALTHFIRST-Medicare Advantage, +85185,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,HEALTHFIRST-Medicare Advantage, +85186,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,HEALTHFIRST-Medicare Advantage, +85187,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,HEALTHFIRST-Medicare Advantage, +85188,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,HEALTHFIRST-Medicare Advantage, +85189,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,HEALTHFIRST-Medicare Advantage, +85190,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,HEALTHFIRST-Medicare Advantage, +85191,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,HEALTHFIRST-Medicare Advantage, +85192,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,HEALTHFIRST-Medicare Advantage, +85193,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,HEALTHFIRST-Medicare Advantage, +85194,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,HEALTHFIRST-Medicare Advantage, +85195,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,HEALTHFIRST-Medicare Advantage, +85196,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,HEALTHFIRST-Medicare Advantage, +85197,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,HEALTHFIRST-Medicare Advantage, +85198,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,HEALTHFIRST-Medicare Advantage, +85199,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,HEALTHFIRST-Medicare Advantage, +85200,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,HEALTHFIRST-Medicare Advantage, +85201,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,HEALTHFIRST-Medicare Advantage, +85202,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,HEALTHFIRST-Medicare Advantage, +85203,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,HEALTHFIRST-Medicare Advantage, +85204,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,HEALTHFIRST-Medicare Advantage, +85205,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,HEALTHFIRST-Medicare Advantage, +85206,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,HEALTHFIRST-Medicare Advantage, +85207,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,HEALTHFIRST-Medicare Advantage, +85208,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,HEALTHFIRST-Medicare Advantage, +85209,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,HEALTHFIRST-Medicare Advantage, +85210,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,HEALTHFIRST-Medicare Advantage, +85211,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,HEALTHFIRST-Medicare Advantage, +85212,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,HEALTHFIRST-Medicare Advantage, +85213,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,HEALTHFIRST-Medicare Advantage, +85214,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,HEALTHFIRST-Medicare Advantage, +85215,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,HEALTHFIRST-Medicare Advantage, +85216,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,HEALTHFIRST-Medicare Advantage, +85217,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,HEALTHFIRST-Medicare Advantage, +85218,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,HEALTHFIRST-Medicare Advantage, +85219,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,HEALTHFIRST-Medicare Advantage, +85220,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,HEALTHFIRST-Medicare Advantage, +85221,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,HEALTHFIRST-Medicare Advantage, +85222,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,HEALTHFIRST-Medicare Advantage, +85223,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,HEALTHFIRST-Medicare Advantage, +85224,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,HEALTHFIRST-Medicare Advantage, +85225,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,HEALTHFIRST-Medicare Advantage, +85226,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,HEALTHFIRST-Medicare Advantage, +85227,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,HEALTHFIRST-Medicare Advantage, +85228,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,HEALTHFIRST-Medicare Advantage, +85229,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,HEALTHFIRST-Medicare Advantage, +85230,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,HEALTHFIRST-Medicare Advantage, +85231,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,HEALTHFIRST-Medicare Advantage, +85232,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,HEALTHFIRST-Medicare Advantage, +85233,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,HEALTHFIRST-Medicare Advantage, +85234,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,HEALTHFIRST-Medicare Advantage, +85235,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,HEALTHFIRST-Medicare Advantage, +85236,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,HEALTHFIRST-Medicare Advantage, +85237,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,HEALTHFIRST-Medicare Advantage, +85238,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +85239,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +85240,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +85241,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,HEALTHFIRST-Medicare Advantage, +85242,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,HEALTHFIRST-Medicare Advantage, +85243,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,HEALTHFIRST-Medicare Advantage, +85244,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,HEALTHFIRST-Medicare Advantage, +85245,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,HEALTHFIRST-Medicare Advantage, +85246,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,HEALTHFIRST-Medicare Advantage, +85247,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,HEALTHFIRST-Medicare Advantage, +85248,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,HEALTHFIRST-Medicare Advantage, +85249,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,HEALTHFIRST-Medicare Advantage, +85250,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,HEALTHFIRST-Medicare Advantage, +85251,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,HEALTHFIRST-Medicare Advantage, +85252,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,HEALTHFIRST-Medicare Advantage, +85253,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,HEALTHFIRST-Medicare Advantage, +85254,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,HEALTHFIRST-Medicare Advantage, +85255,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,HEALTHFIRST-Medicare Advantage, +85256,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,HEALTHFIRST-Medicare Advantage, +85257,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,HEALTHFIRST-Medicare Advantage, +85258,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,HEALTHFIRST-Medicare Advantage, +85259,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,HEALTHFIRST-Medicare Advantage, +85260,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,HEALTHFIRST-Medicare Advantage, +85261,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,HEALTHFIRST-Medicare Advantage, +85262,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,HEALTHFIRST-Medicare Advantage, +85263,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,HEALTHFIRST-Medicare Advantage, +85264,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,HEALTHFIRST-Medicare Advantage, +85265,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,HEALTHFIRST-Medicare Advantage, +85266,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,HEALTHFIRST-Medicare Advantage, +85267,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,HEALTHFIRST-Medicare Advantage, +85268,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,HEALTHFIRST-Medicare Advantage, +85269,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,HEALTHFIRST-Medicare Advantage, +85270,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,HEALTHFIRST-Medicare Advantage, +85271,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,HEALTHFIRST-Medicare Advantage, +85272,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,HEALTHFIRST-Medicare Advantage, +85273,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,HEALTHFIRST-Medicare Advantage, +85274,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,HEALTHFIRST-Medicare Advantage, +85275,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,HEALTHFIRST-Medicare Advantage, +85276,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,HEALTHFIRST-Medicare Advantage, +85277,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,HEALTHFIRST-Medicare Advantage, +85278,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,HEALTHFIRST-Medicare Advantage, +85279,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,HEALTHFIRST-Medicare Advantage, +85280,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,HEALTHFIRST-Medicare Advantage, +85281,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,HEALTHFIRST-Medicare Advantage, +85282,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,HEALTHFIRST-Medicare Advantage, +85283,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,HEALTHFIRST-Medicare Advantage, +85284,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,HEALTHFIRST-Medicare Advantage, +85285,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,HEALTHFIRST-Medicare Advantage, +85286,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,HEALTHFIRST-Medicare Advantage, +85287,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,HEALTHFIRST-Medicare Advantage, +85288,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,HEALTHFIRST-Medicare Advantage, +85289,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,HEALTHFIRST-Medicare Advantage, +85290,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,HEALTHFIRST-Medicare Advantage, +85291,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,HEALTHFIRST-Medicare Advantage, +85292,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,HEALTHFIRST-Medicare Advantage, +85293,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,HEALTHFIRST-Medicare Advantage, +85294,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,HEALTHFIRST-Medicare Advantage, +85295,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,HEALTHFIRST-Medicare Advantage, +85296,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,HEALTHFIRST-Medicare Advantage, +85297,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,HEALTHFIRST-Medicare Advantage, +85298,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,HEALTHFIRST-Medicare Advantage, +85299,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,HEALTHFIRST-Medicare Advantage, +85300,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,HEALTHFIRST-Medicare Advantage, +85301,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,HEALTHFIRST-Medicare Advantage, +85302,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,HEALTHFIRST-Medicare Advantage, +85303,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,HEALTHFIRST-Medicare Advantage, +85304,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,HEALTHFIRST-Medicare Advantage, +85305,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,HEALTHFIRST-Medicare Advantage, +85306,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,HEALTHFIRST-Medicare Advantage, +85307,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,HEALTHFIRST-Medicare Advantage, +85308,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,HEALTHFIRST-Medicare Advantage, +85309,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,HEALTHFIRST-Medicare Advantage, +85310,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,HEALTHFIRST-Medicare Advantage, +85311,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,HEALTHFIRST-Medicare Advantage, +85312,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,HEALTHFIRST-Medicare Advantage, +85313,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,HEALTHFIRST-Medicare Advantage, +85314,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,HEALTHFIRST-Medicare Advantage, +85315,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,HEALTHFIRST-Medicare Advantage, +85316,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,HEALTHFIRST-Medicare Advantage, +85317,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,HEALTHFIRST-Medicare Advantage, +85318,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,HEALTHFIRST-Medicare Advantage, +85319,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,HEALTHFIRST-Medicare Advantage, +85320,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,HEALTHFIRST-Medicare Advantage, +85321,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,HEALTHFIRST-Medicare Advantage, +85322,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,HEALTHFIRST-Medicare Advantage, +85323,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,HEALTHFIRST-Medicare Advantage, +85324,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,HEALTHFIRST-Medicare Advantage, +85325,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,HEALTHFIRST-Medicare Advantage, +85326,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,HEALTHFIRST-Medicare Advantage, +85327,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,HEALTHFIRST-Medicare Advantage, +85328,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,HEALTHFIRST-Medicare Advantage, +85329,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,HEALTHFIRST-Medicare Advantage, +85330,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,HEALTHFIRST-Medicare Advantage, +85331,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,HEALTHFIRST-Medicare Advantage, +85332,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,HEALTHFIRST-Medicare Advantage, +85333,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,HEALTHFIRST-Medicare Advantage, +85334,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,HEALTHFIRST-Medicare Advantage, +85335,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,HEALTHFIRST-Medicare Advantage, +85336,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,HEALTHFIRST-Medicare Advantage, +85337,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +85338,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,HEALTHFIRST-Medicare Advantage, +85339,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,HEALTHFIRST-Medicare Advantage, +85340,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,HEALTHFIRST-Medicare Advantage, +85341,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,HEALTHFIRST-Medicare Advantage, +85342,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,HEALTHFIRST-Medicare Advantage, +85343,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,HEALTHFIRST-Medicare Advantage, +85344,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,HEALTHFIRST-Medicare Advantage, +85345,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,HEALTHFIRST-Medicare Advantage, +85346,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,HEALTHFIRST-Medicare Advantage, +85347,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,HEALTHFIRST-Medicare Advantage, +85348,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,HEALTHFIRST-Medicare Advantage, +85349,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,HEALTHFIRST-Medicare Advantage, +85350,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,HEALTHFIRST-Medicare Advantage, +85351,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,HEALTHFIRST-Medicare Advantage, +85352,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,HEALTHFIRST-Medicare Advantage, +85353,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,HEALTHFIRST-Medicare Advantage, +85354,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,HEALTHFIRST-Medicare Advantage, +85355,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,HEALTHFIRST-Medicare Advantage, +85356,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,HEALTHFIRST-Medicare Advantage, +85357,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,HEALTHFIRST-Medicare Advantage, +85358,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,HEALTHFIRST-Medicare Advantage, +85359,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,HEALTHFIRST-Medicare Advantage, +85360,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,HEALTHFIRST-Medicare Advantage, +85361,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,HEALTHFIRST-Medicare Advantage, +85362,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,HEALTHFIRST-Medicare Advantage, +85363,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,HEALTHFIRST-Medicare Advantage, +85364,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,HEALTHFIRST-Medicare Advantage, +85365,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,HEALTHFIRST-Medicare Advantage, +85366,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,HEALTHFIRST-Medicare Advantage, +85367,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,HEALTHFIRST-Medicare Advantage, +85368,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,HEALTHFIRST-Medicare Advantage, +85369,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,HEALTHFIRST-Medicare Advantage, +85370,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,HEALTHFIRST-Medicare Advantage, +85371,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,HEALTHFIRST-Medicare Advantage, +85372,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,HEALTHFIRST-Medicare Advantage, +85373,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,HEALTHFIRST-Medicare Advantage, +85374,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,HEALTHFIRST-Medicare Advantage, +85375,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,HEALTHFIRST-Medicare Advantage, +85376,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,HEALTHFIRST-Medicare Advantage, +85377,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,HEALTHFIRST-Medicare Advantage, +85378,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,HEALTHFIRST-Medicare Advantage, +85379,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,HEALTHFIRST-Medicare Advantage, +85380,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,HEALTHFIRST-Medicare Advantage, +85381,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,HEALTHFIRST-Medicare Advantage, +85382,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,HEALTHFIRST-Medicare Advantage, +85383,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,HEALTHFIRST-Medicare Advantage, +85384,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,HEALTHFIRST-Medicare Advantage, +85385,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,HEALTHFIRST-Medicare Advantage, +85386,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,HEALTHFIRST-Medicare Advantage, +85387,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,HEALTHFIRST-Medicare Advantage, +85388,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,HEALTHFIRST-Medicare Advantage, +85389,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,HEALTHFIRST-Medicare Advantage, +85390,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,HEALTHFIRST-Medicare Advantage, +85391,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,HEALTHFIRST-Medicare Advantage, +85392,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,HEALTHFIRST-Medicare Advantage, +85393,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,HEALTHFIRST-Medicare Advantage, +85394,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,HEALTHFIRST-Medicare Advantage, +85395,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,HEALTHFIRST-Medicare Advantage, +85396,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,HEALTHFIRST-Medicare Advantage, +85397,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,HEALTHFIRST-Medicare Advantage, +85398,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,HEALTHFIRST-Medicare Advantage, +85399,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,HEALTHFIRST-Medicare Advantage, +85400,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,HEALTHFIRST-Medicare Advantage, +85401,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,HEALTHFIRST-Medicare Advantage, +85402,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,HEALTHFIRST-Medicare Advantage, +85403,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,HEALTHFIRST-Medicare Advantage, +85404,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,HEALTHFIRST-Medicare Advantage, +85405,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,HEALTHFIRST-Medicare Advantage, +85406,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,HEALTHFIRST-Medicare Advantage, +85407,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,HEALTHFIRST-Medicare Advantage,737.08 +85408,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,HEALTHFIRST-Medicare Advantage, +85409,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,HEALTHFIRST-Medicare Advantage, +85410,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,HEALTHFIRST-Medicare Advantage, +85411,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,HEALTHFIRST-Medicare Advantage, +85412,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,HEALTHFIRST-Medicare Advantage, +85413,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,HEALTHFIRST-Medicare Advantage, +85414,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,HEALTHFIRST-Medicare Advantage, +85415,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,HEALTHFIRST-Medicare Advantage, +85416,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,HEALTHFIRST-Medicare Advantage, +85417,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,HEALTHFIRST-Medicare Advantage, +85418,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,HEALTHFIRST-Medicare Advantage, +85419,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,HEALTHFIRST-Medicare Advantage, +85420,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,HEALTHFIRST-Medicare Advantage, +85421,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,HEALTHFIRST-Medicare Advantage, +85422,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,HEALTHFIRST-Medicare Advantage, +85423,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,HEALTHFIRST-Medicare Advantage, +85424,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,HEALTHFIRST-Medicare Advantage, +85425,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,HEALTHFIRST-Medicare Advantage, +85426,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,HEALTHFIRST-Medicare Advantage, +85427,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,HEALTHFIRST-Medicare Advantage, +85428,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,HEALTHFIRST-Medicare Advantage, +85429,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,HEALTHFIRST-Medicare Advantage, +85430,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,HEALTHFIRST-Medicare Advantage, +85431,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,HEALTHFIRST-Medicare Advantage, +85432,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,HEALTHFIRST-Medicare Advantage, +85433,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,HEALTHFIRST-Medicare Advantage, +85434,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,HEALTHFIRST-Medicare Advantage, +85435,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,HEALTHFIRST-Medicare Advantage, +85436,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,HEALTHFIRST-Medicare Advantage, +85437,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,HEALTHFIRST-Medicare Advantage, +85438,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,HEALTHFIRST-Medicare Advantage, +85439,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,HEALTHFIRST-Medicare Advantage, +85440,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,HEALTHFIRST-Medicare Advantage, +85441,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,HEALTHFIRST-Medicare Advantage, +85442,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,HEALTHFIRST-Medicare Advantage, +85443,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,HEALTHFIRST-Medicare Advantage, +85444,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,HEALTHFIRST-Medicare Advantage, +85445,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,HEALTHFIRST-Medicare Advantage, +85446,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,HEALTHFIRST-Medicare Advantage, +85447,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,HEALTHFIRST-Medicare Advantage, +85448,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,HEALTHFIRST-Medicare Advantage, +85449,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHFIRST-Medicare Advantage, +85450,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHFIRST-Medicare Advantage, +85451,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,HEALTHFIRST-Medicare Advantage, +85452,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,HEALTHFIRST-Medicare Advantage, +85453,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,HEALTHFIRST-Medicare Advantage, +85454,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,HEALTHFIRST-Medicare Advantage, +85455,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,HEALTHFIRST-Medicare Advantage, +85456,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,HEALTHFIRST-Medicare Advantage, +85457,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,HEALTHFIRST-Medicare Advantage, +85458,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,HEALTHFIRST-Medicare Advantage, +85459,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,HEALTHFIRST-Medicare Advantage, +85460,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,HEALTHFIRST-Medicare Advantage, +85461,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,HEALTHFIRST-Medicare Advantage, +85462,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,HEALTHFIRST-Medicare Advantage, +85463,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,HEALTHFIRST-Medicare Advantage, +85464,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,HEALTHFIRST-Medicare Advantage, +85465,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,HEALTHFIRST-Medicare Advantage, +85466,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,HEALTHFIRST-Medicare Advantage, +85467,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,HEALTHFIRST-Medicare Advantage, +85468,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,HEALTHFIRST-Medicare Advantage, +85469,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,HEALTHFIRST-Medicare Advantage, +85470,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,HEALTHFIRST-Medicare Advantage, +85471,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,HEALTHFIRST-Medicare Advantage, +85472,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,HEALTHFIRST-Medicare Advantage, +85473,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,HEALTHFIRST-Medicare Advantage, +85474,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,HEALTHFIRST-Medicare Advantage, +85475,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,HEALTHFIRST-Medicare Advantage, +85476,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,HEALTHFIRST-Medicare Advantage, +85477,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,HEALTHFIRST-Medicare Advantage, +85478,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,HEALTHFIRST-Medicare Advantage, +85479,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,HEALTHFIRST-Medicare Advantage, +85480,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,HEALTHFIRST-Medicare Advantage, +85481,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,HEALTHFIRST-Medicare Advantage, +85482,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,HEALTHFIRST-Medicare Advantage, +85483,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,HEALTHFIRST-Medicare Advantage, +85484,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,HEALTHFIRST-Medicare Advantage, +85485,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,HEALTHFIRST-Medicare Advantage, +85486,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,HEALTHFIRST-Medicare Advantage, +85487,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,HEALTHFIRST-Medicare Advantage, +85488,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,HEALTHFIRST-Medicare Advantage, +85489,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,HEALTHFIRST-Medicare Advantage, +85490,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,HEALTHFIRST-Medicare Advantage, +85491,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,HEALTHFIRST-Medicare Advantage, +85492,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,HEALTHFIRST-Medicare Advantage, +85493,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,HEALTHFIRST-Medicare Advantage, +85494,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,HEALTHFIRST-Medicare Advantage, +85495,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,HEALTHFIRST-Medicare Advantage, +85496,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,HEALTHFIRST-Medicare Advantage, +85497,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,HEALTHFIRST-Medicare Advantage, +85498,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,HEALTHFIRST-Medicare Advantage, +85499,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,HEALTHFIRST-Medicare Advantage, +85500,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,HEALTHFIRST-Medicare Advantage, +85501,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,HEALTHFIRST-Medicare Advantage, +85502,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,HEALTHFIRST-Medicare Advantage, +85503,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,HEALTHFIRST-Medicare Advantage, +85504,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,HEALTHFIRST-Medicare Advantage, +85505,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,HEALTHFIRST-Medicare Advantage, +85506,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,HEALTHFIRST-Medicare Advantage, +85507,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,HEALTHFIRST-Medicare Advantage, +85508,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,HEALTHFIRST-Medicare Advantage, +85509,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,HEALTHFIRST-Medicare Advantage, +85510,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,HEALTHFIRST-Medicare Advantage, +85511,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,HEALTHFIRST-Medicare Advantage, +85512,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,HEALTHFIRST-Medicare Advantage, +85513,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,HEALTHFIRST-Medicare Advantage, +85514,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,HEALTHFIRST-Medicare Advantage, +85515,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,HEALTHFIRST-Medicare Advantage, +85516,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,HEALTHFIRST-Medicare Advantage, +85517,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,HEALTHFIRST-Medicare Advantage, +85518,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,HEALTHFIRST-Medicare Advantage, +85519,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,HEALTHFIRST-Medicare Advantage, +85520,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,HEALTHFIRST-Medicare Advantage, +85521,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,HEALTHFIRST-Medicare Advantage, +85522,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,HEALTHFIRST-Medicare Advantage, +85523,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,HEALTHFIRST-Medicare Advantage, +85524,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,HEALTHFIRST-Medicare Advantage, +85525,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,HEALTHFIRST-Medicare Advantage, +85526,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,HEALTHFIRST-Medicare Advantage, +85527,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,HEALTHFIRST-Medicare Advantage, +85528,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,HEALTHFIRST-Medicare Advantage, +85529,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,HEALTHFIRST-Medicare Advantage, +85530,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,HEALTHFIRST-Medicare Advantage, +85531,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,HEALTHFIRST-Medicare Advantage, +85532,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,HEALTHFIRST-Medicare Advantage, +85533,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,HEALTHFIRST-Medicare Advantage, +85534,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,HEALTHFIRST-Medicare Advantage, +85535,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,HEALTHFIRST-Medicare Advantage, +85536,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,HEALTHFIRST-Medicare Advantage, +85537,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,HEALTHFIRST-Medicare Advantage, +85538,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,HEALTHFIRST-Medicare Advantage, +85539,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,HEALTHFIRST-Medicare Advantage, +85540,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,HEALTHFIRST-Medicare Advantage, +85541,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,HEALTHFIRST-Medicare Advantage, +85542,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,HEALTHFIRST-Medicare Advantage, +85543,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,HEALTHFIRST-Medicare Advantage,412.0 +85544,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,HEALTHFIRST-Medicare Advantage, +85545,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,HEALTHFIRST-Medicare Advantage, +85546,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,HEALTHFIRST-Medicare Advantage, +85547,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,HEALTHFIRST-Medicare Advantage, +85548,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,HEALTHFIRST-Medicare Advantage, +85549,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,HEALTHFIRST-Medicare Advantage, +85550,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,HEALTHFIRST-Medicare Advantage, +85551,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,HEALTHFIRST-Medicare Advantage, +85552,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,HEALTHFIRST-Medicare Advantage, +85553,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,HEALTHFIRST-Medicare Advantage, +85554,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,HEALTHFIRST-Medicare Advantage, +85555,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,HEALTHFIRST-Medicare Advantage, +85556,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,HEALTHFIRST-Medicare Advantage, +85557,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,HEALTHFIRST-Medicare Advantage, +85558,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,HEALTHFIRST-Medicare Advantage, +85559,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,HEALTHFIRST-Medicare Advantage,997.25 +85560,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,HEALTHFIRST-Medicare Advantage, +85561,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,HEALTHFIRST-Medicare Advantage, +85562,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,HEALTHFIRST-Medicare Advantage, +85563,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,HEALTHFIRST-Medicare Advantage, +85564,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,HEALTHFIRST-Medicare Advantage, +85565,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,HEALTHFIRST-Medicare Advantage, +85566,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,HEALTHFIRST-Medicare Advantage, +85567,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,HEALTHFIRST-Medicare Advantage, +85568,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,HEALTHFIRST-Medicare Advantage, +85569,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,HEALTHFIRST-Medicare Advantage, +85570,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,HEALTHFIRST-Medicare Advantage, +85571,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,HEALTHFIRST-Medicare Advantage, +85572,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,HEALTHFIRST-Medicare Advantage, +85573,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,HEALTHFIRST-Medicare Advantage, +85574,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,HEALTHFIRST-Medicare Advantage, +85575,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,HEALTHFIRST-Medicare Advantage, +85576,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,HEALTHFIRST-Medicare Advantage, +85577,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,HEALTHFIRST-Medicare Advantage, +85578,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,HEALTHFIRST-Medicare Advantage, +85579,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,HEALTHFIRST-Medicare Advantage, +85580,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,HEALTHFIRST-Medicare Advantage, +85581,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,HEALTHFIRST-Medicare Advantage, +85582,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,HEALTHFIRST-Medicare Advantage, +85583,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,HEALTHFIRST-Medicare Advantage, +85584,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,HEALTHFIRST-Medicare Advantage, +85585,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,HEALTHFIRST-Medicare Advantage, +85586,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,HEALTHFIRST-Medicare Advantage, +85587,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,HEALTHFIRST-Medicare Advantage, +85588,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,HEALTHFIRST-Medicare Advantage, +85589,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,HEALTHFIRST-Medicare Advantage, +85590,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,HEALTHFIRST-Medicare Advantage, +85591,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,HEALTHFIRST-Medicare Advantage, +85592,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,HEALTHFIRST-Medicare Advantage, +85593,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,HEALTHFIRST-Medicare Advantage, +85594,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,HEALTHFIRST-Medicare Advantage, +85595,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,HEALTHFIRST-Medicare Advantage, +85596,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,HEALTHFIRST-Medicare Advantage, +85597,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,HEALTHFIRST-Medicare Advantage, +85598,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,HEALTHFIRST-Medicare Advantage, +85599,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,HEALTHFIRST-Medicare Advantage, +85600,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,HEALTHFIRST-Medicare Advantage, +85601,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,HEALTHFIRST-Medicare Advantage, +85602,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,HEALTHFIRST-Medicare Advantage, +85603,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,HEALTHFIRST-Medicare Advantage, +85604,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,HEALTHFIRST-Medicare Advantage, +85605,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,HEALTHFIRST-Medicare Advantage, +85606,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,HEALTHFIRST-Medicare Advantage, +85607,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,HEALTHFIRST-Medicare Advantage, +85608,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,HEALTHFIRST-Medicare Advantage, +85609,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,HEALTHFIRST-Medicare Advantage, +85610,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,HEALTHFIRST-Medicare Advantage, +85611,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,HEALTHFIRST-Medicare Advantage, +85612,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,HEALTHFIRST-Medicare Advantage, +85613,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,HEALTHFIRST-Medicare Advantage, +85614,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,HEALTHFIRST-Medicare Advantage, +85615,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,HEALTHFIRST-Medicare Advantage, +85616,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,HEALTHFIRST-Medicare Advantage, +85617,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,HEALTHFIRST-Medicare Advantage, +85618,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,HEALTHFIRST-Medicare Advantage, +85619,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,HEALTHFIRST-Medicare Advantage, +85620,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,HEALTHFIRST-Medicare Advantage, +85621,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,HEALTHFIRST-Medicare Advantage, +85622,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,HEALTHFIRST-Medicare Advantage, +85623,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,HEALTHFIRST-Medicare Advantage, +85624,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,HEALTHFIRST-Medicare Advantage, +85625,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,HEALTHFIRST-Medicare Advantage, +85626,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,HEALTHFIRST-Medicare Advantage, +85627,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,HEALTHFIRST-Medicare Advantage, +85628,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,HEALTHFIRST-Medicare Advantage, +85629,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,HEALTHFIRST-Medicare Advantage, +85630,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,HEALTHFIRST-Medicare Advantage, +85631,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,HEALTHFIRST-Medicare Advantage, +85632,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,HEALTHFIRST-Medicare Advantage, +85633,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,HEALTHFIRST-Medicare Advantage, +85634,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,HEALTHFIRST-Medicare Advantage, +85635,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,HEALTHFIRST-Medicare Advantage, +85636,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,HEALTHFIRST-Medicare Advantage, +85637,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,HEALTHFIRST-Medicare Advantage, +85638,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,HEALTHFIRST-Medicare Advantage, +85639,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,HEALTHFIRST-Medicare Advantage, +85640,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,HEALTHFIRST-Medicare Advantage, +85641,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,HEALTHFIRST-Medicare Advantage, +85642,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,HEALTHFIRST-Medicare Advantage, +85643,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,HEALTHFIRST-Medicare Advantage, +85644,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,HEALTHFIRST-Medicare Advantage, +85645,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,HEALTHFIRST-Medicare Advantage, +85646,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,HEALTHFIRST-Medicare Advantage, +85647,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,HEALTHFIRST-Medicare Advantage, +85648,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,HEALTHFIRST-Medicare Advantage, +85649,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,HEALTHFIRST-Medicare Advantage, +85650,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,HEALTHFIRST-Medicare Advantage, +85651,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,HEALTHFIRST-Medicare Advantage, +85652,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,HEALTHFIRST-Medicare Advantage, +85653,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,HEALTHFIRST-Medicare Advantage, +85654,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,HEALTHFIRST-Medicare Advantage, +85655,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,HEALTHFIRST-Medicare Advantage, +85656,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,HEALTHFIRST-Medicare Advantage, +85657,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,HEALTHFIRST-Medicare Advantage, +85658,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,HEALTHFIRST-Medicare Advantage, +85659,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,HEALTHFIRST-Medicare Advantage, +85660,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,HEALTHFIRST-Medicare Advantage, +85661,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,HEALTHFIRST-Medicare Advantage, +85662,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,HEALTHFIRST-Medicare Advantage, +85663,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,HEALTHFIRST-Medicare Advantage, +85664,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,HEALTHFIRST-Medicare Advantage, +85665,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,HEALTHFIRST-Medicare Advantage, +85666,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,HEALTHFIRST-Medicare Advantage, +85667,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,HEALTHFIRST-Medicare Advantage, +85668,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,HEALTHFIRST-Medicare Advantage, +85669,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,HEALTHFIRST-Medicare Advantage, +85670,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,HEALTHFIRST-Medicare Advantage, +85671,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,HEALTHFIRST-Medicare Advantage, +85672,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,HEALTHFIRST-Medicare Advantage, +85673,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,HEALTHFIRST-Medicare Advantage, +85674,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,HEALTHFIRST-Medicare Advantage, +85675,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,HEALTHFIRST-Medicare Advantage, +85676,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,HEALTHFIRST-Medicare Advantage, +85677,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,HEALTHFIRST-Medicare Advantage, +85678,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,HEALTHFIRST-Medicare Advantage, +85679,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,HEALTHFIRST-Medicare Advantage, +85680,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,HEALTHFIRST-Medicare Advantage, +85681,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,HEALTHFIRST-Medicare Advantage, +85682,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,HEALTHFIRST-Medicare Advantage, +85683,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,HEALTHFIRST-Medicare Advantage, +85684,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,HEALTHFIRST-Medicare Advantage, +85685,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,HEALTHFIRST-Medicare Advantage, +85686,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,HEALTHFIRST-Medicare Advantage, +85687,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,HEALTHFIRST-Medicare Advantage, +85688,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,HEALTHFIRST-Medicare Advantage, +85689,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,HEALTHFIRST-Medicare Advantage, +85690,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,HEALTHFIRST-Medicare Advantage, +85691,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,HEALTHFIRST-Medicare Advantage, +85692,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,HEALTHFIRST-Medicare Advantage, +85693,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,HEALTHFIRST-Medicare Advantage, +85694,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,HEALTHFIRST-Medicare Advantage, +85695,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,HEALTHFIRST-Medicare Advantage, +85696,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,HEALTHFIRST-Medicare Advantage, +85697,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,HEALTHFIRST-Medicare Advantage, +85698,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,HEALTHFIRST-Medicare Advantage, +85699,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,HEALTHFIRST-Medicare Advantage, +85700,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,HEALTHFIRST-Medicare Advantage, +85701,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,HEALTHFIRST-Medicare Advantage, +85702,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,HEALTHFIRST-Medicare Advantage, +85703,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,HEALTHFIRST-Medicare Advantage, +85704,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,HEALTHFIRST-Medicare Advantage, +85705,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,HEALTHFIRST-Medicare Advantage, +85706,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,HEALTHFIRST-Medicare Advantage, +85707,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,HEALTHFIRST-Medicare Advantage, +85708,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,HEALTHFIRST-Medicare Advantage, +85709,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,HEALTHFIRST-Medicare Advantage, +85710,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,HEALTHFIRST-Medicare Advantage, +85711,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,HEALTHFIRST-Medicare Advantage, +85712,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,HEALTHFIRST-Medicare Advantage, +85713,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,HEALTHFIRST-Medicare Advantage, +85714,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,HEALTHFIRST-Medicare Advantage, +85715,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,HEALTHFIRST-Medicare Advantage, +85716,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,HEALTHFIRST-Medicare Advantage, +85717,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,HEALTHFIRST-Medicare Advantage, +85718,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,HEALTHFIRST-Medicare Advantage, +85719,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,HEALTHFIRST-Medicare Advantage, +85720,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,HEALTHFIRST-Medicare Advantage, +85721,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,HEALTHFIRST-Medicare Advantage, +85722,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,HEALTHFIRST-Medicare Advantage, +85723,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,HEALTHFIRST-Medicare Advantage, +85724,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,HEALTHFIRST-Medicare Advantage, +85725,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,HEALTHFIRST-Medicare Advantage, +85726,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,HEALTHFIRST-Medicare Advantage, +85727,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,HEALTHFIRST-Medicare Advantage, +85728,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,HEALTHFIRST-Medicare Advantage, +85729,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,HEALTHFIRST-Medicare Advantage, +85730,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,HEALTHFIRST-Medicare Advantage, +85731,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,HEALTHFIRST-Medicare Advantage, +85732,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,HEALTHFIRST-Medicare Advantage, +85733,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,HEALTHFIRST-Medicare Advantage, +85734,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,HEALTHFIRST-Medicare Advantage, +85735,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,HEALTHFIRST-Medicare Advantage, +85736,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,HEALTHFIRST-Medicare Advantage, +85737,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,HEALTHFIRST-Medicare Advantage, +85738,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,HEALTHFIRST-Medicare Advantage, +85739,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,HEALTHFIRST-Medicare Advantage, +85740,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,HEALTHFIRST-Medicare Advantage, +85741,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,HEALTHFIRST-Medicare Advantage, +85742,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,HEALTHFIRST-Medicare Advantage, +85743,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,HEALTHFIRST-Medicare Advantage, +85744,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,HEALTHFIRST-Medicare Advantage, +85745,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,HEALTHFIRST-Medicare Advantage, +85746,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,HEALTHFIRST-Medicare Advantage, +85747,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,HEALTHFIRST-Medicare Advantage, +85748,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,HEALTHFIRST-Medicare Advantage, +85749,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,HEALTHFIRST-Medicare Advantage, +85750,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,HEALTHFIRST-Medicare Advantage, +85751,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,HEALTHFIRST-Medicare Advantage, +85752,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,HEALTHFIRST-Medicare Advantage, +85753,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,HEALTHFIRST-Medicare Advantage, +85754,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,HEALTHFIRST-Medicare Advantage, +85755,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,HEALTHFIRST-Medicare Advantage, +85756,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,HEALTHFIRST-Medicare Advantage, +85757,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,HEALTHFIRST-Medicare Advantage, +85758,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,HEALTHFIRST-Medicare Advantage, +85759,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,HEALTHFIRST-Medicare Advantage, +85760,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,HEALTHFIRST-Medicare Advantage, +85761,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,HEALTHFIRST-Medicare Advantage, +85762,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,HEALTHFIRST-Medicare Advantage, +85763,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,HEALTHFIRST-Medicare Advantage, +85764,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,HEALTHFIRST-Medicare Advantage, +85765,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,HEALTHFIRST-Medicare Advantage, +85766,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,HEALTHFIRST-Medicare Advantage, +85767,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,HEALTHFIRST-Medicare Advantage, +85768,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,HEALTHFIRST-Medicare Advantage, +85769,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,HEALTHFIRST-Medicare Advantage, +85770,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,HEALTHFIRST-Medicare Advantage, +85771,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,HEALTHFIRST-Medicare Advantage, +85772,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,HEALTHFIRST-Medicare Advantage, +85773,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,HEALTHFIRST-Medicare Advantage, +85774,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,HEALTHFIRST-Medicare Advantage, +85775,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,HEALTHFIRST-Medicare Advantage, +85776,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,HEALTHFIRST-Medicare Advantage, +85777,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,HEALTHFIRST-Medicare Advantage, +85778,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,HEALTHFIRST-Medicare Advantage, +85779,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,HEALTHFIRST-Medicare Advantage, +85780,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,HEALTHFIRST-Medicare Advantage, +85781,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,HEALTHFIRST-Medicare Advantage, +85782,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,HEALTHFIRST-Medicare Advantage, +85783,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,HEALTHFIRST-Medicare Advantage, +85784,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,HEALTHFIRST-Medicare Advantage, +85785,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,HEALTHFIRST-Medicare Advantage, +85786,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,HEALTHFIRST-Medicare Advantage, +85787,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,HEALTHFIRST-Medicare Advantage, +85788,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,HEALTHFIRST-Medicare Advantage, +85789,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,HEALTHFIRST-Medicare Advantage, +85790,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,HEALTHFIRST-Medicare Advantage, +85791,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,HEALTHFIRST-Medicare Advantage, +85792,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,HEALTHFIRST-Medicare Advantage, +85793,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,HEALTHFIRST-Medicare Advantage, +85794,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,HEALTHFIRST-Medicare Advantage, +85795,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,HEALTHFIRST-Medicare Advantage, +85796,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,HEALTHFIRST-Medicare Advantage, +85797,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,HEALTHFIRST-Medicare Advantage, +85798,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,HEALTHFIRST-Medicare Advantage, +85799,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,HEALTHFIRST-Medicare Advantage, +85800,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,HEALTHFIRST-Medicare Advantage, +85801,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,HEALTHFIRST-Medicare Advantage, +85802,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,HEALTHFIRST-Medicare Advantage, +85803,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,HEALTHFIRST-Medicare Advantage, +85804,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,HEALTHFIRST-Medicare Advantage, +85805,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,HEALTHFIRST-Medicare Advantage, +85806,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,HEALTHFIRST-Medicare Advantage, +85807,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,HEALTHFIRST-Medicare Advantage, +85808,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,HEALTHFIRST-Medicare Advantage, +85809,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,HEALTHFIRST-Medicare Advantage, +85810,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,HEALTHFIRST-Medicare Advantage, +85811,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,HEALTHFIRST-Medicare Advantage, +85812,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,HEALTHFIRST-Medicare Advantage, +85813,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,HEALTHFIRST-Medicare Advantage, +85814,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,HEALTHFIRST-Medicare Advantage, +85815,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,HEALTHFIRST-Medicare Advantage, +85816,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,HEALTHFIRST-Medicare Advantage, +85817,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,HEALTHFIRST-Medicare Advantage, +85818,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,HEALTHFIRST-Medicare Advantage, +85819,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,HEALTHFIRST-Medicare Advantage, +85820,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,HEALTHFIRST-Medicare Advantage, +85821,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,HEALTHFIRST-Medicare Advantage, +85822,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,HEALTHFIRST-Medicare Advantage, +85823,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,HEALTHFIRST-Medicare Advantage, +85824,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,HEALTHFIRST-Medicare Advantage, +85825,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,HEALTHFIRST-Medicare Advantage, +85826,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,HEALTHFIRST-Medicare Advantage, +85827,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,HEALTHFIRST-Medicare Advantage, +85828,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,HEALTHFIRST-Medicare Advantage, +85829,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,HEALTHFIRST-Medicare Advantage, +85830,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,HEALTHFIRST-Medicare Advantage, +85831,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,HEALTHFIRST-Medicare Advantage, +85832,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,HEALTHFIRST-Medicare Advantage, +85833,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,HEALTHFIRST-Medicare Advantage, +85834,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,HEALTHFIRST-Medicare Advantage, +85835,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,HEALTHFIRST-Medicare Advantage, +85836,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,HEALTHFIRST-Medicare Advantage, +85837,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,HEALTHFIRST-Medicare Advantage, +85838,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,HEALTHFIRST-Medicare Advantage, +85839,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,HEALTHFIRST-Medicare Advantage, +85840,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,HEALTHFIRST-Medicare Advantage, +85841,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,HEALTHFIRST-Medicare Advantage, +85842,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,HEALTHFIRST-Medicare Advantage, +85843,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,HEALTHFIRST-Medicare Advantage, +85844,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,HEALTHFIRST-Medicare Advantage, +85845,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,HEALTHFIRST-Medicare Advantage, +85846,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,HEALTHFIRST-Medicare Advantage, +85847,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,HEALTHFIRST-Medicare Advantage, +85848,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,HEALTHFIRST-Medicare Advantage, +85849,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,HEALTHFIRST-Medicare Advantage, +85850,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,HEALTHFIRST-Medicare Advantage, +85851,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,HEALTHFIRST-Medicare Advantage, +85852,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,HEALTHFIRST-Medicare Advantage, +85853,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,HEALTHFIRST-Medicare Advantage, +85854,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,HEALTHFIRST-Medicare Advantage, +85855,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,HEALTHFIRST-Medicare Advantage, +85856,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,HEALTHFIRST-Medicare Advantage, +85857,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,HEALTHFIRST-Medicare Advantage, +85858,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,HEALTHFIRST-Medicare Advantage, +85859,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,HEALTHFIRST-Medicare Advantage, +85860,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,HEALTHFIRST-Medicare Advantage, +85861,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,HEALTHFIRST-Medicare Advantage, +85862,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,HEALTHFIRST-Medicare Advantage, +85863,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,HEALTHFIRST-Medicare Advantage, +85864,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,HEALTHFIRST-Medicare Advantage, +85865,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,HEALTHFIRST-Medicare Advantage, +85866,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,HEALTHFIRST-Medicare Advantage, +85867,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,HEALTHFIRST-Medicare Advantage, +85868,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,HEALTHFIRST-Medicare Advantage, +85869,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,HEALTHFIRST-Medicare Advantage, +85870,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,HEALTHFIRST-Medicare Advantage, +85871,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,HEALTHFIRST-Medicare Advantage, +85872,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,HEALTHFIRST-Medicare Advantage, +85873,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,HEALTHFIRST-Medicare Advantage, +85874,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,HEALTHFIRST-Medicare Advantage, +85875,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,HEALTHFIRST-Medicare Advantage, +85876,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,HEALTHFIRST-Medicare Advantage, +85877,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,HEALTHFIRST-Medicare Advantage, +85878,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,HEALTHFIRST-Medicare Advantage, +85879,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,HEALTHFIRST-Medicare Advantage, +85880,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,HEALTHFIRST-Medicare Advantage, +85881,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,HEALTHFIRST-Medicare Advantage, +85882,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,HEALTHFIRST-Medicare Advantage, +85883,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,HEALTHFIRST-Medicare Advantage, +85884,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,HEALTHFIRST-Medicare Advantage, +85885,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,HEALTHFIRST-Medicare Advantage, +85886,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,HEALTHFIRST-Medicare Advantage, +85887,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,HEALTHFIRST-Medicare Advantage, +85888,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,HEALTHFIRST-Medicare Advantage, +85889,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,HEALTHFIRST-Medicare Advantage, +85890,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,HEALTHFIRST-Medicare Advantage, +85891,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,HEALTHFIRST-Medicare Advantage, +85892,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,HEALTHFIRST-Medicare Advantage, +85893,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,HEALTHFIRST-Medicare Advantage, +85894,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,HEALTHFIRST-Medicare Advantage, +85895,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,HEALTHFIRST-Medicare Advantage, +85896,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,HEALTHFIRST-Medicare Advantage, +85897,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,HEALTHFIRST-Medicare Advantage, +85898,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,HEALTHFIRST-Medicare Advantage, +85899,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,HEALTHFIRST-Medicare Advantage, +85900,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,HEALTHFIRST-Medicare Advantage, +85901,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,HEALTHFIRST-Medicare Advantage, +85902,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,HEALTHFIRST-Medicare Advantage, +85903,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,HEALTHFIRST-Medicare Advantage, +85904,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,HEALTHFIRST-Medicare Advantage, +85905,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,HEALTHFIRST-Medicare Advantage, +85906,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,HEALTHFIRST-Medicare Advantage, +85907,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,HEALTHFIRST-Medicare Advantage, +85908,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,HEALTHFIRST-Medicare Advantage, +85909,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,HEALTHFIRST-Medicare Advantage, +85910,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,HEALTHFIRST-Medicare Advantage, +85911,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,HEALTHFIRST-Medicare Advantage, +85912,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,HEALTHFIRST-Medicare Advantage, +85913,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,HEALTHFIRST-Medicare Advantage, +85914,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,HEALTHFIRST-Medicare Advantage, +85915,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,HEALTHFIRST-Medicare Advantage, +85916,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,HEALTHFIRST-Medicare Advantage, +85917,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,HEALTHFIRST-Medicare Advantage, +85918,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,HEALTHFIRST-Medicare Advantage, +85919,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,HEALTHFIRST-Medicare Advantage, +85920,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,HEALTHFIRST-Medicare Advantage, +85921,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,HEALTHFIRST-Medicare Advantage, +85922,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,HEALTHFIRST-Medicare Advantage, +85923,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,HEALTHFIRST-Medicare Advantage, +85924,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,HEALTHFIRST-Medicare Advantage, +85925,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,HEALTHFIRST-Medicare Advantage, +85926,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,HEALTHFIRST-Medicare Advantage, +85927,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,HEALTHFIRST-Medicare Advantage, +85928,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,HEALTHFIRST-Medicare Advantage, +85929,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,HEALTHFIRST-Medicare Advantage, +85930,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,HEALTHFIRST-Medicare Advantage, +85931,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,HEALTHFIRST-Medicare Advantage, +85932,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,HEALTHFIRST-Medicare Advantage, +85933,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,HEALTHFIRST-Medicare Advantage, +85934,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,HEALTHFIRST-Medicare Advantage, +85935,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,HEALTHFIRST-Medicare Advantage, +85936,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,HEALTHFIRST-Medicare Advantage, +85937,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,HEALTHFIRST-Medicare Advantage, +85938,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,HEALTHFIRST-Medicare Advantage, +85939,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,HEALTHFIRST-Medicare Advantage, +85940,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,HEALTHFIRST-Medicare Advantage, +85941,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,HEALTHFIRST-Medicare Advantage, +85942,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,HEALTHFIRST-Medicare Advantage, +85943,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,HEALTHFIRST-Medicare Advantage, +85944,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,HEALTHFIRST-Medicare Advantage, +85945,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,HEALTHFIRST-Medicare Advantage, +85946,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,HEALTHFIRST-Medicare Advantage, +85947,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,HEALTHFIRST-Medicare Advantage, +85948,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,HEALTHFIRST-Medicare Advantage, +85949,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,HEALTHFIRST-Medicare Advantage, +85950,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,HEALTHFIRST-Medicare Advantage, +85951,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,HEALTHFIRST-Medicare Advantage, +85952,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,HEALTHFIRST-Medicare Advantage, +85953,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,HEALTHFIRST-Medicare Advantage, +85954,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,HEALTHFIRST-Medicare Advantage, +85955,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,HEALTHFIRST-Medicare Advantage, +85956,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,HEALTHFIRST-Medicare Advantage, +85957,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,HEALTHFIRST-Medicare Advantage, +85958,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,HEALTHFIRST-Medicare Advantage, +85959,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,HEALTHFIRST-Medicare Advantage, +85960,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,HEALTHFIRST-Medicare Advantage, +85961,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,HEALTHFIRST-Medicare Advantage, +85962,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,HEALTHFIRST-Medicare Advantage, +85963,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,HEALTHFIRST-Medicare Advantage, +85964,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,HEALTHFIRST-Medicare Advantage, +85965,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,HEALTHFIRST-Medicare Advantage, +85966,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,HEALTHFIRST-Medicare Advantage, +85967,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,HEALTHFIRST-Medicare Advantage, +85968,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,HEALTHFIRST-Medicare Advantage, +85969,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,HEALTHFIRST-Medicare Advantage, +85970,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,HEALTHFIRST-Medicare Advantage, +85971,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,HEALTHFIRST-Medicare Advantage, +85972,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,HEALTHFIRST-Medicare Advantage, +85973,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,HEALTHFIRST-Medicare Advantage, +85974,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,HEALTHFIRST-Medicare Advantage, +85975,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,HEALTHFIRST-Medicare Advantage, +85976,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,HEALTHFIRST-Medicare Advantage, +85977,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,HEALTHFIRST-Medicare Advantage, +85978,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,HEALTHFIRST-Medicare Advantage, +85979,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,HEALTHFIRST-Medicare Advantage, +85980,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,HEALTHFIRST-Medicare Advantage, +85981,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,HEALTHFIRST-Medicare Advantage, +85982,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,HEALTHFIRST-Medicare Advantage, +85983,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,HEALTHFIRST-Medicare Advantage, +85984,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,HEALTHFIRST-Medicare Advantage, +85985,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,HEALTHFIRST-Medicare Advantage, +85986,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,HEALTHFIRST-Medicare Advantage, +85987,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,HEALTHFIRST-Medicare Advantage, +85988,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,HEALTHFIRST-Medicare Advantage, +85989,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,HEALTHFIRST-Medicare Advantage, +85990,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,HEALTHFIRST-Medicare Advantage, +85991,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,HEALTHFIRST-Medicare Advantage, +85992,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,HEALTHFIRST-Medicare Advantage, +85993,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,HEALTHFIRST-Medicare Advantage, +85994,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,HEALTHFIRST-Medicare Advantage, +85995,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,HEALTHFIRST-Medicare Advantage, +85996,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,HEALTHFIRST-Medicare Advantage, +85997,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,HEALTHFIRST-Medicare Advantage, +85998,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,HEALTHFIRST-Medicare Advantage, +85999,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,HEALTHFIRST-Medicare Advantage, +86000,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,HEALTHFIRST-Medicare Advantage, +86001,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,HEALTHFIRST-Medicare Advantage, +86002,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,HEALTHFIRST-Medicare Advantage, +86003,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,HEALTHFIRST-Medicare Advantage, +86004,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,HEALTHFIRST-Medicare Advantage, +86005,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,HEALTHFIRST-Medicare Advantage, +86006,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,HEALTHFIRST-Medicare Advantage, +86007,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,HEALTHFIRST-Medicare Advantage, +86008,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,HEALTHFIRST-Medicare Advantage, +86009,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,HEALTHFIRST-Medicare Advantage, +86010,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,HEALTHFIRST-Medicare Advantage, +86011,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,HEALTHFIRST-Medicare Advantage, +86012,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,HEALTHFIRST-Medicare Advantage, +86013,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,HEALTHFIRST-Medicare Advantage, +86014,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,HEALTHFIRST-Medicare Advantage, +86015,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,HEALTHFIRST-Medicare Advantage, +86016,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,HEALTHFIRST-Medicare Advantage, +86017,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,HEALTHFIRST-Medicare Advantage, +86018,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,HEALTHFIRST-Medicare Advantage, +86019,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,HEALTHFIRST-Medicare Advantage, +86020,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,HEALTHFIRST-Medicare Advantage, +86021,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,HEALTHFIRST-Medicare Advantage, +86022,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,HEALTHFIRST-Medicare Advantage, +86023,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,HEALTHFIRST-Medicare Advantage, +86024,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,HEALTHFIRST-Medicare Advantage, +86025,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,HEALTHFIRST-Medicare Advantage, +86026,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,HEALTHFIRST-Medicare Advantage, +86027,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,HEALTHFIRST-Medicare Advantage, +86028,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,HEALTHFIRST-Medicare Advantage, +86029,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,HEALTHFIRST-Medicare Advantage, +86030,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,HEALTHFIRST-Medicare Advantage, +86031,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,HEALTHFIRST-Medicare Advantage, +86032,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,HEALTHFIRST-Medicare Advantage, +86033,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,HEALTHFIRST-Medicare Advantage, +86034,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,HEALTHFIRST-Medicare Advantage, +86035,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,HEALTHFIRST-Medicare Advantage, +86036,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,HEALTHFIRST-Medicare Advantage, +86037,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,HEALTHFIRST-Medicare Advantage, +86038,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,HEALTHFIRST-Medicare Advantage, +86039,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,HEALTHFIRST-Medicare Advantage, +86040,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,HEALTHFIRST-Medicare Advantage, +86041,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,HEALTHFIRST-Medicare Advantage, +86042,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,HEALTHFIRST-Medicare Advantage, +86043,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,HEALTHFIRST-Medicare Advantage, +86044,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,HEALTHFIRST-Medicare Advantage, +86045,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,HEALTHFIRST-Medicare Advantage, +86046,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,HEALTHFIRST-Medicare Advantage, +86047,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,HEALTHFIRST-Medicare Advantage, +86048,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,HEALTHFIRST-Medicare Advantage, +86049,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,HEALTHFIRST-Medicare Advantage, +86050,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,HEALTHFIRST-Medicare Advantage, +86051,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,HEALTHFIRST-Medicare Advantage, +86052,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,HEALTHFIRST-Medicare Advantage, +86053,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,HEALTHFIRST-Medicare Advantage, +86054,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,HEALTHFIRST-Medicare Advantage, +86055,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,HEALTHFIRST-Medicare Advantage, +86056,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,HEALTHFIRST-Medicare Advantage, +86057,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,HEALTHFIRST-Medicare Advantage, +86058,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,HEALTHFIRST-Medicare Advantage, +86059,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,HEALTHFIRST-Medicare Advantage, +86060,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,HEALTHFIRST-Medicare Advantage, +86061,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,HEALTHFIRST-Medicare Advantage, +86062,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,HEALTHFIRST-Medicare Advantage, +86063,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,HEALTHFIRST-Medicare Advantage, +86064,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,HEALTHFIRST-Medicare Advantage, +86065,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,HEALTHFIRST-Medicare Advantage, +86066,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,HEALTHFIRST-Medicare Advantage, +86067,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,HEALTHFIRST-Medicare Advantage, +86068,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,HEALTHFIRST-Medicare Advantage, +86069,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,HEALTHFIRST-Medicare Advantage, +86070,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,HEALTHFIRST-Medicare Advantage, +86071,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,HEALTHFIRST-Medicare Advantage, +86072,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,HEALTHFIRST-Medicare Advantage, +86073,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,HEALTHFIRST-Medicare Advantage, +86074,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,HEALTHFIRST-Medicare Advantage, +86075,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,HEALTHFIRST-Medicare Advantage, +86076,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,HEALTHFIRST-Medicare Advantage, +86077,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,HEALTHFIRST-Medicare Advantage, +86078,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,HEALTHFIRST-Medicare Advantage, +86079,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,HEALTHFIRST-Medicare Advantage, +86080,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,HEALTHFIRST-Medicare Advantage, +86081,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,HEALTHFIRST-Medicare Advantage, +86082,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,HEALTHFIRST-Medicare Advantage, +86083,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,HEALTHFIRST-Medicare Advantage, +86084,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,HEALTHFIRST-Medicare Advantage, +86085,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,HEALTHFIRST-Medicare Advantage, +86086,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,HEALTHFIRST-Medicare Advantage, +86087,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,HEALTHFIRST-Medicare Advantage, +86088,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,HEALTHFIRST-Medicare Advantage, +86089,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,HEALTHFIRST-Medicare Advantage, +86090,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,HEALTHFIRST-Medicare Advantage, +86091,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,HEALTHFIRST-Medicare Advantage, +86092,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,HEALTHFIRST-Medicare Advantage, +86093,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,HEALTHFIRST-Medicare Advantage, +86094,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,HEALTHFIRST-Medicare Advantage, +86095,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,HEALTHFIRST-Medicare Advantage, +86096,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,HEALTHFIRST-Medicare Advantage, +86097,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,HEALTHFIRST-Medicare Advantage, +86098,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,HEALTHFIRST-Medicare Advantage, +86099,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,HEALTHFIRST-Medicare Advantage, +86100,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,HEALTHFIRST-Medicare Advantage, +86101,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,HEALTHFIRST-Medicare Advantage, +86102,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,HEALTHFIRST-Medicare Advantage, +86103,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,HEALTHFIRST-Medicare Advantage, +86104,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,HEALTHFIRST-Medicare Advantage, +86105,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,HEALTHFIRST-Medicare Advantage, +86106,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,HEALTHFIRST-Medicare Advantage, +86107,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,HEALTHFIRST-Medicare Advantage, +86108,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,HEALTHFIRST-Medicare Advantage, +86109,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,HEALTHFIRST-Medicare Advantage, +86110,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,HEALTHFIRST-Medicare Advantage, +86111,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,HEALTHFIRST-Medicare Advantage, +86112,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,HEALTHFIRST-Medicare Advantage, +86113,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,HEALTHFIRST-Medicare Advantage, +86114,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,HEALTHFIRST-Medicare Advantage, +86115,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,HEALTHFIRST-Medicare Advantage, +86116,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,HEALTHFIRST-Medicare Advantage, +86117,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,HEALTHFIRST-Medicare Advantage, +86118,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,HEALTHFIRST-Medicare Advantage, +86119,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,HEALTHFIRST-Medicare Advantage, +86120,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,HEALTHFIRST-Medicare Advantage, +86121,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,HEALTHFIRST-Medicare Advantage, +86122,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,HEALTHFIRST-Medicare Advantage, +86123,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,HEALTHFIRST-Medicare Advantage, +86124,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,HEALTHFIRST-Medicare Advantage, +86125,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,HEALTHFIRST-Medicare Advantage, +86126,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,HEALTHFIRST-Medicare Advantage, +86127,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,HEALTHFIRST-Medicare Advantage, +86128,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,HEALTHFIRST-Medicare Advantage, +86129,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,HEALTHFIRST-Medicare Advantage, +86130,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,HEALTHFIRST-Medicare Advantage, +86131,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,HEALTHFIRST-Medicare Advantage, +86132,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,HEALTHFIRST-Medicare Advantage, +86133,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,HEALTHFIRST-Medicare Advantage, +86134,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,HEALTHFIRST-Medicare Advantage, +86135,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,HEALTHFIRST-Medicare Advantage, +86136,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,HEALTHFIRST-Medicare Advantage, +86137,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,HEALTHFIRST-Medicare Advantage, +86138,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,HEALTHFIRST-Medicare Advantage, +86139,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,HEALTHFIRST-Medicare Advantage, +86140,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,HEALTHFIRST-Medicare Advantage, +86141,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,HEALTHFIRST-Medicare Advantage, +86142,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,HEALTHFIRST-Medicare Advantage, +86143,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,HEALTHFIRST-Medicare Advantage, +86144,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,HEALTHFIRST-Medicare Advantage, +86145,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,HEALTHFIRST-Medicare Advantage, +86146,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,HEALTHFIRST-Medicare Advantage, +86147,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,HEALTHFIRST-Medicare Advantage, +86148,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,HEALTHFIRST-Medicare Advantage, +86149,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,HEALTHFIRST-Medicare Advantage, +86150,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,HEALTHFIRST-Medicare Advantage, +86151,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,HEALTHFIRST-Medicare Advantage, +86152,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,HEALTHFIRST-Medicare Advantage, +86153,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,HEALTHFIRST-Medicare Advantage, +86154,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,HEALTHFIRST-Medicare Advantage, +86155,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,HEALTHFIRST-Medicare Advantage, +86156,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,HEALTHFIRST-Medicare Advantage, +86157,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,HEALTHFIRST-Medicare Advantage, +86158,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,HEALTHFIRST-Medicare Advantage, +86159,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,HEALTHFIRST-Medicare Advantage, +86160,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,HEALTHFIRST-Medicare Advantage, +86161,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,HEALTHFIRST-Medicare Advantage, +86162,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,HEALTHFIRST-Medicare Advantage, +86163,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,HEALTHFIRST-Medicare Advantage, +86164,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,HEALTHFIRST-Medicare Advantage, +86165,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,HEALTHFIRST-Medicare Advantage, +86166,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,HEALTHFIRST-Medicare Advantage, +86167,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,HEALTHFIRST-Medicare Advantage, +86168,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,HEALTHFIRST-Medicare Advantage, +86169,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,HEALTHFIRST-Medicare Advantage, +86170,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,HEALTHFIRST-Medicare Advantage, +86171,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,HEALTHFIRST-Medicare Advantage, +86172,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,HEALTHFIRST-Medicare Advantage, +86173,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,HEALTHFIRST-Medicare Advantage, +86174,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,HEALTHFIRST-Medicare Advantage, +86175,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,HEALTHFIRST-Medicare Advantage, +86176,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,HEALTHFIRST-Medicare Advantage, +86177,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,HEALTHFIRST-Medicare Advantage, +86178,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,HEALTHFIRST-Medicare Advantage, +86179,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,HEALTHFIRST-Medicare Advantage, +86180,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,HEALTHFIRST-Medicare Advantage, +86181,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,HEALTHFIRST-Medicare Advantage, +86182,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,HEALTHFIRST-Medicare Advantage, +86183,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,HEALTHFIRST-Medicare Advantage, +86184,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,HEALTHFIRST-Medicare Advantage, +86185,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,HEALTHFIRST-Medicare Advantage, +86186,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,HEALTHFIRST-Medicare Advantage, +86187,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,HEALTHFIRST-Medicare Advantage, +86188,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,HEALTHFIRST-Medicare Advantage, +86189,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,HEALTHFIRST-Medicare Advantage, +86190,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,HEALTHFIRST-Medicare Advantage, +86191,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,HEALTHFIRST-Medicare Advantage, +86192,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,HEALTHFIRST-Medicare Advantage, +86193,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,HEALTHFIRST-Medicare Advantage, +86194,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,HEALTHFIRST-Medicare Advantage, +86195,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,HEALTHFIRST-Medicare Advantage, +86196,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,HEALTHFIRST-Medicare Advantage, +86197,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,HEALTHFIRST-Medicare Advantage, +86198,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,HEALTHFIRST-Medicare Advantage, +86199,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,HEALTHFIRST-Medicare Advantage, +86200,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,HEALTHFIRST-Medicare Advantage, +86201,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,HEALTHFIRST-Medicare Advantage, +86202,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,HEALTHFIRST-Medicare Advantage, +86203,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,HEALTHFIRST-Medicare Advantage, +86204,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,HEALTHFIRST-Medicare Advantage, +86205,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,HEALTHFIRST-Medicare Advantage, +86206,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,HEALTHFIRST-Medicare Advantage, +86207,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,HEALTHFIRST-Medicare Advantage, +86208,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,HEALTHFIRST-Medicare Advantage, +86209,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,HEALTHFIRST-Medicare Advantage, +86210,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,HEALTHFIRST-Medicare Advantage, +86211,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,HEALTHFIRST-Medicare Advantage, +86212,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,HEALTHFIRST-Medicare Advantage, +86213,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,HEALTHFIRST-Medicare Advantage, +86214,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,HEALTHFIRST-Medicare Advantage, +86215,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,HEALTHFIRST-Medicare Advantage, +86216,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,HEALTHFIRST-Medicare Advantage, +86217,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,HEALTHFIRST-Medicare Advantage, +86218,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,HEALTHFIRST-Medicare Advantage, +86219,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,HEALTHFIRST-Medicare Advantage, +86220,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,HEALTHFIRST-Medicare Advantage, +86221,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,HEALTHFIRST-Medicare Advantage, +86222,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,HEALTHFIRST-Medicare Advantage, +86223,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,HEALTHFIRST-Medicare Advantage, +86224,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,HEALTHFIRST-Medicare Advantage, +86225,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,HEALTHFIRST-Medicare Advantage, +86226,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,HEALTHFIRST-Medicare Advantage, +86227,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,HEALTHFIRST-Medicare Advantage, +86228,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,HEALTHFIRST-Medicare Advantage, +86229,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,HEALTHFIRST-Medicare Advantage, +86230,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,HEALTHFIRST-Medicare Advantage, +86231,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,HEALTHFIRST-Medicare Advantage, +86232,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,HEALTHFIRST-Medicare Advantage, +86233,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,HEALTHFIRST-Medicare Advantage, +86234,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,HEALTHFIRST-Medicare Advantage, +86235,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,HEALTHFIRST-Medicare Advantage, +86236,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,HEALTHFIRST-Medicare Advantage, +86237,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,HEALTHFIRST-Medicare Advantage, +86238,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,HEALTHFIRST-Medicare Advantage, +86239,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,HEALTHFIRST-Medicare Advantage, +86240,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,HEALTHFIRST-Medicare Advantage, +86241,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,HEALTHFIRST-Medicare Advantage, +86242,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,HEALTHFIRST-Medicare Advantage, +86243,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,HEALTHFIRST-Medicare Advantage, +86244,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,HEALTHFIRST-Medicare Advantage, +86245,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,HEALTHFIRST-Medicare Advantage, +86246,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,HEALTHFIRST-Medicare Advantage, +86247,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,HEALTHFIRST-Medicare Advantage, +86248,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,HEALTHFIRST-Medicare Advantage, +86249,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,HEALTHFIRST-Medicare Advantage, +86250,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,HEALTHFIRST-Medicare Advantage, +86251,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,HEALTHFIRST-Medicare Advantage, +86252,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,HEALTHFIRST-Medicare Advantage, +86253,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,HEALTHFIRST-Medicare Advantage, +86254,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,HEALTHFIRST-Medicare Advantage, +86255,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,HEALTHFIRST-Medicare Advantage, +86256,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,HEALTHFIRST-Medicare Advantage, +86257,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,HEALTHFIRST-Medicare Advantage, +86258,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,HEALTHFIRST-Medicare Advantage, +86259,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,HEALTHFIRST-Medicare Advantage, +86260,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,HEALTHFIRST-Medicare Advantage, +86261,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,HEALTHFIRST-Medicare Advantage, +86262,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,HEALTHFIRST-Medicare Advantage, +86263,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,HEALTHFIRST-Medicare Advantage, +86264,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,HEALTHFIRST-Medicare Advantage, +86265,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,HEALTHFIRST-Medicare Advantage, +86266,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,HEALTHFIRST-Medicare Advantage, +86267,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,HEALTHFIRST-Medicare Advantage, +86268,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,HEALTHFIRST-Medicare Advantage, +86269,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,HEALTHFIRST-Medicare Advantage, +86270,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,HEALTHFIRST-Medicare Advantage, +86271,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,HEALTHFIRST-Medicare Advantage, +86272,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,HEALTHFIRST-Medicare Advantage, +86273,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,HEALTHFIRST-Medicare Advantage, +86274,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,HEALTHFIRST-Medicare Advantage, +86275,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,HEALTHFIRST-Medicare Advantage, +86276,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,HEALTHFIRST-Medicare Advantage, +86277,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,HEALTHFIRST-Medicare Advantage, +86278,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,HEALTHFIRST-Medicare Advantage, +86279,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,HEALTHFIRST-Medicare Advantage, +86280,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,HEALTHFIRST-Medicare Advantage, +86281,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,HEALTHFIRST-Medicare Advantage, +86282,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,HEALTHFIRST-Medicare Advantage, +86283,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,HEALTHFIRST-Medicare Advantage, +86284,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,HEALTHFIRST-Medicare Advantage, +86285,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,HEALTHFIRST-Medicare Advantage, +86286,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,HEALTHFIRST-Medicare Advantage, +86287,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,HEALTHFIRST-Medicare Advantage, +86288,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,HEALTHFIRST-Medicare Advantage, +86289,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,HEALTHFIRST-Medicare Advantage, +86290,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,HEALTHFIRST-Medicare Advantage, +86291,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,HEALTHFIRST-Medicare Advantage, +86292,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,HEALTHFIRST-Medicare Advantage, +86293,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,HEALTHFIRST-Medicare Advantage, +86294,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,HEALTHFIRST-Medicare Advantage, +86295,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,HEALTHFIRST-Medicare Advantage, +86296,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,HEALTHFIRST-Medicare Advantage, +86297,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,HEALTHFIRST-Medicare Advantage, +86298,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,HEALTHFIRST-Medicare Advantage, +86299,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,HEALTHFIRST-Medicare Advantage, +86300,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,HEALTHFIRST-Medicare Advantage, +86301,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,HEALTHFIRST-Medicare Advantage, +86302,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,HEALTHFIRST-Medicare Advantage, +86303,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,HEALTHFIRST-Medicare Advantage, +86304,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,HEALTHFIRST-Medicare Advantage, +86305,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,HEALTHFIRST-Medicare Advantage, +86306,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,HEALTHFIRST-Medicare Advantage, +86307,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,HEALTHFIRST-Medicare Advantage, +86308,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,HEALTHFIRST-Medicare Advantage, +86309,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,HEALTHFIRST-Medicare Advantage, +86310,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,HEALTHFIRST-Medicare Advantage, +86311,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,HEALTHFIRST-Medicare Advantage, +86312,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,HEALTHFIRST-Medicare Advantage, +86313,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,HEALTHFIRST-Medicare Advantage, +86314,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,HEALTHFIRST-Medicare Advantage, +86315,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,HEALTHFIRST-Medicare Advantage, +86316,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,HEALTHFIRST-Medicare Advantage, +86317,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,HEALTHFIRST-Medicare Advantage, +86318,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,HEALTHFIRST-Medicare Advantage, +86319,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,HEALTHFIRST-Medicare Advantage, +86320,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,HEALTHFIRST-Medicare Advantage, +86321,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,HEALTHFIRST-Medicare Advantage, +86322,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,HEALTHFIRST-Medicare Advantage, +86323,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,HEALTHFIRST-Medicare Advantage, +86324,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,HEALTHFIRST-Medicare Advantage, +86325,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,HEALTHFIRST-Medicare Advantage, +86326,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,HEALTHFIRST-Medicare Advantage, +86327,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,HEALTHFIRST-Medicare Advantage, +86328,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,HEALTHFIRST-Medicare Advantage, +86329,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,HEALTHFIRST-Medicare Advantage, +86330,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,HEALTHFIRST-Medicare Advantage, +86331,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,HEALTHFIRST-Medicare Advantage, +86332,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,HEALTHFIRST-Medicare Advantage, +86333,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,HEALTHFIRST-Medicare Advantage, +86334,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,HEALTHFIRST-Medicare Advantage, +86335,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,HEALTHFIRST-Medicare Advantage, +86336,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,HEALTHFIRST-Medicare Advantage, +86337,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,HEALTHFIRST-Medicare Advantage, +86338,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,HEALTHFIRST-Medicare Advantage, +86339,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,HEALTHFIRST-Medicare Advantage, +86340,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,HEALTHFIRST-Medicare Advantage, +86341,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,HEALTHFIRST-Medicare Advantage, +86342,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,HEALTHFIRST-Medicare Advantage, +86343,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,HEALTHFIRST-Medicare Advantage, +86344,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,HEALTHFIRST-Medicare Advantage, +86345,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,HEALTHFIRST-Medicare Advantage, +86346,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,HEALTHFIRST-Medicare Advantage, +86347,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,HEALTHFIRST-Medicare Advantage, +86348,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,HEALTHFIRST-Medicare Advantage, +86349,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,HEALTHFIRST-Medicare Advantage, +86350,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,HEALTHFIRST-Medicare Advantage, +86351,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,HEALTHFIRST-Medicare Advantage, +86352,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,HEALTHFIRST-Medicare Advantage, +86353,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,HEALTHFIRST-Medicare Advantage, +86354,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,HEALTHFIRST-Medicare Advantage, +86355,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,HEALTHFIRST-Medicare Advantage, +86356,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,HEALTHFIRST-Medicare Advantage, +86357,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,HEALTHFIRST-Medicare Advantage, +86358,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,HEALTHFIRST-Medicare Advantage, +86359,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,HEALTHFIRST-Medicare Advantage, +86360,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,HEALTHFIRST-Medicare Advantage, +86361,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,HEALTHFIRST-Medicare Advantage, +86362,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,HEALTHFIRST-Medicare Advantage, +86363,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,HEALTHFIRST-Medicare Advantage, +86364,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,HEALTHFIRST-Medicare Advantage, +86365,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,HEALTHFIRST-Medicare Advantage, +86366,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,HEALTHFIRST-Medicare Advantage, +86367,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,HEALTHFIRST-Medicare Advantage, +86368,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,HEALTHFIRST-Medicare Advantage, +86369,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,HEALTHFIRST-Medicare Advantage, +86370,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,HEALTHFIRST-Medicare Advantage, +86371,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,HEALTHFIRST-Medicare Advantage, +86372,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,HEALTHFIRST-Medicare Advantage, +86373,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,HEALTHFIRST-Medicare Advantage, +86374,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,HEALTHFIRST-Medicare Advantage, +86375,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,HEALTHFIRST-Medicare Advantage, +86376,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,HEALTHFIRST-Medicare Advantage, +86377,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,HEALTHFIRST-Medicare Advantage, +86378,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,HEALTHFIRST-Medicare Advantage, +86379,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,HEALTHFIRST-Medicare Advantage, +86380,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,HEALTHFIRST-Medicare Advantage, +86381,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,HEALTHFIRST-Medicare Advantage, +86382,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,HEALTHFIRST-Medicare Advantage, +86383,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,HEALTHFIRST-Medicare Advantage, +86384,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,HEALTHFIRST-Medicare Advantage, +86385,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,HEALTHFIRST-Medicare Advantage, +86386,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,HEALTHFIRST-Medicare Advantage, +86387,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,HEALTHFIRST-Medicare Advantage, +86388,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,HEALTHFIRST-Medicare Advantage, +86389,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,HEALTHFIRST-Medicare Advantage, +86390,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,HEALTHFIRST-Medicare Advantage, +86391,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,HEALTHFIRST-Medicare Advantage, +86392,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,HEALTHFIRST-Medicare Advantage, +86393,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,HEALTHFIRST-Medicare Advantage, +86394,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,HEALTHFIRST-Medicare Advantage, +86395,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,HEALTHFIRST-Medicare Advantage, +86396,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,HEALTHFIRST-Medicare Advantage, +86397,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,HEALTHFIRST-Medicare Advantage, +86398,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,HEALTHFIRST-Medicare Advantage, +86399,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,HEALTHFIRST-Medicare Advantage, +86400,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,HEALTHFIRST-Medicare Advantage, +86401,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,HEALTHFIRST-Medicare Advantage, +86402,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,HEALTHFIRST-Medicare Advantage, +86403,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,HEALTHFIRST-Medicare Advantage, +86404,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,HEALTHFIRST-Medicare Advantage, +86405,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,HEALTHFIRST-Medicare Advantage, +86406,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,HEALTHFIRST-Medicare Advantage, +86407,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,HEALTHFIRST-Medicare Advantage, +86408,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,HEALTHFIRST-Medicare Advantage, +86409,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,HEALTHFIRST-Medicare Advantage, +86410,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,HEALTHFIRST-Medicare Advantage, +86411,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,HEALTHFIRST-Medicare Advantage, +86412,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,HEALTHFIRST-Medicare Advantage, +86413,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,HEALTHFIRST-Medicare Advantage, +86414,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,HEALTHFIRST-Medicare Advantage, +86415,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,HEALTHFIRST-Medicare Advantage, +86416,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,HEALTHFIRST-Medicare Advantage, +86417,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,HEALTHFIRST-Medicare Advantage, +86418,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,HEALTHFIRST-Medicare Advantage, +86419,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,HEALTHFIRST-Medicare Advantage, +86420,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,HEALTHFIRST-Medicare Advantage, +86421,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,HEALTHFIRST-Medicare Advantage, +86422,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,HEALTHFIRST-Medicare Advantage, +86423,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,HEALTHFIRST-Medicare Advantage, +86424,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,HEALTHFIRST-Medicare Advantage, +86425,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,HEALTHFIRST-Medicare Advantage, +86426,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,HEALTHFIRST-Medicare Advantage, +86427,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,HEALTHFIRST-Medicare Advantage, +86428,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,HEALTHFIRST-Medicare Advantage, +86429,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,HEALTHFIRST-Medicare Advantage, +86430,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,HEALTHFIRST-Medicare Advantage, +86431,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,HEALTHFIRST-Medicare Advantage, +86432,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,HEALTHFIRST-Medicare Advantage, +86433,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,HEALTHFIRST-Medicare Advantage, +86434,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,HEALTHFIRST-Medicare Advantage, +86435,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,HEALTHFIRST-Medicare Advantage, +86436,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,HEALTHFIRST-Medicare Advantage, +86437,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,HEALTHFIRST-Medicare Advantage, +86438,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,HEALTHFIRST-Medicare Advantage, +86439,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,HEALTHFIRST-Medicare Advantage, +86440,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,HEALTHFIRST-Medicare Advantage, +86441,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,HEALTHFIRST-Medicare Advantage, +86442,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,HEALTHFIRST-Medicare Advantage, +86443,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,HEALTHFIRST-Medicare Advantage, +86444,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86445,3934,30000012,PRIVATE,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86446,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86447,3934,30000038,ICU,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86448,3934,30000046,BURN UNIT,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86449,3934,30000053,NICU,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86450,3934,30000061,ICR ROOM,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86451,3934,30000079,PSYCH,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86452,3934,30000087,NEWBORN,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86453,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86454,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86455,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86456,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86457,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86458,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86459,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86460,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86461,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86462,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86463,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86464,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86465,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86466,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86467,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86468,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86469,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86470,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86471,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86472,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86473,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86474,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86475,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86476,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86477,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86478,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86479,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86480,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86481,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86482,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86483,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86484,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86485,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86486,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86487,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86488,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86489,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86490,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86491,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86492,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86493,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86494,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86495,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86496,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86497,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86498,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86499,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86500,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86501,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86502,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86503,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86504,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86505,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86506,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86507,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86508,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86509,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86510,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86511,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86512,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86513,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86514,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86515,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86516,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86517,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86518,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86519,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86520,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86521,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86522,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86523,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86524,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86525,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86526,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86527,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86528,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86529,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86530,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86531,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86532,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86533,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86534,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86535,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86536,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86537,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86538,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86539,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86540,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86541,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86542,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86543,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86544,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86545,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86546,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86547,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86548,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86549,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86550,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86551,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86552,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86553,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86554,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86555,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86556,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86557,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86558,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86559,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86560,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86561,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86562,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86563,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86564,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86565,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86566,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86567,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86568,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86569,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86570,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86571,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86572,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86573,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86574,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86575,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86576,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86577,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86578,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86579,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86580,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86581,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86582,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86583,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86584,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86585,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86586,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86587,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86588,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86589,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86590,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86591,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86592,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86593,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86594,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86595,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86596,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86597,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86598,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86599,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86600,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86601,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86602,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86603,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86604,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86605,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86606,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86607,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86608,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86609,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86610,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86611,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86612,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86613,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86614,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86615,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86616,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86617,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86618,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86619,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86620,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86621,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86622,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86623,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86624,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86625,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86626,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86627,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86628,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86629,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86630,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86631,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86632,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86633,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86634,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86635,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86636,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86637,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86638,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86639,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86640,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86641,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86642,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86643,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86644,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86645,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86646,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86647,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86648,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86649,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86650,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86651,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86652,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86653,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86654,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86655,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86656,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86657,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86658,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86659,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86660,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86661,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86662,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86663,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86664,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86665,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86666,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86667,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86668,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86669,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86670,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86671,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86672,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86673,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86674,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86675,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86676,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86677,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86678,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86679,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86680,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86681,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86682,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86683,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86684,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86685,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86686,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86687,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86688,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86689,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86690,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86691,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86692,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86693,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86694,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86695,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86696,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86697,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86698,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86699,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86700,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86701,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86702,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86703,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86704,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86705,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86706,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86707,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86708,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86709,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86710,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86711,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86712,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86713,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86714,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86715,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86716,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86717,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86718,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86719,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86720,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86721,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86722,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86723,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86724,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86725,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86726,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86727,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86728,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86729,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86730,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86731,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86732,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86733,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86734,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86735,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86736,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86737,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86738,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86739,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86740,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86741,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86742,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86743,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86744,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86745,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86746,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86747,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86748,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86749,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86750,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86751,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86752,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86753,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86754,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86755,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86756,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86757,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86758,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86759,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86760,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86761,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86762,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86763,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86764,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86765,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86766,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86767,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86768,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86769,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86770,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86771,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86772,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86773,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86774,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86775,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86776,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86777,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86778,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86779,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86780,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86781,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86782,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86783,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86784,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86785,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86786,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86787,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86788,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86789,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86790,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86791,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86792,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86793,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86794,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86795,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86796,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86797,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86798,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86799,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86800,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86801,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86802,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86803,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86804,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86805,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86806,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86807,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86808,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86809,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86810,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86811,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86812,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86813,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86814,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86815,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86816,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86817,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86818,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86819,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86820,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86821,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86822,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86823,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86824,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86825,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86826,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86827,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86828,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86829,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86830,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86831,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86832,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86833,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86834,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86835,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86836,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86837,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86838,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86839,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86840,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86841,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86842,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86843,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86844,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86845,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86846,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86847,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86848,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86849,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86850,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86851,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86852,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86853,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86854,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86855,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86856,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86857,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86858,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86859,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86860,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86861,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86862,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,HEALTHFIRST-Medicare Advantage, +86863,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86864,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86865,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86866,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86867,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86868,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86869,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,HEALTHFIRST-Medicare Advantage, +86870,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86871,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86872,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86873,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86874,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86875,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86876,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86877,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86878,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86879,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86880,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86881,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86882,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86883,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86884,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86885,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86886,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86887,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,HEALTHFIRST-Medicare Advantage, +86888,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,HEALTHFIRST-Medicare Advantage, +86889,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,HEALTHFIRST-Medicare Advantage, +86890,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,HEALTHFIRST-Medicare Advantage, +86891,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,HEALTHFIRST-Medicare Advantage, +86892,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,HEALTHFIRST-Medicare Advantage, +86893,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,HEALTHFIRST-Medicare Advantage, +86894,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86895,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86896,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86897,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86898,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86899,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86900,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86901,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86902,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86903,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86904,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86905,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86906,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,HEALTHFIRST-Medicare Advantage, +86907,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,HEALTHFIRST-Medicare Advantage, +86908,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,HEALTHFIRST-Medicare Advantage, +86909,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,HEALTHFIRST-Medicare Advantage, +86910,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,HEALTHFIRST-Medicare Advantage, +86911,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,HEALTHFIRST-Medicare Advantage, +86912,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,HEALTHFIRST-Medicare Advantage, +86913,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,HEALTHFIRST-Medicare Advantage, +86914,3934,37112000,ACUTE ED,,1580.0,1580.0,,,HEALTHFIRST-Medicare Advantage, +86915,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,HEALTHFIRST-Medicare Advantage, +86916,3934,37112034,TRIAGE,,277.0,277.0,,,HEALTHFIRST-Medicare Advantage, +86917,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,HEALTHFIRST-Medicare Advantage, +86918,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,HEALTHFIRST-Medicare Advantage, +86919,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,HEALTHFIRST-Medicare Advantage, +86920,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,HEALTHFIRST-Medicare Advantage, +86921,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,HEALTHFIRST-Medicare Advantage, +86922,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,HEALTHFIRST-Medicare Advantage, +86923,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,HEALTHFIRST-Medicare Advantage, +86924,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,HEALTHFIRST-Medicare Advantage, +86925,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,HEALTHFIRST-Medicare Advantage, +86926,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,HEALTHFIRST-Medicare Advantage, +86927,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,HEALTHFIRST-Medicare Advantage, +86928,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,HEALTHFIRST-Medicare Advantage, +86929,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,HEALTHFIRST-Medicare Advantage, +86930,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,HEALTHFIRST-Medicare Advantage, +86931,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,HEALTHFIRST-Medicare Advantage, +86932,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,HEALTHFIRST-Medicare Advantage, +86933,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,HEALTHFIRST-Medicare Advantage, +86934,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,HEALTHFIRST-Medicare Advantage, +86935,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,HEALTHFIRST-Medicare Advantage, +86936,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,HEALTHFIRST-Medicare Advantage, +86937,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,HEALTHFIRST-Medicare Advantage, +86938,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,HEALTHFIRST-Medicare Advantage, +86939,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,HEALTHFIRST-Medicare Advantage, +86940,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,HEALTHFIRST-Medicare Advantage, +86941,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,HEALTHFIRST-Medicare Advantage, +86942,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,HEALTHFIRST-Medicare Advantage, +86943,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,HEALTHFIRST-Medicare Advantage, +86944,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,HEALTHFIRST-Medicare Advantage, +86945,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,HEALTHFIRST-Medicare Advantage, +86946,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,HEALTHFIRST-Medicare Advantage, +86947,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,HEALTHFIRST-Medicare Advantage, +86948,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,HEALTHFIRST-Medicare Advantage, +86949,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,HEALTHFIRST-Medicare Advantage, +86950,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,HEALTHFIRST-Medicare Advantage, +86951,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,HEALTHFIRST-Medicare Advantage, +86952,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,HEALTHFIRST-Medicare Advantage, +86953,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,HEALTHFIRST-Medicare Advantage, +86954,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,HEALTHFIRST-Medicare Advantage, +86955,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,HEALTHFIRST-Medicare Advantage, +86956,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,HEALTHFIRST-Medicare Advantage, +86957,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,HEALTHFIRST-Medicare Advantage, +86958,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,HEALTHFIRST-Medicare Advantage, +86959,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,HEALTHFIRST-Medicare Advantage, +86960,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,HEALTHFIRST-Medicare Advantage, +86961,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,HEALTHFIRST-Medicare Advantage, +86962,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,HEALTHFIRST-Medicare Advantage, +86963,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,HEALTHFIRST-Medicare Advantage, +86964,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,HEALTHFIRST-Medicare Advantage, +86965,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,HEALTHFIRST-Medicare Advantage, +86966,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,HEALTHFIRST-Medicare Advantage, +86967,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,HEALTHFIRST-Medicare Advantage, +86968,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,HEALTHFIRST-Medicare Advantage, +86969,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,HEALTHFIRST-Medicare Advantage, +86970,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,HEALTHFIRST-Medicare Advantage, +86971,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,HEALTHFIRST-Medicare Advantage, +86972,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,HEALTHFIRST-Medicare Advantage, +86973,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,HEALTHFIRST-Medicare Advantage, +86974,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,HEALTHFIRST-Medicare Advantage, +86975,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,HEALTHFIRST-Medicare Advantage, +86976,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,HEALTHFIRST-Medicare Advantage, +86977,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,HEALTHFIRST-Medicare Advantage, +86978,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,HEALTHFIRST-Medicare Advantage, +86979,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,HEALTHFIRST-Medicare Advantage, +86980,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,HEALTHFIRST-Medicare Advantage, +86981,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,HEALTHFIRST-Medicare Advantage, +86982,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,HEALTHFIRST-Medicare Advantage, +86983,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,HEALTHFIRST-Medicare Advantage, +86984,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,HEALTHFIRST-Medicare Advantage, +86985,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,HEALTHFIRST-Medicare Advantage, +86986,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,HEALTHFIRST-Medicare Advantage, +86987,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,HEALTHFIRST-Medicare Advantage, +86988,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,HEALTHFIRST-Medicare Advantage, +86989,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,HEALTHFIRST-Medicare Advantage, +86990,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,HEALTHFIRST-Medicare Advantage, +86991,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,HEALTHFIRST-Medicare Advantage, +86992,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,HEALTHFIRST-Medicare Advantage, +86993,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,HEALTHFIRST-Medicare Advantage, +86994,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,HEALTHFIRST-Medicare Advantage, +86995,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,HEALTHFIRST-Medicare Advantage, +86996,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,HEALTHFIRST-Medicare Advantage, +86997,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,HEALTHFIRST-Medicare Advantage, +86998,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,HEALTHFIRST-Medicare Advantage, +86999,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,HEALTHFIRST-Medicare Advantage, +87000,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,HEALTHFIRST-Medicare Advantage, +87001,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,HEALTHFIRST-Medicare Advantage, +87002,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,HEALTHFIRST-Medicare Advantage, +87003,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,HEALTHFIRST-Medicare Advantage, +87004,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,HEALTHFIRST-Medicare Advantage, +87005,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,HEALTHFIRST-Medicare Advantage, +87006,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,HEALTHFIRST-Medicare Advantage, +87007,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,HEALTHFIRST-Medicare Advantage, +87008,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,HEALTHFIRST-Medicare Advantage, +87009,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,HEALTHFIRST-Medicare Advantage, +87010,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,HEALTHFIRST-Medicare Advantage, +87011,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,HEALTHFIRST-Medicare Advantage, +87012,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,HEALTHFIRST-Medicare Advantage, +87013,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,HEALTHFIRST-Medicare Advantage, +87014,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,HEALTHFIRST-Medicare Advantage, +87015,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,HEALTHFIRST-Medicare Advantage, +87016,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicare Advantage, +87017,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87018,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87019,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87020,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87021,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87022,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,HEALTHFIRST-Medicare Advantage, +87023,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,HEALTHFIRST-Medicare Advantage, +87024,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,HEALTHFIRST-Medicare Advantage, +87025,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87026,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87027,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87028,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,HEALTHFIRST-Medicare Advantage, +87029,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,HEALTHFIRST-Medicare Advantage, +87030,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,HEALTHFIRST-Medicare Advantage, +87031,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,HEALTHFIRST-Medicare Advantage, +87032,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,HEALTHFIRST-Medicare Advantage, +87033,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,HEALTHFIRST-Medicare Advantage, +87034,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,HEALTHFIRST-Medicare Advantage, +87035,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,HEALTHFIRST-Medicare Advantage, +87036,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,HEALTHFIRST-Medicare Advantage, +87037,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,HEALTHFIRST-Medicare Advantage, +87038,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,HEALTHFIRST-Medicare Advantage, +87039,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,HEALTHFIRST-Medicare Advantage, +87040,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,HEALTHFIRST-Medicare Advantage, +87041,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,HEALTHFIRST-Medicare Advantage, +87042,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,HEALTHFIRST-Medicare Advantage, +87043,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,HEALTHFIRST-Medicare Advantage, +87044,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,HEALTHFIRST-Medicare Advantage, +87045,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,HEALTHFIRST-Medicare Advantage, +87046,3934,43301043,ALBUNEX,,357.0,357.0,,,HEALTHFIRST-Medicare Advantage, +87047,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,HEALTHFIRST-Medicare Advantage, +87048,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87049,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87050,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87051,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87052,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87053,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,HEALTHFIRST-Medicare Advantage, +87054,3934,43450022,REC RM .5HR,,541.0,541.0,,,HEALTHFIRST-Medicare Advantage, +87055,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,HEALTHFIRST-Medicare Advantage, +87056,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,HEALTHFIRST-Medicare Advantage, +87057,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,HEALTHFIRST-Medicare Advantage, +87058,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,HEALTHFIRST-Medicare Advantage, +87059,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,HEALTHFIRST-Medicare Advantage, +87060,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,HEALTHFIRST-Medicare Advantage, +87061,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,HEALTHFIRST-Medicare Advantage, +87062,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,HEALTHFIRST-Medicare Advantage, +87063,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,HEALTHFIRST-Medicare Advantage, +87064,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,HEALTHFIRST-Medicare Advantage, +87065,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,HEALTHFIRST-Medicare Advantage, +87066,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,HEALTHFIRST-Medicare Advantage, +87067,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,HEALTHFIRST-Medicare Advantage, +87068,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,HEALTHFIRST-Medicare Advantage, +87069,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,HEALTHFIRST-Medicare Advantage, +87070,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,HEALTHFIRST-Medicare Advantage, +87071,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicare Advantage, +87072,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87073,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87074,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87075,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87076,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87077,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,HEALTHFIRST-Medicare Advantage, +87078,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87079,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicare Advantage, +87080,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87081,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87082,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87083,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87084,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,HEALTHFIRST-Medicare Advantage, +87085,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicare Advantage, +87086,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87087,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87088,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87089,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87090,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87091,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicare Advantage, +87092,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87093,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87094,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87095,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87096,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87097,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,HEALTHFIRST-Medicare Advantage, +87098,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,HEALTHFIRST-Medicare Advantage, +87099,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,HEALTHFIRST-Medicare Advantage, +87100,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,HEALTHFIRST-Medicare Advantage, +87101,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,HEALTHFIRST-Medicare Advantage, +87102,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,HEALTHFIRST-Medicare Advantage, +87103,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,HEALTHFIRST-Medicare Advantage, +87104,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,HEALTHFIRST-Medicare Advantage, +87105,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicare Advantage, +87106,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87107,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87108,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87109,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87110,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87111,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87112,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,HEALTHFIRST-Medicare Advantage, +87113,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,HEALTHFIRST-Medicare Advantage, +87114,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,HEALTHFIRST-Medicare Advantage, +87115,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,HEALTHFIRST-Medicare Advantage, +87116,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,HEALTHFIRST-Medicare Advantage, +87117,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,HEALTHFIRST-Medicare Advantage, +87118,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,HEALTHFIRST-Medicare Advantage, +87119,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,HEALTHFIRST-Medicare Advantage, +87120,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,HEALTHFIRST-Medicare Advantage, +87121,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,HEALTHFIRST-Medicare Advantage, +87122,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,HEALTHFIRST-Medicare Advantage, +87123,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,HEALTHFIRST-Medicare Advantage, +87124,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,HEALTHFIRST-Medicare Advantage, +87125,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,HEALTHFIRST-Medicare Advantage, +87126,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,HEALTHFIRST-Medicare Advantage, +87127,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,HEALTHFIRST-Medicare Advantage, +87128,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,HEALTHFIRST-Medicare Advantage, +87129,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,HEALTHFIRST-Medicare Advantage, +87130,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,HEALTHFIRST-Medicare Advantage, +87131,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,HEALTHFIRST-Medicare Advantage, +87132,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,HEALTHFIRST-Medicare Advantage, +87133,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,HEALTHFIRST-Medicare Advantage, +87134,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,HEALTHFIRST-Medicare Advantage, +87135,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,HEALTHFIRST-Medicare Advantage, +87136,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,HEALTHFIRST-Medicare Advantage, +87137,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,HEALTHFIRST-Medicare Advantage, +87138,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,HEALTHFIRST-Medicare Advantage, +87139,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,HEALTHFIRST-Medicare Advantage, +87140,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,HEALTHFIRST-Medicare Advantage, +87141,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,HEALTHFIRST-Medicare Advantage, +87142,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,HEALTHFIRST-Medicare Advantage, +87143,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,HEALTHFIRST-Medicare Advantage, +87144,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,HEALTHFIRST-Medicare Advantage, +87145,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,HEALTHFIRST-Medicare Advantage, +87146,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,HEALTHFIRST-Medicare Advantage, +87147,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,HEALTHFIRST-Medicare Advantage, +87148,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,HEALTHFIRST-Medicare Advantage, +87149,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,HEALTHFIRST-Medicare Advantage, +87150,3934,45924552,ENDO REC RM,,30.0,30.0,,,HEALTHFIRST-Medicare Advantage, +87151,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,HEALTHFIRST-Medicare Advantage, +87152,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,HEALTHFIRST-Medicare Advantage, +87153,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,HEALTHFIRST-Medicare Advantage, +87154,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,HEALTHFIRST-Medicare Advantage, +87155,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,HEALTHFIRST-Medicare Advantage, +87156,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,HEALTHFIRST-Medicare Advantage, +87157,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,HEALTHFIRST-Medicare Advantage, +87158,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,HEALTHFIRST-Medicare Advantage, +87159,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,HEALTHFIRST-Medicare Advantage, +87160,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,HEALTHFIRST-Medicare Advantage, +87161,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,HEALTHFIRST-Medicare Advantage, +87162,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,HEALTHFIRST-Medicare Advantage, +87163,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,HEALTHFIRST-Medicare Advantage, +87164,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,HEALTHFIRST-Medicare Advantage, +87165,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,HEALTHFIRST-Medicare Advantage, +87166,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,HEALTHFIRST-Medicare Advantage, +87167,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,HEALTHFIRST-Medicare Advantage, +87168,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,HEALTHFIRST-Medicare Advantage, +87169,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,HEALTHFIRST-Medicare Advantage, +87170,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,HEALTHFIRST-Medicare Advantage, +87171,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,HEALTHFIRST-Medicare Advantage, +87172,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,HEALTHFIRST-Medicare Advantage, +87173,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,HEALTHFIRST-Medicare Advantage, +87174,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,HEALTHFIRST-Medicare Advantage, +87175,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,HEALTHFIRST-Medicare Advantage, +87176,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,HEALTHFIRST-Medicare Advantage, +87177,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,HEALTHFIRST-Medicare Advantage, +87178,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,HEALTHFIRST-Medicare Advantage, +87179,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHFIRST-Medicare Advantage, +87180,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHFIRST-Medicare Advantage, +87181,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHFIRST-Medicare Advantage, +87182,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHFIRST-Medicare Advantage, +87183,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,HEALTHFIRST-Medicare Advantage, +87184,3934,53200010,GUEST TRAY,,24.0,24.0,,,HEALTHFIRST-Medicare Advantage, +87185,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,HEALTHFIRST-Medicare Advantage, +87186,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,HEALTHFIRST-Medicare Advantage, +87187,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,HEALTHFIRST-Medicare Advantage, +87188,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,HEALTHFIRST-Medicare Advantage, +87189,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,HEALTHFIRST-Medicare Advantage, +87190,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,HEALTHFIRST-Medicare Advantage, +87191,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,HEALTHFIRST-Medicare Advantage, +87192,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,HEALTHFIRST-Medicare Advantage, +87193,3934,53329876,HIV MONITORING,,416.0,416.0,,,HEALTHFIRST-Medicare Advantage, +87194,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,HEALTHFIRST-Medicare Advantage, +87195,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,HEALTHFIRST-Medicare Advantage, +87196,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,HEALTHFIRST-Medicare Advantage, +87197,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,HEALTHFIRST-Medicare Advantage, +87198,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,HEALTHFIRST-Medicare Advantage, +87199,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,HEALTHFIRST-Medicare Advantage, +87200,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,HEALTHFIRST-Medicare Advantage, +87201,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,HEALTHFIRST-Medicare Advantage, +87202,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,HEALTHFIRST-Medicare Advantage, +87203,3934,76010107,COPY X-RAY,,22.0,22.0,,,HEALTHFIRST-Medicare Advantage, +87204,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,HEALTHFIRST-Medicare Advantage, +87205,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,HEALTHFIRST-Medicare Advantage, +87206,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,HEALTHFIRST-Medicare Advantage, +87207,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,HEALTHFIRST-Medicare Advantage, +87208,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,HEALTHFIRST-Medicare Advantage, +87209,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,HEALTHFIRST-Medicare Advantage, +87210,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,HEALTHFIRST-Medicare Advantage, +87211,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,HEALTHFIRST-Medicare Advantage, +87212,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,HEALTHFIRST-Medicare Advantage, +87213,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,HEALTHFIRST-Medicare Advantage, +87214,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,HEALTHFIRST-Medicare Advantage, +87215,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,HEALTHFIRST-Medicare Advantage, +87216,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,HEALTHPLUS-CHP, +87217,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,HEALTHPLUS-CHP, +87218,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,HEALTHPLUS-CHP, +87219,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,HEALTHPLUS-CHP, +87220,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,HEALTHPLUS-CHP, +87221,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,HEALTHPLUS-CHP, +87222,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,HEALTHPLUS-CHP, +87223,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,HEALTHPLUS-CHP, +87224,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,HEALTHPLUS-CHP, +87225,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,HEALTHPLUS-CHP, +87226,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,HEALTHPLUS-CHP, +87227,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,HEALTHPLUS-CHP, +87228,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,HEALTHPLUS-CHP, +87229,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,HEALTHPLUS-CHP, +87230,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,HEALTHPLUS-CHP, +87231,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,HEALTHPLUS-CHP, +87232,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,HEALTHPLUS-CHP, +87233,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,HEALTHPLUS-CHP, +87234,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,HEALTHPLUS-CHP, +87235,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,HEALTHPLUS-CHP, +87236,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,HEALTHPLUS-CHP, +87237,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,HEALTHPLUS-CHP, +87238,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,HEALTHPLUS-CHP, +87239,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,HEALTHPLUS-CHP, +87240,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,HEALTHPLUS-CHP, +87241,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,HEALTHPLUS-CHP, +87242,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,HEALTHPLUS-CHP, +87243,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,HEALTHPLUS-CHP, +87244,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,HEALTHPLUS-CHP, +87245,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,HEALTHPLUS-CHP, +87246,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,HEALTHPLUS-CHP, +87247,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,HEALTHPLUS-CHP, +87248,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,HEALTHPLUS-CHP, +87249,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,HEALTHPLUS-CHP, +87250,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,HEALTHPLUS-CHP, +87251,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,HEALTHPLUS-CHP, +87252,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,HEALTHPLUS-CHP, +87253,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,HEALTHPLUS-CHP, +87254,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,HEALTHPLUS-CHP, +87255,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,HEALTHPLUS-CHP, +87256,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,HEALTHPLUS-CHP, +87257,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,HEALTHPLUS-CHP, +87258,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,HEALTHPLUS-CHP, +87259,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,HEALTHPLUS-CHP, +87260,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,HEALTHPLUS-CHP, +87261,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,HEALTHPLUS-CHP, +87262,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,HEALTHPLUS-CHP, +87263,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,HEALTHPLUS-CHP, +87264,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,HEALTHPLUS-CHP, +87265,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,HEALTHPLUS-CHP, +87266,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,HEALTHPLUS-CHP, +87267,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,HEALTHPLUS-CHP, +87268,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,HEALTHPLUS-CHP, +87269,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,HEALTHPLUS-CHP, +87270,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,HEALTHPLUS-CHP, +87271,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,HEALTHPLUS-CHP, +87272,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,HEALTHPLUS-CHP, +87273,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,HEALTHPLUS-CHP, +87274,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,HEALTHPLUS-CHP, +87275,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,HEALTHPLUS-CHP, +87276,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,HEALTHPLUS-CHP, +87277,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,HEALTHPLUS-CHP, +87278,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,HEALTHPLUS-CHP, +87279,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,HEALTHPLUS-CHP, +87280,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,HEALTHPLUS-CHP, +87281,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,HEALTHPLUS-CHP, +87282,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,HEALTHPLUS-CHP, +87283,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,HEALTHPLUS-CHP, +87284,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,HEALTHPLUS-CHP, +87285,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,HEALTHPLUS-CHP, +87286,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,HEALTHPLUS-CHP, +87287,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,HEALTHPLUS-CHP, +87288,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,HEALTHPLUS-CHP, +87289,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,HEALTHPLUS-CHP, +87290,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,HEALTHPLUS-CHP, +87291,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,HEALTHPLUS-CHP, +87292,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,HEALTHPLUS-CHP, +87293,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,HEALTHPLUS-CHP, +87294,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,HEALTHPLUS-CHP, +87295,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,HEALTHPLUS-CHP, +87296,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,HEALTHPLUS-CHP, +87297,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,HEALTHPLUS-CHP, +87298,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,HEALTHPLUS-CHP, +87299,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,HEALTHPLUS-CHP, +87300,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,HEALTHPLUS-CHP, +87301,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,HEALTHPLUS-CHP, +87302,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,HEALTHPLUS-CHP, +87303,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,HEALTHPLUS-CHP, +87304,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,HEALTHPLUS-CHP, +87305,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,HEALTHPLUS-CHP, +87306,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,HEALTHPLUS-CHP, +87307,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,HEALTHPLUS-CHP, +87308,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,HEALTHPLUS-CHP, +87309,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,HEALTHPLUS-CHP, +87310,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,HEALTHPLUS-CHP, +87311,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,HEALTHPLUS-CHP, +87312,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,HEALTHPLUS-CHP, +87313,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,HEALTHPLUS-CHP, +87314,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,HEALTHPLUS-CHP, +87315,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,HEALTHPLUS-CHP, +87316,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,HEALTHPLUS-CHP, +87317,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,HEALTHPLUS-CHP, +87318,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,HEALTHPLUS-CHP, +87319,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,HEALTHPLUS-CHP, +87320,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,HEALTHPLUS-CHP, +87321,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,HEALTHPLUS-CHP, +87322,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,HEALTHPLUS-CHP, +87323,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,HEALTHPLUS-CHP, +87324,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,HEALTHPLUS-CHP, +87325,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,HEALTHPLUS-CHP, +87326,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,HEALTHPLUS-CHP, +87327,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,HEALTHPLUS-CHP, +87328,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,HEALTHPLUS-CHP, +87329,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,HEALTHPLUS-CHP, +87330,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,HEALTHPLUS-CHP, +87331,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,HEALTHPLUS-CHP, +87332,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,HEALTHPLUS-CHP, +87333,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,HEALTHPLUS-CHP, +87334,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,HEALTHPLUS-CHP, +87335,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,HEALTHPLUS-CHP, +87336,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,HEALTHPLUS-CHP, +87337,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,HEALTHPLUS-CHP, +87338,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,HEALTHPLUS-CHP, +87339,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,HEALTHPLUS-CHP, +87340,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,HEALTHPLUS-CHP, +87341,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,HEALTHPLUS-CHP, +87342,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,HEALTHPLUS-CHP, +87343,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,HEALTHPLUS-CHP, +87344,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,HEALTHPLUS-CHP, +87345,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,HEALTHPLUS-CHP, +87346,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,HEALTHPLUS-CHP, +87347,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,HEALTHPLUS-CHP, +87348,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,HEALTHPLUS-CHP, +87349,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,HEALTHPLUS-CHP, +87350,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,HEALTHPLUS-CHP, +87351,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,HEALTHPLUS-CHP, +87352,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,HEALTHPLUS-CHP, +87353,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,HEALTHPLUS-CHP, +87354,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,HEALTHPLUS-CHP, +87355,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,HEALTHPLUS-CHP, +87356,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,HEALTHPLUS-CHP, +87357,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,HEALTHPLUS-CHP, +87358,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,HEALTHPLUS-CHP, +87359,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,HEALTHPLUS-CHP, +87360,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,HEALTHPLUS-CHP, +87361,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,HEALTHPLUS-CHP, +87362,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,HEALTHPLUS-CHP, +87363,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,HEALTHPLUS-CHP, +87364,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,HEALTHPLUS-CHP, +87365,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,HEALTHPLUS-CHP, +87366,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,HEALTHPLUS-CHP, +87367,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,HEALTHPLUS-CHP, +87368,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,HEALTHPLUS-CHP, +87369,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,HEALTHPLUS-CHP, +87370,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,HEALTHPLUS-CHP, +87371,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,HEALTHPLUS-CHP, +87372,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,HEALTHPLUS-CHP, +87373,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,HEALTHPLUS-CHP, +87374,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,HEALTHPLUS-CHP, +87375,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,HEALTHPLUS-CHP, +87376,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,HEALTHPLUS-CHP, +87377,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,HEALTHPLUS-CHP, +87378,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,HEALTHPLUS-CHP, +87379,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,HEALTHPLUS-CHP, +87380,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,HEALTHPLUS-CHP, +87381,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,HEALTHPLUS-CHP, +87382,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,HEALTHPLUS-CHP, +87383,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,HEALTHPLUS-CHP, +87384,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,HEALTHPLUS-CHP, +87385,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,HEALTHPLUS-CHP, +87386,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,HEALTHPLUS-CHP, +87387,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,HEALTHPLUS-CHP, +87388,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,HEALTHPLUS-CHP, +87389,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,HEALTHPLUS-CHP, +87390,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,HEALTHPLUS-CHP, +87391,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,HEALTHPLUS-CHP, +87392,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,HEALTHPLUS-CHP, +87393,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,HEALTHPLUS-CHP, +87394,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,HEALTHPLUS-CHP, +87395,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,HEALTHPLUS-CHP, +87396,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,HEALTHPLUS-CHP, +87397,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,HEALTHPLUS-CHP, +87398,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,HEALTHPLUS-CHP, +87399,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,HEALTHPLUS-CHP, +87400,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,HEALTHPLUS-CHP, +87401,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,HEALTHPLUS-CHP, +87402,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,HEALTHPLUS-CHP, +87403,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,HEALTHPLUS-CHP, +87404,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,HEALTHPLUS-CHP, +87405,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,HEALTHPLUS-CHP, +87406,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,HEALTHPLUS-CHP, +87407,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,HEALTHPLUS-CHP, +87408,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,HEALTHPLUS-CHP, +87409,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,HEALTHPLUS-CHP, +87410,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,HEALTHPLUS-CHP, +87411,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,HEALTHPLUS-CHP, +87412,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,HEALTHPLUS-CHP, +87413,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,HEALTHPLUS-CHP, +87414,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,HEALTHPLUS-CHP, +87415,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,HEALTHPLUS-CHP, +87416,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,HEALTHPLUS-CHP, +87417,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,HEALTHPLUS-CHP, +87418,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,HEALTHPLUS-CHP, +87419,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,HEALTHPLUS-CHP, +87420,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,HEALTHPLUS-CHP, +87421,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,HEALTHPLUS-CHP, +87422,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,HEALTHPLUS-CHP, +87423,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,HEALTHPLUS-CHP, +87424,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,HEALTHPLUS-CHP, +87425,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,HEALTHPLUS-CHP, +87426,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,HEALTHPLUS-CHP, +87427,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,HEALTHPLUS-CHP, +87428,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,HEALTHPLUS-CHP, +87429,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,HEALTHPLUS-CHP, +87430,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,HEALTHPLUS-CHP, +87431,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,HEALTHPLUS-CHP, +87432,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,HEALTHPLUS-CHP, +87433,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,HEALTHPLUS-CHP, +87434,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,HEALTHPLUS-CHP, +87435,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,HEALTHPLUS-CHP, +87436,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,HEALTHPLUS-CHP, +87437,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,HEALTHPLUS-CHP, +87438,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,HEALTHPLUS-CHP, +87439,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,HEALTHPLUS-CHP, +87440,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,HEALTHPLUS-CHP, +87441,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,HEALTHPLUS-CHP, +87442,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,HEALTHPLUS-CHP, +87443,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,HEALTHPLUS-CHP, +87444,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,HEALTHPLUS-CHP, +87445,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,HEALTHPLUS-CHP, +87446,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,HEALTHPLUS-CHP, +87447,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,HEALTHPLUS-CHP, +87448,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,HEALTHPLUS-CHP, +87449,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,HEALTHPLUS-CHP, +87450,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,HEALTHPLUS-CHP, +87451,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,HEALTHPLUS-CHP, +87452,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,HEALTHPLUS-CHP, +87453,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,HEALTHPLUS-CHP, +87454,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,HEALTHPLUS-CHP, +87455,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,HEALTHPLUS-CHP, +87456,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,HEALTHPLUS-CHP, +87457,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,HEALTHPLUS-CHP, +87458,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,HEALTHPLUS-CHP, +87459,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,HEALTHPLUS-CHP, +87460,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,HEALTHPLUS-CHP, +87461,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,HEALTHPLUS-CHP, +87462,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,HEALTHPLUS-CHP, +87463,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,HEALTHPLUS-CHP, +87464,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,HEALTHPLUS-CHP, +87465,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,HEALTHPLUS-CHP, +87466,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,HEALTHPLUS-CHP, +87467,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,HEALTHPLUS-CHP, +87468,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,HEALTHPLUS-CHP, +87469,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,HEALTHPLUS-CHP, +87470,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,HEALTHPLUS-CHP, +87471,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,HEALTHPLUS-CHP, +87472,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,HEALTHPLUS-CHP, +87473,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,HEALTHPLUS-CHP, +87474,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,HEALTHPLUS-CHP, +87475,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,HEALTHPLUS-CHP, +87476,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,HEALTHPLUS-CHP, +87477,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,HEALTHPLUS-CHP, +87478,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,HEALTHPLUS-CHP, +87479,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,HEALTHPLUS-CHP, +87480,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,HEALTHPLUS-CHP, +87481,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,HEALTHPLUS-CHP, +87482,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,HEALTHPLUS-CHP, +87483,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,HEALTHPLUS-CHP, +87484,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,HEALTHPLUS-CHP, +87485,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,HEALTHPLUS-CHP, +87486,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,HEALTHPLUS-CHP, +87487,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,HEALTHPLUS-CHP, +87488,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,HEALTHPLUS-CHP, +87489,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,HEALTHPLUS-CHP, +87490,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,HEALTHPLUS-CHP, +87491,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,HEALTHPLUS-CHP, +87492,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,HEALTHPLUS-CHP, +87493,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,HEALTHPLUS-CHP, +87494,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,HEALTHPLUS-CHP, +87495,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,HEALTHPLUS-CHP, +87496,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,HEALTHPLUS-CHP, +87497,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,HEALTHPLUS-CHP, +87498,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,HEALTHPLUS-CHP, +87499,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,HEALTHPLUS-CHP, +87500,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,HEALTHPLUS-CHP, +87501,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,HEALTHPLUS-CHP, +87502,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,HEALTHPLUS-CHP, +87503,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,HEALTHPLUS-CHP, +87504,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,HEALTHPLUS-CHP, +87505,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,HEALTHPLUS-CHP, +87506,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,HEALTHPLUS-CHP, +87507,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,HEALTHPLUS-CHP, +87508,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,HEALTHPLUS-CHP, +87509,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,HEALTHPLUS-CHP, +87510,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,HEALTHPLUS-CHP, +87511,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,HEALTHPLUS-CHP, +87512,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,HEALTHPLUS-CHP, +87513,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,HEALTHPLUS-CHP, +87514,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,HEALTHPLUS-CHP, +87515,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,HEALTHPLUS-CHP, +87516,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,HEALTHPLUS-CHP, +87517,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,HEALTHPLUS-CHP, +87518,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,HEALTHPLUS-CHP, +87519,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,HEALTHPLUS-CHP, +87520,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,HEALTHPLUS-CHP, +87521,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,HEALTHPLUS-CHP, +87522,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,HEALTHPLUS-CHP, +87523,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,HEALTHPLUS-CHP, +87524,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,HEALTHPLUS-CHP, +87525,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,HEALTHPLUS-CHP, +87526,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,HEALTHPLUS-CHP, +87527,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,HEALTHPLUS-CHP, +87528,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,HEALTHPLUS-CHP, +87529,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,HEALTHPLUS-CHP, +87530,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,HEALTHPLUS-CHP, +87531,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,HEALTHPLUS-CHP, +87532,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,HEALTHPLUS-CHP, +87533,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,HEALTHPLUS-CHP, +87534,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,HEALTHPLUS-CHP, +87535,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,HEALTHPLUS-CHP, +87536,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,HEALTHPLUS-CHP, +87537,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,HEALTHPLUS-CHP, +87538,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,HEALTHPLUS-CHP, +87539,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,HEALTHPLUS-CHP, +87540,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,HEALTHPLUS-CHP, +87541,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,HEALTHPLUS-CHP, +87542,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,HEALTHPLUS-CHP, +87543,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,HEALTHPLUS-CHP, +87544,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,HEALTHPLUS-CHP, +87545,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,HEALTHPLUS-CHP, +87546,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,HEALTHPLUS-CHP, +87547,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,HEALTHPLUS-CHP, +87548,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,HEALTHPLUS-CHP, +87549,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,HEALTHPLUS-CHP, +87550,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,HEALTHPLUS-CHP, +87551,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,HEALTHPLUS-CHP, +87552,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,HEALTHPLUS-CHP, +87553,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,HEALTHPLUS-CHP, +87554,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,HEALTHPLUS-CHP, +87555,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,HEALTHPLUS-CHP, +87556,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,HEALTHPLUS-CHP, +87557,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,HEALTHPLUS-CHP, +87558,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,HEALTHPLUS-CHP, +87559,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,HEALTHPLUS-CHP, +87560,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,HEALTHPLUS-CHP, +87561,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,HEALTHPLUS-CHP, +87562,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,HEALTHPLUS-CHP, +87563,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,HEALTHPLUS-CHP, +87564,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,HEALTHPLUS-CHP, +87565,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,HEALTHPLUS-CHP, +87566,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,HEALTHPLUS-CHP, +87567,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,HEALTHPLUS-CHP, +87568,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,HEALTHPLUS-CHP, +87569,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,HEALTHPLUS-CHP, +87570,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,HEALTHPLUS-CHP, +87571,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,HEALTHPLUS-CHP, +87572,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,HEALTHPLUS-CHP, +87573,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,HEALTHPLUS-CHP, +87574,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,HEALTHPLUS-CHP, +87575,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,HEALTHPLUS-CHP, +87576,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,HEALTHPLUS-CHP, +87577,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,HEALTHPLUS-CHP, +87578,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,HEALTHPLUS-CHP, +87579,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,HEALTHPLUS-CHP, +87580,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,HEALTHPLUS-CHP, +87581,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,HEALTHPLUS-CHP, +87582,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,HEALTHPLUS-CHP, +87583,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,HEALTHPLUS-CHP, +87584,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,HEALTHPLUS-CHP, +87585,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,HEALTHPLUS-CHP, +87586,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,HEALTHPLUS-CHP, +87587,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,HEALTHPLUS-CHP, +87588,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,HEALTHPLUS-CHP, +87589,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,HEALTHPLUS-CHP, +87590,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,HEALTHPLUS-CHP, +87591,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,HEALTHPLUS-CHP, +87592,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,HEALTHPLUS-CHP, +87593,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,HEALTHPLUS-CHP, +87594,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,HEALTHPLUS-CHP, +87595,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,HEALTHPLUS-CHP, +87596,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,HEALTHPLUS-CHP, +87597,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,HEALTHPLUS-CHP, +87598,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,HEALTHPLUS-CHP, +87599,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,HEALTHPLUS-CHP, +87600,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,HEALTHPLUS-CHP, +87601,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,HEALTHPLUS-CHP, +87602,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,HEALTHPLUS-CHP, +87603,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,HEALTHPLUS-CHP, +87604,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,HEALTHPLUS-CHP, +87605,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,HEALTHPLUS-CHP, +87606,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,HEALTHPLUS-CHP, +87607,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,HEALTHPLUS-CHP, +87608,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,HEALTHPLUS-CHP, +87609,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,HEALTHPLUS-CHP, +87610,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,HEALTHPLUS-CHP, +87611,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,HEALTHPLUS-CHP, +87612,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,HEALTHPLUS-CHP, +87613,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,HEALTHPLUS-CHP, +87614,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,HEALTHPLUS-CHP, +87615,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,HEALTHPLUS-CHP, +87616,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,HEALTHPLUS-CHP, +87617,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,HEALTHPLUS-CHP, +87618,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,HEALTHPLUS-CHP, +87619,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,HEALTHPLUS-CHP, +87620,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,HEALTHPLUS-CHP, +87621,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,HEALTHPLUS-CHP, +87622,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,HEALTHPLUS-CHP, +87623,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,HEALTHPLUS-CHP, +87624,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,HEALTHPLUS-CHP, +87625,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,HEALTHPLUS-CHP, +87626,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,HEALTHPLUS-CHP, +87627,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,HEALTHPLUS-CHP, +87628,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,HEALTHPLUS-CHP, +87629,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,HEALTHPLUS-CHP, +87630,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,HEALTHPLUS-CHP, +87631,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,HEALTHPLUS-CHP, +87632,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,HEALTHPLUS-CHP, +87633,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,HEALTHPLUS-CHP, +87634,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,HEALTHPLUS-CHP, +87635,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,HEALTHPLUS-CHP, +87636,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,HEALTHPLUS-CHP, +87637,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,HEALTHPLUS-CHP, +87638,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,HEALTHPLUS-CHP, +87639,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,HEALTHPLUS-CHP, +87640,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,HEALTHPLUS-CHP, +87641,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,HEALTHPLUS-CHP, +87642,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,HEALTHPLUS-CHP, +87643,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,HEALTHPLUS-CHP, +87644,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,HEALTHPLUS-CHP, +87645,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,HEALTHPLUS-CHP, +87646,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,HEALTHPLUS-CHP, +87647,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,HEALTHPLUS-CHP, +87648,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,HEALTHPLUS-CHP, +87649,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,HEALTHPLUS-CHP, +87650,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,HEALTHPLUS-CHP, +87651,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,HEALTHPLUS-CHP, +87652,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,HEALTHPLUS-CHP, +87653,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,HEALTHPLUS-CHP, +87654,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,HEALTHPLUS-CHP, +87655,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,HEALTHPLUS-CHP, +87656,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,HEALTHPLUS-CHP, +87657,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,HEALTHPLUS-CHP, +87658,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,HEALTHPLUS-CHP, +87659,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,HEALTHPLUS-CHP, +87660,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,HEALTHPLUS-CHP, +87661,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,HEALTHPLUS-CHP, +87662,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,HEALTHPLUS-CHP, +87663,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,HEALTHPLUS-CHP, +87664,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,HEALTHPLUS-CHP, +87665,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,HEALTHPLUS-CHP, +87666,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,HEALTHPLUS-CHP, +87667,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,HEALTHPLUS-CHP, +87668,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,HEALTHPLUS-CHP, +87669,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,HEALTHPLUS-CHP, +87670,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,HEALTHPLUS-CHP, +87671,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,HEALTHPLUS-CHP, +87672,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,HEALTHPLUS-CHP, +87673,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,HEALTHPLUS-CHP, +87674,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,HEALTHPLUS-CHP, +87675,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,HEALTHPLUS-CHP, +87676,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,HEALTHPLUS-CHP, +87677,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,HEALTHPLUS-CHP, +87678,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,HEALTHPLUS-CHP, +87679,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,HEALTHPLUS-CHP, +87680,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,HEALTHPLUS-CHP, +87681,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,HEALTHPLUS-CHP, +87682,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,HEALTHPLUS-CHP, +87683,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,HEALTHPLUS-CHP, +87684,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,HEALTHPLUS-CHP, +87685,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,HEALTHPLUS-CHP, +87686,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,HEALTHPLUS-CHP, +87687,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,HEALTHPLUS-CHP, +87688,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,HEALTHPLUS-CHP, +87689,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,HEALTHPLUS-CHP, +87690,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,HEALTHPLUS-CHP, +87691,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,HEALTHPLUS-CHP, +87692,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,HEALTHPLUS-CHP, +87693,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,HEALTHPLUS-CHP, +87694,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,HEALTHPLUS-CHP, +87695,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,HEALTHPLUS-CHP, +87696,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,HEALTHPLUS-CHP, +87697,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,HEALTHPLUS-CHP, +87698,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,HEALTHPLUS-CHP, +87699,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,HEALTHPLUS-CHP, +87700,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,HEALTHPLUS-CHP, +87701,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,HEALTHPLUS-CHP, +87702,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,HEALTHPLUS-CHP, +87703,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,HEALTHPLUS-CHP, +87704,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,HEALTHPLUS-CHP, +87705,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,HEALTHPLUS-CHP, +87706,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,HEALTHPLUS-CHP, +87707,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,HEALTHPLUS-CHP, +87708,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,HEALTHPLUS-CHP, +87709,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,HEALTHPLUS-CHP, +87710,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,HEALTHPLUS-CHP, +87711,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,HEALTHPLUS-CHP, +87712,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,HEALTHPLUS-CHP, +87713,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,HEALTHPLUS-CHP, +87714,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,HEALTHPLUS-CHP, +87715,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,HEALTHPLUS-CHP, +87716,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,HEALTHPLUS-CHP, +87717,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,HEALTHPLUS-CHP, +87718,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,HEALTHPLUS-CHP, +87719,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,HEALTHPLUS-CHP, +87720,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,HEALTHPLUS-CHP, +87721,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,HEALTHPLUS-CHP, +87722,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,HEALTHPLUS-CHP, +87723,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,HEALTHPLUS-CHP, +87724,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,HEALTHPLUS-CHP, +87725,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,HEALTHPLUS-CHP, +87726,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,HEALTHPLUS-CHP, +87727,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,HEALTHPLUS-CHP, +87728,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,HEALTHPLUS-CHP, +87729,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,HEALTHPLUS-CHP, +87730,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,HEALTHPLUS-CHP, +87731,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,HEALTHPLUS-CHP, +87732,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,HEALTHPLUS-CHP, +87733,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,HEALTHPLUS-CHP, +87734,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,HEALTHPLUS-CHP, +87735,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,HEALTHPLUS-CHP, +87736,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,HEALTHPLUS-CHP, +87737,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,HEALTHPLUS-CHP, +87738,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,HEALTHPLUS-CHP, +87739,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,HEALTHPLUS-CHP, +87740,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,HEALTHPLUS-CHP, +87741,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,HEALTHPLUS-CHP, +87742,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,HEALTHPLUS-CHP, +87743,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,HEALTHPLUS-CHP, +87744,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,HEALTHPLUS-CHP, +87745,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,HEALTHPLUS-CHP, +87746,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,HEALTHPLUS-CHP, +87747,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,HEALTHPLUS-CHP, +87748,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,HEALTHPLUS-CHP, +87749,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,HEALTHPLUS-CHP, +87750,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,HEALTHPLUS-CHP, +87751,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,HEALTHPLUS-CHP, +87752,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,HEALTHPLUS-CHP, +87753,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,HEALTHPLUS-CHP, +87754,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,HEALTHPLUS-CHP, +87755,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,HEALTHPLUS-CHP, +87756,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,HEALTHPLUS-CHP, +87757,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,HEALTHPLUS-CHP, +87758,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,HEALTHPLUS-CHP, +87759,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,HEALTHPLUS-CHP, +87760,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,HEALTHPLUS-CHP, +87761,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,HEALTHPLUS-CHP, +87762,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,HEALTHPLUS-CHP, +87763,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,HEALTHPLUS-CHP, +87764,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,HEALTHPLUS-CHP, +87765,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,HEALTHPLUS-CHP, +87766,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,HEALTHPLUS-CHP, +87767,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,HEALTHPLUS-CHP, +87768,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,HEALTHPLUS-CHP, +87769,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,HEALTHPLUS-CHP, +87770,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,HEALTHPLUS-CHP, +87771,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,HEALTHPLUS-CHP, +87772,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,HEALTHPLUS-CHP, +87773,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,HEALTHPLUS-CHP, +87774,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,HEALTHPLUS-CHP, +87775,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,HEALTHPLUS-CHP, +87776,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,HEALTHPLUS-CHP, +87777,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,HEALTHPLUS-CHP, +87778,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,HEALTHPLUS-CHP, +87779,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,HEALTHPLUS-CHP, +87780,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,HEALTHPLUS-CHP, +87781,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,HEALTHPLUS-CHP, +87782,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,HEALTHPLUS-CHP, +87783,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,HEALTHPLUS-CHP, +87784,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,HEALTHPLUS-CHP, +87785,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,HEALTHPLUS-CHP, +87786,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,HEALTHPLUS-CHP, +87787,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,HEALTHPLUS-CHP, +87788,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,HEALTHPLUS-CHP, +87789,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,HEALTHPLUS-CHP, +87790,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,HEALTHPLUS-CHP, +87791,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,HEALTHPLUS-CHP, +87792,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,HEALTHPLUS-CHP, +87793,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,HEALTHPLUS-CHP, +87794,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,HEALTHPLUS-CHP, +87795,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,HEALTHPLUS-CHP, +87796,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,HEALTHPLUS-CHP, +87797,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,HEALTHPLUS-CHP, +87798,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,HEALTHPLUS-CHP, +87799,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,HEALTHPLUS-CHP, +87800,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,HEALTHPLUS-CHP, +87801,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,HEALTHPLUS-CHP, +87802,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,HEALTHPLUS-CHP, +87803,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,HEALTHPLUS-CHP, +87804,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,HEALTHPLUS-CHP, +87805,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,HEALTHPLUS-CHP, +87806,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,HEALTHPLUS-CHP, +87807,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,HEALTHPLUS-CHP, +87808,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,HEALTHPLUS-CHP, +87809,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,HEALTHPLUS-CHP, +87810,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,HEALTHPLUS-CHP, +87811,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,HEALTHPLUS-CHP, +87812,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,HEALTHPLUS-CHP, +87813,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,HEALTHPLUS-CHP, +87814,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,HEALTHPLUS-CHP, +87815,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,HEALTHPLUS-CHP, +87816,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,HEALTHPLUS-CHP, +87817,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,HEALTHPLUS-CHP, +87818,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,HEALTHPLUS-CHP, +87819,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,HEALTHPLUS-CHP, +87820,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,HEALTHPLUS-CHP, +87821,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,HEALTHPLUS-CHP, +87822,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,HEALTHPLUS-CHP, +87823,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,HEALTHPLUS-CHP, +87824,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,HEALTHPLUS-CHP, +87825,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,HEALTHPLUS-CHP, +87826,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,HEALTHPLUS-CHP, +87827,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,HEALTHPLUS-CHP, +87828,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,HEALTHPLUS-CHP, +87829,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,HEALTHPLUS-CHP, +87830,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,HEALTHPLUS-CHP, +87831,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,HEALTHPLUS-CHP, +87832,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,HEALTHPLUS-CHP, +87833,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,HEALTHPLUS-CHP, +87834,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,HEALTHPLUS-CHP, +87835,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,HEALTHPLUS-CHP, +87836,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,HEALTHPLUS-CHP, +87837,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,HEALTHPLUS-CHP, +87838,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,HEALTHPLUS-CHP, +87839,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,HEALTHPLUS-CHP, +87840,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,HEALTHPLUS-CHP, +87841,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,HEALTHPLUS-CHP, +87842,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,HEALTHPLUS-CHP, +87843,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,HEALTHPLUS-CHP, +87844,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,HEALTHPLUS-CHP, +87845,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,HEALTHPLUS-CHP, +87846,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,HEALTHPLUS-CHP, +87847,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,HEALTHPLUS-CHP, +87848,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,HEALTHPLUS-CHP, +87849,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,HEALTHPLUS-CHP, +87850,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,HEALTHPLUS-CHP, +87851,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,HEALTHPLUS-CHP, +87852,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,HEALTHPLUS-CHP, +87853,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,HEALTHPLUS-CHP, +87854,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,HEALTHPLUS-CHP, +87855,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,HEALTHPLUS-CHP, +87856,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,HEALTHPLUS-CHP, +87857,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,HEALTHPLUS-CHP, +87858,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,HEALTHPLUS-CHP, +87859,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,HEALTHPLUS-CHP, +87860,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,HEALTHPLUS-CHP, +87861,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,HEALTHPLUS-CHP, +87862,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,HEALTHPLUS-CHP, +87863,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,HEALTHPLUS-CHP, +87864,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,HEALTHPLUS-CHP, +87865,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,HEALTHPLUS-CHP, +87866,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,HEALTHPLUS-CHP, +87867,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,HEALTHPLUS-CHP, +87868,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,HEALTHPLUS-CHP, +87869,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,HEALTHPLUS-CHP, +87870,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,HEALTHPLUS-CHP, +87871,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,HEALTHPLUS-CHP, +87872,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,HEALTHPLUS-CHP, +87873,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,HEALTHPLUS-CHP, +87874,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,HEALTHPLUS-CHP, +87875,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,HEALTHPLUS-CHP, +87876,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,HEALTHPLUS-CHP, +87877,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,HEALTHPLUS-CHP, +87878,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,HEALTHPLUS-CHP, +87879,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,HEALTHPLUS-CHP, +87880,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,HEALTHPLUS-CHP, +87881,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,HEALTHPLUS-CHP,346.7 +87882,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,HEALTHPLUS-CHP, +87883,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,HEALTHPLUS-CHP,388.57 +87884,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,HEALTHPLUS-CHP,42.79 +87885,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,HEALTHPLUS-CHP, +87886,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,HEALTHPLUS-CHP, +87887,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,HEALTHPLUS-CHP, +87888,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,HEALTHPLUS-CHP, +87889,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,HEALTHPLUS-CHP, +87890,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,HEALTHPLUS-CHP, +87891,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,HEALTHPLUS-CHP, +87892,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,HEALTHPLUS-CHP, +87893,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,HEALTHPLUS-CHP, +87894,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,HEALTHPLUS-CHP, +87895,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,HEALTHPLUS-CHP, +87896,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,HEALTHPLUS-CHP, +87897,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,HEALTHPLUS-CHP, +87898,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,HEALTHPLUS-CHP, +87899,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,HEALTHPLUS-CHP, +87900,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,HEALTHPLUS-CHP, +87901,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,HEALTHPLUS-CHP, +87902,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,HEALTHPLUS-CHP, +87903,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,HEALTHPLUS-CHP, +87904,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,HEALTHPLUS-CHP, +87905,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,HEALTHPLUS-CHP, +87906,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,HEALTHPLUS-CHP, +87907,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,HEALTHPLUS-CHP, +87908,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,HEALTHPLUS-CHP, +87909,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,HEALTHPLUS-CHP, +87910,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,HEALTHPLUS-CHP, +87911,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,HEALTHPLUS-CHP, +87912,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,HEALTHPLUS-CHP, +87913,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,HEALTHPLUS-CHP, +87914,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,HEALTHPLUS-CHP, +87915,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,HEALTHPLUS-CHP, +87916,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,HEALTHPLUS-CHP, +87917,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,HEALTHPLUS-CHP, +87918,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,HEALTHPLUS-CHP, +87919,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,HEALTHPLUS-CHP, +87920,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,HEALTHPLUS-CHP, +87921,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,HEALTHPLUS-CHP, +87922,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,HEALTHPLUS-CHP, +87923,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,HEALTHPLUS-CHP, +87924,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,HEALTHPLUS-CHP, +87925,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,HEALTHPLUS-CHP, +87926,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,HEALTHPLUS-CHP, +87927,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,HEALTHPLUS-CHP, +87928,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,HEALTHPLUS-CHP, +87929,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,HEALTHPLUS-CHP, +87930,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,HEALTHPLUS-CHP, +87931,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,HEALTHPLUS-CHP, +87932,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,HEALTHPLUS-CHP, +87933,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,HEALTHPLUS-CHP, +87934,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,HEALTHPLUS-CHP, +87935,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,HEALTHPLUS-CHP, +87936,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,HEALTHPLUS-CHP, +87937,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,HEALTHPLUS-CHP, +87938,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,HEALTHPLUS-CHP, +87939,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,HEALTHPLUS-CHP, +87940,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,HEALTHPLUS-CHP, +87941,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,HEALTHPLUS-CHP,39.29 +87942,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,HEALTHPLUS-CHP, +87943,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,HEALTHPLUS-CHP, +87944,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,HEALTHPLUS-CHP, +87945,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,HEALTHPLUS-CHP, +87946,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,HEALTHPLUS-CHP, +87947,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,HEALTHPLUS-CHP, +87948,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,HEALTHPLUS-CHP, +87949,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,HEALTHPLUS-CHP, +87950,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,HEALTHPLUS-CHP, +87951,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,HEALTHPLUS-CHP, +87952,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,HEALTHPLUS-CHP, +87953,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,HEALTHPLUS-CHP, +87954,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,HEALTHPLUS-CHP, +87955,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,HEALTHPLUS-CHP, +87956,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,HEALTHPLUS-CHP, +87957,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,HEALTHPLUS-CHP, +87958,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,HEALTHPLUS-CHP,285.63 +87959,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,HEALTHPLUS-CHP, +87960,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,HEALTHPLUS-CHP, +87961,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,HEALTHPLUS-CHP, +87962,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,HEALTHPLUS-CHP,286.51 +87963,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,HEALTHPLUS-CHP, +87964,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,HEALTHPLUS-CHP, +87965,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,HEALTHPLUS-CHP, +87966,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,HEALTHPLUS-CHP, +87967,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,HEALTHPLUS-CHP, +87968,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,HEALTHPLUS-CHP, +87969,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,HEALTHPLUS-CHP, +87970,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,HEALTHPLUS-CHP, +87971,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,HEALTHPLUS-CHP, +87972,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,HEALTHPLUS-CHP, +87973,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,HEALTHPLUS-CHP, +87974,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,HEALTHPLUS-CHP, +87975,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,HEALTHPLUS-CHP, +87976,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,HEALTHPLUS-CHP, +87977,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,HEALTHPLUS-CHP, +87978,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,HEALTHPLUS-CHP, +87979,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,HEALTHPLUS-CHP, +87980,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,HEALTHPLUS-CHP, +87981,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,HEALTHPLUS-CHP, +87982,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,HEALTHPLUS-CHP, +87983,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,HEALTHPLUS-CHP, +87984,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,HEALTHPLUS-CHP, +87985,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,HEALTHPLUS-CHP, +87986,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,HEALTHPLUS-CHP, +87987,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,HEALTHPLUS-CHP, +87988,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,HEALTHPLUS-CHP, +87989,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,HEALTHPLUS-CHP, +87990,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,HEALTHPLUS-CHP, +87991,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,HEALTHPLUS-CHP, +87992,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,HEALTHPLUS-CHP, +87993,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,HEALTHPLUS-CHP, +87994,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,HEALTHPLUS-CHP, +87995,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,HEALTHPLUS-CHP, +87996,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,HEALTHPLUS-CHP, +87997,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,HEALTHPLUS-CHP, +87998,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,HEALTHPLUS-CHP, +87999,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,HEALTHPLUS-CHP, +88000,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,HEALTHPLUS-CHP, +88001,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,HEALTHPLUS-CHP, +88002,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,HEALTHPLUS-CHP, +88003,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,HEALTHPLUS-CHP, +88004,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,HEALTHPLUS-CHP, +88005,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,HEALTHPLUS-CHP, +88006,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,HEALTHPLUS-CHP, +88007,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,HEALTHPLUS-CHP, +88008,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,HEALTHPLUS-CHP, +88009,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,HEALTHPLUS-CHP, +88010,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,HEALTHPLUS-CHP, +88011,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,HEALTHPLUS-CHP, +88012,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,HEALTHPLUS-CHP, +88013,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,HEALTHPLUS-CHP, +88014,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,HEALTHPLUS-CHP, +88015,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,HEALTHPLUS-CHP, +88016,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,HEALTHPLUS-CHP, +88017,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,HEALTHPLUS-CHP, +88018,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,HEALTHPLUS-CHP, +88019,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,HEALTHPLUS-CHP, +88020,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,HEALTHPLUS-CHP, +88021,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,HEALTHPLUS-CHP, +88022,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,HEALTHPLUS-CHP, +88023,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,HEALTHPLUS-CHP, +88024,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,HEALTHPLUS-CHP, +88025,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,HEALTHPLUS-CHP, +88026,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,HEALTHPLUS-CHP, +88027,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,HEALTHPLUS-CHP, +88028,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,HEALTHPLUS-CHP, +88029,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,HEALTHPLUS-CHP, +88030,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,HEALTHPLUS-CHP, +88031,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,HEALTHPLUS-CHP, +88032,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,HEALTHPLUS-CHP, +88033,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,HEALTHPLUS-CHP, +88034,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,HEALTHPLUS-CHP, +88035,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,HEALTHPLUS-CHP, +88036,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,HEALTHPLUS-CHP, +88037,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,HEALTHPLUS-CHP, +88038,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,HEALTHPLUS-CHP, +88039,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,HEALTHPLUS-CHP, +88040,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,HEALTHPLUS-CHP, +88041,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,HEALTHPLUS-CHP, +88042,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,HEALTHPLUS-CHP, +88043,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,HEALTHPLUS-CHP, +88044,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,HEALTHPLUS-CHP, +88045,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,HEALTHPLUS-CHP, +88046,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,HEALTHPLUS-CHP, +88047,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,HEALTHPLUS-CHP, +88048,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,HEALTHPLUS-CHP, +88049,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,HEALTHPLUS-CHP, +88050,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,HEALTHPLUS-CHP, +88051,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,HEALTHPLUS-CHP, +88052,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,HEALTHPLUS-CHP, +88053,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,HEALTHPLUS-CHP, +88054,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,HEALTHPLUS-CHP, +88055,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,HEALTHPLUS-CHP, +88056,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,HEALTHPLUS-CHP, +88057,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,HEALTHPLUS-CHP, +88058,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,HEALTHPLUS-CHP, +88059,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,HEALTHPLUS-CHP, +88060,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,HEALTHPLUS-CHP, +88061,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,HEALTHPLUS-CHP, +88062,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,HEALTHPLUS-CHP, +88063,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,HEALTHPLUS-CHP, +88064,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,HEALTHPLUS-CHP, +88065,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,HEALTHPLUS-CHP, +88066,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,HEALTHPLUS-CHP, +88067,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,HEALTHPLUS-CHP, +88068,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,HEALTHPLUS-CHP, +88069,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,HEALTHPLUS-CHP, +88070,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,HEALTHPLUS-CHP, +88071,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,HEALTHPLUS-CHP, +88072,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,HEALTHPLUS-CHP, +88073,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,HEALTHPLUS-CHP, +88074,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,HEALTHPLUS-CHP, +88075,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,HEALTHPLUS-CHP, +88076,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,HEALTHPLUS-CHP, +88077,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,HEALTHPLUS-CHP, +88078,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,HEALTHPLUS-CHP, +88079,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,HEALTHPLUS-CHP, +88080,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,HEALTHPLUS-CHP, +88081,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,HEALTHPLUS-CHP, +88082,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,HEALTHPLUS-CHP, +88083,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,HEALTHPLUS-CHP, +88084,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,HEALTHPLUS-CHP, +88085,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,HEALTHPLUS-CHP, +88086,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,HEALTHPLUS-CHP, +88087,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,HEALTHPLUS-CHP, +88088,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,HEALTHPLUS-CHP, +88089,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,HEALTHPLUS-CHP, +88090,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,HEALTHPLUS-CHP, +88091,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,HEALTHPLUS-CHP, +88092,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,HEALTHPLUS-CHP, +88093,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,HEALTHPLUS-CHP, +88094,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,HEALTHPLUS-CHP, +88095,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,HEALTHPLUS-CHP, +88096,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,HEALTHPLUS-CHP, +88097,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,HEALTHPLUS-CHP, +88098,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,HEALTHPLUS-CHP, +88099,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,HEALTHPLUS-CHP, +88100,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,HEALTHPLUS-CHP, +88101,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,HEALTHPLUS-CHP, +88102,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,HEALTHPLUS-CHP, +88103,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,HEALTHPLUS-CHP, +88104,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,HEALTHPLUS-CHP, +88105,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,HEALTHPLUS-CHP, +88106,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,HEALTHPLUS-CHP, +88107,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,HEALTHPLUS-CHP, +88108,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,HEALTHPLUS-CHP, +88109,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,HEALTHPLUS-CHP, +88110,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,HEALTHPLUS-CHP, +88111,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,HEALTHPLUS-CHP, +88112,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,HEALTHPLUS-CHP, +88113,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,HEALTHPLUS-CHP, +88114,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,HEALTHPLUS-CHP, +88115,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,HEALTHPLUS-CHP, +88116,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,HEALTHPLUS-CHP, +88117,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,HEALTHPLUS-CHP, +88118,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,HEALTHPLUS-CHP, +88119,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,HEALTHPLUS-CHP, +88120,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,HEALTHPLUS-CHP, +88121,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,HEALTHPLUS-CHP, +88122,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,HEALTHPLUS-CHP, +88123,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,HEALTHPLUS-CHP, +88124,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,HEALTHPLUS-CHP, +88125,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,HEALTHPLUS-CHP, +88126,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,HEALTHPLUS-CHP, +88127,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,HEALTHPLUS-CHP, +88128,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,HEALTHPLUS-CHP, +88129,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,HEALTHPLUS-CHP, +88130,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,HEALTHPLUS-CHP, +88131,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,HEALTHPLUS-CHP, +88132,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,HEALTHPLUS-CHP, +88133,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,HEALTHPLUS-CHP, +88134,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,HEALTHPLUS-CHP, +88135,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,HEALTHPLUS-CHP, +88136,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,HEALTHPLUS-CHP, +88137,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,HEALTHPLUS-CHP, +88138,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,HEALTHPLUS-CHP, +88139,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,HEALTHPLUS-CHP, +88140,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,HEALTHPLUS-CHP, +88141,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,HEALTHPLUS-CHP, +88142,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,HEALTHPLUS-CHP, +88143,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,HEALTHPLUS-CHP, +88144,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,HEALTHPLUS-CHP, +88145,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,HEALTHPLUS-CHP, +88146,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,HEALTHPLUS-CHP, +88147,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,HEALTHPLUS-CHP, +88148,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,HEALTHPLUS-CHP, +88149,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,HEALTHPLUS-CHP, +88150,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,HEALTHPLUS-CHP, +88151,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,HEALTHPLUS-CHP, +88152,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,HEALTHPLUS-CHP, +88153,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,HEALTHPLUS-CHP, +88154,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,HEALTHPLUS-CHP, +88155,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,HEALTHPLUS-CHP, +88156,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-CHP, +88157,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,HEALTHPLUS-CHP, +88158,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,HEALTHPLUS-CHP, +88159,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,HEALTHPLUS-CHP, +88160,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,HEALTHPLUS-CHP, +88161,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,HEALTHPLUS-CHP, +88162,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,HEALTHPLUS-CHP, +88163,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,HEALTHPLUS-CHP, +88164,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,HEALTHPLUS-CHP, +88165,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,HEALTHPLUS-CHP, +88166,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,HEALTHPLUS-CHP, +88167,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,HEALTHPLUS-CHP, +88168,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,HEALTHPLUS-CHP, +88169,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,HEALTHPLUS-CHP, +88170,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,HEALTHPLUS-CHP, +88171,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,HEALTHPLUS-CHP, +88172,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,HEALTHPLUS-CHP, +88173,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,HEALTHPLUS-CHP, +88174,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,HEALTHPLUS-CHP, +88175,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,HEALTHPLUS-CHP, +88176,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,HEALTHPLUS-CHP, +88177,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,HEALTHPLUS-CHP, +88178,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,HEALTHPLUS-CHP, +88179,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,HEALTHPLUS-CHP, +88180,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,HEALTHPLUS-CHP, +88181,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,HEALTHPLUS-CHP, +88182,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,HEALTHPLUS-CHP, +88183,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,HEALTHPLUS-CHP, +88184,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,HEALTHPLUS-CHP, +88185,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,HEALTHPLUS-CHP, +88186,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,HEALTHPLUS-CHP, +88187,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,HEALTHPLUS-CHP, +88188,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,HEALTHPLUS-CHP, +88189,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,HEALTHPLUS-CHP, +88190,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,HEALTHPLUS-CHP, +88191,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,HEALTHPLUS-CHP,151.35 +88192,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,HEALTHPLUS-CHP, +88193,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,HEALTHPLUS-CHP, +88194,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,HEALTHPLUS-CHP, +88195,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,HEALTHPLUS-CHP, +88196,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,HEALTHPLUS-CHP, +88197,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,HEALTHPLUS-CHP, +88198,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,HEALTHPLUS-CHP, +88199,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,HEALTHPLUS-CHP, +88200,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,HEALTHPLUS-CHP, +88201,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,HEALTHPLUS-CHP, +88202,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,HEALTHPLUS-CHP, +88203,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,HEALTHPLUS-CHP, +88204,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,HEALTHPLUS-CHP, +88205,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,HEALTHPLUS-CHP, +88206,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,HEALTHPLUS-CHP, +88207,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,HEALTHPLUS-CHP, +88208,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,HEALTHPLUS-CHP, +88209,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,HEALTHPLUS-CHP, +88210,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,HEALTHPLUS-CHP, +88211,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,HEALTHPLUS-CHP, +88212,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,HEALTHPLUS-CHP, +88213,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,HEALTHPLUS-CHP, +88214,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,HEALTHPLUS-CHP, +88215,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,HEALTHPLUS-CHP, +88216,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,HEALTHPLUS-CHP, +88217,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,HEALTHPLUS-CHP, +88218,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,HEALTHPLUS-CHP, +88219,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,HEALTHPLUS-CHP, +88220,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,HEALTHPLUS-CHP, +88221,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,HEALTHPLUS-CHP, +88222,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,HEALTHPLUS-CHP, +88223,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,HEALTHPLUS-CHP, +88224,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,HEALTHPLUS-CHP, +88225,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,HEALTHPLUS-CHP, +88226,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,HEALTHPLUS-CHP, +88227,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,HEALTHPLUS-CHP, +88228,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,HEALTHPLUS-CHP, +88229,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,HEALTHPLUS-CHP, +88230,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,HEALTHPLUS-CHP, +88231,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,HEALTHPLUS-CHP,589.2 +88232,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,HEALTHPLUS-CHP, +88233,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,HEALTHPLUS-CHP, +88234,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,HEALTHPLUS-CHP, +88235,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,HEALTHPLUS-CHP, +88236,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,HEALTHPLUS-CHP, +88237,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,HEALTHPLUS-CHP, +88238,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,HEALTHPLUS-CHP, +88239,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,HEALTHPLUS-CHP, +88240,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,HEALTHPLUS-CHP, +88241,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,HEALTHPLUS-CHP, +88242,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,HEALTHPLUS-CHP, +88243,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,HEALTHPLUS-CHP, +88244,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,HEALTHPLUS-CHP, +88245,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,HEALTHPLUS-CHP, +88246,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,HEALTHPLUS-CHP, +88247,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,HEALTHPLUS-CHP, +88248,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,HEALTHPLUS-CHP, +88249,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,HEALTHPLUS-CHP, +88250,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,HEALTHPLUS-CHP, +88251,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,HEALTHPLUS-CHP, +88252,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,HEALTHPLUS-CHP, +88253,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,HEALTHPLUS-CHP, +88254,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,HEALTHPLUS-CHP, +88255,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,HEALTHPLUS-CHP, +88256,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,HEALTHPLUS-CHP, +88257,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,HEALTHPLUS-CHP, +88258,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,HEALTHPLUS-CHP, +88259,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,HEALTHPLUS-CHP, +88260,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,HEALTHPLUS-CHP, +88261,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,HEALTHPLUS-CHP, +88262,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,HEALTHPLUS-CHP, +88263,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,HEALTHPLUS-CHP, +88264,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,HEALTHPLUS-CHP,3378.34 +88265,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,HEALTHPLUS-CHP, +88266,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,HEALTHPLUS-CHP, +88267,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,HEALTHPLUS-CHP, +88268,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,HEALTHPLUS-CHP, +88269,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,HEALTHPLUS-CHP, +88270,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,HEALTHPLUS-CHP,299.81 +88271,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,HEALTHPLUS-CHP, +88272,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,HEALTHPLUS-CHP, +88273,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,HEALTHPLUS-CHP, +88274,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,HEALTHPLUS-CHP, +88275,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,HEALTHPLUS-CHP, +88276,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,HEALTHPLUS-CHP, +88277,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,HEALTHPLUS-CHP, +88278,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,HEALTHPLUS-CHP, +88279,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,HEALTHPLUS-CHP, +88280,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,HEALTHPLUS-CHP, +88281,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,HEALTHPLUS-CHP, +88282,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,HEALTHPLUS-CHP, +88283,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,HEALTHPLUS-CHP, +88284,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,HEALTHPLUS-CHP, +88285,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,HEALTHPLUS-CHP, +88286,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,HEALTHPLUS-CHP, +88287,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,HEALTHPLUS-CHP, +88288,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,HEALTHPLUS-CHP, +88289,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,HEALTHPLUS-CHP, +88290,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,HEALTHPLUS-CHP, +88291,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,HEALTHPLUS-CHP, +88292,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,HEALTHPLUS-CHP, +88293,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,HEALTHPLUS-CHP, +88294,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,HEALTHPLUS-CHP, +88295,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,HEALTHPLUS-CHP, +88296,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,HEALTHPLUS-CHP, +88297,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,HEALTHPLUS-CHP, +88298,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,HEALTHPLUS-CHP, +88299,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,HEALTHPLUS-CHP, +88300,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,HEALTHPLUS-CHP, +88301,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,HEALTHPLUS-CHP, +88302,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,HEALTHPLUS-CHP, +88303,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,HEALTHPLUS-CHP, +88304,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,HEALTHPLUS-CHP, +88305,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,HEALTHPLUS-CHP, +88306,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,HEALTHPLUS-CHP, +88307,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,HEALTHPLUS-CHP, +88308,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,HEALTHPLUS-CHP, +88309,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,HEALTHPLUS-CHP, +88310,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,HEALTHPLUS-CHP, +88311,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,HEALTHPLUS-CHP, +88312,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,HEALTHPLUS-CHP, +88313,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,HEALTHPLUS-CHP, +88314,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,HEALTHPLUS-CHP, +88315,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,HEALTHPLUS-CHP, +88316,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,HEALTHPLUS-CHP, +88317,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,HEALTHPLUS-CHP, +88318,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,HEALTHPLUS-CHP, +88319,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,HEALTHPLUS-CHP, +88320,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,HEALTHPLUS-CHP, +88321,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,HEALTHPLUS-CHP, +88322,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,HEALTHPLUS-CHP, +88323,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,HEALTHPLUS-CHP, +88324,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,HEALTHPLUS-CHP, +88325,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,HEALTHPLUS-CHP, +88326,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,HEALTHPLUS-CHP, +88327,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,HEALTHPLUS-CHP, +88328,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,HEALTHPLUS-CHP, +88329,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,HEALTHPLUS-CHP, +88330,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,HEALTHPLUS-CHP,589.2 +88331,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,HEALTHPLUS-CHP, +88332,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,HEALTHPLUS-CHP, +88333,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,HEALTHPLUS-CHP, +88334,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,HEALTHPLUS-CHP, +88335,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,HEALTHPLUS-CHP, +88336,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,HEALTHPLUS-CHP, +88337,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,HEALTHPLUS-CHP, +88338,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,HEALTHPLUS-CHP, +88339,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,HEALTHPLUS-CHP, +88340,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,HEALTHPLUS-CHP, +88341,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,HEALTHPLUS-CHP, +88342,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,HEALTHPLUS-CHP, +88343,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,HEALTHPLUS-CHP, +88344,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,HEALTHPLUS-CHP, +88345,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,HEALTHPLUS-CHP, +88346,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,HEALTHPLUS-CHP, +88347,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,HEALTHPLUS-CHP, +88348,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,HEALTHPLUS-CHP, +88349,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,HEALTHPLUS-CHP, +88350,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,HEALTHPLUS-CHP, +88351,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,HEALTHPLUS-CHP, +88352,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,HEALTHPLUS-CHP, +88353,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,HEALTHPLUS-CHP, +88354,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,HEALTHPLUS-CHP, +88355,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,HEALTHPLUS-CHP, +88356,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,HEALTHPLUS-CHP, +88357,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,HEALTHPLUS-CHP, +88358,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,HEALTHPLUS-CHP, +88359,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,HEALTHPLUS-CHP, +88360,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,HEALTHPLUS-CHP, +88361,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,HEALTHPLUS-CHP, +88362,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,HEALTHPLUS-CHP, +88363,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,HEALTHPLUS-CHP, +88364,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,HEALTHPLUS-CHP, +88365,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,HEALTHPLUS-CHP, +88366,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,HEALTHPLUS-CHP, +88367,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,HEALTHPLUS-CHP, +88368,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,HEALTHPLUS-CHP, +88369,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,HEALTHPLUS-CHP, +88370,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,HEALTHPLUS-CHP, +88371,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,HEALTHPLUS-CHP, +88372,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,HEALTHPLUS-CHP, +88373,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,HEALTHPLUS-CHP, +88374,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,HEALTHPLUS-CHP, +88375,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,HEALTHPLUS-CHP, +88376,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,HEALTHPLUS-CHP, +88377,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,HEALTHPLUS-CHP, +88378,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,HEALTHPLUS-CHP, +88379,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,HEALTHPLUS-CHP, +88380,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,HEALTHPLUS-CHP, +88381,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,HEALTHPLUS-CHP, +88382,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,HEALTHPLUS-CHP, +88383,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,HEALTHPLUS-CHP, +88384,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,HEALTHPLUS-CHP, +88385,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,HEALTHPLUS-CHP, +88386,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,HEALTHPLUS-CHP, +88387,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,HEALTHPLUS-CHP, +88388,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,HEALTHPLUS-CHP, +88389,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,HEALTHPLUS-CHP, +88390,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,HEALTHPLUS-CHP, +88391,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,HEALTHPLUS-CHP, +88392,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,HEALTHPLUS-CHP, +88393,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,HEALTHPLUS-CHP, +88394,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,HEALTHPLUS-CHP, +88395,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,HEALTHPLUS-CHP, +88396,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,HEALTHPLUS-CHP, +88397,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,HEALTHPLUS-CHP, +88398,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,HEALTHPLUS-CHP, +88399,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,HEALTHPLUS-CHP, +88400,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,HEALTHPLUS-CHP, +88401,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,HEALTHPLUS-CHP, +88402,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,HEALTHPLUS-CHP, +88403,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,HEALTHPLUS-CHP, +88404,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,HEALTHPLUS-CHP, +88405,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,HEALTHPLUS-CHP, +88406,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,HEALTHPLUS-CHP, +88407,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,HEALTHPLUS-CHP, +88408,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,HEALTHPLUS-CHP, +88409,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,HEALTHPLUS-CHP, +88410,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,HEALTHPLUS-CHP, +88411,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,HEALTHPLUS-CHP, +88412,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,HEALTHPLUS-CHP, +88413,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,HEALTHPLUS-CHP, +88414,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,HEALTHPLUS-CHP,589.2 +88415,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,HEALTHPLUS-CHP, +88416,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,HEALTHPLUS-CHP, +88417,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,HEALTHPLUS-CHP, +88418,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,HEALTHPLUS-CHP, +88419,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,HEALTHPLUS-CHP, +88420,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,HEALTHPLUS-CHP, +88421,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,HEALTHPLUS-CHP, +88422,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,HEALTHPLUS-CHP, +88423,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,HEALTHPLUS-CHP, +88424,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,HEALTHPLUS-CHP, +88425,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,HEALTHPLUS-CHP, +88426,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,HEALTHPLUS-CHP, +88427,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,HEALTHPLUS-CHP, +88428,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,HEALTHPLUS-CHP, +88429,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,HEALTHPLUS-CHP, +88430,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,HEALTHPLUS-CHP, +88431,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,HEALTHPLUS-CHP, +88432,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,HEALTHPLUS-CHP, +88433,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,HEALTHPLUS-CHP, +88434,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,HEALTHPLUS-CHP, +88435,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,HEALTHPLUS-CHP, +88436,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,HEALTHPLUS-CHP, +88437,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,HEALTHPLUS-CHP, +88438,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,HEALTHPLUS-CHP, +88439,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,HEALTHPLUS-CHP, +88440,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,HEALTHPLUS-CHP, +88441,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,HEALTHPLUS-CHP, +88442,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,HEALTHPLUS-CHP, +88443,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,HEALTHPLUS-CHP, +88444,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,HEALTHPLUS-CHP, +88445,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,HEALTHPLUS-CHP, +88446,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,HEALTHPLUS-CHP, +88447,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,HEALTHPLUS-CHP, +88448,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,HEALTHPLUS-CHP, +88449,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,HEALTHPLUS-CHP, +88450,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,HEALTHPLUS-CHP, +88451,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,HEALTHPLUS-CHP, +88452,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,HEALTHPLUS-CHP, +88453,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,HEALTHPLUS-CHP, +88454,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,HEALTHPLUS-CHP, +88455,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,HEALTHPLUS-CHP, +88456,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,HEALTHPLUS-CHP, +88457,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,HEALTHPLUS-CHP, +88458,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,HEALTHPLUS-CHP, +88459,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,HEALTHPLUS-CHP, +88460,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,HEALTHPLUS-CHP, +88461,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,HEALTHPLUS-CHP, +88462,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,HEALTHPLUS-CHP, +88463,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,HEALTHPLUS-CHP, +88464,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,HEALTHPLUS-CHP, +88465,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,HEALTHPLUS-CHP, +88466,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,HEALTHPLUS-CHP, +88467,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,HEALTHPLUS-CHP, +88468,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,HEALTHPLUS-CHP, +88469,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,HEALTHPLUS-CHP, +88470,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,HEALTHPLUS-CHP, +88471,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,HEALTHPLUS-CHP, +88472,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,HEALTHPLUS-CHP, +88473,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,HEALTHPLUS-CHP, +88474,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,HEALTHPLUS-CHP, +88475,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,HEALTHPLUS-CHP, +88476,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,HEALTHPLUS-CHP, +88477,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,HEALTHPLUS-CHP, +88478,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,HEALTHPLUS-CHP, +88479,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,HEALTHPLUS-CHP, +88480,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,HEALTHPLUS-CHP, +88481,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,HEALTHPLUS-CHP, +88482,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,HEALTHPLUS-CHP, +88483,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,HEALTHPLUS-CHP, +88484,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,HEALTHPLUS-CHP, +88485,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,HEALTHPLUS-CHP, +88486,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,HEALTHPLUS-CHP, +88487,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,HEALTHPLUS-CHP, +88488,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,HEALTHPLUS-CHP, +88489,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,HEALTHPLUS-CHP, +88490,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,HEALTHPLUS-CHP, +88491,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,HEALTHPLUS-CHP, +88492,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,HEALTHPLUS-CHP, +88493,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,HEALTHPLUS-CHP, +88494,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,HEALTHPLUS-CHP, +88495,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,HEALTHPLUS-CHP, +88496,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,HEALTHPLUS-CHP, +88497,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,HEALTHPLUS-CHP, +88498,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,HEALTHPLUS-CHP, +88499,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,HEALTHPLUS-CHP,99.49 +88500,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,HEALTHPLUS-CHP,258.96 +88501,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,HEALTHPLUS-CHP, +88502,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,HEALTHPLUS-CHP, +88503,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,HEALTHPLUS-CHP, +88504,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,HEALTHPLUS-CHP, +88505,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,HEALTHPLUS-CHP, +88506,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,HEALTHPLUS-CHP,258.96 +88507,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,HEALTHPLUS-CHP,60.15 +88508,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,HEALTHPLUS-CHP, +88509,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,HEALTHPLUS-CHP, +88510,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,HEALTHPLUS-CHP, +88511,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,HEALTHPLUS-CHP, +88512,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,HEALTHPLUS-CHP, +88513,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,HEALTHPLUS-CHP, +88514,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,HEALTHPLUS-CHP, +88515,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,HEALTHPLUS-CHP, +88516,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,HEALTHPLUS-CHP, +88517,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,HEALTHPLUS-CHP, +88518,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,HEALTHPLUS-CHP, +88519,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,HEALTHPLUS-CHP, +88520,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,HEALTHPLUS-CHP, +88521,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,HEALTHPLUS-CHP, +88522,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,HEALTHPLUS-CHP, +88523,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,HEALTHPLUS-CHP, +88524,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,HEALTHPLUS-CHP, +88525,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,HEALTHPLUS-CHP, +88526,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,HEALTHPLUS-CHP, +88527,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,HEALTHPLUS-CHP, +88528,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,HEALTHPLUS-CHP, +88529,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,HEALTHPLUS-CHP, +88530,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,HEALTHPLUS-CHP, +88531,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,HEALTHPLUS-CHP, +88532,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,HEALTHPLUS-CHP, +88533,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,HEALTHPLUS-CHP, +88534,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,HEALTHPLUS-CHP, +88535,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,HEALTHPLUS-CHP, +88536,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,HEALTHPLUS-CHP, +88537,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,HEALTHPLUS-CHP, +88538,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,HEALTHPLUS-CHP,314.17 +88539,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,HEALTHPLUS-CHP, +88540,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,HEALTHPLUS-CHP, +88541,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,HEALTHPLUS-CHP, +88542,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,HEALTHPLUS-CHP, +88543,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,HEALTHPLUS-CHP,489.49 +88544,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,HEALTHPLUS-CHP, +88545,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,HEALTHPLUS-CHP, +88546,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,HEALTHPLUS-CHP, +88547,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,HEALTHPLUS-CHP, +88548,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,HEALTHPLUS-CHP, +88549,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,HEALTHPLUS-CHP, +88550,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,HEALTHPLUS-CHP, +88551,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,HEALTHPLUS-CHP, +88552,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,HEALTHPLUS-CHP, +88553,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,HEALTHPLUS-CHP, +88554,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,HEALTHPLUS-CHP, +88555,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,HEALTHPLUS-CHP, +88556,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,HEALTHPLUS-CHP, +88557,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,HEALTHPLUS-CHP, +88558,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,HEALTHPLUS-CHP, +88559,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,HEALTHPLUS-CHP, +88560,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,HEALTHPLUS-CHP, +88561,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,HEALTHPLUS-CHP, +88562,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,HEALTHPLUS-CHP, +88563,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,HEALTHPLUS-CHP, +88564,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,HEALTHPLUS-CHP, +88565,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,HEALTHPLUS-CHP, +88566,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,HEALTHPLUS-CHP, +88567,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,HEALTHPLUS-CHP, +88568,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,HEALTHPLUS-CHP, +88569,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,HEALTHPLUS-CHP, +88570,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,HEALTHPLUS-CHP, +88571,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,HEALTHPLUS-CHP, +88572,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,HEALTHPLUS-CHP, +88573,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,HEALTHPLUS-CHP, +88574,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,HEALTHPLUS-CHP, +88575,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,HEALTHPLUS-CHP, +88576,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,HEALTHPLUS-CHP, +88577,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,HEALTHPLUS-CHP, +88578,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,HEALTHPLUS-CHP, +88579,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,HEALTHPLUS-CHP, +88580,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,HEALTHPLUS-CHP, +88581,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,HEALTHPLUS-CHP, +88582,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,HEALTHPLUS-CHP, +88583,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,HEALTHPLUS-CHP, +88584,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,HEALTHPLUS-CHP, +88585,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,HEALTHPLUS-CHP, +88586,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,HEALTHPLUS-CHP, +88587,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,HEALTHPLUS-CHP, +88588,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,HEALTHPLUS-CHP, +88589,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,HEALTHPLUS-CHP, +88590,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,HEALTHPLUS-CHP, +88591,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,HEALTHPLUS-CHP, +88592,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,HEALTHPLUS-CHP, +88593,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,HEALTHPLUS-CHP, +88594,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,HEALTHPLUS-CHP, +88595,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,HEALTHPLUS-CHP, +88596,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,HEALTHPLUS-CHP, +88597,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,HEALTHPLUS-CHP, +88598,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,HEALTHPLUS-CHP, +88599,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,HEALTHPLUS-CHP, +88600,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,HEALTHPLUS-CHP, +88601,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,HEALTHPLUS-CHP, +88602,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,HEALTHPLUS-CHP, +88603,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,HEALTHPLUS-CHP, +88604,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,HEALTHPLUS-CHP, +88605,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,HEALTHPLUS-CHP, +88606,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,HEALTHPLUS-CHP, +88607,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,HEALTHPLUS-CHP, +88608,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,HEALTHPLUS-CHP, +88609,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,HEALTHPLUS-CHP, +88610,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,HEALTHPLUS-CHP, +88611,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,HEALTHPLUS-CHP, +88612,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,HEALTHPLUS-CHP, +88613,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,HEALTHPLUS-CHP, +88614,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,HEALTHPLUS-CHP, +88615,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,HEALTHPLUS-CHP, +88616,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,HEALTHPLUS-CHP, +88617,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,HEALTHPLUS-CHP, +88618,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,HEALTHPLUS-CHP, +88619,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,HEALTHPLUS-CHP, +88620,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,HEALTHPLUS-CHP, +88621,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,HEALTHPLUS-CHP, +88622,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,HEALTHPLUS-CHP, +88623,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,HEALTHPLUS-CHP, +88624,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,HEALTHPLUS-CHP, +88625,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,HEALTHPLUS-CHP, +88626,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,HEALTHPLUS-CHP, +88627,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,HEALTHPLUS-CHP, +88628,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,HEALTHPLUS-CHP, +88629,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,HEALTHPLUS-CHP, +88630,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,HEALTHPLUS-CHP, +88631,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,HEALTHPLUS-CHP, +88632,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,HEALTHPLUS-CHP, +88633,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,HEALTHPLUS-CHP, +88634,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,HEALTHPLUS-CHP, +88635,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,HEALTHPLUS-CHP, +88636,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,HEALTHPLUS-CHP, +88637,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,HEALTHPLUS-CHP, +88638,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,HEALTHPLUS-CHP, +88639,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,HEALTHPLUS-CHP, +88640,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,HEALTHPLUS-CHP, +88641,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,HEALTHPLUS-CHP, +88642,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,HEALTHPLUS-CHP, +88643,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,HEALTHPLUS-CHP, +88644,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,HEALTHPLUS-CHP, +88645,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,HEALTHPLUS-CHP, +88646,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,HEALTHPLUS-CHP, +88647,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,HEALTHPLUS-CHP, +88648,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,HEALTHPLUS-CHP, +88649,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,HEALTHPLUS-CHP, +88650,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,HEALTHPLUS-CHP, +88651,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,HEALTHPLUS-CHP, +88652,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,HEALTHPLUS-CHP, +88653,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,HEALTHPLUS-CHP, +88654,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,HEALTHPLUS-CHP, +88655,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,HEALTHPLUS-CHP, +88656,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,HEALTHPLUS-CHP, +88657,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,HEALTHPLUS-CHP, +88658,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,HEALTHPLUS-CHP, +88659,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,HEALTHPLUS-CHP, +88660,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,HEALTHPLUS-CHP, +88661,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,HEALTHPLUS-CHP, +88662,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,HEALTHPLUS-CHP, +88663,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,HEALTHPLUS-CHP, +88664,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,HEALTHPLUS-CHP, +88665,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,HEALTHPLUS-CHP, +88666,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,HEALTHPLUS-CHP, +88667,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,HEALTHPLUS-CHP, +88668,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,HEALTHPLUS-CHP, +88669,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,HEALTHPLUS-CHP, +88670,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,HEALTHPLUS-CHP, +88671,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,HEALTHPLUS-CHP, +88672,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,HEALTHPLUS-CHP, +88673,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,HEALTHPLUS-CHP, +88674,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,HEALTHPLUS-CHP, +88675,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,HEALTHPLUS-CHP, +88676,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,HEALTHPLUS-CHP, +88677,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,HEALTHPLUS-CHP, +88678,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,HEALTHPLUS-CHP, +88679,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,HEALTHPLUS-CHP, +88680,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,HEALTHPLUS-CHP, +88681,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,HEALTHPLUS-CHP, +88682,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,HEALTHPLUS-CHP, +88683,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,HEALTHPLUS-CHP, +88684,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,HEALTHPLUS-CHP, +88685,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,HEALTHPLUS-CHP, +88686,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,HEALTHPLUS-CHP, +88687,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,HEALTHPLUS-CHP, +88688,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,HEALTHPLUS-CHP, +88689,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,HEALTHPLUS-CHP, +88690,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,HEALTHPLUS-CHP, +88691,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,HEALTHPLUS-CHP, +88692,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,HEALTHPLUS-CHP, +88693,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,HEALTHPLUS-CHP, +88694,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,HEALTHPLUS-CHP, +88695,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,HEALTHPLUS-CHP, +88696,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,HEALTHPLUS-CHP, +88697,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,HEALTHPLUS-CHP, +88698,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,HEALTHPLUS-CHP, +88699,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,HEALTHPLUS-CHP,8.68 +88700,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,HEALTHPLUS-CHP,41.06 +88701,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,HEALTHPLUS-CHP, +88702,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,HEALTHPLUS-CHP, +88703,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,HEALTHPLUS-CHP, +88704,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,HEALTHPLUS-CHP, +88705,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,HEALTHPLUS-CHP, +88706,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,HEALTHPLUS-CHP, +88707,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,HEALTHPLUS-CHP, +88708,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,HEALTHPLUS-CHP, +88709,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,HEALTHPLUS-CHP, +88710,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,HEALTHPLUS-CHP, +88711,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,HEALTHPLUS-CHP, +88712,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,HEALTHPLUS-CHP, +88713,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,HEALTHPLUS-CHP, +88714,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,HEALTHPLUS-CHP, +88715,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,HEALTHPLUS-CHP, +88716,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,HEALTHPLUS-CHP, +88717,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,HEALTHPLUS-CHP, +88718,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,HEALTHPLUS-CHP, +88719,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,HEALTHPLUS-CHP, +88720,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,HEALTHPLUS-CHP, +88721,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,HEALTHPLUS-CHP,81.1 +88722,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,HEALTHPLUS-CHP, +88723,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,HEALTHPLUS-CHP, +88724,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,HEALTHPLUS-CHP, +88725,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,HEALTHPLUS-CHP, +88726,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,HEALTHPLUS-CHP, +88727,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,HEALTHPLUS-CHP, +88728,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,HEALTHPLUS-CHP, +88729,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,HEALTHPLUS-CHP, +88730,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,HEALTHPLUS-CHP, +88731,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,HEALTHPLUS-CHP, +88732,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,HEALTHPLUS-CHP, +88733,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,HEALTHPLUS-CHP, +88734,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,HEALTHPLUS-CHP, +88735,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,HEALTHPLUS-CHP, +88736,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,HEALTHPLUS-CHP, +88737,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,HEALTHPLUS-CHP, +88738,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,HEALTHPLUS-CHP, +88739,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,HEALTHPLUS-CHP, +88740,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,HEALTHPLUS-CHP, +88741,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,HEALTHPLUS-CHP, +88742,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,HEALTHPLUS-CHP, +88743,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,HEALTHPLUS-CHP, +88744,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,HEALTHPLUS-CHP, +88745,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,HEALTHPLUS-CHP, +88746,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,HEALTHPLUS-CHP, +88747,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,HEALTHPLUS-CHP, +88748,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,HEALTHPLUS-CHP, +88749,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,HEALTHPLUS-CHP, +88750,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,HEALTHPLUS-CHP, +88751,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,HEALTHPLUS-CHP, +88752,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,HEALTHPLUS-CHP, +88753,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,HEALTHPLUS-CHP, +88754,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,HEALTHPLUS-CHP, +88755,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,HEALTHPLUS-CHP, +88756,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,HEALTHPLUS-CHP, +88757,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,HEALTHPLUS-CHP, +88758,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,HEALTHPLUS-CHP, +88759,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,HEALTHPLUS-CHP, +88760,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,HEALTHPLUS-CHP, +88761,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,HEALTHPLUS-CHP, +88762,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,HEALTHPLUS-CHP, +88763,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,HEALTHPLUS-CHP, +88764,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,HEALTHPLUS-CHP, +88765,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,HEALTHPLUS-CHP, +88766,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,HEALTHPLUS-CHP, +88767,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,HEALTHPLUS-CHP, +88768,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,HEALTHPLUS-CHP, +88769,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,HEALTHPLUS-CHP, +88770,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,HEALTHPLUS-CHP, +88771,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,HEALTHPLUS-CHP, +88772,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,HEALTHPLUS-CHP, +88773,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,HEALTHPLUS-CHP, +88774,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,HEALTHPLUS-CHP, +88775,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,HEALTHPLUS-CHP, +88776,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,HEALTHPLUS-CHP, +88777,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,HEALTHPLUS-CHP, +88778,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,HEALTHPLUS-CHP, +88779,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-CHP, +88780,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-CHP, +88781,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,HEALTHPLUS-CHP, +88782,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,HEALTHPLUS-CHP, +88783,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,HEALTHPLUS-CHP, +88784,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,HEALTHPLUS-CHP, +88785,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,HEALTHPLUS-CHP, +88786,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,HEALTHPLUS-CHP, +88787,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,HEALTHPLUS-CHP, +88788,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,HEALTHPLUS-CHP, +88789,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,HEALTHPLUS-CHP, +88790,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,HEALTHPLUS-CHP, +88791,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,HEALTHPLUS-CHP, +88792,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,HEALTHPLUS-CHP, +88793,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,HEALTHPLUS-CHP, +88794,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,HEALTHPLUS-CHP, +88795,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,HEALTHPLUS-CHP, +88796,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,HEALTHPLUS-CHP, +88797,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,HEALTHPLUS-CHP, +88798,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,HEALTHPLUS-CHP, +88799,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,HEALTHPLUS-CHP, +88800,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,HEALTHPLUS-CHP, +88801,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,HEALTHPLUS-CHP, +88802,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,HEALTHPLUS-CHP, +88803,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,HEALTHPLUS-CHP, +88804,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,HEALTHPLUS-CHP, +88805,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,HEALTHPLUS-CHP, +88806,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,HEALTHPLUS-CHP, +88807,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,HEALTHPLUS-CHP, +88808,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,HEALTHPLUS-CHP, +88809,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,HEALTHPLUS-CHP, +88810,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,HEALTHPLUS-CHP, +88811,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,HEALTHPLUS-CHP, +88812,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,HEALTHPLUS-CHP, +88813,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,HEALTHPLUS-CHP, +88814,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,HEALTHPLUS-CHP, +88815,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,HEALTHPLUS-CHP, +88816,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,HEALTHPLUS-CHP, +88817,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,HEALTHPLUS-CHP, +88818,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,HEALTHPLUS-CHP, +88819,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,HEALTHPLUS-CHP, +88820,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,HEALTHPLUS-CHP, +88821,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,HEALTHPLUS-CHP, +88822,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,HEALTHPLUS-CHP, +88823,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,HEALTHPLUS-CHP, +88824,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,HEALTHPLUS-CHP, +88825,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,HEALTHPLUS-CHP, +88826,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,HEALTHPLUS-CHP, +88827,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,HEALTHPLUS-CHP, +88828,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,HEALTHPLUS-CHP, +88829,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,HEALTHPLUS-CHP, +88830,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,HEALTHPLUS-CHP, +88831,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,HEALTHPLUS-CHP, +88832,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,HEALTHPLUS-CHP, +88833,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,HEALTHPLUS-CHP, +88834,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,HEALTHPLUS-CHP, +88835,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,HEALTHPLUS-CHP, +88836,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,HEALTHPLUS-CHP, +88837,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,HEALTHPLUS-CHP, +88838,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,HEALTHPLUS-CHP, +88839,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,HEALTHPLUS-CHP, +88840,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,HEALTHPLUS-CHP, +88841,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,HEALTHPLUS-CHP, +88842,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,HEALTHPLUS-CHP, +88843,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,HEALTHPLUS-CHP, +88844,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,HEALTHPLUS-CHP, +88845,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,HEALTHPLUS-CHP, +88846,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,HEALTHPLUS-CHP, +88847,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,HEALTHPLUS-CHP, +88848,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,HEALTHPLUS-CHP, +88849,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,HEALTHPLUS-CHP, +88850,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,HEALTHPLUS-CHP, +88851,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,HEALTHPLUS-CHP, +88852,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,HEALTHPLUS-CHP, +88853,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,HEALTHPLUS-CHP, +88854,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,HEALTHPLUS-CHP, +88855,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,HEALTHPLUS-CHP, +88856,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,HEALTHPLUS-CHP, +88857,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,HEALTHPLUS-CHP, +88858,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,HEALTHPLUS-CHP, +88859,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,HEALTHPLUS-CHP, +88860,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,HEALTHPLUS-CHP, +88861,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,HEALTHPLUS-CHP, +88862,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,HEALTHPLUS-CHP, +88863,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,HEALTHPLUS-CHP, +88864,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,HEALTHPLUS-CHP, +88865,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,HEALTHPLUS-CHP, +88866,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,HEALTHPLUS-CHP, +88867,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,HEALTHPLUS-CHP, +88868,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,HEALTHPLUS-CHP, +88869,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,HEALTHPLUS-CHP, +88870,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,HEALTHPLUS-CHP, +88871,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,HEALTHPLUS-CHP, +88872,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,HEALTHPLUS-CHP, +88873,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,HEALTHPLUS-CHP, +88874,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,HEALTHPLUS-CHP, +88875,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,HEALTHPLUS-CHP, +88876,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,HEALTHPLUS-CHP, +88877,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,HEALTHPLUS-CHP, +88878,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,HEALTHPLUS-CHP, +88879,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,HEALTHPLUS-CHP, +88880,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,HEALTHPLUS-CHP, +88881,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,HEALTHPLUS-CHP, +88882,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,HEALTHPLUS-CHP,898.13 +88883,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,HEALTHPLUS-CHP, +88884,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,HEALTHPLUS-CHP, +88885,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,HEALTHPLUS-CHP, +88886,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,HEALTHPLUS-CHP, +88887,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,HEALTHPLUS-CHP, +88888,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,HEALTHPLUS-CHP, +88889,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,HEALTHPLUS-CHP, +88890,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,HEALTHPLUS-CHP, +88891,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,HEALTHPLUS-CHP, +88892,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,HEALTHPLUS-CHP, +88893,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,HEALTHPLUS-CHP, +88894,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,HEALTHPLUS-CHP, +88895,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,HEALTHPLUS-CHP, +88896,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,HEALTHPLUS-CHP, +88897,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,HEALTHPLUS-CHP, +88898,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,HEALTHPLUS-CHP, +88899,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,HEALTHPLUS-CHP, +88900,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,HEALTHPLUS-CHP, +88901,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,HEALTHPLUS-CHP, +88902,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,HEALTHPLUS-CHP, +88903,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,HEALTHPLUS-CHP, +88904,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,HEALTHPLUS-CHP, +88905,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,HEALTHPLUS-CHP, +88906,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,HEALTHPLUS-CHP, +88907,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,HEALTHPLUS-CHP, +88908,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,HEALTHPLUS-CHP, +88909,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,HEALTHPLUS-CHP, +88910,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,HEALTHPLUS-CHP, +88911,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,HEALTHPLUS-CHP, +88912,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,HEALTHPLUS-CHP, +88913,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,HEALTHPLUS-CHP, +88914,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,HEALTHPLUS-CHP, +88915,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,HEALTHPLUS-CHP, +88916,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,HEALTHPLUS-CHP, +88917,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,HEALTHPLUS-CHP, +88918,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,HEALTHPLUS-CHP, +88919,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,HEALTHPLUS-CHP, +88920,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,HEALTHPLUS-CHP, +88921,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,HEALTHPLUS-CHP, +88922,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,HEALTHPLUS-CHP, +88923,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,HEALTHPLUS-CHP, +88924,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,HEALTHPLUS-CHP, +88925,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,HEALTHPLUS-CHP, +88926,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,HEALTHPLUS-CHP, +88927,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,HEALTHPLUS-CHP, +88928,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,HEALTHPLUS-CHP, +88929,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,HEALTHPLUS-CHP, +88930,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,HEALTHPLUS-CHP, +88931,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,HEALTHPLUS-CHP, +88932,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,HEALTHPLUS-CHP, +88933,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,HEALTHPLUS-CHP, +88934,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,HEALTHPLUS-CHP, +88935,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,HEALTHPLUS-CHP, +88936,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,HEALTHPLUS-CHP, +88937,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,HEALTHPLUS-CHP, +88938,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,HEALTHPLUS-CHP, +88939,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,HEALTHPLUS-CHP, +88940,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,HEALTHPLUS-CHP, +88941,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,HEALTHPLUS-CHP, +88942,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,HEALTHPLUS-CHP, +88943,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,HEALTHPLUS-CHP, +88944,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,HEALTHPLUS-CHP, +88945,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,HEALTHPLUS-CHP, +88946,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,HEALTHPLUS-CHP, +88947,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,HEALTHPLUS-CHP, +88948,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,HEALTHPLUS-CHP, +88949,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,HEALTHPLUS-CHP, +88950,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,HEALTHPLUS-CHP, +88951,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,HEALTHPLUS-CHP, +88952,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,HEALTHPLUS-CHP, +88953,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,HEALTHPLUS-CHP, +88954,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,HEALTHPLUS-CHP, +88955,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,HEALTHPLUS-CHP, +88956,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,HEALTHPLUS-CHP, +88957,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,HEALTHPLUS-CHP, +88958,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,HEALTHPLUS-CHP, +88959,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,HEALTHPLUS-CHP, +88960,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,HEALTHPLUS-CHP, +88961,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,HEALTHPLUS-CHP, +88962,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,HEALTHPLUS-CHP, +88963,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,HEALTHPLUS-CHP, +88964,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,HEALTHPLUS-CHP, +88965,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,HEALTHPLUS-CHP, +88966,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,HEALTHPLUS-CHP, +88967,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,HEALTHPLUS-CHP, +88968,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,HEALTHPLUS-CHP, +88969,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,HEALTHPLUS-CHP, +88970,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,HEALTHPLUS-CHP, +88971,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +88972,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,HEALTHPLUS-CHP, +88973,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,HEALTHPLUS-CHP, +88974,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,HEALTHPLUS-CHP, +88975,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,HEALTHPLUS-CHP, +88976,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,HEALTHPLUS-CHP, +88977,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,HEALTHPLUS-CHP, +88978,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,HEALTHPLUS-CHP, +88979,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,HEALTHPLUS-CHP, +88980,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,HEALTHPLUS-CHP, +88981,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,HEALTHPLUS-CHP, +88982,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,HEALTHPLUS-CHP, +88983,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,HEALTHPLUS-CHP, +88984,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,HEALTHPLUS-CHP, +88985,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,HEALTHPLUS-CHP, +88986,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,HEALTHPLUS-CHP, +88987,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,HEALTHPLUS-CHP, +88988,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,HEALTHPLUS-CHP, +88989,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,HEALTHPLUS-CHP, +88990,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,HEALTHPLUS-CHP, +88991,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,HEALTHPLUS-CHP, +88992,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,HEALTHPLUS-CHP, +88993,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,HEALTHPLUS-CHP, +88994,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,HEALTHPLUS-CHP, +88995,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,HEALTHPLUS-CHP, +88996,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,HEALTHPLUS-CHP, +88997,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,HEALTHPLUS-CHP, +88998,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,HEALTHPLUS-CHP, +88999,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,HEALTHPLUS-CHP, +89000,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,HEALTHPLUS-CHP, +89001,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,HEALTHPLUS-CHP, +89002,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,HEALTHPLUS-CHP, +89003,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,HEALTHPLUS-CHP, +89004,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,HEALTHPLUS-CHP, +89005,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,HEALTHPLUS-CHP, +89006,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,HEALTHPLUS-CHP, +89007,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,HEALTHPLUS-CHP, +89008,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,HEALTHPLUS-CHP, +89009,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,HEALTHPLUS-CHP, +89010,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,HEALTHPLUS-CHP, +89011,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,HEALTHPLUS-CHP, +89012,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,HEALTHPLUS-CHP, +89013,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,HEALTHPLUS-CHP, +89014,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,HEALTHPLUS-CHP, +89015,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,HEALTHPLUS-CHP, +89016,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,HEALTHPLUS-CHP, +89017,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,HEALTHPLUS-CHP, +89018,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,HEALTHPLUS-CHP, +89019,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,HEALTHPLUS-CHP, +89020,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,HEALTHPLUS-CHP, +89021,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,HEALTHPLUS-CHP, +89022,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,HEALTHPLUS-CHP, +89023,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,HEALTHPLUS-CHP, +89024,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,HEALTHPLUS-CHP, +89025,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,HEALTHPLUS-CHP, +89026,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,HEALTHPLUS-CHP, +89027,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,HEALTHPLUS-CHP, +89028,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,HEALTHPLUS-CHP, +89029,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,HEALTHPLUS-CHP, +89030,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,HEALTHPLUS-CHP, +89031,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,HEALTHPLUS-CHP, +89032,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,HEALTHPLUS-CHP, +89033,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,HEALTHPLUS-CHP, +89034,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,HEALTHPLUS-CHP, +89035,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,HEALTHPLUS-CHP, +89036,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,HEALTHPLUS-CHP, +89037,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,HEALTHPLUS-CHP, +89038,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,HEALTHPLUS-CHP, +89039,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,HEALTHPLUS-CHP, +89040,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,HEALTHPLUS-CHP, +89041,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,HEALTHPLUS-CHP, +89042,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,HEALTHPLUS-CHP, +89043,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,HEALTHPLUS-CHP, +89044,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,HEALTHPLUS-CHP, +89045,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,HEALTHPLUS-CHP, +89046,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,HEALTHPLUS-CHP, +89047,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,HEALTHPLUS-CHP, +89048,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,HEALTHPLUS-CHP, +89049,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,HEALTHPLUS-CHP, +89050,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,HEALTHPLUS-CHP, +89051,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,HEALTHPLUS-CHP, +89052,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,HEALTHPLUS-CHP, +89053,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,HEALTHPLUS-CHP, +89054,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,HEALTHPLUS-CHP, +89055,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,HEALTHPLUS-CHP, +89056,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,HEALTHPLUS-CHP, +89057,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,HEALTHPLUS-CHP, +89058,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,HEALTHPLUS-CHP, +89059,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,HEALTHPLUS-CHP, +89060,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,HEALTHPLUS-CHP, +89061,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,HEALTHPLUS-CHP, +89062,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,HEALTHPLUS-CHP, +89063,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,HEALTHPLUS-CHP, +89064,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,HEALTHPLUS-CHP, +89065,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,HEALTHPLUS-CHP, +89066,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,HEALTHPLUS-CHP, +89067,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,HEALTHPLUS-CHP, +89068,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,HEALTHPLUS-CHP, +89069,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,HEALTHPLUS-CHP, +89070,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,HEALTHPLUS-CHP, +89071,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,HEALTHPLUS-CHP, +89072,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,HEALTHPLUS-CHP, +89073,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,HEALTHPLUS-CHP, +89074,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,HEALTHPLUS-CHP, +89075,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,HEALTHPLUS-CHP, +89076,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,HEALTHPLUS-CHP, +89077,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,HEALTHPLUS-CHP, +89078,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,HEALTHPLUS-CHP, +89079,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,HEALTHPLUS-CHP, +89080,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,HEALTHPLUS-CHP, +89081,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,HEALTHPLUS-CHP, +89082,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,HEALTHPLUS-CHP, +89083,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,HEALTHPLUS-CHP, +89084,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,HEALTHPLUS-CHP, +89085,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,HEALTHPLUS-CHP, +89086,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,HEALTHPLUS-CHP, +89087,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,HEALTHPLUS-CHP, +89088,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,HEALTHPLUS-CHP, +89089,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,HEALTHPLUS-CHP, +89090,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,HEALTHPLUS-CHP, +89091,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,HEALTHPLUS-CHP, +89092,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,HEALTHPLUS-CHP, +89093,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,HEALTHPLUS-CHP, +89094,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,HEALTHPLUS-CHP, +89095,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,HEALTHPLUS-CHP, +89096,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,HEALTHPLUS-CHP, +89097,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,HEALTHPLUS-CHP, +89098,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,HEALTHPLUS-CHP, +89099,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,HEALTHPLUS-CHP, +89100,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,HEALTHPLUS-CHP, +89101,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,HEALTHPLUS-CHP, +89102,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,HEALTHPLUS-CHP, +89103,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,HEALTHPLUS-CHP, +89104,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,HEALTHPLUS-CHP, +89105,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,HEALTHPLUS-CHP, +89106,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,HEALTHPLUS-CHP, +89107,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,HEALTHPLUS-CHP, +89108,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,HEALTHPLUS-CHP, +89109,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,HEALTHPLUS-CHP, +89110,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,HEALTHPLUS-CHP, +89111,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,HEALTHPLUS-CHP, +89112,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,HEALTHPLUS-CHP, +89113,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,HEALTHPLUS-CHP, +89114,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,HEALTHPLUS-CHP, +89115,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,HEALTHPLUS-CHP, +89116,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,HEALTHPLUS-CHP, +89117,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,HEALTHPLUS-CHP, +89118,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,HEALTHPLUS-CHP, +89119,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,HEALTHPLUS-CHP, +89120,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,HEALTHPLUS-CHP, +89121,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,HEALTHPLUS-CHP, +89122,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,HEALTHPLUS-CHP, +89123,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,HEALTHPLUS-CHP, +89124,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,HEALTHPLUS-CHP, +89125,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,HEALTHPLUS-CHP, +89126,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,HEALTHPLUS-CHP, +89127,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,HEALTHPLUS-CHP, +89128,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,HEALTHPLUS-CHP, +89129,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,HEALTHPLUS-CHP, +89130,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,HEALTHPLUS-CHP, +89131,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,HEALTHPLUS-CHP, +89132,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,HEALTHPLUS-CHP, +89133,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,HEALTHPLUS-CHP, +89134,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,HEALTHPLUS-CHP, +89135,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,HEALTHPLUS-CHP, +89136,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,HEALTHPLUS-CHP, +89137,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,HEALTHPLUS-CHP, +89138,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,HEALTHPLUS-CHP, +89139,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,HEALTHPLUS-CHP, +89140,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,HEALTHPLUS-CHP, +89141,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,HEALTHPLUS-CHP, +89142,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,HEALTHPLUS-CHP, +89143,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,HEALTHPLUS-CHP, +89144,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,HEALTHPLUS-CHP, +89145,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,HEALTHPLUS-CHP, +89146,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,HEALTHPLUS-CHP, +89147,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,HEALTHPLUS-CHP, +89148,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,HEALTHPLUS-CHP, +89149,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,HEALTHPLUS-CHP, +89150,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,HEALTHPLUS-CHP, +89151,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,HEALTHPLUS-CHP, +89152,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,HEALTHPLUS-CHP, +89153,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,HEALTHPLUS-CHP, +89154,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,HEALTHPLUS-CHP, +89155,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,HEALTHPLUS-CHP, +89156,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,HEALTHPLUS-CHP, +89157,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,HEALTHPLUS-CHP, +89158,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,HEALTHPLUS-CHP, +89159,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,HEALTHPLUS-CHP, +89160,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,HEALTHPLUS-CHP, +89161,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,HEALTHPLUS-CHP, +89162,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,HEALTHPLUS-CHP, +89163,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,HEALTHPLUS-CHP, +89164,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,HEALTHPLUS-CHP, +89165,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,HEALTHPLUS-CHP, +89166,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,HEALTHPLUS-CHP, +89167,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,HEALTHPLUS-CHP, +89168,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,HEALTHPLUS-CHP, +89169,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,HEALTHPLUS-CHP, +89170,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,HEALTHPLUS-CHP, +89171,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,HEALTHPLUS-CHP, +89172,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,HEALTHPLUS-CHP, +89173,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,HEALTHPLUS-CHP, +89174,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,HEALTHPLUS-CHP, +89175,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,HEALTHPLUS-CHP, +89176,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,HEALTHPLUS-CHP, +89177,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,HEALTHPLUS-CHP, +89178,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,HEALTHPLUS-CHP, +89179,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,HEALTHPLUS-CHP, +89180,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,HEALTHPLUS-CHP, +89181,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,HEALTHPLUS-CHP, +89182,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,HEALTHPLUS-CHP, +89183,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,HEALTHPLUS-CHP, +89184,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,HEALTHPLUS-CHP, +89185,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,HEALTHPLUS-CHP, +89186,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,HEALTHPLUS-CHP, +89187,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,HEALTHPLUS-CHP, +89188,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,HEALTHPLUS-CHP, +89189,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,HEALTHPLUS-CHP, +89190,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,HEALTHPLUS-CHP, +89191,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,HEALTHPLUS-CHP, +89192,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,HEALTHPLUS-CHP, +89193,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,HEALTHPLUS-CHP, +89194,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,HEALTHPLUS-CHP, +89195,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,HEALTHPLUS-CHP, +89196,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,HEALTHPLUS-CHP, +89197,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,HEALTHPLUS-CHP, +89198,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,HEALTHPLUS-CHP, +89199,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,HEALTHPLUS-CHP, +89200,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,HEALTHPLUS-CHP, +89201,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,HEALTHPLUS-CHP, +89202,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,HEALTHPLUS-CHP, +89203,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,HEALTHPLUS-CHP, +89204,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,HEALTHPLUS-CHP, +89205,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,HEALTHPLUS-CHP, +89206,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,HEALTHPLUS-CHP, +89207,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,HEALTHPLUS-CHP, +89208,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,HEALTHPLUS-CHP, +89209,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,HEALTHPLUS-CHP, +89210,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,HEALTHPLUS-CHP, +89211,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,HEALTHPLUS-CHP, +89212,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,HEALTHPLUS-CHP, +89213,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,HEALTHPLUS-CHP, +89214,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,HEALTHPLUS-CHP, +89215,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,HEALTHPLUS-CHP, +89216,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,HEALTHPLUS-CHP, +89217,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,HEALTHPLUS-CHP, +89218,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,HEALTHPLUS-CHP, +89219,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,HEALTHPLUS-CHP, +89220,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,HEALTHPLUS-CHP, +89221,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,HEALTHPLUS-CHP, +89222,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,HEALTHPLUS-CHP, +89223,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,HEALTHPLUS-CHP, +89224,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,HEALTHPLUS-CHP, +89225,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,HEALTHPLUS-CHP, +89226,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,HEALTHPLUS-CHP, +89227,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,HEALTHPLUS-CHP, +89228,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,HEALTHPLUS-CHP, +89229,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,HEALTHPLUS-CHP, +89230,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,HEALTHPLUS-CHP, +89231,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,HEALTHPLUS-CHP, +89232,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,HEALTHPLUS-CHP, +89233,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,HEALTHPLUS-CHP, +89234,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,HEALTHPLUS-CHP, +89235,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,HEALTHPLUS-CHP, +89236,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,HEALTHPLUS-CHP, +89237,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,HEALTHPLUS-CHP, +89238,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,HEALTHPLUS-CHP, +89239,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,HEALTHPLUS-CHP, +89240,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,HEALTHPLUS-CHP, +89241,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,HEALTHPLUS-CHP, +89242,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,HEALTHPLUS-CHP, +89243,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,HEALTHPLUS-CHP, +89244,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,HEALTHPLUS-CHP, +89245,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,HEALTHPLUS-CHP, +89246,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,HEALTHPLUS-CHP, +89247,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,HEALTHPLUS-CHP, +89248,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,HEALTHPLUS-CHP, +89249,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,HEALTHPLUS-CHP, +89250,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,HEALTHPLUS-CHP, +89251,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,HEALTHPLUS-CHP, +89252,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,HEALTHPLUS-CHP, +89253,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,HEALTHPLUS-CHP, +89254,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,HEALTHPLUS-CHP, +89255,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,HEALTHPLUS-CHP, +89256,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,HEALTHPLUS-CHP, +89257,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,HEALTHPLUS-CHP, +89258,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,HEALTHPLUS-CHP, +89259,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,HEALTHPLUS-CHP, +89260,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,HEALTHPLUS-CHP, +89261,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,HEALTHPLUS-CHP, +89262,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,HEALTHPLUS-CHP, +89263,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,HEALTHPLUS-CHP, +89264,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,HEALTHPLUS-CHP, +89265,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,HEALTHPLUS-CHP, +89266,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,HEALTHPLUS-CHP, +89267,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,HEALTHPLUS-CHP, +89268,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,HEALTHPLUS-CHP, +89269,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,HEALTHPLUS-CHP, +89270,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,HEALTHPLUS-CHP, +89271,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,HEALTHPLUS-CHP, +89272,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,HEALTHPLUS-CHP, +89273,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,HEALTHPLUS-CHP, +89274,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,HEALTHPLUS-CHP, +89275,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,HEALTHPLUS-CHP, +89276,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,HEALTHPLUS-CHP, +89277,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,HEALTHPLUS-CHP, +89278,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,HEALTHPLUS-CHP, +89279,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,HEALTHPLUS-CHP, +89280,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,HEALTHPLUS-CHP, +89281,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,HEALTHPLUS-CHP, +89282,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,HEALTHPLUS-CHP, +89283,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,HEALTHPLUS-CHP, +89284,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,HEALTHPLUS-CHP, +89285,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,HEALTHPLUS-CHP, +89286,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,HEALTHPLUS-CHP, +89287,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,HEALTHPLUS-CHP, +89288,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,HEALTHPLUS-CHP, +89289,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,HEALTHPLUS-CHP, +89290,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,HEALTHPLUS-CHP, +89291,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,HEALTHPLUS-CHP, +89292,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,HEALTHPLUS-CHP, +89293,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,HEALTHPLUS-CHP, +89294,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,HEALTHPLUS-CHP, +89295,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,HEALTHPLUS-CHP, +89296,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,HEALTHPLUS-CHP, +89297,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,HEALTHPLUS-CHP, +89298,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,HEALTHPLUS-CHP, +89299,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,HEALTHPLUS-CHP, +89300,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,HEALTHPLUS-CHP, +89301,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,HEALTHPLUS-CHP, +89302,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,HEALTHPLUS-CHP, +89303,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,HEALTHPLUS-CHP, +89304,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,HEALTHPLUS-CHP, +89305,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,HEALTHPLUS-CHP, +89306,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,HEALTHPLUS-CHP, +89307,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,HEALTHPLUS-CHP, +89308,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,HEALTHPLUS-CHP, +89309,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,HEALTHPLUS-CHP, +89310,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,HEALTHPLUS-CHP, +89311,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,HEALTHPLUS-CHP, +89312,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,HEALTHPLUS-CHP, +89313,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,HEALTHPLUS-CHP, +89314,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,HEALTHPLUS-CHP, +89315,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,HEALTHPLUS-CHP, +89316,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,HEALTHPLUS-CHP, +89317,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,HEALTHPLUS-CHP, +89318,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,HEALTHPLUS-CHP, +89319,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,HEALTHPLUS-CHP, +89320,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,HEALTHPLUS-CHP, +89321,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,HEALTHPLUS-CHP, +89322,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,HEALTHPLUS-CHP, +89323,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,HEALTHPLUS-CHP, +89324,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,HEALTHPLUS-CHP, +89325,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,HEALTHPLUS-CHP, +89326,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +89327,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,HEALTHPLUS-CHP, +89328,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,HEALTHPLUS-CHP, +89329,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,HEALTHPLUS-CHP, +89330,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,HEALTHPLUS-CHP, +89331,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +89332,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +89333,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,HEALTHPLUS-CHP, +89334,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,HEALTHPLUS-CHP, +89335,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,HEALTHPLUS-CHP, +89336,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,HEALTHPLUS-CHP, +89337,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,HEALTHPLUS-CHP, +89338,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,HEALTHPLUS-CHP, +89339,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,HEALTHPLUS-CHP, +89340,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,HEALTHPLUS-CHP, +89341,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,HEALTHPLUS-CHP, +89342,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,HEALTHPLUS-CHP, +89343,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,HEALTHPLUS-CHP, +89344,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,HEALTHPLUS-CHP, +89345,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,HEALTHPLUS-CHP, +89346,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,HEALTHPLUS-CHP, +89347,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,HEALTHPLUS-CHP, +89348,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,HEALTHPLUS-CHP, +89349,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,HEALTHPLUS-CHP, +89350,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,HEALTHPLUS-CHP, +89351,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,HEALTHPLUS-CHP, +89352,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,HEALTHPLUS-CHP, +89353,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,HEALTHPLUS-CHP, +89354,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,HEALTHPLUS-CHP, +89355,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,HEALTHPLUS-CHP, +89356,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,HEALTHPLUS-CHP, +89357,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,HEALTHPLUS-CHP, +89358,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,HEALTHPLUS-CHP, +89359,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,HEALTHPLUS-CHP, +89360,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,HEALTHPLUS-CHP, +89361,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,HEALTHPLUS-CHP, +89362,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,HEALTHPLUS-CHP, +89363,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,HEALTHPLUS-CHP, +89364,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,HEALTHPLUS-CHP, +89365,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,HEALTHPLUS-CHP, +89366,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,HEALTHPLUS-CHP, +89367,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,HEALTHPLUS-CHP, +89368,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +89369,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,HEALTHPLUS-CHP, +89370,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,HEALTHPLUS-CHP, +89371,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,HEALTHPLUS-CHP, +89372,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,HEALTHPLUS-CHP, +89373,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,HEALTHPLUS-CHP, +89374,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,HEALTHPLUS-CHP, +89375,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,HEALTHPLUS-CHP, +89376,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,HEALTHPLUS-CHP, +89377,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,HEALTHPLUS-CHP, +89378,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,HEALTHPLUS-CHP, +89379,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,HEALTHPLUS-CHP, +89380,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,HEALTHPLUS-CHP, +89381,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,HEALTHPLUS-CHP, +89382,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,HEALTHPLUS-CHP, +89383,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,HEALTHPLUS-CHP, +89384,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,HEALTHPLUS-CHP, +89385,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,HEALTHPLUS-CHP, +89386,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,HEALTHPLUS-CHP, +89387,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,HEALTHPLUS-CHP, +89388,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,HEALTHPLUS-CHP, +89389,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,HEALTHPLUS-CHP, +89390,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,HEALTHPLUS-CHP, +89391,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,HEALTHPLUS-CHP, +89392,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,HEALTHPLUS-CHP, +89393,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,HEALTHPLUS-CHP, +89394,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,HEALTHPLUS-CHP, +89395,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,HEALTHPLUS-CHP, +89396,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,HEALTHPLUS-CHP, +89397,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,HEALTHPLUS-CHP, +89398,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,HEALTHPLUS-CHP, +89399,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,HEALTHPLUS-CHP, +89400,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,HEALTHPLUS-CHP, +89401,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,HEALTHPLUS-CHP, +89402,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,HEALTHPLUS-CHP, +89403,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,HEALTHPLUS-CHP, +89404,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,HEALTHPLUS-CHP, +89405,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,HEALTHPLUS-CHP, +89406,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,HEALTHPLUS-CHP, +89407,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,HEALTHPLUS-CHP, +89408,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,HEALTHPLUS-CHP, +89409,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,HEALTHPLUS-CHP, +89410,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,HEALTHPLUS-CHP, +89411,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,HEALTHPLUS-CHP, +89412,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,HEALTHPLUS-CHP, +89413,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,HEALTHPLUS-CHP, +89414,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,HEALTHPLUS-CHP, +89415,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,HEALTHPLUS-CHP, +89416,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,HEALTHPLUS-CHP, +89417,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,HEALTHPLUS-CHP, +89418,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,HEALTHPLUS-CHP, +89419,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,HEALTHPLUS-CHP, +89420,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,HEALTHPLUS-CHP, +89421,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,HEALTHPLUS-CHP, +89422,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,HEALTHPLUS-CHP, +89423,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,HEALTHPLUS-CHP, +89424,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,HEALTHPLUS-CHP, +89425,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,HEALTHPLUS-CHP, +89426,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,HEALTHPLUS-CHP, +89427,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,HEALTHPLUS-CHP, +89428,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,HEALTHPLUS-CHP, +89429,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,HEALTHPLUS-CHP, +89430,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,HEALTHPLUS-CHP, +89431,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,HEALTHPLUS-CHP, +89432,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,HEALTHPLUS-CHP, +89433,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,HEALTHPLUS-CHP, +89434,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,HEALTHPLUS-CHP, +89435,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,HEALTHPLUS-CHP, +89436,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,HEALTHPLUS-CHP, +89437,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,HEALTHPLUS-CHP, +89438,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,HEALTHPLUS-CHP, +89439,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,HEALTHPLUS-CHP, +89440,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,HEALTHPLUS-CHP, +89441,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,HEALTHPLUS-CHP, +89442,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,HEALTHPLUS-CHP, +89443,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-CHP, +89444,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,HEALTHPLUS-CHP, +89445,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,HEALTHPLUS-CHP, +89446,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,HEALTHPLUS-CHP, +89447,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,HEALTHPLUS-CHP, +89448,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,HEALTHPLUS-CHP, +89449,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,HEALTHPLUS-CHP, +89450,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,HEALTHPLUS-CHP, +89451,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,HEALTHPLUS-CHP, +89452,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,HEALTHPLUS-CHP, +89453,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,HEALTHPLUS-CHP, +89454,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,HEALTHPLUS-CHP, +89455,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,HEALTHPLUS-CHP, +89456,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,HEALTHPLUS-CHP, +89457,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,HEALTHPLUS-CHP, +89458,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,HEALTHPLUS-CHP, +89459,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,HEALTHPLUS-CHP, +89460,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,HEALTHPLUS-CHP, +89461,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,HEALTHPLUS-CHP, +89462,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,HEALTHPLUS-CHP, +89463,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,HEALTHPLUS-CHP, +89464,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,HEALTHPLUS-CHP, +89465,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,HEALTHPLUS-CHP, +89466,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,HEALTHPLUS-CHP, +89467,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,HEALTHPLUS-CHP, +89468,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,HEALTHPLUS-CHP, +89469,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,HEALTHPLUS-CHP, +89470,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,HEALTHPLUS-CHP, +89471,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,HEALTHPLUS-CHP, +89472,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,HEALTHPLUS-CHP, +89473,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,HEALTHPLUS-CHP, +89474,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,HEALTHPLUS-CHP, +89475,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,HEALTHPLUS-CHP, +89476,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-CHP, +89477,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,HEALTHPLUS-CHP, +89478,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,HEALTHPLUS-CHP, +89479,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,HEALTHPLUS-CHP, +89480,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,HEALTHPLUS-CHP, +89481,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,HEALTHPLUS-CHP, +89482,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,HEALTHPLUS-CHP, +89483,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,HEALTHPLUS-CHP, +89484,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,HEALTHPLUS-CHP, +89485,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,HEALTHPLUS-CHP, +89486,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,HEALTHPLUS-CHP, +89487,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,HEALTHPLUS-CHP, +89488,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,HEALTHPLUS-CHP, +89489,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,HEALTHPLUS-CHP, +89490,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,HEALTHPLUS-CHP, +89491,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,HEALTHPLUS-CHP, +89492,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,HEALTHPLUS-CHP, +89493,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-CHP, +89494,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,HEALTHPLUS-CHP, +89495,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,HEALTHPLUS-CHP, +89496,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,HEALTHPLUS-CHP, +89497,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,HEALTHPLUS-CHP, +89498,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,HEALTHPLUS-CHP, +89499,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,HEALTHPLUS-CHP, +89500,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,HEALTHPLUS-CHP, +89501,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,HEALTHPLUS-CHP, +89502,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,HEALTHPLUS-CHP, +89503,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,HEALTHPLUS-CHP, +89504,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,HEALTHPLUS-CHP, +89505,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,HEALTHPLUS-CHP, +89506,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,HEALTHPLUS-CHP, +89507,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,HEALTHPLUS-CHP, +89508,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,HEALTHPLUS-CHP, +89509,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,HEALTHPLUS-CHP, +89510,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,HEALTHPLUS-CHP, +89511,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,HEALTHPLUS-CHP, +89512,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,HEALTHPLUS-CHP, +89513,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,HEALTHPLUS-CHP, +89514,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,HEALTHPLUS-CHP, +89515,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,HEALTHPLUS-CHP, +89516,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,HEALTHPLUS-CHP, +89517,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,HEALTHPLUS-CHP, +89518,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,HEALTHPLUS-CHP, +89519,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,HEALTHPLUS-CHP, +89520,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,HEALTHPLUS-CHP, +89521,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,HEALTHPLUS-CHP, +89522,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,HEALTHPLUS-CHP, +89523,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,HEALTHPLUS-CHP, +89524,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,HEALTHPLUS-CHP, +89525,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,HEALTHPLUS-CHP, +89526,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,HEALTHPLUS-CHP, +89527,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,HEALTHPLUS-CHP, +89528,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,HEALTHPLUS-CHP, +89529,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,HEALTHPLUS-CHP, +89530,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,HEALTHPLUS-CHP, +89531,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,HEALTHPLUS-CHP, +89532,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,HEALTHPLUS-CHP, +89533,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,HEALTHPLUS-CHP, +89534,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,HEALTHPLUS-CHP, +89535,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,HEALTHPLUS-CHP, +89536,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,HEALTHPLUS-CHP, +89537,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,HEALTHPLUS-CHP, +89538,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,HEALTHPLUS-CHP, +89539,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,HEALTHPLUS-CHP, +89540,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,HEALTHPLUS-CHP, +89541,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,HEALTHPLUS-CHP, +89542,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,HEALTHPLUS-CHP, +89543,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,HEALTHPLUS-CHP, +89544,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,HEALTHPLUS-CHP, +89545,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,HEALTHPLUS-CHP, +89546,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,HEALTHPLUS-CHP, +89547,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,HEALTHPLUS-CHP, +89548,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,HEALTHPLUS-CHP, +89549,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,HEALTHPLUS-CHP, +89550,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,HEALTHPLUS-CHP, +89551,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,HEALTHPLUS-CHP, +89552,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,HEALTHPLUS-CHP, +89553,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,HEALTHPLUS-CHP, +89554,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,HEALTHPLUS-CHP, +89555,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,HEALTHPLUS-CHP, +89556,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,HEALTHPLUS-CHP, +89557,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,HEALTHPLUS-CHP, +89558,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,HEALTHPLUS-CHP, +89559,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,HEALTHPLUS-CHP, +89560,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,HEALTHPLUS-CHP, +89561,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,HEALTHPLUS-CHP, +89562,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,HEALTHPLUS-CHP, +89563,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,HEALTHPLUS-CHP, +89564,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,HEALTHPLUS-CHP, +89565,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,HEALTHPLUS-CHP, +89566,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,HEALTHPLUS-CHP, +89567,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,HEALTHPLUS-CHP, +89568,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,HEALTHPLUS-CHP, +89569,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,HEALTHPLUS-CHP, +89570,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,HEALTHPLUS-CHP, +89571,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,HEALTHPLUS-CHP, +89572,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,HEALTHPLUS-CHP, +89573,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,HEALTHPLUS-CHP, +89574,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,HEALTHPLUS-CHP, +89575,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,HEALTHPLUS-CHP, +89576,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,HEALTHPLUS-CHP, +89577,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,HEALTHPLUS-CHP, +89578,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,HEALTHPLUS-CHP, +89579,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,HEALTHPLUS-CHP, +89580,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,HEALTHPLUS-CHP, +89581,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,HEALTHPLUS-CHP, +89582,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,HEALTHPLUS-CHP, +89583,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,HEALTHPLUS-CHP, +89584,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,HEALTHPLUS-CHP, +89585,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,HEALTHPLUS-CHP, +89586,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,HEALTHPLUS-CHP, +89587,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,HEALTHPLUS-CHP, +89588,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,HEALTHPLUS-CHP, +89589,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,HEALTHPLUS-CHP, +89590,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,HEALTHPLUS-CHP, +89591,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,HEALTHPLUS-CHP, +89592,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,HEALTHPLUS-CHP, +89593,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,HEALTHPLUS-CHP, +89594,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,HEALTHPLUS-CHP, +89595,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,HEALTHPLUS-CHP, +89596,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,HEALTHPLUS-CHP, +89597,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,HEALTHPLUS-CHP, +89598,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,HEALTHPLUS-CHP, +89599,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,HEALTHPLUS-CHP, +89600,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,HEALTHPLUS-CHP, +89601,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,HEALTHPLUS-CHP, +89602,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,HEALTHPLUS-CHP, +89603,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,HEALTHPLUS-CHP, +89604,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,HEALTHPLUS-CHP, +89605,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,HEALTHPLUS-CHP, +89606,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,HEALTHPLUS-CHP, +89607,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,HEALTHPLUS-CHP, +89608,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,HEALTHPLUS-CHP, +89609,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,HEALTHPLUS-CHP, +89610,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,HEALTHPLUS-CHP, +89611,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,HEALTHPLUS-CHP, +89612,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,HEALTHPLUS-CHP, +89613,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,HEALTHPLUS-CHP, +89614,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,HEALTHPLUS-CHP, +89615,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,HEALTHPLUS-CHP, +89616,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,HEALTHPLUS-CHP, +89617,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,HEALTHPLUS-CHP, +89618,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,HEALTHPLUS-CHP, +89619,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,HEALTHPLUS-CHP,1880.0 +89620,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,HEALTHPLUS-CHP, +89621,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,HEALTHPLUS-CHP, +89622,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,HEALTHPLUS-CHP, +89623,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,HEALTHPLUS-CHP, +89624,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,HEALTHPLUS-CHP, +89625,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,HEALTHPLUS-CHP, +89626,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,HEALTHPLUS-CHP, +89627,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,HEALTHPLUS-CHP, +89628,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,HEALTHPLUS-CHP, +89629,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,HEALTHPLUS-CHP, +89630,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,HEALTHPLUS-CHP, +89631,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,HEALTHPLUS-CHP, +89632,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,HEALTHPLUS-CHP, +89633,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,HEALTHPLUS-CHP, +89634,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,HEALTHPLUS-CHP, +89635,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,HEALTHPLUS-CHP, +89636,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,HEALTHPLUS-CHP, +89637,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,HEALTHPLUS-CHP, +89638,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,HEALTHPLUS-CHP, +89639,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,HEALTHPLUS-CHP, +89640,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,HEALTHPLUS-CHP, +89641,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,HEALTHPLUS-CHP, +89642,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,HEALTHPLUS-CHP, +89643,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,HEALTHPLUS-CHP, +89644,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,HEALTHPLUS-CHP, +89645,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,HEALTHPLUS-CHP, +89646,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,HEALTHPLUS-CHP, +89647,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,HEALTHPLUS-CHP, +89648,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,HEALTHPLUS-CHP, +89649,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,HEALTHPLUS-CHP, +89650,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,HEALTHPLUS-CHP, +89651,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,HEALTHPLUS-CHP, +89652,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,HEALTHPLUS-CHP, +89653,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,HEALTHPLUS-CHP, +89654,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,HEALTHPLUS-CHP, +89655,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,HEALTHPLUS-CHP, +89656,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,HEALTHPLUS-CHP, +89657,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,HEALTHPLUS-CHP, +89658,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,HEALTHPLUS-CHP, +89659,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,HEALTHPLUS-CHP, +89660,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,HEALTHPLUS-CHP, +89661,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,HEALTHPLUS-CHP, +89662,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,HEALTHPLUS-CHP, +89663,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,HEALTHPLUS-CHP, +89664,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,HEALTHPLUS-CHP, +89665,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,HEALTHPLUS-CHP, +89666,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,HEALTHPLUS-CHP, +89667,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,HEALTHPLUS-CHP, +89668,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,HEALTHPLUS-CHP, +89669,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,HEALTHPLUS-CHP, +89670,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,HEALTHPLUS-CHP, +89671,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,HEALTHPLUS-CHP, +89672,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,HEALTHPLUS-CHP, +89673,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,HEALTHPLUS-CHP, +89674,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,HEALTHPLUS-CHP, +89675,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,HEALTHPLUS-CHP, +89676,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,HEALTHPLUS-CHP, +89677,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,HEALTHPLUS-CHP, +89678,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,HEALTHPLUS-CHP, +89679,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,HEALTHPLUS-CHP, +89680,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,HEALTHPLUS-CHP, +89681,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,HEALTHPLUS-CHP, +89682,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,HEALTHPLUS-CHP, +89683,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,HEALTHPLUS-CHP, +89684,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,HEALTHPLUS-CHP, +89685,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,HEALTHPLUS-CHP, +89686,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,HEALTHPLUS-CHP, +89687,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,HEALTHPLUS-CHP, +89688,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,HEALTHPLUS-CHP, +89689,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,HEALTHPLUS-CHP, +89690,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,HEALTHPLUS-CHP, +89691,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,HEALTHPLUS-CHP, +89692,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,HEALTHPLUS-CHP, +89693,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,HEALTHPLUS-CHP, +89694,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,HEALTHPLUS-CHP, +89695,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,HEALTHPLUS-CHP, +89696,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,HEALTHPLUS-CHP, +89697,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,HEALTHPLUS-CHP, +89698,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,HEALTHPLUS-CHP, +89699,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,HEALTHPLUS-CHP, +89700,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,HEALTHPLUS-CHP, +89701,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,HEALTHPLUS-CHP, +89702,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,HEALTHPLUS-CHP, +89703,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,HEALTHPLUS-CHP, +89704,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,HEALTHPLUS-CHP, +89705,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,HEALTHPLUS-CHP, +89706,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,HEALTHPLUS-CHP, +89707,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,HEALTHPLUS-CHP, +89708,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,HEALTHPLUS-CHP, +89709,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,HEALTHPLUS-CHP, +89710,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,HEALTHPLUS-CHP, +89711,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,HEALTHPLUS-CHP, +89712,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,HEALTHPLUS-CHP, +89713,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,HEALTHPLUS-CHP, +89714,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,HEALTHPLUS-CHP, +89715,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,HEALTHPLUS-CHP, +89716,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,HEALTHPLUS-CHP, +89717,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,HEALTHPLUS-CHP, +89718,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,HEALTHPLUS-CHP, +89719,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,HEALTHPLUS-CHP, +89720,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,HEALTHPLUS-CHP, +89721,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,HEALTHPLUS-CHP, +89722,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,HEALTHPLUS-CHP, +89723,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,HEALTHPLUS-CHP, +89724,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,HEALTHPLUS-CHP, +89725,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,HEALTHPLUS-CHP, +89726,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,HEALTHPLUS-CHP, +89727,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,HEALTHPLUS-CHP, +89728,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,HEALTHPLUS-CHP, +89729,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,HEALTHPLUS-CHP, +89730,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,HEALTHPLUS-CHP, +89731,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,HEALTHPLUS-CHP, +89732,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,HEALTHPLUS-CHP, +89733,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,HEALTHPLUS-CHP, +89734,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,HEALTHPLUS-CHP, +89735,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,HEALTHPLUS-CHP, +89736,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,HEALTHPLUS-CHP, +89737,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,HEALTHPLUS-CHP, +89738,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,HEALTHPLUS-CHP, +89739,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,HEALTHPLUS-CHP, +89740,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,HEALTHPLUS-CHP, +89741,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,HEALTHPLUS-CHP, +89742,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,HEALTHPLUS-CHP, +89743,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,HEALTHPLUS-CHP, +89744,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,HEALTHPLUS-CHP, +89745,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,HEALTHPLUS-CHP, +89746,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,HEALTHPLUS-CHP, +89747,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,HEALTHPLUS-CHP, +89748,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,HEALTHPLUS-CHP, +89749,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,HEALTHPLUS-CHP, +89750,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,HEALTHPLUS-CHP,569.25 +89751,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,HEALTHPLUS-CHP, +89752,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,HEALTHPLUS-CHP, +89753,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,HEALTHPLUS-CHP, +89754,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,HEALTHPLUS-CHP, +89755,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,HEALTHPLUS-CHP, +89756,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,HEALTHPLUS-CHP, +89757,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,HEALTHPLUS-CHP, +89758,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,HEALTHPLUS-CHP, +89759,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,HEALTHPLUS-CHP, +89760,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,HEALTHPLUS-CHP, +89761,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,HEALTHPLUS-CHP, +89762,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,HEALTHPLUS-CHP, +89763,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,HEALTHPLUS-CHP, +89764,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,HEALTHPLUS-CHP, +89765,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,HEALTHPLUS-CHP, +89766,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,HEALTHPLUS-CHP, +89767,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,HEALTHPLUS-CHP, +89768,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,HEALTHPLUS-CHP, +89769,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,HEALTHPLUS-CHP, +89770,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,HEALTHPLUS-CHP, +89771,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,HEALTHPLUS-CHP, +89772,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,HEALTHPLUS-CHP, +89773,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,HEALTHPLUS-CHP, +89774,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,HEALTHPLUS-CHP, +89775,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,HEALTHPLUS-CHP, +89776,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,HEALTHPLUS-CHP, +89777,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,HEALTHPLUS-CHP, +89778,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,HEALTHPLUS-CHP, +89779,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,HEALTHPLUS-CHP, +89780,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,HEALTHPLUS-CHP, +89781,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,HEALTHPLUS-CHP, +89782,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,HEALTHPLUS-CHP, +89783,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,HEALTHPLUS-CHP, +89784,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,HEALTHPLUS-CHP, +89785,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,HEALTHPLUS-CHP, +89786,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,HEALTHPLUS-CHP, +89787,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,HEALTHPLUS-CHP, +89788,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,HEALTHPLUS-CHP, +89789,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,HEALTHPLUS-CHP, +89790,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,HEALTHPLUS-CHP, +89791,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,HEALTHPLUS-CHP, +89792,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,HEALTHPLUS-CHP, +89793,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,HEALTHPLUS-CHP, +89794,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,HEALTHPLUS-CHP, +89795,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,HEALTHPLUS-CHP, +89796,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,HEALTHPLUS-CHP, +89797,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,HEALTHPLUS-CHP, +89798,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,HEALTHPLUS-CHP, +89799,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,HEALTHPLUS-CHP, +89800,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,HEALTHPLUS-CHP, +89801,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,HEALTHPLUS-CHP, +89802,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,HEALTHPLUS-CHP, +89803,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,HEALTHPLUS-CHP, +89804,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,HEALTHPLUS-CHP, +89805,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,HEALTHPLUS-CHP, +89806,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,HEALTHPLUS-CHP, +89807,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,HEALTHPLUS-CHP, +89808,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,HEALTHPLUS-CHP, +89809,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,HEALTHPLUS-CHP, +89810,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,HEALTHPLUS-CHP, +89811,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,HEALTHPLUS-CHP, +89812,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,HEALTHPLUS-CHP, +89813,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,HEALTHPLUS-CHP, +89814,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,HEALTHPLUS-CHP, +89815,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,HEALTHPLUS-CHP, +89816,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,HEALTHPLUS-CHP, +89817,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,HEALTHPLUS-CHP, +89818,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,HEALTHPLUS-CHP, +89819,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,HEALTHPLUS-CHP, +89820,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,HEALTHPLUS-CHP, +89821,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,HEALTHPLUS-CHP, +89822,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,HEALTHPLUS-CHP, +89823,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,HEALTHPLUS-CHP, +89824,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,HEALTHPLUS-CHP, +89825,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,HEALTHPLUS-CHP, +89826,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,HEALTHPLUS-CHP, +89827,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,HEALTHPLUS-CHP, +89828,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,HEALTHPLUS-CHP, +89829,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,HEALTHPLUS-CHP, +89830,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,HEALTHPLUS-CHP, +89831,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,HEALTHPLUS-CHP, +89832,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,HEALTHPLUS-CHP, +89833,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,HEALTHPLUS-CHP, +89834,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-CHP, +89835,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,HEALTHPLUS-CHP, +89836,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,HEALTHPLUS-CHP, +89837,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,HEALTHPLUS-CHP, +89838,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,HEALTHPLUS-CHP, +89839,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,HEALTHPLUS-CHP, +89840,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,HEALTHPLUS-CHP, +89841,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,HEALTHPLUS-CHP, +89842,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,HEALTHPLUS-CHP, +89843,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,HEALTHPLUS-CHP, +89844,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,HEALTHPLUS-CHP, +89845,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,HEALTHPLUS-CHP, +89846,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,HEALTHPLUS-CHP, +89847,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,HEALTHPLUS-CHP, +89848,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,HEALTHPLUS-CHP, +89849,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,HEALTHPLUS-CHP, +89850,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,HEALTHPLUS-CHP, +89851,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,HEALTHPLUS-CHP, +89852,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,HEALTHPLUS-CHP, +89853,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,HEALTHPLUS-CHP, +89854,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,HEALTHPLUS-CHP, +89855,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,HEALTHPLUS-CHP, +89856,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,HEALTHPLUS-CHP, +89857,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,HEALTHPLUS-CHP, +89858,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,HEALTHPLUS-CHP, +89859,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,HEALTHPLUS-CHP, +89860,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,HEALTHPLUS-CHP, +89861,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,HEALTHPLUS-CHP, +89862,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,HEALTHPLUS-CHP, +89863,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,HEALTHPLUS-CHP, +89864,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,HEALTHPLUS-CHP, +89865,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,HEALTHPLUS-CHP, +89866,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,HEALTHPLUS-CHP, +89867,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,HEALTHPLUS-CHP, +89868,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,HEALTHPLUS-CHP, +89869,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,HEALTHPLUS-CHP, +89870,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,HEALTHPLUS-CHP, +89871,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,HEALTHPLUS-CHP, +89872,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,HEALTHPLUS-CHP, +89873,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,HEALTHPLUS-CHP, +89874,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,HEALTHPLUS-CHP, +89875,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-CHP, +89876,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,HEALTHPLUS-CHP, +89877,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,HEALTHPLUS-CHP, +89878,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,HEALTHPLUS-CHP, +89879,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,HEALTHPLUS-CHP, +89880,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,HEALTHPLUS-CHP, +89881,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,HEALTHPLUS-CHP, +89882,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,HEALTHPLUS-CHP, +89883,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,HEALTHPLUS-CHP, +89884,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,HEALTHPLUS-CHP, +89885,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,HEALTHPLUS-CHP, +89886,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,HEALTHPLUS-CHP, +89887,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,HEALTHPLUS-CHP, +89888,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,HEALTHPLUS-CHP, +89889,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,HEALTHPLUS-CHP, +89890,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,HEALTHPLUS-CHP, +89891,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,HEALTHPLUS-CHP, +89892,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,HEALTHPLUS-CHP, +89893,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,HEALTHPLUS-CHP, +89894,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,HEALTHPLUS-CHP, +89895,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,HEALTHPLUS-CHP, +89896,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-CHP, +89897,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,HEALTHPLUS-CHP, +89898,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,HEALTHPLUS-CHP, +89899,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,HEALTHPLUS-CHP, +89900,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,HEALTHPLUS-CHP, +89901,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,HEALTHPLUS-CHP, +89902,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,HEALTHPLUS-CHP, +89903,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,HEALTHPLUS-CHP, +89904,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,HEALTHPLUS-CHP, +89905,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,HEALTHPLUS-CHP, +89906,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,HEALTHPLUS-CHP, +89907,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,HEALTHPLUS-CHP, +89908,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,HEALTHPLUS-CHP, +89909,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,HEALTHPLUS-CHP, +89910,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,HEALTHPLUS-CHP, +89911,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,HEALTHPLUS-CHP, +89912,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,HEALTHPLUS-CHP, +89913,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,HEALTHPLUS-CHP, +89914,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,HEALTHPLUS-CHP, +89915,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,HEALTHPLUS-CHP, +89916,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,HEALTHPLUS-CHP, +89917,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,HEALTHPLUS-CHP, +89918,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,HEALTHPLUS-CHP, +89919,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,HEALTHPLUS-CHP, +89920,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,HEALTHPLUS-CHP, +89921,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,HEALTHPLUS-CHP, +89922,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,HEALTHPLUS-CHP, +89923,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,HEALTHPLUS-CHP, +89924,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,HEALTHPLUS-CHP, +89925,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,HEALTHPLUS-CHP, +89926,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,HEALTHPLUS-CHP, +89927,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,HEALTHPLUS-CHP, +89928,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,HEALTHPLUS-CHP, +89929,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,HEALTHPLUS-CHP, +89930,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,HEALTHPLUS-CHP, +89931,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,HEALTHPLUS-CHP, +89932,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,HEALTHPLUS-CHP, +89933,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,HEALTHPLUS-CHP, +89934,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,HEALTHPLUS-CHP, +89935,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,HEALTHPLUS-CHP, +89936,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,HEALTHPLUS-CHP, +89937,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,HEALTHPLUS-CHP, +89938,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,HEALTHPLUS-CHP, +89939,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,HEALTHPLUS-CHP,147.75 +89940,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,HEALTHPLUS-CHP, +89941,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,HEALTHPLUS-CHP, +89942,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +89943,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,HEALTHPLUS-CHP, +89944,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,HEALTHPLUS-CHP, +89945,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,HEALTHPLUS-CHP, +89946,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,HEALTHPLUS-CHP, +89947,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,HEALTHPLUS-CHP, +89948,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,HEALTHPLUS-CHP, +89949,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,HEALTHPLUS-CHP, +89950,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,HEALTHPLUS-CHP, +89951,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,HEALTHPLUS-CHP, +89952,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,HEALTHPLUS-CHP, +89953,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,HEALTHPLUS-CHP, +89954,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,HEALTHPLUS-CHP, +89955,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,HEALTHPLUS-CHP, +89956,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,HEALTHPLUS-CHP, +89957,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,HEALTHPLUS-CHP, +89958,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,HEALTHPLUS-CHP, +89959,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,HEALTHPLUS-CHP, +89960,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,HEALTHPLUS-CHP, +89961,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,HEALTHPLUS-CHP, +89962,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,HEALTHPLUS-CHP, +89963,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,HEALTHPLUS-CHP, +89964,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,HEALTHPLUS-CHP, +89965,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,HEALTHPLUS-CHP, +89966,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,HEALTHPLUS-CHP, +89967,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,HEALTHPLUS-CHP, +89968,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,HEALTHPLUS-CHP, +89969,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,HEALTHPLUS-CHP, +89970,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,HEALTHPLUS-CHP, +89971,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,HEALTHPLUS-CHP, +89972,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,HEALTHPLUS-CHP, +89973,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,HEALTHPLUS-CHP, +89974,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,HEALTHPLUS-CHP, +89975,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,HEALTHPLUS-CHP, +89976,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,HEALTHPLUS-CHP, +89977,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,HEALTHPLUS-CHP, +89978,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,HEALTHPLUS-CHP, +89979,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,HEALTHPLUS-CHP, +89980,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,HEALTHPLUS-CHP, +89981,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,HEALTHPLUS-CHP, +89982,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,HEALTHPLUS-CHP, +89983,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,HEALTHPLUS-CHP, +89984,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,HEALTHPLUS-CHP, +89985,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,HEALTHPLUS-CHP, +89986,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,HEALTHPLUS-CHP, +89987,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,HEALTHPLUS-CHP, +89988,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,HEALTHPLUS-CHP, +89989,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,HEALTHPLUS-CHP, +89990,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,HEALTHPLUS-CHP, +89991,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,HEALTHPLUS-CHP, +89992,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,HEALTHPLUS-CHP, +89993,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,HEALTHPLUS-CHP, +89994,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,HEALTHPLUS-CHP, +89995,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,HEALTHPLUS-CHP, +89996,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,HEALTHPLUS-CHP, +89997,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,HEALTHPLUS-CHP, +89998,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,HEALTHPLUS-CHP, +89999,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,HEALTHPLUS-CHP, +90000,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,HEALTHPLUS-CHP, +90001,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-CHP, +90002,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-CHP, +90003,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-CHP, +90004,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-CHP, +90005,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-CHP, +90006,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,HEALTHPLUS-CHP, +90007,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,HEALTHPLUS-CHP, +90008,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,HEALTHPLUS-CHP, +90009,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,HEALTHPLUS-CHP, +90010,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,HEALTHPLUS-CHP, +90011,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,HEALTHPLUS-CHP, +90012,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,HEALTHPLUS-CHP, +90013,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,HEALTHPLUS-CHP, +90014,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,HEALTHPLUS-CHP, +90015,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,HEALTHPLUS-CHP, +90016,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,HEALTHPLUS-CHP, +90017,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,HEALTHPLUS-CHP, +90018,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,HEALTHPLUS-CHP, +90019,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,HEALTHPLUS-CHP, +90020,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,HEALTHPLUS-CHP, +90021,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,HEALTHPLUS-CHP, +90022,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,HEALTHPLUS-CHP, +90023,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,HEALTHPLUS-CHP, +90024,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,HEALTHPLUS-CHP, +90025,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,HEALTHPLUS-CHP, +90026,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,HEALTHPLUS-CHP, +90027,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,HEALTHPLUS-CHP, +90028,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,HEALTHPLUS-CHP, +90029,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,HEALTHPLUS-CHP, +90030,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,HEALTHPLUS-CHP, +90031,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,HEALTHPLUS-CHP, +90032,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,HEALTHPLUS-CHP, +90033,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,HEALTHPLUS-CHP, +90034,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,HEALTHPLUS-CHP, +90035,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,HEALTHPLUS-CHP, +90036,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,HEALTHPLUS-CHP, +90037,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,HEALTHPLUS-CHP, +90038,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,HEALTHPLUS-CHP, +90039,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,HEALTHPLUS-CHP, +90040,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,HEALTHPLUS-CHP, +90041,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,HEALTHPLUS-CHP, +90042,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,HEALTHPLUS-CHP, +90043,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,HEALTHPLUS-CHP, +90044,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,HEALTHPLUS-CHP, +90045,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,HEALTHPLUS-CHP, +90046,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,HEALTHPLUS-CHP, +90047,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,HEALTHPLUS-CHP, +90048,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,HEALTHPLUS-CHP, +90049,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,HEALTHPLUS-CHP, +90050,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,HEALTHPLUS-CHP, +90051,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,HEALTHPLUS-CHP, +90052,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,HEALTHPLUS-CHP, +90053,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,HEALTHPLUS-CHP, +90054,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,HEALTHPLUS-CHP, +90055,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,HEALTHPLUS-CHP, +90056,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,HEALTHPLUS-CHP, +90057,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,HEALTHPLUS-CHP, +90058,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,HEALTHPLUS-CHP, +90059,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,HEALTHPLUS-CHP, +90060,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,HEALTHPLUS-CHP, +90061,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,HEALTHPLUS-CHP, +90062,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,HEALTHPLUS-CHP, +90063,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,HEALTHPLUS-CHP, +90064,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,HEALTHPLUS-CHP, +90065,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,HEALTHPLUS-CHP, +90066,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,HEALTHPLUS-CHP, +90067,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,HEALTHPLUS-CHP, +90068,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,HEALTHPLUS-CHP, +90069,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,HEALTHPLUS-CHP, +90070,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,HEALTHPLUS-CHP, +90071,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,HEALTHPLUS-CHP, +90072,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,HEALTHPLUS-CHP, +90073,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,HEALTHPLUS-CHP, +90074,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,HEALTHPLUS-CHP, +90075,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,HEALTHPLUS-CHP, +90076,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,HEALTHPLUS-CHP, +90077,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,HEALTHPLUS-CHP, +90078,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,HEALTHPLUS-CHP, +90079,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,HEALTHPLUS-CHP, +90080,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,HEALTHPLUS-CHP, +90081,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,HEALTHPLUS-CHP, +90082,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,HEALTHPLUS-CHP, +90083,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,HEALTHPLUS-CHP, +90084,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,HEALTHPLUS-CHP, +90085,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,HEALTHPLUS-CHP, +90086,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,HEALTHPLUS-CHP, +90087,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,HEALTHPLUS-CHP, +90088,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,HEALTHPLUS-CHP, +90089,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,HEALTHPLUS-CHP, +90090,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,HEALTHPLUS-CHP, +90091,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,HEALTHPLUS-CHP, +90092,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,HEALTHPLUS-CHP, +90093,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,HEALTHPLUS-CHP, +90094,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,HEALTHPLUS-CHP, +90095,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,HEALTHPLUS-CHP, +90096,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,HEALTHPLUS-CHP, +90097,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,HEALTHPLUS-CHP, +90098,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,HEALTHPLUS-CHP, +90099,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,HEALTHPLUS-CHP, +90100,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,HEALTHPLUS-CHP, +90101,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,HEALTHPLUS-CHP, +90102,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,HEALTHPLUS-CHP, +90103,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,HEALTHPLUS-CHP, +90104,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,HEALTHPLUS-CHP, +90105,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,HEALTHPLUS-CHP, +90106,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,HEALTHPLUS-CHP, +90107,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,HEALTHPLUS-CHP, +90108,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,HEALTHPLUS-CHP, +90109,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,HEALTHPLUS-CHP, +90110,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,HEALTHPLUS-CHP, +90111,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,HEALTHPLUS-CHP, +90112,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,HEALTHPLUS-CHP, +90113,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,HEALTHPLUS-CHP, +90114,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,HEALTHPLUS-CHP, +90115,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,HEALTHPLUS-CHP, +90116,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,HEALTHPLUS-CHP, +90117,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,HEALTHPLUS-CHP, +90118,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,HEALTHPLUS-CHP, +90119,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,HEALTHPLUS-CHP, +90120,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,HEALTHPLUS-CHP, +90121,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,HEALTHPLUS-CHP, +90122,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,HEALTHPLUS-CHP, +90123,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,HEALTHPLUS-CHP, +90124,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,HEALTHPLUS-CHP, +90125,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,HEALTHPLUS-CHP, +90126,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,HEALTHPLUS-CHP, +90127,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,HEALTHPLUS-CHP, +90128,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,HEALTHPLUS-CHP, +90129,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,HEALTHPLUS-CHP, +90130,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,HEALTHPLUS-CHP, +90131,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,HEALTHPLUS-CHP, +90132,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,HEALTHPLUS-CHP, +90133,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,HEALTHPLUS-CHP, +90134,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,HEALTHPLUS-CHP, +90135,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,HEALTHPLUS-CHP, +90136,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,HEALTHPLUS-CHP, +90137,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,HEALTHPLUS-CHP, +90138,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,HEALTHPLUS-CHP, +90139,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,HEALTHPLUS-CHP, +90140,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,HEALTHPLUS-CHP, +90141,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,HEALTHPLUS-CHP, +90142,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,HEALTHPLUS-CHP, +90143,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,HEALTHPLUS-CHP, +90144,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,HEALTHPLUS-CHP, +90145,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,HEALTHPLUS-CHP, +90146,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,HEALTHPLUS-CHP, +90147,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,HEALTHPLUS-CHP, +90148,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,HEALTHPLUS-CHP, +90149,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,HEALTHPLUS-CHP, +90150,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,HEALTHPLUS-CHP, +90151,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,HEALTHPLUS-CHP, +90152,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,HEALTHPLUS-CHP, +90153,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,HEALTHPLUS-CHP, +90154,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,HEALTHPLUS-CHP, +90155,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,HEALTHPLUS-CHP, +90156,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,HEALTHPLUS-CHP, +90157,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,HEALTHPLUS-CHP, +90158,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,HEALTHPLUS-CHP, +90159,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,HEALTHPLUS-CHP, +90160,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,HEALTHPLUS-CHP, +90161,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,HEALTHPLUS-CHP, +90162,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,HEALTHPLUS-CHP, +90163,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,HEALTHPLUS-CHP, +90164,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,HEALTHPLUS-CHP, +90165,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,HEALTHPLUS-CHP, +90166,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,HEALTHPLUS-CHP, +90167,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,HEALTHPLUS-CHP, +90168,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,HEALTHPLUS-CHP, +90169,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,HEALTHPLUS-CHP, +90170,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,HEALTHPLUS-CHP, +90171,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,HEALTHPLUS-CHP, +90172,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,HEALTHPLUS-CHP, +90173,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,HEALTHPLUS-CHP, +90174,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,HEALTHPLUS-CHP, +90175,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,HEALTHPLUS-CHP, +90176,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,HEALTHPLUS-CHP, +90177,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,HEALTHPLUS-CHP, +90178,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,HEALTHPLUS-CHP, +90179,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,HEALTHPLUS-CHP, +90180,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,HEALTHPLUS-CHP, +90181,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,HEALTHPLUS-CHP, +90182,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,HEALTHPLUS-CHP, +90183,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,HEALTHPLUS-CHP, +90184,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,HEALTHPLUS-CHP, +90185,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,HEALTHPLUS-CHP, +90186,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,HEALTHPLUS-CHP, +90187,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,HEALTHPLUS-CHP, +90188,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,HEALTHPLUS-CHP, +90189,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,HEALTHPLUS-CHP, +90190,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,HEALTHPLUS-CHP, +90191,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,HEALTHPLUS-CHP, +90192,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,HEALTHPLUS-CHP, +90193,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,HEALTHPLUS-CHP, +90194,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,HEALTHPLUS-CHP, +90195,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,HEALTHPLUS-CHP, +90196,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,HEALTHPLUS-CHP, +90197,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,HEALTHPLUS-CHP, +90198,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,HEALTHPLUS-CHP, +90199,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,HEALTHPLUS-CHP, +90200,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,HEALTHPLUS-CHP, +90201,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,HEALTHPLUS-CHP, +90202,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,HEALTHPLUS-CHP, +90203,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,HEALTHPLUS-CHP, +90204,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,HEALTHPLUS-CHP, +90205,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,HEALTHPLUS-CHP, +90206,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,HEALTHPLUS-CHP, +90207,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,HEALTHPLUS-CHP, +90208,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,HEALTHPLUS-CHP, +90209,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,HEALTHPLUS-CHP, +90210,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,HEALTHPLUS-CHP, +90211,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,HEALTHPLUS-CHP, +90212,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,HEALTHPLUS-CHP, +90213,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,HEALTHPLUS-CHP, +90214,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,HEALTHPLUS-CHP, +90215,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,HEALTHPLUS-CHP, +90216,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,HEALTHPLUS-CHP, +90217,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,HEALTHPLUS-CHP, +90218,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,HEALTHPLUS-CHP, +90219,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,HEALTHPLUS-CHP, +90220,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,HEALTHPLUS-CHP, +90221,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,HEALTHPLUS-CHP, +90222,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,HEALTHPLUS-CHP, +90223,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,HEALTHPLUS-CHP, +90224,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,HEALTHPLUS-CHP, +90225,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,HEALTHPLUS-CHP, +90226,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,HEALTHPLUS-CHP, +90227,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,HEALTHPLUS-CHP, +90228,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,HEALTHPLUS-CHP, +90229,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,HEALTHPLUS-CHP, +90230,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,HEALTHPLUS-CHP, +90231,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,HEALTHPLUS-CHP, +90232,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,HEALTHPLUS-CHP, +90233,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,HEALTHPLUS-CHP, +90234,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,HEALTHPLUS-CHP, +90235,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,HEALTHPLUS-CHP, +90236,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,HEALTHPLUS-CHP, +90237,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,HEALTHPLUS-CHP, +90238,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,HEALTHPLUS-CHP, +90239,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,HEALTHPLUS-CHP, +90240,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,HEALTHPLUS-CHP, +90241,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,HEALTHPLUS-CHP, +90242,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,HEALTHPLUS-CHP, +90243,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,HEALTHPLUS-CHP, +90244,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,HEALTHPLUS-CHP, +90245,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,HEALTHPLUS-CHP, +90246,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,HEALTHPLUS-CHP, +90247,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,HEALTHPLUS-CHP, +90248,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,HEALTHPLUS-CHP, +90249,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,HEALTHPLUS-CHP, +90250,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,HEALTHPLUS-CHP, +90251,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,HEALTHPLUS-CHP, +90252,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,HEALTHPLUS-CHP, +90253,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,HEALTHPLUS-CHP, +90254,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,HEALTHPLUS-CHP, +90255,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,HEALTHPLUS-CHP, +90256,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,HEALTHPLUS-CHP, +90257,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,HEALTHPLUS-CHP, +90258,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,HEALTHPLUS-CHP, +90259,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,HEALTHPLUS-CHP, +90260,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,HEALTHPLUS-CHP, +90261,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,HEALTHPLUS-CHP, +90262,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,HEALTHPLUS-CHP, +90263,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,HEALTHPLUS-CHP, +90264,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,HEALTHPLUS-CHP, +90265,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,HEALTHPLUS-CHP, +90266,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,HEALTHPLUS-CHP, +90267,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,HEALTHPLUS-CHP, +90268,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,HEALTHPLUS-CHP, +90269,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,HEALTHPLUS-CHP, +90270,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,HEALTHPLUS-CHP, +90271,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,HEALTHPLUS-CHP, +90272,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,HEALTHPLUS-CHP, +90273,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,HEALTHPLUS-CHP, +90274,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,HEALTHPLUS-CHP, +90275,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,HEALTHPLUS-CHP, +90276,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,HEALTHPLUS-CHP, +90277,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,HEALTHPLUS-CHP, +90278,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,HEALTHPLUS-CHP, +90279,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,HEALTHPLUS-CHP, +90280,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,HEALTHPLUS-CHP, +90281,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,HEALTHPLUS-CHP, +90282,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,HEALTHPLUS-CHP, +90283,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,HEALTHPLUS-CHP, +90284,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,HEALTHPLUS-CHP, +90285,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,HEALTHPLUS-CHP, +90286,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,HEALTHPLUS-CHP, +90287,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,HEALTHPLUS-CHP, +90288,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,HEALTHPLUS-CHP, +90289,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,HEALTHPLUS-CHP, +90290,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,HEALTHPLUS-CHP, +90291,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,HEALTHPLUS-CHP, +90292,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,HEALTHPLUS-CHP, +90293,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,HEALTHPLUS-CHP, +90294,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,HEALTHPLUS-CHP, +90295,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,HEALTHPLUS-CHP, +90296,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,HEALTHPLUS-CHP, +90297,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,HEALTHPLUS-CHP, +90298,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,HEALTHPLUS-CHP, +90299,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,HEALTHPLUS-CHP, +90300,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,HEALTHPLUS-CHP, +90301,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,HEALTHPLUS-CHP, +90302,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,HEALTHPLUS-CHP, +90303,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,HEALTHPLUS-CHP, +90304,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,HEALTHPLUS-CHP, +90305,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,HEALTHPLUS-CHP, +90306,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,HEALTHPLUS-CHP, +90307,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,HEALTHPLUS-CHP, +90308,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,HEALTHPLUS-CHP, +90309,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,HEALTHPLUS-CHP, +90310,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,HEALTHPLUS-CHP, +90311,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,HEALTHPLUS-CHP, +90312,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,HEALTHPLUS-CHP, +90313,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,HEALTHPLUS-CHP, +90314,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,HEALTHPLUS-CHP, +90315,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,HEALTHPLUS-CHP, +90316,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,HEALTHPLUS-CHP, +90317,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,HEALTHPLUS-CHP, +90318,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,HEALTHPLUS-CHP, +90319,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,HEALTHPLUS-CHP, +90320,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,HEALTHPLUS-CHP, +90321,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,HEALTHPLUS-CHP, +90322,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,HEALTHPLUS-CHP, +90323,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,HEALTHPLUS-CHP, +90324,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,HEALTHPLUS-CHP,63.75 +90325,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,HEALTHPLUS-CHP, +90326,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,HEALTHPLUS-CHP, +90327,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,HEALTHPLUS-CHP, +90328,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,HEALTHPLUS-CHP, +90329,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,HEALTHPLUS-CHP, +90330,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,HEALTHPLUS-CHP, +90331,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,HEALTHPLUS-CHP, +90332,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,HEALTHPLUS-CHP, +90333,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,HEALTHPLUS-CHP, +90334,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,HEALTHPLUS-CHP, +90335,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,HEALTHPLUS-CHP, +90336,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,HEALTHPLUS-CHP, +90337,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,HEALTHPLUS-CHP, +90338,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,HEALTHPLUS-CHP, +90339,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,HEALTHPLUS-CHP, +90340,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,HEALTHPLUS-CHP, +90341,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,HEALTHPLUS-CHP, +90342,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,HEALTHPLUS-CHP, +90343,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,HEALTHPLUS-CHP, +90344,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,HEALTHPLUS-CHP, +90345,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,HEALTHPLUS-CHP, +90346,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,HEALTHPLUS-CHP, +90347,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,HEALTHPLUS-CHP, +90348,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,HEALTHPLUS-CHP, +90349,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,HEALTHPLUS-CHP, +90350,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,HEALTHPLUS-CHP, +90351,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,HEALTHPLUS-CHP, +90352,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,HEALTHPLUS-CHP, +90353,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,HEALTHPLUS-CHP, +90354,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,HEALTHPLUS-CHP, +90355,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,HEALTHPLUS-CHP, +90356,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,HEALTHPLUS-CHP, +90357,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,HEALTHPLUS-CHP, +90358,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,HEALTHPLUS-CHP, +90359,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,HEALTHPLUS-CHP,62.25 +90360,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,HEALTHPLUS-CHP, +90361,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,HEALTHPLUS-CHP, +90362,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,HEALTHPLUS-CHP, +90363,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,HEALTHPLUS-CHP, +90364,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,HEALTHPLUS-CHP, +90365,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,HEALTHPLUS-CHP, +90366,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,HEALTHPLUS-CHP,81.75 +90367,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,HEALTHPLUS-CHP, +90368,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,HEALTHPLUS-CHP, +90369,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,HEALTHPLUS-CHP, +90370,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,HEALTHPLUS-CHP, +90371,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,HEALTHPLUS-CHP, +90372,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,HEALTHPLUS-CHP, +90373,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,HEALTHPLUS-CHP, +90374,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,HEALTHPLUS-CHP, +90375,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,HEALTHPLUS-CHP, +90376,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,HEALTHPLUS-CHP, +90377,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,HEALTHPLUS-CHP, +90378,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,HEALTHPLUS-CHP, +90379,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,HEALTHPLUS-CHP, +90380,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,HEALTHPLUS-CHP, +90381,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,HEALTHPLUS-CHP, +90382,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,HEALTHPLUS-CHP, +90383,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,HEALTHPLUS-CHP, +90384,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,HEALTHPLUS-CHP, +90385,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,HEALTHPLUS-CHP, +90386,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,HEALTHPLUS-CHP, +90387,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,HEALTHPLUS-CHP, +90388,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,HEALTHPLUS-CHP, +90389,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,HEALTHPLUS-CHP, +90390,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,HEALTHPLUS-CHP, +90391,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,HEALTHPLUS-CHP, +90392,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,HEALTHPLUS-CHP, +90393,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,HEALTHPLUS-CHP, +90394,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,HEALTHPLUS-CHP, +90395,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,HEALTHPLUS-CHP, +90396,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,HEALTHPLUS-CHP, +90397,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,HEALTHPLUS-CHP, +90398,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,HEALTHPLUS-CHP, +90399,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,HEALTHPLUS-CHP, +90400,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,HEALTHPLUS-CHP, +90401,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,HEALTHPLUS-CHP, +90402,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,HEALTHPLUS-CHP, +90403,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,HEALTHPLUS-CHP, +90404,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,HEALTHPLUS-CHP, +90405,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,HEALTHPLUS-CHP, +90406,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,HEALTHPLUS-CHP, +90407,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,HEALTHPLUS-CHP, +90408,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,HEALTHPLUS-CHP, +90409,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,HEALTHPLUS-CHP, +90410,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,HEALTHPLUS-CHP, +90411,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,HEALTHPLUS-CHP, +90412,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,HEALTHPLUS-CHP, +90413,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,HEALTHPLUS-CHP, +90414,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,HEALTHPLUS-CHP, +90415,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,HEALTHPLUS-CHP, +90416,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,HEALTHPLUS-CHP, +90417,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,HEALTHPLUS-CHP, +90418,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,HEALTHPLUS-CHP, +90419,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,HEALTHPLUS-CHP, +90420,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,HEALTHPLUS-CHP, +90421,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,HEALTHPLUS-CHP, +90422,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,HEALTHPLUS-CHP, +90423,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,HEALTHPLUS-CHP, +90424,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,HEALTHPLUS-CHP, +90425,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,HEALTHPLUS-CHP, +90426,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,HEALTHPLUS-CHP, +90427,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,HEALTHPLUS-CHP, +90428,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,HEALTHPLUS-CHP, +90429,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,HEALTHPLUS-CHP, +90430,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,HEALTHPLUS-CHP, +90431,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,HEALTHPLUS-CHP, +90432,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,HEALTHPLUS-CHP, +90433,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,HEALTHPLUS-CHP, +90434,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,HEALTHPLUS-CHP, +90435,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,HEALTHPLUS-CHP, +90436,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,HEALTHPLUS-CHP, +90437,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,HEALTHPLUS-CHP, +90438,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,HEALTHPLUS-CHP, +90439,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,HEALTHPLUS-CHP, +90440,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,HEALTHPLUS-CHP, +90441,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,HEALTHPLUS-CHP, +90442,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,HEALTHPLUS-CHP, +90443,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,HEALTHPLUS-CHP, +90444,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,HEALTHPLUS-CHP, +90445,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,HEALTHPLUS-CHP, +90446,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,HEALTHPLUS-CHP, +90447,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,HEALTHPLUS-CHP, +90448,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,HEALTHPLUS-CHP, +90449,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,HEALTHPLUS-CHP, +90450,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,HEALTHPLUS-CHP, +90451,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,HEALTHPLUS-CHP, +90452,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,HEALTHPLUS-CHP, +90453,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,HEALTHPLUS-CHP, +90454,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,HEALTHPLUS-CHP, +90455,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,HEALTHPLUS-CHP, +90456,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,HEALTHPLUS-CHP, +90457,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,HEALTHPLUS-CHP, +90458,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,HEALTHPLUS-CHP, +90459,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,HEALTHPLUS-CHP, +90460,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,HEALTHPLUS-CHP, +90461,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,HEALTHPLUS-CHP, +90462,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,HEALTHPLUS-CHP, +90463,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,HEALTHPLUS-CHP, +90464,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,HEALTHPLUS-CHP, +90465,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,HEALTHPLUS-CHP, +90466,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,HEALTHPLUS-CHP, +90467,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,HEALTHPLUS-CHP, +90468,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,HEALTHPLUS-CHP, +90469,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,HEALTHPLUS-CHP, +90470,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,HEALTHPLUS-CHP, +90471,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,HEALTHPLUS-CHP, +90472,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,HEALTHPLUS-CHP, +90473,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,HEALTHPLUS-CHP, +90474,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,HEALTHPLUS-CHP, +90475,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,HEALTHPLUS-CHP, +90476,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,HEALTHPLUS-CHP, +90477,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,HEALTHPLUS-CHP, +90478,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,HEALTHPLUS-CHP, +90479,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,HEALTHPLUS-CHP, +90480,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,HEALTHPLUS-CHP, +90481,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,HEALTHPLUS-CHP, +90482,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,HEALTHPLUS-CHP, +90483,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,HEALTHPLUS-CHP, +90484,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,HEALTHPLUS-CHP, +90485,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,HEALTHPLUS-CHP, +90486,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,HEALTHPLUS-CHP, +90487,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,HEALTHPLUS-CHP, +90488,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,HEALTHPLUS-CHP, +90489,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,HEALTHPLUS-CHP, +90490,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,HEALTHPLUS-CHP, +90491,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,HEALTHPLUS-CHP, +90492,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,HEALTHPLUS-CHP, +90493,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,HEALTHPLUS-CHP, +90494,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,HEALTHPLUS-CHP, +90495,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,HEALTHPLUS-CHP, +90496,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,HEALTHPLUS-CHP, +90497,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,HEALTHPLUS-CHP, +90498,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,HEALTHPLUS-CHP, +90499,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,HEALTHPLUS-CHP, +90500,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,HEALTHPLUS-CHP, +90501,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,HEALTHPLUS-CHP, +90502,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,HEALTHPLUS-CHP, +90503,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,HEALTHPLUS-CHP, +90504,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,HEALTHPLUS-CHP, +90505,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,HEALTHPLUS-CHP, +90506,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,HEALTHPLUS-CHP, +90507,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,HEALTHPLUS-CHP, +90508,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,HEALTHPLUS-CHP, +90509,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,HEALTHPLUS-CHP, +90510,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,HEALTHPLUS-CHP, +90511,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,HEALTHPLUS-CHP, +90512,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,HEALTHPLUS-CHP, +90513,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,HEALTHPLUS-CHP, +90514,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,HEALTHPLUS-CHP, +90515,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,HEALTHPLUS-CHP, +90516,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,HEALTHPLUS-CHP, +90517,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,HEALTHPLUS-CHP, +90518,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,HEALTHPLUS-CHP, +90519,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,HEALTHPLUS-CHP, +90520,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,HEALTHPLUS-CHP, +90521,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,HEALTHPLUS-CHP, +90522,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,HEALTHPLUS-CHP, +90523,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,HEALTHPLUS-CHP, +90524,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,HEALTHPLUS-CHP, +90525,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,HEALTHPLUS-CHP, +90526,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,HEALTHPLUS-CHP, +90527,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,HEALTHPLUS-CHP, +90528,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,HEALTHPLUS-CHP, +90529,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,HEALTHPLUS-CHP, +90530,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,HEALTHPLUS-CHP, +90531,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,HEALTHPLUS-CHP, +90532,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,HEALTHPLUS-CHP, +90533,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,HEALTHPLUS-CHP, +90534,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,HEALTHPLUS-CHP, +90535,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,HEALTHPLUS-CHP, +90536,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,HEALTHPLUS-CHP, +90537,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,HEALTHPLUS-CHP, +90538,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,HEALTHPLUS-CHP, +90539,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,HEALTHPLUS-CHP, +90540,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,HEALTHPLUS-CHP, +90541,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,HEALTHPLUS-CHP, +90542,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,HEALTHPLUS-CHP, +90543,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,HEALTHPLUS-CHP, +90544,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,HEALTHPLUS-CHP, +90545,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,HEALTHPLUS-CHP, +90546,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,HEALTHPLUS-CHP, +90547,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,HEALTHPLUS-CHP, +90548,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,HEALTHPLUS-CHP, +90549,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,HEALTHPLUS-CHP, +90550,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,HEALTHPLUS-CHP, +90551,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,HEALTHPLUS-CHP, +90552,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,HEALTHPLUS-CHP, +90553,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,HEALTHPLUS-CHP, +90554,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-CHP, +90555,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,HEALTHPLUS-CHP, +90556,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,HEALTHPLUS-CHP, +90557,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,HEALTHPLUS-CHP, +90558,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,HEALTHPLUS-CHP, +90559,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,HEALTHPLUS-CHP, +90560,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,HEALTHPLUS-CHP, +90561,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,HEALTHPLUS-CHP, +90562,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,HEALTHPLUS-CHP, +90563,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,HEALTHPLUS-CHP, +90564,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,HEALTHPLUS-CHP, +90565,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-CHP, +90566,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,HEALTHPLUS-CHP, +90567,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,HEALTHPLUS-CHP, +90568,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,HEALTHPLUS-CHP, +90569,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,HEALTHPLUS-CHP, +90570,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,HEALTHPLUS-CHP, +90571,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,HEALTHPLUS-CHP, +90572,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,HEALTHPLUS-CHP, +90573,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,HEALTHPLUS-CHP, +90574,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,HEALTHPLUS-CHP, +90575,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,HEALTHPLUS-CHP, +90576,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,HEALTHPLUS-CHP, +90577,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,HEALTHPLUS-CHP, +90578,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,HEALTHPLUS-CHP, +90579,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,HEALTHPLUS-CHP, +90580,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,HEALTHPLUS-CHP, +90581,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,HEALTHPLUS-CHP, +90582,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,HEALTHPLUS-CHP, +90583,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,HEALTHPLUS-CHP, +90584,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,HEALTHPLUS-CHP, +90585,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,HEALTHPLUS-CHP, +90586,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,HEALTHPLUS-CHP, +90587,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-CHP, +90588,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,HEALTHPLUS-CHP, +90589,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,HEALTHPLUS-CHP, +90590,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,HEALTHPLUS-CHP, +90591,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,HEALTHPLUS-CHP, +90592,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,HEALTHPLUS-CHP, +90593,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,HEALTHPLUS-CHP, +90594,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,HEALTHPLUS-CHP, +90595,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,HEALTHPLUS-CHP, +90596,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,HEALTHPLUS-CHP, +90597,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,HEALTHPLUS-CHP, +90598,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,HEALTHPLUS-CHP, +90599,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,HEALTHPLUS-CHP, +90600,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,HEALTHPLUS-CHP, +90601,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,HEALTHPLUS-CHP, +90602,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,HEALTHPLUS-CHP, +90603,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,HEALTHPLUS-CHP, +90604,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,HEALTHPLUS-CHP, +90605,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,HEALTHPLUS-CHP, +90606,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,HEALTHPLUS-CHP, +90607,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,HEALTHPLUS-CHP, +90608,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,HEALTHPLUS-CHP, +90609,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,HEALTHPLUS-CHP, +90610,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,HEALTHPLUS-CHP, +90611,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,HEALTHPLUS-CHP, +90612,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,HEALTHPLUS-CHP, +90613,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,HEALTHPLUS-CHP, +90614,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,HEALTHPLUS-CHP, +90615,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,HEALTHPLUS-CHP, +90616,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,HEALTHPLUS-CHP, +90617,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,HEALTHPLUS-CHP, +90618,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,HEALTHPLUS-CHP, +90619,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,HEALTHPLUS-CHP, +90620,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,HEALTHPLUS-CHP, +90621,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,HEALTHPLUS-CHP, +90622,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,HEALTHPLUS-CHP, +90623,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,HEALTHPLUS-CHP, +90624,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,HEALTHPLUS-CHP, +90625,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,HEALTHPLUS-CHP, +90626,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,HEALTHPLUS-CHP, +90627,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,HEALTHPLUS-CHP,801.0 +90628,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,HEALTHPLUS-CHP, +90629,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,HEALTHPLUS-CHP, +90630,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,HEALTHPLUS-CHP, +90631,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,HEALTHPLUS-CHP,1557.75 +90632,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,HEALTHPLUS-CHP, +90633,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,HEALTHPLUS-CHP, +90634,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,HEALTHPLUS-CHP, +90635,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,HEALTHPLUS-CHP, +90636,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,HEALTHPLUS-CHP, +90637,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,HEALTHPLUS-CHP, +90638,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,HEALTHPLUS-CHP, +90639,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,HEALTHPLUS-CHP, +90640,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,HEALTHPLUS-CHP,177.75 +90641,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,HEALTHPLUS-CHP,1450.5 +90642,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,HEALTHPLUS-CHP, +90643,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,HEALTHPLUS-CHP, +90644,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,HEALTHPLUS-CHP, +90645,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,HEALTHPLUS-CHP, +90646,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,HEALTHPLUS-CHP, +90647,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,HEALTHPLUS-CHP, +90648,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,HEALTHPLUS-CHP, +90649,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,HEALTHPLUS-CHP, +90650,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,HEALTHPLUS-CHP, +90651,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,HEALTHPLUS-CHP, +90652,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,HEALTHPLUS-CHP, +90653,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,HEALTHPLUS-CHP, +90654,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,HEALTHPLUS-CHP, +90655,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,HEALTHPLUS-CHP, +90656,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,HEALTHPLUS-CHP, +90657,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,HEALTHPLUS-CHP, +90658,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,HEALTHPLUS-CHP, +90659,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,HEALTHPLUS-CHP, +90660,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,HEALTHPLUS-CHP, +90661,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,HEALTHPLUS-CHP, +90662,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,HEALTHPLUS-CHP, +90663,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,HEALTHPLUS-CHP, +90664,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,HEALTHPLUS-CHP, +90665,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,HEALTHPLUS-CHP, +90666,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,HEALTHPLUS-CHP, +90667,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,HEALTHPLUS-CHP, +90668,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,HEALTHPLUS-CHP, +90669,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,HEALTHPLUS-CHP, +90670,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,HEALTHPLUS-CHP, +90671,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,HEALTHPLUS-CHP, +90672,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,HEALTHPLUS-CHP, +90673,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,HEALTHPLUS-CHP, +90674,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,HEALTHPLUS-CHP, +90675,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,HEALTHPLUS-CHP, +90676,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,HEALTHPLUS-CHP, +90677,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,HEALTHPLUS-CHP, +90678,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,HEALTHPLUS-CHP, +90679,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,HEALTHPLUS-CHP, +90680,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,HEALTHPLUS-CHP, +90681,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,HEALTHPLUS-CHP, +90682,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,HEALTHPLUS-CHP, +90683,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,HEALTHPLUS-CHP, +90684,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,HEALTHPLUS-CHP, +90685,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,HEALTHPLUS-CHP, +90686,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,HEALTHPLUS-CHP, +90687,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,HEALTHPLUS-CHP, +90688,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,HEALTHPLUS-CHP, +90689,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-CHP, +90690,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-CHP, +90691,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +90692,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,HEALTHPLUS-CHP, +90693,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,HEALTHPLUS-CHP, +90694,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,HEALTHPLUS-CHP, +90695,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,HEALTHPLUS-CHP, +90696,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,HEALTHPLUS-CHP, +90697,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,HEALTHPLUS-CHP, +90698,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,HEALTHPLUS-CHP, +90699,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,HEALTHPLUS-CHP, +90700,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,HEALTHPLUS-CHP, +90701,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,HEALTHPLUS-CHP, +90702,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,HEALTHPLUS-CHP, +90703,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,HEALTHPLUS-CHP, +90704,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,HEALTHPLUS-CHP, +90705,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,HEALTHPLUS-CHP, +90706,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,HEALTHPLUS-CHP, +90707,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,HEALTHPLUS-CHP, +90708,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,HEALTHPLUS-CHP, +90709,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,HEALTHPLUS-CHP, +90710,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,HEALTHPLUS-CHP, +90711,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,HEALTHPLUS-CHP, +90712,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,HEALTHPLUS-CHP, +90713,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,HEALTHPLUS-CHP, +90714,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,HEALTHPLUS-CHP, +90715,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,HEALTHPLUS-CHP, +90716,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,HEALTHPLUS-CHP, +90717,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,HEALTHPLUS-CHP, +90718,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,HEALTHPLUS-CHP, +90719,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,HEALTHPLUS-CHP, +90720,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,HEALTHPLUS-CHP, +90721,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,HEALTHPLUS-CHP, +90722,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,HEALTHPLUS-CHP, +90723,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,HEALTHPLUS-CHP, +90724,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,HEALTHPLUS-CHP, +90725,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,HEALTHPLUS-CHP, +90726,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,HEALTHPLUS-CHP, +90727,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,HEALTHPLUS-CHP, +90728,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,HEALTHPLUS-CHP, +90729,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,HEALTHPLUS-CHP, +90730,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,HEALTHPLUS-CHP, +90731,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,HEALTHPLUS-CHP, +90732,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,HEALTHPLUS-CHP, +90733,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,HEALTHPLUS-CHP, +90734,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,HEALTHPLUS-CHP, +90735,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,HEALTHPLUS-CHP, +90736,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,HEALTHPLUS-CHP, +90737,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,HEALTHPLUS-CHP, +90738,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,HEALTHPLUS-CHP, +90739,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,HEALTHPLUS-CHP, +90740,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,HEALTHPLUS-CHP, +90741,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,HEALTHPLUS-CHP, +90742,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,HEALTHPLUS-CHP, +90743,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,HEALTHPLUS-CHP, +90744,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,HEALTHPLUS-CHP, +90745,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,HEALTHPLUS-CHP, +90746,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,HEALTHPLUS-CHP, +90747,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,HEALTHPLUS-CHP, +90748,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,HEALTHPLUS-CHP, +90749,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,HEALTHPLUS-CHP, +90750,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,HEALTHPLUS-CHP, +90751,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,HEALTHPLUS-CHP, +90752,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,HEALTHPLUS-CHP, +90753,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,HEALTHPLUS-CHP, +90754,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,HEALTHPLUS-CHP, +90755,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,HEALTHPLUS-CHP, +90756,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,HEALTHPLUS-CHP, +90757,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,HEALTHPLUS-CHP, +90758,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,HEALTHPLUS-CHP, +90759,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,HEALTHPLUS-CHP, +90760,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,HEALTHPLUS-CHP, +90761,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,HEALTHPLUS-CHP, +90762,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,HEALTHPLUS-CHP, +90763,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,HEALTHPLUS-CHP,996.0 +90764,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,HEALTHPLUS-CHP, +90765,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,HEALTHPLUS-CHP, +90766,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,HEALTHPLUS-CHP, +90767,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,HEALTHPLUS-CHP, +90768,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,HEALTHPLUS-CHP, +90769,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,HEALTHPLUS-CHP, +90770,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,HEALTHPLUS-CHP, +90771,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,HEALTHPLUS-CHP, +90772,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,HEALTHPLUS-CHP, +90773,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,HEALTHPLUS-CHP, +90774,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,HEALTHPLUS-CHP, +90775,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,HEALTHPLUS-CHP, +90776,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,HEALTHPLUS-CHP, +90777,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,HEALTHPLUS-CHP, +90778,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,HEALTHPLUS-CHP, +90779,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,HEALTHPLUS-CHP, +90780,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,HEALTHPLUS-CHP, +90781,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,HEALTHPLUS-CHP, +90782,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,HEALTHPLUS-CHP, +90783,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,HEALTHPLUS-CHP, +90784,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,HEALTHPLUS-CHP, +90785,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,HEALTHPLUS-CHP, +90786,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,HEALTHPLUS-CHP, +90787,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,HEALTHPLUS-CHP, +90788,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +90789,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,HEALTHPLUS-CHP,239.25 +90790,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,HEALTHPLUS-CHP, +90791,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,HEALTHPLUS-CHP, +90792,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,HEALTHPLUS-CHP, +90793,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,HEALTHPLUS-CHP, +90794,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,HEALTHPLUS-CHP, +90795,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,HEALTHPLUS-CHP, +90796,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,HEALTHPLUS-CHP, +90797,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,HEALTHPLUS-CHP, +90798,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,HEALTHPLUS-CHP, +90799,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,HEALTHPLUS-CHP, +90800,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,HEALTHPLUS-CHP, +90801,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,HEALTHPLUS-CHP, +90802,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,HEALTHPLUS-CHP, +90803,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,HEALTHPLUS-CHP, +90804,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,HEALTHPLUS-CHP, +90805,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,HEALTHPLUS-CHP, +90806,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,HEALTHPLUS-CHP, +90807,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,HEALTHPLUS-CHP, +90808,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,HEALTHPLUS-CHP, +90809,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,HEALTHPLUS-CHP, +90810,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,HEALTHPLUS-CHP, +90811,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,HEALTHPLUS-CHP, +90812,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,HEALTHPLUS-CHP, +90813,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,HEALTHPLUS-CHP, +90814,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,HEALTHPLUS-CHP, +90815,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,HEALTHPLUS-CHP, +90816,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,HEALTHPLUS-CHP, +90817,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,HEALTHPLUS-CHP, +90818,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,HEALTHPLUS-CHP, +90819,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,HEALTHPLUS-CHP, +90820,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,HEALTHPLUS-CHP, +90821,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,HEALTHPLUS-CHP, +90822,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,HEALTHPLUS-CHP, +90823,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,HEALTHPLUS-CHP, +90824,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,HEALTHPLUS-CHP, +90825,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,HEALTHPLUS-CHP, +90826,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,HEALTHPLUS-CHP, +90827,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,HEALTHPLUS-CHP, +90828,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,HEALTHPLUS-CHP, +90829,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,HEALTHPLUS-CHP, +90830,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,HEALTHPLUS-CHP, +90831,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,HEALTHPLUS-CHP, +90832,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,HEALTHPLUS-CHP, +90833,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,HEALTHPLUS-CHP, +90834,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,HEALTHPLUS-CHP, +90835,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,HEALTHPLUS-CHP, +90836,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,HEALTHPLUS-CHP, +90837,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,HEALTHPLUS-CHP, +90838,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,HEALTHPLUS-CHP, +90839,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,HEALTHPLUS-CHP, +90840,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,HEALTHPLUS-CHP, +90841,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,HEALTHPLUS-CHP, +90842,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,HEALTHPLUS-CHP, +90843,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,HEALTHPLUS-CHP, +90844,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,HEALTHPLUS-CHP, +90845,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,HEALTHPLUS-CHP, +90846,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,HEALTHPLUS-CHP, +90847,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,HEALTHPLUS-CHP, +90848,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,HEALTHPLUS-CHP, +90849,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,HEALTHPLUS-CHP, +90850,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,HEALTHPLUS-CHP, +90851,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,HEALTHPLUS-CHP, +90852,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,HEALTHPLUS-CHP, +90853,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,HEALTHPLUS-CHP, +90854,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,HEALTHPLUS-CHP, +90855,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,HEALTHPLUS-CHP, +90856,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,HEALTHPLUS-CHP, +90857,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,HEALTHPLUS-CHP, +90858,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,HEALTHPLUS-CHP, +90859,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,HEALTHPLUS-CHP, +90860,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,HEALTHPLUS-CHP, +90861,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,HEALTHPLUS-CHP, +90862,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,HEALTHPLUS-CHP, +90863,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,HEALTHPLUS-CHP, +90864,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,HEALTHPLUS-CHP, +90865,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,HEALTHPLUS-CHP, +90866,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,HEALTHPLUS-CHP, +90867,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,HEALTHPLUS-CHP, +90868,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,HEALTHPLUS-CHP, +90869,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,HEALTHPLUS-CHP, +90870,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,HEALTHPLUS-CHP, +90871,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,HEALTHPLUS-CHP, +90872,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,HEALTHPLUS-CHP, +90873,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,HEALTHPLUS-CHP, +90874,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,HEALTHPLUS-CHP, +90875,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,HEALTHPLUS-CHP, +90876,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,HEALTHPLUS-CHP, +90877,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,HEALTHPLUS-CHP, +90878,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,HEALTHPLUS-CHP, +90879,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,HEALTHPLUS-CHP, +90880,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,HEALTHPLUS-CHP, +90881,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,HEALTHPLUS-CHP, +90882,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,HEALTHPLUS-CHP, +90883,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,HEALTHPLUS-CHP, +90884,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,HEALTHPLUS-CHP, +90885,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,HEALTHPLUS-CHP, +90886,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,HEALTHPLUS-CHP, +90887,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,HEALTHPLUS-CHP, +90888,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,HEALTHPLUS-CHP, +90889,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,HEALTHPLUS-CHP, +90890,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,HEALTHPLUS-CHP, +90891,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,HEALTHPLUS-CHP, +90892,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,HEALTHPLUS-CHP, +90893,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,HEALTHPLUS-CHP, +90894,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,HEALTHPLUS-CHP, +90895,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,HEALTHPLUS-CHP, +90896,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,HEALTHPLUS-CHP, +90897,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,HEALTHPLUS-CHP, +90898,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,HEALTHPLUS-CHP, +90899,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,HEALTHPLUS-CHP, +90900,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-CHP, +90901,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-CHP, +90902,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,HEALTHPLUS-CHP, +90903,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,HEALTHPLUS-CHP, +90904,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,HEALTHPLUS-CHP, +90905,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,HEALTHPLUS-CHP, +90906,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,HEALTHPLUS-CHP, +90907,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,HEALTHPLUS-CHP, +90908,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,HEALTHPLUS-CHP, +90909,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,HEALTHPLUS-CHP, +90910,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,HEALTHPLUS-CHP, +90911,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,HEALTHPLUS-CHP, +90912,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,HEALTHPLUS-CHP, +90913,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,HEALTHPLUS-CHP, +90914,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,HEALTHPLUS-CHP, +90915,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,HEALTHPLUS-CHP, +90916,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,HEALTHPLUS-CHP, +90917,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,HEALTHPLUS-CHP, +90918,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,HEALTHPLUS-CHP, +90919,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,HEALTHPLUS-CHP, +90920,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,HEALTHPLUS-CHP, +90921,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,HEALTHPLUS-CHP, +90922,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,HEALTHPLUS-CHP, +90923,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,HEALTHPLUS-CHP, +90924,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,HEALTHPLUS-CHP, +90925,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,HEALTHPLUS-CHP, +90926,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,HEALTHPLUS-CHP, +90927,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,HEALTHPLUS-CHP, +90928,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,HEALTHPLUS-CHP, +90929,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,HEALTHPLUS-CHP, +90930,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,HEALTHPLUS-CHP, +90931,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,HEALTHPLUS-CHP, +90932,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,HEALTHPLUS-CHP, +90933,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,HEALTHPLUS-CHP, +90934,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,HEALTHPLUS-CHP, +90935,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,HEALTHPLUS-CHP, +90936,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,HEALTHPLUS-CHP, +90937,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,HEALTHPLUS-CHP, +90938,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,HEALTHPLUS-CHP, +90939,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,HEALTHPLUS-CHP, +90940,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,HEALTHPLUS-CHP, +90941,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,HEALTHPLUS-CHP, +90942,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,HEALTHPLUS-CHP, +90943,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,HEALTHPLUS-CHP, +90944,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,HEALTHPLUS-CHP, +90945,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,HEALTHPLUS-CHP, +90946,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,HEALTHPLUS-CHP, +90947,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,HEALTHPLUS-CHP, +90948,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,HEALTHPLUS-CHP, +90949,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,HEALTHPLUS-CHP, +90950,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,HEALTHPLUS-CHP, +90951,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,HEALTHPLUS-CHP, +90952,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,HEALTHPLUS-CHP, +90953,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,HEALTHPLUS-CHP, +90954,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,HEALTHPLUS-CHP, +90955,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,HEALTHPLUS-CHP, +90956,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,HEALTHPLUS-CHP, +90957,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,HEALTHPLUS-CHP, +90958,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,HEALTHPLUS-CHP, +90959,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,HEALTHPLUS-CHP, +90960,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,HEALTHPLUS-CHP, +90961,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,HEALTHPLUS-CHP, +90962,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,HEALTHPLUS-CHP, +90963,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,HEALTHPLUS-CHP, +90964,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,HEALTHPLUS-CHP, +90965,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,HEALTHPLUS-CHP, +90966,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,HEALTHPLUS-CHP, +90967,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,HEALTHPLUS-CHP, +90968,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,HEALTHPLUS-CHP, +90969,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,HEALTHPLUS-CHP, +90970,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,HEALTHPLUS-CHP, +90971,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,HEALTHPLUS-CHP, +90972,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,HEALTHPLUS-CHP, +90973,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,HEALTHPLUS-CHP, +90974,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,HEALTHPLUS-CHP, +90975,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,HEALTHPLUS-CHP, +90976,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,HEALTHPLUS-CHP, +90977,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,HEALTHPLUS-CHP, +90978,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,HEALTHPLUS-CHP, +90979,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,HEALTHPLUS-CHP, +90980,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,HEALTHPLUS-CHP, +90981,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,HEALTHPLUS-CHP, +90982,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,HEALTHPLUS-CHP, +90983,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,HEALTHPLUS-CHP, +90984,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,HEALTHPLUS-CHP, +90985,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,HEALTHPLUS-CHP, +90986,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,HEALTHPLUS-CHP, +90987,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,HEALTHPLUS-CHP, +90988,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,HEALTHPLUS-CHP, +90989,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,HEALTHPLUS-CHP, +90990,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,HEALTHPLUS-CHP, +90991,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,HEALTHPLUS-CHP, +90992,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,HEALTHPLUS-CHP, +90993,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,HEALTHPLUS-CHP, +90994,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,HEALTHPLUS-CHP, +90995,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,HEALTHPLUS-CHP, +90996,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,HEALTHPLUS-CHP, +90997,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,HEALTHPLUS-CHP, +90998,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,HEALTHPLUS-CHP, +90999,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,HEALTHPLUS-CHP, +91000,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,HEALTHPLUS-CHP, +91001,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,HEALTHPLUS-CHP, +91002,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,HEALTHPLUS-CHP, +91003,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,HEALTHPLUS-CHP, +91004,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,HEALTHPLUS-CHP, +91005,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,HEALTHPLUS-CHP, +91006,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,HEALTHPLUS-CHP, +91007,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,HEALTHPLUS-CHP, +91008,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,HEALTHPLUS-CHP,1488.0 +91009,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,HEALTHPLUS-CHP, +91010,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,HEALTHPLUS-CHP, +91011,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,HEALTHPLUS-CHP, +91012,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,HEALTHPLUS-CHP, +91013,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,HEALTHPLUS-CHP, +91014,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,HEALTHPLUS-CHP, +91015,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,HEALTHPLUS-CHP, +91016,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,HEALTHPLUS-CHP, +91017,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,HEALTHPLUS-CHP, +91018,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,HEALTHPLUS-CHP, +91019,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,HEALTHPLUS-CHP, +91020,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,HEALTHPLUS-CHP, +91021,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,HEALTHPLUS-CHP, +91022,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,HEALTHPLUS-CHP, +91023,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,HEALTHPLUS-CHP, +91024,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,HEALTHPLUS-CHP, +91025,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,HEALTHPLUS-CHP, +91026,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,HEALTHPLUS-CHP, +91027,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,HEALTHPLUS-CHP, +91028,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,HEALTHPLUS-CHP, +91029,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,HEALTHPLUS-CHP, +91030,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,HEALTHPLUS-CHP, +91031,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,HEALTHPLUS-CHP, +91032,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,HEALTHPLUS-CHP, +91033,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,HEALTHPLUS-CHP, +91034,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,HEALTHPLUS-CHP, +91035,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,HEALTHPLUS-CHP, +91036,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,HEALTHPLUS-CHP, +91037,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,HEALTHPLUS-CHP, +91038,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,HEALTHPLUS-CHP, +91039,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,HEALTHPLUS-CHP, +91040,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,HEALTHPLUS-CHP, +91041,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,HEALTHPLUS-CHP, +91042,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,HEALTHPLUS-CHP, +91043,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,HEALTHPLUS-CHP, +91044,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,HEALTHPLUS-CHP, +91045,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,HEALTHPLUS-CHP, +91046,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,HEALTHPLUS-CHP, +91047,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,HEALTHPLUS-CHP, +91048,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,HEALTHPLUS-CHP, +91049,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,HEALTHPLUS-CHP, +91050,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,HEALTHPLUS-CHP, +91051,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,HEALTHPLUS-CHP, +91052,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,HEALTHPLUS-CHP, +91053,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,HEALTHPLUS-CHP, +91054,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,HEALTHPLUS-CHP, +91055,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,HEALTHPLUS-CHP, +91056,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,HEALTHPLUS-CHP, +91057,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,HEALTHPLUS-CHP, +91058,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,HEALTHPLUS-CHP, +91059,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,HEALTHPLUS-CHP, +91060,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,HEALTHPLUS-CHP, +91061,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,HEALTHPLUS-CHP, +91062,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,HEALTHPLUS-CHP, +91063,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,HEALTHPLUS-CHP, +91064,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,HEALTHPLUS-CHP, +91065,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,HEALTHPLUS-CHP, +91066,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,HEALTHPLUS-CHP, +91067,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,HEALTHPLUS-CHP, +91068,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,HEALTHPLUS-CHP, +91069,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,HEALTHPLUS-CHP, +91070,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,HEALTHPLUS-CHP, +91071,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,HEALTHPLUS-CHP, +91072,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,HEALTHPLUS-CHP, +91073,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,HEALTHPLUS-CHP, +91074,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,HEALTHPLUS-CHP, +91075,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,HEALTHPLUS-CHP, +91076,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,HEALTHPLUS-CHP, +91077,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,HEALTHPLUS-CHP, +91078,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,HEALTHPLUS-CHP, +91079,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,HEALTHPLUS-CHP, +91080,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,HEALTHPLUS-CHP, +91081,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,HEALTHPLUS-CHP, +91082,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,HEALTHPLUS-CHP, +91083,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,HEALTHPLUS-CHP, +91084,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,HEALTHPLUS-CHP, +91085,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,HEALTHPLUS-CHP, +91086,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,HEALTHPLUS-CHP, +91087,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,HEALTHPLUS-CHP, +91088,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,HEALTHPLUS-CHP, +91089,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,HEALTHPLUS-CHP, +91090,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,HEALTHPLUS-CHP, +91091,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,HEALTHPLUS-CHP, +91092,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,HEALTHPLUS-CHP, +91093,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,HEALTHPLUS-CHP, +91094,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,HEALTHPLUS-CHP, +91095,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,HEALTHPLUS-CHP, +91096,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,HEALTHPLUS-CHP, +91097,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,HEALTHPLUS-CHP, +91098,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,HEALTHPLUS-CHP, +91099,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,HEALTHPLUS-CHP, +91100,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,HEALTHPLUS-CHP, +91101,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,HEALTHPLUS-CHP, +91102,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,HEALTHPLUS-CHP, +91103,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,HEALTHPLUS-CHP, +91104,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,HEALTHPLUS-CHP, +91105,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,HEALTHPLUS-CHP, +91106,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,HEALTHPLUS-CHP, +91107,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,HEALTHPLUS-CHP, +91108,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,HEALTHPLUS-CHP, +91109,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,HEALTHPLUS-CHP, +91110,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,HEALTHPLUS-CHP, +91111,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,HEALTHPLUS-CHP, +91112,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,HEALTHPLUS-CHP, +91113,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,HEALTHPLUS-CHP, +91114,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,HEALTHPLUS-CHP, +91115,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,HEALTHPLUS-CHP, +91116,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,HEALTHPLUS-CHP, +91117,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,HEALTHPLUS-CHP, +91118,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,HEALTHPLUS-CHP, +91119,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,HEALTHPLUS-CHP, +91120,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,HEALTHPLUS-CHP, +91121,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,HEALTHPLUS-CHP, +91122,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,HEALTHPLUS-CHP, +91123,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,HEALTHPLUS-CHP, +91124,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,HEALTHPLUS-CHP, +91125,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,HEALTHPLUS-CHP, +91126,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,HEALTHPLUS-CHP, +91127,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,HEALTHPLUS-CHP, +91128,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,HEALTHPLUS-CHP, +91129,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,HEALTHPLUS-CHP, +91130,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,HEALTHPLUS-CHP, +91131,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,HEALTHPLUS-CHP, +91132,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,HEALTHPLUS-CHP, +91133,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,HEALTHPLUS-CHP, +91134,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,HEALTHPLUS-CHP, +91135,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,HEALTHPLUS-CHP, +91136,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,HEALTHPLUS-CHP, +91137,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,HEALTHPLUS-CHP, +91138,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,HEALTHPLUS-CHP, +91139,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,HEALTHPLUS-CHP, +91140,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,HEALTHPLUS-CHP, +91141,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,HEALTHPLUS-CHP, +91142,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,HEALTHPLUS-CHP, +91143,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,HEALTHPLUS-CHP, +91144,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,HEALTHPLUS-CHP, +91145,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,HEALTHPLUS-CHP, +91146,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,HEALTHPLUS-CHP, +91147,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,HEALTHPLUS-CHP, +91148,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,HEALTHPLUS-CHP, +91149,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,HEALTHPLUS-CHP, +91150,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,HEALTHPLUS-CHP, +91151,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,HEALTHPLUS-CHP, +91152,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,HEALTHPLUS-CHP, +91153,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,HEALTHPLUS-CHP, +91154,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,HEALTHPLUS-CHP, +91155,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,HEALTHPLUS-CHP, +91156,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,HEALTHPLUS-CHP, +91157,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,HEALTHPLUS-CHP, +91158,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,HEALTHPLUS-CHP, +91159,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,HEALTHPLUS-CHP, +91160,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,HEALTHPLUS-CHP, +91161,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,HEALTHPLUS-CHP, +91162,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,HEALTHPLUS-CHP, +91163,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,HEALTHPLUS-CHP, +91164,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,HEALTHPLUS-CHP, +91165,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,HEALTHPLUS-CHP, +91166,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,HEALTHPLUS-CHP, +91167,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,HEALTHPLUS-CHP, +91168,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,HEALTHPLUS-CHP, +91169,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,HEALTHPLUS-CHP, +91170,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,HEALTHPLUS-CHP, +91171,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,HEALTHPLUS-CHP, +91172,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,HEALTHPLUS-CHP, +91173,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,HEALTHPLUS-CHP, +91174,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,HEALTHPLUS-CHP, +91175,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,HEALTHPLUS-CHP, +91176,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,HEALTHPLUS-CHP, +91177,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,HEALTHPLUS-CHP, +91178,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,HEALTHPLUS-CHP, +91179,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,HEALTHPLUS-CHP, +91180,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,HEALTHPLUS-CHP, +91181,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,HEALTHPLUS-CHP, +91182,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,HEALTHPLUS-CHP, +91183,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,HEALTHPLUS-CHP, +91184,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,HEALTHPLUS-CHP, +91185,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,HEALTHPLUS-CHP, +91186,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,HEALTHPLUS-CHP, +91187,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,HEALTHPLUS-CHP, +91188,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,HEALTHPLUS-CHP, +91189,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,HEALTHPLUS-CHP, +91190,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,HEALTHPLUS-CHP, +91191,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,HEALTHPLUS-CHP, +91192,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,HEALTHPLUS-CHP, +91193,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,HEALTHPLUS-CHP, +91194,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,HEALTHPLUS-CHP, +91195,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,HEALTHPLUS-CHP, +91196,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,HEALTHPLUS-CHP, +91197,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,HEALTHPLUS-CHP, +91198,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,HEALTHPLUS-CHP, +91199,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,HEALTHPLUS-CHP, +91200,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,HEALTHPLUS-CHP, +91201,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,HEALTHPLUS-CHP, +91202,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,HEALTHPLUS-CHP, +91203,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,HEALTHPLUS-CHP, +91204,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,HEALTHPLUS-CHP, +91205,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,HEALTHPLUS-CHP, +91206,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,HEALTHPLUS-CHP, +91207,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,HEALTHPLUS-CHP, +91208,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,HEALTHPLUS-CHP, +91209,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,HEALTHPLUS-CHP, +91210,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,HEALTHPLUS-CHP, +91211,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,HEALTHPLUS-CHP, +91212,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,HEALTHPLUS-CHP, +91213,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,HEALTHPLUS-CHP, +91214,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,HEALTHPLUS-CHP, +91215,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,HEALTHPLUS-CHP, +91216,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,HEALTHPLUS-CHP, +91217,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,HEALTHPLUS-CHP, +91218,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,HEALTHPLUS-CHP, +91219,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,HEALTHPLUS-CHP, +91220,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,HEALTHPLUS-CHP, +91221,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,HEALTHPLUS-CHP, +91222,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,HEALTHPLUS-CHP, +91223,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,HEALTHPLUS-CHP, +91224,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,HEALTHPLUS-CHP, +91225,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,HEALTHPLUS-CHP, +91226,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,HEALTHPLUS-CHP, +91227,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,HEALTHPLUS-CHP, +91228,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,HEALTHPLUS-CHP, +91229,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,HEALTHPLUS-CHP, +91230,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,HEALTHPLUS-CHP, +91231,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,HEALTHPLUS-CHP, +91232,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,HEALTHPLUS-CHP, +91233,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,HEALTHPLUS-CHP, +91234,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,HEALTHPLUS-CHP, +91235,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,HEALTHPLUS-CHP, +91236,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,HEALTHPLUS-CHP, +91237,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,HEALTHPLUS-CHP, +91238,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,HEALTHPLUS-CHP, +91239,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,HEALTHPLUS-CHP, +91240,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,HEALTHPLUS-CHP, +91241,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,HEALTHPLUS-CHP, +91242,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,HEALTHPLUS-CHP, +91243,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,HEALTHPLUS-CHP, +91244,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,HEALTHPLUS-CHP, +91245,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,HEALTHPLUS-CHP, +91246,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,HEALTHPLUS-CHP, +91247,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,HEALTHPLUS-CHP, +91248,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,HEALTHPLUS-CHP, +91249,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,HEALTHPLUS-CHP, +91250,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,HEALTHPLUS-CHP, +91251,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,HEALTHPLUS-CHP, +91252,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,HEALTHPLUS-CHP, +91253,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,HEALTHPLUS-CHP, +91254,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,HEALTHPLUS-CHP, +91255,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,HEALTHPLUS-CHP, +91256,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,HEALTHPLUS-CHP, +91257,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,HEALTHPLUS-CHP, +91258,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,HEALTHPLUS-CHP, +91259,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,HEALTHPLUS-CHP, +91260,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,HEALTHPLUS-CHP, +91261,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,HEALTHPLUS-CHP, +91262,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,HEALTHPLUS-CHP, +91263,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,HEALTHPLUS-CHP, +91264,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,HEALTHPLUS-CHP, +91265,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,HEALTHPLUS-CHP, +91266,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,HEALTHPLUS-CHP, +91267,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,HEALTHPLUS-CHP, +91268,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,HEALTHPLUS-CHP, +91269,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,HEALTHPLUS-CHP, +91270,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,HEALTHPLUS-CHP, +91271,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,HEALTHPLUS-CHP, +91272,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,HEALTHPLUS-CHP, +91273,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,HEALTHPLUS-CHP, +91274,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,HEALTHPLUS-CHP, +91275,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,HEALTHPLUS-CHP, +91276,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,HEALTHPLUS-CHP, +91277,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,HEALTHPLUS-CHP, +91278,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,HEALTHPLUS-CHP, +91279,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,HEALTHPLUS-CHP, +91280,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,HEALTHPLUS-CHP, +91281,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,HEALTHPLUS-CHP, +91282,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,HEALTHPLUS-CHP, +91283,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,HEALTHPLUS-CHP, +91284,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,HEALTHPLUS-CHP, +91285,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,HEALTHPLUS-CHP, +91286,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,HEALTHPLUS-CHP, +91287,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,HEALTHPLUS-CHP, +91288,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,HEALTHPLUS-CHP, +91289,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,HEALTHPLUS-CHP, +91290,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,HEALTHPLUS-CHP, +91291,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,HEALTHPLUS-CHP, +91292,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,HEALTHPLUS-CHP, +91293,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,HEALTHPLUS-CHP, +91294,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,HEALTHPLUS-CHP, +91295,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,HEALTHPLUS-CHP, +91296,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,HEALTHPLUS-CHP, +91297,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,HEALTHPLUS-CHP, +91298,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,HEALTHPLUS-CHP, +91299,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,HEALTHPLUS-CHP, +91300,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,HEALTHPLUS-CHP, +91301,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,HEALTHPLUS-CHP, +91302,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,HEALTHPLUS-CHP, +91303,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,HEALTHPLUS-CHP, +91304,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,HEALTHPLUS-CHP, +91305,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,HEALTHPLUS-CHP, +91306,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,HEALTHPLUS-CHP, +91307,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,HEALTHPLUS-CHP, +91308,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,HEALTHPLUS-CHP, +91309,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,HEALTHPLUS-CHP, +91310,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,HEALTHPLUS-CHP, +91311,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,HEALTHPLUS-CHP, +91312,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,HEALTHPLUS-CHP, +91313,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,HEALTHPLUS-CHP, +91314,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,HEALTHPLUS-CHP, +91315,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,HEALTHPLUS-CHP, +91316,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,HEALTHPLUS-CHP, +91317,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,HEALTHPLUS-CHP, +91318,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,HEALTHPLUS-CHP, +91319,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,HEALTHPLUS-CHP, +91320,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,HEALTHPLUS-CHP, +91321,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,HEALTHPLUS-CHP, +91322,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,HEALTHPLUS-CHP, +91323,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,HEALTHPLUS-CHP, +91324,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,HEALTHPLUS-CHP, +91325,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,HEALTHPLUS-CHP, +91326,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,HEALTHPLUS-CHP, +91327,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,HEALTHPLUS-CHP, +91328,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,HEALTHPLUS-CHP, +91329,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,HEALTHPLUS-CHP, +91330,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,HEALTHPLUS-CHP, +91331,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,HEALTHPLUS-CHP, +91332,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,HEALTHPLUS-CHP, +91333,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,HEALTHPLUS-CHP, +91334,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,HEALTHPLUS-CHP, +91335,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,HEALTHPLUS-CHP, +91336,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,HEALTHPLUS-CHP, +91337,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,HEALTHPLUS-CHP, +91338,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,HEALTHPLUS-CHP, +91339,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,HEALTHPLUS-CHP, +91340,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,HEALTHPLUS-CHP, +91341,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,HEALTHPLUS-CHP, +91342,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,HEALTHPLUS-CHP, +91343,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,HEALTHPLUS-CHP, +91344,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,HEALTHPLUS-CHP, +91345,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,HEALTHPLUS-CHP, +91346,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,HEALTHPLUS-CHP, +91347,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,HEALTHPLUS-CHP, +91348,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,HEALTHPLUS-CHP, +91349,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,HEALTHPLUS-CHP, +91350,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,HEALTHPLUS-CHP, +91351,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,HEALTHPLUS-CHP, +91352,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,HEALTHPLUS-CHP, +91353,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,HEALTHPLUS-CHP, +91354,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,HEALTHPLUS-CHP, +91355,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,HEALTHPLUS-CHP, +91356,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,HEALTHPLUS-CHP, +91357,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,HEALTHPLUS-CHP, +91358,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,HEALTHPLUS-CHP, +91359,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,HEALTHPLUS-CHP, +91360,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,HEALTHPLUS-CHP, +91361,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,HEALTHPLUS-CHP, +91362,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,HEALTHPLUS-CHP, +91363,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,HEALTHPLUS-CHP, +91364,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,HEALTHPLUS-CHP, +91365,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,HEALTHPLUS-CHP, +91366,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,HEALTHPLUS-CHP, +91367,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,HEALTHPLUS-CHP, +91368,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,HEALTHPLUS-CHP, +91369,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,HEALTHPLUS-CHP, +91370,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,HEALTHPLUS-CHP, +91371,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,HEALTHPLUS-CHP, +91372,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,HEALTHPLUS-CHP, +91373,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,HEALTHPLUS-CHP, +91374,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,HEALTHPLUS-CHP, +91375,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,HEALTHPLUS-CHP, +91376,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,HEALTHPLUS-CHP, +91377,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,HEALTHPLUS-CHP, +91378,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,HEALTHPLUS-CHP, +91379,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,HEALTHPLUS-CHP, +91380,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,HEALTHPLUS-CHP, +91381,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,HEALTHPLUS-CHP, +91382,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,HEALTHPLUS-CHP, +91383,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,HEALTHPLUS-CHP, +91384,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,HEALTHPLUS-CHP, +91385,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,HEALTHPLUS-CHP, +91386,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,HEALTHPLUS-CHP, +91387,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,HEALTHPLUS-CHP, +91388,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,HEALTHPLUS-CHP, +91389,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,HEALTHPLUS-CHP, +91390,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,HEALTHPLUS-CHP, +91391,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,HEALTHPLUS-CHP, +91392,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,HEALTHPLUS-CHP, +91393,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,HEALTHPLUS-CHP, +91394,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,HEALTHPLUS-CHP, +91395,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,HEALTHPLUS-CHP, +91396,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,HEALTHPLUS-CHP, +91397,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,HEALTHPLUS-CHP, +91398,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,HEALTHPLUS-CHP, +91399,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,HEALTHPLUS-CHP, +91400,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,HEALTHPLUS-CHP, +91401,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,HEALTHPLUS-CHP, +91402,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,HEALTHPLUS-CHP, +91403,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,HEALTHPLUS-CHP, +91404,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,HEALTHPLUS-CHP, +91405,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,HEALTHPLUS-CHP, +91406,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,HEALTHPLUS-CHP, +91407,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,HEALTHPLUS-CHP, +91408,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,HEALTHPLUS-CHP, +91409,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,HEALTHPLUS-CHP, +91410,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,HEALTHPLUS-CHP, +91411,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,HEALTHPLUS-CHP, +91412,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,HEALTHPLUS-CHP, +91413,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,HEALTHPLUS-CHP, +91414,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,HEALTHPLUS-CHP, +91415,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,HEALTHPLUS-CHP, +91416,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,HEALTHPLUS-CHP, +91417,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,HEALTHPLUS-CHP, +91418,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,HEALTHPLUS-CHP, +91419,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,HEALTHPLUS-CHP, +91420,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,HEALTHPLUS-CHP, +91421,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,HEALTHPLUS-CHP, +91422,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,HEALTHPLUS-CHP, +91423,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,HEALTHPLUS-CHP, +91424,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,HEALTHPLUS-CHP, +91425,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,HEALTHPLUS-CHP, +91426,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,HEALTHPLUS-CHP, +91427,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,HEALTHPLUS-CHP, +91428,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,HEALTHPLUS-CHP, +91429,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,HEALTHPLUS-CHP, +91430,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,HEALTHPLUS-CHP, +91431,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,HEALTHPLUS-CHP, +91432,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,HEALTHPLUS-CHP, +91433,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,HEALTHPLUS-CHP, +91434,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,HEALTHPLUS-CHP, +91435,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,HEALTHPLUS-CHP, +91436,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,HEALTHPLUS-CHP, +91437,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,HEALTHPLUS-CHP, +91438,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,HEALTHPLUS-CHP, +91439,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,HEALTHPLUS-CHP, +91440,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,HEALTHPLUS-CHP, +91441,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,HEALTHPLUS-CHP, +91442,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,HEALTHPLUS-CHP, +91443,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,HEALTHPLUS-CHP, +91444,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,HEALTHPLUS-CHP, +91445,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,HEALTHPLUS-CHP, +91446,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,HEALTHPLUS-CHP, +91447,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,HEALTHPLUS-CHP, +91448,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,HEALTHPLUS-CHP, +91449,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,HEALTHPLUS-CHP, +91450,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,HEALTHPLUS-CHP, +91451,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,HEALTHPLUS-CHP, +91452,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,HEALTHPLUS-CHP, +91453,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,HEALTHPLUS-CHP, +91454,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,HEALTHPLUS-CHP, +91455,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,HEALTHPLUS-CHP, +91456,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,HEALTHPLUS-CHP, +91457,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,HEALTHPLUS-CHP, +91458,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,HEALTHPLUS-CHP, +91459,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,HEALTHPLUS-CHP, +91460,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,HEALTHPLUS-CHP, +91461,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,HEALTHPLUS-CHP, +91462,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,HEALTHPLUS-CHP, +91463,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,HEALTHPLUS-CHP, +91464,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,HEALTHPLUS-CHP, +91465,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,HEALTHPLUS-CHP, +91466,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,HEALTHPLUS-CHP, +91467,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,HEALTHPLUS-CHP, +91468,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,HEALTHPLUS-CHP, +91469,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,HEALTHPLUS-CHP, +91470,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,HEALTHPLUS-CHP, +91471,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,HEALTHPLUS-CHP, +91472,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,HEALTHPLUS-CHP, +91473,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,HEALTHPLUS-CHP, +91474,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,HEALTHPLUS-CHP, +91475,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,HEALTHPLUS-CHP, +91476,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,HEALTHPLUS-CHP, +91477,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,HEALTHPLUS-CHP, +91478,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,HEALTHPLUS-CHP, +91479,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,HEALTHPLUS-CHP, +91480,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,HEALTHPLUS-CHP, +91481,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,HEALTHPLUS-CHP, +91482,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,HEALTHPLUS-CHP, +91483,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,HEALTHPLUS-CHP, +91484,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,HEALTHPLUS-CHP, +91485,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,HEALTHPLUS-CHP, +91486,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,HEALTHPLUS-CHP, +91487,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,HEALTHPLUS-CHP, +91488,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,HEALTHPLUS-CHP, +91489,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,HEALTHPLUS-CHP, +91490,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,HEALTHPLUS-CHP, +91491,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,HEALTHPLUS-CHP, +91492,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,HEALTHPLUS-CHP, +91493,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,HEALTHPLUS-CHP, +91494,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,HEALTHPLUS-CHP, +91495,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,HEALTHPLUS-CHP, +91496,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,HEALTHPLUS-CHP, +91497,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,HEALTHPLUS-CHP, +91498,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,HEALTHPLUS-CHP, +91499,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,HEALTHPLUS-CHP, +91500,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,HEALTHPLUS-CHP, +91501,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,HEALTHPLUS-CHP, +91502,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,HEALTHPLUS-CHP, +91503,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,HEALTHPLUS-CHP, +91504,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,HEALTHPLUS-CHP, +91505,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,HEALTHPLUS-CHP, +91506,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,HEALTHPLUS-CHP, +91507,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,HEALTHPLUS-CHP, +91508,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,HEALTHPLUS-CHP, +91509,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,HEALTHPLUS-CHP, +91510,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,HEALTHPLUS-CHP, +91511,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,HEALTHPLUS-CHP, +91512,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,HEALTHPLUS-CHP, +91513,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,HEALTHPLUS-CHP, +91514,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,HEALTHPLUS-CHP, +91515,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,HEALTHPLUS-CHP, +91516,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,HEALTHPLUS-CHP, +91517,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,HEALTHPLUS-CHP, +91518,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,HEALTHPLUS-CHP, +91519,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,HEALTHPLUS-CHP, +91520,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,HEALTHPLUS-CHP, +91521,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,HEALTHPLUS-CHP, +91522,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,HEALTHPLUS-CHP, +91523,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,HEALTHPLUS-CHP, +91524,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,HEALTHPLUS-CHP, +91525,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,HEALTHPLUS-CHP, +91526,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,HEALTHPLUS-CHP, +91527,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,HEALTHPLUS-CHP, +91528,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,HEALTHPLUS-CHP, +91529,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,HEALTHPLUS-CHP, +91530,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,HEALTHPLUS-CHP, +91531,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,HEALTHPLUS-CHP, +91532,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,HEALTHPLUS-CHP, +91533,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,HEALTHPLUS-CHP, +91534,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,HEALTHPLUS-CHP, +91535,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,HEALTHPLUS-CHP, +91536,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,HEALTHPLUS-CHP, +91537,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,HEALTHPLUS-CHP,44.6 +91538,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,HEALTHPLUS-CHP, +91539,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,HEALTHPLUS-CHP, +91540,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,HEALTHPLUS-CHP, +91541,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,HEALTHPLUS-CHP, +91542,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,HEALTHPLUS-CHP, +91543,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,HEALTHPLUS-CHP, +91544,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,HEALTHPLUS-CHP, +91545,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,HEALTHPLUS-CHP, +91546,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,HEALTHPLUS-CHP, +91547,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,HEALTHPLUS-CHP, +91548,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,HEALTHPLUS-CHP, +91549,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,HEALTHPLUS-CHP, +91550,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,HEALTHPLUS-CHP, +91551,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,HEALTHPLUS-CHP, +91552,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,HEALTHPLUS-CHP, +91553,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,HEALTHPLUS-CHP, +91554,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,HEALTHPLUS-CHP, +91555,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,HEALTHPLUS-CHP, +91556,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,HEALTHPLUS-CHP, +91557,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,HEALTHPLUS-CHP, +91558,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,HEALTHPLUS-CHP, +91559,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,HEALTHPLUS-CHP, +91560,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,HEALTHPLUS-CHP, +91561,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,HEALTHPLUS-CHP, +91562,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,HEALTHPLUS-CHP, +91563,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,HEALTHPLUS-CHP, +91564,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,HEALTHPLUS-CHP, +91565,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,HEALTHPLUS-CHP, +91566,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,HEALTHPLUS-CHP, +91567,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,HEALTHPLUS-CHP, +91568,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,HEALTHPLUS-CHP, +91569,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,HEALTHPLUS-CHP, +91570,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,HEALTHPLUS-CHP, +91571,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,HEALTHPLUS-CHP, +91572,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,HEALTHPLUS-CHP, +91573,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,HEALTHPLUS-CHP, +91574,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,HEALTHPLUS-CHP, +91575,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,HEALTHPLUS-CHP, +91576,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,HEALTHPLUS-CHP, +91577,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,HEALTHPLUS-CHP, +91578,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,HEALTHPLUS-CHP, +91579,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,HEALTHPLUS-CHP, +91580,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,HEALTHPLUS-CHP, +91581,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,HEALTHPLUS-CHP, +91582,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,HEALTHPLUS-CHP, +91583,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,HEALTHPLUS-CHP, +91584,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,HEALTHPLUS-CHP, +91585,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,HEALTHPLUS-CHP, +91586,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,HEALTHPLUS-CHP, +91587,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,HEALTHPLUS-CHP, +91588,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,HEALTHPLUS-CHP, +91589,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,HEALTHPLUS-CHP,16.63 +91590,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,HEALTHPLUS-CHP, +91591,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,HEALTHPLUS-CHP, +91592,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,HEALTHPLUS-CHP, +91593,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,HEALTHPLUS-CHP,9.07 +91594,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,HEALTHPLUS-CHP, +91595,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,HEALTHPLUS-CHP, +91596,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,HEALTHPLUS-CHP, +91597,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,HEALTHPLUS-CHP, +91598,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,HEALTHPLUS-CHP, +91599,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,HEALTHPLUS-CHP, +91600,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,HEALTHPLUS-CHP, +91601,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,HEALTHPLUS-CHP, +91602,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,HEALTHPLUS-CHP, +91603,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,HEALTHPLUS-CHP, +91604,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,HEALTHPLUS-CHP, +91605,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,HEALTHPLUS-CHP, +91606,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,HEALTHPLUS-CHP, +91607,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,HEALTHPLUS-CHP, +91608,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,HEALTHPLUS-CHP, +91609,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,HEALTHPLUS-CHP, +91610,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,HEALTHPLUS-CHP, +91611,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,HEALTHPLUS-CHP, +91612,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,HEALTHPLUS-CHP, +91613,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,HEALTHPLUS-CHP, +91614,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,HEALTHPLUS-CHP, +91615,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,HEALTHPLUS-CHP, +91616,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,HEALTHPLUS-CHP, +91617,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,HEALTHPLUS-CHP,5.46 +91618,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,HEALTHPLUS-CHP, +91619,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,HEALTHPLUS-CHP, +91620,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,HEALTHPLUS-CHP, +91621,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,HEALTHPLUS-CHP, +91622,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,HEALTHPLUS-CHP, +91623,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,HEALTHPLUS-CHP, +91624,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,HEALTHPLUS-CHP, +91625,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,HEALTHPLUS-CHP, +91626,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,HEALTHPLUS-CHP, +91627,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,HEALTHPLUS-CHP, +91628,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,HEALTHPLUS-CHP, +91629,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,HEALTHPLUS-CHP, +91630,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,HEALTHPLUS-CHP, +91631,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,HEALTHPLUS-CHP, +91632,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,HEALTHPLUS-CHP, +91633,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,HEALTHPLUS-CHP, +91634,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,HEALTHPLUS-CHP, +91635,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,HEALTHPLUS-CHP, +91636,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,HEALTHPLUS-CHP, +91637,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,HEALTHPLUS-CHP, +91638,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,HEALTHPLUS-CHP, +91639,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,HEALTHPLUS-CHP, +91640,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,HEALTHPLUS-CHP, +91641,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,HEALTHPLUS-CHP, +91642,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,HEALTHPLUS-CHP, +91643,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,HEALTHPLUS-CHP, +91644,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,HEALTHPLUS-CHP,3.56 +91645,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,HEALTHPLUS-CHP, +91646,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,HEALTHPLUS-CHP, +91647,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,HEALTHPLUS-CHP, +91648,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,HEALTHPLUS-CHP, +91649,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,HEALTHPLUS-CHP, +91650,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,HEALTHPLUS-CHP, +91651,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,HEALTHPLUS-CHP, +91652,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,HEALTHPLUS-CHP, +91653,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,HEALTHPLUS-CHP, +91654,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,HEALTHPLUS-CHP, +91655,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,HEALTHPLUS-CHP, +91656,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,HEALTHPLUS-CHP, +91657,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,HEALTHPLUS-CHP, +91658,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,HEALTHPLUS-CHP, +91659,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,HEALTHPLUS-CHP, +91660,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,HEALTHPLUS-CHP, +91661,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,HEALTHPLUS-CHP, +91662,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,HEALTHPLUS-CHP, +91663,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,HEALTHPLUS-CHP, +91664,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,HEALTHPLUS-CHP, +91665,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,HEALTHPLUS-CHP, +91666,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,HEALTHPLUS-CHP, +91667,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,HEALTHPLUS-CHP, +91668,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,HEALTHPLUS-CHP, +91669,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,HEALTHPLUS-CHP, +91670,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,HEALTHPLUS-CHP, +91671,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,HEALTHPLUS-CHP, +91672,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,HEALTHPLUS-CHP, +91673,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,HEALTHPLUS-CHP, +91674,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,HEALTHPLUS-CHP, +91675,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,HEALTHPLUS-CHP, +91676,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,HEALTHPLUS-CHP, +91677,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,HEALTHPLUS-CHP, +91678,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,HEALTHPLUS-CHP, +91679,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,HEALTHPLUS-CHP, +91680,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,HEALTHPLUS-CHP, +91681,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,HEALTHPLUS-CHP, +91682,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,HEALTHPLUS-CHP, +91683,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,HEALTHPLUS-CHP, +91684,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,HEALTHPLUS-CHP, +91685,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,HEALTHPLUS-CHP, +91686,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,HEALTHPLUS-CHP, +91687,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,HEALTHPLUS-CHP, +91688,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,HEALTHPLUS-CHP, +91689,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,HEALTHPLUS-CHP, +91690,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,HEALTHPLUS-CHP, +91691,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,HEALTHPLUS-CHP, +91692,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,HEALTHPLUS-CHP, +91693,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,HEALTHPLUS-CHP, +91694,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,HEALTHPLUS-CHP, +91695,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,HEALTHPLUS-CHP, +91696,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,HEALTHPLUS-CHP, +91697,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,HEALTHPLUS-CHP, +91698,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,HEALTHPLUS-CHP, +91699,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,HEALTHPLUS-CHP, +91700,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,HEALTHPLUS-CHP,17.28 +91701,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,HEALTHPLUS-CHP, +91702,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,HEALTHPLUS-CHP, +91703,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,HEALTHPLUS-CHP,1.75 +91704,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,HEALTHPLUS-CHP, +91705,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,HEALTHPLUS-CHP, +91706,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,HEALTHPLUS-CHP, +91707,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,HEALTHPLUS-CHP, +91708,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,HEALTHPLUS-CHP,2.46 +91709,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,HEALTHPLUS-CHP, +91710,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,HEALTHPLUS-CHP, +91711,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,HEALTHPLUS-CHP, +91712,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,HEALTHPLUS-CHP, +91713,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,HEALTHPLUS-CHP, +91714,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,HEALTHPLUS-CHP, +91715,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,HEALTHPLUS-CHP, +91716,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,HEALTHPLUS-CHP, +91717,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,HEALTHPLUS-CHP, +91718,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,HEALTHPLUS-CHP, +91719,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,HEALTHPLUS-CHP, +91720,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,HEALTHPLUS-CHP, +91721,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,HEALTHPLUS-CHP, +91722,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,HEALTHPLUS-CHP, +91723,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,HEALTHPLUS-CHP, +91724,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,HEALTHPLUS-CHP, +91725,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,HEALTHPLUS-CHP, +91726,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,HEALTHPLUS-CHP, +91727,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,HEALTHPLUS-CHP, +91728,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,HEALTHPLUS-CHP, +91729,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,HEALTHPLUS-CHP, +91730,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,HEALTHPLUS-CHP, +91731,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,HEALTHPLUS-CHP, +91732,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,HEALTHPLUS-CHP, +91733,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,HEALTHPLUS-CHP, +91734,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,HEALTHPLUS-CHP, +91735,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,HEALTHPLUS-CHP, +91736,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,HEALTHPLUS-CHP, +91737,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,HEALTHPLUS-CHP, +91738,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,HEALTHPLUS-CHP, +91739,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,HEALTHPLUS-CHP, +91740,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,HEALTHPLUS-CHP, +91741,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,HEALTHPLUS-CHP, +91742,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,HEALTHPLUS-CHP, +91743,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,HEALTHPLUS-CHP, +91744,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,HEALTHPLUS-CHP, +91745,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,HEALTHPLUS-CHP, +91746,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,HEALTHPLUS-CHP, +91747,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,HEALTHPLUS-CHP, +91748,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,HEALTHPLUS-CHP, +91749,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,HEALTHPLUS-CHP, +91750,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,HEALTHPLUS-CHP, +91751,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,HEALTHPLUS-CHP, +91752,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,HEALTHPLUS-CHP, +91753,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,HEALTHPLUS-CHP, +91754,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,HEALTHPLUS-CHP, +91755,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,HEALTHPLUS-CHP, +91756,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,HEALTHPLUS-CHP, +91757,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,HEALTHPLUS-CHP, +91758,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,HEALTHPLUS-CHP, +91759,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,HEALTHPLUS-CHP, +91760,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,HEALTHPLUS-CHP, +91761,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,HEALTHPLUS-CHP, +91762,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,HEALTHPLUS-CHP, +91763,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,HEALTHPLUS-CHP, +91764,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,HEALTHPLUS-CHP, +91765,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,HEALTHPLUS-CHP, +91766,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,HEALTHPLUS-CHP, +91767,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,HEALTHPLUS-CHP, +91768,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,HEALTHPLUS-CHP, +91769,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,HEALTHPLUS-CHP, +91770,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,HEALTHPLUS-CHP, +91771,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,HEALTHPLUS-CHP, +91772,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,HEALTHPLUS-CHP, +91773,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,HEALTHPLUS-CHP, +91774,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,HEALTHPLUS-CHP, +91775,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,HEALTHPLUS-CHP, +91776,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,HEALTHPLUS-CHP, +91777,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,HEALTHPLUS-CHP, +91778,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,HEALTHPLUS-CHP, +91779,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,HEALTHPLUS-CHP, +91780,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,HEALTHPLUS-CHP, +91781,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,HEALTHPLUS-CHP, +91782,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,HEALTHPLUS-CHP, +91783,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,HEALTHPLUS-CHP, +91784,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,HEALTHPLUS-CHP, +91785,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,HEALTHPLUS-CHP, +91786,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,HEALTHPLUS-CHP, +91787,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,HEALTHPLUS-CHP, +91788,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,HEALTHPLUS-CHP, +91789,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,HEALTHPLUS-CHP, +91790,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,HEALTHPLUS-CHP, +91791,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,HEALTHPLUS-CHP, +91792,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,HEALTHPLUS-CHP, +91793,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,HEALTHPLUS-CHP, +91794,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,HEALTHPLUS-CHP, +91795,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,HEALTHPLUS-CHP, +91796,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,HEALTHPLUS-CHP, +91797,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,HEALTHPLUS-CHP, +91798,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,HEALTHPLUS-CHP, +91799,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,HEALTHPLUS-CHP, +91800,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,HEALTHPLUS-CHP, +91801,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,HEALTHPLUS-CHP, +91802,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,HEALTHPLUS-CHP, +91803,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,HEALTHPLUS-CHP, +91804,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,HEALTHPLUS-CHP, +91805,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,HEALTHPLUS-CHP, +91806,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,HEALTHPLUS-CHP, +91807,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,HEALTHPLUS-CHP, +91808,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,HEALTHPLUS-CHP, +91809,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,HEALTHPLUS-CHP, +91810,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,HEALTHPLUS-CHP, +91811,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,HEALTHPLUS-CHP, +91812,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,HEALTHPLUS-CHP, +91813,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,HEALTHPLUS-CHP, +91814,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,HEALTHPLUS-CHP, +91815,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,HEALTHPLUS-CHP, +91816,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,HEALTHPLUS-CHP, +91817,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,HEALTHPLUS-CHP, +91818,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,HEALTHPLUS-CHP, +91819,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,HEALTHPLUS-CHP, +91820,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,HEALTHPLUS-CHP, +91821,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,HEALTHPLUS-CHP, +91822,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,HEALTHPLUS-CHP, +91823,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,HEALTHPLUS-CHP, +91824,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,HEALTHPLUS-CHP, +91825,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,HEALTHPLUS-CHP, +91826,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,HEALTHPLUS-CHP, +91827,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,HEALTHPLUS-CHP, +91828,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,HEALTHPLUS-CHP, +91829,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,HEALTHPLUS-CHP, +91830,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,HEALTHPLUS-CHP, +91831,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,HEALTHPLUS-CHP, +91832,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,HEALTHPLUS-CHP, +91833,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,HEALTHPLUS-CHP, +91834,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,HEALTHPLUS-CHP, +91835,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,HEALTHPLUS-CHP, +91836,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,HEALTHPLUS-CHP, +91837,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,HEALTHPLUS-CHP, +91838,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,HEALTHPLUS-CHP, +91839,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,HEALTHPLUS-CHP, +91840,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,HEALTHPLUS-CHP, +91841,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,HEALTHPLUS-CHP, +91842,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,HEALTHPLUS-CHP, +91843,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,HEALTHPLUS-CHP, +91844,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,HEALTHPLUS-CHP, +91845,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,HEALTHPLUS-CHP, +91846,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,HEALTHPLUS-CHP, +91847,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,HEALTHPLUS-CHP, +91848,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,HEALTHPLUS-CHP, +91849,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,HEALTHPLUS-CHP, +91850,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,HEALTHPLUS-CHP, +91851,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,HEALTHPLUS-CHP, +91852,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,HEALTHPLUS-CHP, +91853,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,HEALTHPLUS-CHP, +91854,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,HEALTHPLUS-CHP, +91855,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,HEALTHPLUS-CHP, +91856,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,HEALTHPLUS-CHP, +91857,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,HEALTHPLUS-CHP, +91858,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,HEALTHPLUS-CHP, +91859,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,HEALTHPLUS-CHP, +91860,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,HEALTHPLUS-CHP, +91861,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,HEALTHPLUS-CHP, +91862,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,HEALTHPLUS-CHP, +91863,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,HEALTHPLUS-CHP, +91864,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,HEALTHPLUS-CHP, +91865,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,HEALTHPLUS-CHP, +91866,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,HEALTHPLUS-CHP, +91867,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,HEALTHPLUS-CHP, +91868,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,HEALTHPLUS-CHP, +91869,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,HEALTHPLUS-CHP, +91870,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,HEALTHPLUS-CHP, +91871,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,HEALTHPLUS-CHP, +91872,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,HEALTHPLUS-CHP, +91873,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,HEALTHPLUS-CHP, +91874,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,HEALTHPLUS-CHP, +91875,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,HEALTHPLUS-CHP, +91876,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,HEALTHPLUS-CHP, +91877,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,HEALTHPLUS-CHP, +91878,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,HEALTHPLUS-CHP, +91879,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,HEALTHPLUS-CHP, +91880,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,HEALTHPLUS-CHP, +91881,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,HEALTHPLUS-CHP, +91882,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,HEALTHPLUS-CHP, +91883,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,HEALTHPLUS-CHP, +91884,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,HEALTHPLUS-CHP, +91885,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,HEALTHPLUS-CHP, +91886,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,HEALTHPLUS-CHP, +91887,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,HEALTHPLUS-CHP, +91888,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,HEALTHPLUS-CHP, +91889,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,HEALTHPLUS-CHP, +91890,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,HEALTHPLUS-CHP, +91891,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,HEALTHPLUS-CHP, +91892,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,HEALTHPLUS-CHP, +91893,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,HEALTHPLUS-CHP, +91894,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,HEALTHPLUS-CHP, +91895,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91896,3934,30000012,PRIVATE,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91897,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91898,3934,30000038,ICU,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91899,3934,30000046,BURN UNIT,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91900,3934,30000053,NICU,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91901,3934,30000061,ICR ROOM,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91902,3934,30000079,PSYCH,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91903,3934,30000087,NEWBORN,,4140.0,4140.0,,,HEALTHPLUS-CHP, +91904,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91905,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91906,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91907,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91908,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91909,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91910,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91911,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91912,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91913,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91914,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91915,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91916,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91917,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91918,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91919,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91920,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91921,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91922,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91923,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91924,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91925,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91926,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91927,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91928,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91929,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91930,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91931,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91932,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91933,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91934,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91935,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91936,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91937,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91938,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91939,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91940,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91941,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91942,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91943,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91944,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91945,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91946,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91947,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91948,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91949,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91950,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91951,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91952,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91953,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91954,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91955,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91956,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91957,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91958,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91959,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91960,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91961,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91962,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91963,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91964,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91965,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91966,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91967,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91968,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91969,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91970,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91971,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91972,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91973,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91974,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91975,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91976,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91977,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91978,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91979,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91980,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91981,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91982,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91983,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91984,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91985,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91986,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91987,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91988,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91989,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91990,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91991,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +91992,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91993,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91994,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91995,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +91996,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91997,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +91998,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +91999,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92000,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92001,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92002,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92003,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92004,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92005,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92006,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92007,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92008,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92009,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92010,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92011,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92012,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92013,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92014,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92015,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92016,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92017,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92018,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92019,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92020,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92021,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92022,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92023,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92024,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92025,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92026,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92027,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92028,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92029,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92030,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92031,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92032,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92033,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92034,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92035,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92036,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92037,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92038,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92039,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92040,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92041,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92042,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92043,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92044,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92045,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92046,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92047,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92048,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92049,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92050,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92051,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92052,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92053,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92054,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92055,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92056,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92057,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92058,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92059,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92060,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92061,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92062,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92063,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92064,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92065,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92066,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92067,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92068,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92069,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92070,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92071,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92072,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92073,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92074,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92075,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92076,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92077,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92078,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92079,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92080,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92081,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92082,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92083,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92084,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92085,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92086,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92087,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92088,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92089,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92090,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92091,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92092,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92093,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92094,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92095,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92096,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92097,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92098,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92099,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92100,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92101,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92102,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92103,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92104,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92105,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92106,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92107,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92108,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92109,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92110,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92111,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92112,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92113,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92114,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92115,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92116,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92117,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92118,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92119,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92120,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92121,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92122,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92123,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92124,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92125,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92126,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92127,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92128,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92129,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92130,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92131,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92132,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92133,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92134,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92135,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92136,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92137,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92138,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92139,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92140,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92141,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92142,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92143,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92144,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92145,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92146,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92147,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92148,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92149,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92150,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92151,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92152,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92153,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92154,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92155,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92156,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92157,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92158,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92159,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92160,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92161,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92162,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92163,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92164,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92165,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92166,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92167,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92168,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92169,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92170,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92171,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92172,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92173,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92174,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92175,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92176,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92177,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92178,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92179,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92180,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92181,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92182,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92183,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92184,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92185,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92186,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92187,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92188,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92189,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92190,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92191,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92192,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92193,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92194,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92195,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92196,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92197,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92198,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92199,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92200,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92201,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92202,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92203,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92204,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92205,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92206,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92207,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92208,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92209,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92210,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92211,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92212,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92213,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92214,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92215,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92216,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92217,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92218,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92219,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92220,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92221,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92222,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92223,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92224,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92225,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92226,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92227,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92228,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92229,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92230,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92231,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92232,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92233,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92234,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92235,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92236,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92237,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92238,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92239,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92240,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92241,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92242,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92243,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92244,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92245,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92246,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92247,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92248,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92249,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92250,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92251,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92252,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92253,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92254,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92255,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92256,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92257,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92258,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92259,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92260,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92261,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92262,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92263,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92264,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92265,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92266,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92267,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92268,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92269,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92270,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92271,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92272,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92273,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92274,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92275,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92276,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92277,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92278,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92279,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92280,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92281,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92282,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92283,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92284,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92285,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92286,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92287,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92288,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92289,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92290,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92291,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92292,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92293,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92294,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92295,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92296,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92297,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92298,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92299,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92300,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92301,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92302,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92303,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92304,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92305,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92306,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92307,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92308,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92309,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92310,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92311,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92312,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92313,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,HEALTHPLUS-CHP, +92314,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92315,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92316,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92317,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92318,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92319,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92320,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,HEALTHPLUS-CHP, +92321,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92322,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92323,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92324,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92325,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92326,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92327,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92328,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92329,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92330,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92331,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92332,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92333,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92334,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92335,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92336,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92337,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92338,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,HEALTHPLUS-CHP, +92339,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,HEALTHPLUS-CHP, +92340,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,HEALTHPLUS-CHP, +92341,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,HEALTHPLUS-CHP, +92342,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,HEALTHPLUS-CHP, +92343,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,HEALTHPLUS-CHP, +92344,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,HEALTHPLUS-CHP, +92345,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,HEALTHPLUS-CHP, +92346,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,HEALTHPLUS-CHP, +92347,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,HEALTHPLUS-CHP, +92348,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,HEALTHPLUS-CHP, +92349,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,HEALTHPLUS-CHP, +92350,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,HEALTHPLUS-CHP, +92351,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,HEALTHPLUS-CHP, +92352,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,HEALTHPLUS-CHP, +92353,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,HEALTHPLUS-CHP, +92354,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,HEALTHPLUS-CHP, +92355,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,HEALTHPLUS-CHP, +92356,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,HEALTHPLUS-CHP, +92357,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,HEALTHPLUS-CHP, +92358,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,HEALTHPLUS-CHP, +92359,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,HEALTHPLUS-CHP, +92360,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,HEALTHPLUS-CHP, +92361,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,HEALTHPLUS-CHP, +92362,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,HEALTHPLUS-CHP, +92363,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,HEALTHPLUS-CHP, +92364,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,HEALTHPLUS-CHP, +92365,3934,37112000,ACUTE ED,,1580.0,1580.0,,,HEALTHPLUS-CHP, +92366,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,HEALTHPLUS-CHP, +92367,3934,37112034,TRIAGE,,277.0,277.0,,,HEALTHPLUS-CHP, +92368,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,HEALTHPLUS-CHP, +92369,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,HEALTHPLUS-CHP, +92370,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,HEALTHPLUS-CHP, +92371,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,HEALTHPLUS-CHP, +92372,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,HEALTHPLUS-CHP, +92373,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,HEALTHPLUS-CHP, +92374,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,HEALTHPLUS-CHP, +92375,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,HEALTHPLUS-CHP, +92376,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,HEALTHPLUS-CHP, +92377,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,HEALTHPLUS-CHP, +92378,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,HEALTHPLUS-CHP, +92379,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,HEALTHPLUS-CHP, +92380,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,HEALTHPLUS-CHP, +92381,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,HEALTHPLUS-CHP, +92382,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,HEALTHPLUS-CHP, +92383,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,HEALTHPLUS-CHP, +92384,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,HEALTHPLUS-CHP, +92385,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,HEALTHPLUS-CHP, +92386,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,HEALTHPLUS-CHP, +92387,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,HEALTHPLUS-CHP, +92388,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,HEALTHPLUS-CHP, +92389,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,HEALTHPLUS-CHP, +92390,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,HEALTHPLUS-CHP, +92391,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,HEALTHPLUS-CHP, +92392,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,HEALTHPLUS-CHP, +92393,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,HEALTHPLUS-CHP, +92394,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,HEALTHPLUS-CHP, +92395,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,HEALTHPLUS-CHP, +92396,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,HEALTHPLUS-CHP, +92397,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,HEALTHPLUS-CHP, +92398,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,HEALTHPLUS-CHP, +92399,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,HEALTHPLUS-CHP, +92400,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,HEALTHPLUS-CHP, +92401,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,HEALTHPLUS-CHP, +92402,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,HEALTHPLUS-CHP, +92403,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,HEALTHPLUS-CHP, +92404,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,HEALTHPLUS-CHP, +92405,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,HEALTHPLUS-CHP, +92406,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,HEALTHPLUS-CHP, +92407,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,HEALTHPLUS-CHP, +92408,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,HEALTHPLUS-CHP, +92409,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,HEALTHPLUS-CHP, +92410,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,HEALTHPLUS-CHP, +92411,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,HEALTHPLUS-CHP, +92412,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,HEALTHPLUS-CHP, +92413,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,HEALTHPLUS-CHP, +92414,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,HEALTHPLUS-CHP, +92415,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,HEALTHPLUS-CHP, +92416,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,HEALTHPLUS-CHP, +92417,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,HEALTHPLUS-CHP, +92418,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,HEALTHPLUS-CHP, +92419,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,HEALTHPLUS-CHP, +92420,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,HEALTHPLUS-CHP, +92421,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,HEALTHPLUS-CHP, +92422,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,HEALTHPLUS-CHP, +92423,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,HEALTHPLUS-CHP, +92424,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,HEALTHPLUS-CHP, +92425,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-CHP, +92426,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-CHP, +92427,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-CHP, +92428,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-CHP, +92429,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-CHP, +92430,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-CHP, +92431,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-CHP, +92432,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-CHP, +92433,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-CHP, +92434,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-CHP, +92435,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-CHP, +92436,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-CHP, +92437,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-CHP, +92438,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-CHP, +92439,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-CHP, +92440,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-CHP, +92441,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-CHP, +92442,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-CHP, +92443,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-CHP, +92444,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-CHP, +92445,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-CHP, +92446,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-CHP, +92447,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-CHP, +92448,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-CHP, +92449,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-CHP, +92450,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-CHP, +92451,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-CHP, +92452,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-CHP, +92453,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-CHP, +92454,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-CHP, +92455,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-CHP, +92456,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-CHP, +92457,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-CHP, +92458,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-CHP, +92459,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-CHP, +92460,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-CHP, +92461,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-CHP, +92462,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-CHP, +92463,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-CHP, +92464,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-CHP, +92465,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-CHP, +92466,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-CHP, +92467,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-CHP, +92468,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92469,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92470,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92471,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92472,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92473,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,HEALTHPLUS-CHP, +92474,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,HEALTHPLUS-CHP, +92475,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,HEALTHPLUS-CHP, +92476,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92477,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92478,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92479,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,HEALTHPLUS-CHP, +92480,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,HEALTHPLUS-CHP, +92481,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,HEALTHPLUS-CHP, +92482,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,HEALTHPLUS-CHP, +92483,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,HEALTHPLUS-CHP, +92484,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,HEALTHPLUS-CHP, +92485,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,HEALTHPLUS-CHP, +92486,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,HEALTHPLUS-CHP, +92487,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,HEALTHPLUS-CHP, +92488,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,HEALTHPLUS-CHP, +92489,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,HEALTHPLUS-CHP, +92490,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,HEALTHPLUS-CHP, +92491,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,HEALTHPLUS-CHP, +92492,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,HEALTHPLUS-CHP, +92493,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,HEALTHPLUS-CHP, +92494,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,HEALTHPLUS-CHP, +92495,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,HEALTHPLUS-CHP, +92496,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,HEALTHPLUS-CHP, +92497,3934,43301043,ALBUNEX,,357.0,357.0,,,HEALTHPLUS-CHP, +92498,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,HEALTHPLUS-CHP, +92499,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92500,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92501,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92502,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92503,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92504,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,HEALTHPLUS-CHP, +92505,3934,43450022,REC RM .5HR,,541.0,541.0,,,HEALTHPLUS-CHP, +92506,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,HEALTHPLUS-CHP, +92507,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,HEALTHPLUS-CHP, +92508,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,HEALTHPLUS-CHP, +92509,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,HEALTHPLUS-CHP, +92510,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,HEALTHPLUS-CHP, +92511,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,HEALTHPLUS-CHP, +92512,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,HEALTHPLUS-CHP, +92513,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,HEALTHPLUS-CHP, +92514,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,HEALTHPLUS-CHP, +92515,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,HEALTHPLUS-CHP, +92516,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,HEALTHPLUS-CHP, +92517,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,HEALTHPLUS-CHP, +92518,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,HEALTHPLUS-CHP, +92519,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,HEALTHPLUS-CHP, +92520,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,HEALTHPLUS-CHP, +92521,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,HEALTHPLUS-CHP, +92522,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-CHP, +92523,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92524,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92525,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92526,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92527,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92528,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,HEALTHPLUS-CHP, +92529,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92530,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-CHP, +92531,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92532,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92533,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92534,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92535,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,HEALTHPLUS-CHP, +92536,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-CHP, +92537,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92538,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92539,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92540,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92541,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92542,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-CHP, +92543,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92544,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92545,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92546,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92547,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92548,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,HEALTHPLUS-CHP, +92549,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,HEALTHPLUS-CHP, +92550,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,HEALTHPLUS-CHP, +92551,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,HEALTHPLUS-CHP, +92552,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,HEALTHPLUS-CHP, +92553,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,HEALTHPLUS-CHP, +92554,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,HEALTHPLUS-CHP, +92555,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,HEALTHPLUS-CHP, +92556,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-CHP, +92557,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92558,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92559,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92560,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92561,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92562,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92563,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,HEALTHPLUS-CHP, +92564,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,HEALTHPLUS-CHP, +92565,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,HEALTHPLUS-CHP, +92566,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,HEALTHPLUS-CHP, +92567,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,HEALTHPLUS-CHP, +92568,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-CHP, +92569,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-CHP, +92570,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-CHP, +92571,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,HEALTHPLUS-CHP, +92572,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,HEALTHPLUS-CHP, +92573,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,HEALTHPLUS-CHP, +92574,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,HEALTHPLUS-CHP, +92575,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,HEALTHPLUS-CHP, +92576,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,HEALTHPLUS-CHP, +92577,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,HEALTHPLUS-CHP, +92578,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,HEALTHPLUS-CHP, +92579,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,HEALTHPLUS-CHP, +92580,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,HEALTHPLUS-CHP, +92581,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,HEALTHPLUS-CHP, +92582,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,HEALTHPLUS-CHP, +92583,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,HEALTHPLUS-CHP, +92584,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,HEALTHPLUS-CHP, +92585,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,HEALTHPLUS-CHP, +92586,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,HEALTHPLUS-CHP, +92587,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,HEALTHPLUS-CHP, +92588,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,HEALTHPLUS-CHP, +92589,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,HEALTHPLUS-CHP, +92590,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,HEALTHPLUS-CHP, +92591,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,HEALTHPLUS-CHP, +92592,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-CHP, +92593,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,HEALTHPLUS-CHP, +92594,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-CHP, +92595,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,HEALTHPLUS-CHP, +92596,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,HEALTHPLUS-CHP, +92597,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,HEALTHPLUS-CHP, +92598,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,HEALTHPLUS-CHP, +92599,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,HEALTHPLUS-CHP, +92600,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,HEALTHPLUS-CHP, +92601,3934,45924552,ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-CHP, +92602,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,HEALTHPLUS-CHP, +92603,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,HEALTHPLUS-CHP, +92604,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,HEALTHPLUS-CHP, +92605,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,HEALTHPLUS-CHP, +92606,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,HEALTHPLUS-CHP, +92607,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,HEALTHPLUS-CHP, +92608,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,HEALTHPLUS-CHP, +92609,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,HEALTHPLUS-CHP, +92610,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,HEALTHPLUS-CHP, +92611,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,HEALTHPLUS-CHP, +92612,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,HEALTHPLUS-CHP, +92613,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,HEALTHPLUS-CHP, +92614,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,HEALTHPLUS-CHP, +92615,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,HEALTHPLUS-CHP, +92616,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,HEALTHPLUS-CHP, +92617,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,HEALTHPLUS-CHP, +92618,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,HEALTHPLUS-CHP, +92619,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,HEALTHPLUS-CHP, +92620,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,HEALTHPLUS-CHP, +92621,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,HEALTHPLUS-CHP, +92622,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,HEALTHPLUS-CHP, +92623,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,HEALTHPLUS-CHP, +92624,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,HEALTHPLUS-CHP, +92625,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,HEALTHPLUS-CHP, +92626,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,HEALTHPLUS-CHP, +92627,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,HEALTHPLUS-CHP, +92628,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-CHP, +92629,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-CHP, +92630,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-CHP, +92631,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-CHP, +92632,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-CHP, +92633,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-CHP, +92634,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,HEALTHPLUS-CHP, +92635,3934,53200010,GUEST TRAY,,24.0,24.0,,,HEALTHPLUS-CHP, +92636,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,HEALTHPLUS-CHP, +92637,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,HEALTHPLUS-CHP, +92638,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,HEALTHPLUS-CHP, +92639,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,HEALTHPLUS-CHP, +92640,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,HEALTHPLUS-CHP, +92641,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,HEALTHPLUS-CHP, +92642,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,HEALTHPLUS-CHP, +92643,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,HEALTHPLUS-CHP, +92644,3934,53329876,HIV MONITORING,,416.0,416.0,,,HEALTHPLUS-CHP, +92645,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,HEALTHPLUS-CHP, +92646,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,HEALTHPLUS-CHP, +92647,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,HEALTHPLUS-CHP, +92648,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,HEALTHPLUS-CHP, +92649,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,HEALTHPLUS-CHP, +92650,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,HEALTHPLUS-CHP, +92651,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,HEALTHPLUS-CHP, +92652,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,HEALTHPLUS-CHP, +92653,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,HEALTHPLUS-CHP, +92654,3934,76010107,COPY X-RAY,,22.0,22.0,,,HEALTHPLUS-CHP, +92655,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,HEALTHPLUS-CHP, +92656,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,HEALTHPLUS-CHP, +92657,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,HEALTHPLUS-CHP, +92658,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,HEALTHPLUS-CHP, +92659,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,HEALTHPLUS-CHP, +92660,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,HEALTHPLUS-CHP, +92661,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,HEALTHPLUS-CHP, +92662,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,HEALTHPLUS-CHP, +92663,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,HEALTHPLUS-CHP, +92664,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,HEALTHPLUS-CHP, +92665,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,HEALTHPLUS-CHP, +92666,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,HEALTHPLUS-CHP, +92667,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,HEALTHPLUS-Essential, +92668,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,HEALTHPLUS-Essential, +92669,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,HEALTHPLUS-Essential, +92670,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,HEALTHPLUS-Essential, +92671,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,HEALTHPLUS-Essential, +92672,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,HEALTHPLUS-Essential, +92673,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,HEALTHPLUS-Essential, +92674,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,HEALTHPLUS-Essential, +92675,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,HEALTHPLUS-Essential, +92676,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,HEALTHPLUS-Essential, +92677,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,HEALTHPLUS-Essential, +92678,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,HEALTHPLUS-Essential, +92679,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,HEALTHPLUS-Essential, +92680,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,HEALTHPLUS-Essential, +92681,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,HEALTHPLUS-Essential, +92682,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,HEALTHPLUS-Essential, +92683,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,HEALTHPLUS-Essential, +92684,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,HEALTHPLUS-Essential, +92685,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,HEALTHPLUS-Essential, +92686,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,HEALTHPLUS-Essential, +92687,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,HEALTHPLUS-Essential, +92688,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,HEALTHPLUS-Essential, +92689,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,HEALTHPLUS-Essential, +92690,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,HEALTHPLUS-Essential, +92691,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,HEALTHPLUS-Essential, +92692,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,HEALTHPLUS-Essential, +92693,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,HEALTHPLUS-Essential, +92694,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,HEALTHPLUS-Essential, +92695,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,HEALTHPLUS-Essential, +92696,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,HEALTHPLUS-Essential, +92697,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,HEALTHPLUS-Essential, +92698,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,HEALTHPLUS-Essential, +92699,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,HEALTHPLUS-Essential, +92700,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,HEALTHPLUS-Essential, +92701,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,HEALTHPLUS-Essential, +92702,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,HEALTHPLUS-Essential, +92703,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,HEALTHPLUS-Essential, +92704,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,HEALTHPLUS-Essential, +92705,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,HEALTHPLUS-Essential, +92706,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,HEALTHPLUS-Essential, +92707,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,HEALTHPLUS-Essential, +92708,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,HEALTHPLUS-Essential, +92709,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,HEALTHPLUS-Essential, +92710,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,HEALTHPLUS-Essential, +92711,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,HEALTHPLUS-Essential, +92712,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,HEALTHPLUS-Essential, +92713,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,HEALTHPLUS-Essential, +92714,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,HEALTHPLUS-Essential, +92715,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,HEALTHPLUS-Essential, +92716,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,HEALTHPLUS-Essential, +92717,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,HEALTHPLUS-Essential, +92718,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,HEALTHPLUS-Essential, +92719,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,HEALTHPLUS-Essential, +92720,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,HEALTHPLUS-Essential, +92721,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,HEALTHPLUS-Essential, +92722,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,HEALTHPLUS-Essential, +92723,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,HEALTHPLUS-Essential, +92724,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,HEALTHPLUS-Essential, +92725,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,HEALTHPLUS-Essential, +92726,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,HEALTHPLUS-Essential, +92727,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,HEALTHPLUS-Essential, +92728,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,HEALTHPLUS-Essential, +92729,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,HEALTHPLUS-Essential, +92730,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,HEALTHPLUS-Essential, +92731,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,HEALTHPLUS-Essential, +92732,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,HEALTHPLUS-Essential, +92733,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,HEALTHPLUS-Essential, +92734,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,HEALTHPLUS-Essential, +92735,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,HEALTHPLUS-Essential, +92736,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,HEALTHPLUS-Essential, +92737,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,HEALTHPLUS-Essential, +92738,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,HEALTHPLUS-Essential, +92739,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,HEALTHPLUS-Essential, +92740,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,HEALTHPLUS-Essential, +92741,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,HEALTHPLUS-Essential, +92742,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,HEALTHPLUS-Essential, +92743,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,HEALTHPLUS-Essential, +92744,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,HEALTHPLUS-Essential, +92745,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,HEALTHPLUS-Essential, +92746,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,HEALTHPLUS-Essential, +92747,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,HEALTHPLUS-Essential, +92748,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,HEALTHPLUS-Essential, +92749,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,HEALTHPLUS-Essential, +92750,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,HEALTHPLUS-Essential, +92751,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,HEALTHPLUS-Essential, +92752,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,HEALTHPLUS-Essential, +92753,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,HEALTHPLUS-Essential, +92754,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,HEALTHPLUS-Essential, +92755,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,HEALTHPLUS-Essential, +92756,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,HEALTHPLUS-Essential, +92757,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,HEALTHPLUS-Essential, +92758,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,HEALTHPLUS-Essential, +92759,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,HEALTHPLUS-Essential, +92760,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,HEALTHPLUS-Essential, +92761,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,HEALTHPLUS-Essential, +92762,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,HEALTHPLUS-Essential, +92763,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,HEALTHPLUS-Essential, +92764,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,HEALTHPLUS-Essential, +92765,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,HEALTHPLUS-Essential, +92766,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,HEALTHPLUS-Essential, +92767,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,HEALTHPLUS-Essential, +92768,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,HEALTHPLUS-Essential, +92769,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,HEALTHPLUS-Essential, +92770,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,HEALTHPLUS-Essential, +92771,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,HEALTHPLUS-Essential, +92772,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,HEALTHPLUS-Essential, +92773,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,HEALTHPLUS-Essential, +92774,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,HEALTHPLUS-Essential, +92775,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,HEALTHPLUS-Essential, +92776,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,HEALTHPLUS-Essential, +92777,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,HEALTHPLUS-Essential, +92778,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,HEALTHPLUS-Essential, +92779,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,HEALTHPLUS-Essential, +92780,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,HEALTHPLUS-Essential, +92781,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,HEALTHPLUS-Essential, +92782,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,HEALTHPLUS-Essential, +92783,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,HEALTHPLUS-Essential, +92784,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,HEALTHPLUS-Essential, +92785,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,HEALTHPLUS-Essential, +92786,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,HEALTHPLUS-Essential, +92787,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,HEALTHPLUS-Essential, +92788,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,HEALTHPLUS-Essential,19598.19 +92789,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,HEALTHPLUS-Essential, +92790,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,HEALTHPLUS-Essential, +92791,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,HEALTHPLUS-Essential, +92792,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,HEALTHPLUS-Essential, +92793,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,HEALTHPLUS-Essential, +92794,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,HEALTHPLUS-Essential, +92795,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,HEALTHPLUS-Essential, +92796,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,HEALTHPLUS-Essential, +92797,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,HEALTHPLUS-Essential, +92798,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,HEALTHPLUS-Essential, +92799,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,HEALTHPLUS-Essential, +92800,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,HEALTHPLUS-Essential, +92801,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,HEALTHPLUS-Essential, +92802,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,HEALTHPLUS-Essential, +92803,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,HEALTHPLUS-Essential, +92804,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,HEALTHPLUS-Essential, +92805,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,HEALTHPLUS-Essential, +92806,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,HEALTHPLUS-Essential, +92807,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,HEALTHPLUS-Essential, +92808,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,HEALTHPLUS-Essential, +92809,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,HEALTHPLUS-Essential, +92810,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,HEALTHPLUS-Essential, +92811,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,HEALTHPLUS-Essential, +92812,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,HEALTHPLUS-Essential, +92813,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,HEALTHPLUS-Essential, +92814,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,HEALTHPLUS-Essential, +92815,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,HEALTHPLUS-Essential, +92816,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,HEALTHPLUS-Essential, +92817,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,HEALTHPLUS-Essential, +92818,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,HEALTHPLUS-Essential, +92819,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,HEALTHPLUS-Essential, +92820,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,HEALTHPLUS-Essential, +92821,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,HEALTHPLUS-Essential, +92822,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,HEALTHPLUS-Essential, +92823,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,HEALTHPLUS-Essential, +92824,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,HEALTHPLUS-Essential, +92825,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,HEALTHPLUS-Essential, +92826,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,HEALTHPLUS-Essential, +92827,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,HEALTHPLUS-Essential, +92828,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,HEALTHPLUS-Essential, +92829,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,HEALTHPLUS-Essential, +92830,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,HEALTHPLUS-Essential, +92831,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,HEALTHPLUS-Essential, +92832,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,HEALTHPLUS-Essential, +92833,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,HEALTHPLUS-Essential, +92834,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,HEALTHPLUS-Essential, +92835,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,HEALTHPLUS-Essential, +92836,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,HEALTHPLUS-Essential, +92837,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,HEALTHPLUS-Essential, +92838,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,HEALTHPLUS-Essential, +92839,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,HEALTHPLUS-Essential, +92840,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,HEALTHPLUS-Essential, +92841,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,HEALTHPLUS-Essential, +92842,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,HEALTHPLUS-Essential, +92843,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,HEALTHPLUS-Essential, +92844,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,HEALTHPLUS-Essential, +92845,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,HEALTHPLUS-Essential, +92846,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,HEALTHPLUS-Essential, +92847,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,HEALTHPLUS-Essential, +92848,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,HEALTHPLUS-Essential, +92849,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,HEALTHPLUS-Essential, +92850,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,HEALTHPLUS-Essential, +92851,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,HEALTHPLUS-Essential, +92852,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,HEALTHPLUS-Essential, +92853,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,HEALTHPLUS-Essential, +92854,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,HEALTHPLUS-Essential, +92855,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,HEALTHPLUS-Essential, +92856,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,HEALTHPLUS-Essential, +92857,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,HEALTHPLUS-Essential, +92858,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,HEALTHPLUS-Essential, +92859,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,HEALTHPLUS-Essential, +92860,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,HEALTHPLUS-Essential, +92861,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,HEALTHPLUS-Essential, +92862,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,HEALTHPLUS-Essential, +92863,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,HEALTHPLUS-Essential, +92864,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,HEALTHPLUS-Essential, +92865,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,HEALTHPLUS-Essential, +92866,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,HEALTHPLUS-Essential, +92867,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,HEALTHPLUS-Essential, +92868,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,HEALTHPLUS-Essential, +92869,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,HEALTHPLUS-Essential, +92870,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,HEALTHPLUS-Essential, +92871,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,HEALTHPLUS-Essential, +92872,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,HEALTHPLUS-Essential, +92873,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,HEALTHPLUS-Essential, +92874,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,HEALTHPLUS-Essential, +92875,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,HEALTHPLUS-Essential, +92876,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,HEALTHPLUS-Essential, +92877,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,HEALTHPLUS-Essential, +92878,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,HEALTHPLUS-Essential, +92879,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,HEALTHPLUS-Essential, +92880,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,HEALTHPLUS-Essential, +92881,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,HEALTHPLUS-Essential, +92882,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,HEALTHPLUS-Essential, +92883,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,HEALTHPLUS-Essential, +92884,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,HEALTHPLUS-Essential, +92885,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,HEALTHPLUS-Essential, +92886,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,HEALTHPLUS-Essential, +92887,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,HEALTHPLUS-Essential, +92888,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,HEALTHPLUS-Essential, +92889,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,HEALTHPLUS-Essential, +92890,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,HEALTHPLUS-Essential, +92891,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,HEALTHPLUS-Essential, +92892,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,HEALTHPLUS-Essential, +92893,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,HEALTHPLUS-Essential, +92894,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,HEALTHPLUS-Essential, +92895,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,HEALTHPLUS-Essential, +92896,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,HEALTHPLUS-Essential, +92897,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,HEALTHPLUS-Essential, +92898,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,HEALTHPLUS-Essential, +92899,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,HEALTHPLUS-Essential,17031.43 +92900,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,HEALTHPLUS-Essential, +92901,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,HEALTHPLUS-Essential, +92902,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,HEALTHPLUS-Essential, +92903,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,HEALTHPLUS-Essential, +92904,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,HEALTHPLUS-Essential, +92905,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,HEALTHPLUS-Essential, +92906,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,HEALTHPLUS-Essential, +92907,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,HEALTHPLUS-Essential, +92908,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,HEALTHPLUS-Essential, +92909,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,HEALTHPLUS-Essential, +92910,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,HEALTHPLUS-Essential, +92911,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,HEALTHPLUS-Essential, +92912,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,HEALTHPLUS-Essential, +92913,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,HEALTHPLUS-Essential, +92914,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,HEALTHPLUS-Essential, +92915,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,HEALTHPLUS-Essential, +92916,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,HEALTHPLUS-Essential, +92917,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,HEALTHPLUS-Essential, +92918,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,HEALTHPLUS-Essential, +92919,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,HEALTHPLUS-Essential, +92920,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,HEALTHPLUS-Essential, +92921,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,HEALTHPLUS-Essential, +92922,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,HEALTHPLUS-Essential, +92923,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,HEALTHPLUS-Essential, +92924,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,HEALTHPLUS-Essential, +92925,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,HEALTHPLUS-Essential, +92926,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,HEALTHPLUS-Essential, +92927,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,HEALTHPLUS-Essential, +92928,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,HEALTHPLUS-Essential, +92929,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,HEALTHPLUS-Essential, +92930,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,HEALTHPLUS-Essential, +92931,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,HEALTHPLUS-Essential, +92932,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,HEALTHPLUS-Essential, +92933,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,HEALTHPLUS-Essential, +92934,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,HEALTHPLUS-Essential, +92935,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,HEALTHPLUS-Essential, +92936,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,HEALTHPLUS-Essential,8923.56 +92937,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,HEALTHPLUS-Essential, +92938,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,HEALTHPLUS-Essential, +92939,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,HEALTHPLUS-Essential, +92940,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,HEALTHPLUS-Essential, +92941,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,HEALTHPLUS-Essential, +92942,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,HEALTHPLUS-Essential, +92943,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,HEALTHPLUS-Essential, +92944,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,HEALTHPLUS-Essential, +92945,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,HEALTHPLUS-Essential, +92946,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,HEALTHPLUS-Essential, +92947,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,HEALTHPLUS-Essential, +92948,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,HEALTHPLUS-Essential, +92949,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,HEALTHPLUS-Essential, +92950,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,HEALTHPLUS-Essential,6338.35 +92951,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,HEALTHPLUS-Essential, +92952,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,HEALTHPLUS-Essential, +92953,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,HEALTHPLUS-Essential, +92954,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,HEALTHPLUS-Essential, +92955,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,HEALTHPLUS-Essential, +92956,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,HEALTHPLUS-Essential,13759.81 +92957,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,HEALTHPLUS-Essential, +92958,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,HEALTHPLUS-Essential, +92959,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,HEALTHPLUS-Essential, +92960,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,HEALTHPLUS-Essential, +92961,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,HEALTHPLUS-Essential, +92962,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,HEALTHPLUS-Essential, +92963,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,HEALTHPLUS-Essential, +92964,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,HEALTHPLUS-Essential, +92965,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,HEALTHPLUS-Essential, +92966,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,HEALTHPLUS-Essential, +92967,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,HEALTHPLUS-Essential, +92968,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,HEALTHPLUS-Essential, +92969,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,HEALTHPLUS-Essential, +92970,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,HEALTHPLUS-Essential, +92971,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,HEALTHPLUS-Essential, +92972,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,HEALTHPLUS-Essential, +92973,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,HEALTHPLUS-Essential, +92974,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,HEALTHPLUS-Essential, +92975,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,HEALTHPLUS-Essential, +92976,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,HEALTHPLUS-Essential, +92977,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,HEALTHPLUS-Essential, +92978,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,HEALTHPLUS-Essential, +92979,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,HEALTHPLUS-Essential, +92980,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,HEALTHPLUS-Essential, +92981,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,HEALTHPLUS-Essential, +92982,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,HEALTHPLUS-Essential, +92983,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,HEALTHPLUS-Essential, +92984,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,HEALTHPLUS-Essential, +92985,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,HEALTHPLUS-Essential, +92986,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,HEALTHPLUS-Essential, +92987,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,HEALTHPLUS-Essential, +92988,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,HEALTHPLUS-Essential, +92989,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,HEALTHPLUS-Essential, +92990,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,HEALTHPLUS-Essential, +92991,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,HEALTHPLUS-Essential, +92992,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,HEALTHPLUS-Essential, +92993,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,HEALTHPLUS-Essential, +92994,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,HEALTHPLUS-Essential, +92995,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,HEALTHPLUS-Essential, +92996,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,HEALTHPLUS-Essential, +92997,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,HEALTHPLUS-Essential,22442.43 +92998,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,HEALTHPLUS-Essential, +92999,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,HEALTHPLUS-Essential, +93000,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,HEALTHPLUS-Essential, +93001,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,HEALTHPLUS-Essential, +93002,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,HEALTHPLUS-Essential, +93003,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,HEALTHPLUS-Essential, +93004,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,HEALTHPLUS-Essential, +93005,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,HEALTHPLUS-Essential, +93006,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,HEALTHPLUS-Essential, +93007,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,HEALTHPLUS-Essential, +93008,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,HEALTHPLUS-Essential, +93009,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,HEALTHPLUS-Essential, +93010,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,HEALTHPLUS-Essential, +93011,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,HEALTHPLUS-Essential, +93012,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,HEALTHPLUS-Essential, +93013,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,HEALTHPLUS-Essential, +93014,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,HEALTHPLUS-Essential, +93015,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,HEALTHPLUS-Essential, +93016,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,HEALTHPLUS-Essential, +93017,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,HEALTHPLUS-Essential, +93018,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,HEALTHPLUS-Essential, +93019,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,HEALTHPLUS-Essential, +93020,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,HEALTHPLUS-Essential, +93021,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,HEALTHPLUS-Essential, +93022,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,HEALTHPLUS-Essential, +93023,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,HEALTHPLUS-Essential, +93024,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,HEALTHPLUS-Essential, +93025,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,HEALTHPLUS-Essential, +93026,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,HEALTHPLUS-Essential, +93027,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,HEALTHPLUS-Essential, +93028,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,HEALTHPLUS-Essential, +93029,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,HEALTHPLUS-Essential, +93030,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,HEALTHPLUS-Essential, +93031,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,HEALTHPLUS-Essential, +93032,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,HEALTHPLUS-Essential, +93033,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,HEALTHPLUS-Essential, +93034,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,HEALTHPLUS-Essential, +93035,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,HEALTHPLUS-Essential, +93036,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,HEALTHPLUS-Essential, +93037,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,HEALTHPLUS-Essential, +93038,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,HEALTHPLUS-Essential, +93039,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,HEALTHPLUS-Essential, +93040,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,HEALTHPLUS-Essential, +93041,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,HEALTHPLUS-Essential, +93042,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,HEALTHPLUS-Essential, +93043,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,HEALTHPLUS-Essential, +93044,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,HEALTHPLUS-Essential, +93045,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,HEALTHPLUS-Essential, +93046,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,HEALTHPLUS-Essential, +93047,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,HEALTHPLUS-Essential, +93048,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,HEALTHPLUS-Essential, +93049,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,HEALTHPLUS-Essential, +93050,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,HEALTHPLUS-Essential, +93051,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,HEALTHPLUS-Essential, +93052,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,HEALTHPLUS-Essential, +93053,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,HEALTHPLUS-Essential, +93054,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,HEALTHPLUS-Essential, +93055,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,HEALTHPLUS-Essential, +93056,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,HEALTHPLUS-Essential, +93057,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,HEALTHPLUS-Essential, +93058,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,HEALTHPLUS-Essential, +93059,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,HEALTHPLUS-Essential, +93060,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,HEALTHPLUS-Essential, +93061,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,HEALTHPLUS-Essential, +93062,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,HEALTHPLUS-Essential, +93063,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,HEALTHPLUS-Essential, +93064,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,HEALTHPLUS-Essential, +93065,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,HEALTHPLUS-Essential, +93066,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,HEALTHPLUS-Essential, +93067,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,HEALTHPLUS-Essential, +93068,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,HEALTHPLUS-Essential, +93069,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,HEALTHPLUS-Essential, +93070,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,HEALTHPLUS-Essential, +93071,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,HEALTHPLUS-Essential, +93072,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,HEALTHPLUS-Essential, +93073,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,HEALTHPLUS-Essential, +93074,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,HEALTHPLUS-Essential, +93075,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,HEALTHPLUS-Essential, +93076,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,HEALTHPLUS-Essential, +93077,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,HEALTHPLUS-Essential, +93078,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,HEALTHPLUS-Essential, +93079,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,HEALTHPLUS-Essential, +93080,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,HEALTHPLUS-Essential, +93081,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,HEALTHPLUS-Essential, +93082,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,HEALTHPLUS-Essential, +93083,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,HEALTHPLUS-Essential, +93084,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,HEALTHPLUS-Essential, +93085,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,HEALTHPLUS-Essential, +93086,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,HEALTHPLUS-Essential, +93087,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,HEALTHPLUS-Essential, +93088,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,HEALTHPLUS-Essential, +93089,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,HEALTHPLUS-Essential, +93090,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,HEALTHPLUS-Essential, +93091,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,HEALTHPLUS-Essential, +93092,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,HEALTHPLUS-Essential, +93093,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,HEALTHPLUS-Essential, +93094,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,HEALTHPLUS-Essential, +93095,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,HEALTHPLUS-Essential, +93096,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,HEALTHPLUS-Essential, +93097,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,HEALTHPLUS-Essential, +93098,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,HEALTHPLUS-Essential, +93099,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,HEALTHPLUS-Essential, +93100,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,HEALTHPLUS-Essential, +93101,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,HEALTHPLUS-Essential, +93102,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,HEALTHPLUS-Essential, +93103,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,HEALTHPLUS-Essential, +93104,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,HEALTHPLUS-Essential, +93105,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,HEALTHPLUS-Essential, +93106,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,HEALTHPLUS-Essential, +93107,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,HEALTHPLUS-Essential, +93108,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,HEALTHPLUS-Essential, +93109,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,HEALTHPLUS-Essential, +93110,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,HEALTHPLUS-Essential, +93111,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,HEALTHPLUS-Essential, +93112,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,HEALTHPLUS-Essential, +93113,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,HEALTHPLUS-Essential, +93114,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,HEALTHPLUS-Essential, +93115,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,HEALTHPLUS-Essential, +93116,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,HEALTHPLUS-Essential, +93117,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,HEALTHPLUS-Essential, +93118,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,HEALTHPLUS-Essential, +93119,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,HEALTHPLUS-Essential, +93120,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,HEALTHPLUS-Essential, +93121,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,HEALTHPLUS-Essential, +93122,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,HEALTHPLUS-Essential, +93123,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,HEALTHPLUS-Essential, +93124,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,HEALTHPLUS-Essential, +93125,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,HEALTHPLUS-Essential, +93126,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,HEALTHPLUS-Essential, +93127,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,HEALTHPLUS-Essential, +93128,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,HEALTHPLUS-Essential, +93129,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,HEALTHPLUS-Essential, +93130,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,HEALTHPLUS-Essential, +93131,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,HEALTHPLUS-Essential, +93132,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,HEALTHPLUS-Essential, +93133,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,HEALTHPLUS-Essential, +93134,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,HEALTHPLUS-Essential, +93135,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,HEALTHPLUS-Essential, +93136,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,HEALTHPLUS-Essential, +93137,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,HEALTHPLUS-Essential, +93138,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,HEALTHPLUS-Essential, +93139,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,HEALTHPLUS-Essential, +93140,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,HEALTHPLUS-Essential, +93141,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,HEALTHPLUS-Essential, +93142,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,HEALTHPLUS-Essential, +93143,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,HEALTHPLUS-Essential, +93144,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,HEALTHPLUS-Essential, +93145,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,HEALTHPLUS-Essential, +93146,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,HEALTHPLUS-Essential, +93147,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,HEALTHPLUS-Essential, +93148,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,HEALTHPLUS-Essential, +93149,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,HEALTHPLUS-Essential, +93150,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,HEALTHPLUS-Essential, +93151,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,HEALTHPLUS-Essential, +93152,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,HEALTHPLUS-Essential, +93153,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,HEALTHPLUS-Essential, +93154,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,HEALTHPLUS-Essential, +93155,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,HEALTHPLUS-Essential, +93156,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,HEALTHPLUS-Essential, +93157,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,HEALTHPLUS-Essential, +93158,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,HEALTHPLUS-Essential, +93159,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,HEALTHPLUS-Essential, +93160,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,HEALTHPLUS-Essential, +93161,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,HEALTHPLUS-Essential, +93162,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,HEALTHPLUS-Essential, +93163,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,HEALTHPLUS-Essential, +93164,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,HEALTHPLUS-Essential, +93165,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,HEALTHPLUS-Essential, +93166,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,HEALTHPLUS-Essential, +93167,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,HEALTHPLUS-Essential, +93168,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,HEALTHPLUS-Essential, +93169,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,HEALTHPLUS-Essential, +93170,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,HEALTHPLUS-Essential, +93171,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,HEALTHPLUS-Essential, +93172,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,HEALTHPLUS-Essential, +93173,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,HEALTHPLUS-Essential, +93174,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,HEALTHPLUS-Essential, +93175,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,HEALTHPLUS-Essential, +93176,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,HEALTHPLUS-Essential, +93177,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,HEALTHPLUS-Essential, +93178,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,HEALTHPLUS-Essential, +93179,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,HEALTHPLUS-Essential, +93180,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,HEALTHPLUS-Essential, +93181,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,HEALTHPLUS-Essential, +93182,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,HEALTHPLUS-Essential, +93183,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,HEALTHPLUS-Essential, +93184,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,HEALTHPLUS-Essential, +93185,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,HEALTHPLUS-Essential, +93186,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,HEALTHPLUS-Essential, +93187,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,HEALTHPLUS-Essential, +93188,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,HEALTHPLUS-Essential, +93189,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,HEALTHPLUS-Essential, +93190,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,HEALTHPLUS-Essential, +93191,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,HEALTHPLUS-Essential, +93192,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,HEALTHPLUS-Essential, +93193,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,HEALTHPLUS-Essential, +93194,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,HEALTHPLUS-Essential, +93195,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,HEALTHPLUS-Essential, +93196,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,HEALTHPLUS-Essential, +93197,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,HEALTHPLUS-Essential, +93198,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,HEALTHPLUS-Essential, +93199,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,HEALTHPLUS-Essential, +93200,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,HEALTHPLUS-Essential, +93201,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,HEALTHPLUS-Essential, +93202,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,HEALTHPLUS-Essential, +93203,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,HEALTHPLUS-Essential, +93204,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,HEALTHPLUS-Essential, +93205,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,HEALTHPLUS-Essential, +93206,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,HEALTHPLUS-Essential, +93207,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,HEALTHPLUS-Essential, +93208,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,HEALTHPLUS-Essential, +93209,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,HEALTHPLUS-Essential, +93210,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,HEALTHPLUS-Essential, +93211,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,HEALTHPLUS-Essential, +93212,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,HEALTHPLUS-Essential, +93213,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,HEALTHPLUS-Essential, +93214,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,HEALTHPLUS-Essential, +93215,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,HEALTHPLUS-Essential, +93216,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,HEALTHPLUS-Essential, +93217,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,HEALTHPLUS-Essential, +93218,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,HEALTHPLUS-Essential, +93219,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,HEALTHPLUS-Essential, +93220,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,HEALTHPLUS-Essential, +93221,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,HEALTHPLUS-Essential, +93222,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,HEALTHPLUS-Essential, +93223,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,HEALTHPLUS-Essential, +93224,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,HEALTHPLUS-Essential, +93225,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,HEALTHPLUS-Essential, +93226,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,HEALTHPLUS-Essential, +93227,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,HEALTHPLUS-Essential, +93228,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,HEALTHPLUS-Essential, +93229,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,HEALTHPLUS-Essential, +93230,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,HEALTHPLUS-Essential, +93231,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,HEALTHPLUS-Essential, +93232,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,HEALTHPLUS-Essential, +93233,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,HEALTHPLUS-Essential, +93234,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,HEALTHPLUS-Essential, +93235,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,HEALTHPLUS-Essential, +93236,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,HEALTHPLUS-Essential, +93237,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,HEALTHPLUS-Essential, +93238,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,HEALTHPLUS-Essential, +93239,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,HEALTHPLUS-Essential, +93240,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,HEALTHPLUS-Essential, +93241,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,HEALTHPLUS-Essential, +93242,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,HEALTHPLUS-Essential, +93243,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,HEALTHPLUS-Essential, +93244,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,HEALTHPLUS-Essential, +93245,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,HEALTHPLUS-Essential, +93246,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,HEALTHPLUS-Essential, +93247,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,HEALTHPLUS-Essential, +93248,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,HEALTHPLUS-Essential, +93249,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,HEALTHPLUS-Essential, +93250,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,HEALTHPLUS-Essential, +93251,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,HEALTHPLUS-Essential, +93252,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,HEALTHPLUS-Essential, +93253,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,HEALTHPLUS-Essential, +93254,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,HEALTHPLUS-Essential, +93255,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,HEALTHPLUS-Essential, +93256,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,HEALTHPLUS-Essential, +93257,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,HEALTHPLUS-Essential, +93258,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,HEALTHPLUS-Essential, +93259,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,HEALTHPLUS-Essential, +93260,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,HEALTHPLUS-Essential, +93261,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,HEALTHPLUS-Essential, +93262,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,HEALTHPLUS-Essential, +93263,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,HEALTHPLUS-Essential, +93264,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,HEALTHPLUS-Essential, +93265,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,HEALTHPLUS-Essential, +93266,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,HEALTHPLUS-Essential, +93267,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,HEALTHPLUS-Essential, +93268,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,HEALTHPLUS-Essential, +93269,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,HEALTHPLUS-Essential, +93270,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,HEALTHPLUS-Essential, +93271,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,HEALTHPLUS-Essential, +93272,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,HEALTHPLUS-Essential, +93273,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,HEALTHPLUS-Essential, +93274,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,HEALTHPLUS-Essential, +93275,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,HEALTHPLUS-Essential, +93276,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,HEALTHPLUS-Essential, +93277,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,HEALTHPLUS-Essential, +93278,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,HEALTHPLUS-Essential, +93279,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,HEALTHPLUS-Essential, +93280,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,HEALTHPLUS-Essential, +93281,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,HEALTHPLUS-Essential, +93282,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,HEALTHPLUS-Essential, +93283,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,HEALTHPLUS-Essential, +93284,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,HEALTHPLUS-Essential, +93285,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,HEALTHPLUS-Essential, +93286,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,HEALTHPLUS-Essential, +93287,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,HEALTHPLUS-Essential, +93288,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,HEALTHPLUS-Essential, +93289,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,HEALTHPLUS-Essential, +93290,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,HEALTHPLUS-Essential, +93291,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,HEALTHPLUS-Essential, +93292,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,HEALTHPLUS-Essential, +93293,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,HEALTHPLUS-Essential, +93294,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,HEALTHPLUS-Essential, +93295,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,HEALTHPLUS-Essential, +93296,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,HEALTHPLUS-Essential, +93297,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,HEALTHPLUS-Essential, +93298,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,HEALTHPLUS-Essential, +93299,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,HEALTHPLUS-Essential, +93300,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,HEALTHPLUS-Essential, +93301,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,HEALTHPLUS-Essential, +93302,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,HEALTHPLUS-Essential, +93303,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,HEALTHPLUS-Essential, +93304,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,HEALTHPLUS-Essential, +93305,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,HEALTHPLUS-Essential, +93306,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,HEALTHPLUS-Essential, +93307,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,HEALTHPLUS-Essential, +93308,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,HEALTHPLUS-Essential, +93309,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,HEALTHPLUS-Essential, +93310,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,HEALTHPLUS-Essential, +93311,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,HEALTHPLUS-Essential, +93312,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,HEALTHPLUS-Essential, +93313,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,HEALTHPLUS-Essential, +93314,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,HEALTHPLUS-Essential, +93315,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,HEALTHPLUS-Essential, +93316,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,HEALTHPLUS-Essential, +93317,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,HEALTHPLUS-Essential, +93318,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,HEALTHPLUS-Essential, +93319,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,HEALTHPLUS-Essential, +93320,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,HEALTHPLUS-Essential, +93321,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,HEALTHPLUS-Essential, +93322,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,HEALTHPLUS-Essential, +93323,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,HEALTHPLUS-Essential, +93324,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,HEALTHPLUS-Essential, +93325,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,HEALTHPLUS-Essential, +93326,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,HEALTHPLUS-Essential, +93327,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,HEALTHPLUS-Essential, +93328,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,HEALTHPLUS-Essential, +93329,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,HEALTHPLUS-Essential, +93330,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,HEALTHPLUS-Essential, +93331,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,HEALTHPLUS-Essential, +93332,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,HEALTHPLUS-Essential, +93333,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,HEALTHPLUS-Essential, +93334,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,HEALTHPLUS-Essential, +93335,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,HEALTHPLUS-Essential, +93336,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,HEALTHPLUS-Essential, +93337,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,HEALTHPLUS-Essential, +93338,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,HEALTHPLUS-Essential, +93339,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,HEALTHPLUS-Essential, +93340,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,HEALTHPLUS-Essential, +93341,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,HEALTHPLUS-Essential, +93342,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,HEALTHPLUS-Essential, +93343,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,HEALTHPLUS-Essential, +93344,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,HEALTHPLUS-Essential, +93345,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,HEALTHPLUS-Essential, +93346,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,HEALTHPLUS-Essential, +93347,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,HEALTHPLUS-Essential, +93348,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,HEALTHPLUS-Essential, +93349,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,HEALTHPLUS-Essential, +93350,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,HEALTHPLUS-Essential, +93351,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,HEALTHPLUS-Essential, +93352,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,HEALTHPLUS-Essential, +93353,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,HEALTHPLUS-Essential, +93354,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,HEALTHPLUS-Essential, +93355,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,HEALTHPLUS-Essential, +93356,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,HEALTHPLUS-Essential, +93357,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,HEALTHPLUS-Essential, +93358,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,HEALTHPLUS-Essential, +93359,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,HEALTHPLUS-Essential, +93360,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,HEALTHPLUS-Essential, +93361,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,HEALTHPLUS-Essential, +93362,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,HEALTHPLUS-Essential, +93363,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,HEALTHPLUS-Essential, +93364,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,HEALTHPLUS-Essential, +93365,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,HEALTHPLUS-Essential, +93366,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,HEALTHPLUS-Essential, +93367,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,HEALTHPLUS-Essential, +93368,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,HEALTHPLUS-Essential, +93369,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,HEALTHPLUS-Essential, +93370,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,HEALTHPLUS-Essential, +93371,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,HEALTHPLUS-Essential, +93372,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,HEALTHPLUS-Essential, +93373,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,HEALTHPLUS-Essential, +93374,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,HEALTHPLUS-Essential, +93375,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,HEALTHPLUS-Essential, +93376,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,HEALTHPLUS-Essential, +93377,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,HEALTHPLUS-Essential, +93378,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,HEALTHPLUS-Essential, +93379,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,HEALTHPLUS-Essential, +93380,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,HEALTHPLUS-Essential, +93381,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,HEALTHPLUS-Essential, +93382,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,HEALTHPLUS-Essential, +93383,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,HEALTHPLUS-Essential, +93384,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,HEALTHPLUS-Essential, +93385,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,HEALTHPLUS-Essential, +93386,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,HEALTHPLUS-Essential, +93387,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,HEALTHPLUS-Essential, +93388,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,HEALTHPLUS-Essential, +93389,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,HEALTHPLUS-Essential, +93390,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,HEALTHPLUS-Essential, +93391,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,HEALTHPLUS-Essential, +93392,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,HEALTHPLUS-Essential, +93393,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,HEALTHPLUS-Essential, +93394,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,HEALTHPLUS-Essential, +93395,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,HEALTHPLUS-Essential, +93396,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,HEALTHPLUS-Essential, +93397,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,HEALTHPLUS-Essential, +93398,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,HEALTHPLUS-Essential, +93399,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,HEALTHPLUS-Essential, +93400,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,HEALTHPLUS-Essential, +93401,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,HEALTHPLUS-Essential, +93402,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,HEALTHPLUS-Essential, +93403,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,HEALTHPLUS-Essential, +93404,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,HEALTHPLUS-Essential, +93405,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,HEALTHPLUS-Essential, +93406,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,HEALTHPLUS-Essential, +93407,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,HEALTHPLUS-Essential, +93408,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,HEALTHPLUS-Essential, +93409,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,HEALTHPLUS-Essential, +93410,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,HEALTHPLUS-Essential, +93411,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,HEALTHPLUS-Essential, +93412,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,HEALTHPLUS-Essential, +93413,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,HEALTHPLUS-Essential, +93414,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,HEALTHPLUS-Essential,73.07 +93415,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,HEALTHPLUS-Essential, +93416,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,HEALTHPLUS-Essential, +93417,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,HEALTHPLUS-Essential, +93418,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,HEALTHPLUS-Essential, +93419,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,HEALTHPLUS-Essential, +93420,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,HEALTHPLUS-Essential, +93421,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,HEALTHPLUS-Essential, +93422,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,HEALTHPLUS-Essential, +93423,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,HEALTHPLUS-Essential, +93424,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,HEALTHPLUS-Essential, +93425,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,HEALTHPLUS-Essential, +93426,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,HEALTHPLUS-Essential, +93427,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,HEALTHPLUS-Essential, +93428,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,HEALTHPLUS-Essential, +93429,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,HEALTHPLUS-Essential, +93430,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,HEALTHPLUS-Essential, +93431,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,HEALTHPLUS-Essential, +93432,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,HEALTHPLUS-Essential, +93433,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,HEALTHPLUS-Essential, +93434,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,HEALTHPLUS-Essential, +93435,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,HEALTHPLUS-Essential, +93436,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,HEALTHPLUS-Essential, +93437,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,HEALTHPLUS-Essential, +93438,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,HEALTHPLUS-Essential, +93439,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,HEALTHPLUS-Essential, +93440,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,HEALTHPLUS-Essential, +93441,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,HEALTHPLUS-Essential, +93442,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,HEALTHPLUS-Essential, +93443,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,HEALTHPLUS-Essential, +93444,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,HEALTHPLUS-Essential, +93445,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,HEALTHPLUS-Essential, +93446,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,HEALTHPLUS-Essential, +93447,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,HEALTHPLUS-Essential, +93448,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,HEALTHPLUS-Essential, +93449,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,HEALTHPLUS-Essential, +93450,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,HEALTHPLUS-Essential, +93451,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,HEALTHPLUS-Essential, +93452,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,HEALTHPLUS-Essential, +93453,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,HEALTHPLUS-Essential, +93454,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,HEALTHPLUS-Essential, +93455,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,HEALTHPLUS-Essential, +93456,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,HEALTHPLUS-Essential, +93457,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,HEALTHPLUS-Essential, +93458,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,HEALTHPLUS-Essential, +93459,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,HEALTHPLUS-Essential, +93460,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,HEALTHPLUS-Essential, +93461,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,HEALTHPLUS-Essential, +93462,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,HEALTHPLUS-Essential, +93463,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,HEALTHPLUS-Essential, +93464,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,HEALTHPLUS-Essential, +93465,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,HEALTHPLUS-Essential, +93466,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,HEALTHPLUS-Essential, +93467,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,HEALTHPLUS-Essential, +93468,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,HEALTHPLUS-Essential, +93469,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,HEALTHPLUS-Essential, +93470,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,HEALTHPLUS-Essential, +93471,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,HEALTHPLUS-Essential, +93472,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,HEALTHPLUS-Essential, +93473,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,HEALTHPLUS-Essential, +93474,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,HEALTHPLUS-Essential, +93475,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,HEALTHPLUS-Essential, +93476,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,HEALTHPLUS-Essential, +93477,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,HEALTHPLUS-Essential, +93478,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,HEALTHPLUS-Essential, +93479,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,HEALTHPLUS-Essential, +93480,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,HEALTHPLUS-Essential, +93481,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,HEALTHPLUS-Essential, +93482,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,HEALTHPLUS-Essential, +93483,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,HEALTHPLUS-Essential, +93484,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,HEALTHPLUS-Essential, +93485,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,HEALTHPLUS-Essential, +93486,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,HEALTHPLUS-Essential, +93487,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,HEALTHPLUS-Essential, +93488,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,HEALTHPLUS-Essential, +93489,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,HEALTHPLUS-Essential, +93490,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,HEALTHPLUS-Essential, +93491,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,HEALTHPLUS-Essential, +93492,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,HEALTHPLUS-Essential, +93493,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,HEALTHPLUS-Essential, +93494,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,HEALTHPLUS-Essential, +93495,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,HEALTHPLUS-Essential, +93496,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,HEALTHPLUS-Essential, +93497,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,HEALTHPLUS-Essential, +93498,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,HEALTHPLUS-Essential, +93499,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,HEALTHPLUS-Essential, +93500,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,HEALTHPLUS-Essential, +93501,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,HEALTHPLUS-Essential, +93502,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,HEALTHPLUS-Essential, +93503,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,HEALTHPLUS-Essential, +93504,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,HEALTHPLUS-Essential, +93505,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,HEALTHPLUS-Essential, +93506,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,HEALTHPLUS-Essential, +93507,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,HEALTHPLUS-Essential, +93508,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,HEALTHPLUS-Essential, +93509,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,HEALTHPLUS-Essential, +93510,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,HEALTHPLUS-Essential, +93511,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,HEALTHPLUS-Essential, +93512,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,HEALTHPLUS-Essential, +93513,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,HEALTHPLUS-Essential, +93514,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,HEALTHPLUS-Essential, +93515,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,HEALTHPLUS-Essential, +93516,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,HEALTHPLUS-Essential, +93517,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,HEALTHPLUS-Essential, +93518,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,HEALTHPLUS-Essential, +93519,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,HEALTHPLUS-Essential, +93520,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,HEALTHPLUS-Essential, +93521,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,HEALTHPLUS-Essential, +93522,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,HEALTHPLUS-Essential, +93523,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,HEALTHPLUS-Essential, +93524,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,HEALTHPLUS-Essential, +93525,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,HEALTHPLUS-Essential, +93526,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,HEALTHPLUS-Essential, +93527,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,HEALTHPLUS-Essential, +93528,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,HEALTHPLUS-Essential, +93529,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,HEALTHPLUS-Essential, +93530,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,HEALTHPLUS-Essential, +93531,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,HEALTHPLUS-Essential, +93532,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,HEALTHPLUS-Essential, +93533,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,HEALTHPLUS-Essential, +93534,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,HEALTHPLUS-Essential, +93535,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,HEALTHPLUS-Essential, +93536,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,HEALTHPLUS-Essential, +93537,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,HEALTHPLUS-Essential, +93538,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,HEALTHPLUS-Essential, +93539,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,HEALTHPLUS-Essential, +93540,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,HEALTHPLUS-Essential, +93541,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,HEALTHPLUS-Essential, +93542,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,HEALTHPLUS-Essential, +93543,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,HEALTHPLUS-Essential, +93544,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,HEALTHPLUS-Essential, +93545,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,HEALTHPLUS-Essential, +93546,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,HEALTHPLUS-Essential, +93547,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,HEALTHPLUS-Essential, +93548,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,HEALTHPLUS-Essential, +93549,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,HEALTHPLUS-Essential, +93550,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,HEALTHPLUS-Essential, +93551,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,HEALTHPLUS-Essential, +93552,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,HEALTHPLUS-Essential, +93553,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,HEALTHPLUS-Essential, +93554,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,HEALTHPLUS-Essential, +93555,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,HEALTHPLUS-Essential, +93556,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,HEALTHPLUS-Essential, +93557,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,HEALTHPLUS-Essential, +93558,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,HEALTHPLUS-Essential, +93559,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,HEALTHPLUS-Essential, +93560,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,HEALTHPLUS-Essential, +93561,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,HEALTHPLUS-Essential, +93562,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,HEALTHPLUS-Essential, +93563,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,HEALTHPLUS-Essential, +93564,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,HEALTHPLUS-Essential, +93565,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,HEALTHPLUS-Essential, +93566,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,HEALTHPLUS-Essential, +93567,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,HEALTHPLUS-Essential, +93568,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,HEALTHPLUS-Essential, +93569,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,HEALTHPLUS-Essential, +93570,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,HEALTHPLUS-Essential, +93571,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,HEALTHPLUS-Essential, +93572,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,HEALTHPLUS-Essential, +93573,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,HEALTHPLUS-Essential, +93574,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,HEALTHPLUS-Essential, +93575,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,HEALTHPLUS-Essential, +93576,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,HEALTHPLUS-Essential, +93577,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,HEALTHPLUS-Essential, +93578,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,HEALTHPLUS-Essential, +93579,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,HEALTHPLUS-Essential, +93580,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,HEALTHPLUS-Essential, +93581,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,HEALTHPLUS-Essential, +93582,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,HEALTHPLUS-Essential, +93583,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,HEALTHPLUS-Essential, +93584,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,HEALTHPLUS-Essential, +93585,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,HEALTHPLUS-Essential, +93586,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,HEALTHPLUS-Essential, +93587,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,HEALTHPLUS-Essential, +93588,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,HEALTHPLUS-Essential, +93589,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,HEALTHPLUS-Essential, +93590,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,HEALTHPLUS-Essential, +93591,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,HEALTHPLUS-Essential, +93592,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,HEALTHPLUS-Essential, +93593,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,HEALTHPLUS-Essential, +93594,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,HEALTHPLUS-Essential, +93595,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,HEALTHPLUS-Essential, +93596,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,HEALTHPLUS-Essential, +93597,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,HEALTHPLUS-Essential, +93598,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,HEALTHPLUS-Essential, +93599,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,HEALTHPLUS-Essential, +93600,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,HEALTHPLUS-Essential, +93601,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,HEALTHPLUS-Essential, +93602,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,HEALTHPLUS-Essential, +93603,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,HEALTHPLUS-Essential, +93604,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,HEALTHPLUS-Essential, +93605,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,HEALTHPLUS-Essential, +93606,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,HEALTHPLUS-Essential, +93607,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-Essential, +93608,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,HEALTHPLUS-Essential, +93609,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,HEALTHPLUS-Essential, +93610,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,HEALTHPLUS-Essential, +93611,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,HEALTHPLUS-Essential, +93612,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,HEALTHPLUS-Essential, +93613,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,HEALTHPLUS-Essential, +93614,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,HEALTHPLUS-Essential, +93615,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,HEALTHPLUS-Essential, +93616,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,HEALTHPLUS-Essential, +93617,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,HEALTHPLUS-Essential, +93618,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,HEALTHPLUS-Essential, +93619,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,HEALTHPLUS-Essential, +93620,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,HEALTHPLUS-Essential, +93621,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,HEALTHPLUS-Essential, +93622,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,HEALTHPLUS-Essential, +93623,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,HEALTHPLUS-Essential, +93624,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,HEALTHPLUS-Essential, +93625,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,HEALTHPLUS-Essential, +93626,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,HEALTHPLUS-Essential, +93627,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,HEALTHPLUS-Essential, +93628,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,HEALTHPLUS-Essential, +93629,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,HEALTHPLUS-Essential, +93630,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,HEALTHPLUS-Essential, +93631,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,HEALTHPLUS-Essential, +93632,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,HEALTHPLUS-Essential, +93633,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,HEALTHPLUS-Essential, +93634,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,HEALTHPLUS-Essential, +93635,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,HEALTHPLUS-Essential, +93636,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,HEALTHPLUS-Essential, +93637,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,HEALTHPLUS-Essential, +93638,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,HEALTHPLUS-Essential, +93639,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,HEALTHPLUS-Essential, +93640,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,HEALTHPLUS-Essential, +93641,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,HEALTHPLUS-Essential, +93642,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,HEALTHPLUS-Essential, +93643,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,HEALTHPLUS-Essential, +93644,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,HEALTHPLUS-Essential, +93645,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,HEALTHPLUS-Essential, +93646,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,HEALTHPLUS-Essential, +93647,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,HEALTHPLUS-Essential, +93648,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,HEALTHPLUS-Essential, +93649,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,HEALTHPLUS-Essential, +93650,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,HEALTHPLUS-Essential, +93651,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,HEALTHPLUS-Essential, +93652,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,HEALTHPLUS-Essential, +93653,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,HEALTHPLUS-Essential, +93654,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,HEALTHPLUS-Essential, +93655,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,HEALTHPLUS-Essential, +93656,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,HEALTHPLUS-Essential, +93657,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,HEALTHPLUS-Essential, +93658,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,HEALTHPLUS-Essential, +93659,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,HEALTHPLUS-Essential, +93660,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,HEALTHPLUS-Essential, +93661,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,HEALTHPLUS-Essential, +93662,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,HEALTHPLUS-Essential, +93663,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,HEALTHPLUS-Essential, +93664,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,HEALTHPLUS-Essential, +93665,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,HEALTHPLUS-Essential, +93666,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,HEALTHPLUS-Essential, +93667,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,HEALTHPLUS-Essential, +93668,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,HEALTHPLUS-Essential, +93669,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,HEALTHPLUS-Essential, +93670,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,HEALTHPLUS-Essential, +93671,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,HEALTHPLUS-Essential, +93672,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,HEALTHPLUS-Essential, +93673,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,HEALTHPLUS-Essential, +93674,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,HEALTHPLUS-Essential, +93675,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,HEALTHPLUS-Essential, +93676,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,HEALTHPLUS-Essential, +93677,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,HEALTHPLUS-Essential, +93678,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,HEALTHPLUS-Essential, +93679,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,HEALTHPLUS-Essential, +93680,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,HEALTHPLUS-Essential, +93681,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,HEALTHPLUS-Essential, +93682,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,HEALTHPLUS-Essential, +93683,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,HEALTHPLUS-Essential, +93684,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,HEALTHPLUS-Essential, +93685,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,HEALTHPLUS-Essential, +93686,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,HEALTHPLUS-Essential, +93687,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,HEALTHPLUS-Essential, +93688,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,HEALTHPLUS-Essential, +93689,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,HEALTHPLUS-Essential, +93690,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,HEALTHPLUS-Essential, +93691,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,HEALTHPLUS-Essential, +93692,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,HEALTHPLUS-Essential, +93693,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,HEALTHPLUS-Essential, +93694,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,HEALTHPLUS-Essential, +93695,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,HEALTHPLUS-Essential, +93696,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,HEALTHPLUS-Essential, +93697,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,HEALTHPLUS-Essential, +93698,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,HEALTHPLUS-Essential, +93699,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,HEALTHPLUS-Essential, +93700,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,HEALTHPLUS-Essential, +93701,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,HEALTHPLUS-Essential, +93702,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,HEALTHPLUS-Essential, +93703,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,HEALTHPLUS-Essential, +93704,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,HEALTHPLUS-Essential, +93705,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,HEALTHPLUS-Essential, +93706,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,HEALTHPLUS-Essential, +93707,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,HEALTHPLUS-Essential, +93708,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,HEALTHPLUS-Essential, +93709,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,HEALTHPLUS-Essential, +93710,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,HEALTHPLUS-Essential, +93711,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,HEALTHPLUS-Essential, +93712,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,HEALTHPLUS-Essential, +93713,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,HEALTHPLUS-Essential, +93714,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,HEALTHPLUS-Essential, +93715,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,HEALTHPLUS-Essential, +93716,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,HEALTHPLUS-Essential, +93717,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,HEALTHPLUS-Essential, +93718,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,HEALTHPLUS-Essential, +93719,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,HEALTHPLUS-Essential, +93720,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,HEALTHPLUS-Essential, +93721,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,HEALTHPLUS-Essential, +93722,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,HEALTHPLUS-Essential, +93723,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,HEALTHPLUS-Essential, +93724,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,HEALTHPLUS-Essential, +93725,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,HEALTHPLUS-Essential, +93726,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,HEALTHPLUS-Essential, +93727,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,HEALTHPLUS-Essential, +93728,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,HEALTHPLUS-Essential, +93729,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,HEALTHPLUS-Essential, +93730,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,HEALTHPLUS-Essential, +93731,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,HEALTHPLUS-Essential, +93732,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,HEALTHPLUS-Essential, +93733,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,HEALTHPLUS-Essential, +93734,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,HEALTHPLUS-Essential, +93735,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,HEALTHPLUS-Essential, +93736,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,HEALTHPLUS-Essential, +93737,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,HEALTHPLUS-Essential, +93738,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,HEALTHPLUS-Essential, +93739,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,HEALTHPLUS-Essential, +93740,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,HEALTHPLUS-Essential, +93741,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,HEALTHPLUS-Essential, +93742,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,HEALTHPLUS-Essential, +93743,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,HEALTHPLUS-Essential, +93744,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,HEALTHPLUS-Essential, +93745,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,HEALTHPLUS-Essential, +93746,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,HEALTHPLUS-Essential, +93747,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,HEALTHPLUS-Essential, +93748,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,HEALTHPLUS-Essential, +93749,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,HEALTHPLUS-Essential, +93750,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,HEALTHPLUS-Essential, +93751,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,HEALTHPLUS-Essential, +93752,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,HEALTHPLUS-Essential, +93753,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,HEALTHPLUS-Essential, +93754,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,HEALTHPLUS-Essential, +93755,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,HEALTHPLUS-Essential, +93756,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,HEALTHPLUS-Essential, +93757,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,HEALTHPLUS-Essential, +93758,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,HEALTHPLUS-Essential, +93759,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,HEALTHPLUS-Essential, +93760,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,HEALTHPLUS-Essential, +93761,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,HEALTHPLUS-Essential, +93762,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,HEALTHPLUS-Essential, +93763,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,HEALTHPLUS-Essential, +93764,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,HEALTHPLUS-Essential, +93765,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,HEALTHPLUS-Essential, +93766,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,HEALTHPLUS-Essential, +93767,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,HEALTHPLUS-Essential, +93768,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,HEALTHPLUS-Essential, +93769,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,HEALTHPLUS-Essential, +93770,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,HEALTHPLUS-Essential, +93771,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,HEALTHPLUS-Essential, +93772,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,HEALTHPLUS-Essential, +93773,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,HEALTHPLUS-Essential, +93774,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,HEALTHPLUS-Essential, +93775,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,HEALTHPLUS-Essential, +93776,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,HEALTHPLUS-Essential, +93777,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,HEALTHPLUS-Essential, +93778,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,HEALTHPLUS-Essential, +93779,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,HEALTHPLUS-Essential, +93780,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,HEALTHPLUS-Essential, +93781,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,HEALTHPLUS-Essential, +93782,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,HEALTHPLUS-Essential, +93783,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,HEALTHPLUS-Essential, +93784,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,HEALTHPLUS-Essential, +93785,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,HEALTHPLUS-Essential, +93786,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,HEALTHPLUS-Essential, +93787,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,HEALTHPLUS-Essential, +93788,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,HEALTHPLUS-Essential, +93789,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,HEALTHPLUS-Essential, +93790,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,HEALTHPLUS-Essential, +93791,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,HEALTHPLUS-Essential, +93792,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,HEALTHPLUS-Essential, +93793,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,HEALTHPLUS-Essential, +93794,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,HEALTHPLUS-Essential, +93795,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,HEALTHPLUS-Essential, +93796,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,HEALTHPLUS-Essential, +93797,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,HEALTHPLUS-Essential, +93798,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,HEALTHPLUS-Essential, +93799,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,HEALTHPLUS-Essential, +93800,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,HEALTHPLUS-Essential, +93801,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,HEALTHPLUS-Essential, +93802,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,HEALTHPLUS-Essential, +93803,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,HEALTHPLUS-Essential, +93804,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,HEALTHPLUS-Essential, +93805,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,HEALTHPLUS-Essential, +93806,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,HEALTHPLUS-Essential, +93807,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,HEALTHPLUS-Essential, +93808,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,HEALTHPLUS-Essential, +93809,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,HEALTHPLUS-Essential, +93810,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,HEALTHPLUS-Essential, +93811,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,HEALTHPLUS-Essential, +93812,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,HEALTHPLUS-Essential, +93813,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,HEALTHPLUS-Essential, +93814,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,HEALTHPLUS-Essential, +93815,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,HEALTHPLUS-Essential, +93816,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,HEALTHPLUS-Essential, +93817,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,HEALTHPLUS-Essential, +93818,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,HEALTHPLUS-Essential, +93819,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,HEALTHPLUS-Essential, +93820,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,HEALTHPLUS-Essential, +93821,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,HEALTHPLUS-Essential, +93822,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,HEALTHPLUS-Essential, +93823,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,HEALTHPLUS-Essential, +93824,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,HEALTHPLUS-Essential, +93825,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,HEALTHPLUS-Essential, +93826,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,HEALTHPLUS-Essential, +93827,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,HEALTHPLUS-Essential, +93828,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,HEALTHPLUS-Essential, +93829,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,HEALTHPLUS-Essential, +93830,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,HEALTHPLUS-Essential, +93831,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,HEALTHPLUS-Essential, +93832,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,HEALTHPLUS-Essential, +93833,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,HEALTHPLUS-Essential, +93834,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,HEALTHPLUS-Essential, +93835,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,HEALTHPLUS-Essential, +93836,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,HEALTHPLUS-Essential, +93837,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,HEALTHPLUS-Essential, +93838,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,HEALTHPLUS-Essential, +93839,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,HEALTHPLUS-Essential, +93840,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,HEALTHPLUS-Essential, +93841,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,HEALTHPLUS-Essential, +93842,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,HEALTHPLUS-Essential, +93843,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,HEALTHPLUS-Essential, +93844,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,HEALTHPLUS-Essential, +93845,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,HEALTHPLUS-Essential, +93846,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,HEALTHPLUS-Essential, +93847,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,HEALTHPLUS-Essential, +93848,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,HEALTHPLUS-Essential, +93849,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,HEALTHPLUS-Essential, +93850,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,HEALTHPLUS-Essential, +93851,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,HEALTHPLUS-Essential, +93852,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,HEALTHPLUS-Essential, +93853,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,HEALTHPLUS-Essential, +93854,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,HEALTHPLUS-Essential, +93855,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,HEALTHPLUS-Essential, +93856,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,HEALTHPLUS-Essential, +93857,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,HEALTHPLUS-Essential, +93858,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,HEALTHPLUS-Essential, +93859,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,HEALTHPLUS-Essential, +93860,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,HEALTHPLUS-Essential, +93861,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,HEALTHPLUS-Essential, +93862,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,HEALTHPLUS-Essential, +93863,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,HEALTHPLUS-Essential, +93864,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,HEALTHPLUS-Essential, +93865,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,HEALTHPLUS-Essential, +93866,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,HEALTHPLUS-Essential, +93867,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,HEALTHPLUS-Essential, +93868,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,HEALTHPLUS-Essential, +93869,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,HEALTHPLUS-Essential, +93870,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,HEALTHPLUS-Essential, +93871,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,HEALTHPLUS-Essential, +93872,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,HEALTHPLUS-Essential, +93873,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,HEALTHPLUS-Essential, +93874,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,HEALTHPLUS-Essential,500.11 +93875,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,HEALTHPLUS-Essential, +93876,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,HEALTHPLUS-Essential, +93877,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,HEALTHPLUS-Essential, +93878,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,HEALTHPLUS-Essential, +93879,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,HEALTHPLUS-Essential, +93880,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,HEALTHPLUS-Essential, +93881,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,HEALTHPLUS-Essential, +93882,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,HEALTHPLUS-Essential, +93883,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,HEALTHPLUS-Essential, +93884,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,HEALTHPLUS-Essential, +93885,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,HEALTHPLUS-Essential, +93886,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,HEALTHPLUS-Essential, +93887,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,HEALTHPLUS-Essential, +93888,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,HEALTHPLUS-Essential, +93889,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,HEALTHPLUS-Essential, +93890,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,HEALTHPLUS-Essential, +93891,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,HEALTHPLUS-Essential, +93892,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,HEALTHPLUS-Essential, +93893,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,HEALTHPLUS-Essential, +93894,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,HEALTHPLUS-Essential, +93895,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,HEALTHPLUS-Essential, +93896,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,HEALTHPLUS-Essential, +93897,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,HEALTHPLUS-Essential, +93898,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,HEALTHPLUS-Essential, +93899,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,HEALTHPLUS-Essential, +93900,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,HEALTHPLUS-Essential, +93901,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,HEALTHPLUS-Essential, +93902,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,HEALTHPLUS-Essential, +93903,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,HEALTHPLUS-Essential, +93904,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,HEALTHPLUS-Essential, +93905,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,HEALTHPLUS-Essential, +93906,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,HEALTHPLUS-Essential, +93907,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,HEALTHPLUS-Essential, +93908,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,HEALTHPLUS-Essential, +93909,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,HEALTHPLUS-Essential, +93910,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,HEALTHPLUS-Essential, +93911,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,HEALTHPLUS-Essential, +93912,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,HEALTHPLUS-Essential, +93913,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,HEALTHPLUS-Essential, +93914,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,HEALTHPLUS-Essential, +93915,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,HEALTHPLUS-Essential, +93916,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,HEALTHPLUS-Essential, +93917,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,HEALTHPLUS-Essential, +93918,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,HEALTHPLUS-Essential, +93919,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,HEALTHPLUS-Essential, +93920,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,HEALTHPLUS-Essential, +93921,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,HEALTHPLUS-Essential, +93922,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,HEALTHPLUS-Essential, +93923,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,HEALTHPLUS-Essential, +93924,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,HEALTHPLUS-Essential, +93925,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,HEALTHPLUS-Essential, +93926,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,HEALTHPLUS-Essential, +93927,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,HEALTHPLUS-Essential, +93928,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,HEALTHPLUS-Essential, +93929,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,HEALTHPLUS-Essential, +93930,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,HEALTHPLUS-Essential, +93931,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,HEALTHPLUS-Essential, +93932,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,HEALTHPLUS-Essential, +93933,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,HEALTHPLUS-Essential, +93934,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,HEALTHPLUS-Essential, +93935,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,HEALTHPLUS-Essential, +93936,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,HEALTHPLUS-Essential, +93937,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,HEALTHPLUS-Essential, +93938,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,HEALTHPLUS-Essential, +93939,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,HEALTHPLUS-Essential, +93940,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,HEALTHPLUS-Essential, +93941,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,HEALTHPLUS-Essential, +93942,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,HEALTHPLUS-Essential, +93943,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,HEALTHPLUS-Essential, +93944,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,HEALTHPLUS-Essential, +93945,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,HEALTHPLUS-Essential, +93946,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,HEALTHPLUS-Essential, +93947,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,HEALTHPLUS-Essential, +93948,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,HEALTHPLUS-Essential, +93949,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,HEALTHPLUS-Essential, +93950,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,HEALTHPLUS-Essential, +93951,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,HEALTHPLUS-Essential, +93952,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,HEALTHPLUS-Essential, +93953,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,HEALTHPLUS-Essential, +93954,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,HEALTHPLUS-Essential, +93955,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,HEALTHPLUS-Essential, +93956,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,HEALTHPLUS-Essential, +93957,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,HEALTHPLUS-Essential,210.5 +93958,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,HEALTHPLUS-Essential, +93959,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,HEALTHPLUS-Essential, +93960,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,HEALTHPLUS-Essential, +93961,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,HEALTHPLUS-Essential, +93962,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,HEALTHPLUS-Essential, +93963,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,HEALTHPLUS-Essential, +93964,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,HEALTHPLUS-Essential, +93965,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,HEALTHPLUS-Essential, +93966,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,HEALTHPLUS-Essential, +93967,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,HEALTHPLUS-Essential, +93968,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,HEALTHPLUS-Essential, +93969,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,HEALTHPLUS-Essential, +93970,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,HEALTHPLUS-Essential, +93971,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,HEALTHPLUS-Essential, +93972,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,HEALTHPLUS-Essential, +93973,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,HEALTHPLUS-Essential, +93974,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,HEALTHPLUS-Essential, +93975,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,HEALTHPLUS-Essential, +93976,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,HEALTHPLUS-Essential, +93977,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,HEALTHPLUS-Essential, +93978,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,HEALTHPLUS-Essential, +93979,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,HEALTHPLUS-Essential, +93980,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,HEALTHPLUS-Essential, +93981,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,HEALTHPLUS-Essential, +93982,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,HEALTHPLUS-Essential, +93983,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,HEALTHPLUS-Essential, +93984,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,HEALTHPLUS-Essential, +93985,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,HEALTHPLUS-Essential, +93986,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,HEALTHPLUS-Essential, +93987,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,HEALTHPLUS-Essential, +93988,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,HEALTHPLUS-Essential, +93989,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,HEALTHPLUS-Essential, +93990,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,HEALTHPLUS-Essential, +93991,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,HEALTHPLUS-Essential, +93992,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,HEALTHPLUS-Essential, +93993,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,HEALTHPLUS-Essential, +93994,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,HEALTHPLUS-Essential, +93995,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,HEALTHPLUS-Essential, +93996,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,HEALTHPLUS-Essential, +93997,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,HEALTHPLUS-Essential, +93998,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,HEALTHPLUS-Essential, +93999,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,HEALTHPLUS-Essential, +94000,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,HEALTHPLUS-Essential, +94001,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,HEALTHPLUS-Essential, +94002,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,HEALTHPLUS-Essential, +94003,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,HEALTHPLUS-Essential, +94004,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,HEALTHPLUS-Essential, +94005,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,HEALTHPLUS-Essential, +94006,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,HEALTHPLUS-Essential, +94007,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,HEALTHPLUS-Essential, +94008,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,HEALTHPLUS-Essential, +94009,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,HEALTHPLUS-Essential, +94010,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,HEALTHPLUS-Essential, +94011,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,HEALTHPLUS-Essential, +94012,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,HEALTHPLUS-Essential, +94013,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,HEALTHPLUS-Essential, +94014,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,HEALTHPLUS-Essential, +94015,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,HEALTHPLUS-Essential, +94016,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,HEALTHPLUS-Essential, +94017,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,HEALTHPLUS-Essential, +94018,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,HEALTHPLUS-Essential, +94019,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,HEALTHPLUS-Essential, +94020,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,HEALTHPLUS-Essential, +94021,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,HEALTHPLUS-Essential, +94022,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,HEALTHPLUS-Essential, +94023,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,HEALTHPLUS-Essential, +94024,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,HEALTHPLUS-Essential, +94025,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,HEALTHPLUS-Essential, +94026,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,HEALTHPLUS-Essential, +94027,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,HEALTHPLUS-Essential, +94028,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,HEALTHPLUS-Essential, +94029,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,HEALTHPLUS-Essential, +94030,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,HEALTHPLUS-Essential, +94031,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,HEALTHPLUS-Essential, +94032,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,HEALTHPLUS-Essential, +94033,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,HEALTHPLUS-Essential, +94034,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,HEALTHPLUS-Essential, +94035,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,HEALTHPLUS-Essential, +94036,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,HEALTHPLUS-Essential, +94037,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,HEALTHPLUS-Essential, +94038,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,HEALTHPLUS-Essential, +94039,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,HEALTHPLUS-Essential, +94040,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,HEALTHPLUS-Essential, +94041,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,HEALTHPLUS-Essential, +94042,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,HEALTHPLUS-Essential, +94043,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,HEALTHPLUS-Essential, +94044,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,HEALTHPLUS-Essential, +94045,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,HEALTHPLUS-Essential, +94046,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,HEALTHPLUS-Essential, +94047,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,HEALTHPLUS-Essential, +94048,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,HEALTHPLUS-Essential, +94049,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,HEALTHPLUS-Essential, +94050,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,HEALTHPLUS-Essential, +94051,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,HEALTHPLUS-Essential, +94052,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,HEALTHPLUS-Essential, +94053,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,HEALTHPLUS-Essential, +94054,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,HEALTHPLUS-Essential, +94055,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,HEALTHPLUS-Essential, +94056,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,HEALTHPLUS-Essential, +94057,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,HEALTHPLUS-Essential, +94058,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,HEALTHPLUS-Essential, +94059,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,HEALTHPLUS-Essential, +94060,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,HEALTHPLUS-Essential, +94061,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,HEALTHPLUS-Essential, +94062,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,HEALTHPLUS-Essential, +94063,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,HEALTHPLUS-Essential, +94064,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,HEALTHPLUS-Essential, +94065,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,HEALTHPLUS-Essential, +94066,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,HEALTHPLUS-Essential, +94067,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,HEALTHPLUS-Essential, +94068,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,HEALTHPLUS-Essential, +94069,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,HEALTHPLUS-Essential, +94070,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,HEALTHPLUS-Essential, +94071,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,HEALTHPLUS-Essential, +94072,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,HEALTHPLUS-Essential, +94073,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,HEALTHPLUS-Essential, +94074,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,HEALTHPLUS-Essential, +94075,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,HEALTHPLUS-Essential, +94076,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,HEALTHPLUS-Essential, +94077,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,HEALTHPLUS-Essential, +94078,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,HEALTHPLUS-Essential, +94079,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,HEALTHPLUS-Essential, +94080,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,HEALTHPLUS-Essential, +94081,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,HEALTHPLUS-Essential, +94082,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,HEALTHPLUS-Essential, +94083,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,HEALTHPLUS-Essential, +94084,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,HEALTHPLUS-Essential, +94085,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,HEALTHPLUS-Essential, +94086,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,HEALTHPLUS-Essential, +94087,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,HEALTHPLUS-Essential, +94088,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,HEALTHPLUS-Essential, +94089,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,HEALTHPLUS-Essential, +94090,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,HEALTHPLUS-Essential, +94091,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,HEALTHPLUS-Essential, +94092,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,HEALTHPLUS-Essential, +94093,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,HEALTHPLUS-Essential, +94094,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,HEALTHPLUS-Essential, +94095,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,HEALTHPLUS-Essential, +94096,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,HEALTHPLUS-Essential, +94097,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,HEALTHPLUS-Essential, +94098,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,HEALTHPLUS-Essential, +94099,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,HEALTHPLUS-Essential, +94100,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,HEALTHPLUS-Essential, +94101,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,HEALTHPLUS-Essential, +94102,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,HEALTHPLUS-Essential, +94103,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,HEALTHPLUS-Essential, +94104,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,HEALTHPLUS-Essential, +94105,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,HEALTHPLUS-Essential, +94106,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,HEALTHPLUS-Essential, +94107,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,HEALTHPLUS-Essential, +94108,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,HEALTHPLUS-Essential, +94109,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,HEALTHPLUS-Essential, +94110,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,HEALTHPLUS-Essential, +94111,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,HEALTHPLUS-Essential, +94112,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,HEALTHPLUS-Essential, +94113,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,HEALTHPLUS-Essential, +94114,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,HEALTHPLUS-Essential, +94115,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,HEALTHPLUS-Essential, +94116,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,HEALTHPLUS-Essential, +94117,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,HEALTHPLUS-Essential, +94118,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,HEALTHPLUS-Essential, +94119,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,HEALTHPLUS-Essential, +94120,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,HEALTHPLUS-Essential, +94121,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,HEALTHPLUS-Essential, +94122,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,HEALTHPLUS-Essential, +94123,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,HEALTHPLUS-Essential, +94124,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,HEALTHPLUS-Essential, +94125,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,HEALTHPLUS-Essential, +94126,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,HEALTHPLUS-Essential, +94127,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,HEALTHPLUS-Essential, +94128,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,HEALTHPLUS-Essential, +94129,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,HEALTHPLUS-Essential, +94130,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,HEALTHPLUS-Essential, +94131,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,HEALTHPLUS-Essential, +94132,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,HEALTHPLUS-Essential, +94133,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,HEALTHPLUS-Essential, +94134,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,HEALTHPLUS-Essential, +94135,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,HEALTHPLUS-Essential, +94136,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,HEALTHPLUS-Essential, +94137,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,HEALTHPLUS-Essential, +94138,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,HEALTHPLUS-Essential, +94139,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,HEALTHPLUS-Essential, +94140,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,HEALTHPLUS-Essential, +94141,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,HEALTHPLUS-Essential, +94142,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,HEALTHPLUS-Essential, +94143,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,HEALTHPLUS-Essential, +94144,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,HEALTHPLUS-Essential, +94145,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,HEALTHPLUS-Essential, +94146,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,HEALTHPLUS-Essential, +94147,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,HEALTHPLUS-Essential, +94148,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,HEALTHPLUS-Essential, +94149,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,HEALTHPLUS-Essential, +94150,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,HEALTHPLUS-Essential,7.52 +94151,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,HEALTHPLUS-Essential, +94152,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,HEALTHPLUS-Essential, +94153,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,HEALTHPLUS-Essential, +94154,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,HEALTHPLUS-Essential, +94155,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,HEALTHPLUS-Essential, +94156,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,HEALTHPLUS-Essential, +94157,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,HEALTHPLUS-Essential, +94158,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,HEALTHPLUS-Essential, +94159,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,HEALTHPLUS-Essential, +94160,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,HEALTHPLUS-Essential, +94161,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,HEALTHPLUS-Essential, +94162,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,HEALTHPLUS-Essential, +94163,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,HEALTHPLUS-Essential, +94164,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,HEALTHPLUS-Essential, +94165,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,HEALTHPLUS-Essential, +94166,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,HEALTHPLUS-Essential, +94167,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,HEALTHPLUS-Essential, +94168,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,HEALTHPLUS-Essential, +94169,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,HEALTHPLUS-Essential, +94170,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,HEALTHPLUS-Essential, +94171,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,HEALTHPLUS-Essential, +94172,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,HEALTHPLUS-Essential, +94173,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,HEALTHPLUS-Essential, +94174,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,HEALTHPLUS-Essential, +94175,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,HEALTHPLUS-Essential, +94176,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,HEALTHPLUS-Essential, +94177,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,HEALTHPLUS-Essential, +94178,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,HEALTHPLUS-Essential, +94179,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,HEALTHPLUS-Essential, +94180,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,HEALTHPLUS-Essential, +94181,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,HEALTHPLUS-Essential, +94182,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,HEALTHPLUS-Essential, +94183,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,HEALTHPLUS-Essential, +94184,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,HEALTHPLUS-Essential, +94185,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,HEALTHPLUS-Essential, +94186,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,HEALTHPLUS-Essential, +94187,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,HEALTHPLUS-Essential, +94188,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,HEALTHPLUS-Essential, +94189,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,HEALTHPLUS-Essential, +94190,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,HEALTHPLUS-Essential, +94191,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,HEALTHPLUS-Essential, +94192,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,HEALTHPLUS-Essential, +94193,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,HEALTHPLUS-Essential, +94194,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,HEALTHPLUS-Essential, +94195,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,HEALTHPLUS-Essential, +94196,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,HEALTHPLUS-Essential, +94197,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,HEALTHPLUS-Essential, +94198,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,HEALTHPLUS-Essential, +94199,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,HEALTHPLUS-Essential, +94200,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,HEALTHPLUS-Essential, +94201,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,HEALTHPLUS-Essential, +94202,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,HEALTHPLUS-Essential, +94203,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,HEALTHPLUS-Essential, +94204,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,HEALTHPLUS-Essential, +94205,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,HEALTHPLUS-Essential, +94206,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,HEALTHPLUS-Essential, +94207,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,HEALTHPLUS-Essential, +94208,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,HEALTHPLUS-Essential, +94209,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,HEALTHPLUS-Essential, +94210,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,HEALTHPLUS-Essential, +94211,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,HEALTHPLUS-Essential, +94212,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,HEALTHPLUS-Essential, +94213,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,HEALTHPLUS-Essential, +94214,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,HEALTHPLUS-Essential, +94215,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,HEALTHPLUS-Essential, +94216,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,HEALTHPLUS-Essential, +94217,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,HEALTHPLUS-Essential, +94218,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,HEALTHPLUS-Essential, +94219,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,HEALTHPLUS-Essential, +94220,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,HEALTHPLUS-Essential, +94221,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,HEALTHPLUS-Essential, +94222,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,HEALTHPLUS-Essential, +94223,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,HEALTHPLUS-Essential, +94224,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,HEALTHPLUS-Essential, +94225,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,HEALTHPLUS-Essential, +94226,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,HEALTHPLUS-Essential, +94227,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,HEALTHPLUS-Essential, +94228,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,HEALTHPLUS-Essential, +94229,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,HEALTHPLUS-Essential, +94230,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-Essential, +94231,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-Essential, +94232,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,HEALTHPLUS-Essential, +94233,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,HEALTHPLUS-Essential, +94234,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,HEALTHPLUS-Essential, +94235,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,HEALTHPLUS-Essential, +94236,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,HEALTHPLUS-Essential, +94237,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,HEALTHPLUS-Essential, +94238,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,HEALTHPLUS-Essential, +94239,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,HEALTHPLUS-Essential, +94240,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,HEALTHPLUS-Essential, +94241,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,HEALTHPLUS-Essential, +94242,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,HEALTHPLUS-Essential, +94243,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,HEALTHPLUS-Essential, +94244,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,HEALTHPLUS-Essential, +94245,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,HEALTHPLUS-Essential, +94246,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,HEALTHPLUS-Essential, +94247,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,HEALTHPLUS-Essential, +94248,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,HEALTHPLUS-Essential, +94249,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,HEALTHPLUS-Essential, +94250,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,HEALTHPLUS-Essential, +94251,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,HEALTHPLUS-Essential, +94252,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,HEALTHPLUS-Essential, +94253,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,HEALTHPLUS-Essential, +94254,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,HEALTHPLUS-Essential, +94255,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,HEALTHPLUS-Essential, +94256,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,HEALTHPLUS-Essential, +94257,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,HEALTHPLUS-Essential, +94258,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,HEALTHPLUS-Essential, +94259,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,HEALTHPLUS-Essential, +94260,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,HEALTHPLUS-Essential, +94261,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,HEALTHPLUS-Essential, +94262,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,HEALTHPLUS-Essential, +94263,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,HEALTHPLUS-Essential, +94264,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,HEALTHPLUS-Essential, +94265,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,HEALTHPLUS-Essential, +94266,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,HEALTHPLUS-Essential, +94267,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,HEALTHPLUS-Essential, +94268,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,HEALTHPLUS-Essential, +94269,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,HEALTHPLUS-Essential, +94270,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,HEALTHPLUS-Essential, +94271,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,HEALTHPLUS-Essential, +94272,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,HEALTHPLUS-Essential, +94273,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,HEALTHPLUS-Essential, +94274,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,HEALTHPLUS-Essential, +94275,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,HEALTHPLUS-Essential, +94276,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,HEALTHPLUS-Essential, +94277,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,HEALTHPLUS-Essential, +94278,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,HEALTHPLUS-Essential, +94279,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,HEALTHPLUS-Essential, +94280,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,HEALTHPLUS-Essential, +94281,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,HEALTHPLUS-Essential, +94282,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,HEALTHPLUS-Essential, +94283,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,HEALTHPLUS-Essential, +94284,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,HEALTHPLUS-Essential, +94285,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,HEALTHPLUS-Essential, +94286,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,HEALTHPLUS-Essential, +94287,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,HEALTHPLUS-Essential, +94288,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,HEALTHPLUS-Essential, +94289,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,HEALTHPLUS-Essential, +94290,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,HEALTHPLUS-Essential, +94291,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,HEALTHPLUS-Essential, +94292,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,HEALTHPLUS-Essential, +94293,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,HEALTHPLUS-Essential, +94294,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,HEALTHPLUS-Essential, +94295,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,HEALTHPLUS-Essential, +94296,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,HEALTHPLUS-Essential, +94297,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,HEALTHPLUS-Essential, +94298,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,HEALTHPLUS-Essential, +94299,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,HEALTHPLUS-Essential, +94300,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,HEALTHPLUS-Essential, +94301,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,HEALTHPLUS-Essential, +94302,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,HEALTHPLUS-Essential, +94303,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,HEALTHPLUS-Essential, +94304,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,HEALTHPLUS-Essential, +94305,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,HEALTHPLUS-Essential, +94306,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,HEALTHPLUS-Essential, +94307,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,HEALTHPLUS-Essential, +94308,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,HEALTHPLUS-Essential, +94309,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,HEALTHPLUS-Essential, +94310,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,HEALTHPLUS-Essential, +94311,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,HEALTHPLUS-Essential, +94312,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,HEALTHPLUS-Essential, +94313,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,HEALTHPLUS-Essential, +94314,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,HEALTHPLUS-Essential, +94315,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,HEALTHPLUS-Essential, +94316,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,HEALTHPLUS-Essential, +94317,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,HEALTHPLUS-Essential, +94318,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,HEALTHPLUS-Essential, +94319,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,HEALTHPLUS-Essential, +94320,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,HEALTHPLUS-Essential, +94321,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,HEALTHPLUS-Essential, +94322,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,HEALTHPLUS-Essential, +94323,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,HEALTHPLUS-Essential, +94324,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,HEALTHPLUS-Essential, +94325,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,HEALTHPLUS-Essential, +94326,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,HEALTHPLUS-Essential, +94327,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,HEALTHPLUS-Essential, +94328,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,HEALTHPLUS-Essential, +94329,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,HEALTHPLUS-Essential, +94330,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,HEALTHPLUS-Essential, +94331,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,HEALTHPLUS-Essential, +94332,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,HEALTHPLUS-Essential, +94333,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,HEALTHPLUS-Essential, +94334,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,HEALTHPLUS-Essential, +94335,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,HEALTHPLUS-Essential, +94336,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,HEALTHPLUS-Essential, +94337,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,HEALTHPLUS-Essential, +94338,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,HEALTHPLUS-Essential, +94339,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,HEALTHPLUS-Essential, +94340,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,HEALTHPLUS-Essential, +94341,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,HEALTHPLUS-Essential, +94342,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,HEALTHPLUS-Essential, +94343,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,HEALTHPLUS-Essential, +94344,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,HEALTHPLUS-Essential, +94345,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,HEALTHPLUS-Essential, +94346,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,HEALTHPLUS-Essential, +94347,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,HEALTHPLUS-Essential, +94348,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,HEALTHPLUS-Essential, +94349,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,HEALTHPLUS-Essential, +94350,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,HEALTHPLUS-Essential, +94351,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,HEALTHPLUS-Essential, +94352,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,HEALTHPLUS-Essential, +94353,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,HEALTHPLUS-Essential, +94354,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,HEALTHPLUS-Essential, +94355,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,HEALTHPLUS-Essential, +94356,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,HEALTHPLUS-Essential, +94357,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,HEALTHPLUS-Essential, +94358,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,HEALTHPLUS-Essential, +94359,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,HEALTHPLUS-Essential, +94360,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,HEALTHPLUS-Essential, +94361,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,HEALTHPLUS-Essential, +94362,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,HEALTHPLUS-Essential, +94363,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,HEALTHPLUS-Essential, +94364,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,HEALTHPLUS-Essential, +94365,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,HEALTHPLUS-Essential, +94366,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,HEALTHPLUS-Essential, +94367,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,HEALTHPLUS-Essential, +94368,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,HEALTHPLUS-Essential, +94369,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,HEALTHPLUS-Essential, +94370,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,HEALTHPLUS-Essential, +94371,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,HEALTHPLUS-Essential, +94372,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,HEALTHPLUS-Essential, +94373,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,HEALTHPLUS-Essential, +94374,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,HEALTHPLUS-Essential, +94375,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,HEALTHPLUS-Essential, +94376,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,HEALTHPLUS-Essential, +94377,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,HEALTHPLUS-Essential, +94378,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,HEALTHPLUS-Essential, +94379,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,HEALTHPLUS-Essential, +94380,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,HEALTHPLUS-Essential, +94381,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,HEALTHPLUS-Essential, +94382,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,HEALTHPLUS-Essential, +94383,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,HEALTHPLUS-Essential, +94384,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,HEALTHPLUS-Essential, +94385,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,HEALTHPLUS-Essential, +94386,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,HEALTHPLUS-Essential, +94387,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,HEALTHPLUS-Essential, +94388,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,HEALTHPLUS-Essential, +94389,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,HEALTHPLUS-Essential, +94390,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,HEALTHPLUS-Essential, +94391,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,HEALTHPLUS-Essential, +94392,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,HEALTHPLUS-Essential, +94393,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,HEALTHPLUS-Essential, +94394,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,HEALTHPLUS-Essential, +94395,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,HEALTHPLUS-Essential, +94396,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,HEALTHPLUS-Essential, +94397,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,HEALTHPLUS-Essential, +94398,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,HEALTHPLUS-Essential, +94399,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,HEALTHPLUS-Essential, +94400,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,HEALTHPLUS-Essential, +94401,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,HEALTHPLUS-Essential, +94402,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,HEALTHPLUS-Essential, +94403,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,HEALTHPLUS-Essential, +94404,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,HEALTHPLUS-Essential, +94405,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,HEALTHPLUS-Essential, +94406,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,HEALTHPLUS-Essential, +94407,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,HEALTHPLUS-Essential, +94408,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,HEALTHPLUS-Essential, +94409,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,HEALTHPLUS-Essential, +94410,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,HEALTHPLUS-Essential, +94411,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,HEALTHPLUS-Essential, +94412,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,HEALTHPLUS-Essential, +94413,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,HEALTHPLUS-Essential, +94414,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,HEALTHPLUS-Essential, +94415,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,HEALTHPLUS-Essential, +94416,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,HEALTHPLUS-Essential, +94417,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,HEALTHPLUS-Essential, +94418,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,HEALTHPLUS-Essential, +94419,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,HEALTHPLUS-Essential, +94420,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,HEALTHPLUS-Essential, +94421,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,HEALTHPLUS-Essential, +94422,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +94423,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,HEALTHPLUS-Essential, +94424,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,HEALTHPLUS-Essential, +94425,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,HEALTHPLUS-Essential, +94426,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,HEALTHPLUS-Essential, +94427,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,HEALTHPLUS-Essential, +94428,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,HEALTHPLUS-Essential, +94429,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,HEALTHPLUS-Essential, +94430,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,HEALTHPLUS-Essential, +94431,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,HEALTHPLUS-Essential, +94432,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,HEALTHPLUS-Essential, +94433,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,HEALTHPLUS-Essential, +94434,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,HEALTHPLUS-Essential, +94435,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,HEALTHPLUS-Essential, +94436,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,HEALTHPLUS-Essential, +94437,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,HEALTHPLUS-Essential, +94438,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,HEALTHPLUS-Essential, +94439,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,HEALTHPLUS-Essential, +94440,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,HEALTHPLUS-Essential, +94441,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,HEALTHPLUS-Essential, +94442,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,HEALTHPLUS-Essential, +94443,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,HEALTHPLUS-Essential, +94444,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,HEALTHPLUS-Essential, +94445,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,HEALTHPLUS-Essential, +94446,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,HEALTHPLUS-Essential, +94447,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,HEALTHPLUS-Essential, +94448,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,HEALTHPLUS-Essential, +94449,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,HEALTHPLUS-Essential, +94450,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,HEALTHPLUS-Essential, +94451,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,HEALTHPLUS-Essential, +94452,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,HEALTHPLUS-Essential, +94453,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,HEALTHPLUS-Essential, +94454,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,HEALTHPLUS-Essential, +94455,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,HEALTHPLUS-Essential, +94456,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,HEALTHPLUS-Essential, +94457,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,HEALTHPLUS-Essential, +94458,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,HEALTHPLUS-Essential, +94459,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,HEALTHPLUS-Essential, +94460,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,HEALTHPLUS-Essential, +94461,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,HEALTHPLUS-Essential, +94462,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,HEALTHPLUS-Essential, +94463,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,HEALTHPLUS-Essential, +94464,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,HEALTHPLUS-Essential, +94465,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,HEALTHPLUS-Essential, +94466,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,HEALTHPLUS-Essential, +94467,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,HEALTHPLUS-Essential, +94468,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,HEALTHPLUS-Essential, +94469,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,HEALTHPLUS-Essential, +94470,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,HEALTHPLUS-Essential, +94471,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,HEALTHPLUS-Essential, +94472,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,HEALTHPLUS-Essential, +94473,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,HEALTHPLUS-Essential, +94474,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,HEALTHPLUS-Essential, +94475,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,HEALTHPLUS-Essential, +94476,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,HEALTHPLUS-Essential, +94477,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,HEALTHPLUS-Essential, +94478,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,HEALTHPLUS-Essential, +94479,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,HEALTHPLUS-Essential, +94480,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,HEALTHPLUS-Essential, +94481,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,HEALTHPLUS-Essential, +94482,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,HEALTHPLUS-Essential, +94483,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,HEALTHPLUS-Essential, +94484,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,HEALTHPLUS-Essential, +94485,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,HEALTHPLUS-Essential, +94486,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,HEALTHPLUS-Essential, +94487,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,HEALTHPLUS-Essential, +94488,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,HEALTHPLUS-Essential, +94489,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,HEALTHPLUS-Essential, +94490,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,HEALTHPLUS-Essential, +94491,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,HEALTHPLUS-Essential, +94492,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,HEALTHPLUS-Essential, +94493,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,HEALTHPLUS-Essential, +94494,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,HEALTHPLUS-Essential, +94495,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,HEALTHPLUS-Essential, +94496,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,HEALTHPLUS-Essential, +94497,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,HEALTHPLUS-Essential, +94498,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,HEALTHPLUS-Essential, +94499,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,HEALTHPLUS-Essential, +94500,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,HEALTHPLUS-Essential, +94501,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,HEALTHPLUS-Essential, +94502,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,HEALTHPLUS-Essential, +94503,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,HEALTHPLUS-Essential, +94504,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,HEALTHPLUS-Essential, +94505,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,HEALTHPLUS-Essential, +94506,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,HEALTHPLUS-Essential, +94507,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,HEALTHPLUS-Essential, +94508,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,HEALTHPLUS-Essential, +94509,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,HEALTHPLUS-Essential, +94510,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,HEALTHPLUS-Essential, +94511,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,HEALTHPLUS-Essential, +94512,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,HEALTHPLUS-Essential, +94513,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,HEALTHPLUS-Essential, +94514,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,HEALTHPLUS-Essential, +94515,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,HEALTHPLUS-Essential, +94516,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,HEALTHPLUS-Essential, +94517,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,HEALTHPLUS-Essential, +94518,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,HEALTHPLUS-Essential, +94519,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,HEALTHPLUS-Essential, +94520,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,HEALTHPLUS-Essential, +94521,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,HEALTHPLUS-Essential, +94522,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,HEALTHPLUS-Essential, +94523,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,HEALTHPLUS-Essential, +94524,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,HEALTHPLUS-Essential, +94525,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,HEALTHPLUS-Essential, +94526,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,HEALTHPLUS-Essential, +94527,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,HEALTHPLUS-Essential, +94528,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,HEALTHPLUS-Essential, +94529,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,HEALTHPLUS-Essential, +94530,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,HEALTHPLUS-Essential, +94531,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,HEALTHPLUS-Essential, +94532,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,HEALTHPLUS-Essential, +94533,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,HEALTHPLUS-Essential, +94534,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,HEALTHPLUS-Essential, +94535,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,HEALTHPLUS-Essential, +94536,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,HEALTHPLUS-Essential, +94537,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,HEALTHPLUS-Essential, +94538,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,HEALTHPLUS-Essential, +94539,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,HEALTHPLUS-Essential, +94540,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,HEALTHPLUS-Essential, +94541,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,HEALTHPLUS-Essential, +94542,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,HEALTHPLUS-Essential, +94543,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,HEALTHPLUS-Essential, +94544,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,HEALTHPLUS-Essential, +94545,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,HEALTHPLUS-Essential, +94546,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,HEALTHPLUS-Essential, +94547,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,HEALTHPLUS-Essential, +94548,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,HEALTHPLUS-Essential, +94549,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,HEALTHPLUS-Essential, +94550,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,HEALTHPLUS-Essential, +94551,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,HEALTHPLUS-Essential, +94552,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,HEALTHPLUS-Essential, +94553,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,HEALTHPLUS-Essential, +94554,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,HEALTHPLUS-Essential, +94555,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,HEALTHPLUS-Essential, +94556,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,HEALTHPLUS-Essential, +94557,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,HEALTHPLUS-Essential, +94558,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,HEALTHPLUS-Essential, +94559,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,HEALTHPLUS-Essential, +94560,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,HEALTHPLUS-Essential, +94561,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,HEALTHPLUS-Essential, +94562,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,HEALTHPLUS-Essential, +94563,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,HEALTHPLUS-Essential, +94564,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,HEALTHPLUS-Essential, +94565,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,HEALTHPLUS-Essential, +94566,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,HEALTHPLUS-Essential, +94567,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,HEALTHPLUS-Essential, +94568,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,HEALTHPLUS-Essential, +94569,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,HEALTHPLUS-Essential, +94570,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,HEALTHPLUS-Essential, +94571,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,HEALTHPLUS-Essential, +94572,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,HEALTHPLUS-Essential, +94573,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,HEALTHPLUS-Essential, +94574,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,HEALTHPLUS-Essential, +94575,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,HEALTHPLUS-Essential, +94576,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,HEALTHPLUS-Essential, +94577,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,HEALTHPLUS-Essential, +94578,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,HEALTHPLUS-Essential, +94579,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,HEALTHPLUS-Essential, +94580,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,HEALTHPLUS-Essential, +94581,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,HEALTHPLUS-Essential, +94582,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,HEALTHPLUS-Essential, +94583,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,HEALTHPLUS-Essential, +94584,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,HEALTHPLUS-Essential, +94585,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,HEALTHPLUS-Essential, +94586,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,HEALTHPLUS-Essential, +94587,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,HEALTHPLUS-Essential, +94588,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,HEALTHPLUS-Essential, +94589,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,HEALTHPLUS-Essential, +94590,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,HEALTHPLUS-Essential, +94591,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,HEALTHPLUS-Essential, +94592,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,HEALTHPLUS-Essential, +94593,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,HEALTHPLUS-Essential, +94594,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,HEALTHPLUS-Essential, +94595,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,HEALTHPLUS-Essential, +94596,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,HEALTHPLUS-Essential, +94597,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,HEALTHPLUS-Essential, +94598,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,HEALTHPLUS-Essential, +94599,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,HEALTHPLUS-Essential, +94600,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,HEALTHPLUS-Essential, +94601,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,HEALTHPLUS-Essential, +94602,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,HEALTHPLUS-Essential, +94603,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,HEALTHPLUS-Essential, +94604,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,HEALTHPLUS-Essential, +94605,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,HEALTHPLUS-Essential, +94606,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,HEALTHPLUS-Essential, +94607,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,HEALTHPLUS-Essential, +94608,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,HEALTHPLUS-Essential, +94609,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,HEALTHPLUS-Essential, +94610,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,HEALTHPLUS-Essential, +94611,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,HEALTHPLUS-Essential, +94612,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,HEALTHPLUS-Essential, +94613,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,HEALTHPLUS-Essential, +94614,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,HEALTHPLUS-Essential, +94615,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,HEALTHPLUS-Essential, +94616,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,HEALTHPLUS-Essential, +94617,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,HEALTHPLUS-Essential, +94618,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,HEALTHPLUS-Essential, +94619,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,HEALTHPLUS-Essential, +94620,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,HEALTHPLUS-Essential, +94621,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,HEALTHPLUS-Essential, +94622,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,HEALTHPLUS-Essential, +94623,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,HEALTHPLUS-Essential, +94624,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,HEALTHPLUS-Essential, +94625,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,HEALTHPLUS-Essential, +94626,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,HEALTHPLUS-Essential, +94627,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,HEALTHPLUS-Essential, +94628,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,HEALTHPLUS-Essential, +94629,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,HEALTHPLUS-Essential, +94630,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,HEALTHPLUS-Essential, +94631,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,HEALTHPLUS-Essential, +94632,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,HEALTHPLUS-Essential, +94633,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,HEALTHPLUS-Essential, +94634,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,HEALTHPLUS-Essential, +94635,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,HEALTHPLUS-Essential, +94636,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,HEALTHPLUS-Essential, +94637,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,HEALTHPLUS-Essential, +94638,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,HEALTHPLUS-Essential, +94639,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,HEALTHPLUS-Essential, +94640,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,HEALTHPLUS-Essential, +94641,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,HEALTHPLUS-Essential, +94642,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,HEALTHPLUS-Essential, +94643,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,HEALTHPLUS-Essential, +94644,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,HEALTHPLUS-Essential, +94645,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,HEALTHPLUS-Essential, +94646,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,HEALTHPLUS-Essential, +94647,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,HEALTHPLUS-Essential, +94648,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,HEALTHPLUS-Essential, +94649,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,HEALTHPLUS-Essential, +94650,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,HEALTHPLUS-Essential, +94651,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,HEALTHPLUS-Essential, +94652,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,HEALTHPLUS-Essential, +94653,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,HEALTHPLUS-Essential, +94654,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,HEALTHPLUS-Essential, +94655,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,HEALTHPLUS-Essential, +94656,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,HEALTHPLUS-Essential, +94657,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,HEALTHPLUS-Essential, +94658,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,HEALTHPLUS-Essential, +94659,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,HEALTHPLUS-Essential, +94660,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,HEALTHPLUS-Essential, +94661,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,HEALTHPLUS-Essential, +94662,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,HEALTHPLUS-Essential, +94663,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,HEALTHPLUS-Essential, +94664,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,HEALTHPLUS-Essential, +94665,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,HEALTHPLUS-Essential, +94666,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,HEALTHPLUS-Essential, +94667,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,HEALTHPLUS-Essential, +94668,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,HEALTHPLUS-Essential, +94669,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,HEALTHPLUS-Essential, +94670,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,HEALTHPLUS-Essential, +94671,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,HEALTHPLUS-Essential, +94672,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,HEALTHPLUS-Essential, +94673,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,HEALTHPLUS-Essential, +94674,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,HEALTHPLUS-Essential, +94675,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,HEALTHPLUS-Essential, +94676,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,HEALTHPLUS-Essential, +94677,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,HEALTHPLUS-Essential, +94678,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,HEALTHPLUS-Essential, +94679,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,HEALTHPLUS-Essential, +94680,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,HEALTHPLUS-Essential, +94681,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,HEALTHPLUS-Essential, +94682,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,HEALTHPLUS-Essential, +94683,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,HEALTHPLUS-Essential, +94684,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,HEALTHPLUS-Essential, +94685,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,HEALTHPLUS-Essential, +94686,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,HEALTHPLUS-Essential, +94687,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,HEALTHPLUS-Essential, +94688,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,HEALTHPLUS-Essential, +94689,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,HEALTHPLUS-Essential, +94690,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,HEALTHPLUS-Essential, +94691,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,HEALTHPLUS-Essential, +94692,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,HEALTHPLUS-Essential, +94693,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,HEALTHPLUS-Essential, +94694,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,HEALTHPLUS-Essential, +94695,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,HEALTHPLUS-Essential, +94696,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,HEALTHPLUS-Essential, +94697,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,HEALTHPLUS-Essential, +94698,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,HEALTHPLUS-Essential, +94699,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,HEALTHPLUS-Essential, +94700,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,HEALTHPLUS-Essential, +94701,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,HEALTHPLUS-Essential, +94702,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,HEALTHPLUS-Essential, +94703,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,HEALTHPLUS-Essential, +94704,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,HEALTHPLUS-Essential, +94705,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,HEALTHPLUS-Essential, +94706,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,HEALTHPLUS-Essential, +94707,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,HEALTHPLUS-Essential, +94708,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,HEALTHPLUS-Essential, +94709,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,HEALTHPLUS-Essential, +94710,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,HEALTHPLUS-Essential, +94711,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,HEALTHPLUS-Essential, +94712,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,HEALTHPLUS-Essential, +94713,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,HEALTHPLUS-Essential, +94714,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,HEALTHPLUS-Essential, +94715,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,HEALTHPLUS-Essential, +94716,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,HEALTHPLUS-Essential, +94717,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,HEALTHPLUS-Essential, +94718,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,HEALTHPLUS-Essential, +94719,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,HEALTHPLUS-Essential, +94720,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,HEALTHPLUS-Essential, +94721,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,HEALTHPLUS-Essential, +94722,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,HEALTHPLUS-Essential, +94723,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,HEALTHPLUS-Essential, +94724,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,HEALTHPLUS-Essential, +94725,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,HEALTHPLUS-Essential, +94726,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,HEALTHPLUS-Essential, +94727,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,HEALTHPLUS-Essential, +94728,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,HEALTHPLUS-Essential, +94729,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,HEALTHPLUS-Essential, +94730,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,HEALTHPLUS-Essential, +94731,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,HEALTHPLUS-Essential, +94732,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,HEALTHPLUS-Essential, +94733,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,HEALTHPLUS-Essential, +94734,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,HEALTHPLUS-Essential, +94735,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,HEALTHPLUS-Essential, +94736,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,HEALTHPLUS-Essential, +94737,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,HEALTHPLUS-Essential, +94738,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,HEALTHPLUS-Essential, +94739,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,HEALTHPLUS-Essential, +94740,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,HEALTHPLUS-Essential, +94741,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,HEALTHPLUS-Essential, +94742,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,HEALTHPLUS-Essential, +94743,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,HEALTHPLUS-Essential, +94744,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,HEALTHPLUS-Essential, +94745,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,HEALTHPLUS-Essential, +94746,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,HEALTHPLUS-Essential, +94747,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,HEALTHPLUS-Essential, +94748,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,HEALTHPLUS-Essential, +94749,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,HEALTHPLUS-Essential, +94750,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,HEALTHPLUS-Essential, +94751,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,HEALTHPLUS-Essential, +94752,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,HEALTHPLUS-Essential, +94753,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,HEALTHPLUS-Essential, +94754,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,HEALTHPLUS-Essential, +94755,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,HEALTHPLUS-Essential, +94756,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,HEALTHPLUS-Essential, +94757,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,HEALTHPLUS-Essential, +94758,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,HEALTHPLUS-Essential, +94759,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,HEALTHPLUS-Essential, +94760,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,HEALTHPLUS-Essential, +94761,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,HEALTHPLUS-Essential, +94762,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,HEALTHPLUS-Essential, +94763,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,HEALTHPLUS-Essential, +94764,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,HEALTHPLUS-Essential, +94765,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,HEALTHPLUS-Essential, +94766,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,HEALTHPLUS-Essential, +94767,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,HEALTHPLUS-Essential, +94768,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,HEALTHPLUS-Essential, +94769,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,HEALTHPLUS-Essential, +94770,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,HEALTHPLUS-Essential, +94771,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,HEALTHPLUS-Essential, +94772,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,HEALTHPLUS-Essential, +94773,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,HEALTHPLUS-Essential, +94774,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,HEALTHPLUS-Essential, +94775,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,HEALTHPLUS-Essential, +94776,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,HEALTHPLUS-Essential, +94777,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +94778,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,HEALTHPLUS-Essential, +94779,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,HEALTHPLUS-Essential, +94780,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,HEALTHPLUS-Essential, +94781,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,HEALTHPLUS-Essential, +94782,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +94783,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +94784,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,HEALTHPLUS-Essential, +94785,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,HEALTHPLUS-Essential, +94786,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,HEALTHPLUS-Essential, +94787,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,HEALTHPLUS-Essential, +94788,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,HEALTHPLUS-Essential, +94789,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,HEALTHPLUS-Essential, +94790,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,HEALTHPLUS-Essential, +94791,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,HEALTHPLUS-Essential, +94792,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,HEALTHPLUS-Essential, +94793,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,HEALTHPLUS-Essential, +94794,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,HEALTHPLUS-Essential, +94795,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,HEALTHPLUS-Essential, +94796,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,HEALTHPLUS-Essential, +94797,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,HEALTHPLUS-Essential, +94798,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,HEALTHPLUS-Essential, +94799,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,HEALTHPLUS-Essential, +94800,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,HEALTHPLUS-Essential, +94801,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,HEALTHPLUS-Essential, +94802,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,HEALTHPLUS-Essential, +94803,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,HEALTHPLUS-Essential, +94804,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,HEALTHPLUS-Essential, +94805,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,HEALTHPLUS-Essential, +94806,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,HEALTHPLUS-Essential, +94807,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,HEALTHPLUS-Essential, +94808,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,HEALTHPLUS-Essential, +94809,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,HEALTHPLUS-Essential, +94810,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,HEALTHPLUS-Essential, +94811,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,HEALTHPLUS-Essential, +94812,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,HEALTHPLUS-Essential, +94813,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,HEALTHPLUS-Essential, +94814,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,HEALTHPLUS-Essential, +94815,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,HEALTHPLUS-Essential, +94816,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,HEALTHPLUS-Essential, +94817,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,HEALTHPLUS-Essential, +94818,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,HEALTHPLUS-Essential, +94819,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +94820,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,HEALTHPLUS-Essential, +94821,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,HEALTHPLUS-Essential, +94822,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,HEALTHPLUS-Essential, +94823,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,HEALTHPLUS-Essential, +94824,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,HEALTHPLUS-Essential, +94825,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,HEALTHPLUS-Essential, +94826,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,HEALTHPLUS-Essential, +94827,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,HEALTHPLUS-Essential, +94828,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,HEALTHPLUS-Essential, +94829,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,HEALTHPLUS-Essential, +94830,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,HEALTHPLUS-Essential, +94831,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,HEALTHPLUS-Essential, +94832,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,HEALTHPLUS-Essential, +94833,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,HEALTHPLUS-Essential, +94834,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,HEALTHPLUS-Essential, +94835,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,HEALTHPLUS-Essential, +94836,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,HEALTHPLUS-Essential, +94837,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,HEALTHPLUS-Essential, +94838,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,HEALTHPLUS-Essential, +94839,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,HEALTHPLUS-Essential, +94840,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,HEALTHPLUS-Essential, +94841,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,HEALTHPLUS-Essential, +94842,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,HEALTHPLUS-Essential, +94843,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,HEALTHPLUS-Essential, +94844,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,HEALTHPLUS-Essential, +94845,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,HEALTHPLUS-Essential, +94846,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,HEALTHPLUS-Essential, +94847,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,HEALTHPLUS-Essential, +94848,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,HEALTHPLUS-Essential, +94849,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,HEALTHPLUS-Essential, +94850,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,HEALTHPLUS-Essential, +94851,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,HEALTHPLUS-Essential, +94852,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,HEALTHPLUS-Essential, +94853,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,HEALTHPLUS-Essential, +94854,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,HEALTHPLUS-Essential, +94855,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,HEALTHPLUS-Essential, +94856,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,HEALTHPLUS-Essential, +94857,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,HEALTHPLUS-Essential, +94858,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,HEALTHPLUS-Essential, +94859,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,HEALTHPLUS-Essential, +94860,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,HEALTHPLUS-Essential, +94861,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,HEALTHPLUS-Essential, +94862,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,HEALTHPLUS-Essential, +94863,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,HEALTHPLUS-Essential, +94864,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,HEALTHPLUS-Essential, +94865,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,HEALTHPLUS-Essential, +94866,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,HEALTHPLUS-Essential, +94867,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,HEALTHPLUS-Essential, +94868,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,HEALTHPLUS-Essential, +94869,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,HEALTHPLUS-Essential, +94870,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,HEALTHPLUS-Essential, +94871,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,HEALTHPLUS-Essential, +94872,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,HEALTHPLUS-Essential, +94873,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,HEALTHPLUS-Essential, +94874,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,HEALTHPLUS-Essential, +94875,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,HEALTHPLUS-Essential, +94876,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,HEALTHPLUS-Essential, +94877,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,HEALTHPLUS-Essential, +94878,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,HEALTHPLUS-Essential, +94879,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,HEALTHPLUS-Essential, +94880,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,HEALTHPLUS-Essential, +94881,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,HEALTHPLUS-Essential, +94882,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,HEALTHPLUS-Essential, +94883,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,HEALTHPLUS-Essential, +94884,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,HEALTHPLUS-Essential, +94885,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,HEALTHPLUS-Essential, +94886,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,HEALTHPLUS-Essential, +94887,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,HEALTHPLUS-Essential, +94888,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,HEALTHPLUS-Essential, +94889,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,HEALTHPLUS-Essential, +94890,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,HEALTHPLUS-Essential, +94891,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,HEALTHPLUS-Essential, +94892,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,HEALTHPLUS-Essential, +94893,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,HEALTHPLUS-Essential, +94894,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-Essential, +94895,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,HEALTHPLUS-Essential, +94896,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,HEALTHPLUS-Essential, +94897,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,HEALTHPLUS-Essential, +94898,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,HEALTHPLUS-Essential, +94899,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,HEALTHPLUS-Essential, +94900,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,HEALTHPLUS-Essential, +94901,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,HEALTHPLUS-Essential, +94902,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,HEALTHPLUS-Essential, +94903,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,HEALTHPLUS-Essential, +94904,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,HEALTHPLUS-Essential, +94905,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,HEALTHPLUS-Essential, +94906,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,HEALTHPLUS-Essential, +94907,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,HEALTHPLUS-Essential, +94908,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,HEALTHPLUS-Essential, +94909,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,HEALTHPLUS-Essential, +94910,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,HEALTHPLUS-Essential, +94911,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,HEALTHPLUS-Essential, +94912,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,HEALTHPLUS-Essential, +94913,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,HEALTHPLUS-Essential, +94914,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,HEALTHPLUS-Essential, +94915,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,HEALTHPLUS-Essential, +94916,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,HEALTHPLUS-Essential, +94917,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,HEALTHPLUS-Essential, +94918,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,HEALTHPLUS-Essential, +94919,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,HEALTHPLUS-Essential, +94920,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,HEALTHPLUS-Essential, +94921,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,HEALTHPLUS-Essential, +94922,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,HEALTHPLUS-Essential, +94923,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,HEALTHPLUS-Essential, +94924,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,HEALTHPLUS-Essential, +94925,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,HEALTHPLUS-Essential, +94926,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,HEALTHPLUS-Essential, +94927,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-Essential, +94928,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,HEALTHPLUS-Essential, +94929,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,HEALTHPLUS-Essential, +94930,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,HEALTHPLUS-Essential, +94931,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,HEALTHPLUS-Essential, +94932,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,HEALTHPLUS-Essential, +94933,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,HEALTHPLUS-Essential, +94934,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,HEALTHPLUS-Essential, +94935,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,HEALTHPLUS-Essential, +94936,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,HEALTHPLUS-Essential, +94937,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,HEALTHPLUS-Essential, +94938,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,HEALTHPLUS-Essential, +94939,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,HEALTHPLUS-Essential, +94940,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,HEALTHPLUS-Essential, +94941,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,HEALTHPLUS-Essential, +94942,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,HEALTHPLUS-Essential, +94943,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,HEALTHPLUS-Essential, +94944,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-Essential, +94945,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,HEALTHPLUS-Essential, +94946,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,HEALTHPLUS-Essential, +94947,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,HEALTHPLUS-Essential, +94948,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,HEALTHPLUS-Essential, +94949,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,HEALTHPLUS-Essential, +94950,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,HEALTHPLUS-Essential, +94951,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,HEALTHPLUS-Essential, +94952,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,HEALTHPLUS-Essential, +94953,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,HEALTHPLUS-Essential, +94954,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,HEALTHPLUS-Essential, +94955,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,HEALTHPLUS-Essential, +94956,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,HEALTHPLUS-Essential, +94957,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,HEALTHPLUS-Essential, +94958,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,HEALTHPLUS-Essential, +94959,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,HEALTHPLUS-Essential, +94960,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,HEALTHPLUS-Essential, +94961,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,HEALTHPLUS-Essential, +94962,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,HEALTHPLUS-Essential, +94963,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,HEALTHPLUS-Essential, +94964,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,HEALTHPLUS-Essential, +94965,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,HEALTHPLUS-Essential, +94966,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,HEALTHPLUS-Essential, +94967,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,HEALTHPLUS-Essential, +94968,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,HEALTHPLUS-Essential, +94969,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,HEALTHPLUS-Essential, +94970,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,HEALTHPLUS-Essential, +94971,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,HEALTHPLUS-Essential, +94972,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,HEALTHPLUS-Essential, +94973,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,HEALTHPLUS-Essential, +94974,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,HEALTHPLUS-Essential, +94975,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,HEALTHPLUS-Essential, +94976,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,HEALTHPLUS-Essential, +94977,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,HEALTHPLUS-Essential, +94978,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,HEALTHPLUS-Essential, +94979,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,HEALTHPLUS-Essential, +94980,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,HEALTHPLUS-Essential, +94981,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,HEALTHPLUS-Essential, +94982,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,HEALTHPLUS-Essential, +94983,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,HEALTHPLUS-Essential, +94984,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,HEALTHPLUS-Essential, +94985,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,HEALTHPLUS-Essential, +94986,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,HEALTHPLUS-Essential, +94987,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,HEALTHPLUS-Essential, +94988,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,HEALTHPLUS-Essential, +94989,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,HEALTHPLUS-Essential, +94990,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,HEALTHPLUS-Essential, +94991,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,HEALTHPLUS-Essential, +94992,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,HEALTHPLUS-Essential, +94993,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,HEALTHPLUS-Essential, +94994,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,HEALTHPLUS-Essential, +94995,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,HEALTHPLUS-Essential, +94996,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,HEALTHPLUS-Essential, +94997,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,HEALTHPLUS-Essential, +94998,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,HEALTHPLUS-Essential, +94999,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,HEALTHPLUS-Essential, +95000,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,HEALTHPLUS-Essential, +95001,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,HEALTHPLUS-Essential, +95002,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,HEALTHPLUS-Essential, +95003,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,HEALTHPLUS-Essential,2344.63 +95004,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,HEALTHPLUS-Essential, +95005,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,HEALTHPLUS-Essential, +95006,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,HEALTHPLUS-Essential, +95007,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,HEALTHPLUS-Essential, +95008,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,HEALTHPLUS-Essential, +95009,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,HEALTHPLUS-Essential, +95010,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,HEALTHPLUS-Essential, +95011,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,HEALTHPLUS-Essential, +95012,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,HEALTHPLUS-Essential, +95013,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,HEALTHPLUS-Essential, +95014,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,HEALTHPLUS-Essential, +95015,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,HEALTHPLUS-Essential, +95016,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,HEALTHPLUS-Essential, +95017,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,HEALTHPLUS-Essential, +95018,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,HEALTHPLUS-Essential, +95019,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,HEALTHPLUS-Essential, +95020,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,HEALTHPLUS-Essential, +95021,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,HEALTHPLUS-Essential, +95022,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,HEALTHPLUS-Essential, +95023,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,HEALTHPLUS-Essential, +95024,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,HEALTHPLUS-Essential, +95025,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,HEALTHPLUS-Essential, +95026,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,HEALTHPLUS-Essential, +95027,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,HEALTHPLUS-Essential, +95028,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,HEALTHPLUS-Essential, +95029,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,HEALTHPLUS-Essential, +95030,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,HEALTHPLUS-Essential, +95031,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,HEALTHPLUS-Essential, +95032,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,HEALTHPLUS-Essential, +95033,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,HEALTHPLUS-Essential, +95034,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,HEALTHPLUS-Essential, +95035,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,HEALTHPLUS-Essential, +95036,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,HEALTHPLUS-Essential, +95037,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,HEALTHPLUS-Essential, +95038,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,HEALTHPLUS-Essential, +95039,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,HEALTHPLUS-Essential, +95040,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,HEALTHPLUS-Essential, +95041,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,HEALTHPLUS-Essential, +95042,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,HEALTHPLUS-Essential, +95043,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,HEALTHPLUS-Essential, +95044,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,HEALTHPLUS-Essential, +95045,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,HEALTHPLUS-Essential, +95046,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,HEALTHPLUS-Essential, +95047,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,HEALTHPLUS-Essential, +95048,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,HEALTHPLUS-Essential, +95049,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,HEALTHPLUS-Essential, +95050,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,HEALTHPLUS-Essential, +95051,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,HEALTHPLUS-Essential, +95052,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,HEALTHPLUS-Essential, +95053,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,HEALTHPLUS-Essential, +95054,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,HEALTHPLUS-Essential, +95055,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,HEALTHPLUS-Essential, +95056,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,HEALTHPLUS-Essential, +95057,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,HEALTHPLUS-Essential, +95058,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,HEALTHPLUS-Essential, +95059,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,HEALTHPLUS-Essential, +95060,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,HEALTHPLUS-Essential, +95061,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,HEALTHPLUS-Essential, +95062,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,HEALTHPLUS-Essential, +95063,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,HEALTHPLUS-Essential, +95064,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,HEALTHPLUS-Essential, +95065,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,HEALTHPLUS-Essential, +95066,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,HEALTHPLUS-Essential, +95067,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,HEALTHPLUS-Essential, +95068,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,HEALTHPLUS-Essential, +95069,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,HEALTHPLUS-Essential, +95070,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,HEALTHPLUS-Essential, +95071,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,HEALTHPLUS-Essential, +95072,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,HEALTHPLUS-Essential, +95073,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,HEALTHPLUS-Essential, +95074,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,HEALTHPLUS-Essential, +95075,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,HEALTHPLUS-Essential, +95076,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,HEALTHPLUS-Essential, +95077,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,HEALTHPLUS-Essential, +95078,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,HEALTHPLUS-Essential, +95079,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,HEALTHPLUS-Essential, +95080,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,HEALTHPLUS-Essential, +95081,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,HEALTHPLUS-Essential,94.73 +95082,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,HEALTHPLUS-Essential, +95083,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,HEALTHPLUS-Essential, +95084,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,HEALTHPLUS-Essential, +95085,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,HEALTHPLUS-Essential, +95086,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,HEALTHPLUS-Essential, +95087,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,HEALTHPLUS-Essential, +95088,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,HEALTHPLUS-Essential, +95089,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,HEALTHPLUS-Essential, +95090,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,HEALTHPLUS-Essential, +95091,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,HEALTHPLUS-Essential, +95092,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,HEALTHPLUS-Essential, +95093,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,HEALTHPLUS-Essential, +95094,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,HEALTHPLUS-Essential, +95095,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,HEALTHPLUS-Essential, +95096,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,HEALTHPLUS-Essential, +95097,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,HEALTHPLUS-Essential, +95098,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,HEALTHPLUS-Essential, +95099,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,HEALTHPLUS-Essential, +95100,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,HEALTHPLUS-Essential, +95101,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,HEALTHPLUS-Essential, +95102,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,HEALTHPLUS-Essential, +95103,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,HEALTHPLUS-Essential, +95104,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,HEALTHPLUS-Essential, +95105,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,HEALTHPLUS-Essential, +95106,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,HEALTHPLUS-Essential, +95107,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,HEALTHPLUS-Essential, +95108,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,HEALTHPLUS-Essential, +95109,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,HEALTHPLUS-Essential, +95110,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,HEALTHPLUS-Essential, +95111,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,HEALTHPLUS-Essential, +95112,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,HEALTHPLUS-Essential, +95113,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,HEALTHPLUS-Essential, +95114,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,HEALTHPLUS-Essential, +95115,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,HEALTHPLUS-Essential, +95116,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,HEALTHPLUS-Essential, +95117,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,HEALTHPLUS-Essential, +95118,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,HEALTHPLUS-Essential, +95119,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,HEALTHPLUS-Essential, +95120,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,HEALTHPLUS-Essential, +95121,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,HEALTHPLUS-Essential, +95122,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,HEALTHPLUS-Essential, +95123,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,HEALTHPLUS-Essential, +95124,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,HEALTHPLUS-Essential, +95125,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,HEALTHPLUS-Essential, +95126,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,HEALTHPLUS-Essential, +95127,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,HEALTHPLUS-Essential, +95128,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,HEALTHPLUS-Essential, +95129,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,HEALTHPLUS-Essential, +95130,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,HEALTHPLUS-Essential, +95131,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,HEALTHPLUS-Essential, +95132,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,HEALTHPLUS-Essential, +95133,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,HEALTHPLUS-Essential, +95134,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,HEALTHPLUS-Essential, +95135,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,HEALTHPLUS-Essential, +95136,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,HEALTHPLUS-Essential, +95137,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,HEALTHPLUS-Essential, +95138,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,HEALTHPLUS-Essential, +95139,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,HEALTHPLUS-Essential, +95140,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,HEALTHPLUS-Essential, +95141,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,HEALTHPLUS-Essential, +95142,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,HEALTHPLUS-Essential, +95143,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,HEALTHPLUS-Essential, +95144,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,HEALTHPLUS-Essential, +95145,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,HEALTHPLUS-Essential, +95146,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,HEALTHPLUS-Essential, +95147,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,HEALTHPLUS-Essential, +95148,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,HEALTHPLUS-Essential, +95149,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,HEALTHPLUS-Essential, +95150,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,HEALTHPLUS-Essential, +95151,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,HEALTHPLUS-Essential, +95152,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,HEALTHPLUS-Essential, +95153,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,HEALTHPLUS-Essential, +95154,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,HEALTHPLUS-Essential, +95155,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,HEALTHPLUS-Essential, +95156,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,HEALTHPLUS-Essential, +95157,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,HEALTHPLUS-Essential, +95158,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,HEALTHPLUS-Essential, +95159,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,HEALTHPLUS-Essential, +95160,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,HEALTHPLUS-Essential, +95161,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,HEALTHPLUS-Essential, +95162,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,HEALTHPLUS-Essential, +95163,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,HEALTHPLUS-Essential, +95164,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,HEALTHPLUS-Essential, +95165,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,HEALTHPLUS-Essential, +95166,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,HEALTHPLUS-Essential, +95167,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,HEALTHPLUS-Essential,132.12 +95168,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,HEALTHPLUS-Essential, +95169,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,HEALTHPLUS-Essential, +95170,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,HEALTHPLUS-Essential, +95171,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,HEALTHPLUS-Essential, +95172,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,HEALTHPLUS-Essential, +95173,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,HEALTHPLUS-Essential, +95174,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,HEALTHPLUS-Essential, +95175,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,HEALTHPLUS-Essential, +95176,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,HEALTHPLUS-Essential, +95177,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,HEALTHPLUS-Essential, +95178,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,HEALTHPLUS-Essential, +95179,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,HEALTHPLUS-Essential, +95180,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,HEALTHPLUS-Essential, +95181,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,HEALTHPLUS-Essential, +95182,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,HEALTHPLUS-Essential, +95183,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,HEALTHPLUS-Essential, +95184,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,HEALTHPLUS-Essential, +95185,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,HEALTHPLUS-Essential, +95186,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,HEALTHPLUS-Essential, +95187,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,HEALTHPLUS-Essential, +95188,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,HEALTHPLUS-Essential, +95189,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,HEALTHPLUS-Essential, +95190,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,HEALTHPLUS-Essential, +95191,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,HEALTHPLUS-Essential, +95192,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,HEALTHPLUS-Essential, +95193,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,HEALTHPLUS-Essential, +95194,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,HEALTHPLUS-Essential, +95195,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,HEALTHPLUS-Essential, +95196,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,HEALTHPLUS-Essential, +95197,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,HEALTHPLUS-Essential, +95198,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,HEALTHPLUS-Essential, +95199,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,HEALTHPLUS-Essential, +95200,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,HEALTHPLUS-Essential, +95201,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,HEALTHPLUS-Essential, +95202,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,HEALTHPLUS-Essential, +95203,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,HEALTHPLUS-Essential, +95204,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,HEALTHPLUS-Essential, +95205,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,HEALTHPLUS-Essential, +95206,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,HEALTHPLUS-Essential, +95207,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,HEALTHPLUS-Essential, +95208,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,HEALTHPLUS-Essential, +95209,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,HEALTHPLUS-Essential, +95210,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,HEALTHPLUS-Essential, +95211,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,HEALTHPLUS-Essential, +95212,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,HEALTHPLUS-Essential, +95213,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,HEALTHPLUS-Essential, +95214,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,HEALTHPLUS-Essential, +95215,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,HEALTHPLUS-Essential, +95216,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,HEALTHPLUS-Essential, +95217,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,HEALTHPLUS-Essential, +95218,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,HEALTHPLUS-Essential, +95219,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,HEALTHPLUS-Essential, +95220,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,HEALTHPLUS-Essential, +95221,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,HEALTHPLUS-Essential, +95222,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,HEALTHPLUS-Essential, +95223,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,HEALTHPLUS-Essential, +95224,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,HEALTHPLUS-Essential, +95225,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,HEALTHPLUS-Essential, +95226,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,HEALTHPLUS-Essential, +95227,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,HEALTHPLUS-Essential, +95228,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,HEALTHPLUS-Essential, +95229,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,HEALTHPLUS-Essential, +95230,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,HEALTHPLUS-Essential, +95231,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,HEALTHPLUS-Essential, +95232,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,HEALTHPLUS-Essential, +95233,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,HEALTHPLUS-Essential, +95234,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,HEALTHPLUS-Essential, +95235,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,HEALTHPLUS-Essential, +95236,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,HEALTHPLUS-Essential, +95237,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,HEALTHPLUS-Essential, +95238,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,HEALTHPLUS-Essential, +95239,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,HEALTHPLUS-Essential, +95240,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,HEALTHPLUS-Essential, +95241,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,HEALTHPLUS-Essential, +95242,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,HEALTHPLUS-Essential, +95243,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,HEALTHPLUS-Essential, +95244,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,HEALTHPLUS-Essential, +95245,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,HEALTHPLUS-Essential, +95246,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,HEALTHPLUS-Essential, +95247,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,HEALTHPLUS-Essential, +95248,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,HEALTHPLUS-Essential, +95249,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,HEALTHPLUS-Essential, +95250,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,HEALTHPLUS-Essential, +95251,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,HEALTHPLUS-Essential, +95252,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,HEALTHPLUS-Essential, +95253,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,HEALTHPLUS-Essential, +95254,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,HEALTHPLUS-Essential, +95255,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,HEALTHPLUS-Essential, +95256,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,HEALTHPLUS-Essential, +95257,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,HEALTHPLUS-Essential, +95258,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,HEALTHPLUS-Essential, +95259,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,HEALTHPLUS-Essential, +95260,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,HEALTHPLUS-Essential, +95261,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,HEALTHPLUS-Essential, +95262,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,HEALTHPLUS-Essential, +95263,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,HEALTHPLUS-Essential, +95264,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,HEALTHPLUS-Essential, +95265,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,HEALTHPLUS-Essential, +95266,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,HEALTHPLUS-Essential, +95267,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,HEALTHPLUS-Essential, +95268,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,HEALTHPLUS-Essential, +95269,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,HEALTHPLUS-Essential, +95270,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,HEALTHPLUS-Essential, +95271,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,HEALTHPLUS-Essential, +95272,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,HEALTHPLUS-Essential, +95273,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,HEALTHPLUS-Essential, +95274,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,HEALTHPLUS-Essential, +95275,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,HEALTHPLUS-Essential, +95276,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,HEALTHPLUS-Essential, +95277,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,HEALTHPLUS-Essential, +95278,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,HEALTHPLUS-Essential, +95279,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,HEALTHPLUS-Essential, +95280,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,HEALTHPLUS-Essential, +95281,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,HEALTHPLUS-Essential, +95282,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,HEALTHPLUS-Essential, +95283,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,HEALTHPLUS-Essential, +95284,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,HEALTHPLUS-Essential, +95285,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Essential, +95286,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,HEALTHPLUS-Essential, +95287,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,HEALTHPLUS-Essential, +95288,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,HEALTHPLUS-Essential, +95289,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,HEALTHPLUS-Essential, +95290,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,HEALTHPLUS-Essential, +95291,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,HEALTHPLUS-Essential, +95292,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,HEALTHPLUS-Essential, +95293,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,HEALTHPLUS-Essential, +95294,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,HEALTHPLUS-Essential, +95295,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,HEALTHPLUS-Essential, +95296,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,HEALTHPLUS-Essential, +95297,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,HEALTHPLUS-Essential, +95298,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,HEALTHPLUS-Essential, +95299,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,HEALTHPLUS-Essential, +95300,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,HEALTHPLUS-Essential, +95301,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,HEALTHPLUS-Essential, +95302,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,HEALTHPLUS-Essential, +95303,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,HEALTHPLUS-Essential, +95304,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,HEALTHPLUS-Essential, +95305,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,HEALTHPLUS-Essential, +95306,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,HEALTHPLUS-Essential, +95307,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,HEALTHPLUS-Essential, +95308,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,HEALTHPLUS-Essential, +95309,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,HEALTHPLUS-Essential, +95310,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,HEALTHPLUS-Essential, +95311,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,HEALTHPLUS-Essential, +95312,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,HEALTHPLUS-Essential, +95313,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,HEALTHPLUS-Essential, +95314,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,HEALTHPLUS-Essential, +95315,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,HEALTHPLUS-Essential, +95316,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,HEALTHPLUS-Essential, +95317,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,HEALTHPLUS-Essential, +95318,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,HEALTHPLUS-Essential, +95319,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,HEALTHPLUS-Essential, +95320,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,HEALTHPLUS-Essential, +95321,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,HEALTHPLUS-Essential, +95322,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,HEALTHPLUS-Essential, +95323,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,HEALTHPLUS-Essential, +95324,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,HEALTHPLUS-Essential, +95325,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,HEALTHPLUS-Essential, +95326,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Essential, +95327,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,HEALTHPLUS-Essential, +95328,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,HEALTHPLUS-Essential, +95329,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,HEALTHPLUS-Essential, +95330,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,HEALTHPLUS-Essential, +95331,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,HEALTHPLUS-Essential, +95332,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,HEALTHPLUS-Essential, +95333,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,HEALTHPLUS-Essential, +95334,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,HEALTHPLUS-Essential, +95335,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,HEALTHPLUS-Essential, +95336,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,HEALTHPLUS-Essential, +95337,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,HEALTHPLUS-Essential, +95338,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,HEALTHPLUS-Essential, +95339,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,HEALTHPLUS-Essential, +95340,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,HEALTHPLUS-Essential, +95341,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,HEALTHPLUS-Essential, +95342,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,HEALTHPLUS-Essential, +95343,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,HEALTHPLUS-Essential, +95344,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,HEALTHPLUS-Essential, +95345,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,HEALTHPLUS-Essential, +95346,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,HEALTHPLUS-Essential, +95347,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Essential, +95348,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,HEALTHPLUS-Essential, +95349,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,HEALTHPLUS-Essential, +95350,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,HEALTHPLUS-Essential, +95351,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,HEALTHPLUS-Essential, +95352,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,HEALTHPLUS-Essential, +95353,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,HEALTHPLUS-Essential, +95354,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,HEALTHPLUS-Essential, +95355,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,HEALTHPLUS-Essential, +95356,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,HEALTHPLUS-Essential, +95357,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,HEALTHPLUS-Essential, +95358,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,HEALTHPLUS-Essential, +95359,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,HEALTHPLUS-Essential, +95360,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,HEALTHPLUS-Essential, +95361,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,HEALTHPLUS-Essential, +95362,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,HEALTHPLUS-Essential, +95363,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,HEALTHPLUS-Essential, +95364,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,HEALTHPLUS-Essential, +95365,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,HEALTHPLUS-Essential, +95366,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,HEALTHPLUS-Essential, +95367,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,HEALTHPLUS-Essential,441.58 +95368,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,HEALTHPLUS-Essential, +95369,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,HEALTHPLUS-Essential, +95370,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,HEALTHPLUS-Essential, +95371,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,HEALTHPLUS-Essential, +95372,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,HEALTHPLUS-Essential, +95373,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,HEALTHPLUS-Essential, +95374,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,HEALTHPLUS-Essential, +95375,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,HEALTHPLUS-Essential, +95376,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,HEALTHPLUS-Essential, +95377,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,HEALTHPLUS-Essential, +95378,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,HEALTHPLUS-Essential, +95379,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,HEALTHPLUS-Essential, +95380,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,HEALTHPLUS-Essential, +95381,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,HEALTHPLUS-Essential, +95382,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,HEALTHPLUS-Essential, +95383,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,HEALTHPLUS-Essential, +95384,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,HEALTHPLUS-Essential,1529.18 +95385,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,HEALTHPLUS-Essential, +95386,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,HEALTHPLUS-Essential, +95387,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,HEALTHPLUS-Essential, +95388,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,HEALTHPLUS-Essential, +95389,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,HEALTHPLUS-Essential, +95390,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,HEALTHPLUS-Essential, +95391,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,HEALTHPLUS-Essential, +95392,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,HEALTHPLUS-Essential, +95393,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +95394,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,HEALTHPLUS-Essential, +95395,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,HEALTHPLUS-Essential, +95396,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,HEALTHPLUS-Essential, +95397,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,HEALTHPLUS-Essential, +95398,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,HEALTHPLUS-Essential, +95399,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,HEALTHPLUS-Essential, +95400,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,HEALTHPLUS-Essential, +95401,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,HEALTHPLUS-Essential, +95402,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,HEALTHPLUS-Essential, +95403,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,HEALTHPLUS-Essential, +95404,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,HEALTHPLUS-Essential, +95405,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,HEALTHPLUS-Essential, +95406,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,HEALTHPLUS-Essential, +95407,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,HEALTHPLUS-Essential, +95408,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,HEALTHPLUS-Essential, +95409,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,HEALTHPLUS-Essential, +95410,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,HEALTHPLUS-Essential, +95411,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,HEALTHPLUS-Essential, +95412,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,HEALTHPLUS-Essential, +95413,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,HEALTHPLUS-Essential, +95414,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,HEALTHPLUS-Essential, +95415,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,HEALTHPLUS-Essential, +95416,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,HEALTHPLUS-Essential, +95417,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,HEALTHPLUS-Essential, +95418,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,HEALTHPLUS-Essential, +95419,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,HEALTHPLUS-Essential, +95420,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,HEALTHPLUS-Essential, +95421,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,HEALTHPLUS-Essential, +95422,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,HEALTHPLUS-Essential, +95423,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,HEALTHPLUS-Essential, +95424,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,HEALTHPLUS-Essential, +95425,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,HEALTHPLUS-Essential, +95426,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,HEALTHPLUS-Essential, +95427,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,HEALTHPLUS-Essential, +95428,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,HEALTHPLUS-Essential, +95429,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,HEALTHPLUS-Essential, +95430,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,HEALTHPLUS-Essential, +95431,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,HEALTHPLUS-Essential, +95432,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,HEALTHPLUS-Essential, +95433,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,HEALTHPLUS-Essential, +95434,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,HEALTHPLUS-Essential, +95435,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,HEALTHPLUS-Essential, +95436,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,HEALTHPLUS-Essential, +95437,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,HEALTHPLUS-Essential, +95438,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,HEALTHPLUS-Essential, +95439,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,HEALTHPLUS-Essential, +95440,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,HEALTHPLUS-Essential, +95441,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,HEALTHPLUS-Essential, +95442,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,HEALTHPLUS-Essential, +95443,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,HEALTHPLUS-Essential, +95444,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,HEALTHPLUS-Essential, +95445,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,HEALTHPLUS-Essential, +95446,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,HEALTHPLUS-Essential, +95447,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,HEALTHPLUS-Essential, +95448,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,HEALTHPLUS-Essential, +95449,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,HEALTHPLUS-Essential, +95450,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,HEALTHPLUS-Essential, +95451,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,HEALTHPLUS-Essential, +95452,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Essential, +95453,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Essential, +95454,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Essential, +95455,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-Essential, +95456,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-Essential, +95457,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,HEALTHPLUS-Essential, +95458,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,HEALTHPLUS-Essential, +95459,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,HEALTHPLUS-Essential, +95460,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,HEALTHPLUS-Essential, +95461,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,HEALTHPLUS-Essential, +95462,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,HEALTHPLUS-Essential, +95463,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,HEALTHPLUS-Essential, +95464,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,HEALTHPLUS-Essential, +95465,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,HEALTHPLUS-Essential, +95466,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,HEALTHPLUS-Essential, +95467,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,HEALTHPLUS-Essential, +95468,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,HEALTHPLUS-Essential, +95469,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,HEALTHPLUS-Essential, +95470,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,HEALTHPLUS-Essential, +95471,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,HEALTHPLUS-Essential, +95472,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,HEALTHPLUS-Essential, +95473,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,HEALTHPLUS-Essential, +95474,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,HEALTHPLUS-Essential, +95475,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,HEALTHPLUS-Essential, +95476,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,HEALTHPLUS-Essential, +95477,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,HEALTHPLUS-Essential, +95478,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,HEALTHPLUS-Essential, +95479,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,HEALTHPLUS-Essential, +95480,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,HEALTHPLUS-Essential, +95481,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,HEALTHPLUS-Essential, +95482,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,HEALTHPLUS-Essential, +95483,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,HEALTHPLUS-Essential, +95484,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,HEALTHPLUS-Essential, +95485,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,HEALTHPLUS-Essential, +95486,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,HEALTHPLUS-Essential, +95487,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,HEALTHPLUS-Essential, +95488,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,HEALTHPLUS-Essential, +95489,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,HEALTHPLUS-Essential, +95490,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,HEALTHPLUS-Essential, +95491,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,HEALTHPLUS-Essential, +95492,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,HEALTHPLUS-Essential, +95493,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,HEALTHPLUS-Essential, +95494,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,HEALTHPLUS-Essential, +95495,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,HEALTHPLUS-Essential, +95496,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,HEALTHPLUS-Essential, +95497,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,HEALTHPLUS-Essential, +95498,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,HEALTHPLUS-Essential, +95499,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,HEALTHPLUS-Essential, +95500,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,HEALTHPLUS-Essential, +95501,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,HEALTHPLUS-Essential, +95502,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,HEALTHPLUS-Essential, +95503,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,HEALTHPLUS-Essential, +95504,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,HEALTHPLUS-Essential, +95505,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,HEALTHPLUS-Essential, +95506,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,HEALTHPLUS-Essential, +95507,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,HEALTHPLUS-Essential, +95508,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,HEALTHPLUS-Essential, +95509,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,HEALTHPLUS-Essential, +95510,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,HEALTHPLUS-Essential, +95511,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,HEALTHPLUS-Essential, +95512,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,HEALTHPLUS-Essential, +95513,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,HEALTHPLUS-Essential, +95514,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,HEALTHPLUS-Essential, +95515,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,HEALTHPLUS-Essential, +95516,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,HEALTHPLUS-Essential, +95517,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,HEALTHPLUS-Essential, +95518,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,HEALTHPLUS-Essential, +95519,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,HEALTHPLUS-Essential, +95520,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,HEALTHPLUS-Essential, +95521,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,HEALTHPLUS-Essential, +95522,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,HEALTHPLUS-Essential, +95523,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,HEALTHPLUS-Essential, +95524,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,HEALTHPLUS-Essential, +95525,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,HEALTHPLUS-Essential, +95526,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,HEALTHPLUS-Essential, +95527,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,HEALTHPLUS-Essential, +95528,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,HEALTHPLUS-Essential, +95529,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,HEALTHPLUS-Essential, +95530,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,HEALTHPLUS-Essential, +95531,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,HEALTHPLUS-Essential, +95532,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,HEALTHPLUS-Essential, +95533,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,HEALTHPLUS-Essential, +95534,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,HEALTHPLUS-Essential, +95535,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,HEALTHPLUS-Essential, +95536,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,HEALTHPLUS-Essential, +95537,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,HEALTHPLUS-Essential, +95538,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,HEALTHPLUS-Essential, +95539,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,HEALTHPLUS-Essential, +95540,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,HEALTHPLUS-Essential, +95541,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,HEALTHPLUS-Essential, +95542,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,HEALTHPLUS-Essential, +95543,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,HEALTHPLUS-Essential, +95544,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,HEALTHPLUS-Essential, +95545,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,HEALTHPLUS-Essential, +95546,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,HEALTHPLUS-Essential, +95547,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,HEALTHPLUS-Essential, +95548,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,HEALTHPLUS-Essential, +95549,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,HEALTHPLUS-Essential, +95550,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,HEALTHPLUS-Essential, +95551,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,HEALTHPLUS-Essential, +95552,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,HEALTHPLUS-Essential, +95553,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,HEALTHPLUS-Essential, +95554,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,HEALTHPLUS-Essential, +95555,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,HEALTHPLUS-Essential, +95556,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,HEALTHPLUS-Essential, +95557,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,HEALTHPLUS-Essential, +95558,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,HEALTHPLUS-Essential, +95559,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,HEALTHPLUS-Essential, +95560,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,HEALTHPLUS-Essential, +95561,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,HEALTHPLUS-Essential, +95562,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,HEALTHPLUS-Essential, +95563,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,HEALTHPLUS-Essential, +95564,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,HEALTHPLUS-Essential, +95565,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,HEALTHPLUS-Essential, +95566,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,HEALTHPLUS-Essential, +95567,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,HEALTHPLUS-Essential, +95568,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,HEALTHPLUS-Essential, +95569,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,HEALTHPLUS-Essential, +95570,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,HEALTHPLUS-Essential, +95571,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,HEALTHPLUS-Essential, +95572,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,HEALTHPLUS-Essential, +95573,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,HEALTHPLUS-Essential, +95574,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,HEALTHPLUS-Essential, +95575,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,HEALTHPLUS-Essential, +95576,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,HEALTHPLUS-Essential, +95577,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,HEALTHPLUS-Essential, +95578,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,HEALTHPLUS-Essential, +95579,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,HEALTHPLUS-Essential, +95580,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,HEALTHPLUS-Essential, +95581,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,HEALTHPLUS-Essential, +95582,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,HEALTHPLUS-Essential, +95583,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,HEALTHPLUS-Essential, +95584,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,HEALTHPLUS-Essential, +95585,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,HEALTHPLUS-Essential, +95586,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,HEALTHPLUS-Essential, +95587,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,HEALTHPLUS-Essential, +95588,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,HEALTHPLUS-Essential, +95589,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,HEALTHPLUS-Essential, +95590,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,HEALTHPLUS-Essential, +95591,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,HEALTHPLUS-Essential, +95592,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,HEALTHPLUS-Essential, +95593,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,HEALTHPLUS-Essential, +95594,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,HEALTHPLUS-Essential, +95595,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,HEALTHPLUS-Essential, +95596,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,HEALTHPLUS-Essential, +95597,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,HEALTHPLUS-Essential, +95598,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,HEALTHPLUS-Essential, +95599,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,HEALTHPLUS-Essential, +95600,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,HEALTHPLUS-Essential, +95601,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,HEALTHPLUS-Essential, +95602,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,HEALTHPLUS-Essential, +95603,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,HEALTHPLUS-Essential, +95604,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,HEALTHPLUS-Essential, +95605,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,HEALTHPLUS-Essential, +95606,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,HEALTHPLUS-Essential, +95607,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,HEALTHPLUS-Essential, +95608,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,HEALTHPLUS-Essential, +95609,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,HEALTHPLUS-Essential, +95610,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,HEALTHPLUS-Essential, +95611,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,HEALTHPLUS-Essential, +95612,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,HEALTHPLUS-Essential, +95613,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,HEALTHPLUS-Essential, +95614,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,HEALTHPLUS-Essential, +95615,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,HEALTHPLUS-Essential, +95616,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,HEALTHPLUS-Essential, +95617,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,HEALTHPLUS-Essential, +95618,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,HEALTHPLUS-Essential, +95619,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,HEALTHPLUS-Essential, +95620,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,HEALTHPLUS-Essential, +95621,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,HEALTHPLUS-Essential, +95622,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,HEALTHPLUS-Essential, +95623,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,HEALTHPLUS-Essential, +95624,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,HEALTHPLUS-Essential, +95625,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,HEALTHPLUS-Essential, +95626,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,HEALTHPLUS-Essential, +95627,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,HEALTHPLUS-Essential, +95628,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,HEALTHPLUS-Essential, +95629,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,HEALTHPLUS-Essential, +95630,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,HEALTHPLUS-Essential, +95631,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,HEALTHPLUS-Essential, +95632,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,HEALTHPLUS-Essential, +95633,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,HEALTHPLUS-Essential, +95634,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,HEALTHPLUS-Essential, +95635,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,HEALTHPLUS-Essential, +95636,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,HEALTHPLUS-Essential, +95637,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,HEALTHPLUS-Essential, +95638,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,HEALTHPLUS-Essential, +95639,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,HEALTHPLUS-Essential, +95640,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,HEALTHPLUS-Essential, +95641,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,HEALTHPLUS-Essential, +95642,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,HEALTHPLUS-Essential, +95643,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,HEALTHPLUS-Essential, +95644,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,HEALTHPLUS-Essential, +95645,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,HEALTHPLUS-Essential, +95646,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,HEALTHPLUS-Essential, +95647,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,HEALTHPLUS-Essential, +95648,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,HEALTHPLUS-Essential, +95649,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,HEALTHPLUS-Essential, +95650,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,HEALTHPLUS-Essential, +95651,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,HEALTHPLUS-Essential, +95652,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,HEALTHPLUS-Essential, +95653,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,HEALTHPLUS-Essential, +95654,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,HEALTHPLUS-Essential, +95655,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,HEALTHPLUS-Essential, +95656,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,HEALTHPLUS-Essential, +95657,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,HEALTHPLUS-Essential, +95658,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,HEALTHPLUS-Essential, +95659,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,HEALTHPLUS-Essential, +95660,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,HEALTHPLUS-Essential, +95661,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,HEALTHPLUS-Essential, +95662,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,HEALTHPLUS-Essential, +95663,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,HEALTHPLUS-Essential, +95664,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,HEALTHPLUS-Essential, +95665,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,HEALTHPLUS-Essential, +95666,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,HEALTHPLUS-Essential, +95667,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,HEALTHPLUS-Essential, +95668,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,HEALTHPLUS-Essential, +95669,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,HEALTHPLUS-Essential, +95670,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,HEALTHPLUS-Essential, +95671,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,HEALTHPLUS-Essential, +95672,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,HEALTHPLUS-Essential, +95673,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,HEALTHPLUS-Essential, +95674,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,HEALTHPLUS-Essential, +95675,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,HEALTHPLUS-Essential, +95676,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,HEALTHPLUS-Essential, +95677,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,HEALTHPLUS-Essential, +95678,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,HEALTHPLUS-Essential, +95679,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,HEALTHPLUS-Essential, +95680,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,HEALTHPLUS-Essential, +95681,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,HEALTHPLUS-Essential, +95682,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,HEALTHPLUS-Essential, +95683,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,HEALTHPLUS-Essential, +95684,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,HEALTHPLUS-Essential, +95685,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,HEALTHPLUS-Essential, +95686,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,HEALTHPLUS-Essential, +95687,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,HEALTHPLUS-Essential, +95688,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,HEALTHPLUS-Essential, +95689,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,HEALTHPLUS-Essential, +95690,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,HEALTHPLUS-Essential, +95691,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,HEALTHPLUS-Essential, +95692,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,HEALTHPLUS-Essential, +95693,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,HEALTHPLUS-Essential, +95694,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,HEALTHPLUS-Essential, +95695,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,HEALTHPLUS-Essential, +95696,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,HEALTHPLUS-Essential, +95697,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,HEALTHPLUS-Essential, +95698,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,HEALTHPLUS-Essential, +95699,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,HEALTHPLUS-Essential, +95700,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,HEALTHPLUS-Essential, +95701,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,HEALTHPLUS-Essential, +95702,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,HEALTHPLUS-Essential, +95703,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,HEALTHPLUS-Essential, +95704,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,HEALTHPLUS-Essential, +95705,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,HEALTHPLUS-Essential, +95706,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,HEALTHPLUS-Essential, +95707,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,HEALTHPLUS-Essential, +95708,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,HEALTHPLUS-Essential, +95709,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,HEALTHPLUS-Essential, +95710,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,HEALTHPLUS-Essential, +95711,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,HEALTHPLUS-Essential, +95712,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,HEALTHPLUS-Essential, +95713,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,HEALTHPLUS-Essential, +95714,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,HEALTHPLUS-Essential, +95715,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,HEALTHPLUS-Essential, +95716,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,HEALTHPLUS-Essential, +95717,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,HEALTHPLUS-Essential, +95718,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,HEALTHPLUS-Essential, +95719,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,HEALTHPLUS-Essential, +95720,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,HEALTHPLUS-Essential, +95721,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,HEALTHPLUS-Essential, +95722,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,HEALTHPLUS-Essential, +95723,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,HEALTHPLUS-Essential, +95724,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,HEALTHPLUS-Essential, +95725,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,HEALTHPLUS-Essential, +95726,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,HEALTHPLUS-Essential, +95727,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,HEALTHPLUS-Essential, +95728,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,HEALTHPLUS-Essential, +95729,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,HEALTHPLUS-Essential, +95730,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,HEALTHPLUS-Essential, +95731,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,HEALTHPLUS-Essential, +95732,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,HEALTHPLUS-Essential, +95733,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,HEALTHPLUS-Essential, +95734,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,HEALTHPLUS-Essential, +95735,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,HEALTHPLUS-Essential, +95736,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,HEALTHPLUS-Essential, +95737,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,HEALTHPLUS-Essential, +95738,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,HEALTHPLUS-Essential, +95739,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,HEALTHPLUS-Essential, +95740,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,HEALTHPLUS-Essential, +95741,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,HEALTHPLUS-Essential, +95742,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,HEALTHPLUS-Essential, +95743,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,HEALTHPLUS-Essential, +95744,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,HEALTHPLUS-Essential, +95745,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,HEALTHPLUS-Essential, +95746,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,HEALTHPLUS-Essential, +95747,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,HEALTHPLUS-Essential, +95748,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,HEALTHPLUS-Essential, +95749,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,HEALTHPLUS-Essential, +95750,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,HEALTHPLUS-Essential, +95751,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,HEALTHPLUS-Essential, +95752,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,HEALTHPLUS-Essential, +95753,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,HEALTHPLUS-Essential, +95754,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,HEALTHPLUS-Essential, +95755,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,HEALTHPLUS-Essential, +95756,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,HEALTHPLUS-Essential, +95757,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,HEALTHPLUS-Essential, +95758,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,HEALTHPLUS-Essential, +95759,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,HEALTHPLUS-Essential, +95760,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,HEALTHPLUS-Essential, +95761,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,HEALTHPLUS-Essential, +95762,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,HEALTHPLUS-Essential, +95763,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,HEALTHPLUS-Essential, +95764,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,HEALTHPLUS-Essential, +95765,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,HEALTHPLUS-Essential, +95766,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,HEALTHPLUS-Essential, +95767,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,HEALTHPLUS-Essential, +95768,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,HEALTHPLUS-Essential, +95769,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,HEALTHPLUS-Essential, +95770,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,HEALTHPLUS-Essential, +95771,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,HEALTHPLUS-Essential, +95772,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,HEALTHPLUS-Essential, +95773,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,HEALTHPLUS-Essential, +95774,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,HEALTHPLUS-Essential, +95775,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,HEALTHPLUS-Essential, +95776,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,HEALTHPLUS-Essential, +95777,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,HEALTHPLUS-Essential, +95778,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,HEALTHPLUS-Essential, +95779,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,HEALTHPLUS-Essential, +95780,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,HEALTHPLUS-Essential, +95781,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,HEALTHPLUS-Essential, +95782,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,HEALTHPLUS-Essential, +95783,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,HEALTHPLUS-Essential, +95784,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,HEALTHPLUS-Essential, +95785,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,HEALTHPLUS-Essential, +95786,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,HEALTHPLUS-Essential, +95787,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,HEALTHPLUS-Essential, +95788,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,HEALTHPLUS-Essential, +95789,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,HEALTHPLUS-Essential, +95790,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,HEALTHPLUS-Essential, +95791,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,HEALTHPLUS-Essential, +95792,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,HEALTHPLUS-Essential, +95793,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,HEALTHPLUS-Essential, +95794,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,HEALTHPLUS-Essential, +95795,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,HEALTHPLUS-Essential, +95796,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,HEALTHPLUS-Essential, +95797,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,HEALTHPLUS-Essential, +95798,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,HEALTHPLUS-Essential, +95799,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,HEALTHPLUS-Essential, +95800,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,HEALTHPLUS-Essential, +95801,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,HEALTHPLUS-Essential, +95802,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,HEALTHPLUS-Essential, +95803,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,HEALTHPLUS-Essential, +95804,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,HEALTHPLUS-Essential, +95805,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,HEALTHPLUS-Essential, +95806,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,HEALTHPLUS-Essential, +95807,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,HEALTHPLUS-Essential, +95808,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,HEALTHPLUS-Essential, +95809,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,HEALTHPLUS-Essential, +95810,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,HEALTHPLUS-Essential, +95811,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,HEALTHPLUS-Essential, +95812,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,HEALTHPLUS-Essential, +95813,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,HEALTHPLUS-Essential, +95814,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,HEALTHPLUS-Essential, +95815,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,HEALTHPLUS-Essential, +95816,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,HEALTHPLUS-Essential, +95817,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,HEALTHPLUS-Essential, +95818,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,HEALTHPLUS-Essential, +95819,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,HEALTHPLUS-Essential, +95820,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,HEALTHPLUS-Essential, +95821,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,HEALTHPLUS-Essential, +95822,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,HEALTHPLUS-Essential, +95823,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,HEALTHPLUS-Essential, +95824,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,HEALTHPLUS-Essential, +95825,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,HEALTHPLUS-Essential, +95826,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,HEALTHPLUS-Essential, +95827,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,HEALTHPLUS-Essential, +95828,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,HEALTHPLUS-Essential, +95829,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,HEALTHPLUS-Essential, +95830,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,HEALTHPLUS-Essential, +95831,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,HEALTHPLUS-Essential, +95832,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,HEALTHPLUS-Essential, +95833,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,HEALTHPLUS-Essential, +95834,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,HEALTHPLUS-Essential, +95835,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,HEALTHPLUS-Essential, +95836,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,HEALTHPLUS-Essential, +95837,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,HEALTHPLUS-Essential, +95838,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,HEALTHPLUS-Essential, +95839,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,HEALTHPLUS-Essential, +95840,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,HEALTHPLUS-Essential, +95841,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,HEALTHPLUS-Essential, +95842,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,HEALTHPLUS-Essential, +95843,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,HEALTHPLUS-Essential, +95844,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,HEALTHPLUS-Essential, +95845,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,HEALTHPLUS-Essential, +95846,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,HEALTHPLUS-Essential, +95847,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,HEALTHPLUS-Essential, +95848,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,HEALTHPLUS-Essential, +95849,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,HEALTHPLUS-Essential, +95850,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,HEALTHPLUS-Essential, +95851,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,HEALTHPLUS-Essential, +95852,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,HEALTHPLUS-Essential, +95853,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,HEALTHPLUS-Essential, +95854,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,HEALTHPLUS-Essential, +95855,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,HEALTHPLUS-Essential, +95856,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,HEALTHPLUS-Essential, +95857,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,HEALTHPLUS-Essential, +95858,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,HEALTHPLUS-Essential, +95859,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,HEALTHPLUS-Essential, +95860,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,HEALTHPLUS-Essential, +95861,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,HEALTHPLUS-Essential, +95862,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,HEALTHPLUS-Essential, +95863,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,HEALTHPLUS-Essential, +95864,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,HEALTHPLUS-Essential, +95865,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,HEALTHPLUS-Essential, +95866,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,HEALTHPLUS-Essential, +95867,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,HEALTHPLUS-Essential, +95868,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,HEALTHPLUS-Essential, +95869,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,HEALTHPLUS-Essential, +95870,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,HEALTHPLUS-Essential, +95871,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,HEALTHPLUS-Essential, +95872,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,HEALTHPLUS-Essential, +95873,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,HEALTHPLUS-Essential, +95874,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,HEALTHPLUS-Essential, +95875,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,HEALTHPLUS-Essential, +95876,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,HEALTHPLUS-Essential, +95877,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,HEALTHPLUS-Essential, +95878,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,HEALTHPLUS-Essential, +95879,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,HEALTHPLUS-Essential, +95880,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,HEALTHPLUS-Essential, +95881,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,HEALTHPLUS-Essential, +95882,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,HEALTHPLUS-Essential, +95883,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,HEALTHPLUS-Essential, +95884,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,HEALTHPLUS-Essential, +95885,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,HEALTHPLUS-Essential, +95886,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,HEALTHPLUS-Essential, +95887,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,HEALTHPLUS-Essential, +95888,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,HEALTHPLUS-Essential, +95889,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,HEALTHPLUS-Essential, +95890,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,HEALTHPLUS-Essential, +95891,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,HEALTHPLUS-Essential, +95892,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,HEALTHPLUS-Essential, +95893,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,HEALTHPLUS-Essential, +95894,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,HEALTHPLUS-Essential, +95895,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,HEALTHPLUS-Essential, +95896,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,HEALTHPLUS-Essential, +95897,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,HEALTHPLUS-Essential, +95898,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,HEALTHPLUS-Essential, +95899,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,HEALTHPLUS-Essential, +95900,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,HEALTHPLUS-Essential, +95901,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,HEALTHPLUS-Essential, +95902,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,HEALTHPLUS-Essential, +95903,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,HEALTHPLUS-Essential, +95904,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,HEALTHPLUS-Essential, +95905,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,HEALTHPLUS-Essential, +95906,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,HEALTHPLUS-Essential, +95907,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,HEALTHPLUS-Essential, +95908,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,HEALTHPLUS-Essential, +95909,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,HEALTHPLUS-Essential, +95910,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,HEALTHPLUS-Essential, +95911,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,HEALTHPLUS-Essential, +95912,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,HEALTHPLUS-Essential, +95913,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,HEALTHPLUS-Essential, +95914,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,HEALTHPLUS-Essential, +95915,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,HEALTHPLUS-Essential, +95916,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,HEALTHPLUS-Essential, +95917,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,HEALTHPLUS-Essential, +95918,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,HEALTHPLUS-Essential, +95919,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,HEALTHPLUS-Essential, +95920,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,HEALTHPLUS-Essential, +95921,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,HEALTHPLUS-Essential, +95922,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,HEALTHPLUS-Essential, +95923,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,HEALTHPLUS-Essential, +95924,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,HEALTHPLUS-Essential, +95925,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,HEALTHPLUS-Essential, +95926,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,HEALTHPLUS-Essential, +95927,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,HEALTHPLUS-Essential, +95928,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,HEALTHPLUS-Essential, +95929,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,HEALTHPLUS-Essential, +95930,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,HEALTHPLUS-Essential, +95931,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,HEALTHPLUS-Essential, +95932,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,HEALTHPLUS-Essential, +95933,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,HEALTHPLUS-Essential, +95934,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,HEALTHPLUS-Essential, +95935,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,HEALTHPLUS-Essential, +95936,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,HEALTHPLUS-Essential, +95937,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,HEALTHPLUS-Essential, +95938,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,HEALTHPLUS-Essential, +95939,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,HEALTHPLUS-Essential, +95940,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,HEALTHPLUS-Essential, +95941,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,HEALTHPLUS-Essential, +95942,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,HEALTHPLUS-Essential, +95943,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,HEALTHPLUS-Essential, +95944,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,HEALTHPLUS-Essential, +95945,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,HEALTHPLUS-Essential, +95946,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,HEALTHPLUS-Essential, +95947,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,HEALTHPLUS-Essential, +95948,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,HEALTHPLUS-Essential, +95949,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,HEALTHPLUS-Essential, +95950,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,HEALTHPLUS-Essential, +95951,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,HEALTHPLUS-Essential, +95952,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,HEALTHPLUS-Essential, +95953,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,HEALTHPLUS-Essential, +95954,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,HEALTHPLUS-Essential, +95955,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,HEALTHPLUS-Essential, +95956,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,HEALTHPLUS-Essential, +95957,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,HEALTHPLUS-Essential, +95958,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,HEALTHPLUS-Essential, +95959,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,HEALTHPLUS-Essential, +95960,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,HEALTHPLUS-Essential, +95961,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,HEALTHPLUS-Essential, +95962,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,HEALTHPLUS-Essential, +95963,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,HEALTHPLUS-Essential, +95964,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,HEALTHPLUS-Essential, +95965,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,HEALTHPLUS-Essential, +95966,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,HEALTHPLUS-Essential, +95967,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,HEALTHPLUS-Essential, +95968,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,HEALTHPLUS-Essential, +95969,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,HEALTHPLUS-Essential, +95970,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,HEALTHPLUS-Essential, +95971,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,HEALTHPLUS-Essential, +95972,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,HEALTHPLUS-Essential, +95973,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,HEALTHPLUS-Essential, +95974,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,HEALTHPLUS-Essential, +95975,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,HEALTHPLUS-Essential, +95976,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,HEALTHPLUS-Essential, +95977,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,HEALTHPLUS-Essential, +95978,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,HEALTHPLUS-Essential, +95979,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,HEALTHPLUS-Essential, +95980,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,HEALTHPLUS-Essential, +95981,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,HEALTHPLUS-Essential, +95982,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,HEALTHPLUS-Essential, +95983,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,HEALTHPLUS-Essential, +95984,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,HEALTHPLUS-Essential, +95985,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,HEALTHPLUS-Essential, +95986,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,HEALTHPLUS-Essential, +95987,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,HEALTHPLUS-Essential, +95988,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,HEALTHPLUS-Essential, +95989,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,HEALTHPLUS-Essential, +95990,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,HEALTHPLUS-Essential, +95991,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,HEALTHPLUS-Essential, +95992,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,HEALTHPLUS-Essential, +95993,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,HEALTHPLUS-Essential, +95994,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,HEALTHPLUS-Essential, +95995,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,HEALTHPLUS-Essential, +95996,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,HEALTHPLUS-Essential, +95997,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,HEALTHPLUS-Essential, +95998,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,HEALTHPLUS-Essential, +95999,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,HEALTHPLUS-Essential, +96000,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,HEALTHPLUS-Essential, +96001,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,HEALTHPLUS-Essential, +96002,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,HEALTHPLUS-Essential, +96003,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,HEALTHPLUS-Essential, +96004,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,HEALTHPLUS-Essential, +96005,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Essential, +96006,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,HEALTHPLUS-Essential, +96007,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,HEALTHPLUS-Essential, +96008,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,HEALTHPLUS-Essential, +96009,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,HEALTHPLUS-Essential, +96010,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,HEALTHPLUS-Essential, +96011,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,HEALTHPLUS-Essential, +96012,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,HEALTHPLUS-Essential, +96013,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,HEALTHPLUS-Essential, +96014,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,HEALTHPLUS-Essential, +96015,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,HEALTHPLUS-Essential, +96016,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Essential, +96017,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,HEALTHPLUS-Essential, +96018,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,HEALTHPLUS-Essential, +96019,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,HEALTHPLUS-Essential, +96020,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,HEALTHPLUS-Essential, +96021,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,HEALTHPLUS-Essential, +96022,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,HEALTHPLUS-Essential, +96023,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,HEALTHPLUS-Essential, +96024,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,HEALTHPLUS-Essential, +96025,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,HEALTHPLUS-Essential, +96026,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,HEALTHPLUS-Essential, +96027,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,HEALTHPLUS-Essential, +96028,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,HEALTHPLUS-Essential, +96029,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,HEALTHPLUS-Essential, +96030,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,HEALTHPLUS-Essential, +96031,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,HEALTHPLUS-Essential, +96032,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,HEALTHPLUS-Essential, +96033,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,HEALTHPLUS-Essential, +96034,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,HEALTHPLUS-Essential, +96035,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,HEALTHPLUS-Essential, +96036,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,HEALTHPLUS-Essential, +96037,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,HEALTHPLUS-Essential, +96038,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Essential, +96039,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,HEALTHPLUS-Essential, +96040,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,HEALTHPLUS-Essential, +96041,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,HEALTHPLUS-Essential, +96042,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,HEALTHPLUS-Essential, +96043,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,HEALTHPLUS-Essential, +96044,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,HEALTHPLUS-Essential, +96045,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,HEALTHPLUS-Essential, +96046,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,HEALTHPLUS-Essential, +96047,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,HEALTHPLUS-Essential, +96048,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,HEALTHPLUS-Essential, +96049,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,HEALTHPLUS-Essential, +96050,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,HEALTHPLUS-Essential, +96051,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,HEALTHPLUS-Essential, +96052,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,HEALTHPLUS-Essential, +96053,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,HEALTHPLUS-Essential, +96054,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,HEALTHPLUS-Essential, +96055,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,HEALTHPLUS-Essential, +96056,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,HEALTHPLUS-Essential, +96057,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,HEALTHPLUS-Essential, +96058,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,HEALTHPLUS-Essential, +96059,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,HEALTHPLUS-Essential, +96060,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,HEALTHPLUS-Essential, +96061,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,HEALTHPLUS-Essential, +96062,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,HEALTHPLUS-Essential, +96063,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,HEALTHPLUS-Essential, +96064,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,HEALTHPLUS-Essential, +96065,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,HEALTHPLUS-Essential, +96066,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,HEALTHPLUS-Essential, +96067,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,HEALTHPLUS-Essential, +96068,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,HEALTHPLUS-Essential, +96069,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,HEALTHPLUS-Essential, +96070,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,HEALTHPLUS-Essential, +96071,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,HEALTHPLUS-Essential, +96072,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,HEALTHPLUS-Essential, +96073,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,HEALTHPLUS-Essential, +96074,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,HEALTHPLUS-Essential, +96075,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,HEALTHPLUS-Essential, +96076,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,HEALTHPLUS-Essential, +96077,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,HEALTHPLUS-Essential, +96078,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,HEALTHPLUS-Essential, +96079,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,HEALTHPLUS-Essential, +96080,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,HEALTHPLUS-Essential, +96081,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,HEALTHPLUS-Essential, +96082,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,HEALTHPLUS-Essential, +96083,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,HEALTHPLUS-Essential, +96084,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,HEALTHPLUS-Essential, +96085,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,HEALTHPLUS-Essential, +96086,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,HEALTHPLUS-Essential, +96087,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,HEALTHPLUS-Essential, +96088,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,HEALTHPLUS-Essential, +96089,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,HEALTHPLUS-Essential, +96090,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,HEALTHPLUS-Essential, +96091,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,HEALTHPLUS-Essential, +96092,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,HEALTHPLUS-Essential, +96093,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,HEALTHPLUS-Essential, +96094,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,HEALTHPLUS-Essential, +96095,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,HEALTHPLUS-Essential, +96096,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,HEALTHPLUS-Essential, +96097,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,HEALTHPLUS-Essential, +96098,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,HEALTHPLUS-Essential, +96099,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,HEALTHPLUS-Essential, +96100,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,HEALTHPLUS-Essential, +96101,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,HEALTHPLUS-Essential, +96102,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,HEALTHPLUS-Essential, +96103,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,HEALTHPLUS-Essential, +96104,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,HEALTHPLUS-Essential, +96105,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,HEALTHPLUS-Essential, +96106,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,HEALTHPLUS-Essential, +96107,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,HEALTHPLUS-Essential, +96108,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,HEALTHPLUS-Essential, +96109,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,HEALTHPLUS-Essential, +96110,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,HEALTHPLUS-Essential, +96111,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,HEALTHPLUS-Essential, +96112,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,HEALTHPLUS-Essential, +96113,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,HEALTHPLUS-Essential, +96114,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,HEALTHPLUS-Essential, +96115,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,HEALTHPLUS-Essential, +96116,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,HEALTHPLUS-Essential, +96117,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,HEALTHPLUS-Essential, +96118,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,HEALTHPLUS-Essential, +96119,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,HEALTHPLUS-Essential, +96120,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,HEALTHPLUS-Essential, +96121,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,HEALTHPLUS-Essential, +96122,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,HEALTHPLUS-Essential, +96123,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,HEALTHPLUS-Essential, +96124,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,HEALTHPLUS-Essential, +96125,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,HEALTHPLUS-Essential, +96126,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,HEALTHPLUS-Essential, +96127,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,HEALTHPLUS-Essential, +96128,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,HEALTHPLUS-Essential, +96129,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,HEALTHPLUS-Essential, +96130,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,HEALTHPLUS-Essential, +96131,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,HEALTHPLUS-Essential, +96132,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,HEALTHPLUS-Essential, +96133,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,HEALTHPLUS-Essential, +96134,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,HEALTHPLUS-Essential, +96135,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,HEALTHPLUS-Essential, +96136,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,HEALTHPLUS-Essential, +96137,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,HEALTHPLUS-Essential, +96138,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,HEALTHPLUS-Essential, +96139,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,HEALTHPLUS-Essential, +96140,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-Essential, +96141,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-Essential, +96142,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +96143,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,HEALTHPLUS-Essential, +96144,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,HEALTHPLUS-Essential, +96145,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,HEALTHPLUS-Essential, +96146,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,HEALTHPLUS-Essential, +96147,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,HEALTHPLUS-Essential, +96148,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,HEALTHPLUS-Essential, +96149,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,HEALTHPLUS-Essential, +96150,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,HEALTHPLUS-Essential, +96151,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,HEALTHPLUS-Essential, +96152,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,HEALTHPLUS-Essential, +96153,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,HEALTHPLUS-Essential, +96154,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,HEALTHPLUS-Essential, +96155,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,HEALTHPLUS-Essential, +96156,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,HEALTHPLUS-Essential, +96157,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,HEALTHPLUS-Essential, +96158,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,HEALTHPLUS-Essential, +96159,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,HEALTHPLUS-Essential, +96160,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,HEALTHPLUS-Essential, +96161,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,HEALTHPLUS-Essential, +96162,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,HEALTHPLUS-Essential, +96163,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,HEALTHPLUS-Essential, +96164,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,HEALTHPLUS-Essential, +96165,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,HEALTHPLUS-Essential, +96166,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,HEALTHPLUS-Essential, +96167,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,HEALTHPLUS-Essential, +96168,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,HEALTHPLUS-Essential, +96169,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,HEALTHPLUS-Essential, +96170,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,HEALTHPLUS-Essential, +96171,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,HEALTHPLUS-Essential, +96172,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,HEALTHPLUS-Essential, +96173,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,HEALTHPLUS-Essential, +96174,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,HEALTHPLUS-Essential, +96175,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,HEALTHPLUS-Essential, +96176,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,HEALTHPLUS-Essential, +96177,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,HEALTHPLUS-Essential, +96178,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,HEALTHPLUS-Essential, +96179,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,HEALTHPLUS-Essential, +96180,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,HEALTHPLUS-Essential, +96181,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,HEALTHPLUS-Essential, +96182,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,HEALTHPLUS-Essential, +96183,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,HEALTHPLUS-Essential, +96184,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,HEALTHPLUS-Essential, +96185,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,HEALTHPLUS-Essential, +96186,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,HEALTHPLUS-Essential, +96187,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,HEALTHPLUS-Essential, +96188,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,HEALTHPLUS-Essential, +96189,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,HEALTHPLUS-Essential, +96190,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,HEALTHPLUS-Essential, +96191,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,HEALTHPLUS-Essential, +96192,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,HEALTHPLUS-Essential, +96193,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,HEALTHPLUS-Essential, +96194,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,HEALTHPLUS-Essential, +96195,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,HEALTHPLUS-Essential, +96196,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,HEALTHPLUS-Essential, +96197,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,HEALTHPLUS-Essential, +96198,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,HEALTHPLUS-Essential, +96199,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,HEALTHPLUS-Essential, +96200,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,HEALTHPLUS-Essential, +96201,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,HEALTHPLUS-Essential, +96202,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,HEALTHPLUS-Essential, +96203,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,HEALTHPLUS-Essential, +96204,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,HEALTHPLUS-Essential, +96205,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,HEALTHPLUS-Essential, +96206,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,HEALTHPLUS-Essential, +96207,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,HEALTHPLUS-Essential, +96208,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,HEALTHPLUS-Essential, +96209,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,HEALTHPLUS-Essential, +96210,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,HEALTHPLUS-Essential, +96211,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,HEALTHPLUS-Essential, +96212,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,HEALTHPLUS-Essential, +96213,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,HEALTHPLUS-Essential, +96214,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,HEALTHPLUS-Essential, +96215,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,HEALTHPLUS-Essential, +96216,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,HEALTHPLUS-Essential, +96217,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,HEALTHPLUS-Essential, +96218,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,HEALTHPLUS-Essential, +96219,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,HEALTHPLUS-Essential, +96220,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,HEALTHPLUS-Essential, +96221,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,HEALTHPLUS-Essential, +96222,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,HEALTHPLUS-Essential, +96223,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,HEALTHPLUS-Essential, +96224,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,HEALTHPLUS-Essential, +96225,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,HEALTHPLUS-Essential, +96226,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,HEALTHPLUS-Essential, +96227,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,HEALTHPLUS-Essential, +96228,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,HEALTHPLUS-Essential, +96229,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,HEALTHPLUS-Essential, +96230,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,HEALTHPLUS-Essential, +96231,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,HEALTHPLUS-Essential, +96232,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,HEALTHPLUS-Essential, +96233,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,HEALTHPLUS-Essential, +96234,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,HEALTHPLUS-Essential, +96235,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,HEALTHPLUS-Essential, +96236,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,HEALTHPLUS-Essential, +96237,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,HEALTHPLUS-Essential, +96238,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,HEALTHPLUS-Essential, +96239,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +96240,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,HEALTHPLUS-Essential,65.17 +96241,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,HEALTHPLUS-Essential, +96242,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,HEALTHPLUS-Essential, +96243,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,HEALTHPLUS-Essential, +96244,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,HEALTHPLUS-Essential, +96245,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,HEALTHPLUS-Essential, +96246,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,HEALTHPLUS-Essential, +96247,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,HEALTHPLUS-Essential, +96248,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,HEALTHPLUS-Essential, +96249,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,HEALTHPLUS-Essential, +96250,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,HEALTHPLUS-Essential, +96251,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,HEALTHPLUS-Essential, +96252,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,HEALTHPLUS-Essential, +96253,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,HEALTHPLUS-Essential, +96254,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,HEALTHPLUS-Essential, +96255,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,HEALTHPLUS-Essential, +96256,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,HEALTHPLUS-Essential, +96257,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,HEALTHPLUS-Essential, +96258,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,HEALTHPLUS-Essential, +96259,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,HEALTHPLUS-Essential,565.44 +96260,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,HEALTHPLUS-Essential, +96261,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,HEALTHPLUS-Essential, +96262,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,HEALTHPLUS-Essential, +96263,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,HEALTHPLUS-Essential, +96264,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,HEALTHPLUS-Essential, +96265,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,HEALTHPLUS-Essential, +96266,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,HEALTHPLUS-Essential, +96267,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,HEALTHPLUS-Essential, +96268,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,HEALTHPLUS-Essential, +96269,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,HEALTHPLUS-Essential, +96270,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,HEALTHPLUS-Essential, +96271,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,HEALTHPLUS-Essential, +96272,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,HEALTHPLUS-Essential, +96273,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,HEALTHPLUS-Essential, +96274,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,HEALTHPLUS-Essential, +96275,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,HEALTHPLUS-Essential, +96276,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,HEALTHPLUS-Essential, +96277,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,HEALTHPLUS-Essential, +96278,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,HEALTHPLUS-Essential, +96279,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,HEALTHPLUS-Essential, +96280,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,HEALTHPLUS-Essential, +96281,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,HEALTHPLUS-Essential, +96282,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,HEALTHPLUS-Essential, +96283,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,HEALTHPLUS-Essential, +96284,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,HEALTHPLUS-Essential, +96285,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,HEALTHPLUS-Essential, +96286,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,HEALTHPLUS-Essential, +96287,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,HEALTHPLUS-Essential, +96288,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,HEALTHPLUS-Essential, +96289,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,HEALTHPLUS-Essential, +96290,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,HEALTHPLUS-Essential, +96291,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,HEALTHPLUS-Essential, +96292,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,HEALTHPLUS-Essential, +96293,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,HEALTHPLUS-Essential, +96294,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,HEALTHPLUS-Essential, +96295,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,HEALTHPLUS-Essential, +96296,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,HEALTHPLUS-Essential, +96297,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,HEALTHPLUS-Essential, +96298,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,HEALTHPLUS-Essential, +96299,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,HEALTHPLUS-Essential, +96300,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,HEALTHPLUS-Essential, +96301,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,HEALTHPLUS-Essential, +96302,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,HEALTHPLUS-Essential, +96303,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,HEALTHPLUS-Essential, +96304,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,HEALTHPLUS-Essential, +96305,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,HEALTHPLUS-Essential, +96306,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,HEALTHPLUS-Essential, +96307,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,HEALTHPLUS-Essential, +96308,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,HEALTHPLUS-Essential, +96309,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,HEALTHPLUS-Essential, +96310,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,HEALTHPLUS-Essential, +96311,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,HEALTHPLUS-Essential, +96312,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,HEALTHPLUS-Essential, +96313,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,HEALTHPLUS-Essential, +96314,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,HEALTHPLUS-Essential, +96315,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,HEALTHPLUS-Essential, +96316,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,HEALTHPLUS-Essential, +96317,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,HEALTHPLUS-Essential, +96318,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,HEALTHPLUS-Essential, +96319,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,HEALTHPLUS-Essential, +96320,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,HEALTHPLUS-Essential, +96321,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,HEALTHPLUS-Essential, +96322,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,HEALTHPLUS-Essential, +96323,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,HEALTHPLUS-Essential, +96324,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,HEALTHPLUS-Essential, +96325,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,HEALTHPLUS-Essential, +96326,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,HEALTHPLUS-Essential, +96327,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,HEALTHPLUS-Essential, +96328,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,HEALTHPLUS-Essential, +96329,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,HEALTHPLUS-Essential, +96330,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,HEALTHPLUS-Essential, +96331,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,HEALTHPLUS-Essential, +96332,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,HEALTHPLUS-Essential, +96333,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,HEALTHPLUS-Essential, +96334,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,HEALTHPLUS-Essential, +96335,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,HEALTHPLUS-Essential, +96336,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,HEALTHPLUS-Essential, +96337,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,HEALTHPLUS-Essential, +96338,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,HEALTHPLUS-Essential, +96339,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,HEALTHPLUS-Essential, +96340,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,HEALTHPLUS-Essential, +96341,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,HEALTHPLUS-Essential, +96342,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,HEALTHPLUS-Essential, +96343,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,HEALTHPLUS-Essential, +96344,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,HEALTHPLUS-Essential, +96345,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,HEALTHPLUS-Essential, +96346,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,HEALTHPLUS-Essential, +96347,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,HEALTHPLUS-Essential, +96348,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,HEALTHPLUS-Essential, +96349,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,HEALTHPLUS-Essential, +96350,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,HEALTHPLUS-Essential, +96351,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-Essential, +96352,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-Essential, +96353,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,HEALTHPLUS-Essential, +96354,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,HEALTHPLUS-Essential, +96355,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,HEALTHPLUS-Essential, +96356,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,HEALTHPLUS-Essential, +96357,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,HEALTHPLUS-Essential, +96358,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,HEALTHPLUS-Essential, +96359,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,HEALTHPLUS-Essential, +96360,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,HEALTHPLUS-Essential, +96361,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,HEALTHPLUS-Essential, +96362,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,HEALTHPLUS-Essential, +96363,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,HEALTHPLUS-Essential, +96364,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,HEALTHPLUS-Essential, +96365,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,HEALTHPLUS-Essential, +96366,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,HEALTHPLUS-Essential, +96367,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,HEALTHPLUS-Essential, +96368,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,HEALTHPLUS-Essential, +96369,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,HEALTHPLUS-Essential, +96370,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,HEALTHPLUS-Essential, +96371,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,HEALTHPLUS-Essential, +96372,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,HEALTHPLUS-Essential, +96373,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,HEALTHPLUS-Essential, +96374,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,HEALTHPLUS-Essential, +96375,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,HEALTHPLUS-Essential, +96376,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,HEALTHPLUS-Essential, +96377,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,HEALTHPLUS-Essential, +96378,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,HEALTHPLUS-Essential, +96379,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,HEALTHPLUS-Essential, +96380,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,HEALTHPLUS-Essential, +96381,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,HEALTHPLUS-Essential, +96382,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,HEALTHPLUS-Essential, +96383,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,HEALTHPLUS-Essential, +96384,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,HEALTHPLUS-Essential, +96385,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,HEALTHPLUS-Essential, +96386,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,HEALTHPLUS-Essential, +96387,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,HEALTHPLUS-Essential, +96388,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,HEALTHPLUS-Essential, +96389,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,HEALTHPLUS-Essential, +96390,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,HEALTHPLUS-Essential, +96391,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,HEALTHPLUS-Essential, +96392,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,HEALTHPLUS-Essential, +96393,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,HEALTHPLUS-Essential, +96394,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,HEALTHPLUS-Essential, +96395,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,HEALTHPLUS-Essential, +96396,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,HEALTHPLUS-Essential, +96397,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,HEALTHPLUS-Essential, +96398,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,HEALTHPLUS-Essential, +96399,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,HEALTHPLUS-Essential, +96400,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,HEALTHPLUS-Essential, +96401,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,HEALTHPLUS-Essential, +96402,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,HEALTHPLUS-Essential, +96403,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,HEALTHPLUS-Essential, +96404,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,HEALTHPLUS-Essential, +96405,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,HEALTHPLUS-Essential, +96406,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,HEALTHPLUS-Essential, +96407,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,HEALTHPLUS-Essential, +96408,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,HEALTHPLUS-Essential, +96409,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,HEALTHPLUS-Essential, +96410,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,HEALTHPLUS-Essential, +96411,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,HEALTHPLUS-Essential, +96412,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,HEALTHPLUS-Essential, +96413,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,HEALTHPLUS-Essential, +96414,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,HEALTHPLUS-Essential, +96415,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,HEALTHPLUS-Essential, +96416,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,HEALTHPLUS-Essential, +96417,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,HEALTHPLUS-Essential, +96418,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,HEALTHPLUS-Essential, +96419,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,HEALTHPLUS-Essential, +96420,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,HEALTHPLUS-Essential, +96421,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,HEALTHPLUS-Essential, +96422,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,HEALTHPLUS-Essential, +96423,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,HEALTHPLUS-Essential, +96424,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,HEALTHPLUS-Essential, +96425,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,HEALTHPLUS-Essential, +96426,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,HEALTHPLUS-Essential, +96427,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,HEALTHPLUS-Essential, +96428,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,HEALTHPLUS-Essential, +96429,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,HEALTHPLUS-Essential, +96430,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,HEALTHPLUS-Essential, +96431,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,HEALTHPLUS-Essential, +96432,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,HEALTHPLUS-Essential, +96433,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,HEALTHPLUS-Essential, +96434,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,HEALTHPLUS-Essential, +96435,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,HEALTHPLUS-Essential, +96436,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,HEALTHPLUS-Essential, +96437,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,HEALTHPLUS-Essential, +96438,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,HEALTHPLUS-Essential, +96439,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,HEALTHPLUS-Essential, +96440,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,HEALTHPLUS-Essential, +96441,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,HEALTHPLUS-Essential, +96442,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,HEALTHPLUS-Essential, +96443,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,HEALTHPLUS-Essential, +96444,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,HEALTHPLUS-Essential, +96445,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,HEALTHPLUS-Essential, +96446,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,HEALTHPLUS-Essential, +96447,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,HEALTHPLUS-Essential, +96448,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,HEALTHPLUS-Essential, +96449,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,HEALTHPLUS-Essential, +96450,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,HEALTHPLUS-Essential, +96451,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,HEALTHPLUS-Essential, +96452,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,HEALTHPLUS-Essential, +96453,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,HEALTHPLUS-Essential, +96454,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,HEALTHPLUS-Essential, +96455,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,HEALTHPLUS-Essential, +96456,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,HEALTHPLUS-Essential, +96457,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,HEALTHPLUS-Essential, +96458,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,HEALTHPLUS-Essential, +96459,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,HEALTHPLUS-Essential, +96460,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,HEALTHPLUS-Essential, +96461,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,HEALTHPLUS-Essential,425.92 +96462,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,HEALTHPLUS-Essential, +96463,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,HEALTHPLUS-Essential, +96464,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,HEALTHPLUS-Essential, +96465,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,HEALTHPLUS-Essential, +96466,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,HEALTHPLUS-Essential, +96467,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,HEALTHPLUS-Essential, +96468,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,HEALTHPLUS-Essential, +96469,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,HEALTHPLUS-Essential, +96470,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,HEALTHPLUS-Essential, +96471,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,HEALTHPLUS-Essential, +96472,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,HEALTHPLUS-Essential, +96473,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,HEALTHPLUS-Essential, +96474,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,HEALTHPLUS-Essential, +96475,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,HEALTHPLUS-Essential, +96476,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,HEALTHPLUS-Essential, +96477,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,HEALTHPLUS-Essential, +96478,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,HEALTHPLUS-Essential, +96479,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,HEALTHPLUS-Essential, +96480,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,HEALTHPLUS-Essential, +96481,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,HEALTHPLUS-Essential, +96482,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,HEALTHPLUS-Essential, +96483,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,HEALTHPLUS-Essential, +96484,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,HEALTHPLUS-Essential, +96485,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,HEALTHPLUS-Essential, +96486,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,HEALTHPLUS-Essential, +96487,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,HEALTHPLUS-Essential, +96488,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,HEALTHPLUS-Essential, +96489,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,HEALTHPLUS-Essential, +96490,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,HEALTHPLUS-Essential, +96491,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,HEALTHPLUS-Essential, +96492,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,HEALTHPLUS-Essential, +96493,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,HEALTHPLUS-Essential, +96494,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,HEALTHPLUS-Essential, +96495,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,HEALTHPLUS-Essential, +96496,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,HEALTHPLUS-Essential, +96497,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,HEALTHPLUS-Essential, +96498,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,HEALTHPLUS-Essential, +96499,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,HEALTHPLUS-Essential, +96500,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,HEALTHPLUS-Essential, +96501,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,HEALTHPLUS-Essential, +96502,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,HEALTHPLUS-Essential, +96503,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,HEALTHPLUS-Essential, +96504,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,HEALTHPLUS-Essential, +96505,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,HEALTHPLUS-Essential, +96506,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,HEALTHPLUS-Essential, +96507,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,HEALTHPLUS-Essential, +96508,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,HEALTHPLUS-Essential, +96509,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,HEALTHPLUS-Essential, +96510,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,HEALTHPLUS-Essential, +96511,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,HEALTHPLUS-Essential, +96512,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,HEALTHPLUS-Essential, +96513,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,HEALTHPLUS-Essential, +96514,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,HEALTHPLUS-Essential, +96515,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,HEALTHPLUS-Essential, +96516,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,HEALTHPLUS-Essential, +96517,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,HEALTHPLUS-Essential, +96518,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,HEALTHPLUS-Essential, +96519,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,HEALTHPLUS-Essential, +96520,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,HEALTHPLUS-Essential, +96521,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,HEALTHPLUS-Essential, +96522,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,HEALTHPLUS-Essential, +96523,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,HEALTHPLUS-Essential, +96524,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,HEALTHPLUS-Essential, +96525,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,HEALTHPLUS-Essential, +96526,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,HEALTHPLUS-Essential, +96527,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,HEALTHPLUS-Essential, +96528,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,HEALTHPLUS-Essential, +96529,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,HEALTHPLUS-Essential, +96530,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,HEALTHPLUS-Essential, +96531,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,HEALTHPLUS-Essential, +96532,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,HEALTHPLUS-Essential, +96533,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,HEALTHPLUS-Essential, +96534,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,HEALTHPLUS-Essential, +96535,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,HEALTHPLUS-Essential, +96536,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,HEALTHPLUS-Essential, +96537,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,HEALTHPLUS-Essential, +96538,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,HEALTHPLUS-Essential, +96539,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,HEALTHPLUS-Essential, +96540,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,HEALTHPLUS-Essential, +96541,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,HEALTHPLUS-Essential, +96542,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,HEALTHPLUS-Essential, +96543,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,HEALTHPLUS-Essential, +96544,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,HEALTHPLUS-Essential, +96545,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,HEALTHPLUS-Essential, +96546,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,HEALTHPLUS-Essential, +96547,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,HEALTHPLUS-Essential, +96548,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,HEALTHPLUS-Essential, +96549,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,HEALTHPLUS-Essential, +96550,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,HEALTHPLUS-Essential, +96551,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,HEALTHPLUS-Essential, +96552,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,HEALTHPLUS-Essential, +96553,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,HEALTHPLUS-Essential, +96554,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,HEALTHPLUS-Essential, +96555,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,HEALTHPLUS-Essential, +96556,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,HEALTHPLUS-Essential, +96557,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,HEALTHPLUS-Essential, +96558,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,HEALTHPLUS-Essential, +96559,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,HEALTHPLUS-Essential, +96560,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,HEALTHPLUS-Essential, +96561,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,HEALTHPLUS-Essential, +96562,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,HEALTHPLUS-Essential, +96563,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,HEALTHPLUS-Essential, +96564,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,HEALTHPLUS-Essential, +96565,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,HEALTHPLUS-Essential, +96566,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,HEALTHPLUS-Essential, +96567,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,HEALTHPLUS-Essential, +96568,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,HEALTHPLUS-Essential, +96569,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,HEALTHPLUS-Essential, +96570,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,HEALTHPLUS-Essential, +96571,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,HEALTHPLUS-Essential, +96572,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,HEALTHPLUS-Essential, +96573,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,HEALTHPLUS-Essential, +96574,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,HEALTHPLUS-Essential, +96575,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,HEALTHPLUS-Essential, +96576,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,HEALTHPLUS-Essential, +96577,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,HEALTHPLUS-Essential, +96578,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,HEALTHPLUS-Essential, +96579,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,HEALTHPLUS-Essential, +96580,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,HEALTHPLUS-Essential, +96581,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,HEALTHPLUS-Essential, +96582,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,HEALTHPLUS-Essential, +96583,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,HEALTHPLUS-Essential, +96584,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,HEALTHPLUS-Essential, +96585,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,HEALTHPLUS-Essential, +96586,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,HEALTHPLUS-Essential, +96587,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,HEALTHPLUS-Essential, +96588,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,HEALTHPLUS-Essential, +96589,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,HEALTHPLUS-Essential, +96590,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,HEALTHPLUS-Essential, +96591,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,HEALTHPLUS-Essential, +96592,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,HEALTHPLUS-Essential, +96593,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,HEALTHPLUS-Essential, +96594,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,HEALTHPLUS-Essential, +96595,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,HEALTHPLUS-Essential, +96596,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,HEALTHPLUS-Essential, +96597,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,HEALTHPLUS-Essential, +96598,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,HEALTHPLUS-Essential, +96599,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,HEALTHPLUS-Essential, +96600,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,HEALTHPLUS-Essential, +96601,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,HEALTHPLUS-Essential, +96602,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,HEALTHPLUS-Essential, +96603,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,HEALTHPLUS-Essential, +96604,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,HEALTHPLUS-Essential, +96605,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,HEALTHPLUS-Essential, +96606,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,HEALTHPLUS-Essential, +96607,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,HEALTHPLUS-Essential, +96608,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,HEALTHPLUS-Essential, +96609,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,HEALTHPLUS-Essential, +96610,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,HEALTHPLUS-Essential, +96611,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,HEALTHPLUS-Essential, +96612,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,HEALTHPLUS-Essential, +96613,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,HEALTHPLUS-Essential, +96614,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,HEALTHPLUS-Essential, +96615,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,HEALTHPLUS-Essential, +96616,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,HEALTHPLUS-Essential, +96617,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,HEALTHPLUS-Essential, +96618,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,HEALTHPLUS-Essential, +96619,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,HEALTHPLUS-Essential, +96620,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,HEALTHPLUS-Essential, +96621,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,HEALTHPLUS-Essential, +96622,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,HEALTHPLUS-Essential, +96623,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,HEALTHPLUS-Essential, +96624,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,HEALTHPLUS-Essential, +96625,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,HEALTHPLUS-Essential, +96626,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,HEALTHPLUS-Essential, +96627,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,HEALTHPLUS-Essential, +96628,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,HEALTHPLUS-Essential, +96629,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,HEALTHPLUS-Essential, +96630,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,HEALTHPLUS-Essential, +96631,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,HEALTHPLUS-Essential, +96632,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,HEALTHPLUS-Essential, +96633,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,HEALTHPLUS-Essential, +96634,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,HEALTHPLUS-Essential, +96635,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,HEALTHPLUS-Essential, +96636,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,HEALTHPLUS-Essential, +96637,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,HEALTHPLUS-Essential, +96638,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,HEALTHPLUS-Essential, +96639,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,HEALTHPLUS-Essential, +96640,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,HEALTHPLUS-Essential, +96641,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,HEALTHPLUS-Essential, +96642,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,HEALTHPLUS-Essential, +96643,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,HEALTHPLUS-Essential, +96644,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,HEALTHPLUS-Essential, +96645,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,HEALTHPLUS-Essential, +96646,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,HEALTHPLUS-Essential, +96647,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,HEALTHPLUS-Essential, +96648,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,HEALTHPLUS-Essential, +96649,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,HEALTHPLUS-Essential, +96650,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,HEALTHPLUS-Essential, +96651,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,HEALTHPLUS-Essential, +96652,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,HEALTHPLUS-Essential, +96653,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,HEALTHPLUS-Essential, +96654,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,HEALTHPLUS-Essential, +96655,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,HEALTHPLUS-Essential, +96656,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,HEALTHPLUS-Essential, +96657,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,HEALTHPLUS-Essential, +96658,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,HEALTHPLUS-Essential, +96659,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,HEALTHPLUS-Essential, +96660,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,HEALTHPLUS-Essential, +96661,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,HEALTHPLUS-Essential, +96662,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,HEALTHPLUS-Essential, +96663,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,HEALTHPLUS-Essential, +96664,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,HEALTHPLUS-Essential, +96665,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,HEALTHPLUS-Essential, +96666,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,HEALTHPLUS-Essential, +96667,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,HEALTHPLUS-Essential, +96668,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,HEALTHPLUS-Essential, +96669,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,HEALTHPLUS-Essential, +96670,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,HEALTHPLUS-Essential, +96671,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,HEALTHPLUS-Essential, +96672,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,HEALTHPLUS-Essential, +96673,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,HEALTHPLUS-Essential, +96674,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,HEALTHPLUS-Essential, +96675,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,HEALTHPLUS-Essential, +96676,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,HEALTHPLUS-Essential, +96677,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,HEALTHPLUS-Essential, +96678,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,HEALTHPLUS-Essential, +96679,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,HEALTHPLUS-Essential, +96680,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,HEALTHPLUS-Essential, +96681,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,HEALTHPLUS-Essential, +96682,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,HEALTHPLUS-Essential, +96683,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,HEALTHPLUS-Essential, +96684,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,HEALTHPLUS-Essential, +96685,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,HEALTHPLUS-Essential, +96686,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,HEALTHPLUS-Essential, +96687,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,HEALTHPLUS-Essential, +96688,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,HEALTHPLUS-Essential, +96689,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,HEALTHPLUS-Essential, +96690,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,HEALTHPLUS-Essential, +96691,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,HEALTHPLUS-Essential, +96692,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,HEALTHPLUS-Essential, +96693,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,HEALTHPLUS-Essential, +96694,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,HEALTHPLUS-Essential, +96695,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,HEALTHPLUS-Essential, +96696,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,HEALTHPLUS-Essential, +96697,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,HEALTHPLUS-Essential, +96698,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,HEALTHPLUS-Essential, +96699,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,HEALTHPLUS-Essential, +96700,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,HEALTHPLUS-Essential, +96701,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,HEALTHPLUS-Essential, +96702,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,HEALTHPLUS-Essential, +96703,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,HEALTHPLUS-Essential, +96704,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,HEALTHPLUS-Essential, +96705,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,HEALTHPLUS-Essential, +96706,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,HEALTHPLUS-Essential, +96707,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,HEALTHPLUS-Essential, +96708,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,HEALTHPLUS-Essential, +96709,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,HEALTHPLUS-Essential, +96710,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,HEALTHPLUS-Essential, +96711,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,HEALTHPLUS-Essential, +96712,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,HEALTHPLUS-Essential, +96713,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,HEALTHPLUS-Essential, +96714,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,HEALTHPLUS-Essential, +96715,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,HEALTHPLUS-Essential, +96716,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,HEALTHPLUS-Essential, +96717,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,HEALTHPLUS-Essential, +96718,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,HEALTHPLUS-Essential, +96719,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,HEALTHPLUS-Essential, +96720,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,HEALTHPLUS-Essential, +96721,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,HEALTHPLUS-Essential, +96722,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,HEALTHPLUS-Essential, +96723,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,HEALTHPLUS-Essential, +96724,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,HEALTHPLUS-Essential, +96725,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,HEALTHPLUS-Essential, +96726,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,HEALTHPLUS-Essential, +96727,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,HEALTHPLUS-Essential, +96728,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,HEALTHPLUS-Essential, +96729,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,HEALTHPLUS-Essential, +96730,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,HEALTHPLUS-Essential, +96731,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,HEALTHPLUS-Essential, +96732,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,HEALTHPLUS-Essential, +96733,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,HEALTHPLUS-Essential, +96734,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,HEALTHPLUS-Essential, +96735,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,HEALTHPLUS-Essential, +96736,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,HEALTHPLUS-Essential, +96737,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,HEALTHPLUS-Essential, +96738,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,HEALTHPLUS-Essential, +96739,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,HEALTHPLUS-Essential, +96740,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,HEALTHPLUS-Essential, +96741,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,HEALTHPLUS-Essential, +96742,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,HEALTHPLUS-Essential, +96743,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,HEALTHPLUS-Essential, +96744,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,HEALTHPLUS-Essential, +96745,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,HEALTHPLUS-Essential, +96746,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,HEALTHPLUS-Essential, +96747,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,HEALTHPLUS-Essential, +96748,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,HEALTHPLUS-Essential, +96749,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,HEALTHPLUS-Essential, +96750,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,HEALTHPLUS-Essential, +96751,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,HEALTHPLUS-Essential, +96752,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,HEALTHPLUS-Essential, +96753,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,HEALTHPLUS-Essential, +96754,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,HEALTHPLUS-Essential, +96755,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,HEALTHPLUS-Essential, +96756,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,HEALTHPLUS-Essential, +96757,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,HEALTHPLUS-Essential, +96758,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,HEALTHPLUS-Essential, +96759,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,HEALTHPLUS-Essential, +96760,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,HEALTHPLUS-Essential, +96761,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,HEALTHPLUS-Essential, +96762,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,HEALTHPLUS-Essential, +96763,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,HEALTHPLUS-Essential, +96764,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,HEALTHPLUS-Essential, +96765,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,HEALTHPLUS-Essential, +96766,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,HEALTHPLUS-Essential, +96767,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,HEALTHPLUS-Essential, +96768,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,HEALTHPLUS-Essential, +96769,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,HEALTHPLUS-Essential, +96770,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,HEALTHPLUS-Essential, +96771,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,HEALTHPLUS-Essential, +96772,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,HEALTHPLUS-Essential, +96773,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,HEALTHPLUS-Essential, +96774,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,HEALTHPLUS-Essential, +96775,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,HEALTHPLUS-Essential, +96776,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,HEALTHPLUS-Essential, +96777,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,HEALTHPLUS-Essential, +96778,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,HEALTHPLUS-Essential, +96779,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,HEALTHPLUS-Essential, +96780,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,HEALTHPLUS-Essential, +96781,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,HEALTHPLUS-Essential, +96782,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,HEALTHPLUS-Essential, +96783,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,HEALTHPLUS-Essential, +96784,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,HEALTHPLUS-Essential, +96785,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,HEALTHPLUS-Essential, +96786,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,HEALTHPLUS-Essential, +96787,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,HEALTHPLUS-Essential, +96788,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,HEALTHPLUS-Essential, +96789,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,HEALTHPLUS-Essential, +96790,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,HEALTHPLUS-Essential, +96791,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,HEALTHPLUS-Essential, +96792,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,HEALTHPLUS-Essential, +96793,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,HEALTHPLUS-Essential, +96794,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,HEALTHPLUS-Essential, +96795,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,HEALTHPLUS-Essential, +96796,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,HEALTHPLUS-Essential, +96797,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,HEALTHPLUS-Essential, +96798,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,HEALTHPLUS-Essential, +96799,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,HEALTHPLUS-Essential, +96800,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,HEALTHPLUS-Essential, +96801,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,HEALTHPLUS-Essential, +96802,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,HEALTHPLUS-Essential, +96803,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,HEALTHPLUS-Essential, +96804,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,HEALTHPLUS-Essential, +96805,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,HEALTHPLUS-Essential, +96806,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,HEALTHPLUS-Essential, +96807,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,HEALTHPLUS-Essential, +96808,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,HEALTHPLUS-Essential, +96809,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,HEALTHPLUS-Essential, +96810,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,HEALTHPLUS-Essential, +96811,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,HEALTHPLUS-Essential, +96812,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,HEALTHPLUS-Essential, +96813,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,HEALTHPLUS-Essential, +96814,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,HEALTHPLUS-Essential, +96815,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,HEALTHPLUS-Essential, +96816,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,HEALTHPLUS-Essential, +96817,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,HEALTHPLUS-Essential, +96818,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,HEALTHPLUS-Essential, +96819,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,HEALTHPLUS-Essential, +96820,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,HEALTHPLUS-Essential, +96821,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,HEALTHPLUS-Essential, +96822,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,HEALTHPLUS-Essential, +96823,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,HEALTHPLUS-Essential, +96824,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,HEALTHPLUS-Essential, +96825,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,HEALTHPLUS-Essential, +96826,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,HEALTHPLUS-Essential, +96827,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,HEALTHPLUS-Essential, +96828,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,HEALTHPLUS-Essential, +96829,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,HEALTHPLUS-Essential, +96830,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,HEALTHPLUS-Essential, +96831,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,HEALTHPLUS-Essential, +96832,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,HEALTHPLUS-Essential, +96833,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,HEALTHPLUS-Essential, +96834,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,HEALTHPLUS-Essential, +96835,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,HEALTHPLUS-Essential, +96836,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,HEALTHPLUS-Essential, +96837,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,HEALTHPLUS-Essential, +96838,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,HEALTHPLUS-Essential, +96839,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,HEALTHPLUS-Essential, +96840,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,HEALTHPLUS-Essential, +96841,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,HEALTHPLUS-Essential, +96842,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,HEALTHPLUS-Essential, +96843,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,HEALTHPLUS-Essential, +96844,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,HEALTHPLUS-Essential, +96845,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,HEALTHPLUS-Essential, +96846,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,HEALTHPLUS-Essential, +96847,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,HEALTHPLUS-Essential, +96848,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,HEALTHPLUS-Essential, +96849,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,HEALTHPLUS-Essential, +96850,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,HEALTHPLUS-Essential, +96851,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,HEALTHPLUS-Essential, +96852,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,HEALTHPLUS-Essential, +96853,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,HEALTHPLUS-Essential, +96854,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,HEALTHPLUS-Essential, +96855,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,HEALTHPLUS-Essential, +96856,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,HEALTHPLUS-Essential, +96857,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,HEALTHPLUS-Essential, +96858,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,HEALTHPLUS-Essential, +96859,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,HEALTHPLUS-Essential, +96860,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,HEALTHPLUS-Essential, +96861,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,HEALTHPLUS-Essential, +96862,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,HEALTHPLUS-Essential, +96863,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,HEALTHPLUS-Essential, +96864,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,HEALTHPLUS-Essential, +96865,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,HEALTHPLUS-Essential, +96866,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,HEALTHPLUS-Essential, +96867,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,HEALTHPLUS-Essential, +96868,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,HEALTHPLUS-Essential, +96869,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,HEALTHPLUS-Essential, +96870,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,HEALTHPLUS-Essential, +96871,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,HEALTHPLUS-Essential, +96872,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,HEALTHPLUS-Essential, +96873,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,HEALTHPLUS-Essential, +96874,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,HEALTHPLUS-Essential, +96875,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,HEALTHPLUS-Essential, +96876,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,HEALTHPLUS-Essential, +96877,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,HEALTHPLUS-Essential, +96878,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,HEALTHPLUS-Essential, +96879,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,HEALTHPLUS-Essential, +96880,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,HEALTHPLUS-Essential, +96881,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,HEALTHPLUS-Essential, +96882,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,HEALTHPLUS-Essential, +96883,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,HEALTHPLUS-Essential, +96884,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,HEALTHPLUS-Essential, +96885,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,HEALTHPLUS-Essential, +96886,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,HEALTHPLUS-Essential, +96887,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,HEALTHPLUS-Essential, +96888,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,HEALTHPLUS-Essential, +96889,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,HEALTHPLUS-Essential, +96890,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,HEALTHPLUS-Essential, +96891,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,HEALTHPLUS-Essential, +96892,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,HEALTHPLUS-Essential, +96893,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,HEALTHPLUS-Essential, +96894,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,HEALTHPLUS-Essential, +96895,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,HEALTHPLUS-Essential, +96896,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,HEALTHPLUS-Essential, +96897,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,HEALTHPLUS-Essential, +96898,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,HEALTHPLUS-Essential, +96899,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,HEALTHPLUS-Essential, +96900,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,HEALTHPLUS-Essential, +96901,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,HEALTHPLUS-Essential, +96902,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,HEALTHPLUS-Essential, +96903,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,HEALTHPLUS-Essential, +96904,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,HEALTHPLUS-Essential, +96905,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,HEALTHPLUS-Essential, +96906,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,HEALTHPLUS-Essential, +96907,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,HEALTHPLUS-Essential, +96908,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,HEALTHPLUS-Essential, +96909,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,HEALTHPLUS-Essential, +96910,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,HEALTHPLUS-Essential, +96911,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,HEALTHPLUS-Essential, +96912,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,HEALTHPLUS-Essential, +96913,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,HEALTHPLUS-Essential, +96914,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,HEALTHPLUS-Essential, +96915,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,HEALTHPLUS-Essential, +96916,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,HEALTHPLUS-Essential, +96917,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,HEALTHPLUS-Essential, +96918,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,HEALTHPLUS-Essential, +96919,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,HEALTHPLUS-Essential, +96920,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,HEALTHPLUS-Essential, +96921,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,HEALTHPLUS-Essential, +96922,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,HEALTHPLUS-Essential, +96923,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,HEALTHPLUS-Essential, +96924,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,HEALTHPLUS-Essential, +96925,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,HEALTHPLUS-Essential, +96926,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,HEALTHPLUS-Essential, +96927,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,HEALTHPLUS-Essential, +96928,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,HEALTHPLUS-Essential, +96929,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,HEALTHPLUS-Essential, +96930,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,HEALTHPLUS-Essential, +96931,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,HEALTHPLUS-Essential, +96932,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,HEALTHPLUS-Essential, +96933,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,HEALTHPLUS-Essential, +96934,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,HEALTHPLUS-Essential, +96935,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,HEALTHPLUS-Essential, +96936,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,HEALTHPLUS-Essential, +96937,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,HEALTHPLUS-Essential, +96938,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,HEALTHPLUS-Essential, +96939,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,HEALTHPLUS-Essential, +96940,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,HEALTHPLUS-Essential, +96941,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,HEALTHPLUS-Essential, +96942,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,HEALTHPLUS-Essential, +96943,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,HEALTHPLUS-Essential, +96944,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,HEALTHPLUS-Essential, +96945,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,HEALTHPLUS-Essential, +96946,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,HEALTHPLUS-Essential, +96947,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,HEALTHPLUS-Essential, +96948,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,HEALTHPLUS-Essential, +96949,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,HEALTHPLUS-Essential, +96950,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,HEALTHPLUS-Essential, +96951,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,HEALTHPLUS-Essential, +96952,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,HEALTHPLUS-Essential, +96953,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,HEALTHPLUS-Essential, +96954,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,HEALTHPLUS-Essential, +96955,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,HEALTHPLUS-Essential, +96956,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,HEALTHPLUS-Essential, +96957,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,HEALTHPLUS-Essential, +96958,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,HEALTHPLUS-Essential, +96959,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,HEALTHPLUS-Essential, +96960,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,HEALTHPLUS-Essential, +96961,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,HEALTHPLUS-Essential, +96962,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,HEALTHPLUS-Essential, +96963,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,HEALTHPLUS-Essential, +96964,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,HEALTHPLUS-Essential, +96965,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,HEALTHPLUS-Essential, +96966,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,HEALTHPLUS-Essential, +96967,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,HEALTHPLUS-Essential, +96968,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,HEALTHPLUS-Essential, +96969,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,HEALTHPLUS-Essential, +96970,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,HEALTHPLUS-Essential, +96971,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,HEALTHPLUS-Essential, +96972,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,HEALTHPLUS-Essential, +96973,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,HEALTHPLUS-Essential, +96974,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,HEALTHPLUS-Essential, +96975,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,HEALTHPLUS-Essential, +96976,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,HEALTHPLUS-Essential, +96977,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,HEALTHPLUS-Essential, +96978,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,HEALTHPLUS-Essential, +96979,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,HEALTHPLUS-Essential, +96980,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,HEALTHPLUS-Essential, +96981,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,HEALTHPLUS-Essential, +96982,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,HEALTHPLUS-Essential, +96983,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,HEALTHPLUS-Essential, +96984,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,HEALTHPLUS-Essential, +96985,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,HEALTHPLUS-Essential, +96986,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,HEALTHPLUS-Essential, +96987,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,HEALTHPLUS-Essential, +96988,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,HEALTHPLUS-Essential, +96989,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,HEALTHPLUS-Essential, +96990,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,HEALTHPLUS-Essential, +96991,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,HEALTHPLUS-Essential, +96992,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,HEALTHPLUS-Essential, +96993,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,HEALTHPLUS-Essential, +96994,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,HEALTHPLUS-Essential, +96995,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,HEALTHPLUS-Essential, +96996,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,HEALTHPLUS-Essential, +96997,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,HEALTHPLUS-Essential, +96998,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,HEALTHPLUS-Essential, +96999,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,HEALTHPLUS-Essential, +97000,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,HEALTHPLUS-Essential, +97001,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,HEALTHPLUS-Essential, +97002,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,HEALTHPLUS-Essential, +97003,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,HEALTHPLUS-Essential, +97004,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,HEALTHPLUS-Essential, +97005,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,HEALTHPLUS-Essential, +97006,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,HEALTHPLUS-Essential, +97007,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,HEALTHPLUS-Essential, +97008,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,HEALTHPLUS-Essential, +97009,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,HEALTHPLUS-Essential, +97010,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,HEALTHPLUS-Essential, +97011,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,HEALTHPLUS-Essential, +97012,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,HEALTHPLUS-Essential, +97013,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,HEALTHPLUS-Essential, +97014,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,HEALTHPLUS-Essential, +97015,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,HEALTHPLUS-Essential, +97016,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,HEALTHPLUS-Essential, +97017,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,HEALTHPLUS-Essential, +97018,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,HEALTHPLUS-Essential, +97019,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,HEALTHPLUS-Essential, +97020,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,HEALTHPLUS-Essential, +97021,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,HEALTHPLUS-Essential, +97022,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,HEALTHPLUS-Essential, +97023,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,HEALTHPLUS-Essential, +97024,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,HEALTHPLUS-Essential, +97025,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,HEALTHPLUS-Essential, +97026,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,HEALTHPLUS-Essential, +97027,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,HEALTHPLUS-Essential, +97028,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,HEALTHPLUS-Essential, +97029,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,HEALTHPLUS-Essential, +97030,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,HEALTHPLUS-Essential, +97031,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,HEALTHPLUS-Essential, +97032,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,HEALTHPLUS-Essential, +97033,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,HEALTHPLUS-Essential, +97034,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,HEALTHPLUS-Essential, +97035,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,HEALTHPLUS-Essential, +97036,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,HEALTHPLUS-Essential, +97037,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,HEALTHPLUS-Essential, +97038,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,HEALTHPLUS-Essential, +97039,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,HEALTHPLUS-Essential, +97040,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,HEALTHPLUS-Essential, +97041,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,HEALTHPLUS-Essential, +97042,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,HEALTHPLUS-Essential, +97043,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,HEALTHPLUS-Essential, +97044,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,HEALTHPLUS-Essential, +97045,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,HEALTHPLUS-Essential, +97046,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,HEALTHPLUS-Essential, +97047,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,HEALTHPLUS-Essential, +97048,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,HEALTHPLUS-Essential, +97049,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,HEALTHPLUS-Essential, +97050,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,HEALTHPLUS-Essential, +97051,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,HEALTHPLUS-Essential, +97052,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,HEALTHPLUS-Essential, +97053,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,HEALTHPLUS-Essential, +97054,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,HEALTHPLUS-Essential, +97055,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,HEALTHPLUS-Essential, +97056,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,HEALTHPLUS-Essential, +97057,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,HEALTHPLUS-Essential, +97058,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,HEALTHPLUS-Essential, +97059,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,HEALTHPLUS-Essential, +97060,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,HEALTHPLUS-Essential, +97061,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,HEALTHPLUS-Essential, +97062,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,HEALTHPLUS-Essential, +97063,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,HEALTHPLUS-Essential, +97064,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,HEALTHPLUS-Essential, +97065,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,HEALTHPLUS-Essential, +97066,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,HEALTHPLUS-Essential, +97067,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,HEALTHPLUS-Essential, +97068,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,HEALTHPLUS-Essential, +97069,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,HEALTHPLUS-Essential, +97070,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,HEALTHPLUS-Essential, +97071,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,HEALTHPLUS-Essential, +97072,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,HEALTHPLUS-Essential, +97073,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,HEALTHPLUS-Essential, +97074,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,HEALTHPLUS-Essential, +97075,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,HEALTHPLUS-Essential, +97076,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,HEALTHPLUS-Essential, +97077,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,HEALTHPLUS-Essential, +97078,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,HEALTHPLUS-Essential, +97079,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,HEALTHPLUS-Essential, +97080,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,HEALTHPLUS-Essential, +97081,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,HEALTHPLUS-Essential, +97082,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,HEALTHPLUS-Essential, +97083,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,HEALTHPLUS-Essential, +97084,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,HEALTHPLUS-Essential, +97085,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,HEALTHPLUS-Essential, +97086,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,HEALTHPLUS-Essential, +97087,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,HEALTHPLUS-Essential, +97088,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,HEALTHPLUS-Essential, +97089,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,HEALTHPLUS-Essential, +97090,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,HEALTHPLUS-Essential, +97091,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,HEALTHPLUS-Essential, +97092,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,HEALTHPLUS-Essential, +97093,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,HEALTHPLUS-Essential, +97094,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,HEALTHPLUS-Essential, +97095,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,HEALTHPLUS-Essential, +97096,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,HEALTHPLUS-Essential, +97097,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,HEALTHPLUS-Essential, +97098,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,HEALTHPLUS-Essential, +97099,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,HEALTHPLUS-Essential, +97100,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,HEALTHPLUS-Essential, +97101,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,HEALTHPLUS-Essential, +97102,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,HEALTHPLUS-Essential, +97103,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,HEALTHPLUS-Essential, +97104,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,HEALTHPLUS-Essential, +97105,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,HEALTHPLUS-Essential, +97106,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,HEALTHPLUS-Essential, +97107,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,HEALTHPLUS-Essential, +97108,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,HEALTHPLUS-Essential, +97109,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,HEALTHPLUS-Essential, +97110,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,HEALTHPLUS-Essential, +97111,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,HEALTHPLUS-Essential, +97112,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,HEALTHPLUS-Essential, +97113,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,HEALTHPLUS-Essential, +97114,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,HEALTHPLUS-Essential, +97115,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,HEALTHPLUS-Essential, +97116,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,HEALTHPLUS-Essential, +97117,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,HEALTHPLUS-Essential, +97118,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,HEALTHPLUS-Essential, +97119,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,HEALTHPLUS-Essential, +97120,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,HEALTHPLUS-Essential, +97121,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,HEALTHPLUS-Essential, +97122,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,HEALTHPLUS-Essential, +97123,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,HEALTHPLUS-Essential, +97124,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,HEALTHPLUS-Essential, +97125,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,HEALTHPLUS-Essential, +97126,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,HEALTHPLUS-Essential, +97127,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,HEALTHPLUS-Essential, +97128,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,HEALTHPLUS-Essential, +97129,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,HEALTHPLUS-Essential, +97130,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,HEALTHPLUS-Essential, +97131,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,HEALTHPLUS-Essential, +97132,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,HEALTHPLUS-Essential, +97133,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,HEALTHPLUS-Essential, +97134,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,HEALTHPLUS-Essential, +97135,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,HEALTHPLUS-Essential, +97136,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,HEALTHPLUS-Essential, +97137,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,HEALTHPLUS-Essential, +97138,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,HEALTHPLUS-Essential, +97139,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,HEALTHPLUS-Essential, +97140,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,HEALTHPLUS-Essential, +97141,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,HEALTHPLUS-Essential, +97142,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,HEALTHPLUS-Essential, +97143,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,HEALTHPLUS-Essential, +97144,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,HEALTHPLUS-Essential, +97145,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,HEALTHPLUS-Essential, +97146,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,HEALTHPLUS-Essential, +97147,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,HEALTHPLUS-Essential, +97148,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,HEALTHPLUS-Essential, +97149,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,HEALTHPLUS-Essential, +97150,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,HEALTHPLUS-Essential, +97151,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,HEALTHPLUS-Essential, +97152,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,HEALTHPLUS-Essential, +97153,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,HEALTHPLUS-Essential, +97154,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,HEALTHPLUS-Essential, +97155,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,HEALTHPLUS-Essential, +97156,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,HEALTHPLUS-Essential, +97157,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,HEALTHPLUS-Essential, +97158,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,HEALTHPLUS-Essential, +97159,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,HEALTHPLUS-Essential, +97160,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,HEALTHPLUS-Essential, +97161,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,HEALTHPLUS-Essential, +97162,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,HEALTHPLUS-Essential, +97163,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,HEALTHPLUS-Essential, +97164,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,HEALTHPLUS-Essential, +97165,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,HEALTHPLUS-Essential, +97166,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,HEALTHPLUS-Essential, +97167,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,HEALTHPLUS-Essential, +97168,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,HEALTHPLUS-Essential, +97169,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,HEALTHPLUS-Essential, +97170,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,HEALTHPLUS-Essential, +97171,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,HEALTHPLUS-Essential, +97172,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,HEALTHPLUS-Essential, +97173,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,HEALTHPLUS-Essential, +97174,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,HEALTHPLUS-Essential, +97175,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,HEALTHPLUS-Essential, +97176,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,HEALTHPLUS-Essential, +97177,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,HEALTHPLUS-Essential, +97178,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,HEALTHPLUS-Essential, +97179,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,HEALTHPLUS-Essential, +97180,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,HEALTHPLUS-Essential, +97181,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,HEALTHPLUS-Essential, +97182,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,HEALTHPLUS-Essential, +97183,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,HEALTHPLUS-Essential, +97184,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,HEALTHPLUS-Essential, +97185,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,HEALTHPLUS-Essential, +97186,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,HEALTHPLUS-Essential, +97187,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,HEALTHPLUS-Essential, +97188,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,HEALTHPLUS-Essential, +97189,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,HEALTHPLUS-Essential, +97190,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,HEALTHPLUS-Essential, +97191,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,HEALTHPLUS-Essential, +97192,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,HEALTHPLUS-Essential, +97193,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,HEALTHPLUS-Essential, +97194,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,HEALTHPLUS-Essential, +97195,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,HEALTHPLUS-Essential, +97196,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,HEALTHPLUS-Essential, +97197,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,HEALTHPLUS-Essential, +97198,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,HEALTHPLUS-Essential, +97199,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,HEALTHPLUS-Essential, +97200,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,HEALTHPLUS-Essential, +97201,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,HEALTHPLUS-Essential, +97202,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,HEALTHPLUS-Essential, +97203,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,HEALTHPLUS-Essential, +97204,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,HEALTHPLUS-Essential, +97205,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,HEALTHPLUS-Essential, +97206,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,HEALTHPLUS-Essential, +97207,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,HEALTHPLUS-Essential, +97208,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,HEALTHPLUS-Essential, +97209,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,HEALTHPLUS-Essential, +97210,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,HEALTHPLUS-Essential, +97211,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,HEALTHPLUS-Essential, +97212,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,HEALTHPLUS-Essential, +97213,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,HEALTHPLUS-Essential, +97214,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,HEALTHPLUS-Essential, +97215,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,HEALTHPLUS-Essential, +97216,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,HEALTHPLUS-Essential, +97217,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,HEALTHPLUS-Essential, +97218,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,HEALTHPLUS-Essential, +97219,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,HEALTHPLUS-Essential, +97220,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,HEALTHPLUS-Essential, +97221,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,HEALTHPLUS-Essential, +97222,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,HEALTHPLUS-Essential, +97223,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,HEALTHPLUS-Essential, +97224,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,HEALTHPLUS-Essential, +97225,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,HEALTHPLUS-Essential, +97226,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,HEALTHPLUS-Essential, +97227,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,HEALTHPLUS-Essential, +97228,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,HEALTHPLUS-Essential, +97229,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,HEALTHPLUS-Essential, +97230,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,HEALTHPLUS-Essential, +97231,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,HEALTHPLUS-Essential, +97232,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,HEALTHPLUS-Essential, +97233,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,HEALTHPLUS-Essential, +97234,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,HEALTHPLUS-Essential, +97235,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,HEALTHPLUS-Essential, +97236,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,HEALTHPLUS-Essential, +97237,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,HEALTHPLUS-Essential, +97238,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,HEALTHPLUS-Essential, +97239,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,HEALTHPLUS-Essential, +97240,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,HEALTHPLUS-Essential, +97241,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,HEALTHPLUS-Essential, +97242,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,HEALTHPLUS-Essential, +97243,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,HEALTHPLUS-Essential, +97244,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,HEALTHPLUS-Essential, +97245,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,HEALTHPLUS-Essential, +97246,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,HEALTHPLUS-Essential, +97247,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,HEALTHPLUS-Essential, +97248,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,HEALTHPLUS-Essential, +97249,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,HEALTHPLUS-Essential, +97250,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,HEALTHPLUS-Essential, +97251,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,HEALTHPLUS-Essential, +97252,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,HEALTHPLUS-Essential, +97253,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,HEALTHPLUS-Essential, +97254,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,HEALTHPLUS-Essential, +97255,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,HEALTHPLUS-Essential, +97256,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,HEALTHPLUS-Essential, +97257,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,HEALTHPLUS-Essential, +97258,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,HEALTHPLUS-Essential, +97259,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,HEALTHPLUS-Essential, +97260,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,HEALTHPLUS-Essential, +97261,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,HEALTHPLUS-Essential, +97262,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,HEALTHPLUS-Essential, +97263,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,HEALTHPLUS-Essential, +97264,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,HEALTHPLUS-Essential, +97265,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,HEALTHPLUS-Essential, +97266,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,HEALTHPLUS-Essential, +97267,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,HEALTHPLUS-Essential, +97268,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,HEALTHPLUS-Essential, +97269,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,HEALTHPLUS-Essential, +97270,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,HEALTHPLUS-Essential, +97271,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,HEALTHPLUS-Essential, +97272,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,HEALTHPLUS-Essential, +97273,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,HEALTHPLUS-Essential, +97274,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,HEALTHPLUS-Essential, +97275,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,HEALTHPLUS-Essential, +97276,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,HEALTHPLUS-Essential, +97277,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,HEALTHPLUS-Essential, +97278,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,HEALTHPLUS-Essential, +97279,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,HEALTHPLUS-Essential, +97280,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,HEALTHPLUS-Essential, +97281,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,HEALTHPLUS-Essential, +97282,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,HEALTHPLUS-Essential, +97283,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,HEALTHPLUS-Essential, +97284,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,HEALTHPLUS-Essential, +97285,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,HEALTHPLUS-Essential, +97286,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,HEALTHPLUS-Essential, +97287,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,HEALTHPLUS-Essential, +97288,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,HEALTHPLUS-Essential, +97289,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,HEALTHPLUS-Essential, +97290,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,HEALTHPLUS-Essential, +97291,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,HEALTHPLUS-Essential, +97292,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,HEALTHPLUS-Essential, +97293,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,HEALTHPLUS-Essential, +97294,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,HEALTHPLUS-Essential, +97295,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,HEALTHPLUS-Essential, +97296,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,HEALTHPLUS-Essential, +97297,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,HEALTHPLUS-Essential, +97298,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,HEALTHPLUS-Essential, +97299,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,HEALTHPLUS-Essential, +97300,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,HEALTHPLUS-Essential, +97301,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,HEALTHPLUS-Essential, +97302,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,HEALTHPLUS-Essential, +97303,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,HEALTHPLUS-Essential, +97304,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,HEALTHPLUS-Essential, +97305,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,HEALTHPLUS-Essential, +97306,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,HEALTHPLUS-Essential, +97307,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,HEALTHPLUS-Essential, +97308,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,HEALTHPLUS-Essential, +97309,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,HEALTHPLUS-Essential, +97310,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,HEALTHPLUS-Essential, +97311,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,HEALTHPLUS-Essential, +97312,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,HEALTHPLUS-Essential, +97313,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,HEALTHPLUS-Essential, +97314,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,HEALTHPLUS-Essential, +97315,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,HEALTHPLUS-Essential, +97316,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,HEALTHPLUS-Essential, +97317,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,HEALTHPLUS-Essential, +97318,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,HEALTHPLUS-Essential, +97319,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,HEALTHPLUS-Essential, +97320,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,HEALTHPLUS-Essential, +97321,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,HEALTHPLUS-Essential, +97322,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,HEALTHPLUS-Essential, +97323,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,HEALTHPLUS-Essential, +97324,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,HEALTHPLUS-Essential, +97325,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,HEALTHPLUS-Essential, +97326,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,HEALTHPLUS-Essential, +97327,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,HEALTHPLUS-Essential, +97328,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,HEALTHPLUS-Essential, +97329,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,HEALTHPLUS-Essential, +97330,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,HEALTHPLUS-Essential, +97331,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,HEALTHPLUS-Essential, +97332,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,HEALTHPLUS-Essential, +97333,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,HEALTHPLUS-Essential, +97334,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,HEALTHPLUS-Essential, +97335,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,HEALTHPLUS-Essential, +97336,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,HEALTHPLUS-Essential, +97337,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,HEALTHPLUS-Essential, +97338,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,HEALTHPLUS-Essential, +97339,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,HEALTHPLUS-Essential, +97340,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,HEALTHPLUS-Essential, +97341,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,HEALTHPLUS-Essential, +97342,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,HEALTHPLUS-Essential, +97343,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,HEALTHPLUS-Essential, +97344,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,HEALTHPLUS-Essential, +97345,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,HEALTHPLUS-Essential, +97346,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97347,3934,30000012,PRIVATE,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97348,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97349,3934,30000038,ICU,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97350,3934,30000046,BURN UNIT,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97351,3934,30000053,NICU,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97352,3934,30000061,ICR ROOM,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97353,3934,30000079,PSYCH,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97354,3934,30000087,NEWBORN,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97355,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97356,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97357,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97358,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97359,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97360,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97361,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97362,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97363,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97364,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97365,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97366,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97367,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97368,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97369,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97370,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97371,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97372,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97373,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97374,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97375,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97376,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97377,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97378,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97379,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97380,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97381,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97382,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97383,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97384,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97385,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97386,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97387,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97388,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97389,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97390,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97391,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97392,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97393,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97394,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97395,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97396,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97397,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97398,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97399,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97400,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97401,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97402,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97403,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97404,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97405,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97406,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97407,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97408,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97409,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97410,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97411,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97412,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97413,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97414,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97415,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97416,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97417,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97418,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97419,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97420,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97421,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97422,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97423,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97424,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97425,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97426,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97427,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97428,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97429,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97430,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97431,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97432,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97433,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97434,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97435,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97436,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, 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15S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97450,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97451,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97452,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97453,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97454,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97455,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97456,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97457,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97458,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97459,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97460,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97461,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97462,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97463,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97464,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97465,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97466,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97467,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97468,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97469,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97470,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97471,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97472,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97473,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97474,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97475,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97476,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97477,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97478,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97479,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97480,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97481,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97482,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97483,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97484,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97485,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97486,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97487,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97488,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97489,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97490,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97491,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97492,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97493,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97494,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97495,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97496,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97497,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97498,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97499,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97500,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97501,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97502,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97503,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97504,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97505,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97506,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97507,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97508,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, 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PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97533,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97534,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97535,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97536,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97537,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97538,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97539,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97540,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97541,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97542,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97543,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97544,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97545,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97546,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97547,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97548,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97549,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97550,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97551,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97552,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97553,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97554,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97555,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97556,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97557,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97558,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97559,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97560,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97561,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97562,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97563,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97564,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97565,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97566,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97567,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97568,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97569,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97570,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97571,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97572,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97573,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97574,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97575,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97576,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97577,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97578,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97579,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97580,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97581,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97582,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97583,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97584,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97585,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97586,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97587,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97588,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97589,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97590,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97591,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97592,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97593,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97594,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97595,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97596,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97597,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97598,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97599,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97600,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97601,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97602,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97603,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97604,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97605,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97606,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97607,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97608,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97609,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97610,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97611,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97612,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97613,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97614,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97615,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97616,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97617,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97618,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97619,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97620,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97621,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97622,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97623,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97624,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97625,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97626,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97627,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97628,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97629,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97630,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97631,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97632,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97633,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97634,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97635,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97636,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97637,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97638,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97639,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97640,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97641,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97642,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97643,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97644,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97645,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97646,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97647,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97648,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97649,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97650,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97651,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97652,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97653,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97654,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97655,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97656,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97657,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97658,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97659,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97660,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97661,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97662,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97663,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97664,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97665,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97666,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97667,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97668,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97669,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97670,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97671,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97672,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97673,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97674,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97675,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97676,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97677,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97678,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97679,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97680,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97681,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97682,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97683,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97684,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97685,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97686,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97687,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97688,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97689,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97690,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97691,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97692,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97693,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97694,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97695,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97696,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97697,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97698,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97699,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97700,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97701,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97702,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97703,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97704,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97705,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97706,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97707,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97708,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97709,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97710,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97711,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97712,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97713,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97714,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97715,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97716,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97717,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97718,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97719,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97720,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97721,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97722,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97723,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97724,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97725,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97726,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97727,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97728,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97729,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97730,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97731,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97732,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97733,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97734,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97735,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97736,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97737,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97738,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97739,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97740,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97741,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97742,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97743,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97744,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97745,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97746,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97747,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97748,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97749,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97750,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97751,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97752,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97753,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97754,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97755,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97756,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97757,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97758,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97759,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97760,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97761,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97762,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97763,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97764,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,HEALTHPLUS-Essential, +97765,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97766,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97767,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97768,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97769,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97770,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97771,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Essential, +97772,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97773,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97774,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97775,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97776,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97777,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97778,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97779,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97780,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97781,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97782,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97783,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97784,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97785,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97786,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97787,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97788,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97789,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,HEALTHPLUS-Essential, +97790,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,HEALTHPLUS-Essential, +97791,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,HEALTHPLUS-Essential, +97792,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,HEALTHPLUS-Essential, +97793,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,HEALTHPLUS-Essential, +97794,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,HEALTHPLUS-Essential, +97795,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,HEALTHPLUS-Essential, +97796,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,HEALTHPLUS-Essential, +97797,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,HEALTHPLUS-Essential, +97798,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,HEALTHPLUS-Essential, +97799,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,HEALTHPLUS-Essential, +97800,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,HEALTHPLUS-Essential, +97801,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,HEALTHPLUS-Essential, +97802,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,HEALTHPLUS-Essential, +97803,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,HEALTHPLUS-Essential, +97804,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,HEALTHPLUS-Essential, +97805,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,HEALTHPLUS-Essential, +97806,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,HEALTHPLUS-Essential, +97807,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,HEALTHPLUS-Essential, +97808,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,HEALTHPLUS-Essential, +97809,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,HEALTHPLUS-Essential, +97810,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,HEALTHPLUS-Essential, +97811,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,HEALTHPLUS-Essential, +97812,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,HEALTHPLUS-Essential, +97813,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,HEALTHPLUS-Essential, +97814,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,HEALTHPLUS-Essential, +97815,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,HEALTHPLUS-Essential, +97816,3934,37112000,ACUTE ED,,1580.0,1580.0,,,HEALTHPLUS-Essential, +97817,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,HEALTHPLUS-Essential, +97818,3934,37112034,TRIAGE,,277.0,277.0,,,HEALTHPLUS-Essential, +97819,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,HEALTHPLUS-Essential, +97820,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,HEALTHPLUS-Essential, +97821,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,HEALTHPLUS-Essential, +97822,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,HEALTHPLUS-Essential, +97823,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,HEALTHPLUS-Essential, +97824,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,HEALTHPLUS-Essential, +97825,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,HEALTHPLUS-Essential, +97826,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,HEALTHPLUS-Essential, +97827,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,HEALTHPLUS-Essential, +97828,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,HEALTHPLUS-Essential, +97829,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,HEALTHPLUS-Essential, +97830,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,HEALTHPLUS-Essential, +97831,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,HEALTHPLUS-Essential, +97832,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,HEALTHPLUS-Essential, +97833,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,HEALTHPLUS-Essential, +97834,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,HEALTHPLUS-Essential, +97835,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,HEALTHPLUS-Essential, +97836,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,HEALTHPLUS-Essential, +97837,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,HEALTHPLUS-Essential, +97838,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,HEALTHPLUS-Essential, +97839,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,HEALTHPLUS-Essential, +97840,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,HEALTHPLUS-Essential, +97841,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,HEALTHPLUS-Essential, +97842,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,HEALTHPLUS-Essential, +97843,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,HEALTHPLUS-Essential, +97844,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,HEALTHPLUS-Essential, +97845,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,HEALTHPLUS-Essential, +97846,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,HEALTHPLUS-Essential, +97847,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,HEALTHPLUS-Essential, +97848,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,HEALTHPLUS-Essential, +97849,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,HEALTHPLUS-Essential, +97850,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,HEALTHPLUS-Essential, +97851,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,HEALTHPLUS-Essential, +97852,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,HEALTHPLUS-Essential, +97853,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,HEALTHPLUS-Essential, +97854,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,HEALTHPLUS-Essential, +97855,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,HEALTHPLUS-Essential, +97856,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,HEALTHPLUS-Essential, +97857,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,HEALTHPLUS-Essential, +97858,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,HEALTHPLUS-Essential, +97859,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,HEALTHPLUS-Essential, +97860,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,HEALTHPLUS-Essential, +97861,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,HEALTHPLUS-Essential, +97862,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,HEALTHPLUS-Essential, +97863,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,HEALTHPLUS-Essential, +97864,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,HEALTHPLUS-Essential, +97865,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,HEALTHPLUS-Essential, +97866,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,HEALTHPLUS-Essential, +97867,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,HEALTHPLUS-Essential, +97868,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,HEALTHPLUS-Essential, +97869,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,HEALTHPLUS-Essential, +97870,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,HEALTHPLUS-Essential, +97871,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,HEALTHPLUS-Essential, +97872,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,HEALTHPLUS-Essential, +97873,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,HEALTHPLUS-Essential, +97874,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,HEALTHPLUS-Essential, +97875,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,HEALTHPLUS-Essential, +97876,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-Essential, +97877,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-Essential, +97878,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-Essential, +97879,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-Essential, +97880,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-Essential, +97881,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-Essential, +97882,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-Essential, +97883,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-Essential, +97884,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-Essential, +97885,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-Essential, +97886,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-Essential, +97887,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-Essential, +97888,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-Essential, +97889,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-Essential, +97890,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-Essential, +97891,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-Essential, +97892,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-Essential, +97893,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-Essential, +97894,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-Essential, +97895,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-Essential, +97896,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-Essential, +97897,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-Essential, +97898,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-Essential, +97899,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-Essential, +97900,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-Essential, +97901,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-Essential, +97902,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-Essential, +97903,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-Essential, +97904,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-Essential, +97905,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-Essential, +97906,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-Essential, +97907,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-Essential, +97908,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-Essential, +97909,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-Essential, +97910,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-Essential, +97911,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-Essential, +97912,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-Essential, +97913,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-Essential, +97914,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-Essential, +97915,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-Essential, +97916,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-Essential, +97917,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-Essential, +97918,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Essential, +97919,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +97920,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +97921,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +97922,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +97923,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +97924,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,HEALTHPLUS-Essential, +97925,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,HEALTHPLUS-Essential, +97926,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,HEALTHPLUS-Essential, +97927,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +97928,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +97929,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +97930,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,HEALTHPLUS-Essential, +97931,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,HEALTHPLUS-Essential, +97932,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,HEALTHPLUS-Essential, +97933,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,HEALTHPLUS-Essential, +97934,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,HEALTHPLUS-Essential, +97935,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,HEALTHPLUS-Essential, +97936,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,HEALTHPLUS-Essential, +97937,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,HEALTHPLUS-Essential, +97938,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,HEALTHPLUS-Essential, +97939,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,HEALTHPLUS-Essential, +97940,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,HEALTHPLUS-Essential, +97941,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,HEALTHPLUS-Essential, +97942,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,HEALTHPLUS-Essential, +97943,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,HEALTHPLUS-Essential, +97944,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,HEALTHPLUS-Essential, +97945,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,HEALTHPLUS-Essential, +97946,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,HEALTHPLUS-Essential, +97947,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,HEALTHPLUS-Essential, +97948,3934,43301043,ALBUNEX,,357.0,357.0,,,HEALTHPLUS-Essential, +97949,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,HEALTHPLUS-Essential, +97950,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +97951,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +97952,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +97953,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +97954,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +97955,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,HEALTHPLUS-Essential, +97956,3934,43450022,REC RM .5HR,,541.0,541.0,,,HEALTHPLUS-Essential, +97957,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,HEALTHPLUS-Essential, +97958,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,HEALTHPLUS-Essential, +97959,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,HEALTHPLUS-Essential, +97960,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,HEALTHPLUS-Essential, +97961,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,HEALTHPLUS-Essential, +97962,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,HEALTHPLUS-Essential, +97963,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,HEALTHPLUS-Essential, +97964,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,HEALTHPLUS-Essential, +97965,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,HEALTHPLUS-Essential, +97966,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,HEALTHPLUS-Essential, +97967,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,HEALTHPLUS-Essential, +97968,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,HEALTHPLUS-Essential, +97969,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,HEALTHPLUS-Essential, +97970,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,HEALTHPLUS-Essential, +97971,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,HEALTHPLUS-Essential, +97972,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,HEALTHPLUS-Essential, +97973,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Essential, +97974,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +97975,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +97976,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +97977,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +97978,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +97979,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,HEALTHPLUS-Essential, +97980,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +97981,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Essential, +97982,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +97983,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +97984,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +97985,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +97986,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,HEALTHPLUS-Essential, +97987,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Essential, +97988,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +97989,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +97990,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +97991,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +97992,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +97993,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Essential, +97994,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +97995,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +97996,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +97997,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +97998,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +97999,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,HEALTHPLUS-Essential, +98000,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,HEALTHPLUS-Essential, +98001,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,HEALTHPLUS-Essential, +98002,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,HEALTHPLUS-Essential, +98003,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,HEALTHPLUS-Essential, +98004,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,HEALTHPLUS-Essential, +98005,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,HEALTHPLUS-Essential, +98006,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,HEALTHPLUS-Essential, +98007,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Essential, +98008,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +98009,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +98010,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +98011,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +98012,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +98013,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,HEALTHPLUS-Essential, +98014,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,HEALTHPLUS-Essential, +98015,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,HEALTHPLUS-Essential, +98016,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,HEALTHPLUS-Essential, +98017,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,HEALTHPLUS-Essential, +98018,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,HEALTHPLUS-Essential, +98019,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-Essential, +98020,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-Essential, +98021,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-Essential, +98022,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,HEALTHPLUS-Essential, +98023,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,HEALTHPLUS-Essential, +98024,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,HEALTHPLUS-Essential, +98025,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,HEALTHPLUS-Essential, +98026,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,HEALTHPLUS-Essential, +98027,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,HEALTHPLUS-Essential, +98028,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,HEALTHPLUS-Essential, +98029,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,HEALTHPLUS-Essential, +98030,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,HEALTHPLUS-Essential, +98031,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,HEALTHPLUS-Essential, +98032,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,HEALTHPLUS-Essential, +98033,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,HEALTHPLUS-Essential, +98034,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,HEALTHPLUS-Essential, +98035,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,HEALTHPLUS-Essential, +98036,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,HEALTHPLUS-Essential, +98037,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,HEALTHPLUS-Essential, +98038,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,HEALTHPLUS-Essential, +98039,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,HEALTHPLUS-Essential, +98040,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,HEALTHPLUS-Essential, +98041,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,HEALTHPLUS-Essential, +98042,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,HEALTHPLUS-Essential, +98043,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-Essential, +98044,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,HEALTHPLUS-Essential, +98045,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-Essential, +98046,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,HEALTHPLUS-Essential, +98047,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,HEALTHPLUS-Essential, +98048,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,HEALTHPLUS-Essential, +98049,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,HEALTHPLUS-Essential, +98050,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,HEALTHPLUS-Essential, +98051,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,HEALTHPLUS-Essential, +98052,3934,45924552,ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-Essential, +98053,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,HEALTHPLUS-Essential, +98054,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,HEALTHPLUS-Essential, +98055,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,HEALTHPLUS-Essential, +98056,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,HEALTHPLUS-Essential, +98057,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,HEALTHPLUS-Essential, +98058,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,HEALTHPLUS-Essential, +98059,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,HEALTHPLUS-Essential, +98060,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,HEALTHPLUS-Essential, +98061,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,HEALTHPLUS-Essential, +98062,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,HEALTHPLUS-Essential, +98063,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,HEALTHPLUS-Essential, +98064,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,HEALTHPLUS-Essential, +98065,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,HEALTHPLUS-Essential, +98066,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,HEALTHPLUS-Essential, +98067,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,HEALTHPLUS-Essential, +98068,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,HEALTHPLUS-Essential, +98069,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,HEALTHPLUS-Essential, +98070,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,HEALTHPLUS-Essential, +98071,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,HEALTHPLUS-Essential, +98072,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,HEALTHPLUS-Essential, +98073,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,HEALTHPLUS-Essential, +98074,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,HEALTHPLUS-Essential, +98075,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,HEALTHPLUS-Essential, +98076,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,HEALTHPLUS-Essential, +98077,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,HEALTHPLUS-Essential, +98078,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,HEALTHPLUS-Essential, +98079,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Essential, +98080,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Essential, +98081,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Essential, +98082,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Essential, +98083,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Essential, +98084,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Essential, +98085,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,HEALTHPLUS-Essential, +98086,3934,53200010,GUEST TRAY,,24.0,24.0,,,HEALTHPLUS-Essential, +98087,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,HEALTHPLUS-Essential, +98088,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,HEALTHPLUS-Essential, +98089,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,HEALTHPLUS-Essential, +98090,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,HEALTHPLUS-Essential, +98091,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,HEALTHPLUS-Essential, +98092,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,HEALTHPLUS-Essential, +98093,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,HEALTHPLUS-Essential, +98094,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,HEALTHPLUS-Essential, +98095,3934,53329876,HIV MONITORING,,416.0,416.0,,,HEALTHPLUS-Essential, +98096,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,HEALTHPLUS-Essential, +98097,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,HEALTHPLUS-Essential, +98098,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,HEALTHPLUS-Essential, +98099,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,HEALTHPLUS-Essential, +98100,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,HEALTHPLUS-Essential, +98101,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,HEALTHPLUS-Essential, +98102,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,HEALTHPLUS-Essential, +98103,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,HEALTHPLUS-Essential, +98104,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,HEALTHPLUS-Essential, +98105,3934,76010107,COPY X-RAY,,22.0,22.0,,,HEALTHPLUS-Essential, +98106,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,HEALTHPLUS-Essential, +98107,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,HEALTHPLUS-Essential, +98108,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,HEALTHPLUS-Essential, +98109,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,HEALTHPLUS-Essential, +98110,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,HEALTHPLUS-Essential, +98111,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,HEALTHPLUS-Essential, +98112,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,HEALTHPLUS-Essential, +98113,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,HEALTHPLUS-Essential, +98114,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,HEALTHPLUS-Essential, +98115,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,HEALTHPLUS-Essential, +98116,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,HEALTHPLUS-Essential, +98117,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,HEALTHPLUS-Essential, +98118,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,HEALTHPLUS-Medicaid, +98119,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,HEALTHPLUS-Medicaid, +98120,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,HEALTHPLUS-Medicaid, +98121,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,HEALTHPLUS-Medicaid, +98122,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,HEALTHPLUS-Medicaid, +98123,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,HEALTHPLUS-Medicaid, +98124,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,HEALTHPLUS-Medicaid, +98125,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,HEALTHPLUS-Medicaid, +98126,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,HEALTHPLUS-Medicaid, +98127,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,HEALTHPLUS-Medicaid, +98128,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,HEALTHPLUS-Medicaid, +98129,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,HEALTHPLUS-Medicaid, +98130,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,HEALTHPLUS-Medicaid, +98131,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,HEALTHPLUS-Medicaid, +98132,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,HEALTHPLUS-Medicaid, +98133,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,HEALTHPLUS-Medicaid, +98134,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,HEALTHPLUS-Medicaid, +98135,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,HEALTHPLUS-Medicaid, +98136,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,HEALTHPLUS-Medicaid, +98137,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,HEALTHPLUS-Medicaid, +98138,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,HEALTHPLUS-Medicaid, +98139,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,HEALTHPLUS-Medicaid, +98140,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,HEALTHPLUS-Medicaid, +98141,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,HEALTHPLUS-Medicaid, +98142,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,HEALTHPLUS-Medicaid, +98143,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,HEALTHPLUS-Medicaid, +98144,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,HEALTHPLUS-Medicaid, +98145,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,HEALTHPLUS-Medicaid, +98146,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,HEALTHPLUS-Medicaid, +98147,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,HEALTHPLUS-Medicaid, +98148,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,HEALTHPLUS-Medicaid, +98149,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,HEALTHPLUS-Medicaid, +98150,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,HEALTHPLUS-Medicaid, +98151,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,HEALTHPLUS-Medicaid, +98152,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,HEALTHPLUS-Medicaid, +98153,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,HEALTHPLUS-Medicaid, +98154,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,HEALTHPLUS-Medicaid, +98155,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,HEALTHPLUS-Medicaid, +98156,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,HEALTHPLUS-Medicaid, +98157,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,HEALTHPLUS-Medicaid, +98158,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,HEALTHPLUS-Medicaid, +98159,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,HEALTHPLUS-Medicaid, +98160,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,HEALTHPLUS-Medicaid, +98161,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,HEALTHPLUS-Medicaid, +98162,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,HEALTHPLUS-Medicaid, +98163,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,HEALTHPLUS-Medicaid, +98164,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,HEALTHPLUS-Medicaid, +98165,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,HEALTHPLUS-Medicaid, +98166,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,HEALTHPLUS-Medicaid, +98167,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,HEALTHPLUS-Medicaid, +98168,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,HEALTHPLUS-Medicaid, +98169,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,HEALTHPLUS-Medicaid, +98170,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,HEALTHPLUS-Medicaid, +98171,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,HEALTHPLUS-Medicaid, +98172,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,HEALTHPLUS-Medicaid, +98173,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,HEALTHPLUS-Medicaid, +98174,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,HEALTHPLUS-Medicaid, +98175,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,HEALTHPLUS-Medicaid, +98176,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,HEALTHPLUS-Medicaid, +98177,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,HEALTHPLUS-Medicaid, +98178,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,HEALTHPLUS-Medicaid, +98179,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,HEALTHPLUS-Medicaid, +98180,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,HEALTHPLUS-Medicaid, +98181,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,HEALTHPLUS-Medicaid, +98182,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,HEALTHPLUS-Medicaid, +98183,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,HEALTHPLUS-Medicaid, +98184,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,HEALTHPLUS-Medicaid, +98185,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,HEALTHPLUS-Medicaid, +98186,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,HEALTHPLUS-Medicaid, +98187,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,HEALTHPLUS-Medicaid, +98188,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,HEALTHPLUS-Medicaid, +98189,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,HEALTHPLUS-Medicaid, +98190,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,HEALTHPLUS-Medicaid, +98191,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,HEALTHPLUS-Medicaid, +98192,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,HEALTHPLUS-Medicaid, +98193,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,HEALTHPLUS-Medicaid, +98194,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,HEALTHPLUS-Medicaid, +98195,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,HEALTHPLUS-Medicaid, +98196,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,HEALTHPLUS-Medicaid, +98197,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,HEALTHPLUS-Medicaid, +98198,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,HEALTHPLUS-Medicaid, +98199,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,HEALTHPLUS-Medicaid, +98200,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,HEALTHPLUS-Medicaid, +98201,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,HEALTHPLUS-Medicaid, +98202,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,HEALTHPLUS-Medicaid, +98203,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,HEALTHPLUS-Medicaid, +98204,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,HEALTHPLUS-Medicaid, +98205,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,HEALTHPLUS-Medicaid, +98206,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,HEALTHPLUS-Medicaid, +98207,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,HEALTHPLUS-Medicaid, +98208,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,HEALTHPLUS-Medicaid, +98209,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,HEALTHPLUS-Medicaid, +98210,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,HEALTHPLUS-Medicaid, +98211,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,HEALTHPLUS-Medicaid, +98212,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,HEALTHPLUS-Medicaid, +98213,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,HEALTHPLUS-Medicaid, +98214,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,HEALTHPLUS-Medicaid, +98215,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,HEALTHPLUS-Medicaid, +98216,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,HEALTHPLUS-Medicaid, +98217,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,HEALTHPLUS-Medicaid, +98218,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,HEALTHPLUS-Medicaid, +98219,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,HEALTHPLUS-Medicaid, +98220,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,HEALTHPLUS-Medicaid, +98221,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,HEALTHPLUS-Medicaid, +98222,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,HEALTHPLUS-Medicaid, +98223,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,HEALTHPLUS-Medicaid, +98224,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,HEALTHPLUS-Medicaid, +98225,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,HEALTHPLUS-Medicaid, +98226,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,HEALTHPLUS-Medicaid, +98227,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,HEALTHPLUS-Medicaid, +98228,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,HEALTHPLUS-Medicaid, +98229,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,HEALTHPLUS-Medicaid, +98230,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,HEALTHPLUS-Medicaid, +98231,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,HEALTHPLUS-Medicaid, +98232,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,HEALTHPLUS-Medicaid, +98233,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,HEALTHPLUS-Medicaid, +98234,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,HEALTHPLUS-Medicaid, +98235,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,HEALTHPLUS-Medicaid, +98236,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,HEALTHPLUS-Medicaid, +98237,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,HEALTHPLUS-Medicaid, +98238,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,HEALTHPLUS-Medicaid, +98239,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,HEALTHPLUS-Medicaid, +98240,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,HEALTHPLUS-Medicaid, +98241,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,HEALTHPLUS-Medicaid, +98242,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,HEALTHPLUS-Medicaid, +98243,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,HEALTHPLUS-Medicaid, +98244,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,HEALTHPLUS-Medicaid, +98245,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,HEALTHPLUS-Medicaid, +98246,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,HEALTHPLUS-Medicaid, +98247,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,HEALTHPLUS-Medicaid, +98248,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,HEALTHPLUS-Medicaid, +98249,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,HEALTHPLUS-Medicaid, +98250,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,HEALTHPLUS-Medicaid, +98251,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,HEALTHPLUS-Medicaid, +98252,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,HEALTHPLUS-Medicaid, +98253,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,HEALTHPLUS-Medicaid, +98254,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,HEALTHPLUS-Medicaid, +98255,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,HEALTHPLUS-Medicaid, +98256,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,HEALTHPLUS-Medicaid, +98257,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,HEALTHPLUS-Medicaid, +98258,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,HEALTHPLUS-Medicaid, +98259,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,HEALTHPLUS-Medicaid, +98260,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,HEALTHPLUS-Medicaid, +98261,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,HEALTHPLUS-Medicaid, +98262,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,HEALTHPLUS-Medicaid, +98263,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,HEALTHPLUS-Medicaid, +98264,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,HEALTHPLUS-Medicaid, +98265,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,HEALTHPLUS-Medicaid, +98266,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,HEALTHPLUS-Medicaid, +98267,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,HEALTHPLUS-Medicaid, +98268,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,HEALTHPLUS-Medicaid, +98269,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,HEALTHPLUS-Medicaid, +98270,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,HEALTHPLUS-Medicaid, +98271,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,HEALTHPLUS-Medicaid, +98272,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,HEALTHPLUS-Medicaid, +98273,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,HEALTHPLUS-Medicaid, +98274,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,HEALTHPLUS-Medicaid, +98275,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,HEALTHPLUS-Medicaid, +98276,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,HEALTHPLUS-Medicaid, +98277,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,HEALTHPLUS-Medicaid, +98278,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,HEALTHPLUS-Medicaid, +98279,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,HEALTHPLUS-Medicaid, +98280,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,HEALTHPLUS-Medicaid, +98281,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,HEALTHPLUS-Medicaid, +98282,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,HEALTHPLUS-Medicaid, +98283,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,HEALTHPLUS-Medicaid, +98284,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,HEALTHPLUS-Medicaid, +98285,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,HEALTHPLUS-Medicaid, +98286,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,HEALTHPLUS-Medicaid, +98287,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,HEALTHPLUS-Medicaid, +98288,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,HEALTHPLUS-Medicaid, +98289,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,HEALTHPLUS-Medicaid, +98290,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,HEALTHPLUS-Medicaid, +98291,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,HEALTHPLUS-Medicaid, +98292,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,HEALTHPLUS-Medicaid, +98293,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,HEALTHPLUS-Medicaid, +98294,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,HEALTHPLUS-Medicaid, +98295,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,HEALTHPLUS-Medicaid, +98296,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,HEALTHPLUS-Medicaid, +98297,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,HEALTHPLUS-Medicaid, +98298,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,HEALTHPLUS-Medicaid, +98299,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,HEALTHPLUS-Medicaid, +98300,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,HEALTHPLUS-Medicaid, +98301,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,HEALTHPLUS-Medicaid, +98302,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,HEALTHPLUS-Medicaid, +98303,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,HEALTHPLUS-Medicaid, +98304,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,HEALTHPLUS-Medicaid, +98305,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,HEALTHPLUS-Medicaid, +98306,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,HEALTHPLUS-Medicaid, +98307,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,HEALTHPLUS-Medicaid, +98308,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,HEALTHPLUS-Medicaid, +98309,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,HEALTHPLUS-Medicaid, +98310,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,HEALTHPLUS-Medicaid, +98311,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,HEALTHPLUS-Medicaid, +98312,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,HEALTHPLUS-Medicaid, +98313,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,HEALTHPLUS-Medicaid, +98314,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,HEALTHPLUS-Medicaid, +98315,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,HEALTHPLUS-Medicaid, +98316,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,HEALTHPLUS-Medicaid, +98317,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,HEALTHPLUS-Medicaid, +98318,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,HEALTHPLUS-Medicaid, +98319,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,HEALTHPLUS-Medicaid, +98320,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,HEALTHPLUS-Medicaid, +98321,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,HEALTHPLUS-Medicaid, +98322,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,HEALTHPLUS-Medicaid, +98323,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,HEALTHPLUS-Medicaid, +98324,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,HEALTHPLUS-Medicaid, +98325,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,HEALTHPLUS-Medicaid, +98326,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,HEALTHPLUS-Medicaid, +98327,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,HEALTHPLUS-Medicaid, +98328,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,HEALTHPLUS-Medicaid, +98329,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,HEALTHPLUS-Medicaid, +98330,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,HEALTHPLUS-Medicaid, +98331,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,HEALTHPLUS-Medicaid, +98332,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,HEALTHPLUS-Medicaid, +98333,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,HEALTHPLUS-Medicaid, +98334,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,HEALTHPLUS-Medicaid, +98335,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,HEALTHPLUS-Medicaid, +98336,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,HEALTHPLUS-Medicaid, +98337,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,HEALTHPLUS-Medicaid, +98338,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,HEALTHPLUS-Medicaid, +98339,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,HEALTHPLUS-Medicaid, +98340,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,HEALTHPLUS-Medicaid, +98341,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,HEALTHPLUS-Medicaid, +98342,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,HEALTHPLUS-Medicaid, +98343,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,HEALTHPLUS-Medicaid, +98344,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,HEALTHPLUS-Medicaid, +98345,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,HEALTHPLUS-Medicaid, +98346,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,HEALTHPLUS-Medicaid, +98347,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,HEALTHPLUS-Medicaid, +98348,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,HEALTHPLUS-Medicaid, +98349,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,HEALTHPLUS-Medicaid, +98350,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,HEALTHPLUS-Medicaid, +98351,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,HEALTHPLUS-Medicaid, +98352,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,HEALTHPLUS-Medicaid, +98353,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,HEALTHPLUS-Medicaid, +98354,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,HEALTHPLUS-Medicaid, +98355,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,HEALTHPLUS-Medicaid, +98356,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,HEALTHPLUS-Medicaid, +98357,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,HEALTHPLUS-Medicaid, +98358,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,HEALTHPLUS-Medicaid, +98359,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,HEALTHPLUS-Medicaid, +98360,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,HEALTHPLUS-Medicaid, +98361,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,HEALTHPLUS-Medicaid, +98362,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,HEALTHPLUS-Medicaid, +98363,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,HEALTHPLUS-Medicaid, +98364,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,HEALTHPLUS-Medicaid, +98365,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,HEALTHPLUS-Medicaid, +98366,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,HEALTHPLUS-Medicaid, +98367,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,HEALTHPLUS-Medicaid, +98368,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,HEALTHPLUS-Medicaid, +98369,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,HEALTHPLUS-Medicaid, +98370,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,HEALTHPLUS-Medicaid, +98371,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,HEALTHPLUS-Medicaid, +98372,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,HEALTHPLUS-Medicaid, +98373,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,HEALTHPLUS-Medicaid, +98374,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,HEALTHPLUS-Medicaid, +98375,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,HEALTHPLUS-Medicaid, +98376,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,HEALTHPLUS-Medicaid, +98377,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,HEALTHPLUS-Medicaid, +98378,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,HEALTHPLUS-Medicaid, +98379,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,HEALTHPLUS-Medicaid, +98380,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,HEALTHPLUS-Medicaid, +98381,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,HEALTHPLUS-Medicaid, +98382,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,HEALTHPLUS-Medicaid, +98383,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,HEALTHPLUS-Medicaid, +98384,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,HEALTHPLUS-Medicaid, +98385,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,HEALTHPLUS-Medicaid, +98386,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,HEALTHPLUS-Medicaid, +98387,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,HEALTHPLUS-Medicaid, +98388,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,HEALTHPLUS-Medicaid, +98389,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,HEALTHPLUS-Medicaid, +98390,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,HEALTHPLUS-Medicaid, +98391,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,HEALTHPLUS-Medicaid, +98392,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,HEALTHPLUS-Medicaid, +98393,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,HEALTHPLUS-Medicaid, +98394,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,HEALTHPLUS-Medicaid, +98395,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,HEALTHPLUS-Medicaid, +98396,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,HEALTHPLUS-Medicaid, +98397,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,HEALTHPLUS-Medicaid, +98398,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,HEALTHPLUS-Medicaid, +98399,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,HEALTHPLUS-Medicaid, +98400,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,HEALTHPLUS-Medicaid, +98401,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,HEALTHPLUS-Medicaid, +98402,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,HEALTHPLUS-Medicaid, +98403,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,HEALTHPLUS-Medicaid, +98404,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,HEALTHPLUS-Medicaid, +98405,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,HEALTHPLUS-Medicaid, +98406,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,HEALTHPLUS-Medicaid, +98407,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,HEALTHPLUS-Medicaid, +98408,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,HEALTHPLUS-Medicaid, +98409,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,HEALTHPLUS-Medicaid, +98410,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,HEALTHPLUS-Medicaid, +98411,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,HEALTHPLUS-Medicaid, +98412,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,HEALTHPLUS-Medicaid, +98413,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,HEALTHPLUS-Medicaid, +98414,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,HEALTHPLUS-Medicaid, +98415,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,HEALTHPLUS-Medicaid, +98416,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,HEALTHPLUS-Medicaid, +98417,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,HEALTHPLUS-Medicaid, +98418,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,HEALTHPLUS-Medicaid, +98419,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,HEALTHPLUS-Medicaid, +98420,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,HEALTHPLUS-Medicaid, +98421,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,HEALTHPLUS-Medicaid, +98422,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,HEALTHPLUS-Medicaid, +98423,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,HEALTHPLUS-Medicaid, +98424,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,HEALTHPLUS-Medicaid, +98425,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,HEALTHPLUS-Medicaid, +98426,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,HEALTHPLUS-Medicaid, +98427,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,HEALTHPLUS-Medicaid, +98428,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,HEALTHPLUS-Medicaid, +98429,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,HEALTHPLUS-Medicaid, +98430,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,HEALTHPLUS-Medicaid, +98431,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,HEALTHPLUS-Medicaid, +98432,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,HEALTHPLUS-Medicaid, +98433,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,HEALTHPLUS-Medicaid, +98434,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,HEALTHPLUS-Medicaid, +98435,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,HEALTHPLUS-Medicaid, +98436,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,HEALTHPLUS-Medicaid, +98437,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,HEALTHPLUS-Medicaid, +98438,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,HEALTHPLUS-Medicaid, +98439,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,HEALTHPLUS-Medicaid, +98440,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,HEALTHPLUS-Medicaid, +98441,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,HEALTHPLUS-Medicaid, +98442,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,HEALTHPLUS-Medicaid, +98443,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,HEALTHPLUS-Medicaid, +98444,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,HEALTHPLUS-Medicaid, +98445,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,HEALTHPLUS-Medicaid, +98446,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,HEALTHPLUS-Medicaid, +98447,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,HEALTHPLUS-Medicaid, +98448,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,HEALTHPLUS-Medicaid, +98449,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,HEALTHPLUS-Medicaid, +98450,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,HEALTHPLUS-Medicaid, +98451,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,HEALTHPLUS-Medicaid, +98452,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,HEALTHPLUS-Medicaid, +98453,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,HEALTHPLUS-Medicaid, +98454,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,HEALTHPLUS-Medicaid, +98455,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,HEALTHPLUS-Medicaid, +98456,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,HEALTHPLUS-Medicaid, +98457,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,HEALTHPLUS-Medicaid, +98458,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,HEALTHPLUS-Medicaid, +98459,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,HEALTHPLUS-Medicaid, +98460,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,HEALTHPLUS-Medicaid, +98461,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,HEALTHPLUS-Medicaid, +98462,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,HEALTHPLUS-Medicaid, +98463,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,HEALTHPLUS-Medicaid, +98464,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,HEALTHPLUS-Medicaid, +98465,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,HEALTHPLUS-Medicaid, +98466,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,HEALTHPLUS-Medicaid, +98467,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,HEALTHPLUS-Medicaid, +98468,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,HEALTHPLUS-Medicaid, +98469,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,HEALTHPLUS-Medicaid, +98470,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,HEALTHPLUS-Medicaid, +98471,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,HEALTHPLUS-Medicaid, +98472,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,HEALTHPLUS-Medicaid, +98473,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,HEALTHPLUS-Medicaid, +98474,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,HEALTHPLUS-Medicaid, +98475,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,HEALTHPLUS-Medicaid, +98476,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,HEALTHPLUS-Medicaid, +98477,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,HEALTHPLUS-Medicaid, +98478,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,HEALTHPLUS-Medicaid, +98479,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,HEALTHPLUS-Medicaid, +98480,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,HEALTHPLUS-Medicaid, +98481,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,HEALTHPLUS-Medicaid, +98482,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,HEALTHPLUS-Medicaid, +98483,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,HEALTHPLUS-Medicaid, +98484,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,HEALTHPLUS-Medicaid, +98485,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,HEALTHPLUS-Medicaid, +98486,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,HEALTHPLUS-Medicaid, +98487,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,HEALTHPLUS-Medicaid, +98488,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,HEALTHPLUS-Medicaid, +98489,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,HEALTHPLUS-Medicaid, +98490,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,HEALTHPLUS-Medicaid, +98491,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,HEALTHPLUS-Medicaid, +98492,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,HEALTHPLUS-Medicaid, +98493,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,HEALTHPLUS-Medicaid, +98494,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,HEALTHPLUS-Medicaid, +98495,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,HEALTHPLUS-Medicaid, +98496,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,HEALTHPLUS-Medicaid, +98497,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,HEALTHPLUS-Medicaid, +98498,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,HEALTHPLUS-Medicaid, +98499,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,HEALTHPLUS-Medicaid, +98500,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,HEALTHPLUS-Medicaid, +98501,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,HEALTHPLUS-Medicaid, +98502,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,HEALTHPLUS-Medicaid, +98503,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,HEALTHPLUS-Medicaid, +98504,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,HEALTHPLUS-Medicaid, +98505,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,HEALTHPLUS-Medicaid, +98506,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,HEALTHPLUS-Medicaid, +98507,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,HEALTHPLUS-Medicaid, +98508,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,HEALTHPLUS-Medicaid, +98509,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,HEALTHPLUS-Medicaid, +98510,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,HEALTHPLUS-Medicaid, +98511,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,HEALTHPLUS-Medicaid, +98512,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,HEALTHPLUS-Medicaid, +98513,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,HEALTHPLUS-Medicaid, +98514,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,HEALTHPLUS-Medicaid, +98515,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,HEALTHPLUS-Medicaid, +98516,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,HEALTHPLUS-Medicaid, +98517,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,HEALTHPLUS-Medicaid, +98518,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,HEALTHPLUS-Medicaid, +98519,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,HEALTHPLUS-Medicaid, +98520,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,HEALTHPLUS-Medicaid, +98521,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,HEALTHPLUS-Medicaid, +98522,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,HEALTHPLUS-Medicaid, +98523,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,HEALTHPLUS-Medicaid, +98524,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,HEALTHPLUS-Medicaid, +98525,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,HEALTHPLUS-Medicaid, +98526,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,HEALTHPLUS-Medicaid, +98527,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,HEALTHPLUS-Medicaid, +98528,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,HEALTHPLUS-Medicaid, +98529,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,HEALTHPLUS-Medicaid, +98530,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,HEALTHPLUS-Medicaid, +98531,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,HEALTHPLUS-Medicaid, +98532,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,HEALTHPLUS-Medicaid, +98533,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,HEALTHPLUS-Medicaid, +98534,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,HEALTHPLUS-Medicaid, +98535,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,HEALTHPLUS-Medicaid, +98536,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,HEALTHPLUS-Medicaid, +98537,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,HEALTHPLUS-Medicaid, +98538,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,HEALTHPLUS-Medicaid, +98539,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,HEALTHPLUS-Medicaid, +98540,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,HEALTHPLUS-Medicaid, +98541,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,HEALTHPLUS-Medicaid, +98542,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,HEALTHPLUS-Medicaid, +98543,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,HEALTHPLUS-Medicaid, +98544,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,HEALTHPLUS-Medicaid, +98545,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,HEALTHPLUS-Medicaid, +98546,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,HEALTHPLUS-Medicaid, +98547,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,HEALTHPLUS-Medicaid, +98548,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,HEALTHPLUS-Medicaid, +98549,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,HEALTHPLUS-Medicaid, +98550,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,HEALTHPLUS-Medicaid, +98551,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,HEALTHPLUS-Medicaid, +98552,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,HEALTHPLUS-Medicaid, +98553,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,HEALTHPLUS-Medicaid, +98554,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,HEALTHPLUS-Medicaid, +98555,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,HEALTHPLUS-Medicaid, +98556,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,HEALTHPLUS-Medicaid, +98557,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,HEALTHPLUS-Medicaid, +98558,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,HEALTHPLUS-Medicaid, +98559,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,HEALTHPLUS-Medicaid, +98560,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,HEALTHPLUS-Medicaid, +98561,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,HEALTHPLUS-Medicaid, +98562,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,HEALTHPLUS-Medicaid, +98563,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,HEALTHPLUS-Medicaid, +98564,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,HEALTHPLUS-Medicaid, +98565,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,HEALTHPLUS-Medicaid, +98566,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,HEALTHPLUS-Medicaid, +98567,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,HEALTHPLUS-Medicaid, +98568,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,HEALTHPLUS-Medicaid, +98569,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,HEALTHPLUS-Medicaid, +98570,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,HEALTHPLUS-Medicaid, +98571,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,HEALTHPLUS-Medicaid, +98572,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,HEALTHPLUS-Medicaid, +98573,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,HEALTHPLUS-Medicaid, +98574,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,HEALTHPLUS-Medicaid, +98575,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,HEALTHPLUS-Medicaid, +98576,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,HEALTHPLUS-Medicaid, +98577,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,HEALTHPLUS-Medicaid, +98578,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,HEALTHPLUS-Medicaid, +98579,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,HEALTHPLUS-Medicaid, +98580,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,HEALTHPLUS-Medicaid, +98581,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,HEALTHPLUS-Medicaid, +98582,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,HEALTHPLUS-Medicaid, +98583,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,HEALTHPLUS-Medicaid, +98584,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,HEALTHPLUS-Medicaid, +98585,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,HEALTHPLUS-Medicaid, +98586,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,HEALTHPLUS-Medicaid, +98587,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,HEALTHPLUS-Medicaid, +98588,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,HEALTHPLUS-Medicaid, +98589,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,HEALTHPLUS-Medicaid, +98590,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,HEALTHPLUS-Medicaid, +98591,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,HEALTHPLUS-Medicaid, +98592,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,HEALTHPLUS-Medicaid, +98593,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,HEALTHPLUS-Medicaid, +98594,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,HEALTHPLUS-Medicaid, +98595,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,HEALTHPLUS-Medicaid, +98596,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,HEALTHPLUS-Medicaid, +98597,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,HEALTHPLUS-Medicaid, +98598,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,HEALTHPLUS-Medicaid, +98599,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,HEALTHPLUS-Medicaid, +98600,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,HEALTHPLUS-Medicaid, +98601,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,HEALTHPLUS-Medicaid, +98602,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,HEALTHPLUS-Medicaid, +98603,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,HEALTHPLUS-Medicaid, +98604,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,HEALTHPLUS-Medicaid, +98605,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,HEALTHPLUS-Medicaid, +98606,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,HEALTHPLUS-Medicaid, +98607,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,HEALTHPLUS-Medicaid, +98608,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,HEALTHPLUS-Medicaid, +98609,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,HEALTHPLUS-Medicaid, +98610,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,HEALTHPLUS-Medicaid, +98611,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,HEALTHPLUS-Medicaid, +98612,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,HEALTHPLUS-Medicaid, +98613,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,HEALTHPLUS-Medicaid, +98614,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,HEALTHPLUS-Medicaid, +98615,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,HEALTHPLUS-Medicaid, +98616,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,HEALTHPLUS-Medicaid, +98617,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,HEALTHPLUS-Medicaid, +98618,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,HEALTHPLUS-Medicaid, +98619,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,HEALTHPLUS-Medicaid, +98620,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,HEALTHPLUS-Medicaid, +98621,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,HEALTHPLUS-Medicaid, +98622,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,HEALTHPLUS-Medicaid, +98623,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,HEALTHPLUS-Medicaid, +98624,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,HEALTHPLUS-Medicaid, +98625,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,HEALTHPLUS-Medicaid, +98626,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,HEALTHPLUS-Medicaid, +98627,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,HEALTHPLUS-Medicaid, +98628,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,HEALTHPLUS-Medicaid, +98629,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,HEALTHPLUS-Medicaid, +98630,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,HEALTHPLUS-Medicaid, +98631,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,HEALTHPLUS-Medicaid, +98632,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,HEALTHPLUS-Medicaid, +98633,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,HEALTHPLUS-Medicaid, +98634,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,HEALTHPLUS-Medicaid, +98635,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,HEALTHPLUS-Medicaid, +98636,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,HEALTHPLUS-Medicaid, +98637,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,HEALTHPLUS-Medicaid, +98638,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,HEALTHPLUS-Medicaid, +98639,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,HEALTHPLUS-Medicaid, +98640,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,HEALTHPLUS-Medicaid, +98641,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,HEALTHPLUS-Medicaid, +98642,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,HEALTHPLUS-Medicaid, +98643,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,HEALTHPLUS-Medicaid, +98644,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,HEALTHPLUS-Medicaid, +98645,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,HEALTHPLUS-Medicaid, +98646,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,HEALTHPLUS-Medicaid, +98647,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,HEALTHPLUS-Medicaid, +98648,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,HEALTHPLUS-Medicaid, +98649,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,HEALTHPLUS-Medicaid, +98650,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,HEALTHPLUS-Medicaid, +98651,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,HEALTHPLUS-Medicaid, +98652,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,HEALTHPLUS-Medicaid, +98653,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,HEALTHPLUS-Medicaid, +98654,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,HEALTHPLUS-Medicaid, +98655,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,HEALTHPLUS-Medicaid, +98656,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,HEALTHPLUS-Medicaid, +98657,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,HEALTHPLUS-Medicaid, +98658,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,HEALTHPLUS-Medicaid, +98659,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,HEALTHPLUS-Medicaid, +98660,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,HEALTHPLUS-Medicaid, +98661,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,HEALTHPLUS-Medicaid, +98662,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,HEALTHPLUS-Medicaid, +98663,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,HEALTHPLUS-Medicaid, +98664,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,HEALTHPLUS-Medicaid, +98665,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,HEALTHPLUS-Medicaid, +98666,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,HEALTHPLUS-Medicaid, +98667,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,HEALTHPLUS-Medicaid, +98668,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,HEALTHPLUS-Medicaid, +98669,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,HEALTHPLUS-Medicaid, +98670,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,HEALTHPLUS-Medicaid, +98671,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,HEALTHPLUS-Medicaid, +98672,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,HEALTHPLUS-Medicaid, +98673,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,HEALTHPLUS-Medicaid, +98674,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,HEALTHPLUS-Medicaid, +98675,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,HEALTHPLUS-Medicaid, +98676,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,HEALTHPLUS-Medicaid, +98677,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,HEALTHPLUS-Medicaid, +98678,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,HEALTHPLUS-Medicaid, +98679,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,HEALTHPLUS-Medicaid, +98680,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,HEALTHPLUS-Medicaid, +98681,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,HEALTHPLUS-Medicaid, +98682,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,HEALTHPLUS-Medicaid, +98683,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,HEALTHPLUS-Medicaid, +98684,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,HEALTHPLUS-Medicaid, +98685,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,HEALTHPLUS-Medicaid, +98686,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,HEALTHPLUS-Medicaid, +98687,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,HEALTHPLUS-Medicaid, +98688,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,HEALTHPLUS-Medicaid, +98689,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,HEALTHPLUS-Medicaid, +98690,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,HEALTHPLUS-Medicaid, +98691,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,HEALTHPLUS-Medicaid, +98692,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,HEALTHPLUS-Medicaid, +98693,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,HEALTHPLUS-Medicaid, +98694,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,HEALTHPLUS-Medicaid, +98695,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,HEALTHPLUS-Medicaid, +98696,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,HEALTHPLUS-Medicaid, +98697,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,HEALTHPLUS-Medicaid, +98698,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,HEALTHPLUS-Medicaid, +98699,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,HEALTHPLUS-Medicaid, +98700,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,HEALTHPLUS-Medicaid, +98701,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,HEALTHPLUS-Medicaid, +98702,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,HEALTHPLUS-Medicaid, +98703,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,HEALTHPLUS-Medicaid, +98704,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,HEALTHPLUS-Medicaid, +98705,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,HEALTHPLUS-Medicaid, +98706,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,HEALTHPLUS-Medicaid, +98707,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,HEALTHPLUS-Medicaid, +98708,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,HEALTHPLUS-Medicaid, +98709,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,HEALTHPLUS-Medicaid, +98710,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,HEALTHPLUS-Medicaid, +98711,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,HEALTHPLUS-Medicaid, +98712,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,HEALTHPLUS-Medicaid, +98713,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,HEALTHPLUS-Medicaid, +98714,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,HEALTHPLUS-Medicaid, +98715,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,HEALTHPLUS-Medicaid, +98716,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,HEALTHPLUS-Medicaid, +98717,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,HEALTHPLUS-Medicaid, +98718,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,HEALTHPLUS-Medicaid, +98719,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,HEALTHPLUS-Medicaid, +98720,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,HEALTHPLUS-Medicaid, +98721,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,HEALTHPLUS-Medicaid, +98722,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,HEALTHPLUS-Medicaid, +98723,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,HEALTHPLUS-Medicaid, +98724,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,HEALTHPLUS-Medicaid, +98725,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,HEALTHPLUS-Medicaid, +98726,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,HEALTHPLUS-Medicaid, +98727,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,HEALTHPLUS-Medicaid, +98728,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,HEALTHPLUS-Medicaid, +98729,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,HEALTHPLUS-Medicaid, +98730,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,HEALTHPLUS-Medicaid, +98731,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,HEALTHPLUS-Medicaid, +98732,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,HEALTHPLUS-Medicaid, +98733,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,HEALTHPLUS-Medicaid, +98734,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,HEALTHPLUS-Medicaid, +98735,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,HEALTHPLUS-Medicaid, +98736,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,HEALTHPLUS-Medicaid, +98737,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,HEALTHPLUS-Medicaid, +98738,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,HEALTHPLUS-Medicaid, +98739,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,HEALTHPLUS-Medicaid, +98740,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,HEALTHPLUS-Medicaid, +98741,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,HEALTHPLUS-Medicaid, +98742,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,HEALTHPLUS-Medicaid, +98743,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,HEALTHPLUS-Medicaid, +98744,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,HEALTHPLUS-Medicaid, +98745,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,HEALTHPLUS-Medicaid, +98746,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,HEALTHPLUS-Medicaid, +98747,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,HEALTHPLUS-Medicaid, +98748,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,HEALTHPLUS-Medicaid, +98749,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,HEALTHPLUS-Medicaid, +98750,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,HEALTHPLUS-Medicaid, +98751,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,HEALTHPLUS-Medicaid, +98752,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,HEALTHPLUS-Medicaid, +98753,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,HEALTHPLUS-Medicaid, +98754,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,HEALTHPLUS-Medicaid, +98755,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,HEALTHPLUS-Medicaid, +98756,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,HEALTHPLUS-Medicaid, +98757,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,HEALTHPLUS-Medicaid, +98758,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,HEALTHPLUS-Medicaid, +98759,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,HEALTHPLUS-Medicaid, +98760,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,HEALTHPLUS-Medicaid, +98761,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,HEALTHPLUS-Medicaid, +98762,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,HEALTHPLUS-Medicaid, +98763,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,HEALTHPLUS-Medicaid, +98764,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,HEALTHPLUS-Medicaid, +98765,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,HEALTHPLUS-Medicaid, +98766,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,HEALTHPLUS-Medicaid, +98767,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,HEALTHPLUS-Medicaid, +98768,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,HEALTHPLUS-Medicaid, +98769,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,HEALTHPLUS-Medicaid, +98770,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,HEALTHPLUS-Medicaid, +98771,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,HEALTHPLUS-Medicaid, +98772,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,HEALTHPLUS-Medicaid, +98773,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,HEALTHPLUS-Medicaid, +98774,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,HEALTHPLUS-Medicaid, +98775,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,HEALTHPLUS-Medicaid, +98776,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,HEALTHPLUS-Medicaid, +98777,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,HEALTHPLUS-Medicaid, +98778,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,HEALTHPLUS-Medicaid, +98779,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,HEALTHPLUS-Medicaid, +98780,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,HEALTHPLUS-Medicaid, +98781,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,HEALTHPLUS-Medicaid, +98782,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,HEALTHPLUS-Medicaid, +98783,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,HEALTHPLUS-Medicaid,263.75 +98784,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,HEALTHPLUS-Medicaid, +98785,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,HEALTHPLUS-Medicaid, +98786,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,HEALTHPLUS-Medicaid, +98787,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,HEALTHPLUS-Medicaid, +98788,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,HEALTHPLUS-Medicaid, +98789,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,HEALTHPLUS-Medicaid, +98790,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,HEALTHPLUS-Medicaid, +98791,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,HEALTHPLUS-Medicaid, +98792,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,HEALTHPLUS-Medicaid, +98793,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,HEALTHPLUS-Medicaid, +98794,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,HEALTHPLUS-Medicaid, +98795,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,HEALTHPLUS-Medicaid, +98796,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,HEALTHPLUS-Medicaid, +98797,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,HEALTHPLUS-Medicaid, +98798,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,HEALTHPLUS-Medicaid, +98799,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,HEALTHPLUS-Medicaid, +98800,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,HEALTHPLUS-Medicaid, +98801,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,HEALTHPLUS-Medicaid, +98802,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,HEALTHPLUS-Medicaid, +98803,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,HEALTHPLUS-Medicaid, +98804,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,HEALTHPLUS-Medicaid, +98805,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,HEALTHPLUS-Medicaid, +98806,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,HEALTHPLUS-Medicaid, +98807,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,HEALTHPLUS-Medicaid, +98808,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,HEALTHPLUS-Medicaid, +98809,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,HEALTHPLUS-Medicaid, +98810,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,HEALTHPLUS-Medicaid, +98811,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,HEALTHPLUS-Medicaid, +98812,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,HEALTHPLUS-Medicaid, +98813,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,HEALTHPLUS-Medicaid, +98814,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,HEALTHPLUS-Medicaid, +98815,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,HEALTHPLUS-Medicaid, +98816,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,HEALTHPLUS-Medicaid, +98817,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,HEALTHPLUS-Medicaid, +98818,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,HEALTHPLUS-Medicaid, +98819,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,HEALTHPLUS-Medicaid, +98820,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,HEALTHPLUS-Medicaid, +98821,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,HEALTHPLUS-Medicaid, +98822,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,HEALTHPLUS-Medicaid, +98823,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,HEALTHPLUS-Medicaid, +98824,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,HEALTHPLUS-Medicaid, +98825,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,HEALTHPLUS-Medicaid, +98826,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,HEALTHPLUS-Medicaid, +98827,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,HEALTHPLUS-Medicaid, +98828,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,HEALTHPLUS-Medicaid, +98829,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,HEALTHPLUS-Medicaid, +98830,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,HEALTHPLUS-Medicaid, +98831,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,HEALTHPLUS-Medicaid, +98832,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,HEALTHPLUS-Medicaid, +98833,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,HEALTHPLUS-Medicaid, +98834,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,HEALTHPLUS-Medicaid, +98835,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,HEALTHPLUS-Medicaid, +98836,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,HEALTHPLUS-Medicaid, +98837,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,HEALTHPLUS-Medicaid, +98838,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,HEALTHPLUS-Medicaid, +98839,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,HEALTHPLUS-Medicaid, +98840,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,HEALTHPLUS-Medicaid, +98841,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,HEALTHPLUS-Medicaid, +98842,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,HEALTHPLUS-Medicaid, +98843,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,HEALTHPLUS-Medicaid, +98844,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,HEALTHPLUS-Medicaid, +98845,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,HEALTHPLUS-Medicaid,54.55 +98846,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,HEALTHPLUS-Medicaid, +98847,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,HEALTHPLUS-Medicaid, +98848,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,HEALTHPLUS-Medicaid, +98849,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,HEALTHPLUS-Medicaid, +98850,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,HEALTHPLUS-Medicaid, +98851,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,HEALTHPLUS-Medicaid, +98852,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,HEALTHPLUS-Medicaid, +98853,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,HEALTHPLUS-Medicaid, +98854,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,HEALTHPLUS-Medicaid, +98855,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,HEALTHPLUS-Medicaid, +98856,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,HEALTHPLUS-Medicaid, +98857,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,HEALTHPLUS-Medicaid, +98858,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,HEALTHPLUS-Medicaid, +98859,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,HEALTHPLUS-Medicaid, +98860,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,HEALTHPLUS-Medicaid, +98861,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,HEALTHPLUS-Medicaid, +98862,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,HEALTHPLUS-Medicaid, +98863,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,HEALTHPLUS-Medicaid, +98864,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,HEALTHPLUS-Medicaid,365.92 +98865,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,HEALTHPLUS-Medicaid, +98866,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,HEALTHPLUS-Medicaid, +98867,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,HEALTHPLUS-Medicaid, +98868,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,HEALTHPLUS-Medicaid, +98869,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,HEALTHPLUS-Medicaid, +98870,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,HEALTHPLUS-Medicaid, +98871,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,HEALTHPLUS-Medicaid, +98872,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,HEALTHPLUS-Medicaid, +98873,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,HEALTHPLUS-Medicaid, +98874,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,HEALTHPLUS-Medicaid, +98875,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,HEALTHPLUS-Medicaid, +98876,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,HEALTHPLUS-Medicaid, +98877,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,HEALTHPLUS-Medicaid, +98878,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,HEALTHPLUS-Medicaid, +98879,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,HEALTHPLUS-Medicaid, +98880,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,HEALTHPLUS-Medicaid, +98881,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,HEALTHPLUS-Medicaid, +98882,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,HEALTHPLUS-Medicaid, +98883,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,HEALTHPLUS-Medicaid, +98884,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,HEALTHPLUS-Medicaid, +98885,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,HEALTHPLUS-Medicaid, +98886,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,HEALTHPLUS-Medicaid, +98887,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,HEALTHPLUS-Medicaid, +98888,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,HEALTHPLUS-Medicaid, +98889,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,HEALTHPLUS-Medicaid,123.14 +98890,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,HEALTHPLUS-Medicaid, +98891,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,HEALTHPLUS-Medicaid, +98892,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,HEALTHPLUS-Medicaid, +98893,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,HEALTHPLUS-Medicaid, +98894,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,HEALTHPLUS-Medicaid, +98895,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,HEALTHPLUS-Medicaid, +98896,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,HEALTHPLUS-Medicaid, +98897,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,HEALTHPLUS-Medicaid, +98898,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,HEALTHPLUS-Medicaid, +98899,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,HEALTHPLUS-Medicaid, +98900,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,HEALTHPLUS-Medicaid, +98901,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,HEALTHPLUS-Medicaid, +98902,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,HEALTHPLUS-Medicaid, +98903,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,HEALTHPLUS-Medicaid, +98904,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,HEALTHPLUS-Medicaid, +98905,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,HEALTHPLUS-Medicaid, +98906,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,HEALTHPLUS-Medicaid, +98907,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,HEALTHPLUS-Medicaid, +98908,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,HEALTHPLUS-Medicaid, +98909,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,HEALTHPLUS-Medicaid, +98910,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,HEALTHPLUS-Medicaid, +98911,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,HEALTHPLUS-Medicaid, +98912,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,HEALTHPLUS-Medicaid, +98913,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,HEALTHPLUS-Medicaid, +98914,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,HEALTHPLUS-Medicaid, +98915,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,HEALTHPLUS-Medicaid, +98916,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,HEALTHPLUS-Medicaid, +98917,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,HEALTHPLUS-Medicaid, +98918,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,HEALTHPLUS-Medicaid, +98919,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,HEALTHPLUS-Medicaid, +98920,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,HEALTHPLUS-Medicaid, +98921,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,HEALTHPLUS-Medicaid, +98922,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,HEALTHPLUS-Medicaid, +98923,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,HEALTHPLUS-Medicaid, +98924,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,HEALTHPLUS-Medicaid, +98925,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,HEALTHPLUS-Medicaid, +98926,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,HEALTHPLUS-Medicaid, +98927,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,HEALTHPLUS-Medicaid, +98928,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,HEALTHPLUS-Medicaid, +98929,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,HEALTHPLUS-Medicaid, +98930,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,HEALTHPLUS-Medicaid, +98931,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,HEALTHPLUS-Medicaid, +98932,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,HEALTHPLUS-Medicaid, +98933,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,HEALTHPLUS-Medicaid, +98934,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,HEALTHPLUS-Medicaid, +98935,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,HEALTHPLUS-Medicaid, +98936,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,HEALTHPLUS-Medicaid, +98937,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,HEALTHPLUS-Medicaid, +98938,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,HEALTHPLUS-Medicaid, +98939,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,HEALTHPLUS-Medicaid, +98940,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,HEALTHPLUS-Medicaid, +98941,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,HEALTHPLUS-Medicaid, +98942,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,HEALTHPLUS-Medicaid,26.71 +98943,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,HEALTHPLUS-Medicaid, +98944,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,HEALTHPLUS-Medicaid, +98945,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,HEALTHPLUS-Medicaid, +98946,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,HEALTHPLUS-Medicaid, +98947,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,HEALTHPLUS-Medicaid, +98948,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,HEALTHPLUS-Medicaid, +98949,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,HEALTHPLUS-Medicaid, +98950,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,HEALTHPLUS-Medicaid, +98951,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,HEALTHPLUS-Medicaid, +98952,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,HEALTHPLUS-Medicaid, +98953,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,HEALTHPLUS-Medicaid, +98954,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,HEALTHPLUS-Medicaid, +98955,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,HEALTHPLUS-Medicaid, +98956,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,HEALTHPLUS-Medicaid, +98957,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,HEALTHPLUS-Medicaid, +98958,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,HEALTHPLUS-Medicaid, +98959,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,HEALTHPLUS-Medicaid, +98960,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,HEALTHPLUS-Medicaid, +98961,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,HEALTHPLUS-Medicaid, +98962,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,HEALTHPLUS-Medicaid, +98963,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,HEALTHPLUS-Medicaid, +98964,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,HEALTHPLUS-Medicaid, +98965,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,HEALTHPLUS-Medicaid, +98966,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,HEALTHPLUS-Medicaid, +98967,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,HEALTHPLUS-Medicaid, +98968,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,HEALTHPLUS-Medicaid, +98969,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,HEALTHPLUS-Medicaid, +98970,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,HEALTHPLUS-Medicaid, +98971,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,HEALTHPLUS-Medicaid, +98972,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,HEALTHPLUS-Medicaid, +98973,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,HEALTHPLUS-Medicaid, +98974,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,HEALTHPLUS-Medicaid, +98975,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,HEALTHPLUS-Medicaid, +98976,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,HEALTHPLUS-Medicaid, +98977,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,HEALTHPLUS-Medicaid, +98978,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,HEALTHPLUS-Medicaid, +98979,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,HEALTHPLUS-Medicaid, +98980,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,HEALTHPLUS-Medicaid, +98981,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,HEALTHPLUS-Medicaid, +98982,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,HEALTHPLUS-Medicaid, +98983,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,HEALTHPLUS-Medicaid, +98984,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,HEALTHPLUS-Medicaid, +98985,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,HEALTHPLUS-Medicaid, +98986,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,HEALTHPLUS-Medicaid, +98987,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,HEALTHPLUS-Medicaid, +98988,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,HEALTHPLUS-Medicaid, +98989,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,HEALTHPLUS-Medicaid, +98990,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,HEALTHPLUS-Medicaid, +98991,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,HEALTHPLUS-Medicaid, +98992,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,HEALTHPLUS-Medicaid, +98993,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,HEALTHPLUS-Medicaid, +98994,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,HEALTHPLUS-Medicaid, +98995,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,HEALTHPLUS-Medicaid, +98996,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,HEALTHPLUS-Medicaid, +98997,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,HEALTHPLUS-Medicaid, +98998,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,HEALTHPLUS-Medicaid, +98999,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,HEALTHPLUS-Medicaid, +99000,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,HEALTHPLUS-Medicaid, +99001,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,HEALTHPLUS-Medicaid, +99002,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,HEALTHPLUS-Medicaid, +99003,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,HEALTHPLUS-Medicaid, +99004,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,HEALTHPLUS-Medicaid, +99005,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,HEALTHPLUS-Medicaid, +99006,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,HEALTHPLUS-Medicaid, +99007,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,HEALTHPLUS-Medicaid, +99008,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,HEALTHPLUS-Medicaid, +99009,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,HEALTHPLUS-Medicaid, +99010,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,HEALTHPLUS-Medicaid, +99011,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,HEALTHPLUS-Medicaid, +99012,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,HEALTHPLUS-Medicaid, +99013,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,HEALTHPLUS-Medicaid, +99014,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,HEALTHPLUS-Medicaid, +99015,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,HEALTHPLUS-Medicaid, +99016,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,HEALTHPLUS-Medicaid, +99017,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,HEALTHPLUS-Medicaid, +99018,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,HEALTHPLUS-Medicaid, +99019,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,HEALTHPLUS-Medicaid, +99020,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,HEALTHPLUS-Medicaid, +99021,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,HEALTHPLUS-Medicaid, +99022,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,HEALTHPLUS-Medicaid, +99023,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,HEALTHPLUS-Medicaid, +99024,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,HEALTHPLUS-Medicaid, +99025,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,HEALTHPLUS-Medicaid, +99026,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,HEALTHPLUS-Medicaid, +99027,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,HEALTHPLUS-Medicaid, +99028,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,HEALTHPLUS-Medicaid, +99029,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,HEALTHPLUS-Medicaid, +99030,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,HEALTHPLUS-Medicaid, +99031,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,HEALTHPLUS-Medicaid, +99032,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,HEALTHPLUS-Medicaid, +99033,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,HEALTHPLUS-Medicaid, +99034,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,HEALTHPLUS-Medicaid, +99035,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,HEALTHPLUS-Medicaid, +99036,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,HEALTHPLUS-Medicaid, +99037,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,HEALTHPLUS-Medicaid, +99038,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,HEALTHPLUS-Medicaid, +99039,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,HEALTHPLUS-Medicaid, +99040,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,HEALTHPLUS-Medicaid, +99041,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,HEALTHPLUS-Medicaid, +99042,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,HEALTHPLUS-Medicaid, +99043,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,HEALTHPLUS-Medicaid, +99044,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,HEALTHPLUS-Medicaid, +99045,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,HEALTHPLUS-Medicaid, +99046,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,HEALTHPLUS-Medicaid, +99047,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,HEALTHPLUS-Medicaid, +99048,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,HEALTHPLUS-Medicaid, +99049,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,HEALTHPLUS-Medicaid, +99050,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,HEALTHPLUS-Medicaid, +99051,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,HEALTHPLUS-Medicaid, +99052,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,HEALTHPLUS-Medicaid, +99053,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,HEALTHPLUS-Medicaid, +99054,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,HEALTHPLUS-Medicaid, +99055,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,HEALTHPLUS-Medicaid, +99056,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,HEALTHPLUS-Medicaid, +99057,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,HEALTHPLUS-Medicaid, +99058,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-Medicaid, +99059,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,HEALTHPLUS-Medicaid, +99060,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,HEALTHPLUS-Medicaid, +99061,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,HEALTHPLUS-Medicaid, +99062,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,HEALTHPLUS-Medicaid, +99063,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,HEALTHPLUS-Medicaid, +99064,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,HEALTHPLUS-Medicaid, +99065,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,HEALTHPLUS-Medicaid, +99066,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,HEALTHPLUS-Medicaid, +99067,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,HEALTHPLUS-Medicaid, +99068,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,HEALTHPLUS-Medicaid, +99069,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,HEALTHPLUS-Medicaid, +99070,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,HEALTHPLUS-Medicaid, +99071,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,HEALTHPLUS-Medicaid, +99072,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,HEALTHPLUS-Medicaid, +99073,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,HEALTHPLUS-Medicaid, +99074,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,HEALTHPLUS-Medicaid, +99075,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,HEALTHPLUS-Medicaid, +99076,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,HEALTHPLUS-Medicaid, +99077,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,HEALTHPLUS-Medicaid, +99078,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,HEALTHPLUS-Medicaid, +99079,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,HEALTHPLUS-Medicaid, +99080,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,HEALTHPLUS-Medicaid, +99081,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,HEALTHPLUS-Medicaid, +99082,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,HEALTHPLUS-Medicaid, +99083,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,HEALTHPLUS-Medicaid, +99084,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,HEALTHPLUS-Medicaid, +99085,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,HEALTHPLUS-Medicaid, +99086,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,HEALTHPLUS-Medicaid, +99087,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,HEALTHPLUS-Medicaid, +99088,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,HEALTHPLUS-Medicaid, +99089,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,HEALTHPLUS-Medicaid, +99090,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,HEALTHPLUS-Medicaid, +99091,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,HEALTHPLUS-Medicaid, +99092,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,HEALTHPLUS-Medicaid, +99093,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,HEALTHPLUS-Medicaid,136.35 +99094,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,HEALTHPLUS-Medicaid, +99095,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,HEALTHPLUS-Medicaid, +99096,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,HEALTHPLUS-Medicaid, +99097,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,HEALTHPLUS-Medicaid, +99098,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,HEALTHPLUS-Medicaid, +99099,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,HEALTHPLUS-Medicaid, +99100,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,HEALTHPLUS-Medicaid, +99101,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,HEALTHPLUS-Medicaid, +99102,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,HEALTHPLUS-Medicaid, +99103,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,HEALTHPLUS-Medicaid, +99104,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,HEALTHPLUS-Medicaid, +99105,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,HEALTHPLUS-Medicaid, +99106,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,HEALTHPLUS-Medicaid, +99107,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,HEALTHPLUS-Medicaid, +99108,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,HEALTHPLUS-Medicaid, +99109,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,HEALTHPLUS-Medicaid, +99110,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,HEALTHPLUS-Medicaid, +99111,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,HEALTHPLUS-Medicaid, +99112,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,HEALTHPLUS-Medicaid, +99113,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,HEALTHPLUS-Medicaid, +99114,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,HEALTHPLUS-Medicaid, +99115,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,HEALTHPLUS-Medicaid, +99116,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,HEALTHPLUS-Medicaid, +99117,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,HEALTHPLUS-Medicaid, +99118,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,HEALTHPLUS-Medicaid, +99119,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,HEALTHPLUS-Medicaid, +99120,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,HEALTHPLUS-Medicaid, +99121,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,HEALTHPLUS-Medicaid, +99122,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,HEALTHPLUS-Medicaid, +99123,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,HEALTHPLUS-Medicaid, +99124,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,HEALTHPLUS-Medicaid, +99125,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,HEALTHPLUS-Medicaid, +99126,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,HEALTHPLUS-Medicaid, +99127,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,HEALTHPLUS-Medicaid, +99128,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,HEALTHPLUS-Medicaid, +99129,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,HEALTHPLUS-Medicaid, +99130,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,HEALTHPLUS-Medicaid, +99131,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,HEALTHPLUS-Medicaid, +99132,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,HEALTHPLUS-Medicaid, +99133,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,HEALTHPLUS-Medicaid, +99134,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,HEALTHPLUS-Medicaid, +99135,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,HEALTHPLUS-Medicaid, +99136,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,HEALTHPLUS-Medicaid, +99137,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,HEALTHPLUS-Medicaid, +99138,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,HEALTHPLUS-Medicaid, +99139,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,HEALTHPLUS-Medicaid, +99140,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,HEALTHPLUS-Medicaid, +99141,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,HEALTHPLUS-Medicaid, +99142,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,HEALTHPLUS-Medicaid, +99143,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,HEALTHPLUS-Medicaid, +99144,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,HEALTHPLUS-Medicaid, +99145,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,HEALTHPLUS-Medicaid, +99146,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,HEALTHPLUS-Medicaid, +99147,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,HEALTHPLUS-Medicaid, +99148,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,HEALTHPLUS-Medicaid, +99149,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,HEALTHPLUS-Medicaid, +99150,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,HEALTHPLUS-Medicaid, +99151,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,HEALTHPLUS-Medicaid, +99152,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,HEALTHPLUS-Medicaid, +99153,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,HEALTHPLUS-Medicaid, +99154,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,HEALTHPLUS-Medicaid, +99155,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,HEALTHPLUS-Medicaid, +99156,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,HEALTHPLUS-Medicaid, +99157,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,HEALTHPLUS-Medicaid, +99158,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,HEALTHPLUS-Medicaid, +99159,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,HEALTHPLUS-Medicaid, +99160,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,HEALTHPLUS-Medicaid, +99161,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,HEALTHPLUS-Medicaid, +99162,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,HEALTHPLUS-Medicaid, +99163,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,HEALTHPLUS-Medicaid, +99164,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,HEALTHPLUS-Medicaid, +99165,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,HEALTHPLUS-Medicaid, +99166,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,HEALTHPLUS-Medicaid, +99167,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,HEALTHPLUS-Medicaid, +99168,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,HEALTHPLUS-Medicaid, +99169,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,HEALTHPLUS-Medicaid, +99170,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,HEALTHPLUS-Medicaid, +99171,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,HEALTHPLUS-Medicaid, +99172,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,HEALTHPLUS-Medicaid, +99173,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,HEALTHPLUS-Medicaid, +99174,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,HEALTHPLUS-Medicaid, +99175,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,HEALTHPLUS-Medicaid, +99176,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,HEALTHPLUS-Medicaid, +99177,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,HEALTHPLUS-Medicaid, +99178,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,HEALTHPLUS-Medicaid, +99179,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,HEALTHPLUS-Medicaid, +99180,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,HEALTHPLUS-Medicaid, +99181,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,HEALTHPLUS-Medicaid, +99182,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,HEALTHPLUS-Medicaid, +99183,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,HEALTHPLUS-Medicaid, +99184,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,HEALTHPLUS-Medicaid, +99185,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,HEALTHPLUS-Medicaid, +99186,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,HEALTHPLUS-Medicaid, +99187,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,HEALTHPLUS-Medicaid, +99188,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,HEALTHPLUS-Medicaid, +99189,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,HEALTHPLUS-Medicaid, +99190,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,HEALTHPLUS-Medicaid, +99191,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,HEALTHPLUS-Medicaid, +99192,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,HEALTHPLUS-Medicaid, +99193,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,HEALTHPLUS-Medicaid, +99194,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,HEALTHPLUS-Medicaid, +99195,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,HEALTHPLUS-Medicaid, +99196,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,HEALTHPLUS-Medicaid, +99197,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,HEALTHPLUS-Medicaid, +99198,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,HEALTHPLUS-Medicaid, +99199,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,HEALTHPLUS-Medicaid, +99200,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,HEALTHPLUS-Medicaid, +99201,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,HEALTHPLUS-Medicaid, +99202,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,HEALTHPLUS-Medicaid, +99203,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,HEALTHPLUS-Medicaid, +99204,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,HEALTHPLUS-Medicaid, +99205,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,HEALTHPLUS-Medicaid, +99206,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,HEALTHPLUS-Medicaid, +99207,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,HEALTHPLUS-Medicaid, +99208,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,HEALTHPLUS-Medicaid, +99209,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,HEALTHPLUS-Medicaid, +99210,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,HEALTHPLUS-Medicaid, +99211,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,HEALTHPLUS-Medicaid, +99212,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,HEALTHPLUS-Medicaid, +99213,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,HEALTHPLUS-Medicaid, +99214,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,HEALTHPLUS-Medicaid, +99215,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,HEALTHPLUS-Medicaid, +99216,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,HEALTHPLUS-Medicaid, +99217,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,HEALTHPLUS-Medicaid, +99218,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,HEALTHPLUS-Medicaid, +99219,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,HEALTHPLUS-Medicaid, +99220,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,HEALTHPLUS-Medicaid, +99221,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,HEALTHPLUS-Medicaid, +99222,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,HEALTHPLUS-Medicaid, +99223,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,HEALTHPLUS-Medicaid, +99224,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,HEALTHPLUS-Medicaid, +99225,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,HEALTHPLUS-Medicaid,2787.95 +99226,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,HEALTHPLUS-Medicaid, +99227,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,HEALTHPLUS-Medicaid, +99228,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,HEALTHPLUS-Medicaid, +99229,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,HEALTHPLUS-Medicaid, +99230,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,HEALTHPLUS-Medicaid, +99231,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,HEALTHPLUS-Medicaid, +99232,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,HEALTHPLUS-Medicaid, +99233,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,HEALTHPLUS-Medicaid, +99234,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,HEALTHPLUS-Medicaid, +99235,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,HEALTHPLUS-Medicaid, +99236,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,HEALTHPLUS-Medicaid, +99237,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,HEALTHPLUS-Medicaid, +99238,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,HEALTHPLUS-Medicaid, +99239,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,HEALTHPLUS-Medicaid, +99240,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,HEALTHPLUS-Medicaid, +99241,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,HEALTHPLUS-Medicaid, +99242,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,HEALTHPLUS-Medicaid, +99243,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,HEALTHPLUS-Medicaid, +99244,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,HEALTHPLUS-Medicaid, +99245,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,HEALTHPLUS-Medicaid, +99246,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,HEALTHPLUS-Medicaid, +99247,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,HEALTHPLUS-Medicaid, +99248,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,HEALTHPLUS-Medicaid, +99249,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,HEALTHPLUS-Medicaid, +99250,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,HEALTHPLUS-Medicaid, +99251,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,HEALTHPLUS-Medicaid, +99252,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,HEALTHPLUS-Medicaid, +99253,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,HEALTHPLUS-Medicaid, +99254,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,HEALTHPLUS-Medicaid, +99255,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,HEALTHPLUS-Medicaid, +99256,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,HEALTHPLUS-Medicaid, +99257,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,HEALTHPLUS-Medicaid, +99258,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,HEALTHPLUS-Medicaid, +99259,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,HEALTHPLUS-Medicaid, +99260,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,HEALTHPLUS-Medicaid, +99261,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,HEALTHPLUS-Medicaid, +99262,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,HEALTHPLUS-Medicaid, +99263,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,HEALTHPLUS-Medicaid, +99264,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,HEALTHPLUS-Medicaid, +99265,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,HEALTHPLUS-Medicaid, +99266,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,HEALTHPLUS-Medicaid, +99267,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,HEALTHPLUS-Medicaid, +99268,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,HEALTHPLUS-Medicaid, +99269,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,HEALTHPLUS-Medicaid, +99270,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,HEALTHPLUS-Medicaid, +99271,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,HEALTHPLUS-Medicaid, +99272,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,HEALTHPLUS-Medicaid, +99273,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,HEALTHPLUS-Medicaid, +99274,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,HEALTHPLUS-Medicaid, +99275,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,HEALTHPLUS-Medicaid, +99276,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,HEALTHPLUS-Medicaid, +99277,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,HEALTHPLUS-Medicaid, +99278,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,HEALTHPLUS-Medicaid, +99279,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,HEALTHPLUS-Medicaid, +99280,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,HEALTHPLUS-Medicaid, +99281,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,HEALTHPLUS-Medicaid, +99282,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,HEALTHPLUS-Medicaid, +99283,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,HEALTHPLUS-Medicaid, +99284,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,HEALTHPLUS-Medicaid, +99285,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,HEALTHPLUS-Medicaid, +99286,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,HEALTHPLUS-Medicaid, +99287,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,HEALTHPLUS-Medicaid, +99288,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,HEALTHPLUS-Medicaid, +99289,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,HEALTHPLUS-Medicaid, +99290,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,HEALTHPLUS-Medicaid, +99291,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,HEALTHPLUS-Medicaid, +99292,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,HEALTHPLUS-Medicaid, +99293,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,HEALTHPLUS-Medicaid, +99294,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,HEALTHPLUS-Medicaid, +99295,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,HEALTHPLUS-Medicaid, +99296,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,HEALTHPLUS-Medicaid, +99297,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,HEALTHPLUS-Medicaid, +99298,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,HEALTHPLUS-Medicaid, +99299,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,HEALTHPLUS-Medicaid, +99300,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,HEALTHPLUS-Medicaid, +99301,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,HEALTHPLUS-Medicaid, +99302,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,HEALTHPLUS-Medicaid, +99303,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,HEALTHPLUS-Medicaid, +99304,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,HEALTHPLUS-Medicaid, +99305,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,HEALTHPLUS-Medicaid, +99306,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,HEALTHPLUS-Medicaid, +99307,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,HEALTHPLUS-Medicaid, +99308,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,HEALTHPLUS-Medicaid, +99309,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,HEALTHPLUS-Medicaid, +99310,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,HEALTHPLUS-Medicaid, +99311,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,HEALTHPLUS-Medicaid, +99312,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,HEALTHPLUS-Medicaid, +99313,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,HEALTHPLUS-Medicaid, +99314,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,HEALTHPLUS-Medicaid, +99315,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,HEALTHPLUS-Medicaid, +99316,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,HEALTHPLUS-Medicaid, +99317,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,HEALTHPLUS-Medicaid, +99318,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,HEALTHPLUS-Medicaid, +99319,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,HEALTHPLUS-Medicaid, +99320,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,HEALTHPLUS-Medicaid, +99321,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,HEALTHPLUS-Medicaid, +99322,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,HEALTHPLUS-Medicaid, +99323,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,HEALTHPLUS-Medicaid, +99324,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,HEALTHPLUS-Medicaid, +99325,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,HEALTHPLUS-Medicaid, +99326,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,HEALTHPLUS-Medicaid,572.04 +99327,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,HEALTHPLUS-Medicaid, +99328,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,HEALTHPLUS-Medicaid, +99329,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,HEALTHPLUS-Medicaid, +99330,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,HEALTHPLUS-Medicaid, +99331,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,HEALTHPLUS-Medicaid, +99332,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,HEALTHPLUS-Medicaid, +99333,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,HEALTHPLUS-Medicaid, +99334,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,HEALTHPLUS-Medicaid, +99335,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,HEALTHPLUS-Medicaid, +99336,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,HEALTHPLUS-Medicaid, +99337,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,HEALTHPLUS-Medicaid, +99338,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,HEALTHPLUS-Medicaid, +99339,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,HEALTHPLUS-Medicaid, +99340,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,HEALTHPLUS-Medicaid, +99341,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,HEALTHPLUS-Medicaid, +99342,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,HEALTHPLUS-Medicaid, +99343,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,HEALTHPLUS-Medicaid, +99344,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,HEALTHPLUS-Medicaid, +99345,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,HEALTHPLUS-Medicaid, +99346,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,HEALTHPLUS-Medicaid, +99347,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,HEALTHPLUS-Medicaid, +99348,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,HEALTHPLUS-Medicaid, +99349,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,HEALTHPLUS-Medicaid, +99350,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,HEALTHPLUS-Medicaid, +99351,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,HEALTHPLUS-Medicaid, +99352,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,HEALTHPLUS-Medicaid, +99353,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,HEALTHPLUS-Medicaid, +99354,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,HEALTHPLUS-Medicaid, +99355,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,HEALTHPLUS-Medicaid, +99356,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,HEALTHPLUS-Medicaid, +99357,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,HEALTHPLUS-Medicaid, +99358,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,HEALTHPLUS-Medicaid, +99359,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,HEALTHPLUS-Medicaid, +99360,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,HEALTHPLUS-Medicaid, +99361,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,HEALTHPLUS-Medicaid, +99362,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,HEALTHPLUS-Medicaid, +99363,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,HEALTHPLUS-Medicaid, +99364,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,HEALTHPLUS-Medicaid, +99365,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,HEALTHPLUS-Medicaid, +99366,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,HEALTHPLUS-Medicaid, +99367,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,HEALTHPLUS-Medicaid, +99368,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,HEALTHPLUS-Medicaid, +99369,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,HEALTHPLUS-Medicaid, +99370,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,HEALTHPLUS-Medicaid, +99371,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,HEALTHPLUS-Medicaid, +99372,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,HEALTHPLUS-Medicaid, +99373,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,HEALTHPLUS-Medicaid, +99374,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,HEALTHPLUS-Medicaid, +99375,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,HEALTHPLUS-Medicaid, +99376,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,HEALTHPLUS-Medicaid, +99377,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,HEALTHPLUS-Medicaid, +99378,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,HEALTHPLUS-Medicaid, +99379,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,HEALTHPLUS-Medicaid, +99380,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,HEALTHPLUS-Medicaid, +99381,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,HEALTHPLUS-Medicaid, +99382,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,HEALTHPLUS-Medicaid, +99383,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,HEALTHPLUS-Medicaid, +99384,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,HEALTHPLUS-Medicaid, +99385,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,HEALTHPLUS-Medicaid, +99386,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,HEALTHPLUS-Medicaid, +99387,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,HEALTHPLUS-Medicaid, +99388,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,HEALTHPLUS-Medicaid, +99389,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,HEALTHPLUS-Medicaid, +99390,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,HEALTHPLUS-Medicaid, +99391,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,HEALTHPLUS-Medicaid, +99392,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,HEALTHPLUS-Medicaid, +99393,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,HEALTHPLUS-Medicaid, +99394,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,HEALTHPLUS-Medicaid, +99395,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,HEALTHPLUS-Medicaid, +99396,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,HEALTHPLUS-Medicaid, +99397,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,HEALTHPLUS-Medicaid, +99398,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,HEALTHPLUS-Medicaid, +99399,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,HEALTHPLUS-Medicaid, +99400,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,HEALTHPLUS-Medicaid, +99401,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,HEALTHPLUS-Medicaid,233.07 +99402,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,HEALTHPLUS-Medicaid, +99403,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,HEALTHPLUS-Medicaid, +99404,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,HEALTHPLUS-Medicaid, +99405,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,HEALTHPLUS-Medicaid, +99406,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,HEALTHPLUS-Medicaid, +99407,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,HEALTHPLUS-Medicaid,47.81 +99408,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,HEALTHPLUS-Medicaid, +99409,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,HEALTHPLUS-Medicaid,284.59 +99410,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,HEALTHPLUS-Medicaid, +99411,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,HEALTHPLUS-Medicaid, +99412,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,HEALTHPLUS-Medicaid, +99413,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,HEALTHPLUS-Medicaid, +99414,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,HEALTHPLUS-Medicaid, +99415,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,HEALTHPLUS-Medicaid, +99416,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,HEALTHPLUS-Medicaid, +99417,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,HEALTHPLUS-Medicaid, +99418,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,HEALTHPLUS-Medicaid, +99419,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,HEALTHPLUS-Medicaid, +99420,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,HEALTHPLUS-Medicaid, +99421,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,HEALTHPLUS-Medicaid, +99422,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,HEALTHPLUS-Medicaid, +99423,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,HEALTHPLUS-Medicaid, +99424,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,HEALTHPLUS-Medicaid, +99425,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,HEALTHPLUS-Medicaid, +99426,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,HEALTHPLUS-Medicaid, +99427,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,HEALTHPLUS-Medicaid, +99428,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,HEALTHPLUS-Medicaid, +99429,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,HEALTHPLUS-Medicaid, +99430,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,HEALTHPLUS-Medicaid, +99431,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,HEALTHPLUS-Medicaid, +99432,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,HEALTHPLUS-Medicaid, +99433,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,HEALTHPLUS-Medicaid, +99434,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,HEALTHPLUS-Medicaid, +99435,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,HEALTHPLUS-Medicaid, +99436,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,HEALTHPLUS-Medicaid, +99437,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,HEALTHPLUS-Medicaid, +99438,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,HEALTHPLUS-Medicaid, +99439,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,HEALTHPLUS-Medicaid, +99440,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,HEALTHPLUS-Medicaid, +99441,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,HEALTHPLUS-Medicaid, +99442,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,HEALTHPLUS-Medicaid, +99443,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,HEALTHPLUS-Medicaid, +99444,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,HEALTHPLUS-Medicaid, +99445,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,HEALTHPLUS-Medicaid, +99446,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,HEALTHPLUS-Medicaid, +99447,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,HEALTHPLUS-Medicaid, +99448,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,HEALTHPLUS-Medicaid, +99449,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,HEALTHPLUS-Medicaid, +99450,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,HEALTHPLUS-Medicaid, +99451,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,HEALTHPLUS-Medicaid, +99452,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,HEALTHPLUS-Medicaid, +99453,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,HEALTHPLUS-Medicaid, +99454,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,HEALTHPLUS-Medicaid, +99455,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,HEALTHPLUS-Medicaid, +99456,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,HEALTHPLUS-Medicaid, +99457,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,HEALTHPLUS-Medicaid, +99458,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,HEALTHPLUS-Medicaid, +99459,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,HEALTHPLUS-Medicaid, +99460,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,HEALTHPLUS-Medicaid, +99461,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,HEALTHPLUS-Medicaid, +99462,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,HEALTHPLUS-Medicaid, +99463,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,HEALTHPLUS-Medicaid, +99464,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,HEALTHPLUS-Medicaid, +99465,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,HEALTHPLUS-Medicaid, +99466,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,HEALTHPLUS-Medicaid, +99467,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,HEALTHPLUS-Medicaid, +99468,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,HEALTHPLUS-Medicaid, +99469,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,HEALTHPLUS-Medicaid, +99470,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,HEALTHPLUS-Medicaid, +99471,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,HEALTHPLUS-Medicaid, +99472,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,HEALTHPLUS-Medicaid, +99473,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,HEALTHPLUS-Medicaid, +99474,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,HEALTHPLUS-Medicaid, +99475,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,HEALTHPLUS-Medicaid, +99476,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,HEALTHPLUS-Medicaid, +99477,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,HEALTHPLUS-Medicaid, +99478,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,HEALTHPLUS-Medicaid, +99479,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,HEALTHPLUS-Medicaid, +99480,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,HEALTHPLUS-Medicaid, +99481,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,HEALTHPLUS-Medicaid, +99482,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,HEALTHPLUS-Medicaid, +99483,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,HEALTHPLUS-Medicaid, +99484,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,HEALTHPLUS-Medicaid, +99485,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,HEALTHPLUS-Medicaid, +99486,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,HEALTHPLUS-Medicaid, +99487,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,HEALTHPLUS-Medicaid, +99488,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,HEALTHPLUS-Medicaid, +99489,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,HEALTHPLUS-Medicaid, +99490,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,HEALTHPLUS-Medicaid, +99491,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,HEALTHPLUS-Medicaid, +99492,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,HEALTHPLUS-Medicaid, +99493,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,HEALTHPLUS-Medicaid, +99494,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,HEALTHPLUS-Medicaid, +99495,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,HEALTHPLUS-Medicaid, +99496,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,HEALTHPLUS-Medicaid, +99497,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,HEALTHPLUS-Medicaid, +99498,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,HEALTHPLUS-Medicaid, +99499,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,HEALTHPLUS-Medicaid, +99500,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,HEALTHPLUS-Medicaid, +99501,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,HEALTHPLUS-Medicaid, +99502,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,HEALTHPLUS-Medicaid, +99503,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,HEALTHPLUS-Medicaid, +99504,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,HEALTHPLUS-Medicaid, +99505,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,HEALTHPLUS-Medicaid, +99506,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,HEALTHPLUS-Medicaid, +99507,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,HEALTHPLUS-Medicaid, +99508,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,HEALTHPLUS-Medicaid, +99509,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,HEALTHPLUS-Medicaid, +99510,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,HEALTHPLUS-Medicaid, +99511,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,HEALTHPLUS-Medicaid, +99512,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,HEALTHPLUS-Medicaid, +99513,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,HEALTHPLUS-Medicaid, +99514,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,HEALTHPLUS-Medicaid, +99515,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,HEALTHPLUS-Medicaid, +99516,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,HEALTHPLUS-Medicaid, +99517,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,HEALTHPLUS-Medicaid, +99518,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,HEALTHPLUS-Medicaid, +99519,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,HEALTHPLUS-Medicaid, +99520,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,HEALTHPLUS-Medicaid, +99521,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,HEALTHPLUS-Medicaid, +99522,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,HEALTHPLUS-Medicaid, +99523,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,HEALTHPLUS-Medicaid, +99524,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,HEALTHPLUS-Medicaid, +99525,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,HEALTHPLUS-Medicaid, +99526,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,HEALTHPLUS-Medicaid, +99527,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,HEALTHPLUS-Medicaid, +99528,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,HEALTHPLUS-Medicaid, +99529,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,HEALTHPLUS-Medicaid, +99530,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,HEALTHPLUS-Medicaid, +99531,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,HEALTHPLUS-Medicaid, +99532,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,HEALTHPLUS-Medicaid, +99533,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,HEALTHPLUS-Medicaid, +99534,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,HEALTHPLUS-Medicaid, +99535,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,HEALTHPLUS-Medicaid, +99536,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,HEALTHPLUS-Medicaid, +99537,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,HEALTHPLUS-Medicaid, +99538,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,HEALTHPLUS-Medicaid, +99539,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,HEALTHPLUS-Medicaid, +99540,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,HEALTHPLUS-Medicaid, +99541,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,HEALTHPLUS-Medicaid, +99542,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,HEALTHPLUS-Medicaid, +99543,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,HEALTHPLUS-Medicaid, +99544,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,HEALTHPLUS-Medicaid, +99545,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,HEALTHPLUS-Medicaid, +99546,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,HEALTHPLUS-Medicaid, +99547,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,HEALTHPLUS-Medicaid, +99548,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,HEALTHPLUS-Medicaid, +99549,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,HEALTHPLUS-Medicaid, +99550,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,HEALTHPLUS-Medicaid, +99551,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,HEALTHPLUS-Medicaid, +99552,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,HEALTHPLUS-Medicaid, +99553,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,HEALTHPLUS-Medicaid, +99554,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,HEALTHPLUS-Medicaid, +99555,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,HEALTHPLUS-Medicaid, +99556,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,HEALTHPLUS-Medicaid, +99557,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,HEALTHPLUS-Medicaid, +99558,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,HEALTHPLUS-Medicaid, +99559,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,HEALTHPLUS-Medicaid, +99560,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,HEALTHPLUS-Medicaid, +99561,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,HEALTHPLUS-Medicaid, +99562,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,HEALTHPLUS-Medicaid, +99563,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,HEALTHPLUS-Medicaid, +99564,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,HEALTHPLUS-Medicaid, +99565,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,HEALTHPLUS-Medicaid, +99566,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,HEALTHPLUS-Medicaid, +99567,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,HEALTHPLUS-Medicaid, +99568,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,HEALTHPLUS-Medicaid, +99569,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,HEALTHPLUS-Medicaid, +99570,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,HEALTHPLUS-Medicaid, +99571,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,HEALTHPLUS-Medicaid, +99572,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,HEALTHPLUS-Medicaid, +99573,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,HEALTHPLUS-Medicaid, +99574,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,HEALTHPLUS-Medicaid, +99575,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,HEALTHPLUS-Medicaid, +99576,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,HEALTHPLUS-Medicaid, +99577,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,HEALTHPLUS-Medicaid, +99578,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,HEALTHPLUS-Medicaid, +99579,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,HEALTHPLUS-Medicaid, +99580,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,HEALTHPLUS-Medicaid, +99581,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,HEALTHPLUS-Medicaid, +99582,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,HEALTHPLUS-Medicaid, +99583,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,HEALTHPLUS-Medicaid, +99584,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,HEALTHPLUS-Medicaid, +99585,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,HEALTHPLUS-Medicaid, +99586,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,HEALTHPLUS-Medicaid, +99587,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,HEALTHPLUS-Medicaid, +99588,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,HEALTHPLUS-Medicaid, +99589,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,HEALTHPLUS-Medicaid, +99590,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,HEALTHPLUS-Medicaid, +99591,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,HEALTHPLUS-Medicaid, +99592,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,HEALTHPLUS-Medicaid, +99593,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,HEALTHPLUS-Medicaid, +99594,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,HEALTHPLUS-Medicaid, +99595,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,HEALTHPLUS-Medicaid, +99596,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,HEALTHPLUS-Medicaid, +99597,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,HEALTHPLUS-Medicaid, +99598,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,HEALTHPLUS-Medicaid, +99599,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,HEALTHPLUS-Medicaid, +99600,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,HEALTHPLUS-Medicaid, +99601,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,HEALTHPLUS-Medicaid,8.68 +99602,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,HEALTHPLUS-Medicaid, +99603,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,HEALTHPLUS-Medicaid, +99604,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,HEALTHPLUS-Medicaid, +99605,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,HEALTHPLUS-Medicaid, +99606,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,HEALTHPLUS-Medicaid, +99607,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,HEALTHPLUS-Medicaid, +99608,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,HEALTHPLUS-Medicaid, +99609,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,HEALTHPLUS-Medicaid, +99610,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,HEALTHPLUS-Medicaid, +99611,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,HEALTHPLUS-Medicaid, +99612,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,HEALTHPLUS-Medicaid, +99613,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,HEALTHPLUS-Medicaid, +99614,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,HEALTHPLUS-Medicaid, +99615,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,HEALTHPLUS-Medicaid, +99616,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,HEALTHPLUS-Medicaid,281.64 +99617,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,HEALTHPLUS-Medicaid, +99618,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,HEALTHPLUS-Medicaid, +99619,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,HEALTHPLUS-Medicaid, +99620,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,HEALTHPLUS-Medicaid, +99621,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,HEALTHPLUS-Medicaid, +99622,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,HEALTHPLUS-Medicaid, +99623,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,HEALTHPLUS-Medicaid, +99624,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,HEALTHPLUS-Medicaid, +99625,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,HEALTHPLUS-Medicaid, +99626,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,HEALTHPLUS-Medicaid, +99627,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,HEALTHPLUS-Medicaid, +99628,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,HEALTHPLUS-Medicaid, +99629,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,HEALTHPLUS-Medicaid, +99630,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,HEALTHPLUS-Medicaid, +99631,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,HEALTHPLUS-Medicaid, +99632,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,HEALTHPLUS-Medicaid, +99633,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,HEALTHPLUS-Medicaid, +99634,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,HEALTHPLUS-Medicaid, +99635,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,HEALTHPLUS-Medicaid, +99636,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,HEALTHPLUS-Medicaid, +99637,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,HEALTHPLUS-Medicaid, +99638,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,HEALTHPLUS-Medicaid, +99639,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,HEALTHPLUS-Medicaid, +99640,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,HEALTHPLUS-Medicaid, +99641,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,HEALTHPLUS-Medicaid, +99642,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,HEALTHPLUS-Medicaid, +99643,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,HEALTHPLUS-Medicaid, +99644,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,HEALTHPLUS-Medicaid, +99645,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,HEALTHPLUS-Medicaid, +99646,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,HEALTHPLUS-Medicaid, +99647,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,HEALTHPLUS-Medicaid, +99648,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,HEALTHPLUS-Medicaid, +99649,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,HEALTHPLUS-Medicaid, +99650,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,HEALTHPLUS-Medicaid, +99651,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,HEALTHPLUS-Medicaid, +99652,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,HEALTHPLUS-Medicaid, +99653,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,HEALTHPLUS-Medicaid, +99654,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,HEALTHPLUS-Medicaid, +99655,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,HEALTHPLUS-Medicaid, +99656,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,HEALTHPLUS-Medicaid, +99657,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,HEALTHPLUS-Medicaid, +99658,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,HEALTHPLUS-Medicaid, +99659,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,HEALTHPLUS-Medicaid, +99660,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,HEALTHPLUS-Medicaid, +99661,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,HEALTHPLUS-Medicaid, +99662,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,HEALTHPLUS-Medicaid, +99663,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,HEALTHPLUS-Medicaid, +99664,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,HEALTHPLUS-Medicaid, +99665,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,HEALTHPLUS-Medicaid, +99666,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,HEALTHPLUS-Medicaid, +99667,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,HEALTHPLUS-Medicaid, +99668,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,HEALTHPLUS-Medicaid, +99669,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,HEALTHPLUS-Medicaid, +99670,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,HEALTHPLUS-Medicaid, +99671,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,HEALTHPLUS-Medicaid, +99672,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,HEALTHPLUS-Medicaid, +99673,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,HEALTHPLUS-Medicaid, +99674,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,HEALTHPLUS-Medicaid, +99675,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,HEALTHPLUS-Medicaid, +99676,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,HEALTHPLUS-Medicaid, +99677,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,HEALTHPLUS-Medicaid, +99678,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,HEALTHPLUS-Medicaid, +99679,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,HEALTHPLUS-Medicaid, +99680,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,HEALTHPLUS-Medicaid, +99681,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-Medicaid, +99682,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-Medicaid, +99683,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,HEALTHPLUS-Medicaid, +99684,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,HEALTHPLUS-Medicaid, +99685,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,HEALTHPLUS-Medicaid, +99686,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,HEALTHPLUS-Medicaid, +99687,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,HEALTHPLUS-Medicaid, +99688,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,HEALTHPLUS-Medicaid, +99689,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,HEALTHPLUS-Medicaid, +99690,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,HEALTHPLUS-Medicaid, +99691,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,HEALTHPLUS-Medicaid, +99692,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,HEALTHPLUS-Medicaid, +99693,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,HEALTHPLUS-Medicaid, +99694,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,HEALTHPLUS-Medicaid, +99695,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,HEALTHPLUS-Medicaid, +99696,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,HEALTHPLUS-Medicaid, +99697,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,HEALTHPLUS-Medicaid, +99698,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,HEALTHPLUS-Medicaid, +99699,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,HEALTHPLUS-Medicaid, +99700,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,HEALTHPLUS-Medicaid, +99701,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,HEALTHPLUS-Medicaid, +99702,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,HEALTHPLUS-Medicaid, +99703,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,HEALTHPLUS-Medicaid, +99704,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,HEALTHPLUS-Medicaid, +99705,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,HEALTHPLUS-Medicaid, +99706,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,HEALTHPLUS-Medicaid, +99707,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,HEALTHPLUS-Medicaid, +99708,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,HEALTHPLUS-Medicaid, +99709,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,HEALTHPLUS-Medicaid, +99710,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,HEALTHPLUS-Medicaid, +99711,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,HEALTHPLUS-Medicaid, +99712,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,HEALTHPLUS-Medicaid, +99713,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,HEALTHPLUS-Medicaid, +99714,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,HEALTHPLUS-Medicaid, +99715,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,HEALTHPLUS-Medicaid, +99716,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,HEALTHPLUS-Medicaid, +99717,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,HEALTHPLUS-Medicaid, +99718,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,HEALTHPLUS-Medicaid, +99719,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,HEALTHPLUS-Medicaid, +99720,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,HEALTHPLUS-Medicaid, +99721,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,HEALTHPLUS-Medicaid, +99722,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,HEALTHPLUS-Medicaid, +99723,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,HEALTHPLUS-Medicaid, +99724,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,HEALTHPLUS-Medicaid, +99725,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,HEALTHPLUS-Medicaid, +99726,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,HEALTHPLUS-Medicaid, +99727,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,HEALTHPLUS-Medicaid,377.25 +99728,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,HEALTHPLUS-Medicaid, +99729,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,HEALTHPLUS-Medicaid, +99730,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,HEALTHPLUS-Medicaid, +99731,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,HEALTHPLUS-Medicaid, +99732,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,HEALTHPLUS-Medicaid, +99733,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,HEALTHPLUS-Medicaid, +99734,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,HEALTHPLUS-Medicaid, +99735,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,HEALTHPLUS-Medicaid, +99736,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,HEALTHPLUS-Medicaid, +99737,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,HEALTHPLUS-Medicaid, +99738,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,HEALTHPLUS-Medicaid, +99739,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,HEALTHPLUS-Medicaid, +99740,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,HEALTHPLUS-Medicaid, +99741,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,HEALTHPLUS-Medicaid, +99742,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,HEALTHPLUS-Medicaid, +99743,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,HEALTHPLUS-Medicaid, +99744,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,HEALTHPLUS-Medicaid, +99745,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,HEALTHPLUS-Medicaid, +99746,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,HEALTHPLUS-Medicaid, +99747,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,HEALTHPLUS-Medicaid, +99748,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,HEALTHPLUS-Medicaid, +99749,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,HEALTHPLUS-Medicaid, +99750,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,HEALTHPLUS-Medicaid, +99751,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,HEALTHPLUS-Medicaid, +99752,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,HEALTHPLUS-Medicaid, +99753,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,HEALTHPLUS-Medicaid, +99754,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,HEALTHPLUS-Medicaid, +99755,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,HEALTHPLUS-Medicaid, +99756,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,HEALTHPLUS-Medicaid, +99757,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,HEALTHPLUS-Medicaid, +99758,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,HEALTHPLUS-Medicaid, +99759,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,HEALTHPLUS-Medicaid, +99760,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,HEALTHPLUS-Medicaid, +99761,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,HEALTHPLUS-Medicaid, +99762,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,HEALTHPLUS-Medicaid, +99763,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,HEALTHPLUS-Medicaid, +99764,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,HEALTHPLUS-Medicaid, +99765,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,HEALTHPLUS-Medicaid, +99766,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,HEALTHPLUS-Medicaid, +99767,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,HEALTHPLUS-Medicaid, +99768,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,HEALTHPLUS-Medicaid, +99769,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,HEALTHPLUS-Medicaid, +99770,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,HEALTHPLUS-Medicaid, +99771,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,HEALTHPLUS-Medicaid, +99772,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,HEALTHPLUS-Medicaid, +99773,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,HEALTHPLUS-Medicaid, +99774,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,HEALTHPLUS-Medicaid, +99775,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,HEALTHPLUS-Medicaid, +99776,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,HEALTHPLUS-Medicaid, +99777,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,HEALTHPLUS-Medicaid, +99778,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,HEALTHPLUS-Medicaid,966.28 +99779,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,HEALTHPLUS-Medicaid, +99780,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,HEALTHPLUS-Medicaid, +99781,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,HEALTHPLUS-Medicaid, +99782,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,HEALTHPLUS-Medicaid, +99783,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,HEALTHPLUS-Medicaid, +99784,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,HEALTHPLUS-Medicaid, +99785,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,HEALTHPLUS-Medicaid, +99786,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,HEALTHPLUS-Medicaid, +99787,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,HEALTHPLUS-Medicaid, +99788,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,HEALTHPLUS-Medicaid, +99789,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,HEALTHPLUS-Medicaid, +99790,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,HEALTHPLUS-Medicaid, +99791,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,HEALTHPLUS-Medicaid, +99792,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,HEALTHPLUS-Medicaid, +99793,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,HEALTHPLUS-Medicaid, +99794,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,HEALTHPLUS-Medicaid, +99795,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,HEALTHPLUS-Medicaid, +99796,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,HEALTHPLUS-Medicaid, +99797,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,HEALTHPLUS-Medicaid, +99798,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,HEALTHPLUS-Medicaid, +99799,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,HEALTHPLUS-Medicaid, +99800,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,HEALTHPLUS-Medicaid, +99801,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,HEALTHPLUS-Medicaid, +99802,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,HEALTHPLUS-Medicaid, +99803,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,HEALTHPLUS-Medicaid, +99804,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,HEALTHPLUS-Medicaid, +99805,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,HEALTHPLUS-Medicaid, +99806,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,HEALTHPLUS-Medicaid, +99807,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,HEALTHPLUS-Medicaid, +99808,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,HEALTHPLUS-Medicaid, +99809,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,HEALTHPLUS-Medicaid, +99810,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,HEALTHPLUS-Medicaid, +99811,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,HEALTHPLUS-Medicaid, +99812,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,HEALTHPLUS-Medicaid, +99813,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,HEALTHPLUS-Medicaid, +99814,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,HEALTHPLUS-Medicaid, +99815,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,HEALTHPLUS-Medicaid, +99816,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,HEALTHPLUS-Medicaid, +99817,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,HEALTHPLUS-Medicaid, +99818,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,HEALTHPLUS-Medicaid, +99819,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,HEALTHPLUS-Medicaid, +99820,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,HEALTHPLUS-Medicaid, +99821,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,HEALTHPLUS-Medicaid, +99822,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,HEALTHPLUS-Medicaid, +99823,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,HEALTHPLUS-Medicaid, +99824,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,HEALTHPLUS-Medicaid, +99825,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,HEALTHPLUS-Medicaid, +99826,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,HEALTHPLUS-Medicaid, +99827,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,HEALTHPLUS-Medicaid, +99828,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,HEALTHPLUS-Medicaid, +99829,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,HEALTHPLUS-Medicaid, +99830,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,HEALTHPLUS-Medicaid, +99831,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,HEALTHPLUS-Medicaid, +99832,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,HEALTHPLUS-Medicaid, +99833,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,HEALTHPLUS-Medicaid, +99834,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,HEALTHPLUS-Medicaid, +99835,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,HEALTHPLUS-Medicaid, +99836,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,HEALTHPLUS-Medicaid, +99837,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,HEALTHPLUS-Medicaid, +99838,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,HEALTHPLUS-Medicaid, +99839,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,HEALTHPLUS-Medicaid, +99840,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,HEALTHPLUS-Medicaid, +99841,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,HEALTHPLUS-Medicaid, +99842,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,HEALTHPLUS-Medicaid, +99843,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,HEALTHPLUS-Medicaid, +99844,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,HEALTHPLUS-Medicaid, +99845,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,HEALTHPLUS-Medicaid, +99846,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,HEALTHPLUS-Medicaid, +99847,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,HEALTHPLUS-Medicaid, +99848,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,HEALTHPLUS-Medicaid, +99849,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,HEALTHPLUS-Medicaid, +99850,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,HEALTHPLUS-Medicaid, +99851,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,HEALTHPLUS-Medicaid, +99852,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,HEALTHPLUS-Medicaid, +99853,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,HEALTHPLUS-Medicaid, +99854,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,HEALTHPLUS-Medicaid, +99855,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,HEALTHPLUS-Medicaid, +99856,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,HEALTHPLUS-Medicaid, +99857,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,HEALTHPLUS-Medicaid, +99858,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,HEALTHPLUS-Medicaid, +99859,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,HEALTHPLUS-Medicaid, +99860,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,HEALTHPLUS-Medicaid, +99861,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,HEALTHPLUS-Medicaid, +99862,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,HEALTHPLUS-Medicaid, +99863,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,HEALTHPLUS-Medicaid, +99864,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,HEALTHPLUS-Medicaid,409.81 +99865,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,HEALTHPLUS-Medicaid, +99866,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,HEALTHPLUS-Medicaid, +99867,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,HEALTHPLUS-Medicaid, +99868,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,HEALTHPLUS-Medicaid, +99869,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,HEALTHPLUS-Medicaid, +99870,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,HEALTHPLUS-Medicaid, +99871,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,HEALTHPLUS-Medicaid, +99872,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,HEALTHPLUS-Medicaid, +99873,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +99874,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,HEALTHPLUS-Medicaid, +99875,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,HEALTHPLUS-Medicaid, +99876,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,HEALTHPLUS-Medicaid, +99877,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,HEALTHPLUS-Medicaid, +99878,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,HEALTHPLUS-Medicaid, +99879,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,HEALTHPLUS-Medicaid, +99880,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,HEALTHPLUS-Medicaid, +99881,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,HEALTHPLUS-Medicaid, +99882,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,HEALTHPLUS-Medicaid, +99883,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,HEALTHPLUS-Medicaid, +99884,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,HEALTHPLUS-Medicaid, +99885,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,HEALTHPLUS-Medicaid, +99886,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,HEALTHPLUS-Medicaid, +99887,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,HEALTHPLUS-Medicaid, +99888,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,HEALTHPLUS-Medicaid, +99889,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,HEALTHPLUS-Medicaid, +99890,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,HEALTHPLUS-Medicaid, +99891,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,HEALTHPLUS-Medicaid, +99892,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,HEALTHPLUS-Medicaid, +99893,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,HEALTHPLUS-Medicaid, +99894,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,HEALTHPLUS-Medicaid, +99895,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,HEALTHPLUS-Medicaid, +99896,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,HEALTHPLUS-Medicaid, +99897,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,HEALTHPLUS-Medicaid, +99898,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,HEALTHPLUS-Medicaid, +99899,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,HEALTHPLUS-Medicaid, +99900,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,HEALTHPLUS-Medicaid, +99901,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,HEALTHPLUS-Medicaid, +99902,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,HEALTHPLUS-Medicaid, +99903,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,HEALTHPLUS-Medicaid, +99904,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,HEALTHPLUS-Medicaid, +99905,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,HEALTHPLUS-Medicaid, +99906,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,HEALTHPLUS-Medicaid, +99907,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,HEALTHPLUS-Medicaid, +99908,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,HEALTHPLUS-Medicaid, +99909,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,HEALTHPLUS-Medicaid, +99910,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,HEALTHPLUS-Medicaid, +99911,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,HEALTHPLUS-Medicaid, +99912,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,HEALTHPLUS-Medicaid, +99913,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,HEALTHPLUS-Medicaid, +99914,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,HEALTHPLUS-Medicaid, +99915,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,HEALTHPLUS-Medicaid, +99916,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,HEALTHPLUS-Medicaid, +99917,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,HEALTHPLUS-Medicaid, +99918,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,HEALTHPLUS-Medicaid, +99919,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,HEALTHPLUS-Medicaid, +99920,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,HEALTHPLUS-Medicaid, +99921,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,HEALTHPLUS-Medicaid, +99922,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,HEALTHPLUS-Medicaid, +99923,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,HEALTHPLUS-Medicaid, +99924,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,HEALTHPLUS-Medicaid, +99925,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,HEALTHPLUS-Medicaid, +99926,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,HEALTHPLUS-Medicaid, +99927,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,HEALTHPLUS-Medicaid, +99928,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,HEALTHPLUS-Medicaid, +99929,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,HEALTHPLUS-Medicaid, +99930,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,HEALTHPLUS-Medicaid, +99931,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,HEALTHPLUS-Medicaid, +99932,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,HEALTHPLUS-Medicaid, +99933,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,HEALTHPLUS-Medicaid, +99934,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,HEALTHPLUS-Medicaid, +99935,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,HEALTHPLUS-Medicaid, +99936,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,HEALTHPLUS-Medicaid, +99937,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,HEALTHPLUS-Medicaid, +99938,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,HEALTHPLUS-Medicaid, +99939,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,HEALTHPLUS-Medicaid, +99940,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,HEALTHPLUS-Medicaid, +99941,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,HEALTHPLUS-Medicaid, +99942,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,HEALTHPLUS-Medicaid, +99943,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,HEALTHPLUS-Medicaid, +99944,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,HEALTHPLUS-Medicaid, +99945,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,HEALTHPLUS-Medicaid, +99946,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,HEALTHPLUS-Medicaid, +99947,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,HEALTHPLUS-Medicaid, +99948,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,HEALTHPLUS-Medicaid, +99949,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,HEALTHPLUS-Medicaid, +99950,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,HEALTHPLUS-Medicaid, +99951,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,HEALTHPLUS-Medicaid, +99952,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,HEALTHPLUS-Medicaid, +99953,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,HEALTHPLUS-Medicaid, +99954,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,HEALTHPLUS-Medicaid, +99955,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,HEALTHPLUS-Medicaid, +99956,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,HEALTHPLUS-Medicaid, +99957,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,HEALTHPLUS-Medicaid, +99958,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,HEALTHPLUS-Medicaid, +99959,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,HEALTHPLUS-Medicaid, +99960,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,HEALTHPLUS-Medicaid, +99961,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,HEALTHPLUS-Medicaid, +99962,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,HEALTHPLUS-Medicaid, +99963,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,HEALTHPLUS-Medicaid, +99964,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,HEALTHPLUS-Medicaid, +99965,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,HEALTHPLUS-Medicaid, +99966,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,HEALTHPLUS-Medicaid, +99967,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,HEALTHPLUS-Medicaid, +99968,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,HEALTHPLUS-Medicaid, +99969,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,HEALTHPLUS-Medicaid, +99970,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,HEALTHPLUS-Medicaid, +99971,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,HEALTHPLUS-Medicaid, +99972,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,HEALTHPLUS-Medicaid, +99973,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,HEALTHPLUS-Medicaid, +99974,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,HEALTHPLUS-Medicaid, +99975,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,HEALTHPLUS-Medicaid, +99976,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,HEALTHPLUS-Medicaid, +99977,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,HEALTHPLUS-Medicaid, +99978,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,HEALTHPLUS-Medicaid, +99979,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,HEALTHPLUS-Medicaid, +99980,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,HEALTHPLUS-Medicaid, +99981,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,HEALTHPLUS-Medicaid, +99982,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,HEALTHPLUS-Medicaid, +99983,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,HEALTHPLUS-Medicaid, +99984,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,HEALTHPLUS-Medicaid, +99985,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,HEALTHPLUS-Medicaid, +99986,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,HEALTHPLUS-Medicaid, +99987,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,HEALTHPLUS-Medicaid, +99988,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,HEALTHPLUS-Medicaid, +99989,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,HEALTHPLUS-Medicaid, +99990,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,HEALTHPLUS-Medicaid, +99991,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,HEALTHPLUS-Medicaid, +99992,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,HEALTHPLUS-Medicaid, +99993,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,HEALTHPLUS-Medicaid, +99994,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,HEALTHPLUS-Medicaid, +99995,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,HEALTHPLUS-Medicaid, +99996,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,HEALTHPLUS-Medicaid, +99997,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,HEALTHPLUS-Medicaid, +99998,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,HEALTHPLUS-Medicaid, +99999,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,HEALTHPLUS-Medicaid, +100000,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,HEALTHPLUS-Medicaid, +100001,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,HEALTHPLUS-Medicaid, +100002,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,HEALTHPLUS-Medicaid, +100003,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,HEALTHPLUS-Medicaid, +100004,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,HEALTHPLUS-Medicaid, +100005,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,HEALTHPLUS-Medicaid, +100006,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,HEALTHPLUS-Medicaid, +100007,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,HEALTHPLUS-Medicaid, +100008,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,HEALTHPLUS-Medicaid, +100009,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,HEALTHPLUS-Medicaid, +100010,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,HEALTHPLUS-Medicaid, +100011,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,HEALTHPLUS-Medicaid, +100012,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,HEALTHPLUS-Medicaid, +100013,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,HEALTHPLUS-Medicaid, +100014,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,HEALTHPLUS-Medicaid, +100015,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,HEALTHPLUS-Medicaid, +100016,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,HEALTHPLUS-Medicaid, +100017,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,HEALTHPLUS-Medicaid, +100018,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,HEALTHPLUS-Medicaid, +100019,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,HEALTHPLUS-Medicaid, +100020,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,HEALTHPLUS-Medicaid, +100021,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,HEALTHPLUS-Medicaid, +100022,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,HEALTHPLUS-Medicaid, +100023,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,HEALTHPLUS-Medicaid, +100024,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,HEALTHPLUS-Medicaid, +100025,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,HEALTHPLUS-Medicaid, +100026,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,HEALTHPLUS-Medicaid, +100027,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,HEALTHPLUS-Medicaid, +100028,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,HEALTHPLUS-Medicaid, +100029,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,HEALTHPLUS-Medicaid, +100030,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,HEALTHPLUS-Medicaid, +100031,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,HEALTHPLUS-Medicaid, +100032,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,HEALTHPLUS-Medicaid, +100033,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,HEALTHPLUS-Medicaid, +100034,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,HEALTHPLUS-Medicaid, +100035,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,HEALTHPLUS-Medicaid, +100036,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,HEALTHPLUS-Medicaid, +100037,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,HEALTHPLUS-Medicaid, +100038,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,HEALTHPLUS-Medicaid, +100039,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,HEALTHPLUS-Medicaid, +100040,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,HEALTHPLUS-Medicaid, +100041,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,HEALTHPLUS-Medicaid, +100042,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,HEALTHPLUS-Medicaid, +100043,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,HEALTHPLUS-Medicaid, +100044,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,HEALTHPLUS-Medicaid, +100045,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,HEALTHPLUS-Medicaid, +100046,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,HEALTHPLUS-Medicaid, +100047,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,HEALTHPLUS-Medicaid, +100048,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,HEALTHPLUS-Medicaid, +100049,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,HEALTHPLUS-Medicaid, +100050,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,HEALTHPLUS-Medicaid, +100051,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,HEALTHPLUS-Medicaid, +100052,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,HEALTHPLUS-Medicaid, +100053,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,HEALTHPLUS-Medicaid, +100054,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,HEALTHPLUS-Medicaid, +100055,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,HEALTHPLUS-Medicaid, +100056,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,HEALTHPLUS-Medicaid, +100057,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,HEALTHPLUS-Medicaid, +100058,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,HEALTHPLUS-Medicaid, +100059,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,HEALTHPLUS-Medicaid, +100060,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,HEALTHPLUS-Medicaid, +100061,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,HEALTHPLUS-Medicaid, +100062,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,HEALTHPLUS-Medicaid, +100063,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,HEALTHPLUS-Medicaid, +100064,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,HEALTHPLUS-Medicaid, +100065,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,HEALTHPLUS-Medicaid, +100066,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,HEALTHPLUS-Medicaid, +100067,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,HEALTHPLUS-Medicaid, +100068,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,HEALTHPLUS-Medicaid, +100069,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,HEALTHPLUS-Medicaid, +100070,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,HEALTHPLUS-Medicaid, +100071,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,HEALTHPLUS-Medicaid, +100072,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,HEALTHPLUS-Medicaid, +100073,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,HEALTHPLUS-Medicaid, +100074,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,HEALTHPLUS-Medicaid, +100075,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,HEALTHPLUS-Medicaid, +100076,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,HEALTHPLUS-Medicaid, +100077,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,HEALTHPLUS-Medicaid, +100078,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,HEALTHPLUS-Medicaid, +100079,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,HEALTHPLUS-Medicaid, +100080,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,HEALTHPLUS-Medicaid, +100081,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,HEALTHPLUS-Medicaid, +100082,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,HEALTHPLUS-Medicaid, +100083,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,HEALTHPLUS-Medicaid, +100084,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,HEALTHPLUS-Medicaid, +100085,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,HEALTHPLUS-Medicaid, +100086,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,HEALTHPLUS-Medicaid, +100087,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,HEALTHPLUS-Medicaid, +100088,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,HEALTHPLUS-Medicaid, +100089,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,HEALTHPLUS-Medicaid, +100090,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,HEALTHPLUS-Medicaid, +100091,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,HEALTHPLUS-Medicaid, +100092,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,HEALTHPLUS-Medicaid, +100093,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,HEALTHPLUS-Medicaid, +100094,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,HEALTHPLUS-Medicaid, +100095,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,HEALTHPLUS-Medicaid, +100096,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,HEALTHPLUS-Medicaid, +100097,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,HEALTHPLUS-Medicaid, +100098,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,HEALTHPLUS-Medicaid, +100099,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,HEALTHPLUS-Medicaid, +100100,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,HEALTHPLUS-Medicaid, +100101,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,HEALTHPLUS-Medicaid, +100102,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,HEALTHPLUS-Medicaid, +100103,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,HEALTHPLUS-Medicaid, +100104,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,HEALTHPLUS-Medicaid, +100105,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,HEALTHPLUS-Medicaid, +100106,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,HEALTHPLUS-Medicaid, +100107,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,HEALTHPLUS-Medicaid, +100108,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,HEALTHPLUS-Medicaid, +100109,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,HEALTHPLUS-Medicaid, +100110,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,HEALTHPLUS-Medicaid, +100111,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,HEALTHPLUS-Medicaid, +100112,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,HEALTHPLUS-Medicaid, +100113,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,HEALTHPLUS-Medicaid, +100114,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,HEALTHPLUS-Medicaid, +100115,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,HEALTHPLUS-Medicaid, +100116,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,HEALTHPLUS-Medicaid, +100117,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,HEALTHPLUS-Medicaid, +100118,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,HEALTHPLUS-Medicaid, +100119,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,HEALTHPLUS-Medicaid, +100120,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,HEALTHPLUS-Medicaid, +100121,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,HEALTHPLUS-Medicaid, +100122,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,HEALTHPLUS-Medicaid, +100123,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,HEALTHPLUS-Medicaid, +100124,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,HEALTHPLUS-Medicaid, +100125,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,HEALTHPLUS-Medicaid, +100126,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,HEALTHPLUS-Medicaid, +100127,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,HEALTHPLUS-Medicaid, +100128,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,HEALTHPLUS-Medicaid, +100129,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,HEALTHPLUS-Medicaid, +100130,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,HEALTHPLUS-Medicaid, +100131,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,HEALTHPLUS-Medicaid, +100132,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,HEALTHPLUS-Medicaid, +100133,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,HEALTHPLUS-Medicaid, +100134,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,HEALTHPLUS-Medicaid, +100135,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,HEALTHPLUS-Medicaid, +100136,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,HEALTHPLUS-Medicaid, +100137,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,HEALTHPLUS-Medicaid, +100138,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,HEALTHPLUS-Medicaid, +100139,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,HEALTHPLUS-Medicaid, +100140,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,HEALTHPLUS-Medicaid, +100141,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,HEALTHPLUS-Medicaid, +100142,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,HEALTHPLUS-Medicaid, +100143,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,HEALTHPLUS-Medicaid, +100144,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,HEALTHPLUS-Medicaid, +100145,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,HEALTHPLUS-Medicaid, +100146,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,HEALTHPLUS-Medicaid, +100147,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,HEALTHPLUS-Medicaid, +100148,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,HEALTHPLUS-Medicaid, +100149,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,HEALTHPLUS-Medicaid, +100150,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,HEALTHPLUS-Medicaid, +100151,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,HEALTHPLUS-Medicaid, +100152,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,HEALTHPLUS-Medicaid, +100153,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,HEALTHPLUS-Medicaid, +100154,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,HEALTHPLUS-Medicaid, +100155,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,HEALTHPLUS-Medicaid, +100156,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,HEALTHPLUS-Medicaid, +100157,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,HEALTHPLUS-Medicaid, +100158,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,HEALTHPLUS-Medicaid, +100159,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,HEALTHPLUS-Medicaid, +100160,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,HEALTHPLUS-Medicaid, +100161,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,HEALTHPLUS-Medicaid, +100162,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,HEALTHPLUS-Medicaid, +100163,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,HEALTHPLUS-Medicaid, +100164,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,HEALTHPLUS-Medicaid, +100165,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,HEALTHPLUS-Medicaid, +100166,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,HEALTHPLUS-Medicaid, +100167,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,HEALTHPLUS-Medicaid, +100168,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,HEALTHPLUS-Medicaid, +100169,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,HEALTHPLUS-Medicaid, +100170,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,HEALTHPLUS-Medicaid, +100171,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,HEALTHPLUS-Medicaid, +100172,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,HEALTHPLUS-Medicaid, +100173,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,HEALTHPLUS-Medicaid, +100174,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,HEALTHPLUS-Medicaid, +100175,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,HEALTHPLUS-Medicaid, +100176,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,HEALTHPLUS-Medicaid, +100177,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,HEALTHPLUS-Medicaid, +100178,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,HEALTHPLUS-Medicaid, +100179,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,HEALTHPLUS-Medicaid, +100180,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,HEALTHPLUS-Medicaid, +100181,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,HEALTHPLUS-Medicaid, +100182,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,HEALTHPLUS-Medicaid, +100183,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,HEALTHPLUS-Medicaid, +100184,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,HEALTHPLUS-Medicaid, +100185,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,HEALTHPLUS-Medicaid, +100186,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,HEALTHPLUS-Medicaid, +100187,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,HEALTHPLUS-Medicaid, +100188,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,HEALTHPLUS-Medicaid, +100189,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,HEALTHPLUS-Medicaid, +100190,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,HEALTHPLUS-Medicaid, +100191,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,HEALTHPLUS-Medicaid, +100192,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,HEALTHPLUS-Medicaid, +100193,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,HEALTHPLUS-Medicaid, +100194,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,HEALTHPLUS-Medicaid, +100195,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,HEALTHPLUS-Medicaid, +100196,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,HEALTHPLUS-Medicaid, +100197,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,HEALTHPLUS-Medicaid, +100198,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,HEALTHPLUS-Medicaid, +100199,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,HEALTHPLUS-Medicaid, +100200,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,HEALTHPLUS-Medicaid, +100201,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,HEALTHPLUS-Medicaid, +100202,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,HEALTHPLUS-Medicaid, +100203,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,HEALTHPLUS-Medicaid, +100204,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,HEALTHPLUS-Medicaid, +100205,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,HEALTHPLUS-Medicaid, +100206,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,HEALTHPLUS-Medicaid, +100207,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,HEALTHPLUS-Medicaid, +100208,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,HEALTHPLUS-Medicaid, +100209,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,HEALTHPLUS-Medicaid, +100210,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,HEALTHPLUS-Medicaid, +100211,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,HEALTHPLUS-Medicaid, +100212,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,HEALTHPLUS-Medicaid, +100213,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,HEALTHPLUS-Medicaid, +100214,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,HEALTHPLUS-Medicaid, +100215,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,HEALTHPLUS-Medicaid, +100216,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,HEALTHPLUS-Medicaid, +100217,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,HEALTHPLUS-Medicaid, +100218,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,HEALTHPLUS-Medicaid, +100219,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,HEALTHPLUS-Medicaid, +100220,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,HEALTHPLUS-Medicaid, +100221,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,HEALTHPLUS-Medicaid, +100222,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,HEALTHPLUS-Medicaid, +100223,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,HEALTHPLUS-Medicaid, +100224,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,HEALTHPLUS-Medicaid, +100225,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,HEALTHPLUS-Medicaid, +100226,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,HEALTHPLUS-Medicaid, +100227,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,HEALTHPLUS-Medicaid, +100228,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +100229,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,HEALTHPLUS-Medicaid, +100230,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,HEALTHPLUS-Medicaid, +100231,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,HEALTHPLUS-Medicaid, +100232,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,HEALTHPLUS-Medicaid, +100233,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +100234,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +100235,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,HEALTHPLUS-Medicaid, +100236,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,HEALTHPLUS-Medicaid, +100237,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,HEALTHPLUS-Medicaid, +100238,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,HEALTHPLUS-Medicaid, +100239,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,HEALTHPLUS-Medicaid, +100240,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,HEALTHPLUS-Medicaid, +100241,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,HEALTHPLUS-Medicaid, +100242,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,HEALTHPLUS-Medicaid, +100243,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,HEALTHPLUS-Medicaid, +100244,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,HEALTHPLUS-Medicaid, +100245,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,HEALTHPLUS-Medicaid, +100246,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,HEALTHPLUS-Medicaid, +100247,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,HEALTHPLUS-Medicaid, +100248,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,HEALTHPLUS-Medicaid, +100249,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,HEALTHPLUS-Medicaid, +100250,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,HEALTHPLUS-Medicaid, +100251,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,HEALTHPLUS-Medicaid, +100252,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,HEALTHPLUS-Medicaid, +100253,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,HEALTHPLUS-Medicaid, +100254,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,HEALTHPLUS-Medicaid, +100255,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,HEALTHPLUS-Medicaid, +100256,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,HEALTHPLUS-Medicaid, +100257,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,HEALTHPLUS-Medicaid, +100258,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,HEALTHPLUS-Medicaid, +100259,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,HEALTHPLUS-Medicaid, +100260,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,HEALTHPLUS-Medicaid, +100261,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,HEALTHPLUS-Medicaid, +100262,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,HEALTHPLUS-Medicaid, +100263,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,HEALTHPLUS-Medicaid, +100264,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,HEALTHPLUS-Medicaid, +100265,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,HEALTHPLUS-Medicaid, +100266,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,HEALTHPLUS-Medicaid, +100267,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,HEALTHPLUS-Medicaid, +100268,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,HEALTHPLUS-Medicaid, +100269,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,HEALTHPLUS-Medicaid, +100270,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +100271,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,HEALTHPLUS-Medicaid, +100272,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,HEALTHPLUS-Medicaid, +100273,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,HEALTHPLUS-Medicaid, +100274,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,HEALTHPLUS-Medicaid, +100275,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,HEALTHPLUS-Medicaid, +100276,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,HEALTHPLUS-Medicaid, +100277,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,HEALTHPLUS-Medicaid, +100278,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,HEALTHPLUS-Medicaid, +100279,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,HEALTHPLUS-Medicaid, +100280,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,HEALTHPLUS-Medicaid, +100281,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,HEALTHPLUS-Medicaid, +100282,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,HEALTHPLUS-Medicaid, +100283,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,HEALTHPLUS-Medicaid, +100284,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,HEALTHPLUS-Medicaid, +100285,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,HEALTHPLUS-Medicaid, +100286,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,HEALTHPLUS-Medicaid, +100287,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,HEALTHPLUS-Medicaid, +100288,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,HEALTHPLUS-Medicaid, +100289,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,HEALTHPLUS-Medicaid, +100290,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,HEALTHPLUS-Medicaid, +100291,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,HEALTHPLUS-Medicaid, +100292,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,HEALTHPLUS-Medicaid, +100293,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,HEALTHPLUS-Medicaid, +100294,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,HEALTHPLUS-Medicaid, +100295,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,HEALTHPLUS-Medicaid, +100296,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,HEALTHPLUS-Medicaid, +100297,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,HEALTHPLUS-Medicaid, +100298,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,HEALTHPLUS-Medicaid, +100299,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,HEALTHPLUS-Medicaid, +100300,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,HEALTHPLUS-Medicaid, +100301,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,HEALTHPLUS-Medicaid,997.2 +100302,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,HEALTHPLUS-Medicaid, +100303,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,HEALTHPLUS-Medicaid, +100304,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,HEALTHPLUS-Medicaid, +100305,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,HEALTHPLUS-Medicaid, +100306,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,HEALTHPLUS-Medicaid, +100307,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,HEALTHPLUS-Medicaid, +100308,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,HEALTHPLUS-Medicaid, +100309,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,HEALTHPLUS-Medicaid, +100310,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,HEALTHPLUS-Medicaid, +100311,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,HEALTHPLUS-Medicaid, +100312,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,HEALTHPLUS-Medicaid, +100313,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,HEALTHPLUS-Medicaid, +100314,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,HEALTHPLUS-Medicaid, +100315,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,HEALTHPLUS-Medicaid, +100316,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,HEALTHPLUS-Medicaid, +100317,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,HEALTHPLUS-Medicaid, +100318,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,HEALTHPLUS-Medicaid, +100319,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,HEALTHPLUS-Medicaid, +100320,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,HEALTHPLUS-Medicaid, +100321,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,HEALTHPLUS-Medicaid, +100322,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,HEALTHPLUS-Medicaid, +100323,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,HEALTHPLUS-Medicaid, +100324,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,HEALTHPLUS-Medicaid, +100325,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,HEALTHPLUS-Medicaid, +100326,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,HEALTHPLUS-Medicaid, +100327,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,HEALTHPLUS-Medicaid, +100328,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,HEALTHPLUS-Medicaid, +100329,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,HEALTHPLUS-Medicaid, +100330,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,HEALTHPLUS-Medicaid, +100331,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,HEALTHPLUS-Medicaid, +100332,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,HEALTHPLUS-Medicaid, +100333,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,HEALTHPLUS-Medicaid, +100334,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,HEALTHPLUS-Medicaid, +100335,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,HEALTHPLUS-Medicaid, +100336,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,HEALTHPLUS-Medicaid, +100337,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,HEALTHPLUS-Medicaid, +100338,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,HEALTHPLUS-Medicaid, +100339,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,HEALTHPLUS-Medicaid, +100340,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,HEALTHPLUS-Medicaid, +100341,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,HEALTHPLUS-Medicaid, +100342,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,HEALTHPLUS-Medicaid, +100343,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,HEALTHPLUS-Medicaid, +100344,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,HEALTHPLUS-Medicaid, +100345,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-Medicaid, +100346,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,HEALTHPLUS-Medicaid, +100347,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,HEALTHPLUS-Medicaid, +100348,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,HEALTHPLUS-Medicaid, +100349,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,HEALTHPLUS-Medicaid, +100350,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,HEALTHPLUS-Medicaid, +100351,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,HEALTHPLUS-Medicaid, +100352,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,HEALTHPLUS-Medicaid, +100353,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,HEALTHPLUS-Medicaid, +100354,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,HEALTHPLUS-Medicaid, +100355,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,HEALTHPLUS-Medicaid, +100356,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,HEALTHPLUS-Medicaid, +100357,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,HEALTHPLUS-Medicaid, +100358,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,HEALTHPLUS-Medicaid, +100359,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,HEALTHPLUS-Medicaid, +100360,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,HEALTHPLUS-Medicaid, +100361,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,HEALTHPLUS-Medicaid, +100362,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,HEALTHPLUS-Medicaid, +100363,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,HEALTHPLUS-Medicaid, +100364,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,HEALTHPLUS-Medicaid, +100365,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,HEALTHPLUS-Medicaid, +100366,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,HEALTHPLUS-Medicaid, +100367,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,HEALTHPLUS-Medicaid, +100368,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,HEALTHPLUS-Medicaid, +100369,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,HEALTHPLUS-Medicaid, +100370,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,HEALTHPLUS-Medicaid, +100371,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,HEALTHPLUS-Medicaid, +100372,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,HEALTHPLUS-Medicaid, +100373,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,HEALTHPLUS-Medicaid, +100374,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,HEALTHPLUS-Medicaid, +100375,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,HEALTHPLUS-Medicaid, +100376,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,HEALTHPLUS-Medicaid, +100377,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,HEALTHPLUS-Medicaid, +100378,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-Medicaid, +100379,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,HEALTHPLUS-Medicaid, +100380,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,HEALTHPLUS-Medicaid, +100381,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,HEALTHPLUS-Medicaid, +100382,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,HEALTHPLUS-Medicaid, +100383,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,HEALTHPLUS-Medicaid, +100384,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,HEALTHPLUS-Medicaid, +100385,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,HEALTHPLUS-Medicaid, +100386,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,HEALTHPLUS-Medicaid, +100387,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,HEALTHPLUS-Medicaid, +100388,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,HEALTHPLUS-Medicaid, +100389,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,HEALTHPLUS-Medicaid, +100390,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,HEALTHPLUS-Medicaid, +100391,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,HEALTHPLUS-Medicaid, +100392,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,HEALTHPLUS-Medicaid, +100393,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,HEALTHPLUS-Medicaid, +100394,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,HEALTHPLUS-Medicaid, +100395,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-Medicaid, +100396,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,HEALTHPLUS-Medicaid, +100397,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,HEALTHPLUS-Medicaid, +100398,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,HEALTHPLUS-Medicaid, +100399,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,HEALTHPLUS-Medicaid, +100400,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,HEALTHPLUS-Medicaid, +100401,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,HEALTHPLUS-Medicaid, +100402,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,HEALTHPLUS-Medicaid, +100403,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,HEALTHPLUS-Medicaid, +100404,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,HEALTHPLUS-Medicaid, +100405,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,HEALTHPLUS-Medicaid, +100406,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,HEALTHPLUS-Medicaid,2449.48 +100407,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,HEALTHPLUS-Medicaid, +100408,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,HEALTHPLUS-Medicaid, +100409,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,HEALTHPLUS-Medicaid, +100410,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,HEALTHPLUS-Medicaid, +100411,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,HEALTHPLUS-Medicaid, +100412,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,HEALTHPLUS-Medicaid, +100413,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,HEALTHPLUS-Medicaid, +100414,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,HEALTHPLUS-Medicaid, +100415,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,HEALTHPLUS-Medicaid, +100416,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,HEALTHPLUS-Medicaid, +100417,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,HEALTHPLUS-Medicaid, +100418,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,HEALTHPLUS-Medicaid, +100419,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,HEALTHPLUS-Medicaid, +100420,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,HEALTHPLUS-Medicaid, +100421,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,HEALTHPLUS-Medicaid, +100422,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,HEALTHPLUS-Medicaid, +100423,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,HEALTHPLUS-Medicaid, +100424,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,HEALTHPLUS-Medicaid, +100425,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,HEALTHPLUS-Medicaid, +100426,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,HEALTHPLUS-Medicaid, +100427,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,HEALTHPLUS-Medicaid, +100428,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,HEALTHPLUS-Medicaid, +100429,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,HEALTHPLUS-Medicaid, +100430,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,HEALTHPLUS-Medicaid, +100431,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,HEALTHPLUS-Medicaid, +100432,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,HEALTHPLUS-Medicaid, +100433,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,HEALTHPLUS-Medicaid, +100434,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,HEALTHPLUS-Medicaid, +100435,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,HEALTHPLUS-Medicaid, +100436,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,HEALTHPLUS-Medicaid, +100437,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,HEALTHPLUS-Medicaid, +100438,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,HEALTHPLUS-Medicaid, +100439,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,HEALTHPLUS-Medicaid, +100440,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,HEALTHPLUS-Medicaid, +100441,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,HEALTHPLUS-Medicaid, +100442,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,HEALTHPLUS-Medicaid, +100443,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,HEALTHPLUS-Medicaid, +100444,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,HEALTHPLUS-Medicaid, +100445,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,HEALTHPLUS-Medicaid, +100446,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,HEALTHPLUS-Medicaid, +100447,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,HEALTHPLUS-Medicaid, +100448,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,HEALTHPLUS-Medicaid, +100449,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,HEALTHPLUS-Medicaid, +100450,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,HEALTHPLUS-Medicaid, +100451,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,HEALTHPLUS-Medicaid, +100452,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,HEALTHPLUS-Medicaid, +100453,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,HEALTHPLUS-Medicaid, +100454,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,HEALTHPLUS-Medicaid, +100455,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,HEALTHPLUS-Medicaid, +100456,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,HEALTHPLUS-Medicaid, +100457,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,HEALTHPLUS-Medicaid, +100458,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,HEALTHPLUS-Medicaid, +100459,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,HEALTHPLUS-Medicaid, +100460,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,HEALTHPLUS-Medicaid, +100461,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,HEALTHPLUS-Medicaid, +100462,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,HEALTHPLUS-Medicaid, +100463,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,HEALTHPLUS-Medicaid, +100464,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,HEALTHPLUS-Medicaid, +100465,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,HEALTHPLUS-Medicaid, +100466,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,HEALTHPLUS-Medicaid, +100467,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,HEALTHPLUS-Medicaid, +100468,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,HEALTHPLUS-Medicaid, +100469,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,HEALTHPLUS-Medicaid, +100470,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,HEALTHPLUS-Medicaid, +100471,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,HEALTHPLUS-Medicaid, +100472,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,HEALTHPLUS-Medicaid, +100473,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,HEALTHPLUS-Medicaid, +100474,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,HEALTHPLUS-Medicaid, +100475,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,HEALTHPLUS-Medicaid, +100476,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,HEALTHPLUS-Medicaid, +100477,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,HEALTHPLUS-Medicaid, +100478,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,HEALTHPLUS-Medicaid, +100479,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,HEALTHPLUS-Medicaid, +100480,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,HEALTHPLUS-Medicaid, +100481,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,HEALTHPLUS-Medicaid, +100482,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,HEALTHPLUS-Medicaid, +100483,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,HEALTHPLUS-Medicaid, +100484,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,HEALTHPLUS-Medicaid, +100485,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,HEALTHPLUS-Medicaid, +100486,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,HEALTHPLUS-Medicaid, +100487,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,HEALTHPLUS-Medicaid, +100488,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,HEALTHPLUS-Medicaid, +100489,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,HEALTHPLUS-Medicaid, +100490,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,HEALTHPLUS-Medicaid, +100491,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,HEALTHPLUS-Medicaid, +100492,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,HEALTHPLUS-Medicaid, +100493,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,HEALTHPLUS-Medicaid, +100494,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,HEALTHPLUS-Medicaid, +100495,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,HEALTHPLUS-Medicaid, +100496,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,HEALTHPLUS-Medicaid, +100497,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,HEALTHPLUS-Medicaid, +100498,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,HEALTHPLUS-Medicaid, +100499,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,HEALTHPLUS-Medicaid, +100500,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,HEALTHPLUS-Medicaid, +100501,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,HEALTHPLUS-Medicaid, +100502,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,HEALTHPLUS-Medicaid, +100503,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,HEALTHPLUS-Medicaid, +100504,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,HEALTHPLUS-Medicaid, +100505,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,HEALTHPLUS-Medicaid, +100506,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,HEALTHPLUS-Medicaid, +100507,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,HEALTHPLUS-Medicaid, +100508,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,HEALTHPLUS-Medicaid, +100509,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,HEALTHPLUS-Medicaid, +100510,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,HEALTHPLUS-Medicaid, +100511,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,HEALTHPLUS-Medicaid, +100512,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,HEALTHPLUS-Medicaid, +100513,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,HEALTHPLUS-Medicaid, +100514,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,HEALTHPLUS-Medicaid, +100515,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,HEALTHPLUS-Medicaid, +100516,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,HEALTHPLUS-Medicaid, +100517,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,HEALTHPLUS-Medicaid, +100518,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,HEALTHPLUS-Medicaid, +100519,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,HEALTHPLUS-Medicaid, +100520,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,HEALTHPLUS-Medicaid, +100521,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,HEALTHPLUS-Medicaid, +100522,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,HEALTHPLUS-Medicaid, +100523,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,HEALTHPLUS-Medicaid, +100524,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,HEALTHPLUS-Medicaid, +100525,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,HEALTHPLUS-Medicaid, +100526,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,HEALTHPLUS-Medicaid, +100527,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,HEALTHPLUS-Medicaid,282.33 +100528,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,HEALTHPLUS-Medicaid, +100529,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,HEALTHPLUS-Medicaid, +100530,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,HEALTHPLUS-Medicaid, +100531,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,HEALTHPLUS-Medicaid,107.45 +100532,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,HEALTHPLUS-Medicaid,74.81 +100533,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,HEALTHPLUS-Medicaid, +100534,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,HEALTHPLUS-Medicaid, +100535,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,HEALTHPLUS-Medicaid, +100536,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,HEALTHPLUS-Medicaid, +100537,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,HEALTHPLUS-Medicaid, +100538,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,HEALTHPLUS-Medicaid, +100539,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,HEALTHPLUS-Medicaid,135.78 +100540,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,HEALTHPLUS-Medicaid, +100541,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,HEALTHPLUS-Medicaid, +100542,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,HEALTHPLUS-Medicaid, +100543,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,HEALTHPLUS-Medicaid,242.27 +100544,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,HEALTHPLUS-Medicaid, +100545,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,HEALTHPLUS-Medicaid, +100546,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,HEALTHPLUS-Medicaid, +100547,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,HEALTHPLUS-Medicaid, +100548,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,HEALTHPLUS-Medicaid,98.09 +100549,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,HEALTHPLUS-Medicaid, +100550,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,HEALTHPLUS-Medicaid, +100551,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,HEALTHPLUS-Medicaid, +100552,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,HEALTHPLUS-Medicaid, +100553,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,HEALTHPLUS-Medicaid, +100554,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,HEALTHPLUS-Medicaid, +100555,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,HEALTHPLUS-Medicaid, +100556,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,HEALTHPLUS-Medicaid, +100557,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,HEALTHPLUS-Medicaid, +100558,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,HEALTHPLUS-Medicaid, +100559,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,HEALTHPLUS-Medicaid, +100560,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,HEALTHPLUS-Medicaid, +100561,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,HEALTHPLUS-Medicaid, +100562,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,HEALTHPLUS-Medicaid, +100563,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,HEALTHPLUS-Medicaid, +100564,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,HEALTHPLUS-Medicaid, +100565,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,HEALTHPLUS-Medicaid, +100566,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,HEALTHPLUS-Medicaid, +100567,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,HEALTHPLUS-Medicaid, +100568,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,HEALTHPLUS-Medicaid, +100569,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,HEALTHPLUS-Medicaid, +100570,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,HEALTHPLUS-Medicaid, +100571,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,HEALTHPLUS-Medicaid, +100572,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,HEALTHPLUS-Medicaid, +100573,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,HEALTHPLUS-Medicaid, +100574,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,HEALTHPLUS-Medicaid, +100575,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,HEALTHPLUS-Medicaid, +100576,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,HEALTHPLUS-Medicaid, +100577,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,HEALTHPLUS-Medicaid, +100578,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,HEALTHPLUS-Medicaid, +100579,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,HEALTHPLUS-Medicaid, +100580,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,HEALTHPLUS-Medicaid, +100581,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,HEALTHPLUS-Medicaid, +100582,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,HEALTHPLUS-Medicaid, +100583,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,HEALTHPLUS-Medicaid, +100584,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,HEALTHPLUS-Medicaid, +100585,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,HEALTHPLUS-Medicaid, +100586,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,HEALTHPLUS-Medicaid, +100587,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,HEALTHPLUS-Medicaid, +100588,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,HEALTHPLUS-Medicaid, +100589,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,HEALTHPLUS-Medicaid, +100590,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,HEALTHPLUS-Medicaid, +100591,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,HEALTHPLUS-Medicaid, +100592,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,HEALTHPLUS-Medicaid, +100593,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,HEALTHPLUS-Medicaid, +100594,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,HEALTHPLUS-Medicaid, +100595,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,HEALTHPLUS-Medicaid, +100596,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,HEALTHPLUS-Medicaid, +100597,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,HEALTHPLUS-Medicaid, +100598,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,HEALTHPLUS-Medicaid, +100599,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,HEALTHPLUS-Medicaid, +100600,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,HEALTHPLUS-Medicaid, +100601,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,HEALTHPLUS-Medicaid, +100602,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,HEALTHPLUS-Medicaid, +100603,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,HEALTHPLUS-Medicaid, +100604,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,HEALTHPLUS-Medicaid, +100605,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,HEALTHPLUS-Medicaid, +100606,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,HEALTHPLUS-Medicaid, +100607,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,HEALTHPLUS-Medicaid, +100608,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,HEALTHPLUS-Medicaid, +100609,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,HEALTHPLUS-Medicaid, +100610,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,HEALTHPLUS-Medicaid, +100611,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,HEALTHPLUS-Medicaid, +100612,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,HEALTHPLUS-Medicaid, +100613,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,HEALTHPLUS-Medicaid, +100614,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,HEALTHPLUS-Medicaid, +100615,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,HEALTHPLUS-Medicaid, +100616,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,HEALTHPLUS-Medicaid,96.69 +100617,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,HEALTHPLUS-Medicaid, +100618,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,HEALTHPLUS-Medicaid, +100619,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,HEALTHPLUS-Medicaid, +100620,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,HEALTHPLUS-Medicaid, +100621,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,HEALTHPLUS-Medicaid, +100622,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,HEALTHPLUS-Medicaid, +100623,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,HEALTHPLUS-Medicaid, +100624,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,HEALTHPLUS-Medicaid, +100625,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,HEALTHPLUS-Medicaid, +100626,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,HEALTHPLUS-Medicaid, +100627,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,HEALTHPLUS-Medicaid, +100628,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,HEALTHPLUS-Medicaid, +100629,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,HEALTHPLUS-Medicaid, +100630,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,HEALTHPLUS-Medicaid, +100631,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,HEALTHPLUS-Medicaid, +100632,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,HEALTHPLUS-Medicaid, +100633,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,HEALTHPLUS-Medicaid, +100634,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,HEALTHPLUS-Medicaid, +100635,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,HEALTHPLUS-Medicaid, +100636,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,HEALTHPLUS-Medicaid, +100637,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,HEALTHPLUS-Medicaid, +100638,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,HEALTHPLUS-Medicaid, +100639,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,HEALTHPLUS-Medicaid, +100640,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,HEALTHPLUS-Medicaid, +100641,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,HEALTHPLUS-Medicaid,463.4 +100642,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,HEALTHPLUS-Medicaid, +100643,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,HEALTHPLUS-Medicaid, +100644,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,HEALTHPLUS-Medicaid,568.04 +100645,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,HEALTHPLUS-Medicaid, +100646,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,HEALTHPLUS-Medicaid, +100647,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,HEALTHPLUS-Medicaid, +100648,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,HEALTHPLUS-Medicaid, +100649,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,HEALTHPLUS-Medicaid, +100650,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,HEALTHPLUS-Medicaid, +100651,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,HEALTHPLUS-Medicaid, +100652,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,HEALTHPLUS-Medicaid, +100653,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,HEALTHPLUS-Medicaid, +100654,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,HEALTHPLUS-Medicaid, +100655,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,HEALTHPLUS-Medicaid, +100656,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,HEALTHPLUS-Medicaid, +100657,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,HEALTHPLUS-Medicaid, +100658,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,HEALTHPLUS-Medicaid, +100659,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,HEALTHPLUS-Medicaid, +100660,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,HEALTHPLUS-Medicaid, +100661,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,HEALTHPLUS-Medicaid, +100662,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,HEALTHPLUS-Medicaid, +100663,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,HEALTHPLUS-Medicaid, +100664,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,HEALTHPLUS-Medicaid, +100665,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,HEALTHPLUS-Medicaid, +100666,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,HEALTHPLUS-Medicaid, +100667,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,HEALTHPLUS-Medicaid, +100668,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,HEALTHPLUS-Medicaid, +100669,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,HEALTHPLUS-Medicaid, +100670,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,HEALTHPLUS-Medicaid, +100671,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,HEALTHPLUS-Medicaid, +100672,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,HEALTHPLUS-Medicaid, +100673,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,HEALTHPLUS-Medicaid, +100674,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,HEALTHPLUS-Medicaid,242.27 +100675,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,HEALTHPLUS-Medicaid, +100676,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,HEALTHPLUS-Medicaid, +100677,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,HEALTHPLUS-Medicaid, +100678,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,HEALTHPLUS-Medicaid, +100679,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,HEALTHPLUS-Medicaid, +100680,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,HEALTHPLUS-Medicaid, +100681,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,HEALTHPLUS-Medicaid, +100682,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,HEALTHPLUS-Medicaid, +100683,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,HEALTHPLUS-Medicaid, +100684,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,HEALTHPLUS-Medicaid, +100685,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,HEALTHPLUS-Medicaid, +100686,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,HEALTHPLUS-Medicaid, +100687,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,HEALTHPLUS-Medicaid, +100688,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,HEALTHPLUS-Medicaid, +100689,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,HEALTHPLUS-Medicaid, +100690,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,HEALTHPLUS-Medicaid, +100691,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,HEALTHPLUS-Medicaid, +100692,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,HEALTHPLUS-Medicaid, +100693,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,HEALTHPLUS-Medicaid, +100694,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,HEALTHPLUS-Medicaid, +100695,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,HEALTHPLUS-Medicaid, +100696,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,HEALTHPLUS-Medicaid, +100697,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,HEALTHPLUS-Medicaid, +100698,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,HEALTHPLUS-Medicaid, +100699,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,HEALTHPLUS-Medicaid, +100700,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,HEALTHPLUS-Medicaid, +100701,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,HEALTHPLUS-Medicaid, +100702,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,HEALTHPLUS-Medicaid, +100703,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,HEALTHPLUS-Medicaid, +100704,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,HEALTHPLUS-Medicaid, +100705,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,HEALTHPLUS-Medicaid, +100706,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,HEALTHPLUS-Medicaid, +100707,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,HEALTHPLUS-Medicaid, +100708,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,HEALTHPLUS-Medicaid, +100709,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,HEALTHPLUS-Medicaid,96.69 +100710,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,HEALTHPLUS-Medicaid, +100711,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,HEALTHPLUS-Medicaid, +100712,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,HEALTHPLUS-Medicaid, +100713,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,HEALTHPLUS-Medicaid, +100714,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,HEALTHPLUS-Medicaid, +100715,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,HEALTHPLUS-Medicaid, +100716,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,HEALTHPLUS-Medicaid, +100717,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,HEALTHPLUS-Medicaid, +100718,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,HEALTHPLUS-Medicaid, +100719,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,HEALTHPLUS-Medicaid, +100720,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,HEALTHPLUS-Medicaid, +100721,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,HEALTHPLUS-Medicaid, +100722,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,HEALTHPLUS-Medicaid, +100723,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,HEALTHPLUS-Medicaid, +100724,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,HEALTHPLUS-Medicaid, +100725,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,HEALTHPLUS-Medicaid, +100726,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,HEALTHPLUS-Medicaid, +100727,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,HEALTHPLUS-Medicaid, +100728,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,HEALTHPLUS-Medicaid, +100729,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,HEALTHPLUS-Medicaid, +100730,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,HEALTHPLUS-Medicaid, +100731,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,HEALTHPLUS-Medicaid, +100732,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,HEALTHPLUS-Medicaid, +100733,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,HEALTHPLUS-Medicaid, +100734,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,HEALTHPLUS-Medicaid, +100735,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,HEALTHPLUS-Medicaid, +100736,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Medicaid, +100737,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,HEALTHPLUS-Medicaid, +100738,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,HEALTHPLUS-Medicaid, +100739,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,HEALTHPLUS-Medicaid, +100740,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,HEALTHPLUS-Medicaid, +100741,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,HEALTHPLUS-Medicaid, +100742,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,HEALTHPLUS-Medicaid, +100743,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,HEALTHPLUS-Medicaid, +100744,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,HEALTHPLUS-Medicaid, +100745,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,HEALTHPLUS-Medicaid, +100746,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,HEALTHPLUS-Medicaid, +100747,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,HEALTHPLUS-Medicaid, +100748,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,HEALTHPLUS-Medicaid, +100749,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,HEALTHPLUS-Medicaid, +100750,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,HEALTHPLUS-Medicaid, +100751,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,HEALTHPLUS-Medicaid, +100752,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,HEALTHPLUS-Medicaid, +100753,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,HEALTHPLUS-Medicaid, +100754,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,HEALTHPLUS-Medicaid, +100755,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,HEALTHPLUS-Medicaid, +100756,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,HEALTHPLUS-Medicaid, +100757,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,HEALTHPLUS-Medicaid, +100758,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,HEALTHPLUS-Medicaid, +100759,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,HEALTHPLUS-Medicaid,115.23 +100760,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,HEALTHPLUS-Medicaid, +100761,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,HEALTHPLUS-Medicaid, +100762,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,HEALTHPLUS-Medicaid, +100763,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,HEALTHPLUS-Medicaid, +100764,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,HEALTHPLUS-Medicaid, +100765,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,HEALTHPLUS-Medicaid, +100766,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,HEALTHPLUS-Medicaid,135.78 +100767,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,HEALTHPLUS-Medicaid, +100768,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,HEALTHPLUS-Medicaid, +100769,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,HEALTHPLUS-Medicaid, +100770,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,HEALTHPLUS-Medicaid, +100771,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,HEALTHPLUS-Medicaid, +100772,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,HEALTHPLUS-Medicaid, +100773,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,HEALTHPLUS-Medicaid, +100774,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,HEALTHPLUS-Medicaid, +100775,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,HEALTHPLUS-Medicaid, +100776,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,HEALTHPLUS-Medicaid, +100777,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Medicaid, +100778,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,HEALTHPLUS-Medicaid, +100779,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,HEALTHPLUS-Medicaid, +100780,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,HEALTHPLUS-Medicaid, +100781,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,HEALTHPLUS-Medicaid, +100782,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,HEALTHPLUS-Medicaid, +100783,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,HEALTHPLUS-Medicaid, +100784,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,HEALTHPLUS-Medicaid, +100785,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,HEALTHPLUS-Medicaid, +100786,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,HEALTHPLUS-Medicaid, +100787,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,HEALTHPLUS-Medicaid, +100788,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,HEALTHPLUS-Medicaid, +100789,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,HEALTHPLUS-Medicaid, +100790,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,HEALTHPLUS-Medicaid, +100791,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,HEALTHPLUS-Medicaid, +100792,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,HEALTHPLUS-Medicaid, +100793,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,HEALTHPLUS-Medicaid, +100794,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,HEALTHPLUS-Medicaid, +100795,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,HEALTHPLUS-Medicaid, +100796,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,HEALTHPLUS-Medicaid, +100797,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,HEALTHPLUS-Medicaid, +100798,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Medicaid, +100799,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,HEALTHPLUS-Medicaid, +100800,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,HEALTHPLUS-Medicaid, +100801,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,HEALTHPLUS-Medicaid, +100802,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,HEALTHPLUS-Medicaid, +100803,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,HEALTHPLUS-Medicaid, +100804,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,HEALTHPLUS-Medicaid, +100805,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,HEALTHPLUS-Medicaid, +100806,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,HEALTHPLUS-Medicaid, +100807,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,HEALTHPLUS-Medicaid, +100808,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,HEALTHPLUS-Medicaid, +100809,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,HEALTHPLUS-Medicaid, +100810,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,HEALTHPLUS-Medicaid, +100811,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,HEALTHPLUS-Medicaid, +100812,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,HEALTHPLUS-Medicaid, +100813,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,HEALTHPLUS-Medicaid, +100814,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,HEALTHPLUS-Medicaid, +100815,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,HEALTHPLUS-Medicaid, +100816,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,HEALTHPLUS-Medicaid, +100817,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,HEALTHPLUS-Medicaid, +100818,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,HEALTHPLUS-Medicaid, +100819,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,HEALTHPLUS-Medicaid, +100820,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,HEALTHPLUS-Medicaid, +100821,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,HEALTHPLUS-Medicaid, +100822,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,HEALTHPLUS-Medicaid, +100823,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,HEALTHPLUS-Medicaid, +100824,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,HEALTHPLUS-Medicaid, +100825,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,HEALTHPLUS-Medicaid, +100826,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,HEALTHPLUS-Medicaid, +100827,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,HEALTHPLUS-Medicaid, +100828,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,HEALTHPLUS-Medicaid, +100829,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,HEALTHPLUS-Medicaid, +100830,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,HEALTHPLUS-Medicaid, +100831,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,HEALTHPLUS-Medicaid, +100832,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,HEALTHPLUS-Medicaid, +100833,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,HEALTHPLUS-Medicaid,1748.3 +100834,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,HEALTHPLUS-Medicaid, +100835,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,HEALTHPLUS-Medicaid, +100836,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,HEALTHPLUS-Medicaid, +100837,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,HEALTHPLUS-Medicaid, +100838,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,HEALTHPLUS-Medicaid, +100839,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,HEALTHPLUS-Medicaid, +100840,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,HEALTHPLUS-Medicaid, +100841,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,HEALTHPLUS-Medicaid,8.58 +100842,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,HEALTHPLUS-Medicaid, +100843,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,HEALTHPLUS-Medicaid, +100844,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +100845,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,HEALTHPLUS-Medicaid,13.39 +100846,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,HEALTHPLUS-Medicaid, +100847,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,HEALTHPLUS-Medicaid, +100848,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,HEALTHPLUS-Medicaid,8.17 +100849,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,HEALTHPLUS-Medicaid, +100850,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,HEALTHPLUS-Medicaid, +100851,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,HEALTHPLUS-Medicaid, +100852,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,HEALTHPLUS-Medicaid, +100853,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,HEALTHPLUS-Medicaid, +100854,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,HEALTHPLUS-Medicaid, +100855,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,HEALTHPLUS-Medicaid, +100856,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,HEALTHPLUS-Medicaid, +100857,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,HEALTHPLUS-Medicaid, +100858,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,HEALTHPLUS-Medicaid, +100859,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,HEALTHPLUS-Medicaid, +100860,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,HEALTHPLUS-Medicaid, +100861,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,HEALTHPLUS-Medicaid, +100862,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,HEALTHPLUS-Medicaid, +100863,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,HEALTHPLUS-Medicaid, +100864,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,HEALTHPLUS-Medicaid, +100865,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,HEALTHPLUS-Medicaid, +100866,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,HEALTHPLUS-Medicaid, +100867,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,HEALTHPLUS-Medicaid, +100868,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,HEALTHPLUS-Medicaid, +100869,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,HEALTHPLUS-Medicaid, +100870,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,HEALTHPLUS-Medicaid, +100871,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,HEALTHPLUS-Medicaid, +100872,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,HEALTHPLUS-Medicaid, +100873,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,HEALTHPLUS-Medicaid, +100874,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,HEALTHPLUS-Medicaid, +100875,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,HEALTHPLUS-Medicaid, +100876,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,HEALTHPLUS-Medicaid, +100877,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,HEALTHPLUS-Medicaid, +100878,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,HEALTHPLUS-Medicaid, +100879,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,HEALTHPLUS-Medicaid, +100880,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,HEALTHPLUS-Medicaid, +100881,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,HEALTHPLUS-Medicaid, +100882,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,HEALTHPLUS-Medicaid, +100883,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,HEALTHPLUS-Medicaid, +100884,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,HEALTHPLUS-Medicaid, +100885,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,HEALTHPLUS-Medicaid, +100886,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,HEALTHPLUS-Medicaid, +100887,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,HEALTHPLUS-Medicaid, +100888,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,HEALTHPLUS-Medicaid, +100889,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,HEALTHPLUS-Medicaid, +100890,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,HEALTHPLUS-Medicaid, +100891,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,HEALTHPLUS-Medicaid, +100892,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,HEALTHPLUS-Medicaid, +100893,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,HEALTHPLUS-Medicaid, +100894,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,HEALTHPLUS-Medicaid, +100895,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,HEALTHPLUS-Medicaid, +100896,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,HEALTHPLUS-Medicaid, +100897,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,HEALTHPLUS-Medicaid,3.29 +100898,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +100899,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,HEALTHPLUS-Medicaid, +100900,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,HEALTHPLUS-Medicaid, +100901,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,HEALTHPLUS-Medicaid, +100902,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,HEALTHPLUS-Medicaid, +100903,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Medicaid, +100904,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Medicaid, +100905,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Medicaid, +100906,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-Medicaid, +100907,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-Medicaid, +100908,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,HEALTHPLUS-Medicaid, +100909,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,HEALTHPLUS-Medicaid, +100910,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,HEALTHPLUS-Medicaid, +100911,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,HEALTHPLUS-Medicaid, +100912,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,HEALTHPLUS-Medicaid, +100913,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,HEALTHPLUS-Medicaid, +100914,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,HEALTHPLUS-Medicaid, +100915,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,HEALTHPLUS-Medicaid, +100916,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,HEALTHPLUS-Medicaid, +100917,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,HEALTHPLUS-Medicaid, +100918,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,HEALTHPLUS-Medicaid, +100919,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,HEALTHPLUS-Medicaid,152.0 +100920,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,HEALTHPLUS-Medicaid, +100921,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,HEALTHPLUS-Medicaid, +100922,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,HEALTHPLUS-Medicaid, +100923,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,HEALTHPLUS-Medicaid, +100924,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,HEALTHPLUS-Medicaid, +100925,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,HEALTHPLUS-Medicaid, +100926,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,HEALTHPLUS-Medicaid, +100927,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,HEALTHPLUS-Medicaid, +100928,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,HEALTHPLUS-Medicaid, +100929,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,HEALTHPLUS-Medicaid, +100930,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,HEALTHPLUS-Medicaid, +100931,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,HEALTHPLUS-Medicaid, +100932,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,HEALTHPLUS-Medicaid, +100933,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,HEALTHPLUS-Medicaid, +100934,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,HEALTHPLUS-Medicaid, +100935,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,HEALTHPLUS-Medicaid, +100936,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,HEALTHPLUS-Medicaid, +100937,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,HEALTHPLUS-Medicaid, +100938,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,HEALTHPLUS-Medicaid, +100939,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,HEALTHPLUS-Medicaid, +100940,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,HEALTHPLUS-Medicaid, +100941,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,HEALTHPLUS-Medicaid, +100942,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,HEALTHPLUS-Medicaid, +100943,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,HEALTHPLUS-Medicaid, +100944,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,HEALTHPLUS-Medicaid,252.5 +100945,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,HEALTHPLUS-Medicaid, +100946,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,HEALTHPLUS-Medicaid, +100947,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,HEALTHPLUS-Medicaid, +100948,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,HEALTHPLUS-Medicaid, +100949,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,HEALTHPLUS-Medicaid, +100950,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,HEALTHPLUS-Medicaid, +100951,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,HEALTHPLUS-Medicaid, +100952,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,HEALTHPLUS-Medicaid,190.0 +100953,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,HEALTHPLUS-Medicaid,252.5 +100954,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,HEALTHPLUS-Medicaid, +100955,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,HEALTHPLUS-Medicaid, +100956,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,HEALTHPLUS-Medicaid, +100957,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,HEALTHPLUS-Medicaid, +100958,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,HEALTHPLUS-Medicaid, +100959,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,HEALTHPLUS-Medicaid, +100960,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,HEALTHPLUS-Medicaid, +100961,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,HEALTHPLUS-Medicaid, +100962,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,HEALTHPLUS-Medicaid, +100963,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,HEALTHPLUS-Medicaid, +100964,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,HEALTHPLUS-Medicaid, +100965,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,HEALTHPLUS-Medicaid, +100966,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,HEALTHPLUS-Medicaid, +100967,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,HEALTHPLUS-Medicaid, +100968,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,HEALTHPLUS-Medicaid, +100969,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,HEALTHPLUS-Medicaid, +100970,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,HEALTHPLUS-Medicaid, +100971,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,HEALTHPLUS-Medicaid, +100972,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,HEALTHPLUS-Medicaid, +100973,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,HEALTHPLUS-Medicaid, +100974,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,HEALTHPLUS-Medicaid, +100975,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,HEALTHPLUS-Medicaid, +100976,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,HEALTHPLUS-Medicaid, +100977,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,HEALTHPLUS-Medicaid, +100978,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,HEALTHPLUS-Medicaid, +100979,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,HEALTHPLUS-Medicaid, +100980,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,HEALTHPLUS-Medicaid, +100981,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,HEALTHPLUS-Medicaid, +100982,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,HEALTHPLUS-Medicaid, +100983,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,HEALTHPLUS-Medicaid, +100984,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,HEALTHPLUS-Medicaid, +100985,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,HEALTHPLUS-Medicaid, +100986,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,HEALTHPLUS-Medicaid, +100987,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,HEALTHPLUS-Medicaid, +100988,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,HEALTHPLUS-Medicaid, +100989,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,HEALTHPLUS-Medicaid, +100990,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,HEALTHPLUS-Medicaid, +100991,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,HEALTHPLUS-Medicaid, +100992,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,HEALTHPLUS-Medicaid, +100993,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,HEALTHPLUS-Medicaid, +100994,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,HEALTHPLUS-Medicaid, +100995,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,HEALTHPLUS-Medicaid, +100996,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,HEALTHPLUS-Medicaid, +100997,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,HEALTHPLUS-Medicaid, +100998,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,HEALTHPLUS-Medicaid, +100999,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,HEALTHPLUS-Medicaid, +101000,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,HEALTHPLUS-Medicaid, +101001,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,HEALTHPLUS-Medicaid, +101002,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,HEALTHPLUS-Medicaid, +101003,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,HEALTHPLUS-Medicaid, +101004,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,HEALTHPLUS-Medicaid, +101005,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,HEALTHPLUS-Medicaid, +101006,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,HEALTHPLUS-Medicaid, +101007,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,HEALTHPLUS-Medicaid, +101008,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,HEALTHPLUS-Medicaid, +101009,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,HEALTHPLUS-Medicaid, +101010,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,HEALTHPLUS-Medicaid, +101011,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,HEALTHPLUS-Medicaid, +101012,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,HEALTHPLUS-Medicaid, +101013,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,HEALTHPLUS-Medicaid, +101014,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,HEALTHPLUS-Medicaid, +101015,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,HEALTHPLUS-Medicaid, +101016,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,HEALTHPLUS-Medicaid, +101017,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,HEALTHPLUS-Medicaid, +101018,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,HEALTHPLUS-Medicaid, +101019,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,HEALTHPLUS-Medicaid, +101020,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,HEALTHPLUS-Medicaid, +101021,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,HEALTHPLUS-Medicaid, +101022,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,HEALTHPLUS-Medicaid, +101023,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,HEALTHPLUS-Medicaid, +101024,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,HEALTHPLUS-Medicaid, +101025,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,HEALTHPLUS-Medicaid, +101026,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,HEALTHPLUS-Medicaid, +101027,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,HEALTHPLUS-Medicaid, +101028,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,HEALTHPLUS-Medicaid, +101029,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,HEALTHPLUS-Medicaid, +101030,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,HEALTHPLUS-Medicaid, +101031,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,HEALTHPLUS-Medicaid, +101032,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,HEALTHPLUS-Medicaid, +101033,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,HEALTHPLUS-Medicaid, +101034,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,HEALTHPLUS-Medicaid, +101035,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,HEALTHPLUS-Medicaid, +101036,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,HEALTHPLUS-Medicaid, +101037,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,HEALTHPLUS-Medicaid, +101038,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,HEALTHPLUS-Medicaid, +101039,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,HEALTHPLUS-Medicaid, +101040,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,HEALTHPLUS-Medicaid, +101041,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,HEALTHPLUS-Medicaid, +101042,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,HEALTHPLUS-Medicaid, +101043,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,HEALTHPLUS-Medicaid, +101044,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,HEALTHPLUS-Medicaid, +101045,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,HEALTHPLUS-Medicaid, +101046,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,HEALTHPLUS-Medicaid, +101047,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,HEALTHPLUS-Medicaid, +101048,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,HEALTHPLUS-Medicaid, +101049,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,HEALTHPLUS-Medicaid, +101050,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,HEALTHPLUS-Medicaid, +101051,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,HEALTHPLUS-Medicaid,15.08 +101052,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,HEALTHPLUS-Medicaid, +101053,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,HEALTHPLUS-Medicaid, +101054,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,HEALTHPLUS-Medicaid, +101055,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,HEALTHPLUS-Medicaid, +101056,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,HEALTHPLUS-Medicaid,20.0 +101057,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,HEALTHPLUS-Medicaid, +101058,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,HEALTHPLUS-Medicaid, +101059,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,HEALTHPLUS-Medicaid, +101060,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,HEALTHPLUS-Medicaid, +101061,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,HEALTHPLUS-Medicaid, +101062,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,HEALTHPLUS-Medicaid, +101063,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,HEALTHPLUS-Medicaid, +101064,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,HEALTHPLUS-Medicaid, +101065,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,HEALTHPLUS-Medicaid, +101066,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,HEALTHPLUS-Medicaid, +101067,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,HEALTHPLUS-Medicaid, +101068,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,HEALTHPLUS-Medicaid, +101069,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,HEALTHPLUS-Medicaid,13.63 +101070,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,HEALTHPLUS-Medicaid, +101071,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,HEALTHPLUS-Medicaid,14.7 +101072,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,HEALTHPLUS-Medicaid, +101073,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,HEALTHPLUS-Medicaid, +101074,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,HEALTHPLUS-Medicaid, +101075,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,HEALTHPLUS-Medicaid, +101076,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,HEALTHPLUS-Medicaid, +101077,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,HEALTHPLUS-Medicaid, +101078,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,HEALTHPLUS-Medicaid, +101079,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,HEALTHPLUS-Medicaid, +101080,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,HEALTHPLUS-Medicaid, +101081,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,HEALTHPLUS-Medicaid, +101082,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,HEALTHPLUS-Medicaid, +101083,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,HEALTHPLUS-Medicaid, +101084,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,HEALTHPLUS-Medicaid, +101085,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,HEALTHPLUS-Medicaid, +101086,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,HEALTHPLUS-Medicaid, +101087,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,HEALTHPLUS-Medicaid, +101088,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,HEALTHPLUS-Medicaid, +101089,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,HEALTHPLUS-Medicaid, +101090,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,HEALTHPLUS-Medicaid, +101091,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,HEALTHPLUS-Medicaid, +101092,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,HEALTHPLUS-Medicaid, +101093,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,HEALTHPLUS-Medicaid, +101094,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,HEALTHPLUS-Medicaid, +101095,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,HEALTHPLUS-Medicaid, +101096,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,HEALTHPLUS-Medicaid, +101097,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,HEALTHPLUS-Medicaid, +101098,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,HEALTHPLUS-Medicaid, +101099,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,HEALTHPLUS-Medicaid, +101100,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,HEALTHPLUS-Medicaid, +101101,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,HEALTHPLUS-Medicaid, +101102,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,HEALTHPLUS-Medicaid, +101103,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,HEALTHPLUS-Medicaid, +101104,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,HEALTHPLUS-Medicaid, +101105,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,HEALTHPLUS-Medicaid, +101106,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,HEALTHPLUS-Medicaid, +101107,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,HEALTHPLUS-Medicaid, +101108,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,HEALTHPLUS-Medicaid, +101109,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,HEALTHPLUS-Medicaid, +101110,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,HEALTHPLUS-Medicaid, +101111,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,HEALTHPLUS-Medicaid, +101112,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,HEALTHPLUS-Medicaid, +101113,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,HEALTHPLUS-Medicaid, +101114,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,HEALTHPLUS-Medicaid, +101115,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,HEALTHPLUS-Medicaid, +101116,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,HEALTHPLUS-Medicaid, +101117,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,HEALTHPLUS-Medicaid, +101118,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,HEALTHPLUS-Medicaid, +101119,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,HEALTHPLUS-Medicaid, +101120,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,HEALTHPLUS-Medicaid, +101121,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,HEALTHPLUS-Medicaid, +101122,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,HEALTHPLUS-Medicaid, +101123,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,HEALTHPLUS-Medicaid, +101124,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,HEALTHPLUS-Medicaid, +101125,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,HEALTHPLUS-Medicaid, +101126,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,HEALTHPLUS-Medicaid, +101127,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,HEALTHPLUS-Medicaid, +101128,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,HEALTHPLUS-Medicaid, +101129,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,HEALTHPLUS-Medicaid, +101130,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,HEALTHPLUS-Medicaid, +101131,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,HEALTHPLUS-Medicaid, +101132,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,HEALTHPLUS-Medicaid, +101133,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,HEALTHPLUS-Medicaid, +101134,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,HEALTHPLUS-Medicaid, +101135,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,HEALTHPLUS-Medicaid, +101136,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,HEALTHPLUS-Medicaid, +101137,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,HEALTHPLUS-Medicaid, +101138,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,HEALTHPLUS-Medicaid, +101139,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,HEALTHPLUS-Medicaid, +101140,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,HEALTHPLUS-Medicaid, +101141,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,HEALTHPLUS-Medicaid, +101142,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,HEALTHPLUS-Medicaid, +101143,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,HEALTHPLUS-Medicaid, +101144,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,HEALTHPLUS-Medicaid, +101145,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,HEALTHPLUS-Medicaid, +101146,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,HEALTHPLUS-Medicaid, +101147,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,HEALTHPLUS-Medicaid, +101148,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,HEALTHPLUS-Medicaid, +101149,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,HEALTHPLUS-Medicaid, +101150,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,HEALTHPLUS-Medicaid, +101151,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,HEALTHPLUS-Medicaid,5.11 +101152,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,HEALTHPLUS-Medicaid, +101153,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,HEALTHPLUS-Medicaid, +101154,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,HEALTHPLUS-Medicaid, +101155,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,HEALTHPLUS-Medicaid, +101156,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,HEALTHPLUS-Medicaid, +101157,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,HEALTHPLUS-Medicaid, +101158,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,HEALTHPLUS-Medicaid, +101159,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,HEALTHPLUS-Medicaid, +101160,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,HEALTHPLUS-Medicaid, +101161,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,HEALTHPLUS-Medicaid, +101162,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,HEALTHPLUS-Medicaid, +101163,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,HEALTHPLUS-Medicaid, +101164,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,HEALTHPLUS-Medicaid, +101165,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,HEALTHPLUS-Medicaid, +101166,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,HEALTHPLUS-Medicaid, +101167,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,HEALTHPLUS-Medicaid, +101168,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,HEALTHPLUS-Medicaid, +101169,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,HEALTHPLUS-Medicaid, +101170,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,HEALTHPLUS-Medicaid, +101171,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,HEALTHPLUS-Medicaid, +101172,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,HEALTHPLUS-Medicaid, +101173,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,HEALTHPLUS-Medicaid, +101174,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,HEALTHPLUS-Medicaid, +101175,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,HEALTHPLUS-Medicaid, +101176,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,HEALTHPLUS-Medicaid, +101177,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,HEALTHPLUS-Medicaid, +101178,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,HEALTHPLUS-Medicaid, +101179,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,HEALTHPLUS-Medicaid, +101180,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,HEALTHPLUS-Medicaid, +101181,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,HEALTHPLUS-Medicaid, +101182,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,HEALTHPLUS-Medicaid, +101183,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,HEALTHPLUS-Medicaid, +101184,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,HEALTHPLUS-Medicaid, +101185,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,HEALTHPLUS-Medicaid, +101186,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,HEALTHPLUS-Medicaid, +101187,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,HEALTHPLUS-Medicaid, +101188,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,HEALTHPLUS-Medicaid, +101189,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,HEALTHPLUS-Medicaid, +101190,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,HEALTHPLUS-Medicaid, +101191,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,HEALTHPLUS-Medicaid, +101192,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,HEALTHPLUS-Medicaid, +101193,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,HEALTHPLUS-Medicaid,16.8 +101194,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,HEALTHPLUS-Medicaid, +101195,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,HEALTHPLUS-Medicaid, +101196,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,HEALTHPLUS-Medicaid, +101197,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,HEALTHPLUS-Medicaid, +101198,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,HEALTHPLUS-Medicaid, +101199,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,HEALTHPLUS-Medicaid, +101200,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,HEALTHPLUS-Medicaid, +101201,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,HEALTHPLUS-Medicaid, +101202,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,HEALTHPLUS-Medicaid, +101203,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,HEALTHPLUS-Medicaid, +101204,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,HEALTHPLUS-Medicaid, +101205,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,HEALTHPLUS-Medicaid, +101206,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,HEALTHPLUS-Medicaid, +101207,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,HEALTHPLUS-Medicaid, +101208,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,HEALTHPLUS-Medicaid, +101209,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,HEALTHPLUS-Medicaid, +101210,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,HEALTHPLUS-Medicaid, +101211,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,HEALTHPLUS-Medicaid, +101212,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,HEALTHPLUS-Medicaid, +101213,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,HEALTHPLUS-Medicaid, +101214,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,HEALTHPLUS-Medicaid, +101215,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,HEALTHPLUS-Medicaid, +101216,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,HEALTHPLUS-Medicaid, +101217,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,HEALTHPLUS-Medicaid, +101218,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,HEALTHPLUS-Medicaid, +101219,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,HEALTHPLUS-Medicaid, +101220,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,HEALTHPLUS-Medicaid, +101221,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,HEALTHPLUS-Medicaid, +101222,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,HEALTHPLUS-Medicaid, +101223,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,HEALTHPLUS-Medicaid, +101224,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,HEALTHPLUS-Medicaid, +101225,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,HEALTHPLUS-Medicaid,7.91 +101226,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,HEALTHPLUS-Medicaid,6.54 +101227,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,HEALTHPLUS-Medicaid, +101228,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,HEALTHPLUS-Medicaid, +101229,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,HEALTHPLUS-Medicaid, +101230,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,HEALTHPLUS-Medicaid, +101231,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,HEALTHPLUS-Medicaid, +101232,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,HEALTHPLUS-Medicaid, +101233,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,HEALTHPLUS-Medicaid, +101234,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,HEALTHPLUS-Medicaid, +101235,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,HEALTHPLUS-Medicaid, +101236,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,HEALTHPLUS-Medicaid, +101237,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,HEALTHPLUS-Medicaid, +101238,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,HEALTHPLUS-Medicaid, +101239,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,HEALTHPLUS-Medicaid, +101240,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,HEALTHPLUS-Medicaid, +101241,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,HEALTHPLUS-Medicaid, +101242,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,HEALTHPLUS-Medicaid, +101243,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,HEALTHPLUS-Medicaid, +101244,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,HEALTHPLUS-Medicaid, +101245,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,HEALTHPLUS-Medicaid, +101246,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,HEALTHPLUS-Medicaid, +101247,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,HEALTHPLUS-Medicaid, +101248,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,HEALTHPLUS-Medicaid, +101249,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,HEALTHPLUS-Medicaid, +101250,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,HEALTHPLUS-Medicaid, +101251,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,HEALTHPLUS-Medicaid, +101252,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,HEALTHPLUS-Medicaid, +101253,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,HEALTHPLUS-Medicaid, +101254,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,HEALTHPLUS-Medicaid, +101255,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,HEALTHPLUS-Medicaid, +101256,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,HEALTHPLUS-Medicaid, +101257,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,HEALTHPLUS-Medicaid, +101258,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,HEALTHPLUS-Medicaid, +101259,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,HEALTHPLUS-Medicaid, +101260,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,HEALTHPLUS-Medicaid, +101261,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,HEALTHPLUS-Medicaid, +101262,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,HEALTHPLUS-Medicaid, +101263,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,HEALTHPLUS-Medicaid, +101264,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,HEALTHPLUS-Medicaid, +101265,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,HEALTHPLUS-Medicaid, +101266,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,HEALTHPLUS-Medicaid, +101267,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,HEALTHPLUS-Medicaid, +101268,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,HEALTHPLUS-Medicaid, +101269,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,HEALTHPLUS-Medicaid, +101270,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,HEALTHPLUS-Medicaid, +101271,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,HEALTHPLUS-Medicaid, +101272,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,HEALTHPLUS-Medicaid, +101273,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,HEALTHPLUS-Medicaid, +101274,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,HEALTHPLUS-Medicaid, +101275,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,HEALTHPLUS-Medicaid, +101276,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,HEALTHPLUS-Medicaid, +101277,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,HEALTHPLUS-Medicaid, +101278,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,HEALTHPLUS-Medicaid, +101279,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,HEALTHPLUS-Medicaid, +101280,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,HEALTHPLUS-Medicaid, +101281,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,HEALTHPLUS-Medicaid, +101282,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,HEALTHPLUS-Medicaid, +101283,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,HEALTHPLUS-Medicaid, +101284,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,HEALTHPLUS-Medicaid, +101285,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,HEALTHPLUS-Medicaid, +101286,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,HEALTHPLUS-Medicaid, +101287,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,HEALTHPLUS-Medicaid, +101288,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,HEALTHPLUS-Medicaid, +101289,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,HEALTHPLUS-Medicaid, +101290,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,HEALTHPLUS-Medicaid, +101291,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,HEALTHPLUS-Medicaid, +101292,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,HEALTHPLUS-Medicaid, +101293,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,HEALTHPLUS-Medicaid, +101294,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,HEALTHPLUS-Medicaid, +101295,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,HEALTHPLUS-Medicaid, +101296,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,HEALTHPLUS-Medicaid, +101297,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,HEALTHPLUS-Medicaid, +101298,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,HEALTHPLUS-Medicaid, +101299,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,HEALTHPLUS-Medicaid, +101300,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,HEALTHPLUS-Medicaid, +101301,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,HEALTHPLUS-Medicaid, +101302,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,HEALTHPLUS-Medicaid, +101303,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,HEALTHPLUS-Medicaid, +101304,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,HEALTHPLUS-Medicaid, +101305,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,HEALTHPLUS-Medicaid, +101306,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,HEALTHPLUS-Medicaid, +101307,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,HEALTHPLUS-Medicaid, +101308,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,HEALTHPLUS-Medicaid, +101309,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,HEALTHPLUS-Medicaid, +101310,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,HEALTHPLUS-Medicaid, +101311,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,HEALTHPLUS-Medicaid, +101312,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,HEALTHPLUS-Medicaid, +101313,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,HEALTHPLUS-Medicaid, +101314,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,HEALTHPLUS-Medicaid, +101315,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,HEALTHPLUS-Medicaid, +101316,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,HEALTHPLUS-Medicaid, +101317,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,HEALTHPLUS-Medicaid, +101318,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,HEALTHPLUS-Medicaid, +101319,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,HEALTHPLUS-Medicaid, +101320,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,HEALTHPLUS-Medicaid, +101321,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,HEALTHPLUS-Medicaid, +101322,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,HEALTHPLUS-Medicaid, +101323,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,HEALTHPLUS-Medicaid, +101324,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,HEALTHPLUS-Medicaid, +101325,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,HEALTHPLUS-Medicaid, +101326,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,HEALTHPLUS-Medicaid, +101327,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,HEALTHPLUS-Medicaid, +101328,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,HEALTHPLUS-Medicaid, +101329,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,HEALTHPLUS-Medicaid, +101330,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,HEALTHPLUS-Medicaid, +101331,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,HEALTHPLUS-Medicaid, +101332,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,HEALTHPLUS-Medicaid, +101333,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,HEALTHPLUS-Medicaid, +101334,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,HEALTHPLUS-Medicaid, +101335,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,HEALTHPLUS-Medicaid, +101336,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,HEALTHPLUS-Medicaid, +101337,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,HEALTHPLUS-Medicaid, +101338,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,HEALTHPLUS-Medicaid, +101339,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,HEALTHPLUS-Medicaid, +101340,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,HEALTHPLUS-Medicaid, +101341,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,HEALTHPLUS-Medicaid, +101342,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,HEALTHPLUS-Medicaid, +101343,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,HEALTHPLUS-Medicaid, +101344,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,HEALTHPLUS-Medicaid, +101345,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,HEALTHPLUS-Medicaid, +101346,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,HEALTHPLUS-Medicaid, +101347,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,HEALTHPLUS-Medicaid, +101348,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,HEALTHPLUS-Medicaid, +101349,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,HEALTHPLUS-Medicaid, +101350,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,HEALTHPLUS-Medicaid, +101351,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,HEALTHPLUS-Medicaid, +101352,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,HEALTHPLUS-Medicaid, +101353,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,HEALTHPLUS-Medicaid, +101354,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,HEALTHPLUS-Medicaid, +101355,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,HEALTHPLUS-Medicaid, +101356,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,HEALTHPLUS-Medicaid, +101357,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,HEALTHPLUS-Medicaid, +101358,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,HEALTHPLUS-Medicaid, +101359,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,HEALTHPLUS-Medicaid, +101360,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,HEALTHPLUS-Medicaid, +101361,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,HEALTHPLUS-Medicaid, +101362,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,HEALTHPLUS-Medicaid, +101363,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,HEALTHPLUS-Medicaid, +101364,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,HEALTHPLUS-Medicaid, +101365,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,HEALTHPLUS-Medicaid, +101366,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,HEALTHPLUS-Medicaid, +101367,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,HEALTHPLUS-Medicaid, +101368,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,HEALTHPLUS-Medicaid, +101369,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,HEALTHPLUS-Medicaid, +101370,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,HEALTHPLUS-Medicaid, +101371,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,HEALTHPLUS-Medicaid, +101372,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,HEALTHPLUS-Medicaid, +101373,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,HEALTHPLUS-Medicaid, +101374,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,HEALTHPLUS-Medicaid, +101375,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,HEALTHPLUS-Medicaid, +101376,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,HEALTHPLUS-Medicaid, +101377,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,HEALTHPLUS-Medicaid, +101378,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,HEALTHPLUS-Medicaid, +101379,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,HEALTHPLUS-Medicaid, +101380,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,HEALTHPLUS-Medicaid, +101381,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,HEALTHPLUS-Medicaid, +101382,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,HEALTHPLUS-Medicaid, +101383,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,HEALTHPLUS-Medicaid, +101384,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,HEALTHPLUS-Medicaid, +101385,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,HEALTHPLUS-Medicaid, +101386,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,HEALTHPLUS-Medicaid, +101387,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,HEALTHPLUS-Medicaid, +101388,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,HEALTHPLUS-Medicaid, +101389,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,HEALTHPLUS-Medicaid, +101390,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,HEALTHPLUS-Medicaid, +101391,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,HEALTHPLUS-Medicaid, +101392,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,HEALTHPLUS-Medicaid, +101393,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,HEALTHPLUS-Medicaid,127.87 +101394,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,HEALTHPLUS-Medicaid, +101395,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,HEALTHPLUS-Medicaid, +101396,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,HEALTHPLUS-Medicaid, +101397,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,HEALTHPLUS-Medicaid, +101398,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,HEALTHPLUS-Medicaid, +101399,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,HEALTHPLUS-Medicaid, +101400,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,HEALTHPLUS-Medicaid, +101401,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,HEALTHPLUS-Medicaid, +101402,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,HEALTHPLUS-Medicaid, +101403,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,HEALTHPLUS-Medicaid, +101404,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,HEALTHPLUS-Medicaid,8.62 +101405,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,HEALTHPLUS-Medicaid, +101406,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,HEALTHPLUS-Medicaid,8.08 +101407,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,HEALTHPLUS-Medicaid, +101408,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,HEALTHPLUS-Medicaid,8.37 +101409,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,HEALTHPLUS-Medicaid, +101410,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,HEALTHPLUS-Medicaid, +101411,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,HEALTHPLUS-Medicaid, +101412,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,HEALTHPLUS-Medicaid, +101413,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,HEALTHPLUS-Medicaid,10.32 +101414,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,HEALTHPLUS-Medicaid, +101415,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,HEALTHPLUS-Medicaid, +101416,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,HEALTHPLUS-Medicaid, +101417,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,HEALTHPLUS-Medicaid, +101418,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,HEALTHPLUS-Medicaid, +101419,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,HEALTHPLUS-Medicaid, +101420,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,HEALTHPLUS-Medicaid, +101421,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,HEALTHPLUS-Medicaid, +101422,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,HEALTHPLUS-Medicaid, +101423,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,HEALTHPLUS-Medicaid, +101424,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,HEALTHPLUS-Medicaid, +101425,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,HEALTHPLUS-Medicaid, +101426,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,HEALTHPLUS-Medicaid, +101427,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,HEALTHPLUS-Medicaid, +101428,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,HEALTHPLUS-Medicaid, +101429,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,HEALTHPLUS-Medicaid,8.65 +101430,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,HEALTHPLUS-Medicaid, +101431,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,HEALTHPLUS-Medicaid,4.27 +101432,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,HEALTHPLUS-Medicaid, +101433,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,HEALTHPLUS-Medicaid, +101434,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,HEALTHPLUS-Medicaid, +101435,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,HEALTHPLUS-Medicaid, +101436,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,HEALTHPLUS-Medicaid, +101437,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,HEALTHPLUS-Medicaid, +101438,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,HEALTHPLUS-Medicaid, +101439,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,HEALTHPLUS-Medicaid, +101440,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,HEALTHPLUS-Medicaid, +101441,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,HEALTHPLUS-Medicaid, +101442,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,HEALTHPLUS-Medicaid, +101443,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,HEALTHPLUS-Medicaid, +101444,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,HEALTHPLUS-Medicaid, +101445,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,HEALTHPLUS-Medicaid, +101446,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,HEALTHPLUS-Medicaid, +101447,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,HEALTHPLUS-Medicaid, +101448,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,HEALTHPLUS-Medicaid, +101449,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,HEALTHPLUS-Medicaid, +101450,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,HEALTHPLUS-Medicaid, +101451,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,HEALTHPLUS-Medicaid, +101452,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,HEALTHPLUS-Medicaid, +101453,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,HEALTHPLUS-Medicaid, +101454,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,HEALTHPLUS-Medicaid, +101455,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,HEALTHPLUS-Medicaid, +101456,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Medicaid, +101457,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,HEALTHPLUS-Medicaid, +101458,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,HEALTHPLUS-Medicaid, +101459,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,HEALTHPLUS-Medicaid, +101460,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,HEALTHPLUS-Medicaid, +101461,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,HEALTHPLUS-Medicaid, +101462,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,HEALTHPLUS-Medicaid, +101463,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,HEALTHPLUS-Medicaid, +101464,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,HEALTHPLUS-Medicaid, +101465,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,HEALTHPLUS-Medicaid, +101466,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,HEALTHPLUS-Medicaid, +101467,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Medicaid, +101468,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,HEALTHPLUS-Medicaid, +101469,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,HEALTHPLUS-Medicaid, +101470,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,HEALTHPLUS-Medicaid, +101471,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,HEALTHPLUS-Medicaid, +101472,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,HEALTHPLUS-Medicaid, +101473,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,HEALTHPLUS-Medicaid, +101474,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,HEALTHPLUS-Medicaid, +101475,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,HEALTHPLUS-Medicaid, +101476,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,HEALTHPLUS-Medicaid, +101477,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,HEALTHPLUS-Medicaid, +101478,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,HEALTHPLUS-Medicaid, +101479,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,HEALTHPLUS-Medicaid, +101480,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,HEALTHPLUS-Medicaid, +101481,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,HEALTHPLUS-Medicaid, +101482,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,HEALTHPLUS-Medicaid, +101483,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,HEALTHPLUS-Medicaid, +101484,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,HEALTHPLUS-Medicaid, +101485,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,HEALTHPLUS-Medicaid, +101486,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,HEALTHPLUS-Medicaid, +101487,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,HEALTHPLUS-Medicaid,49.42 +101488,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,HEALTHPLUS-Medicaid, +101489,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Medicaid, +101490,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,HEALTHPLUS-Medicaid, +101491,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,HEALTHPLUS-Medicaid, +101492,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,HEALTHPLUS-Medicaid, +101493,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,HEALTHPLUS-Medicaid, +101494,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,HEALTHPLUS-Medicaid, +101495,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,HEALTHPLUS-Medicaid, +101496,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,HEALTHPLUS-Medicaid, +101497,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,HEALTHPLUS-Medicaid, +101498,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,HEALTHPLUS-Medicaid, +101499,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,HEALTHPLUS-Medicaid, +101500,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,HEALTHPLUS-Medicaid, +101501,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,HEALTHPLUS-Medicaid, +101502,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,HEALTHPLUS-Medicaid, +101503,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,HEALTHPLUS-Medicaid, +101504,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,HEALTHPLUS-Medicaid, +101505,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,HEALTHPLUS-Medicaid, +101506,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,HEALTHPLUS-Medicaid, +101507,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,HEALTHPLUS-Medicaid, +101508,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,HEALTHPLUS-Medicaid, +101509,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,HEALTHPLUS-Medicaid, +101510,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,HEALTHPLUS-Medicaid, +101511,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,HEALTHPLUS-Medicaid, +101512,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,HEALTHPLUS-Medicaid, +101513,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,HEALTHPLUS-Medicaid, +101514,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,HEALTHPLUS-Medicaid, +101515,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,HEALTHPLUS-Medicaid, +101516,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,HEALTHPLUS-Medicaid, +101517,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,HEALTHPLUS-Medicaid, +101518,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,HEALTHPLUS-Medicaid, +101519,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,HEALTHPLUS-Medicaid, +101520,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,HEALTHPLUS-Medicaid, +101521,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,HEALTHPLUS-Medicaid, +101522,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,HEALTHPLUS-Medicaid, +101523,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,HEALTHPLUS-Medicaid, +101524,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,HEALTHPLUS-Medicaid, +101525,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,HEALTHPLUS-Medicaid, +101526,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,HEALTHPLUS-Medicaid, +101527,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,HEALTHPLUS-Medicaid, +101528,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,HEALTHPLUS-Medicaid, +101529,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,HEALTHPLUS-Medicaid,61.22 +101530,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,HEALTHPLUS-Medicaid, +101531,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,HEALTHPLUS-Medicaid, +101532,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,HEALTHPLUS-Medicaid, +101533,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,HEALTHPLUS-Medicaid, +101534,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,HEALTHPLUS-Medicaid, +101535,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,HEALTHPLUS-Medicaid, +101536,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,HEALTHPLUS-Medicaid, +101537,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,HEALTHPLUS-Medicaid, +101538,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,HEALTHPLUS-Medicaid, +101539,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,HEALTHPLUS-Medicaid, +101540,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,HEALTHPLUS-Medicaid, +101541,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,HEALTHPLUS-Medicaid, +101542,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,HEALTHPLUS-Medicaid, +101543,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,HEALTHPLUS-Medicaid, +101544,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,HEALTHPLUS-Medicaid, +101545,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,HEALTHPLUS-Medicaid, +101546,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,HEALTHPLUS-Medicaid, +101547,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,HEALTHPLUS-Medicaid, +101548,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,HEALTHPLUS-Medicaid, +101549,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,HEALTHPLUS-Medicaid, +101550,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,HEALTHPLUS-Medicaid, +101551,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,HEALTHPLUS-Medicaid, +101552,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,HEALTHPLUS-Medicaid, +101553,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,HEALTHPLUS-Medicaid, +101554,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,HEALTHPLUS-Medicaid, +101555,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,HEALTHPLUS-Medicaid, +101556,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,HEALTHPLUS-Medicaid, +101557,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,HEALTHPLUS-Medicaid, +101558,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,HEALTHPLUS-Medicaid, +101559,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,HEALTHPLUS-Medicaid, +101560,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,HEALTHPLUS-Medicaid, +101561,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,HEALTHPLUS-Medicaid, +101562,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,HEALTHPLUS-Medicaid, +101563,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,HEALTHPLUS-Medicaid, +101564,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,HEALTHPLUS-Medicaid, +101565,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,HEALTHPLUS-Medicaid, +101566,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,HEALTHPLUS-Medicaid, +101567,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,HEALTHPLUS-Medicaid, +101568,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,HEALTHPLUS-Medicaid, +101569,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,HEALTHPLUS-Medicaid, +101570,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,HEALTHPLUS-Medicaid, +101571,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,HEALTHPLUS-Medicaid, +101572,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,HEALTHPLUS-Medicaid, +101573,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,HEALTHPLUS-Medicaid, +101574,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,HEALTHPLUS-Medicaid, +101575,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,HEALTHPLUS-Medicaid, +101576,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,HEALTHPLUS-Medicaid, +101577,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,HEALTHPLUS-Medicaid, +101578,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,HEALTHPLUS-Medicaid, +101579,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,HEALTHPLUS-Medicaid, +101580,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,HEALTHPLUS-Medicaid, +101581,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,HEALTHPLUS-Medicaid, +101582,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,HEALTHPLUS-Medicaid, +101583,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,HEALTHPLUS-Medicaid, +101584,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,HEALTHPLUS-Medicaid, +101585,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,HEALTHPLUS-Medicaid, +101586,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,HEALTHPLUS-Medicaid, +101587,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,HEALTHPLUS-Medicaid, +101588,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,HEALTHPLUS-Medicaid, +101589,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,HEALTHPLUS-Medicaid, +101590,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,HEALTHPLUS-Medicaid, +101591,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +101592,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +101593,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +101594,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,HEALTHPLUS-Medicaid, +101595,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,HEALTHPLUS-Medicaid, +101596,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,HEALTHPLUS-Medicaid, +101597,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,HEALTHPLUS-Medicaid, +101598,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,HEALTHPLUS-Medicaid, +101599,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,HEALTHPLUS-Medicaid, +101600,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,HEALTHPLUS-Medicaid, +101601,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,HEALTHPLUS-Medicaid, +101602,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,HEALTHPLUS-Medicaid, +101603,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,HEALTHPLUS-Medicaid, +101604,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,HEALTHPLUS-Medicaid, +101605,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,HEALTHPLUS-Medicaid, +101606,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,HEALTHPLUS-Medicaid, +101607,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,HEALTHPLUS-Medicaid, +101608,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,HEALTHPLUS-Medicaid, +101609,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,HEALTHPLUS-Medicaid, +101610,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,HEALTHPLUS-Medicaid, +101611,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,HEALTHPLUS-Medicaid, +101612,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,HEALTHPLUS-Medicaid, +101613,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,HEALTHPLUS-Medicaid, +101614,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,HEALTHPLUS-Medicaid, +101615,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,HEALTHPLUS-Medicaid, +101616,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,HEALTHPLUS-Medicaid, +101617,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,HEALTHPLUS-Medicaid, +101618,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,HEALTHPLUS-Medicaid, +101619,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,HEALTHPLUS-Medicaid, +101620,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,HEALTHPLUS-Medicaid, +101621,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,HEALTHPLUS-Medicaid, +101622,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,HEALTHPLUS-Medicaid, +101623,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,HEALTHPLUS-Medicaid, +101624,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,HEALTHPLUS-Medicaid, +101625,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,HEALTHPLUS-Medicaid, +101626,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,HEALTHPLUS-Medicaid, +101627,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,HEALTHPLUS-Medicaid, +101628,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,HEALTHPLUS-Medicaid, +101629,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,HEALTHPLUS-Medicaid, +101630,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,HEALTHPLUS-Medicaid, +101631,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,HEALTHPLUS-Medicaid, +101632,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,HEALTHPLUS-Medicaid, +101633,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,HEALTHPLUS-Medicaid, +101634,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,HEALTHPLUS-Medicaid, +101635,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,HEALTHPLUS-Medicaid, +101636,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,HEALTHPLUS-Medicaid, +101637,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,HEALTHPLUS-Medicaid, +101638,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,HEALTHPLUS-Medicaid, +101639,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,HEALTHPLUS-Medicaid, +101640,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,HEALTHPLUS-Medicaid, +101641,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,HEALTHPLUS-Medicaid, +101642,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,HEALTHPLUS-Medicaid, +101643,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,HEALTHPLUS-Medicaid, +101644,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,HEALTHPLUS-Medicaid, +101645,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,HEALTHPLUS-Medicaid, +101646,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,HEALTHPLUS-Medicaid, +101647,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,HEALTHPLUS-Medicaid, +101648,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,HEALTHPLUS-Medicaid, +101649,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,HEALTHPLUS-Medicaid, +101650,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,HEALTHPLUS-Medicaid, +101651,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,HEALTHPLUS-Medicaid, +101652,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,HEALTHPLUS-Medicaid, +101653,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,HEALTHPLUS-Medicaid, +101654,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,HEALTHPLUS-Medicaid, +101655,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,HEALTHPLUS-Medicaid, +101656,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,HEALTHPLUS-Medicaid, +101657,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,HEALTHPLUS-Medicaid, +101658,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,HEALTHPLUS-Medicaid, +101659,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,HEALTHPLUS-Medicaid, +101660,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,HEALTHPLUS-Medicaid, +101661,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,HEALTHPLUS-Medicaid, +101662,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,HEALTHPLUS-Medicaid, +101663,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,HEALTHPLUS-Medicaid, +101664,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,HEALTHPLUS-Medicaid, +101665,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,HEALTHPLUS-Medicaid, +101666,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,HEALTHPLUS-Medicaid, +101667,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,HEALTHPLUS-Medicaid, +101668,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,HEALTHPLUS-Medicaid, +101669,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,HEALTHPLUS-Medicaid, +101670,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,HEALTHPLUS-Medicaid, +101671,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,HEALTHPLUS-Medicaid, +101672,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,HEALTHPLUS-Medicaid, +101673,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,HEALTHPLUS-Medicaid, +101674,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,HEALTHPLUS-Medicaid, +101675,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,HEALTHPLUS-Medicaid, +101676,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,HEALTHPLUS-Medicaid, +101677,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,HEALTHPLUS-Medicaid, +101678,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,HEALTHPLUS-Medicaid, +101679,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,HEALTHPLUS-Medicaid, +101680,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,HEALTHPLUS-Medicaid, +101681,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,HEALTHPLUS-Medicaid, +101682,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,HEALTHPLUS-Medicaid, +101683,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,HEALTHPLUS-Medicaid, +101684,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,HEALTHPLUS-Medicaid, +101685,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,HEALTHPLUS-Medicaid, +101686,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,HEALTHPLUS-Medicaid, +101687,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,HEALTHPLUS-Medicaid, +101688,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,HEALTHPLUS-Medicaid, +101689,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,HEALTHPLUS-Medicaid, +101690,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +101691,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,HEALTHPLUS-Medicaid, +101692,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,HEALTHPLUS-Medicaid, +101693,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,HEALTHPLUS-Medicaid, +101694,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,HEALTHPLUS-Medicaid, +101695,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,HEALTHPLUS-Medicaid, +101696,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,HEALTHPLUS-Medicaid, +101697,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,HEALTHPLUS-Medicaid, +101698,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,HEALTHPLUS-Medicaid, +101699,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,HEALTHPLUS-Medicaid, +101700,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,HEALTHPLUS-Medicaid, +101701,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,HEALTHPLUS-Medicaid, +101702,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,HEALTHPLUS-Medicaid, +101703,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,HEALTHPLUS-Medicaid,590.43 +101704,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,HEALTHPLUS-Medicaid, +101705,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,HEALTHPLUS-Medicaid, +101706,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,HEALTHPLUS-Medicaid, +101707,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,HEALTHPLUS-Medicaid, +101708,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,HEALTHPLUS-Medicaid, +101709,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,HEALTHPLUS-Medicaid, +101710,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,HEALTHPLUS-Medicaid, +101711,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,HEALTHPLUS-Medicaid, +101712,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,HEALTHPLUS-Medicaid, +101713,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,HEALTHPLUS-Medicaid, +101714,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,HEALTHPLUS-Medicaid, +101715,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,HEALTHPLUS-Medicaid, +101716,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,HEALTHPLUS-Medicaid,3374.97 +101717,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,HEALTHPLUS-Medicaid, +101718,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,HEALTHPLUS-Medicaid, +101719,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,HEALTHPLUS-Medicaid, +101720,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,HEALTHPLUS-Medicaid, +101721,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,HEALTHPLUS-Medicaid, +101722,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,HEALTHPLUS-Medicaid, +101723,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,HEALTHPLUS-Medicaid, +101724,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,HEALTHPLUS-Medicaid, +101725,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,HEALTHPLUS-Medicaid, +101726,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,HEALTHPLUS-Medicaid, +101727,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,HEALTHPLUS-Medicaid, +101728,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,HEALTHPLUS-Medicaid, +101729,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,HEALTHPLUS-Medicaid, +101730,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,HEALTHPLUS-Medicaid, +101731,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,HEALTHPLUS-Medicaid, +101732,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,HEALTHPLUS-Medicaid, +101733,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,HEALTHPLUS-Medicaid, +101734,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,HEALTHPLUS-Medicaid, +101735,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,HEALTHPLUS-Medicaid, +101736,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,HEALTHPLUS-Medicaid, +101737,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,HEALTHPLUS-Medicaid, +101738,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,HEALTHPLUS-Medicaid, +101739,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,HEALTHPLUS-Medicaid, +101740,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,HEALTHPLUS-Medicaid, +101741,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,HEALTHPLUS-Medicaid, +101742,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,HEALTHPLUS-Medicaid, +101743,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,HEALTHPLUS-Medicaid, +101744,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,HEALTHPLUS-Medicaid, +101745,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,HEALTHPLUS-Medicaid, +101746,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,HEALTHPLUS-Medicaid, +101747,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,HEALTHPLUS-Medicaid, +101748,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,HEALTHPLUS-Medicaid, +101749,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,HEALTHPLUS-Medicaid, +101750,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,HEALTHPLUS-Medicaid, +101751,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,HEALTHPLUS-Medicaid, +101752,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,HEALTHPLUS-Medicaid, +101753,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,HEALTHPLUS-Medicaid, +101754,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,HEALTHPLUS-Medicaid, +101755,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,HEALTHPLUS-Medicaid, +101756,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,HEALTHPLUS-Medicaid, +101757,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,HEALTHPLUS-Medicaid, +101758,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,HEALTHPLUS-Medicaid, +101759,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,HEALTHPLUS-Medicaid, +101760,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,HEALTHPLUS-Medicaid, +101761,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,HEALTHPLUS-Medicaid, +101762,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,HEALTHPLUS-Medicaid, +101763,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,HEALTHPLUS-Medicaid, +101764,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,HEALTHPLUS-Medicaid, +101765,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,HEALTHPLUS-Medicaid, +101766,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,HEALTHPLUS-Medicaid, +101767,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,HEALTHPLUS-Medicaid,302.99 +101768,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,HEALTHPLUS-Medicaid, +101769,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,HEALTHPLUS-Medicaid, +101770,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,HEALTHPLUS-Medicaid, +101771,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,HEALTHPLUS-Medicaid, +101772,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,HEALTHPLUS-Medicaid, +101773,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,HEALTHPLUS-Medicaid, +101774,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,HEALTHPLUS-Medicaid, +101775,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,HEALTHPLUS-Medicaid, +101776,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,HEALTHPLUS-Medicaid, +101777,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,HEALTHPLUS-Medicaid, +101778,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,HEALTHPLUS-Medicaid, +101779,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,HEALTHPLUS-Medicaid, +101780,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,HEALTHPLUS-Medicaid, +101781,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,HEALTHPLUS-Medicaid, +101782,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,HEALTHPLUS-Medicaid, +101783,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,HEALTHPLUS-Medicaid, +101784,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,HEALTHPLUS-Medicaid, +101785,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,HEALTHPLUS-Medicaid, +101786,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,HEALTHPLUS-Medicaid, +101787,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,HEALTHPLUS-Medicaid, +101788,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,HEALTHPLUS-Medicaid, +101789,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,HEALTHPLUS-Medicaid, +101790,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,HEALTHPLUS-Medicaid, +101791,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,HEALTHPLUS-Medicaid, +101792,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,HEALTHPLUS-Medicaid, +101793,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,HEALTHPLUS-Medicaid, +101794,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,HEALTHPLUS-Medicaid, +101795,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,HEALTHPLUS-Medicaid, +101796,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,HEALTHPLUS-Medicaid, +101797,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,HEALTHPLUS-Medicaid, +101798,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,HEALTHPLUS-Medicaid, +101799,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,HEALTHPLUS-Medicaid, +101800,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,HEALTHPLUS-Medicaid, +101801,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,HEALTHPLUS-Medicaid, +101802,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-Medicaid, +101803,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-Medicaid, +101804,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,HEALTHPLUS-Medicaid, +101805,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,HEALTHPLUS-Medicaid, +101806,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,HEALTHPLUS-Medicaid, +101807,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,HEALTHPLUS-Medicaid, +101808,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,HEALTHPLUS-Medicaid, +101809,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,HEALTHPLUS-Medicaid, +101810,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,HEALTHPLUS-Medicaid, +101811,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,HEALTHPLUS-Medicaid, +101812,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,HEALTHPLUS-Medicaid, +101813,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,HEALTHPLUS-Medicaid, +101814,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,HEALTHPLUS-Medicaid, +101815,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,HEALTHPLUS-Medicaid, +101816,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,HEALTHPLUS-Medicaid, +101817,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,HEALTHPLUS-Medicaid, +101818,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,HEALTHPLUS-Medicaid, +101819,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,HEALTHPLUS-Medicaid, +101820,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,HEALTHPLUS-Medicaid, +101821,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,HEALTHPLUS-Medicaid, +101822,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,HEALTHPLUS-Medicaid, +101823,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,HEALTHPLUS-Medicaid, +101824,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,HEALTHPLUS-Medicaid, +101825,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,HEALTHPLUS-Medicaid, +101826,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,HEALTHPLUS-Medicaid, +101827,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,HEALTHPLUS-Medicaid, +101828,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,HEALTHPLUS-Medicaid, +101829,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,HEALTHPLUS-Medicaid, +101830,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,HEALTHPLUS-Medicaid, +101831,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,HEALTHPLUS-Medicaid, +101832,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,HEALTHPLUS-Medicaid, +101833,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,HEALTHPLUS-Medicaid, +101834,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,HEALTHPLUS-Medicaid, +101835,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,HEALTHPLUS-Medicaid, +101836,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,HEALTHPLUS-Medicaid, +101837,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,HEALTHPLUS-Medicaid,224.78 +101838,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,HEALTHPLUS-Medicaid,90.98 +101839,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,HEALTHPLUS-Medicaid, +101840,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,HEALTHPLUS-Medicaid, +101841,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,HEALTHPLUS-Medicaid, +101842,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,HEALTHPLUS-Medicaid,73.01 +101843,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,HEALTHPLUS-Medicaid, +101844,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,HEALTHPLUS-Medicaid, +101845,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,HEALTHPLUS-Medicaid, +101846,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,HEALTHPLUS-Medicaid, +101847,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,HEALTHPLUS-Medicaid, +101848,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,HEALTHPLUS-Medicaid, +101849,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,HEALTHPLUS-Medicaid, +101850,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,HEALTHPLUS-Medicaid, +101851,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,HEALTHPLUS-Medicaid, +101852,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,HEALTHPLUS-Medicaid, +101853,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,HEALTHPLUS-Medicaid, +101854,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,HEALTHPLUS-Medicaid, +101855,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,HEALTHPLUS-Medicaid, +101856,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,HEALTHPLUS-Medicaid, +101857,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,HEALTHPLUS-Medicaid, +101858,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,HEALTHPLUS-Medicaid, +101859,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,HEALTHPLUS-Medicaid, +101860,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,HEALTHPLUS-Medicaid,45.13 +101861,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,HEALTHPLUS-Medicaid,63.6 +101862,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,HEALTHPLUS-Medicaid, +101863,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,HEALTHPLUS-Medicaid, +101864,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,HEALTHPLUS-Medicaid, +101865,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,HEALTHPLUS-Medicaid, +101866,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,HEALTHPLUS-Medicaid, +101867,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,HEALTHPLUS-Medicaid, +101868,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,HEALTHPLUS-Medicaid, +101869,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,HEALTHPLUS-Medicaid, +101870,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,HEALTHPLUS-Medicaid, +101871,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,HEALTHPLUS-Medicaid, +101872,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,HEALTHPLUS-Medicaid, +101873,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,HEALTHPLUS-Medicaid, +101874,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,HEALTHPLUS-Medicaid, +101875,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,HEALTHPLUS-Medicaid, +101876,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,HEALTHPLUS-Medicaid, +101877,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,HEALTHPLUS-Medicaid, +101878,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,HEALTHPLUS-Medicaid, +101879,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,HEALTHPLUS-Medicaid, +101880,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,HEALTHPLUS-Medicaid, +101881,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,HEALTHPLUS-Medicaid, +101882,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,HEALTHPLUS-Medicaid, +101883,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,HEALTHPLUS-Medicaid, +101884,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,HEALTHPLUS-Medicaid, +101885,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,HEALTHPLUS-Medicaid, +101886,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,HEALTHPLUS-Medicaid, +101887,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,HEALTHPLUS-Medicaid, +101888,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,HEALTHPLUS-Medicaid, +101889,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,HEALTHPLUS-Medicaid, +101890,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,HEALTHPLUS-Medicaid, +101891,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,HEALTHPLUS-Medicaid, +101892,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,HEALTHPLUS-Medicaid, +101893,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,HEALTHPLUS-Medicaid, +101894,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,HEALTHPLUS-Medicaid, +101895,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,HEALTHPLUS-Medicaid, +101896,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,HEALTHPLUS-Medicaid, +101897,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,HEALTHPLUS-Medicaid, +101898,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,HEALTHPLUS-Medicaid, +101899,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,HEALTHPLUS-Medicaid, +101900,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,HEALTHPLUS-Medicaid, +101901,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,HEALTHPLUS-Medicaid, +101902,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,HEALTHPLUS-Medicaid, +101903,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,HEALTHPLUS-Medicaid, +101904,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,HEALTHPLUS-Medicaid, +101905,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,HEALTHPLUS-Medicaid, +101906,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,HEALTHPLUS-Medicaid, +101907,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,HEALTHPLUS-Medicaid, +101908,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,HEALTHPLUS-Medicaid, +101909,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,HEALTHPLUS-Medicaid, +101910,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,HEALTHPLUS-Medicaid, +101911,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,HEALTHPLUS-Medicaid, +101912,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,HEALTHPLUS-Medicaid,429.48 +101913,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,HEALTHPLUS-Medicaid,630.82 +101914,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,HEALTHPLUS-Medicaid, +101915,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,HEALTHPLUS-Medicaid, +101916,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,HEALTHPLUS-Medicaid, +101917,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,HEALTHPLUS-Medicaid, +101918,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,HEALTHPLUS-Medicaid, +101919,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,HEALTHPLUS-Medicaid, +101920,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,HEALTHPLUS-Medicaid, +101921,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,HEALTHPLUS-Medicaid, +101922,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,HEALTHPLUS-Medicaid, +101923,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,HEALTHPLUS-Medicaid, +101924,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,HEALTHPLUS-Medicaid, +101925,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,HEALTHPLUS-Medicaid, +101926,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,HEALTHPLUS-Medicaid, +101927,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,HEALTHPLUS-Medicaid, +101928,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,HEALTHPLUS-Medicaid, +101929,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,HEALTHPLUS-Medicaid, +101930,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,HEALTHPLUS-Medicaid, +101931,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,HEALTHPLUS-Medicaid, +101932,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,HEALTHPLUS-Medicaid, +101933,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,HEALTHPLUS-Medicaid, +101934,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,HEALTHPLUS-Medicaid, +101935,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,HEALTHPLUS-Medicaid, +101936,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,HEALTHPLUS-Medicaid, +101937,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,HEALTHPLUS-Medicaid, +101938,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,HEALTHPLUS-Medicaid, +101939,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,HEALTHPLUS-Medicaid, +101940,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,HEALTHPLUS-Medicaid, +101941,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,HEALTHPLUS-Medicaid, +101942,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,HEALTHPLUS-Medicaid, +101943,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,HEALTHPLUS-Medicaid, +101944,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,HEALTHPLUS-Medicaid, +101945,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,HEALTHPLUS-Medicaid, +101946,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,HEALTHPLUS-Medicaid, +101947,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,HEALTHPLUS-Medicaid, +101948,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,HEALTHPLUS-Medicaid, +101949,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,HEALTHPLUS-Medicaid, +101950,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,HEALTHPLUS-Medicaid, +101951,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,HEALTHPLUS-Medicaid, +101952,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,HEALTHPLUS-Medicaid, +101953,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,HEALTHPLUS-Medicaid, +101954,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,HEALTHPLUS-Medicaid, +101955,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,HEALTHPLUS-Medicaid, +101956,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,HEALTHPLUS-Medicaid, +101957,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,HEALTHPLUS-Medicaid, +101958,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,HEALTHPLUS-Medicaid, +101959,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,HEALTHPLUS-Medicaid, +101960,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,HEALTHPLUS-Medicaid, +101961,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,HEALTHPLUS-Medicaid, +101962,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,HEALTHPLUS-Medicaid, +101963,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,HEALTHPLUS-Medicaid, +101964,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,HEALTHPLUS-Medicaid, +101965,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,HEALTHPLUS-Medicaid, +101966,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,HEALTHPLUS-Medicaid, +101967,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,HEALTHPLUS-Medicaid, +101968,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,HEALTHPLUS-Medicaid, +101969,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,HEALTHPLUS-Medicaid, +101970,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,HEALTHPLUS-Medicaid, +101971,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,HEALTHPLUS-Medicaid, +101972,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,HEALTHPLUS-Medicaid, +101973,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,HEALTHPLUS-Medicaid, +101974,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,HEALTHPLUS-Medicaid, +101975,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,HEALTHPLUS-Medicaid, +101976,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,HEALTHPLUS-Medicaid, +101977,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,HEALTHPLUS-Medicaid, +101978,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,HEALTHPLUS-Medicaid, +101979,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,HEALTHPLUS-Medicaid, +101980,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,HEALTHPLUS-Medicaid, +101981,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,HEALTHPLUS-Medicaid, +101982,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,HEALTHPLUS-Medicaid, +101983,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,HEALTHPLUS-Medicaid, +101984,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,HEALTHPLUS-Medicaid, +101985,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,HEALTHPLUS-Medicaid, +101986,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,HEALTHPLUS-Medicaid, +101987,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,HEALTHPLUS-Medicaid, +101988,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,HEALTHPLUS-Medicaid, +101989,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,HEALTHPLUS-Medicaid, +101990,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,HEALTHPLUS-Medicaid, +101991,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,HEALTHPLUS-Medicaid, +101992,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,HEALTHPLUS-Medicaid, +101993,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,HEALTHPLUS-Medicaid, +101994,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,HEALTHPLUS-Medicaid, +101995,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,HEALTHPLUS-Medicaid, +101996,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,HEALTHPLUS-Medicaid, +101997,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,HEALTHPLUS-Medicaid, +101998,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,HEALTHPLUS-Medicaid, +101999,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,HEALTHPLUS-Medicaid, +102000,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,HEALTHPLUS-Medicaid, +102001,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,HEALTHPLUS-Medicaid, +102002,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,HEALTHPLUS-Medicaid, +102003,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,HEALTHPLUS-Medicaid, +102004,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,HEALTHPLUS-Medicaid, +102005,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,HEALTHPLUS-Medicaid, +102006,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,HEALTHPLUS-Medicaid, +102007,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,HEALTHPLUS-Medicaid, +102008,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,HEALTHPLUS-Medicaid, +102009,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,HEALTHPLUS-Medicaid, +102010,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,HEALTHPLUS-Medicaid, +102011,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,HEALTHPLUS-Medicaid, +102012,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,HEALTHPLUS-Medicaid, +102013,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,HEALTHPLUS-Medicaid, +102014,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,HEALTHPLUS-Medicaid, +102015,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,HEALTHPLUS-Medicaid, +102016,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,HEALTHPLUS-Medicaid, +102017,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,HEALTHPLUS-Medicaid, +102018,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,HEALTHPLUS-Medicaid, +102019,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,HEALTHPLUS-Medicaid, +102020,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,HEALTHPLUS-Medicaid, +102021,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,HEALTHPLUS-Medicaid, +102022,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,HEALTHPLUS-Medicaid, +102023,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,HEALTHPLUS-Medicaid, +102024,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,HEALTHPLUS-Medicaid, +102025,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,HEALTHPLUS-Medicaid, +102026,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,HEALTHPLUS-Medicaid, +102027,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,HEALTHPLUS-Medicaid, +102028,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,HEALTHPLUS-Medicaid, +102029,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,HEALTHPLUS-Medicaid, +102030,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,HEALTHPLUS-Medicaid, +102031,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,HEALTHPLUS-Medicaid, +102032,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,HEALTHPLUS-Medicaid, +102033,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,HEALTHPLUS-Medicaid, +102034,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,HEALTHPLUS-Medicaid, +102035,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,HEALTHPLUS-Medicaid, +102036,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,HEALTHPLUS-Medicaid, +102037,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,HEALTHPLUS-Medicaid, +102038,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,HEALTHPLUS-Medicaid, +102039,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,HEALTHPLUS-Medicaid, +102040,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,HEALTHPLUS-Medicaid, +102041,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,HEALTHPLUS-Medicaid, +102042,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,HEALTHPLUS-Medicaid, +102043,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,HEALTHPLUS-Medicaid, +102044,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,HEALTHPLUS-Medicaid, +102045,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,HEALTHPLUS-Medicaid, +102046,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,HEALTHPLUS-Medicaid, +102047,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,HEALTHPLUS-Medicaid, +102048,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,HEALTHPLUS-Medicaid, +102049,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,HEALTHPLUS-Medicaid, +102050,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,HEALTHPLUS-Medicaid, +102051,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,HEALTHPLUS-Medicaid, +102052,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,HEALTHPLUS-Medicaid, +102053,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,HEALTHPLUS-Medicaid, +102054,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,HEALTHPLUS-Medicaid, +102055,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,HEALTHPLUS-Medicaid, +102056,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,HEALTHPLUS-Medicaid, +102057,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,HEALTHPLUS-Medicaid, +102058,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,HEALTHPLUS-Medicaid, +102059,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,HEALTHPLUS-Medicaid, +102060,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,HEALTHPLUS-Medicaid, +102061,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,HEALTHPLUS-Medicaid, +102062,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,HEALTHPLUS-Medicaid, +102063,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,HEALTHPLUS-Medicaid, +102064,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,HEALTHPLUS-Medicaid, +102065,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,HEALTHPLUS-Medicaid, +102066,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,HEALTHPLUS-Medicaid, +102067,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,HEALTHPLUS-Medicaid, +102068,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,HEALTHPLUS-Medicaid, +102069,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,HEALTHPLUS-Medicaid, +102070,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,HEALTHPLUS-Medicaid, +102071,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,HEALTHPLUS-Medicaid, +102072,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,HEALTHPLUS-Medicaid, +102073,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,HEALTHPLUS-Medicaid, +102074,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,HEALTHPLUS-Medicaid, +102075,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,HEALTHPLUS-Medicaid, +102076,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,HEALTHPLUS-Medicaid, +102077,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,HEALTHPLUS-Medicaid, +102078,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,HEALTHPLUS-Medicaid, +102079,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,HEALTHPLUS-Medicaid, +102080,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,HEALTHPLUS-Medicaid, +102081,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,HEALTHPLUS-Medicaid, +102082,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,HEALTHPLUS-Medicaid, +102083,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,HEALTHPLUS-Medicaid, +102084,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,HEALTHPLUS-Medicaid, +102085,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,HEALTHPLUS-Medicaid, +102086,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,HEALTHPLUS-Medicaid, +102087,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,HEALTHPLUS-Medicaid, +102088,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,HEALTHPLUS-Medicaid, +102089,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,HEALTHPLUS-Medicaid, +102090,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,HEALTHPLUS-Medicaid, +102091,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,HEALTHPLUS-Medicaid, +102092,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,HEALTHPLUS-Medicaid, +102093,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,HEALTHPLUS-Medicaid, +102094,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,HEALTHPLUS-Medicaid, +102095,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,HEALTHPLUS-Medicaid, +102096,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,HEALTHPLUS-Medicaid, +102097,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,HEALTHPLUS-Medicaid, +102098,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,HEALTHPLUS-Medicaid, +102099,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,HEALTHPLUS-Medicaid, +102100,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,HEALTHPLUS-Medicaid, +102101,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,HEALTHPLUS-Medicaid, +102102,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,HEALTHPLUS-Medicaid, +102103,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,HEALTHPLUS-Medicaid, +102104,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,HEALTHPLUS-Medicaid, +102105,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,HEALTHPLUS-Medicaid, +102106,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,HEALTHPLUS-Medicaid, +102107,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,HEALTHPLUS-Medicaid, +102108,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,HEALTHPLUS-Medicaid, +102109,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,HEALTHPLUS-Medicaid, +102110,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,HEALTHPLUS-Medicaid, +102111,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,HEALTHPLUS-Medicaid, +102112,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,HEALTHPLUS-Medicaid, +102113,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,HEALTHPLUS-Medicaid, +102114,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,HEALTHPLUS-Medicaid, +102115,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,HEALTHPLUS-Medicaid, +102116,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,HEALTHPLUS-Medicaid, +102117,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,HEALTHPLUS-Medicaid, +102118,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,HEALTHPLUS-Medicaid, +102119,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,HEALTHPLUS-Medicaid, +102120,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,HEALTHPLUS-Medicaid, +102121,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,HEALTHPLUS-Medicaid, +102122,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,HEALTHPLUS-Medicaid, +102123,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,HEALTHPLUS-Medicaid, +102124,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,HEALTHPLUS-Medicaid, +102125,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,HEALTHPLUS-Medicaid, +102126,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,HEALTHPLUS-Medicaid, +102127,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,HEALTHPLUS-Medicaid, +102128,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,HEALTHPLUS-Medicaid, +102129,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,HEALTHPLUS-Medicaid, +102130,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,HEALTHPLUS-Medicaid, +102131,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,HEALTHPLUS-Medicaid, +102132,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,HEALTHPLUS-Medicaid, +102133,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,HEALTHPLUS-Medicaid, +102134,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,HEALTHPLUS-Medicaid, +102135,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,HEALTHPLUS-Medicaid, +102136,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,HEALTHPLUS-Medicaid, +102137,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,HEALTHPLUS-Medicaid, +102138,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,HEALTHPLUS-Medicaid, +102139,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,HEALTHPLUS-Medicaid, +102140,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,HEALTHPLUS-Medicaid, +102141,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,HEALTHPLUS-Medicaid, +102142,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,HEALTHPLUS-Medicaid, +102143,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,HEALTHPLUS-Medicaid, +102144,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,HEALTHPLUS-Medicaid, +102145,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,HEALTHPLUS-Medicaid, +102146,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,HEALTHPLUS-Medicaid, +102147,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,HEALTHPLUS-Medicaid, +102148,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,HEALTHPLUS-Medicaid, +102149,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,HEALTHPLUS-Medicaid, +102150,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,HEALTHPLUS-Medicaid, +102151,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,HEALTHPLUS-Medicaid, +102152,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,HEALTHPLUS-Medicaid, +102153,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,HEALTHPLUS-Medicaid, +102154,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,HEALTHPLUS-Medicaid, +102155,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,HEALTHPLUS-Medicaid, +102156,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,HEALTHPLUS-Medicaid, +102157,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,HEALTHPLUS-Medicaid, +102158,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,HEALTHPLUS-Medicaid, +102159,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,HEALTHPLUS-Medicaid, +102160,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,HEALTHPLUS-Medicaid, +102161,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,HEALTHPLUS-Medicaid, +102162,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,HEALTHPLUS-Medicaid, +102163,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,HEALTHPLUS-Medicaid, +102164,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,HEALTHPLUS-Medicaid, +102165,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,HEALTHPLUS-Medicaid, +102166,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,HEALTHPLUS-Medicaid, +102167,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,HEALTHPLUS-Medicaid, +102168,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,HEALTHPLUS-Medicaid, +102169,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,HEALTHPLUS-Medicaid, +102170,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,HEALTHPLUS-Medicaid, +102171,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,HEALTHPLUS-Medicaid, +102172,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,HEALTHPLUS-Medicaid, +102173,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,HEALTHPLUS-Medicaid, +102174,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,HEALTHPLUS-Medicaid, +102175,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,HEALTHPLUS-Medicaid, +102176,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,HEALTHPLUS-Medicaid, +102177,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,HEALTHPLUS-Medicaid, +102178,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,HEALTHPLUS-Medicaid, +102179,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,HEALTHPLUS-Medicaid, +102180,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,HEALTHPLUS-Medicaid, +102181,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,HEALTHPLUS-Medicaid, +102182,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,HEALTHPLUS-Medicaid, +102183,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,HEALTHPLUS-Medicaid, +102184,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,HEALTHPLUS-Medicaid, +102185,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,HEALTHPLUS-Medicaid, +102186,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,HEALTHPLUS-Medicaid, +102187,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,HEALTHPLUS-Medicaid, +102188,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,HEALTHPLUS-Medicaid, +102189,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,HEALTHPLUS-Medicaid, +102190,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,HEALTHPLUS-Medicaid, +102191,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,HEALTHPLUS-Medicaid, +102192,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,HEALTHPLUS-Medicaid, +102193,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,HEALTHPLUS-Medicaid, +102194,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,HEALTHPLUS-Medicaid, +102195,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,HEALTHPLUS-Medicaid, +102196,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,HEALTHPLUS-Medicaid, +102197,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,HEALTHPLUS-Medicaid, +102198,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,HEALTHPLUS-Medicaid, +102199,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,HEALTHPLUS-Medicaid, +102200,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,HEALTHPLUS-Medicaid, +102201,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,HEALTHPLUS-Medicaid, +102202,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,HEALTHPLUS-Medicaid, +102203,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,HEALTHPLUS-Medicaid, +102204,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,HEALTHPLUS-Medicaid, +102205,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,HEALTHPLUS-Medicaid, +102206,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,HEALTHPLUS-Medicaid, +102207,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,HEALTHPLUS-Medicaid, +102208,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,HEALTHPLUS-Medicaid, +102209,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,HEALTHPLUS-Medicaid, +102210,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,HEALTHPLUS-Medicaid, +102211,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,HEALTHPLUS-Medicaid, +102212,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,HEALTHPLUS-Medicaid, +102213,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,HEALTHPLUS-Medicaid, +102214,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,HEALTHPLUS-Medicaid, +102215,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,HEALTHPLUS-Medicaid, +102216,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,HEALTHPLUS-Medicaid, +102217,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,HEALTHPLUS-Medicaid, +102218,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,HEALTHPLUS-Medicaid, +102219,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,HEALTHPLUS-Medicaid, +102220,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,HEALTHPLUS-Medicaid, +102221,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,HEALTHPLUS-Medicaid, +102222,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,HEALTHPLUS-Medicaid, +102223,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,HEALTHPLUS-Medicaid,436.61 +102224,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,HEALTHPLUS-Medicaid, +102225,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,HEALTHPLUS-Medicaid, +102226,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,HEALTHPLUS-Medicaid, +102227,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,HEALTHPLUS-Medicaid, +102228,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,HEALTHPLUS-Medicaid, +102229,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,HEALTHPLUS-Medicaid, +102230,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,HEALTHPLUS-Medicaid, +102231,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,HEALTHPLUS-Medicaid, +102232,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,HEALTHPLUS-Medicaid, +102233,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,HEALTHPLUS-Medicaid, +102234,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,HEALTHPLUS-Medicaid, +102235,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,HEALTHPLUS-Medicaid, +102236,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,HEALTHPLUS-Medicaid, +102237,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,HEALTHPLUS-Medicaid, +102238,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,HEALTHPLUS-Medicaid, +102239,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,HEALTHPLUS-Medicaid, +102240,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,HEALTHPLUS-Medicaid, +102241,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,HEALTHPLUS-Medicaid, +102242,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,HEALTHPLUS-Medicaid, +102243,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,HEALTHPLUS-Medicaid, +102244,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,HEALTHPLUS-Medicaid, +102245,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,HEALTHPLUS-Medicaid, +102246,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,HEALTHPLUS-Medicaid, +102247,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,HEALTHPLUS-Medicaid, +102248,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,HEALTHPLUS-Medicaid, +102249,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,HEALTHPLUS-Medicaid, +102250,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,HEALTHPLUS-Medicaid, +102251,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,HEALTHPLUS-Medicaid, +102252,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,HEALTHPLUS-Medicaid, +102253,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,HEALTHPLUS-Medicaid, +102254,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,HEALTHPLUS-Medicaid, +102255,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,HEALTHPLUS-Medicaid, +102256,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,HEALTHPLUS-Medicaid, +102257,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,HEALTHPLUS-Medicaid, +102258,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,HEALTHPLUS-Medicaid, +102259,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,HEALTHPLUS-Medicaid, +102260,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,HEALTHPLUS-Medicaid, +102261,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,HEALTHPLUS-Medicaid, +102262,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,HEALTHPLUS-Medicaid, +102263,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,HEALTHPLUS-Medicaid, +102264,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,HEALTHPLUS-Medicaid, +102265,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,HEALTHPLUS-Medicaid, +102266,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,HEALTHPLUS-Medicaid, +102267,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,HEALTHPLUS-Medicaid, +102268,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,HEALTHPLUS-Medicaid, +102269,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,HEALTHPLUS-Medicaid, +102270,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,HEALTHPLUS-Medicaid, +102271,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,HEALTHPLUS-Medicaid, +102272,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,HEALTHPLUS-Medicaid, +102273,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,HEALTHPLUS-Medicaid, +102274,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,HEALTHPLUS-Medicaid, +102275,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,HEALTHPLUS-Medicaid, +102276,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,HEALTHPLUS-Medicaid, +102277,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,HEALTHPLUS-Medicaid, +102278,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,HEALTHPLUS-Medicaid, +102279,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,HEALTHPLUS-Medicaid, +102280,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,HEALTHPLUS-Medicaid, +102281,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,HEALTHPLUS-Medicaid, +102282,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,HEALTHPLUS-Medicaid, +102283,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,HEALTHPLUS-Medicaid, +102284,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,HEALTHPLUS-Medicaid, +102285,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,HEALTHPLUS-Medicaid, +102286,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,HEALTHPLUS-Medicaid, +102287,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,HEALTHPLUS-Medicaid, +102288,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,HEALTHPLUS-Medicaid, +102289,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,HEALTHPLUS-Medicaid, +102290,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,HEALTHPLUS-Medicaid, +102291,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,HEALTHPLUS-Medicaid, +102292,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,HEALTHPLUS-Medicaid, +102293,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,HEALTHPLUS-Medicaid, +102294,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,HEALTHPLUS-Medicaid, +102295,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,HEALTHPLUS-Medicaid, +102296,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,HEALTHPLUS-Medicaid, +102297,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,HEALTHPLUS-Medicaid, +102298,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,HEALTHPLUS-Medicaid, +102299,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,HEALTHPLUS-Medicaid, +102300,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,HEALTHPLUS-Medicaid, +102301,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,HEALTHPLUS-Medicaid, +102302,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,HEALTHPLUS-Medicaid, +102303,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,HEALTHPLUS-Medicaid, +102304,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,HEALTHPLUS-Medicaid, +102305,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,HEALTHPLUS-Medicaid, +102306,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,HEALTHPLUS-Medicaid, +102307,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,HEALTHPLUS-Medicaid, +102308,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,HEALTHPLUS-Medicaid, +102309,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,HEALTHPLUS-Medicaid, +102310,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,HEALTHPLUS-Medicaid, +102311,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,HEALTHPLUS-Medicaid, +102312,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,HEALTHPLUS-Medicaid, +102313,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,HEALTHPLUS-Medicaid, +102314,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,HEALTHPLUS-Medicaid, +102315,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,HEALTHPLUS-Medicaid, +102316,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,HEALTHPLUS-Medicaid, +102317,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,HEALTHPLUS-Medicaid, +102318,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,HEALTHPLUS-Medicaid, +102319,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,HEALTHPLUS-Medicaid, +102320,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,HEALTHPLUS-Medicaid, +102321,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,HEALTHPLUS-Medicaid, +102322,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,HEALTHPLUS-Medicaid, +102323,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,HEALTHPLUS-Medicaid, +102324,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,HEALTHPLUS-Medicaid, +102325,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,HEALTHPLUS-Medicaid, +102326,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,HEALTHPLUS-Medicaid, +102327,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,HEALTHPLUS-Medicaid, +102328,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,HEALTHPLUS-Medicaid, +102329,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,HEALTHPLUS-Medicaid, +102330,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,HEALTHPLUS-Medicaid, +102331,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,HEALTHPLUS-Medicaid, +102332,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,HEALTHPLUS-Medicaid, +102333,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,HEALTHPLUS-Medicaid, +102334,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,HEALTHPLUS-Medicaid, +102335,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,HEALTHPLUS-Medicaid, +102336,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,HEALTHPLUS-Medicaid, +102337,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,HEALTHPLUS-Medicaid, +102338,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,HEALTHPLUS-Medicaid, +102339,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,HEALTHPLUS-Medicaid, +102340,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,HEALTHPLUS-Medicaid, +102341,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,HEALTHPLUS-Medicaid, +102342,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,HEALTHPLUS-Medicaid, +102343,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,HEALTHPLUS-Medicaid, +102344,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,HEALTHPLUS-Medicaid, +102345,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,HEALTHPLUS-Medicaid, +102346,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,HEALTHPLUS-Medicaid, +102347,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,HEALTHPLUS-Medicaid, +102348,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,HEALTHPLUS-Medicaid, +102349,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,HEALTHPLUS-Medicaid, +102350,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,HEALTHPLUS-Medicaid, +102351,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,HEALTHPLUS-Medicaid, +102352,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,HEALTHPLUS-Medicaid, +102353,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,HEALTHPLUS-Medicaid, +102354,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,HEALTHPLUS-Medicaid, +102355,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,HEALTHPLUS-Medicaid, +102356,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,HEALTHPLUS-Medicaid, +102357,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,HEALTHPLUS-Medicaid, +102358,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,HEALTHPLUS-Medicaid, +102359,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,HEALTHPLUS-Medicaid, +102360,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,HEALTHPLUS-Medicaid, +102361,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,HEALTHPLUS-Medicaid, +102362,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,HEALTHPLUS-Medicaid, +102363,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,HEALTHPLUS-Medicaid, +102364,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,HEALTHPLUS-Medicaid, +102365,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,HEALTHPLUS-Medicaid, +102366,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,HEALTHPLUS-Medicaid, +102367,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,HEALTHPLUS-Medicaid, +102368,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,HEALTHPLUS-Medicaid, +102369,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,HEALTHPLUS-Medicaid, +102370,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,HEALTHPLUS-Medicaid, +102371,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,HEALTHPLUS-Medicaid, +102372,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,HEALTHPLUS-Medicaid, +102373,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,HEALTHPLUS-Medicaid, +102374,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,HEALTHPLUS-Medicaid, +102375,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,HEALTHPLUS-Medicaid, +102376,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,HEALTHPLUS-Medicaid, +102377,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,HEALTHPLUS-Medicaid, +102378,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,HEALTHPLUS-Medicaid, +102379,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,HEALTHPLUS-Medicaid, +102380,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,HEALTHPLUS-Medicaid, +102381,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,HEALTHPLUS-Medicaid, +102382,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,HEALTHPLUS-Medicaid, +102383,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,HEALTHPLUS-Medicaid, +102384,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,HEALTHPLUS-Medicaid, +102385,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,HEALTHPLUS-Medicaid, +102386,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,HEALTHPLUS-Medicaid, +102387,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,HEALTHPLUS-Medicaid, +102388,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,HEALTHPLUS-Medicaid, +102389,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,HEALTHPLUS-Medicaid, +102390,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,HEALTHPLUS-Medicaid, +102391,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,HEALTHPLUS-Medicaid, +102392,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,HEALTHPLUS-Medicaid, +102393,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,HEALTHPLUS-Medicaid, +102394,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,HEALTHPLUS-Medicaid, +102395,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,HEALTHPLUS-Medicaid, +102396,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,HEALTHPLUS-Medicaid, +102397,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,HEALTHPLUS-Medicaid, +102398,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,HEALTHPLUS-Medicaid, +102399,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,HEALTHPLUS-Medicaid, +102400,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,HEALTHPLUS-Medicaid, +102401,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,HEALTHPLUS-Medicaid, +102402,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,HEALTHPLUS-Medicaid, +102403,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,HEALTHPLUS-Medicaid, +102404,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,HEALTHPLUS-Medicaid, +102405,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,HEALTHPLUS-Medicaid, +102406,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,HEALTHPLUS-Medicaid, +102407,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,HEALTHPLUS-Medicaid, +102408,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,HEALTHPLUS-Medicaid, +102409,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,HEALTHPLUS-Medicaid, +102410,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,HEALTHPLUS-Medicaid, +102411,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,HEALTHPLUS-Medicaid, +102412,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,HEALTHPLUS-Medicaid, +102413,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,HEALTHPLUS-Medicaid, +102414,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,HEALTHPLUS-Medicaid, +102415,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,HEALTHPLUS-Medicaid, +102416,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,HEALTHPLUS-Medicaid, +102417,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,HEALTHPLUS-Medicaid, +102418,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,HEALTHPLUS-Medicaid, +102419,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,HEALTHPLUS-Medicaid, +102420,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,HEALTHPLUS-Medicaid, +102421,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,HEALTHPLUS-Medicaid,30.67 +102422,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,HEALTHPLUS-Medicaid, +102423,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,HEALTHPLUS-Medicaid, +102424,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,HEALTHPLUS-Medicaid, +102425,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,HEALTHPLUS-Medicaid, +102426,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,HEALTHPLUS-Medicaid, +102427,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,HEALTHPLUS-Medicaid, +102428,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,HEALTHPLUS-Medicaid, +102429,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,HEALTHPLUS-Medicaid, +102430,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,HEALTHPLUS-Medicaid, +102431,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,HEALTHPLUS-Medicaid, +102432,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,HEALTHPLUS-Medicaid, +102433,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,HEALTHPLUS-Medicaid, +102434,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,HEALTHPLUS-Medicaid, +102435,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,HEALTHPLUS-Medicaid, +102436,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,HEALTHPLUS-Medicaid, +102437,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,HEALTHPLUS-Medicaid, +102438,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,HEALTHPLUS-Medicaid, +102439,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,HEALTHPLUS-Medicaid, +102440,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,HEALTHPLUS-Medicaid, +102441,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,HEALTHPLUS-Medicaid, +102442,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,HEALTHPLUS-Medicaid, +102443,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,HEALTHPLUS-Medicaid, +102444,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,HEALTHPLUS-Medicaid, +102445,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,HEALTHPLUS-Medicaid, +102446,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,HEALTHPLUS-Medicaid, +102447,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,HEALTHPLUS-Medicaid, +102448,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,HEALTHPLUS-Medicaid, +102449,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,HEALTHPLUS-Medicaid, +102450,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,HEALTHPLUS-Medicaid, +102451,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,HEALTHPLUS-Medicaid, +102452,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,HEALTHPLUS-Medicaid, +102453,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,HEALTHPLUS-Medicaid, +102454,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,HEALTHPLUS-Medicaid, +102455,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,HEALTHPLUS-Medicaid, +102456,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,HEALTHPLUS-Medicaid, +102457,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,HEALTHPLUS-Medicaid, +102458,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,HEALTHPLUS-Medicaid, +102459,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,HEALTHPLUS-Medicaid, +102460,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,HEALTHPLUS-Medicaid, +102461,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,HEALTHPLUS-Medicaid, +102462,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,HEALTHPLUS-Medicaid, +102463,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,HEALTHPLUS-Medicaid, +102464,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,HEALTHPLUS-Medicaid, +102465,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,HEALTHPLUS-Medicaid, +102466,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,HEALTHPLUS-Medicaid, +102467,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,HEALTHPLUS-Medicaid, +102468,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,HEALTHPLUS-Medicaid, +102469,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,HEALTHPLUS-Medicaid, +102470,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,HEALTHPLUS-Medicaid, +102471,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,HEALTHPLUS-Medicaid, +102472,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,HEALTHPLUS-Medicaid, +102473,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,HEALTHPLUS-Medicaid, +102474,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,HEALTHPLUS-Medicaid, +102475,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,HEALTHPLUS-Medicaid, +102476,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,HEALTHPLUS-Medicaid, +102477,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,HEALTHPLUS-Medicaid, +102478,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,HEALTHPLUS-Medicaid, +102479,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,HEALTHPLUS-Medicaid, +102480,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,HEALTHPLUS-Medicaid, +102481,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,HEALTHPLUS-Medicaid, +102482,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,HEALTHPLUS-Medicaid, +102483,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,HEALTHPLUS-Medicaid, +102484,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,HEALTHPLUS-Medicaid, +102485,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,HEALTHPLUS-Medicaid, +102486,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,HEALTHPLUS-Medicaid, +102487,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,HEALTHPLUS-Medicaid, +102488,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,HEALTHPLUS-Medicaid, +102489,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,HEALTHPLUS-Medicaid, +102490,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,HEALTHPLUS-Medicaid, +102491,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,HEALTHPLUS-Medicaid, +102492,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,HEALTHPLUS-Medicaid, +102493,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,HEALTHPLUS-Medicaid, +102494,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,HEALTHPLUS-Medicaid, +102495,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,HEALTHPLUS-Medicaid, +102496,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,HEALTHPLUS-Medicaid, +102497,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,HEALTHPLUS-Medicaid, +102498,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,HEALTHPLUS-Medicaid, +102499,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,HEALTHPLUS-Medicaid, +102500,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,HEALTHPLUS-Medicaid, +102501,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,HEALTHPLUS-Medicaid, +102502,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,HEALTHPLUS-Medicaid, +102503,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,HEALTHPLUS-Medicaid, +102504,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,HEALTHPLUS-Medicaid, +102505,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,HEALTHPLUS-Medicaid, +102506,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,HEALTHPLUS-Medicaid, +102507,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,HEALTHPLUS-Medicaid, +102508,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,HEALTHPLUS-Medicaid, +102509,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,HEALTHPLUS-Medicaid, +102510,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,HEALTHPLUS-Medicaid, +102511,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,HEALTHPLUS-Medicaid, +102512,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,HEALTHPLUS-Medicaid, +102513,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,HEALTHPLUS-Medicaid, +102514,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,HEALTHPLUS-Medicaid, +102515,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,HEALTHPLUS-Medicaid, +102516,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,HEALTHPLUS-Medicaid, +102517,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,HEALTHPLUS-Medicaid, +102518,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,HEALTHPLUS-Medicaid, +102519,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,HEALTHPLUS-Medicaid, +102520,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,HEALTHPLUS-Medicaid, +102521,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,HEALTHPLUS-Medicaid, +102522,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,HEALTHPLUS-Medicaid, +102523,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,HEALTHPLUS-Medicaid, +102524,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,HEALTHPLUS-Medicaid, +102525,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,HEALTHPLUS-Medicaid, +102526,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,HEALTHPLUS-Medicaid, +102527,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,HEALTHPLUS-Medicaid, +102528,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,HEALTHPLUS-Medicaid, +102529,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,HEALTHPLUS-Medicaid, +102530,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,HEALTHPLUS-Medicaid, +102531,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,HEALTHPLUS-Medicaid, +102532,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,HEALTHPLUS-Medicaid, +102533,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,HEALTHPLUS-Medicaid, +102534,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,HEALTHPLUS-Medicaid, +102535,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,HEALTHPLUS-Medicaid, +102536,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,HEALTHPLUS-Medicaid, +102537,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,HEALTHPLUS-Medicaid, +102538,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,HEALTHPLUS-Medicaid, +102539,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,HEALTHPLUS-Medicaid, +102540,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,HEALTHPLUS-Medicaid, +102541,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,HEALTHPLUS-Medicaid, +102542,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,HEALTHPLUS-Medicaid, +102543,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,HEALTHPLUS-Medicaid, +102544,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,HEALTHPLUS-Medicaid, +102545,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,HEALTHPLUS-Medicaid, +102546,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,HEALTHPLUS-Medicaid, +102547,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,HEALTHPLUS-Medicaid, +102548,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,HEALTHPLUS-Medicaid, +102549,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,HEALTHPLUS-Medicaid, +102550,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,HEALTHPLUS-Medicaid, +102551,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,HEALTHPLUS-Medicaid, +102552,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,HEALTHPLUS-Medicaid, +102553,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,HEALTHPLUS-Medicaid, +102554,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,HEALTHPLUS-Medicaid, +102555,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,HEALTHPLUS-Medicaid, +102556,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,HEALTHPLUS-Medicaid, +102557,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,HEALTHPLUS-Medicaid, +102558,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,HEALTHPLUS-Medicaid, +102559,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,HEALTHPLUS-Medicaid, +102560,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,HEALTHPLUS-Medicaid, +102561,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,HEALTHPLUS-Medicaid, +102562,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,HEALTHPLUS-Medicaid, +102563,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,HEALTHPLUS-Medicaid, +102564,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,HEALTHPLUS-Medicaid, +102565,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,HEALTHPLUS-Medicaid, +102566,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,HEALTHPLUS-Medicaid, +102567,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,HEALTHPLUS-Medicaid, +102568,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,HEALTHPLUS-Medicaid, +102569,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,HEALTHPLUS-Medicaid, +102570,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,HEALTHPLUS-Medicaid, +102571,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,HEALTHPLUS-Medicaid, +102572,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,HEALTHPLUS-Medicaid, +102573,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,HEALTHPLUS-Medicaid, +102574,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,HEALTHPLUS-Medicaid, +102575,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,HEALTHPLUS-Medicaid, +102576,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,HEALTHPLUS-Medicaid, +102577,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,HEALTHPLUS-Medicaid, +102578,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,HEALTHPLUS-Medicaid, +102579,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,HEALTHPLUS-Medicaid, +102580,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,HEALTHPLUS-Medicaid, +102581,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,HEALTHPLUS-Medicaid, +102582,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,HEALTHPLUS-Medicaid, +102583,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,HEALTHPLUS-Medicaid, +102584,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,HEALTHPLUS-Medicaid, +102585,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,HEALTHPLUS-Medicaid, +102586,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,HEALTHPLUS-Medicaid, +102587,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,HEALTHPLUS-Medicaid, +102588,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,HEALTHPLUS-Medicaid, +102589,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,HEALTHPLUS-Medicaid, +102590,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,HEALTHPLUS-Medicaid, +102591,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,HEALTHPLUS-Medicaid, +102592,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,HEALTHPLUS-Medicaid, +102593,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,HEALTHPLUS-Medicaid, +102594,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,HEALTHPLUS-Medicaid, +102595,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,HEALTHPLUS-Medicaid, +102596,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,HEALTHPLUS-Medicaid, +102597,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,HEALTHPLUS-Medicaid, +102598,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,HEALTHPLUS-Medicaid, +102599,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,HEALTHPLUS-Medicaid, +102600,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,HEALTHPLUS-Medicaid, +102601,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,HEALTHPLUS-Medicaid, +102602,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,HEALTHPLUS-Medicaid, +102603,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,HEALTHPLUS-Medicaid, +102604,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,HEALTHPLUS-Medicaid, +102605,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,HEALTHPLUS-Medicaid, +102606,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,HEALTHPLUS-Medicaid, +102607,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,HEALTHPLUS-Medicaid, +102608,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,HEALTHPLUS-Medicaid, +102609,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,HEALTHPLUS-Medicaid, +102610,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,HEALTHPLUS-Medicaid, +102611,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,HEALTHPLUS-Medicaid, +102612,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,HEALTHPLUS-Medicaid, +102613,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,HEALTHPLUS-Medicaid, +102614,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,HEALTHPLUS-Medicaid, +102615,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,HEALTHPLUS-Medicaid, +102616,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,HEALTHPLUS-Medicaid, +102617,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,HEALTHPLUS-Medicaid, +102618,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,HEALTHPLUS-Medicaid, +102619,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,HEALTHPLUS-Medicaid, +102620,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,HEALTHPLUS-Medicaid, +102621,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,HEALTHPLUS-Medicaid, +102622,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,HEALTHPLUS-Medicaid, +102623,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,HEALTHPLUS-Medicaid, +102624,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,HEALTHPLUS-Medicaid, +102625,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,HEALTHPLUS-Medicaid, +102626,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,HEALTHPLUS-Medicaid, +102627,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,HEALTHPLUS-Medicaid, +102628,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,HEALTHPLUS-Medicaid, +102629,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,HEALTHPLUS-Medicaid, +102630,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,HEALTHPLUS-Medicaid, +102631,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,HEALTHPLUS-Medicaid, +102632,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,HEALTHPLUS-Medicaid, +102633,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,HEALTHPLUS-Medicaid, +102634,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,HEALTHPLUS-Medicaid, +102635,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,HEALTHPLUS-Medicaid, +102636,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,HEALTHPLUS-Medicaid, +102637,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,HEALTHPLUS-Medicaid, +102638,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,HEALTHPLUS-Medicaid, +102639,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,HEALTHPLUS-Medicaid, +102640,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,HEALTHPLUS-Medicaid, +102641,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,HEALTHPLUS-Medicaid, +102642,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,HEALTHPLUS-Medicaid, +102643,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,HEALTHPLUS-Medicaid, +102644,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,HEALTHPLUS-Medicaid, +102645,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,HEALTHPLUS-Medicaid, +102646,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,HEALTHPLUS-Medicaid, +102647,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,HEALTHPLUS-Medicaid, +102648,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,HEALTHPLUS-Medicaid, +102649,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,HEALTHPLUS-Medicaid, +102650,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,HEALTHPLUS-Medicaid, +102651,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,HEALTHPLUS-Medicaid, +102652,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,HEALTHPLUS-Medicaid, +102653,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,HEALTHPLUS-Medicaid, +102654,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,HEALTHPLUS-Medicaid, +102655,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,HEALTHPLUS-Medicaid, +102656,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,HEALTHPLUS-Medicaid, +102657,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,HEALTHPLUS-Medicaid, +102658,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,HEALTHPLUS-Medicaid, +102659,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,HEALTHPLUS-Medicaid, +102660,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,HEALTHPLUS-Medicaid, +102661,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,HEALTHPLUS-Medicaid, +102662,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,HEALTHPLUS-Medicaid, +102663,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,HEALTHPLUS-Medicaid, +102664,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,HEALTHPLUS-Medicaid, +102665,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,HEALTHPLUS-Medicaid, +102666,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,HEALTHPLUS-Medicaid, +102667,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,HEALTHPLUS-Medicaid, +102668,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,HEALTHPLUS-Medicaid, +102669,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,HEALTHPLUS-Medicaid, +102670,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,HEALTHPLUS-Medicaid, +102671,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,HEALTHPLUS-Medicaid, +102672,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,HEALTHPLUS-Medicaid, +102673,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,HEALTHPLUS-Medicaid, +102674,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,HEALTHPLUS-Medicaid, +102675,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,HEALTHPLUS-Medicaid, +102676,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,HEALTHPLUS-Medicaid, +102677,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,HEALTHPLUS-Medicaid, +102678,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,HEALTHPLUS-Medicaid, +102679,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,HEALTHPLUS-Medicaid, +102680,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,HEALTHPLUS-Medicaid, +102681,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,HEALTHPLUS-Medicaid, +102682,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,HEALTHPLUS-Medicaid, +102683,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,HEALTHPLUS-Medicaid, +102684,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,HEALTHPLUS-Medicaid, +102685,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,HEALTHPLUS-Medicaid, +102686,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,HEALTHPLUS-Medicaid, +102687,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,HEALTHPLUS-Medicaid, +102688,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,HEALTHPLUS-Medicaid, +102689,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,HEALTHPLUS-Medicaid, +102690,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,HEALTHPLUS-Medicaid, +102691,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,HEALTHPLUS-Medicaid, +102692,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,HEALTHPLUS-Medicaid, +102693,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,HEALTHPLUS-Medicaid, +102694,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,HEALTHPLUS-Medicaid, +102695,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,HEALTHPLUS-Medicaid, +102696,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,HEALTHPLUS-Medicaid, +102697,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,HEALTHPLUS-Medicaid, +102698,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,HEALTHPLUS-Medicaid, +102699,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,HEALTHPLUS-Medicaid, +102700,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,HEALTHPLUS-Medicaid, +102701,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,HEALTHPLUS-Medicaid, +102702,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,HEALTHPLUS-Medicaid, +102703,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,HEALTHPLUS-Medicaid, +102704,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,HEALTHPLUS-Medicaid, +102705,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,HEALTHPLUS-Medicaid, +102706,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,HEALTHPLUS-Medicaid, +102707,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,HEALTHPLUS-Medicaid,975.06 +102708,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,HEALTHPLUS-Medicaid, +102709,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,HEALTHPLUS-Medicaid, +102710,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,HEALTHPLUS-Medicaid, +102711,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,HEALTHPLUS-Medicaid, +102712,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,HEALTHPLUS-Medicaid, +102713,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,HEALTHPLUS-Medicaid, +102714,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,HEALTHPLUS-Medicaid, +102715,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,HEALTHPLUS-Medicaid, +102716,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,HEALTHPLUS-Medicaid, +102717,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,HEALTHPLUS-Medicaid, +102718,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,HEALTHPLUS-Medicaid, +102719,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,HEALTHPLUS-Medicaid, +102720,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,HEALTHPLUS-Medicaid, +102721,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,HEALTHPLUS-Medicaid, +102722,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,HEALTHPLUS-Medicaid, +102723,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,HEALTHPLUS-Medicaid, +102724,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,HEALTHPLUS-Medicaid, +102725,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,HEALTHPLUS-Medicaid, +102726,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,HEALTHPLUS-Medicaid, +102727,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,HEALTHPLUS-Medicaid, +102728,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,HEALTHPLUS-Medicaid, +102729,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,HEALTHPLUS-Medicaid, +102730,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,HEALTHPLUS-Medicaid, +102731,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,HEALTHPLUS-Medicaid, +102732,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,HEALTHPLUS-Medicaid, +102733,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,HEALTHPLUS-Medicaid, +102734,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,HEALTHPLUS-Medicaid, +102735,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,HEALTHPLUS-Medicaid, +102736,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,HEALTHPLUS-Medicaid, +102737,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,HEALTHPLUS-Medicaid, +102738,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,HEALTHPLUS-Medicaid, +102739,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,HEALTHPLUS-Medicaid, +102740,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,HEALTHPLUS-Medicaid, +102741,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,HEALTHPLUS-Medicaid, +102742,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,HEALTHPLUS-Medicaid, +102743,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,HEALTHPLUS-Medicaid, +102744,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,HEALTHPLUS-Medicaid, +102745,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,HEALTHPLUS-Medicaid, +102746,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,HEALTHPLUS-Medicaid, +102747,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,HEALTHPLUS-Medicaid, +102748,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,HEALTHPLUS-Medicaid, +102749,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,HEALTHPLUS-Medicaid, +102750,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,HEALTHPLUS-Medicaid, +102751,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,HEALTHPLUS-Medicaid, +102752,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,HEALTHPLUS-Medicaid, +102753,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,HEALTHPLUS-Medicaid, +102754,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,HEALTHPLUS-Medicaid, +102755,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,HEALTHPLUS-Medicaid, +102756,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,HEALTHPLUS-Medicaid, +102757,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,HEALTHPLUS-Medicaid, +102758,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,HEALTHPLUS-Medicaid, +102759,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,HEALTHPLUS-Medicaid, +102760,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,HEALTHPLUS-Medicaid, +102761,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,HEALTHPLUS-Medicaid, +102762,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,HEALTHPLUS-Medicaid, +102763,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,HEALTHPLUS-Medicaid, +102764,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,HEALTHPLUS-Medicaid, +102765,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,HEALTHPLUS-Medicaid, +102766,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,HEALTHPLUS-Medicaid, +102767,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,HEALTHPLUS-Medicaid, +102768,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,HEALTHPLUS-Medicaid, +102769,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,HEALTHPLUS-Medicaid, +102770,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,HEALTHPLUS-Medicaid, +102771,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,HEALTHPLUS-Medicaid, +102772,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,HEALTHPLUS-Medicaid, +102773,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,HEALTHPLUS-Medicaid, +102774,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,HEALTHPLUS-Medicaid, +102775,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,HEALTHPLUS-Medicaid, +102776,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,HEALTHPLUS-Medicaid, +102777,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,HEALTHPLUS-Medicaid, +102778,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,HEALTHPLUS-Medicaid, +102779,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,HEALTHPLUS-Medicaid, +102780,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,HEALTHPLUS-Medicaid, +102781,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,HEALTHPLUS-Medicaid, +102782,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,HEALTHPLUS-Medicaid, +102783,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,HEALTHPLUS-Medicaid, +102784,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,HEALTHPLUS-Medicaid, +102785,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,HEALTHPLUS-Medicaid, +102786,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,HEALTHPLUS-Medicaid,35.92 +102787,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,HEALTHPLUS-Medicaid, +102788,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,HEALTHPLUS-Medicaid, +102789,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,HEALTHPLUS-Medicaid,75.0 +102790,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,HEALTHPLUS-Medicaid,25.0 +102791,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,HEALTHPLUS-Medicaid, +102792,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,HEALTHPLUS-Medicaid, +102793,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,HEALTHPLUS-Medicaid, +102794,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,HEALTHPLUS-Medicaid, +102795,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,HEALTHPLUS-Medicaid, +102796,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,HEALTHPLUS-Medicaid, +102797,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102798,3934,30000012,PRIVATE,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102799,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102800,3934,30000038,ICU,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102801,3934,30000046,BURN UNIT,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102802,3934,30000053,NICU,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102803,3934,30000061,ICR ROOM,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102804,3934,30000079,PSYCH,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102805,3934,30000087,NEWBORN,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +102806,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102807,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102808,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102809,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102810,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102811,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102812,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102813,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102814,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102815,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102816,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102817,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102818,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102819,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102820,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102821,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102822,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102823,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102824,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102825,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102826,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102827,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102828,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102829,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102830,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102831,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102832,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102833,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102834,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102835,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102836,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102837,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102838,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102839,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102840,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102841,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102842,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102843,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102844,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102845,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102846,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102847,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102848,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102849,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102850,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102851,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102852,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102853,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102854,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102855,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102856,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102857,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102858,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102859,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102860,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102861,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102862,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102863,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102864,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102865,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102866,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102867,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102868,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102869,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102870,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102871,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102872,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102873,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102874,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102875,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102876,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102877,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102878,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102879,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102880,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102881,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102882,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102883,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102884,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102885,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102886,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102887,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102888,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102889,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102890,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102891,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102892,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102893,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102894,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102895,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102896,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102897,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102898,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102899,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102900,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102901,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102902,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102903,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102904,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102905,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102906,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102907,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102908,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102909,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102910,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102911,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102912,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102913,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102914,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102915,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102916,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102917,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102918,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102919,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102920,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102921,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102922,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102923,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102924,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102925,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102926,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102927,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102928,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102929,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102930,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102931,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102932,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102933,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102934,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102935,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102936,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102937,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102938,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102939,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102940,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102941,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102942,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102943,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102944,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102945,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102946,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102947,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102948,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102949,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102950,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102951,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102952,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102953,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102954,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102955,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102956,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102957,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102958,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102959,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102960,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102961,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102962,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102963,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102964,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102965,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102966,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102967,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102968,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102969,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102970,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102971,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102972,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102973,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102974,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102975,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102976,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +102977,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102978,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102979,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102980,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102981,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102982,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102983,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102984,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102985,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102986,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102987,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102988,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102989,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102990,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102991,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102992,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102993,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +102994,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102995,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +102996,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102997,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +102998,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +102999,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103000,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103001,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103002,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103003,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103004,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103005,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103006,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103007,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103008,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103009,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103010,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103011,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103012,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103013,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103014,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103015,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103016,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103017,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103018,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103019,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103020,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103021,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103022,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103023,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103024,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103025,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103026,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103027,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103028,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103029,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103030,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103031,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103032,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103033,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103034,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103035,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103036,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103037,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103038,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103039,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103040,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103041,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103042,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103043,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103044,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103045,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103046,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103047,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103048,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103049,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103050,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103051,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103052,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103053,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103054,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103055,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103056,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103057,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103058,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103059,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103060,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103061,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103062,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103063,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103064,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103065,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103066,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103067,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103068,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103069,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103070,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103071,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103072,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103073,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103074,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103075,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103076,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103077,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103078,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103079,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103080,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103081,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103082,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103083,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103084,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103085,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103086,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103087,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103088,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103089,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103090,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103091,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103092,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103093,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103094,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103095,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103096,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103097,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103098,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103099,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103100,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103101,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103102,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103103,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103104,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103105,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103106,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103107,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103108,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103109,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103110,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103111,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103112,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103113,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103114,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103115,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103116,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103117,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103118,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103119,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103120,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103121,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103122,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103123,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103124,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103125,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103126,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103127,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103128,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103129,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103130,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103131,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103132,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103133,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103134,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103135,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103136,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103137,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103138,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103139,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103140,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103141,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103142,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103143,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103144,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103145,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103146,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103147,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103148,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103149,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103150,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103151,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103152,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103153,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103154,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103155,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103156,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103157,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103158,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103159,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103160,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103161,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103162,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103163,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103164,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103165,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103166,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103167,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103168,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103169,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103170,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103171,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103172,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103173,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103174,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103175,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103176,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103177,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103178,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103179,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103180,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103181,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103182,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103183,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103184,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103185,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103186,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103187,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103188,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103189,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103190,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103191,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103192,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103193,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103194,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103195,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103196,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103197,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103198,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103199,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103200,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103201,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103202,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103203,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103204,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103205,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103206,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103207,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103208,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103209,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103210,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103211,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103212,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103213,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103214,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103215,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicaid, +103216,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103217,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103218,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103219,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103220,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103221,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103222,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicaid, +103223,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103224,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103225,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103226,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103227,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103228,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103229,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103230,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103231,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103232,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103233,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103234,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103235,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103236,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103237,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103238,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103239,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103240,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicaid, +103241,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicaid, +103242,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicaid, +103243,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,HEALTHPLUS-Medicaid, +103244,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,HEALTHPLUS-Medicaid, +103245,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,HEALTHPLUS-Medicaid, +103246,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,HEALTHPLUS-Medicaid, +103247,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103248,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103249,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103250,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103251,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103252,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103253,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103254,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103255,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103256,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103257,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103258,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103259,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,HEALTHPLUS-Medicaid, +103260,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,HEALTHPLUS-Medicaid, +103261,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,HEALTHPLUS-Medicaid, +103262,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,HEALTHPLUS-Medicaid, +103263,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,HEALTHPLUS-Medicaid, +103264,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,HEALTHPLUS-Medicaid, +103265,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,HEALTHPLUS-Medicaid, +103266,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,HEALTHPLUS-Medicaid, +103267,3934,37112000,ACUTE ED,,1580.0,1580.0,,,HEALTHPLUS-Medicaid, +103268,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,HEALTHPLUS-Medicaid, +103269,3934,37112034,TRIAGE,,277.0,277.0,,,HEALTHPLUS-Medicaid, +103270,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,HEALTHPLUS-Medicaid, +103271,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,HEALTHPLUS-Medicaid, +103272,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,HEALTHPLUS-Medicaid, +103273,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,HEALTHPLUS-Medicaid, +103274,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,HEALTHPLUS-Medicaid, +103275,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,HEALTHPLUS-Medicaid, +103276,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,HEALTHPLUS-Medicaid, +103277,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,HEALTHPLUS-Medicaid, +103278,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,HEALTHPLUS-Medicaid, +103279,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,HEALTHPLUS-Medicaid, +103280,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,HEALTHPLUS-Medicaid, +103281,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,HEALTHPLUS-Medicaid, +103282,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,HEALTHPLUS-Medicaid, +103283,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,HEALTHPLUS-Medicaid, +103284,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,HEALTHPLUS-Medicaid, +103285,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,HEALTHPLUS-Medicaid, +103286,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,HEALTHPLUS-Medicaid, +103287,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,HEALTHPLUS-Medicaid, +103288,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,HEALTHPLUS-Medicaid, +103289,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,HEALTHPLUS-Medicaid, +103290,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,HEALTHPLUS-Medicaid, +103291,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,HEALTHPLUS-Medicaid, +103292,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,HEALTHPLUS-Medicaid, +103293,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,HEALTHPLUS-Medicaid, +103294,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,HEALTHPLUS-Medicaid, +103295,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,HEALTHPLUS-Medicaid, +103296,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,HEALTHPLUS-Medicaid, +103297,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,HEALTHPLUS-Medicaid, +103298,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,HEALTHPLUS-Medicaid, +103299,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,HEALTHPLUS-Medicaid, +103300,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,HEALTHPLUS-Medicaid, +103301,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,HEALTHPLUS-Medicaid, +103302,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,HEALTHPLUS-Medicaid, +103303,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,HEALTHPLUS-Medicaid, +103304,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,HEALTHPLUS-Medicaid, +103305,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,HEALTHPLUS-Medicaid, +103306,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,HEALTHPLUS-Medicaid, +103307,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,HEALTHPLUS-Medicaid, +103308,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,HEALTHPLUS-Medicaid, +103309,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,HEALTHPLUS-Medicaid, +103310,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,HEALTHPLUS-Medicaid, +103311,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,HEALTHPLUS-Medicaid, +103312,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,HEALTHPLUS-Medicaid, +103313,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,HEALTHPLUS-Medicaid, +103314,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,HEALTHPLUS-Medicaid, +103315,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,HEALTHPLUS-Medicaid, +103316,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,HEALTHPLUS-Medicaid, +103317,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,HEALTHPLUS-Medicaid, +103318,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,HEALTHPLUS-Medicaid, +103319,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,HEALTHPLUS-Medicaid, +103320,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,HEALTHPLUS-Medicaid, +103321,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,HEALTHPLUS-Medicaid, +103322,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,HEALTHPLUS-Medicaid, +103323,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,HEALTHPLUS-Medicaid, +103324,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,HEALTHPLUS-Medicaid, +103325,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,HEALTHPLUS-Medicaid, +103326,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,HEALTHPLUS-Medicaid, +103327,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-Medicaid, +103328,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-Medicaid, +103329,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-Medicaid, +103330,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-Medicaid, +103331,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-Medicaid, +103332,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-Medicaid, +103333,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-Medicaid, +103334,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-Medicaid, +103335,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-Medicaid, +103336,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-Medicaid, +103337,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-Medicaid, +103338,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-Medicaid, +103339,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-Medicaid, +103340,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-Medicaid, +103341,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-Medicaid, +103342,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-Medicaid, +103343,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-Medicaid, +103344,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-Medicaid, +103345,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-Medicaid, +103346,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-Medicaid, +103347,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-Medicaid, +103348,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-Medicaid, +103349,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-Medicaid, +103350,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-Medicaid, +103351,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-Medicaid, +103352,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-Medicaid, +103353,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-Medicaid, +103354,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-Medicaid, +103355,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-Medicaid, +103356,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-Medicaid, +103357,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-Medicaid, +103358,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-Medicaid, +103359,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-Medicaid, +103360,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-Medicaid, +103361,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-Medicaid, +103362,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-Medicaid, +103363,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-Medicaid, +103364,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-Medicaid, +103365,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-Medicaid, +103366,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-Medicaid, +103367,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-Medicaid, +103368,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-Medicaid, +103369,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicaid, +103370,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103371,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103372,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103373,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103374,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103375,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,HEALTHPLUS-Medicaid, +103376,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,HEALTHPLUS-Medicaid, +103377,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,HEALTHPLUS-Medicaid, +103378,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103379,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103380,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103381,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,HEALTHPLUS-Medicaid, +103382,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,HEALTHPLUS-Medicaid, +103383,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,HEALTHPLUS-Medicaid, +103384,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,HEALTHPLUS-Medicaid, +103385,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,HEALTHPLUS-Medicaid, +103386,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,HEALTHPLUS-Medicaid, +103387,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,HEALTHPLUS-Medicaid, +103388,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,HEALTHPLUS-Medicaid, +103389,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,HEALTHPLUS-Medicaid, +103390,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,HEALTHPLUS-Medicaid, +103391,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,HEALTHPLUS-Medicaid, +103392,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,HEALTHPLUS-Medicaid, +103393,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,HEALTHPLUS-Medicaid, +103394,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,HEALTHPLUS-Medicaid, +103395,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,HEALTHPLUS-Medicaid, +103396,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,HEALTHPLUS-Medicaid, +103397,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,HEALTHPLUS-Medicaid, +103398,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,HEALTHPLUS-Medicaid, +103399,3934,43301043,ALBUNEX,,357.0,357.0,,,HEALTHPLUS-Medicaid, +103400,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,HEALTHPLUS-Medicaid, +103401,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103402,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103403,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103404,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103405,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103406,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,HEALTHPLUS-Medicaid, +103407,3934,43450022,REC RM .5HR,,541.0,541.0,,,HEALTHPLUS-Medicaid, +103408,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,HEALTHPLUS-Medicaid, +103409,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,HEALTHPLUS-Medicaid, +103410,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,HEALTHPLUS-Medicaid, +103411,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,HEALTHPLUS-Medicaid, +103412,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,HEALTHPLUS-Medicaid, +103413,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,HEALTHPLUS-Medicaid, +103414,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,HEALTHPLUS-Medicaid, +103415,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,HEALTHPLUS-Medicaid, +103416,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,HEALTHPLUS-Medicaid, +103417,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,HEALTHPLUS-Medicaid, +103418,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,HEALTHPLUS-Medicaid, +103419,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,HEALTHPLUS-Medicaid, +103420,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,HEALTHPLUS-Medicaid, +103421,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,HEALTHPLUS-Medicaid, +103422,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,HEALTHPLUS-Medicaid, +103423,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,HEALTHPLUS-Medicaid, +103424,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicaid, +103425,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103426,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103427,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103428,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103429,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103430,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,HEALTHPLUS-Medicaid, +103431,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103432,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicaid, +103433,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103434,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103435,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103436,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103437,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,HEALTHPLUS-Medicaid, +103438,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicaid, +103439,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103440,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103441,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103442,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103443,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103444,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicaid, +103445,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103446,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103447,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103448,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103449,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103450,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,HEALTHPLUS-Medicaid, +103451,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,HEALTHPLUS-Medicaid, +103452,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,HEALTHPLUS-Medicaid, +103453,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,HEALTHPLUS-Medicaid, +103454,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,HEALTHPLUS-Medicaid, +103455,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,HEALTHPLUS-Medicaid, +103456,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,HEALTHPLUS-Medicaid, +103457,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,HEALTHPLUS-Medicaid, +103458,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicaid, +103459,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103460,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103461,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103462,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103463,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103464,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103465,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,HEALTHPLUS-Medicaid, +103466,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,HEALTHPLUS-Medicaid, +103467,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,HEALTHPLUS-Medicaid, +103468,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,HEALTHPLUS-Medicaid, +103469,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,HEALTHPLUS-Medicaid, +103470,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-Medicaid, +103471,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-Medicaid, +103472,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-Medicaid, +103473,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,HEALTHPLUS-Medicaid, +103474,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,HEALTHPLUS-Medicaid, +103475,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,HEALTHPLUS-Medicaid, +103476,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,HEALTHPLUS-Medicaid, +103477,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,HEALTHPLUS-Medicaid, +103478,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,HEALTHPLUS-Medicaid, +103479,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,HEALTHPLUS-Medicaid, +103480,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,HEALTHPLUS-Medicaid, +103481,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,HEALTHPLUS-Medicaid, +103482,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,HEALTHPLUS-Medicaid, +103483,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,HEALTHPLUS-Medicaid, +103484,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,HEALTHPLUS-Medicaid, +103485,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,HEALTHPLUS-Medicaid, +103486,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,HEALTHPLUS-Medicaid, +103487,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,HEALTHPLUS-Medicaid, +103488,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,HEALTHPLUS-Medicaid, +103489,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,HEALTHPLUS-Medicaid, +103490,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,HEALTHPLUS-Medicaid, +103491,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,HEALTHPLUS-Medicaid, +103492,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,HEALTHPLUS-Medicaid, +103493,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,HEALTHPLUS-Medicaid, +103494,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-Medicaid, +103495,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,HEALTHPLUS-Medicaid, +103496,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-Medicaid, +103497,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,HEALTHPLUS-Medicaid, +103498,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,HEALTHPLUS-Medicaid, +103499,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,HEALTHPLUS-Medicaid, +103500,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,HEALTHPLUS-Medicaid, +103501,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,HEALTHPLUS-Medicaid, +103502,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,HEALTHPLUS-Medicaid, +103503,3934,45924552,ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-Medicaid, +103504,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,HEALTHPLUS-Medicaid, +103505,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,HEALTHPLUS-Medicaid, +103506,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,HEALTHPLUS-Medicaid, +103507,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,HEALTHPLUS-Medicaid, +103508,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,HEALTHPLUS-Medicaid, +103509,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,HEALTHPLUS-Medicaid, +103510,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,HEALTHPLUS-Medicaid, +103511,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,HEALTHPLUS-Medicaid, +103512,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,HEALTHPLUS-Medicaid, +103513,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,HEALTHPLUS-Medicaid, +103514,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,HEALTHPLUS-Medicaid, +103515,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,HEALTHPLUS-Medicaid, +103516,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,HEALTHPLUS-Medicaid, +103517,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,HEALTHPLUS-Medicaid, +103518,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,HEALTHPLUS-Medicaid, +103519,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,HEALTHPLUS-Medicaid, +103520,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,HEALTHPLUS-Medicaid, +103521,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,HEALTHPLUS-Medicaid, +103522,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,HEALTHPLUS-Medicaid, +103523,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,HEALTHPLUS-Medicaid, +103524,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,HEALTHPLUS-Medicaid, +103525,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,HEALTHPLUS-Medicaid, +103526,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,HEALTHPLUS-Medicaid, +103527,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,HEALTHPLUS-Medicaid, +103528,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,HEALTHPLUS-Medicaid, +103529,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,HEALTHPLUS-Medicaid, +103530,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicaid, +103531,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicaid, +103532,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicaid, +103533,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicaid, +103534,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicaid, +103535,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicaid, +103536,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,HEALTHPLUS-Medicaid, +103537,3934,53200010,GUEST TRAY,,24.0,24.0,,,HEALTHPLUS-Medicaid, +103538,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,HEALTHPLUS-Medicaid, +103539,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,HEALTHPLUS-Medicaid, +103540,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,HEALTHPLUS-Medicaid, +103541,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,HEALTHPLUS-Medicaid, +103542,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,HEALTHPLUS-Medicaid, +103543,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,HEALTHPLUS-Medicaid, +103544,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,HEALTHPLUS-Medicaid, +103545,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,HEALTHPLUS-Medicaid, +103546,3934,53329876,HIV MONITORING,,416.0,416.0,,,HEALTHPLUS-Medicaid, +103547,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,HEALTHPLUS-Medicaid, +103548,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,HEALTHPLUS-Medicaid, +103549,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,HEALTHPLUS-Medicaid, +103550,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,HEALTHPLUS-Medicaid, +103551,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,HEALTHPLUS-Medicaid, +103552,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,HEALTHPLUS-Medicaid, +103553,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,HEALTHPLUS-Medicaid, +103554,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,HEALTHPLUS-Medicaid, +103555,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,HEALTHPLUS-Medicaid, +103556,3934,76010107,COPY X-RAY,,22.0,22.0,,,HEALTHPLUS-Medicaid, +103557,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,HEALTHPLUS-Medicaid, +103558,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,HEALTHPLUS-Medicaid, +103559,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,HEALTHPLUS-Medicaid, +103560,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,HEALTHPLUS-Medicaid, +103561,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,HEALTHPLUS-Medicaid, +103562,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,HEALTHPLUS-Medicaid, +103563,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,HEALTHPLUS-Medicaid, +103564,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,HEALTHPLUS-Medicaid, +103565,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,HEALTHPLUS-Medicaid, +103566,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,HEALTHPLUS-Medicaid, +103567,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,HEALTHPLUS-Medicaid, +103568,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,HEALTHPLUS-Medicaid, +103569,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,HEALTHPLUS-Medicare Advantage, +103570,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,HEALTHPLUS-Medicare Advantage, +103571,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,HEALTHPLUS-Medicare Advantage, +103572,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,HEALTHPLUS-Medicare Advantage, +103573,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,HEALTHPLUS-Medicare Advantage, +103574,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,HEALTHPLUS-Medicare Advantage, +103575,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,HEALTHPLUS-Medicare Advantage, +103576,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,HEALTHPLUS-Medicare Advantage, +103577,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,HEALTHPLUS-Medicare Advantage, +103578,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,HEALTHPLUS-Medicare Advantage, +103579,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,HEALTHPLUS-Medicare Advantage, +103580,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,HEALTHPLUS-Medicare Advantage, +103581,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,HEALTHPLUS-Medicare Advantage, +103582,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,HEALTHPLUS-Medicare Advantage, +103583,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,HEALTHPLUS-Medicare Advantage, +103584,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,HEALTHPLUS-Medicare Advantage, +103585,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,HEALTHPLUS-Medicare Advantage, +103586,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,HEALTHPLUS-Medicare Advantage, +103587,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,HEALTHPLUS-Medicare Advantage, +103588,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,HEALTHPLUS-Medicare Advantage, +103589,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,HEALTHPLUS-Medicare Advantage, +103590,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,HEALTHPLUS-Medicare Advantage, +103591,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,HEALTHPLUS-Medicare Advantage, +103592,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,HEALTHPLUS-Medicare Advantage, +103593,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,HEALTHPLUS-Medicare Advantage, +103594,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,HEALTHPLUS-Medicare Advantage, +103595,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,HEALTHPLUS-Medicare Advantage, +103596,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,HEALTHPLUS-Medicare Advantage, +103597,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,HEALTHPLUS-Medicare Advantage, +103598,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,HEALTHPLUS-Medicare Advantage, +103599,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,HEALTHPLUS-Medicare Advantage, +103600,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,HEALTHPLUS-Medicare Advantage, +103601,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,HEALTHPLUS-Medicare Advantage, +103602,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,HEALTHPLUS-Medicare Advantage, +103603,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,HEALTHPLUS-Medicare Advantage, +103604,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,HEALTHPLUS-Medicare Advantage, +103605,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,HEALTHPLUS-Medicare Advantage, +103606,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,HEALTHPLUS-Medicare Advantage, +103607,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,HEALTHPLUS-Medicare Advantage, +103608,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,HEALTHPLUS-Medicare Advantage, +103609,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,HEALTHPLUS-Medicare Advantage, +103610,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,HEALTHPLUS-Medicare Advantage, +103611,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,HEALTHPLUS-Medicare Advantage, +103612,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,HEALTHPLUS-Medicare Advantage, +103613,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,HEALTHPLUS-Medicare Advantage, +103614,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,HEALTHPLUS-Medicare Advantage, +103615,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,HEALTHPLUS-Medicare Advantage,7511.85 +103616,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,HEALTHPLUS-Medicare Advantage, +103617,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,HEALTHPLUS-Medicare Advantage, +103618,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,HEALTHPLUS-Medicare Advantage, +103619,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,HEALTHPLUS-Medicare Advantage, +103620,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,HEALTHPLUS-Medicare Advantage, +103621,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,HEALTHPLUS-Medicare Advantage, +103622,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,HEALTHPLUS-Medicare Advantage, +103623,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,HEALTHPLUS-Medicare Advantage, +103624,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,HEALTHPLUS-Medicare Advantage, +103625,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,HEALTHPLUS-Medicare Advantage, +103626,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,HEALTHPLUS-Medicare Advantage, +103627,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,HEALTHPLUS-Medicare Advantage, +103628,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,HEALTHPLUS-Medicare Advantage, +103629,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,HEALTHPLUS-Medicare Advantage, +103630,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,HEALTHPLUS-Medicare Advantage, +103631,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,HEALTHPLUS-Medicare Advantage, +103632,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,HEALTHPLUS-Medicare Advantage, +103633,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,HEALTHPLUS-Medicare Advantage, +103634,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,HEALTHPLUS-Medicare Advantage, +103635,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,HEALTHPLUS-Medicare Advantage, +103636,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,HEALTHPLUS-Medicare Advantage, +103637,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,HEALTHPLUS-Medicare Advantage, +103638,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,HEALTHPLUS-Medicare Advantage, +103639,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,HEALTHPLUS-Medicare Advantage, +103640,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,HEALTHPLUS-Medicare Advantage, +103641,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,HEALTHPLUS-Medicare Advantage, +103642,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,HEALTHPLUS-Medicare Advantage, +103643,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,HEALTHPLUS-Medicare Advantage,8913.77 +103644,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,HEALTHPLUS-Medicare Advantage, +103645,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,HEALTHPLUS-Medicare Advantage, +103646,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,HEALTHPLUS-Medicare Advantage, +103647,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,HEALTHPLUS-Medicare Advantage, +103648,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,HEALTHPLUS-Medicare Advantage, +103649,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,HEALTHPLUS-Medicare Advantage, +103650,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,HEALTHPLUS-Medicare Advantage, +103651,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,HEALTHPLUS-Medicare Advantage, +103652,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,HEALTHPLUS-Medicare Advantage, +103653,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,HEALTHPLUS-Medicare Advantage, +103654,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,HEALTHPLUS-Medicare Advantage, +103655,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,HEALTHPLUS-Medicare Advantage, +103656,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,HEALTHPLUS-Medicare Advantage, +103657,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,HEALTHPLUS-Medicare Advantage, +103658,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,HEALTHPLUS-Medicare Advantage, +103659,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,HEALTHPLUS-Medicare Advantage, +103660,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,HEALTHPLUS-Medicare Advantage, +103661,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,HEALTHPLUS-Medicare Advantage, +103662,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,HEALTHPLUS-Medicare Advantage, +103663,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,HEALTHPLUS-Medicare Advantage, +103664,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,HEALTHPLUS-Medicare Advantage, +103665,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,HEALTHPLUS-Medicare Advantage, +103666,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,HEALTHPLUS-Medicare Advantage, +103667,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,HEALTHPLUS-Medicare Advantage, +103668,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,HEALTHPLUS-Medicare Advantage, +103669,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,HEALTHPLUS-Medicare Advantage, +103670,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,HEALTHPLUS-Medicare Advantage, +103671,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,HEALTHPLUS-Medicare Advantage, +103672,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,HEALTHPLUS-Medicare Advantage, +103673,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,HEALTHPLUS-Medicare Advantage, +103674,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,HEALTHPLUS-Medicare Advantage, +103675,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,HEALTHPLUS-Medicare Advantage, +103676,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,HEALTHPLUS-Medicare Advantage, +103677,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,HEALTHPLUS-Medicare Advantage, +103678,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,HEALTHPLUS-Medicare Advantage, +103679,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,HEALTHPLUS-Medicare Advantage, +103680,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,HEALTHPLUS-Medicare Advantage, +103681,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,HEALTHPLUS-Medicare Advantage, +103682,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,HEALTHPLUS-Medicare Advantage, +103683,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,HEALTHPLUS-Medicare Advantage, +103684,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,HEALTHPLUS-Medicare Advantage, +103685,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,HEALTHPLUS-Medicare Advantage, +103686,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,HEALTHPLUS-Medicare Advantage, +103687,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,HEALTHPLUS-Medicare Advantage, +103688,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,HEALTHPLUS-Medicare Advantage, +103689,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,HEALTHPLUS-Medicare Advantage, +103690,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,HEALTHPLUS-Medicare Advantage, +103691,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,HEALTHPLUS-Medicare Advantage,13205.33 +103692,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,HEALTHPLUS-Medicare Advantage, +103693,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,HEALTHPLUS-Medicare Advantage,15686.89 +103694,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,HEALTHPLUS-Medicare Advantage, +103695,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,HEALTHPLUS-Medicare Advantage, +103696,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,HEALTHPLUS-Medicare Advantage, +103697,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,HEALTHPLUS-Medicare Advantage, +103698,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,HEALTHPLUS-Medicare Advantage, +103699,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,HEALTHPLUS-Medicare Advantage, +103700,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,HEALTHPLUS-Medicare Advantage, +103701,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,HEALTHPLUS-Medicare Advantage,11188.41 +103702,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,HEALTHPLUS-Medicare Advantage, +103703,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,HEALTHPLUS-Medicare Advantage, +103704,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,HEALTHPLUS-Medicare Advantage, +103705,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,HEALTHPLUS-Medicare Advantage, +103706,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,HEALTHPLUS-Medicare Advantage, +103707,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,HEALTHPLUS-Medicare Advantage, +103708,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,HEALTHPLUS-Medicare Advantage, +103709,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,HEALTHPLUS-Medicare Advantage, +103710,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,HEALTHPLUS-Medicare Advantage, +103711,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,HEALTHPLUS-Medicare Advantage, +103712,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,HEALTHPLUS-Medicare Advantage, +103713,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,HEALTHPLUS-Medicare Advantage, +103714,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,HEALTHPLUS-Medicare Advantage, +103715,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,HEALTHPLUS-Medicare Advantage, +103716,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,HEALTHPLUS-Medicare Advantage, +103717,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,HEALTHPLUS-Medicare Advantage, +103718,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,HEALTHPLUS-Medicare Advantage, +103719,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,HEALTHPLUS-Medicare Advantage, +103720,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,HEALTHPLUS-Medicare Advantage, +103721,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,HEALTHPLUS-Medicare Advantage, +103722,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,HEALTHPLUS-Medicare Advantage, +103723,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,HEALTHPLUS-Medicare Advantage, +103724,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,HEALTHPLUS-Medicare Advantage, +103725,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,HEALTHPLUS-Medicare Advantage, +103726,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,HEALTHPLUS-Medicare Advantage, +103727,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,HEALTHPLUS-Medicare Advantage, +103728,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,HEALTHPLUS-Medicare Advantage, +103729,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,HEALTHPLUS-Medicare Advantage, +103730,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,HEALTHPLUS-Medicare Advantage, +103731,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,HEALTHPLUS-Medicare Advantage, +103732,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,HEALTHPLUS-Medicare Advantage, +103733,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,HEALTHPLUS-Medicare Advantage, +103734,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,HEALTHPLUS-Medicare Advantage, +103735,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,HEALTHPLUS-Medicare Advantage, +103736,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,HEALTHPLUS-Medicare Advantage, +103737,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,HEALTHPLUS-Medicare Advantage, +103738,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,HEALTHPLUS-Medicare Advantage, +103739,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,HEALTHPLUS-Medicare Advantage, +103740,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,HEALTHPLUS-Medicare Advantage, +103741,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,HEALTHPLUS-Medicare Advantage, +103742,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,HEALTHPLUS-Medicare Advantage, +103743,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,HEALTHPLUS-Medicare Advantage, +103744,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,HEALTHPLUS-Medicare Advantage, +103745,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,HEALTHPLUS-Medicare Advantage, +103746,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,HEALTHPLUS-Medicare Advantage, +103747,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,HEALTHPLUS-Medicare Advantage, +103748,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,HEALTHPLUS-Medicare Advantage, +103749,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,HEALTHPLUS-Medicare Advantage, +103750,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,HEALTHPLUS-Medicare Advantage, +103751,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,HEALTHPLUS-Medicare Advantage, +103752,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,HEALTHPLUS-Medicare Advantage,16257.69 +103753,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,HEALTHPLUS-Medicare Advantage, +103754,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,HEALTHPLUS-Medicare Advantage, +103755,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,HEALTHPLUS-Medicare Advantage, +103756,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,HEALTHPLUS-Medicare Advantage, +103757,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,HEALTHPLUS-Medicare Advantage, +103758,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,HEALTHPLUS-Medicare Advantage, +103759,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,HEALTHPLUS-Medicare Advantage, +103760,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,HEALTHPLUS-Medicare Advantage, +103761,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,HEALTHPLUS-Medicare Advantage, +103762,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,HEALTHPLUS-Medicare Advantage, +103763,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,HEALTHPLUS-Medicare Advantage, +103764,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,HEALTHPLUS-Medicare Advantage, +103765,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,HEALTHPLUS-Medicare Advantage, +103766,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,HEALTHPLUS-Medicare Advantage, +103767,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,HEALTHPLUS-Medicare Advantage, +103768,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,HEALTHPLUS-Medicare Advantage, +103769,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,HEALTHPLUS-Medicare Advantage, +103770,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,HEALTHPLUS-Medicare Advantage, +103771,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,HEALTHPLUS-Medicare Advantage, +103772,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,HEALTHPLUS-Medicare Advantage, +103773,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,HEALTHPLUS-Medicare Advantage, +103774,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,HEALTHPLUS-Medicare Advantage,9594.6 +103775,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,HEALTHPLUS-Medicare Advantage, +103776,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,HEALTHPLUS-Medicare Advantage, +103777,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,HEALTHPLUS-Medicare Advantage, +103778,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,HEALTHPLUS-Medicare Advantage, +103779,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,HEALTHPLUS-Medicare Advantage, +103780,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,HEALTHPLUS-Medicare Advantage, +103781,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,HEALTHPLUS-Medicare Advantage, +103782,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,HEALTHPLUS-Medicare Advantage, +103783,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,HEALTHPLUS-Medicare Advantage, +103784,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,HEALTHPLUS-Medicare Advantage, +103785,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,HEALTHPLUS-Medicare Advantage, +103786,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,HEALTHPLUS-Medicare Advantage, +103787,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,HEALTHPLUS-Medicare Advantage, +103788,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,HEALTHPLUS-Medicare Advantage, +103789,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,HEALTHPLUS-Medicare Advantage, +103790,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,HEALTHPLUS-Medicare Advantage, +103791,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,HEALTHPLUS-Medicare Advantage, +103792,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,HEALTHPLUS-Medicare Advantage,7731.58 +103793,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,HEALTHPLUS-Medicare Advantage, +103794,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,HEALTHPLUS-Medicare Advantage, +103795,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,HEALTHPLUS-Medicare Advantage, +103796,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,HEALTHPLUS-Medicare Advantage, +103797,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,HEALTHPLUS-Medicare Advantage, +103798,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,HEALTHPLUS-Medicare Advantage, +103799,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,HEALTHPLUS-Medicare Advantage, +103800,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,HEALTHPLUS-Medicare Advantage, +103801,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,HEALTHPLUS-Medicare Advantage, +103802,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,HEALTHPLUS-Medicare Advantage, +103803,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,HEALTHPLUS-Medicare Advantage, +103804,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,HEALTHPLUS-Medicare Advantage, +103805,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,HEALTHPLUS-Medicare Advantage, +103806,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,HEALTHPLUS-Medicare Advantage, +103807,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,HEALTHPLUS-Medicare Advantage, +103808,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,HEALTHPLUS-Medicare Advantage, +103809,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,HEALTHPLUS-Medicare Advantage, +103810,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,HEALTHPLUS-Medicare Advantage, +103811,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,HEALTHPLUS-Medicare Advantage, +103812,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,HEALTHPLUS-Medicare Advantage, +103813,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,HEALTHPLUS-Medicare Advantage, +103814,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,HEALTHPLUS-Medicare Advantage, +103815,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,HEALTHPLUS-Medicare Advantage, +103816,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,HEALTHPLUS-Medicare Advantage, +103817,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,HEALTHPLUS-Medicare Advantage, +103818,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,HEALTHPLUS-Medicare Advantage, +103819,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,HEALTHPLUS-Medicare Advantage, +103820,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,HEALTHPLUS-Medicare Advantage, +103821,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,HEALTHPLUS-Medicare Advantage, +103822,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,HEALTHPLUS-Medicare Advantage, +103823,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,HEALTHPLUS-Medicare Advantage, +103824,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,HEALTHPLUS-Medicare Advantage, +103825,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,HEALTHPLUS-Medicare Advantage, +103826,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,HEALTHPLUS-Medicare Advantage, +103827,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,HEALTHPLUS-Medicare Advantage, +103828,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,HEALTHPLUS-Medicare Advantage, +103829,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,HEALTHPLUS-Medicare Advantage, +103830,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,HEALTHPLUS-Medicare Advantage, +103831,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,HEALTHPLUS-Medicare Advantage, +103832,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,HEALTHPLUS-Medicare Advantage, +103833,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,HEALTHPLUS-Medicare Advantage, +103834,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,HEALTHPLUS-Medicare Advantage, +103835,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,HEALTHPLUS-Medicare Advantage, +103836,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,HEALTHPLUS-Medicare Advantage, +103837,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,HEALTHPLUS-Medicare Advantage, +103838,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,HEALTHPLUS-Medicare Advantage, +103839,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,HEALTHPLUS-Medicare Advantage, +103840,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,HEALTHPLUS-Medicare Advantage, +103841,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,HEALTHPLUS-Medicare Advantage, +103842,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,HEALTHPLUS-Medicare Advantage, +103843,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,HEALTHPLUS-Medicare Advantage, +103844,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,HEALTHPLUS-Medicare Advantage, +103845,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,HEALTHPLUS-Medicare Advantage, +103846,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,HEALTHPLUS-Medicare Advantage, +103847,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,HEALTHPLUS-Medicare Advantage, +103848,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,HEALTHPLUS-Medicare Advantage, +103849,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,HEALTHPLUS-Medicare Advantage, +103850,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,HEALTHPLUS-Medicare Advantage, +103851,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,HEALTHPLUS-Medicare Advantage, +103852,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,HEALTHPLUS-Medicare Advantage, +103853,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,HEALTHPLUS-Medicare Advantage, +103854,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,HEALTHPLUS-Medicare Advantage, +103855,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,HEALTHPLUS-Medicare Advantage, +103856,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,HEALTHPLUS-Medicare Advantage, +103857,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,HEALTHPLUS-Medicare Advantage, +103858,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,HEALTHPLUS-Medicare Advantage, +103859,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,HEALTHPLUS-Medicare Advantage, +103860,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,HEALTHPLUS-Medicare Advantage, +103861,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,HEALTHPLUS-Medicare Advantage, +103862,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,HEALTHPLUS-Medicare Advantage, +103863,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,HEALTHPLUS-Medicare Advantage, +103864,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,HEALTHPLUS-Medicare Advantage, +103865,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,HEALTHPLUS-Medicare Advantage, +103866,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,HEALTHPLUS-Medicare Advantage, +103867,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,HEALTHPLUS-Medicare Advantage, +103868,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,HEALTHPLUS-Medicare Advantage, +103869,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,HEALTHPLUS-Medicare Advantage, +103870,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,HEALTHPLUS-Medicare Advantage,15291.24 +103871,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,HEALTHPLUS-Medicare Advantage, +103872,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,HEALTHPLUS-Medicare Advantage, +103873,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,HEALTHPLUS-Medicare Advantage, +103874,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,HEALTHPLUS-Medicare Advantage, +103875,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,HEALTHPLUS-Medicare Advantage, +103876,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,HEALTHPLUS-Medicare Advantage, +103877,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,HEALTHPLUS-Medicare Advantage, +103878,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,HEALTHPLUS-Medicare Advantage, +103879,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,HEALTHPLUS-Medicare Advantage, +103880,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,HEALTHPLUS-Medicare Advantage, +103881,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,HEALTHPLUS-Medicare Advantage, +103882,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,HEALTHPLUS-Medicare Advantage, +103883,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,HEALTHPLUS-Medicare Advantage, +103884,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,HEALTHPLUS-Medicare Advantage, +103885,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,HEALTHPLUS-Medicare Advantage, +103886,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,HEALTHPLUS-Medicare Advantage, +103887,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,HEALTHPLUS-Medicare Advantage, +103888,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,HEALTHPLUS-Medicare Advantage, +103889,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,HEALTHPLUS-Medicare Advantage, +103890,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,HEALTHPLUS-Medicare Advantage, +103891,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,HEALTHPLUS-Medicare Advantage, +103892,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,HEALTHPLUS-Medicare Advantage, +103893,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,HEALTHPLUS-Medicare Advantage, +103894,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,HEALTHPLUS-Medicare Advantage, +103895,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,HEALTHPLUS-Medicare Advantage,33160.26 +103896,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,HEALTHPLUS-Medicare Advantage, +103897,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,HEALTHPLUS-Medicare Advantage, +103898,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,HEALTHPLUS-Medicare Advantage, +103899,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,HEALTHPLUS-Medicare Advantage, +103900,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,HEALTHPLUS-Medicare Advantage, +103901,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,HEALTHPLUS-Medicare Advantage, +103902,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,HEALTHPLUS-Medicare Advantage, +103903,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,HEALTHPLUS-Medicare Advantage, +103904,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,HEALTHPLUS-Medicare Advantage, +103905,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,HEALTHPLUS-Medicare Advantage, +103906,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,HEALTHPLUS-Medicare Advantage, +103907,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,HEALTHPLUS-Medicare Advantage, +103908,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,HEALTHPLUS-Medicare Advantage, +103909,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,HEALTHPLUS-Medicare Advantage, +103910,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,HEALTHPLUS-Medicare Advantage,20435.36 +103911,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,HEALTHPLUS-Medicare Advantage, +103912,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,HEALTHPLUS-Medicare Advantage, +103913,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,HEALTHPLUS-Medicare Advantage, +103914,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,HEALTHPLUS-Medicare Advantage,14962.46 +103915,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,HEALTHPLUS-Medicare Advantage, +103916,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,HEALTHPLUS-Medicare Advantage, +103917,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,HEALTHPLUS-Medicare Advantage, +103918,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,HEALTHPLUS-Medicare Advantage, +103919,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,HEALTHPLUS-Medicare Advantage, +103920,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,HEALTHPLUS-Medicare Advantage, +103921,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,HEALTHPLUS-Medicare Advantage, +103922,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,HEALTHPLUS-Medicare Advantage, +103923,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,HEALTHPLUS-Medicare Advantage, +103924,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,HEALTHPLUS-Medicare Advantage, +103925,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,HEALTHPLUS-Medicare Advantage, +103926,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,HEALTHPLUS-Medicare Advantage, +103927,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,HEALTHPLUS-Medicare Advantage, +103928,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,HEALTHPLUS-Medicare Advantage, +103929,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,HEALTHPLUS-Medicare Advantage, +103930,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,HEALTHPLUS-Medicare Advantage, +103931,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,HEALTHPLUS-Medicare Advantage, +103932,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,HEALTHPLUS-Medicare Advantage, +103933,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,HEALTHPLUS-Medicare Advantage, +103934,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,HEALTHPLUS-Medicare Advantage, +103935,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,HEALTHPLUS-Medicare Advantage, +103936,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,HEALTHPLUS-Medicare Advantage, +103937,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,HEALTHPLUS-Medicare Advantage, +103938,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,HEALTHPLUS-Medicare Advantage, +103939,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,HEALTHPLUS-Medicare Advantage, +103940,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,HEALTHPLUS-Medicare Advantage, +103941,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,HEALTHPLUS-Medicare Advantage, +103942,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,HEALTHPLUS-Medicare Advantage, +103943,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,HEALTHPLUS-Medicare Advantage, +103944,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,HEALTHPLUS-Medicare Advantage, +103945,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,HEALTHPLUS-Medicare Advantage, +103946,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,HEALTHPLUS-Medicare Advantage, +103947,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,HEALTHPLUS-Medicare Advantage, +103948,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,HEALTHPLUS-Medicare Advantage, +103949,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,HEALTHPLUS-Medicare Advantage, +103950,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,HEALTHPLUS-Medicare Advantage, +103951,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,HEALTHPLUS-Medicare Advantage, +103952,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,HEALTHPLUS-Medicare Advantage, +103953,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,HEALTHPLUS-Medicare Advantage, +103954,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,HEALTHPLUS-Medicare Advantage, +103955,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,HEALTHPLUS-Medicare Advantage, +103956,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,HEALTHPLUS-Medicare Advantage, +103957,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,HEALTHPLUS-Medicare Advantage, +103958,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,HEALTHPLUS-Medicare Advantage,9351.63 +103959,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,HEALTHPLUS-Medicare Advantage, +103960,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,HEALTHPLUS-Medicare Advantage, +103961,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,HEALTHPLUS-Medicare Advantage, +103962,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,HEALTHPLUS-Medicare Advantage, +103963,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,HEALTHPLUS-Medicare Advantage, +103964,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,HEALTHPLUS-Medicare Advantage, +103965,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,HEALTHPLUS-Medicare Advantage, +103966,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,HEALTHPLUS-Medicare Advantage, +103967,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,HEALTHPLUS-Medicare Advantage, +103968,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,HEALTHPLUS-Medicare Advantage, +103969,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,HEALTHPLUS-Medicare Advantage, +103970,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,HEALTHPLUS-Medicare Advantage, +103971,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,HEALTHPLUS-Medicare Advantage, +103972,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,HEALTHPLUS-Medicare Advantage, +103973,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,HEALTHPLUS-Medicare Advantage, +103974,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,HEALTHPLUS-Medicare Advantage, +103975,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,HEALTHPLUS-Medicare Advantage, +103976,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,HEALTHPLUS-Medicare Advantage, +103977,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,HEALTHPLUS-Medicare Advantage, +103978,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,HEALTHPLUS-Medicare Advantage, +103979,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,HEALTHPLUS-Medicare Advantage, +103980,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,HEALTHPLUS-Medicare Advantage, +103981,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,HEALTHPLUS-Medicare Advantage, +103982,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,HEALTHPLUS-Medicare Advantage, +103983,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,HEALTHPLUS-Medicare Advantage, +103984,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,HEALTHPLUS-Medicare Advantage, +103985,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,HEALTHPLUS-Medicare Advantage, +103986,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,HEALTHPLUS-Medicare Advantage, +103987,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,HEALTHPLUS-Medicare Advantage, +103988,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,HEALTHPLUS-Medicare Advantage, +103989,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,HEALTHPLUS-Medicare Advantage, +103990,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,HEALTHPLUS-Medicare Advantage, +103991,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,HEALTHPLUS-Medicare Advantage, +103992,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,HEALTHPLUS-Medicare Advantage, +103993,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,HEALTHPLUS-Medicare Advantage, +103994,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,HEALTHPLUS-Medicare Advantage, +103995,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,HEALTHPLUS-Medicare Advantage, +103996,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,HEALTHPLUS-Medicare Advantage, +103997,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,HEALTHPLUS-Medicare Advantage, +103998,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,HEALTHPLUS-Medicare Advantage, +103999,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,HEALTHPLUS-Medicare Advantage, +104000,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,HEALTHPLUS-Medicare Advantage, +104001,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,HEALTHPLUS-Medicare Advantage, +104002,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,HEALTHPLUS-Medicare Advantage, +104003,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,HEALTHPLUS-Medicare Advantage, +104004,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,HEALTHPLUS-Medicare Advantage, +104005,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,HEALTHPLUS-Medicare Advantage, +104006,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,HEALTHPLUS-Medicare Advantage, +104007,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,HEALTHPLUS-Medicare Advantage, +104008,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,HEALTHPLUS-Medicare Advantage, +104009,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,HEALTHPLUS-Medicare Advantage, +104010,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,HEALTHPLUS-Medicare Advantage, +104011,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,HEALTHPLUS-Medicare Advantage, +104012,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,HEALTHPLUS-Medicare Advantage, +104013,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,HEALTHPLUS-Medicare Advantage, +104014,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,HEALTHPLUS-Medicare Advantage, +104015,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,HEALTHPLUS-Medicare Advantage, +104016,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,HEALTHPLUS-Medicare Advantage, +104017,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,HEALTHPLUS-Medicare Advantage, +104018,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,HEALTHPLUS-Medicare Advantage, +104019,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,HEALTHPLUS-Medicare Advantage, +104020,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,HEALTHPLUS-Medicare Advantage, +104021,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,HEALTHPLUS-Medicare Advantage, +104022,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,HEALTHPLUS-Medicare Advantage, +104023,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,HEALTHPLUS-Medicare Advantage, +104024,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,HEALTHPLUS-Medicare Advantage, +104025,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,HEALTHPLUS-Medicare Advantage, +104026,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,HEALTHPLUS-Medicare Advantage, +104027,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,HEALTHPLUS-Medicare Advantage, +104028,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,HEALTHPLUS-Medicare Advantage, +104029,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,HEALTHPLUS-Medicare Advantage, +104030,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,HEALTHPLUS-Medicare Advantage, +104031,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,HEALTHPLUS-Medicare Advantage, +104032,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,HEALTHPLUS-Medicare Advantage, +104033,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,HEALTHPLUS-Medicare Advantage, +104034,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,HEALTHPLUS-Medicare Advantage, +104035,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,HEALTHPLUS-Medicare Advantage, +104036,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,HEALTHPLUS-Medicare Advantage, +104037,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,HEALTHPLUS-Medicare Advantage, +104038,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,HEALTHPLUS-Medicare Advantage, +104039,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,HEALTHPLUS-Medicare Advantage, +104040,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,HEALTHPLUS-Medicare Advantage, +104041,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,HEALTHPLUS-Medicare Advantage, +104042,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,HEALTHPLUS-Medicare Advantage, +104043,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,HEALTHPLUS-Medicare Advantage, +104044,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,HEALTHPLUS-Medicare Advantage, +104045,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,HEALTHPLUS-Medicare Advantage, +104046,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,HEALTHPLUS-Medicare Advantage, +104047,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,HEALTHPLUS-Medicare Advantage, +104048,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,HEALTHPLUS-Medicare Advantage, +104049,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,HEALTHPLUS-Medicare Advantage, +104050,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,HEALTHPLUS-Medicare Advantage, +104051,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,HEALTHPLUS-Medicare Advantage, +104052,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,HEALTHPLUS-Medicare Advantage, +104053,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,HEALTHPLUS-Medicare Advantage, +104054,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,HEALTHPLUS-Medicare Advantage, +104055,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,HEALTHPLUS-Medicare Advantage, +104056,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,HEALTHPLUS-Medicare Advantage, +104057,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,HEALTHPLUS-Medicare Advantage, +104058,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,HEALTHPLUS-Medicare Advantage, +104059,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,HEALTHPLUS-Medicare Advantage, +104060,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,HEALTHPLUS-Medicare Advantage, +104061,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,HEALTHPLUS-Medicare Advantage, +104062,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,HEALTHPLUS-Medicare Advantage, +104063,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,HEALTHPLUS-Medicare Advantage, +104064,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,HEALTHPLUS-Medicare Advantage, +104065,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,HEALTHPLUS-Medicare Advantage, +104066,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,HEALTHPLUS-Medicare Advantage, +104067,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,HEALTHPLUS-Medicare Advantage, +104068,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,HEALTHPLUS-Medicare Advantage, +104069,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,HEALTHPLUS-Medicare Advantage, +104070,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,HEALTHPLUS-Medicare Advantage, +104071,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,HEALTHPLUS-Medicare Advantage, +104072,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,HEALTHPLUS-Medicare Advantage, +104073,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,HEALTHPLUS-Medicare Advantage, +104074,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,HEALTHPLUS-Medicare Advantage, +104075,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,HEALTHPLUS-Medicare Advantage, +104076,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,HEALTHPLUS-Medicare Advantage, +104077,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,HEALTHPLUS-Medicare Advantage, +104078,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,HEALTHPLUS-Medicare Advantage, +104079,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,HEALTHPLUS-Medicare Advantage, +104080,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,HEALTHPLUS-Medicare Advantage, +104081,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,HEALTHPLUS-Medicare Advantage, +104082,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,HEALTHPLUS-Medicare Advantage, +104083,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,HEALTHPLUS-Medicare Advantage, +104084,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,HEALTHPLUS-Medicare Advantage, +104085,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,HEALTHPLUS-Medicare Advantage, +104086,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,HEALTHPLUS-Medicare Advantage, +104087,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,HEALTHPLUS-Medicare Advantage, +104088,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,HEALTHPLUS-Medicare Advantage, +104089,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,HEALTHPLUS-Medicare Advantage, +104090,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,HEALTHPLUS-Medicare Advantage, +104091,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,HEALTHPLUS-Medicare Advantage, +104092,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,HEALTHPLUS-Medicare Advantage, +104093,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,HEALTHPLUS-Medicare Advantage, +104094,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,HEALTHPLUS-Medicare Advantage, +104095,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,HEALTHPLUS-Medicare Advantage, +104096,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,HEALTHPLUS-Medicare Advantage, +104097,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,HEALTHPLUS-Medicare Advantage, +104098,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,HEALTHPLUS-Medicare Advantage, +104099,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,HEALTHPLUS-Medicare Advantage, +104100,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,HEALTHPLUS-Medicare Advantage, +104101,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,HEALTHPLUS-Medicare Advantage, +104102,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,HEALTHPLUS-Medicare Advantage, +104103,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,HEALTHPLUS-Medicare Advantage, +104104,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,HEALTHPLUS-Medicare Advantage, +104105,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,HEALTHPLUS-Medicare Advantage, +104106,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,HEALTHPLUS-Medicare Advantage, +104107,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,HEALTHPLUS-Medicare Advantage, +104108,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,HEALTHPLUS-Medicare Advantage, +104109,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,HEALTHPLUS-Medicare Advantage, +104110,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,HEALTHPLUS-Medicare Advantage, +104111,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,HEALTHPLUS-Medicare Advantage, +104112,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,HEALTHPLUS-Medicare Advantage, +104113,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,HEALTHPLUS-Medicare Advantage, +104114,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,HEALTHPLUS-Medicare Advantage, +104115,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,HEALTHPLUS-Medicare Advantage, +104116,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,HEALTHPLUS-Medicare Advantage, +104117,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,HEALTHPLUS-Medicare Advantage, +104118,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,HEALTHPLUS-Medicare Advantage, +104119,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,HEALTHPLUS-Medicare Advantage, +104120,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,HEALTHPLUS-Medicare Advantage, +104121,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,HEALTHPLUS-Medicare Advantage, +104122,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,HEALTHPLUS-Medicare Advantage, +104123,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,HEALTHPLUS-Medicare Advantage, +104124,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,HEALTHPLUS-Medicare Advantage, +104125,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,HEALTHPLUS-Medicare Advantage, +104126,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,HEALTHPLUS-Medicare Advantage, +104127,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,HEALTHPLUS-Medicare Advantage, +104128,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,HEALTHPLUS-Medicare Advantage, +104129,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,HEALTHPLUS-Medicare Advantage, +104130,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,HEALTHPLUS-Medicare Advantage, +104131,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,HEALTHPLUS-Medicare Advantage, +104132,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,HEALTHPLUS-Medicare Advantage, +104133,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,HEALTHPLUS-Medicare Advantage, +104134,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,HEALTHPLUS-Medicare Advantage, +104135,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,HEALTHPLUS-Medicare Advantage, +104136,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,HEALTHPLUS-Medicare Advantage, +104137,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,HEALTHPLUS-Medicare Advantage, +104138,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,HEALTHPLUS-Medicare Advantage, +104139,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,HEALTHPLUS-Medicare Advantage, +104140,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,HEALTHPLUS-Medicare Advantage, +104141,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,HEALTHPLUS-Medicare Advantage, +104142,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,HEALTHPLUS-Medicare Advantage, +104143,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,HEALTHPLUS-Medicare Advantage, +104144,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,HEALTHPLUS-Medicare Advantage, +104145,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,HEALTHPLUS-Medicare Advantage, +104146,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,HEALTHPLUS-Medicare Advantage, +104147,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,HEALTHPLUS-Medicare Advantage, +104148,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,HEALTHPLUS-Medicare Advantage, +104149,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,HEALTHPLUS-Medicare Advantage, +104150,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,HEALTHPLUS-Medicare Advantage, +104151,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,HEALTHPLUS-Medicare Advantage, +104152,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,HEALTHPLUS-Medicare Advantage, +104153,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,HEALTHPLUS-Medicare Advantage, +104154,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,HEALTHPLUS-Medicare Advantage, +104155,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,HEALTHPLUS-Medicare Advantage, +104156,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,HEALTHPLUS-Medicare Advantage, +104157,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,HEALTHPLUS-Medicare Advantage, +104158,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,HEALTHPLUS-Medicare Advantage, +104159,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,HEALTHPLUS-Medicare Advantage, +104160,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,HEALTHPLUS-Medicare Advantage, +104161,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,HEALTHPLUS-Medicare Advantage, +104162,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,HEALTHPLUS-Medicare Advantage, +104163,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,HEALTHPLUS-Medicare Advantage, +104164,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,HEALTHPLUS-Medicare Advantage, +104165,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,HEALTHPLUS-Medicare Advantage, +104166,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,HEALTHPLUS-Medicare Advantage, +104167,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,HEALTHPLUS-Medicare Advantage, +104168,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,HEALTHPLUS-Medicare Advantage, +104169,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,HEALTHPLUS-Medicare Advantage, +104170,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,HEALTHPLUS-Medicare Advantage,77111.08 +104171,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,HEALTHPLUS-Medicare Advantage, +104172,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,HEALTHPLUS-Medicare Advantage, +104173,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,HEALTHPLUS-Medicare Advantage, +104174,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,HEALTHPLUS-Medicare Advantage, +104175,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,HEALTHPLUS-Medicare Advantage, +104176,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,HEALTHPLUS-Medicare Advantage, +104177,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,HEALTHPLUS-Medicare Advantage, +104178,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,HEALTHPLUS-Medicare Advantage, +104179,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,HEALTHPLUS-Medicare Advantage, +104180,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,HEALTHPLUS-Medicare Advantage, +104181,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,HEALTHPLUS-Medicare Advantage, +104182,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,HEALTHPLUS-Medicare Advantage, +104183,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,HEALTHPLUS-Medicare Advantage, +104184,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,HEALTHPLUS-Medicare Advantage, +104185,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,HEALTHPLUS-Medicare Advantage, +104186,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,HEALTHPLUS-Medicare Advantage, +104187,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,HEALTHPLUS-Medicare Advantage, +104188,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,HEALTHPLUS-Medicare Advantage, +104189,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,HEALTHPLUS-Medicare Advantage, +104190,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,HEALTHPLUS-Medicare Advantage, +104191,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,HEALTHPLUS-Medicare Advantage, +104192,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,HEALTHPLUS-Medicare Advantage, +104193,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,HEALTHPLUS-Medicare Advantage, +104194,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,HEALTHPLUS-Medicare Advantage, +104195,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,HEALTHPLUS-Medicare Advantage, +104196,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,HEALTHPLUS-Medicare Advantage, +104197,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,HEALTHPLUS-Medicare Advantage, +104198,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,HEALTHPLUS-Medicare Advantage, +104199,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,HEALTHPLUS-Medicare Advantage, +104200,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,HEALTHPLUS-Medicare Advantage, +104201,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,HEALTHPLUS-Medicare Advantage, +104202,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,HEALTHPLUS-Medicare Advantage, +104203,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,HEALTHPLUS-Medicare Advantage, +104204,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,HEALTHPLUS-Medicare Advantage, +104205,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,HEALTHPLUS-Medicare Advantage, +104206,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,HEALTHPLUS-Medicare Advantage, +104207,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,HEALTHPLUS-Medicare Advantage, +104208,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,HEALTHPLUS-Medicare Advantage, +104209,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,HEALTHPLUS-Medicare Advantage, +104210,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,HEALTHPLUS-Medicare Advantage, +104211,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,HEALTHPLUS-Medicare Advantage, +104212,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,HEALTHPLUS-Medicare Advantage, +104213,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,HEALTHPLUS-Medicare Advantage, +104214,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,HEALTHPLUS-Medicare Advantage, +104215,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,HEALTHPLUS-Medicare Advantage, +104216,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,HEALTHPLUS-Medicare Advantage, +104217,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,HEALTHPLUS-Medicare Advantage, +104218,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,HEALTHPLUS-Medicare Advantage, +104219,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,HEALTHPLUS-Medicare Advantage, +104220,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,HEALTHPLUS-Medicare Advantage, +104221,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,HEALTHPLUS-Medicare Advantage, +104222,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,HEALTHPLUS-Medicare Advantage, +104223,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,HEALTHPLUS-Medicare Advantage, +104224,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,HEALTHPLUS-Medicare Advantage, +104225,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,HEALTHPLUS-Medicare Advantage, +104226,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,HEALTHPLUS-Medicare Advantage, +104227,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,HEALTHPLUS-Medicare Advantage, +104228,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,HEALTHPLUS-Medicare Advantage, +104229,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,HEALTHPLUS-Medicare Advantage, +104230,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,HEALTHPLUS-Medicare Advantage, +104231,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,HEALTHPLUS-Medicare Advantage, +104232,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,HEALTHPLUS-Medicare Advantage, +104233,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,HEALTHPLUS-Medicare Advantage, +104234,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,HEALTHPLUS-Medicare Advantage, +104235,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,HEALTHPLUS-Medicare Advantage, +104236,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,HEALTHPLUS-Medicare Advantage, +104237,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,HEALTHPLUS-Medicare Advantage, +104238,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,HEALTHPLUS-Medicare Advantage, +104239,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,HEALTHPLUS-Medicare Advantage, +104240,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,HEALTHPLUS-Medicare Advantage, +104241,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,HEALTHPLUS-Medicare Advantage, +104242,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,HEALTHPLUS-Medicare Advantage, +104243,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,HEALTHPLUS-Medicare Advantage, +104244,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,HEALTHPLUS-Medicare Advantage, +104245,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,HEALTHPLUS-Medicare Advantage, +104246,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,HEALTHPLUS-Medicare Advantage, +104247,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,HEALTHPLUS-Medicare Advantage, +104248,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,HEALTHPLUS-Medicare Advantage, +104249,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,HEALTHPLUS-Medicare Advantage, +104250,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,HEALTHPLUS-Medicare Advantage, +104251,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,HEALTHPLUS-Medicare Advantage, +104252,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,HEALTHPLUS-Medicare Advantage, +104253,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,HEALTHPLUS-Medicare Advantage, +104254,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,HEALTHPLUS-Medicare Advantage, +104255,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,HEALTHPLUS-Medicare Advantage, +104256,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,HEALTHPLUS-Medicare Advantage, +104257,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,HEALTHPLUS-Medicare Advantage, +104258,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,HEALTHPLUS-Medicare Advantage, +104259,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,HEALTHPLUS-Medicare Advantage, +104260,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,HEALTHPLUS-Medicare Advantage, +104261,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,HEALTHPLUS-Medicare Advantage, +104262,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,HEALTHPLUS-Medicare Advantage, +104263,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,HEALTHPLUS-Medicare Advantage, +104264,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,HEALTHPLUS-Medicare Advantage, +104265,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,HEALTHPLUS-Medicare Advantage, +104266,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,HEALTHPLUS-Medicare Advantage, +104267,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,HEALTHPLUS-Medicare Advantage, +104268,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,HEALTHPLUS-Medicare Advantage, +104269,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,HEALTHPLUS-Medicare Advantage, +104270,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,HEALTHPLUS-Medicare Advantage, +104271,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,HEALTHPLUS-Medicare Advantage, +104272,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,HEALTHPLUS-Medicare Advantage, +104273,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,HEALTHPLUS-Medicare Advantage, +104274,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,HEALTHPLUS-Medicare Advantage, +104275,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +104276,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,HEALTHPLUS-Medicare Advantage, +104277,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,HEALTHPLUS-Medicare Advantage, +104278,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,HEALTHPLUS-Medicare Advantage, +104279,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,HEALTHPLUS-Medicare Advantage, +104280,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,HEALTHPLUS-Medicare Advantage, +104281,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,HEALTHPLUS-Medicare Advantage, +104282,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,HEALTHPLUS-Medicare Advantage, +104283,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,HEALTHPLUS-Medicare Advantage, +104284,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,HEALTHPLUS-Medicare Advantage, +104285,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,HEALTHPLUS-Medicare Advantage, +104286,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,HEALTHPLUS-Medicare Advantage, +104287,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,HEALTHPLUS-Medicare Advantage, +104288,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,HEALTHPLUS-Medicare Advantage, +104289,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,HEALTHPLUS-Medicare Advantage, +104290,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,HEALTHPLUS-Medicare Advantage, +104291,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,HEALTHPLUS-Medicare Advantage, +104292,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,HEALTHPLUS-Medicare Advantage, +104293,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,HEALTHPLUS-Medicare Advantage, +104294,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,HEALTHPLUS-Medicare Advantage, +104295,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,HEALTHPLUS-Medicare Advantage, +104296,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,HEALTHPLUS-Medicare Advantage, +104297,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,HEALTHPLUS-Medicare Advantage, +104298,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,HEALTHPLUS-Medicare Advantage, +104299,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,HEALTHPLUS-Medicare Advantage, +104300,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,HEALTHPLUS-Medicare Advantage, +104301,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,HEALTHPLUS-Medicare Advantage, +104302,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,HEALTHPLUS-Medicare Advantage, +104303,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,HEALTHPLUS-Medicare Advantage, +104304,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,HEALTHPLUS-Medicare Advantage, +104305,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,HEALTHPLUS-Medicare Advantage, +104306,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,HEALTHPLUS-Medicare Advantage, +104307,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,HEALTHPLUS-Medicare Advantage, +104308,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,HEALTHPLUS-Medicare Advantage, +104309,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,HEALTHPLUS-Medicare Advantage, +104310,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,HEALTHPLUS-Medicare Advantage, +104311,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,HEALTHPLUS-Medicare Advantage, +104312,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,HEALTHPLUS-Medicare Advantage, +104313,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,HEALTHPLUS-Medicare Advantage, +104314,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,HEALTHPLUS-Medicare Advantage, +104315,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,HEALTHPLUS-Medicare Advantage, +104316,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,HEALTHPLUS-Medicare Advantage, +104317,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,HEALTHPLUS-Medicare Advantage, +104318,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,HEALTHPLUS-Medicare Advantage, +104319,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,HEALTHPLUS-Medicare Advantage, +104320,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,HEALTHPLUS-Medicare Advantage, +104321,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,HEALTHPLUS-Medicare Advantage, +104322,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,HEALTHPLUS-Medicare Advantage, +104323,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,HEALTHPLUS-Medicare Advantage, +104324,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,HEALTHPLUS-Medicare Advantage, +104325,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,HEALTHPLUS-Medicare Advantage, +104326,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,HEALTHPLUS-Medicare Advantage, +104327,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,HEALTHPLUS-Medicare Advantage, +104328,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,HEALTHPLUS-Medicare Advantage, +104329,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,HEALTHPLUS-Medicare Advantage, +104330,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,HEALTHPLUS-Medicare Advantage, +104331,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,HEALTHPLUS-Medicare Advantage, +104332,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,HEALTHPLUS-Medicare Advantage, +104333,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,HEALTHPLUS-Medicare Advantage, +104334,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,HEALTHPLUS-Medicare Advantage, +104335,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,HEALTHPLUS-Medicare Advantage, +104336,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,HEALTHPLUS-Medicare Advantage, +104337,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,HEALTHPLUS-Medicare Advantage, +104338,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,HEALTHPLUS-Medicare Advantage, +104339,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,HEALTHPLUS-Medicare Advantage, +104340,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,HEALTHPLUS-Medicare Advantage, +104341,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,HEALTHPLUS-Medicare Advantage, +104342,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,HEALTHPLUS-Medicare Advantage, +104343,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,HEALTHPLUS-Medicare Advantage, +104344,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,HEALTHPLUS-Medicare Advantage, +104345,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,HEALTHPLUS-Medicare Advantage, +104346,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,HEALTHPLUS-Medicare Advantage, +104347,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,HEALTHPLUS-Medicare Advantage, +104348,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,HEALTHPLUS-Medicare Advantage, +104349,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,HEALTHPLUS-Medicare Advantage, +104350,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,HEALTHPLUS-Medicare Advantage, +104351,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,HEALTHPLUS-Medicare Advantage, +104352,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,HEALTHPLUS-Medicare Advantage, +104353,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,HEALTHPLUS-Medicare Advantage, +104354,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,HEALTHPLUS-Medicare Advantage, +104355,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,HEALTHPLUS-Medicare Advantage, +104356,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,HEALTHPLUS-Medicare Advantage, +104357,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,HEALTHPLUS-Medicare Advantage, +104358,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,HEALTHPLUS-Medicare Advantage, +104359,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,HEALTHPLUS-Medicare Advantage, +104360,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,HEALTHPLUS-Medicare Advantage, +104361,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,HEALTHPLUS-Medicare Advantage, +104362,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,HEALTHPLUS-Medicare Advantage, +104363,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,HEALTHPLUS-Medicare Advantage, +104364,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,HEALTHPLUS-Medicare Advantage, +104365,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,HEALTHPLUS-Medicare Advantage, +104366,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,HEALTHPLUS-Medicare Advantage, +104367,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,HEALTHPLUS-Medicare Advantage, +104368,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,HEALTHPLUS-Medicare Advantage, +104369,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,HEALTHPLUS-Medicare Advantage, +104370,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,HEALTHPLUS-Medicare Advantage, +104371,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,HEALTHPLUS-Medicare Advantage, +104372,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,HEALTHPLUS-Medicare Advantage, +104373,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,HEALTHPLUS-Medicare Advantage, +104374,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,HEALTHPLUS-Medicare Advantage, +104375,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,HEALTHPLUS-Medicare Advantage, +104376,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,HEALTHPLUS-Medicare Advantage, +104377,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,HEALTHPLUS-Medicare Advantage, +104378,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,HEALTHPLUS-Medicare Advantage, +104379,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,HEALTHPLUS-Medicare Advantage, +104380,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,HEALTHPLUS-Medicare Advantage, +104381,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,HEALTHPLUS-Medicare Advantage, +104382,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,HEALTHPLUS-Medicare Advantage, +104383,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,HEALTHPLUS-Medicare Advantage, +104384,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,HEALTHPLUS-Medicare Advantage, +104385,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,HEALTHPLUS-Medicare Advantage, +104386,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,HEALTHPLUS-Medicare Advantage, +104387,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,HEALTHPLUS-Medicare Advantage, +104388,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,HEALTHPLUS-Medicare Advantage, +104389,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,HEALTHPLUS-Medicare Advantage, +104390,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,HEALTHPLUS-Medicare Advantage, +104391,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,HEALTHPLUS-Medicare Advantage, +104392,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,HEALTHPLUS-Medicare Advantage, +104393,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,HEALTHPLUS-Medicare Advantage, +104394,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,HEALTHPLUS-Medicare Advantage, +104395,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,HEALTHPLUS-Medicare Advantage, +104396,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,HEALTHPLUS-Medicare Advantage, +104397,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,HEALTHPLUS-Medicare Advantage, +104398,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,HEALTHPLUS-Medicare Advantage, +104399,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,HEALTHPLUS-Medicare Advantage, +104400,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,HEALTHPLUS-Medicare Advantage, +104401,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,HEALTHPLUS-Medicare Advantage, +104402,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,HEALTHPLUS-Medicare Advantage, +104403,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,HEALTHPLUS-Medicare Advantage, +104404,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,HEALTHPLUS-Medicare Advantage, +104405,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,HEALTHPLUS-Medicare Advantage, +104406,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,HEALTHPLUS-Medicare Advantage, +104407,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,HEALTHPLUS-Medicare Advantage, +104408,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,HEALTHPLUS-Medicare Advantage, +104409,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,HEALTHPLUS-Medicare Advantage, +104410,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,HEALTHPLUS-Medicare Advantage, +104411,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,HEALTHPLUS-Medicare Advantage, +104412,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,HEALTHPLUS-Medicare Advantage, +104413,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,HEALTHPLUS-Medicare Advantage, +104414,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,HEALTHPLUS-Medicare Advantage, +104415,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,HEALTHPLUS-Medicare Advantage,3697.52 +104416,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,HEALTHPLUS-Medicare Advantage, +104417,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,HEALTHPLUS-Medicare Advantage, +104418,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,HEALTHPLUS-Medicare Advantage, +104419,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,HEALTHPLUS-Medicare Advantage, +104420,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,HEALTHPLUS-Medicare Advantage, +104421,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,HEALTHPLUS-Medicare Advantage, +104422,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,HEALTHPLUS-Medicare Advantage, +104423,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,HEALTHPLUS-Medicare Advantage, +104424,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,HEALTHPLUS-Medicare Advantage, +104425,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,HEALTHPLUS-Medicare Advantage, +104426,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,HEALTHPLUS-Medicare Advantage, +104427,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,HEALTHPLUS-Medicare Advantage, +104428,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,HEALTHPLUS-Medicare Advantage, +104429,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,HEALTHPLUS-Medicare Advantage, +104430,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,HEALTHPLUS-Medicare Advantage, +104431,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,HEALTHPLUS-Medicare Advantage, +104432,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,HEALTHPLUS-Medicare Advantage, +104433,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,HEALTHPLUS-Medicare Advantage, +104434,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,HEALTHPLUS-Medicare Advantage, +104435,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,HEALTHPLUS-Medicare Advantage, +104436,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,HEALTHPLUS-Medicare Advantage, +104437,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,HEALTHPLUS-Medicare Advantage, +104438,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,HEALTHPLUS-Medicare Advantage, +104439,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,HEALTHPLUS-Medicare Advantage, +104440,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,HEALTHPLUS-Medicare Advantage, +104441,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +104442,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,HEALTHPLUS-Medicare Advantage, +104443,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,HEALTHPLUS-Medicare Advantage, +104444,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,HEALTHPLUS-Medicare Advantage, +104445,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,HEALTHPLUS-Medicare Advantage, +104446,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,HEALTHPLUS-Medicare Advantage, +104447,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,HEALTHPLUS-Medicare Advantage, +104448,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,HEALTHPLUS-Medicare Advantage, +104449,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,HEALTHPLUS-Medicare Advantage, +104450,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,HEALTHPLUS-Medicare Advantage, +104451,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,HEALTHPLUS-Medicare Advantage, +104452,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,HEALTHPLUS-Medicare Advantage, +104453,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,HEALTHPLUS-Medicare Advantage, +104454,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,HEALTHPLUS-Medicare Advantage, +104455,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,HEALTHPLUS-Medicare Advantage, +104456,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,HEALTHPLUS-Medicare Advantage, +104457,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,HEALTHPLUS-Medicare Advantage, +104458,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,HEALTHPLUS-Medicare Advantage, +104459,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,HEALTHPLUS-Medicare Advantage, +104460,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,HEALTHPLUS-Medicare Advantage, +104461,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,HEALTHPLUS-Medicare Advantage, +104462,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,HEALTHPLUS-Medicare Advantage, +104463,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,HEALTHPLUS-Medicare Advantage, +104464,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,HEALTHPLUS-Medicare Advantage, +104465,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,HEALTHPLUS-Medicare Advantage, +104466,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,HEALTHPLUS-Medicare Advantage, +104467,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,HEALTHPLUS-Medicare Advantage, +104468,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,HEALTHPLUS-Medicare Advantage, +104469,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,HEALTHPLUS-Medicare Advantage, +104470,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,HEALTHPLUS-Medicare Advantage, +104471,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,HEALTHPLUS-Medicare Advantage, +104472,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,HEALTHPLUS-Medicare Advantage, +104473,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,HEALTHPLUS-Medicare Advantage, +104474,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,HEALTHPLUS-Medicare Advantage, +104475,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,HEALTHPLUS-Medicare Advantage, +104476,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,HEALTHPLUS-Medicare Advantage, +104477,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,HEALTHPLUS-Medicare Advantage, +104478,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,HEALTHPLUS-Medicare Advantage, +104479,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,HEALTHPLUS-Medicare Advantage, +104480,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,HEALTHPLUS-Medicare Advantage, +104481,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +104482,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,HEALTHPLUS-Medicare Advantage, +104483,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,HEALTHPLUS-Medicare Advantage, +104484,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,HEALTHPLUS-Medicare Advantage, +104485,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,HEALTHPLUS-Medicare Advantage, +104486,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,HEALTHPLUS-Medicare Advantage, +104487,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,HEALTHPLUS-Medicare Advantage, +104488,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,HEALTHPLUS-Medicare Advantage, +104489,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,HEALTHPLUS-Medicare Advantage, +104490,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,HEALTHPLUS-Medicare Advantage, +104491,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,HEALTHPLUS-Medicare Advantage, +104492,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,HEALTHPLUS-Medicare Advantage, +104493,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,HEALTHPLUS-Medicare Advantage, +104494,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,HEALTHPLUS-Medicare Advantage, +104495,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,HEALTHPLUS-Medicare Advantage, +104496,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,HEALTHPLUS-Medicare Advantage, +104497,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,HEALTHPLUS-Medicare Advantage, +104498,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,HEALTHPLUS-Medicare Advantage, +104499,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,HEALTHPLUS-Medicare Advantage, +104500,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,HEALTHPLUS-Medicare Advantage, +104501,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,HEALTHPLUS-Medicare Advantage, +104502,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,HEALTHPLUS-Medicare Advantage, +104503,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,HEALTHPLUS-Medicare Advantage, +104504,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,HEALTHPLUS-Medicare Advantage, +104505,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,HEALTHPLUS-Medicare Advantage, +104506,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,HEALTHPLUS-Medicare Advantage, +104507,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,HEALTHPLUS-Medicare Advantage, +104508,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,HEALTHPLUS-Medicare Advantage, +104509,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-Medicare Advantage, +104510,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,HEALTHPLUS-Medicare Advantage, +104511,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,HEALTHPLUS-Medicare Advantage, +104512,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,HEALTHPLUS-Medicare Advantage, +104513,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,HEALTHPLUS-Medicare Advantage, +104514,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,HEALTHPLUS-Medicare Advantage, +104515,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,HEALTHPLUS-Medicare Advantage, +104516,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,HEALTHPLUS-Medicare Advantage, +104517,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,HEALTHPLUS-Medicare Advantage, +104518,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,HEALTHPLUS-Medicare Advantage, +104519,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,HEALTHPLUS-Medicare Advantage, +104520,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,HEALTHPLUS-Medicare Advantage, +104521,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,HEALTHPLUS-Medicare Advantage, +104522,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,HEALTHPLUS-Medicare Advantage, +104523,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,HEALTHPLUS-Medicare Advantage, +104524,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,HEALTHPLUS-Medicare Advantage, +104525,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,HEALTHPLUS-Medicare Advantage, +104526,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,HEALTHPLUS-Medicare Advantage, +104527,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,HEALTHPLUS-Medicare Advantage, +104528,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,HEALTHPLUS-Medicare Advantage, +104529,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,HEALTHPLUS-Medicare Advantage, +104530,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,HEALTHPLUS-Medicare Advantage, +104531,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,HEALTHPLUS-Medicare Advantage, +104532,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,HEALTHPLUS-Medicare Advantage, +104533,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,HEALTHPLUS-Medicare Advantage, +104534,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,HEALTHPLUS-Medicare Advantage, +104535,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,HEALTHPLUS-Medicare Advantage, +104536,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,HEALTHPLUS-Medicare Advantage, +104537,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,HEALTHPLUS-Medicare Advantage, +104538,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,HEALTHPLUS-Medicare Advantage, +104539,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,HEALTHPLUS-Medicare Advantage, +104540,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,HEALTHPLUS-Medicare Advantage, +104541,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,HEALTHPLUS-Medicare Advantage, +104542,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,HEALTHPLUS-Medicare Advantage, +104543,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,HEALTHPLUS-Medicare Advantage, +104544,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,HEALTHPLUS-Medicare Advantage, +104545,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,HEALTHPLUS-Medicare Advantage, +104546,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,HEALTHPLUS-Medicare Advantage, +104547,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,HEALTHPLUS-Medicare Advantage, +104548,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,HEALTHPLUS-Medicare Advantage, +104549,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,HEALTHPLUS-Medicare Advantage, +104550,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,HEALTHPLUS-Medicare Advantage, +104551,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,HEALTHPLUS-Medicare Advantage, +104552,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,HEALTHPLUS-Medicare Advantage, +104553,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,HEALTHPLUS-Medicare Advantage, +104554,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,HEALTHPLUS-Medicare Advantage, +104555,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,HEALTHPLUS-Medicare Advantage, +104556,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,HEALTHPLUS-Medicare Advantage, +104557,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,HEALTHPLUS-Medicare Advantage, +104558,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,HEALTHPLUS-Medicare Advantage, +104559,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,HEALTHPLUS-Medicare Advantage, +104560,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,HEALTHPLUS-Medicare Advantage, +104561,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,HEALTHPLUS-Medicare Advantage, +104562,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +104563,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,HEALTHPLUS-Medicare Advantage, +104564,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,HEALTHPLUS-Medicare Advantage, +104565,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,HEALTHPLUS-Medicare Advantage, +104566,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,HEALTHPLUS-Medicare Advantage, +104567,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,HEALTHPLUS-Medicare Advantage, +104568,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,HEALTHPLUS-Medicare Advantage, +104569,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,HEALTHPLUS-Medicare Advantage, +104570,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,HEALTHPLUS-Medicare Advantage, +104571,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,HEALTHPLUS-Medicare Advantage, +104572,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,HEALTHPLUS-Medicare Advantage, +104573,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,HEALTHPLUS-Medicare Advantage, +104574,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,HEALTHPLUS-Medicare Advantage, +104575,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,HEALTHPLUS-Medicare Advantage, +104576,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,HEALTHPLUS-Medicare Advantage, +104577,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,HEALTHPLUS-Medicare Advantage, +104578,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,HEALTHPLUS-Medicare Advantage, +104579,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,HEALTHPLUS-Medicare Advantage, +104580,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,HEALTHPLUS-Medicare Advantage, +104581,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,HEALTHPLUS-Medicare Advantage, +104582,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,HEALTHPLUS-Medicare Advantage, +104583,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,HEALTHPLUS-Medicare Advantage, +104584,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,HEALTHPLUS-Medicare Advantage, +104585,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,HEALTHPLUS-Medicare Advantage, +104586,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,HEALTHPLUS-Medicare Advantage, +104587,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,HEALTHPLUS-Medicare Advantage, +104588,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,HEALTHPLUS-Medicare Advantage, +104589,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,HEALTHPLUS-Medicare Advantage, +104590,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,HEALTHPLUS-Medicare Advantage, +104591,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,HEALTHPLUS-Medicare Advantage, +104592,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,HEALTHPLUS-Medicare Advantage, +104593,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,HEALTHPLUS-Medicare Advantage, +104594,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,HEALTHPLUS-Medicare Advantage, +104595,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,HEALTHPLUS-Medicare Advantage, +104596,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,HEALTHPLUS-Medicare Advantage, +104597,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,HEALTHPLUS-Medicare Advantage, +104598,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,HEALTHPLUS-Medicare Advantage, +104599,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,HEALTHPLUS-Medicare Advantage, +104600,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,HEALTHPLUS-Medicare Advantage, +104601,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,HEALTHPLUS-Medicare Advantage, +104602,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,HEALTHPLUS-Medicare Advantage, +104603,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,HEALTHPLUS-Medicare Advantage, +104604,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,HEALTHPLUS-Medicare Advantage, +104605,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,HEALTHPLUS-Medicare Advantage, +104606,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,HEALTHPLUS-Medicare Advantage, +104607,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,HEALTHPLUS-Medicare Advantage, +104608,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,HEALTHPLUS-Medicare Advantage, +104609,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,HEALTHPLUS-Medicare Advantage, +104610,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,HEALTHPLUS-Medicare Advantage, +104611,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,HEALTHPLUS-Medicare Advantage, +104612,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,HEALTHPLUS-Medicare Advantage, +104613,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,HEALTHPLUS-Medicare Advantage, +104614,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,HEALTHPLUS-Medicare Advantage, +104615,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,HEALTHPLUS-Medicare Advantage, +104616,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,HEALTHPLUS-Medicare Advantage, +104617,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,HEALTHPLUS-Medicare Advantage, +104618,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,HEALTHPLUS-Medicare Advantage, +104619,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,HEALTHPLUS-Medicare Advantage, +104620,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,HEALTHPLUS-Medicare Advantage, +104621,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,HEALTHPLUS-Medicare Advantage, +104622,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,HEALTHPLUS-Medicare Advantage, +104623,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,HEALTHPLUS-Medicare Advantage, +104624,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,HEALTHPLUS-Medicare Advantage, +104625,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,HEALTHPLUS-Medicare Advantage, +104626,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,HEALTHPLUS-Medicare Advantage, +104627,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,HEALTHPLUS-Medicare Advantage, +104628,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,HEALTHPLUS-Medicare Advantage, +104629,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,HEALTHPLUS-Medicare Advantage, +104630,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,HEALTHPLUS-Medicare Advantage, +104631,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,HEALTHPLUS-Medicare Advantage, +104632,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,HEALTHPLUS-Medicare Advantage, +104633,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,HEALTHPLUS-Medicare Advantage, +104634,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,HEALTHPLUS-Medicare Advantage, +104635,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,HEALTHPLUS-Medicare Advantage, +104636,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,HEALTHPLUS-Medicare Advantage, +104637,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,HEALTHPLUS-Medicare Advantage, +104638,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,HEALTHPLUS-Medicare Advantage, +104639,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,HEALTHPLUS-Medicare Advantage, +104640,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,HEALTHPLUS-Medicare Advantage, +104641,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,HEALTHPLUS-Medicare Advantage, +104642,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,HEALTHPLUS-Medicare Advantage, +104643,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,HEALTHPLUS-Medicare Advantage, +104644,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,HEALTHPLUS-Medicare Advantage, +104645,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,HEALTHPLUS-Medicare Advantage, +104646,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,HEALTHPLUS-Medicare Advantage, +104647,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,HEALTHPLUS-Medicare Advantage, +104648,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,HEALTHPLUS-Medicare Advantage, +104649,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,HEALTHPLUS-Medicare Advantage, +104650,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,HEALTHPLUS-Medicare Advantage, +104651,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,HEALTHPLUS-Medicare Advantage, +104652,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,HEALTHPLUS-Medicare Advantage, +104653,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,HEALTHPLUS-Medicare Advantage, +104654,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,HEALTHPLUS-Medicare Advantage, +104655,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,HEALTHPLUS-Medicare Advantage, +104656,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,HEALTHPLUS-Medicare Advantage, +104657,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,HEALTHPLUS-Medicare Advantage, +104658,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,HEALTHPLUS-Medicare Advantage, +104659,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,HEALTHPLUS-Medicare Advantage, +104660,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,HEALTHPLUS-Medicare Advantage, +104661,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,HEALTHPLUS-Medicare Advantage, +104662,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,HEALTHPLUS-Medicare Advantage, +104663,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,HEALTHPLUS-Medicare Advantage, +104664,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,HEALTHPLUS-Medicare Advantage, +104665,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,HEALTHPLUS-Medicare Advantage, +104666,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,HEALTHPLUS-Medicare Advantage, +104667,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,HEALTHPLUS-Medicare Advantage, +104668,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,HEALTHPLUS-Medicare Advantage, +104669,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +104670,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,HEALTHPLUS-Medicare Advantage, +104671,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,HEALTHPLUS-Medicare Advantage, +104672,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,HEALTHPLUS-Medicare Advantage, +104673,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,HEALTHPLUS-Medicare Advantage, +104674,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,HEALTHPLUS-Medicare Advantage, +104675,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,HEALTHPLUS-Medicare Advantage, +104676,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,HEALTHPLUS-Medicare Advantage, +104677,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,HEALTHPLUS-Medicare Advantage, +104678,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,HEALTHPLUS-Medicare Advantage, +104679,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,HEALTHPLUS-Medicare Advantage, +104680,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,HEALTHPLUS-Medicare Advantage, +104681,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,HEALTHPLUS-Medicare Advantage, +104682,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,HEALTHPLUS-Medicare Advantage, +104683,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,HEALTHPLUS-Medicare Advantage, +104684,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,HEALTHPLUS-Medicare Advantage, +104685,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,HEALTHPLUS-Medicare Advantage, +104686,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,HEALTHPLUS-Medicare Advantage, +104687,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,HEALTHPLUS-Medicare Advantage, +104688,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,HEALTHPLUS-Medicare Advantage, +104689,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,HEALTHPLUS-Medicare Advantage, +104690,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,HEALTHPLUS-Medicare Advantage, +104691,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,HEALTHPLUS-Medicare Advantage, +104692,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,HEALTHPLUS-Medicare Advantage, +104693,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,HEALTHPLUS-Medicare Advantage, +104694,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,HEALTHPLUS-Medicare Advantage, +104695,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,HEALTHPLUS-Medicare Advantage, +104696,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,HEALTHPLUS-Medicare Advantage, +104697,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,HEALTHPLUS-Medicare Advantage, +104698,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,HEALTHPLUS-Medicare Advantage, +104699,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,HEALTHPLUS-Medicare Advantage, +104700,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,HEALTHPLUS-Medicare Advantage, +104701,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,HEALTHPLUS-Medicare Advantage, +104702,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,HEALTHPLUS-Medicare Advantage, +104703,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,HEALTHPLUS-Medicare Advantage, +104704,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,HEALTHPLUS-Medicare Advantage, +104705,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,HEALTHPLUS-Medicare Advantage, +104706,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,HEALTHPLUS-Medicare Advantage, +104707,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,HEALTHPLUS-Medicare Advantage, +104708,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,HEALTHPLUS-Medicare Advantage, +104709,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,HEALTHPLUS-Medicare Advantage, +104710,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,HEALTHPLUS-Medicare Advantage, +104711,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,HEALTHPLUS-Medicare Advantage, +104712,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,HEALTHPLUS-Medicare Advantage, +104713,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,HEALTHPLUS-Medicare Advantage, +104714,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,HEALTHPLUS-Medicare Advantage, +104715,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,HEALTHPLUS-Medicare Advantage, +104716,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,HEALTHPLUS-Medicare Advantage, +104717,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,HEALTHPLUS-Medicare Advantage, +104718,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,HEALTHPLUS-Medicare Advantage, +104719,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,HEALTHPLUS-Medicare Advantage, +104720,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,HEALTHPLUS-Medicare Advantage, +104721,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,HEALTHPLUS-Medicare Advantage, +104722,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,HEALTHPLUS-Medicare Advantage, +104723,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,HEALTHPLUS-Medicare Advantage, +104724,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,HEALTHPLUS-Medicare Advantage, +104725,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,HEALTHPLUS-Medicare Advantage, +104726,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,HEALTHPLUS-Medicare Advantage, +104727,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,HEALTHPLUS-Medicare Advantage, +104728,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,HEALTHPLUS-Medicare Advantage, +104729,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,HEALTHPLUS-Medicare Advantage, +104730,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,HEALTHPLUS-Medicare Advantage, +104731,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,HEALTHPLUS-Medicare Advantage, +104732,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,HEALTHPLUS-Medicare Advantage, +104733,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,HEALTHPLUS-Medicare Advantage, +104734,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,HEALTHPLUS-Medicare Advantage, +104735,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,HEALTHPLUS-Medicare Advantage, +104736,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,HEALTHPLUS-Medicare Advantage, +104737,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,HEALTHPLUS-Medicare Advantage, +104738,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,HEALTHPLUS-Medicare Advantage, +104739,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,HEALTHPLUS-Medicare Advantage, +104740,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,HEALTHPLUS-Medicare Advantage, +104741,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,HEALTHPLUS-Medicare Advantage, +104742,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,HEALTHPLUS-Medicare Advantage, +104743,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,HEALTHPLUS-Medicare Advantage, +104744,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,HEALTHPLUS-Medicare Advantage, +104745,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,HEALTHPLUS-Medicare Advantage, +104746,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,HEALTHPLUS-Medicare Advantage, +104747,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,HEALTHPLUS-Medicare Advantage, +104748,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,HEALTHPLUS-Medicare Advantage, +104749,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,HEALTHPLUS-Medicare Advantage, +104750,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,HEALTHPLUS-Medicare Advantage, +104751,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,HEALTHPLUS-Medicare Advantage, +104752,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,HEALTHPLUS-Medicare Advantage, +104753,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,HEALTHPLUS-Medicare Advantage, +104754,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,HEALTHPLUS-Medicare Advantage, +104755,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,HEALTHPLUS-Medicare Advantage, +104756,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,HEALTHPLUS-Medicare Advantage, +104757,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,HEALTHPLUS-Medicare Advantage, +104758,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,HEALTHPLUS-Medicare Advantage, +104759,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,HEALTHPLUS-Medicare Advantage, +104760,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,HEALTHPLUS-Medicare Advantage, +104761,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,HEALTHPLUS-Medicare Advantage, +104762,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,HEALTHPLUS-Medicare Advantage, +104763,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,HEALTHPLUS-Medicare Advantage, +104764,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,HEALTHPLUS-Medicare Advantage, +104765,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,HEALTHPLUS-Medicare Advantage, +104766,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,HEALTHPLUS-Medicare Advantage, +104767,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,HEALTHPLUS-Medicare Advantage, +104768,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,HEALTHPLUS-Medicare Advantage, +104769,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,HEALTHPLUS-Medicare Advantage, +104770,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,HEALTHPLUS-Medicare Advantage, +104771,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,HEALTHPLUS-Medicare Advantage, +104772,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,HEALTHPLUS-Medicare Advantage, +104773,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,HEALTHPLUS-Medicare Advantage, +104774,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,HEALTHPLUS-Medicare Advantage, +104775,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,HEALTHPLUS-Medicare Advantage, +104776,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,HEALTHPLUS-Medicare Advantage, +104777,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,HEALTHPLUS-Medicare Advantage, +104778,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,HEALTHPLUS-Medicare Advantage, +104779,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,HEALTHPLUS-Medicare Advantage, +104780,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,HEALTHPLUS-Medicare Advantage, +104781,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,HEALTHPLUS-Medicare Advantage, +104782,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,HEALTHPLUS-Medicare Advantage, +104783,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,HEALTHPLUS-Medicare Advantage, +104784,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,HEALTHPLUS-Medicare Advantage, +104785,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,HEALTHPLUS-Medicare Advantage, +104786,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,HEALTHPLUS-Medicare Advantage, +104787,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,HEALTHPLUS-Medicare Advantage, +104788,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,HEALTHPLUS-Medicare Advantage, +104789,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,HEALTHPLUS-Medicare Advantage, +104790,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,HEALTHPLUS-Medicare Advantage, +104791,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,HEALTHPLUS-Medicare Advantage, +104792,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,HEALTHPLUS-Medicare Advantage, +104793,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,HEALTHPLUS-Medicare Advantage, +104794,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,HEALTHPLUS-Medicare Advantage, +104795,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,HEALTHPLUS-Medicare Advantage, +104796,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,HEALTHPLUS-Medicare Advantage, +104797,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,HEALTHPLUS-Medicare Advantage, +104798,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,HEALTHPLUS-Medicare Advantage, +104799,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,HEALTHPLUS-Medicare Advantage, +104800,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,HEALTHPLUS-Medicare Advantage, +104801,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +104802,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,HEALTHPLUS-Medicare Advantage, +104803,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,HEALTHPLUS-Medicare Advantage, +104804,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,HEALTHPLUS-Medicare Advantage, +104805,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +104806,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,HEALTHPLUS-Medicare Advantage, +104807,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,HEALTHPLUS-Medicare Advantage, +104808,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,HEALTHPLUS-Medicare Advantage, +104809,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,HEALTHPLUS-Medicare Advantage, +104810,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,HEALTHPLUS-Medicare Advantage, +104811,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,HEALTHPLUS-Medicare Advantage, +104812,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,HEALTHPLUS-Medicare Advantage, +104813,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,HEALTHPLUS-Medicare Advantage, +104814,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,HEALTHPLUS-Medicare Advantage, +104815,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,HEALTHPLUS-Medicare Advantage, +104816,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,HEALTHPLUS-Medicare Advantage, +104817,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,HEALTHPLUS-Medicare Advantage, +104818,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,HEALTHPLUS-Medicare Advantage, +104819,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,HEALTHPLUS-Medicare Advantage, +104820,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +104821,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,HEALTHPLUS-Medicare Advantage, +104822,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,HEALTHPLUS-Medicare Advantage, +104823,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,HEALTHPLUS-Medicare Advantage, +104824,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,HEALTHPLUS-Medicare Advantage, +104825,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,HEALTHPLUS-Medicare Advantage, +104826,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,HEALTHPLUS-Medicare Advantage, +104827,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,HEALTHPLUS-Medicare Advantage, +104828,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,HEALTHPLUS-Medicare Advantage, +104829,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,HEALTHPLUS-Medicare Advantage, +104830,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,HEALTHPLUS-Medicare Advantage, +104831,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,HEALTHPLUS-Medicare Advantage, +104832,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,HEALTHPLUS-Medicare Advantage, +104833,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,HEALTHPLUS-Medicare Advantage, +104834,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,HEALTHPLUS-Medicare Advantage, +104835,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,HEALTHPLUS-Medicare Advantage, +104836,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,HEALTHPLUS-Medicare Advantage, +104837,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,HEALTHPLUS-Medicare Advantage, +104838,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,HEALTHPLUS-Medicare Advantage, +104839,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,HEALTHPLUS-Medicare Advantage, +104840,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,HEALTHPLUS-Medicare Advantage, +104841,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,HEALTHPLUS-Medicare Advantage, +104842,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,HEALTHPLUS-Medicare Advantage, +104843,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,HEALTHPLUS-Medicare Advantage, +104844,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,HEALTHPLUS-Medicare Advantage, +104845,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,HEALTHPLUS-Medicare Advantage, +104846,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,HEALTHPLUS-Medicare Advantage, +104847,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,HEALTHPLUS-Medicare Advantage, +104848,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,HEALTHPLUS-Medicare Advantage, +104849,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,HEALTHPLUS-Medicare Advantage, +104850,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,HEALTHPLUS-Medicare Advantage, +104851,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,HEALTHPLUS-Medicare Advantage, +104852,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,HEALTHPLUS-Medicare Advantage, +104853,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,HEALTHPLUS-Medicare Advantage, +104854,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,HEALTHPLUS-Medicare Advantage, +104855,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,HEALTHPLUS-Medicare Advantage, +104856,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,HEALTHPLUS-Medicare Advantage, +104857,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,HEALTHPLUS-Medicare Advantage, +104858,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,HEALTHPLUS-Medicare Advantage, +104859,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,HEALTHPLUS-Medicare Advantage, +104860,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,HEALTHPLUS-Medicare Advantage, +104861,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,HEALTHPLUS-Medicare Advantage, +104862,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,HEALTHPLUS-Medicare Advantage, +104863,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,HEALTHPLUS-Medicare Advantage, +104864,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,HEALTHPLUS-Medicare Advantage, +104865,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,HEALTHPLUS-Medicare Advantage, +104866,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +104867,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +104868,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,HEALTHPLUS-Medicare Advantage, +104869,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,HEALTHPLUS-Medicare Advantage, +104870,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,HEALTHPLUS-Medicare Advantage, +104871,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,HEALTHPLUS-Medicare Advantage, +104872,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,HEALTHPLUS-Medicare Advantage, +104873,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,HEALTHPLUS-Medicare Advantage, +104874,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,HEALTHPLUS-Medicare Advantage, +104875,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,HEALTHPLUS-Medicare Advantage, +104876,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,HEALTHPLUS-Medicare Advantage, +104877,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,HEALTHPLUS-Medicare Advantage, +104878,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,HEALTHPLUS-Medicare Advantage, +104879,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,HEALTHPLUS-Medicare Advantage, +104880,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,HEALTHPLUS-Medicare Advantage, +104881,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,HEALTHPLUS-Medicare Advantage, +104882,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,HEALTHPLUS-Medicare Advantage, +104883,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,HEALTHPLUS-Medicare Advantage, +104884,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,HEALTHPLUS-Medicare Advantage, +104885,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,HEALTHPLUS-Medicare Advantage, +104886,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,HEALTHPLUS-Medicare Advantage, +104887,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,HEALTHPLUS-Medicare Advantage, +104888,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,HEALTHPLUS-Medicare Advantage, +104889,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,HEALTHPLUS-Medicare Advantage, +104890,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,HEALTHPLUS-Medicare Advantage, +104891,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,HEALTHPLUS-Medicare Advantage, +104892,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,HEALTHPLUS-Medicare Advantage, +104893,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,HEALTHPLUS-Medicare Advantage, +104894,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,HEALTHPLUS-Medicare Advantage, +104895,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,HEALTHPLUS-Medicare Advantage, +104896,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,HEALTHPLUS-Medicare Advantage, +104897,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,HEALTHPLUS-Medicare Advantage, +104898,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,HEALTHPLUS-Medicare Advantage, +104899,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,HEALTHPLUS-Medicare Advantage, +104900,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,HEALTHPLUS-Medicare Advantage, +104901,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,HEALTHPLUS-Medicare Advantage, +104902,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,HEALTHPLUS-Medicare Advantage, +104903,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,HEALTHPLUS-Medicare Advantage, +104904,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,HEALTHPLUS-Medicare Advantage, +104905,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,HEALTHPLUS-Medicare Advantage, +104906,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +104907,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,HEALTHPLUS-Medicare Advantage, +104908,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,HEALTHPLUS-Medicare Advantage, +104909,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,HEALTHPLUS-Medicare Advantage, +104910,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,HEALTHPLUS-Medicare Advantage, +104911,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,HEALTHPLUS-Medicare Advantage, +104912,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,HEALTHPLUS-Medicare Advantage, +104913,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,HEALTHPLUS-Medicare Advantage, +104914,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,HEALTHPLUS-Medicare Advantage, +104915,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,HEALTHPLUS-Medicare Advantage, +104916,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,HEALTHPLUS-Medicare Advantage, +104917,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,HEALTHPLUS-Medicare Advantage, +104918,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,HEALTHPLUS-Medicare Advantage, +104919,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,HEALTHPLUS-Medicare Advantage, +104920,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,HEALTHPLUS-Medicare Advantage, +104921,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,HEALTHPLUS-Medicare Advantage, +104922,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,HEALTHPLUS-Medicare Advantage, +104923,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,HEALTHPLUS-Medicare Advantage, +104924,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,HEALTHPLUS-Medicare Advantage, +104925,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,HEALTHPLUS-Medicare Advantage, +104926,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,HEALTHPLUS-Medicare Advantage, +104927,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,HEALTHPLUS-Medicare Advantage, +104928,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,HEALTHPLUS-Medicare Advantage, +104929,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,HEALTHPLUS-Medicare Advantage, +104930,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,HEALTHPLUS-Medicare Advantage, +104931,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,HEALTHPLUS-Medicare Advantage, +104932,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,HEALTHPLUS-Medicare Advantage, +104933,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,HEALTHPLUS-Medicare Advantage, +104934,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,HEALTHPLUS-Medicare Advantage, +104935,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,HEALTHPLUS-Medicare Advantage, +104936,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,HEALTHPLUS-Medicare Advantage, +104937,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,HEALTHPLUS-Medicare Advantage, +104938,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,HEALTHPLUS-Medicare Advantage, +104939,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,HEALTHPLUS-Medicare Advantage, +104940,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,HEALTHPLUS-Medicare Advantage, +104941,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,HEALTHPLUS-Medicare Advantage, +104942,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,HEALTHPLUS-Medicare Advantage, +104943,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,HEALTHPLUS-Medicare Advantage, +104944,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,HEALTHPLUS-Medicare Advantage, +104945,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,HEALTHPLUS-Medicare Advantage, +104946,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,HEALTHPLUS-Medicare Advantage, +104947,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,HEALTHPLUS-Medicare Advantage, +104948,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,HEALTHPLUS-Medicare Advantage, +104949,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,HEALTHPLUS-Medicare Advantage, +104950,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,HEALTHPLUS-Medicare Advantage, +104951,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,HEALTHPLUS-Medicare Advantage, +104952,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,HEALTHPLUS-Medicare Advantage, +104953,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,HEALTHPLUS-Medicare Advantage, +104954,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,HEALTHPLUS-Medicare Advantage, +104955,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,HEALTHPLUS-Medicare Advantage, +104956,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,HEALTHPLUS-Medicare Advantage, +104957,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,HEALTHPLUS-Medicare Advantage, +104958,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,HEALTHPLUS-Medicare Advantage, +104959,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,HEALTHPLUS-Medicare Advantage, +104960,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,HEALTHPLUS-Medicare Advantage, +104961,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,HEALTHPLUS-Medicare Advantage, +104962,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,HEALTHPLUS-Medicare Advantage, +104963,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,HEALTHPLUS-Medicare Advantage, +104964,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,HEALTHPLUS-Medicare Advantage, +104965,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,HEALTHPLUS-Medicare Advantage, +104966,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,HEALTHPLUS-Medicare Advantage, +104967,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,HEALTHPLUS-Medicare Advantage, +104968,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,HEALTHPLUS-Medicare Advantage, +104969,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,HEALTHPLUS-Medicare Advantage, +104970,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,HEALTHPLUS-Medicare Advantage, +104971,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,HEALTHPLUS-Medicare Advantage, +104972,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,HEALTHPLUS-Medicare Advantage, +104973,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,HEALTHPLUS-Medicare Advantage, +104974,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,HEALTHPLUS-Medicare Advantage, +104975,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,HEALTHPLUS-Medicare Advantage, +104976,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,HEALTHPLUS-Medicare Advantage, +104977,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,HEALTHPLUS-Medicare Advantage, +104978,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,HEALTHPLUS-Medicare Advantage, +104979,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,HEALTHPLUS-Medicare Advantage, +104980,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,HEALTHPLUS-Medicare Advantage, +104981,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,HEALTHPLUS-Medicare Advantage, +104982,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,HEALTHPLUS-Medicare Advantage, +104983,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,HEALTHPLUS-Medicare Advantage, +104984,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,HEALTHPLUS-Medicare Advantage, +104985,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,HEALTHPLUS-Medicare Advantage, +104986,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,HEALTHPLUS-Medicare Advantage, +104987,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,HEALTHPLUS-Medicare Advantage, +104988,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,HEALTHPLUS-Medicare Advantage, +104989,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,HEALTHPLUS-Medicare Advantage, +104990,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,HEALTHPLUS-Medicare Advantage, +104991,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,HEALTHPLUS-Medicare Advantage, +104992,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,HEALTHPLUS-Medicare Advantage, +104993,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,HEALTHPLUS-Medicare Advantage, +104994,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,HEALTHPLUS-Medicare Advantage, +104995,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,HEALTHPLUS-Medicare Advantage, +104996,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,HEALTHPLUS-Medicare Advantage, +104997,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,HEALTHPLUS-Medicare Advantage, +104998,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,HEALTHPLUS-Medicare Advantage, +104999,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,HEALTHPLUS-Medicare Advantage, +105000,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,HEALTHPLUS-Medicare Advantage, +105001,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,HEALTHPLUS-Medicare Advantage, +105002,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,HEALTHPLUS-Medicare Advantage, +105003,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,HEALTHPLUS-Medicare Advantage, +105004,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,HEALTHPLUS-Medicare Advantage, +105005,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,HEALTHPLUS-Medicare Advantage, +105006,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,HEALTHPLUS-Medicare Advantage, +105007,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,HEALTHPLUS-Medicare Advantage, +105008,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,HEALTHPLUS-Medicare Advantage, +105009,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,HEALTHPLUS-Medicare Advantage, +105010,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,HEALTHPLUS-Medicare Advantage, +105011,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,HEALTHPLUS-Medicare Advantage, +105012,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,HEALTHPLUS-Medicare Advantage, +105013,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,HEALTHPLUS-Medicare Advantage, +105014,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,HEALTHPLUS-Medicare Advantage, +105015,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,HEALTHPLUS-Medicare Advantage, +105016,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,HEALTHPLUS-Medicare Advantage, +105017,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,HEALTHPLUS-Medicare Advantage, +105018,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +105019,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,HEALTHPLUS-Medicare Advantage, +105020,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,HEALTHPLUS-Medicare Advantage, +105021,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,HEALTHPLUS-Medicare Advantage, +105022,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,HEALTHPLUS-Medicare Advantage, +105023,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,HEALTHPLUS-Medicare Advantage, +105024,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,HEALTHPLUS-Medicare Advantage, +105025,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,HEALTHPLUS-Medicare Advantage, +105026,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,HEALTHPLUS-Medicare Advantage, +105027,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,HEALTHPLUS-Medicare Advantage, +105028,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,HEALTHPLUS-Medicare Advantage, +105029,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,HEALTHPLUS-Medicare Advantage, +105030,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,HEALTHPLUS-Medicare Advantage, +105031,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,HEALTHPLUS-Medicare Advantage, +105032,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,HEALTHPLUS-Medicare Advantage, +105033,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,HEALTHPLUS-Medicare Advantage, +105034,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,HEALTHPLUS-Medicare Advantage, +105035,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,HEALTHPLUS-Medicare Advantage, +105036,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,HEALTHPLUS-Medicare Advantage, +105037,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,HEALTHPLUS-Medicare Advantage, +105038,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,HEALTHPLUS-Medicare Advantage, +105039,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,HEALTHPLUS-Medicare Advantage, +105040,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,HEALTHPLUS-Medicare Advantage, +105041,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,HEALTHPLUS-Medicare Advantage, +105042,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,HEALTHPLUS-Medicare Advantage, +105043,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,HEALTHPLUS-Medicare Advantage, +105044,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,HEALTHPLUS-Medicare Advantage, +105045,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,HEALTHPLUS-Medicare Advantage, +105046,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,HEALTHPLUS-Medicare Advantage, +105047,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,HEALTHPLUS-Medicare Advantage, +105048,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,HEALTHPLUS-Medicare Advantage, +105049,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,HEALTHPLUS-Medicare Advantage, +105050,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,HEALTHPLUS-Medicare Advantage, +105051,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,HEALTHPLUS-Medicare Advantage, +105052,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,HEALTHPLUS-Medicare Advantage,3.0 +105053,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,HEALTHPLUS-Medicare Advantage, +105054,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,HEALTHPLUS-Medicare Advantage, +105055,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,HEALTHPLUS-Medicare Advantage, +105056,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,HEALTHPLUS-Medicare Advantage, +105057,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,HEALTHPLUS-Medicare Advantage, +105058,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,HEALTHPLUS-Medicare Advantage, +105059,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,HEALTHPLUS-Medicare Advantage, +105060,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,HEALTHPLUS-Medicare Advantage, +105061,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,HEALTHPLUS-Medicare Advantage, +105062,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,HEALTHPLUS-Medicare Advantage, +105063,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,HEALTHPLUS-Medicare Advantage, +105064,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,HEALTHPLUS-Medicare Advantage, +105065,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,HEALTHPLUS-Medicare Advantage, +105066,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,HEALTHPLUS-Medicare Advantage, +105067,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,HEALTHPLUS-Medicare Advantage, +105068,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,HEALTHPLUS-Medicare Advantage, +105069,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,HEALTHPLUS-Medicare Advantage, +105070,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,HEALTHPLUS-Medicare Advantage, +105071,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,HEALTHPLUS-Medicare Advantage, +105072,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,HEALTHPLUS-Medicare Advantage, +105073,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,HEALTHPLUS-Medicare Advantage, +105074,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,HEALTHPLUS-Medicare Advantage, +105075,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,HEALTHPLUS-Medicare Advantage, +105076,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,HEALTHPLUS-Medicare Advantage, +105077,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,HEALTHPLUS-Medicare Advantage, +105078,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,HEALTHPLUS-Medicare Advantage, +105079,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,HEALTHPLUS-Medicare Advantage, +105080,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,HEALTHPLUS-Medicare Advantage, +105081,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,HEALTHPLUS-Medicare Advantage, +105082,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105083,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,HEALTHPLUS-Medicare Advantage, +105084,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,HEALTHPLUS-Medicare Advantage, +105085,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,HEALTHPLUS-Medicare Advantage, +105086,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,HEALTHPLUS-Medicare Advantage, +105087,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,HEALTHPLUS-Medicare Advantage, +105088,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,HEALTHPLUS-Medicare Advantage, +105089,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,HEALTHPLUS-Medicare Advantage, +105090,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,HEALTHPLUS-Medicare Advantage, +105091,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,HEALTHPLUS-Medicare Advantage, +105092,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,HEALTHPLUS-Medicare Advantage, +105093,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,HEALTHPLUS-Medicare Advantage, +105094,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,HEALTHPLUS-Medicare Advantage, +105095,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,HEALTHPLUS-Medicare Advantage, +105096,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,HEALTHPLUS-Medicare Advantage, +105097,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,HEALTHPLUS-Medicare Advantage, +105098,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,HEALTHPLUS-Medicare Advantage, +105099,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,HEALTHPLUS-Medicare Advantage, +105100,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,HEALTHPLUS-Medicare Advantage, +105101,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,HEALTHPLUS-Medicare Advantage, +105102,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,HEALTHPLUS-Medicare Advantage, +105103,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,HEALTHPLUS-Medicare Advantage, +105104,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,HEALTHPLUS-Medicare Advantage, +105105,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,HEALTHPLUS-Medicare Advantage, +105106,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,HEALTHPLUS-Medicare Advantage, +105107,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,HEALTHPLUS-Medicare Advantage, +105108,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,HEALTHPLUS-Medicare Advantage, +105109,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,HEALTHPLUS-Medicare Advantage, +105110,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,HEALTHPLUS-Medicare Advantage, +105111,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,HEALTHPLUS-Medicare Advantage, +105112,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,HEALTHPLUS-Medicare Advantage, +105113,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,HEALTHPLUS-Medicare Advantage, +105114,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,HEALTHPLUS-Medicare Advantage, +105115,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,HEALTHPLUS-Medicare Advantage, +105116,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,HEALTHPLUS-Medicare Advantage, +105117,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,HEALTHPLUS-Medicare Advantage, +105118,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,HEALTHPLUS-Medicare Advantage, +105119,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,HEALTHPLUS-Medicare Advantage, +105120,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,HEALTHPLUS-Medicare Advantage, +105121,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,HEALTHPLUS-Medicare Advantage, +105122,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,HEALTHPLUS-Medicare Advantage, +105123,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,HEALTHPLUS-Medicare Advantage, +105124,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,HEALTHPLUS-Medicare Advantage, +105125,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,HEALTHPLUS-Medicare Advantage, +105126,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,HEALTHPLUS-Medicare Advantage, +105127,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,HEALTHPLUS-Medicare Advantage, +105128,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,HEALTHPLUS-Medicare Advantage, +105129,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,HEALTHPLUS-Medicare Advantage, +105130,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,HEALTHPLUS-Medicare Advantage, +105131,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,HEALTHPLUS-Medicare Advantage, +105132,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-Medicare Advantage, +105133,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,HEALTHPLUS-Medicare Advantage, +105134,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,HEALTHPLUS-Medicare Advantage, +105135,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,HEALTHPLUS-Medicare Advantage, +105136,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,HEALTHPLUS-Medicare Advantage, +105137,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,HEALTHPLUS-Medicare Advantage, +105138,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,HEALTHPLUS-Medicare Advantage, +105139,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,HEALTHPLUS-Medicare Advantage, +105140,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,HEALTHPLUS-Medicare Advantage, +105141,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,HEALTHPLUS-Medicare Advantage, +105142,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,HEALTHPLUS-Medicare Advantage, +105143,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,HEALTHPLUS-Medicare Advantage, +105144,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,HEALTHPLUS-Medicare Advantage, +105145,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,HEALTHPLUS-Medicare Advantage, +105146,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,HEALTHPLUS-Medicare Advantage, +105147,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,HEALTHPLUS-Medicare Advantage, +105148,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,HEALTHPLUS-Medicare Advantage, +105149,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,HEALTHPLUS-Medicare Advantage, +105150,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,HEALTHPLUS-Medicare Advantage, +105151,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,HEALTHPLUS-Medicare Advantage, +105152,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,HEALTHPLUS-Medicare Advantage, +105153,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,HEALTHPLUS-Medicare Advantage, +105154,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,HEALTHPLUS-Medicare Advantage, +105155,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,HEALTHPLUS-Medicare Advantage, +105156,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,HEALTHPLUS-Medicare Advantage, +105157,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,HEALTHPLUS-Medicare Advantage, +105158,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,HEALTHPLUS-Medicare Advantage, +105159,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,HEALTHPLUS-Medicare Advantage, +105160,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,HEALTHPLUS-Medicare Advantage, +105161,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,HEALTHPLUS-Medicare Advantage, +105162,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,HEALTHPLUS-Medicare Advantage, +105163,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,HEALTHPLUS-Medicare Advantage, +105164,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,HEALTHPLUS-Medicare Advantage, +105165,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,HEALTHPLUS-Medicare Advantage, +105166,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,HEALTHPLUS-Medicare Advantage, +105167,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,HEALTHPLUS-Medicare Advantage, +105168,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,HEALTHPLUS-Medicare Advantage, +105169,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,HEALTHPLUS-Medicare Advantage, +105170,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,HEALTHPLUS-Medicare Advantage, +105171,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,HEALTHPLUS-Medicare Advantage, +105172,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,HEALTHPLUS-Medicare Advantage, +105173,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,HEALTHPLUS-Medicare Advantage, +105174,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,HEALTHPLUS-Medicare Advantage, +105175,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,HEALTHPLUS-Medicare Advantage, +105176,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,HEALTHPLUS-Medicare Advantage, +105177,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +105178,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,HEALTHPLUS-Medicare Advantage, +105179,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,HEALTHPLUS-Medicare Advantage, +105180,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,HEALTHPLUS-Medicare Advantage, +105181,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,HEALTHPLUS-Medicare Advantage, +105182,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,HEALTHPLUS-Medicare Advantage, +105183,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,HEALTHPLUS-Medicare Advantage, +105184,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,HEALTHPLUS-Medicare Advantage, +105185,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,HEALTHPLUS-Medicare Advantage, +105186,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,HEALTHPLUS-Medicare Advantage, +105187,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,HEALTHPLUS-Medicare Advantage, +105188,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,HEALTHPLUS-Medicare Advantage, +105189,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,HEALTHPLUS-Medicare Advantage, +105190,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,HEALTHPLUS-Medicare Advantage, +105191,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,HEALTHPLUS-Medicare Advantage, +105192,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,HEALTHPLUS-Medicare Advantage, +105193,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,HEALTHPLUS-Medicare Advantage, +105194,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,HEALTHPLUS-Medicare Advantage, +105195,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,HEALTHPLUS-Medicare Advantage, +105196,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,HEALTHPLUS-Medicare Advantage, +105197,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,HEALTHPLUS-Medicare Advantage, +105198,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,HEALTHPLUS-Medicare Advantage, +105199,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,HEALTHPLUS-Medicare Advantage, +105200,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,HEALTHPLUS-Medicare Advantage, +105201,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,HEALTHPLUS-Medicare Advantage, +105202,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105203,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,HEALTHPLUS-Medicare Advantage, +105204,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,HEALTHPLUS-Medicare Advantage, +105205,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,HEALTHPLUS-Medicare Advantage, +105206,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,HEALTHPLUS-Medicare Advantage, +105207,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,HEALTHPLUS-Medicare Advantage, +105208,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,HEALTHPLUS-Medicare Advantage, +105209,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,HEALTHPLUS-Medicare Advantage, +105210,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,HEALTHPLUS-Medicare Advantage, +105211,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,HEALTHPLUS-Medicare Advantage, +105212,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,HEALTHPLUS-Medicare Advantage, +105213,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,HEALTHPLUS-Medicare Advantage, +105214,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,HEALTHPLUS-Medicare Advantage, +105215,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,HEALTHPLUS-Medicare Advantage, +105216,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,HEALTHPLUS-Medicare Advantage, +105217,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,HEALTHPLUS-Medicare Advantage, +105218,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,HEALTHPLUS-Medicare Advantage, +105219,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,HEALTHPLUS-Medicare Advantage, +105220,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,HEALTHPLUS-Medicare Advantage, +105221,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,HEALTHPLUS-Medicare Advantage, +105222,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,HEALTHPLUS-Medicare Advantage, +105223,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,HEALTHPLUS-Medicare Advantage, +105224,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,HEALTHPLUS-Medicare Advantage, +105225,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,HEALTHPLUS-Medicare Advantage, +105226,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,HEALTHPLUS-Medicare Advantage, +105227,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,HEALTHPLUS-Medicare Advantage, +105228,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,HEALTHPLUS-Medicare Advantage, +105229,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,HEALTHPLUS-Medicare Advantage, +105230,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,HEALTHPLUS-Medicare Advantage, +105231,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,HEALTHPLUS-Medicare Advantage, +105232,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,HEALTHPLUS-Medicare Advantage, +105233,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,HEALTHPLUS-Medicare Advantage, +105234,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,HEALTHPLUS-Medicare Advantage, +105235,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,HEALTHPLUS-Medicare Advantage, +105236,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,HEALTHPLUS-Medicare Advantage, +105237,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,HEALTHPLUS-Medicare Advantage, +105238,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,HEALTHPLUS-Medicare Advantage, +105239,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,HEALTHPLUS-Medicare Advantage, +105240,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,HEALTHPLUS-Medicare Advantage, +105241,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,HEALTHPLUS-Medicare Advantage, +105242,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,HEALTHPLUS-Medicare Advantage, +105243,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,HEALTHPLUS-Medicare Advantage, +105244,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,HEALTHPLUS-Medicare Advantage, +105245,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,HEALTHPLUS-Medicare Advantage, +105246,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,HEALTHPLUS-Medicare Advantage, +105247,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,HEALTHPLUS-Medicare Advantage, +105248,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,HEALTHPLUS-Medicare Advantage, +105249,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,HEALTHPLUS-Medicare Advantage, +105250,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,HEALTHPLUS-Medicare Advantage, +105251,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,HEALTHPLUS-Medicare Advantage, +105252,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,HEALTHPLUS-Medicare Advantage, +105253,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,HEALTHPLUS-Medicare Advantage, +105254,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,HEALTHPLUS-Medicare Advantage, +105255,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,HEALTHPLUS-Medicare Advantage, +105256,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,HEALTHPLUS-Medicare Advantage, +105257,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,HEALTHPLUS-Medicare Advantage, +105258,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,HEALTHPLUS-Medicare Advantage, +105259,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,HEALTHPLUS-Medicare Advantage, +105260,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,HEALTHPLUS-Medicare Advantage, +105261,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,HEALTHPLUS-Medicare Advantage, +105262,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,HEALTHPLUS-Medicare Advantage, +105263,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,HEALTHPLUS-Medicare Advantage, +105264,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,HEALTHPLUS-Medicare Advantage, +105265,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,HEALTHPLUS-Medicare Advantage, +105266,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,HEALTHPLUS-Medicare Advantage, +105267,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,HEALTHPLUS-Medicare Advantage, +105268,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,HEALTHPLUS-Medicare Advantage, +105269,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,HEALTHPLUS-Medicare Advantage, +105270,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,HEALTHPLUS-Medicare Advantage, +105271,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,HEALTHPLUS-Medicare Advantage, +105272,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,HEALTHPLUS-Medicare Advantage, +105273,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,HEALTHPLUS-Medicare Advantage, +105274,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,HEALTHPLUS-Medicare Advantage, +105275,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,HEALTHPLUS-Medicare Advantage, +105276,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,HEALTHPLUS-Medicare Advantage, +105277,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,HEALTHPLUS-Medicare Advantage, +105278,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,HEALTHPLUS-Medicare Advantage, +105279,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,HEALTHPLUS-Medicare Advantage, +105280,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,HEALTHPLUS-Medicare Advantage, +105281,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,HEALTHPLUS-Medicare Advantage, +105282,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,HEALTHPLUS-Medicare Advantage, +105283,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,HEALTHPLUS-Medicare Advantage, +105284,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,HEALTHPLUS-Medicare Advantage, +105285,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,HEALTHPLUS-Medicare Advantage, +105286,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,HEALTHPLUS-Medicare Advantage, +105287,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,HEALTHPLUS-Medicare Advantage, +105288,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,HEALTHPLUS-Medicare Advantage, +105289,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,HEALTHPLUS-Medicare Advantage, +105290,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,HEALTHPLUS-Medicare Advantage, +105291,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,HEALTHPLUS-Medicare Advantage, +105292,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,HEALTHPLUS-Medicare Advantage, +105293,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,HEALTHPLUS-Medicare Advantage, +105294,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,HEALTHPLUS-Medicare Advantage, +105295,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,HEALTHPLUS-Medicare Advantage, +105296,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,HEALTHPLUS-Medicare Advantage, +105297,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,HEALTHPLUS-Medicare Advantage, +105298,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,HEALTHPLUS-Medicare Advantage, +105299,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,HEALTHPLUS-Medicare Advantage, +105300,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,HEALTHPLUS-Medicare Advantage, +105301,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,HEALTHPLUS-Medicare Advantage, +105302,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,HEALTHPLUS-Medicare Advantage, +105303,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,HEALTHPLUS-Medicare Advantage, +105304,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,HEALTHPLUS-Medicare Advantage, +105305,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,HEALTHPLUS-Medicare Advantage, +105306,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,HEALTHPLUS-Medicare Advantage, +105307,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,HEALTHPLUS-Medicare Advantage, +105308,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,HEALTHPLUS-Medicare Advantage, +105309,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,HEALTHPLUS-Medicare Advantage, +105310,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,HEALTHPLUS-Medicare Advantage, +105311,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,HEALTHPLUS-Medicare Advantage, +105312,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,HEALTHPLUS-Medicare Advantage, +105313,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,HEALTHPLUS-Medicare Advantage, +105314,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,HEALTHPLUS-Medicare Advantage, +105315,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,HEALTHPLUS-Medicare Advantage, +105316,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,HEALTHPLUS-Medicare Advantage, +105317,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,HEALTHPLUS-Medicare Advantage, +105318,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,HEALTHPLUS-Medicare Advantage, +105319,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,HEALTHPLUS-Medicare Advantage,1214.22 +105320,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,HEALTHPLUS-Medicare Advantage, +105321,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,HEALTHPLUS-Medicare Advantage, +105322,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,HEALTHPLUS-Medicare Advantage, +105323,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,HEALTHPLUS-Medicare Advantage, +105324,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +105325,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,HEALTHPLUS-Medicare Advantage, +105326,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,HEALTHPLUS-Medicare Advantage, +105327,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,HEALTHPLUS-Medicare Advantage, +105328,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,HEALTHPLUS-Medicare Advantage, +105329,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,HEALTHPLUS-Medicare Advantage, +105330,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,HEALTHPLUS-Medicare Advantage, +105331,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,HEALTHPLUS-Medicare Advantage, +105332,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,HEALTHPLUS-Medicare Advantage, +105333,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,HEALTHPLUS-Medicare Advantage, +105334,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,HEALTHPLUS-Medicare Advantage, +105335,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,HEALTHPLUS-Medicare Advantage, +105336,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,HEALTHPLUS-Medicare Advantage, +105337,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,HEALTHPLUS-Medicare Advantage, +105338,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,HEALTHPLUS-Medicare Advantage, +105339,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,HEALTHPLUS-Medicare Advantage, +105340,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,HEALTHPLUS-Medicare Advantage, +105341,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,HEALTHPLUS-Medicare Advantage, +105342,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,HEALTHPLUS-Medicare Advantage, +105343,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,HEALTHPLUS-Medicare Advantage, +105344,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,HEALTHPLUS-Medicare Advantage, +105345,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,HEALTHPLUS-Medicare Advantage, +105346,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,HEALTHPLUS-Medicare Advantage, +105347,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,HEALTHPLUS-Medicare Advantage, +105348,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,HEALTHPLUS-Medicare Advantage, +105349,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,HEALTHPLUS-Medicare Advantage, +105350,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,HEALTHPLUS-Medicare Advantage, +105351,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,HEALTHPLUS-Medicare Advantage, +105352,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,HEALTHPLUS-Medicare Advantage, +105353,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,HEALTHPLUS-Medicare Advantage, +105354,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,HEALTHPLUS-Medicare Advantage, +105355,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,HEALTHPLUS-Medicare Advantage, +105356,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,HEALTHPLUS-Medicare Advantage, +105357,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,HEALTHPLUS-Medicare Advantage, +105358,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,HEALTHPLUS-Medicare Advantage, +105359,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,HEALTHPLUS-Medicare Advantage, +105360,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,HEALTHPLUS-Medicare Advantage, +105361,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,HEALTHPLUS-Medicare Advantage, +105362,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,HEALTHPLUS-Medicare Advantage, +105363,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,HEALTHPLUS-Medicare Advantage, +105364,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,HEALTHPLUS-Medicare Advantage, +105365,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,HEALTHPLUS-Medicare Advantage, +105366,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,HEALTHPLUS-Medicare Advantage, +105367,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,HEALTHPLUS-Medicare Advantage, +105368,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,HEALTHPLUS-Medicare Advantage, +105369,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,HEALTHPLUS-Medicare Advantage, +105370,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,HEALTHPLUS-Medicare Advantage, +105371,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,HEALTHPLUS-Medicare Advantage, +105372,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,HEALTHPLUS-Medicare Advantage, +105373,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,HEALTHPLUS-Medicare Advantage, +105374,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,HEALTHPLUS-Medicare Advantage, +105375,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,HEALTHPLUS-Medicare Advantage, +105376,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,HEALTHPLUS-Medicare Advantage, +105377,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,HEALTHPLUS-Medicare Advantage, +105378,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,HEALTHPLUS-Medicare Advantage, +105379,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,HEALTHPLUS-Medicare Advantage, +105380,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,HEALTHPLUS-Medicare Advantage, +105381,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,HEALTHPLUS-Medicare Advantage, +105382,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,HEALTHPLUS-Medicare Advantage, +105383,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,HEALTHPLUS-Medicare Advantage, +105384,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,HEALTHPLUS-Medicare Advantage, +105385,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,HEALTHPLUS-Medicare Advantage, +105386,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,HEALTHPLUS-Medicare Advantage, +105387,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,HEALTHPLUS-Medicare Advantage, +105388,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,HEALTHPLUS-Medicare Advantage, +105389,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,HEALTHPLUS-Medicare Advantage, +105390,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,HEALTHPLUS-Medicare Advantage, +105391,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,HEALTHPLUS-Medicare Advantage, +105392,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,HEALTHPLUS-Medicare Advantage, +105393,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,HEALTHPLUS-Medicare Advantage, +105394,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,HEALTHPLUS-Medicare Advantage, +105395,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,HEALTHPLUS-Medicare Advantage, +105396,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,HEALTHPLUS-Medicare Advantage, +105397,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,HEALTHPLUS-Medicare Advantage, +105398,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,HEALTHPLUS-Medicare Advantage, +105399,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,HEALTHPLUS-Medicare Advantage, +105400,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,HEALTHPLUS-Medicare Advantage, +105401,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,HEALTHPLUS-Medicare Advantage, +105402,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,HEALTHPLUS-Medicare Advantage, +105403,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,HEALTHPLUS-Medicare Advantage, +105404,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,HEALTHPLUS-Medicare Advantage, +105405,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,HEALTHPLUS-Medicare Advantage, +105406,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,HEALTHPLUS-Medicare Advantage, +105407,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,HEALTHPLUS-Medicare Advantage, +105408,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,HEALTHPLUS-Medicare Advantage, +105409,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,HEALTHPLUS-Medicare Advantage, +105410,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,HEALTHPLUS-Medicare Advantage, +105411,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,HEALTHPLUS-Medicare Advantage, +105412,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,HEALTHPLUS-Medicare Advantage, +105413,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,HEALTHPLUS-Medicare Advantage, +105414,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,HEALTHPLUS-Medicare Advantage, +105415,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,HEALTHPLUS-Medicare Advantage, +105416,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,HEALTHPLUS-Medicare Advantage, +105417,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,HEALTHPLUS-Medicare Advantage, +105418,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,HEALTHPLUS-Medicare Advantage, +105419,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105420,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,HEALTHPLUS-Medicare Advantage, +105421,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,HEALTHPLUS-Medicare Advantage, +105422,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,HEALTHPLUS-Medicare Advantage, +105423,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,HEALTHPLUS-Medicare Advantage, +105424,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,HEALTHPLUS-Medicare Advantage, +105425,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,HEALTHPLUS-Medicare Advantage, +105426,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,HEALTHPLUS-Medicare Advantage, +105427,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,HEALTHPLUS-Medicare Advantage, +105428,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,HEALTHPLUS-Medicare Advantage, +105429,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,HEALTHPLUS-Medicare Advantage, +105430,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,HEALTHPLUS-Medicare Advantage, +105431,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,HEALTHPLUS-Medicare Advantage, +105432,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,HEALTHPLUS-Medicare Advantage, +105433,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,HEALTHPLUS-Medicare Advantage, +105434,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,HEALTHPLUS-Medicare Advantage, +105435,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,HEALTHPLUS-Medicare Advantage, +105436,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,HEALTHPLUS-Medicare Advantage, +105437,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,HEALTHPLUS-Medicare Advantage, +105438,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,HEALTHPLUS-Medicare Advantage, +105439,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,HEALTHPLUS-Medicare Advantage, +105440,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,HEALTHPLUS-Medicare Advantage, +105441,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,HEALTHPLUS-Medicare Advantage, +105442,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,HEALTHPLUS-Medicare Advantage, +105443,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,HEALTHPLUS-Medicare Advantage, +105444,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,HEALTHPLUS-Medicare Advantage, +105445,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,HEALTHPLUS-Medicare Advantage, +105446,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,HEALTHPLUS-Medicare Advantage, +105447,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,HEALTHPLUS-Medicare Advantage, +105448,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,HEALTHPLUS-Medicare Advantage, +105449,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,HEALTHPLUS-Medicare Advantage, +105450,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,HEALTHPLUS-Medicare Advantage, +105451,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,HEALTHPLUS-Medicare Advantage, +105452,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,HEALTHPLUS-Medicare Advantage, +105453,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,HEALTHPLUS-Medicare Advantage, +105454,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,HEALTHPLUS-Medicare Advantage, +105455,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,HEALTHPLUS-Medicare Advantage, +105456,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,HEALTHPLUS-Medicare Advantage, +105457,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,HEALTHPLUS-Medicare Advantage, +105458,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,HEALTHPLUS-Medicare Advantage, +105459,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,HEALTHPLUS-Medicare Advantage, +105460,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,HEALTHPLUS-Medicare Advantage, +105461,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,HEALTHPLUS-Medicare Advantage, +105462,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,HEALTHPLUS-Medicare Advantage, +105463,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,HEALTHPLUS-Medicare Advantage, +105464,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,HEALTHPLUS-Medicare Advantage, +105465,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,HEALTHPLUS-Medicare Advantage, +105466,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,HEALTHPLUS-Medicare Advantage, +105467,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,HEALTHPLUS-Medicare Advantage, +105468,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,HEALTHPLUS-Medicare Advantage, +105469,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,HEALTHPLUS-Medicare Advantage, +105470,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,HEALTHPLUS-Medicare Advantage, +105471,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,HEALTHPLUS-Medicare Advantage, +105472,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,HEALTHPLUS-Medicare Advantage, +105473,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,HEALTHPLUS-Medicare Advantage, +105474,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,HEALTHPLUS-Medicare Advantage, +105475,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,HEALTHPLUS-Medicare Advantage, +105476,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,HEALTHPLUS-Medicare Advantage, +105477,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,HEALTHPLUS-Medicare Advantage, +105478,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,HEALTHPLUS-Medicare Advantage, +105479,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,HEALTHPLUS-Medicare Advantage, +105480,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,HEALTHPLUS-Medicare Advantage, +105481,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,HEALTHPLUS-Medicare Advantage, +105482,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,HEALTHPLUS-Medicare Advantage, +105483,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,HEALTHPLUS-Medicare Advantage, +105484,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,HEALTHPLUS-Medicare Advantage, +105485,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,HEALTHPLUS-Medicare Advantage, +105486,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,HEALTHPLUS-Medicare Advantage, +105487,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,HEALTHPLUS-Medicare Advantage, +105488,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,HEALTHPLUS-Medicare Advantage, +105489,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,HEALTHPLUS-Medicare Advantage, +105490,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,HEALTHPLUS-Medicare Advantage, +105491,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,HEALTHPLUS-Medicare Advantage, +105492,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,HEALTHPLUS-Medicare Advantage, +105493,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,HEALTHPLUS-Medicare Advantage, +105494,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,HEALTHPLUS-Medicare Advantage, +105495,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,HEALTHPLUS-Medicare Advantage, +105496,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,HEALTHPLUS-Medicare Advantage, +105497,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,HEALTHPLUS-Medicare Advantage, +105498,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,HEALTHPLUS-Medicare Advantage, +105499,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,HEALTHPLUS-Medicare Advantage, +105500,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,HEALTHPLUS-Medicare Advantage, +105501,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,HEALTHPLUS-Medicare Advantage, +105502,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,HEALTHPLUS-Medicare Advantage, +105503,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,HEALTHPLUS-Medicare Advantage, +105504,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,HEALTHPLUS-Medicare Advantage, +105505,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,HEALTHPLUS-Medicare Advantage, +105506,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,HEALTHPLUS-Medicare Advantage, +105507,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,HEALTHPLUS-Medicare Advantage, +105508,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,HEALTHPLUS-Medicare Advantage, +105509,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,HEALTHPLUS-Medicare Advantage, +105510,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,HEALTHPLUS-Medicare Advantage, +105511,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +105512,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,HEALTHPLUS-Medicare Advantage, +105513,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +105514,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,HEALTHPLUS-Medicare Advantage, +105515,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,HEALTHPLUS-Medicare Advantage, +105516,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,HEALTHPLUS-Medicare Advantage, +105517,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,HEALTHPLUS-Medicare Advantage, +105518,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,HEALTHPLUS-Medicare Advantage, +105519,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,HEALTHPLUS-Medicare Advantage, +105520,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,HEALTHPLUS-Medicare Advantage, +105521,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,HEALTHPLUS-Medicare Advantage, +105522,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,HEALTHPLUS-Medicare Advantage, +105523,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,HEALTHPLUS-Medicare Advantage, +105524,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,HEALTHPLUS-Medicare Advantage, +105525,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,HEALTHPLUS-Medicare Advantage, +105526,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,HEALTHPLUS-Medicare Advantage, +105527,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,HEALTHPLUS-Medicare Advantage, +105528,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,HEALTHPLUS-Medicare Advantage, +105529,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,HEALTHPLUS-Medicare Advantage, +105530,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,HEALTHPLUS-Medicare Advantage, +105531,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,HEALTHPLUS-Medicare Advantage, +105532,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,HEALTHPLUS-Medicare Advantage, +105533,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,HEALTHPLUS-Medicare Advantage, +105534,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,HEALTHPLUS-Medicare Advantage, +105535,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,HEALTHPLUS-Medicare Advantage, +105536,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,HEALTHPLUS-Medicare Advantage, +105537,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,HEALTHPLUS-Medicare Advantage, +105538,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,HEALTHPLUS-Medicare Advantage, +105539,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +105540,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,HEALTHPLUS-Medicare Advantage, +105541,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,HEALTHPLUS-Medicare Advantage, +105542,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,HEALTHPLUS-Medicare Advantage, +105543,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,HEALTHPLUS-Medicare Advantage, +105544,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,HEALTHPLUS-Medicare Advantage, +105545,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,HEALTHPLUS-Medicare Advantage, +105546,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,HEALTHPLUS-Medicare Advantage, +105547,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,HEALTHPLUS-Medicare Advantage, +105548,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,HEALTHPLUS-Medicare Advantage, +105549,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,HEALTHPLUS-Medicare Advantage, +105550,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,HEALTHPLUS-Medicare Advantage, +105551,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,HEALTHPLUS-Medicare Advantage, +105552,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,HEALTHPLUS-Medicare Advantage, +105553,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,HEALTHPLUS-Medicare Advantage, +105554,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,HEALTHPLUS-Medicare Advantage, +105555,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,HEALTHPLUS-Medicare Advantage, +105556,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,HEALTHPLUS-Medicare Advantage, +105557,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,HEALTHPLUS-Medicare Advantage, +105558,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,HEALTHPLUS-Medicare Advantage, +105559,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,HEALTHPLUS-Medicare Advantage, +105560,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,HEALTHPLUS-Medicare Advantage, +105561,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,HEALTHPLUS-Medicare Advantage, +105562,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,HEALTHPLUS-Medicare Advantage, +105563,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,HEALTHPLUS-Medicare Advantage, +105564,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,HEALTHPLUS-Medicare Advantage, +105565,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,HEALTHPLUS-Medicare Advantage, +105566,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,HEALTHPLUS-Medicare Advantage, +105567,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,HEALTHPLUS-Medicare Advantage, +105568,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,HEALTHPLUS-Medicare Advantage, +105569,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105570,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,HEALTHPLUS-Medicare Advantage, +105571,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,HEALTHPLUS-Medicare Advantage, +105572,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,HEALTHPLUS-Medicare Advantage, +105573,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,HEALTHPLUS-Medicare Advantage, +105574,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,HEALTHPLUS-Medicare Advantage, +105575,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,HEALTHPLUS-Medicare Advantage, +105576,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,HEALTHPLUS-Medicare Advantage, +105577,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,HEALTHPLUS-Medicare Advantage, +105578,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,HEALTHPLUS-Medicare Advantage, +105579,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,HEALTHPLUS-Medicare Advantage, +105580,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,HEALTHPLUS-Medicare Advantage, +105581,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,HEALTHPLUS-Medicare Advantage, +105582,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,HEALTHPLUS-Medicare Advantage, +105583,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,HEALTHPLUS-Medicare Advantage, +105584,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,HEALTHPLUS-Medicare Advantage, +105585,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,HEALTHPLUS-Medicare Advantage, +105586,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,HEALTHPLUS-Medicare Advantage, +105587,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,HEALTHPLUS-Medicare Advantage, +105588,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,HEALTHPLUS-Medicare Advantage, +105589,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,HEALTHPLUS-Medicare Advantage, +105590,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,HEALTHPLUS-Medicare Advantage, +105591,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,HEALTHPLUS-Medicare Advantage, +105592,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,HEALTHPLUS-Medicare Advantage, +105593,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,HEALTHPLUS-Medicare Advantage, +105594,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,HEALTHPLUS-Medicare Advantage, +105595,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,HEALTHPLUS-Medicare Advantage, +105596,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +105597,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,HEALTHPLUS-Medicare Advantage, +105598,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105599,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,HEALTHPLUS-Medicare Advantage, +105600,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,HEALTHPLUS-Medicare Advantage, +105601,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,HEALTHPLUS-Medicare Advantage, +105602,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,HEALTHPLUS-Medicare Advantage, +105603,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,HEALTHPLUS-Medicare Advantage, +105604,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,HEALTHPLUS-Medicare Advantage, +105605,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,HEALTHPLUS-Medicare Advantage, +105606,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,HEALTHPLUS-Medicare Advantage, +105607,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,HEALTHPLUS-Medicare Advantage, +105608,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,HEALTHPLUS-Medicare Advantage, +105609,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,HEALTHPLUS-Medicare Advantage, +105610,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,HEALTHPLUS-Medicare Advantage, +105611,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,HEALTHPLUS-Medicare Advantage, +105612,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,HEALTHPLUS-Medicare Advantage, +105613,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,HEALTHPLUS-Medicare Advantage, +105614,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,HEALTHPLUS-Medicare Advantage, +105615,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,HEALTHPLUS-Medicare Advantage, +105616,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,HEALTHPLUS-Medicare Advantage, +105617,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,HEALTHPLUS-Medicare Advantage, +105618,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,HEALTHPLUS-Medicare Advantage, +105619,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,HEALTHPLUS-Medicare Advantage, +105620,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,HEALTHPLUS-Medicare Advantage, +105621,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,HEALTHPLUS-Medicare Advantage, +105622,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,HEALTHPLUS-Medicare Advantage, +105623,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,HEALTHPLUS-Medicare Advantage, +105624,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,HEALTHPLUS-Medicare Advantage, +105625,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,HEALTHPLUS-Medicare Advantage, +105626,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,HEALTHPLUS-Medicare Advantage, +105627,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,HEALTHPLUS-Medicare Advantage, +105628,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,HEALTHPLUS-Medicare Advantage, +105629,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,HEALTHPLUS-Medicare Advantage, +105630,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,HEALTHPLUS-Medicare Advantage, +105631,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,HEALTHPLUS-Medicare Advantage, +105632,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,HEALTHPLUS-Medicare Advantage, +105633,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105634,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,HEALTHPLUS-Medicare Advantage, +105635,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,HEALTHPLUS-Medicare Advantage, +105636,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,HEALTHPLUS-Medicare Advantage, +105637,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,HEALTHPLUS-Medicare Advantage, +105638,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,HEALTHPLUS-Medicare Advantage, +105639,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,HEALTHPLUS-Medicare Advantage, +105640,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,HEALTHPLUS-Medicare Advantage, +105641,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,HEALTHPLUS-Medicare Advantage, +105642,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,HEALTHPLUS-Medicare Advantage, +105643,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,HEALTHPLUS-Medicare Advantage, +105644,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,HEALTHPLUS-Medicare Advantage, +105645,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,HEALTHPLUS-Medicare Advantage, +105646,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,HEALTHPLUS-Medicare Advantage, +105647,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,HEALTHPLUS-Medicare Advantage, +105648,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,HEALTHPLUS-Medicare Advantage, +105649,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,HEALTHPLUS-Medicare Advantage, +105650,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,HEALTHPLUS-Medicare Advantage, +105651,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,HEALTHPLUS-Medicare Advantage, +105652,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,HEALTHPLUS-Medicare Advantage, +105653,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,HEALTHPLUS-Medicare Advantage, +105654,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,HEALTHPLUS-Medicare Advantage, +105655,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,HEALTHPLUS-Medicare Advantage, +105656,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,HEALTHPLUS-Medicare Advantage, +105657,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,HEALTHPLUS-Medicare Advantage, +105658,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,HEALTHPLUS-Medicare Advantage, +105659,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,HEALTHPLUS-Medicare Advantage, +105660,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,HEALTHPLUS-Medicare Advantage, +105661,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,HEALTHPLUS-Medicare Advantage, +105662,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,HEALTHPLUS-Medicare Advantage, +105663,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,HEALTHPLUS-Medicare Advantage, +105664,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,HEALTHPLUS-Medicare Advantage, +105665,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,HEALTHPLUS-Medicare Advantage, +105666,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,HEALTHPLUS-Medicare Advantage, +105667,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,HEALTHPLUS-Medicare Advantage, +105668,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,HEALTHPLUS-Medicare Advantage, +105669,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,HEALTHPLUS-Medicare Advantage, +105670,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,HEALTHPLUS-Medicare Advantage, +105671,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,HEALTHPLUS-Medicare Advantage, +105672,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,HEALTHPLUS-Medicare Advantage, +105673,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,HEALTHPLUS-Medicare Advantage, +105674,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,HEALTHPLUS-Medicare Advantage, +105675,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,HEALTHPLUS-Medicare Advantage, +105676,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,HEALTHPLUS-Medicare Advantage, +105677,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,HEALTHPLUS-Medicare Advantage, +105678,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,HEALTHPLUS-Medicare Advantage, +105679,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +105680,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,HEALTHPLUS-Medicare Advantage, +105681,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,HEALTHPLUS-Medicare Advantage, +105682,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105683,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,HEALTHPLUS-Medicare Advantage, +105684,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +105685,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +105686,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,HEALTHPLUS-Medicare Advantage, +105687,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,HEALTHPLUS-Medicare Advantage, +105688,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,HEALTHPLUS-Medicare Advantage, +105689,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,HEALTHPLUS-Medicare Advantage, +105690,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,HEALTHPLUS-Medicare Advantage, +105691,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,HEALTHPLUS-Medicare Advantage, +105692,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,HEALTHPLUS-Medicare Advantage, +105693,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,HEALTHPLUS-Medicare Advantage, +105694,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,HEALTHPLUS-Medicare Advantage, +105695,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,HEALTHPLUS-Medicare Advantage, +105696,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,HEALTHPLUS-Medicare Advantage, +105697,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,HEALTHPLUS-Medicare Advantage, +105698,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,HEALTHPLUS-Medicare Advantage, +105699,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,HEALTHPLUS-Medicare Advantage, +105700,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,HEALTHPLUS-Medicare Advantage, +105701,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,HEALTHPLUS-Medicare Advantage, +105702,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,HEALTHPLUS-Medicare Advantage, +105703,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,HEALTHPLUS-Medicare Advantage, +105704,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,HEALTHPLUS-Medicare Advantage, +105705,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,HEALTHPLUS-Medicare Advantage, +105706,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,HEALTHPLUS-Medicare Advantage, +105707,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,HEALTHPLUS-Medicare Advantage, +105708,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,HEALTHPLUS-Medicare Advantage, +105709,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,HEALTHPLUS-Medicare Advantage, +105710,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,HEALTHPLUS-Medicare Advantage, +105711,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,HEALTHPLUS-Medicare Advantage, +105712,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,HEALTHPLUS-Medicare Advantage, +105713,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,HEALTHPLUS-Medicare Advantage, +105714,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105715,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,HEALTHPLUS-Medicare Advantage, +105716,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,HEALTHPLUS-Medicare Advantage, +105717,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,HEALTHPLUS-Medicare Advantage, +105718,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,HEALTHPLUS-Medicare Advantage, +105719,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,HEALTHPLUS-Medicare Advantage, +105720,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,HEALTHPLUS-Medicare Advantage, +105721,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +105722,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,HEALTHPLUS-Medicare Advantage, +105723,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,HEALTHPLUS-Medicare Advantage, +105724,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,HEALTHPLUS-Medicare Advantage, +105725,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,HEALTHPLUS-Medicare Advantage, +105726,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,HEALTHPLUS-Medicare Advantage, +105727,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,HEALTHPLUS-Medicare Advantage, +105728,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,HEALTHPLUS-Medicare Advantage, +105729,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,HEALTHPLUS-Medicare Advantage, +105730,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,HEALTHPLUS-Medicare Advantage, +105731,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,HEALTHPLUS-Medicare Advantage, +105732,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,HEALTHPLUS-Medicare Advantage, +105733,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,HEALTHPLUS-Medicare Advantage, +105734,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,HEALTHPLUS-Medicare Advantage, +105735,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,HEALTHPLUS-Medicare Advantage, +105736,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,HEALTHPLUS-Medicare Advantage, +105737,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,HEALTHPLUS-Medicare Advantage, +105738,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,HEALTHPLUS-Medicare Advantage, +105739,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,HEALTHPLUS-Medicare Advantage, +105740,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,HEALTHPLUS-Medicare Advantage, +105741,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,HEALTHPLUS-Medicare Advantage, +105742,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,HEALTHPLUS-Medicare Advantage, +105743,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,HEALTHPLUS-Medicare Advantage, +105744,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,HEALTHPLUS-Medicare Advantage, +105745,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,HEALTHPLUS-Medicare Advantage, +105746,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,HEALTHPLUS-Medicare Advantage, +105747,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,HEALTHPLUS-Medicare Advantage, +105748,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,HEALTHPLUS-Medicare Advantage, +105749,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,HEALTHPLUS-Medicare Advantage, +105750,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,HEALTHPLUS-Medicare Advantage, +105751,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,HEALTHPLUS-Medicare Advantage, +105752,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,HEALTHPLUS-Medicare Advantage, +105753,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,HEALTHPLUS-Medicare Advantage, +105754,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,HEALTHPLUS-Medicare Advantage, +105755,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,HEALTHPLUS-Medicare Advantage, +105756,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,HEALTHPLUS-Medicare Advantage, +105757,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,HEALTHPLUS-Medicare Advantage, +105758,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,HEALTHPLUS-Medicare Advantage, +105759,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,HEALTHPLUS-Medicare Advantage, +105760,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,HEALTHPLUS-Medicare Advantage, +105761,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,HEALTHPLUS-Medicare Advantage, +105762,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,HEALTHPLUS-Medicare Advantage, +105763,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,HEALTHPLUS-Medicare Advantage, +105764,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,HEALTHPLUS-Medicare Advantage, +105765,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,HEALTHPLUS-Medicare Advantage, +105766,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,HEALTHPLUS-Medicare Advantage, +105767,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,HEALTHPLUS-Medicare Advantage, +105768,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,HEALTHPLUS-Medicare Advantage, +105769,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,HEALTHPLUS-Medicare Advantage, +105770,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,HEALTHPLUS-Medicare Advantage, +105771,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,HEALTHPLUS-Medicare Advantage, +105772,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,HEALTHPLUS-Medicare Advantage, +105773,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,HEALTHPLUS-Medicare Advantage, +105774,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,HEALTHPLUS-Medicare Advantage, +105775,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,HEALTHPLUS-Medicare Advantage, +105776,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,HEALTHPLUS-Medicare Advantage, +105777,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,HEALTHPLUS-Medicare Advantage, +105778,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,HEALTHPLUS-Medicare Advantage, +105779,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,HEALTHPLUS-Medicare Advantage,2082.99 +105780,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,HEALTHPLUS-Medicare Advantage, +105781,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,HEALTHPLUS-Medicare Advantage, +105782,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,HEALTHPLUS-Medicare Advantage, +105783,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,HEALTHPLUS-Medicare Advantage, +105784,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,HEALTHPLUS-Medicare Advantage, +105785,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,HEALTHPLUS-Medicare Advantage, +105786,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,HEALTHPLUS-Medicare Advantage, +105787,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,HEALTHPLUS-Medicare Advantage, +105788,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,HEALTHPLUS-Medicare Advantage, +105789,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,HEALTHPLUS-Medicare Advantage, +105790,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,HEALTHPLUS-Medicare Advantage, +105791,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,HEALTHPLUS-Medicare Advantage, +105792,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,HEALTHPLUS-Medicare Advantage, +105793,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,HEALTHPLUS-Medicare Advantage, +105794,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,HEALTHPLUS-Medicare Advantage, +105795,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,HEALTHPLUS-Medicare Advantage, +105796,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,HEALTHPLUS-Medicare Advantage, +105797,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +105798,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,HEALTHPLUS-Medicare Advantage, +105799,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,HEALTHPLUS-Medicare Advantage, +105800,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,HEALTHPLUS-Medicare Advantage, +105801,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,HEALTHPLUS-Medicare Advantage, +105802,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,HEALTHPLUS-Medicare Advantage, +105803,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,HEALTHPLUS-Medicare Advantage, +105804,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,HEALTHPLUS-Medicare Advantage, +105805,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,HEALTHPLUS-Medicare Advantage, +105806,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,HEALTHPLUS-Medicare Advantage, +105807,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,HEALTHPLUS-Medicare Advantage, +105808,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,HEALTHPLUS-Medicare Advantage, +105809,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,HEALTHPLUS-Medicare Advantage, +105810,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,HEALTHPLUS-Medicare Advantage, +105811,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,HEALTHPLUS-Medicare Advantage, +105812,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,HEALTHPLUS-Medicare Advantage, +105813,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,HEALTHPLUS-Medicare Advantage, +105814,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,HEALTHPLUS-Medicare Advantage, +105815,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,HEALTHPLUS-Medicare Advantage, +105816,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,HEALTHPLUS-Medicare Advantage, +105817,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,HEALTHPLUS-Medicare Advantage, +105818,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,HEALTHPLUS-Medicare Advantage, +105819,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,HEALTHPLUS-Medicare Advantage, +105820,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,HEALTHPLUS-Medicare Advantage, +105821,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,HEALTHPLUS-Medicare Advantage, +105822,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,HEALTHPLUS-Medicare Advantage, +105823,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,HEALTHPLUS-Medicare Advantage, +105824,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,HEALTHPLUS-Medicare Advantage, +105825,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,HEALTHPLUS-Medicare Advantage, +105826,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,HEALTHPLUS-Medicare Advantage, +105827,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,HEALTHPLUS-Medicare Advantage, +105828,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,HEALTHPLUS-Medicare Advantage, +105829,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-Medicare Advantage, +105830,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,HEALTHPLUS-Medicare Advantage, +105831,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,HEALTHPLUS-Medicare Advantage, +105832,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,HEALTHPLUS-Medicare Advantage, +105833,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,HEALTHPLUS-Medicare Advantage, +105834,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,HEALTHPLUS-Medicare Advantage, +105835,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,HEALTHPLUS-Medicare Advantage, +105836,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,HEALTHPLUS-Medicare Advantage, +105837,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,HEALTHPLUS-Medicare Advantage, +105838,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,HEALTHPLUS-Medicare Advantage, +105839,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,HEALTHPLUS-Medicare Advantage, +105840,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,HEALTHPLUS-Medicare Advantage, +105841,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,HEALTHPLUS-Medicare Advantage, +105842,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,HEALTHPLUS-Medicare Advantage, +105843,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,HEALTHPLUS-Medicare Advantage, +105844,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,HEALTHPLUS-Medicare Advantage, +105845,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,HEALTHPLUS-Medicare Advantage, +105846,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,HEALTHPLUS-Medicare Advantage, +105847,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,HEALTHPLUS-Medicare Advantage, +105848,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,HEALTHPLUS-Medicare Advantage, +105849,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,HEALTHPLUS-Medicare Advantage, +105850,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,HEALTHPLUS-Medicare Advantage, +105851,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,HEALTHPLUS-Medicare Advantage, +105852,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,HEALTHPLUS-Medicare Advantage, +105853,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,HEALTHPLUS-Medicare Advantage, +105854,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,HEALTHPLUS-Medicare Advantage, +105855,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,HEALTHPLUS-Medicare Advantage, +105856,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,HEALTHPLUS-Medicare Advantage, +105857,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,HEALTHPLUS-Medicare Advantage, +105858,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,HEALTHPLUS-Medicare Advantage, +105859,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,HEALTHPLUS-Medicare Advantage, +105860,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,HEALTHPLUS-Medicare Advantage, +105861,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,HEALTHPLUS-Medicare Advantage, +105862,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,HEALTHPLUS-Medicare Advantage, +105863,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,HEALTHPLUS-Medicare Advantage, +105864,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,HEALTHPLUS-Medicare Advantage, +105865,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,HEALTHPLUS-Medicare Advantage, +105866,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,HEALTHPLUS-Medicare Advantage, +105867,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,HEALTHPLUS-Medicare Advantage, +105868,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,HEALTHPLUS-Medicare Advantage, +105869,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,HEALTHPLUS-Medicare Advantage, +105870,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,HEALTHPLUS-Medicare Advantage, +105871,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,HEALTHPLUS-Medicare Advantage, +105872,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,HEALTHPLUS-Medicare Advantage, +105873,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,HEALTHPLUS-Medicare Advantage, +105874,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,HEALTHPLUS-Medicare Advantage, +105875,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,HEALTHPLUS-Medicare Advantage, +105876,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,HEALTHPLUS-Medicare Advantage, +105877,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,HEALTHPLUS-Medicare Advantage, +105878,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,HEALTHPLUS-Medicare Advantage, +105879,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,HEALTHPLUS-Medicare Advantage, +105880,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,HEALTHPLUS-Medicare Advantage, +105881,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,HEALTHPLUS-Medicare Advantage, +105882,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,HEALTHPLUS-Medicare Advantage, +105883,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,HEALTHPLUS-Medicare Advantage, +105884,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,HEALTHPLUS-Medicare Advantage, +105885,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,HEALTHPLUS-Medicare Advantage, +105886,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,HEALTHPLUS-Medicare Advantage, +105887,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,HEALTHPLUS-Medicare Advantage, +105888,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,HEALTHPLUS-Medicare Advantage, +105889,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,HEALTHPLUS-Medicare Advantage, +105890,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,HEALTHPLUS-Medicare Advantage, +105891,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,HEALTHPLUS-Medicare Advantage, +105892,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,HEALTHPLUS-Medicare Advantage, +105893,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,HEALTHPLUS-Medicare Advantage, +105894,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,HEALTHPLUS-Medicare Advantage, +105895,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,HEALTHPLUS-Medicare Advantage, +105896,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,HEALTHPLUS-Medicare Advantage, +105897,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,HEALTHPLUS-Medicare Advantage, +105898,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,HEALTHPLUS-Medicare Advantage, +105899,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,HEALTHPLUS-Medicare Advantage, +105900,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,HEALTHPLUS-Medicare Advantage, +105901,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,HEALTHPLUS-Medicare Advantage, +105902,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,HEALTHPLUS-Medicare Advantage, +105903,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,HEALTHPLUS-Medicare Advantage, +105904,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,HEALTHPLUS-Medicare Advantage, +105905,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,HEALTHPLUS-Medicare Advantage, +105906,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,HEALTHPLUS-Medicare Advantage, +105907,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,HEALTHPLUS-Medicare Advantage, +105908,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,HEALTHPLUS-Medicare Advantage, +105909,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,HEALTHPLUS-Medicare Advantage, +105910,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,HEALTHPLUS-Medicare Advantage, +105911,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,HEALTHPLUS-Medicare Advantage, +105912,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,HEALTHPLUS-Medicare Advantage, +105913,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,HEALTHPLUS-Medicare Advantage, +105914,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,HEALTHPLUS-Medicare Advantage, +105915,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,HEALTHPLUS-Medicare Advantage, +105916,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,HEALTHPLUS-Medicare Advantage, +105917,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,HEALTHPLUS-Medicare Advantage, +105918,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,HEALTHPLUS-Medicare Advantage, +105919,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,HEALTHPLUS-Medicare Advantage, +105920,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,HEALTHPLUS-Medicare Advantage, +105921,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,HEALTHPLUS-Medicare Advantage, +105922,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,HEALTHPLUS-Medicare Advantage, +105923,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,HEALTHPLUS-Medicare Advantage, +105924,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,HEALTHPLUS-Medicare Advantage, +105925,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,HEALTHPLUS-Medicare Advantage, +105926,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,HEALTHPLUS-Medicare Advantage, +105927,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,HEALTHPLUS-Medicare Advantage, +105928,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,HEALTHPLUS-Medicare Advantage, +105929,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,HEALTHPLUS-Medicare Advantage, +105930,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,HEALTHPLUS-Medicare Advantage, +105931,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,HEALTHPLUS-Medicare Advantage, +105932,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,HEALTHPLUS-Medicare Advantage, +105933,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,HEALTHPLUS-Medicare Advantage, +105934,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,HEALTHPLUS-Medicare Advantage, +105935,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,HEALTHPLUS-Medicare Advantage, +105936,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,HEALTHPLUS-Medicare Advantage, +105937,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,HEALTHPLUS-Medicare Advantage, +105938,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,HEALTHPLUS-Medicare Advantage, +105939,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,HEALTHPLUS-Medicare Advantage, +105940,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,HEALTHPLUS-Medicare Advantage, +105941,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,HEALTHPLUS-Medicare Advantage, +105942,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,HEALTHPLUS-Medicare Advantage, +105943,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,HEALTHPLUS-Medicare Advantage, +105944,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,HEALTHPLUS-Medicare Advantage, +105945,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,HEALTHPLUS-Medicare Advantage, +105946,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,HEALTHPLUS-Medicare Advantage, +105947,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,HEALTHPLUS-Medicare Advantage, +105948,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,HEALTHPLUS-Medicare Advantage, +105949,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,HEALTHPLUS-Medicare Advantage, +105950,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,HEALTHPLUS-Medicare Advantage, +105951,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,HEALTHPLUS-Medicare Advantage, +105952,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,HEALTHPLUS-Medicare Advantage, +105953,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,HEALTHPLUS-Medicare Advantage, +105954,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,HEALTHPLUS-Medicare Advantage, +105955,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,HEALTHPLUS-Medicare Advantage, +105956,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,HEALTHPLUS-Medicare Advantage, +105957,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,HEALTHPLUS-Medicare Advantage, +105958,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,HEALTHPLUS-Medicare Advantage, +105959,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,HEALTHPLUS-Medicare Advantage, +105960,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,HEALTHPLUS-Medicare Advantage, +105961,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,HEALTHPLUS-Medicare Advantage, +105962,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,HEALTHPLUS-Medicare Advantage, +105963,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,HEALTHPLUS-Medicare Advantage,558.72 +105964,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,HEALTHPLUS-Medicare Advantage, +105965,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,HEALTHPLUS-Medicare Advantage, +105966,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,HEALTHPLUS-Medicare Advantage, +105967,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,HEALTHPLUS-Medicare Advantage, +105968,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,HEALTHPLUS-Medicare Advantage, +105969,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,HEALTHPLUS-Medicare Advantage, +105970,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,HEALTHPLUS-Medicare Advantage, +105971,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,HEALTHPLUS-Medicare Advantage, +105972,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,HEALTHPLUS-Medicare Advantage, +105973,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,HEALTHPLUS-Medicare Advantage, +105974,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,HEALTHPLUS-Medicare Advantage, +105975,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,HEALTHPLUS-Medicare Advantage, +105976,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,HEALTHPLUS-Medicare Advantage, +105977,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,HEALTHPLUS-Medicare Advantage, +105978,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,HEALTHPLUS-Medicare Advantage, +105979,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,HEALTHPLUS-Medicare Advantage, +105980,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,HEALTHPLUS-Medicare Advantage, +105981,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,HEALTHPLUS-Medicare Advantage, +105982,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,HEALTHPLUS-Medicare Advantage,96.69 +105983,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,HEALTHPLUS-Medicare Advantage,96.69 +105984,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,HEALTHPLUS-Medicare Advantage, +105985,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,HEALTHPLUS-Medicare Advantage, +105986,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,HEALTHPLUS-Medicare Advantage, +105987,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,HEALTHPLUS-Medicare Advantage, +105988,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,HEALTHPLUS-Medicare Advantage, +105989,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,HEALTHPLUS-Medicare Advantage, +105990,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,HEALTHPLUS-Medicare Advantage, +105991,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,HEALTHPLUS-Medicare Advantage, +105992,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,HEALTHPLUS-Medicare Advantage, +105993,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,HEALTHPLUS-Medicare Advantage, +105994,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,HEALTHPLUS-Medicare Advantage, +105995,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,HEALTHPLUS-Medicare Advantage, +105996,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,HEALTHPLUS-Medicare Advantage, +105997,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,HEALTHPLUS-Medicare Advantage, +105998,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,HEALTHPLUS-Medicare Advantage, +105999,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,HEALTHPLUS-Medicare Advantage, +106000,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,HEALTHPLUS-Medicare Advantage, +106001,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,HEALTHPLUS-Medicare Advantage, +106002,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,HEALTHPLUS-Medicare Advantage, +106003,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,HEALTHPLUS-Medicare Advantage, +106004,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,HEALTHPLUS-Medicare Advantage, +106005,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,HEALTHPLUS-Medicare Advantage, +106006,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,HEALTHPLUS-Medicare Advantage, +106007,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,HEALTHPLUS-Medicare Advantage, +106008,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,HEALTHPLUS-Medicare Advantage, +106009,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,HEALTHPLUS-Medicare Advantage, +106010,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,HEALTHPLUS-Medicare Advantage, +106011,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,HEALTHPLUS-Medicare Advantage, +106012,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,HEALTHPLUS-Medicare Advantage, +106013,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,HEALTHPLUS-Medicare Advantage, +106014,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,HEALTHPLUS-Medicare Advantage, +106015,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,HEALTHPLUS-Medicare Advantage, +106016,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,HEALTHPLUS-Medicare Advantage, +106017,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,HEALTHPLUS-Medicare Advantage, +106018,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,HEALTHPLUS-Medicare Advantage, +106019,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,HEALTHPLUS-Medicare Advantage,276.87 +106020,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,HEALTHPLUS-Medicare Advantage, +106021,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,HEALTHPLUS-Medicare Advantage, +106022,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,HEALTHPLUS-Medicare Advantage, +106023,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,HEALTHPLUS-Medicare Advantage, +106024,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,HEALTHPLUS-Medicare Advantage, +106025,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,HEALTHPLUS-Medicare Advantage, +106026,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,HEALTHPLUS-Medicare Advantage, +106027,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,HEALTHPLUS-Medicare Advantage, +106028,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,HEALTHPLUS-Medicare Advantage,135.11 +106029,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,HEALTHPLUS-Medicare Advantage, +106030,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,HEALTHPLUS-Medicare Advantage, +106031,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,HEALTHPLUS-Medicare Advantage, +106032,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,HEALTHPLUS-Medicare Advantage, +106033,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,HEALTHPLUS-Medicare Advantage, +106034,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,HEALTHPLUS-Medicare Advantage, +106035,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,HEALTHPLUS-Medicare Advantage, +106036,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,HEALTHPLUS-Medicare Advantage, +106037,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,HEALTHPLUS-Medicare Advantage, +106038,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,HEALTHPLUS-Medicare Advantage, +106039,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,HEALTHPLUS-Medicare Advantage, +106040,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,HEALTHPLUS-Medicare Advantage, +106041,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,HEALTHPLUS-Medicare Advantage, +106042,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,HEALTHPLUS-Medicare Advantage, +106043,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,HEALTHPLUS-Medicare Advantage, +106044,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,HEALTHPLUS-Medicare Advantage, +106045,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,HEALTHPLUS-Medicare Advantage, +106046,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,HEALTHPLUS-Medicare Advantage, +106047,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,HEALTHPLUS-Medicare Advantage, +106048,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,HEALTHPLUS-Medicare Advantage, +106049,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,HEALTHPLUS-Medicare Advantage, +106050,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,HEALTHPLUS-Medicare Advantage, +106051,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,HEALTHPLUS-Medicare Advantage, +106052,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,HEALTHPLUS-Medicare Advantage, +106053,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,HEALTHPLUS-Medicare Advantage, +106054,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,HEALTHPLUS-Medicare Advantage, +106055,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,HEALTHPLUS-Medicare Advantage, +106056,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,HEALTHPLUS-Medicare Advantage, +106057,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,HEALTHPLUS-Medicare Advantage, +106058,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,HEALTHPLUS-Medicare Advantage, +106059,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,HEALTHPLUS-Medicare Advantage, +106060,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,HEALTHPLUS-Medicare Advantage,74.81 +106061,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,HEALTHPLUS-Medicare Advantage, +106062,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,HEALTHPLUS-Medicare Advantage, +106063,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,HEALTHPLUS-Medicare Advantage, +106064,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,HEALTHPLUS-Medicare Advantage, +106065,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,HEALTHPLUS-Medicare Advantage, +106066,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,HEALTHPLUS-Medicare Advantage, +106067,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,HEALTHPLUS-Medicare Advantage, +106068,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,HEALTHPLUS-Medicare Advantage, +106069,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,HEALTHPLUS-Medicare Advantage,132.12 +106070,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,HEALTHPLUS-Medicare Advantage, +106071,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,HEALTHPLUS-Medicare Advantage, +106072,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,HEALTHPLUS-Medicare Advantage, +106073,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,HEALTHPLUS-Medicare Advantage, +106074,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,HEALTHPLUS-Medicare Advantage, +106075,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,HEALTHPLUS-Medicare Advantage, +106076,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,HEALTHPLUS-Medicare Advantage, +106077,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,HEALTHPLUS-Medicare Advantage, +106078,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,HEALTHPLUS-Medicare Advantage, +106079,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,HEALTHPLUS-Medicare Advantage, +106080,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,HEALTHPLUS-Medicare Advantage, +106081,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,HEALTHPLUS-Medicare Advantage, +106082,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,HEALTHPLUS-Medicare Advantage, +106083,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,HEALTHPLUS-Medicare Advantage, +106084,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,HEALTHPLUS-Medicare Advantage, +106085,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,HEALTHPLUS-Medicare Advantage, +106086,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,HEALTHPLUS-Medicare Advantage, +106087,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,HEALTHPLUS-Medicare Advantage, +106088,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,HEALTHPLUS-Medicare Advantage, +106089,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,HEALTHPLUS-Medicare Advantage, +106090,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,HEALTHPLUS-Medicare Advantage, +106091,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,HEALTHPLUS-Medicare Advantage, +106092,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,HEALTHPLUS-Medicare Advantage, +106093,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,HEALTHPLUS-Medicare Advantage, +106094,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,HEALTHPLUS-Medicare Advantage, +106095,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,HEALTHPLUS-Medicare Advantage,558.72 +106096,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,HEALTHPLUS-Medicare Advantage, +106097,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,HEALTHPLUS-Medicare Advantage, +106098,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,HEALTHPLUS-Medicare Advantage, +106099,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,HEALTHPLUS-Medicare Advantage, +106100,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,HEALTHPLUS-Medicare Advantage, +106101,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,HEALTHPLUS-Medicare Advantage, +106102,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,HEALTHPLUS-Medicare Advantage, +106103,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,HEALTHPLUS-Medicare Advantage, +106104,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,HEALTHPLUS-Medicare Advantage, +106105,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,HEALTHPLUS-Medicare Advantage, +106106,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,HEALTHPLUS-Medicare Advantage, +106107,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,HEALTHPLUS-Medicare Advantage, +106108,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,HEALTHPLUS-Medicare Advantage, +106109,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,HEALTHPLUS-Medicare Advantage, +106110,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,HEALTHPLUS-Medicare Advantage, +106111,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,HEALTHPLUS-Medicare Advantage, +106112,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,HEALTHPLUS-Medicare Advantage, +106113,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,HEALTHPLUS-Medicare Advantage, +106114,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,HEALTHPLUS-Medicare Advantage, +106115,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,HEALTHPLUS-Medicare Advantage, +106116,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,HEALTHPLUS-Medicare Advantage, +106117,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,HEALTHPLUS-Medicare Advantage, +106118,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,HEALTHPLUS-Medicare Advantage, +106119,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,HEALTHPLUS-Medicare Advantage, +106120,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,HEALTHPLUS-Medicare Advantage, +106121,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,HEALTHPLUS-Medicare Advantage, +106122,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,HEALTHPLUS-Medicare Advantage, +106123,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,HEALTHPLUS-Medicare Advantage, +106124,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,HEALTHPLUS-Medicare Advantage, +106125,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,HEALTHPLUS-Medicare Advantage, +106126,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,HEALTHPLUS-Medicare Advantage, +106127,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,HEALTHPLUS-Medicare Advantage, +106128,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,HEALTHPLUS-Medicare Advantage, +106129,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,HEALTHPLUS-Medicare Advantage, +106130,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,HEALTHPLUS-Medicare Advantage, +106131,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,HEALTHPLUS-Medicare Advantage, +106132,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,HEALTHPLUS-Medicare Advantage, +106133,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,HEALTHPLUS-Medicare Advantage, +106134,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,HEALTHPLUS-Medicare Advantage, +106135,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,HEALTHPLUS-Medicare Advantage, +106136,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,HEALTHPLUS-Medicare Advantage, +106137,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,HEALTHPLUS-Medicare Advantage, +106138,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,HEALTHPLUS-Medicare Advantage, +106139,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,HEALTHPLUS-Medicare Advantage, +106140,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,HEALTHPLUS-Medicare Advantage, +106141,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,HEALTHPLUS-Medicare Advantage, +106142,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,HEALTHPLUS-Medicare Advantage, +106143,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,HEALTHPLUS-Medicare Advantage, +106144,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,HEALTHPLUS-Medicare Advantage, +106145,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,HEALTHPLUS-Medicare Advantage, +106146,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,HEALTHPLUS-Medicare Advantage, +106147,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,HEALTHPLUS-Medicare Advantage, +106148,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,HEALTHPLUS-Medicare Advantage, +106149,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,HEALTHPLUS-Medicare Advantage, +106150,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,HEALTHPLUS-Medicare Advantage, +106151,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,HEALTHPLUS-Medicare Advantage, +106152,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,HEALTHPLUS-Medicare Advantage, +106153,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,HEALTHPLUS-Medicare Advantage, +106154,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,HEALTHPLUS-Medicare Advantage, +106155,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,HEALTHPLUS-Medicare Advantage, +106156,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,HEALTHPLUS-Medicare Advantage, +106157,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,HEALTHPLUS-Medicare Advantage, +106158,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,HEALTHPLUS-Medicare Advantage, +106159,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,HEALTHPLUS-Medicare Advantage, +106160,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,HEALTHPLUS-Medicare Advantage,96.69 +106161,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,HEALTHPLUS-Medicare Advantage, +106162,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,HEALTHPLUS-Medicare Advantage, +106163,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,HEALTHPLUS-Medicare Advantage, +106164,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,HEALTHPLUS-Medicare Advantage, +106165,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,HEALTHPLUS-Medicare Advantage, +106166,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,HEALTHPLUS-Medicare Advantage, +106167,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,HEALTHPLUS-Medicare Advantage, +106168,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,HEALTHPLUS-Medicare Advantage, +106169,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,HEALTHPLUS-Medicare Advantage, +106170,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,HEALTHPLUS-Medicare Advantage, +106171,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,HEALTHPLUS-Medicare Advantage, +106172,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,HEALTHPLUS-Medicare Advantage, +106173,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,HEALTHPLUS-Medicare Advantage, +106174,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,HEALTHPLUS-Medicare Advantage, +106175,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,HEALTHPLUS-Medicare Advantage, +106176,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,HEALTHPLUS-Medicare Advantage, +106177,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,HEALTHPLUS-Medicare Advantage, +106178,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,HEALTHPLUS-Medicare Advantage, +106179,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,HEALTHPLUS-Medicare Advantage, +106180,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,HEALTHPLUS-Medicare Advantage, +106181,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,HEALTHPLUS-Medicare Advantage, +106182,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,HEALTHPLUS-Medicare Advantage, +106183,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,HEALTHPLUS-Medicare Advantage, +106184,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,HEALTHPLUS-Medicare Advantage, +106185,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,HEALTHPLUS-Medicare Advantage, +106186,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,HEALTHPLUS-Medicare Advantage, +106187,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Medicare Advantage, +106188,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,HEALTHPLUS-Medicare Advantage, +106189,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,HEALTHPLUS-Medicare Advantage, +106190,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,HEALTHPLUS-Medicare Advantage, +106191,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,HEALTHPLUS-Medicare Advantage, +106192,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,HEALTHPLUS-Medicare Advantage, +106193,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,HEALTHPLUS-Medicare Advantage, +106194,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,HEALTHPLUS-Medicare Advantage, +106195,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,HEALTHPLUS-Medicare Advantage, +106196,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,HEALTHPLUS-Medicare Advantage, +106197,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,HEALTHPLUS-Medicare Advantage, +106198,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,HEALTHPLUS-Medicare Advantage, +106199,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,HEALTHPLUS-Medicare Advantage, +106200,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,HEALTHPLUS-Medicare Advantage, +106201,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,HEALTHPLUS-Medicare Advantage, +106202,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,HEALTHPLUS-Medicare Advantage, +106203,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,HEALTHPLUS-Medicare Advantage, +106204,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,HEALTHPLUS-Medicare Advantage, +106205,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,HEALTHPLUS-Medicare Advantage, +106206,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,HEALTHPLUS-Medicare Advantage, +106207,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,HEALTHPLUS-Medicare Advantage, +106208,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,HEALTHPLUS-Medicare Advantage, +106209,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,HEALTHPLUS-Medicare Advantage,30.67 +106210,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,HEALTHPLUS-Medicare Advantage,115.23 +106211,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,HEALTHPLUS-Medicare Advantage, +106212,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,HEALTHPLUS-Medicare Advantage,121.8 +106213,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,HEALTHPLUS-Medicare Advantage, +106214,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,HEALTHPLUS-Medicare Advantage, +106215,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,HEALTHPLUS-Medicare Advantage, +106216,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,HEALTHPLUS-Medicare Advantage, +106217,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,HEALTHPLUS-Medicare Advantage, +106218,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,HEALTHPLUS-Medicare Advantage, +106219,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,HEALTHPLUS-Medicare Advantage, +106220,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,HEALTHPLUS-Medicare Advantage, +106221,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,HEALTHPLUS-Medicare Advantage, +106222,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,HEALTHPLUS-Medicare Advantage, +106223,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,HEALTHPLUS-Medicare Advantage, +106224,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,HEALTHPLUS-Medicare Advantage, +106225,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,HEALTHPLUS-Medicare Advantage, +106226,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,HEALTHPLUS-Medicare Advantage, +106227,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,HEALTHPLUS-Medicare Advantage, +106228,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Medicare Advantage, +106229,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,HEALTHPLUS-Medicare Advantage, +106230,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,HEALTHPLUS-Medicare Advantage, +106231,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,HEALTHPLUS-Medicare Advantage, +106232,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,HEALTHPLUS-Medicare Advantage, +106233,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,HEALTHPLUS-Medicare Advantage, +106234,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,HEALTHPLUS-Medicare Advantage, +106235,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,HEALTHPLUS-Medicare Advantage, +106236,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,HEALTHPLUS-Medicare Advantage, +106237,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,HEALTHPLUS-Medicare Advantage, +106238,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,HEALTHPLUS-Medicare Advantage, +106239,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,HEALTHPLUS-Medicare Advantage, +106240,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,HEALTHPLUS-Medicare Advantage, +106241,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,HEALTHPLUS-Medicare Advantage, +106242,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,HEALTHPLUS-Medicare Advantage, +106243,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,HEALTHPLUS-Medicare Advantage, +106244,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,HEALTHPLUS-Medicare Advantage, +106245,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,HEALTHPLUS-Medicare Advantage, +106246,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,HEALTHPLUS-Medicare Advantage, +106247,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,HEALTHPLUS-Medicare Advantage, +106248,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,HEALTHPLUS-Medicare Advantage, +106249,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,HEALTHPLUS-Medicare Advantage, +106250,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,HEALTHPLUS-Medicare Advantage, +106251,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,HEALTHPLUS-Medicare Advantage, +106252,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,HEALTHPLUS-Medicare Advantage, +106253,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,HEALTHPLUS-Medicare Advantage, +106254,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,HEALTHPLUS-Medicare Advantage, +106255,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,HEALTHPLUS-Medicare Advantage, +106256,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,HEALTHPLUS-Medicare Advantage, +106257,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,HEALTHPLUS-Medicare Advantage, +106258,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,HEALTHPLUS-Medicare Advantage, +106259,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,HEALTHPLUS-Medicare Advantage, +106260,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,HEALTHPLUS-Medicare Advantage, +106261,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,HEALTHPLUS-Medicare Advantage, +106262,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,HEALTHPLUS-Medicare Advantage, +106263,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,HEALTHPLUS-Medicare Advantage, +106264,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,HEALTHPLUS-Medicare Advantage, +106265,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,HEALTHPLUS-Medicare Advantage, +106266,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,HEALTHPLUS-Medicare Advantage, +106267,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,HEALTHPLUS-Medicare Advantage, +106268,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,HEALTHPLUS-Medicare Advantage, +106269,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,HEALTHPLUS-Medicare Advantage, +106270,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,HEALTHPLUS-Medicare Advantage, +106271,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,HEALTHPLUS-Medicare Advantage, +106272,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,HEALTHPLUS-Medicare Advantage, +106273,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,HEALTHPLUS-Medicare Advantage, +106274,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,HEALTHPLUS-Medicare Advantage, +106275,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,HEALTHPLUS-Medicare Advantage, +106276,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,HEALTHPLUS-Medicare Advantage, +106277,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,HEALTHPLUS-Medicare Advantage, +106278,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,HEALTHPLUS-Medicare Advantage, +106279,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,HEALTHPLUS-Medicare Advantage, +106280,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,HEALTHPLUS-Medicare Advantage, +106281,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,HEALTHPLUS-Medicare Advantage, +106282,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,HEALTHPLUS-Medicare Advantage, +106283,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,HEALTHPLUS-Medicare Advantage, +106284,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,HEALTHPLUS-Medicare Advantage, +106285,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,HEALTHPLUS-Medicare Advantage, +106286,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,HEALTHPLUS-Medicare Advantage, +106287,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,HEALTHPLUS-Medicare Advantage, +106288,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,HEALTHPLUS-Medicare Advantage, +106289,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,HEALTHPLUS-Medicare Advantage, +106290,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,HEALTHPLUS-Medicare Advantage, +106291,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,HEALTHPLUS-Medicare Advantage, +106292,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,HEALTHPLUS-Medicare Advantage,8.59 +106293,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,HEALTHPLUS-Medicare Advantage, +106294,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,HEALTHPLUS-Medicare Advantage,10.73 +106295,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +106296,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,HEALTHPLUS-Medicare Advantage,13.54 +106297,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,HEALTHPLUS-Medicare Advantage,8.68 +106298,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,HEALTHPLUS-Medicare Advantage, +106299,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,HEALTHPLUS-Medicare Advantage,8.27 +106300,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,HEALTHPLUS-Medicare Advantage, +106301,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,HEALTHPLUS-Medicare Advantage, +106302,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,HEALTHPLUS-Medicare Advantage, +106303,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,HEALTHPLUS-Medicare Advantage, +106304,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,HEALTHPLUS-Medicare Advantage, +106305,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,HEALTHPLUS-Medicare Advantage, +106306,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,HEALTHPLUS-Medicare Advantage, +106307,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,HEALTHPLUS-Medicare Advantage, +106308,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,HEALTHPLUS-Medicare Advantage, +106309,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,HEALTHPLUS-Medicare Advantage, +106310,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,HEALTHPLUS-Medicare Advantage, +106311,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,HEALTHPLUS-Medicare Advantage, +106312,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,HEALTHPLUS-Medicare Advantage, +106313,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,HEALTHPLUS-Medicare Advantage, +106314,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,HEALTHPLUS-Medicare Advantage, +106315,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,HEALTHPLUS-Medicare Advantage, +106316,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,HEALTHPLUS-Medicare Advantage, +106317,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,HEALTHPLUS-Medicare Advantage, +106318,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,HEALTHPLUS-Medicare Advantage, +106319,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,HEALTHPLUS-Medicare Advantage, +106320,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,HEALTHPLUS-Medicare Advantage, +106321,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,HEALTHPLUS-Medicare Advantage, +106322,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,HEALTHPLUS-Medicare Advantage, +106323,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,HEALTHPLUS-Medicare Advantage, +106324,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,HEALTHPLUS-Medicare Advantage, +106325,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,HEALTHPLUS-Medicare Advantage, +106326,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,HEALTHPLUS-Medicare Advantage, +106327,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,HEALTHPLUS-Medicare Advantage, +106328,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,HEALTHPLUS-Medicare Advantage, +106329,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,HEALTHPLUS-Medicare Advantage, +106330,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,HEALTHPLUS-Medicare Advantage, +106331,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,HEALTHPLUS-Medicare Advantage, +106332,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,HEALTHPLUS-Medicare Advantage, +106333,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,HEALTHPLUS-Medicare Advantage, +106334,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,HEALTHPLUS-Medicare Advantage, +106335,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,HEALTHPLUS-Medicare Advantage, +106336,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,HEALTHPLUS-Medicare Advantage, +106337,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,HEALTHPLUS-Medicare Advantage, +106338,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,HEALTHPLUS-Medicare Advantage, +106339,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,HEALTHPLUS-Medicare Advantage, +106340,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,HEALTHPLUS-Medicare Advantage, +106341,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,HEALTHPLUS-Medicare Advantage, +106342,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,HEALTHPLUS-Medicare Advantage, +106343,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,HEALTHPLUS-Medicare Advantage, +106344,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,HEALTHPLUS-Medicare Advantage, +106345,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,HEALTHPLUS-Medicare Advantage, +106346,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,HEALTHPLUS-Medicare Advantage, +106347,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,HEALTHPLUS-Medicare Advantage, +106348,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,HEALTHPLUS-Medicare Advantage,3.23 +106349,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +106350,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,HEALTHPLUS-Medicare Advantage, +106351,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,HEALTHPLUS-Medicare Advantage, +106352,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,HEALTHPLUS-Medicare Advantage, +106353,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,HEALTHPLUS-Medicare Advantage, +106354,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Medicare Advantage, +106355,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Medicare Advantage, +106356,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,HEALTHPLUS-Medicare Advantage, +106357,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-Medicare Advantage, +106358,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,HEALTHPLUS-Medicare Advantage, +106359,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,HEALTHPLUS-Medicare Advantage, +106360,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,HEALTHPLUS-Medicare Advantage, +106361,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,HEALTHPLUS-Medicare Advantage, +106362,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,HEALTHPLUS-Medicare Advantage, +106363,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,HEALTHPLUS-Medicare Advantage, +106364,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,HEALTHPLUS-Medicare Advantage, +106365,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,HEALTHPLUS-Medicare Advantage, +106366,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,HEALTHPLUS-Medicare Advantage, +106367,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,HEALTHPLUS-Medicare Advantage, +106368,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,HEALTHPLUS-Medicare Advantage, +106369,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,HEALTHPLUS-Medicare Advantage, +106370,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,HEALTHPLUS-Medicare Advantage, +106371,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,HEALTHPLUS-Medicare Advantage, +106372,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,HEALTHPLUS-Medicare Advantage, +106373,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,HEALTHPLUS-Medicare Advantage, +106374,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,HEALTHPLUS-Medicare Advantage, +106375,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,HEALTHPLUS-Medicare Advantage, +106376,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,HEALTHPLUS-Medicare Advantage, +106377,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,HEALTHPLUS-Medicare Advantage, +106378,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,HEALTHPLUS-Medicare Advantage, +106379,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,HEALTHPLUS-Medicare Advantage, +106380,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,HEALTHPLUS-Medicare Advantage, +106381,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,HEALTHPLUS-Medicare Advantage, +106382,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,HEALTHPLUS-Medicare Advantage, +106383,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,HEALTHPLUS-Medicare Advantage, +106384,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,HEALTHPLUS-Medicare Advantage, +106385,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,HEALTHPLUS-Medicare Advantage, +106386,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,HEALTHPLUS-Medicare Advantage, +106387,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,HEALTHPLUS-Medicare Advantage, +106388,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,HEALTHPLUS-Medicare Advantage, +106389,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,HEALTHPLUS-Medicare Advantage, +106390,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,HEALTHPLUS-Medicare Advantage, +106391,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,HEALTHPLUS-Medicare Advantage, +106392,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,HEALTHPLUS-Medicare Advantage, +106393,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,HEALTHPLUS-Medicare Advantage, +106394,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,HEALTHPLUS-Medicare Advantage, +106395,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,HEALTHPLUS-Medicare Advantage, +106396,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,HEALTHPLUS-Medicare Advantage, +106397,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,HEALTHPLUS-Medicare Advantage, +106398,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,HEALTHPLUS-Medicare Advantage, +106399,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,HEALTHPLUS-Medicare Advantage, +106400,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,HEALTHPLUS-Medicare Advantage, +106401,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,HEALTHPLUS-Medicare Advantage, +106402,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,HEALTHPLUS-Medicare Advantage, +106403,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,HEALTHPLUS-Medicare Advantage, +106404,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,HEALTHPLUS-Medicare Advantage, +106405,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,HEALTHPLUS-Medicare Advantage, +106406,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,HEALTHPLUS-Medicare Advantage, +106407,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,HEALTHPLUS-Medicare Advantage, +106408,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,HEALTHPLUS-Medicare Advantage, +106409,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,HEALTHPLUS-Medicare Advantage, +106410,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,HEALTHPLUS-Medicare Advantage, +106411,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,HEALTHPLUS-Medicare Advantage, +106412,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,HEALTHPLUS-Medicare Advantage, +106413,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,HEALTHPLUS-Medicare Advantage, +106414,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,HEALTHPLUS-Medicare Advantage, +106415,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,HEALTHPLUS-Medicare Advantage, +106416,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,HEALTHPLUS-Medicare Advantage, +106417,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,HEALTHPLUS-Medicare Advantage, +106418,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,HEALTHPLUS-Medicare Advantage, +106419,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,HEALTHPLUS-Medicare Advantage, +106420,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,HEALTHPLUS-Medicare Advantage, +106421,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,HEALTHPLUS-Medicare Advantage, +106422,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,HEALTHPLUS-Medicare Advantage, +106423,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,HEALTHPLUS-Medicare Advantage, +106424,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,HEALTHPLUS-Medicare Advantage, +106425,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,HEALTHPLUS-Medicare Advantage, +106426,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,HEALTHPLUS-Medicare Advantage, +106427,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,HEALTHPLUS-Medicare Advantage, +106428,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,HEALTHPLUS-Medicare Advantage, +106429,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,HEALTHPLUS-Medicare Advantage, +106430,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,HEALTHPLUS-Medicare Advantage, +106431,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,HEALTHPLUS-Medicare Advantage, +106432,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,HEALTHPLUS-Medicare Advantage, +106433,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,HEALTHPLUS-Medicare Advantage, +106434,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,HEALTHPLUS-Medicare Advantage, +106435,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,HEALTHPLUS-Medicare Advantage, +106436,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,HEALTHPLUS-Medicare Advantage, +106437,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,HEALTHPLUS-Medicare Advantage, +106438,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,HEALTHPLUS-Medicare Advantage, +106439,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,HEALTHPLUS-Medicare Advantage, +106440,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,HEALTHPLUS-Medicare Advantage, +106441,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,HEALTHPLUS-Medicare Advantage, +106442,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,HEALTHPLUS-Medicare Advantage, +106443,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,HEALTHPLUS-Medicare Advantage, +106444,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,HEALTHPLUS-Medicare Advantage, +106445,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,HEALTHPLUS-Medicare Advantage, +106446,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,HEALTHPLUS-Medicare Advantage, +106447,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,HEALTHPLUS-Medicare Advantage, +106448,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,HEALTHPLUS-Medicare Advantage, +106449,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,HEALTHPLUS-Medicare Advantage, +106450,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,HEALTHPLUS-Medicare Advantage, +106451,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,HEALTHPLUS-Medicare Advantage, +106452,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,HEALTHPLUS-Medicare Advantage, +106453,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,HEALTHPLUS-Medicare Advantage, +106454,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,HEALTHPLUS-Medicare Advantage, +106455,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,HEALTHPLUS-Medicare Advantage, +106456,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,HEALTHPLUS-Medicare Advantage, +106457,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,HEALTHPLUS-Medicare Advantage, +106458,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,HEALTHPLUS-Medicare Advantage, +106459,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,HEALTHPLUS-Medicare Advantage, +106460,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,HEALTHPLUS-Medicare Advantage, +106461,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,HEALTHPLUS-Medicare Advantage, +106462,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,HEALTHPLUS-Medicare Advantage, +106463,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,HEALTHPLUS-Medicare Advantage, +106464,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,HEALTHPLUS-Medicare Advantage,5.02 +106465,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,HEALTHPLUS-Medicare Advantage,5.02 +106466,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,HEALTHPLUS-Medicare Advantage, +106467,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,HEALTHPLUS-Medicare Advantage, +106468,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,HEALTHPLUS-Medicare Advantage, +106469,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,HEALTHPLUS-Medicare Advantage, +106470,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,HEALTHPLUS-Medicare Advantage, +106471,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,HEALTHPLUS-Medicare Advantage, +106472,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,HEALTHPLUS-Medicare Advantage, +106473,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,HEALTHPLUS-Medicare Advantage, +106474,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,HEALTHPLUS-Medicare Advantage, +106475,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,HEALTHPLUS-Medicare Advantage, +106476,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,HEALTHPLUS-Medicare Advantage, +106477,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,HEALTHPLUS-Medicare Advantage, +106478,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,HEALTHPLUS-Medicare Advantage, +106479,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,HEALTHPLUS-Medicare Advantage, +106480,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,HEALTHPLUS-Medicare Advantage, +106481,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,HEALTHPLUS-Medicare Advantage, +106482,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,HEALTHPLUS-Medicare Advantage, +106483,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,HEALTHPLUS-Medicare Advantage, +106484,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,HEALTHPLUS-Medicare Advantage, +106485,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,HEALTHPLUS-Medicare Advantage, +106486,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,HEALTHPLUS-Medicare Advantage, +106487,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,HEALTHPLUS-Medicare Advantage, +106488,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,HEALTHPLUS-Medicare Advantage, +106489,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,HEALTHPLUS-Medicare Advantage, +106490,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,HEALTHPLUS-Medicare Advantage, +106491,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,HEALTHPLUS-Medicare Advantage, +106492,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,HEALTHPLUS-Medicare Advantage, +106493,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,HEALTHPLUS-Medicare Advantage, +106494,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,HEALTHPLUS-Medicare Advantage,6.63 +106495,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,HEALTHPLUS-Medicare Advantage, +106496,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,HEALTHPLUS-Medicare Advantage, +106497,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,HEALTHPLUS-Medicare Advantage, +106498,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,HEALTHPLUS-Medicare Advantage, +106499,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,HEALTHPLUS-Medicare Advantage, +106500,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,HEALTHPLUS-Medicare Advantage, +106501,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,HEALTHPLUS-Medicare Advantage, +106502,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,HEALTHPLUS-Medicare Advantage, +106503,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,HEALTHPLUS-Medicare Advantage, +106504,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,HEALTHPLUS-Medicare Advantage, +106505,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,HEALTHPLUS-Medicare Advantage, +106506,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,HEALTHPLUS-Medicare Advantage, +106507,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,HEALTHPLUS-Medicare Advantage, +106508,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,HEALTHPLUS-Medicare Advantage, +106509,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,HEALTHPLUS-Medicare Advantage, +106510,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,HEALTHPLUS-Medicare Advantage, +106511,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,HEALTHPLUS-Medicare Advantage, +106512,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,HEALTHPLUS-Medicare Advantage, +106513,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,HEALTHPLUS-Medicare Advantage, +106514,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,HEALTHPLUS-Medicare Advantage, +106515,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,HEALTHPLUS-Medicare Advantage, +106516,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,HEALTHPLUS-Medicare Advantage, +106517,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,HEALTHPLUS-Medicare Advantage, +106518,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,HEALTHPLUS-Medicare Advantage, +106519,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,HEALTHPLUS-Medicare Advantage, +106520,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,HEALTHPLUS-Medicare Advantage, +106521,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,HEALTHPLUS-Medicare Advantage, +106522,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,HEALTHPLUS-Medicare Advantage, +106523,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,HEALTHPLUS-Medicare Advantage, +106524,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,HEALTHPLUS-Medicare Advantage, +106525,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,HEALTHPLUS-Medicare Advantage, +106526,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,HEALTHPLUS-Medicare Advantage, +106527,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,HEALTHPLUS-Medicare Advantage, +106528,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,HEALTHPLUS-Medicare Advantage, +106529,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,HEALTHPLUS-Medicare Advantage, +106530,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,HEALTHPLUS-Medicare Advantage, +106531,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,HEALTHPLUS-Medicare Advantage, +106532,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,HEALTHPLUS-Medicare Advantage, +106533,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,HEALTHPLUS-Medicare Advantage, +106534,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,HEALTHPLUS-Medicare Advantage, +106535,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,HEALTHPLUS-Medicare Advantage, +106536,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,HEALTHPLUS-Medicare Advantage, +106537,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,HEALTHPLUS-Medicare Advantage, +106538,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,HEALTHPLUS-Medicare Advantage, +106539,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,HEALTHPLUS-Medicare Advantage, +106540,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,HEALTHPLUS-Medicare Advantage, +106541,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,HEALTHPLUS-Medicare Advantage, +106542,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,HEALTHPLUS-Medicare Advantage, +106543,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,HEALTHPLUS-Medicare Advantage, +106544,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,HEALTHPLUS-Medicare Advantage, +106545,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,HEALTHPLUS-Medicare Advantage, +106546,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,HEALTHPLUS-Medicare Advantage, +106547,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,HEALTHPLUS-Medicare Advantage, +106548,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,HEALTHPLUS-Medicare Advantage, +106549,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,HEALTHPLUS-Medicare Advantage,10.07 +106550,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,HEALTHPLUS-Medicare Advantage, +106551,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,HEALTHPLUS-Medicare Advantage, +106552,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,HEALTHPLUS-Medicare Advantage, +106553,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,HEALTHPLUS-Medicare Advantage, +106554,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,HEALTHPLUS-Medicare Advantage, +106555,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,HEALTHPLUS-Medicare Advantage, +106556,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,HEALTHPLUS-Medicare Advantage, +106557,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,HEALTHPLUS-Medicare Advantage, +106558,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,HEALTHPLUS-Medicare Advantage, +106559,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,HEALTHPLUS-Medicare Advantage, +106560,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,HEALTHPLUS-Medicare Advantage, +106561,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,HEALTHPLUS-Medicare Advantage, +106562,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,HEALTHPLUS-Medicare Advantage, +106563,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,HEALTHPLUS-Medicare Advantage,6.04 +106564,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,HEALTHPLUS-Medicare Advantage, +106565,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,HEALTHPLUS-Medicare Advantage, +106566,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,HEALTHPLUS-Medicare Advantage, +106567,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,HEALTHPLUS-Medicare Advantage, +106568,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,HEALTHPLUS-Medicare Advantage, +106569,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,HEALTHPLUS-Medicare Advantage, +106570,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,HEALTHPLUS-Medicare Advantage, +106571,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,HEALTHPLUS-Medicare Advantage, +106572,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,HEALTHPLUS-Medicare Advantage,6.85 +106573,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,HEALTHPLUS-Medicare Advantage, +106574,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,HEALTHPLUS-Medicare Advantage, +106575,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,HEALTHPLUS-Medicare Advantage, +106576,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,HEALTHPLUS-Medicare Advantage, +106577,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,HEALTHPLUS-Medicare Advantage, +106578,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,HEALTHPLUS-Medicare Advantage, +106579,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,HEALTHPLUS-Medicare Advantage, +106580,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,HEALTHPLUS-Medicare Advantage, +106581,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,HEALTHPLUS-Medicare Advantage,39.26 +106582,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,HEALTHPLUS-Medicare Advantage, +106583,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,HEALTHPLUS-Medicare Advantage, +106584,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,HEALTHPLUS-Medicare Advantage, +106585,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,HEALTHPLUS-Medicare Advantage, +106586,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,HEALTHPLUS-Medicare Advantage, +106587,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,HEALTHPLUS-Medicare Advantage, +106588,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,HEALTHPLUS-Medicare Advantage, +106589,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,HEALTHPLUS-Medicare Advantage, +106590,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,HEALTHPLUS-Medicare Advantage, +106591,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,HEALTHPLUS-Medicare Advantage, +106592,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,HEALTHPLUS-Medicare Advantage, +106593,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,HEALTHPLUS-Medicare Advantage, +106594,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,HEALTHPLUS-Medicare Advantage, +106595,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,HEALTHPLUS-Medicare Advantage,5.18 +106596,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,HEALTHPLUS-Medicare Advantage, +106597,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,HEALTHPLUS-Medicare Advantage,5.01 +106598,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,HEALTHPLUS-Medicare Advantage, +106599,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,HEALTHPLUS-Medicare Advantage, +106600,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,HEALTHPLUS-Medicare Advantage, +106601,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,HEALTHPLUS-Medicare Advantage, +106602,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,HEALTHPLUS-Medicare Advantage, +106603,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,HEALTHPLUS-Medicare Advantage, +106604,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,HEALTHPLUS-Medicare Advantage, +106605,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,HEALTHPLUS-Medicare Advantage, +106606,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,HEALTHPLUS-Medicare Advantage, +106607,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,HEALTHPLUS-Medicare Advantage, +106608,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,HEALTHPLUS-Medicare Advantage, +106609,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,HEALTHPLUS-Medicare Advantage, +106610,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,HEALTHPLUS-Medicare Advantage, +106611,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,HEALTHPLUS-Medicare Advantage, +106612,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,HEALTHPLUS-Medicare Advantage,3.67 +106613,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,HEALTHPLUS-Medicare Advantage, +106614,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,HEALTHPLUS-Medicare Advantage, +106615,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,HEALTHPLUS-Medicare Advantage, +106616,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,HEALTHPLUS-Medicare Advantage, +106617,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,HEALTHPLUS-Medicare Advantage, +106618,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,HEALTHPLUS-Medicare Advantage, +106619,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,HEALTHPLUS-Medicare Advantage, +106620,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,HEALTHPLUS-Medicare Advantage, +106621,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,HEALTHPLUS-Medicare Advantage, +106622,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,HEALTHPLUS-Medicare Advantage, +106623,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,HEALTHPLUS-Medicare Advantage, +106624,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,HEALTHPLUS-Medicare Advantage, +106625,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,HEALTHPLUS-Medicare Advantage, +106626,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,HEALTHPLUS-Medicare Advantage, +106627,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,HEALTHPLUS-Medicare Advantage,5.0 +106628,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,HEALTHPLUS-Medicare Advantage, +106629,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,HEALTHPLUS-Medicare Advantage, +106630,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,HEALTHPLUS-Medicare Advantage, +106631,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,HEALTHPLUS-Medicare Advantage, +106632,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,HEALTHPLUS-Medicare Advantage, +106633,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,HEALTHPLUS-Medicare Advantage, +106634,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,HEALTHPLUS-Medicare Advantage, +106635,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,HEALTHPLUS-Medicare Advantage, +106636,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,HEALTHPLUS-Medicare Advantage, +106637,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,HEALTHPLUS-Medicare Advantage,6.0 +106638,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,HEALTHPLUS-Medicare Advantage,6.0 +106639,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,HEALTHPLUS-Medicare Advantage, +106640,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,HEALTHPLUS-Medicare Advantage, +106641,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,HEALTHPLUS-Medicare Advantage, +106642,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,HEALTHPLUS-Medicare Advantage, +106643,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,HEALTHPLUS-Medicare Advantage, +106644,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,HEALTHPLUS-Medicare Advantage,16.8 +106645,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,HEALTHPLUS-Medicare Advantage, +106646,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,HEALTHPLUS-Medicare Advantage, +106647,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,HEALTHPLUS-Medicare Advantage,5.18 +106648,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,HEALTHPLUS-Medicare Advantage,5.3 +106649,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,HEALTHPLUS-Medicare Advantage, +106650,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,HEALTHPLUS-Medicare Advantage, +106651,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,HEALTHPLUS-Medicare Advantage, +106652,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,HEALTHPLUS-Medicare Advantage, +106653,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,HEALTHPLUS-Medicare Advantage, +106654,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,HEALTHPLUS-Medicare Advantage, +106655,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,HEALTHPLUS-Medicare Advantage, +106656,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,HEALTHPLUS-Medicare Advantage, +106657,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,HEALTHPLUS-Medicare Advantage, +106658,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,HEALTHPLUS-Medicare Advantage, +106659,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,HEALTHPLUS-Medicare Advantage,4.62 +106660,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,HEALTHPLUS-Medicare Advantage, +106661,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,HEALTHPLUS-Medicare Advantage, +106662,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,HEALTHPLUS-Medicare Advantage, +106663,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,HEALTHPLUS-Medicare Advantage, +106664,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,HEALTHPLUS-Medicare Advantage, +106665,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,HEALTHPLUS-Medicare Advantage, +106666,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,HEALTHPLUS-Medicare Advantage, +106667,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,HEALTHPLUS-Medicare Advantage, +106668,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,HEALTHPLUS-Medicare Advantage, +106669,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,HEALTHPLUS-Medicare Advantage, +106670,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,HEALTHPLUS-Medicare Advantage, +106671,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,HEALTHPLUS-Medicare Advantage, +106672,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,HEALTHPLUS-Medicare Advantage, +106673,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,HEALTHPLUS-Medicare Advantage, +106674,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,HEALTHPLUS-Medicare Advantage, +106675,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,HEALTHPLUS-Medicare Advantage, +106676,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,HEALTHPLUS-Medicare Advantage,7.84 +106677,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,HEALTHPLUS-Medicare Advantage,6.65 +106678,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,HEALTHPLUS-Medicare Advantage, +106679,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,HEALTHPLUS-Medicare Advantage, +106680,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,HEALTHPLUS-Medicare Advantage, +106681,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,HEALTHPLUS-Medicare Advantage, +106682,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,HEALTHPLUS-Medicare Advantage, +106683,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,HEALTHPLUS-Medicare Advantage, +106684,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,HEALTHPLUS-Medicare Advantage, +106685,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,HEALTHPLUS-Medicare Advantage, +106686,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,HEALTHPLUS-Medicare Advantage, +106687,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,HEALTHPLUS-Medicare Advantage, +106688,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,HEALTHPLUS-Medicare Advantage, +106689,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,HEALTHPLUS-Medicare Advantage, +106690,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,HEALTHPLUS-Medicare Advantage, +106691,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,HEALTHPLUS-Medicare Advantage, +106692,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,HEALTHPLUS-Medicare Advantage, +106693,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,HEALTHPLUS-Medicare Advantage, +106694,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,HEALTHPLUS-Medicare Advantage, +106695,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,HEALTHPLUS-Medicare Advantage, +106696,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,HEALTHPLUS-Medicare Advantage, +106697,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,HEALTHPLUS-Medicare Advantage, +106698,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,HEALTHPLUS-Medicare Advantage, +106699,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,HEALTHPLUS-Medicare Advantage, +106700,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,HEALTHPLUS-Medicare Advantage, +106701,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,HEALTHPLUS-Medicare Advantage, +106702,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,HEALTHPLUS-Medicare Advantage, +106703,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,HEALTHPLUS-Medicare Advantage, +106704,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,HEALTHPLUS-Medicare Advantage, +106705,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,HEALTHPLUS-Medicare Advantage, +106706,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,HEALTHPLUS-Medicare Advantage, +106707,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,HEALTHPLUS-Medicare Advantage, +106708,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,HEALTHPLUS-Medicare Advantage, +106709,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,HEALTHPLUS-Medicare Advantage, +106710,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,HEALTHPLUS-Medicare Advantage, +106711,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,HEALTHPLUS-Medicare Advantage, +106712,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,HEALTHPLUS-Medicare Advantage, +106713,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,HEALTHPLUS-Medicare Advantage, +106714,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,HEALTHPLUS-Medicare Advantage, +106715,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,HEALTHPLUS-Medicare Advantage, +106716,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,HEALTHPLUS-Medicare Advantage,2.75 +106717,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,HEALTHPLUS-Medicare Advantage, +106718,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,HEALTHPLUS-Medicare Advantage, +106719,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,HEALTHPLUS-Medicare Advantage, +106720,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,HEALTHPLUS-Medicare Advantage, +106721,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,HEALTHPLUS-Medicare Advantage, +106722,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,HEALTHPLUS-Medicare Advantage, +106723,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,HEALTHPLUS-Medicare Advantage, +106724,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,HEALTHPLUS-Medicare Advantage, +106725,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,HEALTHPLUS-Medicare Advantage, +106726,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,HEALTHPLUS-Medicare Advantage, +106727,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,HEALTHPLUS-Medicare Advantage, +106728,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,HEALTHPLUS-Medicare Advantage, +106729,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,HEALTHPLUS-Medicare Advantage, +106730,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,HEALTHPLUS-Medicare Advantage, +106731,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,HEALTHPLUS-Medicare Advantage, +106732,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,HEALTHPLUS-Medicare Advantage, +106733,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,HEALTHPLUS-Medicare Advantage, +106734,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,HEALTHPLUS-Medicare Advantage, +106735,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,HEALTHPLUS-Medicare Advantage, +106736,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,HEALTHPLUS-Medicare Advantage, +106737,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,HEALTHPLUS-Medicare Advantage, +106738,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,HEALTHPLUS-Medicare Advantage, +106739,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,HEALTHPLUS-Medicare Advantage, +106740,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,HEALTHPLUS-Medicare Advantage, +106741,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,HEALTHPLUS-Medicare Advantage,13.19 +106742,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,HEALTHPLUS-Medicare Advantage, +106743,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,HEALTHPLUS-Medicare Advantage, +106744,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,HEALTHPLUS-Medicare Advantage, +106745,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,HEALTHPLUS-Medicare Advantage, +106746,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,HEALTHPLUS-Medicare Advantage, +106747,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,HEALTHPLUS-Medicare Advantage, +106748,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,HEALTHPLUS-Medicare Advantage, +106749,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,HEALTHPLUS-Medicare Advantage, +106750,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,HEALTHPLUS-Medicare Advantage, +106751,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,HEALTHPLUS-Medicare Advantage, +106752,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,HEALTHPLUS-Medicare Advantage, +106753,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,HEALTHPLUS-Medicare Advantage, +106754,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,HEALTHPLUS-Medicare Advantage, +106755,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,HEALTHPLUS-Medicare Advantage, +106756,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,HEALTHPLUS-Medicare Advantage, +106757,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,HEALTHPLUS-Medicare Advantage, +106758,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,HEALTHPLUS-Medicare Advantage, +106759,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,HEALTHPLUS-Medicare Advantage, +106760,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,HEALTHPLUS-Medicare Advantage, +106761,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,HEALTHPLUS-Medicare Advantage, +106762,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,HEALTHPLUS-Medicare Advantage, +106763,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,HEALTHPLUS-Medicare Advantage, +106764,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,HEALTHPLUS-Medicare Advantage, +106765,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,HEALTHPLUS-Medicare Advantage, +106766,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,HEALTHPLUS-Medicare Advantage, +106767,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,HEALTHPLUS-Medicare Advantage, +106768,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,HEALTHPLUS-Medicare Advantage, +106769,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,HEALTHPLUS-Medicare Advantage, +106770,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,HEALTHPLUS-Medicare Advantage, +106771,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,HEALTHPLUS-Medicare Advantage,5.78 +106772,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,HEALTHPLUS-Medicare Advantage, +106773,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,HEALTHPLUS-Medicare Advantage, +106774,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,HEALTHPLUS-Medicare Advantage, +106775,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,HEALTHPLUS-Medicare Advantage, +106776,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,HEALTHPLUS-Medicare Advantage, +106777,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,HEALTHPLUS-Medicare Advantage, +106778,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,HEALTHPLUS-Medicare Advantage, +106779,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,HEALTHPLUS-Medicare Advantage, +106780,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,HEALTHPLUS-Medicare Advantage, +106781,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,HEALTHPLUS-Medicare Advantage, +106782,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,HEALTHPLUS-Medicare Advantage, +106783,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,HEALTHPLUS-Medicare Advantage, +106784,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,HEALTHPLUS-Medicare Advantage, +106785,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,HEALTHPLUS-Medicare Advantage, +106786,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,HEALTHPLUS-Medicare Advantage, +106787,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,HEALTHPLUS-Medicare Advantage, +106788,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,HEALTHPLUS-Medicare Advantage, +106789,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,HEALTHPLUS-Medicare Advantage, +106790,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,HEALTHPLUS-Medicare Advantage, +106791,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,HEALTHPLUS-Medicare Advantage, +106792,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,HEALTHPLUS-Medicare Advantage, +106793,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,HEALTHPLUS-Medicare Advantage, +106794,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,HEALTHPLUS-Medicare Advantage, +106795,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,HEALTHPLUS-Medicare Advantage, +106796,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,HEALTHPLUS-Medicare Advantage, +106797,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,HEALTHPLUS-Medicare Advantage, +106798,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,HEALTHPLUS-Medicare Advantage, +106799,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,HEALTHPLUS-Medicare Advantage, +106800,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,HEALTHPLUS-Medicare Advantage, +106801,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,HEALTHPLUS-Medicare Advantage, +106802,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,HEALTHPLUS-Medicare Advantage, +106803,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,HEALTHPLUS-Medicare Advantage, +106804,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,HEALTHPLUS-Medicare Advantage, +106805,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,HEALTHPLUS-Medicare Advantage, +106806,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,HEALTHPLUS-Medicare Advantage, +106807,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,HEALTHPLUS-Medicare Advantage, +106808,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,HEALTHPLUS-Medicare Advantage, +106809,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,HEALTHPLUS-Medicare Advantage, +106810,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,HEALTHPLUS-Medicare Advantage, +106811,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,HEALTHPLUS-Medicare Advantage, +106812,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,HEALTHPLUS-Medicare Advantage, +106813,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,HEALTHPLUS-Medicare Advantage, +106814,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,HEALTHPLUS-Medicare Advantage, +106815,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,HEALTHPLUS-Medicare Advantage, +106816,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,HEALTHPLUS-Medicare Advantage, +106817,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,HEALTHPLUS-Medicare Advantage, +106818,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,HEALTHPLUS-Medicare Advantage, +106819,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,HEALTHPLUS-Medicare Advantage, +106820,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,HEALTHPLUS-Medicare Advantage, +106821,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,HEALTHPLUS-Medicare Advantage, +106822,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,HEALTHPLUS-Medicare Advantage, +106823,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,HEALTHPLUS-Medicare Advantage, +106824,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,HEALTHPLUS-Medicare Advantage, +106825,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,HEALTHPLUS-Medicare Advantage, +106826,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,HEALTHPLUS-Medicare Advantage, +106827,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,HEALTHPLUS-Medicare Advantage, +106828,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,HEALTHPLUS-Medicare Advantage, +106829,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,HEALTHPLUS-Medicare Advantage, +106830,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,HEALTHPLUS-Medicare Advantage, +106831,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,HEALTHPLUS-Medicare Advantage, +106832,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,HEALTHPLUS-Medicare Advantage, +106833,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,HEALTHPLUS-Medicare Advantage, +106834,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,HEALTHPLUS-Medicare Advantage, +106835,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,HEALTHPLUS-Medicare Advantage, +106836,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,HEALTHPLUS-Medicare Advantage, +106837,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,HEALTHPLUS-Medicare Advantage, +106838,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,HEALTHPLUS-Medicare Advantage,153.8 +106839,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,HEALTHPLUS-Medicare Advantage, +106840,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,HEALTHPLUS-Medicare Advantage, +106841,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,HEALTHPLUS-Medicare Advantage, +106842,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,HEALTHPLUS-Medicare Advantage, +106843,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,HEALTHPLUS-Medicare Advantage, +106844,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,HEALTHPLUS-Medicare Advantage,129.98 +106845,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,HEALTHPLUS-Medicare Advantage, +106846,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,HEALTHPLUS-Medicare Advantage, +106847,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,HEALTHPLUS-Medicare Advantage, +106848,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,HEALTHPLUS-Medicare Advantage, +106849,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,HEALTHPLUS-Medicare Advantage, +106850,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,HEALTHPLUS-Medicare Advantage,250.7 +106851,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,HEALTHPLUS-Medicare Advantage, +106852,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,HEALTHPLUS-Medicare Advantage, +106853,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,HEALTHPLUS-Medicare Advantage, +106854,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,HEALTHPLUS-Medicare Advantage, +106855,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,HEALTHPLUS-Medicare Advantage, +106856,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,HEALTHPLUS-Medicare Advantage, +106857,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,HEALTHPLUS-Medicare Advantage,8.08 +106858,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,HEALTHPLUS-Medicare Advantage, +106859,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,HEALTHPLUS-Medicare Advantage,8.07 +106860,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,HEALTHPLUS-Medicare Advantage, +106861,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,HEALTHPLUS-Medicare Advantage, +106862,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,HEALTHPLUS-Medicare Advantage, +106863,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,HEALTHPLUS-Medicare Advantage, +106864,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,HEALTHPLUS-Medicare Advantage, +106865,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,HEALTHPLUS-Medicare Advantage, +106866,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,HEALTHPLUS-Medicare Advantage, +106867,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,HEALTHPLUS-Medicare Advantage, +106868,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,HEALTHPLUS-Medicare Advantage, +106869,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,HEALTHPLUS-Medicare Advantage, +106870,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,HEALTHPLUS-Medicare Advantage, +106871,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,HEALTHPLUS-Medicare Advantage, +106872,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,HEALTHPLUS-Medicare Advantage, +106873,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,HEALTHPLUS-Medicare Advantage, +106874,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,HEALTHPLUS-Medicare Advantage, +106875,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,HEALTHPLUS-Medicare Advantage, +106876,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,HEALTHPLUS-Medicare Advantage, +106877,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,HEALTHPLUS-Medicare Advantage, +106878,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,HEALTHPLUS-Medicare Advantage,7.48 +106879,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,HEALTHPLUS-Medicare Advantage, +106880,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,HEALTHPLUS-Medicare Advantage, +106881,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,HEALTHPLUS-Medicare Advantage, +106882,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,HEALTHPLUS-Medicare Advantage, +106883,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,HEALTHPLUS-Medicare Advantage, +106884,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,HEALTHPLUS-Medicare Advantage, +106885,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,HEALTHPLUS-Medicare Advantage, +106886,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,HEALTHPLUS-Medicare Advantage, +106887,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,HEALTHPLUS-Medicare Advantage, +106888,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,HEALTHPLUS-Medicare Advantage, +106889,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,HEALTHPLUS-Medicare Advantage, +106890,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,HEALTHPLUS-Medicare Advantage, +106891,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,HEALTHPLUS-Medicare Advantage, +106892,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,HEALTHPLUS-Medicare Advantage, +106893,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,HEALTHPLUS-Medicare Advantage, +106894,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,HEALTHPLUS-Medicare Advantage, +106895,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,HEALTHPLUS-Medicare Advantage, +106896,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,HEALTHPLUS-Medicare Advantage, +106897,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,HEALTHPLUS-Medicare Advantage, +106898,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,HEALTHPLUS-Medicare Advantage, +106899,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,HEALTHPLUS-Medicare Advantage, +106900,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,HEALTHPLUS-Medicare Advantage, +106901,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,HEALTHPLUS-Medicare Advantage, +106902,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,HEALTHPLUS-Medicare Advantage, +106903,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,HEALTHPLUS-Medicare Advantage, +106904,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,HEALTHPLUS-Medicare Advantage, +106905,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,HEALTHPLUS-Medicare Advantage, +106906,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,HEALTHPLUS-Medicare Advantage, +106907,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Medicare Advantage, +106908,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,HEALTHPLUS-Medicare Advantage, +106909,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,HEALTHPLUS-Medicare Advantage, +106910,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,HEALTHPLUS-Medicare Advantage, +106911,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,HEALTHPLUS-Medicare Advantage, +106912,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,HEALTHPLUS-Medicare Advantage, +106913,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,HEALTHPLUS-Medicare Advantage, +106914,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,HEALTHPLUS-Medicare Advantage, +106915,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,HEALTHPLUS-Medicare Advantage, +106916,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,HEALTHPLUS-Medicare Advantage, +106917,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,HEALTHPLUS-Medicare Advantage, +106918,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Medicare Advantage, +106919,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,HEALTHPLUS-Medicare Advantage, +106920,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,HEALTHPLUS-Medicare Advantage, +106921,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,HEALTHPLUS-Medicare Advantage, +106922,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,HEALTHPLUS-Medicare Advantage, +106923,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,HEALTHPLUS-Medicare Advantage, +106924,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,HEALTHPLUS-Medicare Advantage, +106925,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,HEALTHPLUS-Medicare Advantage, +106926,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,HEALTHPLUS-Medicare Advantage, +106927,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,HEALTHPLUS-Medicare Advantage, +106928,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,HEALTHPLUS-Medicare Advantage, +106929,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,HEALTHPLUS-Medicare Advantage, +106930,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,HEALTHPLUS-Medicare Advantage, +106931,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,HEALTHPLUS-Medicare Advantage, +106932,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,HEALTHPLUS-Medicare Advantage, +106933,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,HEALTHPLUS-Medicare Advantage, +106934,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,HEALTHPLUS-Medicare Advantage, +106935,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,HEALTHPLUS-Medicare Advantage, +106936,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,HEALTHPLUS-Medicare Advantage, +106937,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,HEALTHPLUS-Medicare Advantage, +106938,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,HEALTHPLUS-Medicare Advantage, +106939,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,HEALTHPLUS-Medicare Advantage, +106940,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,HEALTHPLUS-Medicare Advantage, +106941,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,HEALTHPLUS-Medicare Advantage, +106942,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,HEALTHPLUS-Medicare Advantage, +106943,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,HEALTHPLUS-Medicare Advantage, +106944,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,HEALTHPLUS-Medicare Advantage, +106945,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,HEALTHPLUS-Medicare Advantage, +106946,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,HEALTHPLUS-Medicare Advantage, +106947,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,HEALTHPLUS-Medicare Advantage, +106948,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,HEALTHPLUS-Medicare Advantage, +106949,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,HEALTHPLUS-Medicare Advantage, +106950,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,HEALTHPLUS-Medicare Advantage, +106951,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,HEALTHPLUS-Medicare Advantage, +106952,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,HEALTHPLUS-Medicare Advantage, +106953,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,HEALTHPLUS-Medicare Advantage, +106954,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,HEALTHPLUS-Medicare Advantage, +106955,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,HEALTHPLUS-Medicare Advantage, +106956,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,HEALTHPLUS-Medicare Advantage, +106957,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,HEALTHPLUS-Medicare Advantage, +106958,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,HEALTHPLUS-Medicare Advantage, +106959,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,HEALTHPLUS-Medicare Advantage, +106960,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,HEALTHPLUS-Medicare Advantage, +106961,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,HEALTHPLUS-Medicare Advantage, +106962,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,HEALTHPLUS-Medicare Advantage, +106963,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,HEALTHPLUS-Medicare Advantage, +106964,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,HEALTHPLUS-Medicare Advantage, +106965,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,HEALTHPLUS-Medicare Advantage, +106966,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,HEALTHPLUS-Medicare Advantage, +106967,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,HEALTHPLUS-Medicare Advantage, +106968,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,HEALTHPLUS-Medicare Advantage, +106969,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,HEALTHPLUS-Medicare Advantage, +106970,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,HEALTHPLUS-Medicare Advantage, +106971,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,HEALTHPLUS-Medicare Advantage, +106972,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,HEALTHPLUS-Medicare Advantage, +106973,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,HEALTHPLUS-Medicare Advantage, +106974,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,HEALTHPLUS-Medicare Advantage, +106975,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,HEALTHPLUS-Medicare Advantage, +106976,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,HEALTHPLUS-Medicare Advantage, +106977,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,HEALTHPLUS-Medicare Advantage, +106978,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,HEALTHPLUS-Medicare Advantage, +106979,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,HEALTHPLUS-Medicare Advantage, +106980,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,HEALTHPLUS-Medicare Advantage,5856.42 +106981,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,HEALTHPLUS-Medicare Advantage, +106982,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,HEALTHPLUS-Medicare Advantage, +106983,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,HEALTHPLUS-Medicare Advantage, +106984,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,HEALTHPLUS-Medicare Advantage, +106985,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,HEALTHPLUS-Medicare Advantage, +106986,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,HEALTHPLUS-Medicare Advantage, +106987,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,HEALTHPLUS-Medicare Advantage, +106988,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,HEALTHPLUS-Medicare Advantage, +106989,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,HEALTHPLUS-Medicare Advantage, +106990,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,HEALTHPLUS-Medicare Advantage, +106991,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,HEALTHPLUS-Medicare Advantage, +106992,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,HEALTHPLUS-Medicare Advantage, +106993,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,HEALTHPLUS-Medicare Advantage, +106994,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,HEALTHPLUS-Medicare Advantage, +106995,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,HEALTHPLUS-Medicare Advantage, +106996,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,HEALTHPLUS-Medicare Advantage, +106997,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,HEALTHPLUS-Medicare Advantage, +106998,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,HEALTHPLUS-Medicare Advantage, +106999,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,HEALTHPLUS-Medicare Advantage, +107000,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,HEALTHPLUS-Medicare Advantage, +107001,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,HEALTHPLUS-Medicare Advantage, +107002,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,HEALTHPLUS-Medicare Advantage, +107003,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,HEALTHPLUS-Medicare Advantage, +107004,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,HEALTHPLUS-Medicare Advantage, +107005,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,HEALTHPLUS-Medicare Advantage, +107006,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,HEALTHPLUS-Medicare Advantage, +107007,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,HEALTHPLUS-Medicare Advantage, +107008,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,HEALTHPLUS-Medicare Advantage, +107009,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,HEALTHPLUS-Medicare Advantage, +107010,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,HEALTHPLUS-Medicare Advantage, +107011,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,HEALTHPLUS-Medicare Advantage, +107012,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,HEALTHPLUS-Medicare Advantage, +107013,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,HEALTHPLUS-Medicare Advantage, +107014,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,HEALTHPLUS-Medicare Advantage, +107015,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,HEALTHPLUS-Medicare Advantage, +107016,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,HEALTHPLUS-Medicare Advantage, +107017,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,HEALTHPLUS-Medicare Advantage, +107018,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,HEALTHPLUS-Medicare Advantage, +107019,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,HEALTHPLUS-Medicare Advantage, +107020,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,HEALTHPLUS-Medicare Advantage, +107021,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,HEALTHPLUS-Medicare Advantage, +107022,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,HEALTHPLUS-Medicare Advantage, +107023,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,HEALTHPLUS-Medicare Advantage, +107024,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,HEALTHPLUS-Medicare Advantage, +107025,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,HEALTHPLUS-Medicare Advantage, +107026,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,HEALTHPLUS-Medicare Advantage, +107027,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,HEALTHPLUS-Medicare Advantage, +107028,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,HEALTHPLUS-Medicare Advantage, +107029,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,HEALTHPLUS-Medicare Advantage, +107030,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,HEALTHPLUS-Medicare Advantage, +107031,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,HEALTHPLUS-Medicare Advantage, +107032,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,HEALTHPLUS-Medicare Advantage, +107033,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,HEALTHPLUS-Medicare Advantage, +107034,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,HEALTHPLUS-Medicare Advantage, +107035,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,HEALTHPLUS-Medicare Advantage, +107036,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,HEALTHPLUS-Medicare Advantage, +107037,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,HEALTHPLUS-Medicare Advantage, +107038,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,HEALTHPLUS-Medicare Advantage, +107039,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,HEALTHPLUS-Medicare Advantage, +107040,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,HEALTHPLUS-Medicare Advantage, +107041,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,HEALTHPLUS-Medicare Advantage, +107042,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +107043,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +107044,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +107045,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,HEALTHPLUS-Medicare Advantage, +107046,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,HEALTHPLUS-Medicare Advantage, +107047,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,HEALTHPLUS-Medicare Advantage, +107048,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,HEALTHPLUS-Medicare Advantage, +107049,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,HEALTHPLUS-Medicare Advantage, +107050,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,HEALTHPLUS-Medicare Advantage, +107051,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,HEALTHPLUS-Medicare Advantage, +107052,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,HEALTHPLUS-Medicare Advantage, +107053,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,HEALTHPLUS-Medicare Advantage, +107054,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,HEALTHPLUS-Medicare Advantage, +107055,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,HEALTHPLUS-Medicare Advantage, +107056,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,HEALTHPLUS-Medicare Advantage, +107057,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,HEALTHPLUS-Medicare Advantage, +107058,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,HEALTHPLUS-Medicare Advantage, +107059,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,HEALTHPLUS-Medicare Advantage, +107060,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,HEALTHPLUS-Medicare Advantage, +107061,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,HEALTHPLUS-Medicare Advantage, +107062,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,HEALTHPLUS-Medicare Advantage, +107063,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,HEALTHPLUS-Medicare Advantage, +107064,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,HEALTHPLUS-Medicare Advantage, +107065,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,HEALTHPLUS-Medicare Advantage, +107066,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,HEALTHPLUS-Medicare Advantage, +107067,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,HEALTHPLUS-Medicare Advantage, +107068,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,HEALTHPLUS-Medicare Advantage, +107069,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,HEALTHPLUS-Medicare Advantage, +107070,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,HEALTHPLUS-Medicare Advantage, +107071,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,HEALTHPLUS-Medicare Advantage, +107072,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,HEALTHPLUS-Medicare Advantage, +107073,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,HEALTHPLUS-Medicare Advantage, +107074,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,HEALTHPLUS-Medicare Advantage, +107075,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,HEALTHPLUS-Medicare Advantage, +107076,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,HEALTHPLUS-Medicare Advantage, +107077,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,HEALTHPLUS-Medicare Advantage, +107078,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,HEALTHPLUS-Medicare Advantage, +107079,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,HEALTHPLUS-Medicare Advantage, +107080,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,HEALTHPLUS-Medicare Advantage, +107081,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,HEALTHPLUS-Medicare Advantage, +107082,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,HEALTHPLUS-Medicare Advantage, +107083,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,HEALTHPLUS-Medicare Advantage, +107084,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,HEALTHPLUS-Medicare Advantage, +107085,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,HEALTHPLUS-Medicare Advantage, +107086,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,HEALTHPLUS-Medicare Advantage, +107087,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,HEALTHPLUS-Medicare Advantage, +107088,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,HEALTHPLUS-Medicare Advantage, +107089,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,HEALTHPLUS-Medicare Advantage, +107090,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,HEALTHPLUS-Medicare Advantage, +107091,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,HEALTHPLUS-Medicare Advantage, +107092,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,HEALTHPLUS-Medicare Advantage, +107093,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,HEALTHPLUS-Medicare Advantage, +107094,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,HEALTHPLUS-Medicare Advantage, +107095,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,HEALTHPLUS-Medicare Advantage, +107096,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,HEALTHPLUS-Medicare Advantage, +107097,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,HEALTHPLUS-Medicare Advantage, +107098,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,HEALTHPLUS-Medicare Advantage, +107099,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,HEALTHPLUS-Medicare Advantage, +107100,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,HEALTHPLUS-Medicare Advantage, +107101,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,HEALTHPLUS-Medicare Advantage, +107102,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,HEALTHPLUS-Medicare Advantage, +107103,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,HEALTHPLUS-Medicare Advantage, +107104,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,HEALTHPLUS-Medicare Advantage, +107105,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,HEALTHPLUS-Medicare Advantage, +107106,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,HEALTHPLUS-Medicare Advantage, +107107,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,HEALTHPLUS-Medicare Advantage, +107108,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,HEALTHPLUS-Medicare Advantage, +107109,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,HEALTHPLUS-Medicare Advantage, +107110,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,HEALTHPLUS-Medicare Advantage, +107111,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,HEALTHPLUS-Medicare Advantage, +107112,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,HEALTHPLUS-Medicare Advantage, +107113,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,HEALTHPLUS-Medicare Advantage, +107114,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,HEALTHPLUS-Medicare Advantage, +107115,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,HEALTHPLUS-Medicare Advantage, +107116,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,HEALTHPLUS-Medicare Advantage, +107117,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,HEALTHPLUS-Medicare Advantage, +107118,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,HEALTHPLUS-Medicare Advantage, +107119,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,HEALTHPLUS-Medicare Advantage, +107120,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,HEALTHPLUS-Medicare Advantage, +107121,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,HEALTHPLUS-Medicare Advantage, +107122,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,HEALTHPLUS-Medicare Advantage, +107123,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,HEALTHPLUS-Medicare Advantage, +107124,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,HEALTHPLUS-Medicare Advantage, +107125,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,HEALTHPLUS-Medicare Advantage, +107126,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,HEALTHPLUS-Medicare Advantage, +107127,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,HEALTHPLUS-Medicare Advantage, +107128,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,HEALTHPLUS-Medicare Advantage, +107129,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,HEALTHPLUS-Medicare Advantage, +107130,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,HEALTHPLUS-Medicare Advantage, +107131,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,HEALTHPLUS-Medicare Advantage, +107132,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,HEALTHPLUS-Medicare Advantage, +107133,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,HEALTHPLUS-Medicare Advantage, +107134,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,HEALTHPLUS-Medicare Advantage, +107135,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,HEALTHPLUS-Medicare Advantage, +107136,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,HEALTHPLUS-Medicare Advantage, +107137,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,HEALTHPLUS-Medicare Advantage, +107138,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,HEALTHPLUS-Medicare Advantage, +107139,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,HEALTHPLUS-Medicare Advantage, +107140,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,HEALTHPLUS-Medicare Advantage, +107141,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +107142,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,HEALTHPLUS-Medicare Advantage,66.64 +107143,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,HEALTHPLUS-Medicare Advantage, +107144,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,HEALTHPLUS-Medicare Advantage, +107145,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,HEALTHPLUS-Medicare Advantage, +107146,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,HEALTHPLUS-Medicare Advantage, +107147,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,HEALTHPLUS-Medicare Advantage, +107148,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,HEALTHPLUS-Medicare Advantage, +107149,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,HEALTHPLUS-Medicare Advantage, +107150,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,HEALTHPLUS-Medicare Advantage, +107151,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,HEALTHPLUS-Medicare Advantage, +107152,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,HEALTHPLUS-Medicare Advantage, +107153,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,HEALTHPLUS-Medicare Advantage, +107154,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,HEALTHPLUS-Medicare Advantage,597.43 +107155,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,HEALTHPLUS-Medicare Advantage, +107156,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,HEALTHPLUS-Medicare Advantage, +107157,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,HEALTHPLUS-Medicare Advantage, +107158,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,HEALTHPLUS-Medicare Advantage, +107159,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,HEALTHPLUS-Medicare Advantage, +107160,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,HEALTHPLUS-Medicare Advantage, +107161,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,HEALTHPLUS-Medicare Advantage, +107162,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,HEALTHPLUS-Medicare Advantage, +107163,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,HEALTHPLUS-Medicare Advantage, +107164,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,HEALTHPLUS-Medicare Advantage, +107165,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,HEALTHPLUS-Medicare Advantage, +107166,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,HEALTHPLUS-Medicare Advantage, +107167,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,HEALTHPLUS-Medicare Advantage, +107168,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,HEALTHPLUS-Medicare Advantage, +107169,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,HEALTHPLUS-Medicare Advantage, +107170,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,HEALTHPLUS-Medicare Advantage, +107171,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,HEALTHPLUS-Medicare Advantage, +107172,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,HEALTHPLUS-Medicare Advantage, +107173,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,HEALTHPLUS-Medicare Advantage,3452.71 +107174,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,HEALTHPLUS-Medicare Advantage, +107175,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,HEALTHPLUS-Medicare Advantage, +107176,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,HEALTHPLUS-Medicare Advantage, +107177,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,HEALTHPLUS-Medicare Advantage, +107178,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,HEALTHPLUS-Medicare Advantage, +107179,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,HEALTHPLUS-Medicare Advantage, +107180,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,HEALTHPLUS-Medicare Advantage, +107181,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,HEALTHPLUS-Medicare Advantage, +107182,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,HEALTHPLUS-Medicare Advantage, +107183,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,HEALTHPLUS-Medicare Advantage, +107184,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,HEALTHPLUS-Medicare Advantage, +107185,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,HEALTHPLUS-Medicare Advantage, +107186,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,HEALTHPLUS-Medicare Advantage, +107187,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,HEALTHPLUS-Medicare Advantage, +107188,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,HEALTHPLUS-Medicare Advantage, +107189,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,HEALTHPLUS-Medicare Advantage, +107190,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,HEALTHPLUS-Medicare Advantage, +107191,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,HEALTHPLUS-Medicare Advantage, +107192,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,HEALTHPLUS-Medicare Advantage, +107193,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,HEALTHPLUS-Medicare Advantage, +107194,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,HEALTHPLUS-Medicare Advantage, +107195,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,HEALTHPLUS-Medicare Advantage, +107196,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,HEALTHPLUS-Medicare Advantage, +107197,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,HEALTHPLUS-Medicare Advantage, +107198,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,HEALTHPLUS-Medicare Advantage, +107199,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,HEALTHPLUS-Medicare Advantage, +107200,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,HEALTHPLUS-Medicare Advantage, +107201,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,HEALTHPLUS-Medicare Advantage, +107202,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,HEALTHPLUS-Medicare Advantage, +107203,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,HEALTHPLUS-Medicare Advantage, +107204,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,HEALTHPLUS-Medicare Advantage, +107205,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,HEALTHPLUS-Medicare Advantage, +107206,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,HEALTHPLUS-Medicare Advantage,135.78 +107207,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,HEALTHPLUS-Medicare Advantage, +107208,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,HEALTHPLUS-Medicare Advantage, +107209,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,HEALTHPLUS-Medicare Advantage, +107210,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,HEALTHPLUS-Medicare Advantage,135.78 +107211,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,HEALTHPLUS-Medicare Advantage, +107212,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,HEALTHPLUS-Medicare Advantage, +107213,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,HEALTHPLUS-Medicare Advantage, +107214,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,HEALTHPLUS-Medicare Advantage, +107215,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,HEALTHPLUS-Medicare Advantage, +107216,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,HEALTHPLUS-Medicare Advantage, +107217,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,HEALTHPLUS-Medicare Advantage, +107218,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,HEALTHPLUS-Medicare Advantage, +107219,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,HEALTHPLUS-Medicare Advantage, +107220,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,HEALTHPLUS-Medicare Advantage, +107221,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,HEALTHPLUS-Medicare Advantage, +107222,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,HEALTHPLUS-Medicare Advantage, +107223,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,HEALTHPLUS-Medicare Advantage, +107224,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,HEALTHPLUS-Medicare Advantage, +107225,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,HEALTHPLUS-Medicare Advantage, +107226,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,HEALTHPLUS-Medicare Advantage, +107227,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,HEALTHPLUS-Medicare Advantage, +107228,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,HEALTHPLUS-Medicare Advantage, +107229,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,HEALTHPLUS-Medicare Advantage, +107230,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,HEALTHPLUS-Medicare Advantage, +107231,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,HEALTHPLUS-Medicare Advantage, +107232,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,HEALTHPLUS-Medicare Advantage, +107233,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,HEALTHPLUS-Medicare Advantage, +107234,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,HEALTHPLUS-Medicare Advantage, +107235,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,HEALTHPLUS-Medicare Advantage, +107236,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,HEALTHPLUS-Medicare Advantage, +107237,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,HEALTHPLUS-Medicare Advantage, +107238,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,HEALTHPLUS-Medicare Advantage, +107239,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,HEALTHPLUS-Medicare Advantage, +107240,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,HEALTHPLUS-Medicare Advantage, +107241,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,HEALTHPLUS-Medicare Advantage, +107242,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,HEALTHPLUS-Medicare Advantage, +107243,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,HEALTHPLUS-Medicare Advantage, +107244,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,HEALTHPLUS-Medicare Advantage, +107245,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,HEALTHPLUS-Medicare Advantage, +107246,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,HEALTHPLUS-Medicare Advantage, +107247,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,HEALTHPLUS-Medicare Advantage, +107248,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,HEALTHPLUS-Medicare Advantage, +107249,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,HEALTHPLUS-Medicare Advantage, +107250,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,HEALTHPLUS-Medicare Advantage, +107251,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,HEALTHPLUS-Medicare Advantage, +107252,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,HEALTHPLUS-Medicare Advantage, +107253,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-Medicare Advantage, +107254,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,HEALTHPLUS-Medicare Advantage, +107255,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,HEALTHPLUS-Medicare Advantage, +107256,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,HEALTHPLUS-Medicare Advantage, +107257,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,HEALTHPLUS-Medicare Advantage, +107258,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,HEALTHPLUS-Medicare Advantage, +107259,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,HEALTHPLUS-Medicare Advantage, +107260,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,HEALTHPLUS-Medicare Advantage, +107261,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,HEALTHPLUS-Medicare Advantage, +107262,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,HEALTHPLUS-Medicare Advantage, +107263,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,HEALTHPLUS-Medicare Advantage, +107264,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,HEALTHPLUS-Medicare Advantage, +107265,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,HEALTHPLUS-Medicare Advantage, +107266,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,HEALTHPLUS-Medicare Advantage, +107267,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,HEALTHPLUS-Medicare Advantage, +107268,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,HEALTHPLUS-Medicare Advantage, +107269,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,HEALTHPLUS-Medicare Advantage, +107270,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,HEALTHPLUS-Medicare Advantage, +107271,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,HEALTHPLUS-Medicare Advantage, +107272,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,HEALTHPLUS-Medicare Advantage, +107273,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,HEALTHPLUS-Medicare Advantage, +107274,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,HEALTHPLUS-Medicare Advantage, +107275,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,HEALTHPLUS-Medicare Advantage, +107276,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,HEALTHPLUS-Medicare Advantage, +107277,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,HEALTHPLUS-Medicare Advantage, +107278,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,HEALTHPLUS-Medicare Advantage, +107279,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,HEALTHPLUS-Medicare Advantage, +107280,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,HEALTHPLUS-Medicare Advantage, +107281,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,HEALTHPLUS-Medicare Advantage,222.6 +107282,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,HEALTHPLUS-Medicare Advantage, +107283,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,HEALTHPLUS-Medicare Advantage, +107284,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,HEALTHPLUS-Medicare Advantage, +107285,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,HEALTHPLUS-Medicare Advantage, +107286,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,HEALTHPLUS-Medicare Advantage, +107287,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,HEALTHPLUS-Medicare Advantage, +107288,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,HEALTHPLUS-Medicare Advantage,222.6 +107289,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,HEALTHPLUS-Medicare Advantage, +107290,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,HEALTHPLUS-Medicare Advantage, +107291,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,HEALTHPLUS-Medicare Advantage, +107292,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,HEALTHPLUS-Medicare Advantage, +107293,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,HEALTHPLUS-Medicare Advantage,71.75 +107294,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,HEALTHPLUS-Medicare Advantage, +107295,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,HEALTHPLUS-Medicare Advantage, +107296,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,HEALTHPLUS-Medicare Advantage, +107297,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,HEALTHPLUS-Medicare Advantage, +107298,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,HEALTHPLUS-Medicare Advantage, +107299,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,HEALTHPLUS-Medicare Advantage, +107300,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,HEALTHPLUS-Medicare Advantage, +107301,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,HEALTHPLUS-Medicare Advantage, +107302,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,HEALTHPLUS-Medicare Advantage, +107303,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,HEALTHPLUS-Medicare Advantage, +107304,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,HEALTHPLUS-Medicare Advantage, +107305,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,HEALTHPLUS-Medicare Advantage, +107306,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,HEALTHPLUS-Medicare Advantage, +107307,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,HEALTHPLUS-Medicare Advantage, +107308,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,HEALTHPLUS-Medicare Advantage, +107309,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,HEALTHPLUS-Medicare Advantage, +107310,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,HEALTHPLUS-Medicare Advantage, +107311,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,HEALTHPLUS-Medicare Advantage, +107312,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,HEALTHPLUS-Medicare Advantage, +107313,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,HEALTHPLUS-Medicare Advantage, +107314,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,HEALTHPLUS-Medicare Advantage, +107315,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,HEALTHPLUS-Medicare Advantage, +107316,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,HEALTHPLUS-Medicare Advantage, +107317,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,HEALTHPLUS-Medicare Advantage, +107318,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,HEALTHPLUS-Medicare Advantage, +107319,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,HEALTHPLUS-Medicare Advantage, +107320,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,HEALTHPLUS-Medicare Advantage,117.68 +107321,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,HEALTHPLUS-Medicare Advantage, +107322,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,HEALTHPLUS-Medicare Advantage, +107323,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,HEALTHPLUS-Medicare Advantage, +107324,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,HEALTHPLUS-Medicare Advantage, +107325,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,HEALTHPLUS-Medicare Advantage, +107326,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,HEALTHPLUS-Medicare Advantage, +107327,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,HEALTHPLUS-Medicare Advantage, +107328,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,HEALTHPLUS-Medicare Advantage, +107329,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,HEALTHPLUS-Medicare Advantage, +107330,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,HEALTHPLUS-Medicare Advantage, +107331,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,HEALTHPLUS-Medicare Advantage, +107332,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,HEALTHPLUS-Medicare Advantage, +107333,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,HEALTHPLUS-Medicare Advantage, +107334,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,HEALTHPLUS-Medicare Advantage, +107335,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,HEALTHPLUS-Medicare Advantage, +107336,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,HEALTHPLUS-Medicare Advantage, +107337,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,HEALTHPLUS-Medicare Advantage, +107338,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,HEALTHPLUS-Medicare Advantage, +107339,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,HEALTHPLUS-Medicare Advantage, +107340,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,HEALTHPLUS-Medicare Advantage, +107341,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,HEALTHPLUS-Medicare Advantage, +107342,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,HEALTHPLUS-Medicare Advantage, +107343,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,HEALTHPLUS-Medicare Advantage, +107344,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,HEALTHPLUS-Medicare Advantage, +107345,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,HEALTHPLUS-Medicare Advantage, +107346,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,HEALTHPLUS-Medicare Advantage, +107347,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,HEALTHPLUS-Medicare Advantage, +107348,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,HEALTHPLUS-Medicare Advantage, +107349,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,HEALTHPLUS-Medicare Advantage, +107350,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,HEALTHPLUS-Medicare Advantage, +107351,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,HEALTHPLUS-Medicare Advantage, +107352,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,HEALTHPLUS-Medicare Advantage, +107353,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,HEALTHPLUS-Medicare Advantage, +107354,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,HEALTHPLUS-Medicare Advantage, +107355,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,HEALTHPLUS-Medicare Advantage, +107356,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,HEALTHPLUS-Medicare Advantage, +107357,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,HEALTHPLUS-Medicare Advantage, +107358,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,HEALTHPLUS-Medicare Advantage, +107359,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,HEALTHPLUS-Medicare Advantage, +107360,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,HEALTHPLUS-Medicare Advantage, +107361,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,HEALTHPLUS-Medicare Advantage, +107362,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,HEALTHPLUS-Medicare Advantage,269.18 +107363,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,HEALTHPLUS-Medicare Advantage,427.5 +107364,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,HEALTHPLUS-Medicare Advantage,2768.24 +107365,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,HEALTHPLUS-Medicare Advantage, +107366,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,HEALTHPLUS-Medicare Advantage, +107367,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,HEALTHPLUS-Medicare Advantage, +107368,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,HEALTHPLUS-Medicare Advantage, +107369,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,HEALTHPLUS-Medicare Advantage, +107370,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,HEALTHPLUS-Medicare Advantage, +107371,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,HEALTHPLUS-Medicare Advantage, +107372,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,HEALTHPLUS-Medicare Advantage, +107373,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,HEALTHPLUS-Medicare Advantage, +107374,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,HEALTHPLUS-Medicare Advantage, +107375,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,HEALTHPLUS-Medicare Advantage, +107376,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,HEALTHPLUS-Medicare Advantage, +107377,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,HEALTHPLUS-Medicare Advantage, +107378,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,HEALTHPLUS-Medicare Advantage, +107379,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,HEALTHPLUS-Medicare Advantage, +107380,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,HEALTHPLUS-Medicare Advantage, +107381,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,HEALTHPLUS-Medicare Advantage, +107382,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,HEALTHPLUS-Medicare Advantage, +107383,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,HEALTHPLUS-Medicare Advantage, +107384,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,HEALTHPLUS-Medicare Advantage, +107385,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,HEALTHPLUS-Medicare Advantage, +107386,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,HEALTHPLUS-Medicare Advantage, +107387,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,HEALTHPLUS-Medicare Advantage, +107388,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,HEALTHPLUS-Medicare Advantage, +107389,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,HEALTHPLUS-Medicare Advantage, +107390,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,HEALTHPLUS-Medicare Advantage, +107391,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,HEALTHPLUS-Medicare Advantage, +107392,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,HEALTHPLUS-Medicare Advantage, +107393,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,HEALTHPLUS-Medicare Advantage, +107394,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,HEALTHPLUS-Medicare Advantage, +107395,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,HEALTHPLUS-Medicare Advantage, +107396,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,HEALTHPLUS-Medicare Advantage, +107397,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,HEALTHPLUS-Medicare Advantage, +107398,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,HEALTHPLUS-Medicare Advantage, +107399,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,HEALTHPLUS-Medicare Advantage, +107400,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,HEALTHPLUS-Medicare Advantage, +107401,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,HEALTHPLUS-Medicare Advantage, +107402,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,HEALTHPLUS-Medicare Advantage, +107403,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,HEALTHPLUS-Medicare Advantage, +107404,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,HEALTHPLUS-Medicare Advantage, +107405,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,HEALTHPLUS-Medicare Advantage, +107406,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,HEALTHPLUS-Medicare Advantage, +107407,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,HEALTHPLUS-Medicare Advantage, +107408,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,HEALTHPLUS-Medicare Advantage, +107409,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,HEALTHPLUS-Medicare Advantage, +107410,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,HEALTHPLUS-Medicare Advantage, +107411,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,HEALTHPLUS-Medicare Advantage, +107412,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,HEALTHPLUS-Medicare Advantage, +107413,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,HEALTHPLUS-Medicare Advantage, +107414,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,HEALTHPLUS-Medicare Advantage, +107415,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,HEALTHPLUS-Medicare Advantage, +107416,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,HEALTHPLUS-Medicare Advantage, +107417,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,HEALTHPLUS-Medicare Advantage, +107418,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,HEALTHPLUS-Medicare Advantage, +107419,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,HEALTHPLUS-Medicare Advantage, +107420,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,HEALTHPLUS-Medicare Advantage, +107421,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,HEALTHPLUS-Medicare Advantage, +107422,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,HEALTHPLUS-Medicare Advantage, +107423,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,HEALTHPLUS-Medicare Advantage, +107424,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,HEALTHPLUS-Medicare Advantage, +107425,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,HEALTHPLUS-Medicare Advantage, +107426,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,HEALTHPLUS-Medicare Advantage, +107427,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,HEALTHPLUS-Medicare Advantage, +107428,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,HEALTHPLUS-Medicare Advantage, +107429,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,HEALTHPLUS-Medicare Advantage, +107430,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,HEALTHPLUS-Medicare Advantage, +107431,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,HEALTHPLUS-Medicare Advantage, +107432,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,HEALTHPLUS-Medicare Advantage, +107433,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,HEALTHPLUS-Medicare Advantage, +107434,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,HEALTHPLUS-Medicare Advantage, +107435,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,HEALTHPLUS-Medicare Advantage, +107436,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,HEALTHPLUS-Medicare Advantage, +107437,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,HEALTHPLUS-Medicare Advantage, +107438,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,HEALTHPLUS-Medicare Advantage, +107439,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,HEALTHPLUS-Medicare Advantage, +107440,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,HEALTHPLUS-Medicare Advantage, +107441,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,HEALTHPLUS-Medicare Advantage, +107442,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,HEALTHPLUS-Medicare Advantage, +107443,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,HEALTHPLUS-Medicare Advantage, +107444,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,HEALTHPLUS-Medicare Advantage, +107445,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,HEALTHPLUS-Medicare Advantage, +107446,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,HEALTHPLUS-Medicare Advantage, +107447,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,HEALTHPLUS-Medicare Advantage, +107448,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,HEALTHPLUS-Medicare Advantage, +107449,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,HEALTHPLUS-Medicare Advantage, +107450,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,HEALTHPLUS-Medicare Advantage, +107451,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,HEALTHPLUS-Medicare Advantage, +107452,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,HEALTHPLUS-Medicare Advantage, +107453,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,HEALTHPLUS-Medicare Advantage, +107454,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,HEALTHPLUS-Medicare Advantage, +107455,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,HEALTHPLUS-Medicare Advantage, +107456,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,HEALTHPLUS-Medicare Advantage, +107457,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,HEALTHPLUS-Medicare Advantage, +107458,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,HEALTHPLUS-Medicare Advantage, +107459,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,HEALTHPLUS-Medicare Advantage, +107460,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,HEALTHPLUS-Medicare Advantage, +107461,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,HEALTHPLUS-Medicare Advantage, +107462,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,HEALTHPLUS-Medicare Advantage, +107463,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,HEALTHPLUS-Medicare Advantage, +107464,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,HEALTHPLUS-Medicare Advantage, +107465,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,HEALTHPLUS-Medicare Advantage, +107466,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,HEALTHPLUS-Medicare Advantage, +107467,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,HEALTHPLUS-Medicare Advantage, +107468,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,HEALTHPLUS-Medicare Advantage, +107469,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,HEALTHPLUS-Medicare Advantage, +107470,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,HEALTHPLUS-Medicare Advantage, +107471,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,HEALTHPLUS-Medicare Advantage, +107472,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,HEALTHPLUS-Medicare Advantage, +107473,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,HEALTHPLUS-Medicare Advantage, +107474,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,HEALTHPLUS-Medicare Advantage, +107475,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,HEALTHPLUS-Medicare Advantage, +107476,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,HEALTHPLUS-Medicare Advantage, +107477,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,HEALTHPLUS-Medicare Advantage, +107478,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,HEALTHPLUS-Medicare Advantage, +107479,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,HEALTHPLUS-Medicare Advantage, +107480,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,HEALTHPLUS-Medicare Advantage, +107481,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,HEALTHPLUS-Medicare Advantage, +107482,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,HEALTHPLUS-Medicare Advantage, +107483,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,HEALTHPLUS-Medicare Advantage, +107484,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,HEALTHPLUS-Medicare Advantage, +107485,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,HEALTHPLUS-Medicare Advantage, +107486,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,HEALTHPLUS-Medicare Advantage, +107487,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,HEALTHPLUS-Medicare Advantage, +107488,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,HEALTHPLUS-Medicare Advantage, +107489,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,HEALTHPLUS-Medicare Advantage, +107490,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,HEALTHPLUS-Medicare Advantage, +107491,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,HEALTHPLUS-Medicare Advantage, +107492,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,HEALTHPLUS-Medicare Advantage, +107493,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,HEALTHPLUS-Medicare Advantage, +107494,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,HEALTHPLUS-Medicare Advantage, +107495,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,HEALTHPLUS-Medicare Advantage, +107496,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,HEALTHPLUS-Medicare Advantage, +107497,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,HEALTHPLUS-Medicare Advantage, +107498,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,HEALTHPLUS-Medicare Advantage, +107499,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,HEALTHPLUS-Medicare Advantage, +107500,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,HEALTHPLUS-Medicare Advantage, +107501,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,HEALTHPLUS-Medicare Advantage, +107502,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,HEALTHPLUS-Medicare Advantage, +107503,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,HEALTHPLUS-Medicare Advantage, +107504,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,HEALTHPLUS-Medicare Advantage, +107505,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,HEALTHPLUS-Medicare Advantage, +107506,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,HEALTHPLUS-Medicare Advantage, +107507,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,HEALTHPLUS-Medicare Advantage, +107508,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,HEALTHPLUS-Medicare Advantage, +107509,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,HEALTHPLUS-Medicare Advantage, +107510,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,HEALTHPLUS-Medicare Advantage, +107511,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,HEALTHPLUS-Medicare Advantage, +107512,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,HEALTHPLUS-Medicare Advantage, +107513,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,HEALTHPLUS-Medicare Advantage, +107514,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,HEALTHPLUS-Medicare Advantage, +107515,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,HEALTHPLUS-Medicare Advantage, +107516,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,HEALTHPLUS-Medicare Advantage, +107517,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,HEALTHPLUS-Medicare Advantage, +107518,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,HEALTHPLUS-Medicare Advantage, +107519,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,HEALTHPLUS-Medicare Advantage, +107520,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,HEALTHPLUS-Medicare Advantage, +107521,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,HEALTHPLUS-Medicare Advantage, +107522,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,HEALTHPLUS-Medicare Advantage, +107523,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,HEALTHPLUS-Medicare Advantage, +107524,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,HEALTHPLUS-Medicare Advantage, +107525,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,HEALTHPLUS-Medicare Advantage, +107526,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,HEALTHPLUS-Medicare Advantage, +107527,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,HEALTHPLUS-Medicare Advantage, +107528,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,HEALTHPLUS-Medicare Advantage, +107529,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,HEALTHPLUS-Medicare Advantage, +107530,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,HEALTHPLUS-Medicare Advantage, +107531,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,HEALTHPLUS-Medicare Advantage, +107532,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,HEALTHPLUS-Medicare Advantage, +107533,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,HEALTHPLUS-Medicare Advantage, +107534,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,HEALTHPLUS-Medicare Advantage, +107535,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,HEALTHPLUS-Medicare Advantage, +107536,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,HEALTHPLUS-Medicare Advantage, +107537,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,HEALTHPLUS-Medicare Advantage, +107538,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,HEALTHPLUS-Medicare Advantage, +107539,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,HEALTHPLUS-Medicare Advantage, +107540,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,HEALTHPLUS-Medicare Advantage, +107541,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,HEALTHPLUS-Medicare Advantage, +107542,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,HEALTHPLUS-Medicare Advantage, +107543,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,HEALTHPLUS-Medicare Advantage, +107544,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,HEALTHPLUS-Medicare Advantage, +107545,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,HEALTHPLUS-Medicare Advantage, +107546,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,HEALTHPLUS-Medicare Advantage, +107547,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,HEALTHPLUS-Medicare Advantage, +107548,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,HEALTHPLUS-Medicare Advantage, +107549,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,HEALTHPLUS-Medicare Advantage, +107550,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,HEALTHPLUS-Medicare Advantage, +107551,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,HEALTHPLUS-Medicare Advantage, +107552,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,HEALTHPLUS-Medicare Advantage, +107553,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,HEALTHPLUS-Medicare Advantage, +107554,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,HEALTHPLUS-Medicare Advantage, +107555,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,HEALTHPLUS-Medicare Advantage, +107556,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,HEALTHPLUS-Medicare Advantage, +107557,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,HEALTHPLUS-Medicare Advantage, +107558,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,HEALTHPLUS-Medicare Advantage, +107559,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,HEALTHPLUS-Medicare Advantage, +107560,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,HEALTHPLUS-Medicare Advantage, +107561,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,HEALTHPLUS-Medicare Advantage, +107562,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,HEALTHPLUS-Medicare Advantage, +107563,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,HEALTHPLUS-Medicare Advantage, +107564,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,HEALTHPLUS-Medicare Advantage, +107565,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,HEALTHPLUS-Medicare Advantage, +107566,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,HEALTHPLUS-Medicare Advantage, +107567,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,HEALTHPLUS-Medicare Advantage, +107568,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,HEALTHPLUS-Medicare Advantage, +107569,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,HEALTHPLUS-Medicare Advantage, +107570,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,HEALTHPLUS-Medicare Advantage, +107571,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,HEALTHPLUS-Medicare Advantage, +107572,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,HEALTHPLUS-Medicare Advantage, +107573,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,HEALTHPLUS-Medicare Advantage, +107574,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,HEALTHPLUS-Medicare Advantage, +107575,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,HEALTHPLUS-Medicare Advantage, +107576,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,HEALTHPLUS-Medicare Advantage, +107577,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,HEALTHPLUS-Medicare Advantage, +107578,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,HEALTHPLUS-Medicare Advantage, +107579,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,HEALTHPLUS-Medicare Advantage, +107580,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,HEALTHPLUS-Medicare Advantage, +107581,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,HEALTHPLUS-Medicare Advantage, +107582,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,HEALTHPLUS-Medicare Advantage, +107583,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,HEALTHPLUS-Medicare Advantage, +107584,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,HEALTHPLUS-Medicare Advantage, +107585,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,HEALTHPLUS-Medicare Advantage, +107586,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,HEALTHPLUS-Medicare Advantage, +107587,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,HEALTHPLUS-Medicare Advantage, +107588,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,HEALTHPLUS-Medicare Advantage, +107589,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,HEALTHPLUS-Medicare Advantage, +107590,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,HEALTHPLUS-Medicare Advantage, +107591,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,HEALTHPLUS-Medicare Advantage, +107592,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,HEALTHPLUS-Medicare Advantage, +107593,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,HEALTHPLUS-Medicare Advantage, +107594,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,HEALTHPLUS-Medicare Advantage, +107595,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,HEALTHPLUS-Medicare Advantage, +107596,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,HEALTHPLUS-Medicare Advantage, +107597,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,HEALTHPLUS-Medicare Advantage, +107598,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,HEALTHPLUS-Medicare Advantage, +107599,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,HEALTHPLUS-Medicare Advantage, +107600,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,HEALTHPLUS-Medicare Advantage, +107601,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,HEALTHPLUS-Medicare Advantage, +107602,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,HEALTHPLUS-Medicare Advantage, +107603,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,HEALTHPLUS-Medicare Advantage, +107604,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,HEALTHPLUS-Medicare Advantage, +107605,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,HEALTHPLUS-Medicare Advantage, +107606,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,HEALTHPLUS-Medicare Advantage, +107607,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,HEALTHPLUS-Medicare Advantage, +107608,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,HEALTHPLUS-Medicare Advantage, +107609,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,HEALTHPLUS-Medicare Advantage, +107610,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,HEALTHPLUS-Medicare Advantage, +107611,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,HEALTHPLUS-Medicare Advantage, +107612,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,HEALTHPLUS-Medicare Advantage, +107613,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,HEALTHPLUS-Medicare Advantage, +107614,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,HEALTHPLUS-Medicare Advantage, +107615,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,HEALTHPLUS-Medicare Advantage, +107616,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,HEALTHPLUS-Medicare Advantage, +107617,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,HEALTHPLUS-Medicare Advantage, +107618,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,HEALTHPLUS-Medicare Advantage, +107619,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,HEALTHPLUS-Medicare Advantage, +107620,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,HEALTHPLUS-Medicare Advantage, +107621,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,HEALTHPLUS-Medicare Advantage, +107622,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,HEALTHPLUS-Medicare Advantage, +107623,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,HEALTHPLUS-Medicare Advantage, +107624,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,HEALTHPLUS-Medicare Advantage, +107625,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,HEALTHPLUS-Medicare Advantage, +107626,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,HEALTHPLUS-Medicare Advantage, +107627,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,HEALTHPLUS-Medicare Advantage, +107628,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,HEALTHPLUS-Medicare Advantage, +107629,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,HEALTHPLUS-Medicare Advantage, +107630,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,HEALTHPLUS-Medicare Advantage, +107631,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,HEALTHPLUS-Medicare Advantage, +107632,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,HEALTHPLUS-Medicare Advantage, +107633,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,HEALTHPLUS-Medicare Advantage, +107634,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,HEALTHPLUS-Medicare Advantage, +107635,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,HEALTHPLUS-Medicare Advantage, +107636,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,HEALTHPLUS-Medicare Advantage, +107637,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,HEALTHPLUS-Medicare Advantage, +107638,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,HEALTHPLUS-Medicare Advantage, +107639,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,HEALTHPLUS-Medicare Advantage, +107640,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,HEALTHPLUS-Medicare Advantage, +107641,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,HEALTHPLUS-Medicare Advantage, +107642,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,HEALTHPLUS-Medicare Advantage, +107643,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,HEALTHPLUS-Medicare Advantage, +107644,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,HEALTHPLUS-Medicare Advantage, +107645,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,HEALTHPLUS-Medicare Advantage, +107646,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,HEALTHPLUS-Medicare Advantage, +107647,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,HEALTHPLUS-Medicare Advantage, +107648,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,HEALTHPLUS-Medicare Advantage, +107649,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,HEALTHPLUS-Medicare Advantage, +107650,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,HEALTHPLUS-Medicare Advantage, +107651,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,HEALTHPLUS-Medicare Advantage, +107652,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,HEALTHPLUS-Medicare Advantage, +107653,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,HEALTHPLUS-Medicare Advantage, +107654,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,HEALTHPLUS-Medicare Advantage, +107655,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,HEALTHPLUS-Medicare Advantage, +107656,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,HEALTHPLUS-Medicare Advantage, +107657,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,HEALTHPLUS-Medicare Advantage, +107658,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,HEALTHPLUS-Medicare Advantage, +107659,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,HEALTHPLUS-Medicare Advantage, +107660,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,HEALTHPLUS-Medicare Advantage, +107661,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,HEALTHPLUS-Medicare Advantage, +107662,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,HEALTHPLUS-Medicare Advantage, +107663,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,HEALTHPLUS-Medicare Advantage, +107664,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,HEALTHPLUS-Medicare Advantage, +107665,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,HEALTHPLUS-Medicare Advantage, +107666,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,HEALTHPLUS-Medicare Advantage, +107667,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,HEALTHPLUS-Medicare Advantage, +107668,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,HEALTHPLUS-Medicare Advantage, +107669,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,HEALTHPLUS-Medicare Advantage, +107670,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,HEALTHPLUS-Medicare Advantage, +107671,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,HEALTHPLUS-Medicare Advantage,677.0 +107672,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,HEALTHPLUS-Medicare Advantage, +107673,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,HEALTHPLUS-Medicare Advantage, +107674,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,HEALTHPLUS-Medicare Advantage, +107675,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,HEALTHPLUS-Medicare Advantage, +107676,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,HEALTHPLUS-Medicare Advantage, +107677,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,HEALTHPLUS-Medicare Advantage, +107678,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,HEALTHPLUS-Medicare Advantage, +107679,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,HEALTHPLUS-Medicare Advantage, +107680,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,HEALTHPLUS-Medicare Advantage, +107681,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,HEALTHPLUS-Medicare Advantage, +107682,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,HEALTHPLUS-Medicare Advantage, +107683,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,HEALTHPLUS-Medicare Advantage, +107684,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,HEALTHPLUS-Medicare Advantage, +107685,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,HEALTHPLUS-Medicare Advantage, +107686,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,HEALTHPLUS-Medicare Advantage, +107687,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,HEALTHPLUS-Medicare Advantage, +107688,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,HEALTHPLUS-Medicare Advantage, +107689,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,HEALTHPLUS-Medicare Advantage, +107690,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,HEALTHPLUS-Medicare Advantage, +107691,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,HEALTHPLUS-Medicare Advantage, +107692,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,HEALTHPLUS-Medicare Advantage, +107693,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,HEALTHPLUS-Medicare Advantage, +107694,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,HEALTHPLUS-Medicare Advantage, +107695,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,HEALTHPLUS-Medicare Advantage, +107696,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,HEALTHPLUS-Medicare Advantage, +107697,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,HEALTHPLUS-Medicare Advantage, +107698,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,HEALTHPLUS-Medicare Advantage, +107699,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,HEALTHPLUS-Medicare Advantage, +107700,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,HEALTHPLUS-Medicare Advantage, +107701,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,HEALTHPLUS-Medicare Advantage, +107702,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,HEALTHPLUS-Medicare Advantage, +107703,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,HEALTHPLUS-Medicare Advantage, +107704,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,HEALTHPLUS-Medicare Advantage, +107705,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,HEALTHPLUS-Medicare Advantage, +107706,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,HEALTHPLUS-Medicare Advantage, +107707,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,HEALTHPLUS-Medicare Advantage, +107708,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,HEALTHPLUS-Medicare Advantage, +107709,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,HEALTHPLUS-Medicare Advantage, +107710,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,HEALTHPLUS-Medicare Advantage, +107711,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,HEALTHPLUS-Medicare Advantage, +107712,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,HEALTHPLUS-Medicare Advantage, +107713,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,HEALTHPLUS-Medicare Advantage, +107714,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,HEALTHPLUS-Medicare Advantage, +107715,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,HEALTHPLUS-Medicare Advantage, +107716,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,HEALTHPLUS-Medicare Advantage, +107717,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,HEALTHPLUS-Medicare Advantage, +107718,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,HEALTHPLUS-Medicare Advantage, +107719,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,HEALTHPLUS-Medicare Advantage, +107720,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,HEALTHPLUS-Medicare Advantage, +107721,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,HEALTHPLUS-Medicare Advantage, +107722,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,HEALTHPLUS-Medicare Advantage, +107723,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,HEALTHPLUS-Medicare Advantage, +107724,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,HEALTHPLUS-Medicare Advantage, +107725,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,HEALTHPLUS-Medicare Advantage, +107726,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,HEALTHPLUS-Medicare Advantage, +107727,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,HEALTHPLUS-Medicare Advantage, +107728,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,HEALTHPLUS-Medicare Advantage, +107729,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,HEALTHPLUS-Medicare Advantage, +107730,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,HEALTHPLUS-Medicare Advantage, +107731,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,HEALTHPLUS-Medicare Advantage, +107732,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,HEALTHPLUS-Medicare Advantage, +107733,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,HEALTHPLUS-Medicare Advantage, +107734,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,HEALTHPLUS-Medicare Advantage, +107735,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,HEALTHPLUS-Medicare Advantage, +107736,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,HEALTHPLUS-Medicare Advantage, +107737,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,HEALTHPLUS-Medicare Advantage, +107738,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,HEALTHPLUS-Medicare Advantage, +107739,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,HEALTHPLUS-Medicare Advantage, +107740,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,HEALTHPLUS-Medicare Advantage, +107741,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,HEALTHPLUS-Medicare Advantage, +107742,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,HEALTHPLUS-Medicare Advantage, +107743,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,HEALTHPLUS-Medicare Advantage, +107744,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,HEALTHPLUS-Medicare Advantage, +107745,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,HEALTHPLUS-Medicare Advantage, +107746,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,HEALTHPLUS-Medicare Advantage, +107747,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,HEALTHPLUS-Medicare Advantage, +107748,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,HEALTHPLUS-Medicare Advantage, +107749,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,HEALTHPLUS-Medicare Advantage, +107750,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,HEALTHPLUS-Medicare Advantage, +107751,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,HEALTHPLUS-Medicare Advantage, +107752,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,HEALTHPLUS-Medicare Advantage, +107753,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,HEALTHPLUS-Medicare Advantage, +107754,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,HEALTHPLUS-Medicare Advantage, +107755,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,HEALTHPLUS-Medicare Advantage, +107756,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,HEALTHPLUS-Medicare Advantage, +107757,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,HEALTHPLUS-Medicare Advantage, +107758,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,HEALTHPLUS-Medicare Advantage, +107759,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,HEALTHPLUS-Medicare Advantage, +107760,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,HEALTHPLUS-Medicare Advantage, +107761,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,HEALTHPLUS-Medicare Advantage, +107762,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,HEALTHPLUS-Medicare Advantage, +107763,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,HEALTHPLUS-Medicare Advantage, +107764,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,HEALTHPLUS-Medicare Advantage, +107765,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,HEALTHPLUS-Medicare Advantage, +107766,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,HEALTHPLUS-Medicare Advantage, +107767,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,HEALTHPLUS-Medicare Advantage, +107768,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,HEALTHPLUS-Medicare Advantage, +107769,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,HEALTHPLUS-Medicare Advantage, +107770,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,HEALTHPLUS-Medicare Advantage, +107771,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,HEALTHPLUS-Medicare Advantage, +107772,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,HEALTHPLUS-Medicare Advantage, +107773,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,HEALTHPLUS-Medicare Advantage, +107774,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,HEALTHPLUS-Medicare Advantage, +107775,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,HEALTHPLUS-Medicare Advantage, +107776,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,HEALTHPLUS-Medicare Advantage, +107777,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,HEALTHPLUS-Medicare Advantage, +107778,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,HEALTHPLUS-Medicare Advantage, +107779,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,HEALTHPLUS-Medicare Advantage, +107780,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,HEALTHPLUS-Medicare Advantage, +107781,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,HEALTHPLUS-Medicare Advantage, +107782,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,HEALTHPLUS-Medicare Advantage, +107783,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,HEALTHPLUS-Medicare Advantage, +107784,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,HEALTHPLUS-Medicare Advantage, +107785,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,HEALTHPLUS-Medicare Advantage, +107786,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,HEALTHPLUS-Medicare Advantage, +107787,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,HEALTHPLUS-Medicare Advantage, +107788,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,HEALTHPLUS-Medicare Advantage, +107789,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,HEALTHPLUS-Medicare Advantage, +107790,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,HEALTHPLUS-Medicare Advantage, +107791,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,HEALTHPLUS-Medicare Advantage, +107792,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,HEALTHPLUS-Medicare Advantage, +107793,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,HEALTHPLUS-Medicare Advantage, +107794,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,HEALTHPLUS-Medicare Advantage, +107795,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,HEALTHPLUS-Medicare Advantage, +107796,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,HEALTHPLUS-Medicare Advantage, +107797,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,HEALTHPLUS-Medicare Advantage, +107798,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,HEALTHPLUS-Medicare Advantage, +107799,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,HEALTHPLUS-Medicare Advantage, +107800,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,HEALTHPLUS-Medicare Advantage, +107801,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,HEALTHPLUS-Medicare Advantage, +107802,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,HEALTHPLUS-Medicare Advantage, +107803,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,HEALTHPLUS-Medicare Advantage, +107804,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,HEALTHPLUS-Medicare Advantage, +107805,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,HEALTHPLUS-Medicare Advantage, +107806,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,HEALTHPLUS-Medicare Advantage, +107807,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,HEALTHPLUS-Medicare Advantage, +107808,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,HEALTHPLUS-Medicare Advantage, +107809,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,HEALTHPLUS-Medicare Advantage, +107810,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,HEALTHPLUS-Medicare Advantage, +107811,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,HEALTHPLUS-Medicare Advantage, +107812,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,HEALTHPLUS-Medicare Advantage, +107813,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,HEALTHPLUS-Medicare Advantage, +107814,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,HEALTHPLUS-Medicare Advantage, +107815,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,HEALTHPLUS-Medicare Advantage, +107816,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,HEALTHPLUS-Medicare Advantage, +107817,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,HEALTHPLUS-Medicare Advantage, +107818,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,HEALTHPLUS-Medicare Advantage, +107819,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,HEALTHPLUS-Medicare Advantage, +107820,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,HEALTHPLUS-Medicare Advantage, +107821,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,HEALTHPLUS-Medicare Advantage, +107822,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,HEALTHPLUS-Medicare Advantage, +107823,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,HEALTHPLUS-Medicare Advantage, +107824,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,HEALTHPLUS-Medicare Advantage, +107825,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,HEALTHPLUS-Medicare Advantage, +107826,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,HEALTHPLUS-Medicare Advantage, +107827,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,HEALTHPLUS-Medicare Advantage, +107828,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,HEALTHPLUS-Medicare Advantage, +107829,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,HEALTHPLUS-Medicare Advantage, +107830,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,HEALTHPLUS-Medicare Advantage, +107831,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,HEALTHPLUS-Medicare Advantage, +107832,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,HEALTHPLUS-Medicare Advantage, +107833,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,HEALTHPLUS-Medicare Advantage, +107834,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,HEALTHPLUS-Medicare Advantage, +107835,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,HEALTHPLUS-Medicare Advantage, +107836,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,HEALTHPLUS-Medicare Advantage, +107837,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,HEALTHPLUS-Medicare Advantage, +107838,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,HEALTHPLUS-Medicare Advantage, +107839,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,HEALTHPLUS-Medicare Advantage, +107840,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,HEALTHPLUS-Medicare Advantage, +107841,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,HEALTHPLUS-Medicare Advantage, +107842,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,HEALTHPLUS-Medicare Advantage, +107843,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,HEALTHPLUS-Medicare Advantage, +107844,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,HEALTHPLUS-Medicare Advantage, +107845,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,HEALTHPLUS-Medicare Advantage, +107846,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,HEALTHPLUS-Medicare Advantage, +107847,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,HEALTHPLUS-Medicare Advantage, +107848,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,HEALTHPLUS-Medicare Advantage, +107849,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,HEALTHPLUS-Medicare Advantage, +107850,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,HEALTHPLUS-Medicare Advantage, +107851,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,HEALTHPLUS-Medicare Advantage, +107852,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,HEALTHPLUS-Medicare Advantage, +107853,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,HEALTHPLUS-Medicare Advantage, +107854,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,HEALTHPLUS-Medicare Advantage, +107855,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,HEALTHPLUS-Medicare Advantage, +107856,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,HEALTHPLUS-Medicare Advantage, +107857,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,HEALTHPLUS-Medicare Advantage, +107858,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,HEALTHPLUS-Medicare Advantage, +107859,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,HEALTHPLUS-Medicare Advantage, +107860,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,HEALTHPLUS-Medicare Advantage, +107861,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,HEALTHPLUS-Medicare Advantage, +107862,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,HEALTHPLUS-Medicare Advantage, +107863,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,HEALTHPLUS-Medicare Advantage, +107864,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,HEALTHPLUS-Medicare Advantage, +107865,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,HEALTHPLUS-Medicare Advantage, +107866,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,HEALTHPLUS-Medicare Advantage, +107867,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,HEALTHPLUS-Medicare Advantage, +107868,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,HEALTHPLUS-Medicare Advantage, +107869,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,HEALTHPLUS-Medicare Advantage, +107870,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,HEALTHPLUS-Medicare Advantage, +107871,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,HEALTHPLUS-Medicare Advantage, +107872,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,HEALTHPLUS-Medicare Advantage, +107873,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,HEALTHPLUS-Medicare Advantage, +107874,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,HEALTHPLUS-Medicare Advantage, +107875,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,HEALTHPLUS-Medicare Advantage, +107876,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,HEALTHPLUS-Medicare Advantage, +107877,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,HEALTHPLUS-Medicare Advantage, +107878,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,HEALTHPLUS-Medicare Advantage, +107879,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,HEALTHPLUS-Medicare Advantage, +107880,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,HEALTHPLUS-Medicare Advantage, +107881,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,HEALTHPLUS-Medicare Advantage, +107882,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,HEALTHPLUS-Medicare Advantage, +107883,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,HEALTHPLUS-Medicare Advantage, +107884,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,HEALTHPLUS-Medicare Advantage, +107885,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,HEALTHPLUS-Medicare Advantage, +107886,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,HEALTHPLUS-Medicare Advantage, +107887,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,HEALTHPLUS-Medicare Advantage, +107888,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,HEALTHPLUS-Medicare Advantage, +107889,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,HEALTHPLUS-Medicare Advantage, +107890,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,HEALTHPLUS-Medicare Advantage, +107891,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,HEALTHPLUS-Medicare Advantage, +107892,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,HEALTHPLUS-Medicare Advantage, +107893,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,HEALTHPLUS-Medicare Advantage, +107894,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,HEALTHPLUS-Medicare Advantage, +107895,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,HEALTHPLUS-Medicare Advantage, +107896,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,HEALTHPLUS-Medicare Advantage, +107897,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,HEALTHPLUS-Medicare Advantage, +107898,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,HEALTHPLUS-Medicare Advantage, +107899,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,HEALTHPLUS-Medicare Advantage, +107900,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,HEALTHPLUS-Medicare Advantage, +107901,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,HEALTHPLUS-Medicare Advantage, +107902,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,HEALTHPLUS-Medicare Advantage, +107903,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,HEALTHPLUS-Medicare Advantage, +107904,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,HEALTHPLUS-Medicare Advantage, +107905,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,HEALTHPLUS-Medicare Advantage, +107906,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,HEALTHPLUS-Medicare Advantage, +107907,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,HEALTHPLUS-Medicare Advantage, +107908,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,HEALTHPLUS-Medicare Advantage, +107909,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,HEALTHPLUS-Medicare Advantage, +107910,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,HEALTHPLUS-Medicare Advantage, +107911,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,HEALTHPLUS-Medicare Advantage, +107912,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,HEALTHPLUS-Medicare Advantage, +107913,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,HEALTHPLUS-Medicare Advantage, +107914,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,HEALTHPLUS-Medicare Advantage, +107915,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,HEALTHPLUS-Medicare Advantage, +107916,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,HEALTHPLUS-Medicare Advantage, +107917,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,HEALTHPLUS-Medicare Advantage, +107918,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,HEALTHPLUS-Medicare Advantage, +107919,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,HEALTHPLUS-Medicare Advantage, +107920,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,HEALTHPLUS-Medicare Advantage, +107921,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,HEALTHPLUS-Medicare Advantage, +107922,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,HEALTHPLUS-Medicare Advantage, +107923,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,HEALTHPLUS-Medicare Advantage, +107924,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,HEALTHPLUS-Medicare Advantage, +107925,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,HEALTHPLUS-Medicare Advantage, +107926,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,HEALTHPLUS-Medicare Advantage, +107927,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,HEALTHPLUS-Medicare Advantage, +107928,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,HEALTHPLUS-Medicare Advantage, +107929,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,HEALTHPLUS-Medicare Advantage, +107930,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,HEALTHPLUS-Medicare Advantage, +107931,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,HEALTHPLUS-Medicare Advantage, +107932,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,HEALTHPLUS-Medicare Advantage, +107933,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,HEALTHPLUS-Medicare Advantage, +107934,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,HEALTHPLUS-Medicare Advantage, +107935,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,HEALTHPLUS-Medicare Advantage, +107936,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,HEALTHPLUS-Medicare Advantage, +107937,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,HEALTHPLUS-Medicare Advantage, +107938,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,HEALTHPLUS-Medicare Advantage, +107939,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,HEALTHPLUS-Medicare Advantage, +107940,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,HEALTHPLUS-Medicare Advantage, +107941,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,HEALTHPLUS-Medicare Advantage, +107942,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,HEALTHPLUS-Medicare Advantage, +107943,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,HEALTHPLUS-Medicare Advantage, +107944,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,HEALTHPLUS-Medicare Advantage, +107945,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,HEALTHPLUS-Medicare Advantage, +107946,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,HEALTHPLUS-Medicare Advantage, +107947,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,HEALTHPLUS-Medicare Advantage, +107948,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,HEALTHPLUS-Medicare Advantage, +107949,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,HEALTHPLUS-Medicare Advantage, +107950,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,HEALTHPLUS-Medicare Advantage, +107951,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,HEALTHPLUS-Medicare Advantage, +107952,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,HEALTHPLUS-Medicare Advantage, +107953,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,HEALTHPLUS-Medicare Advantage, +107954,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,HEALTHPLUS-Medicare Advantage, +107955,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,HEALTHPLUS-Medicare Advantage, +107956,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,HEALTHPLUS-Medicare Advantage, +107957,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,HEALTHPLUS-Medicare Advantage, +107958,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,HEALTHPLUS-Medicare Advantage, +107959,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,HEALTHPLUS-Medicare Advantage, +107960,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,HEALTHPLUS-Medicare Advantage, +107961,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,HEALTHPLUS-Medicare Advantage, +107962,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,HEALTHPLUS-Medicare Advantage, +107963,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,HEALTHPLUS-Medicare Advantage, +107964,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,HEALTHPLUS-Medicare Advantage, +107965,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,HEALTHPLUS-Medicare Advantage, +107966,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,HEALTHPLUS-Medicare Advantage, +107967,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,HEALTHPLUS-Medicare Advantage, +107968,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,HEALTHPLUS-Medicare Advantage, +107969,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,HEALTHPLUS-Medicare Advantage, +107970,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,HEALTHPLUS-Medicare Advantage, +107971,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,HEALTHPLUS-Medicare Advantage, +107972,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,HEALTHPLUS-Medicare Advantage, +107973,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,HEALTHPLUS-Medicare Advantage, +107974,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,HEALTHPLUS-Medicare Advantage, +107975,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,HEALTHPLUS-Medicare Advantage, +107976,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,HEALTHPLUS-Medicare Advantage, +107977,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,HEALTHPLUS-Medicare Advantage, +107978,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,HEALTHPLUS-Medicare Advantage, +107979,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,HEALTHPLUS-Medicare Advantage, +107980,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,HEALTHPLUS-Medicare Advantage, +107981,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,HEALTHPLUS-Medicare Advantage, +107982,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,HEALTHPLUS-Medicare Advantage, +107983,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,HEALTHPLUS-Medicare Advantage, +107984,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,HEALTHPLUS-Medicare Advantage, +107985,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,HEALTHPLUS-Medicare Advantage, +107986,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,HEALTHPLUS-Medicare Advantage, +107987,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,HEALTHPLUS-Medicare Advantage, +107988,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,HEALTHPLUS-Medicare Advantage, +107989,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,HEALTHPLUS-Medicare Advantage, +107990,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,HEALTHPLUS-Medicare Advantage, +107991,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,HEALTHPLUS-Medicare Advantage, +107992,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,HEALTHPLUS-Medicare Advantage, +107993,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,HEALTHPLUS-Medicare Advantage, +107994,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,HEALTHPLUS-Medicare Advantage, +107995,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,HEALTHPLUS-Medicare Advantage, +107996,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,HEALTHPLUS-Medicare Advantage, +107997,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,HEALTHPLUS-Medicare Advantage, +107998,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,HEALTHPLUS-Medicare Advantage, +107999,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,HEALTHPLUS-Medicare Advantage, +108000,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,HEALTHPLUS-Medicare Advantage, +108001,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,HEALTHPLUS-Medicare Advantage, +108002,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,HEALTHPLUS-Medicare Advantage, +108003,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,HEALTHPLUS-Medicare Advantage, +108004,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,HEALTHPLUS-Medicare Advantage, +108005,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,HEALTHPLUS-Medicare Advantage, +108006,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,HEALTHPLUS-Medicare Advantage, +108007,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,HEALTHPLUS-Medicare Advantage, +108008,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,HEALTHPLUS-Medicare Advantage, +108009,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,HEALTHPLUS-Medicare Advantage, +108010,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,HEALTHPLUS-Medicare Advantage, +108011,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,HEALTHPLUS-Medicare Advantage, +108012,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,HEALTHPLUS-Medicare Advantage, +108013,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,HEALTHPLUS-Medicare Advantage, +108014,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,HEALTHPLUS-Medicare Advantage, +108015,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,HEALTHPLUS-Medicare Advantage, +108016,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,HEALTHPLUS-Medicare Advantage, +108017,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,HEALTHPLUS-Medicare Advantage, +108018,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,HEALTHPLUS-Medicare Advantage, +108019,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,HEALTHPLUS-Medicare Advantage, +108020,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,HEALTHPLUS-Medicare Advantage, +108021,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,HEALTHPLUS-Medicare Advantage, +108022,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,HEALTHPLUS-Medicare Advantage, +108023,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,HEALTHPLUS-Medicare Advantage, +108024,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,HEALTHPLUS-Medicare Advantage, +108025,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,HEALTHPLUS-Medicare Advantage, +108026,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,HEALTHPLUS-Medicare Advantage, +108027,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,HEALTHPLUS-Medicare Advantage, +108028,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,HEALTHPLUS-Medicare Advantage, +108029,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,HEALTHPLUS-Medicare Advantage, +108030,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,HEALTHPLUS-Medicare Advantage, +108031,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,HEALTHPLUS-Medicare Advantage, +108032,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,HEALTHPLUS-Medicare Advantage, +108033,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,HEALTHPLUS-Medicare Advantage, +108034,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,HEALTHPLUS-Medicare Advantage, +108035,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,HEALTHPLUS-Medicare Advantage, +108036,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,HEALTHPLUS-Medicare Advantage, +108037,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,HEALTHPLUS-Medicare Advantage, +108038,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,HEALTHPLUS-Medicare Advantage, +108039,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,HEALTHPLUS-Medicare Advantage, +108040,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,HEALTHPLUS-Medicare Advantage, +108041,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,HEALTHPLUS-Medicare Advantage, +108042,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,HEALTHPLUS-Medicare Advantage, +108043,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,HEALTHPLUS-Medicare Advantage, +108044,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,HEALTHPLUS-Medicare Advantage, +108045,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,HEALTHPLUS-Medicare Advantage, +108046,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,HEALTHPLUS-Medicare Advantage, +108047,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,HEALTHPLUS-Medicare Advantage, +108048,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,HEALTHPLUS-Medicare Advantage, +108049,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,HEALTHPLUS-Medicare Advantage, +108050,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,HEALTHPLUS-Medicare Advantage, +108051,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,HEALTHPLUS-Medicare Advantage, +108052,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,HEALTHPLUS-Medicare Advantage, +108053,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,HEALTHPLUS-Medicare Advantage, +108054,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,HEALTHPLUS-Medicare Advantage, +108055,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,HEALTHPLUS-Medicare Advantage, +108056,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,HEALTHPLUS-Medicare Advantage, +108057,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,HEALTHPLUS-Medicare Advantage, +108058,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,HEALTHPLUS-Medicare Advantage, +108059,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,HEALTHPLUS-Medicare Advantage, +108060,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,HEALTHPLUS-Medicare Advantage, +108061,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,HEALTHPLUS-Medicare Advantage, +108062,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,HEALTHPLUS-Medicare Advantage, +108063,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,HEALTHPLUS-Medicare Advantage, +108064,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,HEALTHPLUS-Medicare Advantage, +108065,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,HEALTHPLUS-Medicare Advantage, +108066,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,HEALTHPLUS-Medicare Advantage, +108067,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,HEALTHPLUS-Medicare Advantage, +108068,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,HEALTHPLUS-Medicare Advantage, +108069,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,HEALTHPLUS-Medicare Advantage, +108070,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,HEALTHPLUS-Medicare Advantage, +108071,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,HEALTHPLUS-Medicare Advantage, +108072,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,HEALTHPLUS-Medicare Advantage, +108073,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,HEALTHPLUS-Medicare Advantage, +108074,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,HEALTHPLUS-Medicare Advantage, +108075,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,HEALTHPLUS-Medicare Advantage, +108076,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,HEALTHPLUS-Medicare Advantage, +108077,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,HEALTHPLUS-Medicare Advantage, +108078,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,HEALTHPLUS-Medicare Advantage, +108079,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,HEALTHPLUS-Medicare Advantage, +108080,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,HEALTHPLUS-Medicare Advantage, +108081,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,HEALTHPLUS-Medicare Advantage, +108082,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,HEALTHPLUS-Medicare Advantage, +108083,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,HEALTHPLUS-Medicare Advantage, +108084,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,HEALTHPLUS-Medicare Advantage, +108085,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,HEALTHPLUS-Medicare Advantage, +108086,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,HEALTHPLUS-Medicare Advantage, +108087,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,HEALTHPLUS-Medicare Advantage, +108088,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,HEALTHPLUS-Medicare Advantage, +108089,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,HEALTHPLUS-Medicare Advantage, +108090,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,HEALTHPLUS-Medicare Advantage, +108091,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,HEALTHPLUS-Medicare Advantage, +108092,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,HEALTHPLUS-Medicare Advantage, +108093,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,HEALTHPLUS-Medicare Advantage, +108094,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,HEALTHPLUS-Medicare Advantage, +108095,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,HEALTHPLUS-Medicare Advantage, +108096,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,HEALTHPLUS-Medicare Advantage, +108097,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,HEALTHPLUS-Medicare Advantage, +108098,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,HEALTHPLUS-Medicare Advantage, +108099,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,HEALTHPLUS-Medicare Advantage, +108100,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,HEALTHPLUS-Medicare Advantage, +108101,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,HEALTHPLUS-Medicare Advantage, +108102,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,HEALTHPLUS-Medicare Advantage, +108103,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,HEALTHPLUS-Medicare Advantage, +108104,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,HEALTHPLUS-Medicare Advantage, +108105,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,HEALTHPLUS-Medicare Advantage, +108106,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,HEALTHPLUS-Medicare Advantage, +108107,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,HEALTHPLUS-Medicare Advantage, +108108,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,HEALTHPLUS-Medicare Advantage, +108109,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,HEALTHPLUS-Medicare Advantage, +108110,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,HEALTHPLUS-Medicare Advantage, +108111,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,HEALTHPLUS-Medicare Advantage, +108112,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,HEALTHPLUS-Medicare Advantage, +108113,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,HEALTHPLUS-Medicare Advantage, +108114,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,HEALTHPLUS-Medicare Advantage, +108115,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,HEALTHPLUS-Medicare Advantage, +108116,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,HEALTHPLUS-Medicare Advantage, +108117,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,HEALTHPLUS-Medicare Advantage, +108118,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,HEALTHPLUS-Medicare Advantage, +108119,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,HEALTHPLUS-Medicare Advantage, +108120,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,HEALTHPLUS-Medicare Advantage, +108121,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,HEALTHPLUS-Medicare Advantage, +108122,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,HEALTHPLUS-Medicare Advantage, +108123,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,HEALTHPLUS-Medicare Advantage, +108124,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,HEALTHPLUS-Medicare Advantage, +108125,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,HEALTHPLUS-Medicare Advantage, +108126,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,HEALTHPLUS-Medicare Advantage, +108127,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,HEALTHPLUS-Medicare Advantage, +108128,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,HEALTHPLUS-Medicare Advantage,492.85 +108129,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,HEALTHPLUS-Medicare Advantage, +108130,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,HEALTHPLUS-Medicare Advantage, +108131,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,HEALTHPLUS-Medicare Advantage, +108132,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,HEALTHPLUS-Medicare Advantage, +108133,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,HEALTHPLUS-Medicare Advantage, +108134,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,HEALTHPLUS-Medicare Advantage, +108135,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,HEALTHPLUS-Medicare Advantage, +108136,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,HEALTHPLUS-Medicare Advantage, +108137,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,HEALTHPLUS-Medicare Advantage, +108138,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,HEALTHPLUS-Medicare Advantage, +108139,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,HEALTHPLUS-Medicare Advantage, +108140,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,HEALTHPLUS-Medicare Advantage, +108141,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,HEALTHPLUS-Medicare Advantage, +108142,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,HEALTHPLUS-Medicare Advantage, +108143,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,HEALTHPLUS-Medicare Advantage, +108144,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,HEALTHPLUS-Medicare Advantage, +108145,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,HEALTHPLUS-Medicare Advantage, +108146,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,HEALTHPLUS-Medicare Advantage, +108147,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,HEALTHPLUS-Medicare Advantage, +108148,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,HEALTHPLUS-Medicare Advantage, +108149,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,HEALTHPLUS-Medicare Advantage, +108150,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,HEALTHPLUS-Medicare Advantage, +108151,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,HEALTHPLUS-Medicare Advantage, +108152,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,HEALTHPLUS-Medicare Advantage, +108153,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,HEALTHPLUS-Medicare Advantage, +108154,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,HEALTHPLUS-Medicare Advantage, +108155,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,HEALTHPLUS-Medicare Advantage, +108156,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,HEALTHPLUS-Medicare Advantage, +108157,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,HEALTHPLUS-Medicare Advantage, +108158,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,HEALTHPLUS-Medicare Advantage, +108159,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,HEALTHPLUS-Medicare Advantage, +108160,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,HEALTHPLUS-Medicare Advantage, +108161,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,HEALTHPLUS-Medicare Advantage, +108162,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,HEALTHPLUS-Medicare Advantage, +108163,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,HEALTHPLUS-Medicare Advantage, +108164,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,HEALTHPLUS-Medicare Advantage, +108165,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,HEALTHPLUS-Medicare Advantage, +108166,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,HEALTHPLUS-Medicare Advantage, +108167,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,HEALTHPLUS-Medicare Advantage, +108168,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,HEALTHPLUS-Medicare Advantage, +108169,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,HEALTHPLUS-Medicare Advantage, +108170,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,HEALTHPLUS-Medicare Advantage, +108171,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,HEALTHPLUS-Medicare Advantage, +108172,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,HEALTHPLUS-Medicare Advantage, +108173,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,HEALTHPLUS-Medicare Advantage, +108174,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,HEALTHPLUS-Medicare Advantage, +108175,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,HEALTHPLUS-Medicare Advantage, +108176,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,HEALTHPLUS-Medicare Advantage, +108177,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,HEALTHPLUS-Medicare Advantage, +108178,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,HEALTHPLUS-Medicare Advantage, +108179,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,HEALTHPLUS-Medicare Advantage, +108180,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,HEALTHPLUS-Medicare Advantage, +108181,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,HEALTHPLUS-Medicare Advantage, +108182,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,HEALTHPLUS-Medicare Advantage, +108183,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,HEALTHPLUS-Medicare Advantage, +108184,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,HEALTHPLUS-Medicare Advantage, +108185,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,HEALTHPLUS-Medicare Advantage, +108186,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,HEALTHPLUS-Medicare Advantage, +108187,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,HEALTHPLUS-Medicare Advantage, +108188,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,HEALTHPLUS-Medicare Advantage, +108189,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,HEALTHPLUS-Medicare Advantage, +108190,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,HEALTHPLUS-Medicare Advantage, +108191,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,HEALTHPLUS-Medicare Advantage, +108192,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,HEALTHPLUS-Medicare Advantage, +108193,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,HEALTHPLUS-Medicare Advantage, +108194,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,HEALTHPLUS-Medicare Advantage, +108195,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,HEALTHPLUS-Medicare Advantage, +108196,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,HEALTHPLUS-Medicare Advantage, +108197,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,HEALTHPLUS-Medicare Advantage, +108198,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,HEALTHPLUS-Medicare Advantage, +108199,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,HEALTHPLUS-Medicare Advantage, +108200,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,HEALTHPLUS-Medicare Advantage, +108201,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,HEALTHPLUS-Medicare Advantage, +108202,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,HEALTHPLUS-Medicare Advantage, +108203,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,HEALTHPLUS-Medicare Advantage, +108204,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,HEALTHPLUS-Medicare Advantage, +108205,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,HEALTHPLUS-Medicare Advantage, +108206,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,HEALTHPLUS-Medicare Advantage, +108207,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,HEALTHPLUS-Medicare Advantage, +108208,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,HEALTHPLUS-Medicare Advantage, +108209,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,HEALTHPLUS-Medicare Advantage, +108210,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,HEALTHPLUS-Medicare Advantage, +108211,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,HEALTHPLUS-Medicare Advantage, +108212,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,HEALTHPLUS-Medicare Advantage, +108213,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,HEALTHPLUS-Medicare Advantage, +108214,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,HEALTHPLUS-Medicare Advantage, +108215,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,HEALTHPLUS-Medicare Advantage, +108216,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,HEALTHPLUS-Medicare Advantage, +108217,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,HEALTHPLUS-Medicare Advantage, +108218,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,HEALTHPLUS-Medicare Advantage, +108219,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,HEALTHPLUS-Medicare Advantage, +108220,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,HEALTHPLUS-Medicare Advantage, +108221,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,HEALTHPLUS-Medicare Advantage, +108222,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,HEALTHPLUS-Medicare Advantage, +108223,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,HEALTHPLUS-Medicare Advantage, +108224,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,HEALTHPLUS-Medicare Advantage, +108225,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,HEALTHPLUS-Medicare Advantage, +108226,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,HEALTHPLUS-Medicare Advantage, +108227,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,HEALTHPLUS-Medicare Advantage, +108228,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,HEALTHPLUS-Medicare Advantage, +108229,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,HEALTHPLUS-Medicare Advantage, +108230,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,HEALTHPLUS-Medicare Advantage, +108231,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,HEALTHPLUS-Medicare Advantage, +108232,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,HEALTHPLUS-Medicare Advantage, +108233,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,HEALTHPLUS-Medicare Advantage, +108234,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,HEALTHPLUS-Medicare Advantage, +108235,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,HEALTHPLUS-Medicare Advantage, +108236,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,HEALTHPLUS-Medicare Advantage, +108237,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,HEALTHPLUS-Medicare Advantage,35.92 +108238,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,HEALTHPLUS-Medicare Advantage, +108239,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,HEALTHPLUS-Medicare Advantage, +108240,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,HEALTHPLUS-Medicare Advantage, +108241,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,HEALTHPLUS-Medicare Advantage, +108242,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,HEALTHPLUS-Medicare Advantage, +108243,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,HEALTHPLUS-Medicare Advantage, +108244,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,HEALTHPLUS-Medicare Advantage, +108245,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,HEALTHPLUS-Medicare Advantage, +108246,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,HEALTHPLUS-Medicare Advantage, +108247,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,HEALTHPLUS-Medicare Advantage, +108248,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108249,3934,30000012,PRIVATE,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108250,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108251,3934,30000038,ICU,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108252,3934,30000046,BURN UNIT,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108253,3934,30000053,NICU,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108254,3934,30000061,ICR ROOM,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108255,3934,30000079,PSYCH,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108256,3934,30000087,NEWBORN,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108257,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108258,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108259,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108260,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108261,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108262,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108263,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108264,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108265,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108266,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108267,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108268,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108269,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108270,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108271,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108272,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108273,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108274,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108275,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108276,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108277,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108278,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108279,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108280,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108281,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108282,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108283,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108284,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108285,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108286,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108287,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108288,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108289,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108290,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108291,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108292,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108293,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108294,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108295,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108296,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108297,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108298,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108299,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108300,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108301,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108302,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108303,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108304,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108305,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108306,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108307,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108308,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108309,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108310,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108311,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108312,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108313,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108314,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108315,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108316,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108317,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108318,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108319,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108320,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108321,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108322,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108323,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108324,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108325,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108326,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108327,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108328,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108329,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108330,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108331,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108332,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108333,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108334,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108335,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108336,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108337,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108338,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108339,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108340,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108341,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108342,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108343,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108344,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108345,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108346,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108347,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108348,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108349,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108350,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108351,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108352,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108353,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108354,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108355,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108356,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108357,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108358,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108359,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108360,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108361,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108362,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108363,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108364,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108365,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108366,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108367,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108368,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108369,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108370,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108371,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108372,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108373,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108374,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108375,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108376,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108377,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108378,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108379,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108380,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108381,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108382,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108383,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108384,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108385,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108386,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108387,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108388,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108389,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108390,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108391,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108392,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108393,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108394,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108395,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108396,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108397,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108398,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108399,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108400,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108401,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108402,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108403,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108404,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108405,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108406,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108407,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108408,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108409,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108410,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108411,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108412,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108413,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108414,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108415,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108416,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108417,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108418,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108419,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108420,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108421,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108422,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108423,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108424,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108425,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108426,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108427,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108428,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108429,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108430,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108431,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108432,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108433,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108434,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108435,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108436,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108437,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108438,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108439,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108440,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108441,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108442,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108443,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108444,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108445,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108446,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108447,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108448,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108449,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108450,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108451,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108452,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108453,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108454,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108455,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108456,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108457,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108458,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108459,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108460,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108461,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108462,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108463,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108464,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108465,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108466,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108467,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108468,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108469,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108470,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108471,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108472,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108473,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108474,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108475,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108476,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108477,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108478,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108479,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108480,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108481,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108482,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108483,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108484,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108485,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108486,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108487,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108488,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108489,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108490,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108491,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108492,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108493,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108494,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108495,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108496,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108497,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108498,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108499,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108500,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108501,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108502,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108503,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108504,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108505,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108506,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108507,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108508,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108509,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108510,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108511,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108512,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108513,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108514,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108515,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108516,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108517,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108518,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108519,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108520,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108521,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108522,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108523,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108524,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108525,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108526,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108527,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108528,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108529,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108530,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108531,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108532,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108533,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108534,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108535,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108536,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108537,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108538,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108539,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108540,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108541,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108542,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108543,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108544,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108545,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108546,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108547,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108548,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108549,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108550,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108551,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108552,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108553,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108554,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108555,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108556,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108557,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108558,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108559,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108560,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108561,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108562,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108563,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108564,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108565,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108566,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108567,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108568,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108569,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108570,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108571,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108572,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108573,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108574,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108575,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108576,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108577,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108578,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108579,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108580,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108581,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108582,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108583,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108584,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108585,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108586,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108587,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108588,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108589,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108590,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108591,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108592,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108593,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108594,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108595,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108596,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108597,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108598,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108599,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108600,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108601,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108602,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108603,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108604,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108605,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108606,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108607,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108608,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108609,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108610,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108611,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108612,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108613,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108614,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108615,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108616,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108617,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108618,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108619,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108620,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108621,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108622,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108623,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108624,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108625,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108626,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108627,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108628,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108629,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108630,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108631,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108632,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108633,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108634,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108635,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108636,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108637,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108638,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108639,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108640,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108641,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108642,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108643,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108644,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108645,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108646,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108647,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108648,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108649,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108650,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108651,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108652,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108653,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108654,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108655,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108656,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108657,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108658,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108659,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108660,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108661,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108662,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108663,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108664,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108665,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108666,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,HEALTHPLUS-Medicare Advantage, +108667,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108668,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108669,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108670,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108671,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108672,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108673,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,HEALTHPLUS-Medicare Advantage, +108674,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108675,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108676,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108677,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108678,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108679,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108680,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108681,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108682,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108683,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108684,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108685,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108686,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108687,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108688,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108689,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108690,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108691,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,HEALTHPLUS-Medicare Advantage, +108692,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,HEALTHPLUS-Medicare Advantage, +108693,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,HEALTHPLUS-Medicare Advantage, +108694,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,HEALTHPLUS-Medicare Advantage, +108695,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,HEALTHPLUS-Medicare Advantage, +108696,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,HEALTHPLUS-Medicare Advantage, +108697,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,HEALTHPLUS-Medicare Advantage, +108698,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108699,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108700,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108701,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108702,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108703,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108704,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108705,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108706,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108707,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108708,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108709,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108710,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,HEALTHPLUS-Medicare Advantage, +108711,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,HEALTHPLUS-Medicare Advantage, +108712,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,HEALTHPLUS-Medicare Advantage, +108713,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,HEALTHPLUS-Medicare Advantage, +108714,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,HEALTHPLUS-Medicare Advantage, +108715,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,HEALTHPLUS-Medicare Advantage, +108716,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,HEALTHPLUS-Medicare Advantage, +108717,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,HEALTHPLUS-Medicare Advantage, +108718,3934,37112000,ACUTE ED,,1580.0,1580.0,,,HEALTHPLUS-Medicare Advantage, +108719,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,HEALTHPLUS-Medicare Advantage, +108720,3934,37112034,TRIAGE,,277.0,277.0,,,HEALTHPLUS-Medicare Advantage, +108721,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,HEALTHPLUS-Medicare Advantage, +108722,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,HEALTHPLUS-Medicare Advantage, +108723,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,HEALTHPLUS-Medicare Advantage, +108724,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,HEALTHPLUS-Medicare Advantage, +108725,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,HEALTHPLUS-Medicare Advantage, +108726,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,HEALTHPLUS-Medicare Advantage, +108727,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,HEALTHPLUS-Medicare Advantage, +108728,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,HEALTHPLUS-Medicare Advantage, +108729,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,HEALTHPLUS-Medicare Advantage, +108730,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,HEALTHPLUS-Medicare Advantage, +108731,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,HEALTHPLUS-Medicare Advantage, +108732,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,HEALTHPLUS-Medicare Advantage, +108733,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,HEALTHPLUS-Medicare Advantage, +108734,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,HEALTHPLUS-Medicare Advantage, +108735,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,HEALTHPLUS-Medicare Advantage, +108736,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,HEALTHPLUS-Medicare Advantage, +108737,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,HEALTHPLUS-Medicare Advantage, +108738,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,HEALTHPLUS-Medicare Advantage, +108739,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,HEALTHPLUS-Medicare Advantage, +108740,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,HEALTHPLUS-Medicare Advantage, +108741,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,HEALTHPLUS-Medicare Advantage, +108742,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,HEALTHPLUS-Medicare Advantage, +108743,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,HEALTHPLUS-Medicare Advantage, +108744,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,HEALTHPLUS-Medicare Advantage, +108745,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,HEALTHPLUS-Medicare Advantage, +108746,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,HEALTHPLUS-Medicare Advantage, +108747,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,HEALTHPLUS-Medicare Advantage, +108748,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,HEALTHPLUS-Medicare Advantage, +108749,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,HEALTHPLUS-Medicare Advantage, +108750,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,HEALTHPLUS-Medicare Advantage, +108751,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,HEALTHPLUS-Medicare Advantage, +108752,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,HEALTHPLUS-Medicare Advantage, +108753,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,HEALTHPLUS-Medicare Advantage, +108754,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,HEALTHPLUS-Medicare Advantage, +108755,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,HEALTHPLUS-Medicare Advantage, +108756,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,HEALTHPLUS-Medicare Advantage, +108757,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,HEALTHPLUS-Medicare Advantage, +108758,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,HEALTHPLUS-Medicare Advantage, +108759,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,HEALTHPLUS-Medicare Advantage, +108760,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,HEALTHPLUS-Medicare Advantage, +108761,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,HEALTHPLUS-Medicare Advantage, +108762,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,HEALTHPLUS-Medicare Advantage, +108763,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,HEALTHPLUS-Medicare Advantage, +108764,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,HEALTHPLUS-Medicare Advantage, +108765,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,HEALTHPLUS-Medicare Advantage, +108766,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,HEALTHPLUS-Medicare Advantage, +108767,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,HEALTHPLUS-Medicare Advantage, +108768,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,HEALTHPLUS-Medicare Advantage, +108769,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,HEALTHPLUS-Medicare Advantage, +108770,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,HEALTHPLUS-Medicare Advantage, +108771,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,HEALTHPLUS-Medicare Advantage, +108772,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,HEALTHPLUS-Medicare Advantage, +108773,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,HEALTHPLUS-Medicare Advantage, +108774,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,HEALTHPLUS-Medicare Advantage, +108775,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,HEALTHPLUS-Medicare Advantage, +108776,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,HEALTHPLUS-Medicare Advantage, +108777,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,HEALTHPLUS-Medicare Advantage, +108778,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-Medicare Advantage, +108779,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-Medicare Advantage, +108780,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-Medicare Advantage, +108781,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-Medicare Advantage, +108782,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-Medicare Advantage, +108783,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-Medicare Advantage, +108784,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-Medicare Advantage, +108785,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-Medicare Advantage, +108786,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-Medicare Advantage, +108787,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-Medicare Advantage, +108788,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-Medicare Advantage, +108789,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-Medicare Advantage, +108790,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-Medicare Advantage, +108791,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-Medicare Advantage, +108792,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-Medicare Advantage, +108793,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-Medicare Advantage, +108794,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-Medicare Advantage, +108795,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-Medicare Advantage, +108796,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-Medicare Advantage, +108797,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-Medicare Advantage, +108798,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-Medicare Advantage, +108799,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,HEALTHPLUS-Medicare Advantage, +108800,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,HEALTHPLUS-Medicare Advantage, +108801,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,HEALTHPLUS-Medicare Advantage, +108802,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,HEALTHPLUS-Medicare Advantage, +108803,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,HEALTHPLUS-Medicare Advantage, +108804,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,HEALTHPLUS-Medicare Advantage, +108805,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,HEALTHPLUS-Medicare Advantage, +108806,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,HEALTHPLUS-Medicare Advantage, +108807,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,HEALTHPLUS-Medicare Advantage, +108808,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,HEALTHPLUS-Medicare Advantage, +108809,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,HEALTHPLUS-Medicare Advantage, +108810,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,HEALTHPLUS-Medicare Advantage, +108811,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,HEALTHPLUS-Medicare Advantage, +108812,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,HEALTHPLUS-Medicare Advantage, +108813,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,HEALTHPLUS-Medicare Advantage, +108814,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,HEALTHPLUS-Medicare Advantage, +108815,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,HEALTHPLUS-Medicare Advantage, +108816,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,HEALTHPLUS-Medicare Advantage, +108817,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,HEALTHPLUS-Medicare Advantage, +108818,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,HEALTHPLUS-Medicare Advantage, +108819,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,HEALTHPLUS-Medicare Advantage, +108820,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicare Advantage, +108821,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108822,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108823,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108824,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108825,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108826,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,HEALTHPLUS-Medicare Advantage, +108827,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,HEALTHPLUS-Medicare Advantage, +108828,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,HEALTHPLUS-Medicare Advantage, +108829,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108830,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108831,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108832,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,HEALTHPLUS-Medicare Advantage, +108833,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,HEALTHPLUS-Medicare Advantage, +108834,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,HEALTHPLUS-Medicare Advantage, +108835,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,HEALTHPLUS-Medicare Advantage, +108836,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,HEALTHPLUS-Medicare Advantage, +108837,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,HEALTHPLUS-Medicare Advantage, +108838,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,HEALTHPLUS-Medicare Advantage, +108839,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,HEALTHPLUS-Medicare Advantage, +108840,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,HEALTHPLUS-Medicare Advantage, +108841,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,HEALTHPLUS-Medicare Advantage, +108842,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,HEALTHPLUS-Medicare Advantage, +108843,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,HEALTHPLUS-Medicare Advantage, +108844,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,HEALTHPLUS-Medicare Advantage, +108845,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,HEALTHPLUS-Medicare Advantage, +108846,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,HEALTHPLUS-Medicare Advantage, +108847,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,HEALTHPLUS-Medicare Advantage, +108848,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,HEALTHPLUS-Medicare Advantage, +108849,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,HEALTHPLUS-Medicare Advantage, +108850,3934,43301043,ALBUNEX,,357.0,357.0,,,HEALTHPLUS-Medicare Advantage, +108851,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,HEALTHPLUS-Medicare Advantage, +108852,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108853,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108854,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108855,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108856,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108857,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,HEALTHPLUS-Medicare Advantage, +108858,3934,43450022,REC RM .5HR,,541.0,541.0,,,HEALTHPLUS-Medicare Advantage, +108859,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,HEALTHPLUS-Medicare Advantage, +108860,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,HEALTHPLUS-Medicare Advantage, +108861,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,HEALTHPLUS-Medicare Advantage, +108862,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,HEALTHPLUS-Medicare Advantage, +108863,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,HEALTHPLUS-Medicare Advantage, +108864,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,HEALTHPLUS-Medicare Advantage, +108865,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,HEALTHPLUS-Medicare Advantage, +108866,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,HEALTHPLUS-Medicare Advantage, +108867,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,HEALTHPLUS-Medicare Advantage, +108868,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,HEALTHPLUS-Medicare Advantage, +108869,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,HEALTHPLUS-Medicare Advantage, +108870,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,HEALTHPLUS-Medicare Advantage, +108871,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,HEALTHPLUS-Medicare Advantage, +108872,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,HEALTHPLUS-Medicare Advantage, +108873,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,HEALTHPLUS-Medicare Advantage, +108874,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,HEALTHPLUS-Medicare Advantage, +108875,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicare Advantage, +108876,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108877,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108878,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108879,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108880,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108881,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,HEALTHPLUS-Medicare Advantage, +108882,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108883,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicare Advantage, +108884,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108885,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108886,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108887,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108888,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,HEALTHPLUS-Medicare Advantage, +108889,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicare Advantage, +108890,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108891,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108892,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108893,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108894,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108895,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicare Advantage, +108896,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108897,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108898,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108899,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108900,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108901,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,HEALTHPLUS-Medicare Advantage, +108902,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,HEALTHPLUS-Medicare Advantage, +108903,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,HEALTHPLUS-Medicare Advantage, +108904,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,HEALTHPLUS-Medicare Advantage, +108905,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,HEALTHPLUS-Medicare Advantage, +108906,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,HEALTHPLUS-Medicare Advantage, +108907,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,HEALTHPLUS-Medicare Advantage, +108908,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,HEALTHPLUS-Medicare Advantage, +108909,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicare Advantage, +108910,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108911,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108912,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108913,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108914,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108915,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108916,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,HEALTHPLUS-Medicare Advantage, +108917,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,HEALTHPLUS-Medicare Advantage, +108918,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,HEALTHPLUS-Medicare Advantage, +108919,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,HEALTHPLUS-Medicare Advantage, +108920,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,HEALTHPLUS-Medicare Advantage, +108921,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-Medicare Advantage, +108922,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-Medicare Advantage, +108923,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-Medicare Advantage, +108924,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,HEALTHPLUS-Medicare Advantage, +108925,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,HEALTHPLUS-Medicare Advantage, +108926,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,HEALTHPLUS-Medicare Advantage, +108927,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,HEALTHPLUS-Medicare Advantage, +108928,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,HEALTHPLUS-Medicare Advantage, +108929,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,HEALTHPLUS-Medicare Advantage, +108930,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,HEALTHPLUS-Medicare Advantage, +108931,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,HEALTHPLUS-Medicare Advantage, +108932,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,HEALTHPLUS-Medicare Advantage, +108933,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,HEALTHPLUS-Medicare Advantage, +108934,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,HEALTHPLUS-Medicare Advantage, +108935,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,HEALTHPLUS-Medicare Advantage, +108936,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,HEALTHPLUS-Medicare Advantage, +108937,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,HEALTHPLUS-Medicare Advantage, +108938,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,HEALTHPLUS-Medicare Advantage, +108939,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,HEALTHPLUS-Medicare Advantage, +108940,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,HEALTHPLUS-Medicare Advantage, +108941,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,HEALTHPLUS-Medicare Advantage, +108942,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,HEALTHPLUS-Medicare Advantage, +108943,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,HEALTHPLUS-Medicare Advantage, +108944,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,HEALTHPLUS-Medicare Advantage, +108945,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,HEALTHPLUS-Medicare Advantage, +108946,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,HEALTHPLUS-Medicare Advantage, +108947,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,HEALTHPLUS-Medicare Advantage, +108948,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,HEALTHPLUS-Medicare Advantage, +108949,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,HEALTHPLUS-Medicare Advantage, +108950,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,HEALTHPLUS-Medicare Advantage, +108951,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,HEALTHPLUS-Medicare Advantage, +108952,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,HEALTHPLUS-Medicare Advantage, +108953,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,HEALTHPLUS-Medicare Advantage, +108954,3934,45924552,ENDO REC RM,,30.0,30.0,,,HEALTHPLUS-Medicare Advantage, +108955,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,HEALTHPLUS-Medicare Advantage, +108956,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,HEALTHPLUS-Medicare Advantage, +108957,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,HEALTHPLUS-Medicare Advantage, +108958,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,HEALTHPLUS-Medicare Advantage, +108959,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,HEALTHPLUS-Medicare Advantage, +108960,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,HEALTHPLUS-Medicare Advantage, +108961,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,HEALTHPLUS-Medicare Advantage, +108962,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,HEALTHPLUS-Medicare Advantage, +108963,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,HEALTHPLUS-Medicare Advantage, +108964,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,HEALTHPLUS-Medicare Advantage, +108965,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,HEALTHPLUS-Medicare Advantage, +108966,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,HEALTHPLUS-Medicare Advantage, +108967,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,HEALTHPLUS-Medicare Advantage, +108968,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,HEALTHPLUS-Medicare Advantage, +108969,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,HEALTHPLUS-Medicare Advantage, +108970,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,HEALTHPLUS-Medicare Advantage, +108971,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,HEALTHPLUS-Medicare Advantage, +108972,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,HEALTHPLUS-Medicare Advantage, +108973,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,HEALTHPLUS-Medicare Advantage, +108974,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,HEALTHPLUS-Medicare Advantage, +108975,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,HEALTHPLUS-Medicare Advantage, +108976,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,HEALTHPLUS-Medicare Advantage, +108977,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,HEALTHPLUS-Medicare Advantage, +108978,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,HEALTHPLUS-Medicare Advantage, +108979,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,HEALTHPLUS-Medicare Advantage, +108980,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,HEALTHPLUS-Medicare Advantage, +108981,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,HEALTHPLUS-Medicare Advantage, +108982,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,HEALTHPLUS-Medicare Advantage, +108983,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,HEALTHPLUS-Medicare Advantage, +108984,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,HEALTHPLUS-Medicare Advantage, +108985,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,HEALTHPLUS-Medicare Advantage, +108986,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,HEALTHPLUS-Medicare Advantage, +108987,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,HEALTHPLUS-Medicare Advantage, +108988,3934,53200010,GUEST TRAY,,24.0,24.0,,,HEALTHPLUS-Medicare Advantage, +108989,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,HEALTHPLUS-Medicare Advantage, +108990,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,HEALTHPLUS-Medicare Advantage, +108991,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,HEALTHPLUS-Medicare Advantage, +108992,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,HEALTHPLUS-Medicare Advantage, +108993,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,HEALTHPLUS-Medicare Advantage, +108994,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,HEALTHPLUS-Medicare Advantage, +108995,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,HEALTHPLUS-Medicare Advantage, +108996,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,HEALTHPLUS-Medicare Advantage, +108997,3934,53329876,HIV MONITORING,,416.0,416.0,,,HEALTHPLUS-Medicare Advantage, +108998,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,HEALTHPLUS-Medicare Advantage, +108999,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,HEALTHPLUS-Medicare Advantage, +109000,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,HEALTHPLUS-Medicare Advantage, +109001,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,HEALTHPLUS-Medicare Advantage, +109002,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,HEALTHPLUS-Medicare Advantage, +109003,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,HEALTHPLUS-Medicare Advantage, +109004,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,HEALTHPLUS-Medicare Advantage, +109005,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,HEALTHPLUS-Medicare Advantage, +109006,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,HEALTHPLUS-Medicare Advantage, +109007,3934,76010107,COPY X-RAY,,22.0,22.0,,,HEALTHPLUS-Medicare Advantage, +109008,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,HEALTHPLUS-Medicare Advantage, +109009,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,HEALTHPLUS-Medicare Advantage, +109010,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,HEALTHPLUS-Medicare Advantage, +109011,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,HEALTHPLUS-Medicare Advantage, +109012,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,HEALTHPLUS-Medicare Advantage, +109013,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,HEALTHPLUS-Medicare Advantage, +109014,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,HEALTHPLUS-Medicare Advantage, +109015,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,HEALTHPLUS-Medicare Advantage, +109016,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,HEALTHPLUS-Medicare Advantage, +109017,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,HEALTHPLUS-Medicare Advantage, +109018,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,HEALTHPLUS-Medicare Advantage, +109019,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,HEALTHPLUS-Medicare Advantage, +109020,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,MEDICAID-Traditional Medicaid, +109021,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,MEDICAID-Traditional Medicaid, +109022,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,MEDICAID-Traditional Medicaid, +109023,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,MEDICAID-Traditional Medicaid, +109024,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,MEDICAID-Traditional Medicaid, +109025,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,MEDICAID-Traditional Medicaid, +109026,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,MEDICAID-Traditional Medicaid, +109027,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,MEDICAID-Traditional Medicaid, +109028,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,MEDICAID-Traditional Medicaid, +109029,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,MEDICAID-Traditional Medicaid, +109030,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,MEDICAID-Traditional Medicaid, +109031,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,MEDICAID-Traditional Medicaid, +109032,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,MEDICAID-Traditional Medicaid, +109033,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,MEDICAID-Traditional Medicaid, +109034,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,MEDICAID-Traditional Medicaid, +109035,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,MEDICAID-Traditional Medicaid, +109036,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,MEDICAID-Traditional Medicaid, +109037,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,MEDICAID-Traditional Medicaid, +109038,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,MEDICAID-Traditional Medicaid, +109039,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,MEDICAID-Traditional Medicaid, +109040,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,MEDICAID-Traditional Medicaid, +109041,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,MEDICAID-Traditional Medicaid, +109042,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,MEDICAID-Traditional Medicaid, +109043,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,MEDICAID-Traditional Medicaid, +109044,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,MEDICAID-Traditional Medicaid, +109045,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,MEDICAID-Traditional Medicaid, +109046,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,MEDICAID-Traditional Medicaid, +109047,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,MEDICAID-Traditional Medicaid, +109048,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,MEDICAID-Traditional Medicaid, +109049,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,MEDICAID-Traditional Medicaid, +109050,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,MEDICAID-Traditional Medicaid, +109051,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,MEDICAID-Traditional Medicaid, +109052,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,MEDICAID-Traditional Medicaid, +109053,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,MEDICAID-Traditional Medicaid, +109054,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,MEDICAID-Traditional Medicaid, +109055,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,MEDICAID-Traditional Medicaid, +109056,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,MEDICAID-Traditional Medicaid, +109057,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,MEDICAID-Traditional Medicaid, +109058,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,MEDICAID-Traditional Medicaid, +109059,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,MEDICAID-Traditional Medicaid, +109060,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,MEDICAID-Traditional Medicaid, +109061,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,MEDICAID-Traditional Medicaid, +109062,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,MEDICAID-Traditional Medicaid, +109063,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,MEDICAID-Traditional Medicaid, +109064,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,MEDICAID-Traditional Medicaid, +109065,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,MEDICAID-Traditional Medicaid, +109066,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,MEDICAID-Traditional Medicaid, +109067,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,MEDICAID-Traditional Medicaid, +109068,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,MEDICAID-Traditional Medicaid, +109069,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,MEDICAID-Traditional Medicaid, +109070,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,MEDICAID-Traditional Medicaid, +109071,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,MEDICAID-Traditional Medicaid, +109072,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,MEDICAID-Traditional Medicaid, +109073,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,MEDICAID-Traditional Medicaid, +109074,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,MEDICAID-Traditional Medicaid, +109075,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,MEDICAID-Traditional Medicaid, +109076,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,MEDICAID-Traditional Medicaid, +109077,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,MEDICAID-Traditional Medicaid, +109078,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,MEDICAID-Traditional Medicaid, +109079,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,MEDICAID-Traditional Medicaid, +109080,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,MEDICAID-Traditional Medicaid, +109081,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,MEDICAID-Traditional Medicaid, +109082,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,MEDICAID-Traditional Medicaid, +109083,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,MEDICAID-Traditional Medicaid, +109084,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,MEDICAID-Traditional Medicaid, +109085,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,MEDICAID-Traditional Medicaid, +109086,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,MEDICAID-Traditional Medicaid, +109087,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,MEDICAID-Traditional Medicaid, +109088,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,MEDICAID-Traditional Medicaid, +109089,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,MEDICAID-Traditional Medicaid, +109090,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,MEDICAID-Traditional Medicaid, +109091,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,MEDICAID-Traditional Medicaid, +109092,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,MEDICAID-Traditional Medicaid, +109093,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,MEDICAID-Traditional Medicaid, +109094,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,MEDICAID-Traditional Medicaid, +109095,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,MEDICAID-Traditional Medicaid, +109096,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,MEDICAID-Traditional Medicaid, +109097,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,MEDICAID-Traditional Medicaid, +109098,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,MEDICAID-Traditional Medicaid, +109099,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,MEDICAID-Traditional Medicaid, +109100,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,MEDICAID-Traditional Medicaid, +109101,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,MEDICAID-Traditional Medicaid, +109102,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,MEDICAID-Traditional Medicaid, +109103,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,MEDICAID-Traditional Medicaid, +109104,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,MEDICAID-Traditional Medicaid, +109105,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,MEDICAID-Traditional Medicaid, +109106,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,MEDICAID-Traditional Medicaid, +109107,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,MEDICAID-Traditional Medicaid, +109108,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,MEDICAID-Traditional Medicaid, +109109,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,MEDICAID-Traditional Medicaid, +109110,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,MEDICAID-Traditional Medicaid, +109111,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,MEDICAID-Traditional Medicaid, +109112,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,MEDICAID-Traditional Medicaid, +109113,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,MEDICAID-Traditional Medicaid, +109114,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,MEDICAID-Traditional Medicaid, +109115,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,MEDICAID-Traditional Medicaid, +109116,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,MEDICAID-Traditional Medicaid, +109117,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,MEDICAID-Traditional Medicaid, +109118,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,MEDICAID-Traditional Medicaid, +109119,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,MEDICAID-Traditional Medicaid, +109120,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,MEDICAID-Traditional Medicaid, +109121,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,MEDICAID-Traditional Medicaid, +109122,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,MEDICAID-Traditional Medicaid, +109123,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,MEDICAID-Traditional Medicaid, +109124,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,MEDICAID-Traditional Medicaid, +109125,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,MEDICAID-Traditional Medicaid, +109126,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,MEDICAID-Traditional Medicaid, +109127,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,MEDICAID-Traditional Medicaid, +109128,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,MEDICAID-Traditional Medicaid, +109129,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,MEDICAID-Traditional Medicaid, +109130,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,MEDICAID-Traditional Medicaid, +109131,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,MEDICAID-Traditional Medicaid, +109132,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,MEDICAID-Traditional Medicaid, +109133,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,MEDICAID-Traditional Medicaid, +109134,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,MEDICAID-Traditional Medicaid, +109135,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,MEDICAID-Traditional Medicaid, +109136,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,MEDICAID-Traditional Medicaid, +109137,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,MEDICAID-Traditional Medicaid, +109138,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,MEDICAID-Traditional Medicaid, +109139,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,MEDICAID-Traditional Medicaid, +109140,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,MEDICAID-Traditional Medicaid, +109141,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,MEDICAID-Traditional Medicaid, +109142,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,MEDICAID-Traditional Medicaid, +109143,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,MEDICAID-Traditional Medicaid, +109144,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,MEDICAID-Traditional Medicaid, +109145,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,MEDICAID-Traditional Medicaid, +109146,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,MEDICAID-Traditional Medicaid, +109147,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,MEDICAID-Traditional Medicaid, +109148,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,MEDICAID-Traditional Medicaid, +109149,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,MEDICAID-Traditional Medicaid, +109150,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,MEDICAID-Traditional Medicaid, +109151,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,MEDICAID-Traditional Medicaid, +109152,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,MEDICAID-Traditional Medicaid, +109153,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,MEDICAID-Traditional Medicaid, +109154,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,MEDICAID-Traditional Medicaid, +109155,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,MEDICAID-Traditional Medicaid, +109156,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,MEDICAID-Traditional Medicaid, +109157,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,MEDICAID-Traditional Medicaid, +109158,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,MEDICAID-Traditional Medicaid, +109159,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,MEDICAID-Traditional Medicaid, +109160,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,MEDICAID-Traditional Medicaid, +109161,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,MEDICAID-Traditional Medicaid, +109162,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,MEDICAID-Traditional Medicaid, +109163,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,MEDICAID-Traditional Medicaid, +109164,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,MEDICAID-Traditional Medicaid, +109165,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,MEDICAID-Traditional Medicaid, +109166,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,MEDICAID-Traditional Medicaid, +109167,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,MEDICAID-Traditional Medicaid, +109168,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,MEDICAID-Traditional Medicaid, +109169,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,MEDICAID-Traditional Medicaid, +109170,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,MEDICAID-Traditional Medicaid, +109171,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,MEDICAID-Traditional Medicaid, +109172,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,MEDICAID-Traditional Medicaid, +109173,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,MEDICAID-Traditional Medicaid, +109174,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,MEDICAID-Traditional Medicaid, +109175,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,MEDICAID-Traditional Medicaid, +109176,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,MEDICAID-Traditional Medicaid, +109177,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,MEDICAID-Traditional Medicaid, +109178,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,MEDICAID-Traditional Medicaid, +109179,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,MEDICAID-Traditional Medicaid, +109180,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,MEDICAID-Traditional Medicaid, +109181,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,MEDICAID-Traditional Medicaid, +109182,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,MEDICAID-Traditional Medicaid, +109183,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,MEDICAID-Traditional Medicaid, +109184,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,MEDICAID-Traditional Medicaid, +109185,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,MEDICAID-Traditional Medicaid, +109186,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,MEDICAID-Traditional Medicaid, +109187,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,MEDICAID-Traditional Medicaid, +109188,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,MEDICAID-Traditional Medicaid, +109189,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,MEDICAID-Traditional Medicaid, +109190,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,MEDICAID-Traditional Medicaid, +109191,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,MEDICAID-Traditional Medicaid, +109192,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,MEDICAID-Traditional Medicaid, +109193,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,MEDICAID-Traditional Medicaid, +109194,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,MEDICAID-Traditional Medicaid, +109195,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,MEDICAID-Traditional Medicaid, +109196,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,MEDICAID-Traditional Medicaid, +109197,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,MEDICAID-Traditional Medicaid, +109198,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,MEDICAID-Traditional Medicaid, +109199,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,MEDICAID-Traditional Medicaid, +109200,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,MEDICAID-Traditional Medicaid, +109201,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,MEDICAID-Traditional Medicaid, +109202,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,MEDICAID-Traditional Medicaid, +109203,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,MEDICAID-Traditional Medicaid, +109204,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,MEDICAID-Traditional Medicaid, +109205,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,MEDICAID-Traditional Medicaid, +109206,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,MEDICAID-Traditional Medicaid, +109207,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,MEDICAID-Traditional Medicaid, +109208,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,MEDICAID-Traditional Medicaid, +109209,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,MEDICAID-Traditional Medicaid, +109210,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,MEDICAID-Traditional Medicaid, +109211,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,MEDICAID-Traditional Medicaid, +109212,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,MEDICAID-Traditional Medicaid, +109213,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,MEDICAID-Traditional Medicaid, +109214,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,MEDICAID-Traditional Medicaid, +109215,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,MEDICAID-Traditional Medicaid, +109216,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,MEDICAID-Traditional Medicaid, +109217,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,MEDICAID-Traditional Medicaid, +109218,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,MEDICAID-Traditional Medicaid, +109219,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,MEDICAID-Traditional Medicaid, +109220,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,MEDICAID-Traditional Medicaid, +109221,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,MEDICAID-Traditional Medicaid, +109222,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,MEDICAID-Traditional Medicaid, +109223,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,MEDICAID-Traditional Medicaid, +109224,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,MEDICAID-Traditional Medicaid, +109225,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,MEDICAID-Traditional Medicaid, +109226,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,MEDICAID-Traditional Medicaid, +109227,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,MEDICAID-Traditional Medicaid, +109228,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,MEDICAID-Traditional Medicaid, +109229,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,MEDICAID-Traditional Medicaid, +109230,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,MEDICAID-Traditional Medicaid, +109231,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,MEDICAID-Traditional Medicaid, +109232,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,MEDICAID-Traditional Medicaid, +109233,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,MEDICAID-Traditional Medicaid, +109234,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,MEDICAID-Traditional Medicaid, +109235,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,MEDICAID-Traditional Medicaid, +109236,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,MEDICAID-Traditional Medicaid, +109237,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,MEDICAID-Traditional Medicaid, +109238,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,MEDICAID-Traditional Medicaid, +109239,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,MEDICAID-Traditional Medicaid, +109240,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,MEDICAID-Traditional Medicaid, +109241,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,MEDICAID-Traditional Medicaid, +109242,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,MEDICAID-Traditional Medicaid, +109243,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,MEDICAID-Traditional Medicaid, +109244,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,MEDICAID-Traditional Medicaid, +109245,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,MEDICAID-Traditional Medicaid, +109246,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,MEDICAID-Traditional Medicaid, +109247,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,MEDICAID-Traditional Medicaid, +109248,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,MEDICAID-Traditional Medicaid, +109249,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,MEDICAID-Traditional Medicaid, +109250,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,MEDICAID-Traditional Medicaid, +109251,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,MEDICAID-Traditional Medicaid, +109252,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,MEDICAID-Traditional Medicaid, +109253,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,MEDICAID-Traditional Medicaid, +109254,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,MEDICAID-Traditional Medicaid, +109255,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,MEDICAID-Traditional Medicaid, +109256,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,MEDICAID-Traditional Medicaid, +109257,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,MEDICAID-Traditional Medicaid, +109258,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,MEDICAID-Traditional Medicaid, +109259,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,MEDICAID-Traditional Medicaid, +109260,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,MEDICAID-Traditional Medicaid, +109261,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,MEDICAID-Traditional Medicaid, +109262,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,MEDICAID-Traditional Medicaid, +109263,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,MEDICAID-Traditional Medicaid, +109264,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,MEDICAID-Traditional Medicaid, +109265,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,MEDICAID-Traditional Medicaid, +109266,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,MEDICAID-Traditional Medicaid, +109267,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,MEDICAID-Traditional Medicaid, +109268,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,MEDICAID-Traditional Medicaid, +109269,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,MEDICAID-Traditional Medicaid, +109270,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,MEDICAID-Traditional Medicaid, +109271,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,MEDICAID-Traditional Medicaid, +109272,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,MEDICAID-Traditional Medicaid, +109273,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,MEDICAID-Traditional Medicaid, +109274,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,MEDICAID-Traditional Medicaid, +109275,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,MEDICAID-Traditional Medicaid, +109276,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,MEDICAID-Traditional Medicaid, +109277,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,MEDICAID-Traditional Medicaid, +109278,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,MEDICAID-Traditional Medicaid, +109279,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,MEDICAID-Traditional Medicaid, +109280,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,MEDICAID-Traditional Medicaid, +109281,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,MEDICAID-Traditional Medicaid, +109282,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,MEDICAID-Traditional Medicaid, +109283,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,MEDICAID-Traditional Medicaid, +109284,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,MEDICAID-Traditional Medicaid, +109285,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,MEDICAID-Traditional Medicaid, +109286,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,MEDICAID-Traditional Medicaid, +109287,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,MEDICAID-Traditional Medicaid, +109288,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,MEDICAID-Traditional Medicaid, +109289,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,MEDICAID-Traditional Medicaid, +109290,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,MEDICAID-Traditional Medicaid, +109291,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,MEDICAID-Traditional Medicaid, +109292,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,MEDICAID-Traditional Medicaid, +109293,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,MEDICAID-Traditional Medicaid, +109294,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,MEDICAID-Traditional Medicaid, +109295,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,MEDICAID-Traditional Medicaid, +109296,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,MEDICAID-Traditional Medicaid, +109297,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,MEDICAID-Traditional Medicaid, +109298,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,MEDICAID-Traditional Medicaid, +109299,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,MEDICAID-Traditional Medicaid, +109300,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,MEDICAID-Traditional Medicaid, +109301,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,MEDICAID-Traditional Medicaid, +109302,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,MEDICAID-Traditional Medicaid, +109303,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,MEDICAID-Traditional Medicaid, +109304,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,MEDICAID-Traditional Medicaid, +109305,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,MEDICAID-Traditional Medicaid, +109306,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,MEDICAID-Traditional Medicaid, +109307,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,MEDICAID-Traditional Medicaid, +109308,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,MEDICAID-Traditional Medicaid, +109309,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,MEDICAID-Traditional Medicaid, +109310,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,MEDICAID-Traditional Medicaid, +109311,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,MEDICAID-Traditional Medicaid, +109312,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,MEDICAID-Traditional Medicaid, +109313,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,MEDICAID-Traditional Medicaid, +109314,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,MEDICAID-Traditional Medicaid, +109315,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,MEDICAID-Traditional Medicaid, +109316,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,MEDICAID-Traditional Medicaid, +109317,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,MEDICAID-Traditional Medicaid, +109318,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,MEDICAID-Traditional Medicaid, +109319,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,MEDICAID-Traditional Medicaid, +109320,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,MEDICAID-Traditional Medicaid, +109321,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,MEDICAID-Traditional Medicaid, +109322,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,MEDICAID-Traditional Medicaid, +109323,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,MEDICAID-Traditional Medicaid, +109324,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,MEDICAID-Traditional Medicaid, +109325,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,MEDICAID-Traditional Medicaid, +109326,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,MEDICAID-Traditional Medicaid, +109327,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,MEDICAID-Traditional Medicaid, +109328,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,MEDICAID-Traditional Medicaid, +109329,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,MEDICAID-Traditional Medicaid, +109330,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,MEDICAID-Traditional Medicaid, +109331,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,MEDICAID-Traditional Medicaid, +109332,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,MEDICAID-Traditional Medicaid, +109333,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,MEDICAID-Traditional Medicaid, +109334,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,MEDICAID-Traditional Medicaid, +109335,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,MEDICAID-Traditional Medicaid, +109336,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,MEDICAID-Traditional Medicaid, +109337,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,MEDICAID-Traditional Medicaid, +109338,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,MEDICAID-Traditional Medicaid, +109339,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,MEDICAID-Traditional Medicaid, +109340,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,MEDICAID-Traditional Medicaid, +109341,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,MEDICAID-Traditional Medicaid, +109342,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,MEDICAID-Traditional Medicaid, +109343,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,MEDICAID-Traditional Medicaid, +109344,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,MEDICAID-Traditional Medicaid, +109345,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,MEDICAID-Traditional Medicaid, +109346,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,MEDICAID-Traditional Medicaid, +109347,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,MEDICAID-Traditional Medicaid, +109348,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,MEDICAID-Traditional Medicaid, +109349,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,MEDICAID-Traditional Medicaid, +109350,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,MEDICAID-Traditional Medicaid, +109351,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,MEDICAID-Traditional Medicaid, +109352,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,MEDICAID-Traditional Medicaid, +109353,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,MEDICAID-Traditional Medicaid, +109354,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,MEDICAID-Traditional Medicaid, +109355,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,MEDICAID-Traditional Medicaid, +109356,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,MEDICAID-Traditional Medicaid, +109357,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,MEDICAID-Traditional Medicaid, +109358,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,MEDICAID-Traditional Medicaid, +109359,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,MEDICAID-Traditional Medicaid, +109360,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,MEDICAID-Traditional Medicaid, +109361,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,MEDICAID-Traditional Medicaid, +109362,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,MEDICAID-Traditional Medicaid, +109363,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,MEDICAID-Traditional Medicaid, +109364,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,MEDICAID-Traditional Medicaid, +109365,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,MEDICAID-Traditional Medicaid, +109366,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,MEDICAID-Traditional Medicaid, +109367,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,MEDICAID-Traditional Medicaid, +109368,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,MEDICAID-Traditional Medicaid, +109369,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,MEDICAID-Traditional Medicaid, +109370,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,MEDICAID-Traditional Medicaid, +109371,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,MEDICAID-Traditional Medicaid, +109372,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,MEDICAID-Traditional Medicaid, +109373,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,MEDICAID-Traditional Medicaid, +109374,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,MEDICAID-Traditional Medicaid, +109375,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,MEDICAID-Traditional Medicaid, +109376,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,MEDICAID-Traditional Medicaid, +109377,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,MEDICAID-Traditional Medicaid, +109378,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,MEDICAID-Traditional Medicaid, +109379,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,MEDICAID-Traditional Medicaid, +109380,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,MEDICAID-Traditional Medicaid, +109381,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,MEDICAID-Traditional Medicaid, +109382,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,MEDICAID-Traditional Medicaid, +109383,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,MEDICAID-Traditional Medicaid, +109384,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,MEDICAID-Traditional Medicaid, +109385,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,MEDICAID-Traditional Medicaid, +109386,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,MEDICAID-Traditional Medicaid, +109387,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,MEDICAID-Traditional Medicaid, +109388,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,MEDICAID-Traditional Medicaid, +109389,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,MEDICAID-Traditional Medicaid, +109390,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,MEDICAID-Traditional Medicaid, +109391,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,MEDICAID-Traditional Medicaid, +109392,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,MEDICAID-Traditional Medicaid, +109393,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,MEDICAID-Traditional Medicaid, +109394,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,MEDICAID-Traditional Medicaid, +109395,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,MEDICAID-Traditional Medicaid, +109396,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,MEDICAID-Traditional Medicaid, +109397,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,MEDICAID-Traditional Medicaid, +109398,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,MEDICAID-Traditional Medicaid, +109399,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,MEDICAID-Traditional Medicaid, +109400,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,MEDICAID-Traditional Medicaid, +109401,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,MEDICAID-Traditional Medicaid, +109402,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,MEDICAID-Traditional Medicaid, +109403,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,MEDICAID-Traditional Medicaid, +109404,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,MEDICAID-Traditional Medicaid, +109405,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,MEDICAID-Traditional Medicaid, +109406,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,MEDICAID-Traditional Medicaid, +109407,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,MEDICAID-Traditional Medicaid, +109408,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,MEDICAID-Traditional Medicaid, +109409,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,MEDICAID-Traditional Medicaid, +109410,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,MEDICAID-Traditional Medicaid, +109411,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,MEDICAID-Traditional Medicaid, +109412,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,MEDICAID-Traditional Medicaid, +109413,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,MEDICAID-Traditional Medicaid, +109414,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,MEDICAID-Traditional Medicaid, +109415,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,MEDICAID-Traditional Medicaid, +109416,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,MEDICAID-Traditional Medicaid, +109417,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,MEDICAID-Traditional Medicaid, +109418,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,MEDICAID-Traditional Medicaid, +109419,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,MEDICAID-Traditional Medicaid, +109420,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,MEDICAID-Traditional Medicaid, +109421,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,MEDICAID-Traditional Medicaid, +109422,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,MEDICAID-Traditional Medicaid, +109423,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,MEDICAID-Traditional Medicaid, +109424,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,MEDICAID-Traditional Medicaid, +109425,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,MEDICAID-Traditional Medicaid, +109426,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,MEDICAID-Traditional Medicaid, +109427,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,MEDICAID-Traditional Medicaid, +109428,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,MEDICAID-Traditional Medicaid, +109429,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,MEDICAID-Traditional Medicaid, +109430,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,MEDICAID-Traditional Medicaid, +109431,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,MEDICAID-Traditional Medicaid, +109432,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,MEDICAID-Traditional Medicaid, +109433,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,MEDICAID-Traditional Medicaid, +109434,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,MEDICAID-Traditional Medicaid, +109435,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,MEDICAID-Traditional Medicaid, +109436,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,MEDICAID-Traditional Medicaid, +109437,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,MEDICAID-Traditional Medicaid, +109438,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,MEDICAID-Traditional Medicaid, +109439,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,MEDICAID-Traditional Medicaid, +109440,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,MEDICAID-Traditional Medicaid, +109441,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,MEDICAID-Traditional Medicaid, +109442,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,MEDICAID-Traditional Medicaid, +109443,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,MEDICAID-Traditional Medicaid, +109444,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,MEDICAID-Traditional Medicaid, +109445,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,MEDICAID-Traditional Medicaid, +109446,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,MEDICAID-Traditional Medicaid, +109447,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,MEDICAID-Traditional Medicaid, +109448,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,MEDICAID-Traditional Medicaid, +109449,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,MEDICAID-Traditional Medicaid, +109450,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,MEDICAID-Traditional Medicaid, +109451,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,MEDICAID-Traditional Medicaid, +109452,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,MEDICAID-Traditional Medicaid, +109453,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,MEDICAID-Traditional Medicaid, +109454,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,MEDICAID-Traditional Medicaid, +109455,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,MEDICAID-Traditional Medicaid, +109456,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,MEDICAID-Traditional Medicaid, +109457,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,MEDICAID-Traditional Medicaid, +109458,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,MEDICAID-Traditional Medicaid, +109459,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,MEDICAID-Traditional Medicaid, +109460,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,MEDICAID-Traditional Medicaid, +109461,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,MEDICAID-Traditional Medicaid, +109462,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,MEDICAID-Traditional Medicaid, +109463,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,MEDICAID-Traditional Medicaid, +109464,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,MEDICAID-Traditional Medicaid, +109465,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,MEDICAID-Traditional Medicaid, +109466,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,MEDICAID-Traditional Medicaid, +109467,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,MEDICAID-Traditional Medicaid, +109468,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,MEDICAID-Traditional Medicaid, +109469,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,MEDICAID-Traditional Medicaid, +109470,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,MEDICAID-Traditional Medicaid, +109471,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,MEDICAID-Traditional Medicaid, +109472,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,MEDICAID-Traditional Medicaid, +109473,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,MEDICAID-Traditional Medicaid, +109474,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,MEDICAID-Traditional Medicaid, +109475,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,MEDICAID-Traditional Medicaid, +109476,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,MEDICAID-Traditional Medicaid, +109477,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,MEDICAID-Traditional Medicaid, +109478,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,MEDICAID-Traditional Medicaid, +109479,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,MEDICAID-Traditional Medicaid, +109480,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,MEDICAID-Traditional Medicaid, +109481,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,MEDICAID-Traditional Medicaid, +109482,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,MEDICAID-Traditional Medicaid, +109483,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,MEDICAID-Traditional Medicaid, +109484,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,MEDICAID-Traditional Medicaid, +109485,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,MEDICAID-Traditional Medicaid, +109486,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,MEDICAID-Traditional Medicaid, +109487,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,MEDICAID-Traditional Medicaid, +109488,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,MEDICAID-Traditional Medicaid, +109489,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,MEDICAID-Traditional Medicaid, +109490,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,MEDICAID-Traditional Medicaid, +109491,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,MEDICAID-Traditional Medicaid, +109492,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,MEDICAID-Traditional Medicaid, +109493,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,MEDICAID-Traditional Medicaid, +109494,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,MEDICAID-Traditional Medicaid, +109495,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,MEDICAID-Traditional Medicaid, +109496,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,MEDICAID-Traditional Medicaid, +109497,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,MEDICAID-Traditional Medicaid, +109498,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,MEDICAID-Traditional Medicaid, +109499,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,MEDICAID-Traditional Medicaid, +109500,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,MEDICAID-Traditional Medicaid, +109501,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,MEDICAID-Traditional Medicaid, +109502,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,MEDICAID-Traditional Medicaid, +109503,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,MEDICAID-Traditional Medicaid, +109504,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,MEDICAID-Traditional Medicaid, +109505,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,MEDICAID-Traditional Medicaid, +109506,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,MEDICAID-Traditional Medicaid, +109507,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,MEDICAID-Traditional Medicaid, +109508,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,MEDICAID-Traditional Medicaid, +109509,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,MEDICAID-Traditional Medicaid, +109510,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,MEDICAID-Traditional Medicaid, +109511,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,MEDICAID-Traditional Medicaid, +109512,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,MEDICAID-Traditional Medicaid, +109513,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,MEDICAID-Traditional Medicaid, +109514,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,MEDICAID-Traditional Medicaid, +109515,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,MEDICAID-Traditional Medicaid, +109516,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,MEDICAID-Traditional Medicaid, +109517,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,MEDICAID-Traditional Medicaid, +109518,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,MEDICAID-Traditional Medicaid, +109519,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,MEDICAID-Traditional Medicaid, +109520,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,MEDICAID-Traditional Medicaid, +109521,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,MEDICAID-Traditional Medicaid, +109522,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,MEDICAID-Traditional Medicaid, +109523,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,MEDICAID-Traditional Medicaid, +109524,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,MEDICAID-Traditional Medicaid, +109525,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,MEDICAID-Traditional Medicaid, +109526,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,MEDICAID-Traditional Medicaid, +109527,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,MEDICAID-Traditional Medicaid, +109528,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,MEDICAID-Traditional Medicaid, +109529,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,MEDICAID-Traditional Medicaid, +109530,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,MEDICAID-Traditional Medicaid, +109531,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,MEDICAID-Traditional Medicaid, +109532,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,MEDICAID-Traditional Medicaid, +109533,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,MEDICAID-Traditional Medicaid, +109534,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,MEDICAID-Traditional Medicaid, +109535,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,MEDICAID-Traditional Medicaid, +109536,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,MEDICAID-Traditional Medicaid, +109537,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,MEDICAID-Traditional Medicaid, +109538,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,MEDICAID-Traditional Medicaid, +109539,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,MEDICAID-Traditional Medicaid, +109540,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,MEDICAID-Traditional Medicaid, +109541,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,MEDICAID-Traditional Medicaid, +109542,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,MEDICAID-Traditional Medicaid, +109543,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,MEDICAID-Traditional Medicaid, +109544,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,MEDICAID-Traditional Medicaid, +109545,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,MEDICAID-Traditional Medicaid, +109546,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,MEDICAID-Traditional Medicaid, +109547,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,MEDICAID-Traditional Medicaid, +109548,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,MEDICAID-Traditional Medicaid, +109549,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,MEDICAID-Traditional Medicaid, +109550,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,MEDICAID-Traditional Medicaid, +109551,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,MEDICAID-Traditional Medicaid, +109552,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,MEDICAID-Traditional Medicaid, +109553,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,MEDICAID-Traditional Medicaid, +109554,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,MEDICAID-Traditional Medicaid, +109555,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,MEDICAID-Traditional Medicaid, +109556,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,MEDICAID-Traditional Medicaid, +109557,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,MEDICAID-Traditional Medicaid, +109558,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,MEDICAID-Traditional Medicaid, +109559,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,MEDICAID-Traditional Medicaid, +109560,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,MEDICAID-Traditional Medicaid, +109561,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,MEDICAID-Traditional Medicaid, +109562,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,MEDICAID-Traditional Medicaid, +109563,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,MEDICAID-Traditional Medicaid, +109564,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,MEDICAID-Traditional Medicaid, +109565,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,MEDICAID-Traditional Medicaid, +109566,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,MEDICAID-Traditional Medicaid, +109567,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,MEDICAID-Traditional Medicaid, +109568,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,MEDICAID-Traditional Medicaid, +109569,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,MEDICAID-Traditional Medicaid, +109570,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,MEDICAID-Traditional Medicaid, +109571,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,MEDICAID-Traditional Medicaid, +109572,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,MEDICAID-Traditional Medicaid, +109573,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,MEDICAID-Traditional Medicaid, +109574,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,MEDICAID-Traditional Medicaid, +109575,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,MEDICAID-Traditional Medicaid, +109576,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,MEDICAID-Traditional Medicaid, +109577,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,MEDICAID-Traditional Medicaid, +109578,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,MEDICAID-Traditional Medicaid, +109579,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,MEDICAID-Traditional Medicaid, +109580,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,MEDICAID-Traditional Medicaid, +109581,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,MEDICAID-Traditional Medicaid, +109582,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,MEDICAID-Traditional Medicaid, +109583,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,MEDICAID-Traditional Medicaid, +109584,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,MEDICAID-Traditional Medicaid, +109585,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,MEDICAID-Traditional Medicaid, +109586,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,MEDICAID-Traditional Medicaid, +109587,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,MEDICAID-Traditional Medicaid, +109588,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,MEDICAID-Traditional Medicaid, +109589,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,MEDICAID-Traditional Medicaid, +109590,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,MEDICAID-Traditional Medicaid, +109591,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,MEDICAID-Traditional Medicaid, +109592,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,MEDICAID-Traditional Medicaid, +109593,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,MEDICAID-Traditional Medicaid, +109594,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,MEDICAID-Traditional Medicaid, +109595,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,MEDICAID-Traditional Medicaid, +109596,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,MEDICAID-Traditional Medicaid, +109597,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,MEDICAID-Traditional Medicaid, +109598,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,MEDICAID-Traditional Medicaid, +109599,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,MEDICAID-Traditional Medicaid, +109600,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,MEDICAID-Traditional Medicaid, +109601,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,MEDICAID-Traditional Medicaid, +109602,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,MEDICAID-Traditional Medicaid, +109603,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,MEDICAID-Traditional Medicaid, +109604,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,MEDICAID-Traditional Medicaid, +109605,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,MEDICAID-Traditional Medicaid, +109606,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,MEDICAID-Traditional Medicaid, +109607,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,MEDICAID-Traditional Medicaid, +109608,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,MEDICAID-Traditional Medicaid, +109609,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,MEDICAID-Traditional Medicaid, +109610,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,MEDICAID-Traditional Medicaid, +109611,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,MEDICAID-Traditional Medicaid, +109612,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,MEDICAID-Traditional Medicaid, +109613,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,MEDICAID-Traditional Medicaid, +109614,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,MEDICAID-Traditional Medicaid, +109615,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,MEDICAID-Traditional Medicaid, +109616,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,MEDICAID-Traditional Medicaid, +109617,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,MEDICAID-Traditional Medicaid, +109618,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,MEDICAID-Traditional Medicaid, +109619,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,MEDICAID-Traditional Medicaid, +109620,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,MEDICAID-Traditional Medicaid, +109621,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,MEDICAID-Traditional Medicaid, +109622,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,MEDICAID-Traditional Medicaid, +109623,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,MEDICAID-Traditional Medicaid, +109624,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,MEDICAID-Traditional Medicaid, +109625,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,MEDICAID-Traditional Medicaid, +109626,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,MEDICAID-Traditional Medicaid, +109627,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,MEDICAID-Traditional Medicaid, +109628,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,MEDICAID-Traditional Medicaid, +109629,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,MEDICAID-Traditional Medicaid, +109630,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,MEDICAID-Traditional Medicaid, +109631,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,MEDICAID-Traditional Medicaid, +109632,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,MEDICAID-Traditional Medicaid, +109633,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,MEDICAID-Traditional Medicaid, +109634,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,MEDICAID-Traditional Medicaid, +109635,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,MEDICAID-Traditional Medicaid, +109636,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,MEDICAID-Traditional Medicaid, +109637,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,MEDICAID-Traditional Medicaid, +109638,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,MEDICAID-Traditional Medicaid, +109639,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,MEDICAID-Traditional Medicaid, +109640,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,MEDICAID-Traditional Medicaid, +109641,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,MEDICAID-Traditional Medicaid, +109642,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,MEDICAID-Traditional Medicaid, +109643,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,MEDICAID-Traditional Medicaid, +109644,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,MEDICAID-Traditional Medicaid, +109645,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,MEDICAID-Traditional Medicaid, +109646,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,MEDICAID-Traditional Medicaid, +109647,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,MEDICAID-Traditional Medicaid, +109648,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,MEDICAID-Traditional Medicaid, +109649,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,MEDICAID-Traditional Medicaid, +109650,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,MEDICAID-Traditional Medicaid, +109651,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,MEDICAID-Traditional Medicaid, +109652,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,MEDICAID-Traditional Medicaid, +109653,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,MEDICAID-Traditional Medicaid, +109654,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,MEDICAID-Traditional Medicaid, +109655,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,MEDICAID-Traditional Medicaid, +109656,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,MEDICAID-Traditional Medicaid, +109657,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,MEDICAID-Traditional Medicaid, +109658,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,MEDICAID-Traditional Medicaid, +109659,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,MEDICAID-Traditional Medicaid, +109660,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,MEDICAID-Traditional Medicaid, +109661,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,MEDICAID-Traditional Medicaid, +109662,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,MEDICAID-Traditional Medicaid, +109663,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,MEDICAID-Traditional Medicaid, +109664,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,MEDICAID-Traditional Medicaid, +109665,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,MEDICAID-Traditional Medicaid, +109666,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,MEDICAID-Traditional Medicaid, +109667,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,MEDICAID-Traditional Medicaid, +109668,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,MEDICAID-Traditional Medicaid, +109669,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,MEDICAID-Traditional Medicaid, +109670,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,MEDICAID-Traditional Medicaid, +109671,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,MEDICAID-Traditional Medicaid, +109672,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,MEDICAID-Traditional Medicaid, +109673,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,MEDICAID-Traditional Medicaid, +109674,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,MEDICAID-Traditional Medicaid, +109675,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,MEDICAID-Traditional Medicaid, +109676,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,MEDICAID-Traditional Medicaid, +109677,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,MEDICAID-Traditional Medicaid, +109678,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,MEDICAID-Traditional Medicaid,616.13 +109679,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,MEDICAID-Traditional Medicaid, +109680,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,MEDICAID-Traditional Medicaid, +109681,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,MEDICAID-Traditional Medicaid, +109682,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,MEDICAID-Traditional Medicaid, +109683,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,MEDICAID-Traditional Medicaid,726.34 +109684,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,MEDICAID-Traditional Medicaid, +109685,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,MEDICAID-Traditional Medicaid,368.92 +109686,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,MEDICAID-Traditional Medicaid, +109687,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,MEDICAID-Traditional Medicaid,377.25 +109688,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,MEDICAID-Traditional Medicaid, +109689,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,MEDICAID-Traditional Medicaid, +109690,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,MEDICAID-Traditional Medicaid, +109691,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,MEDICAID-Traditional Medicaid,393.96 +109692,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,MEDICAID-Traditional Medicaid, +109693,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,MEDICAID-Traditional Medicaid, +109694,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,MEDICAID-Traditional Medicaid, +109695,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,MEDICAID-Traditional Medicaid, +109696,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,MEDICAID-Traditional Medicaid, +109697,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,MEDICAID-Traditional Medicaid, +109698,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,MEDICAID-Traditional Medicaid, +109699,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,MEDICAID-Traditional Medicaid, +109700,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,MEDICAID-Traditional Medicaid,777.97 +109701,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,MEDICAID-Traditional Medicaid, +109702,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,MEDICAID-Traditional Medicaid, +109703,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,MEDICAID-Traditional Medicaid, +109704,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,MEDICAID-Traditional Medicaid, +109705,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,MEDICAID-Traditional Medicaid, +109706,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,MEDICAID-Traditional Medicaid, +109707,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,MEDICAID-Traditional Medicaid, +109708,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,MEDICAID-Traditional Medicaid, +109709,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,MEDICAID-Traditional Medicaid, +109710,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,MEDICAID-Traditional Medicaid, +109711,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,MEDICAID-Traditional Medicaid, +109712,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,MEDICAID-Traditional Medicaid, +109713,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,MEDICAID-Traditional Medicaid, +109714,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,MEDICAID-Traditional Medicaid, +109715,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,MEDICAID-Traditional Medicaid, +109716,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,MEDICAID-Traditional Medicaid, +109717,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,MEDICAID-Traditional Medicaid, +109718,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,MEDICAID-Traditional Medicaid, +109719,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,MEDICAID-Traditional Medicaid, +109720,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,MEDICAID-Traditional Medicaid, +109721,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,MEDICAID-Traditional Medicaid, +109722,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,MEDICAID-Traditional Medicaid,3503.83 +109723,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,MEDICAID-Traditional Medicaid, +109724,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,MEDICAID-Traditional Medicaid, +109725,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,MEDICAID-Traditional Medicaid, +109726,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,MEDICAID-Traditional Medicaid, +109727,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,MEDICAID-Traditional Medicaid, +109728,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,MEDICAID-Traditional Medicaid, +109729,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,MEDICAID-Traditional Medicaid, +109730,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,MEDICAID-Traditional Medicaid, +109731,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,MEDICAID-Traditional Medicaid, +109732,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,MEDICAID-Traditional Medicaid, +109733,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,MEDICAID-Traditional Medicaid, +109734,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,MEDICAID-Traditional Medicaid, +109735,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,MEDICAID-Traditional Medicaid, +109736,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,MEDICAID-Traditional Medicaid,469.79 +109737,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,MEDICAID-Traditional Medicaid,5033.78 +109738,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,MEDICAID-Traditional Medicaid, +109739,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,MEDICAID-Traditional Medicaid, +109740,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,MEDICAID-Traditional Medicaid, +109741,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,MEDICAID-Traditional Medicaid, +109742,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,MEDICAID-Traditional Medicaid, +109743,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,MEDICAID-Traditional Medicaid,163.52 +109744,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,MEDICAID-Traditional Medicaid,129.42 +109745,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,MEDICAID-Traditional Medicaid,129.42 +109746,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,MEDICAID-Traditional Medicaid, +109747,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,MEDICAID-Traditional Medicaid,224.02 +109748,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,MEDICAID-Traditional Medicaid,129.42 +109749,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,MEDICAID-Traditional Medicaid, +109750,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,MEDICAID-Traditional Medicaid, +109751,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,MEDICAID-Traditional Medicaid, +109752,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,MEDICAID-Traditional Medicaid, +109753,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,MEDICAID-Traditional Medicaid, +109754,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,MEDICAID-Traditional Medicaid,702.22 +109755,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,MEDICAID-Traditional Medicaid, +109756,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,MEDICAID-Traditional Medicaid, +109757,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,MEDICAID-Traditional Medicaid, +109758,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,MEDICAID-Traditional Medicaid,702.22 +109759,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,MEDICAID-Traditional Medicaid,393.96 +109760,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,MEDICAID-Traditional Medicaid,393.96 +109761,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,MEDICAID-Traditional Medicaid, +109762,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,MEDICAID-Traditional Medicaid,523.9 +109763,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,MEDICAID-Traditional Medicaid,523.9 +109764,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,MEDICAID-Traditional Medicaid, +109765,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,MEDICAID-Traditional Medicaid, +109766,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,MEDICAID-Traditional Medicaid,461.73 +109767,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,MEDICAID-Traditional Medicaid,523.9 +109768,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,MEDICAID-Traditional Medicaid, +109769,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,MEDICAID-Traditional Medicaid, +109770,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,MEDICAID-Traditional Medicaid, +109771,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,MEDICAID-Traditional Medicaid, +109772,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,MEDICAID-Traditional Medicaid, +109773,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,MEDICAID-Traditional Medicaid, +109774,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,MEDICAID-Traditional Medicaid,781.7 +109775,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,MEDICAID-Traditional Medicaid,781.7 +109776,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,MEDICAID-Traditional Medicaid, +109777,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,MEDICAID-Traditional Medicaid, +109778,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,MEDICAID-Traditional Medicaid, +109779,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,MEDICAID-Traditional Medicaid, +109780,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,MEDICAID-Traditional Medicaid, +109781,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,MEDICAID-Traditional Medicaid, +109782,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,MEDICAID-Traditional Medicaid, +109783,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,MEDICAID-Traditional Medicaid, +109784,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,MEDICAID-Traditional Medicaid,781.7 +109785,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,MEDICAID-Traditional Medicaid, +109786,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,MEDICAID-Traditional Medicaid, +109787,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,MEDICAID-Traditional Medicaid,781.7 +109788,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,MEDICAID-Traditional Medicaid, +109789,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,MEDICAID-Traditional Medicaid, +109790,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,MEDICAID-Traditional Medicaid, +109791,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,MEDICAID-Traditional Medicaid, +109792,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,MEDICAID-Traditional Medicaid,708.77 +109793,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,MEDICAID-Traditional Medicaid, +109794,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,MEDICAID-Traditional Medicaid, +109795,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,MEDICAID-Traditional Medicaid, +109796,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,MEDICAID-Traditional Medicaid,336.04 +109797,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,MEDICAID-Traditional Medicaid, +109798,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,MEDICAID-Traditional Medicaid, +109799,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,MEDICAID-Traditional Medicaid, +109800,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,MEDICAID-Traditional Medicaid, +109801,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,MEDICAID-Traditional Medicaid, +109802,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,MEDICAID-Traditional Medicaid, +109803,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,MEDICAID-Traditional Medicaid, +109804,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,MEDICAID-Traditional Medicaid, +109805,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,MEDICAID-Traditional Medicaid, +109806,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,MEDICAID-Traditional Medicaid, +109807,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,MEDICAID-Traditional Medicaid, +109808,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,MEDICAID-Traditional Medicaid, +109809,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,MEDICAID-Traditional Medicaid, +109810,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,MEDICAID-Traditional Medicaid, +109811,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,MEDICAID-Traditional Medicaid, +109812,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,MEDICAID-Traditional Medicaid, +109813,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,MEDICAID-Traditional Medicaid, +109814,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,MEDICAID-Traditional Medicaid, +109815,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,MEDICAID-Traditional Medicaid, +109816,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,MEDICAID-Traditional Medicaid, +109817,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,MEDICAID-Traditional Medicaid, +109818,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,MEDICAID-Traditional Medicaid, +109819,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,MEDICAID-Traditional Medicaid, +109820,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,MEDICAID-Traditional Medicaid, +109821,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,MEDICAID-Traditional Medicaid, +109822,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,MEDICAID-Traditional Medicaid,1663.01 +109823,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,MEDICAID-Traditional Medicaid, +109824,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,MEDICAID-Traditional Medicaid, +109825,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,MEDICAID-Traditional Medicaid, +109826,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,MEDICAID-Traditional Medicaid, +109827,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,MEDICAID-Traditional Medicaid, +109828,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,MEDICAID-Traditional Medicaid, +109829,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,MEDICAID-Traditional Medicaid, +109830,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,MEDICAID-Traditional Medicaid, +109831,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,MEDICAID-Traditional Medicaid, +109832,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,MEDICAID-Traditional Medicaid, +109833,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,MEDICAID-Traditional Medicaid, +109834,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,MEDICAID-Traditional Medicaid, +109835,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,MEDICAID-Traditional Medicaid, +109836,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,MEDICAID-Traditional Medicaid, +109837,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,MEDICAID-Traditional Medicaid, +109838,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,MEDICAID-Traditional Medicaid, +109839,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,MEDICAID-Traditional Medicaid, +109840,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,MEDICAID-Traditional Medicaid, +109841,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,MEDICAID-Traditional Medicaid, +109842,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,MEDICAID-Traditional Medicaid, +109843,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,MEDICAID-Traditional Medicaid, +109844,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,MEDICAID-Traditional Medicaid,523.9 +109845,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,MEDICAID-Traditional Medicaid,523.9 +109846,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,MEDICAID-Traditional Medicaid, +109847,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,MEDICAID-Traditional Medicaid,393.96 +109848,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,MEDICAID-Traditional Medicaid, +109849,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,MEDICAID-Traditional Medicaid, +109850,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,MEDICAID-Traditional Medicaid,1861.52 +109851,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,MEDICAID-Traditional Medicaid, +109852,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,MEDICAID-Traditional Medicaid,1861.52 +109853,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,MEDICAID-Traditional Medicaid, +109854,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,MEDICAID-Traditional Medicaid,1861.51 +109855,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,MEDICAID-Traditional Medicaid, +109856,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,MEDICAID-Traditional Medicaid, +109857,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,MEDICAID-Traditional Medicaid, +109858,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,MEDICAID-Traditional Medicaid, +109859,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,MEDICAID-Traditional Medicaid, +109860,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,MEDICAID-Traditional Medicaid, +109861,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,MEDICAID-Traditional Medicaid, +109862,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,MEDICAID-Traditional Medicaid, +109863,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,MEDICAID-Traditional Medicaid, +109864,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,MEDICAID-Traditional Medicaid, +109865,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,MEDICAID-Traditional Medicaid, +109866,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,MEDICAID-Traditional Medicaid,2915.93 +109867,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,MEDICAID-Traditional Medicaid, +109868,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,MEDICAID-Traditional Medicaid, +109869,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,MEDICAID-Traditional Medicaid, +109870,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,MEDICAID-Traditional Medicaid, +109871,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,MEDICAID-Traditional Medicaid, +109872,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,MEDICAID-Traditional Medicaid, +109873,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,MEDICAID-Traditional Medicaid, +109874,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,MEDICAID-Traditional Medicaid, +109875,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,MEDICAID-Traditional Medicaid, +109876,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,MEDICAID-Traditional Medicaid, +109877,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,MEDICAID-Traditional Medicaid, +109878,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,MEDICAID-Traditional Medicaid,5680.14 +109879,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,MEDICAID-Traditional Medicaid, +109880,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,MEDICAID-Traditional Medicaid, +109881,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,MEDICAID-Traditional Medicaid,3272.42 +109882,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,MEDICAID-Traditional Medicaid, +109883,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,MEDICAID-Traditional Medicaid, +109884,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,MEDICAID-Traditional Medicaid, +109885,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,MEDICAID-Traditional Medicaid, +109886,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,MEDICAID-Traditional Medicaid, +109887,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,MEDICAID-Traditional Medicaid, +109888,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,MEDICAID-Traditional Medicaid, +109889,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,MEDICAID-Traditional Medicaid, +109890,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,MEDICAID-Traditional Medicaid, +109891,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,MEDICAID-Traditional Medicaid, +109892,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,MEDICAID-Traditional Medicaid, +109893,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,MEDICAID-Traditional Medicaid, +109894,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,MEDICAID-Traditional Medicaid, +109895,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,MEDICAID-Traditional Medicaid,365.16 +109896,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,MEDICAID-Traditional Medicaid, +109897,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,MEDICAID-Traditional Medicaid, +109898,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,MEDICAID-Traditional Medicaid,347.26 +109899,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,MEDICAID-Traditional Medicaid, +109900,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,MEDICAID-Traditional Medicaid, +109901,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,MEDICAID-Traditional Medicaid, +109902,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,MEDICAID-Traditional Medicaid,373.21 +109903,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,MEDICAID-Traditional Medicaid, +109904,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,MEDICAID-Traditional Medicaid, +109905,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,MEDICAID-Traditional Medicaid, +109906,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,MEDICAID-Traditional Medicaid, +109907,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,MEDICAID-Traditional Medicaid, +109908,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,MEDICAID-Traditional Medicaid, +109909,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,MEDICAID-Traditional Medicaid,1944.21 +109910,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,MEDICAID-Traditional Medicaid, +109911,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,MEDICAID-Traditional Medicaid, +109912,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,MEDICAID-Traditional Medicaid, +109913,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,MEDICAID-Traditional Medicaid, +109914,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,MEDICAID-Traditional Medicaid, +109915,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,MEDICAID-Traditional Medicaid, +109916,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,MEDICAID-Traditional Medicaid, +109917,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,MEDICAID-Traditional Medicaid, +109918,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,MEDICAID-Traditional Medicaid, +109919,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,MEDICAID-Traditional Medicaid, +109920,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,MEDICAID-Traditional Medicaid, +109921,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,MEDICAID-Traditional Medicaid, +109922,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,MEDICAID-Traditional Medicaid, +109923,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,MEDICAID-Traditional Medicaid, +109924,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,MEDICAID-Traditional Medicaid, +109925,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,MEDICAID-Traditional Medicaid, +109926,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,MEDICAID-Traditional Medicaid,521.57 +109927,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,MEDICAID-Traditional Medicaid, +109928,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,MEDICAID-Traditional Medicaid, +109929,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,MEDICAID-Traditional Medicaid, +109930,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,MEDICAID-Traditional Medicaid, +109931,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,MEDICAID-Traditional Medicaid, +109932,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,MEDICAID-Traditional Medicaid, +109933,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,MEDICAID-Traditional Medicaid, +109934,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,MEDICAID-Traditional Medicaid, +109935,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,MEDICAID-Traditional Medicaid, +109936,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,MEDICAID-Traditional Medicaid, +109937,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,MEDICAID-Traditional Medicaid, +109938,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,MEDICAID-Traditional Medicaid, +109939,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,MEDICAID-Traditional Medicaid, +109940,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,MEDICAID-Traditional Medicaid, +109941,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,MEDICAID-Traditional Medicaid,1444.99 +109942,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,MEDICAID-Traditional Medicaid, +109943,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,MEDICAID-Traditional Medicaid, +109944,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,MEDICAID-Traditional Medicaid, +109945,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,MEDICAID-Traditional Medicaid, +109946,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,MEDICAID-Traditional Medicaid, +109947,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,MEDICAID-Traditional Medicaid, +109948,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,MEDICAID-Traditional Medicaid, +109949,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,MEDICAID-Traditional Medicaid,440.13 +109950,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,MEDICAID-Traditional Medicaid, +109951,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,MEDICAID-Traditional Medicaid,465.95 +109952,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,MEDICAID-Traditional Medicaid, +109953,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,MEDICAID-Traditional Medicaid, +109954,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,MEDICAID-Traditional Medicaid, +109955,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,MEDICAID-Traditional Medicaid, +109956,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,MEDICAID-Traditional Medicaid, +109957,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,MEDICAID-Traditional Medicaid, +109958,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,MEDICAID-Traditional Medicaid, +109959,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,MEDICAID-Traditional Medicaid, +109960,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,MEDICAID-Traditional Medicaid, +109961,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,MEDICAID-Traditional Medicaid, +109962,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,MEDICAID-Traditional Medicaid, +109963,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,MEDICAID-Traditional Medicaid, +109964,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,MEDICAID-Traditional Medicaid, +109965,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,MEDICAID-Traditional Medicaid, +109966,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,MEDICAID-Traditional Medicaid, +109967,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,MEDICAID-Traditional Medicaid, +109968,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,MEDICAID-Traditional Medicaid, +109969,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,MEDICAID-Traditional Medicaid, +109970,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,MEDICAID-Traditional Medicaid, +109971,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,MEDICAID-Traditional Medicaid, +109972,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,MEDICAID-Traditional Medicaid, +109973,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,MEDICAID-Traditional Medicaid, +109974,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,MEDICAID-Traditional Medicaid, +109975,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,MEDICAID-Traditional Medicaid, +109976,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,MEDICAID-Traditional Medicaid, +109977,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,MEDICAID-Traditional Medicaid, +109978,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,MEDICAID-Traditional Medicaid, +109979,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,MEDICAID-Traditional Medicaid, +109980,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,MEDICAID-Traditional Medicaid, +109981,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,MEDICAID-Traditional Medicaid, +109982,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,MEDICAID-Traditional Medicaid, +109983,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,MEDICAID-Traditional Medicaid, +109984,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,MEDICAID-Traditional Medicaid, +109985,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,MEDICAID-Traditional Medicaid, +109986,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,MEDICAID-Traditional Medicaid, +109987,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,MEDICAID-Traditional Medicaid, +109988,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,MEDICAID-Traditional Medicaid, +109989,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,MEDICAID-Traditional Medicaid, +109990,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,MEDICAID-Traditional Medicaid, +109991,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,MEDICAID-Traditional Medicaid,3279.94 +109992,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,MEDICAID-Traditional Medicaid, +109993,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,MEDICAID-Traditional Medicaid, +109994,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,MEDICAID-Traditional Medicaid, +109995,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,MEDICAID-Traditional Medicaid,572.04 +109996,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,MEDICAID-Traditional Medicaid, +109997,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,MEDICAID-Traditional Medicaid, +109998,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,MEDICAID-Traditional Medicaid, +109999,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,MEDICAID-Traditional Medicaid, +110000,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,MEDICAID-Traditional Medicaid, +110001,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,MEDICAID-Traditional Medicaid, +110002,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,MEDICAID-Traditional Medicaid, +110003,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,MEDICAID-Traditional Medicaid, +110004,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,MEDICAID-Traditional Medicaid, +110005,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,MEDICAID-Traditional Medicaid, +110006,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,MEDICAID-Traditional Medicaid, +110007,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,MEDICAID-Traditional Medicaid, +110008,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,MEDICAID-Traditional Medicaid, +110009,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,MEDICAID-Traditional Medicaid, +110010,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,MEDICAID-Traditional Medicaid, +110011,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,MEDICAID-Traditional Medicaid, +110012,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,MEDICAID-Traditional Medicaid, +110013,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,MEDICAID-Traditional Medicaid, +110014,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,MEDICAID-Traditional Medicaid, +110015,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,MEDICAID-Traditional Medicaid, +110016,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,MEDICAID-Traditional Medicaid, +110017,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,MEDICAID-Traditional Medicaid,572.04 +110018,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,MEDICAID-Traditional Medicaid, +110019,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,MEDICAID-Traditional Medicaid, +110020,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,MEDICAID-Traditional Medicaid, +110021,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,MEDICAID-Traditional Medicaid, +110022,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,MEDICAID-Traditional Medicaid, +110023,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,MEDICAID-Traditional Medicaid, +110024,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,MEDICAID-Traditional Medicaid, +110025,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,MEDICAID-Traditional Medicaid, +110026,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,MEDICAID-Traditional Medicaid, +110027,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,MEDICAID-Traditional Medicaid, +110028,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,MEDICAID-Traditional Medicaid, +110029,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,MEDICAID-Traditional Medicaid, +110030,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,MEDICAID-Traditional Medicaid, +110031,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,MEDICAID-Traditional Medicaid, +110032,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,MEDICAID-Traditional Medicaid,3279.94 +110033,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,MEDICAID-Traditional Medicaid, +110034,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,MEDICAID-Traditional Medicaid,575.09 +110035,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,MEDICAID-Traditional Medicaid, +110036,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,MEDICAID-Traditional Medicaid, +110037,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,MEDICAID-Traditional Medicaid, +110038,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,MEDICAID-Traditional Medicaid, +110039,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,MEDICAID-Traditional Medicaid, +110040,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,MEDICAID-Traditional Medicaid, +110041,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,MEDICAID-Traditional Medicaid, +110042,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,MEDICAID-Traditional Medicaid, +110043,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,MEDICAID-Traditional Medicaid, +110044,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,MEDICAID-Traditional Medicaid, +110045,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,MEDICAID-Traditional Medicaid, +110046,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,MEDICAID-Traditional Medicaid, +110047,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,MEDICAID-Traditional Medicaid, +110048,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,MEDICAID-Traditional Medicaid, +110049,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,MEDICAID-Traditional Medicaid, +110050,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,MEDICAID-Traditional Medicaid, +110051,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,MEDICAID-Traditional Medicaid, +110052,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,MEDICAID-Traditional Medicaid, +110053,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,MEDICAID-Traditional Medicaid, +110054,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,MEDICAID-Traditional Medicaid, +110055,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,MEDICAID-Traditional Medicaid, +110056,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,MEDICAID-Traditional Medicaid, +110057,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,MEDICAID-Traditional Medicaid, +110058,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,MEDICAID-Traditional Medicaid, +110059,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,MEDICAID-Traditional Medicaid, +110060,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,MEDICAID-Traditional Medicaid, +110061,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,MEDICAID-Traditional Medicaid, +110062,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,MEDICAID-Traditional Medicaid, +110063,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,MEDICAID-Traditional Medicaid, +110064,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,MEDICAID-Traditional Medicaid,2532.41 +110065,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,MEDICAID-Traditional Medicaid, +110066,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,MEDICAID-Traditional Medicaid, +110067,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,MEDICAID-Traditional Medicaid,572.04 +110068,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,MEDICAID-Traditional Medicaid, +110069,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,MEDICAID-Traditional Medicaid, +110070,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,MEDICAID-Traditional Medicaid, +110071,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,MEDICAID-Traditional Medicaid, +110072,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,MEDICAID-Traditional Medicaid, +110073,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,MEDICAID-Traditional Medicaid, +110074,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,MEDICAID-Traditional Medicaid,572.04 +110075,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,MEDICAID-Traditional Medicaid,3279.94 +110076,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,MEDICAID-Traditional Medicaid, +110077,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,MEDICAID-Traditional Medicaid,3279.94 +110078,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,MEDICAID-Traditional Medicaid,3279.94 +110079,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,MEDICAID-Traditional Medicaid, +110080,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,MEDICAID-Traditional Medicaid, +110081,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,MEDICAID-Traditional Medicaid, +110082,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,MEDICAID-Traditional Medicaid, +110083,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,MEDICAID-Traditional Medicaid, +110084,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,MEDICAID-Traditional Medicaid,377.25 +110085,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,MEDICAID-Traditional Medicaid, +110086,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,MEDICAID-Traditional Medicaid, +110087,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,MEDICAID-Traditional Medicaid, +110088,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,MEDICAID-Traditional Medicaid, +110089,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,MEDICAID-Traditional Medicaid, +110090,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,MEDICAID-Traditional Medicaid, +110091,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,MEDICAID-Traditional Medicaid, +110092,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,MEDICAID-Traditional Medicaid, +110093,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,MEDICAID-Traditional Medicaid, +110094,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,MEDICAID-Traditional Medicaid, +110095,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,MEDICAID-Traditional Medicaid, +110096,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,MEDICAID-Traditional Medicaid, +110097,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,MEDICAID-Traditional Medicaid, +110098,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,MEDICAID-Traditional Medicaid, +110099,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,MEDICAID-Traditional Medicaid, +110100,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,MEDICAID-Traditional Medicaid, +110101,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,MEDICAID-Traditional Medicaid, +110102,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,MEDICAID-Traditional Medicaid, +110103,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,MEDICAID-Traditional Medicaid, +110104,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,MEDICAID-Traditional Medicaid, +110105,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,MEDICAID-Traditional Medicaid, +110106,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,MEDICAID-Traditional Medicaid, +110107,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,MEDICAID-Traditional Medicaid, +110108,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,MEDICAID-Traditional Medicaid, +110109,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,MEDICAID-Traditional Medicaid, +110110,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,MEDICAID-Traditional Medicaid,1466.39 +110111,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,MEDICAID-Traditional Medicaid, +110112,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,MEDICAID-Traditional Medicaid, +110113,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,MEDICAID-Traditional Medicaid, +110114,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,MEDICAID-Traditional Medicaid, +110115,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,MEDICAID-Traditional Medicaid, +110116,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,MEDICAID-Traditional Medicaid, +110117,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,MEDICAID-Traditional Medicaid, +110118,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,MEDICAID-Traditional Medicaid, +110119,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,MEDICAID-Traditional Medicaid, +110120,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,MEDICAID-Traditional Medicaid, +110121,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,MEDICAID-Traditional Medicaid, +110122,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,MEDICAID-Traditional Medicaid, +110123,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,MEDICAID-Traditional Medicaid, +110124,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,MEDICAID-Traditional Medicaid, +110125,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,MEDICAID-Traditional Medicaid,572.04 +110126,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,MEDICAID-Traditional Medicaid, +110127,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,MEDICAID-Traditional Medicaid, +110128,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,MEDICAID-Traditional Medicaid,2148.07 +110129,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,MEDICAID-Traditional Medicaid, +110130,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,MEDICAID-Traditional Medicaid,572.04 +110131,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,MEDICAID-Traditional Medicaid, +110132,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,MEDICAID-Traditional Medicaid, +110133,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,MEDICAID-Traditional Medicaid, +110134,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,MEDICAID-Traditional Medicaid, +110135,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,MEDICAID-Traditional Medicaid, +110136,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,MEDICAID-Traditional Medicaid, +110137,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,MEDICAID-Traditional Medicaid, +110138,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,MEDICAID-Traditional Medicaid, +110139,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,MEDICAID-Traditional Medicaid, +110140,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,MEDICAID-Traditional Medicaid,572.04 +110141,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,MEDICAID-Traditional Medicaid, +110142,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,MEDICAID-Traditional Medicaid, +110143,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,MEDICAID-Traditional Medicaid, +110144,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,MEDICAID-Traditional Medicaid, +110145,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,MEDICAID-Traditional Medicaid, +110146,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,MEDICAID-Traditional Medicaid, +110147,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,MEDICAID-Traditional Medicaid,2615.4 +110148,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,MEDICAID-Traditional Medicaid, +110149,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,MEDICAID-Traditional Medicaid,781.93 +110150,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,MEDICAID-Traditional Medicaid, +110151,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,MEDICAID-Traditional Medicaid, +110152,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,MEDICAID-Traditional Medicaid, +110153,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,MEDICAID-Traditional Medicaid, +110154,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,MEDICAID-Traditional Medicaid, +110155,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,MEDICAID-Traditional Medicaid, +110156,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,MEDICAID-Traditional Medicaid, +110157,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,MEDICAID-Traditional Medicaid, +110158,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,MEDICAID-Traditional Medicaid, +110159,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,MEDICAID-Traditional Medicaid, +110160,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,MEDICAID-Traditional Medicaid, +110161,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,MEDICAID-Traditional Medicaid, +110162,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,MEDICAID-Traditional Medicaid, +110163,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,MEDICAID-Traditional Medicaid, +110164,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,MEDICAID-Traditional Medicaid, +110165,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,MEDICAID-Traditional Medicaid, +110166,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,MEDICAID-Traditional Medicaid, +110167,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,MEDICAID-Traditional Medicaid, +110168,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,MEDICAID-Traditional Medicaid, +110169,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,MEDICAID-Traditional Medicaid, +110170,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,MEDICAID-Traditional Medicaid, +110171,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,MEDICAID-Traditional Medicaid, +110172,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,MEDICAID-Traditional Medicaid, +110173,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,MEDICAID-Traditional Medicaid, +110174,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,MEDICAID-Traditional Medicaid, +110175,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,MEDICAID-Traditional Medicaid, +110176,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,MEDICAID-Traditional Medicaid, +110177,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,MEDICAID-Traditional Medicaid, +110178,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,MEDICAID-Traditional Medicaid, +110179,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,MEDICAID-Traditional Medicaid, +110180,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,MEDICAID-Traditional Medicaid, +110181,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,MEDICAID-Traditional Medicaid, +110182,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,MEDICAID-Traditional Medicaid, +110183,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,MEDICAID-Traditional Medicaid, +110184,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,MEDICAID-Traditional Medicaid, +110185,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,MEDICAID-Traditional Medicaid, +110186,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,MEDICAID-Traditional Medicaid, +110187,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,MEDICAID-Traditional Medicaid, +110188,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,MEDICAID-Traditional Medicaid, +110189,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,MEDICAID-Traditional Medicaid, +110190,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,MEDICAID-Traditional Medicaid, +110191,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,MEDICAID-Traditional Medicaid, +110192,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,MEDICAID-Traditional Medicaid, +110193,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,MEDICAID-Traditional Medicaid, +110194,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,MEDICAID-Traditional Medicaid, +110195,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,MEDICAID-Traditional Medicaid, +110196,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,MEDICAID-Traditional Medicaid, +110197,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,MEDICAID-Traditional Medicaid, +110198,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,MEDICAID-Traditional Medicaid, +110199,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,MEDICAID-Traditional Medicaid, +110200,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,MEDICAID-Traditional Medicaid, +110201,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,MEDICAID-Traditional Medicaid, +110202,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,MEDICAID-Traditional Medicaid, +110203,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,MEDICAID-Traditional Medicaid, +110204,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,MEDICAID-Traditional Medicaid, +110205,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,MEDICAID-Traditional Medicaid, +110206,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,MEDICAID-Traditional Medicaid, +110207,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,MEDICAID-Traditional Medicaid, +110208,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,MEDICAID-Traditional Medicaid, +110209,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,MEDICAID-Traditional Medicaid, +110210,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,MEDICAID-Traditional Medicaid, +110211,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,MEDICAID-Traditional Medicaid, +110212,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,MEDICAID-Traditional Medicaid, +110213,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,MEDICAID-Traditional Medicaid, +110214,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,MEDICAID-Traditional Medicaid, +110215,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,MEDICAID-Traditional Medicaid, +110216,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,MEDICAID-Traditional Medicaid, +110217,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,MEDICAID-Traditional Medicaid, +110218,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,MEDICAID-Traditional Medicaid, +110219,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,MEDICAID-Traditional Medicaid, +110220,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,MEDICAID-Traditional Medicaid, +110221,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,MEDICAID-Traditional Medicaid, +110222,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,MEDICAID-Traditional Medicaid, +110223,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,MEDICAID-Traditional Medicaid, +110224,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,MEDICAID-Traditional Medicaid,572.04 +110225,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,MEDICAID-Traditional Medicaid,3279.94 +110226,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,MEDICAID-Traditional Medicaid,572.04 +110227,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,MEDICAID-Traditional Medicaid, +110228,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,MEDICAID-Traditional Medicaid, +110229,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,MEDICAID-Traditional Medicaid, +110230,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,MEDICAID-Traditional Medicaid, +110231,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,MEDICAID-Traditional Medicaid, +110232,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,MEDICAID-Traditional Medicaid, +110233,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,MEDICAID-Traditional Medicaid, +110234,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,MEDICAID-Traditional Medicaid, +110235,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,MEDICAID-Traditional Medicaid, +110236,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,MEDICAID-Traditional Medicaid, +110237,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,MEDICAID-Traditional Medicaid, +110238,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,MEDICAID-Traditional Medicaid, +110239,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,MEDICAID-Traditional Medicaid, +110240,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,MEDICAID-Traditional Medicaid, +110241,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,MEDICAID-Traditional Medicaid, +110242,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,MEDICAID-Traditional Medicaid, +110243,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,MEDICAID-Traditional Medicaid, +110244,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,MEDICAID-Traditional Medicaid, +110245,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,MEDICAID-Traditional Medicaid, +110246,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,MEDICAID-Traditional Medicaid, +110247,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,MEDICAID-Traditional Medicaid, +110248,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,MEDICAID-Traditional Medicaid, +110249,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,MEDICAID-Traditional Medicaid, +110250,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,MEDICAID-Traditional Medicaid, +110251,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,MEDICAID-Traditional Medicaid, +110252,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,MEDICAID-Traditional Medicaid, +110253,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,MEDICAID-Traditional Medicaid, +110254,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,MEDICAID-Traditional Medicaid, +110255,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,MEDICAID-Traditional Medicaid, +110256,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,MEDICAID-Traditional Medicaid, +110257,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,MEDICAID-Traditional Medicaid, +110258,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,MEDICAID-Traditional Medicaid, +110259,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,MEDICAID-Traditional Medicaid, +110260,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,MEDICAID-Traditional Medicaid, +110261,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,MEDICAID-Traditional Medicaid, +110262,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,MEDICAID-Traditional Medicaid, +110263,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,MEDICAID-Traditional Medicaid, +110264,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,MEDICAID-Traditional Medicaid, +110265,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,MEDICAID-Traditional Medicaid, +110266,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,MEDICAID-Traditional Medicaid, +110267,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,MEDICAID-Traditional Medicaid, +110268,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,MEDICAID-Traditional Medicaid, +110269,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,MEDICAID-Traditional Medicaid, +110270,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,MEDICAID-Traditional Medicaid, +110271,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,MEDICAID-Traditional Medicaid, +110272,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,MEDICAID-Traditional Medicaid, +110273,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,MEDICAID-Traditional Medicaid, +110274,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,MEDICAID-Traditional Medicaid, +110275,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,MEDICAID-Traditional Medicaid, +110276,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,MEDICAID-Traditional Medicaid,597.86 +110277,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,MEDICAID-Traditional Medicaid,3279.94 +110278,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,MEDICAID-Traditional Medicaid, +110279,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,MEDICAID-Traditional Medicaid, +110280,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,MEDICAID-Traditional Medicaid, +110281,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,MEDICAID-Traditional Medicaid, +110282,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,MEDICAID-Traditional Medicaid, +110283,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,MEDICAID-Traditional Medicaid, +110284,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,MEDICAID-Traditional Medicaid, +110285,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,MEDICAID-Traditional Medicaid, +110286,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,MEDICAID-Traditional Medicaid, +110287,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,MEDICAID-Traditional Medicaid, +110288,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,MEDICAID-Traditional Medicaid, +110289,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,MEDICAID-Traditional Medicaid, +110290,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,MEDICAID-Traditional Medicaid, +110291,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,MEDICAID-Traditional Medicaid, +110292,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,MEDICAID-Traditional Medicaid, +110293,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,MEDICAID-Traditional Medicaid, +110294,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,MEDICAID-Traditional Medicaid, +110295,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,MEDICAID-Traditional Medicaid, +110296,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,MEDICAID-Traditional Medicaid, +110297,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,MEDICAID-Traditional Medicaid, +110298,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,MEDICAID-Traditional Medicaid, +110299,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,MEDICAID-Traditional Medicaid, +110300,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,MEDICAID-Traditional Medicaid, +110301,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,MEDICAID-Traditional Medicaid, +110302,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,MEDICAID-Traditional Medicaid,238.59 +110303,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,MEDICAID-Traditional Medicaid,250.23 +110304,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,MEDICAID-Traditional Medicaid,251.32 +110305,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,MEDICAID-Traditional Medicaid, +110306,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,MEDICAID-Traditional Medicaid, +110307,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,MEDICAID-Traditional Medicaid,342.71 +110308,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,MEDICAID-Traditional Medicaid, +110309,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,MEDICAID-Traditional Medicaid,349.42 +110310,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,MEDICAID-Traditional Medicaid,258.96 +110311,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,MEDICAID-Traditional Medicaid,431.55 +110312,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,MEDICAID-Traditional Medicaid,258.96 +110313,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,MEDICAID-Traditional Medicaid, +110314,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,MEDICAID-Traditional Medicaid, +110315,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,MEDICAID-Traditional Medicaid,3814.42 +110316,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,MEDICAID-Traditional Medicaid, +110317,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,MEDICAID-Traditional Medicaid, +110318,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,MEDICAID-Traditional Medicaid, +110319,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,MEDICAID-Traditional Medicaid, +110320,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,MEDICAID-Traditional Medicaid, +110321,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,MEDICAID-Traditional Medicaid, +110322,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,MEDICAID-Traditional Medicaid, +110323,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,MEDICAID-Traditional Medicaid, +110324,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,MEDICAID-Traditional Medicaid, +110325,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,MEDICAID-Traditional Medicaid, +110326,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,MEDICAID-Traditional Medicaid, +110327,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,MEDICAID-Traditional Medicaid, +110328,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,MEDICAID-Traditional Medicaid, +110329,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,MEDICAID-Traditional Medicaid, +110330,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,MEDICAID-Traditional Medicaid, +110331,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,MEDICAID-Traditional Medicaid, +110332,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,MEDICAID-Traditional Medicaid, +110333,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,MEDICAID-Traditional Medicaid, +110334,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,MEDICAID-Traditional Medicaid, +110335,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,MEDICAID-Traditional Medicaid, +110336,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,MEDICAID-Traditional Medicaid, +110337,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,MEDICAID-Traditional Medicaid, +110338,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,MEDICAID-Traditional Medicaid, +110339,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,MEDICAID-Traditional Medicaid, +110340,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,MEDICAID-Traditional Medicaid, +110341,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,MEDICAID-Traditional Medicaid, +110342,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,MEDICAID-Traditional Medicaid, +110343,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,MEDICAID-Traditional Medicaid, +110344,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,MEDICAID-Traditional Medicaid, +110345,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,MEDICAID-Traditional Medicaid, +110346,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,MEDICAID-Traditional Medicaid, +110347,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,MEDICAID-Traditional Medicaid, +110348,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,MEDICAID-Traditional Medicaid, +110349,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,MEDICAID-Traditional Medicaid, +110350,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,MEDICAID-Traditional Medicaid, +110351,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,MEDICAID-Traditional Medicaid, +110352,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,MEDICAID-Traditional Medicaid, +110353,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,MEDICAID-Traditional Medicaid, +110354,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,MEDICAID-Traditional Medicaid, +110355,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,MEDICAID-Traditional Medicaid, +110356,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,MEDICAID-Traditional Medicaid, +110357,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,MEDICAID-Traditional Medicaid, +110358,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,MEDICAID-Traditional Medicaid, +110359,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,MEDICAID-Traditional Medicaid, +110360,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,MEDICAID-Traditional Medicaid, +110361,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,MEDICAID-Traditional Medicaid, +110362,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,MEDICAID-Traditional Medicaid, +110363,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,MEDICAID-Traditional Medicaid, +110364,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,MEDICAID-Traditional Medicaid, +110365,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,MEDICAID-Traditional Medicaid, +110366,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,MEDICAID-Traditional Medicaid, +110367,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,MEDICAID-Traditional Medicaid, +110368,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,MEDICAID-Traditional Medicaid, +110369,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,MEDICAID-Traditional Medicaid, +110370,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,MEDICAID-Traditional Medicaid, +110371,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,MEDICAID-Traditional Medicaid, +110372,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,MEDICAID-Traditional Medicaid, +110373,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,MEDICAID-Traditional Medicaid, +110374,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,MEDICAID-Traditional Medicaid, +110375,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,MEDICAID-Traditional Medicaid, +110376,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,MEDICAID-Traditional Medicaid, +110377,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,MEDICAID-Traditional Medicaid, +110378,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,MEDICAID-Traditional Medicaid, +110379,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,MEDICAID-Traditional Medicaid, +110380,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,MEDICAID-Traditional Medicaid,592.18 +110381,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,MEDICAID-Traditional Medicaid, +110382,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,MEDICAID-Traditional Medicaid, +110383,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,MEDICAID-Traditional Medicaid, +110384,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,MEDICAID-Traditional Medicaid, +110385,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,MEDICAID-Traditional Medicaid, +110386,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,MEDICAID-Traditional Medicaid, +110387,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,MEDICAID-Traditional Medicaid,142.94 +110388,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,MEDICAID-Traditional Medicaid, +110389,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,MEDICAID-Traditional Medicaid, +110390,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,MEDICAID-Traditional Medicaid, +110391,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,MEDICAID-Traditional Medicaid, +110392,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,MEDICAID-Traditional Medicaid, +110393,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,MEDICAID-Traditional Medicaid, +110394,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,MEDICAID-Traditional Medicaid, +110395,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,MEDICAID-Traditional Medicaid, +110396,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,MEDICAID-Traditional Medicaid, +110397,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,MEDICAID-Traditional Medicaid, +110398,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,MEDICAID-Traditional Medicaid, +110399,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,MEDICAID-Traditional Medicaid,134.13 +110400,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,MEDICAID-Traditional Medicaid, +110401,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,MEDICAID-Traditional Medicaid, +110402,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,MEDICAID-Traditional Medicaid, +110403,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,MEDICAID-Traditional Medicaid, +110404,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,MEDICAID-Traditional Medicaid, +110405,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,MEDICAID-Traditional Medicaid, +110406,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,MEDICAID-Traditional Medicaid,1366.42 +110407,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,MEDICAID-Traditional Medicaid, +110408,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,MEDICAID-Traditional Medicaid, +110409,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,MEDICAID-Traditional Medicaid, +110410,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,MEDICAID-Traditional Medicaid, +110411,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,MEDICAID-Traditional Medicaid, +110412,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,MEDICAID-Traditional Medicaid, +110413,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,MEDICAID-Traditional Medicaid, +110414,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,MEDICAID-Traditional Medicaid, +110415,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,MEDICAID-Traditional Medicaid, +110416,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,MEDICAID-Traditional Medicaid, +110417,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,MEDICAID-Traditional Medicaid, +110418,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,MEDICAID-Traditional Medicaid, +110419,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,MEDICAID-Traditional Medicaid, +110420,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,MEDICAID-Traditional Medicaid, +110421,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,MEDICAID-Traditional Medicaid, +110422,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,MEDICAID-Traditional Medicaid, +110423,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,MEDICAID-Traditional Medicaid, +110424,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,MEDICAID-Traditional Medicaid, +110425,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,MEDICAID-Traditional Medicaid, +110426,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,MEDICAID-Traditional Medicaid, +110427,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,MEDICAID-Traditional Medicaid, +110428,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,MEDICAID-Traditional Medicaid, +110429,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,MEDICAID-Traditional Medicaid, +110430,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,MEDICAID-Traditional Medicaid, +110431,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,MEDICAID-Traditional Medicaid, +110432,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,MEDICAID-Traditional Medicaid, +110433,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,MEDICAID-Traditional Medicaid,697.12 +110434,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,MEDICAID-Traditional Medicaid,679.91 +110435,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,MEDICAID-Traditional Medicaid, +110436,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,MEDICAID-Traditional Medicaid, +110437,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,MEDICAID-Traditional Medicaid, +110438,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,MEDICAID-Traditional Medicaid, +110439,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,MEDICAID-Traditional Medicaid, +110440,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,MEDICAID-Traditional Medicaid, +110441,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,MEDICAID-Traditional Medicaid, +110442,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,MEDICAID-Traditional Medicaid, +110443,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,MEDICAID-Traditional Medicaid, +110444,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,MEDICAID-Traditional Medicaid, +110445,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,MEDICAID-Traditional Medicaid, +110446,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,MEDICAID-Traditional Medicaid, +110447,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,MEDICAID-Traditional Medicaid, +110448,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,MEDICAID-Traditional Medicaid, +110449,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,MEDICAID-Traditional Medicaid, +110450,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,MEDICAID-Traditional Medicaid, +110451,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,MEDICAID-Traditional Medicaid, +110452,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,MEDICAID-Traditional Medicaid, +110453,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,MEDICAID-Traditional Medicaid, +110454,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,MEDICAID-Traditional Medicaid, +110455,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,MEDICAID-Traditional Medicaid, +110456,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,MEDICAID-Traditional Medicaid, +110457,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,MEDICAID-Traditional Medicaid, +110458,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,MEDICAID-Traditional Medicaid, +110459,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,MEDICAID-Traditional Medicaid, +110460,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,MEDICAID-Traditional Medicaid, +110461,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,MEDICAID-Traditional Medicaid, +110462,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,MEDICAID-Traditional Medicaid, +110463,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,MEDICAID-Traditional Medicaid, +110464,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,MEDICAID-Traditional Medicaid,6874.56 +110465,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,MEDICAID-Traditional Medicaid, +110466,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,MEDICAID-Traditional Medicaid, +110467,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,MEDICAID-Traditional Medicaid, +110468,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,MEDICAID-Traditional Medicaid, +110469,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,MEDICAID-Traditional Medicaid, +110470,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,MEDICAID-Traditional Medicaid, +110471,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,MEDICAID-Traditional Medicaid, +110472,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,MEDICAID-Traditional Medicaid, +110473,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,MEDICAID-Traditional Medicaid, +110474,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,MEDICAID-Traditional Medicaid, +110475,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,MEDICAID-Traditional Medicaid, +110476,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,MEDICAID-Traditional Medicaid, +110477,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,MEDICAID-Traditional Medicaid, +110478,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,MEDICAID-Traditional Medicaid, +110479,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,MEDICAID-Traditional Medicaid, +110480,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,MEDICAID-Traditional Medicaid, +110481,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,MEDICAID-Traditional Medicaid, +110482,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,MEDICAID-Traditional Medicaid, +110483,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,MEDICAID-Traditional Medicaid, +110484,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,MEDICAID-Traditional Medicaid, +110485,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,MEDICAID-Traditional Medicaid, +110486,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,MEDICAID-Traditional Medicaid, +110487,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,MEDICAID-Traditional Medicaid, +110488,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,MEDICAID-Traditional Medicaid, +110489,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,MEDICAID-Traditional Medicaid, +110490,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,MEDICAID-Traditional Medicaid, +110491,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,MEDICAID-Traditional Medicaid,1027.81 +110492,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,MEDICAID-Traditional Medicaid, +110493,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,MEDICAID-Traditional Medicaid, +110494,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,MEDICAID-Traditional Medicaid, +110495,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,MEDICAID-Traditional Medicaid, +110496,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,MEDICAID-Traditional Medicaid, +110497,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,MEDICAID-Traditional Medicaid, +110498,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,MEDICAID-Traditional Medicaid, +110499,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,MEDICAID-Traditional Medicaid, +110500,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,MEDICAID-Traditional Medicaid, +110501,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,MEDICAID-Traditional Medicaid, +110502,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,MEDICAID-Traditional Medicaid,34.42 +110503,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,MEDICAID-Traditional Medicaid,8.0 +110504,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,MEDICAID-Traditional Medicaid,50.88 +110505,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,MEDICAID-Traditional Medicaid,723.52 +110506,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,MEDICAID-Traditional Medicaid, +110507,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,MEDICAID-Traditional Medicaid, +110508,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,MEDICAID-Traditional Medicaid, +110509,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,MEDICAID-Traditional Medicaid, +110510,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,MEDICAID-Traditional Medicaid, +110511,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,MEDICAID-Traditional Medicaid,2118.68 +110512,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,MEDICAID-Traditional Medicaid,281.64 +110513,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,MEDICAID-Traditional Medicaid,1596.12 +110514,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,MEDICAID-Traditional Medicaid, +110515,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,MEDICAID-Traditional Medicaid,2200.51 +110516,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,MEDICAID-Traditional Medicaid,251.09 +110517,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,MEDICAID-Traditional Medicaid, +110518,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,MEDICAID-Traditional Medicaid, +110519,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,MEDICAID-Traditional Medicaid, +110520,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,MEDICAID-Traditional Medicaid, +110521,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,MEDICAID-Traditional Medicaid, +110522,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,MEDICAID-Traditional Medicaid, +110523,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,MEDICAID-Traditional Medicaid, +110524,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,MEDICAID-Traditional Medicaid,992.16 +110525,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,MEDICAID-Traditional Medicaid,88.45 +110526,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,MEDICAID-Traditional Medicaid,71.31 +110527,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,MEDICAID-Traditional Medicaid, +110528,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,MEDICAID-Traditional Medicaid, +110529,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,MEDICAID-Traditional Medicaid, +110530,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,MEDICAID-Traditional Medicaid,137.15 +110531,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,MEDICAID-Traditional Medicaid, +110532,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,MEDICAID-Traditional Medicaid, +110533,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,MEDICAID-Traditional Medicaid, +110534,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,MEDICAID-Traditional Medicaid,2764.72 +110535,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,MEDICAID-Traditional Medicaid, +110536,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,MEDICAID-Traditional Medicaid, +110537,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,MEDICAID-Traditional Medicaid, +110538,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,MEDICAID-Traditional Medicaid, +110539,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,MEDICAID-Traditional Medicaid,2478.21 +110540,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,MEDICAID-Traditional Medicaid, +110541,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,MEDICAID-Traditional Medicaid, +110542,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,MEDICAID-Traditional Medicaid, +110543,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,MEDICAID-Traditional Medicaid, +110544,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,MEDICAID-Traditional Medicaid, +110545,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,MEDICAID-Traditional Medicaid, +110546,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,MEDICAID-Traditional Medicaid, +110547,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,MEDICAID-Traditional Medicaid, +110548,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,MEDICAID-Traditional Medicaid, +110549,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,MEDICAID-Traditional Medicaid, +110550,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,MEDICAID-Traditional Medicaid,2478.21 +110551,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,MEDICAID-Traditional Medicaid, +110552,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,MEDICAID-Traditional Medicaid, +110553,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,MEDICAID-Traditional Medicaid, +110554,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,MEDICAID-Traditional Medicaid, +110555,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,MEDICAID-Traditional Medicaid, +110556,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,MEDICAID-Traditional Medicaid, +110557,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,MEDICAID-Traditional Medicaid, +110558,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,MEDICAID-Traditional Medicaid, +110559,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,MEDICAID-Traditional Medicaid, +110560,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,MEDICAID-Traditional Medicaid, +110561,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,MEDICAID-Traditional Medicaid, +110562,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,MEDICAID-Traditional Medicaid, +110563,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,MEDICAID-Traditional Medicaid, +110564,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,MEDICAID-Traditional Medicaid, +110565,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,MEDICAID-Traditional Medicaid, +110566,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,MEDICAID-Traditional Medicaid, +110567,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,MEDICAID-Traditional Medicaid, +110568,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,MEDICAID-Traditional Medicaid, +110569,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,MEDICAID-Traditional Medicaid, +110570,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,MEDICAID-Traditional Medicaid, +110571,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,MEDICAID-Traditional Medicaid, +110572,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,MEDICAID-Traditional Medicaid, +110573,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,MEDICAID-Traditional Medicaid, +110574,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,MEDICAID-Traditional Medicaid, +110575,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,MEDICAID-Traditional Medicaid, +110576,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,MEDICAID-Traditional Medicaid, +110577,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,MEDICAID-Traditional Medicaid, +110578,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,MEDICAID-Traditional Medicaid, +110579,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,MEDICAID-Traditional Medicaid, +110580,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,MEDICAID-Traditional Medicaid, +110581,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,MEDICAID-Traditional Medicaid,2156.09 +110582,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,MEDICAID-Traditional Medicaid,2334.72 +110583,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,MEDICAID-Traditional Medicaid, +110584,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,MEDICAID-Traditional Medicaid, +110585,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,MEDICAID-Traditional Medicaid,816.48 +110586,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,MEDICAID-Traditional Medicaid, +110587,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,MEDICAID-Traditional Medicaid,816.48 +110588,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,MEDICAID-Traditional Medicaid, +110589,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,MEDICAID-Traditional Medicaid, +110590,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,MEDICAID-Traditional Medicaid,1684.03 +110591,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,MEDICAID-Traditional Medicaid,1421.94 +110592,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,MEDICAID-Traditional Medicaid, +110593,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,MEDICAID-Traditional Medicaid, +110594,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,MEDICAID-Traditional Medicaid, +110595,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,MEDICAID-Traditional Medicaid, +110596,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,MEDICAID-Traditional Medicaid, +110597,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,MEDICAID-Traditional Medicaid, +110598,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,MEDICAID-Traditional Medicaid, +110599,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,MEDICAID-Traditional Medicaid, +110600,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,MEDICAID-Traditional Medicaid, +110601,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,MEDICAID-Traditional Medicaid, +110602,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,MEDICAID-Traditional Medicaid,494.84 +110603,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,MEDICAID-Traditional Medicaid, +110604,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,MEDICAID-Traditional Medicaid, +110605,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,MEDICAID-Traditional Medicaid, +110606,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,MEDICAID-Traditional Medicaid, +110607,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,MEDICAID-Traditional Medicaid, +110608,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,MEDICAID-Traditional Medicaid, +110609,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,MEDICAID-Traditional Medicaid, +110610,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,MEDICAID-Traditional Medicaid, +110611,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,MEDICAID-Traditional Medicaid, +110612,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,MEDICAID-Traditional Medicaid, +110613,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,MEDICAID-Traditional Medicaid, +110614,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,MEDICAID-Traditional Medicaid, +110615,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,MEDICAID-Traditional Medicaid, +110616,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,MEDICAID-Traditional Medicaid, +110617,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,MEDICAID-Traditional Medicaid, +110618,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,MEDICAID-Traditional Medicaid, +110619,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,MEDICAID-Traditional Medicaid,2547.06 +110620,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,MEDICAID-Traditional Medicaid, +110621,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,MEDICAID-Traditional Medicaid, +110622,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,MEDICAID-Traditional Medicaid,1943.39 +110623,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,MEDICAID-Traditional Medicaid, +110624,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,MEDICAID-Traditional Medicaid, +110625,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,MEDICAID-Traditional Medicaid, +110626,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,MEDICAID-Traditional Medicaid, +110627,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,MEDICAID-Traditional Medicaid, +110628,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,MEDICAID-Traditional Medicaid, +110629,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,MEDICAID-Traditional Medicaid,170.15 +110630,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,MEDICAID-Traditional Medicaid, +110631,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,MEDICAID-Traditional Medicaid, +110632,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,MEDICAID-Traditional Medicaid, +110633,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,MEDICAID-Traditional Medicaid, +110634,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,MEDICAID-Traditional Medicaid, +110635,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,MEDICAID-Traditional Medicaid, +110636,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,MEDICAID-Traditional Medicaid, +110637,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,MEDICAID-Traditional Medicaid, +110638,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,MEDICAID-Traditional Medicaid, +110639,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,MEDICAID-Traditional Medicaid, +110640,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,MEDICAID-Traditional Medicaid, +110641,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,MEDICAID-Traditional Medicaid, +110642,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,MEDICAID-Traditional Medicaid, +110643,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,MEDICAID-Traditional Medicaid, +110644,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,MEDICAID-Traditional Medicaid, +110645,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,MEDICAID-Traditional Medicaid, +110646,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,MEDICAID-Traditional Medicaid, +110647,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,MEDICAID-Traditional Medicaid,3855.99 +110648,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,MEDICAID-Traditional Medicaid, +110649,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,MEDICAID-Traditional Medicaid, +110650,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,MEDICAID-Traditional Medicaid, +110651,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,MEDICAID-Traditional Medicaid, +110652,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,MEDICAID-Traditional Medicaid, +110653,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,MEDICAID-Traditional Medicaid, +110654,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,MEDICAID-Traditional Medicaid, +110655,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,MEDICAID-Traditional Medicaid, +110656,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,MEDICAID-Traditional Medicaid, +110657,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,MEDICAID-Traditional Medicaid, +110658,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,MEDICAID-Traditional Medicaid,1724.49 +110659,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,MEDICAID-Traditional Medicaid, +110660,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,MEDICAID-Traditional Medicaid, +110661,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,MEDICAID-Traditional Medicaid, +110662,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,MEDICAID-Traditional Medicaid, +110663,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,MEDICAID-Traditional Medicaid, +110664,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,MEDICAID-Traditional Medicaid, +110665,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,MEDICAID-Traditional Medicaid, +110666,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,MEDICAID-Traditional Medicaid, +110667,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,MEDICAID-Traditional Medicaid, +110668,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,MEDICAID-Traditional Medicaid, +110669,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,MEDICAID-Traditional Medicaid, +110670,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,MEDICAID-Traditional Medicaid, +110671,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,MEDICAID-Traditional Medicaid, +110672,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,MEDICAID-Traditional Medicaid, +110673,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,MEDICAID-Traditional Medicaid, +110674,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,MEDICAID-Traditional Medicaid, +110675,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,MEDICAID-Traditional Medicaid, +110676,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,MEDICAID-Traditional Medicaid,975.42 +110677,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,MEDICAID-Traditional Medicaid, +110678,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,MEDICAID-Traditional Medicaid, +110679,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,MEDICAID-Traditional Medicaid, +110680,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,MEDICAID-Traditional Medicaid,1040.07 +110681,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,MEDICAID-Traditional Medicaid, +110682,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,MEDICAID-Traditional Medicaid,975.42 +110683,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,MEDICAID-Traditional Medicaid, +110684,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,MEDICAID-Traditional Medicaid,975.42 +110685,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,MEDICAID-Traditional Medicaid,975.42 +110686,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,MEDICAID-Traditional Medicaid,975.42 +110687,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,MEDICAID-Traditional Medicaid, +110688,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,MEDICAID-Traditional Medicaid,429.87 +110689,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,MEDICAID-Traditional Medicaid, +110690,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,MEDICAID-Traditional Medicaid, +110691,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,MEDICAID-Traditional Medicaid, +110692,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,MEDICAID-Traditional Medicaid, +110693,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,MEDICAID-Traditional Medicaid,975.42 +110694,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,MEDICAID-Traditional Medicaid,1432.46 +110695,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,MEDICAID-Traditional Medicaid, +110696,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,MEDICAID-Traditional Medicaid, +110697,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,MEDICAID-Traditional Medicaid,1572.66 +110698,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,MEDICAID-Traditional Medicaid, +110699,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,MEDICAID-Traditional Medicaid, +110700,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,MEDICAID-Traditional Medicaid, +110701,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,MEDICAID-Traditional Medicaid, +110702,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,MEDICAID-Traditional Medicaid, +110703,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,MEDICAID-Traditional Medicaid, +110704,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,MEDICAID-Traditional Medicaid, +110705,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,MEDICAID-Traditional Medicaid, +110706,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,MEDICAID-Traditional Medicaid, +110707,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,MEDICAID-Traditional Medicaid, +110708,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,MEDICAID-Traditional Medicaid, +110709,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,MEDICAID-Traditional Medicaid, +110710,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,MEDICAID-Traditional Medicaid, +110711,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,MEDICAID-Traditional Medicaid, +110712,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,MEDICAID-Traditional Medicaid, +110713,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,MEDICAID-Traditional Medicaid, +110714,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,MEDICAID-Traditional Medicaid, +110715,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,MEDICAID-Traditional Medicaid, +110716,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,MEDICAID-Traditional Medicaid, +110717,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,MEDICAID-Traditional Medicaid,412.32 +110718,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,MEDICAID-Traditional Medicaid, +110719,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,MEDICAID-Traditional Medicaid, +110720,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,MEDICAID-Traditional Medicaid,3558.85 +110721,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,MEDICAID-Traditional Medicaid, +110722,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,MEDICAID-Traditional Medicaid, +110723,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,MEDICAID-Traditional Medicaid, +110724,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,MEDICAID-Traditional Medicaid, +110725,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,MEDICAID-Traditional Medicaid, +110726,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,MEDICAID-Traditional Medicaid, +110727,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,MEDICAID-Traditional Medicaid, +110728,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,MEDICAID-Traditional Medicaid, +110729,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,MEDICAID-Traditional Medicaid, +110730,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,MEDICAID-Traditional Medicaid, +110731,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,MEDICAID-Traditional Medicaid, +110732,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,MEDICAID-Traditional Medicaid, +110733,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,MEDICAID-Traditional Medicaid, +110734,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,MEDICAID-Traditional Medicaid, +110735,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,MEDICAID-Traditional Medicaid, +110736,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,MEDICAID-Traditional Medicaid, +110737,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,MEDICAID-Traditional Medicaid, +110738,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,MEDICAID-Traditional Medicaid, +110739,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,MEDICAID-Traditional Medicaid, +110740,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,MEDICAID-Traditional Medicaid, +110741,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,MEDICAID-Traditional Medicaid, +110742,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,MEDICAID-Traditional Medicaid, +110743,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,MEDICAID-Traditional Medicaid,1327.73 +110744,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,MEDICAID-Traditional Medicaid, +110745,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,MEDICAID-Traditional Medicaid, +110746,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,MEDICAID-Traditional Medicaid,3026.69 +110747,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,MEDICAID-Traditional Medicaid, +110748,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,MEDICAID-Traditional Medicaid, +110749,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,MEDICAID-Traditional Medicaid, +110750,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,MEDICAID-Traditional Medicaid, +110751,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,MEDICAID-Traditional Medicaid, +110752,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,MEDICAID-Traditional Medicaid, +110753,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,MEDICAID-Traditional Medicaid, +110754,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,MEDICAID-Traditional Medicaid, +110755,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,MEDICAID-Traditional Medicaid, +110756,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,MEDICAID-Traditional Medicaid, +110757,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,MEDICAID-Traditional Medicaid, +110758,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,MEDICAID-Traditional Medicaid, +110759,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,MEDICAID-Traditional Medicaid, +110760,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,MEDICAID-Traditional Medicaid,941.56 +110761,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,MEDICAID-Traditional Medicaid, +110762,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,MEDICAID-Traditional Medicaid, +110763,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,MEDICAID-Traditional Medicaid, +110764,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,MEDICAID-Traditional Medicaid,706.17 +110765,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,MEDICAID-Traditional Medicaid, +110766,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,MEDICAID-Traditional Medicaid,546.56 +110767,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,MEDICAID-Traditional Medicaid, +110768,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,MEDICAID-Traditional Medicaid, +110769,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,MEDICAID-Traditional Medicaid, +110770,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,MEDICAID-Traditional Medicaid,1010.76 +110771,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,MEDICAID-Traditional Medicaid, +110772,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,MEDICAID-Traditional Medicaid, +110773,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,MEDICAID-Traditional Medicaid, +110774,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,MEDICAID-Traditional Medicaid, +110775,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +110776,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,MEDICAID-Traditional Medicaid, +110777,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,MEDICAID-Traditional Medicaid, +110778,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,MEDICAID-Traditional Medicaid, +110779,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,MEDICAID-Traditional Medicaid, +110780,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,MEDICAID-Traditional Medicaid, +110781,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,MEDICAID-Traditional Medicaid, +110782,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,MEDICAID-Traditional Medicaid, +110783,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,MEDICAID-Traditional Medicaid, +110784,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,MEDICAID-Traditional Medicaid, +110785,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,MEDICAID-Traditional Medicaid, +110786,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,MEDICAID-Traditional Medicaid, +110787,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,MEDICAID-Traditional Medicaid, +110788,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,MEDICAID-Traditional Medicaid, +110789,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,MEDICAID-Traditional Medicaid, +110790,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,MEDICAID-Traditional Medicaid, +110791,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,MEDICAID-Traditional Medicaid, +110792,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,MEDICAID-Traditional Medicaid, +110793,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,MEDICAID-Traditional Medicaid, +110794,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,MEDICAID-Traditional Medicaid, +110795,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,MEDICAID-Traditional Medicaid, +110796,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,MEDICAID-Traditional Medicaid, +110797,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,MEDICAID-Traditional Medicaid, +110798,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,MEDICAID-Traditional Medicaid, +110799,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,MEDICAID-Traditional Medicaid, +110800,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,MEDICAID-Traditional Medicaid, +110801,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,MEDICAID-Traditional Medicaid, +110802,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,MEDICAID-Traditional Medicaid, +110803,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,MEDICAID-Traditional Medicaid, +110804,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,MEDICAID-Traditional Medicaid, +110805,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,MEDICAID-Traditional Medicaid, +110806,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,MEDICAID-Traditional Medicaid, +110807,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,MEDICAID-Traditional Medicaid, +110808,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,MEDICAID-Traditional Medicaid, +110809,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,MEDICAID-Traditional Medicaid, +110810,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,MEDICAID-Traditional Medicaid, +110811,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,MEDICAID-Traditional Medicaid, +110812,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,MEDICAID-Traditional Medicaid, +110813,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,MEDICAID-Traditional Medicaid, +110814,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,MEDICAID-Traditional Medicaid, +110815,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,MEDICAID-Traditional Medicaid, +110816,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,MEDICAID-Traditional Medicaid, +110817,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,MEDICAID-Traditional Medicaid, +110818,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,MEDICAID-Traditional Medicaid, +110819,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,MEDICAID-Traditional Medicaid, +110820,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,MEDICAID-Traditional Medicaid, +110821,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,MEDICAID-Traditional Medicaid, +110822,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,MEDICAID-Traditional Medicaid, +110823,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,MEDICAID-Traditional Medicaid, +110824,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,MEDICAID-Traditional Medicaid, +110825,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,MEDICAID-Traditional Medicaid, +110826,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,MEDICAID-Traditional Medicaid, +110827,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,MEDICAID-Traditional Medicaid, +110828,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,MEDICAID-Traditional Medicaid, +110829,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,MEDICAID-Traditional Medicaid, +110830,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,MEDICAID-Traditional Medicaid, +110831,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,MEDICAID-Traditional Medicaid, +110832,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,MEDICAID-Traditional Medicaid, +110833,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,MEDICAID-Traditional Medicaid, +110834,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,MEDICAID-Traditional Medicaid, +110835,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,MEDICAID-Traditional Medicaid, +110836,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,MEDICAID-Traditional Medicaid, +110837,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,MEDICAID-Traditional Medicaid, +110838,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,MEDICAID-Traditional Medicaid, +110839,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,MEDICAID-Traditional Medicaid, +110840,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,MEDICAID-Traditional Medicaid, +110841,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,MEDICAID-Traditional Medicaid, +110842,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,MEDICAID-Traditional Medicaid, +110843,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,MEDICAID-Traditional Medicaid, +110844,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,MEDICAID-Traditional Medicaid, +110845,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,MEDICAID-Traditional Medicaid, +110846,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,MEDICAID-Traditional Medicaid, +110847,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,MEDICAID-Traditional Medicaid, +110848,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,MEDICAID-Traditional Medicaid, +110849,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,MEDICAID-Traditional Medicaid, +110850,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,MEDICAID-Traditional Medicaid, +110851,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,MEDICAID-Traditional Medicaid, +110852,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,MEDICAID-Traditional Medicaid, +110853,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,MEDICAID-Traditional Medicaid, +110854,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,MEDICAID-Traditional Medicaid, +110855,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,MEDICAID-Traditional Medicaid, +110856,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,MEDICAID-Traditional Medicaid, +110857,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,MEDICAID-Traditional Medicaid, +110858,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,MEDICAID-Traditional Medicaid, +110859,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,MEDICAID-Traditional Medicaid, +110860,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,MEDICAID-Traditional Medicaid, +110861,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,MEDICAID-Traditional Medicaid, +110862,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,MEDICAID-Traditional Medicaid, +110863,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,MEDICAID-Traditional Medicaid, +110864,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,MEDICAID-Traditional Medicaid, +110865,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,MEDICAID-Traditional Medicaid, +110866,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,MEDICAID-Traditional Medicaid, +110867,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,MEDICAID-Traditional Medicaid, +110868,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,MEDICAID-Traditional Medicaid, +110869,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,MEDICAID-Traditional Medicaid, +110870,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,MEDICAID-Traditional Medicaid, +110871,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,MEDICAID-Traditional Medicaid, +110872,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,MEDICAID-Traditional Medicaid, +110873,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,MEDICAID-Traditional Medicaid, +110874,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,MEDICAID-Traditional Medicaid, +110875,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,MEDICAID-Traditional Medicaid, +110876,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,MEDICAID-Traditional Medicaid, +110877,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,MEDICAID-Traditional Medicaid, +110878,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,MEDICAID-Traditional Medicaid, +110879,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,MEDICAID-Traditional Medicaid, +110880,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,MEDICAID-Traditional Medicaid, +110881,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,MEDICAID-Traditional Medicaid, +110882,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,MEDICAID-Traditional Medicaid, +110883,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,MEDICAID-Traditional Medicaid, +110884,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,MEDICAID-Traditional Medicaid, +110885,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,MEDICAID-Traditional Medicaid, +110886,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,MEDICAID-Traditional Medicaid, +110887,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,MEDICAID-Traditional Medicaid, +110888,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,MEDICAID-Traditional Medicaid, +110889,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,MEDICAID-Traditional Medicaid, +110890,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,MEDICAID-Traditional Medicaid, +110891,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,MEDICAID-Traditional Medicaid, +110892,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,MEDICAID-Traditional Medicaid, +110893,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,MEDICAID-Traditional Medicaid, +110894,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,MEDICAID-Traditional Medicaid, +110895,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,MEDICAID-Traditional Medicaid, +110896,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,MEDICAID-Traditional Medicaid, +110897,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,MEDICAID-Traditional Medicaid, +110898,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,MEDICAID-Traditional Medicaid, +110899,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,MEDICAID-Traditional Medicaid, +110900,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,MEDICAID-Traditional Medicaid, +110901,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,MEDICAID-Traditional Medicaid, +110902,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,MEDICAID-Traditional Medicaid, +110903,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,MEDICAID-Traditional Medicaid, +110904,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,MEDICAID-Traditional Medicaid, +110905,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,MEDICAID-Traditional Medicaid, +110906,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,MEDICAID-Traditional Medicaid, +110907,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,MEDICAID-Traditional Medicaid, +110908,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,MEDICAID-Traditional Medicaid, +110909,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,MEDICAID-Traditional Medicaid, +110910,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,MEDICAID-Traditional Medicaid, +110911,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,MEDICAID-Traditional Medicaid, +110912,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,MEDICAID-Traditional Medicaid, +110913,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,MEDICAID-Traditional Medicaid, +110914,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,MEDICAID-Traditional Medicaid, +110915,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,MEDICAID-Traditional Medicaid, +110916,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,MEDICAID-Traditional Medicaid, +110917,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,MEDICAID-Traditional Medicaid, +110918,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,MEDICAID-Traditional Medicaid, +110919,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,MEDICAID-Traditional Medicaid, +110920,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,MEDICAID-Traditional Medicaid, +110921,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,MEDICAID-Traditional Medicaid, +110922,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,MEDICAID-Traditional Medicaid, +110923,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,MEDICAID-Traditional Medicaid, +110924,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,MEDICAID-Traditional Medicaid, +110925,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,MEDICAID-Traditional Medicaid, +110926,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,MEDICAID-Traditional Medicaid, +110927,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,MEDICAID-Traditional Medicaid, +110928,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,MEDICAID-Traditional Medicaid, +110929,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,MEDICAID-Traditional Medicaid, +110930,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,MEDICAID-Traditional Medicaid, +110931,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,MEDICAID-Traditional Medicaid, +110932,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,MEDICAID-Traditional Medicaid, +110933,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,MEDICAID-Traditional Medicaid, +110934,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,MEDICAID-Traditional Medicaid, +110935,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,MEDICAID-Traditional Medicaid, +110936,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,MEDICAID-Traditional Medicaid, +110937,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,MEDICAID-Traditional Medicaid, +110938,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,MEDICAID-Traditional Medicaid, +110939,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,MEDICAID-Traditional Medicaid, +110940,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,MEDICAID-Traditional Medicaid, +110941,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,MEDICAID-Traditional Medicaid, +110942,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,MEDICAID-Traditional Medicaid, +110943,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,MEDICAID-Traditional Medicaid, +110944,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,MEDICAID-Traditional Medicaid, +110945,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,MEDICAID-Traditional Medicaid, +110946,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,MEDICAID-Traditional Medicaid, +110947,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,MEDICAID-Traditional Medicaid, +110948,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,MEDICAID-Traditional Medicaid, +110949,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,MEDICAID-Traditional Medicaid, +110950,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,MEDICAID-Traditional Medicaid, +110951,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,MEDICAID-Traditional Medicaid, +110952,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,MEDICAID-Traditional Medicaid, +110953,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,MEDICAID-Traditional Medicaid, +110954,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,MEDICAID-Traditional Medicaid, +110955,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,MEDICAID-Traditional Medicaid, +110956,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,MEDICAID-Traditional Medicaid, +110957,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,MEDICAID-Traditional Medicaid, +110958,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,MEDICAID-Traditional Medicaid, +110959,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,MEDICAID-Traditional Medicaid, +110960,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,MEDICAID-Traditional Medicaid, +110961,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,MEDICAID-Traditional Medicaid, +110962,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,MEDICAID-Traditional Medicaid, +110963,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,MEDICAID-Traditional Medicaid, +110964,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,MEDICAID-Traditional Medicaid, +110965,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,MEDICAID-Traditional Medicaid, +110966,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,MEDICAID-Traditional Medicaid, +110967,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,MEDICAID-Traditional Medicaid, +110968,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,MEDICAID-Traditional Medicaid, +110969,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,MEDICAID-Traditional Medicaid, +110970,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,MEDICAID-Traditional Medicaid, +110971,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,MEDICAID-Traditional Medicaid, +110972,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,MEDICAID-Traditional Medicaid, +110973,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,MEDICAID-Traditional Medicaid, +110974,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,MEDICAID-Traditional Medicaid, +110975,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,MEDICAID-Traditional Medicaid, +110976,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,MEDICAID-Traditional Medicaid, +110977,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,MEDICAID-Traditional Medicaid, +110978,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,MEDICAID-Traditional Medicaid, +110979,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,MEDICAID-Traditional Medicaid, +110980,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,MEDICAID-Traditional Medicaid, +110981,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,MEDICAID-Traditional Medicaid, +110982,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,MEDICAID-Traditional Medicaid, +110983,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,MEDICAID-Traditional Medicaid, +110984,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,MEDICAID-Traditional Medicaid, +110985,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,MEDICAID-Traditional Medicaid, +110986,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,MEDICAID-Traditional Medicaid, +110987,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,MEDICAID-Traditional Medicaid, +110988,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,MEDICAID-Traditional Medicaid, +110989,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,MEDICAID-Traditional Medicaid, +110990,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,MEDICAID-Traditional Medicaid, +110991,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,MEDICAID-Traditional Medicaid, +110992,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,MEDICAID-Traditional Medicaid, +110993,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,MEDICAID-Traditional Medicaid, +110994,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,MEDICAID-Traditional Medicaid, +110995,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,MEDICAID-Traditional Medicaid, +110996,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,MEDICAID-Traditional Medicaid, +110997,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,MEDICAID-Traditional Medicaid, +110998,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,MEDICAID-Traditional Medicaid, +110999,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,MEDICAID-Traditional Medicaid, +111000,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,MEDICAID-Traditional Medicaid, +111001,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,MEDICAID-Traditional Medicaid, +111002,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,MEDICAID-Traditional Medicaid, +111003,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,MEDICAID-Traditional Medicaid, +111004,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,MEDICAID-Traditional Medicaid, +111005,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,MEDICAID-Traditional Medicaid, +111006,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,MEDICAID-Traditional Medicaid, +111007,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,MEDICAID-Traditional Medicaid, +111008,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,MEDICAID-Traditional Medicaid, +111009,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,MEDICAID-Traditional Medicaid, +111010,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,MEDICAID-Traditional Medicaid, +111011,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,MEDICAID-Traditional Medicaid, +111012,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,MEDICAID-Traditional Medicaid, +111013,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,MEDICAID-Traditional Medicaid, +111014,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,MEDICAID-Traditional Medicaid, +111015,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,MEDICAID-Traditional Medicaid, +111016,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,MEDICAID-Traditional Medicaid, +111017,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,MEDICAID-Traditional Medicaid, +111018,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,MEDICAID-Traditional Medicaid, +111019,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,MEDICAID-Traditional Medicaid, +111020,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,MEDICAID-Traditional Medicaid, +111021,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,MEDICAID-Traditional Medicaid, +111022,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,MEDICAID-Traditional Medicaid, +111023,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,MEDICAID-Traditional Medicaid, +111024,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,MEDICAID-Traditional Medicaid, +111025,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,MEDICAID-Traditional Medicaid, +111026,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,MEDICAID-Traditional Medicaid, +111027,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,MEDICAID-Traditional Medicaid, +111028,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,MEDICAID-Traditional Medicaid, +111029,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,MEDICAID-Traditional Medicaid, +111030,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,MEDICAID-Traditional Medicaid, +111031,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,MEDICAID-Traditional Medicaid, +111032,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,MEDICAID-Traditional Medicaid, +111033,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,MEDICAID-Traditional Medicaid, +111034,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,MEDICAID-Traditional Medicaid, +111035,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,MEDICAID-Traditional Medicaid, +111036,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,MEDICAID-Traditional Medicaid, +111037,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,MEDICAID-Traditional Medicaid, +111038,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,MEDICAID-Traditional Medicaid, +111039,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,MEDICAID-Traditional Medicaid, +111040,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,MEDICAID-Traditional Medicaid, +111041,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,MEDICAID-Traditional Medicaid, +111042,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,MEDICAID-Traditional Medicaid, +111043,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,MEDICAID-Traditional Medicaid, +111044,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,MEDICAID-Traditional Medicaid, +111045,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,MEDICAID-Traditional Medicaid, +111046,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,MEDICAID-Traditional Medicaid, +111047,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,MEDICAID-Traditional Medicaid, +111048,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,MEDICAID-Traditional Medicaid, +111049,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,MEDICAID-Traditional Medicaid, +111050,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,MEDICAID-Traditional Medicaid, +111051,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,MEDICAID-Traditional Medicaid, +111052,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,MEDICAID-Traditional Medicaid, +111053,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,MEDICAID-Traditional Medicaid, +111054,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,MEDICAID-Traditional Medicaid, +111055,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,MEDICAID-Traditional Medicaid, +111056,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,MEDICAID-Traditional Medicaid, +111057,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,MEDICAID-Traditional Medicaid, +111058,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,MEDICAID-Traditional Medicaid, +111059,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,MEDICAID-Traditional Medicaid, +111060,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,MEDICAID-Traditional Medicaid, +111061,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,MEDICAID-Traditional Medicaid, +111062,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,MEDICAID-Traditional Medicaid, +111063,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,MEDICAID-Traditional Medicaid, +111064,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,MEDICAID-Traditional Medicaid, +111065,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,MEDICAID-Traditional Medicaid, +111066,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,MEDICAID-Traditional Medicaid, +111067,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,MEDICAID-Traditional Medicaid, +111068,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,MEDICAID-Traditional Medicaid, +111069,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,MEDICAID-Traditional Medicaid, +111070,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,MEDICAID-Traditional Medicaid, +111071,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,MEDICAID-Traditional Medicaid, +111072,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,MEDICAID-Traditional Medicaid, +111073,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,MEDICAID-Traditional Medicaid, +111074,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,MEDICAID-Traditional Medicaid, +111075,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,MEDICAID-Traditional Medicaid, +111076,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,MEDICAID-Traditional Medicaid, +111077,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,MEDICAID-Traditional Medicaid, +111078,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,MEDICAID-Traditional Medicaid, +111079,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,MEDICAID-Traditional Medicaid, +111080,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,MEDICAID-Traditional Medicaid, +111081,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,MEDICAID-Traditional Medicaid, +111082,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,MEDICAID-Traditional Medicaid, +111083,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,MEDICAID-Traditional Medicaid, +111084,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,MEDICAID-Traditional Medicaid, +111085,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,MEDICAID-Traditional Medicaid, +111086,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,MEDICAID-Traditional Medicaid, +111087,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,MEDICAID-Traditional Medicaid, +111088,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,MEDICAID-Traditional Medicaid, +111089,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,MEDICAID-Traditional Medicaid, +111090,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,MEDICAID-Traditional Medicaid, +111091,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,MEDICAID-Traditional Medicaid, +111092,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,MEDICAID-Traditional Medicaid, +111093,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,MEDICAID-Traditional Medicaid, +111094,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,MEDICAID-Traditional Medicaid, +111095,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,MEDICAID-Traditional Medicaid, +111096,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,MEDICAID-Traditional Medicaid, +111097,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,MEDICAID-Traditional Medicaid, +111098,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,MEDICAID-Traditional Medicaid, +111099,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,MEDICAID-Traditional Medicaid, +111100,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,MEDICAID-Traditional Medicaid, +111101,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,MEDICAID-Traditional Medicaid, +111102,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,MEDICAID-Traditional Medicaid, +111103,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,MEDICAID-Traditional Medicaid, +111104,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,MEDICAID-Traditional Medicaid, +111105,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,MEDICAID-Traditional Medicaid, +111106,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,MEDICAID-Traditional Medicaid, +111107,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,MEDICAID-Traditional Medicaid, +111108,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,MEDICAID-Traditional Medicaid, +111109,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,MEDICAID-Traditional Medicaid, +111110,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,MEDICAID-Traditional Medicaid, +111111,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,MEDICAID-Traditional Medicaid, +111112,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,MEDICAID-Traditional Medicaid, +111113,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,MEDICAID-Traditional Medicaid, +111114,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,MEDICAID-Traditional Medicaid, +111115,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,MEDICAID-Traditional Medicaid, +111116,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,MEDICAID-Traditional Medicaid, +111117,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,MEDICAID-Traditional Medicaid, +111118,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,MEDICAID-Traditional Medicaid, +111119,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,MEDICAID-Traditional Medicaid, +111120,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,MEDICAID-Traditional Medicaid, +111121,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,MEDICAID-Traditional Medicaid, +111122,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,MEDICAID-Traditional Medicaid, +111123,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,MEDICAID-Traditional Medicaid, +111124,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,MEDICAID-Traditional Medicaid, +111125,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,MEDICAID-Traditional Medicaid, +111126,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,MEDICAID-Traditional Medicaid, +111127,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,MEDICAID-Traditional Medicaid, +111128,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,MEDICAID-Traditional Medicaid, +111129,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,MEDICAID-Traditional Medicaid, +111130,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +111131,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,MEDICAID-Traditional Medicaid, +111132,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,MEDICAID-Traditional Medicaid, +111133,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,MEDICAID-Traditional Medicaid, +111134,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,MEDICAID-Traditional Medicaid, +111135,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +111136,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +111137,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,MEDICAID-Traditional Medicaid, +111138,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,MEDICAID-Traditional Medicaid, +111139,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,MEDICAID-Traditional Medicaid, +111140,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,MEDICAID-Traditional Medicaid, +111141,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,MEDICAID-Traditional Medicaid, +111142,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,MEDICAID-Traditional Medicaid, +111143,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,MEDICAID-Traditional Medicaid, +111144,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,MEDICAID-Traditional Medicaid, +111145,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,MEDICAID-Traditional Medicaid, +111146,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,MEDICAID-Traditional Medicaid, +111147,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,MEDICAID-Traditional Medicaid, +111148,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,MEDICAID-Traditional Medicaid, +111149,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,MEDICAID-Traditional Medicaid, +111150,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,MEDICAID-Traditional Medicaid, +111151,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,MEDICAID-Traditional Medicaid, +111152,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,MEDICAID-Traditional Medicaid, +111153,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,MEDICAID-Traditional Medicaid, +111154,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,MEDICAID-Traditional Medicaid, +111155,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,MEDICAID-Traditional Medicaid, +111156,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,MEDICAID-Traditional Medicaid, +111157,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,MEDICAID-Traditional Medicaid, +111158,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,MEDICAID-Traditional Medicaid, +111159,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,MEDICAID-Traditional Medicaid, +111160,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,MEDICAID-Traditional Medicaid, +111161,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,MEDICAID-Traditional Medicaid, +111162,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,MEDICAID-Traditional Medicaid, +111163,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,MEDICAID-Traditional Medicaid, +111164,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,MEDICAID-Traditional Medicaid, +111165,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,MEDICAID-Traditional Medicaid, +111166,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,MEDICAID-Traditional Medicaid, +111167,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,MEDICAID-Traditional Medicaid, +111168,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,MEDICAID-Traditional Medicaid, +111169,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,MEDICAID-Traditional Medicaid, +111170,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,MEDICAID-Traditional Medicaid, +111171,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,MEDICAID-Traditional Medicaid, +111172,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +111173,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,MEDICAID-Traditional Medicaid, +111174,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,MEDICAID-Traditional Medicaid, +111175,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,MEDICAID-Traditional Medicaid, +111176,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,MEDICAID-Traditional Medicaid, +111177,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,MEDICAID-Traditional Medicaid, +111178,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,MEDICAID-Traditional Medicaid, +111179,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,MEDICAID-Traditional Medicaid, +111180,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,MEDICAID-Traditional Medicaid, +111181,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,MEDICAID-Traditional Medicaid, +111182,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,MEDICAID-Traditional Medicaid, +111183,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,MEDICAID-Traditional Medicaid, +111184,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,MEDICAID-Traditional Medicaid, +111185,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,MEDICAID-Traditional Medicaid, +111186,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,MEDICAID-Traditional Medicaid, +111187,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,MEDICAID-Traditional Medicaid, +111188,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,MEDICAID-Traditional Medicaid, +111189,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,MEDICAID-Traditional Medicaid, +111190,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,MEDICAID-Traditional Medicaid, +111191,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,MEDICAID-Traditional Medicaid, +111192,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,MEDICAID-Traditional Medicaid, +111193,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,MEDICAID-Traditional Medicaid, +111194,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,MEDICAID-Traditional Medicaid, +111195,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,MEDICAID-Traditional Medicaid, +111196,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,MEDICAID-Traditional Medicaid, +111197,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,MEDICAID-Traditional Medicaid, +111198,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,MEDICAID-Traditional Medicaid, +111199,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,MEDICAID-Traditional Medicaid, +111200,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,MEDICAID-Traditional Medicaid, +111201,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,MEDICAID-Traditional Medicaid, +111202,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,MEDICAID-Traditional Medicaid, +111203,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,MEDICAID-Traditional Medicaid, +111204,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,MEDICAID-Traditional Medicaid, +111205,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,MEDICAID-Traditional Medicaid, +111206,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,MEDICAID-Traditional Medicaid, +111207,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,MEDICAID-Traditional Medicaid, +111208,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,MEDICAID-Traditional Medicaid, +111209,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,MEDICAID-Traditional Medicaid, +111210,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,MEDICAID-Traditional Medicaid, +111211,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,MEDICAID-Traditional Medicaid, +111212,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,MEDICAID-Traditional Medicaid, +111213,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,MEDICAID-Traditional Medicaid, +111214,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,MEDICAID-Traditional Medicaid, +111215,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,MEDICAID-Traditional Medicaid, +111216,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,MEDICAID-Traditional Medicaid, +111217,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,MEDICAID-Traditional Medicaid, +111218,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,MEDICAID-Traditional Medicaid, +111219,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,MEDICAID-Traditional Medicaid, +111220,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,MEDICAID-Traditional Medicaid, +111221,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,MEDICAID-Traditional Medicaid, +111222,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,MEDICAID-Traditional Medicaid, +111223,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,MEDICAID-Traditional Medicaid, +111224,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,MEDICAID-Traditional Medicaid, +111225,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,MEDICAID-Traditional Medicaid, +111226,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,MEDICAID-Traditional Medicaid, +111227,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,MEDICAID-Traditional Medicaid, +111228,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,MEDICAID-Traditional Medicaid, +111229,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,MEDICAID-Traditional Medicaid, +111230,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,MEDICAID-Traditional Medicaid, +111231,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,MEDICAID-Traditional Medicaid, +111232,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,MEDICAID-Traditional Medicaid, +111233,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,MEDICAID-Traditional Medicaid, +111234,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,MEDICAID-Traditional Medicaid, +111235,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,MEDICAID-Traditional Medicaid, +111236,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,MEDICAID-Traditional Medicaid, +111237,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,MEDICAID-Traditional Medicaid, +111238,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,MEDICAID-Traditional Medicaid, +111239,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,MEDICAID-Traditional Medicaid, +111240,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,MEDICAID-Traditional Medicaid, +111241,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,MEDICAID-Traditional Medicaid, +111242,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,MEDICAID-Traditional Medicaid, +111243,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,MEDICAID-Traditional Medicaid, +111244,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,MEDICAID-Traditional Medicaid, +111245,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,MEDICAID-Traditional Medicaid, +111246,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,MEDICAID-Traditional Medicaid, +111247,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,MEDICAID-Traditional Medicaid, +111248,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,MEDICAID-Traditional Medicaid, +111249,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,MEDICAID-Traditional Medicaid, +111250,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,MEDICAID-Traditional Medicaid, +111251,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,MEDICAID-Traditional Medicaid, +111252,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,MEDICAID-Traditional Medicaid, +111253,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,MEDICAID-Traditional Medicaid, +111254,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,MEDICAID-Traditional Medicaid, +111255,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,MEDICAID-Traditional Medicaid, +111256,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,MEDICAID-Traditional Medicaid, +111257,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,MEDICAID-Traditional Medicaid, +111258,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,MEDICAID-Traditional Medicaid, +111259,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,MEDICAID-Traditional Medicaid, +111260,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,MEDICAID-Traditional Medicaid, +111261,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,MEDICAID-Traditional Medicaid, +111262,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,MEDICAID-Traditional Medicaid, +111263,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,MEDICAID-Traditional Medicaid, +111264,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,MEDICAID-Traditional Medicaid, +111265,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,MEDICAID-Traditional Medicaid, +111266,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,MEDICAID-Traditional Medicaid, +111267,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,MEDICAID-Traditional Medicaid, +111268,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,MEDICAID-Traditional Medicaid, +111269,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,MEDICAID-Traditional Medicaid, +111270,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,MEDICAID-Traditional Medicaid, +111271,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,MEDICAID-Traditional Medicaid, +111272,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,MEDICAID-Traditional Medicaid, +111273,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,MEDICAID-Traditional Medicaid, +111274,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,MEDICAID-Traditional Medicaid, +111275,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,MEDICAID-Traditional Medicaid, +111276,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,MEDICAID-Traditional Medicaid, +111277,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,MEDICAID-Traditional Medicaid, +111278,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,MEDICAID-Traditional Medicaid, +111279,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,MEDICAID-Traditional Medicaid, +111280,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,MEDICAID-Traditional Medicaid, +111281,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,MEDICAID-Traditional Medicaid, +111282,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,MEDICAID-Traditional Medicaid, +111283,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,MEDICAID-Traditional Medicaid, +111284,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,MEDICAID-Traditional Medicaid, +111285,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,MEDICAID-Traditional Medicaid, +111286,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,MEDICAID-Traditional Medicaid, +111287,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,MEDICAID-Traditional Medicaid, +111288,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,MEDICAID-Traditional Medicaid, +111289,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,MEDICAID-Traditional Medicaid, +111290,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,MEDICAID-Traditional Medicaid, +111291,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,MEDICAID-Traditional Medicaid, +111292,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,MEDICAID-Traditional Medicaid, +111293,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,MEDICAID-Traditional Medicaid, +111294,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,MEDICAID-Traditional Medicaid, +111295,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,MEDICAID-Traditional Medicaid, +111296,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,MEDICAID-Traditional Medicaid, +111297,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,MEDICAID-Traditional Medicaid, +111298,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,MEDICAID-Traditional Medicaid, +111299,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,MEDICAID-Traditional Medicaid, +111300,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,MEDICAID-Traditional Medicaid, +111301,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,MEDICAID-Traditional Medicaid, +111302,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,MEDICAID-Traditional Medicaid, +111303,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,MEDICAID-Traditional Medicaid, +111304,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,MEDICAID-Traditional Medicaid, +111305,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,MEDICAID-Traditional Medicaid, +111306,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,MEDICAID-Traditional Medicaid, +111307,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,MEDICAID-Traditional Medicaid, +111308,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,MEDICAID-Traditional Medicaid, +111309,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,MEDICAID-Traditional Medicaid, +111310,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,MEDICAID-Traditional Medicaid, +111311,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,MEDICAID-Traditional Medicaid, +111312,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,MEDICAID-Traditional Medicaid, +111313,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,MEDICAID-Traditional Medicaid, +111314,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,MEDICAID-Traditional Medicaid, +111315,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,MEDICAID-Traditional Medicaid, +111316,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,MEDICAID-Traditional Medicaid, +111317,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,MEDICAID-Traditional Medicaid, +111318,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,MEDICAID-Traditional Medicaid, +111319,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,MEDICAID-Traditional Medicaid, +111320,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,MEDICAID-Traditional Medicaid, +111321,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,MEDICAID-Traditional Medicaid, +111322,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,MEDICAID-Traditional Medicaid, +111323,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,MEDICAID-Traditional Medicaid, +111324,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,MEDICAID-Traditional Medicaid, +111325,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,MEDICAID-Traditional Medicaid, +111326,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,MEDICAID-Traditional Medicaid, +111327,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,MEDICAID-Traditional Medicaid, +111328,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,MEDICAID-Traditional Medicaid, +111329,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,MEDICAID-Traditional Medicaid, +111330,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,MEDICAID-Traditional Medicaid, +111331,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,MEDICAID-Traditional Medicaid, +111332,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,MEDICAID-Traditional Medicaid, +111333,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,MEDICAID-Traditional Medicaid, +111334,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,MEDICAID-Traditional Medicaid, +111335,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,MEDICAID-Traditional Medicaid, +111336,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,MEDICAID-Traditional Medicaid, +111337,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,MEDICAID-Traditional Medicaid, +111338,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,MEDICAID-Traditional Medicaid, +111339,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,MEDICAID-Traditional Medicaid, +111340,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,MEDICAID-Traditional Medicaid, +111341,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,MEDICAID-Traditional Medicaid, +111342,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,MEDICAID-Traditional Medicaid, +111343,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,MEDICAID-Traditional Medicaid, +111344,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,MEDICAID-Traditional Medicaid, +111345,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,MEDICAID-Traditional Medicaid, +111346,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,MEDICAID-Traditional Medicaid, +111347,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,MEDICAID-Traditional Medicaid, +111348,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,MEDICAID-Traditional Medicaid, +111349,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,MEDICAID-Traditional Medicaid, +111350,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,MEDICAID-Traditional Medicaid, +111351,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,MEDICAID-Traditional Medicaid, +111352,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,MEDICAID-Traditional Medicaid, +111353,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,MEDICAID-Traditional Medicaid, +111354,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,MEDICAID-Traditional Medicaid, +111355,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,MEDICAID-Traditional Medicaid, +111356,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,MEDICAID-Traditional Medicaid, +111357,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,MEDICAID-Traditional Medicaid, +111358,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,MEDICAID-Traditional Medicaid, +111359,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,MEDICAID-Traditional Medicaid, +111360,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,MEDICAID-Traditional Medicaid, +111361,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,MEDICAID-Traditional Medicaid, +111362,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,MEDICAID-Traditional Medicaid, +111363,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,MEDICAID-Traditional Medicaid, +111364,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,MEDICAID-Traditional Medicaid, +111365,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,MEDICAID-Traditional Medicaid, +111366,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,MEDICAID-Traditional Medicaid, +111367,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,MEDICAID-Traditional Medicaid, +111368,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,MEDICAID-Traditional Medicaid, +111369,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,MEDICAID-Traditional Medicaid, +111370,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,MEDICAID-Traditional Medicaid, +111371,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,MEDICAID-Traditional Medicaid, +111372,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,MEDICAID-Traditional Medicaid, +111373,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,MEDICAID-Traditional Medicaid, +111374,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,MEDICAID-Traditional Medicaid, +111375,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,MEDICAID-Traditional Medicaid, +111376,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,MEDICAID-Traditional Medicaid, +111377,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,MEDICAID-Traditional Medicaid, +111378,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,MEDICAID-Traditional Medicaid, +111379,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,MEDICAID-Traditional Medicaid, +111380,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,MEDICAID-Traditional Medicaid, +111381,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,MEDICAID-Traditional Medicaid, +111382,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,MEDICAID-Traditional Medicaid, +111383,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,MEDICAID-Traditional Medicaid, +111384,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,MEDICAID-Traditional Medicaid, +111385,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,MEDICAID-Traditional Medicaid, +111386,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,MEDICAID-Traditional Medicaid, +111387,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,MEDICAID-Traditional Medicaid, +111388,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,MEDICAID-Traditional Medicaid, +111389,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,MEDICAID-Traditional Medicaid, +111390,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,MEDICAID-Traditional Medicaid, +111391,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,MEDICAID-Traditional Medicaid, +111392,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,MEDICAID-Traditional Medicaid, +111393,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,MEDICAID-Traditional Medicaid, +111394,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,MEDICAID-Traditional Medicaid, +111395,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,MEDICAID-Traditional Medicaid, +111396,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,MEDICAID-Traditional Medicaid, +111397,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,MEDICAID-Traditional Medicaid, +111398,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,MEDICAID-Traditional Medicaid, +111399,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,MEDICAID-Traditional Medicaid, +111400,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,MEDICAID-Traditional Medicaid, +111401,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,MEDICAID-Traditional Medicaid, +111402,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,MEDICAID-Traditional Medicaid, +111403,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,MEDICAID-Traditional Medicaid, +111404,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,MEDICAID-Traditional Medicaid, +111405,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,MEDICAID-Traditional Medicaid, +111406,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,MEDICAID-Traditional Medicaid, +111407,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,MEDICAID-Traditional Medicaid, +111408,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,MEDICAID-Traditional Medicaid,135.78 +111409,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,MEDICAID-Traditional Medicaid, +111410,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,MEDICAID-Traditional Medicaid, +111411,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,MEDICAID-Traditional Medicaid, +111412,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,MEDICAID-Traditional Medicaid, +111413,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,MEDICAID-Traditional Medicaid, +111414,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,MEDICAID-Traditional Medicaid, +111415,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,MEDICAID-Traditional Medicaid, +111416,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,MEDICAID-Traditional Medicaid, +111417,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,MEDICAID-Traditional Medicaid, +111418,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,MEDICAID-Traditional Medicaid, +111419,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,MEDICAID-Traditional Medicaid, +111420,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,MEDICAID-Traditional Medicaid, +111421,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,MEDICAID-Traditional Medicaid, +111422,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,MEDICAID-Traditional Medicaid, +111423,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,MEDICAID-Traditional Medicaid, +111424,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,MEDICAID-Traditional Medicaid, +111425,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,MEDICAID-Traditional Medicaid, +111426,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,MEDICAID-Traditional Medicaid, +111427,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,MEDICAID-Traditional Medicaid, +111428,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,MEDICAID-Traditional Medicaid, +111429,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,MEDICAID-Traditional Medicaid,276.87 +111430,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,MEDICAID-Traditional Medicaid, +111431,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,MEDICAID-Traditional Medicaid, +111432,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,MEDICAID-Traditional Medicaid, +111433,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,MEDICAID-Traditional Medicaid, +111434,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,MEDICAID-Traditional Medicaid,74.81 +111435,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,MEDICAID-Traditional Medicaid, +111436,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,MEDICAID-Traditional Medicaid, +111437,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,MEDICAID-Traditional Medicaid, +111438,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,MEDICAID-Traditional Medicaid, +111439,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,MEDICAID-Traditional Medicaid, +111440,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,MEDICAID-Traditional Medicaid, +111441,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,MEDICAID-Traditional Medicaid, +111442,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,MEDICAID-Traditional Medicaid, +111443,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,MEDICAID-Traditional Medicaid, +111444,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,MEDICAID-Traditional Medicaid, +111445,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,MEDICAID-Traditional Medicaid, +111446,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,MEDICAID-Traditional Medicaid, +111447,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,MEDICAID-Traditional Medicaid, +111448,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,MEDICAID-Traditional Medicaid, +111449,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,MEDICAID-Traditional Medicaid, +111450,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,MEDICAID-Traditional Medicaid, +111451,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,MEDICAID-Traditional Medicaid, +111452,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,MEDICAID-Traditional Medicaid, +111453,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,MEDICAID-Traditional Medicaid, +111454,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,MEDICAID-Traditional Medicaid, +111455,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,MEDICAID-Traditional Medicaid, +111456,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,MEDICAID-Traditional Medicaid, +111457,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,MEDICAID-Traditional Medicaid, +111458,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,MEDICAID-Traditional Medicaid, +111459,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,MEDICAID-Traditional Medicaid, +111460,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,MEDICAID-Traditional Medicaid, +111461,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,MEDICAID-Traditional Medicaid, +111462,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,MEDICAID-Traditional Medicaid, +111463,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,MEDICAID-Traditional Medicaid, +111464,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,MEDICAID-Traditional Medicaid, +111465,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,MEDICAID-Traditional Medicaid, +111466,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,MEDICAID-Traditional Medicaid, +111467,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,MEDICAID-Traditional Medicaid, +111468,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,MEDICAID-Traditional Medicaid, +111469,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,MEDICAID-Traditional Medicaid, +111470,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,MEDICAID-Traditional Medicaid, +111471,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,MEDICAID-Traditional Medicaid, +111472,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,MEDICAID-Traditional Medicaid, +111473,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,MEDICAID-Traditional Medicaid, +111474,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,MEDICAID-Traditional Medicaid, +111475,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,MEDICAID-Traditional Medicaid, +111476,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,MEDICAID-Traditional Medicaid, +111477,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,MEDICAID-Traditional Medicaid, +111478,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,MEDICAID-Traditional Medicaid, +111479,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,MEDICAID-Traditional Medicaid, +111480,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,MEDICAID-Traditional Medicaid, +111481,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,MEDICAID-Traditional Medicaid, +111482,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,MEDICAID-Traditional Medicaid, +111483,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,MEDICAID-Traditional Medicaid, +111484,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,MEDICAID-Traditional Medicaid, +111485,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,MEDICAID-Traditional Medicaid, +111486,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,MEDICAID-Traditional Medicaid, +111487,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,MEDICAID-Traditional Medicaid, +111488,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,MEDICAID-Traditional Medicaid, +111489,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,MEDICAID-Traditional Medicaid, +111490,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,MEDICAID-Traditional Medicaid, +111491,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,MEDICAID-Traditional Medicaid, +111492,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,MEDICAID-Traditional Medicaid, +111493,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,MEDICAID-Traditional Medicaid, +111494,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,MEDICAID-Traditional Medicaid, +111495,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,MEDICAID-Traditional Medicaid, +111496,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,MEDICAID-Traditional Medicaid, +111497,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,MEDICAID-Traditional Medicaid, +111498,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,MEDICAID-Traditional Medicaid, +111499,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,MEDICAID-Traditional Medicaid, +111500,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,MEDICAID-Traditional Medicaid, +111501,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,MEDICAID-Traditional Medicaid, +111502,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,MEDICAID-Traditional Medicaid, +111503,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,MEDICAID-Traditional Medicaid, +111504,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,MEDICAID-Traditional Medicaid, +111505,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,MEDICAID-Traditional Medicaid, +111506,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,MEDICAID-Traditional Medicaid, +111507,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,MEDICAID-Traditional Medicaid, +111508,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,MEDICAID-Traditional Medicaid, +111509,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,MEDICAID-Traditional Medicaid, +111510,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,MEDICAID-Traditional Medicaid, +111511,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,MEDICAID-Traditional Medicaid, +111512,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,MEDICAID-Traditional Medicaid, +111513,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,MEDICAID-Traditional Medicaid, +111514,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,MEDICAID-Traditional Medicaid, +111515,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,MEDICAID-Traditional Medicaid, +111516,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,MEDICAID-Traditional Medicaid, +111517,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,MEDICAID-Traditional Medicaid, +111518,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,MEDICAID-Traditional Medicaid, +111519,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,MEDICAID-Traditional Medicaid, +111520,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,MEDICAID-Traditional Medicaid, +111521,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,MEDICAID-Traditional Medicaid, +111522,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,MEDICAID-Traditional Medicaid, +111523,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,MEDICAID-Traditional Medicaid, +111524,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,MEDICAID-Traditional Medicaid, +111525,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,MEDICAID-Traditional Medicaid, +111526,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,MEDICAID-Traditional Medicaid, +111527,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,MEDICAID-Traditional Medicaid, +111528,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,MEDICAID-Traditional Medicaid, +111529,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,MEDICAID-Traditional Medicaid, +111530,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,MEDICAID-Traditional Medicaid, +111531,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,MEDICAID-Traditional Medicaid, +111532,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,MEDICAID-Traditional Medicaid, +111533,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,MEDICAID-Traditional Medicaid, +111534,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,MEDICAID-Traditional Medicaid, +111535,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,MEDICAID-Traditional Medicaid, +111536,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,MEDICAID-Traditional Medicaid, +111537,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,MEDICAID-Traditional Medicaid, +111538,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,MEDICAID-Traditional Medicaid, +111539,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,MEDICAID-Traditional Medicaid, +111540,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,MEDICAID-Traditional Medicaid, +111541,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,MEDICAID-Traditional Medicaid, +111542,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,MEDICAID-Traditional Medicaid, +111543,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,MEDICAID-Traditional Medicaid, +111544,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,MEDICAID-Traditional Medicaid, +111545,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,MEDICAID-Traditional Medicaid, +111546,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,MEDICAID-Traditional Medicaid, +111547,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,MEDICAID-Traditional Medicaid, +111548,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,MEDICAID-Traditional Medicaid, +111549,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,MEDICAID-Traditional Medicaid, +111550,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,MEDICAID-Traditional Medicaid, +111551,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,MEDICAID-Traditional Medicaid, +111552,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,MEDICAID-Traditional Medicaid, +111553,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,MEDICAID-Traditional Medicaid, +111554,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,MEDICAID-Traditional Medicaid, +111555,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,MEDICAID-Traditional Medicaid, +111556,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,MEDICAID-Traditional Medicaid, +111557,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,MEDICAID-Traditional Medicaid, +111558,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,MEDICAID-Traditional Medicaid, +111559,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,MEDICAID-Traditional Medicaid, +111560,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,MEDICAID-Traditional Medicaid, +111561,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,MEDICAID-Traditional Medicaid, +111562,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,MEDICAID-Traditional Medicaid, +111563,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,MEDICAID-Traditional Medicaid, +111564,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,MEDICAID-Traditional Medicaid, +111565,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,MEDICAID-Traditional Medicaid, +111566,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,MEDICAID-Traditional Medicaid, +111567,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,MEDICAID-Traditional Medicaid, +111568,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,MEDICAID-Traditional Medicaid, +111569,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,MEDICAID-Traditional Medicaid, +111570,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,MEDICAID-Traditional Medicaid, +111571,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,MEDICAID-Traditional Medicaid, +111572,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,MEDICAID-Traditional Medicaid, +111573,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,MEDICAID-Traditional Medicaid, +111574,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,MEDICAID-Traditional Medicaid, +111575,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,MEDICAID-Traditional Medicaid, +111576,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,MEDICAID-Traditional Medicaid, +111577,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,MEDICAID-Traditional Medicaid, +111578,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,MEDICAID-Traditional Medicaid, +111579,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,MEDICAID-Traditional Medicaid, +111580,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,MEDICAID-Traditional Medicaid, +111581,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,MEDICAID-Traditional Medicaid, +111582,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,MEDICAID-Traditional Medicaid, +111583,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,MEDICAID-Traditional Medicaid, +111584,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,MEDICAID-Traditional Medicaid, +111585,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,MEDICAID-Traditional Medicaid, +111586,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,MEDICAID-Traditional Medicaid, +111587,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,MEDICAID-Traditional Medicaid, +111588,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,MEDICAID-Traditional Medicaid, +111589,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,MEDICAID-Traditional Medicaid, +111590,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,MEDICAID-Traditional Medicaid, +111591,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,MEDICAID-Traditional Medicaid, +111592,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,MEDICAID-Traditional Medicaid, +111593,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,MEDICAID-Traditional Medicaid, +111594,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,MEDICAID-Traditional Medicaid, +111595,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,MEDICAID-Traditional Medicaid, +111596,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,MEDICAID-Traditional Medicaid, +111597,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,MEDICAID-Traditional Medicaid, +111598,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,MEDICAID-Traditional Medicaid, +111599,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,MEDICAID-Traditional Medicaid, +111600,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,MEDICAID-Traditional Medicaid, +111601,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,MEDICAID-Traditional Medicaid, +111602,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,MEDICAID-Traditional Medicaid, +111603,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,MEDICAID-Traditional Medicaid, +111604,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,MEDICAID-Traditional Medicaid, +111605,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,MEDICAID-Traditional Medicaid, +111606,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,MEDICAID-Traditional Medicaid, +111607,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,MEDICAID-Traditional Medicaid, +111608,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,MEDICAID-Traditional Medicaid, +111609,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,MEDICAID-Traditional Medicaid, +111610,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,MEDICAID-Traditional Medicaid, +111611,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,MEDICAID-Traditional Medicaid,96.69 +111612,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,MEDICAID-Traditional Medicaid, +111613,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,MEDICAID-Traditional Medicaid, +111614,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,MEDICAID-Traditional Medicaid, +111615,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,MEDICAID-Traditional Medicaid, +111616,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,MEDICAID-Traditional Medicaid, +111617,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,MEDICAID-Traditional Medicaid, +111618,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,MEDICAID-Traditional Medicaid, +111619,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,MEDICAID-Traditional Medicaid, +111620,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,MEDICAID-Traditional Medicaid, +111621,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,MEDICAID-Traditional Medicaid, +111622,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,MEDICAID-Traditional Medicaid, +111623,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,MEDICAID-Traditional Medicaid, +111624,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,MEDICAID-Traditional Medicaid, +111625,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,MEDICAID-Traditional Medicaid, +111626,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,MEDICAID-Traditional Medicaid, +111627,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,MEDICAID-Traditional Medicaid, +111628,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,MEDICAID-Traditional Medicaid, +111629,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,MEDICAID-Traditional Medicaid, +111630,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,MEDICAID-Traditional Medicaid, +111631,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,MEDICAID-Traditional Medicaid, +111632,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,MEDICAID-Traditional Medicaid, +111633,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,MEDICAID-Traditional Medicaid, +111634,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,MEDICAID-Traditional Medicaid, +111635,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,MEDICAID-Traditional Medicaid, +111636,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,MEDICAID-Traditional Medicaid, +111637,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,MEDICAID-Traditional Medicaid, +111638,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,MEDICAID-Traditional Medicaid, +111639,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,MEDICAID-Traditional Medicaid, +111640,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,MEDICAID-Traditional Medicaid, +111641,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,MEDICAID-Traditional Medicaid, +111642,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,MEDICAID-Traditional Medicaid, +111643,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,MEDICAID-Traditional Medicaid, +111644,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,MEDICAID-Traditional Medicaid, +111645,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,MEDICAID-Traditional Medicaid, +111646,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,MEDICAID-Traditional Medicaid, +111647,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,MEDICAID-Traditional Medicaid, +111648,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,MEDICAID-Traditional Medicaid, +111649,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,MEDICAID-Traditional Medicaid, +111650,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,MEDICAID-Traditional Medicaid, +111651,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,MEDICAID-Traditional Medicaid, +111652,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,MEDICAID-Traditional Medicaid, +111653,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,MEDICAID-Traditional Medicaid, +111654,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,MEDICAID-Traditional Medicaid, +111655,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,MEDICAID-Traditional Medicaid, +111656,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,MEDICAID-Traditional Medicaid, +111657,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,MEDICAID-Traditional Medicaid, +111658,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,MEDICAID-Traditional Medicaid, +111659,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,MEDICAID-Traditional Medicaid, +111660,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,MEDICAID-Traditional Medicaid, +111661,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,MEDICAID-Traditional Medicaid, +111662,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,MEDICAID-Traditional Medicaid, +111663,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,MEDICAID-Traditional Medicaid,120.2 +111664,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,MEDICAID-Traditional Medicaid, +111665,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,MEDICAID-Traditional Medicaid, +111666,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,MEDICAID-Traditional Medicaid, +111667,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,MEDICAID-Traditional Medicaid, +111668,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,MEDICAID-Traditional Medicaid, +111669,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,MEDICAID-Traditional Medicaid, +111670,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,MEDICAID-Traditional Medicaid, +111671,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,MEDICAID-Traditional Medicaid, +111672,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,MEDICAID-Traditional Medicaid, +111673,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,MEDICAID-Traditional Medicaid, +111674,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,MEDICAID-Traditional Medicaid, +111675,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,MEDICAID-Traditional Medicaid, +111676,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,MEDICAID-Traditional Medicaid, +111677,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,MEDICAID-Traditional Medicaid, +111678,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,MEDICAID-Traditional Medicaid, +111679,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,MEDICAID-Traditional Medicaid, +111680,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,MEDICAID-Traditional Medicaid, +111681,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,MEDICAID-Traditional Medicaid, +111682,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,MEDICAID-Traditional Medicaid, +111683,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,MEDICAID-Traditional Medicaid, +111684,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,MEDICAID-Traditional Medicaid, +111685,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,MEDICAID-Traditional Medicaid, +111686,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,MEDICAID-Traditional Medicaid, +111687,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,MEDICAID-Traditional Medicaid, +111688,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,MEDICAID-Traditional Medicaid, +111689,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,MEDICAID-Traditional Medicaid, +111690,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,MEDICAID-Traditional Medicaid, +111691,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,MEDICAID-Traditional Medicaid, +111692,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,MEDICAID-Traditional Medicaid, +111693,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,MEDICAID-Traditional Medicaid, +111694,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,MEDICAID-Traditional Medicaid, +111695,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,MEDICAID-Traditional Medicaid, +111696,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,MEDICAID-Traditional Medicaid, +111697,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,MEDICAID-Traditional Medicaid, +111698,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,MEDICAID-Traditional Medicaid, +111699,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,MEDICAID-Traditional Medicaid, +111700,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,MEDICAID-Traditional Medicaid, +111701,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,MEDICAID-Traditional Medicaid, +111702,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,MEDICAID-Traditional Medicaid, +111703,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,MEDICAID-Traditional Medicaid, +111704,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,MEDICAID-Traditional Medicaid, +111705,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,MEDICAID-Traditional Medicaid, +111706,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,MEDICAID-Traditional Medicaid, +111707,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,MEDICAID-Traditional Medicaid, +111708,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,MEDICAID-Traditional Medicaid, +111709,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,MEDICAID-Traditional Medicaid, +111710,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,MEDICAID-Traditional Medicaid, +111711,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,MEDICAID-Traditional Medicaid, +111712,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,MEDICAID-Traditional Medicaid, +111713,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,MEDICAID-Traditional Medicaid, +111714,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,MEDICAID-Traditional Medicaid, +111715,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,MEDICAID-Traditional Medicaid, +111716,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,MEDICAID-Traditional Medicaid, +111717,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,MEDICAID-Traditional Medicaid, +111718,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,MEDICAID-Traditional Medicaid, +111719,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,MEDICAID-Traditional Medicaid, +111720,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,MEDICAID-Traditional Medicaid, +111721,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,MEDICAID-Traditional Medicaid, +111722,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,MEDICAID-Traditional Medicaid, +111723,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,MEDICAID-Traditional Medicaid, +111724,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,MEDICAID-Traditional Medicaid, +111725,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,MEDICAID-Traditional Medicaid, +111726,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,MEDICAID-Traditional Medicaid, +111727,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,MEDICAID-Traditional Medicaid, +111728,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,MEDICAID-Traditional Medicaid, +111729,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,MEDICAID-Traditional Medicaid, +111730,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,MEDICAID-Traditional Medicaid, +111731,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,MEDICAID-Traditional Medicaid, +111732,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,MEDICAID-Traditional Medicaid, +111733,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,MEDICAID-Traditional Medicaid, +111734,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,MEDICAID-Traditional Medicaid, +111735,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,MEDICAID-Traditional Medicaid, +111736,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,MEDICAID-Traditional Medicaid, +111737,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,MEDICAID-Traditional Medicaid, +111738,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,MEDICAID-Traditional Medicaid, +111739,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,MEDICAID-Traditional Medicaid, +111740,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,MEDICAID-Traditional Medicaid, +111741,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,MEDICAID-Traditional Medicaid, +111742,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,MEDICAID-Traditional Medicaid, +111743,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,MEDICAID-Traditional Medicaid,8.46 +111744,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,MEDICAID-Traditional Medicaid, +111745,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,MEDICAID-Traditional Medicaid, +111746,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +111747,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,MEDICAID-Traditional Medicaid, +111748,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,MEDICAID-Traditional Medicaid, +111749,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,MEDICAID-Traditional Medicaid, +111750,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,MEDICAID-Traditional Medicaid, +111751,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,MEDICAID-Traditional Medicaid, +111752,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,MEDICAID-Traditional Medicaid, +111753,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,MEDICAID-Traditional Medicaid, +111754,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,MEDICAID-Traditional Medicaid, +111755,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,MEDICAID-Traditional Medicaid, +111756,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,MEDICAID-Traditional Medicaid, +111757,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,MEDICAID-Traditional Medicaid, +111758,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,MEDICAID-Traditional Medicaid, +111759,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,MEDICAID-Traditional Medicaid, +111760,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,MEDICAID-Traditional Medicaid, +111761,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,MEDICAID-Traditional Medicaid, +111762,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,MEDICAID-Traditional Medicaid, +111763,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,MEDICAID-Traditional Medicaid, +111764,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,MEDICAID-Traditional Medicaid, +111765,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,MEDICAID-Traditional Medicaid, +111766,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,MEDICAID-Traditional Medicaid, +111767,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,MEDICAID-Traditional Medicaid, +111768,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,MEDICAID-Traditional Medicaid, +111769,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,MEDICAID-Traditional Medicaid, +111770,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,MEDICAID-Traditional Medicaid, +111771,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,MEDICAID-Traditional Medicaid, +111772,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,MEDICAID-Traditional Medicaid, +111773,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,MEDICAID-Traditional Medicaid, +111774,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,MEDICAID-Traditional Medicaid, +111775,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,MEDICAID-Traditional Medicaid, +111776,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,MEDICAID-Traditional Medicaid, +111777,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,MEDICAID-Traditional Medicaid, +111778,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,MEDICAID-Traditional Medicaid, +111779,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,MEDICAID-Traditional Medicaid, +111780,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,MEDICAID-Traditional Medicaid, +111781,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,MEDICAID-Traditional Medicaid, +111782,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,MEDICAID-Traditional Medicaid, +111783,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,MEDICAID-Traditional Medicaid, +111784,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,MEDICAID-Traditional Medicaid, +111785,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,MEDICAID-Traditional Medicaid, +111786,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,MEDICAID-Traditional Medicaid, +111787,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,MEDICAID-Traditional Medicaid, +111788,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,MEDICAID-Traditional Medicaid, +111789,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,MEDICAID-Traditional Medicaid, +111790,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,MEDICAID-Traditional Medicaid, +111791,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,MEDICAID-Traditional Medicaid, +111792,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,MEDICAID-Traditional Medicaid, +111793,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,MEDICAID-Traditional Medicaid, +111794,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,MEDICAID-Traditional Medicaid, +111795,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,MEDICAID-Traditional Medicaid, +111796,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,MEDICAID-Traditional Medicaid, +111797,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,MEDICAID-Traditional Medicaid, +111798,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,MEDICAID-Traditional Medicaid, +111799,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,MEDICAID-Traditional Medicaid, +111800,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +111801,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,MEDICAID-Traditional Medicaid, +111802,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,MEDICAID-Traditional Medicaid, +111803,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,MEDICAID-Traditional Medicaid, +111804,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,MEDICAID-Traditional Medicaid, +111805,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,MEDICAID-Traditional Medicaid, +111806,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,MEDICAID-Traditional Medicaid, +111807,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,MEDICAID-Traditional Medicaid, +111808,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,MEDICAID-Traditional Medicaid, +111809,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,MEDICAID-Traditional Medicaid, +111810,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,MEDICAID-Traditional Medicaid, +111811,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,MEDICAID-Traditional Medicaid, +111812,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,MEDICAID-Traditional Medicaid, +111813,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,MEDICAID-Traditional Medicaid, +111814,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,MEDICAID-Traditional Medicaid, +111815,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,MEDICAID-Traditional Medicaid, +111816,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,MEDICAID-Traditional Medicaid, +111817,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,MEDICAID-Traditional Medicaid, +111818,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,MEDICAID-Traditional Medicaid, +111819,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,MEDICAID-Traditional Medicaid, +111820,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,MEDICAID-Traditional Medicaid, +111821,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,MEDICAID-Traditional Medicaid, +111822,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,MEDICAID-Traditional Medicaid, +111823,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,MEDICAID-Traditional Medicaid, +111824,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,MEDICAID-Traditional Medicaid, +111825,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,MEDICAID-Traditional Medicaid, +111826,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,MEDICAID-Traditional Medicaid, +111827,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,MEDICAID-Traditional Medicaid, +111828,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,MEDICAID-Traditional Medicaid, +111829,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,MEDICAID-Traditional Medicaid, +111830,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,MEDICAID-Traditional Medicaid, +111831,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,MEDICAID-Traditional Medicaid, +111832,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,MEDICAID-Traditional Medicaid, +111833,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,MEDICAID-Traditional Medicaid, +111834,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,MEDICAID-Traditional Medicaid, +111835,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,MEDICAID-Traditional Medicaid, +111836,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,MEDICAID-Traditional Medicaid, +111837,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,MEDICAID-Traditional Medicaid, +111838,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,MEDICAID-Traditional Medicaid, +111839,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,MEDICAID-Traditional Medicaid, +111840,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,MEDICAID-Traditional Medicaid, +111841,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,MEDICAID-Traditional Medicaid, +111842,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,MEDICAID-Traditional Medicaid, +111843,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,MEDICAID-Traditional Medicaid, +111844,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,MEDICAID-Traditional Medicaid, +111845,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,MEDICAID-Traditional Medicaid, +111846,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,MEDICAID-Traditional Medicaid, +111847,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,MEDICAID-Traditional Medicaid, +111848,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,MEDICAID-Traditional Medicaid, +111849,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,MEDICAID-Traditional Medicaid, +111850,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,MEDICAID-Traditional Medicaid, +111851,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,MEDICAID-Traditional Medicaid, +111852,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,MEDICAID-Traditional Medicaid, +111853,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,MEDICAID-Traditional Medicaid, +111854,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,MEDICAID-Traditional Medicaid, +111855,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,MEDICAID-Traditional Medicaid, +111856,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,MEDICAID-Traditional Medicaid, +111857,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,MEDICAID-Traditional Medicaid, +111858,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,MEDICAID-Traditional Medicaid, +111859,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,MEDICAID-Traditional Medicaid, +111860,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,MEDICAID-Traditional Medicaid, +111861,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,MEDICAID-Traditional Medicaid, +111862,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,MEDICAID-Traditional Medicaid, +111863,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,MEDICAID-Traditional Medicaid, +111864,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,MEDICAID-Traditional Medicaid, +111865,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,MEDICAID-Traditional Medicaid, +111866,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,MEDICAID-Traditional Medicaid, +111867,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,MEDICAID-Traditional Medicaid, +111868,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,MEDICAID-Traditional Medicaid, +111869,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,MEDICAID-Traditional Medicaid, +111870,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,MEDICAID-Traditional Medicaid, +111871,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,MEDICAID-Traditional Medicaid, +111872,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,MEDICAID-Traditional Medicaid, +111873,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,MEDICAID-Traditional Medicaid, +111874,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,MEDICAID-Traditional Medicaid, +111875,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,MEDICAID-Traditional Medicaid, +111876,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,MEDICAID-Traditional Medicaid, +111877,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,MEDICAID-Traditional Medicaid, +111878,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,MEDICAID-Traditional Medicaid, +111879,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,MEDICAID-Traditional Medicaid, +111880,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,MEDICAID-Traditional Medicaid, +111881,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,MEDICAID-Traditional Medicaid, +111882,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,MEDICAID-Traditional Medicaid, +111883,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,MEDICAID-Traditional Medicaid, +111884,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,MEDICAID-Traditional Medicaid, +111885,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,MEDICAID-Traditional Medicaid, +111886,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,MEDICAID-Traditional Medicaid, +111887,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,MEDICAID-Traditional Medicaid, +111888,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,MEDICAID-Traditional Medicaid, +111889,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,MEDICAID-Traditional Medicaid, +111890,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,MEDICAID-Traditional Medicaid, +111891,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,MEDICAID-Traditional Medicaid, +111892,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,MEDICAID-Traditional Medicaid, +111893,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,MEDICAID-Traditional Medicaid, +111894,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,MEDICAID-Traditional Medicaid, +111895,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,MEDICAID-Traditional Medicaid, +111896,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,MEDICAID-Traditional Medicaid, +111897,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,MEDICAID-Traditional Medicaid, +111898,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,MEDICAID-Traditional Medicaid, +111899,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,MEDICAID-Traditional Medicaid, +111900,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,MEDICAID-Traditional Medicaid, +111901,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,MEDICAID-Traditional Medicaid, +111902,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,MEDICAID-Traditional Medicaid, +111903,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,MEDICAID-Traditional Medicaid, +111904,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,MEDICAID-Traditional Medicaid, +111905,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,MEDICAID-Traditional Medicaid, +111906,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,MEDICAID-Traditional Medicaid, +111907,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,MEDICAID-Traditional Medicaid, +111908,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,MEDICAID-Traditional Medicaid, +111909,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,MEDICAID-Traditional Medicaid, +111910,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,MEDICAID-Traditional Medicaid, +111911,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,MEDICAID-Traditional Medicaid, +111912,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,MEDICAID-Traditional Medicaid, +111913,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,MEDICAID-Traditional Medicaid, +111914,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,MEDICAID-Traditional Medicaid, +111915,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,MEDICAID-Traditional Medicaid, +111916,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,MEDICAID-Traditional Medicaid, +111917,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,MEDICAID-Traditional Medicaid, +111918,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,MEDICAID-Traditional Medicaid, +111919,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,MEDICAID-Traditional Medicaid, +111920,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,MEDICAID-Traditional Medicaid, +111921,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,MEDICAID-Traditional Medicaid, +111922,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,MEDICAID-Traditional Medicaid, +111923,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,MEDICAID-Traditional Medicaid, +111924,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,MEDICAID-Traditional Medicaid, +111925,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,MEDICAID-Traditional Medicaid, +111926,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,MEDICAID-Traditional Medicaid, +111927,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,MEDICAID-Traditional Medicaid, +111928,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,MEDICAID-Traditional Medicaid, +111929,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,MEDICAID-Traditional Medicaid, +111930,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,MEDICAID-Traditional Medicaid, +111931,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,MEDICAID-Traditional Medicaid, +111932,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,MEDICAID-Traditional Medicaid, +111933,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,MEDICAID-Traditional Medicaid, +111934,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,MEDICAID-Traditional Medicaid, +111935,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,MEDICAID-Traditional Medicaid, +111936,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,MEDICAID-Traditional Medicaid, +111937,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,MEDICAID-Traditional Medicaid, +111938,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,MEDICAID-Traditional Medicaid, +111939,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,MEDICAID-Traditional Medicaid, +111940,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,MEDICAID-Traditional Medicaid, +111941,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,MEDICAID-Traditional Medicaid, +111942,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,MEDICAID-Traditional Medicaid, +111943,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,MEDICAID-Traditional Medicaid, +111944,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,MEDICAID-Traditional Medicaid, +111945,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,MEDICAID-Traditional Medicaid, +111946,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,MEDICAID-Traditional Medicaid, +111947,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,MEDICAID-Traditional Medicaid, +111948,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,MEDICAID-Traditional Medicaid, +111949,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,MEDICAID-Traditional Medicaid, +111950,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,MEDICAID-Traditional Medicaid, +111951,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,MEDICAID-Traditional Medicaid, +111952,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,MEDICAID-Traditional Medicaid, +111953,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,MEDICAID-Traditional Medicaid, +111954,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,MEDICAID-Traditional Medicaid, +111955,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,MEDICAID-Traditional Medicaid, +111956,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,MEDICAID-Traditional Medicaid, +111957,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,MEDICAID-Traditional Medicaid, +111958,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,MEDICAID-Traditional Medicaid, +111959,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,MEDICAID-Traditional Medicaid, +111960,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,MEDICAID-Traditional Medicaid, +111961,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,MEDICAID-Traditional Medicaid, +111962,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,MEDICAID-Traditional Medicaid, +111963,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,MEDICAID-Traditional Medicaid, +111964,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,MEDICAID-Traditional Medicaid, +111965,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,MEDICAID-Traditional Medicaid, +111966,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,MEDICAID-Traditional Medicaid, +111967,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,MEDICAID-Traditional Medicaid, +111968,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,MEDICAID-Traditional Medicaid, +111969,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,MEDICAID-Traditional Medicaid, +111970,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,MEDICAID-Traditional Medicaid, +111971,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,MEDICAID-Traditional Medicaid, +111972,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,MEDICAID-Traditional Medicaid, +111973,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,MEDICAID-Traditional Medicaid, +111974,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,MEDICAID-Traditional Medicaid, +111975,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,MEDICAID-Traditional Medicaid, +111976,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,MEDICAID-Traditional Medicaid, +111977,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,MEDICAID-Traditional Medicaid, +111978,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,MEDICAID-Traditional Medicaid, +111979,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,MEDICAID-Traditional Medicaid, +111980,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,MEDICAID-Traditional Medicaid, +111981,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,MEDICAID-Traditional Medicaid, +111982,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,MEDICAID-Traditional Medicaid, +111983,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,MEDICAID-Traditional Medicaid, +111984,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,MEDICAID-Traditional Medicaid, +111985,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,MEDICAID-Traditional Medicaid, +111986,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,MEDICAID-Traditional Medicaid, +111987,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,MEDICAID-Traditional Medicaid, +111988,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,MEDICAID-Traditional Medicaid, +111989,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,MEDICAID-Traditional Medicaid, +111990,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,MEDICAID-Traditional Medicaid, +111991,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,MEDICAID-Traditional Medicaid, +111992,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,MEDICAID-Traditional Medicaid, +111993,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,MEDICAID-Traditional Medicaid, +111994,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,MEDICAID-Traditional Medicaid, +111995,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,MEDICAID-Traditional Medicaid, +111996,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,MEDICAID-Traditional Medicaid, +111997,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,MEDICAID-Traditional Medicaid, +111998,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,MEDICAID-Traditional Medicaid, +111999,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,MEDICAID-Traditional Medicaid, +112000,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,MEDICAID-Traditional Medicaid, +112001,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,MEDICAID-Traditional Medicaid, +112002,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,MEDICAID-Traditional Medicaid, +112003,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,MEDICAID-Traditional Medicaid, +112004,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,MEDICAID-Traditional Medicaid, +112005,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,MEDICAID-Traditional Medicaid, +112006,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,MEDICAID-Traditional Medicaid, +112007,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,MEDICAID-Traditional Medicaid, +112008,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,MEDICAID-Traditional Medicaid, +112009,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,MEDICAID-Traditional Medicaid, +112010,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,MEDICAID-Traditional Medicaid, +112011,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,MEDICAID-Traditional Medicaid, +112012,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,MEDICAID-Traditional Medicaid, +112013,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,MEDICAID-Traditional Medicaid, +112014,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,MEDICAID-Traditional Medicaid,6.71 +112015,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,MEDICAID-Traditional Medicaid, +112016,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,MEDICAID-Traditional Medicaid, +112017,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,MEDICAID-Traditional Medicaid, +112018,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,MEDICAID-Traditional Medicaid, +112019,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,MEDICAID-Traditional Medicaid, +112020,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,MEDICAID-Traditional Medicaid, +112021,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,MEDICAID-Traditional Medicaid, +112022,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,MEDICAID-Traditional Medicaid, +112023,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,MEDICAID-Traditional Medicaid,6.7 +112024,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,MEDICAID-Traditional Medicaid, +112025,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,MEDICAID-Traditional Medicaid, +112026,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,MEDICAID-Traditional Medicaid, +112027,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,MEDICAID-Traditional Medicaid, +112028,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,MEDICAID-Traditional Medicaid, +112029,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,MEDICAID-Traditional Medicaid, +112030,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,MEDICAID-Traditional Medicaid, +112031,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,MEDICAID-Traditional Medicaid, +112032,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,MEDICAID-Traditional Medicaid, +112033,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,MEDICAID-Traditional Medicaid, +112034,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,MEDICAID-Traditional Medicaid, +112035,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,MEDICAID-Traditional Medicaid, +112036,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,MEDICAID-Traditional Medicaid, +112037,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,MEDICAID-Traditional Medicaid, +112038,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,MEDICAID-Traditional Medicaid, +112039,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,MEDICAID-Traditional Medicaid, +112040,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,MEDICAID-Traditional Medicaid, +112041,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,MEDICAID-Traditional Medicaid, +112042,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,MEDICAID-Traditional Medicaid, +112043,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,MEDICAID-Traditional Medicaid, +112044,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,MEDICAID-Traditional Medicaid, +112045,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,MEDICAID-Traditional Medicaid, +112046,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,MEDICAID-Traditional Medicaid, +112047,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,MEDICAID-Traditional Medicaid, +112048,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,MEDICAID-Traditional Medicaid, +112049,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,MEDICAID-Traditional Medicaid, +112050,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,MEDICAID-Traditional Medicaid, +112051,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,MEDICAID-Traditional Medicaid, +112052,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,MEDICAID-Traditional Medicaid, +112053,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,MEDICAID-Traditional Medicaid, +112054,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,MEDICAID-Traditional Medicaid, +112055,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,MEDICAID-Traditional Medicaid, +112056,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,MEDICAID-Traditional Medicaid, +112057,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,MEDICAID-Traditional Medicaid, +112058,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,MEDICAID-Traditional Medicaid, +112059,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,MEDICAID-Traditional Medicaid, +112060,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,MEDICAID-Traditional Medicaid, +112061,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,MEDICAID-Traditional Medicaid, +112062,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,MEDICAID-Traditional Medicaid, +112063,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,MEDICAID-Traditional Medicaid, +112064,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,MEDICAID-Traditional Medicaid, +112065,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,MEDICAID-Traditional Medicaid, +112066,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,MEDICAID-Traditional Medicaid, +112067,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,MEDICAID-Traditional Medicaid, +112068,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,MEDICAID-Traditional Medicaid, +112069,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,MEDICAID-Traditional Medicaid, +112070,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,MEDICAID-Traditional Medicaid, +112071,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,MEDICAID-Traditional Medicaid, +112072,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,MEDICAID-Traditional Medicaid, +112073,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,MEDICAID-Traditional Medicaid, +112074,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,MEDICAID-Traditional Medicaid, +112075,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,MEDICAID-Traditional Medicaid, +112076,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,MEDICAID-Traditional Medicaid, +112077,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,MEDICAID-Traditional Medicaid, +112078,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,MEDICAID-Traditional Medicaid, +112079,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,MEDICAID-Traditional Medicaid, +112080,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,MEDICAID-Traditional Medicaid, +112081,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,MEDICAID-Traditional Medicaid, +112082,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,MEDICAID-Traditional Medicaid, +112083,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,MEDICAID-Traditional Medicaid, +112084,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,MEDICAID-Traditional Medicaid, +112085,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,MEDICAID-Traditional Medicaid, +112086,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,MEDICAID-Traditional Medicaid, +112087,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,MEDICAID-Traditional Medicaid, +112088,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,MEDICAID-Traditional Medicaid, +112089,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,MEDICAID-Traditional Medicaid, +112090,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,MEDICAID-Traditional Medicaid, +112091,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,MEDICAID-Traditional Medicaid, +112092,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,MEDICAID-Traditional Medicaid, +112093,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,MEDICAID-Traditional Medicaid, +112094,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,MEDICAID-Traditional Medicaid, +112095,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,MEDICAID-Traditional Medicaid, +112096,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,MEDICAID-Traditional Medicaid, +112097,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,MEDICAID-Traditional Medicaid, +112098,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,MEDICAID-Traditional Medicaid, +112099,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,MEDICAID-Traditional Medicaid, +112100,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,MEDICAID-Traditional Medicaid, +112101,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,MEDICAID-Traditional Medicaid, +112102,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,MEDICAID-Traditional Medicaid, +112103,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,MEDICAID-Traditional Medicaid, +112104,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,MEDICAID-Traditional Medicaid, +112105,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,MEDICAID-Traditional Medicaid, +112106,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,MEDICAID-Traditional Medicaid, +112107,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,MEDICAID-Traditional Medicaid, +112108,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,MEDICAID-Traditional Medicaid, +112109,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,MEDICAID-Traditional Medicaid, +112110,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,MEDICAID-Traditional Medicaid, +112111,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,MEDICAID-Traditional Medicaid, +112112,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,MEDICAID-Traditional Medicaid, +112113,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,MEDICAID-Traditional Medicaid, +112114,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,MEDICAID-Traditional Medicaid, +112115,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,MEDICAID-Traditional Medicaid, +112116,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,MEDICAID-Traditional Medicaid, +112117,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,MEDICAID-Traditional Medicaid, +112118,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,MEDICAID-Traditional Medicaid, +112119,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,MEDICAID-Traditional Medicaid, +112120,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,MEDICAID-Traditional Medicaid, +112121,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,MEDICAID-Traditional Medicaid, +112122,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,MEDICAID-Traditional Medicaid, +112123,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,MEDICAID-Traditional Medicaid, +112124,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,MEDICAID-Traditional Medicaid, +112125,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,MEDICAID-Traditional Medicaid, +112126,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,MEDICAID-Traditional Medicaid, +112127,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,MEDICAID-Traditional Medicaid, +112128,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,MEDICAID-Traditional Medicaid,6.47 +112129,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,MEDICAID-Traditional Medicaid, +112130,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,MEDICAID-Traditional Medicaid, +112131,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,MEDICAID-Traditional Medicaid, +112132,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,MEDICAID-Traditional Medicaid, +112133,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,MEDICAID-Traditional Medicaid, +112134,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,MEDICAID-Traditional Medicaid, +112135,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,MEDICAID-Traditional Medicaid, +112136,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,MEDICAID-Traditional Medicaid, +112137,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,MEDICAID-Traditional Medicaid, +112138,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,MEDICAID-Traditional Medicaid, +112139,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,MEDICAID-Traditional Medicaid, +112140,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,MEDICAID-Traditional Medicaid, +112141,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,MEDICAID-Traditional Medicaid, +112142,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,MEDICAID-Traditional Medicaid, +112143,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,MEDICAID-Traditional Medicaid, +112144,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,MEDICAID-Traditional Medicaid, +112145,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,MEDICAID-Traditional Medicaid, +112146,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,MEDICAID-Traditional Medicaid, +112147,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,MEDICAID-Traditional Medicaid, +112148,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,MEDICAID-Traditional Medicaid, +112149,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,MEDICAID-Traditional Medicaid, +112150,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,MEDICAID-Traditional Medicaid, +112151,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,MEDICAID-Traditional Medicaid, +112152,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,MEDICAID-Traditional Medicaid, +112153,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,MEDICAID-Traditional Medicaid, +112154,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,MEDICAID-Traditional Medicaid, +112155,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,MEDICAID-Traditional Medicaid, +112156,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,MEDICAID-Traditional Medicaid, +112157,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,MEDICAID-Traditional Medicaid, +112158,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,MEDICAID-Traditional Medicaid, +112159,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,MEDICAID-Traditional Medicaid, +112160,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,MEDICAID-Traditional Medicaid, +112161,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,MEDICAID-Traditional Medicaid, +112162,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,MEDICAID-Traditional Medicaid, +112163,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,MEDICAID-Traditional Medicaid, +112164,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,MEDICAID-Traditional Medicaid, +112165,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,MEDICAID-Traditional Medicaid, +112166,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,MEDICAID-Traditional Medicaid, +112167,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,MEDICAID-Traditional Medicaid, +112168,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,MEDICAID-Traditional Medicaid, +112169,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,MEDICAID-Traditional Medicaid, +112170,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,MEDICAID-Traditional Medicaid, +112171,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,MEDICAID-Traditional Medicaid, +112172,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,MEDICAID-Traditional Medicaid, +112173,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,MEDICAID-Traditional Medicaid, +112174,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,MEDICAID-Traditional Medicaid, +112175,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,MEDICAID-Traditional Medicaid, +112176,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,MEDICAID-Traditional Medicaid, +112177,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,MEDICAID-Traditional Medicaid, +112178,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,MEDICAID-Traditional Medicaid, +112179,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,MEDICAID-Traditional Medicaid, +112180,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,MEDICAID-Traditional Medicaid, +112181,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,MEDICAID-Traditional Medicaid, +112182,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,MEDICAID-Traditional Medicaid, +112183,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,MEDICAID-Traditional Medicaid, +112184,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,MEDICAID-Traditional Medicaid, +112185,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,MEDICAID-Traditional Medicaid, +112186,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,MEDICAID-Traditional Medicaid, +112187,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,MEDICAID-Traditional Medicaid, +112188,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,MEDICAID-Traditional Medicaid, +112189,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,MEDICAID-Traditional Medicaid, +112190,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,MEDICAID-Traditional Medicaid, +112191,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,MEDICAID-Traditional Medicaid, +112192,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,MEDICAID-Traditional Medicaid, +112193,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,MEDICAID-Traditional Medicaid, +112194,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,MEDICAID-Traditional Medicaid, +112195,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,MEDICAID-Traditional Medicaid, +112196,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,MEDICAID-Traditional Medicaid, +112197,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,MEDICAID-Traditional Medicaid, +112198,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,MEDICAID-Traditional Medicaid, +112199,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,MEDICAID-Traditional Medicaid, +112200,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,MEDICAID-Traditional Medicaid, +112201,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,MEDICAID-Traditional Medicaid, +112202,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,MEDICAID-Traditional Medicaid, +112203,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,MEDICAID-Traditional Medicaid, +112204,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,MEDICAID-Traditional Medicaid, +112205,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,MEDICAID-Traditional Medicaid, +112206,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,MEDICAID-Traditional Medicaid, +112207,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,MEDICAID-Traditional Medicaid, +112208,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,MEDICAID-Traditional Medicaid, +112209,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,MEDICAID-Traditional Medicaid, +112210,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,MEDICAID-Traditional Medicaid, +112211,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,MEDICAID-Traditional Medicaid, +112212,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,MEDICAID-Traditional Medicaid, +112213,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,MEDICAID-Traditional Medicaid, +112214,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,MEDICAID-Traditional Medicaid, +112215,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,MEDICAID-Traditional Medicaid, +112216,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,MEDICAID-Traditional Medicaid, +112217,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,MEDICAID-Traditional Medicaid, +112218,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,MEDICAID-Traditional Medicaid, +112219,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,MEDICAID-Traditional Medicaid, +112220,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,MEDICAID-Traditional Medicaid, +112221,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,MEDICAID-Traditional Medicaid, +112222,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,MEDICAID-Traditional Medicaid, +112223,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,MEDICAID-Traditional Medicaid, +112224,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,MEDICAID-Traditional Medicaid, +112225,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,MEDICAID-Traditional Medicaid, +112226,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,MEDICAID-Traditional Medicaid, +112227,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,MEDICAID-Traditional Medicaid, +112228,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,MEDICAID-Traditional Medicaid, +112229,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,MEDICAID-Traditional Medicaid, +112230,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,MEDICAID-Traditional Medicaid, +112231,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,MEDICAID-Traditional Medicaid, +112232,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,MEDICAID-Traditional Medicaid, +112233,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,MEDICAID-Traditional Medicaid, +112234,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,MEDICAID-Traditional Medicaid, +112235,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,MEDICAID-Traditional Medicaid, +112236,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,MEDICAID-Traditional Medicaid, +112237,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,MEDICAID-Traditional Medicaid, +112238,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,MEDICAID-Traditional Medicaid, +112239,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,MEDICAID-Traditional Medicaid, +112240,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,MEDICAID-Traditional Medicaid, +112241,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,MEDICAID-Traditional Medicaid, +112242,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,MEDICAID-Traditional Medicaid, +112243,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,MEDICAID-Traditional Medicaid, +112244,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,MEDICAID-Traditional Medicaid, +112245,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,MEDICAID-Traditional Medicaid, +112246,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,MEDICAID-Traditional Medicaid, +112247,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,MEDICAID-Traditional Medicaid, +112248,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,MEDICAID-Traditional Medicaid, +112249,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,MEDICAID-Traditional Medicaid, +112250,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,MEDICAID-Traditional Medicaid, +112251,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,MEDICAID-Traditional Medicaid, +112252,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,MEDICAID-Traditional Medicaid, +112253,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,MEDICAID-Traditional Medicaid, +112254,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,MEDICAID-Traditional Medicaid, +112255,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,MEDICAID-Traditional Medicaid, +112256,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,MEDICAID-Traditional Medicaid, +112257,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,MEDICAID-Traditional Medicaid, +112258,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,MEDICAID-Traditional Medicaid, +112259,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,MEDICAID-Traditional Medicaid, +112260,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,MEDICAID-Traditional Medicaid, +112261,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,MEDICAID-Traditional Medicaid, +112262,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,MEDICAID-Traditional Medicaid, +112263,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,MEDICAID-Traditional Medicaid, +112264,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,MEDICAID-Traditional Medicaid, +112265,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,MEDICAID-Traditional Medicaid, +112266,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,MEDICAID-Traditional Medicaid, +112267,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,MEDICAID-Traditional Medicaid, +112268,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,MEDICAID-Traditional Medicaid, +112269,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,MEDICAID-Traditional Medicaid, +112270,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,MEDICAID-Traditional Medicaid, +112271,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,MEDICAID-Traditional Medicaid, +112272,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,MEDICAID-Traditional Medicaid, +112273,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,MEDICAID-Traditional Medicaid, +112274,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,MEDICAID-Traditional Medicaid, +112275,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,MEDICAID-Traditional Medicaid, +112276,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,MEDICAID-Traditional Medicaid, +112277,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,MEDICAID-Traditional Medicaid, +112278,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,MEDICAID-Traditional Medicaid, +112279,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,MEDICAID-Traditional Medicaid, +112280,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,MEDICAID-Traditional Medicaid, +112281,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,MEDICAID-Traditional Medicaid, +112282,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,MEDICAID-Traditional Medicaid, +112283,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,MEDICAID-Traditional Medicaid, +112284,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,MEDICAID-Traditional Medicaid, +112285,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,MEDICAID-Traditional Medicaid, +112286,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,MEDICAID-Traditional Medicaid, +112287,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,MEDICAID-Traditional Medicaid, +112288,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,MEDICAID-Traditional Medicaid, +112289,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,MEDICAID-Traditional Medicaid, +112290,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,MEDICAID-Traditional Medicaid, +112291,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,MEDICAID-Traditional Medicaid, +112292,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,MEDICAID-Traditional Medicaid, +112293,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,MEDICAID-Traditional Medicaid, +112294,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,MEDICAID-Traditional Medicaid, +112295,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,MEDICAID-Traditional Medicaid, +112296,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,MEDICAID-Traditional Medicaid, +112297,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,MEDICAID-Traditional Medicaid, +112298,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,MEDICAID-Traditional Medicaid, +112299,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,MEDICAID-Traditional Medicaid, +112300,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,MEDICAID-Traditional Medicaid, +112301,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,MEDICAID-Traditional Medicaid, +112302,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,MEDICAID-Traditional Medicaid, +112303,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,MEDICAID-Traditional Medicaid, +112304,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,MEDICAID-Traditional Medicaid, +112305,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,MEDICAID-Traditional Medicaid, +112306,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,MEDICAID-Traditional Medicaid, +112307,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,MEDICAID-Traditional Medicaid, +112308,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,MEDICAID-Traditional Medicaid, +112309,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,MEDICAID-Traditional Medicaid, +112310,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,MEDICAID-Traditional Medicaid, +112311,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,MEDICAID-Traditional Medicaid, +112312,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,MEDICAID-Traditional Medicaid, +112313,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,MEDICAID-Traditional Medicaid, +112314,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,MEDICAID-Traditional Medicaid, +112315,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,MEDICAID-Traditional Medicaid, +112316,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,MEDICAID-Traditional Medicaid, +112317,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,MEDICAID-Traditional Medicaid, +112318,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,MEDICAID-Traditional Medicaid, +112319,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,MEDICAID-Traditional Medicaid, +112320,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,MEDICAID-Traditional Medicaid, +112321,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,MEDICAID-Traditional Medicaid, +112322,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,MEDICAID-Traditional Medicaid, +112323,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,MEDICAID-Traditional Medicaid, +112324,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,MEDICAID-Traditional Medicaid, +112325,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,MEDICAID-Traditional Medicaid, +112326,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,MEDICAID-Traditional Medicaid, +112327,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,MEDICAID-Traditional Medicaid, +112328,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,MEDICAID-Traditional Medicaid, +112329,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,MEDICAID-Traditional Medicaid, +112330,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,MEDICAID-Traditional Medicaid, +112331,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,MEDICAID-Traditional Medicaid, +112332,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,MEDICAID-Traditional Medicaid, +112333,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,MEDICAID-Traditional Medicaid, +112334,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,MEDICAID-Traditional Medicaid, +112335,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,MEDICAID-Traditional Medicaid, +112336,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,MEDICAID-Traditional Medicaid, +112337,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,MEDICAID-Traditional Medicaid, +112338,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,MEDICAID-Traditional Medicaid, +112339,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,MEDICAID-Traditional Medicaid, +112340,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,MEDICAID-Traditional Medicaid, +112341,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,MEDICAID-Traditional Medicaid, +112342,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,MEDICAID-Traditional Medicaid, +112343,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,MEDICAID-Traditional Medicaid, +112344,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,MEDICAID-Traditional Medicaid, +112345,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,MEDICAID-Traditional Medicaid, +112346,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,MEDICAID-Traditional Medicaid, +112347,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,MEDICAID-Traditional Medicaid, +112348,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,MEDICAID-Traditional Medicaid, +112349,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,MEDICAID-Traditional Medicaid, +112350,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,MEDICAID-Traditional Medicaid, +112351,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,MEDICAID-Traditional Medicaid, +112352,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,MEDICAID-Traditional Medicaid, +112353,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,MEDICAID-Traditional Medicaid, +112354,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,MEDICAID-Traditional Medicaid, +112355,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,MEDICAID-Traditional Medicaid, +112356,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,MEDICAID-Traditional Medicaid, +112357,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,MEDICAID-Traditional Medicaid, +112358,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,MEDICAID-Traditional Medicaid, +112359,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,MEDICAID-Traditional Medicaid, +112360,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,MEDICAID-Traditional Medicaid, +112361,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,MEDICAID-Traditional Medicaid, +112362,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,MEDICAID-Traditional Medicaid, +112363,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,MEDICAID-Traditional Medicaid, +112364,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,MEDICAID-Traditional Medicaid, +112365,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,MEDICAID-Traditional Medicaid, +112366,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,MEDICAID-Traditional Medicaid, +112367,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,MEDICAID-Traditional Medicaid, +112368,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,MEDICAID-Traditional Medicaid, +112369,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,MEDICAID-Traditional Medicaid, +112370,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,MEDICAID-Traditional Medicaid, +112371,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,MEDICAID-Traditional Medicaid, +112372,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,MEDICAID-Traditional Medicaid, +112373,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,MEDICAID-Traditional Medicaid, +112374,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,MEDICAID-Traditional Medicaid, +112375,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,MEDICAID-Traditional Medicaid, +112376,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,MEDICAID-Traditional Medicaid, +112377,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,MEDICAID-Traditional Medicaid, +112378,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,MEDICAID-Traditional Medicaid, +112379,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,MEDICAID-Traditional Medicaid, +112380,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,MEDICAID-Traditional Medicaid, +112381,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,MEDICAID-Traditional Medicaid, +112382,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,MEDICAID-Traditional Medicaid, +112383,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,MEDICAID-Traditional Medicaid, +112384,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,MEDICAID-Traditional Medicaid, +112385,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,MEDICAID-Traditional Medicaid, +112386,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,MEDICAID-Traditional Medicaid, +112387,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,MEDICAID-Traditional Medicaid, +112388,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,MEDICAID-Traditional Medicaid, +112389,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,MEDICAID-Traditional Medicaid, +112390,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,MEDICAID-Traditional Medicaid, +112391,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,MEDICAID-Traditional Medicaid, +112392,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,MEDICAID-Traditional Medicaid, +112393,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,MEDICAID-Traditional Medicaid, +112394,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,MEDICAID-Traditional Medicaid, +112395,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,MEDICAID-Traditional Medicaid, +112396,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,MEDICAID-Traditional Medicaid, +112397,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,MEDICAID-Traditional Medicaid, +112398,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,MEDICAID-Traditional Medicaid, +112399,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,MEDICAID-Traditional Medicaid, +112400,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,MEDICAID-Traditional Medicaid, +112401,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,MEDICAID-Traditional Medicaid, +112402,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,MEDICAID-Traditional Medicaid, +112403,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,MEDICAID-Traditional Medicaid, +112404,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,MEDICAID-Traditional Medicaid, +112405,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,MEDICAID-Traditional Medicaid, +112406,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,MEDICAID-Traditional Medicaid, +112407,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,MEDICAID-Traditional Medicaid, +112408,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,MEDICAID-Traditional Medicaid, +112409,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,MEDICAID-Traditional Medicaid, +112410,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,MEDICAID-Traditional Medicaid, +112411,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,MEDICAID-Traditional Medicaid, +112412,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,MEDICAID-Traditional Medicaid, +112413,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,MEDICAID-Traditional Medicaid, +112414,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,MEDICAID-Traditional Medicaid, +112415,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,MEDICAID-Traditional Medicaid, +112416,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,MEDICAID-Traditional Medicaid, +112417,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,MEDICAID-Traditional Medicaid, +112418,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,MEDICAID-Traditional Medicaid, +112419,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,MEDICAID-Traditional Medicaid, +112420,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,MEDICAID-Traditional Medicaid, +112421,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,MEDICAID-Traditional Medicaid, +112422,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,MEDICAID-Traditional Medicaid, +112423,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,MEDICAID-Traditional Medicaid, +112424,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,MEDICAID-Traditional Medicaid, +112425,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,MEDICAID-Traditional Medicaid, +112426,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,MEDICAID-Traditional Medicaid, +112427,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,MEDICAID-Traditional Medicaid, +112428,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,MEDICAID-Traditional Medicaid, +112429,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,MEDICAID-Traditional Medicaid, +112430,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,MEDICAID-Traditional Medicaid, +112431,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,MEDICAID-Traditional Medicaid, +112432,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,MEDICAID-Traditional Medicaid, +112433,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,MEDICAID-Traditional Medicaid, +112434,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,MEDICAID-Traditional Medicaid, +112435,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,MEDICAID-Traditional Medicaid, +112436,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,MEDICAID-Traditional Medicaid, +112437,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,MEDICAID-Traditional Medicaid, +112438,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,MEDICAID-Traditional Medicaid, +112439,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,MEDICAID-Traditional Medicaid, +112440,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,MEDICAID-Traditional Medicaid, +112441,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,MEDICAID-Traditional Medicaid, +112442,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,MEDICAID-Traditional Medicaid, +112443,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,MEDICAID-Traditional Medicaid, +112444,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,MEDICAID-Traditional Medicaid, +112445,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,MEDICAID-Traditional Medicaid, +112446,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,MEDICAID-Traditional Medicaid, +112447,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,MEDICAID-Traditional Medicaid, +112448,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,MEDICAID-Traditional Medicaid, +112449,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,MEDICAID-Traditional Medicaid, +112450,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,MEDICAID-Traditional Medicaid, +112451,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,MEDICAID-Traditional Medicaid, +112452,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,MEDICAID-Traditional Medicaid, +112453,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,MEDICAID-Traditional Medicaid, +112454,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,MEDICAID-Traditional Medicaid, +112455,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,MEDICAID-Traditional Medicaid, +112456,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,MEDICAID-Traditional Medicaid, +112457,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,MEDICAID-Traditional Medicaid, +112458,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,MEDICAID-Traditional Medicaid, +112459,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,MEDICAID-Traditional Medicaid, +112460,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,MEDICAID-Traditional Medicaid, +112461,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,MEDICAID-Traditional Medicaid, +112462,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,MEDICAID-Traditional Medicaid, +112463,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,MEDICAID-Traditional Medicaid, +112464,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,MEDICAID-Traditional Medicaid, +112465,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,MEDICAID-Traditional Medicaid, +112466,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,MEDICAID-Traditional Medicaid, +112467,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,MEDICAID-Traditional Medicaid, +112468,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,MEDICAID-Traditional Medicaid, +112469,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,MEDICAID-Traditional Medicaid, +112470,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,MEDICAID-Traditional Medicaid, +112471,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,MEDICAID-Traditional Medicaid, +112472,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,MEDICAID-Traditional Medicaid, +112473,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,MEDICAID-Traditional Medicaid, +112474,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,MEDICAID-Traditional Medicaid, +112475,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,MEDICAID-Traditional Medicaid, +112476,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,MEDICAID-Traditional Medicaid, +112477,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,MEDICAID-Traditional Medicaid, +112478,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,MEDICAID-Traditional Medicaid, +112479,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,MEDICAID-Traditional Medicaid, +112480,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,MEDICAID-Traditional Medicaid, +112481,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,MEDICAID-Traditional Medicaid, +112482,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,MEDICAID-Traditional Medicaid, +112483,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,MEDICAID-Traditional Medicaid, +112484,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,MEDICAID-Traditional Medicaid, +112485,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,MEDICAID-Traditional Medicaid, +112486,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,MEDICAID-Traditional Medicaid, +112487,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,MEDICAID-Traditional Medicaid, +112488,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,MEDICAID-Traditional Medicaid, +112489,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,MEDICAID-Traditional Medicaid, +112490,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,MEDICAID-Traditional Medicaid, +112491,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,MEDICAID-Traditional Medicaid, +112492,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,MEDICAID-Traditional Medicaid, +112493,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +112494,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +112495,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +112496,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,MEDICAID-Traditional Medicaid, +112497,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,MEDICAID-Traditional Medicaid, +112498,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,MEDICAID-Traditional Medicaid, +112499,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,MEDICAID-Traditional Medicaid, +112500,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,MEDICAID-Traditional Medicaid, +112501,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,MEDICAID-Traditional Medicaid, +112502,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,MEDICAID-Traditional Medicaid, +112503,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,MEDICAID-Traditional Medicaid, +112504,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,MEDICAID-Traditional Medicaid, +112505,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,MEDICAID-Traditional Medicaid, +112506,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,MEDICAID-Traditional Medicaid, +112507,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,MEDICAID-Traditional Medicaid, +112508,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,MEDICAID-Traditional Medicaid, +112509,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,MEDICAID-Traditional Medicaid, +112510,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,MEDICAID-Traditional Medicaid, +112511,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,MEDICAID-Traditional Medicaid, +112512,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,MEDICAID-Traditional Medicaid, +112513,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,MEDICAID-Traditional Medicaid, +112514,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,MEDICAID-Traditional Medicaid, +112515,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,MEDICAID-Traditional Medicaid, +112516,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,MEDICAID-Traditional Medicaid, +112517,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,MEDICAID-Traditional Medicaid, +112518,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,MEDICAID-Traditional Medicaid, +112519,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,MEDICAID-Traditional Medicaid, +112520,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,MEDICAID-Traditional Medicaid, +112521,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,MEDICAID-Traditional Medicaid, +112522,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,MEDICAID-Traditional Medicaid, +112523,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,MEDICAID-Traditional Medicaid, +112524,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,MEDICAID-Traditional Medicaid, +112525,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,MEDICAID-Traditional Medicaid, +112526,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,MEDICAID-Traditional Medicaid, +112527,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,MEDICAID-Traditional Medicaid, +112528,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,MEDICAID-Traditional Medicaid, +112529,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,MEDICAID-Traditional Medicaid, +112530,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,MEDICAID-Traditional Medicaid, +112531,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,MEDICAID-Traditional Medicaid, +112532,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,MEDICAID-Traditional Medicaid, +112533,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,MEDICAID-Traditional Medicaid, +112534,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,MEDICAID-Traditional Medicaid, +112535,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,MEDICAID-Traditional Medicaid, +112536,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,MEDICAID-Traditional Medicaid, +112537,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,MEDICAID-Traditional Medicaid, +112538,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,MEDICAID-Traditional Medicaid, +112539,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,MEDICAID-Traditional Medicaid, +112540,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,MEDICAID-Traditional Medicaid, +112541,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,MEDICAID-Traditional Medicaid, +112542,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,MEDICAID-Traditional Medicaid, +112543,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,MEDICAID-Traditional Medicaid, +112544,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,MEDICAID-Traditional Medicaid, +112545,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,MEDICAID-Traditional Medicaid, +112546,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,MEDICAID-Traditional Medicaid, +112547,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,MEDICAID-Traditional Medicaid, +112548,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,MEDICAID-Traditional Medicaid, +112549,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,MEDICAID-Traditional Medicaid, +112550,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,MEDICAID-Traditional Medicaid, +112551,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,MEDICAID-Traditional Medicaid, +112552,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,MEDICAID-Traditional Medicaid, +112553,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,MEDICAID-Traditional Medicaid, +112554,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,MEDICAID-Traditional Medicaid, +112555,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,MEDICAID-Traditional Medicaid, +112556,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,MEDICAID-Traditional Medicaid, +112557,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,MEDICAID-Traditional Medicaid, +112558,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,MEDICAID-Traditional Medicaid, +112559,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,MEDICAID-Traditional Medicaid, +112560,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,MEDICAID-Traditional Medicaid, +112561,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,MEDICAID-Traditional Medicaid, +112562,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,MEDICAID-Traditional Medicaid, +112563,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,MEDICAID-Traditional Medicaid, +112564,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,MEDICAID-Traditional Medicaid, +112565,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,MEDICAID-Traditional Medicaid, +112566,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,MEDICAID-Traditional Medicaid, +112567,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,MEDICAID-Traditional Medicaid, +112568,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,MEDICAID-Traditional Medicaid, +112569,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,MEDICAID-Traditional Medicaid, +112570,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,MEDICAID-Traditional Medicaid, +112571,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,MEDICAID-Traditional Medicaid, +112572,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,MEDICAID-Traditional Medicaid, +112573,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,MEDICAID-Traditional Medicaid, +112574,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,MEDICAID-Traditional Medicaid, +112575,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,MEDICAID-Traditional Medicaid, +112576,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,MEDICAID-Traditional Medicaid, +112577,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,MEDICAID-Traditional Medicaid, +112578,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,MEDICAID-Traditional Medicaid, +112579,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,MEDICAID-Traditional Medicaid, +112580,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,MEDICAID-Traditional Medicaid, +112581,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,MEDICAID-Traditional Medicaid, +112582,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,MEDICAID-Traditional Medicaid, +112583,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,MEDICAID-Traditional Medicaid, +112584,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,MEDICAID-Traditional Medicaid, +112585,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,MEDICAID-Traditional Medicaid, +112586,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,MEDICAID-Traditional Medicaid, +112587,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,MEDICAID-Traditional Medicaid, +112588,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,MEDICAID-Traditional Medicaid, +112589,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,MEDICAID-Traditional Medicaid, +112590,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,MEDICAID-Traditional Medicaid, +112591,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,MEDICAID-Traditional Medicaid, +112592,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +112593,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,MEDICAID-Traditional Medicaid, +112594,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,MEDICAID-Traditional Medicaid, +112595,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,MEDICAID-Traditional Medicaid, +112596,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,MEDICAID-Traditional Medicaid, +112597,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,MEDICAID-Traditional Medicaid, +112598,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,MEDICAID-Traditional Medicaid, +112599,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,MEDICAID-Traditional Medicaid, +112600,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,MEDICAID-Traditional Medicaid, +112601,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,MEDICAID-Traditional Medicaid, +112602,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,MEDICAID-Traditional Medicaid, +112603,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,MEDICAID-Traditional Medicaid, +112604,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,MEDICAID-Traditional Medicaid, +112605,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,MEDICAID-Traditional Medicaid, +112606,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,MEDICAID-Traditional Medicaid, +112607,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,MEDICAID-Traditional Medicaid, +112608,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,MEDICAID-Traditional Medicaid, +112609,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,MEDICAID-Traditional Medicaid, +112610,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,MEDICAID-Traditional Medicaid, +112611,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,MEDICAID-Traditional Medicaid, +112612,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,MEDICAID-Traditional Medicaid, +112613,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,MEDICAID-Traditional Medicaid, +112614,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,MEDICAID-Traditional Medicaid, +112615,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,MEDICAID-Traditional Medicaid, +112616,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,MEDICAID-Traditional Medicaid, +112617,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,MEDICAID-Traditional Medicaid, +112618,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,MEDICAID-Traditional Medicaid, +112619,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,MEDICAID-Traditional Medicaid, +112620,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,MEDICAID-Traditional Medicaid, +112621,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,MEDICAID-Traditional Medicaid, +112622,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,MEDICAID-Traditional Medicaid, +112623,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,MEDICAID-Traditional Medicaid, +112624,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,MEDICAID-Traditional Medicaid, +112625,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,MEDICAID-Traditional Medicaid, +112626,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,MEDICAID-Traditional Medicaid, +112627,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,MEDICAID-Traditional Medicaid, +112628,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,MEDICAID-Traditional Medicaid, +112629,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,MEDICAID-Traditional Medicaid, +112630,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,MEDICAID-Traditional Medicaid, +112631,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,MEDICAID-Traditional Medicaid, +112632,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,MEDICAID-Traditional Medicaid, +112633,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,MEDICAID-Traditional Medicaid, +112634,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,MEDICAID-Traditional Medicaid, +112635,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,MEDICAID-Traditional Medicaid, +112636,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,MEDICAID-Traditional Medicaid, +112637,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,MEDICAID-Traditional Medicaid, +112638,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,MEDICAID-Traditional Medicaid, +112639,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,MEDICAID-Traditional Medicaid, +112640,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,MEDICAID-Traditional Medicaid, +112641,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,MEDICAID-Traditional Medicaid, +112642,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,MEDICAID-Traditional Medicaid, +112643,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,MEDICAID-Traditional Medicaid, +112644,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,MEDICAID-Traditional Medicaid, +112645,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,MEDICAID-Traditional Medicaid, +112646,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,MEDICAID-Traditional Medicaid, +112647,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,MEDICAID-Traditional Medicaid, +112648,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,MEDICAID-Traditional Medicaid, +112649,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,MEDICAID-Traditional Medicaid, +112650,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,MEDICAID-Traditional Medicaid, +112651,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,MEDICAID-Traditional Medicaid, +112652,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,MEDICAID-Traditional Medicaid, +112653,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,MEDICAID-Traditional Medicaid, +112654,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,MEDICAID-Traditional Medicaid, +112655,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,MEDICAID-Traditional Medicaid, +112656,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,MEDICAID-Traditional Medicaid, +112657,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,MEDICAID-Traditional Medicaid, +112658,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,MEDICAID-Traditional Medicaid, +112659,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,MEDICAID-Traditional Medicaid, +112660,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,MEDICAID-Traditional Medicaid, +112661,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,MEDICAID-Traditional Medicaid, +112662,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,MEDICAID-Traditional Medicaid, +112663,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,MEDICAID-Traditional Medicaid, +112664,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,MEDICAID-Traditional Medicaid, +112665,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,MEDICAID-Traditional Medicaid, +112666,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,MEDICAID-Traditional Medicaid, +112667,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,MEDICAID-Traditional Medicaid, +112668,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,MEDICAID-Traditional Medicaid, +112669,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,MEDICAID-Traditional Medicaid, +112670,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,MEDICAID-Traditional Medicaid, +112671,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,MEDICAID-Traditional Medicaid, +112672,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,MEDICAID-Traditional Medicaid, +112673,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,MEDICAID-Traditional Medicaid, +112674,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,MEDICAID-Traditional Medicaid, +112675,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,MEDICAID-Traditional Medicaid, +112676,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,MEDICAID-Traditional Medicaid, +112677,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,MEDICAID-Traditional Medicaid, +112678,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,MEDICAID-Traditional Medicaid, +112679,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,MEDICAID-Traditional Medicaid, +112680,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,MEDICAID-Traditional Medicaid, +112681,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,MEDICAID-Traditional Medicaid, +112682,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,MEDICAID-Traditional Medicaid, +112683,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,MEDICAID-Traditional Medicaid, +112684,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,MEDICAID-Traditional Medicaid, +112685,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,MEDICAID-Traditional Medicaid, +112686,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,MEDICAID-Traditional Medicaid, +112687,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,MEDICAID-Traditional Medicaid, +112688,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,MEDICAID-Traditional Medicaid, +112689,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,MEDICAID-Traditional Medicaid, +112690,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,MEDICAID-Traditional Medicaid, +112691,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,MEDICAID-Traditional Medicaid, +112692,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,MEDICAID-Traditional Medicaid, +112693,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,MEDICAID-Traditional Medicaid, +112694,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,MEDICAID-Traditional Medicaid, +112695,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,MEDICAID-Traditional Medicaid, +112696,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,MEDICAID-Traditional Medicaid, +112697,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,MEDICAID-Traditional Medicaid, +112698,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,MEDICAID-Traditional Medicaid, +112699,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,MEDICAID-Traditional Medicaid, +112700,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,MEDICAID-Traditional Medicaid, +112701,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,MEDICAID-Traditional Medicaid, +112702,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,MEDICAID-Traditional Medicaid, +112703,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,MEDICAID-Traditional Medicaid, +112704,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,MEDICAID-Traditional Medicaid, +112705,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,MEDICAID-Traditional Medicaid, +112706,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,MEDICAID-Traditional Medicaid, +112707,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,MEDICAID-Traditional Medicaid, +112708,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,MEDICAID-Traditional Medicaid, +112709,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,MEDICAID-Traditional Medicaid, +112710,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,MEDICAID-Traditional Medicaid, +112711,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,MEDICAID-Traditional Medicaid, +112712,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,MEDICAID-Traditional Medicaid, +112713,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,MEDICAID-Traditional Medicaid, +112714,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,MEDICAID-Traditional Medicaid, +112715,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,MEDICAID-Traditional Medicaid, +112716,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,MEDICAID-Traditional Medicaid, +112717,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,MEDICAID-Traditional Medicaid, +112718,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,MEDICAID-Traditional Medicaid, +112719,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,MEDICAID-Traditional Medicaid, +112720,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,MEDICAID-Traditional Medicaid, +112721,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,MEDICAID-Traditional Medicaid, +112722,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,MEDICAID-Traditional Medicaid, +112723,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,MEDICAID-Traditional Medicaid, +112724,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,MEDICAID-Traditional Medicaid, +112725,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,MEDICAID-Traditional Medicaid, +112726,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,MEDICAID-Traditional Medicaid, +112727,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,MEDICAID-Traditional Medicaid, +112728,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,MEDICAID-Traditional Medicaid, +112729,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,MEDICAID-Traditional Medicaid, +112730,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,MEDICAID-Traditional Medicaid, +112731,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,MEDICAID-Traditional Medicaid, +112732,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,MEDICAID-Traditional Medicaid, +112733,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,MEDICAID-Traditional Medicaid, +112734,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,MEDICAID-Traditional Medicaid, +112735,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,MEDICAID-Traditional Medicaid, +112736,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,MEDICAID-Traditional Medicaid, +112737,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,MEDICAID-Traditional Medicaid, +112738,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,MEDICAID-Traditional Medicaid, +112739,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,MEDICAID-Traditional Medicaid, +112740,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,MEDICAID-Traditional Medicaid, +112741,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,MEDICAID-Traditional Medicaid, +112742,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,MEDICAID-Traditional Medicaid, +112743,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,MEDICAID-Traditional Medicaid, +112744,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,MEDICAID-Traditional Medicaid, +112745,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,MEDICAID-Traditional Medicaid, +112746,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,MEDICAID-Traditional Medicaid, +112747,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,MEDICAID-Traditional Medicaid, +112748,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,MEDICAID-Traditional Medicaid, +112749,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,MEDICAID-Traditional Medicaid, +112750,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,MEDICAID-Traditional Medicaid, +112751,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,MEDICAID-Traditional Medicaid, +112752,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,MEDICAID-Traditional Medicaid, +112753,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,MEDICAID-Traditional Medicaid, +112754,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,MEDICAID-Traditional Medicaid, +112755,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,MEDICAID-Traditional Medicaid, +112756,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,MEDICAID-Traditional Medicaid, +112757,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,MEDICAID-Traditional Medicaid, +112758,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,MEDICAID-Traditional Medicaid, +112759,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,MEDICAID-Traditional Medicaid, +112760,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,MEDICAID-Traditional Medicaid, +112761,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,MEDICAID-Traditional Medicaid, +112762,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,MEDICAID-Traditional Medicaid,90.04 +112763,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,MEDICAID-Traditional Medicaid, +112764,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,MEDICAID-Traditional Medicaid, +112765,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,MEDICAID-Traditional Medicaid, +112766,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,MEDICAID-Traditional Medicaid, +112767,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,MEDICAID-Traditional Medicaid, +112768,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,MEDICAID-Traditional Medicaid, +112769,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,MEDICAID-Traditional Medicaid, +112770,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,MEDICAID-Traditional Medicaid, +112771,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,MEDICAID-Traditional Medicaid, +112772,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,MEDICAID-Traditional Medicaid, +112773,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,MEDICAID-Traditional Medicaid, +112774,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,MEDICAID-Traditional Medicaid, +112775,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,MEDICAID-Traditional Medicaid, +112776,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,MEDICAID-Traditional Medicaid, +112777,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,MEDICAID-Traditional Medicaid, +112778,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,MEDICAID-Traditional Medicaid, +112779,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,MEDICAID-Traditional Medicaid, +112780,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,MEDICAID-Traditional Medicaid, +112781,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,MEDICAID-Traditional Medicaid, +112782,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,MEDICAID-Traditional Medicaid, +112783,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,MEDICAID-Traditional Medicaid, +112784,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,MEDICAID-Traditional Medicaid, +112785,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,MEDICAID-Traditional Medicaid, +112786,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,MEDICAID-Traditional Medicaid, +112787,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,MEDICAID-Traditional Medicaid, +112788,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,MEDICAID-Traditional Medicaid, +112789,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,MEDICAID-Traditional Medicaid, +112790,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,MEDICAID-Traditional Medicaid, +112791,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,MEDICAID-Traditional Medicaid, +112792,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,MEDICAID-Traditional Medicaid, +112793,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,MEDICAID-Traditional Medicaid, +112794,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,MEDICAID-Traditional Medicaid, +112795,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,MEDICAID-Traditional Medicaid, +112796,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,MEDICAID-Traditional Medicaid, +112797,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,MEDICAID-Traditional Medicaid, +112798,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,MEDICAID-Traditional Medicaid, +112799,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,MEDICAID-Traditional Medicaid, +112800,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,MEDICAID-Traditional Medicaid, +112801,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,MEDICAID-Traditional Medicaid, +112802,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,MEDICAID-Traditional Medicaid, +112803,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,MEDICAID-Traditional Medicaid, +112804,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,MEDICAID-Traditional Medicaid, +112805,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,MEDICAID-Traditional Medicaid, +112806,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,MEDICAID-Traditional Medicaid, +112807,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,MEDICAID-Traditional Medicaid, +112808,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,MEDICAID-Traditional Medicaid, +112809,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,MEDICAID-Traditional Medicaid, +112810,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,MEDICAID-Traditional Medicaid, +112811,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,MEDICAID-Traditional Medicaid, +112812,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,MEDICAID-Traditional Medicaid, +112813,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,MEDICAID-Traditional Medicaid, +112814,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,MEDICAID-Traditional Medicaid,432.76 +112815,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,MEDICAID-Traditional Medicaid,2669.66 +112816,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,MEDICAID-Traditional Medicaid, +112817,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,MEDICAID-Traditional Medicaid, +112818,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,MEDICAID-Traditional Medicaid, +112819,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,MEDICAID-Traditional Medicaid, +112820,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,MEDICAID-Traditional Medicaid, +112821,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,MEDICAID-Traditional Medicaid, +112822,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,MEDICAID-Traditional Medicaid, +112823,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,MEDICAID-Traditional Medicaid, +112824,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,MEDICAID-Traditional Medicaid, +112825,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,MEDICAID-Traditional Medicaid, +112826,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,MEDICAID-Traditional Medicaid, +112827,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,MEDICAID-Traditional Medicaid, +112828,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,MEDICAID-Traditional Medicaid, +112829,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,MEDICAID-Traditional Medicaid, +112830,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,MEDICAID-Traditional Medicaid, +112831,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,MEDICAID-Traditional Medicaid, +112832,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,MEDICAID-Traditional Medicaid, +112833,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,MEDICAID-Traditional Medicaid, +112834,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,MEDICAID-Traditional Medicaid, +112835,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,MEDICAID-Traditional Medicaid, +112836,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,MEDICAID-Traditional Medicaid, +112837,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,MEDICAID-Traditional Medicaid, +112838,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,MEDICAID-Traditional Medicaid, +112839,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,MEDICAID-Traditional Medicaid, +112840,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,MEDICAID-Traditional Medicaid, +112841,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,MEDICAID-Traditional Medicaid, +112842,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,MEDICAID-Traditional Medicaid, +112843,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,MEDICAID-Traditional Medicaid, +112844,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,MEDICAID-Traditional Medicaid, +112845,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,MEDICAID-Traditional Medicaid, +112846,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,MEDICAID-Traditional Medicaid, +112847,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,MEDICAID-Traditional Medicaid, +112848,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,MEDICAID-Traditional Medicaid, +112849,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,MEDICAID-Traditional Medicaid, +112850,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,MEDICAID-Traditional Medicaid, +112851,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,MEDICAID-Traditional Medicaid, +112852,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,MEDICAID-Traditional Medicaid, +112853,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,MEDICAID-Traditional Medicaid, +112854,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,MEDICAID-Traditional Medicaid, +112855,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,MEDICAID-Traditional Medicaid, +112856,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,MEDICAID-Traditional Medicaid, +112857,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,MEDICAID-Traditional Medicaid, +112858,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,MEDICAID-Traditional Medicaid, +112859,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,MEDICAID-Traditional Medicaid, +112860,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,MEDICAID-Traditional Medicaid, +112861,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,MEDICAID-Traditional Medicaid, +112862,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,MEDICAID-Traditional Medicaid, +112863,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,MEDICAID-Traditional Medicaid, +112864,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,MEDICAID-Traditional Medicaid, +112865,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,MEDICAID-Traditional Medicaid, +112866,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,MEDICAID-Traditional Medicaid, +112867,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,MEDICAID-Traditional Medicaid, +112868,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,MEDICAID-Traditional Medicaid, +112869,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,MEDICAID-Traditional Medicaid, +112870,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,MEDICAID-Traditional Medicaid, +112871,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,MEDICAID-Traditional Medicaid, +112872,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,MEDICAID-Traditional Medicaid, +112873,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,MEDICAID-Traditional Medicaid, +112874,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,MEDICAID-Traditional Medicaid, +112875,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,MEDICAID-Traditional Medicaid, +112876,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,MEDICAID-Traditional Medicaid, +112877,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,MEDICAID-Traditional Medicaid, +112878,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,MEDICAID-Traditional Medicaid, +112879,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,MEDICAID-Traditional Medicaid, +112880,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,MEDICAID-Traditional Medicaid, +112881,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,MEDICAID-Traditional Medicaid, +112882,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,MEDICAID-Traditional Medicaid, +112883,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,MEDICAID-Traditional Medicaid, +112884,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,MEDICAID-Traditional Medicaid, +112885,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,MEDICAID-Traditional Medicaid, +112886,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,MEDICAID-Traditional Medicaid, +112887,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,MEDICAID-Traditional Medicaid, +112888,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,MEDICAID-Traditional Medicaid, +112889,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,MEDICAID-Traditional Medicaid, +112890,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,MEDICAID-Traditional Medicaid, +112891,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,MEDICAID-Traditional Medicaid, +112892,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,MEDICAID-Traditional Medicaid, +112893,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,MEDICAID-Traditional Medicaid, +112894,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,MEDICAID-Traditional Medicaid, +112895,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,MEDICAID-Traditional Medicaid, +112896,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,MEDICAID-Traditional Medicaid, +112897,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,MEDICAID-Traditional Medicaid, +112898,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,MEDICAID-Traditional Medicaid, +112899,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,MEDICAID-Traditional Medicaid, +112900,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,MEDICAID-Traditional Medicaid, +112901,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,MEDICAID-Traditional Medicaid, +112902,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,MEDICAID-Traditional Medicaid, +112903,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,MEDICAID-Traditional Medicaid, +112904,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,MEDICAID-Traditional Medicaid, +112905,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,MEDICAID-Traditional Medicaid, +112906,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,MEDICAID-Traditional Medicaid, +112907,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,MEDICAID-Traditional Medicaid, +112908,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,MEDICAID-Traditional Medicaid, +112909,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,MEDICAID-Traditional Medicaid, +112910,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,MEDICAID-Traditional Medicaid, +112911,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,MEDICAID-Traditional Medicaid, +112912,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,MEDICAID-Traditional Medicaid, +112913,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,MEDICAID-Traditional Medicaid, +112914,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,MEDICAID-Traditional Medicaid, +112915,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,MEDICAID-Traditional Medicaid, +112916,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,MEDICAID-Traditional Medicaid, +112917,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,MEDICAID-Traditional Medicaid, +112918,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,MEDICAID-Traditional Medicaid, +112919,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,MEDICAID-Traditional Medicaid, +112920,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,MEDICAID-Traditional Medicaid, +112921,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,MEDICAID-Traditional Medicaid, +112922,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,MEDICAID-Traditional Medicaid, +112923,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,MEDICAID-Traditional Medicaid, +112924,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,MEDICAID-Traditional Medicaid, +112925,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,MEDICAID-Traditional Medicaid, +112926,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,MEDICAID-Traditional Medicaid, +112927,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,MEDICAID-Traditional Medicaid, +112928,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,MEDICAID-Traditional Medicaid, +112929,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,MEDICAID-Traditional Medicaid, +112930,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,MEDICAID-Traditional Medicaid, +112931,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,MEDICAID-Traditional Medicaid, +112932,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,MEDICAID-Traditional Medicaid, +112933,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,MEDICAID-Traditional Medicaid, +112934,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,MEDICAID-Traditional Medicaid, +112935,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,MEDICAID-Traditional Medicaid, +112936,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,MEDICAID-Traditional Medicaid, +112937,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,MEDICAID-Traditional Medicaid, +112938,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,MEDICAID-Traditional Medicaid, +112939,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,MEDICAID-Traditional Medicaid, +112940,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,MEDICAID-Traditional Medicaid, +112941,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,MEDICAID-Traditional Medicaid, +112942,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,MEDICAID-Traditional Medicaid, +112943,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,MEDICAID-Traditional Medicaid, +112944,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,MEDICAID-Traditional Medicaid, +112945,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,MEDICAID-Traditional Medicaid, +112946,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,MEDICAID-Traditional Medicaid, +112947,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,MEDICAID-Traditional Medicaid, +112948,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,MEDICAID-Traditional Medicaid, +112949,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,MEDICAID-Traditional Medicaid, +112950,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,MEDICAID-Traditional Medicaid, +112951,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,MEDICAID-Traditional Medicaid, +112952,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,MEDICAID-Traditional Medicaid, +112953,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,MEDICAID-Traditional Medicaid, +112954,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,MEDICAID-Traditional Medicaid, +112955,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,MEDICAID-Traditional Medicaid, +112956,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,MEDICAID-Traditional Medicaid, +112957,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,MEDICAID-Traditional Medicaid, +112958,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,MEDICAID-Traditional Medicaid, +112959,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,MEDICAID-Traditional Medicaid, +112960,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,MEDICAID-Traditional Medicaid, +112961,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,MEDICAID-Traditional Medicaid, +112962,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,MEDICAID-Traditional Medicaid, +112963,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,MEDICAID-Traditional Medicaid, +112964,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,MEDICAID-Traditional Medicaid, +112965,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,MEDICAID-Traditional Medicaid, +112966,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,MEDICAID-Traditional Medicaid, +112967,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,MEDICAID-Traditional Medicaid, +112968,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,MEDICAID-Traditional Medicaid, +112969,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,MEDICAID-Traditional Medicaid, +112970,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,MEDICAID-Traditional Medicaid, +112971,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,MEDICAID-Traditional Medicaid, +112972,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,MEDICAID-Traditional Medicaid, +112973,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,MEDICAID-Traditional Medicaid, +112974,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,MEDICAID-Traditional Medicaid, +112975,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,MEDICAID-Traditional Medicaid, +112976,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,MEDICAID-Traditional Medicaid, +112977,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,MEDICAID-Traditional Medicaid, +112978,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,MEDICAID-Traditional Medicaid, +112979,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,MEDICAID-Traditional Medicaid, +112980,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,MEDICAID-Traditional Medicaid, +112981,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,MEDICAID-Traditional Medicaid, +112982,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,MEDICAID-Traditional Medicaid, +112983,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,MEDICAID-Traditional Medicaid, +112984,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,MEDICAID-Traditional Medicaid, +112985,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,MEDICAID-Traditional Medicaid, +112986,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,MEDICAID-Traditional Medicaid, +112987,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,MEDICAID-Traditional Medicaid, +112988,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,MEDICAID-Traditional Medicaid, +112989,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,MEDICAID-Traditional Medicaid, +112990,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,MEDICAID-Traditional Medicaid, +112991,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,MEDICAID-Traditional Medicaid, +112992,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,MEDICAID-Traditional Medicaid, +112993,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,MEDICAID-Traditional Medicaid, +112994,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,MEDICAID-Traditional Medicaid, +112995,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,MEDICAID-Traditional Medicaid, +112996,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,MEDICAID-Traditional Medicaid, +112997,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,MEDICAID-Traditional Medicaid, +112998,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,MEDICAID-Traditional Medicaid, +112999,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,MEDICAID-Traditional Medicaid, +113000,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,MEDICAID-Traditional Medicaid, +113001,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,MEDICAID-Traditional Medicaid, +113002,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,MEDICAID-Traditional Medicaid, +113003,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,MEDICAID-Traditional Medicaid, +113004,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,MEDICAID-Traditional Medicaid, +113005,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,MEDICAID-Traditional Medicaid, +113006,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,MEDICAID-Traditional Medicaid, +113007,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,MEDICAID-Traditional Medicaid, +113008,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,MEDICAID-Traditional Medicaid, +113009,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,MEDICAID-Traditional Medicaid, +113010,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,MEDICAID-Traditional Medicaid, +113011,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,MEDICAID-Traditional Medicaid, +113012,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,MEDICAID-Traditional Medicaid, +113013,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,MEDICAID-Traditional Medicaid, +113014,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,MEDICAID-Traditional Medicaid, +113015,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,MEDICAID-Traditional Medicaid, +113016,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,MEDICAID-Traditional Medicaid, +113017,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,MEDICAID-Traditional Medicaid, +113018,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,MEDICAID-Traditional Medicaid, +113019,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,MEDICAID-Traditional Medicaid, +113020,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,MEDICAID-Traditional Medicaid, +113021,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,MEDICAID-Traditional Medicaid, +113022,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,MEDICAID-Traditional Medicaid, +113023,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,MEDICAID-Traditional Medicaid, +113024,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,MEDICAID-Traditional Medicaid, +113025,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,MEDICAID-Traditional Medicaid, +113026,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,MEDICAID-Traditional Medicaid, +113027,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,MEDICAID-Traditional Medicaid, +113028,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,MEDICAID-Traditional Medicaid, +113029,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,MEDICAID-Traditional Medicaid, +113030,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,MEDICAID-Traditional Medicaid, +113031,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,MEDICAID-Traditional Medicaid, +113032,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,MEDICAID-Traditional Medicaid, +113033,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,MEDICAID-Traditional Medicaid, +113034,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,MEDICAID-Traditional Medicaid, +113035,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,MEDICAID-Traditional Medicaid, +113036,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,MEDICAID-Traditional Medicaid, +113037,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,MEDICAID-Traditional Medicaid, +113038,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,MEDICAID-Traditional Medicaid, +113039,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,MEDICAID-Traditional Medicaid, +113040,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,MEDICAID-Traditional Medicaid, +113041,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,MEDICAID-Traditional Medicaid, +113042,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,MEDICAID-Traditional Medicaid, +113043,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,MEDICAID-Traditional Medicaid, +113044,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,MEDICAID-Traditional Medicaid, +113045,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,MEDICAID-Traditional Medicaid, +113046,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,MEDICAID-Traditional Medicaid, +113047,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,MEDICAID-Traditional Medicaid, +113048,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,MEDICAID-Traditional Medicaid, +113049,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,MEDICAID-Traditional Medicaid, +113050,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,MEDICAID-Traditional Medicaid, +113051,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,MEDICAID-Traditional Medicaid, +113052,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,MEDICAID-Traditional Medicaid, +113053,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,MEDICAID-Traditional Medicaid, +113054,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,MEDICAID-Traditional Medicaid, +113055,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,MEDICAID-Traditional Medicaid, +113056,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,MEDICAID-Traditional Medicaid, +113057,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,MEDICAID-Traditional Medicaid, +113058,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,MEDICAID-Traditional Medicaid, +113059,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,MEDICAID-Traditional Medicaid, +113060,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,MEDICAID-Traditional Medicaid, +113061,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,MEDICAID-Traditional Medicaid, +113062,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,MEDICAID-Traditional Medicaid, +113063,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,MEDICAID-Traditional Medicaid, +113064,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,MEDICAID-Traditional Medicaid, +113065,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,MEDICAID-Traditional Medicaid, +113066,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,MEDICAID-Traditional Medicaid, +113067,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,MEDICAID-Traditional Medicaid, +113068,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,MEDICAID-Traditional Medicaid, +113069,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,MEDICAID-Traditional Medicaid, +113070,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,MEDICAID-Traditional Medicaid, +113071,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,MEDICAID-Traditional Medicaid, +113072,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,MEDICAID-Traditional Medicaid, +113073,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,MEDICAID-Traditional Medicaid, +113074,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,MEDICAID-Traditional Medicaid, +113075,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,MEDICAID-Traditional Medicaid, +113076,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,MEDICAID-Traditional Medicaid, +113077,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,MEDICAID-Traditional Medicaid, +113078,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,MEDICAID-Traditional Medicaid, +113079,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,MEDICAID-Traditional Medicaid, +113080,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,MEDICAID-Traditional Medicaid, +113081,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,MEDICAID-Traditional Medicaid, +113082,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,MEDICAID-Traditional Medicaid, +113083,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,MEDICAID-Traditional Medicaid, +113084,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,MEDICAID-Traditional Medicaid, +113085,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,MEDICAID-Traditional Medicaid, +113086,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,MEDICAID-Traditional Medicaid, +113087,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,MEDICAID-Traditional Medicaid, +113088,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,MEDICAID-Traditional Medicaid, +113089,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,MEDICAID-Traditional Medicaid, +113090,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,MEDICAID-Traditional Medicaid, +113091,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,MEDICAID-Traditional Medicaid, +113092,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,MEDICAID-Traditional Medicaid, +113093,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,MEDICAID-Traditional Medicaid, +113094,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,MEDICAID-Traditional Medicaid, +113095,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,MEDICAID-Traditional Medicaid, +113096,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,MEDICAID-Traditional Medicaid, +113097,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,MEDICAID-Traditional Medicaid, +113098,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,MEDICAID-Traditional Medicaid, +113099,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,MEDICAID-Traditional Medicaid, +113100,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,MEDICAID-Traditional Medicaid, +113101,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,MEDICAID-Traditional Medicaid, +113102,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,MEDICAID-Traditional Medicaid, +113103,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,MEDICAID-Traditional Medicaid, +113104,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,MEDICAID-Traditional Medicaid, +113105,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,MEDICAID-Traditional Medicaid, +113106,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,MEDICAID-Traditional Medicaid, +113107,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,MEDICAID-Traditional Medicaid, +113108,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,MEDICAID-Traditional Medicaid, +113109,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,MEDICAID-Traditional Medicaid, +113110,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,MEDICAID-Traditional Medicaid, +113111,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,MEDICAID-Traditional Medicaid, +113112,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,MEDICAID-Traditional Medicaid, +113113,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,MEDICAID-Traditional Medicaid, +113114,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,MEDICAID-Traditional Medicaid, +113115,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,MEDICAID-Traditional Medicaid, +113116,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,MEDICAID-Traditional Medicaid, +113117,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,MEDICAID-Traditional Medicaid, +113118,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,MEDICAID-Traditional Medicaid, +113119,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,MEDICAID-Traditional Medicaid, +113120,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,MEDICAID-Traditional Medicaid, +113121,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,MEDICAID-Traditional Medicaid, +113122,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,MEDICAID-Traditional Medicaid,402.68 +113123,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,MEDICAID-Traditional Medicaid, +113124,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,MEDICAID-Traditional Medicaid, +113125,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,MEDICAID-Traditional Medicaid, +113126,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,MEDICAID-Traditional Medicaid, +113127,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,MEDICAID-Traditional Medicaid, +113128,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,MEDICAID-Traditional Medicaid, +113129,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,MEDICAID-Traditional Medicaid, +113130,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,MEDICAID-Traditional Medicaid, +113131,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,MEDICAID-Traditional Medicaid, +113132,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,MEDICAID-Traditional Medicaid, +113133,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,MEDICAID-Traditional Medicaid, +113134,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,MEDICAID-Traditional Medicaid, +113135,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,MEDICAID-Traditional Medicaid, +113136,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,MEDICAID-Traditional Medicaid, +113137,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,MEDICAID-Traditional Medicaid, +113138,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,MEDICAID-Traditional Medicaid, +113139,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,MEDICAID-Traditional Medicaid, +113140,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,MEDICAID-Traditional Medicaid, +113141,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,MEDICAID-Traditional Medicaid, +113142,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,MEDICAID-Traditional Medicaid, +113143,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,MEDICAID-Traditional Medicaid, +113144,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,MEDICAID-Traditional Medicaid, +113145,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,MEDICAID-Traditional Medicaid, +113146,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,MEDICAID-Traditional Medicaid, +113147,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,MEDICAID-Traditional Medicaid, +113148,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,MEDICAID-Traditional Medicaid, +113149,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,MEDICAID-Traditional Medicaid, +113150,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,MEDICAID-Traditional Medicaid, +113151,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,MEDICAID-Traditional Medicaid, +113152,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,MEDICAID-Traditional Medicaid, +113153,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,MEDICAID-Traditional Medicaid, +113154,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,MEDICAID-Traditional Medicaid, +113155,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,MEDICAID-Traditional Medicaid, +113156,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,MEDICAID-Traditional Medicaid, +113157,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,MEDICAID-Traditional Medicaid, +113158,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,MEDICAID-Traditional Medicaid, +113159,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,MEDICAID-Traditional Medicaid, +113160,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,MEDICAID-Traditional Medicaid, +113161,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,MEDICAID-Traditional Medicaid, +113162,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,MEDICAID-Traditional Medicaid, +113163,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,MEDICAID-Traditional Medicaid, +113164,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,MEDICAID-Traditional Medicaid, +113165,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,MEDICAID-Traditional Medicaid, +113166,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,MEDICAID-Traditional Medicaid, +113167,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,MEDICAID-Traditional Medicaid, +113168,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,MEDICAID-Traditional Medicaid, +113169,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,MEDICAID-Traditional Medicaid, +113170,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,MEDICAID-Traditional Medicaid, +113171,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,MEDICAID-Traditional Medicaid, +113172,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,MEDICAID-Traditional Medicaid, +113173,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,MEDICAID-Traditional Medicaid, +113174,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,MEDICAID-Traditional Medicaid, +113175,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,MEDICAID-Traditional Medicaid, +113176,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,MEDICAID-Traditional Medicaid, +113177,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,MEDICAID-Traditional Medicaid, +113178,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,MEDICAID-Traditional Medicaid, +113179,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,MEDICAID-Traditional Medicaid, +113180,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,MEDICAID-Traditional Medicaid, +113181,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,MEDICAID-Traditional Medicaid, +113182,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,MEDICAID-Traditional Medicaid, +113183,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,MEDICAID-Traditional Medicaid, +113184,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,MEDICAID-Traditional Medicaid, +113185,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,MEDICAID-Traditional Medicaid, +113186,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,MEDICAID-Traditional Medicaid, +113187,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,MEDICAID-Traditional Medicaid, +113188,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,MEDICAID-Traditional Medicaid, +113189,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,MEDICAID-Traditional Medicaid, +113190,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,MEDICAID-Traditional Medicaid, +113191,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,MEDICAID-Traditional Medicaid, +113192,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,MEDICAID-Traditional Medicaid, +113193,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,MEDICAID-Traditional Medicaid, +113194,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,MEDICAID-Traditional Medicaid, +113195,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,MEDICAID-Traditional Medicaid, +113196,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,MEDICAID-Traditional Medicaid, +113197,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,MEDICAID-Traditional Medicaid, +113198,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,MEDICAID-Traditional Medicaid, +113199,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,MEDICAID-Traditional Medicaid, +113200,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,MEDICAID-Traditional Medicaid, +113201,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,MEDICAID-Traditional Medicaid, +113202,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,MEDICAID-Traditional Medicaid, +113203,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,MEDICAID-Traditional Medicaid, +113204,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,MEDICAID-Traditional Medicaid, +113205,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,MEDICAID-Traditional Medicaid, +113206,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,MEDICAID-Traditional Medicaid, +113207,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,MEDICAID-Traditional Medicaid, +113208,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,MEDICAID-Traditional Medicaid, +113209,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,MEDICAID-Traditional Medicaid, +113210,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,MEDICAID-Traditional Medicaid, +113211,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,MEDICAID-Traditional Medicaid, +113212,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,MEDICAID-Traditional Medicaid, +113213,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,MEDICAID-Traditional Medicaid, +113214,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,MEDICAID-Traditional Medicaid, +113215,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,MEDICAID-Traditional Medicaid, +113216,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,MEDICAID-Traditional Medicaid, +113217,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,MEDICAID-Traditional Medicaid, +113218,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,MEDICAID-Traditional Medicaid, +113219,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,MEDICAID-Traditional Medicaid, +113220,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,MEDICAID-Traditional Medicaid, +113221,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,MEDICAID-Traditional Medicaid, +113222,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,MEDICAID-Traditional Medicaid, +113223,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,MEDICAID-Traditional Medicaid, +113224,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,MEDICAID-Traditional Medicaid, +113225,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,MEDICAID-Traditional Medicaid, +113226,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,MEDICAID-Traditional Medicaid, +113227,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,MEDICAID-Traditional Medicaid, +113228,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,MEDICAID-Traditional Medicaid, +113229,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,MEDICAID-Traditional Medicaid, +113230,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,MEDICAID-Traditional Medicaid, +113231,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,MEDICAID-Traditional Medicaid, +113232,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,MEDICAID-Traditional Medicaid, +113233,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,MEDICAID-Traditional Medicaid, +113234,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,MEDICAID-Traditional Medicaid, +113235,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,MEDICAID-Traditional Medicaid, +113236,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,MEDICAID-Traditional Medicaid, +113237,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,MEDICAID-Traditional Medicaid, +113238,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,MEDICAID-Traditional Medicaid, +113239,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,MEDICAID-Traditional Medicaid, +113240,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,MEDICAID-Traditional Medicaid, +113241,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,MEDICAID-Traditional Medicaid, +113242,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,MEDICAID-Traditional Medicaid, +113243,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,MEDICAID-Traditional Medicaid, +113244,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,MEDICAID-Traditional Medicaid, +113245,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,MEDICAID-Traditional Medicaid, +113246,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,MEDICAID-Traditional Medicaid, +113247,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,MEDICAID-Traditional Medicaid, +113248,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,MEDICAID-Traditional Medicaid, +113249,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,MEDICAID-Traditional Medicaid,462.61 +113250,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,MEDICAID-Traditional Medicaid, +113251,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,MEDICAID-Traditional Medicaid, +113252,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,MEDICAID-Traditional Medicaid, +113253,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,MEDICAID-Traditional Medicaid, +113254,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,MEDICAID-Traditional Medicaid, +113255,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,MEDICAID-Traditional Medicaid, +113256,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,MEDICAID-Traditional Medicaid, +113257,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,MEDICAID-Traditional Medicaid, +113258,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,MEDICAID-Traditional Medicaid, +113259,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,MEDICAID-Traditional Medicaid, +113260,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,MEDICAID-Traditional Medicaid, +113261,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,MEDICAID-Traditional Medicaid, +113262,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,MEDICAID-Traditional Medicaid, +113263,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,MEDICAID-Traditional Medicaid, +113264,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,MEDICAID-Traditional Medicaid, +113265,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,MEDICAID-Traditional Medicaid, +113266,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,MEDICAID-Traditional Medicaid, +113267,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,MEDICAID-Traditional Medicaid, +113268,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,MEDICAID-Traditional Medicaid, +113269,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,MEDICAID-Traditional Medicaid, +113270,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,MEDICAID-Traditional Medicaid, +113271,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,MEDICAID-Traditional Medicaid, +113272,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,MEDICAID-Traditional Medicaid, +113273,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,MEDICAID-Traditional Medicaid, +113274,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,MEDICAID-Traditional Medicaid, +113275,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,MEDICAID-Traditional Medicaid, +113276,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,MEDICAID-Traditional Medicaid, +113277,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,MEDICAID-Traditional Medicaid, +113278,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,MEDICAID-Traditional Medicaid, +113279,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,MEDICAID-Traditional Medicaid, +113280,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,MEDICAID-Traditional Medicaid, +113281,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,MEDICAID-Traditional Medicaid, +113282,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,MEDICAID-Traditional Medicaid, +113283,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,MEDICAID-Traditional Medicaid, +113284,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,MEDICAID-Traditional Medicaid, +113285,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,MEDICAID-Traditional Medicaid, +113286,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,MEDICAID-Traditional Medicaid, +113287,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,MEDICAID-Traditional Medicaid, +113288,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,MEDICAID-Traditional Medicaid, +113289,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,MEDICAID-Traditional Medicaid, +113290,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,MEDICAID-Traditional Medicaid, +113291,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,MEDICAID-Traditional Medicaid, +113292,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,MEDICAID-Traditional Medicaid, +113293,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,MEDICAID-Traditional Medicaid, +113294,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,MEDICAID-Traditional Medicaid, +113295,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,MEDICAID-Traditional Medicaid, +113296,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,MEDICAID-Traditional Medicaid, +113297,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,MEDICAID-Traditional Medicaid, +113298,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,MEDICAID-Traditional Medicaid, +113299,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,MEDICAID-Traditional Medicaid, +113300,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,MEDICAID-Traditional Medicaid, +113301,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,MEDICAID-Traditional Medicaid, +113302,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,MEDICAID-Traditional Medicaid, +113303,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,MEDICAID-Traditional Medicaid, +113304,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,MEDICAID-Traditional Medicaid, +113305,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,MEDICAID-Traditional Medicaid, +113306,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,MEDICAID-Traditional Medicaid, +113307,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,MEDICAID-Traditional Medicaid, +113308,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,MEDICAID-Traditional Medicaid, +113309,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,MEDICAID-Traditional Medicaid, +113310,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,MEDICAID-Traditional Medicaid, +113311,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,MEDICAID-Traditional Medicaid, +113312,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,MEDICAID-Traditional Medicaid, +113313,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,MEDICAID-Traditional Medicaid, +113314,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,MEDICAID-Traditional Medicaid, +113315,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,MEDICAID-Traditional Medicaid, +113316,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,MEDICAID-Traditional Medicaid, +113317,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,MEDICAID-Traditional Medicaid, +113318,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,MEDICAID-Traditional Medicaid, +113319,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,MEDICAID-Traditional Medicaid, +113320,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,MEDICAID-Traditional Medicaid, +113321,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,MEDICAID-Traditional Medicaid, +113322,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,MEDICAID-Traditional Medicaid, +113323,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,MEDICAID-Traditional Medicaid, +113324,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,MEDICAID-Traditional Medicaid, +113325,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,MEDICAID-Traditional Medicaid, +113326,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,MEDICAID-Traditional Medicaid, +113327,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,MEDICAID-Traditional Medicaid, +113328,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,MEDICAID-Traditional Medicaid, +113329,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,MEDICAID-Traditional Medicaid, +113330,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,MEDICAID-Traditional Medicaid, +113331,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,MEDICAID-Traditional Medicaid, +113332,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,MEDICAID-Traditional Medicaid, +113333,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,MEDICAID-Traditional Medicaid, +113334,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,MEDICAID-Traditional Medicaid, +113335,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,MEDICAID-Traditional Medicaid, +113336,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,MEDICAID-Traditional Medicaid, +113337,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,MEDICAID-Traditional Medicaid, +113338,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,MEDICAID-Traditional Medicaid, +113339,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,MEDICAID-Traditional Medicaid, +113340,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,MEDICAID-Traditional Medicaid, +113341,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,MEDICAID-Traditional Medicaid, +113342,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,MEDICAID-Traditional Medicaid, +113343,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,MEDICAID-Traditional Medicaid, +113344,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,MEDICAID-Traditional Medicaid, +113345,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,MEDICAID-Traditional Medicaid, +113346,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,MEDICAID-Traditional Medicaid, +113347,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,MEDICAID-Traditional Medicaid, +113348,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,MEDICAID-Traditional Medicaid, +113349,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,MEDICAID-Traditional Medicaid, +113350,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,MEDICAID-Traditional Medicaid, +113351,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,MEDICAID-Traditional Medicaid, +113352,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,MEDICAID-Traditional Medicaid, +113353,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,MEDICAID-Traditional Medicaid, +113354,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,MEDICAID-Traditional Medicaid, +113355,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,MEDICAID-Traditional Medicaid, +113356,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,MEDICAID-Traditional Medicaid, +113357,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,MEDICAID-Traditional Medicaid, +113358,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,MEDICAID-Traditional Medicaid, +113359,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,MEDICAID-Traditional Medicaid, +113360,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,MEDICAID-Traditional Medicaid, +113361,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,MEDICAID-Traditional Medicaid, +113362,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,MEDICAID-Traditional Medicaid, +113363,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,MEDICAID-Traditional Medicaid, +113364,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,MEDICAID-Traditional Medicaid, +113365,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,MEDICAID-Traditional Medicaid, +113366,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,MEDICAID-Traditional Medicaid, +113367,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,MEDICAID-Traditional Medicaid, +113368,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,MEDICAID-Traditional Medicaid, +113369,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,MEDICAID-Traditional Medicaid, +113370,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,MEDICAID-Traditional Medicaid, +113371,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,MEDICAID-Traditional Medicaid, +113372,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,MEDICAID-Traditional Medicaid, +113373,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,MEDICAID-Traditional Medicaid, +113374,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,MEDICAID-Traditional Medicaid, +113375,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,MEDICAID-Traditional Medicaid, +113376,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,MEDICAID-Traditional Medicaid, +113377,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,MEDICAID-Traditional Medicaid, +113378,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,MEDICAID-Traditional Medicaid, +113379,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,MEDICAID-Traditional Medicaid, +113380,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,MEDICAID-Traditional Medicaid, +113381,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,MEDICAID-Traditional Medicaid, +113382,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,MEDICAID-Traditional Medicaid, +113383,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,MEDICAID-Traditional Medicaid, +113384,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,MEDICAID-Traditional Medicaid, +113385,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,MEDICAID-Traditional Medicaid, +113386,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,MEDICAID-Traditional Medicaid, +113387,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,MEDICAID-Traditional Medicaid, +113388,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,MEDICAID-Traditional Medicaid, +113389,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,MEDICAID-Traditional Medicaid, +113390,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,MEDICAID-Traditional Medicaid, +113391,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,MEDICAID-Traditional Medicaid, +113392,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,MEDICAID-Traditional Medicaid, +113393,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,MEDICAID-Traditional Medicaid, +113394,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,MEDICAID-Traditional Medicaid, +113395,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,MEDICAID-Traditional Medicaid, +113396,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,MEDICAID-Traditional Medicaid, +113397,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,MEDICAID-Traditional Medicaid, +113398,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,MEDICAID-Traditional Medicaid, +113399,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,MEDICAID-Traditional Medicaid, +113400,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,MEDICAID-Traditional Medicaid, +113401,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,MEDICAID-Traditional Medicaid, +113402,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,MEDICAID-Traditional Medicaid, +113403,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,MEDICAID-Traditional Medicaid, +113404,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,MEDICAID-Traditional Medicaid, +113405,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,MEDICAID-Traditional Medicaid, +113406,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,MEDICAID-Traditional Medicaid, +113407,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,MEDICAID-Traditional Medicaid, +113408,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,MEDICAID-Traditional Medicaid, +113409,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,MEDICAID-Traditional Medicaid, +113410,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,MEDICAID-Traditional Medicaid, +113411,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,MEDICAID-Traditional Medicaid, +113412,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,MEDICAID-Traditional Medicaid, +113413,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,MEDICAID-Traditional Medicaid, +113414,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,MEDICAID-Traditional Medicaid, +113415,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,MEDICAID-Traditional Medicaid, +113416,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,MEDICAID-Traditional Medicaid, +113417,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,MEDICAID-Traditional Medicaid, +113418,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,MEDICAID-Traditional Medicaid, +113419,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,MEDICAID-Traditional Medicaid, +113420,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,MEDICAID-Traditional Medicaid, +113421,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,MEDICAID-Traditional Medicaid, +113422,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,MEDICAID-Traditional Medicaid, +113423,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,MEDICAID-Traditional Medicaid, +113424,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,MEDICAID-Traditional Medicaid, +113425,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,MEDICAID-Traditional Medicaid, +113426,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,MEDICAID-Traditional Medicaid, +113427,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,MEDICAID-Traditional Medicaid, +113428,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,MEDICAID-Traditional Medicaid, +113429,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,MEDICAID-Traditional Medicaid, +113430,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,MEDICAID-Traditional Medicaid, +113431,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,MEDICAID-Traditional Medicaid, +113432,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,MEDICAID-Traditional Medicaid, +113433,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,MEDICAID-Traditional Medicaid, +113434,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,MEDICAID-Traditional Medicaid, +113435,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,MEDICAID-Traditional Medicaid, +113436,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,MEDICAID-Traditional Medicaid, +113437,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,MEDICAID-Traditional Medicaid, +113438,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,MEDICAID-Traditional Medicaid, +113439,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,MEDICAID-Traditional Medicaid, +113440,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,MEDICAID-Traditional Medicaid, +113441,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,MEDICAID-Traditional Medicaid, +113442,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,MEDICAID-Traditional Medicaid, +113443,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,MEDICAID-Traditional Medicaid, +113444,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,MEDICAID-Traditional Medicaid, +113445,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,MEDICAID-Traditional Medicaid, +113446,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,MEDICAID-Traditional Medicaid, +113447,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,MEDICAID-Traditional Medicaid, +113448,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,MEDICAID-Traditional Medicaid, +113449,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,MEDICAID-Traditional Medicaid, +113450,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,MEDICAID-Traditional Medicaid, +113451,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,MEDICAID-Traditional Medicaid, +113452,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,MEDICAID-Traditional Medicaid, +113453,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,MEDICAID-Traditional Medicaid, +113454,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,MEDICAID-Traditional Medicaid, +113455,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,MEDICAID-Traditional Medicaid, +113456,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,MEDICAID-Traditional Medicaid, +113457,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,MEDICAID-Traditional Medicaid, +113458,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,MEDICAID-Traditional Medicaid, +113459,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,MEDICAID-Traditional Medicaid, +113460,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,MEDICAID-Traditional Medicaid, +113461,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,MEDICAID-Traditional Medicaid, +113462,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,MEDICAID-Traditional Medicaid, +113463,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,MEDICAID-Traditional Medicaid, +113464,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,MEDICAID-Traditional Medicaid, +113465,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,MEDICAID-Traditional Medicaid, +113466,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,MEDICAID-Traditional Medicaid, +113467,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,MEDICAID-Traditional Medicaid, +113468,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,MEDICAID-Traditional Medicaid, +113469,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,MEDICAID-Traditional Medicaid, +113470,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,MEDICAID-Traditional Medicaid, +113471,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,MEDICAID-Traditional Medicaid, +113472,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,MEDICAID-Traditional Medicaid, +113473,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,MEDICAID-Traditional Medicaid, +113474,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,MEDICAID-Traditional Medicaid, +113475,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,MEDICAID-Traditional Medicaid, +113476,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,MEDICAID-Traditional Medicaid, +113477,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,MEDICAID-Traditional Medicaid, +113478,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,MEDICAID-Traditional Medicaid, +113479,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,MEDICAID-Traditional Medicaid, +113480,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,MEDICAID-Traditional Medicaid, +113481,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,MEDICAID-Traditional Medicaid, +113482,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,MEDICAID-Traditional Medicaid, +113483,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,MEDICAID-Traditional Medicaid, +113484,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,MEDICAID-Traditional Medicaid, +113485,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,MEDICAID-Traditional Medicaid, +113486,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,MEDICAID-Traditional Medicaid, +113487,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,MEDICAID-Traditional Medicaid, +113488,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,MEDICAID-Traditional Medicaid, +113489,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,MEDICAID-Traditional Medicaid, +113490,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,MEDICAID-Traditional Medicaid, +113491,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,MEDICAID-Traditional Medicaid, +113492,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,MEDICAID-Traditional Medicaid, +113493,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,MEDICAID-Traditional Medicaid, +113494,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,MEDICAID-Traditional Medicaid, +113495,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,MEDICAID-Traditional Medicaid, +113496,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,MEDICAID-Traditional Medicaid, +113497,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,MEDICAID-Traditional Medicaid, +113498,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,MEDICAID-Traditional Medicaid, +113499,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,MEDICAID-Traditional Medicaid, +113500,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,MEDICAID-Traditional Medicaid, +113501,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,MEDICAID-Traditional Medicaid, +113502,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,MEDICAID-Traditional Medicaid, +113503,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,MEDICAID-Traditional Medicaid, +113504,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,MEDICAID-Traditional Medicaid, +113505,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,MEDICAID-Traditional Medicaid, +113506,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,MEDICAID-Traditional Medicaid, +113507,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,MEDICAID-Traditional Medicaid, +113508,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,MEDICAID-Traditional Medicaid, +113509,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,MEDICAID-Traditional Medicaid, +113510,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,MEDICAID-Traditional Medicaid, +113511,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,MEDICAID-Traditional Medicaid, +113512,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,MEDICAID-Traditional Medicaid, +113513,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,MEDICAID-Traditional Medicaid, +113514,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,MEDICAID-Traditional Medicaid, +113515,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,MEDICAID-Traditional Medicaid, +113516,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,MEDICAID-Traditional Medicaid, +113517,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,MEDICAID-Traditional Medicaid, +113518,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,MEDICAID-Traditional Medicaid, +113519,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,MEDICAID-Traditional Medicaid, +113520,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,MEDICAID-Traditional Medicaid, +113521,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,MEDICAID-Traditional Medicaid, +113522,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,MEDICAID-Traditional Medicaid, +113523,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,MEDICAID-Traditional Medicaid, +113524,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,MEDICAID-Traditional Medicaid, +113525,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,MEDICAID-Traditional Medicaid, +113526,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,MEDICAID-Traditional Medicaid, +113527,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,MEDICAID-Traditional Medicaid, +113528,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,MEDICAID-Traditional Medicaid, +113529,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,MEDICAID-Traditional Medicaid, +113530,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,MEDICAID-Traditional Medicaid, +113531,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,MEDICAID-Traditional Medicaid, +113532,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,MEDICAID-Traditional Medicaid, +113533,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,MEDICAID-Traditional Medicaid, +113534,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,MEDICAID-Traditional Medicaid, +113535,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,MEDICAID-Traditional Medicaid, +113536,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,MEDICAID-Traditional Medicaid, +113537,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,MEDICAID-Traditional Medicaid, +113538,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,MEDICAID-Traditional Medicaid, +113539,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,MEDICAID-Traditional Medicaid, +113540,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,MEDICAID-Traditional Medicaid, +113541,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,MEDICAID-Traditional Medicaid, +113542,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,MEDICAID-Traditional Medicaid, +113543,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,MEDICAID-Traditional Medicaid, +113544,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,MEDICAID-Traditional Medicaid, +113545,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,MEDICAID-Traditional Medicaid, +113546,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,MEDICAID-Traditional Medicaid, +113547,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,MEDICAID-Traditional Medicaid, +113548,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,MEDICAID-Traditional Medicaid, +113549,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,MEDICAID-Traditional Medicaid, +113550,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,MEDICAID-Traditional Medicaid, +113551,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,MEDICAID-Traditional Medicaid, +113552,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,MEDICAID-Traditional Medicaid, +113553,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,MEDICAID-Traditional Medicaid, +113554,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,MEDICAID-Traditional Medicaid, +113555,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,MEDICAID-Traditional Medicaid, +113556,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,MEDICAID-Traditional Medicaid, +113557,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,MEDICAID-Traditional Medicaid, +113558,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,MEDICAID-Traditional Medicaid, +113559,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,MEDICAID-Traditional Medicaid, +113560,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,MEDICAID-Traditional Medicaid, +113561,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,MEDICAID-Traditional Medicaid, +113562,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,MEDICAID-Traditional Medicaid, +113563,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,MEDICAID-Traditional Medicaid, +113564,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,MEDICAID-Traditional Medicaid, +113565,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,MEDICAID-Traditional Medicaid, +113566,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,MEDICAID-Traditional Medicaid, +113567,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,MEDICAID-Traditional Medicaid, +113568,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,MEDICAID-Traditional Medicaid, +113569,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,MEDICAID-Traditional Medicaid, +113570,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,MEDICAID-Traditional Medicaid, +113571,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,MEDICAID-Traditional Medicaid, +113572,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,MEDICAID-Traditional Medicaid, +113573,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,MEDICAID-Traditional Medicaid, +113574,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,MEDICAID-Traditional Medicaid, +113575,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,MEDICAID-Traditional Medicaid, +113576,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,MEDICAID-Traditional Medicaid, +113577,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,MEDICAID-Traditional Medicaid, +113578,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,MEDICAID-Traditional Medicaid, +113579,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,MEDICAID-Traditional Medicaid, +113580,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,MEDICAID-Traditional Medicaid, +113581,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,MEDICAID-Traditional Medicaid, +113582,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,MEDICAID-Traditional Medicaid, +113583,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,MEDICAID-Traditional Medicaid, +113584,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,MEDICAID-Traditional Medicaid, +113585,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,MEDICAID-Traditional Medicaid, +113586,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,MEDICAID-Traditional Medicaid, +113587,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,MEDICAID-Traditional Medicaid, +113588,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,MEDICAID-Traditional Medicaid, +113589,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,MEDICAID-Traditional Medicaid, +113590,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,MEDICAID-Traditional Medicaid, +113591,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,MEDICAID-Traditional Medicaid, +113592,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,MEDICAID-Traditional Medicaid, +113593,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,MEDICAID-Traditional Medicaid, +113594,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,MEDICAID-Traditional Medicaid, +113595,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,MEDICAID-Traditional Medicaid, +113596,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,MEDICAID-Traditional Medicaid, +113597,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,MEDICAID-Traditional Medicaid, +113598,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,MEDICAID-Traditional Medicaid, +113599,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,MEDICAID-Traditional Medicaid, +113600,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,MEDICAID-Traditional Medicaid, +113601,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,MEDICAID-Traditional Medicaid, +113602,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,MEDICAID-Traditional Medicaid, +113603,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,MEDICAID-Traditional Medicaid, +113604,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,MEDICAID-Traditional Medicaid, +113605,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,MEDICAID-Traditional Medicaid, +113606,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,MEDICAID-Traditional Medicaid, +113607,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,MEDICAID-Traditional Medicaid, +113608,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,MEDICAID-Traditional Medicaid, +113609,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,MEDICAID-Traditional Medicaid, +113610,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,MEDICAID-Traditional Medicaid, +113611,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,MEDICAID-Traditional Medicaid, +113612,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,MEDICAID-Traditional Medicaid, +113613,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,MEDICAID-Traditional Medicaid, +113614,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,MEDICAID-Traditional Medicaid, +113615,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,MEDICAID-Traditional Medicaid, +113616,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,MEDICAID-Traditional Medicaid, +113617,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,MEDICAID-Traditional Medicaid, +113618,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,MEDICAID-Traditional Medicaid, +113619,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,MEDICAID-Traditional Medicaid, +113620,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,MEDICAID-Traditional Medicaid, +113621,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,MEDICAID-Traditional Medicaid, +113622,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,MEDICAID-Traditional Medicaid, +113623,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,MEDICAID-Traditional Medicaid, +113624,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,MEDICAID-Traditional Medicaid, +113625,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,MEDICAID-Traditional Medicaid, +113626,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,MEDICAID-Traditional Medicaid, +113627,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,MEDICAID-Traditional Medicaid, +113628,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,MEDICAID-Traditional Medicaid, +113629,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,MEDICAID-Traditional Medicaid, +113630,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,MEDICAID-Traditional Medicaid, +113631,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,MEDICAID-Traditional Medicaid, +113632,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,MEDICAID-Traditional Medicaid, +113633,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,MEDICAID-Traditional Medicaid, +113634,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,MEDICAID-Traditional Medicaid, +113635,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,MEDICAID-Traditional Medicaid, +113636,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,MEDICAID-Traditional Medicaid, +113637,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,MEDICAID-Traditional Medicaid, +113638,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,MEDICAID-Traditional Medicaid, +113639,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,MEDICAID-Traditional Medicaid, +113640,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,MEDICAID-Traditional Medicaid, +113641,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,MEDICAID-Traditional Medicaid, +113642,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,MEDICAID-Traditional Medicaid, +113643,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,MEDICAID-Traditional Medicaid, +113644,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,MEDICAID-Traditional Medicaid, +113645,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,MEDICAID-Traditional Medicaid, +113646,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,MEDICAID-Traditional Medicaid, +113647,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,MEDICAID-Traditional Medicaid, +113648,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,MEDICAID-Traditional Medicaid, +113649,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,MEDICAID-Traditional Medicaid, +113650,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,MEDICAID-Traditional Medicaid, +113651,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,MEDICAID-Traditional Medicaid, +113652,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,MEDICAID-Traditional Medicaid, +113653,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,MEDICAID-Traditional Medicaid, +113654,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,MEDICAID-Traditional Medicaid, +113655,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,MEDICAID-Traditional Medicaid, +113656,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,MEDICAID-Traditional Medicaid, +113657,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,MEDICAID-Traditional Medicaid, +113658,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,MEDICAID-Traditional Medicaid, +113659,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,MEDICAID-Traditional Medicaid, +113660,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,MEDICAID-Traditional Medicaid, +113661,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,MEDICAID-Traditional Medicaid, +113662,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,MEDICAID-Traditional Medicaid, +113663,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,MEDICAID-Traditional Medicaid, +113664,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,MEDICAID-Traditional Medicaid, +113665,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,MEDICAID-Traditional Medicaid, +113666,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,MEDICAID-Traditional Medicaid, +113667,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,MEDICAID-Traditional Medicaid, +113668,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,MEDICAID-Traditional Medicaid, +113669,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,MEDICAID-Traditional Medicaid, +113670,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,MEDICAID-Traditional Medicaid, +113671,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,MEDICAID-Traditional Medicaid, +113672,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,MEDICAID-Traditional Medicaid, +113673,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,MEDICAID-Traditional Medicaid, +113674,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,MEDICAID-Traditional Medicaid, +113675,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,MEDICAID-Traditional Medicaid, +113676,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,MEDICAID-Traditional Medicaid, +113677,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,MEDICAID-Traditional Medicaid, +113678,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,MEDICAID-Traditional Medicaid, +113679,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,MEDICAID-Traditional Medicaid, +113680,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,MEDICAID-Traditional Medicaid, +113681,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,MEDICAID-Traditional Medicaid, +113682,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,MEDICAID-Traditional Medicaid, +113683,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,MEDICAID-Traditional Medicaid, +113684,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,MEDICAID-Traditional Medicaid, +113685,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,MEDICAID-Traditional Medicaid, +113686,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,MEDICAID-Traditional Medicaid, +113687,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,MEDICAID-Traditional Medicaid, +113688,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,MEDICAID-Traditional Medicaid, +113689,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,MEDICAID-Traditional Medicaid, +113690,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,MEDICAID-Traditional Medicaid, +113691,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,MEDICAID-Traditional Medicaid, +113692,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,MEDICAID-Traditional Medicaid, +113693,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,MEDICAID-Traditional Medicaid, +113694,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,MEDICAID-Traditional Medicaid, +113695,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,MEDICAID-Traditional Medicaid, +113696,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,MEDICAID-Traditional Medicaid, +113697,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,MEDICAID-Traditional Medicaid, +113698,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,MEDICAID-Traditional Medicaid, +113699,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113700,3934,30000012,PRIVATE,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113701,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113702,3934,30000038,ICU,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113703,3934,30000046,BURN UNIT,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113704,3934,30000053,NICU,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113705,3934,30000061,ICR ROOM,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113706,3934,30000079,PSYCH,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113707,3934,30000087,NEWBORN,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +113708,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113709,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113710,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113711,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113712,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113713,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113714,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113715,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113716,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113717,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113718,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113719,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113720,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113721,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113722,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113723,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113724,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113725,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113726,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113727,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113728,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113729,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113730,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113731,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113732,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113733,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113734,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113735,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113736,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113737,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113738,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113739,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113740,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113741,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113742,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113743,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113744,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113745,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113746,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113747,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113748,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113749,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113750,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113751,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113752,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113753,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113754,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113755,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113756,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113757,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113758,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113759,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113760,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113761,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113762,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113763,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113764,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113765,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113766,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113767,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113768,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113769,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113770,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113771,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113772,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113773,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113774,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113775,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113776,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113777,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113778,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113779,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113780,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113781,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113782,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113783,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113784,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113785,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113786,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113787,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113788,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113789,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113790,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113791,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113792,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113793,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113794,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113795,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113796,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113797,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113798,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113799,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113800,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113801,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113802,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113803,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113804,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113805,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113806,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113807,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113808,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113809,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113810,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113811,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113812,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113813,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113814,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113815,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113816,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113817,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113818,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113819,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113820,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113821,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113822,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113823,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113824,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113825,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113826,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113827,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113828,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113829,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113830,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113831,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113832,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113833,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113834,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113835,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113836,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113837,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113838,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113839,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113840,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113841,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113842,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113843,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113844,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113845,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113846,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113847,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113848,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113849,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113850,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113851,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113852,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113853,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113854,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113855,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113856,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113857,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113858,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113859,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113860,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113861,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113862,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113863,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113864,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113865,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113866,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113867,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113868,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113869,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113870,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113871,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113872,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113873,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113874,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113875,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113876,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113877,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113878,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +113879,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113880,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113881,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113882,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113883,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113884,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113885,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113886,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113887,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113888,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113889,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113890,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113891,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113892,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113893,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113894,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113895,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113896,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113897,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113898,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113899,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113900,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113901,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113902,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113903,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113904,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113905,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113906,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113907,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113908,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113909,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113910,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113911,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113912,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113913,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113914,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113915,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113916,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +113917,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113918,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113919,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113920,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113921,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113922,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113923,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113924,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113925,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113926,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113927,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113928,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113929,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113930,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113931,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113932,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113933,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113934,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113935,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113936,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113937,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113938,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113939,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113940,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113941,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113942,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113943,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113944,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113945,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113946,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113947,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113948,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113949,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113950,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113951,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113952,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113953,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113954,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113955,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113956,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113957,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113958,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113959,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113960,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113961,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113962,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113963,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113964,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113965,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113966,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113967,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113968,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113969,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113970,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113971,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113972,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113973,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113974,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113975,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113976,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113977,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113978,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113979,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113980,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113981,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113982,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113983,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113984,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113985,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113986,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113987,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113988,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113989,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113990,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113991,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +113992,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +113993,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113994,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113995,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113996,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +113997,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113998,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +113999,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114000,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114001,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114002,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114003,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114004,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114005,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114006,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114007,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114008,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114009,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114010,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114011,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114012,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114013,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114014,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114015,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114016,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114017,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114018,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114019,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114020,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114021,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114022,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114023,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114024,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114025,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114026,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114027,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114028,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +114029,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114030,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114031,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114032,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114033,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114034,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114035,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114036,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114037,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114038,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114039,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114040,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114041,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114042,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114043,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114044,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114045,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114046,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114047,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114048,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114049,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114050,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114051,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114052,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114053,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114054,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114055,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114056,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114057,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114058,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114059,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114060,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114061,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114062,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114063,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114064,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114065,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114066,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114067,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114068,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114069,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114070,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114071,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114072,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114073,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114074,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114075,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114076,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114077,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114078,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114079,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114080,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114081,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114082,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114083,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114084,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114085,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114086,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114087,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114088,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114089,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114090,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114091,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114092,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114093,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114094,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114095,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114096,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114097,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114098,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114099,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114100,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114101,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +114102,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114103,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114104,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114105,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114106,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114107,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114108,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114109,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +114110,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114111,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +114112,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114113,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114114,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114115,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +114116,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +114117,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,MEDICAID-Traditional Medicaid, +114118,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114119,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114120,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114121,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114122,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114123,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114124,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,MEDICAID-Traditional Medicaid, +114125,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114126,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114127,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114128,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114129,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114130,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114131,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114132,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114133,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114134,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114135,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114136,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114137,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114138,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114139,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114140,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114141,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114142,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,MEDICAID-Traditional Medicaid, +114143,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,MEDICAID-Traditional Medicaid, +114144,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,MEDICAID-Traditional Medicaid, +114145,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,MEDICAID-Traditional Medicaid, +114146,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,MEDICAID-Traditional Medicaid, +114147,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,MEDICAID-Traditional Medicaid, +114148,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,MEDICAID-Traditional Medicaid, +114149,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114150,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114151,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114152,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114153,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114154,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114155,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114156,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114157,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114158,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114159,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114160,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114161,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,MEDICAID-Traditional Medicaid, +114162,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,MEDICAID-Traditional Medicaid, +114163,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,MEDICAID-Traditional Medicaid, +114164,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,MEDICAID-Traditional Medicaid, +114165,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,MEDICAID-Traditional Medicaid, +114166,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,MEDICAID-Traditional Medicaid, +114167,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,MEDICAID-Traditional Medicaid, +114168,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,MEDICAID-Traditional Medicaid, +114169,3934,37112000,ACUTE ED,,1580.0,1580.0,,,MEDICAID-Traditional Medicaid, +114170,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,MEDICAID-Traditional Medicaid, +114171,3934,37112034,TRIAGE,,277.0,277.0,,,MEDICAID-Traditional Medicaid, +114172,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,MEDICAID-Traditional Medicaid, +114173,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,MEDICAID-Traditional Medicaid, +114174,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,MEDICAID-Traditional Medicaid, +114175,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,MEDICAID-Traditional Medicaid, +114176,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,MEDICAID-Traditional Medicaid, +114177,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,MEDICAID-Traditional Medicaid, +114178,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,MEDICAID-Traditional Medicaid, +114179,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,MEDICAID-Traditional Medicaid, +114180,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,MEDICAID-Traditional Medicaid, +114181,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,MEDICAID-Traditional Medicaid, +114182,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,MEDICAID-Traditional Medicaid, +114183,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,MEDICAID-Traditional Medicaid, +114184,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,MEDICAID-Traditional Medicaid, +114185,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,MEDICAID-Traditional Medicaid, +114186,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,MEDICAID-Traditional Medicaid, +114187,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,MEDICAID-Traditional Medicaid, +114188,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,MEDICAID-Traditional Medicaid, +114189,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,MEDICAID-Traditional Medicaid, +114190,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,MEDICAID-Traditional Medicaid, +114191,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,MEDICAID-Traditional Medicaid, +114192,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,MEDICAID-Traditional Medicaid, +114193,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,MEDICAID-Traditional Medicaid, +114194,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,MEDICAID-Traditional Medicaid, +114195,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,MEDICAID-Traditional Medicaid, +114196,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,MEDICAID-Traditional Medicaid, +114197,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,MEDICAID-Traditional Medicaid, +114198,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,MEDICAID-Traditional Medicaid, +114199,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,MEDICAID-Traditional Medicaid, +114200,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,MEDICAID-Traditional Medicaid, +114201,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,MEDICAID-Traditional Medicaid, +114202,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,MEDICAID-Traditional Medicaid, +114203,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,MEDICAID-Traditional Medicaid, +114204,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,MEDICAID-Traditional Medicaid, +114205,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,MEDICAID-Traditional Medicaid, +114206,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,MEDICAID-Traditional Medicaid, +114207,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,MEDICAID-Traditional Medicaid, +114208,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,MEDICAID-Traditional Medicaid, +114209,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,MEDICAID-Traditional Medicaid, +114210,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,MEDICAID-Traditional Medicaid, +114211,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,MEDICAID-Traditional Medicaid, +114212,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,MEDICAID-Traditional Medicaid, +114213,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,MEDICAID-Traditional Medicaid, +114214,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,MEDICAID-Traditional Medicaid, +114215,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,MEDICAID-Traditional Medicaid, +114216,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,MEDICAID-Traditional Medicaid, +114217,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,MEDICAID-Traditional Medicaid, +114218,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,MEDICAID-Traditional Medicaid, +114219,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,MEDICAID-Traditional Medicaid, +114220,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,MEDICAID-Traditional Medicaid, +114221,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,MEDICAID-Traditional Medicaid, +114222,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,MEDICAID-Traditional Medicaid, +114223,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,MEDICAID-Traditional Medicaid, +114224,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,MEDICAID-Traditional Medicaid, +114225,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,MEDICAID-Traditional Medicaid, +114226,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,MEDICAID-Traditional Medicaid, +114227,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,MEDICAID-Traditional Medicaid, +114228,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,MEDICAID-Traditional Medicaid, +114229,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,MEDICAID-Traditional Medicaid, +114230,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,MEDICAID-Traditional Medicaid, +114231,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,MEDICAID-Traditional Medicaid, +114232,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,MEDICAID-Traditional Medicaid, +114233,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,MEDICAID-Traditional Medicaid, +114234,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,MEDICAID-Traditional Medicaid, +114235,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,MEDICAID-Traditional Medicaid, +114236,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,MEDICAID-Traditional Medicaid, +114237,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,MEDICAID-Traditional Medicaid, +114238,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,MEDICAID-Traditional Medicaid, +114239,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,MEDICAID-Traditional Medicaid, +114240,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,MEDICAID-Traditional Medicaid, +114241,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,MEDICAID-Traditional Medicaid, +114242,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,MEDICAID-Traditional Medicaid, +114243,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,MEDICAID-Traditional Medicaid, +114244,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,MEDICAID-Traditional Medicaid, +114245,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,MEDICAID-Traditional Medicaid, +114246,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,MEDICAID-Traditional Medicaid, +114247,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,MEDICAID-Traditional Medicaid, +114248,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,MEDICAID-Traditional Medicaid, +114249,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,MEDICAID-Traditional Medicaid, +114250,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,MEDICAID-Traditional Medicaid, +114251,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,MEDICAID-Traditional Medicaid, +114252,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,MEDICAID-Traditional Medicaid, +114253,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,MEDICAID-Traditional Medicaid, +114254,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,MEDICAID-Traditional Medicaid, +114255,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,MEDICAID-Traditional Medicaid, +114256,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,MEDICAID-Traditional Medicaid, +114257,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,MEDICAID-Traditional Medicaid, +114258,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,MEDICAID-Traditional Medicaid, +114259,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,MEDICAID-Traditional Medicaid, +114260,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,MEDICAID-Traditional Medicaid, +114261,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,MEDICAID-Traditional Medicaid, +114262,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,MEDICAID-Traditional Medicaid, +114263,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,MEDICAID-Traditional Medicaid, +114264,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,MEDICAID-Traditional Medicaid, +114265,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,MEDICAID-Traditional Medicaid, +114266,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,MEDICAID-Traditional Medicaid, +114267,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,MEDICAID-Traditional Medicaid, +114268,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,MEDICAID-Traditional Medicaid, +114269,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,MEDICAID-Traditional Medicaid, +114270,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,MEDICAID-Traditional Medicaid, +114271,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,MEDICAID-Traditional Medicaid, +114272,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114273,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114274,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114275,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114276,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114277,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,MEDICAID-Traditional Medicaid, +114278,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,MEDICAID-Traditional Medicaid, +114279,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,MEDICAID-Traditional Medicaid, +114280,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114281,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114282,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114283,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,MEDICAID-Traditional Medicaid, +114284,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,MEDICAID-Traditional Medicaid, +114285,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,MEDICAID-Traditional Medicaid, +114286,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,MEDICAID-Traditional Medicaid, +114287,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,MEDICAID-Traditional Medicaid, +114288,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,MEDICAID-Traditional Medicaid, +114289,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,MEDICAID-Traditional Medicaid, +114290,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,MEDICAID-Traditional Medicaid, +114291,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,MEDICAID-Traditional Medicaid, +114292,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,MEDICAID-Traditional Medicaid, +114293,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,MEDICAID-Traditional Medicaid, +114294,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,MEDICAID-Traditional Medicaid, +114295,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,MEDICAID-Traditional Medicaid, +114296,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,MEDICAID-Traditional Medicaid, +114297,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,MEDICAID-Traditional Medicaid, +114298,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,MEDICAID-Traditional Medicaid, +114299,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,MEDICAID-Traditional Medicaid, +114300,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,MEDICAID-Traditional Medicaid, +114301,3934,43301043,ALBUNEX,,357.0,357.0,,,MEDICAID-Traditional Medicaid, +114302,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,MEDICAID-Traditional Medicaid, +114303,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114304,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114305,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114306,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114307,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114308,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,MEDICAID-Traditional Medicaid, +114309,3934,43450022,REC RM .5HR,,541.0,541.0,,,MEDICAID-Traditional Medicaid, +114310,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,MEDICAID-Traditional Medicaid, +114311,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,MEDICAID-Traditional Medicaid, +114312,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,MEDICAID-Traditional Medicaid, +114313,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,MEDICAID-Traditional Medicaid, +114314,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,MEDICAID-Traditional Medicaid, +114315,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,MEDICAID-Traditional Medicaid, +114316,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,MEDICAID-Traditional Medicaid, +114317,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,MEDICAID-Traditional Medicaid, +114318,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,MEDICAID-Traditional Medicaid, +114319,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,MEDICAID-Traditional Medicaid, +114320,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,MEDICAID-Traditional Medicaid, +114321,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,MEDICAID-Traditional Medicaid, +114322,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,MEDICAID-Traditional Medicaid, +114323,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,MEDICAID-Traditional Medicaid, +114324,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,MEDICAID-Traditional Medicaid, +114325,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,MEDICAID-Traditional Medicaid, +114326,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,MEDICAID-Traditional Medicaid, +114327,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114328,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114329,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114330,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114331,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114332,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,MEDICAID-Traditional Medicaid, +114333,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114334,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,MEDICAID-Traditional Medicaid, +114335,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114336,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114337,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114338,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114339,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,MEDICAID-Traditional Medicaid, +114340,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,MEDICAID-Traditional Medicaid, +114341,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114342,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114343,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114344,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114345,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114346,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,MEDICAID-Traditional Medicaid, +114347,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114348,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114349,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114350,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114351,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114352,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,MEDICAID-Traditional Medicaid, +114353,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,MEDICAID-Traditional Medicaid, +114354,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,MEDICAID-Traditional Medicaid, +114355,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,MEDICAID-Traditional Medicaid, +114356,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,MEDICAID-Traditional Medicaid, +114357,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,MEDICAID-Traditional Medicaid, +114358,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,MEDICAID-Traditional Medicaid, +114359,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,MEDICAID-Traditional Medicaid, +114360,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,MEDICAID-Traditional Medicaid, +114361,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114362,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114363,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114364,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114365,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114366,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114367,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,MEDICAID-Traditional Medicaid, +114368,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,MEDICAID-Traditional Medicaid, +114369,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,MEDICAID-Traditional Medicaid, +114370,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,MEDICAID-Traditional Medicaid, +114371,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,MEDICAID-Traditional Medicaid, +114372,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,MEDICAID-Traditional Medicaid, +114373,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,MEDICAID-Traditional Medicaid, +114374,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,MEDICAID-Traditional Medicaid, +114375,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,MEDICAID-Traditional Medicaid, +114376,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,MEDICAID-Traditional Medicaid, +114377,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,MEDICAID-Traditional Medicaid, +114378,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,MEDICAID-Traditional Medicaid, +114379,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,MEDICAID-Traditional Medicaid, +114380,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,MEDICAID-Traditional Medicaid, +114381,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,MEDICAID-Traditional Medicaid, +114382,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,MEDICAID-Traditional Medicaid, +114383,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,MEDICAID-Traditional Medicaid, +114384,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,MEDICAID-Traditional Medicaid, +114385,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,MEDICAID-Traditional Medicaid, +114386,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,MEDICAID-Traditional Medicaid, +114387,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,MEDICAID-Traditional Medicaid, +114388,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,MEDICAID-Traditional Medicaid, +114389,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,MEDICAID-Traditional Medicaid, +114390,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,MEDICAID-Traditional Medicaid, +114391,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,MEDICAID-Traditional Medicaid, +114392,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,MEDICAID-Traditional Medicaid, +114393,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,MEDICAID-Traditional Medicaid, +114394,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,MEDICAID-Traditional Medicaid, +114395,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,MEDICAID-Traditional Medicaid, +114396,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,MEDICAID-Traditional Medicaid, +114397,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,MEDICAID-Traditional Medicaid, +114398,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,MEDICAID-Traditional Medicaid, +114399,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,MEDICAID-Traditional Medicaid, +114400,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,MEDICAID-Traditional Medicaid, +114401,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,MEDICAID-Traditional Medicaid, +114402,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,MEDICAID-Traditional Medicaid, +114403,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,MEDICAID-Traditional Medicaid, +114404,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,MEDICAID-Traditional Medicaid, +114405,3934,45924552,ENDO REC RM,,30.0,30.0,,,MEDICAID-Traditional Medicaid, +114406,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,MEDICAID-Traditional Medicaid, +114407,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,MEDICAID-Traditional Medicaid, +114408,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,MEDICAID-Traditional Medicaid, +114409,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,MEDICAID-Traditional Medicaid, +114410,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,MEDICAID-Traditional Medicaid, +114411,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,MEDICAID-Traditional Medicaid, +114412,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,MEDICAID-Traditional Medicaid, +114413,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,MEDICAID-Traditional Medicaid, +114414,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,MEDICAID-Traditional Medicaid, +114415,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,MEDICAID-Traditional Medicaid, +114416,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,MEDICAID-Traditional Medicaid, +114417,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,MEDICAID-Traditional Medicaid, +114418,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,MEDICAID-Traditional Medicaid, +114419,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,MEDICAID-Traditional Medicaid, +114420,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,MEDICAID-Traditional Medicaid, +114421,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,MEDICAID-Traditional Medicaid, +114422,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,MEDICAID-Traditional Medicaid, +114423,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,MEDICAID-Traditional Medicaid, +114424,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,MEDICAID-Traditional Medicaid, +114425,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,MEDICAID-Traditional Medicaid, +114426,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,MEDICAID-Traditional Medicaid, +114427,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,MEDICAID-Traditional Medicaid, +114428,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,MEDICAID-Traditional Medicaid, +114429,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,MEDICAID-Traditional Medicaid, +114430,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,MEDICAID-Traditional Medicaid, +114431,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,MEDICAID-Traditional Medicaid, +114432,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,MEDICAID-Traditional Medicaid, +114433,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,MEDICAID-Traditional Medicaid, +114434,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICAID-Traditional Medicaid, +114435,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,MEDICAID-Traditional Medicaid, +114436,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICAID-Traditional Medicaid, +114437,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,MEDICAID-Traditional Medicaid, +114438,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,MEDICAID-Traditional Medicaid, +114439,3934,53200010,GUEST TRAY,,24.0,24.0,,,MEDICAID-Traditional Medicaid, +114440,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,MEDICAID-Traditional Medicaid, +114441,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,MEDICAID-Traditional Medicaid, +114442,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,MEDICAID-Traditional Medicaid, +114443,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,MEDICAID-Traditional Medicaid, +114444,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,MEDICAID-Traditional Medicaid, +114445,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,MEDICAID-Traditional Medicaid, +114446,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,MEDICAID-Traditional Medicaid, +114447,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,MEDICAID-Traditional Medicaid, +114448,3934,53329876,HIV MONITORING,,416.0,416.0,,,MEDICAID-Traditional Medicaid, +114449,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,MEDICAID-Traditional Medicaid, +114450,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,MEDICAID-Traditional Medicaid, +114451,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,MEDICAID-Traditional Medicaid, +114452,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,MEDICAID-Traditional Medicaid, +114453,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,MEDICAID-Traditional Medicaid, +114454,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,MEDICAID-Traditional Medicaid, +114455,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,MEDICAID-Traditional Medicaid, +114456,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,MEDICAID-Traditional Medicaid, +114457,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,MEDICAID-Traditional Medicaid, +114458,3934,76010107,COPY X-RAY,,22.0,22.0,,,MEDICAID-Traditional Medicaid, +114459,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,MEDICAID-Traditional Medicaid, +114460,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,MEDICAID-Traditional Medicaid, +114461,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,MEDICAID-Traditional Medicaid, +114462,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,MEDICAID-Traditional Medicaid, +114463,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,MEDICAID-Traditional Medicaid, +114464,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,MEDICAID-Traditional Medicaid, +114465,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,MEDICAID-Traditional Medicaid, +114466,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,MEDICAID-Traditional Medicaid, +114467,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,MEDICAID-Traditional Medicaid, +114468,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,MEDICAID-Traditional Medicaid, +114469,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,MEDICAID-Traditional Medicaid, +114470,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,MEDICAID-Traditional Medicaid, +114471,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,MEDICARE-Traditional Medicare,153951.55 +114472,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,MEDICARE-Traditional Medicare,35545.95 +114473,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,MEDICARE-Traditional Medicare,231886.3 +114474,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,MEDICARE-Traditional Medicare,219628.58 +114475,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,MEDICARE-Traditional Medicare,48368.68 +114476,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,MEDICARE-Traditional Medicare,40978.18 +114477,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,MEDICARE-Traditional Medicare,145653.28 +114478,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,MEDICARE-Traditional Medicare,88093.07 +114479,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,MEDICARE-Traditional Medicare, +114480,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,MEDICARE-Traditional Medicare,60721.01 +114481,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,MEDICARE-Traditional Medicare,67215.68 +114482,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,MEDICARE-Traditional Medicare,51871.48 +114483,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,MEDICARE-Traditional Medicare,54185.99 +114484,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,MEDICARE-Traditional Medicare,31192.95 +114485,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,MEDICARE-Traditional Medicare,40868.68 +114486,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,MEDICARE-Traditional Medicare,28967.65 +114487,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,MEDICARE-Traditional Medicare,21876.23 +114488,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,MEDICARE-Traditional Medicare,59265.81 +114489,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,MEDICARE-Traditional Medicare,31323.08 +114490,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,MEDICARE-Traditional Medicare,24463.24 +114491,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,MEDICARE-Traditional Medicare,37359.61 +114492,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,MEDICARE-Traditional Medicare,22563.31 +114493,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,MEDICARE-Traditional Medicare,16914.25 +114494,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,MEDICARE-Traditional Medicare,25294.05 +114495,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,MEDICARE-Traditional Medicare,20536.1 +114496,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,MEDICARE-Traditional Medicare,15707.13 +114497,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,MEDICARE-Traditional Medicare,28621.4 +114498,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,MEDICARE-Traditional Medicare,17920.16 +114499,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,MEDICARE-Traditional Medicare,11015.14 +114500,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,MEDICARE-Traditional Medicare,37512.72 +114501,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,MEDICARE-Traditional Medicare,23926.45 +114502,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,MEDICARE-Traditional Medicare,16615.11 +114503,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,MEDICARE-Traditional Medicare,31174.36 +114504,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,MEDICARE-Traditional Medicare,13749.18 +114505,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,MEDICARE-Traditional Medicare,12344.22 +114506,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,MEDICARE-Traditional Medicare,11015.71 +114507,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,MEDICARE-Traditional Medicare,22661.44 +114508,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,MEDICARE-Traditional Medicare,12627.69 +114509,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,MEDICARE-Traditional Medicare,21973.73 +114510,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,MEDICARE-Traditional Medicare,12734.5 +114511,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,MEDICARE-Traditional Medicare,11714.91 +114512,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,MEDICARE-Traditional Medicare,26448.25 +114513,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,MEDICARE-Traditional Medicare,21069.94 +114514,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,MEDICARE-Traditional Medicare,10895.35 +114515,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,MEDICARE-Traditional Medicare,19233.58 +114516,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,MEDICARE-Traditional Medicare,9703.68 +114517,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,MEDICARE-Traditional Medicare,5841.06 +114518,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,MEDICARE-Traditional Medicare,6241.78 +114519,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,MEDICARE-Traditional Medicare,8731.33 +114520,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,MEDICARE-Traditional Medicare,15134.78 +114521,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,MEDICARE-Traditional Medicare,15941.23 +114522,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,MEDICARE-Traditional Medicare,9384.24 +114523,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,MEDICARE-Traditional Medicare,15038.23 +114524,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,MEDICARE-Traditional Medicare,9518.55 +114525,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,MEDICARE-Traditional Medicare,184124.98 +114526,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,MEDICARE-Traditional Medicare,14984.4 +114527,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,MEDICARE-Traditional Medicare,20740.02 +114528,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,MEDICARE-Traditional Medicare,25188.16 +114529,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,MEDICARE-Traditional Medicare,16905.72 +114530,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,MEDICARE-Traditional Medicare,7829.49 +114531,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,MEDICARE-Traditional Medicare,22671.01 +114532,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,MEDICARE-Traditional Medicare,12677.47 +114533,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,MEDICARE-Traditional Medicare,8358.04 +114534,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,MEDICARE-Traditional Medicare,2367.79 +114535,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,MEDICARE-Traditional Medicare,15597.38 +114536,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,MEDICARE-Traditional Medicare,9500.12 +114537,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,MEDICARE-Traditional Medicare,7812.03 +114538,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,MEDICARE-Traditional Medicare,45686.43 +114539,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,MEDICARE-Traditional Medicare,23981.06 +114540,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,MEDICARE-Traditional Medicare,25563.4 +114541,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,MEDICARE-Traditional Medicare,99067.88 +114542,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,MEDICARE-Traditional Medicare,24673.94 +114543,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,MEDICARE-Traditional Medicare, +114544,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,MEDICARE-Traditional Medicare,28910.03 +114545,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,MEDICARE-Traditional Medicare,9366.05 +114546,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,MEDICARE-Traditional Medicare,13565.04 +114547,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,MEDICARE-Traditional Medicare,9523.15 +114548,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,MEDICARE-Traditional Medicare,13736.49 +114549,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,MEDICARE-Traditional Medicare,16632.29 +114550,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,MEDICARE-Traditional Medicare,15913.82 +114551,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,MEDICARE-Traditional Medicare,13043.5 +114552,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,MEDICARE-Traditional Medicare,14048.59 +114553,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,MEDICARE-Traditional Medicare,7512.43 +114554,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,MEDICARE-Traditional Medicare,16358.13 +114555,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,MEDICARE-Traditional Medicare,6700.59 +114556,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,MEDICARE-Traditional Medicare,24416.59 +114557,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,MEDICARE-Traditional Medicare, +114558,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,MEDICARE-Traditional Medicare,28820.11 +114559,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,MEDICARE-Traditional Medicare,13816.55 +114560,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,MEDICARE-Traditional Medicare,14145.94 +114561,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,MEDICARE-Traditional Medicare,13347.74 +114562,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,MEDICARE-Traditional Medicare,86495.64 +114563,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,MEDICARE-Traditional Medicare,25676.08 +114564,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,MEDICARE-Traditional Medicare,10425.03 +114565,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,MEDICARE-Traditional Medicare,6782.56 +114566,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,MEDICARE-Traditional Medicare,42334.45 +114567,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,MEDICARE-Traditional Medicare,24302.34 +114568,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,MEDICARE-Traditional Medicare,18213.67 +114569,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,MEDICARE-Traditional Medicare,19654.74 +114570,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,MEDICARE-Traditional Medicare,8449.0 +114571,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,MEDICARE-Traditional Medicare,14779.61 +114572,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,MEDICARE-Traditional Medicare,3148.12 +114573,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,MEDICARE-Traditional Medicare,9331.07 +114574,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,MEDICARE-Traditional Medicare,9140.09 +114575,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,MEDICARE-Traditional Medicare,7915.76 +114576,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,MEDICARE-Traditional Medicare,11569.71 +114577,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,MEDICARE-Traditional Medicare,5019.27 +114578,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,MEDICARE-Traditional Medicare,21805.1 +114579,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,MEDICARE-Traditional Medicare,8461.31 +114580,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,MEDICARE-Traditional Medicare,1467.27 +114581,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,MEDICARE-Traditional Medicare,17045.99 +114582,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,MEDICARE-Traditional Medicare,10325.35 +114583,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,MEDICARE-Traditional Medicare,8132.37 +114584,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,MEDICARE-Traditional Medicare,52092.4 +114585,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,MEDICARE-Traditional Medicare,20236.94 +114586,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,MEDICARE-Traditional Medicare,17343.03 +114587,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,MEDICARE-Traditional Medicare,29801.87 +114588,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,MEDICARE-Traditional Medicare,14316.25 +114589,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,MEDICARE-Traditional Medicare,15139.28 +114590,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,MEDICARE-Traditional Medicare,14888.67 +114591,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,MEDICARE-Traditional Medicare,8164.38 +114592,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,MEDICARE-Traditional Medicare,21598.64 +114593,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,MEDICARE-Traditional Medicare,12841.91 +114594,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,MEDICARE-Traditional Medicare,10155.67 +114595,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,MEDICARE-Traditional Medicare,17619.09 +114596,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,MEDICARE-Traditional Medicare,10262.01 +114597,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,MEDICARE-Traditional Medicare,17924.19 +114598,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,MEDICARE-Traditional Medicare,10851.56 +114599,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,MEDICARE-Traditional Medicare,8778.39 +114600,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,MEDICARE-Traditional Medicare,9671.61 +114601,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,MEDICARE-Traditional Medicare,10105.84 +114602,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,MEDICARE-Traditional Medicare,11895.28 +114603,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,MEDICARE-Traditional Medicare,9568.74 +114604,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,MEDICARE-Traditional Medicare,7362.63 +114605,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,MEDICARE-Traditional Medicare,8263.65 +114606,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,MEDICARE-Traditional Medicare,12119.31 +114607,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,MEDICARE-Traditional Medicare,10381.72 +114608,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,MEDICARE-Traditional Medicare,7455.08 +114609,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,MEDICARE-Traditional Medicare,17709.85 +114610,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,MEDICARE-Traditional Medicare,11733.03 +114611,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,MEDICARE-Traditional Medicare,147978.82 +114612,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,MEDICARE-Traditional Medicare,12671.87 +114613,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,MEDICARE-Traditional Medicare,1784.64 +114614,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,MEDICARE-Traditional Medicare,9648.4 +114615,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,MEDICARE-Traditional Medicare,8569.35 +114616,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,MEDICARE-Traditional Medicare,8891.42 +114617,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,MEDICARE-Traditional Medicare,17375.29 +114618,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,MEDICARE-Traditional Medicare,9073.91 +114619,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,MEDICARE-Traditional Medicare,70089.03 +114620,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,MEDICARE-Traditional Medicare,27505.77 +114621,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,MEDICARE-Traditional Medicare,95724.43 +114622,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,MEDICARE-Traditional Medicare,65882.26 +114623,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,MEDICARE-Traditional Medicare,16254.38 +114624,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,MEDICARE-Traditional Medicare,80633.97 +114625,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,MEDICARE-Traditional Medicare,46380.01 +114626,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,MEDICARE-Traditional Medicare,33702.81 +114627,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,MEDICARE-Traditional Medicare,53970.9 +114628,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,MEDICARE-Traditional Medicare,13860.71 +114629,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,MEDICARE-Traditional Medicare,48101.01 +114630,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,MEDICARE-Traditional Medicare,56247.45 +114631,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,MEDICARE-Traditional Medicare,79614.81 +114632,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,MEDICARE-Traditional Medicare,54005.71 +114633,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,MEDICARE-Traditional Medicare,64382.31 +114634,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,MEDICARE-Traditional Medicare,37615.46 +114635,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,MEDICARE-Traditional Medicare,134996.33 +114636,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,MEDICARE-Traditional Medicare, +114637,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,MEDICARE-Traditional Medicare,81748.85 +114638,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,MEDICARE-Traditional Medicare,46698.63 +114639,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,MEDICARE-Traditional Medicare,56272.06 +114640,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,MEDICARE-Traditional Medicare,37917.24 +114641,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,MEDICARE-Traditional Medicare,38671.73 +114642,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,MEDICARE-Traditional Medicare,18324.4 +114643,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,MEDICARE-Traditional Medicare,39333.78 +114644,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,MEDICARE-Traditional Medicare,24832.26 +114645,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,MEDICARE-Traditional Medicare,18361.8 +114646,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,MEDICARE-Traditional Medicare,58775.48 +114647,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,MEDICARE-Traditional Medicare,29367.38 +114648,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,MEDICARE-Traditional Medicare,19281.87 +114649,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,MEDICARE-Traditional Medicare,22099.0 +114650,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,MEDICARE-Traditional Medicare,19332.55 +114651,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,MEDICARE-Traditional Medicare,16370.94 +114652,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,MEDICARE-Traditional Medicare,32533.04 +114653,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,MEDICARE-Traditional Medicare,22610.08 +114654,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,MEDICARE-Traditional Medicare,17845.59 +114655,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,MEDICARE-Traditional Medicare, +114656,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,MEDICARE-Traditional Medicare,11471.19 +114657,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,MEDICARE-Traditional Medicare,2772.11 +114658,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,MEDICARE-Traditional Medicare,32681.38 +114659,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,MEDICARE-Traditional Medicare,14251.86 +114660,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,MEDICARE-Traditional Medicare,33989.28 +114661,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,MEDICARE-Traditional Medicare,18486.83 +114662,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,MEDICARE-Traditional Medicare,16162.25 +114663,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,MEDICARE-Traditional Medicare,5143.69 +114664,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,MEDICARE-Traditional Medicare,40224.83 +114665,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,MEDICARE-Traditional Medicare,32669.03 +114666,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,MEDICARE-Traditional Medicare,62974.95 +114667,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,MEDICARE-Traditional Medicare,52401.46 +114668,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,MEDICARE-Traditional Medicare,73111.06 +114669,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,MEDICARE-Traditional Medicare,36643.97 +114670,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,MEDICARE-Traditional Medicare,50392.71 +114671,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,MEDICARE-Traditional Medicare,37098.04 +114672,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,MEDICARE-Traditional Medicare,29175.94 +114673,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,MEDICARE-Traditional Medicare,38100.39 +114674,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,MEDICARE-Traditional Medicare,30065.5 +114675,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,MEDICARE-Traditional Medicare,14795.67 +114676,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,MEDICARE-Traditional Medicare,8708.43 +114677,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,MEDICARE-Traditional Medicare,7459.75 +114678,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,MEDICARE-Traditional Medicare,32281.3 +114679,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,MEDICARE-Traditional Medicare,1776.46 +114680,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,MEDICARE-Traditional Medicare,22343.31 +114681,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,MEDICARE-Traditional Medicare,12063.97 +114682,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,MEDICARE-Traditional Medicare,21921.05 +114683,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,MEDICARE-Traditional Medicare,11270.95 +114684,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,MEDICARE-Traditional Medicare,12746.84 +114685,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,MEDICARE-Traditional Medicare,8477.72 +114686,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,MEDICARE-Traditional Medicare,7368.74 +114687,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,MEDICARE-Traditional Medicare,40696.12 +114688,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,MEDICARE-Traditional Medicare,16759.53 +114689,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,MEDICARE-Traditional Medicare,9238.86 +114690,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,MEDICARE-Traditional Medicare,8650.26 +114691,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,MEDICARE-Traditional Medicare,12824.81 +114692,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,MEDICARE-Traditional Medicare,7380.84 +114693,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,MEDICARE-Traditional Medicare,11011.22 +114694,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,MEDICARE-Traditional Medicare,8225.93 +114695,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,MEDICARE-Traditional Medicare,14782.88 +114696,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,MEDICARE-Traditional Medicare,6265.78 +114697,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,MEDICARE-Traditional Medicare,11358.45 +114698,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,MEDICARE-Traditional Medicare,7773.87 +114699,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,MEDICARE-Traditional Medicare,6232.97 +114700,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,MEDICARE-Traditional Medicare,8475.55 +114701,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,MEDICARE-Traditional Medicare,8887.69 +114702,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,MEDICARE-Traditional Medicare,7560.68 +114703,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,MEDICARE-Traditional Medicare,20345.67 +114704,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,MEDICARE-Traditional Medicare,9757.56 +114705,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,MEDICARE-Traditional Medicare,8874.87 +114706,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,MEDICARE-Traditional Medicare,35712.13 +114707,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,MEDICARE-Traditional Medicare,26704.46 +114708,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,MEDICARE-Traditional Medicare,40690.85 +114709,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,MEDICARE-Traditional Medicare,14337.08 +114710,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,MEDICARE-Traditional Medicare,16657.48 +114711,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,MEDICARE-Traditional Medicare,48505.71 +114712,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,MEDICARE-Traditional Medicare,24049.86 +114713,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,MEDICARE-Traditional Medicare,14815.26 +114714,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,MEDICARE-Traditional Medicare, +114715,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,MEDICARE-Traditional Medicare, +114716,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,MEDICARE-Traditional Medicare,36039.82 +114717,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,MEDICARE-Traditional Medicare,22857.62 +114718,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,MEDICARE-Traditional Medicare,16435.82 +114719,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,MEDICARE-Traditional Medicare, +114720,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,MEDICARE-Traditional Medicare,19163.66 +114721,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,MEDICARE-Traditional Medicare,9999.76 +114722,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,MEDICARE-Traditional Medicare,6251.18 +114723,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,MEDICARE-Traditional Medicare,16634.19 +114724,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,MEDICARE-Traditional Medicare,13274.93 +114725,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,MEDICARE-Traditional Medicare,33038.66 +114726,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,MEDICARE-Traditional Medicare,24527.09 +114727,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,MEDICARE-Traditional Medicare,27576.81 +114728,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,MEDICARE-Traditional Medicare,15440.43 +114729,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,MEDICARE-Traditional Medicare,10779.86 +114730,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,MEDICARE-Traditional Medicare,15952.6 +114731,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,MEDICARE-Traditional Medicare,12799.33 +114732,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,MEDICARE-Traditional Medicare,27379.19 +114733,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,MEDICARE-Traditional Medicare,16945.9 +114734,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,MEDICARE-Traditional Medicare,15511.28 +114735,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,MEDICARE-Traditional Medicare,35257.28 +114736,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,MEDICARE-Traditional Medicare,20800.59 +114737,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,MEDICARE-Traditional Medicare,15047.39 +114738,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,MEDICARE-Traditional Medicare,23511.52 +114739,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,MEDICARE-Traditional Medicare,18868.27 +114740,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,MEDICARE-Traditional Medicare,10224.11 +114741,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,MEDICARE-Traditional Medicare,8113.41 +114742,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,MEDICARE-Traditional Medicare,18291.91 +114743,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,MEDICARE-Traditional Medicare,12862.01 +114744,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,MEDICARE-Traditional Medicare,11255.73 +114745,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,MEDICARE-Traditional Medicare,21042.75 +114746,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,MEDICARE-Traditional Medicare,9730.83 +114747,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,MEDICARE-Traditional Medicare,6661.92 +114748,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,MEDICARE-Traditional Medicare,15181.85 +114749,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,MEDICARE-Traditional Medicare,10436.68 +114750,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,MEDICARE-Traditional Medicare, +114751,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,MEDICARE-Traditional Medicare,10286.45 +114752,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,MEDICARE-Traditional Medicare,16038.08 +114753,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,MEDICARE-Traditional Medicare,10037.59 +114754,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,MEDICARE-Traditional Medicare,7970.3 +114755,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,MEDICARE-Traditional Medicare,18631.22 +114756,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,MEDICARE-Traditional Medicare,8559.2 +114757,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,MEDICARE-Traditional Medicare,5848.76 +114758,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,MEDICARE-Traditional Medicare,12333.34 +114759,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,MEDICARE-Traditional Medicare,8186.5 +114760,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,MEDICARE-Traditional Medicare,20589.51 +114761,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,MEDICARE-Traditional Medicare,10351.05 +114762,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,MEDICARE-Traditional Medicare,7410.81 +114763,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,MEDICARE-Traditional Medicare,69860.07 +114764,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,MEDICARE-Traditional Medicare,31896.32 +114765,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,MEDICARE-Traditional Medicare,14196.09 +114766,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,MEDICARE-Traditional Medicare,39984.22 +114767,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,MEDICARE-Traditional Medicare,24542.9 +114768,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,MEDICARE-Traditional Medicare,3493.46 +114769,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,MEDICARE-Traditional Medicare, +114770,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,MEDICARE-Traditional Medicare,5013.7 +114771,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,MEDICARE-Traditional Medicare,18626.43 +114772,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,MEDICARE-Traditional Medicare,14741.26 +114773,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,MEDICARE-Traditional Medicare,13728.03 +114774,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,MEDICARE-Traditional Medicare,33228.03 +114775,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,MEDICARE-Traditional Medicare,19955.0 +114776,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,MEDICARE-Traditional Medicare, +114777,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,MEDICARE-Traditional Medicare,31313.91 +114778,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,MEDICARE-Traditional Medicare,14490.29 +114779,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,MEDICARE-Traditional Medicare,11060.4 +114780,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,MEDICARE-Traditional Medicare,19463.67 +114781,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,MEDICARE-Traditional Medicare,13397.04 +114782,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,MEDICARE-Traditional Medicare,30208.95 +114783,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,MEDICARE-Traditional Medicare,7495.83 +114784,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,MEDICARE-Traditional Medicare,6669.07 +114785,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,MEDICARE-Traditional Medicare,15787.09 +114786,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,MEDICARE-Traditional Medicare,9172.89 +114787,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,MEDICARE-Traditional Medicare,8593.02 +114788,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,MEDICARE-Traditional Medicare,15931.64 +114789,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,MEDICARE-Traditional Medicare,11628.39 +114790,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,MEDICARE-Traditional Medicare,9660.04 +114791,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,MEDICARE-Traditional Medicare,55864.49 +114792,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,MEDICARE-Traditional Medicare,50934.51 +114793,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,MEDICARE-Traditional Medicare,98035.16 +114794,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,MEDICARE-Traditional Medicare,77098.21 +114795,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,MEDICARE-Traditional Medicare,52878.51 +114796,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,MEDICARE-Traditional Medicare,79676.54 +114797,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,MEDICARE-Traditional Medicare,37010.76 +114798,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,MEDICARE-Traditional Medicare, +114799,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,MEDICARE-Traditional Medicare,26826.95 +114800,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,MEDICARE-Traditional Medicare,37227.98 +114801,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,MEDICARE-Traditional Medicare,20543.65 +114802,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,MEDICARE-Traditional Medicare,54338.68 +114803,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,MEDICARE-Traditional Medicare,33940.59 +114804,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,MEDICARE-Traditional Medicare,28518.59 +114805,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,MEDICARE-Traditional Medicare,24305.81 +114806,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,MEDICARE-Traditional Medicare,18985.73 +114807,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,MEDICARE-Traditional Medicare,28248.24 +114808,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,MEDICARE-Traditional Medicare,24973.28 +114809,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,MEDICARE-Traditional Medicare,14173.22 +114810,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,MEDICARE-Traditional Medicare,23670.54 +114811,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,MEDICARE-Traditional Medicare,34898.61 +114812,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,MEDICARE-Traditional Medicare,14820.66 +114813,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,MEDICARE-Traditional Medicare,19795.51 +114814,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,MEDICARE-Traditional Medicare,33272.58 +114815,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,MEDICARE-Traditional Medicare,18443.64 +114816,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,MEDICARE-Traditional Medicare,16119.41 +114817,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,MEDICARE-Traditional Medicare,22322.76 +114818,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,MEDICARE-Traditional Medicare,23445.22 +114819,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,MEDICARE-Traditional Medicare, +114820,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,MEDICARE-Traditional Medicare, +114821,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,MEDICARE-Traditional Medicare, +114822,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,MEDICARE-Traditional Medicare,42336.56 +114823,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,MEDICARE-Traditional Medicare,18958.42 +114824,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,MEDICARE-Traditional Medicare,19583.33 +114825,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,MEDICARE-Traditional Medicare,22038.27 +114826,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,MEDICARE-Traditional Medicare,16684.05 +114827,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,MEDICARE-Traditional Medicare,20138.53 +114828,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,MEDICARE-Traditional Medicare,31608.34 +114829,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,MEDICARE-Traditional Medicare,17302.24 +114830,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,MEDICARE-Traditional Medicare,14575.73 +114831,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,MEDICARE-Traditional Medicare,9226.13 +114832,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,MEDICARE-Traditional Medicare,11197.37 +114833,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,MEDICARE-Traditional Medicare, +114834,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,MEDICARE-Traditional Medicare,15403.96 +114835,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,MEDICARE-Traditional Medicare,14113.94 +114836,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,MEDICARE-Traditional Medicare,17578.6 +114837,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,MEDICARE-Traditional Medicare, +114838,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,MEDICARE-Traditional Medicare,29443.28 +114839,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,MEDICARE-Traditional Medicare,15205.2 +114840,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,MEDICARE-Traditional Medicare,12528.63 +114841,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,MEDICARE-Traditional Medicare,32866.39 +114842,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,MEDICARE-Traditional Medicare,17295.28 +114843,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,MEDICARE-Traditional Medicare,12796.65 +114844,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,MEDICARE-Traditional Medicare,26297.69 +114845,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,MEDICARE-Traditional Medicare,19495.21 +114846,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,MEDICARE-Traditional Medicare,9639.04 +114847,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,MEDICARE-Traditional Medicare,10703.59 +114848,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,MEDICARE-Traditional Medicare,7441.39 +114849,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,MEDICARE-Traditional Medicare,12442.01 +114850,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,MEDICARE-Traditional Medicare,12704.9 +114851,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,MEDICARE-Traditional Medicare,17991.93 +114852,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,MEDICARE-Traditional Medicare,11621.5 +114853,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,MEDICARE-Traditional Medicare,4648.4 +114854,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,MEDICARE-Traditional Medicare,24051.43 +114855,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,MEDICARE-Traditional Medicare,11355.43 +114856,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,MEDICARE-Traditional Medicare,1979.62 +114857,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,MEDICARE-Traditional Medicare,12715.66 +114858,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,MEDICARE-Traditional Medicare,2915.56 +114859,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,MEDICARE-Traditional Medicare,20014.24 +114860,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,MEDICARE-Traditional Medicare,9332.27 +114861,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,MEDICARE-Traditional Medicare,14804.19 +114862,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,MEDICARE-Traditional Medicare,12612.3 +114863,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,MEDICARE-Traditional Medicare,15149.76 +114864,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,MEDICARE-Traditional Medicare,8693.1 +114865,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,MEDICARE-Traditional Medicare,13817.48 +114866,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,MEDICARE-Traditional Medicare,8624.42 +114867,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,MEDICARE-Traditional Medicare,10100.66 +114868,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,MEDICARE-Traditional Medicare,10133.94 +114869,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,MEDICARE-Traditional Medicare,14149.37 +114870,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,MEDICARE-Traditional Medicare,8881.61 +114871,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,MEDICARE-Traditional Medicare,14731.91 +114872,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,MEDICARE-Traditional Medicare,9353.67 +114873,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,MEDICARE-Traditional Medicare,32413.62 +114874,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,MEDICARE-Traditional Medicare,16680.77 +114875,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,MEDICARE-Traditional Medicare, +114876,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,MEDICARE-Traditional Medicare,18988.23 +114877,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,MEDICARE-Traditional Medicare,19449.91 +114878,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,MEDICARE-Traditional Medicare,28928.42 +114879,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,MEDICARE-Traditional Medicare,13302.21 +114880,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,MEDICARE-Traditional Medicare,11481.55 +114881,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,MEDICARE-Traditional Medicare,17211.15 +114882,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,MEDICARE-Traditional Medicare,15985.02 +114883,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,MEDICARE-Traditional Medicare, +114884,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,MEDICARE-Traditional Medicare, +114885,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,MEDICARE-Traditional Medicare,21308.04 +114886,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,MEDICARE-Traditional Medicare,5755.9 +114887,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,MEDICARE-Traditional Medicare,16370.16 +114888,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,MEDICARE-Traditional Medicare,7656.66 +114889,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,MEDICARE-Traditional Medicare, +114890,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,MEDICARE-Traditional Medicare,2221.65 +114891,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,MEDICARE-Traditional Medicare, +114892,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,MEDICARE-Traditional Medicare,13635.22 +114893,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,MEDICARE-Traditional Medicare,8462.07 +114894,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,MEDICARE-Traditional Medicare,16741.1 +114895,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,MEDICARE-Traditional Medicare,10158.16 +114896,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,MEDICARE-Traditional Medicare,29180.46 +114897,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,MEDICARE-Traditional Medicare,8520.88 +114898,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,MEDICARE-Traditional Medicare,19886.7 +114899,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,MEDICARE-Traditional Medicare,18544.37 +114900,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,MEDICARE-Traditional Medicare,31056.78 +114901,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,MEDICARE-Traditional Medicare,13567.54 +114902,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,MEDICARE-Traditional Medicare,34833.14 +114903,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,MEDICARE-Traditional Medicare,17371.25 +114904,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,MEDICARE-Traditional Medicare,14894.05 +114905,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,MEDICARE-Traditional Medicare,30630.6 +114906,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,MEDICARE-Traditional Medicare,17684.16 +114907,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,MEDICARE-Traditional Medicare,26295.79 +114908,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,MEDICARE-Traditional Medicare,16366.04 +114909,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,MEDICARE-Traditional Medicare,13383.26 +114910,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,MEDICARE-Traditional Medicare, +114911,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,MEDICARE-Traditional Medicare,23387.16 +114912,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,MEDICARE-Traditional Medicare,13234.76 +114913,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,MEDICARE-Traditional Medicare,8815.25 +114914,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,MEDICARE-Traditional Medicare,7617.92 +114915,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,MEDICARE-Traditional Medicare,16422.69 +114916,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,MEDICARE-Traditional Medicare,8389.26 +114917,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,MEDICARE-Traditional Medicare,14765.54 +114918,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,MEDICARE-Traditional Medicare,16516.85 +114919,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,MEDICARE-Traditional Medicare,10551.91 +114920,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,MEDICARE-Traditional Medicare,7726.93 +114921,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,MEDICARE-Traditional Medicare,57927.36 +114922,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,MEDICARE-Traditional Medicare,49546.89 +114923,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,MEDICARE-Traditional Medicare,36602.65 +114924,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,MEDICARE-Traditional Medicare,37973.95 +114925,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,MEDICARE-Traditional Medicare,29766.5 +114926,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,MEDICARE-Traditional Medicare,22932.35 +114927,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,MEDICARE-Traditional Medicare,31320.25 +114928,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,MEDICARE-Traditional Medicare,19054.56 +114929,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,MEDICARE-Traditional Medicare,14919.53 +114930,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,MEDICARE-Traditional Medicare,29688.34 +114931,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,MEDICARE-Traditional Medicare,15477.57 +114932,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,MEDICARE-Traditional Medicare,11619.22 +114933,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,MEDICARE-Traditional Medicare,32197.22 +114934,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,MEDICARE-Traditional Medicare,17635.15 +114935,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,MEDICARE-Traditional Medicare,13714.67 +114936,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,MEDICARE-Traditional Medicare,16182.37 +114937,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,MEDICARE-Traditional Medicare,6407.59 +114938,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,MEDICARE-Traditional Medicare,30022.6 +114939,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,MEDICARE-Traditional Medicare,15921.52 +114940,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,MEDICARE-Traditional Medicare,11276.97 +114941,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,MEDICARE-Traditional Medicare,37910.83 +114942,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,MEDICARE-Traditional Medicare,21715.77 +114943,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,MEDICARE-Traditional Medicare,14445.69 +114944,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,MEDICARE-Traditional Medicare,8805.07 +114945,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,MEDICARE-Traditional Medicare,7725.08 +114946,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,MEDICARE-Traditional Medicare, +114947,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,MEDICARE-Traditional Medicare,7361.4 +114948,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,MEDICARE-Traditional Medicare,11235.15 +114949,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,MEDICARE-Traditional Medicare,8219.64 +114950,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,MEDICARE-Traditional Medicare,9081.05 +114951,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,MEDICARE-Traditional Medicare,7427.72 +114952,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,MEDICARE-Traditional Medicare,13743.02 +114953,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,MEDICARE-Traditional Medicare,6706.5 +114954,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,MEDICARE-Traditional Medicare,19978.56 +114955,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,MEDICARE-Traditional Medicare,10610.23 +114956,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,MEDICARE-Traditional Medicare,9425.27 +114957,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,MEDICARE-Traditional Medicare,19060.68 +114958,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,MEDICARE-Traditional Medicare,15051.53 +114959,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,MEDICARE-Traditional Medicare,23111.79 +114960,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,MEDICARE-Traditional Medicare, +114961,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,MEDICARE-Traditional Medicare,15894.61 +114962,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,MEDICARE-Traditional Medicare, +114963,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,MEDICARE-Traditional Medicare,15281.73 +114964,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,MEDICARE-Traditional Medicare,15604.65 +114965,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,MEDICARE-Traditional Medicare,13584.41 +114966,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,MEDICARE-Traditional Medicare,13831.72 +114967,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,MEDICARE-Traditional Medicare,6816.9 +114968,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,MEDICARE-Traditional Medicare,12460.57 +114969,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,MEDICARE-Traditional Medicare,8500.67 +114970,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,MEDICARE-Traditional Medicare,24457.94 +114971,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,MEDICARE-Traditional Medicare,16224.14 +114972,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,MEDICARE-Traditional Medicare, +114973,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,MEDICARE-Traditional Medicare,22699.57 +114974,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,MEDICARE-Traditional Medicare,17315.23 +114975,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,MEDICARE-Traditional Medicare,19894.26 +114976,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,MEDICARE-Traditional Medicare,14864.75 +114977,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,MEDICARE-Traditional Medicare,16553.32 +114978,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,MEDICARE-Traditional Medicare,12586.37 +114979,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,MEDICARE-Traditional Medicare,4168.17 +114980,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,MEDICARE-Traditional Medicare, +114981,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,MEDICARE-Traditional Medicare,13743.38 +114982,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,MEDICARE-Traditional Medicare,15669.42 +114983,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,MEDICARE-Traditional Medicare,29184.76 +114984,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,MEDICARE-Traditional Medicare, +114985,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,MEDICARE-Traditional Medicare,22320.07 +114986,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,MEDICARE-Traditional Medicare,11295.02 +114987,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,MEDICARE-Traditional Medicare,10800.4 +114988,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,MEDICARE-Traditional Medicare,1581.29 +114989,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,MEDICARE-Traditional Medicare,6519.93 +114990,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,MEDICARE-Traditional Medicare, +114991,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,MEDICARE-Traditional Medicare, +114992,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,MEDICARE-Traditional Medicare, +114993,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,MEDICARE-Traditional Medicare, +114994,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,MEDICARE-Traditional Medicare, +114995,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,MEDICARE-Traditional Medicare, +114996,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,MEDICARE-Traditional Medicare, +114997,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,MEDICARE-Traditional Medicare,21135.31 +114998,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,MEDICARE-Traditional Medicare,11040.18 +114999,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,MEDICARE-Traditional Medicare, +115000,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,MEDICARE-Traditional Medicare, +115001,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,MEDICARE-Traditional Medicare, +115002,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,MEDICARE-Traditional Medicare, +115003,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,MEDICARE-Traditional Medicare, +115004,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,MEDICARE-Traditional Medicare, +115005,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,MEDICARE-Traditional Medicare, +115006,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,MEDICARE-Traditional Medicare, +115007,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,MEDICARE-Traditional Medicare,20944.17 +115008,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,MEDICARE-Traditional Medicare, +115009,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,MEDICARE-Traditional Medicare,10623.64 +115010,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,MEDICARE-Traditional Medicare, +115011,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,MEDICARE-Traditional Medicare, +115012,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,MEDICARE-Traditional Medicare,33459.61 +115013,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,MEDICARE-Traditional Medicare,12790.53 +115014,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,MEDICARE-Traditional Medicare, +115015,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,MEDICARE-Traditional Medicare, +115016,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,MEDICARE-Traditional Medicare,1637.51 +115017,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,MEDICARE-Traditional Medicare,8219.45 +115018,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,MEDICARE-Traditional Medicare,24577.3 +115019,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,MEDICARE-Traditional Medicare,12769.76 +115020,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,MEDICARE-Traditional Medicare, +115021,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,MEDICARE-Traditional Medicare,14258.3 +115022,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,MEDICARE-Traditional Medicare,9970.54 +115023,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,MEDICARE-Traditional Medicare,14714.41 +115024,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,MEDICARE-Traditional Medicare,16731.04 +115025,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,MEDICARE-Traditional Medicare,11685.32 +115026,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,MEDICARE-Traditional Medicare, +115027,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,MEDICARE-Traditional Medicare, +115028,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,MEDICARE-Traditional Medicare, +115029,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,MEDICARE-Traditional Medicare, +115030,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,MEDICARE-Traditional Medicare,70403.34 +115031,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,MEDICARE-Traditional Medicare,19165.31 +115032,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,MEDICARE-Traditional Medicare,10433.15 +115033,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,MEDICARE-Traditional Medicare,34432.07 +115034,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,MEDICARE-Traditional Medicare,11988.91 +115035,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,MEDICARE-Traditional Medicare,16941.96 +115036,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,MEDICARE-Traditional Medicare,87144.5 +115037,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,MEDICARE-Traditional Medicare,20543.75 +115038,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,MEDICARE-Traditional Medicare,8485.23 +115039,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,MEDICARE-Traditional Medicare,34483.86 +115040,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,MEDICARE-Traditional Medicare, +115041,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,MEDICARE-Traditional Medicare,8940.09 +115042,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,MEDICARE-Traditional Medicare,3359.08 +115043,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,MEDICARE-Traditional Medicare,1274.27 +115044,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,MEDICARE-Traditional Medicare,64287.24 +115045,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,MEDICARE-Traditional Medicare,19678.72 +115046,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,MEDICARE-Traditional Medicare,14481.89 +115047,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,MEDICARE-Traditional Medicare,101636.78 +115048,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,MEDICARE-Traditional Medicare, +115049,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,MEDICARE-Traditional Medicare,14932.09 +115050,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,MEDICARE-Traditional Medicare,32837.88 +115051,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,MEDICARE-Traditional Medicare,12993.8 +115052,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,MEDICARE-Traditional Medicare, +115053,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,MEDICARE-Traditional Medicare,18681.55 +115054,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,MEDICARE-Traditional Medicare,8488.81 +115055,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,MEDICARE-Traditional Medicare, +115056,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,MEDICARE-Traditional Medicare,15129.6 +115057,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,MEDICARE-Traditional Medicare, +115058,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,MEDICARE-Traditional Medicare,60866.97 +115059,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,MEDICARE-Traditional Medicare,17224.1 +115060,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,MEDICARE-Traditional Medicare,44300.86 +115061,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,MEDICARE-Traditional Medicare,25898.88 +115062,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,MEDICARE-Traditional Medicare,15972.59 +115063,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,MEDICARE-Traditional Medicare,21086.97 +115064,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,MEDICARE-Traditional Medicare,11142.64 +115065,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,MEDICARE-Traditional Medicare,9676.28 +115066,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,MEDICARE-Traditional Medicare,13878.63 +115067,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,MEDICARE-Traditional Medicare,9778.21 +115068,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,MEDICARE-Traditional Medicare,32012.07 +115069,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,MEDICARE-Traditional Medicare,10819.52 +115070,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,MEDICARE-Traditional Medicare,5045.16 +115071,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,MEDICARE-Traditional Medicare,84266.34 +115072,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,MEDICARE-Traditional Medicare,19614.88 +115073,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,MEDICARE-Traditional Medicare,10039.19 +115074,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,MEDICARE-Traditional Medicare,7891.0 +115075,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,MEDICARE-Traditional Medicare,9555.48 +115076,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,MEDICARE-Traditional Medicare,8137.27 +115077,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,MEDICARE-Traditional Medicare,7386.68 +115078,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,MEDICARE-Traditional Medicare,18521.87 +115079,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,MEDICARE-Traditional Medicare,11710.81 +115080,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,MEDICARE-Traditional Medicare,28334.25 +115081,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,MEDICARE-Traditional Medicare, +115082,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,MEDICARE-Traditional Medicare, +115083,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,MEDICARE-Traditional Medicare,6996.03 +115084,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,MEDICARE-Traditional Medicare, +115085,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,MEDICARE-Traditional Medicare,17877.41 +115086,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,MEDICARE-Traditional Medicare,7215.86 +115087,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,MEDICARE-Traditional Medicare, +115088,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,MEDICARE-Traditional Medicare,2744.82 +115089,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,MEDICARE-Traditional Medicare,30843.04 +115090,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,MEDICARE-Traditional Medicare,12174.65 +115091,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,MEDICARE-Traditional Medicare,47558.91 +115092,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,MEDICARE-Traditional Medicare,23477.15 +115093,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,MEDICARE-Traditional Medicare,12578.81 +115094,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,MEDICARE-Traditional Medicare,3571.53 +115095,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,MEDICARE-Traditional Medicare,8533.88 +115096,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,MEDICARE-Traditional Medicare,48463.71 +115097,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,MEDICARE-Traditional Medicare,6275.98 +115098,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,MEDICARE-Traditional Medicare,15366.91 +115099,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,MEDICARE-Traditional Medicare,8316.97 +115100,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,MEDICARE-Traditional Medicare,18455.96 +115101,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,MEDICARE-Traditional Medicare,9424.42 +115102,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,MEDICARE-Traditional Medicare,8555.1 +115103,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,MEDICARE-Traditional Medicare,12080.37 +115104,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,MEDICARE-Traditional Medicare,10535.31 +115105,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,MEDICARE-Traditional Medicare,68222.74 +115106,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,MEDICARE-Traditional Medicare,31456.3 +115107,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,MEDICARE-Traditional Medicare,19254.12 +115108,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,MEDICARE-Traditional Medicare,16448.11 +115109,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,MEDICARE-Traditional Medicare,38336.19 +115110,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,MEDICARE-Traditional Medicare,12410.96 +115111,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,MEDICARE-Traditional Medicare,7715.56 +115112,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,MEDICARE-Traditional Medicare, +115113,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,MEDICARE-Traditional Medicare, +115114,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,MEDICARE-Traditional Medicare,9545.53 +115115,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,MEDICARE-Traditional Medicare,63063.49 +115116,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,MEDICARE-Traditional Medicare,26662.93 +115117,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,MEDICARE-Traditional Medicare,118648.64 +115118,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,MEDICARE-Traditional Medicare,30763.98 +115119,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,MEDICARE-Traditional Medicare,23560.54 +115120,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,MEDICARE-Traditional Medicare,13140.66 +115121,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,MEDICARE-Traditional Medicare,27910.47 +115122,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,MEDICARE-Traditional Medicare,10937.19 +115123,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,MEDICARE-Traditional Medicare,59126.72 +115124,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,MEDICARE-Traditional Medicare,22947.76 +115125,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,MEDICARE-Traditional Medicare,18441.58 +115126,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,MEDICARE-Traditional Medicare,33107.9 +115127,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,MEDICARE-Traditional Medicare,16370.06 +115128,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,MEDICARE-Traditional Medicare,12755.07 +115129,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,MEDICARE-Traditional Medicare,2353.47 +115130,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,MEDICARE-Traditional Medicare,607.17 +115131,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,MEDICARE-Traditional Medicare,4107.25 +115132,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,MEDICARE-Traditional Medicare, +115133,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,MEDICARE-Traditional Medicare,697.0 +115134,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,MEDICARE-Traditional Medicare,2112.46 +115135,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,MEDICARE-Traditional Medicare,2137.82 +115136,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,MEDICARE-Traditional Medicare,1173.83 +115137,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,MEDICARE-Traditional Medicare,696.0 +115138,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,MEDICARE-Traditional Medicare, +115139,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,MEDICARE-Traditional Medicare,2471.53 +115140,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,MEDICARE-Traditional Medicare, +115141,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,MEDICARE-Traditional Medicare,3375.38 +115142,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,MEDICARE-Traditional Medicare,3112.5 +115143,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,MEDICARE-Traditional Medicare, +115144,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,MEDICARE-Traditional Medicare, +115145,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,MEDICARE-Traditional Medicare, +115146,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,MEDICARE-Traditional Medicare,3569.67 +115147,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,MEDICARE-Traditional Medicare,7255.36 +115148,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,MEDICARE-Traditional Medicare,3230.0 +115149,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,MEDICARE-Traditional Medicare,1760.0 +115150,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,MEDICARE-Traditional Medicare,1022.0 +115151,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,MEDICARE-Traditional Medicare,1428.0 +115152,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,MEDICARE-Traditional Medicare,612.0 +115153,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,MEDICARE-Traditional Medicare, +115154,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,MEDICARE-Traditional Medicare,5518.2 +115155,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,MEDICARE-Traditional Medicare,928.2 +115156,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,MEDICARE-Traditional Medicare, +115157,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,MEDICARE-Traditional Medicare, +115158,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,MEDICARE-Traditional Medicare,4374.11 +115159,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,MEDICARE-Traditional Medicare,4784.7 +115160,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,MEDICARE-Traditional Medicare,6446.4 +115161,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,MEDICARE-Traditional Medicare,6337.31 +115162,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,MEDICARE-Traditional Medicare,7483.73 +115163,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,MEDICARE-Traditional Medicare, +115164,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,MEDICARE-Traditional Medicare,5111.48 +115165,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,MEDICARE-Traditional Medicare,5376.0 +115166,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,MEDICARE-Traditional Medicare,4214.25 +115167,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,MEDICARE-Traditional Medicare,9367.2 +115168,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,MEDICARE-Traditional Medicare,6913.33 +115169,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,MEDICARE-Traditional Medicare, +115170,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,MEDICARE-Traditional Medicare,7080.5 +115171,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,MEDICARE-Traditional Medicare, +115172,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,MEDICARE-Traditional Medicare,10573.33 +115173,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,MEDICARE-Traditional Medicare, +115174,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,MEDICARE-Traditional Medicare, +115175,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,MEDICARE-Traditional Medicare, +115176,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,MEDICARE-Traditional Medicare, +115177,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,MEDICARE-Traditional Medicare, +115178,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,MEDICARE-Traditional Medicare,5599.0 +115179,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,MEDICARE-Traditional Medicare,6016.58 +115180,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,MEDICARE-Traditional Medicare,6217.56 +115181,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,MEDICARE-Traditional Medicare,7356.75 +115182,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,MEDICARE-Traditional Medicare,7128.0 +115183,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,MEDICARE-Traditional Medicare,7722.0 +115184,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,MEDICARE-Traditional Medicare,8178.06 +115185,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,MEDICARE-Traditional Medicare, +115186,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,MEDICARE-Traditional Medicare,7317.79 +115187,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,MEDICARE-Traditional Medicare, +115188,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,MEDICARE-Traditional Medicare, +115189,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,MEDICARE-Traditional Medicare,6023.86 +115190,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,MEDICARE-Traditional Medicare,4988.03 +115191,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,MEDICARE-Traditional Medicare, +115192,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,MEDICARE-Traditional Medicare,10523.75 +115193,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,MEDICARE-Traditional Medicare, +115194,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,MEDICARE-Traditional Medicare, +115195,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,MEDICARE-Traditional Medicare,2142.0 +115196,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,MEDICARE-Traditional Medicare,2234.0 +115197,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,MEDICARE-Traditional Medicare, +115198,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,MEDICARE-Traditional Medicare,1106.33 +115199,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,MEDICARE-Traditional Medicare, +115200,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,MEDICARE-Traditional Medicare, +115201,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,MEDICARE-Traditional Medicare,8544.0 +115202,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,MEDICARE-Traditional Medicare, +115203,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,MEDICARE-Traditional Medicare,4008.0 +115204,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,MEDICARE-Traditional Medicare,6432.0 +115205,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,MEDICARE-Traditional Medicare, +115206,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,MEDICARE-Traditional Medicare,14601.0 +115207,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,MEDICARE-Traditional Medicare, +115208,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,MEDICARE-Traditional Medicare,7200.17 +115209,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,MEDICARE-Traditional Medicare, +115210,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,MEDICARE-Traditional Medicare,1632.0 +115211,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,MEDICARE-Traditional Medicare, +115212,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,MEDICARE-Traditional Medicare, +115213,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,MEDICARE-Traditional Medicare,862.32 +115214,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,MEDICARE-Traditional Medicare,855.06 +115215,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,MEDICARE-Traditional Medicare,850.62 +115216,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,MEDICARE-Traditional Medicare,1003.0 +115217,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,MEDICARE-Traditional Medicare,840.11 +115218,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,MEDICARE-Traditional Medicare,851.3 +115219,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,MEDICARE-Traditional Medicare,5185.0 +115220,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,MEDICARE-Traditional Medicare,725.0 +115221,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,MEDICARE-Traditional Medicare,8948.72 +115222,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,MEDICARE-Traditional Medicare,1327.0 +115223,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,MEDICARE-Traditional Medicare, +115224,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,MEDICARE-Traditional Medicare,1961.43 +115225,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,MEDICARE-Traditional Medicare,1089.79 +115226,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,MEDICARE-Traditional Medicare,1096.55 +115227,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,MEDICARE-Traditional Medicare,1338.87 +115228,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,MEDICARE-Traditional Medicare, +115229,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,MEDICARE-Traditional Medicare,6082.13 +115230,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,MEDICARE-Traditional Medicare, +115231,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,MEDICARE-Traditional Medicare,1279.42 +115232,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,MEDICARE-Traditional Medicare, +115233,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,MEDICARE-Traditional Medicare,12774.19 +115234,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,MEDICARE-Traditional Medicare,3899.32 +115235,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,MEDICARE-Traditional Medicare,1133.26 +115236,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,MEDICARE-Traditional Medicare,927.43 +115237,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,MEDICARE-Traditional Medicare, +115238,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,MEDICARE-Traditional Medicare, +115239,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,MEDICARE-Traditional Medicare,5939.71 +115240,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,MEDICARE-Traditional Medicare,1312.75 +115241,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,MEDICARE-Traditional Medicare, +115242,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,MEDICARE-Traditional Medicare,1432.8 +115243,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,MEDICARE-Traditional Medicare,1142.31 +115244,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,MEDICARE-Traditional Medicare,2288.1 +115245,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,MEDICARE-Traditional Medicare,1978.95 +115246,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,MEDICARE-Traditional Medicare,3735.0 +115247,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,MEDICARE-Traditional Medicare, +115248,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,MEDICARE-Traditional Medicare,2629.86 +115249,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,MEDICARE-Traditional Medicare, +115250,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,MEDICARE-Traditional Medicare, +115251,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,MEDICARE-Traditional Medicare,5259.2 +115252,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,MEDICARE-Traditional Medicare,5912.55 +115253,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,MEDICARE-Traditional Medicare,8526.12 +115254,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,MEDICARE-Traditional Medicare,10159.0 +115255,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,MEDICARE-Traditional Medicare,6914.15 +115256,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,MEDICARE-Traditional Medicare,6810.44 +115257,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,MEDICARE-Traditional Medicare,7421.33 +115258,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,MEDICARE-Traditional Medicare,2363.41 +115259,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,MEDICARE-Traditional Medicare,4461.13 +115260,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,MEDICARE-Traditional Medicare,634.13 +115261,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,MEDICARE-Traditional Medicare,2102.26 +115262,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,MEDICARE-Traditional Medicare,7007.53 +115263,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,MEDICARE-Traditional Medicare,991.22 +115264,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,MEDICARE-Traditional Medicare,7274.37 +115265,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,MEDICARE-Traditional Medicare,6007.33 +115266,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,MEDICARE-Traditional Medicare,7725.19 +115267,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,MEDICARE-Traditional Medicare,6350.18 +115268,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,MEDICARE-Traditional Medicare,3506.85 +115269,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,MEDICARE-Traditional Medicare,1989.75 +115270,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,MEDICARE-Traditional Medicare,3492.93 +115271,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,MEDICARE-Traditional Medicare,3188.26 +115272,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,MEDICARE-Traditional Medicare,2285.46 +115273,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,MEDICARE-Traditional Medicare, +115274,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,MEDICARE-Traditional Medicare,5162.17 +115275,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,MEDICARE-Traditional Medicare,12618.41 +115276,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,MEDICARE-Traditional Medicare,9684.81 +115277,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,MEDICARE-Traditional Medicare,8642.33 +115278,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,MEDICARE-Traditional Medicare,20618.33 +115279,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,MEDICARE-Traditional Medicare,12289.35 +115280,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,MEDICARE-Traditional Medicare, +115281,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,MEDICARE-Traditional Medicare,4098.69 +115282,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,MEDICARE-Traditional Medicare,2296.0 +115283,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,MEDICARE-Traditional Medicare,9260.18 +115284,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,MEDICARE-Traditional Medicare,7386.4 +115285,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,MEDICARE-Traditional Medicare,7366.65 +115286,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,MEDICARE-Traditional Medicare,17000.77 +115287,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,MEDICARE-Traditional Medicare,28026.0 +115288,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,MEDICARE-Traditional Medicare, +115289,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,MEDICARE-Traditional Medicare,6998.33 +115290,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,MEDICARE-Traditional Medicare,3501.29 +115291,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,MEDICARE-Traditional Medicare, +115292,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,MEDICARE-Traditional Medicare, +115293,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,MEDICARE-Traditional Medicare, +115294,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,MEDICARE-Traditional Medicare, +115295,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,MEDICARE-Traditional Medicare,508.08 +115296,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,MEDICARE-Traditional Medicare, +115297,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,MEDICARE-Traditional Medicare,282.0 +115298,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,MEDICARE-Traditional Medicare, +115299,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,MEDICARE-Traditional Medicare,3215.5 +115300,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,MEDICARE-Traditional Medicare, +115301,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,MEDICARE-Traditional Medicare,5063.45 +115302,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,MEDICARE-Traditional Medicare,1598.5 +115303,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,MEDICARE-Traditional Medicare,4484.35 +115304,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,MEDICARE-Traditional Medicare,1447.31 +115305,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,MEDICARE-Traditional Medicare,6030.26 +115306,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,MEDICARE-Traditional Medicare,1864.43 +115307,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,MEDICARE-Traditional Medicare, +115308,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,MEDICARE-Traditional Medicare,7191.0 +115309,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,MEDICARE-Traditional Medicare,9375.55 +115310,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,MEDICARE-Traditional Medicare,8592.25 +115311,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,MEDICARE-Traditional Medicare,1693.03 +115312,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,MEDICARE-Traditional Medicare, +115313,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,MEDICARE-Traditional Medicare,2563.95 +115314,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,MEDICARE-Traditional Medicare,2060.71 +115315,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,MEDICARE-Traditional Medicare, +115316,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,MEDICARE-Traditional Medicare,23446.9 +115317,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,MEDICARE-Traditional Medicare,12375.73 +115318,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,MEDICARE-Traditional Medicare,15026.35 +115319,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,MEDICARE-Traditional Medicare,23664.36 +115320,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,MEDICARE-Traditional Medicare,5049.68 +115321,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,MEDICARE-Traditional Medicare,17088.97 +115322,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,MEDICARE-Traditional Medicare, +115323,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,MEDICARE-Traditional Medicare, +115324,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,MEDICARE-Traditional Medicare, +115325,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,MEDICARE-Traditional Medicare,9479.59 +115326,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,MEDICARE-Traditional Medicare,14173.09 +115327,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,MEDICARE-Traditional Medicare, +115328,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,MEDICARE-Traditional Medicare,9071.93 +115329,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,MEDICARE-Traditional Medicare, +115330,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,MEDICARE-Traditional Medicare, +115331,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,MEDICARE-Traditional Medicare,15106.77 +115332,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,MEDICARE-Traditional Medicare,10891.37 +115333,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,MEDICARE-Traditional Medicare, +115334,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,MEDICARE-Traditional Medicare, +115335,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,MEDICARE-Traditional Medicare, +115336,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,MEDICARE-Traditional Medicare,6426.0 +115337,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,MEDICARE-Traditional Medicare,10206.2 +115338,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,MEDICARE-Traditional Medicare,1986.79 +115339,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,MEDICARE-Traditional Medicare,4348.14 +115340,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,MEDICARE-Traditional Medicare,6113.4 +115341,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,MEDICARE-Traditional Medicare,8900.0 +115342,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,MEDICARE-Traditional Medicare,8868.0 +115343,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,MEDICARE-Traditional Medicare, +115344,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,MEDICARE-Traditional Medicare, +115345,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,MEDICARE-Traditional Medicare,700.77 +115346,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,MEDICARE-Traditional Medicare,5564.5 +115347,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,MEDICARE-Traditional Medicare, +115348,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,MEDICARE-Traditional Medicare,779.0 +115349,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,MEDICARE-Traditional Medicare, +115350,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,MEDICARE-Traditional Medicare,943.6 +115351,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,MEDICARE-Traditional Medicare,792.75 +115352,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,MEDICARE-Traditional Medicare,849.54 +115353,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,MEDICARE-Traditional Medicare,951.3 +115354,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,MEDICARE-Traditional Medicare,1227.0 +115355,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,MEDICARE-Traditional Medicare, +115356,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,MEDICARE-Traditional Medicare, +115357,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,MEDICARE-Traditional Medicare,3214.44 +115358,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,MEDICARE-Traditional Medicare,9360.07 +115359,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,MEDICARE-Traditional Medicare,16091.0 +115360,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,MEDICARE-Traditional Medicare,6612.2 +115361,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,MEDICARE-Traditional Medicare,3230.0 +115362,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,MEDICARE-Traditional Medicare, +115363,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,MEDICARE-Traditional Medicare, +115364,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,MEDICARE-Traditional Medicare,3524.4 +115365,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,MEDICARE-Traditional Medicare,10860.0 +115366,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,MEDICARE-Traditional Medicare,8482.0 +115367,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,MEDICARE-Traditional Medicare, +115368,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,MEDICARE-Traditional Medicare,7691.0 +115369,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,MEDICARE-Traditional Medicare, +115370,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,MEDICARE-Traditional Medicare,5736.0 +115371,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,MEDICARE-Traditional Medicare,15040.68 +115372,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,MEDICARE-Traditional Medicare,3547.67 +115373,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,MEDICARE-Traditional Medicare, +115374,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,MEDICARE-Traditional Medicare,16701.0 +115375,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,MEDICARE-Traditional Medicare, +115376,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,MEDICARE-Traditional Medicare, +115377,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,MEDICARE-Traditional Medicare,6835.0 +115378,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,MEDICARE-Traditional Medicare,30999.84 +115379,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,MEDICARE-Traditional Medicare,18130.0 +115380,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,MEDICARE-Traditional Medicare, +115381,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,MEDICARE-Traditional Medicare, +115382,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,MEDICARE-Traditional Medicare, +115383,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,MEDICARE-Traditional Medicare, +115384,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,MEDICARE-Traditional Medicare, +115385,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,MEDICARE-Traditional Medicare, +115386,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,MEDICARE-Traditional Medicare,39194.79 +115387,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,MEDICARE-Traditional Medicare,13131.8 +115388,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,MEDICARE-Traditional Medicare,14582.48 +115389,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,MEDICARE-Traditional Medicare, +115390,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,MEDICARE-Traditional Medicare,3067.94 +115391,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,MEDICARE-Traditional Medicare,8546.82 +115392,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,MEDICARE-Traditional Medicare,7658.0 +115393,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,MEDICARE-Traditional Medicare, +115394,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,MEDICARE-Traditional Medicare, +115395,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,MEDICARE-Traditional Medicare, +115396,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,MEDICARE-Traditional Medicare,14779.95 +115397,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,MEDICARE-Traditional Medicare, +115398,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,MEDICARE-Traditional Medicare, +115399,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,MEDICARE-Traditional Medicare,49287.99 +115400,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,MEDICARE-Traditional Medicare, +115401,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,MEDICARE-Traditional Medicare, +115402,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,MEDICARE-Traditional Medicare, +115403,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,MEDICARE-Traditional Medicare,500.0 +115404,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,MEDICARE-Traditional Medicare,7892.84 +115405,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,MEDICARE-Traditional Medicare, +115406,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,MEDICARE-Traditional Medicare,2998.35 +115407,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,MEDICARE-Traditional Medicare,7502.33 +115408,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,MEDICARE-Traditional Medicare, +115409,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,MEDICARE-Traditional Medicare,5236.0 +115410,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,MEDICARE-Traditional Medicare,7296.0 +115411,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,MEDICARE-Traditional Medicare,35282.0 +115412,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,MEDICARE-Traditional Medicare,35962.94 +115413,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,MEDICARE-Traditional Medicare, +115414,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,MEDICARE-Traditional Medicare,7990.5 +115415,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,MEDICARE-Traditional Medicare,11983.0 +115416,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,MEDICARE-Traditional Medicare,8137.33 +115417,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,MEDICARE-Traditional Medicare, +115418,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,MEDICARE-Traditional Medicare, +115419,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,MEDICARE-Traditional Medicare,8798.79 +115420,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,MEDICARE-Traditional Medicare,15814.67 +115421,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,MEDICARE-Traditional Medicare,1905.14 +115422,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,MEDICARE-Traditional Medicare,23047.5 +115423,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,MEDICARE-Traditional Medicare, +115424,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,MEDICARE-Traditional Medicare,3524.4 +115425,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,MEDICARE-Traditional Medicare,3524.4 +115426,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,MEDICARE-Traditional Medicare, +115427,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,MEDICARE-Traditional Medicare,26179.82 +115428,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,MEDICARE-Traditional Medicare,24520.37 +115429,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,MEDICARE-Traditional Medicare,4800.0 +115430,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,MEDICARE-Traditional Medicare,6990.67 +115431,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,MEDICARE-Traditional Medicare,6518.0 +115432,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,MEDICARE-Traditional Medicare, +115433,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,MEDICARE-Traditional Medicare, +115434,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,MEDICARE-Traditional Medicare,7917.85 +115435,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,MEDICARE-Traditional Medicare, +115436,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,MEDICARE-Traditional Medicare, +115437,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,MEDICARE-Traditional Medicare, +115438,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,MEDICARE-Traditional Medicare, +115439,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,MEDICARE-Traditional Medicare,11696.0 +115440,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,MEDICARE-Traditional Medicare, +115441,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,MEDICARE-Traditional Medicare,20235.0 +115442,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,MEDICARE-Traditional Medicare, +115443,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,MEDICARE-Traditional Medicare, +115444,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,MEDICARE-Traditional Medicare, +115445,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,MEDICARE-Traditional Medicare, +115446,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,MEDICARE-Traditional Medicare,2477.36 +115447,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,MEDICARE-Traditional Medicare,1683.0 +115448,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,MEDICARE-Traditional Medicare, +115449,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,MEDICARE-Traditional Medicare, +115450,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,MEDICARE-Traditional Medicare,7629.25 +115451,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,MEDICARE-Traditional Medicare, +115452,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,MEDICARE-Traditional Medicare,3845.6 +115453,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,MEDICARE-Traditional Medicare, +115454,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,MEDICARE-Traditional Medicare, +115455,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,MEDICARE-Traditional Medicare, +115456,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,MEDICARE-Traditional Medicare, +115457,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,MEDICARE-Traditional Medicare, +115458,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,MEDICARE-Traditional Medicare, +115459,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,MEDICARE-Traditional Medicare,14808.62 +115460,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,MEDICARE-Traditional Medicare, +115461,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,MEDICARE-Traditional Medicare,9198.0 +115462,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,MEDICARE-Traditional Medicare, +115463,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,MEDICARE-Traditional Medicare, +115464,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,MEDICARE-Traditional Medicare, +115465,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,MEDICARE-Traditional Medicare,8209.0 +115466,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,MEDICARE-Traditional Medicare,50817.08 +115467,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,MEDICARE-Traditional Medicare,47664.86 +115468,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,MEDICARE-Traditional Medicare,2354.0 +115469,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,MEDICARE-Traditional Medicare, +115470,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,MEDICARE-Traditional Medicare, +115471,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,MEDICARE-Traditional Medicare, +115472,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,MEDICARE-Traditional Medicare, +115473,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,MEDICARE-Traditional Medicare,30841.3 +115474,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,MEDICARE-Traditional Medicare, +115475,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,MEDICARE-Traditional Medicare, +115476,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,MEDICARE-Traditional Medicare, +115477,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,MEDICARE-Traditional Medicare, +115478,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,MEDICARE-Traditional Medicare, +115479,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,MEDICARE-Traditional Medicare, +115480,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,MEDICARE-Traditional Medicare,3249.33 +115481,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,MEDICARE-Traditional Medicare, +115482,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,MEDICARE-Traditional Medicare, +115483,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,MEDICARE-Traditional Medicare, +115484,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,MEDICARE-Traditional Medicare, +115485,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,MEDICARE-Traditional Medicare,8277.0 +115486,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,MEDICARE-Traditional Medicare, +115487,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,MEDICARE-Traditional Medicare, +115488,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,MEDICARE-Traditional Medicare,5781.0 +115489,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,MEDICARE-Traditional Medicare,22546.0 +115490,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,MEDICARE-Traditional Medicare,5530.8 +115491,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,MEDICARE-Traditional Medicare, +115492,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,MEDICARE-Traditional Medicare, +115493,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,MEDICARE-Traditional Medicare,6779.5 +115494,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,MEDICARE-Traditional Medicare,7029.0 +115495,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,MEDICARE-Traditional Medicare,3549.6 +115496,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,MEDICARE-Traditional Medicare, +115497,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,MEDICARE-Traditional Medicare, +115498,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,MEDICARE-Traditional Medicare, +115499,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,MEDICARE-Traditional Medicare,6214.67 +115500,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,MEDICARE-Traditional Medicare, +115501,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,MEDICARE-Traditional Medicare,5130.62 +115502,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,MEDICARE-Traditional Medicare, +115503,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,MEDICARE-Traditional Medicare,8927.0 +115504,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,MEDICARE-Traditional Medicare, +115505,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,MEDICARE-Traditional Medicare, +115506,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,MEDICARE-Traditional Medicare,9359.0 +115507,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,MEDICARE-Traditional Medicare, +115508,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,MEDICARE-Traditional Medicare, +115509,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,MEDICARE-Traditional Medicare, +115510,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,MEDICARE-Traditional Medicare,6290.4 +115511,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,MEDICARE-Traditional Medicare,10958.26 +115512,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,MEDICARE-Traditional Medicare,1862.57 +115513,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,MEDICARE-Traditional Medicare,15436.0 +115514,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,MEDICARE-Traditional Medicare, +115515,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,MEDICARE-Traditional Medicare,13248.0 +115516,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,MEDICARE-Traditional Medicare,9056.31 +115517,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,MEDICARE-Traditional Medicare, +115518,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,MEDICARE-Traditional Medicare, +115519,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,MEDICARE-Traditional Medicare, +115520,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,MEDICARE-Traditional Medicare, +115521,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,MEDICARE-Traditional Medicare, +115522,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,MEDICARE-Traditional Medicare, +115523,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,MEDICARE-Traditional Medicare, +115524,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,MEDICARE-Traditional Medicare, +115525,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,MEDICARE-Traditional Medicare,4558.75 +115526,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,MEDICARE-Traditional Medicare, +115527,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,MEDICARE-Traditional Medicare, +115528,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,MEDICARE-Traditional Medicare,11237.0 +115529,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,MEDICARE-Traditional Medicare,18569.83 +115530,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,MEDICARE-Traditional Medicare, +115531,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,MEDICARE-Traditional Medicare, +115532,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,MEDICARE-Traditional Medicare, +115533,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,MEDICARE-Traditional Medicare, +115534,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,MEDICARE-Traditional Medicare, +115535,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,MEDICARE-Traditional Medicare,500.0 +115536,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,MEDICARE-Traditional Medicare,4053.0 +115537,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,MEDICARE-Traditional Medicare,4742.81 +115538,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,MEDICARE-Traditional Medicare, +115539,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,MEDICARE-Traditional Medicare, +115540,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,MEDICARE-Traditional Medicare, +115541,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,MEDICARE-Traditional Medicare, +115542,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,MEDICARE-Traditional Medicare,5692.1 +115543,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,MEDICARE-Traditional Medicare, +115544,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,MEDICARE-Traditional Medicare,4380.0 +115545,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,MEDICARE-Traditional Medicare,8465.1 +115546,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,MEDICARE-Traditional Medicare,2137.54 +115547,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,MEDICARE-Traditional Medicare,4066.33 +115548,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,MEDICARE-Traditional Medicare,5732.11 +115549,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,MEDICARE-Traditional Medicare,6208.0 +115550,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,MEDICARE-Traditional Medicare, +115551,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,MEDICARE-Traditional Medicare, +115552,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,MEDICARE-Traditional Medicare, +115553,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,MEDICARE-Traditional Medicare, +115554,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,MEDICARE-Traditional Medicare,1442.4 +115555,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,MEDICARE-Traditional Medicare, +115556,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,MEDICARE-Traditional Medicare, +115557,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,MEDICARE-Traditional Medicare, +115558,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,MEDICARE-Traditional Medicare,3409.6 +115559,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,MEDICARE-Traditional Medicare, +115560,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,MEDICARE-Traditional Medicare,7150.0 +115561,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,MEDICARE-Traditional Medicare,5173.77 +115562,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,MEDICARE-Traditional Medicare, +115563,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,MEDICARE-Traditional Medicare,11681.92 +115564,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,MEDICARE-Traditional Medicare, +115565,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,MEDICARE-Traditional Medicare,5271.0 +115566,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,MEDICARE-Traditional Medicare,6527.0 +115567,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,MEDICARE-Traditional Medicare,10679.0 +115568,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,MEDICARE-Traditional Medicare, +115569,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,MEDICARE-Traditional Medicare,15927.0 +115570,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,MEDICARE-Traditional Medicare,6831.0 +115571,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,MEDICARE-Traditional Medicare, +115572,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,MEDICARE-Traditional Medicare,6417.0 +115573,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,MEDICARE-Traditional Medicare, +115574,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,MEDICARE-Traditional Medicare, +115575,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,MEDICARE-Traditional Medicare, +115576,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,MEDICARE-Traditional Medicare,2265.0 +115577,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,MEDICARE-Traditional Medicare, +115578,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,MEDICARE-Traditional Medicare, +115579,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,MEDICARE-Traditional Medicare, +115580,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,MEDICARE-Traditional Medicare, +115581,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,MEDICARE-Traditional Medicare, +115582,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,MEDICARE-Traditional Medicare,5482.0 +115583,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,MEDICARE-Traditional Medicare, +115584,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,MEDICARE-Traditional Medicare, +115585,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,MEDICARE-Traditional Medicare,4404.5 +115586,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,MEDICARE-Traditional Medicare,6170.0 +115587,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,MEDICARE-Traditional Medicare, +115588,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,MEDICARE-Traditional Medicare,2486.4 +115589,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,MEDICARE-Traditional Medicare, +115590,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,MEDICARE-Traditional Medicare, +115591,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,MEDICARE-Traditional Medicare,1385.0 +115592,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,MEDICARE-Traditional Medicare, +115593,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,MEDICARE-Traditional Medicare,10214.0 +115594,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,MEDICARE-Traditional Medicare,5546.11 +115595,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,MEDICARE-Traditional Medicare, +115596,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,MEDICARE-Traditional Medicare,4539.0 +115597,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,MEDICARE-Traditional Medicare, +115598,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,MEDICARE-Traditional Medicare, +115599,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,MEDICARE-Traditional Medicare, +115600,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,MEDICARE-Traditional Medicare, +115601,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,MEDICARE-Traditional Medicare,23653.85 +115602,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,MEDICARE-Traditional Medicare, +115603,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,MEDICARE-Traditional Medicare, +115604,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,MEDICARE-Traditional Medicare, +115605,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,MEDICARE-Traditional Medicare, +115606,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,MEDICARE-Traditional Medicare, +115607,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,MEDICARE-Traditional Medicare, +115608,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,MEDICARE-Traditional Medicare, +115609,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,MEDICARE-Traditional Medicare,10158.0 +115610,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,MEDICARE-Traditional Medicare,6266.68 +115611,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,MEDICARE-Traditional Medicare,10262.05 +115612,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,MEDICARE-Traditional Medicare,25934.0 +115613,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,MEDICARE-Traditional Medicare,4285.67 +115614,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,MEDICARE-Traditional Medicare, +115615,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,MEDICARE-Traditional Medicare,4862.0 +115616,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,MEDICARE-Traditional Medicare,5572.6 +115617,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,MEDICARE-Traditional Medicare, +115618,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,MEDICARE-Traditional Medicare,8143.0 +115619,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,MEDICARE-Traditional Medicare,11253.27 +115620,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,MEDICARE-Traditional Medicare, +115621,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,MEDICARE-Traditional Medicare,6949.0 +115622,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,MEDICARE-Traditional Medicare, +115623,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,MEDICARE-Traditional Medicare, +115624,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,MEDICARE-Traditional Medicare, +115625,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,MEDICARE-Traditional Medicare, +115626,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,MEDICARE-Traditional Medicare,15905.0 +115627,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,MEDICARE-Traditional Medicare, +115628,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,MEDICARE-Traditional Medicare, +115629,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,MEDICARE-Traditional Medicare, +115630,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,MEDICARE-Traditional Medicare, +115631,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,MEDICARE-Traditional Medicare, +115632,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,MEDICARE-Traditional Medicare, +115633,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,MEDICARE-Traditional Medicare,24421.32 +115634,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,MEDICARE-Traditional Medicare, +115635,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,MEDICARE-Traditional Medicare, +115636,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,MEDICARE-Traditional Medicare, +115637,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,MEDICARE-Traditional Medicare, +115638,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,MEDICARE-Traditional Medicare, +115639,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,MEDICARE-Traditional Medicare, +115640,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,MEDICARE-Traditional Medicare, +115641,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,MEDICARE-Traditional Medicare, +115642,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,MEDICARE-Traditional Medicare, +115643,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,MEDICARE-Traditional Medicare, +115644,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,MEDICARE-Traditional Medicare, +115645,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,MEDICARE-Traditional Medicare,3515.5 +115646,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,MEDICARE-Traditional Medicare, +115647,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,MEDICARE-Traditional Medicare, +115648,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,MEDICARE-Traditional Medicare, +115649,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,MEDICARE-Traditional Medicare,2687.8 +115650,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,MEDICARE-Traditional Medicare, +115651,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,MEDICARE-Traditional Medicare, +115652,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,MEDICARE-Traditional Medicare,9507.38 +115653,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,MEDICARE-Traditional Medicare, +115654,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,MEDICARE-Traditional Medicare,7909.0 +115655,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,MEDICARE-Traditional Medicare, +115656,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,MEDICARE-Traditional Medicare, +115657,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,MEDICARE-Traditional Medicare, +115658,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,MEDICARE-Traditional Medicare,7568.0 +115659,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,MEDICARE-Traditional Medicare,15471.0 +115660,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,MEDICARE-Traditional Medicare, +115661,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,MEDICARE-Traditional Medicare, +115662,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,MEDICARE-Traditional Medicare, +115663,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,MEDICARE-Traditional Medicare, +115664,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,MEDICARE-Traditional Medicare,9939.67 +115665,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,MEDICARE-Traditional Medicare, +115666,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,MEDICARE-Traditional Medicare, +115667,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,MEDICARE-Traditional Medicare, +115668,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,MEDICARE-Traditional Medicare, +115669,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,MEDICARE-Traditional Medicare, +115670,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,MEDICARE-Traditional Medicare, +115671,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,MEDICARE-Traditional Medicare, +115672,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,MEDICARE-Traditional Medicare, +115673,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,MEDICARE-Traditional Medicare, +115674,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,MEDICARE-Traditional Medicare, +115675,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,MEDICARE-Traditional Medicare,2719.54 +115676,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,MEDICARE-Traditional Medicare,11712.12 +115677,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,MEDICARE-Traditional Medicare, +115678,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,MEDICARE-Traditional Medicare,11892.75 +115679,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,MEDICARE-Traditional Medicare,7895.74 +115680,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,MEDICARE-Traditional Medicare,14153.5 +115681,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,MEDICARE-Traditional Medicare,24655.0 +115682,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,MEDICARE-Traditional Medicare, +115683,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,MEDICARE-Traditional Medicare, +115684,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,MEDICARE-Traditional Medicare, +115685,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,MEDICARE-Traditional Medicare,20723.0 +115686,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,MEDICARE-Traditional Medicare,9181.75 +115687,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,MEDICARE-Traditional Medicare, +115688,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,MEDICARE-Traditional Medicare,8569.92 +115689,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,MEDICARE-Traditional Medicare, +115690,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,MEDICARE-Traditional Medicare, +115691,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,MEDICARE-Traditional Medicare,9903.2 +115692,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,MEDICARE-Traditional Medicare,8629.0 +115693,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,MEDICARE-Traditional Medicare,6426.0 +115694,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,MEDICARE-Traditional Medicare, +115695,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,MEDICARE-Traditional Medicare, +115696,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,MEDICARE-Traditional Medicare, +115697,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,MEDICARE-Traditional Medicare, +115698,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,MEDICARE-Traditional Medicare, +115699,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,MEDICARE-Traditional Medicare,20158.29 +115700,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,MEDICARE-Traditional Medicare,2704.5 +115701,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,MEDICARE-Traditional Medicare, +115702,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,MEDICARE-Traditional Medicare,9808.0 +115703,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,MEDICARE-Traditional Medicare, +115704,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,MEDICARE-Traditional Medicare,3799.9 +115705,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,MEDICARE-Traditional Medicare, +115706,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,MEDICARE-Traditional Medicare,5696.0 +115707,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,MEDICARE-Traditional Medicare, +115708,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,MEDICARE-Traditional Medicare,4886.79 +115709,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,MEDICARE-Traditional Medicare, +115710,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,MEDICARE-Traditional Medicare,5279.34 +115711,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,MEDICARE-Traditional Medicare,5849.88 +115712,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,MEDICARE-Traditional Medicare, +115713,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,MEDICARE-Traditional Medicare,9990.0 +115714,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,MEDICARE-Traditional Medicare,7286.4 +115715,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,MEDICARE-Traditional Medicare, +115716,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,MEDICARE-Traditional Medicare,8568.0 +115717,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,MEDICARE-Traditional Medicare, +115718,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,MEDICARE-Traditional Medicare,9043.0 +115719,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,MEDICARE-Traditional Medicare, +115720,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,MEDICARE-Traditional Medicare, +115721,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,MEDICARE-Traditional Medicare,8326.0 +115722,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,MEDICARE-Traditional Medicare, +115723,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,MEDICARE-Traditional Medicare, +115724,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,MEDICARE-Traditional Medicare, +115725,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,MEDICARE-Traditional Medicare, +115726,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,MEDICARE-Traditional Medicare, +115727,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,MEDICARE-Traditional Medicare, +115728,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,MEDICARE-Traditional Medicare, +115729,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,MEDICARE-Traditional Medicare, +115730,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,MEDICARE-Traditional Medicare,807.0 +115731,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,MEDICARE-Traditional Medicare,7974.0 +115732,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,MEDICARE-Traditional Medicare, +115733,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,MEDICARE-Traditional Medicare, +115734,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,MEDICARE-Traditional Medicare, +115735,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,MEDICARE-Traditional Medicare, +115736,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,MEDICARE-Traditional Medicare, +115737,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,MEDICARE-Traditional Medicare, +115738,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,MEDICARE-Traditional Medicare, +115739,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,MEDICARE-Traditional Medicare,1294.0 +115740,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,MEDICARE-Traditional Medicare, +115741,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,MEDICARE-Traditional Medicare,17493.0 +115742,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,MEDICARE-Traditional Medicare, +115743,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,MEDICARE-Traditional Medicare,10316.0 +115744,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,MEDICARE-Traditional Medicare,13833.33 +115745,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,MEDICARE-Traditional Medicare,6789.33 +115746,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,MEDICARE-Traditional Medicare,14434.6 +115747,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,MEDICARE-Traditional Medicare,11363.0 +115748,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,MEDICARE-Traditional Medicare,4950.07 +115749,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,MEDICARE-Traditional Medicare,3160.5 +115750,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,MEDICARE-Traditional Medicare, +115751,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,MEDICARE-Traditional Medicare, +115752,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,MEDICARE-Traditional Medicare, +115753,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,MEDICARE-Traditional Medicare,473.5 +115754,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,MEDICARE-Traditional Medicare,469.75 +115755,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,MEDICARE-Traditional Medicare,468.0 +115756,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,MEDICARE-Traditional Medicare, +115757,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,MEDICARE-Traditional Medicare, +115758,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,MEDICARE-Traditional Medicare,2017.62 +115759,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,MEDICARE-Traditional Medicare, +115760,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,MEDICARE-Traditional Medicare,1667.5 +115761,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,MEDICARE-Traditional Medicare,824.36 +115762,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,MEDICARE-Traditional Medicare,3470.92 +115763,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,MEDICARE-Traditional Medicare, +115764,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,MEDICARE-Traditional Medicare, +115765,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,MEDICARE-Traditional Medicare,9036.0 +115766,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,MEDICARE-Traditional Medicare, +115767,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,MEDICARE-Traditional Medicare,17536.0 +115768,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,MEDICARE-Traditional Medicare, +115769,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,MEDICARE-Traditional Medicare, +115770,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,MEDICARE-Traditional Medicare,6783.0 +115771,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,MEDICARE-Traditional Medicare,8105.46 +115772,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,MEDICARE-Traditional Medicare,5952.0 +115773,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,MEDICARE-Traditional Medicare, +115774,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,MEDICARE-Traditional Medicare,2318.6 +115775,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,MEDICARE-Traditional Medicare,13535.85 +115776,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,MEDICARE-Traditional Medicare,6486.25 +115777,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,MEDICARE-Traditional Medicare, +115778,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,MEDICARE-Traditional Medicare, +115779,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,MEDICARE-Traditional Medicare, +115780,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,MEDICARE-Traditional Medicare,5423.2 +115781,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,MEDICARE-Traditional Medicare, +115782,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,MEDICARE-Traditional Medicare, +115783,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,MEDICARE-Traditional Medicare, +115784,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,MEDICARE-Traditional Medicare,4114.0 +115785,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,MEDICARE-Traditional Medicare, +115786,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,MEDICARE-Traditional Medicare, +115787,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,MEDICARE-Traditional Medicare, +115788,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,MEDICARE-Traditional Medicare,7395.0 +115789,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,MEDICARE-Traditional Medicare,6616.75 +115790,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,MEDICARE-Traditional Medicare, +115791,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,MEDICARE-Traditional Medicare, +115792,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,MEDICARE-Traditional Medicare,8108.0 +115793,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,MEDICARE-Traditional Medicare,8157.45 +115794,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,MEDICARE-Traditional Medicare, +115795,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,MEDICARE-Traditional Medicare, +115796,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,MEDICARE-Traditional Medicare, +115797,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,MEDICARE-Traditional Medicare, +115798,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,MEDICARE-Traditional Medicare, +115799,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,MEDICARE-Traditional Medicare,7327.0 +115800,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,MEDICARE-Traditional Medicare,6681.0 +115801,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,MEDICARE-Traditional Medicare, +115802,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,MEDICARE-Traditional Medicare,6326.5 +115803,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,MEDICARE-Traditional Medicare, +115804,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,MEDICARE-Traditional Medicare,4165.29 +115805,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,MEDICARE-Traditional Medicare, +115806,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,MEDICARE-Traditional Medicare,8046.44 +115807,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,MEDICARE-Traditional Medicare, +115808,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,MEDICARE-Traditional Medicare, +115809,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,MEDICARE-Traditional Medicare, +115810,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,MEDICARE-Traditional Medicare,26050.66 +115811,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,MEDICARE-Traditional Medicare,7408.06 +115812,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,MEDICARE-Traditional Medicare,9168.0 +115813,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,MEDICARE-Traditional Medicare,6968.32 +115814,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,MEDICARE-Traditional Medicare, +115815,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,MEDICARE-Traditional Medicare,481.28 +115816,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,MEDICARE-Traditional Medicare,2115.17 +115817,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,MEDICARE-Traditional Medicare,2636.0 +115818,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,MEDICARE-Traditional Medicare, +115819,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,MEDICARE-Traditional Medicare,4324.17 +115820,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,MEDICARE-Traditional Medicare,12355.79 +115821,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,MEDICARE-Traditional Medicare, +115822,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,MEDICARE-Traditional Medicare, +115823,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,MEDICARE-Traditional Medicare,5741.0 +115824,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,MEDICARE-Traditional Medicare,6563.67 +115825,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,MEDICARE-Traditional Medicare,14311.0 +115826,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,MEDICARE-Traditional Medicare,7796.2 +115827,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,MEDICARE-Traditional Medicare, +115828,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,MEDICARE-Traditional Medicare, +115829,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,MEDICARE-Traditional Medicare,6642.72 +115830,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,MEDICARE-Traditional Medicare,5322.54 +115831,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,MEDICARE-Traditional Medicare,6850.17 +115832,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,MEDICARE-Traditional Medicare,7881.3 +115833,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,MEDICARE-Traditional Medicare, +115834,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,MEDICARE-Traditional Medicare, +115835,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,MEDICARE-Traditional Medicare, +115836,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,MEDICARE-Traditional Medicare, +115837,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,MEDICARE-Traditional Medicare,784.87 +115838,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,MEDICARE-Traditional Medicare, +115839,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,MEDICARE-Traditional Medicare,3583.3 +115840,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,MEDICARE-Traditional Medicare, +115841,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,MEDICARE-Traditional Medicare,17979.0 +115842,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,MEDICARE-Traditional Medicare, +115843,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,MEDICARE-Traditional Medicare, +115844,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,MEDICARE-Traditional Medicare,10009.73 +115845,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,MEDICARE-Traditional Medicare,6788.71 +115846,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,MEDICARE-Traditional Medicare, +115847,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,MEDICARE-Traditional Medicare,15195.34 +115848,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,MEDICARE-Traditional Medicare,8441.62 +115849,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,MEDICARE-Traditional Medicare, +115850,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,MEDICARE-Traditional Medicare,1577.88 +115851,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,MEDICARE-Traditional Medicare,14556.29 +115852,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,MEDICARE-Traditional Medicare,19465.0 +115853,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,MEDICARE-Traditional Medicare,9166.0 +115854,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,MEDICARE-Traditional Medicare, +115855,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,MEDICARE-Traditional Medicare, +115856,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,MEDICARE-Traditional Medicare, +115857,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,MEDICARE-Traditional Medicare,7558.89 +115858,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,MEDICARE-Traditional Medicare,8440.03 +115859,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,MEDICARE-Traditional Medicare,9207.19 +115860,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,MEDICARE-Traditional Medicare,9091.7 +115861,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,MEDICARE-Traditional Medicare,3922.0 +115862,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,MEDICARE-Traditional Medicare,9033.59 +115863,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,MEDICARE-Traditional Medicare,8852.0 +115864,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,MEDICARE-Traditional Medicare,9904.7 +115865,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,MEDICARE-Traditional Medicare,4015.7 +115866,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,MEDICARE-Traditional Medicare,16413.33 +115867,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,MEDICARE-Traditional Medicare,12384.21 +115868,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,MEDICARE-Traditional Medicare,19229.01 +115869,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,MEDICARE-Traditional Medicare,11913.43 +115870,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,MEDICARE-Traditional Medicare,25461.5 +115871,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,MEDICARE-Traditional Medicare, +115872,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,MEDICARE-Traditional Medicare,15594.93 +115873,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,MEDICARE-Traditional Medicare,15122.63 +115874,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,MEDICARE-Traditional Medicare,2310.4 +115875,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,MEDICARE-Traditional Medicare,221.33 +115876,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,MEDICARE-Traditional Medicare, +115877,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,MEDICARE-Traditional Medicare,2782.36 +115878,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,MEDICARE-Traditional Medicare,7667.56 +115879,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,MEDICARE-Traditional Medicare,2754.38 +115880,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,MEDICARE-Traditional Medicare,9240.71 +115881,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,MEDICARE-Traditional Medicare,2337.54 +115882,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,MEDICARE-Traditional Medicare,3810.5 +115883,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,MEDICARE-Traditional Medicare,2970.05 +115884,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,MEDICARE-Traditional Medicare,3277.0 +115885,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,MEDICARE-Traditional Medicare,2826.68 +115886,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,MEDICARE-Traditional Medicare, +115887,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,MEDICARE-Traditional Medicare,2439.52 +115888,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,MEDICARE-Traditional Medicare, +115889,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,MEDICARE-Traditional Medicare,91204.47 +115890,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,MEDICARE-Traditional Medicare,27679.82 +115891,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,MEDICARE-Traditional Medicare,48874.59 +115892,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,MEDICARE-Traditional Medicare,8852.17 +115893,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,MEDICARE-Traditional Medicare,18193.01 +115894,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,MEDICARE-Traditional Medicare,25610.98 +115895,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,MEDICARE-Traditional Medicare, +115896,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,MEDICARE-Traditional Medicare,7883.26 +115897,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,MEDICARE-Traditional Medicare,148590.8 +115898,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,MEDICARE-Traditional Medicare,53091.64 +115899,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,MEDICARE-Traditional Medicare,34583.81 +115900,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,MEDICARE-Traditional Medicare,34922.21 +115901,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,MEDICARE-Traditional Medicare,37772.75 +115902,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,MEDICARE-Traditional Medicare,45198.95 +115903,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,MEDICARE-Traditional Medicare,8516.51 +115904,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,MEDICARE-Traditional Medicare,10899.96 +115905,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,MEDICARE-Traditional Medicare,8635.41 +115906,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,MEDICARE-Traditional Medicare,7710.91 +115907,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,MEDICARE-Traditional Medicare,13476.64 +115908,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,MEDICARE-Traditional Medicare,111523.0 +115909,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,MEDICARE-Traditional Medicare,119608.08 +115910,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,MEDICARE-Traditional Medicare,127831.34 +115911,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,MEDICARE-Traditional Medicare,130719.81 +115912,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,MEDICARE-Traditional Medicare,136873.03 +115913,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,MEDICARE-Traditional Medicare,156911.05 +115914,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,MEDICARE-Traditional Medicare,60597.74 +115915,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,MEDICARE-Traditional Medicare,29303.87 +115916,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,MEDICARE-Traditional Medicare,1668.6 +115917,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,MEDICARE-Traditional Medicare, +115918,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,MEDICARE-Traditional Medicare, +115919,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,MEDICARE-Traditional Medicare,8010.0 +115920,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,MEDICARE-Traditional Medicare, +115921,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,MEDICARE-Traditional Medicare, +115922,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,MEDICARE-Traditional Medicare,4005.0 +115923,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,MEDICARE-Traditional Medicare,10598.0 +115924,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,MEDICARE-Traditional Medicare, +115925,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,MEDICARE-Traditional Medicare, +115926,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,MEDICARE-Traditional Medicare, +115927,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,MEDICARE-Traditional Medicare, +115928,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,MEDICARE-Traditional Medicare, +115929,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,MEDICARE-Traditional Medicare, +115930,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,MEDICARE-Traditional Medicare,17292.0 +115931,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,MEDICARE-Traditional Medicare,40.9 +115932,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,MEDICARE-Traditional Medicare,5186.58 +115933,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,MEDICARE-Traditional Medicare,4850.5 +115934,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,MEDICARE-Traditional Medicare,3448.75 +115935,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,MEDICARE-Traditional Medicare, +115936,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,MEDICARE-Traditional Medicare,6452.5 +115937,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,MEDICARE-Traditional Medicare,3782.5 +115938,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,MEDICARE-Traditional Medicare,966.4 +115939,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,MEDICARE-Traditional Medicare,3069.5 +115940,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,MEDICARE-Traditional Medicare,25930.59 +115941,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,MEDICARE-Traditional Medicare,2277.19 +115942,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,MEDICARE-Traditional Medicare,2452.22 +115943,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,MEDICARE-Traditional Medicare,3037.79 +115944,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,MEDICARE-Traditional Medicare,1585.04 +115945,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,MEDICARE-Traditional Medicare,824.0 +115946,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,MEDICARE-Traditional Medicare,4594.63 +115947,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,MEDICARE-Traditional Medicare,5804.82 +115948,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,MEDICARE-Traditional Medicare,6407.52 +115949,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,MEDICARE-Traditional Medicare,2437.89 +115950,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,MEDICARE-Traditional Medicare,4553.52 +115951,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,MEDICARE-Traditional Medicare,8179.0 +115952,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,MEDICARE-Traditional Medicare, +115953,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,MEDICARE-Traditional Medicare,157.27 +115954,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,MEDICARE-Traditional Medicare,21.83 +115955,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,MEDICARE-Traditional Medicare, +115956,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,MEDICARE-Traditional Medicare,2763.64 +115957,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,MEDICARE-Traditional Medicare, +115958,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,MEDICARE-Traditional Medicare, +115959,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,MEDICARE-Traditional Medicare, +115960,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,MEDICARE-Traditional Medicare,71757.56 +115961,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,MEDICARE-Traditional Medicare,10426.9 +115962,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,MEDICARE-Traditional Medicare,10066.22 +115963,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,MEDICARE-Traditional Medicare,3642.23 +115964,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,MEDICARE-Traditional Medicare,3512.24 +115965,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,MEDICARE-Traditional Medicare, +115966,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,MEDICARE-Traditional Medicare,6187.7 +115967,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,MEDICARE-Traditional Medicare,3523.6 +115968,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,MEDICARE-Traditional Medicare, +115969,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,MEDICARE-Traditional Medicare,1130.02 +115970,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,MEDICARE-Traditional Medicare, +115971,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,MEDICARE-Traditional Medicare,3784.67 +115972,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,MEDICARE-Traditional Medicare,6302.67 +115973,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,MEDICARE-Traditional Medicare,2484.44 +115974,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,MEDICARE-Traditional Medicare,2276.07 +115975,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,MEDICARE-Traditional Medicare,3898.26 +115976,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,MEDICARE-Traditional Medicare,536.22 +115977,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,MEDICARE-Traditional Medicare,534.22 +115978,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,MEDICARE-Traditional Medicare, +115979,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,MEDICARE-Traditional Medicare, +115980,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,MEDICARE-Traditional Medicare,1376.0 +115981,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,MEDICARE-Traditional Medicare,422.2 +115982,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,MEDICARE-Traditional Medicare, +115983,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,MEDICARE-Traditional Medicare,1418.0 +115984,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,MEDICARE-Traditional Medicare, +115985,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,MEDICARE-Traditional Medicare,16200.88 +115986,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,MEDICARE-Traditional Medicare,20424.19 +115987,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,MEDICARE-Traditional Medicare,26162.58 +115988,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,MEDICARE-Traditional Medicare,17928.83 +115989,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,MEDICARE-Traditional Medicare,20086.0 +115990,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,MEDICARE-Traditional Medicare,9577.53 +115991,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,MEDICARE-Traditional Medicare,7780.34 +115992,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,MEDICARE-Traditional Medicare,11513.56 +115993,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,MEDICARE-Traditional Medicare, +115994,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,MEDICARE-Traditional Medicare,2951.67 +115995,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,MEDICARE-Traditional Medicare, +115996,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,MEDICARE-Traditional Medicare, +115997,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,MEDICARE-Traditional Medicare, +115998,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,MEDICARE-Traditional Medicare, +115999,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,MEDICARE-Traditional Medicare,6656.0 +116000,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,MEDICARE-Traditional Medicare,15402.0 +116001,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,MEDICARE-Traditional Medicare,7249.45 +116002,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,MEDICARE-Traditional Medicare,12876.04 +116003,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,MEDICARE-Traditional Medicare, +116004,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,MEDICARE-Traditional Medicare,8208.83 +116005,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,MEDICARE-Traditional Medicare,11411.73 +116006,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,MEDICARE-Traditional Medicare,2881.67 +116007,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,MEDICARE-Traditional Medicare,1886.8 +116008,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,MEDICARE-Traditional Medicare,8403.94 +116009,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,MEDICARE-Traditional Medicare,14624.17 +116010,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,MEDICARE-Traditional Medicare,14568.16 +116011,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,MEDICARE-Traditional Medicare,11311.51 +116012,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,MEDICARE-Traditional Medicare,15793.32 +116013,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,MEDICARE-Traditional Medicare,20806.37 +116014,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,MEDICARE-Traditional Medicare, +116015,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,MEDICARE-Traditional Medicare,3943.38 +116016,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,MEDICARE-Traditional Medicare,7810.77 +116017,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,MEDICARE-Traditional Medicare,22457.5 +116018,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,MEDICARE-Traditional Medicare,3048.25 +116019,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,MEDICARE-Traditional Medicare, +116020,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,MEDICARE-Traditional Medicare,5953.67 +116021,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,MEDICARE-Traditional Medicare,4046.19 +116022,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,MEDICARE-Traditional Medicare, +116023,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,MEDICARE-Traditional Medicare,19009.67 +116024,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,MEDICARE-Traditional Medicare,4541.5 +116025,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,MEDICARE-Traditional Medicare,870.75 +116026,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,MEDICARE-Traditional Medicare,2664.06 +116027,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,MEDICARE-Traditional Medicare,2033.15 +116028,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,MEDICARE-Traditional Medicare,10805.6 +116029,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,MEDICARE-Traditional Medicare, +116030,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,MEDICARE-Traditional Medicare,1267.5 +116031,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,MEDICARE-Traditional Medicare, +116032,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,MEDICARE-Traditional Medicare,19008.39 +116033,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,MEDICARE-Traditional Medicare,19008.39 +116034,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,MEDICARE-Traditional Medicare,19008.39 +116035,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,MEDICARE-Traditional Medicare,19008.39 +116036,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,MEDICARE-Traditional Medicare,14339.68 +116037,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,MEDICARE-Traditional Medicare,14313.29 +116038,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,MEDICARE-Traditional Medicare,14638.78 +116039,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,MEDICARE-Traditional Medicare,12365.58 +116040,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,MEDICARE-Traditional Medicare,2521.82 +116041,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,MEDICARE-Traditional Medicare,8325.05 +116042,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,MEDICARE-Traditional Medicare,10771.59 +116043,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,MEDICARE-Traditional Medicare,8383.08 +116044,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,MEDICARE-Traditional Medicare,19371.44 +116045,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,MEDICARE-Traditional Medicare,30905.26 +116046,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,MEDICARE-Traditional Medicare,30118.29 +116047,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,MEDICARE-Traditional Medicare,33147.68 +116048,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,MEDICARE-Traditional Medicare,39970.61 +116049,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,MEDICARE-Traditional Medicare, +116050,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,MEDICARE-Traditional Medicare, +116051,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,MEDICARE-Traditional Medicare,14542.03 +116052,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,MEDICARE-Traditional Medicare,12978.2 +116053,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,MEDICARE-Traditional Medicare,2131.47 +116054,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,MEDICARE-Traditional Medicare,11932.0 +116055,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,MEDICARE-Traditional Medicare, +116056,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,MEDICARE-Traditional Medicare, +116057,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,MEDICARE-Traditional Medicare,14050.57 +116058,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,MEDICARE-Traditional Medicare, +116059,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,MEDICARE-Traditional Medicare, +116060,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,MEDICARE-Traditional Medicare, +116061,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,MEDICARE-Traditional Medicare, +116062,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,MEDICARE-Traditional Medicare, +116063,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,MEDICARE-Traditional Medicare,14304.57 +116064,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,MEDICARE-Traditional Medicare, +116065,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,MEDICARE-Traditional Medicare, +116066,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,MEDICARE-Traditional Medicare,13685.06 +116067,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,MEDICARE-Traditional Medicare, +116068,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,MEDICARE-Traditional Medicare, +116069,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,MEDICARE-Traditional Medicare, +116070,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,MEDICARE-Traditional Medicare, +116071,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,MEDICARE-Traditional Medicare, +116072,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,MEDICARE-Traditional Medicare,7961.0 +116073,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,MEDICARE-Traditional Medicare, +116074,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,MEDICARE-Traditional Medicare, +116075,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,MEDICARE-Traditional Medicare, +116076,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,MEDICARE-Traditional Medicare, +116077,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,MEDICARE-Traditional Medicare,16084.43 +116078,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,MEDICARE-Traditional Medicare,895.0 +116079,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,MEDICARE-Traditional Medicare, +116080,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,MEDICARE-Traditional Medicare,926.5 +116081,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,MEDICARE-Traditional Medicare, +116082,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,MEDICARE-Traditional Medicare,13035.5 +116083,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,MEDICARE-Traditional Medicare, +116084,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,MEDICARE-Traditional Medicare, +116085,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,MEDICARE-Traditional Medicare, +116086,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,MEDICARE-Traditional Medicare,4429.33 +116087,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,MEDICARE-Traditional Medicare, +116088,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,MEDICARE-Traditional Medicare, +116089,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,MEDICARE-Traditional Medicare, +116090,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,MEDICARE-Traditional Medicare, +116091,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,MEDICARE-Traditional Medicare, +116092,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,MEDICARE-Traditional Medicare, +116093,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,MEDICARE-Traditional Medicare,2996.0 +116094,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,MEDICARE-Traditional Medicare, +116095,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,MEDICARE-Traditional Medicare, +116096,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,MEDICARE-Traditional Medicare, +116097,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,MEDICARE-Traditional Medicare,13802.5 +116098,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,MEDICARE-Traditional Medicare,21949.0 +116099,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,MEDICARE-Traditional Medicare, +116100,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,MEDICARE-Traditional Medicare,12837.07 +116101,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,MEDICARE-Traditional Medicare, +116102,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,MEDICARE-Traditional Medicare,8782.9 +116103,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,MEDICARE-Traditional Medicare, +116104,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,MEDICARE-Traditional Medicare, +116105,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,MEDICARE-Traditional Medicare,18305.62 +116106,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,MEDICARE-Traditional Medicare, +116107,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,MEDICARE-Traditional Medicare, +116108,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,MEDICARE-Traditional Medicare, +116109,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,MEDICARE-Traditional Medicare, +116110,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,MEDICARE-Traditional Medicare, +116111,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,MEDICARE-Traditional Medicare, +116112,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,MEDICARE-Traditional Medicare, +116113,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,MEDICARE-Traditional Medicare, +116114,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,MEDICARE-Traditional Medicare, +116115,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,MEDICARE-Traditional Medicare, +116116,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,MEDICARE-Traditional Medicare,747.0 +116117,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,MEDICARE-Traditional Medicare, +116118,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,MEDICARE-Traditional Medicare, +116119,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,MEDICARE-Traditional Medicare, +116120,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,MEDICARE-Traditional Medicare, +116121,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,MEDICARE-Traditional Medicare, +116122,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,MEDICARE-Traditional Medicare,12998.0 +116123,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,MEDICARE-Traditional Medicare, +116124,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,MEDICARE-Traditional Medicare, +116125,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,MEDICARE-Traditional Medicare,6589.0 +116126,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,MEDICARE-Traditional Medicare,5000.0 +116127,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,MEDICARE-Traditional Medicare,4512.3 +116128,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,MEDICARE-Traditional Medicare,5397.27 +116129,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,MEDICARE-Traditional Medicare,4580.65 +116130,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,MEDICARE-Traditional Medicare,7667.06 +116131,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,MEDICARE-Traditional Medicare,5172.73 +116132,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,MEDICARE-Traditional Medicare,12272.34 +116133,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,MEDICARE-Traditional Medicare,8157.23 +116134,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,MEDICARE-Traditional Medicare,6260.09 +116135,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,MEDICARE-Traditional Medicare,5190.78 +116136,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,MEDICARE-Traditional Medicare,7233.21 +116137,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,MEDICARE-Traditional Medicare,6306.66 +116138,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,MEDICARE-Traditional Medicare,5820.39 +116139,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,MEDICARE-Traditional Medicare,5689.87 +116140,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,MEDICARE-Traditional Medicare,5886.23 +116141,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,MEDICARE-Traditional Medicare,7472.0 +116142,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,MEDICARE-Traditional Medicare,18897.75 +116143,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,MEDICARE-Traditional Medicare,6774.75 +116144,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,MEDICARE-Traditional Medicare,6768.55 +116145,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,MEDICARE-Traditional Medicare,13985.1 +116146,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,MEDICARE-Traditional Medicare,6694.47 +116147,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,MEDICARE-Traditional Medicare,11001.34 +116148,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,MEDICARE-Traditional Medicare,6900.64 +116149,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,MEDICARE-Traditional Medicare,23133.0 +116150,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,MEDICARE-Traditional Medicare,10901.09 +116151,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,MEDICARE-Traditional Medicare,6432.62 +116152,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,MEDICARE-Traditional Medicare,10052.07 +116153,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,MEDICARE-Traditional Medicare,4595.85 +116154,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,MEDICARE-Traditional Medicare,7389.79 +116155,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,MEDICARE-Traditional Medicare,11556.25 +116156,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,MEDICARE-Traditional Medicare,7267.1 +116157,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,MEDICARE-Traditional Medicare, +116158,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,MEDICARE-Traditional Medicare,9783.08 +116159,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,MEDICARE-Traditional Medicare,14676.21 +116160,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,MEDICARE-Traditional Medicare,16564.95 +116161,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,MEDICARE-Traditional Medicare,4669.75 +116162,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,MEDICARE-Traditional Medicare,21208.1 +116163,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,MEDICARE-Traditional Medicare, +116164,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,MEDICARE-Traditional Medicare, +116165,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,MEDICARE-Traditional Medicare,13366.62 +116166,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,MEDICARE-Traditional Medicare,15301.02 +116167,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,MEDICARE-Traditional Medicare, +116168,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,MEDICARE-Traditional Medicare,1052.89 +116169,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,MEDICARE-Traditional Medicare, +116170,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,MEDICARE-Traditional Medicare,10161.14 +116171,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,MEDICARE-Traditional Medicare, +116172,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,MEDICARE-Traditional Medicare, +116173,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,MEDICARE-Traditional Medicare, +116174,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,MEDICARE-Traditional Medicare,15099.33 +116175,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,MEDICARE-Traditional Medicare, +116176,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,MEDICARE-Traditional Medicare, +116177,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,MEDICARE-Traditional Medicare,12468.93 +116178,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,MEDICARE-Traditional Medicare,13567.15 +116179,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,MEDICARE-Traditional Medicare,9033.0 +116180,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,MEDICARE-Traditional Medicare,13998.0 +116181,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,MEDICARE-Traditional Medicare,18090.19 +116182,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,MEDICARE-Traditional Medicare, +116183,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,MEDICARE-Traditional Medicare,10090.0 +116184,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,MEDICARE-Traditional Medicare,19606.0 +116185,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,MEDICARE-Traditional Medicare, +116186,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,MEDICARE-Traditional Medicare, +116187,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,MEDICARE-Traditional Medicare,3419.0 +116188,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,MEDICARE-Traditional Medicare, +116189,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,MEDICARE-Traditional Medicare,6039.0 +116190,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,MEDICARE-Traditional Medicare,9153.0 +116191,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,MEDICARE-Traditional Medicare,8319.0 +116192,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,MEDICARE-Traditional Medicare,9202.0 +116193,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,MEDICARE-Traditional Medicare, +116194,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,MEDICARE-Traditional Medicare,11588.84 +116195,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,MEDICARE-Traditional Medicare,68928.84 +116196,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,MEDICARE-Traditional Medicare, +116197,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,MEDICARE-Traditional Medicare,18444.15 +116198,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,MEDICARE-Traditional Medicare,37884.85 +116199,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,MEDICARE-Traditional Medicare, +116200,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,MEDICARE-Traditional Medicare,11249.0 +116201,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,MEDICARE-Traditional Medicare, +116202,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,MEDICARE-Traditional Medicare, +116203,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,MEDICARE-Traditional Medicare,4385.44 +116204,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,MEDICARE-Traditional Medicare,5475.75 +116205,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,MEDICARE-Traditional Medicare,10217.75 +116206,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,MEDICARE-Traditional Medicare,25275.28 +116207,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,MEDICARE-Traditional Medicare,2985.33 +116208,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,MEDICARE-Traditional Medicare,4452.67 +116209,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,MEDICARE-Traditional Medicare,5857.34 +116210,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,MEDICARE-Traditional Medicare,4647.67 +116211,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,MEDICARE-Traditional Medicare,4150.0 +116212,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,MEDICARE-Traditional Medicare,8872.5 +116213,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,MEDICARE-Traditional Medicare,5574.0 +116214,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,MEDICARE-Traditional Medicare,18604.94 +116215,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,MEDICARE-Traditional Medicare,5837.22 +116216,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,MEDICARE-Traditional Medicare,3786.67 +116217,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,MEDICARE-Traditional Medicare,6437.24 +116218,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,MEDICARE-Traditional Medicare,11572.5 +116219,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,MEDICARE-Traditional Medicare, +116220,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,MEDICARE-Traditional Medicare,7652.5 +116221,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,MEDICARE-Traditional Medicare,8120.5 +116222,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,MEDICARE-Traditional Medicare,6788.05 +116223,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,MEDICARE-Traditional Medicare,6185.56 +116224,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,MEDICARE-Traditional Medicare,28550.0 +116225,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,MEDICARE-Traditional Medicare,10535.3 +116226,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +116227,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,MEDICARE-Traditional Medicare, +116228,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,MEDICARE-Traditional Medicare, +116229,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,MEDICARE-Traditional Medicare, +116230,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,MEDICARE-Traditional Medicare, +116231,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,MEDICARE-Traditional Medicare, +116232,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,MEDICARE-Traditional Medicare,2417.0 +116233,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,MEDICARE-Traditional Medicare, +116234,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,MEDICARE-Traditional Medicare, +116235,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,MEDICARE-Traditional Medicare, +116236,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,MEDICARE-Traditional Medicare, +116237,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,MEDICARE-Traditional Medicare,4356.0 +116238,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,MEDICARE-Traditional Medicare, +116239,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,MEDICARE-Traditional Medicare, +116240,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,MEDICARE-Traditional Medicare, +116241,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,MEDICARE-Traditional Medicare,4356.0 +116242,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,MEDICARE-Traditional Medicare, +116243,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,MEDICARE-Traditional Medicare, +116244,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,MEDICARE-Traditional Medicare, +116245,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,MEDICARE-Traditional Medicare,4356.0 +116246,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,MEDICARE-Traditional Medicare, +116247,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,MEDICARE-Traditional Medicare, +116248,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,MEDICARE-Traditional Medicare,4356.0 +116249,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,MEDICARE-Traditional Medicare, +116250,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,MEDICARE-Traditional Medicare, +116251,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,MEDICARE-Traditional Medicare, +116252,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,MEDICARE-Traditional Medicare, +116253,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,MEDICARE-Traditional Medicare, +116254,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,MEDICARE-Traditional Medicare, +116255,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,MEDICARE-Traditional Medicare, +116256,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,MEDICARE-Traditional Medicare, +116257,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,MEDICARE-Traditional Medicare, +116258,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,MEDICARE-Traditional Medicare, +116259,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,MEDICARE-Traditional Medicare, +116260,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,MEDICARE-Traditional Medicare, +116261,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,MEDICARE-Traditional Medicare, +116262,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,MEDICARE-Traditional Medicare, +116263,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,MEDICARE-Traditional Medicare, +116264,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,MEDICARE-Traditional Medicare, +116265,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,MEDICARE-Traditional Medicare,2280.63 +116266,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,MEDICARE-Traditional Medicare,2178.0 +116267,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,MEDICARE-Traditional Medicare, +116268,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,MEDICARE-Traditional Medicare, +116269,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,MEDICARE-Traditional Medicare, +116270,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,MEDICARE-Traditional Medicare, +116271,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,MEDICARE-Traditional Medicare, +116272,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,MEDICARE-Traditional Medicare, +116273,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,MEDICARE-Traditional Medicare,8714.4 +116274,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,MEDICARE-Traditional Medicare, +116275,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,MEDICARE-Traditional Medicare, +116276,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,MEDICARE-Traditional Medicare, +116277,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,MEDICARE-Traditional Medicare, +116278,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,MEDICARE-Traditional Medicare, +116279,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,MEDICARE-Traditional Medicare, +116280,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,MEDICARE-Traditional Medicare,3996.0 +116281,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,MEDICARE-Traditional Medicare, +116282,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,MEDICARE-Traditional Medicare, +116283,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,MEDICARE-Traditional Medicare, +116284,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,MEDICARE-Traditional Medicare, +116285,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,MEDICARE-Traditional Medicare,9012.0 +116286,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,MEDICARE-Traditional Medicare, +116287,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,MEDICARE-Traditional Medicare, +116288,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,MEDICARE-Traditional Medicare, +116289,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,MEDICARE-Traditional Medicare, +116290,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,MEDICARE-Traditional Medicare, +116291,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,MEDICARE-Traditional Medicare, +116292,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,MEDICARE-Traditional Medicare, +116293,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,MEDICARE-Traditional Medicare, +116294,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,MEDICARE-Traditional Medicare, +116295,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,MEDICARE-Traditional Medicare, +116296,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,MEDICARE-Traditional Medicare, +116297,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,MEDICARE-Traditional Medicare,4176.0 +116298,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,MEDICARE-Traditional Medicare, +116299,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,MEDICARE-Traditional Medicare, +116300,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,MEDICARE-Traditional Medicare, +116301,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,MEDICARE-Traditional Medicare, +116302,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,MEDICARE-Traditional Medicare, +116303,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,MEDICARE-Traditional Medicare, +116304,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,MEDICARE-Traditional Medicare, +116305,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,MEDICARE-Traditional Medicare, +116306,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,MEDICARE-Traditional Medicare, +116307,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,MEDICARE-Traditional Medicare,3603.33 +116308,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,MEDICARE-Traditional Medicare,3996.0 +116309,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,MEDICARE-Traditional Medicare,4356.0 +116310,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,MEDICARE-Traditional Medicare, +116311,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,MEDICARE-Traditional Medicare,4266.0 +116312,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,MEDICARE-Traditional Medicare, +116313,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,MEDICARE-Traditional Medicare, +116314,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,MEDICARE-Traditional Medicare, +116315,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,MEDICARE-Traditional Medicare,2178.0 +116316,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,MEDICARE-Traditional Medicare, +116317,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,MEDICARE-Traditional Medicare, +116318,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,MEDICARE-Traditional Medicare, +116319,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,MEDICARE-Traditional Medicare,4176.0 +116320,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,MEDICARE-Traditional Medicare, +116321,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,MEDICARE-Traditional Medicare, +116322,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,MEDICARE-Traditional Medicare, +116323,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,MEDICARE-Traditional Medicare,11514.51 +116324,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,MEDICARE-Traditional Medicare,11890.5 +116325,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,MEDICARE-Traditional Medicare,8304.5 +116326,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,MEDICARE-Traditional Medicare, +116327,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,MEDICARE-Traditional Medicare,8268.0 +116328,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,MEDICARE-Traditional Medicare, +116329,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,MEDICARE-Traditional Medicare, +116330,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,MEDICARE-Traditional Medicare,4356.0 +116331,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,MEDICARE-Traditional Medicare, +116332,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,MEDICARE-Traditional Medicare,3996.0 +116333,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,MEDICARE-Traditional Medicare, +116334,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,MEDICARE-Traditional Medicare, +116335,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,MEDICARE-Traditional Medicare, +116336,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,MEDICARE-Traditional Medicare,4356.0 +116337,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,MEDICARE-Traditional Medicare,4356.0 +116338,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,MEDICARE-Traditional Medicare, +116339,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,MEDICARE-Traditional Medicare, +116340,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,MEDICARE-Traditional Medicare, +116341,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,MEDICARE-Traditional Medicare,4176.0 +116342,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,MEDICARE-Traditional Medicare, +116343,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,MEDICARE-Traditional Medicare,9012.0 +116344,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,MEDICARE-Traditional Medicare, +116345,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,MEDICARE-Traditional Medicare, +116346,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,MEDICARE-Traditional Medicare, +116347,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,MEDICARE-Traditional Medicare,10900.0 +116348,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,MEDICARE-Traditional Medicare, +116349,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,MEDICARE-Traditional Medicare, +116350,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,MEDICARE-Traditional Medicare, +116351,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,MEDICARE-Traditional Medicare, +116352,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,MEDICARE-Traditional Medicare, +116353,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,MEDICARE-Traditional Medicare, +116354,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,MEDICARE-Traditional Medicare,5301.0 +116355,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,MEDICARE-Traditional Medicare, +116356,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,MEDICARE-Traditional Medicare, +116357,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,MEDICARE-Traditional Medicare,1998.0 +116358,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,MEDICARE-Traditional Medicare, +116359,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,MEDICARE-Traditional Medicare, +116360,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,MEDICARE-Traditional Medicare, +116361,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,MEDICARE-Traditional Medicare, +116362,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,MEDICARE-Traditional Medicare, +116363,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,MEDICARE-Traditional Medicare,3996.0 +116364,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,MEDICARE-Traditional Medicare, +116365,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,MEDICARE-Traditional Medicare,4059.26 +116366,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,MEDICARE-Traditional Medicare, +116367,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,MEDICARE-Traditional Medicare,2530.5 +116368,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,MEDICARE-Traditional Medicare, +116369,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,MEDICARE-Traditional Medicare, +116370,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,MEDICARE-Traditional Medicare,733.5 +116371,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,MEDICARE-Traditional Medicare,382.5 +116372,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,MEDICARE-Traditional Medicare, +116373,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,MEDICARE-Traditional Medicare,2001.28 +116374,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,MEDICARE-Traditional Medicare,3390.3 +116375,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,MEDICARE-Traditional Medicare, +116376,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,MEDICARE-Traditional Medicare, +116377,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,MEDICARE-Traditional Medicare,3162.93 +116378,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,MEDICARE-Traditional Medicare, +116379,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,MEDICARE-Traditional Medicare, +116380,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,MEDICARE-Traditional Medicare,4356.0 +116381,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,MEDICARE-Traditional Medicare,2182.63 +116382,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,MEDICARE-Traditional Medicare, +116383,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,MEDICARE-Traditional Medicare, +116384,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,MEDICARE-Traditional Medicare, +116385,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,MEDICARE-Traditional Medicare, +116386,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,MEDICARE-Traditional Medicare, +116387,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,MEDICARE-Traditional Medicare, +116388,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,MEDICARE-Traditional Medicare, +116389,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,MEDICARE-Traditional Medicare,4176.0 +116390,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,MEDICARE-Traditional Medicare, +116391,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,MEDICARE-Traditional Medicare,3996.0 +116392,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,MEDICARE-Traditional Medicare, +116393,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,MEDICARE-Traditional Medicare, +116394,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,MEDICARE-Traditional Medicare,2904.0 +116395,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,MEDICARE-Traditional Medicare, +116396,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,MEDICARE-Traditional Medicare, +116397,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,MEDICARE-Traditional Medicare,2814.0 +116398,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,MEDICARE-Traditional Medicare, +116399,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,MEDICARE-Traditional Medicare, +116400,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,MEDICARE-Traditional Medicare,6534.0 +116401,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,MEDICARE-Traditional Medicare,4356.0 +116402,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,MEDICARE-Traditional Medicare,6264.0 +116403,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,MEDICARE-Traditional Medicare, +116404,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,MEDICARE-Traditional Medicare, +116405,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,MEDICARE-Traditional Medicare,4054.59 +116406,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,MEDICARE-Traditional Medicare,488.65 +116407,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,MEDICARE-Traditional Medicare,3538.22 +116408,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,MEDICARE-Traditional Medicare, +116409,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,MEDICARE-Traditional Medicare,3147.0 +116410,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,MEDICARE-Traditional Medicare, +116411,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,MEDICARE-Traditional Medicare,4176.0 +116412,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,MEDICARE-Traditional Medicare,4356.0 +116413,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,MEDICARE-Traditional Medicare,3996.0 +116414,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,MEDICARE-Traditional Medicare, +116415,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,MEDICARE-Traditional Medicare,3996.0 +116416,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,MEDICARE-Traditional Medicare, +116417,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,MEDICARE-Traditional Medicare, +116418,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,MEDICARE-Traditional Medicare, +116419,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,MEDICARE-Traditional Medicare, +116420,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,MEDICARE-Traditional Medicare, +116421,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,MEDICARE-Traditional Medicare,1998.0 +116422,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,MEDICARE-Traditional Medicare, +116423,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,MEDICARE-Traditional Medicare, +116424,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,MEDICARE-Traditional Medicare, +116425,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,MEDICARE-Traditional Medicare, +116426,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,MEDICARE-Traditional Medicare, +116427,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,MEDICARE-Traditional Medicare, +116428,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,MEDICARE-Traditional Medicare, +116429,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,MEDICARE-Traditional Medicare, +116430,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,MEDICARE-Traditional Medicare, +116431,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,MEDICARE-Traditional Medicare,4356.0 +116432,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,MEDICARE-Traditional Medicare,3267.0 +116433,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,MEDICARE-Traditional Medicare,3996.0 +116434,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,MEDICARE-Traditional Medicare, +116435,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,MEDICARE-Traditional Medicare, +116436,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,MEDICARE-Traditional Medicare,4356.0 +116437,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,MEDICARE-Traditional Medicare, +116438,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,MEDICARE-Traditional Medicare, +116439,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,MEDICARE-Traditional Medicare, +116440,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,MEDICARE-Traditional Medicare,4356.0 +116441,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,MEDICARE-Traditional Medicare, +116442,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,MEDICARE-Traditional Medicare, +116443,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,MEDICARE-Traditional Medicare, +116444,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,MEDICARE-Traditional Medicare, +116445,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,MEDICARE-Traditional Medicare, +116446,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,MEDICARE-Traditional Medicare, +116447,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,MEDICARE-Traditional Medicare, +116448,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,MEDICARE-Traditional Medicare, +116449,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,MEDICARE-Traditional Medicare, +116450,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,MEDICARE-Traditional Medicare, +116451,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,MEDICARE-Traditional Medicare, +116452,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,MEDICARE-Traditional Medicare, +116453,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,MEDICARE-Traditional Medicare,3996.0 +116454,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,MEDICARE-Traditional Medicare,3206.5 +116455,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,MEDICARE-Traditional Medicare,1686.84 +116456,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,MEDICARE-Traditional Medicare,4356.0 +116457,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,MEDICARE-Traditional Medicare, +116458,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,MEDICARE-Traditional Medicare,2766.75 +116459,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,MEDICARE-Traditional Medicare,8268.0 +116460,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,MEDICARE-Traditional Medicare, +116461,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,MEDICARE-Traditional Medicare, +116462,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,MEDICARE-Traditional Medicare,2677.5 +116463,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,MEDICARE-Traditional Medicare, +116464,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,MEDICARE-Traditional Medicare,3177.0 +116465,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,MEDICARE-Traditional Medicare, +116466,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,MEDICARE-Traditional Medicare, +116467,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,MEDICARE-Traditional Medicare, +116468,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,MEDICARE-Traditional Medicare, +116469,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,MEDICARE-Traditional Medicare, +116470,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,MEDICARE-Traditional Medicare,3766.5 +116471,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,MEDICARE-Traditional Medicare,4356.0 +116472,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,MEDICARE-Traditional Medicare, +116473,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,MEDICARE-Traditional Medicare, +116474,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,MEDICARE-Traditional Medicare,4236.0 +116475,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,MEDICARE-Traditional Medicare, +116476,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,MEDICARE-Traditional Medicare, +116477,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,MEDICARE-Traditional Medicare,10454.25 +116478,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,MEDICARE-Traditional Medicare, +116479,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,MEDICARE-Traditional Medicare,3303.75 +116480,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,MEDICARE-Traditional Medicare, +116481,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,MEDICARE-Traditional Medicare,1196.0 +116482,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,MEDICARE-Traditional Medicare, +116483,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,MEDICARE-Traditional Medicare, +116484,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,MEDICARE-Traditional Medicare, +116485,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,MEDICARE-Traditional Medicare, +116486,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,MEDICARE-Traditional Medicare, +116487,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,MEDICARE-Traditional Medicare, +116488,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,MEDICARE-Traditional Medicare, +116489,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,MEDICARE-Traditional Medicare,3996.0 +116490,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,MEDICARE-Traditional Medicare, +116491,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,MEDICARE-Traditional Medicare, +116492,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,MEDICARE-Traditional Medicare, +116493,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,MEDICARE-Traditional Medicare, +116494,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,MEDICARE-Traditional Medicare, +116495,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,MEDICARE-Traditional Medicare, +116496,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,MEDICARE-Traditional Medicare, +116497,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,MEDICARE-Traditional Medicare, +116498,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,MEDICARE-Traditional Medicare, +116499,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,MEDICARE-Traditional Medicare, +116500,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,MEDICARE-Traditional Medicare, +116501,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,MEDICARE-Traditional Medicare, +116502,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,MEDICARE-Traditional Medicare,4359.44 +116503,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,MEDICARE-Traditional Medicare, +116504,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,MEDICARE-Traditional Medicare, +116505,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,MEDICARE-Traditional Medicare, +116506,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,MEDICARE-Traditional Medicare,3996.0 +116507,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,MEDICARE-Traditional Medicare, +116508,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,MEDICARE-Traditional Medicare,1398.47 +116509,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,MEDICARE-Traditional Medicare, +116510,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,MEDICARE-Traditional Medicare, +116511,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,MEDICARE-Traditional Medicare,7520.54 +116512,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,MEDICARE-Traditional Medicare, +116513,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,MEDICARE-Traditional Medicare, +116514,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,MEDICARE-Traditional Medicare,5546.0 +116515,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,MEDICARE-Traditional Medicare, +116516,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,MEDICARE-Traditional Medicare, +116517,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,MEDICARE-Traditional Medicare, +116518,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,MEDICARE-Traditional Medicare, +116519,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,MEDICARE-Traditional Medicare, +116520,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,MEDICARE-Traditional Medicare, +116521,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,MEDICARE-Traditional Medicare, +116522,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,MEDICARE-Traditional Medicare, +116523,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,MEDICARE-Traditional Medicare, +116524,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,MEDICARE-Traditional Medicare,3338.25 +116525,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,MEDICARE-Traditional Medicare, +116526,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,MEDICARE-Traditional Medicare, +116527,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,MEDICARE-Traditional Medicare, +116528,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,MEDICARE-Traditional Medicare, +116529,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,MEDICARE-Traditional Medicare,1262.25 +116530,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,MEDICARE-Traditional Medicare, +116531,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,MEDICARE-Traditional Medicare, +116532,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,MEDICARE-Traditional Medicare, +116533,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,MEDICARE-Traditional Medicare,2088.0 +116534,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,MEDICARE-Traditional Medicare,1200.0 +116535,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,MEDICARE-Traditional Medicare,4356.0 +116536,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,MEDICARE-Traditional Medicare,3996.0 +116537,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,MEDICARE-Traditional Medicare,3996.0 +116538,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,MEDICARE-Traditional Medicare, +116539,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,MEDICARE-Traditional Medicare, +116540,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,MEDICARE-Traditional Medicare,1998.0 +116541,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,MEDICARE-Traditional Medicare,2088.0 +116542,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,MEDICARE-Traditional Medicare, +116543,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,MEDICARE-Traditional Medicare, +116544,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,MEDICARE-Traditional Medicare,3996.0 +116545,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,MEDICARE-Traditional Medicare, +116546,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,MEDICARE-Traditional Medicare,9015.28 +116547,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,MEDICARE-Traditional Medicare, +116548,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,MEDICARE-Traditional Medicare,9013.54 +116549,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,MEDICARE-Traditional Medicare,12254.5 +116550,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,MEDICARE-Traditional Medicare, +116551,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,MEDICARE-Traditional Medicare, +116552,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,MEDICARE-Traditional Medicare, +116553,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,MEDICARE-Traditional Medicare,4382.0 +116554,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,MEDICARE-Traditional Medicare,12084.43 +116555,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,MEDICARE-Traditional Medicare, +116556,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,MEDICARE-Traditional Medicare, +116557,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,MEDICARE-Traditional Medicare,7431.38 +116558,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,MEDICARE-Traditional Medicare, +116559,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,MEDICARE-Traditional Medicare,8640.39 +116560,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,MEDICARE-Traditional Medicare, +116561,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,MEDICARE-Traditional Medicare,11567.12 +116562,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,MEDICARE-Traditional Medicare,8271.28 +116563,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,MEDICARE-Traditional Medicare, +116564,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,MEDICARE-Traditional Medicare, +116565,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,MEDICARE-Traditional Medicare,7791.89 +116566,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,MEDICARE-Traditional Medicare,5574.0 +116567,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,MEDICARE-Traditional Medicare, +116568,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,MEDICARE-Traditional Medicare, +116569,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,MEDICARE-Traditional Medicare, +116570,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,MEDICARE-Traditional Medicare, +116571,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,MEDICARE-Traditional Medicare, +116572,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,MEDICARE-Traditional Medicare, +116573,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,MEDICARE-Traditional Medicare, +116574,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,MEDICARE-Traditional Medicare, +116575,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,MEDICARE-Traditional Medicare,695.09 +116576,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,MEDICARE-Traditional Medicare, +116577,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,MEDICARE-Traditional Medicare, +116578,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,MEDICARE-Traditional Medicare, +116579,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,MEDICARE-Traditional Medicare, +116580,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,MEDICARE-Traditional Medicare,4000.91 +116581,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +116582,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,MEDICARE-Traditional Medicare, +116583,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,MEDICARE-Traditional Medicare,3998.46 +116584,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,MEDICARE-Traditional Medicare, +116585,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,MEDICARE-Traditional Medicare, +116586,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +116587,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +116588,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,MEDICARE-Traditional Medicare,3996.0 +116589,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,MEDICARE-Traditional Medicare,3172.62 +116590,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,MEDICARE-Traditional Medicare, +116591,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,MEDICARE-Traditional Medicare, +116592,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,MEDICARE-Traditional Medicare,3413.28 +116593,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,MEDICARE-Traditional Medicare,3996.0 +116594,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,MEDICARE-Traditional Medicare, +116595,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,MEDICARE-Traditional Medicare, +116596,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,MEDICARE-Traditional Medicare, +116597,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,MEDICARE-Traditional Medicare,4116.0 +116598,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,MEDICARE-Traditional Medicare, +116599,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,MEDICARE-Traditional Medicare,4356.0 +116600,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,MEDICARE-Traditional Medicare,4176.0 +116601,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,MEDICARE-Traditional Medicare, +116602,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,MEDICARE-Traditional Medicare, +116603,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,MEDICARE-Traditional Medicare, +116604,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,MEDICARE-Traditional Medicare,4356.0 +116605,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,MEDICARE-Traditional Medicare,2178.0 +116606,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,MEDICARE-Traditional Medicare, +116607,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,MEDICARE-Traditional Medicare, +116608,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,MEDICARE-Traditional Medicare, +116609,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,MEDICARE-Traditional Medicare, +116610,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,MEDICARE-Traditional Medicare,1089.0 +116611,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,MEDICARE-Traditional Medicare, +116612,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,MEDICARE-Traditional Medicare, +116613,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,MEDICARE-Traditional Medicare, +116614,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,MEDICARE-Traditional Medicare, +116615,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,MEDICARE-Traditional Medicare, +116616,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,MEDICARE-Traditional Medicare,4356.0 +116617,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,MEDICARE-Traditional Medicare,2326.5 +116618,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,MEDICARE-Traditional Medicare, +116619,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,MEDICARE-Traditional Medicare, +116620,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,MEDICARE-Traditional Medicare,4356.0 +116621,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,MEDICARE-Traditional Medicare, +116622,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,MEDICARE-Traditional Medicare,4356.0 +116623,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +116624,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,MEDICARE-Traditional Medicare,4356.0 +116625,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,MEDICARE-Traditional Medicare, +116626,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,MEDICARE-Traditional Medicare, +116627,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,MEDICARE-Traditional Medicare, +116628,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,MEDICARE-Traditional Medicare, +116629,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,MEDICARE-Traditional Medicare,25721.0 +116630,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,MEDICARE-Traditional Medicare, +116631,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,MEDICARE-Traditional Medicare, +116632,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,MEDICARE-Traditional Medicare, +116633,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,MEDICARE-Traditional Medicare, +116634,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,MEDICARE-Traditional Medicare,4356.0 +116635,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,MEDICARE-Traditional Medicare,2178.0 +116636,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,MEDICARE-Traditional Medicare, +116637,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,MEDICARE-Traditional Medicare, +116638,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,MEDICARE-Traditional Medicare, +116639,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,MEDICARE-Traditional Medicare, +116640,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,MEDICARE-Traditional Medicare, +116641,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,MEDICARE-Traditional Medicare, +116642,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,MEDICARE-Traditional Medicare, +116643,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,MEDICARE-Traditional Medicare, +116644,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,MEDICARE-Traditional Medicare, +116645,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,MEDICARE-Traditional Medicare, +116646,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,MEDICARE-Traditional Medicare, +116647,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,MEDICARE-Traditional Medicare, +116648,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,MEDICARE-Traditional Medicare, +116649,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,MEDICARE-Traditional Medicare, +116650,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,MEDICARE-Traditional Medicare, +116651,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,MEDICARE-Traditional Medicare, +116652,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,MEDICARE-Traditional Medicare, +116653,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,MEDICARE-Traditional Medicare, +116654,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,MEDICARE-Traditional Medicare,4090.2 +116655,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,MEDICARE-Traditional Medicare,2178.0 +116656,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,MEDICARE-Traditional Medicare, +116657,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,MEDICARE-Traditional Medicare, +116658,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,MEDICARE-Traditional Medicare, +116659,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,MEDICARE-Traditional Medicare, +116660,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,MEDICARE-Traditional Medicare, +116661,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,MEDICARE-Traditional Medicare, +116662,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,MEDICARE-Traditional Medicare, +116663,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,MEDICARE-Traditional Medicare, +116664,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,MEDICARE-Traditional Medicare, +116665,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,MEDICARE-Traditional Medicare, +116666,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,MEDICARE-Traditional Medicare, +116667,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,MEDICARE-Traditional Medicare,47625.74 +116668,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,MEDICARE-Traditional Medicare,4500.0 +116669,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,MEDICARE-Traditional Medicare, +116670,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,MEDICARE-Traditional Medicare, +116671,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,MEDICARE-Traditional Medicare, +116672,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,MEDICARE-Traditional Medicare, +116673,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,MEDICARE-Traditional Medicare,2997.0 +116674,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,MEDICARE-Traditional Medicare,2178.0 +116675,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,MEDICARE-Traditional Medicare, +116676,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,MEDICARE-Traditional Medicare, +116677,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,MEDICARE-Traditional Medicare, +116678,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,MEDICARE-Traditional Medicare, +116679,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,MEDICARE-Traditional Medicare,6534.0 +116680,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,MEDICARE-Traditional Medicare,2178.0 +116681,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,MEDICARE-Traditional Medicare,999.0 +116682,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,MEDICARE-Traditional Medicare,1107.0 +116683,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,MEDICARE-Traditional Medicare, +116684,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,MEDICARE-Traditional Medicare, +116685,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,MEDICARE-Traditional Medicare, +116686,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,MEDICARE-Traditional Medicare, +116687,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,MEDICARE-Traditional Medicare, +116688,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,MEDICARE-Traditional Medicare,1089.0 +116689,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,MEDICARE-Traditional Medicare, +116690,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,MEDICARE-Traditional Medicare,3267.0 +116691,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,MEDICARE-Traditional Medicare, +116692,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,MEDICARE-Traditional Medicare, +116693,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,MEDICARE-Traditional Medicare,2826.0 +116694,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,MEDICARE-Traditional Medicare, +116695,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,MEDICARE-Traditional Medicare,3510.0 +116696,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,MEDICARE-Traditional Medicare,1089.0 +116697,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,MEDICARE-Traditional Medicare,1998.0 +116698,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,MEDICARE-Traditional Medicare, +116699,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,MEDICARE-Traditional Medicare,3996.0 +116700,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,MEDICARE-Traditional Medicare, +116701,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,MEDICARE-Traditional Medicare, +116702,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,MEDICARE-Traditional Medicare, +116703,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,MEDICARE-Traditional Medicare, +116704,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,MEDICARE-Traditional Medicare, +116705,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,MEDICARE-Traditional Medicare, +116706,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,MEDICARE-Traditional Medicare, +116707,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,MEDICARE-Traditional Medicare, +116708,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,MEDICARE-Traditional Medicare, +116709,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,MEDICARE-Traditional Medicare,1075.7 +116710,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,MEDICARE-Traditional Medicare, +116711,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,MEDICARE-Traditional Medicare, +116712,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,MEDICARE-Traditional Medicare, +116713,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,MEDICARE-Traditional Medicare, +116714,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,MEDICARE-Traditional Medicare, +116715,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,MEDICARE-Traditional Medicare, +116716,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,MEDICARE-Traditional Medicare, +116717,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,MEDICARE-Traditional Medicare, +116718,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,MEDICARE-Traditional Medicare, +116719,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,MEDICARE-Traditional Medicare, +116720,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,MEDICARE-Traditional Medicare, +116721,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,MEDICARE-Traditional Medicare, +116722,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,MEDICARE-Traditional Medicare, +116723,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,MEDICARE-Traditional Medicare, +116724,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,MEDICARE-Traditional Medicare, +116725,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,MEDICARE-Traditional Medicare, +116726,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,MEDICARE-Traditional Medicare, +116727,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,MEDICARE-Traditional Medicare, +116728,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,MEDICARE-Traditional Medicare, +116729,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,MEDICARE-Traditional Medicare, +116730,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,MEDICARE-Traditional Medicare, +116731,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,MEDICARE-Traditional Medicare, +116732,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,MEDICARE-Traditional Medicare, +116733,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,MEDICARE-Traditional Medicare, +116734,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,MEDICARE-Traditional Medicare, +116735,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,MEDICARE-Traditional Medicare, +116736,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,MEDICARE-Traditional Medicare, +116737,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,MEDICARE-Traditional Medicare, +116738,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,MEDICARE-Traditional Medicare, +116739,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,MEDICARE-Traditional Medicare, +116740,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,MEDICARE-Traditional Medicare,4357.59 +116741,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,MEDICARE-Traditional Medicare, +116742,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,MEDICARE-Traditional Medicare, +116743,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,MEDICARE-Traditional Medicare, +116744,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,MEDICARE-Traditional Medicare, +116745,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,MEDICARE-Traditional Medicare, +116746,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,MEDICARE-Traditional Medicare, +116747,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,MEDICARE-Traditional Medicare, +116748,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,MEDICARE-Traditional Medicare, +116749,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,MEDICARE-Traditional Medicare, +116750,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,MEDICARE-Traditional Medicare, +116751,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,MEDICARE-Traditional Medicare, +116752,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,MEDICARE-Traditional Medicare, +116753,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,MEDICARE-Traditional Medicare, +116754,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,MEDICARE-Traditional Medicare, +116755,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,MEDICARE-Traditional Medicare, +116756,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,MEDICARE-Traditional Medicare, +116757,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,MEDICARE-Traditional Medicare, +116758,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,MEDICARE-Traditional Medicare,4176.0 +116759,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,MEDICARE-Traditional Medicare,4176.0 +116760,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,MEDICARE-Traditional Medicare, +116761,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,MEDICARE-Traditional Medicare, +116762,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,MEDICARE-Traditional Medicare, +116763,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,MEDICARE-Traditional Medicare, +116764,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,MEDICARE-Traditional Medicare, +116765,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,MEDICARE-Traditional Medicare, +116766,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,MEDICARE-Traditional Medicare, +116767,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,MEDICARE-Traditional Medicare, +116768,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,MEDICARE-Traditional Medicare,3996.0 +116769,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,MEDICARE-Traditional Medicare, +116770,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,MEDICARE-Traditional Medicare, +116771,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,MEDICARE-Traditional Medicare, +116772,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,MEDICARE-Traditional Medicare,4356.0 +116773,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,MEDICARE-Traditional Medicare, +116774,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,MEDICARE-Traditional Medicare, +116775,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,MEDICARE-Traditional Medicare, +116776,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,MEDICARE-Traditional Medicare, +116777,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,MEDICARE-Traditional Medicare, +116778,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,MEDICARE-Traditional Medicare, +116779,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,MEDICARE-Traditional Medicare,3207.0 +116780,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,MEDICARE-Traditional Medicare, +116781,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,MEDICARE-Traditional Medicare,3996.0 +116782,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,MEDICARE-Traditional Medicare, +116783,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,MEDICARE-Traditional Medicare, +116784,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,MEDICARE-Traditional Medicare, +116785,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,MEDICARE-Traditional Medicare, +116786,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,MEDICARE-Traditional Medicare, +116787,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,MEDICARE-Traditional Medicare, +116788,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,MEDICARE-Traditional Medicare, +116789,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,MEDICARE-Traditional Medicare, +116790,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,MEDICARE-Traditional Medicare, +116791,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,MEDICARE-Traditional Medicare,3267.0 +116792,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,MEDICARE-Traditional Medicare, +116793,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,MEDICARE-Traditional Medicare, +116794,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,MEDICARE-Traditional Medicare, +116795,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,MEDICARE-Traditional Medicare, +116796,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,MEDICARE-Traditional Medicare, +116797,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,MEDICARE-Traditional Medicare,3996.0 +116798,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,MEDICARE-Traditional Medicare, +116799,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,MEDICARE-Traditional Medicare, +116800,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,MEDICARE-Traditional Medicare, +116801,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,MEDICARE-Traditional Medicare,3996.0 +116802,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,MEDICARE-Traditional Medicare, +116803,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,MEDICARE-Traditional Medicare, +116804,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,MEDICARE-Traditional Medicare, +116805,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,MEDICARE-Traditional Medicare, +116806,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,MEDICARE-Traditional Medicare, +116807,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,MEDICARE-Traditional Medicare, +116808,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,MEDICARE-Traditional Medicare, +116809,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,MEDICARE-Traditional Medicare, +116810,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,MEDICARE-Traditional Medicare, +116811,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,MEDICARE-Traditional Medicare,4356.0 +116812,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,MEDICARE-Traditional Medicare, +116813,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,MEDICARE-Traditional Medicare,3996.0 +116814,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,MEDICARE-Traditional Medicare, +116815,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,MEDICARE-Traditional Medicare, +116816,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,MEDICARE-Traditional Medicare, +116817,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,MEDICARE-Traditional Medicare, +116818,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,MEDICARE-Traditional Medicare, +116819,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,MEDICARE-Traditional Medicare, +116820,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,MEDICARE-Traditional Medicare, +116821,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,MEDICARE-Traditional Medicare, +116822,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,MEDICARE-Traditional Medicare, +116823,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,MEDICARE-Traditional Medicare, +116824,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,MEDICARE-Traditional Medicare, +116825,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,MEDICARE-Traditional Medicare, +116826,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,MEDICARE-Traditional Medicare, +116827,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,MEDICARE-Traditional Medicare, +116828,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,MEDICARE-Traditional Medicare, +116829,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,MEDICARE-Traditional Medicare, +116830,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,MEDICARE-Traditional Medicare, +116831,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,MEDICARE-Traditional Medicare, +116832,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,MEDICARE-Traditional Medicare, +116833,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,MEDICARE-Traditional Medicare, +116834,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,MEDICARE-Traditional Medicare, +116835,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,MEDICARE-Traditional Medicare, +116836,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,MEDICARE-Traditional Medicare, +116837,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,MEDICARE-Traditional Medicare, +116838,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,MEDICARE-Traditional Medicare,4183.2 +116839,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,MEDICARE-Traditional Medicare, +116840,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,MEDICARE-Traditional Medicare, +116841,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,MEDICARE-Traditional Medicare, +116842,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,MEDICARE-Traditional Medicare, +116843,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,MEDICARE-Traditional Medicare, +116844,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,MEDICARE-Traditional Medicare, +116845,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,MEDICARE-Traditional Medicare, +116846,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,MEDICARE-Traditional Medicare, +116847,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,MEDICARE-Traditional Medicare, +116848,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,MEDICARE-Traditional Medicare, +116849,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,MEDICARE-Traditional Medicare, +116850,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,MEDICARE-Traditional Medicare, +116851,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,MEDICARE-Traditional Medicare, +116852,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,MEDICARE-Traditional Medicare,1261.33 +116853,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,MEDICARE-Traditional Medicare, +116854,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,MEDICARE-Traditional Medicare, +116855,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,MEDICARE-Traditional Medicare, +116856,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,MEDICARE-Traditional Medicare, +116857,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,MEDICARE-Traditional Medicare, +116858,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,MEDICARE-Traditional Medicare,311.67 +116859,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,MEDICARE-Traditional Medicare,1309.05 +116860,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,MEDICARE-Traditional Medicare, +116861,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,MEDICARE-Traditional Medicare, +116862,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,MEDICARE-Traditional Medicare,1250.0 +116863,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,MEDICARE-Traditional Medicare, +116864,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,MEDICARE-Traditional Medicare, +116865,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,MEDICARE-Traditional Medicare,2386.33 +116866,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,MEDICARE-Traditional Medicare,2022.77 +116867,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,MEDICARE-Traditional Medicare, +116868,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,MEDICARE-Traditional Medicare,1250.0 +116869,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,MEDICARE-Traditional Medicare,1250.0 +116870,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,MEDICARE-Traditional Medicare, +116871,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,MEDICARE-Traditional Medicare,2701.81 +116872,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,MEDICARE-Traditional Medicare,2591.21 +116873,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,MEDICARE-Traditional Medicare,2049.0 +116874,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,MEDICARE-Traditional Medicare,1880.0 +116875,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,MEDICARE-Traditional Medicare,1917.0 +116876,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,MEDICARE-Traditional Medicare, +116877,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,MEDICARE-Traditional Medicare, +116878,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,MEDICARE-Traditional Medicare,3929.0 +116879,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,MEDICARE-Traditional Medicare, +116880,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,MEDICARE-Traditional Medicare,2200.61 +116881,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,MEDICARE-Traditional Medicare, +116882,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,MEDICARE-Traditional Medicare,2075.82 +116883,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,MEDICARE-Traditional Medicare, +116884,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,MEDICARE-Traditional Medicare,800.28 +116885,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,MEDICARE-Traditional Medicare,503.45 +116886,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,MEDICARE-Traditional Medicare,486.5 +116887,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,MEDICARE-Traditional Medicare,813.0 +116888,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,MEDICARE-Traditional Medicare, +116889,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,MEDICARE-Traditional Medicare, +116890,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,MEDICARE-Traditional Medicare, +116891,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,MEDICARE-Traditional Medicare, +116892,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,MEDICARE-Traditional Medicare,1302.5 +116893,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,MEDICARE-Traditional Medicare,2526.44 +116894,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,MEDICARE-Traditional Medicare, +116895,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,MEDICARE-Traditional Medicare, +116896,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,MEDICARE-Traditional Medicare,1252.54 +116897,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,MEDICARE-Traditional Medicare, +116898,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,MEDICARE-Traditional Medicare, +116899,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,MEDICARE-Traditional Medicare,2049.0 +116900,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,MEDICARE-Traditional Medicare,261.54 +116901,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,MEDICARE-Traditional Medicare,422.74 +116902,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,MEDICARE-Traditional Medicare,625.75 +116903,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,MEDICARE-Traditional Medicare,736.5 +116904,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,MEDICARE-Traditional Medicare,371.67 +116905,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,MEDICARE-Traditional Medicare, +116906,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,MEDICARE-Traditional Medicare, +116907,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,MEDICARE-Traditional Medicare,286.25 +116908,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,MEDICARE-Traditional Medicare,483.29 +116909,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,MEDICARE-Traditional Medicare, +116910,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,MEDICARE-Traditional Medicare,483.75 +116911,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,MEDICARE-Traditional Medicare,469.45 +116912,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,MEDICARE-Traditional Medicare,830.45 +116913,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,MEDICARE-Traditional Medicare, +116914,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,MEDICARE-Traditional Medicare,2543.5 +116915,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,MEDICARE-Traditional Medicare, +116916,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,MEDICARE-Traditional Medicare, +116917,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,MEDICARE-Traditional Medicare, +116918,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,MEDICARE-Traditional Medicare,1250.0 +116919,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,MEDICARE-Traditional Medicare,5622.55 +116920,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,MEDICARE-Traditional Medicare, +116921,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,MEDICARE-Traditional Medicare,1913.8 +116922,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,MEDICARE-Traditional Medicare,3929.0 +116923,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,MEDICARE-Traditional Medicare,1936.33 +116924,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,MEDICARE-Traditional Medicare,1880.0 +116925,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,MEDICARE-Traditional Medicare,2107.82 +116926,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,MEDICARE-Traditional Medicare, +116927,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,MEDICARE-Traditional Medicare,1964.5 +116928,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,MEDICARE-Traditional Medicare,1964.5 +116929,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,MEDICARE-Traditional Medicare,1992.67 +116930,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,MEDICARE-Traditional Medicare,336.88 +116931,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,MEDICARE-Traditional Medicare,343.5 +116932,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,MEDICARE-Traditional Medicare,4392.0 +116933,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,MEDICARE-Traditional Medicare,1250.0 +116934,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,MEDICARE-Traditional Medicare,1363.0 +116935,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,MEDICARE-Traditional Medicare,1936.33 +116936,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,MEDICARE-Traditional Medicare, +116937,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,MEDICARE-Traditional Medicare,1856.58 +116938,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,MEDICARE-Traditional Medicare, +116939,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,MEDICARE-Traditional Medicare,342.0 +116940,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,MEDICARE-Traditional Medicare,369.27 +116941,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,MEDICARE-Traditional Medicare,401.85 +116942,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,MEDICARE-Traditional Medicare, +116943,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,MEDICARE-Traditional Medicare,403.58 +116944,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,MEDICARE-Traditional Medicare, +116945,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,MEDICARE-Traditional Medicare,569.25 +116946,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,MEDICARE-Traditional Medicare,352.91 +116947,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,MEDICARE-Traditional Medicare,412.4 +116948,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,MEDICARE-Traditional Medicare,428.03 +116949,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,MEDICARE-Traditional Medicare,390.32 +116950,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,MEDICARE-Traditional Medicare,514.03 +116951,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,MEDICARE-Traditional Medicare, +116952,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,MEDICARE-Traditional Medicare,598.16 +116953,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,MEDICARE-Traditional Medicare,422.26 +116954,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,MEDICARE-Traditional Medicare,21.0 +116955,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,MEDICARE-Traditional Medicare, +116956,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,MEDICARE-Traditional Medicare, +116957,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,MEDICARE-Traditional Medicare, +116958,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,MEDICARE-Traditional Medicare, +116959,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,MEDICARE-Traditional Medicare,2049.0 +116960,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,MEDICARE-Traditional Medicare, +116961,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,MEDICARE-Traditional Medicare, +116962,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,MEDICARE-Traditional Medicare,374.14 +116963,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,MEDICARE-Traditional Medicare, +116964,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,MEDICARE-Traditional Medicare, +116965,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,MEDICARE-Traditional Medicare,452.13 +116966,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,MEDICARE-Traditional Medicare,643.5 +116967,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,MEDICARE-Traditional Medicare, +116968,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,MEDICARE-Traditional Medicare,282.81 +116969,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,MEDICARE-Traditional Medicare,341.39 +116970,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,MEDICARE-Traditional Medicare,415.83 +116971,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,MEDICARE-Traditional Medicare,501.05 +116972,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,MEDICARE-Traditional Medicare,279.0 +116973,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,MEDICARE-Traditional Medicare,437.02 +116974,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,MEDICARE-Traditional Medicare,399.0 +116975,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,MEDICARE-Traditional Medicare,355.25 +116976,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,MEDICARE-Traditional Medicare,519.88 +116977,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,MEDICARE-Traditional Medicare,324.75 +116978,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,MEDICARE-Traditional Medicare,503.17 +116979,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,MEDICARE-Traditional Medicare,346.24 +116980,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,MEDICARE-Traditional Medicare,446.4 +116981,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,MEDICARE-Traditional Medicare,1363.0 +116982,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,MEDICARE-Traditional Medicare, +116983,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,MEDICARE-Traditional Medicare, +116984,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,MEDICARE-Traditional Medicare, +116985,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,MEDICARE-Traditional Medicare, +116986,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,MEDICARE-Traditional Medicare,1988.64 +116987,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,MEDICARE-Traditional Medicare,1880.0 +116988,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,MEDICARE-Traditional Medicare, +116989,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,MEDICARE-Traditional Medicare,621.29 +116990,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,MEDICARE-Traditional Medicare,413.64 +116991,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,MEDICARE-Traditional Medicare, +116992,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,MEDICARE-Traditional Medicare,1306.5 +116993,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,MEDICARE-Traditional Medicare, +116994,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,MEDICARE-Traditional Medicare,2253.67 +116995,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,MEDICARE-Traditional Medicare, +116996,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,MEDICARE-Traditional Medicare,1380.3 +116997,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,MEDICARE-Traditional Medicare,1691.9 +116998,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,MEDICARE-Traditional Medicare,1295.2 +116999,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,MEDICARE-Traditional Medicare,1964.5 +117000,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,MEDICARE-Traditional Medicare,1958.0 +117001,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,MEDICARE-Traditional Medicare, +117002,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,MEDICARE-Traditional Medicare, +117003,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,MEDICARE-Traditional Medicare, +117004,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,MEDICARE-Traditional Medicare, +117005,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,MEDICARE-Traditional Medicare,619.24 +117006,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,MEDICARE-Traditional Medicare,622.71 +117007,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,MEDICARE-Traditional Medicare, +117008,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,MEDICARE-Traditional Medicare,62.25 +117009,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,MEDICARE-Traditional Medicare, +117010,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,MEDICARE-Traditional Medicare, +117011,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,MEDICARE-Traditional Medicare,729.0 +117012,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,MEDICARE-Traditional Medicare, +117013,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,MEDICARE-Traditional Medicare, +117014,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,MEDICARE-Traditional Medicare, +117015,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,MEDICARE-Traditional Medicare, +117016,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,MEDICARE-Traditional Medicare, +117017,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,MEDICARE-Traditional Medicare, +117018,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,MEDICARE-Traditional Medicare, +117019,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,MEDICARE-Traditional Medicare,1144.5 +117020,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,MEDICARE-Traditional Medicare,1964.5 +117021,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,MEDICARE-Traditional Medicare, +117022,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,MEDICARE-Traditional Medicare, +117023,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,MEDICARE-Traditional Medicare, +117024,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,MEDICARE-Traditional Medicare,4440.64 +117025,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,MEDICARE-Traditional Medicare,1992.67 +117026,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,MEDICARE-Traditional Medicare,1306.5 +117027,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,MEDICARE-Traditional Medicare,1621.55 +117028,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,MEDICARE-Traditional Medicare, +117029,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,MEDICARE-Traditional Medicare, +117030,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,MEDICARE-Traditional Medicare, +117031,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,MEDICARE-Traditional Medicare, +117032,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,MEDICARE-Traditional Medicare, +117033,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,MEDICARE-Traditional Medicare, +117034,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,MEDICARE-Traditional Medicare, +117035,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,MEDICARE-Traditional Medicare,678.0 +117036,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,MEDICARE-Traditional Medicare, +117037,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,MEDICARE-Traditional Medicare, +117038,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,MEDICARE-Traditional Medicare, +117039,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,MEDICARE-Traditional Medicare, +117040,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,MEDICARE-Traditional Medicare, +117041,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,MEDICARE-Traditional Medicare, +117042,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,MEDICARE-Traditional Medicare, +117043,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,MEDICARE-Traditional Medicare, +117044,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,MEDICARE-Traditional Medicare, +117045,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,MEDICARE-Traditional Medicare,850.5 +117046,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,MEDICARE-Traditional Medicare,458.5 +117047,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,MEDICARE-Traditional Medicare, +117048,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,MEDICARE-Traditional Medicare,910.5 +117049,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,MEDICARE-Traditional Medicare, +117050,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,MEDICARE-Traditional Medicare,651.51 +117051,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,MEDICARE-Traditional Medicare, +117052,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,MEDICARE-Traditional Medicare, +117053,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,MEDICARE-Traditional Medicare, +117054,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,MEDICARE-Traditional Medicare, +117055,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,MEDICARE-Traditional Medicare, +117056,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,MEDICARE-Traditional Medicare, +117057,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,MEDICARE-Traditional Medicare, +117058,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,MEDICARE-Traditional Medicare,183.67 +117059,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,MEDICARE-Traditional Medicare,837.14 +117060,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,MEDICARE-Traditional Medicare,1084.5 +117061,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,MEDICARE-Traditional Medicare,621.18 +117062,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,MEDICARE-Traditional Medicare,606.45 +117063,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,MEDICARE-Traditional Medicare,836.69 +117064,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,MEDICARE-Traditional Medicare,1125.02 +117065,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,MEDICARE-Traditional Medicare, +117066,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,MEDICARE-Traditional Medicare,895.92 +117067,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,MEDICARE-Traditional Medicare,794.88 +117068,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,MEDICARE-Traditional Medicare, +117069,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,MEDICARE-Traditional Medicare,396.0 +117070,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,MEDICARE-Traditional Medicare, +117071,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,MEDICARE-Traditional Medicare, +117072,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,MEDICARE-Traditional Medicare, +117073,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,MEDICARE-Traditional Medicare, +117074,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,MEDICARE-Traditional Medicare, +117075,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,MEDICARE-Traditional Medicare, +117076,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,MEDICARE-Traditional Medicare,434.75 +117077,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,MEDICARE-Traditional Medicare, +117078,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,MEDICARE-Traditional Medicare, +117079,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,MEDICARE-Traditional Medicare,1379.71 +117080,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,MEDICARE-Traditional Medicare,1414.0 +117081,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,MEDICARE-Traditional Medicare, +117082,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,MEDICARE-Traditional Medicare,5029.47 +117083,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,MEDICARE-Traditional Medicare,4910.97 +117084,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,MEDICARE-Traditional Medicare,4195.55 +117085,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,MEDICARE-Traditional Medicare,2987.43 +117086,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,MEDICARE-Traditional Medicare,501.38 +117087,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,MEDICARE-Traditional Medicare,2412.99 +117088,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,MEDICARE-Traditional Medicare,1830.0 +117089,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,MEDICARE-Traditional Medicare, +117090,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,MEDICARE-Traditional Medicare, +117091,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,MEDICARE-Traditional Medicare,484.13 +117092,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,MEDICARE-Traditional Medicare,399.38 +117093,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,MEDICARE-Traditional Medicare, +117094,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,MEDICARE-Traditional Medicare, +117095,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,MEDICARE-Traditional Medicare,1645.5 +117096,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,MEDICARE-Traditional Medicare, +117097,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,MEDICARE-Traditional Medicare,896.69 +117098,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,MEDICARE-Traditional Medicare,492.0 +117099,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,MEDICARE-Traditional Medicare, +117100,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,MEDICARE-Traditional Medicare, +117101,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,MEDICARE-Traditional Medicare, +117102,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,MEDICARE-Traditional Medicare,1007.3 +117103,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,MEDICARE-Traditional Medicare, +117104,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,MEDICARE-Traditional Medicare, +117105,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,MEDICARE-Traditional Medicare,1880.0 +117106,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,MEDICARE-Traditional Medicare, +117107,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,MEDICARE-Traditional Medicare,2001.84 +117108,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,MEDICARE-Traditional Medicare, +117109,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,MEDICARE-Traditional Medicare,119.74 +117110,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,MEDICARE-Traditional Medicare,119.64 +117111,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,MEDICARE-Traditional Medicare,139.85 +117112,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,MEDICARE-Traditional Medicare,527.52 +117113,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,MEDICARE-Traditional Medicare,649.8 +117114,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,MEDICARE-Traditional Medicare,648.43 +117115,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,MEDICARE-Traditional Medicare,392.17 +117116,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,MEDICARE-Traditional Medicare,564.03 +117117,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,MEDICARE-Traditional Medicare, +117118,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,MEDICARE-Traditional Medicare,545.0 +117119,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,MEDICARE-Traditional Medicare,690.72 +117120,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,MEDICARE-Traditional Medicare,208.29 +117121,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,MEDICARE-Traditional Medicare,785.06 +117122,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,MEDICARE-Traditional Medicare,2020.2 +117123,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,MEDICARE-Traditional Medicare,201.0 +117124,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,MEDICARE-Traditional Medicare,13239.19 +117125,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,MEDICARE-Traditional Medicare,2146.22 +117126,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,MEDICARE-Traditional Medicare,11130.25 +117127,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,MEDICARE-Traditional Medicare,6837.6 +117128,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,MEDICARE-Traditional Medicare, +117129,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,MEDICARE-Traditional Medicare, +117130,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,MEDICARE-Traditional Medicare, +117131,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,MEDICARE-Traditional Medicare, +117132,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,MEDICARE-Traditional Medicare,2626.84 +117133,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,MEDICARE-Traditional Medicare, +117134,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,MEDICARE-Traditional Medicare,4030.2 +117135,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,MEDICARE-Traditional Medicare,1029.73 +117136,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,MEDICARE-Traditional Medicare,11269.13 +117137,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,MEDICARE-Traditional Medicare,1488.0 +117138,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,MEDICARE-Traditional Medicare, +117139,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,MEDICARE-Traditional Medicare,6800.65 +117140,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,MEDICARE-Traditional Medicare, +117141,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,MEDICARE-Traditional Medicare,3459.63 +117142,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,MEDICARE-Traditional Medicare,335.25 +117143,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,MEDICARE-Traditional Medicare, +117144,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,MEDICARE-Traditional Medicare, +117145,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,MEDICARE-Traditional Medicare,1086.5 +117146,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,MEDICARE-Traditional Medicare,505.36 +117147,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,MEDICARE-Traditional Medicare, +117148,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,MEDICARE-Traditional Medicare, +117149,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,MEDICARE-Traditional Medicare, +117150,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,MEDICARE-Traditional Medicare,13887.0 +117151,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,MEDICARE-Traditional Medicare, +117152,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,MEDICARE-Traditional Medicare, +117153,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,MEDICARE-Traditional Medicare,1209.6 +117154,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,MEDICARE-Traditional Medicare, +117155,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,MEDICARE-Traditional Medicare,1356.2 +117156,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,MEDICARE-Traditional Medicare, +117157,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,MEDICARE-Traditional Medicare,1324.0 +117158,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,MEDICARE-Traditional Medicare, +117159,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,MEDICARE-Traditional Medicare, +117160,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,MEDICARE-Traditional Medicare,1223.6 +117161,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,MEDICARE-Traditional Medicare,1321.56 +117162,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,MEDICARE-Traditional Medicare, +117163,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,MEDICARE-Traditional Medicare,1307.7 +117164,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,MEDICARE-Traditional Medicare, +117165,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,MEDICARE-Traditional Medicare, +117166,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,MEDICARE-Traditional Medicare,2176.14 +117167,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,MEDICARE-Traditional Medicare, +117168,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,MEDICARE-Traditional Medicare,1341.5 +117169,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,MEDICARE-Traditional Medicare, +117170,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,MEDICARE-Traditional Medicare, +117171,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,MEDICARE-Traditional Medicare, +117172,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,MEDICARE-Traditional Medicare, +117173,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,MEDICARE-Traditional Medicare,6474.35 +117174,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,MEDICARE-Traditional Medicare, +117175,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,MEDICARE-Traditional Medicare, +117176,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,MEDICARE-Traditional Medicare, +117177,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,MEDICARE-Traditional Medicare, +117178,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,MEDICARE-Traditional Medicare,1176.0 +117179,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,MEDICARE-Traditional Medicare, +117180,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,MEDICARE-Traditional Medicare, +117181,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,MEDICARE-Traditional Medicare, +117182,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,MEDICARE-Traditional Medicare, +117183,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,MEDICARE-Traditional Medicare,7893.0 +117184,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,MEDICARE-Traditional Medicare, +117185,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,MEDICARE-Traditional Medicare, +117186,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,MEDICARE-Traditional Medicare,7932.19 +117187,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,MEDICARE-Traditional Medicare,8715.35 +117188,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,MEDICARE-Traditional Medicare,1282.0 +117189,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,MEDICARE-Traditional Medicare, +117190,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,MEDICARE-Traditional Medicare,1204.0 +117191,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,MEDICARE-Traditional Medicare, +117192,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,MEDICARE-Traditional Medicare, +117193,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,MEDICARE-Traditional Medicare, +117194,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,MEDICARE-Traditional Medicare,179.48 +117195,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,MEDICARE-Traditional Medicare, +117196,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,MEDICARE-Traditional Medicare,355.47 +117197,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +117198,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,MEDICARE-Traditional Medicare,215.83 +117199,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,MEDICARE-Traditional Medicare, +117200,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,MEDICARE-Traditional Medicare,486.79 +117201,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,MEDICARE-Traditional Medicare,234.55 +117202,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,MEDICARE-Traditional Medicare,404.25 +117203,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,MEDICARE-Traditional Medicare, +117204,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,MEDICARE-Traditional Medicare, +117205,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,MEDICARE-Traditional Medicare, +117206,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,MEDICARE-Traditional Medicare, +117207,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,MEDICARE-Traditional Medicare, +117208,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,MEDICARE-Traditional Medicare, +117209,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,MEDICARE-Traditional Medicare,152.17 +117210,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,MEDICARE-Traditional Medicare,52.0 +117211,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,MEDICARE-Traditional Medicare, +117212,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,MEDICARE-Traditional Medicare, +117213,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,MEDICARE-Traditional Medicare, +117214,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,MEDICARE-Traditional Medicare,10.5 +117215,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,MEDICARE-Traditional Medicare,17.0 +117216,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,MEDICARE-Traditional Medicare, +117217,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,MEDICARE-Traditional Medicare,164.44 +117218,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,MEDICARE-Traditional Medicare,21.06 +117219,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,MEDICARE-Traditional Medicare, +117220,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,MEDICARE-Traditional Medicare, +117221,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,MEDICARE-Traditional Medicare, +117222,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,MEDICARE-Traditional Medicare, +117223,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,MEDICARE-Traditional Medicare,207.44 +117224,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,MEDICARE-Traditional Medicare, +117225,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,MEDICARE-Traditional Medicare, +117226,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,MEDICARE-Traditional Medicare, +117227,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,MEDICARE-Traditional Medicare,404.25 +117228,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,MEDICARE-Traditional Medicare, +117229,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,MEDICARE-Traditional Medicare, +117230,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,MEDICARE-Traditional Medicare, +117231,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,MEDICARE-Traditional Medicare, +117232,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,MEDICARE-Traditional Medicare,46.5 +117233,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,MEDICARE-Traditional Medicare,545.68 +117234,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,MEDICARE-Traditional Medicare,245.29 +117235,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,MEDICARE-Traditional Medicare, +117236,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,MEDICARE-Traditional Medicare, +117237,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,MEDICARE-Traditional Medicare,240.78 +117238,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,MEDICARE-Traditional Medicare, +117239,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,MEDICARE-Traditional Medicare, +117240,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,MEDICARE-Traditional Medicare, +117241,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,MEDICARE-Traditional Medicare, +117242,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,MEDICARE-Traditional Medicare, +117243,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,MEDICARE-Traditional Medicare, +117244,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,MEDICARE-Traditional Medicare, +117245,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,MEDICARE-Traditional Medicare, +117246,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,MEDICARE-Traditional Medicare, +117247,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,MEDICARE-Traditional Medicare, +117248,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,MEDICARE-Traditional Medicare, +117249,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,MEDICARE-Traditional Medicare, +117250,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,MEDICARE-Traditional Medicare,126.52 +117251,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +117252,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,MEDICARE-Traditional Medicare,50.75 +117253,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,MEDICARE-Traditional Medicare, +117254,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,MEDICARE-Traditional Medicare, +117255,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,MEDICARE-Traditional Medicare,72.75 +117256,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,MEDICARE-Traditional Medicare, +117257,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,MEDICARE-Traditional Medicare, +117258,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,MEDICARE-Traditional Medicare, +117259,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,MEDICARE-Traditional Medicare, +117260,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,MEDICARE-Traditional Medicare, +117261,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,MEDICARE-Traditional Medicare,72.75 +117262,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,MEDICARE-Traditional Medicare, +117263,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,MEDICARE-Traditional Medicare, +117264,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,MEDICARE-Traditional Medicare, +117265,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,MEDICARE-Traditional Medicare, +117266,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,MEDICARE-Traditional Medicare, +117267,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,MEDICARE-Traditional Medicare, +117268,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,MEDICARE-Traditional Medicare, +117269,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,MEDICARE-Traditional Medicare,1263.75 +117270,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,MEDICARE-Traditional Medicare, +117271,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,MEDICARE-Traditional Medicare, +117272,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,MEDICARE-Traditional Medicare, +117273,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,MEDICARE-Traditional Medicare, +117274,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,MEDICARE-Traditional Medicare,200.0 +117275,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,MEDICARE-Traditional Medicare, +117276,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,MEDICARE-Traditional Medicare, +117277,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,MEDICARE-Traditional Medicare, +117278,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,MEDICARE-Traditional Medicare, +117279,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,MEDICARE-Traditional Medicare, +117280,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,MEDICARE-Traditional Medicare,246.0 +117281,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,MEDICARE-Traditional Medicare,307.5 +117282,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,MEDICARE-Traditional Medicare, +117283,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,MEDICARE-Traditional Medicare, +117284,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,MEDICARE-Traditional Medicare, +117285,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,MEDICARE-Traditional Medicare, +117286,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,MEDICARE-Traditional Medicare, +117287,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,MEDICARE-Traditional Medicare, +117288,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,MEDICARE-Traditional Medicare,269.25 +117289,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,MEDICARE-Traditional Medicare,546.0 +117290,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,MEDICARE-Traditional Medicare, +117291,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,MEDICARE-Traditional Medicare, +117292,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,MEDICARE-Traditional Medicare, +117293,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,MEDICARE-Traditional Medicare,798.0 +117294,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,MEDICARE-Traditional Medicare,2323.5 +117295,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,MEDICARE-Traditional Medicare, +117296,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,MEDICARE-Traditional Medicare,133.33 +117297,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,MEDICARE-Traditional Medicare, +117298,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,MEDICARE-Traditional Medicare, +117299,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,MEDICARE-Traditional Medicare, +117300,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,MEDICARE-Traditional Medicare, +117301,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,MEDICARE-Traditional Medicare, +117302,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,MEDICARE-Traditional Medicare, +117303,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,MEDICARE-Traditional Medicare, +117304,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,MEDICARE-Traditional Medicare, +117305,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,MEDICARE-Traditional Medicare, +117306,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,MEDICARE-Traditional Medicare, +117307,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,MEDICARE-Traditional Medicare, +117308,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,MEDICARE-Traditional Medicare, +117309,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,MEDICARE-Traditional Medicare, +117310,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,MEDICARE-Traditional Medicare, +117311,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,MEDICARE-Traditional Medicare, +117312,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,MEDICARE-Traditional Medicare, +117313,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,MEDICARE-Traditional Medicare, +117314,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,MEDICARE-Traditional Medicare, +117315,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,MEDICARE-Traditional Medicare, +117316,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,MEDICARE-Traditional Medicare, +117317,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,MEDICARE-Traditional Medicare, +117318,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,MEDICARE-Traditional Medicare, +117319,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,MEDICARE-Traditional Medicare, +117320,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,MEDICARE-Traditional Medicare, +117321,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,MEDICARE-Traditional Medicare, +117322,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,MEDICARE-Traditional Medicare, +117323,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,MEDICARE-Traditional Medicare, +117324,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,MEDICARE-Traditional Medicare, +117325,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,MEDICARE-Traditional Medicare, +117326,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,MEDICARE-Traditional Medicare,256.5 +117327,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,MEDICARE-Traditional Medicare, +117328,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,MEDICARE-Traditional Medicare,337.0 +117329,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,MEDICARE-Traditional Medicare, +117330,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,MEDICARE-Traditional Medicare,357.28 +117331,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,MEDICARE-Traditional Medicare, +117332,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,MEDICARE-Traditional Medicare,607.58 +117333,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,MEDICARE-Traditional Medicare, +117334,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,MEDICARE-Traditional Medicare, +117335,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,MEDICARE-Traditional Medicare, +117336,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,MEDICARE-Traditional Medicare, +117337,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,MEDICARE-Traditional Medicare, +117338,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,MEDICARE-Traditional Medicare,888.75 +117339,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,MEDICARE-Traditional Medicare, +117340,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,MEDICARE-Traditional Medicare, +117341,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,MEDICARE-Traditional Medicare,124.33 +117342,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,MEDICARE-Traditional Medicare,20.25 +117343,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,MEDICARE-Traditional Medicare,12.75 +117344,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,MEDICARE-Traditional Medicare,45.13 +117345,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,MEDICARE-Traditional Medicare,43.35 +117346,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,MEDICARE-Traditional Medicare,94.95 +117347,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,MEDICARE-Traditional Medicare,4.5 +117348,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,MEDICARE-Traditional Medicare,11.25 +117349,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,MEDICARE-Traditional Medicare, +117350,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,MEDICARE-Traditional Medicare, +117351,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,MEDICARE-Traditional Medicare,199.5 +117352,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,MEDICARE-Traditional Medicare, +117353,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,MEDICARE-Traditional Medicare, +117354,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,MEDICARE-Traditional Medicare, +117355,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,MEDICARE-Traditional Medicare, +117356,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,MEDICARE-Traditional Medicare,58.5 +117357,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,MEDICARE-Traditional Medicare,95.25 +117358,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,MEDICARE-Traditional Medicare,107.61 +117359,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,MEDICARE-Traditional Medicare, +117360,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,MEDICARE-Traditional Medicare,13.94 +117361,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,MEDICARE-Traditional Medicare, +117362,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,MEDICARE-Traditional Medicare, +117363,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,MEDICARE-Traditional Medicare, +117364,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,MEDICARE-Traditional Medicare,145.73 +117365,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,MEDICARE-Traditional Medicare,14.0 +117366,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,MEDICARE-Traditional Medicare,92.2 +117367,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,MEDICARE-Traditional Medicare,81.35 +117368,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,MEDICARE-Traditional Medicare, +117369,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,MEDICARE-Traditional Medicare, +117370,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,MEDICARE-Traditional Medicare, +117371,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,MEDICARE-Traditional Medicare, +117372,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,MEDICARE-Traditional Medicare,341.61 +117373,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,MEDICARE-Traditional Medicare, +117374,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,MEDICARE-Traditional Medicare,71.66 +117375,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,MEDICARE-Traditional Medicare,180.63 +117376,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,MEDICARE-Traditional Medicare, +117377,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,MEDICARE-Traditional Medicare,10.5 +117378,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,MEDICARE-Traditional Medicare,105.57 +117379,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,MEDICARE-Traditional Medicare, +117380,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,MEDICARE-Traditional Medicare,204.99 +117381,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,MEDICARE-Traditional Medicare,21.0 +117382,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,MEDICARE-Traditional Medicare, +117383,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,MEDICARE-Traditional Medicare, +117384,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,MEDICARE-Traditional Medicare, +117385,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,MEDICARE-Traditional Medicare, +117386,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,MEDICARE-Traditional Medicare,65.02 +117387,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,MEDICARE-Traditional Medicare,60.0 +117388,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,MEDICARE-Traditional Medicare,29.25 +117389,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,MEDICARE-Traditional Medicare,100.22 +117390,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,MEDICARE-Traditional Medicare, +117391,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,MEDICARE-Traditional Medicare, +117392,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,MEDICARE-Traditional Medicare, +117393,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,MEDICARE-Traditional Medicare, +117394,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,MEDICARE-Traditional Medicare,420.75 +117395,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,MEDICARE-Traditional Medicare,216.0 +117396,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,MEDICARE-Traditional Medicare,77.1 +117397,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,MEDICARE-Traditional Medicare, +117398,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,MEDICARE-Traditional Medicare, +117399,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,MEDICARE-Traditional Medicare,125.32 +117400,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,MEDICARE-Traditional Medicare,64.53 +117401,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,MEDICARE-Traditional Medicare, +117402,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,MEDICARE-Traditional Medicare, +117403,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,MEDICARE-Traditional Medicare,66.0 +117404,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,MEDICARE-Traditional Medicare,125.35 +117405,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,MEDICARE-Traditional Medicare, +117406,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,MEDICARE-Traditional Medicare, +117407,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,MEDICARE-Traditional Medicare, +117408,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,MEDICARE-Traditional Medicare, +117409,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,MEDICARE-Traditional Medicare,15.0 +117410,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,MEDICARE-Traditional Medicare, +117411,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,MEDICARE-Traditional Medicare, +117412,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,MEDICARE-Traditional Medicare, +117413,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,MEDICARE-Traditional Medicare,8.0 +117414,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,MEDICARE-Traditional Medicare,289.41 +117415,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,MEDICARE-Traditional Medicare, +117416,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,MEDICARE-Traditional Medicare, +117417,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,MEDICARE-Traditional Medicare, +117418,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,MEDICARE-Traditional Medicare, +117419,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,MEDICARE-Traditional Medicare, +117420,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,MEDICARE-Traditional Medicare, +117421,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,MEDICARE-Traditional Medicare, +117422,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,MEDICARE-Traditional Medicare,139.67 +117423,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,MEDICARE-Traditional Medicare,736.67 +117424,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,MEDICARE-Traditional Medicare,137.58 +117425,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,MEDICARE-Traditional Medicare,14.25 +117426,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,MEDICARE-Traditional Medicare,302.06 +117427,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,MEDICARE-Traditional Medicare,215.25 +117428,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,MEDICARE-Traditional Medicare,24.38 +117429,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,MEDICARE-Traditional Medicare, +117430,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,MEDICARE-Traditional Medicare,158.25 +117431,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,MEDICARE-Traditional Medicare, +117432,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,MEDICARE-Traditional Medicare,52.52 +117433,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,MEDICARE-Traditional Medicare,50.46 +117434,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,MEDICARE-Traditional Medicare, +117435,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,MEDICARE-Traditional Medicare, +117436,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,MEDICARE-Traditional Medicare,162.75 +117437,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,MEDICARE-Traditional Medicare, +117438,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,MEDICARE-Traditional Medicare,12.0 +117439,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,MEDICARE-Traditional Medicare, +117440,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,MEDICARE-Traditional Medicare,66.15 +117441,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,MEDICARE-Traditional Medicare,8.25 +117442,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,MEDICARE-Traditional Medicare,174.25 +117443,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,MEDICARE-Traditional Medicare,143.7 +117444,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,MEDICARE-Traditional Medicare,52.5 +117445,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,MEDICARE-Traditional Medicare, +117446,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,MEDICARE-Traditional Medicare,132.15 +117447,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,MEDICARE-Traditional Medicare, +117448,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,MEDICARE-Traditional Medicare, +117449,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,MEDICARE-Traditional Medicare,107.5 +117450,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,MEDICARE-Traditional Medicare, +117451,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,MEDICARE-Traditional Medicare,147.78 +117452,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,MEDICARE-Traditional Medicare, +117453,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,MEDICARE-Traditional Medicare, +117454,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,MEDICARE-Traditional Medicare, +117455,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,MEDICARE-Traditional Medicare,174.4 +117456,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,MEDICARE-Traditional Medicare,12.75 +117457,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,MEDICARE-Traditional Medicare, +117458,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,MEDICARE-Traditional Medicare, +117459,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,MEDICARE-Traditional Medicare,43.48 +117460,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,MEDICARE-Traditional Medicare,91.5 +117461,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,MEDICARE-Traditional Medicare,114.19 +117462,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,MEDICARE-Traditional Medicare, +117463,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,MEDICARE-Traditional Medicare,92.41 +117464,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,MEDICARE-Traditional Medicare,181.95 +117465,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,MEDICARE-Traditional Medicare,79.12 +117466,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,MEDICARE-Traditional Medicare, +117467,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,MEDICARE-Traditional Medicare, +117468,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,MEDICARE-Traditional Medicare,4.5 +117469,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,MEDICARE-Traditional Medicare,146.16 +117470,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,MEDICARE-Traditional Medicare, +117471,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,MEDICARE-Traditional Medicare, +117472,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,MEDICARE-Traditional Medicare,49.5 +117473,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,MEDICARE-Traditional Medicare,8.25 +117474,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,MEDICARE-Traditional Medicare,66.8 +117475,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,MEDICARE-Traditional Medicare, +117476,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,MEDICARE-Traditional Medicare, +117477,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,MEDICARE-Traditional Medicare, +117478,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,MEDICARE-Traditional Medicare, +117479,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,MEDICARE-Traditional Medicare, +117480,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,MEDICARE-Traditional Medicare,18.75 +117481,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,MEDICARE-Traditional Medicare, +117482,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,MEDICARE-Traditional Medicare,211.0 +117483,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,MEDICARE-Traditional Medicare,292.71 +117484,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,MEDICARE-Traditional Medicare,298.97 +117485,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,MEDICARE-Traditional Medicare,24.0 +117486,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,MEDICARE-Traditional Medicare, +117487,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,MEDICARE-Traditional Medicare,13.5 +117488,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,MEDICARE-Traditional Medicare,56.17 +117489,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,MEDICARE-Traditional Medicare,72.0 +117490,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,MEDICARE-Traditional Medicare, +117491,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,MEDICARE-Traditional Medicare, +117492,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,MEDICARE-Traditional Medicare,342.0 +117493,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,MEDICARE-Traditional Medicare, +117494,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,MEDICARE-Traditional Medicare, +117495,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,MEDICARE-Traditional Medicare, +117496,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,MEDICARE-Traditional Medicare, +117497,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,MEDICARE-Traditional Medicare,42.0 +117498,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,MEDICARE-Traditional Medicare,11.25 +117499,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,MEDICARE-Traditional Medicare,50.84 +117500,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,MEDICARE-Traditional Medicare, +117501,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,MEDICARE-Traditional Medicare,204.0 +117502,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,MEDICARE-Traditional Medicare, +117503,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,MEDICARE-Traditional Medicare, +117504,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,MEDICARE-Traditional Medicare,75.71 +117505,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,MEDICARE-Traditional Medicare,61.0 +117506,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,MEDICARE-Traditional Medicare, +117507,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,MEDICARE-Traditional Medicare, +117508,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,MEDICARE-Traditional Medicare,158.25 +117509,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,MEDICARE-Traditional Medicare,143.86 +117510,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,MEDICARE-Traditional Medicare,556.75 +117511,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,MEDICARE-Traditional Medicare, +117512,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,MEDICARE-Traditional Medicare,167.92 +117513,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,MEDICARE-Traditional Medicare,9.0 +117514,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,MEDICARE-Traditional Medicare, +117515,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,MEDICARE-Traditional Medicare,48.38 +117516,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,MEDICARE-Traditional Medicare,61.88 +117517,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,MEDICARE-Traditional Medicare,137.53 +117518,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,MEDICARE-Traditional Medicare,132.43 +117519,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,MEDICARE-Traditional Medicare, +117520,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,MEDICARE-Traditional Medicare, +117521,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,MEDICARE-Traditional Medicare, +117522,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,MEDICARE-Traditional Medicare, +117523,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,MEDICARE-Traditional Medicare, +117524,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,MEDICARE-Traditional Medicare, +117525,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,MEDICARE-Traditional Medicare,9.75 +117526,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,MEDICARE-Traditional Medicare, +117527,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,MEDICARE-Traditional Medicare, +117528,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,MEDICARE-Traditional Medicare, +117529,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,MEDICARE-Traditional Medicare,3.75 +117530,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,MEDICARE-Traditional Medicare,58.85 +117531,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,MEDICARE-Traditional Medicare,61.0 +117532,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,MEDICARE-Traditional Medicare, +117533,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,MEDICARE-Traditional Medicare,9.75 +117534,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,MEDICARE-Traditional Medicare, +117535,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,MEDICARE-Traditional Medicare, +117536,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,MEDICARE-Traditional Medicare, +117537,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,MEDICARE-Traditional Medicare, +117538,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,MEDICARE-Traditional Medicare, +117539,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,MEDICARE-Traditional Medicare,4.5 +117540,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,MEDICARE-Traditional Medicare,10.5 +117541,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,MEDICARE-Traditional Medicare,8.25 +117542,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,MEDICARE-Traditional Medicare,12.0 +117543,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,MEDICARE-Traditional Medicare,113.58 +117544,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,MEDICARE-Traditional Medicare,158.45 +117545,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,MEDICARE-Traditional Medicare, +117546,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,MEDICARE-Traditional Medicare,217.8 +117547,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,MEDICARE-Traditional Medicare, +117548,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,MEDICARE-Traditional Medicare,22.5 +117549,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,MEDICARE-Traditional Medicare,58.32 +117550,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,MEDICARE-Traditional Medicare,71.05 +117551,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,MEDICARE-Traditional Medicare,123.01 +117552,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,MEDICARE-Traditional Medicare,96.75 +117553,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,MEDICARE-Traditional Medicare,101.63 +117554,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,MEDICARE-Traditional Medicare,113.89 +117555,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,MEDICARE-Traditional Medicare,8.75 +117556,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,MEDICARE-Traditional Medicare, +117557,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,MEDICARE-Traditional Medicare,242.67 +117558,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,MEDICARE-Traditional Medicare, +117559,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,MEDICARE-Traditional Medicare,69.8 +117560,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,MEDICARE-Traditional Medicare, +117561,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,MEDICARE-Traditional Medicare,62.44 +117562,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,MEDICARE-Traditional Medicare, +117563,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,MEDICARE-Traditional Medicare,12.75 +117564,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,MEDICARE-Traditional Medicare, +117565,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,MEDICARE-Traditional Medicare, +117566,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,MEDICARE-Traditional Medicare,10.5 +117567,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,MEDICARE-Traditional Medicare,45.0 +117568,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,MEDICARE-Traditional Medicare, +117569,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,MEDICARE-Traditional Medicare, +117570,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,MEDICARE-Traditional Medicare,381.12 +117571,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,MEDICARE-Traditional Medicare,201.22 +117572,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,MEDICARE-Traditional Medicare, +117573,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,MEDICARE-Traditional Medicare,1178.75 +117574,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,MEDICARE-Traditional Medicare,52.24 +117575,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,MEDICARE-Traditional Medicare, +117576,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,MEDICARE-Traditional Medicare,31.5 +117577,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,MEDICARE-Traditional Medicare,30.75 +117578,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,MEDICARE-Traditional Medicare,104.1 +117579,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,MEDICARE-Traditional Medicare,69.41 +117580,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,MEDICARE-Traditional Medicare, +117581,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,MEDICARE-Traditional Medicare,50.59 +117582,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,MEDICARE-Traditional Medicare, +117583,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,MEDICARE-Traditional Medicare,69.0 +117584,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,MEDICARE-Traditional Medicare, +117585,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,MEDICARE-Traditional Medicare, +117586,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,MEDICARE-Traditional Medicare, +117587,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,MEDICARE-Traditional Medicare,366.75 +117588,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,MEDICARE-Traditional Medicare,298.13 +117589,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,MEDICARE-Traditional Medicare,256.25 +117590,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,MEDICARE-Traditional Medicare,232.5 +117591,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,MEDICARE-Traditional Medicare,127.5 +117592,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,MEDICARE-Traditional Medicare, +117593,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,MEDICARE-Traditional Medicare, +117594,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,MEDICARE-Traditional Medicare, +117595,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,MEDICARE-Traditional Medicare, +117596,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,MEDICARE-Traditional Medicare,171.0 +117597,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,MEDICARE-Traditional Medicare,218.75 +117598,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,MEDICARE-Traditional Medicare, +117599,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,MEDICARE-Traditional Medicare, +117600,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,MEDICARE-Traditional Medicare,313.25 +117601,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,MEDICARE-Traditional Medicare,274.0 +117602,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,MEDICARE-Traditional Medicare, +117603,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,MEDICARE-Traditional Medicare, +117604,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,MEDICARE-Traditional Medicare, +117605,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,MEDICARE-Traditional Medicare,185.55 +117606,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,MEDICARE-Traditional Medicare,119.28 +117607,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,MEDICARE-Traditional Medicare, +117608,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,MEDICARE-Traditional Medicare,90.75 +117609,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,MEDICARE-Traditional Medicare, +117610,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,MEDICARE-Traditional Medicare, +117611,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,MEDICARE-Traditional Medicare, +117612,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,MEDICARE-Traditional Medicare, +117613,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,MEDICARE-Traditional Medicare,700.88 +117614,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,MEDICARE-Traditional Medicare,70.21 +117615,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,MEDICARE-Traditional Medicare, +117616,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,MEDICARE-Traditional Medicare,222.99 +117617,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,MEDICARE-Traditional Medicare, +117618,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,MEDICARE-Traditional Medicare,65.24 +117619,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,MEDICARE-Traditional Medicare, +117620,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,MEDICARE-Traditional Medicare,21.6 +117621,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,MEDICARE-Traditional Medicare,92.81 +117622,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,MEDICARE-Traditional Medicare, +117623,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,MEDICARE-Traditional Medicare, +117624,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,MEDICARE-Traditional Medicare,186.75 +117625,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,MEDICARE-Traditional Medicare,39.0 +117626,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,MEDICARE-Traditional Medicare, +117627,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,MEDICARE-Traditional Medicare, +117628,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,MEDICARE-Traditional Medicare,54.75 +117629,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,MEDICARE-Traditional Medicare, +117630,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,MEDICARE-Traditional Medicare,128.64 +117631,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,MEDICARE-Traditional Medicare,94.5 +117632,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,MEDICARE-Traditional Medicare, +117633,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,MEDICARE-Traditional Medicare,110.19 +117634,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,MEDICARE-Traditional Medicare,155.92 +117635,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,MEDICARE-Traditional Medicare,22.5 +117636,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,MEDICARE-Traditional Medicare,410.25 +117637,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,MEDICARE-Traditional Medicare,31.5 +117638,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,MEDICARE-Traditional Medicare, +117639,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,MEDICARE-Traditional Medicare,10.5 +117640,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,MEDICARE-Traditional Medicare,407.75 +117641,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,MEDICARE-Traditional Medicare,61.5 +117642,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,MEDICARE-Traditional Medicare,13.5 +117643,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,MEDICARE-Traditional Medicare,116.25 +117644,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,MEDICARE-Traditional Medicare, +117645,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,MEDICARE-Traditional Medicare,174.25 +117646,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,MEDICARE-Traditional Medicare,223.13 +117647,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,MEDICARE-Traditional Medicare,250.5 +117648,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,MEDICARE-Traditional Medicare,114.69 +117649,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,MEDICARE-Traditional Medicare,244.13 +117650,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,MEDICARE-Traditional Medicare,244.13 +117651,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,MEDICARE-Traditional Medicare,278.63 +117652,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,MEDICARE-Traditional Medicare,70.13 +117653,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,MEDICARE-Traditional Medicare,143.0 +117654,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,MEDICARE-Traditional Medicare, +117655,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,MEDICARE-Traditional Medicare,25.5 +117656,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,MEDICARE-Traditional Medicare,60.0 +117657,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,MEDICARE-Traditional Medicare, +117658,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,MEDICARE-Traditional Medicare,171.85 +117659,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,MEDICARE-Traditional Medicare,198.64 +117660,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,MEDICARE-Traditional Medicare, +117661,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,MEDICARE-Traditional Medicare, +117662,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,MEDICARE-Traditional Medicare, +117663,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,MEDICARE-Traditional Medicare,683.25 +117664,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,MEDICARE-Traditional Medicare,126.0 +117665,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,MEDICARE-Traditional Medicare, +117666,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,MEDICARE-Traditional Medicare, +117667,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,MEDICARE-Traditional Medicare, +117668,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,MEDICARE-Traditional Medicare, +117669,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,MEDICARE-Traditional Medicare,253.58 +117670,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,MEDICARE-Traditional Medicare,374.67 +117671,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,MEDICARE-Traditional Medicare, +117672,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,MEDICARE-Traditional Medicare,6.0 +117673,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,MEDICARE-Traditional Medicare,70.05 +117674,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,MEDICARE-Traditional Medicare,262.5 +117675,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,MEDICARE-Traditional Medicare, +117676,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,MEDICARE-Traditional Medicare,49.86 +117677,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,MEDICARE-Traditional Medicare, +117678,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,MEDICARE-Traditional Medicare, +117679,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,MEDICARE-Traditional Medicare, +117680,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,MEDICARE-Traditional Medicare, +117681,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,MEDICARE-Traditional Medicare,18.0 +117682,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,MEDICARE-Traditional Medicare,19.25 +117683,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,MEDICARE-Traditional Medicare,220.61 +117684,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,MEDICARE-Traditional Medicare,145.11 +117685,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,MEDICARE-Traditional Medicare, +117686,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,MEDICARE-Traditional Medicare, +117687,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,MEDICARE-Traditional Medicare, +117688,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,MEDICARE-Traditional Medicare, +117689,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,MEDICARE-Traditional Medicare, +117690,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,MEDICARE-Traditional Medicare, +117691,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,MEDICARE-Traditional Medicare,168.38 +117692,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,MEDICARE-Traditional Medicare,7.13 +117693,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,MEDICARE-Traditional Medicare,61.5 +117694,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,MEDICARE-Traditional Medicare,3.29 +117695,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,MEDICARE-Traditional Medicare,4.11 +117696,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,MEDICARE-Traditional Medicare,11.5 +117697,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,MEDICARE-Traditional Medicare,26.25 +117698,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,MEDICARE-Traditional Medicare, +117699,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,MEDICARE-Traditional Medicare,36.75 +117700,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,MEDICARE-Traditional Medicare, +117701,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,MEDICARE-Traditional Medicare, +117702,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,MEDICARE-Traditional Medicare,15.83 +117703,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,MEDICARE-Traditional Medicare, +117704,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,MEDICARE-Traditional Medicare, +117705,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,MEDICARE-Traditional Medicare, +117706,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,MEDICARE-Traditional Medicare,117.0 +117707,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,MEDICARE-Traditional Medicare,177.0 +117708,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,MEDICARE-Traditional Medicare, +117709,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,MEDICARE-Traditional Medicare,107.0 +117710,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,MEDICARE-Traditional Medicare, +117711,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,MEDICARE-Traditional Medicare,97.2 +117712,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,MEDICARE-Traditional Medicare, +117713,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,MEDICARE-Traditional Medicare, +117714,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,MEDICARE-Traditional Medicare, +117715,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,MEDICARE-Traditional Medicare, +117716,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,MEDICARE-Traditional Medicare,12.0 +117717,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,MEDICARE-Traditional Medicare,153.5 +117718,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,MEDICARE-Traditional Medicare,22.0 +117719,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,MEDICARE-Traditional Medicare, +117720,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,MEDICARE-Traditional Medicare,21.75 +117721,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,MEDICARE-Traditional Medicare,15.0 +117722,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,MEDICARE-Traditional Medicare,102.0 +117723,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,MEDICARE-Traditional Medicare,105.0 +117724,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,MEDICARE-Traditional Medicare,118.0 +117725,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,MEDICARE-Traditional Medicare,63.0 +117726,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,MEDICARE-Traditional Medicare,141.0 +117727,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,MEDICARE-Traditional Medicare,133.0 +117728,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,MEDICARE-Traditional Medicare, +117729,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,MEDICARE-Traditional Medicare,165.84 +117730,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,MEDICARE-Traditional Medicare, +117731,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,MEDICARE-Traditional Medicare, +117732,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,MEDICARE-Traditional Medicare,90.0 +117733,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,MEDICARE-Traditional Medicare,6.0 +117734,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,MEDICARE-Traditional Medicare,183.46 +117735,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,MEDICARE-Traditional Medicare, +117736,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,MEDICARE-Traditional Medicare,274.5 +117737,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,MEDICARE-Traditional Medicare,119.63 +117738,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,MEDICARE-Traditional Medicare,390.25 +117739,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,MEDICARE-Traditional Medicare,384.5 +117740,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,MEDICARE-Traditional Medicare,621.79 +117741,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,MEDICARE-Traditional Medicare, +117742,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,MEDICARE-Traditional Medicare,747.64 +117743,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,MEDICARE-Traditional Medicare,600.8 +117744,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,MEDICARE-Traditional Medicare,280.0 +117745,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,MEDICARE-Traditional Medicare, +117746,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,MEDICARE-Traditional Medicare,418.51 +117747,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,MEDICARE-Traditional Medicare,419.73 +117748,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,MEDICARE-Traditional Medicare,3912.0 +117749,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,MEDICARE-Traditional Medicare,1051.88 +117750,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,MEDICARE-Traditional Medicare,313.5 +117751,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,MEDICARE-Traditional Medicare,1014.0 +117752,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,MEDICARE-Traditional Medicare,578.31 +117753,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,MEDICARE-Traditional Medicare,194.0 +117754,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,MEDICARE-Traditional Medicare,179.23 +117755,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,MEDICARE-Traditional Medicare, +117756,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,MEDICARE-Traditional Medicare, +117757,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,MEDICARE-Traditional Medicare,194.76 +117758,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,MEDICARE-Traditional Medicare,307.65 +117759,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,MEDICARE-Traditional Medicare,92.97 +117760,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,MEDICARE-Traditional Medicare,98.39 +117761,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,MEDICARE-Traditional Medicare,156.97 +117762,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,MEDICARE-Traditional Medicare,160.71 +117763,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,MEDICARE-Traditional Medicare,68.1 +117764,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,MEDICARE-Traditional Medicare,143.44 +117765,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,MEDICARE-Traditional Medicare, +117766,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,MEDICARE-Traditional Medicare,59.25 +117767,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,MEDICARE-Traditional Medicare,47.25 +117768,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,MEDICARE-Traditional Medicare, +117769,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,MEDICARE-Traditional Medicare, +117770,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,MEDICARE-Traditional Medicare, +117771,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,MEDICARE-Traditional Medicare, +117772,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,MEDICARE-Traditional Medicare,30.75 +117773,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,MEDICARE-Traditional Medicare, +117774,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,MEDICARE-Traditional Medicare, +117775,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,MEDICARE-Traditional Medicare, +117776,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,MEDICARE-Traditional Medicare, +117777,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,MEDICARE-Traditional Medicare, +117778,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,MEDICARE-Traditional Medicare,146.25 +117779,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,MEDICARE-Traditional Medicare,63.75 +117780,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,MEDICARE-Traditional Medicare,97.01 +117781,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,MEDICARE-Traditional Medicare, +117782,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,MEDICARE-Traditional Medicare,106.16 +117783,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,MEDICARE-Traditional Medicare, +117784,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,MEDICARE-Traditional Medicare,63.9 +117785,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,MEDICARE-Traditional Medicare,87.25 +117786,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,MEDICARE-Traditional Medicare,82.0 +117787,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,MEDICARE-Traditional Medicare,51.0 +117788,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,MEDICARE-Traditional Medicare,11.25 +117789,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,MEDICARE-Traditional Medicare,9.0 +117790,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,MEDICARE-Traditional Medicare, +117791,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,MEDICARE-Traditional Medicare,76.5 +117792,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,MEDICARE-Traditional Medicare, +117793,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,MEDICARE-Traditional Medicare, +117794,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,MEDICARE-Traditional Medicare, +117795,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,MEDICARE-Traditional Medicare, +117796,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,MEDICARE-Traditional Medicare,127.0 +117797,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,MEDICARE-Traditional Medicare, +117798,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,MEDICARE-Traditional Medicare, +117799,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,MEDICARE-Traditional Medicare, +117800,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,MEDICARE-Traditional Medicare,93.12 +117801,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,MEDICARE-Traditional Medicare, +117802,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,MEDICARE-Traditional Medicare, +117803,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,MEDICARE-Traditional Medicare, +117804,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,MEDICARE-Traditional Medicare,113.57 +117805,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,MEDICARE-Traditional Medicare, +117806,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,MEDICARE-Traditional Medicare, +117807,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,MEDICARE-Traditional Medicare, +117808,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,MEDICARE-Traditional Medicare,54.0 +117809,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,MEDICARE-Traditional Medicare,12.0 +117810,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,MEDICARE-Traditional Medicare, +117811,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,MEDICARE-Traditional Medicare,247.5 +117812,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,MEDICARE-Traditional Medicare, +117813,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,MEDICARE-Traditional Medicare,230.11 +117814,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,MEDICARE-Traditional Medicare,232.5 +117815,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,MEDICARE-Traditional Medicare,52.5 +117816,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,MEDICARE-Traditional Medicare,109.29 +117817,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,MEDICARE-Traditional Medicare, +117818,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,MEDICARE-Traditional Medicare, +117819,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,MEDICARE-Traditional Medicare, +117820,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,MEDICARE-Traditional Medicare,12.0 +117821,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,MEDICARE-Traditional Medicare, +117822,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,MEDICARE-Traditional Medicare, +117823,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,MEDICARE-Traditional Medicare, +117824,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,MEDICARE-Traditional Medicare, +117825,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,MEDICARE-Traditional Medicare,676.0 +117826,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,MEDICARE-Traditional Medicare,49.85 +117827,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,MEDICARE-Traditional Medicare, +117828,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,MEDICARE-Traditional Medicare,133.5 +117829,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,MEDICARE-Traditional Medicare, +117830,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,MEDICARE-Traditional Medicare,458.63 +117831,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,MEDICARE-Traditional Medicare, +117832,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,MEDICARE-Traditional Medicare, +117833,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,MEDICARE-Traditional Medicare, +117834,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,MEDICARE-Traditional Medicare, +117835,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,MEDICARE-Traditional Medicare,224.09 +117836,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,MEDICARE-Traditional Medicare,149.34 +117837,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,MEDICARE-Traditional Medicare,507.09 +117838,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,MEDICARE-Traditional Medicare, +117839,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,MEDICARE-Traditional Medicare,1377.68 +117840,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,MEDICARE-Traditional Medicare,87.02 +117841,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,MEDICARE-Traditional Medicare, +117842,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,MEDICARE-Traditional Medicare,12.0 +117843,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,MEDICARE-Traditional Medicare, +117844,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,MEDICARE-Traditional Medicare,184.61 +117845,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,MEDICARE-Traditional Medicare,67.95 +117846,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,MEDICARE-Traditional Medicare, +117847,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,MEDICARE-Traditional Medicare, +117848,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,MEDICARE-Traditional Medicare,107.89 +117849,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,MEDICARE-Traditional Medicare, +117850,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,MEDICARE-Traditional Medicare, +117851,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,MEDICARE-Traditional Medicare, +117852,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,MEDICARE-Traditional Medicare, +117853,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,MEDICARE-Traditional Medicare, +117854,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,MEDICARE-Traditional Medicare, +117855,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,MEDICARE-Traditional Medicare, +117856,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,MEDICARE-Traditional Medicare, +117857,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,MEDICARE-Traditional Medicare,123.0 +117858,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,MEDICARE-Traditional Medicare,174.11 +117859,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,MEDICARE-Traditional Medicare, +117860,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,MEDICARE-Traditional Medicare,139.97 +117861,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,MEDICARE-Traditional Medicare,3812.75 +117862,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,MEDICARE-Traditional Medicare,3487.11 +117863,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,MEDICARE-Traditional Medicare, +117864,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,MEDICARE-Traditional Medicare,129.0 +117865,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,MEDICARE-Traditional Medicare,120.75 +117866,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,MEDICARE-Traditional Medicare, +117867,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,MEDICARE-Traditional Medicare,531.0 +117868,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,MEDICARE-Traditional Medicare,2762.37 +117869,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,MEDICARE-Traditional Medicare, +117870,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,MEDICARE-Traditional Medicare, +117871,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,MEDICARE-Traditional Medicare, +117872,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,MEDICARE-Traditional Medicare,848.25 +117873,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,MEDICARE-Traditional Medicare, +117874,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,MEDICARE-Traditional Medicare,1226.25 +117875,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,MEDICARE-Traditional Medicare, +117876,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,MEDICARE-Traditional Medicare,2250.0 +117877,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,MEDICARE-Traditional Medicare,335.25 +117878,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,MEDICARE-Traditional Medicare, +117879,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,MEDICARE-Traditional Medicare,2607.75 +117880,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,MEDICARE-Traditional Medicare, +117881,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,MEDICARE-Traditional Medicare,3138.13 +117882,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,MEDICARE-Traditional Medicare,865.32 +117883,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,MEDICARE-Traditional Medicare,4719.25 +117884,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,MEDICARE-Traditional Medicare,3657.49 +117885,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,MEDICARE-Traditional Medicare,99.75 +117886,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,MEDICARE-Traditional Medicare,2273.94 +117887,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,MEDICARE-Traditional Medicare,734.25 +117888,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,MEDICARE-Traditional Medicare,549.0 +117889,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,MEDICARE-Traditional Medicare, +117890,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,MEDICARE-Traditional Medicare, +117891,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,MEDICARE-Traditional Medicare,1563.0 +117892,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,MEDICARE-Traditional Medicare, +117893,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,MEDICARE-Traditional Medicare,2397.63 +117894,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,MEDICARE-Traditional Medicare,111.75 +117895,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,MEDICARE-Traditional Medicare,909.33 +117896,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,MEDICARE-Traditional Medicare,895.11 +117897,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,MEDICARE-Traditional Medicare,1552.33 +117898,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,MEDICARE-Traditional Medicare, +117899,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,MEDICARE-Traditional Medicare, +117900,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,MEDICARE-Traditional Medicare, +117901,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,MEDICARE-Traditional Medicare,1383.75 +117902,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,MEDICARE-Traditional Medicare, +117903,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,MEDICARE-Traditional Medicare, +117904,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,MEDICARE-Traditional Medicare, +117905,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,MEDICARE-Traditional Medicare, +117906,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,MEDICARE-Traditional Medicare, +117907,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,MEDICARE-Traditional Medicare,42.58 +117908,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,MEDICARE-Traditional Medicare,56.75 +117909,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,MEDICARE-Traditional Medicare,132.14 +117910,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,MEDICARE-Traditional Medicare,735.21 +117911,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,MEDICARE-Traditional Medicare,3126.64 +117912,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,MEDICARE-Traditional Medicare,263.25 +117913,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,MEDICARE-Traditional Medicare, +117914,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,MEDICARE-Traditional Medicare,146.58 +117915,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,MEDICARE-Traditional Medicare,91.75 +117916,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,MEDICARE-Traditional Medicare, +117917,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,MEDICARE-Traditional Medicare, +117918,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,MEDICARE-Traditional Medicare,19.69 +117919,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,MEDICARE-Traditional Medicare, +117920,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,MEDICARE-Traditional Medicare, +117921,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,MEDICARE-Traditional Medicare, +117922,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,MEDICARE-Traditional Medicare,412.4 +117923,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,MEDICARE-Traditional Medicare, +117924,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,MEDICARE-Traditional Medicare,19.38 +117925,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,MEDICARE-Traditional Medicare,83.99 +117926,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,MEDICARE-Traditional Medicare, +117927,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,MEDICARE-Traditional Medicare,26.88 +117928,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,MEDICARE-Traditional Medicare,85.18 +117929,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,MEDICARE-Traditional Medicare,91.78 +117930,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,MEDICARE-Traditional Medicare, +117931,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,MEDICARE-Traditional Medicare,65.89 +117932,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,MEDICARE-Traditional Medicare,176.4 +117933,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,MEDICARE-Traditional Medicare, +117934,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,MEDICARE-Traditional Medicare, +117935,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,MEDICARE-Traditional Medicare,340.5 +117936,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,MEDICARE-Traditional Medicare, +117937,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,MEDICARE-Traditional Medicare,285.0 +117938,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,MEDICARE-Traditional Medicare, +117939,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,MEDICARE-Traditional Medicare, +117940,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,MEDICARE-Traditional Medicare, +117941,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,MEDICARE-Traditional Medicare, +117942,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,MEDICARE-Traditional Medicare, +117943,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,MEDICARE-Traditional Medicare, +117944,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +117945,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +117946,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +117947,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,MEDICARE-Traditional Medicare,1100.0 +117948,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,MEDICARE-Traditional Medicare, +117949,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,MEDICARE-Traditional Medicare, +117950,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,MEDICARE-Traditional Medicare, +117951,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,MEDICARE-Traditional Medicare, +117952,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,MEDICARE-Traditional Medicare,3769.13 +117953,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,MEDICARE-Traditional Medicare,930.0 +117954,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,MEDICARE-Traditional Medicare,3769.13 +117955,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,MEDICARE-Traditional Medicare,888.0 +117956,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,MEDICARE-Traditional Medicare, +117957,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,MEDICARE-Traditional Medicare,281.54 +117958,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,MEDICARE-Traditional Medicare, +117959,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,MEDICARE-Traditional Medicare, +117960,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,MEDICARE-Traditional Medicare,919.25 +117961,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,MEDICARE-Traditional Medicare,919.25 +117962,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,MEDICARE-Traditional Medicare, +117963,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,MEDICARE-Traditional Medicare, +117964,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,MEDICARE-Traditional Medicare, +117965,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,MEDICARE-Traditional Medicare, +117966,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,MEDICARE-Traditional Medicare, +117967,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,MEDICARE-Traditional Medicare, +117968,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,MEDICARE-Traditional Medicare, +117969,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,MEDICARE-Traditional Medicare, +117970,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,MEDICARE-Traditional Medicare, +117971,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,MEDICARE-Traditional Medicare, +117972,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,MEDICARE-Traditional Medicare, +117973,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,MEDICARE-Traditional Medicare, +117974,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,MEDICARE-Traditional Medicare, +117975,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,MEDICARE-Traditional Medicare, +117976,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,MEDICARE-Traditional Medicare, +117977,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,MEDICARE-Traditional Medicare, +117978,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,MEDICARE-Traditional Medicare, +117979,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,MEDICARE-Traditional Medicare, +117980,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,MEDICARE-Traditional Medicare,237.42 +117981,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,MEDICARE-Traditional Medicare, +117982,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,MEDICARE-Traditional Medicare, +117983,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,MEDICARE-Traditional Medicare,340.13 +117984,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,MEDICARE-Traditional Medicare, +117985,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,MEDICARE-Traditional Medicare, +117986,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,MEDICARE-Traditional Medicare,359.25 +117987,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,MEDICARE-Traditional Medicare,1422.0 +117988,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,MEDICARE-Traditional Medicare, +117989,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,MEDICARE-Traditional Medicare,1422.0 +117990,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,MEDICARE-Traditional Medicare, +117991,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,MEDICARE-Traditional Medicare,397.5 +117992,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,MEDICARE-Traditional Medicare,316.06 +117993,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,MEDICARE-Traditional Medicare, +117994,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,MEDICARE-Traditional Medicare,171.11 +117995,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,MEDICARE-Traditional Medicare,468.0 +117996,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,MEDICARE-Traditional Medicare,134.96 +117997,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,MEDICARE-Traditional Medicare,1122.74 +117998,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,MEDICARE-Traditional Medicare,407.4 +117999,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,MEDICARE-Traditional Medicare, +118000,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,MEDICARE-Traditional Medicare, +118001,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,MEDICARE-Traditional Medicare, +118002,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,MEDICARE-Traditional Medicare,137.19 +118003,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,MEDICARE-Traditional Medicare,366.75 +118004,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,MEDICARE-Traditional Medicare,525.5 +118005,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,MEDICARE-Traditional Medicare,395.38 +118006,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,MEDICARE-Traditional Medicare,534.0 +118007,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,MEDICARE-Traditional Medicare,704.25 +118008,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,MEDICARE-Traditional Medicare,790.0 +118009,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,MEDICARE-Traditional Medicare,509.02 +118010,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,MEDICARE-Traditional Medicare, +118011,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,MEDICARE-Traditional Medicare, +118012,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,MEDICARE-Traditional Medicare, +118013,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,MEDICARE-Traditional Medicare, +118014,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,MEDICARE-Traditional Medicare,647.25 +118015,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,MEDICARE-Traditional Medicare, +118016,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,MEDICARE-Traditional Medicare, +118017,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,MEDICARE-Traditional Medicare,562.31 +118018,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,MEDICARE-Traditional Medicare,852.0 +118019,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,MEDICARE-Traditional Medicare, +118020,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,MEDICARE-Traditional Medicare,590.25 +118021,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,MEDICARE-Traditional Medicare,152.25 +118022,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,MEDICARE-Traditional Medicare, +118023,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,MEDICARE-Traditional Medicare, +118024,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,MEDICARE-Traditional Medicare, +118025,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,MEDICARE-Traditional Medicare, +118026,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,MEDICARE-Traditional Medicare, +118027,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,MEDICARE-Traditional Medicare,1422.0 +118028,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,MEDICARE-Traditional Medicare, +118029,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,MEDICARE-Traditional Medicare,6563.25 +118030,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,MEDICARE-Traditional Medicare, +118031,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,MEDICARE-Traditional Medicare,21303.99 +118032,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,MEDICARE-Traditional Medicare,17020.0 +118033,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,MEDICARE-Traditional Medicare, +118034,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,MEDICARE-Traditional Medicare, +118035,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,MEDICARE-Traditional Medicare, +118036,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,MEDICARE-Traditional Medicare, +118037,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,MEDICARE-Traditional Medicare,4873.63 +118038,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,MEDICARE-Traditional Medicare, +118039,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,MEDICARE-Traditional Medicare,2158.88 +118040,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,MEDICARE-Traditional Medicare,5741.6 +118041,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,MEDICARE-Traditional Medicare,7272.75 +118042,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,MEDICARE-Traditional Medicare, +118043,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +118044,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,MEDICARE-Traditional Medicare,273.53 +118045,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,MEDICARE-Traditional Medicare,569.85 +118046,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,MEDICARE-Traditional Medicare,866.0 +118047,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,MEDICARE-Traditional Medicare, +118048,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,MEDICARE-Traditional Medicare, +118049,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,MEDICARE-Traditional Medicare, +118050,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,MEDICARE-Traditional Medicare,78.0 +118051,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,MEDICARE-Traditional Medicare, +118052,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,MEDICARE-Traditional Medicare, +118053,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,MEDICARE-Traditional Medicare, +118054,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,MEDICARE-Traditional Medicare,4834.78 +118055,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,MEDICARE-Traditional Medicare, +118056,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,MEDICARE-Traditional Medicare,2919.61 +118057,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,MEDICARE-Traditional Medicare,1752.28 +118058,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,MEDICARE-Traditional Medicare,3461.5 +118059,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,MEDICARE-Traditional Medicare, +118060,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,MEDICARE-Traditional Medicare,796.83 +118061,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,MEDICARE-Traditional Medicare,1572.4 +118062,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,MEDICARE-Traditional Medicare,2460.35 +118063,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,MEDICARE-Traditional Medicare,3568.0 +118064,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,MEDICARE-Traditional Medicare, +118065,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,MEDICARE-Traditional Medicare,2742.0 +118066,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,MEDICARE-Traditional Medicare,5893.03 +118067,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,MEDICARE-Traditional Medicare, +118068,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,MEDICARE-Traditional Medicare, +118069,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,MEDICARE-Traditional Medicare,7794.66 +118070,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,MEDICARE-Traditional Medicare, +118071,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,MEDICARE-Traditional Medicare, +118072,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,MEDICARE-Traditional Medicare, +118073,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,MEDICARE-Traditional Medicare,7000.51 +118074,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,MEDICARE-Traditional Medicare,2873.53 +118075,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,MEDICARE-Traditional Medicare,7372.82 +118076,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,MEDICARE-Traditional Medicare, +118077,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,MEDICARE-Traditional Medicare, +118078,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,MEDICARE-Traditional Medicare,5018.95 +118079,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,MEDICARE-Traditional Medicare, +118080,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,MEDICARE-Traditional Medicare,6762.63 +118081,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,MEDICARE-Traditional Medicare,1998.0 +118082,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,MEDICARE-Traditional Medicare, +118083,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,MEDICARE-Traditional Medicare, +118084,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,MEDICARE-Traditional Medicare,15643.78 +118085,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,MEDICARE-Traditional Medicare, +118086,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,MEDICARE-Traditional Medicare,3732.0 +118087,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,MEDICARE-Traditional Medicare, +118088,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,MEDICARE-Traditional Medicare, +118089,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,MEDICARE-Traditional Medicare, +118090,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,MEDICARE-Traditional Medicare, +118091,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,MEDICARE-Traditional Medicare,22383.0 +118092,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,MEDICARE-Traditional Medicare,21556.46 +118093,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,MEDICARE-Traditional Medicare, +118094,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,MEDICARE-Traditional Medicare,22124.7 +118095,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,MEDICARE-Traditional Medicare, +118096,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,MEDICARE-Traditional Medicare, +118097,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,MEDICARE-Traditional Medicare,2999.5 +118098,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,MEDICARE-Traditional Medicare, +118099,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,MEDICARE-Traditional Medicare,364.5 +118100,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,MEDICARE-Traditional Medicare,233.36 +118101,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,MEDICARE-Traditional Medicare, +118102,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,MEDICARE-Traditional Medicare,1737.63 +118103,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,MEDICARE-Traditional Medicare, +118104,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,MEDICARE-Traditional Medicare, +118105,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,MEDICARE-Traditional Medicare,652.88 +118106,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,MEDICARE-Traditional Medicare, +118107,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,MEDICARE-Traditional Medicare,1437.0 +118108,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,MEDICARE-Traditional Medicare,880.5 +118109,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,MEDICARE-Traditional Medicare,1469.25 +118110,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,MEDICARE-Traditional Medicare, +118111,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,MEDICARE-Traditional Medicare,1351.0 +118112,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,MEDICARE-Traditional Medicare,916.0 +118113,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,MEDICARE-Traditional Medicare,1203.83 +118114,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,MEDICARE-Traditional Medicare, +118115,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,MEDICARE-Traditional Medicare, +118116,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,MEDICARE-Traditional Medicare, +118117,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,MEDICARE-Traditional Medicare, +118118,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,MEDICARE-Traditional Medicare, +118119,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,MEDICARE-Traditional Medicare,264.94 +118120,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,MEDICARE-Traditional Medicare,752.76 +118121,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,MEDICARE-Traditional Medicare, +118122,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,MEDICARE-Traditional Medicare, +118123,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,MEDICARE-Traditional Medicare, +118124,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,MEDICARE-Traditional Medicare, +118125,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,MEDICARE-Traditional Medicare,839.63 +118126,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,MEDICARE-Traditional Medicare,357.15 +118127,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,MEDICARE-Traditional Medicare, +118128,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,MEDICARE-Traditional Medicare, +118129,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,MEDICARE-Traditional Medicare,1419.85 +118130,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,MEDICARE-Traditional Medicare,765.83 +118131,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,MEDICARE-Traditional Medicare,265.85 +118132,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,MEDICARE-Traditional Medicare,169.63 +118133,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,MEDICARE-Traditional Medicare,935.93 +118134,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,MEDICARE-Traditional Medicare,240.0 +118135,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,MEDICARE-Traditional Medicare, +118136,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,MEDICARE-Traditional Medicare, +118137,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,MEDICARE-Traditional Medicare,6962.0 +118138,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,MEDICARE-Traditional Medicare, +118139,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,MEDICARE-Traditional Medicare, +118140,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,MEDICARE-Traditional Medicare, +118141,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,MEDICARE-Traditional Medicare, +118142,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,MEDICARE-Traditional Medicare,10169.0 +118143,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,MEDICARE-Traditional Medicare, +118144,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,MEDICARE-Traditional Medicare,3991.5 +118145,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,MEDICARE-Traditional Medicare,7986.0 +118146,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,MEDICARE-Traditional Medicare,4290.11 +118147,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,MEDICARE-Traditional Medicare,4159.35 +118148,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,MEDICARE-Traditional Medicare, +118149,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,MEDICARE-Traditional Medicare,2226.56 +118150,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,MEDICARE-Traditional Medicare,665.88 +118151,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,MEDICARE-Traditional Medicare,768.0 +118152,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,MEDICARE-Traditional Medicare,681.0 +118153,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,MEDICARE-Traditional Medicare,149.7 +118154,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,MEDICARE-Traditional Medicare,150.66 +118155,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,MEDICARE-Traditional Medicare, +118156,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,MEDICARE-Traditional Medicare, +118157,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,MEDICARE-Traditional Medicare, +118158,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,MEDICARE-Traditional Medicare, +118159,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,MEDICARE-Traditional Medicare, +118160,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,MEDICARE-Traditional Medicare, +118161,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,MEDICARE-Traditional Medicare, +118162,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,MEDICARE-Traditional Medicare, +118163,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,MEDICARE-Traditional Medicare, +118164,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,MEDICARE-Traditional Medicare, +118165,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,MEDICARE-Traditional Medicare, +118166,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,MEDICARE-Traditional Medicare, +118167,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,MEDICARE-Traditional Medicare, +118168,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,MEDICARE-Traditional Medicare, +118169,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,MEDICARE-Traditional Medicare, +118170,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,MEDICARE-Traditional Medicare,205.5 +118171,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,MEDICARE-Traditional Medicare, +118172,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,MEDICARE-Traditional Medicare,501.1 +118173,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,MEDICARE-Traditional Medicare,508.41 +118174,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,MEDICARE-Traditional Medicare,30.75 +118175,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,MEDICARE-Traditional Medicare, +118176,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,MEDICARE-Traditional Medicare, +118177,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,MEDICARE-Traditional Medicare,484.7 +118178,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,MEDICARE-Traditional Medicare,543.14 +118179,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,MEDICARE-Traditional Medicare,1582.55 +118180,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,MEDICARE-Traditional Medicare,885.27 +118181,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,MEDICARE-Traditional Medicare, +118182,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,MEDICARE-Traditional Medicare, +118183,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,MEDICARE-Traditional Medicare,1178.08 +118184,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,MEDICARE-Traditional Medicare,1280.47 +118185,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,MEDICARE-Traditional Medicare,669.46 +118186,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,MEDICARE-Traditional Medicare,1728.37 +118187,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,MEDICARE-Traditional Medicare,800.73 +118188,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,MEDICARE-Traditional Medicare,507.19 +118189,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,MEDICARE-Traditional Medicare,416.75 +118190,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,MEDICARE-Traditional Medicare,1299.2 +118191,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,MEDICARE-Traditional Medicare,1319.12 +118192,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,MEDICARE-Traditional Medicare,1790.68 +118193,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,MEDICARE-Traditional Medicare,3048.83 +118194,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,MEDICARE-Traditional Medicare, +118195,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,MEDICARE-Traditional Medicare,1761.47 +118196,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,MEDICARE-Traditional Medicare,1720.71 +118197,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,MEDICARE-Traditional Medicare,3139.99 +118198,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,MEDICARE-Traditional Medicare,1698.18 +118199,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,MEDICARE-Traditional Medicare,1931.93 +118200,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,MEDICARE-Traditional Medicare, +118201,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,MEDICARE-Traditional Medicare,2745.06 +118202,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,MEDICARE-Traditional Medicare, +118203,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,MEDICARE-Traditional Medicare,2031.0 +118204,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,MEDICARE-Traditional Medicare,206.28 +118205,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,MEDICARE-Traditional Medicare,1304.3 +118206,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,MEDICARE-Traditional Medicare,78.99 +118207,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,MEDICARE-Traditional Medicare,72.21 +118208,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,MEDICARE-Traditional Medicare,79.68 +118209,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,MEDICARE-Traditional Medicare, +118210,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,MEDICARE-Traditional Medicare, +118211,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,MEDICARE-Traditional Medicare,103.5 +118212,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,MEDICARE-Traditional Medicare,80.06 +118213,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,MEDICARE-Traditional Medicare,370.06 +118214,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,MEDICARE-Traditional Medicare,237.69 +118215,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,MEDICARE-Traditional Medicare, +118216,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,MEDICARE-Traditional Medicare,218.71 +118217,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,MEDICARE-Traditional Medicare,39.75 +118218,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,MEDICARE-Traditional Medicare,66.25 +118219,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,MEDICARE-Traditional Medicare,101.25 +118220,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,MEDICARE-Traditional Medicare,213.6 +118221,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,MEDICARE-Traditional Medicare, +118222,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,MEDICARE-Traditional Medicare,170.8 +118223,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,MEDICARE-Traditional Medicare,260.7 +118224,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,MEDICARE-Traditional Medicare,327.75 +118225,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,MEDICARE-Traditional Medicare, +118226,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,MEDICARE-Traditional Medicare,224.93 +118227,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,MEDICARE-Traditional Medicare,240.36 +118228,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,MEDICARE-Traditional Medicare,396.0 +118229,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,MEDICARE-Traditional Medicare,279.0 +118230,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,MEDICARE-Traditional Medicare,336.01 +118231,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,MEDICARE-Traditional Medicare,161.39 +118232,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,MEDICARE-Traditional Medicare,207.0 +118233,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,MEDICARE-Traditional Medicare, +118234,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,MEDICARE-Traditional Medicare,222.53 +118235,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,MEDICARE-Traditional Medicare,302.33 +118236,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,MEDICARE-Traditional Medicare,174.38 +118237,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,MEDICARE-Traditional Medicare, +118238,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,MEDICARE-Traditional Medicare, +118239,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,MEDICARE-Traditional Medicare,985.5 +118240,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,MEDICARE-Traditional Medicare,942.01 +118241,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,MEDICARE-Traditional Medicare, +118242,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,MEDICARE-Traditional Medicare, +118243,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,MEDICARE-Traditional Medicare, +118244,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,MEDICARE-Traditional Medicare, +118245,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,MEDICARE-Traditional Medicare,133.13 +118246,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,MEDICARE-Traditional Medicare,256.5 +118247,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,MEDICARE-Traditional Medicare, +118248,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,MEDICARE-Traditional Medicare,252.0 +118249,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,MEDICARE-Traditional Medicare, +118250,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,MEDICARE-Traditional Medicare, +118251,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,MEDICARE-Traditional Medicare, +118252,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,MEDICARE-Traditional Medicare, +118253,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,MEDICARE-Traditional Medicare, +118254,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,MEDICARE-Traditional Medicare,277.5 +118255,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,MEDICARE-Traditional Medicare,254.05 +118256,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,MEDICARE-Traditional Medicare,225.0 +118257,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,MEDICARE-Traditional Medicare, +118258,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,MEDICARE-Traditional Medicare, +118259,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,MEDICARE-Traditional Medicare,208.5 +118260,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,MEDICARE-Traditional Medicare,253.5 +118261,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,MEDICARE-Traditional Medicare, +118262,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,MEDICARE-Traditional Medicare,1538.96 +118263,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,MEDICARE-Traditional Medicare,1612.04 +118264,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,MEDICARE-Traditional Medicare,1522.15 +118265,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,MEDICARE-Traditional Medicare,1878.46 +118266,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,MEDICARE-Traditional Medicare,3613.55 +118267,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,MEDICARE-Traditional Medicare,5849.46 +118268,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,MEDICARE-Traditional Medicare,169.5 +118269,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,MEDICARE-Traditional Medicare, +118270,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,MEDICARE-Traditional Medicare,169.5 +118271,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,MEDICARE-Traditional Medicare, +118272,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,MEDICARE-Traditional Medicare, +118273,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,MEDICARE-Traditional Medicare, +118274,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,MEDICARE-Traditional Medicare, +118275,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,MEDICARE-Traditional Medicare,169.5 +118276,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,MEDICARE-Traditional Medicare, +118277,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,MEDICARE-Traditional Medicare,169.5 +118278,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,MEDICARE-Traditional Medicare,169.5 +118279,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,MEDICARE-Traditional Medicare, +118280,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,MEDICARE-Traditional Medicare, +118281,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,MEDICARE-Traditional Medicare, +118282,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,MEDICARE-Traditional Medicare, +118283,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,MEDICARE-Traditional Medicare, +118284,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,MEDICARE-Traditional Medicare, +118285,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,MEDICARE-Traditional Medicare, +118286,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,MEDICARE-Traditional Medicare, +118287,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,MEDICARE-Traditional Medicare,370.14 +118288,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,MEDICARE-Traditional Medicare, +118289,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,MEDICARE-Traditional Medicare, +118290,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,MEDICARE-Traditional Medicare, +118291,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,MEDICARE-Traditional Medicare,1777.25 +118292,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,MEDICARE-Traditional Medicare, +118293,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,MEDICARE-Traditional Medicare, +118294,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,MEDICARE-Traditional Medicare, +118295,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,MEDICARE-Traditional Medicare, +118296,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,MEDICARE-Traditional Medicare, +118297,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,MEDICARE-Traditional Medicare, +118298,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,MEDICARE-Traditional Medicare, +118299,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,MEDICARE-Traditional Medicare, +118300,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,MEDICARE-Traditional Medicare, +118301,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,MEDICARE-Traditional Medicare, +118302,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,MEDICARE-Traditional Medicare, +118303,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,MEDICARE-Traditional Medicare, +118304,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,MEDICARE-Traditional Medicare, +118305,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,MEDICARE-Traditional Medicare, +118306,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,MEDICARE-Traditional Medicare, +118307,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,MEDICARE-Traditional Medicare, +118308,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,MEDICARE-Traditional Medicare, +118309,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,MEDICARE-Traditional Medicare, +118310,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,MEDICARE-Traditional Medicare, +118311,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,MEDICARE-Traditional Medicare, +118312,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,MEDICARE-Traditional Medicare, +118313,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,MEDICARE-Traditional Medicare, +118314,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,MEDICARE-Traditional Medicare, +118315,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,MEDICARE-Traditional Medicare,1402.88 +118316,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,MEDICARE-Traditional Medicare, +118317,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,MEDICARE-Traditional Medicare,1632.38 +118318,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,MEDICARE-Traditional Medicare, +118319,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,MEDICARE-Traditional Medicare, +118320,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,MEDICARE-Traditional Medicare, +118321,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,MEDICARE-Traditional Medicare, +118322,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,MEDICARE-Traditional Medicare, +118323,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,MEDICARE-Traditional Medicare, +118324,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,MEDICARE-Traditional Medicare, +118325,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,MEDICARE-Traditional Medicare, +118326,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,MEDICARE-Traditional Medicare, +118327,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,MEDICARE-Traditional Medicare, +118328,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,MEDICARE-Traditional Medicare, +118329,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,MEDICARE-Traditional Medicare, +118330,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,MEDICARE-Traditional Medicare, +118331,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,MEDICARE-Traditional Medicare, +118332,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,MEDICARE-Traditional Medicare, +118333,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,MEDICARE-Traditional Medicare, +118334,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,MEDICARE-Traditional Medicare, +118335,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,MEDICARE-Traditional Medicare, +118336,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,MEDICARE-Traditional Medicare, +118337,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,MEDICARE-Traditional Medicare, +118338,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,MEDICARE-Traditional Medicare, +118339,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,MEDICARE-Traditional Medicare, +118340,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,MEDICARE-Traditional Medicare, +118341,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,MEDICARE-Traditional Medicare, +118342,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,MEDICARE-Traditional Medicare, +118343,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,MEDICARE-Traditional Medicare, +118344,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,MEDICARE-Traditional Medicare, +118345,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,MEDICARE-Traditional Medicare, +118346,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,MEDICARE-Traditional Medicare, +118347,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,MEDICARE-Traditional Medicare, +118348,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,MEDICARE-Traditional Medicare, +118349,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,MEDICARE-Traditional Medicare, +118350,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,MEDICARE-Traditional Medicare, +118351,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,MEDICARE-Traditional Medicare, +118352,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,MEDICARE-Traditional Medicare, +118353,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,MEDICARE-Traditional Medicare, +118354,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,MEDICARE-Traditional Medicare, +118355,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,MEDICARE-Traditional Medicare, +118356,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,MEDICARE-Traditional Medicare, +118357,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,MEDICARE-Traditional Medicare, +118358,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,MEDICARE-Traditional Medicare, +118359,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,MEDICARE-Traditional Medicare, +118360,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,MEDICARE-Traditional Medicare, +118361,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,MEDICARE-Traditional Medicare, +118362,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,MEDICARE-Traditional Medicare, +118363,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,MEDICARE-Traditional Medicare, +118364,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,MEDICARE-Traditional Medicare, +118365,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,MEDICARE-Traditional Medicare, +118366,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,MEDICARE-Traditional Medicare, +118367,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,MEDICARE-Traditional Medicare, +118368,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,MEDICARE-Traditional Medicare, +118369,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,MEDICARE-Traditional Medicare, +118370,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,MEDICARE-Traditional Medicare, +118371,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,MEDICARE-Traditional Medicare, +118372,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,MEDICARE-Traditional Medicare, +118373,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,MEDICARE-Traditional Medicare, +118374,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,MEDICARE-Traditional Medicare, +118375,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,MEDICARE-Traditional Medicare, +118376,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,MEDICARE-Traditional Medicare, +118377,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,MEDICARE-Traditional Medicare, +118378,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,MEDICARE-Traditional Medicare, +118379,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,MEDICARE-Traditional Medicare, +118380,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,MEDICARE-Traditional Medicare, +118381,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,MEDICARE-Traditional Medicare, +118382,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,MEDICARE-Traditional Medicare, +118383,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,MEDICARE-Traditional Medicare, +118384,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,MEDICARE-Traditional Medicare, +118385,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,MEDICARE-Traditional Medicare, +118386,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,MEDICARE-Traditional Medicare, +118387,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,MEDICARE-Traditional Medicare, +118388,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,MEDICARE-Traditional Medicare, +118389,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,MEDICARE-Traditional Medicare, +118390,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,MEDICARE-Traditional Medicare, +118391,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,MEDICARE-Traditional Medicare, +118392,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,MEDICARE-Traditional Medicare, +118393,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,MEDICARE-Traditional Medicare, +118394,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,MEDICARE-Traditional Medicare, +118395,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,MEDICARE-Traditional Medicare, +118396,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,MEDICARE-Traditional Medicare, +118397,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,MEDICARE-Traditional Medicare, +118398,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,MEDICARE-Traditional Medicare, +118399,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,MEDICARE-Traditional Medicare, +118400,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,MEDICARE-Traditional Medicare, +118401,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,MEDICARE-Traditional Medicare, +118402,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,MEDICARE-Traditional Medicare, +118403,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,MEDICARE-Traditional Medicare, +118404,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,MEDICARE-Traditional Medicare, +118405,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,MEDICARE-Traditional Medicare, +118406,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,MEDICARE-Traditional Medicare, +118407,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,MEDICARE-Traditional Medicare, +118408,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,MEDICARE-Traditional Medicare, +118409,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,MEDICARE-Traditional Medicare, +118410,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,MEDICARE-Traditional Medicare, +118411,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,MEDICARE-Traditional Medicare, +118412,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,MEDICARE-Traditional Medicare, +118413,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,MEDICARE-Traditional Medicare, +118414,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,MEDICARE-Traditional Medicare, +118415,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,MEDICARE-Traditional Medicare, +118416,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,MEDICARE-Traditional Medicare, +118417,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,MEDICARE-Traditional Medicare, +118418,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,MEDICARE-Traditional Medicare, +118419,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,MEDICARE-Traditional Medicare, +118420,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,MEDICARE-Traditional Medicare, +118421,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,MEDICARE-Traditional Medicare, +118422,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,MEDICARE-Traditional Medicare, +118423,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,MEDICARE-Traditional Medicare, +118424,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,MEDICARE-Traditional Medicare, +118425,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,MEDICARE-Traditional Medicare, +118426,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,MEDICARE-Traditional Medicare, +118427,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,MEDICARE-Traditional Medicare, +118428,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,MEDICARE-Traditional Medicare, +118429,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,MEDICARE-Traditional Medicare, +118430,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,MEDICARE-Traditional Medicare, +118431,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,MEDICARE-Traditional Medicare, +118432,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,MEDICARE-Traditional Medicare, +118433,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,MEDICARE-Traditional Medicare, +118434,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,MEDICARE-Traditional Medicare, +118435,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,MEDICARE-Traditional Medicare, +118436,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,MEDICARE-Traditional Medicare, +118437,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,MEDICARE-Traditional Medicare, +118438,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,MEDICARE-Traditional Medicare, +118439,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,MEDICARE-Traditional Medicare, +118440,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,MEDICARE-Traditional Medicare, +118441,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,MEDICARE-Traditional Medicare, +118442,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,MEDICARE-Traditional Medicare, +118443,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,MEDICARE-Traditional Medicare, +118444,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,MEDICARE-Traditional Medicare, +118445,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,MEDICARE-Traditional Medicare, +118446,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,MEDICARE-Traditional Medicare, +118447,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,MEDICARE-Traditional Medicare, +118448,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,MEDICARE-Traditional Medicare, +118449,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,MEDICARE-Traditional Medicare, +118450,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,MEDICARE-Traditional Medicare, +118451,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,MEDICARE-Traditional Medicare, +118452,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,MEDICARE-Traditional Medicare, +118453,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,MEDICARE-Traditional Medicare, +118454,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,MEDICARE-Traditional Medicare, +118455,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,MEDICARE-Traditional Medicare, +118456,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,MEDICARE-Traditional Medicare, +118457,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,MEDICARE-Traditional Medicare, +118458,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,MEDICARE-Traditional Medicare, +118459,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,MEDICARE-Traditional Medicare, +118460,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,MEDICARE-Traditional Medicare, +118461,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,MEDICARE-Traditional Medicare, +118462,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,MEDICARE-Traditional Medicare, +118463,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,MEDICARE-Traditional Medicare, +118464,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,MEDICARE-Traditional Medicare, +118465,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,MEDICARE-Traditional Medicare, +118466,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,MEDICARE-Traditional Medicare, +118467,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,MEDICARE-Traditional Medicare, +118468,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,MEDICARE-Traditional Medicare, +118469,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,MEDICARE-Traditional Medicare, +118470,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,MEDICARE-Traditional Medicare, +118471,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,MEDICARE-Traditional Medicare, +118472,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,MEDICARE-Traditional Medicare, +118473,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,MEDICARE-Traditional Medicare, +118474,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,MEDICARE-Traditional Medicare, +118475,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,MEDICARE-Traditional Medicare, +118476,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,MEDICARE-Traditional Medicare, +118477,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,MEDICARE-Traditional Medicare, +118478,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,MEDICARE-Traditional Medicare, +118479,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,MEDICARE-Traditional Medicare, +118480,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,MEDICARE-Traditional Medicare, +118481,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,MEDICARE-Traditional Medicare, +118482,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,MEDICARE-Traditional Medicare, +118483,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,MEDICARE-Traditional Medicare, +118484,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,MEDICARE-Traditional Medicare, +118485,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,MEDICARE-Traditional Medicare, +118486,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,MEDICARE-Traditional Medicare, +118487,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,MEDICARE-Traditional Medicare, +118488,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,MEDICARE-Traditional Medicare, +118489,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,MEDICARE-Traditional Medicare, +118490,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,MEDICARE-Traditional Medicare, +118491,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,MEDICARE-Traditional Medicare, +118492,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,MEDICARE-Traditional Medicare, +118493,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,MEDICARE-Traditional Medicare, +118494,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,MEDICARE-Traditional Medicare, +118495,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,MEDICARE-Traditional Medicare, +118496,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,MEDICARE-Traditional Medicare, +118497,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,MEDICARE-Traditional Medicare, +118498,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,MEDICARE-Traditional Medicare, +118499,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,MEDICARE-Traditional Medicare, +118500,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,MEDICARE-Traditional Medicare, +118501,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,MEDICARE-Traditional Medicare, +118502,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,MEDICARE-Traditional Medicare, +118503,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,MEDICARE-Traditional Medicare, +118504,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,MEDICARE-Traditional Medicare, +118505,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,MEDICARE-Traditional Medicare, +118506,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,MEDICARE-Traditional Medicare, +118507,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,MEDICARE-Traditional Medicare, +118508,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,MEDICARE-Traditional Medicare, +118509,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,MEDICARE-Traditional Medicare, +118510,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,MEDICARE-Traditional Medicare, +118511,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,MEDICARE-Traditional Medicare, +118512,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,MEDICARE-Traditional Medicare, +118513,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,MEDICARE-Traditional Medicare, +118514,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,MEDICARE-Traditional Medicare, +118515,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,MEDICARE-Traditional Medicare, +118516,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,MEDICARE-Traditional Medicare, +118517,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,MEDICARE-Traditional Medicare, +118518,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,MEDICARE-Traditional Medicare, +118519,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,MEDICARE-Traditional Medicare, +118520,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,MEDICARE-Traditional Medicare, +118521,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,MEDICARE-Traditional Medicare, +118522,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,MEDICARE-Traditional Medicare, +118523,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,MEDICARE-Traditional Medicare, +118524,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,MEDICARE-Traditional Medicare, +118525,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,MEDICARE-Traditional Medicare, +118526,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,MEDICARE-Traditional Medicare, +118527,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,MEDICARE-Traditional Medicare, +118528,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,MEDICARE-Traditional Medicare, +118529,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,MEDICARE-Traditional Medicare, +118530,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,MEDICARE-Traditional Medicare, +118531,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,MEDICARE-Traditional Medicare, +118532,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,MEDICARE-Traditional Medicare, +118533,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,MEDICARE-Traditional Medicare, +118534,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,MEDICARE-Traditional Medicare, +118535,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,MEDICARE-Traditional Medicare, +118536,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,MEDICARE-Traditional Medicare, +118537,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,MEDICARE-Traditional Medicare, +118538,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,MEDICARE-Traditional Medicare, +118539,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,MEDICARE-Traditional Medicare, +118540,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,MEDICARE-Traditional Medicare, +118541,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,MEDICARE-Traditional Medicare, +118542,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,MEDICARE-Traditional Medicare, +118543,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,MEDICARE-Traditional Medicare, +118544,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,MEDICARE-Traditional Medicare, +118545,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,MEDICARE-Traditional Medicare, +118546,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,MEDICARE-Traditional Medicare, +118547,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,MEDICARE-Traditional Medicare, +118548,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,MEDICARE-Traditional Medicare, +118549,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,MEDICARE-Traditional Medicare, +118550,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,MEDICARE-Traditional Medicare, +118551,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,MEDICARE-Traditional Medicare, +118552,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,MEDICARE-Traditional Medicare, +118553,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,MEDICARE-Traditional Medicare, +118554,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,MEDICARE-Traditional Medicare, +118555,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,MEDICARE-Traditional Medicare, +118556,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,MEDICARE-Traditional Medicare, +118557,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,MEDICARE-Traditional Medicare, +118558,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,MEDICARE-Traditional Medicare, +118559,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,MEDICARE-Traditional Medicare, +118560,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,MEDICARE-Traditional Medicare, +118561,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,MEDICARE-Traditional Medicare, +118562,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,MEDICARE-Traditional Medicare, +118563,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,MEDICARE-Traditional Medicare, +118564,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,MEDICARE-Traditional Medicare, +118565,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,MEDICARE-Traditional Medicare, +118566,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,MEDICARE-Traditional Medicare, +118567,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,MEDICARE-Traditional Medicare, +118568,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,MEDICARE-Traditional Medicare, +118569,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,MEDICARE-Traditional Medicare, +118570,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,MEDICARE-Traditional Medicare, +118571,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,MEDICARE-Traditional Medicare, +118572,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,MEDICARE-Traditional Medicare,508.44 +118573,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,MEDICARE-Traditional Medicare,971.45 +118574,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,MEDICARE-Traditional Medicare,1534.69 +118575,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,MEDICARE-Traditional Medicare,804.49 +118576,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,MEDICARE-Traditional Medicare,1270.5 +118577,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,MEDICARE-Traditional Medicare, +118578,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,MEDICARE-Traditional Medicare,2582.25 +118579,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,MEDICARE-Traditional Medicare, +118580,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,MEDICARE-Traditional Medicare, +118581,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,MEDICARE-Traditional Medicare, +118582,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,MEDICARE-Traditional Medicare, +118583,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,MEDICARE-Traditional Medicare,258.14 +118584,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,MEDICARE-Traditional Medicare, +118585,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,MEDICARE-Traditional Medicare, +118586,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,MEDICARE-Traditional Medicare, +118587,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,MEDICARE-Traditional Medicare, +118588,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,MEDICARE-Traditional Medicare, +118589,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,MEDICARE-Traditional Medicare,105.19 +118590,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,MEDICARE-Traditional Medicare,47.16 +118591,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,MEDICARE-Traditional Medicare, +118592,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,MEDICARE-Traditional Medicare, +118593,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,MEDICARE-Traditional Medicare, +118594,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,MEDICARE-Traditional Medicare,33.6 +118595,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,MEDICARE-Traditional Medicare,28.0 +118596,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,MEDICARE-Traditional Medicare, +118597,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,MEDICARE-Traditional Medicare, +118598,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,MEDICARE-Traditional Medicare,47.6 +118599,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,MEDICARE-Traditional Medicare,33.25 +118600,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,MEDICARE-Traditional Medicare,55.65 +118601,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,MEDICARE-Traditional Medicare,20.3 +118602,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,MEDICARE-Traditional Medicare,54.18 +118603,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,MEDICARE-Traditional Medicare, +118604,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,MEDICARE-Traditional Medicare, +118605,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,MEDICARE-Traditional Medicare,112.57 +118606,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,MEDICARE-Traditional Medicare, +118607,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,MEDICARE-Traditional Medicare,59.5 +118608,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,MEDICARE-Traditional Medicare,143.85 +118609,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,MEDICARE-Traditional Medicare, +118610,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,MEDICARE-Traditional Medicare, +118611,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,MEDICARE-Traditional Medicare,220.5 +118612,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,MEDICARE-Traditional Medicare,1386.0 +118613,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,MEDICARE-Traditional Medicare,3570.0 +118614,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,MEDICARE-Traditional Medicare, +118615,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,MEDICARE-Traditional Medicare,539.0 +118616,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,MEDICARE-Traditional Medicare, +118617,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,MEDICARE-Traditional Medicare, +118618,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,MEDICARE-Traditional Medicare,1003.48 +118619,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,MEDICARE-Traditional Medicare, +118620,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,MEDICARE-Traditional Medicare,881.5 +118621,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,MEDICARE-Traditional Medicare, +118622,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,MEDICARE-Traditional Medicare, +118623,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,MEDICARE-Traditional Medicare, +118624,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,MEDICARE-Traditional Medicare,801.5 +118625,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,MEDICARE-Traditional Medicare, +118626,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,MEDICARE-Traditional Medicare, +118627,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,MEDICARE-Traditional Medicare, +118628,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,MEDICARE-Traditional Medicare, +118629,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,MEDICARE-Traditional Medicare,140.0 +118630,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,MEDICARE-Traditional Medicare, +118631,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,MEDICARE-Traditional Medicare,5603.0 +118632,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,MEDICARE-Traditional Medicare,816.0 +118633,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,MEDICARE-Traditional Medicare, +118634,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,MEDICARE-Traditional Medicare,271.0 +118635,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,MEDICARE-Traditional Medicare, +118636,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,MEDICARE-Traditional Medicare, +118637,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,MEDICARE-Traditional Medicare, +118638,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,MEDICARE-Traditional Medicare, +118639,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,MEDICARE-Traditional Medicare,2576.0 +118640,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,MEDICARE-Traditional Medicare, +118641,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,MEDICARE-Traditional Medicare,1223.1 +118642,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,MEDICARE-Traditional Medicare,2472.3 +118643,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,MEDICARE-Traditional Medicare,4600.0 +118644,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,MEDICARE-Traditional Medicare, +118645,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,MEDICARE-Traditional Medicare,950.0 +118646,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,MEDICARE-Traditional Medicare, +118647,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,MEDICARE-Traditional Medicare, +118648,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,MEDICARE-Traditional Medicare,98.85 +118649,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,MEDICARE-Traditional Medicare,1315.0 +118650,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,MEDICARE-Traditional Medicare,21365.0 +118651,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,MEDICARE-Traditional Medicare, +118652,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,MEDICARE-Traditional Medicare, +118653,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,MEDICARE-Traditional Medicare, +118654,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,MEDICARE-Traditional Medicare, +118655,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,MEDICARE-Traditional Medicare, +118656,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,MEDICARE-Traditional Medicare,615.7 +118657,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,MEDICARE-Traditional Medicare, +118658,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,MEDICARE-Traditional Medicare,4317.5 +118659,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,MEDICARE-Traditional Medicare, +118660,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,MEDICARE-Traditional Medicare, +118661,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,MEDICARE-Traditional Medicare,283.67 +118662,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,MEDICARE-Traditional Medicare,2282.0 +118663,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,MEDICARE-Traditional Medicare, +118664,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,MEDICARE-Traditional Medicare, +118665,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,MEDICARE-Traditional Medicare, +118666,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,MEDICARE-Traditional Medicare, +118667,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,MEDICARE-Traditional Medicare,37728.5 +118668,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,MEDICARE-Traditional Medicare, +118669,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,MEDICARE-Traditional Medicare, +118670,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,MEDICARE-Traditional Medicare,1695.0 +118671,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,MEDICARE-Traditional Medicare, +118672,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,MEDICARE-Traditional Medicare, +118673,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,MEDICARE-Traditional Medicare, +118674,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,MEDICARE-Traditional Medicare,21112.0 +118675,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,MEDICARE-Traditional Medicare, +118676,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,MEDICARE-Traditional Medicare, +118677,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,MEDICARE-Traditional Medicare, +118678,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,MEDICARE-Traditional Medicare,1133.0 +118679,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,MEDICARE-Traditional Medicare,212.5 +118680,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,MEDICARE-Traditional Medicare, +118681,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,MEDICARE-Traditional Medicare, +118682,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,MEDICARE-Traditional Medicare,140.0 +118683,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,MEDICARE-Traditional Medicare,9.0 +118684,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,MEDICARE-Traditional Medicare, +118685,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,MEDICARE-Traditional Medicare, +118686,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,MEDICARE-Traditional Medicare, +118687,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,MEDICARE-Traditional Medicare,1067.5 +118688,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,MEDICARE-Traditional Medicare, +118689,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,MEDICARE-Traditional Medicare, +118690,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,MEDICARE-Traditional Medicare, +118691,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,MEDICARE-Traditional Medicare, +118692,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,MEDICARE-Traditional Medicare, +118693,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,MEDICARE-Traditional Medicare, +118694,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,MEDICARE-Traditional Medicare,964.0 +118695,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,MEDICARE-Traditional Medicare, +118696,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,MEDICARE-Traditional Medicare, +118697,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,MEDICARE-Traditional Medicare, +118698,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,MEDICARE-Traditional Medicare, +118699,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,MEDICARE-Traditional Medicare, +118700,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,MEDICARE-Traditional Medicare, +118701,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,MEDICARE-Traditional Medicare, +118702,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,MEDICARE-Traditional Medicare, +118703,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,MEDICARE-Traditional Medicare, +118704,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,MEDICARE-Traditional Medicare, +118705,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,MEDICARE-Traditional Medicare, +118706,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,MEDICARE-Traditional Medicare, +118707,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,MEDICARE-Traditional Medicare,222.59 +118708,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,MEDICARE-Traditional Medicare,9.59 +118709,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,MEDICARE-Traditional Medicare, +118710,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,MEDICARE-Traditional Medicare, +118711,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,MEDICARE-Traditional Medicare, +118712,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,MEDICARE-Traditional Medicare, +118713,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,MEDICARE-Traditional Medicare, +118714,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,MEDICARE-Traditional Medicare,219.24 +118715,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,MEDICARE-Traditional Medicare, +118716,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,MEDICARE-Traditional Medicare, +118717,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,MEDICARE-Traditional Medicare, +118718,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,MEDICARE-Traditional Medicare, +118719,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,MEDICARE-Traditional Medicare, +118720,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,MEDICARE-Traditional Medicare, +118721,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,MEDICARE-Traditional Medicare, +118722,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,MEDICARE-Traditional Medicare, +118723,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,MEDICARE-Traditional Medicare, +118724,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,MEDICARE-Traditional Medicare, +118725,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,MEDICARE-Traditional Medicare, +118726,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,MEDICARE-Traditional Medicare, +118727,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,MEDICARE-Traditional Medicare, +118728,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,MEDICARE-Traditional Medicare,46.0 +118729,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,MEDICARE-Traditional Medicare, +118730,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,MEDICARE-Traditional Medicare, +118731,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,MEDICARE-Traditional Medicare, +118732,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,MEDICARE-Traditional Medicare, +118733,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,MEDICARE-Traditional Medicare, +118734,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,MEDICARE-Traditional Medicare, +118735,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,MEDICARE-Traditional Medicare, +118736,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,MEDICARE-Traditional Medicare, +118737,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,MEDICARE-Traditional Medicare, +118738,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,MEDICARE-Traditional Medicare, +118739,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,MEDICARE-Traditional Medicare, +118740,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,MEDICARE-Traditional Medicare, +118741,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,MEDICARE-Traditional Medicare, +118742,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,MEDICARE-Traditional Medicare, +118743,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,MEDICARE-Traditional Medicare, +118744,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,MEDICARE-Traditional Medicare, +118745,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,MEDICARE-Traditional Medicare, +118746,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,MEDICARE-Traditional Medicare, +118747,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,MEDICARE-Traditional Medicare, +118748,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,MEDICARE-Traditional Medicare,1713.5 +118749,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,MEDICARE-Traditional Medicare, +118750,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,MEDICARE-Traditional Medicare, +118751,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,MEDICARE-Traditional Medicare, +118752,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,MEDICARE-Traditional Medicare, +118753,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,MEDICARE-Traditional Medicare,4356.0 +118754,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,MEDICARE-Traditional Medicare, +118755,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,MEDICARE-Traditional Medicare,1233.0 +118756,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,MEDICARE-Traditional Medicare, +118757,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,MEDICARE-Traditional Medicare, +118758,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,MEDICARE-Traditional Medicare,58.5 +118759,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,MEDICARE-Traditional Medicare,124.86 +118760,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,MEDICARE-Traditional Medicare,126.0 +118761,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,MEDICARE-Traditional Medicare, +118762,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,MEDICARE-Traditional Medicare, +118763,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,MEDICARE-Traditional Medicare, +118764,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,MEDICARE-Traditional Medicare, +118765,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,MEDICARE-Traditional Medicare, +118766,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,MEDICARE-Traditional Medicare,188.25 +118767,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,MEDICARE-Traditional Medicare, +118768,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,MEDICARE-Traditional Medicare, +118769,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,MEDICARE-Traditional Medicare,231.24 +118770,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,MEDICARE-Traditional Medicare, +118771,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,MEDICARE-Traditional Medicare, +118772,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,MEDICARE-Traditional Medicare,134.46 +118773,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,MEDICARE-Traditional Medicare, +118774,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,MEDICARE-Traditional Medicare, +118775,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,MEDICARE-Traditional Medicare, +118776,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,MEDICARE-Traditional Medicare,1363.0 +118777,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,MEDICARE-Traditional Medicare,4662.71 +118778,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,MEDICARE-Traditional Medicare, +118779,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,MEDICARE-Traditional Medicare, +118780,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,MEDICARE-Traditional Medicare, +118781,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,MEDICARE-Traditional Medicare, +118782,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,MEDICARE-Traditional Medicare, +118783,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,MEDICARE-Traditional Medicare, +118784,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,MEDICARE-Traditional Medicare,513.04 +118785,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,MEDICARE-Traditional Medicare, +118786,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,MEDICARE-Traditional Medicare, +118787,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,MEDICARE-Traditional Medicare, +118788,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,MEDICARE-Traditional Medicare, +118789,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,MEDICARE-Traditional Medicare, +118790,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,MEDICARE-Traditional Medicare, +118791,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,MEDICARE-Traditional Medicare, +118792,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,MEDICARE-Traditional Medicare,622.41 +118793,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,MEDICARE-Traditional Medicare, +118794,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,MEDICARE-Traditional Medicare, +118795,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,MEDICARE-Traditional Medicare,55.19 +118796,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,MEDICARE-Traditional Medicare,14.14 +118797,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,MEDICARE-Traditional Medicare, +118798,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,MEDICARE-Traditional Medicare, +118799,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,MEDICARE-Traditional Medicare, +118800,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,MEDICARE-Traditional Medicare, +118801,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,MEDICARE-Traditional Medicare,14.81 +118802,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,MEDICARE-Traditional Medicare, +118803,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,MEDICARE-Traditional Medicare, +118804,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,MEDICARE-Traditional Medicare,23.76 +118805,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,MEDICARE-Traditional Medicare,11.84 +118806,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,MEDICARE-Traditional Medicare, +118807,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,MEDICARE-Traditional Medicare, +118808,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,MEDICARE-Traditional Medicare, +118809,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,MEDICARE-Traditional Medicare, +118810,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,MEDICARE-Traditional Medicare,92.21 +118811,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,MEDICARE-Traditional Medicare,69.3 +118812,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,MEDICARE-Traditional Medicare,181.13 +118813,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,MEDICARE-Traditional Medicare,8.13 +118814,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,MEDICARE-Traditional Medicare,931.03 +118815,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,MEDICARE-Traditional Medicare,757.26 +118816,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,MEDICARE-Traditional Medicare,6.15 +118817,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,MEDICARE-Traditional Medicare, +118818,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,MEDICARE-Traditional Medicare, +118819,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,MEDICARE-Traditional Medicare, +118820,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,MEDICARE-Traditional Medicare,185.47 +118821,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,MEDICARE-Traditional Medicare,14.89 +118822,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,MEDICARE-Traditional Medicare,32.12 +118823,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,MEDICARE-Traditional Medicare,45.23 +118824,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,MEDICARE-Traditional Medicare,15.65 +118825,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,MEDICARE-Traditional Medicare, +118826,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,MEDICARE-Traditional Medicare, +118827,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,MEDICARE-Traditional Medicare, +118828,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,MEDICARE-Traditional Medicare, +118829,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,MEDICARE-Traditional Medicare,4.71 +118830,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,MEDICARE-Traditional Medicare,6108.91 +118831,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,MEDICARE-Traditional Medicare,20.68 +118832,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,MEDICARE-Traditional Medicare, +118833,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,MEDICARE-Traditional Medicare, +118834,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,MEDICARE-Traditional Medicare,2925.72 +118835,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,MEDICARE-Traditional Medicare, +118836,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,MEDICARE-Traditional Medicare, +118837,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,MEDICARE-Traditional Medicare, +118838,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,MEDICARE-Traditional Medicare, +118839,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,MEDICARE-Traditional Medicare, +118840,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,MEDICARE-Traditional Medicare,1707.0 +118841,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,MEDICARE-Traditional Medicare, +118842,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,MEDICARE-Traditional Medicare, +118843,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,MEDICARE-Traditional Medicare, +118844,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,MEDICARE-Traditional Medicare,305.41 +118845,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,MEDICARE-Traditional Medicare, +118846,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,MEDICARE-Traditional Medicare, +118847,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,MEDICARE-Traditional Medicare, +118848,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,MEDICARE-Traditional Medicare,7.58 +118849,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,MEDICARE-Traditional Medicare,1.24 +118850,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,MEDICARE-Traditional Medicare, +118851,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,MEDICARE-Traditional Medicare, +118852,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,MEDICARE-Traditional Medicare, +118853,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,MEDICARE-Traditional Medicare, +118854,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,MEDICARE-Traditional Medicare, +118855,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,MEDICARE-Traditional Medicare, +118856,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,MEDICARE-Traditional Medicare, +118857,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,MEDICARE-Traditional Medicare,1325.84 +118858,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,MEDICARE-Traditional Medicare, +118859,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,MEDICARE-Traditional Medicare, +118860,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,MEDICARE-Traditional Medicare,374.26 +118861,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,MEDICARE-Traditional Medicare, +118862,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,MEDICARE-Traditional Medicare, +118863,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,MEDICARE-Traditional Medicare, +118864,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,MEDICARE-Traditional Medicare, +118865,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,MEDICARE-Traditional Medicare,14854.79 +118866,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,MEDICARE-Traditional Medicare,5.78 +118867,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,MEDICARE-Traditional Medicare, +118868,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,MEDICARE-Traditional Medicare,216.22 +118869,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,MEDICARE-Traditional Medicare,8.44 +118870,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,MEDICARE-Traditional Medicare, +118871,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,MEDICARE-Traditional Medicare,0.56 +118872,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,MEDICARE-Traditional Medicare,5.69 +118873,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,MEDICARE-Traditional Medicare,49.4 +118874,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,MEDICARE-Traditional Medicare, +118875,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,MEDICARE-Traditional Medicare,560.5 +118876,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,MEDICARE-Traditional Medicare,18.01 +118877,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,MEDICARE-Traditional Medicare, +118878,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,MEDICARE-Traditional Medicare,6719.96 +118879,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,MEDICARE-Traditional Medicare,128.12 +118880,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,MEDICARE-Traditional Medicare,4.28 +118881,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,MEDICARE-Traditional Medicare,59.04 +118882,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,MEDICARE-Traditional Medicare,7.29 +118883,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,MEDICARE-Traditional Medicare, +118884,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,MEDICARE-Traditional Medicare,15.66 +118885,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,MEDICARE-Traditional Medicare, +118886,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,MEDICARE-Traditional Medicare,48.76 +118887,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,MEDICARE-Traditional Medicare,13.86 +118888,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,MEDICARE-Traditional Medicare,4.45 +118889,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,MEDICARE-Traditional Medicare,94.5 +118890,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,MEDICARE-Traditional Medicare,2.82 +118891,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,MEDICARE-Traditional Medicare, +118892,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,MEDICARE-Traditional Medicare, +118893,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,MEDICARE-Traditional Medicare,20.51 +118894,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,MEDICARE-Traditional Medicare, +118895,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,MEDICARE-Traditional Medicare, +118896,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,MEDICARE-Traditional Medicare, +118897,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,MEDICARE-Traditional Medicare,1.2 +118898,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,MEDICARE-Traditional Medicare,39.04 +118899,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,MEDICARE-Traditional Medicare,4.67 +118900,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,MEDICARE-Traditional Medicare,3.52 +118901,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,MEDICARE-Traditional Medicare,97.71 +118902,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,MEDICARE-Traditional Medicare, +118903,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,MEDICARE-Traditional Medicare, +118904,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,MEDICARE-Traditional Medicare, +118905,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,MEDICARE-Traditional Medicare, +118906,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,MEDICARE-Traditional Medicare,12.52 +118907,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,MEDICARE-Traditional Medicare, +118908,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,MEDICARE-Traditional Medicare, +118909,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,MEDICARE-Traditional Medicare, +118910,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,MEDICARE-Traditional Medicare,10.3 +118911,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,MEDICARE-Traditional Medicare,176.4 +118912,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,MEDICARE-Traditional Medicare,7399.39 +118913,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,MEDICARE-Traditional Medicare,39.88 +118914,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,MEDICARE-Traditional Medicare,53.21 +118915,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,MEDICARE-Traditional Medicare, +118916,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,MEDICARE-Traditional Medicare, +118917,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,MEDICARE-Traditional Medicare, +118918,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,MEDICARE-Traditional Medicare,11.85 +118919,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,MEDICARE-Traditional Medicare,525.65 +118920,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,MEDICARE-Traditional Medicare, +118921,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,MEDICARE-Traditional Medicare, +118922,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,MEDICARE-Traditional Medicare,49.97 +118923,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,MEDICARE-Traditional Medicare, +118924,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,MEDICARE-Traditional Medicare,1.74 +118925,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,MEDICARE-Traditional Medicare, +118926,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,MEDICARE-Traditional Medicare,259.35 +118927,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,MEDICARE-Traditional Medicare,102.9 +118928,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,MEDICARE-Traditional Medicare, +118929,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,MEDICARE-Traditional Medicare, +118930,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,MEDICARE-Traditional Medicare, +118931,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,MEDICARE-Traditional Medicare,88.46 +118932,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,MEDICARE-Traditional Medicare, +118933,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,MEDICARE-Traditional Medicare,12.02 +118934,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,MEDICARE-Traditional Medicare,10.77 +118935,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,MEDICARE-Traditional Medicare, +118936,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,MEDICARE-Traditional Medicare,2.77 +118937,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,MEDICARE-Traditional Medicare, +118938,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,MEDICARE-Traditional Medicare,5.04 +118939,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,MEDICARE-Traditional Medicare,82.09 +118940,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,MEDICARE-Traditional Medicare,1561.29 +118941,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,MEDICARE-Traditional Medicare,3531.57 +118942,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,MEDICARE-Traditional Medicare,17.12 +118943,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,MEDICARE-Traditional Medicare,6048.0 +118944,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,MEDICARE-Traditional Medicare,36.74 +118945,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,MEDICARE-Traditional Medicare,22.93 +118946,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,MEDICARE-Traditional Medicare,6071.94 +118947,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,MEDICARE-Traditional Medicare, +118948,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,MEDICARE-Traditional Medicare,14.93 +118949,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,MEDICARE-Traditional Medicare,9.18 +118950,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,MEDICARE-Traditional Medicare, +118951,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,MEDICARE-Traditional Medicare, +118952,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,MEDICARE-Traditional Medicare,13.96 +118953,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,MEDICARE-Traditional Medicare,9.4 +118954,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,MEDICARE-Traditional Medicare,330.28 +118955,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,MEDICARE-Traditional Medicare,23.4 +118956,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,MEDICARE-Traditional Medicare, +118957,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,MEDICARE-Traditional Medicare,6.28 +118958,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,MEDICARE-Traditional Medicare,2.86 +118959,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,MEDICARE-Traditional Medicare,3.31 +118960,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,MEDICARE-Traditional Medicare,2.82 +118961,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,MEDICARE-Traditional Medicare,3.3 +118962,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,MEDICARE-Traditional Medicare,9.1 +118963,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,MEDICARE-Traditional Medicare,3.36 +118964,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,MEDICARE-Traditional Medicare, +118965,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,MEDICARE-Traditional Medicare, +118966,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,MEDICARE-Traditional Medicare, +118967,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,MEDICARE-Traditional Medicare, +118968,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,MEDICARE-Traditional Medicare,6468.0 +118969,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,MEDICARE-Traditional Medicare, +118970,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,MEDICARE-Traditional Medicare, +118971,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,MEDICARE-Traditional Medicare, +118972,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,MEDICARE-Traditional Medicare, +118973,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,MEDICARE-Traditional Medicare, +118974,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,MEDICARE-Traditional Medicare, +118975,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,MEDICARE-Traditional Medicare, +118976,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,MEDICARE-Traditional Medicare,1.52 +118977,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,MEDICARE-Traditional Medicare,13.78 +118978,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,MEDICARE-Traditional Medicare, +118979,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,MEDICARE-Traditional Medicare, +118980,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,MEDICARE-Traditional Medicare,6.18 +118981,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,MEDICARE-Traditional Medicare, +118982,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,MEDICARE-Traditional Medicare, +118983,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,MEDICARE-Traditional Medicare,385.32 +118984,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,MEDICARE-Traditional Medicare, +118985,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,MEDICARE-Traditional Medicare, +118986,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,MEDICARE-Traditional Medicare, +118987,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,MEDICARE-Traditional Medicare,127.36 +118988,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,MEDICARE-Traditional Medicare, +118989,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,MEDICARE-Traditional Medicare,1.7 +118990,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,MEDICARE-Traditional Medicare,0.73 +118991,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,MEDICARE-Traditional Medicare, +118992,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,MEDICARE-Traditional Medicare, +118993,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,MEDICARE-Traditional Medicare,89.96 +118994,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,MEDICARE-Traditional Medicare, +118995,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,MEDICARE-Traditional Medicare, +118996,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,MEDICARE-Traditional Medicare,8288.45 +118997,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,MEDICARE-Traditional Medicare, +118998,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,MEDICARE-Traditional Medicare,182.89 +118999,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,MEDICARE-Traditional Medicare, +119000,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,MEDICARE-Traditional Medicare,4907.34 +119001,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,MEDICARE-Traditional Medicare, +119002,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,MEDICARE-Traditional Medicare, +119003,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,MEDICARE-Traditional Medicare, +119004,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,MEDICARE-Traditional Medicare, +119005,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,MEDICARE-Traditional Medicare, +119006,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,MEDICARE-Traditional Medicare,1160.15 +119007,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,MEDICARE-Traditional Medicare, +119008,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,MEDICARE-Traditional Medicare, +119009,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,MEDICARE-Traditional Medicare,49.01 +119010,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,MEDICARE-Traditional Medicare,1540.18 +119011,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,MEDICARE-Traditional Medicare, +119012,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,MEDICARE-Traditional Medicare, +119013,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,MEDICARE-Traditional Medicare, +119014,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,MEDICARE-Traditional Medicare, +119015,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,MEDICARE-Traditional Medicare, +119016,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,MEDICARE-Traditional Medicare,338.04 +119017,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,MEDICARE-Traditional Medicare, +119018,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,MEDICARE-Traditional Medicare,489.22 +119019,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,MEDICARE-Traditional Medicare, +119020,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,MEDICARE-Traditional Medicare, +119021,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,MEDICARE-Traditional Medicare, +119022,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,MEDICARE-Traditional Medicare, +119023,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,MEDICARE-Traditional Medicare,25.71 +119024,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,MEDICARE-Traditional Medicare,177.41 +119025,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,MEDICARE-Traditional Medicare,897.82 +119026,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,MEDICARE-Traditional Medicare, +119027,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,MEDICARE-Traditional Medicare, +119028,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,MEDICARE-Traditional Medicare, +119029,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,MEDICARE-Traditional Medicare, +119030,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,MEDICARE-Traditional Medicare,1707.38 +119031,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,MEDICARE-Traditional Medicare, +119032,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,MEDICARE-Traditional Medicare, +119033,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,MEDICARE-Traditional Medicare, +119034,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,MEDICARE-Traditional Medicare,1.68 +119035,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,MEDICARE-Traditional Medicare, +119036,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,MEDICARE-Traditional Medicare,504.0 +119037,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,MEDICARE-Traditional Medicare,3113.73 +119038,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,MEDICARE-Traditional Medicare,23437.74 +119039,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,MEDICARE-Traditional Medicare,54.08 +119040,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,MEDICARE-Traditional Medicare,13824.76 +119041,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,MEDICARE-Traditional Medicare, +119042,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,MEDICARE-Traditional Medicare, +119043,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,MEDICARE-Traditional Medicare, +119044,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,MEDICARE-Traditional Medicare, +119045,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,MEDICARE-Traditional Medicare, +119046,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,MEDICARE-Traditional Medicare,8071.81 +119047,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,MEDICARE-Traditional Medicare,19943.4 +119048,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,MEDICARE-Traditional Medicare, +119049,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,MEDICARE-Traditional Medicare, +119050,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,MEDICARE-Traditional Medicare,8574.08 +119051,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,MEDICARE-Traditional Medicare, +119052,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,MEDICARE-Traditional Medicare,7056.0 +119053,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,MEDICARE-Traditional Medicare, +119054,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,MEDICARE-Traditional Medicare, +119055,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,MEDICARE-Traditional Medicare, +119056,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,MEDICARE-Traditional Medicare, +119057,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,MEDICARE-Traditional Medicare, +119058,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,MEDICARE-Traditional Medicare,37.93 +119059,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,MEDICARE-Traditional Medicare,90.72 +119060,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,MEDICARE-Traditional Medicare, +119061,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,MEDICARE-Traditional Medicare, +119062,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,MEDICARE-Traditional Medicare, +119063,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,MEDICARE-Traditional Medicare, +119064,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,MEDICARE-Traditional Medicare, +119065,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,MEDICARE-Traditional Medicare, +119066,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,MEDICARE-Traditional Medicare, +119067,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,MEDICARE-Traditional Medicare,346.0 +119068,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,MEDICARE-Traditional Medicare,334.5 +119069,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,MEDICARE-Traditional Medicare, +119070,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,MEDICARE-Traditional Medicare,63.0 +119071,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,MEDICARE-Traditional Medicare, +119072,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,MEDICARE-Traditional Medicare, +119073,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,MEDICARE-Traditional Medicare,2025.0 +119074,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,MEDICARE-Traditional Medicare, +119075,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,MEDICARE-Traditional Medicare, +119076,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,MEDICARE-Traditional Medicare, +119077,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,MEDICARE-Traditional Medicare, +119078,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,MEDICARE-Traditional Medicare, +119079,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,MEDICARE-Traditional Medicare, +119080,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,MEDICARE-Traditional Medicare, +119081,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,MEDICARE-Traditional Medicare, +119082,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,MEDICARE-Traditional Medicare,4391.0 +119083,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,MEDICARE-Traditional Medicare,564.75 +119084,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,MEDICARE-Traditional Medicare,564.75 +119085,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,MEDICARE-Traditional Medicare, +119086,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,MEDICARE-Traditional Medicare, +119087,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,MEDICARE-Traditional Medicare,312.0 +119088,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,MEDICARE-Traditional Medicare,2100.93 +119089,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,MEDICARE-Traditional Medicare, +119090,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,MEDICARE-Traditional Medicare, +119091,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,MEDICARE-Traditional Medicare,4863.96 +119092,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,MEDICARE-Traditional Medicare,4094.28 +119093,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,MEDICARE-Traditional Medicare, +119094,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,MEDICARE-Traditional Medicare,2335.88 +119095,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,MEDICARE-Traditional Medicare, +119096,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,MEDICARE-Traditional Medicare, +119097,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,MEDICARE-Traditional Medicare, +119098,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,MEDICARE-Traditional Medicare,324.0 +119099,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,MEDICARE-Traditional Medicare, +119100,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,MEDICARE-Traditional Medicare,30.11 +119101,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,MEDICARE-Traditional Medicare,45.26 +119102,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,MEDICARE-Traditional Medicare,0.68 +119103,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,MEDICARE-Traditional Medicare, +119104,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,MEDICARE-Traditional Medicare, +119105,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,MEDICARE-Traditional Medicare, +119106,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,MEDICARE-Traditional Medicare, +119107,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,MEDICARE-Traditional Medicare,1.86 +119108,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,MEDICARE-Traditional Medicare, +119109,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,MEDICARE-Traditional Medicare, +119110,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,MEDICARE-Traditional Medicare, +119111,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,MEDICARE-Traditional Medicare, +119112,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,MEDICARE-Traditional Medicare, +119113,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,MEDICARE-Traditional Medicare,15.0 +119114,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,MEDICARE-Traditional Medicare, +119115,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,MEDICARE-Traditional Medicare, +119116,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,MEDICARE-Traditional Medicare,1525.0 +119117,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,MEDICARE-Traditional Medicare,1767.5 +119118,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,MEDICARE-Traditional Medicare, +119119,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,MEDICARE-Traditional Medicare, +119120,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,MEDICARE-Traditional Medicare, +119121,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,MEDICARE-Traditional Medicare, +119122,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,MEDICARE-Traditional Medicare, +119123,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,MEDICARE-Traditional Medicare, +119124,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,MEDICARE-Traditional Medicare,13115.49 +119125,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,MEDICARE-Traditional Medicare,7226.5 +119126,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,MEDICARE-Traditional Medicare, +119127,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,MEDICARE-Traditional Medicare, +119128,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,MEDICARE-Traditional Medicare, +119129,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,MEDICARE-Traditional Medicare,127.4 +119130,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,MEDICARE-Traditional Medicare, +119131,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,MEDICARE-Traditional Medicare, +119132,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,MEDICARE-Traditional Medicare,238.27 +119133,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,MEDICARE-Traditional Medicare,161.19 +119134,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,MEDICARE-Traditional Medicare,253.29 +119135,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,MEDICARE-Traditional Medicare, +119136,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,MEDICARE-Traditional Medicare, +119137,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,MEDICARE-Traditional Medicare, +119138,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,MEDICARE-Traditional Medicare, +119139,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,MEDICARE-Traditional Medicare,80.53 +119140,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,MEDICARE-Traditional Medicare, +119141,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,MEDICARE-Traditional Medicare, +119142,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,MEDICARE-Traditional Medicare,124.06 +119143,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,MEDICARE-Traditional Medicare,39.13 +119144,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,MEDICARE-Traditional Medicare, +119145,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,MEDICARE-Traditional Medicare, +119146,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,MEDICARE-Traditional Medicare, +119147,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,MEDICARE-Traditional Medicare,207.0 +119148,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,MEDICARE-Traditional Medicare,661.0 +119149,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,MEDICARE-Traditional Medicare, +119150,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119151,3934,30000012,PRIVATE,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119152,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119153,3934,30000038,ICU,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119154,3934,30000046,BURN UNIT,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119155,3934,30000053,NICU,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119156,3934,30000061,ICR ROOM,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119157,3934,30000079,PSYCH,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119158,3934,30000087,NEWBORN,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119159,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119160,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119161,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119162,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119163,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119164,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119165,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119166,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119167,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119168,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119169,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119170,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119171,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119172,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119173,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119174,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119175,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119176,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119177,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119178,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119179,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119180,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119181,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119182,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119183,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119184,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119185,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119186,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119187,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119188,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119189,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119190,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119191,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119192,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119193,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119194,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119195,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119196,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119197,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119198,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119199,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119200,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119201,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119202,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119203,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119204,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119205,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119206,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119207,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119208,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119209,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119210,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119211,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119212,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119213,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119214,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119215,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119216,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119217,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119218,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119219,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119220,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119221,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119222,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119223,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119224,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119225,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119226,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119227,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119228,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119229,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119230,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119231,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119232,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119233,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119234,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119235,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119236,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119237,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119238,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119239,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119240,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119241,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119242,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119243,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119244,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119245,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119246,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119247,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119248,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119249,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119250,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119251,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119252,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119253,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119254,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119255,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119256,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119257,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119258,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119259,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119260,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119261,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119262,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119263,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119264,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119265,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119266,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119267,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119268,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119269,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119270,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119271,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119272,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119273,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119274,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119275,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119276,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119277,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119278,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119279,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119280,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119281,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119282,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119283,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119284,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119285,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119286,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119287,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119288,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119289,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119290,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119291,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119292,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119293,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119294,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119295,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119296,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119297,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119298,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119299,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119300,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119301,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119302,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119303,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119304,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119305,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119306,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119307,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119308,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119309,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119310,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119311,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119312,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119313,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119314,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119315,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119316,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119317,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119318,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119319,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119320,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119321,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119322,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119323,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119324,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119325,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119326,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, 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PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119338,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119339,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119340,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119341,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119342,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119343,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119344,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119345,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119346,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119347,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, 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PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119359,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119360,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119361,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119362,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119363,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119364,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119365,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119366,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119367,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119368,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, 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PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119380,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119381,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119382,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119383,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119384,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119385,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119386,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119387,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119388,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119389,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119390,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119391,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119392,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119393,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119394,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119395,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119396,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119397,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119398,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119399,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119400,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119401,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119402,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119403,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119404,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119405,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119406,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119407,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119408,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119409,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119410,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119411,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119412,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119413,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119414,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119415,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119416,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119417,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119418,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119419,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119420,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119421,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, 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PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119433,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119434,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119435,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119436,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119437,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119438,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119439,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119440,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119441,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119442,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, 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PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119454,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119455,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119456,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119457,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119458,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119459,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119460,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119461,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119462,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119463,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119464,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119465,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119466,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119467,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119468,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119469,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119470,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119471,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119472,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119473,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119474,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119475,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119476,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119477,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119478,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119479,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119480,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119481,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119482,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119483,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119484,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119485,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119486,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119487,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119488,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119489,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119490,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119491,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119492,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119493,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119494,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119495,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119496,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119497,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119498,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119499,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119500,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119501,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119502,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119503,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119504,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119505,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119506,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119507,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119508,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119509,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119510,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119511,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119512,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119513,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119514,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119515,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119516,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119517,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119518,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119519,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119520,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119521,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119522,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119523,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119524,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119525,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119526,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119527,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119528,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119529,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119530,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119531,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119532,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119533,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119534,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119535,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119536,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119537,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119538,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119539,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119540,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119541,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119542,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119543,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119544,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119545,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119546,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119547,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119548,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119549,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119550,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119551,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119552,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119553,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119554,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119555,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119556,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119557,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119558,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119559,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119560,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119561,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119562,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119563,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119564,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119565,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119566,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119567,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119568,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,MEDICARE-Traditional Medicare, +119569,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119570,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119571,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119572,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119573,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119574,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119575,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,MEDICARE-Traditional Medicare, +119576,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119577,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119578,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119579,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119580,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119581,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119582,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119583,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119584,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119585,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119586,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119587,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119588,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119589,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119590,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119591,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119592,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119593,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,MEDICARE-Traditional Medicare, +119594,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,MEDICARE-Traditional Medicare, +119595,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,MEDICARE-Traditional Medicare, +119596,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,MEDICARE-Traditional Medicare, +119597,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,MEDICARE-Traditional Medicare, +119598,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,MEDICARE-Traditional Medicare, +119599,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,MEDICARE-Traditional Medicare, +119600,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119601,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119602,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119603,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119604,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119605,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119606,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119607,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119608,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119609,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119610,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119611,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119612,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,MEDICARE-Traditional Medicare, +119613,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,MEDICARE-Traditional Medicare, +119614,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,MEDICARE-Traditional Medicare, +119615,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,MEDICARE-Traditional Medicare, +119616,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,MEDICARE-Traditional Medicare, +119617,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,MEDICARE-Traditional Medicare, +119618,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,MEDICARE-Traditional Medicare, +119619,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,MEDICARE-Traditional Medicare, +119620,3934,37112000,ACUTE ED,,1580.0,1580.0,,,MEDICARE-Traditional Medicare, +119621,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,MEDICARE-Traditional Medicare, +119622,3934,37112034,TRIAGE,,277.0,277.0,,,MEDICARE-Traditional Medicare, +119623,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,MEDICARE-Traditional Medicare, +119624,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,MEDICARE-Traditional Medicare, +119625,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,MEDICARE-Traditional Medicare, +119626,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,MEDICARE-Traditional Medicare, +119627,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,MEDICARE-Traditional Medicare, +119628,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,MEDICARE-Traditional Medicare, +119629,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,MEDICARE-Traditional Medicare, +119630,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,MEDICARE-Traditional Medicare, +119631,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,MEDICARE-Traditional Medicare, +119632,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,MEDICARE-Traditional Medicare, +119633,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,MEDICARE-Traditional Medicare, +119634,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,MEDICARE-Traditional Medicare, +119635,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,MEDICARE-Traditional Medicare, +119636,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,MEDICARE-Traditional Medicare, +119637,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,MEDICARE-Traditional Medicare, +119638,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,MEDICARE-Traditional Medicare, +119639,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,MEDICARE-Traditional Medicare, +119640,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,MEDICARE-Traditional Medicare, +119641,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,MEDICARE-Traditional Medicare, +119642,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,MEDICARE-Traditional Medicare, +119643,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,MEDICARE-Traditional Medicare, +119644,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,MEDICARE-Traditional Medicare, +119645,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,MEDICARE-Traditional Medicare, +119646,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,MEDICARE-Traditional Medicare, +119647,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,MEDICARE-Traditional Medicare, +119648,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,MEDICARE-Traditional Medicare, +119649,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,MEDICARE-Traditional Medicare, +119650,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,MEDICARE-Traditional Medicare, +119651,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,MEDICARE-Traditional Medicare, +119652,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,MEDICARE-Traditional Medicare, +119653,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,MEDICARE-Traditional Medicare, +119654,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,MEDICARE-Traditional Medicare, +119655,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,MEDICARE-Traditional Medicare, +119656,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,MEDICARE-Traditional Medicare, +119657,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,MEDICARE-Traditional Medicare, +119658,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,MEDICARE-Traditional Medicare, +119659,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,MEDICARE-Traditional Medicare, +119660,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,MEDICARE-Traditional Medicare, +119661,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,MEDICARE-Traditional Medicare, +119662,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,MEDICARE-Traditional Medicare, +119663,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,MEDICARE-Traditional Medicare, +119664,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,MEDICARE-Traditional Medicare, +119665,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,MEDICARE-Traditional Medicare, +119666,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,MEDICARE-Traditional Medicare, +119667,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,MEDICARE-Traditional Medicare, +119668,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,MEDICARE-Traditional Medicare, +119669,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,MEDICARE-Traditional Medicare, +119670,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,MEDICARE-Traditional Medicare, +119671,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,MEDICARE-Traditional Medicare, +119672,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,MEDICARE-Traditional Medicare, +119673,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,MEDICARE-Traditional Medicare, +119674,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,MEDICARE-Traditional Medicare, +119675,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,MEDICARE-Traditional Medicare, +119676,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,MEDICARE-Traditional Medicare, +119677,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,MEDICARE-Traditional Medicare, +119678,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,MEDICARE-Traditional Medicare, +119679,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,MEDICARE-Traditional Medicare, +119680,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,MEDICARE-Traditional Medicare, +119681,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,MEDICARE-Traditional Medicare, +119682,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,MEDICARE-Traditional Medicare, +119683,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,MEDICARE-Traditional Medicare, +119684,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,MEDICARE-Traditional Medicare, +119685,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,MEDICARE-Traditional Medicare, +119686,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,MEDICARE-Traditional Medicare, +119687,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,MEDICARE-Traditional Medicare, +119688,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,MEDICARE-Traditional Medicare, +119689,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,MEDICARE-Traditional Medicare, +119690,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,MEDICARE-Traditional Medicare, +119691,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,MEDICARE-Traditional Medicare, +119692,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,MEDICARE-Traditional Medicare, +119693,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,MEDICARE-Traditional Medicare, +119694,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,MEDICARE-Traditional Medicare, +119695,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,MEDICARE-Traditional Medicare, +119696,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,MEDICARE-Traditional Medicare, +119697,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,MEDICARE-Traditional Medicare, +119698,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,MEDICARE-Traditional Medicare, +119699,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,MEDICARE-Traditional Medicare, +119700,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,MEDICARE-Traditional Medicare, +119701,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,MEDICARE-Traditional Medicare, +119702,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,MEDICARE-Traditional Medicare, +119703,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,MEDICARE-Traditional Medicare, +119704,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,MEDICARE-Traditional Medicare, +119705,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,MEDICARE-Traditional Medicare, +119706,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,MEDICARE-Traditional Medicare, +119707,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,MEDICARE-Traditional Medicare, +119708,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,MEDICARE-Traditional Medicare, +119709,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,MEDICARE-Traditional Medicare, +119710,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,MEDICARE-Traditional Medicare, +119711,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,MEDICARE-Traditional Medicare, +119712,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,MEDICARE-Traditional Medicare, +119713,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,MEDICARE-Traditional Medicare, +119714,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,MEDICARE-Traditional Medicare, +119715,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,MEDICARE-Traditional Medicare, +119716,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,MEDICARE-Traditional Medicare, +119717,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,MEDICARE-Traditional Medicare, +119718,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,MEDICARE-Traditional Medicare, +119719,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,MEDICARE-Traditional Medicare, +119720,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,MEDICARE-Traditional Medicare, +119721,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,MEDICARE-Traditional Medicare, +119722,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,MEDICARE-Traditional Medicare, +119723,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119724,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119725,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119726,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119727,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119728,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,MEDICARE-Traditional Medicare, +119729,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,MEDICARE-Traditional Medicare, +119730,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,MEDICARE-Traditional Medicare, +119731,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119732,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119733,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119734,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,MEDICARE-Traditional Medicare, +119735,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,MEDICARE-Traditional Medicare, +119736,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,MEDICARE-Traditional Medicare, +119737,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,MEDICARE-Traditional Medicare, +119738,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,MEDICARE-Traditional Medicare, +119739,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,MEDICARE-Traditional Medicare, +119740,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,MEDICARE-Traditional Medicare, +119741,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,MEDICARE-Traditional Medicare, +119742,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,MEDICARE-Traditional Medicare, +119743,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,MEDICARE-Traditional Medicare, +119744,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,MEDICARE-Traditional Medicare, +119745,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,MEDICARE-Traditional Medicare, +119746,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,MEDICARE-Traditional Medicare, +119747,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,MEDICARE-Traditional Medicare, +119748,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,MEDICARE-Traditional Medicare, +119749,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,MEDICARE-Traditional Medicare, +119750,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,MEDICARE-Traditional Medicare, +119751,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,MEDICARE-Traditional Medicare, +119752,3934,43301043,ALBUNEX,,357.0,357.0,,,MEDICARE-Traditional Medicare, +119753,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,MEDICARE-Traditional Medicare, +119754,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119755,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119756,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119757,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119758,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119759,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,MEDICARE-Traditional Medicare, +119760,3934,43450022,REC RM .5HR,,541.0,541.0,,,MEDICARE-Traditional Medicare, +119761,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,MEDICARE-Traditional Medicare, +119762,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,MEDICARE-Traditional Medicare, +119763,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,MEDICARE-Traditional Medicare, +119764,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,MEDICARE-Traditional Medicare, +119765,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,MEDICARE-Traditional Medicare, +119766,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,MEDICARE-Traditional Medicare, +119767,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,MEDICARE-Traditional Medicare, +119768,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,MEDICARE-Traditional Medicare, +119769,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,MEDICARE-Traditional Medicare, +119770,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,MEDICARE-Traditional Medicare, +119771,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,MEDICARE-Traditional Medicare, +119772,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,MEDICARE-Traditional Medicare, +119773,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,MEDICARE-Traditional Medicare, +119774,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,MEDICARE-Traditional Medicare, +119775,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,MEDICARE-Traditional Medicare, +119776,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,MEDICARE-Traditional Medicare, +119777,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,MEDICARE-Traditional Medicare, +119778,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119779,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119780,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119781,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119782,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119783,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,MEDICARE-Traditional Medicare, +119784,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119785,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,MEDICARE-Traditional Medicare, +119786,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119787,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119788,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119789,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119790,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,MEDICARE-Traditional Medicare, +119791,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,MEDICARE-Traditional Medicare, +119792,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119793,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119794,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119795,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119796,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119797,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,MEDICARE-Traditional Medicare, +119798,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119799,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119800,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119801,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119802,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119803,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,MEDICARE-Traditional Medicare, +119804,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,MEDICARE-Traditional Medicare, +119805,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,MEDICARE-Traditional Medicare, +119806,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,MEDICARE-Traditional Medicare, +119807,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,MEDICARE-Traditional Medicare, +119808,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,MEDICARE-Traditional Medicare, +119809,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,MEDICARE-Traditional Medicare, +119810,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,MEDICARE-Traditional Medicare, +119811,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,MEDICARE-Traditional Medicare, +119812,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119813,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119814,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119815,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119816,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119817,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119818,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,MEDICARE-Traditional Medicare, +119819,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,MEDICARE-Traditional Medicare, +119820,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,MEDICARE-Traditional Medicare, +119821,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,MEDICARE-Traditional Medicare, +119822,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,MEDICARE-Traditional Medicare, +119823,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,MEDICARE-Traditional Medicare, +119824,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,MEDICARE-Traditional Medicare, +119825,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,MEDICARE-Traditional Medicare, +119826,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,MEDICARE-Traditional Medicare, +119827,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,MEDICARE-Traditional Medicare, +119828,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,MEDICARE-Traditional Medicare, +119829,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,MEDICARE-Traditional Medicare, +119830,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,MEDICARE-Traditional Medicare, +119831,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,MEDICARE-Traditional Medicare, +119832,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,MEDICARE-Traditional Medicare, +119833,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,MEDICARE-Traditional Medicare, +119834,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,MEDICARE-Traditional Medicare, +119835,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,MEDICARE-Traditional Medicare, +119836,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,MEDICARE-Traditional Medicare, +119837,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,MEDICARE-Traditional Medicare, +119838,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,MEDICARE-Traditional Medicare, +119839,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,MEDICARE-Traditional Medicare, +119840,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,MEDICARE-Traditional Medicare, +119841,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,MEDICARE-Traditional Medicare, +119842,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,MEDICARE-Traditional Medicare, +119843,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,MEDICARE-Traditional Medicare, +119844,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,MEDICARE-Traditional Medicare, +119845,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,MEDICARE-Traditional Medicare, +119846,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,MEDICARE-Traditional Medicare, +119847,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,MEDICARE-Traditional Medicare, +119848,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,MEDICARE-Traditional Medicare, +119849,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,MEDICARE-Traditional Medicare, +119850,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,MEDICARE-Traditional Medicare, +119851,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,MEDICARE-Traditional Medicare, +119852,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,MEDICARE-Traditional Medicare, +119853,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,MEDICARE-Traditional Medicare, +119854,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,MEDICARE-Traditional Medicare, +119855,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,MEDICARE-Traditional Medicare, +119856,3934,45924552,ENDO REC RM,,30.0,30.0,,,MEDICARE-Traditional Medicare, +119857,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,MEDICARE-Traditional Medicare, +119858,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,MEDICARE-Traditional Medicare, +119859,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,MEDICARE-Traditional Medicare, +119860,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,MEDICARE-Traditional Medicare, +119861,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,MEDICARE-Traditional Medicare, +119862,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,MEDICARE-Traditional Medicare, +119863,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,MEDICARE-Traditional Medicare, +119864,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,MEDICARE-Traditional Medicare, +119865,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,MEDICARE-Traditional Medicare, +119866,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,MEDICARE-Traditional Medicare, +119867,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,MEDICARE-Traditional Medicare, +119868,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,MEDICARE-Traditional Medicare, +119869,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,MEDICARE-Traditional Medicare, +119870,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,MEDICARE-Traditional Medicare, +119871,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,MEDICARE-Traditional Medicare, +119872,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,MEDICARE-Traditional Medicare, +119873,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,MEDICARE-Traditional Medicare, +119874,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,MEDICARE-Traditional Medicare, +119875,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,MEDICARE-Traditional Medicare, +119876,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,MEDICARE-Traditional Medicare, +119877,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,MEDICARE-Traditional Medicare, +119878,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,MEDICARE-Traditional Medicare, +119879,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,MEDICARE-Traditional Medicare, +119880,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,MEDICARE-Traditional Medicare, +119881,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,MEDICARE-Traditional Medicare, +119882,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,MEDICARE-Traditional Medicare, +119883,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,MEDICARE-Traditional Medicare, +119884,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,MEDICARE-Traditional Medicare, +119885,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,MEDICARE-Traditional Medicare, +119886,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,MEDICARE-Traditional Medicare, +119887,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,MEDICARE-Traditional Medicare, +119888,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,MEDICARE-Traditional Medicare, +119889,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,MEDICARE-Traditional Medicare, +119890,3934,53200010,GUEST TRAY,,24.0,24.0,,,MEDICARE-Traditional Medicare, +119891,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,MEDICARE-Traditional Medicare, +119892,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,MEDICARE-Traditional Medicare, +119893,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,MEDICARE-Traditional Medicare, +119894,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,MEDICARE-Traditional Medicare, +119895,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,MEDICARE-Traditional Medicare, +119896,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,MEDICARE-Traditional Medicare, +119897,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,MEDICARE-Traditional Medicare, +119898,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,MEDICARE-Traditional Medicare, +119899,3934,53329876,HIV MONITORING,,416.0,416.0,,,MEDICARE-Traditional Medicare, +119900,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,MEDICARE-Traditional Medicare, +119901,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,MEDICARE-Traditional Medicare, +119902,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,MEDICARE-Traditional Medicare, +119903,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,MEDICARE-Traditional Medicare, +119904,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,MEDICARE-Traditional Medicare, +119905,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,MEDICARE-Traditional Medicare, +119906,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,MEDICARE-Traditional Medicare, +119907,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,MEDICARE-Traditional Medicare, +119908,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,MEDICARE-Traditional Medicare, +119909,3934,76010107,COPY X-RAY,,22.0,22.0,,,MEDICARE-Traditional Medicare, +119910,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,MEDICARE-Traditional Medicare, +119911,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,MEDICARE-Traditional Medicare, +119912,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,MEDICARE-Traditional Medicare, +119913,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,MEDICARE-Traditional Medicare, +119914,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,MEDICARE-Traditional Medicare, +119915,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,MEDICARE-Traditional Medicare, +119916,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,MEDICARE-Traditional Medicare, +119917,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,MEDICARE-Traditional Medicare, +119918,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,MEDICARE-Traditional Medicare, +119919,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,MEDICARE-Traditional Medicare, +119920,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,MEDICARE-Traditional Medicare, +119921,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,MEDICARE-Traditional Medicare, +119922,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,OPTUM VA CCN-Commercial, +119923,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,OPTUM VA CCN-Commercial, +119924,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,OPTUM VA CCN-Commercial, +119925,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,OPTUM VA CCN-Commercial, +119926,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,OPTUM VA CCN-Commercial, +119927,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,OPTUM VA CCN-Commercial, +119928,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,OPTUM VA CCN-Commercial, +119929,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,OPTUM VA CCN-Commercial, +119930,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,OPTUM VA CCN-Commercial, +119931,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,OPTUM VA CCN-Commercial, +119932,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,OPTUM VA CCN-Commercial, +119933,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,OPTUM VA CCN-Commercial, +119934,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,OPTUM VA CCN-Commercial, +119935,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,OPTUM VA CCN-Commercial, +119936,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,OPTUM VA CCN-Commercial, +119937,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,OPTUM VA CCN-Commercial, +119938,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,OPTUM VA CCN-Commercial, +119939,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,OPTUM VA CCN-Commercial, +119940,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,OPTUM VA CCN-Commercial, +119941,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,OPTUM VA CCN-Commercial, +119942,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,OPTUM VA CCN-Commercial, +119943,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,OPTUM VA CCN-Commercial, +119944,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,OPTUM VA CCN-Commercial, +119945,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,OPTUM VA CCN-Commercial, +119946,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,OPTUM VA CCN-Commercial, +119947,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,OPTUM VA CCN-Commercial, +119948,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,OPTUM VA CCN-Commercial, +119949,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,OPTUM VA CCN-Commercial, +119950,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,OPTUM VA CCN-Commercial, +119951,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,OPTUM VA CCN-Commercial, +119952,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,OPTUM VA CCN-Commercial, +119953,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,OPTUM VA CCN-Commercial, +119954,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,OPTUM VA CCN-Commercial, +119955,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,OPTUM VA CCN-Commercial, +119956,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,OPTUM VA CCN-Commercial, +119957,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,OPTUM VA CCN-Commercial, +119958,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,OPTUM VA CCN-Commercial, +119959,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,OPTUM VA CCN-Commercial, +119960,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,OPTUM VA CCN-Commercial, +119961,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,OPTUM VA CCN-Commercial, +119962,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,OPTUM VA CCN-Commercial, +119963,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,OPTUM VA CCN-Commercial, +119964,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,OPTUM VA CCN-Commercial, +119965,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,OPTUM VA CCN-Commercial, +119966,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,OPTUM VA CCN-Commercial, +119967,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,OPTUM VA CCN-Commercial, +119968,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,OPTUM VA CCN-Commercial, +119969,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,OPTUM VA CCN-Commercial, +119970,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,OPTUM VA CCN-Commercial, +119971,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,OPTUM VA CCN-Commercial, +119972,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,OPTUM VA CCN-Commercial, +119973,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,OPTUM VA CCN-Commercial, +119974,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,OPTUM VA CCN-Commercial, +119975,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,OPTUM VA CCN-Commercial, +119976,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,OPTUM VA CCN-Commercial, +119977,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,OPTUM VA CCN-Commercial, +119978,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,OPTUM VA CCN-Commercial, +119979,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,OPTUM VA CCN-Commercial, +119980,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,OPTUM VA CCN-Commercial, +119981,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,OPTUM VA CCN-Commercial, +119982,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,OPTUM VA CCN-Commercial, +119983,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,OPTUM VA CCN-Commercial, +119984,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,OPTUM VA CCN-Commercial, +119985,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,OPTUM VA CCN-Commercial, +119986,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,OPTUM VA CCN-Commercial, +119987,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,OPTUM VA CCN-Commercial, +119988,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,OPTUM VA CCN-Commercial, +119989,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,OPTUM VA CCN-Commercial, +119990,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,OPTUM VA CCN-Commercial, +119991,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,OPTUM VA CCN-Commercial, +119992,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,OPTUM VA CCN-Commercial, +119993,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,OPTUM VA CCN-Commercial, +119994,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,OPTUM VA CCN-Commercial, +119995,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,OPTUM VA CCN-Commercial, +119996,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,OPTUM VA CCN-Commercial, +119997,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,OPTUM VA CCN-Commercial, +119998,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,OPTUM VA CCN-Commercial, +119999,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,OPTUM VA CCN-Commercial, +120000,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,OPTUM VA CCN-Commercial, +120001,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,OPTUM VA CCN-Commercial, +120002,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,OPTUM VA CCN-Commercial, +120003,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,OPTUM VA CCN-Commercial, +120004,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,OPTUM VA CCN-Commercial, +120005,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,OPTUM VA CCN-Commercial, +120006,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,OPTUM VA CCN-Commercial, +120007,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,OPTUM VA CCN-Commercial, +120008,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,OPTUM VA CCN-Commercial, +120009,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,OPTUM VA CCN-Commercial, +120010,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,OPTUM VA CCN-Commercial, +120011,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,OPTUM VA CCN-Commercial, +120012,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,OPTUM VA CCN-Commercial, +120013,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,OPTUM VA CCN-Commercial, +120014,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,OPTUM VA CCN-Commercial, +120015,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,OPTUM VA CCN-Commercial, +120016,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,OPTUM VA CCN-Commercial, +120017,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,OPTUM VA CCN-Commercial, +120018,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,OPTUM VA CCN-Commercial, +120019,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,OPTUM VA CCN-Commercial, +120020,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,OPTUM VA CCN-Commercial, +120021,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,OPTUM VA CCN-Commercial, +120022,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,OPTUM VA CCN-Commercial, +120023,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,OPTUM VA CCN-Commercial, +120024,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,OPTUM VA CCN-Commercial, +120025,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,OPTUM VA CCN-Commercial, +120026,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,OPTUM VA CCN-Commercial, +120027,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,OPTUM VA CCN-Commercial, +120028,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,OPTUM VA CCN-Commercial, +120029,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,OPTUM VA CCN-Commercial, +120030,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,OPTUM VA CCN-Commercial, +120031,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,OPTUM VA CCN-Commercial, +120032,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,OPTUM VA CCN-Commercial, +120033,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,OPTUM VA CCN-Commercial, +120034,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,OPTUM VA CCN-Commercial, +120035,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,OPTUM VA CCN-Commercial, +120036,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,OPTUM VA CCN-Commercial, +120037,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,OPTUM VA CCN-Commercial, +120038,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,OPTUM VA CCN-Commercial, +120039,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,OPTUM VA CCN-Commercial, +120040,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,OPTUM VA CCN-Commercial, +120041,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,OPTUM VA CCN-Commercial, +120042,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,OPTUM VA CCN-Commercial, +120043,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,OPTUM VA CCN-Commercial, +120044,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,OPTUM VA CCN-Commercial, +120045,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,OPTUM VA CCN-Commercial, +120046,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,OPTUM VA CCN-Commercial, +120047,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,OPTUM VA CCN-Commercial, +120048,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,OPTUM VA CCN-Commercial, +120049,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,OPTUM VA CCN-Commercial, +120050,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,OPTUM VA CCN-Commercial, +120051,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,OPTUM VA CCN-Commercial, +120052,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,OPTUM VA CCN-Commercial, +120053,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,OPTUM VA CCN-Commercial, +120054,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,OPTUM VA CCN-Commercial, +120055,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,OPTUM VA CCN-Commercial, +120056,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,OPTUM VA CCN-Commercial, +120057,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,OPTUM VA CCN-Commercial, +120058,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,OPTUM VA CCN-Commercial, +120059,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,OPTUM VA CCN-Commercial, +120060,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,OPTUM VA CCN-Commercial, +120061,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,OPTUM VA CCN-Commercial, +120062,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,OPTUM VA CCN-Commercial, +120063,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,OPTUM VA CCN-Commercial, +120064,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,OPTUM VA CCN-Commercial, +120065,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,OPTUM VA CCN-Commercial, +120066,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,OPTUM VA CCN-Commercial, +120067,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,OPTUM VA CCN-Commercial, +120068,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,OPTUM VA CCN-Commercial, +120069,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,OPTUM VA CCN-Commercial, +120070,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,OPTUM VA CCN-Commercial, +120071,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,OPTUM VA CCN-Commercial, +120072,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,OPTUM VA CCN-Commercial, +120073,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,OPTUM VA CCN-Commercial, +120074,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,OPTUM VA CCN-Commercial, +120075,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,OPTUM VA CCN-Commercial, +120076,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,OPTUM VA CCN-Commercial, +120077,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,OPTUM VA CCN-Commercial, +120078,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,OPTUM VA CCN-Commercial, +120079,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,OPTUM VA CCN-Commercial, +120080,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,OPTUM VA CCN-Commercial, +120081,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,OPTUM VA CCN-Commercial, +120082,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,OPTUM VA CCN-Commercial, +120083,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,OPTUM VA CCN-Commercial, +120084,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,OPTUM VA CCN-Commercial, +120085,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,OPTUM VA CCN-Commercial, +120086,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,OPTUM VA CCN-Commercial, +120087,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,OPTUM VA CCN-Commercial, +120088,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,OPTUM VA CCN-Commercial, +120089,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,OPTUM VA CCN-Commercial, +120090,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,OPTUM VA CCN-Commercial, +120091,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,OPTUM VA CCN-Commercial, +120092,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,OPTUM VA CCN-Commercial, +120093,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,OPTUM VA CCN-Commercial, +120094,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,OPTUM VA CCN-Commercial, +120095,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,OPTUM VA CCN-Commercial, +120096,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,OPTUM VA CCN-Commercial, +120097,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,OPTUM VA CCN-Commercial, +120098,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,OPTUM VA CCN-Commercial, +120099,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,OPTUM VA CCN-Commercial, +120100,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,OPTUM VA CCN-Commercial, +120101,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,OPTUM VA CCN-Commercial, +120102,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,OPTUM VA CCN-Commercial, +120103,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,OPTUM VA CCN-Commercial, +120104,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,OPTUM VA CCN-Commercial, +120105,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,OPTUM VA CCN-Commercial, +120106,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,OPTUM VA CCN-Commercial, +120107,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,OPTUM VA CCN-Commercial, +120108,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,OPTUM VA CCN-Commercial, +120109,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,OPTUM VA CCN-Commercial, +120110,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,OPTUM VA CCN-Commercial, +120111,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,OPTUM VA CCN-Commercial, +120112,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,OPTUM VA CCN-Commercial, +120113,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,OPTUM VA CCN-Commercial, +120114,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,OPTUM VA CCN-Commercial, +120115,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,OPTUM VA CCN-Commercial, +120116,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,OPTUM VA CCN-Commercial, +120117,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,OPTUM VA CCN-Commercial, +120118,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,OPTUM VA CCN-Commercial, +120119,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,OPTUM VA CCN-Commercial, +120120,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,OPTUM VA CCN-Commercial, +120121,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,OPTUM VA CCN-Commercial, +120122,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,OPTUM VA CCN-Commercial, +120123,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,OPTUM VA CCN-Commercial, +120124,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,OPTUM VA CCN-Commercial, +120125,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,OPTUM VA CCN-Commercial, +120126,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,OPTUM VA CCN-Commercial, +120127,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,OPTUM VA CCN-Commercial, +120128,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,OPTUM VA CCN-Commercial, +120129,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,OPTUM VA CCN-Commercial, +120130,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,OPTUM VA CCN-Commercial, +120131,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,OPTUM VA CCN-Commercial, +120132,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,OPTUM VA CCN-Commercial, +120133,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,OPTUM VA CCN-Commercial, +120134,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,OPTUM VA CCN-Commercial, +120135,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,OPTUM VA CCN-Commercial, +120136,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,OPTUM VA CCN-Commercial, +120137,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,OPTUM VA CCN-Commercial, +120138,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,OPTUM VA CCN-Commercial, +120139,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,OPTUM VA CCN-Commercial, +120140,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,OPTUM VA CCN-Commercial, +120141,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,OPTUM VA CCN-Commercial, +120142,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,OPTUM VA CCN-Commercial, +120143,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,OPTUM VA CCN-Commercial, +120144,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,OPTUM VA CCN-Commercial, +120145,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,OPTUM VA CCN-Commercial, +120146,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,OPTUM VA CCN-Commercial, +120147,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,OPTUM VA CCN-Commercial, +120148,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,OPTUM VA CCN-Commercial, +120149,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,OPTUM VA CCN-Commercial, +120150,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,OPTUM VA CCN-Commercial, +120151,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,OPTUM VA CCN-Commercial, +120152,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,OPTUM VA CCN-Commercial, +120153,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,OPTUM VA CCN-Commercial, +120154,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,OPTUM VA CCN-Commercial, +120155,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,OPTUM VA CCN-Commercial, +120156,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,OPTUM VA CCN-Commercial, +120157,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,OPTUM VA CCN-Commercial, +120158,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,OPTUM VA CCN-Commercial, +120159,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,OPTUM VA CCN-Commercial, +120160,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,OPTUM VA CCN-Commercial, +120161,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,OPTUM VA CCN-Commercial, +120162,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,OPTUM VA CCN-Commercial, +120163,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,OPTUM VA CCN-Commercial, +120164,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,OPTUM VA CCN-Commercial, +120165,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,OPTUM VA CCN-Commercial, +120166,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,OPTUM VA CCN-Commercial, +120167,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,OPTUM VA CCN-Commercial, +120168,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,OPTUM VA CCN-Commercial, +120169,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,OPTUM VA CCN-Commercial, +120170,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,OPTUM VA CCN-Commercial, +120171,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,OPTUM VA CCN-Commercial, +120172,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,OPTUM VA CCN-Commercial, +120173,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,OPTUM VA CCN-Commercial, +120174,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,OPTUM VA CCN-Commercial, +120175,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,OPTUM VA CCN-Commercial, +120176,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,OPTUM VA CCN-Commercial, +120177,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,OPTUM VA CCN-Commercial, +120178,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,OPTUM VA CCN-Commercial, +120179,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,OPTUM VA CCN-Commercial, +120180,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,OPTUM VA CCN-Commercial, +120181,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,OPTUM VA CCN-Commercial, +120182,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,OPTUM VA CCN-Commercial, +120183,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,OPTUM VA CCN-Commercial, +120184,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,OPTUM VA CCN-Commercial, +120185,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,OPTUM VA CCN-Commercial, +120186,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,OPTUM VA CCN-Commercial, +120187,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,OPTUM VA CCN-Commercial, +120188,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,OPTUM VA CCN-Commercial, +120189,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,OPTUM VA CCN-Commercial, +120190,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,OPTUM VA CCN-Commercial, +120191,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,OPTUM VA CCN-Commercial, +120192,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,OPTUM VA CCN-Commercial, +120193,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,OPTUM VA CCN-Commercial, +120194,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,OPTUM VA CCN-Commercial, +120195,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,OPTUM VA CCN-Commercial, +120196,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,OPTUM VA CCN-Commercial, +120197,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,OPTUM VA CCN-Commercial, +120198,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,OPTUM VA CCN-Commercial, +120199,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,OPTUM VA CCN-Commercial, +120200,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,OPTUM VA CCN-Commercial, +120201,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,OPTUM VA CCN-Commercial, +120202,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,OPTUM VA CCN-Commercial, +120203,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,OPTUM VA CCN-Commercial, +120204,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,OPTUM VA CCN-Commercial, +120205,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,OPTUM VA CCN-Commercial, +120206,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,OPTUM VA CCN-Commercial, +120207,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,OPTUM VA CCN-Commercial, +120208,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,OPTUM VA CCN-Commercial, +120209,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,OPTUM VA CCN-Commercial, +120210,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,OPTUM VA CCN-Commercial, +120211,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,OPTUM VA CCN-Commercial, +120212,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,OPTUM VA CCN-Commercial, +120213,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,OPTUM VA CCN-Commercial, +120214,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,OPTUM VA CCN-Commercial, +120215,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,OPTUM VA CCN-Commercial, +120216,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,OPTUM VA CCN-Commercial, +120217,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,OPTUM VA CCN-Commercial, +120218,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,OPTUM VA CCN-Commercial, +120219,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,OPTUM VA CCN-Commercial, +120220,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,OPTUM VA CCN-Commercial, +120221,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,OPTUM VA CCN-Commercial, +120222,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,OPTUM VA CCN-Commercial, +120223,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,OPTUM VA CCN-Commercial, +120224,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,OPTUM VA CCN-Commercial, +120225,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,OPTUM VA CCN-Commercial, +120226,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,OPTUM VA CCN-Commercial, +120227,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,OPTUM VA CCN-Commercial, +120228,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,OPTUM VA CCN-Commercial, +120229,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,OPTUM VA CCN-Commercial, +120230,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,OPTUM VA CCN-Commercial, +120231,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,OPTUM VA CCN-Commercial, +120232,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,OPTUM VA CCN-Commercial, +120233,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,OPTUM VA CCN-Commercial, +120234,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,OPTUM VA CCN-Commercial, +120235,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,OPTUM VA CCN-Commercial, +120236,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,OPTUM VA CCN-Commercial, +120237,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,OPTUM VA CCN-Commercial, +120238,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,OPTUM VA CCN-Commercial, +120239,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,OPTUM VA CCN-Commercial, +120240,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,OPTUM VA CCN-Commercial, +120241,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,OPTUM VA CCN-Commercial, +120242,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,OPTUM VA CCN-Commercial, +120243,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,OPTUM VA CCN-Commercial, +120244,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,OPTUM VA CCN-Commercial, +120245,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,OPTUM VA CCN-Commercial, +120246,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,OPTUM VA CCN-Commercial, +120247,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,OPTUM VA CCN-Commercial, +120248,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,OPTUM VA CCN-Commercial, +120249,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,OPTUM VA CCN-Commercial, +120250,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,OPTUM VA CCN-Commercial, +120251,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,OPTUM VA CCN-Commercial, +120252,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,OPTUM VA CCN-Commercial, +120253,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,OPTUM VA CCN-Commercial, +120254,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,OPTUM VA CCN-Commercial, +120255,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,OPTUM VA CCN-Commercial, +120256,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,OPTUM VA CCN-Commercial, +120257,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,OPTUM VA CCN-Commercial, +120258,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,OPTUM VA CCN-Commercial, +120259,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,OPTUM VA CCN-Commercial, +120260,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,OPTUM VA CCN-Commercial, +120261,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,OPTUM VA CCN-Commercial, +120262,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,OPTUM VA CCN-Commercial, +120263,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,OPTUM VA CCN-Commercial, +120264,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,OPTUM VA CCN-Commercial, +120265,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,OPTUM VA CCN-Commercial, +120266,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,OPTUM VA CCN-Commercial, +120267,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,OPTUM VA CCN-Commercial, +120268,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,OPTUM VA CCN-Commercial, +120269,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,OPTUM VA CCN-Commercial, +120270,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,OPTUM VA CCN-Commercial, +120271,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,OPTUM VA CCN-Commercial, +120272,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,OPTUM VA CCN-Commercial, +120273,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,OPTUM VA CCN-Commercial, +120274,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,OPTUM VA CCN-Commercial, +120275,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,OPTUM VA CCN-Commercial, +120276,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,OPTUM VA CCN-Commercial, +120277,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,OPTUM VA CCN-Commercial, +120278,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,OPTUM VA CCN-Commercial, +120279,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,OPTUM VA CCN-Commercial, +120280,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,OPTUM VA CCN-Commercial, +120281,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,OPTUM VA CCN-Commercial, +120282,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,OPTUM VA CCN-Commercial, +120283,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,OPTUM VA CCN-Commercial, +120284,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,OPTUM VA CCN-Commercial, +120285,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,OPTUM VA CCN-Commercial, +120286,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,OPTUM VA CCN-Commercial, +120287,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,OPTUM VA CCN-Commercial, +120288,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,OPTUM VA CCN-Commercial, +120289,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,OPTUM VA CCN-Commercial, +120290,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,OPTUM VA CCN-Commercial, +120291,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,OPTUM VA CCN-Commercial, +120292,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,OPTUM VA CCN-Commercial, +120293,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,OPTUM VA CCN-Commercial, +120294,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,OPTUM VA CCN-Commercial, +120295,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,OPTUM VA CCN-Commercial, +120296,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,OPTUM VA CCN-Commercial, +120297,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,OPTUM VA CCN-Commercial, +120298,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,OPTUM VA CCN-Commercial, +120299,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,OPTUM VA CCN-Commercial, +120300,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,OPTUM VA CCN-Commercial, +120301,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,OPTUM VA CCN-Commercial, +120302,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,OPTUM VA CCN-Commercial, +120303,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,OPTUM VA CCN-Commercial, +120304,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,OPTUM VA CCN-Commercial, +120305,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,OPTUM VA CCN-Commercial, +120306,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,OPTUM VA CCN-Commercial, +120307,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,OPTUM VA CCN-Commercial, +120308,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,OPTUM VA CCN-Commercial, +120309,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,OPTUM VA CCN-Commercial, +120310,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,OPTUM VA CCN-Commercial, +120311,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,OPTUM VA CCN-Commercial, +120312,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,OPTUM VA CCN-Commercial, +120313,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,OPTUM VA CCN-Commercial, +120314,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,OPTUM VA CCN-Commercial, +120315,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,OPTUM VA CCN-Commercial, +120316,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,OPTUM VA CCN-Commercial, +120317,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,OPTUM VA CCN-Commercial, +120318,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,OPTUM VA CCN-Commercial, +120319,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,OPTUM VA CCN-Commercial, +120320,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,OPTUM VA CCN-Commercial, +120321,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,OPTUM VA CCN-Commercial, +120322,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,OPTUM VA CCN-Commercial, +120323,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,OPTUM VA CCN-Commercial, +120324,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,OPTUM VA CCN-Commercial, +120325,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,OPTUM VA CCN-Commercial, +120326,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,OPTUM VA CCN-Commercial, +120327,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,OPTUM VA CCN-Commercial, +120328,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,OPTUM VA CCN-Commercial, +120329,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,OPTUM VA CCN-Commercial, +120330,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,OPTUM VA CCN-Commercial, +120331,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,OPTUM VA CCN-Commercial, +120332,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,OPTUM VA CCN-Commercial, +120333,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,OPTUM VA CCN-Commercial, +120334,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,OPTUM VA CCN-Commercial, +120335,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,OPTUM VA CCN-Commercial, +120336,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,OPTUM VA CCN-Commercial, +120337,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,OPTUM VA CCN-Commercial, +120338,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,OPTUM VA CCN-Commercial, +120339,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,OPTUM VA CCN-Commercial, +120340,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,OPTUM VA CCN-Commercial, +120341,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,OPTUM VA CCN-Commercial, +120342,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,OPTUM VA CCN-Commercial, +120343,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,OPTUM VA CCN-Commercial, +120344,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,OPTUM VA CCN-Commercial, +120345,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,OPTUM VA CCN-Commercial, +120346,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,OPTUM VA CCN-Commercial, +120347,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,OPTUM VA CCN-Commercial, +120348,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,OPTUM VA CCN-Commercial, +120349,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,OPTUM VA CCN-Commercial, +120350,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,OPTUM VA CCN-Commercial, +120351,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,OPTUM VA CCN-Commercial, +120352,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,OPTUM VA CCN-Commercial, +120353,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,OPTUM VA CCN-Commercial, +120354,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,OPTUM VA CCN-Commercial, +120355,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,OPTUM VA CCN-Commercial, +120356,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,OPTUM VA CCN-Commercial, +120357,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,OPTUM VA CCN-Commercial, +120358,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,OPTUM VA CCN-Commercial, +120359,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,OPTUM VA CCN-Commercial, +120360,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,OPTUM VA CCN-Commercial, +120361,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,OPTUM VA CCN-Commercial, +120362,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,OPTUM VA CCN-Commercial, +120363,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,OPTUM VA CCN-Commercial, +120364,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,OPTUM VA CCN-Commercial, +120365,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,OPTUM VA CCN-Commercial, +120366,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,OPTUM VA CCN-Commercial, +120367,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,OPTUM VA CCN-Commercial, +120368,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,OPTUM VA CCN-Commercial, +120369,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,OPTUM VA CCN-Commercial, +120370,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,OPTUM VA CCN-Commercial, +120371,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,OPTUM VA CCN-Commercial, +120372,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,OPTUM VA CCN-Commercial, +120373,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,OPTUM VA CCN-Commercial, +120374,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,OPTUM VA CCN-Commercial, +120375,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,OPTUM VA CCN-Commercial, +120376,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,OPTUM VA CCN-Commercial, +120377,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,OPTUM VA CCN-Commercial, +120378,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,OPTUM VA CCN-Commercial, +120379,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,OPTUM VA CCN-Commercial, +120380,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,OPTUM VA CCN-Commercial, +120381,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,OPTUM VA CCN-Commercial, +120382,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,OPTUM VA CCN-Commercial, +120383,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,OPTUM VA CCN-Commercial, +120384,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,OPTUM VA CCN-Commercial, +120385,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,OPTUM VA CCN-Commercial, +120386,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,OPTUM VA CCN-Commercial, +120387,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,OPTUM VA CCN-Commercial, +120388,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,OPTUM VA CCN-Commercial, +120389,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,OPTUM VA CCN-Commercial, +120390,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,OPTUM VA CCN-Commercial, +120391,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,OPTUM VA CCN-Commercial, +120392,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,OPTUM VA CCN-Commercial, +120393,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,OPTUM VA CCN-Commercial, +120394,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,OPTUM VA CCN-Commercial, +120395,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,OPTUM VA CCN-Commercial, +120396,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,OPTUM VA CCN-Commercial, +120397,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,OPTUM VA CCN-Commercial, +120398,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,OPTUM VA CCN-Commercial, +120399,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,OPTUM VA CCN-Commercial, +120400,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,OPTUM VA CCN-Commercial, +120401,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,OPTUM VA CCN-Commercial, +120402,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,OPTUM VA CCN-Commercial, +120403,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,OPTUM VA CCN-Commercial, +120404,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,OPTUM VA CCN-Commercial, +120405,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,OPTUM VA CCN-Commercial, +120406,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,OPTUM VA CCN-Commercial, +120407,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,OPTUM VA CCN-Commercial, +120408,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,OPTUM VA CCN-Commercial, +120409,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,OPTUM VA CCN-Commercial, +120410,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,OPTUM VA CCN-Commercial, +120411,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,OPTUM VA CCN-Commercial, +120412,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,OPTUM VA CCN-Commercial, +120413,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,OPTUM VA CCN-Commercial, +120414,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,OPTUM VA CCN-Commercial, +120415,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,OPTUM VA CCN-Commercial, +120416,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,OPTUM VA CCN-Commercial, +120417,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,OPTUM VA CCN-Commercial, +120418,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,OPTUM VA CCN-Commercial, +120419,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,OPTUM VA CCN-Commercial, +120420,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,OPTUM VA CCN-Commercial, +120421,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,OPTUM VA CCN-Commercial, +120422,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,OPTUM VA CCN-Commercial, +120423,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,OPTUM VA CCN-Commercial, +120424,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,OPTUM VA CCN-Commercial, +120425,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,OPTUM VA CCN-Commercial, +120426,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,OPTUM VA CCN-Commercial, +120427,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,OPTUM VA CCN-Commercial, +120428,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,OPTUM VA CCN-Commercial, +120429,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,OPTUM VA CCN-Commercial, +120430,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,OPTUM VA CCN-Commercial, +120431,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,OPTUM VA CCN-Commercial, +120432,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,OPTUM VA CCN-Commercial, +120433,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,OPTUM VA CCN-Commercial, +120434,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,OPTUM VA CCN-Commercial, +120435,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,OPTUM VA CCN-Commercial, +120436,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,OPTUM VA CCN-Commercial, +120437,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,OPTUM VA CCN-Commercial, +120438,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,OPTUM VA CCN-Commercial, +120439,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,OPTUM VA CCN-Commercial, +120440,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,OPTUM VA CCN-Commercial, +120441,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,OPTUM VA CCN-Commercial, +120442,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,OPTUM VA CCN-Commercial, +120443,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,OPTUM VA CCN-Commercial, +120444,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,OPTUM VA CCN-Commercial, +120445,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,OPTUM VA CCN-Commercial, +120446,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,OPTUM VA CCN-Commercial, +120447,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,OPTUM VA CCN-Commercial, +120448,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,OPTUM VA CCN-Commercial, +120449,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,OPTUM VA CCN-Commercial, +120450,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,OPTUM VA CCN-Commercial, +120451,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,OPTUM VA CCN-Commercial, +120452,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,OPTUM VA CCN-Commercial, +120453,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,OPTUM VA CCN-Commercial, +120454,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,OPTUM VA CCN-Commercial, +120455,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,OPTUM VA CCN-Commercial, +120456,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,OPTUM VA CCN-Commercial, +120457,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,OPTUM VA CCN-Commercial, +120458,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,OPTUM VA CCN-Commercial, +120459,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,OPTUM VA CCN-Commercial, +120460,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,OPTUM VA CCN-Commercial, +120461,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,OPTUM VA CCN-Commercial, +120462,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,OPTUM VA CCN-Commercial, +120463,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,OPTUM VA CCN-Commercial, +120464,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,OPTUM VA CCN-Commercial, +120465,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,OPTUM VA CCN-Commercial, +120466,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,OPTUM VA CCN-Commercial, +120467,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,OPTUM VA CCN-Commercial, +120468,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,OPTUM VA CCN-Commercial, +120469,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,OPTUM VA CCN-Commercial, +120470,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,OPTUM VA CCN-Commercial, +120471,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,OPTUM VA CCN-Commercial, +120472,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,OPTUM VA CCN-Commercial, +120473,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,OPTUM VA CCN-Commercial, +120474,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,OPTUM VA CCN-Commercial, +120475,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,OPTUM VA CCN-Commercial, +120476,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,OPTUM VA CCN-Commercial, +120477,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,OPTUM VA CCN-Commercial, +120478,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,OPTUM VA CCN-Commercial, +120479,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,OPTUM VA CCN-Commercial, +120480,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,OPTUM VA CCN-Commercial, +120481,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,OPTUM VA CCN-Commercial, +120482,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,OPTUM VA CCN-Commercial, +120483,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,OPTUM VA CCN-Commercial, +120484,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,OPTUM VA CCN-Commercial, +120485,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,OPTUM VA CCN-Commercial, +120486,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,OPTUM VA CCN-Commercial, +120487,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,OPTUM VA CCN-Commercial, +120488,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,OPTUM VA CCN-Commercial, +120489,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,OPTUM VA CCN-Commercial, +120490,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,OPTUM VA CCN-Commercial, +120491,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,OPTUM VA CCN-Commercial, +120492,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,OPTUM VA CCN-Commercial, +120493,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,OPTUM VA CCN-Commercial, +120494,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,OPTUM VA CCN-Commercial, +120495,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,OPTUM VA CCN-Commercial, +120496,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,OPTUM VA CCN-Commercial, +120497,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,OPTUM VA CCN-Commercial, +120498,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,OPTUM VA CCN-Commercial, +120499,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,OPTUM VA CCN-Commercial, +120500,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,OPTUM VA CCN-Commercial, +120501,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,OPTUM VA CCN-Commercial, +120502,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,OPTUM VA CCN-Commercial, +120503,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,OPTUM VA CCN-Commercial, +120504,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,OPTUM VA CCN-Commercial, +120505,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,OPTUM VA CCN-Commercial, +120506,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,OPTUM VA CCN-Commercial, +120507,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,OPTUM VA CCN-Commercial, +120508,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,OPTUM VA CCN-Commercial, +120509,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,OPTUM VA CCN-Commercial, +120510,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,OPTUM VA CCN-Commercial, +120511,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,OPTUM VA CCN-Commercial, +120512,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,OPTUM VA CCN-Commercial, +120513,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,OPTUM VA CCN-Commercial, +120514,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,OPTUM VA CCN-Commercial, +120515,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,OPTUM VA CCN-Commercial, +120516,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,OPTUM VA CCN-Commercial, +120517,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,OPTUM VA CCN-Commercial, +120518,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,OPTUM VA CCN-Commercial, +120519,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,OPTUM VA CCN-Commercial, +120520,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,OPTUM VA CCN-Commercial, +120521,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,OPTUM VA CCN-Commercial, +120522,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,OPTUM VA CCN-Commercial, +120523,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,OPTUM VA CCN-Commercial, +120524,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,OPTUM VA CCN-Commercial, +120525,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,OPTUM VA CCN-Commercial, +120526,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,OPTUM VA CCN-Commercial, +120527,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,OPTUM VA CCN-Commercial, +120528,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,OPTUM VA CCN-Commercial, +120529,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,OPTUM VA CCN-Commercial, +120530,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,OPTUM VA CCN-Commercial, +120531,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,OPTUM VA CCN-Commercial, +120532,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,OPTUM VA CCN-Commercial, +120533,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,OPTUM VA CCN-Commercial, +120534,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,OPTUM VA CCN-Commercial, +120535,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,OPTUM VA CCN-Commercial, +120536,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,OPTUM VA CCN-Commercial, +120537,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,OPTUM VA CCN-Commercial, +120538,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,OPTUM VA CCN-Commercial, +120539,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,OPTUM VA CCN-Commercial, +120540,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,OPTUM VA CCN-Commercial, +120541,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,OPTUM VA CCN-Commercial, +120542,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,OPTUM VA CCN-Commercial, +120543,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,OPTUM VA CCN-Commercial, +120544,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,OPTUM VA CCN-Commercial, +120545,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,OPTUM VA CCN-Commercial, +120546,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,OPTUM VA CCN-Commercial, +120547,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,OPTUM VA CCN-Commercial, +120548,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,OPTUM VA CCN-Commercial, +120549,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,OPTUM VA CCN-Commercial, +120550,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,OPTUM VA CCN-Commercial, +120551,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,OPTUM VA CCN-Commercial, +120552,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,OPTUM VA CCN-Commercial, +120553,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,OPTUM VA CCN-Commercial, +120554,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,OPTUM VA CCN-Commercial, +120555,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,OPTUM VA CCN-Commercial, +120556,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,OPTUM VA CCN-Commercial, +120557,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,OPTUM VA CCN-Commercial, +120558,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,OPTUM VA CCN-Commercial, +120559,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,OPTUM VA CCN-Commercial, +120560,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,OPTUM VA CCN-Commercial, +120561,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,OPTUM VA CCN-Commercial, +120562,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,OPTUM VA CCN-Commercial, +120563,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,OPTUM VA CCN-Commercial, +120564,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,OPTUM VA CCN-Commercial, +120565,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,OPTUM VA CCN-Commercial, +120566,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,OPTUM VA CCN-Commercial, +120567,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,OPTUM VA CCN-Commercial, +120568,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,OPTUM VA CCN-Commercial, +120569,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,OPTUM VA CCN-Commercial, +120570,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,OPTUM VA CCN-Commercial, +120571,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,OPTUM VA CCN-Commercial, +120572,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,OPTUM VA CCN-Commercial, +120573,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,OPTUM VA CCN-Commercial, +120574,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,OPTUM VA CCN-Commercial, +120575,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,OPTUM VA CCN-Commercial, +120576,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,OPTUM VA CCN-Commercial, +120577,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,OPTUM VA CCN-Commercial, +120578,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,OPTUM VA CCN-Commercial, +120579,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,OPTUM VA CCN-Commercial, +120580,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,OPTUM VA CCN-Commercial, +120581,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,OPTUM VA CCN-Commercial, +120582,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,OPTUM VA CCN-Commercial, +120583,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,OPTUM VA CCN-Commercial, +120584,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,OPTUM VA CCN-Commercial, +120585,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,OPTUM VA CCN-Commercial, +120586,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,OPTUM VA CCN-Commercial, +120587,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,OPTUM VA CCN-Commercial, +120588,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,OPTUM VA CCN-Commercial, +120589,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,OPTUM VA CCN-Commercial, +120590,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,OPTUM VA CCN-Commercial, +120591,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,OPTUM VA CCN-Commercial, +120592,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,OPTUM VA CCN-Commercial, +120593,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,OPTUM VA CCN-Commercial, +120594,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,OPTUM VA CCN-Commercial, +120595,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,OPTUM VA CCN-Commercial, +120596,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,OPTUM VA CCN-Commercial, +120597,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,OPTUM VA CCN-Commercial, +120598,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,OPTUM VA CCN-Commercial, +120599,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,OPTUM VA CCN-Commercial, +120600,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,OPTUM VA CCN-Commercial, +120601,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,OPTUM VA CCN-Commercial, +120602,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,OPTUM VA CCN-Commercial, +120603,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,OPTUM VA CCN-Commercial, +120604,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,OPTUM VA CCN-Commercial, +120605,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,OPTUM VA CCN-Commercial, +120606,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,OPTUM VA CCN-Commercial, +120607,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,OPTUM VA CCN-Commercial, +120608,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,OPTUM VA CCN-Commercial, +120609,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,OPTUM VA CCN-Commercial, +120610,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,OPTUM VA CCN-Commercial, +120611,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,OPTUM VA CCN-Commercial, +120612,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,OPTUM VA CCN-Commercial, +120613,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,OPTUM VA CCN-Commercial, +120614,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,OPTUM VA CCN-Commercial, +120615,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,OPTUM VA CCN-Commercial, +120616,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,OPTUM VA CCN-Commercial, +120617,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,OPTUM VA CCN-Commercial, +120618,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,OPTUM VA CCN-Commercial, +120619,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,OPTUM VA CCN-Commercial, +120620,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,OPTUM VA CCN-Commercial, +120621,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,OPTUM VA CCN-Commercial, +120622,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,OPTUM VA CCN-Commercial, +120623,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,OPTUM VA CCN-Commercial, +120624,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,OPTUM VA CCN-Commercial, +120625,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,OPTUM VA CCN-Commercial, +120626,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,OPTUM VA CCN-Commercial, +120627,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,OPTUM VA CCN-Commercial, +120628,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,OPTUM VA CCN-Commercial, +120629,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,OPTUM VA CCN-Commercial, +120630,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,OPTUM VA CCN-Commercial, +120631,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,OPTUM VA CCN-Commercial, +120632,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,OPTUM VA CCN-Commercial, +120633,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,OPTUM VA CCN-Commercial, +120634,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,OPTUM VA CCN-Commercial, +120635,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,OPTUM VA CCN-Commercial, +120636,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,OPTUM VA CCN-Commercial, +120637,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,OPTUM VA CCN-Commercial, +120638,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,OPTUM VA CCN-Commercial, +120639,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,OPTUM VA CCN-Commercial, +120640,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,OPTUM VA CCN-Commercial, +120641,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,OPTUM VA CCN-Commercial, +120642,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,OPTUM VA CCN-Commercial, +120643,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,OPTUM VA CCN-Commercial, +120644,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,OPTUM VA CCN-Commercial, +120645,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,OPTUM VA CCN-Commercial, +120646,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,OPTUM VA CCN-Commercial, +120647,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,OPTUM VA CCN-Commercial, +120648,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,OPTUM VA CCN-Commercial, +120649,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,OPTUM VA CCN-Commercial, +120650,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,OPTUM VA CCN-Commercial, +120651,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,OPTUM VA CCN-Commercial, +120652,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,OPTUM VA CCN-Commercial, +120653,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,OPTUM VA CCN-Commercial, +120654,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,OPTUM VA CCN-Commercial, +120655,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,OPTUM VA CCN-Commercial, +120656,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,OPTUM VA CCN-Commercial, +120657,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,OPTUM VA CCN-Commercial, +120658,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,OPTUM VA CCN-Commercial, +120659,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,OPTUM VA CCN-Commercial, +120660,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,OPTUM VA CCN-Commercial, +120661,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,OPTUM VA CCN-Commercial, +120662,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,OPTUM VA CCN-Commercial, +120663,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,OPTUM VA CCN-Commercial, +120664,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,OPTUM VA CCN-Commercial, +120665,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,OPTUM VA CCN-Commercial, +120666,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,OPTUM VA CCN-Commercial, +120667,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,OPTUM VA CCN-Commercial, +120668,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,OPTUM VA CCN-Commercial, +120669,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,OPTUM VA CCN-Commercial, +120670,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,OPTUM VA CCN-Commercial, +120671,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,OPTUM VA CCN-Commercial, +120672,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,OPTUM VA CCN-Commercial, +120673,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,OPTUM VA CCN-Commercial, +120674,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,OPTUM VA CCN-Commercial, +120675,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,OPTUM VA CCN-Commercial, +120676,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,OPTUM VA CCN-Commercial, +120677,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,OPTUM VA CCN-Commercial, +120678,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,OPTUM VA CCN-Commercial, +120679,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,OPTUM VA CCN-Commercial, +120680,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,OPTUM VA CCN-Commercial, +120681,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,OPTUM VA CCN-Commercial, +120682,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,OPTUM VA CCN-Commercial, +120683,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,OPTUM VA CCN-Commercial, +120684,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,OPTUM VA CCN-Commercial, +120685,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,OPTUM VA CCN-Commercial, +120686,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,OPTUM VA CCN-Commercial, +120687,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,OPTUM VA CCN-Commercial, +120688,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,OPTUM VA CCN-Commercial, +120689,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,OPTUM VA CCN-Commercial, +120690,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,OPTUM VA CCN-Commercial, +120691,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,OPTUM VA CCN-Commercial, +120692,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,OPTUM VA CCN-Commercial, +120693,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,OPTUM VA CCN-Commercial, +120694,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,OPTUM VA CCN-Commercial, +120695,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,OPTUM VA CCN-Commercial, +120696,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,OPTUM VA CCN-Commercial, +120697,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,OPTUM VA CCN-Commercial, +120698,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,OPTUM VA CCN-Commercial, +120699,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,OPTUM VA CCN-Commercial, +120700,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,OPTUM VA CCN-Commercial, +120701,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,OPTUM VA CCN-Commercial, +120702,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,OPTUM VA CCN-Commercial, +120703,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,OPTUM VA CCN-Commercial, +120704,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,OPTUM VA CCN-Commercial, +120705,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,OPTUM VA CCN-Commercial, +120706,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,OPTUM VA CCN-Commercial, +120707,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,OPTUM VA CCN-Commercial, +120708,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,OPTUM VA CCN-Commercial, +120709,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,OPTUM VA CCN-Commercial, +120710,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,OPTUM VA CCN-Commercial, +120711,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,OPTUM VA CCN-Commercial, +120712,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,OPTUM VA CCN-Commercial, +120713,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,OPTUM VA CCN-Commercial, +120714,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,OPTUM VA CCN-Commercial, +120715,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,OPTUM VA CCN-Commercial, +120716,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,OPTUM VA CCN-Commercial, +120717,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,OPTUM VA CCN-Commercial, +120718,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,OPTUM VA CCN-Commercial, +120719,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,OPTUM VA CCN-Commercial, +120720,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,OPTUM VA CCN-Commercial, +120721,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,OPTUM VA CCN-Commercial, +120722,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,OPTUM VA CCN-Commercial, +120723,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,OPTUM VA CCN-Commercial, +120724,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,OPTUM VA CCN-Commercial, +120725,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,OPTUM VA CCN-Commercial, +120726,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,OPTUM VA CCN-Commercial, +120727,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,OPTUM VA CCN-Commercial, +120728,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,OPTUM VA CCN-Commercial, +120729,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,OPTUM VA CCN-Commercial, +120730,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,OPTUM VA CCN-Commercial, +120731,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,OPTUM VA CCN-Commercial, +120732,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,OPTUM VA CCN-Commercial, +120733,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,OPTUM VA CCN-Commercial, +120734,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,OPTUM VA CCN-Commercial, +120735,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,OPTUM VA CCN-Commercial, +120736,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,OPTUM VA CCN-Commercial, +120737,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,OPTUM VA CCN-Commercial, +120738,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,OPTUM VA CCN-Commercial, +120739,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,OPTUM VA CCN-Commercial, +120740,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,OPTUM VA CCN-Commercial, +120741,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,OPTUM VA CCN-Commercial, +120742,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,OPTUM VA CCN-Commercial, +120743,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,OPTUM VA CCN-Commercial, +120744,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,OPTUM VA CCN-Commercial, +120745,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,OPTUM VA CCN-Commercial, +120746,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,OPTUM VA CCN-Commercial, +120747,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,OPTUM VA CCN-Commercial, +120748,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,OPTUM VA CCN-Commercial, +120749,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,OPTUM VA CCN-Commercial, +120750,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,OPTUM VA CCN-Commercial, +120751,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,OPTUM VA CCN-Commercial, +120752,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,OPTUM VA CCN-Commercial, +120753,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,OPTUM VA CCN-Commercial, +120754,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,OPTUM VA CCN-Commercial, +120755,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,OPTUM VA CCN-Commercial, +120756,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,OPTUM VA CCN-Commercial, +120757,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,OPTUM VA CCN-Commercial, +120758,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,OPTUM VA CCN-Commercial, +120759,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,OPTUM VA CCN-Commercial, +120760,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,OPTUM VA CCN-Commercial, +120761,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,OPTUM VA CCN-Commercial, +120762,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,OPTUM VA CCN-Commercial, +120763,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,OPTUM VA CCN-Commercial, +120764,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,OPTUM VA CCN-Commercial, +120765,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,OPTUM VA CCN-Commercial, +120766,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,OPTUM VA CCN-Commercial, +120767,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,OPTUM VA CCN-Commercial, +120768,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,OPTUM VA CCN-Commercial, +120769,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,OPTUM VA CCN-Commercial, +120770,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,OPTUM VA CCN-Commercial, +120771,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,OPTUM VA CCN-Commercial, +120772,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,OPTUM VA CCN-Commercial, +120773,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,OPTUM VA CCN-Commercial, +120774,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,OPTUM VA CCN-Commercial, +120775,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,OPTUM VA CCN-Commercial, +120776,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,OPTUM VA CCN-Commercial, +120777,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,OPTUM VA CCN-Commercial, +120778,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,OPTUM VA CCN-Commercial, +120779,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,OPTUM VA CCN-Commercial, +120780,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,OPTUM VA CCN-Commercial, +120781,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,OPTUM VA CCN-Commercial, +120782,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,OPTUM VA CCN-Commercial, +120783,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,OPTUM VA CCN-Commercial, +120784,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,OPTUM VA CCN-Commercial, +120785,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,OPTUM VA CCN-Commercial, +120786,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,OPTUM VA CCN-Commercial, +120787,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,OPTUM VA CCN-Commercial, +120788,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,OPTUM VA CCN-Commercial, +120789,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,OPTUM VA CCN-Commercial, +120790,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,OPTUM VA CCN-Commercial, +120791,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,OPTUM VA CCN-Commercial, +120792,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,OPTUM VA CCN-Commercial, +120793,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,OPTUM VA CCN-Commercial, +120794,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,OPTUM VA CCN-Commercial, +120795,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,OPTUM VA CCN-Commercial, +120796,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,OPTUM VA CCN-Commercial, +120797,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,OPTUM VA CCN-Commercial, +120798,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,OPTUM VA CCN-Commercial, +120799,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,OPTUM VA CCN-Commercial, +120800,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,OPTUM VA CCN-Commercial, +120801,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,OPTUM VA CCN-Commercial, +120802,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,OPTUM VA CCN-Commercial, +120803,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,OPTUM VA CCN-Commercial, +120804,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,OPTUM VA CCN-Commercial, +120805,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,OPTUM VA CCN-Commercial, +120806,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,OPTUM VA CCN-Commercial, +120807,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,OPTUM VA CCN-Commercial, +120808,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,OPTUM VA CCN-Commercial, +120809,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,OPTUM VA CCN-Commercial, +120810,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,OPTUM VA CCN-Commercial, +120811,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,OPTUM VA CCN-Commercial, +120812,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,OPTUM VA CCN-Commercial, +120813,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,OPTUM VA CCN-Commercial, +120814,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,OPTUM VA CCN-Commercial, +120815,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,OPTUM VA CCN-Commercial, +120816,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,OPTUM VA CCN-Commercial, +120817,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,OPTUM VA CCN-Commercial, +120818,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,OPTUM VA CCN-Commercial, +120819,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,OPTUM VA CCN-Commercial, +120820,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,OPTUM VA CCN-Commercial, +120821,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,OPTUM VA CCN-Commercial, +120822,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,OPTUM VA CCN-Commercial, +120823,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,OPTUM VA CCN-Commercial, +120824,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,OPTUM VA CCN-Commercial, +120825,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,OPTUM VA CCN-Commercial, +120826,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,OPTUM VA CCN-Commercial, +120827,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,OPTUM VA CCN-Commercial, +120828,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,OPTUM VA CCN-Commercial, +120829,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,OPTUM VA CCN-Commercial, +120830,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,OPTUM VA CCN-Commercial, +120831,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,OPTUM VA CCN-Commercial, +120832,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,OPTUM VA CCN-Commercial, +120833,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,OPTUM VA CCN-Commercial, +120834,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,OPTUM VA CCN-Commercial, +120835,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,OPTUM VA CCN-Commercial, +120836,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,OPTUM VA CCN-Commercial, +120837,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,OPTUM VA CCN-Commercial, +120838,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,OPTUM VA CCN-Commercial, +120839,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,OPTUM VA CCN-Commercial, +120840,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,OPTUM VA CCN-Commercial, +120841,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,OPTUM VA CCN-Commercial, +120842,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,OPTUM VA CCN-Commercial, +120843,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,OPTUM VA CCN-Commercial, +120844,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,OPTUM VA CCN-Commercial, +120845,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,OPTUM VA CCN-Commercial, +120846,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,OPTUM VA CCN-Commercial, +120847,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,OPTUM VA CCN-Commercial, +120848,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,OPTUM VA CCN-Commercial, +120849,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,OPTUM VA CCN-Commercial, +120850,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,OPTUM VA CCN-Commercial, +120851,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,OPTUM VA CCN-Commercial, +120852,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,OPTUM VA CCN-Commercial, +120853,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,OPTUM VA CCN-Commercial, +120854,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,OPTUM VA CCN-Commercial, +120855,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,OPTUM VA CCN-Commercial, +120856,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,OPTUM VA CCN-Commercial, +120857,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,OPTUM VA CCN-Commercial, +120858,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,OPTUM VA CCN-Commercial, +120859,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,OPTUM VA CCN-Commercial, +120860,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,OPTUM VA CCN-Commercial, +120861,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,OPTUM VA CCN-Commercial, +120862,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,OPTUM VA CCN-Commercial, +120863,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,OPTUM VA CCN-Commercial, +120864,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,OPTUM VA CCN-Commercial, +120865,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,OPTUM VA CCN-Commercial, +120866,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,OPTUM VA CCN-Commercial, +120867,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,OPTUM VA CCN-Commercial, +120868,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,OPTUM VA CCN-Commercial, +120869,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,OPTUM VA CCN-Commercial, +120870,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,OPTUM VA CCN-Commercial, +120871,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,OPTUM VA CCN-Commercial, +120872,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,OPTUM VA CCN-Commercial, +120873,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,OPTUM VA CCN-Commercial, +120874,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,OPTUM VA CCN-Commercial, +120875,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,OPTUM VA CCN-Commercial, +120876,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,OPTUM VA CCN-Commercial, +120877,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,OPTUM VA CCN-Commercial, +120878,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,OPTUM VA CCN-Commercial, +120879,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,OPTUM VA CCN-Commercial, +120880,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,OPTUM VA CCN-Commercial, +120881,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,OPTUM VA CCN-Commercial, +120882,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,OPTUM VA CCN-Commercial, +120883,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,OPTUM VA CCN-Commercial, +120884,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,OPTUM VA CCN-Commercial, +120885,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,OPTUM VA CCN-Commercial, +120886,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,OPTUM VA CCN-Commercial, +120887,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,OPTUM VA CCN-Commercial, +120888,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,OPTUM VA CCN-Commercial, +120889,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,OPTUM VA CCN-Commercial, +120890,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,OPTUM VA CCN-Commercial, +120891,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,OPTUM VA CCN-Commercial, +120892,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,OPTUM VA CCN-Commercial, +120893,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,OPTUM VA CCN-Commercial, +120894,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,OPTUM VA CCN-Commercial, +120895,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,OPTUM VA CCN-Commercial, +120896,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,OPTUM VA CCN-Commercial, +120897,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,OPTUM VA CCN-Commercial, +120898,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,OPTUM VA CCN-Commercial, +120899,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,OPTUM VA CCN-Commercial, +120900,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,OPTUM VA CCN-Commercial, +120901,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,OPTUM VA CCN-Commercial, +120902,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,OPTUM VA CCN-Commercial, +120903,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,OPTUM VA CCN-Commercial, +120904,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,OPTUM VA CCN-Commercial, +120905,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,OPTUM VA CCN-Commercial, +120906,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,OPTUM VA CCN-Commercial, +120907,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,OPTUM VA CCN-Commercial, +120908,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,OPTUM VA CCN-Commercial, +120909,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,OPTUM VA CCN-Commercial, +120910,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,OPTUM VA CCN-Commercial, +120911,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,OPTUM VA CCN-Commercial, +120912,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,OPTUM VA CCN-Commercial, +120913,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,OPTUM VA CCN-Commercial, +120914,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,OPTUM VA CCN-Commercial, +120915,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,OPTUM VA CCN-Commercial, +120916,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,OPTUM VA CCN-Commercial, +120917,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,OPTUM VA CCN-Commercial, +120918,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,OPTUM VA CCN-Commercial, +120919,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,OPTUM VA CCN-Commercial, +120920,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,OPTUM VA CCN-Commercial, +120921,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,OPTUM VA CCN-Commercial, +120922,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,OPTUM VA CCN-Commercial, +120923,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,OPTUM VA CCN-Commercial, +120924,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,OPTUM VA CCN-Commercial, +120925,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,OPTUM VA CCN-Commercial, +120926,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,OPTUM VA CCN-Commercial, +120927,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,OPTUM VA CCN-Commercial, +120928,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,OPTUM VA CCN-Commercial, +120929,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,OPTUM VA CCN-Commercial, +120930,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,OPTUM VA CCN-Commercial, +120931,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,OPTUM VA CCN-Commercial, +120932,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,OPTUM VA CCN-Commercial, +120933,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,OPTUM VA CCN-Commercial, +120934,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,OPTUM VA CCN-Commercial, +120935,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,OPTUM VA CCN-Commercial, +120936,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,OPTUM VA CCN-Commercial, +120937,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,OPTUM VA CCN-Commercial, +120938,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,OPTUM VA CCN-Commercial, +120939,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,OPTUM VA CCN-Commercial, +120940,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,OPTUM VA CCN-Commercial, +120941,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,OPTUM VA CCN-Commercial, +120942,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,OPTUM VA CCN-Commercial, +120943,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,OPTUM VA CCN-Commercial, +120944,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,OPTUM VA CCN-Commercial, +120945,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,OPTUM VA CCN-Commercial, +120946,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,OPTUM VA CCN-Commercial, +120947,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,OPTUM VA CCN-Commercial, +120948,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,OPTUM VA CCN-Commercial, +120949,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,OPTUM VA CCN-Commercial, +120950,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,OPTUM VA CCN-Commercial, +120951,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,OPTUM VA CCN-Commercial, +120952,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,OPTUM VA CCN-Commercial, +120953,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,OPTUM VA CCN-Commercial, +120954,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,OPTUM VA CCN-Commercial, +120955,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,OPTUM VA CCN-Commercial, +120956,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,OPTUM VA CCN-Commercial, +120957,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,OPTUM VA CCN-Commercial, +120958,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,OPTUM VA CCN-Commercial, +120959,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,OPTUM VA CCN-Commercial, +120960,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,OPTUM VA CCN-Commercial, +120961,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,OPTUM VA CCN-Commercial, +120962,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,OPTUM VA CCN-Commercial, +120963,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,OPTUM VA CCN-Commercial, +120964,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,OPTUM VA CCN-Commercial, +120965,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,OPTUM VA CCN-Commercial, +120966,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,OPTUM VA CCN-Commercial, +120967,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,OPTUM VA CCN-Commercial, +120968,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,OPTUM VA CCN-Commercial, +120969,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,OPTUM VA CCN-Commercial, +120970,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,OPTUM VA CCN-Commercial, +120971,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,OPTUM VA CCN-Commercial, +120972,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,OPTUM VA CCN-Commercial, +120973,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,OPTUM VA CCN-Commercial, +120974,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,OPTUM VA CCN-Commercial, +120975,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,OPTUM VA CCN-Commercial, +120976,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,OPTUM VA CCN-Commercial, +120977,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,OPTUM VA CCN-Commercial, +120978,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,OPTUM VA CCN-Commercial, +120979,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,OPTUM VA CCN-Commercial, +120980,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,OPTUM VA CCN-Commercial, +120981,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,OPTUM VA CCN-Commercial, +120982,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,OPTUM VA CCN-Commercial, +120983,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,OPTUM VA CCN-Commercial, +120984,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,OPTUM VA CCN-Commercial, +120985,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,OPTUM VA CCN-Commercial, +120986,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,OPTUM VA CCN-Commercial, +120987,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,OPTUM VA CCN-Commercial, +120988,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,OPTUM VA CCN-Commercial, +120989,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,OPTUM VA CCN-Commercial, +120990,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,OPTUM VA CCN-Commercial, +120991,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,OPTUM VA CCN-Commercial, +120992,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,OPTUM VA CCN-Commercial, +120993,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,OPTUM VA CCN-Commercial, +120994,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,OPTUM VA CCN-Commercial, +120995,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,OPTUM VA CCN-Commercial, +120996,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,OPTUM VA CCN-Commercial, +120997,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,OPTUM VA CCN-Commercial, +120998,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,OPTUM VA CCN-Commercial, +120999,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,OPTUM VA CCN-Commercial, +121000,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,OPTUM VA CCN-Commercial, +121001,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,OPTUM VA CCN-Commercial, +121002,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,OPTUM VA CCN-Commercial, +121003,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,OPTUM VA CCN-Commercial, +121004,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,OPTUM VA CCN-Commercial, +121005,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,OPTUM VA CCN-Commercial, +121006,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,OPTUM VA CCN-Commercial, +121007,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,OPTUM VA CCN-Commercial, +121008,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,OPTUM VA CCN-Commercial, +121009,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,OPTUM VA CCN-Commercial, +121010,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,OPTUM VA CCN-Commercial, +121011,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,OPTUM VA CCN-Commercial, +121012,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,OPTUM VA CCN-Commercial, +121013,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,OPTUM VA CCN-Commercial, +121014,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,OPTUM VA CCN-Commercial, +121015,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,OPTUM VA CCN-Commercial, +121016,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,OPTUM VA CCN-Commercial, +121017,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,OPTUM VA CCN-Commercial, +121018,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,OPTUM VA CCN-Commercial, +121019,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,OPTUM VA CCN-Commercial, +121020,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,OPTUM VA CCN-Commercial, +121021,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,OPTUM VA CCN-Commercial, +121022,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,OPTUM VA CCN-Commercial, +121023,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,OPTUM VA CCN-Commercial, +121024,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,OPTUM VA CCN-Commercial, +121025,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,OPTUM VA CCN-Commercial, +121026,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,OPTUM VA CCN-Commercial, +121027,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,OPTUM VA CCN-Commercial, +121028,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,OPTUM VA CCN-Commercial, +121029,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,OPTUM VA CCN-Commercial, +121030,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,OPTUM VA CCN-Commercial, +121031,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,OPTUM VA CCN-Commercial, +121032,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,OPTUM VA CCN-Commercial, +121033,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,OPTUM VA CCN-Commercial, +121034,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,OPTUM VA CCN-Commercial, +121035,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,OPTUM VA CCN-Commercial, +121036,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,OPTUM VA CCN-Commercial, +121037,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,OPTUM VA CCN-Commercial, +121038,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,OPTUM VA CCN-Commercial, +121039,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,OPTUM VA CCN-Commercial, +121040,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,OPTUM VA CCN-Commercial, +121041,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,OPTUM VA CCN-Commercial, +121042,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,OPTUM VA CCN-Commercial, +121043,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,OPTUM VA CCN-Commercial, +121044,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,OPTUM VA CCN-Commercial, +121045,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,OPTUM VA CCN-Commercial, +121046,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,OPTUM VA CCN-Commercial, +121047,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,OPTUM VA CCN-Commercial, +121048,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,OPTUM VA CCN-Commercial, +121049,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,OPTUM VA CCN-Commercial, +121050,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,OPTUM VA CCN-Commercial, +121051,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,OPTUM VA CCN-Commercial, +121052,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,OPTUM VA CCN-Commercial, +121053,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,OPTUM VA CCN-Commercial, +121054,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,OPTUM VA CCN-Commercial, +121055,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,OPTUM VA CCN-Commercial, +121056,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,OPTUM VA CCN-Commercial, +121057,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,OPTUM VA CCN-Commercial, +121058,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,OPTUM VA CCN-Commercial, +121059,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,OPTUM VA CCN-Commercial, +121060,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,OPTUM VA CCN-Commercial, +121061,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,OPTUM VA CCN-Commercial, +121062,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,OPTUM VA CCN-Commercial, +121063,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,OPTUM VA CCN-Commercial, +121064,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,OPTUM VA CCN-Commercial, +121065,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,OPTUM VA CCN-Commercial, +121066,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,OPTUM VA CCN-Commercial, +121067,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,OPTUM VA CCN-Commercial, +121068,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,OPTUM VA CCN-Commercial, +121069,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,OPTUM VA CCN-Commercial, +121070,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,OPTUM VA CCN-Commercial, +121071,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,OPTUM VA CCN-Commercial, +121072,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,OPTUM VA CCN-Commercial, +121073,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,OPTUM VA CCN-Commercial, +121074,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,OPTUM VA CCN-Commercial, +121075,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,OPTUM VA CCN-Commercial, +121076,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,OPTUM VA CCN-Commercial, +121077,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,OPTUM VA CCN-Commercial, +121078,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,OPTUM VA CCN-Commercial, +121079,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,OPTUM VA CCN-Commercial, +121080,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,OPTUM VA CCN-Commercial, +121081,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,OPTUM VA CCN-Commercial, +121082,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,OPTUM VA CCN-Commercial, +121083,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,OPTUM VA CCN-Commercial, +121084,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,OPTUM VA CCN-Commercial, +121085,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,OPTUM VA CCN-Commercial, +121086,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,OPTUM VA CCN-Commercial, +121087,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,OPTUM VA CCN-Commercial, +121088,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,OPTUM VA CCN-Commercial, +121089,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,OPTUM VA CCN-Commercial, +121090,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,OPTUM VA CCN-Commercial, +121091,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,OPTUM VA CCN-Commercial, +121092,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,OPTUM VA CCN-Commercial, +121093,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,OPTUM VA CCN-Commercial, +121094,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,OPTUM VA CCN-Commercial, +121095,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,OPTUM VA CCN-Commercial, +121096,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,OPTUM VA CCN-Commercial, +121097,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,OPTUM VA CCN-Commercial, +121098,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,OPTUM VA CCN-Commercial, +121099,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,OPTUM VA CCN-Commercial, +121100,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,OPTUM VA CCN-Commercial, +121101,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,OPTUM VA CCN-Commercial, +121102,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,OPTUM VA CCN-Commercial, +121103,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,OPTUM VA CCN-Commercial, +121104,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,OPTUM VA CCN-Commercial, +121105,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,OPTUM VA CCN-Commercial, +121106,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,OPTUM VA CCN-Commercial, +121107,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,OPTUM VA CCN-Commercial, +121108,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,OPTUM VA CCN-Commercial, +121109,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,OPTUM VA CCN-Commercial, +121110,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,OPTUM VA CCN-Commercial, +121111,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,OPTUM VA CCN-Commercial, +121112,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,OPTUM VA CCN-Commercial, +121113,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,OPTUM VA CCN-Commercial, +121114,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,OPTUM VA CCN-Commercial, +121115,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,OPTUM VA CCN-Commercial, +121116,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,OPTUM VA CCN-Commercial, +121117,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,OPTUM VA CCN-Commercial, +121118,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,OPTUM VA CCN-Commercial, +121119,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,OPTUM VA CCN-Commercial, +121120,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,OPTUM VA CCN-Commercial, +121121,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,OPTUM VA CCN-Commercial, +121122,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,OPTUM VA CCN-Commercial, +121123,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,OPTUM VA CCN-Commercial, +121124,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,OPTUM VA CCN-Commercial, +121125,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,OPTUM VA CCN-Commercial, +121126,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,OPTUM VA CCN-Commercial, +121127,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,OPTUM VA CCN-Commercial, +121128,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,OPTUM VA CCN-Commercial, +121129,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,OPTUM VA CCN-Commercial, +121130,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,OPTUM VA CCN-Commercial, +121131,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,OPTUM VA CCN-Commercial, +121132,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,OPTUM VA CCN-Commercial, +121133,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,OPTUM VA CCN-Commercial, +121134,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,OPTUM VA CCN-Commercial, +121135,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,OPTUM VA CCN-Commercial, +121136,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,OPTUM VA CCN-Commercial, +121137,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,OPTUM VA CCN-Commercial, +121138,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,OPTUM VA CCN-Commercial, +121139,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,OPTUM VA CCN-Commercial, +121140,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,OPTUM VA CCN-Commercial, +121141,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,OPTUM VA CCN-Commercial, +121142,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,OPTUM VA CCN-Commercial, +121143,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,OPTUM VA CCN-Commercial, +121144,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,OPTUM VA CCN-Commercial, +121145,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,OPTUM VA CCN-Commercial, +121146,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,OPTUM VA CCN-Commercial, +121147,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,OPTUM VA CCN-Commercial, +121148,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,OPTUM VA CCN-Commercial, +121149,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,OPTUM VA CCN-Commercial, +121150,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,OPTUM VA CCN-Commercial, +121151,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,OPTUM VA CCN-Commercial, +121152,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,OPTUM VA CCN-Commercial, +121153,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,OPTUM VA CCN-Commercial, +121154,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,OPTUM VA CCN-Commercial, +121155,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,OPTUM VA CCN-Commercial, +121156,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,OPTUM VA CCN-Commercial, +121157,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,OPTUM VA CCN-Commercial, +121158,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,OPTUM VA CCN-Commercial, +121159,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,OPTUM VA CCN-Commercial, +121160,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,OPTUM VA CCN-Commercial, +121161,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,OPTUM VA CCN-Commercial, +121162,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,OPTUM VA CCN-Commercial, +121163,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,OPTUM VA CCN-Commercial, +121164,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,OPTUM VA CCN-Commercial, +121165,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,OPTUM VA CCN-Commercial, +121166,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,OPTUM VA CCN-Commercial, +121167,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,OPTUM VA CCN-Commercial, +121168,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,OPTUM VA CCN-Commercial, +121169,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,OPTUM VA CCN-Commercial, +121170,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,OPTUM VA CCN-Commercial, +121171,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,OPTUM VA CCN-Commercial, +121172,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,OPTUM VA CCN-Commercial, +121173,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,OPTUM VA CCN-Commercial, +121174,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,OPTUM VA CCN-Commercial, +121175,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,OPTUM VA CCN-Commercial, +121176,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,OPTUM VA CCN-Commercial, +121177,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,OPTUM VA CCN-Commercial, +121178,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,OPTUM VA CCN-Commercial, +121179,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,OPTUM VA CCN-Commercial, +121180,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,OPTUM VA CCN-Commercial, +121181,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,OPTUM VA CCN-Commercial, +121182,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,OPTUM VA CCN-Commercial, +121183,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,OPTUM VA CCN-Commercial, +121184,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,OPTUM VA CCN-Commercial, +121185,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,OPTUM VA CCN-Commercial, +121186,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,OPTUM VA CCN-Commercial, +121187,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,OPTUM VA CCN-Commercial, +121188,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,OPTUM VA CCN-Commercial, +121189,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,OPTUM VA CCN-Commercial, +121190,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,OPTUM VA CCN-Commercial, +121191,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,OPTUM VA CCN-Commercial, +121192,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,OPTUM VA CCN-Commercial, +121193,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,OPTUM VA CCN-Commercial, +121194,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,OPTUM VA CCN-Commercial, +121195,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,OPTUM VA CCN-Commercial, +121196,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,OPTUM VA CCN-Commercial, +121197,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,OPTUM VA CCN-Commercial, +121198,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,OPTUM VA CCN-Commercial, +121199,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,OPTUM VA CCN-Commercial, +121200,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,OPTUM VA CCN-Commercial, +121201,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,OPTUM VA CCN-Commercial, +121202,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,OPTUM VA CCN-Commercial, +121203,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,OPTUM VA CCN-Commercial, +121204,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,OPTUM VA CCN-Commercial, +121205,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,OPTUM VA CCN-Commercial, +121206,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,OPTUM VA CCN-Commercial, +121207,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,OPTUM VA CCN-Commercial, +121208,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,OPTUM VA CCN-Commercial, +121209,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,OPTUM VA CCN-Commercial, +121210,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,OPTUM VA CCN-Commercial, +121211,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,OPTUM VA CCN-Commercial, +121212,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,OPTUM VA CCN-Commercial, +121213,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,OPTUM VA CCN-Commercial, +121214,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,OPTUM VA CCN-Commercial, +121215,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,OPTUM VA CCN-Commercial, +121216,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,OPTUM VA CCN-Commercial, +121217,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,OPTUM VA CCN-Commercial, +121218,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,OPTUM VA CCN-Commercial, +121219,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,OPTUM VA CCN-Commercial, +121220,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,OPTUM VA CCN-Commercial, +121221,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,OPTUM VA CCN-Commercial, +121222,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,OPTUM VA CCN-Commercial, +121223,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,OPTUM VA CCN-Commercial, +121224,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,OPTUM VA CCN-Commercial, +121225,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,OPTUM VA CCN-Commercial, +121226,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,OPTUM VA CCN-Commercial, +121227,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,OPTUM VA CCN-Commercial, +121228,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,OPTUM VA CCN-Commercial, +121229,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,OPTUM VA CCN-Commercial, +121230,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,OPTUM VA CCN-Commercial, +121231,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,OPTUM VA CCN-Commercial, +121232,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,OPTUM VA CCN-Commercial, +121233,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,OPTUM VA CCN-Commercial, +121234,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,OPTUM VA CCN-Commercial, +121235,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,OPTUM VA CCN-Commercial, +121236,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,OPTUM VA CCN-Commercial, +121237,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,OPTUM VA CCN-Commercial, +121238,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,OPTUM VA CCN-Commercial, +121239,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,OPTUM VA CCN-Commercial, +121240,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,OPTUM VA CCN-Commercial, +121241,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,OPTUM VA CCN-Commercial, +121242,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,OPTUM VA CCN-Commercial, +121243,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,OPTUM VA CCN-Commercial, +121244,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,OPTUM VA CCN-Commercial, +121245,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,OPTUM VA CCN-Commercial, +121246,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,OPTUM VA CCN-Commercial, +121247,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,OPTUM VA CCN-Commercial, +121248,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,OPTUM VA CCN-Commercial, +121249,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,OPTUM VA CCN-Commercial, +121250,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,OPTUM VA CCN-Commercial, +121251,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,OPTUM VA CCN-Commercial, +121252,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,OPTUM VA CCN-Commercial, +121253,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,OPTUM VA CCN-Commercial, +121254,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,OPTUM VA CCN-Commercial, +121255,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,OPTUM VA CCN-Commercial, +121256,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,OPTUM VA CCN-Commercial, +121257,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,OPTUM VA CCN-Commercial, +121258,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,OPTUM VA CCN-Commercial, +121259,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,OPTUM VA CCN-Commercial, +121260,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,OPTUM VA CCN-Commercial, +121261,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,OPTUM VA CCN-Commercial, +121262,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,OPTUM VA CCN-Commercial, +121263,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,OPTUM VA CCN-Commercial, +121264,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,OPTUM VA CCN-Commercial, +121265,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,OPTUM VA CCN-Commercial, +121266,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,OPTUM VA CCN-Commercial, +121267,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,OPTUM VA CCN-Commercial, +121268,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,OPTUM VA CCN-Commercial, +121269,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,OPTUM VA CCN-Commercial, +121270,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,OPTUM VA CCN-Commercial, +121271,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,OPTUM VA CCN-Commercial, +121272,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,OPTUM VA CCN-Commercial, +121273,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,OPTUM VA CCN-Commercial, +121274,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,OPTUM VA CCN-Commercial, +121275,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,OPTUM VA CCN-Commercial, +121276,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,OPTUM VA CCN-Commercial, +121277,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,OPTUM VA CCN-Commercial, +121278,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,OPTUM VA CCN-Commercial, +121279,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,OPTUM VA CCN-Commercial, +121280,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,OPTUM VA CCN-Commercial, +121281,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,OPTUM VA CCN-Commercial, +121282,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,OPTUM VA CCN-Commercial, +121283,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,OPTUM VA CCN-Commercial, +121284,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,OPTUM VA CCN-Commercial, +121285,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,OPTUM VA CCN-Commercial, +121286,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,OPTUM VA CCN-Commercial, +121287,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,OPTUM VA CCN-Commercial, +121288,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,OPTUM VA CCN-Commercial, +121289,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,OPTUM VA CCN-Commercial, +121290,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,OPTUM VA CCN-Commercial, +121291,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,OPTUM VA CCN-Commercial, +121292,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,OPTUM VA CCN-Commercial, +121293,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,OPTUM VA CCN-Commercial, +121294,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,OPTUM VA CCN-Commercial, +121295,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,OPTUM VA CCN-Commercial, +121296,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,OPTUM VA CCN-Commercial, +121297,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,OPTUM VA CCN-Commercial, +121298,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,OPTUM VA CCN-Commercial, +121299,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,OPTUM VA CCN-Commercial, +121300,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,OPTUM VA CCN-Commercial, +121301,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,OPTUM VA CCN-Commercial, +121302,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,OPTUM VA CCN-Commercial, +121303,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,OPTUM VA CCN-Commercial, +121304,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,OPTUM VA CCN-Commercial, +121305,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,OPTUM VA CCN-Commercial, +121306,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,OPTUM VA CCN-Commercial, +121307,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,OPTUM VA CCN-Commercial, +121308,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,OPTUM VA CCN-Commercial, +121309,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,OPTUM VA CCN-Commercial, +121310,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,OPTUM VA CCN-Commercial, +121311,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,OPTUM VA CCN-Commercial, +121312,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,OPTUM VA CCN-Commercial, +121313,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,OPTUM VA CCN-Commercial, +121314,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,OPTUM VA CCN-Commercial, +121315,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,OPTUM VA CCN-Commercial, +121316,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,OPTUM VA CCN-Commercial, +121317,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,OPTUM VA CCN-Commercial, +121318,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,OPTUM VA CCN-Commercial, +121319,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,OPTUM VA CCN-Commercial, +121320,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,OPTUM VA CCN-Commercial, +121321,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,OPTUM VA CCN-Commercial, +121322,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,OPTUM VA CCN-Commercial, +121323,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,OPTUM VA CCN-Commercial, +121324,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,OPTUM VA CCN-Commercial, +121325,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,OPTUM VA CCN-Commercial, +121326,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,OPTUM VA CCN-Commercial, +121327,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,OPTUM VA CCN-Commercial, +121328,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,OPTUM VA CCN-Commercial, +121329,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,OPTUM VA CCN-Commercial, +121330,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,OPTUM VA CCN-Commercial, +121331,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,OPTUM VA CCN-Commercial, +121332,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,OPTUM VA CCN-Commercial, +121333,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,OPTUM VA CCN-Commercial, +121334,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,OPTUM VA CCN-Commercial, +121335,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,OPTUM VA CCN-Commercial, +121336,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,OPTUM VA CCN-Commercial, +121337,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,OPTUM VA CCN-Commercial, +121338,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,OPTUM VA CCN-Commercial, +121339,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,OPTUM VA CCN-Commercial, +121340,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,OPTUM VA CCN-Commercial, +121341,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,OPTUM VA CCN-Commercial, +121342,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,OPTUM VA CCN-Commercial, +121343,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,OPTUM VA CCN-Commercial, +121344,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,OPTUM VA CCN-Commercial, +121345,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,OPTUM VA CCN-Commercial, +121346,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,OPTUM VA CCN-Commercial, +121347,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,OPTUM VA CCN-Commercial, +121348,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,OPTUM VA CCN-Commercial, +121349,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,OPTUM VA CCN-Commercial, +121350,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,OPTUM VA CCN-Commercial, +121351,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,OPTUM VA CCN-Commercial, +121352,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,OPTUM VA CCN-Commercial, +121353,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,OPTUM VA CCN-Commercial, +121354,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,OPTUM VA CCN-Commercial, +121355,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,OPTUM VA CCN-Commercial, +121356,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,OPTUM VA CCN-Commercial, +121357,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,OPTUM VA CCN-Commercial, +121358,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,OPTUM VA CCN-Commercial, +121359,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,OPTUM VA CCN-Commercial, +121360,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,OPTUM VA CCN-Commercial, +121361,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,OPTUM VA CCN-Commercial, +121362,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,OPTUM VA CCN-Commercial, +121363,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,OPTUM VA CCN-Commercial, +121364,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,OPTUM VA CCN-Commercial, +121365,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,OPTUM VA CCN-Commercial, +121366,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,OPTUM VA CCN-Commercial, +121367,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,OPTUM VA CCN-Commercial, +121368,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,OPTUM VA CCN-Commercial, +121369,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,OPTUM VA CCN-Commercial, +121370,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,OPTUM VA CCN-Commercial, +121371,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,OPTUM VA CCN-Commercial, +121372,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,OPTUM VA CCN-Commercial, +121373,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,OPTUM VA CCN-Commercial, +121374,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,OPTUM VA CCN-Commercial, +121375,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,OPTUM VA CCN-Commercial, +121376,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,OPTUM VA CCN-Commercial, +121377,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,OPTUM VA CCN-Commercial, +121378,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,OPTUM VA CCN-Commercial, +121379,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,OPTUM VA CCN-Commercial, +121380,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,OPTUM VA CCN-Commercial, +121381,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,OPTUM VA CCN-Commercial, +121382,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,OPTUM VA CCN-Commercial, +121383,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,OPTUM VA CCN-Commercial, +121384,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,OPTUM VA CCN-Commercial, +121385,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,OPTUM VA CCN-Commercial, +121386,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,OPTUM VA CCN-Commercial, +121387,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,OPTUM VA CCN-Commercial, +121388,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,OPTUM VA CCN-Commercial, +121389,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,OPTUM VA CCN-Commercial, +121390,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,OPTUM VA CCN-Commercial, +121391,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,OPTUM VA CCN-Commercial, +121392,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,OPTUM VA CCN-Commercial, +121393,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,OPTUM VA CCN-Commercial, +121394,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,OPTUM VA CCN-Commercial, +121395,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,OPTUM VA CCN-Commercial, +121396,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,OPTUM VA CCN-Commercial, +121397,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,OPTUM VA CCN-Commercial, +121398,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,OPTUM VA CCN-Commercial, +121399,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,OPTUM VA CCN-Commercial, +121400,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,OPTUM VA CCN-Commercial, +121401,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,OPTUM VA CCN-Commercial, +121402,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,OPTUM VA CCN-Commercial, +121403,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,OPTUM VA CCN-Commercial, +121404,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,OPTUM VA CCN-Commercial, +121405,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,OPTUM VA CCN-Commercial, +121406,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,OPTUM VA CCN-Commercial, +121407,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,OPTUM VA CCN-Commercial, +121408,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,OPTUM VA CCN-Commercial, +121409,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,OPTUM VA CCN-Commercial, +121410,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,OPTUM VA CCN-Commercial, +121411,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,OPTUM VA CCN-Commercial, +121412,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,OPTUM VA CCN-Commercial, +121413,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,OPTUM VA CCN-Commercial, +121414,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,OPTUM VA CCN-Commercial, +121415,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,OPTUM VA CCN-Commercial, +121416,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,OPTUM VA CCN-Commercial, +121417,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,OPTUM VA CCN-Commercial, +121418,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,OPTUM VA CCN-Commercial, +121419,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,OPTUM VA CCN-Commercial, +121420,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,OPTUM VA CCN-Commercial, +121421,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,OPTUM VA CCN-Commercial, +121422,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,OPTUM VA CCN-Commercial, +121423,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,OPTUM VA CCN-Commercial, +121424,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,OPTUM VA CCN-Commercial, +121425,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,OPTUM VA CCN-Commercial, +121426,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,OPTUM VA CCN-Commercial, +121427,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,OPTUM VA CCN-Commercial, +121428,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,OPTUM VA CCN-Commercial, +121429,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,OPTUM VA CCN-Commercial, +121430,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,OPTUM VA CCN-Commercial, +121431,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,OPTUM VA CCN-Commercial, +121432,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,OPTUM VA CCN-Commercial, +121433,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,OPTUM VA CCN-Commercial, +121434,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,OPTUM VA CCN-Commercial, +121435,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,OPTUM VA CCN-Commercial, +121436,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,OPTUM VA CCN-Commercial, +121437,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,OPTUM VA CCN-Commercial, +121438,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,OPTUM VA CCN-Commercial, +121439,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,OPTUM VA CCN-Commercial, +121440,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,OPTUM VA CCN-Commercial, +121441,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,OPTUM VA CCN-Commercial, +121442,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,OPTUM VA CCN-Commercial, +121443,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,OPTUM VA CCN-Commercial, +121444,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,OPTUM VA CCN-Commercial, +121445,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,OPTUM VA CCN-Commercial, +121446,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,OPTUM VA CCN-Commercial, +121447,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,OPTUM VA CCN-Commercial, +121448,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,OPTUM VA CCN-Commercial, +121449,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,OPTUM VA CCN-Commercial, +121450,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,OPTUM VA CCN-Commercial, +121451,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,OPTUM VA CCN-Commercial, +121452,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,OPTUM VA CCN-Commercial, +121453,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,OPTUM VA CCN-Commercial, +121454,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,OPTUM VA CCN-Commercial, +121455,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,OPTUM VA CCN-Commercial, +121456,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,OPTUM VA CCN-Commercial, +121457,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,OPTUM VA CCN-Commercial, +121458,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,OPTUM VA CCN-Commercial, +121459,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,OPTUM VA CCN-Commercial, +121460,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,OPTUM VA CCN-Commercial, +121461,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,OPTUM VA CCN-Commercial, +121462,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,OPTUM VA CCN-Commercial, +121463,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,OPTUM VA CCN-Commercial, +121464,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,OPTUM VA CCN-Commercial, +121465,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,OPTUM VA CCN-Commercial, +121466,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,OPTUM VA CCN-Commercial, +121467,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,OPTUM VA CCN-Commercial, +121468,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,OPTUM VA CCN-Commercial, +121469,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,OPTUM VA CCN-Commercial, +121470,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,OPTUM VA CCN-Commercial, +121471,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,OPTUM VA CCN-Commercial, +121472,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,OPTUM VA CCN-Commercial, +121473,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,OPTUM VA CCN-Commercial, +121474,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,OPTUM VA CCN-Commercial, +121475,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,OPTUM VA CCN-Commercial, +121476,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,OPTUM VA CCN-Commercial, +121477,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,OPTUM VA CCN-Commercial, +121478,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,OPTUM VA CCN-Commercial, +121479,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,OPTUM VA CCN-Commercial, +121480,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,OPTUM VA CCN-Commercial, +121481,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,OPTUM VA CCN-Commercial, +121482,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,OPTUM VA CCN-Commercial, +121483,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,OPTUM VA CCN-Commercial, +121484,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,OPTUM VA CCN-Commercial, +121485,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,OPTUM VA CCN-Commercial, +121486,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,OPTUM VA CCN-Commercial, +121487,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,OPTUM VA CCN-Commercial, +121488,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,OPTUM VA CCN-Commercial, +121489,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,OPTUM VA CCN-Commercial, +121490,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,OPTUM VA CCN-Commercial, +121491,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,OPTUM VA CCN-Commercial, +121492,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,OPTUM VA CCN-Commercial, +121493,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,OPTUM VA CCN-Commercial, +121494,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,OPTUM VA CCN-Commercial, +121495,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,OPTUM VA CCN-Commercial, +121496,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,OPTUM VA CCN-Commercial, +121497,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,OPTUM VA CCN-Commercial, +121498,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,OPTUM VA CCN-Commercial, +121499,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,OPTUM VA CCN-Commercial, +121500,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,OPTUM VA CCN-Commercial, +121501,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,OPTUM VA CCN-Commercial, +121502,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,OPTUM VA CCN-Commercial, +121503,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,OPTUM VA CCN-Commercial, +121504,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,OPTUM VA CCN-Commercial, +121505,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,OPTUM VA CCN-Commercial, +121506,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,OPTUM VA CCN-Commercial, +121507,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,OPTUM VA CCN-Commercial, +121508,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,OPTUM VA CCN-Commercial, +121509,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,OPTUM VA CCN-Commercial, +121510,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,OPTUM VA CCN-Commercial, +121511,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,OPTUM VA CCN-Commercial, +121512,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,OPTUM VA CCN-Commercial, +121513,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,OPTUM VA CCN-Commercial, +121514,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,OPTUM VA CCN-Commercial, +121515,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,OPTUM VA CCN-Commercial, +121516,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,OPTUM VA CCN-Commercial, +121517,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,OPTUM VA CCN-Commercial, +121518,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,OPTUM VA CCN-Commercial, +121519,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,OPTUM VA CCN-Commercial, +121520,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,OPTUM VA CCN-Commercial, +121521,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,OPTUM VA CCN-Commercial, +121522,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,OPTUM VA CCN-Commercial, +121523,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,OPTUM VA CCN-Commercial, +121524,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,OPTUM VA CCN-Commercial, +121525,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,OPTUM VA CCN-Commercial, +121526,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,OPTUM VA CCN-Commercial, +121527,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,OPTUM VA CCN-Commercial, +121528,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,OPTUM VA CCN-Commercial, +121529,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,OPTUM VA CCN-Commercial, +121530,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,OPTUM VA CCN-Commercial, +121531,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,OPTUM VA CCN-Commercial, +121532,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,OPTUM VA CCN-Commercial, +121533,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,OPTUM VA CCN-Commercial, +121534,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,OPTUM VA CCN-Commercial, +121535,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,OPTUM VA CCN-Commercial, +121536,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,OPTUM VA CCN-Commercial, +121537,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,OPTUM VA CCN-Commercial, +121538,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,OPTUM VA CCN-Commercial, +121539,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,OPTUM VA CCN-Commercial, +121540,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,OPTUM VA CCN-Commercial, +121541,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,OPTUM VA CCN-Commercial, +121542,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,OPTUM VA CCN-Commercial, +121543,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,OPTUM VA CCN-Commercial, +121544,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,OPTUM VA CCN-Commercial, +121545,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,OPTUM VA CCN-Commercial, +121546,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,OPTUM VA CCN-Commercial, +121547,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,OPTUM VA CCN-Commercial, +121548,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,OPTUM VA CCN-Commercial, +121549,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,OPTUM VA CCN-Commercial, +121550,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,OPTUM VA CCN-Commercial, +121551,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,OPTUM VA CCN-Commercial, +121552,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,OPTUM VA CCN-Commercial, +121553,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,OPTUM VA CCN-Commercial, +121554,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,OPTUM VA CCN-Commercial, +121555,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,OPTUM VA CCN-Commercial, +121556,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,OPTUM VA CCN-Commercial, +121557,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,OPTUM VA CCN-Commercial, +121558,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,OPTUM VA CCN-Commercial, +121559,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,OPTUM VA CCN-Commercial, +121560,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,OPTUM VA CCN-Commercial, +121561,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,OPTUM VA CCN-Commercial, +121562,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,OPTUM VA CCN-Commercial, +121563,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,OPTUM VA CCN-Commercial, +121564,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,OPTUM VA CCN-Commercial, +121565,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,OPTUM VA CCN-Commercial, +121566,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,OPTUM VA CCN-Commercial, +121567,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,OPTUM VA CCN-Commercial, +121568,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,OPTUM VA CCN-Commercial, +121569,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,OPTUM VA CCN-Commercial, +121570,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,OPTUM VA CCN-Commercial, +121571,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,OPTUM VA CCN-Commercial, +121572,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,OPTUM VA CCN-Commercial, +121573,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,OPTUM VA CCN-Commercial, +121574,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,OPTUM VA CCN-Commercial, +121575,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,OPTUM VA CCN-Commercial, +121576,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,OPTUM VA CCN-Commercial, +121577,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,OPTUM VA CCN-Commercial, +121578,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,OPTUM VA CCN-Commercial, +121579,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,OPTUM VA CCN-Commercial, +121580,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,OPTUM VA CCN-Commercial, +121581,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,OPTUM VA CCN-Commercial, +121582,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,OPTUM VA CCN-Commercial, +121583,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,OPTUM VA CCN-Commercial, +121584,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,OPTUM VA CCN-Commercial, +121585,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,OPTUM VA CCN-Commercial, +121586,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,OPTUM VA CCN-Commercial, +121587,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,OPTUM VA CCN-Commercial, +121588,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,OPTUM VA CCN-Commercial, +121589,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,OPTUM VA CCN-Commercial, +121590,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,OPTUM VA CCN-Commercial, +121591,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,OPTUM VA CCN-Commercial, +121592,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,OPTUM VA CCN-Commercial, +121593,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,OPTUM VA CCN-Commercial, +121594,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,OPTUM VA CCN-Commercial, +121595,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,OPTUM VA CCN-Commercial, +121596,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,OPTUM VA CCN-Commercial, +121597,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,OPTUM VA CCN-Commercial, +121598,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,OPTUM VA CCN-Commercial, +121599,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,OPTUM VA CCN-Commercial, +121600,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,OPTUM VA CCN-Commercial, +121601,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,OPTUM VA CCN-Commercial, +121602,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,OPTUM VA CCN-Commercial, +121603,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,OPTUM VA CCN-Commercial, +121604,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,OPTUM VA CCN-Commercial, +121605,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,OPTUM VA CCN-Commercial, +121606,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,OPTUM VA CCN-Commercial, +121607,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,OPTUM VA CCN-Commercial, +121608,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,OPTUM VA CCN-Commercial, +121609,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,OPTUM VA CCN-Commercial, +121610,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,OPTUM VA CCN-Commercial, +121611,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,OPTUM VA CCN-Commercial, +121612,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,OPTUM VA CCN-Commercial, +121613,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,OPTUM VA CCN-Commercial, +121614,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,OPTUM VA CCN-Commercial, +121615,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,OPTUM VA CCN-Commercial, +121616,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,OPTUM VA CCN-Commercial, +121617,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,OPTUM VA CCN-Commercial, +121618,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,OPTUM VA CCN-Commercial, +121619,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,OPTUM VA CCN-Commercial, +121620,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,OPTUM VA CCN-Commercial, +121621,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,OPTUM VA CCN-Commercial, +121622,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,OPTUM VA CCN-Commercial, +121623,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,OPTUM VA CCN-Commercial, +121624,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,OPTUM VA CCN-Commercial, +121625,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,OPTUM VA CCN-Commercial, +121626,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,OPTUM VA CCN-Commercial, +121627,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,OPTUM VA CCN-Commercial, +121628,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,OPTUM VA CCN-Commercial, +121629,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,OPTUM VA CCN-Commercial, +121630,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,OPTUM VA CCN-Commercial, +121631,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,OPTUM VA CCN-Commercial, +121632,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,OPTUM VA CCN-Commercial, +121633,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,OPTUM VA CCN-Commercial, +121634,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,OPTUM VA CCN-Commercial, +121635,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,OPTUM VA CCN-Commercial, +121636,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,OPTUM VA CCN-Commercial, +121637,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,OPTUM VA CCN-Commercial, +121638,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,OPTUM VA CCN-Commercial, +121639,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,OPTUM VA CCN-Commercial, +121640,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,OPTUM VA CCN-Commercial, +121641,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,OPTUM VA CCN-Commercial, +121642,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,OPTUM VA CCN-Commercial, +121643,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,OPTUM VA CCN-Commercial, +121644,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,OPTUM VA CCN-Commercial, +121645,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,OPTUM VA CCN-Commercial, +121646,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,OPTUM VA CCN-Commercial, +121647,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,OPTUM VA CCN-Commercial, +121648,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,OPTUM VA CCN-Commercial, +121649,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,OPTUM VA CCN-Commercial, +121650,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,OPTUM VA CCN-Commercial, +121651,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,OPTUM VA CCN-Commercial, +121652,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,OPTUM VA CCN-Commercial, +121653,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,OPTUM VA CCN-Commercial, +121654,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,OPTUM VA CCN-Commercial, +121655,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,OPTUM VA CCN-Commercial, +121656,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,OPTUM VA CCN-Commercial, +121657,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,OPTUM VA CCN-Commercial, +121658,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,OPTUM VA CCN-Commercial, +121659,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,OPTUM VA CCN-Commercial, +121660,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,OPTUM VA CCN-Commercial, +121661,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,OPTUM VA CCN-Commercial, +121662,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,OPTUM VA CCN-Commercial, +121663,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,OPTUM VA CCN-Commercial, +121664,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,OPTUM VA CCN-Commercial, +121665,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,OPTUM VA CCN-Commercial, +121666,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,OPTUM VA CCN-Commercial, +121667,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,OPTUM VA CCN-Commercial, +121668,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,OPTUM VA CCN-Commercial, +121669,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,OPTUM VA CCN-Commercial, +121670,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,OPTUM VA CCN-Commercial, +121671,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,OPTUM VA CCN-Commercial, +121672,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,OPTUM VA CCN-Commercial, +121673,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,OPTUM VA CCN-Commercial, +121674,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,OPTUM VA CCN-Commercial, +121675,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,OPTUM VA CCN-Commercial, +121676,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,OPTUM VA CCN-Commercial, +121677,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +121678,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,OPTUM VA CCN-Commercial, +121679,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,OPTUM VA CCN-Commercial, +121680,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,OPTUM VA CCN-Commercial, +121681,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,OPTUM VA CCN-Commercial, +121682,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,OPTUM VA CCN-Commercial, +121683,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,OPTUM VA CCN-Commercial, +121684,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,OPTUM VA CCN-Commercial, +121685,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,OPTUM VA CCN-Commercial, +121686,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,OPTUM VA CCN-Commercial, +121687,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,OPTUM VA CCN-Commercial, +121688,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,OPTUM VA CCN-Commercial, +121689,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,OPTUM VA CCN-Commercial, +121690,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,OPTUM VA CCN-Commercial, +121691,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,OPTUM VA CCN-Commercial, +121692,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,OPTUM VA CCN-Commercial, +121693,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,OPTUM VA CCN-Commercial, +121694,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,OPTUM VA CCN-Commercial, +121695,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,OPTUM VA CCN-Commercial, +121696,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,OPTUM VA CCN-Commercial, +121697,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,OPTUM VA CCN-Commercial, +121698,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,OPTUM VA CCN-Commercial, +121699,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,OPTUM VA CCN-Commercial, +121700,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,OPTUM VA CCN-Commercial, +121701,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,OPTUM VA CCN-Commercial, +121702,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,OPTUM VA CCN-Commercial, +121703,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,OPTUM VA CCN-Commercial, +121704,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,OPTUM VA CCN-Commercial, +121705,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,OPTUM VA CCN-Commercial, +121706,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,OPTUM VA CCN-Commercial, +121707,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,OPTUM VA CCN-Commercial, +121708,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,OPTUM VA CCN-Commercial, +121709,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,OPTUM VA CCN-Commercial, +121710,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,OPTUM VA CCN-Commercial, +121711,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,OPTUM VA CCN-Commercial, +121712,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,OPTUM VA CCN-Commercial, +121713,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,OPTUM VA CCN-Commercial, +121714,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,OPTUM VA CCN-Commercial, +121715,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,OPTUM VA CCN-Commercial, +121716,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,OPTUM VA CCN-Commercial, +121717,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,OPTUM VA CCN-Commercial, +121718,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,OPTUM VA CCN-Commercial, +121719,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,OPTUM VA CCN-Commercial, +121720,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,OPTUM VA CCN-Commercial, +121721,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,OPTUM VA CCN-Commercial, +121722,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,OPTUM VA CCN-Commercial, +121723,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,OPTUM VA CCN-Commercial, +121724,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,OPTUM VA CCN-Commercial, +121725,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,OPTUM VA CCN-Commercial, +121726,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,OPTUM VA CCN-Commercial, +121727,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,OPTUM VA CCN-Commercial, +121728,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,OPTUM VA CCN-Commercial, +121729,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,OPTUM VA CCN-Commercial, +121730,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,OPTUM VA CCN-Commercial, +121731,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,OPTUM VA CCN-Commercial, +121732,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,OPTUM VA CCN-Commercial, +121733,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,OPTUM VA CCN-Commercial, +121734,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,OPTUM VA CCN-Commercial, +121735,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,OPTUM VA CCN-Commercial, +121736,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,OPTUM VA CCN-Commercial, +121737,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,OPTUM VA CCN-Commercial, +121738,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,OPTUM VA CCN-Commercial, +121739,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,OPTUM VA CCN-Commercial, +121740,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,OPTUM VA CCN-Commercial, +121741,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,OPTUM VA CCN-Commercial, +121742,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,OPTUM VA CCN-Commercial, +121743,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,OPTUM VA CCN-Commercial, +121744,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,OPTUM VA CCN-Commercial, +121745,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,OPTUM VA CCN-Commercial, +121746,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,OPTUM VA CCN-Commercial, +121747,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,OPTUM VA CCN-Commercial, +121748,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,OPTUM VA CCN-Commercial, +121749,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,OPTUM VA CCN-Commercial, +121750,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,OPTUM VA CCN-Commercial, +121751,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,OPTUM VA CCN-Commercial, +121752,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,OPTUM VA CCN-Commercial, +121753,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,OPTUM VA CCN-Commercial, +121754,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,OPTUM VA CCN-Commercial, +121755,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,OPTUM VA CCN-Commercial, +121756,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,OPTUM VA CCN-Commercial, +121757,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,OPTUM VA CCN-Commercial, +121758,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,OPTUM VA CCN-Commercial, +121759,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,OPTUM VA CCN-Commercial, +121760,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,OPTUM VA CCN-Commercial, +121761,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,OPTUM VA CCN-Commercial, +121762,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,OPTUM VA CCN-Commercial, +121763,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,OPTUM VA CCN-Commercial, +121764,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,OPTUM VA CCN-Commercial, +121765,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,OPTUM VA CCN-Commercial, +121766,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,OPTUM VA CCN-Commercial, +121767,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,OPTUM VA CCN-Commercial, +121768,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,OPTUM VA CCN-Commercial, +121769,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,OPTUM VA CCN-Commercial, +121770,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,OPTUM VA CCN-Commercial, +121771,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,OPTUM VA CCN-Commercial, +121772,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,OPTUM VA CCN-Commercial, +121773,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,OPTUM VA CCN-Commercial, +121774,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,OPTUM VA CCN-Commercial, +121775,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,OPTUM VA CCN-Commercial, +121776,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,OPTUM VA CCN-Commercial, +121777,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,OPTUM VA CCN-Commercial, +121778,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,OPTUM VA CCN-Commercial, +121779,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,OPTUM VA CCN-Commercial, +121780,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,OPTUM VA CCN-Commercial, +121781,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,OPTUM VA CCN-Commercial, +121782,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,OPTUM VA CCN-Commercial, +121783,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,OPTUM VA CCN-Commercial, +121784,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,OPTUM VA CCN-Commercial, +121785,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,OPTUM VA CCN-Commercial, +121786,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,OPTUM VA CCN-Commercial, +121787,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,OPTUM VA CCN-Commercial, +121788,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,OPTUM VA CCN-Commercial, +121789,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,OPTUM VA CCN-Commercial, +121790,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,OPTUM VA CCN-Commercial, +121791,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,OPTUM VA CCN-Commercial, +121792,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,OPTUM VA CCN-Commercial, +121793,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,OPTUM VA CCN-Commercial, +121794,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,OPTUM VA CCN-Commercial, +121795,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,OPTUM VA CCN-Commercial, +121796,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,OPTUM VA CCN-Commercial, +121797,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,OPTUM VA CCN-Commercial, +121798,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,OPTUM VA CCN-Commercial, +121799,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,OPTUM VA CCN-Commercial, +121800,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,OPTUM VA CCN-Commercial, +121801,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,OPTUM VA CCN-Commercial, +121802,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,OPTUM VA CCN-Commercial, +121803,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,OPTUM VA CCN-Commercial, +121804,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,OPTUM VA CCN-Commercial, +121805,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,OPTUM VA CCN-Commercial, +121806,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,OPTUM VA CCN-Commercial, +121807,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,OPTUM VA CCN-Commercial, +121808,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,OPTUM VA CCN-Commercial, +121809,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,OPTUM VA CCN-Commercial, +121810,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,OPTUM VA CCN-Commercial, +121811,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,OPTUM VA CCN-Commercial, +121812,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,OPTUM VA CCN-Commercial, +121813,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,OPTUM VA CCN-Commercial, +121814,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,OPTUM VA CCN-Commercial, +121815,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,OPTUM VA CCN-Commercial, +121816,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,OPTUM VA CCN-Commercial, +121817,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,OPTUM VA CCN-Commercial, +121818,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,OPTUM VA CCN-Commercial, +121819,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,OPTUM VA CCN-Commercial, +121820,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,OPTUM VA CCN-Commercial, +121821,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,OPTUM VA CCN-Commercial, +121822,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,OPTUM VA CCN-Commercial, +121823,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,OPTUM VA CCN-Commercial, +121824,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,OPTUM VA CCN-Commercial, +121825,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,OPTUM VA CCN-Commercial, +121826,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,OPTUM VA CCN-Commercial, +121827,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,OPTUM VA CCN-Commercial, +121828,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,OPTUM VA CCN-Commercial, +121829,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,OPTUM VA CCN-Commercial, +121830,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,OPTUM VA CCN-Commercial, +121831,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,OPTUM VA CCN-Commercial, +121832,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,OPTUM VA CCN-Commercial, +121833,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,OPTUM VA CCN-Commercial, +121834,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,OPTUM VA CCN-Commercial, +121835,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,OPTUM VA CCN-Commercial, +121836,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,OPTUM VA CCN-Commercial, +121837,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,OPTUM VA CCN-Commercial, +121838,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,OPTUM VA CCN-Commercial, +121839,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,OPTUM VA CCN-Commercial, +121840,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,OPTUM VA CCN-Commercial, +121841,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,OPTUM VA CCN-Commercial, +121842,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,OPTUM VA CCN-Commercial, +121843,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,OPTUM VA CCN-Commercial, +121844,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,OPTUM VA CCN-Commercial, +121845,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,OPTUM VA CCN-Commercial, +121846,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,OPTUM VA CCN-Commercial, +121847,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,OPTUM VA CCN-Commercial, +121848,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,OPTUM VA CCN-Commercial, +121849,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,OPTUM VA CCN-Commercial, +121850,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,OPTUM VA CCN-Commercial, +121851,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,OPTUM VA CCN-Commercial, +121852,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,OPTUM VA CCN-Commercial, +121853,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,OPTUM VA CCN-Commercial, +121854,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,OPTUM VA CCN-Commercial, +121855,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,OPTUM VA CCN-Commercial, +121856,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,OPTUM VA CCN-Commercial, +121857,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,OPTUM VA CCN-Commercial, +121858,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,OPTUM VA CCN-Commercial, +121859,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,OPTUM VA CCN-Commercial, +121860,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,OPTUM VA CCN-Commercial, +121861,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,OPTUM VA CCN-Commercial, +121862,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,OPTUM VA CCN-Commercial, +121863,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,OPTUM VA CCN-Commercial, +121864,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,OPTUM VA CCN-Commercial, +121865,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,OPTUM VA CCN-Commercial, +121866,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,OPTUM VA CCN-Commercial, +121867,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,OPTUM VA CCN-Commercial, +121868,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,OPTUM VA CCN-Commercial, +121869,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,OPTUM VA CCN-Commercial, +121870,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,OPTUM VA CCN-Commercial, +121871,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,OPTUM VA CCN-Commercial, +121872,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,OPTUM VA CCN-Commercial, +121873,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,OPTUM VA CCN-Commercial, +121874,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,OPTUM VA CCN-Commercial, +121875,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,OPTUM VA CCN-Commercial, +121876,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,OPTUM VA CCN-Commercial, +121877,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,OPTUM VA CCN-Commercial, +121878,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,OPTUM VA CCN-Commercial, +121879,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,OPTUM VA CCN-Commercial, +121880,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,OPTUM VA CCN-Commercial, +121881,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,OPTUM VA CCN-Commercial, +121882,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,OPTUM VA CCN-Commercial, +121883,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,OPTUM VA CCN-Commercial, +121884,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,OPTUM VA CCN-Commercial, +121885,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,OPTUM VA CCN-Commercial, +121886,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,OPTUM VA CCN-Commercial, +121887,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,OPTUM VA CCN-Commercial, +121888,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,OPTUM VA CCN-Commercial, +121889,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,OPTUM VA CCN-Commercial, +121890,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,OPTUM VA CCN-Commercial, +121891,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,OPTUM VA CCN-Commercial, +121892,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,OPTUM VA CCN-Commercial, +121893,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,OPTUM VA CCN-Commercial, +121894,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,OPTUM VA CCN-Commercial, +121895,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,OPTUM VA CCN-Commercial, +121896,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,OPTUM VA CCN-Commercial, +121897,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,OPTUM VA CCN-Commercial, +121898,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,OPTUM VA CCN-Commercial, +121899,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,OPTUM VA CCN-Commercial, +121900,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,OPTUM VA CCN-Commercial, +121901,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,OPTUM VA CCN-Commercial, +121902,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,OPTUM VA CCN-Commercial, +121903,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,OPTUM VA CCN-Commercial, +121904,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,OPTUM VA CCN-Commercial, +121905,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,OPTUM VA CCN-Commercial, +121906,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,OPTUM VA CCN-Commercial, +121907,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,OPTUM VA CCN-Commercial, +121908,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,OPTUM VA CCN-Commercial, +121909,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,OPTUM VA CCN-Commercial, +121910,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,OPTUM VA CCN-Commercial, +121911,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,OPTUM VA CCN-Commercial, +121912,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,OPTUM VA CCN-Commercial, +121913,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,OPTUM VA CCN-Commercial, +121914,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,OPTUM VA CCN-Commercial, +121915,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,OPTUM VA CCN-Commercial, +121916,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,OPTUM VA CCN-Commercial, +121917,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,OPTUM VA CCN-Commercial, +121918,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,OPTUM VA CCN-Commercial, +121919,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,OPTUM VA CCN-Commercial, +121920,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,OPTUM VA CCN-Commercial, +121921,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,OPTUM VA CCN-Commercial, +121922,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,OPTUM VA CCN-Commercial, +121923,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,OPTUM VA CCN-Commercial, +121924,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,OPTUM VA CCN-Commercial, +121925,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,OPTUM VA CCN-Commercial, +121926,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,OPTUM VA CCN-Commercial, +121927,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,OPTUM VA CCN-Commercial, +121928,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,OPTUM VA CCN-Commercial, +121929,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,OPTUM VA CCN-Commercial, +121930,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,OPTUM VA CCN-Commercial, +121931,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,OPTUM VA CCN-Commercial, +121932,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,OPTUM VA CCN-Commercial, +121933,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,OPTUM VA CCN-Commercial, +121934,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,OPTUM VA CCN-Commercial, +121935,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,OPTUM VA CCN-Commercial, +121936,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,OPTUM VA CCN-Commercial, +121937,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,OPTUM VA CCN-Commercial, +121938,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,OPTUM VA CCN-Commercial, +121939,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,OPTUM VA CCN-Commercial, +121940,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,OPTUM VA CCN-Commercial, +121941,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,OPTUM VA CCN-Commercial, +121942,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,OPTUM VA CCN-Commercial, +121943,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,OPTUM VA CCN-Commercial, +121944,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,OPTUM VA CCN-Commercial, +121945,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,OPTUM VA CCN-Commercial, +121946,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,OPTUM VA CCN-Commercial, +121947,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,OPTUM VA CCN-Commercial, +121948,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,OPTUM VA CCN-Commercial, +121949,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,OPTUM VA CCN-Commercial, +121950,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,OPTUM VA CCN-Commercial, +121951,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,OPTUM VA CCN-Commercial, +121952,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,OPTUM VA CCN-Commercial, +121953,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,OPTUM VA CCN-Commercial, +121954,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,OPTUM VA CCN-Commercial, +121955,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,OPTUM VA CCN-Commercial, +121956,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,OPTUM VA CCN-Commercial, +121957,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,OPTUM VA CCN-Commercial, +121958,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,OPTUM VA CCN-Commercial, +121959,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,OPTUM VA CCN-Commercial, +121960,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,OPTUM VA CCN-Commercial, +121961,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,OPTUM VA CCN-Commercial, +121962,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,OPTUM VA CCN-Commercial, +121963,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,OPTUM VA CCN-Commercial, +121964,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,OPTUM VA CCN-Commercial, +121965,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,OPTUM VA CCN-Commercial, +121966,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,OPTUM VA CCN-Commercial, +121967,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,OPTUM VA CCN-Commercial, +121968,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,OPTUM VA CCN-Commercial, +121969,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,OPTUM VA CCN-Commercial, +121970,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,OPTUM VA CCN-Commercial, +121971,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,OPTUM VA CCN-Commercial, +121972,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,OPTUM VA CCN-Commercial, +121973,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,OPTUM VA CCN-Commercial, +121974,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,OPTUM VA CCN-Commercial, +121975,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,OPTUM VA CCN-Commercial, +121976,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,OPTUM VA CCN-Commercial, +121977,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,OPTUM VA CCN-Commercial, +121978,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,OPTUM VA CCN-Commercial, +121979,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,OPTUM VA CCN-Commercial, +121980,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,OPTUM VA CCN-Commercial, +121981,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,OPTUM VA CCN-Commercial, +121982,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,OPTUM VA CCN-Commercial, +121983,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,OPTUM VA CCN-Commercial, +121984,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,OPTUM VA CCN-Commercial, +121985,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,OPTUM VA CCN-Commercial, +121986,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,OPTUM VA CCN-Commercial, +121987,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,OPTUM VA CCN-Commercial, +121988,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,OPTUM VA CCN-Commercial, +121989,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,OPTUM VA CCN-Commercial, +121990,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,OPTUM VA CCN-Commercial, +121991,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,OPTUM VA CCN-Commercial, +121992,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,OPTUM VA CCN-Commercial, +121993,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,OPTUM VA CCN-Commercial, +121994,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,OPTUM VA CCN-Commercial, +121995,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,OPTUM VA CCN-Commercial, +121996,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,OPTUM VA CCN-Commercial, +121997,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,OPTUM VA CCN-Commercial, +121998,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,OPTUM VA CCN-Commercial, +121999,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,OPTUM VA CCN-Commercial, +122000,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,OPTUM VA CCN-Commercial, +122001,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,OPTUM VA CCN-Commercial, +122002,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,OPTUM VA CCN-Commercial, +122003,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,OPTUM VA CCN-Commercial, +122004,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,OPTUM VA CCN-Commercial, +122005,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,OPTUM VA CCN-Commercial, +122006,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,OPTUM VA CCN-Commercial, +122007,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,OPTUM VA CCN-Commercial, +122008,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,OPTUM VA CCN-Commercial, +122009,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,OPTUM VA CCN-Commercial, +122010,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,OPTUM VA CCN-Commercial, +122011,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,OPTUM VA CCN-Commercial, +122012,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,OPTUM VA CCN-Commercial, +122013,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,OPTUM VA CCN-Commercial, +122014,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,OPTUM VA CCN-Commercial, +122015,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,OPTUM VA CCN-Commercial, +122016,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,OPTUM VA CCN-Commercial, +122017,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,OPTUM VA CCN-Commercial, +122018,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,OPTUM VA CCN-Commercial, +122019,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,OPTUM VA CCN-Commercial, +122020,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,OPTUM VA CCN-Commercial, +122021,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,OPTUM VA CCN-Commercial, +122022,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,OPTUM VA CCN-Commercial, +122023,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,OPTUM VA CCN-Commercial, +122024,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,OPTUM VA CCN-Commercial, +122025,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,OPTUM VA CCN-Commercial, +122026,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,OPTUM VA CCN-Commercial, +122027,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,OPTUM VA CCN-Commercial, +122028,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,OPTUM VA CCN-Commercial, +122029,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,OPTUM VA CCN-Commercial, +122030,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,OPTUM VA CCN-Commercial, +122031,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,OPTUM VA CCN-Commercial, +122032,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +122033,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,OPTUM VA CCN-Commercial, +122034,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,OPTUM VA CCN-Commercial, +122035,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,OPTUM VA CCN-Commercial, +122036,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,OPTUM VA CCN-Commercial, +122037,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +122038,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +122039,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,OPTUM VA CCN-Commercial, +122040,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,OPTUM VA CCN-Commercial, +122041,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,OPTUM VA CCN-Commercial, +122042,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,OPTUM VA CCN-Commercial, +122043,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,OPTUM VA CCN-Commercial, +122044,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,OPTUM VA CCN-Commercial, +122045,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,OPTUM VA CCN-Commercial, +122046,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,OPTUM VA CCN-Commercial, +122047,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,OPTUM VA CCN-Commercial, +122048,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,OPTUM VA CCN-Commercial, +122049,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,OPTUM VA CCN-Commercial, +122050,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,OPTUM VA CCN-Commercial, +122051,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,OPTUM VA CCN-Commercial, +122052,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,OPTUM VA CCN-Commercial, +122053,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,OPTUM VA CCN-Commercial, +122054,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,OPTUM VA CCN-Commercial, +122055,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,OPTUM VA CCN-Commercial, +122056,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,OPTUM VA CCN-Commercial, +122057,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,OPTUM VA CCN-Commercial, +122058,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,OPTUM VA CCN-Commercial, +122059,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,OPTUM VA CCN-Commercial, +122060,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,OPTUM VA CCN-Commercial, +122061,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,OPTUM VA CCN-Commercial, +122062,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,OPTUM VA CCN-Commercial, +122063,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,OPTUM VA CCN-Commercial, +122064,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,OPTUM VA CCN-Commercial, +122065,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,OPTUM VA CCN-Commercial, +122066,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,OPTUM VA CCN-Commercial, +122067,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,OPTUM VA CCN-Commercial, +122068,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,OPTUM VA CCN-Commercial, +122069,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,OPTUM VA CCN-Commercial, +122070,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,OPTUM VA CCN-Commercial, +122071,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,OPTUM VA CCN-Commercial, +122072,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,OPTUM VA CCN-Commercial, +122073,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,OPTUM VA CCN-Commercial, +122074,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +122075,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,OPTUM VA CCN-Commercial, +122076,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,OPTUM VA CCN-Commercial, +122077,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,OPTUM VA CCN-Commercial, +122078,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,OPTUM VA CCN-Commercial, +122079,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,OPTUM VA CCN-Commercial, +122080,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,OPTUM VA CCN-Commercial, +122081,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,OPTUM VA CCN-Commercial, +122082,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,OPTUM VA CCN-Commercial, +122083,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,OPTUM VA CCN-Commercial, +122084,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,OPTUM VA CCN-Commercial, +122085,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,OPTUM VA CCN-Commercial, +122086,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,OPTUM VA CCN-Commercial, +122087,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,OPTUM VA CCN-Commercial, +122088,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,OPTUM VA CCN-Commercial, +122089,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,OPTUM VA CCN-Commercial, +122090,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,OPTUM VA CCN-Commercial, +122091,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,OPTUM VA CCN-Commercial, +122092,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,OPTUM VA CCN-Commercial, +122093,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,OPTUM VA CCN-Commercial, +122094,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,OPTUM VA CCN-Commercial, +122095,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,OPTUM VA CCN-Commercial, +122096,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,OPTUM VA CCN-Commercial, +122097,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,OPTUM VA CCN-Commercial, +122098,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,OPTUM VA CCN-Commercial, +122099,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,OPTUM VA CCN-Commercial, +122100,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,OPTUM VA CCN-Commercial, +122101,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,OPTUM VA CCN-Commercial, +122102,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,OPTUM VA CCN-Commercial, +122103,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,OPTUM VA CCN-Commercial, +122104,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,OPTUM VA CCN-Commercial, +122105,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,OPTUM VA CCN-Commercial, +122106,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,OPTUM VA CCN-Commercial, +122107,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,OPTUM VA CCN-Commercial, +122108,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,OPTUM VA CCN-Commercial, +122109,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,OPTUM VA CCN-Commercial, +122110,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,OPTUM VA CCN-Commercial, +122111,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,OPTUM VA CCN-Commercial, +122112,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,OPTUM VA CCN-Commercial, +122113,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,OPTUM VA CCN-Commercial, +122114,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,OPTUM VA CCN-Commercial, +122115,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,OPTUM VA CCN-Commercial, +122116,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,OPTUM VA CCN-Commercial, +122117,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,OPTUM VA CCN-Commercial, +122118,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,OPTUM VA CCN-Commercial, +122119,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,OPTUM VA CCN-Commercial, +122120,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,OPTUM VA CCN-Commercial, +122121,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,OPTUM VA CCN-Commercial, +122122,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,OPTUM VA CCN-Commercial, +122123,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,OPTUM VA CCN-Commercial, +122124,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,OPTUM VA CCN-Commercial, +122125,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,OPTUM VA CCN-Commercial, +122126,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,OPTUM VA CCN-Commercial, +122127,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,OPTUM VA CCN-Commercial, +122128,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,OPTUM VA CCN-Commercial, +122129,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,OPTUM VA CCN-Commercial, +122130,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,OPTUM VA CCN-Commercial, +122131,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,OPTUM VA CCN-Commercial, +122132,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,OPTUM VA CCN-Commercial, +122133,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,OPTUM VA CCN-Commercial, +122134,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,OPTUM VA CCN-Commercial, +122135,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,OPTUM VA CCN-Commercial, +122136,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,OPTUM VA CCN-Commercial, +122137,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,OPTUM VA CCN-Commercial, +122138,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,OPTUM VA CCN-Commercial, +122139,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,OPTUM VA CCN-Commercial, +122140,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,OPTUM VA CCN-Commercial, +122141,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,OPTUM VA CCN-Commercial, +122142,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,OPTUM VA CCN-Commercial, +122143,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,OPTUM VA CCN-Commercial, +122144,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,OPTUM VA CCN-Commercial, +122145,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,OPTUM VA CCN-Commercial, +122146,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,OPTUM VA CCN-Commercial, +122147,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,OPTUM VA CCN-Commercial, +122148,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,OPTUM VA CCN-Commercial, +122149,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,OPTUM VA CCN-Commercial, +122150,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,OPTUM VA CCN-Commercial, +122151,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,OPTUM VA CCN-Commercial, +122152,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,OPTUM VA CCN-Commercial, +122153,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,OPTUM VA CCN-Commercial, +122154,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,OPTUM VA CCN-Commercial, +122155,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,OPTUM VA CCN-Commercial, +122156,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,OPTUM VA CCN-Commercial, +122157,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,OPTUM VA CCN-Commercial, +122158,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,OPTUM VA CCN-Commercial, +122159,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,OPTUM VA CCN-Commercial, +122160,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,OPTUM VA CCN-Commercial, +122161,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,OPTUM VA CCN-Commercial, +122162,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,OPTUM VA CCN-Commercial, +122163,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,OPTUM VA CCN-Commercial, +122164,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,OPTUM VA CCN-Commercial, +122165,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,OPTUM VA CCN-Commercial, +122166,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,OPTUM VA CCN-Commercial, +122167,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,OPTUM VA CCN-Commercial, +122168,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,OPTUM VA CCN-Commercial, +122169,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,OPTUM VA CCN-Commercial, +122170,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,OPTUM VA CCN-Commercial, +122171,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,OPTUM VA CCN-Commercial, +122172,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,OPTUM VA CCN-Commercial, +122173,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,OPTUM VA CCN-Commercial, +122174,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,OPTUM VA CCN-Commercial, +122175,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,OPTUM VA CCN-Commercial, +122176,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,OPTUM VA CCN-Commercial, +122177,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,OPTUM VA CCN-Commercial, +122178,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,OPTUM VA CCN-Commercial, +122179,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,OPTUM VA CCN-Commercial, +122180,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,OPTUM VA CCN-Commercial, +122181,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,OPTUM VA CCN-Commercial, +122182,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,OPTUM VA CCN-Commercial, +122183,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,OPTUM VA CCN-Commercial, +122184,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,OPTUM VA CCN-Commercial, +122185,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,OPTUM VA CCN-Commercial, +122186,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,OPTUM VA CCN-Commercial, +122187,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,OPTUM VA CCN-Commercial, +122188,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,OPTUM VA CCN-Commercial, +122189,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,OPTUM VA CCN-Commercial, +122190,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,OPTUM VA CCN-Commercial, +122191,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,OPTUM VA CCN-Commercial, +122192,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,OPTUM VA CCN-Commercial, +122193,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,OPTUM VA CCN-Commercial, +122194,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,OPTUM VA CCN-Commercial, +122195,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,OPTUM VA CCN-Commercial, +122196,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,OPTUM VA CCN-Commercial, +122197,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,OPTUM VA CCN-Commercial, +122198,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,OPTUM VA CCN-Commercial, +122199,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,OPTUM VA CCN-Commercial, +122200,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,OPTUM VA CCN-Commercial, +122201,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,OPTUM VA CCN-Commercial, +122202,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,OPTUM VA CCN-Commercial, +122203,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,OPTUM VA CCN-Commercial, +122204,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,OPTUM VA CCN-Commercial, +122205,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,OPTUM VA CCN-Commercial, +122206,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,OPTUM VA CCN-Commercial, +122207,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,OPTUM VA CCN-Commercial, +122208,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,OPTUM VA CCN-Commercial, +122209,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,OPTUM VA CCN-Commercial, +122210,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,OPTUM VA CCN-Commercial, +122211,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,OPTUM VA CCN-Commercial, +122212,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,OPTUM VA CCN-Commercial, +122213,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,OPTUM VA CCN-Commercial, +122214,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,OPTUM VA CCN-Commercial, +122215,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,OPTUM VA CCN-Commercial, +122216,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,OPTUM VA CCN-Commercial, +122217,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,OPTUM VA CCN-Commercial, +122218,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,OPTUM VA CCN-Commercial, +122219,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,OPTUM VA CCN-Commercial, +122220,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,OPTUM VA CCN-Commercial, +122221,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,OPTUM VA CCN-Commercial, +122222,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,OPTUM VA CCN-Commercial, +122223,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,OPTUM VA CCN-Commercial, +122224,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,OPTUM VA CCN-Commercial, +122225,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,OPTUM VA CCN-Commercial, +122226,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,OPTUM VA CCN-Commercial, +122227,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,OPTUM VA CCN-Commercial, +122228,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,OPTUM VA CCN-Commercial, +122229,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,OPTUM VA CCN-Commercial, +122230,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,OPTUM VA CCN-Commercial, +122231,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,OPTUM VA CCN-Commercial, +122232,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,OPTUM VA CCN-Commercial, +122233,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,OPTUM VA CCN-Commercial, +122234,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,OPTUM VA CCN-Commercial, +122235,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,OPTUM VA CCN-Commercial, +122236,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,OPTUM VA CCN-Commercial, +122237,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,OPTUM VA CCN-Commercial, +122238,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,OPTUM VA CCN-Commercial, +122239,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,OPTUM VA CCN-Commercial, +122240,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,OPTUM VA CCN-Commercial, +122241,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,OPTUM VA CCN-Commercial, +122242,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,OPTUM VA CCN-Commercial, +122243,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,OPTUM VA CCN-Commercial, +122244,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,OPTUM VA CCN-Commercial, +122245,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,OPTUM VA CCN-Commercial, +122246,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,OPTUM VA CCN-Commercial, +122247,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,OPTUM VA CCN-Commercial, +122248,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,OPTUM VA CCN-Commercial, +122249,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,OPTUM VA CCN-Commercial, +122250,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,OPTUM VA CCN-Commercial, +122251,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,OPTUM VA CCN-Commercial, +122252,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,OPTUM VA CCN-Commercial, +122253,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,OPTUM VA CCN-Commercial, +122254,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,OPTUM VA CCN-Commercial, +122255,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,OPTUM VA CCN-Commercial, +122256,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,OPTUM VA CCN-Commercial, +122257,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,OPTUM VA CCN-Commercial, +122258,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,OPTUM VA CCN-Commercial, +122259,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,OPTUM VA CCN-Commercial, +122260,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,OPTUM VA CCN-Commercial, +122261,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,OPTUM VA CCN-Commercial, +122262,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,OPTUM VA CCN-Commercial, +122263,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,OPTUM VA CCN-Commercial, +122264,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,OPTUM VA CCN-Commercial, +122265,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,OPTUM VA CCN-Commercial, +122266,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,OPTUM VA CCN-Commercial, +122267,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,OPTUM VA CCN-Commercial, +122268,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,OPTUM VA CCN-Commercial, +122269,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,OPTUM VA CCN-Commercial, +122270,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,OPTUM VA CCN-Commercial, +122271,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,OPTUM VA CCN-Commercial, +122272,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,OPTUM VA CCN-Commercial, +122273,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,OPTUM VA CCN-Commercial, +122274,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,OPTUM VA CCN-Commercial, +122275,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,OPTUM VA CCN-Commercial, +122276,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,OPTUM VA CCN-Commercial, +122277,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,OPTUM VA CCN-Commercial, +122278,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,OPTUM VA CCN-Commercial, +122279,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,OPTUM VA CCN-Commercial, +122280,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,OPTUM VA CCN-Commercial, +122281,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,OPTUM VA CCN-Commercial, +122282,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,OPTUM VA CCN-Commercial, +122283,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,OPTUM VA CCN-Commercial, +122284,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,OPTUM VA CCN-Commercial, +122285,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,OPTUM VA CCN-Commercial, +122286,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,OPTUM VA CCN-Commercial, +122287,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,OPTUM VA CCN-Commercial, +122288,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,OPTUM VA CCN-Commercial, +122289,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,OPTUM VA CCN-Commercial, +122290,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,OPTUM VA CCN-Commercial, +122291,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,OPTUM VA CCN-Commercial, +122292,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,OPTUM VA CCN-Commercial, +122293,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,OPTUM VA CCN-Commercial, +122294,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,OPTUM VA CCN-Commercial, +122295,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,OPTUM VA CCN-Commercial, +122296,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,OPTUM VA CCN-Commercial, +122297,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,OPTUM VA CCN-Commercial, +122298,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,OPTUM VA CCN-Commercial, +122299,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,OPTUM VA CCN-Commercial, +122300,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,OPTUM VA CCN-Commercial, +122301,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,OPTUM VA CCN-Commercial, +122302,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,OPTUM VA CCN-Commercial, +122303,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,OPTUM VA CCN-Commercial, +122304,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,OPTUM VA CCN-Commercial, +122305,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,OPTUM VA CCN-Commercial, +122306,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,OPTUM VA CCN-Commercial, +122307,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,OPTUM VA CCN-Commercial, +122308,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,OPTUM VA CCN-Commercial, +122309,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,OPTUM VA CCN-Commercial, +122310,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,OPTUM VA CCN-Commercial, +122311,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,OPTUM VA CCN-Commercial, +122312,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,OPTUM VA CCN-Commercial, +122313,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,OPTUM VA CCN-Commercial, +122314,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,OPTUM VA CCN-Commercial, +122315,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,OPTUM VA CCN-Commercial, +122316,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,OPTUM VA CCN-Commercial, +122317,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,OPTUM VA CCN-Commercial, +122318,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,OPTUM VA CCN-Commercial, +122319,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,OPTUM VA CCN-Commercial, +122320,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,OPTUM VA CCN-Commercial, +122321,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,OPTUM VA CCN-Commercial, +122322,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,OPTUM VA CCN-Commercial, +122323,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,OPTUM VA CCN-Commercial, +122324,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,OPTUM VA CCN-Commercial, +122325,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,OPTUM VA CCN-Commercial, +122326,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,OPTUM VA CCN-Commercial, +122327,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,OPTUM VA CCN-Commercial, +122328,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,OPTUM VA CCN-Commercial, +122329,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,OPTUM VA CCN-Commercial, +122330,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,OPTUM VA CCN-Commercial, +122331,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,OPTUM VA CCN-Commercial, +122332,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,OPTUM VA CCN-Commercial, +122333,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,OPTUM VA CCN-Commercial, +122334,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,OPTUM VA CCN-Commercial, +122335,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,OPTUM VA CCN-Commercial, +122336,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,OPTUM VA CCN-Commercial, +122337,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,OPTUM VA CCN-Commercial, +122338,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,OPTUM VA CCN-Commercial, +122339,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,OPTUM VA CCN-Commercial, +122340,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,OPTUM VA CCN-Commercial, +122341,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,OPTUM VA CCN-Commercial, +122342,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,OPTUM VA CCN-Commercial, +122343,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,OPTUM VA CCN-Commercial, +122344,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,OPTUM VA CCN-Commercial, +122345,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,OPTUM VA CCN-Commercial, +122346,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,OPTUM VA CCN-Commercial, +122347,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,OPTUM VA CCN-Commercial, +122348,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,OPTUM VA CCN-Commercial, +122349,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,OPTUM VA CCN-Commercial, +122350,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,OPTUM VA CCN-Commercial, +122351,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,OPTUM VA CCN-Commercial, +122352,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,OPTUM VA CCN-Commercial, +122353,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,OPTUM VA CCN-Commercial, +122354,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,OPTUM VA CCN-Commercial, +122355,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,OPTUM VA CCN-Commercial, +122356,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,OPTUM VA CCN-Commercial, +122357,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,OPTUM VA CCN-Commercial, +122358,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,OPTUM VA CCN-Commercial, +122359,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,OPTUM VA CCN-Commercial, +122360,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,OPTUM VA CCN-Commercial, +122361,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,OPTUM VA CCN-Commercial, +122362,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,OPTUM VA CCN-Commercial, +122363,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,OPTUM VA CCN-Commercial, +122364,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,OPTUM VA CCN-Commercial, +122365,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,OPTUM VA CCN-Commercial, +122366,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,OPTUM VA CCN-Commercial, +122367,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,OPTUM VA CCN-Commercial, +122368,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,OPTUM VA CCN-Commercial, +122369,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,OPTUM VA CCN-Commercial, +122370,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,OPTUM VA CCN-Commercial, +122371,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,OPTUM VA CCN-Commercial, +122372,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,OPTUM VA CCN-Commercial, +122373,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,OPTUM VA CCN-Commercial, +122374,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,OPTUM VA CCN-Commercial, +122375,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,OPTUM VA CCN-Commercial, +122376,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,OPTUM VA CCN-Commercial, +122377,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,OPTUM VA CCN-Commercial, +122378,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,OPTUM VA CCN-Commercial, +122379,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,OPTUM VA CCN-Commercial, +122380,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,OPTUM VA CCN-Commercial, +122381,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,OPTUM VA CCN-Commercial, +122382,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,OPTUM VA CCN-Commercial, +122383,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,OPTUM VA CCN-Commercial, +122384,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,OPTUM VA CCN-Commercial, +122385,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,OPTUM VA CCN-Commercial, +122386,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,OPTUM VA CCN-Commercial, +122387,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,OPTUM VA CCN-Commercial, +122388,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,OPTUM VA CCN-Commercial, +122389,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,OPTUM VA CCN-Commercial, +122390,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,OPTUM VA CCN-Commercial, +122391,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,OPTUM VA CCN-Commercial, +122392,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,OPTUM VA CCN-Commercial, +122393,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,OPTUM VA CCN-Commercial, +122394,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,OPTUM VA CCN-Commercial, +122395,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,OPTUM VA CCN-Commercial, +122396,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,OPTUM VA CCN-Commercial, +122397,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,OPTUM VA CCN-Commercial, +122398,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,OPTUM VA CCN-Commercial, +122399,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,OPTUM VA CCN-Commercial, +122400,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,OPTUM VA CCN-Commercial, +122401,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,OPTUM VA CCN-Commercial, +122402,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,OPTUM VA CCN-Commercial, +122403,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,OPTUM VA CCN-Commercial, +122404,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,OPTUM VA CCN-Commercial, +122405,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,OPTUM VA CCN-Commercial, +122406,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,OPTUM VA CCN-Commercial, +122407,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,OPTUM VA CCN-Commercial, +122408,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,OPTUM VA CCN-Commercial, +122409,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,OPTUM VA CCN-Commercial, +122410,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,OPTUM VA CCN-Commercial, +122411,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,OPTUM VA CCN-Commercial, +122412,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,OPTUM VA CCN-Commercial, +122413,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,OPTUM VA CCN-Commercial, +122414,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,OPTUM VA CCN-Commercial, +122415,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,OPTUM VA CCN-Commercial, +122416,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,OPTUM VA CCN-Commercial, +122417,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,OPTUM VA CCN-Commercial, +122418,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,OPTUM VA CCN-Commercial, +122419,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,OPTUM VA CCN-Commercial, +122420,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,OPTUM VA CCN-Commercial, +122421,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,OPTUM VA CCN-Commercial, +122422,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,OPTUM VA CCN-Commercial, +122423,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,OPTUM VA CCN-Commercial, +122424,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,OPTUM VA CCN-Commercial, +122425,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,OPTUM VA CCN-Commercial, +122426,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,OPTUM VA CCN-Commercial, +122427,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,OPTUM VA CCN-Commercial, +122428,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,OPTUM VA CCN-Commercial, +122429,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,OPTUM VA CCN-Commercial, +122430,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,OPTUM VA CCN-Commercial, +122431,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,OPTUM VA CCN-Commercial, +122432,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,OPTUM VA CCN-Commercial, +122433,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,OPTUM VA CCN-Commercial, +122434,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,OPTUM VA CCN-Commercial, +122435,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,OPTUM VA CCN-Commercial, +122436,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,OPTUM VA CCN-Commercial, +122437,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,OPTUM VA CCN-Commercial, +122438,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,OPTUM VA CCN-Commercial, +122439,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,OPTUM VA CCN-Commercial, +122440,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,OPTUM VA CCN-Commercial, +122441,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,OPTUM VA CCN-Commercial, +122442,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,OPTUM VA CCN-Commercial, +122443,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,OPTUM VA CCN-Commercial, +122444,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,OPTUM VA CCN-Commercial, +122445,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,OPTUM VA CCN-Commercial, +122446,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,OPTUM VA CCN-Commercial, +122447,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,OPTUM VA CCN-Commercial, +122448,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,OPTUM VA CCN-Commercial, +122449,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,OPTUM VA CCN-Commercial, +122450,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,OPTUM VA CCN-Commercial, +122451,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,OPTUM VA CCN-Commercial, +122452,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,OPTUM VA CCN-Commercial, +122453,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,OPTUM VA CCN-Commercial, +122454,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,OPTUM VA CCN-Commercial, +122455,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,OPTUM VA CCN-Commercial, +122456,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,OPTUM VA CCN-Commercial, +122457,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,OPTUM VA CCN-Commercial, +122458,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,OPTUM VA CCN-Commercial, +122459,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,OPTUM VA CCN-Commercial, +122460,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,OPTUM VA CCN-Commercial, +122461,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,OPTUM VA CCN-Commercial, +122462,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,OPTUM VA CCN-Commercial, +122463,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,OPTUM VA CCN-Commercial, +122464,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,OPTUM VA CCN-Commercial, +122465,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,OPTUM VA CCN-Commercial, +122466,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,OPTUM VA CCN-Commercial, +122467,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,OPTUM VA CCN-Commercial, +122468,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,OPTUM VA CCN-Commercial, +122469,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,OPTUM VA CCN-Commercial, +122470,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,OPTUM VA CCN-Commercial, +122471,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,OPTUM VA CCN-Commercial, +122472,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,OPTUM VA CCN-Commercial, +122473,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,OPTUM VA CCN-Commercial, +122474,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,OPTUM VA CCN-Commercial, +122475,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,OPTUM VA CCN-Commercial, +122476,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,OPTUM VA CCN-Commercial, +122477,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,OPTUM VA CCN-Commercial, +122478,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,OPTUM VA CCN-Commercial, +122479,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,OPTUM VA CCN-Commercial, +122480,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,OPTUM VA CCN-Commercial, +122481,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,OPTUM VA CCN-Commercial, +122482,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,OPTUM VA CCN-Commercial, +122483,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,OPTUM VA CCN-Commercial, +122484,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,OPTUM VA CCN-Commercial, +122485,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,OPTUM VA CCN-Commercial, +122486,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,OPTUM VA CCN-Commercial, +122487,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,OPTUM VA CCN-Commercial, +122488,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,OPTUM VA CCN-Commercial, +122489,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,OPTUM VA CCN-Commercial, +122490,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,OPTUM VA CCN-Commercial, +122491,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,OPTUM VA CCN-Commercial, +122492,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,OPTUM VA CCN-Commercial, +122493,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,OPTUM VA CCN-Commercial, +122494,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,OPTUM VA CCN-Commercial, +122495,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,OPTUM VA CCN-Commercial, +122496,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,OPTUM VA CCN-Commercial, +122497,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,OPTUM VA CCN-Commercial, +122498,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,OPTUM VA CCN-Commercial, +122499,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,OPTUM VA CCN-Commercial, +122500,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,OPTUM VA CCN-Commercial, +122501,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,OPTUM VA CCN-Commercial, +122502,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,OPTUM VA CCN-Commercial, +122503,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,OPTUM VA CCN-Commercial, +122504,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,OPTUM VA CCN-Commercial, +122505,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,OPTUM VA CCN-Commercial, +122506,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,OPTUM VA CCN-Commercial, +122507,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,OPTUM VA CCN-Commercial, +122508,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,OPTUM VA CCN-Commercial, +122509,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,OPTUM VA CCN-Commercial, +122510,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,OPTUM VA CCN-Commercial, +122511,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,OPTUM VA CCN-Commercial, +122512,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,OPTUM VA CCN-Commercial, +122513,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,OPTUM VA CCN-Commercial, +122514,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,OPTUM VA CCN-Commercial, +122515,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,OPTUM VA CCN-Commercial, +122516,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,OPTUM VA CCN-Commercial, +122517,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,OPTUM VA CCN-Commercial, +122518,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,OPTUM VA CCN-Commercial, +122519,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,OPTUM VA CCN-Commercial, +122520,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,OPTUM VA CCN-Commercial, +122521,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,OPTUM VA CCN-Commercial, +122522,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,OPTUM VA CCN-Commercial, +122523,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,OPTUM VA CCN-Commercial, +122524,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,OPTUM VA CCN-Commercial, +122525,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,OPTUM VA CCN-Commercial, +122526,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,OPTUM VA CCN-Commercial, +122527,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,OPTUM VA CCN-Commercial, +122528,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,OPTUM VA CCN-Commercial, +122529,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,OPTUM VA CCN-Commercial, +122530,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,OPTUM VA CCN-Commercial, +122531,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,OPTUM VA CCN-Commercial, +122532,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,OPTUM VA CCN-Commercial, +122533,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,OPTUM VA CCN-Commercial, +122534,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,OPTUM VA CCN-Commercial, +122535,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,OPTUM VA CCN-Commercial, +122536,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,OPTUM VA CCN-Commercial, +122537,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,OPTUM VA CCN-Commercial, +122538,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,OPTUM VA CCN-Commercial, +122539,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,OPTUM VA CCN-Commercial, +122540,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,OPTUM VA CCN-Commercial, +122541,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,OPTUM VA CCN-Commercial, +122542,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,OPTUM VA CCN-Commercial, +122543,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,OPTUM VA CCN-Commercial, +122544,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,OPTUM VA CCN-Commercial, +122545,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,OPTUM VA CCN-Commercial, +122546,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,OPTUM VA CCN-Commercial, +122547,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,OPTUM VA CCN-Commercial, +122548,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,OPTUM VA CCN-Commercial, +122549,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,OPTUM VA CCN-Commercial, +122550,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,OPTUM VA CCN-Commercial, +122551,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,OPTUM VA CCN-Commercial, +122552,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,OPTUM VA CCN-Commercial, +122553,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,OPTUM VA CCN-Commercial, +122554,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,OPTUM VA CCN-Commercial, +122555,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,OPTUM VA CCN-Commercial, +122556,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,OPTUM VA CCN-Commercial, +122557,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,OPTUM VA CCN-Commercial, +122558,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,OPTUM VA CCN-Commercial, +122559,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,OPTUM VA CCN-Commercial, +122560,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,OPTUM VA CCN-Commercial,111.75 +122561,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,OPTUM VA CCN-Commercial, +122562,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,OPTUM VA CCN-Commercial, +122563,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,OPTUM VA CCN-Commercial,486.0 +122564,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,OPTUM VA CCN-Commercial, +122565,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,OPTUM VA CCN-Commercial, +122566,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,OPTUM VA CCN-Commercial, +122567,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,OPTUM VA CCN-Commercial, +122568,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,OPTUM VA CCN-Commercial, +122569,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,OPTUM VA CCN-Commercial, +122570,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,OPTUM VA CCN-Commercial, +122571,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,OPTUM VA CCN-Commercial, +122572,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,OPTUM VA CCN-Commercial, +122573,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,OPTUM VA CCN-Commercial, +122574,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,OPTUM VA CCN-Commercial, +122575,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,OPTUM VA CCN-Commercial, +122576,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,OPTUM VA CCN-Commercial, +122577,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,OPTUM VA CCN-Commercial, +122578,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,OPTUM VA CCN-Commercial, +122579,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,OPTUM VA CCN-Commercial, +122580,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,OPTUM VA CCN-Commercial, +122581,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,OPTUM VA CCN-Commercial, +122582,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,OPTUM VA CCN-Commercial, +122583,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,OPTUM VA CCN-Commercial, +122584,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,OPTUM VA CCN-Commercial, +122585,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,OPTUM VA CCN-Commercial, +122586,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,OPTUM VA CCN-Commercial, +122587,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,OPTUM VA CCN-Commercial, +122588,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,OPTUM VA CCN-Commercial, +122589,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,OPTUM VA CCN-Commercial, +122590,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,OPTUM VA CCN-Commercial, +122591,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,OPTUM VA CCN-Commercial, +122592,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,OPTUM VA CCN-Commercial, +122593,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,OPTUM VA CCN-Commercial, +122594,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,OPTUM VA CCN-Commercial, +122595,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,OPTUM VA CCN-Commercial, +122596,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,OPTUM VA CCN-Commercial, +122597,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,OPTUM VA CCN-Commercial, +122598,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,OPTUM VA CCN-Commercial, +122599,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,OPTUM VA CCN-Commercial, +122600,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,OPTUM VA CCN-Commercial, +122601,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,OPTUM VA CCN-Commercial, +122602,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,OPTUM VA CCN-Commercial, +122603,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,OPTUM VA CCN-Commercial, +122604,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,OPTUM VA CCN-Commercial, +122605,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,OPTUM VA CCN-Commercial, +122606,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,OPTUM VA CCN-Commercial, +122607,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,OPTUM VA CCN-Commercial, +122608,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,OPTUM VA CCN-Commercial, +122609,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,OPTUM VA CCN-Commercial, +122610,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,OPTUM VA CCN-Commercial, +122611,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,OPTUM VA CCN-Commercial, +122612,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,OPTUM VA CCN-Commercial, +122613,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,OPTUM VA CCN-Commercial, +122614,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,OPTUM VA CCN-Commercial, +122615,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,OPTUM VA CCN-Commercial, +122616,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,OPTUM VA CCN-Commercial, +122617,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,OPTUM VA CCN-Commercial, +122618,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,OPTUM VA CCN-Commercial, +122619,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,OPTUM VA CCN-Commercial, +122620,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,OPTUM VA CCN-Commercial, +122621,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,OPTUM VA CCN-Commercial, +122622,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,OPTUM VA CCN-Commercial, +122623,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,OPTUM VA CCN-Commercial, +122624,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,OPTUM VA CCN-Commercial, +122625,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,OPTUM VA CCN-Commercial, +122626,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,OPTUM VA CCN-Commercial, +122627,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,OPTUM VA CCN-Commercial, +122628,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,OPTUM VA CCN-Commercial, +122629,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,OPTUM VA CCN-Commercial, +122630,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,OPTUM VA CCN-Commercial, +122631,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,OPTUM VA CCN-Commercial, +122632,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,OPTUM VA CCN-Commercial, +122633,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,OPTUM VA CCN-Commercial, +122634,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,OPTUM VA CCN-Commercial, +122635,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,OPTUM VA CCN-Commercial, +122636,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,OPTUM VA CCN-Commercial, +122637,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,OPTUM VA CCN-Commercial, +122638,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,OPTUM VA CCN-Commercial, +122639,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,OPTUM VA CCN-Commercial, +122640,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,OPTUM VA CCN-Commercial, +122641,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,OPTUM VA CCN-Commercial, +122642,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,OPTUM VA CCN-Commercial, +122643,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,OPTUM VA CCN-Commercial, +122644,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,OPTUM VA CCN-Commercial, +122645,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,OPTUM VA CCN-Commercial, +122646,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,OPTUM VA CCN-Commercial, +122647,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,OPTUM VA CCN-Commercial, +122648,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +122649,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,OPTUM VA CCN-Commercial, +122650,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,OPTUM VA CCN-Commercial, +122651,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,OPTUM VA CCN-Commercial, +122652,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,OPTUM VA CCN-Commercial, +122653,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,OPTUM VA CCN-Commercial, +122654,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,OPTUM VA CCN-Commercial, +122655,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,OPTUM VA CCN-Commercial, +122656,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,OPTUM VA CCN-Commercial, +122657,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,OPTUM VA CCN-Commercial, +122658,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,OPTUM VA CCN-Commercial, +122659,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,OPTUM VA CCN-Commercial, +122660,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,OPTUM VA CCN-Commercial, +122661,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,OPTUM VA CCN-Commercial, +122662,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,OPTUM VA CCN-Commercial, +122663,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,OPTUM VA CCN-Commercial, +122664,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,OPTUM VA CCN-Commercial, +122665,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,OPTUM VA CCN-Commercial, +122666,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,OPTUM VA CCN-Commercial, +122667,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,OPTUM VA CCN-Commercial, +122668,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,OPTUM VA CCN-Commercial, +122669,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,OPTUM VA CCN-Commercial, +122670,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,OPTUM VA CCN-Commercial, +122671,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,OPTUM VA CCN-Commercial, +122672,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,OPTUM VA CCN-Commercial, +122673,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,OPTUM VA CCN-Commercial, +122674,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,OPTUM VA CCN-Commercial, +122675,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,OPTUM VA CCN-Commercial, +122676,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,OPTUM VA CCN-Commercial, +122677,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,OPTUM VA CCN-Commercial, +122678,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,OPTUM VA CCN-Commercial, +122679,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,OPTUM VA CCN-Commercial, +122680,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,OPTUM VA CCN-Commercial, +122681,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,OPTUM VA CCN-Commercial, +122682,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,OPTUM VA CCN-Commercial, +122683,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,OPTUM VA CCN-Commercial, +122684,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,OPTUM VA CCN-Commercial, +122685,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,OPTUM VA CCN-Commercial, +122686,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,OPTUM VA CCN-Commercial, +122687,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,OPTUM VA CCN-Commercial, +122688,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,OPTUM VA CCN-Commercial, +122689,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,OPTUM VA CCN-Commercial, +122690,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,OPTUM VA CCN-Commercial, +122691,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,OPTUM VA CCN-Commercial, +122692,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,OPTUM VA CCN-Commercial, +122693,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,OPTUM VA CCN-Commercial, +122694,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,OPTUM VA CCN-Commercial, +122695,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,OPTUM VA CCN-Commercial, +122696,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,OPTUM VA CCN-Commercial, +122697,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,OPTUM VA CCN-Commercial, +122698,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,OPTUM VA CCN-Commercial, +122699,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,OPTUM VA CCN-Commercial, +122700,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,OPTUM VA CCN-Commercial, +122701,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,OPTUM VA CCN-Commercial, +122702,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +122703,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,OPTUM VA CCN-Commercial, +122704,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,OPTUM VA CCN-Commercial, +122705,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,OPTUM VA CCN-Commercial, +122706,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,OPTUM VA CCN-Commercial, +122707,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,OPTUM VA CCN-Commercial, +122708,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,OPTUM VA CCN-Commercial, +122709,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,OPTUM VA CCN-Commercial, +122710,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,OPTUM VA CCN-Commercial, +122711,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,OPTUM VA CCN-Commercial, +122712,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,OPTUM VA CCN-Commercial, +122713,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,OPTUM VA CCN-Commercial, +122714,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,OPTUM VA CCN-Commercial, +122715,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,OPTUM VA CCN-Commercial, +122716,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,OPTUM VA CCN-Commercial, +122717,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,OPTUM VA CCN-Commercial, +122718,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,OPTUM VA CCN-Commercial, +122719,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,OPTUM VA CCN-Commercial, +122720,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,OPTUM VA CCN-Commercial, +122721,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,OPTUM VA CCN-Commercial, +122722,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,OPTUM VA CCN-Commercial, +122723,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,OPTUM VA CCN-Commercial, +122724,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,OPTUM VA CCN-Commercial, +122725,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,OPTUM VA CCN-Commercial, +122726,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,OPTUM VA CCN-Commercial, +122727,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,OPTUM VA CCN-Commercial, +122728,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,OPTUM VA CCN-Commercial, +122729,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,OPTUM VA CCN-Commercial, +122730,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,OPTUM VA CCN-Commercial, +122731,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,OPTUM VA CCN-Commercial, +122732,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,OPTUM VA CCN-Commercial, +122733,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,OPTUM VA CCN-Commercial, +122734,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,OPTUM VA CCN-Commercial, +122735,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,OPTUM VA CCN-Commercial, +122736,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,OPTUM VA CCN-Commercial, +122737,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,OPTUM VA CCN-Commercial, +122738,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,OPTUM VA CCN-Commercial, +122739,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,OPTUM VA CCN-Commercial, +122740,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,OPTUM VA CCN-Commercial, +122741,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,OPTUM VA CCN-Commercial, +122742,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,OPTUM VA CCN-Commercial, +122743,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,OPTUM VA CCN-Commercial, +122744,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,OPTUM VA CCN-Commercial, +122745,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,OPTUM VA CCN-Commercial, +122746,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,OPTUM VA CCN-Commercial, +122747,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,OPTUM VA CCN-Commercial, +122748,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,OPTUM VA CCN-Commercial, +122749,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,OPTUM VA CCN-Commercial, +122750,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,OPTUM VA CCN-Commercial, +122751,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,OPTUM VA CCN-Commercial, +122752,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,OPTUM VA CCN-Commercial, +122753,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,OPTUM VA CCN-Commercial, +122754,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,OPTUM VA CCN-Commercial, +122755,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,OPTUM VA CCN-Commercial, +122756,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,OPTUM VA CCN-Commercial, +122757,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,OPTUM VA CCN-Commercial, +122758,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,OPTUM VA CCN-Commercial, +122759,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,OPTUM VA CCN-Commercial, +122760,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,OPTUM VA CCN-Commercial, +122761,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,OPTUM VA CCN-Commercial, +122762,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,OPTUM VA CCN-Commercial, +122763,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,OPTUM VA CCN-Commercial, +122764,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,OPTUM VA CCN-Commercial, +122765,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,OPTUM VA CCN-Commercial, +122766,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,OPTUM VA CCN-Commercial, +122767,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,OPTUM VA CCN-Commercial, +122768,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,OPTUM VA CCN-Commercial, +122769,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,OPTUM VA CCN-Commercial, +122770,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,OPTUM VA CCN-Commercial, +122771,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,OPTUM VA CCN-Commercial, +122772,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,OPTUM VA CCN-Commercial, +122773,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,OPTUM VA CCN-Commercial, +122774,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,OPTUM VA CCN-Commercial, +122775,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,OPTUM VA CCN-Commercial, +122776,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,OPTUM VA CCN-Commercial, +122777,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,OPTUM VA CCN-Commercial, +122778,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,OPTUM VA CCN-Commercial, +122779,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,OPTUM VA CCN-Commercial, +122780,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,OPTUM VA CCN-Commercial, +122781,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,OPTUM VA CCN-Commercial, +122782,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,OPTUM VA CCN-Commercial, +122783,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,OPTUM VA CCN-Commercial, +122784,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,OPTUM VA CCN-Commercial, +122785,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,OPTUM VA CCN-Commercial, +122786,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,OPTUM VA CCN-Commercial, +122787,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,OPTUM VA CCN-Commercial, +122788,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,OPTUM VA CCN-Commercial, +122789,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,OPTUM VA CCN-Commercial, +122790,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,OPTUM VA CCN-Commercial, +122791,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,OPTUM VA CCN-Commercial, +122792,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,OPTUM VA CCN-Commercial, +122793,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,OPTUM VA CCN-Commercial, +122794,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,OPTUM VA CCN-Commercial, +122795,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,OPTUM VA CCN-Commercial, +122796,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,OPTUM VA CCN-Commercial, +122797,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,OPTUM VA CCN-Commercial, +122798,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,OPTUM VA CCN-Commercial, +122799,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,OPTUM VA CCN-Commercial, +122800,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,OPTUM VA CCN-Commercial, +122801,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,OPTUM VA CCN-Commercial, +122802,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,OPTUM VA CCN-Commercial, +122803,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,OPTUM VA CCN-Commercial, +122804,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,OPTUM VA CCN-Commercial, +122805,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,OPTUM VA CCN-Commercial, +122806,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,OPTUM VA CCN-Commercial, +122807,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,OPTUM VA CCN-Commercial, +122808,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,OPTUM VA CCN-Commercial, +122809,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,OPTUM VA CCN-Commercial, +122810,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,OPTUM VA CCN-Commercial, +122811,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,OPTUM VA CCN-Commercial, +122812,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,OPTUM VA CCN-Commercial, +122813,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,OPTUM VA CCN-Commercial, +122814,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,OPTUM VA CCN-Commercial, +122815,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,OPTUM VA CCN-Commercial, +122816,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,OPTUM VA CCN-Commercial, +122817,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,OPTUM VA CCN-Commercial, +122818,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,OPTUM VA CCN-Commercial, +122819,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,OPTUM VA CCN-Commercial, +122820,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,OPTUM VA CCN-Commercial, +122821,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,OPTUM VA CCN-Commercial, +122822,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,OPTUM VA CCN-Commercial, +122823,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,OPTUM VA CCN-Commercial, +122824,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,OPTUM VA CCN-Commercial, +122825,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,OPTUM VA CCN-Commercial, +122826,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,OPTUM VA CCN-Commercial, +122827,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,OPTUM VA CCN-Commercial, +122828,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,OPTUM VA CCN-Commercial, +122829,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,OPTUM VA CCN-Commercial, +122830,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,OPTUM VA CCN-Commercial, +122831,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,OPTUM VA CCN-Commercial, +122832,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,OPTUM VA CCN-Commercial, +122833,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,OPTUM VA CCN-Commercial, +122834,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,OPTUM VA CCN-Commercial, +122835,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,OPTUM VA CCN-Commercial, +122836,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,OPTUM VA CCN-Commercial, +122837,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,OPTUM VA CCN-Commercial, +122838,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,OPTUM VA CCN-Commercial, +122839,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,OPTUM VA CCN-Commercial, +122840,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,OPTUM VA CCN-Commercial, +122841,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,OPTUM VA CCN-Commercial, +122842,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,OPTUM VA CCN-Commercial, +122843,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,OPTUM VA CCN-Commercial, +122844,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,OPTUM VA CCN-Commercial, +122845,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,OPTUM VA CCN-Commercial, +122846,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,OPTUM VA CCN-Commercial, +122847,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,OPTUM VA CCN-Commercial, +122848,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,OPTUM VA CCN-Commercial, +122849,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,OPTUM VA CCN-Commercial, +122850,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,OPTUM VA CCN-Commercial, +122851,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,OPTUM VA CCN-Commercial, +122852,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,OPTUM VA CCN-Commercial, +122853,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,OPTUM VA CCN-Commercial, +122854,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,OPTUM VA CCN-Commercial, +122855,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,OPTUM VA CCN-Commercial, +122856,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,OPTUM VA CCN-Commercial, +122857,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,OPTUM VA CCN-Commercial, +122858,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,OPTUM VA CCN-Commercial, +122859,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,OPTUM VA CCN-Commercial, +122860,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,OPTUM VA CCN-Commercial, +122861,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,OPTUM VA CCN-Commercial, +122862,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,OPTUM VA CCN-Commercial, +122863,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,OPTUM VA CCN-Commercial, +122864,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,OPTUM VA CCN-Commercial, +122865,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,OPTUM VA CCN-Commercial, +122866,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,OPTUM VA CCN-Commercial, +122867,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,OPTUM VA CCN-Commercial, +122868,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,OPTUM VA CCN-Commercial, +122869,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,OPTUM VA CCN-Commercial, +122870,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,OPTUM VA CCN-Commercial, +122871,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,OPTUM VA CCN-Commercial, +122872,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,OPTUM VA CCN-Commercial, +122873,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,OPTUM VA CCN-Commercial, +122874,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,OPTUM VA CCN-Commercial, +122875,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,OPTUM VA CCN-Commercial, +122876,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,OPTUM VA CCN-Commercial, +122877,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,OPTUM VA CCN-Commercial, +122878,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,OPTUM VA CCN-Commercial, +122879,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,OPTUM VA CCN-Commercial, +122880,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,OPTUM VA CCN-Commercial, +122881,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,OPTUM VA CCN-Commercial, +122882,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,OPTUM VA CCN-Commercial, +122883,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,OPTUM VA CCN-Commercial, +122884,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,OPTUM VA CCN-Commercial, +122885,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,OPTUM VA CCN-Commercial, +122886,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,OPTUM VA CCN-Commercial, +122887,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,OPTUM VA CCN-Commercial, +122888,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,OPTUM VA CCN-Commercial, +122889,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,OPTUM VA CCN-Commercial, +122890,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,OPTUM VA CCN-Commercial, +122891,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,OPTUM VA CCN-Commercial, +122892,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,OPTUM VA CCN-Commercial, +122893,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,OPTUM VA CCN-Commercial, +122894,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,OPTUM VA CCN-Commercial, +122895,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,OPTUM VA CCN-Commercial, +122896,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,OPTUM VA CCN-Commercial, +122897,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,OPTUM VA CCN-Commercial, +122898,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,OPTUM VA CCN-Commercial, +122899,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,OPTUM VA CCN-Commercial, +122900,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,OPTUM VA CCN-Commercial, +122901,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,OPTUM VA CCN-Commercial, +122902,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,OPTUM VA CCN-Commercial, +122903,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,OPTUM VA CCN-Commercial, +122904,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,OPTUM VA CCN-Commercial, +122905,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,OPTUM VA CCN-Commercial, +122906,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,OPTUM VA CCN-Commercial, +122907,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,OPTUM VA CCN-Commercial, +122908,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,OPTUM VA CCN-Commercial, +122909,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,OPTUM VA CCN-Commercial, +122910,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,OPTUM VA CCN-Commercial, +122911,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,OPTUM VA CCN-Commercial, +122912,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,OPTUM VA CCN-Commercial, +122913,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,OPTUM VA CCN-Commercial, +122914,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,OPTUM VA CCN-Commercial, +122915,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,OPTUM VA CCN-Commercial, +122916,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,OPTUM VA CCN-Commercial, +122917,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,OPTUM VA CCN-Commercial, +122918,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,OPTUM VA CCN-Commercial, +122919,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,OPTUM VA CCN-Commercial, +122920,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,OPTUM VA CCN-Commercial, +122921,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,OPTUM VA CCN-Commercial, +122922,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,OPTUM VA CCN-Commercial, +122923,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,OPTUM VA CCN-Commercial, +122924,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,OPTUM VA CCN-Commercial, +122925,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,OPTUM VA CCN-Commercial, +122926,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,OPTUM VA CCN-Commercial, +122927,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,OPTUM VA CCN-Commercial, +122928,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,OPTUM VA CCN-Commercial, +122929,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,OPTUM VA CCN-Commercial, +122930,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,OPTUM VA CCN-Commercial, +122931,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,OPTUM VA CCN-Commercial, +122932,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,OPTUM VA CCN-Commercial, +122933,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,OPTUM VA CCN-Commercial, +122934,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,OPTUM VA CCN-Commercial, +122935,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,OPTUM VA CCN-Commercial, +122936,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,OPTUM VA CCN-Commercial, +122937,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,OPTUM VA CCN-Commercial, +122938,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,OPTUM VA CCN-Commercial, +122939,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,OPTUM VA CCN-Commercial, +122940,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,OPTUM VA CCN-Commercial, +122941,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,OPTUM VA CCN-Commercial, +122942,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,OPTUM VA CCN-Commercial, +122943,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,OPTUM VA CCN-Commercial, +122944,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,OPTUM VA CCN-Commercial, +122945,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,OPTUM VA CCN-Commercial, +122946,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,OPTUM VA CCN-Commercial, +122947,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,OPTUM VA CCN-Commercial, +122948,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,OPTUM VA CCN-Commercial, +122949,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,OPTUM VA CCN-Commercial, +122950,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,OPTUM VA CCN-Commercial, +122951,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,OPTUM VA CCN-Commercial, +122952,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,OPTUM VA CCN-Commercial, +122953,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,OPTUM VA CCN-Commercial, +122954,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,OPTUM VA CCN-Commercial, +122955,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,OPTUM VA CCN-Commercial, +122956,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,OPTUM VA CCN-Commercial, +122957,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,OPTUM VA CCN-Commercial, +122958,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,OPTUM VA CCN-Commercial, +122959,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,OPTUM VA CCN-Commercial, +122960,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,OPTUM VA CCN-Commercial, +122961,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,OPTUM VA CCN-Commercial, +122962,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,OPTUM VA CCN-Commercial, +122963,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,OPTUM VA CCN-Commercial, +122964,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,OPTUM VA CCN-Commercial, +122965,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,OPTUM VA CCN-Commercial, +122966,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,OPTUM VA CCN-Commercial, +122967,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,OPTUM VA CCN-Commercial, +122968,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,OPTUM VA CCN-Commercial, +122969,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,OPTUM VA CCN-Commercial, +122970,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,OPTUM VA CCN-Commercial, +122971,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,OPTUM VA CCN-Commercial, +122972,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,OPTUM VA CCN-Commercial, +122973,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,OPTUM VA CCN-Commercial, +122974,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,OPTUM VA CCN-Commercial, +122975,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,OPTUM VA CCN-Commercial, +122976,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,OPTUM VA CCN-Commercial, +122977,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,OPTUM VA CCN-Commercial, +122978,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,OPTUM VA CCN-Commercial, +122979,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,OPTUM VA CCN-Commercial, +122980,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,OPTUM VA CCN-Commercial, +122981,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,OPTUM VA CCN-Commercial, +122982,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,OPTUM VA CCN-Commercial, +122983,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,OPTUM VA CCN-Commercial, +122984,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,OPTUM VA CCN-Commercial, +122985,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,OPTUM VA CCN-Commercial, +122986,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,OPTUM VA CCN-Commercial, +122987,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,OPTUM VA CCN-Commercial, +122988,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,OPTUM VA CCN-Commercial, +122989,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,OPTUM VA CCN-Commercial, +122990,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,OPTUM VA CCN-Commercial, +122991,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,OPTUM VA CCN-Commercial, +122992,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,OPTUM VA CCN-Commercial, +122993,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,OPTUM VA CCN-Commercial, +122994,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,OPTUM VA CCN-Commercial, +122995,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,OPTUM VA CCN-Commercial, +122996,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,OPTUM VA CCN-Commercial, +122997,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,OPTUM VA CCN-Commercial, +122998,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,OPTUM VA CCN-Commercial, +122999,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,OPTUM VA CCN-Commercial, +123000,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,OPTUM VA CCN-Commercial, +123001,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,OPTUM VA CCN-Commercial, +123002,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,OPTUM VA CCN-Commercial, +123003,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,OPTUM VA CCN-Commercial, +123004,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,OPTUM VA CCN-Commercial, +123005,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,OPTUM VA CCN-Commercial, +123006,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,OPTUM VA CCN-Commercial, +123007,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,OPTUM VA CCN-Commercial, +123008,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,OPTUM VA CCN-Commercial, +123009,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,OPTUM VA CCN-Commercial, +123010,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,OPTUM VA CCN-Commercial, +123011,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,OPTUM VA CCN-Commercial, +123012,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,OPTUM VA CCN-Commercial, +123013,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,OPTUM VA CCN-Commercial, +123014,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,OPTUM VA CCN-Commercial, +123015,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,OPTUM VA CCN-Commercial, +123016,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,OPTUM VA CCN-Commercial, +123017,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,OPTUM VA CCN-Commercial, +123018,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,OPTUM VA CCN-Commercial, +123019,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,OPTUM VA CCN-Commercial, +123020,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,OPTUM VA CCN-Commercial, +123021,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,OPTUM VA CCN-Commercial, +123022,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,OPTUM VA CCN-Commercial, +123023,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,OPTUM VA CCN-Commercial, +123024,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,OPTUM VA CCN-Commercial, +123025,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,OPTUM VA CCN-Commercial, +123026,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,OPTUM VA CCN-Commercial, +123027,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,OPTUM VA CCN-Commercial, +123028,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,OPTUM VA CCN-Commercial, +123029,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,OPTUM VA CCN-Commercial, +123030,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,OPTUM VA CCN-Commercial, +123031,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,OPTUM VA CCN-Commercial, +123032,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,OPTUM VA CCN-Commercial, +123033,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,OPTUM VA CCN-Commercial, +123034,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,OPTUM VA CCN-Commercial, +123035,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,OPTUM VA CCN-Commercial, +123036,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,OPTUM VA CCN-Commercial, +123037,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,OPTUM VA CCN-Commercial, +123038,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,OPTUM VA CCN-Commercial, +123039,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,OPTUM VA CCN-Commercial, +123040,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,OPTUM VA CCN-Commercial, +123041,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,OPTUM VA CCN-Commercial, +123042,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,OPTUM VA CCN-Commercial, +123043,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,OPTUM VA CCN-Commercial, +123044,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,OPTUM VA CCN-Commercial, +123045,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,OPTUM VA CCN-Commercial, +123046,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,OPTUM VA CCN-Commercial, +123047,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,OPTUM VA CCN-Commercial, +123048,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,OPTUM VA CCN-Commercial, +123049,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,OPTUM VA CCN-Commercial, +123050,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,OPTUM VA CCN-Commercial, +123051,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,OPTUM VA CCN-Commercial, +123052,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,OPTUM VA CCN-Commercial, +123053,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,OPTUM VA CCN-Commercial, +123054,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,OPTUM VA CCN-Commercial, +123055,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,OPTUM VA CCN-Commercial, +123056,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,OPTUM VA CCN-Commercial, +123057,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,OPTUM VA CCN-Commercial, +123058,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,OPTUM VA CCN-Commercial, +123059,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,OPTUM VA CCN-Commercial, +123060,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,OPTUM VA CCN-Commercial, +123061,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,OPTUM VA CCN-Commercial, +123062,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,OPTUM VA CCN-Commercial, +123063,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,OPTUM VA CCN-Commercial, +123064,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,OPTUM VA CCN-Commercial, +123065,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,OPTUM VA CCN-Commercial, +123066,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,OPTUM VA CCN-Commercial, +123067,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,OPTUM VA CCN-Commercial, +123068,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,OPTUM VA CCN-Commercial, +123069,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,OPTUM VA CCN-Commercial, +123070,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,OPTUM VA CCN-Commercial, +123071,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,OPTUM VA CCN-Commercial, +123072,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,OPTUM VA CCN-Commercial, +123073,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,OPTUM VA CCN-Commercial, +123074,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,OPTUM VA CCN-Commercial, +123075,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,OPTUM VA CCN-Commercial, +123076,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,OPTUM VA CCN-Commercial, +123077,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,OPTUM VA CCN-Commercial, +123078,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,OPTUM VA CCN-Commercial, +123079,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,OPTUM VA CCN-Commercial, +123080,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,OPTUM VA CCN-Commercial, +123081,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,OPTUM VA CCN-Commercial, +123082,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,OPTUM VA CCN-Commercial, +123083,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,OPTUM VA CCN-Commercial, +123084,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,OPTUM VA CCN-Commercial, +123085,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,OPTUM VA CCN-Commercial, +123086,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,OPTUM VA CCN-Commercial, +123087,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,OPTUM VA CCN-Commercial, +123088,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,OPTUM VA CCN-Commercial, +123089,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,OPTUM VA CCN-Commercial, +123090,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,OPTUM VA CCN-Commercial, +123091,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,OPTUM VA CCN-Commercial, +123092,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,OPTUM VA CCN-Commercial, +123093,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,OPTUM VA CCN-Commercial, +123094,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,OPTUM VA CCN-Commercial, +123095,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,OPTUM VA CCN-Commercial, +123096,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,OPTUM VA CCN-Commercial, +123097,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,OPTUM VA CCN-Commercial, +123098,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,OPTUM VA CCN-Commercial, +123099,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,OPTUM VA CCN-Commercial, +123100,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,OPTUM VA CCN-Commercial, +123101,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,OPTUM VA CCN-Commercial, +123102,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,OPTUM VA CCN-Commercial, +123103,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,OPTUM VA CCN-Commercial, +123104,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,OPTUM VA CCN-Commercial, +123105,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,OPTUM VA CCN-Commercial, +123106,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,OPTUM VA CCN-Commercial, +123107,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,OPTUM VA CCN-Commercial, +123108,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,OPTUM VA CCN-Commercial, +123109,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,OPTUM VA CCN-Commercial, +123110,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,OPTUM VA CCN-Commercial, +123111,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,OPTUM VA CCN-Commercial, +123112,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,OPTUM VA CCN-Commercial, +123113,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,OPTUM VA CCN-Commercial, +123114,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,OPTUM VA CCN-Commercial, +123115,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,OPTUM VA CCN-Commercial, +123116,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,OPTUM VA CCN-Commercial, +123117,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,OPTUM VA CCN-Commercial, +123118,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,OPTUM VA CCN-Commercial, +123119,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,OPTUM VA CCN-Commercial, +123120,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,OPTUM VA CCN-Commercial, +123121,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,OPTUM VA CCN-Commercial, +123122,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,OPTUM VA CCN-Commercial, +123123,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,OPTUM VA CCN-Commercial, +123124,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,OPTUM VA CCN-Commercial, +123125,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,OPTUM VA CCN-Commercial, +123126,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,OPTUM VA CCN-Commercial, +123127,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,OPTUM VA CCN-Commercial, +123128,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,OPTUM VA CCN-Commercial, +123129,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,OPTUM VA CCN-Commercial, +123130,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,OPTUM VA CCN-Commercial, +123131,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,OPTUM VA CCN-Commercial, +123132,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,OPTUM VA CCN-Commercial, +123133,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,OPTUM VA CCN-Commercial, +123134,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,OPTUM VA CCN-Commercial, +123135,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,OPTUM VA CCN-Commercial, +123136,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,OPTUM VA CCN-Commercial, +123137,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,OPTUM VA CCN-Commercial, +123138,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,OPTUM VA CCN-Commercial, +123139,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,OPTUM VA CCN-Commercial, +123140,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,OPTUM VA CCN-Commercial, +123141,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,OPTUM VA CCN-Commercial, +123142,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,OPTUM VA CCN-Commercial, +123143,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,OPTUM VA CCN-Commercial, +123144,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,OPTUM VA CCN-Commercial, +123145,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,OPTUM VA CCN-Commercial, +123146,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,OPTUM VA CCN-Commercial, +123147,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,OPTUM VA CCN-Commercial, +123148,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,OPTUM VA CCN-Commercial, +123149,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,OPTUM VA CCN-Commercial, +123150,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,OPTUM VA CCN-Commercial, +123151,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,OPTUM VA CCN-Commercial, +123152,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,OPTUM VA CCN-Commercial, +123153,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,OPTUM VA CCN-Commercial, +123154,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,OPTUM VA CCN-Commercial, +123155,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,OPTUM VA CCN-Commercial, +123156,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,OPTUM VA CCN-Commercial, +123157,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,OPTUM VA CCN-Commercial, +123158,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,OPTUM VA CCN-Commercial, +123159,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,OPTUM VA CCN-Commercial, +123160,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,OPTUM VA CCN-Commercial, +123161,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,OPTUM VA CCN-Commercial, +123162,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,OPTUM VA CCN-Commercial, +123163,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,OPTUM VA CCN-Commercial, +123164,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,OPTUM VA CCN-Commercial, +123165,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,OPTUM VA CCN-Commercial, +123166,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,OPTUM VA CCN-Commercial, +123167,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,OPTUM VA CCN-Commercial, +123168,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,OPTUM VA CCN-Commercial, +123169,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,OPTUM VA CCN-Commercial, +123170,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,OPTUM VA CCN-Commercial, +123171,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,OPTUM VA CCN-Commercial, +123172,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,OPTUM VA CCN-Commercial, +123173,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,OPTUM VA CCN-Commercial, +123174,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,OPTUM VA CCN-Commercial, +123175,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,OPTUM VA CCN-Commercial, +123176,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,OPTUM VA CCN-Commercial, +123177,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,OPTUM VA CCN-Commercial, +123178,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,OPTUM VA CCN-Commercial, +123179,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,OPTUM VA CCN-Commercial, +123180,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,OPTUM VA CCN-Commercial, +123181,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,OPTUM VA CCN-Commercial, +123182,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,OPTUM VA CCN-Commercial, +123183,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,OPTUM VA CCN-Commercial, +123184,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,OPTUM VA CCN-Commercial, +123185,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,OPTUM VA CCN-Commercial, +123186,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,OPTUM VA CCN-Commercial, +123187,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,OPTUM VA CCN-Commercial, +123188,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,OPTUM VA CCN-Commercial, +123189,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,OPTUM VA CCN-Commercial, +123190,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,OPTUM VA CCN-Commercial, +123191,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,OPTUM VA CCN-Commercial, +123192,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,OPTUM VA CCN-Commercial, +123193,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,OPTUM VA CCN-Commercial, +123194,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,OPTUM VA CCN-Commercial, +123195,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,OPTUM VA CCN-Commercial, +123196,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,OPTUM VA CCN-Commercial, +123197,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,OPTUM VA CCN-Commercial, +123198,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,OPTUM VA CCN-Commercial, +123199,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,OPTUM VA CCN-Commercial, +123200,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,OPTUM VA CCN-Commercial, +123201,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,OPTUM VA CCN-Commercial, +123202,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,OPTUM VA CCN-Commercial, +123203,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,OPTUM VA CCN-Commercial, +123204,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,OPTUM VA CCN-Commercial, +123205,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,OPTUM VA CCN-Commercial, +123206,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,OPTUM VA CCN-Commercial, +123207,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,OPTUM VA CCN-Commercial, +123208,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,OPTUM VA CCN-Commercial, +123209,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,OPTUM VA CCN-Commercial, +123210,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,OPTUM VA CCN-Commercial, +123211,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,OPTUM VA CCN-Commercial, +123212,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,OPTUM VA CCN-Commercial, +123213,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,OPTUM VA CCN-Commercial, +123214,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,OPTUM VA CCN-Commercial, +123215,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,OPTUM VA CCN-Commercial, +123216,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,OPTUM VA CCN-Commercial, +123217,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,OPTUM VA CCN-Commercial, +123218,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,OPTUM VA CCN-Commercial, +123219,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,OPTUM VA CCN-Commercial, +123220,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,OPTUM VA CCN-Commercial, +123221,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,OPTUM VA CCN-Commercial, +123222,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,OPTUM VA CCN-Commercial, +123223,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,OPTUM VA CCN-Commercial, +123224,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,OPTUM VA CCN-Commercial, +123225,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,OPTUM VA CCN-Commercial, +123226,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,OPTUM VA CCN-Commercial, +123227,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,OPTUM VA CCN-Commercial, +123228,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,OPTUM VA CCN-Commercial, +123229,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,OPTUM VA CCN-Commercial, +123230,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,OPTUM VA CCN-Commercial, +123231,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,OPTUM VA CCN-Commercial, +123232,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,OPTUM VA CCN-Commercial, +123233,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,OPTUM VA CCN-Commercial, +123234,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,OPTUM VA CCN-Commercial, +123235,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,OPTUM VA CCN-Commercial, +123236,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,OPTUM VA CCN-Commercial, +123237,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,OPTUM VA CCN-Commercial, +123238,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,OPTUM VA CCN-Commercial, +123239,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,OPTUM VA CCN-Commercial, +123240,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,OPTUM VA CCN-Commercial, +123241,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,OPTUM VA CCN-Commercial, +123242,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,OPTUM VA CCN-Commercial, +123243,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,OPTUM VA CCN-Commercial, +123244,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,OPTUM VA CCN-Commercial, +123245,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,OPTUM VA CCN-Commercial, +123246,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,OPTUM VA CCN-Commercial, +123247,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,OPTUM VA CCN-Commercial, +123248,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,OPTUM VA CCN-Commercial, +123249,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,OPTUM VA CCN-Commercial, +123250,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,OPTUM VA CCN-Commercial, +123251,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,OPTUM VA CCN-Commercial, +123252,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,OPTUM VA CCN-Commercial, +123253,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,OPTUM VA CCN-Commercial, +123254,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,OPTUM VA CCN-Commercial, +123255,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,OPTUM VA CCN-Commercial, +123256,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,OPTUM VA CCN-Commercial, +123257,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,OPTUM VA CCN-Commercial, +123258,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,OPTUM VA CCN-Commercial, +123259,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,OPTUM VA CCN-Commercial, +123260,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,OPTUM VA CCN-Commercial, +123261,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,OPTUM VA CCN-Commercial, +123262,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,OPTUM VA CCN-Commercial, +123263,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,OPTUM VA CCN-Commercial, +123264,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,OPTUM VA CCN-Commercial, +123265,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,OPTUM VA CCN-Commercial, +123266,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,OPTUM VA CCN-Commercial, +123267,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,OPTUM VA CCN-Commercial, +123268,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,OPTUM VA CCN-Commercial, +123269,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,OPTUM VA CCN-Commercial, +123270,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,OPTUM VA CCN-Commercial, +123271,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,OPTUM VA CCN-Commercial, +123272,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,OPTUM VA CCN-Commercial, +123273,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,OPTUM VA CCN-Commercial, +123274,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,OPTUM VA CCN-Commercial, +123275,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,OPTUM VA CCN-Commercial, +123276,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,OPTUM VA CCN-Commercial, +123277,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,OPTUM VA CCN-Commercial, +123278,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,OPTUM VA CCN-Commercial, +123279,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,OPTUM VA CCN-Commercial, +123280,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,OPTUM VA CCN-Commercial, +123281,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,OPTUM VA CCN-Commercial, +123282,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,OPTUM VA CCN-Commercial, +123283,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,OPTUM VA CCN-Commercial, +123284,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,OPTUM VA CCN-Commercial, +123285,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,OPTUM VA CCN-Commercial, +123286,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,OPTUM VA CCN-Commercial, +123287,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,OPTUM VA CCN-Commercial, +123288,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,OPTUM VA CCN-Commercial, +123289,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,OPTUM VA CCN-Commercial, +123290,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,OPTUM VA CCN-Commercial, +123291,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,OPTUM VA CCN-Commercial, +123292,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,OPTUM VA CCN-Commercial, +123293,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,OPTUM VA CCN-Commercial, +123294,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,OPTUM VA CCN-Commercial, +123295,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,OPTUM VA CCN-Commercial, +123296,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,OPTUM VA CCN-Commercial, +123297,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,OPTUM VA CCN-Commercial, +123298,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,OPTUM VA CCN-Commercial, +123299,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,OPTUM VA CCN-Commercial, +123300,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,OPTUM VA CCN-Commercial, +123301,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,OPTUM VA CCN-Commercial, +123302,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,OPTUM VA CCN-Commercial, +123303,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,OPTUM VA CCN-Commercial, +123304,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,OPTUM VA CCN-Commercial, +123305,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,OPTUM VA CCN-Commercial, +123306,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,OPTUM VA CCN-Commercial, +123307,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,OPTUM VA CCN-Commercial, +123308,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,OPTUM VA CCN-Commercial, +123309,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,OPTUM VA CCN-Commercial, +123310,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,OPTUM VA CCN-Commercial, +123311,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,OPTUM VA CCN-Commercial, +123312,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,OPTUM VA CCN-Commercial, +123313,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,OPTUM VA CCN-Commercial, +123314,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,OPTUM VA CCN-Commercial, +123315,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,OPTUM VA CCN-Commercial, +123316,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,OPTUM VA CCN-Commercial, +123317,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,OPTUM VA CCN-Commercial, +123318,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,OPTUM VA CCN-Commercial, +123319,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,OPTUM VA CCN-Commercial, +123320,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,OPTUM VA CCN-Commercial, +123321,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,OPTUM VA CCN-Commercial, +123322,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,OPTUM VA CCN-Commercial, +123323,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,OPTUM VA CCN-Commercial, +123324,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,OPTUM VA CCN-Commercial, +123325,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,OPTUM VA CCN-Commercial, +123326,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,OPTUM VA CCN-Commercial, +123327,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,OPTUM VA CCN-Commercial, +123328,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,OPTUM VA CCN-Commercial, +123329,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,OPTUM VA CCN-Commercial, +123330,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,OPTUM VA CCN-Commercial, +123331,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,OPTUM VA CCN-Commercial, +123332,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,OPTUM VA CCN-Commercial, +123333,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,OPTUM VA CCN-Commercial, +123334,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,OPTUM VA CCN-Commercial, +123335,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,OPTUM VA CCN-Commercial, +123336,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,OPTUM VA CCN-Commercial, +123337,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,OPTUM VA CCN-Commercial, +123338,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,OPTUM VA CCN-Commercial, +123339,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,OPTUM VA CCN-Commercial, +123340,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,OPTUM VA CCN-Commercial, +123341,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,OPTUM VA CCN-Commercial, +123342,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,OPTUM VA CCN-Commercial, +123343,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,OPTUM VA CCN-Commercial, +123344,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,OPTUM VA CCN-Commercial, +123345,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,OPTUM VA CCN-Commercial, +123346,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,OPTUM VA CCN-Commercial, +123347,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,OPTUM VA CCN-Commercial, +123348,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,OPTUM VA CCN-Commercial, +123349,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,OPTUM VA CCN-Commercial, +123350,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,OPTUM VA CCN-Commercial, +123351,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,OPTUM VA CCN-Commercial, +123352,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,OPTUM VA CCN-Commercial, +123353,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,OPTUM VA CCN-Commercial, +123354,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,OPTUM VA CCN-Commercial, +123355,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,OPTUM VA CCN-Commercial, +123356,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,OPTUM VA CCN-Commercial, +123357,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,OPTUM VA CCN-Commercial, +123358,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,OPTUM VA CCN-Commercial, +123359,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,OPTUM VA CCN-Commercial, +123360,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,OPTUM VA CCN-Commercial, +123361,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,OPTUM VA CCN-Commercial, +123362,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,OPTUM VA CCN-Commercial, +123363,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,OPTUM VA CCN-Commercial, +123364,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,OPTUM VA CCN-Commercial, +123365,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,OPTUM VA CCN-Commercial, +123366,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,OPTUM VA CCN-Commercial, +123367,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,OPTUM VA CCN-Commercial, +123368,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,OPTUM VA CCN-Commercial, +123369,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,OPTUM VA CCN-Commercial, +123370,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,OPTUM VA CCN-Commercial, +123371,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,OPTUM VA CCN-Commercial, +123372,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,OPTUM VA CCN-Commercial, +123373,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,OPTUM VA CCN-Commercial, +123374,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,OPTUM VA CCN-Commercial, +123375,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,OPTUM VA CCN-Commercial, +123376,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,OPTUM VA CCN-Commercial, +123377,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,OPTUM VA CCN-Commercial, +123378,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,OPTUM VA CCN-Commercial, +123379,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,OPTUM VA CCN-Commercial, +123380,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,OPTUM VA CCN-Commercial, +123381,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,OPTUM VA CCN-Commercial, +123382,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,OPTUM VA CCN-Commercial, +123383,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,OPTUM VA CCN-Commercial, +123384,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,OPTUM VA CCN-Commercial, +123385,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,OPTUM VA CCN-Commercial, +123386,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,OPTUM VA CCN-Commercial, +123387,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,OPTUM VA CCN-Commercial, +123388,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,OPTUM VA CCN-Commercial, +123389,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,OPTUM VA CCN-Commercial, +123390,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,OPTUM VA CCN-Commercial, +123391,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,OPTUM VA CCN-Commercial, +123392,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,OPTUM VA CCN-Commercial, +123393,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,OPTUM VA CCN-Commercial, +123394,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,OPTUM VA CCN-Commercial, +123395,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +123396,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +123397,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +123398,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,OPTUM VA CCN-Commercial, +123399,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,OPTUM VA CCN-Commercial, +123400,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,OPTUM VA CCN-Commercial, +123401,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,OPTUM VA CCN-Commercial, +123402,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,OPTUM VA CCN-Commercial, +123403,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,OPTUM VA CCN-Commercial, +123404,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,OPTUM VA CCN-Commercial, +123405,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,OPTUM VA CCN-Commercial, +123406,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,OPTUM VA CCN-Commercial, +123407,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,OPTUM VA CCN-Commercial, +123408,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,OPTUM VA CCN-Commercial, +123409,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,OPTUM VA CCN-Commercial, +123410,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,OPTUM VA CCN-Commercial, +123411,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,OPTUM VA CCN-Commercial, +123412,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,OPTUM VA CCN-Commercial, +123413,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,OPTUM VA CCN-Commercial, +123414,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,OPTUM VA CCN-Commercial, +123415,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,OPTUM VA CCN-Commercial, +123416,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,OPTUM VA CCN-Commercial, +123417,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,OPTUM VA CCN-Commercial, +123418,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,OPTUM VA CCN-Commercial, +123419,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,OPTUM VA CCN-Commercial, +123420,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,OPTUM VA CCN-Commercial, +123421,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,OPTUM VA CCN-Commercial, +123422,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,OPTUM VA CCN-Commercial, +123423,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,OPTUM VA CCN-Commercial, +123424,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,OPTUM VA CCN-Commercial, +123425,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,OPTUM VA CCN-Commercial, +123426,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,OPTUM VA CCN-Commercial, +123427,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,OPTUM VA CCN-Commercial, +123428,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,OPTUM VA CCN-Commercial, +123429,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,OPTUM VA CCN-Commercial, +123430,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,OPTUM VA CCN-Commercial, +123431,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,OPTUM VA CCN-Commercial, +123432,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,OPTUM VA CCN-Commercial, +123433,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,OPTUM VA CCN-Commercial, +123434,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,OPTUM VA CCN-Commercial, +123435,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,OPTUM VA CCN-Commercial, +123436,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,OPTUM VA CCN-Commercial, +123437,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,OPTUM VA CCN-Commercial, +123438,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,OPTUM VA CCN-Commercial, +123439,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,OPTUM VA CCN-Commercial, +123440,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,OPTUM VA CCN-Commercial, +123441,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,OPTUM VA CCN-Commercial, +123442,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,OPTUM VA CCN-Commercial, +123443,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,OPTUM VA CCN-Commercial, +123444,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,OPTUM VA CCN-Commercial, +123445,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,OPTUM VA CCN-Commercial, +123446,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,OPTUM VA CCN-Commercial, +123447,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,OPTUM VA CCN-Commercial, +123448,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,OPTUM VA CCN-Commercial, +123449,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,OPTUM VA CCN-Commercial, +123450,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,OPTUM VA CCN-Commercial, +123451,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,OPTUM VA CCN-Commercial, +123452,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,OPTUM VA CCN-Commercial, +123453,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,OPTUM VA CCN-Commercial, +123454,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,OPTUM VA CCN-Commercial, +123455,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,OPTUM VA CCN-Commercial, +123456,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,OPTUM VA CCN-Commercial, +123457,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,OPTUM VA CCN-Commercial, +123458,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,OPTUM VA CCN-Commercial, +123459,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,OPTUM VA CCN-Commercial, +123460,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,OPTUM VA CCN-Commercial, +123461,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,OPTUM VA CCN-Commercial, +123462,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,OPTUM VA CCN-Commercial, +123463,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,OPTUM VA CCN-Commercial, +123464,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,OPTUM VA CCN-Commercial, +123465,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,OPTUM VA CCN-Commercial, +123466,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,OPTUM VA CCN-Commercial, +123467,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,OPTUM VA CCN-Commercial, +123468,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,OPTUM VA CCN-Commercial, +123469,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,OPTUM VA CCN-Commercial, +123470,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,OPTUM VA CCN-Commercial, +123471,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,OPTUM VA CCN-Commercial, +123472,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,OPTUM VA CCN-Commercial, +123473,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,OPTUM VA CCN-Commercial, +123474,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,OPTUM VA CCN-Commercial, +123475,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,OPTUM VA CCN-Commercial, +123476,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,OPTUM VA CCN-Commercial, +123477,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,OPTUM VA CCN-Commercial, +123478,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,OPTUM VA CCN-Commercial, +123479,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,OPTUM VA CCN-Commercial, +123480,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,OPTUM VA CCN-Commercial, +123481,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,OPTUM VA CCN-Commercial, +123482,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,OPTUM VA CCN-Commercial, +123483,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,OPTUM VA CCN-Commercial, +123484,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,OPTUM VA CCN-Commercial, +123485,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,OPTUM VA CCN-Commercial, +123486,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,OPTUM VA CCN-Commercial, +123487,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,OPTUM VA CCN-Commercial, +123488,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,OPTUM VA CCN-Commercial, +123489,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,OPTUM VA CCN-Commercial, +123490,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,OPTUM VA CCN-Commercial, +123491,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,OPTUM VA CCN-Commercial, +123492,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,OPTUM VA CCN-Commercial, +123493,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,OPTUM VA CCN-Commercial, +123494,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +123495,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,OPTUM VA CCN-Commercial, +123496,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,OPTUM VA CCN-Commercial, +123497,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,OPTUM VA CCN-Commercial, +123498,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,OPTUM VA CCN-Commercial, +123499,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,OPTUM VA CCN-Commercial, +123500,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,OPTUM VA CCN-Commercial, +123501,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,OPTUM VA CCN-Commercial, +123502,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,OPTUM VA CCN-Commercial, +123503,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,OPTUM VA CCN-Commercial, +123504,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,OPTUM VA CCN-Commercial, +123505,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,OPTUM VA CCN-Commercial, +123506,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,OPTUM VA CCN-Commercial, +123507,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,OPTUM VA CCN-Commercial, +123508,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,OPTUM VA CCN-Commercial, +123509,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,OPTUM VA CCN-Commercial, +123510,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,OPTUM VA CCN-Commercial, +123511,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,OPTUM VA CCN-Commercial, +123512,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,OPTUM VA CCN-Commercial, +123513,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,OPTUM VA CCN-Commercial, +123514,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,OPTUM VA CCN-Commercial, +123515,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,OPTUM VA CCN-Commercial, +123516,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,OPTUM VA CCN-Commercial, +123517,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,OPTUM VA CCN-Commercial, +123518,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,OPTUM VA CCN-Commercial, +123519,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,OPTUM VA CCN-Commercial, +123520,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,OPTUM VA CCN-Commercial, +123521,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,OPTUM VA CCN-Commercial, +123522,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,OPTUM VA CCN-Commercial, +123523,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,OPTUM VA CCN-Commercial, +123524,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,OPTUM VA CCN-Commercial, +123525,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,OPTUM VA CCN-Commercial, +123526,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,OPTUM VA CCN-Commercial, +123527,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,OPTUM VA CCN-Commercial, +123528,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,OPTUM VA CCN-Commercial, +123529,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,OPTUM VA CCN-Commercial, +123530,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,OPTUM VA CCN-Commercial, +123531,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,OPTUM VA CCN-Commercial, +123532,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,OPTUM VA CCN-Commercial, +123533,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,OPTUM VA CCN-Commercial, +123534,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,OPTUM VA CCN-Commercial, +123535,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,OPTUM VA CCN-Commercial, +123536,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,OPTUM VA CCN-Commercial, +123537,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,OPTUM VA CCN-Commercial, +123538,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,OPTUM VA CCN-Commercial, +123539,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,OPTUM VA CCN-Commercial, +123540,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,OPTUM VA CCN-Commercial, +123541,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,OPTUM VA CCN-Commercial, +123542,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,OPTUM VA CCN-Commercial, +123543,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,OPTUM VA CCN-Commercial, +123544,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,OPTUM VA CCN-Commercial, +123545,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,OPTUM VA CCN-Commercial, +123546,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,OPTUM VA CCN-Commercial, +123547,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,OPTUM VA CCN-Commercial, +123548,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,OPTUM VA CCN-Commercial, +123549,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,OPTUM VA CCN-Commercial, +123550,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,OPTUM VA CCN-Commercial, +123551,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,OPTUM VA CCN-Commercial, +123552,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,OPTUM VA CCN-Commercial, +123553,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,OPTUM VA CCN-Commercial, +123554,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,OPTUM VA CCN-Commercial, +123555,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,OPTUM VA CCN-Commercial, +123556,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,OPTUM VA CCN-Commercial, +123557,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,OPTUM VA CCN-Commercial, +123558,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,OPTUM VA CCN-Commercial, +123559,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,OPTUM VA CCN-Commercial, +123560,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,OPTUM VA CCN-Commercial, +123561,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,OPTUM VA CCN-Commercial, +123562,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,OPTUM VA CCN-Commercial, +123563,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,OPTUM VA CCN-Commercial, +123564,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,OPTUM VA CCN-Commercial, +123565,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,OPTUM VA CCN-Commercial, +123566,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,OPTUM VA CCN-Commercial, +123567,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,OPTUM VA CCN-Commercial, +123568,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,OPTUM VA CCN-Commercial, +123569,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,OPTUM VA CCN-Commercial, +123570,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,OPTUM VA CCN-Commercial, +123571,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,OPTUM VA CCN-Commercial, +123572,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,OPTUM VA CCN-Commercial, +123573,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,OPTUM VA CCN-Commercial, +123574,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,OPTUM VA CCN-Commercial, +123575,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,OPTUM VA CCN-Commercial, +123576,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,OPTUM VA CCN-Commercial, +123577,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,OPTUM VA CCN-Commercial, +123578,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,OPTUM VA CCN-Commercial, +123579,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,OPTUM VA CCN-Commercial, +123580,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,OPTUM VA CCN-Commercial, +123581,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,OPTUM VA CCN-Commercial, +123582,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,OPTUM VA CCN-Commercial, +123583,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,OPTUM VA CCN-Commercial, +123584,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,OPTUM VA CCN-Commercial, +123585,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,OPTUM VA CCN-Commercial, +123586,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,OPTUM VA CCN-Commercial, +123587,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,OPTUM VA CCN-Commercial, +123588,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,OPTUM VA CCN-Commercial, +123589,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,OPTUM VA CCN-Commercial, +123590,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,OPTUM VA CCN-Commercial, +123591,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,OPTUM VA CCN-Commercial, +123592,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,OPTUM VA CCN-Commercial, +123593,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,OPTUM VA CCN-Commercial, +123594,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,OPTUM VA CCN-Commercial, +123595,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,OPTUM VA CCN-Commercial, +123596,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,OPTUM VA CCN-Commercial, +123597,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,OPTUM VA CCN-Commercial, +123598,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,OPTUM VA CCN-Commercial, +123599,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,OPTUM VA CCN-Commercial, +123600,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,OPTUM VA CCN-Commercial, +123601,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,OPTUM VA CCN-Commercial, +123602,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,OPTUM VA CCN-Commercial, +123603,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,OPTUM VA CCN-Commercial, +123604,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,OPTUM VA CCN-Commercial, +123605,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,OPTUM VA CCN-Commercial, +123606,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,OPTUM VA CCN-Commercial, +123607,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,OPTUM VA CCN-Commercial, +123608,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,OPTUM VA CCN-Commercial, +123609,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,OPTUM VA CCN-Commercial, +123610,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,OPTUM VA CCN-Commercial, +123611,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,OPTUM VA CCN-Commercial, +123612,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,OPTUM VA CCN-Commercial, +123613,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,OPTUM VA CCN-Commercial, +123614,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,OPTUM VA CCN-Commercial, +123615,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,OPTUM VA CCN-Commercial, +123616,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,OPTUM VA CCN-Commercial, +123617,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,OPTUM VA CCN-Commercial, +123618,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,OPTUM VA CCN-Commercial, +123619,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,OPTUM VA CCN-Commercial, +123620,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,OPTUM VA CCN-Commercial, +123621,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,OPTUM VA CCN-Commercial, +123622,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,OPTUM VA CCN-Commercial, +123623,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,OPTUM VA CCN-Commercial, +123624,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,OPTUM VA CCN-Commercial, +123625,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,OPTUM VA CCN-Commercial, +123626,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,OPTUM VA CCN-Commercial, +123627,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,OPTUM VA CCN-Commercial, +123628,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,OPTUM VA CCN-Commercial, +123629,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,OPTUM VA CCN-Commercial, +123630,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,OPTUM VA CCN-Commercial, +123631,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,OPTUM VA CCN-Commercial, +123632,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,OPTUM VA CCN-Commercial, +123633,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,OPTUM VA CCN-Commercial, +123634,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,OPTUM VA CCN-Commercial, +123635,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,OPTUM VA CCN-Commercial, +123636,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,OPTUM VA CCN-Commercial, +123637,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,OPTUM VA CCN-Commercial, +123638,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,OPTUM VA CCN-Commercial, +123639,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,OPTUM VA CCN-Commercial, +123640,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,OPTUM VA CCN-Commercial, +123641,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,OPTUM VA CCN-Commercial, +123642,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,OPTUM VA CCN-Commercial, +123643,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,OPTUM VA CCN-Commercial, +123644,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,OPTUM VA CCN-Commercial, +123645,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,OPTUM VA CCN-Commercial, +123646,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,OPTUM VA CCN-Commercial, +123647,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,OPTUM VA CCN-Commercial, +123648,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,OPTUM VA CCN-Commercial, +123649,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,OPTUM VA CCN-Commercial, +123650,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,OPTUM VA CCN-Commercial, +123651,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,OPTUM VA CCN-Commercial, +123652,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,OPTUM VA CCN-Commercial, +123653,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,OPTUM VA CCN-Commercial, +123654,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,OPTUM VA CCN-Commercial, +123655,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,OPTUM VA CCN-Commercial, +123656,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,OPTUM VA CCN-Commercial, +123657,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,OPTUM VA CCN-Commercial, +123658,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,OPTUM VA CCN-Commercial, +123659,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,OPTUM VA CCN-Commercial, +123660,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,OPTUM VA CCN-Commercial, +123661,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,OPTUM VA CCN-Commercial, +123662,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,OPTUM VA CCN-Commercial, +123663,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,OPTUM VA CCN-Commercial, +123664,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,OPTUM VA CCN-Commercial, +123665,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,OPTUM VA CCN-Commercial, +123666,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,OPTUM VA CCN-Commercial, +123667,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,OPTUM VA CCN-Commercial, +123668,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,OPTUM VA CCN-Commercial, +123669,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,OPTUM VA CCN-Commercial, +123670,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,OPTUM VA CCN-Commercial, +123671,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,OPTUM VA CCN-Commercial, +123672,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,OPTUM VA CCN-Commercial, +123673,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,OPTUM VA CCN-Commercial, +123674,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,OPTUM VA CCN-Commercial, +123675,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,OPTUM VA CCN-Commercial, +123676,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,OPTUM VA CCN-Commercial, +123677,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,OPTUM VA CCN-Commercial, +123678,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,OPTUM VA CCN-Commercial, +123679,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,OPTUM VA CCN-Commercial, +123680,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,OPTUM VA CCN-Commercial, +123681,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,OPTUM VA CCN-Commercial, +123682,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,OPTUM VA CCN-Commercial, +123683,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,OPTUM VA CCN-Commercial, +123684,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,OPTUM VA CCN-Commercial, +123685,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,OPTUM VA CCN-Commercial, +123686,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,OPTUM VA CCN-Commercial, +123687,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,OPTUM VA CCN-Commercial, +123688,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,OPTUM VA CCN-Commercial, +123689,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,OPTUM VA CCN-Commercial, +123690,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,OPTUM VA CCN-Commercial, +123691,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,OPTUM VA CCN-Commercial, +123692,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,OPTUM VA CCN-Commercial, +123693,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,OPTUM VA CCN-Commercial, +123694,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,OPTUM VA CCN-Commercial, +123695,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,OPTUM VA CCN-Commercial, +123696,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,OPTUM VA CCN-Commercial, +123697,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,OPTUM VA CCN-Commercial, +123698,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,OPTUM VA CCN-Commercial, +123699,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,OPTUM VA CCN-Commercial, +123700,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,OPTUM VA CCN-Commercial, +123701,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,OPTUM VA CCN-Commercial, +123702,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,OPTUM VA CCN-Commercial, +123703,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,OPTUM VA CCN-Commercial, +123704,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,OPTUM VA CCN-Commercial, +123705,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,OPTUM VA CCN-Commercial, +123706,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,OPTUM VA CCN-Commercial, +123707,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,OPTUM VA CCN-Commercial, +123708,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,OPTUM VA CCN-Commercial, +123709,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,OPTUM VA CCN-Commercial, +123710,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,OPTUM VA CCN-Commercial, +123711,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,OPTUM VA CCN-Commercial, +123712,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,OPTUM VA CCN-Commercial, +123713,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,OPTUM VA CCN-Commercial, +123714,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,OPTUM VA CCN-Commercial, +123715,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,OPTUM VA CCN-Commercial, +123716,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,OPTUM VA CCN-Commercial, +123717,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,OPTUM VA CCN-Commercial, +123718,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,OPTUM VA CCN-Commercial, +123719,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,OPTUM VA CCN-Commercial, +123720,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,OPTUM VA CCN-Commercial, +123721,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,OPTUM VA CCN-Commercial, +123722,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,OPTUM VA CCN-Commercial, +123723,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,OPTUM VA CCN-Commercial, +123724,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,OPTUM VA CCN-Commercial, +123725,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,OPTUM VA CCN-Commercial, +123726,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,OPTUM VA CCN-Commercial, +123727,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,OPTUM VA CCN-Commercial, +123728,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,OPTUM VA CCN-Commercial, +123729,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,OPTUM VA CCN-Commercial, +123730,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,OPTUM VA CCN-Commercial, +123731,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,OPTUM VA CCN-Commercial, +123732,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,OPTUM VA CCN-Commercial, +123733,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,OPTUM VA CCN-Commercial, +123734,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,OPTUM VA CCN-Commercial, +123735,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,OPTUM VA CCN-Commercial, +123736,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,OPTUM VA CCN-Commercial, +123737,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,OPTUM VA CCN-Commercial, +123738,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,OPTUM VA CCN-Commercial, +123739,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,OPTUM VA CCN-Commercial, +123740,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,OPTUM VA CCN-Commercial, +123741,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,OPTUM VA CCN-Commercial, +123742,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,OPTUM VA CCN-Commercial, +123743,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,OPTUM VA CCN-Commercial, +123744,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,OPTUM VA CCN-Commercial, +123745,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,OPTUM VA CCN-Commercial, +123746,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,OPTUM VA CCN-Commercial, +123747,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,OPTUM VA CCN-Commercial, +123748,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,OPTUM VA CCN-Commercial, +123749,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,OPTUM VA CCN-Commercial, +123750,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,OPTUM VA CCN-Commercial, +123751,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,OPTUM VA CCN-Commercial, +123752,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,OPTUM VA CCN-Commercial, +123753,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,OPTUM VA CCN-Commercial, +123754,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,OPTUM VA CCN-Commercial, +123755,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,OPTUM VA CCN-Commercial, +123756,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,OPTUM VA CCN-Commercial, +123757,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,OPTUM VA CCN-Commercial, +123758,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,OPTUM VA CCN-Commercial, +123759,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,OPTUM VA CCN-Commercial, +123760,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,OPTUM VA CCN-Commercial, +123761,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,OPTUM VA CCN-Commercial, +123762,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,OPTUM VA CCN-Commercial, +123763,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,OPTUM VA CCN-Commercial, +123764,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,OPTUM VA CCN-Commercial, +123765,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,OPTUM VA CCN-Commercial, +123766,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,OPTUM VA CCN-Commercial, +123767,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,OPTUM VA CCN-Commercial, +123768,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,OPTUM VA CCN-Commercial, +123769,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,OPTUM VA CCN-Commercial, +123770,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,OPTUM VA CCN-Commercial, +123771,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,OPTUM VA CCN-Commercial, +123772,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,OPTUM VA CCN-Commercial, +123773,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,OPTUM VA CCN-Commercial, +123774,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,OPTUM VA CCN-Commercial, +123775,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,OPTUM VA CCN-Commercial, +123776,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,OPTUM VA CCN-Commercial, +123777,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,OPTUM VA CCN-Commercial, +123778,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,OPTUM VA CCN-Commercial, +123779,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,OPTUM VA CCN-Commercial, +123780,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,OPTUM VA CCN-Commercial, +123781,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,OPTUM VA CCN-Commercial, +123782,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,OPTUM VA CCN-Commercial, +123783,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,OPTUM VA CCN-Commercial, +123784,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,OPTUM VA CCN-Commercial, +123785,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,OPTUM VA CCN-Commercial, +123786,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,OPTUM VA CCN-Commercial, +123787,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,OPTUM VA CCN-Commercial, +123788,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,OPTUM VA CCN-Commercial, +123789,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,OPTUM VA CCN-Commercial, +123790,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,OPTUM VA CCN-Commercial, +123791,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,OPTUM VA CCN-Commercial, +123792,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,OPTUM VA CCN-Commercial, +123793,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,OPTUM VA CCN-Commercial, +123794,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,OPTUM VA CCN-Commercial, +123795,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,OPTUM VA CCN-Commercial, +123796,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,OPTUM VA CCN-Commercial, +123797,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,OPTUM VA CCN-Commercial, +123798,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,OPTUM VA CCN-Commercial, +123799,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,OPTUM VA CCN-Commercial, +123800,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,OPTUM VA CCN-Commercial, +123801,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,OPTUM VA CCN-Commercial, +123802,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,OPTUM VA CCN-Commercial, +123803,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,OPTUM VA CCN-Commercial, +123804,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,OPTUM VA CCN-Commercial, +123805,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,OPTUM VA CCN-Commercial, +123806,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,OPTUM VA CCN-Commercial, +123807,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,OPTUM VA CCN-Commercial, +123808,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,OPTUM VA CCN-Commercial, +123809,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,OPTUM VA CCN-Commercial, +123810,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,OPTUM VA CCN-Commercial, +123811,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,OPTUM VA CCN-Commercial, +123812,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,OPTUM VA CCN-Commercial, +123813,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,OPTUM VA CCN-Commercial, +123814,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,OPTUM VA CCN-Commercial, +123815,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,OPTUM VA CCN-Commercial, +123816,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,OPTUM VA CCN-Commercial, +123817,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,OPTUM VA CCN-Commercial, +123818,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,OPTUM VA CCN-Commercial, +123819,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,OPTUM VA CCN-Commercial, +123820,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,OPTUM VA CCN-Commercial, +123821,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,OPTUM VA CCN-Commercial, +123822,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,OPTUM VA CCN-Commercial, +123823,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,OPTUM VA CCN-Commercial, +123824,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,OPTUM VA CCN-Commercial, +123825,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,OPTUM VA CCN-Commercial, +123826,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,OPTUM VA CCN-Commercial, +123827,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,OPTUM VA CCN-Commercial, +123828,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,OPTUM VA CCN-Commercial, +123829,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,OPTUM VA CCN-Commercial, +123830,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,OPTUM VA CCN-Commercial, +123831,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,OPTUM VA CCN-Commercial, +123832,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,OPTUM VA CCN-Commercial, +123833,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,OPTUM VA CCN-Commercial, +123834,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,OPTUM VA CCN-Commercial, +123835,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,OPTUM VA CCN-Commercial, +123836,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,OPTUM VA CCN-Commercial, +123837,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,OPTUM VA CCN-Commercial, +123838,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,OPTUM VA CCN-Commercial, +123839,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,OPTUM VA CCN-Commercial, +123840,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,OPTUM VA CCN-Commercial, +123841,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,OPTUM VA CCN-Commercial, +123842,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,OPTUM VA CCN-Commercial, +123843,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,OPTUM VA CCN-Commercial, +123844,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,OPTUM VA CCN-Commercial, +123845,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,OPTUM VA CCN-Commercial, +123846,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,OPTUM VA CCN-Commercial, +123847,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,OPTUM VA CCN-Commercial, +123848,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,OPTUM VA CCN-Commercial, +123849,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,OPTUM VA CCN-Commercial, +123850,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,OPTUM VA CCN-Commercial, +123851,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,OPTUM VA CCN-Commercial, +123852,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,OPTUM VA CCN-Commercial, +123853,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,OPTUM VA CCN-Commercial, +123854,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,OPTUM VA CCN-Commercial, +123855,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,OPTUM VA CCN-Commercial, +123856,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,OPTUM VA CCN-Commercial, +123857,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,OPTUM VA CCN-Commercial, +123858,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,OPTUM VA CCN-Commercial, +123859,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,OPTUM VA CCN-Commercial, +123860,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,OPTUM VA CCN-Commercial, +123861,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,OPTUM VA CCN-Commercial, +123862,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,OPTUM VA CCN-Commercial, +123863,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,OPTUM VA CCN-Commercial, +123864,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,OPTUM VA CCN-Commercial, +123865,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,OPTUM VA CCN-Commercial, +123866,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,OPTUM VA CCN-Commercial, +123867,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,OPTUM VA CCN-Commercial, +123868,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,OPTUM VA CCN-Commercial, +123869,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,OPTUM VA CCN-Commercial, +123870,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,OPTUM VA CCN-Commercial, +123871,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,OPTUM VA CCN-Commercial, +123872,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,OPTUM VA CCN-Commercial, +123873,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,OPTUM VA CCN-Commercial, +123874,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,OPTUM VA CCN-Commercial, +123875,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,OPTUM VA CCN-Commercial, +123876,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,OPTUM VA CCN-Commercial, +123877,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,OPTUM VA CCN-Commercial, +123878,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,OPTUM VA CCN-Commercial, +123879,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,OPTUM VA CCN-Commercial, +123880,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,OPTUM VA CCN-Commercial, +123881,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,OPTUM VA CCN-Commercial, +123882,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,OPTUM VA CCN-Commercial, +123883,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,OPTUM VA CCN-Commercial, +123884,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,OPTUM VA CCN-Commercial, +123885,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,OPTUM VA CCN-Commercial, +123886,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,OPTUM VA CCN-Commercial, +123887,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,OPTUM VA CCN-Commercial, +123888,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,OPTUM VA CCN-Commercial, +123889,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,OPTUM VA CCN-Commercial, +123890,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,OPTUM VA CCN-Commercial, +123891,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,OPTUM VA CCN-Commercial, +123892,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,OPTUM VA CCN-Commercial, +123893,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,OPTUM VA CCN-Commercial, +123894,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,OPTUM VA CCN-Commercial, +123895,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,OPTUM VA CCN-Commercial, +123896,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,OPTUM VA CCN-Commercial, +123897,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,OPTUM VA CCN-Commercial, +123898,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,OPTUM VA CCN-Commercial, +123899,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,OPTUM VA CCN-Commercial, +123900,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,OPTUM VA CCN-Commercial, +123901,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,OPTUM VA CCN-Commercial, +123902,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,OPTUM VA CCN-Commercial, +123903,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,OPTUM VA CCN-Commercial, +123904,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,OPTUM VA CCN-Commercial, +123905,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,OPTUM VA CCN-Commercial, +123906,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,OPTUM VA CCN-Commercial, +123907,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,OPTUM VA CCN-Commercial, +123908,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,OPTUM VA CCN-Commercial, +123909,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,OPTUM VA CCN-Commercial, +123910,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,OPTUM VA CCN-Commercial, +123911,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,OPTUM VA CCN-Commercial, +123912,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,OPTUM VA CCN-Commercial, +123913,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,OPTUM VA CCN-Commercial, +123914,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,OPTUM VA CCN-Commercial, +123915,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,OPTUM VA CCN-Commercial, +123916,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,OPTUM VA CCN-Commercial, +123917,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,OPTUM VA CCN-Commercial, +123918,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,OPTUM VA CCN-Commercial, +123919,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,OPTUM VA CCN-Commercial, +123920,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,OPTUM VA CCN-Commercial, +123921,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,OPTUM VA CCN-Commercial, +123922,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,OPTUM VA CCN-Commercial, +123923,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,OPTUM VA CCN-Commercial, +123924,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,OPTUM VA CCN-Commercial, +123925,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,OPTUM VA CCN-Commercial, +123926,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,OPTUM VA CCN-Commercial, +123927,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,OPTUM VA CCN-Commercial, +123928,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,OPTUM VA CCN-Commercial, +123929,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,OPTUM VA CCN-Commercial, +123930,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,OPTUM VA CCN-Commercial, +123931,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,OPTUM VA CCN-Commercial, +123932,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,OPTUM VA CCN-Commercial, +123933,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,OPTUM VA CCN-Commercial, +123934,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,OPTUM VA CCN-Commercial, +123935,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,OPTUM VA CCN-Commercial, +123936,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,OPTUM VA CCN-Commercial, +123937,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,OPTUM VA CCN-Commercial, +123938,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,OPTUM VA CCN-Commercial, +123939,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,OPTUM VA CCN-Commercial, +123940,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,OPTUM VA CCN-Commercial, +123941,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,OPTUM VA CCN-Commercial, +123942,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,OPTUM VA CCN-Commercial, +123943,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,OPTUM VA CCN-Commercial, +123944,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,OPTUM VA CCN-Commercial, +123945,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,OPTUM VA CCN-Commercial, +123946,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,OPTUM VA CCN-Commercial, +123947,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,OPTUM VA CCN-Commercial, +123948,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,OPTUM VA CCN-Commercial, +123949,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,OPTUM VA CCN-Commercial, +123950,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,OPTUM VA CCN-Commercial, +123951,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,OPTUM VA CCN-Commercial, +123952,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,OPTUM VA CCN-Commercial, +123953,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,OPTUM VA CCN-Commercial, +123954,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,OPTUM VA CCN-Commercial, +123955,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,OPTUM VA CCN-Commercial, +123956,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,OPTUM VA CCN-Commercial, +123957,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,OPTUM VA CCN-Commercial, +123958,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,OPTUM VA CCN-Commercial, +123959,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,OPTUM VA CCN-Commercial, +123960,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,OPTUM VA CCN-Commercial, +123961,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,OPTUM VA CCN-Commercial, +123962,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,OPTUM VA CCN-Commercial, +123963,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,OPTUM VA CCN-Commercial, +123964,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,OPTUM VA CCN-Commercial, +123965,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,OPTUM VA CCN-Commercial, +123966,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,OPTUM VA CCN-Commercial, +123967,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,OPTUM VA CCN-Commercial, +123968,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,OPTUM VA CCN-Commercial, +123969,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,OPTUM VA CCN-Commercial, +123970,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,OPTUM VA CCN-Commercial, +123971,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,OPTUM VA CCN-Commercial, +123972,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,OPTUM VA CCN-Commercial, +123973,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,OPTUM VA CCN-Commercial, +123974,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,OPTUM VA CCN-Commercial, +123975,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,OPTUM VA CCN-Commercial, +123976,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,OPTUM VA CCN-Commercial, +123977,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,OPTUM VA CCN-Commercial, +123978,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,OPTUM VA CCN-Commercial, +123979,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,OPTUM VA CCN-Commercial, +123980,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,OPTUM VA CCN-Commercial, +123981,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,OPTUM VA CCN-Commercial, +123982,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,OPTUM VA CCN-Commercial, +123983,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,OPTUM VA CCN-Commercial, +123984,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,OPTUM VA CCN-Commercial, +123985,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,OPTUM VA CCN-Commercial, +123986,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,OPTUM VA CCN-Commercial, +123987,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,OPTUM VA CCN-Commercial, +123988,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,OPTUM VA CCN-Commercial, +123989,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,OPTUM VA CCN-Commercial, +123990,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,OPTUM VA CCN-Commercial, +123991,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,OPTUM VA CCN-Commercial, +123992,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,OPTUM VA CCN-Commercial, +123993,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,OPTUM VA CCN-Commercial, +123994,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,OPTUM VA CCN-Commercial, +123995,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,OPTUM VA CCN-Commercial, +123996,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,OPTUM VA CCN-Commercial, +123997,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,OPTUM VA CCN-Commercial, +123998,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,OPTUM VA CCN-Commercial, +123999,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,OPTUM VA CCN-Commercial, +124000,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,OPTUM VA CCN-Commercial, +124001,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,OPTUM VA CCN-Commercial, +124002,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,OPTUM VA CCN-Commercial, +124003,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,OPTUM VA CCN-Commercial, +124004,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,OPTUM VA CCN-Commercial, +124005,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,OPTUM VA CCN-Commercial, +124006,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,OPTUM VA CCN-Commercial, +124007,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,OPTUM VA CCN-Commercial, +124008,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,OPTUM VA CCN-Commercial, +124009,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,OPTUM VA CCN-Commercial, +124010,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,OPTUM VA CCN-Commercial, +124011,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,OPTUM VA CCN-Commercial, +124012,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,OPTUM VA CCN-Commercial, +124013,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,OPTUM VA CCN-Commercial, +124014,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,OPTUM VA CCN-Commercial, +124015,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,OPTUM VA CCN-Commercial, +124016,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,OPTUM VA CCN-Commercial, +124017,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,OPTUM VA CCN-Commercial, +124018,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,OPTUM VA CCN-Commercial, +124019,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,OPTUM VA CCN-Commercial, +124020,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,OPTUM VA CCN-Commercial, +124021,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,OPTUM VA CCN-Commercial, +124022,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,OPTUM VA CCN-Commercial, +124023,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,OPTUM VA CCN-Commercial, +124024,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,OPTUM VA CCN-Commercial, +124025,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,OPTUM VA CCN-Commercial, +124026,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,OPTUM VA CCN-Commercial, +124027,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,OPTUM VA CCN-Commercial, +124028,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,OPTUM VA CCN-Commercial, +124029,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,OPTUM VA CCN-Commercial, +124030,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,OPTUM VA CCN-Commercial, +124031,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,OPTUM VA CCN-Commercial, +124032,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,OPTUM VA CCN-Commercial, +124033,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,OPTUM VA CCN-Commercial, +124034,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,OPTUM VA CCN-Commercial, +124035,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,OPTUM VA CCN-Commercial, +124036,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,OPTUM VA CCN-Commercial, +124037,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,OPTUM VA CCN-Commercial, +124038,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,OPTUM VA CCN-Commercial, +124039,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,OPTUM VA CCN-Commercial, +124040,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,OPTUM VA CCN-Commercial, +124041,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,OPTUM VA CCN-Commercial, +124042,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,OPTUM VA CCN-Commercial, +124043,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,OPTUM VA CCN-Commercial, +124044,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,OPTUM VA CCN-Commercial, +124045,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,OPTUM VA CCN-Commercial, +124046,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,OPTUM VA CCN-Commercial, +124047,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,OPTUM VA CCN-Commercial, +124048,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,OPTUM VA CCN-Commercial, +124049,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,OPTUM VA CCN-Commercial, +124050,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,OPTUM VA CCN-Commercial, +124051,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,OPTUM VA CCN-Commercial, +124052,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,OPTUM VA CCN-Commercial, +124053,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,OPTUM VA CCN-Commercial, +124054,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,OPTUM VA CCN-Commercial, +124055,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,OPTUM VA CCN-Commercial, +124056,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,OPTUM VA CCN-Commercial, +124057,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,OPTUM VA CCN-Commercial, +124058,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,OPTUM VA CCN-Commercial, +124059,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,OPTUM VA CCN-Commercial, +124060,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,OPTUM VA CCN-Commercial, +124061,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,OPTUM VA CCN-Commercial, +124062,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,OPTUM VA CCN-Commercial, +124063,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,OPTUM VA CCN-Commercial, +124064,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,OPTUM VA CCN-Commercial, +124065,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,OPTUM VA CCN-Commercial, +124066,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,OPTUM VA CCN-Commercial, +124067,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,OPTUM VA CCN-Commercial, +124068,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,OPTUM VA CCN-Commercial, +124069,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,OPTUM VA CCN-Commercial, +124070,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,OPTUM VA CCN-Commercial, +124071,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,OPTUM VA CCN-Commercial, +124072,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,OPTUM VA CCN-Commercial, +124073,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,OPTUM VA CCN-Commercial, +124074,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,OPTUM VA CCN-Commercial, +124075,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,OPTUM VA CCN-Commercial, +124076,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,OPTUM VA CCN-Commercial, +124077,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,OPTUM VA CCN-Commercial, +124078,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,OPTUM VA CCN-Commercial, +124079,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,OPTUM VA CCN-Commercial, +124080,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,OPTUM VA CCN-Commercial, +124081,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,OPTUM VA CCN-Commercial, +124082,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,OPTUM VA CCN-Commercial, +124083,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,OPTUM VA CCN-Commercial, +124084,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,OPTUM VA CCN-Commercial, +124085,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,OPTUM VA CCN-Commercial, +124086,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,OPTUM VA CCN-Commercial, +124087,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,OPTUM VA CCN-Commercial, +124088,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,OPTUM VA CCN-Commercial, +124089,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,OPTUM VA CCN-Commercial, +124090,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,OPTUM VA CCN-Commercial, +124091,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,OPTUM VA CCN-Commercial, +124092,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,OPTUM VA CCN-Commercial, +124093,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,OPTUM VA CCN-Commercial, +124094,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,OPTUM VA CCN-Commercial, +124095,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,OPTUM VA CCN-Commercial, +124096,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,OPTUM VA CCN-Commercial, +124097,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,OPTUM VA CCN-Commercial, +124098,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,OPTUM VA CCN-Commercial, +124099,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,OPTUM VA CCN-Commercial, +124100,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,OPTUM VA CCN-Commercial, +124101,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,OPTUM VA CCN-Commercial, +124102,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,OPTUM VA CCN-Commercial, +124103,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,OPTUM VA CCN-Commercial, +124104,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,OPTUM VA CCN-Commercial, +124105,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,OPTUM VA CCN-Commercial, +124106,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,OPTUM VA CCN-Commercial, +124107,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,OPTUM VA CCN-Commercial, +124108,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,OPTUM VA CCN-Commercial, +124109,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,OPTUM VA CCN-Commercial, +124110,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,OPTUM VA CCN-Commercial, +124111,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,OPTUM VA CCN-Commercial, +124112,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,OPTUM VA CCN-Commercial, +124113,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,OPTUM VA CCN-Commercial, +124114,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,OPTUM VA CCN-Commercial, +124115,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,OPTUM VA CCN-Commercial, +124116,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,OPTUM VA CCN-Commercial, +124117,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,OPTUM VA CCN-Commercial, +124118,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,OPTUM VA CCN-Commercial, +124119,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,OPTUM VA CCN-Commercial, +124120,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,OPTUM VA CCN-Commercial, +124121,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,OPTUM VA CCN-Commercial, +124122,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,OPTUM VA CCN-Commercial, +124123,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,OPTUM VA CCN-Commercial, +124124,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,OPTUM VA CCN-Commercial, +124125,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,OPTUM VA CCN-Commercial, +124126,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,OPTUM VA CCN-Commercial, +124127,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,OPTUM VA CCN-Commercial, +124128,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,OPTUM VA CCN-Commercial, +124129,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,OPTUM VA CCN-Commercial, +124130,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,OPTUM VA CCN-Commercial, +124131,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,OPTUM VA CCN-Commercial, +124132,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,OPTUM VA CCN-Commercial, +124133,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,OPTUM VA CCN-Commercial, +124134,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,OPTUM VA CCN-Commercial, +124135,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,OPTUM VA CCN-Commercial, +124136,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,OPTUM VA CCN-Commercial, +124137,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,OPTUM VA CCN-Commercial, +124138,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,OPTUM VA CCN-Commercial, +124139,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,OPTUM VA CCN-Commercial, +124140,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,OPTUM VA CCN-Commercial, +124141,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,OPTUM VA CCN-Commercial, +124142,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,OPTUM VA CCN-Commercial, +124143,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,OPTUM VA CCN-Commercial, +124144,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,OPTUM VA CCN-Commercial, +124145,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,OPTUM VA CCN-Commercial, +124146,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,OPTUM VA CCN-Commercial, +124147,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,OPTUM VA CCN-Commercial, +124148,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,OPTUM VA CCN-Commercial, +124149,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,OPTUM VA CCN-Commercial, +124150,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,OPTUM VA CCN-Commercial, +124151,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,OPTUM VA CCN-Commercial, +124152,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,OPTUM VA CCN-Commercial, +124153,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,OPTUM VA CCN-Commercial, +124154,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,OPTUM VA CCN-Commercial, +124155,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,OPTUM VA CCN-Commercial, +124156,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,OPTUM VA CCN-Commercial, +124157,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,OPTUM VA CCN-Commercial, +124158,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,OPTUM VA CCN-Commercial, +124159,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,OPTUM VA CCN-Commercial, +124160,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,OPTUM VA CCN-Commercial, +124161,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,OPTUM VA CCN-Commercial, +124162,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,OPTUM VA CCN-Commercial, +124163,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,OPTUM VA CCN-Commercial, +124164,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,OPTUM VA CCN-Commercial, +124165,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,OPTUM VA CCN-Commercial, +124166,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,OPTUM VA CCN-Commercial, +124167,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,OPTUM VA CCN-Commercial, +124168,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,OPTUM VA CCN-Commercial, +124169,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,OPTUM VA CCN-Commercial, +124170,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,OPTUM VA CCN-Commercial, +124171,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,OPTUM VA CCN-Commercial, +124172,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,OPTUM VA CCN-Commercial, +124173,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,OPTUM VA CCN-Commercial, +124174,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,OPTUM VA CCN-Commercial, +124175,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,OPTUM VA CCN-Commercial, +124176,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,OPTUM VA CCN-Commercial, +124177,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,OPTUM VA CCN-Commercial, +124178,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,OPTUM VA CCN-Commercial, +124179,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,OPTUM VA CCN-Commercial, +124180,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,OPTUM VA CCN-Commercial, +124181,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,OPTUM VA CCN-Commercial, +124182,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,OPTUM VA CCN-Commercial, +124183,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,OPTUM VA CCN-Commercial, +124184,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,OPTUM VA CCN-Commercial, +124185,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,OPTUM VA CCN-Commercial, +124186,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,OPTUM VA CCN-Commercial, +124187,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,OPTUM VA CCN-Commercial, +124188,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,OPTUM VA CCN-Commercial, +124189,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,OPTUM VA CCN-Commercial, +124190,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,OPTUM VA CCN-Commercial, +124191,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,OPTUM VA CCN-Commercial, +124192,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,OPTUM VA CCN-Commercial, +124193,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,OPTUM VA CCN-Commercial, +124194,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,OPTUM VA CCN-Commercial, +124195,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,OPTUM VA CCN-Commercial, +124196,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,OPTUM VA CCN-Commercial, +124197,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,OPTUM VA CCN-Commercial, +124198,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,OPTUM VA CCN-Commercial, +124199,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,OPTUM VA CCN-Commercial, +124200,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,OPTUM VA CCN-Commercial, +124201,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,OPTUM VA CCN-Commercial, +124202,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,OPTUM VA CCN-Commercial, +124203,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,OPTUM VA CCN-Commercial, +124204,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,OPTUM VA CCN-Commercial, +124205,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,OPTUM VA CCN-Commercial, +124206,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,OPTUM VA CCN-Commercial, +124207,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,OPTUM VA CCN-Commercial, +124208,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,OPTUM VA CCN-Commercial, +124209,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,OPTUM VA CCN-Commercial, +124210,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,OPTUM VA CCN-Commercial, +124211,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,OPTUM VA CCN-Commercial, +124212,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,OPTUM VA CCN-Commercial, +124213,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,OPTUM VA CCN-Commercial, +124214,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,OPTUM VA CCN-Commercial, +124215,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,OPTUM VA CCN-Commercial, +124216,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,OPTUM VA CCN-Commercial, +124217,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,OPTUM VA CCN-Commercial, +124218,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,OPTUM VA CCN-Commercial, +124219,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,OPTUM VA CCN-Commercial, +124220,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,OPTUM VA CCN-Commercial, +124221,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,OPTUM VA CCN-Commercial, +124222,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,OPTUM VA CCN-Commercial, +124223,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,OPTUM VA CCN-Commercial, +124224,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,OPTUM VA CCN-Commercial, +124225,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,OPTUM VA CCN-Commercial, +124226,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,OPTUM VA CCN-Commercial, +124227,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,OPTUM VA CCN-Commercial, +124228,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,OPTUM VA CCN-Commercial, +124229,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,OPTUM VA CCN-Commercial, +124230,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,OPTUM VA CCN-Commercial, +124231,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,OPTUM VA CCN-Commercial, +124232,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,OPTUM VA CCN-Commercial, +124233,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,OPTUM VA CCN-Commercial, +124234,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,OPTUM VA CCN-Commercial, +124235,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,OPTUM VA CCN-Commercial, +124236,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,OPTUM VA CCN-Commercial, +124237,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,OPTUM VA CCN-Commercial, +124238,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,OPTUM VA CCN-Commercial, +124239,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,OPTUM VA CCN-Commercial, +124240,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,OPTUM VA CCN-Commercial, +124241,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,OPTUM VA CCN-Commercial, +124242,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,OPTUM VA CCN-Commercial, +124243,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,OPTUM VA CCN-Commercial, +124244,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,OPTUM VA CCN-Commercial, +124245,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,OPTUM VA CCN-Commercial, +124246,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,OPTUM VA CCN-Commercial, +124247,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,OPTUM VA CCN-Commercial, +124248,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,OPTUM VA CCN-Commercial, +124249,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,OPTUM VA CCN-Commercial, +124250,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,OPTUM VA CCN-Commercial, +124251,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,OPTUM VA CCN-Commercial, +124252,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,OPTUM VA CCN-Commercial, +124253,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,OPTUM VA CCN-Commercial, +124254,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,OPTUM VA CCN-Commercial, +124255,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,OPTUM VA CCN-Commercial, +124256,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,OPTUM VA CCN-Commercial, +124257,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,OPTUM VA CCN-Commercial, +124258,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,OPTUM VA CCN-Commercial, +124259,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,OPTUM VA CCN-Commercial, +124260,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,OPTUM VA CCN-Commercial, +124261,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,OPTUM VA CCN-Commercial, +124262,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,OPTUM VA CCN-Commercial, +124263,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,OPTUM VA CCN-Commercial, +124264,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,OPTUM VA CCN-Commercial, +124265,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,OPTUM VA CCN-Commercial, +124266,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,OPTUM VA CCN-Commercial, +124267,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,OPTUM VA CCN-Commercial, +124268,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,OPTUM VA CCN-Commercial, +124269,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,OPTUM VA CCN-Commercial, +124270,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,OPTUM VA CCN-Commercial, +124271,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,OPTUM VA CCN-Commercial, +124272,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,OPTUM VA CCN-Commercial, +124273,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,OPTUM VA CCN-Commercial, +124274,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,OPTUM VA CCN-Commercial, +124275,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,OPTUM VA CCN-Commercial, +124276,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,OPTUM VA CCN-Commercial, +124277,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,OPTUM VA CCN-Commercial, +124278,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,OPTUM VA CCN-Commercial, +124279,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,OPTUM VA CCN-Commercial, +124280,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,OPTUM VA CCN-Commercial, +124281,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,OPTUM VA CCN-Commercial, +124282,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,OPTUM VA CCN-Commercial, +124283,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,OPTUM VA CCN-Commercial, +124284,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,OPTUM VA CCN-Commercial, +124285,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,OPTUM VA CCN-Commercial, +124286,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,OPTUM VA CCN-Commercial, +124287,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,OPTUM VA CCN-Commercial, +124288,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,OPTUM VA CCN-Commercial, +124289,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,OPTUM VA CCN-Commercial, +124290,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,OPTUM VA CCN-Commercial, +124291,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,OPTUM VA CCN-Commercial, +124292,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,OPTUM VA CCN-Commercial, +124293,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,OPTUM VA CCN-Commercial, +124294,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,OPTUM VA CCN-Commercial, +124295,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,OPTUM VA CCN-Commercial, +124296,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,OPTUM VA CCN-Commercial, +124297,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,OPTUM VA CCN-Commercial, +124298,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,OPTUM VA CCN-Commercial, +124299,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,OPTUM VA CCN-Commercial, +124300,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,OPTUM VA CCN-Commercial, +124301,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,OPTUM VA CCN-Commercial, +124302,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,OPTUM VA CCN-Commercial, +124303,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,OPTUM VA CCN-Commercial, +124304,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,OPTUM VA CCN-Commercial, +124305,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,OPTUM VA CCN-Commercial, +124306,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,OPTUM VA CCN-Commercial, +124307,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,OPTUM VA CCN-Commercial, +124308,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,OPTUM VA CCN-Commercial, +124309,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,OPTUM VA CCN-Commercial, +124310,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,OPTUM VA CCN-Commercial, +124311,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,OPTUM VA CCN-Commercial, +124312,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,OPTUM VA CCN-Commercial, +124313,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,OPTUM VA CCN-Commercial, +124314,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,OPTUM VA CCN-Commercial, +124315,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,OPTUM VA CCN-Commercial, +124316,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,OPTUM VA CCN-Commercial, +124317,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,OPTUM VA CCN-Commercial, +124318,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,OPTUM VA CCN-Commercial, +124319,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,OPTUM VA CCN-Commercial, +124320,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,OPTUM VA CCN-Commercial, +124321,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,OPTUM VA CCN-Commercial, +124322,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,OPTUM VA CCN-Commercial, +124323,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,OPTUM VA CCN-Commercial, +124324,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,OPTUM VA CCN-Commercial, +124325,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,OPTUM VA CCN-Commercial, +124326,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,OPTUM VA CCN-Commercial, +124327,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,OPTUM VA CCN-Commercial, +124328,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,OPTUM VA CCN-Commercial, +124329,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,OPTUM VA CCN-Commercial, +124330,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,OPTUM VA CCN-Commercial, +124331,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,OPTUM VA CCN-Commercial, +124332,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,OPTUM VA CCN-Commercial, +124333,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,OPTUM VA CCN-Commercial, +124334,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,OPTUM VA CCN-Commercial, +124335,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,OPTUM VA CCN-Commercial, +124336,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,OPTUM VA CCN-Commercial, +124337,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,OPTUM VA CCN-Commercial, +124338,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,OPTUM VA CCN-Commercial, +124339,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,OPTUM VA CCN-Commercial, +124340,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,OPTUM VA CCN-Commercial, +124341,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,OPTUM VA CCN-Commercial, +124342,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,OPTUM VA CCN-Commercial, +124343,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,OPTUM VA CCN-Commercial, +124344,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,OPTUM VA CCN-Commercial, +124345,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,OPTUM VA CCN-Commercial, +124346,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,OPTUM VA CCN-Commercial, +124347,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,OPTUM VA CCN-Commercial, +124348,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,OPTUM VA CCN-Commercial, +124349,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,OPTUM VA CCN-Commercial, +124350,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,OPTUM VA CCN-Commercial, +124351,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,OPTUM VA CCN-Commercial, +124352,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,OPTUM VA CCN-Commercial, +124353,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,OPTUM VA CCN-Commercial, +124354,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,OPTUM VA CCN-Commercial, +124355,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,OPTUM VA CCN-Commercial, +124356,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,OPTUM VA CCN-Commercial, +124357,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,OPTUM VA CCN-Commercial, +124358,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,OPTUM VA CCN-Commercial, +124359,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,OPTUM VA CCN-Commercial, +124360,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,OPTUM VA CCN-Commercial, +124361,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,OPTUM VA CCN-Commercial, +124362,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,OPTUM VA CCN-Commercial, +124363,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,OPTUM VA CCN-Commercial, +124364,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,OPTUM VA CCN-Commercial, +124365,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,OPTUM VA CCN-Commercial, +124366,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,OPTUM VA CCN-Commercial, +124367,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,OPTUM VA CCN-Commercial, +124368,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,OPTUM VA CCN-Commercial, +124369,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,OPTUM VA CCN-Commercial, +124370,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,OPTUM VA CCN-Commercial, +124371,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,OPTUM VA CCN-Commercial, +124372,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,OPTUM VA CCN-Commercial, +124373,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,OPTUM VA CCN-Commercial, +124374,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,OPTUM VA CCN-Commercial, +124375,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,OPTUM VA CCN-Commercial, +124376,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,OPTUM VA CCN-Commercial, +124377,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,OPTUM VA CCN-Commercial, +124378,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,OPTUM VA CCN-Commercial, +124379,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,OPTUM VA CCN-Commercial, +124380,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,OPTUM VA CCN-Commercial, +124381,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,OPTUM VA CCN-Commercial, +124382,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,OPTUM VA CCN-Commercial, +124383,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,OPTUM VA CCN-Commercial, +124384,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,OPTUM VA CCN-Commercial, +124385,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,OPTUM VA CCN-Commercial, +124386,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,OPTUM VA CCN-Commercial, +124387,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,OPTUM VA CCN-Commercial, +124388,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,OPTUM VA CCN-Commercial, +124389,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,OPTUM VA CCN-Commercial, +124390,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,OPTUM VA CCN-Commercial, +124391,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,OPTUM VA CCN-Commercial, +124392,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,OPTUM VA CCN-Commercial, +124393,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,OPTUM VA CCN-Commercial, +124394,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,OPTUM VA CCN-Commercial, +124395,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,OPTUM VA CCN-Commercial, +124396,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,OPTUM VA CCN-Commercial, +124397,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,OPTUM VA CCN-Commercial, +124398,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,OPTUM VA CCN-Commercial, +124399,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,OPTUM VA CCN-Commercial, +124400,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,OPTUM VA CCN-Commercial, +124401,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,OPTUM VA CCN-Commercial, +124402,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,OPTUM VA CCN-Commercial, +124403,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,OPTUM VA CCN-Commercial, +124404,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,OPTUM VA CCN-Commercial, +124405,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,OPTUM VA CCN-Commercial, +124406,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,OPTUM VA CCN-Commercial, +124407,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,OPTUM VA CCN-Commercial, +124408,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,OPTUM VA CCN-Commercial, +124409,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,OPTUM VA CCN-Commercial, +124410,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,OPTUM VA CCN-Commercial, +124411,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,OPTUM VA CCN-Commercial, +124412,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,OPTUM VA CCN-Commercial, +124413,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,OPTUM VA CCN-Commercial, +124414,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,OPTUM VA CCN-Commercial, +124415,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,OPTUM VA CCN-Commercial, +124416,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,OPTUM VA CCN-Commercial, +124417,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,OPTUM VA CCN-Commercial, +124418,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,OPTUM VA CCN-Commercial, +124419,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,OPTUM VA CCN-Commercial, +124420,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,OPTUM VA CCN-Commercial, +124421,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,OPTUM VA CCN-Commercial, +124422,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,OPTUM VA CCN-Commercial, +124423,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,OPTUM VA CCN-Commercial, +124424,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,OPTUM VA CCN-Commercial, +124425,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,OPTUM VA CCN-Commercial, +124426,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,OPTUM VA CCN-Commercial, +124427,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,OPTUM VA CCN-Commercial, +124428,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,OPTUM VA CCN-Commercial, +124429,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,OPTUM VA CCN-Commercial, +124430,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,OPTUM VA CCN-Commercial, +124431,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,OPTUM VA CCN-Commercial, +124432,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,OPTUM VA CCN-Commercial, +124433,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,OPTUM VA CCN-Commercial, +124434,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,OPTUM VA CCN-Commercial, +124435,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,OPTUM VA CCN-Commercial, +124436,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,OPTUM VA CCN-Commercial, +124437,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,OPTUM VA CCN-Commercial, +124438,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,OPTUM VA CCN-Commercial, +124439,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,OPTUM VA CCN-Commercial, +124440,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,OPTUM VA CCN-Commercial, +124441,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,OPTUM VA CCN-Commercial, +124442,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,OPTUM VA CCN-Commercial, +124443,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,OPTUM VA CCN-Commercial, +124444,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,OPTUM VA CCN-Commercial, +124445,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,OPTUM VA CCN-Commercial, +124446,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,OPTUM VA CCN-Commercial, +124447,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,OPTUM VA CCN-Commercial, +124448,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,OPTUM VA CCN-Commercial, +124449,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,OPTUM VA CCN-Commercial, +124450,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,OPTUM VA CCN-Commercial, +124451,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,OPTUM VA CCN-Commercial, +124452,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,OPTUM VA CCN-Commercial, +124453,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,OPTUM VA CCN-Commercial, +124454,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,OPTUM VA CCN-Commercial, +124455,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,OPTUM VA CCN-Commercial, +124456,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,OPTUM VA CCN-Commercial, +124457,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,OPTUM VA CCN-Commercial, +124458,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,OPTUM VA CCN-Commercial, +124459,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,OPTUM VA CCN-Commercial, +124460,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,OPTUM VA CCN-Commercial, +124461,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,OPTUM VA CCN-Commercial, +124462,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,OPTUM VA CCN-Commercial, +124463,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,OPTUM VA CCN-Commercial, +124464,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,OPTUM VA CCN-Commercial, +124465,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,OPTUM VA CCN-Commercial, +124466,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,OPTUM VA CCN-Commercial, +124467,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,OPTUM VA CCN-Commercial, +124468,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,OPTUM VA CCN-Commercial, +124469,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,OPTUM VA CCN-Commercial, +124470,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,OPTUM VA CCN-Commercial, +124471,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,OPTUM VA CCN-Commercial, +124472,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,OPTUM VA CCN-Commercial, +124473,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,OPTUM VA CCN-Commercial, +124474,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,OPTUM VA CCN-Commercial, +124475,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,OPTUM VA CCN-Commercial, +124476,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,OPTUM VA CCN-Commercial, +124477,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,OPTUM VA CCN-Commercial, +124478,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,OPTUM VA CCN-Commercial, +124479,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,OPTUM VA CCN-Commercial, +124480,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,OPTUM VA CCN-Commercial, +124481,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,OPTUM VA CCN-Commercial, +124482,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,OPTUM VA CCN-Commercial, +124483,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,OPTUM VA CCN-Commercial, +124484,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,OPTUM VA CCN-Commercial, +124485,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,OPTUM VA CCN-Commercial, +124486,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,OPTUM VA CCN-Commercial, +124487,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,OPTUM VA CCN-Commercial, +124488,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,OPTUM VA CCN-Commercial, +124489,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,OPTUM VA CCN-Commercial, +124490,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,OPTUM VA CCN-Commercial, +124491,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,OPTUM VA CCN-Commercial, +124492,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,OPTUM VA CCN-Commercial, +124493,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,OPTUM VA CCN-Commercial, +124494,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,OPTUM VA CCN-Commercial, +124495,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,OPTUM VA CCN-Commercial, +124496,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,OPTUM VA CCN-Commercial, +124497,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,OPTUM VA CCN-Commercial, +124498,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,OPTUM VA CCN-Commercial, +124499,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,OPTUM VA CCN-Commercial, +124500,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,OPTUM VA CCN-Commercial, +124501,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,OPTUM VA CCN-Commercial, +124502,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,OPTUM VA CCN-Commercial, +124503,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,OPTUM VA CCN-Commercial, +124504,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,OPTUM VA CCN-Commercial, +124505,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,OPTUM VA CCN-Commercial, +124506,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,OPTUM VA CCN-Commercial, +124507,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,OPTUM VA CCN-Commercial, +124508,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,OPTUM VA CCN-Commercial, +124509,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,OPTUM VA CCN-Commercial, +124510,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,OPTUM VA CCN-Commercial, +124511,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,OPTUM VA CCN-Commercial, +124512,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,OPTUM VA CCN-Commercial, +124513,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,OPTUM VA CCN-Commercial, +124514,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,OPTUM VA CCN-Commercial, +124515,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,OPTUM VA CCN-Commercial, +124516,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,OPTUM VA CCN-Commercial, +124517,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,OPTUM VA CCN-Commercial, +124518,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,OPTUM VA CCN-Commercial, +124519,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,OPTUM VA CCN-Commercial, +124520,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,OPTUM VA CCN-Commercial, +124521,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,OPTUM VA CCN-Commercial, +124522,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,OPTUM VA CCN-Commercial, +124523,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,OPTUM VA CCN-Commercial, +124524,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,OPTUM VA CCN-Commercial, +124525,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,OPTUM VA CCN-Commercial, +124526,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,OPTUM VA CCN-Commercial, +124527,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,OPTUM VA CCN-Commercial, +124528,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,OPTUM VA CCN-Commercial, +124529,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,OPTUM VA CCN-Commercial, +124530,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,OPTUM VA CCN-Commercial, +124531,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,OPTUM VA CCN-Commercial, +124532,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,OPTUM VA CCN-Commercial, +124533,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,OPTUM VA CCN-Commercial, +124534,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,OPTUM VA CCN-Commercial, +124535,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,OPTUM VA CCN-Commercial, +124536,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,OPTUM VA CCN-Commercial, +124537,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,OPTUM VA CCN-Commercial, +124538,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,OPTUM VA CCN-Commercial, +124539,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,OPTUM VA CCN-Commercial, +124540,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,OPTUM VA CCN-Commercial, +124541,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,OPTUM VA CCN-Commercial, +124542,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,OPTUM VA CCN-Commercial, +124543,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,OPTUM VA CCN-Commercial, +124544,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,OPTUM VA CCN-Commercial, +124545,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,OPTUM VA CCN-Commercial, +124546,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,OPTUM VA CCN-Commercial, +124547,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,OPTUM VA CCN-Commercial, +124548,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,OPTUM VA CCN-Commercial, +124549,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,OPTUM VA CCN-Commercial, +124550,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,OPTUM VA CCN-Commercial, +124551,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,OPTUM VA CCN-Commercial, +124552,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,OPTUM VA CCN-Commercial, +124553,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,OPTUM VA CCN-Commercial, +124554,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,OPTUM VA CCN-Commercial, +124555,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,OPTUM VA CCN-Commercial, +124556,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,OPTUM VA CCN-Commercial, +124557,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,OPTUM VA CCN-Commercial, +124558,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,OPTUM VA CCN-Commercial, +124559,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,OPTUM VA CCN-Commercial, +124560,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,OPTUM VA CCN-Commercial, +124561,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,OPTUM VA CCN-Commercial, +124562,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,OPTUM VA CCN-Commercial, +124563,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,OPTUM VA CCN-Commercial, +124564,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,OPTUM VA CCN-Commercial, +124565,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,OPTUM VA CCN-Commercial, +124566,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,OPTUM VA CCN-Commercial, +124567,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,OPTUM VA CCN-Commercial, +124568,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,OPTUM VA CCN-Commercial, +124569,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,OPTUM VA CCN-Commercial, +124570,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,OPTUM VA CCN-Commercial, +124571,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,OPTUM VA CCN-Commercial, +124572,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,OPTUM VA CCN-Commercial, +124573,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,OPTUM VA CCN-Commercial, +124574,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,OPTUM VA CCN-Commercial, +124575,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,OPTUM VA CCN-Commercial, +124576,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,OPTUM VA CCN-Commercial, +124577,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,OPTUM VA CCN-Commercial, +124578,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,OPTUM VA CCN-Commercial, +124579,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,OPTUM VA CCN-Commercial, +124580,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,OPTUM VA CCN-Commercial, +124581,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,OPTUM VA CCN-Commercial, +124582,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,OPTUM VA CCN-Commercial, +124583,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,OPTUM VA CCN-Commercial, +124584,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,OPTUM VA CCN-Commercial, +124585,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,OPTUM VA CCN-Commercial, +124586,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,OPTUM VA CCN-Commercial, +124587,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,OPTUM VA CCN-Commercial, +124588,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,OPTUM VA CCN-Commercial, +124589,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,OPTUM VA CCN-Commercial, +124590,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,OPTUM VA CCN-Commercial, +124591,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,OPTUM VA CCN-Commercial, +124592,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,OPTUM VA CCN-Commercial, +124593,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,OPTUM VA CCN-Commercial, +124594,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,OPTUM VA CCN-Commercial, +124595,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,OPTUM VA CCN-Commercial, +124596,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,OPTUM VA CCN-Commercial, +124597,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,OPTUM VA CCN-Commercial, +124598,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,OPTUM VA CCN-Commercial, +124599,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,OPTUM VA CCN-Commercial, +124600,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,OPTUM VA CCN-Commercial, +124601,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124602,3934,30000012,PRIVATE,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124603,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124604,3934,30000038,ICU,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124605,3934,30000046,BURN UNIT,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124606,3934,30000053,NICU,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124607,3934,30000061,ICR ROOM,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124608,3934,30000079,PSYCH,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124609,3934,30000087,NEWBORN,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +124610,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124611,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124612,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124613,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124614,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124615,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124616,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124617,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124618,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124619,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124620,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124621,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124622,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124623,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124624,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124625,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124626,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124627,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124628,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124629,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124630,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124631,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124632,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124633,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124634,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124635,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124636,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124637,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124638,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124639,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124640,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124641,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124642,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124643,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124644,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124645,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124646,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124647,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124648,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124649,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124650,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124651,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124652,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124653,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124654,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124655,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124656,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124657,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124658,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124659,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124660,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124661,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124662,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124663,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124664,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124665,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124666,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124667,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124668,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124669,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124670,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124671,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124672,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124673,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124674,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124675,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124676,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124677,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124678,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124679,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124680,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124681,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124682,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124683,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124684,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124685,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124686,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124687,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124688,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124689,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124690,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124691,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124692,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124693,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124694,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124695,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124696,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124697,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124698,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124699,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124700,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124701,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124702,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124703,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124704,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124705,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124706,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124707,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124708,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124709,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124710,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124711,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124712,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124713,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124714,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124715,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124716,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124717,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124718,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124719,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124720,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124721,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124722,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124723,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124724,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124725,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124726,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124727,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124728,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124729,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124730,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124731,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124732,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124733,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124734,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, 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CCN-Commercial, +124747,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124748,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124749,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124750,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124751,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124752,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124753,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124754,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124755,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124756,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124757,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124758,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124759,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124760,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124761,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124762,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124763,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124764,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124765,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124766,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124767,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124768,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124769,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, 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OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124793,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124794,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124795,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124796,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124797,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124798,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124799,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124800,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124801,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124802,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124803,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124804,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124805,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124806,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124807,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124808,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124809,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124810,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124811,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124812,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124813,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124814,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124815,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124816,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124817,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124818,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +124819,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124820,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124821,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124822,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124823,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124824,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124825,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124826,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124827,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124828,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124829,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124830,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124831,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124832,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124833,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124834,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124835,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124836,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124837,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124838,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124839,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124840,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124841,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124842,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124843,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124844,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124845,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124846,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124847,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124848,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124849,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124850,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124851,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124852,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124853,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124854,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124855,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124856,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124857,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124858,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124859,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124860,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124861,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124862,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124863,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124864,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124865,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124866,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124867,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124868,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124869,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124870,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124871,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124872,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124873,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124874,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124875,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124876,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124877,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124878,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124879,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124880,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124881,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124882,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124883,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124884,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124885,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124886,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124887,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124888,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124889,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124890,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124891,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124892,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124893,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124894,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124895,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124896,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124897,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124898,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124899,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124900,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124901,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124902,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124903,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124904,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124905,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124906,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124907,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124908,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124909,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124910,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124911,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124912,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124913,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124914,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124915,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124916,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124917,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124918,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124919,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124920,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124921,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124922,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124923,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124924,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124925,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124926,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124927,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124928,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124929,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124930,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +124931,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124932,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124933,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124934,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124935,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124936,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124937,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124938,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124939,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124940,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124941,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124942,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124943,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124944,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124945,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124946,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124947,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124948,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124949,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124950,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124951,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124952,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124953,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124954,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124955,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124956,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124957,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124958,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124959,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124960,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124961,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124962,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124963,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124964,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124965,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124966,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124967,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124968,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124969,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124970,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124971,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124972,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124973,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124974,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124975,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124976,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124977,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124978,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124979,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124980,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124981,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124982,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124983,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124984,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124985,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124986,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124987,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124988,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124989,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124990,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +124991,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +124992,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124993,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124994,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124995,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124996,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124997,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +124998,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +124999,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125000,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +125001,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125002,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +125003,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +125004,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125005,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125006,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125007,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +125008,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125009,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +125010,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125011,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +125012,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125013,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +125014,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125015,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125016,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125017,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +125018,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +125019,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,OPTUM VA CCN-Commercial, +125020,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125021,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125022,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125023,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125024,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125025,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +125026,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,OPTUM VA CCN-Commercial, +125027,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +125028,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125029,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125030,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125031,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +125032,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125033,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +125034,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125035,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125036,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125037,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +125038,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125039,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +125040,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125041,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125042,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125043,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125044,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,OPTUM VA CCN-Commercial, +125045,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,OPTUM VA CCN-Commercial, +125046,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,OPTUM VA CCN-Commercial, +125047,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,OPTUM VA CCN-Commercial, +125048,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,OPTUM VA CCN-Commercial, +125049,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,OPTUM VA CCN-Commercial, +125050,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,OPTUM VA CCN-Commercial, +125051,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125052,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125053,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125054,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125055,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125056,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125057,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125058,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125059,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125060,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125061,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125062,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125063,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,OPTUM VA CCN-Commercial, +125064,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,OPTUM VA CCN-Commercial, +125065,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,OPTUM VA CCN-Commercial, +125066,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,OPTUM VA CCN-Commercial, +125067,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,OPTUM VA CCN-Commercial, +125068,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,OPTUM VA CCN-Commercial, +125069,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,OPTUM VA CCN-Commercial, +125070,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,OPTUM VA CCN-Commercial, +125071,3934,37112000,ACUTE ED,,1580.0,1580.0,,,OPTUM VA CCN-Commercial, +125072,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,OPTUM VA CCN-Commercial, +125073,3934,37112034,TRIAGE,,277.0,277.0,,,OPTUM VA CCN-Commercial, +125074,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,OPTUM VA CCN-Commercial, +125075,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,OPTUM VA CCN-Commercial, +125076,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,OPTUM VA CCN-Commercial, +125077,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,OPTUM VA CCN-Commercial, +125078,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,OPTUM VA CCN-Commercial, +125079,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,OPTUM VA CCN-Commercial, +125080,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,OPTUM VA CCN-Commercial, +125081,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,OPTUM VA CCN-Commercial, +125082,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,OPTUM VA CCN-Commercial, +125083,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,OPTUM VA CCN-Commercial, +125084,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,OPTUM VA CCN-Commercial, +125085,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,OPTUM VA CCN-Commercial, +125086,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,OPTUM VA CCN-Commercial, +125087,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,OPTUM VA CCN-Commercial, +125088,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,OPTUM VA CCN-Commercial, +125089,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,OPTUM VA CCN-Commercial, +125090,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,OPTUM VA CCN-Commercial, +125091,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,OPTUM VA CCN-Commercial, +125092,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,OPTUM VA CCN-Commercial, +125093,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,OPTUM VA CCN-Commercial, +125094,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,OPTUM VA CCN-Commercial, +125095,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,OPTUM VA CCN-Commercial, +125096,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,OPTUM VA CCN-Commercial, +125097,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,OPTUM VA CCN-Commercial, +125098,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,OPTUM VA CCN-Commercial, +125099,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,OPTUM VA CCN-Commercial, +125100,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,OPTUM VA CCN-Commercial, +125101,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,OPTUM VA CCN-Commercial, +125102,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,OPTUM VA CCN-Commercial, +125103,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,OPTUM VA CCN-Commercial, +125104,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,OPTUM VA CCN-Commercial, +125105,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,OPTUM VA CCN-Commercial, +125106,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,OPTUM VA CCN-Commercial, +125107,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,OPTUM VA CCN-Commercial, +125108,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,OPTUM VA CCN-Commercial, +125109,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,OPTUM VA CCN-Commercial, +125110,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,OPTUM VA CCN-Commercial, +125111,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,OPTUM VA CCN-Commercial, +125112,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,OPTUM VA CCN-Commercial, +125113,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,OPTUM VA CCN-Commercial, +125114,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,OPTUM VA CCN-Commercial, +125115,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,OPTUM VA CCN-Commercial, +125116,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,OPTUM VA CCN-Commercial, +125117,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,OPTUM VA CCN-Commercial, +125118,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,OPTUM VA CCN-Commercial, +125119,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,OPTUM VA CCN-Commercial, +125120,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,OPTUM VA CCN-Commercial, +125121,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,OPTUM VA CCN-Commercial, +125122,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,OPTUM VA CCN-Commercial, +125123,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,OPTUM VA CCN-Commercial, +125124,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,OPTUM VA CCN-Commercial, +125125,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,OPTUM VA CCN-Commercial, +125126,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,OPTUM VA CCN-Commercial, +125127,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,OPTUM VA CCN-Commercial, +125128,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,OPTUM VA CCN-Commercial, +125129,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,OPTUM VA CCN-Commercial, +125130,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,OPTUM VA CCN-Commercial, +125131,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,OPTUM VA CCN-Commercial, +125132,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,OPTUM VA CCN-Commercial, +125133,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,OPTUM VA CCN-Commercial, +125134,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,OPTUM VA CCN-Commercial, +125135,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,OPTUM VA CCN-Commercial, +125136,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,OPTUM VA CCN-Commercial, +125137,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,OPTUM VA CCN-Commercial, +125138,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,OPTUM VA CCN-Commercial, +125139,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,OPTUM VA CCN-Commercial, +125140,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,OPTUM VA CCN-Commercial, +125141,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,OPTUM VA CCN-Commercial, +125142,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,OPTUM VA CCN-Commercial, +125143,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,OPTUM VA CCN-Commercial, +125144,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,OPTUM VA CCN-Commercial, +125145,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,OPTUM VA CCN-Commercial, +125146,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,OPTUM VA CCN-Commercial, +125147,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,OPTUM VA CCN-Commercial, +125148,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,OPTUM VA CCN-Commercial, +125149,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,OPTUM VA CCN-Commercial, +125150,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,OPTUM VA CCN-Commercial, +125151,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,OPTUM VA CCN-Commercial, +125152,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,OPTUM VA CCN-Commercial, +125153,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,OPTUM VA CCN-Commercial, +125154,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,OPTUM VA CCN-Commercial, +125155,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,OPTUM VA CCN-Commercial, +125156,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,OPTUM VA CCN-Commercial, +125157,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,OPTUM VA CCN-Commercial, +125158,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,OPTUM VA CCN-Commercial, +125159,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,OPTUM VA CCN-Commercial, +125160,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,OPTUM VA CCN-Commercial, +125161,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,OPTUM VA CCN-Commercial, +125162,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,OPTUM VA CCN-Commercial, +125163,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,OPTUM VA CCN-Commercial, +125164,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,OPTUM VA CCN-Commercial, +125165,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,OPTUM VA CCN-Commercial, +125166,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,OPTUM VA CCN-Commercial, +125167,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,OPTUM VA CCN-Commercial, +125168,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,OPTUM VA CCN-Commercial, +125169,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,OPTUM VA CCN-Commercial, +125170,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,OPTUM VA CCN-Commercial, +125171,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,OPTUM VA CCN-Commercial, +125172,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,OPTUM VA CCN-Commercial, +125173,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,OPTUM VA CCN-Commercial, +125174,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125175,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125176,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125177,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125178,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125179,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,OPTUM VA CCN-Commercial, +125180,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,OPTUM VA CCN-Commercial, +125181,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,OPTUM VA CCN-Commercial, +125182,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125183,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125184,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125185,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,OPTUM VA CCN-Commercial, +125186,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,OPTUM VA CCN-Commercial, +125187,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,OPTUM VA CCN-Commercial, +125188,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,OPTUM VA CCN-Commercial, +125189,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,OPTUM VA CCN-Commercial, +125190,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,OPTUM VA CCN-Commercial, +125191,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,OPTUM VA CCN-Commercial, +125192,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,OPTUM VA CCN-Commercial, +125193,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,OPTUM VA CCN-Commercial, +125194,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,OPTUM VA CCN-Commercial, +125195,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,OPTUM VA CCN-Commercial, +125196,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,OPTUM VA CCN-Commercial, +125197,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,OPTUM VA CCN-Commercial, +125198,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,OPTUM VA CCN-Commercial, +125199,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,OPTUM VA CCN-Commercial, +125200,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,OPTUM VA CCN-Commercial, +125201,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,OPTUM VA CCN-Commercial, +125202,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,OPTUM VA CCN-Commercial, +125203,3934,43301043,ALBUNEX,,357.0,357.0,,,OPTUM VA CCN-Commercial, +125204,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,OPTUM VA CCN-Commercial, +125205,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125206,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125207,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125208,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125209,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125210,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,OPTUM VA CCN-Commercial, +125211,3934,43450022,REC RM .5HR,,541.0,541.0,,,OPTUM VA CCN-Commercial, +125212,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,OPTUM VA CCN-Commercial, +125213,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,OPTUM VA CCN-Commercial, +125214,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,OPTUM VA CCN-Commercial, +125215,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,OPTUM VA CCN-Commercial, +125216,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,OPTUM VA CCN-Commercial, +125217,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,OPTUM VA CCN-Commercial, +125218,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,OPTUM VA CCN-Commercial, +125219,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,OPTUM VA CCN-Commercial, +125220,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,OPTUM VA CCN-Commercial, +125221,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,OPTUM VA CCN-Commercial, +125222,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,OPTUM VA CCN-Commercial, +125223,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,OPTUM VA CCN-Commercial, +125224,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,OPTUM VA CCN-Commercial, +125225,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,OPTUM VA CCN-Commercial, +125226,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,OPTUM VA CCN-Commercial, +125227,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,OPTUM VA CCN-Commercial, +125228,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,OPTUM VA CCN-Commercial, +125229,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125230,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125231,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125232,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125233,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125234,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,OPTUM VA CCN-Commercial, +125235,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125236,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,OPTUM VA CCN-Commercial, +125237,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125238,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125239,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125240,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125241,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,OPTUM VA CCN-Commercial, +125242,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,OPTUM VA CCN-Commercial, +125243,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125244,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125245,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125246,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125247,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125248,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,OPTUM VA CCN-Commercial, +125249,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125250,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125251,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125252,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125253,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125254,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,OPTUM VA CCN-Commercial, +125255,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,OPTUM VA CCN-Commercial, +125256,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,OPTUM VA CCN-Commercial, +125257,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,OPTUM VA CCN-Commercial, +125258,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,OPTUM VA CCN-Commercial, +125259,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,OPTUM VA CCN-Commercial, +125260,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,OPTUM VA CCN-Commercial, +125261,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,OPTUM VA CCN-Commercial, +125262,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,OPTUM VA CCN-Commercial, +125263,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125264,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125265,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125266,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125267,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125268,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125269,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,OPTUM VA CCN-Commercial, +125270,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,OPTUM VA CCN-Commercial, +125271,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,OPTUM VA CCN-Commercial, +125272,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,OPTUM VA CCN-Commercial, +125273,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,OPTUM VA CCN-Commercial, +125274,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,OPTUM VA CCN-Commercial, +125275,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,OPTUM VA CCN-Commercial, +125276,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,OPTUM VA CCN-Commercial, +125277,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,OPTUM VA CCN-Commercial, +125278,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,OPTUM VA CCN-Commercial, +125279,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,OPTUM VA CCN-Commercial, +125280,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,OPTUM VA CCN-Commercial, +125281,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,OPTUM VA CCN-Commercial, +125282,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,OPTUM VA CCN-Commercial, +125283,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,OPTUM VA CCN-Commercial, +125284,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,OPTUM VA CCN-Commercial, +125285,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,OPTUM VA CCN-Commercial, +125286,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,OPTUM VA CCN-Commercial, +125287,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,OPTUM VA CCN-Commercial, +125288,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,OPTUM VA CCN-Commercial, +125289,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,OPTUM VA CCN-Commercial, +125290,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,OPTUM VA CCN-Commercial, +125291,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,OPTUM VA CCN-Commercial, +125292,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,OPTUM VA CCN-Commercial, +125293,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,OPTUM VA CCN-Commercial, +125294,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,OPTUM VA CCN-Commercial, +125295,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,OPTUM VA CCN-Commercial, +125296,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,OPTUM VA CCN-Commercial, +125297,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,OPTUM VA CCN-Commercial, +125298,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,OPTUM VA CCN-Commercial, +125299,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,OPTUM VA CCN-Commercial, +125300,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,OPTUM VA CCN-Commercial, +125301,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,OPTUM VA CCN-Commercial, +125302,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,OPTUM VA CCN-Commercial, +125303,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,OPTUM VA CCN-Commercial, +125304,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,OPTUM VA CCN-Commercial, +125305,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,OPTUM VA CCN-Commercial, +125306,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,OPTUM VA CCN-Commercial, +125307,3934,45924552,ENDO REC RM,,30.0,30.0,,,OPTUM VA CCN-Commercial, +125308,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,OPTUM VA CCN-Commercial, +125309,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,OPTUM VA CCN-Commercial, +125310,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,OPTUM VA CCN-Commercial, +125311,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,OPTUM VA CCN-Commercial, +125312,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,OPTUM VA CCN-Commercial, +125313,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,OPTUM VA CCN-Commercial, +125314,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,OPTUM VA CCN-Commercial, +125315,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,OPTUM VA CCN-Commercial, +125316,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,OPTUM VA CCN-Commercial, +125317,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,OPTUM VA CCN-Commercial, +125318,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,OPTUM VA CCN-Commercial, +125319,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,OPTUM VA CCN-Commercial, +125320,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,OPTUM VA CCN-Commercial, +125321,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,OPTUM VA CCN-Commercial, +125322,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,OPTUM VA CCN-Commercial, +125323,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,OPTUM VA CCN-Commercial, +125324,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,OPTUM VA CCN-Commercial, +125325,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,OPTUM VA CCN-Commercial, +125326,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,OPTUM VA CCN-Commercial, +125327,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,OPTUM VA CCN-Commercial, +125328,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,OPTUM VA CCN-Commercial, +125329,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,OPTUM VA CCN-Commercial, +125330,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,OPTUM VA CCN-Commercial, +125331,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,OPTUM VA CCN-Commercial, +125332,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,OPTUM VA CCN-Commercial, +125333,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,OPTUM VA CCN-Commercial, +125334,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,OPTUM VA CCN-Commercial, +125335,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,OPTUM VA CCN-Commercial, +125336,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,OPTUM VA CCN-Commercial, +125337,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,OPTUM VA CCN-Commercial, +125338,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,OPTUM VA CCN-Commercial, +125339,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,OPTUM VA CCN-Commercial, +125340,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,OPTUM VA CCN-Commercial, +125341,3934,53200010,GUEST TRAY,,24.0,24.0,,,OPTUM VA CCN-Commercial, +125342,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,OPTUM VA CCN-Commercial, +125343,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,OPTUM VA CCN-Commercial, +125344,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,OPTUM VA CCN-Commercial, +125345,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,OPTUM VA CCN-Commercial, +125346,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,OPTUM VA CCN-Commercial, +125347,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,OPTUM VA CCN-Commercial, +125348,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,OPTUM VA CCN-Commercial, +125349,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,OPTUM VA CCN-Commercial, +125350,3934,53329876,HIV MONITORING,,416.0,416.0,,,OPTUM VA CCN-Commercial, +125351,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,OPTUM VA CCN-Commercial, +125352,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,OPTUM VA CCN-Commercial, +125353,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,OPTUM VA CCN-Commercial, +125354,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,OPTUM VA CCN-Commercial, +125355,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,OPTUM VA CCN-Commercial, +125356,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,OPTUM VA CCN-Commercial, +125357,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,OPTUM VA CCN-Commercial, +125358,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,OPTUM VA CCN-Commercial, +125359,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,OPTUM VA CCN-Commercial, +125360,3934,76010107,COPY X-RAY,,22.0,22.0,,,OPTUM VA CCN-Commercial, +125361,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,OPTUM VA CCN-Commercial, +125362,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,OPTUM VA CCN-Commercial, +125363,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,OPTUM VA CCN-Commercial, +125364,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,OPTUM VA CCN-Commercial, +125365,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,OPTUM VA CCN-Commercial, +125366,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,OPTUM VA CCN-Commercial, +125367,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,OPTUM VA CCN-Commercial, +125368,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,OPTUM VA CCN-Commercial, +125369,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,OPTUM VA CCN-Commercial, +125370,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,OPTUM VA CCN-Commercial, +125371,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,OPTUM VA CCN-Commercial, +125372,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,OPTUM VA CCN-Commercial, +125373,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,OXFORD HEALTH INSURANCE-Commercial, +125374,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,OXFORD HEALTH INSURANCE-Commercial, +125375,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,OXFORD HEALTH INSURANCE-Commercial,1196979.01 +125376,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,OXFORD HEALTH INSURANCE-Commercial,592868.09 +125377,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,OXFORD HEALTH INSURANCE-Commercial, +125378,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,OXFORD HEALTH INSURANCE-Commercial, +125379,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,OXFORD HEALTH INSURANCE-Commercial, +125380,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,OXFORD HEALTH INSURANCE-Commercial, +125381,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,OXFORD HEALTH INSURANCE-Commercial, +125382,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,OXFORD HEALTH INSURANCE-Commercial,300970.11 +125383,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,OXFORD HEALTH INSURANCE-Commercial, +125384,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,OXFORD HEALTH INSURANCE-Commercial, +125385,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,OXFORD HEALTH INSURANCE-Commercial,119567.93 +125386,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,OXFORD HEALTH INSURANCE-Commercial, +125387,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,OXFORD HEALTH INSURANCE-Commercial,190020.7 +125388,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,OXFORD HEALTH INSURANCE-Commercial,127346.03 +125389,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,OXFORD HEALTH INSURANCE-Commercial,50444.92 +125390,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,OXFORD HEALTH INSURANCE-Commercial,135106.5 +125391,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,OXFORD HEALTH INSURANCE-Commercial,70604.17 +125392,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,OXFORD HEALTH INSURANCE-Commercial, +125393,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,OXFORD HEALTH INSURANCE-Commercial,43359.73 +125394,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,OXFORD HEALTH INSURANCE-Commercial, +125395,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,OXFORD HEALTH INSURANCE-Commercial, +125396,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,OXFORD HEALTH INSURANCE-Commercial,245678.6 +125397,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,OXFORD HEALTH INSURANCE-Commercial, +125398,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,OXFORD HEALTH INSURANCE-Commercial, +125399,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,OXFORD HEALTH INSURANCE-Commercial,99753.8 +125400,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,OXFORD HEALTH INSURANCE-Commercial, +125401,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,OXFORD HEALTH INSURANCE-Commercial, +125402,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,OXFORD HEALTH INSURANCE-Commercial,67852.99 +125403,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,OXFORD HEALTH INSURANCE-Commercial,45951.11 +125404,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,OXFORD HEALTH INSURANCE-Commercial,34866.59 +125405,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,OXFORD HEALTH INSURANCE-Commercial, +125406,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,OXFORD HEALTH INSURANCE-Commercial, +125407,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,OXFORD HEALTH INSURANCE-Commercial, +125408,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,OXFORD HEALTH INSURANCE-Commercial,16912.34 +125409,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,OXFORD HEALTH INSURANCE-Commercial,52364.84 +125410,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,OXFORD HEALTH INSURANCE-Commercial,13246.75 +125411,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,OXFORD HEALTH INSURANCE-Commercial, +125412,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,OXFORD HEALTH INSURANCE-Commercial,17864.14 +125413,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,OXFORD HEALTH INSURANCE-Commercial,15312.05 +125414,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,OXFORD HEALTH INSURANCE-Commercial, +125415,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,OXFORD HEALTH INSURANCE-Commercial, +125416,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,OXFORD HEALTH INSURANCE-Commercial, +125417,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,OXFORD HEALTH INSURANCE-Commercial,26082.04 +125418,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,OXFORD HEALTH INSURANCE-Commercial,21373.47 +125419,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,OXFORD HEALTH INSURANCE-Commercial,15088.05 +125420,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,OXFORD HEALTH INSURANCE-Commercial,17693.34 +125421,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,OXFORD HEALTH INSURANCE-Commercial, +125422,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,OXFORD HEALTH INSURANCE-Commercial, +125423,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,OXFORD HEALTH INSURANCE-Commercial, +125424,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,OXFORD HEALTH INSURANCE-Commercial, +125425,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,OXFORD HEALTH INSURANCE-Commercial, +125426,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,OXFORD HEALTH INSURANCE-Commercial,17974.56 +125427,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,OXFORD HEALTH INSURANCE-Commercial, +125428,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,OXFORD HEALTH INSURANCE-Commercial, +125429,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,OXFORD HEALTH INSURANCE-Commercial, +125430,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,OXFORD HEALTH INSURANCE-Commercial, +125431,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,OXFORD HEALTH INSURANCE-Commercial, +125432,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,OXFORD HEALTH INSURANCE-Commercial, +125433,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,OXFORD HEALTH INSURANCE-Commercial, +125434,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,OXFORD HEALTH INSURANCE-Commercial, +125435,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,OXFORD HEALTH INSURANCE-Commercial,15842.95 +125436,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,OXFORD HEALTH INSURANCE-Commercial, +125437,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,OXFORD HEALTH INSURANCE-Commercial, +125438,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,OXFORD HEALTH INSURANCE-Commercial, +125439,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,OXFORD HEALTH INSURANCE-Commercial,14683.45 +125440,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,OXFORD HEALTH INSURANCE-Commercial, +125441,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,OXFORD HEALTH INSURANCE-Commercial, +125442,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,OXFORD HEALTH INSURANCE-Commercial,74075.64 +125443,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,OXFORD HEALTH INSURANCE-Commercial, +125444,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,OXFORD HEALTH INSURANCE-Commercial, +125445,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,OXFORD HEALTH INSURANCE-Commercial, +125446,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,OXFORD HEALTH INSURANCE-Commercial, +125447,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,OXFORD HEALTH INSURANCE-Commercial,16600.7 +125448,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,OXFORD HEALTH INSURANCE-Commercial, +125449,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,OXFORD HEALTH INSURANCE-Commercial,13807.57 +125450,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,OXFORD HEALTH INSURANCE-Commercial, +125451,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,OXFORD HEALTH INSURANCE-Commercial, +125452,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,OXFORD HEALTH INSURANCE-Commercial, +125453,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,OXFORD HEALTH INSURANCE-Commercial, +125454,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,OXFORD HEALTH INSURANCE-Commercial, +125455,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,OXFORD HEALTH INSURANCE-Commercial,17216.34 +125456,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,OXFORD HEALTH INSURANCE-Commercial, +125457,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,OXFORD HEALTH INSURANCE-Commercial, +125458,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,OXFORD HEALTH INSURANCE-Commercial,55442.62 +125459,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,OXFORD HEALTH INSURANCE-Commercial, +125460,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,OXFORD HEALTH INSURANCE-Commercial, +125461,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,OXFORD HEALTH INSURANCE-Commercial, +125462,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,OXFORD HEALTH INSURANCE-Commercial, +125463,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,OXFORD HEALTH INSURANCE-Commercial,22628.71 +125464,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,OXFORD HEALTH INSURANCE-Commercial, +125465,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,OXFORD HEALTH INSURANCE-Commercial, +125466,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,OXFORD HEALTH INSURANCE-Commercial,16291.8 +125467,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,OXFORD HEALTH INSURANCE-Commercial, +125468,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,OXFORD HEALTH INSURANCE-Commercial, +125469,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,OXFORD HEALTH INSURANCE-Commercial, +125470,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,OXFORD HEALTH INSURANCE-Commercial, +125471,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,OXFORD HEALTH INSURANCE-Commercial, +125472,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,OXFORD HEALTH INSURANCE-Commercial, +125473,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,OXFORD HEALTH INSURANCE-Commercial, +125474,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,OXFORD HEALTH INSURANCE-Commercial, +125475,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,OXFORD HEALTH INSURANCE-Commercial, +125476,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,OXFORD HEALTH INSURANCE-Commercial, +125477,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,OXFORD HEALTH INSURANCE-Commercial, +125478,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,OXFORD HEALTH INSURANCE-Commercial, +125479,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,OXFORD HEALTH INSURANCE-Commercial,13533.25 +125480,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,OXFORD HEALTH INSURANCE-Commercial, +125481,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,OXFORD HEALTH INSURANCE-Commercial, +125482,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,OXFORD HEALTH INSURANCE-Commercial, +125483,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,OXFORD HEALTH INSURANCE-Commercial, +125484,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,OXFORD HEALTH INSURANCE-Commercial, +125485,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,OXFORD HEALTH INSURANCE-Commercial, +125486,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,OXFORD HEALTH INSURANCE-Commercial, +125487,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,OXFORD HEALTH INSURANCE-Commercial,35975.61 +125488,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,OXFORD HEALTH INSURANCE-Commercial, +125489,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,OXFORD HEALTH INSURANCE-Commercial, +125490,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,OXFORD HEALTH INSURANCE-Commercial, +125491,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,OXFORD HEALTH INSURANCE-Commercial, +125492,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,OXFORD HEALTH INSURANCE-Commercial,24923.85 +125493,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,OXFORD HEALTH INSURANCE-Commercial,16797.24 +125494,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,OXFORD HEALTH INSURANCE-Commercial,39463.91 +125495,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,OXFORD HEALTH INSURANCE-Commercial,22755.51 +125496,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,OXFORD HEALTH INSURANCE-Commercial, +125497,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,OXFORD HEALTH INSURANCE-Commercial,34441.41 +125498,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,OXFORD HEALTH INSURANCE-Commercial, +125499,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,OXFORD HEALTH INSURANCE-Commercial, +125500,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,OXFORD HEALTH INSURANCE-Commercial, +125501,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,OXFORD HEALTH INSURANCE-Commercial, +125502,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,OXFORD HEALTH INSURANCE-Commercial, +125503,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,OXFORD HEALTH INSURANCE-Commercial, +125504,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,OXFORD HEALTH INSURANCE-Commercial,20904.48 +125505,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,OXFORD HEALTH INSURANCE-Commercial,20136.03 +125506,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,OXFORD HEALTH INSURANCE-Commercial, +125507,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,OXFORD HEALTH INSURANCE-Commercial, +125508,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,OXFORD HEALTH INSURANCE-Commercial,25606.69 +125509,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,OXFORD HEALTH INSURANCE-Commercial,15843.05 +125510,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,OXFORD HEALTH INSURANCE-Commercial,12891.84 +125511,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,OXFORD HEALTH INSURANCE-Commercial, +125512,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,OXFORD HEALTH INSURANCE-Commercial, +125513,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,OXFORD HEALTH INSURANCE-Commercial, +125514,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,OXFORD HEALTH INSURANCE-Commercial, +125515,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,OXFORD HEALTH INSURANCE-Commercial, +125516,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,OXFORD HEALTH INSURANCE-Commercial, +125517,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,OXFORD HEALTH INSURANCE-Commercial,12050.84 +125518,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,OXFORD HEALTH INSURANCE-Commercial, +125519,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,OXFORD HEALTH INSURANCE-Commercial, +125520,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,OXFORD HEALTH INSURANCE-Commercial,16007.91 +125521,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,OXFORD HEALTH INSURANCE-Commercial,25793.6 +125522,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,OXFORD HEALTH INSURANCE-Commercial,43860.96 +125523,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,OXFORD HEALTH INSURANCE-Commercial, +125524,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,OXFORD HEALTH INSURANCE-Commercial, +125525,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,OXFORD HEALTH INSURANCE-Commercial, +125526,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,OXFORD HEALTH INSURANCE-Commercial,163605.05 +125527,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,OXFORD HEALTH INSURANCE-Commercial,92983.29 +125528,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,OXFORD HEALTH INSURANCE-Commercial, +125529,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,OXFORD HEALTH INSURANCE-Commercial, +125530,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,OXFORD HEALTH INSURANCE-Commercial, +125531,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,OXFORD HEALTH INSURANCE-Commercial, +125532,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,OXFORD HEALTH INSURANCE-Commercial, +125533,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,OXFORD HEALTH INSURANCE-Commercial, +125534,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,OXFORD HEALTH INSURANCE-Commercial,111218.08 +125535,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,OXFORD HEALTH INSURANCE-Commercial,195084.3 +125536,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,OXFORD HEALTH INSURANCE-Commercial,73536.6 +125537,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,OXFORD HEALTH INSURANCE-Commercial, +125538,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,OXFORD HEALTH INSURANCE-Commercial,234019.15 +125539,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,OXFORD HEALTH INSURANCE-Commercial, +125540,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,OXFORD HEALTH INSURANCE-Commercial, +125541,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,OXFORD HEALTH INSURANCE-Commercial, +125542,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,OXFORD HEALTH INSURANCE-Commercial, +125543,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,OXFORD HEALTH INSURANCE-Commercial, +125544,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,OXFORD HEALTH INSURANCE-Commercial,52703.25 +125545,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,OXFORD HEALTH INSURANCE-Commercial, +125546,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,OXFORD HEALTH INSURANCE-Commercial,53590.24 +125547,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,OXFORD HEALTH INSURANCE-Commercial,41015.11 +125548,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,OXFORD HEALTH INSURANCE-Commercial, +125549,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,OXFORD HEALTH INSURANCE-Commercial,61998.49 +125550,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,OXFORD HEALTH INSURANCE-Commercial,43871.52 +125551,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,OXFORD HEALTH INSURANCE-Commercial, +125552,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,OXFORD HEALTH INSURANCE-Commercial, +125553,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,OXFORD HEALTH INSURANCE-Commercial, +125554,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,OXFORD HEALTH INSURANCE-Commercial, +125555,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,OXFORD HEALTH INSURANCE-Commercial, +125556,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,OXFORD HEALTH INSURANCE-Commercial,31389.97 +125557,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,OXFORD HEALTH INSURANCE-Commercial, +125558,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,OXFORD HEALTH INSURANCE-Commercial, +125559,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,OXFORD HEALTH INSURANCE-Commercial, +125560,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,OXFORD HEALTH INSURANCE-Commercial, +125561,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,OXFORD HEALTH INSURANCE-Commercial, +125562,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,OXFORD HEALTH INSURANCE-Commercial, +125563,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,OXFORD HEALTH INSURANCE-Commercial, +125564,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,OXFORD HEALTH INSURANCE-Commercial, +125565,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,OXFORD HEALTH INSURANCE-Commercial, +125566,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,OXFORD HEALTH INSURANCE-Commercial, +125567,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,OXFORD HEALTH INSURANCE-Commercial, +125568,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,OXFORD HEALTH INSURANCE-Commercial, +125569,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,OXFORD HEALTH INSURANCE-Commercial, +125570,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,OXFORD HEALTH INSURANCE-Commercial, +125571,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,OXFORD HEALTH INSURANCE-Commercial, +125572,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,OXFORD HEALTH INSURANCE-Commercial, +125573,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,OXFORD HEALTH INSURANCE-Commercial,76235.38 +125574,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,OXFORD HEALTH INSURANCE-Commercial, +125575,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,OXFORD HEALTH INSURANCE-Commercial, +125576,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,OXFORD HEALTH INSURANCE-Commercial,72816.53 +125577,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,OXFORD HEALTH INSURANCE-Commercial,32158.08 +125578,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,OXFORD HEALTH INSURANCE-Commercial,22547.31 +125579,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,OXFORD HEALTH INSURANCE-Commercial,15333.33 +125580,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,OXFORD HEALTH INSURANCE-Commercial, +125581,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,OXFORD HEALTH INSURANCE-Commercial, +125582,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,OXFORD HEALTH INSURANCE-Commercial,41512.23 +125583,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,OXFORD HEALTH INSURANCE-Commercial,22138.67 +125584,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,OXFORD HEALTH INSURANCE-Commercial, +125585,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,OXFORD HEALTH INSURANCE-Commercial, +125586,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,OXFORD HEALTH INSURANCE-Commercial,24979.74 +125587,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,OXFORD HEALTH INSURANCE-Commercial,16819.05 +125588,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,OXFORD HEALTH INSURANCE-Commercial, +125589,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,OXFORD HEALTH INSURANCE-Commercial, +125590,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,OXFORD HEALTH INSURANCE-Commercial, +125591,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,OXFORD HEALTH INSURANCE-Commercial,20028.06 +125592,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,OXFORD HEALTH INSURANCE-Commercial, +125593,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,OXFORD HEALTH INSURANCE-Commercial, +125594,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,OXFORD HEALTH INSURANCE-Commercial,11606.93 +125595,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,OXFORD HEALTH INSURANCE-Commercial,19098.1 +125596,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,OXFORD HEALTH INSURANCE-Commercial,12558.57 +125597,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,OXFORD HEALTH INSURANCE-Commercial,26481.44 +125598,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,OXFORD HEALTH INSURANCE-Commercial, +125599,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,OXFORD HEALTH INSURANCE-Commercial,23850.65 +125600,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,OXFORD HEALTH INSURANCE-Commercial, +125601,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,OXFORD HEALTH INSURANCE-Commercial,9656.27 +125602,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,OXFORD HEALTH INSURANCE-Commercial, +125603,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,OXFORD HEALTH INSURANCE-Commercial, +125604,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,OXFORD HEALTH INSURANCE-Commercial,12613.77 +125605,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,OXFORD HEALTH INSURANCE-Commercial,40604.56 +125606,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,OXFORD HEALTH INSURANCE-Commercial,25916.0 +125607,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,OXFORD HEALTH INSURANCE-Commercial,15896.64 +125608,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,OXFORD HEALTH INSURANCE-Commercial, +125609,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,OXFORD HEALTH INSURANCE-Commercial, +125610,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,OXFORD HEALTH INSURANCE-Commercial,311862.55 +125611,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,OXFORD HEALTH INSURANCE-Commercial, +125612,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,OXFORD HEALTH INSURANCE-Commercial, +125613,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,OXFORD HEALTH INSURANCE-Commercial,70009.97 +125614,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,OXFORD HEALTH INSURANCE-Commercial,49447.79 +125615,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,OXFORD HEALTH INSURANCE-Commercial,29477.72 +125616,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,OXFORD HEALTH INSURANCE-Commercial, +125617,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,OXFORD HEALTH INSURANCE-Commercial, +125618,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,OXFORD HEALTH INSURANCE-Commercial, +125619,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,OXFORD HEALTH INSURANCE-Commercial,44154.89 +125620,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,OXFORD HEALTH INSURANCE-Commercial,30796.45 +125621,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,OXFORD HEALTH INSURANCE-Commercial, +125622,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,OXFORD HEALTH INSURANCE-Commercial,33548.18 +125623,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,OXFORD HEALTH INSURANCE-Commercial,23729.67 +125624,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,OXFORD HEALTH INSURANCE-Commercial, +125625,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,OXFORD HEALTH INSURANCE-Commercial, +125626,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,OXFORD HEALTH INSURANCE-Commercial, +125627,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,OXFORD HEALTH INSURANCE-Commercial, +125628,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,OXFORD HEALTH INSURANCE-Commercial, +125629,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,OXFORD HEALTH INSURANCE-Commercial, +125630,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,OXFORD HEALTH INSURANCE-Commercial, +125631,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,OXFORD HEALTH INSURANCE-Commercial, +125632,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,OXFORD HEALTH INSURANCE-Commercial, +125633,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,OXFORD HEALTH INSURANCE-Commercial, +125634,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,OXFORD HEALTH INSURANCE-Commercial, +125635,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,OXFORD HEALTH INSURANCE-Commercial,33543.6 +125636,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,OXFORD HEALTH INSURANCE-Commercial,25710.04 +125637,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,OXFORD HEALTH INSURANCE-Commercial, +125638,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,OXFORD HEALTH INSURANCE-Commercial, +125639,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,OXFORD HEALTH INSURANCE-Commercial, +125640,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,OXFORD HEALTH INSURANCE-Commercial, +125641,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,OXFORD HEALTH INSURANCE-Commercial,31293.5 +125642,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,OXFORD HEALTH INSURANCE-Commercial, +125643,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,OXFORD HEALTH INSURANCE-Commercial,14207.38 +125644,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,OXFORD HEALTH INSURANCE-Commercial, +125645,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,OXFORD HEALTH INSURANCE-Commercial,20830.75 +125646,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,OXFORD HEALTH INSURANCE-Commercial, +125647,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,OXFORD HEALTH INSURANCE-Commercial,31987.49 +125648,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,OXFORD HEALTH INSURANCE-Commercial,18481.51 +125649,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,OXFORD HEALTH INSURANCE-Commercial, +125650,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,OXFORD HEALTH INSURANCE-Commercial, +125651,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,OXFORD HEALTH INSURANCE-Commercial, +125652,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,OXFORD HEALTH INSURANCE-Commercial, +125653,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,OXFORD HEALTH INSURANCE-Commercial, +125654,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,OXFORD HEALTH INSURANCE-Commercial, +125655,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,OXFORD HEALTH INSURANCE-Commercial,18691.71 +125656,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,OXFORD HEALTH INSURANCE-Commercial,15124.84 +125657,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,OXFORD HEALTH INSURANCE-Commercial, +125658,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,OXFORD HEALTH INSURANCE-Commercial,14577.77 +125659,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,OXFORD HEALTH INSURANCE-Commercial,10079.19 +125660,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,OXFORD HEALTH INSURANCE-Commercial,15003.86 +125661,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,OXFORD HEALTH INSURANCE-Commercial,76813.08 +125662,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,OXFORD HEALTH INSURANCE-Commercial,30248.64 +125663,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,OXFORD HEALTH INSURANCE-Commercial,17530.0 +125664,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,OXFORD HEALTH INSURANCE-Commercial, +125665,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,OXFORD HEALTH INSURANCE-Commercial, +125666,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,OXFORD HEALTH INSURANCE-Commercial, +125667,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,OXFORD HEALTH INSURANCE-Commercial, +125668,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,OXFORD HEALTH INSURANCE-Commercial, +125669,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,OXFORD HEALTH INSURANCE-Commercial, +125670,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,OXFORD HEALTH INSURANCE-Commercial, +125671,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,OXFORD HEALTH INSURANCE-Commercial, +125672,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,OXFORD HEALTH INSURANCE-Commercial, +125673,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,OXFORD HEALTH INSURANCE-Commercial,28916.55 +125674,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,OXFORD HEALTH INSURANCE-Commercial,31689.55 +125675,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,OXFORD HEALTH INSURANCE-Commercial, +125676,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,OXFORD HEALTH INSURANCE-Commercial, +125677,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,OXFORD HEALTH INSURANCE-Commercial, +125678,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,OXFORD HEALTH INSURANCE-Commercial, +125679,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,OXFORD HEALTH INSURANCE-Commercial, +125680,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,OXFORD HEALTH INSURANCE-Commercial,30775.92 +125681,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,OXFORD HEALTH INSURANCE-Commercial,20065.52 +125682,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,OXFORD HEALTH INSURANCE-Commercial,31927.8 +125683,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,OXFORD HEALTH INSURANCE-Commercial, +125684,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,OXFORD HEALTH INSURANCE-Commercial,30325.2 +125685,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,OXFORD HEALTH INSURANCE-Commercial,17194.67 +125686,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,OXFORD HEALTH INSURANCE-Commercial,10646.8 +125687,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,OXFORD HEALTH INSURANCE-Commercial, +125688,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,OXFORD HEALTH INSURANCE-Commercial, +125689,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,OXFORD HEALTH INSURANCE-Commercial, +125690,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,OXFORD HEALTH INSURANCE-Commercial,31354.84 +125691,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,OXFORD HEALTH INSURANCE-Commercial, +125692,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,OXFORD HEALTH INSURANCE-Commercial,15742.72 +125693,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,OXFORD HEALTH INSURANCE-Commercial, +125694,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,OXFORD HEALTH INSURANCE-Commercial, +125695,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,OXFORD HEALTH INSURANCE-Commercial, +125696,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,OXFORD HEALTH INSURANCE-Commercial, +125697,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,OXFORD HEALTH INSURANCE-Commercial,133411.27 +125698,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,OXFORD HEALTH INSURANCE-Commercial, +125699,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,OXFORD HEALTH INSURANCE-Commercial, +125700,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,OXFORD HEALTH INSURANCE-Commercial,86339.63 +125701,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,OXFORD HEALTH INSURANCE-Commercial, +125702,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,OXFORD HEALTH INSURANCE-Commercial,69767.74 +125703,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,OXFORD HEALTH INSURANCE-Commercial, +125704,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,OXFORD HEALTH INSURANCE-Commercial, +125705,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,OXFORD HEALTH INSURANCE-Commercial, +125706,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,OXFORD HEALTH INSURANCE-Commercial, +125707,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,OXFORD HEALTH INSURANCE-Commercial, +125708,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,OXFORD HEALTH INSURANCE-Commercial,43719.16 +125709,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,OXFORD HEALTH INSURANCE-Commercial,62472.94 +125710,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,OXFORD HEALTH INSURANCE-Commercial,55273.16 +125711,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,OXFORD HEALTH INSURANCE-Commercial, +125712,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,OXFORD HEALTH INSURANCE-Commercial, +125713,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,OXFORD HEALTH INSURANCE-Commercial, +125714,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,OXFORD HEALTH INSURANCE-Commercial,41929.1 +125715,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,OXFORD HEALTH INSURANCE-Commercial, +125716,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,OXFORD HEALTH INSURANCE-Commercial, +125717,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,OXFORD HEALTH INSURANCE-Commercial, +125718,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,OXFORD HEALTH INSURANCE-Commercial,33695.28 +125719,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,OXFORD HEALTH INSURANCE-Commercial,56998.54 +125720,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,OXFORD HEALTH INSURANCE-Commercial, +125721,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,OXFORD HEALTH INSURANCE-Commercial, +125722,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,OXFORD HEALTH INSURANCE-Commercial,35281.96 +125723,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,OXFORD HEALTH INSURANCE-Commercial,23798.62 +125724,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,OXFORD HEALTH INSURANCE-Commercial,68442.48 +125725,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,OXFORD HEALTH INSURANCE-Commercial,42386.93 +125726,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,OXFORD HEALTH INSURANCE-Commercial,40671.48 +125727,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,OXFORD HEALTH INSURANCE-Commercial, +125728,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,OXFORD HEALTH INSURANCE-Commercial, +125729,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,OXFORD HEALTH INSURANCE-Commercial, +125730,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,OXFORD HEALTH INSURANCE-Commercial, +125731,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,OXFORD HEALTH INSURANCE-Commercial, +125732,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,OXFORD HEALTH INSURANCE-Commercial, +125733,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,OXFORD HEALTH INSURANCE-Commercial, +125734,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,OXFORD HEALTH INSURANCE-Commercial,29441.58 +125735,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,OXFORD HEALTH INSURANCE-Commercial,36502.47 +125736,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,OXFORD HEALTH INSURANCE-Commercial,34643.67 +125737,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,OXFORD HEALTH INSURANCE-Commercial, +125738,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,OXFORD HEALTH INSURANCE-Commercial, +125739,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,OXFORD HEALTH INSURANCE-Commercial, +125740,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,OXFORD HEALTH INSURANCE-Commercial, +125741,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,OXFORD HEALTH INSURANCE-Commercial,36780.33 +125742,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,OXFORD HEALTH INSURANCE-Commercial,26828.57 +125743,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,OXFORD HEALTH INSURANCE-Commercial, +125744,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,OXFORD HEALTH INSURANCE-Commercial,35858.19 +125745,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,OXFORD HEALTH INSURANCE-Commercial,23210.71 +125746,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,OXFORD HEALTH INSURANCE-Commercial, +125747,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,OXFORD HEALTH INSURANCE-Commercial, +125748,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,OXFORD HEALTH INSURANCE-Commercial, +125749,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,OXFORD HEALTH INSURANCE-Commercial, +125750,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,OXFORD HEALTH INSURANCE-Commercial,13845.48 +125751,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,OXFORD HEALTH INSURANCE-Commercial,36289.59 +125752,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,OXFORD HEALTH INSURANCE-Commercial, +125753,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,OXFORD HEALTH INSURANCE-Commercial, +125754,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,OXFORD HEALTH INSURANCE-Commercial,19086.98 +125755,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,OXFORD HEALTH INSURANCE-Commercial, +125756,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,OXFORD HEALTH INSURANCE-Commercial, +125757,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,OXFORD HEALTH INSURANCE-Commercial,24829.51 +125758,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,OXFORD HEALTH INSURANCE-Commercial, +125759,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,OXFORD HEALTH INSURANCE-Commercial, +125760,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,OXFORD HEALTH INSURANCE-Commercial, +125761,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,OXFORD HEALTH INSURANCE-Commercial, +125762,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,OXFORD HEALTH INSURANCE-Commercial, +125763,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,OXFORD HEALTH INSURANCE-Commercial, +125764,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,OXFORD HEALTH INSURANCE-Commercial, +125765,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,OXFORD HEALTH INSURANCE-Commercial, +125766,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,OXFORD HEALTH INSURANCE-Commercial, +125767,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,OXFORD HEALTH INSURANCE-Commercial, +125768,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,OXFORD HEALTH INSURANCE-Commercial, +125769,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,OXFORD HEALTH INSURANCE-Commercial, +125770,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,OXFORD HEALTH INSURANCE-Commercial, +125771,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,OXFORD HEALTH INSURANCE-Commercial,16786.87 +125772,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,OXFORD HEALTH INSURANCE-Commercial, +125773,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,OXFORD HEALTH INSURANCE-Commercial, +125774,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,OXFORD HEALTH INSURANCE-Commercial, +125775,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,OXFORD HEALTH INSURANCE-Commercial, +125776,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,OXFORD HEALTH INSURANCE-Commercial, +125777,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,OXFORD HEALTH INSURANCE-Commercial,24327.27 +125778,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,OXFORD HEALTH INSURANCE-Commercial, +125779,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,OXFORD HEALTH INSURANCE-Commercial, +125780,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,OXFORD HEALTH INSURANCE-Commercial, +125781,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,OXFORD HEALTH INSURANCE-Commercial,29528.17 +125782,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,OXFORD HEALTH INSURANCE-Commercial,24627.8 +125783,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,OXFORD HEALTH INSURANCE-Commercial,39303.41 +125784,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,OXFORD HEALTH INSURANCE-Commercial, +125785,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,OXFORD HEALTH INSURANCE-Commercial, +125786,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,OXFORD HEALTH INSURANCE-Commercial,33790.43 +125787,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,OXFORD HEALTH INSURANCE-Commercial, +125788,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,OXFORD HEALTH INSURANCE-Commercial, +125789,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,OXFORD HEALTH INSURANCE-Commercial, +125790,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,OXFORD HEALTH INSURANCE-Commercial, +125791,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,OXFORD HEALTH INSURANCE-Commercial, +125792,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,OXFORD HEALTH INSURANCE-Commercial, +125793,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,OXFORD HEALTH INSURANCE-Commercial,13341.53 +125794,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,OXFORD HEALTH INSURANCE-Commercial, +125795,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,OXFORD HEALTH INSURANCE-Commercial,16809.59 +125796,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,OXFORD HEALTH INSURANCE-Commercial, +125797,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,OXFORD HEALTH INSURANCE-Commercial, +125798,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,OXFORD HEALTH INSURANCE-Commercial, +125799,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,OXFORD HEALTH INSURANCE-Commercial,21388.82 +125800,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,OXFORD HEALTH INSURANCE-Commercial,42396.33 +125801,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,OXFORD HEALTH INSURANCE-Commercial, +125802,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,OXFORD HEALTH INSURANCE-Commercial, +125803,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,OXFORD HEALTH INSURANCE-Commercial, +125804,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,OXFORD HEALTH INSURANCE-Commercial, +125805,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,OXFORD HEALTH INSURANCE-Commercial, +125806,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,OXFORD HEALTH INSURANCE-Commercial,30104.8 +125807,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,OXFORD HEALTH INSURANCE-Commercial, +125808,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,OXFORD HEALTH INSURANCE-Commercial, +125809,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,OXFORD HEALTH INSURANCE-Commercial, +125810,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,OXFORD HEALTH INSURANCE-Commercial,29455.18 +125811,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,OXFORD HEALTH INSURANCE-Commercial, +125812,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,OXFORD HEALTH INSURANCE-Commercial, +125813,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,OXFORD HEALTH INSURANCE-Commercial,41212.57 +125814,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,OXFORD HEALTH INSURANCE-Commercial,16074.45 +125815,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,OXFORD HEALTH INSURANCE-Commercial,16121.81 +125816,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,OXFORD HEALTH INSURANCE-Commercial,11497.52 +125817,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,OXFORD HEALTH INSURANCE-Commercial,23406.46 +125818,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,OXFORD HEALTH INSURANCE-Commercial,18603.57 +125819,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,OXFORD HEALTH INSURANCE-Commercial, +125820,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,OXFORD HEALTH INSURANCE-Commercial,32046.04 +125821,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,OXFORD HEALTH INSURANCE-Commercial, +125822,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,OXFORD HEALTH INSURANCE-Commercial,14348.0 +125823,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,OXFORD HEALTH INSURANCE-Commercial, +125824,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,OXFORD HEALTH INSURANCE-Commercial, +125825,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,OXFORD HEALTH INSURANCE-Commercial,117072.17 +125826,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,OXFORD HEALTH INSURANCE-Commercial, +125827,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,OXFORD HEALTH INSURANCE-Commercial, +125828,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,OXFORD HEALTH INSURANCE-Commercial, +125829,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,OXFORD HEALTH INSURANCE-Commercial, +125830,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,OXFORD HEALTH INSURANCE-Commercial, +125831,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,OXFORD HEALTH INSURANCE-Commercial,42030.68 +125832,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,OXFORD HEALTH INSURANCE-Commercial, +125833,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,OXFORD HEALTH INSURANCE-Commercial, +125834,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,OXFORD HEALTH INSURANCE-Commercial, +125835,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,OXFORD HEALTH INSURANCE-Commercial, +125836,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,OXFORD HEALTH INSURANCE-Commercial,29159.45 +125837,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,OXFORD HEALTH INSURANCE-Commercial, +125838,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,OXFORD HEALTH INSURANCE-Commercial, +125839,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,OXFORD HEALTH INSURANCE-Commercial, +125840,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,OXFORD HEALTH INSURANCE-Commercial, +125841,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,OXFORD HEALTH INSURANCE-Commercial, +125842,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,OXFORD HEALTH INSURANCE-Commercial, +125843,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,OXFORD HEALTH INSURANCE-Commercial, +125844,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,OXFORD HEALTH INSURANCE-Commercial, +125845,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,OXFORD HEALTH INSURANCE-Commercial,26708.5 +125846,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,OXFORD HEALTH INSURANCE-Commercial,15550.08 +125847,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,OXFORD HEALTH INSURANCE-Commercial, +125848,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,OXFORD HEALTH INSURANCE-Commercial, +125849,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,OXFORD HEALTH INSURANCE-Commercial, +125850,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,OXFORD HEALTH INSURANCE-Commercial,20096.87 +125851,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,OXFORD HEALTH INSURANCE-Commercial,14899.3 +125852,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,OXFORD HEALTH INSURANCE-Commercial, +125853,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,OXFORD HEALTH INSURANCE-Commercial, +125854,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,OXFORD HEALTH INSURANCE-Commercial, +125855,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,OXFORD HEALTH INSURANCE-Commercial, +125856,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,OXFORD HEALTH INSURANCE-Commercial,28820.53 +125857,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,OXFORD HEALTH INSURANCE-Commercial,14182.55 +125858,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,OXFORD HEALTH INSURANCE-Commercial,12903.98 +125859,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,OXFORD HEALTH INSURANCE-Commercial, +125860,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,OXFORD HEALTH INSURANCE-Commercial, +125861,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,OXFORD HEALTH INSURANCE-Commercial, +125862,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,OXFORD HEALTH INSURANCE-Commercial, +125863,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,OXFORD HEALTH INSURANCE-Commercial, +125864,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,OXFORD HEALTH INSURANCE-Commercial, +125865,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,OXFORD HEALTH INSURANCE-Commercial, +125866,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,OXFORD HEALTH INSURANCE-Commercial, +125867,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,OXFORD HEALTH INSURANCE-Commercial, +125868,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,OXFORD HEALTH INSURANCE-Commercial, +125869,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,OXFORD HEALTH INSURANCE-Commercial, +125870,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,OXFORD HEALTH INSURANCE-Commercial, +125871,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,OXFORD HEALTH INSURANCE-Commercial, +125872,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,OXFORD HEALTH INSURANCE-Commercial, +125873,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,OXFORD HEALTH INSURANCE-Commercial, +125874,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,OXFORD HEALTH INSURANCE-Commercial, +125875,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,OXFORD HEALTH INSURANCE-Commercial,42298.18 +125876,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,OXFORD HEALTH INSURANCE-Commercial, +125877,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,OXFORD HEALTH INSURANCE-Commercial, +125878,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,OXFORD HEALTH INSURANCE-Commercial, +125879,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,OXFORD HEALTH INSURANCE-Commercial,32226.08 +125880,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,OXFORD HEALTH INSURANCE-Commercial,20420.52 +125881,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,OXFORD HEALTH INSURANCE-Commercial, +125882,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,OXFORD HEALTH INSURANCE-Commercial, +125883,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,OXFORD HEALTH INSURANCE-Commercial, +125884,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,OXFORD HEALTH INSURANCE-Commercial, +125885,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,OXFORD HEALTH INSURANCE-Commercial, +125886,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,OXFORD HEALTH INSURANCE-Commercial, +125887,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,OXFORD HEALTH INSURANCE-Commercial, +125888,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,OXFORD HEALTH INSURANCE-Commercial, +125889,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,OXFORD HEALTH INSURANCE-Commercial, +125890,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,OXFORD HEALTH INSURANCE-Commercial,11589.06 +125891,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,OXFORD HEALTH INSURANCE-Commercial, +125892,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,OXFORD HEALTH INSURANCE-Commercial,18225.96 +125893,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,OXFORD HEALTH INSURANCE-Commercial, +125894,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,OXFORD HEALTH INSURANCE-Commercial,12350.8 +125895,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,OXFORD HEALTH INSURANCE-Commercial, +125896,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,OXFORD HEALTH INSURANCE-Commercial,31572.69 +125897,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,OXFORD HEALTH INSURANCE-Commercial,15722.1 +125898,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,OXFORD HEALTH INSURANCE-Commercial,15690.84 +125899,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,OXFORD HEALTH INSURANCE-Commercial,22330.94 +125900,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,OXFORD HEALTH INSURANCE-Commercial,25639.11 +125901,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,OXFORD HEALTH INSURANCE-Commercial,15981.11 +125902,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,OXFORD HEALTH INSURANCE-Commercial,1854.25 +125903,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,OXFORD HEALTH INSURANCE-Commercial,157958.83 +125904,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,OXFORD HEALTH INSURANCE-Commercial,122724.14 +125905,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,OXFORD HEALTH INSURANCE-Commercial,10711.82 +125906,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,OXFORD HEALTH INSURANCE-Commercial,80301.76 +125907,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,OXFORD HEALTH INSURANCE-Commercial,5706.45 +125908,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,OXFORD HEALTH INSURANCE-Commercial,3656.19 +125909,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,OXFORD HEALTH INSURANCE-Commercial, +125910,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,OXFORD HEALTH INSURANCE-Commercial,9463.35 +125911,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,OXFORD HEALTH INSURANCE-Commercial, +125912,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,OXFORD HEALTH INSURANCE-Commercial, +125913,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,OXFORD HEALTH INSURANCE-Commercial, +125914,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,OXFORD HEALTH INSURANCE-Commercial, +125915,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,OXFORD HEALTH INSURANCE-Commercial, +125916,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,OXFORD HEALTH INSURANCE-Commercial, +125917,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,OXFORD HEALTH INSURANCE-Commercial,13922.73 +125918,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,OXFORD HEALTH INSURANCE-Commercial,12313.67 +125919,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,OXFORD HEALTH INSURANCE-Commercial,12572.0 +125920,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,OXFORD HEALTH INSURANCE-Commercial,36789.06 +125921,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,OXFORD HEALTH INSURANCE-Commercial,22747.07 +125922,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,OXFORD HEALTH INSURANCE-Commercial, +125923,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,OXFORD HEALTH INSURANCE-Commercial,26015.83 +125924,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,OXFORD HEALTH INSURANCE-Commercial,16498.05 +125925,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,OXFORD HEALTH INSURANCE-Commercial, +125926,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,OXFORD HEALTH INSURANCE-Commercial, +125927,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,OXFORD HEALTH INSURANCE-Commercial, +125928,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,OXFORD HEALTH INSURANCE-Commercial,13405.43 +125929,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,OXFORD HEALTH INSURANCE-Commercial, +125930,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,OXFORD HEALTH INSURANCE-Commercial, +125931,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,OXFORD HEALTH INSURANCE-Commercial, +125932,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,OXFORD HEALTH INSURANCE-Commercial,419207.35 +125933,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,OXFORD HEALTH INSURANCE-Commercial, +125934,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,OXFORD HEALTH INSURANCE-Commercial, +125935,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,OXFORD HEALTH INSURANCE-Commercial,964252.61 +125936,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,OXFORD HEALTH INSURANCE-Commercial, +125937,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,OXFORD HEALTH INSURANCE-Commercial, +125938,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,OXFORD HEALTH INSURANCE-Commercial, +125939,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,OXFORD HEALTH INSURANCE-Commercial, +125940,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,OXFORD HEALTH INSURANCE-Commercial, +125941,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,OXFORD HEALTH INSURANCE-Commercial,58986.35 +125942,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,OXFORD HEALTH INSURANCE-Commercial, +125943,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,OXFORD HEALTH INSURANCE-Commercial,19740.62 +125944,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,OXFORD HEALTH INSURANCE-Commercial,9510.92 +125945,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,OXFORD HEALTH INSURANCE-Commercial,9639.3 +125946,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,OXFORD HEALTH INSURANCE-Commercial, +125947,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,OXFORD HEALTH INSURANCE-Commercial, +125948,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,OXFORD HEALTH INSURANCE-Commercial, +125949,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,OXFORD HEALTH INSURANCE-Commercial, +125950,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,OXFORD HEALTH INSURANCE-Commercial, +125951,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,OXFORD HEALTH INSURANCE-Commercial, +125952,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,OXFORD HEALTH INSURANCE-Commercial,69955.89 +125953,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,OXFORD HEALTH INSURANCE-Commercial, +125954,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,OXFORD HEALTH INSURANCE-Commercial, +125955,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,OXFORD HEALTH INSURANCE-Commercial, +125956,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,OXFORD HEALTH INSURANCE-Commercial, +125957,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,OXFORD HEALTH INSURANCE-Commercial,49757.76 +125958,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,OXFORD HEALTH INSURANCE-Commercial,26591.08 +125959,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,OXFORD HEALTH INSURANCE-Commercial,20883.36 +125960,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,OXFORD HEALTH INSURANCE-Commercial,300277.09 +125961,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,OXFORD HEALTH INSURANCE-Commercial,41003.48 +125962,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,OXFORD HEALTH INSURANCE-Commercial, +125963,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,OXFORD HEALTH INSURANCE-Commercial, +125964,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,OXFORD HEALTH INSURANCE-Commercial,25328.18 +125965,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,OXFORD HEALTH INSURANCE-Commercial,35051.79 +125966,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,OXFORD HEALTH INSURANCE-Commercial,18217.4 +125967,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,OXFORD HEALTH INSURANCE-Commercial,14706.52 +125968,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,OXFORD HEALTH INSURANCE-Commercial, +125969,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,OXFORD HEALTH INSURANCE-Commercial,16566.85 +125970,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,OXFORD HEALTH INSURANCE-Commercial, +125971,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,OXFORD HEALTH INSURANCE-Commercial,18807.0 +125972,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,OXFORD HEALTH INSURANCE-Commercial,14128.41 +125973,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,OXFORD HEALTH INSURANCE-Commercial,616731.95 +125974,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,OXFORD HEALTH INSURANCE-Commercial,40228.7 +125975,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,OXFORD HEALTH INSURANCE-Commercial,20493.49 +125976,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,OXFORD HEALTH INSURANCE-Commercial, +125977,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,OXFORD HEALTH INSURANCE-Commercial, +125978,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,OXFORD HEALTH INSURANCE-Commercial, +125979,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,OXFORD HEALTH INSURANCE-Commercial,13239.73 +125980,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,OXFORD HEALTH INSURANCE-Commercial, +125981,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,OXFORD HEALTH INSURANCE-Commercial,24653.0 +125982,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,OXFORD HEALTH INSURANCE-Commercial,42161.76 +125983,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,OXFORD HEALTH INSURANCE-Commercial,92838.7 +125984,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,OXFORD HEALTH INSURANCE-Commercial, +125985,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,OXFORD HEALTH INSURANCE-Commercial, +125986,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,OXFORD HEALTH INSURANCE-Commercial, +125987,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,OXFORD HEALTH INSURANCE-Commercial, +125988,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,OXFORD HEALTH INSURANCE-Commercial,13273.26 +125989,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,OXFORD HEALTH INSURANCE-Commercial, +125990,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,OXFORD HEALTH INSURANCE-Commercial, +125991,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,OXFORD HEALTH INSURANCE-Commercial, +125992,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,OXFORD HEALTH INSURANCE-Commercial,262905.51 +125993,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,OXFORD HEALTH INSURANCE-Commercial, +125994,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,OXFORD HEALTH INSURANCE-Commercial,38330.97 +125995,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,OXFORD HEALTH INSURANCE-Commercial,29071.99 +125996,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,OXFORD HEALTH INSURANCE-Commercial, +125997,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,OXFORD HEALTH INSURANCE-Commercial, +125998,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,OXFORD HEALTH INSURANCE-Commercial, +125999,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,OXFORD HEALTH INSURANCE-Commercial, +126000,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,OXFORD HEALTH INSURANCE-Commercial,33162.57 +126001,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,OXFORD HEALTH INSURANCE-Commercial,15921.99 +126002,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,OXFORD HEALTH INSURANCE-Commercial, +126003,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,OXFORD HEALTH INSURANCE-Commercial,20938.6 +126004,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,OXFORD HEALTH INSURANCE-Commercial, +126005,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,OXFORD HEALTH INSURANCE-Commercial, +126006,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,OXFORD HEALTH INSURANCE-Commercial, +126007,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,OXFORD HEALTH INSURANCE-Commercial, +126008,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,OXFORD HEALTH INSURANCE-Commercial, +126009,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,OXFORD HEALTH INSURANCE-Commercial,22098.97 +126010,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,OXFORD HEALTH INSURANCE-Commercial,6665.76 +126011,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,OXFORD HEALTH INSURANCE-Commercial, +126012,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,OXFORD HEALTH INSURANCE-Commercial, +126013,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,OXFORD HEALTH INSURANCE-Commercial,13367.46 +126014,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,OXFORD HEALTH INSURANCE-Commercial, +126015,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,OXFORD HEALTH INSURANCE-Commercial, +126016,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,OXFORD HEALTH INSURANCE-Commercial, +126017,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,OXFORD HEALTH INSURANCE-Commercial,334448.98 +126018,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,OXFORD HEALTH INSURANCE-Commercial,78960.25 +126019,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,OXFORD HEALTH INSURANCE-Commercial, +126020,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,OXFORD HEALTH INSURANCE-Commercial, +126021,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,OXFORD HEALTH INSURANCE-Commercial, +126022,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,OXFORD HEALTH INSURANCE-Commercial,29232.88 +126023,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,OXFORD HEALTH INSURANCE-Commercial, +126024,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,OXFORD HEALTH INSURANCE-Commercial, +126025,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,OXFORD HEALTH INSURANCE-Commercial, +126026,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,OXFORD HEALTH INSURANCE-Commercial, +126027,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,OXFORD HEALTH INSURANCE-Commercial, +126028,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,OXFORD HEALTH INSURANCE-Commercial,433756.24 +126029,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,OXFORD HEALTH INSURANCE-Commercial,33612.03 +126030,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,OXFORD HEALTH INSURANCE-Commercial, +126031,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126032,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,OXFORD HEALTH INSURANCE-Commercial,3267.0 +126033,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,OXFORD HEALTH INSURANCE-Commercial, +126034,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,OXFORD HEALTH INSURANCE-Commercial, +126035,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,OXFORD HEALTH INSURANCE-Commercial, +126036,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126037,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126038,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,OXFORD HEALTH INSURANCE-Commercial,3108.0 +126039,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,OXFORD HEALTH INSURANCE-Commercial, +126040,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126041,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,OXFORD HEALTH INSURANCE-Commercial,3996.0 +126042,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,OXFORD HEALTH INSURANCE-Commercial, +126043,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,OXFORD HEALTH INSURANCE-Commercial, +126044,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126045,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,OXFORD HEALTH INSURANCE-Commercial, +126046,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,OXFORD HEALTH INSURANCE-Commercial, +126047,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,OXFORD HEALTH INSURANCE-Commercial, +126048,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,OXFORD HEALTH INSURANCE-Commercial, +126049,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,OXFORD HEALTH INSURANCE-Commercial,4022.85 +126050,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126051,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,2613.6 +126052,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,OXFORD HEALTH INSURANCE-Commercial, +126053,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,OXFORD HEALTH INSURANCE-Commercial, +126054,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,OXFORD HEALTH INSURANCE-Commercial, +126055,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,OXFORD HEALTH INSURANCE-Commercial, +126056,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,OXFORD HEALTH INSURANCE-Commercial, +126057,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,OXFORD HEALTH INSURANCE-Commercial, +126058,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126059,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,OXFORD HEALTH INSURANCE-Commercial, +126060,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126061,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,OXFORD HEALTH INSURANCE-Commercial, +126062,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,OXFORD HEALTH INSURANCE-Commercial, +126063,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,OXFORD HEALTH INSURANCE-Commercial, +126064,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,OXFORD HEALTH INSURANCE-Commercial, +126065,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126066,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,OXFORD HEALTH INSURANCE-Commercial, +126067,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,OXFORD HEALTH INSURANCE-Commercial, +126068,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,OXFORD HEALTH INSURANCE-Commercial, +126069,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,OXFORD HEALTH INSURANCE-Commercial, +126070,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,OXFORD HEALTH INSURANCE-Commercial, +126071,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,OXFORD HEALTH INSURANCE-Commercial, +126072,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,OXFORD HEALTH INSURANCE-Commercial, +126073,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,OXFORD HEALTH INSURANCE-Commercial, +126074,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,OXFORD HEALTH INSURANCE-Commercial, +126075,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,OXFORD HEALTH INSURANCE-Commercial, +126076,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,OXFORD HEALTH INSURANCE-Commercial, +126077,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,OXFORD HEALTH INSURANCE-Commercial, +126078,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,OXFORD HEALTH INSURANCE-Commercial, +126079,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126080,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,OXFORD HEALTH INSURANCE-Commercial, +126081,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,OXFORD HEALTH INSURANCE-Commercial, +126082,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,OXFORD HEALTH INSURANCE-Commercial, +126083,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126084,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126085,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,OXFORD HEALTH INSURANCE-Commercial, +126086,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,OXFORD HEALTH INSURANCE-Commercial, +126087,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126088,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,OXFORD HEALTH INSURANCE-Commercial, +126089,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,OXFORD HEALTH INSURANCE-Commercial, +126090,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,OXFORD HEALTH INSURANCE-Commercial, +126091,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,OXFORD HEALTH INSURANCE-Commercial, +126092,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,OXFORD HEALTH INSURANCE-Commercial, +126093,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,OXFORD HEALTH INSURANCE-Commercial, +126094,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,OXFORD HEALTH INSURANCE-Commercial, +126095,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,OXFORD HEALTH INSURANCE-Commercial, +126096,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,OXFORD HEALTH INSURANCE-Commercial, +126097,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126098,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,OXFORD HEALTH INSURANCE-Commercial, +126099,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126100,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126101,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,OXFORD HEALTH INSURANCE-Commercial, +126102,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,OXFORD HEALTH INSURANCE-Commercial, +126103,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126104,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,OXFORD HEALTH INSURANCE-Commercial, +126105,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126106,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,OXFORD HEALTH INSURANCE-Commercial, +126107,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,OXFORD HEALTH INSURANCE-Commercial, +126108,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,OXFORD HEALTH INSURANCE-Commercial, +126109,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,OXFORD HEALTH INSURANCE-Commercial,6535.54 +126110,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,OXFORD HEALTH INSURANCE-Commercial, +126111,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,OXFORD HEALTH INSURANCE-Commercial, +126112,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,OXFORD HEALTH INSURANCE-Commercial, +126113,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,OXFORD HEALTH INSURANCE-Commercial, +126114,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,OXFORD HEALTH INSURANCE-Commercial, +126115,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126116,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126117,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126118,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,OXFORD HEALTH INSURANCE-Commercial, +126119,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126120,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126121,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,OXFORD HEALTH INSURANCE-Commercial, +126122,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,OXFORD HEALTH INSURANCE-Commercial, +126123,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,OXFORD HEALTH INSURANCE-Commercial, +126124,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,OXFORD HEALTH INSURANCE-Commercial, +126125,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,OXFORD HEALTH INSURANCE-Commercial, +126126,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126127,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126128,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126129,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,OXFORD HEALTH INSURANCE-Commercial, +126130,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,OXFORD HEALTH INSURANCE-Commercial, +126131,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,OXFORD HEALTH INSURANCE-Commercial, +126132,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,OXFORD HEALTH INSURANCE-Commercial, +126133,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,OXFORD HEALTH INSURANCE-Commercial, +126134,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,OXFORD HEALTH INSURANCE-Commercial, +126135,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,OXFORD HEALTH INSURANCE-Commercial, +126136,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,OXFORD HEALTH INSURANCE-Commercial, +126137,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126138,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126139,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,OXFORD HEALTH INSURANCE-Commercial, +126140,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,OXFORD HEALTH INSURANCE-Commercial, +126141,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126142,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126143,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126144,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,OXFORD HEALTH INSURANCE-Commercial, +126145,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126146,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,OXFORD HEALTH INSURANCE-Commercial, +126147,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,OXFORD HEALTH INSURANCE-Commercial, +126148,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,OXFORD HEALTH INSURANCE-Commercial, +126149,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,OXFORD HEALTH INSURANCE-Commercial,1982.8 +126150,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,OXFORD HEALTH INSURANCE-Commercial, +126151,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126152,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126153,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,OXFORD HEALTH INSURANCE-Commercial, +126154,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,OXFORD HEALTH INSURANCE-Commercial, +126155,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,OXFORD HEALTH INSURANCE-Commercial, +126156,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,OXFORD HEALTH INSURANCE-Commercial, +126157,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126158,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,OXFORD HEALTH INSURANCE-Commercial, +126159,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126160,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,OXFORD HEALTH INSURANCE-Commercial,3267.0 +126161,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,OXFORD HEALTH INSURANCE-Commercial, +126162,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126163,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,OXFORD HEALTH INSURANCE-Commercial, +126164,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,OXFORD HEALTH INSURANCE-Commercial, +126165,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,OXFORD HEALTH INSURANCE-Commercial, +126166,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,OXFORD HEALTH INSURANCE-Commercial, +126167,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,OXFORD HEALTH INSURANCE-Commercial, +126168,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,OXFORD HEALTH INSURANCE-Commercial, +126169,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,OXFORD HEALTH INSURANCE-Commercial, +126170,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,OXFORD HEALTH INSURANCE-Commercial, +126171,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,OXFORD HEALTH INSURANCE-Commercial, +126172,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,OXFORD HEALTH INSURANCE-Commercial, +126173,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,OXFORD HEALTH INSURANCE-Commercial, +126174,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,OXFORD HEALTH INSURANCE-Commercial, +126175,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126176,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,OXFORD HEALTH INSURANCE-Commercial, +126177,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,OXFORD HEALTH INSURANCE-Commercial, +126178,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,OXFORD HEALTH INSURANCE-Commercial, +126179,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,OXFORD HEALTH INSURANCE-Commercial, +126180,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,OXFORD HEALTH INSURANCE-Commercial, +126181,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,OXFORD HEALTH INSURANCE-Commercial,4357.54 +126182,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126183,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,OXFORD HEALTH INSURANCE-Commercial, +126184,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126185,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,OXFORD HEALTH INSURANCE-Commercial, +126186,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,OXFORD HEALTH INSURANCE-Commercial, +126187,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,OXFORD HEALTH INSURANCE-Commercial,6534.0 +126188,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,OXFORD HEALTH INSURANCE-Commercial, +126189,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,OXFORD HEALTH INSURANCE-Commercial, +126190,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,OXFORD HEALTH INSURANCE-Commercial, +126191,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,OXFORD HEALTH INSURANCE-Commercial, +126192,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,OXFORD HEALTH INSURANCE-Commercial, +126193,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,OXFORD HEALTH INSURANCE-Commercial, +126194,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,OXFORD HEALTH INSURANCE-Commercial, +126195,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,OXFORD HEALTH INSURANCE-Commercial, +126196,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,OXFORD HEALTH INSURANCE-Commercial, +126197,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126198,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,OXFORD HEALTH INSURANCE-Commercial, +126199,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,OXFORD HEALTH INSURANCE-Commercial, +126200,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,OXFORD HEALTH INSURANCE-Commercial, +126201,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126202,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,OXFORD HEALTH INSURANCE-Commercial, +126203,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,OXFORD HEALTH INSURANCE-Commercial,3811.5 +126204,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,OXFORD HEALTH INSURANCE-Commercial,3630.0 +126205,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126206,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126207,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126208,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126209,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,OXFORD HEALTH INSURANCE-Commercial, +126210,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,OXFORD HEALTH INSURANCE-Commercial,3267.0 +126211,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,OXFORD HEALTH INSURANCE-Commercial,3996.0 +126212,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126213,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,OXFORD HEALTH INSURANCE-Commercial, +126214,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,OXFORD HEALTH INSURANCE-Commercial, +126215,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126216,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,OXFORD HEALTH INSURANCE-Commercial, +126217,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,OXFORD HEALTH INSURANCE-Commercial, +126218,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,OXFORD HEALTH INSURANCE-Commercial, +126219,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,OXFORD HEALTH INSURANCE-Commercial,3267.0 +126220,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,OXFORD HEALTH INSURANCE-Commercial,3863.19 +126221,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,OXFORD HEALTH INSURANCE-Commercial, +126222,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,OXFORD HEALTH INSURANCE-Commercial, +126223,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,OXFORD HEALTH INSURANCE-Commercial,6535.54 +126224,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,OXFORD HEALTH INSURANCE-Commercial, +126225,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,OXFORD HEALTH INSURANCE-Commercial, +126226,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126227,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,OXFORD HEALTH INSURANCE-Commercial,6534.0 +126228,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,OXFORD HEALTH INSURANCE-Commercial, +126229,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,OXFORD HEALTH INSURANCE-Commercial, +126230,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,OXFORD HEALTH INSURANCE-Commercial,5481.3 +126231,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,OXFORD HEALTH INSURANCE-Commercial, +126232,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,OXFORD HEALTH INSURANCE-Commercial, +126233,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,OXFORD HEALTH INSURANCE-Commercial,3267.0 +126234,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,OXFORD HEALTH INSURANCE-Commercial,6535.54 +126235,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,OXFORD HEALTH INSURANCE-Commercial, +126236,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,OXFORD HEALTH INSURANCE-Commercial, +126237,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,OXFORD HEALTH INSURANCE-Commercial, +126238,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,OXFORD HEALTH INSURANCE-Commercial, +126239,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126240,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126241,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,OXFORD HEALTH INSURANCE-Commercial, +126242,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,OXFORD HEALTH INSURANCE-Commercial, +126243,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,OXFORD HEALTH INSURANCE-Commercial, +126244,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,OXFORD HEALTH INSURANCE-Commercial, +126245,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126246,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126247,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,OXFORD HEALTH INSURANCE-Commercial,451.18 +126248,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,OXFORD HEALTH INSURANCE-Commercial, +126249,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,OXFORD HEALTH INSURANCE-Commercial, +126250,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,OXFORD HEALTH INSURANCE-Commercial, +126251,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126252,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,OXFORD HEALTH INSURANCE-Commercial, +126253,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,OXFORD HEALTH INSURANCE-Commercial, +126254,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,OXFORD HEALTH INSURANCE-Commercial, +126255,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126256,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,OXFORD HEALTH INSURANCE-Commercial, +126257,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,OXFORD HEALTH INSURANCE-Commercial, +126258,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,OXFORD HEALTH INSURANCE-Commercial, +126259,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,OXFORD HEALTH INSURANCE-Commercial, +126260,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126261,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,OXFORD HEALTH INSURANCE-Commercial, +126262,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,OXFORD HEALTH INSURANCE-Commercial, +126263,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,OXFORD HEALTH INSURANCE-Commercial, +126264,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,OXFORD HEALTH INSURANCE-Commercial,7184.0 +126265,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,OXFORD HEALTH INSURANCE-Commercial, +126266,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126267,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,OXFORD HEALTH INSURANCE-Commercial, +126268,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,OXFORD HEALTH INSURANCE-Commercial, +126269,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,OXFORD HEALTH INSURANCE-Commercial, +126270,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,OXFORD HEALTH INSURANCE-Commercial, +126271,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,OXFORD HEALTH INSURANCE-Commercial, +126272,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,OXFORD HEALTH INSURANCE-Commercial, +126273,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,OXFORD HEALTH INSURANCE-Commercial, +126274,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,OXFORD HEALTH INSURANCE-Commercial, +126275,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,OXFORD HEALTH INSURANCE-Commercial, +126276,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,OXFORD HEALTH INSURANCE-Commercial, +126277,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126278,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,OXFORD HEALTH INSURANCE-Commercial, +126279,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,OXFORD HEALTH INSURANCE-Commercial, +126280,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,OXFORD HEALTH INSURANCE-Commercial, +126281,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,OXFORD HEALTH INSURANCE-Commercial, +126282,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,OXFORD HEALTH INSURANCE-Commercial, +126283,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,OXFORD HEALTH INSURANCE-Commercial, +126284,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126285,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +126286,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126287,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126288,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,OXFORD HEALTH INSURANCE-Commercial, +126289,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,OXFORD HEALTH INSURANCE-Commercial, +126290,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,OXFORD HEALTH INSURANCE-Commercial, +126291,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,OXFORD HEALTH INSURANCE-Commercial, +126292,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,OXFORD HEALTH INSURANCE-Commercial, +126293,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,OXFORD HEALTH INSURANCE-Commercial, +126294,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,OXFORD HEALTH INSURANCE-Commercial, +126295,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,OXFORD HEALTH INSURANCE-Commercial, +126296,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,OXFORD HEALTH INSURANCE-Commercial, +126297,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,OXFORD HEALTH INSURANCE-Commercial, +126298,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,OXFORD HEALTH INSURANCE-Commercial, +126299,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,OXFORD HEALTH INSURANCE-Commercial, +126300,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,OXFORD HEALTH INSURANCE-Commercial, +126301,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,OXFORD HEALTH INSURANCE-Commercial, +126302,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,OXFORD HEALTH INSURANCE-Commercial, +126303,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,OXFORD HEALTH INSURANCE-Commercial, +126304,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,OXFORD HEALTH INSURANCE-Commercial,5418.5 +126305,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,OXFORD HEALTH INSURANCE-Commercial, +126306,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,OXFORD HEALTH INSURANCE-Commercial, +126307,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126308,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,OXFORD HEALTH INSURANCE-Commercial, +126309,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,OXFORD HEALTH INSURANCE-Commercial, +126310,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,OXFORD HEALTH INSURANCE-Commercial, +126311,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,OXFORD HEALTH INSURANCE-Commercial, +126312,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,OXFORD HEALTH INSURANCE-Commercial, +126313,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,OXFORD HEALTH INSURANCE-Commercial, +126314,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,OXFORD HEALTH INSURANCE-Commercial, +126315,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,OXFORD HEALTH INSURANCE-Commercial, +126316,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,OXFORD HEALTH INSURANCE-Commercial, +126317,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,OXFORD HEALTH INSURANCE-Commercial, +126318,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,OXFORD HEALTH INSURANCE-Commercial, +126319,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,OXFORD HEALTH INSURANCE-Commercial, +126320,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,OXFORD HEALTH INSURANCE-Commercial, +126321,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,OXFORD HEALTH INSURANCE-Commercial, +126322,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,OXFORD HEALTH INSURANCE-Commercial, +126323,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,OXFORD HEALTH INSURANCE-Commercial, +126324,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,OXFORD HEALTH INSURANCE-Commercial,17639.5 +126325,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126326,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126327,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126328,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,OXFORD HEALTH INSURANCE-Commercial, +126329,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,OXFORD HEALTH INSURANCE-Commercial, +126330,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,OXFORD HEALTH INSURANCE-Commercial, +126331,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,OXFORD HEALTH INSURANCE-Commercial, +126332,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,OXFORD HEALTH INSURANCE-Commercial, +126333,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,OXFORD HEALTH INSURANCE-Commercial, +126334,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,OXFORD HEALTH INSURANCE-Commercial, +126335,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,OXFORD HEALTH INSURANCE-Commercial, +126336,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,OXFORD HEALTH INSURANCE-Commercial, +126337,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,OXFORD HEALTH INSURANCE-Commercial, +126338,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,OXFORD HEALTH INSURANCE-Commercial, +126339,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,OXFORD HEALTH INSURANCE-Commercial, +126340,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,OXFORD HEALTH INSURANCE-Commercial, +126341,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,OXFORD HEALTH INSURANCE-Commercial, +126342,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,OXFORD HEALTH INSURANCE-Commercial, +126343,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126344,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,OXFORD HEALTH INSURANCE-Commercial, +126345,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,OXFORD HEALTH INSURANCE-Commercial, +126346,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,OXFORD HEALTH INSURANCE-Commercial, +126347,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,OXFORD HEALTH INSURANCE-Commercial,4594.5 +126348,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,OXFORD HEALTH INSURANCE-Commercial, +126349,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126350,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,OXFORD HEALTH INSURANCE-Commercial, +126351,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126352,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,OXFORD HEALTH INSURANCE-Commercial, +126353,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,OXFORD HEALTH INSURANCE-Commercial, +126354,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,OXFORD HEALTH INSURANCE-Commercial, +126355,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,OXFORD HEALTH INSURANCE-Commercial, +126356,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,OXFORD HEALTH INSURANCE-Commercial, +126357,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,OXFORD HEALTH INSURANCE-Commercial, +126358,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,OXFORD HEALTH INSURANCE-Commercial, +126359,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,OXFORD HEALTH INSURANCE-Commercial, +126360,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,OXFORD HEALTH INSURANCE-Commercial, +126361,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,OXFORD HEALTH INSURANCE-Commercial, +126362,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,OXFORD HEALTH INSURANCE-Commercial, +126363,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126364,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,OXFORD HEALTH INSURANCE-Commercial, +126365,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,OXFORD HEALTH INSURANCE-Commercial, +126366,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126367,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126368,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,OXFORD HEALTH INSURANCE-Commercial, +126369,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,OXFORD HEALTH INSURANCE-Commercial, +126370,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,OXFORD HEALTH INSURANCE-Commercial, +126371,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,OXFORD HEALTH INSURANCE-Commercial, +126372,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,OXFORD HEALTH INSURANCE-Commercial, +126373,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,OXFORD HEALTH INSURANCE-Commercial, +126374,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,OXFORD HEALTH INSURANCE-Commercial, +126375,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,OXFORD HEALTH INSURANCE-Commercial, +126376,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,OXFORD HEALTH INSURANCE-Commercial, +126377,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,OXFORD HEALTH INSURANCE-Commercial, +126378,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,OXFORD HEALTH INSURANCE-Commercial, +126379,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,OXFORD HEALTH INSURANCE-Commercial, +126380,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,OXFORD HEALTH INSURANCE-Commercial, +126381,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,OXFORD HEALTH INSURANCE-Commercial, +126382,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,OXFORD HEALTH INSURANCE-Commercial, +126383,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,OXFORD HEALTH INSURANCE-Commercial, +126384,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,OXFORD HEALTH INSURANCE-Commercial, +126385,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,OXFORD HEALTH INSURANCE-Commercial, +126386,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126387,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,OXFORD HEALTH INSURANCE-Commercial, +126388,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,OXFORD HEALTH INSURANCE-Commercial, +126389,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,OXFORD HEALTH INSURANCE-Commercial,4759.0 +126390,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,OXFORD HEALTH INSURANCE-Commercial, +126391,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,OXFORD HEALTH INSURANCE-Commercial, +126392,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,OXFORD HEALTH INSURANCE-Commercial,5338.0 +126393,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,OXFORD HEALTH INSURANCE-Commercial, +126394,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,OXFORD HEALTH INSURANCE-Commercial, +126395,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,OXFORD HEALTH INSURANCE-Commercial, +126396,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,OXFORD HEALTH INSURANCE-Commercial, +126397,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,OXFORD HEALTH INSURANCE-Commercial, +126398,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,OXFORD HEALTH INSURANCE-Commercial, +126399,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,OXFORD HEALTH INSURANCE-Commercial, +126400,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,OXFORD HEALTH INSURANCE-Commercial, +126401,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126402,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,OXFORD HEALTH INSURANCE-Commercial, +126403,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,OXFORD HEALTH INSURANCE-Commercial, +126404,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,OXFORD HEALTH INSURANCE-Commercial, +126405,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,OXFORD HEALTH INSURANCE-Commercial, +126406,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126407,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,OXFORD HEALTH INSURANCE-Commercial, +126408,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,OXFORD HEALTH INSURANCE-Commercial, +126409,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,OXFORD HEALTH INSURANCE-Commercial, +126410,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126411,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,OXFORD HEALTH INSURANCE-Commercial, +126412,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,OXFORD HEALTH INSURANCE-Commercial, +126413,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,OXFORD HEALTH INSURANCE-Commercial, +126414,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,OXFORD HEALTH INSURANCE-Commercial, +126415,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,OXFORD HEALTH INSURANCE-Commercial, +126416,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,OXFORD HEALTH INSURANCE-Commercial, +126417,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,OXFORD HEALTH INSURANCE-Commercial, +126418,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,OXFORD HEALTH INSURANCE-Commercial, +126419,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,OXFORD HEALTH INSURANCE-Commercial, +126420,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126421,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,OXFORD HEALTH INSURANCE-Commercial, +126422,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,OXFORD HEALTH INSURANCE-Commercial, +126423,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,OXFORD HEALTH INSURANCE-Commercial, +126424,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,OXFORD HEALTH INSURANCE-Commercial, +126425,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,OXFORD HEALTH INSURANCE-Commercial, +126426,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,OXFORD HEALTH INSURANCE-Commercial, +126427,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126428,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126429,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,OXFORD HEALTH INSURANCE-Commercial, +126430,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,OXFORD HEALTH INSURANCE-Commercial, +126431,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126432,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126433,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,OXFORD HEALTH INSURANCE-Commercial, +126434,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,OXFORD HEALTH INSURANCE-Commercial, +126435,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,OXFORD HEALTH INSURANCE-Commercial, +126436,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,OXFORD HEALTH INSURANCE-Commercial, +126437,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,OXFORD HEALTH INSURANCE-Commercial, +126438,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,OXFORD HEALTH INSURANCE-Commercial, +126439,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126440,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,OXFORD HEALTH INSURANCE-Commercial, +126441,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,OXFORD HEALTH INSURANCE-Commercial, +126442,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,OXFORD HEALTH INSURANCE-Commercial, +126443,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,OXFORD HEALTH INSURANCE-Commercial, +126444,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126445,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126446,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,OXFORD HEALTH INSURANCE-Commercial, +126447,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,OXFORD HEALTH INSURANCE-Commercial, +126448,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,OXFORD HEALTH INSURANCE-Commercial, +126449,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,OXFORD HEALTH INSURANCE-Commercial, +126450,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,OXFORD HEALTH INSURANCE-Commercial, +126451,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,OXFORD HEALTH INSURANCE-Commercial, +126452,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126453,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,OXFORD HEALTH INSURANCE-Commercial, +126454,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,OXFORD HEALTH INSURANCE-Commercial, +126455,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,OXFORD HEALTH INSURANCE-Commercial, +126456,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,OXFORD HEALTH INSURANCE-Commercial,931.26 +126457,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126458,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,OXFORD HEALTH INSURANCE-Commercial, +126459,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,OXFORD HEALTH INSURANCE-Commercial, +126460,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,OXFORD HEALTH INSURANCE-Commercial, +126461,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,OXFORD HEALTH INSURANCE-Commercial, +126462,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,OXFORD HEALTH INSURANCE-Commercial, +126463,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,OXFORD HEALTH INSURANCE-Commercial, +126464,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,OXFORD HEALTH INSURANCE-Commercial, +126465,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,OXFORD HEALTH INSURANCE-Commercial, +126466,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,OXFORD HEALTH INSURANCE-Commercial, +126467,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,OXFORD HEALTH INSURANCE-Commercial, +126468,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,OXFORD HEALTH INSURANCE-Commercial, +126469,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,OXFORD HEALTH INSURANCE-Commercial, +126470,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,OXFORD HEALTH INSURANCE-Commercial, +126471,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,OXFORD HEALTH INSURANCE-Commercial, +126472,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126473,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126474,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,OXFORD HEALTH INSURANCE-Commercial, +126475,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,OXFORD HEALTH INSURANCE-Commercial, +126476,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126477,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,OXFORD HEALTH INSURANCE-Commercial, +126478,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126479,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,OXFORD HEALTH INSURANCE-Commercial, +126480,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,OXFORD HEALTH INSURANCE-Commercial, +126481,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126482,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,OXFORD HEALTH INSURANCE-Commercial, +126483,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126484,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,OXFORD HEALTH INSURANCE-Commercial, +126485,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,OXFORD HEALTH INSURANCE-Commercial, +126486,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,OXFORD HEALTH INSURANCE-Commercial, +126487,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,OXFORD HEALTH INSURANCE-Commercial, +126488,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126489,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,OXFORD HEALTH INSURANCE-Commercial, +126490,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,OXFORD HEALTH INSURANCE-Commercial, +126491,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,OXFORD HEALTH INSURANCE-Commercial, +126492,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,OXFORD HEALTH INSURANCE-Commercial, +126493,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126494,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,OXFORD HEALTH INSURANCE-Commercial, +126495,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,OXFORD HEALTH INSURANCE-Commercial, +126496,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,OXFORD HEALTH INSURANCE-Commercial, +126497,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126498,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,OXFORD HEALTH INSURANCE-Commercial, +126499,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,OXFORD HEALTH INSURANCE-Commercial, +126500,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,OXFORD HEALTH INSURANCE-Commercial, +126501,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,OXFORD HEALTH INSURANCE-Commercial, +126502,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,OXFORD HEALTH INSURANCE-Commercial, +126503,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,OXFORD HEALTH INSURANCE-Commercial, +126504,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,OXFORD HEALTH INSURANCE-Commercial, +126505,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,OXFORD HEALTH INSURANCE-Commercial, +126506,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,OXFORD HEALTH INSURANCE-Commercial, +126507,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,OXFORD HEALTH INSURANCE-Commercial, +126508,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,OXFORD HEALTH INSURANCE-Commercial, +126509,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,OXFORD HEALTH INSURANCE-Commercial, +126510,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,OXFORD HEALTH INSURANCE-Commercial, +126511,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,OXFORD HEALTH INSURANCE-Commercial, +126512,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,OXFORD HEALTH INSURANCE-Commercial, +126513,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,OXFORD HEALTH INSURANCE-Commercial, +126514,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,OXFORD HEALTH INSURANCE-Commercial, +126515,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,OXFORD HEALTH INSURANCE-Commercial, +126516,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,OXFORD HEALTH INSURANCE-Commercial, +126517,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,OXFORD HEALTH INSURANCE-Commercial, +126518,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,OXFORD HEALTH INSURANCE-Commercial, +126519,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,OXFORD HEALTH INSURANCE-Commercial, +126520,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126521,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,OXFORD HEALTH INSURANCE-Commercial, +126522,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126523,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,OXFORD HEALTH INSURANCE-Commercial, +126524,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,OXFORD HEALTH INSURANCE-Commercial, +126525,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,OXFORD HEALTH INSURANCE-Commercial, +126526,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126527,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,OXFORD HEALTH INSURANCE-Commercial, +126528,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,OXFORD HEALTH INSURANCE-Commercial, +126529,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,OXFORD HEALTH INSURANCE-Commercial, +126530,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,OXFORD HEALTH INSURANCE-Commercial, +126531,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126532,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,OXFORD HEALTH INSURANCE-Commercial, +126533,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,OXFORD HEALTH INSURANCE-Commercial, +126534,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,OXFORD HEALTH INSURANCE-Commercial, +126535,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,OXFORD HEALTH INSURANCE-Commercial,17526.47 +126536,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,OXFORD HEALTH INSURANCE-Commercial, +126537,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,OXFORD HEALTH INSURANCE-Commercial, +126538,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,OXFORD HEALTH INSURANCE-Commercial, +126539,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,OXFORD HEALTH INSURANCE-Commercial, +126540,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,OXFORD HEALTH INSURANCE-Commercial, +126541,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,OXFORD HEALTH INSURANCE-Commercial, +126542,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126543,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,OXFORD HEALTH INSURANCE-Commercial, +126544,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,OXFORD HEALTH INSURANCE-Commercial, +126545,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,OXFORD HEALTH INSURANCE-Commercial, +126546,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126547,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,OXFORD HEALTH INSURANCE-Commercial, +126548,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,OXFORD HEALTH INSURANCE-Commercial, +126549,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,OXFORD HEALTH INSURANCE-Commercial, +126550,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126551,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,OXFORD HEALTH INSURANCE-Commercial, +126552,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,OXFORD HEALTH INSURANCE-Commercial, +126553,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,OXFORD HEALTH INSURANCE-Commercial, +126554,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,OXFORD HEALTH INSURANCE-Commercial, +126555,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,OXFORD HEALTH INSURANCE-Commercial, +126556,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,OXFORD HEALTH INSURANCE-Commercial, +126557,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,OXFORD HEALTH INSURANCE-Commercial, +126558,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,OXFORD HEALTH INSURANCE-Commercial, +126559,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,OXFORD HEALTH INSURANCE-Commercial,3996.0 +126560,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,OXFORD HEALTH INSURANCE-Commercial, +126561,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,OXFORD HEALTH INSURANCE-Commercial, +126562,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126563,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,OXFORD HEALTH INSURANCE-Commercial, +126564,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126565,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126566,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,OXFORD HEALTH INSURANCE-Commercial, +126567,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,OXFORD HEALTH INSURANCE-Commercial, +126568,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,OXFORD HEALTH INSURANCE-Commercial, +126569,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,OXFORD HEALTH INSURANCE-Commercial, +126570,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,OXFORD HEALTH INSURANCE-Commercial, +126571,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126572,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,OXFORD HEALTH INSURANCE-Commercial, +126573,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,OXFORD HEALTH INSURANCE-Commercial, +126574,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,OXFORD HEALTH INSURANCE-Commercial, +126575,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,OXFORD HEALTH INSURANCE-Commercial, +126576,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,OXFORD HEALTH INSURANCE-Commercial, +126577,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,OXFORD HEALTH INSURANCE-Commercial, +126578,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,OXFORD HEALTH INSURANCE-Commercial,4883.5 +126579,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,OXFORD HEALTH INSURANCE-Commercial, +126580,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,OXFORD HEALTH INSURANCE-Commercial, +126581,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,OXFORD HEALTH INSURANCE-Commercial, +126582,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,OXFORD HEALTH INSURANCE-Commercial, +126583,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,OXFORD HEALTH INSURANCE-Commercial, +126584,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,OXFORD HEALTH INSURANCE-Commercial, +126585,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,OXFORD HEALTH INSURANCE-Commercial, +126586,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,OXFORD HEALTH INSURANCE-Commercial, +126587,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,OXFORD HEALTH INSURANCE-Commercial, +126588,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,OXFORD HEALTH INSURANCE-Commercial, +126589,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,OXFORD HEALTH INSURANCE-Commercial, +126590,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,OXFORD HEALTH INSURANCE-Commercial, +126591,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,OXFORD HEALTH INSURANCE-Commercial, +126592,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,OXFORD HEALTH INSURANCE-Commercial, +126593,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,OXFORD HEALTH INSURANCE-Commercial, +126594,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,OXFORD HEALTH INSURANCE-Commercial, +126595,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,OXFORD HEALTH INSURANCE-Commercial, +126596,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,OXFORD HEALTH INSURANCE-Commercial, +126597,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,OXFORD HEALTH INSURANCE-Commercial, +126598,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,OXFORD HEALTH INSURANCE-Commercial, +126599,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,OXFORD HEALTH INSURANCE-Commercial, +126600,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,OXFORD HEALTH INSURANCE-Commercial, +126601,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,OXFORD HEALTH INSURANCE-Commercial, +126602,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,OXFORD HEALTH INSURANCE-Commercial, +126603,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,OXFORD HEALTH INSURANCE-Commercial, +126604,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126605,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126606,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,OXFORD HEALTH INSURANCE-Commercial, +126607,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126608,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,OXFORD HEALTH INSURANCE-Commercial, +126609,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126610,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126611,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,OXFORD HEALTH INSURANCE-Commercial, +126612,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,OXFORD HEALTH INSURANCE-Commercial, +126613,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126614,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,OXFORD HEALTH INSURANCE-Commercial, +126615,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,OXFORD HEALTH INSURANCE-Commercial, +126616,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,OXFORD HEALTH INSURANCE-Commercial, +126617,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,OXFORD HEALTH INSURANCE-Commercial, +126618,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,OXFORD HEALTH INSURANCE-Commercial, +126619,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126620,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,OXFORD HEALTH INSURANCE-Commercial, +126621,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,OXFORD HEALTH INSURANCE-Commercial, +126622,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,OXFORD HEALTH INSURANCE-Commercial, +126623,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,OXFORD HEALTH INSURANCE-Commercial, +126624,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126625,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,OXFORD HEALTH INSURANCE-Commercial, +126626,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,OXFORD HEALTH INSURANCE-Commercial, +126627,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,OXFORD HEALTH INSURANCE-Commercial, +126628,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,OXFORD HEALTH INSURANCE-Commercial, +126629,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,OXFORD HEALTH INSURANCE-Commercial, +126630,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,OXFORD HEALTH INSURANCE-Commercial,4828.0 +126631,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126632,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,OXFORD HEALTH INSURANCE-Commercial, +126633,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,OXFORD HEALTH INSURANCE-Commercial, +126634,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,OXFORD HEALTH INSURANCE-Commercial, +126635,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,OXFORD HEALTH INSURANCE-Commercial, +126636,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,OXFORD HEALTH INSURANCE-Commercial, +126637,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,OXFORD HEALTH INSURANCE-Commercial, +126638,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,OXFORD HEALTH INSURANCE-Commercial, +126639,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,OXFORD HEALTH INSURANCE-Commercial, +126640,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,OXFORD HEALTH INSURANCE-Commercial, +126641,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,OXFORD HEALTH INSURANCE-Commercial, +126642,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,OXFORD HEALTH INSURANCE-Commercial, +126643,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,OXFORD HEALTH INSURANCE-Commercial, +126644,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,OXFORD HEALTH INSURANCE-Commercial, +126645,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,OXFORD HEALTH INSURANCE-Commercial, +126646,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,OXFORD HEALTH INSURANCE-Commercial,4280.0 +126647,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,OXFORD HEALTH INSURANCE-Commercial, +126648,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,OXFORD HEALTH INSURANCE-Commercial, +126649,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,OXFORD HEALTH INSURANCE-Commercial, +126650,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,OXFORD HEALTH INSURANCE-Commercial, +126651,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,OXFORD HEALTH INSURANCE-Commercial, +126652,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,OXFORD HEALTH INSURANCE-Commercial, +126653,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,OXFORD HEALTH INSURANCE-Commercial, +126654,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,OXFORD HEALTH INSURANCE-Commercial, +126655,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126656,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,OXFORD HEALTH INSURANCE-Commercial,1939.0 +126657,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126658,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,OXFORD HEALTH INSURANCE-Commercial, +126659,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126660,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126661,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,OXFORD HEALTH INSURANCE-Commercial, +126662,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126663,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126664,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,OXFORD HEALTH INSURANCE-Commercial,2419.5 +126665,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,OXFORD HEALTH INSURANCE-Commercial, +126666,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,OXFORD HEALTH INSURANCE-Commercial, +126667,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,OXFORD HEALTH INSURANCE-Commercial, +126668,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126669,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,OXFORD HEALTH INSURANCE-Commercial, +126670,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126671,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126672,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,OXFORD HEALTH INSURANCE-Commercial, +126673,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126674,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,OXFORD HEALTH INSURANCE-Commercial, +126675,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,OXFORD HEALTH INSURANCE-Commercial, +126676,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126677,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,OXFORD HEALTH INSURANCE-Commercial,8034.0 +126678,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,OXFORD HEALTH INSURANCE-Commercial,3678.0 +126679,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,OXFORD HEALTH INSURANCE-Commercial, +126680,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,OXFORD HEALTH INSURANCE-Commercial, +126681,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,OXFORD HEALTH INSURANCE-Commercial, +126682,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126683,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,OXFORD HEALTH INSURANCE-Commercial, +126684,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,OXFORD HEALTH INSURANCE-Commercial, +126685,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,OXFORD HEALTH INSURANCE-Commercial, +126686,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,OXFORD HEALTH INSURANCE-Commercial, +126687,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,OXFORD HEALTH INSURANCE-Commercial, +126688,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126689,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126690,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,OXFORD HEALTH INSURANCE-Commercial, +126691,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126692,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,OXFORD HEALTH INSURANCE-Commercial, +126693,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +126694,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,OXFORD HEALTH INSURANCE-Commercial, +126695,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126696,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126697,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,OXFORD HEALTH INSURANCE-Commercial, +126698,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126699,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,OXFORD HEALTH INSURANCE-Commercial, +126700,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,OXFORD HEALTH INSURANCE-Commercial,3993.0 +126701,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,OXFORD HEALTH INSURANCE-Commercial, +126702,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,OXFORD HEALTH INSURANCE-Commercial, +126703,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126704,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,OXFORD HEALTH INSURANCE-Commercial, +126705,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,OXFORD HEALTH INSURANCE-Commercial, +126706,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,OXFORD HEALTH INSURANCE-Commercial, +126707,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,OXFORD HEALTH INSURANCE-Commercial, +126708,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126709,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126710,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126711,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,OXFORD HEALTH INSURANCE-Commercial,1998.0 +126712,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,OXFORD HEALTH INSURANCE-Commercial, +126713,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126714,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,OXFORD HEALTH INSURANCE-Commercial, +126715,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,OXFORD HEALTH INSURANCE-Commercial, +126716,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,OXFORD HEALTH INSURANCE-Commercial, +126717,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,OXFORD HEALTH INSURANCE-Commercial, +126718,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126719,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,OXFORD HEALTH INSURANCE-Commercial, +126720,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,OXFORD HEALTH INSURANCE-Commercial, +126721,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,OXFORD HEALTH INSURANCE-Commercial, +126722,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,OXFORD HEALTH INSURANCE-Commercial, +126723,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,OXFORD HEALTH INSURANCE-Commercial, +126724,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,OXFORD HEALTH INSURANCE-Commercial, +126725,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,OXFORD HEALTH INSURANCE-Commercial, +126726,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,OXFORD HEALTH INSURANCE-Commercial, +126727,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,OXFORD HEALTH INSURANCE-Commercial,3996.0 +126728,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,OXFORD HEALTH INSURANCE-Commercial, +126729,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,OXFORD HEALTH INSURANCE-Commercial, +126730,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,OXFORD HEALTH INSURANCE-Commercial, +126731,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,OXFORD HEALTH INSURANCE-Commercial, +126732,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,OXFORD HEALTH INSURANCE-Commercial, +126733,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,OXFORD HEALTH INSURANCE-Commercial, +126734,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,OXFORD HEALTH INSURANCE-Commercial, +126735,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,OXFORD HEALTH INSURANCE-Commercial, +126736,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,OXFORD HEALTH INSURANCE-Commercial, +126737,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,OXFORD HEALTH INSURANCE-Commercial, +126738,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,OXFORD HEALTH INSURANCE-Commercial, +126739,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,OXFORD HEALTH INSURANCE-Commercial, +126740,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,OXFORD HEALTH INSURANCE-Commercial, +126741,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126742,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,OXFORD HEALTH INSURANCE-Commercial, +126743,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,OXFORD HEALTH INSURANCE-Commercial, +126744,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,OXFORD HEALTH INSURANCE-Commercial, +126745,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,OXFORD HEALTH INSURANCE-Commercial, +126746,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,OXFORD HEALTH INSURANCE-Commercial, +126747,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126748,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,OXFORD HEALTH INSURANCE-Commercial, +126749,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,OXFORD HEALTH INSURANCE-Commercial, +126750,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126751,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,OXFORD HEALTH INSURANCE-Commercial, +126752,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126753,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,OXFORD HEALTH INSURANCE-Commercial, +126754,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,OXFORD HEALTH INSURANCE-Commercial, +126755,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,OXFORD HEALTH INSURANCE-Commercial, +126756,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +126757,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,OXFORD HEALTH INSURANCE-Commercial, +126758,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,OXFORD HEALTH INSURANCE-Commercial, +126759,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126760,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,OXFORD HEALTH INSURANCE-Commercial, +126761,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126762,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,OXFORD HEALTH INSURANCE-Commercial, +126763,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126764,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126765,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,OXFORD HEALTH INSURANCE-Commercial, +126766,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,OXFORD HEALTH INSURANCE-Commercial, +126767,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,OXFORD HEALTH INSURANCE-Commercial, +126768,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,OXFORD HEALTH INSURANCE-Commercial, +126769,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,OXFORD HEALTH INSURANCE-Commercial, +126770,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,OXFORD HEALTH INSURANCE-Commercial, +126771,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,OXFORD HEALTH INSURANCE-Commercial, +126772,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,OXFORD HEALTH INSURANCE-Commercial, +126773,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,OXFORD HEALTH INSURANCE-Commercial, +126774,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,OXFORD HEALTH INSURANCE-Commercial, +126775,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,OXFORD HEALTH INSURANCE-Commercial,3996.0 +126776,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,OXFORD HEALTH INSURANCE-Commercial, +126777,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +126778,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,OXFORD HEALTH INSURANCE-Commercial, +126779,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,OXFORD HEALTH INSURANCE-Commercial, +126780,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,OXFORD HEALTH INSURANCE-Commercial, +126781,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126782,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,OXFORD HEALTH INSURANCE-Commercial, +126783,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,OXFORD HEALTH INSURANCE-Commercial, +126784,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126785,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,OXFORD HEALTH INSURANCE-Commercial, +126786,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,OXFORD HEALTH INSURANCE-Commercial, +126787,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126788,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,OXFORD HEALTH INSURANCE-Commercial, +126789,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,OXFORD HEALTH INSURANCE-Commercial, +126790,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,OXFORD HEALTH INSURANCE-Commercial, +126791,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,OXFORD HEALTH INSURANCE-Commercial, +126792,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,OXFORD HEALTH INSURANCE-Commercial, +126793,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,OXFORD HEALTH INSURANCE-Commercial,7730.98 +126794,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,OXFORD HEALTH INSURANCE-Commercial, +126795,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,OXFORD HEALTH INSURANCE-Commercial, +126796,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,OXFORD HEALTH INSURANCE-Commercial, +126797,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,OXFORD HEALTH INSURANCE-Commercial, +126798,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,OXFORD HEALTH INSURANCE-Commercial, +126799,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,OXFORD HEALTH INSURANCE-Commercial, +126800,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,OXFORD HEALTH INSURANCE-Commercial, +126801,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,OXFORD HEALTH INSURANCE-Commercial, +126802,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,OXFORD HEALTH INSURANCE-Commercial, +126803,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,OXFORD HEALTH INSURANCE-Commercial, +126804,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,OXFORD HEALTH INSURANCE-Commercial, +126805,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,OXFORD HEALTH INSURANCE-Commercial, +126806,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,OXFORD HEALTH INSURANCE-Commercial, +126807,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,OXFORD HEALTH INSURANCE-Commercial, +126808,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,OXFORD HEALTH INSURANCE-Commercial, +126809,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,OXFORD HEALTH INSURANCE-Commercial, +126810,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,OXFORD HEALTH INSURANCE-Commercial, +126811,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,OXFORD HEALTH INSURANCE-Commercial, +126812,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,OXFORD HEALTH INSURANCE-Commercial, +126813,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,OXFORD HEALTH INSURANCE-Commercial, +126814,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,OXFORD HEALTH INSURANCE-Commercial,29991.68 +126815,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,OXFORD HEALTH INSURANCE-Commercial, +126816,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,OXFORD HEALTH INSURANCE-Commercial, +126817,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,OXFORD HEALTH INSURANCE-Commercial,9501.0 +126818,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,OXFORD HEALTH INSURANCE-Commercial,4368.98 +126819,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,OXFORD HEALTH INSURANCE-Commercial, +126820,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,OXFORD HEALTH INSURANCE-Commercial, +126821,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,OXFORD HEALTH INSURANCE-Commercial, +126822,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126823,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,OXFORD HEALTH INSURANCE-Commercial, +126824,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,OXFORD HEALTH INSURANCE-Commercial, +126825,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,OXFORD HEALTH INSURANCE-Commercial, +126826,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,OXFORD HEALTH INSURANCE-Commercial, +126827,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,OXFORD HEALTH INSURANCE-Commercial, +126828,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,OXFORD HEALTH INSURANCE-Commercial, +126829,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,OXFORD HEALTH INSURANCE-Commercial, +126830,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,OXFORD HEALTH INSURANCE-Commercial, +126831,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,OXFORD HEALTH INSURANCE-Commercial, +126832,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,OXFORD HEALTH INSURANCE-Commercial, +126833,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,OXFORD HEALTH INSURANCE-Commercial, +126834,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,OXFORD HEALTH INSURANCE-Commercial, +126835,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,OXFORD HEALTH INSURANCE-Commercial,6534.0 +126836,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,OXFORD HEALTH INSURANCE-Commercial, +126837,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,OXFORD HEALTH INSURANCE-Commercial, +126838,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,OXFORD HEALTH INSURANCE-Commercial, +126839,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,OXFORD HEALTH INSURANCE-Commercial, +126840,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,OXFORD HEALTH INSURANCE-Commercial, +126841,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,OXFORD HEALTH INSURANCE-Commercial, +126842,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,OXFORD HEALTH INSURANCE-Commercial, +126843,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,OXFORD HEALTH INSURANCE-Commercial, +126844,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,OXFORD HEALTH INSURANCE-Commercial,5265.0 +126845,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,OXFORD HEALTH INSURANCE-Commercial, +126846,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126847,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,OXFORD HEALTH INSURANCE-Commercial, +126848,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,OXFORD HEALTH INSURANCE-Commercial, +126849,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,OXFORD HEALTH INSURANCE-Commercial, +126850,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,OXFORD HEALTH INSURANCE-Commercial, +126851,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,OXFORD HEALTH INSURANCE-Commercial, +126852,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,OXFORD HEALTH INSURANCE-Commercial, +126853,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,OXFORD HEALTH INSURANCE-Commercial, +126854,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,OXFORD HEALTH INSURANCE-Commercial, +126855,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,OXFORD HEALTH INSURANCE-Commercial, +126856,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,OXFORD HEALTH INSURANCE-Commercial,42.84 +126857,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,OXFORD HEALTH INSURANCE-Commercial, +126858,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,OXFORD HEALTH INSURANCE-Commercial,2037.33 +126859,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,OXFORD HEALTH INSURANCE-Commercial, +126860,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126861,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,OXFORD HEALTH INSURANCE-Commercial, +126862,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,OXFORD HEALTH INSURANCE-Commercial, +126863,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,OXFORD HEALTH INSURANCE-Commercial,6281.62 +126864,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,OXFORD HEALTH INSURANCE-Commercial, +126865,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126866,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,OXFORD HEALTH INSURANCE-Commercial, +126867,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,OXFORD HEALTH INSURANCE-Commercial, +126868,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126869,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,OXFORD HEALTH INSURANCE-Commercial, +126870,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,OXFORD HEALTH INSURANCE-Commercial, +126871,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126872,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,OXFORD HEALTH INSURANCE-Commercial, +126873,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,OXFORD HEALTH INSURANCE-Commercial, +126874,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,OXFORD HEALTH INSURANCE-Commercial, +126875,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,OXFORD HEALTH INSURANCE-Commercial, +126876,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,OXFORD HEALTH INSURANCE-Commercial, +126877,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126878,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,OXFORD HEALTH INSURANCE-Commercial,373.75 +126879,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,OXFORD HEALTH INSURANCE-Commercial,358.36 +126880,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,OXFORD HEALTH INSURANCE-Commercial, +126881,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,OXFORD HEALTH INSURANCE-Commercial, +126882,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126883,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,OXFORD HEALTH INSURANCE-Commercial, +126884,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,OXFORD HEALTH INSURANCE-Commercial, +126885,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,OXFORD HEALTH INSURANCE-Commercial, +126886,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126887,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,OXFORD HEALTH INSURANCE-Commercial, +126888,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,OXFORD HEALTH INSURANCE-Commercial, +126889,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,OXFORD HEALTH INSURANCE-Commercial, +126890,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,OXFORD HEALTH INSURANCE-Commercial, +126891,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,OXFORD HEALTH INSURANCE-Commercial, +126892,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,OXFORD HEALTH INSURANCE-Commercial, +126893,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,OXFORD HEALTH INSURANCE-Commercial, +126894,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,OXFORD HEALTH INSURANCE-Commercial, +126895,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,OXFORD HEALTH INSURANCE-Commercial, +126896,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,OXFORD HEALTH INSURANCE-Commercial, +126897,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,OXFORD HEALTH INSURANCE-Commercial, +126898,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,OXFORD HEALTH INSURANCE-Commercial, +126899,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,OXFORD HEALTH INSURANCE-Commercial, +126900,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,OXFORD HEALTH INSURANCE-Commercial, +126901,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,OXFORD HEALTH INSURANCE-Commercial, +126902,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,OXFORD HEALTH INSURANCE-Commercial, +126903,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,OXFORD HEALTH INSURANCE-Commercial, +126904,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,OXFORD HEALTH INSURANCE-Commercial, +126905,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,OXFORD HEALTH INSURANCE-Commercial, +126906,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,OXFORD HEALTH INSURANCE-Commercial, +126907,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,OXFORD HEALTH INSURANCE-Commercial, +126908,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,OXFORD HEALTH INSURANCE-Commercial, +126909,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,OXFORD HEALTH INSURANCE-Commercial, +126910,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,OXFORD HEALTH INSURANCE-Commercial, +126911,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,OXFORD HEALTH INSURANCE-Commercial, +126912,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,OXFORD HEALTH INSURANCE-Commercial, +126913,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,OXFORD HEALTH INSURANCE-Commercial, +126914,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,OXFORD HEALTH INSURANCE-Commercial, +126915,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,OXFORD HEALTH INSURANCE-Commercial, +126916,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,OXFORD HEALTH INSURANCE-Commercial, +126917,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,OXFORD HEALTH INSURANCE-Commercial, +126918,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,OXFORD HEALTH INSURANCE-Commercial, +126919,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,OXFORD HEALTH INSURANCE-Commercial, +126920,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,OXFORD HEALTH INSURANCE-Commercial, +126921,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,OXFORD HEALTH INSURANCE-Commercial, +126922,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,OXFORD HEALTH INSURANCE-Commercial, +126923,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,OXFORD HEALTH INSURANCE-Commercial,4358.75 +126924,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,OXFORD HEALTH INSURANCE-Commercial, +126925,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,OXFORD HEALTH INSURANCE-Commercial, +126926,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,OXFORD HEALTH INSURANCE-Commercial, +126927,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,OXFORD HEALTH INSURANCE-Commercial, +126928,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,OXFORD HEALTH INSURANCE-Commercial, +126929,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,OXFORD HEALTH INSURANCE-Commercial, +126930,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,OXFORD HEALTH INSURANCE-Commercial, +126931,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,OXFORD HEALTH INSURANCE-Commercial, +126932,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,OXFORD HEALTH INSURANCE-Commercial, +126933,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,OXFORD HEALTH INSURANCE-Commercial, +126934,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,OXFORD HEALTH INSURANCE-Commercial, +126935,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,OXFORD HEALTH INSURANCE-Commercial, +126936,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,OXFORD HEALTH INSURANCE-Commercial, +126937,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,OXFORD HEALTH INSURANCE-Commercial, +126938,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,OXFORD HEALTH INSURANCE-Commercial, +126939,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,OXFORD HEALTH INSURANCE-Commercial, +126940,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,OXFORD HEALTH INSURANCE-Commercial, +126941,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,OXFORD HEALTH INSURANCE-Commercial,6534.0 +126942,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126943,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126944,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,OXFORD HEALTH INSURANCE-Commercial,6535.54 +126945,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126946,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,OXFORD HEALTH INSURANCE-Commercial,11871.0 +126947,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,OXFORD HEALTH INSURANCE-Commercial, +126948,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,OXFORD HEALTH INSURANCE-Commercial, +126949,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,OXFORD HEALTH INSURANCE-Commercial, +126950,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,OXFORD HEALTH INSURANCE-Commercial, +126951,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,OXFORD HEALTH INSURANCE-Commercial, +126952,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,OXFORD HEALTH INSURANCE-Commercial, +126953,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,OXFORD HEALTH INSURANCE-Commercial, +126954,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,OXFORD HEALTH INSURANCE-Commercial, +126955,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,OXFORD HEALTH INSURANCE-Commercial,3267.0 +126956,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,OXFORD HEALTH INSURANCE-Commercial, +126957,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,OXFORD HEALTH INSURANCE-Commercial, +126958,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,OXFORD HEALTH INSURANCE-Commercial, +126959,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,OXFORD HEALTH INSURANCE-Commercial, +126960,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,OXFORD HEALTH INSURANCE-Commercial, +126961,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,OXFORD HEALTH INSURANCE-Commercial, +126962,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,OXFORD HEALTH INSURANCE-Commercial, +126963,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,OXFORD HEALTH INSURANCE-Commercial, +126964,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,OXFORD HEALTH INSURANCE-Commercial, +126965,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,OXFORD HEALTH INSURANCE-Commercial, +126966,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,OXFORD HEALTH INSURANCE-Commercial, +126967,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,OXFORD HEALTH INSURANCE-Commercial, +126968,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,OXFORD HEALTH INSURANCE-Commercial, +126969,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,OXFORD HEALTH INSURANCE-Commercial, +126970,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,OXFORD HEALTH INSURANCE-Commercial, +126971,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,OXFORD HEALTH INSURANCE-Commercial, +126972,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,OXFORD HEALTH INSURANCE-Commercial, +126973,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,OXFORD HEALTH INSURANCE-Commercial, +126974,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,OXFORD HEALTH INSURANCE-Commercial, +126975,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,OXFORD HEALTH INSURANCE-Commercial, +126976,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,OXFORD HEALTH INSURANCE-Commercial,3996.0 +126977,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,OXFORD HEALTH INSURANCE-Commercial, +126978,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,OXFORD HEALTH INSURANCE-Commercial, +126979,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,OXFORD HEALTH INSURANCE-Commercial, +126980,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,OXFORD HEALTH INSURANCE-Commercial, +126981,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +126982,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,OXFORD HEALTH INSURANCE-Commercial,2484.0 +126983,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,OXFORD HEALTH INSURANCE-Commercial, +126984,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,OXFORD HEALTH INSURANCE-Commercial, +126985,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,OXFORD HEALTH INSURANCE-Commercial,4356.0 +126986,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,OXFORD HEALTH INSURANCE-Commercial, +126987,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,OXFORD HEALTH INSURANCE-Commercial, +126988,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,OXFORD HEALTH INSURANCE-Commercial, +126989,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,OXFORD HEALTH INSURANCE-Commercial, +126990,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,OXFORD HEALTH INSURANCE-Commercial, +126991,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,OXFORD HEALTH INSURANCE-Commercial, +126992,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,OXFORD HEALTH INSURANCE-Commercial, +126993,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,OXFORD HEALTH INSURANCE-Commercial, +126994,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,OXFORD HEALTH INSURANCE-Commercial, +126995,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,OXFORD HEALTH INSURANCE-Commercial, +126996,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,OXFORD HEALTH INSURANCE-Commercial, +126997,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,OXFORD HEALTH INSURANCE-Commercial, +126998,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,OXFORD HEALTH INSURANCE-Commercial, +126999,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,OXFORD HEALTH INSURANCE-Commercial, +127000,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,OXFORD HEALTH INSURANCE-Commercial, +127001,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,OXFORD HEALTH INSURANCE-Commercial, +127002,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,OXFORD HEALTH INSURANCE-Commercial, +127003,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,OXFORD HEALTH INSURANCE-Commercial, +127004,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,OXFORD HEALTH INSURANCE-Commercial, +127005,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,OXFORD HEALTH INSURANCE-Commercial, +127006,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +127007,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,OXFORD HEALTH INSURANCE-Commercial, +127008,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,OXFORD HEALTH INSURANCE-Commercial, +127009,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,OXFORD HEALTH INSURANCE-Commercial, +127010,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,OXFORD HEALTH INSURANCE-Commercial, +127011,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,OXFORD HEALTH INSURANCE-Commercial,3267.0 +127012,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,OXFORD HEALTH INSURANCE-Commercial,3996.0 +127013,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,OXFORD HEALTH INSURANCE-Commercial, +127014,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,OXFORD HEALTH INSURANCE-Commercial, +127015,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127016,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,OXFORD HEALTH INSURANCE-Commercial, +127017,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,OXFORD HEALTH INSURANCE-Commercial, +127018,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,OXFORD HEALTH INSURANCE-Commercial, +127019,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,OXFORD HEALTH INSURANCE-Commercial, +127020,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,OXFORD HEALTH INSURANCE-Commercial, +127021,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,OXFORD HEALTH INSURANCE-Commercial, +127022,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,OXFORD HEALTH INSURANCE-Commercial, +127023,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,OXFORD HEALTH INSURANCE-Commercial, +127024,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,OXFORD HEALTH INSURANCE-Commercial, +127025,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,OXFORD HEALTH INSURANCE-Commercial, +127026,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,OXFORD HEALTH INSURANCE-Commercial, +127027,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,OXFORD HEALTH INSURANCE-Commercial, +127028,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,OXFORD HEALTH INSURANCE-Commercial, +127029,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,OXFORD HEALTH INSURANCE-Commercial,3721.5 +127030,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,OXFORD HEALTH INSURANCE-Commercial, +127031,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,OXFORD HEALTH INSURANCE-Commercial, +127032,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,OXFORD HEALTH INSURANCE-Commercial, +127033,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,OXFORD HEALTH INSURANCE-Commercial,4041.6 +127034,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,OXFORD HEALTH INSURANCE-Commercial, +127035,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,OXFORD HEALTH INSURANCE-Commercial,3996.0 +127036,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,OXFORD HEALTH INSURANCE-Commercial, +127037,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,OXFORD HEALTH INSURANCE-Commercial, +127038,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,OXFORD HEALTH INSURANCE-Commercial, +127039,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +127040,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,OXFORD HEALTH INSURANCE-Commercial, +127041,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,OXFORD HEALTH INSURANCE-Commercial, +127042,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,OXFORD HEALTH INSURANCE-Commercial, +127043,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,OXFORD HEALTH INSURANCE-Commercial, +127044,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,OXFORD HEALTH INSURANCE-Commercial, +127045,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,OXFORD HEALTH INSURANCE-Commercial, +127046,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,OXFORD HEALTH INSURANCE-Commercial,4236.0 +127047,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,OXFORD HEALTH INSURANCE-Commercial, +127048,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +127049,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,OXFORD HEALTH INSURANCE-Commercial, +127050,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +127051,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,OXFORD HEALTH INSURANCE-Commercial, +127052,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,OXFORD HEALTH INSURANCE-Commercial, +127053,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +127054,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,OXFORD HEALTH INSURANCE-Commercial, +127055,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +127056,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,OXFORD HEALTH INSURANCE-Commercial, +127057,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,OXFORD HEALTH INSURANCE-Commercial, +127058,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,OXFORD HEALTH INSURANCE-Commercial, +127059,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,OXFORD HEALTH INSURANCE-Commercial,9012.0 +127060,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,OXFORD HEALTH INSURANCE-Commercial, +127061,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,OXFORD HEALTH INSURANCE-Commercial,9014.68 +127062,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,OXFORD HEALTH INSURANCE-Commercial, +127063,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,OXFORD HEALTH INSURANCE-Commercial, +127064,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,OXFORD HEALTH INSURANCE-Commercial, +127065,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,OXFORD HEALTH INSURANCE-Commercial, +127066,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,OXFORD HEALTH INSURANCE-Commercial, +127067,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,OXFORD HEALTH INSURANCE-Commercial, +127068,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,OXFORD HEALTH INSURANCE-Commercial, +127069,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,OXFORD HEALTH INSURANCE-Commercial,2484.0 +127070,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,OXFORD HEALTH INSURANCE-Commercial, +127071,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,OXFORD HEALTH INSURANCE-Commercial, +127072,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,OXFORD HEALTH INSURANCE-Commercial, +127073,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,OXFORD HEALTH INSURANCE-Commercial,9012.0 +127074,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127075,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +127076,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,OXFORD HEALTH INSURANCE-Commercial, +127077,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,OXFORD HEALTH INSURANCE-Commercial, +127078,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,OXFORD HEALTH INSURANCE-Commercial, +127079,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,OXFORD HEALTH INSURANCE-Commercial, +127080,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,OXFORD HEALTH INSURANCE-Commercial, +127081,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,OXFORD HEALTH INSURANCE-Commercial, +127082,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,OXFORD HEALTH INSURANCE-Commercial, +127083,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,OXFORD HEALTH INSURANCE-Commercial, +127084,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,OXFORD HEALTH INSURANCE-Commercial, +127085,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,OXFORD HEALTH INSURANCE-Commercial, +127086,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,OXFORD HEALTH INSURANCE-Commercial, +127087,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,OXFORD HEALTH INSURANCE-Commercial, +127088,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,OXFORD HEALTH INSURANCE-Commercial, +127089,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,OXFORD HEALTH INSURANCE-Commercial, +127090,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,OXFORD HEALTH INSURANCE-Commercial, +127091,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +127092,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,OXFORD HEALTH INSURANCE-Commercial, +127093,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,OXFORD HEALTH INSURANCE-Commercial, +127094,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,OXFORD HEALTH INSURANCE-Commercial, +127095,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,OXFORD HEALTH INSURANCE-Commercial, +127096,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,OXFORD HEALTH INSURANCE-Commercial, +127097,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,OXFORD HEALTH INSURANCE-Commercial, +127098,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,OXFORD HEALTH INSURANCE-Commercial, +127099,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,OXFORD HEALTH INSURANCE-Commercial,9012.0 +127100,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,OXFORD HEALTH INSURANCE-Commercial, +127101,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,OXFORD HEALTH INSURANCE-Commercial, +127102,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,OXFORD HEALTH INSURANCE-Commercial, +127103,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,OXFORD HEALTH INSURANCE-Commercial, +127104,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,OXFORD HEALTH INSURANCE-Commercial, +127105,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,OXFORD HEALTH INSURANCE-Commercial, +127106,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,OXFORD HEALTH INSURANCE-Commercial, +127107,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,OXFORD HEALTH INSURANCE-Commercial, +127108,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,OXFORD HEALTH INSURANCE-Commercial, +127109,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,OXFORD HEALTH INSURANCE-Commercial, +127110,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,OXFORD HEALTH INSURANCE-Commercial, +127111,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,OXFORD HEALTH INSURANCE-Commercial, +127112,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,OXFORD HEALTH INSURANCE-Commercial, +127113,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,OXFORD HEALTH INSURANCE-Commercial, +127114,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,OXFORD HEALTH INSURANCE-Commercial, +127115,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,OXFORD HEALTH INSURANCE-Commercial, +127116,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,OXFORD HEALTH INSURANCE-Commercial, +127117,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,OXFORD HEALTH INSURANCE-Commercial,4158.0 +127118,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,OXFORD HEALTH INSURANCE-Commercial,2178.0 +127119,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,OXFORD HEALTH INSURANCE-Commercial,3476.77 +127120,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,OXFORD HEALTH INSURANCE-Commercial,5445.0 +127121,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,OXFORD HEALTH INSURANCE-Commercial, +127122,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,OXFORD HEALTH INSURANCE-Commercial, +127123,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,OXFORD HEALTH INSURANCE-Commercial,3682.29 +127124,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,OXFORD HEALTH INSURANCE-Commercial,2178.0 +127125,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,OXFORD HEALTH INSURANCE-Commercial,2178.0 +127126,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,OXFORD HEALTH INSURANCE-Commercial, +127127,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +127128,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +127129,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,OXFORD HEALTH INSURANCE-Commercial, +127130,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,OXFORD HEALTH INSURANCE-Commercial, +127131,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,OXFORD HEALTH INSURANCE-Commercial, +127132,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,OXFORD HEALTH INSURANCE-Commercial, +127133,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,OXFORD HEALTH INSURANCE-Commercial, +127134,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,OXFORD HEALTH INSURANCE-Commercial, +127135,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,OXFORD HEALTH INSURANCE-Commercial, +127136,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,OXFORD HEALTH INSURANCE-Commercial, +127137,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,OXFORD HEALTH INSURANCE-Commercial, +127138,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127139,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,OXFORD HEALTH INSURANCE-Commercial, +127140,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,OXFORD HEALTH INSURANCE-Commercial, +127141,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,OXFORD HEALTH INSURANCE-Commercial, +127142,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,OXFORD HEALTH INSURANCE-Commercial, +127143,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,OXFORD HEALTH INSURANCE-Commercial, +127144,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127145,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,OXFORD HEALTH INSURANCE-Commercial, +127146,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,OXFORD HEALTH INSURANCE-Commercial, +127147,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,OXFORD HEALTH INSURANCE-Commercial, +127148,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,OXFORD HEALTH INSURANCE-Commercial, +127149,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,OXFORD HEALTH INSURANCE-Commercial, +127150,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,OXFORD HEALTH INSURANCE-Commercial, +127151,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,OXFORD HEALTH INSURANCE-Commercial, +127152,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,OXFORD HEALTH INSURANCE-Commercial, +127153,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,OXFORD HEALTH INSURANCE-Commercial, +127154,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127155,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,OXFORD HEALTH INSURANCE-Commercial, +127156,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,OXFORD HEALTH INSURANCE-Commercial, +127157,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,OXFORD HEALTH INSURANCE-Commercial, +127158,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,OXFORD HEALTH INSURANCE-Commercial, +127159,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,OXFORD HEALTH INSURANCE-Commercial, +127160,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,OXFORD HEALTH INSURANCE-Commercial, +127161,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,OXFORD HEALTH INSURANCE-Commercial, +127162,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,OXFORD HEALTH INSURANCE-Commercial, +127163,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,OXFORD HEALTH INSURANCE-Commercial, +127164,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,OXFORD HEALTH INSURANCE-Commercial, +127165,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,OXFORD HEALTH INSURANCE-Commercial, +127166,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,OXFORD HEALTH INSURANCE-Commercial, +127167,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,OXFORD HEALTH INSURANCE-Commercial, +127168,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,OXFORD HEALTH INSURANCE-Commercial, +127169,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,OXFORD HEALTH INSURANCE-Commercial, +127170,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,OXFORD HEALTH INSURANCE-Commercial, +127171,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,OXFORD HEALTH INSURANCE-Commercial, +127172,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,OXFORD HEALTH INSURANCE-Commercial, +127173,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,OXFORD HEALTH INSURANCE-Commercial, +127174,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,OXFORD HEALTH INSURANCE-Commercial, +127175,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,OXFORD HEALTH INSURANCE-Commercial,9301.01 +127176,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,OXFORD HEALTH INSURANCE-Commercial, +127177,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,OXFORD HEALTH INSURANCE-Commercial, +127178,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,OXFORD HEALTH INSURANCE-Commercial, +127179,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,OXFORD HEALTH INSURANCE-Commercial,0.07 +127180,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,OXFORD HEALTH INSURANCE-Commercial, +127181,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,OXFORD HEALTH INSURANCE-Commercial, +127182,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,OXFORD HEALTH INSURANCE-Commercial, +127183,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,OXFORD HEALTH INSURANCE-Commercial, +127184,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,OXFORD HEALTH INSURANCE-Commercial, +127185,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,OXFORD HEALTH INSURANCE-Commercial, +127186,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,OXFORD HEALTH INSURANCE-Commercial, +127187,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,OXFORD HEALTH INSURANCE-Commercial, +127188,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,OXFORD HEALTH INSURANCE-Commercial, +127189,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,OXFORD HEALTH INSURANCE-Commercial, +127190,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,OXFORD HEALTH INSURANCE-Commercial, +127191,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,OXFORD HEALTH INSURANCE-Commercial, +127192,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +127193,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,OXFORD HEALTH INSURANCE-Commercial, +127194,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,OXFORD HEALTH INSURANCE-Commercial, +127195,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,OXFORD HEALTH INSURANCE-Commercial, +127196,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,OXFORD HEALTH INSURANCE-Commercial, +127197,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,OXFORD HEALTH INSURANCE-Commercial, +127198,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,OXFORD HEALTH INSURANCE-Commercial, +127199,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,OXFORD HEALTH INSURANCE-Commercial, +127200,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,OXFORD HEALTH INSURANCE-Commercial, +127201,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,OXFORD HEALTH INSURANCE-Commercial, +127202,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,OXFORD HEALTH INSURANCE-Commercial, +127203,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,OXFORD HEALTH INSURANCE-Commercial, +127204,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,OXFORD HEALTH INSURANCE-Commercial, +127205,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,OXFORD HEALTH INSURANCE-Commercial, +127206,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,OXFORD HEALTH INSURANCE-Commercial, +127207,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,OXFORD HEALTH INSURANCE-Commercial, +127208,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,OXFORD HEALTH INSURANCE-Commercial, +127209,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +127210,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,OXFORD HEALTH INSURANCE-Commercial,3727.58 +127211,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,OXFORD HEALTH INSURANCE-Commercial, +127212,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,OXFORD HEALTH INSURANCE-Commercial, +127213,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,OXFORD HEALTH INSURANCE-Commercial, +127214,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,OXFORD HEALTH INSURANCE-Commercial, +127215,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,OXFORD HEALTH INSURANCE-Commercial, +127216,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,OXFORD HEALTH INSURANCE-Commercial,3996.0 +127217,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,OXFORD HEALTH INSURANCE-Commercial,1998.0 +127218,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,OXFORD HEALTH INSURANCE-Commercial, +127219,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,OXFORD HEALTH INSURANCE-Commercial, +127220,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,OXFORD HEALTH INSURANCE-Commercial, +127221,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,OXFORD HEALTH INSURANCE-Commercial, +127222,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,OXFORD HEALTH INSURANCE-Commercial,3859.76 +127223,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127224,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,OXFORD HEALTH INSURANCE-Commercial, +127225,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,OXFORD HEALTH INSURANCE-Commercial, +127226,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,OXFORD HEALTH INSURANCE-Commercial, +127227,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,OXFORD HEALTH INSURANCE-Commercial, +127228,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,OXFORD HEALTH INSURANCE-Commercial, +127229,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,OXFORD HEALTH INSURANCE-Commercial, +127230,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,OXFORD HEALTH INSURANCE-Commercial, +127231,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,OXFORD HEALTH INSURANCE-Commercial, +127232,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127233,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,OXFORD HEALTH INSURANCE-Commercial, +127234,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,OXFORD HEALTH INSURANCE-Commercial, +127235,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,OXFORD HEALTH INSURANCE-Commercial, +127236,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,OXFORD HEALTH INSURANCE-Commercial, +127237,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,OXFORD HEALTH INSURANCE-Commercial,674.24 +127238,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127239,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,OXFORD HEALTH INSURANCE-Commercial, +127240,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,OXFORD HEALTH INSURANCE-Commercial, +127241,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,OXFORD HEALTH INSURANCE-Commercial, +127242,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,OXFORD HEALTH INSURANCE-Commercial, +127243,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,OXFORD HEALTH INSURANCE-Commercial, +127244,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,OXFORD HEALTH INSURANCE-Commercial, +127245,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,OXFORD HEALTH INSURANCE-Commercial, +127246,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,OXFORD HEALTH INSURANCE-Commercial, +127247,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,OXFORD HEALTH INSURANCE-Commercial, +127248,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,OXFORD HEALTH INSURANCE-Commercial, +127249,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,OXFORD HEALTH INSURANCE-Commercial,3656.96 +127250,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,OXFORD HEALTH INSURANCE-Commercial, +127251,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,OXFORD HEALTH INSURANCE-Commercial, +127252,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,OXFORD HEALTH INSURANCE-Commercial, +127253,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,OXFORD HEALTH INSURANCE-Commercial, +127254,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,OXFORD HEALTH INSURANCE-Commercial, +127255,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,OXFORD HEALTH INSURANCE-Commercial, +127256,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,OXFORD HEALTH INSURANCE-Commercial, +127257,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,OXFORD HEALTH INSURANCE-Commercial, +127258,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,OXFORD HEALTH INSURANCE-Commercial, +127259,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,OXFORD HEALTH INSURANCE-Commercial, +127260,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,OXFORD HEALTH INSURANCE-Commercial, +127261,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,OXFORD HEALTH INSURANCE-Commercial, +127262,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,OXFORD HEALTH INSURANCE-Commercial, +127263,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,OXFORD HEALTH INSURANCE-Commercial,169.2 +127264,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,OXFORD HEALTH INSURANCE-Commercial, +127265,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,OXFORD HEALTH INSURANCE-Commercial, +127266,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,OXFORD HEALTH INSURANCE-Commercial, +127267,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,OXFORD HEALTH INSURANCE-Commercial,284.58 +127268,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,OXFORD HEALTH INSURANCE-Commercial, +127269,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,OXFORD HEALTH INSURANCE-Commercial, +127270,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,OXFORD HEALTH INSURANCE-Commercial, +127271,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,OXFORD HEALTH INSURANCE-Commercial, +127272,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,OXFORD HEALTH INSURANCE-Commercial, +127273,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,OXFORD HEALTH INSURANCE-Commercial, +127274,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,OXFORD HEALTH INSURANCE-Commercial, +127275,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,OXFORD HEALTH INSURANCE-Commercial, +127276,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,OXFORD HEALTH INSURANCE-Commercial,673.02 +127277,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,OXFORD HEALTH INSURANCE-Commercial, +127278,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,OXFORD HEALTH INSURANCE-Commercial, +127279,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,OXFORD HEALTH INSURANCE-Commercial,2146.23 +127280,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,OXFORD HEALTH INSURANCE-Commercial, +127281,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,OXFORD HEALTH INSURANCE-Commercial, +127282,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,OXFORD HEALTH INSURANCE-Commercial, +127283,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,OXFORD HEALTH INSURANCE-Commercial,3602.21 +127284,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,OXFORD HEALTH INSURANCE-Commercial,5126.61 +127285,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127286,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,OXFORD HEALTH INSURANCE-Commercial, +127287,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,OXFORD HEALTH INSURANCE-Commercial, +127288,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,OXFORD HEALTH INSURANCE-Commercial, +127289,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,OXFORD HEALTH INSURANCE-Commercial, +127290,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,OXFORD HEALTH INSURANCE-Commercial, +127291,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,OXFORD HEALTH INSURANCE-Commercial, +127292,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,OXFORD HEALTH INSURANCE-Commercial, +127293,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,OXFORD HEALTH INSURANCE-Commercial, +127294,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,OXFORD HEALTH INSURANCE-Commercial, +127295,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,OXFORD HEALTH INSURANCE-Commercial, +127296,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,OXFORD HEALTH INSURANCE-Commercial, +127297,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,OXFORD HEALTH INSURANCE-Commercial, +127298,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,OXFORD HEALTH INSURANCE-Commercial, +127299,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,OXFORD HEALTH INSURANCE-Commercial,1089.0 +127300,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,OXFORD HEALTH INSURANCE-Commercial, +127301,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,OXFORD HEALTH INSURANCE-Commercial, +127302,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,OXFORD HEALTH INSURANCE-Commercial, +127303,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,OXFORD HEALTH INSURANCE-Commercial, +127304,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,OXFORD HEALTH INSURANCE-Commercial, +127305,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,OXFORD HEALTH INSURANCE-Commercial, +127306,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,OXFORD HEALTH INSURANCE-Commercial,68.33 +127307,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,OXFORD HEALTH INSURANCE-Commercial, +127308,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,OXFORD HEALTH INSURANCE-Commercial, +127309,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127310,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,OXFORD HEALTH INSURANCE-Commercial, +127311,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,OXFORD HEALTH INSURANCE-Commercial, +127312,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,OXFORD HEALTH INSURANCE-Commercial, +127313,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,OXFORD HEALTH INSURANCE-Commercial, +127314,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,OXFORD HEALTH INSURANCE-Commercial, +127315,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +127316,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,OXFORD HEALTH INSURANCE-Commercial, +127317,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +127318,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,OXFORD HEALTH INSURANCE-Commercial, +127319,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,OXFORD HEALTH INSURANCE-Commercial, +127320,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,OXFORD HEALTH INSURANCE-Commercial, +127321,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,OXFORD HEALTH INSURANCE-Commercial, +127322,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,OXFORD HEALTH INSURANCE-Commercial, +127323,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,OXFORD HEALTH INSURANCE-Commercial, +127324,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,OXFORD HEALTH INSURANCE-Commercial, +127325,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,OXFORD HEALTH INSURANCE-Commercial, +127326,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,OXFORD HEALTH INSURANCE-Commercial, +127327,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,OXFORD HEALTH INSURANCE-Commercial, +127328,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +127329,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,OXFORD HEALTH INSURANCE-Commercial, +127330,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,OXFORD HEALTH INSURANCE-Commercial, +127331,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,OXFORD HEALTH INSURANCE-Commercial, +127332,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,OXFORD HEALTH INSURANCE-Commercial, +127333,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,OXFORD HEALTH INSURANCE-Commercial, +127334,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,OXFORD HEALTH INSURANCE-Commercial, +127335,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,OXFORD HEALTH INSURANCE-Commercial, +127336,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,OXFORD HEALTH INSURANCE-Commercial, +127337,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,OXFORD HEALTH INSURANCE-Commercial, +127338,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,OXFORD HEALTH INSURANCE-Commercial, +127339,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,OXFORD HEALTH INSURANCE-Commercial, +127340,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,OXFORD HEALTH INSURANCE-Commercial, +127341,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,OXFORD HEALTH INSURANCE-Commercial, +127342,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127343,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127344,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,OXFORD HEALTH INSURANCE-Commercial, +127345,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,OXFORD HEALTH INSURANCE-Commercial, +127346,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +127347,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,OXFORD HEALTH INSURANCE-Commercial, +127348,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,OXFORD HEALTH INSURANCE-Commercial, +127349,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,OXFORD HEALTH INSURANCE-Commercial, +127350,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,OXFORD HEALTH INSURANCE-Commercial, +127351,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,OXFORD HEALTH INSURANCE-Commercial, +127352,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,OXFORD HEALTH INSURANCE-Commercial, +127353,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,OXFORD HEALTH INSURANCE-Commercial, +127354,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,OXFORD HEALTH INSURANCE-Commercial, +127355,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,OXFORD HEALTH INSURANCE-Commercial, +127356,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,OXFORD HEALTH INSURANCE-Commercial, +127357,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,OXFORD HEALTH INSURANCE-Commercial,268.78 +127358,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,OXFORD HEALTH INSURANCE-Commercial, +127359,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,OXFORD HEALTH INSURANCE-Commercial, +127360,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,OXFORD HEALTH INSURANCE-Commercial, +127361,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,OXFORD HEALTH INSURANCE-Commercial, +127362,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,OXFORD HEALTH INSURANCE-Commercial, +127363,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,OXFORD HEALTH INSURANCE-Commercial, +127364,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,OXFORD HEALTH INSURANCE-Commercial, +127365,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,OXFORD HEALTH INSURANCE-Commercial, +127366,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,OXFORD HEALTH INSURANCE-Commercial, +127367,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,OXFORD HEALTH INSURANCE-Commercial, +127368,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,OXFORD HEALTH INSURANCE-Commercial, +127369,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,OXFORD HEALTH INSURANCE-Commercial, +127370,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127371,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,OXFORD HEALTH INSURANCE-Commercial, +127372,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,OXFORD HEALTH INSURANCE-Commercial, +127373,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127374,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,OXFORD HEALTH INSURANCE-Commercial, +127375,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,OXFORD HEALTH INSURANCE-Commercial, +127376,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,OXFORD HEALTH INSURANCE-Commercial, +127377,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,OXFORD HEALTH INSURANCE-Commercial, +127378,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,OXFORD HEALTH INSURANCE-Commercial, +127379,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,OXFORD HEALTH INSURANCE-Commercial, +127380,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,OXFORD HEALTH INSURANCE-Commercial, +127381,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,OXFORD HEALTH INSURANCE-Commercial, +127382,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,OXFORD HEALTH INSURANCE-Commercial, +127383,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,OXFORD HEALTH INSURANCE-Commercial, +127384,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,OXFORD HEALTH INSURANCE-Commercial, +127385,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127386,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,OXFORD HEALTH INSURANCE-Commercial, +127387,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,OXFORD HEALTH INSURANCE-Commercial, +127388,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,OXFORD HEALTH INSURANCE-Commercial, +127389,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,OXFORD HEALTH INSURANCE-Commercial, +127390,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,OXFORD HEALTH INSURANCE-Commercial, +127391,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,OXFORD HEALTH INSURANCE-Commercial, +127392,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,OXFORD HEALTH INSURANCE-Commercial, +127393,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,OXFORD HEALTH INSURANCE-Commercial, +127394,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,OXFORD HEALTH INSURANCE-Commercial, +127395,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127396,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,OXFORD HEALTH INSURANCE-Commercial, +127397,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,OXFORD HEALTH INSURANCE-Commercial, +127398,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,OXFORD HEALTH INSURANCE-Commercial, +127399,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,OXFORD HEALTH INSURANCE-Commercial, +127400,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127401,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,OXFORD HEALTH INSURANCE-Commercial, +127402,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127403,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,OXFORD HEALTH INSURANCE-Commercial, +127404,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,OXFORD HEALTH INSURANCE-Commercial, +127405,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,OXFORD HEALTH INSURANCE-Commercial, +127406,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,OXFORD HEALTH INSURANCE-Commercial, +127407,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127408,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,OXFORD HEALTH INSURANCE-Commercial, +127409,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,OXFORD HEALTH INSURANCE-Commercial, +127410,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,OXFORD HEALTH INSURANCE-Commercial, +127411,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,OXFORD HEALTH INSURANCE-Commercial, +127412,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,OXFORD HEALTH INSURANCE-Commercial, +127413,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,OXFORD HEALTH INSURANCE-Commercial, +127414,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,OXFORD HEALTH INSURANCE-Commercial, +127415,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,OXFORD HEALTH INSURANCE-Commercial, +127416,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,OXFORD HEALTH INSURANCE-Commercial, +127417,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,OXFORD HEALTH INSURANCE-Commercial, +127418,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,OXFORD HEALTH INSURANCE-Commercial, +127419,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,OXFORD HEALTH INSURANCE-Commercial, +127420,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,OXFORD HEALTH INSURANCE-Commercial, +127421,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,OXFORD HEALTH INSURANCE-Commercial, +127422,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,OXFORD HEALTH INSURANCE-Commercial, +127423,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,OXFORD HEALTH INSURANCE-Commercial, +127424,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,OXFORD HEALTH INSURANCE-Commercial, +127425,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,OXFORD HEALTH INSURANCE-Commercial, +127426,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,OXFORD HEALTH INSURANCE-Commercial, +127427,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,OXFORD HEALTH INSURANCE-Commercial, +127428,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,OXFORD HEALTH INSURANCE-Commercial, +127429,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,OXFORD HEALTH INSURANCE-Commercial, +127430,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,OXFORD HEALTH INSURANCE-Commercial, +127431,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,OXFORD HEALTH INSURANCE-Commercial, +127432,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127433,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,OXFORD HEALTH INSURANCE-Commercial, +127434,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,OXFORD HEALTH INSURANCE-Commercial, +127435,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,OXFORD HEALTH INSURANCE-Commercial, +127436,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,OXFORD HEALTH INSURANCE-Commercial, +127437,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127438,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,OXFORD HEALTH INSURANCE-Commercial, +127439,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,OXFORD HEALTH INSURANCE-Commercial, +127440,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,OXFORD HEALTH INSURANCE-Commercial, +127441,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,OXFORD HEALTH INSURANCE-Commercial, +127442,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,OXFORD HEALTH INSURANCE-Commercial, +127443,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,OXFORD HEALTH INSURANCE-Commercial, +127444,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,OXFORD HEALTH INSURANCE-Commercial, +127445,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,OXFORD HEALTH INSURANCE-Commercial, +127446,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,OXFORD HEALTH INSURANCE-Commercial, +127447,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,OXFORD HEALTH INSURANCE-Commercial, +127448,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,OXFORD HEALTH INSURANCE-Commercial, +127449,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,OXFORD HEALTH INSURANCE-Commercial, +127450,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,OXFORD HEALTH INSURANCE-Commercial, +127451,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,OXFORD HEALTH INSURANCE-Commercial, +127452,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,OXFORD HEALTH INSURANCE-Commercial, +127453,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,OXFORD HEALTH INSURANCE-Commercial, +127454,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,OXFORD HEALTH INSURANCE-Commercial, +127455,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,OXFORD HEALTH INSURANCE-Commercial, +127456,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,OXFORD HEALTH INSURANCE-Commercial,9012.0 +127457,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,OXFORD HEALTH INSURANCE-Commercial, +127458,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,OXFORD HEALTH INSURANCE-Commercial, +127459,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,OXFORD HEALTH INSURANCE-Commercial, +127460,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,OXFORD HEALTH INSURANCE-Commercial, +127461,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,OXFORD HEALTH INSURANCE-Commercial, +127462,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,OXFORD HEALTH INSURANCE-Commercial, +127463,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,OXFORD HEALTH INSURANCE-Commercial, +127464,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,OXFORD HEALTH INSURANCE-Commercial, +127465,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,OXFORD HEALTH INSURANCE-Commercial, +127466,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,OXFORD HEALTH INSURANCE-Commercial, +127467,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,OXFORD HEALTH INSURANCE-Commercial, +127468,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,OXFORD HEALTH INSURANCE-Commercial, +127469,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,OXFORD HEALTH INSURANCE-Commercial, +127470,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,OXFORD HEALTH INSURANCE-Commercial, +127471,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,OXFORD HEALTH INSURANCE-Commercial, +127472,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,OXFORD HEALTH INSURANCE-Commercial, +127473,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,OXFORD HEALTH INSURANCE-Commercial, +127474,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,OXFORD HEALTH INSURANCE-Commercial, +127475,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,OXFORD HEALTH INSURANCE-Commercial, +127476,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,OXFORD HEALTH INSURANCE-Commercial, +127477,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,OXFORD HEALTH INSURANCE-Commercial,1488.0 +127478,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,OXFORD HEALTH INSURANCE-Commercial, +127479,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,OXFORD HEALTH INSURANCE-Commercial, +127480,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,OXFORD HEALTH INSURANCE-Commercial, +127481,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,OXFORD HEALTH INSURANCE-Commercial, +127482,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,OXFORD HEALTH INSURANCE-Commercial, +127483,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +127484,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,OXFORD HEALTH INSURANCE-Commercial, +127485,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,OXFORD HEALTH INSURANCE-Commercial, +127486,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127487,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,OXFORD HEALTH INSURANCE-Commercial, +127488,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +127489,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +127490,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,OXFORD HEALTH INSURANCE-Commercial, +127491,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,OXFORD HEALTH INSURANCE-Commercial, +127492,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,OXFORD HEALTH INSURANCE-Commercial, +127493,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,OXFORD HEALTH INSURANCE-Commercial, +127494,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,OXFORD HEALTH INSURANCE-Commercial,4356.0 +127495,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,OXFORD HEALTH INSURANCE-Commercial, +127496,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,OXFORD HEALTH INSURANCE-Commercial, +127497,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,OXFORD HEALTH INSURANCE-Commercial, +127498,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,OXFORD HEALTH INSURANCE-Commercial, +127499,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,OXFORD HEALTH INSURANCE-Commercial, +127500,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,OXFORD HEALTH INSURANCE-Commercial, +127501,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,OXFORD HEALTH INSURANCE-Commercial, +127502,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,OXFORD HEALTH INSURANCE-Commercial, +127503,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,OXFORD HEALTH INSURANCE-Commercial, +127504,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,OXFORD HEALTH INSURANCE-Commercial, +127505,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,OXFORD HEALTH INSURANCE-Commercial, +127506,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,OXFORD HEALTH INSURANCE-Commercial, +127507,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,OXFORD HEALTH INSURANCE-Commercial, +127508,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,OXFORD HEALTH INSURANCE-Commercial, +127509,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,OXFORD HEALTH INSURANCE-Commercial, +127510,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,OXFORD HEALTH INSURANCE-Commercial, +127511,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,OXFORD HEALTH INSURANCE-Commercial, +127512,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,OXFORD HEALTH INSURANCE-Commercial, +127513,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,OXFORD HEALTH INSURANCE-Commercial, +127514,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,OXFORD HEALTH INSURANCE-Commercial, +127515,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,OXFORD HEALTH INSURANCE-Commercial, +127516,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,OXFORD HEALTH INSURANCE-Commercial, +127517,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,OXFORD HEALTH INSURANCE-Commercial, +127518,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127519,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,OXFORD HEALTH INSURANCE-Commercial, +127520,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,OXFORD HEALTH INSURANCE-Commercial, +127521,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,OXFORD HEALTH INSURANCE-Commercial, +127522,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127523,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,OXFORD HEALTH INSURANCE-Commercial, +127524,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,OXFORD HEALTH INSURANCE-Commercial, +127525,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +127526,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,OXFORD HEALTH INSURANCE-Commercial, +127527,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,OXFORD HEALTH INSURANCE-Commercial, +127528,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,OXFORD HEALTH INSURANCE-Commercial, +127529,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,OXFORD HEALTH INSURANCE-Commercial, +127530,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,OXFORD HEALTH INSURANCE-Commercial, +127531,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,OXFORD HEALTH INSURANCE-Commercial, +127532,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,OXFORD HEALTH INSURANCE-Commercial, +127533,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,OXFORD HEALTH INSURANCE-Commercial, +127534,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,OXFORD HEALTH INSURANCE-Commercial, +127535,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,OXFORD HEALTH INSURANCE-Commercial, +127536,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,OXFORD HEALTH INSURANCE-Commercial, +127537,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,OXFORD HEALTH INSURANCE-Commercial, +127538,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,OXFORD HEALTH INSURANCE-Commercial, +127539,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,OXFORD HEALTH INSURANCE-Commercial, +127540,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,OXFORD HEALTH INSURANCE-Commercial, +127541,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,OXFORD HEALTH INSURANCE-Commercial, +127542,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,OXFORD HEALTH INSURANCE-Commercial, +127543,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,OXFORD HEALTH INSURANCE-Commercial, +127544,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,OXFORD HEALTH INSURANCE-Commercial, +127545,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,OXFORD HEALTH INSURANCE-Commercial, +127546,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,OXFORD HEALTH INSURANCE-Commercial, +127547,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,OXFORD HEALTH INSURANCE-Commercial, +127548,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,OXFORD HEALTH INSURANCE-Commercial, +127549,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,OXFORD HEALTH INSURANCE-Commercial, +127550,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,OXFORD HEALTH INSURANCE-Commercial, +127551,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,OXFORD HEALTH INSURANCE-Commercial, +127552,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,OXFORD HEALTH INSURANCE-Commercial, +127553,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,OXFORD HEALTH INSURANCE-Commercial,72.64 +127554,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,OXFORD HEALTH INSURANCE-Commercial, +127555,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,OXFORD HEALTH INSURANCE-Commercial, +127556,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,OXFORD HEALTH INSURANCE-Commercial,3630.0 +127557,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,OXFORD HEALTH INSURANCE-Commercial, +127558,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,OXFORD HEALTH INSURANCE-Commercial, +127559,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,OXFORD HEALTH INSURANCE-Commercial, +127560,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,OXFORD HEALTH INSURANCE-Commercial, +127561,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127562,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,OXFORD HEALTH INSURANCE-Commercial, +127563,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127564,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,OXFORD HEALTH INSURANCE-Commercial, +127565,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,OXFORD HEALTH INSURANCE-Commercial, +127566,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,OXFORD HEALTH INSURANCE-Commercial, +127567,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,OXFORD HEALTH INSURANCE-Commercial, +127568,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,OXFORD HEALTH INSURANCE-Commercial, +127569,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,OXFORD HEALTH INSURANCE-Commercial, +127570,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,OXFORD HEALTH INSURANCE-Commercial, +127571,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,OXFORD HEALTH INSURANCE-Commercial, +127572,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,OXFORD HEALTH INSURANCE-Commercial, +127573,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,OXFORD HEALTH INSURANCE-Commercial, +127574,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,OXFORD HEALTH INSURANCE-Commercial, +127575,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,OXFORD HEALTH INSURANCE-Commercial, +127576,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,OXFORD HEALTH INSURANCE-Commercial, +127577,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,OXFORD HEALTH INSURANCE-Commercial, +127578,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,OXFORD HEALTH INSURANCE-Commercial, +127579,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,OXFORD HEALTH INSURANCE-Commercial, +127580,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,OXFORD HEALTH INSURANCE-Commercial, +127581,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,OXFORD HEALTH INSURANCE-Commercial, +127582,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,OXFORD HEALTH INSURANCE-Commercial, +127583,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,OXFORD HEALTH INSURANCE-Commercial, +127584,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,OXFORD HEALTH INSURANCE-Commercial, +127585,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,OXFORD HEALTH INSURANCE-Commercial, +127586,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,OXFORD HEALTH INSURANCE-Commercial, +127587,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,OXFORD HEALTH INSURANCE-Commercial, +127588,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,OXFORD HEALTH INSURANCE-Commercial, +127589,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,OXFORD HEALTH INSURANCE-Commercial, +127590,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127591,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,OXFORD HEALTH INSURANCE-Commercial, +127592,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,OXFORD HEALTH INSURANCE-Commercial, +127593,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,OXFORD HEALTH INSURANCE-Commercial, +127594,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,OXFORD HEALTH INSURANCE-Commercial, +127595,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,OXFORD HEALTH INSURANCE-Commercial,3996.0 +127596,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,OXFORD HEALTH INSURANCE-Commercial, +127597,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,OXFORD HEALTH INSURANCE-Commercial, +127598,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,OXFORD HEALTH INSURANCE-Commercial, +127599,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,OXFORD HEALTH INSURANCE-Commercial, +127600,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,OXFORD HEALTH INSURANCE-Commercial, +127601,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +127602,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,OXFORD HEALTH INSURANCE-Commercial, +127603,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,OXFORD HEALTH INSURANCE-Commercial, +127604,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,OXFORD HEALTH INSURANCE-Commercial, +127605,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,OXFORD HEALTH INSURANCE-Commercial, +127606,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,OXFORD HEALTH INSURANCE-Commercial, +127607,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,OXFORD HEALTH INSURANCE-Commercial, +127608,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,OXFORD HEALTH INSURANCE-Commercial, +127609,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,OXFORD HEALTH INSURANCE-Commercial, +127610,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,OXFORD HEALTH INSURANCE-Commercial, +127611,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,OXFORD HEALTH INSURANCE-Commercial, +127612,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,OXFORD HEALTH INSURANCE-Commercial, +127613,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,OXFORD HEALTH INSURANCE-Commercial, +127614,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,OXFORD HEALTH INSURANCE-Commercial, +127615,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,OXFORD HEALTH INSURANCE-Commercial, +127616,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,OXFORD HEALTH INSURANCE-Commercial, +127617,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,OXFORD HEALTH INSURANCE-Commercial, +127618,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,OXFORD HEALTH INSURANCE-Commercial, +127619,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,OXFORD HEALTH INSURANCE-Commercial, +127620,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,OXFORD HEALTH INSURANCE-Commercial, +127621,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,OXFORD HEALTH INSURANCE-Commercial, +127622,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,OXFORD HEALTH INSURANCE-Commercial, +127623,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,OXFORD HEALTH INSURANCE-Commercial, +127624,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,OXFORD HEALTH INSURANCE-Commercial, +127625,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,OXFORD HEALTH INSURANCE-Commercial, +127626,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,OXFORD HEALTH INSURANCE-Commercial, +127627,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,OXFORD HEALTH INSURANCE-Commercial, +127628,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,OXFORD HEALTH INSURANCE-Commercial, +127629,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,OXFORD HEALTH INSURANCE-Commercial, +127630,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,OXFORD HEALTH INSURANCE-Commercial, +127631,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,OXFORD HEALTH INSURANCE-Commercial, +127632,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,OXFORD HEALTH INSURANCE-Commercial, +127633,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,OXFORD HEALTH INSURANCE-Commercial, +127634,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,OXFORD HEALTH INSURANCE-Commercial, +127635,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,OXFORD HEALTH INSURANCE-Commercial, +127636,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,OXFORD HEALTH INSURANCE-Commercial, +127637,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,OXFORD HEALTH INSURANCE-Commercial, +127638,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,OXFORD HEALTH INSURANCE-Commercial, +127639,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,OXFORD HEALTH INSURANCE-Commercial, +127640,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,OXFORD HEALTH INSURANCE-Commercial, +127641,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,OXFORD HEALTH INSURANCE-Commercial, +127642,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,OXFORD HEALTH INSURANCE-Commercial, +127643,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,OXFORD HEALTH INSURANCE-Commercial, +127644,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,OXFORD HEALTH INSURANCE-Commercial, +127645,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,OXFORD HEALTH INSURANCE-Commercial, +127646,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,OXFORD HEALTH INSURANCE-Commercial, +127647,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,OXFORD HEALTH INSURANCE-Commercial, +127648,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,OXFORD HEALTH INSURANCE-Commercial, +127649,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,OXFORD HEALTH INSURANCE-Commercial, +127650,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,OXFORD HEALTH INSURANCE-Commercial, +127651,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,OXFORD HEALTH INSURANCE-Commercial, +127652,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,OXFORD HEALTH INSURANCE-Commercial, +127653,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,OXFORD HEALTH INSURANCE-Commercial, +127654,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,OXFORD HEALTH INSURANCE-Commercial, +127655,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,OXFORD HEALTH INSURANCE-Commercial, +127656,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,OXFORD HEALTH INSURANCE-Commercial, +127657,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,OXFORD HEALTH INSURANCE-Commercial, +127658,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,OXFORD HEALTH INSURANCE-Commercial, +127659,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,OXFORD HEALTH INSURANCE-Commercial, +127660,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,OXFORD HEALTH INSURANCE-Commercial, +127661,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,OXFORD HEALTH INSURANCE-Commercial,2449.48 +127662,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,OXFORD HEALTH INSURANCE-Commercial, +127663,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,OXFORD HEALTH INSURANCE-Commercial, +127664,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,OXFORD HEALTH INSURANCE-Commercial, +127665,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,OXFORD HEALTH INSURANCE-Commercial, +127666,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,OXFORD HEALTH INSURANCE-Commercial, +127667,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,OXFORD HEALTH INSURANCE-Commercial, +127668,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,OXFORD HEALTH INSURANCE-Commercial, +127669,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,OXFORD HEALTH INSURANCE-Commercial, +127670,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,OXFORD HEALTH INSURANCE-Commercial, +127671,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,OXFORD HEALTH INSURANCE-Commercial, +127672,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,OXFORD HEALTH INSURANCE-Commercial, +127673,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,OXFORD HEALTH INSURANCE-Commercial, +127674,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,OXFORD HEALTH INSURANCE-Commercial, +127675,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,OXFORD HEALTH INSURANCE-Commercial, +127676,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,OXFORD HEALTH INSURANCE-Commercial, +127677,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,OXFORD HEALTH INSURANCE-Commercial, +127678,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,OXFORD HEALTH INSURANCE-Commercial, +127679,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,OXFORD HEALTH INSURANCE-Commercial, +127680,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,OXFORD HEALTH INSURANCE-Commercial, +127681,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,OXFORD HEALTH INSURANCE-Commercial, +127682,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,OXFORD HEALTH INSURANCE-Commercial, +127683,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,OXFORD HEALTH INSURANCE-Commercial, +127684,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,OXFORD HEALTH INSURANCE-Commercial, +127685,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,OXFORD HEALTH INSURANCE-Commercial, +127686,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,OXFORD HEALTH INSURANCE-Commercial, +127687,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,OXFORD HEALTH INSURANCE-Commercial, +127688,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,OXFORD HEALTH INSURANCE-Commercial, +127689,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,OXFORD HEALTH INSURANCE-Commercial, +127690,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,OXFORD HEALTH INSURANCE-Commercial, +127691,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,OXFORD HEALTH INSURANCE-Commercial, +127692,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,OXFORD HEALTH INSURANCE-Commercial, +127693,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,OXFORD HEALTH INSURANCE-Commercial, +127694,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,OXFORD HEALTH INSURANCE-Commercial, +127695,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,OXFORD HEALTH INSURANCE-Commercial, +127696,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,OXFORD HEALTH INSURANCE-Commercial, +127697,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127698,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,OXFORD HEALTH INSURANCE-Commercial, +127699,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,OXFORD HEALTH INSURANCE-Commercial, +127700,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,OXFORD HEALTH INSURANCE-Commercial, +127701,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127702,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,OXFORD HEALTH INSURANCE-Commercial, +127703,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,OXFORD HEALTH INSURANCE-Commercial, +127704,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,OXFORD HEALTH INSURANCE-Commercial, +127705,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,OXFORD HEALTH INSURANCE-Commercial, +127706,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,OXFORD HEALTH INSURANCE-Commercial,2344.49 +127707,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,OXFORD HEALTH INSURANCE-Commercial, +127708,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,OXFORD HEALTH INSURANCE-Commercial, +127709,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,OXFORD HEALTH INSURANCE-Commercial, +127710,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,OXFORD HEALTH INSURANCE-Commercial, +127711,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,OXFORD HEALTH INSURANCE-Commercial, +127712,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,OXFORD HEALTH INSURANCE-Commercial, +127713,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,OXFORD HEALTH INSURANCE-Commercial, +127714,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,OXFORD HEALTH INSURANCE-Commercial, +127715,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,OXFORD HEALTH INSURANCE-Commercial, +127716,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,OXFORD HEALTH INSURANCE-Commercial, +127717,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,OXFORD HEALTH INSURANCE-Commercial, +127718,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,OXFORD HEALTH INSURANCE-Commercial, +127719,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,OXFORD HEALTH INSURANCE-Commercial, +127720,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,OXFORD HEALTH INSURANCE-Commercial, +127721,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,OXFORD HEALTH INSURANCE-Commercial, +127722,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,OXFORD HEALTH INSURANCE-Commercial, +127723,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,OXFORD HEALTH INSURANCE-Commercial, +127724,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,OXFORD HEALTH INSURANCE-Commercial, +127725,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,OXFORD HEALTH INSURANCE-Commercial, +127726,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,OXFORD HEALTH INSURANCE-Commercial, +127727,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,OXFORD HEALTH INSURANCE-Commercial, +127728,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,OXFORD HEALTH INSURANCE-Commercial, +127729,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,OXFORD HEALTH INSURANCE-Commercial, +127730,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,OXFORD HEALTH INSURANCE-Commercial, +127731,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,OXFORD HEALTH INSURANCE-Commercial, +127732,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,OXFORD HEALTH INSURANCE-Commercial, +127733,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,OXFORD HEALTH INSURANCE-Commercial, +127734,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,OXFORD HEALTH INSURANCE-Commercial, +127735,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,OXFORD HEALTH INSURANCE-Commercial, +127736,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,OXFORD HEALTH INSURANCE-Commercial, +127737,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,OXFORD HEALTH INSURANCE-Commercial, +127738,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,OXFORD HEALTH INSURANCE-Commercial, +127739,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,OXFORD HEALTH INSURANCE-Commercial, +127740,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,OXFORD HEALTH INSURANCE-Commercial, +127741,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,OXFORD HEALTH INSURANCE-Commercial, +127742,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,OXFORD HEALTH INSURANCE-Commercial, +127743,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,OXFORD HEALTH INSURANCE-Commercial, +127744,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,OXFORD HEALTH INSURANCE-Commercial, +127745,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,OXFORD HEALTH INSURANCE-Commercial, +127746,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,OXFORD HEALTH INSURANCE-Commercial, +127747,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,OXFORD HEALTH INSURANCE-Commercial, +127748,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,OXFORD HEALTH INSURANCE-Commercial, +127749,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,OXFORD HEALTH INSURANCE-Commercial, +127750,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,OXFORD HEALTH INSURANCE-Commercial, +127751,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,OXFORD HEALTH INSURANCE-Commercial, +127752,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,OXFORD HEALTH INSURANCE-Commercial, +127753,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,OXFORD HEALTH INSURANCE-Commercial, +127754,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,OXFORD HEALTH INSURANCE-Commercial, +127755,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,OXFORD HEALTH INSURANCE-Commercial, +127756,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,OXFORD HEALTH INSURANCE-Commercial, +127757,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,OXFORD HEALTH INSURANCE-Commercial, +127758,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,OXFORD HEALTH INSURANCE-Commercial, +127759,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,OXFORD HEALTH INSURANCE-Commercial, +127760,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,OXFORD HEALTH INSURANCE-Commercial, +127761,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,OXFORD HEALTH INSURANCE-Commercial,2136.0 +127762,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,OXFORD HEALTH INSURANCE-Commercial, +127763,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,OXFORD HEALTH INSURANCE-Commercial, +127764,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,OXFORD HEALTH INSURANCE-Commercial, +127765,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,OXFORD HEALTH INSURANCE-Commercial, +127766,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,OXFORD HEALTH INSURANCE-Commercial, +127767,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,OXFORD HEALTH INSURANCE-Commercial,257.15 +127768,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,OXFORD HEALTH INSURANCE-Commercial, +127769,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,OXFORD HEALTH INSURANCE-Commercial, +127770,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,OXFORD HEALTH INSURANCE-Commercial, +127771,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,OXFORD HEALTH INSURANCE-Commercial,577.35 +127772,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,OXFORD HEALTH INSURANCE-Commercial, +127773,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,OXFORD HEALTH INSURANCE-Commercial,558.72 +127774,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,OXFORD HEALTH INSURANCE-Commercial, +127775,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,OXFORD HEALTH INSURANCE-Commercial, +127776,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,OXFORD HEALTH INSURANCE-Commercial,462.61 +127777,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,OXFORD HEALTH INSURANCE-Commercial, +127778,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,OXFORD HEALTH INSURANCE-Commercial, +127779,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,OXFORD HEALTH INSURANCE-Commercial, +127780,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,OXFORD HEALTH INSURANCE-Commercial, +127781,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,OXFORD HEALTH INSURANCE-Commercial, +127782,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,OXFORD HEALTH INSURANCE-Commercial,658.06 +127783,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,OXFORD HEALTH INSURANCE-Commercial, +127784,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,OXFORD HEALTH INSURANCE-Commercial,1880.0 +127785,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,OXFORD HEALTH INSURANCE-Commercial, +127786,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,OXFORD HEALTH INSURANCE-Commercial,552.38 +127787,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,OXFORD HEALTH INSURANCE-Commercial,497.0 +127788,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,OXFORD HEALTH INSURANCE-Commercial, +127789,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,OXFORD HEALTH INSURANCE-Commercial, +127790,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,OXFORD HEALTH INSURANCE-Commercial, +127791,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,OXFORD HEALTH INSURANCE-Commercial, +127792,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,OXFORD HEALTH INSURANCE-Commercial, +127793,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,OXFORD HEALTH INSURANCE-Commercial, +127794,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,OXFORD HEALTH INSURANCE-Commercial,293.23 +127795,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,OXFORD HEALTH INSURANCE-Commercial,1250.0 +127796,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,OXFORD HEALTH INSURANCE-Commercial, +127797,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,OXFORD HEALTH INSURANCE-Commercial, +127798,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,OXFORD HEALTH INSURANCE-Commercial,577.35 +127799,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,OXFORD HEALTH INSURANCE-Commercial, +127800,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,OXFORD HEALTH INSURANCE-Commercial, +127801,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,OXFORD HEALTH INSURANCE-Commercial, +127802,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,OXFORD HEALTH INSURANCE-Commercial, +127803,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,OXFORD HEALTH INSURANCE-Commercial, +127804,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,OXFORD HEALTH INSURANCE-Commercial, +127805,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,OXFORD HEALTH INSURANCE-Commercial, +127806,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,OXFORD HEALTH INSURANCE-Commercial, +127807,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,OXFORD HEALTH INSURANCE-Commercial, +127808,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,OXFORD HEALTH INSURANCE-Commercial, +127809,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,OXFORD HEALTH INSURANCE-Commercial, +127810,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,OXFORD HEALTH INSURANCE-Commercial, +127811,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,OXFORD HEALTH INSURANCE-Commercial, +127812,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,OXFORD HEALTH INSURANCE-Commercial, +127813,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,OXFORD HEALTH INSURANCE-Commercial,509.25 +127814,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,OXFORD HEALTH INSURANCE-Commercial,899.0 +127815,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,OXFORD HEALTH INSURANCE-Commercial, +127816,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,OXFORD HEALTH INSURANCE-Commercial, +127817,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,OXFORD HEALTH INSURANCE-Commercial, +127818,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,OXFORD HEALTH INSURANCE-Commercial, +127819,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,OXFORD HEALTH INSURANCE-Commercial, +127820,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,OXFORD HEALTH INSURANCE-Commercial, +127821,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,OXFORD HEALTH INSURANCE-Commercial, +127822,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,OXFORD HEALTH INSURANCE-Commercial, +127823,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,OXFORD HEALTH INSURANCE-Commercial, +127824,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,OXFORD HEALTH INSURANCE-Commercial, +127825,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,OXFORD HEALTH INSURANCE-Commercial, +127826,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,OXFORD HEALTH INSURANCE-Commercial, +127827,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,OXFORD HEALTH INSURANCE-Commercial, +127828,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,OXFORD HEALTH INSURANCE-Commercial, +127829,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,OXFORD HEALTH INSURANCE-Commercial, +127830,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,OXFORD HEALTH INSURANCE-Commercial, +127831,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,OXFORD HEALTH INSURANCE-Commercial, +127832,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,OXFORD HEALTH INSURANCE-Commercial,330.75 +127833,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,OXFORD HEALTH INSURANCE-Commercial, +127834,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,OXFORD HEALTH INSURANCE-Commercial, +127835,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,OXFORD HEALTH INSURANCE-Commercial, +127836,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,OXFORD HEALTH INSURANCE-Commercial, +127837,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,OXFORD HEALTH INSURANCE-Commercial, +127838,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,OXFORD HEALTH INSURANCE-Commercial, +127839,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,OXFORD HEALTH INSURANCE-Commercial, +127840,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,OXFORD HEALTH INSURANCE-Commercial, +127841,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,OXFORD HEALTH INSURANCE-Commercial, +127842,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,OXFORD HEALTH INSURANCE-Commercial, +127843,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,OXFORD HEALTH INSURANCE-Commercial, +127844,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,OXFORD HEALTH INSURANCE-Commercial, +127845,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,OXFORD HEALTH INSURANCE-Commercial,96.69 +127846,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,OXFORD HEALTH INSURANCE-Commercial, +127847,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,OXFORD HEALTH INSURANCE-Commercial,353.25 +127848,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,OXFORD HEALTH INSURANCE-Commercial, +127849,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,OXFORD HEALTH INSURANCE-Commercial,372.75 +127850,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,OXFORD HEALTH INSURANCE-Commercial,385.5 +127851,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,OXFORD HEALTH INSURANCE-Commercial, +127852,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,OXFORD HEALTH INSURANCE-Commercial,478.5 +127853,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,OXFORD HEALTH INSURANCE-Commercial, +127854,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,OXFORD HEALTH INSURANCE-Commercial,501.0 +127855,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,OXFORD HEALTH INSURANCE-Commercial, +127856,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,OXFORD HEALTH INSURANCE-Commercial, +127857,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,OXFORD HEALTH INSURANCE-Commercial, +127858,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,OXFORD HEALTH INSURANCE-Commercial, +127859,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,OXFORD HEALTH INSURANCE-Commercial, +127860,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,OXFORD HEALTH INSURANCE-Commercial, +127861,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,OXFORD HEALTH INSURANCE-Commercial, +127862,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,OXFORD HEALTH INSURANCE-Commercial, +127863,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,OXFORD HEALTH INSURANCE-Commercial, +127864,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,OXFORD HEALTH INSURANCE-Commercial,370.5 +127865,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,OXFORD HEALTH INSURANCE-Commercial,135.11 +127866,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,OXFORD HEALTH INSURANCE-Commercial, +127867,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,OXFORD HEALTH INSURANCE-Commercial, +127868,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,OXFORD HEALTH INSURANCE-Commercial, +127869,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,OXFORD HEALTH INSURANCE-Commercial, +127870,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,OXFORD HEALTH INSURANCE-Commercial, +127871,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,OXFORD HEALTH INSURANCE-Commercial,340.5 +127872,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,OXFORD HEALTH INSURANCE-Commercial, +127873,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,OXFORD HEALTH INSURANCE-Commercial,526.25 +127874,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,OXFORD HEALTH INSURANCE-Commercial, +127875,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,OXFORD HEALTH INSURANCE-Commercial,422.25 +127876,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,OXFORD HEALTH INSURANCE-Commercial, +127877,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,OXFORD HEALTH INSURANCE-Commercial, +127878,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,OXFORD HEALTH INSURANCE-Commercial, +127879,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,OXFORD HEALTH INSURANCE-Commercial, +127880,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,OXFORD HEALTH INSURANCE-Commercial,1600.0 +127881,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,OXFORD HEALTH INSURANCE-Commercial,348.75 +127882,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,OXFORD HEALTH INSURANCE-Commercial, +127883,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,OXFORD HEALTH INSURANCE-Commercial, +127884,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,OXFORD HEALTH INSURANCE-Commercial, +127885,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,OXFORD HEALTH INSURANCE-Commercial, +127886,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,OXFORD HEALTH INSURANCE-Commercial, +127887,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,OXFORD HEALTH INSURANCE-Commercial, +127888,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,OXFORD HEALTH INSURANCE-Commercial, +127889,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,OXFORD HEALTH INSURANCE-Commercial, +127890,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,OXFORD HEALTH INSURANCE-Commercial, +127891,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,OXFORD HEALTH INSURANCE-Commercial, +127892,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,OXFORD HEALTH INSURANCE-Commercial, +127893,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,OXFORD HEALTH INSURANCE-Commercial, +127894,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,OXFORD HEALTH INSURANCE-Commercial, +127895,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,OXFORD HEALTH INSURANCE-Commercial, +127896,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,OXFORD HEALTH INSURANCE-Commercial,462.61 +127897,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,OXFORD HEALTH INSURANCE-Commercial, +127898,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,OXFORD HEALTH INSURANCE-Commercial,293.23 +127899,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,OXFORD HEALTH INSURANCE-Commercial,1250.0 +127900,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,OXFORD HEALTH INSURANCE-Commercial, +127901,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,OXFORD HEALTH INSURANCE-Commercial, +127902,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,OXFORD HEALTH INSURANCE-Commercial, +127903,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,OXFORD HEALTH INSURANCE-Commercial, +127904,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,OXFORD HEALTH INSURANCE-Commercial, +127905,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,OXFORD HEALTH INSURANCE-Commercial, +127906,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,OXFORD HEALTH INSURANCE-Commercial, +127907,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,OXFORD HEALTH INSURANCE-Commercial, +127908,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,OXFORD HEALTH INSURANCE-Commercial, +127909,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,OXFORD HEALTH INSURANCE-Commercial, +127910,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,OXFORD HEALTH INSURANCE-Commercial, +127911,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,OXFORD HEALTH INSURANCE-Commercial, +127912,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,OXFORD HEALTH INSURANCE-Commercial, +127913,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,OXFORD HEALTH INSURANCE-Commercial, +127914,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,OXFORD HEALTH INSURANCE-Commercial, +127915,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,OXFORD HEALTH INSURANCE-Commercial, +127916,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,OXFORD HEALTH INSURANCE-Commercial, +127917,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,OXFORD HEALTH INSURANCE-Commercial, +127918,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,OXFORD HEALTH INSURANCE-Commercial, +127919,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,OXFORD HEALTH INSURANCE-Commercial, +127920,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,OXFORD HEALTH INSURANCE-Commercial, +127921,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,OXFORD HEALTH INSURANCE-Commercial, +127922,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,OXFORD HEALTH INSURANCE-Commercial,1880.0 +127923,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,OXFORD HEALTH INSURANCE-Commercial, +127924,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,OXFORD HEALTH INSURANCE-Commercial, +127925,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,OXFORD HEALTH INSURANCE-Commercial, +127926,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,OXFORD HEALTH INSURANCE-Commercial, +127927,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,OXFORD HEALTH INSURANCE-Commercial, +127928,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,OXFORD HEALTH INSURANCE-Commercial, +127929,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,OXFORD HEALTH INSURANCE-Commercial,1250.0 +127930,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,OXFORD HEALTH INSURANCE-Commercial, +127931,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,OXFORD HEALTH INSURANCE-Commercial, +127932,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,OXFORD HEALTH INSURANCE-Commercial, +127933,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,OXFORD HEALTH INSURANCE-Commercial, +127934,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,OXFORD HEALTH INSURANCE-Commercial, +127935,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,OXFORD HEALTH INSURANCE-Commercial, +127936,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,OXFORD HEALTH INSURANCE-Commercial, +127937,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,OXFORD HEALTH INSURANCE-Commercial, +127938,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,OXFORD HEALTH INSURANCE-Commercial, +127939,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,OXFORD HEALTH INSURANCE-Commercial, +127940,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,OXFORD HEALTH INSURANCE-Commercial, +127941,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,OXFORD HEALTH INSURANCE-Commercial, +127942,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,OXFORD HEALTH INSURANCE-Commercial, +127943,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,OXFORD HEALTH INSURANCE-Commercial, +127944,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,OXFORD HEALTH INSURANCE-Commercial, +127945,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,OXFORD HEALTH INSURANCE-Commercial, +127946,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,OXFORD HEALTH INSURANCE-Commercial, +127947,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,OXFORD HEALTH INSURANCE-Commercial, +127948,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,OXFORD HEALTH INSURANCE-Commercial, +127949,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,OXFORD HEALTH INSURANCE-Commercial,583.43 +127950,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,OXFORD HEALTH INSURANCE-Commercial, +127951,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,OXFORD HEALTH INSURANCE-Commercial, +127952,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,OXFORD HEALTH INSURANCE-Commercial,549.75 +127953,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,OXFORD HEALTH INSURANCE-Commercial, +127954,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,OXFORD HEALTH INSURANCE-Commercial, +127955,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,OXFORD HEALTH INSURANCE-Commercial, +127956,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,OXFORD HEALTH INSURANCE-Commercial, +127957,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,OXFORD HEALTH INSURANCE-Commercial, +127958,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,OXFORD HEALTH INSURANCE-Commercial, +127959,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,OXFORD HEALTH INSURANCE-Commercial, +127960,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,OXFORD HEALTH INSURANCE-Commercial, +127961,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,OXFORD HEALTH INSURANCE-Commercial,787.13 +127962,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,OXFORD HEALTH INSURANCE-Commercial, +127963,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,OXFORD HEALTH INSURANCE-Commercial,621.0 +127964,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,OXFORD HEALTH INSURANCE-Commercial,525.75 +127965,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,OXFORD HEALTH INSURANCE-Commercial, +127966,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,OXFORD HEALTH INSURANCE-Commercial,127.6 +127967,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,OXFORD HEALTH INSURANCE-Commercial, +127968,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,OXFORD HEALTH INSURANCE-Commercial,135.11 +127969,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,OXFORD HEALTH INSURANCE-Commercial, +127970,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,OXFORD HEALTH INSURANCE-Commercial, +127971,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,OXFORD HEALTH INSURANCE-Commercial, +127972,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,OXFORD HEALTH INSURANCE-Commercial, +127973,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,OXFORD HEALTH INSURANCE-Commercial, +127974,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,OXFORD HEALTH INSURANCE-Commercial, +127975,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,OXFORD HEALTH INSURANCE-Commercial, +127976,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,OXFORD HEALTH INSURANCE-Commercial, +127977,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,OXFORD HEALTH INSURANCE-Commercial, +127978,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,OXFORD HEALTH INSURANCE-Commercial, +127979,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,OXFORD HEALTH INSURANCE-Commercial, +127980,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,OXFORD HEALTH INSURANCE-Commercial, +127981,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,OXFORD HEALTH INSURANCE-Commercial, +127982,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,OXFORD HEALTH INSURANCE-Commercial, +127983,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,OXFORD HEALTH INSURANCE-Commercial, +127984,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,OXFORD HEALTH INSURANCE-Commercial, +127985,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,OXFORD HEALTH INSURANCE-Commercial, +127986,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,OXFORD HEALTH INSURANCE-Commercial,553.89 +127987,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,OXFORD HEALTH INSURANCE-Commercial,418.11 +127988,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,OXFORD HEALTH INSURANCE-Commercial,657.0 +127989,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,OXFORD HEALTH INSURANCE-Commercial, +127990,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,OXFORD HEALTH INSURANCE-Commercial, +127991,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,OXFORD HEALTH INSURANCE-Commercial, +127992,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,OXFORD HEALTH INSURANCE-Commercial, +127993,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,OXFORD HEALTH INSURANCE-Commercial, +127994,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,OXFORD HEALTH INSURANCE-Commercial, +127995,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,OXFORD HEALTH INSURANCE-Commercial, +127996,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,OXFORD HEALTH INSURANCE-Commercial, +127997,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,OXFORD HEALTH INSURANCE-Commercial,202.46 +127998,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,OXFORD HEALTH INSURANCE-Commercial, +127999,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,OXFORD HEALTH INSURANCE-Commercial, +128000,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,OXFORD HEALTH INSURANCE-Commercial, +128001,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,OXFORD HEALTH INSURANCE-Commercial, +128002,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,OXFORD HEALTH INSURANCE-Commercial, +128003,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,OXFORD HEALTH INSURANCE-Commercial, +128004,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,OXFORD HEALTH INSURANCE-Commercial, +128005,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,OXFORD HEALTH INSURANCE-Commercial, +128006,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,OXFORD HEALTH INSURANCE-Commercial, +128007,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,OXFORD HEALTH INSURANCE-Commercial, +128008,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,OXFORD HEALTH INSURANCE-Commercial, +128009,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,OXFORD HEALTH INSURANCE-Commercial, +128010,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,OXFORD HEALTH INSURANCE-Commercial, +128011,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,OXFORD HEALTH INSURANCE-Commercial,119.25 +128012,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,OXFORD HEALTH INSURANCE-Commercial,119.25 +128013,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,OXFORD HEALTH INSURANCE-Commercial,156.75 +128014,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,OXFORD HEALTH INSURANCE-Commercial,519.75 +128015,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,OXFORD HEALTH INSURANCE-Commercial,654.0 +128016,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,OXFORD HEALTH INSURANCE-Commercial,699.75 +128017,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,OXFORD HEALTH INSURANCE-Commercial, +128018,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,OXFORD HEALTH INSURANCE-Commercial, +128019,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,OXFORD HEALTH INSURANCE-Commercial, +128020,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,OXFORD HEALTH INSURANCE-Commercial, +128021,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,OXFORD HEALTH INSURANCE-Commercial,649.5 +128022,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,OXFORD HEALTH INSURANCE-Commercial, +128023,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,OXFORD HEALTH INSURANCE-Commercial, +128024,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,OXFORD HEALTH INSURANCE-Commercial, +128025,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,OXFORD HEALTH INSURANCE-Commercial, +128026,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,OXFORD HEALTH INSURANCE-Commercial,2528.22 +128027,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,OXFORD HEALTH INSURANCE-Commercial,613.44 +128028,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,OXFORD HEALTH INSURANCE-Commercial,2528.22 +128029,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,OXFORD HEALTH INSURANCE-Commercial, +128030,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,OXFORD HEALTH INSURANCE-Commercial, +128031,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,OXFORD HEALTH INSURANCE-Commercial, +128032,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,OXFORD HEALTH INSURANCE-Commercial, +128033,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,OXFORD HEALTH INSURANCE-Commercial, +128034,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,OXFORD HEALTH INSURANCE-Commercial, +128035,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,OXFORD HEALTH INSURANCE-Commercial, +128036,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,OXFORD HEALTH INSURANCE-Commercial,406.05 +128037,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,OXFORD HEALTH INSURANCE-Commercial,153.36 +128038,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,OXFORD HEALTH INSURANCE-Commercial,2528.22 +128039,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,OXFORD HEALTH INSURANCE-Commercial,153.36 +128040,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,OXFORD HEALTH INSURANCE-Commercial, +128041,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,OXFORD HEALTH INSURANCE-Commercial, +128042,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,OXFORD HEALTH INSURANCE-Commercial, +128043,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,OXFORD HEALTH INSURANCE-Commercial,652.79 +128044,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,OXFORD HEALTH INSURANCE-Commercial, +128045,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,OXFORD HEALTH INSURANCE-Commercial, +128046,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,OXFORD HEALTH INSURANCE-Commercial, +128047,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,OXFORD HEALTH INSURANCE-Commercial,275.15 +128048,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,OXFORD HEALTH INSURANCE-Commercial, +128049,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,OXFORD HEALTH INSURANCE-Commercial,1058.84 +128050,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,OXFORD HEALTH INSURANCE-Commercial, +128051,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,OXFORD HEALTH INSURANCE-Commercial, +128052,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,OXFORD HEALTH INSURANCE-Commercial, +128053,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,OXFORD HEALTH INSURANCE-Commercial, +128054,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,OXFORD HEALTH INSURANCE-Commercial, +128055,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,OXFORD HEALTH INSURANCE-Commercial, +128056,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,OXFORD HEALTH INSURANCE-Commercial, +128057,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,OXFORD HEALTH INSURANCE-Commercial, +128058,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,OXFORD HEALTH INSURANCE-Commercial, +128059,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,OXFORD HEALTH INSURANCE-Commercial, +128060,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,OXFORD HEALTH INSURANCE-Commercial, +128061,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,OXFORD HEALTH INSURANCE-Commercial, +128062,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,OXFORD HEALTH INSURANCE-Commercial, +128063,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,OXFORD HEALTH INSURANCE-Commercial, +128064,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,OXFORD HEALTH INSURANCE-Commercial, +128065,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,OXFORD HEALTH INSURANCE-Commercial, +128066,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,OXFORD HEALTH INSURANCE-Commercial, +128067,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,OXFORD HEALTH INSURANCE-Commercial, +128068,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,OXFORD HEALTH INSURANCE-Commercial,1541.26 +128069,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,OXFORD HEALTH INSURANCE-Commercial, +128070,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,OXFORD HEALTH INSURANCE-Commercial, +128071,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,OXFORD HEALTH INSURANCE-Commercial, +128072,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,OXFORD HEALTH INSURANCE-Commercial, +128073,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,OXFORD HEALTH INSURANCE-Commercial, +128074,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,OXFORD HEALTH INSURANCE-Commercial, +128075,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,OXFORD HEALTH INSURANCE-Commercial,8723.05 +128076,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,OXFORD HEALTH INSURANCE-Commercial, +128077,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,OXFORD HEALTH INSURANCE-Commercial, +128078,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,OXFORD HEALTH INSURANCE-Commercial, +128079,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,OXFORD HEALTH INSURANCE-Commercial, +128080,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,OXFORD HEALTH INSURANCE-Commercial,571.8 +128081,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,OXFORD HEALTH INSURANCE-Commercial, +128082,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,OXFORD HEALTH INSURANCE-Commercial, +128083,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,OXFORD HEALTH INSURANCE-Commercial, +128084,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,OXFORD HEALTH INSURANCE-Commercial, +128085,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,OXFORD HEALTH INSURANCE-Commercial,1748.3 +128086,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,OXFORD HEALTH INSURANCE-Commercial, +128087,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,OXFORD HEALTH INSURANCE-Commercial, +128088,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,OXFORD HEALTH INSURANCE-Commercial,1748.39 +128089,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,OXFORD HEALTH INSURANCE-Commercial, +128090,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,OXFORD HEALTH INSURANCE-Commercial, +128091,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,OXFORD HEALTH INSURANCE-Commercial, +128092,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,OXFORD HEALTH INSURANCE-Commercial, +128093,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,OXFORD HEALTH INSURANCE-Commercial, +128094,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,OXFORD HEALTH INSURANCE-Commercial, +128095,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,OXFORD HEALTH INSURANCE-Commercial, +128096,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,OXFORD HEALTH INSURANCE-Commercial,196.33 +128097,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,OXFORD HEALTH INSURANCE-Commercial, +128098,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,OXFORD HEALTH INSURANCE-Commercial,41.97 +128099,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +128100,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,OXFORD HEALTH INSURANCE-Commercial,163.5 +128101,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,OXFORD HEALTH INSURANCE-Commercial, +128102,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,OXFORD HEALTH INSURANCE-Commercial,50.0 +128103,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,OXFORD HEALTH INSURANCE-Commercial,257.5 +128104,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,OXFORD HEALTH INSURANCE-Commercial, +128105,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,OXFORD HEALTH INSURANCE-Commercial, +128106,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,OXFORD HEALTH INSURANCE-Commercial, +128107,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,OXFORD HEALTH INSURANCE-Commercial, +128108,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,OXFORD HEALTH INSURANCE-Commercial, +128109,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,OXFORD HEALTH INSURANCE-Commercial, +128110,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,OXFORD HEALTH INSURANCE-Commercial, +128111,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,OXFORD HEALTH INSURANCE-Commercial,15.05 +128112,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,OXFORD HEALTH INSURANCE-Commercial, +128113,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,OXFORD HEALTH INSURANCE-Commercial, +128114,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,OXFORD HEALTH INSURANCE-Commercial, +128115,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,OXFORD HEALTH INSURANCE-Commercial,10.85 +128116,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,OXFORD HEALTH INSURANCE-Commercial,10.85 +128117,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,OXFORD HEALTH INSURANCE-Commercial,10.85 +128118,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,OXFORD HEALTH INSURANCE-Commercial, +128119,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,OXFORD HEALTH INSURANCE-Commercial,14.78 +128120,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,OXFORD HEALTH INSURANCE-Commercial, +128121,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,OXFORD HEALTH INSURANCE-Commercial, +128122,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,OXFORD HEALTH INSURANCE-Commercial, +128123,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,OXFORD HEALTH INSURANCE-Commercial, +128124,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,OXFORD HEALTH INSURANCE-Commercial, +128125,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,OXFORD HEALTH INSURANCE-Commercial,19.17 +128126,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,OXFORD HEALTH INSURANCE-Commercial, +128127,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,OXFORD HEALTH INSURANCE-Commercial, +128128,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,OXFORD HEALTH INSURANCE-Commercial, +128129,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,OXFORD HEALTH INSURANCE-Commercial, +128130,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,OXFORD HEALTH INSURANCE-Commercial, +128131,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,OXFORD HEALTH INSURANCE-Commercial,23.14 +128132,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,OXFORD HEALTH INSURANCE-Commercial, +128133,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,OXFORD HEALTH INSURANCE-Commercial, +128134,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,OXFORD HEALTH INSURANCE-Commercial, +128135,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,OXFORD HEALTH INSURANCE-Commercial,269.96 +128136,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,OXFORD HEALTH INSURANCE-Commercial,217.0 +128137,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,OXFORD HEALTH INSURANCE-Commercial, +128138,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,OXFORD HEALTH INSURANCE-Commercial, +128139,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,OXFORD HEALTH INSURANCE-Commercial, +128140,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,OXFORD HEALTH INSURANCE-Commercial, +128141,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,OXFORD HEALTH INSURANCE-Commercial, +128142,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,OXFORD HEALTH INSURANCE-Commercial, +128143,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,OXFORD HEALTH INSURANCE-Commercial, +128144,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,OXFORD HEALTH INSURANCE-Commercial, +128145,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,OXFORD HEALTH INSURANCE-Commercial, +128146,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,OXFORD HEALTH INSURANCE-Commercial, +128147,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,OXFORD HEALTH INSURANCE-Commercial, +128148,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,OXFORD HEALTH INSURANCE-Commercial, +128149,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,OXFORD HEALTH INSURANCE-Commercial, +128150,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,OXFORD HEALTH INSURANCE-Commercial, +128151,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,OXFORD HEALTH INSURANCE-Commercial, +128152,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,OXFORD HEALTH INSURANCE-Commercial,136.33 +128153,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +128154,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,OXFORD HEALTH INSURANCE-Commercial, +128155,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,OXFORD HEALTH INSURANCE-Commercial, +128156,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,OXFORD HEALTH INSURANCE-Commercial,5.19 +128157,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,OXFORD HEALTH INSURANCE-Commercial, +128158,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,OXFORD HEALTH INSURANCE-Commercial, +128159,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,OXFORD HEALTH INSURANCE-Commercial, +128160,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,OXFORD HEALTH INSURANCE-Commercial, +128161,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,OXFORD HEALTH INSURANCE-Commercial, +128162,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,OXFORD HEALTH INSURANCE-Commercial, +128163,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,OXFORD HEALTH INSURANCE-Commercial, +128164,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,OXFORD HEALTH INSURANCE-Commercial, +128165,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,OXFORD HEALTH INSURANCE-Commercial, +128166,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,OXFORD HEALTH INSURANCE-Commercial, +128167,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,OXFORD HEALTH INSURANCE-Commercial, +128168,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,OXFORD HEALTH INSURANCE-Commercial, +128169,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,OXFORD HEALTH INSURANCE-Commercial, +128170,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,OXFORD HEALTH INSURANCE-Commercial, +128171,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,OXFORD HEALTH INSURANCE-Commercial, +128172,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,OXFORD HEALTH INSURANCE-Commercial, +128173,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,OXFORD HEALTH INSURANCE-Commercial, +128174,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,OXFORD HEALTH INSURANCE-Commercial, +128175,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,OXFORD HEALTH INSURANCE-Commercial, +128176,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,OXFORD HEALTH INSURANCE-Commercial, +128177,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,OXFORD HEALTH INSURANCE-Commercial, +128178,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,OXFORD HEALTH INSURANCE-Commercial, +128179,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,OXFORD HEALTH INSURANCE-Commercial, +128180,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,OXFORD HEALTH INSURANCE-Commercial, +128181,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,OXFORD HEALTH INSURANCE-Commercial, +128182,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,OXFORD HEALTH INSURANCE-Commercial, +128183,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,OXFORD HEALTH INSURANCE-Commercial, +128184,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,OXFORD HEALTH INSURANCE-Commercial, +128185,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,OXFORD HEALTH INSURANCE-Commercial, +128186,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,OXFORD HEALTH INSURANCE-Commercial, +128187,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,OXFORD HEALTH INSURANCE-Commercial, +128188,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,OXFORD HEALTH INSURANCE-Commercial, +128189,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,OXFORD HEALTH INSURANCE-Commercial,57.0 +128190,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,OXFORD HEALTH INSURANCE-Commercial, +128191,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,OXFORD HEALTH INSURANCE-Commercial, +128192,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,OXFORD HEALTH INSURANCE-Commercial, +128193,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,OXFORD HEALTH INSURANCE-Commercial, +128194,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,OXFORD HEALTH INSURANCE-Commercial, +128195,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,OXFORD HEALTH INSURANCE-Commercial, +128196,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,OXFORD HEALTH INSURANCE-Commercial, +128197,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,OXFORD HEALTH INSURANCE-Commercial, +128198,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,OXFORD HEALTH INSURANCE-Commercial,96.0 +128199,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,OXFORD HEALTH INSURANCE-Commercial, +128200,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,OXFORD HEALTH INSURANCE-Commercial, +128201,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,OXFORD HEALTH INSURANCE-Commercial, +128202,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,OXFORD HEALTH INSURANCE-Commercial, +128203,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,OXFORD HEALTH INSURANCE-Commercial, +128204,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,OXFORD HEALTH INSURANCE-Commercial, +128205,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,OXFORD HEALTH INSURANCE-Commercial, +128206,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,OXFORD HEALTH INSURANCE-Commercial, +128207,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,OXFORD HEALTH INSURANCE-Commercial, +128208,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,OXFORD HEALTH INSURANCE-Commercial, +128209,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,OXFORD HEALTH INSURANCE-Commercial, +128210,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,OXFORD HEALTH INSURANCE-Commercial, +128211,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,OXFORD HEALTH INSURANCE-Commercial, +128212,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,OXFORD HEALTH INSURANCE-Commercial, +128213,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,OXFORD HEALTH INSURANCE-Commercial, +128214,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,OXFORD HEALTH INSURANCE-Commercial, +128215,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,OXFORD HEALTH INSURANCE-Commercial, +128216,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,OXFORD HEALTH INSURANCE-Commercial, +128217,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,OXFORD HEALTH INSURANCE-Commercial,223.88 +128218,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,OXFORD HEALTH INSURANCE-Commercial, +128219,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,OXFORD HEALTH INSURANCE-Commercial, +128220,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,OXFORD HEALTH INSURANCE-Commercial, +128221,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,OXFORD HEALTH INSURANCE-Commercial,1810.8 +128222,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,OXFORD HEALTH INSURANCE-Commercial, +128223,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,OXFORD HEALTH INSURANCE-Commercial, +128224,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,OXFORD HEALTH INSURANCE-Commercial,2.5 +128225,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,OXFORD HEALTH INSURANCE-Commercial, +128226,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,OXFORD HEALTH INSURANCE-Commercial,37.88 +128227,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,OXFORD HEALTH INSURANCE-Commercial, +128228,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,OXFORD HEALTH INSURANCE-Commercial, +128229,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,OXFORD HEALTH INSURANCE-Commercial, +128230,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,OXFORD HEALTH INSURANCE-Commercial, +128231,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,OXFORD HEALTH INSURANCE-Commercial, +128232,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,OXFORD HEALTH INSURANCE-Commercial,456.0 +128233,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,OXFORD HEALTH INSURANCE-Commercial, +128234,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,OXFORD HEALTH INSURANCE-Commercial,582.0 +128235,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,OXFORD HEALTH INSURANCE-Commercial,1782.0 +128236,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,OXFORD HEALTH INSURANCE-Commercial,676.28 +128237,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,OXFORD HEALTH INSURANCE-Commercial, +128238,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,OXFORD HEALTH INSURANCE-Commercial, +128239,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,OXFORD HEALTH INSURANCE-Commercial, +128240,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,OXFORD HEALTH INSURANCE-Commercial,684.0 +128241,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,OXFORD HEALTH INSURANCE-Commercial,34.2 +128242,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,OXFORD HEALTH INSURANCE-Commercial, +128243,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,OXFORD HEALTH INSURANCE-Commercial, +128244,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,OXFORD HEALTH INSURANCE-Commercial, +128245,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,OXFORD HEALTH INSURANCE-Commercial,17.0 +128246,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,OXFORD HEALTH INSURANCE-Commercial,45.75 +128247,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,OXFORD HEALTH INSURANCE-Commercial, +128248,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,OXFORD HEALTH INSURANCE-Commercial,9.59 +128249,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,OXFORD HEALTH INSURANCE-Commercial, +128250,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,OXFORD HEALTH INSURANCE-Commercial, +128251,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,OXFORD HEALTH INSURANCE-Commercial,22.52 +128252,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,OXFORD HEALTH INSURANCE-Commercial, +128253,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,OXFORD HEALTH INSURANCE-Commercial,13.09 +128254,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,OXFORD HEALTH INSURANCE-Commercial, +128255,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,OXFORD HEALTH INSURANCE-Commercial, +128256,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,OXFORD HEALTH INSURANCE-Commercial, +128257,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,OXFORD HEALTH INSURANCE-Commercial, +128258,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,OXFORD HEALTH INSURANCE-Commercial, +128259,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,OXFORD HEALTH INSURANCE-Commercial, +128260,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,OXFORD HEALTH INSURANCE-Commercial,90.59 +128261,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,OXFORD HEALTH INSURANCE-Commercial, +128262,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,OXFORD HEALTH INSURANCE-Commercial,7.0 +128263,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,OXFORD HEALTH INSURANCE-Commercial, +128264,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,OXFORD HEALTH INSURANCE-Commercial, +128265,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,OXFORD HEALTH INSURANCE-Commercial,18.83 +128266,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,OXFORD HEALTH INSURANCE-Commercial, +128267,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,OXFORD HEALTH INSURANCE-Commercial, +128268,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,OXFORD HEALTH INSURANCE-Commercial,3.25 +128269,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,OXFORD HEALTH INSURANCE-Commercial,5.02 +128270,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,OXFORD HEALTH INSURANCE-Commercial,3.15 +128271,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,OXFORD HEALTH INSURANCE-Commercial, +128272,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,OXFORD HEALTH INSURANCE-Commercial,18.09 +128273,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,OXFORD HEALTH INSURANCE-Commercial, +128274,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,OXFORD HEALTH INSURANCE-Commercial,319.5 +128275,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,OXFORD HEALTH INSURANCE-Commercial,15.75 +128276,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,OXFORD HEALTH INSURANCE-Commercial,5.16 +128277,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,OXFORD HEALTH INSURANCE-Commercial,5.27 +128278,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,OXFORD HEALTH INSURANCE-Commercial,3.15 +128279,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,OXFORD HEALTH INSURANCE-Commercial,8.4 +128280,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,OXFORD HEALTH INSURANCE-Commercial, +128281,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,OXFORD HEALTH INSURANCE-Commercial, +128282,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,OXFORD HEALTH INSURANCE-Commercial,209.25 +128283,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,OXFORD HEALTH INSURANCE-Commercial, +128284,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,OXFORD HEALTH INSURANCE-Commercial, +128285,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,OXFORD HEALTH INSURANCE-Commercial, +128286,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,OXFORD HEALTH INSURANCE-Commercial,8.4 +128287,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,OXFORD HEALTH INSURANCE-Commercial, +128288,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,OXFORD HEALTH INSURANCE-Commercial, +128289,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,OXFORD HEALTH INSURANCE-Commercial, +128290,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,OXFORD HEALTH INSURANCE-Commercial, +128291,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,OXFORD HEALTH INSURANCE-Commercial,4.84 +128292,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,OXFORD HEALTH INSURANCE-Commercial, +128293,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,OXFORD HEALTH INSURANCE-Commercial, +128294,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,OXFORD HEALTH INSURANCE-Commercial,9.15 +128295,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,OXFORD HEALTH INSURANCE-Commercial,19.0 +128296,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,OXFORD HEALTH INSURANCE-Commercial,16.8 +128297,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,OXFORD HEALTH INSURANCE-Commercial,18.02 +128298,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,OXFORD HEALTH INSURANCE-Commercial,60.0 +128299,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,OXFORD HEALTH INSURANCE-Commercial,11.55 +128300,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,OXFORD HEALTH INSURANCE-Commercial, +128301,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,OXFORD HEALTH INSURANCE-Commercial,5.12 +128302,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,OXFORD HEALTH INSURANCE-Commercial,5.18 +128303,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,OXFORD HEALTH INSURANCE-Commercial,5.01 +128304,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,OXFORD HEALTH INSURANCE-Commercial, +128305,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,OXFORD HEALTH INSURANCE-Commercial, +128306,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,OXFORD HEALTH INSURANCE-Commercial,117.0 +128307,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,OXFORD HEALTH INSURANCE-Commercial,15.86 +128308,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,OXFORD HEALTH INSURANCE-Commercial, +128309,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,OXFORD HEALTH INSURANCE-Commercial,14.0 +128310,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,OXFORD HEALTH INSURANCE-Commercial, +128311,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,OXFORD HEALTH INSURANCE-Commercial,20.0 +128312,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,OXFORD HEALTH INSURANCE-Commercial, +128313,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,OXFORD HEALTH INSURANCE-Commercial, +128314,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,OXFORD HEALTH INSURANCE-Commercial, +128315,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,OXFORD HEALTH INSURANCE-Commercial, +128316,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,OXFORD HEALTH INSURANCE-Commercial,322.5 +128317,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,OXFORD HEALTH INSURANCE-Commercial,33.6 +128318,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,OXFORD HEALTH INSURANCE-Commercial, +128319,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,OXFORD HEALTH INSURANCE-Commercial, +128320,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,OXFORD HEALTH INSURANCE-Commercial,6.55 +128321,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,OXFORD HEALTH INSURANCE-Commercial,12.6 +128322,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,OXFORD HEALTH INSURANCE-Commercial, +128323,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,OXFORD HEALTH INSURANCE-Commercial, +128324,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,OXFORD HEALTH INSURANCE-Commercial,132.0 +128325,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,OXFORD HEALTH INSURANCE-Commercial,350.0 +128326,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,OXFORD HEALTH INSURANCE-Commercial,128.25 +128327,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,OXFORD HEALTH INSURANCE-Commercial, +128328,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,OXFORD HEALTH INSURANCE-Commercial,28.52 +128329,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,OXFORD HEALTH INSURANCE-Commercial,9.43 +128330,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,OXFORD HEALTH INSURANCE-Commercial,40.0 +128331,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,OXFORD HEALTH INSURANCE-Commercial, +128332,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,OXFORD HEALTH INSURANCE-Commercial, +128333,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,OXFORD HEALTH INSURANCE-Commercial, +128334,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,OXFORD HEALTH INSURANCE-Commercial, +128335,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,OXFORD HEALTH INSURANCE-Commercial,3.93 +128336,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,OXFORD HEALTH INSURANCE-Commercial, +128337,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,OXFORD HEALTH INSURANCE-Commercial, +128338,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,OXFORD HEALTH INSURANCE-Commercial,6.19 +128339,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,OXFORD HEALTH INSURANCE-Commercial, +128340,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,OXFORD HEALTH INSURANCE-Commercial, +128341,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,OXFORD HEALTH INSURANCE-Commercial, +128342,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,OXFORD HEALTH INSURANCE-Commercial,3.86 +128343,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,OXFORD HEALTH INSURANCE-Commercial, +128344,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,OXFORD HEALTH INSURANCE-Commercial,216.75 +128345,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,OXFORD HEALTH INSURANCE-Commercial,18.52 +128346,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,OXFORD HEALTH INSURANCE-Commercial, +128347,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,OXFORD HEALTH INSURANCE-Commercial, +128348,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,OXFORD HEALTH INSURANCE-Commercial,123.75 +128349,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,OXFORD HEALTH INSURANCE-Commercial, +128350,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,OXFORD HEALTH INSURANCE-Commercial,73.0 +128351,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,OXFORD HEALTH INSURANCE-Commercial,105.0 +128352,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,OXFORD HEALTH INSURANCE-Commercial, +128353,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,OXFORD HEALTH INSURANCE-Commercial,159.0 +128354,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,OXFORD HEALTH INSURANCE-Commercial, +128355,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,OXFORD HEALTH INSURANCE-Commercial, +128356,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,OXFORD HEALTH INSURANCE-Commercial, +128357,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,OXFORD HEALTH INSURANCE-Commercial,175.0 +128358,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,OXFORD HEALTH INSURANCE-Commercial, +128359,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,OXFORD HEALTH INSURANCE-Commercial, +128360,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,OXFORD HEALTH INSURANCE-Commercial,23.51 +128361,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,OXFORD HEALTH INSURANCE-Commercial,12.53 +128362,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,OXFORD HEALTH INSURANCE-Commercial,235.5 +128363,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,OXFORD HEALTH INSURANCE-Commercial,225.75 +128364,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,OXFORD HEALTH INSURANCE-Commercial,8.0 +128365,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,OXFORD HEALTH INSURANCE-Commercial,92.25 +128366,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,OXFORD HEALTH INSURANCE-Commercial, +128367,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,OXFORD HEALTH INSURANCE-Commercial,61.5 +128368,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,OXFORD HEALTH INSURANCE-Commercial, +128369,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,OXFORD HEALTH INSURANCE-Commercial, +128370,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,OXFORD HEALTH INSURANCE-Commercial,6.0 +128371,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,OXFORD HEALTH INSURANCE-Commercial,86.43 +128372,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,OXFORD HEALTH INSURANCE-Commercial, +128373,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,OXFORD HEALTH INSURANCE-Commercial, +128374,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,OXFORD HEALTH INSURANCE-Commercial, +128375,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,OXFORD HEALTH INSURANCE-Commercial, +128376,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,OXFORD HEALTH INSURANCE-Commercial,75.0 +128377,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,OXFORD HEALTH INSURANCE-Commercial, +128378,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,OXFORD HEALTH INSURANCE-Commercial, +128379,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,OXFORD HEALTH INSURANCE-Commercial, +128380,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,OXFORD HEALTH INSURANCE-Commercial, +128381,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,OXFORD HEALTH INSURANCE-Commercial, +128382,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,OXFORD HEALTH INSURANCE-Commercial, +128383,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,OXFORD HEALTH INSURANCE-Commercial, +128384,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,OXFORD HEALTH INSURANCE-Commercial, +128385,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,OXFORD HEALTH INSURANCE-Commercial,309.5 +128386,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,OXFORD HEALTH INSURANCE-Commercial,283.5 +128387,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,OXFORD HEALTH INSURANCE-Commercial, +128388,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,OXFORD HEALTH INSURANCE-Commercial,43.17 +128389,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,OXFORD HEALTH INSURANCE-Commercial, +128390,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,OXFORD HEALTH INSURANCE-Commercial,5.25 +128391,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,OXFORD HEALTH INSURANCE-Commercial,5.25 +128392,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,OXFORD HEALTH INSURANCE-Commercial, +128393,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,OXFORD HEALTH INSURANCE-Commercial, +128394,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,OXFORD HEALTH INSURANCE-Commercial,62.96 +128395,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,OXFORD HEALTH INSURANCE-Commercial, +128396,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,OXFORD HEALTH INSURANCE-Commercial, +128397,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,OXFORD HEALTH INSURANCE-Commercial,26.91 +128398,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,OXFORD HEALTH INSURANCE-Commercial, +128399,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,OXFORD HEALTH INSURANCE-Commercial, +128400,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,OXFORD HEALTH INSURANCE-Commercial,12.6 +128401,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,OXFORD HEALTH INSURANCE-Commercial,56.0 +128402,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,OXFORD HEALTH INSURANCE-Commercial, +128403,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,OXFORD HEALTH INSURANCE-Commercial, +128404,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,OXFORD HEALTH INSURANCE-Commercial, +128405,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,OXFORD HEALTH INSURANCE-Commercial, +128406,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,OXFORD HEALTH INSURANCE-Commercial,3.25 +128407,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,OXFORD HEALTH INSURANCE-Commercial, +128408,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,OXFORD HEALTH INSURANCE-Commercial,9.59 +128409,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,OXFORD HEALTH INSURANCE-Commercial, +128410,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,OXFORD HEALTH INSURANCE-Commercial,13.7 +128411,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,OXFORD HEALTH INSURANCE-Commercial, +128412,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,OXFORD HEALTH INSURANCE-Commercial,13.11 +128413,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,OXFORD HEALTH INSURANCE-Commercial,23.1 +128414,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,OXFORD HEALTH INSURANCE-Commercial,26.01 +128415,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,OXFORD HEALTH INSURANCE-Commercial,12.0 +128416,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,OXFORD HEALTH INSURANCE-Commercial, +128417,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,OXFORD HEALTH INSURANCE-Commercial,5.12 +128418,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,OXFORD HEALTH INSURANCE-Commercial, +128419,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,OXFORD HEALTH INSURANCE-Commercial,129.0 +128420,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,OXFORD HEALTH INSURANCE-Commercial,126.0 +128421,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,OXFORD HEALTH INSURANCE-Commercial, +128422,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,OXFORD HEALTH INSURANCE-Commercial, +128423,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,OXFORD HEALTH INSURANCE-Commercial, +128424,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,OXFORD HEALTH INSURANCE-Commercial,7.5 +128425,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,OXFORD HEALTH INSURANCE-Commercial, +128426,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,OXFORD HEALTH INSURANCE-Commercial, +128427,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,OXFORD HEALTH INSURANCE-Commercial, +128428,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,OXFORD HEALTH INSURANCE-Commercial, +128429,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,OXFORD HEALTH INSURANCE-Commercial,13.28 +128430,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,OXFORD HEALTH INSURANCE-Commercial, +128431,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,OXFORD HEALTH INSURANCE-Commercial,9.86 +128432,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,OXFORD HEALTH INSURANCE-Commercial, +128433,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,OXFORD HEALTH INSURANCE-Commercial,2.1 +128434,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,OXFORD HEALTH INSURANCE-Commercial, +128435,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,OXFORD HEALTH INSURANCE-Commercial,13.0 +128436,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,OXFORD HEALTH INSURANCE-Commercial, +128437,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,OXFORD HEALTH INSURANCE-Commercial, +128438,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,OXFORD HEALTH INSURANCE-Commercial, +128439,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,OXFORD HEALTH INSURANCE-Commercial,11.5 +128440,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,OXFORD HEALTH INSURANCE-Commercial, +128441,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,OXFORD HEALTH INSURANCE-Commercial,6.0 +128442,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,OXFORD HEALTH INSURANCE-Commercial,11.5 +128443,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,OXFORD HEALTH INSURANCE-Commercial,11.0 +128444,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,OXFORD HEALTH INSURANCE-Commercial,23.25 +128445,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,OXFORD HEALTH INSURANCE-Commercial,6.87 +128446,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,OXFORD HEALTH INSURANCE-Commercial,13.54 +128447,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,OXFORD HEALTH INSURANCE-Commercial,15.75 +128448,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,OXFORD HEALTH INSURANCE-Commercial,244.0 +128449,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,OXFORD HEALTH INSURANCE-Commercial, +128450,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,OXFORD HEALTH INSURANCE-Commercial,22.5 +128451,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,OXFORD HEALTH INSURANCE-Commercial, +128452,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,OXFORD HEALTH INSURANCE-Commercial, +128453,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,OXFORD HEALTH INSURANCE-Commercial,123.0 +128454,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,OXFORD HEALTH INSURANCE-Commercial, +128455,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,OXFORD HEALTH INSURANCE-Commercial,3.0 +128456,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,OXFORD HEALTH INSURANCE-Commercial,9.91 +128457,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,OXFORD HEALTH INSURANCE-Commercial,26.07 +128458,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,OXFORD HEALTH INSURANCE-Commercial,14.39 +128459,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,OXFORD HEALTH INSURANCE-Commercial,429.0 +128460,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,OXFORD HEALTH INSURANCE-Commercial, +128461,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,OXFORD HEALTH INSURANCE-Commercial,3.95 +128462,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,OXFORD HEALTH INSURANCE-Commercial, +128463,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,OXFORD HEALTH INSURANCE-Commercial,12.03 +128464,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,OXFORD HEALTH INSURANCE-Commercial, +128465,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,OXFORD HEALTH INSURANCE-Commercial, +128466,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,OXFORD HEALTH INSURANCE-Commercial, +128467,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,OXFORD HEALTH INSURANCE-Commercial,15.19 +128468,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,OXFORD HEALTH INSURANCE-Commercial,10.97 +128469,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,OXFORD HEALTH INSURANCE-Commercial,5.25 +128470,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,OXFORD HEALTH INSURANCE-Commercial,11.0 +128471,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,OXFORD HEALTH INSURANCE-Commercial,11.0 +128472,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,OXFORD HEALTH INSURANCE-Commercial,314.0 +128473,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,OXFORD HEALTH INSURANCE-Commercial,236.0 +128474,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,OXFORD HEALTH INSURANCE-Commercial, +128475,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,OXFORD HEALTH INSURANCE-Commercial,405.55 +128476,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,OXFORD HEALTH INSURANCE-Commercial, +128477,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,OXFORD HEALTH INSURANCE-Commercial, +128478,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,OXFORD HEALTH INSURANCE-Commercial,2.1 +128479,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,OXFORD HEALTH INSURANCE-Commercial,2.1 +128480,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,OXFORD HEALTH INSURANCE-Commercial,113.56 +128481,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,OXFORD HEALTH INSURANCE-Commercial,72.75 +128482,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,OXFORD HEALTH INSURANCE-Commercial, +128483,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,OXFORD HEALTH INSURANCE-Commercial,50.25 +128484,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,OXFORD HEALTH INSURANCE-Commercial, +128485,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,OXFORD HEALTH INSURANCE-Commercial, +128486,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,OXFORD HEALTH INSURANCE-Commercial, +128487,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,OXFORD HEALTH INSURANCE-Commercial, +128488,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,OXFORD HEALTH INSURANCE-Commercial, +128489,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,OXFORD HEALTH INSURANCE-Commercial, +128490,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,OXFORD HEALTH INSURANCE-Commercial, +128491,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,OXFORD HEALTH INSURANCE-Commercial, +128492,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,OXFORD HEALTH INSURANCE-Commercial, +128493,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,OXFORD HEALTH INSURANCE-Commercial, +128494,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,OXFORD HEALTH INSURANCE-Commercial, +128495,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,OXFORD HEALTH INSURANCE-Commercial, +128496,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,OXFORD HEALTH INSURANCE-Commercial, +128497,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,OXFORD HEALTH INSURANCE-Commercial, +128498,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,OXFORD HEALTH INSURANCE-Commercial, +128499,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,OXFORD HEALTH INSURANCE-Commercial, +128500,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,OXFORD HEALTH INSURANCE-Commercial, +128501,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,OXFORD HEALTH INSURANCE-Commercial, +128502,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,OXFORD HEALTH INSURANCE-Commercial, +128503,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,OXFORD HEALTH INSURANCE-Commercial, +128504,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,OXFORD HEALTH INSURANCE-Commercial, +128505,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,OXFORD HEALTH INSURANCE-Commercial, +128506,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,OXFORD HEALTH INSURANCE-Commercial, +128507,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,OXFORD HEALTH INSURANCE-Commercial,10.18 +128508,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,OXFORD HEALTH INSURANCE-Commercial, +128509,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,OXFORD HEALTH INSURANCE-Commercial, +128510,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,OXFORD HEALTH INSURANCE-Commercial, +128511,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,OXFORD HEALTH INSURANCE-Commercial, +128512,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,OXFORD HEALTH INSURANCE-Commercial, +128513,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,OXFORD HEALTH INSURANCE-Commercial, +128514,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,OXFORD HEALTH INSURANCE-Commercial, +128515,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,OXFORD HEALTH INSURANCE-Commercial, +128516,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,OXFORD HEALTH INSURANCE-Commercial,83.0 +128517,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,OXFORD HEALTH INSURANCE-Commercial, +128518,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,OXFORD HEALTH INSURANCE-Commercial,12.74 +128519,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,OXFORD HEALTH INSURANCE-Commercial, +128520,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,OXFORD HEALTH INSURANCE-Commercial,56.25 +128521,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,OXFORD HEALTH INSURANCE-Commercial, +128522,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,OXFORD HEALTH INSURANCE-Commercial,11.51 +128523,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,OXFORD HEALTH INSURANCE-Commercial,109.0 +128524,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,OXFORD HEALTH INSURANCE-Commercial, +128525,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,OXFORD HEALTH INSURANCE-Commercial, +128526,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,OXFORD HEALTH INSURANCE-Commercial, +128527,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,OXFORD HEALTH INSURANCE-Commercial,37.8 +128528,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,OXFORD HEALTH INSURANCE-Commercial, +128529,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,OXFORD HEALTH INSURANCE-Commercial,13.28 +128530,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,OXFORD HEALTH INSURANCE-Commercial, +128531,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,OXFORD HEALTH INSURANCE-Commercial, +128532,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,OXFORD HEALTH INSURANCE-Commercial,7.84 +128533,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,OXFORD HEALTH INSURANCE-Commercial,16.1 +128534,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,OXFORD HEALTH INSURANCE-Commercial,4.87 +128535,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,OXFORD HEALTH INSURANCE-Commercial,83.25 +128536,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,OXFORD HEALTH INSURANCE-Commercial,17.89 +128537,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,OXFORD HEALTH INSURANCE-Commercial,44.0 +128538,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,OXFORD HEALTH INSURANCE-Commercial,22.86 +128539,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,OXFORD HEALTH INSURANCE-Commercial,26.53 +128540,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,OXFORD HEALTH INSURANCE-Commercial, +128541,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,OXFORD HEALTH INSURANCE-Commercial, +128542,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,OXFORD HEALTH INSURANCE-Commercial,43.42 +128543,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,OXFORD HEALTH INSURANCE-Commercial, +128544,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,OXFORD HEALTH INSURANCE-Commercial, +128545,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,OXFORD HEALTH INSURANCE-Commercial,18.09 +128546,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,OXFORD HEALTH INSURANCE-Commercial, +128547,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,OXFORD HEALTH INSURANCE-Commercial,9.28 +128548,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,OXFORD HEALTH INSURANCE-Commercial,24.06 +128549,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,OXFORD HEALTH INSURANCE-Commercial,210.0 +128550,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,OXFORD HEALTH INSURANCE-Commercial,14.57 +128551,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,OXFORD HEALTH INSURANCE-Commercial,252.0 +128552,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,OXFORD HEALTH INSURANCE-Commercial,20.81 +128553,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,OXFORD HEALTH INSURANCE-Commercial,279.75 +128554,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,OXFORD HEALTH INSURANCE-Commercial, +128555,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,OXFORD HEALTH INSURANCE-Commercial,3.13 +128556,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,OXFORD HEALTH INSURANCE-Commercial, +128557,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,OXFORD HEALTH INSURANCE-Commercial,16.65 +128558,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,OXFORD HEALTH INSURANCE-Commercial, +128559,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,OXFORD HEALTH INSURANCE-Commercial, +128560,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,OXFORD HEALTH INSURANCE-Commercial,160.5 +128561,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,OXFORD HEALTH INSURANCE-Commercial,189.0 +128562,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,OXFORD HEALTH INSURANCE-Commercial, +128563,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,OXFORD HEALTH INSURANCE-Commercial, +128564,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,OXFORD HEALTH INSURANCE-Commercial, +128565,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,OXFORD HEALTH INSURANCE-Commercial,27.65 +128566,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,OXFORD HEALTH INSURANCE-Commercial, +128567,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,OXFORD HEALTH INSURANCE-Commercial, +128568,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,OXFORD HEALTH INSURANCE-Commercial,52.7 +128569,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,OXFORD HEALTH INSURANCE-Commercial, +128570,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,OXFORD HEALTH INSURANCE-Commercial,52.7 +128571,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,OXFORD HEALTH INSURANCE-Commercial,21.0 +128572,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,OXFORD HEALTH INSURANCE-Commercial,31.5 +128573,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,OXFORD HEALTH INSURANCE-Commercial, +128574,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,OXFORD HEALTH INSURANCE-Commercial,8.59 +128575,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,OXFORD HEALTH INSURANCE-Commercial,9.17 +128576,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,OXFORD HEALTH INSURANCE-Commercial,154.25 +128577,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,OXFORD HEALTH INSURANCE-Commercial, +128578,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,OXFORD HEALTH INSURANCE-Commercial,4.27 +128579,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,OXFORD HEALTH INSURANCE-Commercial, +128580,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,OXFORD HEALTH INSURANCE-Commercial, +128581,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,OXFORD HEALTH INSURANCE-Commercial, +128582,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,OXFORD HEALTH INSURANCE-Commercial, +128583,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,OXFORD HEALTH INSURANCE-Commercial,24.0 +128584,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,OXFORD HEALTH INSURANCE-Commercial,15.99 +128585,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,OXFORD HEALTH INSURANCE-Commercial,216.75 +128586,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,OXFORD HEALTH INSURANCE-Commercial,256.5 +128587,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,OXFORD HEALTH INSURANCE-Commercial, +128588,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,OXFORD HEALTH INSURANCE-Commercial, +128589,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,OXFORD HEALTH INSURANCE-Commercial, +128590,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,OXFORD HEALTH INSURANCE-Commercial, +128591,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,OXFORD HEALTH INSURANCE-Commercial, +128592,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,OXFORD HEALTH INSURANCE-Commercial, +128593,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,OXFORD HEALTH INSURANCE-Commercial,232.0 +128594,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,OXFORD HEALTH INSURANCE-Commercial,9.0 +128595,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,OXFORD HEALTH INSURANCE-Commercial, +128596,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,OXFORD HEALTH INSURANCE-Commercial,4.0 +128597,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,OXFORD HEALTH INSURANCE-Commercial,5.0 +128598,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,OXFORD HEALTH INSURANCE-Commercial,14.0 +128599,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,OXFORD HEALTH INSURANCE-Commercial,26.26 +128600,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,OXFORD HEALTH INSURANCE-Commercial, +128601,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,OXFORD HEALTH INSURANCE-Commercial, +128602,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,OXFORD HEALTH INSURANCE-Commercial, +128603,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,OXFORD HEALTH INSURANCE-Commercial, +128604,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,OXFORD HEALTH INSURANCE-Commercial, +128605,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,OXFORD HEALTH INSURANCE-Commercial, +128606,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,OXFORD HEALTH INSURANCE-Commercial, +128607,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,OXFORD HEALTH INSURANCE-Commercial, +128608,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,OXFORD HEALTH INSURANCE-Commercial, +128609,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,OXFORD HEALTH INSURANCE-Commercial, +128610,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,OXFORD HEALTH INSURANCE-Commercial, +128611,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,OXFORD HEALTH INSURANCE-Commercial,9.9 +128612,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,OXFORD HEALTH INSURANCE-Commercial,12.5 +128613,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,OXFORD HEALTH INSURANCE-Commercial,8.64 +128614,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,OXFORD HEALTH INSURANCE-Commercial,9.45 +128615,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,OXFORD HEALTH INSURANCE-Commercial,9.0 +128616,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,OXFORD HEALTH INSURANCE-Commercial,10.8 +128617,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,OXFORD HEALTH INSURANCE-Commercial, +128618,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,OXFORD HEALTH INSURANCE-Commercial, +128619,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,OXFORD HEALTH INSURANCE-Commercial,28.66 +128620,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,OXFORD HEALTH INSURANCE-Commercial,22.0 +128621,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,OXFORD HEALTH INSURANCE-Commercial, +128622,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,OXFORD HEALTH INSURANCE-Commercial, +128623,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,OXFORD HEALTH INSURANCE-Commercial,20.0 +128624,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,OXFORD HEALTH INSURANCE-Commercial,32.0 +128625,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,OXFORD HEALTH INSURANCE-Commercial,7.2 +128626,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,OXFORD HEALTH INSURANCE-Commercial,15.99 +128627,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,OXFORD HEALTH INSURANCE-Commercial,41.42 +128628,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,OXFORD HEALTH INSURANCE-Commercial,151.0 +128629,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,OXFORD HEALTH INSURANCE-Commercial, +128630,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,OXFORD HEALTH INSURANCE-Commercial, +128631,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,OXFORD HEALTH INSURANCE-Commercial,15.99 +128632,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,OXFORD HEALTH INSURANCE-Commercial, +128633,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,OXFORD HEALTH INSURANCE-Commercial, +128634,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,OXFORD HEALTH INSURANCE-Commercial,21.71 +128635,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,OXFORD HEALTH INSURANCE-Commercial,8.0 +128636,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,OXFORD HEALTH INSURANCE-Commercial,34.5 +128637,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,OXFORD HEALTH INSURANCE-Commercial,115.12 +128638,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,OXFORD HEALTH INSURANCE-Commercial, +128639,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,OXFORD HEALTH INSURANCE-Commercial, +128640,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,OXFORD HEALTH INSURANCE-Commercial,60.9 +128641,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,OXFORD HEALTH INSURANCE-Commercial, +128642,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,OXFORD HEALTH INSURANCE-Commercial,691.0 +128643,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,OXFORD HEALTH INSURANCE-Commercial, +128644,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,OXFORD HEALTH INSURANCE-Commercial,341.05 +128645,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,OXFORD HEALTH INSURANCE-Commercial, +128646,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,OXFORD HEALTH INSURANCE-Commercial, +128647,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,OXFORD HEALTH INSURANCE-Commercial, +128648,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,OXFORD HEALTH INSURANCE-Commercial,494.0 +128649,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,OXFORD HEALTH INSURANCE-Commercial,494.0 +128650,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,OXFORD HEALTH INSURANCE-Commercial, +128651,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,OXFORD HEALTH INSURANCE-Commercial, +128652,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,OXFORD HEALTH INSURANCE-Commercial, +128653,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,OXFORD HEALTH INSURANCE-Commercial, +128654,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,OXFORD HEALTH INSURANCE-Commercial,173.85 +128655,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,OXFORD HEALTH INSURANCE-Commercial,4.96 +128656,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,OXFORD HEALTH INSURANCE-Commercial,10.5 +128657,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,OXFORD HEALTH INSURANCE-Commercial,17.2 +128658,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,OXFORD HEALTH INSURANCE-Commercial,33.69 +128659,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,OXFORD HEALTH INSURANCE-Commercial,15.34 +128660,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,OXFORD HEALTH INSURANCE-Commercial,10.95 +128661,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,OXFORD HEALTH INSURANCE-Commercial,76.0 +128662,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,OXFORD HEALTH INSURANCE-Commercial,78.0 +128663,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,OXFORD HEALTH INSURANCE-Commercial,141.33 +128664,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,OXFORD HEALTH INSURANCE-Commercial,22.43 +128665,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,OXFORD HEALTH INSURANCE-Commercial,8.4 +128666,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,OXFORD HEALTH INSURANCE-Commercial,6.62 +128667,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,OXFORD HEALTH INSURANCE-Commercial, +128668,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,OXFORD HEALTH INSURANCE-Commercial,10.32 +128669,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,OXFORD HEALTH INSURANCE-Commercial,11.54 +128670,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,OXFORD HEALTH INSURANCE-Commercial, +128671,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,OXFORD HEALTH INSURANCE-Commercial,15.47 +128672,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,OXFORD HEALTH INSURANCE-Commercial,25.0 +128673,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,OXFORD HEALTH INSURANCE-Commercial,10.0 +128674,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,OXFORD HEALTH INSURANCE-Commercial,3.15 +128675,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,OXFORD HEALTH INSURANCE-Commercial, +128676,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,OXFORD HEALTH INSURANCE-Commercial, +128677,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,OXFORD HEALTH INSURANCE-Commercial, +128678,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,OXFORD HEALTH INSURANCE-Commercial,9.67 +128679,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,OXFORD HEALTH INSURANCE-Commercial, +128680,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,OXFORD HEALTH INSURANCE-Commercial,8.4 +128681,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,OXFORD HEALTH INSURANCE-Commercial,6.13 +128682,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,OXFORD HEALTH INSURANCE-Commercial,101.0 +128683,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,OXFORD HEALTH INSURANCE-Commercial, +128684,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,OXFORD HEALTH INSURANCE-Commercial,82.0 +128685,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,OXFORD HEALTH INSURANCE-Commercial, +128686,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,OXFORD HEALTH INSURANCE-Commercial,5.04 +128687,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,OXFORD HEALTH INSURANCE-Commercial,6.81 +128688,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,OXFORD HEALTH INSURANCE-Commercial,4.2 +128689,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,OXFORD HEALTH INSURANCE-Commercial,25.11 +128690,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,OXFORD HEALTH INSURANCE-Commercial,15.0 +128691,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,OXFORD HEALTH INSURANCE-Commercial,12.0 +128692,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,OXFORD HEALTH INSURANCE-Commercial, +128693,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,OXFORD HEALTH INSURANCE-Commercial, +128694,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,OXFORD HEALTH INSURANCE-Commercial, +128695,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,OXFORD HEALTH INSURANCE-Commercial, +128696,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,OXFORD HEALTH INSURANCE-Commercial,16.01 +128697,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,OXFORD HEALTH INSURANCE-Commercial,40.0 +128698,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,OXFORD HEALTH INSURANCE-Commercial,8.71 +128699,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,OXFORD HEALTH INSURANCE-Commercial, +128700,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,OXFORD HEALTH INSURANCE-Commercial,14.0 +128701,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,OXFORD HEALTH INSURANCE-Commercial, +128702,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,OXFORD HEALTH INSURANCE-Commercial,99.0 +128703,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,OXFORD HEALTH INSURANCE-Commercial, +128704,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,OXFORD HEALTH INSURANCE-Commercial, +128705,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,OXFORD HEALTH INSURANCE-Commercial, +128706,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,OXFORD HEALTH INSURANCE-Commercial,126.0 +128707,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,OXFORD HEALTH INSURANCE-Commercial, +128708,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,OXFORD HEALTH INSURANCE-Commercial, +128709,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,OXFORD HEALTH INSURANCE-Commercial, +128710,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,OXFORD HEALTH INSURANCE-Commercial,60.74 +128711,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,OXFORD HEALTH INSURANCE-Commercial,16.0 +128712,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,OXFORD HEALTH INSURANCE-Commercial,55.12 +128713,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,OXFORD HEALTH INSURANCE-Commercial, +128714,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,OXFORD HEALTH INSURANCE-Commercial, +128715,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,OXFORD HEALTH INSURANCE-Commercial,62.16 +128716,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,OXFORD HEALTH INSURANCE-Commercial,66.42 +128717,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,OXFORD HEALTH INSURANCE-Commercial, +128718,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,OXFORD HEALTH INSURANCE-Commercial,65.0 +128719,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,OXFORD HEALTH INSURANCE-Commercial, +128720,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,OXFORD HEALTH INSURANCE-Commercial, +128721,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,OXFORD HEALTH INSURANCE-Commercial, +128722,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,OXFORD HEALTH INSURANCE-Commercial,16.0 +128723,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,OXFORD HEALTH INSURANCE-Commercial, +128724,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,OXFORD HEALTH INSURANCE-Commercial, +128725,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,OXFORD HEALTH INSURANCE-Commercial,63.7 +128726,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,OXFORD HEALTH INSURANCE-Commercial, +128727,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,OXFORD HEALTH INSURANCE-Commercial, +128728,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,OXFORD HEALTH INSURANCE-Commercial,66.28 +128729,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,OXFORD HEALTH INSURANCE-Commercial,122.5 +128730,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,OXFORD HEALTH INSURANCE-Commercial, +128731,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,OXFORD HEALTH INSURANCE-Commercial, +128732,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,OXFORD HEALTH INSURANCE-Commercial, +128733,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,OXFORD HEALTH INSURANCE-Commercial, +128734,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,OXFORD HEALTH INSURANCE-Commercial, +128735,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,OXFORD HEALTH INSURANCE-Commercial, +128736,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,OXFORD HEALTH INSURANCE-Commercial, +128737,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,OXFORD HEALTH INSURANCE-Commercial,61.7 +128738,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,OXFORD HEALTH INSURANCE-Commercial,35.09 +128739,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,OXFORD HEALTH INSURANCE-Commercial, +128740,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,OXFORD HEALTH INSURANCE-Commercial, +128741,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,OXFORD HEALTH INSURANCE-Commercial,1249.25 +128742,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,OXFORD HEALTH INSURANCE-Commercial,77.25 +128743,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,OXFORD HEALTH INSURANCE-Commercial, +128744,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,OXFORD HEALTH INSURANCE-Commercial,16.0 +128745,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,OXFORD HEALTH INSURANCE-Commercial,28.72 +128746,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,OXFORD HEALTH INSURANCE-Commercial,9.67 +128747,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,OXFORD HEALTH INSURANCE-Commercial,61.25 +128748,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,OXFORD HEALTH INSURANCE-Commercial, +128749,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,OXFORD HEALTH INSURANCE-Commercial, +128750,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,OXFORD HEALTH INSURANCE-Commercial,104.0 +128751,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,OXFORD HEALTH INSURANCE-Commercial, +128752,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,OXFORD HEALTH INSURANCE-Commercial, +128753,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,OXFORD HEALTH INSURANCE-Commercial, +128754,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,OXFORD HEALTH INSURANCE-Commercial, +128755,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,OXFORD HEALTH INSURANCE-Commercial, +128756,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,OXFORD HEALTH INSURANCE-Commercial, +128757,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,OXFORD HEALTH INSURANCE-Commercial, +128758,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,OXFORD HEALTH INSURANCE-Commercial, +128759,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,OXFORD HEALTH INSURANCE-Commercial,38.54 +128760,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,OXFORD HEALTH INSURANCE-Commercial,2583.56 +128761,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,OXFORD HEALTH INSURANCE-Commercial,452.0 +128762,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,OXFORD HEALTH INSURANCE-Commercial,25.0 +128763,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,OXFORD HEALTH INSURANCE-Commercial, +128764,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,OXFORD HEALTH INSURANCE-Commercial, +128765,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,OXFORD HEALTH INSURANCE-Commercial, +128766,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,OXFORD HEALTH INSURANCE-Commercial, +128767,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,OXFORD HEALTH INSURANCE-Commercial, +128768,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,OXFORD HEALTH INSURANCE-Commercial,169.05 +128769,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,OXFORD HEALTH INSURANCE-Commercial,204.21 +128770,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,OXFORD HEALTH INSURANCE-Commercial, +128771,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,OXFORD HEALTH INSURANCE-Commercial, +128772,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,OXFORD HEALTH INSURANCE-Commercial, +128773,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,OXFORD HEALTH INSURANCE-Commercial, +128774,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,OXFORD HEALTH INSURANCE-Commercial,200.0 +128775,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,OXFORD HEALTH INSURANCE-Commercial, +128776,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,OXFORD HEALTH INSURANCE-Commercial, +128777,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,OXFORD HEALTH INSURANCE-Commercial, +128778,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,OXFORD HEALTH INSURANCE-Commercial, +128779,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,OXFORD HEALTH INSURANCE-Commercial,36.41 +128780,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,OXFORD HEALTH INSURANCE-Commercial, +128781,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,OXFORD HEALTH INSURANCE-Commercial, +128782,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,OXFORD HEALTH INSURANCE-Commercial,70.93 +128783,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,OXFORD HEALTH INSURANCE-Commercial,228.88 +128784,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,OXFORD HEALTH INSURANCE-Commercial,918.0 +128785,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,OXFORD HEALTH INSURANCE-Commercial,113.4 +128786,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,OXFORD HEALTH INSURANCE-Commercial,3306.75 +128787,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,OXFORD HEALTH INSURANCE-Commercial,8.51 +128788,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,OXFORD HEALTH INSURANCE-Commercial,107.66 +128789,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,OXFORD HEALTH INSURANCE-Commercial,67.74 +128790,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,OXFORD HEALTH INSURANCE-Commercial,178.71 +128791,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,OXFORD HEALTH INSURANCE-Commercial, +128792,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,OXFORD HEALTH INSURANCE-Commercial, +128793,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,OXFORD HEALTH INSURANCE-Commercial, +128794,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,OXFORD HEALTH INSURANCE-Commercial, +128795,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,OXFORD HEALTH INSURANCE-Commercial, +128796,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,OXFORD HEALTH INSURANCE-Commercial, +128797,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,OXFORD HEALTH INSURANCE-Commercial,408.0 +128798,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,OXFORD HEALTH INSURANCE-Commercial,371.25 +128799,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,OXFORD HEALTH INSURANCE-Commercial,180.61 +128800,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,OXFORD HEALTH INSURANCE-Commercial, +128801,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,OXFORD HEALTH INSURANCE-Commercial,365.48 +128802,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,OXFORD HEALTH INSURANCE-Commercial, +128803,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,OXFORD HEALTH INSURANCE-Commercial, +128804,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,OXFORD HEALTH INSURANCE-Commercial, +128805,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,OXFORD HEALTH INSURANCE-Commercial, +128806,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,OXFORD HEALTH INSURANCE-Commercial, +128807,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,OXFORD HEALTH INSURANCE-Commercial, +128808,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,OXFORD HEALTH INSURANCE-Commercial, +128809,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,OXFORD HEALTH INSURANCE-Commercial,1542.75 +128810,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,OXFORD HEALTH INSURANCE-Commercial,7.74 +128811,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,OXFORD HEALTH INSURANCE-Commercial, +128812,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,OXFORD HEALTH INSURANCE-Commercial, +128813,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,OXFORD HEALTH INSURANCE-Commercial, +128814,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,OXFORD HEALTH INSURANCE-Commercial, +128815,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,OXFORD HEALTH INSURANCE-Commercial, +128816,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,OXFORD HEALTH INSURANCE-Commercial,93.0 +128817,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,OXFORD HEALTH INSURANCE-Commercial, +128818,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,OXFORD HEALTH INSURANCE-Commercial, +128819,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,OXFORD HEALTH INSURANCE-Commercial, +128820,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,OXFORD HEALTH INSURANCE-Commercial, +128821,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,OXFORD HEALTH INSURANCE-Commercial, +128822,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,OXFORD HEALTH INSURANCE-Commercial, +128823,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,OXFORD HEALTH INSURANCE-Commercial, +128824,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,OXFORD HEALTH INSURANCE-Commercial, +128825,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,OXFORD HEALTH INSURANCE-Commercial, +128826,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,OXFORD HEALTH INSURANCE-Commercial,157.52 +128827,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,OXFORD HEALTH INSURANCE-Commercial, +128828,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,OXFORD HEALTH INSURANCE-Commercial, +128829,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,OXFORD HEALTH INSURANCE-Commercial, +128830,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,OXFORD HEALTH INSURANCE-Commercial, +128831,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,OXFORD HEALTH INSURANCE-Commercial, +128832,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,OXFORD HEALTH INSURANCE-Commercial, +128833,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,OXFORD HEALTH INSURANCE-Commercial, +128834,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,OXFORD HEALTH INSURANCE-Commercial, +128835,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,OXFORD HEALTH INSURANCE-Commercial, +128836,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,OXFORD HEALTH INSURANCE-Commercial, +128837,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,OXFORD HEALTH INSURANCE-Commercial, +128838,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,OXFORD HEALTH INSURANCE-Commercial, +128839,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,OXFORD HEALTH INSURANCE-Commercial, +128840,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,OXFORD HEALTH INSURANCE-Commercial, +128841,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,OXFORD HEALTH INSURANCE-Commercial, +128842,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,OXFORD HEALTH INSURANCE-Commercial, +128843,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,OXFORD HEALTH INSURANCE-Commercial, +128844,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,OXFORD HEALTH INSURANCE-Commercial, +128845,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,OXFORD HEALTH INSURANCE-Commercial, +128846,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +128847,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +128848,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +128849,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,OXFORD HEALTH INSURANCE-Commercial, +128850,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,OXFORD HEALTH INSURANCE-Commercial, +128851,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,OXFORD HEALTH INSURANCE-Commercial, +128852,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,OXFORD HEALTH INSURANCE-Commercial, +128853,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,OXFORD HEALTH INSURANCE-Commercial, +128854,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,OXFORD HEALTH INSURANCE-Commercial, +128855,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,OXFORD HEALTH INSURANCE-Commercial, +128856,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,OXFORD HEALTH INSURANCE-Commercial, +128857,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,OXFORD HEALTH INSURANCE-Commercial, +128858,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,OXFORD HEALTH INSURANCE-Commercial, +128859,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,OXFORD HEALTH INSURANCE-Commercial,167.61 +128860,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,OXFORD HEALTH INSURANCE-Commercial, +128861,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,OXFORD HEALTH INSURANCE-Commercial, +128862,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,OXFORD HEALTH INSURANCE-Commercial, +128863,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,OXFORD HEALTH INSURANCE-Commercial, +128864,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,OXFORD HEALTH INSURANCE-Commercial, +128865,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,OXFORD HEALTH INSURANCE-Commercial, +128866,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,OXFORD HEALTH INSURANCE-Commercial, +128867,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,OXFORD HEALTH INSURANCE-Commercial, +128868,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,OXFORD HEALTH INSURANCE-Commercial, +128869,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,OXFORD HEALTH INSURANCE-Commercial, +128870,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,OXFORD HEALTH INSURANCE-Commercial, +128871,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,OXFORD HEALTH INSURANCE-Commercial, +128872,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,OXFORD HEALTH INSURANCE-Commercial, +128873,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,OXFORD HEALTH INSURANCE-Commercial, +128874,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,OXFORD HEALTH INSURANCE-Commercial, +128875,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,OXFORD HEALTH INSURANCE-Commercial, +128876,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,OXFORD HEALTH INSURANCE-Commercial, +128877,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,OXFORD HEALTH INSURANCE-Commercial, +128878,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,OXFORD HEALTH INSURANCE-Commercial, +128879,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,OXFORD HEALTH INSURANCE-Commercial, +128880,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,OXFORD HEALTH INSURANCE-Commercial, +128881,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,OXFORD HEALTH INSURANCE-Commercial, +128882,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,OXFORD HEALTH INSURANCE-Commercial,218.1 +128883,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,OXFORD HEALTH INSURANCE-Commercial, +128884,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,OXFORD HEALTH INSURANCE-Commercial, +128885,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,OXFORD HEALTH INSURANCE-Commercial,162.1 +128886,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,OXFORD HEALTH INSURANCE-Commercial,458.76 +128887,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,OXFORD HEALTH INSURANCE-Commercial,611.05 +128888,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,OXFORD HEALTH INSURANCE-Commercial,218.99 +128889,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,OXFORD HEALTH INSURANCE-Commercial, +128890,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,OXFORD HEALTH INSURANCE-Commercial, +128891,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,OXFORD HEALTH INSURANCE-Commercial, +128892,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,OXFORD HEALTH INSURANCE-Commercial, +128893,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,OXFORD HEALTH INSURANCE-Commercial, +128894,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,OXFORD HEALTH INSURANCE-Commercial,330.0 +128895,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,OXFORD HEALTH INSURANCE-Commercial, +128896,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,OXFORD HEALTH INSURANCE-Commercial, +128897,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,OXFORD HEALTH INSURANCE-Commercial, +128898,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,OXFORD HEALTH INSURANCE-Commercial, +128899,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,OXFORD HEALTH INSURANCE-Commercial, +128900,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,OXFORD HEALTH INSURANCE-Commercial,412.5 +128901,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,OXFORD HEALTH INSURANCE-Commercial, +128902,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,OXFORD HEALTH INSURANCE-Commercial, +128903,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,OXFORD HEALTH INSURANCE-Commercial, +128904,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,OXFORD HEALTH INSURANCE-Commercial, +128905,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,OXFORD HEALTH INSURANCE-Commercial, +128906,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,OXFORD HEALTH INSURANCE-Commercial, +128907,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,OXFORD HEALTH INSURANCE-Commercial, +128908,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,OXFORD HEALTH INSURANCE-Commercial, +128909,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,OXFORD HEALTH INSURANCE-Commercial, +128910,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,OXFORD HEALTH INSURANCE-Commercial, +128911,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,OXFORD HEALTH INSURANCE-Commercial,519.0 +128912,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,OXFORD HEALTH INSURANCE-Commercial, +128913,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,OXFORD HEALTH INSURANCE-Commercial,813.76 +128914,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,OXFORD HEALTH INSURANCE-Commercial, +128915,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,OXFORD HEALTH INSURANCE-Commercial, +128916,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,OXFORD HEALTH INSURANCE-Commercial, +128917,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,OXFORD HEALTH INSURANCE-Commercial, +128918,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,OXFORD HEALTH INSURANCE-Commercial, +128919,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,OXFORD HEALTH INSURANCE-Commercial,336.44 +128920,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,OXFORD HEALTH INSURANCE-Commercial,1110.0 +128921,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,OXFORD HEALTH INSURANCE-Commercial, +128922,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,OXFORD HEALTH INSURANCE-Commercial, +128923,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,OXFORD HEALTH INSURANCE-Commercial, +128924,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,OXFORD HEALTH INSURANCE-Commercial, +128925,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,OXFORD HEALTH INSURANCE-Commercial, +128926,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,OXFORD HEALTH INSURANCE-Commercial, +128927,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,OXFORD HEALTH INSURANCE-Commercial, +128928,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,OXFORD HEALTH INSURANCE-Commercial, +128929,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,OXFORD HEALTH INSURANCE-Commercial, +128930,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,OXFORD HEALTH INSURANCE-Commercial, +128931,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,OXFORD HEALTH INSURANCE-Commercial, +128932,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,OXFORD HEALTH INSURANCE-Commercial, +128933,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,OXFORD HEALTH INSURANCE-Commercial, +128934,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,OXFORD HEALTH INSURANCE-Commercial, +128935,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,OXFORD HEALTH INSURANCE-Commercial, +128936,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,OXFORD HEALTH INSURANCE-Commercial, +128937,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,OXFORD HEALTH INSURANCE-Commercial, +128938,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,OXFORD HEALTH INSURANCE-Commercial, +128939,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,OXFORD HEALTH INSURANCE-Commercial, +128940,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,OXFORD HEALTH INSURANCE-Commercial, +128941,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,OXFORD HEALTH INSURANCE-Commercial,657.96 +128942,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,OXFORD HEALTH INSURANCE-Commercial, +128943,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,OXFORD HEALTH INSURANCE-Commercial, +128944,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,OXFORD HEALTH INSURANCE-Commercial, +128945,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +128946,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,OXFORD HEALTH INSURANCE-Commercial,319.38 +128947,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,OXFORD HEALTH INSURANCE-Commercial,529.0 +128948,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,OXFORD HEALTH INSURANCE-Commercial, +128949,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,OXFORD HEALTH INSURANCE-Commercial, +128950,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,OXFORD HEALTH INSURANCE-Commercial, +128951,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,OXFORD HEALTH INSURANCE-Commercial, +128952,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,OXFORD HEALTH INSURANCE-Commercial, +128953,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,OXFORD HEALTH INSURANCE-Commercial, +128954,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,OXFORD HEALTH INSURANCE-Commercial, +128955,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,OXFORD HEALTH INSURANCE-Commercial, +128956,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,OXFORD HEALTH INSURANCE-Commercial,2989.0 +128957,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,OXFORD HEALTH INSURANCE-Commercial, +128958,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,OXFORD HEALTH INSURANCE-Commercial,2989.0 +128959,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,OXFORD HEALTH INSURANCE-Commercial, +128960,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,OXFORD HEALTH INSURANCE-Commercial,565.44 +128961,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,OXFORD HEALTH INSURANCE-Commercial, +128962,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,OXFORD HEALTH INSURANCE-Commercial,842.0 +128963,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,OXFORD HEALTH INSURANCE-Commercial, +128964,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,OXFORD HEALTH INSURANCE-Commercial, +128965,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,OXFORD HEALTH INSURANCE-Commercial,583.43 +128966,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,OXFORD HEALTH INSURANCE-Commercial, +128967,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,OXFORD HEALTH INSURANCE-Commercial, +128968,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,OXFORD HEALTH INSURANCE-Commercial, +128969,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,OXFORD HEALTH INSURANCE-Commercial, +128970,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,OXFORD HEALTH INSURANCE-Commercial, +128971,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,OXFORD HEALTH INSURANCE-Commercial,3452.71 +128972,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,OXFORD HEALTH INSURANCE-Commercial, +128973,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,OXFORD HEALTH INSURANCE-Commercial, +128974,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,OXFORD HEALTH INSURANCE-Commercial, +128975,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,OXFORD HEALTH INSURANCE-Commercial,7148.91 +128976,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,OXFORD HEALTH INSURANCE-Commercial,3374.97 +128977,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,OXFORD HEALTH INSURANCE-Commercial,3452.71 +128978,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,OXFORD HEALTH INSURANCE-Commercial,3452.71 +128979,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,OXFORD HEALTH INSURANCE-Commercial, +128980,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,OXFORD HEALTH INSURANCE-Commercial, +128981,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,OXFORD HEALTH INSURANCE-Commercial, +128982,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,OXFORD HEALTH INSURANCE-Commercial, +128983,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,OXFORD HEALTH INSURANCE-Commercial, +128984,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,OXFORD HEALTH INSURANCE-Commercial, +128985,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,OXFORD HEALTH INSURANCE-Commercial, +128986,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,OXFORD HEALTH INSURANCE-Commercial, +128987,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,OXFORD HEALTH INSURANCE-Commercial, +128988,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,OXFORD HEALTH INSURANCE-Commercial, +128989,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,OXFORD HEALTH INSURANCE-Commercial, +128990,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,OXFORD HEALTH INSURANCE-Commercial, +128991,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,OXFORD HEALTH INSURANCE-Commercial, +128992,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,OXFORD HEALTH INSURANCE-Commercial, +128993,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,OXFORD HEALTH INSURANCE-Commercial, +128994,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,OXFORD HEALTH INSURANCE-Commercial, +128995,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,OXFORD HEALTH INSURANCE-Commercial, +128996,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,OXFORD HEALTH INSURANCE-Commercial, +128997,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,OXFORD HEALTH INSURANCE-Commercial, +128998,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,OXFORD HEALTH INSURANCE-Commercial, +128999,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,OXFORD HEALTH INSURANCE-Commercial, +129000,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,OXFORD HEALTH INSURANCE-Commercial, +129001,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,OXFORD HEALTH INSURANCE-Commercial,123.49 +129002,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,OXFORD HEALTH INSURANCE-Commercial,77.24 +129003,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,OXFORD HEALTH INSURANCE-Commercial, +129004,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,OXFORD HEALTH INSURANCE-Commercial,282.33 +129005,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,OXFORD HEALTH INSURANCE-Commercial, +129006,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,OXFORD HEALTH INSURANCE-Commercial, +129007,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,OXFORD HEALTH INSURANCE-Commercial, +129008,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,OXFORD HEALTH INSURANCE-Commercial, +129009,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,OXFORD HEALTH INSURANCE-Commercial, +129010,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,OXFORD HEALTH INSURANCE-Commercial, +129011,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,OXFORD HEALTH INSURANCE-Commercial, +129012,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,OXFORD HEALTH INSURANCE-Commercial, +129013,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,OXFORD HEALTH INSURANCE-Commercial,282.33 +129014,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,OXFORD HEALTH INSURANCE-Commercial,135.78 +129015,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,OXFORD HEALTH INSURANCE-Commercial,282.33 +129016,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,OXFORD HEALTH INSURANCE-Commercial, +129017,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,OXFORD HEALTH INSURANCE-Commercial, +129018,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,OXFORD HEALTH INSURANCE-Commercial, +129019,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,OXFORD HEALTH INSURANCE-Commercial, +129020,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,OXFORD HEALTH INSURANCE-Commercial, +129021,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,OXFORD HEALTH INSURANCE-Commercial, +129022,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,OXFORD HEALTH INSURANCE-Commercial, +129023,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,OXFORD HEALTH INSURANCE-Commercial, +129024,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,OXFORD HEALTH INSURANCE-Commercial, +129025,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,OXFORD HEALTH INSURANCE-Commercial, +129026,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,OXFORD HEALTH INSURANCE-Commercial, +129027,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,OXFORD HEALTH INSURANCE-Commercial, +129028,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,OXFORD HEALTH INSURANCE-Commercial, +129029,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,OXFORD HEALTH INSURANCE-Commercial, +129030,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,OXFORD HEALTH INSURANCE-Commercial, +129031,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,OXFORD HEALTH INSURANCE-Commercial, +129032,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,OXFORD HEALTH INSURANCE-Commercial, +129033,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,OXFORD HEALTH INSURANCE-Commercial, +129034,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,OXFORD HEALTH INSURANCE-Commercial, +129035,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,OXFORD HEALTH INSURANCE-Commercial, +129036,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,OXFORD HEALTH INSURANCE-Commercial, +129037,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,OXFORD HEALTH INSURANCE-Commercial, +129038,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,OXFORD HEALTH INSURANCE-Commercial, +129039,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,OXFORD HEALTH INSURANCE-Commercial, +129040,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,OXFORD HEALTH INSURANCE-Commercial, +129041,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,OXFORD HEALTH INSURANCE-Commercial, +129042,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,OXFORD HEALTH INSURANCE-Commercial, +129043,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,OXFORD HEALTH INSURANCE-Commercial, +129044,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,OXFORD HEALTH INSURANCE-Commercial, +129045,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,OXFORD HEALTH INSURANCE-Commercial, +129046,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,OXFORD HEALTH INSURANCE-Commercial, +129047,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,OXFORD HEALTH INSURANCE-Commercial, +129048,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,OXFORD HEALTH INSURANCE-Commercial, +129049,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,OXFORD HEALTH INSURANCE-Commercial, +129050,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,OXFORD HEALTH INSURANCE-Commercial, +129051,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,OXFORD HEALTH INSURANCE-Commercial, +129052,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,OXFORD HEALTH INSURANCE-Commercial,306.63 +129053,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,OXFORD HEALTH INSURANCE-Commercial, +129054,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,OXFORD HEALTH INSURANCE-Commercial, +129055,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,OXFORD HEALTH INSURANCE-Commercial,26.0 +129056,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,OXFORD HEALTH INSURANCE-Commercial,26.0 +129057,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,OXFORD HEALTH INSURANCE-Commercial, +129058,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,OXFORD HEALTH INSURANCE-Commercial, +129059,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,OXFORD HEALTH INSURANCE-Commercial, +129060,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,OXFORD HEALTH INSURANCE-Commercial, +129061,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,OXFORD HEALTH INSURANCE-Commercial, +129062,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,OXFORD HEALTH INSURANCE-Commercial, +129063,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,OXFORD HEALTH INSURANCE-Commercial, +129064,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,OXFORD HEALTH INSURANCE-Commercial, +129065,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,OXFORD HEALTH INSURANCE-Commercial, +129066,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,OXFORD HEALTH INSURANCE-Commercial, +129067,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,OXFORD HEALTH INSURANCE-Commercial, +129068,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,OXFORD HEALTH INSURANCE-Commercial, +129069,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,OXFORD HEALTH INSURANCE-Commercial, +129070,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,OXFORD HEALTH INSURANCE-Commercial, +129071,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,OXFORD HEALTH INSURANCE-Commercial, +129072,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,OXFORD HEALTH INSURANCE-Commercial, +129073,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,OXFORD HEALTH INSURANCE-Commercial, +129074,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,OXFORD HEALTH INSURANCE-Commercial,669.0 +129075,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,OXFORD HEALTH INSURANCE-Commercial,501.75 +129076,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,OXFORD HEALTH INSURANCE-Commercial, +129077,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,OXFORD HEALTH INSURANCE-Commercial, +129078,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,OXFORD HEALTH INSURANCE-Commercial, +129079,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,OXFORD HEALTH INSURANCE-Commercial, +129080,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,OXFORD HEALTH INSURANCE-Commercial, +129081,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,OXFORD HEALTH INSURANCE-Commercial, +129082,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,OXFORD HEALTH INSURANCE-Commercial, +129083,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,OXFORD HEALTH INSURANCE-Commercial, +129084,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,OXFORD HEALTH INSURANCE-Commercial, +129085,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,OXFORD HEALTH INSURANCE-Commercial, +129086,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,OXFORD HEALTH INSURANCE-Commercial,1492.71 +129087,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,OXFORD HEALTH INSURANCE-Commercial,664.0 +129088,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,OXFORD HEALTH INSURANCE-Commercial, +129089,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,OXFORD HEALTH INSURANCE-Commercial, +129090,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,OXFORD HEALTH INSURANCE-Commercial, +129091,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,OXFORD HEALTH INSURANCE-Commercial,519.44 +129092,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,OXFORD HEALTH INSURANCE-Commercial,1861.17 +129093,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,OXFORD HEALTH INSURANCE-Commercial,2412.0 +129094,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,OXFORD HEALTH INSURANCE-Commercial,1498.58 +129095,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,OXFORD HEALTH INSURANCE-Commercial, +129096,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,OXFORD HEALTH INSURANCE-Commercial, +129097,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,OXFORD HEALTH INSURANCE-Commercial,73.36 +129098,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,OXFORD HEALTH INSURANCE-Commercial,1784.0 +129099,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,OXFORD HEALTH INSURANCE-Commercial, +129100,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,OXFORD HEALTH INSURANCE-Commercial,1525.35 +129101,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,OXFORD HEALTH INSURANCE-Commercial,1777.0 +129102,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,OXFORD HEALTH INSURANCE-Commercial, +129103,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,OXFORD HEALTH INSURANCE-Commercial,418.06 +129104,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,OXFORD HEALTH INSURANCE-Commercial, +129105,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,OXFORD HEALTH INSURANCE-Commercial, +129106,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,OXFORD HEALTH INSURANCE-Commercial, +129107,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,OXFORD HEALTH INSURANCE-Commercial, +129108,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,OXFORD HEALTH INSURANCE-Commercial,1200.0 +129109,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,OXFORD HEALTH INSURANCE-Commercial,17.0 +129110,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,OXFORD HEALTH INSURANCE-Commercial, +129111,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,OXFORD HEALTH INSURANCE-Commercial,17.0 +129112,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,OXFORD HEALTH INSURANCE-Commercial,17.0 +129113,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,OXFORD HEALTH INSURANCE-Commercial, +129114,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,OXFORD HEALTH INSURANCE-Commercial,19.63 +129115,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,OXFORD HEALTH INSURANCE-Commercial,54.24 +129116,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,OXFORD HEALTH INSURANCE-Commercial,39.44 +129117,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,OXFORD HEALTH INSURANCE-Commercial, +129118,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,OXFORD HEALTH INSURANCE-Commercial,17.0 +129119,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,OXFORD HEALTH INSURANCE-Commercial,17.45 +129120,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,OXFORD HEALTH INSURANCE-Commercial,60.5 +129121,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,OXFORD HEALTH INSURANCE-Commercial, +129122,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,OXFORD HEALTH INSURANCE-Commercial,84.53 +129123,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,OXFORD HEALTH INSURANCE-Commercial, +129124,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,OXFORD HEALTH INSURANCE-Commercial,98.83 +129125,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,OXFORD HEALTH INSURANCE-Commercial,109.49 +129126,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,OXFORD HEALTH INSURANCE-Commercial, +129127,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,OXFORD HEALTH INSURANCE-Commercial, +129128,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,OXFORD HEALTH INSURANCE-Commercial,88.0 +129129,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,OXFORD HEALTH INSURANCE-Commercial,316.5 +129130,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,OXFORD HEALTH INSURANCE-Commercial, +129131,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,OXFORD HEALTH INSURANCE-Commercial, +129132,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,OXFORD HEALTH INSURANCE-Commercial,95.57 +129133,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,OXFORD HEALTH INSURANCE-Commercial,32.91 +129134,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,OXFORD HEALTH INSURANCE-Commercial, +129135,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,OXFORD HEALTH INSURANCE-Commercial,41.01 +129136,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,OXFORD HEALTH INSURANCE-Commercial,684.0 +129137,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,OXFORD HEALTH INSURANCE-Commercial,271.89 +129138,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,OXFORD HEALTH INSURANCE-Commercial,163.18 +129139,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,OXFORD HEALTH INSURANCE-Commercial, +129140,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,OXFORD HEALTH INSURANCE-Commercial, +129141,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,OXFORD HEALTH INSURANCE-Commercial, +129142,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,OXFORD HEALTH INSURANCE-Commercial, +129143,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,OXFORD HEALTH INSURANCE-Commercial, +129144,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,OXFORD HEALTH INSURANCE-Commercial, +129145,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,OXFORD HEALTH INSURANCE-Commercial, +129146,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,OXFORD HEALTH INSURANCE-Commercial, +129147,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,OXFORD HEALTH INSURANCE-Commercial, +129148,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,OXFORD HEALTH INSURANCE-Commercial, +129149,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,OXFORD HEALTH INSURANCE-Commercial, +129150,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,OXFORD HEALTH INSURANCE-Commercial, +129151,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,OXFORD HEALTH INSURANCE-Commercial, +129152,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,OXFORD HEALTH INSURANCE-Commercial, +129153,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,OXFORD HEALTH INSURANCE-Commercial, +129154,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,OXFORD HEALTH INSURANCE-Commercial, +129155,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,OXFORD HEALTH INSURANCE-Commercial, +129156,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,OXFORD HEALTH INSURANCE-Commercial, +129157,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,OXFORD HEALTH INSURANCE-Commercial, +129158,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,OXFORD HEALTH INSURANCE-Commercial, +129159,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,OXFORD HEALTH INSURANCE-Commercial, +129160,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,OXFORD HEALTH INSURANCE-Commercial, +129161,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,OXFORD HEALTH INSURANCE-Commercial, +129162,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,OXFORD HEALTH INSURANCE-Commercial,253.5 +129163,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,OXFORD HEALTH INSURANCE-Commercial, +129164,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,OXFORD HEALTH INSURANCE-Commercial,84.34 +129165,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,OXFORD HEALTH INSURANCE-Commercial,1669.0 +129166,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,OXFORD HEALTH INSURANCE-Commercial,1939.0 +129167,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,OXFORD HEALTH INSURANCE-Commercial,9586.16 +129168,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,OXFORD HEALTH INSURANCE-Commercial,3383.0 +129169,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,OXFORD HEALTH INSURANCE-Commercial, +129170,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,OXFORD HEALTH INSURANCE-Commercial, +129171,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,OXFORD HEALTH INSURANCE-Commercial, +129172,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,OXFORD HEALTH INSURANCE-Commercial, +129173,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,OXFORD HEALTH INSURANCE-Commercial, +129174,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,OXFORD HEALTH INSURANCE-Commercial, +129175,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,OXFORD HEALTH INSURANCE-Commercial, +129176,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,OXFORD HEALTH INSURANCE-Commercial, +129177,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,OXFORD HEALTH INSURANCE-Commercial, +129178,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,OXFORD HEALTH INSURANCE-Commercial, +129179,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,OXFORD HEALTH INSURANCE-Commercial, +129180,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,OXFORD HEALTH INSURANCE-Commercial, +129181,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,OXFORD HEALTH INSURANCE-Commercial, +129182,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,OXFORD HEALTH INSURANCE-Commercial, +129183,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,OXFORD HEALTH INSURANCE-Commercial, +129184,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,OXFORD HEALTH INSURANCE-Commercial, +129185,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,OXFORD HEALTH INSURANCE-Commercial, +129186,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,OXFORD HEALTH INSURANCE-Commercial, +129187,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,OXFORD HEALTH INSURANCE-Commercial, +129188,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,OXFORD HEALTH INSURANCE-Commercial, +129189,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,OXFORD HEALTH INSURANCE-Commercial,154.0 +129190,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,OXFORD HEALTH INSURANCE-Commercial, +129191,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,OXFORD HEALTH INSURANCE-Commercial, +129192,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,OXFORD HEALTH INSURANCE-Commercial, +129193,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,OXFORD HEALTH INSURANCE-Commercial, +129194,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,OXFORD HEALTH INSURANCE-Commercial, +129195,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,OXFORD HEALTH INSURANCE-Commercial, +129196,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,OXFORD HEALTH INSURANCE-Commercial, +129197,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,OXFORD HEALTH INSURANCE-Commercial, +129198,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,OXFORD HEALTH INSURANCE-Commercial, +129199,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,OXFORD HEALTH INSURANCE-Commercial, +129200,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,OXFORD HEALTH INSURANCE-Commercial, +129201,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,OXFORD HEALTH INSURANCE-Commercial, +129202,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,OXFORD HEALTH INSURANCE-Commercial, +129203,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,OXFORD HEALTH INSURANCE-Commercial, +129204,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,OXFORD HEALTH INSURANCE-Commercial, +129205,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,OXFORD HEALTH INSURANCE-Commercial, +129206,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,OXFORD HEALTH INSURANCE-Commercial, +129207,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,OXFORD HEALTH INSURANCE-Commercial, +129208,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,OXFORD HEALTH INSURANCE-Commercial, +129209,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,OXFORD HEALTH INSURANCE-Commercial, +129210,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,OXFORD HEALTH INSURANCE-Commercial, +129211,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,OXFORD HEALTH INSURANCE-Commercial, +129212,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,OXFORD HEALTH INSURANCE-Commercial, +129213,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,OXFORD HEALTH INSURANCE-Commercial, +129214,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,OXFORD HEALTH INSURANCE-Commercial, +129215,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,OXFORD HEALTH INSURANCE-Commercial, +129216,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,OXFORD HEALTH INSURANCE-Commercial, +129217,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,OXFORD HEALTH INSURANCE-Commercial, +129218,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,OXFORD HEALTH INSURANCE-Commercial, +129219,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,OXFORD HEALTH INSURANCE-Commercial, +129220,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,OXFORD HEALTH INSURANCE-Commercial, +129221,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,OXFORD HEALTH INSURANCE-Commercial, +129222,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,OXFORD HEALTH INSURANCE-Commercial, +129223,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,OXFORD HEALTH INSURANCE-Commercial, +129224,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,OXFORD HEALTH INSURANCE-Commercial, +129225,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,OXFORD HEALTH INSURANCE-Commercial, +129226,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,OXFORD HEALTH INSURANCE-Commercial, +129227,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,OXFORD HEALTH INSURANCE-Commercial, +129228,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,OXFORD HEALTH INSURANCE-Commercial, +129229,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,OXFORD HEALTH INSURANCE-Commercial, +129230,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,OXFORD HEALTH INSURANCE-Commercial, +129231,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,OXFORD HEALTH INSURANCE-Commercial, +129232,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,OXFORD HEALTH INSURANCE-Commercial, +129233,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,OXFORD HEALTH INSURANCE-Commercial, +129234,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,OXFORD HEALTH INSURANCE-Commercial, +129235,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,OXFORD HEALTH INSURANCE-Commercial, +129236,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,OXFORD HEALTH INSURANCE-Commercial, +129237,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,OXFORD HEALTH INSURANCE-Commercial, +129238,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,OXFORD HEALTH INSURANCE-Commercial, +129239,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,OXFORD HEALTH INSURANCE-Commercial, +129240,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,OXFORD HEALTH INSURANCE-Commercial, +129241,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,OXFORD HEALTH INSURANCE-Commercial, +129242,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,OXFORD HEALTH INSURANCE-Commercial, +129243,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,OXFORD HEALTH INSURANCE-Commercial, +129244,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,OXFORD HEALTH INSURANCE-Commercial, +129245,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,OXFORD HEALTH INSURANCE-Commercial, +129246,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,OXFORD HEALTH INSURANCE-Commercial, +129247,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,OXFORD HEALTH INSURANCE-Commercial, +129248,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,OXFORD HEALTH INSURANCE-Commercial, +129249,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,OXFORD HEALTH INSURANCE-Commercial, +129250,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,OXFORD HEALTH INSURANCE-Commercial, +129251,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,OXFORD HEALTH INSURANCE-Commercial, +129252,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,OXFORD HEALTH INSURANCE-Commercial, +129253,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,OXFORD HEALTH INSURANCE-Commercial, +129254,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,OXFORD HEALTH INSURANCE-Commercial, +129255,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,OXFORD HEALTH INSURANCE-Commercial, +129256,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,OXFORD HEALTH INSURANCE-Commercial, +129257,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,OXFORD HEALTH INSURANCE-Commercial, +129258,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,OXFORD HEALTH INSURANCE-Commercial, +129259,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,OXFORD HEALTH INSURANCE-Commercial, +129260,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,OXFORD HEALTH INSURANCE-Commercial, +129261,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,OXFORD HEALTH INSURANCE-Commercial, +129262,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,OXFORD HEALTH INSURANCE-Commercial, +129263,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,OXFORD HEALTH INSURANCE-Commercial, +129264,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,OXFORD HEALTH INSURANCE-Commercial, +129265,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,OXFORD HEALTH INSURANCE-Commercial, +129266,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,OXFORD HEALTH INSURANCE-Commercial, +129267,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,OXFORD HEALTH INSURANCE-Commercial, +129268,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,OXFORD HEALTH INSURANCE-Commercial, +129269,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,OXFORD HEALTH INSURANCE-Commercial, +129270,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,OXFORD HEALTH INSURANCE-Commercial, +129271,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,OXFORD HEALTH INSURANCE-Commercial, +129272,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,OXFORD HEALTH INSURANCE-Commercial, +129273,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,OXFORD HEALTH INSURANCE-Commercial, +129274,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,OXFORD HEALTH INSURANCE-Commercial, +129275,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,OXFORD HEALTH INSURANCE-Commercial, +129276,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,OXFORD HEALTH INSURANCE-Commercial, +129277,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,OXFORD HEALTH INSURANCE-Commercial, +129278,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,OXFORD HEALTH INSURANCE-Commercial, +129279,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,OXFORD HEALTH INSURANCE-Commercial, +129280,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,OXFORD HEALTH INSURANCE-Commercial, +129281,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,OXFORD HEALTH INSURANCE-Commercial, +129282,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,OXFORD HEALTH INSURANCE-Commercial, +129283,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,OXFORD HEALTH INSURANCE-Commercial, +129284,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,OXFORD HEALTH INSURANCE-Commercial, +129285,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,OXFORD HEALTH INSURANCE-Commercial, +129286,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,OXFORD HEALTH INSURANCE-Commercial, +129287,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,OXFORD HEALTH INSURANCE-Commercial, +129288,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,OXFORD HEALTH INSURANCE-Commercial, +129289,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,OXFORD HEALTH INSURANCE-Commercial, +129290,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,OXFORD HEALTH INSURANCE-Commercial, +129291,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,OXFORD HEALTH INSURANCE-Commercial, +129292,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,OXFORD HEALTH INSURANCE-Commercial, +129293,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,OXFORD HEALTH INSURANCE-Commercial, +129294,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,OXFORD HEALTH INSURANCE-Commercial, +129295,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,OXFORD HEALTH INSURANCE-Commercial, +129296,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,OXFORD HEALTH INSURANCE-Commercial, +129297,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,OXFORD HEALTH INSURANCE-Commercial, +129298,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,OXFORD HEALTH INSURANCE-Commercial, +129299,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,OXFORD HEALTH INSURANCE-Commercial, +129300,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,OXFORD HEALTH INSURANCE-Commercial, +129301,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,OXFORD HEALTH INSURANCE-Commercial, +129302,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,OXFORD HEALTH INSURANCE-Commercial, +129303,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,OXFORD HEALTH INSURANCE-Commercial, +129304,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,OXFORD HEALTH INSURANCE-Commercial, +129305,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,OXFORD HEALTH INSURANCE-Commercial, +129306,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,OXFORD HEALTH INSURANCE-Commercial, +129307,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,OXFORD HEALTH INSURANCE-Commercial, +129308,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,OXFORD HEALTH INSURANCE-Commercial, +129309,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,OXFORD HEALTH INSURANCE-Commercial, +129310,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,OXFORD HEALTH INSURANCE-Commercial, +129311,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,OXFORD HEALTH INSURANCE-Commercial, +129312,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,OXFORD HEALTH INSURANCE-Commercial, +129313,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,OXFORD HEALTH INSURANCE-Commercial, +129314,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,OXFORD HEALTH INSURANCE-Commercial, +129315,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,OXFORD HEALTH INSURANCE-Commercial, +129316,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,OXFORD HEALTH INSURANCE-Commercial, +129317,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,OXFORD HEALTH INSURANCE-Commercial, +129318,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,OXFORD HEALTH INSURANCE-Commercial, +129319,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,OXFORD HEALTH INSURANCE-Commercial, +129320,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,OXFORD HEALTH INSURANCE-Commercial, +129321,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,OXFORD HEALTH INSURANCE-Commercial, +129322,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,OXFORD HEALTH INSURANCE-Commercial, +129323,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,OXFORD HEALTH INSURANCE-Commercial, +129324,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,OXFORD HEALTH INSURANCE-Commercial, +129325,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,OXFORD HEALTH INSURANCE-Commercial, +129326,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,OXFORD HEALTH INSURANCE-Commercial, +129327,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,OXFORD HEALTH INSURANCE-Commercial, +129328,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,OXFORD HEALTH INSURANCE-Commercial, +129329,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,OXFORD HEALTH INSURANCE-Commercial, +129330,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,OXFORD HEALTH INSURANCE-Commercial, +129331,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,OXFORD HEALTH INSURANCE-Commercial, +129332,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,OXFORD HEALTH INSURANCE-Commercial, +129333,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,OXFORD HEALTH INSURANCE-Commercial, +129334,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,OXFORD HEALTH INSURANCE-Commercial, +129335,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,OXFORD HEALTH INSURANCE-Commercial, +129336,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,OXFORD HEALTH INSURANCE-Commercial, +129337,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,OXFORD HEALTH INSURANCE-Commercial, +129338,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,OXFORD HEALTH INSURANCE-Commercial, +129339,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,OXFORD HEALTH INSURANCE-Commercial, +129340,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,OXFORD HEALTH INSURANCE-Commercial, +129341,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,OXFORD HEALTH INSURANCE-Commercial, +129342,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,OXFORD HEALTH INSURANCE-Commercial, +129343,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,OXFORD HEALTH INSURANCE-Commercial, +129344,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,OXFORD HEALTH INSURANCE-Commercial, +129345,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,OXFORD HEALTH INSURANCE-Commercial, +129346,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,OXFORD HEALTH INSURANCE-Commercial, +129347,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,OXFORD HEALTH INSURANCE-Commercial, +129348,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,OXFORD HEALTH INSURANCE-Commercial, +129349,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,OXFORD HEALTH INSURANCE-Commercial, +129350,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,OXFORD HEALTH INSURANCE-Commercial, +129351,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,OXFORD HEALTH INSURANCE-Commercial, +129352,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,OXFORD HEALTH INSURANCE-Commercial, +129353,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,OXFORD HEALTH INSURANCE-Commercial, +129354,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,OXFORD HEALTH INSURANCE-Commercial, +129355,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,OXFORD HEALTH INSURANCE-Commercial, +129356,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,OXFORD HEALTH INSURANCE-Commercial, +129357,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,OXFORD HEALTH INSURANCE-Commercial, +129358,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,OXFORD HEALTH INSURANCE-Commercial, +129359,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,OXFORD HEALTH INSURANCE-Commercial, +129360,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,OXFORD HEALTH INSURANCE-Commercial, +129361,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,OXFORD HEALTH INSURANCE-Commercial, +129362,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,OXFORD HEALTH INSURANCE-Commercial, +129363,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,OXFORD HEALTH INSURANCE-Commercial, +129364,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,OXFORD HEALTH INSURANCE-Commercial, +129365,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,OXFORD HEALTH INSURANCE-Commercial, +129366,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,OXFORD HEALTH INSURANCE-Commercial, +129367,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,OXFORD HEALTH INSURANCE-Commercial, +129368,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,OXFORD HEALTH INSURANCE-Commercial, +129369,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,OXFORD HEALTH INSURANCE-Commercial, +129370,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,OXFORD HEALTH INSURANCE-Commercial, +129371,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,OXFORD HEALTH INSURANCE-Commercial, +129372,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,OXFORD HEALTH INSURANCE-Commercial, +129373,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,OXFORD HEALTH INSURANCE-Commercial, +129374,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,OXFORD HEALTH INSURANCE-Commercial, +129375,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,OXFORD HEALTH INSURANCE-Commercial, +129376,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,OXFORD HEALTH INSURANCE-Commercial, +129377,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,OXFORD HEALTH INSURANCE-Commercial, +129378,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,OXFORD HEALTH INSURANCE-Commercial, +129379,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,OXFORD HEALTH INSURANCE-Commercial, +129380,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,OXFORD HEALTH INSURANCE-Commercial, +129381,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,OXFORD HEALTH INSURANCE-Commercial, +129382,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,OXFORD HEALTH INSURANCE-Commercial, +129383,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,OXFORD HEALTH INSURANCE-Commercial, +129384,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,OXFORD HEALTH INSURANCE-Commercial, +129385,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,OXFORD HEALTH INSURANCE-Commercial, +129386,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,OXFORD HEALTH INSURANCE-Commercial, +129387,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,OXFORD HEALTH INSURANCE-Commercial, +129388,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,OXFORD HEALTH INSURANCE-Commercial, +129389,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,OXFORD HEALTH INSURANCE-Commercial, +129390,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,OXFORD HEALTH INSURANCE-Commercial, +129391,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,OXFORD HEALTH INSURANCE-Commercial, +129392,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,OXFORD HEALTH INSURANCE-Commercial, +129393,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,OXFORD HEALTH INSURANCE-Commercial, +129394,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,OXFORD HEALTH INSURANCE-Commercial, +129395,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,OXFORD HEALTH INSURANCE-Commercial, +129396,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,OXFORD HEALTH INSURANCE-Commercial, +129397,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,OXFORD HEALTH INSURANCE-Commercial, +129398,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,OXFORD HEALTH INSURANCE-Commercial, +129399,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,OXFORD HEALTH INSURANCE-Commercial, +129400,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,OXFORD HEALTH INSURANCE-Commercial, +129401,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,OXFORD HEALTH INSURANCE-Commercial, +129402,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,OXFORD HEALTH INSURANCE-Commercial, +129403,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,OXFORD HEALTH INSURANCE-Commercial, +129404,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,OXFORD HEALTH INSURANCE-Commercial, +129405,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,OXFORD HEALTH INSURANCE-Commercial, +129406,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,OXFORD HEALTH INSURANCE-Commercial, +129407,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,OXFORD HEALTH INSURANCE-Commercial, +129408,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,OXFORD HEALTH INSURANCE-Commercial, +129409,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,OXFORD HEALTH INSURANCE-Commercial, +129410,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,OXFORD HEALTH INSURANCE-Commercial, +129411,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,OXFORD HEALTH INSURANCE-Commercial, +129412,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,OXFORD HEALTH INSURANCE-Commercial, +129413,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,OXFORD HEALTH INSURANCE-Commercial, +129414,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,OXFORD HEALTH INSURANCE-Commercial, +129415,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,OXFORD HEALTH INSURANCE-Commercial, +129416,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,OXFORD HEALTH INSURANCE-Commercial, +129417,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,OXFORD HEALTH INSURANCE-Commercial, +129418,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,OXFORD HEALTH INSURANCE-Commercial, +129419,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,OXFORD HEALTH INSURANCE-Commercial, +129420,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,OXFORD HEALTH INSURANCE-Commercial, +129421,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,OXFORD HEALTH INSURANCE-Commercial, +129422,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,OXFORD HEALTH INSURANCE-Commercial, +129423,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,OXFORD HEALTH INSURANCE-Commercial, +129424,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,OXFORD HEALTH INSURANCE-Commercial, +129425,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,OXFORD HEALTH INSURANCE-Commercial, +129426,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,OXFORD HEALTH INSURANCE-Commercial, +129427,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,OXFORD HEALTH INSURANCE-Commercial, +129428,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,OXFORD HEALTH INSURANCE-Commercial, +129429,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,OXFORD HEALTH INSURANCE-Commercial, +129430,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,OXFORD HEALTH INSURANCE-Commercial, +129431,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,OXFORD HEALTH INSURANCE-Commercial, +129432,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,OXFORD HEALTH INSURANCE-Commercial, +129433,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,OXFORD HEALTH INSURANCE-Commercial, +129434,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,OXFORD HEALTH INSURANCE-Commercial, +129435,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,OXFORD HEALTH INSURANCE-Commercial, +129436,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,OXFORD HEALTH INSURANCE-Commercial, +129437,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,OXFORD HEALTH INSURANCE-Commercial, +129438,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,OXFORD HEALTH INSURANCE-Commercial, +129439,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,OXFORD HEALTH INSURANCE-Commercial, +129440,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,OXFORD HEALTH INSURANCE-Commercial, +129441,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,OXFORD HEALTH INSURANCE-Commercial, +129442,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,OXFORD HEALTH INSURANCE-Commercial, +129443,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,OXFORD HEALTH INSURANCE-Commercial, +129444,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,OXFORD HEALTH INSURANCE-Commercial, +129445,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,OXFORD HEALTH INSURANCE-Commercial, +129446,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,OXFORD HEALTH INSURANCE-Commercial, +129447,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,OXFORD HEALTH INSURANCE-Commercial, +129448,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,OXFORD HEALTH INSURANCE-Commercial, +129449,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,OXFORD HEALTH INSURANCE-Commercial, +129450,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,OXFORD HEALTH INSURANCE-Commercial, +129451,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,OXFORD HEALTH INSURANCE-Commercial, +129452,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,OXFORD HEALTH INSURANCE-Commercial, +129453,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,OXFORD HEALTH INSURANCE-Commercial, +129454,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,OXFORD HEALTH INSURANCE-Commercial, +129455,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,OXFORD HEALTH INSURANCE-Commercial, +129456,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,OXFORD HEALTH INSURANCE-Commercial, +129457,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,OXFORD HEALTH INSURANCE-Commercial, +129458,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,OXFORD HEALTH INSURANCE-Commercial, +129459,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,OXFORD HEALTH INSURANCE-Commercial, +129460,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,OXFORD HEALTH INSURANCE-Commercial, +129461,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,OXFORD HEALTH INSURANCE-Commercial, +129462,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,OXFORD HEALTH INSURANCE-Commercial, +129463,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,OXFORD HEALTH INSURANCE-Commercial, +129464,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,OXFORD HEALTH INSURANCE-Commercial, +129465,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,OXFORD HEALTH INSURANCE-Commercial, +129466,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,OXFORD HEALTH INSURANCE-Commercial, +129467,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,OXFORD HEALTH INSURANCE-Commercial, +129468,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,OXFORD HEALTH INSURANCE-Commercial, +129469,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,OXFORD HEALTH INSURANCE-Commercial, +129470,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,OXFORD HEALTH INSURANCE-Commercial, +129471,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,OXFORD HEALTH INSURANCE-Commercial, +129472,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,OXFORD HEALTH INSURANCE-Commercial, +129473,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,OXFORD HEALTH INSURANCE-Commercial, +129474,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,OXFORD HEALTH INSURANCE-Commercial,760.5 +129475,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,OXFORD HEALTH INSURANCE-Commercial,782.83 +129476,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,OXFORD HEALTH INSURANCE-Commercial, +129477,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,OXFORD HEALTH INSURANCE-Commercial, +129478,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,OXFORD HEALTH INSURANCE-Commercial,459.26 +129479,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,OXFORD HEALTH INSURANCE-Commercial, +129480,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,OXFORD HEALTH INSURANCE-Commercial,2763.0 +129481,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,OXFORD HEALTH INSURANCE-Commercial, +129482,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,OXFORD HEALTH INSURANCE-Commercial, +129483,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,OXFORD HEALTH INSURANCE-Commercial, +129484,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,OXFORD HEALTH INSURANCE-Commercial, +129485,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,OXFORD HEALTH INSURANCE-Commercial, +129486,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,OXFORD HEALTH INSURANCE-Commercial, +129487,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,OXFORD HEALTH INSURANCE-Commercial, +129488,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,OXFORD HEALTH INSURANCE-Commercial, +129489,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,OXFORD HEALTH INSURANCE-Commercial, +129490,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,OXFORD HEALTH INSURANCE-Commercial, +129491,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,OXFORD HEALTH INSURANCE-Commercial, +129492,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,OXFORD HEALTH INSURANCE-Commercial, +129493,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,OXFORD HEALTH INSURANCE-Commercial, +129494,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,OXFORD HEALTH INSURANCE-Commercial, +129495,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,OXFORD HEALTH INSURANCE-Commercial, +129496,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,OXFORD HEALTH INSURANCE-Commercial, +129497,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,OXFORD HEALTH INSURANCE-Commercial, +129498,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,OXFORD HEALTH INSURANCE-Commercial, +129499,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,OXFORD HEALTH INSURANCE-Commercial, +129500,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,OXFORD HEALTH INSURANCE-Commercial, +129501,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,OXFORD HEALTH INSURANCE-Commercial, +129502,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,OXFORD HEALTH INSURANCE-Commercial, +129503,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,OXFORD HEALTH INSURANCE-Commercial, +129504,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,OXFORD HEALTH INSURANCE-Commercial, +129505,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,OXFORD HEALTH INSURANCE-Commercial, +129506,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,OXFORD HEALTH INSURANCE-Commercial, +129507,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,OXFORD HEALTH INSURANCE-Commercial,120.05 +129508,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,OXFORD HEALTH INSURANCE-Commercial, +129509,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,OXFORD HEALTH INSURANCE-Commercial, +129510,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,OXFORD HEALTH INSURANCE-Commercial, +129511,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,OXFORD HEALTH INSURANCE-Commercial, +129512,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,OXFORD HEALTH INSURANCE-Commercial, +129513,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,OXFORD HEALTH INSURANCE-Commercial, +129514,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,OXFORD HEALTH INSURANCE-Commercial, +129515,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,OXFORD HEALTH INSURANCE-Commercial, +129516,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,OXFORD HEALTH INSURANCE-Commercial, +129517,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,OXFORD HEALTH INSURANCE-Commercial, +129518,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,OXFORD HEALTH INSURANCE-Commercial, +129519,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,OXFORD HEALTH INSURANCE-Commercial, +129520,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,OXFORD HEALTH INSURANCE-Commercial, +129521,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,OXFORD HEALTH INSURANCE-Commercial, +129522,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,OXFORD HEALTH INSURANCE-Commercial, +129523,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,OXFORD HEALTH INSURANCE-Commercial, +129524,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,OXFORD HEALTH INSURANCE-Commercial, +129525,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,OXFORD HEALTH INSURANCE-Commercial, +129526,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,OXFORD HEALTH INSURANCE-Commercial, +129527,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,OXFORD HEALTH INSURANCE-Commercial, +129528,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,OXFORD HEALTH INSURANCE-Commercial, +129529,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,OXFORD HEALTH INSURANCE-Commercial, +129530,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,OXFORD HEALTH INSURANCE-Commercial, +129531,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,OXFORD HEALTH INSURANCE-Commercial, +129532,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,OXFORD HEALTH INSURANCE-Commercial, +129533,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,OXFORD HEALTH INSURANCE-Commercial, +129534,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,OXFORD HEALTH INSURANCE-Commercial, +129535,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,OXFORD HEALTH INSURANCE-Commercial, +129536,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,OXFORD HEALTH INSURANCE-Commercial, +129537,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,OXFORD HEALTH INSURANCE-Commercial, +129538,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,OXFORD HEALTH INSURANCE-Commercial, +129539,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,OXFORD HEALTH INSURANCE-Commercial, +129540,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,OXFORD HEALTH INSURANCE-Commercial, +129541,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,OXFORD HEALTH INSURANCE-Commercial, +129542,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,OXFORD HEALTH INSURANCE-Commercial, +129543,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,OXFORD HEALTH INSURANCE-Commercial, +129544,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,OXFORD HEALTH INSURANCE-Commercial, +129545,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,OXFORD HEALTH INSURANCE-Commercial, +129546,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,OXFORD HEALTH INSURANCE-Commercial, +129547,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,OXFORD HEALTH INSURANCE-Commercial, +129548,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,OXFORD HEALTH INSURANCE-Commercial, +129549,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,OXFORD HEALTH INSURANCE-Commercial, +129550,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,OXFORD HEALTH INSURANCE-Commercial,12004.12 +129551,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,OXFORD HEALTH INSURANCE-Commercial, +129552,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,OXFORD HEALTH INSURANCE-Commercial, +129553,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,OXFORD HEALTH INSURANCE-Commercial, +129554,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,OXFORD HEALTH INSURANCE-Commercial, +129555,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,OXFORD HEALTH INSURANCE-Commercial, +129556,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,OXFORD HEALTH INSURANCE-Commercial, +129557,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,OXFORD HEALTH INSURANCE-Commercial, +129558,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,OXFORD HEALTH INSURANCE-Commercial, +129559,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,OXFORD HEALTH INSURANCE-Commercial, +129560,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,OXFORD HEALTH INSURANCE-Commercial, +129561,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,OXFORD HEALTH INSURANCE-Commercial, +129562,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,OXFORD HEALTH INSURANCE-Commercial, +129563,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,OXFORD HEALTH INSURANCE-Commercial, +129564,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,OXFORD HEALTH INSURANCE-Commercial, +129565,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,OXFORD HEALTH INSURANCE-Commercial, +129566,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,OXFORD HEALTH INSURANCE-Commercial, +129567,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,OXFORD HEALTH INSURANCE-Commercial, +129568,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,OXFORD HEALTH INSURANCE-Commercial, +129569,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,OXFORD HEALTH INSURANCE-Commercial, +129570,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,OXFORD HEALTH INSURANCE-Commercial, +129571,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,OXFORD HEALTH INSURANCE-Commercial, +129572,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,OXFORD HEALTH INSURANCE-Commercial, +129573,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,OXFORD HEALTH INSURANCE-Commercial, +129574,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,OXFORD HEALTH INSURANCE-Commercial, +129575,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,OXFORD HEALTH INSURANCE-Commercial, +129576,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,OXFORD HEALTH INSURANCE-Commercial, +129577,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,OXFORD HEALTH INSURANCE-Commercial, +129578,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,OXFORD HEALTH INSURANCE-Commercial, +129579,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,OXFORD HEALTH INSURANCE-Commercial, +129580,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,OXFORD HEALTH INSURANCE-Commercial, +129581,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,OXFORD HEALTH INSURANCE-Commercial, +129582,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,OXFORD HEALTH INSURANCE-Commercial, +129583,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,OXFORD HEALTH INSURANCE-Commercial, +129584,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,OXFORD HEALTH INSURANCE-Commercial, +129585,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,OXFORD HEALTH INSURANCE-Commercial, +129586,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,OXFORD HEALTH INSURANCE-Commercial, +129587,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,OXFORD HEALTH INSURANCE-Commercial, +129588,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,OXFORD HEALTH INSURANCE-Commercial, +129589,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,OXFORD HEALTH INSURANCE-Commercial, +129590,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,OXFORD HEALTH INSURANCE-Commercial, +129591,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,OXFORD HEALTH INSURANCE-Commercial, +129592,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,OXFORD HEALTH INSURANCE-Commercial, +129593,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,OXFORD HEALTH INSURANCE-Commercial, +129594,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,OXFORD HEALTH INSURANCE-Commercial, +129595,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,OXFORD HEALTH INSURANCE-Commercial, +129596,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,OXFORD HEALTH INSURANCE-Commercial, +129597,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,OXFORD HEALTH INSURANCE-Commercial, +129598,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,OXFORD HEALTH INSURANCE-Commercial, +129599,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,OXFORD HEALTH INSURANCE-Commercial, +129600,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,OXFORD HEALTH INSURANCE-Commercial, +129601,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,OXFORD HEALTH INSURANCE-Commercial, +129602,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,OXFORD HEALTH INSURANCE-Commercial, +129603,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,OXFORD HEALTH INSURANCE-Commercial, +129604,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,OXFORD HEALTH INSURANCE-Commercial, +129605,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,OXFORD HEALTH INSURANCE-Commercial, +129606,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,OXFORD HEALTH INSURANCE-Commercial, +129607,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,OXFORD HEALTH INSURANCE-Commercial, +129608,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,OXFORD HEALTH INSURANCE-Commercial,824.81 +129609,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,OXFORD HEALTH INSURANCE-Commercial, +129610,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,OXFORD HEALTH INSURANCE-Commercial, +129611,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,OXFORD HEALTH INSURANCE-Commercial, +129612,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,OXFORD HEALTH INSURANCE-Commercial, +129613,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,OXFORD HEALTH INSURANCE-Commercial, +129614,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,OXFORD HEALTH INSURANCE-Commercial, +129615,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,OXFORD HEALTH INSURANCE-Commercial, +129616,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,OXFORD HEALTH INSURANCE-Commercial, +129617,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,OXFORD HEALTH INSURANCE-Commercial, +129618,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,OXFORD HEALTH INSURANCE-Commercial,12004.12 +129619,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,OXFORD HEALTH INSURANCE-Commercial, +129620,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,OXFORD HEALTH INSURANCE-Commercial,19311.27 +129621,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,OXFORD HEALTH INSURANCE-Commercial, +129622,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,OXFORD HEALTH INSURANCE-Commercial, +129623,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,OXFORD HEALTH INSURANCE-Commercial, +129624,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,OXFORD HEALTH INSURANCE-Commercial, +129625,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,OXFORD HEALTH INSURANCE-Commercial, +129626,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,OXFORD HEALTH INSURANCE-Commercial, +129627,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,OXFORD HEALTH INSURANCE-Commercial, +129628,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,OXFORD HEALTH INSURANCE-Commercial, +129629,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,OXFORD HEALTH INSURANCE-Commercial, +129630,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,OXFORD HEALTH INSURANCE-Commercial, +129631,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,OXFORD HEALTH INSURANCE-Commercial, +129632,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,OXFORD HEALTH INSURANCE-Commercial, +129633,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,OXFORD HEALTH INSURANCE-Commercial, +129634,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,OXFORD HEALTH INSURANCE-Commercial, +129635,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,OXFORD HEALTH INSURANCE-Commercial, +129636,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,OXFORD HEALTH INSURANCE-Commercial, +129637,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,OXFORD HEALTH INSURANCE-Commercial, +129638,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,OXFORD HEALTH INSURANCE-Commercial, +129639,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,OXFORD HEALTH INSURANCE-Commercial, +129640,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,OXFORD HEALTH INSURANCE-Commercial, +129641,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,OXFORD HEALTH INSURANCE-Commercial, +129642,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,OXFORD HEALTH INSURANCE-Commercial, +129643,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,OXFORD HEALTH INSURANCE-Commercial, +129644,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,OXFORD HEALTH INSURANCE-Commercial, +129645,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,OXFORD HEALTH INSURANCE-Commercial, +129646,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,OXFORD HEALTH INSURANCE-Commercial, +129647,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,OXFORD HEALTH INSURANCE-Commercial, +129648,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,OXFORD HEALTH INSURANCE-Commercial, +129649,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,OXFORD HEALTH INSURANCE-Commercial, +129650,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,OXFORD HEALTH INSURANCE-Commercial, +129651,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,OXFORD HEALTH INSURANCE-Commercial,5139.75 +129652,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,OXFORD HEALTH INSURANCE-Commercial, +129653,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,OXFORD HEALTH INSURANCE-Commercial, +129654,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,OXFORD HEALTH INSURANCE-Commercial, +129655,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,OXFORD HEALTH INSURANCE-Commercial, +129656,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,OXFORD HEALTH INSURANCE-Commercial, +129657,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,OXFORD HEALTH INSURANCE-Commercial, +129658,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,OXFORD HEALTH INSURANCE-Commercial, +129659,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,OXFORD HEALTH INSURANCE-Commercial, +129660,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,OXFORD HEALTH INSURANCE-Commercial,89.0 +129661,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,OXFORD HEALTH INSURANCE-Commercial,1624.0 +129662,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,OXFORD HEALTH INSURANCE-Commercial, +129663,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,OXFORD HEALTH INSURANCE-Commercial, +129664,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,OXFORD HEALTH INSURANCE-Commercial, +129665,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,OXFORD HEALTH INSURANCE-Commercial, +129666,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,OXFORD HEALTH INSURANCE-Commercial, +129667,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,OXFORD HEALTH INSURANCE-Commercial, +129668,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,OXFORD HEALTH INSURANCE-Commercial, +129669,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,OXFORD HEALTH INSURANCE-Commercial, +129670,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,OXFORD HEALTH INSURANCE-Commercial, +129671,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,OXFORD HEALTH INSURANCE-Commercial,159.73 +129672,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,OXFORD HEALTH INSURANCE-Commercial,148.28 +129673,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,OXFORD HEALTH INSURANCE-Commercial, +129674,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,OXFORD HEALTH INSURANCE-Commercial,24.08 +129675,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,OXFORD HEALTH INSURANCE-Commercial, +129676,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,OXFORD HEALTH INSURANCE-Commercial,30.86 +129677,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,OXFORD HEALTH INSURANCE-Commercial,16.33 +129678,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,OXFORD HEALTH INSURANCE-Commercial,85.75 +129679,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,OXFORD HEALTH INSURANCE-Commercial,4178.0 +129680,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,OXFORD HEALTH INSURANCE-Commercial, +129681,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,OXFORD HEALTH INSURANCE-Commercial, +129682,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,OXFORD HEALTH INSURANCE-Commercial, +129683,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,OXFORD HEALTH INSURANCE-Commercial, +129684,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,OXFORD HEALTH INSURANCE-Commercial, +129685,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,OXFORD HEALTH INSURANCE-Commercial,140.45 +129686,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,OXFORD HEALTH INSURANCE-Commercial, +129687,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,OXFORD HEALTH INSURANCE-Commercial, +129688,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,OXFORD HEALTH INSURANCE-Commercial, +129689,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,OXFORD HEALTH INSURANCE-Commercial, +129690,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,OXFORD HEALTH INSURANCE-Commercial, +129691,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,OXFORD HEALTH INSURANCE-Commercial, +129692,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,OXFORD HEALTH INSURANCE-Commercial, +129693,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,OXFORD HEALTH INSURANCE-Commercial, +129694,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,OXFORD HEALTH INSURANCE-Commercial, +129695,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,OXFORD HEALTH INSURANCE-Commercial, +129696,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,OXFORD HEALTH INSURANCE-Commercial, +129697,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,OXFORD HEALTH INSURANCE-Commercial, +129698,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,OXFORD HEALTH INSURANCE-Commercial, +129699,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,OXFORD HEALTH INSURANCE-Commercial, +129700,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,OXFORD HEALTH INSURANCE-Commercial, +129701,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,OXFORD HEALTH INSURANCE-Commercial, +129702,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,OXFORD HEALTH INSURANCE-Commercial, +129703,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,OXFORD HEALTH INSURANCE-Commercial, +129704,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,OXFORD HEALTH INSURANCE-Commercial, +129705,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,OXFORD HEALTH INSURANCE-Commercial, +129706,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,OXFORD HEALTH INSURANCE-Commercial,30.24 +129707,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,OXFORD HEALTH INSURANCE-Commercial, +129708,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,OXFORD HEALTH INSURANCE-Commercial, +129709,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,OXFORD HEALTH INSURANCE-Commercial, +129710,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,OXFORD HEALTH INSURANCE-Commercial, +129711,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,OXFORD HEALTH INSURANCE-Commercial, +129712,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,OXFORD HEALTH INSURANCE-Commercial, +129713,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,OXFORD HEALTH INSURANCE-Commercial, +129714,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,OXFORD HEALTH INSURANCE-Commercial, +129715,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,OXFORD HEALTH INSURANCE-Commercial, +129716,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,OXFORD HEALTH INSURANCE-Commercial, +129717,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,OXFORD HEALTH INSURANCE-Commercial, +129718,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,OXFORD HEALTH INSURANCE-Commercial, +129719,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,OXFORD HEALTH INSURANCE-Commercial, +129720,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,OXFORD HEALTH INSURANCE-Commercial, +129721,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,OXFORD HEALTH INSURANCE-Commercial, +129722,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,OXFORD HEALTH INSURANCE-Commercial, +129723,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,OXFORD HEALTH INSURANCE-Commercial, +129724,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,OXFORD HEALTH INSURANCE-Commercial, +129725,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,OXFORD HEALTH INSURANCE-Commercial, +129726,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,OXFORD HEALTH INSURANCE-Commercial,23.36 +129727,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,OXFORD HEALTH INSURANCE-Commercial, +129728,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,OXFORD HEALTH INSURANCE-Commercial, +129729,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,OXFORD HEALTH INSURANCE-Commercial, +129730,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,OXFORD HEALTH INSURANCE-Commercial, +129731,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,OXFORD HEALTH INSURANCE-Commercial, +129732,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,OXFORD HEALTH INSURANCE-Commercial, +129733,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,OXFORD HEALTH INSURANCE-Commercial, +129734,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,OXFORD HEALTH INSURANCE-Commercial, +129735,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,OXFORD HEALTH INSURANCE-Commercial, +129736,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,OXFORD HEALTH INSURANCE-Commercial, +129737,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,OXFORD HEALTH INSURANCE-Commercial, +129738,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,OXFORD HEALTH INSURANCE-Commercial, +129739,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,OXFORD HEALTH INSURANCE-Commercial, +129740,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,OXFORD HEALTH INSURANCE-Commercial, +129741,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,OXFORD HEALTH INSURANCE-Commercial, +129742,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,OXFORD HEALTH INSURANCE-Commercial,1815.65 +129743,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,OXFORD HEALTH INSURANCE-Commercial, +129744,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,OXFORD HEALTH INSURANCE-Commercial, +129745,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,OXFORD HEALTH INSURANCE-Commercial, +129746,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,OXFORD HEALTH INSURANCE-Commercial,4.91 +129747,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,OXFORD HEALTH INSURANCE-Commercial, +129748,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,OXFORD HEALTH INSURANCE-Commercial, +129749,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,OXFORD HEALTH INSURANCE-Commercial, +129750,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,OXFORD HEALTH INSURANCE-Commercial,3.63 +129751,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,OXFORD HEALTH INSURANCE-Commercial, +129752,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,OXFORD HEALTH INSURANCE-Commercial, +129753,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,OXFORD HEALTH INSURANCE-Commercial, +129754,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,OXFORD HEALTH INSURANCE-Commercial, +129755,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,OXFORD HEALTH INSURANCE-Commercial, +129756,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,OXFORD HEALTH INSURANCE-Commercial, +129757,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,OXFORD HEALTH INSURANCE-Commercial, +129758,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,OXFORD HEALTH INSURANCE-Commercial, +129759,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,OXFORD HEALTH INSURANCE-Commercial,614.25 +129760,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,OXFORD HEALTH INSURANCE-Commercial,338.4 +129761,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,OXFORD HEALTH INSURANCE-Commercial, +129762,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,OXFORD HEALTH INSURANCE-Commercial, +129763,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,OXFORD HEALTH INSURANCE-Commercial, +129764,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,OXFORD HEALTH INSURANCE-Commercial, +129765,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,OXFORD HEALTH INSURANCE-Commercial, +129766,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,OXFORD HEALTH INSURANCE-Commercial, +129767,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,OXFORD HEALTH INSURANCE-Commercial, +129768,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,OXFORD HEALTH INSURANCE-Commercial, +129769,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,OXFORD HEALTH INSURANCE-Commercial, +129770,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,OXFORD HEALTH INSURANCE-Commercial, +129771,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,OXFORD HEALTH INSURANCE-Commercial, +129772,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,OXFORD HEALTH INSURANCE-Commercial, +129773,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,OXFORD HEALTH INSURANCE-Commercial, +129774,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,OXFORD HEALTH INSURANCE-Commercial, +129775,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,OXFORD HEALTH INSURANCE-Commercial,119.07 +129776,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,OXFORD HEALTH INSURANCE-Commercial, +129777,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,OXFORD HEALTH INSURANCE-Commercial, +129778,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,OXFORD HEALTH INSURANCE-Commercial, +129779,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,OXFORD HEALTH INSURANCE-Commercial, +129780,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,OXFORD HEALTH INSURANCE-Commercial,6179.65 +129781,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,OXFORD HEALTH INSURANCE-Commercial, +129782,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,OXFORD HEALTH INSURANCE-Commercial, +129783,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,OXFORD HEALTH INSURANCE-Commercial,277.67 +129784,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,OXFORD HEALTH INSURANCE-Commercial,6.3 +129785,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,OXFORD HEALTH INSURANCE-Commercial, +129786,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,OXFORD HEALTH INSURANCE-Commercial, +129787,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,OXFORD HEALTH INSURANCE-Commercial, +129788,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,OXFORD HEALTH INSURANCE-Commercial, +129789,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,OXFORD HEALTH INSURANCE-Commercial, +129790,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,OXFORD HEALTH INSURANCE-Commercial, +129791,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,OXFORD HEALTH INSURANCE-Commercial, +129792,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,OXFORD HEALTH INSURANCE-Commercial, +129793,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,OXFORD HEALTH INSURANCE-Commercial, +129794,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,OXFORD HEALTH INSURANCE-Commercial, +129795,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,OXFORD HEALTH INSURANCE-Commercial, +129796,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,OXFORD HEALTH INSURANCE-Commercial, +129797,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,OXFORD HEALTH INSURANCE-Commercial, +129798,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,OXFORD HEALTH INSURANCE-Commercial, +129799,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,OXFORD HEALTH INSURANCE-Commercial,2.34 +129800,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,OXFORD HEALTH INSURANCE-Commercial, +129801,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,OXFORD HEALTH INSURANCE-Commercial,7.11 +129802,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,OXFORD HEALTH INSURANCE-Commercial, +129803,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,OXFORD HEALTH INSURANCE-Commercial, +129804,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,OXFORD HEALTH INSURANCE-Commercial, +129805,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,OXFORD HEALTH INSURANCE-Commercial, +129806,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,OXFORD HEALTH INSURANCE-Commercial, +129807,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,OXFORD HEALTH INSURANCE-Commercial, +129808,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,OXFORD HEALTH INSURANCE-Commercial, +129809,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,OXFORD HEALTH INSURANCE-Commercial, +129810,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,OXFORD HEALTH INSURANCE-Commercial, +129811,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,OXFORD HEALTH INSURANCE-Commercial, +129812,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,OXFORD HEALTH INSURANCE-Commercial,12.24 +129813,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,OXFORD HEALTH INSURANCE-Commercial, +129814,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,OXFORD HEALTH INSURANCE-Commercial,3836.67 +129815,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,OXFORD HEALTH INSURANCE-Commercial, +129816,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,OXFORD HEALTH INSURANCE-Commercial, +129817,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,OXFORD HEALTH INSURANCE-Commercial, +129818,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,OXFORD HEALTH INSURANCE-Commercial, +129819,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,OXFORD HEALTH INSURANCE-Commercial, +129820,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,OXFORD HEALTH INSURANCE-Commercial,1.88 +129821,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,OXFORD HEALTH INSURANCE-Commercial, +129822,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,OXFORD HEALTH INSURANCE-Commercial, +129823,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,OXFORD HEALTH INSURANCE-Commercial, +129824,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,OXFORD HEALTH INSURANCE-Commercial, +129825,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,OXFORD HEALTH INSURANCE-Commercial, +129826,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,OXFORD HEALTH INSURANCE-Commercial,1.4 +129827,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,OXFORD HEALTH INSURANCE-Commercial, +129828,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,OXFORD HEALTH INSURANCE-Commercial, +129829,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,OXFORD HEALTH INSURANCE-Commercial, +129830,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,OXFORD HEALTH INSURANCE-Commercial, +129831,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,OXFORD HEALTH INSURANCE-Commercial, +129832,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,OXFORD HEALTH INSURANCE-Commercial, +129833,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,OXFORD HEALTH INSURANCE-Commercial, +129834,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,OXFORD HEALTH INSURANCE-Commercial, +129835,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,OXFORD HEALTH INSURANCE-Commercial, +129836,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,OXFORD HEALTH INSURANCE-Commercial, +129837,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,OXFORD HEALTH INSURANCE-Commercial, +129838,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,OXFORD HEALTH INSURANCE-Commercial, +129839,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,OXFORD HEALTH INSURANCE-Commercial, +129840,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,OXFORD HEALTH INSURANCE-Commercial, +129841,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,OXFORD HEALTH INSURANCE-Commercial, +129842,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,OXFORD HEALTH INSURANCE-Commercial, +129843,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,OXFORD HEALTH INSURANCE-Commercial, +129844,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,OXFORD HEALTH INSURANCE-Commercial, +129845,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,OXFORD HEALTH INSURANCE-Commercial, +129846,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,OXFORD HEALTH INSURANCE-Commercial, +129847,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,OXFORD HEALTH INSURANCE-Commercial, +129848,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,OXFORD HEALTH INSURANCE-Commercial,6071.94 +129849,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,OXFORD HEALTH INSURANCE-Commercial, +129850,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,OXFORD HEALTH INSURANCE-Commercial, +129851,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,OXFORD HEALTH INSURANCE-Commercial, +129852,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,OXFORD HEALTH INSURANCE-Commercial, +129853,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,OXFORD HEALTH INSURANCE-Commercial, +129854,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,OXFORD HEALTH INSURANCE-Commercial,9.32 +129855,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,OXFORD HEALTH INSURANCE-Commercial, +129856,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,OXFORD HEALTH INSURANCE-Commercial,226.8 +129857,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,OXFORD HEALTH INSURANCE-Commercial,80.72 +129858,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,OXFORD HEALTH INSURANCE-Commercial,67.5 +129859,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,OXFORD HEALTH INSURANCE-Commercial,8.44 +129860,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,OXFORD HEALTH INSURANCE-Commercial, +129861,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,OXFORD HEALTH INSURANCE-Commercial, +129862,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,OXFORD HEALTH INSURANCE-Commercial,3.7 +129863,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,OXFORD HEALTH INSURANCE-Commercial, +129864,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,OXFORD HEALTH INSURANCE-Commercial, +129865,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,OXFORD HEALTH INSURANCE-Commercial,3.28 +129866,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,OXFORD HEALTH INSURANCE-Commercial, +129867,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,OXFORD HEALTH INSURANCE-Commercial, +129868,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,OXFORD HEALTH INSURANCE-Commercial, +129869,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,OXFORD HEALTH INSURANCE-Commercial, +129870,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,OXFORD HEALTH INSURANCE-Commercial, +129871,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,OXFORD HEALTH INSURANCE-Commercial, +129872,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,OXFORD HEALTH INSURANCE-Commercial, +129873,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,OXFORD HEALTH INSURANCE-Commercial, +129874,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,OXFORD HEALTH INSURANCE-Commercial, +129875,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,OXFORD HEALTH INSURANCE-Commercial, +129876,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,OXFORD HEALTH INSURANCE-Commercial, +129877,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,OXFORD HEALTH INSURANCE-Commercial, +129878,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,OXFORD HEALTH INSURANCE-Commercial, +129879,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,OXFORD HEALTH INSURANCE-Commercial,1.16 +129880,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,OXFORD HEALTH INSURANCE-Commercial, +129881,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,OXFORD HEALTH INSURANCE-Commercial, +129882,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,OXFORD HEALTH INSURANCE-Commercial, +129883,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,OXFORD HEALTH INSURANCE-Commercial, +129884,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,OXFORD HEALTH INSURANCE-Commercial, +129885,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,OXFORD HEALTH INSURANCE-Commercial, +129886,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,OXFORD HEALTH INSURANCE-Commercial, +129887,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,OXFORD HEALTH INSURANCE-Commercial, +129888,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,OXFORD HEALTH INSURANCE-Commercial, +129889,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,OXFORD HEALTH INSURANCE-Commercial, +129890,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,OXFORD HEALTH INSURANCE-Commercial, +129891,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,OXFORD HEALTH INSURANCE-Commercial, +129892,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,OXFORD HEALTH INSURANCE-Commercial, +129893,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,OXFORD HEALTH INSURANCE-Commercial, +129894,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,OXFORD HEALTH INSURANCE-Commercial, +129895,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,OXFORD HEALTH INSURANCE-Commercial, +129896,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,OXFORD HEALTH INSURANCE-Commercial, +129897,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,OXFORD HEALTH INSURANCE-Commercial, +129898,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,OXFORD HEALTH INSURANCE-Commercial, +129899,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,OXFORD HEALTH INSURANCE-Commercial, +129900,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,OXFORD HEALTH INSURANCE-Commercial, +129901,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,OXFORD HEALTH INSURANCE-Commercial, +129902,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,OXFORD HEALTH INSURANCE-Commercial, +129903,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,OXFORD HEALTH INSURANCE-Commercial, +129904,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,OXFORD HEALTH INSURANCE-Commercial, +129905,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,OXFORD HEALTH INSURANCE-Commercial, +129906,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,OXFORD HEALTH INSURANCE-Commercial, +129907,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,OXFORD HEALTH INSURANCE-Commercial, +129908,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,OXFORD HEALTH INSURANCE-Commercial, +129909,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,OXFORD HEALTH INSURANCE-Commercial, +129910,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,OXFORD HEALTH INSURANCE-Commercial,1429.27 +129911,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,OXFORD HEALTH INSURANCE-Commercial, +129912,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,OXFORD HEALTH INSURANCE-Commercial, +129913,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,OXFORD HEALTH INSURANCE-Commercial, +129914,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,OXFORD HEALTH INSURANCE-Commercial, +129915,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,OXFORD HEALTH INSURANCE-Commercial, +129916,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,OXFORD HEALTH INSURANCE-Commercial, +129917,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,OXFORD HEALTH INSURANCE-Commercial, +129918,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,OXFORD HEALTH INSURANCE-Commercial, +129919,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,OXFORD HEALTH INSURANCE-Commercial, +129920,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,OXFORD HEALTH INSURANCE-Commercial, +129921,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,OXFORD HEALTH INSURANCE-Commercial, +129922,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,OXFORD HEALTH INSURANCE-Commercial, +129923,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,OXFORD HEALTH INSURANCE-Commercial, +129924,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,OXFORD HEALTH INSURANCE-Commercial, +129925,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,OXFORD HEALTH INSURANCE-Commercial, +129926,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,OXFORD HEALTH INSURANCE-Commercial, +129927,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,OXFORD HEALTH INSURANCE-Commercial,367.82 +129928,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,OXFORD HEALTH INSURANCE-Commercial, +129929,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,OXFORD HEALTH INSURANCE-Commercial, +129930,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,OXFORD HEALTH INSURANCE-Commercial, +129931,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,OXFORD HEALTH INSURANCE-Commercial, +129932,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,OXFORD HEALTH INSURANCE-Commercial, +129933,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,OXFORD HEALTH INSURANCE-Commercial, +129934,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,OXFORD HEALTH INSURANCE-Commercial, +129935,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,OXFORD HEALTH INSURANCE-Commercial, +129936,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,OXFORD HEALTH INSURANCE-Commercial, +129937,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,OXFORD HEALTH INSURANCE-Commercial, +129938,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,OXFORD HEALTH INSURANCE-Commercial, +129939,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,OXFORD HEALTH INSURANCE-Commercial, +129940,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,OXFORD HEALTH INSURANCE-Commercial, +129941,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,OXFORD HEALTH INSURANCE-Commercial, +129942,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,OXFORD HEALTH INSURANCE-Commercial, +129943,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,OXFORD HEALTH INSURANCE-Commercial,334.64 +129944,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,OXFORD HEALTH INSURANCE-Commercial,4941.6 +129945,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,OXFORD HEALTH INSURANCE-Commercial, +129946,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,OXFORD HEALTH INSURANCE-Commercial, +129947,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,OXFORD HEALTH INSURANCE-Commercial, +129948,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,OXFORD HEALTH INSURANCE-Commercial, +129949,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,OXFORD HEALTH INSURANCE-Commercial, +129950,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,OXFORD HEALTH INSURANCE-Commercial, +129951,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,OXFORD HEALTH INSURANCE-Commercial, +129952,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,OXFORD HEALTH INSURANCE-Commercial, +129953,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,OXFORD HEALTH INSURANCE-Commercial, +129954,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,OXFORD HEALTH INSURANCE-Commercial, +129955,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,OXFORD HEALTH INSURANCE-Commercial, +129956,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,OXFORD HEALTH INSURANCE-Commercial, +129957,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,OXFORD HEALTH INSURANCE-Commercial, +129958,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,OXFORD HEALTH INSURANCE-Commercial, +129959,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,OXFORD HEALTH INSURANCE-Commercial, +129960,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,OXFORD HEALTH INSURANCE-Commercial, +129961,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,OXFORD HEALTH INSURANCE-Commercial, +129962,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,OXFORD HEALTH INSURANCE-Commercial, +129963,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,OXFORD HEALTH INSURANCE-Commercial, +129964,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,OXFORD HEALTH INSURANCE-Commercial, +129965,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,OXFORD HEALTH INSURANCE-Commercial, +129966,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,OXFORD HEALTH INSURANCE-Commercial, +129967,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,OXFORD HEALTH INSURANCE-Commercial, +129968,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,OXFORD HEALTH INSURANCE-Commercial, +129969,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,OXFORD HEALTH INSURANCE-Commercial, +129970,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,OXFORD HEALTH INSURANCE-Commercial, +129971,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,OXFORD HEALTH INSURANCE-Commercial, +129972,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,OXFORD HEALTH INSURANCE-Commercial, +129973,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,OXFORD HEALTH INSURANCE-Commercial, +129974,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,OXFORD HEALTH INSURANCE-Commercial,474.0 +129975,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,OXFORD HEALTH INSURANCE-Commercial, +129976,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,OXFORD HEALTH INSURANCE-Commercial, +129977,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,OXFORD HEALTH INSURANCE-Commercial, +129978,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,OXFORD HEALTH INSURANCE-Commercial, +129979,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,OXFORD HEALTH INSURANCE-Commercial, +129980,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,OXFORD HEALTH INSURANCE-Commercial, +129981,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,OXFORD HEALTH INSURANCE-Commercial, +129982,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,OXFORD HEALTH INSURANCE-Commercial, +129983,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,OXFORD HEALTH INSURANCE-Commercial, +129984,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,OXFORD HEALTH INSURANCE-Commercial, +129985,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,OXFORD HEALTH INSURANCE-Commercial, +129986,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,OXFORD HEALTH INSURANCE-Commercial, +129987,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,OXFORD HEALTH INSURANCE-Commercial, +129988,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,OXFORD HEALTH INSURANCE-Commercial, +129989,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,OXFORD HEALTH INSURANCE-Commercial, +129990,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,OXFORD HEALTH INSURANCE-Commercial,376.7 +129991,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,OXFORD HEALTH INSURANCE-Commercial, +129992,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,OXFORD HEALTH INSURANCE-Commercial, +129993,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,OXFORD HEALTH INSURANCE-Commercial, +129994,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,OXFORD HEALTH INSURANCE-Commercial,995.63 +129995,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,OXFORD HEALTH INSURANCE-Commercial, +129996,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,OXFORD HEALTH INSURANCE-Commercial, +129997,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,OXFORD HEALTH INSURANCE-Commercial, +129998,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,OXFORD HEALTH INSURANCE-Commercial, +129999,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,OXFORD HEALTH INSURANCE-Commercial, +130000,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,OXFORD HEALTH INSURANCE-Commercial, +130001,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,OXFORD HEALTH INSURANCE-Commercial, +130002,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,OXFORD HEALTH INSURANCE-Commercial, +130003,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,OXFORD HEALTH INSURANCE-Commercial,24.27 +130004,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,OXFORD HEALTH INSURANCE-Commercial, +130005,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,OXFORD HEALTH INSURANCE-Commercial, +130006,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,OXFORD HEALTH INSURANCE-Commercial, +130007,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,OXFORD HEALTH INSURANCE-Commercial, +130008,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,OXFORD HEALTH INSURANCE-Commercial, +130009,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,OXFORD HEALTH INSURANCE-Commercial, +130010,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,OXFORD HEALTH INSURANCE-Commercial, +130011,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,OXFORD HEALTH INSURANCE-Commercial, +130012,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,OXFORD HEALTH INSURANCE-Commercial, +130013,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,OXFORD HEALTH INSURANCE-Commercial, +130014,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,OXFORD HEALTH INSURANCE-Commercial, +130015,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,OXFORD HEALTH INSURANCE-Commercial, +130016,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,OXFORD HEALTH INSURANCE-Commercial, +130017,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,OXFORD HEALTH INSURANCE-Commercial, +130018,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,OXFORD HEALTH INSURANCE-Commercial, +130019,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,OXFORD HEALTH INSURANCE-Commercial, +130020,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,OXFORD HEALTH INSURANCE-Commercial, +130021,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,OXFORD HEALTH INSURANCE-Commercial, +130022,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,OXFORD HEALTH INSURANCE-Commercial, +130023,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,OXFORD HEALTH INSURANCE-Commercial, +130024,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,OXFORD HEALTH INSURANCE-Commercial, +130025,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,OXFORD HEALTH INSURANCE-Commercial, +130026,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,OXFORD HEALTH INSURANCE-Commercial, +130027,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,OXFORD HEALTH INSURANCE-Commercial, +130028,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,OXFORD HEALTH INSURANCE-Commercial, +130029,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,OXFORD HEALTH INSURANCE-Commercial, +130030,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,OXFORD HEALTH INSURANCE-Commercial, +130031,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,OXFORD HEALTH INSURANCE-Commercial,127.4 +130032,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,OXFORD HEALTH INSURANCE-Commercial, +130033,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,OXFORD HEALTH INSURANCE-Commercial, +130034,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,OXFORD HEALTH INSURANCE-Commercial, +130035,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,OXFORD HEALTH INSURANCE-Commercial, +130036,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,OXFORD HEALTH INSURANCE-Commercial, +130037,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,OXFORD HEALTH INSURANCE-Commercial, +130038,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,OXFORD HEALTH INSURANCE-Commercial, +130039,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,OXFORD HEALTH INSURANCE-Commercial, +130040,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,OXFORD HEALTH INSURANCE-Commercial, +130041,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,OXFORD HEALTH INSURANCE-Commercial,39.5 +130042,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,OXFORD HEALTH INSURANCE-Commercial, +130043,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,OXFORD HEALTH INSURANCE-Commercial, +130044,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,OXFORD HEALTH INSURANCE-Commercial,114.29 +130045,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,OXFORD HEALTH INSURANCE-Commercial,37.5 +130046,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,OXFORD HEALTH INSURANCE-Commercial, +130047,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,OXFORD HEALTH INSURANCE-Commercial, +130048,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,OXFORD HEALTH INSURANCE-Commercial, +130049,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,OXFORD HEALTH INSURANCE-Commercial, +130050,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,OXFORD HEALTH INSURANCE-Commercial, +130051,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,OXFORD HEALTH INSURANCE-Commercial, +130052,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130053,3934,30000012,PRIVATE,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130054,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130055,3934,30000038,ICU,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130056,3934,30000046,BURN UNIT,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130057,3934,30000053,NICU,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130058,3934,30000061,ICR ROOM,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130059,3934,30000079,PSYCH,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130060,3934,30000087,NEWBORN,,4140.0,4140.0,,,OXFORD HEALTH INSURANCE-Commercial, 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HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130082,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130083,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130084,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130085,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130086,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130087,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130088,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130089,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130090,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130091,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130092,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130093,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130094,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130095,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130096,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130097,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130098,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130099,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130100,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130101,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130102,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130103,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130104,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130105,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130106,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130107,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130108,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130109,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130110,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130111,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, 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PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130153,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130154,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130155,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130156,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130157,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130158,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130159,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130160,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130161,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130162,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130163,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130164,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130165,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130166,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130167,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130168,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130169,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130170,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130171,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130172,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130173,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130174,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130175,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130176,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130177,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130178,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130179,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130180,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130181,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130182,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130183,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130184,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130185,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130186,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130187,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130188,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130189,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130190,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130191,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130192,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,OXFORD HEALTH 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INSURANCE-Commercial, +130203,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130204,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130205,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130206,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130207,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130208,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130209,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130210,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130211,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130212,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130213,3934,30512008,R&B REV 05SD 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INSURANCE-Commercial, +130295,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130296,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130297,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130298,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130299,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130300,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130301,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130302,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130303,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130304,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,OXFORD 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INSURANCE-Commercial, +130315,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130316,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130317,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130318,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130319,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130320,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130321,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130322,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130323,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130324,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130325,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130326,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130327,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130328,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130329,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130330,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130331,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130332,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130333,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130334,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, 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PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130406,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130407,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130408,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130409,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130410,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130411,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130412,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130413,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130414,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130415,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130416,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130417,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130418,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130419,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130420,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130421,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130422,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130423,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130424,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130425,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, 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PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130437,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130438,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130439,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130440,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130441,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130442,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130443,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130444,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130445,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130446,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130447,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130448,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130449,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130450,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130451,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130452,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130453,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130454,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,OXFORD HEALTH INSURANCE-Commercial, +130455,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130456,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130457,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130458,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130459,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130460,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130461,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130462,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,OXFORD HEALTH INSURANCE-Commercial, +130463,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130464,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,OXFORD HEALTH INSURANCE-Commercial, +130465,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130466,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130467,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130468,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,OXFORD HEALTH INSURANCE-Commercial, +130469,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,OXFORD HEALTH INSURANCE-Commercial, +130470,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,OXFORD HEALTH INSURANCE-Commercial, +130471,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130472,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130473,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130474,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130475,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130476,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130477,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,OXFORD HEALTH INSURANCE-Commercial, +130478,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130479,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130480,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130481,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130482,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,OXFORD HEALTH INSURANCE-Commercial, +130483,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130484,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130485,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130486,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,OXFORD HEALTH INSURANCE-Commercial, 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+130497,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,OXFORD HEALTH INSURANCE-Commercial, +130498,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,OXFORD HEALTH INSURANCE-Commercial, +130499,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,OXFORD HEALTH INSURANCE-Commercial, +130500,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,OXFORD HEALTH INSURANCE-Commercial, +130501,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,OXFORD HEALTH INSURANCE-Commercial, +130502,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130503,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130504,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130505,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130506,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130507,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130508,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130509,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130510,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130511,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130512,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130513,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130514,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,OXFORD HEALTH INSURANCE-Commercial, +130515,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,OXFORD HEALTH INSURANCE-Commercial, +130516,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,OXFORD HEALTH INSURANCE-Commercial, +130517,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,OXFORD HEALTH INSURANCE-Commercial, +130518,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,OXFORD HEALTH INSURANCE-Commercial, +130519,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,OXFORD HEALTH INSURANCE-Commercial, +130520,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,OXFORD HEALTH INSURANCE-Commercial, +130521,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,OXFORD HEALTH INSURANCE-Commercial, +130522,3934,37112000,ACUTE ED,,1580.0,1580.0,,,OXFORD HEALTH INSURANCE-Commercial, +130523,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,OXFORD HEALTH INSURANCE-Commercial, +130524,3934,37112034,TRIAGE,,277.0,277.0,,,OXFORD HEALTH INSURANCE-Commercial, +130525,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,OXFORD HEALTH INSURANCE-Commercial, +130526,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,OXFORD HEALTH INSURANCE-Commercial, +130527,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,OXFORD HEALTH INSURANCE-Commercial, +130528,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,OXFORD HEALTH INSURANCE-Commercial, +130529,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,OXFORD HEALTH INSURANCE-Commercial, +130530,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,OXFORD HEALTH INSURANCE-Commercial, +130531,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,OXFORD HEALTH INSURANCE-Commercial, +130532,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,OXFORD HEALTH INSURANCE-Commercial, +130533,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,OXFORD HEALTH INSURANCE-Commercial, +130534,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,OXFORD HEALTH INSURANCE-Commercial, +130535,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,OXFORD HEALTH INSURANCE-Commercial, +130536,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,OXFORD HEALTH INSURANCE-Commercial, +130537,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,OXFORD HEALTH INSURANCE-Commercial, +130538,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,OXFORD HEALTH INSURANCE-Commercial, +130539,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,OXFORD HEALTH INSURANCE-Commercial, +130540,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,OXFORD HEALTH INSURANCE-Commercial, +130541,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,OXFORD HEALTH INSURANCE-Commercial, +130542,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,OXFORD HEALTH INSURANCE-Commercial, +130543,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,OXFORD HEALTH INSURANCE-Commercial, +130544,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,OXFORD HEALTH INSURANCE-Commercial, +130545,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,OXFORD HEALTH INSURANCE-Commercial, +130546,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,OXFORD HEALTH INSURANCE-Commercial, +130547,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,OXFORD HEALTH INSURANCE-Commercial, +130548,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,OXFORD HEALTH INSURANCE-Commercial, +130549,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,OXFORD HEALTH INSURANCE-Commercial, +130550,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,OXFORD HEALTH INSURANCE-Commercial, +130551,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,OXFORD HEALTH INSURANCE-Commercial, +130552,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,OXFORD HEALTH INSURANCE-Commercial, +130553,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,OXFORD HEALTH INSURANCE-Commercial, +130554,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,OXFORD HEALTH INSURANCE-Commercial, +130555,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,OXFORD HEALTH INSURANCE-Commercial, +130556,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,OXFORD HEALTH INSURANCE-Commercial, +130557,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,OXFORD HEALTH INSURANCE-Commercial, +130558,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,OXFORD HEALTH INSURANCE-Commercial, +130559,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,OXFORD HEALTH INSURANCE-Commercial, +130560,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,OXFORD HEALTH INSURANCE-Commercial, +130561,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,OXFORD HEALTH INSURANCE-Commercial, +130562,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,OXFORD HEALTH INSURANCE-Commercial, +130563,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,OXFORD HEALTH INSURANCE-Commercial, +130564,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,OXFORD HEALTH INSURANCE-Commercial, +130565,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,OXFORD HEALTH INSURANCE-Commercial, +130566,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,OXFORD HEALTH INSURANCE-Commercial, +130567,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,OXFORD HEALTH INSURANCE-Commercial, +130568,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,OXFORD HEALTH INSURANCE-Commercial, +130569,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,OXFORD HEALTH INSURANCE-Commercial, +130570,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,OXFORD HEALTH INSURANCE-Commercial, +130571,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,OXFORD HEALTH INSURANCE-Commercial, +130572,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,OXFORD HEALTH INSURANCE-Commercial, +130573,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,OXFORD HEALTH INSURANCE-Commercial, +130574,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,OXFORD HEALTH INSURANCE-Commercial, +130575,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,OXFORD HEALTH INSURANCE-Commercial, +130576,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,OXFORD HEALTH INSURANCE-Commercial, +130577,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,OXFORD HEALTH INSURANCE-Commercial, +130578,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,OXFORD HEALTH INSURANCE-Commercial, +130579,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,OXFORD HEALTH INSURANCE-Commercial, +130580,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,OXFORD HEALTH INSURANCE-Commercial, +130581,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,OXFORD HEALTH INSURANCE-Commercial, +130582,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,OXFORD HEALTH INSURANCE-Commercial, +130583,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,OXFORD HEALTH INSURANCE-Commercial, +130584,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,OXFORD HEALTH INSURANCE-Commercial, +130585,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,OXFORD HEALTH INSURANCE-Commercial, +130586,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,OXFORD HEALTH INSURANCE-Commercial, +130587,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,OXFORD HEALTH INSURANCE-Commercial, +130588,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,OXFORD HEALTH INSURANCE-Commercial, +130589,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,OXFORD HEALTH INSURANCE-Commercial, +130590,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,OXFORD HEALTH INSURANCE-Commercial, +130591,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,OXFORD HEALTH INSURANCE-Commercial, +130592,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,OXFORD HEALTH INSURANCE-Commercial, +130593,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,OXFORD HEALTH INSURANCE-Commercial, +130594,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,OXFORD HEALTH INSURANCE-Commercial, +130595,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,OXFORD HEALTH INSURANCE-Commercial, +130596,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,OXFORD HEALTH INSURANCE-Commercial, +130597,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,OXFORD HEALTH INSURANCE-Commercial, +130598,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,OXFORD HEALTH INSURANCE-Commercial, +130599,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,OXFORD HEALTH INSURANCE-Commercial, +130600,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,OXFORD HEALTH INSURANCE-Commercial, +130601,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,OXFORD HEALTH INSURANCE-Commercial, +130602,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,OXFORD HEALTH INSURANCE-Commercial, +130603,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,OXFORD HEALTH INSURANCE-Commercial, +130604,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,OXFORD HEALTH INSURANCE-Commercial, +130605,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,OXFORD HEALTH INSURANCE-Commercial, +130606,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,OXFORD HEALTH INSURANCE-Commercial, +130607,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,OXFORD HEALTH INSURANCE-Commercial, +130608,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,OXFORD HEALTH INSURANCE-Commercial, +130609,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,OXFORD HEALTH INSURANCE-Commercial, +130610,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,OXFORD HEALTH INSURANCE-Commercial, +130611,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,OXFORD HEALTH INSURANCE-Commercial, +130612,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,OXFORD HEALTH INSURANCE-Commercial, +130613,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,OXFORD HEALTH INSURANCE-Commercial, +130614,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,OXFORD HEALTH INSURANCE-Commercial, +130615,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,OXFORD HEALTH INSURANCE-Commercial, +130616,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,OXFORD HEALTH INSURANCE-Commercial, +130617,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,OXFORD HEALTH INSURANCE-Commercial, +130618,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,OXFORD HEALTH INSURANCE-Commercial, +130619,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,OXFORD HEALTH INSURANCE-Commercial, +130620,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,OXFORD HEALTH INSURANCE-Commercial, +130621,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,OXFORD HEALTH INSURANCE-Commercial, +130622,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,OXFORD HEALTH INSURANCE-Commercial, +130623,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,OXFORD HEALTH INSURANCE-Commercial, +130624,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130625,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130626,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130627,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130628,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130629,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130630,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,OXFORD HEALTH INSURANCE-Commercial, +130631,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,OXFORD HEALTH INSURANCE-Commercial, +130632,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,OXFORD HEALTH INSURANCE-Commercial, +130633,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130634,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130635,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130636,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,OXFORD HEALTH INSURANCE-Commercial, +130637,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130638,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130639,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130640,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,OXFORD HEALTH INSURANCE-Commercial, +130641,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,OXFORD HEALTH INSURANCE-Commercial, +130642,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,OXFORD HEALTH INSURANCE-Commercial, +130643,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,OXFORD HEALTH INSURANCE-Commercial, +130644,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,OXFORD HEALTH INSURANCE-Commercial, +130645,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,OXFORD HEALTH INSURANCE-Commercial, +130646,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,OXFORD HEALTH INSURANCE-Commercial, +130647,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,OXFORD HEALTH INSURANCE-Commercial, +130648,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,OXFORD HEALTH INSURANCE-Commercial, +130649,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,OXFORD HEALTH INSURANCE-Commercial, +130650,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,OXFORD HEALTH INSURANCE-Commercial, +130651,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,OXFORD HEALTH INSURANCE-Commercial, +130652,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,OXFORD HEALTH INSURANCE-Commercial, +130653,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,OXFORD HEALTH INSURANCE-Commercial, +130654,3934,43301043,ALBUNEX,,357.0,357.0,,,OXFORD HEALTH INSURANCE-Commercial, +130655,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,OXFORD HEALTH INSURANCE-Commercial, +130656,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130657,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130658,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130659,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, 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5HRS,,5405.0,5405.0,,,OXFORD HEALTH INSURANCE-Commercial, +130672,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,OXFORD HEALTH INSURANCE-Commercial, +130673,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,OXFORD HEALTH INSURANCE-Commercial, +130674,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,OXFORD HEALTH INSURANCE-Commercial, +130675,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,OXFORD HEALTH INSURANCE-Commercial, +130676,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,OXFORD HEALTH INSURANCE-Commercial, +130677,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,OXFORD HEALTH INSURANCE-Commercial, +130678,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,OXFORD HEALTH INSURANCE-Commercial, +130679,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130680,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130681,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130682,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130683,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130684,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130685,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,OXFORD HEALTH INSURANCE-Commercial, +130686,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130687,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130688,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130689,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130690,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130691,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130692,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,OXFORD HEALTH INSURANCE-Commercial, +130693,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130694,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130695,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130696,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130697,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130698,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130699,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130700,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130701,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130702,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130703,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130704,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130705,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,OXFORD HEALTH INSURANCE-Commercial, +130706,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,OXFORD HEALTH INSURANCE-Commercial, +130707,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,OXFORD HEALTH INSURANCE-Commercial, +130708,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,OXFORD HEALTH INSURANCE-Commercial, +130709,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,OXFORD HEALTH INSURANCE-Commercial, +130710,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,OXFORD HEALTH INSURANCE-Commercial, +130711,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,OXFORD HEALTH INSURANCE-Commercial, +130712,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,OXFORD HEALTH INSURANCE-Commercial, +130713,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130714,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130715,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130716,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130717,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130718,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130719,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130720,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,OXFORD HEALTH INSURANCE-Commercial, +130721,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,OXFORD HEALTH INSURANCE-Commercial, +130722,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,OXFORD HEALTH INSURANCE-Commercial, +130723,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,OXFORD HEALTH INSURANCE-Commercial, +130724,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,OXFORD HEALTH INSURANCE-Commercial, +130725,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,OXFORD HEALTH INSURANCE-Commercial, +130726,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,OXFORD HEALTH INSURANCE-Commercial, +130727,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,OXFORD HEALTH INSURANCE-Commercial, +130728,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,OXFORD HEALTH INSURANCE-Commercial, +130729,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,OXFORD HEALTH INSURANCE-Commercial, +130730,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,OXFORD HEALTH INSURANCE-Commercial, +130731,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,OXFORD HEALTH INSURANCE-Commercial, +130732,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,OXFORD HEALTH INSURANCE-Commercial, +130733,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,OXFORD HEALTH INSURANCE-Commercial, +130734,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,OXFORD HEALTH INSURANCE-Commercial, +130735,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,OXFORD HEALTH INSURANCE-Commercial, +130736,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,OXFORD HEALTH INSURANCE-Commercial, +130737,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,OXFORD HEALTH INSURANCE-Commercial, +130738,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,OXFORD HEALTH INSURANCE-Commercial, +130739,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,OXFORD HEALTH INSURANCE-Commercial, +130740,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,OXFORD HEALTH INSURANCE-Commercial, +130741,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,OXFORD HEALTH INSURANCE-Commercial, +130742,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,OXFORD HEALTH INSURANCE-Commercial, +130743,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,OXFORD HEALTH INSURANCE-Commercial, +130744,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,OXFORD HEALTH INSURANCE-Commercial, +130745,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,OXFORD HEALTH INSURANCE-Commercial, +130746,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,OXFORD HEALTH INSURANCE-Commercial, +130747,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,OXFORD HEALTH INSURANCE-Commercial, +130748,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,OXFORD HEALTH INSURANCE-Commercial, +130749,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,OXFORD HEALTH INSURANCE-Commercial, +130750,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,OXFORD HEALTH INSURANCE-Commercial, +130751,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,OXFORD HEALTH INSURANCE-Commercial, +130752,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,OXFORD HEALTH INSURANCE-Commercial, +130753,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,OXFORD HEALTH INSURANCE-Commercial, +130754,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,OXFORD HEALTH INSURANCE-Commercial, +130755,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,OXFORD HEALTH INSURANCE-Commercial, +130756,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,OXFORD HEALTH INSURANCE-Commercial, +130757,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,OXFORD HEALTH INSURANCE-Commercial, +130758,3934,45924552,ENDO REC RM,,30.0,30.0,,,OXFORD HEALTH INSURANCE-Commercial, +130759,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,OXFORD HEALTH INSURANCE-Commercial, +130760,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,OXFORD HEALTH INSURANCE-Commercial, +130761,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,OXFORD HEALTH INSURANCE-Commercial, +130762,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,OXFORD HEALTH INSURANCE-Commercial, +130763,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,OXFORD HEALTH INSURANCE-Commercial, +130764,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,OXFORD HEALTH INSURANCE-Commercial, +130765,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,OXFORD HEALTH INSURANCE-Commercial, +130766,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,OXFORD HEALTH INSURANCE-Commercial, +130767,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,OXFORD HEALTH INSURANCE-Commercial, +130768,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,OXFORD HEALTH INSURANCE-Commercial, +130769,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,OXFORD HEALTH INSURANCE-Commercial, +130770,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,OXFORD HEALTH INSURANCE-Commercial, +130771,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,OXFORD HEALTH INSURANCE-Commercial, +130772,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,OXFORD HEALTH INSURANCE-Commercial, +130773,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,OXFORD HEALTH INSURANCE-Commercial, +130774,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,OXFORD HEALTH INSURANCE-Commercial, +130775,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,OXFORD HEALTH INSURANCE-Commercial, +130776,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,OXFORD HEALTH INSURANCE-Commercial, +130777,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,OXFORD HEALTH INSURANCE-Commercial, +130778,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,OXFORD HEALTH INSURANCE-Commercial, +130779,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,OXFORD HEALTH INSURANCE-Commercial, +130780,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,OXFORD HEALTH INSURANCE-Commercial, +130781,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,OXFORD HEALTH INSURANCE-Commercial, +130782,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,OXFORD HEALTH INSURANCE-Commercial, +130783,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,OXFORD HEALTH INSURANCE-Commercial, +130784,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,OXFORD HEALTH INSURANCE-Commercial, +130785,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,OXFORD HEALTH INSURANCE-Commercial, +130786,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130787,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,OXFORD HEALTH INSURANCE-Commercial, +130788,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,OXFORD HEALTH INSURANCE-Commercial, +130789,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,OXFORD HEALTH INSURANCE-Commercial, +130790,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,OXFORD HEALTH INSURANCE-Commercial, +130791,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,OXFORD HEALTH INSURANCE-Commercial, +130792,3934,53200010,GUEST TRAY,,24.0,24.0,,,OXFORD HEALTH INSURANCE-Commercial, +130793,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,OXFORD HEALTH INSURANCE-Commercial, +130794,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,OXFORD HEALTH INSURANCE-Commercial, +130795,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,OXFORD HEALTH INSURANCE-Commercial, +130796,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,OXFORD HEALTH INSURANCE-Commercial, +130797,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,OXFORD HEALTH INSURANCE-Commercial, +130798,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,OXFORD HEALTH INSURANCE-Commercial, +130799,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,OXFORD HEALTH INSURANCE-Commercial, +130800,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,OXFORD HEALTH INSURANCE-Commercial, +130801,3934,53329876,HIV MONITORING,,416.0,416.0,,,OXFORD HEALTH INSURANCE-Commercial, +130802,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,OXFORD HEALTH INSURANCE-Commercial, +130803,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,OXFORD HEALTH INSURANCE-Commercial, +130804,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,OXFORD HEALTH INSURANCE-Commercial, +130805,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,OXFORD HEALTH INSURANCE-Commercial, +130806,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,OXFORD HEALTH INSURANCE-Commercial, +130807,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,OXFORD HEALTH INSURANCE-Commercial, +130808,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,OXFORD HEALTH INSURANCE-Commercial, +130809,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,OXFORD HEALTH INSURANCE-Commercial, +130810,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,OXFORD HEALTH INSURANCE-Commercial, +130811,3934,76010107,COPY X-RAY,,22.0,22.0,,,OXFORD HEALTH INSURANCE-Commercial, +130812,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,OXFORD HEALTH INSURANCE-Commercial, +130813,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,OXFORD HEALTH INSURANCE-Commercial, +130814,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,OXFORD HEALTH INSURANCE-Commercial, +130815,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,OXFORD HEALTH INSURANCE-Commercial, +130816,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,OXFORD HEALTH INSURANCE-Commercial, +130817,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,OXFORD HEALTH INSURANCE-Commercial, +130818,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,OXFORD HEALTH INSURANCE-Commercial, +130819,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,OXFORD HEALTH INSURANCE-Commercial, +130820,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,OXFORD HEALTH INSURANCE-Commercial, +130821,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,OXFORD HEALTH INSURANCE-Commercial, +130822,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,OXFORD HEALTH INSURANCE-Commercial, +130823,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,OXFORD HEALTH INSURANCE-Commercial, +130824,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,TRICARE-Commercial, +130825,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,TRICARE-Commercial, +130826,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,TRICARE-Commercial, +130827,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,TRICARE-Commercial, +130828,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,TRICARE-Commercial, +130829,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,TRICARE-Commercial, +130830,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,TRICARE-Commercial, +130831,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,TRICARE-Commercial, +130832,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,TRICARE-Commercial, +130833,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,TRICARE-Commercial, +130834,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,TRICARE-Commercial, +130835,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,TRICARE-Commercial, +130836,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,TRICARE-Commercial, +130837,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,TRICARE-Commercial, +130838,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,TRICARE-Commercial, +130839,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,TRICARE-Commercial, +130840,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,TRICARE-Commercial, +130841,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,TRICARE-Commercial, +130842,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,TRICARE-Commercial, +130843,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,TRICARE-Commercial, +130844,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,TRICARE-Commercial, +130845,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,TRICARE-Commercial, +130846,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,TRICARE-Commercial, +130847,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,TRICARE-Commercial, +130848,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,TRICARE-Commercial, +130849,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,TRICARE-Commercial, +130850,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,TRICARE-Commercial, +130851,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,TRICARE-Commercial, +130852,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,TRICARE-Commercial, +130853,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,TRICARE-Commercial, +130854,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,TRICARE-Commercial, +130855,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,TRICARE-Commercial, +130856,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,TRICARE-Commercial, +130857,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,TRICARE-Commercial, +130858,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,TRICARE-Commercial, +130859,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,TRICARE-Commercial, +130860,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,TRICARE-Commercial, +130861,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,TRICARE-Commercial, +130862,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,TRICARE-Commercial, +130863,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,TRICARE-Commercial, +130864,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,TRICARE-Commercial, +130865,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,TRICARE-Commercial, +130866,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,TRICARE-Commercial, +130867,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,TRICARE-Commercial, +130868,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,TRICARE-Commercial, +130869,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,TRICARE-Commercial, +130870,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,TRICARE-Commercial, +130871,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,TRICARE-Commercial, +130872,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,TRICARE-Commercial, +130873,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,TRICARE-Commercial, +130874,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,TRICARE-Commercial, +130875,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,TRICARE-Commercial, +130876,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,TRICARE-Commercial, +130877,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,TRICARE-Commercial, +130878,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,TRICARE-Commercial, +130879,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,TRICARE-Commercial, +130880,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,TRICARE-Commercial, +130881,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,TRICARE-Commercial, +130882,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,TRICARE-Commercial, +130883,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,TRICARE-Commercial, +130884,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,TRICARE-Commercial, +130885,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,TRICARE-Commercial, +130886,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,TRICARE-Commercial, +130887,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,TRICARE-Commercial, +130888,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,TRICARE-Commercial, +130889,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,TRICARE-Commercial, +130890,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,TRICARE-Commercial, +130891,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,TRICARE-Commercial, +130892,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,TRICARE-Commercial, +130893,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,TRICARE-Commercial, +130894,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,TRICARE-Commercial, +130895,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,TRICARE-Commercial, +130896,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,TRICARE-Commercial, +130897,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,TRICARE-Commercial, +130898,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,TRICARE-Commercial, +130899,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,TRICARE-Commercial, +130900,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,TRICARE-Commercial, +130901,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,TRICARE-Commercial, +130902,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,TRICARE-Commercial, +130903,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,TRICARE-Commercial, +130904,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,TRICARE-Commercial, +130905,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,TRICARE-Commercial, +130906,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,TRICARE-Commercial, +130907,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,TRICARE-Commercial, +130908,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,TRICARE-Commercial, +130909,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,TRICARE-Commercial, +130910,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,TRICARE-Commercial, +130911,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,TRICARE-Commercial, +130912,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,TRICARE-Commercial, +130913,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,TRICARE-Commercial, +130914,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,TRICARE-Commercial, +130915,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,TRICARE-Commercial, +130916,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,TRICARE-Commercial, +130917,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,TRICARE-Commercial, +130918,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,TRICARE-Commercial, +130919,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,TRICARE-Commercial, +130920,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,TRICARE-Commercial, +130921,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,TRICARE-Commercial, +130922,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,TRICARE-Commercial, +130923,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,TRICARE-Commercial, +130924,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,TRICARE-Commercial, +130925,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,TRICARE-Commercial, +130926,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,TRICARE-Commercial, +130927,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,TRICARE-Commercial, +130928,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,TRICARE-Commercial, +130929,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,TRICARE-Commercial, +130930,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,TRICARE-Commercial, +130931,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,TRICARE-Commercial, +130932,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,TRICARE-Commercial, +130933,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,TRICARE-Commercial, +130934,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,TRICARE-Commercial, +130935,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,TRICARE-Commercial, +130936,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,TRICARE-Commercial, +130937,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,TRICARE-Commercial, +130938,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,TRICARE-Commercial, +130939,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,TRICARE-Commercial, +130940,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,TRICARE-Commercial, +130941,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,TRICARE-Commercial, +130942,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,TRICARE-Commercial, +130943,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,TRICARE-Commercial, +130944,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,TRICARE-Commercial, +130945,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,TRICARE-Commercial, +130946,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,TRICARE-Commercial, +130947,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,TRICARE-Commercial, +130948,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,TRICARE-Commercial, +130949,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,TRICARE-Commercial, +130950,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,TRICARE-Commercial, +130951,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,TRICARE-Commercial, +130952,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,TRICARE-Commercial, +130953,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,TRICARE-Commercial, +130954,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,TRICARE-Commercial, +130955,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,TRICARE-Commercial, +130956,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,TRICARE-Commercial, +130957,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,TRICARE-Commercial, +130958,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,TRICARE-Commercial, +130959,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,TRICARE-Commercial, +130960,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,TRICARE-Commercial, +130961,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,TRICARE-Commercial, +130962,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,TRICARE-Commercial, +130963,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,TRICARE-Commercial, +130964,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,TRICARE-Commercial, +130965,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,TRICARE-Commercial, +130966,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,TRICARE-Commercial, +130967,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,TRICARE-Commercial, +130968,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,TRICARE-Commercial, +130969,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,TRICARE-Commercial, +130970,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,TRICARE-Commercial, +130971,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,TRICARE-Commercial, +130972,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,TRICARE-Commercial, +130973,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,TRICARE-Commercial, +130974,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,TRICARE-Commercial, +130975,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,TRICARE-Commercial, +130976,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,TRICARE-Commercial, +130977,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,TRICARE-Commercial, +130978,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,TRICARE-Commercial, +130979,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,TRICARE-Commercial, +130980,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,TRICARE-Commercial, +130981,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,TRICARE-Commercial, +130982,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,TRICARE-Commercial, +130983,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,TRICARE-Commercial, +130984,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,TRICARE-Commercial, +130985,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,TRICARE-Commercial, +130986,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,TRICARE-Commercial, +130987,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,TRICARE-Commercial, +130988,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,TRICARE-Commercial, +130989,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,TRICARE-Commercial, +130990,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,TRICARE-Commercial, +130991,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,TRICARE-Commercial, +130992,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,TRICARE-Commercial, +130993,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,TRICARE-Commercial, +130994,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,TRICARE-Commercial, +130995,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,TRICARE-Commercial, +130996,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,TRICARE-Commercial, +130997,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,TRICARE-Commercial, +130998,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,TRICARE-Commercial, +130999,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,TRICARE-Commercial, +131000,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,TRICARE-Commercial, +131001,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,TRICARE-Commercial, +131002,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,TRICARE-Commercial, +131003,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,TRICARE-Commercial, +131004,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,TRICARE-Commercial, +131005,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,TRICARE-Commercial, +131006,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,TRICARE-Commercial, +131007,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,TRICARE-Commercial, +131008,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,TRICARE-Commercial, +131009,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,TRICARE-Commercial, +131010,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,TRICARE-Commercial, +131011,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,TRICARE-Commercial, +131012,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,TRICARE-Commercial, +131013,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,TRICARE-Commercial, +131014,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,TRICARE-Commercial, +131015,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,TRICARE-Commercial, +131016,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,TRICARE-Commercial, +131017,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,TRICARE-Commercial, +131018,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,TRICARE-Commercial, +131019,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,TRICARE-Commercial, +131020,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,TRICARE-Commercial, +131021,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,TRICARE-Commercial, +131022,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,TRICARE-Commercial, +131023,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,TRICARE-Commercial, +131024,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,TRICARE-Commercial, +131025,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,TRICARE-Commercial, +131026,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,TRICARE-Commercial, +131027,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,TRICARE-Commercial, +131028,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,TRICARE-Commercial, +131029,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,TRICARE-Commercial, +131030,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,TRICARE-Commercial, +131031,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,TRICARE-Commercial, +131032,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,TRICARE-Commercial, +131033,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,TRICARE-Commercial, +131034,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,TRICARE-Commercial, +131035,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,TRICARE-Commercial, +131036,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,TRICARE-Commercial, +131037,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,TRICARE-Commercial, +131038,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,TRICARE-Commercial, +131039,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,TRICARE-Commercial, +131040,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,TRICARE-Commercial, +131041,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,TRICARE-Commercial, +131042,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,TRICARE-Commercial, +131043,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,TRICARE-Commercial, +131044,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,TRICARE-Commercial, +131045,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,TRICARE-Commercial, +131046,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,TRICARE-Commercial, +131047,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,TRICARE-Commercial, +131048,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,TRICARE-Commercial, +131049,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,TRICARE-Commercial, +131050,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,TRICARE-Commercial, +131051,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,TRICARE-Commercial, +131052,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,TRICARE-Commercial, +131053,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,TRICARE-Commercial, +131054,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,TRICARE-Commercial, +131055,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,TRICARE-Commercial, +131056,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,TRICARE-Commercial, +131057,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,TRICARE-Commercial, +131058,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,TRICARE-Commercial, +131059,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,TRICARE-Commercial, +131060,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,TRICARE-Commercial, +131061,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,TRICARE-Commercial, +131062,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,TRICARE-Commercial, +131063,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,TRICARE-Commercial, +131064,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,TRICARE-Commercial, +131065,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,TRICARE-Commercial, +131066,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,TRICARE-Commercial, +131067,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,TRICARE-Commercial, +131068,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,TRICARE-Commercial, +131069,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,TRICARE-Commercial, +131070,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,TRICARE-Commercial, +131071,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,TRICARE-Commercial, +131072,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,TRICARE-Commercial, +131073,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,TRICARE-Commercial, +131074,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,TRICARE-Commercial, +131075,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,TRICARE-Commercial, +131076,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,TRICARE-Commercial, +131077,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,TRICARE-Commercial, +131078,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,TRICARE-Commercial, +131079,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,TRICARE-Commercial, +131080,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,TRICARE-Commercial, +131081,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,TRICARE-Commercial, +131082,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,TRICARE-Commercial, +131083,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,TRICARE-Commercial, +131084,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,TRICARE-Commercial, +131085,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,TRICARE-Commercial, +131086,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,TRICARE-Commercial, +131087,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,TRICARE-Commercial, +131088,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,TRICARE-Commercial, +131089,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,TRICARE-Commercial, +131090,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,TRICARE-Commercial, +131091,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,TRICARE-Commercial, +131092,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,TRICARE-Commercial, +131093,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,TRICARE-Commercial, +131094,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,TRICARE-Commercial, +131095,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,TRICARE-Commercial, +131096,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,TRICARE-Commercial, +131097,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,TRICARE-Commercial, +131098,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,TRICARE-Commercial, +131099,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,TRICARE-Commercial, +131100,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,TRICARE-Commercial, +131101,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,TRICARE-Commercial, +131102,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,TRICARE-Commercial, +131103,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,TRICARE-Commercial, +131104,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,TRICARE-Commercial, +131105,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,TRICARE-Commercial, +131106,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,TRICARE-Commercial, +131107,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,TRICARE-Commercial, +131108,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,TRICARE-Commercial, +131109,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,TRICARE-Commercial, +131110,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,TRICARE-Commercial, +131111,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,TRICARE-Commercial, +131112,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,TRICARE-Commercial, +131113,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,TRICARE-Commercial, +131114,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,TRICARE-Commercial, +131115,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,TRICARE-Commercial, +131116,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,TRICARE-Commercial, +131117,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,TRICARE-Commercial, +131118,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,TRICARE-Commercial, +131119,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,TRICARE-Commercial, +131120,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,TRICARE-Commercial, +131121,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,TRICARE-Commercial, +131122,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,TRICARE-Commercial, +131123,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,TRICARE-Commercial, +131124,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,TRICARE-Commercial, +131125,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,TRICARE-Commercial, +131126,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,TRICARE-Commercial, +131127,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,TRICARE-Commercial, +131128,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,TRICARE-Commercial, +131129,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,TRICARE-Commercial, +131130,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,TRICARE-Commercial, +131131,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,TRICARE-Commercial, +131132,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,TRICARE-Commercial, +131133,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,TRICARE-Commercial, +131134,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,TRICARE-Commercial, +131135,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,TRICARE-Commercial, +131136,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,TRICARE-Commercial, +131137,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,TRICARE-Commercial, +131138,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,TRICARE-Commercial, +131139,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,TRICARE-Commercial, +131140,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,TRICARE-Commercial, +131141,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,TRICARE-Commercial, +131142,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,TRICARE-Commercial, +131143,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,TRICARE-Commercial, +131144,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,TRICARE-Commercial, +131145,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,TRICARE-Commercial, +131146,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,TRICARE-Commercial, +131147,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,TRICARE-Commercial, +131148,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,TRICARE-Commercial, +131149,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,TRICARE-Commercial, +131150,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,TRICARE-Commercial, +131151,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,TRICARE-Commercial, +131152,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,TRICARE-Commercial, +131153,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,TRICARE-Commercial, +131154,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,TRICARE-Commercial, +131155,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,TRICARE-Commercial, +131156,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,TRICARE-Commercial, +131157,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,TRICARE-Commercial, +131158,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,TRICARE-Commercial, +131159,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,TRICARE-Commercial, +131160,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,TRICARE-Commercial, +131161,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,TRICARE-Commercial, +131162,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,TRICARE-Commercial, +131163,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,TRICARE-Commercial, +131164,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,TRICARE-Commercial, +131165,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,TRICARE-Commercial, +131166,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,TRICARE-Commercial, +131167,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,TRICARE-Commercial, +131168,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,TRICARE-Commercial, +131169,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,TRICARE-Commercial, +131170,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,TRICARE-Commercial, +131171,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,TRICARE-Commercial, +131172,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,TRICARE-Commercial, +131173,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,TRICARE-Commercial, +131174,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,TRICARE-Commercial, +131175,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,TRICARE-Commercial, +131176,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,TRICARE-Commercial, +131177,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,TRICARE-Commercial, +131178,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,TRICARE-Commercial, +131179,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,TRICARE-Commercial, +131180,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,TRICARE-Commercial, +131181,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,TRICARE-Commercial, +131182,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,TRICARE-Commercial, +131183,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,TRICARE-Commercial, +131184,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,TRICARE-Commercial, +131185,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,TRICARE-Commercial, +131186,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,TRICARE-Commercial, +131187,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,TRICARE-Commercial, +131188,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,TRICARE-Commercial, +131189,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,TRICARE-Commercial, +131190,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,TRICARE-Commercial, +131191,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,TRICARE-Commercial, +131192,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,TRICARE-Commercial, +131193,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,TRICARE-Commercial, +131194,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,TRICARE-Commercial, +131195,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,TRICARE-Commercial, +131196,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,TRICARE-Commercial, +131197,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,TRICARE-Commercial, +131198,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,TRICARE-Commercial, +131199,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,TRICARE-Commercial, +131200,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,TRICARE-Commercial, +131201,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,TRICARE-Commercial, +131202,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,TRICARE-Commercial, +131203,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,TRICARE-Commercial, +131204,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,TRICARE-Commercial, +131205,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,TRICARE-Commercial, +131206,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,TRICARE-Commercial, +131207,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,TRICARE-Commercial, +131208,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,TRICARE-Commercial, +131209,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,TRICARE-Commercial, +131210,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,TRICARE-Commercial, +131211,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,TRICARE-Commercial, +131212,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,TRICARE-Commercial, +131213,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,TRICARE-Commercial, +131214,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,TRICARE-Commercial, +131215,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,TRICARE-Commercial, +131216,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,TRICARE-Commercial, +131217,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,TRICARE-Commercial, +131218,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,TRICARE-Commercial, +131219,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,TRICARE-Commercial, +131220,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,TRICARE-Commercial, +131221,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,TRICARE-Commercial, +131222,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,TRICARE-Commercial, +131223,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,TRICARE-Commercial, +131224,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,TRICARE-Commercial, +131225,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,TRICARE-Commercial, +131226,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,TRICARE-Commercial, +131227,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,TRICARE-Commercial, +131228,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,TRICARE-Commercial, +131229,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,TRICARE-Commercial, +131230,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,TRICARE-Commercial, +131231,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,TRICARE-Commercial, +131232,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,TRICARE-Commercial, +131233,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,TRICARE-Commercial, +131234,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,TRICARE-Commercial, +131235,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,TRICARE-Commercial, +131236,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,TRICARE-Commercial, +131237,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,TRICARE-Commercial, +131238,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,TRICARE-Commercial, +131239,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,TRICARE-Commercial, +131240,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,TRICARE-Commercial, +131241,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,TRICARE-Commercial, +131242,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,TRICARE-Commercial, +131243,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,TRICARE-Commercial, +131244,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,TRICARE-Commercial, +131245,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,TRICARE-Commercial, +131246,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,TRICARE-Commercial, +131247,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,TRICARE-Commercial, +131248,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,TRICARE-Commercial, +131249,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,TRICARE-Commercial, +131250,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,TRICARE-Commercial, +131251,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,TRICARE-Commercial, +131252,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,TRICARE-Commercial, +131253,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,TRICARE-Commercial, +131254,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,TRICARE-Commercial, +131255,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,TRICARE-Commercial, +131256,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,TRICARE-Commercial, +131257,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,TRICARE-Commercial, +131258,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,TRICARE-Commercial, +131259,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,TRICARE-Commercial, +131260,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,TRICARE-Commercial, +131261,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,TRICARE-Commercial, +131262,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,TRICARE-Commercial, +131263,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,TRICARE-Commercial, +131264,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,TRICARE-Commercial, +131265,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,TRICARE-Commercial, +131266,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,TRICARE-Commercial, +131267,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,TRICARE-Commercial, +131268,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,TRICARE-Commercial, +131269,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,TRICARE-Commercial, +131270,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,TRICARE-Commercial, +131271,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,TRICARE-Commercial, +131272,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,TRICARE-Commercial, +131273,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,TRICARE-Commercial, +131274,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,TRICARE-Commercial, +131275,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,TRICARE-Commercial, +131276,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,TRICARE-Commercial, +131277,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,TRICARE-Commercial, +131278,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,TRICARE-Commercial, +131279,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,TRICARE-Commercial, +131280,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,TRICARE-Commercial, +131281,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,TRICARE-Commercial, +131282,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,TRICARE-Commercial, +131283,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,TRICARE-Commercial, +131284,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,TRICARE-Commercial, +131285,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,TRICARE-Commercial, +131286,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,TRICARE-Commercial, +131287,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,TRICARE-Commercial, +131288,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,TRICARE-Commercial, +131289,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,TRICARE-Commercial, +131290,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,TRICARE-Commercial, +131291,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,TRICARE-Commercial, +131292,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,TRICARE-Commercial, +131293,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,TRICARE-Commercial, +131294,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,TRICARE-Commercial, +131295,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,TRICARE-Commercial, +131296,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,TRICARE-Commercial, +131297,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,TRICARE-Commercial, +131298,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,TRICARE-Commercial, +131299,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,TRICARE-Commercial, +131300,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,TRICARE-Commercial, +131301,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,TRICARE-Commercial, +131302,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,TRICARE-Commercial, +131303,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,TRICARE-Commercial, +131304,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,TRICARE-Commercial, +131305,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,TRICARE-Commercial, +131306,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,TRICARE-Commercial, +131307,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,TRICARE-Commercial, +131308,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,TRICARE-Commercial, +131309,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,TRICARE-Commercial, +131310,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,TRICARE-Commercial, +131311,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,TRICARE-Commercial, +131312,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,TRICARE-Commercial, +131313,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,TRICARE-Commercial, +131314,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,TRICARE-Commercial, +131315,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,TRICARE-Commercial, +131316,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,TRICARE-Commercial, +131317,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,TRICARE-Commercial, +131318,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,TRICARE-Commercial, +131319,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,TRICARE-Commercial, +131320,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,TRICARE-Commercial, +131321,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,TRICARE-Commercial, +131322,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,TRICARE-Commercial, +131323,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,TRICARE-Commercial, +131324,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,TRICARE-Commercial, +131325,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,TRICARE-Commercial, +131326,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,TRICARE-Commercial, +131327,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,TRICARE-Commercial, +131328,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,TRICARE-Commercial, +131329,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,TRICARE-Commercial, +131330,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,TRICARE-Commercial, +131331,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,TRICARE-Commercial, +131332,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,TRICARE-Commercial, +131333,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,TRICARE-Commercial, +131334,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,TRICARE-Commercial, +131335,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,TRICARE-Commercial, +131336,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,TRICARE-Commercial, +131337,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,TRICARE-Commercial, +131338,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,TRICARE-Commercial, +131339,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,TRICARE-Commercial, +131340,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,TRICARE-Commercial, +131341,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,TRICARE-Commercial, +131342,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,TRICARE-Commercial, +131343,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,TRICARE-Commercial, +131344,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,TRICARE-Commercial, +131345,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,TRICARE-Commercial, +131346,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,TRICARE-Commercial, +131347,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,TRICARE-Commercial, +131348,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,TRICARE-Commercial, +131349,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,TRICARE-Commercial, +131350,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,TRICARE-Commercial, +131351,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,TRICARE-Commercial, +131352,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,TRICARE-Commercial, +131353,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,TRICARE-Commercial, +131354,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,TRICARE-Commercial, +131355,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,TRICARE-Commercial, +131356,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,TRICARE-Commercial, +131357,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,TRICARE-Commercial, +131358,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,TRICARE-Commercial, +131359,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,TRICARE-Commercial, +131360,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,TRICARE-Commercial, +131361,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,TRICARE-Commercial, +131362,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,TRICARE-Commercial, +131363,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,TRICARE-Commercial, +131364,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,TRICARE-Commercial, +131365,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,TRICARE-Commercial, +131366,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,TRICARE-Commercial, +131367,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,TRICARE-Commercial, +131368,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,TRICARE-Commercial, +131369,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,TRICARE-Commercial, +131370,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,TRICARE-Commercial, +131371,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,TRICARE-Commercial, +131372,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,TRICARE-Commercial, +131373,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,TRICARE-Commercial, +131374,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,TRICARE-Commercial, +131375,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,TRICARE-Commercial, +131376,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,TRICARE-Commercial, +131377,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,TRICARE-Commercial, +131378,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,TRICARE-Commercial, +131379,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,TRICARE-Commercial, +131380,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,TRICARE-Commercial, +131381,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,TRICARE-Commercial, +131382,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,TRICARE-Commercial, +131383,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,TRICARE-Commercial, +131384,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,TRICARE-Commercial, +131385,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,TRICARE-Commercial, +131386,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,TRICARE-Commercial, +131387,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,TRICARE-Commercial, +131388,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,TRICARE-Commercial, +131389,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,TRICARE-Commercial, +131390,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,TRICARE-Commercial, +131391,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,TRICARE-Commercial, +131392,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,TRICARE-Commercial, +131393,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,TRICARE-Commercial, +131394,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,TRICARE-Commercial, +131395,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,TRICARE-Commercial, +131396,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,TRICARE-Commercial, +131397,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,TRICARE-Commercial, +131398,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,TRICARE-Commercial, +131399,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,TRICARE-Commercial, +131400,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,TRICARE-Commercial, +131401,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,TRICARE-Commercial, +131402,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,TRICARE-Commercial, +131403,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,TRICARE-Commercial, +131404,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,TRICARE-Commercial, +131405,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,TRICARE-Commercial, +131406,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,TRICARE-Commercial, +131407,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,TRICARE-Commercial, +131408,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,TRICARE-Commercial, +131409,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,TRICARE-Commercial, +131410,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,TRICARE-Commercial, +131411,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,TRICARE-Commercial, +131412,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,TRICARE-Commercial, +131413,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,TRICARE-Commercial, +131414,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,TRICARE-Commercial, +131415,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,TRICARE-Commercial, +131416,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,TRICARE-Commercial, +131417,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,TRICARE-Commercial, +131418,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,TRICARE-Commercial, +131419,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,TRICARE-Commercial, +131420,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,TRICARE-Commercial, +131421,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,TRICARE-Commercial, +131422,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,TRICARE-Commercial, +131423,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,TRICARE-Commercial, +131424,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,TRICARE-Commercial, +131425,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,TRICARE-Commercial, +131426,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,TRICARE-Commercial, +131427,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,TRICARE-Commercial, +131428,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,TRICARE-Commercial, +131429,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,TRICARE-Commercial, +131430,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,TRICARE-Commercial, +131431,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,TRICARE-Commercial, +131432,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,TRICARE-Commercial, +131433,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,TRICARE-Commercial, +131434,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,TRICARE-Commercial, +131435,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,TRICARE-Commercial, +131436,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,TRICARE-Commercial, +131437,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,TRICARE-Commercial, +131438,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,TRICARE-Commercial, +131439,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,TRICARE-Commercial, +131440,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,TRICARE-Commercial, +131441,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,TRICARE-Commercial, +131442,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,TRICARE-Commercial, +131443,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,TRICARE-Commercial, +131444,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,TRICARE-Commercial, +131445,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,TRICARE-Commercial, +131446,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,TRICARE-Commercial, +131447,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,TRICARE-Commercial, +131448,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,TRICARE-Commercial, +131449,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,TRICARE-Commercial, +131450,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,TRICARE-Commercial, +131451,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,TRICARE-Commercial, +131452,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,TRICARE-Commercial, +131453,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,TRICARE-Commercial, +131454,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,TRICARE-Commercial, +131455,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,TRICARE-Commercial, +131456,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,TRICARE-Commercial, +131457,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,TRICARE-Commercial, +131458,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,TRICARE-Commercial, +131459,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,TRICARE-Commercial, +131460,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,TRICARE-Commercial, +131461,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,TRICARE-Commercial, +131462,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,TRICARE-Commercial, +131463,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,TRICARE-Commercial, +131464,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,TRICARE-Commercial, +131465,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,TRICARE-Commercial, +131466,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,TRICARE-Commercial, +131467,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,TRICARE-Commercial, +131468,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,TRICARE-Commercial, +131469,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,TRICARE-Commercial, +131470,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,TRICARE-Commercial, +131471,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,TRICARE-Commercial, +131472,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,TRICARE-Commercial, +131473,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,TRICARE-Commercial, +131474,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,TRICARE-Commercial, +131475,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,TRICARE-Commercial, +131476,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,TRICARE-Commercial, +131477,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,TRICARE-Commercial, +131478,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,TRICARE-Commercial, +131479,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,TRICARE-Commercial, +131480,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,TRICARE-Commercial, +131481,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,TRICARE-Commercial, +131482,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,TRICARE-Commercial, +131483,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,TRICARE-Commercial, +131484,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,TRICARE-Commercial, +131485,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,TRICARE-Commercial, +131486,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,TRICARE-Commercial, +131487,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,TRICARE-Commercial, +131488,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,TRICARE-Commercial, +131489,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,TRICARE-Commercial, +131490,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,TRICARE-Commercial, +131491,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,TRICARE-Commercial, +131492,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,TRICARE-Commercial, +131493,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,TRICARE-Commercial, +131494,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,TRICARE-Commercial, +131495,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,TRICARE-Commercial, +131496,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,TRICARE-Commercial, +131497,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,TRICARE-Commercial, +131498,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,TRICARE-Commercial, +131499,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,TRICARE-Commercial, +131500,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,TRICARE-Commercial, +131501,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,TRICARE-Commercial, +131502,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,TRICARE-Commercial, +131503,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,TRICARE-Commercial, +131504,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,TRICARE-Commercial, +131505,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,TRICARE-Commercial, +131506,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,TRICARE-Commercial, +131507,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,TRICARE-Commercial, +131508,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,TRICARE-Commercial, +131509,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,TRICARE-Commercial, +131510,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,TRICARE-Commercial, +131511,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,TRICARE-Commercial, +131512,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,TRICARE-Commercial, +131513,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,TRICARE-Commercial, +131514,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,TRICARE-Commercial, +131515,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,TRICARE-Commercial, +131516,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,TRICARE-Commercial, +131517,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,TRICARE-Commercial, +131518,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,TRICARE-Commercial, +131519,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,TRICARE-Commercial, +131520,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,TRICARE-Commercial, +131521,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,TRICARE-Commercial, +131522,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,TRICARE-Commercial, +131523,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,TRICARE-Commercial, +131524,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,TRICARE-Commercial, +131525,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,TRICARE-Commercial, +131526,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,TRICARE-Commercial, +131527,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,TRICARE-Commercial, +131528,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,TRICARE-Commercial, +131529,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,TRICARE-Commercial, +131530,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,TRICARE-Commercial, +131531,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,TRICARE-Commercial, +131532,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,TRICARE-Commercial, +131533,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,TRICARE-Commercial, +131534,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,TRICARE-Commercial, +131535,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,TRICARE-Commercial, +131536,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,TRICARE-Commercial, +131537,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,TRICARE-Commercial, +131538,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,TRICARE-Commercial, +131539,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,TRICARE-Commercial, +131540,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,TRICARE-Commercial, +131541,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,TRICARE-Commercial, +131542,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,TRICARE-Commercial, +131543,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,TRICARE-Commercial, +131544,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,TRICARE-Commercial, +131545,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,TRICARE-Commercial, +131546,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,TRICARE-Commercial, +131547,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,TRICARE-Commercial, +131548,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,TRICARE-Commercial, +131549,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,TRICARE-Commercial, +131550,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,TRICARE-Commercial, +131551,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,TRICARE-Commercial, +131552,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,TRICARE-Commercial, +131553,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,TRICARE-Commercial, +131554,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,TRICARE-Commercial, +131555,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,TRICARE-Commercial, +131556,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,TRICARE-Commercial, +131557,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,TRICARE-Commercial, +131558,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,TRICARE-Commercial, +131559,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,TRICARE-Commercial, +131560,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,TRICARE-Commercial, +131561,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,TRICARE-Commercial, +131562,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,TRICARE-Commercial, +131563,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,TRICARE-Commercial, +131564,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,TRICARE-Commercial, +131565,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,TRICARE-Commercial, +131566,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,TRICARE-Commercial, +131567,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,TRICARE-Commercial, +131568,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,TRICARE-Commercial, +131569,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,TRICARE-Commercial, +131570,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,TRICARE-Commercial, +131571,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,TRICARE-Commercial, +131572,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,TRICARE-Commercial, +131573,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,TRICARE-Commercial, +131574,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,TRICARE-Commercial, +131575,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,TRICARE-Commercial, +131576,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,TRICARE-Commercial, +131577,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,TRICARE-Commercial, +131578,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,TRICARE-Commercial, +131579,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,TRICARE-Commercial, +131580,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,TRICARE-Commercial, +131581,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,TRICARE-Commercial, +131582,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,TRICARE-Commercial, +131583,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,TRICARE-Commercial, +131584,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,TRICARE-Commercial, +131585,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,TRICARE-Commercial, +131586,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,TRICARE-Commercial, +131587,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,TRICARE-Commercial, +131588,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,TRICARE-Commercial, +131589,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,TRICARE-Commercial, +131590,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,TRICARE-Commercial, +131591,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,TRICARE-Commercial, +131592,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,TRICARE-Commercial, +131593,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,TRICARE-Commercial, +131594,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,TRICARE-Commercial, +131595,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,TRICARE-Commercial, +131596,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,TRICARE-Commercial, +131597,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,TRICARE-Commercial, +131598,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,TRICARE-Commercial, +131599,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,TRICARE-Commercial, +131600,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,TRICARE-Commercial, +131601,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,TRICARE-Commercial, +131602,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,TRICARE-Commercial, +131603,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,TRICARE-Commercial, +131604,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,TRICARE-Commercial, +131605,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,TRICARE-Commercial, +131606,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,TRICARE-Commercial, +131607,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,TRICARE-Commercial, +131608,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,TRICARE-Commercial, +131609,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,TRICARE-Commercial, +131610,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,TRICARE-Commercial, +131611,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,TRICARE-Commercial, +131612,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,TRICARE-Commercial, +131613,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,TRICARE-Commercial, +131614,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,TRICARE-Commercial, +131615,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,TRICARE-Commercial, +131616,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,TRICARE-Commercial, +131617,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,TRICARE-Commercial, +131618,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,TRICARE-Commercial, +131619,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,TRICARE-Commercial, +131620,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,TRICARE-Commercial, +131621,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,TRICARE-Commercial, +131622,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,TRICARE-Commercial, +131623,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,TRICARE-Commercial, +131624,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,TRICARE-Commercial, +131625,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,TRICARE-Commercial, +131626,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,TRICARE-Commercial, +131627,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,TRICARE-Commercial, +131628,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,TRICARE-Commercial, +131629,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,TRICARE-Commercial, +131630,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,TRICARE-Commercial, +131631,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,TRICARE-Commercial, +131632,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,TRICARE-Commercial, +131633,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,TRICARE-Commercial, +131634,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,TRICARE-Commercial, +131635,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,TRICARE-Commercial, +131636,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,TRICARE-Commercial, +131637,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,TRICARE-Commercial, +131638,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,TRICARE-Commercial, +131639,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,TRICARE-Commercial, +131640,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,TRICARE-Commercial, +131641,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,TRICARE-Commercial, +131642,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,TRICARE-Commercial, +131643,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,TRICARE-Commercial, +131644,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,TRICARE-Commercial, +131645,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,TRICARE-Commercial, +131646,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,TRICARE-Commercial, +131647,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,TRICARE-Commercial, +131648,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,TRICARE-Commercial, +131649,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,TRICARE-Commercial, +131650,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,TRICARE-Commercial, +131651,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,TRICARE-Commercial, +131652,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,TRICARE-Commercial, +131653,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,TRICARE-Commercial, +131654,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,TRICARE-Commercial, +131655,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,TRICARE-Commercial, +131656,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,TRICARE-Commercial, +131657,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,TRICARE-Commercial, +131658,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,TRICARE-Commercial, +131659,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,TRICARE-Commercial, +131660,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,TRICARE-Commercial, +131661,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,TRICARE-Commercial, +131662,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,TRICARE-Commercial, +131663,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,TRICARE-Commercial, +131664,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,TRICARE-Commercial, +131665,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,TRICARE-Commercial, +131666,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,TRICARE-Commercial, +131667,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,TRICARE-Commercial, +131668,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,TRICARE-Commercial, +131669,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,TRICARE-Commercial, +131670,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,TRICARE-Commercial, +131671,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,TRICARE-Commercial, +131672,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,TRICARE-Commercial, +131673,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,TRICARE-Commercial, +131674,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,TRICARE-Commercial, +131675,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,TRICARE-Commercial, +131676,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,TRICARE-Commercial, +131677,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,TRICARE-Commercial, +131678,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,TRICARE-Commercial, +131679,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,TRICARE-Commercial, +131680,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,TRICARE-Commercial, +131681,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,TRICARE-Commercial, +131682,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,TRICARE-Commercial, +131683,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,TRICARE-Commercial, +131684,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,TRICARE-Commercial, +131685,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,TRICARE-Commercial, +131686,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,TRICARE-Commercial, +131687,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,TRICARE-Commercial, +131688,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,TRICARE-Commercial, +131689,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,TRICARE-Commercial, +131690,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,TRICARE-Commercial, +131691,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,TRICARE-Commercial, +131692,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,TRICARE-Commercial, +131693,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,TRICARE-Commercial, +131694,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,TRICARE-Commercial, +131695,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,TRICARE-Commercial, +131696,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,TRICARE-Commercial, +131697,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,TRICARE-Commercial, +131698,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,TRICARE-Commercial, +131699,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,TRICARE-Commercial, +131700,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,TRICARE-Commercial, +131701,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,TRICARE-Commercial, +131702,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,TRICARE-Commercial, +131703,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,TRICARE-Commercial, +131704,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,TRICARE-Commercial, +131705,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,TRICARE-Commercial, +131706,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,TRICARE-Commercial, +131707,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,TRICARE-Commercial, +131708,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,TRICARE-Commercial, +131709,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,TRICARE-Commercial, +131710,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,TRICARE-Commercial, +131711,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,TRICARE-Commercial, +131712,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,TRICARE-Commercial, +131713,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,TRICARE-Commercial, +131714,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,TRICARE-Commercial, +131715,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,TRICARE-Commercial, +131716,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,TRICARE-Commercial, +131717,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,TRICARE-Commercial, +131718,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,TRICARE-Commercial, +131719,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,TRICARE-Commercial, +131720,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,TRICARE-Commercial, +131721,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,TRICARE-Commercial, +131722,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,TRICARE-Commercial, +131723,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,TRICARE-Commercial, +131724,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,TRICARE-Commercial, +131725,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,TRICARE-Commercial, +131726,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,TRICARE-Commercial, +131727,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,TRICARE-Commercial, +131728,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,TRICARE-Commercial, +131729,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,TRICARE-Commercial, +131730,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,TRICARE-Commercial, +131731,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,TRICARE-Commercial, +131732,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,TRICARE-Commercial, +131733,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,TRICARE-Commercial, +131734,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,TRICARE-Commercial, +131735,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,TRICARE-Commercial, +131736,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,TRICARE-Commercial, +131737,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,TRICARE-Commercial, +131738,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,TRICARE-Commercial, +131739,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,TRICARE-Commercial, +131740,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,TRICARE-Commercial, +131741,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,TRICARE-Commercial, +131742,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,TRICARE-Commercial, +131743,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,TRICARE-Commercial, +131744,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,TRICARE-Commercial, +131745,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,TRICARE-Commercial, +131746,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,TRICARE-Commercial, +131747,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,TRICARE-Commercial, +131748,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,TRICARE-Commercial, +131749,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,TRICARE-Commercial, +131750,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,TRICARE-Commercial, +131751,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,TRICARE-Commercial, +131752,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,TRICARE-Commercial, +131753,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,TRICARE-Commercial, +131754,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,TRICARE-Commercial, +131755,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,TRICARE-Commercial, +131756,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,TRICARE-Commercial, +131757,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,TRICARE-Commercial, +131758,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,TRICARE-Commercial, +131759,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,TRICARE-Commercial, +131760,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,TRICARE-Commercial, +131761,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,TRICARE-Commercial, +131762,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,TRICARE-Commercial, +131763,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,TRICARE-Commercial, +131764,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,TRICARE-Commercial, +131765,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,TRICARE-Commercial, +131766,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,TRICARE-Commercial, +131767,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,TRICARE-Commercial, +131768,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,TRICARE-Commercial, +131769,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,TRICARE-Commercial, +131770,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,TRICARE-Commercial, +131771,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,TRICARE-Commercial, +131772,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,TRICARE-Commercial, +131773,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,TRICARE-Commercial, +131774,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,TRICARE-Commercial, +131775,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,TRICARE-Commercial, +131776,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,TRICARE-Commercial, +131777,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,TRICARE-Commercial, +131778,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,TRICARE-Commercial, +131779,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,TRICARE-Commercial, +131780,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,TRICARE-Commercial, +131781,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,TRICARE-Commercial, +131782,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,TRICARE-Commercial, +131783,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,TRICARE-Commercial, +131784,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,TRICARE-Commercial, +131785,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,TRICARE-Commercial, +131786,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,TRICARE-Commercial, +131787,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,TRICARE-Commercial, +131788,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,TRICARE-Commercial, +131789,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,TRICARE-Commercial, +131790,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,TRICARE-Commercial, +131791,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,TRICARE-Commercial, +131792,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,TRICARE-Commercial, +131793,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,TRICARE-Commercial, +131794,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,TRICARE-Commercial, +131795,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,TRICARE-Commercial, +131796,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,TRICARE-Commercial, +131797,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,TRICARE-Commercial, +131798,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,TRICARE-Commercial, +131799,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,TRICARE-Commercial, +131800,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,TRICARE-Commercial, +131801,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,TRICARE-Commercial, +131802,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,TRICARE-Commercial, +131803,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,TRICARE-Commercial, +131804,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,TRICARE-Commercial, +131805,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,TRICARE-Commercial, +131806,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,TRICARE-Commercial, +131807,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,TRICARE-Commercial, +131808,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,TRICARE-Commercial, +131809,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,TRICARE-Commercial, +131810,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,TRICARE-Commercial, +131811,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,TRICARE-Commercial, +131812,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,TRICARE-Commercial, +131813,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,TRICARE-Commercial, +131814,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,TRICARE-Commercial, +131815,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,TRICARE-Commercial, +131816,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,TRICARE-Commercial, +131817,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,TRICARE-Commercial, +131818,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,TRICARE-Commercial, +131819,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,TRICARE-Commercial, +131820,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,TRICARE-Commercial, +131821,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,TRICARE-Commercial, +131822,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,TRICARE-Commercial, +131823,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,TRICARE-Commercial, +131824,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,TRICARE-Commercial, +131825,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,TRICARE-Commercial, +131826,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,TRICARE-Commercial, +131827,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,TRICARE-Commercial, +131828,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,TRICARE-Commercial, +131829,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,TRICARE-Commercial, +131830,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,TRICARE-Commercial, +131831,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,TRICARE-Commercial, +131832,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,TRICARE-Commercial, +131833,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,TRICARE-Commercial, +131834,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,TRICARE-Commercial, +131835,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,TRICARE-Commercial, +131836,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,TRICARE-Commercial, +131837,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,TRICARE-Commercial, +131838,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,TRICARE-Commercial, +131839,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,TRICARE-Commercial, +131840,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,TRICARE-Commercial, +131841,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,TRICARE-Commercial, +131842,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,TRICARE-Commercial, +131843,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,TRICARE-Commercial, +131844,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,TRICARE-Commercial, +131845,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,TRICARE-Commercial, +131846,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,TRICARE-Commercial, +131847,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,TRICARE-Commercial, +131848,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,TRICARE-Commercial, +131849,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,TRICARE-Commercial, +131850,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,TRICARE-Commercial, +131851,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,TRICARE-Commercial, +131852,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,TRICARE-Commercial, +131853,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,TRICARE-Commercial, +131854,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,TRICARE-Commercial, +131855,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,TRICARE-Commercial, +131856,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,TRICARE-Commercial, +131857,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,TRICARE-Commercial, +131858,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,TRICARE-Commercial, +131859,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,TRICARE-Commercial, +131860,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,TRICARE-Commercial, +131861,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,TRICARE-Commercial, +131862,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,TRICARE-Commercial, +131863,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,TRICARE-Commercial, +131864,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,TRICARE-Commercial, +131865,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,TRICARE-Commercial, +131866,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,TRICARE-Commercial, +131867,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,TRICARE-Commercial, +131868,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,TRICARE-Commercial, +131869,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,TRICARE-Commercial, +131870,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,TRICARE-Commercial, +131871,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,TRICARE-Commercial, +131872,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,TRICARE-Commercial, +131873,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,TRICARE-Commercial, +131874,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,TRICARE-Commercial, +131875,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,TRICARE-Commercial, +131876,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,TRICARE-Commercial, +131877,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,TRICARE-Commercial, +131878,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,TRICARE-Commercial, +131879,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,TRICARE-Commercial, +131880,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,TRICARE-Commercial, +131881,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,TRICARE-Commercial, +131882,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,TRICARE-Commercial, +131883,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,TRICARE-Commercial, +131884,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,TRICARE-Commercial, +131885,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,TRICARE-Commercial, +131886,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,TRICARE-Commercial, +131887,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,TRICARE-Commercial, +131888,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,TRICARE-Commercial, +131889,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,TRICARE-Commercial, +131890,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,TRICARE-Commercial, +131891,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,TRICARE-Commercial, +131892,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,TRICARE-Commercial, +131893,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,TRICARE-Commercial, +131894,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,TRICARE-Commercial, +131895,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,TRICARE-Commercial, +131896,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,TRICARE-Commercial, +131897,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,TRICARE-Commercial, +131898,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,TRICARE-Commercial, +131899,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,TRICARE-Commercial, +131900,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,TRICARE-Commercial, +131901,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,TRICARE-Commercial, +131902,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,TRICARE-Commercial, +131903,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,TRICARE-Commercial, +131904,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,TRICARE-Commercial, +131905,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,TRICARE-Commercial, +131906,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,TRICARE-Commercial, +131907,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,TRICARE-Commercial, +131908,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,TRICARE-Commercial, +131909,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,TRICARE-Commercial, +131910,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,TRICARE-Commercial, +131911,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,TRICARE-Commercial, +131912,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,TRICARE-Commercial, +131913,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,TRICARE-Commercial, +131914,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,TRICARE-Commercial, +131915,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,TRICARE-Commercial, +131916,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,TRICARE-Commercial, +131917,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,TRICARE-Commercial, +131918,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,TRICARE-Commercial, +131919,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,TRICARE-Commercial, +131920,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,TRICARE-Commercial, +131921,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,TRICARE-Commercial, +131922,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,TRICARE-Commercial, +131923,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,TRICARE-Commercial, +131924,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,TRICARE-Commercial, +131925,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,TRICARE-Commercial, +131926,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,TRICARE-Commercial, +131927,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,TRICARE-Commercial, +131928,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,TRICARE-Commercial, +131929,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,TRICARE-Commercial, +131930,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,TRICARE-Commercial, +131931,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,TRICARE-Commercial, +131932,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,TRICARE-Commercial, +131933,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,TRICARE-Commercial, +131934,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,TRICARE-Commercial, +131935,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,TRICARE-Commercial, +131936,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,TRICARE-Commercial, +131937,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,TRICARE-Commercial, +131938,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,TRICARE-Commercial, +131939,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,TRICARE-Commercial, +131940,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,TRICARE-Commercial, +131941,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,TRICARE-Commercial, +131942,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,TRICARE-Commercial, +131943,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,TRICARE-Commercial, +131944,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,TRICARE-Commercial, +131945,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,TRICARE-Commercial, +131946,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,TRICARE-Commercial, +131947,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,TRICARE-Commercial, +131948,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,TRICARE-Commercial, +131949,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,TRICARE-Commercial, +131950,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,TRICARE-Commercial, +131951,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,TRICARE-Commercial, +131952,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,TRICARE-Commercial, +131953,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,TRICARE-Commercial, +131954,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,TRICARE-Commercial, +131955,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,TRICARE-Commercial, +131956,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,TRICARE-Commercial, +131957,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,TRICARE-Commercial, +131958,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,TRICARE-Commercial, +131959,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,TRICARE-Commercial, +131960,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,TRICARE-Commercial, +131961,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,TRICARE-Commercial, +131962,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,TRICARE-Commercial, +131963,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,TRICARE-Commercial, +131964,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,TRICARE-Commercial, +131965,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,TRICARE-Commercial, +131966,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,TRICARE-Commercial, +131967,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,TRICARE-Commercial, +131968,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,TRICARE-Commercial, +131969,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,TRICARE-Commercial, +131970,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,TRICARE-Commercial, +131971,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,TRICARE-Commercial, +131972,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,TRICARE-Commercial, +131973,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,TRICARE-Commercial, +131974,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,TRICARE-Commercial, +131975,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,TRICARE-Commercial, +131976,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,TRICARE-Commercial, +131977,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,TRICARE-Commercial, +131978,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,TRICARE-Commercial, +131979,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,TRICARE-Commercial, +131980,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,TRICARE-Commercial, +131981,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,TRICARE-Commercial, +131982,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,TRICARE-Commercial, +131983,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,TRICARE-Commercial, +131984,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,TRICARE-Commercial, +131985,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,TRICARE-Commercial, +131986,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,TRICARE-Commercial, +131987,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,TRICARE-Commercial, +131988,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,TRICARE-Commercial, +131989,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,TRICARE-Commercial, +131990,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,TRICARE-Commercial, +131991,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,TRICARE-Commercial, +131992,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,TRICARE-Commercial, +131993,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,TRICARE-Commercial, +131994,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,TRICARE-Commercial, +131995,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,TRICARE-Commercial, +131996,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,TRICARE-Commercial, +131997,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,TRICARE-Commercial, +131998,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,TRICARE-Commercial, +131999,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,TRICARE-Commercial, +132000,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,TRICARE-Commercial, +132001,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,TRICARE-Commercial, +132002,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,TRICARE-Commercial, +132003,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,TRICARE-Commercial, +132004,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,TRICARE-Commercial, +132005,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,TRICARE-Commercial, +132006,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,TRICARE-Commercial, +132007,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,TRICARE-Commercial, +132008,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,TRICARE-Commercial, +132009,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,TRICARE-Commercial, +132010,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,TRICARE-Commercial, +132011,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,TRICARE-Commercial, +132012,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,TRICARE-Commercial, +132013,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,TRICARE-Commercial, +132014,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,TRICARE-Commercial, +132015,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,TRICARE-Commercial, +132016,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,TRICARE-Commercial, +132017,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,TRICARE-Commercial, +132018,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,TRICARE-Commercial, +132019,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,TRICARE-Commercial, +132020,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,TRICARE-Commercial, +132021,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,TRICARE-Commercial, +132022,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,TRICARE-Commercial, +132023,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,TRICARE-Commercial, +132024,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,TRICARE-Commercial, +132025,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,TRICARE-Commercial, +132026,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,TRICARE-Commercial, +132027,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,TRICARE-Commercial, +132028,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,TRICARE-Commercial, +132029,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,TRICARE-Commercial, +132030,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,TRICARE-Commercial, +132031,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,TRICARE-Commercial, +132032,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,TRICARE-Commercial, +132033,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,TRICARE-Commercial, +132034,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,TRICARE-Commercial, +132035,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,TRICARE-Commercial, +132036,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,TRICARE-Commercial, +132037,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,TRICARE-Commercial, +132038,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,TRICARE-Commercial, +132039,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,TRICARE-Commercial, +132040,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,TRICARE-Commercial, +132041,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,TRICARE-Commercial, +132042,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,TRICARE-Commercial, +132043,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,TRICARE-Commercial, +132044,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,TRICARE-Commercial, +132045,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,TRICARE-Commercial, +132046,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,TRICARE-Commercial, +132047,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,TRICARE-Commercial, +132048,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,TRICARE-Commercial, +132049,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,TRICARE-Commercial, +132050,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,TRICARE-Commercial, +132051,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,TRICARE-Commercial, +132052,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,TRICARE-Commercial, +132053,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,TRICARE-Commercial, +132054,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,TRICARE-Commercial, +132055,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,TRICARE-Commercial, +132056,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,TRICARE-Commercial, +132057,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,TRICARE-Commercial, +132058,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,TRICARE-Commercial, +132059,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,TRICARE-Commercial, +132060,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,TRICARE-Commercial, +132061,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,TRICARE-Commercial, +132062,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,TRICARE-Commercial, +132063,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,TRICARE-Commercial, +132064,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,TRICARE-Commercial, +132065,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,TRICARE-Commercial, +132066,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,TRICARE-Commercial, +132067,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,TRICARE-Commercial, +132068,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,TRICARE-Commercial, +132069,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,TRICARE-Commercial, +132070,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,TRICARE-Commercial, +132071,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,TRICARE-Commercial, +132072,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,TRICARE-Commercial, +132073,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,TRICARE-Commercial, +132074,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,TRICARE-Commercial, +132075,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,TRICARE-Commercial, +132076,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,TRICARE-Commercial, +132077,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,TRICARE-Commercial, +132078,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,TRICARE-Commercial, +132079,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,TRICARE-Commercial, +132080,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,TRICARE-Commercial, +132081,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,TRICARE-Commercial, +132082,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,TRICARE-Commercial, +132083,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,TRICARE-Commercial, +132084,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,TRICARE-Commercial, +132085,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,TRICARE-Commercial, +132086,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,TRICARE-Commercial, +132087,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,TRICARE-Commercial, +132088,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,TRICARE-Commercial, +132089,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,TRICARE-Commercial, +132090,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,TRICARE-Commercial, +132091,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,TRICARE-Commercial, +132092,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,TRICARE-Commercial, +132093,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,TRICARE-Commercial, +132094,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,TRICARE-Commercial, +132095,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,TRICARE-Commercial, +132096,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,TRICARE-Commercial, +132097,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,TRICARE-Commercial, +132098,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,TRICARE-Commercial, +132099,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,TRICARE-Commercial, +132100,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,TRICARE-Commercial, +132101,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,TRICARE-Commercial, +132102,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,TRICARE-Commercial, +132103,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,TRICARE-Commercial, +132104,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,TRICARE-Commercial, +132105,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,TRICARE-Commercial, +132106,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,TRICARE-Commercial, +132107,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,TRICARE-Commercial, +132108,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,TRICARE-Commercial, +132109,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,TRICARE-Commercial, +132110,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,TRICARE-Commercial, +132111,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,TRICARE-Commercial, +132112,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,TRICARE-Commercial, +132113,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,TRICARE-Commercial, +132114,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,TRICARE-Commercial, +132115,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,TRICARE-Commercial, +132116,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,TRICARE-Commercial, +132117,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,TRICARE-Commercial, +132118,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,TRICARE-Commercial, +132119,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,TRICARE-Commercial, +132120,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,TRICARE-Commercial, +132121,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,TRICARE-Commercial, +132122,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,TRICARE-Commercial, +132123,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,TRICARE-Commercial, +132124,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,TRICARE-Commercial, +132125,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,TRICARE-Commercial, +132126,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,TRICARE-Commercial, +132127,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,TRICARE-Commercial, +132128,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,TRICARE-Commercial, +132129,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,TRICARE-Commercial, +132130,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,TRICARE-Commercial, +132131,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,TRICARE-Commercial, +132132,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,TRICARE-Commercial, +132133,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,TRICARE-Commercial, +132134,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,TRICARE-Commercial, +132135,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,TRICARE-Commercial, +132136,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,TRICARE-Commercial, +132137,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,TRICARE-Commercial, +132138,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,TRICARE-Commercial, +132139,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,TRICARE-Commercial, +132140,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,TRICARE-Commercial, +132141,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,TRICARE-Commercial, +132142,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,TRICARE-Commercial, +132143,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,TRICARE-Commercial, +132144,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,TRICARE-Commercial, +132145,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,TRICARE-Commercial, +132146,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,TRICARE-Commercial, +132147,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,TRICARE-Commercial, +132148,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,TRICARE-Commercial, +132149,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,TRICARE-Commercial, +132150,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,TRICARE-Commercial, +132151,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,TRICARE-Commercial, +132152,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,TRICARE-Commercial, +132153,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,TRICARE-Commercial, +132154,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,TRICARE-Commercial, +132155,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,TRICARE-Commercial, +132156,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,TRICARE-Commercial, +132157,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,TRICARE-Commercial, +132158,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,TRICARE-Commercial, +132159,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,TRICARE-Commercial, +132160,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,TRICARE-Commercial, +132161,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,TRICARE-Commercial, +132162,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,TRICARE-Commercial, +132163,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,TRICARE-Commercial, +132164,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,TRICARE-Commercial, +132165,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,TRICARE-Commercial, +132166,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,TRICARE-Commercial, +132167,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,TRICARE-Commercial, +132168,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,TRICARE-Commercial, +132169,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,TRICARE-Commercial, +132170,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,TRICARE-Commercial, +132171,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,TRICARE-Commercial, +132172,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,TRICARE-Commercial, +132173,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,TRICARE-Commercial, +132174,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,TRICARE-Commercial, +132175,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,TRICARE-Commercial, +132176,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,TRICARE-Commercial, +132177,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,TRICARE-Commercial, +132178,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,TRICARE-Commercial, +132179,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,TRICARE-Commercial, +132180,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,TRICARE-Commercial, +132181,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,TRICARE-Commercial, +132182,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,TRICARE-Commercial, +132183,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,TRICARE-Commercial, +132184,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,TRICARE-Commercial, +132185,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,TRICARE-Commercial, +132186,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,TRICARE-Commercial, +132187,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,TRICARE-Commercial, +132188,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,TRICARE-Commercial, +132189,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,TRICARE-Commercial, +132190,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,TRICARE-Commercial, +132191,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,TRICARE-Commercial, +132192,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,TRICARE-Commercial, +132193,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,TRICARE-Commercial, +132194,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,TRICARE-Commercial, +132195,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,TRICARE-Commercial, +132196,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,TRICARE-Commercial, +132197,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,TRICARE-Commercial, +132198,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,TRICARE-Commercial, +132199,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,TRICARE-Commercial, +132200,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,TRICARE-Commercial, +132201,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,TRICARE-Commercial, +132202,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,TRICARE-Commercial, +132203,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,TRICARE-Commercial, +132204,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,TRICARE-Commercial, +132205,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,TRICARE-Commercial, +132206,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,TRICARE-Commercial, +132207,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,TRICARE-Commercial, +132208,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,TRICARE-Commercial, +132209,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,TRICARE-Commercial, +132210,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,TRICARE-Commercial, +132211,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,TRICARE-Commercial, +132212,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,TRICARE-Commercial, +132213,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,TRICARE-Commercial, +132214,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,TRICARE-Commercial, +132215,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,TRICARE-Commercial, +132216,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,TRICARE-Commercial, +132217,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,TRICARE-Commercial, +132218,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,TRICARE-Commercial, +132219,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,TRICARE-Commercial, +132220,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,TRICARE-Commercial, +132221,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,TRICARE-Commercial, +132222,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,TRICARE-Commercial, +132223,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,TRICARE-Commercial, +132224,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,TRICARE-Commercial, +132225,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,TRICARE-Commercial, +132226,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,TRICARE-Commercial, +132227,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,TRICARE-Commercial, +132228,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,TRICARE-Commercial, +132229,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,TRICARE-Commercial, +132230,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,TRICARE-Commercial, +132231,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,TRICARE-Commercial, +132232,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,TRICARE-Commercial, +132233,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,TRICARE-Commercial, +132234,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,TRICARE-Commercial, +132235,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,TRICARE-Commercial, +132236,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,TRICARE-Commercial, +132237,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,TRICARE-Commercial, +132238,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,TRICARE-Commercial, +132239,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,TRICARE-Commercial, +132240,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,TRICARE-Commercial, +132241,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,TRICARE-Commercial, +132242,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,TRICARE-Commercial, +132243,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,TRICARE-Commercial, +132244,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,TRICARE-Commercial, +132245,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,TRICARE-Commercial, +132246,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,TRICARE-Commercial, +132247,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,TRICARE-Commercial, +132248,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,TRICARE-Commercial, +132249,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,TRICARE-Commercial, +132250,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,TRICARE-Commercial, +132251,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,TRICARE-Commercial, +132252,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,TRICARE-Commercial, +132253,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,TRICARE-Commercial, +132254,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,TRICARE-Commercial, +132255,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,TRICARE-Commercial, +132256,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,TRICARE-Commercial, +132257,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,TRICARE-Commercial, +132258,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,TRICARE-Commercial, +132259,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,TRICARE-Commercial, +132260,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,TRICARE-Commercial, +132261,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,TRICARE-Commercial, +132262,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,TRICARE-Commercial, +132263,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,TRICARE-Commercial, +132264,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,TRICARE-Commercial, +132265,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,TRICARE-Commercial, +132266,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,TRICARE-Commercial, +132267,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,TRICARE-Commercial, +132268,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,TRICARE-Commercial, +132269,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,TRICARE-Commercial, +132270,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,TRICARE-Commercial, +132271,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,TRICARE-Commercial, +132272,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,TRICARE-Commercial, +132273,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,TRICARE-Commercial, +132274,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,TRICARE-Commercial, +132275,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,TRICARE-Commercial, +132276,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,TRICARE-Commercial, +132277,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,TRICARE-Commercial, +132278,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,TRICARE-Commercial, +132279,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,TRICARE-Commercial, +132280,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,TRICARE-Commercial, +132281,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,TRICARE-Commercial, +132282,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,TRICARE-Commercial, +132283,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,TRICARE-Commercial, +132284,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,TRICARE-Commercial, +132285,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,TRICARE-Commercial, +132286,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,TRICARE-Commercial, +132287,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,TRICARE-Commercial, +132288,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,TRICARE-Commercial, +132289,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,TRICARE-Commercial, +132290,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,TRICARE-Commercial, +132291,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,TRICARE-Commercial, +132292,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,TRICARE-Commercial, +132293,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,TRICARE-Commercial, +132294,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,TRICARE-Commercial, +132295,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,TRICARE-Commercial, +132296,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,TRICARE-Commercial, +132297,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,TRICARE-Commercial, +132298,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,TRICARE-Commercial, +132299,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,TRICARE-Commercial, +132300,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,TRICARE-Commercial, +132301,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,TRICARE-Commercial, +132302,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,TRICARE-Commercial, +132303,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,TRICARE-Commercial, +132304,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,TRICARE-Commercial, +132305,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,TRICARE-Commercial, +132306,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,TRICARE-Commercial, +132307,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,TRICARE-Commercial, +132308,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,TRICARE-Commercial, +132309,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,TRICARE-Commercial, +132310,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,TRICARE-Commercial, +132311,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,TRICARE-Commercial, +132312,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,TRICARE-Commercial, +132313,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,TRICARE-Commercial, +132314,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,TRICARE-Commercial, +132315,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,TRICARE-Commercial, +132316,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,TRICARE-Commercial, +132317,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,TRICARE-Commercial, +132318,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,TRICARE-Commercial, +132319,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,TRICARE-Commercial, +132320,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,TRICARE-Commercial, +132321,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,TRICARE-Commercial, +132322,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,TRICARE-Commercial, +132323,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,TRICARE-Commercial, +132324,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,TRICARE-Commercial, +132325,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,TRICARE-Commercial, +132326,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,TRICARE-Commercial, +132327,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,TRICARE-Commercial, +132328,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,TRICARE-Commercial, +132329,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,TRICARE-Commercial, +132330,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,TRICARE-Commercial, +132331,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,TRICARE-Commercial, +132332,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,TRICARE-Commercial, +132333,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,TRICARE-Commercial, +132334,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,TRICARE-Commercial, +132335,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,TRICARE-Commercial, +132336,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,TRICARE-Commercial, +132337,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,TRICARE-Commercial, +132338,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,TRICARE-Commercial, +132339,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,TRICARE-Commercial, +132340,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,TRICARE-Commercial, +132341,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,TRICARE-Commercial, +132342,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,TRICARE-Commercial, +132343,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,TRICARE-Commercial, +132344,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,TRICARE-Commercial, +132345,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,TRICARE-Commercial, +132346,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,TRICARE-Commercial, +132347,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,TRICARE-Commercial, +132348,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,TRICARE-Commercial, +132349,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,TRICARE-Commercial, +132350,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,TRICARE-Commercial, +132351,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,TRICARE-Commercial, +132352,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,TRICARE-Commercial, +132353,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,TRICARE-Commercial, +132354,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,TRICARE-Commercial, +132355,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,TRICARE-Commercial, +132356,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,TRICARE-Commercial, +132357,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,TRICARE-Commercial, +132358,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,TRICARE-Commercial, +132359,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,TRICARE-Commercial, +132360,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,TRICARE-Commercial, +132361,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,TRICARE-Commercial, +132362,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,TRICARE-Commercial, +132363,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,TRICARE-Commercial, +132364,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,TRICARE-Commercial, +132365,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,TRICARE-Commercial, +132366,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,TRICARE-Commercial, +132367,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,TRICARE-Commercial, +132368,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,TRICARE-Commercial, +132369,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,TRICARE-Commercial, +132370,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,TRICARE-Commercial, +132371,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,TRICARE-Commercial, +132372,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,TRICARE-Commercial, +132373,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,TRICARE-Commercial, +132374,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,TRICARE-Commercial, +132375,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,TRICARE-Commercial, +132376,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,TRICARE-Commercial, +132377,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,TRICARE-Commercial, +132378,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,TRICARE-Commercial, +132379,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,TRICARE-Commercial, +132380,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,TRICARE-Commercial, +132381,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,TRICARE-Commercial, +132382,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,TRICARE-Commercial, +132383,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,TRICARE-Commercial, +132384,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,TRICARE-Commercial, +132385,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,TRICARE-Commercial, +132386,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,TRICARE-Commercial, +132387,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,TRICARE-Commercial, +132388,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,TRICARE-Commercial, +132389,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,TRICARE-Commercial, +132390,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,TRICARE-Commercial, +132391,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,TRICARE-Commercial, +132392,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,TRICARE-Commercial, +132393,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,TRICARE-Commercial, +132394,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,TRICARE-Commercial, +132395,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,TRICARE-Commercial, +132396,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,TRICARE-Commercial, +132397,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,TRICARE-Commercial, +132398,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,TRICARE-Commercial, +132399,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,TRICARE-Commercial, +132400,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,TRICARE-Commercial, +132401,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,TRICARE-Commercial, +132402,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,TRICARE-Commercial, +132403,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,TRICARE-Commercial, +132404,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,TRICARE-Commercial, +132405,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,TRICARE-Commercial, +132406,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,TRICARE-Commercial, +132407,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,TRICARE-Commercial, +132408,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,TRICARE-Commercial, +132409,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,TRICARE-Commercial, +132410,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,TRICARE-Commercial, +132411,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,TRICARE-Commercial, +132412,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,TRICARE-Commercial, +132413,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,TRICARE-Commercial, +132414,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,TRICARE-Commercial, +132415,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,TRICARE-Commercial, +132416,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,TRICARE-Commercial, +132417,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,TRICARE-Commercial, +132418,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,TRICARE-Commercial, +132419,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,TRICARE-Commercial, +132420,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,TRICARE-Commercial, +132421,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,TRICARE-Commercial, +132422,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,TRICARE-Commercial, +132423,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,TRICARE-Commercial, +132424,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,TRICARE-Commercial, +132425,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,TRICARE-Commercial, +132426,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,TRICARE-Commercial, +132427,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,TRICARE-Commercial, +132428,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,TRICARE-Commercial, +132429,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,TRICARE-Commercial, +132430,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,TRICARE-Commercial, +132431,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,TRICARE-Commercial, +132432,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,TRICARE-Commercial, +132433,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,TRICARE-Commercial, +132434,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,TRICARE-Commercial, +132435,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,TRICARE-Commercial, +132436,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,TRICARE-Commercial, +132437,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,TRICARE-Commercial, +132438,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,TRICARE-Commercial, +132439,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,TRICARE-Commercial, +132440,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,TRICARE-Commercial, +132441,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,TRICARE-Commercial, +132442,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,TRICARE-Commercial, +132443,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,TRICARE-Commercial, +132444,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,TRICARE-Commercial, +132445,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,TRICARE-Commercial, +132446,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,TRICARE-Commercial, +132447,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,TRICARE-Commercial, +132448,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,TRICARE-Commercial, +132449,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,TRICARE-Commercial, +132450,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,TRICARE-Commercial, +132451,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,TRICARE-Commercial, +132452,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,TRICARE-Commercial, +132453,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,TRICARE-Commercial, +132454,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,TRICARE-Commercial, +132455,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,TRICARE-Commercial, +132456,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,TRICARE-Commercial, +132457,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,TRICARE-Commercial, +132458,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,TRICARE-Commercial, +132459,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,TRICARE-Commercial, +132460,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,TRICARE-Commercial, +132461,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,TRICARE-Commercial, +132462,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,TRICARE-Commercial, +132463,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,TRICARE-Commercial, +132464,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,TRICARE-Commercial, +132465,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,TRICARE-Commercial, +132466,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,TRICARE-Commercial, +132467,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,TRICARE-Commercial, +132468,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,TRICARE-Commercial, +132469,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,TRICARE-Commercial, +132470,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,TRICARE-Commercial, +132471,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,TRICARE-Commercial, +132472,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,TRICARE-Commercial, +132473,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,TRICARE-Commercial, +132474,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,TRICARE-Commercial, +132475,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,TRICARE-Commercial, +132476,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,TRICARE-Commercial, +132477,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,TRICARE-Commercial, +132478,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,TRICARE-Commercial, +132479,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,TRICARE-Commercial, +132480,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,TRICARE-Commercial, +132481,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,TRICARE-Commercial, +132482,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,TRICARE-Commercial, +132483,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,TRICARE-Commercial, +132484,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,TRICARE-Commercial, +132485,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,TRICARE-Commercial, +132486,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,TRICARE-Commercial, +132487,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,TRICARE-Commercial, +132488,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,TRICARE-Commercial, +132489,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,TRICARE-Commercial, +132490,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,TRICARE-Commercial, +132491,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,TRICARE-Commercial, +132492,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,TRICARE-Commercial, +132493,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,TRICARE-Commercial, +132494,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,TRICARE-Commercial, +132495,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,TRICARE-Commercial, +132496,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,TRICARE-Commercial, +132497,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,TRICARE-Commercial, +132498,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,TRICARE-Commercial, +132499,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,TRICARE-Commercial, +132500,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,TRICARE-Commercial, +132501,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,TRICARE-Commercial, +132502,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,TRICARE-Commercial, +132503,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,TRICARE-Commercial, +132504,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,TRICARE-Commercial, +132505,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,TRICARE-Commercial, +132506,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,TRICARE-Commercial, +132507,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,TRICARE-Commercial, +132508,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,TRICARE-Commercial, +132509,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,TRICARE-Commercial, +132510,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,TRICARE-Commercial, +132511,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,TRICARE-Commercial, +132512,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,TRICARE-Commercial, +132513,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,TRICARE-Commercial, +132514,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,TRICARE-Commercial, +132515,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,TRICARE-Commercial, +132516,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,TRICARE-Commercial, +132517,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,TRICARE-Commercial, +132518,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,TRICARE-Commercial, +132519,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,TRICARE-Commercial, +132520,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,TRICARE-Commercial, +132521,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,TRICARE-Commercial, +132522,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,TRICARE-Commercial, +132523,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,TRICARE-Commercial, +132524,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,TRICARE-Commercial, +132525,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,TRICARE-Commercial, +132526,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,TRICARE-Commercial, +132527,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,TRICARE-Commercial, +132528,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,TRICARE-Commercial, +132529,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,TRICARE-Commercial, +132530,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,TRICARE-Commercial, +132531,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,TRICARE-Commercial, +132532,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,TRICARE-Commercial, +132533,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,TRICARE-Commercial, +132534,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,TRICARE-Commercial, +132535,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,TRICARE-Commercial, +132536,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,TRICARE-Commercial, +132537,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,TRICARE-Commercial, +132538,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,TRICARE-Commercial, +132539,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,TRICARE-Commercial, +132540,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,TRICARE-Commercial, +132541,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,TRICARE-Commercial, +132542,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,TRICARE-Commercial, +132543,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,TRICARE-Commercial, +132544,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,TRICARE-Commercial, +132545,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,TRICARE-Commercial, +132546,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,TRICARE-Commercial, +132547,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,TRICARE-Commercial, +132548,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,TRICARE-Commercial, +132549,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,TRICARE-Commercial, +132550,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,TRICARE-Commercial, +132551,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,TRICARE-Commercial, +132552,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,TRICARE-Commercial, +132553,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,TRICARE-Commercial, +132554,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,TRICARE-Commercial, +132555,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,TRICARE-Commercial, +132556,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,TRICARE-Commercial, +132557,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,TRICARE-Commercial, +132558,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,TRICARE-Commercial, +132559,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,TRICARE-Commercial, +132560,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,TRICARE-Commercial, +132561,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,TRICARE-Commercial, +132562,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,TRICARE-Commercial, +132563,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,TRICARE-Commercial, +132564,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,TRICARE-Commercial, +132565,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,TRICARE-Commercial, +132566,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,TRICARE-Commercial, +132567,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,TRICARE-Commercial, +132568,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,TRICARE-Commercial, +132569,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,TRICARE-Commercial, +132570,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,TRICARE-Commercial, +132571,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,TRICARE-Commercial, +132572,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,TRICARE-Commercial, +132573,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,TRICARE-Commercial, +132574,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,TRICARE-Commercial, +132575,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,TRICARE-Commercial, +132576,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,TRICARE-Commercial, +132577,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,TRICARE-Commercial, +132578,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,TRICARE-Commercial, +132579,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,TRICARE-Commercial, +132580,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,TRICARE-Commercial, +132581,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,TRICARE-Commercial, +132582,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,TRICARE-Commercial, +132583,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,TRICARE-Commercial, +132584,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,TRICARE-Commercial, +132585,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,TRICARE-Commercial, +132586,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,TRICARE-Commercial, +132587,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,TRICARE-Commercial, +132588,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,TRICARE-Commercial, +132589,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,TRICARE-Commercial, +132590,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,TRICARE-Commercial, +132591,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,TRICARE-Commercial, +132592,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,TRICARE-Commercial, +132593,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,TRICARE-Commercial, +132594,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,TRICARE-Commercial, +132595,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,TRICARE-Commercial, +132596,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,TRICARE-Commercial, +132597,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,TRICARE-Commercial, +132598,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,TRICARE-Commercial, +132599,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,TRICARE-Commercial, +132600,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,TRICARE-Commercial, +132601,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,TRICARE-Commercial, +132602,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,TRICARE-Commercial, +132603,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,TRICARE-Commercial, +132604,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,TRICARE-Commercial, +132605,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,TRICARE-Commercial, +132606,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,TRICARE-Commercial, +132607,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,TRICARE-Commercial, +132608,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,TRICARE-Commercial, +132609,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,TRICARE-Commercial, +132610,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,TRICARE-Commercial, +132611,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,TRICARE-Commercial, +132612,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,TRICARE-Commercial, +132613,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,TRICARE-Commercial, +132614,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,TRICARE-Commercial, +132615,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,TRICARE-Commercial, +132616,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,TRICARE-Commercial, +132617,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,TRICARE-Commercial, +132618,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,TRICARE-Commercial, +132619,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,TRICARE-Commercial, +132620,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,TRICARE-Commercial, +132621,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,TRICARE-Commercial, +132622,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,TRICARE-Commercial, +132623,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,TRICARE-Commercial, +132624,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,TRICARE-Commercial, +132625,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,TRICARE-Commercial, +132626,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,TRICARE-Commercial, +132627,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,TRICARE-Commercial, +132628,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,TRICARE-Commercial, +132629,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,TRICARE-Commercial, +132630,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,TRICARE-Commercial, +132631,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,TRICARE-Commercial, +132632,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,TRICARE-Commercial, +132633,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,TRICARE-Commercial, +132634,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,TRICARE-Commercial, +132635,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,TRICARE-Commercial, +132636,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,TRICARE-Commercial, +132637,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,TRICARE-Commercial, +132638,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,TRICARE-Commercial, +132639,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,TRICARE-Commercial, +132640,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,TRICARE-Commercial, +132641,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,TRICARE-Commercial, +132642,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,TRICARE-Commercial, +132643,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,TRICARE-Commercial, +132644,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,TRICARE-Commercial, +132645,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,TRICARE-Commercial, +132646,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,TRICARE-Commercial, +132647,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,TRICARE-Commercial, +132648,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,TRICARE-Commercial, +132649,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,TRICARE-Commercial, +132650,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,TRICARE-Commercial, +132651,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,TRICARE-Commercial, +132652,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,TRICARE-Commercial, +132653,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,TRICARE-Commercial, +132654,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,TRICARE-Commercial, +132655,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,TRICARE-Commercial, +132656,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,TRICARE-Commercial, +132657,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,TRICARE-Commercial, +132658,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,TRICARE-Commercial, +132659,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,TRICARE-Commercial, +132660,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,TRICARE-Commercial, +132661,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,TRICARE-Commercial, +132662,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,TRICARE-Commercial, +132663,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,TRICARE-Commercial, +132664,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,TRICARE-Commercial, +132665,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,TRICARE-Commercial, +132666,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,TRICARE-Commercial, +132667,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,TRICARE-Commercial, +132668,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,TRICARE-Commercial, +132669,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,TRICARE-Commercial, +132670,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,TRICARE-Commercial, +132671,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,TRICARE-Commercial, +132672,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,TRICARE-Commercial, +132673,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,TRICARE-Commercial, +132674,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,TRICARE-Commercial, +132675,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,TRICARE-Commercial, +132676,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,TRICARE-Commercial, +132677,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,TRICARE-Commercial, +132678,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,TRICARE-Commercial, +132679,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,TRICARE-Commercial, +132680,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,TRICARE-Commercial, +132681,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,TRICARE-Commercial, +132682,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,TRICARE-Commercial, +132683,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,TRICARE-Commercial, +132684,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,TRICARE-Commercial, +132685,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,TRICARE-Commercial, +132686,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,TRICARE-Commercial, +132687,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,TRICARE-Commercial, +132688,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,TRICARE-Commercial, +132689,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,TRICARE-Commercial, +132690,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,TRICARE-Commercial, +132691,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,TRICARE-Commercial, +132692,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,TRICARE-Commercial, +132693,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,TRICARE-Commercial, +132694,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,TRICARE-Commercial, +132695,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,TRICARE-Commercial, +132696,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,TRICARE-Commercial, +132697,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,TRICARE-Commercial, +132698,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,TRICARE-Commercial, +132699,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,TRICARE-Commercial, +132700,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,TRICARE-Commercial, +132701,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,TRICARE-Commercial, +132702,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,TRICARE-Commercial, +132703,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,TRICARE-Commercial, +132704,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,TRICARE-Commercial, +132705,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,TRICARE-Commercial, +132706,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,TRICARE-Commercial, +132707,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,TRICARE-Commercial, +132708,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,TRICARE-Commercial, +132709,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,TRICARE-Commercial, +132710,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,TRICARE-Commercial, +132711,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,TRICARE-Commercial, +132712,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,TRICARE-Commercial, +132713,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,TRICARE-Commercial, +132714,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,TRICARE-Commercial, +132715,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,TRICARE-Commercial, +132716,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,TRICARE-Commercial, +132717,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,TRICARE-Commercial, +132718,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,TRICARE-Commercial, +132719,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,TRICARE-Commercial, +132720,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,TRICARE-Commercial, +132721,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,TRICARE-Commercial, +132722,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,TRICARE-Commercial, +132723,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,TRICARE-Commercial, +132724,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,TRICARE-Commercial, +132725,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,TRICARE-Commercial, +132726,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,TRICARE-Commercial, +132727,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,TRICARE-Commercial, +132728,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,TRICARE-Commercial, +132729,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,TRICARE-Commercial, +132730,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,TRICARE-Commercial, +132731,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,TRICARE-Commercial, +132732,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,TRICARE-Commercial, +132733,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,TRICARE-Commercial, +132734,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,TRICARE-Commercial, +132735,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,TRICARE-Commercial, +132736,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,TRICARE-Commercial, +132737,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,TRICARE-Commercial, +132738,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,TRICARE-Commercial, +132739,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,TRICARE-Commercial, +132740,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,TRICARE-Commercial, +132741,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,TRICARE-Commercial, +132742,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,TRICARE-Commercial, +132743,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,TRICARE-Commercial, +132744,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,TRICARE-Commercial, +132745,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,TRICARE-Commercial, +132746,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,TRICARE-Commercial, +132747,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,TRICARE-Commercial, +132748,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,TRICARE-Commercial, +132749,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,TRICARE-Commercial, +132750,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,TRICARE-Commercial, +132751,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,TRICARE-Commercial, +132752,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,TRICARE-Commercial, +132753,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,TRICARE-Commercial, +132754,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,TRICARE-Commercial, +132755,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,TRICARE-Commercial, +132756,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,TRICARE-Commercial, +132757,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,TRICARE-Commercial, +132758,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,TRICARE-Commercial, +132759,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,TRICARE-Commercial, +132760,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,TRICARE-Commercial, +132761,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,TRICARE-Commercial, +132762,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,TRICARE-Commercial, +132763,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,TRICARE-Commercial, +132764,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,TRICARE-Commercial, +132765,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,TRICARE-Commercial, +132766,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,TRICARE-Commercial, +132767,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,TRICARE-Commercial, +132768,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,TRICARE-Commercial, +132769,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,TRICARE-Commercial, +132770,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,TRICARE-Commercial, +132771,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,TRICARE-Commercial, +132772,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,TRICARE-Commercial, +132773,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,TRICARE-Commercial, +132774,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,TRICARE-Commercial, +132775,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,TRICARE-Commercial, +132776,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,TRICARE-Commercial, +132777,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,TRICARE-Commercial, +132778,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,TRICARE-Commercial, +132779,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,TRICARE-Commercial, +132780,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,TRICARE-Commercial, +132781,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,TRICARE-Commercial, +132782,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,TRICARE-Commercial, +132783,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,TRICARE-Commercial, +132784,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,TRICARE-Commercial, +132785,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,TRICARE-Commercial, +132786,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,TRICARE-Commercial, +132787,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,TRICARE-Commercial, +132788,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,TRICARE-Commercial, +132789,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,TRICARE-Commercial, +132790,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,TRICARE-Commercial, +132791,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,TRICARE-Commercial, +132792,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,TRICARE-Commercial, +132793,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,TRICARE-Commercial, +132794,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,TRICARE-Commercial, +132795,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,TRICARE-Commercial, +132796,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,TRICARE-Commercial, +132797,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,TRICARE-Commercial, +132798,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,TRICARE-Commercial, +132799,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,TRICARE-Commercial, +132800,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,TRICARE-Commercial, +132801,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,TRICARE-Commercial, +132802,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,TRICARE-Commercial, +132803,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,TRICARE-Commercial, +132804,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,TRICARE-Commercial, +132805,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,TRICARE-Commercial, +132806,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,TRICARE-Commercial, +132807,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,TRICARE-Commercial, +132808,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,TRICARE-Commercial, +132809,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,TRICARE-Commercial, +132810,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,TRICARE-Commercial, +132811,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,TRICARE-Commercial, +132812,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,TRICARE-Commercial, +132813,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,TRICARE-Commercial, +132814,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,TRICARE-Commercial, +132815,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,TRICARE-Commercial, +132816,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,TRICARE-Commercial, +132817,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,TRICARE-Commercial, +132818,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,TRICARE-Commercial, +132819,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,TRICARE-Commercial, +132820,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,TRICARE-Commercial, +132821,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,TRICARE-Commercial, +132822,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,TRICARE-Commercial, +132823,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,TRICARE-Commercial, +132824,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,TRICARE-Commercial, +132825,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,TRICARE-Commercial, +132826,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,TRICARE-Commercial, +132827,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,TRICARE-Commercial, +132828,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,TRICARE-Commercial, +132829,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,TRICARE-Commercial, +132830,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,TRICARE-Commercial, +132831,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,TRICARE-Commercial, +132832,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,TRICARE-Commercial, +132833,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,TRICARE-Commercial, +132834,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,TRICARE-Commercial, +132835,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,TRICARE-Commercial, +132836,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,TRICARE-Commercial, +132837,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,TRICARE-Commercial, +132838,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,TRICARE-Commercial, +132839,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,TRICARE-Commercial, +132840,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,TRICARE-Commercial, +132841,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,TRICARE-Commercial, +132842,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,TRICARE-Commercial, +132843,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,TRICARE-Commercial, +132844,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,TRICARE-Commercial, +132845,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,TRICARE-Commercial, +132846,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,TRICARE-Commercial, +132847,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,TRICARE-Commercial, +132848,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,TRICARE-Commercial, +132849,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,TRICARE-Commercial, +132850,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,TRICARE-Commercial, +132851,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,TRICARE-Commercial, +132852,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,TRICARE-Commercial, +132853,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,TRICARE-Commercial, +132854,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,TRICARE-Commercial, +132855,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,TRICARE-Commercial, +132856,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,TRICARE-Commercial, +132857,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,TRICARE-Commercial, +132858,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,TRICARE-Commercial, +132859,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,TRICARE-Commercial, +132860,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,TRICARE-Commercial, +132861,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,TRICARE-Commercial, +132862,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,TRICARE-Commercial, +132863,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,TRICARE-Commercial, +132864,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,TRICARE-Commercial, +132865,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,TRICARE-Commercial, +132866,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,TRICARE-Commercial, +132867,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,TRICARE-Commercial, +132868,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,TRICARE-Commercial, +132869,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,TRICARE-Commercial, +132870,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,TRICARE-Commercial, +132871,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,TRICARE-Commercial, +132872,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,TRICARE-Commercial, +132873,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,TRICARE-Commercial, +132874,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,TRICARE-Commercial, +132875,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,TRICARE-Commercial, +132876,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,TRICARE-Commercial, +132877,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,TRICARE-Commercial, +132878,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,TRICARE-Commercial, +132879,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,TRICARE-Commercial, +132880,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,TRICARE-Commercial, +132881,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,TRICARE-Commercial, +132882,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,TRICARE-Commercial, +132883,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,TRICARE-Commercial, +132884,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,TRICARE-Commercial, +132885,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,TRICARE-Commercial, +132886,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,TRICARE-Commercial, +132887,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,TRICARE-Commercial, +132888,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,TRICARE-Commercial, +132889,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,TRICARE-Commercial, +132890,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,TRICARE-Commercial, +132891,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,TRICARE-Commercial, +132892,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,TRICARE-Commercial, +132893,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,TRICARE-Commercial, +132894,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,TRICARE-Commercial, +132895,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,TRICARE-Commercial, +132896,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,TRICARE-Commercial, +132897,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,TRICARE-Commercial, +132898,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,TRICARE-Commercial, +132899,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,TRICARE-Commercial, +132900,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,TRICARE-Commercial, +132901,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,TRICARE-Commercial, +132902,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,TRICARE-Commercial, +132903,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,TRICARE-Commercial, +132904,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,TRICARE-Commercial, +132905,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,TRICARE-Commercial, +132906,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,TRICARE-Commercial, +132907,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,TRICARE-Commercial, +132908,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,TRICARE-Commercial, +132909,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,TRICARE-Commercial, +132910,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,TRICARE-Commercial, +132911,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,TRICARE-Commercial, +132912,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,TRICARE-Commercial, +132913,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,TRICARE-Commercial, +132914,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,TRICARE-Commercial, +132915,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,TRICARE-Commercial, +132916,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,TRICARE-Commercial, +132917,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,TRICARE-Commercial, +132918,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,TRICARE-Commercial, +132919,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,TRICARE-Commercial, +132920,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,TRICARE-Commercial, +132921,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,TRICARE-Commercial, +132922,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,TRICARE-Commercial, +132923,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,TRICARE-Commercial, +132924,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,TRICARE-Commercial, +132925,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,TRICARE-Commercial, +132926,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,TRICARE-Commercial, +132927,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,TRICARE-Commercial, +132928,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,TRICARE-Commercial, +132929,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,TRICARE-Commercial, +132930,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,TRICARE-Commercial, +132931,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,TRICARE-Commercial, +132932,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,TRICARE-Commercial, +132933,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,TRICARE-Commercial, +132934,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,TRICARE-Commercial, +132935,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,TRICARE-Commercial, +132936,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,TRICARE-Commercial, +132937,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,TRICARE-Commercial, +132938,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,TRICARE-Commercial, +132939,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,TRICARE-Commercial, +132940,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,TRICARE-Commercial, +132941,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,TRICARE-Commercial, +132942,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,TRICARE-Commercial, +132943,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,TRICARE-Commercial, +132944,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,TRICARE-Commercial, +132945,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,TRICARE-Commercial, +132946,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,TRICARE-Commercial, +132947,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,TRICARE-Commercial, +132948,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,TRICARE-Commercial, +132949,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,TRICARE-Commercial, +132950,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,TRICARE-Commercial, +132951,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,TRICARE-Commercial, +132952,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,TRICARE-Commercial, +132953,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,TRICARE-Commercial, +132954,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,TRICARE-Commercial, +132955,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,TRICARE-Commercial, +132956,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,TRICARE-Commercial, +132957,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,TRICARE-Commercial, +132958,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,TRICARE-Commercial, +132959,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,TRICARE-Commercial, +132960,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,TRICARE-Commercial, +132961,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,TRICARE-Commercial, +132962,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,TRICARE-Commercial, +132963,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,TRICARE-Commercial, +132964,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,TRICARE-Commercial, +132965,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,TRICARE-Commercial, +132966,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,TRICARE-Commercial, +132967,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,TRICARE-Commercial, +132968,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,TRICARE-Commercial, +132969,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,TRICARE-Commercial, +132970,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,TRICARE-Commercial, +132971,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,TRICARE-Commercial, +132972,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,TRICARE-Commercial, +132973,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,TRICARE-Commercial, +132974,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,TRICARE-Commercial, +132975,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,TRICARE-Commercial, +132976,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,TRICARE-Commercial, +132977,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,TRICARE-Commercial, +132978,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,TRICARE-Commercial, +132979,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,TRICARE-Commercial, +132980,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,TRICARE-Commercial, +132981,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,TRICARE-Commercial, +132982,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,TRICARE-Commercial, +132983,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,TRICARE-Commercial, +132984,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,TRICARE-Commercial, +132985,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,TRICARE-Commercial, +132986,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,TRICARE-Commercial, +132987,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,TRICARE-Commercial, +132988,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,TRICARE-Commercial, +132989,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,TRICARE-Commercial, +132990,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,TRICARE-Commercial, +132991,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,TRICARE-Commercial, +132992,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,TRICARE-Commercial, +132993,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,TRICARE-Commercial, +132994,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,TRICARE-Commercial, +132995,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,TRICARE-Commercial, +132996,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,TRICARE-Commercial, +132997,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,TRICARE-Commercial, +132998,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,TRICARE-Commercial, +132999,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,TRICARE-Commercial, +133000,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,TRICARE-Commercial, +133001,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,TRICARE-Commercial, +133002,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,TRICARE-Commercial, +133003,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,TRICARE-Commercial, +133004,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,TRICARE-Commercial, +133005,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,TRICARE-Commercial, +133006,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,TRICARE-Commercial, +133007,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,TRICARE-Commercial, +133008,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,TRICARE-Commercial, +133009,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,TRICARE-Commercial, +133010,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,TRICARE-Commercial, +133011,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,TRICARE-Commercial, +133012,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,TRICARE-Commercial, +133013,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,TRICARE-Commercial, +133014,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,TRICARE-Commercial, +133015,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,TRICARE-Commercial, +133016,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,TRICARE-Commercial, +133017,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,TRICARE-Commercial, +133018,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,TRICARE-Commercial, +133019,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,TRICARE-Commercial, +133020,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,TRICARE-Commercial, +133021,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,TRICARE-Commercial, +133022,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,TRICARE-Commercial, +133023,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,TRICARE-Commercial, +133024,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,TRICARE-Commercial, +133025,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,TRICARE-Commercial, +133026,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,TRICARE-Commercial, +133027,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,TRICARE-Commercial, +133028,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,TRICARE-Commercial, +133029,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,TRICARE-Commercial, +133030,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,TRICARE-Commercial, +133031,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,TRICARE-Commercial, +133032,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,TRICARE-Commercial, +133033,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,TRICARE-Commercial, +133034,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,TRICARE-Commercial, +133035,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,TRICARE-Commercial, +133036,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,TRICARE-Commercial, +133037,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,TRICARE-Commercial, +133038,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,TRICARE-Commercial, +133039,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,TRICARE-Commercial, +133040,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,TRICARE-Commercial, +133041,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,TRICARE-Commercial, +133042,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,TRICARE-Commercial, +133043,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,TRICARE-Commercial, +133044,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,TRICARE-Commercial, +133045,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,TRICARE-Commercial, +133046,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,TRICARE-Commercial, +133047,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,TRICARE-Commercial, +133048,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,TRICARE-Commercial, +133049,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,TRICARE-Commercial, +133050,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,TRICARE-Commercial, +133051,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,TRICARE-Commercial, +133052,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,TRICARE-Commercial, +133053,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,TRICARE-Commercial, +133054,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,TRICARE-Commercial, +133055,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,TRICARE-Commercial, +133056,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,TRICARE-Commercial, +133057,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,TRICARE-Commercial, +133058,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,TRICARE-Commercial, +133059,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,TRICARE-Commercial, +133060,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,TRICARE-Commercial, +133061,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,TRICARE-Commercial, +133062,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,TRICARE-Commercial, +133063,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,TRICARE-Commercial, +133064,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,TRICARE-Commercial, +133065,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,TRICARE-Commercial, +133066,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,TRICARE-Commercial, +133067,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,TRICARE-Commercial, +133068,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,TRICARE-Commercial, +133069,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,TRICARE-Commercial, +133070,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,TRICARE-Commercial, +133071,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,TRICARE-Commercial, +133072,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,TRICARE-Commercial, +133073,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,TRICARE-Commercial, +133074,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,TRICARE-Commercial, +133075,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,TRICARE-Commercial, +133076,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,TRICARE-Commercial, +133077,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,TRICARE-Commercial, +133078,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,TRICARE-Commercial, +133079,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,TRICARE-Commercial, +133080,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,TRICARE-Commercial, +133081,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,TRICARE-Commercial, +133082,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,TRICARE-Commercial, +133083,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,TRICARE-Commercial, +133084,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,TRICARE-Commercial, +133085,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,TRICARE-Commercial, +133086,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,TRICARE-Commercial, +133087,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,TRICARE-Commercial, +133088,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,TRICARE-Commercial, +133089,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,TRICARE-Commercial, +133090,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,TRICARE-Commercial, +133091,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,TRICARE-Commercial, +133092,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,TRICARE-Commercial, +133093,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,TRICARE-Commercial, +133094,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,TRICARE-Commercial, +133095,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,TRICARE-Commercial, +133096,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,TRICARE-Commercial, +133097,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,TRICARE-Commercial, +133098,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,TRICARE-Commercial, +133099,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,TRICARE-Commercial, +133100,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,TRICARE-Commercial, +133101,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,TRICARE-Commercial, +133102,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,TRICARE-Commercial, +133103,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,TRICARE-Commercial, +133104,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,TRICARE-Commercial, +133105,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,TRICARE-Commercial, +133106,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,TRICARE-Commercial, +133107,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,TRICARE-Commercial, +133108,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,TRICARE-Commercial, +133109,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,TRICARE-Commercial, +133110,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,TRICARE-Commercial, +133111,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,TRICARE-Commercial, +133112,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,TRICARE-Commercial, +133113,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,TRICARE-Commercial, +133114,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,TRICARE-Commercial, +133115,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,TRICARE-Commercial, +133116,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,TRICARE-Commercial, +133117,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,TRICARE-Commercial, +133118,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,TRICARE-Commercial, +133119,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,TRICARE-Commercial, +133120,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,TRICARE-Commercial, +133121,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,TRICARE-Commercial, +133122,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,TRICARE-Commercial, +133123,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,TRICARE-Commercial, +133124,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,TRICARE-Commercial, +133125,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,TRICARE-Commercial, +133126,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,TRICARE-Commercial, +133127,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,TRICARE-Commercial, +133128,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,TRICARE-Commercial, +133129,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,TRICARE-Commercial, +133130,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,TRICARE-Commercial, +133131,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,TRICARE-Commercial, +133132,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,TRICARE-Commercial, +133133,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,TRICARE-Commercial, +133134,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,TRICARE-Commercial, +133135,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,TRICARE-Commercial, +133136,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,TRICARE-Commercial, +133137,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,TRICARE-Commercial, +133138,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,TRICARE-Commercial, +133139,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,TRICARE-Commercial, +133140,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,TRICARE-Commercial, +133141,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,TRICARE-Commercial, +133142,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,TRICARE-Commercial, +133143,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,TRICARE-Commercial, +133144,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,TRICARE-Commercial, +133145,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,TRICARE-Commercial, +133146,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,TRICARE-Commercial, +133147,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,TRICARE-Commercial, +133148,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,TRICARE-Commercial, +133149,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,TRICARE-Commercial, +133150,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,TRICARE-Commercial, +133151,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,TRICARE-Commercial, +133152,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,TRICARE-Commercial, +133153,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,TRICARE-Commercial, +133154,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,TRICARE-Commercial, +133155,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,TRICARE-Commercial, +133156,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,TRICARE-Commercial, +133157,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,TRICARE-Commercial, +133158,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,TRICARE-Commercial, +133159,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,TRICARE-Commercial, +133160,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,TRICARE-Commercial, +133161,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,TRICARE-Commercial, +133162,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,TRICARE-Commercial, +133163,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,TRICARE-Commercial, +133164,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,TRICARE-Commercial, +133165,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,TRICARE-Commercial, +133166,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,TRICARE-Commercial, +133167,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,TRICARE-Commercial, +133168,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,TRICARE-Commercial, +133169,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,TRICARE-Commercial, +133170,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,TRICARE-Commercial, +133171,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,TRICARE-Commercial, +133172,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,TRICARE-Commercial, +133173,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,TRICARE-Commercial, +133174,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,TRICARE-Commercial, +133175,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,TRICARE-Commercial, +133176,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,TRICARE-Commercial, +133177,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,TRICARE-Commercial, +133178,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,TRICARE-Commercial, +133179,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,TRICARE-Commercial, +133180,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,TRICARE-Commercial, +133181,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,TRICARE-Commercial, +133182,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,TRICARE-Commercial, +133183,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,TRICARE-Commercial, +133184,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,TRICARE-Commercial, +133185,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,TRICARE-Commercial, +133186,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,TRICARE-Commercial, +133187,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,TRICARE-Commercial, +133188,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,TRICARE-Commercial, +133189,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,TRICARE-Commercial, +133190,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,TRICARE-Commercial, +133191,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,TRICARE-Commercial, +133192,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,TRICARE-Commercial, +133193,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,TRICARE-Commercial, +133194,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,TRICARE-Commercial, +133195,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,TRICARE-Commercial, +133196,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,TRICARE-Commercial, +133197,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,TRICARE-Commercial, +133198,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,TRICARE-Commercial, +133199,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,TRICARE-Commercial, +133200,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,TRICARE-Commercial, +133201,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,TRICARE-Commercial, +133202,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,TRICARE-Commercial, +133203,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,TRICARE-Commercial, +133204,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,TRICARE-Commercial, +133205,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,TRICARE-Commercial, +133206,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,TRICARE-Commercial, +133207,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,TRICARE-Commercial, +133208,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,TRICARE-Commercial, +133209,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,TRICARE-Commercial, +133210,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,TRICARE-Commercial, +133211,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,TRICARE-Commercial, +133212,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,TRICARE-Commercial,558.72 +133213,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,TRICARE-Commercial, +133214,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,TRICARE-Commercial, +133215,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,TRICARE-Commercial, +133216,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,TRICARE-Commercial, +133217,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,TRICARE-Commercial, +133218,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,TRICARE-Commercial, +133219,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,TRICARE-Commercial, +133220,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,TRICARE-Commercial, +133221,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,TRICARE-Commercial, +133222,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,TRICARE-Commercial, +133223,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,TRICARE-Commercial, +133224,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,TRICARE-Commercial, +133225,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,TRICARE-Commercial, +133226,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,TRICARE-Commercial, +133227,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,TRICARE-Commercial, +133228,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,TRICARE-Commercial, +133229,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,TRICARE-Commercial, +133230,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,TRICARE-Commercial, +133231,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,TRICARE-Commercial, +133232,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,TRICARE-Commercial, +133233,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,TRICARE-Commercial, +133234,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,TRICARE-Commercial, +133235,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,TRICARE-Commercial, +133236,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,TRICARE-Commercial, +133237,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,TRICARE-Commercial, +133238,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,TRICARE-Commercial, +133239,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,TRICARE-Commercial, +133240,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,TRICARE-Commercial, +133241,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,TRICARE-Commercial, +133242,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,TRICARE-Commercial, +133243,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,TRICARE-Commercial, +133244,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,TRICARE-Commercial, +133245,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,TRICARE-Commercial, +133246,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,TRICARE-Commercial, +133247,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,TRICARE-Commercial, +133248,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,TRICARE-Commercial, +133249,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,TRICARE-Commercial, +133250,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,TRICARE-Commercial, +133251,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,TRICARE-Commercial, +133252,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,TRICARE-Commercial, +133253,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,TRICARE-Commercial, +133254,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,TRICARE-Commercial, +133255,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,TRICARE-Commercial, +133256,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,TRICARE-Commercial, +133257,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,TRICARE-Commercial, +133258,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,TRICARE-Commercial, +133259,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,TRICARE-Commercial, +133260,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,TRICARE-Commercial, +133261,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,TRICARE-Commercial, +133262,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,TRICARE-Commercial, +133263,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,TRICARE-Commercial, +133264,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,TRICARE-Commercial, +133265,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,TRICARE-Commercial, +133266,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,TRICARE-Commercial, +133267,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,TRICARE-Commercial, +133268,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,TRICARE-Commercial, +133269,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,TRICARE-Commercial, +133270,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,TRICARE-Commercial, +133271,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,TRICARE-Commercial, +133272,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,TRICARE-Commercial, +133273,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,TRICARE-Commercial, +133274,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,TRICARE-Commercial, +133275,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,TRICARE-Commercial, +133276,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,TRICARE-Commercial, +133277,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,TRICARE-Commercial, +133278,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,TRICARE-Commercial, +133279,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,TRICARE-Commercial, +133280,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,TRICARE-Commercial, +133281,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,TRICARE-Commercial, +133282,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,TRICARE-Commercial, +133283,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,TRICARE-Commercial, +133284,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,TRICARE-Commercial, +133285,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,TRICARE-Commercial, +133286,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,TRICARE-Commercial, +133287,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,TRICARE-Commercial, +133288,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,TRICARE-Commercial, +133289,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,TRICARE-Commercial, +133290,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,TRICARE-Commercial, +133291,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,TRICARE-Commercial, +133292,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,TRICARE-Commercial, +133293,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,TRICARE-Commercial, +133294,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,TRICARE-Commercial, +133295,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,TRICARE-Commercial, +133296,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,TRICARE-Commercial, +133297,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,TRICARE-Commercial, +133298,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,TRICARE-Commercial, +133299,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,TRICARE-Commercial, +133300,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,TRICARE-Commercial, +133301,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,TRICARE-Commercial, +133302,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,TRICARE-Commercial, +133303,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,TRICARE-Commercial, +133304,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,TRICARE-Commercial, +133305,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,TRICARE-Commercial, +133306,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,TRICARE-Commercial, +133307,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,TRICARE-Commercial, +133308,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,TRICARE-Commercial, +133309,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,TRICARE-Commercial, +133310,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,TRICARE-Commercial, +133311,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,TRICARE-Commercial, +133312,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,TRICARE-Commercial, +133313,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,TRICARE-Commercial, +133314,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,TRICARE-Commercial, +133315,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,TRICARE-Commercial, +133316,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,TRICARE-Commercial, +133317,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,TRICARE-Commercial, +133318,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,TRICARE-Commercial, +133319,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,TRICARE-Commercial, +133320,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,TRICARE-Commercial, +133321,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,TRICARE-Commercial, +133322,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,TRICARE-Commercial, +133323,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,TRICARE-Commercial, +133324,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,TRICARE-Commercial, +133325,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,TRICARE-Commercial, +133326,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,TRICARE-Commercial, +133327,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,TRICARE-Commercial, +133328,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,TRICARE-Commercial, +133329,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,TRICARE-Commercial, +133330,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,TRICARE-Commercial, +133331,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,TRICARE-Commercial, +133332,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,TRICARE-Commercial, +133333,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,TRICARE-Commercial, +133334,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,TRICARE-Commercial, +133335,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,TRICARE-Commercial, +133336,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,TRICARE-Commercial, +133337,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,TRICARE-Commercial, +133338,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,TRICARE-Commercial, +133339,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,TRICARE-Commercial, +133340,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,TRICARE-Commercial, +133341,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,TRICARE-Commercial, +133342,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,TRICARE-Commercial, +133343,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,TRICARE-Commercial, +133344,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,TRICARE-Commercial, +133345,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,TRICARE-Commercial, +133346,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,TRICARE-Commercial, +133347,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,TRICARE-Commercial, +133348,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,TRICARE-Commercial, +133349,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,TRICARE-Commercial, +133350,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,TRICARE-Commercial, +133351,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,TRICARE-Commercial, +133352,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,TRICARE-Commercial, +133353,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,TRICARE-Commercial, +133354,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,TRICARE-Commercial, +133355,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,TRICARE-Commercial, +133356,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,TRICARE-Commercial, +133357,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,TRICARE-Commercial, +133358,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,TRICARE-Commercial, +133359,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,TRICARE-Commercial, +133360,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,TRICARE-Commercial, +133361,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,TRICARE-Commercial, +133362,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,TRICARE-Commercial, +133363,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,TRICARE-Commercial, +133364,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,TRICARE-Commercial, +133365,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,TRICARE-Commercial, +133366,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,TRICARE-Commercial, +133367,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,TRICARE-Commercial, +133368,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,TRICARE-Commercial, +133369,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,TRICARE-Commercial, +133370,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,TRICARE-Commercial, +133371,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,TRICARE-Commercial, +133372,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,TRICARE-Commercial, +133373,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,TRICARE-Commercial, +133374,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,TRICARE-Commercial, +133375,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,TRICARE-Commercial, +133376,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,TRICARE-Commercial, +133377,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,TRICARE-Commercial, +133378,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,TRICARE-Commercial, +133379,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,TRICARE-Commercial, +133380,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,TRICARE-Commercial, +133381,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,TRICARE-Commercial, +133382,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,TRICARE-Commercial, +133383,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,TRICARE-Commercial, +133384,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,TRICARE-Commercial, +133385,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,TRICARE-Commercial, +133386,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,TRICARE-Commercial, +133387,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,TRICARE-Commercial, +133388,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,TRICARE-Commercial, +133389,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,TRICARE-Commercial, +133390,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,TRICARE-Commercial, +133391,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,TRICARE-Commercial, +133392,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,TRICARE-Commercial, +133393,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,TRICARE-Commercial, +133394,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,TRICARE-Commercial, +133395,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,TRICARE-Commercial, +133396,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,TRICARE-Commercial, +133397,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,TRICARE-Commercial, +133398,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,TRICARE-Commercial, +133399,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,TRICARE-Commercial, +133400,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,TRICARE-Commercial, +133401,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,TRICARE-Commercial, +133402,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,TRICARE-Commercial, +133403,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,TRICARE-Commercial, +133404,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,TRICARE-Commercial, +133405,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,TRICARE-Commercial, +133406,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,TRICARE-Commercial, +133407,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,TRICARE-Commercial, +133408,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,TRICARE-Commercial, +133409,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,TRICARE-Commercial, +133410,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,TRICARE-Commercial, +133411,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,TRICARE-Commercial, +133412,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,TRICARE-Commercial, +133413,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,TRICARE-Commercial, +133414,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,TRICARE-Commercial, +133415,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,TRICARE-Commercial, +133416,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,TRICARE-Commercial, +133417,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,TRICARE-Commercial, +133418,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,TRICARE-Commercial, +133419,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,TRICARE-Commercial, +133420,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,TRICARE-Commercial, +133421,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,TRICARE-Commercial, +133422,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,TRICARE-Commercial, +133423,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,TRICARE-Commercial, +133424,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,TRICARE-Commercial, +133425,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,TRICARE-Commercial, +133426,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,TRICARE-Commercial, +133427,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,TRICARE-Commercial, +133428,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,TRICARE-Commercial, +133429,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,TRICARE-Commercial, +133430,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,TRICARE-Commercial, +133431,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,TRICARE-Commercial, +133432,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,TRICARE-Commercial, +133433,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,TRICARE-Commercial, +133434,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,TRICARE-Commercial, +133435,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,TRICARE-Commercial, +133436,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,TRICARE-Commercial, +133437,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,TRICARE-Commercial, +133438,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,TRICARE-Commercial, +133439,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,TRICARE-Commercial, +133440,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,TRICARE-Commercial, +133441,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,TRICARE-Commercial, +133442,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,TRICARE-Commercial, +133443,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,TRICARE-Commercial, +133444,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,TRICARE-Commercial, +133445,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,TRICARE-Commercial, +133446,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,TRICARE-Commercial, +133447,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,TRICARE-Commercial, +133448,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,TRICARE-Commercial, +133449,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,TRICARE-Commercial, +133450,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,TRICARE-Commercial, +133451,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,TRICARE-Commercial, +133452,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,TRICARE-Commercial, +133453,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,TRICARE-Commercial, +133454,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,TRICARE-Commercial, +133455,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,TRICARE-Commercial, +133456,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,TRICARE-Commercial, +133457,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,TRICARE-Commercial, +133458,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,TRICARE-Commercial, +133459,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,TRICARE-Commercial, +133460,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,TRICARE-Commercial, +133461,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,TRICARE-Commercial, +133462,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,TRICARE-Commercial, +133463,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,TRICARE-Commercial, +133464,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,TRICARE-Commercial, +133465,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,TRICARE-Commercial, +133466,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,TRICARE-Commercial, +133467,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,TRICARE-Commercial,119.46 +133468,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,TRICARE-Commercial, +133469,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,TRICARE-Commercial, +133470,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,TRICARE-Commercial, +133471,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,TRICARE-Commercial, +133472,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,TRICARE-Commercial,132.12 +133473,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,TRICARE-Commercial, +133474,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,TRICARE-Commercial, +133475,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,TRICARE-Commercial, +133476,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,TRICARE-Commercial, +133477,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,TRICARE-Commercial, +133478,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,TRICARE-Commercial, +133479,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,TRICARE-Commercial, +133480,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,TRICARE-Commercial, +133481,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,TRICARE-Commercial, +133482,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,TRICARE-Commercial, +133483,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,TRICARE-Commercial, +133484,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,TRICARE-Commercial, +133485,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,TRICARE-Commercial, +133486,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,TRICARE-Commercial, +133487,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,TRICARE-Commercial, +133488,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,TRICARE-Commercial, +133489,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,TRICARE-Commercial, +133490,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,TRICARE-Commercial, +133491,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,TRICARE-Commercial, +133492,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,TRICARE-Commercial, +133493,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,TRICARE-Commercial, +133494,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,TRICARE-Commercial, +133495,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,TRICARE-Commercial, +133496,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,TRICARE-Commercial, +133497,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,TRICARE-Commercial, +133498,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,TRICARE-Commercial, +133499,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,TRICARE-Commercial, +133500,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,TRICARE-Commercial, +133501,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,TRICARE-Commercial, +133502,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,TRICARE-Commercial, +133503,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,TRICARE-Commercial, +133504,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,TRICARE-Commercial, +133505,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,TRICARE-Commercial, +133506,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,TRICARE-Commercial, +133507,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,TRICARE-Commercial, +133508,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,TRICARE-Commercial, +133509,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,TRICARE-Commercial, +133510,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,TRICARE-Commercial, +133511,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,TRICARE-Commercial, +133512,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,TRICARE-Commercial, +133513,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,TRICARE-Commercial, +133514,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,TRICARE-Commercial, +133515,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,TRICARE-Commercial, +133516,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,TRICARE-Commercial, +133517,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,TRICARE-Commercial, +133518,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,TRICARE-Commercial, +133519,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,TRICARE-Commercial, +133520,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,TRICARE-Commercial, +133521,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,TRICARE-Commercial, +133522,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,TRICARE-Commercial, +133523,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,TRICARE-Commercial, +133524,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,TRICARE-Commercial, +133525,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,TRICARE-Commercial, +133526,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,TRICARE-Commercial, +133527,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,TRICARE-Commercial, +133528,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,TRICARE-Commercial, +133529,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,TRICARE-Commercial, +133530,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,TRICARE-Commercial, +133531,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,TRICARE-Commercial, +133532,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,TRICARE-Commercial, +133533,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,TRICARE-Commercial, +133534,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,TRICARE-Commercial, +133535,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,TRICARE-Commercial, +133536,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,TRICARE-Commercial, +133537,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,TRICARE-Commercial, +133538,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,TRICARE-Commercial, +133539,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,TRICARE-Commercial, +133540,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,TRICARE-Commercial, +133541,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,TRICARE-Commercial, +133542,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,TRICARE-Commercial, +133543,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,TRICARE-Commercial, +133544,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,TRICARE-Commercial, +133545,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,TRICARE-Commercial, +133546,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,TRICARE-Commercial, +133547,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,TRICARE-Commercial, +133548,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,TRICARE-Commercial, +133549,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,TRICARE-Commercial, +133550,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,TRICARE-Commercial, +133551,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,TRICARE-Commercial, +133552,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,TRICARE-Commercial, +133553,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,TRICARE-Commercial, +133554,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,TRICARE-Commercial, +133555,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,TRICARE-Commercial, +133556,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,TRICARE-Commercial, +133557,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,TRICARE-Commercial, +133558,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,TRICARE-Commercial, +133559,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,TRICARE-Commercial, +133560,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,TRICARE-Commercial, +133561,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,TRICARE-Commercial, +133562,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,TRICARE-Commercial, +133563,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,TRICARE-Commercial, +133564,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,TRICARE-Commercial, +133565,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,TRICARE-Commercial, +133566,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,TRICARE-Commercial, +133567,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,TRICARE-Commercial, +133568,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,TRICARE-Commercial, +133569,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,TRICARE-Commercial, +133570,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,TRICARE-Commercial, +133571,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,TRICARE-Commercial, +133572,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,TRICARE-Commercial, +133573,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,TRICARE-Commercial, +133574,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,TRICARE-Commercial, +133575,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,TRICARE-Commercial, +133576,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,TRICARE-Commercial, +133577,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,TRICARE-Commercial, +133578,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,TRICARE-Commercial, +133579,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,TRICARE-Commercial, +133580,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,TRICARE-Commercial, +133581,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,TRICARE-Commercial, +133582,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,TRICARE-Commercial, +133583,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,TRICARE-Commercial, +133584,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,TRICARE-Commercial, +133585,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,TRICARE-Commercial, +133586,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,TRICARE-Commercial, +133587,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,TRICARE-Commercial, +133588,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,TRICARE-Commercial, +133589,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,TRICARE-Commercial, +133590,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,TRICARE-Commercial, +133591,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,TRICARE-Commercial, +133592,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,TRICARE-Commercial, +133593,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,TRICARE-Commercial, +133594,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,TRICARE-Commercial, +133595,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,TRICARE-Commercial, +133596,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,TRICARE-Commercial, +133597,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,TRICARE-Commercial, +133598,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,TRICARE-Commercial, +133599,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,TRICARE-Commercial, +133600,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,TRICARE-Commercial, +133601,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,TRICARE-Commercial, +133602,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,TRICARE-Commercial, +133603,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,TRICARE-Commercial, +133604,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,TRICARE-Commercial, +133605,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,TRICARE-Commercial, +133606,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,TRICARE-Commercial, +133607,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,TRICARE-Commercial, +133608,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,TRICARE-Commercial, +133609,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,TRICARE-Commercial, +133610,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,TRICARE-Commercial, +133611,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,TRICARE-Commercial, +133612,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,TRICARE-Commercial, +133613,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,TRICARE-Commercial, +133614,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,TRICARE-Commercial, +133615,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,TRICARE-Commercial, +133616,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,TRICARE-Commercial, +133617,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,TRICARE-Commercial, +133618,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,TRICARE-Commercial, +133619,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,TRICARE-Commercial, +133620,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,TRICARE-Commercial, +133621,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,TRICARE-Commercial, +133622,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,TRICARE-Commercial, +133623,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,TRICARE-Commercial, +133624,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,TRICARE-Commercial, +133625,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,TRICARE-Commercial, +133626,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,TRICARE-Commercial, +133627,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,TRICARE-Commercial, +133628,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,TRICARE-Commercial, +133629,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,TRICARE-Commercial, +133630,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,TRICARE-Commercial, +133631,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,TRICARE-Commercial, +133632,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,TRICARE-Commercial, +133633,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,TRICARE-Commercial, +133634,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,TRICARE-Commercial, +133635,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,TRICARE-Commercial, +133636,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,TRICARE-Commercial, +133637,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,TRICARE-Commercial, +133638,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,TRICARE-Commercial, +133639,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,TRICARE-Commercial, +133640,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,TRICARE-Commercial, +133641,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,TRICARE-Commercial, +133642,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,TRICARE-Commercial, +133643,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,TRICARE-Commercial, +133644,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,TRICARE-Commercial, +133645,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,TRICARE-Commercial, +133646,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,TRICARE-Commercial, +133647,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,TRICARE-Commercial, +133648,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,TRICARE-Commercial, +133649,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,TRICARE-Commercial, +133650,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,TRICARE-Commercial, +133651,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,TRICARE-Commercial, +133652,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,TRICARE-Commercial, +133653,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,TRICARE-Commercial, +133654,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,TRICARE-Commercial, +133655,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,TRICARE-Commercial, +133656,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,TRICARE-Commercial, +133657,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,TRICARE-Commercial, +133658,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,TRICARE-Commercial, +133659,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,TRICARE-Commercial, +133660,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,TRICARE-Commercial, +133661,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,TRICARE-Commercial, +133662,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,TRICARE-Commercial, +133663,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,TRICARE-Commercial, +133664,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,TRICARE-Commercial, +133665,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,TRICARE-Commercial, +133666,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,TRICARE-Commercial, +133667,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,TRICARE-Commercial, +133668,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,TRICARE-Commercial, +133669,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,TRICARE-Commercial, +133670,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,TRICARE-Commercial, +133671,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,TRICARE-Commercial, +133672,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,TRICARE-Commercial, +133673,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,TRICARE-Commercial, +133674,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,TRICARE-Commercial, +133675,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,TRICARE-Commercial, +133676,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,TRICARE-Commercial, +133677,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,TRICARE-Commercial, +133678,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,TRICARE-Commercial, +133679,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,TRICARE-Commercial, +133680,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,TRICARE-Commercial, +133681,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,TRICARE-Commercial, +133682,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,TRICARE-Commercial, +133683,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,TRICARE-Commercial, +133684,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,TRICARE-Commercial, +133685,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,TRICARE-Commercial, +133686,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,TRICARE-Commercial, +133687,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,TRICARE-Commercial, +133688,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,TRICARE-Commercial, +133689,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,TRICARE-Commercial, +133690,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,TRICARE-Commercial, +133691,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,TRICARE-Commercial, +133692,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,TRICARE-Commercial, +133693,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,TRICARE-Commercial, +133694,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,TRICARE-Commercial, +133695,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,TRICARE-Commercial, +133696,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,TRICARE-Commercial, +133697,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,TRICARE-Commercial, +133698,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,TRICARE-Commercial, +133699,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,TRICARE-Commercial, +133700,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,TRICARE-Commercial, +133701,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,TRICARE-Commercial, +133702,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,TRICARE-Commercial, +133703,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,TRICARE-Commercial, +133704,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,TRICARE-Commercial, +133705,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,TRICARE-Commercial, +133706,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,TRICARE-Commercial, +133707,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,TRICARE-Commercial, +133708,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,TRICARE-Commercial, +133709,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,TRICARE-Commercial, +133710,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,TRICARE-Commercial, +133711,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,TRICARE-Commercial, +133712,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,TRICARE-Commercial, +133713,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,TRICARE-Commercial, +133714,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,TRICARE-Commercial, +133715,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,TRICARE-Commercial, +133716,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,TRICARE-Commercial, +133717,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,TRICARE-Commercial, +133718,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,TRICARE-Commercial, +133719,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,TRICARE-Commercial, +133720,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,TRICARE-Commercial, +133721,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,TRICARE-Commercial, +133722,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,TRICARE-Commercial, +133723,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,TRICARE-Commercial, +133724,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,TRICARE-Commercial, +133725,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,TRICARE-Commercial, +133726,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,TRICARE-Commercial, +133727,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,TRICARE-Commercial, +133728,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,TRICARE-Commercial, +133729,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,TRICARE-Commercial, +133730,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,TRICARE-Commercial, +133731,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,TRICARE-Commercial, +133732,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,TRICARE-Commercial, +133733,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,TRICARE-Commercial, +133734,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,TRICARE-Commercial, +133735,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,TRICARE-Commercial, +133736,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,TRICARE-Commercial, +133737,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,TRICARE-Commercial, +133738,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,TRICARE-Commercial, +133739,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,TRICARE-Commercial, +133740,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,TRICARE-Commercial, +133741,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,TRICARE-Commercial, +133742,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,TRICARE-Commercial, +133743,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,TRICARE-Commercial, +133744,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,TRICARE-Commercial, +133745,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,TRICARE-Commercial, +133746,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,TRICARE-Commercial, +133747,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,TRICARE-Commercial, +133748,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,TRICARE-Commercial, +133749,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,TRICARE-Commercial, +133750,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,TRICARE-Commercial, +133751,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,TRICARE-Commercial, +133752,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,TRICARE-Commercial, +133753,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,TRICARE-Commercial, +133754,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,TRICARE-Commercial, +133755,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,TRICARE-Commercial, +133756,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,TRICARE-Commercial, +133757,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,TRICARE-Commercial, +133758,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,TRICARE-Commercial, +133759,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,TRICARE-Commercial, +133760,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,TRICARE-Commercial, +133761,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,TRICARE-Commercial, +133762,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,TRICARE-Commercial, +133763,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,TRICARE-Commercial, +133764,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,TRICARE-Commercial, +133765,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,TRICARE-Commercial, +133766,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,TRICARE-Commercial, +133767,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,TRICARE-Commercial, +133768,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,TRICARE-Commercial, +133769,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,TRICARE-Commercial, +133770,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,TRICARE-Commercial, +133771,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,TRICARE-Commercial, +133772,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,TRICARE-Commercial, +133773,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,TRICARE-Commercial, +133774,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,TRICARE-Commercial, +133775,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,TRICARE-Commercial, +133776,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,TRICARE-Commercial, +133777,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,TRICARE-Commercial, +133778,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,TRICARE-Commercial, +133779,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,TRICARE-Commercial, +133780,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,TRICARE-Commercial, +133781,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,TRICARE-Commercial, +133782,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,TRICARE-Commercial, +133783,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,TRICARE-Commercial, +133784,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,TRICARE-Commercial, +133785,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,TRICARE-Commercial, +133786,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,TRICARE-Commercial, +133787,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,TRICARE-Commercial, +133788,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,TRICARE-Commercial, +133789,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,TRICARE-Commercial, +133790,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,TRICARE-Commercial, +133791,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,TRICARE-Commercial, +133792,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,TRICARE-Commercial, +133793,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,TRICARE-Commercial, +133794,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,TRICARE-Commercial, +133795,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,TRICARE-Commercial, +133796,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,TRICARE-Commercial, +133797,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,TRICARE-Commercial, +133798,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,TRICARE-Commercial, +133799,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,TRICARE-Commercial, +133800,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,TRICARE-Commercial, +133801,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,TRICARE-Commercial, +133802,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,TRICARE-Commercial, +133803,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,TRICARE-Commercial, +133804,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,TRICARE-Commercial, +133805,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,TRICARE-Commercial, +133806,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,TRICARE-Commercial, +133807,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,TRICARE-Commercial, +133808,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,TRICARE-Commercial, +133809,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,TRICARE-Commercial, +133810,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,TRICARE-Commercial, +133811,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,TRICARE-Commercial, +133812,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,TRICARE-Commercial, +133813,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,TRICARE-Commercial, +133814,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,TRICARE-Commercial, +133815,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,TRICARE-Commercial, +133816,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,TRICARE-Commercial, +133817,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,TRICARE-Commercial, +133818,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,TRICARE-Commercial, +133819,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,TRICARE-Commercial, +133820,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,TRICARE-Commercial, +133821,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,TRICARE-Commercial, +133822,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,TRICARE-Commercial, +133823,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,TRICARE-Commercial, +133824,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,TRICARE-Commercial, +133825,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,TRICARE-Commercial, +133826,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,TRICARE-Commercial, +133827,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,TRICARE-Commercial, +133828,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,TRICARE-Commercial, +133829,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,TRICARE-Commercial, +133830,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,TRICARE-Commercial, +133831,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,TRICARE-Commercial, +133832,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,TRICARE-Commercial, +133833,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,TRICARE-Commercial, +133834,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,TRICARE-Commercial, +133835,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,TRICARE-Commercial, +133836,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,TRICARE-Commercial, +133837,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,TRICARE-Commercial, +133838,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,TRICARE-Commercial, +133839,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,TRICARE-Commercial, +133840,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,TRICARE-Commercial, +133841,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,TRICARE-Commercial, +133842,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,TRICARE-Commercial, +133843,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,TRICARE-Commercial, +133844,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,TRICARE-Commercial, +133845,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,TRICARE-Commercial, +133846,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,TRICARE-Commercial, +133847,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,TRICARE-Commercial, +133848,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,TRICARE-Commercial, +133849,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,TRICARE-Commercial, +133850,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,TRICARE-Commercial, +133851,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,TRICARE-Commercial, +133852,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,TRICARE-Commercial, +133853,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,TRICARE-Commercial, +133854,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,TRICARE-Commercial, +133855,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,TRICARE-Commercial, +133856,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,TRICARE-Commercial, +133857,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,TRICARE-Commercial, +133858,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,TRICARE-Commercial, +133859,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,TRICARE-Commercial, +133860,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,TRICARE-Commercial, +133861,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,TRICARE-Commercial, +133862,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,TRICARE-Commercial, +133863,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,TRICARE-Commercial, +133864,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,TRICARE-Commercial, +133865,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,TRICARE-Commercial, +133866,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,TRICARE-Commercial, +133867,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,TRICARE-Commercial, +133868,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,TRICARE-Commercial, +133869,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,TRICARE-Commercial, +133870,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,TRICARE-Commercial, +133871,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,TRICARE-Commercial, +133872,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,TRICARE-Commercial, +133873,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,TRICARE-Commercial, +133874,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,TRICARE-Commercial, +133875,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,TRICARE-Commercial, +133876,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,TRICARE-Commercial, +133877,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,TRICARE-Commercial, +133878,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,TRICARE-Commercial, +133879,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,TRICARE-Commercial, +133880,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,TRICARE-Commercial, +133881,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,TRICARE-Commercial, +133882,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,TRICARE-Commercial, +133883,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,TRICARE-Commercial, +133884,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,TRICARE-Commercial, +133885,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,TRICARE-Commercial, +133886,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,TRICARE-Commercial, +133887,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,TRICARE-Commercial, +133888,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,TRICARE-Commercial, +133889,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,TRICARE-Commercial, +133890,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,TRICARE-Commercial, +133891,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,TRICARE-Commercial, +133892,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,TRICARE-Commercial, +133893,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,TRICARE-Commercial, +133894,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,TRICARE-Commercial, +133895,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,TRICARE-Commercial, +133896,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,TRICARE-Commercial, +133897,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,TRICARE-Commercial, +133898,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,TRICARE-Commercial, +133899,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,TRICARE-Commercial, +133900,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,TRICARE-Commercial, +133901,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,TRICARE-Commercial, +133902,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,TRICARE-Commercial, +133903,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,TRICARE-Commercial, +133904,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,TRICARE-Commercial, +133905,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,TRICARE-Commercial, +133906,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,TRICARE-Commercial, +133907,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,TRICARE-Commercial, +133908,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,TRICARE-Commercial, +133909,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,TRICARE-Commercial, +133910,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,TRICARE-Commercial, +133911,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,TRICARE-Commercial, +133912,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,TRICARE-Commercial, +133913,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,TRICARE-Commercial, +133914,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,TRICARE-Commercial, +133915,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,TRICARE-Commercial, +133916,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,TRICARE-Commercial, +133917,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,TRICARE-Commercial, +133918,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,TRICARE-Commercial, +133919,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,TRICARE-Commercial, +133920,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,TRICARE-Commercial, +133921,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,TRICARE-Commercial, +133922,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,TRICARE-Commercial, +133923,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,TRICARE-Commercial, +133924,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,TRICARE-Commercial, +133925,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,TRICARE-Commercial, +133926,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,TRICARE-Commercial, +133927,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,TRICARE-Commercial, +133928,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,TRICARE-Commercial, +133929,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,TRICARE-Commercial, +133930,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,TRICARE-Commercial, +133931,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,TRICARE-Commercial, +133932,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,TRICARE-Commercial, +133933,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,TRICARE-Commercial, +133934,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,TRICARE-Commercial, +133935,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,TRICARE-Commercial, +133936,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,TRICARE-Commercial, +133937,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,TRICARE-Commercial, +133938,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,TRICARE-Commercial, +133939,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,TRICARE-Commercial, +133940,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,TRICARE-Commercial, +133941,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,TRICARE-Commercial, +133942,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,TRICARE-Commercial, +133943,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,TRICARE-Commercial, +133944,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,TRICARE-Commercial, +133945,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,TRICARE-Commercial, +133946,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,TRICARE-Commercial, +133947,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,TRICARE-Commercial, +133948,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,TRICARE-Commercial, +133949,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,TRICARE-Commercial, +133950,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,TRICARE-Commercial, +133951,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,TRICARE-Commercial, +133952,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,TRICARE-Commercial, +133953,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,TRICARE-Commercial, +133954,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,TRICARE-Commercial, +133955,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,TRICARE-Commercial, +133956,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,TRICARE-Commercial, +133957,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,TRICARE-Commercial, +133958,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,TRICARE-Commercial, +133959,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,TRICARE-Commercial, +133960,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,TRICARE-Commercial, +133961,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,TRICARE-Commercial, +133962,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,TRICARE-Commercial, +133963,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,TRICARE-Commercial, +133964,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,TRICARE-Commercial, +133965,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,TRICARE-Commercial, +133966,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,TRICARE-Commercial, +133967,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,TRICARE-Commercial, +133968,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,TRICARE-Commercial, +133969,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,TRICARE-Commercial, +133970,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,TRICARE-Commercial, +133971,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,TRICARE-Commercial, +133972,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,TRICARE-Commercial, +133973,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,TRICARE-Commercial, +133974,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,TRICARE-Commercial, +133975,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,TRICARE-Commercial, +133976,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,TRICARE-Commercial, +133977,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,TRICARE-Commercial, +133978,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,TRICARE-Commercial, +133979,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,TRICARE-Commercial, +133980,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,TRICARE-Commercial, +133981,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,TRICARE-Commercial, +133982,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,TRICARE-Commercial, +133983,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,TRICARE-Commercial, +133984,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,TRICARE-Commercial, +133985,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,TRICARE-Commercial, +133986,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,TRICARE-Commercial, +133987,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,TRICARE-Commercial, +133988,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,TRICARE-Commercial, +133989,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,TRICARE-Commercial, +133990,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,TRICARE-Commercial, +133991,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,TRICARE-Commercial, +133992,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,TRICARE-Commercial, +133993,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,TRICARE-Commercial, +133994,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,TRICARE-Commercial, +133995,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,TRICARE-Commercial, +133996,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,TRICARE-Commercial, +133997,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,TRICARE-Commercial, +133998,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,TRICARE-Commercial, +133999,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,TRICARE-Commercial, +134000,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,TRICARE-Commercial, +134001,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,TRICARE-Commercial, +134002,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,TRICARE-Commercial, +134003,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,TRICARE-Commercial, +134004,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,TRICARE-Commercial, +134005,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,TRICARE-Commercial, +134006,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,TRICARE-Commercial, +134007,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,TRICARE-Commercial, +134008,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,TRICARE-Commercial, +134009,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,TRICARE-Commercial, +134010,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,TRICARE-Commercial, +134011,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,TRICARE-Commercial, +134012,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,TRICARE-Commercial, +134013,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,TRICARE-Commercial, +134014,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,TRICARE-Commercial, +134015,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,TRICARE-Commercial, +134016,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,TRICARE-Commercial, +134017,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,TRICARE-Commercial, +134018,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,TRICARE-Commercial, +134019,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,TRICARE-Commercial, +134020,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,TRICARE-Commercial, +134021,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,TRICARE-Commercial, +134022,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,TRICARE-Commercial, +134023,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,TRICARE-Commercial, +134024,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,TRICARE-Commercial, +134025,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,TRICARE-Commercial, +134026,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,TRICARE-Commercial, +134027,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,TRICARE-Commercial, +134028,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,TRICARE-Commercial, +134029,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,TRICARE-Commercial, +134030,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,TRICARE-Commercial, +134031,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,TRICARE-Commercial, +134032,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,TRICARE-Commercial, +134033,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,TRICARE-Commercial, +134034,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,TRICARE-Commercial, +134035,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,TRICARE-Commercial, +134036,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,TRICARE-Commercial, +134037,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,TRICARE-Commercial, +134038,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,TRICARE-Commercial, +134039,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,TRICARE-Commercial, +134040,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,TRICARE-Commercial, +134041,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,TRICARE-Commercial, +134042,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,TRICARE-Commercial, +134043,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,TRICARE-Commercial, +134044,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,TRICARE-Commercial, +134045,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,TRICARE-Commercial, +134046,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,TRICARE-Commercial, +134047,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,TRICARE-Commercial, +134048,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,TRICARE-Commercial, +134049,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,TRICARE-Commercial, +134050,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,TRICARE-Commercial, +134051,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,TRICARE-Commercial, +134052,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,TRICARE-Commercial, +134053,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,TRICARE-Commercial, +134054,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,TRICARE-Commercial, +134055,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,TRICARE-Commercial, +134056,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,TRICARE-Commercial, +134057,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,TRICARE-Commercial, +134058,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,TRICARE-Commercial, +134059,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,TRICARE-Commercial, +134060,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,TRICARE-Commercial, +134061,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,TRICARE-Commercial, +134062,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,TRICARE-Commercial, +134063,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,TRICARE-Commercial, +134064,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,TRICARE-Commercial, +134065,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,TRICARE-Commercial, +134066,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,TRICARE-Commercial, +134067,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,TRICARE-Commercial, +134068,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,TRICARE-Commercial, +134069,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,TRICARE-Commercial, +134070,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,TRICARE-Commercial, +134071,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,TRICARE-Commercial, +134072,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,TRICARE-Commercial, +134073,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,TRICARE-Commercial, +134074,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,TRICARE-Commercial, +134075,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,TRICARE-Commercial, +134076,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,TRICARE-Commercial, +134077,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,TRICARE-Commercial, +134078,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,TRICARE-Commercial, +134079,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,TRICARE-Commercial, +134080,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,TRICARE-Commercial, +134081,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,TRICARE-Commercial, +134082,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,TRICARE-Commercial, +134083,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,TRICARE-Commercial, +134084,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,TRICARE-Commercial, +134085,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,TRICARE-Commercial, +134086,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,TRICARE-Commercial, +134087,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,TRICARE-Commercial, +134088,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,TRICARE-Commercial, +134089,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,TRICARE-Commercial, +134090,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,TRICARE-Commercial, +134091,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,TRICARE-Commercial, +134092,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,TRICARE-Commercial, +134093,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,TRICARE-Commercial, +134094,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,TRICARE-Commercial, +134095,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,TRICARE-Commercial, +134096,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,TRICARE-Commercial, +134097,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,TRICARE-Commercial, +134098,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,TRICARE-Commercial, +134099,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,TRICARE-Commercial, +134100,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,TRICARE-Commercial, +134101,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,TRICARE-Commercial, +134102,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,TRICARE-Commercial, +134103,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,TRICARE-Commercial, +134104,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,TRICARE-Commercial, +134105,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,TRICARE-Commercial, +134106,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,TRICARE-Commercial, +134107,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,TRICARE-Commercial, +134108,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,TRICARE-Commercial, +134109,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,TRICARE-Commercial, +134110,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,TRICARE-Commercial, +134111,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,TRICARE-Commercial, +134112,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,TRICARE-Commercial, +134113,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,TRICARE-Commercial, +134114,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,TRICARE-Commercial, +134115,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,TRICARE-Commercial, +134116,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,TRICARE-Commercial, +134117,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,TRICARE-Commercial, +134118,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,TRICARE-Commercial, +134119,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,TRICARE-Commercial, +134120,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,TRICARE-Commercial, +134121,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,TRICARE-Commercial, +134122,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,TRICARE-Commercial, +134123,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,TRICARE-Commercial, +134124,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,TRICARE-Commercial, +134125,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,TRICARE-Commercial, +134126,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,TRICARE-Commercial, +134127,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,TRICARE-Commercial, +134128,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,TRICARE-Commercial, +134129,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,TRICARE-Commercial, +134130,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,TRICARE-Commercial, +134131,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,TRICARE-Commercial, +134132,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,TRICARE-Commercial, +134133,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,TRICARE-Commercial, +134134,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,TRICARE-Commercial, +134135,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,TRICARE-Commercial, +134136,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,TRICARE-Commercial, +134137,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,TRICARE-Commercial, +134138,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,TRICARE-Commercial, +134139,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,TRICARE-Commercial, +134140,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,TRICARE-Commercial, +134141,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,TRICARE-Commercial, +134142,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,TRICARE-Commercial, +134143,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,TRICARE-Commercial, +134144,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,TRICARE-Commercial, +134145,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,TRICARE-Commercial, +134146,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,TRICARE-Commercial, +134147,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,TRICARE-Commercial, +134148,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,TRICARE-Commercial, +134149,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,TRICARE-Commercial, +134150,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,TRICARE-Commercial, +134151,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,TRICARE-Commercial, +134152,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,TRICARE-Commercial, +134153,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,TRICARE-Commercial, +134154,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,TRICARE-Commercial, +134155,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,TRICARE-Commercial, +134156,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,TRICARE-Commercial, +134157,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,TRICARE-Commercial, +134158,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,TRICARE-Commercial, +134159,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,TRICARE-Commercial, +134160,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,TRICARE-Commercial, +134161,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,TRICARE-Commercial, +134162,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,TRICARE-Commercial, +134163,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,TRICARE-Commercial, +134164,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,TRICARE-Commercial, +134165,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,TRICARE-Commercial, +134166,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,TRICARE-Commercial, +134167,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,TRICARE-Commercial, +134168,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,TRICARE-Commercial, +134169,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,TRICARE-Commercial, +134170,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,TRICARE-Commercial, +134171,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,TRICARE-Commercial, +134172,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,TRICARE-Commercial, +134173,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,TRICARE-Commercial, +134174,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,TRICARE-Commercial, +134175,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,TRICARE-Commercial, +134176,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,TRICARE-Commercial, +134177,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,TRICARE-Commercial, +134178,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,TRICARE-Commercial, +134179,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,TRICARE-Commercial, +134180,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,TRICARE-Commercial, +134181,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,TRICARE-Commercial, +134182,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,TRICARE-Commercial, +134183,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,TRICARE-Commercial, +134184,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,TRICARE-Commercial, +134185,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,TRICARE-Commercial, +134186,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,TRICARE-Commercial, +134187,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,TRICARE-Commercial, +134188,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,TRICARE-Commercial, +134189,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,TRICARE-Commercial, +134190,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,TRICARE-Commercial, +134191,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,TRICARE-Commercial, +134192,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,TRICARE-Commercial, +134193,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,TRICARE-Commercial, +134194,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,TRICARE-Commercial, +134195,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,TRICARE-Commercial, +134196,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,TRICARE-Commercial, +134197,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,TRICARE-Commercial, +134198,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,TRICARE-Commercial, +134199,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,TRICARE-Commercial, +134200,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,TRICARE-Commercial, +134201,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,TRICARE-Commercial, +134202,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,TRICARE-Commercial, +134203,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,TRICARE-Commercial, +134204,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,TRICARE-Commercial, +134205,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,TRICARE-Commercial, +134206,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,TRICARE-Commercial, +134207,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,TRICARE-Commercial, +134208,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,TRICARE-Commercial, +134209,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,TRICARE-Commercial, +134210,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,TRICARE-Commercial, +134211,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,TRICARE-Commercial, +134212,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,TRICARE-Commercial, +134213,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,TRICARE-Commercial, +134214,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,TRICARE-Commercial, +134215,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,TRICARE-Commercial, +134216,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,TRICARE-Commercial, +134217,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,TRICARE-Commercial, +134218,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,TRICARE-Commercial, +134219,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,TRICARE-Commercial, +134220,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,TRICARE-Commercial, +134221,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,TRICARE-Commercial, +134222,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,TRICARE-Commercial, +134223,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,TRICARE-Commercial, +134224,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,TRICARE-Commercial, +134225,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,TRICARE-Commercial, +134226,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,TRICARE-Commercial, +134227,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,TRICARE-Commercial, +134228,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,TRICARE-Commercial, +134229,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,TRICARE-Commercial, +134230,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,TRICARE-Commercial, +134231,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,TRICARE-Commercial, +134232,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,TRICARE-Commercial, +134233,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,TRICARE-Commercial, +134234,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,TRICARE-Commercial, +134235,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,TRICARE-Commercial, +134236,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,TRICARE-Commercial, +134237,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,TRICARE-Commercial, +134238,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,TRICARE-Commercial, +134239,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,TRICARE-Commercial, +134240,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,TRICARE-Commercial, +134241,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,TRICARE-Commercial, +134242,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,TRICARE-Commercial, +134243,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,TRICARE-Commercial, +134244,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,TRICARE-Commercial, +134245,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,TRICARE-Commercial, +134246,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,TRICARE-Commercial, +134247,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,TRICARE-Commercial, +134248,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,TRICARE-Commercial, +134249,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,TRICARE-Commercial, +134250,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,TRICARE-Commercial, +134251,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,TRICARE-Commercial, +134252,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,TRICARE-Commercial, +134253,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,TRICARE-Commercial, +134254,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,TRICARE-Commercial, +134255,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,TRICARE-Commercial, +134256,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,TRICARE-Commercial, +134257,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,TRICARE-Commercial, +134258,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,TRICARE-Commercial, +134259,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,TRICARE-Commercial, +134260,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,TRICARE-Commercial, +134261,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,TRICARE-Commercial, +134262,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,TRICARE-Commercial, +134263,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,TRICARE-Commercial, +134264,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,TRICARE-Commercial, +134265,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,TRICARE-Commercial, +134266,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,TRICARE-Commercial, +134267,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,TRICARE-Commercial, +134268,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,TRICARE-Commercial, +134269,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,TRICARE-Commercial, +134270,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,TRICARE-Commercial, +134271,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,TRICARE-Commercial, +134272,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,TRICARE-Commercial, +134273,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,TRICARE-Commercial, +134274,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,TRICARE-Commercial, +134275,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,TRICARE-Commercial, +134276,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,TRICARE-Commercial, +134277,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,TRICARE-Commercial, +134278,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,TRICARE-Commercial, +134279,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,TRICARE-Commercial, +134280,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,TRICARE-Commercial, +134281,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,TRICARE-Commercial, +134282,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,TRICARE-Commercial, +134283,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,TRICARE-Commercial, +134284,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,TRICARE-Commercial, +134285,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,TRICARE-Commercial, +134286,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,TRICARE-Commercial, +134287,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,TRICARE-Commercial, +134288,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,TRICARE-Commercial, +134289,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,TRICARE-Commercial, +134290,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,TRICARE-Commercial, +134291,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,TRICARE-Commercial, +134292,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,TRICARE-Commercial, +134293,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,TRICARE-Commercial, +134294,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,TRICARE-Commercial, +134295,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,TRICARE-Commercial, +134296,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,TRICARE-Commercial, +134297,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,TRICARE-Commercial, +134298,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,TRICARE-Commercial, +134299,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,TRICARE-Commercial, +134300,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,TRICARE-Commercial,546.72 +134301,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,TRICARE-Commercial, +134302,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,TRICARE-Commercial, +134303,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,TRICARE-Commercial, +134304,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,TRICARE-Commercial, +134305,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,TRICARE-Commercial, +134306,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,TRICARE-Commercial, +134307,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,TRICARE-Commercial, +134308,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,TRICARE-Commercial, +134309,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,TRICARE-Commercial, +134310,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,TRICARE-Commercial, +134311,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,TRICARE-Commercial, +134312,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,TRICARE-Commercial, +134313,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,TRICARE-Commercial, +134314,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,TRICARE-Commercial, +134315,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,TRICARE-Commercial, +134316,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,TRICARE-Commercial, +134317,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,TRICARE-Commercial, +134318,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,TRICARE-Commercial, +134319,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,TRICARE-Commercial, +134320,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,TRICARE-Commercial, +134321,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,TRICARE-Commercial, +134322,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,TRICARE-Commercial, +134323,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,TRICARE-Commercial, +134324,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,TRICARE-Commercial, +134325,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,TRICARE-Commercial, +134326,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,TRICARE-Commercial, +134327,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,TRICARE-Commercial, +134328,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,TRICARE-Commercial, +134329,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,TRICARE-Commercial, +134330,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,TRICARE-Commercial, +134331,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,TRICARE-Commercial, +134332,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,TRICARE-Commercial, +134333,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,TRICARE-Commercial, +134334,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,TRICARE-Commercial, +134335,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,TRICARE-Commercial, +134336,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,TRICARE-Commercial, +134337,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,TRICARE-Commercial, +134338,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,TRICARE-Commercial, +134339,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,TRICARE-Commercial, +134340,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,TRICARE-Commercial, +134341,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,TRICARE-Commercial, +134342,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,TRICARE-Commercial, +134343,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,TRICARE-Commercial, +134344,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,TRICARE-Commercial, +134345,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,TRICARE-Commercial, +134346,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,TRICARE-Commercial, +134347,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,TRICARE-Commercial, +134348,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,TRICARE-Commercial, +134349,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,TRICARE-Commercial, +134350,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,TRICARE-Commercial, +134351,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,TRICARE-Commercial, +134352,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,TRICARE-Commercial, +134353,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,TRICARE-Commercial, +134354,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,TRICARE-Commercial, +134355,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,TRICARE-Commercial, +134356,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,TRICARE-Commercial, +134357,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,TRICARE-Commercial, +134358,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,TRICARE-Commercial, +134359,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,TRICARE-Commercial, +134360,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,TRICARE-Commercial, +134361,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,TRICARE-Commercial, +134362,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,TRICARE-Commercial, +134363,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,TRICARE-Commercial, +134364,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,TRICARE-Commercial, +134365,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,TRICARE-Commercial, +134366,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,TRICARE-Commercial, +134367,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,TRICARE-Commercial, +134368,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,TRICARE-Commercial, +134369,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,TRICARE-Commercial, +134370,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,TRICARE-Commercial, +134371,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,TRICARE-Commercial, +134372,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,TRICARE-Commercial, +134373,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,TRICARE-Commercial, +134374,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,TRICARE-Commercial, +134375,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,TRICARE-Commercial, +134376,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,TRICARE-Commercial, +134377,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,TRICARE-Commercial, +134378,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,TRICARE-Commercial, +134379,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,TRICARE-Commercial, +134380,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,TRICARE-Commercial, +134381,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,TRICARE-Commercial, +134382,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,TRICARE-Commercial, +134383,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,TRICARE-Commercial, +134384,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,TRICARE-Commercial, +134385,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,TRICARE-Commercial, +134386,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,TRICARE-Commercial, +134387,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,TRICARE-Commercial, +134388,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,TRICARE-Commercial, +134389,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,TRICARE-Commercial, +134390,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,TRICARE-Commercial, +134391,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,TRICARE-Commercial, +134392,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,TRICARE-Commercial, +134393,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,TRICARE-Commercial, +134394,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,TRICARE-Commercial, +134395,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,TRICARE-Commercial, +134396,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,TRICARE-Commercial, +134397,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,TRICARE-Commercial, +134398,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,TRICARE-Commercial, +134399,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,TRICARE-Commercial, +134400,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,TRICARE-Commercial, +134401,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,TRICARE-Commercial, +134402,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,TRICARE-Commercial, +134403,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,TRICARE-Commercial, +134404,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,TRICARE-Commercial, +134405,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,TRICARE-Commercial, +134406,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,TRICARE-Commercial, +134407,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,TRICARE-Commercial, +134408,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,TRICARE-Commercial, +134409,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,TRICARE-Commercial, +134410,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,TRICARE-Commercial, +134411,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,TRICARE-Commercial, +134412,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,TRICARE-Commercial, +134413,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,TRICARE-Commercial, +134414,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,TRICARE-Commercial, +134415,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,TRICARE-Commercial, +134416,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,TRICARE-Commercial, +134417,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,TRICARE-Commercial, +134418,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,TRICARE-Commercial, +134419,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,TRICARE-Commercial, +134420,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,TRICARE-Commercial, +134421,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,TRICARE-Commercial, +134422,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,TRICARE-Commercial, +134423,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,TRICARE-Commercial, +134424,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,TRICARE-Commercial, +134425,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,TRICARE-Commercial, +134426,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,TRICARE-Commercial, +134427,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,TRICARE-Commercial, +134428,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,TRICARE-Commercial, +134429,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,TRICARE-Commercial, +134430,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,TRICARE-Commercial, +134431,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,TRICARE-Commercial, +134432,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,TRICARE-Commercial, +134433,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,TRICARE-Commercial, +134434,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,TRICARE-Commercial, +134435,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,TRICARE-Commercial, +134436,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,TRICARE-Commercial, +134437,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,TRICARE-Commercial, +134438,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,TRICARE-Commercial, +134439,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,TRICARE-Commercial, +134440,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,TRICARE-Commercial, +134441,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,TRICARE-Commercial, +134442,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,TRICARE-Commercial, +134443,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,TRICARE-Commercial, +134444,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,TRICARE-Commercial, +134445,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,TRICARE-Commercial, +134446,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,TRICARE-Commercial, +134447,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,TRICARE-Commercial, +134448,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,TRICARE-Commercial, +134449,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,TRICARE-Commercial, +134450,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,TRICARE-Commercial, +134451,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,TRICARE-Commercial, +134452,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,TRICARE-Commercial, +134453,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,TRICARE-Commercial, +134454,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,TRICARE-Commercial, +134455,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,TRICARE-Commercial, +134456,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,TRICARE-Commercial, +134457,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,TRICARE-Commercial, +134458,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,TRICARE-Commercial, +134459,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,TRICARE-Commercial, +134460,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,TRICARE-Commercial, +134461,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,TRICARE-Commercial, +134462,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,TRICARE-Commercial, +134463,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,TRICARE-Commercial, +134464,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,TRICARE-Commercial, +134465,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,TRICARE-Commercial, +134466,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,TRICARE-Commercial, +134467,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,TRICARE-Commercial, +134468,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,TRICARE-Commercial, +134469,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,TRICARE-Commercial, +134470,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,TRICARE-Commercial, +134471,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,TRICARE-Commercial, +134472,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,TRICARE-Commercial, +134473,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,TRICARE-Commercial, +134474,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,TRICARE-Commercial, +134475,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,TRICARE-Commercial, +134476,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,TRICARE-Commercial, +134477,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,TRICARE-Commercial, +134478,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,TRICARE-Commercial, +134479,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,TRICARE-Commercial, +134480,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,TRICARE-Commercial, +134481,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,TRICARE-Commercial, +134482,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,TRICARE-Commercial, +134483,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,TRICARE-Commercial, +134484,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,TRICARE-Commercial, +134485,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,TRICARE-Commercial, +134486,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,TRICARE-Commercial, +134487,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,TRICARE-Commercial, +134488,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,TRICARE-Commercial, +134489,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,TRICARE-Commercial, +134490,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,TRICARE-Commercial, +134491,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,TRICARE-Commercial, +134492,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,TRICARE-Commercial, +134493,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,TRICARE-Commercial, +134494,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,TRICARE-Commercial, +134495,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,TRICARE-Commercial, +134496,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,TRICARE-Commercial, +134497,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,TRICARE-Commercial, +134498,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,TRICARE-Commercial, +134499,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,TRICARE-Commercial, +134500,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,TRICARE-Commercial, +134501,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,TRICARE-Commercial, +134502,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,TRICARE-Commercial, +134503,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,TRICARE-Commercial, +134504,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,TRICARE-Commercial, +134505,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,TRICARE-Commercial, +134506,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,TRICARE-Commercial, +134507,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,TRICARE-Commercial, +134508,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,TRICARE-Commercial, +134509,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,TRICARE-Commercial, +134510,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,TRICARE-Commercial, +134511,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,TRICARE-Commercial, +134512,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,TRICARE-Commercial, +134513,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,TRICARE-Commercial, +134514,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,TRICARE-Commercial, +134515,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,TRICARE-Commercial, +134516,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,TRICARE-Commercial, +134517,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,TRICARE-Commercial, +134518,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,TRICARE-Commercial, +134519,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,TRICARE-Commercial, +134520,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,TRICARE-Commercial, +134521,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,TRICARE-Commercial, +134522,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,TRICARE-Commercial, +134523,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,TRICARE-Commercial, +134524,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,TRICARE-Commercial, +134525,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,TRICARE-Commercial, +134526,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,TRICARE-Commercial, +134527,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,TRICARE-Commercial, +134528,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,TRICARE-Commercial, +134529,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,TRICARE-Commercial, +134530,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,TRICARE-Commercial, +134531,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,TRICARE-Commercial, +134532,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,TRICARE-Commercial, +134533,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,TRICARE-Commercial, +134534,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,TRICARE-Commercial, +134535,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,TRICARE-Commercial, +134536,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,TRICARE-Commercial, +134537,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,TRICARE-Commercial, +134538,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,TRICARE-Commercial, +134539,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,TRICARE-Commercial, +134540,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,TRICARE-Commercial, +134541,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,TRICARE-Commercial, +134542,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,TRICARE-Commercial, +134543,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,TRICARE-Commercial,222.6 +134544,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,TRICARE-Commercial,46.17 +134545,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,TRICARE-Commercial, +134546,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,TRICARE-Commercial, +134547,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,TRICARE-Commercial, +134548,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,TRICARE-Commercial, +134549,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,TRICARE-Commercial, +134550,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,TRICARE-Commercial, +134551,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,TRICARE-Commercial, +134552,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,TRICARE-Commercial, +134553,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,TRICARE-Commercial, +134554,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,TRICARE-Commercial, +134555,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,TRICARE-Commercial, +134556,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,TRICARE-Commercial, +134557,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,TRICARE-Commercial, +134558,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,TRICARE-Commercial, +134559,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,TRICARE-Commercial, +134560,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,TRICARE-Commercial, +134561,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,TRICARE-Commercial, +134562,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,TRICARE-Commercial, +134563,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,TRICARE-Commercial, +134564,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,TRICARE-Commercial, +134565,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,TRICARE-Commercial, +134566,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,TRICARE-Commercial, +134567,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,TRICARE-Commercial, +134568,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,TRICARE-Commercial, +134569,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,TRICARE-Commercial, +134570,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,TRICARE-Commercial, +134571,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,TRICARE-Commercial, +134572,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,TRICARE-Commercial, +134573,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,TRICARE-Commercial, +134574,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,TRICARE-Commercial, +134575,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,TRICARE-Commercial, +134576,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,TRICARE-Commercial, +134577,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,TRICARE-Commercial, +134578,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,TRICARE-Commercial, +134579,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,TRICARE-Commercial, +134580,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,TRICARE-Commercial, +134581,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,TRICARE-Commercial, +134582,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,TRICARE-Commercial, +134583,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,TRICARE-Commercial, +134584,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,TRICARE-Commercial, +134585,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,TRICARE-Commercial, +134586,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,TRICARE-Commercial, +134587,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,TRICARE-Commercial, +134588,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,TRICARE-Commercial, +134589,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,TRICARE-Commercial, +134590,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,TRICARE-Commercial, +134591,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,TRICARE-Commercial, +134592,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,TRICARE-Commercial, +134593,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,TRICARE-Commercial, +134594,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,TRICARE-Commercial, +134595,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,TRICARE-Commercial, +134596,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,TRICARE-Commercial, +134597,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,TRICARE-Commercial, +134598,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,TRICARE-Commercial, +134599,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,TRICARE-Commercial, +134600,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,TRICARE-Commercial, +134601,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,TRICARE-Commercial, +134602,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,TRICARE-Commercial, +134603,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,TRICARE-Commercial, +134604,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,TRICARE-Commercial, +134605,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,TRICARE-Commercial, +134606,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,TRICARE-Commercial, +134607,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,TRICARE-Commercial, +134608,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,TRICARE-Commercial, +134609,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,TRICARE-Commercial, +134610,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,TRICARE-Commercial, +134611,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,TRICARE-Commercial, +134612,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,TRICARE-Commercial, +134613,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,TRICARE-Commercial, +134614,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,TRICARE-Commercial, +134615,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,TRICARE-Commercial, +134616,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,TRICARE-Commercial, +134617,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,TRICARE-Commercial, +134618,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,TRICARE-Commercial,426.19 +134619,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,TRICARE-Commercial, +134620,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,TRICARE-Commercial, +134621,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,TRICARE-Commercial, +134622,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,TRICARE-Commercial, +134623,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,TRICARE-Commercial, +134624,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,TRICARE-Commercial, +134625,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,TRICARE-Commercial, +134626,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,TRICARE-Commercial, +134627,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,TRICARE-Commercial, +134628,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,TRICARE-Commercial, +134629,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,TRICARE-Commercial, +134630,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,TRICARE-Commercial, +134631,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,TRICARE-Commercial, +134632,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,TRICARE-Commercial, +134633,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,TRICARE-Commercial, +134634,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,TRICARE-Commercial, +134635,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,TRICARE-Commercial, +134636,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,TRICARE-Commercial, +134637,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,TRICARE-Commercial, +134638,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,TRICARE-Commercial, +134639,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,TRICARE-Commercial, +134640,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,TRICARE-Commercial, +134641,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,TRICARE-Commercial, +134642,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,TRICARE-Commercial, +134643,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,TRICARE-Commercial, +134644,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,TRICARE-Commercial, +134645,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,TRICARE-Commercial, +134646,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,TRICARE-Commercial, +134647,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,TRICARE-Commercial, +134648,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,TRICARE-Commercial, +134649,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,TRICARE-Commercial, +134650,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,TRICARE-Commercial, +134651,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,TRICARE-Commercial, +134652,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,TRICARE-Commercial, +134653,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,TRICARE-Commercial, +134654,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,TRICARE-Commercial, +134655,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,TRICARE-Commercial, +134656,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,TRICARE-Commercial, +134657,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,TRICARE-Commercial, +134658,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,TRICARE-Commercial, +134659,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,TRICARE-Commercial, +134660,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,TRICARE-Commercial, +134661,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,TRICARE-Commercial, +134662,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,TRICARE-Commercial, +134663,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,TRICARE-Commercial, +134664,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,TRICARE-Commercial, +134665,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,TRICARE-Commercial, +134666,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,TRICARE-Commercial, +134667,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,TRICARE-Commercial, +134668,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,TRICARE-Commercial, +134669,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,TRICARE-Commercial, +134670,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,TRICARE-Commercial, +134671,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,TRICARE-Commercial, +134672,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,TRICARE-Commercial, +134673,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,TRICARE-Commercial, +134674,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,TRICARE-Commercial, +134675,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,TRICARE-Commercial, +134676,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,TRICARE-Commercial, +134677,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,TRICARE-Commercial, +134678,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,TRICARE-Commercial, +134679,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,TRICARE-Commercial, +134680,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,TRICARE-Commercial, +134681,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,TRICARE-Commercial, +134682,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,TRICARE-Commercial, +134683,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,TRICARE-Commercial, +134684,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,TRICARE-Commercial, +134685,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,TRICARE-Commercial, +134686,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,TRICARE-Commercial, +134687,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,TRICARE-Commercial, +134688,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,TRICARE-Commercial, +134689,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,TRICARE-Commercial, +134690,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,TRICARE-Commercial, +134691,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,TRICARE-Commercial, +134692,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,TRICARE-Commercial, +134693,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,TRICARE-Commercial, +134694,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,TRICARE-Commercial, +134695,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,TRICARE-Commercial, +134696,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,TRICARE-Commercial, +134697,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,TRICARE-Commercial, +134698,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,TRICARE-Commercial, +134699,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,TRICARE-Commercial, +134700,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,TRICARE-Commercial, +134701,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,TRICARE-Commercial, +134702,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,TRICARE-Commercial, +134703,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,TRICARE-Commercial, +134704,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,TRICARE-Commercial, +134705,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,TRICARE-Commercial, +134706,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,TRICARE-Commercial, +134707,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,TRICARE-Commercial, +134708,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,TRICARE-Commercial, +134709,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,TRICARE-Commercial, +134710,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,TRICARE-Commercial, +134711,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,TRICARE-Commercial, +134712,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,TRICARE-Commercial, +134713,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,TRICARE-Commercial, +134714,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,TRICARE-Commercial, +134715,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,TRICARE-Commercial, +134716,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,TRICARE-Commercial, +134717,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,TRICARE-Commercial, +134718,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,TRICARE-Commercial, +134719,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,TRICARE-Commercial, +134720,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,TRICARE-Commercial, +134721,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,TRICARE-Commercial, +134722,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,TRICARE-Commercial, +134723,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,TRICARE-Commercial, +134724,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,TRICARE-Commercial, +134725,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,TRICARE-Commercial, +134726,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,TRICARE-Commercial, +134727,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,TRICARE-Commercial, +134728,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,TRICARE-Commercial, +134729,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,TRICARE-Commercial, +134730,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,TRICARE-Commercial, +134731,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,TRICARE-Commercial, +134732,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,TRICARE-Commercial, +134733,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,TRICARE-Commercial, +134734,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,TRICARE-Commercial, +134735,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,TRICARE-Commercial, +134736,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,TRICARE-Commercial, +134737,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,TRICARE-Commercial, +134738,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,TRICARE-Commercial, +134739,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,TRICARE-Commercial, +134740,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,TRICARE-Commercial, +134741,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,TRICARE-Commercial, +134742,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,TRICARE-Commercial, +134743,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,TRICARE-Commercial, +134744,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,TRICARE-Commercial, +134745,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,TRICARE-Commercial, +134746,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,TRICARE-Commercial, +134747,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,TRICARE-Commercial, +134748,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,TRICARE-Commercial, +134749,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,TRICARE-Commercial, +134750,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,TRICARE-Commercial, +134751,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,TRICARE-Commercial, +134752,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,TRICARE-Commercial, +134753,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,TRICARE-Commercial, +134754,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,TRICARE-Commercial, +134755,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,TRICARE-Commercial, +134756,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,TRICARE-Commercial, +134757,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,TRICARE-Commercial, +134758,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,TRICARE-Commercial, +134759,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,TRICARE-Commercial, +134760,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,TRICARE-Commercial, +134761,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,TRICARE-Commercial, +134762,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,TRICARE-Commercial, +134763,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,TRICARE-Commercial, +134764,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,TRICARE-Commercial, +134765,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,TRICARE-Commercial, +134766,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,TRICARE-Commercial, +134767,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,TRICARE-Commercial, +134768,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,TRICARE-Commercial, +134769,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,TRICARE-Commercial, +134770,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,TRICARE-Commercial, +134771,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,TRICARE-Commercial, +134772,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,TRICARE-Commercial, +134773,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,TRICARE-Commercial, +134774,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,TRICARE-Commercial, +134775,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,TRICARE-Commercial, +134776,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,TRICARE-Commercial, +134777,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,TRICARE-Commercial, +134778,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,TRICARE-Commercial, +134779,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,TRICARE-Commercial, +134780,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,TRICARE-Commercial, +134781,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,TRICARE-Commercial, +134782,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,TRICARE-Commercial, +134783,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,TRICARE-Commercial, +134784,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,TRICARE-Commercial, +134785,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,TRICARE-Commercial, +134786,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,TRICARE-Commercial, +134787,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,TRICARE-Commercial, +134788,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,TRICARE-Commercial, +134789,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,TRICARE-Commercial, +134790,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,TRICARE-Commercial, +134791,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,TRICARE-Commercial, +134792,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,TRICARE-Commercial, +134793,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,TRICARE-Commercial, +134794,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,TRICARE-Commercial, +134795,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,TRICARE-Commercial, +134796,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,TRICARE-Commercial, +134797,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,TRICARE-Commercial, +134798,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,TRICARE-Commercial, +134799,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,TRICARE-Commercial, +134800,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,TRICARE-Commercial, +134801,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,TRICARE-Commercial, +134802,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,TRICARE-Commercial, +134803,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,TRICARE-Commercial, +134804,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,TRICARE-Commercial, +134805,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,TRICARE-Commercial, +134806,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,TRICARE-Commercial, +134807,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,TRICARE-Commercial, +134808,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,TRICARE-Commercial, +134809,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,TRICARE-Commercial, +134810,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,TRICARE-Commercial, +134811,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,TRICARE-Commercial, +134812,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,TRICARE-Commercial, +134813,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,TRICARE-Commercial, +134814,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,TRICARE-Commercial, +134815,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,TRICARE-Commercial, +134816,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,TRICARE-Commercial, +134817,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,TRICARE-Commercial, +134818,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,TRICARE-Commercial, +134819,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,TRICARE-Commercial, +134820,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,TRICARE-Commercial, +134821,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,TRICARE-Commercial, +134822,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,TRICARE-Commercial, +134823,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,TRICARE-Commercial, +134824,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,TRICARE-Commercial, +134825,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,TRICARE-Commercial, +134826,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,TRICARE-Commercial, +134827,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,TRICARE-Commercial, +134828,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,TRICARE-Commercial, +134829,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,TRICARE-Commercial, +134830,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,TRICARE-Commercial, +134831,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,TRICARE-Commercial, +134832,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,TRICARE-Commercial, +134833,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,TRICARE-Commercial, +134834,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,TRICARE-Commercial, +134835,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,TRICARE-Commercial, +134836,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,TRICARE-Commercial, +134837,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,TRICARE-Commercial, +134838,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,TRICARE-Commercial, +134839,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,TRICARE-Commercial, +134840,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,TRICARE-Commercial, +134841,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,TRICARE-Commercial, +134842,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,TRICARE-Commercial, +134843,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,TRICARE-Commercial, +134844,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,TRICARE-Commercial, +134845,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,TRICARE-Commercial, +134846,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,TRICARE-Commercial, +134847,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,TRICARE-Commercial, +134848,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,TRICARE-Commercial, +134849,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,TRICARE-Commercial, +134850,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,TRICARE-Commercial, +134851,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,TRICARE-Commercial, +134852,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,TRICARE-Commercial, +134853,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,TRICARE-Commercial, +134854,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,TRICARE-Commercial, +134855,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,TRICARE-Commercial, +134856,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,TRICARE-Commercial, +134857,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,TRICARE-Commercial, +134858,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,TRICARE-Commercial, +134859,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,TRICARE-Commercial, +134860,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,TRICARE-Commercial, +134861,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,TRICARE-Commercial, +134862,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,TRICARE-Commercial, +134863,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,TRICARE-Commercial, +134864,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,TRICARE-Commercial, +134865,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,TRICARE-Commercial, +134866,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,TRICARE-Commercial, +134867,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,TRICARE-Commercial, +134868,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,TRICARE-Commercial, +134869,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,TRICARE-Commercial, +134870,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,TRICARE-Commercial, +134871,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,TRICARE-Commercial, +134872,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,TRICARE-Commercial, +134873,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,TRICARE-Commercial, +134874,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,TRICARE-Commercial, +134875,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,TRICARE-Commercial, +134876,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,TRICARE-Commercial, +134877,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,TRICARE-Commercial, +134878,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,TRICARE-Commercial, +134879,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,TRICARE-Commercial, +134880,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,TRICARE-Commercial, +134881,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,TRICARE-Commercial, +134882,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,TRICARE-Commercial, +134883,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,TRICARE-Commercial, +134884,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,TRICARE-Commercial, +134885,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,TRICARE-Commercial, +134886,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,TRICARE-Commercial, +134887,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,TRICARE-Commercial, +134888,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,TRICARE-Commercial, +134889,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,TRICARE-Commercial, +134890,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,TRICARE-Commercial, +134891,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,TRICARE-Commercial, +134892,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,TRICARE-Commercial, +134893,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,TRICARE-Commercial, +134894,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,TRICARE-Commercial, +134895,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,TRICARE-Commercial, +134896,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,TRICARE-Commercial, +134897,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,TRICARE-Commercial, +134898,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,TRICARE-Commercial, +134899,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,TRICARE-Commercial, +134900,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,TRICARE-Commercial, +134901,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,TRICARE-Commercial, +134902,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,TRICARE-Commercial, +134903,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,TRICARE-Commercial, +134904,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,TRICARE-Commercial, +134905,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,TRICARE-Commercial, +134906,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,TRICARE-Commercial, +134907,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,TRICARE-Commercial, +134908,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,TRICARE-Commercial, +134909,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,TRICARE-Commercial, +134910,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,TRICARE-Commercial, +134911,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,TRICARE-Commercial, +134912,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,TRICARE-Commercial, +134913,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,TRICARE-Commercial, +134914,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,TRICARE-Commercial, +134915,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,TRICARE-Commercial, +134916,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,TRICARE-Commercial, +134917,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,TRICARE-Commercial, +134918,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,TRICARE-Commercial, +134919,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,TRICARE-Commercial, +134920,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,TRICARE-Commercial, +134921,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,TRICARE-Commercial, +134922,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,TRICARE-Commercial, +134923,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,TRICARE-Commercial, +134924,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,TRICARE-Commercial, +134925,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,TRICARE-Commercial, +134926,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,TRICARE-Commercial,372.2 +134927,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,TRICARE-Commercial, +134928,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,TRICARE-Commercial, +134929,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,TRICARE-Commercial, +134930,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,TRICARE-Commercial, +134931,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,TRICARE-Commercial, +134932,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,TRICARE-Commercial, +134933,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,TRICARE-Commercial, +134934,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,TRICARE-Commercial, +134935,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,TRICARE-Commercial, +134936,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,TRICARE-Commercial, +134937,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,TRICARE-Commercial, +134938,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,TRICARE-Commercial, +134939,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,TRICARE-Commercial, +134940,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,TRICARE-Commercial, +134941,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,TRICARE-Commercial, +134942,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,TRICARE-Commercial, +134943,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,TRICARE-Commercial, +134944,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,TRICARE-Commercial, +134945,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,TRICARE-Commercial, +134946,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,TRICARE-Commercial, +134947,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,TRICARE-Commercial, +134948,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,TRICARE-Commercial, +134949,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,TRICARE-Commercial, +134950,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,TRICARE-Commercial, +134951,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,TRICARE-Commercial, +134952,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,TRICARE-Commercial, +134953,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,TRICARE-Commercial, +134954,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,TRICARE-Commercial, +134955,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,TRICARE-Commercial, +134956,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,TRICARE-Commercial, +134957,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,TRICARE-Commercial, +134958,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,TRICARE-Commercial, +134959,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,TRICARE-Commercial, +134960,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,TRICARE-Commercial, +134961,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,TRICARE-Commercial, +134962,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,TRICARE-Commercial, +134963,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,TRICARE-Commercial, +134964,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,TRICARE-Commercial, +134965,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,TRICARE-Commercial, +134966,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,TRICARE-Commercial, +134967,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,TRICARE-Commercial, +134968,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,TRICARE-Commercial, +134969,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,TRICARE-Commercial, +134970,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,TRICARE-Commercial, +134971,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,TRICARE-Commercial, +134972,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,TRICARE-Commercial, +134973,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,TRICARE-Commercial, +134974,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,TRICARE-Commercial, +134975,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,TRICARE-Commercial, +134976,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,TRICARE-Commercial, +134977,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,TRICARE-Commercial, +134978,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,TRICARE-Commercial, +134979,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,TRICARE-Commercial, +134980,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,TRICARE-Commercial, +134981,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,TRICARE-Commercial, +134982,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,TRICARE-Commercial, +134983,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,TRICARE-Commercial, +134984,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,TRICARE-Commercial, +134985,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,TRICARE-Commercial, +134986,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,TRICARE-Commercial, +134987,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,TRICARE-Commercial, +134988,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,TRICARE-Commercial, +134989,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,TRICARE-Commercial, +134990,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,TRICARE-Commercial, +134991,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,TRICARE-Commercial, +134992,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,TRICARE-Commercial, +134993,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,TRICARE-Commercial, +134994,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,TRICARE-Commercial, +134995,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,TRICARE-Commercial, +134996,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,TRICARE-Commercial, +134997,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,TRICARE-Commercial, +134998,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,TRICARE-Commercial, +134999,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,TRICARE-Commercial, +135000,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,TRICARE-Commercial, +135001,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,TRICARE-Commercial, +135002,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,TRICARE-Commercial, +135003,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,TRICARE-Commercial, +135004,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,TRICARE-Commercial, +135005,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,TRICARE-Commercial, +135006,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,TRICARE-Commercial, +135007,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,TRICARE-Commercial, +135008,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,TRICARE-Commercial, +135009,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,TRICARE-Commercial, +135010,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,TRICARE-Commercial, +135011,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,TRICARE-Commercial, +135012,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,TRICARE-Commercial, +135013,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,TRICARE-Commercial, +135014,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,TRICARE-Commercial, +135015,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,TRICARE-Commercial, +135016,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,TRICARE-Commercial, +135017,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,TRICARE-Commercial, +135018,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,TRICARE-Commercial, +135019,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,TRICARE-Commercial, +135020,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,TRICARE-Commercial, +135021,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,TRICARE-Commercial, +135022,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,TRICARE-Commercial, +135023,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,TRICARE-Commercial, +135024,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,TRICARE-Commercial, +135025,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,TRICARE-Commercial, +135026,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,TRICARE-Commercial, +135027,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,TRICARE-Commercial, +135028,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,TRICARE-Commercial, +135029,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,TRICARE-Commercial, +135030,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,TRICARE-Commercial, +135031,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,TRICARE-Commercial, +135032,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,TRICARE-Commercial, +135033,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,TRICARE-Commercial, +135034,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,TRICARE-Commercial, +135035,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,TRICARE-Commercial, +135036,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,TRICARE-Commercial, +135037,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,TRICARE-Commercial, +135038,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,TRICARE-Commercial, +135039,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,TRICARE-Commercial, +135040,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,TRICARE-Commercial, +135041,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,TRICARE-Commercial, +135042,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,TRICARE-Commercial, +135043,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,TRICARE-Commercial, +135044,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,TRICARE-Commercial, +135045,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,TRICARE-Commercial, +135046,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,TRICARE-Commercial, +135047,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,TRICARE-Commercial, +135048,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,TRICARE-Commercial, +135049,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,TRICARE-Commercial, +135050,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,TRICARE-Commercial, +135051,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,TRICARE-Commercial, +135052,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,TRICARE-Commercial, +135053,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,TRICARE-Commercial, +135054,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,TRICARE-Commercial, +135055,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,TRICARE-Commercial, +135056,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,TRICARE-Commercial, +135057,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,TRICARE-Commercial, +135058,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,TRICARE-Commercial, +135059,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,TRICARE-Commercial, +135060,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,TRICARE-Commercial, +135061,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,TRICARE-Commercial, +135062,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,TRICARE-Commercial, +135063,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,TRICARE-Commercial, +135064,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,TRICARE-Commercial, +135065,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,TRICARE-Commercial, +135066,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,TRICARE-Commercial, +135067,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,TRICARE-Commercial, +135068,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,TRICARE-Commercial, +135069,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,TRICARE-Commercial, +135070,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,TRICARE-Commercial, +135071,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,TRICARE-Commercial, +135072,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,TRICARE-Commercial, +135073,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,TRICARE-Commercial, +135074,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,TRICARE-Commercial, +135075,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,TRICARE-Commercial, +135076,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,TRICARE-Commercial, +135077,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,TRICARE-Commercial, +135078,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,TRICARE-Commercial, +135079,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,TRICARE-Commercial, +135080,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,TRICARE-Commercial, +135081,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,TRICARE-Commercial, +135082,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,TRICARE-Commercial, +135083,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,TRICARE-Commercial, +135084,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,TRICARE-Commercial, +135085,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,TRICARE-Commercial, +135086,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,TRICARE-Commercial, +135087,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,TRICARE-Commercial, +135088,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,TRICARE-Commercial, +135089,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,TRICARE-Commercial, +135090,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,TRICARE-Commercial, +135091,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,TRICARE-Commercial, +135092,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,TRICARE-Commercial, +135093,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,TRICARE-Commercial, +135094,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,TRICARE-Commercial, +135095,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,TRICARE-Commercial, +135096,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,TRICARE-Commercial, +135097,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,TRICARE-Commercial, +135098,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,TRICARE-Commercial, +135099,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,TRICARE-Commercial, +135100,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,TRICARE-Commercial, +135101,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,TRICARE-Commercial, +135102,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,TRICARE-Commercial, +135103,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,TRICARE-Commercial, +135104,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,TRICARE-Commercial, +135105,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,TRICARE-Commercial, +135106,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,TRICARE-Commercial, +135107,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,TRICARE-Commercial, +135108,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,TRICARE-Commercial, +135109,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,TRICARE-Commercial, +135110,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,TRICARE-Commercial, +135111,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,TRICARE-Commercial, +135112,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,TRICARE-Commercial, +135113,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,TRICARE-Commercial, +135114,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,TRICARE-Commercial, +135115,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,TRICARE-Commercial, +135116,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,TRICARE-Commercial, +135117,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,TRICARE-Commercial, +135118,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,TRICARE-Commercial, +135119,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,TRICARE-Commercial, +135120,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,TRICARE-Commercial, +135121,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,TRICARE-Commercial, +135122,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,TRICARE-Commercial, +135123,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,TRICARE-Commercial, +135124,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,TRICARE-Commercial, +135125,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,TRICARE-Commercial, +135126,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,TRICARE-Commercial, +135127,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,TRICARE-Commercial, +135128,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,TRICARE-Commercial, +135129,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,TRICARE-Commercial, +135130,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,TRICARE-Commercial, +135131,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,TRICARE-Commercial, +135132,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,TRICARE-Commercial, +135133,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,TRICARE-Commercial, +135134,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,TRICARE-Commercial, +135135,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,TRICARE-Commercial, +135136,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,TRICARE-Commercial, +135137,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,TRICARE-Commercial, +135138,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,TRICARE-Commercial, +135139,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,TRICARE-Commercial, +135140,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,TRICARE-Commercial, +135141,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,TRICARE-Commercial, +135142,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,TRICARE-Commercial, +135143,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,TRICARE-Commercial, +135144,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,TRICARE-Commercial, +135145,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,TRICARE-Commercial, +135146,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,TRICARE-Commercial, +135147,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,TRICARE-Commercial, +135148,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,TRICARE-Commercial, +135149,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,TRICARE-Commercial, +135150,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,TRICARE-Commercial, +135151,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,TRICARE-Commercial, +135152,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,TRICARE-Commercial, +135153,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,TRICARE-Commercial, +135154,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,TRICARE-Commercial, +135155,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,TRICARE-Commercial, +135156,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,TRICARE-Commercial, +135157,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,TRICARE-Commercial, +135158,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,TRICARE-Commercial, +135159,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,TRICARE-Commercial, +135160,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,TRICARE-Commercial, +135161,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,TRICARE-Commercial, +135162,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,TRICARE-Commercial, +135163,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,TRICARE-Commercial, +135164,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,TRICARE-Commercial, +135165,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,TRICARE-Commercial, +135166,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,TRICARE-Commercial, +135167,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,TRICARE-Commercial, +135168,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,TRICARE-Commercial, +135169,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,TRICARE-Commercial, +135170,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,TRICARE-Commercial, +135171,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,TRICARE-Commercial, +135172,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,TRICARE-Commercial, +135173,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,TRICARE-Commercial, +135174,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,TRICARE-Commercial, +135175,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,TRICARE-Commercial, +135176,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,TRICARE-Commercial, +135177,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,TRICARE-Commercial, +135178,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,TRICARE-Commercial, +135179,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,TRICARE-Commercial, +135180,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,TRICARE-Commercial, +135181,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,TRICARE-Commercial, +135182,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,TRICARE-Commercial, +135183,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,TRICARE-Commercial, +135184,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,TRICARE-Commercial, +135185,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,TRICARE-Commercial, +135186,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,TRICARE-Commercial, +135187,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,TRICARE-Commercial, +135188,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,TRICARE-Commercial, +135189,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,TRICARE-Commercial, +135190,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,TRICARE-Commercial, +135191,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,TRICARE-Commercial, +135192,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,TRICARE-Commercial, +135193,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,TRICARE-Commercial, +135194,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,TRICARE-Commercial, +135195,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,TRICARE-Commercial, +135196,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,TRICARE-Commercial, +135197,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,TRICARE-Commercial, +135198,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,TRICARE-Commercial, +135199,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,TRICARE-Commercial, +135200,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,TRICARE-Commercial, +135201,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,TRICARE-Commercial, +135202,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,TRICARE-Commercial, +135203,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,TRICARE-Commercial, +135204,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,TRICARE-Commercial, +135205,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,TRICARE-Commercial, +135206,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,TRICARE-Commercial, +135207,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,TRICARE-Commercial, +135208,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,TRICARE-Commercial, +135209,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,TRICARE-Commercial, +135210,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,TRICARE-Commercial, +135211,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,TRICARE-Commercial, +135212,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,TRICARE-Commercial, +135213,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,TRICARE-Commercial, +135214,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,TRICARE-Commercial, +135215,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,TRICARE-Commercial, +135216,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,TRICARE-Commercial, +135217,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,TRICARE-Commercial, +135218,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,TRICARE-Commercial, +135219,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,TRICARE-Commercial, +135220,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,TRICARE-Commercial, +135221,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,TRICARE-Commercial, +135222,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,TRICARE-Commercial, +135223,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,TRICARE-Commercial, +135224,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,TRICARE-Commercial, +135225,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,TRICARE-Commercial, +135226,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,TRICARE-Commercial, +135227,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,TRICARE-Commercial, +135228,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,TRICARE-Commercial, +135229,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,TRICARE-Commercial, +135230,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,TRICARE-Commercial, +135231,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,TRICARE-Commercial, +135232,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,TRICARE-Commercial, +135233,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,TRICARE-Commercial, +135234,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,TRICARE-Commercial, +135235,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,TRICARE-Commercial, +135236,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,TRICARE-Commercial, +135237,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,TRICARE-Commercial, +135238,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,TRICARE-Commercial, +135239,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,TRICARE-Commercial, +135240,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,TRICARE-Commercial, +135241,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,TRICARE-Commercial, +135242,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,TRICARE-Commercial, +135243,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,TRICARE-Commercial, +135244,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,TRICARE-Commercial, +135245,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,TRICARE-Commercial, +135246,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,TRICARE-Commercial, +135247,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,TRICARE-Commercial, +135248,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,TRICARE-Commercial, +135249,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,TRICARE-Commercial, +135250,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,TRICARE-Commercial, +135251,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,TRICARE-Commercial, +135252,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,TRICARE-Commercial, +135253,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,TRICARE-Commercial, +135254,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,TRICARE-Commercial, +135255,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,TRICARE-Commercial, +135256,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,TRICARE-Commercial, +135257,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,TRICARE-Commercial, +135258,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,TRICARE-Commercial, +135259,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,TRICARE-Commercial, +135260,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,TRICARE-Commercial, +135261,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,TRICARE-Commercial, +135262,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,TRICARE-Commercial, +135263,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,TRICARE-Commercial, +135264,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,TRICARE-Commercial, +135265,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,TRICARE-Commercial, +135266,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,TRICARE-Commercial, +135267,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,TRICARE-Commercial, +135268,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,TRICARE-Commercial, +135269,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,TRICARE-Commercial, +135270,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,TRICARE-Commercial, +135271,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,TRICARE-Commercial, +135272,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,TRICARE-Commercial, +135273,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,TRICARE-Commercial, +135274,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,TRICARE-Commercial, +135275,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,TRICARE-Commercial, +135276,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,TRICARE-Commercial, +135277,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,TRICARE-Commercial, +135278,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,TRICARE-Commercial, +135279,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,TRICARE-Commercial, +135280,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,TRICARE-Commercial, +135281,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,TRICARE-Commercial, +135282,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,TRICARE-Commercial, +135283,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,TRICARE-Commercial, +135284,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,TRICARE-Commercial, +135285,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,TRICARE-Commercial, +135286,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,TRICARE-Commercial, +135287,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,TRICARE-Commercial, +135288,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,TRICARE-Commercial, +135289,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,TRICARE-Commercial, +135290,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,TRICARE-Commercial, +135291,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,TRICARE-Commercial, +135292,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,TRICARE-Commercial, +135293,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,TRICARE-Commercial, +135294,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,TRICARE-Commercial, +135295,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,TRICARE-Commercial, +135296,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,TRICARE-Commercial, +135297,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,TRICARE-Commercial, +135298,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,TRICARE-Commercial, +135299,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,TRICARE-Commercial, +135300,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,TRICARE-Commercial, +135301,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,TRICARE-Commercial, +135302,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,TRICARE-Commercial, +135303,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,TRICARE-Commercial, +135304,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,TRICARE-Commercial, +135305,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,TRICARE-Commercial, +135306,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,TRICARE-Commercial, +135307,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,TRICARE-Commercial, +135308,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,TRICARE-Commercial, +135309,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,TRICARE-Commercial, +135310,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,TRICARE-Commercial, +135311,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,TRICARE-Commercial, +135312,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,TRICARE-Commercial, +135313,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,TRICARE-Commercial, +135314,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,TRICARE-Commercial, +135315,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,TRICARE-Commercial, +135316,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,TRICARE-Commercial, +135317,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,TRICARE-Commercial, +135318,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,TRICARE-Commercial, +135319,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,TRICARE-Commercial, +135320,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,TRICARE-Commercial, +135321,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,TRICARE-Commercial, +135322,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,TRICARE-Commercial, +135323,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,TRICARE-Commercial, +135324,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,TRICARE-Commercial, +135325,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,TRICARE-Commercial, +135326,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,TRICARE-Commercial, +135327,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,TRICARE-Commercial, +135328,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,TRICARE-Commercial, +135329,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,TRICARE-Commercial, +135330,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,TRICARE-Commercial, +135331,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,TRICARE-Commercial, +135332,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,TRICARE-Commercial, +135333,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,TRICARE-Commercial, +135334,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,TRICARE-Commercial, +135335,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,TRICARE-Commercial, +135336,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,TRICARE-Commercial, +135337,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,TRICARE-Commercial, +135338,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,TRICARE-Commercial, +135339,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,TRICARE-Commercial, +135340,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,TRICARE-Commercial, +135341,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,TRICARE-Commercial, +135342,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,TRICARE-Commercial, +135343,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,TRICARE-Commercial, +135344,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,TRICARE-Commercial, +135345,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,TRICARE-Commercial, +135346,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,TRICARE-Commercial, +135347,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,TRICARE-Commercial, +135348,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,TRICARE-Commercial, +135349,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,TRICARE-Commercial, +135350,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,TRICARE-Commercial, +135351,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,TRICARE-Commercial, +135352,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,TRICARE-Commercial, +135353,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,TRICARE-Commercial, +135354,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,TRICARE-Commercial, +135355,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,TRICARE-Commercial, +135356,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,TRICARE-Commercial, +135357,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,TRICARE-Commercial, +135358,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,TRICARE-Commercial, +135359,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,TRICARE-Commercial, +135360,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,TRICARE-Commercial, +135361,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,TRICARE-Commercial, +135362,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,TRICARE-Commercial, +135363,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,TRICARE-Commercial, +135364,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,TRICARE-Commercial, +135365,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,TRICARE-Commercial, +135366,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,TRICARE-Commercial, +135367,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,TRICARE-Commercial, +135368,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,TRICARE-Commercial, +135369,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,TRICARE-Commercial, +135370,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,TRICARE-Commercial, +135371,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,TRICARE-Commercial, +135372,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,TRICARE-Commercial, +135373,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,TRICARE-Commercial, +135374,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,TRICARE-Commercial, +135375,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,TRICARE-Commercial, +135376,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,TRICARE-Commercial, +135377,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,TRICARE-Commercial, +135378,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,TRICARE-Commercial, +135379,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,TRICARE-Commercial, +135380,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,TRICARE-Commercial, +135381,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,TRICARE-Commercial, +135382,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,TRICARE-Commercial, +135383,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,TRICARE-Commercial, +135384,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,TRICARE-Commercial, +135385,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,TRICARE-Commercial, +135386,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,TRICARE-Commercial, +135387,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,TRICARE-Commercial, +135388,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,TRICARE-Commercial, +135389,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,TRICARE-Commercial, +135390,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,TRICARE-Commercial, +135391,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,TRICARE-Commercial, +135392,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,TRICARE-Commercial, +135393,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,TRICARE-Commercial, +135394,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,TRICARE-Commercial, +135395,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,TRICARE-Commercial, +135396,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,TRICARE-Commercial, +135397,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,TRICARE-Commercial, +135398,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,TRICARE-Commercial, +135399,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,TRICARE-Commercial, +135400,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,TRICARE-Commercial, +135401,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,TRICARE-Commercial, +135402,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,TRICARE-Commercial, +135403,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,TRICARE-Commercial, +135404,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,TRICARE-Commercial, +135405,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,TRICARE-Commercial, +135406,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,TRICARE-Commercial, +135407,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,TRICARE-Commercial, +135408,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,TRICARE-Commercial, +135409,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,TRICARE-Commercial, +135410,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,TRICARE-Commercial, +135411,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,TRICARE-Commercial, +135412,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,TRICARE-Commercial, +135413,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,TRICARE-Commercial, +135414,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,TRICARE-Commercial, +135415,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,TRICARE-Commercial, +135416,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,TRICARE-Commercial, +135417,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,TRICARE-Commercial, +135418,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,TRICARE-Commercial, +135419,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,TRICARE-Commercial, +135420,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,TRICARE-Commercial, +135421,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,TRICARE-Commercial, +135422,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,TRICARE-Commercial, +135423,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,TRICARE-Commercial, +135424,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,TRICARE-Commercial, +135425,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,TRICARE-Commercial, +135426,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,TRICARE-Commercial, +135427,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,TRICARE-Commercial, +135428,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,TRICARE-Commercial, +135429,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,TRICARE-Commercial, +135430,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,TRICARE-Commercial, +135431,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,TRICARE-Commercial, +135432,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,TRICARE-Commercial, +135433,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,TRICARE-Commercial, +135434,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,TRICARE-Commercial, +135435,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,TRICARE-Commercial, +135436,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,TRICARE-Commercial, +135437,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,TRICARE-Commercial, +135438,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,TRICARE-Commercial, +135439,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,TRICARE-Commercial, +135440,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,TRICARE-Commercial, +135441,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,TRICARE-Commercial, +135442,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,TRICARE-Commercial, +135443,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,TRICARE-Commercial, +135444,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,TRICARE-Commercial, +135445,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,TRICARE-Commercial, +135446,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,TRICARE-Commercial, +135447,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,TRICARE-Commercial, +135448,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,TRICARE-Commercial, +135449,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,TRICARE-Commercial, +135450,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,TRICARE-Commercial, +135451,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,TRICARE-Commercial, +135452,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,TRICARE-Commercial, +135453,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,TRICARE-Commercial, +135454,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,TRICARE-Commercial, +135455,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,TRICARE-Commercial, +135456,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,TRICARE-Commercial, +135457,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,TRICARE-Commercial, +135458,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,TRICARE-Commercial, +135459,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,TRICARE-Commercial, +135460,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,TRICARE-Commercial, +135461,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,TRICARE-Commercial, +135462,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,TRICARE-Commercial, +135463,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,TRICARE-Commercial, +135464,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,TRICARE-Commercial, +135465,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,TRICARE-Commercial, +135466,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,TRICARE-Commercial, +135467,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,TRICARE-Commercial, +135468,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,TRICARE-Commercial, +135469,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,TRICARE-Commercial, +135470,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,TRICARE-Commercial, +135471,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,TRICARE-Commercial, +135472,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,TRICARE-Commercial, +135473,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,TRICARE-Commercial, +135474,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,TRICARE-Commercial, +135475,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,TRICARE-Commercial, +135476,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,TRICARE-Commercial, +135477,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,TRICARE-Commercial, +135478,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,TRICARE-Commercial, +135479,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,TRICARE-Commercial, +135480,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,TRICARE-Commercial, +135481,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,TRICARE-Commercial, +135482,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,TRICARE-Commercial, +135483,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,TRICARE-Commercial, +135484,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,TRICARE-Commercial, +135485,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,TRICARE-Commercial, +135486,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,TRICARE-Commercial, +135487,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,TRICARE-Commercial, +135488,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,TRICARE-Commercial, +135489,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,TRICARE-Commercial, +135490,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,TRICARE-Commercial, +135491,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,TRICARE-Commercial, +135492,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,TRICARE-Commercial,35.92 +135493,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,TRICARE-Commercial, +135494,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,TRICARE-Commercial, +135495,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,TRICARE-Commercial, +135496,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,TRICARE-Commercial, +135497,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,TRICARE-Commercial, +135498,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,TRICARE-Commercial, +135499,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,TRICARE-Commercial, +135500,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,TRICARE-Commercial, +135501,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,TRICARE-Commercial, +135502,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,TRICARE-Commercial, +135503,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,TRICARE-Commercial, +135504,3934,30000012,PRIVATE,,8380.0,8380.0,,,TRICARE-Commercial, +135505,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,TRICARE-Commercial, +135506,3934,30000038,ICU,,12700.0,12700.0,,,TRICARE-Commercial, +135507,3934,30000046,BURN UNIT,,12700.0,12700.0,,,TRICARE-Commercial, +135508,3934,30000053,NICU,,12700.0,12700.0,,,TRICARE-Commercial, +135509,3934,30000061,ICR ROOM,,7630.0,7630.0,,,TRICARE-Commercial, +135510,3934,30000079,PSYCH,,7630.0,7630.0,,,TRICARE-Commercial, +135511,3934,30000087,NEWBORN,,4140.0,4140.0,,,TRICARE-Commercial, +135512,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,TRICARE-Commercial, +135513,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135514,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,TRICARE-Commercial, +135515,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135516,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135517,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135518,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135519,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135520,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135521,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135522,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135523,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135524,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135525,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135526,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135527,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135528,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135529,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135530,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135531,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135532,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135533,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135534,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135535,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135536,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135537,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135538,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135539,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135540,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,TRICARE-Commercial, +135541,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135542,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135543,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135544,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135545,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135546,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135547,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135548,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135549,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135550,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135551,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135552,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135553,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135554,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135555,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,TRICARE-Commercial, +135556,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135557,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135558,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135559,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135560,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135561,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135562,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135563,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135564,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135565,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135566,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135567,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135568,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135569,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135570,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135571,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135572,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135573,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135574,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135575,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135576,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135577,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135578,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135579,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135580,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135581,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135582,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,TRICARE-Commercial, +135583,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135584,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135585,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135586,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135587,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135588,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135589,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135590,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135591,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135592,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135593,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135594,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135595,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135596,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135597,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135598,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135599,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135600,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135601,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135602,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135603,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135604,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135605,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135606,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135607,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135608,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135609,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135610,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135611,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135612,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135613,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135614,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135615,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135616,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135617,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,TRICARE-Commercial, 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PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135630,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135631,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135632,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135633,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135634,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135635,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135636,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135637,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135638,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135639,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135640,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135641,3934,30351050,HICS HOSP.OBSERVATION 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REV PED 11N1 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135799,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135800,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135801,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135802,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135803,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135804,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135805,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135806,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135807,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135808,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135809,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135810,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135811,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135812,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135813,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135814,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135815,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135816,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135817,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135818,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135819,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135820,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,TRICARE-Commercial, +135821,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135822,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,TRICARE-Commercial, +135823,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135824,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135825,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135826,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135827,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135828,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135829,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135830,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135831,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135832,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,TRICARE-Commercial, +135833,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135834,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135835,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135836,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135837,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135838,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135839,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135840,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135841,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135842,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135843,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135844,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135845,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135846,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135847,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135848,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135849,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135850,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135851,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135852,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135853,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135854,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135855,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135856,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135857,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135858,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,TRICARE-Commercial, 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INPATIENT 18S3 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135872,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135873,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135874,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135875,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135876,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,TRICARE-Commercial, +135877,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135878,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135879,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135880,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,TRICARE-Commercial, +135881,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135882,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135883,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135884,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135885,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135886,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135887,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135888,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135889,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135890,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135891,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135892,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135893,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135894,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135895,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135896,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135897,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135898,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135899,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135900,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135901,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135902,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135903,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135904,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135905,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,TRICARE-Commercial, +135906,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135907,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135908,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135909,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135910,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135911,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135912,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135913,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,TRICARE-Commercial, +135914,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135915,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,TRICARE-Commercial, +135916,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135917,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135918,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135919,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,TRICARE-Commercial, +135920,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,TRICARE-Commercial, +135921,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,TRICARE-Commercial, +135922,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135923,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,TRICARE-Commercial, +135924,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135925,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135926,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135927,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135928,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,TRICARE-Commercial, +135929,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135930,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135931,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135932,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135933,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135934,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135935,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135936,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,TRICARE-Commercial, +135937,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135938,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135939,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135940,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135941,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135942,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135943,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135944,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,TRICARE-Commercial, +135945,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,TRICARE-Commercial, +135946,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,TRICARE-Commercial, +135947,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,TRICARE-Commercial, +135948,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,TRICARE-Commercial, +135949,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,TRICARE-Commercial, +135950,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,TRICARE-Commercial, +135951,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,TRICARE-Commercial, +135952,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,TRICARE-Commercial, +135953,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,TRICARE-Commercial, +135954,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,TRICARE-Commercial, +135955,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,TRICARE-Commercial, +135956,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,TRICARE-Commercial, +135957,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,TRICARE-Commercial, +135958,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,TRICARE-Commercial, +135959,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,TRICARE-Commercial, +135960,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,TRICARE-Commercial, +135961,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,TRICARE-Commercial, +135962,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,TRICARE-Commercial, +135963,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,TRICARE-Commercial, +135964,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,TRICARE-Commercial, +135965,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,TRICARE-Commercial, +135966,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,TRICARE-Commercial, +135967,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,TRICARE-Commercial, +135968,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,TRICARE-Commercial, +135969,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,TRICARE-Commercial, +135970,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,TRICARE-Commercial, +135971,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,TRICARE-Commercial, +135972,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,TRICARE-Commercial, +135973,3934,37112000,ACUTE ED,,1580.0,1580.0,,,TRICARE-Commercial, +135974,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,TRICARE-Commercial, +135975,3934,37112034,TRIAGE,,277.0,277.0,,,TRICARE-Commercial, +135976,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,TRICARE-Commercial, +135977,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,TRICARE-Commercial, +135978,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,TRICARE-Commercial, +135979,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,TRICARE-Commercial, +135980,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,TRICARE-Commercial, +135981,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,TRICARE-Commercial, +135982,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,TRICARE-Commercial, +135983,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,TRICARE-Commercial, +135984,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,TRICARE-Commercial, +135985,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,TRICARE-Commercial, +135986,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,TRICARE-Commercial, +135987,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,TRICARE-Commercial, +135988,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,TRICARE-Commercial, +135989,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,TRICARE-Commercial, +135990,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,TRICARE-Commercial, +135991,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,TRICARE-Commercial, +135992,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,TRICARE-Commercial, +135993,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,TRICARE-Commercial, +135994,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,TRICARE-Commercial, +135995,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,TRICARE-Commercial, +135996,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,TRICARE-Commercial, +135997,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,TRICARE-Commercial, +135998,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,TRICARE-Commercial, +135999,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,TRICARE-Commercial, +136000,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,TRICARE-Commercial, +136001,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,TRICARE-Commercial, +136002,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,TRICARE-Commercial, +136003,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,TRICARE-Commercial, +136004,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,TRICARE-Commercial, +136005,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,TRICARE-Commercial, +136006,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,TRICARE-Commercial, +136007,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,TRICARE-Commercial, +136008,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,TRICARE-Commercial, +136009,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,TRICARE-Commercial, +136010,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,TRICARE-Commercial, +136011,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,TRICARE-Commercial, +136012,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,TRICARE-Commercial, +136013,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,TRICARE-Commercial, +136014,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,TRICARE-Commercial, +136015,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,TRICARE-Commercial, +136016,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,TRICARE-Commercial, +136017,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,TRICARE-Commercial, +136018,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,TRICARE-Commercial, +136019,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,TRICARE-Commercial, +136020,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,TRICARE-Commercial, +136021,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,TRICARE-Commercial, +136022,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,TRICARE-Commercial, +136023,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,TRICARE-Commercial, +136024,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,TRICARE-Commercial, +136025,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,TRICARE-Commercial, +136026,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,TRICARE-Commercial, +136027,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,TRICARE-Commercial, +136028,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,TRICARE-Commercial, +136029,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,TRICARE-Commercial, +136030,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,TRICARE-Commercial, +136031,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,TRICARE-Commercial, +136032,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,TRICARE-Commercial, +136033,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,TRICARE-Commercial, +136034,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,TRICARE-Commercial, +136035,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,TRICARE-Commercial, +136036,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,TRICARE-Commercial, +136037,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,TRICARE-Commercial, +136038,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,TRICARE-Commercial, +136039,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,TRICARE-Commercial, +136040,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,TRICARE-Commercial, +136041,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,TRICARE-Commercial, +136042,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,TRICARE-Commercial, +136043,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,TRICARE-Commercial, +136044,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,TRICARE-Commercial, +136045,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,TRICARE-Commercial, +136046,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,TRICARE-Commercial, +136047,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,TRICARE-Commercial, +136048,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,TRICARE-Commercial, +136049,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,TRICARE-Commercial, +136050,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,TRICARE-Commercial, +136051,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,TRICARE-Commercial, +136052,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,TRICARE-Commercial, +136053,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,TRICARE-Commercial, +136054,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,TRICARE-Commercial, +136055,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,TRICARE-Commercial, +136056,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,TRICARE-Commercial, +136057,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,TRICARE-Commercial, +136058,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,TRICARE-Commercial, +136059,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,TRICARE-Commercial, +136060,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,TRICARE-Commercial, +136061,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,TRICARE-Commercial, +136062,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,TRICARE-Commercial, +136063,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,TRICARE-Commercial, +136064,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,TRICARE-Commercial, +136065,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,TRICARE-Commercial, +136066,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,TRICARE-Commercial, +136067,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,TRICARE-Commercial, +136068,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,TRICARE-Commercial, +136069,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,TRICARE-Commercial, +136070,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,TRICARE-Commercial, +136071,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,TRICARE-Commercial, +136072,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,TRICARE-Commercial, +136073,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,TRICARE-Commercial, +136074,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,TRICARE-Commercial, +136075,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,TRICARE-Commercial, +136076,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136077,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136078,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136079,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136080,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136081,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,TRICARE-Commercial, +136082,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,TRICARE-Commercial, +136083,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,TRICARE-Commercial, +136084,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136085,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136086,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136087,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,TRICARE-Commercial, +136088,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,TRICARE-Commercial, +136089,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,TRICARE-Commercial, +136090,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,TRICARE-Commercial, +136091,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,TRICARE-Commercial, +136092,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,TRICARE-Commercial, +136093,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,TRICARE-Commercial, +136094,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,TRICARE-Commercial, +136095,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,TRICARE-Commercial, +136096,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,TRICARE-Commercial, +136097,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,TRICARE-Commercial, +136098,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,TRICARE-Commercial, +136099,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,TRICARE-Commercial, +136100,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,TRICARE-Commercial, +136101,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,TRICARE-Commercial, +136102,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,TRICARE-Commercial, +136103,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,TRICARE-Commercial, +136104,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,TRICARE-Commercial, +136105,3934,43301043,ALBUNEX,,357.0,357.0,,,TRICARE-Commercial, +136106,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,TRICARE-Commercial, +136107,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136108,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136109,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136110,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136111,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136112,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,TRICARE-Commercial, +136113,3934,43450022,REC RM .5HR,,541.0,541.0,,,TRICARE-Commercial, +136114,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,TRICARE-Commercial, +136115,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,TRICARE-Commercial, +136116,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,TRICARE-Commercial, +136117,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,TRICARE-Commercial, +136118,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,TRICARE-Commercial, +136119,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,TRICARE-Commercial, +136120,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,TRICARE-Commercial, +136121,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,TRICARE-Commercial, +136122,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,TRICARE-Commercial, +136123,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,TRICARE-Commercial, +136124,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,TRICARE-Commercial, +136125,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,TRICARE-Commercial, +136126,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,TRICARE-Commercial, +136127,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,TRICARE-Commercial, +136128,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,TRICARE-Commercial, +136129,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,TRICARE-Commercial, +136130,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,TRICARE-Commercial, +136131,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136132,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136133,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136134,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136135,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136136,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,TRICARE-Commercial, +136137,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136138,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,TRICARE-Commercial, +136139,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136140,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136141,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136142,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136143,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,TRICARE-Commercial, +136144,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,TRICARE-Commercial, +136145,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136146,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136147,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136148,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136149,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136150,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,TRICARE-Commercial, +136151,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136152,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136153,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136154,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136155,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136156,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,TRICARE-Commercial, +136157,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,TRICARE-Commercial, +136158,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,TRICARE-Commercial, +136159,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,TRICARE-Commercial, +136160,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,TRICARE-Commercial, +136161,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,TRICARE-Commercial, +136162,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,TRICARE-Commercial, +136163,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,TRICARE-Commercial, +136164,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,TRICARE-Commercial, +136165,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136166,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136167,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136168,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136169,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136170,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,TRICARE-Commercial, +136171,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,TRICARE-Commercial, +136172,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,TRICARE-Commercial, +136173,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,TRICARE-Commercial, +136174,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,TRICARE-Commercial, +136175,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,TRICARE-Commercial, +136176,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,TRICARE-Commercial, +136177,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,TRICARE-Commercial, +136178,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,TRICARE-Commercial, +136179,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,TRICARE-Commercial, +136180,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,TRICARE-Commercial, +136181,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,TRICARE-Commercial, +136182,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,TRICARE-Commercial, +136183,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,TRICARE-Commercial, +136184,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,TRICARE-Commercial, +136185,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,TRICARE-Commercial, +136186,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,TRICARE-Commercial, +136187,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,TRICARE-Commercial, +136188,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,TRICARE-Commercial, +136189,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,TRICARE-Commercial, +136190,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,TRICARE-Commercial, +136191,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,TRICARE-Commercial, +136192,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,TRICARE-Commercial, +136193,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,TRICARE-Commercial, +136194,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,TRICARE-Commercial, +136195,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,TRICARE-Commercial, +136196,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,TRICARE-Commercial, +136197,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,TRICARE-Commercial, +136198,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,TRICARE-Commercial, +136199,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,TRICARE-Commercial, +136200,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,TRICARE-Commercial, +136201,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,TRICARE-Commercial, +136202,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,TRICARE-Commercial, +136203,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,TRICARE-Commercial, +136204,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,TRICARE-Commercial, +136205,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,TRICARE-Commercial, +136206,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,TRICARE-Commercial, +136207,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,TRICARE-Commercial, +136208,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,TRICARE-Commercial, +136209,3934,45924552,ENDO REC RM,,30.0,30.0,,,TRICARE-Commercial, +136210,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,TRICARE-Commercial, +136211,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,TRICARE-Commercial, +136212,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,TRICARE-Commercial, +136213,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,TRICARE-Commercial, +136214,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,TRICARE-Commercial, +136215,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,TRICARE-Commercial, +136216,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,TRICARE-Commercial, +136217,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,TRICARE-Commercial, +136218,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,TRICARE-Commercial, +136219,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,TRICARE-Commercial, +136220,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,TRICARE-Commercial, +136221,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,TRICARE-Commercial, +136222,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,TRICARE-Commercial, +136223,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,TRICARE-Commercial, +136224,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,TRICARE-Commercial, +136225,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,TRICARE-Commercial, +136226,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,TRICARE-Commercial, +136227,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,TRICARE-Commercial, +136228,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,TRICARE-Commercial, +136229,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,TRICARE-Commercial, +136230,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,TRICARE-Commercial, +136231,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,TRICARE-Commercial, +136232,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,TRICARE-Commercial, +136233,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,TRICARE-Commercial, +136234,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,TRICARE-Commercial, +136235,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,TRICARE-Commercial, +136236,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,TRICARE-Commercial, +136237,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,TRICARE-Commercial, +136238,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,TRICARE-Commercial, +136239,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,TRICARE-Commercial, +136240,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,TRICARE-Commercial, +136241,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,TRICARE-Commercial, +136242,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,TRICARE-Commercial, +136243,3934,53200010,GUEST TRAY,,24.0,24.0,,,TRICARE-Commercial, +136244,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,TRICARE-Commercial, +136245,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,TRICARE-Commercial, +136246,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,TRICARE-Commercial, +136247,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,TRICARE-Commercial, +136248,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,TRICARE-Commercial, +136249,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,TRICARE-Commercial, +136250,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,TRICARE-Commercial, +136251,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,TRICARE-Commercial, +136252,3934,53329876,HIV MONITORING,,416.0,416.0,,,TRICARE-Commercial, +136253,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,TRICARE-Commercial, +136254,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,TRICARE-Commercial, +136255,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,TRICARE-Commercial, +136256,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,TRICARE-Commercial, +136257,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,TRICARE-Commercial, +136258,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,TRICARE-Commercial, +136259,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,TRICARE-Commercial, +136260,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,TRICARE-Commercial, +136261,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,TRICARE-Commercial, +136262,3934,76010107,COPY X-RAY,,22.0,22.0,,,TRICARE-Commercial, +136263,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,TRICARE-Commercial, +136264,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,TRICARE-Commercial, +136265,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,TRICARE-Commercial, +136266,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,TRICARE-Commercial, +136267,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,TRICARE-Commercial, +136268,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,TRICARE-Commercial, +136269,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,TRICARE-Commercial, +136270,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,TRICARE-Commercial, +136271,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,TRICARE-Commercial, +136272,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,TRICARE-Commercial, +136273,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,TRICARE-Commercial, +136274,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,TRICARE-Commercial, +136275,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,United Healthcare-Commercial,232440.37 +136276,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,United Healthcare-Commercial, +136277,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,United Healthcare-Commercial,163156.58 +136278,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,United Healthcare-Commercial,280260.83 +136279,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,United Healthcare-Commercial, +136280,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,United Healthcare-Commercial,59440.37 +136281,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,United Healthcare-Commercial,103403.0 +136282,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,United Healthcare-Commercial, +136283,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,United Healthcare-Commercial, +136284,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,United Healthcare-Commercial,86434.89 +136285,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,United Healthcare-Commercial, +136286,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,United Healthcare-Commercial, +136287,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,United Healthcare-Commercial,72480.46 +136288,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,United Healthcare-Commercial,82940.01 +136289,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,United Healthcare-Commercial,89954.27 +136290,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,United Healthcare-Commercial,53732.05 +136291,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,United Healthcare-Commercial,58250.46 +136292,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,United Healthcare-Commercial, +136293,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,United Healthcare-Commercial, +136294,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,United Healthcare-Commercial, +136295,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,United Healthcare-Commercial,36610.51 +136296,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,United Healthcare-Commercial,48244.94 +136297,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,United Healthcare-Commercial,33875.6 +136298,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,United Healthcare-Commercial, +136299,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,United Healthcare-Commercial,21426.84 +136300,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,United Healthcare-Commercial,14497.76 +136301,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,United Healthcare-Commercial, +136302,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,United Healthcare-Commercial,32082.85 +136303,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,United Healthcare-Commercial,13523.3 +136304,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,United Healthcare-Commercial, +136305,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,United Healthcare-Commercial,19396.33 +136306,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,United Healthcare-Commercial, +136307,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,United Healthcare-Commercial, +136308,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,United Healthcare-Commercial, +136309,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,United Healthcare-Commercial,13294.86 +136310,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,United Healthcare-Commercial,15519.76 +136311,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,United Healthcare-Commercial, +136312,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,United Healthcare-Commercial,26188.63 +136313,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,United Healthcare-Commercial, +136314,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,United Healthcare-Commercial, +136315,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,United Healthcare-Commercial,12902.67 +136316,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,United Healthcare-Commercial,29899.97 +136317,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,United Healthcare-Commercial,16722.2 +136318,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,United Healthcare-Commercial,14212.11 +136319,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,United Healthcare-Commercial,35033.15 +136320,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,United Healthcare-Commercial,10384.23 +136321,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,United Healthcare-Commercial,6898.63 +136322,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,United Healthcare-Commercial,7966.76 +136323,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,United Healthcare-Commercial,8442.9 +136324,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,United Healthcare-Commercial,15889.57 +136325,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,United Healthcare-Commercial, +136326,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,United Healthcare-Commercial,13078.32 +136327,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,United Healthcare-Commercial, +136328,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,United Healthcare-Commercial,19970.53 +136329,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,United Healthcare-Commercial,33739.82 +136330,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,United Healthcare-Commercial,13101.06 +136331,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,United Healthcare-Commercial, +136332,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,United Healthcare-Commercial,116557.66 +136333,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,United Healthcare-Commercial, +136334,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,United Healthcare-Commercial, +136335,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,United Healthcare-Commercial, +136336,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,United Healthcare-Commercial,7309.26 +136337,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,United Healthcare-Commercial,7762.92 +136338,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,United Healthcare-Commercial, +136339,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,United Healthcare-Commercial,13804.09 +136340,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,United Healthcare-Commercial,18733.53 +136341,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,United Healthcare-Commercial,6822.65 +136342,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,United Healthcare-Commercial, +136343,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,United Healthcare-Commercial, +136344,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,United Healthcare-Commercial,28239.64 +136345,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,United Healthcare-Commercial, +136346,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,United Healthcare-Commercial, +136347,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,United Healthcare-Commercial, +136348,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,United Healthcare-Commercial,144889.5 +136349,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,United Healthcare-Commercial,16951.68 +136350,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,United Healthcare-Commercial, +136351,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,United Healthcare-Commercial,15962.24 +136352,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,United Healthcare-Commercial,23909.68 +136353,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,United Healthcare-Commercial,26187.89 +136354,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,United Healthcare-Commercial, +136355,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,United Healthcare-Commercial, +136356,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,United Healthcare-Commercial, +136357,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,United Healthcare-Commercial,7473.37 +136358,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,United Healthcare-Commercial, +136359,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,United Healthcare-Commercial,8502.99 +136360,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,United Healthcare-Commercial, +136361,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,United Healthcare-Commercial, +136362,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,United Healthcare-Commercial, +136363,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,United Healthcare-Commercial, +136364,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,United Healthcare-Commercial, +136365,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,United Healthcare-Commercial,20600.62 +136366,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,United Healthcare-Commercial,44332.2 +136367,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,United Healthcare-Commercial, +136368,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,United Healthcare-Commercial, +136369,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,United Healthcare-Commercial, +136370,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,United Healthcare-Commercial, +136371,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,United Healthcare-Commercial,42928.76 +136372,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,United Healthcare-Commercial, +136373,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,United Healthcare-Commercial, +136374,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,United Healthcare-Commercial, +136375,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,United Healthcare-Commercial, +136376,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,United Healthcare-Commercial, +136377,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,United Healthcare-Commercial,6463.8 +136378,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,United Healthcare-Commercial,27069.21 +136379,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,United Healthcare-Commercial, +136380,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,United Healthcare-Commercial,18436.7 +136381,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,United Healthcare-Commercial,10517.15 +136382,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,United Healthcare-Commercial, +136383,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,United Healthcare-Commercial,9452.45 +136384,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,United Healthcare-Commercial, +136385,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,United Healthcare-Commercial, +136386,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,United Healthcare-Commercial, +136387,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,United Healthcare-Commercial, +136388,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,United Healthcare-Commercial, +136389,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,United Healthcare-Commercial,51590.82 +136390,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,United Healthcare-Commercial,34161.03 +136391,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,United Healthcare-Commercial, +136392,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,United Healthcare-Commercial,16674.84 +136393,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,United Healthcare-Commercial,11367.41 +136394,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,United Healthcare-Commercial,17874.4 +136395,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,United Healthcare-Commercial,8911.4 +136396,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,United Healthcare-Commercial,45659.13 +136397,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,United Healthcare-Commercial,15285.59 +136398,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,United Healthcare-Commercial,16864.05 +136399,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,United Healthcare-Commercial,31585.36 +136400,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,United Healthcare-Commercial, +136401,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,United Healthcare-Commercial,13328.53 +136402,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,United Healthcare-Commercial,18140.04 +136403,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,United Healthcare-Commercial, +136404,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,United Healthcare-Commercial, +136405,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,United Healthcare-Commercial,10069.7 +136406,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,United Healthcare-Commercial,14331.74 +136407,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,United Healthcare-Commercial,10799.71 +136408,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,United Healthcare-Commercial,7735.9 +136409,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,United Healthcare-Commercial, +136410,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,United Healthcare-Commercial,21694.27 +136411,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,United Healthcare-Commercial,15769.99 +136412,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,United Healthcare-Commercial,12105.38 +136413,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,United Healthcare-Commercial,15975.72 +136414,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,United Healthcare-Commercial, +136415,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,United Healthcare-Commercial, +136416,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,United Healthcare-Commercial,10417.47 +136417,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,United Healthcare-Commercial, +136418,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,United Healthcare-Commercial,8411.97 +136419,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,United Healthcare-Commercial,12221.29 +136420,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,United Healthcare-Commercial, +136421,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,United Healthcare-Commercial,23386.25 +136422,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,United Healthcare-Commercial, +136423,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,United Healthcare-Commercial,150981.84 +136424,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,United Healthcare-Commercial,48296.94 +136425,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,United Healthcare-Commercial, +136426,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,United Healthcare-Commercial,84885.31 +136427,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,United Healthcare-Commercial, +136428,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,United Healthcare-Commercial,59136.0 +136429,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,United Healthcare-Commercial,67288.74 +136430,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,United Healthcare-Commercial,81814.94 +136431,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,United Healthcare-Commercial, +136432,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,United Healthcare-Commercial, +136433,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,United Healthcare-Commercial, +136434,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,United Healthcare-Commercial,62080.37 +136435,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,United Healthcare-Commercial,83500.98 +136436,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,United Healthcare-Commercial, +136437,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,United Healthcare-Commercial, +136438,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,United Healthcare-Commercial,11514.04 +136439,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,United Healthcare-Commercial, +136440,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,United Healthcare-Commercial, +136441,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,United Healthcare-Commercial, +136442,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,United Healthcare-Commercial,42534.67 +136443,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,United Healthcare-Commercial, +136444,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,United Healthcare-Commercial, +136445,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,United Healthcare-Commercial, +136446,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,United Healthcare-Commercial, +136447,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,United Healthcare-Commercial,30522.78 +136448,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,United Healthcare-Commercial, +136449,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,United Healthcare-Commercial,19145.76 +136450,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,United Healthcare-Commercial, +136451,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,United Healthcare-Commercial,47039.52 +136452,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,United Healthcare-Commercial,39091.87 +136453,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,United Healthcare-Commercial, +136454,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,United Healthcare-Commercial, +136455,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,United Healthcare-Commercial,32351.7 +136456,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,United Healthcare-Commercial,58005.97 +136457,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,United Healthcare-Commercial,21649.65 +136458,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,United Healthcare-Commercial, +136459,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,United Healthcare-Commercial, +136460,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,United Healthcare-Commercial, +136461,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,United Healthcare-Commercial, +136462,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,United Healthcare-Commercial, +136463,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,United Healthcare-Commercial, +136464,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,United Healthcare-Commercial, +136465,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,United Healthcare-Commercial,16362.71 +136466,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,United Healthcare-Commercial,23314.86 +136467,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,United Healthcare-Commercial, +136468,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,United Healthcare-Commercial, +136469,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,United Healthcare-Commercial, +136470,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,United Healthcare-Commercial,99573.02 +136471,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,United Healthcare-Commercial,48714.92 +136472,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,United Healthcare-Commercial, +136473,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,United Healthcare-Commercial,34983.87 +136474,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,United Healthcare-Commercial,156349.29 +136475,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,United Healthcare-Commercial, +136476,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,United Healthcare-Commercial, +136477,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,United Healthcare-Commercial, +136478,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,United Healthcare-Commercial,42090.1 +136479,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,United Healthcare-Commercial,31601.02 +136480,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,United Healthcare-Commercial,18639.21 +136481,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,United Healthcare-Commercial,6853.65 +136482,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,United Healthcare-Commercial, +136483,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,United Healthcare-Commercial, +136484,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,United Healthcare-Commercial,20387.0 +136485,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,United Healthcare-Commercial,22643.53 +136486,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,United Healthcare-Commercial, +136487,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,United Healthcare-Commercial, +136488,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,United Healthcare-Commercial,139826.85 +136489,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,United Healthcare-Commercial,13237.63 +136490,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,United Healthcare-Commercial, +136491,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,United Healthcare-Commercial, +136492,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,United Healthcare-Commercial,14428.94 +136493,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,United Healthcare-Commercial,20018.26 +136494,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,United Healthcare-Commercial, +136495,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,United Healthcare-Commercial, +136496,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,United Healthcare-Commercial,7525.35 +136497,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,United Healthcare-Commercial,10574.42 +136498,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,United Healthcare-Commercial,6585.78 +136499,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,United Healthcare-Commercial,27397.09 +136500,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,United Healthcare-Commercial,8209.36 +136501,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,United Healthcare-Commercial,11899.0 +136502,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,United Healthcare-Commercial,13632.92 +136503,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,United Healthcare-Commercial,11951.52 +136504,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,United Healthcare-Commercial,6699.13 +136505,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,United Healthcare-Commercial,8517.34 +136506,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,United Healthcare-Commercial,25306.86 +136507,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,United Healthcare-Commercial,65315.89 +136508,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,United Healthcare-Commercial,33391.64 +136509,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,United Healthcare-Commercial, +136510,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,United Healthcare-Commercial, +136511,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,United Healthcare-Commercial, +136512,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,United Healthcare-Commercial,105128.86 +136513,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,United Healthcare-Commercial,47016.33 +136514,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,United Healthcare-Commercial,15503.73 +136515,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,United Healthcare-Commercial,96862.57 +136516,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,United Healthcare-Commercial,51657.04 +136517,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,United Healthcare-Commercial,40457.23 +136518,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,United Healthcare-Commercial, +136519,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,United Healthcare-Commercial, +136520,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,United Healthcare-Commercial, +136521,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,United Healthcare-Commercial,28883.32 +136522,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,United Healthcare-Commercial, +136523,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,United Healthcare-Commercial, +136524,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,United Healthcare-Commercial,24247.14 +136525,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,United Healthcare-Commercial,23786.14 +136526,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,United Healthcare-Commercial, +136527,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,United Healthcare-Commercial, +136528,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,United Healthcare-Commercial,24171.9 +136529,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,United Healthcare-Commercial, +136530,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,United Healthcare-Commercial, +136531,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,United Healthcare-Commercial, +136532,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,United Healthcare-Commercial, +136533,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,United Healthcare-Commercial, +136534,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,United Healthcare-Commercial, +136535,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,United Healthcare-Commercial, +136536,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,United Healthcare-Commercial, +136537,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,United Healthcare-Commercial, +136538,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,United Healthcare-Commercial,26586.22 +136539,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,United Healthcare-Commercial,75664.99 +136540,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,United Healthcare-Commercial,18011.34 +136541,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,United Healthcare-Commercial, +136542,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,United Healthcare-Commercial,85530.37 +136543,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,United Healthcare-Commercial,33324.23 +136544,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,United Healthcare-Commercial,20042.83 +136545,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,United Healthcare-Commercial,15933.83 +136546,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,United Healthcare-Commercial,29809.31 +136547,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,United Healthcare-Commercial, +136548,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,United Healthcare-Commercial,15076.96 +136549,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,United Healthcare-Commercial,17461.98 +136550,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,United Healthcare-Commercial,14382.69 +136551,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,United Healthcare-Commercial, +136552,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,United Healthcare-Commercial,41613.97 +136553,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,United Healthcare-Commercial, +136554,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,United Healthcare-Commercial, +136555,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,United Healthcare-Commercial, +136556,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,United Healthcare-Commercial,87900.2 +136557,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,United Healthcare-Commercial, +136558,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,United Healthcare-Commercial,22440.61 +136559,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,United Healthcare-Commercial,12715.31 +136560,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,United Healthcare-Commercial,10574.48 +136561,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,United Healthcare-Commercial,10599.55 +136562,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,United Healthcare-Commercial,12977.62 +136563,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,United Healthcare-Commercial,11281.68 +136564,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,United Healthcare-Commercial,13759.81 +136565,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,United Healthcare-Commercial, +136566,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,United Healthcare-Commercial,14696.02 +136567,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,United Healthcare-Commercial,49257.81 +136568,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,United Healthcare-Commercial,62408.2 +136569,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,United Healthcare-Commercial,18697.7 +136570,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,United Healthcare-Commercial, +136571,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,United Healthcare-Commercial, +136572,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,United Healthcare-Commercial, +136573,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,United Healthcare-Commercial, +136574,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,United Healthcare-Commercial, +136575,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,United Healthcare-Commercial,207294.47 +136576,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,United Healthcare-Commercial,17377.54 +136577,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,United Healthcare-Commercial,13006.23 +136578,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,United Healthcare-Commercial, +136579,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,United Healthcare-Commercial, +136580,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,United Healthcare-Commercial,11772.77 +136581,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,United Healthcare-Commercial, +136582,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,United Healthcare-Commercial,64894.24 +136583,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,United Healthcare-Commercial, +136584,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,United Healthcare-Commercial,18734.54 +136585,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,United Healthcare-Commercial, +136586,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,United Healthcare-Commercial,16007.89 +136587,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,United Healthcare-Commercial,16087.29 +136588,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,United Healthcare-Commercial,6157.37 +136589,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,United Healthcare-Commercial, +136590,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,United Healthcare-Commercial,9625.86 +136591,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,United Healthcare-Commercial, +136592,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,United Healthcare-Commercial,13527.89 +136593,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,United Healthcare-Commercial,20646.22 +136594,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,United Healthcare-Commercial, +136595,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,United Healthcare-Commercial,93168.89 +136596,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,United Healthcare-Commercial,100765.5 +136597,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,United Healthcare-Commercial, +136598,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,United Healthcare-Commercial, +136599,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,United Healthcare-Commercial, +136600,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,United Healthcare-Commercial,102577.28 +136601,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,United Healthcare-Commercial,90084.44 +136602,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,United Healthcare-Commercial, +136603,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,United Healthcare-Commercial,42707.37 +136604,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,United Healthcare-Commercial,114151.34 +136605,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,United Healthcare-Commercial, +136606,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,United Healthcare-Commercial, +136607,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,United Healthcare-Commercial, +136608,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,United Healthcare-Commercial, +136609,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,United Healthcare-Commercial, +136610,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,United Healthcare-Commercial,43165.72 +136611,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,United Healthcare-Commercial,59376.55 +136612,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,United Healthcare-Commercial,22074.72 +136613,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,United Healthcare-Commercial,39982.88 +136614,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,United Healthcare-Commercial, +136615,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,United Healthcare-Commercial,58138.41 +136616,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,United Healthcare-Commercial,26971.19 +136617,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,United Healthcare-Commercial,26488.32 +136618,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,United Healthcare-Commercial,32332.86 +136619,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,United Healthcare-Commercial,17481.8 +136620,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,United Healthcare-Commercial,16479.87 +136621,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,United Healthcare-Commercial,48076.94 +136622,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,United Healthcare-Commercial, +136623,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,United Healthcare-Commercial, +136624,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,United Healthcare-Commercial, +136625,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,United Healthcare-Commercial, +136626,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,United Healthcare-Commercial, +136627,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,United Healthcare-Commercial,36012.33 +136628,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,United Healthcare-Commercial,33582.21 +136629,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,United Healthcare-Commercial, +136630,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,United Healthcare-Commercial, +136631,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,United Healthcare-Commercial, +136632,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,United Healthcare-Commercial, +136633,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,United Healthcare-Commercial,14189.6 +136634,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,United Healthcare-Commercial,13147.24 +136635,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,United Healthcare-Commercial,16819.89 +136636,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,United Healthcare-Commercial, +136637,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,United Healthcare-Commercial, +136638,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,United Healthcare-Commercial, +136639,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,United Healthcare-Commercial, +136640,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,United Healthcare-Commercial, +136641,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,United Healthcare-Commercial, +136642,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,United Healthcare-Commercial, +136643,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,United Healthcare-Commercial,24744.48 +136644,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,United Healthcare-Commercial,27886.63 +136645,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,United Healthcare-Commercial,72523.82 +136646,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,United Healthcare-Commercial, +136647,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,United Healthcare-Commercial,27391.95 +136648,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,United Healthcare-Commercial,59215.93 +136649,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,United Healthcare-Commercial,20188.24 +136650,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,United Healthcare-Commercial, +136651,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,United Healthcare-Commercial, +136652,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,United Healthcare-Commercial,7995.09 +136653,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,United Healthcare-Commercial,120930.11 +136654,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,United Healthcare-Commercial, +136655,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,United Healthcare-Commercial, +136656,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,United Healthcare-Commercial, +136657,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,United Healthcare-Commercial,13365.29 +136658,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,United Healthcare-Commercial, +136659,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,United Healthcare-Commercial,10191.73 +136660,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,United Healthcare-Commercial, +136661,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,United Healthcare-Commercial, +136662,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,United Healthcare-Commercial, +136663,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,United Healthcare-Commercial,13222.09 +136664,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,United Healthcare-Commercial,10766.41 +136665,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,United Healthcare-Commercial, +136666,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,United Healthcare-Commercial, +136667,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,United Healthcare-Commercial, +136668,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,United Healthcare-Commercial,6946.77 +136669,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,United Healthcare-Commercial, +136670,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,United Healthcare-Commercial,7937.28 +136671,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,United Healthcare-Commercial, +136672,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,United Healthcare-Commercial, +136673,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,United Healthcare-Commercial,7425.91 +136674,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,United Healthcare-Commercial,16532.25 +136675,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,United Healthcare-Commercial, +136676,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,United Healthcare-Commercial, +136677,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,United Healthcare-Commercial, +136678,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,United Healthcare-Commercial, +136679,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,United Healthcare-Commercial,10605.7 +136680,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,United Healthcare-Commercial,50170.88 +136681,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,United Healthcare-Commercial, +136682,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,United Healthcare-Commercial,52882.53 +136683,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,United Healthcare-Commercial, +136684,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,United Healthcare-Commercial,28754.09 +136685,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,United Healthcare-Commercial, +136686,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,United Healthcare-Commercial, +136687,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,United Healthcare-Commercial, +136688,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,United Healthcare-Commercial,36427.11 +136689,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,United Healthcare-Commercial, +136690,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,United Healthcare-Commercial, +136691,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,United Healthcare-Commercial,37459.14 +136692,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,United Healthcare-Commercial, +136693,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,United Healthcare-Commercial, +136694,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,United Healthcare-Commercial, +136695,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,United Healthcare-Commercial, +136696,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,United Healthcare-Commercial,13883.83 +136697,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,United Healthcare-Commercial,22327.79 +136698,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,United Healthcare-Commercial,13724.55 +136699,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,United Healthcare-Commercial,7744.23 +136700,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,United Healthcare-Commercial, +136701,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,United Healthcare-Commercial, +136702,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,United Healthcare-Commercial, +136703,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,United Healthcare-Commercial, +136704,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,United Healthcare-Commercial, +136705,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,United Healthcare-Commercial, +136706,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,United Healthcare-Commercial, +136707,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,United Healthcare-Commercial,34182.9 +136708,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,United Healthcare-Commercial,32151.57 +136709,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,United Healthcare-Commercial, +136710,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,United Healthcare-Commercial, +136711,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,United Healthcare-Commercial, +136712,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,United Healthcare-Commercial,15006.23 +136713,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,United Healthcare-Commercial, +136714,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,United Healthcare-Commercial, +136715,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,United Healthcare-Commercial, +136716,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,United Healthcare-Commercial,27694.43 +136717,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,United Healthcare-Commercial,10039.86 +136718,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,United Healthcare-Commercial,5626.05 +136719,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,United Healthcare-Commercial,6787.43 +136720,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,United Healthcare-Commercial,14914.22 +136721,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,United Healthcare-Commercial, +136722,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,United Healthcare-Commercial, +136723,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,United Healthcare-Commercial,117667.6 +136724,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,United Healthcare-Commercial,13655.91 +136725,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,United Healthcare-Commercial, +136726,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,United Healthcare-Commercial, +136727,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,United Healthcare-Commercial,58500.0 +136728,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,United Healthcare-Commercial,38073.31 +136729,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,United Healthcare-Commercial, +136730,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,United Healthcare-Commercial, +136731,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,United Healthcare-Commercial, +136732,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,United Healthcare-Commercial,35596.1 +136733,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,United Healthcare-Commercial,32510.81 +136734,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,United Healthcare-Commercial,25285.09 +136735,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,United Healthcare-Commercial,27419.12 +136736,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,United Healthcare-Commercial,21797.89 +136737,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,United Healthcare-Commercial, +136738,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,United Healthcare-Commercial, +136739,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,United Healthcare-Commercial, +136740,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,United Healthcare-Commercial, +136741,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,United Healthcare-Commercial, +136742,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,United Healthcare-Commercial,46629.83 +136743,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,United Healthcare-Commercial, +136744,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,United Healthcare-Commercial, +136745,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,United Healthcare-Commercial, +136746,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,United Healthcare-Commercial, +136747,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,United Healthcare-Commercial,15155.88 +136748,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,United Healthcare-Commercial,13327.51 +136749,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,United Healthcare-Commercial, +136750,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,United Healthcare-Commercial, +136751,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,United Healthcare-Commercial,8991.22 +136752,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,United Healthcare-Commercial,9718.8 +136753,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,United Healthcare-Commercial,10669.14 +136754,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,United Healthcare-Commercial, +136755,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,United Healthcare-Commercial, +136756,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,United Healthcare-Commercial, +136757,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,United Healthcare-Commercial,11997.39 +136758,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,United Healthcare-Commercial,18440.6 +136759,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,United Healthcare-Commercial,10013.97 +136760,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,United Healthcare-Commercial,6702.39 +136761,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,United Healthcare-Commercial,32990.02 +136762,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,United Healthcare-Commercial, +136763,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,United Healthcare-Commercial, +136764,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,United Healthcare-Commercial, +136765,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,United Healthcare-Commercial, +136766,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,United Healthcare-Commercial, +136767,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,United Healthcare-Commercial, +136768,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,United Healthcare-Commercial, +136769,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,United Healthcare-Commercial, +136770,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,United Healthcare-Commercial, +136771,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,United Healthcare-Commercial, +136772,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,United Healthcare-Commercial, +136773,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,United Healthcare-Commercial, +136774,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,United Healthcare-Commercial, +136775,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,United Healthcare-Commercial, +136776,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,United Healthcare-Commercial, +136777,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,United Healthcare-Commercial,17677.81 +136778,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,United Healthcare-Commercial, +136779,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,United Healthcare-Commercial,43760.48 +136780,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,United Healthcare-Commercial, +136781,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,United Healthcare-Commercial,21664.52 +136782,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,United Healthcare-Commercial,22269.59 +136783,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,United Healthcare-Commercial, +136784,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,United Healthcare-Commercial, +136785,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,United Healthcare-Commercial,15329.17 +136786,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,United Healthcare-Commercial, +136787,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,United Healthcare-Commercial, +136788,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,United Healthcare-Commercial, +136789,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,United Healthcare-Commercial,39965.0 +136790,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,United Healthcare-Commercial, +136791,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,United Healthcare-Commercial,12118.56 +136792,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,United Healthcare-Commercial, +136793,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,United Healthcare-Commercial, +136794,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,United Healthcare-Commercial,14921.85 +136795,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,United Healthcare-Commercial, +136796,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,United Healthcare-Commercial,8235.27 +136797,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,United Healthcare-Commercial, +136798,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,United Healthcare-Commercial, +136799,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,United Healthcare-Commercial,10557.96 +136800,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,United Healthcare-Commercial,10024.07 +136801,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,United Healthcare-Commercial,12943.13 +136802,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,United Healthcare-Commercial,16393.09 +136803,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,United Healthcare-Commercial,11444.57 +136804,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,United Healthcare-Commercial,4524.71 +136805,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,United Healthcare-Commercial,107534.38 +136806,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,United Healthcare-Commercial,30875.66 +136807,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,United Healthcare-Commercial,5565.36 +136808,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,United Healthcare-Commercial,30199.79 +136809,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,United Healthcare-Commercial,6334.69 +136810,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,United Healthcare-Commercial,5753.23 +136811,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,United Healthcare-Commercial, +136812,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,United Healthcare-Commercial,13277.39 +136813,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,United Healthcare-Commercial, +136814,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,United Healthcare-Commercial,55083.66 +136815,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,United Healthcare-Commercial, +136816,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,United Healthcare-Commercial, +136817,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,United Healthcare-Commercial, +136818,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,United Healthcare-Commercial, +136819,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,United Healthcare-Commercial,27497.88 +136820,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,United Healthcare-Commercial,9478.91 +136821,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,United Healthcare-Commercial,10982.34 +136822,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,United Healthcare-Commercial, +136823,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,United Healthcare-Commercial,12291.0 +136824,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,United Healthcare-Commercial, +136825,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,United Healthcare-Commercial, +136826,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,United Healthcare-Commercial,8632.64 +136827,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,United Healthcare-Commercial,15725.85 +136828,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,United Healthcare-Commercial,16904.11 +136829,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,United Healthcare-Commercial,19642.52 +136830,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,United Healthcare-Commercial, +136831,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,United Healthcare-Commercial, +136832,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,United Healthcare-Commercial, +136833,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,United Healthcare-Commercial,2937.62 +136834,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,United Healthcare-Commercial, +136835,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,United Healthcare-Commercial, +136836,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,United Healthcare-Commercial,24278.95 +136837,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,United Healthcare-Commercial, +136838,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,United Healthcare-Commercial, +136839,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,United Healthcare-Commercial, +136840,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,United Healthcare-Commercial, +136841,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,United Healthcare-Commercial, +136842,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,United Healthcare-Commercial,32529.12 +136843,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,United Healthcare-Commercial, +136844,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,United Healthcare-Commercial, +136845,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,United Healthcare-Commercial,19062.8 +136846,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,United Healthcare-Commercial,13302.68 +136847,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,United Healthcare-Commercial,9581.42 +136848,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,United Healthcare-Commercial,77340.51 +136849,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,United Healthcare-Commercial, +136850,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,United Healthcare-Commercial, +136851,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,United Healthcare-Commercial,102145.18 +136852,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,United Healthcare-Commercial,24582.0 +136853,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,United Healthcare-Commercial, +136854,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,United Healthcare-Commercial,55871.29 +136855,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,United Healthcare-Commercial, +136856,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,United Healthcare-Commercial, +136857,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,United Healthcare-Commercial,182164.33 +136858,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,United Healthcare-Commercial, +136859,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,United Healthcare-Commercial, +136860,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,United Healthcare-Commercial, +136861,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,United Healthcare-Commercial, +136862,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,United Healthcare-Commercial,95514.4 +136863,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,United Healthcare-Commercial,22565.51 +136864,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,United Healthcare-Commercial, +136865,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,United Healthcare-Commercial, +136866,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,United Healthcare-Commercial, +136867,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,United Healthcare-Commercial,18107.04 +136868,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,United Healthcare-Commercial, +136869,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,United Healthcare-Commercial,8497.8 +136870,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,United Healthcare-Commercial, +136871,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,United Healthcare-Commercial,7213.16 +136872,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,United Healthcare-Commercial, +136873,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,United Healthcare-Commercial,21285.11 +136874,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,United Healthcare-Commercial, +136875,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,United Healthcare-Commercial,91729.98 +136876,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,United Healthcare-Commercial,21365.91 +136877,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,United Healthcare-Commercial,14300.19 +136878,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,United Healthcare-Commercial, +136879,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,United Healthcare-Commercial,16581.12 +136880,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,United Healthcare-Commercial,11000.0 +136881,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,United Healthcare-Commercial, +136882,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,United Healthcare-Commercial, +136883,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,United Healthcare-Commercial,13868.83 +136884,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,United Healthcare-Commercial,29126.0 +136885,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,United Healthcare-Commercial,55000.0 +136886,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,United Healthcare-Commercial, +136887,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,United Healthcare-Commercial, +136888,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,United Healthcare-Commercial, +136889,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,United Healthcare-Commercial,13398.9 +136890,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,United Healthcare-Commercial,16950.0 +136891,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,United Healthcare-Commercial, +136892,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,United Healthcare-Commercial, +136893,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,United Healthcare-Commercial,147040.81 +136894,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,United Healthcare-Commercial, +136895,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,United Healthcare-Commercial,81504.96 +136896,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,United Healthcare-Commercial,27556.1 +136897,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,United Healthcare-Commercial, +136898,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,United Healthcare-Commercial,12355.83 +136899,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,United Healthcare-Commercial,17104.92 +136900,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,United Healthcare-Commercial, +136901,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,United Healthcare-Commercial, +136902,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,United Healthcare-Commercial,28117.49 +136903,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,United Healthcare-Commercial,19349.25 +136904,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,United Healthcare-Commercial,34141.2 +136905,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,United Healthcare-Commercial,10460.35 +136906,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,United Healthcare-Commercial,12712.08 +136907,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,United Healthcare-Commercial,14491.16 +136908,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,United Healthcare-Commercial, +136909,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,United Healthcare-Commercial, +136910,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,United Healthcare-Commercial, +136911,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,United Healthcare-Commercial, +136912,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,United Healthcare-Commercial,7391.25 +136913,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,United Healthcare-Commercial, +136914,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,United Healthcare-Commercial,10825.61 +136915,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,United Healthcare-Commercial,6972.2 +136916,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,United Healthcare-Commercial, +136917,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,United Healthcare-Commercial, +136918,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,United Healthcare-Commercial,11260.8 +136919,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,United Healthcare-Commercial, +136920,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,United Healthcare-Commercial, +136921,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,United Healthcare-Commercial, +136922,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,United Healthcare-Commercial,82181.28 +136923,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,United Healthcare-Commercial, +136924,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,United Healthcare-Commercial,14317.1 +136925,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,United Healthcare-Commercial, +136926,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,United Healthcare-Commercial, +136927,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,United Healthcare-Commercial, +136928,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,United Healthcare-Commercial, +136929,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,United Healthcare-Commercial, +136930,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,United Healthcare-Commercial,31528.39 +136931,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,United Healthcare-Commercial, +136932,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,United Healthcare-Commercial,10980.18 +136933,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,United Healthcare-Commercial,4284.0 +136934,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,United Healthcare-Commercial, +136935,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,United Healthcare-Commercial, +136936,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,United Healthcare-Commercial, +136937,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,United Healthcare-Commercial, +136938,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,United Healthcare-Commercial, +136939,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,United Healthcare-Commercial,4095.68 +136940,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,United Healthcare-Commercial,377.25 +136941,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,United Healthcare-Commercial,377.25 +136942,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,United Healthcare-Commercial, +136943,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,United Healthcare-Commercial, +136944,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,United Healthcare-Commercial, +136945,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,United Healthcare-Commercial, +136946,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,United Healthcare-Commercial, +136947,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,United Healthcare-Commercial, +136948,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,United Healthcare-Commercial, +136949,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,United Healthcare-Commercial, +136950,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,United Healthcare-Commercial, +136951,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,United Healthcare-Commercial, +136952,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,United Healthcare-Commercial,3996.0 +136953,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,United Healthcare-Commercial, +136954,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,United Healthcare-Commercial, +136955,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,United Healthcare-Commercial, +136956,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,United Healthcare-Commercial, +136957,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,United Healthcare-Commercial, +136958,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,United Healthcare-Commercial, +136959,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,United Healthcare-Commercial, +136960,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,United Healthcare-Commercial,4356.0 +136961,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,United Healthcare-Commercial, +136962,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,United Healthcare-Commercial,3996.0 +136963,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,United Healthcare-Commercial, +136964,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,United Healthcare-Commercial, +136965,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,United Healthcare-Commercial,1435.46 +136966,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,United Healthcare-Commercial,787.77 +136967,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,United Healthcare-Commercial, +136968,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,United Healthcare-Commercial,1998.0 +136969,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,United Healthcare-Commercial,4356.0 +136970,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,United Healthcare-Commercial, +136971,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,United Healthcare-Commercial, +136972,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,United Healthcare-Commercial, +136973,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,United Healthcare-Commercial,3996.0 +136974,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,United Healthcare-Commercial, +136975,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,United Healthcare-Commercial,1435.46 +136976,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,United Healthcare-Commercial, +136977,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,United Healthcare-Commercial, +136978,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,United Healthcare-Commercial, +136979,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,United Healthcare-Commercial, +136980,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,United Healthcare-Commercial,4137.62 +136981,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,United Healthcare-Commercial, +136982,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,United Healthcare-Commercial, +136983,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,United Healthcare-Commercial, +136984,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,United Healthcare-Commercial, +136985,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,United Healthcare-Commercial, +136986,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,United Healthcare-Commercial, +136987,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,United Healthcare-Commercial, +136988,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,United Healthcare-Commercial, +136989,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,United Healthcare-Commercial,2809.34 +136990,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,United Healthcare-Commercial,2856.04 +136991,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,United Healthcare-Commercial, +136992,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,United Healthcare-Commercial, +136993,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,United Healthcare-Commercial,728.29 +136994,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,United Healthcare-Commercial, +136995,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,United Healthcare-Commercial, +136996,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,United Healthcare-Commercial, +136997,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,United Healthcare-Commercial, +136998,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,United Healthcare-Commercial, +136999,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,United Healthcare-Commercial,389.0 +137000,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,United Healthcare-Commercial, +137001,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,United Healthcare-Commercial,3996.0 +137002,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,United Healthcare-Commercial,1148.0 +137003,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,United Healthcare-Commercial, +137004,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,United Healthcare-Commercial,4356.0 +137005,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,United Healthcare-Commercial,2137.17 +137006,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,United Healthcare-Commercial, +137007,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,United Healthcare-Commercial,633.38 +137008,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,United Healthcare-Commercial, +137009,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,United Healthcare-Commercial, +137010,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,United Healthcare-Commercial, +137011,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,United Healthcare-Commercial,3996.0 +137012,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,United Healthcare-Commercial,105.57 +137013,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,United Healthcare-Commercial, +137014,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,United Healthcare-Commercial, +137015,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,United Healthcare-Commercial, +137016,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,United Healthcare-Commercial, +137017,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,United Healthcare-Commercial,2053.86 +137018,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,United Healthcare-Commercial,800.6 +137019,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,United Healthcare-Commercial, +137020,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,United Healthcare-Commercial, +137021,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,United Healthcare-Commercial,896.0 +137022,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,United Healthcare-Commercial,866.5 +137023,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,United Healthcare-Commercial, +137024,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,United Healthcare-Commercial, +137025,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,United Healthcare-Commercial, +137026,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,United Healthcare-Commercial, +137027,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,United Healthcare-Commercial, +137028,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,United Healthcare-Commercial,404.96 +137029,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,United Healthcare-Commercial,1998.0 +137030,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,United Healthcare-Commercial,2994.3 +137031,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,United Healthcare-Commercial, +137032,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,United Healthcare-Commercial, +137033,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,United Healthcare-Commercial, +137034,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,United Healthcare-Commercial,999.0 +137035,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,United Healthcare-Commercial,954.0 +137036,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,United Healthcare-Commercial, +137037,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,United Healthcare-Commercial, +137038,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,United Healthcare-Commercial, +137039,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,United Healthcare-Commercial,1177.33 +137040,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,United Healthcare-Commercial,892.0 +137041,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,United Healthcare-Commercial, +137042,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,United Healthcare-Commercial, +137043,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,United Healthcare-Commercial,2616.28 +137044,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,United Healthcare-Commercial,1633.5 +137045,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,United Healthcare-Commercial, +137046,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,United Healthcare-Commercial,1327.0 +137047,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,United Healthcare-Commercial, +137048,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,United Healthcare-Commercial,365.92 +137049,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,United Healthcare-Commercial,1327.0 +137050,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,United Healthcare-Commercial,1164.0 +137051,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,United Healthcare-Commercial, +137052,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,United Healthcare-Commercial, +137053,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,United Healthcare-Commercial,4356.0 +137054,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,United Healthcare-Commercial, +137055,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,United Healthcare-Commercial, +137056,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,United Healthcare-Commercial, +137057,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,United Healthcare-Commercial,3267.0 +137058,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,United Healthcare-Commercial, +137059,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,United Healthcare-Commercial,4669.34 +137060,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,United Healthcare-Commercial, +137061,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,United Healthcare-Commercial,3996.0 +137062,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,United Healthcare-Commercial, +137063,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,United Healthcare-Commercial,659.88 +137064,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,United Healthcare-Commercial, +137065,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,United Healthcare-Commercial,2088.0 +137066,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,United Healthcare-Commercial,1802.66 +137067,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,United Healthcare-Commercial, +137068,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,United Healthcare-Commercial,4270.47 +137069,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,United Healthcare-Commercial, +137070,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,United Healthcare-Commercial,1998.0 +137071,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,United Healthcare-Commercial,3996.0 +137072,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,United Healthcare-Commercial, +137073,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,United Healthcare-Commercial, +137074,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,United Healthcare-Commercial, +137075,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,United Healthcare-Commercial,3996.0 +137076,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,United Healthcare-Commercial, +137077,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,United Healthcare-Commercial, +137078,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,United Healthcare-Commercial, +137079,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,United Healthcare-Commercial, +137080,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,United Healthcare-Commercial, +137081,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,United Healthcare-Commercial, +137082,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,United Healthcare-Commercial, +137083,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,United Healthcare-Commercial, +137084,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,United Healthcare-Commercial, +137085,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,United Healthcare-Commercial, +137086,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,United Healthcare-Commercial, +137087,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,United Healthcare-Commercial, +137088,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,United Healthcare-Commercial, +137089,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,United Healthcare-Commercial,3297.0 +137090,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,United Healthcare-Commercial, +137091,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,United Healthcare-Commercial, +137092,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,United Healthcare-Commercial, +137093,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,United Healthcare-Commercial, +137094,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,United Healthcare-Commercial, +137095,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,United Healthcare-Commercial, +137096,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,United Healthcare-Commercial,4356.0 +137097,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,United Healthcare-Commercial, +137098,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,United Healthcare-Commercial, +137099,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,United Healthcare-Commercial, +137100,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,United Healthcare-Commercial, +137101,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,United Healthcare-Commercial, +137102,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,United Healthcare-Commercial,310.14 +137103,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,United Healthcare-Commercial,3996.0 +137104,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,United Healthcare-Commercial, +137105,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,United Healthcare-Commercial,4312.5 +137106,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,United Healthcare-Commercial,1815.75 +137107,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,United Healthcare-Commercial,3511.08 +137108,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,United Healthcare-Commercial,2178.0 +137109,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,United Healthcare-Commercial,3992.63 +137110,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,United Healthcare-Commercial,1996.1 +137111,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,United Healthcare-Commercial, +137112,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,United Healthcare-Commercial,4611.6 +137113,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,United Healthcare-Commercial,3895.5 +137114,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,United Healthcare-Commercial,2932.07 +137115,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,United Healthcare-Commercial,1089.0 +137116,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,United Healthcare-Commercial, +137117,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,United Healthcare-Commercial, +137118,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,United Healthcare-Commercial, +137119,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,United Healthcare-Commercial,754.11 +137120,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,United Healthcare-Commercial,3267.0 +137121,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,United Healthcare-Commercial,3596.0 +137122,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,United Healthcare-Commercial, +137123,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,United Healthcare-Commercial, +137124,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,United Healthcare-Commercial, +137125,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,United Healthcare-Commercial,6265.54 +137126,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,United Healthcare-Commercial, +137127,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,United Healthcare-Commercial, +137128,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,United Healthcare-Commercial, +137129,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,United Healthcare-Commercial, +137130,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,United Healthcare-Commercial,4224.83 +137131,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,United Healthcare-Commercial,2001.28 +137132,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,United Healthcare-Commercial,3270.28 +137133,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,United Healthcare-Commercial, +137134,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,United Healthcare-Commercial,1089.0 +137135,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,United Healthcare-Commercial,3736.21 +137136,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,United Healthcare-Commercial,4329.0 +137137,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,United Healthcare-Commercial,2000.45 +137138,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,United Healthcare-Commercial, +137139,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,United Healthcare-Commercial, +137140,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,United Healthcare-Commercial, +137141,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,United Healthcare-Commercial, +137142,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,United Healthcare-Commercial,4116.0 +137143,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,United Healthcare-Commercial, +137144,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,United Healthcare-Commercial,3811.5 +137145,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,United Healthcare-Commercial, +137146,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,United Healthcare-Commercial, +137147,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,United Healthcare-Commercial,3996.0 +137148,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,United Healthcare-Commercial, +137149,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,United Healthcare-Commercial,514.5 +137150,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,United Healthcare-Commercial,1998.0 +137151,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,United Healthcare-Commercial, +137152,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,United Healthcare-Commercial, +137153,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,United Healthcare-Commercial, +137154,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,United Healthcare-Commercial, +137155,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,United Healthcare-Commercial,6534.0 +137156,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,United Healthcare-Commercial, +137157,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,United Healthcare-Commercial,317.13 +137158,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,United Healthcare-Commercial, +137159,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,United Healthcare-Commercial, +137160,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,United Healthcare-Commercial, +137161,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,United Healthcare-Commercial,4356.0 +137162,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,United Healthcare-Commercial,3267.0 +137163,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,United Healthcare-Commercial, +137164,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,United Healthcare-Commercial, +137165,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,United Healthcare-Commercial,1998.0 +137166,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,United Healthcare-Commercial, +137167,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,United Healthcare-Commercial, +137168,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,United Healthcare-Commercial,3996.0 +137169,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,United Healthcare-Commercial,3660.75 +137170,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,United Healthcare-Commercial, +137171,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,United Healthcare-Commercial, +137172,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,United Healthcare-Commercial, +137173,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,United Healthcare-Commercial, +137174,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,United Healthcare-Commercial,1444.99 +137175,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,United Healthcare-Commercial, +137176,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,United Healthcare-Commercial, +137177,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,United Healthcare-Commercial, +137178,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,United Healthcare-Commercial, +137179,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,United Healthcare-Commercial,3996.0 +137180,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,United Healthcare-Commercial,1563.75 +137181,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,United Healthcare-Commercial,85.5 +137182,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,United Healthcare-Commercial, +137183,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,United Healthcare-Commercial, +137184,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,United Healthcare-Commercial, +137185,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,United Healthcare-Commercial,3996.0 +137186,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,United Healthcare-Commercial, +137187,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,United Healthcare-Commercial,4356.0 +137188,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,United Healthcare-Commercial, +137189,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,United Healthcare-Commercial, +137190,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,United Healthcare-Commercial, +137191,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,United Healthcare-Commercial,20.0 +137192,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,United Healthcare-Commercial, +137193,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,United Healthcare-Commercial,4025.16 +137194,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,United Healthcare-Commercial, +137195,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,United Healthcare-Commercial, +137196,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,United Healthcare-Commercial, +137197,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,United Healthcare-Commercial, +137198,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,United Healthcare-Commercial, +137199,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,United Healthcare-Commercial, +137200,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,United Healthcare-Commercial, +137201,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,United Healthcare-Commercial,4363.25 +137202,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,United Healthcare-Commercial, +137203,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,United Healthcare-Commercial, +137204,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,United Healthcare-Commercial, +137205,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,United Healthcare-Commercial, +137206,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,United Healthcare-Commercial, +137207,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,United Healthcare-Commercial, +137208,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,United Healthcare-Commercial,4656.0 +137209,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,United Healthcare-Commercial, +137210,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,United Healthcare-Commercial, +137211,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,United Healthcare-Commercial,3996.0 +137212,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,United Healthcare-Commercial,787.77 +137213,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,United Healthcare-Commercial, +137214,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,United Healthcare-Commercial, +137215,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,United Healthcare-Commercial, +137216,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,United Healthcare-Commercial, +137217,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,United Healthcare-Commercial, +137218,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,United Healthcare-Commercial,3996.0 +137219,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,United Healthcare-Commercial, +137220,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,United Healthcare-Commercial,3996.0 +137221,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,United Healthcare-Commercial, +137222,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,United Healthcare-Commercial, +137223,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,United Healthcare-Commercial, +137224,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,United Healthcare-Commercial, +137225,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,United Healthcare-Commercial, +137226,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,United Healthcare-Commercial,3996.0 +137227,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,United Healthcare-Commercial,999.0 +137228,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,United Healthcare-Commercial,999.0 +137229,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,United Healthcare-Commercial, +137230,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,United Healthcare-Commercial,4293.09 +137231,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,United Healthcare-Commercial, +137232,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,United Healthcare-Commercial, +137233,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,United Healthcare-Commercial, +137234,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,United Healthcare-Commercial, +137235,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,United Healthcare-Commercial,3996.0 +137236,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,United Healthcare-Commercial, +137237,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,United Healthcare-Commercial, +137238,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,United Healthcare-Commercial, +137239,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,United Healthcare-Commercial, +137240,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,United Healthcare-Commercial,12644.71 +137241,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,United Healthcare-Commercial, +137242,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,United Healthcare-Commercial, +137243,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,United Healthcare-Commercial,1798.0 +137244,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,United Healthcare-Commercial, +137245,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,United Healthcare-Commercial,3525.96 +137246,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,United Healthcare-Commercial,6323.0 +137247,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,United Healthcare-Commercial, +137248,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,United Healthcare-Commercial, +137249,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,United Healthcare-Commercial, +137250,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,United Healthcare-Commercial,1488.0 +137251,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,United Healthcare-Commercial, +137252,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,United Healthcare-Commercial, +137253,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,United Healthcare-Commercial, +137254,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,United Healthcare-Commercial, +137255,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,United Healthcare-Commercial,3996.0 +137256,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,United Healthcare-Commercial, +137257,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,United Healthcare-Commercial, +137258,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,United Healthcare-Commercial,4356.0 +137259,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,United Healthcare-Commercial, +137260,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,United Healthcare-Commercial, +137261,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,United Healthcare-Commercial, +137262,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,United Healthcare-Commercial, +137263,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,United Healthcare-Commercial, +137264,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,United Healthcare-Commercial, +137265,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,United Healthcare-Commercial,5078.0 +137266,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,United Healthcare-Commercial, +137267,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,United Healthcare-Commercial, +137268,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,United Healthcare-Commercial,3996.0 +137269,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,United Healthcare-Commercial,3996.0 +137270,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,United Healthcare-Commercial, +137271,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,United Healthcare-Commercial, +137272,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,United Healthcare-Commercial, +137273,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,United Healthcare-Commercial, +137274,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,United Healthcare-Commercial, +137275,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,United Healthcare-Commercial, +137276,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,United Healthcare-Commercial, +137277,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,United Healthcare-Commercial, +137278,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,United Healthcare-Commercial, +137279,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,United Healthcare-Commercial,4698.5 +137280,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,United Healthcare-Commercial, +137281,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,United Healthcare-Commercial, +137282,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,United Healthcare-Commercial, +137283,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,United Healthcare-Commercial, +137284,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,United Healthcare-Commercial, +137285,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,United Healthcare-Commercial, +137286,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,United Healthcare-Commercial, +137287,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,United Healthcare-Commercial, +137288,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,United Healthcare-Commercial,572.04 +137289,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,United Healthcare-Commercial, +137290,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,United Healthcare-Commercial, +137291,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,United Healthcare-Commercial, +137292,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,United Healthcare-Commercial, +137293,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,United Healthcare-Commercial,4356.0 +137294,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,United Healthcare-Commercial,4356.0 +137295,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,United Healthcare-Commercial, +137296,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,United Healthcare-Commercial, +137297,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,United Healthcare-Commercial, +137298,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,United Healthcare-Commercial, +137299,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,United Healthcare-Commercial, +137300,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,United Healthcare-Commercial, +137301,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,United Healthcare-Commercial, +137302,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,United Healthcare-Commercial, +137303,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,United Healthcare-Commercial,4176.0 +137304,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,United Healthcare-Commercial, +137305,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,United Healthcare-Commercial, +137306,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,United Healthcare-Commercial, +137307,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,United Healthcare-Commercial, +137308,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,United Healthcare-Commercial,3996.0 +137309,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,United Healthcare-Commercial, +137310,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,United Healthcare-Commercial, +137311,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,United Healthcare-Commercial, +137312,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,United Healthcare-Commercial,3996.0 +137313,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,United Healthcare-Commercial, +137314,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,United Healthcare-Commercial, +137315,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,United Healthcare-Commercial, +137316,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,United Healthcare-Commercial, +137317,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,United Healthcare-Commercial, +137318,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,United Healthcare-Commercial, +137319,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,United Healthcare-Commercial, +137320,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,United Healthcare-Commercial,3996.0 +137321,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,United Healthcare-Commercial, +137322,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,United Healthcare-Commercial, +137323,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,United Healthcare-Commercial, +137324,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,United Healthcare-Commercial, +137325,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,United Healthcare-Commercial, +137326,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,United Healthcare-Commercial,1939.0 +137327,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,United Healthcare-Commercial,5667.25 +137328,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,United Healthcare-Commercial, +137329,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,United Healthcare-Commercial,572.04 +137330,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,United Healthcare-Commercial, +137331,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,United Healthcare-Commercial,5765.5 +137332,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,United Healthcare-Commercial,999.0 +137333,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,United Healthcare-Commercial, +137334,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,United Healthcare-Commercial, +137335,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,United Healthcare-Commercial, +137336,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,United Healthcare-Commercial,4167.0 +137337,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,United Healthcare-Commercial, +137338,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,United Healthcare-Commercial, +137339,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,United Healthcare-Commercial, +137340,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,United Healthcare-Commercial, +137341,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,United Healthcare-Commercial,3025.5 +137342,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,United Healthcare-Commercial, +137343,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,United Healthcare-Commercial,4007.5 +137344,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,United Healthcare-Commercial, +137345,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,United Healthcare-Commercial, +137346,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,United Healthcare-Commercial,4356.0 +137347,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,United Healthcare-Commercial,3996.0 +137348,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,United Healthcare-Commercial, +137349,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,United Healthcare-Commercial, +137350,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,United Healthcare-Commercial, +137351,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,United Healthcare-Commercial,3267.0 +137352,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,United Healthcare-Commercial,4176.0 +137353,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,United Healthcare-Commercial, +137354,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,United Healthcare-Commercial, +137355,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,United Healthcare-Commercial, +137356,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,United Healthcare-Commercial, +137357,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,United Healthcare-Commercial, +137358,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,United Healthcare-Commercial,1062.0 +137359,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,United Healthcare-Commercial, +137360,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,United Healthcare-Commercial, +137361,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,United Healthcare-Commercial, +137362,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,United Healthcare-Commercial,1103.0 +137363,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,United Healthcare-Commercial, +137364,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,United Healthcare-Commercial, +137365,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,United Healthcare-Commercial, +137366,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,United Healthcare-Commercial, +137367,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,United Healthcare-Commercial,5994.0 +137368,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,United Healthcare-Commercial, +137369,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,United Healthcare-Commercial, +137370,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,United Healthcare-Commercial, +137371,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,United Healthcare-Commercial, +137372,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,United Healthcare-Commercial, +137373,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,United Healthcare-Commercial, +137374,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,United Healthcare-Commercial,1466.39 +137375,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,United Healthcare-Commercial,3996.0 +137376,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,United Healthcare-Commercial, +137377,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,United Healthcare-Commercial, +137378,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,United Healthcare-Commercial,3996.0 +137379,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,United Healthcare-Commercial, +137380,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,United Healthcare-Commercial, +137381,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,United Healthcare-Commercial, +137382,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,United Healthcare-Commercial,3996.0 +137383,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,United Healthcare-Commercial, +137384,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,United Healthcare-Commercial, +137385,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,United Healthcare-Commercial, +137386,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,United Healthcare-Commercial, +137387,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,United Healthcare-Commercial, +137388,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,United Healthcare-Commercial, +137389,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,United Healthcare-Commercial, +137390,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,United Healthcare-Commercial, +137391,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,United Healthcare-Commercial, +137392,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,United Healthcare-Commercial, +137393,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,United Healthcare-Commercial, +137394,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,United Healthcare-Commercial, +137395,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,United Healthcare-Commercial, +137396,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,United Healthcare-Commercial, +137397,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,United Healthcare-Commercial, +137398,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,United Healthcare-Commercial,1466.39 +137399,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,United Healthcare-Commercial, +137400,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,United Healthcare-Commercial, +137401,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,United Healthcare-Commercial, +137402,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,United Healthcare-Commercial, +137403,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,United Healthcare-Commercial, +137404,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,United Healthcare-Commercial,3237.0 +137405,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,United Healthcare-Commercial, +137406,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,United Healthcare-Commercial, +137407,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,United Healthcare-Commercial, +137408,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,United Healthcare-Commercial, +137409,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,United Healthcare-Commercial, +137410,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,United Healthcare-Commercial, +137411,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,United Healthcare-Commercial, +137412,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,United Healthcare-Commercial, +137413,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,United Healthcare-Commercial, +137414,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,United Healthcare-Commercial, +137415,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,United Healthcare-Commercial, +137416,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,United Healthcare-Commercial, +137417,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,United Healthcare-Commercial, +137418,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,United Healthcare-Commercial, +137419,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,United Healthcare-Commercial, +137420,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,United Healthcare-Commercial, +137421,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,United Healthcare-Commercial,1428.0 +137422,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,United Healthcare-Commercial, +137423,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,United Healthcare-Commercial, +137424,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,United Healthcare-Commercial,3996.0 +137425,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,United Healthcare-Commercial, +137426,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,United Healthcare-Commercial, +137427,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,United Healthcare-Commercial, +137428,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,United Healthcare-Commercial, +137429,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,United Healthcare-Commercial, +137430,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,United Healthcare-Commercial, +137431,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,United Healthcare-Commercial, +137432,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,United Healthcare-Commercial, +137433,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,United Healthcare-Commercial,4578.0 +137434,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,United Healthcare-Commercial, +137435,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,United Healthcare-Commercial,5497.0 +137436,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,United Healthcare-Commercial,6246.0 +137437,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,United Healthcare-Commercial, +137438,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,United Healthcare-Commercial, +137439,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,United Healthcare-Commercial, +137440,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,United Healthcare-Commercial, +137441,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,United Healthcare-Commercial, +137442,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,United Healthcare-Commercial, +137443,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,United Healthcare-Commercial,4678.0 +137444,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,United Healthcare-Commercial, +137445,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,United Healthcare-Commercial, +137446,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,United Healthcare-Commercial, +137447,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,United Healthcare-Commercial, +137448,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,United Healthcare-Commercial, +137449,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,United Healthcare-Commercial, +137450,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,United Healthcare-Commercial, +137451,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,United Healthcare-Commercial,652.28 +137452,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,United Healthcare-Commercial, +137453,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,United Healthcare-Commercial,4356.0 +137454,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,United Healthcare-Commercial, +137455,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,United Healthcare-Commercial, +137456,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,United Healthcare-Commercial, +137457,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,United Healthcare-Commercial, +137458,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,United Healthcare-Commercial, +137459,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,United Healthcare-Commercial, +137460,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,United Healthcare-Commercial,3596.0 +137461,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,United Healthcare-Commercial, +137462,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,United Healthcare-Commercial, +137463,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,United Healthcare-Commercial, +137464,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,United Healthcare-Commercial, +137465,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,United Healthcare-Commercial, +137466,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,United Healthcare-Commercial, +137467,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,United Healthcare-Commercial, +137468,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,United Healthcare-Commercial,1998.0 +137469,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,United Healthcare-Commercial,999.0 +137470,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,United Healthcare-Commercial, +137471,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,United Healthcare-Commercial, +137472,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,United Healthcare-Commercial, +137473,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,United Healthcare-Commercial,3147.5 +137474,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,United Healthcare-Commercial, +137475,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,United Healthcare-Commercial, +137476,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,United Healthcare-Commercial, +137477,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,United Healthcare-Commercial,1939.0 +137478,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,United Healthcare-Commercial,4435.0 +137479,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,United Healthcare-Commercial, +137480,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,United Healthcare-Commercial,5120.5 +137481,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,United Healthcare-Commercial, +137482,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,United Healthcare-Commercial, +137483,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,United Healthcare-Commercial, +137484,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,United Healthcare-Commercial, +137485,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,United Healthcare-Commercial, +137486,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,United Healthcare-Commercial, +137487,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,United Healthcare-Commercial,572.04 +137488,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,United Healthcare-Commercial,3996.0 +137489,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,United Healthcare-Commercial, +137490,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,United Healthcare-Commercial,3436.0 +137491,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,United Healthcare-Commercial,1988.94 +137492,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,United Healthcare-Commercial, +137493,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,United Healthcare-Commercial, +137494,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,United Healthcare-Commercial, +137495,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,United Healthcare-Commercial, +137496,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,United Healthcare-Commercial,3177.0 +137497,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,United Healthcare-Commercial,4356.0 +137498,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,United Healthcare-Commercial, +137499,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,United Healthcare-Commercial, +137500,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,United Healthcare-Commercial, +137501,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,United Healthcare-Commercial, +137502,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,United Healthcare-Commercial,1089.0 +137503,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,United Healthcare-Commercial, +137504,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,United Healthcare-Commercial, +137505,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,United Healthcare-Commercial,869.94 +137506,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,United Healthcare-Commercial, +137507,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,United Healthcare-Commercial, +137508,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,United Healthcare-Commercial, +137509,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,United Healthcare-Commercial, +137510,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,United Healthcare-Commercial, +137511,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,United Healthcare-Commercial,3996.0 +137512,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,United Healthcare-Commercial, +137513,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,United Healthcare-Commercial, +137514,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,United Healthcare-Commercial,1815.0 +137515,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,United Healthcare-Commercial,3267.0 +137516,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,United Healthcare-Commercial, +137517,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,United Healthcare-Commercial,3596.0 +137518,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,United Healthcare-Commercial, +137519,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,United Healthcare-Commercial, +137520,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,United Healthcare-Commercial,4176.0 +137521,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,United Healthcare-Commercial,2882.63 +137522,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,United Healthcare-Commercial,3996.0 +137523,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,United Healthcare-Commercial, +137524,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,United Healthcare-Commercial, +137525,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,United Healthcare-Commercial,3996.0 +137526,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,United Healthcare-Commercial, +137527,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,United Healthcare-Commercial, +137528,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,United Healthcare-Commercial, +137529,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,United Healthcare-Commercial, +137530,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,United Healthcare-Commercial,4356.0 +137531,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,United Healthcare-Commercial, +137532,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,United Healthcare-Commercial, +137533,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,United Healthcare-Commercial, +137534,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,United Healthcare-Commercial, +137535,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,United Healthcare-Commercial, +137536,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,United Healthcare-Commercial, +137537,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,United Healthcare-Commercial, +137538,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,United Healthcare-Commercial, +137539,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,United Healthcare-Commercial, +137540,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,United Healthcare-Commercial, +137541,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,United Healthcare-Commercial, +137542,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,United Healthcare-Commercial, +137543,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,United Healthcare-Commercial, +137544,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,United Healthcare-Commercial, +137545,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,United Healthcare-Commercial,676.8 +137546,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,United Healthcare-Commercial, +137547,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,United Healthcare-Commercial, +137548,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,United Healthcare-Commercial,6657.0 +137549,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,United Healthcare-Commercial, +137550,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,United Healthcare-Commercial, +137551,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,United Healthcare-Commercial, +137552,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,United Healthcare-Commercial, +137553,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,United Healthcare-Commercial, +137554,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,United Healthcare-Commercial, +137555,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,United Healthcare-Commercial, +137556,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,United Healthcare-Commercial, +137557,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,United Healthcare-Commercial,258.96 +137558,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,United Healthcare-Commercial, +137559,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,United Healthcare-Commercial,468.0 +137560,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,United Healthcare-Commercial, +137561,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,United Healthcare-Commercial, +137562,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,United Healthcare-Commercial,1414.0 +137563,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,United Healthcare-Commercial, +137564,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,United Healthcare-Commercial,759.0 +137565,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,United Healthcare-Commercial,871.0 +137566,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,United Healthcare-Commercial,1939.0 +137567,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,United Healthcare-Commercial,258.96 +137568,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,United Healthcare-Commercial,1939.0 +137569,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,United Healthcare-Commercial,3434.76 +137570,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,United Healthcare-Commercial,3996.0 +137571,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,United Healthcare-Commercial, +137572,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,United Healthcare-Commercial, +137573,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,United Healthcare-Commercial, +137574,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,United Healthcare-Commercial, +137575,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,United Healthcare-Commercial,2295.5 +137576,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,United Healthcare-Commercial,1260.0 +137577,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,United Healthcare-Commercial, +137578,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,United Healthcare-Commercial,1798.0 +137579,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,United Healthcare-Commercial,4609.7 +137580,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,United Healthcare-Commercial,4356.0 +137581,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,United Healthcare-Commercial, +137582,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,United Healthcare-Commercial, +137583,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,United Healthcare-Commercial, +137584,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,United Healthcare-Commercial,4029.0 +137585,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,United Healthcare-Commercial, +137586,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,United Healthcare-Commercial, +137587,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,United Healthcare-Commercial, +137588,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,United Healthcare-Commercial, +137589,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,United Healthcare-Commercial, +137590,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,United Healthcare-Commercial,2178.0 +137591,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,United Healthcare-Commercial,1998.0 +137592,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,United Healthcare-Commercial,4356.0 +137593,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,United Healthcare-Commercial,4356.0 +137594,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,United Healthcare-Commercial, +137595,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,United Healthcare-Commercial,3267.0 +137596,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,United Healthcare-Commercial,4356.0 +137597,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,United Healthcare-Commercial,4356.0 +137598,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,United Healthcare-Commercial,3087.0 +137599,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,United Healthcare-Commercial, +137600,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,United Healthcare-Commercial, +137601,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,United Healthcare-Commercial, +137602,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,United Healthcare-Commercial,4176.0 +137603,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,United Healthcare-Commercial, +137604,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,United Healthcare-Commercial, +137605,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,United Healthcare-Commercial, +137606,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,United Healthcare-Commercial,2062.0 +137607,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,United Healthcare-Commercial, +137608,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,United Healthcare-Commercial,4356.0 +137609,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,United Healthcare-Commercial, +137610,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,United Healthcare-Commercial, +137611,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,United Healthcare-Commercial,125.0 +137612,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,United Healthcare-Commercial, +137613,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,United Healthcare-Commercial,4176.0 +137614,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,United Healthcare-Commercial, +137615,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,United Healthcare-Commercial,2650.21 +137616,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,United Healthcare-Commercial, +137617,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,United Healthcare-Commercial, +137618,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,United Healthcare-Commercial, +137619,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,United Healthcare-Commercial, +137620,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,United Healthcare-Commercial, +137621,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,United Healthcare-Commercial, +137622,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,United Healthcare-Commercial, +137623,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,United Healthcare-Commercial, +137624,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,United Healthcare-Commercial, +137625,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,United Healthcare-Commercial, +137626,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,United Healthcare-Commercial, +137627,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,United Healthcare-Commercial,1733.18 +137628,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,United Healthcare-Commercial, +137629,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,United Healthcare-Commercial,4356.0 +137630,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,United Healthcare-Commercial, +137631,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,United Healthcare-Commercial,1410.35 +137632,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,United Healthcare-Commercial, +137633,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,United Healthcare-Commercial, +137634,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,United Healthcare-Commercial, +137635,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,United Healthcare-Commercial,6534.0 +137636,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,United Healthcare-Commercial, +137637,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,United Healthcare-Commercial, +137638,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,United Healthcare-Commercial, +137639,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,United Healthcare-Commercial, +137640,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,United Healthcare-Commercial, +137641,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,United Healthcare-Commercial, +137642,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,United Healthcare-Commercial, +137643,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,United Healthcare-Commercial, +137644,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,United Healthcare-Commercial, +137645,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,United Healthcare-Commercial, +137646,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,United Healthcare-Commercial, +137647,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,United Healthcare-Commercial, +137648,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,United Healthcare-Commercial, +137649,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,United Healthcare-Commercial,1798.0 +137650,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,United Healthcare-Commercial, +137651,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,United Healthcare-Commercial,3596.0 +137652,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,United Healthcare-Commercial,3996.0 +137653,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,United Healthcare-Commercial, +137654,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,United Healthcare-Commercial,106.35 +137655,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,United Healthcare-Commercial, +137656,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,United Healthcare-Commercial, +137657,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,United Healthcare-Commercial, +137658,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,United Healthcare-Commercial,4176.0 +137659,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,United Healthcare-Commercial,4403.06 +137660,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,United Healthcare-Commercial, +137661,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,United Healthcare-Commercial,1089.0 +137662,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,United Healthcare-Commercial,1089.0 +137663,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,United Healthcare-Commercial,1089.0 +137664,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,United Healthcare-Commercial, +137665,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,United Healthcare-Commercial, +137666,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,United Healthcare-Commercial,4356.0 +137667,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,United Healthcare-Commercial, +137668,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,United Healthcare-Commercial, +137669,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,United Healthcare-Commercial,2178.0 +137670,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,United Healthcare-Commercial, +137671,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,United Healthcare-Commercial, +137672,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,United Healthcare-Commercial, +137673,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,United Healthcare-Commercial, +137674,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,United Healthcare-Commercial, +137675,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,United Healthcare-Commercial, +137676,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,United Healthcare-Commercial,4356.0 +137677,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,United Healthcare-Commercial,3558.07 +137678,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,United Healthcare-Commercial, +137679,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,United Healthcare-Commercial, +137680,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,United Healthcare-Commercial, +137681,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,United Healthcare-Commercial, +137682,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,United Healthcare-Commercial,4358.75 +137683,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,United Healthcare-Commercial,1570.5 +137684,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,United Healthcare-Commercial, +137685,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,United Healthcare-Commercial, +137686,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,United Healthcare-Commercial, +137687,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,United Healthcare-Commercial, +137688,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,United Healthcare-Commercial, +137689,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,United Healthcare-Commercial, +137690,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,United Healthcare-Commercial, +137691,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,United Healthcare-Commercial, +137692,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,United Healthcare-Commercial, +137693,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,United Healthcare-Commercial, +137694,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,United Healthcare-Commercial, +137695,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,United Healthcare-Commercial,12420.23 +137696,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,United Healthcare-Commercial, +137697,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,United Healthcare-Commercial, +137698,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,United Healthcare-Commercial, +137699,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,United Healthcare-Commercial, +137700,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,United Healthcare-Commercial, +137701,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,United Healthcare-Commercial, +137702,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,United Healthcare-Commercial, +137703,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,United Healthcare-Commercial, +137704,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,United Healthcare-Commercial, +137705,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,United Healthcare-Commercial, +137706,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,United Healthcare-Commercial, +137707,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,United Healthcare-Commercial, +137708,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,United Healthcare-Commercial, +137709,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,United Healthcare-Commercial, +137710,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,United Healthcare-Commercial, +137711,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,United Healthcare-Commercial, +137712,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,United Healthcare-Commercial,39110.42 +137713,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,United Healthcare-Commercial, +137714,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,United Healthcare-Commercial, +137715,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,United Healthcare-Commercial,25468.0 +137716,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,United Healthcare-Commercial,39110.42 +137717,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,United Healthcare-Commercial, +137718,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,United Healthcare-Commercial, +137719,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,United Healthcare-Commercial,9571.39 +137720,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,United Healthcare-Commercial,3584.35 +137721,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,United Healthcare-Commercial, +137722,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,United Healthcare-Commercial, +137723,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,United Healthcare-Commercial, +137724,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,United Healthcare-Commercial,3996.0 +137725,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,United Healthcare-Commercial,1998.0 +137726,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,United Healthcare-Commercial, +137727,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,United Healthcare-Commercial, +137728,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,United Healthcare-Commercial,4356.0 +137729,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,United Healthcare-Commercial, +137730,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,United Healthcare-Commercial, +137731,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,United Healthcare-Commercial, +137732,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,United Healthcare-Commercial, +137733,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,United Healthcare-Commercial,2417.0 +137734,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,United Healthcare-Commercial, +137735,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,United Healthcare-Commercial, +137736,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,United Healthcare-Commercial, +137737,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,United Healthcare-Commercial, +137738,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,United Healthcare-Commercial, +137739,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,United Healthcare-Commercial, +137740,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,United Healthcare-Commercial, +137741,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,United Healthcare-Commercial, +137742,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,United Healthcare-Commercial, +137743,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,United Healthcare-Commercial, +137744,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,United Healthcare-Commercial, +137745,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,United Healthcare-Commercial,5568.28 +137746,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,United Healthcare-Commercial,5568.28 +137747,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,United Healthcare-Commercial, +137748,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,United Healthcare-Commercial,1798.0 +137749,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,United Healthcare-Commercial,2178.0 +137750,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,United Healthcare-Commercial, +137751,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,United Healthcare-Commercial, +137752,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,United Healthcare-Commercial,3996.0 +137753,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,United Healthcare-Commercial, +137754,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,United Healthcare-Commercial,3596.0 +137755,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,United Healthcare-Commercial, +137756,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,United Healthcare-Commercial, +137757,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,United Healthcare-Commercial,34.42 +137758,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,United Healthcare-Commercial,127.93 +137759,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,United Healthcare-Commercial, +137760,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,United Healthcare-Commercial,2391.4 +137761,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,United Healthcare-Commercial, +137762,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,United Healthcare-Commercial, +137763,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,United Healthcare-Commercial, +137764,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,United Healthcare-Commercial, +137765,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,United Healthcare-Commercial,6443.25 +137766,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,United Healthcare-Commercial, +137767,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,United Healthcare-Commercial, +137768,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,United Healthcare-Commercial, +137769,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,United Healthcare-Commercial, +137770,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,United Healthcare-Commercial,4141.59 +137771,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,United Healthcare-Commercial,1646.51 +137772,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,United Healthcare-Commercial, +137773,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,United Healthcare-Commercial,4176.0 +137774,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,United Healthcare-Commercial, +137775,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,United Healthcare-Commercial,3469.65 +137776,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,United Healthcare-Commercial, +137777,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,United Healthcare-Commercial, +137778,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,United Healthcare-Commercial,2417.0 +137779,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,United Healthcare-Commercial,3676.5 +137780,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,United Healthcare-Commercial,868.05 +137781,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,United Healthcare-Commercial,418.83 +137782,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,United Healthcare-Commercial, +137783,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,United Healthcare-Commercial, +137784,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,United Healthcare-Commercial, +137785,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,United Healthcare-Commercial,1264.05 +137786,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,United Healthcare-Commercial,144.27 +137787,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,United Healthcare-Commercial, +137788,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,United Healthcare-Commercial, +137789,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,United Healthcare-Commercial,3996.0 +137790,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,United Healthcare-Commercial, +137791,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,United Healthcare-Commercial, +137792,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,United Healthcare-Commercial,5255.68 +137793,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,United Healthcare-Commercial, +137794,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,United Healthcare-Commercial, +137795,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,United Healthcare-Commercial, +137796,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,United Healthcare-Commercial, +137797,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,United Healthcare-Commercial, +137798,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,United Healthcare-Commercial, +137799,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,United Healthcare-Commercial, +137800,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,United Healthcare-Commercial, +137801,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,United Healthcare-Commercial, +137802,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,United Healthcare-Commercial, +137803,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,United Healthcare-Commercial, +137804,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,United Healthcare-Commercial, +137805,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,United Healthcare-Commercial,2478.21 +137806,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,United Healthcare-Commercial, +137807,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,United Healthcare-Commercial, +137808,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,United Healthcare-Commercial, +137809,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,United Healthcare-Commercial, +137810,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,United Healthcare-Commercial, +137811,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,United Healthcare-Commercial, +137812,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,United Healthcare-Commercial, +137813,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,United Healthcare-Commercial, +137814,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,United Healthcare-Commercial,4599.0 +137815,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,United Healthcare-Commercial, +137816,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,United Healthcare-Commercial, +137817,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,United Healthcare-Commercial, +137818,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,United Healthcare-Commercial, +137819,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,United Healthcare-Commercial, +137820,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,United Healthcare-Commercial, +137821,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,United Healthcare-Commercial, +137822,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,United Healthcare-Commercial, +137823,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,United Healthcare-Commercial,4356.0 +137824,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,United Healthcare-Commercial, +137825,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,United Healthcare-Commercial, +137826,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,United Healthcare-Commercial,2964.84 +137827,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,United Healthcare-Commercial, +137828,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,United Healthcare-Commercial, +137829,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,United Healthcare-Commercial, +137830,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,United Healthcare-Commercial,1798.0 +137831,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,United Healthcare-Commercial, +137832,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,United Healthcare-Commercial,3596.0 +137833,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,United Healthcare-Commercial, +137834,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,United Healthcare-Commercial, +137835,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,United Healthcare-Commercial, +137836,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,United Healthcare-Commercial, +137837,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,United Healthcare-Commercial, +137838,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,United Healthcare-Commercial, +137839,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,United Healthcare-Commercial, +137840,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,United Healthcare-Commercial,1647.51 +137841,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,United Healthcare-Commercial, +137842,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,United Healthcare-Commercial,4002.28 +137843,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,United Healthcare-Commercial,4270.88 +137844,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,United Healthcare-Commercial,2846.64 +137845,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,United Healthcare-Commercial, +137846,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,United Healthcare-Commercial,6479.91 +137847,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,United Healthcare-Commercial, +137848,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,United Healthcare-Commercial, +137849,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,United Healthcare-Commercial,10192.48 +137850,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,United Healthcare-Commercial,12402.0 +137851,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,United Healthcare-Commercial, +137852,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,United Healthcare-Commercial,13518.0 +137853,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,United Healthcare-Commercial, +137854,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,United Healthcare-Commercial, +137855,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,United Healthcare-Commercial, +137856,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,United Healthcare-Commercial, +137857,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,United Healthcare-Commercial,1798.0 +137858,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,United Healthcare-Commercial,3996.0 +137859,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,United Healthcare-Commercial, +137860,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,United Healthcare-Commercial, +137861,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,United Healthcare-Commercial, +137862,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,United Healthcare-Commercial, +137863,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,United Healthcare-Commercial, +137864,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,United Healthcare-Commercial, +137865,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,United Healthcare-Commercial, +137866,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,United Healthcare-Commercial, +137867,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,United Healthcare-Commercial, +137868,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,United Healthcare-Commercial, +137869,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,United Healthcare-Commercial, +137870,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,United Healthcare-Commercial, +137871,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,United Healthcare-Commercial, +137872,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,United Healthcare-Commercial, +137873,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,United Healthcare-Commercial,4356.0 +137874,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,United Healthcare-Commercial, +137875,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,United Healthcare-Commercial, +137876,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,United Healthcare-Commercial, +137877,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,United Healthcare-Commercial, +137878,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,United Healthcare-Commercial,2178.0 +137879,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,United Healthcare-Commercial, +137880,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,United Healthcare-Commercial, +137881,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,United Healthcare-Commercial, +137882,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,United Healthcare-Commercial, +137883,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,United Healthcare-Commercial, +137884,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,United Healthcare-Commercial,958.0 +137885,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,United Healthcare-Commercial, +137886,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,United Healthcare-Commercial, +137887,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,United Healthcare-Commercial,4356.0 +137888,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,United Healthcare-Commercial, +137889,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,United Healthcare-Commercial, +137890,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,United Healthcare-Commercial, +137891,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,United Healthcare-Commercial, +137892,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,United Healthcare-Commercial, +137893,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,United Healthcare-Commercial, +137894,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,United Healthcare-Commercial, +137895,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,United Healthcare-Commercial, +137896,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,United Healthcare-Commercial,3996.0 +137897,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,United Healthcare-Commercial, +137898,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,United Healthcare-Commercial, +137899,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,United Healthcare-Commercial, +137900,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,United Healthcare-Commercial, +137901,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,United Healthcare-Commercial,5876.42 +137902,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,United Healthcare-Commercial, +137903,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,United Healthcare-Commercial,1994.93 +137904,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,United Healthcare-Commercial, +137905,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,United Healthcare-Commercial, +137906,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,United Healthcare-Commercial,1998.0 +137907,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,United Healthcare-Commercial,31.0 +137908,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,United Healthcare-Commercial, +137909,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,United Healthcare-Commercial, +137910,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,United Healthcare-Commercial, +137911,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,United Healthcare-Commercial, +137912,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,United Healthcare-Commercial, +137913,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,United Healthcare-Commercial,1724.49 +137914,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,United Healthcare-Commercial, +137915,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,United Healthcare-Commercial, +137916,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,United Healthcare-Commercial,4176.0 +137917,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,United Healthcare-Commercial, +137918,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,United Healthcare-Commercial, +137919,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,United Healthcare-Commercial, +137920,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,United Healthcare-Commercial, +137921,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,United Healthcare-Commercial,4356.0 +137922,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,United Healthcare-Commercial, +137923,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,United Healthcare-Commercial,1886.79 +137924,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,United Healthcare-Commercial, +137925,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,United Healthcare-Commercial,3684.36 +137926,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,United Healthcare-Commercial, +137927,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,United Healthcare-Commercial, +137928,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,United Healthcare-Commercial, +137929,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,United Healthcare-Commercial, +137930,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,United Healthcare-Commercial, +137931,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,United Healthcare-Commercial,3176.77 +137932,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,United Healthcare-Commercial, +137933,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,United Healthcare-Commercial, +137934,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,United Healthcare-Commercial, +137935,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,United Healthcare-Commercial,3066.61 +137936,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,United Healthcare-Commercial, +137937,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,United Healthcare-Commercial,3996.0 +137938,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,United Healthcare-Commercial,975.42 +137939,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,United Healthcare-Commercial, +137940,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,United Healthcare-Commercial,6536.02 +137941,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,United Healthcare-Commercial,2178.0 +137942,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,United Healthcare-Commercial, +137943,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,United Healthcare-Commercial, +137944,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,United Healthcare-Commercial,2178.0 +137945,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,United Healthcare-Commercial, +137946,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,United Healthcare-Commercial,1998.0 +137947,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,United Healthcare-Commercial, +137948,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,United Healthcare-Commercial,4356.0 +137949,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,United Healthcare-Commercial, +137950,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,United Healthcare-Commercial, +137951,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,United Healthcare-Commercial,1998.0 +137952,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,United Healthcare-Commercial,3996.0 +137953,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,United Healthcare-Commercial, +137954,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,United Healthcare-Commercial, +137955,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,United Healthcare-Commercial,3996.0 +137956,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,United Healthcare-Commercial,5791.98 +137957,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,United Healthcare-Commercial,1998.0 +137958,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,United Healthcare-Commercial, +137959,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,United Healthcare-Commercial, +137960,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,United Healthcare-Commercial, +137961,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,United Healthcare-Commercial, +137962,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,United Healthcare-Commercial, +137963,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,United Healthcare-Commercial, +137964,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,United Healthcare-Commercial, +137965,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,United Healthcare-Commercial, +137966,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,United Healthcare-Commercial,4356.0 +137967,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,United Healthcare-Commercial, +137968,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,United Healthcare-Commercial, +137969,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,United Healthcare-Commercial, +137970,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,United Healthcare-Commercial, +137971,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,United Healthcare-Commercial, +137972,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,United Healthcare-Commercial, +137973,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,United Healthcare-Commercial, +137974,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,United Healthcare-Commercial, +137975,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,United Healthcare-Commercial,9012.0 +137976,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,United Healthcare-Commercial,4356.0 +137977,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,United Healthcare-Commercial, +137978,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,United Healthcare-Commercial, +137979,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,United Healthcare-Commercial, +137980,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,United Healthcare-Commercial,9012.0 +137981,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,United Healthcare-Commercial, +137982,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,United Healthcare-Commercial, +137983,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,United Healthcare-Commercial, +137984,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,United Healthcare-Commercial, +137985,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,United Healthcare-Commercial,3996.0 +137986,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,United Healthcare-Commercial, +137987,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,United Healthcare-Commercial,975.42 +137988,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,United Healthcare-Commercial, +137989,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,United Healthcare-Commercial, +137990,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,United Healthcare-Commercial, +137991,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,United Healthcare-Commercial, +137992,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,United Healthcare-Commercial, +137993,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,United Healthcare-Commercial, +137994,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,United Healthcare-Commercial, +137995,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,United Healthcare-Commercial, +137996,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,United Healthcare-Commercial, +137997,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,United Healthcare-Commercial, +137998,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,United Healthcare-Commercial, +137999,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,United Healthcare-Commercial, +138000,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,United Healthcare-Commercial, +138001,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,United Healthcare-Commercial,9012.0 +138002,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,United Healthcare-Commercial, +138003,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,United Healthcare-Commercial, +138004,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,United Healthcare-Commercial, +138005,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,United Healthcare-Commercial, +138006,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,United Healthcare-Commercial,2178.0 +138007,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,United Healthcare-Commercial, +138008,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,United Healthcare-Commercial,1950.0 +138009,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,United Healthcare-Commercial, +138010,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,United Healthcare-Commercial, +138011,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,United Healthcare-Commercial, +138012,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,United Healthcare-Commercial,1214.22 +138013,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,United Healthcare-Commercial,946.23 +138014,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,United Healthcare-Commercial, +138015,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,United Healthcare-Commercial,2178.0 +138016,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,United Healthcare-Commercial, +138017,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,United Healthcare-Commercial, +138018,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,United Healthcare-Commercial,4356.0 +138019,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,United Healthcare-Commercial,4393.05 +138020,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,United Healthcare-Commercial, +138021,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,United Healthcare-Commercial,3996.0 +138022,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,United Healthcare-Commercial,4986.0 +138023,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,United Healthcare-Commercial, +138024,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,United Healthcare-Commercial, +138025,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,United Healthcare-Commercial,4356.0 +138026,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,United Healthcare-Commercial, +138027,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,United Healthcare-Commercial, +138028,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,United Healthcare-Commercial, +138029,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,United Healthcare-Commercial,3697.88 +138030,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,United Healthcare-Commercial, +138031,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,United Healthcare-Commercial, +138032,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,United Healthcare-Commercial, +138033,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,United Healthcare-Commercial, +138034,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,United Healthcare-Commercial, +138035,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,United Healthcare-Commercial, +138036,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,United Healthcare-Commercial, +138037,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,United Healthcare-Commercial, +138038,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,United Healthcare-Commercial, +138039,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,United Healthcare-Commercial, +138040,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,United Healthcare-Commercial, +138041,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,United Healthcare-Commercial,1217.48 +138042,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,United Healthcare-Commercial, +138043,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,United Healthcare-Commercial, +138044,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,United Healthcare-Commercial, +138045,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,United Healthcare-Commercial, +138046,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,United Healthcare-Commercial, +138047,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,United Healthcare-Commercial, +138048,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,United Healthcare-Commercial, +138049,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,United Healthcare-Commercial,1822.3 +138050,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,United Healthcare-Commercial, +138051,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,United Healthcare-Commercial, +138052,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,United Healthcare-Commercial, +138053,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,United Healthcare-Commercial,1822.3 +138054,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,United Healthcare-Commercial,1753.1 +138055,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,United Healthcare-Commercial,1753.1 +138056,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,United Healthcare-Commercial,1753.1 +138057,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,United Healthcare-Commercial, +138058,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,United Healthcare-Commercial, +138059,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,United Healthcare-Commercial, +138060,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,United Healthcare-Commercial, +138061,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,United Healthcare-Commercial, +138062,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,United Healthcare-Commercial, +138063,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,United Healthcare-Commercial, +138064,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,United Healthcare-Commercial, +138065,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,United Healthcare-Commercial,650.88 +138066,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,United Healthcare-Commercial, +138067,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,United Healthcare-Commercial, +138068,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,United Healthcare-Commercial, +138069,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,United Healthcare-Commercial, +138070,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,United Healthcare-Commercial,1225.23 +138071,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,United Healthcare-Commercial, +138072,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,United Healthcare-Commercial,2980.04 +138073,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,United Healthcare-Commercial, +138074,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,United Healthcare-Commercial,494.09 +138075,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,United Healthcare-Commercial, +138076,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,United Healthcare-Commercial,1216.09 +138077,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,United Healthcare-Commercial,5925.47 +138078,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,United Healthcare-Commercial,4352.74 +138079,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,United Healthcare-Commercial, +138080,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,United Healthcare-Commercial, +138081,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,United Healthcare-Commercial, +138082,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,United Healthcare-Commercial, +138083,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,United Healthcare-Commercial,718.64 +138084,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,United Healthcare-Commercial,952.14 +138085,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,United Healthcare-Commercial, +138086,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,United Healthcare-Commercial, +138087,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,United Healthcare-Commercial, +138088,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,United Healthcare-Commercial, +138089,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,United Healthcare-Commercial,5856.04 +138090,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,United Healthcare-Commercial, +138091,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,United Healthcare-Commercial, +138092,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,United Healthcare-Commercial, +138093,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,United Healthcare-Commercial,5856.04 +138094,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,United Healthcare-Commercial, +138095,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,United Healthcare-Commercial, +138096,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,United Healthcare-Commercial,815.89 +138097,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,United Healthcare-Commercial, +138098,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,United Healthcare-Commercial, +138099,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,United Healthcare-Commercial, +138100,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,United Healthcare-Commercial, +138101,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,United Healthcare-Commercial,610.54 +138102,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,United Healthcare-Commercial,529.92 +138103,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,United Healthcare-Commercial,651.6 +138104,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,United Healthcare-Commercial, +138105,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,United Healthcare-Commercial, +138106,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,United Healthcare-Commercial,651.6 +138107,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,United Healthcare-Commercial,388.16 +138108,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,United Healthcare-Commercial, +138109,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,United Healthcare-Commercial, +138110,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,United Healthcare-Commercial,2295.45 +138111,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,United Healthcare-Commercial,3766.97 +138112,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,United Healthcare-Commercial,2295.45 +138113,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,United Healthcare-Commercial,2295.45 +138114,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,United Healthcare-Commercial, +138115,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,United Healthcare-Commercial, +138116,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,United Healthcare-Commercial,2295.45 +138117,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,United Healthcare-Commercial,2295.45 +138118,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,United Healthcare-Commercial, +138119,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,United Healthcare-Commercial, +138120,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,United Healthcare-Commercial, +138121,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,United Healthcare-Commercial, +138122,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,United Healthcare-Commercial,2295.45 +138123,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,United Healthcare-Commercial,2295.45 +138124,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,United Healthcare-Commercial,2295.45 +138125,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,United Healthcare-Commercial, +138126,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,United Healthcare-Commercial,2946.33 +138127,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,United Healthcare-Commercial,5856.04 +138128,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,United Healthcare-Commercial,5519.06 +138129,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,United Healthcare-Commercial, +138130,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,United Healthcare-Commercial,10192.48 +138131,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,United Healthcare-Commercial, +138132,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,United Healthcare-Commercial,2804.2 +138133,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,United Healthcare-Commercial, +138134,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,United Healthcare-Commercial, +138135,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,United Healthcare-Commercial, +138136,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,United Healthcare-Commercial,1286.21 +138137,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,United Healthcare-Commercial,2146.23 +138138,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,United Healthcare-Commercial, +138139,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,United Healthcare-Commercial, +138140,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,United Healthcare-Commercial, +138141,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,United Healthcare-Commercial,569.45 +138142,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,United Healthcare-Commercial,2146.23 +138143,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,United Healthcare-Commercial, +138144,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,United Healthcare-Commercial, +138145,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,United Healthcare-Commercial,2146.23 +138146,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,United Healthcare-Commercial, +138147,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,United Healthcare-Commercial, +138148,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,United Healthcare-Commercial, +138149,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,United Healthcare-Commercial, +138150,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,United Healthcare-Commercial, +138151,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,United Healthcare-Commercial,3602.21 +138152,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,United Healthcare-Commercial, +138153,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,United Healthcare-Commercial, +138154,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,United Healthcare-Commercial, +138155,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,United Healthcare-Commercial, +138156,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,United Healthcare-Commercial, +138157,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,United Healthcare-Commercial, +138158,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,United Healthcare-Commercial, +138159,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,United Healthcare-Commercial, +138160,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,United Healthcare-Commercial, +138161,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,United Healthcare-Commercial, +138162,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,United Healthcare-Commercial, +138163,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,United Healthcare-Commercial,452.13 +138164,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,United Healthcare-Commercial,477.52 +138165,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,United Healthcare-Commercial, +138166,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,United Healthcare-Commercial, +138167,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,United Healthcare-Commercial, +138168,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,United Healthcare-Commercial, +138169,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,United Healthcare-Commercial,569.45 +138170,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,United Healthcare-Commercial,674.24 +138171,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,United Healthcare-Commercial,634.59 +138172,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,United Healthcare-Commercial, +138173,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,United Healthcare-Commercial, +138174,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,United Healthcare-Commercial,460.61 +138175,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,United Healthcare-Commercial,392.0 +138176,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,United Healthcare-Commercial,65.17 +138177,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,United Healthcare-Commercial, +138178,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,United Healthcare-Commercial,1846.24 +138179,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,United Healthcare-Commercial, +138180,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,United Healthcare-Commercial,1461.8 +138181,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,United Healthcare-Commercial,2099.48 +138182,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,United Healthcare-Commercial, +138183,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,United Healthcare-Commercial,1846.24 +138184,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,United Healthcare-Commercial, +138185,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,United Healthcare-Commercial,1077.36 +138186,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,United Healthcare-Commercial,5126.61 +138187,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,United Healthcare-Commercial,2036.09 +138188,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,United Healthcare-Commercial, +138189,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,United Healthcare-Commercial, +138190,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,United Healthcare-Commercial,158.4 +138191,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,United Healthcare-Commercial, +138192,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,United Healthcare-Commercial, +138193,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,United Healthcare-Commercial, +138194,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,United Healthcare-Commercial, +138195,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,United Healthcare-Commercial,2146.23 +138196,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,United Healthcare-Commercial, +138197,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,United Healthcare-Commercial,2225.94 +138198,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,United Healthcare-Commercial, +138199,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,United Healthcare-Commercial, +138200,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,United Healthcare-Commercial, +138201,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,United Healthcare-Commercial,3602.21 +138202,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,United Healthcare-Commercial, +138203,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,United Healthcare-Commercial, +138204,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,United Healthcare-Commercial, +138205,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,United Healthcare-Commercial,2225.94 +138206,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,United Healthcare-Commercial,3656.96 +138207,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,United Healthcare-Commercial, +138208,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,United Healthcare-Commercial, +138209,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,United Healthcare-Commercial,5168.41 +138210,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,United Healthcare-Commercial, +138211,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,United Healthcare-Commercial,2990.7 +138212,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,United Healthcare-Commercial,3729.94 +138213,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,United Healthcare-Commercial,5126.61 +138214,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,United Healthcare-Commercial, +138215,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,United Healthcare-Commercial,5126.61 +138216,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,United Healthcare-Commercial, +138217,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,United Healthcare-Commercial, +138218,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,United Healthcare-Commercial, +138219,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,United Healthcare-Commercial, +138220,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,United Healthcare-Commercial, +138221,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,United Healthcare-Commercial,1186.77 +138222,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,United Healthcare-Commercial,1186.77 +138223,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,United Healthcare-Commercial,417.76 +138224,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,United Healthcare-Commercial, +138225,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,United Healthcare-Commercial, +138226,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,United Healthcare-Commercial, +138227,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,United Healthcare-Commercial, +138228,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,United Healthcare-Commercial,1125.28 +138229,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,United Healthcare-Commercial,1194.48 +138230,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,United Healthcare-Commercial, +138231,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,United Healthcare-Commercial, +138232,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,United Healthcare-Commercial, +138233,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,United Healthcare-Commercial, +138234,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,United Healthcare-Commercial, +138235,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,United Healthcare-Commercial,1218.21 +138236,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,United Healthcare-Commercial,1125.28 +138237,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,United Healthcare-Commercial,1380.83 +138238,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,United Healthcare-Commercial,452.13 +138239,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,United Healthcare-Commercial, +138240,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,United Healthcare-Commercial,1125.28 +138241,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,United Healthcare-Commercial, +138242,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,United Healthcare-Commercial,1173.35 +138243,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,United Healthcare-Commercial,1173.35 +138244,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,United Healthcare-Commercial,1125.28 +138245,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,United Healthcare-Commercial, +138246,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,United Healthcare-Commercial, +138247,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,United Healthcare-Commercial,1125.28 +138248,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,United Healthcare-Commercial, +138249,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,United Healthcare-Commercial, +138250,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,United Healthcare-Commercial,5759.82 +138251,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,United Healthcare-Commercial, +138252,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,United Healthcare-Commercial, +138253,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,United Healthcare-Commercial, +138254,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,United Healthcare-Commercial, +138255,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,United Healthcare-Commercial, +138256,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,United Healthcare-Commercial, +138257,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,United Healthcare-Commercial, +138258,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,United Healthcare-Commercial, +138259,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,United Healthcare-Commercial, +138260,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,United Healthcare-Commercial,1661.04 +138261,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,United Healthcare-Commercial, +138262,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,United Healthcare-Commercial,1677.08 +138263,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,United Healthcare-Commercial, +138264,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,United Healthcare-Commercial, +138265,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,United Healthcare-Commercial, +138266,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,United Healthcare-Commercial, +138267,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,United Healthcare-Commercial,1572.79 +138268,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,United Healthcare-Commercial,2295.45 +138269,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,United Healthcare-Commercial, +138270,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,United Healthcare-Commercial, +138271,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,United Healthcare-Commercial, +138272,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,United Healthcare-Commercial, +138273,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,United Healthcare-Commercial, +138274,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,United Healthcare-Commercial,1503.59 +138275,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,United Healthcare-Commercial, +138276,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,United Healthcare-Commercial, +138277,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,United Healthcare-Commercial, +138278,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,United Healthcare-Commercial,2467.1 +138279,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,United Healthcare-Commercial, +138280,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,United Healthcare-Commercial, +138281,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,United Healthcare-Commercial,2733.97 +138282,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,United Healthcare-Commercial, +138283,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,United Healthcare-Commercial,755.98 +138284,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,United Healthcare-Commercial,1572.79 +138285,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,United Healthcare-Commercial,158.71 +138286,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,United Healthcare-Commercial,377.25 +138287,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,United Healthcare-Commercial,1498.27 +138288,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,United Healthcare-Commercial,1567.47 +138289,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,United Healthcare-Commercial,325.0 +138290,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,United Healthcare-Commercial, +138291,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,United Healthcare-Commercial,787.77 +138292,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,United Healthcare-Commercial, +138293,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,United Healthcare-Commercial,2146.84 +138294,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,United Healthcare-Commercial, +138295,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,United Healthcare-Commercial, +138296,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,United Healthcare-Commercial, +138297,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,United Healthcare-Commercial, +138298,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,United Healthcare-Commercial, +138299,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,United Healthcare-Commercial, +138300,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,United Healthcare-Commercial, +138301,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,United Healthcare-Commercial, +138302,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,United Healthcare-Commercial, +138303,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,United Healthcare-Commercial, +138304,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,United Healthcare-Commercial, +138305,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,United Healthcare-Commercial, +138306,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,United Healthcare-Commercial,917.31 +138307,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,United Healthcare-Commercial, +138308,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,United Healthcare-Commercial, +138309,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,United Healthcare-Commercial, +138310,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,United Healthcare-Commercial, +138311,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,United Healthcare-Commercial, +138312,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,United Healthcare-Commercial, +138313,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,United Healthcare-Commercial, +138314,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,United Healthcare-Commercial, +138315,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,United Healthcare-Commercial, +138316,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,United Healthcare-Commercial, +138317,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,United Healthcare-Commercial,1186.77 +138318,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,United Healthcare-Commercial,4954.63 +138319,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,United Healthcare-Commercial, +138320,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,United Healthcare-Commercial, +138321,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,United Healthcare-Commercial, +138322,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,United Healthcare-Commercial, +138323,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,United Healthcare-Commercial, +138324,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,United Healthcare-Commercial,636.26 +138325,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,United Healthcare-Commercial,609.52 +138326,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,United Healthcare-Commercial, +138327,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,United Healthcare-Commercial, +138328,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,United Healthcare-Commercial,256.12 +138329,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,United Healthcare-Commercial, +138330,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,United Healthcare-Commercial, +138331,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,United Healthcare-Commercial,639.45 +138332,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,United Healthcare-Commercial, +138333,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,United Healthcare-Commercial, +138334,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,United Healthcare-Commercial,1606.41 +138335,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,United Healthcare-Commercial,1746.36 +138336,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,United Healthcare-Commercial,636.26 +138337,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,United Healthcare-Commercial, +138338,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,United Healthcare-Commercial, +138339,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,United Healthcare-Commercial, +138340,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,United Healthcare-Commercial, +138341,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,United Healthcare-Commercial, +138342,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,United Healthcare-Commercial, +138343,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,United Healthcare-Commercial, +138344,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,United Healthcare-Commercial,232.4 +138345,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,United Healthcare-Commercial,259.11 +138346,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,United Healthcare-Commercial, +138347,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,United Healthcare-Commercial,745.35 +138348,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,United Healthcare-Commercial, +138349,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,United Healthcare-Commercial, +138350,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,United Healthcare-Commercial, +138351,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,United Healthcare-Commercial, +138352,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,United Healthcare-Commercial, +138353,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,United Healthcare-Commercial, +138354,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,United Healthcare-Commercial, +138355,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,United Healthcare-Commercial, +138356,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,United Healthcare-Commercial,2604.12 +138357,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,United Healthcare-Commercial, +138358,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,United Healthcare-Commercial,2010.73 +138359,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,United Healthcare-Commercial, +138360,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,United Healthcare-Commercial, +138361,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,United Healthcare-Commercial,1088.02 +138362,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,United Healthcare-Commercial, +138363,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,United Healthcare-Commercial,1675.61 +138364,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,United Healthcare-Commercial, +138365,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,United Healthcare-Commercial,2706.6 +138366,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,United Healthcare-Commercial, +138367,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,United Healthcare-Commercial, +138368,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,United Healthcare-Commercial, +138369,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,United Healthcare-Commercial,2804.2 +138370,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,United Healthcare-Commercial,1934.91 +138371,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,United Healthcare-Commercial,2804.2 +138372,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,United Healthcare-Commercial, +138373,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,United Healthcare-Commercial, +138374,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,United Healthcare-Commercial,2048.7 +138375,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,United Healthcare-Commercial, +138376,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,United Healthcare-Commercial, +138377,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,United Healthcare-Commercial, +138378,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,United Healthcare-Commercial, +138379,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,United Healthcare-Commercial,557.13 +138380,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,United Healthcare-Commercial,2573.27 +138381,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,United Healthcare-Commercial,1266.21 +138382,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,United Healthcare-Commercial,925.36 +138383,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,United Healthcare-Commercial,1140.69 +138384,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,United Healthcare-Commercial,1290.3 +138385,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,United Healthcare-Commercial, +138386,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,United Healthcare-Commercial,2296.07 +138387,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,United Healthcare-Commercial,262.52 +138388,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,United Healthcare-Commercial, +138389,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,United Healthcare-Commercial, +138390,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,United Healthcare-Commercial, +138391,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,United Healthcare-Commercial, +138392,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,United Healthcare-Commercial,957.27 +138393,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,United Healthcare-Commercial,996.13 +138394,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,United Healthcare-Commercial,1010.15 +138395,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,United Healthcare-Commercial,926.93 +138396,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,United Healthcare-Commercial,926.93 +138397,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,United Healthcare-Commercial,926.93 +138398,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,United Healthcare-Commercial, +138399,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,United Healthcare-Commercial,1906.41 +138400,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,United Healthcare-Commercial,1215.78 +138401,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,United Healthcare-Commercial,1192.12 +138402,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,United Healthcare-Commercial, +138403,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,United Healthcare-Commercial,3324.79 +138404,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,United Healthcare-Commercial,3454.01 +138405,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,United Healthcare-Commercial, +138406,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,United Healthcare-Commercial,3360.33 +138407,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,United Healthcare-Commercial, +138408,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,United Healthcare-Commercial,3373.1 +138409,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,United Healthcare-Commercial, +138410,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,United Healthcare-Commercial, +138411,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,United Healthcare-Commercial,529.39 +138412,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,United Healthcare-Commercial, +138413,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,United Healthcare-Commercial, +138414,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,United Healthcare-Commercial, +138415,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,United Healthcare-Commercial, +138416,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,United Healthcare-Commercial, +138417,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,United Healthcare-Commercial, +138418,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,United Healthcare-Commercial, +138419,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,United Healthcare-Commercial, +138420,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,United Healthcare-Commercial, +138421,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,United Healthcare-Commercial,757.25 +138422,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,United Healthcare-Commercial, +138423,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,United Healthcare-Commercial,627.49 +138424,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,United Healthcare-Commercial,610.54 +138425,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,United Healthcare-Commercial, +138426,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,United Healthcare-Commercial,707.22 +138427,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,United Healthcare-Commercial, +138428,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,United Healthcare-Commercial,707.22 +138429,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,United Healthcare-Commercial,707.22 +138430,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,United Healthcare-Commercial, +138431,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,United Healthcare-Commercial, +138432,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,United Healthcare-Commercial, +138433,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,United Healthcare-Commercial, +138434,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,United Healthcare-Commercial, +138435,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,United Healthcare-Commercial, +138436,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,United Healthcare-Commercial, +138437,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,United Healthcare-Commercial, +138438,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,United Healthcare-Commercial,3560.08 +138439,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,United Healthcare-Commercial, +138440,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,United Healthcare-Commercial,3560.08 +138441,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,United Healthcare-Commercial, +138442,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,United Healthcare-Commercial, +138443,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,United Healthcare-Commercial, +138444,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,United Healthcare-Commercial,2378.75 +138445,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,United Healthcare-Commercial, +138446,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,United Healthcare-Commercial,18162.96 +138447,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,United Healthcare-Commercial, +138448,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,United Healthcare-Commercial,529.39 +138449,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,United Healthcare-Commercial, +138450,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,United Healthcare-Commercial, +138451,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,United Healthcare-Commercial, +138452,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,United Healthcare-Commercial, +138453,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,United Healthcare-Commercial,610.01 +138454,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,United Healthcare-Commercial,628.75 +138455,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,United Healthcare-Commercial,635.27 +138456,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,United Healthcare-Commercial, +138457,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,United Healthcare-Commercial, +138458,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,United Healthcare-Commercial,1002.98 +138459,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,United Healthcare-Commercial, +138460,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,United Healthcare-Commercial,1002.98 +138461,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,United Healthcare-Commercial, +138462,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,United Healthcare-Commercial,949.22 +138463,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,United Healthcare-Commercial,1002.98 +138464,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,United Healthcare-Commercial, +138465,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,United Healthcare-Commercial, +138466,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,United Healthcare-Commercial, +138467,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,United Healthcare-Commercial, +138468,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,United Healthcare-Commercial,1444.58 +138469,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,United Healthcare-Commercial, +138470,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,United Healthcare-Commercial, +138471,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,United Healthcare-Commercial, +138472,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,United Healthcare-Commercial, +138473,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,United Healthcare-Commercial,12775.2 +138474,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,United Healthcare-Commercial, +138475,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,United Healthcare-Commercial,12502.74 +138476,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,United Healthcare-Commercial, +138477,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,United Healthcare-Commercial, +138478,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,United Healthcare-Commercial,535.43 +138479,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,United Healthcare-Commercial,818.14 +138480,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,United Healthcare-Commercial,608.17 +138481,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,United Healthcare-Commercial, +138482,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,United Healthcare-Commercial, +138483,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,United Healthcare-Commercial,707.22 +138484,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,United Healthcare-Commercial, +138485,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,United Healthcare-Commercial,1002.98 +138486,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,United Healthcare-Commercial, +138487,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,United Healthcare-Commercial, +138488,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,United Healthcare-Commercial, +138489,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,United Healthcare-Commercial, +138490,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,United Healthcare-Commercial, +138491,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,United Healthcare-Commercial, +138492,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,United Healthcare-Commercial,708.19 +138493,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,United Healthcare-Commercial, +138494,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,United Healthcare-Commercial,2082.99 +138495,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,United Healthcare-Commercial, +138496,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,United Healthcare-Commercial, +138497,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,United Healthcare-Commercial,914.16 +138498,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,United Healthcare-Commercial, +138499,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,United Healthcare-Commercial,3030.09 +138500,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,United Healthcare-Commercial, +138501,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,United Healthcare-Commercial, +138502,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,United Healthcare-Commercial, +138503,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,United Healthcare-Commercial, +138504,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,United Healthcare-Commercial, +138505,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,United Healthcare-Commercial, +138506,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,United Healthcare-Commercial, +138507,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,United Healthcare-Commercial, +138508,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,United Healthcare-Commercial, +138509,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,United Healthcare-Commercial, +138510,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,United Healthcare-Commercial, +138511,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,United Healthcare-Commercial, +138512,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,United Healthcare-Commercial, +138513,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,United Healthcare-Commercial,2378.75 +138514,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,United Healthcare-Commercial, +138515,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,United Healthcare-Commercial, +138516,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,United Healthcare-Commercial, +138517,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,United Healthcare-Commercial, +138518,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,United Healthcare-Commercial, +138519,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,United Healthcare-Commercial, +138520,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,United Healthcare-Commercial,212.56 +138521,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,United Healthcare-Commercial,332.11 +138522,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,United Healthcare-Commercial, +138523,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,United Healthcare-Commercial, +138524,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,United Healthcare-Commercial, +138525,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,United Healthcare-Commercial, +138526,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,United Healthcare-Commercial, +138527,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,United Healthcare-Commercial, +138528,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,United Healthcare-Commercial, +138529,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,United Healthcare-Commercial, +138530,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,United Healthcare-Commercial, +138531,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,United Healthcare-Commercial, +138532,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,United Healthcare-Commercial, +138533,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,United Healthcare-Commercial, +138534,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,United Healthcare-Commercial, +138535,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,United Healthcare-Commercial, +138536,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,United Healthcare-Commercial, +138537,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,United Healthcare-Commercial,2456.5 +138538,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,United Healthcare-Commercial, +138539,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,United Healthcare-Commercial, +138540,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,United Healthcare-Commercial, +138541,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,United Healthcare-Commercial, +138542,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,United Healthcare-Commercial, +138543,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,United Healthcare-Commercial, +138544,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,United Healthcare-Commercial, +138545,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,United Healthcare-Commercial,2456.5 +138546,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,United Healthcare-Commercial, +138547,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,United Healthcare-Commercial,3489.0 +138548,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,United Healthcare-Commercial, +138549,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,United Healthcare-Commercial, +138550,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,United Healthcare-Commercial, +138551,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,United Healthcare-Commercial, +138552,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,United Healthcare-Commercial, +138553,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,United Healthcare-Commercial, +138554,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,United Healthcare-Commercial,1862.51 +138555,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,United Healthcare-Commercial, +138556,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,United Healthcare-Commercial, +138557,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,United Healthcare-Commercial, +138558,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,United Healthcare-Commercial, +138559,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,United Healthcare-Commercial, +138560,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,United Healthcare-Commercial, +138561,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,United Healthcare-Commercial, +138562,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,United Healthcare-Commercial,2290.99 +138563,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,United Healthcare-Commercial,3889.61 +138564,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,United Healthcare-Commercial, +138565,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,United Healthcare-Commercial, +138566,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,United Healthcare-Commercial,1862.51 +138567,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,United Healthcare-Commercial, +138568,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,United Healthcare-Commercial, +138569,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,United Healthcare-Commercial, +138570,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,United Healthcare-Commercial, +138571,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,United Healthcare-Commercial, +138572,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,United Healthcare-Commercial,3079.93 +138573,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,United Healthcare-Commercial, +138574,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,United Healthcare-Commercial, +138575,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,United Healthcare-Commercial, +138576,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,United Healthcare-Commercial,3079.93 +138577,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,United Healthcare-Commercial, +138578,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,United Healthcare-Commercial, +138579,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,United Healthcare-Commercial, +138580,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,United Healthcare-Commercial, +138581,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,United Healthcare-Commercial, +138582,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,United Healthcare-Commercial, +138583,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,United Healthcare-Commercial,2898.81 +138584,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,United Healthcare-Commercial, +138585,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,United Healthcare-Commercial, +138586,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,United Healthcare-Commercial, +138587,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,United Healthcare-Commercial, +138588,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,United Healthcare-Commercial,2151.99 +138589,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,United Healthcare-Commercial, +138590,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,United Healthcare-Commercial, +138591,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,United Healthcare-Commercial, +138592,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,United Healthcare-Commercial, +138593,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,United Healthcare-Commercial, +138594,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,United Healthcare-Commercial, +138595,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,United Healthcare-Commercial, +138596,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,United Healthcare-Commercial, +138597,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,United Healthcare-Commercial, +138598,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,United Healthcare-Commercial, +138599,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,United Healthcare-Commercial, +138600,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,United Healthcare-Commercial, +138601,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,United Healthcare-Commercial, +138602,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,United Healthcare-Commercial, +138603,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,United Healthcare-Commercial, +138604,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,United Healthcare-Commercial, +138605,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,United Healthcare-Commercial,2151.99 +138606,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,United Healthcare-Commercial,2151.99 +138607,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,United Healthcare-Commercial, +138608,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,United Healthcare-Commercial,2427.77 +138609,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,United Healthcare-Commercial, +138610,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,United Healthcare-Commercial, +138611,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,United Healthcare-Commercial, +138612,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,United Healthcare-Commercial, +138613,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,United Healthcare-Commercial,854.93 +138614,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,United Healthcare-Commercial, +138615,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,United Healthcare-Commercial,2151.99 +138616,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,United Healthcare-Commercial, +138617,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,United Healthcare-Commercial, +138618,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,United Healthcare-Commercial, +138619,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,United Healthcare-Commercial, +138620,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,United Healthcare-Commercial, +138621,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,United Healthcare-Commercial, +138622,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,United Healthcare-Commercial, +138623,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,United Healthcare-Commercial, +138624,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,United Healthcare-Commercial, +138625,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,United Healthcare-Commercial, +138626,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,United Healthcare-Commercial, +138627,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,United Healthcare-Commercial,2491.37 +138628,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,United Healthcare-Commercial,757.88 +138629,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,United Healthcare-Commercial, +138630,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,United Healthcare-Commercial,174.8 +138631,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,United Healthcare-Commercial, +138632,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,United Healthcare-Commercial, +138633,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,United Healthcare-Commercial, +138634,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,United Healthcare-Commercial,352.54 +138635,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,United Healthcare-Commercial,1444.99 +138636,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,United Healthcare-Commercial,296.3 +138637,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,United Healthcare-Commercial,205.71 +138638,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,United Healthcare-Commercial, +138639,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,United Healthcare-Commercial, +138640,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,United Healthcare-Commercial,1054.82 +138641,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,United Healthcare-Commercial,664.64 +138642,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,United Healthcare-Commercial,2109.63 +138643,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,United Healthcare-Commercial, +138644,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,United Healthcare-Commercial, +138645,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,United Healthcare-Commercial,4398.43 +138646,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,United Healthcare-Commercial,2350.95 +138647,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,United Healthcare-Commercial,2350.95 +138648,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,United Healthcare-Commercial, +138649,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,United Healthcare-Commercial, +138650,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,United Healthcare-Commercial,3833.91 +138651,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,United Healthcare-Commercial, +138652,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,United Healthcare-Commercial,3764.71 +138653,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,United Healthcare-Commercial,27065.52 +138654,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,United Healthcare-Commercial, +138655,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,United Healthcare-Commercial, +138656,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,United Healthcare-Commercial, +138657,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,United Healthcare-Commercial, +138658,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,United Healthcare-Commercial, +138659,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,United Healthcare-Commercial, +138660,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,United Healthcare-Commercial,15.0 +138661,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,United Healthcare-Commercial, +138662,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,United Healthcare-Commercial, +138663,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,United Healthcare-Commercial,439.23 +138664,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,United Healthcare-Commercial, +138665,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,United Healthcare-Commercial,558.72 +138666,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,United Healthcare-Commercial,290.93 +138667,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,United Healthcare-Commercial,452.7 +138668,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,United Healthcare-Commercial, +138669,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,United Healthcare-Commercial,492.35 +138670,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,United Healthcare-Commercial,433.32 +138671,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,United Healthcare-Commercial,341.73 +138672,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,United Healthcare-Commercial,312.46 +138673,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,United Healthcare-Commercial,410.08 +138674,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,United Healthcare-Commercial,410.08 +138675,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,United Healthcare-Commercial,558.72 +138676,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,United Healthcare-Commercial,537.28 +138677,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,United Healthcare-Commercial, +138678,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,United Healthcare-Commercial,500.0 +138679,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,United Healthcare-Commercial,622.24 +138680,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,United Healthcare-Commercial, +138681,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,United Healthcare-Commercial,622.24 +138682,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,United Healthcare-Commercial,934.96 +138683,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,United Healthcare-Commercial,243.99 +138684,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,United Healthcare-Commercial,623.01 +138685,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,United Healthcare-Commercial, +138686,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,United Healthcare-Commercial,726.35 +138687,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,United Healthcare-Commercial,158.47 +138688,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,United Healthcare-Commercial,469.9 +138689,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,United Healthcare-Commercial,98.09 +138690,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,United Healthcare-Commercial,45.33 +138691,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,United Healthcare-Commercial, +138692,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,United Healthcare-Commercial, +138693,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,United Healthcare-Commercial, +138694,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,United Healthcare-Commercial, +138695,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,United Healthcare-Commercial, +138696,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,United Healthcare-Commercial,349.12 +138697,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,United Healthcare-Commercial,634.46 +138698,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,United Healthcare-Commercial,390.74 +138699,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,United Healthcare-Commercial,98.09 +138700,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,United Healthcare-Commercial,509.51 +138701,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,United Healthcare-Commercial, +138702,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,United Healthcare-Commercial,500.0 +138703,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,United Healthcare-Commercial, +138704,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,United Healthcare-Commercial,223.35 +138705,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,United Healthcare-Commercial,89.4 +138706,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,United Healthcare-Commercial,135.78 +138707,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,United Healthcare-Commercial,30.0 +138708,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,United Healthcare-Commercial,15.0 +138709,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,United Healthcare-Commercial, +138710,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,United Healthcare-Commercial, +138711,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,United Healthcare-Commercial,11.72 +138712,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,United Healthcare-Commercial,135.78 +138713,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,United Healthcare-Commercial,20.43 +138714,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,United Healthcare-Commercial,24.3 +138715,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,United Healthcare-Commercial,131.61 +138716,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,United Healthcare-Commercial,135.78 +138717,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,United Healthcare-Commercial,135.78 +138718,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,United Healthcare-Commercial,4653.0 +138719,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,United Healthcare-Commercial, +138720,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,United Healthcare-Commercial,349.12 +138721,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,United Healthcare-Commercial, +138722,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,United Healthcare-Commercial,293.23 +138723,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,United Healthcare-Commercial,462.61 +138724,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,United Healthcare-Commercial, +138725,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,United Healthcare-Commercial,500.0 +138726,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,United Healthcare-Commercial,1000.0 +138727,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,United Healthcare-Commercial,500.0 +138728,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,United Healthcare-Commercial,380.32 +138729,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,United Healthcare-Commercial,500.0 +138730,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,United Healthcare-Commercial, +138731,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,United Healthcare-Commercial,726.35 +138732,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,United Healthcare-Commercial,605.29 +138733,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,United Healthcare-Commercial,521.06 +138734,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,United Healthcare-Commercial,288.39 +138735,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,United Healthcare-Commercial,20.0 +138736,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,United Healthcare-Commercial, +138737,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,United Healthcare-Commercial,318.17 +138738,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,United Healthcare-Commercial, +138739,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,United Healthcare-Commercial,500.0 +138740,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,United Healthcare-Commercial, +138741,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,United Healthcare-Commercial,500.0 +138742,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,United Healthcare-Commercial,12.0 +138743,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,United Healthcare-Commercial,15.0 +138744,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,United Healthcare-Commercial,54.27 +138745,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,United Healthcare-Commercial, +138746,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,United Healthcare-Commercial, +138747,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,United Healthcare-Commercial,140.76 +138748,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,United Healthcare-Commercial,17.5 +138749,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,United Healthcare-Commercial,10.0 +138750,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,United Healthcare-Commercial,10.0 +138751,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,United Healthcare-Commercial,97.39 +138752,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,United Healthcare-Commercial,35.38 +138753,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,United Healthcare-Commercial,10.0 +138754,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,United Healthcare-Commercial,96.69 +138755,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,United Healthcare-Commercial,10.0 +138756,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,United Healthcare-Commercial,96.69 +138757,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,United Healthcare-Commercial,7.5 +138758,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,United Healthcare-Commercial,290.93 +138759,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,United Healthcare-Commercial,353.07 +138760,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,United Healthcare-Commercial,371.28 +138761,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,United Healthcare-Commercial,500.0 +138762,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,United Healthcare-Commercial,500.0 +138763,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,United Healthcare-Commercial,500.0 +138764,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,United Healthcare-Commercial, +138765,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,United Healthcare-Commercial,500.0 +138766,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,United Healthcare-Commercial,462.0 +138767,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,United Healthcare-Commercial,127.6 +138768,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,United Healthcare-Commercial, +138769,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,United Healthcare-Commercial,135.78 +138770,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,United Healthcare-Commercial,17.09 +138771,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,United Healthcare-Commercial, +138772,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,United Healthcare-Commercial,96.69 +138773,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,United Healthcare-Commercial,96.69 +138774,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,United Healthcare-Commercial,97.39 +138775,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,United Healthcare-Commercial,135.78 +138776,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,United Healthcare-Commercial, +138777,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,United Healthcare-Commercial,10.0 +138778,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,United Healthcare-Commercial, +138779,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,United Healthcare-Commercial,10.0 +138780,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,United Healthcare-Commercial,639.0 +138781,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,United Healthcare-Commercial,10.0 +138782,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,United Healthcare-Commercial,656.0 +138783,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,United Healthcare-Commercial,10.0 +138784,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,United Healthcare-Commercial,7.5 +138785,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,United Healthcare-Commercial,275.66 +138786,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,United Healthcare-Commercial,358.94 +138787,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,United Healthcare-Commercial,386.55 +138788,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,United Healthcare-Commercial,596.12 +138789,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,United Healthcare-Commercial,605.29 +138790,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,United Healthcare-Commercial,750.0 +138791,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,United Healthcare-Commercial,605.29 +138792,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,United Healthcare-Commercial, +138793,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,United Healthcare-Commercial,10.0 +138794,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,United Healthcare-Commercial,9.0 +138795,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,United Healthcare-Commercial,140.0 +138796,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,United Healthcare-Commercial,341.73 +138797,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,United Healthcare-Commercial, +138798,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,United Healthcare-Commercial,463.4 +138799,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,United Healthcare-Commercial, +138800,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,United Healthcare-Commercial,386.47 +138801,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,United Healthcare-Commercial,577.35 +138802,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,United Healthcare-Commercial,462.61 +138803,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,United Healthcare-Commercial,500.0 +138804,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,United Healthcare-Commercial,726.35 +138805,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,United Healthcare-Commercial, +138806,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,United Healthcare-Commercial,274.95 +138807,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,United Healthcare-Commercial,175.25 +138808,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,United Healthcare-Commercial,274.95 +138809,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,United Healthcare-Commercial,465.79 +138810,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,United Healthcare-Commercial,274.95 +138811,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,United Healthcare-Commercial, +138812,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,United Healthcare-Commercial,17.09 +138813,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,United Healthcare-Commercial, +138814,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,United Healthcare-Commercial,135.11 +138815,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,United Healthcare-Commercial, +138816,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,United Healthcare-Commercial, +138817,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,United Healthcare-Commercial, +138818,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,United Healthcare-Commercial, +138819,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,United Healthcare-Commercial, +138820,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,United Healthcare-Commercial, +138821,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,United Healthcare-Commercial, +138822,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,United Healthcare-Commercial,272.46 +138823,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,United Healthcare-Commercial,327.25 +138824,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,United Healthcare-Commercial,174.16 +138825,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,United Healthcare-Commercial,25.0 +138826,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,United Healthcare-Commercial, +138827,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,United Healthcare-Commercial,500.0 +138828,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,United Healthcare-Commercial,557.8 +138829,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,United Healthcare-Commercial,57.8 +138830,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,United Healthcare-Commercial,242.27 +138831,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,United Healthcare-Commercial,432.88 +138832,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,United Healthcare-Commercial, +138833,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,United Healthcare-Commercial,254.0 +138834,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,United Healthcare-Commercial, +138835,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,United Healthcare-Commercial, +138836,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,United Healthcare-Commercial, +138837,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,United Healthcare-Commercial, +138838,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,United Healthcare-Commercial, +138839,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,United Healthcare-Commercial,694.5 +138840,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,United Healthcare-Commercial, +138841,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,United Healthcare-Commercial, +138842,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,United Healthcare-Commercial,252.26 +138843,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,United Healthcare-Commercial,1139.46 +138844,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,United Healthcare-Commercial, +138845,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,United Healthcare-Commercial, +138846,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,United Healthcare-Commercial,378.39 +138847,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,United Healthcare-Commercial, +138848,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,United Healthcare-Commercial, +138849,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,United Healthcare-Commercial,326.95 +138850,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,United Healthcare-Commercial, +138851,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,United Healthcare-Commercial,883.0 +138852,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,United Healthcare-Commercial,353.37 +138853,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,United Healthcare-Commercial, +138854,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,United Healthcare-Commercial,100.0 +138855,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,United Healthcare-Commercial, +138856,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,United Healthcare-Commercial, +138857,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,United Healthcare-Commercial, +138858,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,United Healthcare-Commercial, +138859,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,United Healthcare-Commercial,189.44 +138860,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,United Healthcare-Commercial, +138861,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,United Healthcare-Commercial, +138862,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,United Healthcare-Commercial,146.61 +138863,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,United Healthcare-Commercial,135.78 +138864,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,United Healthcare-Commercial,258.31 +138865,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,United Healthcare-Commercial,135.78 +138866,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,United Healthcare-Commercial,227.33 +138867,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,United Healthcare-Commercial,863.71 +138868,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,United Healthcare-Commercial,372.8 +138869,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,United Healthcare-Commercial, +138870,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,United Healthcare-Commercial,863.71 +138871,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,United Healthcare-Commercial,126.11 +138872,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,United Healthcare-Commercial,227.33 +138873,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,United Healthcare-Commercial,60.0 +138874,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,United Healthcare-Commercial,1028.47 +138875,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,United Healthcare-Commercial,68.65 +138876,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,United Healthcare-Commercial,137.3 +138877,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,United Healthcare-Commercial,199.25 +138878,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,United Healthcare-Commercial, +138879,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,United Healthcare-Commercial, +138880,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,United Healthcare-Commercial,164.76 +138881,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,United Healthcare-Commercial, +138882,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,United Healthcare-Commercial,155.61 +138883,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,United Healthcare-Commercial,543.28 +138884,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,United Healthcare-Commercial,452.73 +138885,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,United Healthcare-Commercial, +138886,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,United Healthcare-Commercial,410.82 +138887,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,United Healthcare-Commercial,410.82 +138888,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,United Healthcare-Commercial,171.8 +138889,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,United Healthcare-Commercial,1308.22 +138890,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,United Healthcare-Commercial,190.67 +138891,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,United Healthcare-Commercial,189.44 +138892,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,United Healthcare-Commercial,2624.55 +138893,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Commercial, +138894,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,United Healthcare-Commercial, +138895,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,United Healthcare-Commercial,190.91 +138896,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,United Healthcare-Commercial,30.0 +138897,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,United Healthcare-Commercial, +138898,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,United Healthcare-Commercial,271.2 +138899,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,United Healthcare-Commercial,259.8 +138900,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,United Healthcare-Commercial, +138901,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,United Healthcare-Commercial,116.51 +138902,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,United Healthcare-Commercial, +138903,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,United Healthcare-Commercial,378.39 +138904,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,United Healthcare-Commercial,494.09 +138905,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,United Healthcare-Commercial,78.74 +138906,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,United Healthcare-Commercial,218.65 +138907,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,United Healthcare-Commercial,208.13 +138908,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,United Healthcare-Commercial, +138909,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,United Healthcare-Commercial, +138910,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,United Healthcare-Commercial, +138911,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,United Healthcare-Commercial, +138912,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,United Healthcare-Commercial, +138913,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,United Healthcare-Commercial,63.96 +138914,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,United Healthcare-Commercial,81.9 +138915,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,United Healthcare-Commercial,42.29 +138916,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,United Healthcare-Commercial,115.23 +138917,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,United Healthcare-Commercial,146.77 +138918,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,United Healthcare-Commercial,136.89 +138919,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,United Healthcare-Commercial,15.0 +138920,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,United Healthcare-Commercial,135.78 +138921,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,United Healthcare-Commercial, +138922,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,United Healthcare-Commercial, +138923,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,United Healthcare-Commercial,135.78 +138924,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,United Healthcare-Commercial,76.51 +138925,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,United Healthcare-Commercial,259.08 +138926,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,United Healthcare-Commercial,406.05 +138927,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,United Healthcare-Commercial,539.61 +138928,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,United Healthcare-Commercial,2627.55 +138929,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,United Healthcare-Commercial,749.63 +138930,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,United Healthcare-Commercial,2747.31 +138931,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,United Healthcare-Commercial,1622.2 +138932,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,United Healthcare-Commercial, +138933,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,United Healthcare-Commercial,1224.57 +138934,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Commercial, +138935,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,United Healthcare-Commercial, +138936,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,United Healthcare-Commercial,715.44 +138937,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,United Healthcare-Commercial, +138938,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,United Healthcare-Commercial,676.75 +138939,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,United Healthcare-Commercial,539.61 +138940,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,United Healthcare-Commercial,2754.4 +138941,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,United Healthcare-Commercial,539.61 +138942,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,United Healthcare-Commercial,4860.57 +138943,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,United Healthcare-Commercial,2142.48 +138944,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,United Healthcare-Commercial,652.79 +138945,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,United Healthcare-Commercial,652.36 +138946,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,United Healthcare-Commercial,377.17 +138947,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,United Healthcare-Commercial,372.17 +138948,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,United Healthcare-Commercial, +138949,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,United Healthcare-Commercial,412.86 +138950,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,United Healthcare-Commercial, +138951,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,United Healthcare-Commercial,1043.45 +138952,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,United Healthcare-Commercial,984.24 +138953,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,United Healthcare-Commercial, +138954,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,United Healthcare-Commercial,1800.75 +138955,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Commercial, +138956,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,United Healthcare-Commercial, +138957,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,United Healthcare-Commercial,441.58 +138958,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,United Healthcare-Commercial,82.8 +138959,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,United Healthcare-Commercial, +138960,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,United Healthcare-Commercial, +138961,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,United Healthcare-Commercial,573.06 +138962,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,United Healthcare-Commercial,194.05 +138963,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,United Healthcare-Commercial,143.89 +138964,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,United Healthcare-Commercial, +138965,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,United Healthcare-Commercial,445.99 +138966,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,United Healthcare-Commercial,40.0 +138967,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,United Healthcare-Commercial,445.99 +138968,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,United Healthcare-Commercial,445.99 +138969,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,United Healthcare-Commercial,818.5 +138970,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,United Healthcare-Commercial,1541.26 +138971,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,United Healthcare-Commercial, +138972,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,United Healthcare-Commercial, +138973,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,United Healthcare-Commercial,424.5 +138974,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,United Healthcare-Commercial,371.62 +138975,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,United Healthcare-Commercial,62.14 +138976,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,United Healthcare-Commercial, +138977,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,United Healthcare-Commercial,1748.3 +138978,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,United Healthcare-Commercial, +138979,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,United Healthcare-Commercial,833.83 +138980,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,United Healthcare-Commercial, +138981,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,United Healthcare-Commercial, +138982,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,United Healthcare-Commercial,100.0 +138983,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,United Healthcare-Commercial, +138984,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,United Healthcare-Commercial,2332.0 +138985,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,United Healthcare-Commercial,342.0 +138986,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,United Healthcare-Commercial, +138987,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,United Healthcare-Commercial,1748.3 +138988,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,United Healthcare-Commercial, +138989,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,United Healthcare-Commercial, +138990,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,United Healthcare-Commercial,1748.39 +138991,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,United Healthcare-Commercial,1748.39 +138992,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,United Healthcare-Commercial,1556.29 +138993,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,United Healthcare-Commercial,259.94 +138994,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,United Healthcare-Commercial,907.67 +138995,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,United Healthcare-Commercial,287.61 +138996,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,United Healthcare-Commercial,3211.18 +138997,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,United Healthcare-Commercial,25.82 +138998,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,United Healthcare-Commercial,211.0 +138999,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,United Healthcare-Commercial, +139000,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,United Healthcare-Commercial,29.83 +139001,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,United Healthcare-Commercial, +139002,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,United Healthcare-Commercial,35.31 +139003,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,United Healthcare-Commercial,25.82 +139004,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,United Healthcare-Commercial,52.93 +139005,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,United Healthcare-Commercial,279.0 +139006,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,United Healthcare-Commercial,10.5 +139007,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,United Healthcare-Commercial, +139008,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,United Healthcare-Commercial, +139009,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,United Healthcare-Commercial, +139010,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,United Healthcare-Commercial, +139011,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,United Healthcare-Commercial,10.5 +139012,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,United Healthcare-Commercial,96.92 +139013,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,United Healthcare-Commercial,178.0 +139014,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,United Healthcare-Commercial,10.5 +139015,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,United Healthcare-Commercial, +139016,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,United Healthcare-Commercial, +139017,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,United Healthcare-Commercial, +139018,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,United Healthcare-Commercial,16.96 +139019,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,United Healthcare-Commercial,10.5 +139020,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,United Healthcare-Commercial,7.04 +139021,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,United Healthcare-Commercial,18.72 +139022,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,United Healthcare-Commercial,10.5 +139023,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,United Healthcare-Commercial, +139024,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,United Healthcare-Commercial, +139025,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,United Healthcare-Commercial, +139026,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,United Healthcare-Commercial, +139027,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,United Healthcare-Commercial,16.96 +139028,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,United Healthcare-Commercial, +139029,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,United Healthcare-Commercial, +139030,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,United Healthcare-Commercial, +139031,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,United Healthcare-Commercial,10.5 +139032,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,United Healthcare-Commercial, +139033,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,United Healthcare-Commercial, +139034,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,United Healthcare-Commercial, +139035,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,United Healthcare-Commercial,88.55 +139036,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,United Healthcare-Commercial,5.0 +139037,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,United Healthcare-Commercial,418.0 +139038,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,United Healthcare-Commercial, +139039,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,United Healthcare-Commercial,6.92 +139040,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,United Healthcare-Commercial, +139041,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,United Healthcare-Commercial,16.42 +139042,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,United Healthcare-Commercial, +139043,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,United Healthcare-Commercial,16.41 +139044,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,United Healthcare-Commercial,5.0 +139045,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,United Healthcare-Commercial,5.0 +139046,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,United Healthcare-Commercial, +139047,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,United Healthcare-Commercial, +139048,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,United Healthcare-Commercial,16.42 +139049,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,United Healthcare-Commercial, +139050,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,United Healthcare-Commercial, +139051,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,United Healthcare-Commercial, +139052,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,United Healthcare-Commercial, +139053,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,United Healthcare-Commercial, +139054,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,United Healthcare-Commercial,26.45 +139055,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,United Healthcare-Commercial, +139056,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,United Healthcare-Commercial,7.12 +139057,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,United Healthcare-Commercial,3.83 +139058,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,United Healthcare-Commercial,2.51 +139059,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,United Healthcare-Commercial, +139060,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Commercial, +139061,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Commercial, +139062,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Commercial, +139063,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,United Healthcare-Commercial, +139064,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,United Healthcare-Commercial, +139065,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,United Healthcare-Commercial, +139066,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,United Healthcare-Commercial, +139067,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,United Healthcare-Commercial, +139068,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,United Healthcare-Commercial, +139069,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,United Healthcare-Commercial, +139070,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,United Healthcare-Commercial, +139071,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,United Healthcare-Commercial, +139072,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,United Healthcare-Commercial, +139073,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,United Healthcare-Commercial,202.42 +139074,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,United Healthcare-Commercial, +139075,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,United Healthcare-Commercial, +139076,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,United Healthcare-Commercial, +139077,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,United Healthcare-Commercial, +139078,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,United Healthcare-Commercial,82.71 +139079,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,United Healthcare-Commercial, +139080,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,United Healthcare-Commercial, +139081,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,United Healthcare-Commercial, +139082,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,United Healthcare-Commercial,619.82 +139083,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,United Healthcare-Commercial, +139084,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,United Healthcare-Commercial, +139085,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,United Healthcare-Commercial,75.44 +139086,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,United Healthcare-Commercial,133.28 +139087,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,United Healthcare-Commercial, +139088,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,United Healthcare-Commercial, +139089,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,United Healthcare-Commercial, +139090,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,United Healthcare-Commercial, +139091,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,United Healthcare-Commercial, +139092,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,United Healthcare-Commercial, +139093,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,United Healthcare-Commercial, +139094,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,United Healthcare-Commercial,294.52 +139095,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,United Healthcare-Commercial, +139096,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,United Healthcare-Commercial, +139097,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,United Healthcare-Commercial,141.07 +139098,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,United Healthcare-Commercial,354.68 +139099,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,United Healthcare-Commercial, +139100,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,United Healthcare-Commercial,62.33 +139101,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,United Healthcare-Commercial, +139102,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,United Healthcare-Commercial, +139103,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,United Healthcare-Commercial, +139104,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,United Healthcare-Commercial, +139105,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,United Healthcare-Commercial, +139106,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,United Healthcare-Commercial, +139107,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,United Healthcare-Commercial, +139108,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,United Healthcare-Commercial, +139109,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,United Healthcare-Commercial, +139110,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,United Healthcare-Commercial, +139111,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,United Healthcare-Commercial,214.99 +139112,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,United Healthcare-Commercial, +139113,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,United Healthcare-Commercial, +139114,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,United Healthcare-Commercial, +139115,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,United Healthcare-Commercial, +139116,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,United Healthcare-Commercial, +139117,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,United Healthcare-Commercial, +139118,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,United Healthcare-Commercial,98.85 +139119,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,United Healthcare-Commercial, +139120,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,United Healthcare-Commercial, +139121,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,United Healthcare-Commercial,446.8 +139122,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,United Healthcare-Commercial, +139123,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,United Healthcare-Commercial, +139124,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,United Healthcare-Commercial, +139125,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,United Healthcare-Commercial, +139126,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,United Healthcare-Commercial,267.0 +139127,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,United Healthcare-Commercial, +139128,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,United Healthcare-Commercial,100.0 +139129,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,United Healthcare-Commercial, +139130,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,United Healthcare-Commercial, +139131,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,United Healthcare-Commercial, +139132,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,United Healthcare-Commercial, +139133,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,United Healthcare-Commercial, +139134,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,United Healthcare-Commercial, +139135,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,United Healthcare-Commercial, +139136,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,United Healthcare-Commercial, +139137,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,United Healthcare-Commercial,1103.3 +139138,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,United Healthcare-Commercial,431.8 +139139,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,United Healthcare-Commercial, +139140,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,United Healthcare-Commercial, +139141,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,United Healthcare-Commercial, +139142,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,United Healthcare-Commercial,606.56 +139143,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,United Healthcare-Commercial,42.87 +139144,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,United Healthcare-Commercial, +139145,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,United Healthcare-Commercial, +139146,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,United Healthcare-Commercial,20.83 +139147,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,United Healthcare-Commercial,47.68 +139148,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,United Healthcare-Commercial,8.93 +139149,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,United Healthcare-Commercial,15.56 +139150,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,United Healthcare-Commercial,10.54 +139151,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,United Healthcare-Commercial,6.85 +139152,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,United Healthcare-Commercial,48.84 +139153,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,United Healthcare-Commercial,12.5 +139154,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,United Healthcare-Commercial, +139155,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,United Healthcare-Commercial,9.9 +139156,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,United Healthcare-Commercial, +139157,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,United Healthcare-Commercial, +139158,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,United Healthcare-Commercial,82.34 +139159,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,United Healthcare-Commercial, +139160,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,United Healthcare-Commercial,82.34 +139161,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,United Healthcare-Commercial,17.99 +139162,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,United Healthcare-Commercial,70.74 +139163,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,United Healthcare-Commercial,30.0 +139164,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,United Healthcare-Commercial,16.77 +139165,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,United Healthcare-Commercial,15.93 +139166,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,United Healthcare-Commercial,22.0 +139167,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,United Healthcare-Commercial,9.9 +139168,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,United Healthcare-Commercial, +139169,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,United Healthcare-Commercial,13.05 +139170,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,United Healthcare-Commercial,5.81 +139171,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,United Healthcare-Commercial,5.03 +139172,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,United Healthcare-Commercial,3.4 +139173,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,United Healthcare-Commercial,3.34 +139174,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,United Healthcare-Commercial, +139175,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,United Healthcare-Commercial,15.8 +139176,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,United Healthcare-Commercial,66.36 +139177,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,United Healthcare-Commercial,33.08 +139178,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,United Healthcare-Commercial,79.0 +139179,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,United Healthcare-Commercial,5.03 +139180,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,United Healthcare-Commercial,6.38 +139181,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,United Healthcare-Commercial,12.39 +139182,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,United Healthcare-Commercial,116.0 +139183,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,United Healthcare-Commercial, +139184,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,United Healthcare-Commercial,23.41 +139185,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,United Healthcare-Commercial,10.5 +139186,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,United Healthcare-Commercial, +139187,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,United Healthcare-Commercial, +139188,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,United Healthcare-Commercial,8.1 +139189,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,United Healthcare-Commercial,10.75 +139190,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,United Healthcare-Commercial,72.0 +139191,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,United Healthcare-Commercial,5.75 +139192,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,United Healthcare-Commercial,5.03 +139193,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,United Healthcare-Commercial,5.03 +139194,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,United Healthcare-Commercial,25.3 +139195,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,United Healthcare-Commercial,20.0 +139196,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,United Healthcare-Commercial,18.91 +139197,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,United Healthcare-Commercial,18.45 +139198,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,United Healthcare-Commercial,18.45 +139199,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,United Healthcare-Commercial,16.38 +139200,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,United Healthcare-Commercial,86.0 +139201,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,United Healthcare-Commercial,9.4 +139202,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,United Healthcare-Commercial,9.85 +139203,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,United Healthcare-Commercial,34.94 +139204,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,United Healthcare-Commercial,6.67 +139205,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,United Healthcare-Commercial,13.92 +139206,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,United Healthcare-Commercial, +139207,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,United Healthcare-Commercial,5.48 +139208,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,United Healthcare-Commercial,16.75 +139209,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,United Healthcare-Commercial,12.59 +139210,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,United Healthcare-Commercial, +139211,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,United Healthcare-Commercial,23.82 +139212,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,United Healthcare-Commercial,21.02 +139213,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,United Healthcare-Commercial,105.14 +139214,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,United Healthcare-Commercial,17.77 +139215,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,United Healthcare-Commercial,59.88 +139216,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,United Healthcare-Commercial,41.82 +139217,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,United Healthcare-Commercial,17.06 +139218,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,United Healthcare-Commercial,34.21 +139219,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,United Healthcare-Commercial, +139220,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,United Healthcare-Commercial,17.5 +139221,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,United Healthcare-Commercial,25.3 +139222,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,United Healthcare-Commercial,5.22 +139223,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,United Healthcare-Commercial, +139224,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,United Healthcare-Commercial, +139225,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,United Healthcare-Commercial, +139226,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,United Healthcare-Commercial,14.75 +139227,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,United Healthcare-Commercial,57.95 +139228,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,United Healthcare-Commercial,16.34 +139229,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,United Healthcare-Commercial, +139230,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,United Healthcare-Commercial,63.0 +139231,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,United Healthcare-Commercial,15.63 +139232,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,United Healthcare-Commercial,32.08 +139233,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,United Healthcare-Commercial, +139234,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,United Healthcare-Commercial,123.79 +139235,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,United Healthcare-Commercial, +139236,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,United Healthcare-Commercial,4.85 +139237,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,United Healthcare-Commercial,17.56 +139238,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,United Healthcare-Commercial,2.0 +139239,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,United Healthcare-Commercial,5.69 +139240,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,United Healthcare-Commercial,10.75 +139241,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,United Healthcare-Commercial,1.4 +139242,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,United Healthcare-Commercial,11.97 +139243,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,United Healthcare-Commercial, +139244,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,United Healthcare-Commercial,10.06 +139245,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,United Healthcare-Commercial,11.0 +139246,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,United Healthcare-Commercial,22.1 +139247,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,United Healthcare-Commercial,20.88 +139248,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,United Healthcare-Commercial, +139249,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,United Healthcare-Commercial, +139250,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,United Healthcare-Commercial,13.81 +139251,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,United Healthcare-Commercial,5.94 +139252,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,United Healthcare-Commercial, +139253,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,United Healthcare-Commercial,18.54 +139254,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,United Healthcare-Commercial,20.61 +139255,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,United Healthcare-Commercial,53.49 +139256,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,United Healthcare-Commercial, +139257,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,United Healthcare-Commercial, +139258,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,United Healthcare-Commercial, +139259,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,United Healthcare-Commercial,18.54 +139260,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,United Healthcare-Commercial,6.25 +139261,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,United Healthcare-Commercial,15.92 +139262,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,United Healthcare-Commercial,33.54 +139263,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,United Healthcare-Commercial,26.75 +139264,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,United Healthcare-Commercial,18.77 +139265,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,United Healthcare-Commercial,69.08 +139266,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,United Healthcare-Commercial,12.5 +139267,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,United Healthcare-Commercial,6.47 +139268,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,United Healthcare-Commercial,13.88 +139269,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,United Healthcare-Commercial,88.0 +139270,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,United Healthcare-Commercial, +139271,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,United Healthcare-Commercial, +139272,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,United Healthcare-Commercial,14.95 +139273,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,United Healthcare-Commercial,73.45 +139274,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,United Healthcare-Commercial,9.77 +139275,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,United Healthcare-Commercial,23.84 +139276,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,United Healthcare-Commercial, +139277,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,United Healthcare-Commercial,7.14 +139278,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,United Healthcare-Commercial,80.0 +139279,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,United Healthcare-Commercial,30.37 +139280,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,United Healthcare-Commercial, +139281,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,United Healthcare-Commercial,20.07 +139282,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,United Healthcare-Commercial,20.92 +139283,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,United Healthcare-Commercial,20.15 +139284,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,United Healthcare-Commercial,19.12 +139285,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,United Healthcare-Commercial,9.76 +139286,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,United Healthcare-Commercial,40.26 +139287,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,United Healthcare-Commercial,179.63 +139288,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,United Healthcare-Commercial,27.2 +139289,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,United Healthcare-Commercial,27.39 +139290,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,United Healthcare-Commercial,22.75 +139291,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,United Healthcare-Commercial,21.21 +139292,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,United Healthcare-Commercial,6.04 +139293,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,United Healthcare-Commercial,6.04 +139294,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,United Healthcare-Commercial,11.9 +139295,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,United Healthcare-Commercial, +139296,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,United Healthcare-Commercial,64.54 +139297,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,United Healthcare-Commercial,2.43 +139298,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,United Healthcare-Commercial, +139299,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,United Healthcare-Commercial,19.63 +139300,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,United Healthcare-Commercial, +139301,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,United Healthcare-Commercial,5.03 +139302,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,United Healthcare-Commercial,14.78 +139303,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,United Healthcare-Commercial,60.0 +139304,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,United Healthcare-Commercial,5.03 +139305,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,United Healthcare-Commercial,57.95 +139306,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,United Healthcare-Commercial,15.94 +139307,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,United Healthcare-Commercial, +139308,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,United Healthcare-Commercial,5.03 +139309,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,United Healthcare-Commercial,5.03 +139310,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,United Healthcare-Commercial,7.32 +139311,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,United Healthcare-Commercial,28.16 +139312,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,United Healthcare-Commercial,23.09 +139313,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,United Healthcare-Commercial,27.22 +139314,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,United Healthcare-Commercial,24.79 +139315,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,United Healthcare-Commercial, +139316,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,United Healthcare-Commercial,246.0 +139317,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,United Healthcare-Commercial,22.71 +139318,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,United Healthcare-Commercial,4.53 +139319,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,United Healthcare-Commercial,4.53 +139320,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,United Healthcare-Commercial,4.53 +139321,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,United Healthcare-Commercial,11.34 +139322,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,United Healthcare-Commercial,17.83 +139323,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,United Healthcare-Commercial, +139324,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,United Healthcare-Commercial,116.84 +139325,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,United Healthcare-Commercial, +139326,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,United Healthcare-Commercial,34.69 +139327,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,United Healthcare-Commercial,9.85 +139328,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,United Healthcare-Commercial, +139329,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,United Healthcare-Commercial,14.95 +139330,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,United Healthcare-Commercial, +139331,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,United Healthcare-Commercial,19.29 +139332,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,United Healthcare-Commercial, +139333,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,United Healthcare-Commercial,16.42 +139334,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,United Healthcare-Commercial,65.0 +139335,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,United Healthcare-Commercial,5.06 +139336,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,United Healthcare-Commercial, +139337,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,United Healthcare-Commercial,20.5 +139338,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,United Healthcare-Commercial,5.51 +139339,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,United Healthcare-Commercial, +139340,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,United Healthcare-Commercial, +139341,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,United Healthcare-Commercial, +139342,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,United Healthcare-Commercial,3.73 +139343,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,United Healthcare-Commercial,30.54 +139344,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,United Healthcare-Commercial,42.49 +139345,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,United Healthcare-Commercial,15.0 +139346,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,United Healthcare-Commercial,54.48 +139347,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,United Healthcare-Commercial,7.63 +139348,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,United Healthcare-Commercial,11.72 +139349,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,United Healthcare-Commercial,9.0 +139350,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,United Healthcare-Commercial,20.12 +139351,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,United Healthcare-Commercial,38.43 +139352,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,United Healthcare-Commercial,17.51 +139353,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,United Healthcare-Commercial,6.12 +139354,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,United Healthcare-Commercial,5.03 +139355,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,United Healthcare-Commercial,12.76 +139356,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,United Healthcare-Commercial,6.38 +139357,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,United Healthcare-Commercial,3.3 +139358,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,United Healthcare-Commercial,14.18 +139359,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,United Healthcare-Commercial,12.62 +139360,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,United Healthcare-Commercial,5.7 +139361,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,United Healthcare-Commercial,296.0 +139362,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,United Healthcare-Commercial,12.56 +139363,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,United Healthcare-Commercial,40.7 +139364,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,United Healthcare-Commercial,5.56 +139365,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,United Healthcare-Commercial,85.0 +139366,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,United Healthcare-Commercial,5.03 +139367,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,United Healthcare-Commercial,21.16 +139368,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,United Healthcare-Commercial, +139369,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,United Healthcare-Commercial, +139370,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,United Healthcare-Commercial,14.33 +139371,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,United Healthcare-Commercial,16.94 +139372,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,United Healthcare-Commercial,9.46 +139373,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,United Healthcare-Commercial,21.72 +139374,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,United Healthcare-Commercial,1100.44 +139375,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,United Healthcare-Commercial,7.52 +139376,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,United Healthcare-Commercial,11.56 +139377,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,United Healthcare-Commercial,425.0 +139378,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,United Healthcare-Commercial,3.8 +139379,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,United Healthcare-Commercial, +139380,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,United Healthcare-Commercial,2.37 +139381,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,United Healthcare-Commercial,2.37 +139382,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,United Healthcare-Commercial,127.0 +139383,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,United Healthcare-Commercial,25.32 +139384,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,United Healthcare-Commercial, +139385,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,United Healthcare-Commercial,5.1 +139386,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,United Healthcare-Commercial, +139387,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,United Healthcare-Commercial,3.17 +139388,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,United Healthcare-Commercial,218.6 +139389,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,United Healthcare-Commercial,14.48 +139390,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,United Healthcare-Commercial,19.3 +139391,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,United Healthcare-Commercial,19.9 +139392,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,United Healthcare-Commercial,30.57 +139393,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,United Healthcare-Commercial,75.67 +139394,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,United Healthcare-Commercial,19.94 +139395,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,United Healthcare-Commercial,19.94 +139396,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,United Healthcare-Commercial,19.9 +139397,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,United Healthcare-Commercial,19.3 +139398,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,United Healthcare-Commercial,19.3 +139399,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,United Healthcare-Commercial,19.9 +139400,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,United Healthcare-Commercial,7.1 +139401,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,United Healthcare-Commercial,9.43 +139402,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,United Healthcare-Commercial, +139403,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,United Healthcare-Commercial,14.83 +139404,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,United Healthcare-Commercial,15.41 +139405,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,United Healthcare-Commercial,22.01 +139406,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,United Healthcare-Commercial, +139407,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,United Healthcare-Commercial, +139408,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,United Healthcare-Commercial, +139409,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,United Healthcare-Commercial,13.3 +139410,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,United Healthcare-Commercial,6.9 +139411,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,United Healthcare-Commercial, +139412,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,United Healthcare-Commercial,12.99 +139413,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,United Healthcare-Commercial,4.94 +139414,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,United Healthcare-Commercial, +139415,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,United Healthcare-Commercial, +139416,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,United Healthcare-Commercial,13.3 +139417,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,United Healthcare-Commercial,124.55 +139418,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,United Healthcare-Commercial,52.08 +139419,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,United Healthcare-Commercial,2.68 +139420,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,United Healthcare-Commercial,13.3 +139421,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,United Healthcare-Commercial, +139422,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,United Healthcare-Commercial,80.0 +139423,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,United Healthcare-Commercial, +139424,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,United Healthcare-Commercial,5.77 +139425,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,United Healthcare-Commercial,17.91 +139426,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,United Healthcare-Commercial,12.38 +139427,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,United Healthcare-Commercial, +139428,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,United Healthcare-Commercial,79.22 +139429,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,United Healthcare-Commercial,4.02 +139430,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,United Healthcare-Commercial,5.42 +139431,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,United Healthcare-Commercial,5.27 +139432,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,United Healthcare-Commercial,11.38 +139433,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,United Healthcare-Commercial,13.88 +139434,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,United Healthcare-Commercial,12.09 +139435,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,United Healthcare-Commercial,11.16 +139436,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,United Healthcare-Commercial, +139437,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,United Healthcare-Commercial,119.0 +139438,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,United Healthcare-Commercial,10.25 +139439,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,United Healthcare-Commercial,23.46 +139440,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,United Healthcare-Commercial,109.0 +139441,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,United Healthcare-Commercial,23.46 +139442,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,United Healthcare-Commercial, +139443,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,United Healthcare-Commercial,5.2 +139444,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,United Healthcare-Commercial,24.5 +139445,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,United Healthcare-Commercial,14.81 +139446,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,United Healthcare-Commercial,19.39 +139447,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,United Healthcare-Commercial,12.95 +139448,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,United Healthcare-Commercial, +139449,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,United Healthcare-Commercial,13.74 +139450,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,United Healthcare-Commercial,9.36 +139451,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,United Healthcare-Commercial,82.05 +139452,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,United Healthcare-Commercial,56.44 +139453,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,United Healthcare-Commercial,26.6 +139454,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,United Healthcare-Commercial,22.36 +139455,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,United Healthcare-Commercial,24.35 +139456,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,United Healthcare-Commercial,24.35 +139457,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,United Healthcare-Commercial,4.73 +139458,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,United Healthcare-Commercial,13.26 +139459,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,United Healthcare-Commercial,11.32 +139460,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,United Healthcare-Commercial, +139461,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,United Healthcare-Commercial, +139462,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,United Healthcare-Commercial,27.42 +139463,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,United Healthcare-Commercial,35.16 +139464,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,United Healthcare-Commercial,6.5 +139465,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,United Healthcare-Commercial, +139466,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,United Healthcare-Commercial,11.36 +139467,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,United Healthcare-Commercial, +139468,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,United Healthcare-Commercial,146.89 +139469,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,United Healthcare-Commercial,37.04 +139470,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,United Healthcare-Commercial,26.43 +139471,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,United Healthcare-Commercial, +139472,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,United Healthcare-Commercial,23.17 +139473,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,United Healthcare-Commercial,37.73 +139474,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,United Healthcare-Commercial,83.51 +139475,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,United Healthcare-Commercial, +139476,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,United Healthcare-Commercial,14.91 +139477,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,United Healthcare-Commercial,5.67 +139478,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,United Healthcare-Commercial,69.78 +139479,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,United Healthcare-Commercial,5.0 +139480,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,United Healthcare-Commercial,4.75 +139481,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,United Healthcare-Commercial, +139482,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,United Healthcare-Commercial, +139483,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,United Healthcare-Commercial, +139484,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,United Healthcare-Commercial, +139485,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,United Healthcare-Commercial,16.06 +139486,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,United Healthcare-Commercial, +139487,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,United Healthcare-Commercial,34.42 +139488,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,United Healthcare-Commercial,37.84 +139489,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,United Healthcare-Commercial,29.58 +139490,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,United Healthcare-Commercial, +139491,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,United Healthcare-Commercial, +139492,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,United Healthcare-Commercial, +139493,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,United Healthcare-Commercial, +139494,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,United Healthcare-Commercial,8.03 +139495,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,United Healthcare-Commercial,15.99 +139496,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,United Healthcare-Commercial,9.0 +139497,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,United Healthcare-Commercial, +139498,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,United Healthcare-Commercial,14.5 +139499,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,United Healthcare-Commercial,16.91 +139500,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,United Healthcare-Commercial,36.63 +139501,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,United Healthcare-Commercial,13.38 +139502,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,United Healthcare-Commercial, +139503,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,United Healthcare-Commercial,16.66 +139504,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,United Healthcare-Commercial, +139505,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,United Healthcare-Commercial, +139506,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,United Healthcare-Commercial,25.0 +139507,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,United Healthcare-Commercial,9.96 +139508,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,United Healthcare-Commercial,14.5 +139509,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,United Healthcare-Commercial, +139510,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,United Healthcare-Commercial, +139511,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,United Healthcare-Commercial, +139512,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,United Healthcare-Commercial,15.19 +139513,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,United Healthcare-Commercial,12.05 +139514,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,United Healthcare-Commercial,19.58 +139515,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,United Healthcare-Commercial,10.75 +139516,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,United Healthcare-Commercial,10.46 +139517,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,United Healthcare-Commercial,10.0 +139518,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,United Healthcare-Commercial,11.26 +139519,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,United Healthcare-Commercial, +139520,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,United Healthcare-Commercial, +139521,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,United Healthcare-Commercial,8.03 +139522,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,United Healthcare-Commercial,14.65 +139523,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,United Healthcare-Commercial, +139524,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,United Healthcare-Commercial,33.24 +139525,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,United Healthcare-Commercial,9.82 +139526,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,United Healthcare-Commercial,42.8 +139527,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,United Healthcare-Commercial,15.91 +139528,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,United Healthcare-Commercial,14.25 +139529,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,United Healthcare-Commercial,42.13 +139530,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,United Healthcare-Commercial,15.99 +139531,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,United Healthcare-Commercial,16.01 +139532,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,United Healthcare-Commercial,12.63 +139533,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,United Healthcare-Commercial,14.31 +139534,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,United Healthcare-Commercial, +139535,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,United Healthcare-Commercial, +139536,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,United Healthcare-Commercial, +139537,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,United Healthcare-Commercial,13.35 +139538,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,United Healthcare-Commercial,14.27 +139539,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,United Healthcare-Commercial, +139540,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,United Healthcare-Commercial,118.7 +139541,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,United Healthcare-Commercial,64.19 +139542,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,United Healthcare-Commercial,323.75 +139543,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,United Healthcare-Commercial,325.8 +139544,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,United Healthcare-Commercial,739.0 +139545,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,United Healthcare-Commercial,173.9 +139546,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,United Healthcare-Commercial,342.2 +139547,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,United Healthcare-Commercial,134.75 +139548,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,United Healthcare-Commercial, +139549,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,United Healthcare-Commercial,49.54 +139550,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,United Healthcare-Commercial,508.86 +139551,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,United Healthcare-Commercial,528.0 +139552,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,United Healthcare-Commercial, +139553,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,United Healthcare-Commercial,184.03 +139554,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,United Healthcare-Commercial,173.85 +139555,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,United Healthcare-Commercial,195.93 +139556,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,United Healthcare-Commercial,238.44 +139557,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,United Healthcare-Commercial,6.68 +139558,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,United Healthcare-Commercial,173.0 +139559,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,United Healthcare-Commercial,8.15 +139560,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,United Healthcare-Commercial,8.85 +139561,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,United Healthcare-Commercial,231.0 +139562,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,United Healthcare-Commercial,19.4 +139563,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,United Healthcare-Commercial,12.13 +139564,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,United Healthcare-Commercial,12.46 +139565,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,United Healthcare-Commercial,29.1 +139566,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,United Healthcare-Commercial,9.7 +139567,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,United Healthcare-Commercial,9.43 +139568,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,United Healthcare-Commercial,10.38 +139569,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,United Healthcare-Commercial, +139570,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,United Healthcare-Commercial,10.32 +139571,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,United Healthcare-Commercial, +139572,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,United Healthcare-Commercial,8.15 +139573,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,United Healthcare-Commercial, +139574,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,United Healthcare-Commercial,13.34 +139575,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,United Healthcare-Commercial, +139576,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,United Healthcare-Commercial,3.75 +139577,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,United Healthcare-Commercial, +139578,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,United Healthcare-Commercial,65.17 +139579,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,United Healthcare-Commercial, +139580,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,United Healthcare-Commercial, +139581,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,United Healthcare-Commercial, +139582,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,United Healthcare-Commercial,10.99 +139583,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,United Healthcare-Commercial,4.5 +139584,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,United Healthcare-Commercial,7.48 +139585,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,United Healthcare-Commercial, +139586,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,United Healthcare-Commercial,11.53 +139587,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,United Healthcare-Commercial, +139588,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,United Healthcare-Commercial,4.98 +139589,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,United Healthcare-Commercial,5.85 +139590,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,United Healthcare-Commercial,7.0 +139591,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,United Healthcare-Commercial,5.85 +139592,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,United Healthcare-Commercial,38.29 +139593,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,United Healthcare-Commercial, +139594,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,United Healthcare-Commercial, +139595,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,United Healthcare-Commercial,8.03 +139596,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,United Healthcare-Commercial, +139597,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,United Healthcare-Commercial, +139598,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,United Healthcare-Commercial,14.8 +139599,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,United Healthcare-Commercial,8.03 +139600,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,United Healthcare-Commercial,11.7 +139601,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,United Healthcare-Commercial,11.1 +139602,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,United Healthcare-Commercial,10.1 +139603,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,United Healthcare-Commercial, +139604,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,United Healthcare-Commercial,18.49 +139605,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,United Healthcare-Commercial, +139606,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,United Healthcare-Commercial, +139607,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,United Healthcare-Commercial, +139608,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,United Healthcare-Commercial,173.99 +139609,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,United Healthcare-Commercial,3.75 +139610,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,United Healthcare-Commercial,7.15 +139611,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,United Healthcare-Commercial,23.86 +139612,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,United Healthcare-Commercial,27.05 +139613,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Commercial,20.05 +139614,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,United Healthcare-Commercial, +139615,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,United Healthcare-Commercial, +139616,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,United Healthcare-Commercial,38.29 +139617,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,United Healthcare-Commercial,45.95 +139618,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,United Healthcare-Commercial,38.99 +139619,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,United Healthcare-Commercial,23.39 +139620,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,United Healthcare-Commercial,45.22 +139621,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,United Healthcare-Commercial,53.45 +139622,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,United Healthcare-Commercial,37.41 +139623,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,United Healthcare-Commercial, +139624,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Commercial,20.05 +139625,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,United Healthcare-Commercial, +139626,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,United Healthcare-Commercial, +139627,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,United Healthcare-Commercial,30.98 +139628,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,United Healthcare-Commercial, +139629,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,United Healthcare-Commercial,85.45 +139630,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,United Healthcare-Commercial,38.99 +139631,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,United Healthcare-Commercial,58.26 +139632,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,United Healthcare-Commercial,26.09 +139633,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,United Healthcare-Commercial, +139634,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,United Healthcare-Commercial,105.06 +139635,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,United Healthcare-Commercial, +139636,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,United Healthcare-Commercial, +139637,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,United Healthcare-Commercial, +139638,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,United Healthcare-Commercial,38.29 +139639,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,United Healthcare-Commercial,30.32 +139640,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,United Healthcare-Commercial,38.99 +139641,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,United Healthcare-Commercial,484.0 +139642,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,United Healthcare-Commercial, +139643,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,United Healthcare-Commercial,1798.0 +139644,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,United Healthcare-Commercial,67.64 +139645,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,United Healthcare-Commercial,38.29 +139646,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Commercial,20.05 +139647,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,United Healthcare-Commercial,21.43 +139648,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,United Healthcare-Commercial,250.0 +139649,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,United Healthcare-Commercial,45.22 +139650,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,United Healthcare-Commercial,40.0 +139651,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,United Healthcare-Commercial, +139652,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,United Healthcare-Commercial, +139653,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,United Healthcare-Commercial,8.03 +139654,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,United Healthcare-Commercial,317.84 +139655,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,United Healthcare-Commercial,317.84 +139656,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,United Healthcare-Commercial, +139657,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,United Healthcare-Commercial, +139658,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,United Healthcare-Commercial, +139659,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,United Healthcare-Commercial, +139660,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,United Healthcare-Commercial, +139661,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,United Healthcare-Commercial,40.5 +139662,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,United Healthcare-Commercial,40.5 +139663,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,United Healthcare-Commercial, +139664,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,United Healthcare-Commercial,26.32 +139665,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,United Healthcare-Commercial,424.87 +139666,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,United Healthcare-Commercial,401.7 +139667,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,United Healthcare-Commercial, +139668,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,United Healthcare-Commercial,37.18 +139669,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,United Healthcare-Commercial,37.18 +139670,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,United Healthcare-Commercial,40.0 +139671,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,United Healthcare-Commercial,131.91 +139672,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,United Healthcare-Commercial,100.03 +139673,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,United Healthcare-Commercial,131.91 +139674,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,United Healthcare-Commercial, +139675,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,United Healthcare-Commercial, +139676,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,United Healthcare-Commercial,100.0 +139677,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,United Healthcare-Commercial,90.0 +139678,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,United Healthcare-Commercial,95.18 +139679,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,United Healthcare-Commercial,39.66 +139680,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,United Healthcare-Commercial,217.56 +139681,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,United Healthcare-Commercial,10.0 +139682,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,United Healthcare-Commercial, +139683,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,United Healthcare-Commercial,37.18 +139684,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,United Healthcare-Commercial, +139685,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,United Healthcare-Commercial,862.85 +139686,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,United Healthcare-Commercial,381.0 +139687,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,United Healthcare-Commercial,5419.16 +139688,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,United Healthcare-Commercial,206.73 +139689,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,United Healthcare-Commercial,6.13 +139690,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,United Healthcare-Commercial,114.18 +139691,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,United Healthcare-Commercial,1662.9 +139692,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,United Healthcare-Commercial, +139693,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,United Healthcare-Commercial,69.2 +139694,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,United Healthcare-Commercial, +139695,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,United Healthcare-Commercial,62.48 +139696,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,United Healthcare-Commercial,34.6 +139697,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,United Healthcare-Commercial,60.55 +139698,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,United Healthcare-Commercial,43.25 +139699,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,United Healthcare-Commercial,109.24 +139700,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,United Healthcare-Commercial,173.85 +139701,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,United Healthcare-Commercial,68.27 +139702,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,United Healthcare-Commercial,63.38 +139703,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,United Healthcare-Commercial,154.61 +139704,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,United Healthcare-Commercial,39.01 +139705,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,United Healthcare-Commercial,140.0 +139706,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,United Healthcare-Commercial,269.36 +139707,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,United Healthcare-Commercial, +139708,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,United Healthcare-Commercial, +139709,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,United Healthcare-Commercial,172.07 +139710,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,United Healthcare-Commercial, +139711,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,United Healthcare-Commercial,6.12 +139712,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,United Healthcare-Commercial,6.0 +139713,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,United Healthcare-Commercial,11.41 +139714,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,United Healthcare-Commercial, +139715,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,United Healthcare-Commercial,11668.26 +139716,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,United Healthcare-Commercial, +139717,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,United Healthcare-Commercial, +139718,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,United Healthcare-Commercial, +139719,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,United Healthcare-Commercial, +139720,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,United Healthcare-Commercial, +139721,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,United Healthcare-Commercial, +139722,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,United Healthcare-Commercial, +139723,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,United Healthcare-Commercial, +139724,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,United Healthcare-Commercial,43.72 +139725,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,United Healthcare-Commercial,59.5 +139726,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,United Healthcare-Commercial,59.5 +139727,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,United Healthcare-Commercial, +139728,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,United Healthcare-Commercial,34.43 +139729,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,United Healthcare-Commercial, +139730,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,United Healthcare-Commercial, +139731,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,United Healthcare-Commercial,34.43 +139732,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,United Healthcare-Commercial,34.43 +139733,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,United Healthcare-Commercial,43.25 +139734,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,United Healthcare-Commercial, +139735,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,United Healthcare-Commercial, +139736,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,United Healthcare-Commercial, +139737,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,United Healthcare-Commercial, +139738,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,United Healthcare-Commercial,1688.64 +139739,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,United Healthcare-Commercial,261.43 +139740,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,United Healthcare-Commercial,185.49 +139741,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,United Healthcare-Commercial,68.35 +139742,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,United Healthcare-Commercial,164.73 +139743,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,United Healthcare-Commercial,177.91 +139744,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,United Healthcare-Commercial,86.73 +139745,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,United Healthcare-Commercial, +139746,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,United Healthcare-Commercial,159.14 +139747,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,United Healthcare-Commercial, +139748,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,United Healthcare-Commercial, +139749,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,United Healthcare-Commercial, +139750,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,United Healthcare-Commercial, +139751,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,United Healthcare-Commercial,548.14 +139752,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,United Healthcare-Commercial, +139753,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,United Healthcare-Commercial, +139754,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,United Healthcare-Commercial, +139755,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,United Healthcare-Commercial, +139756,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,United Healthcare-Commercial,894.95 +139757,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,United Healthcare-Commercial,574.44 +139758,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,United Healthcare-Commercial,894.95 +139759,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,United Healthcare-Commercial,588.32 +139760,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,United Healthcare-Commercial, +139761,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,United Healthcare-Commercial,166.16 +139762,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,United Healthcare-Commercial, +139763,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,United Healthcare-Commercial,574.44 +139764,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,United Healthcare-Commercial,235.25 +139765,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,United Healthcare-Commercial,235.25 +139766,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,United Healthcare-Commercial, +139767,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,United Healthcare-Commercial, +139768,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,United Healthcare-Commercial, +139769,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,United Healthcare-Commercial, +139770,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,United Healthcare-Commercial, +139771,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,United Healthcare-Commercial,1971.11 +139772,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,United Healthcare-Commercial, +139773,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,United Healthcare-Commercial, +139774,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,United Healthcare-Commercial, +139775,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,United Healthcare-Commercial, +139776,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,United Healthcare-Commercial, +139777,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,United Healthcare-Commercial, +139778,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,United Healthcare-Commercial, +139779,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,United Healthcare-Commercial, +139780,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,United Healthcare-Commercial, +139781,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,United Healthcare-Commercial, +139782,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,United Healthcare-Commercial, +139783,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,United Healthcare-Commercial, +139784,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,United Healthcare-Commercial,193.09 +139785,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,United Healthcare-Commercial,144.25 +139786,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,United Healthcare-Commercial,143.52 +139787,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,United Healthcare-Commercial,236.69 +139788,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,United Healthcare-Commercial,226.6 +139789,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,United Healthcare-Commercial,236.69 +139790,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,United Healthcare-Commercial,193.09 +139791,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,United Healthcare-Commercial,409.39 +139792,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,United Healthcare-Commercial, +139793,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,United Healthcare-Commercial,307.63 +139794,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,United Healthcare-Commercial, +139795,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,United Healthcare-Commercial, +139796,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,United Healthcare-Commercial,207.04 +139797,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,United Healthcare-Commercial,80.92 +139798,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,United Healthcare-Commercial,152.51 +139799,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,United Healthcare-Commercial,265.59 +139800,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,United Healthcare-Commercial,152.51 +139801,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,United Healthcare-Commercial,347.53 +139802,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,United Healthcare-Commercial,167.61 +139803,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,United Healthcare-Commercial, +139804,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,United Healthcare-Commercial, +139805,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,United Healthcare-Commercial,40.46 +139806,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,United Healthcare-Commercial,152.51 +139807,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,United Healthcare-Commercial,77.28 +139808,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,United Healthcare-Commercial,134.0 +139809,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,United Healthcare-Commercial,94.08 +139810,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,United Healthcare-Commercial,52.91 +139811,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,United Healthcare-Commercial,148.87 +139812,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,United Healthcare-Commercial,207.04 +139813,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,United Healthcare-Commercial,320.64 +139814,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,United Healthcare-Commercial, +139815,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,United Healthcare-Commercial,85.23 +139816,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,United Healthcare-Commercial,154.99 +139817,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,United Healthcare-Commercial,154.99 +139818,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,United Healthcare-Commercial,167.61 +139819,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,United Healthcare-Commercial, +139820,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,United Healthcare-Commercial, +139821,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,United Healthcare-Commercial,193.09 +139822,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,United Healthcare-Commercial,152.76 +139823,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,United Healthcare-Commercial,574.44 +139824,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,United Healthcare-Commercial,94.08 +139825,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,United Healthcare-Commercial, +139826,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,United Healthcare-Commercial, +139827,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,United Healthcare-Commercial, +139828,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,United Healthcare-Commercial, +139829,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,United Healthcare-Commercial, +139830,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,United Healthcare-Commercial, +139831,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,United Healthcare-Commercial,531.44 +139832,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,United Healthcare-Commercial, +139833,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,United Healthcare-Commercial,2964.84 +139834,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,United Healthcare-Commercial, +139835,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,United Healthcare-Commercial,4007.78 +139836,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,United Healthcare-Commercial, +139837,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,United Healthcare-Commercial, +139838,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,United Healthcare-Commercial, +139839,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,United Healthcare-Commercial, +139840,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,United Healthcare-Commercial, +139841,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,United Healthcare-Commercial, +139842,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,United Healthcare-Commercial,591.5 +139843,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,United Healthcare-Commercial,652.6 +139844,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,United Healthcare-Commercial,454.07 +139845,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,United Healthcare-Commercial, +139846,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,United Healthcare-Commercial, +139847,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,United Healthcare-Commercial, +139848,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,United Healthcare-Commercial,79.86 +139849,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,United Healthcare-Commercial,215.18 +139850,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,United Healthcare-Commercial,350.44 +139851,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,United Healthcare-Commercial,350.44 +139852,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,United Healthcare-Commercial, +139853,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,United Healthcare-Commercial, +139854,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,United Healthcare-Commercial, +139855,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,United Healthcare-Commercial,106.9 +139856,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,United Healthcare-Commercial,123.12 +139857,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,United Healthcare-Commercial, +139858,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,United Healthcare-Commercial,742.91 +139859,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,United Healthcare-Commercial, +139860,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,United Healthcare-Commercial,583.43 +139861,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,United Healthcare-Commercial,471.08 +139862,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,United Healthcare-Commercial,583.43 +139863,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,United Healthcare-Commercial, +139864,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,United Healthcare-Commercial,396.2 +139865,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,United Healthcare-Commercial, +139866,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,United Healthcare-Commercial,219.33 +139867,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,United Healthcare-Commercial, +139868,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,United Healthcare-Commercial, +139869,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,United Healthcare-Commercial,8.34 +139870,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,United Healthcare-Commercial,1982.65 +139871,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,United Healthcare-Commercial, +139872,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,United Healthcare-Commercial, +139873,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,United Healthcare-Commercial,6009.97 +139874,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,United Healthcare-Commercial,1911.06 +139875,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,United Healthcare-Commercial,3452.71 +139876,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,United Healthcare-Commercial, +139877,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,United Healthcare-Commercial,4060.88 +139878,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,United Healthcare-Commercial,3452.71 +139879,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,United Healthcare-Commercial,3465.16 +139880,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,United Healthcare-Commercial, +139881,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,United Healthcare-Commercial, +139882,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,United Healthcare-Commercial, +139883,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,United Healthcare-Commercial, +139884,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,United Healthcare-Commercial,887.98 +139885,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,United Healthcare-Commercial, +139886,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,United Healthcare-Commercial,4139.34 +139887,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,United Healthcare-Commercial,994.67 +139888,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,United Healthcare-Commercial,1023.29 +139889,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,United Healthcare-Commercial, +139890,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,United Healthcare-Commercial, +139891,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,United Healthcare-Commercial,994.67 +139892,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,United Healthcare-Commercial, +139893,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,United Healthcare-Commercial, +139894,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,United Healthcare-Commercial, +139895,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,United Healthcare-Commercial,23073.4 +139896,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,United Healthcare-Commercial, +139897,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,United Healthcare-Commercial, +139898,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,United Healthcare-Commercial,24757.33 +139899,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,United Healthcare-Commercial, +139900,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,United Healthcare-Commercial,238.33 +139901,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,United Healthcare-Commercial,983.74 +139902,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,United Healthcare-Commercial, +139903,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,United Healthcare-Commercial,141.15 +139904,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,United Healthcare-Commercial,141.88 +139905,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,United Healthcare-Commercial, +139906,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,United Healthcare-Commercial,282.33 +139907,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,United Healthcare-Commercial, +139908,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,United Healthcare-Commercial,108.0 +139909,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,United Healthcare-Commercial,213.23 +139910,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,United Healthcare-Commercial,106.62 +139911,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,United Healthcare-Commercial,712.44 +139912,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,United Healthcare-Commercial,185.76 +139913,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,United Healthcare-Commercial,189.44 +139914,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,United Healthcare-Commercial,79.45 +139915,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,United Healthcare-Commercial,719.76 +139916,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,United Healthcare-Commercial,227.33 +139917,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,United Healthcare-Commercial,863.71 +139918,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,United Healthcare-Commercial,58.0 +139919,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,United Healthcare-Commercial,282.33 +139920,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,United Healthcare-Commercial, +139921,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,United Healthcare-Commercial, +139922,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,United Healthcare-Commercial, +139923,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,United Healthcare-Commercial,345.27 +139924,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,United Healthcare-Commercial,345.27 +139925,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,United Healthcare-Commercial,345.27 +139926,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,United Healthcare-Commercial, +139927,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,United Healthcare-Commercial, +139928,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,United Healthcare-Commercial,345.27 +139929,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,United Healthcare-Commercial,345.27 +139930,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,United Healthcare-Commercial, +139931,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,United Healthcare-Commercial,258.67 +139932,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,United Healthcare-Commercial,3.0 +139933,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,United Healthcare-Commercial,219.7 +139934,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,United Healthcare-Commercial,182.67 +139935,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,United Healthcare-Commercial,37.03 +139936,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,United Healthcare-Commercial, +139937,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,United Healthcare-Commercial, +139938,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,United Healthcare-Commercial,663.21 +139939,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,United Healthcare-Commercial,444.98 +139940,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,United Healthcare-Commercial, +139941,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,United Healthcare-Commercial,161.51 +139942,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,United Healthcare-Commercial,261.01 +139943,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,United Healthcare-Commercial,261.06 +139944,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,United Healthcare-Commercial, +139945,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,United Healthcare-Commercial,761.02 +139946,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,United Healthcare-Commercial,731.91 +139947,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,United Healthcare-Commercial,643.4 +139948,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,United Healthcare-Commercial,930.31 +139949,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,United Healthcare-Commercial, +139950,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,United Healthcare-Commercial,1115.24 +139951,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,United Healthcare-Commercial,930.31 +139952,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,United Healthcare-Commercial, +139953,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,United Healthcare-Commercial,416.6 +139954,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,United Healthcare-Commercial,306.63 +139955,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,United Healthcare-Commercial,306.63 +139956,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,United Healthcare-Commercial,306.63 +139957,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,United Healthcare-Commercial, +139958,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,United Healthcare-Commercial, +139959,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,United Healthcare-Commercial, +139960,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,United Healthcare-Commercial, +139961,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,United Healthcare-Commercial, +139962,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,United Healthcare-Commercial,208.82 +139963,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,United Healthcare-Commercial, +139964,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,United Healthcare-Commercial, +139965,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,United Healthcare-Commercial, +139966,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,United Healthcare-Commercial, +139967,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,United Healthcare-Commercial, +139968,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,United Healthcare-Commercial, +139969,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,United Healthcare-Commercial, +139970,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,United Healthcare-Commercial, +139971,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,United Healthcare-Commercial, +139972,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,United Healthcare-Commercial, +139973,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,United Healthcare-Commercial, +139974,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,United Healthcare-Commercial,223.46 +139975,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,United Healthcare-Commercial,223.46 +139976,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,United Healthcare-Commercial,299.41 +139977,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,United Healthcare-Commercial,75.95 +139978,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,United Healthcare-Commercial,22.73 +139979,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,United Healthcare-Commercial, +139980,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,United Healthcare-Commercial, +139981,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,United Healthcare-Commercial,167.61 +139982,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,United Healthcare-Commercial,42.14 +139983,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,United Healthcare-Commercial,345.53 +139984,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,United Healthcare-Commercial,75.95 +139985,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,United Healthcare-Commercial, +139986,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,United Healthcare-Commercial, +139987,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,United Healthcare-Commercial,414.02 +139988,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,United Healthcare-Commercial,384.37 +139989,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,United Healthcare-Commercial,383.04 +139990,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,United Healthcare-Commercial,463.35 +139991,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,United Healthcare-Commercial,369.62 +139992,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,United Healthcare-Commercial,339.98 +139993,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,United Healthcare-Commercial,97.88 +139994,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,United Healthcare-Commercial,625.75 +139995,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,United Healthcare-Commercial,812.78 +139996,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,United Healthcare-Commercial,362.25 +139997,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,United Healthcare-Commercial,411.63 +139998,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,United Healthcare-Commercial,73.26 +139999,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,United Healthcare-Commercial,268.56 +140000,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,United Healthcare-Commercial,69.7 +140001,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,United Healthcare-Commercial,687.2 +140002,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,United Healthcare-Commercial,375.08 +140003,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,United Healthcare-Commercial,762.35 +140004,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,United Healthcare-Commercial,826.97 +140005,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,United Healthcare-Commercial,459.61 +140006,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,United Healthcare-Commercial, +140007,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,United Healthcare-Commercial,795.84 +140008,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,United Healthcare-Commercial,180.7 +140009,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,United Healthcare-Commercial, +140010,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,United Healthcare-Commercial,25.64 +140011,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,United Healthcare-Commercial, +140012,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,United Healthcare-Commercial,28.31 +140013,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,United Healthcare-Commercial, +140014,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,United Healthcare-Commercial,96.9 +140015,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,United Healthcare-Commercial,13.69 +140016,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,United Healthcare-Commercial,25.31 +140017,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,United Healthcare-Commercial,192.72 +140018,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,United Healthcare-Commercial,57.17 +140019,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,United Healthcare-Commercial,196.9 +140020,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,United Healthcare-Commercial,84.52 +140021,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,United Healthcare-Commercial,62.5 +140022,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,United Healthcare-Commercial,116.13 +140023,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,United Healthcare-Commercial, +140024,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,United Healthcare-Commercial,116.57 +140025,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,United Healthcare-Commercial,142.95 +140026,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,United Healthcare-Commercial,156.46 +140027,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,United Healthcare-Commercial,171.38 +140028,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,United Healthcare-Commercial,292.61 +140029,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,United Healthcare-Commercial, +140030,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,United Healthcare-Commercial,128.83 +140031,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,United Healthcare-Commercial,191.12 +140032,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,United Healthcare-Commercial,182.44 +140033,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,United Healthcare-Commercial, +140034,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,United Healthcare-Commercial,196.9 +140035,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,United Healthcare-Commercial,95.3 +140036,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,United Healthcare-Commercial,772.36 +140037,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,United Healthcare-Commercial, +140038,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,United Healthcare-Commercial,103.67 +140039,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,United Healthcare-Commercial,158.72 +140040,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,United Healthcare-Commercial,67.8 +140041,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,United Healthcare-Commercial, +140042,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,United Healthcare-Commercial, +140043,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,United Healthcare-Commercial,17.36 +140044,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,United Healthcare-Commercial,8.59 +140045,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,United Healthcare-Commercial, +140046,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,United Healthcare-Commercial, +140047,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,United Healthcare-Commercial, +140048,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,United Healthcare-Commercial, +140049,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,United Healthcare-Commercial,90.88 +140050,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,United Healthcare-Commercial,103.6 +140051,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,United Healthcare-Commercial,196.48 +140052,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,United Healthcare-Commercial,194.99 +140053,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,United Healthcare-Commercial,227.37 +140054,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,United Healthcare-Commercial,209.92 +140055,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,United Healthcare-Commercial,216.32 +140056,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,United Healthcare-Commercial,20.0 +140057,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,United Healthcare-Commercial,206.65 +140058,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,United Healthcare-Commercial,203.43 +140059,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,United Healthcare-Commercial,206.1 +140060,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,United Healthcare-Commercial,210.95 +140061,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,United Healthcare-Commercial,206.65 +140062,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,United Healthcare-Commercial,146.1 +140063,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,United Healthcare-Commercial,206.81 +140064,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,United Healthcare-Commercial,212.05 +140065,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,United Healthcare-Commercial,193.24 +140066,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,United Healthcare-Commercial,482.01 +140067,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,United Healthcare-Commercial,273.88 +140068,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,United Healthcare-Commercial,1963.0 +140069,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,United Healthcare-Commercial,1549.82 +140070,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,United Healthcare-Commercial,6645.78 +140071,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,United Healthcare-Commercial,2511.78 +140072,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,United Healthcare-Commercial,199.47 +140073,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,United Healthcare-Commercial,199.47 +140074,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,United Healthcare-Commercial,199.47 +140075,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,United Healthcare-Commercial,199.88 +140076,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,United Healthcare-Commercial,199.47 +140077,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,United Healthcare-Commercial,200.1 +140078,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,United Healthcare-Commercial, +140079,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,United Healthcare-Commercial,193.14 +140080,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,United Healthcare-Commercial,168.39 +140081,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,United Healthcare-Commercial,199.47 +140082,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,United Healthcare-Commercial,199.47 +140083,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,United Healthcare-Commercial,202.34 +140084,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,United Healthcare-Commercial,199.86 +140085,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,United Healthcare-Commercial, +140086,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,United Healthcare-Commercial, +140087,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,United Healthcare-Commercial,128.54 +140088,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,United Healthcare-Commercial,91.21 +140089,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,United Healthcare-Commercial, +140090,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,United Healthcare-Commercial, +140091,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,United Healthcare-Commercial,66.4 +140092,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,United Healthcare-Commercial,66.4 +140093,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,United Healthcare-Commercial, +140094,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,United Healthcare-Commercial, +140095,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,United Healthcare-Commercial,254.73 +140096,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,United Healthcare-Commercial,127994.08 +140097,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,United Healthcare-Commercial, +140098,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,United Healthcare-Commercial, +140099,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,United Healthcare-Commercial,416.78 +140100,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,United Healthcare-Commercial, +140101,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,United Healthcare-Commercial,51930.06 +140102,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,United Healthcare-Commercial,416.83 +140103,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,United Healthcare-Commercial,25737.06 +140104,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,United Healthcare-Commercial,57919.04 +140105,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,United Healthcare-Commercial, +140106,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,United Healthcare-Commercial,32535.22 +140107,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,United Healthcare-Commercial,14506.48 +140108,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,United Healthcare-Commercial,1855.57 +140109,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,United Healthcare-Commercial, +140110,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,United Healthcare-Commercial, +140111,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,United Healthcare-Commercial,15997.67 +140112,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,United Healthcare-Commercial, +140113,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,United Healthcare-Commercial,8683.89 +140114,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,United Healthcare-Commercial, +140115,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,United Healthcare-Commercial, +140116,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,United Healthcare-Commercial,20895.84 +140117,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,United Healthcare-Commercial,12727.4 +140118,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,United Healthcare-Commercial,7178.13 +140119,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,United Healthcare-Commercial,860.04 +140120,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,United Healthcare-Commercial, +140121,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,United Healthcare-Commercial, +140122,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,United Healthcare-Commercial,6329.6 +140123,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,United Healthcare-Commercial, +140124,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,United Healthcare-Commercial, +140125,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,United Healthcare-Commercial,7763.51 +140126,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,United Healthcare-Commercial,5698.89 +140127,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,United Healthcare-Commercial,11754.4 +140128,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,United Healthcare-Commercial, +140129,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,United Healthcare-Commercial,6449.08 +140130,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,United Healthcare-Commercial, +140131,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,United Healthcare-Commercial,6111.64 +140132,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,United Healthcare-Commercial,8424.61 +140133,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,United Healthcare-Commercial, +140134,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,United Healthcare-Commercial,29818.5 +140135,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,United Healthcare-Commercial, +140136,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,United Healthcare-Commercial,16433.76 +140137,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,United Healthcare-Commercial, +140138,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,United Healthcare-Commercial,17156.59 +140139,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,United Healthcare-Commercial,13586.85 +140140,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,United Healthcare-Commercial, +140141,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,United Healthcare-Commercial,5660.32 +140142,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,United Healthcare-Commercial,4500.9 +140143,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,United Healthcare-Commercial, +140144,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,United Healthcare-Commercial,17595.19 +140145,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,United Healthcare-Commercial,24662.84 +140146,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,United Healthcare-Commercial,43824.77 +140147,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,United Healthcare-Commercial,17988.79 +140148,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,United Healthcare-Commercial,9771.61 +140149,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,United Healthcare-Commercial,8542.67 +140150,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,United Healthcare-Commercial,10649.51 +140151,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,United Healthcare-Commercial,12352.81 +140152,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,United Healthcare-Commercial,15799.85 +140153,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,United Healthcare-Commercial,10718.9 +140154,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,United Healthcare-Commercial,7939.21 +140155,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,United Healthcare-Commercial,8895.28 +140156,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,United Healthcare-Commercial,7982.11 +140157,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,United Healthcare-Commercial, +140158,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,United Healthcare-Commercial,4952.42 +140159,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,United Healthcare-Commercial,5217.57 +140160,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,United Healthcare-Commercial,163105.89 +140161,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,United Healthcare-Commercial,54226.92 +140162,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,United Healthcare-Commercial, +140163,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,United Healthcare-Commercial, +140164,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,United Healthcare-Commercial, +140165,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,United Healthcare-Commercial,47674.64 +140166,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,United Healthcare-Commercial, +140167,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,United Healthcare-Commercial,19147.69 +140168,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,United Healthcare-Commercial,16232.65 +140169,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,United Healthcare-Commercial,15467.21 +140170,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,United Healthcare-Commercial, +140171,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,United Healthcare-Commercial,35030.67 +140172,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,United Healthcare-Commercial,27331.17 +140173,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,United Healthcare-Commercial,23841.82 +140174,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,United Healthcare-Commercial,6304.33 +140175,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,United Healthcare-Commercial,7550.72 +140176,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,United Healthcare-Commercial,30033.93 +140177,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,United Healthcare-Commercial,16290.99 +140178,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,United Healthcare-Commercial,14073.98 +140179,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,United Healthcare-Commercial, +140180,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,United Healthcare-Commercial,34846.27 +140181,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,United Healthcare-Commercial,4891.06 +140182,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,United Healthcare-Commercial,6489.94 +140183,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,United Healthcare-Commercial, +140184,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,United Healthcare-Commercial,8837.06 +140185,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,United Healthcare-Commercial,6444.56 +140186,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,United Healthcare-Commercial,5260.36 +140187,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,United Healthcare-Commercial, +140188,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,United Healthcare-Commercial,9913.54 +140189,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,United Healthcare-Commercial, +140190,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,United Healthcare-Commercial,14517.91 +140191,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,United Healthcare-Commercial,21701.14 +140192,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,United Healthcare-Commercial,24536.95 +140193,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,United Healthcare-Commercial,10118.56 +140194,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,United Healthcare-Commercial,12636.95 +140195,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,United Healthcare-Commercial,10768.61 +140196,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,United Healthcare-Commercial, +140197,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,United Healthcare-Commercial,8695.49 +140198,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,United Healthcare-Commercial, +140199,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,United Healthcare-Commercial,23405.69 +140200,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,United Healthcare-Commercial,14800.56 +140201,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,United Healthcare-Commercial,10778.7 +140202,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,United Healthcare-Commercial,23282.61 +140203,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,United Healthcare-Commercial,5639.14 +140204,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,United Healthcare-Commercial,6064.26 +140205,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,United Healthcare-Commercial,11725.67 +140206,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,United Healthcare-Commercial,9852.18 +140207,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,United Healthcare-Commercial,15467.14 +140208,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,United Healthcare-Commercial,5152.46 +140209,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,United Healthcare-Commercial,5381.13 +140210,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,United Healthcare-Commercial,21068.82 +140211,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,United Healthcare-Commercial,10521.71 +140212,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,United Healthcare-Commercial,9780.64 +140213,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,United Healthcare-Commercial,12743.99 +140214,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,United Healthcare-Commercial,20425.75 +140215,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,United Healthcare-Commercial,10458.2 +140216,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,United Healthcare-Commercial,50437.45 +140217,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,United Healthcare-Commercial,8939.3 +140218,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,United Healthcare-Commercial,12013.51 +140219,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,United Healthcare-Commercial, +140220,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,United Healthcare-Commercial,12838.26 +140221,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,United Healthcare-Commercial,9594.03 +140222,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,United Healthcare-Commercial,10471.44 +140223,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,United Healthcare-Commercial,19020.74 +140224,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,United Healthcare-Commercial,20121.31 +140225,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,United Healthcare-Commercial,40790.35 +140226,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,United Healthcare-Commercial,38526.93 +140227,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,United Healthcare-Commercial,31728.66 +140228,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,United Healthcare-Commercial,16950.37 +140229,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,United Healthcare-Commercial,25143.98 +140230,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,United Healthcare-Commercial,7272.82 +140231,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,United Healthcare-Commercial, +140232,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,United Healthcare-Commercial,16628.78 +140233,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,United Healthcare-Commercial,13105.75 +140234,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,United Healthcare-Commercial,13015.93 +140235,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,United Healthcare-Commercial,16110.26 +140236,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,United Healthcare-Commercial,11292.14 +140237,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,United Healthcare-Commercial,9261.67 +140238,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,United Healthcare-Commercial,14138.07 +140239,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,United Healthcare-Commercial,13649.14 +140240,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,United Healthcare-Commercial, +140241,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,United Healthcare-Commercial,5768.21 +140242,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,United Healthcare-Commercial,6963.96 +140243,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,United Healthcare-Commercial,16484.04 +140244,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,United Healthcare-Commercial,42460.01 +140245,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,United Healthcare-Commercial,4994.91 +140246,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,United Healthcare-Commercial,7311.31 +140247,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,United Healthcare-Commercial,7922.37 +140248,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,United Healthcare-Commercial,29374.7 +140249,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,United Healthcare-Commercial,13922.74 +140250,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,United Healthcare-Commercial,11796.75 +140251,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,United Healthcare-Commercial,10939.94 +140252,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,United Healthcare-Commercial,6996.24 +140253,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,United Healthcare-Commercial,11420.96 +140254,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,United Healthcare-Commercial,6347.78 +140255,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,United Healthcare-Commercial,5254.92 +140256,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,United Healthcare-Commercial,14230.59 +140257,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,United Healthcare-Commercial,11095.56 +140258,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,United Healthcare-Commercial,7234.12 +140259,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,United Healthcare-Commercial,60065.49 +140260,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,United Healthcare-Commercial,7162.75 +140261,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,United Healthcare-Commercial,17410.27 +140262,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,United Healthcare-Commercial,7512.71 +140263,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,United Healthcare-Commercial, +140264,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,United Healthcare-Commercial,9971.94 +140265,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,United Healthcare-Commercial,8340.0 +140266,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,United Healthcare-Commercial, +140267,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,United Healthcare-Commercial, +140268,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,United Healthcare-Commercial,16401.56 +140269,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,United Healthcare-Commercial,18038.72 +140270,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,United Healthcare-Commercial,28636.74 +140271,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,United Healthcare-Commercial, +140272,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,United Healthcare-Commercial,21710.75 +140273,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,United Healthcare-Commercial, +140274,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,United Healthcare-Commercial,8068.48 +140275,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,United Healthcare-Commercial,6122.44 +140276,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,United Healthcare-Commercial, +140277,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,United Healthcare-Commercial, +140278,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,United Healthcare-Commercial, +140279,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,United Healthcare-Commercial,9984.41 +140280,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,United Healthcare-Commercial,15115.18 +140281,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,United Healthcare-Commercial, +140282,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,United Healthcare-Commercial, +140283,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,United Healthcare-Commercial,19063.83 +140284,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,United Healthcare-Commercial,8482.01 +140285,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,United Healthcare-Commercial,8118.3 +140286,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,United Healthcare-Commercial, +140287,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,United Healthcare-Commercial,7168.16 +140288,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,United Healthcare-Commercial, +140289,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,United Healthcare-Commercial, +140290,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,United Healthcare-Commercial, +140291,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,United Healthcare-Commercial,38196.5 +140292,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,United Healthcare-Commercial,7047.17 +140293,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,United Healthcare-Commercial,5900.84 +140294,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,United Healthcare-Commercial, +140295,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,United Healthcare-Commercial, +140296,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,United Healthcare-Commercial,5440.75 +140297,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,United Healthcare-Commercial,6461.72 +140298,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,United Healthcare-Commercial,3801.27 +140299,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,United Healthcare-Commercial,3874.31 +140300,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,United Healthcare-Commercial, +140301,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,United Healthcare-Commercial, +140302,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,United Healthcare-Commercial,5258.22 +140303,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,United Healthcare-Commercial,178232.75 +140304,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,United Healthcare-Commercial, +140305,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,United Healthcare-Commercial, +140306,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,United Healthcare-Commercial,107297.74 +140307,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,United Healthcare-Commercial,65373.48 +140308,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,United Healthcare-Commercial,58779.46 +140309,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,United Healthcare-Commercial,41458.51 +140310,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,United Healthcare-Commercial,20744.9 +140311,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,United Healthcare-Commercial,7511.3 +140312,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,United Healthcare-Commercial,18004.74 +140313,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,United Healthcare-Commercial,17107.65 +140314,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,United Healthcare-Commercial,5075.13 +140315,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,United Healthcare-Commercial,21807.61 +140316,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,United Healthcare-Commercial,19840.26 +140317,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,United Healthcare-Commercial,13850.84 +140318,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,United Healthcare-Commercial,18576.2 +140319,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,United Healthcare-Commercial,11264.35 +140320,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,United Healthcare-Commercial,2717.56 +140321,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,United Healthcare-Commercial, +140322,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,United Healthcare-Commercial,7484.17 +140323,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,United Healthcare-Commercial,17421.21 +140324,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,United Healthcare-Commercial,10634.1 +140325,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,United Healthcare-Commercial,9104.73 +140326,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,United Healthcare-Commercial, +140327,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,United Healthcare-Commercial,20231.38 +140328,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,United Healthcare-Commercial,43686.72 +140329,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,United Healthcare-Commercial, +140330,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,United Healthcare-Commercial, +140331,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,United Healthcare-Commercial, +140332,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,United Healthcare-Commercial,8610.82 +140333,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,United Healthcare-Commercial,54673.88 +140334,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,United Healthcare-Commercial,21715.39 +140335,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,United Healthcare-Commercial,28380.09 +140336,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,United Healthcare-Commercial,17872.27 +140337,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,United Healthcare-Commercial,8717.16 +140338,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,United Healthcare-Commercial,20002.04 +140339,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,United Healthcare-Commercial, +140340,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,United Healthcare-Commercial, +140341,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,United Healthcare-Commercial,13697.41 +140342,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,United Healthcare-Commercial,16966.2 +140343,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,United Healthcare-Commercial,7878.18 +140344,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,United Healthcare-Commercial,14059.16 +140345,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,United Healthcare-Commercial,16575.98 +140346,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,United Healthcare-Commercial,4806.52 +140347,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,United Healthcare-Commercial,6977.84 +140348,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,United Healthcare-Commercial,7904.27 +140349,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,United Healthcare-Commercial, +140350,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,United Healthcare-Commercial, +140351,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,United Healthcare-Commercial,5348.04 +140352,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,United Healthcare-Commercial,16537.2 +140353,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,United Healthcare-Commercial,8211.06 +140354,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,United Healthcare-Commercial,5686.18 +140355,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,United Healthcare-Commercial,7883.43 +140356,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,United Healthcare-Commercial,5109.55 +140357,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,United Healthcare-Commercial,15557.83 +140358,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,United Healthcare-Commercial,9626.77 +140359,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,United Healthcare-Commercial,11484.19 +140360,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,United Healthcare-Commercial,9210.23 +140361,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,United Healthcare-Commercial, +140362,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,United Healthcare-Commercial,15875.65 +140363,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,United Healthcare-Commercial,21108.96 +140364,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,United Healthcare-Commercial,15783.82 +140365,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,United Healthcare-Commercial,23858.73 +140366,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,United Healthcare-Commercial,10055.06 +140367,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,United Healthcare-Commercial,9948.88 +140368,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,United Healthcare-Commercial, +140369,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,United Healthcare-Commercial, +140370,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,United Healthcare-Commercial,46719.62 +140371,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,United Healthcare-Commercial,34599.17 +140372,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,United Healthcare-Commercial,7445.38 +140373,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,United Healthcare-Commercial,58081.95 +140374,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,United Healthcare-Commercial,32712.39 +140375,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,United Healthcare-Commercial, +140376,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,United Healthcare-Commercial,440.0 +140377,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,United Healthcare-Commercial,1271.0 +140378,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,United Healthcare-Commercial,1250.0 +140379,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,United Healthcare-Commercial,1000.0 +140380,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,United Healthcare-Commercial,1500.0 +140381,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,United Healthcare-Commercial, +140382,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,United Healthcare-Commercial,1500.0 +140383,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,United Healthcare-Commercial, +140384,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,United Healthcare-Commercial, +140385,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,United Healthcare-Commercial, +140386,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,United Healthcare-Commercial, +140387,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,United Healthcare-Commercial, +140388,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,United Healthcare-Commercial, +140389,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,United Healthcare-Commercial, +140390,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,United Healthcare-Commercial, +140391,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,United Healthcare-Commercial, +140392,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,United Healthcare-Commercial, +140393,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,United Healthcare-Commercial, +140394,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,United Healthcare-Commercial, +140395,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,United Healthcare-Commercial, +140396,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,United Healthcare-Commercial, +140397,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,United Healthcare-Commercial, +140398,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,United Healthcare-Commercial, +140399,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,United Healthcare-Commercial,613.93 +140400,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,United Healthcare-Commercial, +140401,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,United Healthcare-Commercial, +140402,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,United Healthcare-Commercial, +140403,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,United Healthcare-Commercial, +140404,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,United Healthcare-Commercial, +140405,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,United Healthcare-Commercial, +140406,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,United Healthcare-Commercial, +140407,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,United Healthcare-Commercial, +140408,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,United Healthcare-Commercial, +140409,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,United Healthcare-Commercial, +140410,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,United Healthcare-Commercial, +140411,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,United Healthcare-Commercial, +140412,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,United Healthcare-Commercial, +140413,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,United Healthcare-Commercial, +140414,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,United Healthcare-Commercial, +140415,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,United Healthcare-Commercial, +140416,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,United Healthcare-Commercial, +140417,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,United Healthcare-Commercial, +140418,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,United Healthcare-Commercial, +140419,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,United Healthcare-Commercial, +140420,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,United Healthcare-Commercial,10297.4 +140421,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,United Healthcare-Commercial, +140422,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,United Healthcare-Commercial, +140423,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,United Healthcare-Commercial, +140424,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,United Healthcare-Commercial,1058.83 +140425,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,United Healthcare-Commercial, +140426,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,United Healthcare-Commercial, +140427,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,United Healthcare-Commercial, +140428,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,United Healthcare-Commercial,115.89 +140429,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,United Healthcare-Commercial,3466.19 +140430,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,United Healthcare-Commercial, +140431,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,United Healthcare-Commercial, +140432,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,United Healthcare-Commercial,3441.97 +140433,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,United Healthcare-Commercial, +140434,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,United Healthcare-Commercial, +140435,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,United Healthcare-Commercial, +140436,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,United Healthcare-Commercial, +140437,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,United Healthcare-Commercial, +140438,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,United Healthcare-Commercial, +140439,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,United Healthcare-Commercial, +140440,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,United Healthcare-Commercial, +140441,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,United Healthcare-Commercial, +140442,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,United Healthcare-Commercial, +140443,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,United Healthcare-Commercial, +140444,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,United Healthcare-Commercial, +140445,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,United Healthcare-Commercial,1033.15 +140446,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,United Healthcare-Commercial, +140447,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,United Healthcare-Commercial, +140448,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,United Healthcare-Commercial, +140449,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,United Healthcare-Commercial, +140450,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,United Healthcare-Commercial, +140451,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,United Healthcare-Commercial, +140452,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,United Healthcare-Commercial,5496.98 +140453,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,United Healthcare-Commercial, +140454,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,United Healthcare-Commercial, +140455,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,United Healthcare-Commercial, +140456,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,United Healthcare-Commercial, +140457,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,United Healthcare-Commercial, +140458,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,United Healthcare-Commercial, +140459,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,United Healthcare-Commercial, +140460,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,United Healthcare-Commercial, +140461,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,United Healthcare-Commercial, +140462,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,United Healthcare-Commercial, +140463,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,United Healthcare-Commercial, +140464,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,United Healthcare-Commercial, +140465,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,United Healthcare-Commercial, +140466,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,United Healthcare-Commercial, +140467,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,United Healthcare-Commercial, +140468,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,United Healthcare-Commercial, +140469,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,United Healthcare-Commercial, +140470,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,United Healthcare-Commercial, +140471,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,United Healthcare-Commercial, +140472,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,United Healthcare-Commercial, +140473,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,United Healthcare-Commercial, +140474,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,United Healthcare-Commercial,401.15 +140475,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,United Healthcare-Commercial, +140476,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,United Healthcare-Commercial,1033.15 +140477,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,United Healthcare-Commercial, +140478,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,United Healthcare-Commercial, +140479,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,United Healthcare-Commercial, +140480,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,United Healthcare-Commercial, +140481,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,United Healthcare-Commercial, +140482,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,United Healthcare-Commercial, +140483,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,United Healthcare-Commercial,3172.15 +140484,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,United Healthcare-Commercial, +140485,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,United Healthcare-Commercial, +140486,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,United Healthcare-Commercial,12.84 +140487,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,United Healthcare-Commercial,18.5 +140488,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,United Healthcare-Commercial, +140489,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,United Healthcare-Commercial, +140490,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,United Healthcare-Commercial, +140491,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,United Healthcare-Commercial, +140492,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,United Healthcare-Commercial, +140493,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,United Healthcare-Commercial, +140494,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,United Healthcare-Commercial, +140495,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,United Healthcare-Commercial, +140496,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,United Healthcare-Commercial, +140497,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,United Healthcare-Commercial, +140498,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,United Healthcare-Commercial, +140499,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,United Healthcare-Commercial, +140500,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,United Healthcare-Commercial, +140501,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,United Healthcare-Commercial, +140502,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,United Healthcare-Commercial, +140503,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,United Healthcare-Commercial,574.74 +140504,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,United Healthcare-Commercial,462.61 +140505,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,United Healthcare-Commercial, +140506,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,United Healthcare-Commercial, +140507,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,United Healthcare-Commercial, +140508,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,United Healthcare-Commercial,209.46 +140509,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,United Healthcare-Commercial,636.81 +140510,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,United Healthcare-Commercial,1228.88 +140511,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,United Healthcare-Commercial, +140512,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,United Healthcare-Commercial,4.5 +140513,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,United Healthcare-Commercial,5243.64 +140514,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,United Healthcare-Commercial, +140515,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,United Healthcare-Commercial, +140516,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,United Healthcare-Commercial, +140517,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,United Healthcare-Commercial, +140518,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,United Healthcare-Commercial, +140519,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,United Healthcare-Commercial,439.28 +140520,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,United Healthcare-Commercial,13634.53 +140521,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,United Healthcare-Commercial, +140522,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,United Healthcare-Commercial,19311.27 +140523,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,United Healthcare-Commercial, +140524,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,United Healthcare-Commercial,12004.12 +140525,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,United Healthcare-Commercial,18438.91 +140526,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,United Healthcare-Commercial,5168.41 +140527,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,United Healthcare-Commercial, +140528,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,United Healthcare-Commercial, +140529,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,United Healthcare-Commercial, +140530,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,United Healthcare-Commercial, +140531,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,United Healthcare-Commercial, +140532,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,United Healthcare-Commercial,27.22 +140533,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,United Healthcare-Commercial,63.82 +140534,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,United Healthcare-Commercial, +140535,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,United Healthcare-Commercial, +140536,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,United Healthcare-Commercial,244.03 +140537,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,United Healthcare-Commercial, +140538,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,United Healthcare-Commercial, +140539,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,United Healthcare-Commercial, +140540,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,United Healthcare-Commercial, +140541,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,United Healthcare-Commercial, +140542,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,United Healthcare-Commercial, +140543,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,United Healthcare-Commercial, +140544,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,United Healthcare-Commercial, +140545,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,United Healthcare-Commercial, +140546,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,United Healthcare-Commercial, +140547,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,United Healthcare-Commercial, +140548,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,United Healthcare-Commercial, +140549,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,United Healthcare-Commercial, +140550,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,United Healthcare-Commercial, +140551,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,United Healthcare-Commercial, +140552,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,United Healthcare-Commercial,178.41 +140553,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,United Healthcare-Commercial,5063.0 +140554,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,United Healthcare-Commercial,206.35 +140555,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,United Healthcare-Commercial, +140556,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,United Healthcare-Commercial, +140557,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,United Healthcare-Commercial, +140558,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,United Healthcare-Commercial,230.19 +140559,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,United Healthcare-Commercial,163.14 +140560,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,United Healthcare-Commercial, +140561,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,United Healthcare-Commercial,135.0 +140562,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,United Healthcare-Commercial, +140563,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,United Healthcare-Commercial, +140564,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,United Healthcare-Commercial, +140565,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,United Healthcare-Commercial,244.78 +140566,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,United Healthcare-Commercial, +140567,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,United Healthcare-Commercial,46.51 +140568,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,United Healthcare-Commercial,60.34 +140569,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,United Healthcare-Commercial, +140570,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,United Healthcare-Commercial, +140571,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,United Healthcare-Commercial, +140572,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,United Healthcare-Commercial,909.98 +140573,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,United Healthcare-Commercial,131.78 +140574,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,United Healthcare-Commercial, +140575,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,United Healthcare-Commercial, +140576,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,United Healthcare-Commercial,22.51 +140577,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,United Healthcare-Commercial, +140578,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,United Healthcare-Commercial,31.15 +140579,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,United Healthcare-Commercial,25.31 +140580,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,United Healthcare-Commercial,102.28 +140581,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,United Healthcare-Commercial,2412.67 +140582,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,United Healthcare-Commercial, +140583,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,United Healthcare-Commercial, +140584,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,United Healthcare-Commercial,1100.44 +140585,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,United Healthcare-Commercial,163.33 +140586,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,United Healthcare-Commercial, +140587,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,United Healthcare-Commercial,199.47 +140588,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,United Healthcare-Commercial,188.58 +140589,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,United Healthcare-Commercial, +140590,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,United Healthcare-Commercial, +140591,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,United Healthcare-Commercial,1997.0 +140592,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,United Healthcare-Commercial,120.24 +140593,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,United Healthcare-Commercial,58.78 +140594,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,United Healthcare-Commercial, +140595,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,United Healthcare-Commercial, +140596,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,United Healthcare-Commercial,39.0 +140597,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,United Healthcare-Commercial, +140598,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,United Healthcare-Commercial, +140599,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,United Healthcare-Commercial, +140600,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,United Healthcare-Commercial, +140601,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,United Healthcare-Commercial, +140602,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,United Healthcare-Commercial, +140603,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,United Healthcare-Commercial, +140604,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,United Healthcare-Commercial, +140605,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,United Healthcare-Commercial, +140606,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,United Healthcare-Commercial, +140607,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,United Healthcare-Commercial, +140608,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,United Healthcare-Commercial, +140609,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,United Healthcare-Commercial, +140610,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,United Healthcare-Commercial, +140611,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,United Healthcare-Commercial, +140612,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,United Healthcare-Commercial, +140613,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,United Healthcare-Commercial,1895.09 +140614,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,United Healthcare-Commercial, +140615,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,United Healthcare-Commercial, +140616,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,United Healthcare-Commercial,90.18 +140617,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,United Healthcare-Commercial,412.87 +140618,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,United Healthcare-Commercial,364.95 +140619,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,United Healthcare-Commercial,329.46 +140620,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,United Healthcare-Commercial, +140621,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,United Healthcare-Commercial, +140622,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,United Healthcare-Commercial,1966.14 +140623,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,United Healthcare-Commercial, +140624,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,United Healthcare-Commercial,115.17 +140625,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,United Healthcare-Commercial, +140626,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,United Healthcare-Commercial, +140627,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,United Healthcare-Commercial, +140628,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,United Healthcare-Commercial,2.39 +140629,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,United Healthcare-Commercial, +140630,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,United Healthcare-Commercial, +140631,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,United Healthcare-Commercial, +140632,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,United Healthcare-Commercial, +140633,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,United Healthcare-Commercial,1.1 +140634,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,United Healthcare-Commercial, +140635,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,United Healthcare-Commercial, +140636,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,United Healthcare-Commercial, +140637,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,United Healthcare-Commercial,40.11 +140638,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,United Healthcare-Commercial, +140639,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,United Healthcare-Commercial, +140640,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,United Healthcare-Commercial,308.96 +140641,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,United Healthcare-Commercial,144.3 +140642,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,United Healthcare-Commercial, +140643,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,United Healthcare-Commercial, +140644,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,United Healthcare-Commercial, +140645,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,United Healthcare-Commercial, +140646,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,United Healthcare-Commercial,20.4 +140647,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,United Healthcare-Commercial, +140648,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,United Healthcare-Commercial, +140649,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,United Healthcare-Commercial, +140650,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,United Healthcare-Commercial,29.78 +140651,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,United Healthcare-Commercial, +140652,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,United Healthcare-Commercial,5.18 +140653,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,United Healthcare-Commercial,0.62 +140654,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,United Healthcare-Commercial, +140655,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,United Healthcare-Commercial, +140656,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,United Healthcare-Commercial, +140657,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,United Healthcare-Commercial, +140658,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,United Healthcare-Commercial, +140659,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,United Healthcare-Commercial, +140660,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,United Healthcare-Commercial, +140661,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,United Healthcare-Commercial,606.75 +140662,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,United Healthcare-Commercial,431.64 +140663,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,United Healthcare-Commercial, +140664,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,United Healthcare-Commercial,195.69 +140665,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,United Healthcare-Commercial,416.87 +140666,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,United Healthcare-Commercial,4242.7 +140667,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,United Healthcare-Commercial, +140668,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,United Healthcare-Commercial, +140669,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,United Healthcare-Commercial,1347.5 +140670,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,United Healthcare-Commercial, +140671,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,United Healthcare-Commercial,799.28 +140672,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,United Healthcare-Commercial,142.15 +140673,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,United Healthcare-Commercial,0.99 +140674,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,United Healthcare-Commercial, +140675,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,United Healthcare-Commercial,0.32 +140676,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,United Healthcare-Commercial,1.54 +140677,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,United Healthcare-Commercial,4.97 +140678,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,United Healthcare-Commercial, +140679,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,United Healthcare-Commercial, +140680,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,United Healthcare-Commercial, +140681,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,United Healthcare-Commercial, +140682,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,United Healthcare-Commercial,3927.0 +140683,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,United Healthcare-Commercial,49.23 +140684,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,United Healthcare-Commercial, +140685,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,United Healthcare-Commercial,415.34 +140686,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,United Healthcare-Commercial,1.06 +140687,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,United Healthcare-Commercial, +140688,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,United Healthcare-Commercial,1.31 +140689,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,United Healthcare-Commercial, +140690,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,United Healthcare-Commercial, +140691,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,United Healthcare-Commercial, +140692,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,United Healthcare-Commercial,0.4 +140693,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,United Healthcare-Commercial, +140694,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,United Healthcare-Commercial,0.45 +140695,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,United Healthcare-Commercial, +140696,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,United Healthcare-Commercial, +140697,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,United Healthcare-Commercial, +140698,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,United Healthcare-Commercial, +140699,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,United Healthcare-Commercial, +140700,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,United Healthcare-Commercial, +140701,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,United Healthcare-Commercial,9.03 +140702,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,United Healthcare-Commercial, +140703,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,United Healthcare-Commercial,1.87 +140704,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,United Healthcare-Commercial, +140705,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,United Healthcare-Commercial,20.0 +140706,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,United Healthcare-Commercial, +140707,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,United Healthcare-Commercial, +140708,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,United Healthcare-Commercial, +140709,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,United Healthcare-Commercial, +140710,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,United Healthcare-Commercial, +140711,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,United Healthcare-Commercial, +140712,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,United Healthcare-Commercial, +140713,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,United Healthcare-Commercial, +140714,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,United Healthcare-Commercial,0.39 +140715,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,United Healthcare-Commercial,51.18 +140716,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,United Healthcare-Commercial,3910.44 +140717,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,United Healthcare-Commercial, +140718,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,United Healthcare-Commercial,22.55 +140719,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,United Healthcare-Commercial, +140720,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,United Healthcare-Commercial, +140721,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,United Healthcare-Commercial, +140722,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,United Healthcare-Commercial, +140723,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,United Healthcare-Commercial,121.45 +140724,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,United Healthcare-Commercial, +140725,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,United Healthcare-Commercial, +140726,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,United Healthcare-Commercial,7.0 +140727,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,United Healthcare-Commercial, +140728,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,United Healthcare-Commercial,1100.44 +140729,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,United Healthcare-Commercial, +140730,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,United Healthcare-Commercial, +140731,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,United Healthcare-Commercial,81.16 +140732,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,United Healthcare-Commercial,363.69 +140733,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,United Healthcare-Commercial, +140734,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,United Healthcare-Commercial, +140735,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,United Healthcare-Commercial, +140736,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,United Healthcare-Commercial, +140737,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,United Healthcare-Commercial,8.52 +140738,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,United Healthcare-Commercial, +140739,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,United Healthcare-Commercial,255.7 +140740,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,United Healthcare-Commercial,2.17 +140741,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,United Healthcare-Commercial, +140742,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,United Healthcare-Commercial, +140743,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,United Healthcare-Commercial, +140744,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,United Healthcare-Commercial,840.32 +140745,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,United Healthcare-Commercial,840.32 +140746,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,United Healthcare-Commercial, +140747,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,United Healthcare-Commercial,3981.41 +140748,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,United Healthcare-Commercial, +140749,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,United Healthcare-Commercial, +140750,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,United Healthcare-Commercial,10894.2 +140751,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,United Healthcare-Commercial, +140752,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,United Healthcare-Commercial,2.53 +140753,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,United Healthcare-Commercial, +140754,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,United Healthcare-Commercial, +140755,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,United Healthcare-Commercial, +140756,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,United Healthcare-Commercial, +140757,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,United Healthcare-Commercial, +140758,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,United Healthcare-Commercial,50.8 +140759,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,United Healthcare-Commercial,0.15 +140760,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,United Healthcare-Commercial,270.0 +140761,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,United Healthcare-Commercial,5.08 +140762,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,United Healthcare-Commercial, +140763,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,United Healthcare-Commercial, +140764,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,United Healthcare-Commercial,7.02 +140765,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,United Healthcare-Commercial, +140766,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,United Healthcare-Commercial, +140767,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,United Healthcare-Commercial,7.02 +140768,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,United Healthcare-Commercial, +140769,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,United Healthcare-Commercial, +140770,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,United Healthcare-Commercial, +140771,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,United Healthcare-Commercial, +140772,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,United Healthcare-Commercial,328.38 +140773,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,United Healthcare-Commercial,429.66 +140774,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,United Healthcare-Commercial, +140775,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,United Healthcare-Commercial, +140776,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,United Healthcare-Commercial, +140777,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,United Healthcare-Commercial, +140778,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,United Healthcare-Commercial, +140779,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,United Healthcare-Commercial, +140780,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,United Healthcare-Commercial, +140781,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,United Healthcare-Commercial,1.54 +140782,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,United Healthcare-Commercial, +140783,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,United Healthcare-Commercial, +140784,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,United Healthcare-Commercial, +140785,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,United Healthcare-Commercial, +140786,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,United Healthcare-Commercial, +140787,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,United Healthcare-Commercial, +140788,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,United Healthcare-Commercial, +140789,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,United Healthcare-Commercial, +140790,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,United Healthcare-Commercial, +140791,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,United Healthcare-Commercial,21.55 +140792,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,United Healthcare-Commercial, +140793,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,United Healthcare-Commercial,4.74 +140794,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,United Healthcare-Commercial, +140795,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,United Healthcare-Commercial, +140796,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,United Healthcare-Commercial, +140797,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,United Healthcare-Commercial,3.0 +140798,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,United Healthcare-Commercial, +140799,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,United Healthcare-Commercial,7245.48 +140800,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,United Healthcare-Commercial, +140801,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,United Healthcare-Commercial,192.86 +140802,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,United Healthcare-Commercial, +140803,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,United Healthcare-Commercial, +140804,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,United Healthcare-Commercial,2803.07 +140805,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,United Healthcare-Commercial, +140806,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,United Healthcare-Commercial, +140807,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,United Healthcare-Commercial, +140808,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,United Healthcare-Commercial, +140809,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,United Healthcare-Commercial, +140810,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,United Healthcare-Commercial,25.04 +140811,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,United Healthcare-Commercial, +140812,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,United Healthcare-Commercial, +140813,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,United Healthcare-Commercial,11.84 +140814,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,United Healthcare-Commercial,475.6 +140815,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,United Healthcare-Commercial,0.63 +140816,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,United Healthcare-Commercial, +140817,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,United Healthcare-Commercial,0.05 +140818,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,United Healthcare-Commercial, +140819,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,United Healthcare-Commercial, +140820,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,United Healthcare-Commercial, +140821,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,United Healthcare-Commercial, +140822,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,United Healthcare-Commercial,63.2 +140823,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,United Healthcare-Commercial,5328.39 +140824,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,United Healthcare-Commercial, +140825,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,United Healthcare-Commercial, +140826,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,United Healthcare-Commercial,7.54 +140827,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,United Healthcare-Commercial,22.6 +140828,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,United Healthcare-Commercial,29.77 +140829,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,United Healthcare-Commercial,172.59 +140830,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,United Healthcare-Commercial, +140831,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,United Healthcare-Commercial,27.54 +140832,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,United Healthcare-Commercial,7.63 +140833,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,United Healthcare-Commercial, +140834,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,United Healthcare-Commercial,9756.48 +140835,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,United Healthcare-Commercial, +140836,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,United Healthcare-Commercial, +140837,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,United Healthcare-Commercial, +140838,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,United Healthcare-Commercial,1.72 +140839,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,United Healthcare-Commercial, +140840,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,United Healthcare-Commercial,511.17 +140841,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,United Healthcare-Commercial,2776.13 +140842,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,United Healthcare-Commercial, +140843,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,United Healthcare-Commercial, +140844,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,United Healthcare-Commercial,9877.8 +140845,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,United Healthcare-Commercial,50.82 +140846,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,United Healthcare-Commercial,26522.1 +140847,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,United Healthcare-Commercial, +140848,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,United Healthcare-Commercial, +140849,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,United Healthcare-Commercial,3444.47 +140850,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,United Healthcare-Commercial,10793.1 +140851,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,United Healthcare-Commercial,4896.23 +140852,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,United Healthcare-Commercial, +140853,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,United Healthcare-Commercial,6093.92 +140854,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,United Healthcare-Commercial,4637.34 +140855,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,United Healthcare-Commercial, +140856,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,United Healthcare-Commercial, +140857,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,United Healthcare-Commercial, +140858,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,United Healthcare-Commercial, +140859,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,United Healthcare-Commercial, +140860,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,United Healthcare-Commercial, +140861,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,United Healthcare-Commercial, +140862,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,United Healthcare-Commercial,7.66 +140863,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,United Healthcare-Commercial, +140864,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,United Healthcare-Commercial,1387.3 +140865,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,United Healthcare-Commercial, +140866,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,United Healthcare-Commercial, +140867,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,United Healthcare-Commercial, +140868,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,United Healthcare-Commercial, +140869,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,United Healthcare-Commercial, +140870,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,United Healthcare-Commercial, +140871,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,United Healthcare-Commercial, +140872,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,United Healthcare-Commercial, +140873,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,United Healthcare-Commercial, +140874,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,United Healthcare-Commercial, +140875,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,United Healthcare-Commercial, +140876,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,United Healthcare-Commercial,106.61 +140877,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,United Healthcare-Commercial, +140878,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,United Healthcare-Commercial, +140879,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,United Healthcare-Commercial, +140880,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,United Healthcare-Commercial, +140881,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,United Healthcare-Commercial, +140882,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,United Healthcare-Commercial, +140883,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,United Healthcare-Commercial, +140884,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,United Healthcare-Commercial, +140885,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,United Healthcare-Commercial, +140886,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,United Healthcare-Commercial, +140887,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,United Healthcare-Commercial,309.6 +140888,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,United Healthcare-Commercial, +140889,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,United Healthcare-Commercial, +140890,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,United Healthcare-Commercial, +140891,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,United Healthcare-Commercial, +140892,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,United Healthcare-Commercial,828.87 +140893,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,United Healthcare-Commercial, +140894,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,United Healthcare-Commercial, +140895,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,United Healthcare-Commercial,871.1 +140896,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,United Healthcare-Commercial,995.63 +140897,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,United Healthcare-Commercial, +140898,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,United Healthcare-Commercial,715.9 +140899,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,United Healthcare-Commercial, +140900,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,United Healthcare-Commercial,701.05 +140901,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,United Healthcare-Commercial,584.21 +140902,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,United Healthcare-Commercial, +140903,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,United Healthcare-Commercial,622.58 +140904,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,United Healthcare-Commercial, +140905,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,United Healthcare-Commercial,0.04 +140906,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,United Healthcare-Commercial,0.7 +140907,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,United Healthcare-Commercial, +140908,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,United Healthcare-Commercial, +140909,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,United Healthcare-Commercial, +140910,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,United Healthcare-Commercial, +140911,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,United Healthcare-Commercial,0.3 +140912,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,United Healthcare-Commercial, +140913,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,United Healthcare-Commercial, +140914,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,United Healthcare-Commercial, +140915,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,United Healthcare-Commercial, +140916,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,United Healthcare-Commercial, +140917,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,United Healthcare-Commercial, +140918,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,United Healthcare-Commercial, +140919,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,United Healthcare-Commercial, +140920,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,United Healthcare-Commercial, +140921,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,United Healthcare-Commercial, +140922,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,United Healthcare-Commercial, +140923,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,United Healthcare-Commercial,1033.15 +140924,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,United Healthcare-Commercial, +140925,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,United Healthcare-Commercial, +140926,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,United Healthcare-Commercial, +140927,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,United Healthcare-Commercial,304.55 +140928,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,United Healthcare-Commercial,2074.23 +140929,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,United Healthcare-Commercial, +140930,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,United Healthcare-Commercial, +140931,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,United Healthcare-Commercial, +140932,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,United Healthcare-Commercial,21.94 +140933,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,United Healthcare-Commercial,47.63 +140934,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,United Healthcare-Commercial, +140935,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,United Healthcare-Commercial, +140936,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 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Healthcare-Commercial, +141310,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,United Healthcare-Commercial, +141311,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,United Healthcare-Commercial, +141312,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,United Healthcare-Commercial, +141313,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,United Healthcare-Commercial, +141314,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,United Healthcare-Commercial, +141315,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,United Healthcare-Commercial, +141316,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,United Healthcare-Commercial, +141317,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,United Healthcare-Commercial, +141318,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,United Healthcare-Commercial, +141319,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,United Healthcare-Commercial, +141320,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,United Healthcare-Commercial, +141321,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,United Healthcare-Commercial, +141322,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,United Healthcare-Commercial, +141323,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,United Healthcare-Commercial, +141324,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,United Healthcare-Commercial, +141325,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,United Healthcare-Commercial, +141326,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Commercial, +141327,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,United Healthcare-Commercial, +141328,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,United Healthcare-Commercial, +141329,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,United Healthcare-Commercial, +141330,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,United Healthcare-Commercial, +141331,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,United Healthcare-Commercial, 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PT-T,,7630.0,7630.0,,,United Healthcare-Commercial, +141343,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,United Healthcare-Commercial, +141344,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,United Healthcare-Commercial, +141345,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,United Healthcare-Commercial, +141346,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,United Healthcare-Commercial, +141347,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,United Healthcare-Commercial, +141348,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,United Healthcare-Commercial, +141349,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Commercial, +141350,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,United Healthcare-Commercial, +141351,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,United Healthcare-Commercial, +141352,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,United Healthcare-Commercial, 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PT-U,,7630.0,7630.0,,,United Healthcare-Commercial, +141375,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,United Healthcare-Commercial, +141376,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Commercial, +141377,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,United Healthcare-Commercial, +141378,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,United Healthcare-Commercial, +141379,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,United Healthcare-Commercial, +141380,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,United Healthcare-Commercial, +141381,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,United Healthcare-Commercial, +141382,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,United Healthcare-Commercial, +141383,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Commercial, +141384,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,United Healthcare-Commercial, +141385,3934,39913009,R&B REV OR 04L3 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OVN,,1963.0,1963.0,,,United Healthcare-Commercial, +141420,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,United Healthcare-Commercial, +141421,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,United Healthcare-Commercial, +141422,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,United Healthcare-Commercial, +141423,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,United Healthcare-Commercial, +141424,3934,37112000,ACUTE ED,,1580.0,1580.0,,,United Healthcare-Commercial, +141425,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,United Healthcare-Commercial, +141426,3934,37112034,TRIAGE,,277.0,277.0,,,United Healthcare-Commercial, +141427,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,United Healthcare-Commercial, +141428,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,United Healthcare-Commercial, +141429,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,United Healthcare-Commercial, +141430,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,United Healthcare-Commercial, +141431,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,United Healthcare-Commercial, +141432,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,United Healthcare-Commercial, +141433,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,United Healthcare-Commercial, +141434,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,United Healthcare-Commercial, +141435,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,United Healthcare-Commercial, +141436,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,United Healthcare-Commercial, +141437,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,United Healthcare-Commercial, +141438,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,United Healthcare-Commercial, +141439,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,United Healthcare-Commercial, +141440,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,United Healthcare-Commercial, +141441,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,United Healthcare-Commercial, +141442,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,United Healthcare-Commercial, +141443,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,United Healthcare-Commercial, +141444,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,United Healthcare-Commercial, +141445,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,United Healthcare-Commercial, +141446,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,United Healthcare-Commercial, +141447,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,United Healthcare-Commercial, +141448,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,United Healthcare-Commercial, +141449,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,United Healthcare-Commercial, +141450,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,United Healthcare-Commercial, +141451,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,United Healthcare-Commercial, +141452,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,United Healthcare-Commercial, +141453,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,United Healthcare-Commercial, +141454,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,United Healthcare-Commercial, +141455,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,United Healthcare-Commercial, +141456,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,United Healthcare-Commercial, +141457,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,United Healthcare-Commercial, +141458,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,United Healthcare-Commercial, +141459,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,United Healthcare-Commercial, +141460,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,United Healthcare-Commercial, +141461,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,United Healthcare-Commercial, +141462,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,United Healthcare-Commercial, +141463,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,United Healthcare-Commercial, +141464,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,United Healthcare-Commercial, +141465,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,United Healthcare-Commercial, +141466,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,United Healthcare-Commercial, +141467,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,United Healthcare-Commercial, +141468,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,United Healthcare-Commercial, +141469,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,United Healthcare-Commercial, +141470,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,United Healthcare-Commercial, +141471,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,United Healthcare-Commercial, +141472,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,United Healthcare-Commercial, +141473,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,United Healthcare-Commercial, +141474,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,United Healthcare-Commercial, +141475,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,United Healthcare-Commercial, +141476,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,United Healthcare-Commercial, +141477,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,United Healthcare-Commercial, +141478,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,United Healthcare-Commercial, +141479,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,United Healthcare-Commercial, +141480,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,United Healthcare-Commercial, +141481,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,United Healthcare-Commercial, +141482,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,United Healthcare-Commercial, +141483,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,United Healthcare-Commercial, +141484,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,United Healthcare-Commercial, +141485,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,United Healthcare-Commercial, +141486,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,United Healthcare-Commercial, +141487,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,United Healthcare-Commercial, +141488,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,United Healthcare-Commercial, +141489,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,United Healthcare-Commercial, +141490,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,United Healthcare-Commercial, +141491,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,United Healthcare-Commercial, +141492,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,United Healthcare-Commercial, +141493,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,United Healthcare-Commercial, +141494,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,United Healthcare-Commercial, +141495,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,United Healthcare-Commercial, +141496,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,United Healthcare-Commercial, +141497,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,United Healthcare-Commercial, +141498,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,United Healthcare-Commercial, +141499,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,United Healthcare-Commercial, +141500,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,United Healthcare-Commercial, +141501,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,United Healthcare-Commercial, +141502,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,United Healthcare-Commercial, +141503,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,United Healthcare-Commercial, +141504,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,United Healthcare-Commercial, +141505,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,United Healthcare-Commercial, +141506,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,United Healthcare-Commercial, +141507,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,United Healthcare-Commercial, +141508,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,United Healthcare-Commercial, +141509,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,United Healthcare-Commercial, +141510,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,United Healthcare-Commercial, +141511,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,United Healthcare-Commercial, +141512,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,United Healthcare-Commercial, +141513,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,United Healthcare-Commercial, +141514,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,United Healthcare-Commercial, +141515,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,United Healthcare-Commercial, +141516,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,United Healthcare-Commercial, +141517,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,United Healthcare-Commercial, +141518,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,United Healthcare-Commercial, +141519,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,United Healthcare-Commercial, +141520,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,United Healthcare-Commercial, +141521,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,United Healthcare-Commercial, +141522,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,United Healthcare-Commercial, +141523,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,United Healthcare-Commercial, +141524,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,United Healthcare-Commercial, +141525,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,United Healthcare-Commercial, +141526,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Commercial, +141527,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141528,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141529,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141530,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141531,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141532,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,United Healthcare-Commercial, +141533,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,United Healthcare-Commercial, +141534,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,United Healthcare-Commercial, +141535,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141536,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141537,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141538,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,United Healthcare-Commercial, +141539,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,United Healthcare-Commercial, +141540,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,United Healthcare-Commercial, +141541,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,United Healthcare-Commercial, +141542,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,United Healthcare-Commercial, +141543,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,United Healthcare-Commercial, +141544,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,United Healthcare-Commercial, +141545,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,United Healthcare-Commercial, +141546,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,United Healthcare-Commercial, +141547,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,United Healthcare-Commercial, +141548,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,United Healthcare-Commercial, +141549,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,United Healthcare-Commercial, +141550,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,United Healthcare-Commercial, +141551,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,United Healthcare-Commercial, +141552,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,United Healthcare-Commercial, +141553,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,United Healthcare-Commercial, +141554,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,United Healthcare-Commercial, +141555,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,United Healthcare-Commercial, +141556,3934,43301043,ALBUNEX,,357.0,357.0,,,United Healthcare-Commercial, +141557,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,United Healthcare-Commercial, +141558,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141559,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141560,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141561,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141562,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141563,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,United Healthcare-Commercial, +141564,3934,43450022,REC RM .5HR,,541.0,541.0,,,United Healthcare-Commercial, +141565,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,United Healthcare-Commercial, +141566,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,United Healthcare-Commercial, +141567,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,United Healthcare-Commercial, +141568,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,United Healthcare-Commercial, +141569,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,United Healthcare-Commercial, +141570,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,United Healthcare-Commercial, +141571,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,United Healthcare-Commercial, +141572,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,United Healthcare-Commercial, +141573,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,United Healthcare-Commercial, +141574,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,United Healthcare-Commercial, +141575,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,United Healthcare-Commercial, +141576,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,United Healthcare-Commercial, +141577,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,United Healthcare-Commercial, +141578,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,United Healthcare-Commercial, +141579,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,United Healthcare-Commercial, +141580,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,United Healthcare-Commercial, +141581,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Commercial, +141582,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141583,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141584,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141585,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141586,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141587,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,United Healthcare-Commercial, +141588,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141589,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Commercial, +141590,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141591,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141592,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141593,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141594,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,United Healthcare-Commercial, +141595,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Commercial, +141596,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141597,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141598,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141599,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141600,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141601,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Commercial, +141602,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141603,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141604,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141605,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141606,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141607,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,United Healthcare-Commercial, +141608,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,United Healthcare-Commercial, +141609,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,United Healthcare-Commercial, +141610,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,United Healthcare-Commercial, +141611,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,United Healthcare-Commercial, +141612,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,United Healthcare-Commercial, +141613,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,United Healthcare-Commercial, +141614,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,United Healthcare-Commercial, +141615,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Commercial, +141616,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141617,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141618,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141619,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141620,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141621,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,United Healthcare-Commercial, +141622,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,United Healthcare-Commercial, +141623,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,United Healthcare-Commercial, +141624,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,United Healthcare-Commercial, +141625,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,United Healthcare-Commercial, +141626,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,United Healthcare-Commercial, +141627,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,United Healthcare-Commercial, +141628,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,United Healthcare-Commercial, +141629,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,United Healthcare-Commercial, +141630,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,United Healthcare-Commercial, +141631,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,United Healthcare-Commercial, +141632,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,United Healthcare-Commercial, +141633,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,United Healthcare-Commercial, +141634,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,United Healthcare-Commercial, +141635,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,United Healthcare-Commercial, +141636,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,United Healthcare-Commercial, +141637,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,United Healthcare-Commercial, +141638,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,United Healthcare-Commercial, +141639,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,United Healthcare-Commercial, +141640,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,United Healthcare-Commercial, +141641,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,United Healthcare-Commercial, +141642,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,United Healthcare-Commercial, +141643,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,United Healthcare-Commercial, +141644,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,United Healthcare-Commercial, +141645,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,United Healthcare-Commercial, +141646,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,United Healthcare-Commercial, +141647,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,United Healthcare-Commercial, +141648,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,United Healthcare-Commercial, +141649,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,United Healthcare-Commercial, +141650,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,United Healthcare-Commercial, +141651,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,United Healthcare-Commercial, +141652,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,United Healthcare-Commercial, +141653,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,United Healthcare-Commercial, +141654,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,United Healthcare-Commercial, +141655,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,United Healthcare-Commercial, +141656,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,United Healthcare-Commercial, +141657,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,United Healthcare-Commercial, +141658,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,United Healthcare-Commercial, +141659,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,United Healthcare-Commercial, +141660,3934,45924552,ENDO REC RM,,30.0,30.0,,,United Healthcare-Commercial, +141661,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,United Healthcare-Commercial, +141662,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,United Healthcare-Commercial, +141663,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,United Healthcare-Commercial, +141664,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,United Healthcare-Commercial, +141665,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,United Healthcare-Commercial, +141666,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,United Healthcare-Commercial, +141667,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,United Healthcare-Commercial, +141668,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,United Healthcare-Commercial, +141669,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,United Healthcare-Commercial, +141670,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,United Healthcare-Commercial, +141671,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,United Healthcare-Commercial, +141672,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,United Healthcare-Commercial, +141673,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,United Healthcare-Commercial, +141674,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,United Healthcare-Commercial, +141675,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,United Healthcare-Commercial, +141676,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,United Healthcare-Commercial, +141677,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,United Healthcare-Commercial, +141678,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,United Healthcare-Commercial, +141679,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,United Healthcare-Commercial, +141680,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,United Healthcare-Commercial, +141681,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,United Healthcare-Commercial, +141682,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,United Healthcare-Commercial, +141683,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,United Healthcare-Commercial, +141684,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,United Healthcare-Commercial, +141685,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,United Healthcare-Commercial, +141686,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,United Healthcare-Commercial, +141687,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Commercial, +141688,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Commercial, +141689,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Commercial, +141690,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Commercial, +141691,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Commercial, +141692,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Commercial, +141693,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,United Healthcare-Commercial, +141694,3934,53200010,GUEST TRAY,,24.0,24.0,,,United Healthcare-Commercial, +141695,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,United Healthcare-Commercial, +141696,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,United Healthcare-Commercial, +141697,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,United Healthcare-Commercial, +141698,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,United Healthcare-Commercial, +141699,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,United Healthcare-Commercial, +141700,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,United Healthcare-Commercial, +141701,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,United Healthcare-Commercial, +141702,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,United Healthcare-Commercial, +141703,3934,53329876,HIV MONITORING,,416.0,416.0,,,United Healthcare-Commercial, +141704,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,United Healthcare-Commercial, +141705,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,United Healthcare-Commercial, +141706,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,United Healthcare-Commercial, +141707,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,United Healthcare-Commercial, +141708,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,United Healthcare-Commercial, +141709,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,United Healthcare-Commercial, +141710,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,United Healthcare-Commercial, +141711,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,United Healthcare-Commercial, +141712,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,United Healthcare-Commercial, +141713,3934,76010107,COPY X-RAY,,22.0,22.0,,,United Healthcare-Commercial, +141714,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,United Healthcare-Commercial, +141715,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,United Healthcare-Commercial, +141716,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,United Healthcare-Commercial, +141717,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,United Healthcare-Commercial, +141718,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,United Healthcare-Commercial, +141719,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,United Healthcare-Commercial, +141720,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,United Healthcare-Commercial, +141721,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,United Healthcare-Commercial, +141722,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,United Healthcare-Commercial, +141723,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,United Healthcare-Commercial, +141724,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,United Healthcare-Commercial, +141725,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,United Healthcare-Commercial, +141726,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,United Healthcare-Medicaid, +141727,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,United Healthcare-Medicaid, +141728,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,United Healthcare-Medicaid, +141729,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,United Healthcare-Medicaid, +141730,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,United Healthcare-Medicaid, +141731,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,United Healthcare-Medicaid, +141732,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,United Healthcare-Medicaid, +141733,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,United Healthcare-Medicaid, +141734,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,United Healthcare-Medicaid, +141735,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,United Healthcare-Medicaid, +141736,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,United Healthcare-Medicaid, +141737,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,United Healthcare-Medicaid, +141738,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,United Healthcare-Medicaid, +141739,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,United Healthcare-Medicaid, +141740,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,United Healthcare-Medicaid, +141741,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,United Healthcare-Medicaid, +141742,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,United Healthcare-Medicaid, +141743,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,United Healthcare-Medicaid, +141744,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,United Healthcare-Medicaid, +141745,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,United Healthcare-Medicaid, +141746,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,United Healthcare-Medicaid, +141747,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,United Healthcare-Medicaid, +141748,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,United Healthcare-Medicaid, +141749,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,United Healthcare-Medicaid, +141750,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,United Healthcare-Medicaid, +141751,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,United Healthcare-Medicaid, +141752,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,United Healthcare-Medicaid, +141753,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,United Healthcare-Medicaid, +141754,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,United Healthcare-Medicaid, +141755,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,United Healthcare-Medicaid, +141756,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,United Healthcare-Medicaid,20569.31 +141757,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,United Healthcare-Medicaid, +141758,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,United Healthcare-Medicaid, +141759,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,United Healthcare-Medicaid, +141760,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,United Healthcare-Medicaid, +141761,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,United Healthcare-Medicaid, +141762,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,United Healthcare-Medicaid,37892.07 +141763,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,United Healthcare-Medicaid, +141764,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,United Healthcare-Medicaid, +141765,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,United Healthcare-Medicaid, +141766,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,United Healthcare-Medicaid, +141767,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,United Healthcare-Medicaid, +141768,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,United Healthcare-Medicaid, +141769,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,United Healthcare-Medicaid, +141770,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,United Healthcare-Medicaid, +141771,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,United Healthcare-Medicaid,7741.58 +141772,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,United Healthcare-Medicaid, +141773,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,United Healthcare-Medicaid, +141774,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,United Healthcare-Medicaid, +141775,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,United Healthcare-Medicaid, +141776,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,United Healthcare-Medicaid, +141777,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,United Healthcare-Medicaid, +141778,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,United Healthcare-Medicaid, +141779,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,United Healthcare-Medicaid, +141780,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,United Healthcare-Medicaid, +141781,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,United Healthcare-Medicaid, +141782,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,United Healthcare-Medicaid, +141783,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,United Healthcare-Medicaid, +141784,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,United Healthcare-Medicaid, +141785,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,United Healthcare-Medicaid, +141786,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,United Healthcare-Medicaid, +141787,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,United Healthcare-Medicaid, +141788,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,United Healthcare-Medicaid, +141789,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,United Healthcare-Medicaid, +141790,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,United Healthcare-Medicaid, +141791,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,United Healthcare-Medicaid, +141792,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,United Healthcare-Medicaid, +141793,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,United Healthcare-Medicaid, +141794,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,United Healthcare-Medicaid, +141795,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,United Healthcare-Medicaid, +141796,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,United Healthcare-Medicaid, +141797,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,United Healthcare-Medicaid, +141798,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,United Healthcare-Medicaid, +141799,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,United Healthcare-Medicaid, +141800,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,United Healthcare-Medicaid, +141801,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,United Healthcare-Medicaid, +141802,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,United Healthcare-Medicaid, +141803,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,United Healthcare-Medicaid, +141804,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,United Healthcare-Medicaid, +141805,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,United Healthcare-Medicaid, +141806,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,United Healthcare-Medicaid, +141807,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,United Healthcare-Medicaid, +141808,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,United Healthcare-Medicaid, +141809,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,United Healthcare-Medicaid, +141810,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,United Healthcare-Medicaid, +141811,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,United Healthcare-Medicaid, +141812,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,United Healthcare-Medicaid, +141813,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,United Healthcare-Medicaid, +141814,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,United Healthcare-Medicaid, +141815,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,United Healthcare-Medicaid, +141816,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,United Healthcare-Medicaid, +141817,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,United Healthcare-Medicaid, +141818,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,United Healthcare-Medicaid, +141819,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,United Healthcare-Medicaid, +141820,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,United Healthcare-Medicaid, +141821,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,United Healthcare-Medicaid, +141822,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,United Healthcare-Medicaid, +141823,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,United Healthcare-Medicaid, +141824,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,United Healthcare-Medicaid, +141825,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,United Healthcare-Medicaid, +141826,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,United Healthcare-Medicaid, +141827,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,United Healthcare-Medicaid, +141828,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,United Healthcare-Medicaid, +141829,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,United Healthcare-Medicaid, +141830,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,United Healthcare-Medicaid, +141831,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,United Healthcare-Medicaid, +141832,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,United Healthcare-Medicaid, +141833,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,United Healthcare-Medicaid, +141834,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,United Healthcare-Medicaid, +141835,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,United Healthcare-Medicaid, +141836,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,United Healthcare-Medicaid, +141837,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,United Healthcare-Medicaid, +141838,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,United Healthcare-Medicaid, +141839,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,United Healthcare-Medicaid, +141840,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,United Healthcare-Medicaid, +141841,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,United Healthcare-Medicaid, +141842,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,United Healthcare-Medicaid, +141843,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,United Healthcare-Medicaid, +141844,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,United Healthcare-Medicaid, +141845,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,United Healthcare-Medicaid, +141846,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,United Healthcare-Medicaid,7524.92 +141847,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,United Healthcare-Medicaid,25697.15 +141848,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,United Healthcare-Medicaid, +141849,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,United Healthcare-Medicaid, +141850,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,United Healthcare-Medicaid, +141851,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,United Healthcare-Medicaid, +141852,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,United Healthcare-Medicaid, +141853,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,United Healthcare-Medicaid, +141854,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,United Healthcare-Medicaid, +141855,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,United Healthcare-Medicaid, +141856,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,United Healthcare-Medicaid, +141857,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,United Healthcare-Medicaid, +141858,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,United Healthcare-Medicaid, +141859,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,United Healthcare-Medicaid, +141860,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,United Healthcare-Medicaid, +141861,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,United Healthcare-Medicaid, +141862,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,United Healthcare-Medicaid, +141863,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,United Healthcare-Medicaid, +141864,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,United Healthcare-Medicaid, +141865,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,United Healthcare-Medicaid, +141866,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,United Healthcare-Medicaid, +141867,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,United Healthcare-Medicaid, +141868,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,United Healthcare-Medicaid, +141869,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,United Healthcare-Medicaid, +141870,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,United Healthcare-Medicaid, +141871,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,United Healthcare-Medicaid, +141872,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,United Healthcare-Medicaid, +141873,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,United Healthcare-Medicaid, +141874,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,United Healthcare-Medicaid, +141875,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,United Healthcare-Medicaid, +141876,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,United Healthcare-Medicaid, +141877,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,United Healthcare-Medicaid, +141878,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,United Healthcare-Medicaid,54145.65 +141879,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,United Healthcare-Medicaid, +141880,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,United Healthcare-Medicaid, +141881,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,United Healthcare-Medicaid, +141882,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,United Healthcare-Medicaid, +141883,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,United Healthcare-Medicaid, +141884,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,United Healthcare-Medicaid, +141885,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,United Healthcare-Medicaid, +141886,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,United Healthcare-Medicaid,54488.26 +141887,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,United Healthcare-Medicaid, +141888,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,United Healthcare-Medicaid, +141889,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,United Healthcare-Medicaid, +141890,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,United Healthcare-Medicaid, +141891,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,United Healthcare-Medicaid, +141892,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,United Healthcare-Medicaid, +141893,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,United Healthcare-Medicaid, +141894,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,United Healthcare-Medicaid, +141895,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,United Healthcare-Medicaid, +141896,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,United Healthcare-Medicaid, +141897,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,United Healthcare-Medicaid, +141898,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,United Healthcare-Medicaid, +141899,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,United Healthcare-Medicaid, +141900,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,United Healthcare-Medicaid, +141901,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,United Healthcare-Medicaid, +141902,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,United Healthcare-Medicaid, +141903,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,United Healthcare-Medicaid, +141904,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,United Healthcare-Medicaid, +141905,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,United Healthcare-Medicaid, +141906,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,United Healthcare-Medicaid, +141907,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,United Healthcare-Medicaid,29642.84 +141908,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,United Healthcare-Medicaid, +141909,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,United Healthcare-Medicaid, +141910,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,United Healthcare-Medicaid, +141911,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,United Healthcare-Medicaid, +141912,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,United Healthcare-Medicaid, +141913,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,United Healthcare-Medicaid, +141914,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,United Healthcare-Medicaid, +141915,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,United Healthcare-Medicaid, +141916,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,United Healthcare-Medicaid, +141917,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,United Healthcare-Medicaid, +141918,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,United Healthcare-Medicaid, +141919,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,United Healthcare-Medicaid, +141920,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,United Healthcare-Medicaid, +141921,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,United Healthcare-Medicaid, +141922,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,United Healthcare-Medicaid, +141923,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,United Healthcare-Medicaid, +141924,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,United Healthcare-Medicaid, +141925,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,United Healthcare-Medicaid,40999.93 +141926,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,United Healthcare-Medicaid, +141927,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,United Healthcare-Medicaid, +141928,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,United Healthcare-Medicaid, +141929,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,United Healthcare-Medicaid, +141930,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,United Healthcare-Medicaid,15469.67 +141931,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,United Healthcare-Medicaid, +141932,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,United Healthcare-Medicaid, +141933,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,United Healthcare-Medicaid, +141934,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,United Healthcare-Medicaid, +141935,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,United Healthcare-Medicaid, +141936,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,United Healthcare-Medicaid, +141937,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,United Healthcare-Medicaid, +141938,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,United Healthcare-Medicaid, +141939,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,United Healthcare-Medicaid,12527.22 +141940,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,United Healthcare-Medicaid, +141941,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,United Healthcare-Medicaid, +141942,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,United Healthcare-Medicaid, +141943,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,United Healthcare-Medicaid, +141944,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,United Healthcare-Medicaid, +141945,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,United Healthcare-Medicaid, +141946,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,United Healthcare-Medicaid, +141947,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,United Healthcare-Medicaid, +141948,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,United Healthcare-Medicaid, +141949,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,United Healthcare-Medicaid, +141950,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,United Healthcare-Medicaid, +141951,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,United Healthcare-Medicaid, +141952,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,United Healthcare-Medicaid,11649.49 +141953,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,United Healthcare-Medicaid, +141954,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,United Healthcare-Medicaid, +141955,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,United Healthcare-Medicaid, +141956,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,United Healthcare-Medicaid, +141957,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,United Healthcare-Medicaid, +141958,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,United Healthcare-Medicaid, +141959,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,United Healthcare-Medicaid, +141960,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,United Healthcare-Medicaid, +141961,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,United Healthcare-Medicaid, +141962,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,United Healthcare-Medicaid, +141963,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,United Healthcare-Medicaid, +141964,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,United Healthcare-Medicaid, +141965,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,United Healthcare-Medicaid, +141966,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,United Healthcare-Medicaid, +141967,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,United Healthcare-Medicaid, +141968,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,United Healthcare-Medicaid, +141969,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,United Healthcare-Medicaid, +141970,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,United Healthcare-Medicaid, +141971,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,United Healthcare-Medicaid, +141972,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,United Healthcare-Medicaid, +141973,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,United Healthcare-Medicaid, +141974,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,United Healthcare-Medicaid, +141975,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,United Healthcare-Medicaid, +141976,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,United Healthcare-Medicaid, +141977,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,United Healthcare-Medicaid, +141978,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,United Healthcare-Medicaid, +141979,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,United Healthcare-Medicaid, +141980,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,United Healthcare-Medicaid, +141981,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,United Healthcare-Medicaid, +141982,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,United Healthcare-Medicaid, +141983,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,United Healthcare-Medicaid, +141984,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,United Healthcare-Medicaid, +141985,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,United Healthcare-Medicaid, +141986,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,United Healthcare-Medicaid, +141987,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,United Healthcare-Medicaid, +141988,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,United Healthcare-Medicaid, +141989,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,United Healthcare-Medicaid, +141990,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,United Healthcare-Medicaid, +141991,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,United Healthcare-Medicaid, +141992,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,United Healthcare-Medicaid, +141993,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,United Healthcare-Medicaid, +141994,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,United Healthcare-Medicaid, +141995,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,United Healthcare-Medicaid, +141996,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,United Healthcare-Medicaid, +141997,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,United Healthcare-Medicaid,19915.98 +141998,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,United Healthcare-Medicaid, +141999,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,United Healthcare-Medicaid, +142000,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,United Healthcare-Medicaid, +142001,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,United Healthcare-Medicaid, +142002,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,United Healthcare-Medicaid, +142003,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,United Healthcare-Medicaid, +142004,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,United Healthcare-Medicaid, +142005,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,United Healthcare-Medicaid, +142006,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,United Healthcare-Medicaid, +142007,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,United Healthcare-Medicaid, +142008,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,United Healthcare-Medicaid, +142009,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,United Healthcare-Medicaid, +142010,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,United Healthcare-Medicaid, +142011,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,United Healthcare-Medicaid, +142012,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,United Healthcare-Medicaid, +142013,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,United Healthcare-Medicaid, +142014,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,United Healthcare-Medicaid, +142015,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,United Healthcare-Medicaid, +142016,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,United Healthcare-Medicaid, +142017,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,United Healthcare-Medicaid, +142018,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,United Healthcare-Medicaid, +142019,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,United Healthcare-Medicaid, +142020,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,United Healthcare-Medicaid, +142021,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,United Healthcare-Medicaid, +142022,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,United Healthcare-Medicaid, +142023,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,United Healthcare-Medicaid, +142024,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,United Healthcare-Medicaid, +142025,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,United Healthcare-Medicaid, +142026,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,United Healthcare-Medicaid, +142027,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,United Healthcare-Medicaid, +142028,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,United Healthcare-Medicaid, +142029,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,United Healthcare-Medicaid, +142030,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,United Healthcare-Medicaid, +142031,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,United Healthcare-Medicaid, +142032,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,United Healthcare-Medicaid, +142033,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,United Healthcare-Medicaid, +142034,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,United Healthcare-Medicaid,8269.04 +142035,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,United Healthcare-Medicaid, +142036,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,United Healthcare-Medicaid, +142037,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,United Healthcare-Medicaid, +142038,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,United Healthcare-Medicaid, +142039,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,United Healthcare-Medicaid, +142040,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,United Healthcare-Medicaid, +142041,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,United Healthcare-Medicaid, +142042,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,United Healthcare-Medicaid, +142043,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,United Healthcare-Medicaid, +142044,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,United Healthcare-Medicaid, +142045,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,United Healthcare-Medicaid, +142046,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,United Healthcare-Medicaid, +142047,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,United Healthcare-Medicaid, +142048,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,United Healthcare-Medicaid, +142049,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,United Healthcare-Medicaid, +142050,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,United Healthcare-Medicaid, +142051,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,United Healthcare-Medicaid, +142052,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,United Healthcare-Medicaid, +142053,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,United Healthcare-Medicaid, +142054,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,United Healthcare-Medicaid, +142055,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,United Healthcare-Medicaid, +142056,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,United Healthcare-Medicaid, +142057,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,United Healthcare-Medicaid, +142058,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,United Healthcare-Medicaid, +142059,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,United Healthcare-Medicaid,23300.54 +142060,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,United Healthcare-Medicaid, +142061,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,United Healthcare-Medicaid, +142062,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,United Healthcare-Medicaid, +142063,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,United Healthcare-Medicaid, +142064,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,United Healthcare-Medicaid, +142065,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,United Healthcare-Medicaid, +142066,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,United Healthcare-Medicaid, +142067,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,United Healthcare-Medicaid, +142068,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,United Healthcare-Medicaid, +142069,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,United Healthcare-Medicaid, +142070,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,United Healthcare-Medicaid, +142071,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,United Healthcare-Medicaid, +142072,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,United Healthcare-Medicaid, +142073,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,United Healthcare-Medicaid, +142074,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,United Healthcare-Medicaid, +142075,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,United Healthcare-Medicaid, +142076,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,United Healthcare-Medicaid, +142077,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,United Healthcare-Medicaid, +142078,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,United Healthcare-Medicaid, +142079,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,United Healthcare-Medicaid, +142080,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,United Healthcare-Medicaid, +142081,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,United Healthcare-Medicaid, +142082,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,United Healthcare-Medicaid, +142083,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,United Healthcare-Medicaid, +142084,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,United Healthcare-Medicaid, +142085,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,United Healthcare-Medicaid, +142086,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,United Healthcare-Medicaid, +142087,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,United Healthcare-Medicaid, +142088,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,United Healthcare-Medicaid, +142089,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,United Healthcare-Medicaid, +142090,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,United Healthcare-Medicaid, +142091,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,United Healthcare-Medicaid, +142092,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,United Healthcare-Medicaid, +142093,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,United Healthcare-Medicaid, +142094,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,United Healthcare-Medicaid, +142095,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,United Healthcare-Medicaid, +142096,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,United Healthcare-Medicaid, +142097,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,United Healthcare-Medicaid, +142098,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,United Healthcare-Medicaid, +142099,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,United Healthcare-Medicaid, +142100,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,United Healthcare-Medicaid, +142101,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,United Healthcare-Medicaid, +142102,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,United Healthcare-Medicaid, +142103,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,United Healthcare-Medicaid, +142104,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,United Healthcare-Medicaid, +142105,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,United Healthcare-Medicaid, +142106,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,United Healthcare-Medicaid, +142107,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,United Healthcare-Medicaid, +142108,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,United Healthcare-Medicaid, +142109,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,United Healthcare-Medicaid, +142110,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,United Healthcare-Medicaid, +142111,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,United Healthcare-Medicaid, +142112,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,United Healthcare-Medicaid, +142113,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,United Healthcare-Medicaid, +142114,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,United Healthcare-Medicaid, +142115,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,United Healthcare-Medicaid,7910.44 +142116,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,United Healthcare-Medicaid, +142117,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,United Healthcare-Medicaid, +142118,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,United Healthcare-Medicaid, +142119,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,United Healthcare-Medicaid, +142120,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,United Healthcare-Medicaid, +142121,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,United Healthcare-Medicaid, +142122,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,United Healthcare-Medicaid, +142123,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,United Healthcare-Medicaid, +142124,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,United Healthcare-Medicaid, +142125,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,United Healthcare-Medicaid, +142126,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,United Healthcare-Medicaid, +142127,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,United Healthcare-Medicaid, +142128,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,United Healthcare-Medicaid, +142129,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,United Healthcare-Medicaid, +142130,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,United Healthcare-Medicaid, +142131,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,United Healthcare-Medicaid, +142132,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,United Healthcare-Medicaid, +142133,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,United Healthcare-Medicaid, +142134,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,United Healthcare-Medicaid, +142135,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,United Healthcare-Medicaid, +142136,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,United Healthcare-Medicaid, +142137,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,United Healthcare-Medicaid, +142138,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,United Healthcare-Medicaid, +142139,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,United Healthcare-Medicaid, +142140,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,United Healthcare-Medicaid, +142141,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,United Healthcare-Medicaid, +142142,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,United Healthcare-Medicaid,27020.91 +142143,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,United Healthcare-Medicaid, +142144,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,United Healthcare-Medicaid, +142145,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,United Healthcare-Medicaid, +142146,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,United Healthcare-Medicaid, +142147,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,United Healthcare-Medicaid, +142148,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,United Healthcare-Medicaid,7485.56 +142149,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,United Healthcare-Medicaid, +142150,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,United Healthcare-Medicaid, +142151,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,United Healthcare-Medicaid, +142152,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,United Healthcare-Medicaid, +142153,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,United Healthcare-Medicaid, +142154,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,United Healthcare-Medicaid, +142155,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,United Healthcare-Medicaid, +142156,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,United Healthcare-Medicaid, +142157,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,United Healthcare-Medicaid, +142158,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,United Healthcare-Medicaid, +142159,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,United Healthcare-Medicaid, +142160,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,United Healthcare-Medicaid, +142161,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,United Healthcare-Medicaid, +142162,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,United Healthcare-Medicaid, +142163,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,United Healthcare-Medicaid, +142164,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,United Healthcare-Medicaid, +142165,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,United Healthcare-Medicaid, +142166,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,United Healthcare-Medicaid, +142167,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,United Healthcare-Medicaid,12796.3 +142168,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,United Healthcare-Medicaid, +142169,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,United Healthcare-Medicaid, +142170,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,United Healthcare-Medicaid, +142171,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,United Healthcare-Medicaid, +142172,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,United Healthcare-Medicaid, +142173,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,United Healthcare-Medicaid, +142174,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,United Healthcare-Medicaid, +142175,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,United Healthcare-Medicaid, +142176,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,United Healthcare-Medicaid, +142177,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,United Healthcare-Medicaid, +142178,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,United Healthcare-Medicaid, +142179,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,United Healthcare-Medicaid, +142180,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,United Healthcare-Medicaid, +142181,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,United Healthcare-Medicaid, +142182,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,United Healthcare-Medicaid, +142183,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,United Healthcare-Medicaid, +142184,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,United Healthcare-Medicaid, +142185,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,United Healthcare-Medicaid, +142186,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,United Healthcare-Medicaid, +142187,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,United Healthcare-Medicaid, +142188,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,United Healthcare-Medicaid, +142189,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,United Healthcare-Medicaid, +142190,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,United Healthcare-Medicaid, +142191,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,United Healthcare-Medicaid, +142192,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,United Healthcare-Medicaid, +142193,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,United Healthcare-Medicaid, +142194,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,United Healthcare-Medicaid, +142195,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,United Healthcare-Medicaid, +142196,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,United Healthcare-Medicaid, +142197,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,United Healthcare-Medicaid, +142198,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,United Healthcare-Medicaid, +142199,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,United Healthcare-Medicaid, +142200,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,United Healthcare-Medicaid, +142201,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,United Healthcare-Medicaid, +142202,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,United Healthcare-Medicaid, +142203,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,United Healthcare-Medicaid,15262.17 +142204,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,United Healthcare-Medicaid,7062.17 +142205,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,United Healthcare-Medicaid, +142206,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,United Healthcare-Medicaid, +142207,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,United Healthcare-Medicaid, +142208,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,United Healthcare-Medicaid, +142209,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,United Healthcare-Medicaid, +142210,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,United Healthcare-Medicaid, +142211,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,United Healthcare-Medicaid, +142212,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,United Healthcare-Medicaid, +142213,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,United Healthcare-Medicaid, +142214,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,United Healthcare-Medicaid, +142215,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,United Healthcare-Medicaid, +142216,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,United Healthcare-Medicaid, +142217,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,United Healthcare-Medicaid, +142218,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,United Healthcare-Medicaid, +142219,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,United Healthcare-Medicaid, +142220,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,United Healthcare-Medicaid, +142221,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,United Healthcare-Medicaid, +142222,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,United Healthcare-Medicaid, +142223,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,United Healthcare-Medicaid, +142224,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,United Healthcare-Medicaid, +142225,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,United Healthcare-Medicaid, +142226,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,United Healthcare-Medicaid, +142227,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,United Healthcare-Medicaid, +142228,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,United Healthcare-Medicaid, +142229,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,United Healthcare-Medicaid, +142230,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,United Healthcare-Medicaid, +142231,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,United Healthcare-Medicaid, +142232,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,United Healthcare-Medicaid, +142233,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,United Healthcare-Medicaid,9775.25 +142234,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,United Healthcare-Medicaid, +142235,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,United Healthcare-Medicaid, +142236,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,United Healthcare-Medicaid, +142237,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,United Healthcare-Medicaid, +142238,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,United Healthcare-Medicaid, +142239,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,United Healthcare-Medicaid, +142240,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,United Healthcare-Medicaid, +142241,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,United Healthcare-Medicaid, +142242,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,United Healthcare-Medicaid, +142243,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,United Healthcare-Medicaid, +142244,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,United Healthcare-Medicaid, +142245,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,United Healthcare-Medicaid, +142246,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,United Healthcare-Medicaid, +142247,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,United Healthcare-Medicaid, +142248,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,United Healthcare-Medicaid, +142249,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,United Healthcare-Medicaid, +142250,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,United Healthcare-Medicaid, +142251,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,United Healthcare-Medicaid, +142252,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,United Healthcare-Medicaid, +142253,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,United Healthcare-Medicaid, +142254,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,United Healthcare-Medicaid, +142255,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,United Healthcare-Medicaid, +142256,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,United Healthcare-Medicaid, +142257,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,United Healthcare-Medicaid, +142258,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,United Healthcare-Medicaid, +142259,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,United Healthcare-Medicaid,33420.94 +142260,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,United Healthcare-Medicaid, +142261,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,United Healthcare-Medicaid,3369.02 +142262,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,United Healthcare-Medicaid, +142263,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,United Healthcare-Medicaid, +142264,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,United Healthcare-Medicaid, +142265,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,United Healthcare-Medicaid, +142266,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,United Healthcare-Medicaid, +142267,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,United Healthcare-Medicaid, +142268,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,United Healthcare-Medicaid, +142269,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,United Healthcare-Medicaid, +142270,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,United Healthcare-Medicaid, +142271,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,United Healthcare-Medicaid, +142272,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,United Healthcare-Medicaid, +142273,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,United Healthcare-Medicaid, +142274,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,United Healthcare-Medicaid, +142275,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,United Healthcare-Medicaid, +142276,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,United Healthcare-Medicaid, +142277,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,United Healthcare-Medicaid, +142278,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,United Healthcare-Medicaid, +142279,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,United Healthcare-Medicaid, +142280,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,United Healthcare-Medicaid, +142281,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,United Healthcare-Medicaid, +142282,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,United Healthcare-Medicaid, +142283,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,United Healthcare-Medicaid, +142284,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,United Healthcare-Medicaid, +142285,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,United Healthcare-Medicaid, +142286,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,United Healthcare-Medicaid, +142287,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,United Healthcare-Medicaid, +142288,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,United Healthcare-Medicaid, +142289,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,United Healthcare-Medicaid,19048.76 +142290,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,United Healthcare-Medicaid, +142291,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,United Healthcare-Medicaid, +142292,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,United Healthcare-Medicaid, +142293,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,United Healthcare-Medicaid, +142294,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,United Healthcare-Medicaid, +142295,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,United Healthcare-Medicaid, +142296,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,United Healthcare-Medicaid,10777.42 +142297,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,United Healthcare-Medicaid, +142298,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,United Healthcare-Medicaid, +142299,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,United Healthcare-Medicaid, +142300,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,United Healthcare-Medicaid, +142301,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,United Healthcare-Medicaid, +142302,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,United Healthcare-Medicaid, +142303,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,United Healthcare-Medicaid, +142304,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,United Healthcare-Medicaid, +142305,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,United Healthcare-Medicaid, +142306,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,United Healthcare-Medicaid, +142307,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,United Healthcare-Medicaid, +142308,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,United Healthcare-Medicaid, +142309,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,United Healthcare-Medicaid, +142310,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,United Healthcare-Medicaid, +142311,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,United Healthcare-Medicaid, +142312,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,United Healthcare-Medicaid, +142313,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,United Healthcare-Medicaid, +142314,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,United Healthcare-Medicaid,13336.78 +142315,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,United Healthcare-Medicaid, +142316,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,United Healthcare-Medicaid, +142317,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,United Healthcare-Medicaid, +142318,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,United Healthcare-Medicaid, +142319,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,United Healthcare-Medicaid, +142320,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,United Healthcare-Medicaid, +142321,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,United Healthcare-Medicaid, +142322,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,United Healthcare-Medicaid, +142323,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,United Healthcare-Medicaid,18334.0 +142324,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,United Healthcare-Medicaid, +142325,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,United Healthcare-Medicaid, +142326,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,United Healthcare-Medicaid,62338.41 +142327,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,United Healthcare-Medicaid,18716.16 +142328,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,United Healthcare-Medicaid, +142329,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,United Healthcare-Medicaid, +142330,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,United Healthcare-Medicaid, +142331,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,United Healthcare-Medicaid, +142332,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,United Healthcare-Medicaid, +142333,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,United Healthcare-Medicaid, +142334,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,United Healthcare-Medicaid, +142335,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,United Healthcare-Medicaid,21149.91 +142336,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,United Healthcare-Medicaid, +142337,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,United Healthcare-Medicaid, +142338,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,United Healthcare-Medicaid, +142339,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,United Healthcare-Medicaid, +142340,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,United Healthcare-Medicaid, +142341,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,United Healthcare-Medicaid,7311.23 +142342,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,United Healthcare-Medicaid, +142343,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,United Healthcare-Medicaid, +142344,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,United Healthcare-Medicaid, +142345,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,United Healthcare-Medicaid, +142346,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,United Healthcare-Medicaid, +142347,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,United Healthcare-Medicaid, +142348,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,United Healthcare-Medicaid,13374.23 +142349,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,United Healthcare-Medicaid, +142350,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,United Healthcare-Medicaid, +142351,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,United Healthcare-Medicaid, +142352,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,United Healthcare-Medicaid, +142353,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,United Healthcare-Medicaid, +142354,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,United Healthcare-Medicaid, +142355,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,United Healthcare-Medicaid, +142356,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,United Healthcare-Medicaid, +142357,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,United Healthcare-Medicaid, +142358,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,United Healthcare-Medicaid, +142359,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,United Healthcare-Medicaid, +142360,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,United Healthcare-Medicaid, +142361,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,United Healthcare-Medicaid, +142362,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,United Healthcare-Medicaid, +142363,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,United Healthcare-Medicaid, +142364,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,United Healthcare-Medicaid, +142365,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,United Healthcare-Medicaid, +142366,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,United Healthcare-Medicaid, +142367,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,United Healthcare-Medicaid, +142368,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,United Healthcare-Medicaid,7188.71 +142369,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,United Healthcare-Medicaid, +142370,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,United Healthcare-Medicaid, +142371,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,United Healthcare-Medicaid, +142372,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,United Healthcare-Medicaid, +142373,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,United Healthcare-Medicaid, +142374,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,United Healthcare-Medicaid, +142375,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,United Healthcare-Medicaid, +142376,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,United Healthcare-Medicaid, +142377,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,United Healthcare-Medicaid, +142378,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,United Healthcare-Medicaid, +142379,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,United Healthcare-Medicaid, +142380,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,United Healthcare-Medicaid, +142381,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,United Healthcare-Medicaid, +142382,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,United Healthcare-Medicaid, +142383,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,United Healthcare-Medicaid, +142384,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,United Healthcare-Medicaid,656.23 +142385,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,United Healthcare-Medicaid, +142386,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,United Healthcare-Medicaid, +142387,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,United Healthcare-Medicaid, +142388,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,United Healthcare-Medicaid, +142389,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,United Healthcare-Medicaid,765.94 +142390,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,United Healthcare-Medicaid,1001.55 +142391,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,United Healthcare-Medicaid,383.93 +142392,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,United Healthcare-Medicaid,377.25 +142393,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,United Healthcare-Medicaid,377.25 +142394,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,United Healthcare-Medicaid,431.92 +142395,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,United Healthcare-Medicaid, +142396,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,United Healthcare-Medicaid,686.74 +142397,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,United Healthcare-Medicaid,380.59 +142398,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,United Healthcare-Medicaid,813.98 +142399,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,United Healthcare-Medicaid, +142400,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,United Healthcare-Medicaid, +142401,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,United Healthcare-Medicaid,795.76 +142402,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,United Healthcare-Medicaid, +142403,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,United Healthcare-Medicaid,1597.86 +142404,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,United Healthcare-Medicaid, +142405,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,United Healthcare-Medicaid, +142406,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,United Healthcare-Medicaid, +142407,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,United Healthcare-Medicaid, +142408,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,United Healthcare-Medicaid,777.97 +142409,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,United Healthcare-Medicaid,436.92 +142410,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,United Healthcare-Medicaid, +142411,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,United Healthcare-Medicaid, +142412,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,United Healthcare-Medicaid, +142413,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,United Healthcare-Medicaid,787.77 +142414,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,United Healthcare-Medicaid, +142415,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,United Healthcare-Medicaid, +142416,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,United Healthcare-Medicaid,2328.31 +142417,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,United Healthcare-Medicaid, +142418,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,United Healthcare-Medicaid,787.77 +142419,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,United Healthcare-Medicaid,1435.46 +142420,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,United Healthcare-Medicaid, +142421,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,United Healthcare-Medicaid, +142422,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,United Healthcare-Medicaid,2328.31 +142423,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,United Healthcare-Medicaid,856.97 +142424,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,United Healthcare-Medicaid, +142425,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,United Healthcare-Medicaid, +142426,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,United Healthcare-Medicaid, +142427,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,United Healthcare-Medicaid, +142428,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,United Healthcare-Medicaid,2397.51 +142429,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,United Healthcare-Medicaid, +142430,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,United Healthcare-Medicaid, +142431,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,United Healthcare-Medicaid, +142432,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,United Healthcare-Medicaid, +142433,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,United Healthcare-Medicaid, +142434,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,United Healthcare-Medicaid, +142435,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,United Healthcare-Medicaid, +142436,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,United Healthcare-Medicaid, +142437,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,United Healthcare-Medicaid, +142438,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,United Healthcare-Medicaid, +142439,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,United Healthcare-Medicaid, +142440,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,United Healthcare-Medicaid, +142441,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,United Healthcare-Medicaid, +142442,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,United Healthcare-Medicaid, +142443,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,United Healthcare-Medicaid, +142444,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,United Healthcare-Medicaid, +142445,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,United Healthcare-Medicaid, +142446,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,United Healthcare-Medicaid, +142447,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,United Healthcare-Medicaid, +142448,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,United Healthcare-Medicaid, +142449,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,United Healthcare-Medicaid, +142450,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,United Healthcare-Medicaid,129.42 +142451,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,United Healthcare-Medicaid,129.42 +142452,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,United Healthcare-Medicaid, +142453,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,United Healthcare-Medicaid,129.42 +142454,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,United Healthcare-Medicaid, +142455,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,United Healthcare-Medicaid,1435.46 +142456,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,United Healthcare-Medicaid, +142457,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,United Healthcare-Medicaid, +142458,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,United Healthcare-Medicaid,171.78 +142459,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,United Healthcare-Medicaid, +142460,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,United Healthcare-Medicaid, +142461,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,United Healthcare-Medicaid, +142462,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,United Healthcare-Medicaid, +142463,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,United Healthcare-Medicaid, +142464,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,United Healthcare-Medicaid, +142465,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,United Healthcare-Medicaid,393.96 +142466,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,United Healthcare-Medicaid,415.72 +142467,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,United Healthcare-Medicaid, +142468,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,United Healthcare-Medicaid,523.9 +142469,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,United Healthcare-Medicaid,523.9 +142470,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,United Healthcare-Medicaid,523.9 +142471,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,United Healthcare-Medicaid, +142472,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,United Healthcare-Medicaid,607.61 +142473,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,United Healthcare-Medicaid,523.9 +142474,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,United Healthcare-Medicaid, +142475,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,United Healthcare-Medicaid, +142476,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,United Healthcare-Medicaid, +142477,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,United Healthcare-Medicaid,847.47 +142478,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,United Healthcare-Medicaid, +142479,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,United Healthcare-Medicaid,365.92 +142480,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,United Healthcare-Medicaid,781.7 +142481,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,United Healthcare-Medicaid, +142482,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,United Healthcare-Medicaid, +142483,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,United Healthcare-Medicaid, +142484,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,United Healthcare-Medicaid, +142485,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,United Healthcare-Medicaid,781.7 +142486,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,United Healthcare-Medicaid,781.7 +142487,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,United Healthcare-Medicaid, +142488,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,United Healthcare-Medicaid, +142489,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,United Healthcare-Medicaid, +142490,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,United Healthcare-Medicaid,781.7 +142491,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,United Healthcare-Medicaid,781.7 +142492,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,United Healthcare-Medicaid, +142493,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,United Healthcare-Medicaid, +142494,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,United Healthcare-Medicaid, +142495,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,United Healthcare-Medicaid, +142496,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,United Healthcare-Medicaid, +142497,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,United Healthcare-Medicaid,787.77 +142498,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,United Healthcare-Medicaid,336.03 +142499,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,United Healthcare-Medicaid, +142500,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,United Healthcare-Medicaid,712.75 +142501,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,United Healthcare-Medicaid, +142502,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,United Healthcare-Medicaid,925.21 +142503,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,United Healthcare-Medicaid, +142504,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,United Healthcare-Medicaid, +142505,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,United Healthcare-Medicaid, +142506,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,United Healthcare-Medicaid, +142507,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,United Healthcare-Medicaid, +142508,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,United Healthcare-Medicaid, +142509,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,United Healthcare-Medicaid, +142510,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,United Healthcare-Medicaid,1663.01 +142511,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,United Healthcare-Medicaid, +142512,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,United Healthcare-Medicaid,1663.01 +142513,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,United Healthcare-Medicaid, +142514,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,United Healthcare-Medicaid, +142515,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,United Healthcare-Medicaid, +142516,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,United Healthcare-Medicaid,1435.46 +142517,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,United Healthcare-Medicaid,1663.01 +142518,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,United Healthcare-Medicaid, +142519,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,United Healthcare-Medicaid, +142520,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,United Healthcare-Medicaid, +142521,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,United Healthcare-Medicaid, +142522,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,United Healthcare-Medicaid, +142523,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,United Healthcare-Medicaid,1488.19 +142524,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,United Healthcare-Medicaid, +142525,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,United Healthcare-Medicaid, +142526,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,United Healthcare-Medicaid,1491.44 +142527,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,United Healthcare-Medicaid, +142528,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,United Healthcare-Medicaid, +142529,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,United Healthcare-Medicaid, +142530,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,United Healthcare-Medicaid, +142531,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,United Healthcare-Medicaid, +142532,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,United Healthcare-Medicaid, +142533,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,United Healthcare-Medicaid, +142534,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,United Healthcare-Medicaid, +142535,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,United Healthcare-Medicaid, +142536,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,United Healthcare-Medicaid,1663.01 +142537,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,United Healthcare-Medicaid, +142538,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,United Healthcare-Medicaid, +142539,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,United Healthcare-Medicaid, +142540,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,United Healthcare-Medicaid,3434.62 +142541,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,United Healthcare-Medicaid, +142542,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,United Healthcare-Medicaid, +142543,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,United Healthcare-Medicaid, +142544,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,United Healthcare-Medicaid, +142545,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,United Healthcare-Medicaid,1435.46 +142546,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,United Healthcare-Medicaid,1435.46 +142547,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,United Healthcare-Medicaid, +142548,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,United Healthcare-Medicaid, +142549,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,United Healthcare-Medicaid,523.9 +142550,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,United Healthcare-Medicaid,523.9 +142551,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,United Healthcare-Medicaid,523.9 +142552,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,United Healthcare-Medicaid, +142553,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,United Healthcare-Medicaid,367.14 +142554,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,United Healthcare-Medicaid, +142555,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,United Healthcare-Medicaid, +142556,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,United Healthcare-Medicaid,1861.52 +142557,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,United Healthcare-Medicaid, +142558,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,United Healthcare-Medicaid,1861.52 +142559,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,United Healthcare-Medicaid, +142560,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,United Healthcare-Medicaid,1854.6 +142561,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,United Healthcare-Medicaid, +142562,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,United Healthcare-Medicaid, +142563,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,United Healthcare-Medicaid,1792.32 +142564,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,United Healthcare-Medicaid, +142565,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,United Healthcare-Medicaid,1273.3 +142566,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,United Healthcare-Medicaid,442.92 +142567,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,United Healthcare-Medicaid, +142568,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,United Healthcare-Medicaid,885.85 +142569,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,United Healthcare-Medicaid, +142570,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,United Healthcare-Medicaid, +142571,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,United Healthcare-Medicaid,3736.21 +142572,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,United Healthcare-Medicaid,2900.23 +142573,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,United Healthcare-Medicaid, +142574,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,United Healthcare-Medicaid, +142575,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,United Healthcare-Medicaid, +142576,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,United Healthcare-Medicaid,5271.14 +142577,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,United Healthcare-Medicaid, +142578,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,United Healthcare-Medicaid, +142579,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,United Healthcare-Medicaid, +142580,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,United Healthcare-Medicaid, +142581,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,United Healthcare-Medicaid,3075.13 +142582,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,United Healthcare-Medicaid, +142583,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,United Healthcare-Medicaid,5201.94 +142584,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,United Healthcare-Medicaid, +142585,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,United Healthcare-Medicaid, +142586,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,United Healthcare-Medicaid,3736.21 +142587,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,United Healthcare-Medicaid,3667.01 +142588,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,United Healthcare-Medicaid, +142589,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,United Healthcare-Medicaid, +142590,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,United Healthcare-Medicaid, +142591,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,United Healthcare-Medicaid, +142592,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,United Healthcare-Medicaid,1433.61 +142593,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,United Healthcare-Medicaid,656.23 +142594,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,United Healthcare-Medicaid,787.77 +142595,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,United Healthcare-Medicaid, +142596,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,United Healthcare-Medicaid, +142597,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,United Healthcare-Medicaid, +142598,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,United Healthcare-Medicaid, +142599,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,United Healthcare-Medicaid, +142600,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,United Healthcare-Medicaid, +142601,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,United Healthcare-Medicaid, +142602,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,United Healthcare-Medicaid, +142603,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,United Healthcare-Medicaid,315.73 +142604,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,United Healthcare-Medicaid,365.16 +142605,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,United Healthcare-Medicaid, +142606,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,United Healthcare-Medicaid, +142607,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,United Healthcare-Medicaid, +142608,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,United Healthcare-Medicaid,501.93 +142609,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,United Healthcare-Medicaid,643.48 +142610,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,United Healthcare-Medicaid, +142611,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,United Healthcare-Medicaid, +142612,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,United Healthcare-Medicaid,1944.21 +142613,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,United Healthcare-Medicaid,1815.47 +142614,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,United Healthcare-Medicaid,1944.21 +142615,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,United Healthcare-Medicaid,1944.21 +142616,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,United Healthcare-Medicaid, +142617,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,United Healthcare-Medicaid, +142618,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,United Healthcare-Medicaid, +142619,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,United Healthcare-Medicaid, +142620,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,United Healthcare-Medicaid, +142621,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,United Healthcare-Medicaid, +142622,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,United Healthcare-Medicaid, +142623,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,United Healthcare-Medicaid, +142624,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,United Healthcare-Medicaid,1330.74 +142625,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,United Healthcare-Medicaid,1261.54 +142626,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,United Healthcare-Medicaid, +142627,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,United Healthcare-Medicaid, +142628,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,United Healthcare-Medicaid, +142629,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,United Healthcare-Medicaid, +142630,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,United Healthcare-Medicaid, +142631,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,United Healthcare-Medicaid, +142632,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,United Healthcare-Medicaid, +142633,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,United Healthcare-Medicaid, +142634,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,United Healthcare-Medicaid, +142635,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,United Healthcare-Medicaid, +142636,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,United Healthcare-Medicaid, +142637,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,United Healthcare-Medicaid, +142638,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,United Healthcare-Medicaid, +142639,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,United Healthcare-Medicaid, +142640,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,United Healthcare-Medicaid, +142641,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,United Healthcare-Medicaid, +142642,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,United Healthcare-Medicaid, +142643,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,United Healthcare-Medicaid, +142644,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,United Healthcare-Medicaid,5709.09 +142645,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,United Healthcare-Medicaid, +142646,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,United Healthcare-Medicaid, +142647,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,United Healthcare-Medicaid,1444.99 +142648,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,United Healthcare-Medicaid, +142649,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,United Healthcare-Medicaid, +142650,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,United Healthcare-Medicaid, +142651,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,United Healthcare-Medicaid, +142652,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,United Healthcare-Medicaid, +142653,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,United Healthcare-Medicaid,440.13 +142654,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,United Healthcare-Medicaid, +142655,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,United Healthcare-Medicaid, +142656,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,United Healthcare-Medicaid, +142657,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,United Healthcare-Medicaid,432.36 +142658,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,United Healthcare-Medicaid, +142659,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,United Healthcare-Medicaid, +142660,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,United Healthcare-Medicaid, +142661,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,United Healthcare-Medicaid,2032.46 +142662,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,United Healthcare-Medicaid,856.97 +142663,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,United Healthcare-Medicaid, +142664,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,United Healthcare-Medicaid, +142665,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,United Healthcare-Medicaid, +142666,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,United Healthcare-Medicaid, +142667,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,United Healthcare-Medicaid, +142668,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,United Healthcare-Medicaid, +142669,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,United Healthcare-Medicaid, +142670,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,United Healthcare-Medicaid, +142671,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,United Healthcare-Medicaid, +142672,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,United Healthcare-Medicaid, +142673,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,United Healthcare-Medicaid,1104.52 +142674,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,United Healthcare-Medicaid, +142675,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,United Healthcare-Medicaid, +142676,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,United Healthcare-Medicaid, +142677,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,United Healthcare-Medicaid,6381.79 +142678,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,United Healthcare-Medicaid, +142679,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,United Healthcare-Medicaid,2088.7 +142680,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,United Healthcare-Medicaid, +142681,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,United Healthcare-Medicaid, +142682,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,United Healthcare-Medicaid, +142683,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,United Healthcare-Medicaid, +142684,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,United Healthcare-Medicaid, +142685,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,United Healthcare-Medicaid, +142686,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,United Healthcare-Medicaid, +142687,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,United Healthcare-Medicaid,856.97 +142688,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,United Healthcare-Medicaid, +142689,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,United Healthcare-Medicaid, +142690,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,United Healthcare-Medicaid, +142691,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,United Healthcare-Medicaid, +142692,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,United Healthcare-Medicaid, +142693,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,United Healthcare-Medicaid, +142694,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,United Healthcare-Medicaid, +142695,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,United Healthcare-Medicaid,2547.53 +142696,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,United Healthcare-Medicaid,1980.16 +142697,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,United Healthcare-Medicaid,3279.94 +142698,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,United Healthcare-Medicaid, +142699,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,United Healthcare-Medicaid,4313.09 +142700,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,United Healthcare-Medicaid, +142701,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,United Healthcare-Medicaid,572.04 +142702,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,United Healthcare-Medicaid, +142703,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,United Healthcare-Medicaid, +142704,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,United Healthcare-Medicaid, +142705,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,United Healthcare-Medicaid, +142706,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,United Healthcare-Medicaid, +142707,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,United Healthcare-Medicaid, +142708,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,United Healthcare-Medicaid, +142709,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,United Healthcare-Medicaid, +142710,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,United Healthcare-Medicaid,3073.63 +142711,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,United Healthcare-Medicaid,2547.53 +142712,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,United Healthcare-Medicaid,2236.33 +142713,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,United Healthcare-Medicaid, +142714,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,United Healthcare-Medicaid, +142715,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,United Healthcare-Medicaid,2547.53 +142716,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,United Healthcare-Medicaid, +142717,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,United Healthcare-Medicaid, +142718,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,United Healthcare-Medicaid, +142719,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,United Healthcare-Medicaid, +142720,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,United Healthcare-Medicaid,2236.33 +142721,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,United Healthcare-Medicaid, +142722,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,United Healthcare-Medicaid, +142723,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,United Healthcare-Medicaid, +142724,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,United Healthcare-Medicaid, +142725,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,United Healthcare-Medicaid, +142726,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,United Healthcare-Medicaid, +142727,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,United Healthcare-Medicaid,3552.4 +142728,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,United Healthcare-Medicaid,3552.4 +142729,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,United Healthcare-Medicaid, +142730,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,United Healthcare-Medicaid, +142731,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,United Healthcare-Medicaid, +142732,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,United Healthcare-Medicaid, +142733,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,United Healthcare-Medicaid,3552.4 +142734,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,United Healthcare-Medicaid, +142735,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,United Healthcare-Medicaid, +142736,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,United Healthcare-Medicaid, +142737,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,United Healthcare-Medicaid, +142738,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,United Healthcare-Medicaid, +142739,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,United Healthcare-Medicaid,572.04 +142740,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,United Healthcare-Medicaid, +142741,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,United Healthcare-Medicaid,612.16 +142742,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,United Healthcare-Medicaid,3279.94 +142743,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,United Healthcare-Medicaid, +142744,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,United Healthcare-Medicaid, +142745,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,United Healthcare-Medicaid,2236.33 +142746,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,United Healthcare-Medicaid, +142747,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,United Healthcare-Medicaid,3013.72 +142748,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,United Healthcare-Medicaid, +142749,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,United Healthcare-Medicaid, +142750,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,United Healthcare-Medicaid, +142751,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,United Healthcare-Medicaid, +142752,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,United Healthcare-Medicaid,2305.53 +142753,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,United Healthcare-Medicaid, +142754,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,United Healthcare-Medicaid,1535.59 +142755,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,United Healthcare-Medicaid, +142756,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,United Healthcare-Medicaid, +142757,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,United Healthcare-Medicaid,2305.53 +142758,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,United Healthcare-Medicaid, +142759,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,United Healthcare-Medicaid, +142760,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,United Healthcare-Medicaid, +142761,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,United Healthcare-Medicaid,2236.33 +142762,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,United Healthcare-Medicaid, +142763,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,United Healthcare-Medicaid, +142764,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,United Healthcare-Medicaid,2305.53 +142765,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,United Healthcare-Medicaid, +142766,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,United Healthcare-Medicaid, +142767,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,United Healthcare-Medicaid, +142768,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,United Healthcare-Medicaid,2532.41 +142769,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,United Healthcare-Medicaid,2532.41 +142770,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,United Healthcare-Medicaid, +142771,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,United Healthcare-Medicaid,3361.5 +142772,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,United Healthcare-Medicaid,575.09 +142773,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,United Healthcare-Medicaid, +142774,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,United Healthcare-Medicaid, +142775,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,United Healthcare-Medicaid, +142776,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,United Healthcare-Medicaid, +142777,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,United Healthcare-Medicaid,572.04 +142778,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,United Healthcare-Medicaid,3552.4 +142779,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,United Healthcare-Medicaid,575.09 +142780,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,United Healthcare-Medicaid,572.04 +142781,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,United Healthcare-Medicaid,3279.94 +142782,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,United Healthcare-Medicaid, +142783,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,United Healthcare-Medicaid,3279.94 +142784,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,United Healthcare-Medicaid,3279.94 +142785,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,United Healthcare-Medicaid, +142786,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,United Healthcare-Medicaid, +142787,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,United Healthcare-Medicaid, +142788,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,United Healthcare-Medicaid, +142789,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,United Healthcare-Medicaid, +142790,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,United Healthcare-Medicaid,418.25 +142791,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,United Healthcare-Medicaid,686.74 +142792,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,United Healthcare-Medicaid,1466.39 +142793,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,United Healthcare-Medicaid, +142794,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,United Healthcare-Medicaid, +142795,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,United Healthcare-Medicaid, +142796,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,United Healthcare-Medicaid, +142797,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,United Healthcare-Medicaid,1466.39 +142798,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,United Healthcare-Medicaid, +142799,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,United Healthcare-Medicaid, +142800,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,United Healthcare-Medicaid, +142801,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,United Healthcare-Medicaid, +142802,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,United Healthcare-Medicaid, +142803,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,United Healthcare-Medicaid,1070.87 +142804,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,United Healthcare-Medicaid, +142805,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,United Healthcare-Medicaid, +142806,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,United Healthcare-Medicaid,2401.65 +142807,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,United Healthcare-Medicaid, +142808,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,United Healthcare-Medicaid, +142809,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,United Healthcare-Medicaid, +142810,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,United Healthcare-Medicaid, +142811,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,United Healthcare-Medicaid,2349.75 +142812,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,United Healthcare-Medicaid, +142813,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,United Healthcare-Medicaid, +142814,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,United Healthcare-Medicaid,2349.75 +142815,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,United Healthcare-Medicaid, +142816,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,United Healthcare-Medicaid,1466.39 +142817,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,United Healthcare-Medicaid,1466.39 +142818,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,United Healthcare-Medicaid,4478.52 +142819,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,United Healthcare-Medicaid, +142820,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,United Healthcare-Medicaid, +142821,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,United Healthcare-Medicaid, +142822,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,United Healthcare-Medicaid, +142823,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,United Healthcare-Medicaid, +142824,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,United Healthcare-Medicaid, +142825,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,United Healthcare-Medicaid,1466.39 +142826,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,United Healthcare-Medicaid, +142827,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,United Healthcare-Medicaid, +142828,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,United Healthcare-Medicaid,2349.75 +142829,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,United Healthcare-Medicaid, +142830,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,United Healthcare-Medicaid,2349.75 +142831,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,United Healthcare-Medicaid,572.04 +142832,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,United Healthcare-Medicaid, +142833,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,United Healthcare-Medicaid,3279.94 +142834,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,United Healthcare-Medicaid, +142835,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,United Healthcare-Medicaid,572.04 +142836,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,United Healthcare-Medicaid, +142837,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,United Healthcare-Medicaid, +142838,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,United Healthcare-Medicaid, +142839,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,United Healthcare-Medicaid, +142840,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,United Healthcare-Medicaid,572.04 +142841,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,United Healthcare-Medicaid,3279.94 +142842,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,United Healthcare-Medicaid, +142843,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,United Healthcare-Medicaid, +142844,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,United Healthcare-Medicaid, +142845,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,United Healthcare-Medicaid, +142846,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,United Healthcare-Medicaid, +142847,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,United Healthcare-Medicaid, +142848,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,United Healthcare-Medicaid, +142849,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,United Healthcare-Medicaid, +142850,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,United Healthcare-Medicaid, +142851,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,United Healthcare-Medicaid, +142852,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,United Healthcare-Medicaid, +142853,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,United Healthcare-Medicaid, +142854,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,United Healthcare-Medicaid,857.96 +142855,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,United Healthcare-Medicaid,856.09 +142856,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,United Healthcare-Medicaid,4101.63 +142857,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,United Healthcare-Medicaid, +142858,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,United Healthcare-Medicaid, +142859,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,United Healthcare-Medicaid,2455.17 +142860,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,United Healthcare-Medicaid, +142861,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,United Healthcare-Medicaid, +142862,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,United Healthcare-Medicaid,4012.28 +142863,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,United Healthcare-Medicaid, +142864,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,United Healthcare-Medicaid, +142865,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,United Healthcare-Medicaid, +142866,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,United Healthcare-Medicaid, +142867,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,United Healthcare-Medicaid, +142868,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,United Healthcare-Medicaid, +142869,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,United Healthcare-Medicaid, +142870,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,United Healthcare-Medicaid, +142871,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,United Healthcare-Medicaid, +142872,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,United Healthcare-Medicaid, +142873,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,United Healthcare-Medicaid, +142874,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,United Healthcare-Medicaid, +142875,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,United Healthcare-Medicaid,1988.94 +142876,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,United Healthcare-Medicaid, +142877,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,United Healthcare-Medicaid, +142878,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,United Healthcare-Medicaid, +142879,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,United Healthcare-Medicaid, +142880,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,United Healthcare-Medicaid,2250.84 +142881,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,United Healthcare-Medicaid,2455.17 +142882,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,United Healthcare-Medicaid, +142883,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,United Healthcare-Medicaid,2455.17 +142884,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,United Healthcare-Medicaid,2250.84 +142885,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,United Healthcare-Medicaid, +142886,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,United Healthcare-Medicaid,2250.84 +142887,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,United Healthcare-Medicaid, +142888,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,United Healthcare-Medicaid,3986.15 +142889,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,United Healthcare-Medicaid, +142890,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,United Healthcare-Medicaid,2455.17 +142891,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,United Healthcare-Medicaid, +142892,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,United Healthcare-Medicaid,3198.03 +142893,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,United Healthcare-Medicaid, +142894,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,United Healthcare-Medicaid, +142895,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,United Healthcare-Medicaid, +142896,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,United Healthcare-Medicaid, +142897,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,United Healthcare-Medicaid, +142898,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,United Healthcare-Medicaid, +142899,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,United Healthcare-Medicaid,572.04 +142900,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,United Healthcare-Medicaid, +142901,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,United Healthcare-Medicaid,2185.23 +142902,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,United Healthcare-Medicaid, +142903,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,United Healthcare-Medicaid, +142904,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,United Healthcare-Medicaid, +142905,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,United Healthcare-Medicaid, +142906,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,United Healthcare-Medicaid, +142907,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,United Healthcare-Medicaid, +142908,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,United Healthcare-Medicaid, +142909,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,United Healthcare-Medicaid, +142910,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,United Healthcare-Medicaid,1988.94 +142911,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,United Healthcare-Medicaid, +142912,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,United Healthcare-Medicaid, +142913,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,United Healthcare-Medicaid, +142914,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,United Healthcare-Medicaid,1988.94 +142915,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,United Healthcare-Medicaid, +142916,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,United Healthcare-Medicaid, +142917,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,United Healthcare-Medicaid, +142918,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,United Healthcare-Medicaid,2250.84 +142919,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,United Healthcare-Medicaid, +142920,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,United Healthcare-Medicaid, +142921,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,United Healthcare-Medicaid, +142922,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,United Healthcare-Medicaid,2250.84 +142923,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,United Healthcare-Medicaid, +142924,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,United Healthcare-Medicaid, +142925,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,United Healthcare-Medicaid, +142926,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,United Healthcare-Medicaid, +142927,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,United Healthcare-Medicaid, +142928,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,United Healthcare-Medicaid, +142929,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,United Healthcare-Medicaid, +142930,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,United Healthcare-Medicaid,572.04 +142931,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,United Healthcare-Medicaid,3279.94 +142932,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,United Healthcare-Medicaid,1642.05 +142933,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,United Healthcare-Medicaid,3552.4 +142934,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,United Healthcare-Medicaid, +142935,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,United Healthcare-Medicaid, +142936,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,United Healthcare-Medicaid,3552.4 +142937,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,United Healthcare-Medicaid, +142938,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,United Healthcare-Medicaid,572.04 +142939,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,United Healthcare-Medicaid,3552.4 +142940,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,United Healthcare-Medicaid,3552.4 +142941,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,United Healthcare-Medicaid,3279.94 +142942,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,United Healthcare-Medicaid, +142943,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,United Healthcare-Medicaid, +142944,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,United Healthcare-Medicaid, +142945,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,United Healthcare-Medicaid, +142946,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,United Healthcare-Medicaid, +142947,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,United Healthcare-Medicaid,1924.77 +142948,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,United Healthcare-Medicaid,1855.57 +142949,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,United Healthcare-Medicaid, +142950,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,United Healthcare-Medicaid, +142951,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,United Healthcare-Medicaid,2341.96 +142952,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,United Healthcare-Medicaid, +142953,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,United Healthcare-Medicaid, +142954,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,United Healthcare-Medicaid, +142955,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,United Healthcare-Medicaid, +142956,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,United Healthcare-Medicaid, +142957,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,United Healthcare-Medicaid, +142958,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,United Healthcare-Medicaid, +142959,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,United Healthcare-Medicaid,1113.13 +142960,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,United Healthcare-Medicaid, +142961,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,United Healthcare-Medicaid, +142962,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,United Healthcare-Medicaid, +142963,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,United Healthcare-Medicaid, +142964,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,United Healthcare-Medicaid,2341.96 +142965,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,United Healthcare-Medicaid, +142966,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,United Healthcare-Medicaid, +142967,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,United Healthcare-Medicaid, +142968,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,United Healthcare-Medicaid, +142969,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,United Healthcare-Medicaid,2341.96 +142970,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,United Healthcare-Medicaid, +142971,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,United Healthcare-Medicaid,2341.96 +142972,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,United Healthcare-Medicaid, +142973,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,United Healthcare-Medicaid,2341.96 +142974,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,United Healthcare-Medicaid,2341.96 +142975,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,United Healthcare-Medicaid, +142976,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,United Healthcare-Medicaid,1855.57 +142977,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,United Healthcare-Medicaid, +142978,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,United Healthcare-Medicaid,1855.57 +142979,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,United Healthcare-Medicaid,2341.96 +142980,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,United Healthcare-Medicaid, +142981,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,United Healthcare-Medicaid, +142982,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,United Healthcare-Medicaid, +142983,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,United Healthcare-Medicaid, +142984,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,United Healthcare-Medicaid, +142985,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,United Healthcare-Medicaid, +142986,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,United Healthcare-Medicaid, +142987,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,United Healthcare-Medicaid, +142988,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,United Healthcare-Medicaid, +142989,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,United Healthcare-Medicaid, +142990,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,United Healthcare-Medicaid, +142991,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,United Healthcare-Medicaid, +142992,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,United Healthcare-Medicaid,3279.94 +142993,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,United Healthcare-Medicaid, +142994,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,United Healthcare-Medicaid, +142995,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,United Healthcare-Medicaid, +142996,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,United Healthcare-Medicaid, +142997,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,United Healthcare-Medicaid, +142998,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,United Healthcare-Medicaid, +142999,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,United Healthcare-Medicaid, +143000,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,United Healthcare-Medicaid, +143001,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,United Healthcare-Medicaid, +143002,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,United Healthcare-Medicaid,2341.96 +143003,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,United Healthcare-Medicaid, +143004,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,United Healthcare-Medicaid, +143005,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,United Healthcare-Medicaid, +143006,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,United Healthcare-Medicaid,477.42 +143007,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,United Healthcare-Medicaid, +143008,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,United Healthcare-Medicaid,258.96 +143009,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,United Healthcare-Medicaid,259.53 +143010,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,United Healthcare-Medicaid,258.96 +143011,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,United Healthcare-Medicaid, +143012,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,United Healthcare-Medicaid, +143013,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,United Healthcare-Medicaid,327.44 +143014,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,United Healthcare-Medicaid,525.48 +143015,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,United Healthcare-Medicaid,342.71 +143016,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,United Healthcare-Medicaid,258.96 +143017,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,United Healthcare-Medicaid,443.32 +143018,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,United Healthcare-Medicaid, +143019,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,United Healthcare-Medicaid,451.81 +143020,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,United Healthcare-Medicaid, +143021,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,United Healthcare-Medicaid,3814.42 +143022,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,United Healthcare-Medicaid, +143023,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,United Healthcare-Medicaid, +143024,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,United Healthcare-Medicaid, +143025,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,United Healthcare-Medicaid,973.15 +143026,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,United Healthcare-Medicaid, +143027,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,United Healthcare-Medicaid,2062.0 +143028,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,United Healthcare-Medicaid, +143029,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,United Healthcare-Medicaid, +143030,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,United Healthcare-Medicaid,3814.42 +143031,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,United Healthcare-Medicaid, +143032,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,United Healthcare-Medicaid, +143033,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,United Healthcare-Medicaid, +143034,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,United Healthcare-Medicaid,2062.0 +143035,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,United Healthcare-Medicaid,1989.74 +143036,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,United Healthcare-Medicaid, +143037,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,United Healthcare-Medicaid, +143038,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,United Healthcare-Medicaid, +143039,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,United Healthcare-Medicaid, +143040,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,United Healthcare-Medicaid, +143041,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,United Healthcare-Medicaid, +143042,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,United Healthcare-Medicaid, +143043,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,United Healthcare-Medicaid, +143044,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,United Healthcare-Medicaid,2062.0 +143045,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,United Healthcare-Medicaid,2062.0 +143046,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,United Healthcare-Medicaid, +143047,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,United Healthcare-Medicaid,2062.0 +143048,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,United Healthcare-Medicaid,2788.17 +143049,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,United Healthcare-Medicaid,2062.0 +143050,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,United Healthcare-Medicaid, +143051,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,United Healthcare-Medicaid, +143052,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,United Healthcare-Medicaid, +143053,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,United Healthcare-Medicaid,3814.42 +143054,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,United Healthcare-Medicaid, +143055,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,United Healthcare-Medicaid,1855.57 +143056,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,United Healthcare-Medicaid, +143057,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,United Healthcare-Medicaid, +143058,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,United Healthcare-Medicaid, +143059,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,United Healthcare-Medicaid, +143060,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,United Healthcare-Medicaid, +143061,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,United Healthcare-Medicaid,2798.0 +143062,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,United Healthcare-Medicaid,144.25 +143063,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,United Healthcare-Medicaid, +143064,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,United Healthcare-Medicaid, +143065,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,United Healthcare-Medicaid, +143066,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,United Healthcare-Medicaid,1567.3 +143067,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,United Healthcare-Medicaid, +143068,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,United Healthcare-Medicaid, +143069,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,United Healthcare-Medicaid, +143070,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,United Healthcare-Medicaid,210.86 +143071,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,United Healthcare-Medicaid,144.25 +143072,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,United Healthcare-Medicaid, +143073,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,United Healthcare-Medicaid,1230.7 +143074,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,United Healthcare-Medicaid, +143075,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,United Healthcare-Medicaid, +143076,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,United Healthcare-Medicaid, +143077,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,United Healthcare-Medicaid, +143078,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,United Healthcare-Medicaid, +143079,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,United Healthcare-Medicaid, +143080,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,United Healthcare-Medicaid, +143081,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,United Healthcare-Medicaid, +143082,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,United Healthcare-Medicaid,2718.18 +143083,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,United Healthcare-Medicaid, +143084,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,United Healthcare-Medicaid,1983.76 +143085,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,United Healthcare-Medicaid, +143086,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,United Healthcare-Medicaid, +143087,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,United Healthcare-Medicaid,618.85 +143088,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,United Healthcare-Medicaid, +143089,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,United Healthcare-Medicaid, +143090,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,United Healthcare-Medicaid,2813.99 +143091,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,United Healthcare-Medicaid, +143092,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,United Healthcare-Medicaid, +143093,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,United Healthcare-Medicaid, +143094,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,United Healthcare-Medicaid,203.64 +143095,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,United Healthcare-Medicaid,4112.45 +143096,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,United Healthcare-Medicaid, +143097,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,United Healthcare-Medicaid, +143098,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,United Healthcare-Medicaid, +143099,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,United Healthcare-Medicaid, +143100,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,United Healthcare-Medicaid, +143101,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,United Healthcare-Medicaid, +143102,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,United Healthcare-Medicaid,1983.76 +143103,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,United Healthcare-Medicaid,1914.56 +143104,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,United Healthcare-Medicaid, +143105,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,United Healthcare-Medicaid,266.91 +143106,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,United Healthcare-Medicaid, +143107,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,United Healthcare-Medicaid,1444.99 +143108,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,United Healthcare-Medicaid, +143109,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,United Healthcare-Medicaid, +143110,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,United Healthcare-Medicaid, +143111,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,United Healthcare-Medicaid, +143112,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,United Healthcare-Medicaid,625.36 +143113,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,United Healthcare-Medicaid, +143114,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,United Healthcare-Medicaid,1250.36 +143115,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,United Healthcare-Medicaid, +143116,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,United Healthcare-Medicaid, +143117,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,United Healthcare-Medicaid, +143118,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,United Healthcare-Medicaid, +143119,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,United Healthcare-Medicaid, +143120,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,United Healthcare-Medicaid, +143121,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,United Healthcare-Medicaid, +143122,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,United Healthcare-Medicaid, +143123,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,United Healthcare-Medicaid, +143124,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,United Healthcare-Medicaid, +143125,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,United Healthcare-Medicaid, +143126,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,United Healthcare-Medicaid, +143127,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,United Healthcare-Medicaid, +143128,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,United Healthcare-Medicaid,1560.7 +143129,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,United Healthcare-Medicaid, +143130,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,United Healthcare-Medicaid, +143131,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,United Healthcare-Medicaid, +143132,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,United Healthcare-Medicaid, +143133,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,United Healthcare-Medicaid,1001.9 +143134,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,United Healthcare-Medicaid, +143135,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,United Healthcare-Medicaid, +143136,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,United Healthcare-Medicaid, +143137,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,United Healthcare-Medicaid,759.17 +143138,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,United Healthcare-Medicaid, +143139,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,United Healthcare-Medicaid, +143140,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,United Healthcare-Medicaid,759.17 +143141,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,United Healthcare-Medicaid, +143142,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,United Healthcare-Medicaid, +143143,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,United Healthcare-Medicaid, +143144,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,United Healthcare-Medicaid, +143145,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,United Healthcare-Medicaid, +143146,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,United Healthcare-Medicaid, +143147,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,United Healthcare-Medicaid, +143148,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,United Healthcare-Medicaid, +143149,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,United Healthcare-Medicaid, +143150,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,United Healthcare-Medicaid, +143151,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,United Healthcare-Medicaid, +143152,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,United Healthcare-Medicaid, +143153,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,United Healthcare-Medicaid, +143154,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,United Healthcare-Medicaid, +143155,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,United Healthcare-Medicaid, +143156,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,United Healthcare-Medicaid, +143157,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,United Healthcare-Medicaid, +143158,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,United Healthcare-Medicaid, +143159,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,United Healthcare-Medicaid, +143160,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,United Healthcare-Medicaid, +143161,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,United Healthcare-Medicaid, +143162,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,United Healthcare-Medicaid, +143163,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,United Healthcare-Medicaid,13295.57 +143164,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,United Healthcare-Medicaid, +143165,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,United Healthcare-Medicaid, +143166,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,United Healthcare-Medicaid,13295.57 +143167,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,United Healthcare-Medicaid, +143168,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,United Healthcare-Medicaid, +143169,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,United Healthcare-Medicaid, +143170,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,United Healthcare-Medicaid,9546.18 +143171,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,United Healthcare-Medicaid, +143172,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,United Healthcare-Medicaid, +143173,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,United Healthcare-Medicaid, +143174,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,United Healthcare-Medicaid, +143175,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,United Healthcare-Medicaid, +143176,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,United Healthcare-Medicaid, +143177,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,United Healthcare-Medicaid, +143178,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,United Healthcare-Medicaid, +143179,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,United Healthcare-Medicaid, +143180,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,United Healthcare-Medicaid, +143181,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,United Healthcare-Medicaid, +143182,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,United Healthcare-Medicaid, +143183,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,United Healthcare-Medicaid,2843.73 +143184,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,United Healthcare-Medicaid, +143185,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,United Healthcare-Medicaid, +143186,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,United Healthcare-Medicaid,34.42 +143187,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,United Healthcare-Medicaid, +143188,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,United Healthcare-Medicaid, +143189,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,United Healthcare-Medicaid, +143190,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,United Healthcare-Medicaid, +143191,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,United Healthcare-Medicaid, +143192,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,United Healthcare-Medicaid, +143193,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,United Healthcare-Medicaid, +143194,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,United Healthcare-Medicaid, +143195,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,United Healthcare-Medicaid, +143196,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,United Healthcare-Medicaid,1180.63 +143197,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,United Healthcare-Medicaid,1350.98 +143198,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,United Healthcare-Medicaid, +143199,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,United Healthcare-Medicaid,741.16 +143200,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,United Healthcare-Medicaid, +143201,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,United Healthcare-Medicaid, +143202,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,United Healthcare-Medicaid, +143203,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,United Healthcare-Medicaid, +143204,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,United Healthcare-Medicaid, +143205,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,United Healthcare-Medicaid, +143206,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,United Healthcare-Medicaid, +143207,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,United Healthcare-Medicaid, +143208,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,United Healthcare-Medicaid,34.42 +143209,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,United Healthcare-Medicaid,5.22 +143210,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,United Healthcare-Medicaid,39.86 +143211,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,United Healthcare-Medicaid,614.8 +143212,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,United Healthcare-Medicaid, +143213,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,United Healthcare-Medicaid, +143214,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,United Healthcare-Medicaid, +143215,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,United Healthcare-Medicaid, +143216,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,United Healthcare-Medicaid, +143217,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,United Healthcare-Medicaid, +143218,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,United Healthcare-Medicaid,251.09 +143219,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,United Healthcare-Medicaid, +143220,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,United Healthcare-Medicaid,1907.31 +143221,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,United Healthcare-Medicaid,2200.51 +143222,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,United Healthcare-Medicaid, +143223,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,United Healthcare-Medicaid, +143224,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,United Healthcare-Medicaid,296.0 +143225,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,United Healthcare-Medicaid, +143226,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,United Healthcare-Medicaid,1596.12 +143227,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,United Healthcare-Medicaid, +143228,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,United Healthcare-Medicaid, +143229,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,United Healthcare-Medicaid, +143230,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,United Healthcare-Medicaid,992.16 +143231,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,United Healthcare-Medicaid,117.75 +143232,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,United Healthcare-Medicaid,116.62 +143233,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,United Healthcare-Medicaid, +143234,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,United Healthcare-Medicaid, +143235,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,United Healthcare-Medicaid, +143236,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,United Healthcare-Medicaid,76.1 +143237,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,United Healthcare-Medicaid, +143238,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,United Healthcare-Medicaid, +143239,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,United Healthcare-Medicaid, +143240,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,United Healthcare-Medicaid, +143241,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,United Healthcare-Medicaid, +143242,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,United Healthcare-Medicaid, +143243,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,United Healthcare-Medicaid, +143244,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,United Healthcare-Medicaid, +143245,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,United Healthcare-Medicaid, +143246,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,United Healthcare-Medicaid, +143247,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,United Healthcare-Medicaid, +143248,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,United Healthcare-Medicaid, +143249,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,United Healthcare-Medicaid, +143250,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,United Healthcare-Medicaid, +143251,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,United Healthcare-Medicaid, +143252,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,United Healthcare-Medicaid, +143253,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,United Healthcare-Medicaid, +143254,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,United Healthcare-Medicaid, +143255,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,United Healthcare-Medicaid, +143256,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,United Healthcare-Medicaid,2478.21 +143257,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,United Healthcare-Medicaid, +143258,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,United Healthcare-Medicaid, +143259,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,United Healthcare-Medicaid, +143260,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,United Healthcare-Medicaid, +143261,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,United Healthcare-Medicaid, +143262,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,United Healthcare-Medicaid, +143263,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,United Healthcare-Medicaid,2964.84 +143264,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,United Healthcare-Medicaid, +143265,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,United Healthcare-Medicaid, +143266,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,United Healthcare-Medicaid, +143267,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,United Healthcare-Medicaid, +143268,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,United Healthcare-Medicaid, +143269,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,United Healthcare-Medicaid, +143270,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,United Healthcare-Medicaid, +143271,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,United Healthcare-Medicaid, +143272,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,United Healthcare-Medicaid, +143273,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,United Healthcare-Medicaid, +143274,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,United Healthcare-Medicaid, +143275,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,United Healthcare-Medicaid,2964.84 +143276,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,United Healthcare-Medicaid,2964.84 +143277,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,United Healthcare-Medicaid, +143278,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,United Healthcare-Medicaid,2478.21 +143279,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,United Healthcare-Medicaid, +143280,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,United Healthcare-Medicaid, +143281,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,United Healthcare-Medicaid, +143282,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,United Healthcare-Medicaid, +143283,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,United Healthcare-Medicaid, +143284,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,United Healthcare-Medicaid, +143285,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,United Healthcare-Medicaid, +143286,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,United Healthcare-Medicaid, +143287,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,United Healthcare-Medicaid, +143288,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,United Healthcare-Medicaid, +143289,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,United Healthcare-Medicaid, +143290,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,United Healthcare-Medicaid, +143291,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,United Healthcare-Medicaid,851.06 +143292,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,United Healthcare-Medicaid,833.76 +143293,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,United Healthcare-Medicaid,567.43 +143294,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,United Healthcare-Medicaid,1762.25 +143295,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,United Healthcare-Medicaid, +143296,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,United Healthcare-Medicaid,1718.62 +143297,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,United Healthcare-Medicaid,1589.34 +143298,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,United Healthcare-Medicaid, +143299,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,United Healthcare-Medicaid, +143300,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,United Healthcare-Medicaid, +143301,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,United Healthcare-Medicaid, +143302,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,United Healthcare-Medicaid, +143303,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,United Healthcare-Medicaid, +143304,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,United Healthcare-Medicaid,1649.42 +143305,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,United Healthcare-Medicaid, +143306,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,United Healthcare-Medicaid, +143307,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,United Healthcare-Medicaid, +143308,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,United Healthcare-Medicaid,494.84 +143309,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,United Healthcare-Medicaid, +143310,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,United Healthcare-Medicaid, +143311,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,United Healthcare-Medicaid, +143312,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,United Healthcare-Medicaid, +143313,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,United Healthcare-Medicaid, +143314,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,United Healthcare-Medicaid,3522.27 +143315,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,United Healthcare-Medicaid, +143316,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,United Healthcare-Medicaid,174.8 +143317,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,United Healthcare-Medicaid, +143318,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,United Healthcare-Medicaid, +143319,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,United Healthcare-Medicaid,1973.1 +143320,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,United Healthcare-Medicaid, +143321,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,United Healthcare-Medicaid, +143322,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,United Healthcare-Medicaid, +143323,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,United Healthcare-Medicaid,1444.99 +143324,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,United Healthcare-Medicaid,1444.99 +143325,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,United Healthcare-Medicaid, +143326,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,United Healthcare-Medicaid, +143327,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,United Healthcare-Medicaid, +143328,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,United Healthcare-Medicaid, +143329,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,United Healthcare-Medicaid, +143330,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,United Healthcare-Medicaid, +143331,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,United Healthcare-Medicaid, +143332,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,United Healthcare-Medicaid,2650.21 +143333,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,United Healthcare-Medicaid, +143334,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,United Healthcare-Medicaid, +143335,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,United Healthcare-Medicaid,299.58 +143336,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,United Healthcare-Medicaid, +143337,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,United Healthcare-Medicaid, +143338,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,United Healthcare-Medicaid,590.77 +143339,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,United Healthcare-Medicaid, +143340,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,United Healthcare-Medicaid, +143341,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,United Healthcare-Medicaid,1372.0 +143342,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,United Healthcare-Medicaid, +143343,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,United Healthcare-Medicaid, +143344,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,United Healthcare-Medicaid, +143345,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,United Healthcare-Medicaid, +143346,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,United Healthcare-Medicaid,1397.82 +143347,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,United Healthcare-Medicaid, +143348,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,United Healthcare-Medicaid, +143349,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,United Healthcare-Medicaid, +143350,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,United Healthcare-Medicaid, +143351,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,United Healthcare-Medicaid, +143352,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,United Healthcare-Medicaid,3764.71 +143353,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,United Healthcare-Medicaid,3835.46 +143354,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,United Healthcare-Medicaid, +143355,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,United Healthcare-Medicaid, +143356,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,United Healthcare-Medicaid, +143357,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,United Healthcare-Medicaid,1444.99 +143358,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,United Healthcare-Medicaid,144.25 +143359,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,United Healthcare-Medicaid, +143360,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,United Healthcare-Medicaid, +143361,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,United Healthcare-Medicaid, +143362,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,United Healthcare-Medicaid,2650.21 +143363,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,United Healthcare-Medicaid, +143364,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,United Healthcare-Medicaid,1724.49 +143365,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,United Healthcare-Medicaid,1724.49 +143366,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,United Healthcare-Medicaid,838.99 +143367,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,United Healthcare-Medicaid,1655.29 +143368,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,United Healthcare-Medicaid,1655.29 +143369,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,United Healthcare-Medicaid,1655.29 +143370,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,United Healthcare-Medicaid, +143371,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,United Healthcare-Medicaid, +143372,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,United Healthcare-Medicaid,2041.54 +143373,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,United Healthcare-Medicaid, +143374,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,United Healthcare-Medicaid, +143375,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,United Healthcare-Medicaid,1332.99 +143376,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,United Healthcare-Medicaid, +143377,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,United Healthcare-Medicaid, +143378,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,United Healthcare-Medicaid, +143379,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,United Healthcare-Medicaid, +143380,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,United Healthcare-Medicaid, +143381,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,United Healthcare-Medicaid, +143382,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,United Healthcare-Medicaid,1397.22 +143383,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,United Healthcare-Medicaid,975.42 +143384,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,United Healthcare-Medicaid,975.42 +143385,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,United Healthcare-Medicaid,975.42 +143386,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,United Healthcare-Medicaid,1486.99 +143387,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,United Healthcare-Medicaid, +143388,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,United Healthcare-Medicaid,975.42 +143389,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,United Healthcare-Medicaid,975.42 +143390,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,United Healthcare-Medicaid,975.42 +143391,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,United Healthcare-Medicaid,1810.43 +143392,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,United Healthcare-Medicaid,898.13 +143393,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,United Healthcare-Medicaid,975.42 +143394,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,United Healthcare-Medicaid,956.1 +143395,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,United Healthcare-Medicaid, +143396,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,United Healthcare-Medicaid, +143397,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,United Healthcare-Medicaid,1099.01 +143398,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,United Healthcare-Medicaid, +143399,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,United Healthcare-Medicaid,975.42 +143400,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,United Healthcare-Medicaid,1504.9 +143401,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,United Healthcare-Medicaid, +143402,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,United Healthcare-Medicaid, +143403,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,United Healthcare-Medicaid,1643.83 +143404,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,United Healthcare-Medicaid, +143405,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,United Healthcare-Medicaid, +143406,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,United Healthcare-Medicaid, +143407,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,United Healthcare-Medicaid,1643.83 +143408,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,United Healthcare-Medicaid,1504.9 +143409,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,United Healthcare-Medicaid, +143410,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,United Healthcare-Medicaid, +143411,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,United Healthcare-Medicaid, +143412,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,United Healthcare-Medicaid, +143413,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,United Healthcare-Medicaid, +143414,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,United Healthcare-Medicaid,3558.85 +143415,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,United Healthcare-Medicaid, +143416,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,United Healthcare-Medicaid, +143417,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,United Healthcare-Medicaid,1401.12 +143418,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,United Healthcare-Medicaid, +143419,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,United Healthcare-Medicaid, +143420,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,United Healthcare-Medicaid, +143421,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,United Healthcare-Medicaid, +143422,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,United Healthcare-Medicaid, +143423,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,United Healthcare-Medicaid,417.02 +143424,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,United Healthcare-Medicaid, +143425,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,United Healthcare-Medicaid, +143426,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,United Healthcare-Medicaid,3558.85 +143427,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,United Healthcare-Medicaid, +143428,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,United Healthcare-Medicaid, +143429,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,United Healthcare-Medicaid, +143430,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,United Healthcare-Medicaid, +143431,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,United Healthcare-Medicaid, +143432,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,United Healthcare-Medicaid,975.42 +143433,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,United Healthcare-Medicaid, +143434,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,United Healthcare-Medicaid, +143435,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,United Healthcare-Medicaid, +143436,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,United Healthcare-Medicaid, +143437,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,United Healthcare-Medicaid, +143438,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,United Healthcare-Medicaid, +143439,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,United Healthcare-Medicaid, +143440,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,United Healthcare-Medicaid, +143441,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,United Healthcare-Medicaid,1010.76 +143442,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,United Healthcare-Medicaid, +143443,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,United Healthcare-Medicaid, +143444,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,United Healthcare-Medicaid, +143445,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,United Healthcare-Medicaid, +143446,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,United Healthcare-Medicaid, +143447,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,United Healthcare-Medicaid, +143448,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,United Healthcare-Medicaid, +143449,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,United Healthcare-Medicaid, +143450,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,United Healthcare-Medicaid, +143451,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,United Healthcare-Medicaid, +143452,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,United Healthcare-Medicaid,5925.47 +143453,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,United Healthcare-Medicaid, +143454,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,United Healthcare-Medicaid, +143455,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,United Healthcare-Medicaid, +143456,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,United Healthcare-Medicaid, +143457,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,United Healthcare-Medicaid,825.86 +143458,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,United Healthcare-Medicaid, +143459,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,United Healthcare-Medicaid, +143460,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,United Healthcare-Medicaid, +143461,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,United Healthcare-Medicaid, +143462,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,United Healthcare-Medicaid, +143463,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,United Healthcare-Medicaid, +143464,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,United Healthcare-Medicaid, +143465,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,United Healthcare-Medicaid, +143466,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,United Healthcare-Medicaid, +143467,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,United Healthcare-Medicaid, +143468,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,United Healthcare-Medicaid, +143469,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,United Healthcare-Medicaid, +143470,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,United Healthcare-Medicaid,1006.82 +143471,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,United Healthcare-Medicaid, +143472,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,United Healthcare-Medicaid,1180.24 +143473,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,United Healthcare-Medicaid,447.53 +143474,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,United Healthcare-Medicaid, +143475,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,United Healthcare-Medicaid, +143476,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,United Healthcare-Medicaid,1506.91 +143477,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,United Healthcare-Medicaid, +143478,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,United Healthcare-Medicaid, +143479,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,United Healthcare-Medicaid, +143480,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,United Healthcare-Medicaid,1788.59 +143481,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,United Healthcare-Medicaid, +143482,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,United Healthcare-Medicaid, +143483,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,United Healthcare-Medicaid, +143484,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,United Healthcare-Medicaid, +143485,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,United Healthcare-Medicaid, +143486,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,United Healthcare-Medicaid, +143487,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,United Healthcare-Medicaid, +143488,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,United Healthcare-Medicaid, +143489,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,United Healthcare-Medicaid, +143490,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,United Healthcare-Medicaid, +143491,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,United Healthcare-Medicaid, +143492,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,United Healthcare-Medicaid, +143493,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,United Healthcare-Medicaid, +143494,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,United Healthcare-Medicaid, +143495,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,United Healthcare-Medicaid, +143496,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,United Healthcare-Medicaid, +143497,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,United Healthcare-Medicaid, +143498,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,United Healthcare-Medicaid, +143499,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,United Healthcare-Medicaid, +143500,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,United Healthcare-Medicaid, +143501,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,United Healthcare-Medicaid, +143502,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,United Healthcare-Medicaid, +143503,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,United Healthcare-Medicaid, +143504,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,United Healthcare-Medicaid, +143505,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,United Healthcare-Medicaid, +143506,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,United Healthcare-Medicaid, +143507,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,United Healthcare-Medicaid, +143508,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,United Healthcare-Medicaid, +143509,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,United Healthcare-Medicaid, +143510,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,United Healthcare-Medicaid, +143511,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,United Healthcare-Medicaid, +143512,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,United Healthcare-Medicaid, +143513,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,United Healthcare-Medicaid, +143514,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,United Healthcare-Medicaid, +143515,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,United Healthcare-Medicaid, +143516,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,United Healthcare-Medicaid, +143517,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,United Healthcare-Medicaid, +143518,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,United Healthcare-Medicaid, +143519,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,United Healthcare-Medicaid, +143520,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,United Healthcare-Medicaid, +143521,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,United Healthcare-Medicaid, +143522,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,United Healthcare-Medicaid, +143523,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,United Healthcare-Medicaid, +143524,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,United Healthcare-Medicaid, +143525,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,United Healthcare-Medicaid, +143526,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,United Healthcare-Medicaid, +143527,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,United Healthcare-Medicaid, +143528,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,United Healthcare-Medicaid, +143529,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,United Healthcare-Medicaid, +143530,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,United Healthcare-Medicaid, +143531,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,United Healthcare-Medicaid, +143532,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,United Healthcare-Medicaid, +143533,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,United Healthcare-Medicaid, +143534,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,United Healthcare-Medicaid, +143535,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,United Healthcare-Medicaid, +143536,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,United Healthcare-Medicaid, +143537,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,United Healthcare-Medicaid, +143538,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,United Healthcare-Medicaid, +143539,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,United Healthcare-Medicaid, +143540,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,United Healthcare-Medicaid, +143541,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,United Healthcare-Medicaid, +143542,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,United Healthcare-Medicaid, +143543,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,United Healthcare-Medicaid, +143544,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,United Healthcare-Medicaid, +143545,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,United Healthcare-Medicaid, +143546,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,United Healthcare-Medicaid, +143547,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,United Healthcare-Medicaid, +143548,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,United Healthcare-Medicaid, +143549,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,United Healthcare-Medicaid, +143550,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,United Healthcare-Medicaid, +143551,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,United Healthcare-Medicaid, +143552,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,United Healthcare-Medicaid, +143553,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,United Healthcare-Medicaid, +143554,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,United Healthcare-Medicaid, +143555,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,United Healthcare-Medicaid, +143556,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,United Healthcare-Medicaid, +143557,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,United Healthcare-Medicaid, +143558,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,United Healthcare-Medicaid, +143559,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,United Healthcare-Medicaid, +143560,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,United Healthcare-Medicaid, +143561,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,United Healthcare-Medicaid, +143562,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,United Healthcare-Medicaid, +143563,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,United Healthcare-Medicaid, +143564,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,United Healthcare-Medicaid, +143565,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,United Healthcare-Medicaid, +143566,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,United Healthcare-Medicaid, +143567,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,United Healthcare-Medicaid, +143568,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,United Healthcare-Medicaid, +143569,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,United Healthcare-Medicaid, +143570,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,United Healthcare-Medicaid, +143571,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,United Healthcare-Medicaid, +143572,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,United Healthcare-Medicaid, +143573,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,United Healthcare-Medicaid, +143574,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,United Healthcare-Medicaid, +143575,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,United Healthcare-Medicaid, +143576,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,United Healthcare-Medicaid, +143577,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,United Healthcare-Medicaid, +143578,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,United Healthcare-Medicaid, +143579,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,United Healthcare-Medicaid, +143580,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,United Healthcare-Medicaid, +143581,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,United Healthcare-Medicaid, +143582,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,United Healthcare-Medicaid, +143583,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,United Healthcare-Medicaid, +143584,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,United Healthcare-Medicaid, +143585,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,United Healthcare-Medicaid, +143586,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,United Healthcare-Medicaid, +143587,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,United Healthcare-Medicaid, +143588,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,United Healthcare-Medicaid, +143589,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,United Healthcare-Medicaid, +143590,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,United Healthcare-Medicaid, +143591,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,United Healthcare-Medicaid, +143592,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,United Healthcare-Medicaid, +143593,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,United Healthcare-Medicaid, +143594,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,United Healthcare-Medicaid, +143595,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,United Healthcare-Medicaid, +143596,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,United Healthcare-Medicaid, +143597,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,United Healthcare-Medicaid, +143598,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,United Healthcare-Medicaid, +143599,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,United Healthcare-Medicaid, +143600,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,United Healthcare-Medicaid, +143601,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,United Healthcare-Medicaid, +143602,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,United Healthcare-Medicaid, +143603,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,United Healthcare-Medicaid, +143604,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,United Healthcare-Medicaid, +143605,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,United Healthcare-Medicaid, +143606,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,United Healthcare-Medicaid, +143607,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,United Healthcare-Medicaid, +143608,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,United Healthcare-Medicaid, +143609,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,United Healthcare-Medicaid, +143610,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,United Healthcare-Medicaid, +143611,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,United Healthcare-Medicaid, +143612,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,United Healthcare-Medicaid, +143613,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,United Healthcare-Medicaid, +143614,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,United Healthcare-Medicaid, +143615,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,United Healthcare-Medicaid, +143616,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,United Healthcare-Medicaid, +143617,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,United Healthcare-Medicaid, +143618,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,United Healthcare-Medicaid, +143619,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,United Healthcare-Medicaid, +143620,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,United Healthcare-Medicaid, +143621,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,United Healthcare-Medicaid, +143622,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,United Healthcare-Medicaid, +143623,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,United Healthcare-Medicaid, +143624,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,United Healthcare-Medicaid, +143625,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,United Healthcare-Medicaid, +143626,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,United Healthcare-Medicaid, +143627,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,United Healthcare-Medicaid, +143628,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,United Healthcare-Medicaid, +143629,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,United Healthcare-Medicaid, +143630,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,United Healthcare-Medicaid, +143631,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,United Healthcare-Medicaid, +143632,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,United Healthcare-Medicaid, +143633,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,United Healthcare-Medicaid, +143634,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,United Healthcare-Medicaid, +143635,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,United Healthcare-Medicaid, +143636,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,United Healthcare-Medicaid, +143637,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,United Healthcare-Medicaid, +143638,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,United Healthcare-Medicaid, +143639,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,United Healthcare-Medicaid, +143640,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,United Healthcare-Medicaid, +143641,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,United Healthcare-Medicaid, +143642,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,United Healthcare-Medicaid, +143643,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,United Healthcare-Medicaid, +143644,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,United Healthcare-Medicaid, +143645,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,United Healthcare-Medicaid, +143646,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,United Healthcare-Medicaid, +143647,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,United Healthcare-Medicaid, +143648,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,United Healthcare-Medicaid, +143649,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,United Healthcare-Medicaid, +143650,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,United Healthcare-Medicaid, +143651,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,United Healthcare-Medicaid, +143652,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,United Healthcare-Medicaid, +143653,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,United Healthcare-Medicaid, +143654,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,United Healthcare-Medicaid, +143655,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,United Healthcare-Medicaid, +143656,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,United Healthcare-Medicaid, +143657,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,United Healthcare-Medicaid, +143658,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,United Healthcare-Medicaid, +143659,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,United Healthcare-Medicaid, +143660,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,United Healthcare-Medicaid, +143661,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,United Healthcare-Medicaid, +143662,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,United Healthcare-Medicaid, +143663,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,United Healthcare-Medicaid, +143664,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,United Healthcare-Medicaid, +143665,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,United Healthcare-Medicaid, +143666,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,United Healthcare-Medicaid, +143667,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,United Healthcare-Medicaid, +143668,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,United Healthcare-Medicaid, +143669,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,United Healthcare-Medicaid, +143670,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,United Healthcare-Medicaid, +143671,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,United Healthcare-Medicaid, +143672,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,United Healthcare-Medicaid, +143673,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,United Healthcare-Medicaid, +143674,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,United Healthcare-Medicaid, +143675,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,United Healthcare-Medicaid, +143676,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,United Healthcare-Medicaid, +143677,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,United Healthcare-Medicaid, +143678,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,United Healthcare-Medicaid, +143679,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,United Healthcare-Medicaid, +143680,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,United Healthcare-Medicaid, +143681,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,United Healthcare-Medicaid, +143682,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,United Healthcare-Medicaid, +143683,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,United Healthcare-Medicaid, +143684,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,United Healthcare-Medicaid, +143685,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,United Healthcare-Medicaid, +143686,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,United Healthcare-Medicaid, +143687,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,United Healthcare-Medicaid, +143688,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,United Healthcare-Medicaid, +143689,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,United Healthcare-Medicaid, +143690,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,United Healthcare-Medicaid, +143691,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,United Healthcare-Medicaid, +143692,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,United Healthcare-Medicaid, +143693,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,United Healthcare-Medicaid, +143694,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,United Healthcare-Medicaid, +143695,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,United Healthcare-Medicaid, +143696,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,United Healthcare-Medicaid, +143697,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,United Healthcare-Medicaid, +143698,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,United Healthcare-Medicaid, +143699,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,United Healthcare-Medicaid, +143700,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,United Healthcare-Medicaid, +143701,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,United Healthcare-Medicaid, +143702,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,United Healthcare-Medicaid, +143703,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,United Healthcare-Medicaid, +143704,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,United Healthcare-Medicaid, +143705,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,United Healthcare-Medicaid, +143706,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,United Healthcare-Medicaid, +143707,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,United Healthcare-Medicaid, +143708,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,United Healthcare-Medicaid, +143709,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,United Healthcare-Medicaid, +143710,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,United Healthcare-Medicaid, +143711,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,United Healthcare-Medicaid, +143712,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,United Healthcare-Medicaid, +143713,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,United Healthcare-Medicaid, +143714,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,United Healthcare-Medicaid, +143715,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,United Healthcare-Medicaid, +143716,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,United Healthcare-Medicaid, +143717,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,United Healthcare-Medicaid, +143718,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,United Healthcare-Medicaid, +143719,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,United Healthcare-Medicaid, +143720,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,United Healthcare-Medicaid, +143721,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,United Healthcare-Medicaid, +143722,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,United Healthcare-Medicaid, +143723,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,United Healthcare-Medicaid, +143724,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,United Healthcare-Medicaid, +143725,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,United Healthcare-Medicaid, +143726,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,United Healthcare-Medicaid, +143727,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,United Healthcare-Medicaid, +143728,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,United Healthcare-Medicaid, +143729,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,United Healthcare-Medicaid, +143730,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,United Healthcare-Medicaid, +143731,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,United Healthcare-Medicaid, +143732,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,United Healthcare-Medicaid, +143733,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,United Healthcare-Medicaid, +143734,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,United Healthcare-Medicaid, +143735,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,United Healthcare-Medicaid, +143736,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,United Healthcare-Medicaid, +143737,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,United Healthcare-Medicaid, +143738,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,United Healthcare-Medicaid, +143739,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,United Healthcare-Medicaid, +143740,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,United Healthcare-Medicaid, +143741,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,United Healthcare-Medicaid, +143742,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,United Healthcare-Medicaid, +143743,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,United Healthcare-Medicaid, +143744,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,United Healthcare-Medicaid, +143745,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,United Healthcare-Medicaid, +143746,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,United Healthcare-Medicaid, +143747,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,United Healthcare-Medicaid, +143748,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,United Healthcare-Medicaid, +143749,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,United Healthcare-Medicaid, +143750,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,United Healthcare-Medicaid, +143751,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,United Healthcare-Medicaid, +143752,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,United Healthcare-Medicaid, +143753,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,United Healthcare-Medicaid, +143754,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,United Healthcare-Medicaid, +143755,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,United Healthcare-Medicaid, +143756,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,United Healthcare-Medicaid, +143757,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,United Healthcare-Medicaid, +143758,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,United Healthcare-Medicaid, +143759,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,United Healthcare-Medicaid, +143760,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,United Healthcare-Medicaid, +143761,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,United Healthcare-Medicaid, +143762,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,United Healthcare-Medicaid, +143763,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,United Healthcare-Medicaid, +143764,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,United Healthcare-Medicaid, +143765,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,United Healthcare-Medicaid, +143766,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,United Healthcare-Medicaid, +143767,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,United Healthcare-Medicaid, +143768,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,United Healthcare-Medicaid, +143769,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,United Healthcare-Medicaid, +143770,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,United Healthcare-Medicaid, +143771,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,United Healthcare-Medicaid, +143772,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,United Healthcare-Medicaid, +143773,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,United Healthcare-Medicaid, +143774,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,United Healthcare-Medicaid, +143775,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,United Healthcare-Medicaid, +143776,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,United Healthcare-Medicaid, +143777,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,United Healthcare-Medicaid, +143778,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,United Healthcare-Medicaid, +143779,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,United Healthcare-Medicaid, +143780,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,United Healthcare-Medicaid, +143781,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,United Healthcare-Medicaid, +143782,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,United Healthcare-Medicaid, +143783,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,United Healthcare-Medicaid, +143784,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,United Healthcare-Medicaid, +143785,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,United Healthcare-Medicaid, +143786,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,United Healthcare-Medicaid, +143787,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,United Healthcare-Medicaid, +143788,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,United Healthcare-Medicaid, +143789,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,United Healthcare-Medicaid, +143790,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,United Healthcare-Medicaid, +143791,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,United Healthcare-Medicaid, +143792,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,United Healthcare-Medicaid, +143793,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,United Healthcare-Medicaid, +143794,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,United Healthcare-Medicaid, +143795,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,United Healthcare-Medicaid, +143796,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,United Healthcare-Medicaid, +143797,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,United Healthcare-Medicaid, +143798,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,United Healthcare-Medicaid, +143799,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,United Healthcare-Medicaid, +143800,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,United Healthcare-Medicaid, +143801,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,United Healthcare-Medicaid, +143802,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,United Healthcare-Medicaid, +143803,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,United Healthcare-Medicaid, +143804,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,United Healthcare-Medicaid, +143805,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,United Healthcare-Medicaid, +143806,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,United Healthcare-Medicaid, +143807,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,United Healthcare-Medicaid, +143808,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,United Healthcare-Medicaid, +143809,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,United Healthcare-Medicaid, +143810,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,United Healthcare-Medicaid, +143811,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,United Healthcare-Medicaid, +143812,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,United Healthcare-Medicaid, +143813,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,United Healthcare-Medicaid, +143814,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,United Healthcare-Medicaid, +143815,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,United Healthcare-Medicaid, +143816,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,United Healthcare-Medicaid, +143817,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,United Healthcare-Medicaid, +143818,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,United Healthcare-Medicaid, +143819,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,United Healthcare-Medicaid, +143820,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,United Healthcare-Medicaid, +143821,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,United Healthcare-Medicaid, +143822,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,United Healthcare-Medicaid, +143823,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,United Healthcare-Medicaid, +143824,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,United Healthcare-Medicaid, +143825,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,United Healthcare-Medicaid, +143826,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,United Healthcare-Medicaid, +143827,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,United Healthcare-Medicaid, +143828,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,United Healthcare-Medicaid, +143829,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,United Healthcare-Medicaid, +143830,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,United Healthcare-Medicaid, +143831,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,United Healthcare-Medicaid, +143832,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,United Healthcare-Medicaid, +143833,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,United Healthcare-Medicaid, +143834,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,United Healthcare-Medicaid, +143835,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,United Healthcare-Medicaid, +143836,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,United Healthcare-Medicaid, +143837,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,United Healthcare-Medicaid, +143838,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,United Healthcare-Medicaid, +143839,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,United Healthcare-Medicaid, +143840,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,United Healthcare-Medicaid, +143841,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,United Healthcare-Medicaid, +143842,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,United Healthcare-Medicaid, +143843,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,United Healthcare-Medicaid, +143844,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,United Healthcare-Medicaid, +143845,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,United Healthcare-Medicaid, +143846,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,United Healthcare-Medicaid, +143847,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,United Healthcare-Medicaid, +143848,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,United Healthcare-Medicaid, +143849,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,United Healthcare-Medicaid, +143850,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,United Healthcare-Medicaid, +143851,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,United Healthcare-Medicaid, +143852,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,United Healthcare-Medicaid, +143853,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,United Healthcare-Medicaid, +143854,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,United Healthcare-Medicaid, +143855,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,United Healthcare-Medicaid, +143856,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,United Healthcare-Medicaid, +143857,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,United Healthcare-Medicaid, +143858,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,United Healthcare-Medicaid, +143859,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,United Healthcare-Medicaid, +143860,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,United Healthcare-Medicaid, +143861,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,United Healthcare-Medicaid, +143862,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,United Healthcare-Medicaid, +143863,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,United Healthcare-Medicaid, +143864,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,United Healthcare-Medicaid, +143865,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,United Healthcare-Medicaid, +143866,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,United Healthcare-Medicaid, +143867,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,United Healthcare-Medicaid, +143868,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,United Healthcare-Medicaid, +143869,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,United Healthcare-Medicaid, +143870,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,United Healthcare-Medicaid, +143871,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,United Healthcare-Medicaid, +143872,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,United Healthcare-Medicaid, +143873,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,United Healthcare-Medicaid, +143874,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,United Healthcare-Medicaid, +143875,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,United Healthcare-Medicaid, +143876,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,United Healthcare-Medicaid, +143877,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,United Healthcare-Medicaid, +143878,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,United Healthcare-Medicaid, +143879,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,United Healthcare-Medicaid, +143880,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,United Healthcare-Medicaid, +143881,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,United Healthcare-Medicaid, +143882,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,United Healthcare-Medicaid, +143883,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,United Healthcare-Medicaid, +143884,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,United Healthcare-Medicaid, +143885,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,United Healthcare-Medicaid, +143886,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,United Healthcare-Medicaid, +143887,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,United Healthcare-Medicaid, +143888,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,United Healthcare-Medicaid, +143889,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,United Healthcare-Medicaid, +143890,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,United Healthcare-Medicaid, +143891,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,United Healthcare-Medicaid, +143892,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,United Healthcare-Medicaid, +143893,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,United Healthcare-Medicaid, +143894,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,United Healthcare-Medicaid, +143895,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,United Healthcare-Medicaid, +143896,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,United Healthcare-Medicaid, +143897,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,United Healthcare-Medicaid, +143898,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,United Healthcare-Medicaid, +143899,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,United Healthcare-Medicaid, +143900,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,United Healthcare-Medicaid, +143901,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,United Healthcare-Medicaid, +143902,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,United Healthcare-Medicaid, +143903,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,United Healthcare-Medicaid, +143904,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,United Healthcare-Medicaid, +143905,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,United Healthcare-Medicaid, +143906,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,United Healthcare-Medicaid, +143907,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,United Healthcare-Medicaid, +143908,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,United Healthcare-Medicaid, +143909,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,United Healthcare-Medicaid, +143910,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,United Healthcare-Medicaid, +143911,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,United Healthcare-Medicaid, +143912,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,United Healthcare-Medicaid, +143913,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,United Healthcare-Medicaid, +143914,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,United Healthcare-Medicaid, +143915,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,United Healthcare-Medicaid, +143916,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,United Healthcare-Medicaid, +143917,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,United Healthcare-Medicaid, +143918,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,United Healthcare-Medicaid, +143919,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,United Healthcare-Medicaid, +143920,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,United Healthcare-Medicaid, +143921,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,United Healthcare-Medicaid, +143922,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,United Healthcare-Medicaid, +143923,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,United Healthcare-Medicaid, +143924,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,United Healthcare-Medicaid, +143925,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,United Healthcare-Medicaid, +143926,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,United Healthcare-Medicaid, +143927,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,United Healthcare-Medicaid, +143928,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,United Healthcare-Medicaid, +143929,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,United Healthcare-Medicaid, +143930,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,United Healthcare-Medicaid, +143931,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,United Healthcare-Medicaid, +143932,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,United Healthcare-Medicaid, +143933,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,United Healthcare-Medicaid, +143934,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,United Healthcare-Medicaid, +143935,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,United Healthcare-Medicaid, +143936,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,United Healthcare-Medicaid, +143937,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,United Healthcare-Medicaid, +143938,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,United Healthcare-Medicaid, +143939,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,United Healthcare-Medicaid, +143940,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,United Healthcare-Medicaid, +143941,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,United Healthcare-Medicaid, +143942,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,United Healthcare-Medicaid, +143943,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,United Healthcare-Medicaid, +143944,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,United Healthcare-Medicaid, +143945,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,United Healthcare-Medicaid, +143946,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,United Healthcare-Medicaid, +143947,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,United Healthcare-Medicaid, +143948,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,United Healthcare-Medicaid, +143949,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,United Healthcare-Medicaid, +143950,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,United Healthcare-Medicaid, +143951,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,United Healthcare-Medicaid, +143952,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,United Healthcare-Medicaid, +143953,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,United Healthcare-Medicaid, +143954,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,United Healthcare-Medicaid, +143955,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,United Healthcare-Medicaid, +143956,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,United Healthcare-Medicaid, +143957,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,United Healthcare-Medicaid, +143958,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,United Healthcare-Medicaid, +143959,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,United Healthcare-Medicaid, +143960,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,United Healthcare-Medicaid, +143961,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,United Healthcare-Medicaid, +143962,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,United Healthcare-Medicaid, +143963,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,United Healthcare-Medicaid, +143964,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,United Healthcare-Medicaid, +143965,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,United Healthcare-Medicaid, +143966,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,United Healthcare-Medicaid, +143967,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,United Healthcare-Medicaid, +143968,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,United Healthcare-Medicaid, +143969,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,United Healthcare-Medicaid, +143970,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,United Healthcare-Medicaid, +143971,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,United Healthcare-Medicaid, +143972,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,United Healthcare-Medicaid, +143973,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,United Healthcare-Medicaid, +143974,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,United Healthcare-Medicaid, +143975,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,United Healthcare-Medicaid, +143976,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,United Healthcare-Medicaid, +143977,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,United Healthcare-Medicaid, +143978,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,United Healthcare-Medicaid, +143979,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,United Healthcare-Medicaid, +143980,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,United Healthcare-Medicaid, +143981,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,United Healthcare-Medicaid, +143982,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,United Healthcare-Medicaid, +143983,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,United Healthcare-Medicaid, +143984,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,United Healthcare-Medicaid, +143985,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,United Healthcare-Medicaid, +143986,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,United Healthcare-Medicaid, +143987,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,United Healthcare-Medicaid, +143988,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,United Healthcare-Medicaid, +143989,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,United Healthcare-Medicaid, +143990,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,United Healthcare-Medicaid, +143991,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,United Healthcare-Medicaid, +143992,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,United Healthcare-Medicaid, +143993,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,United Healthcare-Medicaid, +143994,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,United Healthcare-Medicaid, +143995,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,United Healthcare-Medicaid, +143996,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,United Healthcare-Medicaid, +143997,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,United Healthcare-Medicaid, +143998,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,United Healthcare-Medicaid, +143999,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,United Healthcare-Medicaid, +144000,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,United Healthcare-Medicaid, +144001,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,United Healthcare-Medicaid, +144002,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,United Healthcare-Medicaid, +144003,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,United Healthcare-Medicaid, +144004,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,United Healthcare-Medicaid, +144005,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,United Healthcare-Medicaid, +144006,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,United Healthcare-Medicaid, +144007,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,United Healthcare-Medicaid, +144008,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,United Healthcare-Medicaid, +144009,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,United Healthcare-Medicaid, +144010,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,United Healthcare-Medicaid, +144011,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,United Healthcare-Medicaid, +144012,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,United Healthcare-Medicaid, +144013,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,United Healthcare-Medicaid, +144014,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,United Healthcare-Medicaid, +144015,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,United Healthcare-Medicaid, +144016,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,United Healthcare-Medicaid, +144017,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,United Healthcare-Medicaid, +144018,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,United Healthcare-Medicaid, +144019,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,United Healthcare-Medicaid, +144020,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,United Healthcare-Medicaid, +144021,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,United Healthcare-Medicaid, +144022,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,United Healthcare-Medicaid, +144023,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,United Healthcare-Medicaid, +144024,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,United Healthcare-Medicaid, +144025,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,United Healthcare-Medicaid, +144026,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,United Healthcare-Medicaid, +144027,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,United Healthcare-Medicaid, +144028,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,United Healthcare-Medicaid, +144029,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,United Healthcare-Medicaid, +144030,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,United Healthcare-Medicaid, +144031,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,United Healthcare-Medicaid, +144032,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,United Healthcare-Medicaid, +144033,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,United Healthcare-Medicaid, +144034,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,United Healthcare-Medicaid, +144035,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,United Healthcare-Medicaid, +144036,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,United Healthcare-Medicaid, +144037,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,United Healthcare-Medicaid, +144038,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,United Healthcare-Medicaid, +144039,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,United Healthcare-Medicaid, +144040,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,United Healthcare-Medicaid, +144041,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,United Healthcare-Medicaid, +144042,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,United Healthcare-Medicaid, +144043,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,United Healthcare-Medicaid, +144044,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,United Healthcare-Medicaid, +144045,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,United Healthcare-Medicaid, +144046,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,United Healthcare-Medicaid, +144047,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,United Healthcare-Medicaid, +144048,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,United Healthcare-Medicaid, +144049,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,United Healthcare-Medicaid, +144050,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,United Healthcare-Medicaid, +144051,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,United Healthcare-Medicaid, +144052,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,United Healthcare-Medicaid, +144053,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,United Healthcare-Medicaid, +144054,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,United Healthcare-Medicaid, +144055,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,United Healthcare-Medicaid, +144056,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,United Healthcare-Medicaid, +144057,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,United Healthcare-Medicaid, +144058,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,United Healthcare-Medicaid, +144059,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,United Healthcare-Medicaid, +144060,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,United Healthcare-Medicaid, +144061,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,United Healthcare-Medicaid, +144062,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,United Healthcare-Medicaid, +144063,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,United Healthcare-Medicaid, +144064,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,United Healthcare-Medicaid, +144065,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,United Healthcare-Medicaid, +144066,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,United Healthcare-Medicaid, +144067,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,United Healthcare-Medicaid, +144068,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,United Healthcare-Medicaid, +144069,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,United Healthcare-Medicaid, +144070,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,United Healthcare-Medicaid, +144071,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,United Healthcare-Medicaid, +144072,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,United Healthcare-Medicaid, +144073,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,United Healthcare-Medicaid, +144074,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,United Healthcare-Medicaid, +144075,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,United Healthcare-Medicaid, +144076,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,United Healthcare-Medicaid, +144077,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,United Healthcare-Medicaid, +144078,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,United Healthcare-Medicaid, +144079,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,United Healthcare-Medicaid, +144080,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,United Healthcare-Medicaid, +144081,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,United Healthcare-Medicaid, +144082,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,United Healthcare-Medicaid, +144083,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,United Healthcare-Medicaid, +144084,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,United Healthcare-Medicaid, +144085,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,United Healthcare-Medicaid, +144086,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,United Healthcare-Medicaid, +144087,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,United Healthcare-Medicaid, +144088,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,United Healthcare-Medicaid, +144089,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,United Healthcare-Medicaid, +144090,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,United Healthcare-Medicaid, +144091,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,United Healthcare-Medicaid, +144092,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,United Healthcare-Medicaid, +144093,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,United Healthcare-Medicaid, +144094,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,United Healthcare-Medicaid, +144095,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,United Healthcare-Medicaid, +144096,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,United Healthcare-Medicaid, +144097,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,United Healthcare-Medicaid, +144098,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,United Healthcare-Medicaid, +144099,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,United Healthcare-Medicaid, +144100,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,United Healthcare-Medicaid, +144101,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,United Healthcare-Medicaid, +144102,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,United Healthcare-Medicaid, +144103,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,United Healthcare-Medicaid, +144104,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,United Healthcare-Medicaid, +144105,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,United Healthcare-Medicaid, +144106,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,United Healthcare-Medicaid, +144107,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,United Healthcare-Medicaid, +144108,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,United Healthcare-Medicaid, +144109,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,United Healthcare-Medicaid, +144110,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,United Healthcare-Medicaid, +144111,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,United Healthcare-Medicaid, +144112,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,United Healthcare-Medicaid, +144113,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,United Healthcare-Medicaid, +144114,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,United Healthcare-Medicaid, +144115,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,United Healthcare-Medicaid, +144116,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,United Healthcare-Medicaid, +144117,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,United Healthcare-Medicaid, +144118,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,United Healthcare-Medicaid, +144119,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,United Healthcare-Medicaid, +144120,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,United Healthcare-Medicaid, +144121,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,United Healthcare-Medicaid, +144122,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,United Healthcare-Medicaid, +144123,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,United Healthcare-Medicaid, +144124,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,United Healthcare-Medicaid, +144125,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,United Healthcare-Medicaid, +144126,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,United Healthcare-Medicaid, +144127,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,United Healthcare-Medicaid, +144128,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,United Healthcare-Medicaid, +144129,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,United Healthcare-Medicaid, +144130,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,United Healthcare-Medicaid, +144131,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,United Healthcare-Medicaid, +144132,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,United Healthcare-Medicaid, +144133,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,United Healthcare-Medicaid, +144134,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,United Healthcare-Medicaid, +144135,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,United Healthcare-Medicaid, +144136,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,United Healthcare-Medicaid, +144137,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,United Healthcare-Medicaid, +144138,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,United Healthcare-Medicaid, +144139,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,United Healthcare-Medicaid, +144140,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,United Healthcare-Medicaid, +144141,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,United Healthcare-Medicaid, +144142,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,United Healthcare-Medicaid, +144143,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,United Healthcare-Medicaid, +144144,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,United Healthcare-Medicaid, +144145,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,United Healthcare-Medicaid, +144146,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,United Healthcare-Medicaid, +144147,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,United Healthcare-Medicaid, +144148,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,United Healthcare-Medicaid, +144149,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,United Healthcare-Medicaid, +144150,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,United Healthcare-Medicaid, +144151,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,United Healthcare-Medicaid, +144152,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,United Healthcare-Medicaid, +144153,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,United Healthcare-Medicaid, +144154,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,United Healthcare-Medicaid, +144155,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,United Healthcare-Medicaid, +144156,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,United Healthcare-Medicaid, +144157,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,United Healthcare-Medicaid, +144158,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,United Healthcare-Medicaid, +144159,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,United Healthcare-Medicaid, +144160,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,United Healthcare-Medicaid, +144161,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,United Healthcare-Medicaid, +144162,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,United Healthcare-Medicaid, +144163,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,United Healthcare-Medicaid, +144164,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,United Healthcare-Medicaid, +144165,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,United Healthcare-Medicaid, +144166,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,United Healthcare-Medicaid, +144167,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,United Healthcare-Medicaid, +144168,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,United Healthcare-Medicaid, +144169,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,United Healthcare-Medicaid, +144170,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,United Healthcare-Medicaid, +144171,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,United Healthcare-Medicaid, +144172,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,United Healthcare-Medicaid, +144173,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,United Healthcare-Medicaid, +144174,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,United Healthcare-Medicaid, +144175,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,United Healthcare-Medicaid, +144176,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,United Healthcare-Medicaid, +144177,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,United Healthcare-Medicaid, +144178,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,United Healthcare-Medicaid, +144179,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,United Healthcare-Medicaid, +144180,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,United Healthcare-Medicaid, +144181,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,United Healthcare-Medicaid, +144182,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,United Healthcare-Medicaid, +144183,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,United Healthcare-Medicaid, +144184,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,United Healthcare-Medicaid, +144185,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,United Healthcare-Medicaid, +144186,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,United Healthcare-Medicaid, +144187,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,United Healthcare-Medicaid, +144188,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,United Healthcare-Medicaid, +144189,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,United Healthcare-Medicaid, +144190,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,United Healthcare-Medicaid, +144191,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,United Healthcare-Medicaid, +144192,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,United Healthcare-Medicaid, +144193,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,United Healthcare-Medicaid, +144194,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,United Healthcare-Medicaid, +144195,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,United Healthcare-Medicaid, +144196,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,United Healthcare-Medicaid, +144197,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,United Healthcare-Medicaid, +144198,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,United Healthcare-Medicaid, +144199,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,United Healthcare-Medicaid, +144200,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,United Healthcare-Medicaid, +144201,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,United Healthcare-Medicaid, +144202,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,United Healthcare-Medicaid, +144203,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,United Healthcare-Medicaid, +144204,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,United Healthcare-Medicaid, +144205,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,United Healthcare-Medicaid, +144206,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,United Healthcare-Medicaid, +144207,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,United Healthcare-Medicaid, +144208,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,United Healthcare-Medicaid, +144209,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,United Healthcare-Medicaid, +144210,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,United Healthcare-Medicaid, +144211,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,United Healthcare-Medicaid, +144212,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,United Healthcare-Medicaid, +144213,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,United Healthcare-Medicaid, +144214,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,United Healthcare-Medicaid, +144215,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,United Healthcare-Medicaid, +144216,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,United Healthcare-Medicaid, +144217,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,United Healthcare-Medicaid, +144218,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,United Healthcare-Medicaid, +144219,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,United Healthcare-Medicaid, +144220,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,United Healthcare-Medicaid, +144221,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,United Healthcare-Medicaid, +144222,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,United Healthcare-Medicaid, +144223,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,United Healthcare-Medicaid, +144224,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,United Healthcare-Medicaid, +144225,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,United Healthcare-Medicaid, +144226,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,United Healthcare-Medicaid, +144227,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,United Healthcare-Medicaid, +144228,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,United Healthcare-Medicaid, +144229,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,United Healthcare-Medicaid, +144230,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,United Healthcare-Medicaid, +144231,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,United Healthcare-Medicaid, +144232,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,United Healthcare-Medicaid, +144233,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,United Healthcare-Medicaid, +144234,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,United Healthcare-Medicaid, +144235,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,United Healthcare-Medicaid, +144236,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,United Healthcare-Medicaid, +144237,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,United Healthcare-Medicaid, +144238,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,United Healthcare-Medicaid, +144239,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,United Healthcare-Medicaid, +144240,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,United Healthcare-Medicaid, +144241,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,United Healthcare-Medicaid, +144242,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,United Healthcare-Medicaid, +144243,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,United Healthcare-Medicaid, +144244,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,United Healthcare-Medicaid, +144245,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,United Healthcare-Medicaid, +144246,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,United Healthcare-Medicaid, +144247,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,United Healthcare-Medicaid, +144248,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,United Healthcare-Medicaid, +144249,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,United Healthcare-Medicaid, +144250,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,United Healthcare-Medicaid, +144251,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,United Healthcare-Medicaid, +144252,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,United Healthcare-Medicaid, +144253,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,United Healthcare-Medicaid, +144254,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,United Healthcare-Medicaid, +144255,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,United Healthcare-Medicaid, +144256,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,United Healthcare-Medicaid, +144257,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,United Healthcare-Medicaid, +144258,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,United Healthcare-Medicaid, +144259,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,United Healthcare-Medicaid, +144260,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,United Healthcare-Medicaid, +144261,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,United Healthcare-Medicaid, +144262,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,United Healthcare-Medicaid, +144263,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,United Healthcare-Medicaid, +144264,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,United Healthcare-Medicaid, +144265,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,United Healthcare-Medicaid, +144266,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,United Healthcare-Medicaid, +144267,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,United Healthcare-Medicaid, +144268,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,United Healthcare-Medicaid, +144269,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,United Healthcare-Medicaid, +144270,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,United Healthcare-Medicaid, +144271,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,United Healthcare-Medicaid, +144272,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,United Healthcare-Medicaid, +144273,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,United Healthcare-Medicaid, +144274,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,United Healthcare-Medicaid, +144275,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,United Healthcare-Medicaid, +144276,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,United Healthcare-Medicaid, +144277,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,United Healthcare-Medicaid, +144278,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,United Healthcare-Medicaid, +144279,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,United Healthcare-Medicaid, +144280,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,United Healthcare-Medicaid, +144281,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,United Healthcare-Medicaid, +144282,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,United Healthcare-Medicaid, +144283,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,United Healthcare-Medicaid, +144284,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,United Healthcare-Medicaid, +144285,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,United Healthcare-Medicaid, +144286,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,United Healthcare-Medicaid, +144287,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,United Healthcare-Medicaid, +144288,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,United Healthcare-Medicaid, +144289,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,United Healthcare-Medicaid, +144290,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,United Healthcare-Medicaid, +144291,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,United Healthcare-Medicaid, +144292,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,United Healthcare-Medicaid, +144293,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,United Healthcare-Medicaid, +144294,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,United Healthcare-Medicaid, +144295,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,United Healthcare-Medicaid, +144296,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,United Healthcare-Medicaid, +144297,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,United Healthcare-Medicaid, +144298,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,United Healthcare-Medicaid, +144299,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,United Healthcare-Medicaid, +144300,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,United Healthcare-Medicaid, +144301,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,United Healthcare-Medicaid, +144302,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,United Healthcare-Medicaid, +144303,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,United Healthcare-Medicaid, +144304,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,United Healthcare-Medicaid, +144305,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,United Healthcare-Medicaid, +144306,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,United Healthcare-Medicaid, +144307,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,United Healthcare-Medicaid, +144308,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,United Healthcare-Medicaid, +144309,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,United Healthcare-Medicaid, +144310,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,United Healthcare-Medicaid, +144311,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,United Healthcare-Medicaid, +144312,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,United Healthcare-Medicaid, +144313,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,United Healthcare-Medicaid, +144314,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,United Healthcare-Medicaid, +144315,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,United Healthcare-Medicaid, +144316,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,United Healthcare-Medicaid, +144317,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,United Healthcare-Medicaid, +144318,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,United Healthcare-Medicaid, +144319,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,United Healthcare-Medicaid, +144320,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,United Healthcare-Medicaid, +144321,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,United Healthcare-Medicaid, +144322,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,United Healthcare-Medicaid, +144323,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,United Healthcare-Medicaid, +144324,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,United Healthcare-Medicaid, +144325,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,United Healthcare-Medicaid, +144326,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,United Healthcare-Medicaid, +144327,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,United Healthcare-Medicaid, +144328,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,United Healthcare-Medicaid, +144329,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,United Healthcare-Medicaid, +144330,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,United Healthcare-Medicaid, +144331,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,United Healthcare-Medicaid, +144332,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,United Healthcare-Medicaid, +144333,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,United Healthcare-Medicaid, +144334,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,United Healthcare-Medicaid, +144335,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,United Healthcare-Medicaid, +144336,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,United Healthcare-Medicaid, +144337,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,United Healthcare-Medicaid, +144338,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,United Healthcare-Medicaid, +144339,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,United Healthcare-Medicaid, +144340,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,United Healthcare-Medicaid, +144341,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,United Healthcare-Medicaid, +144342,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,United Healthcare-Medicaid, +144343,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,United Healthcare-Medicaid, +144344,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Medicaid, +144345,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,United Healthcare-Medicaid, +144346,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,United Healthcare-Medicaid, +144347,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,United Healthcare-Medicaid, +144348,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,United Healthcare-Medicaid, +144349,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,United Healthcare-Medicaid, +144350,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,United Healthcare-Medicaid, +144351,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,United Healthcare-Medicaid, +144352,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,United Healthcare-Medicaid, +144353,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,United Healthcare-Medicaid, +144354,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,United Healthcare-Medicaid, +144355,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,United Healthcare-Medicaid, +144356,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,United Healthcare-Medicaid, +144357,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,United Healthcare-Medicaid, +144358,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,United Healthcare-Medicaid, +144359,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,United Healthcare-Medicaid, +144360,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,United Healthcare-Medicaid, +144361,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,United Healthcare-Medicaid, +144362,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,United Healthcare-Medicaid, +144363,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,United Healthcare-Medicaid, +144364,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,United Healthcare-Medicaid, +144365,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,United Healthcare-Medicaid, +144366,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,United Healthcare-Medicaid, +144367,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,United Healthcare-Medicaid, +144368,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,United Healthcare-Medicaid, +144369,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,United Healthcare-Medicaid, +144370,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,United Healthcare-Medicaid, +144371,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,United Healthcare-Medicaid, +144372,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,United Healthcare-Medicaid, +144373,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,United Healthcare-Medicaid, +144374,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,United Healthcare-Medicaid, +144375,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,United Healthcare-Medicaid, +144376,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,United Healthcare-Medicaid, +144377,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,United Healthcare-Medicaid, +144378,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,United Healthcare-Medicaid, +144379,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,United Healthcare-Medicaid, +144380,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,United Healthcare-Medicaid, +144381,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,United Healthcare-Medicaid, +144382,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,United Healthcare-Medicaid, +144383,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,United Healthcare-Medicaid, +144384,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,United Healthcare-Medicaid, +144385,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Medicaid, +144386,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,United Healthcare-Medicaid, +144387,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,United Healthcare-Medicaid, +144388,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,United Healthcare-Medicaid, +144389,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,United Healthcare-Medicaid, +144390,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,United Healthcare-Medicaid, +144391,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,United Healthcare-Medicaid, +144392,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,United Healthcare-Medicaid, +144393,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,United Healthcare-Medicaid, +144394,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,United Healthcare-Medicaid, +144395,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,United Healthcare-Medicaid, +144396,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,United Healthcare-Medicaid, +144397,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,United Healthcare-Medicaid, +144398,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,United Healthcare-Medicaid, +144399,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,United Healthcare-Medicaid, +144400,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,United Healthcare-Medicaid, +144401,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,United Healthcare-Medicaid, +144402,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,United Healthcare-Medicaid, +144403,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,United Healthcare-Medicaid, +144404,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,United Healthcare-Medicaid, +144405,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,United Healthcare-Medicaid, +144406,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Medicaid, +144407,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,United Healthcare-Medicaid, +144408,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,United Healthcare-Medicaid, +144409,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,United Healthcare-Medicaid, +144410,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,United Healthcare-Medicaid, +144411,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,United Healthcare-Medicaid, +144412,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,United Healthcare-Medicaid, +144413,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,United Healthcare-Medicaid, +144414,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,United Healthcare-Medicaid, +144415,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,United Healthcare-Medicaid, +144416,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,United Healthcare-Medicaid, +144417,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,United Healthcare-Medicaid, +144418,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,United Healthcare-Medicaid, +144419,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,United Healthcare-Medicaid, +144420,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,United Healthcare-Medicaid, +144421,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,United Healthcare-Medicaid, +144422,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,United Healthcare-Medicaid, +144423,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,United Healthcare-Medicaid, +144424,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,United Healthcare-Medicaid, +144425,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,United Healthcare-Medicaid, +144426,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,United Healthcare-Medicaid, +144427,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,United Healthcare-Medicaid, +144428,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,United Healthcare-Medicaid, +144429,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,United Healthcare-Medicaid, +144430,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,United Healthcare-Medicaid, +144431,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,United Healthcare-Medicaid, +144432,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,United Healthcare-Medicaid, +144433,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,United Healthcare-Medicaid, +144434,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,United Healthcare-Medicaid, +144435,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,United Healthcare-Medicaid, +144436,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,United Healthcare-Medicaid, +144437,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,United Healthcare-Medicaid, +144438,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,United Healthcare-Medicaid, +144439,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,United Healthcare-Medicaid, +144440,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,United Healthcare-Medicaid, +144441,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,United Healthcare-Medicaid, +144442,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,United Healthcare-Medicaid, +144443,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,United Healthcare-Medicaid, +144444,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,United Healthcare-Medicaid, +144445,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,United Healthcare-Medicaid, +144446,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,United Healthcare-Medicaid, +144447,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,United Healthcare-Medicaid, +144448,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,United Healthcare-Medicaid, +144449,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,United Healthcare-Medicaid, +144450,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,United Healthcare-Medicaid, +144451,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,United Healthcare-Medicaid, +144452,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,United Healthcare-Medicaid, +144453,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,United Healthcare-Medicaid, +144454,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,United Healthcare-Medicaid, +144455,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,United Healthcare-Medicaid, +144456,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,United Healthcare-Medicaid, +144457,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,United Healthcare-Medicaid, +144458,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,United Healthcare-Medicaid, +144459,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,United Healthcare-Medicaid, +144460,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,United Healthcare-Medicaid, +144461,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,United Healthcare-Medicaid, +144462,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,United Healthcare-Medicaid, +144463,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,United Healthcare-Medicaid, +144464,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,United Healthcare-Medicaid, +144465,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,United Healthcare-Medicaid, +144466,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,United Healthcare-Medicaid, +144467,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,United Healthcare-Medicaid, +144468,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,United Healthcare-Medicaid, +144469,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,United Healthcare-Medicaid, +144470,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,United Healthcare-Medicaid, +144471,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,United Healthcare-Medicaid, +144472,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,United Healthcare-Medicaid, +144473,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,United Healthcare-Medicaid, +144474,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,United Healthcare-Medicaid, +144475,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,United Healthcare-Medicaid, +144476,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,United Healthcare-Medicaid, +144477,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,United Healthcare-Medicaid, +144478,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,United Healthcare-Medicaid, +144479,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,United Healthcare-Medicaid, +144480,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,United Healthcare-Medicaid, +144481,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,United Healthcare-Medicaid, +144482,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,United Healthcare-Medicaid, +144483,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,United Healthcare-Medicaid, +144484,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,United Healthcare-Medicaid, +144485,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,United Healthcare-Medicaid, +144486,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,United Healthcare-Medicaid, +144487,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,United Healthcare-Medicaid, +144488,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,United Healthcare-Medicaid, +144489,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,United Healthcare-Medicaid, +144490,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,United Healthcare-Medicaid, +144491,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,United Healthcare-Medicaid, +144492,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,United Healthcare-Medicaid, +144493,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,United Healthcare-Medicaid, +144494,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,United Healthcare-Medicaid, +144495,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,United Healthcare-Medicaid, +144496,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,United Healthcare-Medicaid, +144497,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,United Healthcare-Medicaid, +144498,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,United Healthcare-Medicaid, +144499,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,United Healthcare-Medicaid, +144500,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,United Healthcare-Medicaid, +144501,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,United Healthcare-Medicaid, +144502,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,United Healthcare-Medicaid, +144503,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,United Healthcare-Medicaid, +144504,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,United Healthcare-Medicaid, +144505,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,United Healthcare-Medicaid, +144506,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,United Healthcare-Medicaid, +144507,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,United Healthcare-Medicaid, +144508,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,United Healthcare-Medicaid, +144509,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,United Healthcare-Medicaid, +144510,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,United Healthcare-Medicaid, +144511,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Medicaid, +144512,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Medicaid, +144513,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Medicaid, +144514,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,United Healthcare-Medicaid, +144515,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,United Healthcare-Medicaid, +144516,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,United Healthcare-Medicaid, +144517,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,United Healthcare-Medicaid, +144518,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,United Healthcare-Medicaid, +144519,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,United Healthcare-Medicaid, +144520,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,United Healthcare-Medicaid, +144521,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,United Healthcare-Medicaid, +144522,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,United Healthcare-Medicaid, +144523,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,United Healthcare-Medicaid, +144524,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,United Healthcare-Medicaid, +144525,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,United Healthcare-Medicaid, +144526,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,United Healthcare-Medicaid, +144527,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,United Healthcare-Medicaid, +144528,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,United Healthcare-Medicaid, +144529,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,United Healthcare-Medicaid, +144530,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,United Healthcare-Medicaid, +144531,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,United Healthcare-Medicaid, +144532,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,United Healthcare-Medicaid, +144533,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,United Healthcare-Medicaid, +144534,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,United Healthcare-Medicaid, +144535,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,United Healthcare-Medicaid, +144536,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,United Healthcare-Medicaid, +144537,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,United Healthcare-Medicaid, +144538,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,United Healthcare-Medicaid, +144539,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,United Healthcare-Medicaid, +144540,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,United Healthcare-Medicaid, +144541,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,United Healthcare-Medicaid, +144542,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,United Healthcare-Medicaid, +144543,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,United Healthcare-Medicaid, +144544,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,United Healthcare-Medicaid, +144545,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,United Healthcare-Medicaid, +144546,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,United Healthcare-Medicaid, +144547,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,United Healthcare-Medicaid, +144548,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,United Healthcare-Medicaid, +144549,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,United Healthcare-Medicaid, +144550,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,United Healthcare-Medicaid, +144551,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,United Healthcare-Medicaid, +144552,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,United Healthcare-Medicaid, +144553,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,United Healthcare-Medicaid, +144554,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,United Healthcare-Medicaid, +144555,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,United Healthcare-Medicaid, +144556,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,United Healthcare-Medicaid, +144557,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,United Healthcare-Medicaid, +144558,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,United Healthcare-Medicaid, +144559,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,United Healthcare-Medicaid, +144560,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,United Healthcare-Medicaid, +144561,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,United Healthcare-Medicaid, +144562,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,United Healthcare-Medicaid, +144563,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,United Healthcare-Medicaid, +144564,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,United Healthcare-Medicaid, +144565,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,United Healthcare-Medicaid, +144566,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,United Healthcare-Medicaid, +144567,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,United Healthcare-Medicaid, +144568,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,United Healthcare-Medicaid, +144569,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,United Healthcare-Medicaid, +144570,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,United Healthcare-Medicaid, +144571,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,United Healthcare-Medicaid, +144572,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,United Healthcare-Medicaid, +144573,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,United Healthcare-Medicaid, +144574,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,United Healthcare-Medicaid, +144575,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,United Healthcare-Medicaid, +144576,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,United Healthcare-Medicaid, +144577,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,United Healthcare-Medicaid, +144578,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,United Healthcare-Medicaid, +144579,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,United Healthcare-Medicaid, +144580,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,United Healthcare-Medicaid, +144581,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,United Healthcare-Medicaid, +144582,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,United Healthcare-Medicaid, +144583,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,United Healthcare-Medicaid, +144584,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,United Healthcare-Medicaid, +144585,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,United Healthcare-Medicaid, +144586,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,United Healthcare-Medicaid, +144587,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,United Healthcare-Medicaid, +144588,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,United Healthcare-Medicaid, +144589,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,United Healthcare-Medicaid, +144590,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,United Healthcare-Medicaid, +144591,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,United Healthcare-Medicaid, +144592,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,United Healthcare-Medicaid, +144593,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,United Healthcare-Medicaid, +144594,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,United Healthcare-Medicaid, +144595,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,United Healthcare-Medicaid, +144596,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,United Healthcare-Medicaid, +144597,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,United Healthcare-Medicaid, +144598,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,United Healthcare-Medicaid, +144599,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,United Healthcare-Medicaid, +144600,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,United Healthcare-Medicaid, +144601,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,United Healthcare-Medicaid, +144602,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,United Healthcare-Medicaid, +144603,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,United Healthcare-Medicaid, +144604,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,United Healthcare-Medicaid, +144605,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,United Healthcare-Medicaid, +144606,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,United Healthcare-Medicaid, +144607,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,United Healthcare-Medicaid, +144608,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,United Healthcare-Medicaid, +144609,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,United Healthcare-Medicaid, +144610,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,United Healthcare-Medicaid, +144611,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,United Healthcare-Medicaid, +144612,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,United Healthcare-Medicaid, +144613,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,United Healthcare-Medicaid, +144614,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,United Healthcare-Medicaid, +144615,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,United Healthcare-Medicaid, +144616,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,United Healthcare-Medicaid, +144617,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,United Healthcare-Medicaid, +144618,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,United Healthcare-Medicaid, +144619,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,United Healthcare-Medicaid, +144620,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,United Healthcare-Medicaid, +144621,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,United Healthcare-Medicaid, +144622,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,United Healthcare-Medicaid, +144623,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,United Healthcare-Medicaid, +144624,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,United Healthcare-Medicaid, +144625,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,United Healthcare-Medicaid, +144626,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,United Healthcare-Medicaid, +144627,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,United Healthcare-Medicaid, +144628,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,United Healthcare-Medicaid, +144629,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,United Healthcare-Medicaid, +144630,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,United Healthcare-Medicaid, +144631,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,United Healthcare-Medicaid, +144632,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,United Healthcare-Medicaid, +144633,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,United Healthcare-Medicaid, +144634,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,United Healthcare-Medicaid, +144635,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,United Healthcare-Medicaid, +144636,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,United Healthcare-Medicaid, +144637,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,United Healthcare-Medicaid, +144638,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,United Healthcare-Medicaid, +144639,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,United Healthcare-Medicaid, +144640,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,United Healthcare-Medicaid, +144641,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,United Healthcare-Medicaid, +144642,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,United Healthcare-Medicaid, +144643,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,United Healthcare-Medicaid, +144644,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,United Healthcare-Medicaid, +144645,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,United Healthcare-Medicaid, +144646,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,United Healthcare-Medicaid, +144647,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,United Healthcare-Medicaid, +144648,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,United Healthcare-Medicaid, +144649,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,United Healthcare-Medicaid, +144650,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,United Healthcare-Medicaid, +144651,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,United Healthcare-Medicaid, +144652,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,United Healthcare-Medicaid, +144653,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,United Healthcare-Medicaid, +144654,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,United Healthcare-Medicaid, +144655,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,United Healthcare-Medicaid, +144656,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,United Healthcare-Medicaid, +144657,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,United Healthcare-Medicaid, +144658,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,United Healthcare-Medicaid, +144659,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,United Healthcare-Medicaid, +144660,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,United Healthcare-Medicaid, +144661,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,United Healthcare-Medicaid, +144662,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,United Healthcare-Medicaid, +144663,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,United Healthcare-Medicaid, +144664,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,United Healthcare-Medicaid, +144665,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,United Healthcare-Medicaid, +144666,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,United Healthcare-Medicaid, +144667,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,United Healthcare-Medicaid, +144668,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,United Healthcare-Medicaid, +144669,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,United Healthcare-Medicaid, +144670,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,United Healthcare-Medicaid, +144671,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,United Healthcare-Medicaid, +144672,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,United Healthcare-Medicaid, +144673,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,United Healthcare-Medicaid, +144674,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,United Healthcare-Medicaid, +144675,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,United Healthcare-Medicaid, +144676,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,United Healthcare-Medicaid, +144677,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,United Healthcare-Medicaid, +144678,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,United Healthcare-Medicaid, +144679,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,United Healthcare-Medicaid, +144680,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,United Healthcare-Medicaid, +144681,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,United Healthcare-Medicaid, +144682,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,United Healthcare-Medicaid, +144683,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,United Healthcare-Medicaid, +144684,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,United Healthcare-Medicaid, +144685,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,United Healthcare-Medicaid, +144686,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,United Healthcare-Medicaid, +144687,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,United Healthcare-Medicaid, +144688,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,United Healthcare-Medicaid, +144689,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,United Healthcare-Medicaid, +144690,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,United Healthcare-Medicaid, +144691,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,United Healthcare-Medicaid, +144692,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,United Healthcare-Medicaid, +144693,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,United Healthcare-Medicaid, +144694,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,United Healthcare-Medicaid, +144695,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,United Healthcare-Medicaid, +144696,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,United Healthcare-Medicaid, +144697,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,United Healthcare-Medicaid, +144698,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,United Healthcare-Medicaid, +144699,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,United Healthcare-Medicaid, +144700,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,United Healthcare-Medicaid, +144701,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,United Healthcare-Medicaid, +144702,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,United Healthcare-Medicaid, +144703,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,United Healthcare-Medicaid, +144704,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,United Healthcare-Medicaid, +144705,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,United Healthcare-Medicaid, +144706,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,United Healthcare-Medicaid, +144707,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,United Healthcare-Medicaid, +144708,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,United Healthcare-Medicaid, +144709,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,United Healthcare-Medicaid, +144710,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,United Healthcare-Medicaid, +144711,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,United Healthcare-Medicaid, +144712,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,United Healthcare-Medicaid, +144713,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,United Healthcare-Medicaid, +144714,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,United Healthcare-Medicaid, +144715,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,United Healthcare-Medicaid, +144716,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,United Healthcare-Medicaid, +144717,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,United Healthcare-Medicaid, +144718,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,United Healthcare-Medicaid, +144719,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,United Healthcare-Medicaid, +144720,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,United Healthcare-Medicaid, +144721,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,United Healthcare-Medicaid, +144722,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,United Healthcare-Medicaid, +144723,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,United Healthcare-Medicaid, +144724,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,United Healthcare-Medicaid, +144725,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,United Healthcare-Medicaid, +144726,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,United Healthcare-Medicaid, +144727,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,United Healthcare-Medicaid, +144728,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,United Healthcare-Medicaid, +144729,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,United Healthcare-Medicaid, +144730,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,United Healthcare-Medicaid, +144731,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,United Healthcare-Medicaid, +144732,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,United Healthcare-Medicaid, +144733,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,United Healthcare-Medicaid, +144734,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,United Healthcare-Medicaid, +144735,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,United Healthcare-Medicaid, +144736,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,United Healthcare-Medicaid, +144737,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,United Healthcare-Medicaid, +144738,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,United Healthcare-Medicaid, +144739,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,United Healthcare-Medicaid, +144740,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,United Healthcare-Medicaid, +144741,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,United Healthcare-Medicaid, +144742,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,United Healthcare-Medicaid, +144743,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,United Healthcare-Medicaid, +144744,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,United Healthcare-Medicaid, +144745,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,United Healthcare-Medicaid, +144746,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,United Healthcare-Medicaid, +144747,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,United Healthcare-Medicaid, +144748,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,United Healthcare-Medicaid, +144749,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,United Healthcare-Medicaid, +144750,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,United Healthcare-Medicaid, +144751,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,United Healthcare-Medicaid, +144752,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,United Healthcare-Medicaid, +144753,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,United Healthcare-Medicaid, +144754,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,United Healthcare-Medicaid, +144755,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,United Healthcare-Medicaid, +144756,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,United Healthcare-Medicaid, +144757,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,United Healthcare-Medicaid, +144758,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,United Healthcare-Medicaid, +144759,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,United Healthcare-Medicaid, +144760,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,United Healthcare-Medicaid, +144761,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,United Healthcare-Medicaid, +144762,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,United Healthcare-Medicaid, +144763,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,United Healthcare-Medicaid, +144764,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,United Healthcare-Medicaid, +144765,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,United Healthcare-Medicaid, +144766,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,United Healthcare-Medicaid, +144767,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,United Healthcare-Medicaid, +144768,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,United Healthcare-Medicaid, +144769,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,United Healthcare-Medicaid, +144770,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,United Healthcare-Medicaid, +144771,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,United Healthcare-Medicaid, +144772,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,United Healthcare-Medicaid, +144773,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,United Healthcare-Medicaid, +144774,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,United Healthcare-Medicaid, +144775,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,United Healthcare-Medicaid, +144776,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,United Healthcare-Medicaid, +144777,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,United Healthcare-Medicaid, +144778,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,United Healthcare-Medicaid, +144779,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,United Healthcare-Medicaid, +144780,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,United Healthcare-Medicaid, +144781,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,United Healthcare-Medicaid, +144782,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,United Healthcare-Medicaid, +144783,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,United Healthcare-Medicaid, +144784,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,United Healthcare-Medicaid, +144785,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,United Healthcare-Medicaid, +144786,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,United Healthcare-Medicaid, +144787,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,United Healthcare-Medicaid, +144788,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,United Healthcare-Medicaid, +144789,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,United Healthcare-Medicaid, +144790,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,United Healthcare-Medicaid, +144791,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,United Healthcare-Medicaid, +144792,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,United Healthcare-Medicaid, +144793,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,United Healthcare-Medicaid, +144794,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,United Healthcare-Medicaid, +144795,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,United Healthcare-Medicaid, +144796,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,United Healthcare-Medicaid, +144797,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,United Healthcare-Medicaid, +144798,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,United Healthcare-Medicaid, +144799,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,United Healthcare-Medicaid, +144800,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,United Healthcare-Medicaid, +144801,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,United Healthcare-Medicaid, +144802,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,United Healthcare-Medicaid, +144803,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,United Healthcare-Medicaid, +144804,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,United Healthcare-Medicaid, +144805,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,United Healthcare-Medicaid, +144806,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,United Healthcare-Medicaid, +144807,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,United Healthcare-Medicaid, +144808,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,United Healthcare-Medicaid, +144809,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,United Healthcare-Medicaid, +144810,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,United Healthcare-Medicaid, +144811,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,United Healthcare-Medicaid, +144812,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,United Healthcare-Medicaid, +144813,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,United Healthcare-Medicaid, +144814,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,United Healthcare-Medicaid, +144815,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,United Healthcare-Medicaid, +144816,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,United Healthcare-Medicaid, +144817,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,United Healthcare-Medicaid, +144818,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,United Healthcare-Medicaid, +144819,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,United Healthcare-Medicaid, +144820,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,United Healthcare-Medicaid, +144821,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,United Healthcare-Medicaid, +144822,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,United Healthcare-Medicaid, +144823,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,United Healthcare-Medicaid, +144824,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,United Healthcare-Medicaid, +144825,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,United Healthcare-Medicaid, +144826,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,United Healthcare-Medicaid, +144827,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,United Healthcare-Medicaid, +144828,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,United Healthcare-Medicaid, +144829,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,United Healthcare-Medicaid, +144830,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,United Healthcare-Medicaid, +144831,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,United Healthcare-Medicaid, +144832,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,United Healthcare-Medicaid, +144833,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,United Healthcare-Medicaid, +144834,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,United Healthcare-Medicaid, +144835,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,United Healthcare-Medicaid, +144836,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,United Healthcare-Medicaid, +144837,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,United Healthcare-Medicaid, +144838,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,United Healthcare-Medicaid, +144839,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,United Healthcare-Medicaid, +144840,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,United Healthcare-Medicaid, +144841,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,United Healthcare-Medicaid, +144842,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,United Healthcare-Medicaid, +144843,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,United Healthcare-Medicaid, +144844,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,United Healthcare-Medicaid, +144845,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,United Healthcare-Medicaid, +144846,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,United Healthcare-Medicaid, +144847,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,United Healthcare-Medicaid, +144848,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,United Healthcare-Medicaid, +144849,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,United Healthcare-Medicaid, +144850,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,United Healthcare-Medicaid, +144851,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,United Healthcare-Medicaid, +144852,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,United Healthcare-Medicaid, +144853,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,United Healthcare-Medicaid, +144854,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,United Healthcare-Medicaid, +144855,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,United Healthcare-Medicaid, +144856,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,United Healthcare-Medicaid, +144857,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,United Healthcare-Medicaid, +144858,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,United Healthcare-Medicaid, +144859,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,United Healthcare-Medicaid, +144860,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,United Healthcare-Medicaid, +144861,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,United Healthcare-Medicaid, +144862,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,United Healthcare-Medicaid, +144863,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,United Healthcare-Medicaid, +144864,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,United Healthcare-Medicaid, +144865,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,United Healthcare-Medicaid, +144866,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,United Healthcare-Medicaid, +144867,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,United Healthcare-Medicaid, +144868,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,United Healthcare-Medicaid, +144869,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,United Healthcare-Medicaid, +144870,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,United Healthcare-Medicaid, +144871,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,United Healthcare-Medicaid, +144872,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,United Healthcare-Medicaid, +144873,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,United Healthcare-Medicaid, +144874,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,United Healthcare-Medicaid, +144875,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,United Healthcare-Medicaid, +144876,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,United Healthcare-Medicaid, +144877,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,United Healthcare-Medicaid, +144878,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,United Healthcare-Medicaid, +144879,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,United Healthcare-Medicaid, +144880,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,United Healthcare-Medicaid, +144881,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,United Healthcare-Medicaid, +144882,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,United Healthcare-Medicaid, +144883,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,United Healthcare-Medicaid, +144884,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,United Healthcare-Medicaid, +144885,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,United Healthcare-Medicaid, +144886,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,United Healthcare-Medicaid, +144887,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,United Healthcare-Medicaid, +144888,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,United Healthcare-Medicaid, +144889,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,United Healthcare-Medicaid, +144890,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,United Healthcare-Medicaid, +144891,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,United Healthcare-Medicaid, +144892,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,United Healthcare-Medicaid, +144893,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,United Healthcare-Medicaid, +144894,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,United Healthcare-Medicaid, +144895,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,United Healthcare-Medicaid, +144896,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,United Healthcare-Medicaid, +144897,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,United Healthcare-Medicaid, +144898,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,United Healthcare-Medicaid, +144899,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,United Healthcare-Medicaid, +144900,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,United Healthcare-Medicaid, +144901,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,United Healthcare-Medicaid, +144902,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,United Healthcare-Medicaid, +144903,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,United Healthcare-Medicaid, +144904,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,United Healthcare-Medicaid, +144905,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,United Healthcare-Medicaid, +144906,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,United Healthcare-Medicaid, +144907,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,United Healthcare-Medicaid, +144908,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,United Healthcare-Medicaid, +144909,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,United Healthcare-Medicaid, +144910,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,United Healthcare-Medicaid, +144911,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,United Healthcare-Medicaid, +144912,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,United Healthcare-Medicaid, +144913,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,United Healthcare-Medicaid, +144914,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,United Healthcare-Medicaid, +144915,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,United Healthcare-Medicaid, +144916,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,United Healthcare-Medicaid, +144917,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,United Healthcare-Medicaid, +144918,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,United Healthcare-Medicaid, +144919,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,United Healthcare-Medicaid, +144920,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,United Healthcare-Medicaid, +144921,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,United Healthcare-Medicaid, +144922,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,United Healthcare-Medicaid, +144923,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,United Healthcare-Medicaid, +144924,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,United Healthcare-Medicaid, +144925,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,United Healthcare-Medicaid, +144926,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,United Healthcare-Medicaid, +144927,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,United Healthcare-Medicaid, +144928,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,United Healthcare-Medicaid, +144929,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,United Healthcare-Medicaid, +144930,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,United Healthcare-Medicaid, +144931,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,United Healthcare-Medicaid, +144932,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,United Healthcare-Medicaid, +144933,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,United Healthcare-Medicaid, +144934,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,United Healthcare-Medicaid, +144935,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,United Healthcare-Medicaid, +144936,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,United Healthcare-Medicaid, +144937,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,United Healthcare-Medicaid, +144938,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,United Healthcare-Medicaid, +144939,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,United Healthcare-Medicaid, +144940,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,United Healthcare-Medicaid, +144941,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,United Healthcare-Medicaid, +144942,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,United Healthcare-Medicaid, +144943,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,United Healthcare-Medicaid, +144944,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,United Healthcare-Medicaid, +144945,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,United Healthcare-Medicaid, +144946,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,United Healthcare-Medicaid, +144947,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,United Healthcare-Medicaid, +144948,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,United Healthcare-Medicaid, +144949,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,United Healthcare-Medicaid, +144950,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,United Healthcare-Medicaid, +144951,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,United Healthcare-Medicaid, +144952,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,United Healthcare-Medicaid, +144953,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,United Healthcare-Medicaid, +144954,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,United Healthcare-Medicaid, +144955,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,United Healthcare-Medicaid, +144956,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,United Healthcare-Medicaid, +144957,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,United Healthcare-Medicaid, +144958,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,United Healthcare-Medicaid, +144959,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,United Healthcare-Medicaid, +144960,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,United Healthcare-Medicaid, +144961,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,United Healthcare-Medicaid, +144962,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,United Healthcare-Medicaid, +144963,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,United Healthcare-Medicaid, +144964,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,United Healthcare-Medicaid, +144965,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,United Healthcare-Medicaid, +144966,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,United Healthcare-Medicaid, +144967,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,United Healthcare-Medicaid, +144968,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,United Healthcare-Medicaid, +144969,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,United Healthcare-Medicaid, +144970,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,United Healthcare-Medicaid, +144971,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,United Healthcare-Medicaid, +144972,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,United Healthcare-Medicaid, +144973,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,United Healthcare-Medicaid, +144974,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,United Healthcare-Medicaid, +144975,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,United Healthcare-Medicaid, +144976,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,United Healthcare-Medicaid, +144977,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,United Healthcare-Medicaid, +144978,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,United Healthcare-Medicaid, +144979,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,United Healthcare-Medicaid, +144980,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,United Healthcare-Medicaid, +144981,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,United Healthcare-Medicaid, +144982,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,United Healthcare-Medicaid, +144983,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,United Healthcare-Medicaid, +144984,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,United Healthcare-Medicaid, +144985,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,United Healthcare-Medicaid, +144986,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,United Healthcare-Medicaid, +144987,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,United Healthcare-Medicaid, +144988,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,United Healthcare-Medicaid, +144989,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,United Healthcare-Medicaid, +144990,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,United Healthcare-Medicaid, +144991,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,United Healthcare-Medicaid, +144992,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,United Healthcare-Medicaid, +144993,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,United Healthcare-Medicaid, +144994,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,United Healthcare-Medicaid, +144995,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,United Healthcare-Medicaid, +144996,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,United Healthcare-Medicaid, +144997,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,United Healthcare-Medicaid, +144998,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,United Healthcare-Medicaid, +144999,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,United Healthcare-Medicaid, +145000,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,United Healthcare-Medicaid, +145001,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,United Healthcare-Medicaid, +145002,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,United Healthcare-Medicaid, +145003,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,United Healthcare-Medicaid, +145004,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,United Healthcare-Medicaid, +145005,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,United Healthcare-Medicaid, +145006,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,United Healthcare-Medicaid, +145007,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,United Healthcare-Medicaid, +145008,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,United Healthcare-Medicaid, +145009,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,United Healthcare-Medicaid, +145010,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,United Healthcare-Medicaid, +145011,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,United Healthcare-Medicaid, +145012,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,United Healthcare-Medicaid, +145013,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,United Healthcare-Medicaid, +145014,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,United Healthcare-Medicaid, +145015,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,United Healthcare-Medicaid, +145016,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,United Healthcare-Medicaid, +145017,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,United Healthcare-Medicaid, +145018,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,United Healthcare-Medicaid, +145019,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,United Healthcare-Medicaid, +145020,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,United Healthcare-Medicaid, +145021,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,United Healthcare-Medicaid, +145022,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,United Healthcare-Medicaid, +145023,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,United Healthcare-Medicaid, +145024,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,United Healthcare-Medicaid, +145025,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,United Healthcare-Medicaid, +145026,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,United Healthcare-Medicaid, +145027,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,United Healthcare-Medicaid, +145028,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,United Healthcare-Medicaid, +145029,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,United Healthcare-Medicaid, +145030,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,United Healthcare-Medicaid, +145031,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,United Healthcare-Medicaid, +145032,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,United Healthcare-Medicaid, +145033,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,United Healthcare-Medicaid, +145034,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,United Healthcare-Medicaid, +145035,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,United Healthcare-Medicaid, +145036,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,United Healthcare-Medicaid, +145037,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,United Healthcare-Medicaid, +145038,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,United Healthcare-Medicaid, +145039,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,United Healthcare-Medicaid, +145040,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,United Healthcare-Medicaid, +145041,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,United Healthcare-Medicaid, +145042,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,United Healthcare-Medicaid, +145043,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,United Healthcare-Medicaid, +145044,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,United Healthcare-Medicaid, +145045,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,United Healthcare-Medicaid, +145046,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,United Healthcare-Medicaid, +145047,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,United Healthcare-Medicaid, +145048,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,United Healthcare-Medicaid, +145049,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,United Healthcare-Medicaid, +145050,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,United Healthcare-Medicaid, +145051,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,United Healthcare-Medicaid, +145052,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,United Healthcare-Medicaid, +145053,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,United Healthcare-Medicaid, +145054,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,United Healthcare-Medicaid, +145055,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,United Healthcare-Medicaid, +145056,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,United Healthcare-Medicaid, +145057,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,United Healthcare-Medicaid, +145058,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,United Healthcare-Medicaid, +145059,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,United Healthcare-Medicaid, +145060,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,United Healthcare-Medicaid, +145061,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,United Healthcare-Medicaid, +145062,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,United Healthcare-Medicaid, +145063,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,United Healthcare-Medicaid, +145064,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Medicaid, +145065,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,United Healthcare-Medicaid, +145066,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,United Healthcare-Medicaid, +145067,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,United Healthcare-Medicaid, +145068,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,United Healthcare-Medicaid, +145069,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,United Healthcare-Medicaid, +145070,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,United Healthcare-Medicaid, +145071,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,United Healthcare-Medicaid, +145072,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,United Healthcare-Medicaid, +145073,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,United Healthcare-Medicaid, +145074,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,United Healthcare-Medicaid, +145075,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Medicaid, +145076,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,United Healthcare-Medicaid, +145077,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,United Healthcare-Medicaid, +145078,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,United Healthcare-Medicaid, +145079,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,United Healthcare-Medicaid, +145080,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,United Healthcare-Medicaid, +145081,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,United Healthcare-Medicaid, +145082,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,United Healthcare-Medicaid, +145083,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,United Healthcare-Medicaid, +145084,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,United Healthcare-Medicaid, +145085,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,United Healthcare-Medicaid, +145086,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,United Healthcare-Medicaid, +145087,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,United Healthcare-Medicaid, +145088,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,United Healthcare-Medicaid, +145089,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,United Healthcare-Medicaid, +145090,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,United Healthcare-Medicaid, +145091,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,United Healthcare-Medicaid, +145092,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,United Healthcare-Medicaid, +145093,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,United Healthcare-Medicaid, +145094,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,United Healthcare-Medicaid, +145095,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,United Healthcare-Medicaid, +145096,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,United Healthcare-Medicaid, +145097,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Medicaid, +145098,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,United Healthcare-Medicaid, +145099,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,United Healthcare-Medicaid, +145100,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,United Healthcare-Medicaid, +145101,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,United Healthcare-Medicaid, +145102,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,United Healthcare-Medicaid, +145103,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,United Healthcare-Medicaid, +145104,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,United Healthcare-Medicaid, +145105,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,United Healthcare-Medicaid, +145106,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,United Healthcare-Medicaid, +145107,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,United Healthcare-Medicaid, +145108,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,United Healthcare-Medicaid, +145109,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,United Healthcare-Medicaid, +145110,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,United Healthcare-Medicaid, +145111,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,United Healthcare-Medicaid, +145112,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,United Healthcare-Medicaid, +145113,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,United Healthcare-Medicaid, +145114,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,United Healthcare-Medicaid, +145115,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,United Healthcare-Medicaid, +145116,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,United Healthcare-Medicaid, +145117,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,United Healthcare-Medicaid, +145118,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,United Healthcare-Medicaid, +145119,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,United Healthcare-Medicaid, +145120,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,United Healthcare-Medicaid, +145121,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,United Healthcare-Medicaid, +145122,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,United Healthcare-Medicaid, +145123,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,United Healthcare-Medicaid, +145124,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,United Healthcare-Medicaid, +145125,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,United Healthcare-Medicaid, +145126,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,United Healthcare-Medicaid, +145127,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,United Healthcare-Medicaid, +145128,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,United Healthcare-Medicaid, +145129,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,United Healthcare-Medicaid, +145130,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,United Healthcare-Medicaid, +145131,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,United Healthcare-Medicaid, +145132,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,United Healthcare-Medicaid, +145133,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,United Healthcare-Medicaid, +145134,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,United Healthcare-Medicaid, +145135,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,United Healthcare-Medicaid, +145136,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,United Healthcare-Medicaid, +145137,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,United Healthcare-Medicaid, +145138,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,United Healthcare-Medicaid, +145139,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,United Healthcare-Medicaid, +145140,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,United Healthcare-Medicaid, +145141,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,United Healthcare-Medicaid, +145142,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,United Healthcare-Medicaid, +145143,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,United Healthcare-Medicaid, +145144,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,United Healthcare-Medicaid, +145145,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,United Healthcare-Medicaid, +145146,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,United Healthcare-Medicaid, +145147,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,United Healthcare-Medicaid, +145148,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,United Healthcare-Medicaid, +145149,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,United Healthcare-Medicaid, +145150,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,United Healthcare-Medicaid, +145151,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,United Healthcare-Medicaid, +145152,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,United Healthcare-Medicaid, +145153,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,United Healthcare-Medicaid, +145154,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,United Healthcare-Medicaid, +145155,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,United Healthcare-Medicaid, +145156,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,United Healthcare-Medicaid, +145157,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,United Healthcare-Medicaid, +145158,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,United Healthcare-Medicaid, +145159,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,United Healthcare-Medicaid, +145160,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,United Healthcare-Medicaid, +145161,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,United Healthcare-Medicaid, +145162,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,United Healthcare-Medicaid, +145163,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,United Healthcare-Medicaid, +145164,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,United Healthcare-Medicaid, +145165,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,United Healthcare-Medicaid, +145166,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,United Healthcare-Medicaid, +145167,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,United Healthcare-Medicaid, +145168,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,United Healthcare-Medicaid, +145169,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,United Healthcare-Medicaid, +145170,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,United Healthcare-Medicaid, +145171,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,United Healthcare-Medicaid, +145172,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,United Healthcare-Medicaid, +145173,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,United Healthcare-Medicaid, +145174,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,United Healthcare-Medicaid, +145175,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,United Healthcare-Medicaid, +145176,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,United Healthcare-Medicaid, +145177,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,United Healthcare-Medicaid, +145178,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,United Healthcare-Medicaid, +145179,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,United Healthcare-Medicaid, +145180,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,United Healthcare-Medicaid, +145181,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,United Healthcare-Medicaid, +145182,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,United Healthcare-Medicaid, +145183,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,United Healthcare-Medicaid, +145184,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,United Healthcare-Medicaid, +145185,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,United Healthcare-Medicaid, +145186,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,United Healthcare-Medicaid, +145187,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,United Healthcare-Medicaid, +145188,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,United Healthcare-Medicaid, +145189,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,United Healthcare-Medicaid, +145190,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,United Healthcare-Medicaid, +145191,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,United Healthcare-Medicaid, +145192,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,United Healthcare-Medicaid, +145193,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,United Healthcare-Medicaid, +145194,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,United Healthcare-Medicaid, +145195,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,United Healthcare-Medicaid, +145196,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,United Healthcare-Medicaid, +145197,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,United Healthcare-Medicaid, +145198,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,United Healthcare-Medicaid, +145199,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,United Healthcare-Medicaid, +145200,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,United Healthcare-Medicaid, +145201,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,United Healthcare-Medicaid, +145202,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,United Healthcare-Medicaid, +145203,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,United Healthcare-Medicaid, +145204,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,United Healthcare-Medicaid, +145205,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,United Healthcare-Medicaid, +145206,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,United Healthcare-Medicaid, +145207,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,United Healthcare-Medicaid, +145208,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,United Healthcare-Medicaid, +145209,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,United Healthcare-Medicaid, +145210,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,United Healthcare-Medicaid, +145211,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,United Healthcare-Medicaid, +145212,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,United Healthcare-Medicaid, +145213,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,United Healthcare-Medicaid, +145214,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,United Healthcare-Medicaid, +145215,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,United Healthcare-Medicaid, +145216,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,United Healthcare-Medicaid, +145217,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,United Healthcare-Medicaid, +145218,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,United Healthcare-Medicaid, +145219,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,United Healthcare-Medicaid, +145220,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,United Healthcare-Medicaid, +145221,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,United Healthcare-Medicaid, +145222,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,United Healthcare-Medicaid, +145223,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,United Healthcare-Medicaid, +145224,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,United Healthcare-Medicaid, +145225,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,United Healthcare-Medicaid, +145226,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,United Healthcare-Medicaid, +145227,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,United Healthcare-Medicaid, +145228,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,United Healthcare-Medicaid, +145229,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,United Healthcare-Medicaid, +145230,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,United Healthcare-Medicaid, +145231,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,United Healthcare-Medicaid, +145232,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,United Healthcare-Medicaid, +145233,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,United Healthcare-Medicaid, +145234,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,United Healthcare-Medicaid, +145235,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,United Healthcare-Medicaid, +145236,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,United Healthcare-Medicaid, +145237,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,United Healthcare-Medicaid, +145238,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,United Healthcare-Medicaid, +145239,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,United Healthcare-Medicaid, +145240,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,United Healthcare-Medicaid, +145241,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,United Healthcare-Medicaid, +145242,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,United Healthcare-Medicaid, +145243,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,United Healthcare-Medicaid, +145244,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,United Healthcare-Medicaid, +145245,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,United Healthcare-Medicaid, +145246,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,United Healthcare-Medicaid, +145247,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,United Healthcare-Medicaid, +145248,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,United Healthcare-Medicaid, +145249,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,United Healthcare-Medicaid, +145250,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,United Healthcare-Medicaid, +145251,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,United Healthcare-Medicaid, +145252,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,United Healthcare-Medicaid, +145253,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,United Healthcare-Medicaid, +145254,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,United Healthcare-Medicaid, +145255,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,United Healthcare-Medicaid, +145256,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,United Healthcare-Medicaid, +145257,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,United Healthcare-Medicaid, +145258,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,United Healthcare-Medicaid, +145259,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,United Healthcare-Medicaid, +145260,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,United Healthcare-Medicaid, +145261,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,United Healthcare-Medicaid, +145262,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,United Healthcare-Medicaid, +145263,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,United Healthcare-Medicaid, +145264,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,United Healthcare-Medicaid, +145265,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,United Healthcare-Medicaid, +145266,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,United Healthcare-Medicaid, +145267,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,United Healthcare-Medicaid, +145268,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,United Healthcare-Medicaid, +145269,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,United Healthcare-Medicaid, +145270,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,United Healthcare-Medicaid, +145271,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,United Healthcare-Medicaid, +145272,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,United Healthcare-Medicaid, +145273,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,United Healthcare-Medicaid, +145274,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,United Healthcare-Medicaid, +145275,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,United Healthcare-Medicaid, +145276,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,United Healthcare-Medicaid, +145277,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,United Healthcare-Medicaid, +145278,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,United Healthcare-Medicaid, +145279,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,United Healthcare-Medicaid, +145280,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,United Healthcare-Medicaid, +145281,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,United Healthcare-Medicaid, +145282,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,United Healthcare-Medicaid, +145283,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,United Healthcare-Medicaid, +145284,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,United Healthcare-Medicaid, +145285,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,United Healthcare-Medicaid, +145286,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,United Healthcare-Medicaid, +145287,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,United Healthcare-Medicaid, +145288,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,United Healthcare-Medicaid, +145289,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,United Healthcare-Medicaid, +145290,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,United Healthcare-Medicaid, +145291,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,United Healthcare-Medicaid, +145292,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,United Healthcare-Medicaid, +145293,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,United Healthcare-Medicaid, +145294,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,United Healthcare-Medicaid, +145295,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,United Healthcare-Medicaid, +145296,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,United Healthcare-Medicaid, +145297,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,United Healthcare-Medicaid, +145298,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,United Healthcare-Medicaid, +145299,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,United Healthcare-Medicaid, +145300,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,United Healthcare-Medicaid, +145301,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,United Healthcare-Medicaid, +145302,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,United Healthcare-Medicaid, +145303,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,United Healthcare-Medicaid, +145304,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,United Healthcare-Medicaid, +145305,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,United Healthcare-Medicaid, +145306,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,United Healthcare-Medicaid, +145307,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,United Healthcare-Medicaid, +145308,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,United Healthcare-Medicaid, +145309,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,United Healthcare-Medicaid, +145310,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,United Healthcare-Medicaid, +145311,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,United Healthcare-Medicaid, +145312,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,United Healthcare-Medicaid, +145313,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,United Healthcare-Medicaid, +145314,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,United Healthcare-Medicaid, +145315,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,United Healthcare-Medicaid, +145316,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,United Healthcare-Medicaid, +145317,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,United Healthcare-Medicaid, +145318,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,United Healthcare-Medicaid, +145319,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,United Healthcare-Medicaid, +145320,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,United Healthcare-Medicaid, +145321,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,United Healthcare-Medicaid, +145322,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,United Healthcare-Medicaid, +145323,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,United Healthcare-Medicaid, +145324,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,United Healthcare-Medicaid, +145325,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,United Healthcare-Medicaid, +145326,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,United Healthcare-Medicaid, +145327,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,United Healthcare-Medicaid, +145328,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,United Healthcare-Medicaid, +145329,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,United Healthcare-Medicaid, +145330,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,United Healthcare-Medicaid, +145331,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,United Healthcare-Medicaid, +145332,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,United Healthcare-Medicaid, +145333,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,United Healthcare-Medicaid, +145334,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,United Healthcare-Medicaid, +145335,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,United Healthcare-Medicaid, +145336,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,United Healthcare-Medicaid, +145337,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,United Healthcare-Medicaid, +145338,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,United Healthcare-Medicaid, +145339,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,United Healthcare-Medicaid, +145340,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,United Healthcare-Medicaid, +145341,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,United Healthcare-Medicaid, +145342,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,United Healthcare-Medicaid, +145343,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,United Healthcare-Medicaid, +145344,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,United Healthcare-Medicaid, +145345,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,United Healthcare-Medicaid, +145346,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,United Healthcare-Medicaid, +145347,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,United Healthcare-Medicaid, +145348,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,United Healthcare-Medicaid, +145349,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,United Healthcare-Medicaid, +145350,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,United Healthcare-Medicaid, +145351,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,United Healthcare-Medicaid, +145352,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,United Healthcare-Medicaid, +145353,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,United Healthcare-Medicaid, +145354,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,United Healthcare-Medicaid, +145355,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,United Healthcare-Medicaid, +145356,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,United Healthcare-Medicaid, +145357,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,United Healthcare-Medicaid, +145358,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,United Healthcare-Medicaid, +145359,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,United Healthcare-Medicaid, +145360,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,United Healthcare-Medicaid, +145361,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,United Healthcare-Medicaid, +145362,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,United Healthcare-Medicaid, +145363,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,United Healthcare-Medicaid, +145364,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,United Healthcare-Medicaid, +145365,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,United Healthcare-Medicaid, +145366,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,United Healthcare-Medicaid, +145367,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,United Healthcare-Medicaid, +145368,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,United Healthcare-Medicaid, +145369,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,United Healthcare-Medicaid, +145370,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,United Healthcare-Medicaid, +145371,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,United Healthcare-Medicaid, +145372,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,United Healthcare-Medicaid, +145373,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,United Healthcare-Medicaid, +145374,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,United Healthcare-Medicaid, +145375,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,United Healthcare-Medicaid, +145376,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,United Healthcare-Medicaid, +145377,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,United Healthcare-Medicaid, +145378,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,United Healthcare-Medicaid, +145379,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,United Healthcare-Medicaid, +145380,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,United Healthcare-Medicaid, +145381,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,United Healthcare-Medicaid, +145382,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,United Healthcare-Medicaid, +145383,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,United Healthcare-Medicaid, +145384,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,United Healthcare-Medicaid, +145385,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,United Healthcare-Medicaid, +145386,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,United Healthcare-Medicaid, +145387,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,United Healthcare-Medicaid, +145388,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,United Healthcare-Medicaid, +145389,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,United Healthcare-Medicaid, +145390,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,United Healthcare-Medicaid, +145391,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,United Healthcare-Medicaid, +145392,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,United Healthcare-Medicaid, +145393,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,United Healthcare-Medicaid, +145394,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,United Healthcare-Medicaid, +145395,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,United Healthcare-Medicaid, +145396,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,United Healthcare-Medicaid, +145397,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,United Healthcare-Medicaid, +145398,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,United Healthcare-Medicaid, +145399,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,United Healthcare-Medicaid, +145400,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,United Healthcare-Medicaid, +145401,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,United Healthcare-Medicaid, +145402,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,United Healthcare-Medicaid, +145403,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,United Healthcare-Medicaid, +145404,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,United Healthcare-Medicaid, +145405,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,United Healthcare-Medicaid, +145406,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,United Healthcare-Medicaid, +145407,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,United Healthcare-Medicaid, +145408,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,United Healthcare-Medicaid, +145409,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,United Healthcare-Medicaid, +145410,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,United Healthcare-Medicaid, +145411,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,United Healthcare-Medicaid, +145412,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,United Healthcare-Medicaid, +145413,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,United Healthcare-Medicaid, +145414,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,United Healthcare-Medicaid, +145415,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,United Healthcare-Medicaid, +145416,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,United Healthcare-Medicaid, +145417,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,United Healthcare-Medicaid, +145418,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,United Healthcare-Medicaid, +145419,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,United Healthcare-Medicaid, +145420,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,United Healthcare-Medicaid, +145421,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,United Healthcare-Medicaid, +145422,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,United Healthcare-Medicaid, +145423,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,United Healthcare-Medicaid, +145424,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,United Healthcare-Medicaid, +145425,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,United Healthcare-Medicaid, +145426,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,United Healthcare-Medicaid, +145427,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,United Healthcare-Medicaid, +145428,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,United Healthcare-Medicaid, +145429,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,United Healthcare-Medicaid, +145430,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,United Healthcare-Medicaid, +145431,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,United Healthcare-Medicaid, +145432,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,United Healthcare-Medicaid, +145433,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,United Healthcare-Medicaid, +145434,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,United Healthcare-Medicaid, +145435,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,United Healthcare-Medicaid, +145436,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,United Healthcare-Medicaid, +145437,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,United Healthcare-Medicaid, +145438,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,United Healthcare-Medicaid, +145439,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,United Healthcare-Medicaid, +145440,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,United Healthcare-Medicaid, +145441,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,United Healthcare-Medicaid, +145442,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,United Healthcare-Medicaid, +145443,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,United Healthcare-Medicaid, +145444,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,United Healthcare-Medicaid, +145445,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,United Healthcare-Medicaid, +145446,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,United Healthcare-Medicaid, +145447,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,United Healthcare-Medicaid, +145448,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,United Healthcare-Medicaid, +145449,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,United Healthcare-Medicaid, +145450,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,United Healthcare-Medicaid, +145451,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,United Healthcare-Medicaid, +145452,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,United Healthcare-Medicaid, +145453,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,United Healthcare-Medicaid, +145454,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,United Healthcare-Medicaid, +145455,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,United Healthcare-Medicaid, +145456,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,United Healthcare-Medicaid, +145457,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,United Healthcare-Medicaid, +145458,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,United Healthcare-Medicaid, +145459,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,United Healthcare-Medicaid, +145460,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,United Healthcare-Medicaid, +145461,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,United Healthcare-Medicaid, +145462,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,United Healthcare-Medicaid, +145463,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,United Healthcare-Medicaid, +145464,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,United Healthcare-Medicaid, +145465,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,United Healthcare-Medicaid, +145466,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,United Healthcare-Medicaid, +145467,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,United Healthcare-Medicaid, +145468,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,United Healthcare-Medicaid, +145469,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,United Healthcare-Medicaid, +145470,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,United Healthcare-Medicaid, +145471,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,United Healthcare-Medicaid, +145472,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,United Healthcare-Medicaid, +145473,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,United Healthcare-Medicaid, +145474,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,United Healthcare-Medicaid, +145475,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,United Healthcare-Medicaid, +145476,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,United Healthcare-Medicaid, +145477,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,United Healthcare-Medicaid, +145478,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,United Healthcare-Medicaid, +145479,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,United Healthcare-Medicaid, +145480,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,United Healthcare-Medicaid, +145481,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,United Healthcare-Medicaid, +145482,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,United Healthcare-Medicaid, +145483,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,United Healthcare-Medicaid, +145484,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,United Healthcare-Medicaid, +145485,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,United Healthcare-Medicaid, +145486,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,United Healthcare-Medicaid, +145487,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,United Healthcare-Medicaid, +145488,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,United Healthcare-Medicaid, +145489,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,United Healthcare-Medicaid, +145490,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,United Healthcare-Medicaid, +145491,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,United Healthcare-Medicaid, +145492,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,United Healthcare-Medicaid, +145493,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,United Healthcare-Medicaid, +145494,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,United Healthcare-Medicaid, +145495,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,United Healthcare-Medicaid, +145496,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,United Healthcare-Medicaid, +145497,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,United Healthcare-Medicaid, +145498,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,United Healthcare-Medicaid, +145499,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,United Healthcare-Medicaid, +145500,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,United Healthcare-Medicaid, +145501,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,United Healthcare-Medicaid, +145502,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,United Healthcare-Medicaid, +145503,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,United Healthcare-Medicaid, +145504,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,United Healthcare-Medicaid, +145505,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,United Healthcare-Medicaid, +145506,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,United Healthcare-Medicaid, +145507,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,United Healthcare-Medicaid, +145508,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,United Healthcare-Medicaid, +145509,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,United Healthcare-Medicaid, +145510,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,United Healthcare-Medicaid, +145511,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,United Healthcare-Medicaid, +145512,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,United Healthcare-Medicaid, +145513,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,United Healthcare-Medicaid, +145514,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,United Healthcare-Medicaid, +145515,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,United Healthcare-Medicaid, +145516,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,United Healthcare-Medicaid, +145517,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,United Healthcare-Medicaid, +145518,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,United Healthcare-Medicaid, +145519,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,United Healthcare-Medicaid, +145520,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,United Healthcare-Medicaid, +145521,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,United Healthcare-Medicaid, +145522,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,United Healthcare-Medicaid, +145523,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,United Healthcare-Medicaid, +145524,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,United Healthcare-Medicaid, +145525,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,United Healthcare-Medicaid, +145526,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,United Healthcare-Medicaid, +145527,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,United Healthcare-Medicaid, +145528,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,United Healthcare-Medicaid, +145529,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,United Healthcare-Medicaid, +145530,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,United Healthcare-Medicaid, +145531,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,United Healthcare-Medicaid, +145532,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,United Healthcare-Medicaid, +145533,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,United Healthcare-Medicaid, +145534,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,United Healthcare-Medicaid, +145535,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,United Healthcare-Medicaid, +145536,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,United Healthcare-Medicaid, +145537,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,United Healthcare-Medicaid, +145538,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,United Healthcare-Medicaid, +145539,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,United Healthcare-Medicaid, +145540,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,United Healthcare-Medicaid, +145541,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,United Healthcare-Medicaid, +145542,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,United Healthcare-Medicaid, +145543,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,United Healthcare-Medicaid, +145544,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,United Healthcare-Medicaid, +145545,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,United Healthcare-Medicaid, +145546,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,United Healthcare-Medicaid, +145547,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,United Healthcare-Medicaid, +145548,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,United Healthcare-Medicaid, +145549,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,United Healthcare-Medicaid, +145550,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,United Healthcare-Medicaid, +145551,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,United Healthcare-Medicaid, +145552,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,United Healthcare-Medicaid, +145553,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,United Healthcare-Medicaid, +145554,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,United Healthcare-Medicaid, +145555,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,United Healthcare-Medicaid, +145556,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,United Healthcare-Medicaid, +145557,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,United Healthcare-Medicaid, +145558,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,United Healthcare-Medicaid, +145559,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,United Healthcare-Medicaid, +145560,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,United Healthcare-Medicaid, +145561,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,United Healthcare-Medicaid, +145562,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,United Healthcare-Medicaid, +145563,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,United Healthcare-Medicaid, +145564,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,United Healthcare-Medicaid, +145565,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,United Healthcare-Medicaid, +145566,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,United Healthcare-Medicaid, +145567,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,United Healthcare-Medicaid, +145568,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,United Healthcare-Medicaid, +145569,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,United Healthcare-Medicaid, +145570,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,United Healthcare-Medicaid, +145571,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,United Healthcare-Medicaid, +145572,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,United Healthcare-Medicaid, +145573,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,United Healthcare-Medicaid, +145574,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,United Healthcare-Medicaid, +145575,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,United Healthcare-Medicaid, +145576,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,United Healthcare-Medicaid, +145577,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,United Healthcare-Medicaid, +145578,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,United Healthcare-Medicaid, +145579,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,United Healthcare-Medicaid, +145580,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,United Healthcare-Medicaid, +145581,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,United Healthcare-Medicaid, +145582,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,United Healthcare-Medicaid, +145583,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,United Healthcare-Medicaid, +145584,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,United Healthcare-Medicaid, +145585,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,United Healthcare-Medicaid, +145586,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,United Healthcare-Medicaid, +145587,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,United Healthcare-Medicaid, +145588,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,United Healthcare-Medicaid, +145589,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,United Healthcare-Medicaid, +145590,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,United Healthcare-Medicaid, +145591,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,United Healthcare-Medicaid, +145592,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,United Healthcare-Medicaid, +145593,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,United Healthcare-Medicaid, +145594,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,United Healthcare-Medicaid, +145595,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,United Healthcare-Medicaid, +145596,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,United Healthcare-Medicaid, +145597,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,United Healthcare-Medicaid, +145598,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,United Healthcare-Medicaid, +145599,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,United Healthcare-Medicaid, +145600,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,United Healthcare-Medicaid, +145601,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,United Healthcare-Medicaid, +145602,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,United Healthcare-Medicaid, +145603,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,United Healthcare-Medicaid, +145604,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,United Healthcare-Medicaid, +145605,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,United Healthcare-Medicaid, +145606,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,United Healthcare-Medicaid, +145607,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,United Healthcare-Medicaid, +145608,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,United Healthcare-Medicaid, +145609,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,United Healthcare-Medicaid, +145610,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,United Healthcare-Medicaid, +145611,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,United Healthcare-Medicaid, +145612,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,United Healthcare-Medicaid, +145613,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,United Healthcare-Medicaid, +145614,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,United Healthcare-Medicaid, +145615,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,United Healthcare-Medicaid, +145616,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,United Healthcare-Medicaid, +145617,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,United Healthcare-Medicaid, +145618,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,United Healthcare-Medicaid, +145619,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,United Healthcare-Medicaid, +145620,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,United Healthcare-Medicaid, +145621,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,United Healthcare-Medicaid, +145622,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,United Healthcare-Medicaid, +145623,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,United Healthcare-Medicaid, +145624,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,United Healthcare-Medicaid, +145625,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,United Healthcare-Medicaid, +145626,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,United Healthcare-Medicaid, +145627,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,United Healthcare-Medicaid, +145628,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,United Healthcare-Medicaid, +145629,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,United Healthcare-Medicaid, +145630,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,United Healthcare-Medicaid, +145631,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,United Healthcare-Medicaid, +145632,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,United Healthcare-Medicaid, +145633,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,United Healthcare-Medicaid, +145634,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,United Healthcare-Medicaid, +145635,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,United Healthcare-Medicaid, +145636,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,United Healthcare-Medicaid, +145637,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,United Healthcare-Medicaid, +145638,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,United Healthcare-Medicaid, +145639,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,United Healthcare-Medicaid, +145640,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,United Healthcare-Medicaid, +145641,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,United Healthcare-Medicaid, +145642,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,United Healthcare-Medicaid, +145643,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,United Healthcare-Medicaid, +145644,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,United Healthcare-Medicaid, +145645,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,United Healthcare-Medicaid, +145646,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,United Healthcare-Medicaid, +145647,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,United Healthcare-Medicaid, +145648,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,United Healthcare-Medicaid, +145649,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,United Healthcare-Medicaid, +145650,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,United Healthcare-Medicaid, +145651,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,United Healthcare-Medicaid, +145652,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,United Healthcare-Medicaid, +145653,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,United Healthcare-Medicaid, +145654,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,United Healthcare-Medicaid, +145655,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,United Healthcare-Medicaid, +145656,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,United Healthcare-Medicaid, +145657,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,United Healthcare-Medicaid, +145658,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,United Healthcare-Medicaid, +145659,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,United Healthcare-Medicaid, +145660,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,United Healthcare-Medicaid, +145661,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,United Healthcare-Medicaid, +145662,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,United Healthcare-Medicaid, +145663,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,United Healthcare-Medicaid, +145664,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,United Healthcare-Medicaid, +145665,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,United Healthcare-Medicaid, +145666,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,United Healthcare-Medicaid, +145667,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,United Healthcare-Medicaid, +145668,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,United Healthcare-Medicaid, +145669,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,United Healthcare-Medicaid, +145670,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,United Healthcare-Medicaid, +145671,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,United Healthcare-Medicaid, +145672,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,United Healthcare-Medicaid, +145673,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,United Healthcare-Medicaid, +145674,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,United Healthcare-Medicaid, +145675,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,United Healthcare-Medicaid, +145676,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,United Healthcare-Medicaid, +145677,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,United Healthcare-Medicaid, +145678,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,United Healthcare-Medicaid, +145679,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,United Healthcare-Medicaid, +145680,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,United Healthcare-Medicaid, +145681,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,United Healthcare-Medicaid, +145682,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,United Healthcare-Medicaid, +145683,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,United Healthcare-Medicaid, +145684,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,United Healthcare-Medicaid, +145685,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,United Healthcare-Medicaid, +145686,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,United Healthcare-Medicaid, +145687,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,United Healthcare-Medicaid, +145688,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,United Healthcare-Medicaid, +145689,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,United Healthcare-Medicaid, +145690,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,United Healthcare-Medicaid, +145691,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,United Healthcare-Medicaid, +145692,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,United Healthcare-Medicaid, +145693,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,United Healthcare-Medicaid, +145694,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,United Healthcare-Medicaid, +145695,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,United Healthcare-Medicaid, +145696,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,United Healthcare-Medicaid, +145697,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,United Healthcare-Medicaid, +145698,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,United Healthcare-Medicaid, +145699,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,United Healthcare-Medicaid, +145700,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,United Healthcare-Medicaid, +145701,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,United Healthcare-Medicaid, +145702,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,United Healthcare-Medicaid, +145703,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,United Healthcare-Medicaid, +145704,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,United Healthcare-Medicaid, +145705,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,United Healthcare-Medicaid, +145706,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,United Healthcare-Medicaid, +145707,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,United Healthcare-Medicaid, +145708,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,United Healthcare-Medicaid, +145709,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,United Healthcare-Medicaid, +145710,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,United Healthcare-Medicaid, +145711,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,United Healthcare-Medicaid, +145712,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,United Healthcare-Medicaid, +145713,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,United Healthcare-Medicaid, +145714,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,United Healthcare-Medicaid, +145715,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,United Healthcare-Medicaid, +145716,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,United Healthcare-Medicaid, +145717,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,United Healthcare-Medicaid, +145718,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,United Healthcare-Medicaid, +145719,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,United Healthcare-Medicaid, +145720,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,United Healthcare-Medicaid, +145721,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,United Healthcare-Medicaid, +145722,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,United Healthcare-Medicaid, +145723,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,United Healthcare-Medicaid, +145724,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,United Healthcare-Medicaid, +145725,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,United Healthcare-Medicaid, +145726,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,United Healthcare-Medicaid, +145727,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,United Healthcare-Medicaid, +145728,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,United Healthcare-Medicaid, +145729,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,United Healthcare-Medicaid, +145730,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,United Healthcare-Medicaid, +145731,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,United Healthcare-Medicaid, +145732,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,United Healthcare-Medicaid, +145733,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,United Healthcare-Medicaid, +145734,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,United Healthcare-Medicaid, +145735,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,United Healthcare-Medicaid, +145736,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,United Healthcare-Medicaid, +145737,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,United Healthcare-Medicaid, +145738,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,United Healthcare-Medicaid, +145739,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,United Healthcare-Medicaid, +145740,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,United Healthcare-Medicaid, +145741,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,United Healthcare-Medicaid, +145742,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,United Healthcare-Medicaid, +145743,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,United Healthcare-Medicaid, +145744,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,United Healthcare-Medicaid, +145745,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,United Healthcare-Medicaid, +145746,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,United Healthcare-Medicaid, +145747,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,United Healthcare-Medicaid, +145748,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,United Healthcare-Medicaid, +145749,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,United Healthcare-Medicaid, +145750,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,United Healthcare-Medicaid, +145751,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,United Healthcare-Medicaid, +145752,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,United Healthcare-Medicaid, +145753,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,United Healthcare-Medicaid, +145754,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,United Healthcare-Medicaid, +145755,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,United Healthcare-Medicaid, +145756,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,United Healthcare-Medicaid, +145757,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,United Healthcare-Medicaid, +145758,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,United Healthcare-Medicaid, +145759,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,United Healthcare-Medicaid, +145760,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,United Healthcare-Medicaid, +145761,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,United Healthcare-Medicaid, +145762,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,United Healthcare-Medicaid, +145763,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,United Healthcare-Medicaid, +145764,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,United Healthcare-Medicaid, +145765,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,United Healthcare-Medicaid, +145766,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,United Healthcare-Medicaid, +145767,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,United Healthcare-Medicaid, +145768,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,United Healthcare-Medicaid, +145769,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,United Healthcare-Medicaid, +145770,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,United Healthcare-Medicaid, +145771,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,United Healthcare-Medicaid, +145772,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,United Healthcare-Medicaid, +145773,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,United Healthcare-Medicaid, +145774,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,United Healthcare-Medicaid, +145775,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,United Healthcare-Medicaid, +145776,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,United Healthcare-Medicaid, +145777,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,United Healthcare-Medicaid, +145778,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,United Healthcare-Medicaid, +145779,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,United Healthcare-Medicaid, +145780,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,United Healthcare-Medicaid, +145781,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,United Healthcare-Medicaid, +145782,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,United Healthcare-Medicaid, +145783,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,United Healthcare-Medicaid, +145784,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,United Healthcare-Medicaid, +145785,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,United Healthcare-Medicaid, +145786,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,United Healthcare-Medicaid, +145787,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,United Healthcare-Medicaid, +145788,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,United Healthcare-Medicaid, +145789,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,United Healthcare-Medicaid, +145790,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,United Healthcare-Medicaid, +145791,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,United Healthcare-Medicaid, +145792,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,United Healthcare-Medicaid, +145793,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,United Healthcare-Medicaid, +145794,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,United Healthcare-Medicaid, +145795,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,United Healthcare-Medicaid, +145796,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,United Healthcare-Medicaid, +145797,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,United Healthcare-Medicaid, +145798,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,United Healthcare-Medicaid, +145799,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,United Healthcare-Medicaid, +145800,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,United Healthcare-Medicaid, +145801,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,United Healthcare-Medicaid, +145802,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,United Healthcare-Medicaid, +145803,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,United Healthcare-Medicaid, +145804,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,United Healthcare-Medicaid, +145805,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,United Healthcare-Medicaid, +145806,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,United Healthcare-Medicaid, +145807,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,United Healthcare-Medicaid, +145808,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,United Healthcare-Medicaid, +145809,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,United Healthcare-Medicaid, +145810,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,United Healthcare-Medicaid, +145811,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,United Healthcare-Medicaid, +145812,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,United Healthcare-Medicaid, +145813,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,United Healthcare-Medicaid, +145814,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,United Healthcare-Medicaid, +145815,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,United Healthcare-Medicaid, +145816,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,United Healthcare-Medicaid, +145817,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,United Healthcare-Medicaid, +145818,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,United Healthcare-Medicaid, +145819,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,United Healthcare-Medicaid, +145820,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,United Healthcare-Medicaid, +145821,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,United Healthcare-Medicaid, +145822,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,United Healthcare-Medicaid, +145823,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,United Healthcare-Medicaid, +145824,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,United Healthcare-Medicaid, +145825,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,United Healthcare-Medicaid, +145826,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,United Healthcare-Medicaid, +145827,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,United Healthcare-Medicaid, +145828,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,United Healthcare-Medicaid, +145829,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,United Healthcare-Medicaid, +145830,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,United Healthcare-Medicaid, +145831,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,United Healthcare-Medicaid, +145832,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,United Healthcare-Medicaid, +145833,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,United Healthcare-Medicaid, +145834,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,United Healthcare-Medicaid, +145835,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,United Healthcare-Medicaid, +145836,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,United Healthcare-Medicaid, +145837,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,United Healthcare-Medicaid, +145838,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,United Healthcare-Medicaid, +145839,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,United Healthcare-Medicaid, +145840,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,United Healthcare-Medicaid, +145841,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,United Healthcare-Medicaid, +145842,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,United Healthcare-Medicaid, +145843,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,United Healthcare-Medicaid, +145844,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,United Healthcare-Medicaid, +145845,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,United Healthcare-Medicaid, +145846,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,United Healthcare-Medicaid, +145847,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,United Healthcare-Medicaid, +145848,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,United Healthcare-Medicaid, +145849,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,United Healthcare-Medicaid, +145850,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,United Healthcare-Medicaid, +145851,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,United Healthcare-Medicaid, +145852,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,United Healthcare-Medicaid, +145853,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,United Healthcare-Medicaid, +145854,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,United Healthcare-Medicaid, +145855,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,United Healthcare-Medicaid, +145856,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,United Healthcare-Medicaid, +145857,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,United Healthcare-Medicaid, +145858,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,United Healthcare-Medicaid, +145859,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,United Healthcare-Medicaid, +145860,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,United Healthcare-Medicaid, +145861,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,United Healthcare-Medicaid, +145862,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,United Healthcare-Medicaid, +145863,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,United Healthcare-Medicaid, +145864,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,United Healthcare-Medicaid, +145865,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,United Healthcare-Medicaid, +145866,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,United Healthcare-Medicaid, +145867,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,United Healthcare-Medicaid, +145868,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,United Healthcare-Medicaid, +145869,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,United Healthcare-Medicaid, +145870,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,United Healthcare-Medicaid, +145871,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,United Healthcare-Medicaid, +145872,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,United Healthcare-Medicaid, +145873,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,United Healthcare-Medicaid, +145874,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,United Healthcare-Medicaid, +145875,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,United Healthcare-Medicaid, +145876,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,United Healthcare-Medicaid, +145877,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,United Healthcare-Medicaid, +145878,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,United Healthcare-Medicaid, +145879,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,United Healthcare-Medicaid, +145880,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,United Healthcare-Medicaid, +145881,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,United Healthcare-Medicaid, +145882,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,United Healthcare-Medicaid, +145883,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,United Healthcare-Medicaid, +145884,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,United Healthcare-Medicaid, +145885,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,United Healthcare-Medicaid, +145886,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,United Healthcare-Medicaid, +145887,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,United Healthcare-Medicaid, +145888,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,United Healthcare-Medicaid, +145889,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,United Healthcare-Medicaid, +145890,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,United Healthcare-Medicaid, +145891,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,United Healthcare-Medicaid, +145892,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,United Healthcare-Medicaid, +145893,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,United Healthcare-Medicaid, +145894,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,United Healthcare-Medicaid, +145895,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,United Healthcare-Medicaid, +145896,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,United Healthcare-Medicaid, +145897,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,United Healthcare-Medicaid, +145898,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,United Healthcare-Medicaid, +145899,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,United Healthcare-Medicaid, +145900,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,United Healthcare-Medicaid, +145901,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,United Healthcare-Medicaid, +145902,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,United Healthcare-Medicaid, +145903,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,United Healthcare-Medicaid, +145904,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,United Healthcare-Medicaid, +145905,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,United Healthcare-Medicaid, +145906,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,United Healthcare-Medicaid, +145907,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,United Healthcare-Medicaid, +145908,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,United Healthcare-Medicaid, +145909,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,United Healthcare-Medicaid, +145910,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,United Healthcare-Medicaid, +145911,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,United Healthcare-Medicaid, +145912,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,United Healthcare-Medicaid, +145913,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,United Healthcare-Medicaid, +145914,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,United Healthcare-Medicaid, +145915,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,United Healthcare-Medicaid, +145916,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,United Healthcare-Medicaid, +145917,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,United Healthcare-Medicaid, +145918,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,United Healthcare-Medicaid, +145919,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,United Healthcare-Medicaid, +145920,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,United Healthcare-Medicaid, +145921,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,United Healthcare-Medicaid, +145922,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,United Healthcare-Medicaid, +145923,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,United Healthcare-Medicaid, +145924,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,United Healthcare-Medicaid, +145925,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,United Healthcare-Medicaid, +145926,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,United Healthcare-Medicaid, +145927,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,United Healthcare-Medicaid, +145928,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,United Healthcare-Medicaid, +145929,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,United Healthcare-Medicaid, +145930,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,United Healthcare-Medicaid, +145931,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,United Healthcare-Medicaid, +145932,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,United Healthcare-Medicaid, +145933,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,United Healthcare-Medicaid, +145934,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,United Healthcare-Medicaid, +145935,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,United Healthcare-Medicaid, +145936,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,United Healthcare-Medicaid, +145937,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,United Healthcare-Medicaid, +145938,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,United Healthcare-Medicaid, +145939,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,United Healthcare-Medicaid, +145940,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,United Healthcare-Medicaid, +145941,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,United Healthcare-Medicaid, +145942,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,United Healthcare-Medicaid, +145943,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,United Healthcare-Medicaid, +145944,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,United Healthcare-Medicaid, +145945,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,United Healthcare-Medicaid, +145946,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,United Healthcare-Medicaid, +145947,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,United Healthcare-Medicaid, +145948,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,United Healthcare-Medicaid, +145949,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,United Healthcare-Medicaid, +145950,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,United Healthcare-Medicaid, +145951,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,United Healthcare-Medicaid, +145952,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,United Healthcare-Medicaid, +145953,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,United Healthcare-Medicaid, +145954,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,United Healthcare-Medicaid, +145955,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,United Healthcare-Medicaid, +145956,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,United Healthcare-Medicaid, +145957,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,United Healthcare-Medicaid, +145958,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,United Healthcare-Medicaid, +145959,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,United Healthcare-Medicaid, +145960,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,United Healthcare-Medicaid, +145961,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,United Healthcare-Medicaid, +145962,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,United Healthcare-Medicaid, +145963,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,United Healthcare-Medicaid, +145964,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,United Healthcare-Medicaid, +145965,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,United Healthcare-Medicaid, +145966,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,United Healthcare-Medicaid, +145967,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,United Healthcare-Medicaid, +145968,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,United Healthcare-Medicaid, +145969,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,United Healthcare-Medicaid, +145970,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,United Healthcare-Medicaid, +145971,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,United Healthcare-Medicaid, +145972,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,United Healthcare-Medicaid, +145973,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,United Healthcare-Medicaid, +145974,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,United Healthcare-Medicaid, +145975,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,United Healthcare-Medicaid, +145976,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,United Healthcare-Medicaid, +145977,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,United Healthcare-Medicaid, +145978,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,United Healthcare-Medicaid, +145979,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,United Healthcare-Medicaid, +145980,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,United Healthcare-Medicaid, +145981,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,United Healthcare-Medicaid, +145982,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,United Healthcare-Medicaid, +145983,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,United Healthcare-Medicaid, +145984,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,United Healthcare-Medicaid, +145985,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,United Healthcare-Medicaid, +145986,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,United Healthcare-Medicaid, +145987,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,United Healthcare-Medicaid, +145988,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,United Healthcare-Medicaid, +145989,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,United Healthcare-Medicaid, +145990,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,United Healthcare-Medicaid, +145991,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,United Healthcare-Medicaid, +145992,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,United Healthcare-Medicaid, +145993,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,United Healthcare-Medicaid, +145994,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,United Healthcare-Medicaid, +145995,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,United Healthcare-Medicaid, +145996,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,United Healthcare-Medicaid, +145997,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,United Healthcare-Medicaid, +145998,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,United Healthcare-Medicaid, +145999,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,United Healthcare-Medicaid, +146000,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,United Healthcare-Medicaid, +146001,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,United Healthcare-Medicaid, +146002,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,United Healthcare-Medicaid, +146003,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,United Healthcare-Medicaid, +146004,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,United Healthcare-Medicaid, +146005,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,United Healthcare-Medicaid, +146006,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,United Healthcare-Medicaid, +146007,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,United Healthcare-Medicaid, +146008,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,United Healthcare-Medicaid, +146009,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,United Healthcare-Medicaid, +146010,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,United Healthcare-Medicaid, +146011,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,United Healthcare-Medicaid, +146012,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,United Healthcare-Medicaid, +146013,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,United Healthcare-Medicaid, +146014,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,United Healthcare-Medicaid, +146015,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,United Healthcare-Medicaid, +146016,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,United Healthcare-Medicaid, +146017,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,United Healthcare-Medicaid, +146018,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,United Healthcare-Medicaid, +146019,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,United Healthcare-Medicaid, +146020,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,United Healthcare-Medicaid, +146021,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,United Healthcare-Medicaid, +146022,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,United Healthcare-Medicaid, +146023,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,United Healthcare-Medicaid, +146024,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,United Healthcare-Medicaid, +146025,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,United Healthcare-Medicaid, +146026,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,United Healthcare-Medicaid, +146027,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,United Healthcare-Medicaid, +146028,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,United Healthcare-Medicaid, +146029,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,United Healthcare-Medicaid, +146030,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,United Healthcare-Medicaid, +146031,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,United Healthcare-Medicaid, +146032,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,United Healthcare-Medicaid, +146033,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,United Healthcare-Medicaid, +146034,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,United Healthcare-Medicaid, +146035,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,United Healthcare-Medicaid, +146036,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,United Healthcare-Medicaid, +146037,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,United Healthcare-Medicaid, +146038,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,United Healthcare-Medicaid, +146039,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,United Healthcare-Medicaid, +146040,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,United Healthcare-Medicaid, +146041,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,United Healthcare-Medicaid, +146042,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,United Healthcare-Medicaid, +146043,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,United Healthcare-Medicaid, +146044,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,United Healthcare-Medicaid, +146045,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,United Healthcare-Medicaid, +146046,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,United Healthcare-Medicaid, +146047,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,United Healthcare-Medicaid, +146048,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,United Healthcare-Medicaid, +146049,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,United Healthcare-Medicaid, +146050,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,United Healthcare-Medicaid, +146051,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,United Healthcare-Medicaid, +146052,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,United Healthcare-Medicaid, +146053,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,United Healthcare-Medicaid, +146054,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,United Healthcare-Medicaid, +146055,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,United Healthcare-Medicaid, +146056,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,United Healthcare-Medicaid, +146057,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,United Healthcare-Medicaid, +146058,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,United Healthcare-Medicaid, +146059,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,United Healthcare-Medicaid, +146060,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,United Healthcare-Medicaid, +146061,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,United Healthcare-Medicaid, +146062,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,United Healthcare-Medicaid, +146063,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,United Healthcare-Medicaid, +146064,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,United Healthcare-Medicaid, +146065,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,United Healthcare-Medicaid, +146066,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,United Healthcare-Medicaid, +146067,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,United Healthcare-Medicaid, +146068,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,United Healthcare-Medicaid, +146069,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,United Healthcare-Medicaid, +146070,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,United Healthcare-Medicaid, +146071,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,United Healthcare-Medicaid, +146072,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,United Healthcare-Medicaid, +146073,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,United Healthcare-Medicaid, +146074,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,United Healthcare-Medicaid, +146075,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,United Healthcare-Medicaid, +146076,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,United Healthcare-Medicaid, +146077,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,United Healthcare-Medicaid, +146078,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,United Healthcare-Medicaid, +146079,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,United Healthcare-Medicaid, +146080,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,United Healthcare-Medicaid, +146081,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,United Healthcare-Medicaid, +146082,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,United Healthcare-Medicaid, +146083,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,United Healthcare-Medicaid, +146084,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,United Healthcare-Medicaid, +146085,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,United Healthcare-Medicaid, +146086,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,United Healthcare-Medicaid, +146087,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,United Healthcare-Medicaid, +146088,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,United Healthcare-Medicaid, +146089,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,United Healthcare-Medicaid, +146090,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,United Healthcare-Medicaid, +146091,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,United Healthcare-Medicaid, +146092,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,United Healthcare-Medicaid, +146093,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,United Healthcare-Medicaid, +146094,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,United Healthcare-Medicaid, +146095,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,United Healthcare-Medicaid, +146096,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,United Healthcare-Medicaid, +146097,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,United Healthcare-Medicaid, +146098,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,United Healthcare-Medicaid, +146099,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,United Healthcare-Medicaid, +146100,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,United Healthcare-Medicaid, +146101,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,United Healthcare-Medicaid, +146102,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,United Healthcare-Medicaid, +146103,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,United Healthcare-Medicaid, +146104,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,United Healthcare-Medicaid, +146105,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,United Healthcare-Medicaid, +146106,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,United Healthcare-Medicaid, +146107,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,United Healthcare-Medicaid, +146108,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,United Healthcare-Medicaid, +146109,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,United Healthcare-Medicaid, +146110,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,United Healthcare-Medicaid, +146111,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,United Healthcare-Medicaid, +146112,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,United Healthcare-Medicaid, +146113,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,United Healthcare-Medicaid, +146114,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,United Healthcare-Medicaid, +146115,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,United Healthcare-Medicaid, +146116,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,United Healthcare-Medicaid, +146117,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,United Healthcare-Medicaid, +146118,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,United Healthcare-Medicaid, +146119,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,United Healthcare-Medicaid, +146120,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,United Healthcare-Medicaid, +146121,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,United Healthcare-Medicaid, +146122,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,United Healthcare-Medicaid, +146123,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,United Healthcare-Medicaid, +146124,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,United Healthcare-Medicaid, +146125,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,United Healthcare-Medicaid, +146126,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,United Healthcare-Medicaid, +146127,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,United Healthcare-Medicaid, +146128,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,United Healthcare-Medicaid, +146129,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,United Healthcare-Medicaid, +146130,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,United Healthcare-Medicaid, +146131,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,United Healthcare-Medicaid, +146132,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,United Healthcare-Medicaid, +146133,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,United Healthcare-Medicaid, +146134,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,United Healthcare-Medicaid, +146135,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,United Healthcare-Medicaid, +146136,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,United Healthcare-Medicaid, +146137,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,United Healthcare-Medicaid, +146138,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,United Healthcare-Medicaid, +146139,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,United Healthcare-Medicaid, +146140,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,United Healthcare-Medicaid, +146141,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,United Healthcare-Medicaid, +146142,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,United Healthcare-Medicaid, +146143,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,United Healthcare-Medicaid, +146144,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,United Healthcare-Medicaid, +146145,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,United Healthcare-Medicaid, +146146,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,United Healthcare-Medicaid, +146147,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,United Healthcare-Medicaid, +146148,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,United Healthcare-Medicaid, +146149,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,United Healthcare-Medicaid, +146150,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,United Healthcare-Medicaid, +146151,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,United Healthcare-Medicaid, +146152,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,United Healthcare-Medicaid, +146153,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,United Healthcare-Medicaid, +146154,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,United Healthcare-Medicaid, +146155,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,United Healthcare-Medicaid, +146156,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,United Healthcare-Medicaid, +146157,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,United Healthcare-Medicaid, +146158,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,United Healthcare-Medicaid, +146159,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,United Healthcare-Medicaid, +146160,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,United Healthcare-Medicaid, +146161,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,United Healthcare-Medicaid, +146162,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,United Healthcare-Medicaid, +146163,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,United Healthcare-Medicaid, +146164,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,United Healthcare-Medicaid, +146165,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,United Healthcare-Medicaid, +146166,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,United Healthcare-Medicaid, +146167,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,United Healthcare-Medicaid, +146168,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,United Healthcare-Medicaid, +146169,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,United Healthcare-Medicaid, +146170,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,United Healthcare-Medicaid, +146171,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,United Healthcare-Medicaid, +146172,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,United Healthcare-Medicaid, +146173,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,United Healthcare-Medicaid, +146174,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,United Healthcare-Medicaid, +146175,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,United Healthcare-Medicaid, +146176,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,United Healthcare-Medicaid, +146177,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,United Healthcare-Medicaid, +146178,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,United Healthcare-Medicaid, +146179,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,United Healthcare-Medicaid, +146180,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,United Healthcare-Medicaid, +146181,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,United Healthcare-Medicaid, +146182,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,United Healthcare-Medicaid, +146183,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,United Healthcare-Medicaid, +146184,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,United Healthcare-Medicaid, +146185,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,United Healthcare-Medicaid, +146186,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,United Healthcare-Medicaid, +146187,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,United Healthcare-Medicaid, +146188,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,United Healthcare-Medicaid, +146189,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,United Healthcare-Medicaid, +146190,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,United Healthcare-Medicaid, +146191,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,United Healthcare-Medicaid, +146192,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,United Healthcare-Medicaid, +146193,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,United Healthcare-Medicaid, +146194,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,United Healthcare-Medicaid, +146195,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,United Healthcare-Medicaid, +146196,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,United Healthcare-Medicaid, +146197,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,United Healthcare-Medicaid, +146198,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,United Healthcare-Medicaid, +146199,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,United Healthcare-Medicaid, +146200,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,United Healthcare-Medicaid, +146201,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,United Healthcare-Medicaid, +146202,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,United Healthcare-Medicaid, +146203,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,United Healthcare-Medicaid, +146204,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,United Healthcare-Medicaid, +146205,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,United Healthcare-Medicaid, +146206,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,United Healthcare-Medicaid, +146207,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,United Healthcare-Medicaid, +146208,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,United Healthcare-Medicaid, +146209,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,United Healthcare-Medicaid, +146210,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,United Healthcare-Medicaid, +146211,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,United Healthcare-Medicaid, +146212,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,United Healthcare-Medicaid, +146213,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,United Healthcare-Medicaid, +146214,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,United Healthcare-Medicaid, +146215,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,United Healthcare-Medicaid, +146216,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,United Healthcare-Medicaid, +146217,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,United Healthcare-Medicaid, +146218,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,United Healthcare-Medicaid, +146219,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,United Healthcare-Medicaid, +146220,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,United Healthcare-Medicaid, +146221,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,United Healthcare-Medicaid, +146222,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,United Healthcare-Medicaid, +146223,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,United Healthcare-Medicaid, +146224,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,United Healthcare-Medicaid, +146225,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,United Healthcare-Medicaid, +146226,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,United Healthcare-Medicaid, +146227,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,United Healthcare-Medicaid, +146228,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,United Healthcare-Medicaid, +146229,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,United Healthcare-Medicaid, +146230,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,United Healthcare-Medicaid, +146231,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,United Healthcare-Medicaid, +146232,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,United Healthcare-Medicaid, +146233,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,United Healthcare-Medicaid, +146234,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,United Healthcare-Medicaid, +146235,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,United Healthcare-Medicaid, +146236,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,United Healthcare-Medicaid, +146237,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,United Healthcare-Medicaid, +146238,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,United Healthcare-Medicaid, +146239,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,United Healthcare-Medicaid, +146240,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,United Healthcare-Medicaid, +146241,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,United Healthcare-Medicaid, +146242,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,United Healthcare-Medicaid, +146243,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,United Healthcare-Medicaid, +146244,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,United Healthcare-Medicaid, +146245,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,United Healthcare-Medicaid, +146246,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,United Healthcare-Medicaid, +146247,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,United Healthcare-Medicaid, +146248,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,United Healthcare-Medicaid, +146249,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,United Healthcare-Medicaid, +146250,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,United Healthcare-Medicaid, +146251,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,United Healthcare-Medicaid, +146252,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,United Healthcare-Medicaid, +146253,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,United Healthcare-Medicaid, +146254,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,United Healthcare-Medicaid, +146255,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,United Healthcare-Medicaid, +146256,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,United Healthcare-Medicaid, +146257,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,United Healthcare-Medicaid, +146258,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,United Healthcare-Medicaid, +146259,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,United Healthcare-Medicaid, +146260,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,United Healthcare-Medicaid, +146261,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,United Healthcare-Medicaid, +146262,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,United Healthcare-Medicaid, +146263,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,United Healthcare-Medicaid, +146264,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,United Healthcare-Medicaid, +146265,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,United Healthcare-Medicaid, +146266,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,United Healthcare-Medicaid, +146267,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,United Healthcare-Medicaid, +146268,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,United Healthcare-Medicaid, +146269,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,United Healthcare-Medicaid, +146270,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,United Healthcare-Medicaid, +146271,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,United Healthcare-Medicaid, +146272,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,United Healthcare-Medicaid, +146273,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,United Healthcare-Medicaid, +146274,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,United Healthcare-Medicaid, +146275,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,United Healthcare-Medicaid, +146276,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,United Healthcare-Medicaid, +146277,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,United Healthcare-Medicaid, +146278,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,United Healthcare-Medicaid, +146279,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,United Healthcare-Medicaid, +146280,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,United Healthcare-Medicaid, +146281,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,United Healthcare-Medicaid, +146282,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,United Healthcare-Medicaid, +146283,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,United Healthcare-Medicaid, +146284,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,United Healthcare-Medicaid, +146285,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,United Healthcare-Medicaid, +146286,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,United Healthcare-Medicaid, +146287,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,United Healthcare-Medicaid, +146288,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,United Healthcare-Medicaid, +146289,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,United Healthcare-Medicaid, +146290,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,United Healthcare-Medicaid, +146291,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,United Healthcare-Medicaid, +146292,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,United Healthcare-Medicaid, +146293,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,United Healthcare-Medicaid, +146294,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,United Healthcare-Medicaid, +146295,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,United Healthcare-Medicaid, +146296,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,United Healthcare-Medicaid, +146297,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,United Healthcare-Medicaid, +146298,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,United Healthcare-Medicaid, +146299,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,United Healthcare-Medicaid, +146300,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,United Healthcare-Medicaid, +146301,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,United Healthcare-Medicaid, +146302,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,United Healthcare-Medicaid, +146303,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,United Healthcare-Medicaid, +146304,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,United Healthcare-Medicaid, +146305,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,United Healthcare-Medicaid, +146306,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,United Healthcare-Medicaid, +146307,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,United Healthcare-Medicaid, +146308,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,United Healthcare-Medicaid, +146309,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,United Healthcare-Medicaid, +146310,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,United Healthcare-Medicaid, +146311,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,United Healthcare-Medicaid, +146312,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,United Healthcare-Medicaid, +146313,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,United Healthcare-Medicaid, +146314,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,United Healthcare-Medicaid, +146315,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,United Healthcare-Medicaid, +146316,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,United Healthcare-Medicaid, +146317,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,United Healthcare-Medicaid, +146318,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,United Healthcare-Medicaid, +146319,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,United Healthcare-Medicaid, +146320,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,United Healthcare-Medicaid, +146321,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,United Healthcare-Medicaid, +146322,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,United Healthcare-Medicaid, +146323,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,United Healthcare-Medicaid, +146324,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,United Healthcare-Medicaid, +146325,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,United Healthcare-Medicaid, +146326,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,United Healthcare-Medicaid, +146327,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,United Healthcare-Medicaid, +146328,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,United Healthcare-Medicaid, +146329,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,United Healthcare-Medicaid, +146330,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,United Healthcare-Medicaid, +146331,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,United Healthcare-Medicaid, +146332,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,United Healthcare-Medicaid, +146333,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,United Healthcare-Medicaid, +146334,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,United Healthcare-Medicaid, +146335,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,United Healthcare-Medicaid, +146336,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,United Healthcare-Medicaid, +146337,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,United Healthcare-Medicaid, +146338,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,United Healthcare-Medicaid, +146339,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,United Healthcare-Medicaid, +146340,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,United Healthcare-Medicaid, +146341,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,United Healthcare-Medicaid, +146342,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,United Healthcare-Medicaid, +146343,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,United Healthcare-Medicaid, +146344,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,United Healthcare-Medicaid, +146345,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,United Healthcare-Medicaid, +146346,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,United Healthcare-Medicaid, +146347,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,United Healthcare-Medicaid, +146348,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,United Healthcare-Medicaid, +146349,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,United Healthcare-Medicaid, +146350,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,United Healthcare-Medicaid, +146351,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,United Healthcare-Medicaid, +146352,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,United Healthcare-Medicaid, +146353,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,United Healthcare-Medicaid, +146354,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,United Healthcare-Medicaid, +146355,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,United Healthcare-Medicaid, +146356,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,United Healthcare-Medicaid, +146357,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,United Healthcare-Medicaid, +146358,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,United Healthcare-Medicaid, +146359,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,United Healthcare-Medicaid, +146360,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,United Healthcare-Medicaid, +146361,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,United Healthcare-Medicaid, +146362,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,United Healthcare-Medicaid, +146363,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,United Healthcare-Medicaid, +146364,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,United Healthcare-Medicaid, +146365,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,United Healthcare-Medicaid, +146366,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,United Healthcare-Medicaid, +146367,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,United Healthcare-Medicaid, +146368,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,United Healthcare-Medicaid, +146369,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,United Healthcare-Medicaid, +146370,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,United Healthcare-Medicaid, +146371,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,United Healthcare-Medicaid, +146372,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,United Healthcare-Medicaid, +146373,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,United Healthcare-Medicaid, +146374,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,United Healthcare-Medicaid, +146375,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,United Healthcare-Medicaid, +146376,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,United Healthcare-Medicaid, +146377,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,United Healthcare-Medicaid, +146378,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,United Healthcare-Medicaid, +146379,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,United Healthcare-Medicaid, +146380,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,United Healthcare-Medicaid, +146381,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,United Healthcare-Medicaid, +146382,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,United Healthcare-Medicaid, +146383,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,United Healthcare-Medicaid, +146384,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,United Healthcare-Medicaid, +146385,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,United Healthcare-Medicaid, +146386,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,United Healthcare-Medicaid, +146387,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,United Healthcare-Medicaid, +146388,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,United Healthcare-Medicaid, +146389,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,United Healthcare-Medicaid, +146390,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,United Healthcare-Medicaid, +146391,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,United Healthcare-Medicaid, +146392,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,United Healthcare-Medicaid, +146393,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,United Healthcare-Medicaid, +146394,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,United Healthcare-Medicaid, +146395,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,United Healthcare-Medicaid, +146396,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,United Healthcare-Medicaid, +146397,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,United Healthcare-Medicaid, +146398,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,United Healthcare-Medicaid, +146399,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,United Healthcare-Medicaid, +146400,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,United Healthcare-Medicaid, +146401,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,United Healthcare-Medicaid, +146402,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,United Healthcare-Medicaid, +146403,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,United Healthcare-Medicaid, +146404,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,United Healthcare-Medicaid, +146405,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,United Healthcare-Medicaid, +146406,3934,30000012,PRIVATE,,8380.0,8380.0,,,United Healthcare-Medicaid, +146407,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,United Healthcare-Medicaid, +146408,3934,30000038,ICU,,12700.0,12700.0,,,United Healthcare-Medicaid, +146409,3934,30000046,BURN UNIT,,12700.0,12700.0,,,United Healthcare-Medicaid, +146410,3934,30000053,NICU,,12700.0,12700.0,,,United Healthcare-Medicaid, +146411,3934,30000061,ICR ROOM,,7630.0,7630.0,,,United Healthcare-Medicaid, +146412,3934,30000079,PSYCH,,7630.0,7630.0,,,United Healthcare-Medicaid, +146413,3934,30000087,NEWBORN,,4140.0,4140.0,,,United Healthcare-Medicaid, +146414,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,United Healthcare-Medicaid, +146415,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146416,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,United Healthcare-Medicaid, +146417,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146418,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146419,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146420,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146421,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146422,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146423,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146424,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146425,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146426,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146427,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146428,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146429,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146430,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146431,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146432,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146433,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146434,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146435,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146436,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146437,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146438,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146439,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146440,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146441,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146442,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,United Healthcare-Medicaid, +146443,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146444,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146445,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146446,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146447,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146448,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146449,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146450,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146451,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146452,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146453,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146454,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146455,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146456,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146457,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,United Healthcare-Medicaid, +146458,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146459,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146460,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146461,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146462,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146463,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146464,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146465,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146466,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146467,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146468,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146469,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146470,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146471,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146472,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146473,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146474,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146475,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146476,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146477,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146478,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146479,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146480,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146481,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146482,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146483,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146484,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,United Healthcare-Medicaid, +146485,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146486,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146487,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146488,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146489,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146490,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146491,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146492,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146493,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146494,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146495,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146496,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146497,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146498,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146499,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146500,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146501,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146502,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146503,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146504,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146505,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146506,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146507,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146508,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146509,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146510,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146511,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146512,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146513,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146514,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146515,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146516,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146517,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146518,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146519,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146520,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146521,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146522,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146523,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146524,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146525,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146526,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146527,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146528,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146529,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146530,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146531,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146532,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146533,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146534,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146535,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146536,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146537,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146538,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146539,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146540,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146541,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146542,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146543,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146544,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146545,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146546,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146547,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146548,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146549,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146550,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146551,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146552,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146553,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146554,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146555,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146556,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146557,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146558,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146559,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146560,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146561,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146562,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146563,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146564,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146565,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146566,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146567,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146568,3934,30514004,R&B REV 05SD PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146569,3934,30517007,R&B REV 05SD PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146570,3934,30517015,R&B REV 05SD PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146571,3934,30521058,05CC HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146572,3934,30521207,R&B 05CC ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146573,3934,30523005,R&B REV 05CC PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146574,3934,30524003,R&B REV 05CC PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146575,3934,30661003,R&B 19S2 PACKET FOR PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146576,3934,30661052,19S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146577,3934,30661102,R&B 19S2 PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146578,3934,30661201,R&B 19S2 PACKET FOR PT-W,,7630.0,7630.0,,,United Healthcare-Medicaid, +146579,3934,30661300,R&B 19S2 PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146580,3934,30662001,R&B 19S2 PACKET FOR PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146581,3934,30663009,R&B 19S2 PACKET FOR PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146582,3934,30664007,R&B 19S2 PACKET FOR PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146583,3934,30665004,R&B 19S2 PACKET FOR PT-U,,7630.0,7630.0,,,United Healthcare-Medicaid, +146584,3934,30666002,R&B 19S2 PACKET FOR PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146585,3934,30667000,R&B 19S2 PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146586,3934,30711006,R&B OVERFLOW IP 1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146587,3934,30711055,R&B OVERFLOW IP 1 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146588,3934,30711303,R&B OVERFLOW IP 1 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146589,3934,30712004,R&B OVERFLOW IP 1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146590,3934,30713002,R&B OVERFLOW IP 1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146591,3934,30714000,R&B OVERFLOW IP 1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146592,3934,30721005,R&B OVERFLOW IP 2 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146593,3934,30721054,R&B OVERFLOW IP 2 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146594,3934,30721302,R&B OVERFLOW IP 2 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146595,3934,30722003,R&B OVERFLOW IP 2 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146596,3934,30723001,R&B OVERFLOW IP 2 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146597,3934,30724009,R&B OVERFLOW IP 2 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146598,3934,30731004,R&B OVERFLOW IP 3 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146599,3934,30731053,R&B OVERFLOW IP 3 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146600,3934,30731301,R&B OVERFLOW IP 3 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146601,3934,30732002,R&B OVERFLOW IP 3 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146602,3934,30733000,R&B OVERFLOW IP 3 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146603,3934,30734008,R&B OVERFLOW IP 3 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146604,3934,30741003,R&B OVERFLOW IP 4 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146605,3934,30741052,R&B OVERFLOW IP 4 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146606,3934,30741300,R&B OVERFLOW IP 4 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146607,3934,30742001,R&B OVERFLOW IP 4 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146608,3934,30743009,R&B OVERFLOW IP 4 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146609,3934,30744007,R&B OVERFLOW IP 4 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146610,3934,30751002,R&B OVERFLOW IP 5 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146611,3934,30751051,R&B OVERFLOW IP 5 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146612,3934,30751309,R&B OVERFLOW IP 5 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146613,3934,30752000,R&B OVERFLOW IP 5 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146614,3934,30753008,R&B OVERFLOW IP 5 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146615,3934,30754006,R&B OVERFLOW IP 5 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146616,3934,30761001,R&B OVERFLOW IP 6 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146617,3934,30761050,R&B OVERFLOW IP 6 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146618,3934,30761308,R&B OVERFLOW IP 6 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146619,3934,30762009,R&B OVERFLOW IP 6 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146620,3934,30763007,R&B OVERFLOW IP 6 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146621,3934,30764005,R&B OVERFLOW IP 6 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146622,3934,30776009,R&B 05NV PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146623,3934,30781009,R&B OVERFLOW IP 7 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146624,3934,30781058,R&B OVERFLOW IP 7 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146625,3934,30781306,R&B OVERFLOW IP 7 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146626,3934,30782007,R&B OVERFLOW IP 7 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146627,3934,30783005,R&B OVERFLOW IP 7 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146628,3934,30784003,R&B OVERFLOW IP 7 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146629,3934,30791008,R&B OVERFLOW IP 8 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146630,3934,30791057,R&B OVERFLOW IP 8 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146631,3934,30791305,R&B OVERFLOW IP 8 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146632,3934,30792006,R&B OVERFLOW IP 8 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146633,3934,30793004,R&B OVERFLOW IP 8 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146634,3934,30794002,R&B OVERFLOW IP 8 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146635,3934,30801005,R&B 08BN PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146636,3934,30801054,R&B 08BN PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146637,3934,30801203,R&B 08BN ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146638,3934,30802003,R&B 08BN PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146639,3934,30803001,R&B 08BN PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146640,3934,30804009,R&B 08BN PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146641,3934,30901003,R&B PICU 06W1 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146642,3934,30901052,R&B PICU 06W1 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146643,3934,30901201,R&B PICU 06W1 ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146644,3934,30903009,R&B PICU 06W1 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146645,3934,30904007,R&B PICU 06W1 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146646,3934,30911002,R&B PEDS 06W2 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146647,3934,30911051,R&B PEDS 06W2 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146648,3934,30913008,R&B PEDS 06W2 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146649,3934,30921001,R&B PEDS HEM/ONC 06W3 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146650,3934,30921050,R&B PEDS HEM/ONC 06W3 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146651,3934,30921068,R&B PEDS HEM/ONC 06W3 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146652,3934,30923007,R&B PEDS HEM/ONC 06W3 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146653,3934,30931000,R&B CTICU 07W1 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146654,3934,30931059,R&B CTICU 07W1 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146655,3934,30931208,R&B CTICU 07W1 ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146656,3934,30933006,R&B CTICU 07W1 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146657,3934,30934004,R&B CTICU 07W1 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146658,3934,30941009,R&B CTICR 07W2 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146659,3934,30941058,R&B CTICR 07W2 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146660,3934,30941108,R&B CTICR 07W2 - PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146661,3934,30941207,R&B CTICR 07W2 - PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146662,3934,30943005,R&B CTICR 07W2 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146663,3934,30947006,R&B CTICR 07W2 - PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146664,3934,30947014,R&B CTICR 07W2 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146665,3934,30951008,R&B ADOL 07W3 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146666,3934,30951057,R&B ADOB 07W3 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146667,3934,30953004,R&B ADOL 07W3 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146668,3934,30953012,R&B ADOL 07W3 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146669,3934,30961007,R&B NEUROICU 08W1 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146670,3934,30961056,R&B NEUROICU 08W1 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146671,3934,30961205,R&B NEUROICU 08W1 ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146672,3934,30963003,R&B NEUROICU 08W1 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146673,3934,30964001,R&B NEUROICU 08W1 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146674,3934,30971006,R&B SICR 08W3 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146675,3934,30971055,R&B SICR 08W3 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146676,3934,30971105,R&B SICR 08W3 - PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146677,3934,30971204,R&B SICR 08W3 - PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146678,3934,30973002,R&B SICR 08W3 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146679,3934,30973101,R&B SICR 08W3 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146680,3934,30977003,R&B SICR 08W3 - PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146681,3934,30981054,R&B SICU 09W1 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146682,3934,30981203,R&B SICU 09W1 ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146683,3934,30983001,R&B SICU 09W1 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146684,3934,30984009,R&B SICU 09W1 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146685,3934,30991004,R&B SICR 09W2 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146686,3934,30991053,R&B SICR 09W2 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146687,3934,30991103,R&B SICR 09W2 - PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146688,3934,30991202,R&B SICR 09W2 - PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146689,3934,30993000,R&B SICR 09W2 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146690,3934,30993018,R&B TICR 09W2 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146691,3934,30997001,R&B SICR 09W2 - PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146692,3934,31001001,R&B NEUROICR 08W2 - PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146693,3934,31001050,R&B NEURICR 08W2 - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146694,3934,31001100,R&B NEUROICR 08W2 - PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146695,3934,31001209,R&B NEUROICR 08W2 - PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146696,3934,31003007,R&B NEUROICR 08W2 - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146697,3934,31003015,R&B NEUROICR 08W2 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146698,3934,31007008,R&B NEUROICR 08W2 - PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146699,3934,31700008,R&B REV PED 11N1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146700,3934,31701006,R&B REV PED 11N1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146701,3934,31701055,11N1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146702,3934,31702004,R&B REV PED 11N1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146703,3934,31703002,R&B REV PED 11N1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146704,3934,31710007,R&B REV PED 11S1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146705,3934,31711005,R&B REV 11S1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146706,3934,31711054,11S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146707,3934,31712003,R&B REV PED 11S1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146708,3934,31713001,R&B REV PED 11S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146709,3934,31751001,R&B INPATIENT 11N1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146710,3934,31751050,R&B INPATIENT 11N1 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146711,3934,31751308,R&B INPATIENT 11N1 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146712,3934,31752009,R&B INPATIENT 11N1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146713,3934,31753007,R&B INPATIENT 11N1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146714,3934,31754005,R&B INPATIENT 11N1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146715,3934,31901002,R&B INPATIENT 11S2 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146716,3934,31901051,R&B INPATIENT 11S2 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146717,3934,31901309,R&B INPATIENT 11S2 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146718,3934,31902000,R&B INPATIENT 11S2 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146719,3934,31903008,R&B INPATIENT 11S2 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146720,3934,31904006,R&B INPATIENT 11S2 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146721,3934,32100000,R&B REV PSYCH 10N PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146722,3934,32105009,R&B REV PSYCH 10N PT-U,,7630.0,7630.0,,,United Healthcare-Medicaid, +146723,3934,32110009,R&B REV PPY 12N1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146724,3934,32115008,R&B REV PPY 12N1 PT-U,,7630.0,7630.0,,,United Healthcare-Medicaid, +146725,3934,32500001,R&B REV OBS 09N1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146726,3934,32501009,R&B 09N (SURGERY) PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146727,3934,32501058,09N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146728,3934,32501066,09N SURGICAL ACUTE PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146729,3934,32510000,R&B REV OBS 09S1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146730,3934,32511008,R&B 09S1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146731,3934,32520009,R&B REV L&D 08N PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146732,3934,32521007,R&B L&D 05OB PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146733,3934,32521056,05OB HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146734,3934,32526006,R&B REV L&D 08N PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146735,3934,32531006,R&B 05EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146736,3934,32531055,05EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146737,3934,32541005,R&B 06EP OB POSTPARTUM PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146738,3934,32541054,06EP HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146739,3934,32543001,R&B 06EP OB POSTPARTUM PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146740,3934,33100009,R&B REV MICU 17S1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146741,3934,33101056,17S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146742,3934,33101205,R&B MICU 17S1 ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146743,3934,33103003,R&B REV MICU 17S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146744,3934,33104001,R&B REV MICU 17S1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146745,3934,33107004,R&B MICU 17S1 PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146746,3934,33110008,R&B REV SICU 18S1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146747,3934,33111006,R&B REV SICU 18S1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146748,3934,33111055,18S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146749,3934,33113002,R&B REV SICU 18S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146750,3934,33114000,R&B REV SICU 18S1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146751,3934,33123001,R&B 17SD PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146752,3934,33124009,R&B 17SD PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146753,3934,33127002,R&B 17SD PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146754,3934,33140005,R&B REV CCU 17S2 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146755,3934,33141409,R&B 18S3 NCCU - PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146756,3934,33143009,R&B 18S3 NCCU - PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146757,3934,33144007,R&B 18S3 NCCU - PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146758,3934,33151002,R&B 17N PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146759,3934,33151051,17N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146760,3934,33152000,R&B 17N PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146761,3934,33153008,R&B 17N PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146762,3934,33155003,R&B 17N PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146763,3934,33157009,R&B 17N PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146764,3934,33161001,R&B INPATIENT 18S1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146765,3934,33161050,R&B INPATIENT 18S1 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146766,3934,33161308,R&B INPATIENT 18S1 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146767,3934,33162009,R&B INPATIENT 18S1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146768,3934,33163007,R&B INPATIENT 18S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146769,3934,33164005,R&B INPATIENT 18S1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146770,3934,33171000,R&B INPATIENT 18S3 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146771,3934,33171059,R&B INPATIENT 18S3 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146772,3934,33171307,R&B INPATIENT 18S3 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146773,3934,33172008,R&B INPATIENT 18S3 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146774,3934,33173006,R&B INPATIENT 18S3 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146775,3934,33174004,R&B INPATIENT 18S3 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146776,3934,33181009,R&B 17DI PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146777,3934,33181058,17DI HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146778,3934,33181108,R&B 17DI PT-M,,7630.0,7630.0,,,United Healthcare-Medicaid, +146779,3934,33181207,R&B 17DI PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146780,3934,33182007,R&B 17DI PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146781,3934,33183005,R&B 17DI PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146782,3934,33187006,R&B 17DI PT-C,,11300.0,11300.0,,,United Healthcare-Medicaid, +146783,3934,33211004,R&B INPATIENT 11S1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146784,3934,33211053,R&B INPATIENT 11S1 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146785,3934,33211301,R&B INPATIENT 11S1 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146786,3934,33212002,R&B INPATIENT 11S1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146787,3934,33213000,R&B INPATIENT 11S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146788,3934,33214008,R&B INPATIENT 11S1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146789,3934,33300005,R&B REV CVICU O4L1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146790,3934,33304007,R&B REV CVICU 04L1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146791,3934,33304056,04L1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146792,3934,33441007,R&B INPATIENT 04L1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146793,3934,33441056,R&B INPATIENT 04L1 PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146794,3934,33441304,R&B INPATIENT 04L1 PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146795,3934,33442005,R&B INPATIENT 04L1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146796,3934,33443003,R&B INPATIENT 04L1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146797,3934,33444001,R&B INPATIENT 04L1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146798,3934,33500000,RB REV PICU 11S2 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146799,3934,33501008,R&B REV PICU 11S2 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146800,3934,33501057,11S2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146801,3934,33503004,R&B REV PICU 11S2 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146802,3934,33504002,R&B REV PICU 11S2 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146803,3934,33700006,R&B REV NICU 08S1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146804,3934,33701202,R&B 05NN NICU ICR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146805,3934,33703000,R&B REV NICU 08S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146806,3934,33704008,R&B NICU 05NN PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146807,3934,33706003,R&B 05NN PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146808,3934,33800004,R&B REV BURN 04L2 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146809,3934,33801002,R&B 04L2 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146810,3934,33801051,04L2 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146811,3934,33802000,R&B 04L2 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146812,3934,33803008,R&B 04L2 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146813,3934,33804006,R&B REV BURN 04L2 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146814,3934,35100007,R&B REV NURS 09N2 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146815,3934,35106004,R&B REV NURS 09N2 PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146816,3934,35110006,R&B REV NURS 09S2 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146817,3934,35116003,R&B REV NURS 09S2 PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146818,3934,35121003,R&B 05EA ANTEPARTUM PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146819,3934,35121052,05EA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146820,3934,35123009,R&B 05EA ANTEPARTUM PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146821,3934,35136001,R&B 05EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146822,3934,35146000,R&B 06EN NEWBORN NURSERY PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146823,3934,35176007,05ON (L&D NURSERY) PT-B,,4140.0,4140.0,,,United Healthcare-Medicaid, +146824,3934,36110005,R&B PSYOB 04PS PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146825,3934,36115004,R&B PSYOB 04PS PT-U,,7630.0,7630.0,,,United Healthcare-Medicaid, +146826,3934,38101002,R&B REV 04LS PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146827,3934,38101051,04LS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146828,3934,38102000,R&B REV 04LS PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146829,3934,38103008,R&B REV 04LS PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146830,3934,38103107,R&B REV 04LS PT-Z,,11300.0,11300.0,,,United Healthcare-Medicaid, +146831,3934,38104006,R&B REV 04LS PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146832,3934,39910005,R&B REV OR 04L3 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146833,3934,39911003,R&B REV OR 04L3 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146834,3934,39911052,04L3 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146835,3934,39912001,R&B REV OR 04L3 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146836,3934,39913009,R&B REV OR 04L3 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146837,3934,39914007,R&B REV OR 04L3 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146838,3934,39920004,R&B REV RECV 04L5 PT-X,,7630.0,7630.0,,,United Healthcare-Medicaid, +146839,3934,39921002,R&B REV RECV 04L5 PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146840,3934,39921051,04L5 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146841,3934,39922000,R&B REV RECV 04L5 PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146842,3934,39923008,R&B REV RECV 04L5 PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146843,3934,39924006,R&B REV RECV 04L5 PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146844,3934,39931001,R&B 04NS PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146845,3934,39931050,04NS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146846,3934,39941000,04L4 OR HOLDING PT-S,,7630.0,7630.0,,,United Healthcare-Medicaid, +146847,3934,39941059,04L4 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicaid, +146848,3934,39942008,04L4 OR HOLDING PT-P,,8380.0,8380.0,,,United Healthcare-Medicaid, +146849,3934,39943006,04L4 OR HOLDING PT-J,,7630.0,7630.0,,,United Healthcare-Medicaid, +146850,3934,39944004,04L4 OR HOLDING PT-I,,12700.0,12700.0,,,United Healthcare-Medicaid, +146851,3934,40000002,HOSPICE ROOM,,4280.0,4280.0,,,United Healthcare-Medicaid, +146852,3934,28611945,ASC MINUTE CHARGE,,86.0,86.0,,,United Healthcare-Medicaid, +146853,3934,28611952,ASC RECOVERY MIN,,20.0,20.0,,,United Healthcare-Medicaid, +146854,3934,30100077,CONTINUOUS BEDSIDE EEG - 19N,,507.0,507.0,,,United Healthcare-Medicaid, +146855,3934,30100085,TELEMETRY-19N,,479.0,479.0,,,United Healthcare-Medicaid, +146856,3934,30140008,TELEMETRY - 13N,,479.0,479.0,,,United Healthcare-Medicaid, +146857,3934,30150072,TELEMETRY - 15N,,479.0,479.0,,,United Healthcare-Medicaid, +146858,3934,30160071,TELEMETRY - 09S,,479.0,479.0,,,United Healthcare-Medicaid, +146859,3934,30170070,TELEMETRY - 16N,,479.0,479.0,,,United Healthcare-Medicaid, +146860,3934,30180079,TELEMETRY - 16S,,479.0,479.0,,,United Healthcare-Medicaid, +146861,3934,30199012,TELEMETRY - 05CH,,479.0,479.0,,,United Healthcare-Medicaid, +146862,3934,30210074,TELEMETRY - 15S3,,479.0,479.0,,,United Healthcare-Medicaid, +146863,3934,30220099,TELEMETRY - 12S1 MEDICINE,,479.0,479.0,,,United Healthcare-Medicaid, +146864,3934,30400071,TELEMETRY - 15S1,,479.0,479.0,,,United Healthcare-Medicaid, +146865,3934,30500011,TELEMETRY - 05SD,,479.0,479.0,,,United Healthcare-Medicaid, +146866,3934,30660005,TELEMETRY - 19S2,,479.0,479.0,,,United Healthcare-Medicaid, +146867,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,United Healthcare-Medicaid, +146868,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,United Healthcare-Medicaid, +146869,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,United Healthcare-Medicaid, +146870,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,United Healthcare-Medicaid, +146871,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,United Healthcare-Medicaid, +146872,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,United Healthcare-Medicaid, +146873,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,United Healthcare-Medicaid, +146874,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,United Healthcare-Medicaid, +146875,3934,37112000,ACUTE ED,,1580.0,1580.0,,,United Healthcare-Medicaid, +146876,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,United Healthcare-Medicaid, +146877,3934,37112034,TRIAGE,,277.0,277.0,,,United Healthcare-Medicaid, +146878,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,United Healthcare-Medicaid, +146879,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,United Healthcare-Medicaid, +146880,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,United Healthcare-Medicaid, +146881,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,United Healthcare-Medicaid, +146882,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,United Healthcare-Medicaid, +146883,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,United Healthcare-Medicaid, +146884,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,United Healthcare-Medicaid, +146885,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,United Healthcare-Medicaid, +146886,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,United Healthcare-Medicaid, +146887,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,United Healthcare-Medicaid, +146888,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,United Healthcare-Medicaid, +146889,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,United Healthcare-Medicaid, +146890,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,United Healthcare-Medicaid, +146891,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,United Healthcare-Medicaid, +146892,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,United Healthcare-Medicaid, +146893,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,United Healthcare-Medicaid, +146894,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,United Healthcare-Medicaid, +146895,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,United Healthcare-Medicaid, +146896,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,United Healthcare-Medicaid, +146897,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,United Healthcare-Medicaid, +146898,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,United Healthcare-Medicaid, +146899,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,United Healthcare-Medicaid, +146900,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,United Healthcare-Medicaid, +146901,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,United Healthcare-Medicaid, +146902,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,United Healthcare-Medicaid, +146903,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,United Healthcare-Medicaid, +146904,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,United Healthcare-Medicaid, +146905,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,United Healthcare-Medicaid, +146906,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,United Healthcare-Medicaid, +146907,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,United Healthcare-Medicaid, +146908,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,United Healthcare-Medicaid, +146909,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,United Healthcare-Medicaid, +146910,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,United Healthcare-Medicaid, +146911,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,United Healthcare-Medicaid, +146912,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,United Healthcare-Medicaid, +146913,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,United Healthcare-Medicaid, +146914,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,United Healthcare-Medicaid, +146915,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,United Healthcare-Medicaid, +146916,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,United Healthcare-Medicaid, +146917,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,United Healthcare-Medicaid, +146918,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,United Healthcare-Medicaid, +146919,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,United Healthcare-Medicaid, +146920,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,United Healthcare-Medicaid, +146921,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,United Healthcare-Medicaid, +146922,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,United Healthcare-Medicaid, +146923,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,United Healthcare-Medicaid, +146924,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,United Healthcare-Medicaid, +146925,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,United Healthcare-Medicaid, +146926,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,United Healthcare-Medicaid, +146927,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,United Healthcare-Medicaid, +146928,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,United Healthcare-Medicaid, +146929,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,United Healthcare-Medicaid, +146930,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,United Healthcare-Medicaid, +146931,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,United Healthcare-Medicaid, +146932,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,United Healthcare-Medicaid, +146933,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,United Healthcare-Medicaid, +146934,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,United Healthcare-Medicaid, +146935,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,United Healthcare-Medicaid, +146936,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,United Healthcare-Medicaid, +146937,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,United Healthcare-Medicaid, +146938,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,United Healthcare-Medicaid, +146939,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,United Healthcare-Medicaid, +146940,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,United Healthcare-Medicaid, +146941,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,United Healthcare-Medicaid, +146942,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,United Healthcare-Medicaid, +146943,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,United Healthcare-Medicaid, +146944,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,United Healthcare-Medicaid, +146945,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,United Healthcare-Medicaid, +146946,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,United Healthcare-Medicaid, +146947,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,United Healthcare-Medicaid, +146948,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,United Healthcare-Medicaid, +146949,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,United Healthcare-Medicaid, +146950,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,United Healthcare-Medicaid, +146951,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,United Healthcare-Medicaid, +146952,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,United Healthcare-Medicaid, +146953,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,United Healthcare-Medicaid, +146954,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,United Healthcare-Medicaid, +146955,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,United Healthcare-Medicaid, +146956,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,United Healthcare-Medicaid, +146957,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,United Healthcare-Medicaid, +146958,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,United Healthcare-Medicaid, +146959,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,United Healthcare-Medicaid, +146960,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,United Healthcare-Medicaid, +146961,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,United Healthcare-Medicaid, +146962,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,United Healthcare-Medicaid, +146963,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,United Healthcare-Medicaid, +146964,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,United Healthcare-Medicaid, +146965,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,United Healthcare-Medicaid, +146966,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,United Healthcare-Medicaid, +146967,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,United Healthcare-Medicaid, +146968,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,United Healthcare-Medicaid, +146969,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,United Healthcare-Medicaid, +146970,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,United Healthcare-Medicaid, +146971,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,United Healthcare-Medicaid, +146972,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,United Healthcare-Medicaid, +146973,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,United Healthcare-Medicaid, +146974,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,United Healthcare-Medicaid, +146975,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,United Healthcare-Medicaid, +146976,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,United Healthcare-Medicaid, +146977,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicaid, +146978,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +146979,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +146980,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +146981,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +146982,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +146983,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,United Healthcare-Medicaid, +146984,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,United Healthcare-Medicaid, +146985,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,United Healthcare-Medicaid, +146986,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +146987,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +146988,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +146989,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,United Healthcare-Medicaid, +146990,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,United Healthcare-Medicaid, +146991,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,United Healthcare-Medicaid, +146992,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,United Healthcare-Medicaid, +146993,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,United Healthcare-Medicaid, +146994,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,United Healthcare-Medicaid, +146995,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,United Healthcare-Medicaid, +146996,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,United Healthcare-Medicaid, +146997,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,United Healthcare-Medicaid, +146998,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,United Healthcare-Medicaid, +146999,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,United Healthcare-Medicaid, +147000,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,United Healthcare-Medicaid, +147001,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,United Healthcare-Medicaid, +147002,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,United Healthcare-Medicaid, +147003,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,United Healthcare-Medicaid, +147004,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,United Healthcare-Medicaid, +147005,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,United Healthcare-Medicaid, +147006,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,United Healthcare-Medicaid, +147007,3934,43301043,ALBUNEX,,357.0,357.0,,,United Healthcare-Medicaid, +147008,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,United Healthcare-Medicaid, +147009,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +147010,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +147011,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +147012,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +147013,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +147014,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,United Healthcare-Medicaid, +147015,3934,43450022,REC RM .5HR,,541.0,541.0,,,United Healthcare-Medicaid, +147016,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,United Healthcare-Medicaid, +147017,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,United Healthcare-Medicaid, +147018,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,United Healthcare-Medicaid, +147019,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,United Healthcare-Medicaid, +147020,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,United Healthcare-Medicaid, +147021,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,United Healthcare-Medicaid, +147022,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,United Healthcare-Medicaid, +147023,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,United Healthcare-Medicaid, +147024,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,United Healthcare-Medicaid, +147025,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,United Healthcare-Medicaid, +147026,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,United Healthcare-Medicaid, +147027,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,United Healthcare-Medicaid, +147028,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,United Healthcare-Medicaid, +147029,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,United Healthcare-Medicaid, +147030,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,United Healthcare-Medicaid, +147031,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,United Healthcare-Medicaid, +147032,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicaid, +147033,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +147034,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +147035,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +147036,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +147037,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +147038,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,United Healthcare-Medicaid, +147039,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +147040,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicaid, +147041,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +147042,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +147043,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +147044,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +147045,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,United Healthcare-Medicaid, +147046,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicaid, +147047,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +147048,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +147049,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +147050,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +147051,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +147052,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicaid, +147053,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +147054,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +147055,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +147056,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +147057,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +147058,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,United Healthcare-Medicaid, +147059,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,United Healthcare-Medicaid, +147060,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,United Healthcare-Medicaid, +147061,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,United Healthcare-Medicaid, +147062,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,United Healthcare-Medicaid, +147063,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,United Healthcare-Medicaid, +147064,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,United Healthcare-Medicaid, +147065,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,United Healthcare-Medicaid, +147066,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicaid, +147067,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +147068,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +147069,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +147070,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +147071,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +147072,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,United Healthcare-Medicaid, +147073,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,United Healthcare-Medicaid, +147074,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,United Healthcare-Medicaid, +147075,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,United Healthcare-Medicaid, +147076,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,United Healthcare-Medicaid, +147077,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,United Healthcare-Medicaid, +147078,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,United Healthcare-Medicaid, +147079,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,United Healthcare-Medicaid, +147080,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,United Healthcare-Medicaid, +147081,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,United Healthcare-Medicaid, +147082,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,United Healthcare-Medicaid, +147083,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,United Healthcare-Medicaid, +147084,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,United Healthcare-Medicaid, +147085,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,United Healthcare-Medicaid, +147086,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,United Healthcare-Medicaid, +147087,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,United Healthcare-Medicaid, +147088,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,United Healthcare-Medicaid, +147089,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,United Healthcare-Medicaid, +147090,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,United Healthcare-Medicaid, +147091,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,United Healthcare-Medicaid, +147092,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,United Healthcare-Medicaid, +147093,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,United Healthcare-Medicaid, +147094,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,United Healthcare-Medicaid, +147095,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,United Healthcare-Medicaid, +147096,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,United Healthcare-Medicaid, +147097,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,United Healthcare-Medicaid, +147098,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,United Healthcare-Medicaid, +147099,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,United Healthcare-Medicaid, +147100,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,United Healthcare-Medicaid, +147101,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,United Healthcare-Medicaid, +147102,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,United Healthcare-Medicaid, +147103,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,United Healthcare-Medicaid, +147104,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,United Healthcare-Medicaid, +147105,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,United Healthcare-Medicaid, +147106,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,United Healthcare-Medicaid, +147107,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,United Healthcare-Medicaid, +147108,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,United Healthcare-Medicaid, +147109,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,United Healthcare-Medicaid, +147110,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,United Healthcare-Medicaid, +147111,3934,45924552,ENDO REC RM,,30.0,30.0,,,United Healthcare-Medicaid, +147112,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,United Healthcare-Medicaid, +147113,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,United Healthcare-Medicaid, +147114,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,United Healthcare-Medicaid, +147115,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,United Healthcare-Medicaid, +147116,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,United Healthcare-Medicaid, +147117,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,United Healthcare-Medicaid, +147118,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,United Healthcare-Medicaid, +147119,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,United Healthcare-Medicaid, +147120,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,United Healthcare-Medicaid, +147121,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,United Healthcare-Medicaid, +147122,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,United Healthcare-Medicaid, +147123,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,United Healthcare-Medicaid, +147124,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,United Healthcare-Medicaid, +147125,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,United Healthcare-Medicaid, +147126,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,United Healthcare-Medicaid, +147127,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,United Healthcare-Medicaid, +147128,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,United Healthcare-Medicaid, +147129,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,United Healthcare-Medicaid, +147130,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,United Healthcare-Medicaid, +147131,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,United Healthcare-Medicaid, +147132,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,United Healthcare-Medicaid, +147133,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,United Healthcare-Medicaid, +147134,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,United Healthcare-Medicaid, +147135,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,United Healthcare-Medicaid, +147136,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,United Healthcare-Medicaid, +147137,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,United Healthcare-Medicaid, +147138,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicaid, +147139,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicaid, +147140,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicaid, +147141,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicaid, +147142,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicaid, +147143,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicaid, +147144,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,United Healthcare-Medicaid, +147145,3934,53200010,GUEST TRAY,,24.0,24.0,,,United Healthcare-Medicaid, +147146,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,United Healthcare-Medicaid, +147147,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,United Healthcare-Medicaid, +147148,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,United Healthcare-Medicaid, +147149,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,United Healthcare-Medicaid, +147150,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,United Healthcare-Medicaid, +147151,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,United Healthcare-Medicaid, +147152,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,United Healthcare-Medicaid, +147153,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,United Healthcare-Medicaid, +147154,3934,53329876,HIV MONITORING,,416.0,416.0,,,United Healthcare-Medicaid, +147155,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,United Healthcare-Medicaid, +147156,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,United Healthcare-Medicaid, +147157,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,United Healthcare-Medicaid, +147158,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,United Healthcare-Medicaid, +147159,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,United Healthcare-Medicaid, +147160,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,United Healthcare-Medicaid, +147161,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,United Healthcare-Medicaid, +147162,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,United Healthcare-Medicaid, +147163,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,United Healthcare-Medicaid, +147164,3934,76010107,COPY X-RAY,,22.0,22.0,,,United Healthcare-Medicaid, +147165,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,United Healthcare-Medicaid, +147166,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,United Healthcare-Medicaid, +147167,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,United Healthcare-Medicaid, +147168,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,United Healthcare-Medicaid, +147169,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,United Healthcare-Medicaid, +147170,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,United Healthcare-Medicaid, +147171,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,United Healthcare-Medicaid, +147172,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,United Healthcare-Medicaid, +147173,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,United Healthcare-Medicaid, +147174,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,United Healthcare-Medicaid, +147175,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,United Healthcare-Medicaid, +147176,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,United Healthcare-Medicaid, +147177,3934,1,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEMWITHCOMORBITY,DRG,1321641.18,1321641.18,64628.2,326487.83,United Healthcare-Medicare Advantage, +147178,3934,2,HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT COMORBITY,DRG,903148.56,903148.56,35545.95,35545.95,United Healthcare-Medicare Advantage, +147179,3934,3,"ECMO OR TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITH MAJ O.R.",DRG,903414.14,903414.14,11962.0,1196979.01,United Healthcare-Medicare Advantage, +147180,3934,4,"TRACH WITH MV >96 HRS OR PDX EXC FACE, MOUTH & NECK WITHOUT MAJ O.R.",DRG,955101.83,955101.83,26467.01,669759.47,United Healthcare-Medicare Advantage, +147181,3934,11,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMORBITY",DRG,430935.07,430935.07,11192.81,95653.0,United Healthcare-Medicare Advantage, +147182,3934,12,"TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY WITH COMPLICATION",DRG,289703.53,289703.53,8549.9,77844.62,United Healthcare-Medicare Advantage, +147183,3934,14,ALLOGENEIC BONE MARROW TRANSPLANT,DRG,666906.31,666906.31,9486.0,300321.07,United Healthcare-Medicare Advantage, +147184,3934,16,AUTOLOGOUS BONE MARROW TRANSPLANT WITH COMPLICATION/COMORBITY OR T-CELL IMMUNOTHERAPY,DRG,449353.44,449353.44,3827.9,225630.26,United Healthcare-Medicare Advantage, +147185,3934,17,AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT COMPLICATION/COMORBITY,DRG,258103.67,258103.67,84766.0,95290.0,United Healthcare-Medicare Advantage, +147186,3934,20,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMORBITY,DRG,418730.58,418730.58,23026.66,373964.14,United Healthcare-Medicare Advantage,64254.85 +147187,3934,21,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITH COMPLICATION,DRG,214064.85,214064.85,20218.28,216762.23,United Healthcare-Medicare Advantage, +147188,3934,22,INTRACRANIAL VASCULAR PROCEDURES WITH PDX HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,59305.31,59305.31,51273.71,52260.66,United Healthcare-Medicare Advantage, +147189,3934,23,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX WITH COMORBITY OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,DRG,257407.52,257407.52,2452.06,167030.98,United Healthcare-Medicare Advantage,41788.2 +147190,3934,24,CRANIO WITH MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX WITHOUT COMORBITY,DRG,139472.94,139472.94,7597.72,96258.48,United Healthcare-Medicare Advantage,32584.84 +147191,3934,25,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMORBITY,DRG,243256.06,243256.06,610.0,511169.46,United Healthcare-Medicare Advantage,38088.1 +147192,3934,26,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,122892.0,122892.0,2432.18,127346.03,United Healthcare-Medicare Advantage,48981.18 +147193,3934,27,CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,96506.09,96506.09,5604.44,65528.03,United Healthcare-Medicare Advantage, +147194,3934,28,SPINAL PROCEDURES WITH COMORBITY,DRG,187385.36,187385.36,56903.56,139606.5,United Healthcare-Medicare Advantage, +147195,3934,29,SPINAL PROCEDURES WITH COMPLICATION OR SPINAL NEUROSTIMULATORS,DRG,146283.7,146283.7,1042.7,70604.17,United Healthcare-Medicare Advantage, +147196,3934,30,SPINAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,103368.79,103368.79,19003.75,59910.41,United Healthcare-Medicare Advantage, +147197,3934,31,VENTRICULAR SHUNT PROCEDURES WITH COMORBITY,DRG,113303.29,113303.29,9741.83,139264.3,United Healthcare-Medicare Advantage, +147198,3934,32,VENTRICULAR SHUNT PROCEDURES WITH COMPLICATION,DRG,67302.88,67302.88,5249.65,48244.94,United Healthcare-Medicare Advantage, +147199,3934,33,VENTRICULAR SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53804.21,53804.21,3839.3,36443.0,United Healthcare-Medicare Advantage, +147200,3934,34,CAROTID ARTERY STENT PROCEDURE WITH COMORBITY,DRG,239294.95,239294.95,10641.96,253151.0,United Healthcare-Medicare Advantage,30311.94 +147201,3934,35,CAROTID ARTERY STENT PROCEDURE WITH COMPLICATION,DRG,117577.66,117577.66,5214.64,51218.0,United Healthcare-Medicare Advantage, +147202,3934,36,CAROTID ARTERY STENT PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,44102.4,44102.4,4193.3,40569.0,United Healthcare-Medicare Advantage, +147203,3934,37,EXTRACRANIAL PROCEDURES WITH COMORBITY,DRG,176232.73,176232.73,3829.01,99753.8,United Healthcare-Medicare Advantage, +147204,3934,38,EXTRACRANIAL PROCEDURES WITH COMPLICATION,DRG,148112.72,148112.72,1711.93,86341.63,United Healthcare-Medicare Advantage, +147205,3934,39,EXTRACRANIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68665.6,68665.6,2541.39,35397.17,United Healthcare-Medicare Advantage, +147206,3934,40,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMORBITY,DRG,131823.92,131823.92,8146.55,107197.08,United Healthcare-Medicare Advantage,26990.29 +147207,3934,41,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITH COMPLICATION OR PERIPH NEUROSTIM,DRG,133101.52,133101.52,5245.88,120178.01,United Healthcare-Medicare Advantage, +147208,3934,42,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC WITHOUT COMPLICATION/COMORBITY,DRG,86812.67,86812.67,4205.67,53181.14,United Healthcare-Medicare Advantage, +147209,3934,52,SPINAL DISORDERS & INJURIES WITH COMPLICATION/COMORBITY,DRG,67493.95,67493.95,17422.58,54681.83,United Healthcare-Medicare Advantage, +147210,3934,53,SPINAL DISORDERS & INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,51582.75,51582.75,13406.41,14091.94,United Healthcare-Medicare Advantage, +147211,3934,54,NERVOUS SYSTEM NEOPLASMS WITH COMORBITY,DRG,102485.86,102485.86,143.56,50099.48,United Healthcare-Medicare Advantage,30787.27 +147212,3934,55,NERVOUS SYSTEM NEOPLASMS WITHOUT COMORBITY,DRG,71547.1,71547.1,11015.71,22866.0,United Healthcare-Medicare Advantage, +147213,3934,56,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH COMORBITY,DRG,120775.2,120775.2,4773.12,52364.84,United Healthcare-Medicare Advantage, +147214,3934,57,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT COMORBITY,DRG,68990.53,68990.53,1170.0,97546.85,United Healthcare-Medicare Advantage, +147215,3934,58,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMORBITY,DRG,71139.91,71139.91,21141.42,38060.0,United Healthcare-Medicare Advantage, +147216,3934,59,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITH COMPLICATION,DRG,67052.68,67052.68,9397.27,24687.0,United Healthcare-Medicare Advantage, +147217,3934,60,MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA WITHOUT COMPLICATION/COMORBITY,DRG,76803.72,76803.72,149.67,20065.0,United Healthcare-Medicare Advantage, +147218,3934,61,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMORBITY",DRG,151429.23,151429.23,6444.28,49207.5,United Healthcare-Medicare Advantage, +147219,3934,62,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH COMPLICATION",DRG,107181.53,107181.53,4914.73,46348.1,United Healthcare-Medicare Advantage, +147220,3934,63,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT COMPLICATION/COMORBITY",DRG,94845.19,94845.19,4107.34,40292.51,United Healthcare-Medicare Advantage, +147221,3934,64,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMORBITY,DRG,145949.37,145949.37,96.63,114110.71,United Healthcare-Medicare Advantage,15486.49 +147222,3934,65,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR TPA IN 24 HRS,DRG,87115.0,87115.0,155.97,44215.74,United Healthcare-Medicare Advantage,8965.35 +147223,3934,66,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT COMPLICATION/COMORBITY,DRG,67778.19,67778.19,147.97,17671.47,United Healthcare-Medicare Advantage, +147224,3934,68,NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WITHOUT INFARCT WITHOUT COMORBITY,DRG,60380.89,60380.89,1982.68,17693.34,United Healthcare-Medicare Advantage, +147225,3934,69,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,DRG,63616.14,63616.14,1753.98,17227.0,United Healthcare-Medicare Advantage, +147226,3934,70,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMORBITY,DRG,105763.12,105763.12,3740.46,36738.0,United Healthcare-Medicare Advantage,35731.09 +147227,3934,71,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH COMPLICATION,DRG,74686.9,74686.9,2050.33,71096.35,United Healthcare-Medicare Advantage, +147228,3934,72,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,60738.05,60738.05,8428.64,15823.0,United Healthcare-Medicare Advantage, +147229,3934,73,CRANIAL & PERIPHERAL NERVE DISORDERS WITH COMORBITY,DRG,157824.36,157824.36,3233.96,27389.0,United Healthcare-Medicare Advantage, +147230,3934,74,CRANIAL & PERIPHERAL NERVE DISORDERS WITHOUT COMORBITY,DRG,84397.32,84397.32,2272.3,34913.36,United Healthcare-Medicare Advantage,10385.9 +147231,3934,75,VIRAL MENINGITIS WITH COMPLICATION/COMORBITY,DRG,97402.59,97402.59,3934.31,275756.91,United Healthcare-Medicare Advantage, +147232,3934,77,HYPERTENSIVE ENCEPHALOPATHY WITH COMORBITY,DRG,40034.71,40034.71,3769.38,19824.57,United Healthcare-Medicare Advantage, +147233,3934,80,NONTRAUMATIC STUPOR & COMA WITH COMORBITY,DRG,52324.63,52324.63,20740.02,41059.0,United Healthcare-Medicare Advantage, +147234,3934,82,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMORBITY",DRG,101201.15,101201.15,5038.37,139971.2,United Healthcare-Medicare Advantage, +147235,3934,83,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITH COMPLICATION",DRG,106068.4,106068.4,2993.66,107733.01,United Healthcare-Medicare Advantage, +147236,3934,84,"TRAUMATIC STUPOR & COMA, COMA >1 HR WITHOUT COMPLICATION/COMORBITY",DRG,66869.57,66869.57,2017.49,19816.0,United Healthcare-Medicare Advantage, +147237,3934,85,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMORBITY",DRG,197326.36,197326.36,5370.1,65316.12,United Healthcare-Medicare Advantage, +147238,3934,86,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITH COMPLICATION",DRG,88335.16,88335.16,2840.15,32485.2,United Healthcare-Medicare Advantage,11985.89 +147239,3934,87,"TRAUMATIC STUPOR & COMA, COMA <1 HR WITHOUT COMPLICATION/COMORBITY",DRG,38804.06,38804.06,4.74,19339.36,United Healthcare-Medicare Advantage,8701.81 +147240,3934,89,CONCUSSION WITH COMPLICATION,DRG,174528.26,174528.26,2367.79,28378.81,United Healthcare-Medicare Advantage, +147241,3934,91,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMORBITY,DRG,212644.1,212644.1,38.94,55388.42,United Healthcare-Medicare Advantage,13062.17 +147242,3934,92,OTHER DISORDERS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,56336.33,56336.33,2200.23,27797.6,United Healthcare-Medicare Advantage,8501.31 +147243,3934,93,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,45955.15,45955.15,236.75,16309.0,United Healthcare-Medicare Advantage, +147244,3934,94,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMORBITY,DRG,220861.39,220861.39,45686.43,76808.0,United Healthcare-Medicare Advantage, +147245,3934,95,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH COMPLICATION,DRG,54850.73,54850.73,15044.13,46573.0,United Healthcare-Medicare Advantage, +147246,3934,96,BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT COMPLICATION/COMORBITY,DRG,141409.37,141409.37,2940.0,114726.43,United Healthcare-Medicare Advantage, +147247,3934,97,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMORBITY,DRG,57573.17,57573.17,79356.12,118779.63,United Healthcare-Medicare Advantage, +147248,3934,98,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITH COMPLICATION,DRG,82019.28,82019.28,20766.8,31289.09,United Healthcare-Medicare Advantage, +147249,3934,99,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS WITHOUT COMPLICATION/COMORBITY,DRG,70619.62,70619.62,19380.75,30735.28,United Healthcare-Medicare Advantage, +147250,3934,100,SEIZURES WITH COMORBITY,DRG,168778.19,168778.19,969.55,198799.56,United Healthcare-Medicare Advantage, +147251,3934,101,SEIZURES WITHOUT COMORBITY,DRG,46895.13,46895.13,825.0,40937.89,United Healthcare-Medicare Advantage,11840.48 +147252,3934,102,HEADACHES WITH COMORBITY,DRG,97740.1,97740.1,13565.04,13565.04,United Healthcare-Medicare Advantage, +147253,3934,103,HEADACHES WITHOUT COMORBITY,DRG,45351.49,45351.49,8891.87,18150.0,United Healthcare-Medicare Advantage, +147254,3934,113,ORBITAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,46590.39,46590.39,4890.44,45682.0,United Healthcare-Medicare Advantage, +147255,3934,115,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,DRG,59389.76,59389.76,12444.12,26187.89,United Healthcare-Medicare Advantage, +147256,3934,116,INTRAOCULAR PROCEDURES WITH COMPLICATION/COMORBITY,DRG,210990.75,210990.75,4721.82,22076.38,United Healthcare-Medicare Advantage, +147257,3934,117,INTRAOCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66162.06,66162.06,13043.5,13043.5,United Healthcare-Medicare Advantage, +147258,3934,121,ACUTE MAJOR EYE INFECTIONS WITH COMPLICATION/COMORBITY,DRG,119014.5,119014.5,13721.29,14657.61,United Healthcare-Medicare Advantage, +147259,3934,123,NEUROLOGICAL EYE DISORDERS,DRG,82672.87,82672.87,252.98,23813.62,United Healthcare-Medicare Advantage,6981.85 +147260,3934,124,OTHER DISORDERS OF THE EYE WITH COMORBITY,DRG,31096.67,31096.67,16074.87,16921.5,United Healthcare-Medicare Advantage, +147261,3934,125,OTHER DISORDERS OF THE EYE WITHOUT COMORBITY,DRG,40836.0,40836.0,1863.98,16914.0,United Healthcare-Medicare Advantage, +147262,3934,129,MAJOR HEAD & NECK PROCEDURES WITH COMPLICATION/COMORBITY OR MAJOR DEVICE,DRG,289301.48,289301.48,24194.22,55442.62,United Healthcare-Medicare Advantage, +147263,3934,130,MAJOR HEAD & NECK PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,314798.84,314798.84,30370.81,30370.81,United Healthcare-Medicare Advantage, +147264,3934,131,CRANIAL/FACIAL PROCEDURES WITH COMPLICATION/COMORBITY,DRG,124672.78,124672.78,28820.11,28820.11,United Healthcare-Medicare Advantage, +147265,3934,132,CRANIAL/FACIAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,83063.37,83063.37,3884.23,38463.92,United Healthcare-Medicare Advantage, +147266,3934,133,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITH COMPLICATION/COMORBITY",DRG,80699.79,80699.79,5141.41,23150.46,United Healthcare-Medicare Advantage, +147267,3934,134,"OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,58031.06,58031.06,13347.74,25906.0,United Healthcare-Medicare Advantage, +147268,3934,135,SINUS & MASTOID PROCEDURES WITH COMPLICATION/COMORBITY,DRG,76369.52,76369.52,19083.06,86495.64,United Healthcare-Medicare Advantage, +147269,3934,137,MOUTH PROCEDURES WITH COMPLICATION/COMORBITY,DRG,72084.8,72084.8,291.41,66611.53,United Healthcare-Medicare Advantage, +147270,3934,138,MOUTH PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,31944.82,31944.82,10423.41,18477.0,United Healthcare-Medicare Advantage, +147271,3934,139,SALIVARY GLAND PROCEDURES,DRG,58421.11,58421.11,2737.29,14325.63,United Healthcare-Medicare Advantage, +147272,3934,140,MAJOR HEAD AND NECK PROCEDURES WITH MCC,DRG,58969.63,58969.63,42334.45,42334.45,United Healthcare-Medicare Advantage, +147273,3934,141,MAJOR HEAD AND NECK PROCEDURES WITH CC,DRG,34141.54,34141.54,24302.34,48377.0,United Healthcare-Medicare Advantage, +147274,3934,142,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,DRG,63082.34,63082.34,18213.67,35257.0,United Healthcare-Medicare Advantage, +147275,3934,144,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",DRG,43703.59,43703.59,19654.74,38362.0,United Healthcare-Medicare Advantage, +147276,3934,145,"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",DRG,130882.19,130882.19,2707.62,26594.0,United Healthcare-Medicare Advantage, +147277,3934,146,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMORBITY",DRG,261168.75,261168.75,4712.88,22528.74,United Healthcare-Medicare Advantage, +147278,3934,147,"EAR, NOSE, MOUTH & THROAT MALIGNANCY WITH COMPLICATION",DRG,90267.09,90267.09,3148.12,3148.12,United Healthcare-Medicare Advantage, +147279,3934,149,DYSEQUILIBRIUM,DRG,37750.34,37750.34,6463.8,14134.0,United Healthcare-Medicare Advantage, +147280,3934,150,EPISTAXIS WITH COMORBITY,DRG,84015.29,84015.29,2955.73,29031.0,United Healthcare-Medicare Advantage, +147281,3934,151,EPISTAXIS WITHOUT COMORBITY,DRG,49994.34,49994.34,469.67,9790.47,United Healthcare-Medicare Advantage, +147282,3934,152,OTITIS MEDIA & URI WITH COMORBITY,DRG,26871.51,26871.51,11569.71,20163.0,United Healthcare-Medicare Advantage, +147283,3934,153,OTITIS MEDIA & URI WITHOUT COMORBITY,DRG,50733.91,50733.91,125.91,20325.25,United Healthcare-Medicare Advantage, +147284,3934,154,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMORBITY",DRG,29758.57,29758.57,4130.03,45829.25,United Healthcare-Medicare Advantage,16374.25 +147285,3934,155,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITH COMPLICATION",DRG,53144.79,53144.79,2202.0,13826.63,United Healthcare-Medicare Advantage, +147286,3934,156,"OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES WITHOUT COMPLICATION/COMORBITY",DRG,30496.56,30496.56,1467.27,14411.0,United Healthcare-Medicare Advantage, +147287,3934,157,DENTAL & ORAL DISEASES WITH COMORBITY,DRG,95062.71,95062.71,17045.99,34459.0,United Healthcare-Medicare Advantage, +147288,3934,158,DENTAL & ORAL DISEASES WITH COMPLICATION,DRG,64877.19,64877.19,8446.42,19485.0,United Healthcare-Medicare Advantage, +147289,3934,159,DENTAL & ORAL DISEASES WITHOUT COMPLICATION/COMORBITY,DRG,48369.27,48369.27,7742.91,8521.83,United Healthcare-Medicare Advantage, +147290,3934,163,MAJOR CHEST PROCEDURES WITH COMORBITY,DRG,215188.92,215188.92,1272.51,136227.71,United Healthcare-Medicare Advantage, +147291,3934,164,MAJOR CHEST PROCEDURES WITH COMPLICATION,DRG,103002.43,103002.43,5389.13,57838.0,United Healthcare-Medicare Advantage, +147292,3934,165,MAJOR CHEST PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,117867.17,117867.17,877.4,56952.6,United Healthcare-Medicare Advantage,17704.92 +147293,3934,166,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,177370.23,177370.23,8459.32,67679.0,United Healthcare-Medicare Advantage, +147294,3934,167,OTHER RESP SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,145519.23,145519.23,3598.46,40804.0,United Healthcare-Medicare Advantage, +147295,3934,168,OTHER RESP SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,43061.29,43061.29,11220.08,23847.43,United Healthcare-Medicare Advantage, +147296,3934,175,PULMONARY EMBOLISM WITH COMORBITY OR ACUTE COR PULMONALE,DRG,99290.69,99290.69,164.33,53025.52,United Healthcare-Medicare Advantage,7532.44 +147297,3934,176,PULMONARY EMBOLISM WITHOUT COMORBITY,DRG,55985.78,55985.78,148.91,20342.39,United Healthcare-Medicare Advantage,8406.73 +147298,3934,177,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMORBITY,DRG,82473.15,82473.15,21.7,135274.25,United Healthcare-Medicare Advantage,75048.06 +147299,3934,178,RESPIRATORY INFECTIONS & INFLAMMATIONS WITH COMPLICATION,DRG,56436.18,56436.18,1614.4,54452.56,United Healthcare-Medicare Advantage, +147300,3934,179,RESPIRATORY INFECTIONS & INFLAMMATIONS WITHOUT COMPLICATION/COMORBITY,DRG,37242.27,37242.27,2332.36,25588.78,United Healthcare-Medicare Advantage,10053.38 +147301,3934,180,RESPIRATORY NEOPLASMS WITH COMORBITY,DRG,118659.06,118659.06,3877.46,43224.36,United Healthcare-Medicare Advantage,15686.89 +147302,3934,181,RESPIRATORY NEOPLASMS WITH COMPLICATION,DRG,93877.08,93877.08,2501.0,27618.76,United Healthcare-Medicare Advantage, +147303,3934,183,MAJOR CHEST TRAUMA WITH COMORBITY,DRG,45618.14,45618.14,72.5,26584.56,United Healthcare-Medicare Advantage, +147304,3934,184,MAJOR CHEST TRAUMA WITH COMPLICATION,DRG,76910.51,76910.51,2319.16,24403.2,United Healthcare-Medicare Advantage, +147305,3934,185,MAJOR CHEST TRAUMA WITHOUT COMPLICATION/COMORBITY,DRG,49597.18,49597.18,1726.09,16953.0,United Healthcare-Medicare Advantage, +147306,3934,186,PLEURAL EFFUSION WITH COMORBITY,DRG,80496.2,80496.2,3443.26,34227.88,United Healthcare-Medicare Advantage, +147307,3934,187,PLEURAL EFFUSION WITH COMPLICATION,DRG,65360.33,65360.33,2303.09,22621.0,United Healthcare-Medicare Advantage, +147308,3934,189,PULMONARY EDEMA & RESPIRATORY FAILURE,DRG,56629.51,56629.51,90.39,34606.97,United Healthcare-Medicare Advantage,9913.25 +147309,3934,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMORBITY,DRG,66680.5,66680.5,2282.96,32916.31,United Healthcare-Medicare Advantage,7801.06 +147310,3934,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION,DRG,55981.79,55981.79,1970.41,19353.0,United Healthcare-Medicare Advantage,8882.72 +147311,3934,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,82879.87,82879.87,7988.07,17006.18,United Healthcare-Medicare Advantage, +147312,3934,193,SIMPLE PNEUMONIA & PLEURISY WITH COMORBITY,DRG,74944.38,74944.38,270.05,52469.72,United Healthcare-Medicare Advantage,11255.17 +147313,3934,194,SIMPLE PNEUMONIA & PLEURISY WITH COMPLICATION,DRG,53626.16,53626.16,236.66,133425.06,United Healthcare-Medicare Advantage,8967.78 +147314,3934,195,SIMPLE PNEUMONIA & PLEURISY WITHOUT COMPLICATION/COMORBITY,DRG,26462.88,26462.88,1672.71,14615.0,United Healthcare-Medicare Advantage, +147315,3934,196,INTERSTITIAL LUNG DISEASE WITH COMORBITY,DRG,50157.4,50157.4,3873.66,20555.99,United Healthcare-Medicare Advantage, +147316,3934,197,INTERSTITIAL LUNG DISEASE WITH COMPLICATION,DRG,56210.12,56210.12,11386.8,12079.25,United Healthcare-Medicare Advantage, +147317,3934,199,PNEUMOTHORAX WITH COMORBITY,DRG,47523.37,47523.37,19462.69,786429.48,United Healthcare-Medicare Advantage, +147318,3934,200,PNEUMOTHORAX WITH COMPLICATION,DRG,46189.99,46189.99,58.61,48124.67,United Healthcare-Medicare Advantage, +147319,3934,201,PNEUMOTHORAX WITHOUT COMPLICATION/COMORBITY,DRG,45335.62,45335.62,1784.64,17383.99,United Healthcare-Medicare Advantage,7802.2 +147320,3934,202,BRONCHITIS & ASTHMA WITH COMPLICATION/COMORBITY,DRG,30992.31,30992.31,100.92,22729.51,United Healthcare-Medicare Advantage,6284.65 +147321,3934,203,BRONCHITIS & ASTHMA WITHOUT COMPLICATION/COMORBITY,DRG,20186.59,20186.59,7808.2,16054.5,United Healthcare-Medicare Advantage, +147322,3934,204,RESPIRATORY SIGNS & SYMPTOMS,DRG,40596.18,40596.18,1768.26,17409.0,United Healthcare-Medicare Advantage,7108.83 +147323,3934,205,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,76231.56,76231.56,1136.01,44662.18,United Healthcare-Medicare Advantage, +147324,3934,206,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT COMORBITY,DRG,64608.47,64608.47,2132.11,18694.0,United Healthcare-Medicare Advantage, +147325,3934,207,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,DRG,326843.77,326843.77,12776.99,431777.68,United Healthcare-Medicare Advantage, +147326,3934,208,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,DRG,169182.79,169182.79,5672.49,159011.41,United Healthcare-Medicare Advantage, +147327,3934,215,OTHER HEART ASSIST SYSTEM IMPLANT,DRG,359455.1,359455.1,24896.0,164536.18,United Healthcare-Medicare Advantage,90679.26 +147328,3934,216,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMORBITY,DRG,519008.97,519008.97,20334.0,151102.59,United Healthcare-Medicare Advantage,141495.41 +147329,3934,217,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITH CARD CATH WITH COMPLICATION,DRG,180170.93,180170.93,16254.38,90355.96,United Healthcare-Medicare Advantage, +147330,3934,219,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMORBITY,DRG,257299.54,257299.54,16055.19,167982.0,United Healthcare-Medicare Advantage, +147331,3934,220,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITH COMPLICATION,DRG,145595.3,145595.3,12048.49,102659.0,United Healthcare-Medicare Advantage, +147332,3934,221,CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC WITHOUT CARD CATH WITHOUT COMPLICATION/COMORBITY,DRG,146888.24,146888.24,10157.29,82667.81,United Healthcare-Medicare Advantage, +147333,3934,222,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITH COMORBITY,DRG,193570.74,193570.74,1897.2,95555.28,United Healthcare-Medicare Advantage, +147334,3934,223,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITH AMI/HF/SHOCK WITHOUT COMORBITY,DRG,122960.4,122960.4,13860.71,116144.0,United Healthcare-Medicare Advantage, +147335,3934,224,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITH COMORBITY,DRG,212057.82,212057.82,16426.86,81178.51,United Healthcare-Medicare Advantage, +147336,3934,225,CARDIAC DEFIB IMPLANT WITH CARDIAC CATH WITHOUT AMI/HF/SHOCK WITHOUT COMORBITY,DRG,62890.34,62890.34,12554.76,99503.61,United Healthcare-Medicare Advantage, +147337,3934,226,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITH COMORBITY,DRG,290441.19,290441.19,14752.54,298770.6,United Healthcare-Medicare Advantage,54488.26 +147338,3934,227,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,117012.8,117012.8,11718.27,111218.08,United Healthcare-Medicare Advantage, +147339,3934,228,OTHER CARDIOTHORACIC PROCEDURES WITH COMORBITY,DRG,229536.95,229536.95,13867.85,214472.37,United Healthcare-Medicare Advantage, +147340,3934,229,OTHER CARDIOTHORACIC PROCEDURES WITHOUT COMORBITY,DRG,115619.66,115619.66,8898.2,87952.0,United Healthcare-Medicare Advantage, +147341,3934,231,CORONARY BYPASS WITH PTCA WITH COMORBITY,DRG,259828.96,259828.96,2940.5,134996.33,United Healthcare-Medicare Advantage, +147342,3934,232,CORONARY BYPASS WITH PTCA WITHOUT COMORBITY,DRG,326638.59,326638.59,234019.15,234019.15,United Healthcare-Medicare Advantage, +147343,3934,233,CORONARY BYPASS WITH CARDIAC CATH WITH COMORBITY,DRG,248724.76,248724.76,6928.23,164340.02,United Healthcare-Medicare Advantage, +147344,3934,234,CORONARY BYPASS WITH CARDIAC CATH WITHOUT COMORBITY,DRG,191984.14,191984.14,1921.0,116531.0,United Healthcare-Medicare Advantage, +147345,3934,235,CORONARY BYPASS WITHOUT CARDIAC CATH WITH COMORBITY,DRG,220086.93,220086.93,32072.52,128961.0,United Healthcare-Medicare Advantage,32550.91 +147346,3934,236,CORONARY BYPASS WITHOUT CARDIAC CATH WITHOUT COMORBITY,DRG,127366.67,127366.67,7587.41,118558.08,United Healthcare-Medicare Advantage, +147347,3934,239,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMORBITY,DRG,335260.41,335260.41,10729.38,123287.72,United Healthcare-Medicare Advantage, +147348,3934,240,AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE WITH COMPLICATION,DRG,153261.7,153261.7,6224.95,52703.25,United Healthcare-Medicare Advantage, +147349,3934,242,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMORBITY,DRG,185710.76,185710.76,8305.81,85539.68,United Healthcare-Medicare Advantage, +147350,3934,243,PERMANENT CARDIAC PACEMAKER IMPLANT WITH COMPLICATION,DRG,97151.67,97151.67,5650.85,54195.0,United Healthcare-Medicare Advantage,22014.21 +147351,3934,244,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT COMPLICATION/COMORBITY,DRG,66338.27,66338.27,4583.3,41015.11,United Healthcare-Medicare Advantage, +147352,3934,245,AICD GENERATOR PROCEDURES,DRG,93525.08,93525.08,55145.65,71981.48,United Healthcare-Medicare Advantage, +147353,3934,246,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH COMORBITY OR 4+ ARTERIES OR STENTS,DRG,174973.97,174973.97,621.5,100293.36,United Healthcare-Medicare Advantage,26198.28 +147354,3934,247,PERCUTANEOUS CARDIOVASC PROC WITH DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,95275.64,95275.64,547.8,62056.32,United Healthcare-Medicare Advantage,17430.67 +147355,3934,249,PERCUTANEOUS CARDIOVASC PROC WITH NON-DRUG-ELUTING STENT WITHOUT COMORBITY,DRG,45502.64,45502.64,22099.0,41185.0,United Healthcare-Medicare Advantage, +147356,3934,250,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITH COMORBITY,DRG,284979.67,284979.67,5628.98,41012.36,United Healthcare-Medicare Advantage, +147357,3934,251,PERCUTANEOUS CARDIOVASC PROC WITHOUT CORONARY ARTERY STENT WITHOUT COMORBITY,DRG,77108.53,77108.53,3703.42,32351.7,United Healthcare-Medicare Advantage, +147358,3934,252,OTHER VASCULAR PROCEDURES WITH COMORBITY,DRG,128367.89,128367.89,633.17,71776.85,United Healthcare-Medicare Advantage, +147359,3934,253,OTHER VASCULAR PROCEDURES WITH COMPLICATION,DRG,110666.08,110666.08,5921.05,91407.62,United Healthcare-Medicare Advantage,22978.27 +147360,3934,254,OTHER VASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,52773.24,52773.24,4037.43,52369.74,United Healthcare-Medicare Advantage, +147361,3934,255,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMORBITY,DRG,88802.11,88802.11,51264.0,51264.0,United Healthcare-Medicare Advantage, +147362,3934,256,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITH COMPLICATION,DRG,120319.98,120319.98,3666.16,19276.22,United Healthcare-Medicare Advantage, +147363,3934,257,UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,76547.49,76547.49,2772.11,2772.11,United Healthcare-Medicare Advantage, +147364,3934,258,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH COMORBITY,DRG,68819.36,68819.36,25053.1,32681.38,United Healthcare-Medicare Advantage, +147365,3934,259,CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT COMORBITY,DRG,78126.29,78126.29,5089.21,44622.0,United Healthcare-Medicare Advantage, +147366,3934,260,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMORBITY,DRG,153492.02,153492.02,7997.22,79268.0,United Healthcare-Medicare Advantage, +147367,3934,261,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH COMPLICATION,DRG,116120.82,116120.82,4443.08,41749.0,United Healthcare-Medicare Advantage, +147368,3934,262,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,82587.15,82587.15,3811.19,32399.79,United Healthcare-Medicare Advantage,15450.45 +147369,3934,263,VEIN LIGATION & STRIPPING,DRG,64671.99,64671.99,5143.69,20204.69,United Healthcare-Medicare Advantage, +147370,3934,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,DRG,114400.92,114400.92,7912.64,141405.94,United Healthcare-Medicare Advantage,26825.4 +147371,3934,265,AICD LEAD PROCEDURES,DRG,81012.63,81012.63,32669.03,32669.03,United Healthcare-Medicare Advantage, +147372,3934,266,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITH COMORBITY,DRG,226881.27,226881.27,15835.58,155535.0,United Healthcare-Medicare Advantage, +147373,3934,267,ENDOVASCULAR CARDIAC VALVE REPLACEMENT & SUPPLEMENT PROCEDURES WITHOUT COMORBITY,DRG,113537.86,113537.86,12496.97,118694.15,United Healthcare-Medicare Advantage, +147374,3934,268,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH COMORBITY,DRG,204079.71,204079.71,30000.0,99137.0,United Healthcare-Medicare Advantage, +147375,3934,269,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT COMORBITY,DRG,84465.77,84465.77,9626.92,60602.46,United Healthcare-Medicare Advantage,34358.75 +147376,3934,270,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMORBITY,DRG,269196.33,269196.33,11561.41,218977.12,United Healthcare-Medicare Advantage,42965.37 +147377,3934,271,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH COMPLICATION,DRG,122308.71,122308.71,7953.49,82442.18,United Healthcare-Medicare Advantage,36467.48 +147378,3934,272,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,85416.07,85416.07,1400.0,58925.0,United Healthcare-Medicare Advantage, +147379,3934,273,PERCUTANEOUS INTRACARDIAC PROCEDURES WITH COMORBITY,DRG,217766.31,217766.31,8561.73,59715.57,United Healthcare-Medicare Advantage, +147380,3934,274,PERCUTANEOUS INTRACARDIAC PROCEDURES WITHOUT COMORBITY,DRG,133930.08,133930.08,6158.06,106831.67,United Healthcare-Medicare Advantage,26093.84 +147381,3934,280,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMORBITY",DRG,101610.99,101610.99,1945.97,46925.89,United Healthcare-Medicare Advantage,26184.01 +147382,3934,281,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH COMPLICATION",DRG,52845.24,52845.24,100.84,22547.31,United Healthcare-Medicare Advantage,8672.7 +147383,3934,282,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT COMPLICATION/COMORBITY",DRG,52307.5,52307.5,33.61,15899.0,United Healthcare-Medicare Advantage, +147384,3934,283,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMORBITY",DRG,131101.42,131101.42,4160.38,83826.27,United Healthcare-Medicare Advantage, +147385,3934,284,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH COMPLICATION",DRG,71879.64,71879.64,1776.46,1776.46,United Healthcare-Medicare Advantage, +147386,3934,286,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITH COMORBITY",DRG,117159.07,117159.07,4940.2,84243.32,United Healthcare-Medicare Advantage, +147387,3934,287,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARD CATH WITHOUT COMORBITY",DRG,50065.88,50065.88,2565.93,25202.0,United Healthcare-Medicare Advantage,9784.13 +147388,3934,288,ACUTE & SUBACUTE ENDOCARDITIS WITH COMORBITY,DRG,198195.06,198195.06,6363.96,38912.79,United Healthcare-Medicare Advantage, +147389,3934,289,ACUTE & SUBACUTE ENDOCARDITIS WITH COMPLICATION,DRG,145712.57,145712.57,3984.47,35649.0,United Healthcare-Medicare Advantage, +147390,3934,291,HEART FAILURE & SHOCK WITH COMORBITY,DRG,86552.11,86552.11,870.29,139826.85,United Healthcare-Medicare Advantage,12561.66 +147391,3934,292,HEART FAILURE & SHOCK WITH COMPLICATION,DRG,58919.85,58919.85,235.03,19844.0,United Healthcare-Medicare Advantage,8124.82 +147392,3934,293,HEART FAILURE & SHOCK WITHOUT COMPLICATION/COMORBITY,DRG,44201.55,44201.55,1456.11,14302.0,United Healthcare-Medicare Advantage,7326.29 +147393,3934,296,"CARDIAC ARREST, UNEXPLAINED WITH COMORBITY",DRG,23152.35,23152.35,13085.84,64267.84,United Healthcare-Medicare Advantage, +147394,3934,299,PERIPHERAL VASCULAR DISORDERS WITH COMORBITY,DRG,88459.53,88459.53,209.02,80492.62,United Healthcare-Medicare Advantage,13101.15 +147395,3934,300,PERIPHERAL VASCULAR DISORDERS WITH COMPLICATION,DRG,62783.45,62783.45,408.59,24637.27,United Healthcare-Medicare Advantage,10149.3 +147396,3934,301,PERIPHERAL VASCULAR DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,81893.38,81893.38,7487.14,13944.31,United Healthcare-Medicare Advantage, +147397,3934,302,ATHEROSCLEROSIS WITH COMORBITY,DRG,62534.7,62534.7,12231.39,23964.0,United Healthcare-Medicare Advantage, +147398,3934,303,ATHEROSCLEROSIS WITHOUT COMORBITY,DRG,69989.27,69989.27,1509.21,16203.28,United Healthcare-Medicare Advantage, +147399,3934,304,HYPERTENSION WITH COMORBITY,DRG,120466.13,120466.13,780.0,19098.1,United Healthcare-Medicare Advantage, +147400,3934,305,HYPERTENSION WITHOUT COMORBITY,DRG,59732.17,59732.17,38.42,15673.0,United Healthcare-Medicare Advantage,6492.01 +147401,3934,306,CARDIAC CONGENITAL & VALVULAR DISORDERS WITH COMORBITY,DRG,44540.71,44540.71,3782.34,27397.09,United Healthcare-Medicare Advantage, +147402,3934,307,CARDIAC CONGENITAL & VALVULAR DISORDERS WITHOUT COMORBITY,DRG,40014.29,40014.29,1937.61,10683.94,United Healthcare-Medicare Advantage, +147403,3934,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMORBITY,DRG,95049.56,95049.56,2675.93,31665.63,United Healthcare-Medicare Advantage, +147404,3934,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITH COMPLICATION,DRG,61249.65,61249.65,1670.2,18192.12,United Healthcare-Medicare Advantage,7818.36 +147405,3934,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,31557.17,31557.17,5.2,22929.0,United Healthcare-Medicare Advantage,5110.7 +147406,3934,311,ANGINA PECTORIS,DRG,36589.63,36589.63,15.86,15275.0,United Healthcare-Medicare Advantage, +147407,3934,312,SYNCOPE & COLLAPSE,DRG,56089.27,56089.27,2.46,25267.4,United Healthcare-Medicare Advantage,8693.83 +147408,3934,313,CHEST PAIN,DRG,90803.19,90803.19,250.0,25306.86,United Healthcare-Medicare Advantage, +147409,3934,314,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMORBITY,DRG,137535.34,137535.34,2905.36,115945.11,United Healthcare-Medicare Advantage,9592.55 +147410,3934,315,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH COMPLICATION,DRG,80064.05,80064.05,1693.85,33391.64,United Healthcare-Medicare Advantage,8373.34 +147411,3934,316,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,53990.34,53990.34,6671.73,21355.32,United Healthcare-Medicare Advantage,7404.25 +147412,3934,319,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH COMORBITY,DRG,217715.19,217715.19,10020.8,46488.81,United Healthcare-Medicare Advantage, +147413,3934,320,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT COMORBITY,DRG,94147.57,94147.57,26704.46,26704.46,United Healthcare-Medicare Advantage, +147414,3934,326,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMORBITY",DRG,221386.49,221386.49,3711.28,311862.55,United Healthcare-Medicare Advantage,46628.0 +147415,3934,327,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITH COMPLICATION",DRG,78919.78,78919.78,4189.85,55127.0,United Healthcare-Medicare Advantage, +147416,3934,328,"STOMACH, ESOPHAGEAL & DUODENAL PROC WITHOUT COMPLICATION/COMORBITY",DRG,47283.95,47283.95,767.45,36499.0,United Healthcare-Medicare Advantage, +147417,3934,329,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,283921.33,283921.33,2095.01,121221.7,United Healthcare-Medicare Advantage, +147418,3934,330,MAJOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,120122.85,120122.85,3037.99,241438.06,United Healthcare-Medicare Advantage,21008.55 +147419,3934,331,MAJOR SMALL & LARGE BOWEL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,74505.52,74505.52,3468.81,45881.9,United Healthcare-Medicare Advantage,16171.45 +147420,3934,333,RECTAL RESECTION WITH COMPLICATION,DRG,81401.52,81401.52,48491.0,48491.0,United Healthcare-Medicare Advantage, +147421,3934,334,RECTAL RESECTION WITHOUT COMPLICATION/COMORBITY,DRG,58354.83,58354.83,28593.02,33002.0,United Healthcare-Medicare Advantage, +147422,3934,335,PERITONEAL ADHESIOLYSIS WITH COMORBITY,DRG,177533.86,177533.86,8680.43,69569.61,United Healthcare-Medicare Advantage, +147423,3934,336,PERITONEAL ADHESIOLYSIS WITH COMPLICATION,DRG,100235.13,100235.13,5427.11,55846.36,United Healthcare-Medicare Advantage, +147424,3934,337,PERITONEAL ADHESIOLYSIS WITHOUT COMPLICATION/COMORBITY,DRG,95979.83,95979.83,3950.22,39298.69,United Healthcare-Medicare Advantage, +147425,3934,338,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,79408.78,79408.78,61336.0,61336.0,United Healthcare-Medicare Advantage, +147426,3934,339,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,83226.79,83226.79,14242.26,41138.56,United Healthcare-Medicare Advantage, +147427,3934,340,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,51212.36,51212.36,1986.54,29834.84,United Healthcare-Medicare Advantage, +147428,3934,341,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMORBITY,DRG,59898.94,59898.94,6251.18,54810.0,United Healthcare-Medicare Advantage, +147429,3934,342,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITH COMPLICATION,DRG,59780.96,59780.96,15210.31,33536.58,United Healthcare-Medicare Advantage, +147430,3934,343,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAG WITHOUT COMPLICATION/COMORBITY,DRG,40843.57,40843.57,12746.71,27650.31,United Healthcare-Medicare Advantage, +147431,3934,344,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMORBITY,DRG,88502.17,88502.17,6777.02,61331.59,United Healthcare-Medicare Advantage, +147432,3934,345,MINOR SMALL & LARGE BOWEL PROCEDURES WITH COMPLICATION,DRG,69632.83,69632.83,17468.56,44845.0,United Healthcare-Medicare Advantage, +147433,3934,347,ANAL & STOMAL PROCEDURES WITH COMORBITY,DRG,58287.07,58287.07,21476.15,56488.0,United Healthcare-Medicare Advantage, +147434,3934,348,ANAL & STOMAL PROCEDURES WITH COMPLICATION,DRG,88961.56,88961.56,15440.43,18470.84,United Healthcare-Medicare Advantage, +147435,3934,349,ANAL & STOMAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57823.1,57823.1,10779.86,10779.86,United Healthcare-Medicare Advantage, +147436,3934,351,INGUINAL & FEMORAL HERNIA PROCEDURES WITH COMPLICATION,DRG,49792.94,49792.94,15952.6,15952.6,United Healthcare-Medicare Advantage, +147437,3934,352,INGUINAL & FEMORAL HERNIA PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,29426.56,29426.56,11763.04,23072.0,United Healthcare-Medicare Advantage, +147438,3934,353,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMORBITY,DRG,116618.47,116618.47,7250.16,57105.7,United Healthcare-Medicare Advantage, +147439,3934,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITH COMPLICATION,DRG,85561.15,85561.15,3978.31,33543.6,United Healthcare-Medicare Advantage, +147440,3934,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL WITHOUT COMPLICATION/COMORBITY,DRG,53197.68,53197.68,11773.44,29787.0,United Healthcare-Medicare Advantage, +147441,3934,356,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMORBITY,DRG,222506.72,222506.72,1839.0,94046.0,United Healthcare-Medicare Advantage, +147442,3934,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION,DRG,69771.81,69771.81,5499.26,49390.0,United Healthcare-Medicare Advantage, +147443,3934,358,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,45239.94,45239.94,15047.39,29344.0,United Healthcare-Medicare Advantage, +147444,3934,368,MAJOR ESOPHAGEAL DISORDERS WITH COMORBITY,DRG,106236.64,106236.64,20607.27,139494.99,United Healthcare-Medicare Advantage, +147445,3934,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMORBITY,DRG,75313.49,75313.49,2338.85,71485.17,United Healthcare-Medicare Advantage, +147446,3934,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITH COMPLICATION,DRG,53030.97,53030.97,564.04,22520.0,United Healthcare-Medicare Advantage,8791.48 +147447,3934,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS WITHOUT COMPLICATION/COMORBITY,DRG,49662.17,49662.17,1724.59,21343.81,United Healthcare-Medicare Advantage, +147448,3934,374,DIGESTIVE MALIGNANCY WITH COMORBITY,DRG,101705.6,101705.6,595.23,50752.38,United Healthcare-Medicare Advantage,16756.35 +147449,3934,375,DIGESTIVE MALIGNANCY WITH COMPLICATION,DRG,59929.26,59929.26,2688.42,25868.0,United Healthcare-Medicare Advantage,10408.19 +147450,3934,376,DIGESTIVE MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,66378.1,66378.1,11175.65,19373.0,United Healthcare-Medicare Advantage, +147451,3934,377,G.I. HEMORRHAGE WITH COMORBITY,DRG,108789.01,108789.01,385.07,148817.31,United Healthcare-Medicare Advantage,14927.9 +147452,3934,378,G.I. HEMORRHAGE WITH COMPLICATION,DRG,69178.03,69178.03,20.64,23941.18,United Healthcare-Medicare Advantage,9759.23 +147453,3934,379,G.I. HEMORRHAGE WITHOUT COMPLICATION/COMORBITY,DRG,39234.7,39234.7,1421.53,8919.75,United Healthcare-Medicare Advantage, +147454,3934,380,COMPLICATED PEPTIC ULCER WITH COMORBITY,DRG,79619.22,79619.22,4201.66,41613.97,United Healthcare-Medicare Advantage, +147455,3934,381,COMPLICATED PEPTIC ULCER WITH COMPLICATION,DRG,60122.95,60122.95,1477.78,23069.0,United Healthcare-Medicare Advantage, +147456,3934,382,COMPLICATED PEPTIC ULCER WITHOUT COMPLICATION/COMORBITY,DRG,53498.58,53498.58,7074.02,7074.02,United Healthcare-Medicare Advantage, +147457,3934,384,UNCOMPLICATED PEPTIC ULCER WITHOUT COMORBITY,DRG,65612.77,65612.77,7726.25,12078.16,United Healthcare-Medicare Advantage, +147458,3934,385,INFLAMMATORY BOWEL DISEASE WITH COMORBITY,DRG,133664.04,133664.04,1957.79,144882.63,United Healthcare-Medicare Advantage, +147459,3934,386,INFLAMMATORY BOWEL DISEASE WITH COMPLICATION,DRG,49875.91,49875.91,2216.74,21773.0,United Healthcare-Medicare Advantage, +147460,3934,387,INFLAMMATORY BOWEL DISEASE WITHOUT COMPLICATION/COMORBITY,DRG,57369.58,57369.58,6338.35,22440.61,United Healthcare-Medicare Advantage, +147461,3934,388,G.I. OBSTRUCTION WITH COMORBITY,DRG,81381.1,81381.1,3373.19,99510.51,United Healthcare-Medicare Advantage,13887.74 +147462,3934,389,G.I. OBSTRUCTION WITH COMPLICATION,DRG,43962.42,43962.42,18.74,25610.01,United Healthcare-Medicare Advantage, +147463,3934,390,G.I. OBSTRUCTION WITHOUT COMPLICATION/COMORBITY,DRG,33305.18,33305.18,1299.92,12419.0,United Healthcare-Medicare Advantage,5937.23 +147464,3934,391,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITH COMORBITY",DRG,78093.58,78093.58,2062.75,28203.37,United Healthcare-Medicare Advantage,11759.0 +147465,3934,392,"ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS WITHOUT COMORBITY",DRG,46731.34,46731.34,59.38,76813.08,United Healthcare-Medicare Advantage, +147466,3934,393,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMORBITY,DRG,110059.74,110059.74,3689.58,146224.41,United Healthcare-Medicare Advantage,15698.87 +147467,3934,394,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH COMPLICATION,DRG,56978.96,56978.96,1949.0,20569.0,United Healthcare-Medicare Advantage, +147468,3934,395,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,51454.79,51454.79,1599.14,16758.6,United Healthcare-Medicare Advantage, +147469,3934,405,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMORBITY",DRG,346963.27,346963.27,12113.59,211027.62,United Healthcare-Medicare Advantage, +147470,3934,406,"PANCREAS, LIVER & SHUNT PROCEDURES WITH COMPLICATION",DRG,127320.97,127320.97,6419.29,79840.28,United Healthcare-Medicare Advantage, +147471,3934,407,"PANCREAS, LIVER & SHUNT PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,112253.93,112253.93,4721.31,44701.0,United Healthcare-Medicare Advantage, +147472,3934,408,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMORBITY,DRG,218191.68,218191.68,29102.44,148391.73,United Healthcare-Medicare Advantage, +147473,3934,409,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITH COMPLICATION,DRG,78943.92,78943.92,23354.53,25731.27,United Healthcare-Medicare Advantage, +147474,3934,410,BILIARY TRACT PROC EXCEPT ONLY CHOLECYST WITH OR WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,86972.72,86972.72,3493.46,3493.46,United Healthcare-Medicare Advantage, +147475,3934,414,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMORBITY,DRG,99277.75,99277.75,23687.6,47032.32,United Healthcare-Medicare Advantage, +147476,3934,415,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH COMPLICATION,DRG,108336.8,108336.8,5013.7,49181.88,United Healthcare-Medicare Advantage,16901.77 +147477,3934,417,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMORBITY,DRG,166443.91,166443.91,460.87,392450.47,United Healthcare-Medicare Advantage,20610.78 +147478,3934,418,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH COMPLICATION,DRG,67116.34,67116.34,23.37,40130.29,United Healthcare-Medicare Advantage, +147479,3934,419,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT COMPLICATION/COMORBITY,DRG,59397.61,59397.61,760.61,31495.76,United Healthcare-Medicare Advantage, +147480,3934,420,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMORBITY,DRG,47998.57,47998.57,8393.55,73594.0,United Healthcare-Medicare Advantage, +147481,3934,421,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH COMPLICATION,DRG,68528.05,68528.05,19955.0,39450.0,United Healthcare-Medicare Advantage, +147482,3934,422,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,44430.15,44430.15,11772.77,11772.77,United Healthcare-Medicare Advantage, +147483,3934,423,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH COMORBITY,DRG,87538.0,87538.0,9324.37,45010.56,United Healthcare-Medicare Advantage, +147484,3934,432,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMORBITY,DRG,131221.82,131221.82,4366.69,156169.82,United Healthcare-Medicare Advantage, +147485,3934,433,CIRRHOSIS & ALCOHOLIC HEPATITIS WITH COMPLICATION,DRG,61356.02,61356.02,2521.88,24733.94,United Healthcare-Medicare Advantage, +147486,3934,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMORBITY,DRG,85301.22,85301.22,36.26,70496.09,United Healthcare-Medicare Advantage,47707.3 +147487,3934,436,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH COMPLICATION,DRG,63163.25,63163.25,9677.5,24549.0,United Healthcare-Medicare Advantage, +147488,3934,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMORBITY,DRG,101876.81,101876.81,1366.82,202614.97,United Healthcare-Medicare Advantage,13637.5 +147489,3934,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH COMPLICATION,DRG,49350.09,49350.09,308.47,19310.15,United Healthcare-Medicare Advantage, +147490,3934,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,130759.19,130759.19,129.1,13278.0,United Healthcare-Medicare Advantage, +147491,3934,441,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMORBITY",DRG,98218.1,98218.1,4202.99,41281.0,United Healthcare-Medicare Advantage,15575.41 +147492,3934,442,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITH COMPLICATION",DRG,85935.81,85935.81,251.44,22414.72,United Healthcare-Medicare Advantage,8051.73 +147493,3934,443,"DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA WITHOUT COMPLICATION/COMORBITY",DRG,67968.76,67968.76,1868.57,8985.95,United Healthcare-Medicare Advantage, +147494,3934,444,DISORDERS OF THE BILIARY TRACT WITH COMORBITY,DRG,99095.42,99095.42,3723.5,34841.0,United Healthcare-Medicare Advantage, +147495,3934,445,DISORDERS OF THE BILIARY TRACT WITH COMPLICATION,DRG,57215.46,57215.46,2402.6,23022.0,United Healthcare-Medicare Advantage,10424.75 +147496,3934,446,DISORDERS OF THE BILIARY TRACT WITHOUT COMPLICATION/COMORBITY,DRG,47011.14,47011.14,9055.36,17887.0,United Healthcare-Medicare Advantage, +147497,3934,454,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITH COMPLICATION,DRG,142585.98,142585.98,47.5,144041.05,United Healthcare-Medicare Advantage, +147498,3934,455,COMBINED ANTERIOR/POSTERIOR SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,84735.26,84735.26,50071.54,115425.27,United Healthcare-Medicare Advantage, +147499,3934,456,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMORBITY,DRG,172844.06,172844.06,98035.16,98035.16,United Healthcare-Medicare Advantage, +147500,3934,457,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITH COMPLICATION,DRG,161281.8,161281.8,67499.9,142491.0,United Healthcare-Medicare Advantage, +147501,3934,458,SPINAL FUS EXC CERV WITH SPINAL CURV/MALIG/INFEC OR EXT FUS WITHOUT COMPLICATION/COMORBITY,DRG,160140.17,160140.17,52878.51,140130.3,United Healthcare-Medicare Advantage, +147502,3934,459,SPINAL FUSION EXCEPT CERVICAL WITH COMORBITY,DRG,256443.21,256443.21,19989.0,154087.32,United Healthcare-Medicare Advantage, +147503,3934,460,SPINAL FUSION EXCEPT CERVICAL WITHOUT COMORBITY,DRG,95559.22,95559.22,8774.81,90084.44,United Healthcare-Medicare Advantage, +147504,3934,462,BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,88007.97,88007.97,54510.71,86339.63,United Healthcare-Medicare Advantage, +147505,3934,463,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMORBITY",DRG,68146.11,68146.11,12519.57,56417.61,United Healthcare-Medicare Advantage, +147506,3934,464,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITH COMPLICATION",DRG,195918.55,195918.55,6636.84,171205.98,United Healthcare-Medicare Advantage, +147507,3934,465,"WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS WITHOUT COMPLICATION/COMORBITY",DRG,84332.48,84332.48,20358.76,49532.47,United Healthcare-Medicare Advantage, +147508,3934,466,REVISION OF HIP OR KNEE REPLACEMENT WITH COMORBITY,DRG,51604.21,51604.21,5841.51,104353.21,United Healthcare-Medicare Advantage, +147509,3934,467,REVISION OF HIP OR KNEE REPLACEMENT WITH COMPLICATION,DRG,107302.61,107302.61,8582.45,78372.0,United Healthcare-Medicare Advantage, +147510,3934,468,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT COMPLICATION/COMORBITY,DRG,63381.95,63381.95,6871.87,63668.82,United Healthcare-Medicare Advantage, +147511,3934,469,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH COMORBITY OR TOTAL ANKLE REPLACEMENT,DRG,75975.57,75975.57,4799.67,75253.98,United Healthcare-Medicare Advantage,26584.47 +147512,3934,470,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT COMORBITY,DRG,48892.69,48892.69,4239.14,51250.08,United Healthcare-Medicare Advantage,16298.17 +147513,3934,472,CERVICAL SPINAL FUSION WITH COMPLICATION,DRG,84681.64,84681.64,7283.81,90834.88,United Healthcare-Medicare Advantage, +147514,3934,473,CERVICAL SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,59878.77,59878.77,5667.81,55668.0,United Healthcare-Medicare Advantage, +147515,3934,474,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMORBITY,DRG,133326.88,133326.88,1768.0,78197.76,United Healthcare-Medicare Advantage, +147516,3934,475,AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS WITH COMPLICATION,DRG,128693.73,128693.73,22226.16,25114.91,United Healthcare-Medicare Advantage, +147517,3934,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMORBITY,DRG,223751.56,223751.56,29961.48,69748.0,United Healthcare-Medicare Advantage,29961.48 +147518,3934,478,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION,DRG,84900.68,84900.68,419.23,49646.0,United Healthcare-Medicare Advantage, +147519,3934,479,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY,DRG,62601.68,62601.68,18431.71,32198.97,United Healthcare-Medicare Advantage, +147520,3934,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMORBITY,DRG,131172.97,131172.97,6748.4,144309.65,United Healthcare-Medicare Advantage, +147521,3934,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH COMPLICATION,DRG,114274.88,114274.88,3968.62,53827.83,United Healthcare-Medicare Advantage,17818.75 +147522,3934,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT COMPLICATION/COMORBITY,DRG,76340.18,76340.18,3674.41,36090.0,United Healthcare-Medicare Advantage, +147523,3934,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,DRG,79403.31,79403.31,5324.42,62581.34,United Healthcare-Medicare Advantage, +147524,3934,486,KNEE PROCEDURES WITH PDX OF INFECTION WITH COMPLICATION,DRG,127391.07,127391.07,23189.14,47082.0,United Healthcare-Medicare Advantage, +147525,3934,487,KNEE PROCEDURES WITH PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,66546.04,66546.04,34436.0,35947.0,United Healthcare-Medicare Advantage, +147526,3934,488,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITH COMPLICATION/COMORBITY,DRG,128198.08,128198.08,35281.96,43155.0,United Healthcare-Medicare Advantage, +147527,3934,489,KNEE PROCEDURES WITHOUT PDX OF INFECTION WITHOUT COMPLICATION/COMORBITY,DRG,76382.54,76382.54,23798.62,28450.0,United Healthcare-Medicare Advantage, +147528,3934,492,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMORBITY",DRG,122772.8,122772.8,8419.21,123403.67,United Healthcare-Medicare Advantage, +147529,3934,493,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITH COMPLICATION",DRG,106891.99,106891.99,183.7,50957.0,United Healthcare-Medicare Advantage, +147530,3934,494,"LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR WITHOUT COMPLICATION/COMORBITY",DRG,68893.96,68893.96,122.99,41556.81,United Healthcare-Medicare Advantage,15074.95 +147531,3934,496,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITH COMPLICATION,DRG,59067.99,59067.99,22038.27,22038.27,United Healthcare-Medicare Advantage, +147532,3934,497,LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR WITHOUT COMPLICATION/COMORBITY,DRG,50204.69,50204.69,16684.05,16684.05,United Healthcare-Medicare Advantage, +147533,3934,498,LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR WITH COMPLICATION/COMORBITY,DRG,173924.49,173924.49,5982.38,28134.34,United Healthcare-Medicare Advantage, +147534,3934,500,SOFT TISSUE PROCEDURES WITH COMORBITY,DRG,162988.74,162988.74,31608.34,64604.0,United Healthcare-Medicare Advantage, +147535,3934,501,SOFT TISSUE PROCEDURES WITH COMPLICATION,DRG,82466.41,82466.41,4100.49,35953.0,United Healthcare-Medicare Advantage, +147536,3934,502,SOFT TISSUE PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,48064.66,48064.66,937.03,28297.0,United Healthcare-Medicare Advantage, +147537,3934,504,FOOT PROCEDURES WITH COMPLICATION,DRG,126474.45,126474.45,3051.33,37206.0,United Healthcare-Medicare Advantage, +147538,3934,505,FOOT PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,72993.86,72993.86,4109.05,36028.0,United Healthcare-Medicare Advantage, +147539,3934,507,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH COMPLICATION/COMORBITY,DRG,60049.24,60049.24,36502.47,36502.47,United Healthcare-Medicare Advantage, +147540,3934,511,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITH COMPLICATION",DRG,49967.35,49967.35,4604.38,34643.67,United Healthcare-Medicare Advantage, +147541,3934,512,"SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,47896.38,47896.38,3625.26,36290.02,United Healthcare-Medicare Advantage, +147542,3934,513,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITH COMPLICATION/COMORBITY",DRG,50203.95,50203.95,17194.41,17962.79,United Healthcare-Medicare Advantage, +147543,3934,514,"HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC WITHOUT COMPLICATION/COMORBITY",DRG,40238.71,40238.71,22857.0,22857.0,United Healthcare-Medicare Advantage, +147544,3934,515,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMORBITY,DRG,247006.31,247006.31,7553.22,62792.61,United Healthcare-Medicare Advantage,25553.7 +147545,3934,516,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITH COMPLICATION,DRG,132830.12,132830.12,2727.5,55815.0,United Healthcare-Medicare Advantage, +147546,3934,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,54715.26,54715.26,3116.38,30609.0,United Healthcare-Medicare Advantage, +147547,3934,518,BACK & NECK PROC EXC SPINAL FUSION WITH COMORBITY OR DISC DEVICE/NEUROSTIM,DRG,101653.19,101653.19,27431.43,72523.82,United Healthcare-Medicare Advantage, +147548,3934,519,BACK & NECK PROC EXC SPINAL FUSION WITH COMPLICATION,DRG,86565.7,86565.7,4570.96,40896.0,United Healthcare-Medicare Advantage, +147549,3934,520,BACK & NECK PROC EXC SPINAL FUSION WITHOUT COMPLICATION/COMORBITY,DRG,46188.38,46188.38,3269.64,31062.0,United Healthcare-Medicare Advantage, +147550,3934,521,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,DRG,127493.31,127493.31,6173.55,59215.93,United Healthcare-Medicare Advantage, +147551,3934,522,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,DRG,117612.05,117612.05,4884.42,25439.29,United Healthcare-Medicare Advantage, +147552,3934,534,FRACTURES OF FEMUR WITHOUT COMORBITY,DRG,31343.73,31343.73,8697.54,16665.0,United Healthcare-Medicare Advantage, +147553,3934,535,FRACTURES OF HIP & PELVIS WITH COMORBITY,DRG,67979.17,67979.17,2173.42,15143.58,United Healthcare-Medicare Advantage, +147554,3934,536,FRACTURES OF HIP & PELVIS WITHOUT COMORBITY,DRG,62643.34,62643.34,1721.63,13845.48,United Healthcare-Medicare Advantage, +147555,3934,539,OSTEOMYELITIS WITH COMORBITY,DRG,156963.31,156963.31,1420.17,199612.0,United Healthcare-Medicare Advantage,15854.18 +147556,3934,540,OSTEOMYELITIS WITH COMPLICATION,DRG,39204.42,39204.42,3176.79,28386.0,United Healthcare-Medicare Advantage, +147557,3934,542,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMORBITY,DRG,53862.49,53862.49,4028.06,24783.21,United Healthcare-Medicare Advantage, +147558,3934,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITH COMPLICATION,DRG,121585.7,121585.7,9195.11,91973.71,United Healthcare-Medicare Advantage,9195.11 +147559,3934,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG WITHOUT COMPLICATION/COMORBITY,DRG,55470.02,55470.02,1731.89,16249.0,United Healthcare-Medicare Advantage,6801.88 +147560,3934,545,CONNECTIVE TISSUE DISORDERS WITH COMORBITY,DRG,83964.17,83964.17,4335.46,54777.0,United Healthcare-Medicare Advantage, +147561,3934,546,CONNECTIVE TISSUE DISORDERS WITH COMPLICATION,DRG,59908.39,59908.39,802.24,94241.33,United Healthcare-Medicare Advantage, +147562,3934,547,CONNECTIVE TISSUE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,46982.56,46982.56,1979.62,17357.0,United Healthcare-Medicare Advantage, +147563,3934,548,SEPTIC ARTHRITIS WITH COMORBITY,DRG,114268.13,114268.13,12715.66,12715.66,United Healthcare-Medicare Advantage, +147564,3934,549,SEPTIC ARTHRITIS WITH COMPLICATION,DRG,76989.85,76989.85,2915.56,49816.0,United Healthcare-Medicare Advantage, +147565,3934,551,MEDICAL BACK PROBLEMS WITH COMORBITY,DRG,99504.59,99504.59,1949.0,79828.14,United Healthcare-Medicare Advantage, +147566,3934,552,MEDICAL BACK PROBLEMS WITHOUT COMORBITY,DRG,63061.39,63061.39,31.63,20644.0,United Healthcare-Medicare Advantage,9351.63 +147567,3934,553,BONE DISEASES & ARTHROPATHIES WITH COMORBITY,DRG,126696.69,126696.69,14146.37,15515.34,United Healthcare-Medicare Advantage, +147568,3934,554,BONE DISEASES & ARTHROPATHIES WITHOUT COMORBITY,DRG,56594.75,56594.75,7310.05,49832.34,United Healthcare-Medicare Advantage, +147569,3934,555,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITH COMORBITY,DRG,55570.29,55570.29,14457.85,28182.0,United Healthcare-Medicare Advantage, +147570,3934,556,SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE WITHOUT COMORBITY,DRG,47603.48,47603.48,1896.2,16965.0,United Healthcare-Medicare Advantage,7070.2 +147571,3934,557,"TENDONITIS, MYOSITIS & BURSITIS WITH COMORBITY",DRG,66490.93,66490.93,3563.37,17884.42,United Healthcare-Medicare Advantage,10689.33 +147572,3934,558,"TENDONITIS, MYOSITIS & BURSITIS WITHOUT COMORBITY",DRG,53644.0,53644.0,18.98,20653.95,United Healthcare-Medicare Advantage, +147573,3934,560,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITH COMPLICATION",DRG,26058.68,26058.68,2549.98,23589.0,United Healthcare-Medicare Advantage, +147574,3934,561,"AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE WITHOUT COMPLICATION/COMORBITY",DRG,22362.16,22362.16,6585.75,10373.4,United Healthcare-Medicare Advantage, +147575,3934,562,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITH COMORBITY",DRG,63409.28,63409.28,3141.59,30856.0,United Healthcare-Medicare Advantage,13061.4 +147576,3934,563,"FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH WITHOUT COMORBITY",DRG,39137.45,39137.45,1391.34,19084.0,United Healthcare-Medicare Advantage,8307.03 +147577,3934,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMORBITY,DRG,108406.49,108406.49,3620.95,17247.54,United Healthcare-Medicare Advantage,12667.81 +147578,3934,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES WITH COMPLICATION,DRG,42699.18,42699.18,2396.03,23499.64,United Healthcare-Medicare Advantage, +147579,3934,570,SKIN DEBRIDEMENT WITH COMORBITY,DRG,80409.6,80409.6,28853.23,32413.62,United Healthcare-Medicare Advantage, +147580,3934,571,SKIN DEBRIDEMENT WITH COMPLICATION,DRG,101474.91,101474.91,14411.2,19442.91,United Healthcare-Medicare Advantage, +147581,3934,572,SKIN DEBRIDEMENT WITHOUT COMPLICATION/COMORBITY,DRG,49377.31,49377.31,41.48,24327.27,United Healthcare-Medicare Advantage, +147582,3934,577,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITH COMPLICATION,DRG,162581.0,162581.0,5902.95,119679.32,United Healthcare-Medicare Advantage, +147583,3934,578,SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS WITHOUT COMPLICATION/COMORBITY,DRG,87844.85,87844.85,17408.1,34869.0,United Healthcare-Medicare Advantage, +147584,3934,579,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMORBITY",DRG,98816.24,98816.24,14280.73,57775.0,United Healthcare-Medicare Advantage,24261.98 +147585,3934,580,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITH COMPLICATION",DRG,63422.57,63422.57,1788.45,38599.63,United Healthcare-Medicare Advantage, +147586,3934,581,"OTHER SKIN, SUBCUT TISS & BREAST PROC WITHOUT COMPLICATION/COMORBITY",DRG,47781.38,47781.38,2811.15,33501.76,United Healthcare-Medicare Advantage, +147587,3934,582,MASTECTOMY FOR MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,47362.98,47362.98,17211.15,39303.41,United Healthcare-Medicare Advantage, +147588,3934,583,MASTECTOMY FOR MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,57257.12,57257.12,15985.02,33703.0,United Healthcare-Medicare Advantage, +147589,3934,584,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITH COMPLICATION/COMORBITY",DRG,115789.5,115789.5,39175.0,39175.0,United Healthcare-Medicare Advantage, +147590,3934,585,"BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,59691.09,59691.09,14380.75,39202.13,United Healthcare-Medicare Advantage, +147591,3934,592,SKIN ULCERS WITH COMORBITY,DRG,84632.72,84632.72,14558.03,31290.18,United Healthcare-Medicare Advantage, +147592,3934,593,SKIN ULCERS WITH COMPLICATION,DRG,755540.54,755540.54,2536.48,11144.23,United Healthcare-Medicare Advantage,10902.39 +147593,3934,595,MAJOR SKIN DISORDERS WITH COMORBITY,DRG,176913.32,176913.32,4489.49,37459.14,United Healthcare-Medicare Advantage,26905.75 +147594,3934,596,MAJOR SKIN DISORDERS WITHOUT COMORBITY,DRG,49294.63,49294.63,2207.15,11912.44,United Healthcare-Medicare Advantage,11315.84 +147595,3934,597,MALIGNANT BREAST DISORDERS WITH COMORBITY,DRG,112794.75,112794.75,36272.0,36272.0,United Healthcare-Medicare Advantage, +147596,3934,600,NON-MALIGNANT BREAST DISORDERS WITH COMPLICATION/COMORBITY,DRG,79995.93,79995.93,2221.65,2221.65,United Healthcare-Medicare Advantage, +147597,3934,601,NON-MALIGNANT BREAST DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,36413.04,36413.04,11114.26,13341.53,United Healthcare-Medicare Advantage, +147598,3934,602,CELLULITIS WITH COMORBITY,DRG,312126.8,312126.8,3205.41,30635.0,United Healthcare-Medicare Advantage,12195.67 +147599,3934,603,CELLULITIS WITHOUT COMORBITY,DRG,43276.46,43276.46,1874.42,32730.91,United Healthcare-Medicare Advantage,9139.21 +147600,3934,604,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITH COMORBITY",DRG,115507.97,115507.97,3327.46,35802.36,United Healthcare-Medicare Advantage, +147601,3934,605,"TRAUMA TO THE SKIN, SUBCUT TISS & BREAST WITHOUT COMORBITY",DRG,56994.73,56994.73,17.72,20987.9,United Healthcare-Medicare Advantage, +147602,3934,606,MINOR SKIN DISORDERS WITH COMORBITY,DRG,74305.64,74305.64,28935.0,33114.0,United Healthcare-Medicare Advantage, +147603,3934,607,MINOR SKIN DISORDERS WITHOUT COMORBITY,DRG,273382.89,273382.89,1842.12,21388.82,United Healthcare-Medicare Advantage, +147604,3934,614,ADRENAL & PITUITARY PROCEDURES WITH COMPLICATION/COMORBITY,DRG,141611.17,141611.17,5946.21,52307.0,United Healthcare-Medicare Advantage, +147605,3934,615,ADRENAL & PITUITARY PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,68647.81,68647.81,18544.37,32524.0,United Healthcare-Medicare Advantage, +147606,3934,616,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMORBITY",DRG,183919.76,183919.76,8899.98,72301.99,United Healthcare-Medicare Advantage, +147607,3934,617,"AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS WITH COMPLICATION",DRG,129590.66,129590.66,4538.57,43951.0,United Healthcare-Medicare Advantage, +147608,3934,619,O.R. PROCEDURES FOR OBESITY WITH COMORBITY,DRG,32849.85,32849.85,34833.14,34833.14,United Healthcare-Medicare Advantage, +147609,3934,620,O.R. PROCEDURES FOR OBESITY WITH COMPLICATION,DRG,32665.12,32665.12,3929.44,34182.9,United Healthcare-Medicare Advantage,15872.38 +147610,3934,621,O.R. PROCEDURES FOR OBESITY WITHOUT COMPLICATION/COMORBITY,DRG,65799.31,65799.31,3841.47,37676.12,United Healthcare-Medicare Advantage,14561.23 +147611,3934,622,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMORBITY",DRG,349878.02,349878.02,8061.04,40174.02,United Healthcare-Medicare Advantage, +147612,3934,623,"SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS WITH COMPLICATION",DRG,120198.77,120198.77,4178.9,26239.53,United Healthcare-Medicare Advantage, +147613,3934,625,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMORBITY",DRG,188169.72,188169.72,6339.41,31284.88,United Healthcare-Medicare Advantage, +147614,3934,626,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITH COMPLICATION",DRG,49564.02,49564.02,3686.68,36210.0,United Healthcare-Medicare Advantage, +147615,3934,627,"THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION/COMORBITY",DRG,45020.47,45020.47,12643.24,24462.0,United Healthcare-Medicare Advantage, +147616,3934,628,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMORBITY",DRG,157397.48,157397.48,21008.56,30465.37,United Healthcare-Medicare Advantage, +147617,3934,629,"OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC WITH COMPLICATION",DRG,76381.8,76381.8,12849.16,49768.0,United Healthcare-Medicare Advantage, +147618,3934,637,DIABETES WITH COMORBITY,DRG,75028.66,75028.66,3067.29,52842.46,United Healthcare-Medicare Advantage, +147619,3934,638,DIABETES WITH COMPLICATION,DRG,46700.09,46700.09,230.69,21277.06,United Healthcare-Medicare Advantage,7811.73 +147620,3934,639,DIABETES WITHOUT COMPLICATION/COMORBITY,DRG,47510.38,47510.38,346.55,13353.0,United Healthcare-Medicare Advantage, +147621,3934,640,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITH COMORBITY",DRG,15439.46,15439.46,1962.18,172187.85,United Healthcare-Medicare Advantage,11856.96 +147622,3934,641,"MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES WITHOUT COMORBITY",DRG,46139.98,46139.98,9.61,21429.0,United Healthcare-Medicare Advantage,7847.03 +147623,3934,642,INBORN AND OTHER DISORDERS OF METABOLISM,DRG,49533.09,49533.09,13417.8,28216.0,United Healthcare-Medicare Advantage, +147624,3934,643,ENDOCRINE DISORDERS WITH COMORBITY,DRG,105209.58,105209.58,3711.23,62078.9,United Healthcare-Medicare Advantage, +147625,3934,644,ENDOCRINE DISORDERS WITH COMPLICATION,DRG,57740.62,57740.62,2272.08,117667.6,United Healthcare-Medicare Advantage, +147626,3934,645,ENDOCRINE DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,41580.09,41580.09,1869.9,16395.0,United Healthcare-Medicare Advantage, +147627,3934,650,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,DRG,487283.91,487283.91,47749.89,102650.52,United Healthcare-Medicare Advantage, +147628,3934,651,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,DRG,115559.9,115559.9,39415.72,96578.13,United Healthcare-Medicare Advantage, +147629,3934,652,KIDNEY TRANSPLANT,DRG,223491.32,223491.32,7099.6,139500.0,United Healthcare-Medicare Advantage,27183.21 +147630,3934,653,MAJOR BLADDER PROCEDURES WITH COMORBITY,DRG,458762.32,458762.32,8229.83,119419.0,United Healthcare-Medicare Advantage, +147631,3934,654,MAJOR BLADDER PROCEDURES WITH COMPLICATION,DRG,106897.6,106897.6,2449.82,63558.0,United Healthcare-Medicare Advantage, +147632,3934,655,MAJOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,57230.05,57230.05,22267.2,41832.92,United Healthcare-Medicare Advantage, +147633,3934,656,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMORBITY,DRG,204746.29,204746.29,7322.27,71918.0,United Healthcare-Medicare Advantage, +147634,3934,657,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITH COMPLICATION,DRG,94448.12,94448.12,4315.45,42386.0,United Healthcare-Medicare Advantage, +147635,3934,658,KIDNEY & URETER PROCEDURES FOR NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,62606.11,62606.11,3523.36,42030.68,United Healthcare-Medicare Advantage, +147636,3934,659,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMORBITY,DRG,183105.76,183105.76,55.02,151025.28,United Healthcare-Medicare Advantage, +147637,3934,660,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITH COMPLICATION,DRG,70448.83,70448.83,3220.58,31632.0,United Healthcare-Medicare Advantage,12167.9 +147638,3934,661,KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM WITHOUT COMPLICATION/COMORBITY,DRG,56004.16,56004.16,123.89,34184.99,United Healthcare-Medicare Advantage, +147639,3934,662,MINOR BLADDER PROCEDURES WITH COMORBITY,DRG,52326.66,52326.66,6537.1,56814.34,United Healthcare-Medicare Advantage, +147640,3934,663,MINOR BLADDER PROCEDURES WITH COMPLICATION,DRG,55207.97,55207.97,12830.19,29159.45,United Healthcare-Medicare Advantage, +147641,3934,664,MINOR BLADDER PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,53906.13,53906.13,9623.77,14610.28,United Healthcare-Medicare Advantage, +147642,3934,666,PROSTATECTOMY WITH COMPLICATION,DRG,78360.84,78360.84,3869.65,19489.99,United Healthcare-Medicare Advantage, +147643,3934,667,PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,90976.44,90976.44,2293.88,10521.29,United Healthcare-Medicare Advantage, +147644,3934,668,TRANSURETHRAL PROCEDURES WITH COMORBITY,DRG,76421.1,76421.1,29282.04,59742.0,United Healthcare-Medicare Advantage, +147645,3934,669,TRANSURETHRAL PROCEDURES WITH COMPLICATION,DRG,139054.25,139054.25,3777.2,46936.61,United Healthcare-Medicare Advantage, +147646,3934,670,TRANSURETHRAL PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,23568.65,23568.65,10939.41,11783.3,United Healthcare-Medicare Advantage, +147647,3934,673,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMORBITY,DRG,207232.92,207232.92,7727.02,112881.3,United Healthcare-Medicare Advantage, +147648,3934,674,OTHER KIDNEY & URINARY TRACT PROCEDURES WITH COMPLICATION,DRG,148215.76,148215.76,5311.25,52369.0,United Healthcare-Medicare Advantage,40128.31 +147649,3934,682,RENAL FAILURE WITH COMORBITY,DRG,87702.09,87702.09,1525.7,83540.93,United Healthcare-Medicare Advantage,15393.53 +147650,3934,683,RENAL FAILURE WITH COMPLICATION,DRG,53807.73,53807.73,1414.74,25256.66,United Healthcare-Medicare Advantage,7798.81 +147651,3934,684,RENAL FAILURE WITHOUT COMPLICATION/COMORBITY,DRG,47315.79,47315.79,5572.88,13313.0,United Healthcare-Medicare Advantage,5572.88 +147652,3934,686,KIDNEY & URINARY TRACT NEOPLASMS WITH COMORBITY,DRG,69802.76,69802.76,33977.0,33977.0,United Healthcare-Medicare Advantage, +147653,3934,687,KIDNEY & URINARY TRACT NEOPLASMS WITH COMPLICATION,DRG,67096.65,67096.65,2337.9,13140.43,United Healthcare-Medicare Advantage, +147654,3934,689,KIDNEY & URINARY TRACT INFECTIONS WITH COMORBITY,DRG,63645.13,63645.13,1409.87,32185.48,United Healthcare-Medicare Advantage,9550.41 +147655,3934,690,KIDNEY & URINARY TRACT INFECTIONS WITHOUT COMORBITY,DRG,87564.93,87564.93,454.16,24118.61,United Healthcare-Medicare Advantage,8493.93 +147656,3934,693,URINARY STONES WITH COMORBITY,DRG,77551.29,77551.29,3307.03,14855.06,United Healthcare-Medicare Advantage,11624.27 +147657,3934,694,URINARY STONES WITHOUT COMORBITY,DRG,162569.78,162569.78,1809.3,15864.0,United Healthcare-Medicare Advantage, +147658,3934,695,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITH COMORBITY,DRG,126003.95,126003.95,10137.41,15562.12,United Healthcare-Medicare Advantage, +147659,3934,696,KIDNEY & URINARY TRACT SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,41786.41,41786.41,1627.04,11997.39,United Healthcare-Medicare Advantage, +147660,3934,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMORBITY,DRG,113760.55,113760.55,187.4,99946.74,United Healthcare-Medicare Advantage, +147661,3934,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITH COMPLICATION,DRG,64977.5,64977.5,1503.49,22467.0,United Healthcare-Medicare Advantage, +147662,3934,700,OTHER KIDNEY & URINARY TRACT DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,33241.57,33241.57,20.8,16322.0,United Healthcare-Medicare Advantage, +147663,3934,707,MAJOR MALE PELVIC PROCEDURES WITH COMPLICATION/COMORBITY,DRG,77784.83,77784.83,4478.05,46519.92,United Healthcare-Medicare Advantage, +147664,3934,708,MAJOR MALE PELVIC PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,64072.86,64072.86,3608.63,41778.4,United Healthcare-Medicare Advantage,12154.15 +147665,3934,711,TESTES PROCEDURES WITH COMPLICATION/COMORBITY,DRG,181855.42,181855.42,23111.79,29719.75,United Healthcare-Medicare Advantage, +147666,3934,712,TESTES PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,30255.91,30255.91,19739.0,19739.0,United Healthcare-Medicare Advantage, +147667,3934,713,TRANSURETHRAL PROSTATECTOMY WITH COMPLICATION/COMORBITY,DRG,39473.35,39473.35,3501.21,31330.77,United Healthcare-Medicare Advantage, +147668,3934,714,TRANSURETHRAL PROSTATECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,44504.11,44504.11,13250.29,13250.29,United Healthcare-Medicare Advantage, +147669,3934,717,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,77343.22,77343.22,4012.89,39414.0,United Healthcare-Medicare Advantage, +147670,3934,722,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43552.5,43552.5,4410.6,19575.57,United Healthcare-Medicare Advantage, +147671,3934,723,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,56542.54,56542.54,13584.41,13584.41,United Healthcare-Medicare Advantage, +147672,3934,725,BENIGN PROSTATIC HYPERTROPHY WITH COMORBITY,DRG,19745.11,19745.11,13831.72,13831.72,United Healthcare-Medicare Advantage, +147673,3934,726,BENIGN PROSTATIC HYPERTROPHY WITHOUT COMORBITY,DRG,25771.7,25771.7,1658.48,16681.23,United Healthcare-Medicare Advantage, +147674,3934,727,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH COMORBITY,DRG,65933.42,65933.42,3487.87,15628.58,United Healthcare-Medicare Advantage,7156.19 +147675,3934,728,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT COMORBITY,DRG,46474.06,46474.06,1792.8,17609.0,United Healthcare-Medicare Advantage, +147676,3934,734,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITH COMPLICATION/COMORBITY",DRG,104004.76,104004.76,1468.15,24457.94,United Healthcare-Medicare Advantage, +147677,3934,735,"PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY WITHOUT COMPLICATION/COMORBITY",DRG,26457.16,26457.16,16224.14,16224.14,United Healthcare-Medicare Advantage, +147678,3934,736,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMORBITY,DRG,84365.79,84365.79,57444.37,57444.37,United Healthcare-Medicare Advantage, +147679,3934,737,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITH COMPLICATION,DRG,54320.2,54320.2,352.85,50281.13,United Healthcare-Medicare Advantage, +147680,3934,738,UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,36928.78,36928.78,16869.21,29544.0,United Healthcare-Medicare Advantage, +147681,3934,740,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITH COMPLICATION",DRG,64200.16,64200.16,19366.52,43760.48,United Healthcare-Medicare Advantage, +147682,3934,741,"UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG WITHOUT COMPLICATION/COMORBITY",DRG,37671.29,37671.29,14864.75,28486.0,United Healthcare-Medicare Advantage, +147683,3934,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITH COMPLICATION/COMORBITY,DRG,64331.83,64331.83,42.25,51528.06,United Healthcare-Medicare Advantage, +147684,3934,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY WITHOUT COMPLICATION/COMORBITY,DRG,37348.24,37348.24,2750.44,35028.1,United Healthcare-Medicare Advantage, +147685,3934,744,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITH COMPLICATION/COMORBITY",DRG,86006.76,86006.76,4168.17,4168.17,United Healthcare-Medicare Advantage, +147686,3934,745,"D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION WITHOUT COMPLICATION/COMORBITY",DRG,53894.43,53894.43,22825.0,22825.0,United Healthcare-Medicare Advantage, +147687,3934,746,"VAGINA, CERVIX & VULVA PROCEDURES WITH COMPLICATION/COMORBITY",DRG,118404.25,118404.25,3590.96,19190.78,United Healthcare-Medicare Advantage, +147688,3934,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,DRG,49960.34,49960.34,11338.96,29548.0,United Healthcare-Medicare Advantage, +147689,3934,749,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH COMPLICATION/COMORBITY,DRG,180993.64,180993.64,27805.11,30564.41,United Healthcare-Medicare Advantage, +147690,3934,750,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT COMPLICATION/COMORBITY,DRG,66120.6,66120.6,28522.0,28522.0,United Healthcare-Medicare Advantage, +147691,3934,754,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMORBITY",DRG,43545.92,43545.92,20371.72,39965.0,United Healthcare-Medicare Advantage, +147692,3934,755,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,63625.38,63625.38,2515.95,13999.25,United Healthcare-Medicare Advantage, +147693,3934,758,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH COMPLICATION",DRG,61579.12,61579.12,416.41,19887.78,United Healthcare-Medicare Advantage, +147694,3934,759,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT COMPLICATION/COMORBITY",DRG,32427.62,32427.62,1581.29,14148.0,United Healthcare-Medicare Advantage, +147695,3934,761,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,20499.9,20499.9,6519.93,12930.0,United Healthcare-Medicare Advantage, +147696,3934,768,VAGINAL DELIVERY WITH O.R. PROC EXCEPT STERIL &/OR D&C,DRG,31723.73,31723.73,39.62,82350.0,United Healthcare-Medicare Advantage, +147697,3934,769,POSTPARTUM & POST ABORTION DIAGNOSES WITH O.R. PROCEDURE,DRG,25871.45,25871.45,22470.09,27919.0,United Healthcare-Medicare Advantage, +147698,3934,776,POSTPARTUM & POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURE,DRG,36507.09,36507.09,28.95,17218.39,United Healthcare-Medicare Advantage, +147699,3934,779,ABORTION WITHOUT D&C,DRG,25489.17,25489.17,1957.79,22092.0,United Healthcare-Medicare Advantage, +147700,3934,783,CESAREAN SECTION WITH STERILIZATION WITH COMORBITY,DRG,46218.48,46218.48,10980.0,54720.0,United Healthcare-Medicare Advantage, +147701,3934,784,CESAREAN SECTION WITH STERILIZATION WITH COMPLICATION,DRG,33702.45,33702.45,68.17,37308.0,United Healthcare-Medicare Advantage, +147702,3934,785,CESAREAN SECTION WITH STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,27727.55,27727.55,90.94,26180.34,United Healthcare-Medicare Advantage, +147703,3934,786,CESAREAN SECTION WITHOUT STERILIZATION WITH COMORBITY,DRG,49289.17,49289.17,112.57,182464.0,United Healthcare-Medicare Advantage, +147704,3934,787,CESAREAN SECTION WITHOUT STERILIZATION WITH COMPLICATION,DRG,36782.86,36782.86,32.63,186050.75,United Healthcare-Medicare Advantage, +147705,3934,788,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT COMPLICATION/COMORBITY,DRG,30394.52,30394.52,43.39,42560.0,United Healthcare-Medicare Advantage, +147706,3934,789,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",DRG,115354.18,115354.18,1846.3,369848.98,United Healthcare-Medicare Advantage, +147707,3934,790,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",DRG,423684.81,423684.81,108.62,738015.92,United Healthcare-Medicare Advantage, +147708,3934,791,PREMATURITY WITH MAJOR PROBLEMS,DRG,127530.56,127530.56,67.38,399880.15,United Healthcare-Medicare Advantage, +147709,3934,792,PREMATURITY WITHOUT MAJOR PROBLEMS,DRG,40310.9,40310.9,37.52,61308.0,United Healthcare-Medicare Advantage, +147710,3934,793,FULL TERM NEONATE WITH MAJOR PROBLEMS,DRG,57742.26,57742.26,22.68,322344.0,United Healthcare-Medicare Advantage, +147711,3934,794,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,DRG,16774.78,16774.78,48.19,46441.71,United Healthcare-Medicare Advantage, +147712,3934,795,NORMAL NEWBORN,DRG,8188.39,8188.39,54.71,23310.0,United Healthcare-Medicare Advantage, +147713,3934,796,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMORBITY,DRG,63812.59,63812.59,20944.17,20944.17,United Healthcare-Medicare Advantage, +147714,3934,797,VAGINAL DELIVERY WITH STERILIZATION/D&C WITH COMPLICATION,DRG,35897.56,35897.56,9463.35,18654.0,United Healthcare-Medicare Advantage, +147715,3934,798,VAGINAL DELIVERY WITH STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,24404.61,24404.61,10623.64,20687.51,United Healthcare-Medicare Advantage, +147716,3934,800,SPLENECTOMY WITH COMPLICATION,DRG,46139.42,46139.42,55083.66,55083.66,United Healthcare-Medicare Advantage, +147717,3934,801,SPLENECTOMY WITHOUT COMPLICATION/COMORBITY,DRG,222231.85,222231.85,38698.77,38698.77,United Healthcare-Medicare Advantage, +147718,3934,802,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMORBITY,DRG,118720.21,118720.21,33057.21,50995.0,United Healthcare-Medicare Advantage, +147719,3934,803,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITH COMPLICATION,DRG,62706.72,62706.72,4560.51,21020.55,United Healthcare-Medicare Advantage, +147720,3934,804,OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS WITHOUT COMPLICATION/COMORBITY,DRG,59626.42,59626.42,29896.0,29896.0,United Healthcare-Medicare Advantage, +147721,3934,805,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMORBITY,DRG,30937.27,30937.27,50.73,166173.75,United Healthcare-Medicare Advantage, +147722,3934,806,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITH COMPLICATION,DRG,26439.2,26439.2,27.27,36255.0,United Healthcare-Medicare Advantage, +147723,3934,807,VAGINAL DELIVERY WITHOUT STERILIZATION/D&C WITHOUT COMPLICATION/COMORBITY,DRG,23918.93,23918.93,11.49,49744.0,United Healthcare-Medicare Advantage, +147724,3934,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMORBITY,DRG,140323.42,140323.42,4859.43,66394.99,United Healthcare-Medicare Advantage, +147725,3934,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITH COMPLICATION,DRG,105188.06,105188.06,2725.91,29141.48,United Healthcare-Medicare Advantage, +147726,3934,810,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL WITHOUT COMPLICATION/COMORBITY,DRG,28118.77,28118.77,21054.0,21054.0,United Healthcare-Medicare Advantage, +147727,3934,811,RED BLOOD CELL DISORDERS WITH COMORBITY,DRG,70252.08,70252.08,3275.26,30976.01,United Healthcare-Medicare Advantage,30976.01 +147728,3934,812,RED BLOOD CELL DISORDERS WITHOUT COMORBITY,DRG,46139.43,46139.43,137.72,38601.62,United Healthcare-Medicare Advantage, +147729,3934,813,COAGULATION DISORDERS,DRG,78378.38,78378.38,3446.6,179628.36,United Healthcare-Medicare Advantage,25902.09 +147730,3934,814,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMORBITY,DRG,154340.88,154340.88,4218.61,45157.53,United Healthcare-Medicare Advantage, +147731,3934,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITH COMPLICATION,DRG,40210.74,40210.74,11295.87,21751.0,United Healthcare-Medicare Advantage, +147732,3934,816,RETICULOENDOTHELIAL & IMMUNITY DISORDERS WITHOUT COMPLICATION/COMORBITY,DRG,51392.26,51392.26,13405.43,20598.59,United Healthcare-Medicare Advantage, +147733,3934,817,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMORBITY,DRG,74427.94,74427.94,39690.01,39690.01,United Healthcare-Medicare Advantage, +147734,3934,818,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,39594.59,39594.59,27295.0,27295.0,United Healthcare-Medicare Advantage, +147735,3934,819,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,41630.78,41630.78,2937.62,17096.0,United Healthcare-Medicare Advantage, +147736,3934,820,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,418729.02,418729.02,59691.29,419207.35,United Healthcare-Medicare Advantage, +147737,3934,821,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,193250.09,193250.09,4808.55,44860.0,United Healthcare-Medicare Advantage, +147738,3934,822,LYMPHOMA & LEUKEMIA WITH MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,84687.54,84687.54,2792.63,24278.95,United Healthcare-Medicare Advantage, +147739,3934,823,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMORBITY,DRG,425958.05,425958.05,2177.48,964952.47,United Healthcare-Medicare Advantage,34693.05 +147740,3934,824,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITH COMPLICATION,DRG,203404.51,203404.51,5271.76,49818.0,United Healthcare-Medicare Advantage, +147741,3934,825,LYMPHOMA & NON-ACUTE LEUKEMIA WITH OTHER PROC WITHOUT COMPLICATION/COMORBITY,DRG,120893.1,120893.1,16941.96,32463.3,United Healthcare-Medicare Advantage, +147742,3934,826,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMORBITY,DRG,289180.19,289180.19,83575.97,97030.0,United Healthcare-Medicare Advantage, +147743,3934,827,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITH COMPLICATION,DRG,91422.91,91422.91,5572.75,28763.73,United Healthcare-Medicare Advantage, +147744,3934,828,MYELOPROLIF DISORD OR POORLY DIFF NEOPL WITH MAJ O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,75738.74,75738.74,3743.36,32529.12,United Healthcare-Medicare Advantage, +147745,3934,829,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITH COMPLICATION/COMORBITY,DRG,158678.81,158678.81,1808.05,75253.98,United Healthcare-Medicare Advantage, +147746,3934,830,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,107443.55,107443.55,23762.65,23762.65,United Healthcare-Medicare Advantage, +147747,3934,831,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMORBITY,DRG,39908.62,39908.62,2501.45,24569.0,United Healthcare-Medicare Advantage, +147748,3934,832,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITH COMPLICATION,DRG,43942.34,43942.34,2.79,21822.03,United Healthcare-Medicare Advantage, +147749,3934,833,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,27879.87,27879.87,59.63,11746.0,United Healthcare-Medicare Advantage, +147750,3934,834,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMORBITY,DRG,448623.23,448623.23,3620.0,201124.32,United Healthcare-Medicare Advantage, +147751,3934,835,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITH COMPLICATION,DRG,330526.8,330526.8,4956.27,209482.26,United Healthcare-Medicare Advantage, +147752,3934,836,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURE WITHOUT COMPLICATION/COMORBITY,DRG,232473.38,232473.38,14481.89,14481.89,United Healthcare-Medicare Advantage, +147753,3934,837,CHEMO WITH ACUTE LEUKEMIA AS SDX OR WITH HIGH DOSE CHEMO AGENT WITH COMORBITY,DRG,219323.07,219323.07,38520.16,151843.68,United Healthcare-Medicare Advantage, +147754,3934,838,CHEMO WITH ACUTE LEUKEMIA AS SDX WITH COMPLICATION OR HIGH DOSE CHEMO AGENT,DRG,63562.79,63562.79,16843.77,46872.89,United Healthcare-Medicare Advantage, +147755,3934,839,CHEMO WITH ACUTE LEUKEMIA AS SDX WITHOUT COMPLICATION/COMORBITY,DRG,54425.23,54425.23,13779.26,32572.0,United Healthcare-Medicare Advantage, +147756,3934,840,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMORBITY,DRG,253532.5,253532.5,7175.01,73932.09,United Healthcare-Medicare Advantage, +147757,3934,841,LYMPHOMA & NON-ACUTE LEUKEMIA WITH COMPLICATION,DRG,117477.73,117477.73,3616.4,34532.0,United Healthcare-Medicare Advantage,14755.46 +147758,3934,842,LYMPHOMA & NON-ACUTE LEUKEMIA WITHOUT COMPLICATION/COMORBITY,DRG,77162.3,77162.3,15135.32,50119.58,United Healthcare-Medicare Advantage, +147759,3934,843,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMORBITY,DRG,170080.8,170080.8,4568.81,182164.33,United Healthcare-Medicare Advantage, +147760,3934,844,OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG WITH COMPLICATION,DRG,74995.34,74995.34,2633.98,26473.0,United Healthcare-Medicare Advantage, +147761,3934,846,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMORBITY,DRG,59791.36,59791.36,42356.27,54521.0,United Healthcare-Medicare Advantage, +147762,3934,847,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH COMPLICATION,DRG,50418.45,50418.45,14464.12,51726.99,United Healthcare-Medicare Advantage, +147763,3934,848,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,36824.01,36824.01,18262.74,27320.58,United Healthcare-Medicare Advantage, +147764,3934,853,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMORBITY,DRG,309569.0,309569.0,4597.29,423904.85,United Healthcare-Medicare Advantage,40911.95 +147765,3934,854,INFECTIOUS & PARASITIC DISEASES WITH O.R. PROCEDURE WITH COMPLICATION,DRG,89983.22,89983.22,3760.92,62184.21,United Healthcare-Medicare Advantage,18071.46 +147766,3934,856,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMORBITY,DRG,281052.06,281052.06,10142.56,110165.54,United Healthcare-Medicare Advantage, +147767,3934,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITH COMPLICATION,DRG,100297.37,100297.37,4539.91,78145.65,United Healthcare-Medicare Advantage, +147768,3934,858,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROC WITHOUT COMPLICATION/COMORBITY,DRG,41014.67,41014.67,11778.85,29491.0,United Healthcare-Medicare Advantage, +147769,3934,862,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITH COMORBITY,DRG,117844.48,117844.48,682.55,47445.63,United Healthcare-Medicare Advantage, +147770,3934,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS WITHOUT COMORBITY,DRG,50695.0,50695.0,2180.82,21420.0,United Healthcare-Medicare Advantage, +147771,3934,864,FEVER AND INFLAMMATORY CONDITIONS,DRG,44992.1,44992.1,198.87,19176.0,United Healthcare-Medicare Advantage, +147772,3934,865,VIRAL ILLNESS WITH COMORBITY,DRG,90217.45,90217.45,3299.79,45880.51,United Healthcare-Medicare Advantage, +147773,3934,866,VIRAL ILLNESS WITHOUT COMORBITY,DRG,41177.87,41177.87,4.91,18347.0,United Healthcare-Medicare Advantage, +147774,3934,867,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMORBITY,DRG,79779.42,79779.42,5339.93,106501.77,United Healthcare-Medicare Advantage, +147775,3934,868,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITH COMPLICATION,DRG,54370.35,54370.35,2680.72,26423.56,United Healthcare-Medicare Advantage, +147776,3934,869,OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES WITHOUT COMPLICATION/COMORBITY,DRG,48456.46,48456.46,1619.88,15910.0,United Healthcare-Medicare Advantage, +147777,3934,870,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,DRG,415843.94,415843.94,1950.0,1297646.44,United Healthcare-Medicare Advantage,50683.68 +147778,3934,871,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH COMORBITY,DRG,111205.41,111205.41,230.7,122810.7,United Healthcare-Medicare Advantage,32811.44 +147779,3934,872,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT COMORBITY,DRG,62537.73,62537.73,12.22,29903.78,United Healthcare-Medicare Advantage,9191.62 +147780,3934,876,O.R. PROCEDURE WITH PRINCIPAL DIAGNOSES OF MENTAL ILLNESS,DRG,310519.12,310519.12,7891.0,7891.0,United Healthcare-Medicare Advantage, +147781,3934,880,ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION,DRG,76019.21,76019.21,2093.99,21393.71,United Healthcare-Medicare Advantage, +147782,3934,881,DEPRESSIVE NEUROSES,DRG,61015.36,61015.36,3225.18,20128.0,United Healthcare-Medicare Advantage, +147783,3934,882,NEUROSES EXCEPT DEPRESSIVE,DRG,54033.42,54033.42,1241.72,13239.73,United Healthcare-Medicare Advantage, +147784,3934,883,DISORDERS OF PERSONALITY & IMPULSE CONTROL,DRG,68695.45,68695.45,12508.71,26860.0,United Healthcare-Medicare Advantage, +147785,3934,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,DRG,74160.29,74160.29,128.06,66744.85,United Healthcare-Medicare Advantage,12036.23 +147786,3934,885,PSYCHOSES,DRG,96411.63,96411.63,19.02,164962.99,United Healthcare-Medicare Advantage,12290.73 +147787,3934,886,BEHAVIORAL & DEVELOPMENTAL DISORDERS,DRG,95391.89,95391.89,16938.54,92838.7,United Healthcare-Medicare Advantage, +147788,3934,887,OTHER MENTAL DISORDER DIAGNOSES,DRG,32154.69,32154.69,23314.0,23314.0,United Healthcare-Medicare Advantage, +147789,3934,894,"ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA",DRG,50630.62,50630.62,6776.04,7656.01,United Healthcare-Medicare Advantage, +147790,3934,895,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY,DRG,53833.0,53833.0,8807.54,8807.54,United Healthcare-Medicare Advantage, +147791,3934,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH COMORBITY,DRG,82128.1,82128.1,1813.51,41216.05,United Healthcare-Medicare Advantage, +147792,3934,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT COMORBITY,DRG,40650.27,40650.27,1762.48,31135.0,United Healthcare-Medicare Advantage,7635.86 +147793,3934,902,WOUND DEBRIDEMENTS FOR INJURIES WITH COMPLICATION,DRG,258482.99,258482.99,27929.48,27929.48,United Healthcare-Medicare Advantage, +147794,3934,903,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,21400.89,21400.89,2744.82,2744.82,United Healthcare-Medicare Advantage, +147795,3934,904,SKIN GRAFTS FOR INJURIES WITH COMPLICATION/COMORBITY,DRG,334134.88,334134.88,8303.35,147040.81,United Healthcare-Medicare Advantage, +147796,3934,906,HAND PROCEDURES FOR INJURIES,DRG,102371.59,102371.59,4254.2,262905.51,United Healthcare-Medicare Advantage, +147797,3934,907,OTHER O.R. PROCEDURES FOR INJURIES WITH COMORBITY,DRG,209953.96,209953.96,8829.26,132080.2,United Healthcare-Medicare Advantage, +147798,3934,908,OTHER O.R. PROCEDURES FOR INJURIES WITH COMPLICATION,DRG,82210.76,82210.76,1417.57,53136.18,United Healthcare-Medicare Advantage, +147799,3934,909,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT COMPLICATION/COMORBITY,DRG,78074.44,78074.44,3325.96,29071.99,United Healthcare-Medicare Advantage, +147800,3934,913,TRAUMATIC INJURY WITH COMORBITY,DRG,34740.5,34740.5,3535.45,12355.83,United Healthcare-Medicare Advantage, +147801,3934,914,TRAUMATIC INJURY WITHOUT COMORBITY,DRG,51403.45,51403.45,2105.72,19474.0,United Healthcare-Medicare Advantage,7659.25 +147802,3934,915,ALLERGIC REACTIONS WITH COMORBITY,DRG,44709.85,44709.85,18469.67,66602.99,United Healthcare-Medicare Advantage, +147803,3934,916,ALLERGIC REACTIONS WITHOUT COMORBITY,DRG,38103.9,38103.9,1516.39,13567.0,United Healthcare-Medicare Advantage, +147804,3934,917,POISONING & TOXIC EFFECTS OF DRUGS WITH COMORBITY,DRG,117022.93,117022.93,1419.4,114501.38,United Healthcare-Medicare Advantage, +147805,3934,918,POISONING & TOXIC EFFECTS OF DRUGS WITHOUT COMORBITY,DRG,41197.54,41197.54,1100.0,55000.0,United Healthcare-Medicare Advantage,7475.98 +147806,3934,919,COMPLICATIONS OF TREATMENT WITH COMORBITY,DRG,135702.15,135702.15,4092.99,137349.33,United Healthcare-Medicare Advantage, +147807,3934,920,COMPLICATIONS OF TREATMENT WITH COMPLICATION,DRG,71028.13,71028.13,2292.16,30727.74,United Healthcare-Medicare Advantage, +147808,3934,921,COMPLICATIONS OF TREATMENT WITHOUT COMPLICATION/COMORBITY,DRG,41848.07,41848.07,7927.94,15152.0,United Healthcare-Medicare Advantage, +147809,3934,922,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITH COMORBITY",DRG,142858.98,142858.98,3542.32,22555.05,United Healthcare-Medicare Advantage, +147810,3934,923,"OTHER INJURY, POISONING & TOXIC EFFECT DIAG WITHOUT COMORBITY",DRG,74971.38,74971.38,9756.15,18544.0,United Healthcare-Medicare Advantage, +147811,3934,928,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITH COMPLICATION/COMORBITY,DRG,249508.24,249508.24,68222.74,109687.9,United Healthcare-Medicare Advantage, +147812,3934,929,FULL THICKNESS BURN WITH SKIN GRAFT OR INHAL INJ WITHOUT COMPLICATION/COMORBITY,DRG,109426.47,109426.47,31456.3,31456.3,United Healthcare-Medicare Advantage, +147813,3934,934,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHAL INJ,DRG,24573.91,24573.91,13486.53,22098.97,United Healthcare-Medicare Advantage, +147814,3934,935,NON-EXTENSIVE BURNS,DRG,32798.06,32798.06,4721.92,46320.21,United Healthcare-Medicare Advantage, +147815,3934,939,O.R. PROC WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH COMORBITY,DRG,127498.39,127498.39,38336.19,38336.19,United Healthcare-Medicare Advantage, +147816,3934,947,SIGNS & SYMPTOMS WITH COMORBITY,DRG,80596.59,80596.59,560.77,21090.44,United Healthcare-Medicare Advantage,10161.7 +147817,3934,948,SIGNS & SYMPTOMS WITHOUT COMORBITY,DRG,53668.4,53668.4,1348.3,58895.07,United Healthcare-Medicare Advantage,7705.46 +147818,3934,949,AFTERCARE WITH COMPLICATION/COMORBITY,DRG,38295.5,38295.5,1258.22,9466.67,United Healthcare-Medicare Advantage, +147819,3934,950,AFTERCARE WITHOUT COMPLICATION/COMORBITY,DRG,196462.7,196462.7,629.11,7188.71,United Healthcare-Medicare Advantage, +147820,3934,951,OTHER FACTORS INFLUENCING HEALTH STATUS,DRG,168945.96,168945.96,1404.56,27923.53,United Healthcare-Medicare Advantage, +147821,3934,955,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,DRG,587664.56,587664.56,63063.49,334448.98,United Healthcare-Medicare Advantage, +147822,3934,956,"LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA",DRG,239580.34,239580.34,7701.53,112885.11,United Healthcare-Medicare Advantage, +147823,3934,957,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,509903.45,509903.45,79457.97,157839.3,United Healthcare-Medicare Advantage, +147824,3934,958,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,238072.52,238072.52,9383.27,82181.28,United Healthcare-Medicare Advantage, +147825,3934,963,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMORBITY,DRG,154966.4,154966.4,6659.27,97121.32,United Healthcare-Medicare Advantage, +147826,3934,964,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH COMPLICATION,DRG,103694.58,103694.58,3320.98,29232.88,United Healthcare-Medicare Advantage, +147827,3934,974,HIV WITH MAJOR RELATED CONDITION WITH COMORBITY,DRG,503082.22,503082.22,7190.94,42361.21,United Healthcare-Medicare Advantage, +147828,3934,975,HIV WITH MAJOR RELATED CONDITION WITH COMPLICATION,DRG,177052.21,177052.21,3217.1,167473.4,United Healthcare-Medicare Advantage, +147829,3934,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,201354.28,201354.28,9791.74,252895.71,United Healthcare-Medicare Advantage, +147830,3934,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,115623.7,115623.7,5670.04,52239.0,United Healthcare-Medicare Advantage, +147831,3934,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,56665.23,56665.23,13861.04,36265.0,United Healthcare-Medicare Advantage, +147832,3934,987,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMORBITY,DRG,409346.42,409346.42,424.45,433756.24,United Healthcare-Medicare Advantage,27821.67 +147833,3934,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITH COMPLICATION,DRG,80990.11,80990.11,3183.04,36833.0,United Healthcare-Medicare Advantage, +147834,3934,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT COMPLICATION/COMORBITY,DRG,65085.39,65085.39,328.75,24455.0,United Healthcare-Medicare Advantage, +147835,3934,10005,Fine needle aspiration of first lesion using ultrasound guidance,CPT/HCPCS,2231.95,2231.95,83.05,7922.0,United Healthcare-Medicare Advantage, +147836,3934,10006,Fine needle aspiration of additional lesion using ultrasound guidance,CPT/HCPCS,823.36,823.36,586.67,4544.0,United Healthcare-Medicare Advantage, +147837,3934,10009,Fine needle aspiration of first lesion using CT guidance,CPT/HCPCS,3069.19,3069.19,1653.64,9214.32,United Healthcare-Medicare Advantage, +147838,3934,10010,Fine needle aspiration of additional lesion using CT guidance,CPT/HCPCS,545.0,545.0,2400.35,2400.35,United Healthcare-Medicare Advantage, +147839,3934,10021,Fine needle aspiration of first lesion,CPT/HCPCS,2289.7,2289.7,576.03,15806.32,United Healthcare-Medicare Advantage, +147840,3934,10030,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2078.18,2078.18,686.74,5511.1,United Healthcare-Medicare Advantage,739.03 +147841,3934,10035,"Placement of soft tissue localization device accessed through the skin with imaging guidance, first lesion",CPT/HCPCS,2634.03,2634.03,97.88,5260.5,United Healthcare-Medicare Advantage, +147842,3934,10060,Drainage of abscess,CPT/HCPCS,914.4,914.4,36.75,5785.0,United Healthcare-Medicare Advantage,211.9 +147843,3934,10061,Drainage of multiple abscess,CPT/HCPCS,1485.0,1485.0,334.0,9648.0,United Healthcare-Medicare Advantage, +147844,3934,10080,Drainage of tailbone cyst,CPT/HCPCS,1000.85,1000.85,150.0,4544.0,United Healthcare-Medicare Advantage, +147845,3934,10120,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,1556.28,1556.28,42.79,5511.1,United Healthcare-Medicare Advantage, +147846,3934,10121,"Removal of foreign body from tissue, accessed beneath the skin",CPT/HCPCS,4067.13,4067.13,1382.86,4800.7,United Healthcare-Medicare Advantage, +147847,3934,10140,Drainage of blood or fluid accumulation,CPT/HCPCS,4682.93,4682.93,150.0,6625.25,United Healthcare-Medicare Advantage, +147848,3934,10160,"Aspiration of abscess, blood accumulation, blister, or cyst",CPT/HCPCS,1114.81,1114.81,150.0,4356.0,United Healthcare-Medicare Advantage, +147849,3934,11000,"Removal of inflamed or infected skin, up to 10% of body surface",CPT/HCPCS,3869.28,3869.28,807.52,820.43,United Healthcare-Medicare Advantage, +147850,3934,11010,Removal of foreign material from skin and tissue at open fracture and/or dislocation,CPT/HCPCS,2534.18,2534.18,2865.73,2865.73,United Healthcare-Medicare Advantage, +147851,3934,11012,"Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation",CPT/HCPCS,4855.33,4855.33,2272.0,14659.58,United Healthcare-Medicare Advantage, +147852,3934,11042,Removal of skin and tissue first 20 sq cm or less,CPT/HCPCS,2685.02,2685.02,77.43,3619.33,United Healthcare-Medicare Advantage, +147853,3934,11043,Removal of skin and/or muscle first 20 sq cm or less,CPT/HCPCS,6785.98,6785.98,2404.0,13471.0,United Healthcare-Medicare Advantage, +147854,3934,11044,Removal of skin and bone first 20 sq cm or less,CPT/HCPCS,3107.23,3107.23,1597.86,3996.0,United Healthcare-Medicare Advantage, +147855,3934,11045,Removal of skin and tissue,CPT/HCPCS,806.11,806.11,1760.0,4356.0,United Healthcare-Medicare Advantage, +147856,3934,11102,Tangential biopsy of single skin lesion,CPT/HCPCS,687.6,687.6,1020.0,1024.0,United Healthcare-Medicare Advantage, +147857,3934,11104,Punch biopsy of single skin lesion,CPT/HCPCS,1357.28,1357.28,681.2,1789.0,United Healthcare-Medicare Advantage, +147858,3934,11105,Punch biopsy of additional skin lesion,CPT/HCPCS,549.0,549.0,612.0,612.0,United Healthcare-Medicare Advantage, +147859,3934,11106,Incisional biopsy of single skin lesion,CPT/HCPCS,1953.43,1953.43,86.29,2154.29,United Healthcare-Medicare Advantage, +147860,3934,11200,Removal of up to and including 15 skin tags,CPT/HCPCS,5427.36,5427.36,4959.93,5518.2,United Healthcare-Medicare Advantage, +147861,3934,11201,Removal of skin tags,CPT/HCPCS,928.2,928.2,928.2,928.2,United Healthcare-Medicare Advantage, +147862,3934,11400,"Removal of growth (0.5 centimeters or less) of the trunk, arms or legs",CPT/HCPCS,6250.87,6250.87,2766.3,6522.53,United Healthcare-Medicare Advantage, +147863,3934,11401,"Removal of growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5467.57,5467.57,3560.05,6592.05,United Healthcare-Medicare Advantage, +147864,3934,11402,"Removal of growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5558.07,5558.07,2195.72,9111.1,United Healthcare-Medicare Advantage, +147865,3934,11403,"Removal of growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5235.07,5235.07,2169.72,9024.7,United Healthcare-Medicare Advantage, +147866,3934,11404,"Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5826.77,5826.77,1523.5,9134.0,United Healthcare-Medicare Advantage, +147867,3934,11406,"Removal of growth (4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,5961.4,5961.4,2364.0,12229.0,United Healthcare-Medicare Advantage, +147868,3934,11420,"Removal of growth (0.5 centimeters or less) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5382.3,5382.3,4687.77,9361.0,United Healthcare-Medicare Advantage, +147869,3934,11421,"Removal of growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5061.46,5061.46,2855.06,6875.03,United Healthcare-Medicare Advantage, +147870,3934,11422,"Removal of growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5400.16,5400.16,4273.8,12474.62,United Healthcare-Medicare Advantage, +147871,3934,11423,"Removal of growth (2.1 to 3.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,5317.41,5317.41,5167.5,8166.62,United Healthcare-Medicare Advantage, +147872,3934,11424,"Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6728.63,6728.63,4214.25,8676.92,United Healthcare-Medicare Advantage, +147873,3934,11426,"Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7371.46,7371.46,4148.31,9367.2,United Healthcare-Medicare Advantage, +147874,3934,11440,"Removal of growth (0.5 centimeters or less) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4937.68,4937.68,2241.19,8313.46,United Healthcare-Medicare Advantage, +147875,3934,11441,"Removal of growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5479.19,5479.19,1424.46,5299.22,United Healthcare-Medicare Advantage, +147876,3934,11442,"Removal of growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,5186.69,5186.69,3467.86,8631.1,United Healthcare-Medicare Advantage, +147877,3934,11443,"Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,4855.47,4855.47,659.88,1662.9,United Healthcare-Medicare Advantage, +147878,3934,11446,"Removal (over 4.0 centimeters) growth of the face, ears, eyelids, nose, lips, or mouth",CPT/HCPCS,7067.33,7067.33,3031.0,12528.33,United Healthcare-Medicare Advantage, +147879,3934,11450,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,8932.41,8932.41,2305.33,8335.85,United Healthcare-Medicare Advantage, +147880,3934,11451,Removal of skin and tissue beneath the skin of underarms for excessive sweating,CPT/HCPCS,10602.33,10602.33,4800.7,4800.7,United Healthcare-Medicare Advantage, +147881,3934,11462,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6838.08,6838.08,2272.0,5523.44,United Healthcare-Medicare Advantage, +147882,3934,11463,Removal of skin and tissue beneath the skin of groin for excessive sweating,CPT/HCPCS,6700.64,6700.64,4137.62,4137.62,United Healthcare-Medicare Advantage, +147883,3934,11470,Removal of skin and tissue beneath the skin of anus or navel for excessive sweating,CPT/HCPCS,6158.13,6158.13,4544.0,4544.0,United Healthcare-Medicare Advantage, +147884,3934,11601,"Removal of malignant growth (0.6 to 1.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7394.0,7394.0,5599.0,5599.0,United Healthcare-Medicare Advantage, +147885,3934,11602,"Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6016.58,6016.58,2513.0,9157.5,United Healthcare-Medicare Advantage, +147886,3934,11603,"Removal of malignant growth (2.1 to 3.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6366.38,6366.38,2383.0,12531.33,United Healthcare-Medicare Advantage, +147887,3934,11604,"Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs",CPT/HCPCS,6417.89,6417.89,7356.75,8647.0,United Healthcare-Medicare Advantage, +147888,3934,11606,"Removal of malignant growth (over 4.0 centimeters) of the trunk, arms, or legs",CPT/HCPCS,7103.38,7103.38,2346.34,21932.75,United Healthcare-Medicare Advantage, +147889,3934,11621,"Removal of malignant growth (0.6 to 1.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,7722.0,7722.0,7722.0,7722.0,United Healthcare-Medicare Advantage, +147890,3934,11622,"Removal of malignant growth (1.1 to 2.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6711.48,6711.48,1992.37,13712.0,United Healthcare-Medicare Advantage, +147891,3934,11624,"Removal of malignant growth (3.1 to 4 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,6215.9,6215.9,2809.34,4287.0,United Healthcare-Medicare Advantage, +147892,3934,11626,"Removal of malignant growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals",CPT/HCPCS,8132.72,8132.72,2881.14,13028.99,United Healthcare-Medicare Advantage, +147893,3934,11640,"Removal of malignant growth (0.5 centimeters or less) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,9127.17,9127.17,405.26,856.99,United Healthcare-Medicare Advantage, +147894,3934,11641,"Removal of malignant growth (0.6 to 1.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,82355.58,82355.58,5033.78,5033.78,United Healthcare-Medicare Advantage, +147895,3934,11642,"Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6716.25,6716.25,2097.52,7227.4,United Healthcare-Medicare Advantage, +147896,3934,11643,"Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,6148.07,6148.07,769.0,7942.44,United Healthcare-Medicare Advantage, +147897,3934,11644,"Removal of malignant growth (3.1 to 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,4966.96,4966.96,2520.5,2520.5,United Healthcare-Medicare Advantage, +147898,3934,11646,"Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips",CPT/HCPCS,10378.32,10378.32,3665.75,23693.0,United Healthcare-Medicare Advantage, +147899,3934,11720,Removal of tissue from 1 to 5 finger or toe nails,CPT/HCPCS,2223.0,2223.0,287.61,400.0,United Healthcare-Medicare Advantage, +147900,3934,11721,Removal of tissue from 6 or more finger or toe nails,CPT/HCPCS,1283.0,1283.0,163.52,163.52,United Healthcare-Medicare Advantage, +147901,3934,11730,Separation of nail plate from nail bed,CPT/HCPCS,622.33,622.33,129.42,2178.0,United Healthcare-Medicare Advantage, +147902,3934,11740,Removal of blood accumulation between nail and nail bed,CPT/HCPCS,2059.27,2059.27,39.29,2234.0,United Healthcare-Medicare Advantage, +147903,3934,11750,Removal of nail,CPT/HCPCS,3071.7,3071.7,708.77,4544.0,United Healthcare-Medicare Advantage, +147904,3934,11760,Repair of finger or toe nail bed,CPT/HCPCS,1079.84,1079.84,54.55,2484.0,United Healthcare-Medicare Advantage, +147905,3934,11765,Removal of skin of finger or toe nail,CPT/HCPCS,660.0,660.0,129.42,287.1,United Healthcare-Medicare Advantage, +147906,3934,11770,Removal of tailbone cyst,CPT/HCPCS,6447.66,6447.66,3607.72,9000.26,United Healthcare-Medicare Advantage, +147907,3934,11771,Removal of tailbone cyst,CPT/HCPCS,7592.45,7592.45,6409.17,10533.0,United Healthcare-Medicare Advantage, +147908,3934,11772,Removal of tailbone cyst,CPT/HCPCS,9914.33,9914.33,1435.46,1435.46,United Healthcare-Medicare Advantage, +147909,3934,11900,Injection of up to 7 skin growths,CPT/HCPCS,4143.06,4143.06,3395.25,7650.0,United Healthcare-Medicare Advantage, +147910,3934,11901,Injection of more than 7 skin growths,CPT/HCPCS,6432.0,6432.0,6432.0,6432.0,United Healthcare-Medicare Advantage, +147911,3934,11921,Introduction of pigment into skin (6.1 to 20.0 sq cm) to correct color defect,CPT/HCPCS,817.0,817.0,702.22,702.22,United Healthcare-Medicare Advantage, +147912,3934,11960,Insertion of tissue expanders,CPT/HCPCS,12572.5,12572.5,7488.0,14601.0,United Healthcare-Medicare Advantage, +147913,3934,11970,Replacement of tissue expander with permanent prosthesis,CPT/HCPCS,8873.91,8873.91,3122.04,12049.81,United Healthcare-Medicare Advantage, +147914,3934,11971,Removal of tissue expanders,CPT/HCPCS,6487.16,6487.16,1405.57,7671.33,United Healthcare-Medicare Advantage, +147915,3934,11976,Removal of implantable contraceptive capsules,CPT/HCPCS,1714.82,1714.82,113.47,702.22,United Healthcare-Medicare Advantage, +147916,3934,11981,Insertion of drug delivery implant into tissue,CPT/HCPCS,882.92,882.92,79.9,2149.84,United Healthcare-Medicare Advantage, +147917,3934,11982,Removal of drug delivery implant from tissue,CPT/HCPCS,890.91,890.91,93.72,3805.0,United Healthcare-Medicare Advantage, +147918,3934,11983,Removal with reinsertion of drug delivery implant into tissue,CPT/HCPCS,993.17,993.17,207.89,3338.0,United Healthcare-Medicare Advantage, +147919,3934,12001,"Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs",CPT/HCPCS,764.77,764.77,47.35,10381.85,United Healthcare-Medicare Advantage, +147920,3934,12002,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,795.36,795.36,100.0,10441.41,United Healthcare-Medicare Advantage, +147921,3934,12004,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,845.41,845.41,365.92,3004.0,United Healthcare-Medicare Advantage, +147922,3934,12005,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs",CPT/HCPCS,994.6,994.6,266.0,2005.0,United Healthcare-Medicare Advantage, +147923,3934,12011,"Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,817.14,817.14,49.11,9648.0,United Healthcare-Medicare Advantage, +147924,3934,12013,"Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,840.02,840.02,73.07,1949.0,United Healthcare-Medicare Advantage, +147925,3934,12014,"Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,4880.61,4880.61,5185.0,5185.0,United Healthcare-Medicare Advantage, +147926,3934,12015,"Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,752.82,752.82,110.46,725.0,United Healthcare-Medicare Advantage, +147927,3934,12016,"Repair of wound (12.6 to 20.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes",CPT/HCPCS,8770.2,8770.2,8642.13,9255.31,United Healthcare-Medicare Advantage, +147928,3934,12020,Repair of separation of wound closure,CPT/HCPCS,1328.5,1328.5,150.99,1327.0,United Healthcare-Medicare Advantage,602.14 +147929,3934,12021,Repair of separation of wound closure with insertion of packing,CPT/HCPCS,3173.0,3173.0,781.7,781.7,United Healthcare-Medicare Advantage, +147930,3934,12031,"Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1238.05,1238.05,40.0,2687.8,United Healthcare-Medicare Advantage, +147931,3934,12032,"Repair of wound (2.6 to 7.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,996.18,996.18,193.55,2484.0,United Healthcare-Medicare Advantage, +147932,3934,12034,"Repair of wound (7.6 to 12.5 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1191.68,1191.68,358.53,2994.3,United Healthcare-Medicare Advantage, +147933,3934,12035,"Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,1639.13,1639.13,793.57,2283.87,United Healthcare-Medicare Advantage, +147934,3934,12036,"Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,18764.14,18764.14,7418.14,10909.9,United Healthcare-Medicare Advantage, +147935,3934,12037,"Repair of wound (over 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs",CPT/HCPCS,6082.13,6082.13,2754.0,9410.25,United Healthcare-Medicare Advantage, +147936,3934,12041,"Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals",CPT/HCPCS,924.51,924.51,100.0,2755.55,United Healthcare-Medicare Advantage, +147937,3934,12042,"Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,1141.07,1141.07,365.92,8423.0,United Healthcare-Medicare Advantage, +147938,3934,12044,"Repair of wound (7.6 to 12.5 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,2980.13,2980.13,3054.0,3054.0,United Healthcare-Medicare Advantage, +147939,3934,12045,"Repair of wound (12.6 to 20.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,12828.26,12828.26,11827.73,12774.19,United Healthcare-Medicare Advantage, +147940,3934,12046,"Repair of wound (20.1 to 30.0 centimeters) of neck, hands, feet, and/or genitals",CPT/HCPCS,3137.85,3137.85,2725.4,4573.96,United Healthcare-Medicare Advantage, +147941,3934,12051,"Repair of wound (2.5 centimeters or less) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,978.81,978.81,100.0,3960.5,United Healthcare-Medicare Advantage, +147942,3934,12052,"Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1009.64,1009.64,150.0,1949.0,United Healthcare-Medicare Advantage, +147943,3934,12053,"Repair of wound (5.1 to 7.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,1039.71,1039.71,150.0,1946.0,United Healthcare-Medicare Advantage, +147944,3934,12054,"Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth",CPT/HCPCS,815.0,815.0,781.7,781.7,United Healthcare-Medicare Advantage, +147945,3934,13101,Repair of wound (2.6 to 7.5 centimeters) of trunk,CPT/HCPCS,6250.4,6250.4,2382.87,13584.0,United Healthcare-Medicare Advantage, +147946,3934,13102,Repair of wound of trunk,CPT/HCPCS,1231.66,1231.66,822.86,8638.23,United Healthcare-Medicare Advantage, +147947,3934,13120,"Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,752.29,752.29,166.16,2400.35,United Healthcare-Medicare Advantage, +147948,3934,13121,"Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs",CPT/HCPCS,1636.22,1636.22,123.14,5089.02,United Healthcare-Medicare Advantage, +147949,3934,13122,"Repair of wound of scalp, arms, and/or legs",CPT/HCPCS,1095.25,1095.25,336.03,4287.0,United Healthcare-Medicare Advantage, +147950,3934,13131,"Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2530.2,2530.2,394.25,5190.36,United Healthcare-Medicare Advantage, +147951,3934,13132,"Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,2165.34,2165.34,150.0,5518.0,United Healthcare-Medicare Advantage, +147952,3934,13133,"Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,1340.5,1340.5,1164.0,3735.0,United Healthcare-Medicare Advantage, +147953,3934,13151,"Repair of wound (1.1 to 2.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2499.49,2499.49,336.04,6675.0,United Healthcare-Medicare Advantage, +147954,3934,13152,"Repair of wound (2.6 to 7.5 centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,2982.82,2982.82,1410.6,3849.12,United Healthcare-Medicare Advantage, +147955,3934,13160,Second repair of surgical wound,CPT/HCPCS,12042.0,12042.0,4356.0,5511.1,United Healthcare-Medicare Advantage, +147956,3934,14000,Tissue transfer repair of wound (10 sq centimeters or less) of the trunk,CPT/HCPCS,8360.42,8360.42,5731.46,5731.46,United Healthcare-Medicare Advantage, +147957,3934,14020,"Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs",CPT/HCPCS,5254.53,5254.53,4624.0,6285.95,United Healthcare-Medicare Advantage, +147958,3934,14021,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs",CPT/HCPCS,5555.75,5555.75,3237.6,8587.5,United Healthcare-Medicare Advantage, +147959,3934,14040,"Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,6909.42,6909.42,3232.66,13821.0,United Healthcare-Medicare Advantage, +147960,3934,14041,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet",CPT/HCPCS,9339.4,9339.4,2152.98,10515.0,United Healthcare-Medicare Advantage, +147961,3934,14060,"Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips",CPT/HCPCS,6519.41,6519.41,1272.88,16761.55,United Healthcare-Medicare Advantage, +147962,3934,14061,"Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of eyelids, nose, ears, and/or lips",CPT/HCPCS,8551.37,8551.37,3278.1,13649.84,United Healthcare-Medicare Advantage, +147963,3934,14301,Tissue transfer repair of wound (30.1 to 60.0 sq centimeters),CPT/HCPCS,7898.78,7898.78,3098.29,15366.0,United Healthcare-Medicare Advantage, +147964,3934,14302,Tissue transfer repair of wound (30.0 sq centimeters),CPT/HCPCS,2149.8,2149.8,2143.5,4356.0,United Healthcare-Medicare Advantage, +147965,3934,15002,"Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and children)",CPT/HCPCS,5014.77,5014.77,1454.05,10800.0,United Healthcare-Medicare Advantage, +147966,3934,15003,"Preparation of graft site at trunk, arms, or legs",CPT/HCPCS,1558.43,1558.43,634.13,4287.0,United Healthcare-Medicare Advantage, +147967,3934,15004,"Preparation of graft site of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,1948.59,1948.59,289.83,10203.31,United Healthcare-Medicare Advantage,317.77 +147968,3934,15100,"Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)",CPT/HCPCS,6945.69,6945.69,2365.62,13728.0,United Healthcare-Medicare Advantage, +147969,3934,15101,"Skin graft at trunk, arms, or legs",CPT/HCPCS,1506.47,1506.47,634.13,2143.5,United Healthcare-Medicare Advantage, +147970,3934,15120,"Skin graft of face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 100 sq cm or less, or 1% body area of infants and children)",CPT/HCPCS,7258.75,7258.75,2754.0,11466.0,United Healthcare-Medicare Advantage, +147971,3934,15220,"Relocation of patient skin (20 sq centimeters or less) to scalp, arms, and/or legs",CPT/HCPCS,6007.33,6007.33,4168.0,7660.0,United Healthcare-Medicare Advantage, +147972,3934,15240,"Relocation of patient skin to forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, and/or feet (20 sq centimeters or less)",CPT/HCPCS,8304.03,8304.03,5387.63,10477.0,United Healthcare-Medicare Advantage, +147973,3934,15260,"Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)",CPT/HCPCS,6339.69,6339.69,2101.98,17016.69,United Healthcare-Medicare Advantage, +147974,3934,15271,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less)",CPT/HCPCS,4508.21,4508.21,1887.92,5294.72,United Healthcare-Medicare Advantage, +147975,3934,15272,"Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs",CPT/HCPCS,1546.32,1546.32,973.0,2128.0,United Healthcare-Medicare Advantage, +147976,3934,15273,"Application of skin substitute (wound surface greater or equal to 100 sq cm) to trunk, arms, or legs (first 100 sq cm or 1% body area of infants and children)",CPT/HCPCS,4363.77,4363.77,3492.93,3492.93,United Healthcare-Medicare Advantage, +147977,3934,15275,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less)",CPT/HCPCS,2812.47,2812.47,1050.6,7362.5,United Healthcare-Medicare Advantage,2079.81 +147978,3934,15276,"Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes",CPT/HCPCS,1892.35,1892.35,729.6,4331.33,United Healthcare-Medicare Advantage, +147979,3934,15620,"Transfer of skin flap to forehead, cheeks, chin, neck, underarms, genitals, hands, or feet",CPT/HCPCS,10709.74,10709.74,1663.01,4544.0,United Healthcare-Medicare Advantage, +147980,3934,15630,"Transfer of skin flap to eyelids, nose, ears, or lips",CPT/HCPCS,6519.59,6519.59,1919.0,8405.33,United Healthcare-Medicare Advantage, +147981,3934,15731,"Creation of flap graft to nose, forehead, temple, or scalp",CPT/HCPCS,13139.02,13139.02,4924.0,21875.18,United Healthcare-Medicare Advantage, +147982,3934,15733,Creation of flap graft to head and/or neck,CPT/HCPCS,10107.67,10107.67,5270.6,12601.47,United Healthcare-Medicare Advantage, +147983,3934,15734,Muscle flap wound repair at trunk,CPT/HCPCS,6593.78,6593.78,8642.33,8642.33,United Healthcare-Medicare Advantage, +147984,3934,15769,"Grafting of patient soft tissue, harvested by direct excision",CPT/HCPCS,8351.24,8351.24,20618.33,20618.33,United Healthcare-Medicare Advantage, +147985,3934,15771,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; 50 cubic centimeters or less",CPT/HCPCS,9041.07,9041.07,3088.61,20270.39,United Healthcare-Medicare Advantage, +147986,3934,15772,"Grafting of patient fat, harvested by liposuction to trunk, breasts, scalp, arms, and/or legs; additional 50 cubic centimeters or less",CPT/HCPCS,1775.13,1775.13,1013.63,4356.0,United Healthcare-Medicare Advantage, +147987,3934,15773,"Grafting of patient fat, harvested by liposuction to to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate",CPT/HCPCS,8542.56,8542.56,2443.66,6599.27,United Healthcare-Medicare Advantage, +147988,3934,15777,Implantation of biologic implant to soft tissue,CPT/HCPCS,3009.25,3009.25,984.28,4848.0,United Healthcare-Medicare Advantage, +147989,3934,15821,Removal of excessive skin of lower eyelid and fat around eye,CPT/HCPCS,6233.94,6233.94,3678.09,9260.18,United Healthcare-Medicare Advantage, +147990,3934,15822,Removal of excessive skin of upper eyelid,CPT/HCPCS,6742.14,6742.14,5650.02,9016.62,United Healthcare-Medicare Advantage, +147991,3934,15823,Removal of excessive skin and fat of upper eyelid,CPT/HCPCS,6553.61,6553.61,2254.09,16586.88,United Healthcare-Medicare Advantage, +147992,3934,15830,Removal of excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,14624.56,14624.56,1674.58,30225.24,United Healthcare-Medicare Advantage, +147993,3934,15838,Removal of excessive skin and tissue beneath the skin under chin,CPT/HCPCS,28026.0,28026.0,28026.0,28026.0,United Healthcare-Medicare Advantage, +147994,3934,15839,Removal of excessive skin and tissue beneath the skin,CPT/HCPCS,13105.99,13105.99,2328.31,2328.31,United Healthcare-Medicare Advantage, +147995,3934,15847,Removal of additional excessive skin and tissue beneath the skin of abdomen,CPT/HCPCS,4683.21,4683.21,1977.82,6998.33,United Healthcare-Medicare Advantage, +147996,3934,15850,Removal of sutures under anesthesia by same surgeon,CPT/HCPCS,4625.67,4625.67,3127.08,6780.64,United Healthcare-Medicare Advantage, +147997,3934,15851,Removal of sutures under anesthesia by other surgeon,CPT/HCPCS,3083.22,3083.22,1435.46,1435.46,United Healthcare-Medicare Advantage, +147998,3934,15877,Suction assisted removal of fat from trunk,CPT/HCPCS,8791.69,8791.69,3017.87,7873.3,United Healthcare-Medicare Advantage, +147999,3934,15878,Suction assisted removal of fat from arm,CPT/HCPCS,5716.42,5716.42,5299.51,5299.51,United Healthcare-Medicare Advantage, +148000,3934,16000,First degree burn treatment,CPT/HCPCS,2039.43,2039.43,1707.0,3506.0,United Healthcare-Medicare Advantage, +148001,3934,16020,Dressing change and/or removal of burn tissue (less than 5% total body surface),CPT/HCPCS,459.72,459.72,26.71,2484.0,United Healthcare-Medicare Advantage, +148002,3934,16025,Dressing change and/or removal of burn tissue (5% to 10% total body surface),CPT/HCPCS,511.82,511.82,523.9,523.9,United Healthcare-Medicare Advantage, +148003,3934,17110,Destruction of up to 14 skin growths,CPT/HCPCS,807.25,807.25,282.0,393.96,United Healthcare-Medicare Advantage, +148004,3934,17250,Application of chemical agent to excessive wound tissue,CPT/HCPCS,466.56,466.56,42.77,393.96,United Healthcare-Medicare Advantage, +148005,3934,19000,Aspiration of breast cyst,CPT/HCPCS,2793.15,2793.15,656.23,4287.0,United Healthcare-Medicare Advantage,695.72 +148006,3934,19020,Drainage of breast abscess,CPT/HCPCS,11693.91,11693.91,1907.22,1907.22,United Healthcare-Medicare Advantage, +148007,3934,19081,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,5129.08,5129.08,1728.67,8944.0,United Healthcare-Medicare Advantage, +148008,3934,19082,Biopsy of breast accessed through the skin with stereotactic guidance,CPT/HCPCS,1548.79,1548.79,1089.0,5511.1,United Healthcare-Medicare Advantage, +148009,3934,19083,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,4460.7,4460.7,241.35,11236.0,United Healthcare-Medicare Advantage,1662.9 +148010,3934,19084,Biopsy of breast accessed through the skin with ultrasound guidance,CPT/HCPCS,1320.8,1320.8,582.24,4544.0,United Healthcare-Medicare Advantage, +148011,3934,19085,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,6175.77,6175.77,2176.74,13443.5,United Healthcare-Medicare Advantage,1705.93 +148012,3934,19086,Biopsy of breast accessed through the skin with MRI guidance,CPT/HCPCS,2026.51,2026.51,1266.6,4544.0,United Healthcare-Medicare Advantage, +148013,3934,19100,Needle biopsy of breast,CPT/HCPCS,8960.04,8960.04,2292.02,2292.02,United Healthcare-Medicare Advantage, +148014,3934,19120,"Removal of 1 or more breast growth, open procedure",CPT/HCPCS,7551.77,7551.77,3592.25,12422.18,United Healthcare-Medicare Advantage, +148015,3934,19125,"Removal of breast growth, open procedure",CPT/HCPCS,10482.94,10482.94,3100.5,18928.0,United Healthcare-Medicare Advantage, +148016,3934,19281,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,8847.02,8847.02,441.94,22486.0,United Healthcare-Medicare Advantage, +148017,3934,19282,Placement of breast localization devices accessed through the skin with mammographic guidance,CPT/HCPCS,1882.89,1882.89,442.92,4305.3,United Healthcare-Medicare Advantage, +148018,3934,19283,Placement of breast localization devices accessed through the skin with stereotactic guidance,CPT/HCPCS,22778.02,22778.02,10549.5,10549.5,United Healthcare-Medicare Advantage, +148019,3934,19285,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,2458.32,2458.32,739.03,5934.0,United Healthcare-Medicare Advantage, +148020,3934,19286,Placement of breast localization devices accessed through the skin with ultrasound guidance,CPT/HCPCS,1943.73,1943.73,2060.71,2060.71,United Healthcare-Medicare Advantage, +148021,3934,19287,Placement of breast localization devices accessed through the skin with MRI guidance,CPT/HCPCS,3789.89,3789.89,754.11,3998.75,United Healthcare-Medicare Advantage, +148022,3934,19300,Removal of extra breast tissue,CPT/HCPCS,13433.3,13433.3,3841.56,23446.9,United Healthcare-Medicare Advantage, +148023,3934,19301,Partial removal of breast,CPT/HCPCS,12748.72,12748.72,929.8,38466.0,United Healthcare-Medicare Advantage, +148024,3934,19303,Total removal of breast,CPT/HCPCS,13299.51,13299.51,2714.8,26174.36,United Healthcare-Medicare Advantage, +148025,3934,19307,Removal of breast and underarm lymph nodes,CPT/HCPCS,28280.01,28280.01,23664.36,23664.36,United Healthcare-Medicare Advantage, +148026,3934,19316,Enlargement of breast,CPT/HCPCS,8373.75,8373.75,4015.43,9518.19,United Healthcare-Medicare Advantage, +148027,3934,19318,Repositioning of breast on chest,CPT/HCPCS,14446.26,14446.26,912.03,40041.6,United Healthcare-Medicare Advantage, +148028,3934,19324,Enlargement of breast,CPT/HCPCS,16975.76,16975.76,6371.0,8643.0,United Healthcare-Medicare Advantage, +148029,3934,19328,Removal of intact breast implant,CPT/HCPCS,8139.14,8139.14,2066.67,15996.69,United Healthcare-Medicare Advantage, +148030,3934,19330,Removal of mammary implant material,CPT/HCPCS,7064.74,7064.74,4287.0,5731.46,United Healthcare-Medicare Advantage, +148031,3934,19340,"Insertion of breast prosthesis at time of breast repositioning, removal or reconstruction",CPT/HCPCS,7484.96,7484.96,2500.72,34085.17,United Healthcare-Medicare Advantage, +148032,3934,19342,"Insertion of breast prosthesis following breast repositioning, removal or reconstruction",CPT/HCPCS,10250.82,10250.82,4969.22,21456.42,United Healthcare-Medicare Advantage, +148033,3934,19350,Reconstruction of nipple or area around nipple,CPT/HCPCS,6468.98,6468.98,3542.16,8403.62,United Healthcare-Medicare Advantage, +148034,3934,19357,Insertion of tissue expander in breast,CPT/HCPCS,9888.49,9888.49,2400.07,22327.8,United Healthcare-Medicare Advantage, +148035,3934,19366,Plastic surgery to reconstruct breast,CPT/HCPCS,22679.68,22679.68,7679.25,10480.84,United Healthcare-Medicare Advantage, +148036,3934,19370,"Incision of capsule surrounding breast with freeing of scar tissue, open procedure",CPT/HCPCS,6385.94,6385.94,1090.57,4711.77,United Healthcare-Medicare Advantage, +148037,3934,19371,Removal of capsule surrounding breast,CPT/HCPCS,10131.01,10131.01,4546.22,26717.39,United Healthcare-Medicare Advantage, +148038,3934,19380,Revision of reconstructed breast,CPT/HCPCS,9015.56,9015.56,17.98,40219.75,United Healthcare-Medicare Advantage, +148039,3934,19499,Breast procedure,CPT/HCPCS,19355.02,19355.02,2000.45,2000.45,United Healthcare-Medicare Advantage, +148040,3934,20100,Exploration of penetrating wound of neck,CPT/HCPCS,15368.68,15368.68,2698.36,2742.32,United Healthcare-Medicare Advantage, +148041,3934,20103,Exploration of penetrating wound of arm or leg,CPT/HCPCS,5372.25,5372.25,1011.84,2728.25,United Healthcare-Medicare Advantage, +148042,3934,20200,Biopsy of muscle,CPT/HCPCS,4482.0,4482.0,6426.0,6426.0,United Healthcare-Medicare Advantage, +148043,3934,20205,Deep biopsy of muscle,CPT/HCPCS,10592.77,10592.77,2192.23,15428.0,United Healthcare-Medicare Advantage, +148044,3934,20206,"Needle biopsy of muscle, accessed through the skin",CPT/HCPCS,2204.19,2204.19,501.67,5731.46,United Healthcare-Medicare Advantage, +148045,3934,20220,Biopsy of bone using needle or trocar,CPT/HCPCS,4377.45,4377.45,1813.77,13245.33,United Healthcare-Medicare Advantage, +148046,3934,20225,Deep biopsy of bone using needle or trocar,CPT/HCPCS,6188.71,6188.71,4501.88,8929.46,United Healthcare-Medicare Advantage, +148047,3934,20240,"Biopsy of bone, open procedure",CPT/HCPCS,3537.99,3537.99,2411.0,8900.0,United Healthcare-Medicare Advantage, +148048,3934,20245,"Biopsy of bone, open procedure",CPT/HCPCS,11297.91,11297.91,2626.41,12317.96,United Healthcare-Medicare Advantage, +148049,3934,20520,Removal of foreign body in muscle or tendon,CPT/HCPCS,6171.0,6171.0,3996.0,3996.0,United Healthcare-Medicare Advantage, +148050,3934,20525,Removal of deep foreign body in muscle or tendon,CPT/HCPCS,5870.4,5870.4,2178.0,2178.0,United Healthcare-Medicare Advantage, +148051,3934,20527,Injection of enzyme in palm tissue,CPT/HCPCS,723.96,723.96,63.43,734.0,United Healthcare-Medicare Advantage, +148052,3934,20550,"Injections of tendon sheath, ligament, or muscle membrane",CPT/HCPCS,3956.27,3956.27,4654.4,7149.0,United Healthcare-Medicare Advantage, +148053,3934,20551,Injections of tendon attachment to bone,CPT/HCPCS,3246.4,3246.4,2399.23,2399.23,United Healthcare-Medicare Advantage, +148054,3934,20552,Injections of trigger points in 1 or 2 muscles,CPT/HCPCS,941.81,941.81,43.53,779.0,United Healthcare-Medicare Advantage, +148055,3934,20553,Injections of trigger points in 3 or more muscles,CPT/HCPCS,711.19,711.19,49.53,5511.1,United Healthcare-Medicare Advantage, +148056,3934,20600,Aspiration and/or injection of small joint or joint capsule,CPT/HCPCS,1003.07,1003.07,156.43,2755.55,United Healthcare-Medicare Advantage, +148057,3934,20605,Aspiration and/or injection of medium joint or joint capsule,CPT/HCPCS,1621.79,1621.79,42.91,7445.46,United Healthcare-Medicare Advantage, +148058,3934,20606,Aspiration and/or injection of intermediate joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,4299.68,4299.68,467.53,1368.46,United Healthcare-Medicare Advantage,849.54 +148059,3934,20610,Aspiration and/or injection of large joint or joint capsule,CPT/HCPCS,837.74,837.74,27.66,5511.1,United Healthcare-Medicare Advantage, +148060,3934,20611,Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound guidance,CPT/HCPCS,1435.15,1435.15,207.0,3892.0,United Healthcare-Medicare Advantage, +148061,3934,20612,Aspiration and/or injection of cysts,CPT/HCPCS,4083.92,4083.92,1718.0,5244.0,United Healthcare-Medicare Advantage, +148062,3934,20615,Aspiration and injection treatment of bone cyst,CPT/HCPCS,7883.0,7883.0,3892.0,3892.0,United Healthcare-Medicare Advantage, +148063,3934,20670,Removal of bone implant,CPT/HCPCS,2584.26,2584.26,1944.21,4356.0,United Healthcare-Medicare Advantage, +148064,3934,20680,Removal of deep bone implant,CPT/HCPCS,7853.46,7853.46,572.9,18256.0,United Healthcare-Medicare Advantage, +148065,3934,20690,Application of uniplane external bone fixation on one arm or leg,CPT/HCPCS,16899.6,16899.6,12092.21,33257.41,United Healthcare-Medicare Advantage, +148066,3934,20694,Removal of external bone fixation under anesthesia,CPT/HCPCS,6589.02,6589.02,2942.05,12510.0,United Healthcare-Medicare Advantage,1642.05 +148067,3934,20700,Preparation and insertion of drug-delivery devices beneath fibrous covering of muscle,CPT/HCPCS,3209.0,3209.0,1998.0,3230.0,United Healthcare-Medicare Advantage, +148068,3934,20902,Bone graft harvest,CPT/HCPCS,13084.62,13084.62,4846.0,9507.0,United Healthcare-Medicare Advantage, +148069,3934,20931,Donor bone graft for spine surgery,CPT/HCPCS,4023.1,4023.1,26397.54,26397.54,United Healthcare-Medicare Advantage, +148070,3934,20936,Harvest of bone from same spine incision for graft,CPT/HCPCS,3006.18,3006.18,1377.78,20441.84,United Healthcare-Medicare Advantage, +148071,3934,20982,Destruction of 1 or more bone growths accessed through the skin,CPT/HCPCS,7912.22,7912.22,6780.75,10860.0,United Healthcare-Medicare Advantage, +148072,3934,20983,"Destruction of 1 or more bone growths, accessed through the skin",CPT/HCPCS,6809.55,6809.55,4924.0,11511.33,United Healthcare-Medicare Advantage, +148073,3934,21011,Removal of (less than 2 centimeter) tissue growth beneath the skin of face and scalp,CPT/HCPCS,6343.46,6343.46,572.92,5299.51,United Healthcare-Medicare Advantage, +148074,3934,21012,Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp,CPT/HCPCS,8143.5,8143.5,7691.0,7691.0,United Healthcare-Medicare Advantage, +148075,3934,21013,Removal of (less than 2 centimeters) muscle growth of face and scalp,CPT/HCPCS,8573.8,8573.8,1330.74,1330.74,United Healthcare-Medicare Advantage, +148076,3934,21014,Removal of (2 centimeters or greater) muscle growth of face and scalp,CPT/HCPCS,7350.93,7350.93,5101.54,10101.0,United Healthcare-Medicare Advantage, +148077,3934,21025,Removal of lower jaw bone,CPT/HCPCS,12890.49,12890.49,8841.0,19706.0,United Healthcare-Medicare Advantage, +148078,3934,21026,Removal of facial bones,CPT/HCPCS,5259.0,5259.0,3547.67,9273.79,United Healthcare-Medicare Advantage, +148079,3934,21029,Removal of facial bone growth,CPT/HCPCS,6171.0,6171.0,2830.7,2830.7,United Healthcare-Medicare Advantage, +148080,3934,21032,Removal of bony growth of upper jaw bone inside mouth,CPT/HCPCS,16701.0,16701.0,16701.0,16701.0,United Healthcare-Medicare Advantage, +148081,3934,21046,Oral removal of lower jaw bone growth or cyst,CPT/HCPCS,8279.58,8279.58,521.57,5731.46,United Healthcare-Medicare Advantage, +148082,3934,21047,External removal of lower jaw bone growth or cyst,CPT/HCPCS,16331.0,16331.0,1563.75,1563.75,United Healthcare-Medicare Advantage, +148083,3934,21048,Oral removal of upper jaw bone growth or cyst,CPT/HCPCS,9905.47,9905.47,1525.5,8750.0,United Healthcare-Medicare Advantage, +148084,3934,21050,Removal of hinged joint of upper and lower jaw bones,CPT/HCPCS,30999.84,30999.84,23724.0,38275.67,United Healthcare-Medicare Advantage, +148085,3934,21070,Removal of diseased or fractured portion of lower jaw bone,CPT/HCPCS,17002.0,17002.0,18130.0,18130.0,United Healthcare-Medicare Advantage, +148086,3934,21110,Application and removal of dental fixation device,CPT/HCPCS,36032.88,36032.88,2822.23,4459.2,United Healthcare-Medicare Advantage, +148087,3934,21141,Reconstruction of midface bones,CPT/HCPCS,19478.3,19478.3,3996.0,7743.0,United Healthcare-Medicare Advantage, +148088,3934,21142,Reconstruction of midface bones,CPT/HCPCS,19910.45,19910.45,4356.0,5731.46,United Healthcare-Medicare Advantage, +148089,3934,21143,Reconstruction of midface bones,CPT/HCPCS,12282.0,12282.0,4356.0,4356.0,United Healthcare-Medicare Advantage, +148090,3934,21145,Reconstruction of midface bones with bone graft,CPT/HCPCS,20501.0,20501.0,4287.0,4287.0,United Healthcare-Medicare Advantage, +148091,3934,21196,Reconstruction of jaw bones with insertion of hardware,CPT/HCPCS,12919.35,12919.35,2178.0,6164.98,United Healthcare-Medicare Advantage, +148092,3934,21230,Harvest of rib cartilage for grafting,CPT/HCPCS,39194.79,39194.79,39194.79,39194.79,United Healthcare-Medicare Advantage, +148093,3934,21235,Obtaining ear cartilage for grafting,CPT/HCPCS,9211.35,9211.35,1710.0,17952.0,United Healthcare-Medicare Advantage, +148094,3934,21240,Repair of hinged joint of upper and lower jaw bones,CPT/HCPCS,15537.9,15537.9,2772.3,19759.32,United Healthcare-Medicare Advantage, +148095,3934,21243,Repair of hinged joint of upper and lower jaw bones with prosthesis,CPT/HCPCS,71142.54,71142.54,8548.5,105973.57,United Healthcare-Medicare Advantage, +148096,3934,21282,Reattachment of nasal and eye socket ligament,CPT/HCPCS,3656.07,3656.07,2101.2,4034.67,United Healthcare-Medicare Advantage, +148097,3934,21299,Skull and face bone procedure,CPT/HCPCS,8546.82,8546.82,8546.82,8546.82,United Healthcare-Medicare Advantage, +148098,3934,21320,Closed treatment of broken nasal bone with stabilization,CPT/HCPCS,6343.16,6343.16,1528.0,13669.0,United Healthcare-Medicare Advantage, +148099,3934,21337,Closed treatment of nasal cartilage dividing nasal passages,CPT/HCPCS,5937.8,5937.8,2067.07,2067.07,United Healthcare-Medicare Advantage, +148100,3934,21356,Open treatment of broken cheek bone,CPT/HCPCS,8361.68,8361.68,7743.0,7743.0,United Healthcare-Medicare Advantage, +148101,3934,21365,Open treatment of broken cheek bones with insertion of internal hardware,CPT/HCPCS,22103.01,22103.01,3792.8,3915.38,United Healthcare-Medicare Advantage, +148102,3934,21390,Open treatment of broken eye socket bone with implant,CPT/HCPCS,18603.77,18603.77,9531.96,17506.08,United Healthcare-Medicare Advantage, +148103,3934,21407,Open treatment of broken eye socket bone with implant,CPT/HCPCS,14158.63,14158.63,4363.25,4363.25,United Healthcare-Medicare Advantage, +148104,3934,21421,Closed treatment of fracture at roof of mouth or cheek bone with insertion of hardware or oral splint,CPT/HCPCS,11628.0,11628.0,440.13,440.13,United Healthcare-Medicare Advantage, +148105,3934,21452,"Treatment of broken jaw bone with placement of external hardware, accessed through the skin",CPT/HCPCS,49859.7,49859.7,49099.31,49604.11,United Healthcare-Medicare Advantage, +148106,3934,21453,Closed treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,11176.75,11176.75,440.13,440.13,United Healthcare-Medicare Advantage, +148107,3934,21461,Open treatment of broken jaw bone,CPT/HCPCS,23966.94,23966.94,565.32,565.32,United Healthcare-Medicare Advantage, +148108,3934,21462,Open treatment of broken jaw bone with insertion of hardware or oral splint,CPT/HCPCS,19540.87,19540.87,1379.81,6079.97,United Healthcare-Medicare Advantage, +148109,3934,21480,Closed treatment of jaw temporomandibular joint (TMJ) dislocation,CPT/HCPCS,445.06,445.06,500.0,9648.0,United Healthcare-Medicare Advantage, +148110,3934,21499,Musculoskeletal procedure on head,CPT/HCPCS,8726.66,8726.66,2496.71,9737.0,United Healthcare-Medicare Advantage, +148111,3934,21501,Incision and drainage of abscess or blood accumulation in soft tissues of neck or chest,CPT/HCPCS,14343.41,14343.41,4287.0,4287.0,United Healthcare-Medicare Advantage, +148112,3934,21550,Biopsy of soft tissue of neck or chest,CPT/HCPCS,5182.6,5182.6,1994.85,6080.85,United Healthcare-Medicare Advantage, +148113,3934,21552,Removal of (3 centimeters or greater) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,7989.82,7989.82,959.12,12880.0,United Healthcare-Medicare Advantage, +148114,3934,21554,Removal of (5 centimeters or greater) muscle growth of neck or front of chest,CPT/HCPCS,7214.78,7214.78,787.77,6828.0,United Healthcare-Medicare Advantage, +148115,3934,21555,Removal of (less than 3 centimeters) tissue growth beneath the skin of neck or front of chest,CPT/HCPCS,6183.75,6183.75,5236.0,10904.0,United Healthcare-Medicare Advantage, +148116,3934,21556,Removal of (less than 5 centimeters) muscle growth of neck or front of chest,CPT/HCPCS,9003.94,9003.94,2303.66,8512.12,United Healthcare-Medicare Advantage, +148117,3934,21557,Removal of (less than 5 centimeters) growth of neck or front of chest,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,United Healthcare-Medicare Advantage, +148118,3934,21601,Removal of tumor from chest wall including ribs,CPT/HCPCS,35962.93,35962.93,35946.32,35975.39,United Healthcare-Medicare Advantage, +148119,3934,21930,Removal (less than 3 centimeters) tissue growth beneath the skin of back or flank,CPT/HCPCS,5543.17,5543.17,4216.77,4216.77,United Healthcare-Medicare Advantage, +148120,3934,21931,Removal (3 centimeters or greater) tissue growth beneath the skin of back or flank,CPT/HCPCS,7024.49,7024.49,3618.8,16921.0,United Healthcare-Medicare Advantage, +148121,3934,21932,Removal (less than 5 centimeters) muscle growth of back or flank,CPT/HCPCS,6776.37,6776.37,11983.0,11983.0,United Healthcare-Medicare Advantage, +148122,3934,21933,Removal (5 centimeters or greater) muscle growth of back or flank,CPT/HCPCS,6946.81,6946.81,2345.46,13758.0,United Healthcare-Medicare Advantage, +148123,3934,22310,Closed treatment of broken spine bones with casting or bracing,CPT/HCPCS,18529.56,18529.56,1034.25,1034.25,United Healthcare-Medicare Advantage, +148124,3934,22505,Manipulation of spine under anesthesia,CPT/HCPCS,7616.5,7616.5,1104.52,1104.52,United Healthcare-Medicare Advantage, +148125,3934,22513,Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance,CPT/HCPCS,16539.72,16539.72,5768.07,13762.07,United Healthcare-Medicare Advantage, +148126,3934,22514,Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,11681.76,11681.76,14829.64,24266.08,United Healthcare-Medicare Advantage, +148127,3934,22515,Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance,CPT/HCPCS,2065.57,2065.57,1605.33,2171.5,United Healthcare-Medicare Advantage, +148128,3934,22551,"Fusion of spine bones with removal of disc at upper spinal column, anterior approach",CPT/HCPCS,26336.55,26336.55,9904.99,55684.27,United Healthcare-Medicare Advantage, +148129,3934,22552,"Fusion of spine bones with removal of disc in upper spinal column below second vertebra of neck , anterior approach",CPT/HCPCS,3213.61,3213.61,23.13,2865.73,United Healthcare-Medicare Advantage, +148130,3934,22845,"Insertion of anterior spinal instrumentation for spinal stabilization, 2 to 3 vertebral segments",CPT/HCPCS,3090.28,3090.28,999.0,9558.0,United Healthcare-Medicare Advantage, +148131,3934,22853,Insertion of device into intervertebral disc space of spine and fusion of vertebrae,CPT/HCPCS,2934.98,2934.98,1432.86,31589.17,United Healthcare-Medicare Advantage, +148132,3934,22856,"Insertion of artificial upper spine disc, anterior approach",CPT/HCPCS,32054.75,32054.75,4293.09,4293.09,United Healthcare-Medicare Advantage, +148133,3934,22867,Insertion of stabilizing or separating device into lower spine at single level with open decompression,CPT/HCPCS,26179.82,26179.82,22594.1,29765.53,United Healthcare-Medicare Advantage, +148134,3934,22869,Insertion of stabilizing or separating device into lower spine at single level,CPT/HCPCS,24520.37,24520.37,24520.37,24520.37,United Healthcare-Medicare Advantage, +148135,3934,22902,Removal (less than 3 centimeters) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7509.79,7509.79,3212.92,6774.5,United Healthcare-Medicare Advantage, +148136,3934,22903,Removal (3 centimeters or greater) tissue growth beneath the skin in abdominal wall,CPT/HCPCS,7185.33,7185.33,1340.0,13044.0,United Healthcare-Medicare Advantage, +148137,3934,23071,Removal (3 centimeters or greater) tissue growth beneath the skin of shoulder area,CPT/HCPCS,7609.07,7609.07,4237.0,11041.0,United Healthcare-Medicare Advantage, +148138,3934,23073,Removal (5 centimeters or greater) muscle growth of shoulder area,CPT/HCPCS,7916.0,7916.0,1417.47,6383.83,United Healthcare-Medicare Advantage, +148139,3934,23075,Removal (less than 3 centimeters) tissue growth beneath the skin of shoulder area,CPT/HCPCS,6354.0,6354.0,4975.66,4975.66,United Healthcare-Medicare Advantage, +148140,3934,23100,Incision and biopsy of shoulder joint,CPT/HCPCS,7917.85,7917.85,7917.85,7917.85,United Healthcare-Medicare Advantage, +148141,3934,23150,Removal of cyst or growth of upper arm bone,CPT/HCPCS,10212.23,10212.23,6562.07,7998.8,United Healthcare-Medicare Advantage, +148142,3934,23156,Removal of cyst or growth of upper arm bone with donor bone graft,CPT/HCPCS,28376.36,28376.36,12644.71,12644.71,United Healthcare-Medicare Advantage, +148143,3934,23410,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,10928.0,10928.0,11343.0,11343.0,United Healthcare-Medicare Advantage, +148144,3934,23412,"Repair of torn tendons of shoulder, open procedure",CPT/HCPCS,9338.67,9338.67,4950.07,4950.07,United Healthcare-Medicare Advantage, +148145,3934,23430,Anchoring of biceps tendon,CPT/HCPCS,10595.19,10595.19,3513.15,11696.0,United Healthcare-Medicare Advantage, +148146,3934,23440,Transplantation of biceps tendon,CPT/HCPCS,7811.58,7811.58,2547.53,2547.53,United Healthcare-Medicare Advantage, +148147,3934,23472,Prosthetic repair of shoulder joint,CPT/HCPCS,18749.31,18749.31,1808.38,20995.0,United Healthcare-Medicare Advantage, +148148,3934,23515,Open treatment of collar bone broken,CPT/HCPCS,17996.26,17996.26,5323.64,12271.35,United Healthcare-Medicare Advantage, +148149,3934,23550,Open treatment of collar bone and shoulder joint dislocation,CPT/HCPCS,12223.1,12223.1,8515.0,8515.0,United Healthcare-Medicare Advantage, +148150,3934,23552,Open treatment of collar bone and shoulder joint dislocation with tissue graft,CPT/HCPCS,14950.08,14950.08,4313.09,4313.09,United Healthcare-Medicare Advantage, +148151,3934,23630,Open treatment of broken upper arm bone at shoulder joint,CPT/HCPCS,19857.25,19857.25,4594.5,4594.5,United Healthcare-Medicare Advantage, +148152,3934,23650,Closed treatment of shoulder dislocation with manipulation,CPT/HCPCS,2362.53,2362.53,24.4,3209.0,United Healthcare-Medicare Advantage,270.31 +148153,3934,23655,Closed treatment of shoulder dislocation with manipulation under anesthesia,CPT/HCPCS,9664.72,9664.72,1674.89,2484.0,United Healthcare-Medicare Advantage, +148154,3934,23675,Closed treatment of shoulder dislocation and broken upper arm bone with manipulation,CPT/HCPCS,1523.4,1523.4,661.0,661.0,United Healthcare-Medicare Advantage, +148155,3934,23700,Manipulation of shoulder joint under anesthesia,CPT/HCPCS,5694.4,5694.4,5511.1,5511.1,United Healthcare-Medicare Advantage, +148156,3934,24071,Removal (3 centimeters or greater) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6728.15,6728.15,3443.5,14823.64,United Healthcare-Medicare Advantage, +148157,3934,24073,Removal (5 centimeters or greater) muscle growth of upper arm or elbow,CPT/HCPCS,5927.52,5927.52,3996.0,4703.0,United Healthcare-Medicare Advantage, +148158,3934,24075,Removal (less than 3 centimeters) tissue growth beneath the skin of upper arm or elbow,CPT/HCPCS,6226.12,6226.12,3345.12,8460.0,United Healthcare-Medicare Advantage, +148159,3934,24102,Removal of elbow joint lining,CPT/HCPCS,10962.0,10962.0,6828.0,6828.0,United Healthcare-Medicare Advantage, +148160,3934,24105,Removal of fluid-filled sac of elbow,CPT/HCPCS,7083.82,7083.82,4574.56,7314.21,United Healthcare-Medicare Advantage, +148161,3934,24110,Removal of upper arm bone cyst or growth,CPT/HCPCS,37863.73,37863.73,3073.63,3073.63,United Healthcare-Medicare Advantage, +148162,3934,24140,Partial removal of upper arm bone,CPT/HCPCS,14440.95,14440.95,2547.53,2547.53,United Healthcare-Medicare Advantage, +148163,3934,24147,Partial removal of elbow bone,CPT/HCPCS,6329.34,6329.34,2236.33,2236.33,United Healthcare-Medicare Advantage, +148164,3934,24149,Removal of elbow joint capsule and bone,CPT/HCPCS,7834.0,7834.0,1208.36,1208.36,United Healthcare-Medicare Advantage, +148165,3934,24305,Lengthening of tendon of upper arm or elbow,CPT/HCPCS,14252.18,14252.18,14808.62,14808.62,United Healthcare-Medicare Advantage, +148166,3934,24341,Repair of tendon or muscle of upper arm or elbow,CPT/HCPCS,11666.24,11666.24,2892.03,6372.5,United Healthcare-Medicare Advantage, +148167,3934,24342,Reinsertion of torn biceps or triceps tendon at elbow,CPT/HCPCS,11465.05,11465.05,4515.11,12444.87,United Healthcare-Medicare Advantage, +148168,3934,24343,Repair of ligament at elbow,CPT/HCPCS,9015.0,9015.0,4373.03,4373.03,United Healthcare-Medicare Advantage, +148169,3934,24345,Repair of ligament at elbow,CPT/HCPCS,11010.87,11010.87,2867.91,8906.5,United Healthcare-Medicare Advantage, +148170,3934,24358,"Removal of tissue and/or bone at elbow, open procedure",CPT/HCPCS,5227.33,5227.33,3996.0,3996.0,United Healthcare-Medicare Advantage, +148171,3934,24359,"Removal of tissue and/or bone at elbow with tendon repair, open procedure",CPT/HCPCS,7921.02,7921.02,6279.14,10303.0,United Healthcare-Medicare Advantage, +148172,3934,24363,Prosthetic repair of elbow joint,CPT/HCPCS,50795.98,50795.98,50817.08,50817.08,United Healthcare-Medicare Advantage, +148173,3934,24371,Revision of total elbow repair,CPT/HCPCS,47664.86,47664.86,47664.86,47664.86,United Healthcare-Medicare Advantage, +148174,3934,24505,Closed treatment of broken upper arm bone with manipulation,CPT/HCPCS,2752.89,2752.89,2119.04,3124.16,United Healthcare-Medicare Advantage, +148175,3934,24515,Open treatment of broken upper arm bone,CPT/HCPCS,22791.73,22791.73,3552.4,9830.46,United Healthcare-Medicare Advantage, +148176,3934,24516,Treatment of broken upper arm bone,CPT/HCPCS,16478.98,16478.98,3627.39,12218.29,United Healthcare-Medicare Advantage, +148177,3934,24535,Closed treatment of growth plate or broken upper arm bone at elbow with manipulation,CPT/HCPCS,5004.9,5004.9,572.04,572.04,United Healthcare-Medicare Advantage, +148178,3934,24538,"Insertion of hardware to growth plate or broken upper arm bone at elbow, accessed through the skin",CPT/HCPCS,8261.25,8261.25,2214.56,8221.75,United Healthcare-Medicare Advantage, +148179,3934,24545,Open treatment of growth plate or broken upper arm bone at elbow,CPT/HCPCS,19699.29,19699.29,6381.7,30841.3,United Healthcare-Medicare Advantage, +148180,3934,24546,Open treatment of growth plate or broken upper arm at elbow,CPT/HCPCS,32948.4,32948.4,9851.9,9876.68,United Healthcare-Medicare Advantage, +148181,3934,24575,Open treatment of broken upper arm bone at elbow,CPT/HCPCS,13027.02,13027.02,4515.42,6699.7,United Healthcare-Medicare Advantage, +148182,3934,24577,Closed treatment of broken of upper arm bone at shoulder with manipulation,CPT/HCPCS,12302.0,12302.0,7269.6,7269.6,United Healthcare-Medicare Advantage, +148183,3934,24579,Open treatment of broken upper arm bone at shoulder,CPT/HCPCS,13151.5,13151.5,9345.0,9558.0,United Healthcare-Medicare Advantage, +148184,3934,24582,"Insertion of hardware to broken upper arm bone at shoulder with manipulation, accessed through the skin",CPT/HCPCS,6617.78,6617.78,3552.4,3552.4,United Healthcare-Medicare Advantage, +148185,3934,24586,Open treatment of broken and/or dislocated upper or lower arm bones at elbow,CPT/HCPCS,13993.84,13993.84,4741.6,4741.6,United Healthcare-Medicare Advantage, +148186,3934,24600,Treatment of elbow dislocation,CPT/HCPCS,3399.26,3399.26,2951.45,3604.0,United Healthcare-Medicare Advantage, +148187,3934,24605,Treatment of dislocated elbow under anesthesia,CPT/HCPCS,10123.24,10123.24,3342.56,5141.56,United Healthcare-Medicare Advantage, +148188,3934,24620,Closed treatment of broken and dislocated forearm bones at elbow with manipulation,CPT/HCPCS,7686.0,7686.0,836.11,836.11,United Healthcare-Medicare Advantage, +148189,3934,24635,Open treatment of broken and dislocated forearm bones at elbow,CPT/HCPCS,16547.0,16547.0,4973.57,7692.45,United Healthcare-Medicare Advantage, +148190,3934,24640,"Closed treatment of dislocated forearm bone of elbow, child",CPT/HCPCS,2903.27,2903.27,1326.0,4041.0,United Healthcare-Medicare Advantage, +148191,3934,24650,Closed treatment of broken forearm bone at elbow,CPT/HCPCS,3419.5,3419.5,575.09,8277.0,United Healthcare-Medicare Advantage, +148192,3934,24655,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,2415.25,2415.25,100.0,3569.0,United Healthcare-Medicare Advantage, +148193,3934,24665,Open treatment of broken forearm bone at elbow,CPT/HCPCS,7977.18,7977.18,3682.94,4759.0,United Healthcare-Medicare Advantage, +148194,3934,24675,Closed treatment of broken forearm bone at elbow with manipulation,CPT/HCPCS,4583.48,4583.48,5781.0,6551.16,United Healthcare-Medicare Advantage, +148195,3934,24685,Open treatment of broken forearm bone at elbow,CPT/HCPCS,16590.83,16590.83,2804.74,29640.7,United Healthcare-Medicare Advantage, +148196,3934,25000,Incision to repair tendon covering at wrist,CPT/HCPCS,5703.95,5703.95,2649.56,13559.96,United Healthcare-Medicare Advantage,325.0 +148197,3934,25020,Incision of tissue of forearm and/or wrist muscle compartment,CPT/HCPCS,26257.36,26257.36,2054.7,2054.7,United Healthcare-Medicare Advantage, +148198,3934,25066,Biopsy of tissue of forearm and/or wrist,CPT/HCPCS,3634.0,3634.0,3013.72,3013.72,United Healthcare-Medicare Advantage, +148199,3934,25071,Removal (3 centimeters or greater) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,7016.11,7016.11,5171.0,12130.46,United Healthcare-Medicare Advantage, +148200,3934,25073,Removal (3 centimeters or greater) muscle growth at forearm and/or wrist,CPT/HCPCS,7675.02,7675.02,4378.31,7029.0,United Healthcare-Medicare Advantage, +148201,3934,25075,Removal (less than 3 centimeters) tissue growth beneath the skin at forearm and/or wrist,CPT/HCPCS,4520.14,4520.14,3175.5,8656.0,United Healthcare-Medicare Advantage, +148202,3934,25076,Removal (less than 3 centimeters) muscle growth at forearm and/or wrist,CPT/HCPCS,6901.33,6901.33,3715.32,5206.12,United Healthcare-Medicare Advantage, +148203,3934,25101,Incision and exploration of wrist joint,CPT/HCPCS,9649.05,9649.05,2305.53,2305.53,United Healthcare-Medicare Advantage, +148204,3934,25110,Removal of growth of tendon covering at forearm and/or wrist,CPT/HCPCS,9415.0,9415.0,2236.33,2236.33,United Healthcare-Medicare Advantage, +148205,3934,25111,Removal of cyst at wrist,CPT/HCPCS,7175.26,7175.26,3248.01,12223.0,United Healthcare-Medicare Advantage, +148206,3934,25112,Removal of cyst at wrist,CPT/HCPCS,7043.8,7043.8,5340.0,5340.0,United Healthcare-Medicare Advantage, +148207,3934,25115,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,5672.12,5672.12,5130.62,9688.24,United Healthcare-Medicare Advantage, +148208,3934,25116,Removal of fluid-filled sac (bursa) of wrist joint lining or forearm tendon,CPT/HCPCS,7998.08,7998.08,2305.53,2305.53,United Healthcare-Medicare Advantage, +148209,3934,25118,Removal of lining of tendon covering of wrist,CPT/HCPCS,6037.5,6037.5,6551.0,11303.0,United Healthcare-Medicare Advantage, +148210,3934,25210,Removal of wrist bone,CPT/HCPCS,8762.0,8762.0,3316.42,3996.0,United Healthcare-Medicare Advantage, +148211,3934,25215,Removal of multiple wrist bones,CPT/HCPCS,9904.67,9904.67,5554.04,5976.12,United Healthcare-Medicare Advantage, +148212,3934,25240,Partial removal of forearm bone,CPT/HCPCS,10557.1,10557.1,7107.33,10319.0,United Healthcare-Medicare Advantage, +148213,3934,25260,Repair of tendon or muscle of forearm and/or wrist,CPT/HCPCS,6356.39,6356.39,1070.02,4929.0,United Healthcare-Medicare Advantage, +148214,3934,25270,Repair of forearm and/or wrist tendon or muscle,CPT/HCPCS,7637.72,7637.72,3996.0,5511.1,United Healthcare-Medicare Advantage, +148215,3934,25275,Repair of forearm and/or wrist tendon covering with graft,CPT/HCPCS,7235.3,7235.3,2305.53,2305.53,United Healthcare-Medicare Advantage, +148216,3934,25280,Lengthening or shortening of tendon of forearm and/or wrist,CPT/HCPCS,6450.23,6450.23,4665.6,7603.2,United Healthcare-Medicare Advantage, +148217,3934,25290,"Incision of tendon of forearm and/or wrist, open procedure",CPT/HCPCS,10471.79,10471.79,9699.59,12415.32,United Healthcare-Medicare Advantage, +148218,3934,25310,Relocation of tendon of forearm and/or wrist,CPT/HCPCS,4956.45,4956.45,1626.2,2067.0,United Healthcare-Medicare Advantage, +148219,3934,25320,"Repair of wrist joint, open procedure",CPT/HCPCS,13591.45,13591.45,5916.5,19249.0,United Healthcare-Medicare Advantage, +148220,3934,25390,Shortening of one of the forearm bones,CPT/HCPCS,11933.0,11933.0,2532.41,2532.41,United Healthcare-Medicare Advantage, +148221,3934,25400,Repair non-healed fracture of forearm bone,CPT/HCPCS,12376.75,12376.75,8580.41,13295.13,United Healthcare-Medicare Advantage, +148222,3934,25447,Removal of bone joints between wrist and fingers,CPT/HCPCS,8916.07,8916.07,2717.22,14258.0,United Healthcare-Medicare Advantage, +148223,3934,25500,Closed treatment of broken forearm bone,CPT/HCPCS,670.0,670.0,575.09,575.09,United Healthcare-Medicare Advantage, +148224,3934,25505,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,4215.18,4215.18,200.0,4287.0,United Healthcare-Medicare Advantage, +148225,3934,25515,Open treatment of broken forearm bone,CPT/HCPCS,12500.57,12500.57,3455.22,6026.91,United Healthcare-Medicare Advantage, +148226,3934,25525,Open treatment of broken forearm bone and closed treatment of joint dislocation,CPT/HCPCS,14240.67,14240.67,7247.13,7743.0,United Healthcare-Medicare Advantage, +148227,3934,25535,Closed treatment of broken forearm bone with manipulation,CPT/HCPCS,1505.04,1505.04,2865.73,2865.73,United Healthcare-Medicare Advantage, +148228,3934,25565,Closed treatment of broken forearm bones with manipulation,CPT/HCPCS,6294.39,6294.39,2652.0,8127.0,United Healthcare-Medicare Advantage, +148229,3934,25575,Open treatment of broken forearm bones,CPT/HCPCS,18096.73,18096.73,3821.9,12014.64,United Healthcare-Medicare Advantage, +148230,3934,25600,Closed treatment of broken forearm bones,CPT/HCPCS,755.33,755.33,575.09,2006.0,United Healthcare-Medicare Advantage, +148231,3934,25605,Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation,CPT/HCPCS,4334.88,4334.88,135.0,8572.15,United Healthcare-Medicare Advantage,1642.05 +148232,3934,25606,"Insertion of hardware to lower forearm bone broken or growth plate separation, accessed through the skin",CPT/HCPCS,7082.8,7082.8,2929.31,5871.12,United Healthcare-Medicare Advantage, +148233,3934,25607,Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware,CPT/HCPCS,12725.64,12725.64,5498.19,12871.9,United Healthcare-Medicare Advantage, +148234,3934,25608,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2 fragments,CPT/HCPCS,13972.59,13972.59,5232.87,11237.0,United Healthcare-Medicare Advantage, +148235,3934,25609,Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or more fragments,CPT/HCPCS,16612.99,16612.99,6050.9,41702.0,United Healthcare-Medicare Advantage, +148236,3934,25650,Closed treatment of broken forearm at wrist bone,CPT/HCPCS,8711.55,8711.55,1949.0,1949.0,United Healthcare-Medicare Advantage, +148237,3934,25652,Open treatment of broken wrist,CPT/HCPCS,14175.74,14175.74,5798.71,5798.71,United Healthcare-Medicare Advantage, +148238,3934,25690,Closed treatment of dislocated wrist bone with manipulation,CPT/HCPCS,4629.0,4629.0,3709.0,4625.0,United Healthcare-Medicare Advantage, +148239,3934,25800,Fusion of entire wrist joint,CPT/HCPCS,11299.7,11299.7,2439.62,2439.62,United Healthcare-Medicare Advantage, +148240,3934,25820,Fusion of part of wrist joint,CPT/HCPCS,15492.75,15492.75,2515.17,7247.13,United Healthcare-Medicare Advantage, +148241,3934,26010,Drainage of finger abscess,CPT/HCPCS,916.25,916.25,100.0,10452.0,United Healthcare-Medicare Advantage, +148242,3934,26011,Drainage of finger abscess,CPT/HCPCS,4266.0,4266.0,813.74,4053.0,United Healthcare-Medicare Advantage, +148243,3934,26055,Incision of tendon covering,CPT/HCPCS,4779.42,4779.42,1993.82,15046.92,United Healthcare-Medicare Advantage, +148244,3934,26080,"Exploration, drainage, or removal of foreign body of hand joint",CPT/HCPCS,6197.6,6197.6,4289.4,10618.59,United Healthcare-Medicare Advantage, +148245,3934,26110,Biopsy of finger joint,CPT/HCPCS,4615.0,4615.0,4007.5,4007.5,United Healthcare-Medicare Advantage, +148246,3934,26111,Removal (1.5 centimeters or greater) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5055.0,5055.0,1784.5,1784.5,United Healthcare-Medicare Advantage, +148247,3934,26113,Removal (1.5 centimeters or greater) muscle growth of hand or finger,CPT/HCPCS,6574.67,6574.67,5446.36,7190.04,United Healthcare-Medicare Advantage, +148248,3934,26115,Removal (less than 1.5 centimeters) tissue beneath the skin growth of hand or finger,CPT/HCPCS,5444.29,5444.29,2679.0,11223.0,United Healthcare-Medicare Advantage, +148249,3934,26116,Removal (less than 1.5 centimeters) muscle growth of hand or finger,CPT/HCPCS,5830.17,5830.17,1466.39,3996.0,United Healthcare-Medicare Advantage, +148250,3934,26121,Removal of tissue of palm,CPT/HCPCS,5156.0,5156.0,2826.0,10568.98,United Healthcare-Medicare Advantage, +148251,3934,26123,Removal of tissue of palm,CPT/HCPCS,8631.33,8631.33,2614.86,15595.0,United Healthcare-Medicare Advantage, +148252,3934,26125,Removal of tissue of palm,CPT/HCPCS,1962.13,1962.13,1356.0,7920.0,United Healthcare-Medicare Advantage, +148253,3934,26145,"Repair of tendon, finger and/or hand",CPT/HCPCS,4411.11,4411.11,2981.0,5159.0,United Healthcare-Medicare Advantage, +148254,3934,26160,Removal of growth of tendon finger or hand,CPT/HCPCS,5623.74,5623.74,2533.41,12079.0,United Healthcare-Medicare Advantage, +148255,3934,26200,Removal or scraping of hand bone cyst or growth,CPT/HCPCS,8006.0,8006.0,4955.62,6208.0,United Healthcare-Medicare Advantage, +148256,3934,26210,Removal or scraping of finger bone cyst or growth,CPT/HCPCS,6303.11,6303.11,4287.0,5511.1,United Healthcare-Medicare Advantage, +148257,3934,26230,Partial removal of hand bone,CPT/HCPCS,5078.2,5078.2,2384.35,2418.95,United Healthcare-Medicare Advantage, +148258,3934,26236,Partial removal of finger bone,CPT/HCPCS,2772.0,2772.0,1412.66,5041.0,United Healthcare-Medicare Advantage, +148259,3934,26340,Manipulation of finger joint under anesthesia,CPT/HCPCS,5111.0,5111.0,2843.8,2843.8,United Healthcare-Medicare Advantage, +148260,3934,26341,Manipulation of palm pretendinous cord following enzyme injection,CPT/HCPCS,1468.5,1468.5,52.25,1515.0,United Healthcare-Medicare Advantage, +148261,3934,26350,Repair of finger tendon,CPT/HCPCS,9644.63,9644.63,5731.46,5731.46,United Healthcare-Medicare Advantage, +148262,3934,26356,Repair of finger tendon,CPT/HCPCS,7600.84,7600.84,2143.5,6992.0,United Healthcare-Medicare Advantage, +148263,3934,26410,Repair of hand tendon,CPT/HCPCS,2764.4,2764.4,1393.6,1393.6,United Healthcare-Medicare Advantage, +148264,3934,26418,Repair of finger tendon,CPT/HCPCS,3838.01,3838.01,267.0,5542.0,United Healthcare-Medicare Advantage, +148265,3934,26426,Repair of finger tendon using tissue,CPT/HCPCS,5512.33,5512.33,2349.75,5694.79,United Healthcare-Medicare Advantage, +148266,3934,26433,Repair of finger tendon,CPT/HCPCS,6241.33,6241.33,7150.0,7150.0,United Healthcare-Medicare Advantage, +148267,3934,26437,Repair of finger tendon,CPT/HCPCS,7708.0,7708.0,4477.4,6173.0,United Healthcare-Medicare Advantage, +148268,3934,26440,Removal of scar tissue to release tendon of palm or finger,CPT/HCPCS,6206.49,6206.49,1466.39,1466.39,United Healthcare-Medicare Advantage, +148269,3934,26480,Transplant of tendon of hand,CPT/HCPCS,11013.66,11013.66,5095.02,18143.0,United Healthcare-Medicare Advantage, +148270,3934,26500,Repair of tendon ligament,CPT/HCPCS,9653.5,9653.5,1186.22,2418.95,United Healthcare-Medicare Advantage, +148271,3934,26520,Removal of hand or finger joint capsule,CPT/HCPCS,5311.0,5311.0,3275.47,6227.39,United Healthcare-Medicare Advantage, +148272,3934,26525,"Repair of joint capsule, hand and finger",CPT/HCPCS,6557.66,6557.66,3149.25,14381.62,United Healthcare-Medicare Advantage, +148273,3934,26531,Repair of joint of hand bone and finger,CPT/HCPCS,10847.0,10847.0,10679.0,10679.0,United Healthcare-Medicare Advantage, +148274,3934,26535,Repair of finger joint,CPT/HCPCS,18268.02,18268.02,3361.5,3361.5,United Healthcare-Medicare Advantage, +148275,3934,26536,Repair of finger joint,CPT/HCPCS,17754.21,17754.21,12760.5,15927.0,United Healthcare-Medicare Advantage, +148276,3934,26540,Repair of ligament of hand or finger joint,CPT/HCPCS,9431.7,9431.7,6053.39,11579.0,United Healthcare-Medicare Advantage, +148277,3934,26542,Repair of ligament of hand or finger joint,CPT/HCPCS,8388.83,8388.83,3996.0,3996.0,United Healthcare-Medicare Advantage, +148278,3934,26548,Repair of floor of finger joint,CPT/HCPCS,5422.89,5422.89,6417.0,6417.0,United Healthcare-Medicare Advantage, +148279,3934,26561,Repair of webbed finger,CPT/HCPCS,11626.47,11626.47,2349.75,2349.75,United Healthcare-Medicare Advantage, +148280,3934,26565,Incision of bone of hand,CPT/HCPCS,9535.0,9535.0,2349.75,3996.0,United Healthcare-Medicare Advantage, +148281,3934,26587,Removal of extra finger,CPT/HCPCS,8700.67,8700.67,2349.75,2349.75,United Healthcare-Medicare Advantage, +148282,3934,26605,Closed treatment of fracture of bone of hand with manipulation,CPT/HCPCS,2314.46,2314.46,1486.0,3820.0,United Healthcare-Medicare Advantage, +148283,3934,26607,Closed treatment of fracture of bone of hand with manipulation and external hardware,CPT/HCPCS,3680.29,3680.29,3150.32,3150.32,United Healthcare-Medicare Advantage, +148284,3934,26608,"Insertion of hardware to broken finger, accessed through the skin",CPT/HCPCS,7085.76,7085.76,2787.95,6146.0,United Healthcare-Medicare Advantage, +148285,3934,26615,Open treatment of broken finger,CPT/HCPCS,9085.41,9085.41,1582.13,5731.46,United Healthcare-Medicare Advantage, +148286,3934,26641,Closed treatment of thumb dislocation with manipulation,CPT/HCPCS,3235.5,3235.5,572.04,572.04,United Healthcare-Medicare Advantage, +148287,3934,26645,Closed treatment of broken thumb with manipulation,CPT/HCPCS,3300.82,3300.82,100.0,1949.0,United Healthcare-Medicare Advantage, +148288,3934,26650,"Insertion of hardware to broken thumb with manipulation, accessed through the skin",CPT/HCPCS,7045.5,7045.5,5482.0,5482.0,United Healthcare-Medicare Advantage, +148289,3934,26705,Closed treatment of dislocated hand joint with manipulation under anesthesia,CPT/HCPCS,867.33,867.33,1642.05,1642.05,United Healthcare-Medicare Advantage, +148290,3934,26720,Closed treatment of broken finger or thumb,CPT/HCPCS,9595.4,9595.4,9403.0,9403.0,United Healthcare-Medicare Advantage, +148291,3934,26725,Closed treatment of broken finger or thumb with manipulation,CPT/HCPCS,2559.16,2559.16,929.25,6653.0,United Healthcare-Medicare Advantage, +148292,3934,26727,"Insertion of hardware to broken finger or thumb with manipulation, accessed through the skin",CPT/HCPCS,7210.54,7210.54,3008.08,10119.09,United Healthcare-Medicare Advantage, +148293,3934,26735,Open treatment of broken finger,CPT/HCPCS,9501.5,9501.5,3397.51,6851.0,United Healthcare-Medicare Advantage, +148294,3934,26742,Closed treatment of broken hand or finger with manipulation,CPT/HCPCS,1213.6,1213.6,572.04,2486.4,United Healthcare-Medicare Advantage, +148295,3934,26746,Open treatment of broken hand or finger,CPT/HCPCS,4269.58,4269.58,3223.74,3223.74,United Healthcare-Medicare Advantage, +148296,3934,26765,Open treatment of broken finger or thumb,CPT/HCPCS,4724.0,4724.0,3279.94,3279.94,United Healthcare-Medicare Advantage, +148297,3934,26770,Closed treatment of dislocated finger joint with manipulation,CPT/HCPCS,1289.28,1289.28,200.0,2484.0,United Healthcare-Medicare Advantage, +148298,3934,26785,Open treatment of dislocated finger joint,CPT/HCPCS,5514.67,5514.67,3279.94,3279.94,United Healthcare-Medicare Advantage, +148299,3934,26860,Fusion of finger joint,CPT/HCPCS,8755.3,8755.3,3841.39,15242.0,United Healthcare-Medicare Advantage, +148300,3934,26951,Amputation of finger or thumb,CPT/HCPCS,5095.29,5095.29,154.11,5546.11,United Healthcare-Medicare Advantage, +148301,3934,27043,Removal (3 centimeters or greater) tissue growth beneath the skin of pelvis or hip,CPT/HCPCS,6498.3,6498.3,4287.0,4287.0,United Healthcare-Medicare Advantage, +148302,3934,27045,Removal (5 centimeters or greater) muscle growth of pelvis or hip,CPT/HCPCS,4658.4,4658.4,4539.0,4539.0,United Healthcare-Medicare Advantage, +148303,3934,27047,Removal (less than 3 centimeters) tissue growth of pelvis or hip,CPT/HCPCS,6770.0,6770.0,1303.02,1303.02,United Healthcare-Medicare Advantage, +148304,3934,27052,Biopsy of hip joint,CPT/HCPCS,7052.0,7052.0,2615.4,2615.4,United Healthcare-Medicare Advantage, +148305,3934,27095,Injection procedure for X-ray imaging of hip under anesthesia,CPT/HCPCS,8165.75,8165.75,643.29,857.96,United Healthcare-Medicare Advantage, +148306,3934,27096,Injection procedure into sacroiliac joint for anesthetic or steroid,CPT/HCPCS,845.13,845.13,48.12,8597.18,United Healthcare-Medicare Advantage, +148307,3934,27130,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,28384.42,28384.42,6752.0,52782.87,United Healthcare-Medicare Advantage, +148308,3934,27132,Replacement of thigh bone and hip joint prosthesis,CPT/HCPCS,9671.5,9671.5,8571.0,16977.35,United Healthcare-Medicare Advantage, +148309,3934,27140,Transfer of head of thigh bone,CPT/HCPCS,15486.0,15486.0,4495.78,4495.78,United Healthcare-Medicare Advantage, +148310,3934,27146,Incision of pelvic bone,CPT/HCPCS,4242.33,4242.33,2455.17,2455.17,United Healthcare-Medicare Advantage, +148311,3934,27176,Surgical treatment of growth plate at upper thigh bone,CPT/HCPCS,11258.5,11258.5,2455.17,3191.72,United Healthcare-Medicare Advantage, +148312,3934,27215,Open treatment of broken bones on one side of pelvis,CPT/HCPCS,16699.5,16699.5,6303.0,6303.0,United Healthcare-Medicare Advantage, +148313,3934,27235,"Insertion of hardware to broken thigh bone, accessed through the skin",CPT/HCPCS,27626.25,27626.25,4012.28,19989.59,United Healthcare-Medicare Advantage, +148314,3934,27250,Treatment of hip dislocation,CPT/HCPCS,8447.81,8447.81,5631.85,5801.62,United Healthcare-Medicare Advantage, +148315,3934,27252,Closed treatment of hip dislocation under anesthesia,CPT/HCPCS,10464.5,10464.5,9594.6,10788.6,United Healthcare-Medicare Advantage, +148316,3934,27265,Closed treatment of dislocated hip prosthesis,CPT/HCPCS,6231.9,6231.9,2122.07,7025.0,United Healthcare-Medicare Advantage, +148317,3934,27266,Closed treatment of dislocated hip prosthesis under anesthesia,CPT/HCPCS,10180.76,10180.76,5635.33,11292.0,United Healthcare-Medicare Advantage, +148318,3934,27279,Fusion sacroiliac joint through the skin or minimally invasive using image guidance,CPT/HCPCS,23900.6,23900.6,21764.0,30104.0,United Healthcare-Medicare Advantage, +148319,3934,27299,Pelvis or hip joint procedure,CPT/HCPCS,4484.27,4484.27,4285.67,4285.67,United Healthcare-Medicare Advantage, +148320,3934,27305,"Removal of tissue at thigh or knee region, open procedure",CPT/HCPCS,7969.62,7969.62,7969.62,7969.62,United Healthcare-Medicare Advantage, +148321,3934,27310,"Exploration, drainage, or removal of foreign body in knee joint",CPT/HCPCS,5702.67,5702.67,4862.0,4862.0,United Healthcare-Medicare Advantage, +148322,3934,27327,Removal (less than 3 centimeters) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,5940.97,5940.97,3175.5,10866.1,United Healthcare-Medicare Advantage, +148323,3934,27328,Removal (less than 5 centimeters) muscle growth of thigh or knee,CPT/HCPCS,6279.33,6279.33,1428.0,6675.0,United Healthcare-Medicare Advantage, +148324,3934,27337,Removal (3 centimeters or greater) tissue growth beneath the skin of thigh or knee,CPT/HCPCS,6485.45,6485.45,6891.52,10866.1,United Healthcare-Medicare Advantage, +148325,3934,27339,Removal (5 centimeters or greater) muscle growth of thigh or knee,CPT/HCPCS,11588.98,11588.98,11253.27,11253.27,United Healthcare-Medicare Advantage, +148326,3934,27340,Removal of fluid-filled sac (bursa) below knee joint,CPT/HCPCS,9343.2,9343.2,1916.07,3996.0,United Healthcare-Medicare Advantage, +148327,3934,27347,Removal of growth of knee cartilage or capsule,CPT/HCPCS,6061.0,6061.0,6949.0,6949.0,United Healthcare-Medicare Advantage, +148328,3934,27355,Removal or scraping of cyst or growth of thigh bone,CPT/HCPCS,10462.0,10462.0,3768.4,6828.0,United Healthcare-Medicare Advantage, +148329,3934,27372,Removal of foreign body of thigh or knee,CPT/HCPCS,6765.0,6765.0,6765.0,6765.0,United Healthcare-Medicare Advantage, +148330,3934,27380,Suture of tendon below knee,CPT/HCPCS,12078.25,12078.25,3436.0,5731.46,United Healthcare-Medicare Advantage, +148331,3934,27381,Suture of tendon below knee,CPT/HCPCS,14194.77,14194.77,2250.84,2250.84,United Healthcare-Medicare Advantage, +148332,3934,27385,Suture of ruptured muscle of thigh,CPT/HCPCS,13547.23,13547.23,5535.17,15905.0,United Healthcare-Medicare Advantage, +148333,3934,27392,"Repair of multiple hamstring tendons of both legs, open procedure",CPT/HCPCS,8841.03,8841.03,2628.01,2628.01,United Healthcare-Medicare Advantage, +148334,3934,27395,Lengthening of multiple hamstring tendons in both legs,CPT/HCPCS,14160.22,14160.22,2455.17,2455.17,United Healthcare-Medicare Advantage, +148335,3934,27418,Repair of upper end of shin bone at knee joint,CPT/HCPCS,10296.29,10296.29,2570.37,9966.54,United Healthcare-Medicare Advantage, +148336,3934,27420,Repair of dislocating knee cap,CPT/HCPCS,7692.22,7692.22,2891.16,2891.16,United Healthcare-Medicare Advantage, +148337,3934,27422,Repair of dislocating knee cap,CPT/HCPCS,10346.66,10346.66,2232.57,10579.0,United Healthcare-Medicare Advantage, +148338,3934,27427,Reconstruction of knee joint ligaments,CPT/HCPCS,11859.72,11859.72,4058.37,6246.0,United Healthcare-Medicare Advantage, +148339,3934,27447,Repair of knee joint,CPT/HCPCS,23813.38,23813.38,2266.68,41810.6,United Healthcare-Medicare Advantage, +148340,3934,27450,Repair of thigh bone with insertion of stabilizing fixation,CPT/HCPCS,14648.56,14648.56,1220.16,17503.85,United Healthcare-Medicare Advantage, +148341,3934,27472,Repair of non-healed fracture of thigh bone with patient-derived bone graft,CPT/HCPCS,24653.0,24653.0,2455.17,2455.17,United Healthcare-Medicare Advantage, +148342,3934,27475,Removal of growth plate of lower end of thigh bone,CPT/HCPCS,13604.03,13604.03,8219.61,8351.11,United Healthcare-Medicare Advantage, +148343,3934,27485,Removal of growth plate of leg or thigh bones,CPT/HCPCS,14365.37,14365.37,2261.4,3198.03,United Healthcare-Medicare Advantage, +148344,3934,27509,"Insertion of hardware to stabilize broken thigh bone or separated growth plate, accessed through the skin",CPT/HCPCS,11052.14,11052.14,3053.2,3057.22,United Healthcare-Medicare Advantage, +148345,3934,27524,Open treatment of knee cap fracture with insertion of hardware and/or removal of knee cap,CPT/HCPCS,15616.75,15616.75,3499.0,5857.0,United Healthcare-Medicare Advantage, +148346,3934,27532,Closed treatment of fracture of shin bone with traction,CPT/HCPCS,6681.8,6681.8,2484.0,2484.0,United Healthcare-Medicare Advantage, +148347,3934,27535,Open treatment of broken shin bone,CPT/HCPCS,15336.61,15336.61,3259.42,4800.7,United Healthcare-Medicare Advantage, +148348,3934,27536,Open treatment of broken shin bone,CPT/HCPCS,19958.67,19958.67,3279.94,3279.94,United Healthcare-Medicare Advantage, +148349,3934,27552,Closed treatment of knee dislocation under anesthesia,CPT/HCPCS,30970.88,30970.88,3802.06,3802.06,United Healthcare-Medicare Advantage, +148350,3934,27560,Closed treatment of dislocation of knee cap,CPT/HCPCS,2606.13,2606.13,946.04,3154.5,United Healthcare-Medicare Advantage, +148351,3934,27570,Alignment of knee joint under anesthesia,CPT/HCPCS,2112.8,2112.8,1691.0,5340.0,United Healthcare-Medicare Advantage, +148352,3934,27580,Fusion of knee,CPT/HCPCS,611.67,611.67,2185.23,2185.23,United Healthcare-Medicare Advantage, +148353,3934,27599,Thigh or knee procedure,CPT/HCPCS,9614.09,9614.09,652.28,652.28,United Healthcare-Medicare Advantage, +148354,3934,27600,Incision of tissue of front and/or lateral muscle compartments of lower leg,CPT/HCPCS,3306.2,3306.2,5731.46,5731.46,United Healthcare-Medicare Advantage, +148355,3934,27606,"Incision of Achilles tendon, accessed through the skin requiring general anesthesia",CPT/HCPCS,6678.13,6678.13,1988.94,4356.0,United Healthcare-Medicare Advantage, +148356,3934,27610,"Exploration, drainage, or removal of foreign body of ankle",CPT/HCPCS,16672.02,16672.02,8246.2,8246.2,United Healthcare-Medicare Advantage, +148357,3934,27618,Removal (less than 3 centimeters) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,5146.0,5146.0,2544.51,5089.02,United Healthcare-Medicare Advantage, +148358,3934,27619,Removal of (less than 5 centimeters) muscle growth of leg or ankle,CPT/HCPCS,9486.19,9486.19,9507.38,9507.38,United Healthcare-Medicare Advantage, +148359,3934,27620,Exploration of ankle joint,CPT/HCPCS,15171.24,15171.24,11645.5,11645.5,United Healthcare-Medicare Advantage, +148360,3934,27630,Removal of growth of leg and/or ankle tendon lining or capsule,CPT/HCPCS,6671.5,6671.5,7909.0,7909.0,United Healthcare-Medicare Advantage, +148361,3934,27632,Removal (3 centimeters or greater) tissue growth beneath the skin of leg or ankle,CPT/HCPCS,6302.75,6302.75,1988.94,1988.94,United Healthcare-Medicare Advantage, +148362,3934,27635,Removal or scraping of cyst or growth of either bone of lower leg,CPT/HCPCS,8534.5,8534.5,1988.94,6675.0,United Healthcare-Medicare Advantage, +148363,3934,27650,"Repair of ruptured Achilles tendon, open or through skin procedure",CPT/HCPCS,9337.96,9337.96,3996.0,6828.0,United Healthcare-Medicare Advantage, +148364,3934,27654,Repair of ruptured Achilles tendon,CPT/HCPCS,8088.8,8088.8,7496.37,7568.0,United Healthcare-Medicare Advantage, +148365,3934,27658,Repair of leg tendon,CPT/HCPCS,9118.77,9118.77,6170.94,18423.0,United Healthcare-Medicare Advantage, +148366,3934,27685,Lengthening or shortening of tendon of leg or ankle,CPT/HCPCS,6948.92,6948.92,4356.0,8597.18,United Healthcare-Medicare Advantage, +148367,3934,27686,Lengthening or shortening of multiple tendons of leg or ankle,CPT/HCPCS,32537.62,32537.62,3161.5,3161.5,United Healthcare-Medicare Advantage, +148368,3934,27687,Lengthening of calf muscle,CPT/HCPCS,8609.9,8609.9,2143.5,4287.0,United Healthcare-Medicare Advantage, +148369,3934,27691,Transplant of deep tendon with muscle rerouting at lower leg or ankle,CPT/HCPCS,8649.31,8649.31,1998.0,8515.0,United Healthcare-Medicare Advantage, +148370,3934,27695,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8012.61,8012.61,7061.0,9939.67,United Healthcare-Medicare Advantage, +148371,3934,27696,Repair of disruption of both collateral ligaments of ankle,CPT/HCPCS,7574.33,7574.33,999.0,999.0,United Healthcare-Medicare Advantage, +148372,3934,27698,Repair of disrupted collateral ligament of ankle,CPT/HCPCS,8284.0,8284.0,4642.0,4642.0,United Healthcare-Medicare Advantage, +148373,3934,27707,Incision of leg bone,CPT/HCPCS,7476.25,7476.25,2250.84,2250.84,United Healthcare-Medicare Advantage, +148374,3934,27745,Insertion of hardware to shin bone,CPT/HCPCS,34945.25,34945.25,10012.5,10012.5,United Healthcare-Medicare Advantage, +148375,3934,27752,Closed treatment of broken shin bone with manipulation,CPT/HCPCS,7316.88,7316.88,100.0,4356.0,United Healthcare-Medicare Advantage, +148376,3934,27759,Treatment of broken shin bone,CPT/HCPCS,26077.26,26077.26,5140.17,5143.37,United Healthcare-Medicare Advantage, +148377,3934,27762,Closed treatment of broken ankle with manipulation,CPT/HCPCS,7131.03,7131.03,686.45,686.45,United Healthcare-Medicare Advantage, +148378,3934,27766,Open treatment of broken ankle,CPT/HCPCS,12597.04,12597.04,2545.9,8844.9,United Healthcare-Medicare Advantage, +148379,3934,27781,Closed treatment of broken ankle with manipulation,CPT/HCPCS,8357.87,8357.87,572.04,1939.0,United Healthcare-Medicare Advantage, +148380,3934,27784,Open treatment of broken ankle,CPT/HCPCS,12000.7,12000.7,4435.0,4983.0,United Healthcare-Medicare Advantage, +148381,3934,27788,Closed treatment of broken ankle with manipulation,CPT/HCPCS,2557.65,2557.65,1992.62,3937.12,United Healthcare-Medicare Advantage,270.31 +148382,3934,27792,Open treatment of broken ankle,CPT/HCPCS,13111.32,13111.32,4354.2,16227.33,United Healthcare-Medicare Advantage, +148383,3934,27810,Closed treatment of broken ankle with manipulation,CPT/HCPCS,3936.63,3936.63,572.04,1642.05,United Healthcare-Medicare Advantage, +148384,3934,27814,Open treatment of broken ankle,CPT/HCPCS,15659.37,15659.37,2602.11,19241.0,United Healthcare-Medicare Advantage, +148385,3934,27818,Closed treatment of broken ankle with manipulation,CPT/HCPCS,6323.8,6323.8,4351.78,9812.74,United Healthcare-Medicare Advantage, +148386,3934,27822,Open treatment of broken ankle,CPT/HCPCS,15041.53,15041.53,3503.93,15689.0,United Healthcare-Medicare Advantage, +148387,3934,27823,Open treatment of broken ankle,CPT/HCPCS,23659.26,23659.26,4237.65,24655.0,United Healthcare-Medicare Advantage, +148388,3934,27824,Closed treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,5098.6,5098.6,572.04,572.04,United Healthcare-Medicare Advantage, +148389,3934,27825,Closed treatment of fracture of lower weight bearing joint of shin bone with traction and/or manipulation,CPT/HCPCS,6521.63,6521.63,51.69,652.28,United Healthcare-Medicare Advantage, +148390,3934,27827,Open treatment of fracture of lower weight bearing joint of shin bone,CPT/HCPCS,17605.21,17605.21,3552.4,4268.46,United Healthcare-Medicare Advantage, +148391,3934,27828,Open treatment of fracture of lower weight bearing joint of both lower leg bones,CPT/HCPCS,19240.67,19240.67,12053.4,20723.0,United Healthcare-Medicare Advantage, +148392,3934,27829,Open treatment of ligament tear at ankle joint,CPT/HCPCS,12190.46,12190.46,5473.0,17932.0,United Healthcare-Medicare Advantage, +148393,3934,28035,Release of nerve between tissue and bone of foot,CPT/HCPCS,8981.25,8981.25,1916.07,6992.0,United Healthcare-Medicare Advantage, +148394,3934,28041,Removal (1.5 centimeters or greater) muscle growth of foot or toe,CPT/HCPCS,8569.92,8569.92,8569.92,8569.92,United Healthcare-Medicare Advantage, +148395,3934,28043,Removal (less than 1.5 centimeters) tissue growth beneath the skin of foot or toe,CPT/HCPCS,8219.33,8219.33,4287.0,5041.0,United Healthcare-Medicare Advantage, +148396,3934,28045,Removal (less than 1.5 centimeters) muscle growth of foot or toe,CPT/HCPCS,6182.7,6182.7,2809.34,2809.34,United Healthcare-Medicare Advantage, +148397,3934,28047,Removal (3 centimeters or greater) tissue growth of foot or toe,CPT/HCPCS,9903.2,9903.2,9903.2,9903.2,United Healthcare-Medicare Advantage, +148398,3934,28080,Removal of fibrous nerve growth from between toes,CPT/HCPCS,7161.9,7161.9,7204.77,11585.0,United Healthcare-Medicare Advantage, +148399,3934,28090,Removal of growth of tendon covering or joint capsule of foot,CPT/HCPCS,6756.67,6756.67,3639.51,7529.72,United Healthcare-Medicare Advantage, +148400,3934,28092,Removal of growth of tendon covering or joint capsule of toes,CPT/HCPCS,6433.88,6433.88,2272.0,2272.0,United Healthcare-Medicare Advantage, +148401,3934,28100,Removal or scraping of bone cyst or growth of heel bone,CPT/HCPCS,4792.0,4792.0,2272.0,2272.0,United Healthcare-Medicare Advantage, +148402,3934,28103,Removal or scraping of bone cyst or growth of heel bone with donor bone graft,CPT/HCPCS,12637.88,12637.88,2341.96,2341.96,United Healthcare-Medicare Advantage, +148403,3934,28104,Removal or scraping of bone cyst or growth of ankle bone,CPT/HCPCS,7599.38,7599.38,5062.74,7807.72,United Healthcare-Medicare Advantage, +148404,3934,28110,Removal of bunion at fifth toe joint,CPT/HCPCS,6697.45,6697.45,1089.0,1089.0,United Healthcare-Medicare Advantage, +148405,3934,28111,Removal of bone at fifth toe joint,CPT/HCPCS,20158.29,20158.29,20158.29,20158.29,United Healthcare-Medicare Advantage, +148406,3934,28112,"Removal of bones at second, third, or fourth toe joints",CPT/HCPCS,2403.21,2403.21,1887.28,4487.72,United Healthcare-Medicare Advantage, +148407,3934,28116,Removal of abnormal bones at ankle joint,CPT/HCPCS,8717.31,8717.31,869.94,869.94,United Healthcare-Medicare Advantage, +148408,3934,28118,Removal of heel bone,CPT/HCPCS,10348.71,10348.71,7115.58,9808.0,United Healthcare-Medicare Advantage, +148409,3934,28120,Partial removal of foot or heel bone,CPT/HCPCS,10087.5,10087.5,4356.0,4356.0,United Healthcare-Medicare Advantage, +148410,3934,28122,Partial removal of foot or heel bone,CPT/HCPCS,3648.24,3648.24,1546.13,6923.0,United Healthcare-Medicare Advantage, +148411,3934,28124,Partial removal of toe bone,CPT/HCPCS,9742.95,9742.95,1855.57,5731.46,United Healthcare-Medicare Advantage, +148412,3934,28190,"Removal of foreign body of foot tissue, accessed beneath the skin",CPT/HCPCS,3521.0,3521.0,3892.0,5696.0,United Healthcare-Medicare Advantage, +148413,3934,28200,Repair of foot tendon,CPT/HCPCS,4451.0,4451.0,3996.0,3996.0,United Healthcare-Medicare Advantage, +148414,3934,28232,"Incision to lengthen toe tendon, open procedure",CPT/HCPCS,4936.46,4936.46,4820.57,6256.0,United Healthcare-Medicare Advantage, +148415,3934,28238,Advancement of ankle tendon with removal of ankle joint bone,CPT/HCPCS,8647.97,8647.97,4623.52,8816.97,United Healthcare-Medicare Advantage, +148416,3934,28270,Incision of joint capsule of foot and toe,CPT/HCPCS,6288.1,6288.1,3959.0,13179.0,United Healthcare-Medicare Advantage, +148417,3934,28285,Correction of toe joint deformity,CPT/HCPCS,6302.14,6302.14,3428.57,19842.72,United Healthcare-Medicare Advantage, +148418,3934,28288,Removal of foot bone spur,CPT/HCPCS,1569.1,1569.1,4471.9,4471.9,United Healthcare-Medicare Advantage, +148419,3934,28289,Correction of rigid deformity of first joint of big toe,CPT/HCPCS,7429.8,7429.8,7217.0,11616.0,United Healthcare-Medicare Advantage, +148420,3934,28292,Correction of bunion,CPT/HCPCS,8254.01,8254.01,5808.15,11254.17,United Healthcare-Medicare Advantage, +148421,3934,28295,Correction of bunion,CPT/HCPCS,11048.33,11048.33,2353.46,4555.5,United Healthcare-Medicare Advantage, +148422,3934,28296,Correction of bunion,CPT/HCPCS,9769.87,9769.87,2929.49,11967.23,United Healthcare-Medicare Advantage, +148423,3934,28298,Correction of bunion,CPT/HCPCS,7305.57,7305.57,1409.25,4544.0,United Healthcare-Medicare Advantage, +148424,3934,28299,Correction of bunion,CPT/HCPCS,9065.62,9065.62,5568.15,13466.0,United Healthcare-Medicare Advantage, +148425,3934,28300,Incision to repair heel bone,CPT/HCPCS,7186.08,7186.08,2143.5,14217.73,United Healthcare-Medicare Advantage, +148426,3934,28304,Incision to correct foot or ankle bones,CPT/HCPCS,9026.11,9026.11,2143.5,2143.5,United Healthcare-Medicare Advantage, +148427,3934,28308,Incision to straighten toe bone,CPT/HCPCS,8766.9,8766.9,6673.57,11135.0,United Healthcare-Medicare Advantage, +148428,3934,28313,Reconstruction of soft tissue angular deformity of toe,CPT/HCPCS,2388.3,2388.3,4544.0,4544.0,United Healthcare-Medicare Advantage, +148429,3934,28315,Removal of small bone underlying long bone of foot at toe joint,CPT/HCPCS,7312.0,7312.0,1855.57,2383.44,United Healthcare-Medicare Advantage, +148430,3934,28322,Repair of non-healed foot bone,CPT/HCPCS,13016.75,13016.75,2341.96,2341.96,United Healthcare-Medicare Advantage, +148431,3934,28406,"Insertion of hardware to broken heel bone with manipulation, accessed through the skin",CPT/HCPCS,28384.67,28384.67,5253.0,5253.0,United Healthcare-Medicare Advantage, +148432,3934,28415,Open treatment of broken heel bone,CPT/HCPCS,18032.57,18032.57,4262.87,4682.95,United Healthcare-Medicare Advantage, +148433,3934,28435,Closed treatment of broken ankle joint bone with manipulation,CPT/HCPCS,9541.41,9541.41,597.86,597.86,United Healthcare-Medicare Advantage, +148434,3934,28445,Open treatment of broken heel bone,CPT/HCPCS,13564.33,13564.33,3751.94,4828.0,United Healthcare-Medicare Advantage, +148435,3934,28465,Open treatment of broken foot bone,CPT/HCPCS,10674.75,10674.75,4544.0,5511.1,United Healthcare-Medicare Advantage, +148436,3934,28475,Closed treatment of fracture of foot with manipulation,CPT/HCPCS,1287.64,1287.64,807.0,1074.92,United Healthcare-Medicare Advantage, +148437,3934,28485,Open treatment of broken foot bone,CPT/HCPCS,9756.6,9756.6,5104.34,8577.69,United Healthcare-Medicare Advantage, +148438,3934,28495,Closed treatment of broken great toe with manipulation,CPT/HCPCS,3427.45,3427.45,572.04,572.04,United Healthcare-Medicare Advantage, +148439,3934,28496,"Insertion of hardware to broken great toe with manipulation, accessed through the skin",CPT/HCPCS,10091.16,10091.16,4822.0,4822.0,United Healthcare-Medicare Advantage, +148440,3934,28505,Open treatment of broken great toe,CPT/HCPCS,10578.5,10578.5,6062.25,6062.25,United Healthcare-Medicare Advantage, +148441,3934,28515,Closed treatment of broken toe with manipulation,CPT/HCPCS,1729.75,1729.75,496.01,496.01,United Healthcare-Medicare Advantage, +148442,3934,28575,Closed treatment of dislocated foot joint under anesthesia,CPT/HCPCS,7985.77,7985.77,6835.0,6835.0,United Healthcare-Medicare Advantage, +148443,3934,28615,Open treatment of dislocated foot joint,CPT/HCPCS,8441.74,8441.74,5035.31,6659.33,United Healthcare-Medicare Advantage, +148444,3934,28630,Closed treatment of dislocated foot bone,CPT/HCPCS,3626.6,3626.6,612.31,612.31,United Healthcare-Medicare Advantage, +148445,3934,28660,Closed treatment of dislocation of toe joint,CPT/HCPCS,1316.75,1316.75,461.95,1294.0,United Healthcare-Medicare Advantage, +148446,3934,28725,Fusion of foot joint,CPT/HCPCS,13472.86,13472.86,3081.34,5938.92,United Healthcare-Medicare Advantage, +148447,3934,28730,Fusion of multiple foot joints,CPT/HCPCS,13196.6,13196.6,8683.8,17493.0,United Healthcare-Medicare Advantage, +148448,3934,28735,Fusion of multiple foot joints,CPT/HCPCS,20867.58,20867.58,2256.15,2256.15,United Healthcare-Medicare Advantage, +148449,3934,28740,Fusion of foot joint,CPT/HCPCS,13193.28,13193.28,7872.96,15377.0,United Healthcare-Medicare Advantage, +148450,3934,28750,Fusion of great toe,CPT/HCPCS,12599.29,12599.29,5371.0,22651.0,United Healthcare-Medicare Advantage, +148451,3934,28755,Fusion of great toe,CPT/HCPCS,7151.75,7151.75,5278.16,9456.0,United Healthcare-Medicare Advantage, +148452,3934,28805,Amputation of foot,CPT/HCPCS,15148.8,15148.8,14434.6,43205.11,United Healthcare-Medicare Advantage, +148453,3934,28810,Amputation of foot,CPT/HCPCS,6599.13,6599.13,1735.64,11410.96,United Healthcare-Medicare Advantage, +148454,3934,28820,Amputation of foot,CPT/HCPCS,4737.56,4737.56,2802.0,6166.0,United Healthcare-Medicare Advantage, +148455,3934,28825,Amputation of foot,CPT/HCPCS,3047.84,3047.84,1938.0,3648.0,United Healthcare-Medicare Advantage, +148456,3934,29010,Application of jacket type body cast,CPT/HCPCS,8947.6,8947.6,1287.64,6770.0,United Healthcare-Medicare Advantage, +148457,3934,29065,"Application of cast, shoulder to hand (long arm)",CPT/HCPCS,2675.68,2675.68,477.42,2083.71,United Healthcare-Medicare Advantage, +148458,3934,29075,"Application of cast, elbow to finger (short arm)",CPT/HCPCS,2785.33,2785.33,674.96,1994.32,United Healthcare-Medicare Advantage, +148459,3934,29105,Application of long arm splint (shoulder to hand),CPT/HCPCS,472.06,472.06,100.0,1949.0,United Healthcare-Medicare Advantage, +148460,3934,29125,"Application of non-moveable, short arm splint (forearm to hand)",CPT/HCPCS,412.98,412.98,19.76,1949.0,United Healthcare-Medicare Advantage, +148461,3934,29130,"Application of non-moveable, hinged finger splint",CPT/HCPCS,468.91,468.91,75.0,4578.15,United Healthcare-Medicare Advantage, +148462,3934,29200,Strapping of chest,CPT/HCPCS,531.91,531.91,162.03,162.03,United Healthcare-Medicare Advantage, +148463,3934,29280,Strapping of hand or finger,CPT/HCPCS,329.33,329.33,171.55,1949.0,United Healthcare-Medicare Advantage, +148464,3934,29345,Application of long leg cast (thigh to toes),CPT/HCPCS,1746.31,1746.31,915.78,3689.62,United Healthcare-Medicare Advantage, +148465,3934,29355,"Application of long leg cast (thigh to toes), walker or ambulatory type",CPT/HCPCS,3628.63,3628.63,493.07,525.48,United Healthcare-Medicare Advantage, +148466,3934,29405,Application of short leg cast (below knee to toes),CPT/HCPCS,1665.2,1665.2,47.81,3762.0,United Healthcare-Medicare Advantage, +148467,3934,29505,Application of long leg splint (thigh to ankle or toes),CPT/HCPCS,817.71,817.71,50.0,2484.0,United Healthcare-Medicare Advantage,162.03 +148468,3934,29515,Application of short leg splint (calf to foot),CPT/HCPCS,3155.65,3155.65,51.13,5268.0,United Healthcare-Medicare Advantage, +148469,3934,29530,Strapping of knee,CPT/HCPCS,340.11,340.11,258.96,258.96,United Healthcare-Medicare Advantage, +148470,3934,29540,Strapping of ankle and/or foot,CPT/HCPCS,3311.72,3311.72,451.81,1939.0,United Healthcare-Medicare Advantage, +148471,3934,29804,Examination of jaw joint using an endoscope,CPT/HCPCS,8694.79,8694.79,3316.26,9793.26,United Healthcare-Medicare Advantage, +148472,3934,29806,Incision of should joint capsule using an endoscope,CPT/HCPCS,11566.49,11566.49,4084.09,12999.16,United Healthcare-Medicare Advantage, +148473,3934,29807,Repair of shoulder socket cartilage using an endoscope,CPT/HCPCS,9165.27,9165.27,9764.47,17536.0,United Healthcare-Medicare Advantage, +148474,3934,29819,Removal of loose or foreign body of shoulder using an endoscope,CPT/HCPCS,13639.78,13639.78,4544.0,4544.0,United Healthcare-Medicare Advantage, +148475,3934,29821,Removal of entire shoulder joint lining using an endoscope,CPT/HCPCS,13631.0,13631.0,4356.0,4356.0,United Healthcare-Medicare Advantage, +148476,3934,29822,Removal of shoulder joint tissue using an endoscope,CPT/HCPCS,8674.23,8674.23,1421.95,11209.56,United Healthcare-Medicare Advantage, +148477,3934,29823,Extensive removal of shoulder joint tissue using an endoscope,CPT/HCPCS,6669.19,6669.19,2663.8,19438.0,United Healthcare-Medicare Advantage, +148478,3934,29824,Partial removal of collar bone at shoulder using an endoscope,CPT/HCPCS,6537.54,6537.54,3770.5,14180.18,United Healthcare-Medicare Advantage, +148479,3934,29825,Release or removal of shoulder scar tissue using an endoscope,CPT/HCPCS,8394.22,8394.22,4332.6,6828.0,United Healthcare-Medicare Advantage, +148480,3934,29826,Shaving of shoulder bone using an endoscope,CPT/HCPCS,2123.85,2123.85,498.0,12422.18,United Healthcare-Medicare Advantage, +148481,3934,29827,Repair of shoulder rotator cuff using an endoscope,CPT/HCPCS,12165.17,12165.17,3877.25,33440.47,United Healthcare-Medicare Advantage, +148482,3934,29828,Release of shoulder biceps tendon using an endoscope,CPT/HCPCS,8054.14,8054.14,2252.45,19555.97,United Healthcare-Medicare Advantage, +148483,3934,29834,Removal of loose or foreign body of elbow using an endoscope,CPT/HCPCS,8464.8,8464.8,6261.0,6261.0,United Healthcare-Medicare Advantage, +148484,3934,29840,Diagnostic examination of the wrist using an endoscope,CPT/HCPCS,7267.8,7267.8,3014.0,4062.4,United Healthcare-Medicare Advantage, +148485,3934,29846,Removal or repair of wrist joint lining using an endoscope,CPT/HCPCS,7537.33,7537.33,2062.0,9026.0,United Healthcare-Medicare Advantage, +148486,3934,29848,Release of wrist ligament using an endoscope,CPT/HCPCS,5494.68,5494.68,616.7,13788.33,United Healthcare-Medicare Advantage, +148487,3934,29851,Treatment of knee joint fractures with assistance of an endoscope with fixation,CPT/HCPCS,9978.33,9978.33,2062.0,2062.0,United Healthcare-Medicare Advantage, +148488,3934,29855,Treatment of broken leg bone with assistance of an endoscope,CPT/HCPCS,10000.77,10000.77,9398.6,9436.9,United Healthcare-Medicare Advantage, +148489,3934,29866,Patient-derived cartilage grafts at knee joint using an endoscope,CPT/HCPCS,8683.62,8683.62,6879.0,6879.0,United Healthcare-Medicare Advantage, +148490,3934,29870,Diagnostic examination of knee using an endoscope,CPT/HCPCS,6502.67,6502.67,4114.0,4114.0,United Healthcare-Medicare Advantage, +148491,3934,29871,Irrigation and drainage of knee joint for infection using an endoscope,CPT/HCPCS,40237.67,40237.67,7319.0,7319.0,United Healthcare-Medicare Advantage, +148492,3934,29873,Release of ligaments at outer aspect of knee joint using an endoscope,CPT/HCPCS,7054.7,7054.7,1331.1,7835.06,United Healthcare-Medicare Advantage, +148493,3934,29874,Removal of loose or foreign body of knee joint using an endoscope,CPT/HCPCS,8899.24,8899.24,1998.0,4356.0,United Healthcare-Medicare Advantage, +148494,3934,29875,Partial removal of knee joint lining using an endoscope,CPT/HCPCS,6662.52,6662.52,7395.0,10026.0,United Healthcare-Medicare Advantage, +148495,3934,29876,Removal of joint lining from two or more knee joint compartments using an endoscope,CPT/HCPCS,6066.65,6066.65,499.2,13472.0,United Healthcare-Medicare Advantage, +148496,3934,29877,Removal or shaving of knee joint cartilage using an endoscope,CPT/HCPCS,9456.07,9456.07,2062.0,2062.0,United Healthcare-Medicare Advantage, +148497,3934,29879,Repair of knee joint using an endoscope,CPT/HCPCS,6128.83,6128.83,2178.0,4356.0,United Healthcare-Medicare Advantage, +148498,3934,29880,Removal of both knee cartilages using an endoscope,CPT/HCPCS,7534.58,7534.58,3868.05,14223.0,United Healthcare-Medicare Advantage, +148499,3934,29881,Removal of one knee cartilage using an endoscope,CPT/HCPCS,7197.94,7197.94,669.37,12422.18,United Healthcare-Medicare Advantage, +148500,3934,29882,Repair of knee joint using an endoscope,CPT/HCPCS,7694.37,7694.37,3948.23,11003.98,United Healthcare-Medicare Advantage, +148501,3934,29883,Repair of knee joint using an endoscope,CPT/HCPCS,14130.13,14130.13,7366.0,7366.0,United Healthcare-Medicare Advantage, +148502,3934,29886,Repair of knee joint with bone graft using an endoscope,CPT/HCPCS,7543.55,7543.55,2062.0,4544.0,United Healthcare-Medicare Advantage, +148503,3934,29887,Repair of knee joint with bone graft and hardware using an endoscope,CPT/HCPCS,9797.33,9797.33,5013.9,5013.9,United Healthcare-Medicare Advantage, +148504,3934,29888,Repair of anterior cruciate ligament of knee with assistance of an endoscope,CPT/HCPCS,10813.32,10813.32,1385.98,15281.98,United Healthcare-Medicare Advantage, +148505,3934,29892,Removal and repair of large bone defect of shin or ankle using an endoscope,CPT/HCPCS,8482.17,8482.17,7327.0,7327.0,United Healthcare-Medicare Advantage, +148506,3934,29893,Repair of fibrous tissue of foot using an endoscope,CPT/HCPCS,6454.43,6454.43,4415.68,11454.0,United Healthcare-Medicare Advantage, +148507,3934,29895,Partial removal of ankle joint lining using an endoscope,CPT/HCPCS,7684.0,7684.0,4287.0,4287.0,United Healthcare-Medicare Advantage, +148508,3934,29898,Removal of dead or infected ankle joint tissue using an endoscope,CPT/HCPCS,7109.7,7109.7,4298.95,9723.0,United Healthcare-Medicare Advantage, +148509,3934,29999,Joint procedure using an endoscope,CPT/HCPCS,10449.53,10449.53,832.0,2604.0,United Healthcare-Medicare Advantage, +148510,3934,30117,Removal or destruction of growth in nose,CPT/HCPCS,6997.85,6997.85,3725.52,6365.62,United Healthcare-Medicare Advantage, +148511,3934,30130,Removal of nasal air passage,CPT/HCPCS,21052.96,21052.96,3049.08,3049.08,United Healthcare-Medicare Advantage, +148512,3934,30140,Removal of nasal air passage,CPT/HCPCS,6395.14,6395.14,5229.63,13554.15,United Healthcare-Medicare Advantage, +148513,3934,30300,Removal of foreign body in nose,CPT/HCPCS,207.39,207.39,125.0,1949.0,United Healthcare-Medicare Advantage, +148514,3934,30310,Removal of foreign body in nose under anesthesia,CPT/HCPCS,3627.0,3627.0,4544.0,4544.0,United Healthcare-Medicare Advantage, +148515,3934,30420,Reshaping of bony cartilage dividing nasal passages,CPT/HCPCS,20690.48,20690.48,1998.0,8139.0,United Healthcare-Medicare Advantage, +148516,3934,30465,Widening of nasal passage,CPT/HCPCS,8947.58,8947.58,14538.46,26050.66,United Healthcare-Medicare Advantage, +148517,3934,30520,Reshaping of nasal cartilage,CPT/HCPCS,7896.2,7896.2,2585.72,20385.3,United Healthcare-Medicare Advantage, +148518,3934,30580,Repair of abnormal drainage tract between two nasal sinuses,CPT/HCPCS,8251.5,8251.5,9168.0,9168.0,United Healthcare-Medicare Advantage, +148519,3934,30600,Repair of abnormal drainage tract between mouth and nasal cavity,CPT/HCPCS,8347.11,8347.11,5306.77,6968.32,United Healthcare-Medicare Advantage, +148520,3934,30630,Repair of openings in nasal cartilage,CPT/HCPCS,10549.34,10549.34,4642.0,4642.0,United Healthcare-Medicare Advantage, +148521,3934,30901,Simple control of nose bleed,CPT/HCPCS,487.45,487.45,144.25,1839.0,United Healthcare-Medicare Advantage, +148522,3934,30905,Control of nose bleed and insertion of packing,CPT/HCPCS,1456.97,1456.97,133.09,10236.79,United Healthcare-Medicare Advantage, +148523,3934,30906,Control of nosebleed and insertion of packing,CPT/HCPCS,2636.0,2636.0,2636.0,2636.0,United Healthcare-Medicare Advantage, +148524,3934,30930,Therapeutic fracture of nasal passages,CPT/HCPCS,6557.93,6557.93,4446.59,7686.64,United Healthcare-Medicare Advantage, +148525,3934,30999,Nasal procedure,CPT/HCPCS,3466.72,3466.72,4324.17,4324.17,United Healthcare-Medicare Advantage, +148526,3934,31030,Incision of nasal sinus,CPT/HCPCS,10314.73,10314.73,6441.31,12355.79,United Healthcare-Medicare Advantage, +148527,3934,31225,Removal of nasal sinus,CPT/HCPCS,8410.5,8410.5,2143.5,2143.5,United Healthcare-Medicare Advantage, +148528,3934,31231,Diagnostic examination of nasal passages using an endoscope,CPT/HCPCS,948.37,948.37,174.8,2272.0,United Healthcare-Medicare Advantage, +148529,3934,31237,Biopsy or removal of nasal polyp or tissue using an endoscope,CPT/HCPCS,8951.22,8951.22,1733.18,5741.0,United Healthcare-Medicare Advantage, +148530,3934,31238,Control of nasal bleeding using an endoscope,CPT/HCPCS,5165.97,5165.97,871.95,13015.0,United Healthcare-Medicare Advantage, +148531,3934,31239,Incision of tear duct using an endoscope,CPT/HCPCS,10157.38,10157.38,7664.0,25582.25,United Healthcare-Medicare Advantage, +148532,3934,31240,Removal of nasal breathing passages using an endoscope,CPT/HCPCS,6557.66,6557.66,3789.29,10658.1,United Healthcare-Medicare Advantage, +148533,3934,31253,Complete examination of nose and sinuses using an endoscope,CPT/HCPCS,10476.56,10476.56,1410.35,16344.2,United Healthcare-Medicare Advantage, +148534,3934,31254,Partial removal of nasal sinus using an endoscope,CPT/HCPCS,8376.35,8376.35,8010.0,8010.0,United Healthcare-Medicare Advantage, +148535,3934,31255,Complete removal of nasal sinus using an endoscope,CPT/HCPCS,5739.77,5739.77,3666.05,8196.97,United Healthcare-Medicare Advantage, +148536,3934,31256,Incision of nasal sinus using an endoscope,CPT/HCPCS,6436.65,6436.65,4113.04,6253.79,United Healthcare-Medicare Advantage, +148537,3934,31267,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,8197.23,8197.23,2282.18,11150.82,United Healthcare-Medicare Advantage, +148538,3934,31276,Exploration of nasal sinus using an endoscope,CPT/HCPCS,10565.95,10565.95,5821.18,12744.3,United Healthcare-Medicare Advantage, +148539,3934,31287,Incision of nasal sinus using an endoscope,CPT/HCPCS,7520.7,7520.7,6675.0,6675.0,United Healthcare-Medicare Advantage, +148540,3934,31288,Removal of nasal sinus tissue using an endoscope,CPT/HCPCS,10668.0,10668.0,2146.79,2146.79,United Healthcare-Medicare Advantage, +148541,3934,31295,Dilation of opening from sinus above teeth (maxillary sinus) into cavity of nose using endoscope,CPT/HCPCS,5909.23,5909.23,1575.75,2813.99,United Healthcare-Medicare Advantage, +148542,3934,31297,Dilation of opening from sinus behind eye (sphenoid sinus) into cavity of nose using endoscope,CPT/HCPCS,10980.5,10980.5,4727.25,7878.75,United Healthcare-Medicare Advantage, +148543,3934,31500,Emergent insertion of breathing tube into windpipe cartilage using an endoscope,CPT/HCPCS,848.34,848.34,14.04,26325.26,United Healthcare-Medicare Advantage, +148544,3934,31502,Change of breathing tube of windpipe in neck,CPT/HCPCS,1430.5,1430.5,142.94,144.25,United Healthcare-Medicare Advantage, +148545,3934,31525,Diagnostic examination of voice box using an endoscope,CPT/HCPCS,3560.77,3560.77,203.64,6764.0,United Healthcare-Medicare Advantage, +148546,3934,31526,Diagnostic examination of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,13536.42,13536.42,4112.45,4112.45,United Healthcare-Medicare Advantage, +148547,3934,31529,Dilation of the voice box using an endoscope,CPT/HCPCS,17979.0,17979.0,17979.0,17979.0,United Healthcare-Medicare Advantage, +148548,3934,31530,Removal of foreign body from voice box using an endoscope,CPT/HCPCS,8948.75,8948.75,1059.25,5719.38,United Healthcare-Medicare Advantage, +148549,3934,31531,Removal of foreign body from voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,17478.5,17478.5,2018.36,2018.36,United Healthcare-Medicare Advantage, +148550,3934,31535,Biopsy of voice box using an endoscope,CPT/HCPCS,8334.95,8334.95,1173.93,15938.0,United Healthcare-Medicare Advantage, +148551,3934,31536,Biopsy of voice box using an endoscope with operating microscope or telescope,CPT/HCPCS,7034.92,7034.92,3216.75,11551.33,United Healthcare-Medicare Advantage, +148552,3934,31540,Removal of growth of tongue and/or vocal cord stripping using an endoscope,CPT/HCPCS,7624.11,7624.11,2578.89,4479.96,United Healthcare-Medicare Advantage, +148553,3934,31541,Removal of growth of tongue and/or vocal cord stripping using an endoscope with operating microscope or telescope,CPT/HCPCS,11115.77,11115.77,2893.76,26183.0,United Healthcare-Medicare Advantage,3996.0 +148554,3934,31571,Injection of vocal cords using an endoscope with operating microscope or telescope,CPT/HCPCS,6936.14,6936.14,2746.56,17483.0,United Healthcare-Medicare Advantage, +148555,3934,31573,Injection of drug into one side of voice box using a flexible endoscope,CPT/HCPCS,12918.6,12918.6,4025.35,4025.35,United Healthcare-Medicare Advantage, +148556,3934,31575,Diagnostic examination of voice box using flexible endoscope,CPT/HCPCS,1076.59,1076.59,106.35,4544.0,United Healthcare-Medicare Advantage, +148557,3934,31591,Repair of one side of voice box by moving vocal cord to middle,CPT/HCPCS,18058.81,18058.81,7438.71,14556.29,United Healthcare-Medicare Advantage, +148558,3934,31599,Voice box procedure,CPT/HCPCS,10621.83,10621.83,2984.99,19465.0,United Healthcare-Medicare Advantage, +148559,3934,31611,Creation of opening of windpipe and with insertion of speech prosthesis,CPT/HCPCS,7296.25,7296.25,6118.66,9166.0,United Healthcare-Medicare Advantage, +148560,3934,31613,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,8306.67,8306.67,3996.0,4356.0,United Healthcare-Medicare Advantage, +148561,3934,31614,Revision of permanent opening of windpipe for breathing,CPT/HCPCS,17697.34,17697.34,4403.06,4403.06,United Healthcare-Medicare Advantage, +148562,3934,31615,Examination of windpipe and lung airways through permanent skin opening to windpipe using an endoscope,CPT/HCPCS,6783.0,6783.0,1829.72,1829.72,United Healthcare-Medicare Advantage, +148563,3934,31622,Diagnostic examination of lung airways using an endoscope,CPT/HCPCS,6287.3,6287.3,1564.44,10710.0,United Healthcare-Medicare Advantage, +148564,3934,31623,Examination of lung airways using an endoscope,CPT/HCPCS,8819.01,8819.01,3564.0,11187.0,United Healthcare-Medicare Advantage, +148565,3934,31624,Irrigation and suction of lung airways to obtain cells using an endoscope,CPT/HCPCS,8993.45,8993.45,2095.56,20507.99,United Healthcare-Medicare Advantage, +148566,3934,31625,Biopsy of lung airways using an endoscope,CPT/HCPCS,9630.29,9630.29,3247.14,17172.52,United Healthcare-Medicare Advantage, +148567,3934,31627,Computer-assisted image-guided navigation of lung airways using an endoscope,CPT/HCPCS,4175.04,4175.04,3922.0,4356.0,United Healthcare-Medicare Advantage, +148568,3934,31628,Biopsy of one lobe of lung using an endoscope,CPT/HCPCS,9730.18,9730.18,2386.68,16390.08,United Healthcare-Medicare Advantage, +148569,3934,31629,"Needle biopsy of windpipe cartilage, airway, and/or lung using an endoscope",CPT/HCPCS,10259.88,10259.88,8852.0,10702.0,United Healthcare-Medicare Advantage, +148570,3934,31630,Treatment of windpipe cartilage fracture or dilation of windpipe cartilage using an endoscope,CPT/HCPCS,7493.93,7493.93,3904.81,11130.75,United Healthcare-Medicare Advantage, +148571,3934,31632,Biopsy of lung using an endoscope,CPT/HCPCS,3639.8,3639.8,2178.0,5130.0,United Healthcare-Medicare Advantage, +148572,3934,31634,Examination of lung airways with repair of air leak using an endoscope,CPT/HCPCS,16146.5,16146.5,9244.82,18660.0,United Healthcare-Medicare Advantage, +148573,3934,31635,Removal of foreign body in lung airways using an endoscope,CPT/HCPCS,8659.76,8659.76,12384.21,12384.21,United Healthcare-Medicare Advantage, +148574,3934,31636,Insertion of stents in lung airways using an endoscope,CPT/HCPCS,18522.25,18522.25,13702.0,24756.0,United Healthcare-Medicare Advantage, +148575,3934,31641,Destruction of growth or narrowing of lung airway using an endoscope,CPT/HCPCS,10875.69,10875.69,1946.0,18777.33,United Healthcare-Medicare Advantage, +148576,3934,31647,"Assessment of air leak, airway sizing, and insertion of bronchial valves in lung airways using an endoscope",CPT/HCPCS,25461.5,25461.5,25358.0,25565.0,United Healthcare-Medicare Advantage, +148577,3934,31648,Removal of bronchial valves in lung airways using an endoscope,CPT/HCPCS,11969.12,11969.12,5984.56,5984.56,United Healthcare-Medicare Advantage, +148578,3934,31652,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,26372.11,26372.11,2458.7,33108.0,United Healthcare-Medicare Advantage,3558.07 +148579,3934,31653,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,15436.95,15436.95,2589.1,23463.05,United Healthcare-Medicare Advantage, +148580,3934,31654,Examination of lung airways using an endoscope with imaging guidance and ultrasound,CPT/HCPCS,4600.8,4600.8,2310.4,2310.4,United Healthcare-Medicare Advantage, +148581,3934,31820,Closure of permanent windpipe opening or abnormal drainage tract,CPT/HCPCS,4293.96,4293.96,221.33,2178.0,United Healthcare-Medicare Advantage, +148582,3934,32160,Massage of heart muscle through chest cavity,CPT/HCPCS,7724.5,7724.5,1001.36,1001.36,United Healthcare-Medicare Advantage, +148583,3934,32400,"Needle biopsy of lining of lung, accessed through the skin",CPT/HCPCS,2796.07,2796.07,893.57,3554.85,United Healthcare-Medicare Advantage, +148584,3934,32405,"Needle biopsy of lung or chest tissue, accessed through the skin",CPT/HCPCS,7461.97,7461.97,833.91,13445.49,United Healthcare-Medicare Advantage,1662.9 +148585,3934,32408,"Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed",CPT/HCPCS,2689.91,2689.91,1570.5,5089.02,United Healthcare-Medicare Advantage, +148586,3934,32550,Insertion of permanent catheter for drainage of lung fluid,CPT/HCPCS,5928.51,5928.51,1591.0,20212.0,United Healthcare-Medicare Advantage, +148587,3934,32551,"Removal of fluid from between lung and chest cavity, open procedure",CPT/HCPCS,2442.64,2442.64,410.06,2816.0,United Healthcare-Medicare Advantage, +148588,3934,32552,Removal of tunneled catheter in lung lining,CPT/HCPCS,2610.04,2610.04,759.17,5874.0,United Healthcare-Medicare Advantage, +148589,3934,32553,"Insertion of devices in chest cavity for radiation therapy guidance, accessed through the skin",CPT/HCPCS,2970.05,2970.05,1400.52,5127.85,United Healthcare-Medicare Advantage, +148590,3934,32554,Removal of fluid from chest cavity,CPT/HCPCS,4295.55,4295.55,2095.82,3277.0,United Healthcare-Medicare Advantage,763.86 +148591,3934,32555,Removal of fluid from chest cavity with imaging guidance,CPT/HCPCS,2821.76,2821.76,679.91,8968.0,United Healthcare-Medicare Advantage, +148592,3934,32556,"Removal of fluid from chest cavity with insertion of indwelling catheter, accessed through the skin",CPT/HCPCS,15000.91,15000.91,1816.96,1816.96,United Healthcare-Medicare Advantage, +148593,3934,32557,"Removal of fluid from chest cavity with insertion of indwelling catheter and imaging guidance, accessed through the skin",CPT/HCPCS,3012.98,3012.98,2439.52,4000.61,United Healthcare-Medicare Advantage, +148594,3934,33016,Drainage of heart sac,CPT/HCPCS,1492.11,1492.11,2143.5,8586.15,United Healthcare-Medicare Advantage, +148595,3934,33206,Insertion or replacement of permanent pacemaker and upper chamber electrodes,CPT/HCPCS,92830.76,92830.76,91192.08,91216.86,United Healthcare-Medicare Advantage, +148596,3934,33207,Insertion or replacement of permanent pacemaker and lower chamber electrodes,CPT/HCPCS,27090.36,27090.36,4290.31,36382.96,United Healthcare-Medicare Advantage, +148597,3934,33208,Insertion of new or replacement of permanent pacemaker including upper and lower chamber electrodes,CPT/HCPCS,47851.64,47851.64,7178.39,64053.27,United Healthcare-Medicare Advantage, +148598,3934,33215,Repositioning of implanted pacemaker or defibrillator device,CPT/HCPCS,8108.35,8108.35,4662.53,9198.1,United Healthcare-Medicare Advantage, +148599,3934,33216,Insertion of electrode for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,17096.89,17096.89,15642.65,21313.27,United Healthcare-Medicare Advantage, +148600,3934,33217,Insertion of electrodes for permanent pacemaker or pacing defibrillator device,CPT/HCPCS,25610.98,25610.98,25594.52,25643.9,United Healthcare-Medicare Advantage, +148601,3934,33221,Insertion of pacemaker pulse generator with existing multiple leads,CPT/HCPCS,50613.03,50613.03,22565.41,22565.41,United Healthcare-Medicare Advantage, +148602,3934,33222,Relocation of pacemaker generator skin pocket,CPT/HCPCS,7859.95,7859.95,6700.03,8996.0,United Healthcare-Medicare Advantage, +148603,3934,33223,Relocation of defibrillator device skin pocket,CPT/HCPCS,148590.8,148590.8,148590.8,148590.8,United Healthcare-Medicare Advantage, +148604,3934,33224,Insertion of left heart electrode with attachment to pacemaker or pacing defibrillator device,CPT/HCPCS,53091.64,53091.64,53080.05,53103.23,United Healthcare-Medicare Advantage, +148605,3934,33225,Insertion of left heart electrode for pacing defibrillator device,CPT/HCPCS,34327.73,34327.73,2229.4,57360.18,United Healthcare-Medicare Advantage, +148606,3934,33227,Removal and replacement of single lead permanent pacemaker pulse generator,CPT/HCPCS,34184.18,34184.18,6621.66,38825.33,United Healthcare-Medicare Advantage, +148607,3934,33228,Removal and replacement of dual lead permanent pacemaker pulse generator,CPT/HCPCS,37406.49,37406.49,8018.54,44018.37,United Healthcare-Medicare Advantage, +148608,3934,33229,Removal and replacement of multiple lead permanent pacemaker pulse generator,CPT/HCPCS,45643.2,45643.2,21011.67,49788.6,United Healthcare-Medicare Advantage,21230.37 +148609,3934,33233,Removal of permanent pacemaker pulse generator,CPT/HCPCS,8415.93,8415.93,3551.11,10849.43,United Healthcare-Medicare Advantage, +148610,3934,33234,Removal of electrode from right heart,CPT/HCPCS,10899.96,10899.96,10139.18,11660.73,United Healthcare-Medicare Advantage, +148611,3934,33235,Removal of electrodes from right heart,CPT/HCPCS,8275.02,8275.02,7534.19,10536.62,United Healthcare-Medicare Advantage, +148612,3934,33241,Removal of defibrillator pulse generator,CPT/HCPCS,7459.98,7459.98,3559.78,9847.23,United Healthcare-Medicare Advantage, +148613,3934,33244,Removal of defibrillator electrodes,CPT/HCPCS,11724.94,11724.94,9763.75,13912.45,United Healthcare-Medicare Advantage, +148614,3934,33249,Insertion or replacement of single or dual chamber pacing defibrillator leads,CPT/HCPCS,105502.28,105502.28,2876.8,119130.99,United Healthcare-Medicare Advantage,38452.37 +148615,3934,33262,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,119350.7,119350.7,27120.8,140088.22,United Healthcare-Medicare Advantage, +148616,3934,33263,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,125814.15,125814.15,20965.07,136738.72,United Healthcare-Medicare Advantage, +148617,3934,33264,Removal and replacement of defibrillator pulse generator,CPT/HCPCS,130916.25,130916.25,25794.67,146325.07,United Healthcare-Medicare Advantage,39110.42 +148618,3934,33270,Insertion or replacement of defibrillator with electrode,CPT/HCPCS,144096.85,144096.85,29224.18,164072.99,United Healthcare-Medicare Advantage, +148619,3934,33272,Removal of defibrillator electrode,CPT/HCPCS,153809.97,153809.97,156911.05,156911.05,United Healthcare-Medicare Advantage, +148620,3934,33274,Insertion or replacement of permanent leadless pacemaker into lower right chamber of heart via catheter using imaging guidance,CPT/HCPCS,55203.25,55203.25,23287.8,71652.02,United Healthcare-Medicare Advantage, +148621,3934,33285,Insertion of heart rhythm monitor under skin,CPT/HCPCS,28331.29,28331.29,408.91,69901.05,United Healthcare-Medicare Advantage, +148622,3934,33286,Removal of heart rhythm monitor from under skin,CPT/HCPCS,1688.21,1688.21,99.73,5660.15,United Healthcare-Medicare Advantage, +148623,3934,34101,Removal of blood clot in artery,CPT/HCPCS,18832.02,18832.02,5637.13,5637.13,United Healthcare-Medicare Advantage, +148624,3934,34201,Removal of blood clot in artery,CPT/HCPCS,25413.29,25413.29,5390.32,5414.17,United Healthcare-Medicare Advantage, +148625,3934,34704,Placement of graft for repair of aorta and groin artery including radiological supervision and interpretation,CPT/HCPCS,8010.0,8010.0,8010.0,8010.0,United Healthcare-Medicare Advantage, +148626,3934,34707,Placement of graft for repair of groin artery including radiological supervision and interpretation,CPT/HCPCS,9374.67,9374.67,3996.0,3996.0,United Healthcare-Medicare Advantage, +148627,3934,34713,"Exposure of one groin artery for delivery of graft, accessed through the skin",CPT/HCPCS,4687.33,4687.33,1998.0,1998.0,United Healthcare-Medicare Advantage, +148628,3934,34812,"Exposure of one thigh artery for insertion of prosthesis, open procedure",CPT/HCPCS,4005.0,4005.0,4005.0,4005.0,United Healthcare-Medicare Advantage, +148629,3934,35206,Repair of blood vessel of arm,CPT/HCPCS,10744.0,10744.0,2783.55,10598.0,United Healthcare-Medicare Advantage, +148630,3934,35207,Repair of blood vessel of hand or finger,CPT/HCPCS,6845.94,6845.94,2178.0,6534.0,United Healthcare-Medicare Advantage, +148631,3934,35226,Repair of blood vessel of leg,CPT/HCPCS,8548.0,8548.0,125.0,3340.26,United Healthcare-Medicare Advantage, +148632,3934,35302,Removal of blood clot and portion of artery of upper thigh,CPT/HCPCS,19046.0,19046.0,6261.0,6261.0,United Healthcare-Medicare Advantage, +148633,3934,35371,Removal of blood clot and portion of artery of upper thigh artery,CPT/HCPCS,21042.5,21042.5,3651.5,3651.5,United Healthcare-Medicare Advantage, +148634,3934,35820,"Exploration of chest for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,3984.0,3984.0,2843.73,2843.73,United Healthcare-Medicare Advantage, +148635,3934,35840,"Exploration of abdomen for postsurgical bleeding, blood clot, or infection",CPT/HCPCS,8574.33,8574.33,2417.0,6236.0,United Healthcare-Medicare Advantage, +148636,3934,35875,Removal of blood clot of arterial or venous graft,CPT/HCPCS,20894.0,20894.0,11524.0,21750.0,United Healthcare-Medicare Advantage, +148637,3934,36000,Insertion of needle or catheter into a vein,CPT/HCPCS,48.42,48.42,33.16,11382.5,United Healthcare-Medicare Advantage, +148638,3934,36002,"Injection to cause blood clot in a diseased or bulging vessel of arm or leg, accessed through the skin",CPT/HCPCS,4797.27,4797.27,3263.11,8977.67,United Healthcare-Medicare Advantage, +148639,3934,36010,Introduction of catheter into the upper or lower major vein (vena cava),CPT/HCPCS,4262.0,4262.0,441.32,6534.0,United Healthcare-Medicare Advantage, +148640,3934,36011,Insertion of catheter into vein,CPT/HCPCS,5951.33,5951.33,3448.75,3448.75,United Healthcare-Medicare Advantage, +148641,3934,36012,Insertion of catheter into vein,CPT/HCPCS,2923.57,2923.57,2143.5,4287.0,United Healthcare-Medicare Advantage, +148642,3934,36140,Insertion of needle or catheter into an artery of arm or leg,CPT/HCPCS,3796.15,3796.15,2755.55,6452.5,United Healthcare-Medicare Advantage, +148643,3934,36200,Insertion of catheter into aorta,CPT/HCPCS,4872.75,4872.75,318.78,3782.5,United Healthcare-Medicare Advantage, +148644,3934,36215,Insertion of catheter into chest or arm artery,CPT/HCPCS,2551.68,2551.68,318.78,1020.0,United Healthcare-Medicare Advantage, +148645,3934,36221,Insertion of catheter into chest aorta for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,3314.0,3314.0,2740.0,10244.52,United Healthcare-Medicare Advantage, +148646,3934,36222,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,26195.59,26195.59,25930.59,25930.59,United Healthcare-Medicare Advantage, +148647,3934,36223,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1965.91,1965.91,377.08,16341.0,United Healthcare-Medicare Advantage, +148648,3934,36224,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2375.68,2375.68,318.35,23740.93,United Healthcare-Medicare Advantage,5568.28 +148649,3934,36225,Insertion of catheter into artery on one side of chest for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,2486.9,2486.9,1278.58,7784.0,United Healthcare-Medicare Advantage, +148650,3934,36226,Insertion of catheter into chest artery for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,1483.9,1483.9,242.44,16253.0,United Healthcare-Medicare Advantage, +148651,3934,36227,Insertion of catheter into artery on one side of neck for diagnosis or treatment including radiological supervision and interpretation,CPT/HCPCS,725.7,725.7,124.95,2755.55,United Healthcare-Medicare Advantage, +148652,3934,36245,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4247.52,4247.52,318.78,11837.0,United Healthcare-Medicare Advantage, +148653,3934,36246,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,6102.45,6102.45,1148.0,8898.33,United Healthcare-Medicare Advantage, +148654,3934,36247,Insertion of catheter into abdominal pelvic or leg artery,CPT/HCPCS,4394.63,4394.63,361.6,11970.0,United Healthcare-Medicare Advantage, +148655,3934,36248,"Insertion of catheter into each additional abdominal, pelvic or leg artery",CPT/HCPCS,2074.64,2074.64,56.47,2990.0,United Healthcare-Medicare Advantage, +148656,3934,36251,Insertion of catheters into main and accessory arteries of one kidney for imaging including radiological supervision and interpretation,CPT/HCPCS,4087.15,4087.15,1998.83,11698.0,United Healthcare-Medicare Advantage,3350.83 +148657,3934,36252,Insertion of catheters into main and accessory arteries of both kidneys for imaging including radiological supervision and interpretation,CPT/HCPCS,7473.18,7473.18,8179.0,8776.0,United Healthcare-Medicare Advantage, +148658,3934,36406,"Insertion of needle into vein, patient younger than 3 years",CPT/HCPCS,654.33,654.33,42.87,42.87,United Healthcare-Medicare Advantage, +148659,3934,36410,"Insertion of needle into vein, patient 3 years or older",CPT/HCPCS,111.93,111.93,10.87,4738.0,United Healthcare-Medicare Advantage, +148660,3934,36415,Insertion of needle into vein for collection of blood sample,CPT/HCPCS,59.43,59.43,0.06,23400.0,United Healthcare-Medicare Advantage,486.75 +148661,3934,36416,Puncture of skin for collection of blood sample,CPT/HCPCS,25.63,25.63,13.97,111.45,United Healthcare-Medicare Advantage, +148662,3934,36430,Transfusion of blood or blood products,CPT/HCPCS,2780.66,2780.66,52.42,7351.0,United Healthcare-Medicare Advantage,470.11 +148663,3934,36481,"Insertion of catheter into portal vein of liver, accessed through the skin",CPT/HCPCS,3375.5,3375.5,386.5,386.5,United Healthcare-Medicare Advantage, +148664,3934,36500,Insertion of catheter into vein with collection of blood sample,CPT/HCPCS,3162.33,3162.33,3268.0,4356.0,United Healthcare-Medicare Advantage, +148665,3934,36512,Mechanical separation of red blood cells from blood,CPT/HCPCS,6973.72,6973.72,135.02,2327.33,United Healthcare-Medicare Advantage, +148666,3934,36513,Mechanical separation of platelet cells from blood,CPT/HCPCS,71757.56,71757.56,71651.08,71961.04,United Healthcare-Medicare Advantage, +148667,3934,36514,Mechanical separation of plasma from opening blood,CPT/HCPCS,10265.86,10265.86,83.35,12434.0,United Healthcare-Medicare Advantage,325.0 +148668,3934,36522,Mechanical separation of white blood cells and platelets from blood,CPT/HCPCS,10040.61,10040.61,111.74,10666.0,United Healthcare-Medicare Advantage, +148669,3934,36556,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3132.66,3132.66,100.0,5731.46,United Healthcare-Medicare Advantage,1313.32 +148670,3934,36558,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3376.77,3376.77,28.08,12278.75,United Healthcare-Medicare Advantage, +148671,3934,36560,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient younger than 5 years",CPT/HCPCS,13425.32,13425.32,1907.31,1907.31,United Healthcare-Medicare Advantage, +148672,3934,36561,"Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older",CPT/HCPCS,6274.45,6274.45,206.77,17705.11,United Healthcare-Medicare Advantage,3357.41 +148673,3934,36569,"Insertion of central venous catheter for infusion, patient 5 years or older",CPT/HCPCS,3275.95,3275.95,125.54,5469.61,United Healthcare-Medicare Advantage, +148674,3934,36572,"Insertion of central venous catheter for infusion using imaging guidance, patient younger than 5 years",CPT/HCPCS,22056.54,22056.54,2704.33,2704.33,United Healthcare-Medicare Advantage, +148675,3934,36573,"Insertion of central venous catheter for infusion using imaging guidance, patient 5 years or older",CPT/HCPCS,1547.55,1547.55,44.05,4544.0,United Healthcare-Medicare Advantage, +148676,3934,36576,Repair of central venous catheter for infusion,CPT/HCPCS,1838.44,1838.44,635.4,4105.5,United Healthcare-Medicare Advantage, +148677,3934,36581,Replacement of central venous catheter,CPT/HCPCS,2902.67,2902.67,1596.12,5008.0,United Healthcare-Medicare Advantage, +148678,3934,36582,Replacement of central venous catheter,CPT/HCPCS,7160.15,7160.15,5554.0,6820.0,United Healthcare-Medicare Advantage, +148679,3934,36584,Replacement of catheter in peripheral vein accessed through same vein,CPT/HCPCS,2829.04,2829.04,69.58,2938.33,United Healthcare-Medicare Advantage, +148680,3934,36589,Removal of central venous catheter for infusion,CPT/HCPCS,2591.55,2591.55,545.23,7456.1,United Healthcare-Medicare Advantage, +148681,3934,36590,Removal of peripheral venous catheter for infusion,CPT/HCPCS,4562.62,4562.62,915.67,11167.0,United Healthcare-Medicare Advantage, +148682,3934,36591,Collection of blood specimen from a completely implantable venous access device,CPT/HCPCS,534.24,534.24,20.29,10668.53,United Healthcare-Medicare Advantage, +148683,3934,36592,Collection of blood specimen from central or peripheral venous catheter,CPT/HCPCS,528.72,528.72,41.26,800.5,United Healthcare-Medicare Advantage, +148684,3934,36593,Declotting infusion of implanted central venous access device or catheter,CPT/HCPCS,26151.82,26151.82,5629.55,5639.05,United Healthcare-Medicare Advantage, +148685,3934,36597,Repositioning of central venous catheter using fluoroscopic guidance,CPT/HCPCS,2862.33,2862.33,2556.0,2556.0,United Healthcare-Medicare Advantage, +148686,3934,36598,Contrast injections for X-ray imaging procedure to evaluate central venous access device,CPT/HCPCS,1468.0,1468.0,588.17,4356.0,United Healthcare-Medicare Advantage, +148687,3934,36600,Arterial puncture withdrawal of blood for diagnosis,CPT/HCPCS,385.6,385.6,24.46,4119.0,United Healthcare-Medicare Advantage, +148688,3934,36620,"Insertion of arterial catheter for blood sampling or infusion, accessed through the skin",CPT/HCPCS,3928.67,3928.67,144.27,144.27,United Healthcare-Medicare Advantage, +148689,3934,36680,Insertion of needle for infusion into bone,CPT/HCPCS,1428.98,1428.98,1418.0,1418.0,United Healthcare-Medicare Advantage, +148690,3934,36818,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13778.5,13778.5,4356.0,4356.0,United Healthcare-Medicare Advantage, +148691,3934,36821,"Relocation of arm vein with connection to arm artery, open procedure",CPT/HCPCS,13710.48,13710.48,2764.72,20470.0,United Healthcare-Medicare Advantage,3357.41 +148692,3934,36830,Connection of tube graft to vein and artery for dialysis,CPT/HCPCS,19085.76,19085.76,2825.07,28302.0,United Healthcare-Medicare Advantage, +148693,3934,36831,"Removal of blood clot from dialysis graft, open procedure",CPT/HCPCS,22164.16,22164.16,16116.0,36747.0,United Healthcare-Medicare Advantage, +148694,3934,36832,"Revision of dialysis graft, open procedure",CPT/HCPCS,15450.64,15450.64,2825.07,26967.0,United Healthcare-Medicare Advantage, +148695,3934,36833,"Revision of dialysis graft with removal of blood cot, open procedure",CPT/HCPCS,17225.14,17225.14,3628.74,32490.0,United Healthcare-Medicare Advantage, +148696,3934,36902,"Insertion of needle and/or catheter into dialysis circuit and balloon dilation of dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,8632.84,8632.84,2498.21,33017.68,United Healthcare-Medicare Advantage, +148697,3934,36903,"Insertion of needle and/or catheter into dialysis circuit and insertion of stent in dialysis segment, with imaging including radiological supervision and interpretation",CPT/HCPCS,14339.13,14339.13,3304.84,10308.0,United Healthcare-Medicare Advantage, +148698,3934,36905,"Excision of blood clot and/or infusion to dissolve blood clot in dialysis circuit and balloon dilation of dialysis segment, , accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,11109.47,11109.47,6889.0,15597.0,United Healthcare-Medicare Advantage, +148699,3934,36906,"Excision of blood clot and/or infusion to dissolve blood clot and balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,21565.3,21565.3,9697.0,9725.52,United Healthcare-Medicare Advantage, +148700,3934,36907,"Balloon dilation of dialysis segment, accessed through the skin, with imaging including radiological supervision and interpretation",CPT/HCPCS,5914.67,5914.67,2136.0,3808.28,United Healthcare-Medicare Advantage, +148701,3934,36909,"Permanent blockage of dialysis circuit, with imaging including radiological supervision and interpretation",CPT/HCPCS,3901.0,3901.0,3173.56,3173.56,United Healthcare-Medicare Advantage, +148702,3934,37183,Revision of shunts to bypass blood flow to liver using imaging guidance,CPT/HCPCS,9875.5,9875.5,6001.66,6001.66,United Healthcare-Medicare Advantage, +148703,3934,37184,"Removal of blood clot and injections to dissolve blood clot from artery or arterial graft using fluoroscopic guidance, accessed through the skin",CPT/HCPCS,12520.0,12520.0,28890.6,33104.41,United Healthcare-Medicare Advantage, +148704,3934,37187,Removal of blood clot and injections (accessed through the skin) to dissolve blood clot from veins using fluoroscopic guidance,CPT/HCPCS,38854.05,38854.05,8327.55,8327.55,United Healthcare-Medicare Advantage, +148705,3934,37191,"Insertion of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,6802.8,6802.8,4226.0,9498.71,United Healthcare-Medicare Advantage, +148706,3934,37192,"Repositioning of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,15402.0,15402.0,15402.0,15402.0,United Healthcare-Medicare Advantage, +148707,3934,37193,"Removal of vena cava filter by endovascular approach, including radiological supervision and interpretation",CPT/HCPCS,7690.86,7690.86,559.94,10536.0,United Healthcare-Medicare Advantage, +148708,3934,37200,Biopsy of blood vessel via catheter,CPT/HCPCS,10191.35,10191.35,9458.09,16560.08,United Healthcare-Medicare Advantage, +148709,3934,37215,"Insertion of stents and blood clot protection device in neck artery, open or accessed through the skin",CPT/HCPCS,7068.0,7068.0,2964.84,17191.24,United Healthcare-Medicare Advantage, +148710,3934,37220,"Balloon dilation of artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9350.03,9350.03,5460.0,16722.0,United Healthcare-Medicare Advantage, +148711,3934,37221,"Insertion of stents in artery in one side of groin, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12468.62,12468.62,3313.5,19284.12,United Healthcare-Medicare Advantage, +148712,3934,37222,"Balloon dilation of groin artery, endovascular, open, or percutaneous approach",CPT/HCPCS,2699.34,2699.34,2881.67,2881.67,United Healthcare-Medicare Advantage, +148713,3934,37223,"Insertion of stents into groin artery, endovascular, accessed through the skin or open procedure",CPT/HCPCS,2975.99,2975.99,1886.8,3808.28,United Healthcare-Medicare Advantage, +148714,3934,37224,"Balloon dilation of arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,9793.52,9793.52,3005.61,31003.29,United Healthcare-Medicare Advantage, +148715,3934,37225,"Removal of plaque in arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15410.33,15410.33,7087.56,15277.33,United Healthcare-Medicare Advantage, +148716,3934,37226,"Insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,15963.33,15963.33,5090.21,21558.0,United Healthcare-Medicare Advantage, +148717,3934,37227,"Removal of plaque and insertion of stents into arteries in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14339.46,14339.46,10918.99,11311.51,United Healthcare-Medicare Advantage, +148718,3934,37228,"Balloon dilation of artery of one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,14071.28,14071.28,3996.69,34130.0,United Healthcare-Medicare Advantage, +148719,3934,37229,"Removal of plaque in artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,20806.37,20806.37,20806.37,20806.37,United Healthcare-Medicare Advantage, +148720,3934,37230,"Insertion of stents into artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,12887.33,12887.33,19697.5,19697.5,United Healthcare-Medicare Advantage, +148721,3934,37232,"Balloon dilation of artery in one leg, endovascular, accessed through the skin or open procedure",CPT/HCPCS,3819.23,3819.23,3471.0,4322.5,United Healthcare-Medicare Advantage, +148722,3934,37236,"Insertion of intravascular stents in artery (except lower extremity, cervical carotid, extracranial vertebral or intrathoracic carotid, intracranial, or coronary), open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,5999.45,5999.45,2968.51,31055.07,United Healthcare-Medicare Advantage, +148723,3934,37238,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,16812.33,16812.33,6835.85,37789.5,United Healthcare-Medicare Advantage, +148724,3934,37239,"Insertion of intravascular stents in vein, open or accessed through the skin, with radiological supervision and interpretation",CPT/HCPCS,3048.25,3048.25,3048.25,3048.25,United Healthcare-Medicare Advantage, +148725,3934,37241,"Occlusion of venous malformations (other than hemorrhage) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,6613.28,6613.28,4356.0,5511.1,United Healthcare-Medicare Advantage, +148726,3934,37242,"Occlusion of artery (other than hemorrhage or tumor) with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5764.19,5764.19,3048.84,7416.0,United Healthcare-Medicare Advantage, +148727,3934,37243,"Occlusion of tumors or obstructed blood vessel with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5978.27,5978.27,1433.31,9667.35,United Healthcare-Medicare Advantage, +148728,3934,37244,"Occlusion of arterial or venous hemorrhage with radiological supervision and interpretation, roadmapping, and imaging guidance",CPT/HCPCS,5068.04,5068.04,3602.84,5182.0,United Healthcare-Medicare Advantage, +148729,3934,37246,"Balloon dilation of artery, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,12096.79,12096.79,2478.21,19009.67,United Healthcare-Medicare Advantage, +148730,3934,37248,"Balloon dilation of first vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,10404.51,10404.51,4541.5,4541.5,United Healthcare-Medicare Advantage, +148731,3934,37249,"Balloon dilation of additional vein, accessed through the skin or by open procedure, with imaging including radiological supervision and interpretation",CPT/HCPCS,2946.94,2946.94,870.75,870.75,United Healthcare-Medicare Advantage, +148732,3934,37252,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2522.26,2522.26,486.04,5644.0,United Healthcare-Medicare Advantage, +148733,3934,37253,Ultrasound evaluation of blood vessel during diagnosis or treatment,CPT/HCPCS,2350.28,2350.28,208.81,3226.25,United Healthcare-Medicare Advantage, +148734,3934,37607,Tying or banding of a passage between an artery and vein,CPT/HCPCS,10366.86,10366.86,475.79,20292.0,United Healthcare-Medicare Advantage, +148735,3934,37700,Tying and incision leg vein,CPT/HCPCS,11179.32,11179.32,2674.27,2674.27,United Healthcare-Medicare Advantage, +148736,3934,37799,Blood vessel procedure,CPT/HCPCS,2914.5,2914.5,1247.0,1288.0,United Healthcare-Medicare Advantage, +148737,3934,38120,Examination of spleen using an endoscope,CPT/HCPCS,16296.17,16296.17,11974.5,11974.5,United Healthcare-Medicare Advantage, +148738,3934,38206,Collection of stem cells for transplantation,CPT/HCPCS,18704.72,18704.72,3108.7,21364.3,United Healthcare-Medicare Advantage, +148739,3934,38207,"Freezing, preservation, and storage of stem cells for transplantation",CPT/HCPCS,18687.16,18687.16,3156.3,23165.76,United Healthcare-Medicare Advantage, +148740,3934,38214,Preparation of stem cells for transplantation with reduction of excessive opening blood fluid (plasma) volume,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,United Healthcare-Medicare Advantage, +148741,3934,38215,Preparation of stem cells for transplantation with cell concentration,CPT/HCPCS,18687.49,18687.49,3400.89,21364.3,United Healthcare-Medicare Advantage, +148742,3934,38220,Diagnostic bone marrow aspiration,CPT/HCPCS,14385.51,14385.51,167.92,24401.88,United Healthcare-Medicare Advantage, +148743,3934,38221,Bone marrow biopsy,CPT/HCPCS,16785.77,16785.77,2711.9,130228.03,United Healthcare-Medicare Advantage, +148744,3934,38222,Bone marrow biopsy and aspiration,CPT/HCPCS,14396.97,14396.97,201.8,23330.63,United Healthcare-Medicare Advantage, +148745,3934,38500,"Biopsy or removal of lymph nodes, open procedure",CPT/HCPCS,12694.43,12694.43,2906.49,37289.48,United Healthcare-Medicare Advantage,5902.58 +148746,3934,38505,Needle biopsy or removal of lymph nodes,CPT/HCPCS,2822.19,2822.19,225.2,6654.1,United Healthcare-Medicare Advantage, +148747,3934,38510,"Biopsy or removal of lymph nodes of neck, open procedure",CPT/HCPCS,10337.71,10337.71,2944.02,14962.0,United Healthcare-Medicare Advantage, +148748,3934,38525,"Biopsy or removal of lymph nodes of under the arm, open procedure",CPT/HCPCS,11845.07,11845.07,1523.41,29954.53,United Healthcare-Medicare Advantage,6344.98 +148749,3934,38531,Open biopsy or excision of lymph nodes in groin,CPT/HCPCS,8081.6,8081.6,2701.0,15241.5,United Healthcare-Medicare Advantage, +148750,3934,38570,Removal of abdominal cavity lymph nodes using an endoscope,CPT/HCPCS,15201.96,15201.96,5712.5,34052.0,United Healthcare-Medicare Advantage, +148751,3934,38571,Removal of total lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,28899.64,28899.64,2765.14,67076.28,United Healthcare-Medicare Advantage, +148752,3934,38572,Removal of total lymph nodes of both sides of pelvis and abdominal lymph node biopsy using an endoscope,CPT/HCPCS,30099.38,30099.38,22674.42,39552.9,United Healthcare-Medicare Advantage, +148753,3934,38573,Removal of all lymph nodes of both sides of pelvis using an endoscope,CPT/HCPCS,29617.57,29617.57,33147.68,33147.68,United Healthcare-Medicare Advantage, +148754,3934,38589,Lymph node procedure using an endoscope,CPT/HCPCS,28064.13,28064.13,23703.18,56778.78,United Healthcare-Medicare Advantage, +148755,3934,38724,"Removal of lymph nodes, muscle, and tissue of neck",CPT/HCPCS,14720.76,14720.76,1649.42,8192.0,United Healthcare-Medicare Advantage, +148756,3934,38740,Removal of underarm lymph nodes,CPT/HCPCS,15232.02,15232.02,6964.42,6964.42,United Healthcare-Medicare Advantage, +148757,3934,38745,Removal of all underarm lymph nodes,CPT/HCPCS,13279.7,13279.7,14542.03,14542.03,United Healthcare-Medicare Advantage, +148758,3934,38792,Injection of radioactive dye for X-ray identification of lymph node,CPT/HCPCS,10396.76,10396.76,12978.2,12978.2,United Healthcare-Medicare Advantage, +148759,3934,38900,Lymph node imaging during surgery,CPT/HCPCS,1960.11,1960.11,356.4,6274.5,United Healthcare-Medicare Advantage, +148760,3934,39402,Examination of chest using an endoscope with lymph node biopsy,CPT/HCPCS,13297.48,13297.48,6850.0,11932.0,United Healthcare-Medicare Advantage, +148761,3934,40490,Biopsy of lip,CPT/HCPCS,10692.41,10692.41,2483.11,2483.11,United Healthcare-Medicare Advantage, +148762,3934,40510,Removal of wedge of lip tissue,CPT/HCPCS,9790.82,9790.82,924.8,924.8,United Healthcare-Medicare Advantage, +148763,3934,40530,Partial removal of lip,CPT/HCPCS,14050.57,14050.57,8276.29,19824.84,United Healthcare-Medicare Advantage, +148764,3934,40650,Repair of lip and border,CPT/HCPCS,2274.0,2274.0,1707.0,1707.0,United Healthcare-Medicare Advantage, +148765,3934,40701,Plastic repair of deformity present at birth on both sides of the nose or lip,CPT/HCPCS,29391.87,29391.87,3522.27,3522.27,United Healthcare-Medicare Advantage, +148766,3934,40720,Plastic repair of nasal and lip deformity present at birth,CPT/HCPCS,8480.25,8480.25,3392.79,7407.0,United Healthcare-Medicare Advantage, +148767,3934,40800,"Incision of abscess, cyst, or blood accumulation in mouth",CPT/HCPCS,1662.03,1662.03,157.16,200.62,United Healthcare-Medicare Advantage, +148768,3934,40806,Incision of tissue joining lip and gums,CPT/HCPCS,2913.23,2913.23,2272.0,2295.0,United Healthcare-Medicare Advantage, +148769,3934,40808,Biopsy of mouth,CPT/HCPCS,14577.65,14577.65,14304.57,14304.57,United Healthcare-Medicare Advantage, +148770,3934,40812,Removal of growth of mouth,CPT/HCPCS,5198.23,5198.23,1514.19,5433.96,United Healthcare-Medicare Advantage, +148771,3934,40814,Removal of growth of mouth with plastic repair,CPT/HCPCS,10626.61,10626.61,4379.0,6130.37,United Healthcare-Medicare Advantage, +148772,3934,40816,Removal of tissue and muscle growth of mouth,CPT/HCPCS,13685.06,13685.06,13685.06,13685.06,United Healthcare-Medicare Advantage, +148773,3934,40818,Removal of mouth tissue for grafting,CPT/HCPCS,54286.23,54286.23,1171.78,1171.78,United Healthcare-Medicare Advantage, +148774,3934,41008,"Drainage of abscess, cyst, or blood accumulation under the jaw bone",CPT/HCPCS,5559.98,5559.98,1372.0,1949.0,United Healthcare-Medicare Advantage, +148775,3934,41010,Incision of tissue connecting tongue and floor of mouth,CPT/HCPCS,3558.95,3558.95,1392.04,4356.0,United Healthcare-Medicare Advantage, +148776,3934,41016,"Drainage of abscess, cyst, or blood accumulation under the tongue or lower lip",CPT/HCPCS,31235.2,31235.2,2547.06,2547.06,United Healthcare-Medicare Advantage, +148777,3934,41017,"Drainage of abscess, cyst, or blood accumulation under the tongue or jaw bone",CPT/HCPCS,13049.58,13049.58,1580.7,1580.7,United Healthcare-Medicare Advantage, +148778,3934,41105,Biopsy of tongue,CPT/HCPCS,7961.0,7961.0,7961.0,7961.0,United Healthcare-Medicare Advantage, +148779,3934,41108,Biopsy of floor of mouth,CPT/HCPCS,30252.25,30252.25,1943.39,1943.39,United Healthcare-Medicare Advantage, +148780,3934,41112,Removal of growth of tongue,CPT/HCPCS,6659.18,6659.18,2178.0,5731.46,United Healthcare-Medicare Advantage, +148781,3934,41113,Removal of growth of tongue,CPT/HCPCS,8388.0,8388.0,4299.69,4299.69,United Healthcare-Medicare Advantage, +148782,3934,41115,Removal of tissue connecting tongue and floor of mouth,CPT/HCPCS,4965.23,4965.23,5770.28,8467.79,United Healthcare-Medicare Advantage, +148783,3934,41120,Partial removal of tongue,CPT/HCPCS,16031.72,16031.72,3950.21,33175.0,United Healthcare-Medicare Advantage, +148784,3934,41250,Repair of (2.5 centimeter or less) laceration to floor of mouth and/or tongue,CPT/HCPCS,875.33,875.33,895.0,895.0,United Healthcare-Medicare Advantage, +148785,3934,41599,Tongue or floor of mouth procedure,CPT/HCPCS,28026.45,28026.45,4544.0,4544.0,United Healthcare-Medicare Advantage, +148786,3934,41800,"Drainage of abscess, cyst, or blood accumulation of dental bone",CPT/HCPCS,914.96,914.96,50.0,4578.15,United Healthcare-Medicare Advantage, +148787,3934,41806,Removal of foreign body in dental bone,CPT/HCPCS,24277.44,24277.44,3654.01,3677.86,United Healthcare-Medicare Advantage, +148788,3934,41825,Removal of growth of dental bone,CPT/HCPCS,9613.75,9613.75,13035.5,13035.5,United Healthcare-Medicare Advantage, +148789,3934,41826,Removal of growth of dental bone with repair,CPT/HCPCS,7804.96,7804.96,4099.79,8265.2,United Healthcare-Medicare Advantage, +148790,3934,41827,Removal of growth of dental bone with repair,CPT/HCPCS,18483.06,18483.06,5731.46,5731.46,United Healthcare-Medicare Advantage, +148791,3934,41874,Reshaping of tooth bone,CPT/HCPCS,2865.7,2865.7,214.09,214.09,United Healthcare-Medicare Advantage, +148792,3934,41899,Relocation of mouth tissue to gum surface,CPT/HCPCS,4468.8,4468.8,1372.0,4528.0,United Healthcare-Medicare Advantage, +148793,3934,42180,Repair of (up to 2 centimeters) laceration at roof of mouth,CPT/HCPCS,11575.12,11575.12,4708.47,4708.47,United Healthcare-Medicare Advantage, +148794,3934,42210,Repair of defect of roof of mouth,CPT/HCPCS,27164.78,27164.78,3764.71,3764.71,United Healthcare-Medicare Advantage, +148795,3934,42215,Repair of defect of roof of mouth,CPT/HCPCS,10956.88,10956.88,3392.79,3392.79,United Healthcare-Medicare Advantage, +148796,3934,42281,Insertion of roof of mouth prosthesis,CPT/HCPCS,10176.98,10176.98,3875.8,3875.8,United Healthcare-Medicare Advantage, +148797,3934,42310,Drainage of lower jaw abscess,CPT/HCPCS,2354.5,2354.5,1397.82,1397.82,United Healthcare-Medicare Advantage, +148798,3934,42330,Removal of salivary gland stone,CPT/HCPCS,7719.5,7719.5,1903.9,3996.0,United Healthcare-Medicare Advantage, +148799,3934,42400,Needle biopsy of salivary gland,CPT/HCPCS,2887.0,2887.0,2996.0,4802.0,United Healthcare-Medicare Advantage, +148800,3934,42405,Biopsy of salivary gland,CPT/HCPCS,9565.5,9565.5,2445.52,2445.52,United Healthcare-Medicare Advantage, +148801,3934,42408,Removal of salivary cyst under tongue,CPT/HCPCS,9969.0,9969.0,1903.9,8413.86,United Healthcare-Medicare Advantage, +148802,3934,42410,"Removal of salivary gland growth or salivary gland, lateral lobe",CPT/HCPCS,10667.25,10667.25,7743.0,7920.0,United Healthcare-Medicare Advantage, +148803,3934,42415,Partial removal of salivary gland growth with release of facial nerve,CPT/HCPCS,22433.2,22433.2,6044.71,17404.0,United Healthcare-Medicare Advantage, +148804,3934,42420,Removal of total salivary gland growth or salivary gland with release of facial nerve,CPT/HCPCS,25950.4,25950.4,6965.46,21949.0,United Healthcare-Medicare Advantage, +148805,3934,42440,Removal of salivary gland under floor of mouth,CPT/HCPCS,18882.78,18882.78,1994.93,1994.93,United Healthcare-Medicare Advantage, +148806,3934,42505,Plastic repair of salivary duct,CPT/HCPCS,12837.07,12837.07,9202.28,16471.85,United Healthcare-Medicare Advantage, +148807,3934,42650,Insertion of probe for salivary gland duct dilation,CPT/HCPCS,7840.67,7840.67,5041.0,5041.0,United Healthcare-Medicare Advantage, +148808,3934,42699,Salivary gland or duct procedure,CPT/HCPCS,9664.82,9664.82,2614.99,14043.33,United Healthcare-Medicare Advantage, +148809,3934,42700,Drainage of tonsil abscess,CPT/HCPCS,1127.04,1127.04,31.0,1949.0,United Healthcare-Medicare Advantage, +148810,3934,42800,Biopsy of back of throat,CPT/HCPCS,9555.74,9555.74,4356.0,4356.0,United Healthcare-Medicare Advantage, +148811,3934,42808,Removal or destruction of throat growth,CPT/HCPCS,22006.49,22006.49,18305.62,18305.62,United Healthcare-Medicare Advantage, +148812,3934,42809,Removal of foreign body from throat,CPT/HCPCS,313.4,313.4,75.0,75.0,United Healthcare-Medicare Advantage, +148813,3934,42810,Removal of congenital skin and tissue cyst,CPT/HCPCS,5100.25,5100.25,3303.01,7217.72,United Healthcare-Medicare Advantage, +148814,3934,42815,Removal of congenital cyst or abnormal drainage tract into mouth,CPT/HCPCS,6480.5,6480.5,8139.0,8139.0,United Healthcare-Medicare Advantage, +148815,3934,42820,Removal of tonsils and adenoid glands patient younger than age 12,CPT/HCPCS,8371.33,8371.33,1954.91,12422.18,United Healthcare-Medicare Advantage, +148816,3934,42821,Removal of tonsils and adenoid glands patient age 12 or over,CPT/HCPCS,9390.32,9390.32,1724.49,7720.96,United Healthcare-Medicare Advantage, +148817,3934,42825,Removal of tonsils patient younger than age 12,CPT/HCPCS,7175.24,7175.24,838.99,7989.2,United Healthcare-Medicare Advantage, +148818,3934,42826,Removal of tonsils patient age 12 or over,CPT/HCPCS,9056.36,9056.36,1655.29,6992.0,United Healthcare-Medicare Advantage, +148819,3934,42830,Removal of adenoids patient younger than age 12,CPT/HCPCS,6098.69,6098.69,1655.29,4544.0,United Healthcare-Medicare Advantage, +148820,3934,42831,Removal of adenoids patient age 12 or over,CPT/HCPCS,5430.63,5430.63,769.79,7395.0,United Healthcare-Medicare Advantage, +148821,3934,42870,Removal or destruction of growth of tongue lymph node,CPT/HCPCS,8414.3,8414.3,1757.65,7015.86,United Healthcare-Medicare Advantage, +148822,3934,42960,Control of bleeding of throat,CPT/HCPCS,3526.75,3526.75,747.0,3362.0,United Healthcare-Medicare Advantage, +148823,3934,42962,Control of bleeding of throat,CPT/HCPCS,11828.12,11828.12,3370.39,8473.14,United Healthcare-Medicare Advantage, +148824,3934,42999,"Throat, adenoids, or tonsils procedure",CPT/HCPCS,1163.5,1163.5,247.77,247.77,United Healthcare-Medicare Advantage, +148825,3934,43191,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,5954.79,5954.79,473.64,1886.79,United Healthcare-Medicare Advantage, +148826,3934,43194,Removal of foreign bodies of esophagus using an endoscope,CPT/HCPCS,8667.11,8667.11,1249.01,3946.83,United Healthcare-Medicare Advantage, +148827,3934,43195,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5810.11,5810.11,3633.39,3735.33,United Healthcare-Medicare Advantage, +148828,3934,43196,Insertion of wire and dilation of esophagus using an endoscope,CPT/HCPCS,12998.0,12998.0,12998.0,12998.0,United Healthcare-Medicare Advantage, +148829,3934,43200,Diagnostic examination of esophagus using an endoscope,CPT/HCPCS,12575.23,12575.23,1331.36,1331.36,United Healthcare-Medicare Advantage, +148830,3934,43215,Removal of foreign bodies in esophagus using an endoscope,CPT/HCPCS,7413.67,7413.67,975.42,975.42,United Healthcare-Medicare Advantage, +148831,3934,43220,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5495.33,5495.33,3502.8,6594.0,United Healthcare-Medicare Advantage, +148832,3934,43233,"Balloon dilation of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11456.0,11456.0,5000.0,5000.0,United Healthcare-Medicare Advantage, +148833,3934,43235,"Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4337.57,4337.57,253.86,12422.18,United Healthcare-Medicare Advantage,793.45 +148834,3934,43236,"Injections of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,4875.24,4875.24,430.8,11228.0,United Healthcare-Medicare Advantage, +148835,3934,43237,"Ultrasound examination of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5698.06,5698.06,1193.82,7808.0,United Healthcare-Medicare Advantage,1781.33 +148836,3934,43238,Ultrasound guided needle aspiration or biopsies of esophagus using an endoscope,CPT/HCPCS,7874.82,7874.82,976.36,9696.0,United Healthcare-Medicare Advantage, +148837,3934,43239,"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5461.32,5461.32,163.85,12422.18,United Healthcare-Medicare Advantage,3617.98 +148838,3934,43240,"Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,13349.88,13349.88,2432.51,15062.67,United Healthcare-Medicare Advantage, +148839,3934,43242,"Ultrasound guided needle aspiration or biopsy of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,8451.54,8451.54,455.6,22311.33,United Healthcare-Medicare Advantage,1886.79 +148840,3934,43244,Tying of dilated veins of stomach and/or esophagus using an endoscope,CPT/HCPCS,5835.67,5835.67,1509.13,18433.67,United Healthcare-Medicare Advantage,6133.67 +148841,3934,43245,Dilation of stomach outlet using an endoscope,CPT/HCPCS,6079.73,6079.73,2003.42,7528.67,United Healthcare-Medicare Advantage, +148842,3934,43246,Insertion of stomach tube using an endoscope,CPT/HCPCS,7567.78,7567.78,1726.82,15365.0,United Healthcare-Medicare Advantage, +148843,3934,43247,"Removal of foreign bodies of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5983.48,5983.48,634.85,14672.0,United Healthcare-Medicare Advantage,966.88 +148844,3934,43248,Insertion of guide wire with dilation of esophagus using an endoscope,CPT/HCPCS,5567.59,5567.59,1502.53,15854.0,United Healthcare-Medicare Advantage,952.14 +148845,3934,43249,Balloon dilation of esophagus using an endoscope,CPT/HCPCS,5073.74,5073.74,515.67,14584.0,United Healthcare-Medicare Advantage,1970.27 +148846,3934,43251,"Removal of polyps or growths of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,5713.27,5713.27,1565.0,15586.0,United Healthcare-Medicare Advantage, +148847,3934,43253,"Injection of diagnostic or therapeutic substances or markers in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7166.43,7166.43,1589.68,8518.0,United Healthcare-Medicare Advantage, +148848,3934,43254,"Removal of tissue lining of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,12605.57,12605.57,1307.01,60760.0,United Healthcare-Medicare Advantage, +148849,3934,43255,"Control of bleeding of esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,7335.74,7335.74,2514.5,9868.0,United Healthcare-Medicare Advantage, +148850,3934,43259,"Ultrasound examination of esophagus, stomach and/or upper small bowel using an endoscope",CPT/HCPCS,6066.88,6066.88,510.4,39104.0,United Healthcare-Medicare Advantage,1886.79 +148851,3934,43260,"Diagnostic examination of gallbladder and pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,12040.32,12040.32,2602.46,29734.0,United Healthcare-Medicare Advantage, +148852,3934,43261,"Biopsy of gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,6767.48,6767.48,2845.0,13704.0,United Healthcare-Medicare Advantage, +148853,3934,43262,Incision of pancreatic outlet muscle using an endoscope,CPT/HCPCS,9236.62,9236.62,3796.83,17487.0,United Healthcare-Medicare Advantage, +148854,3934,43264,Removal of stone from bile or pancreatic duct using an endoscope,CPT/HCPCS,7371.94,7371.94,396.8,25666.0,United Healthcare-Medicare Advantage,3684.36 +148855,3934,43265,Destruction of stone in bile or pancreatic duct using an endoscope,CPT/HCPCS,18784.45,18784.45,4869.67,23434.5,United Healthcare-Medicare Advantage, +148856,3934,43266,"Placement of stent in esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,11062.91,11062.91,2020.07,19606.0,United Healthcare-Medicare Advantage, +148857,3934,43270,"Destruction of growths on esophagus, stomach, and/or upper small bowel using an endoscope",CPT/HCPCS,6114.29,6114.29,1645.01,12348.0,United Healthcare-Medicare Advantage, +148858,3934,43274,Placement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,10125.24,10125.24,1391.19,24356.0,United Healthcare-Medicare Advantage,5791.98 +148859,3934,43275,Removal of foreign body or stent from pancreatic or bile duct using an endoscope,CPT/HCPCS,4887.79,4887.79,816.4,15314.0,United Healthcare-Medicare Advantage, +148860,3934,43276,Replacement of stent pancreatic or bile duct using an endoscope,CPT/HCPCS,8122.66,8122.66,487.72,16726.4,United Healthcare-Medicare Advantage,5791.98 +148861,3934,43277,Balloon dilation of pancreatic or bile duct using an endoscope,CPT/HCPCS,11248.69,11248.69,4956.0,16829.5,United Healthcare-Medicare Advantage, +148862,3934,43278,"Destruction of mass on gallbladder, pancreatic, liver, and bile ducts using an endoscope",CPT/HCPCS,8691.56,8691.56,4929.0,9605.2,United Healthcare-Medicare Advantage, +148863,3934,43279,Repair of muscle to lower esophagus and stomach using an endoscope,CPT/HCPCS,14052.34,14052.34,9012.0,9558.0,United Healthcare-Medicare Advantage, +148864,3934,43280,Repair of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,10845.21,10845.21,9783.08,15271.91,United Healthcare-Medicare Advantage, +148865,3934,43281,Repair of hernia of muscle at esophagus and stomach using an endoscope,CPT/HCPCS,13989.86,13989.86,5489.27,21285.73,United Healthcare-Medicare Advantage, +148866,3934,43282,Repair of hernia of muscle at esophagus and stomach with implantation of mesh using an endoscope,CPT/HCPCS,19887.9,19887.9,9540.85,21169.76,United Healthcare-Medicare Advantage, +148867,3934,43450,Dilation of esophagus,CPT/HCPCS,4882.98,4882.98,2280.75,9010.67,United Healthcare-Medicare Advantage, +148868,3934,43499,Esophagus procedure,CPT/HCPCS,24808.49,24808.49,2191.67,32775.0,United Healthcare-Medicare Advantage,8153.81 +148869,3934,43520,Severing of muscle at stomach outlet to upper small bowel,CPT/HCPCS,5829.5,5829.5,866.28,3851.0,United Healthcare-Medicare Advantage, +148870,3934,43644,Bypass operation of stomach using an endoscope,CPT/HCPCS,7977.09,7977.09,3815.5,3815.5,United Healthcare-Medicare Advantage, +148871,3934,43653,Creation of stomach feeding tube using an endoscope,CPT/HCPCS,11785.93,11785.93,13366.62,13366.62,United Healthcare-Medicare Advantage, +148872,3934,43659,Stomach procedure using an endoscope,CPT/HCPCS,6969.07,6969.07,5810.08,24038.42,United Healthcare-Medicare Advantage, +148873,3934,43752,Insertion of nasal or oral stomach tube using fluoroscopic guidance,CPT/HCPCS,617.5,617.5,2484.0,2484.0,United Healthcare-Medicare Advantage, +148874,3934,43762,Replacement of stomach stoma tube accessed through skin,CPT/HCPCS,817.63,817.63,46.4,4462.0,United Healthcare-Medicare Advantage, +148875,3934,43770,Insertion of adjustable stomach reduction device using an endoscope,CPT/HCPCS,8047.75,8047.75,8736.57,8736.57,United Healthcare-Medicare Advantage, +148876,3934,43774,Removal of stomach reduction device and port beneath the skin using an endoscope,CPT/HCPCS,10347.79,10347.79,4110.86,16918.61,United Healthcare-Medicare Advantage, +148877,3934,43775,Stomach reduction procedure with partial removal of stomach using an endoscope,CPT/HCPCS,9360.51,9360.51,2211.32,27507.0,United Healthcare-Medicare Advantage, +148878,3934,43870,Closure of skin opening to stomach,CPT/HCPCS,8192.33,8192.33,2272.0,4356.0,United Healthcare-Medicare Advantage, +148879,3934,43887,"Removal of skin level port of stomach banding device, open procedure",CPT/HCPCS,7605.85,7605.85,4287.0,4287.0,United Healthcare-Medicare Advantage, +148880,3934,43999,Stomach procedure,CPT/HCPCS,11500.21,11500.21,1237.53,41614.0,United Healthcare-Medicare Advantage, +148881,3934,44180,Release of small bowel scar tissue using an endoscope,CPT/HCPCS,11334.5,11334.5,6677.0,7640.64,United Healthcare-Medicare Advantage, +148882,3934,44202,Partial removal of small bowel using an endoscope,CPT/HCPCS,17088.0,17088.0,9012.0,9012.0,United Healthcare-Medicare Advantage, +148883,3934,44360,Examination of small bowel using an endoscope,CPT/HCPCS,13353.58,13353.58,1402.65,21042.0,United Healthcare-Medicare Advantage, +148884,3934,44361,Biopsy of small bowel using an endoscope,CPT/HCPCS,11048.55,11048.55,2032.62,17984.0,United Healthcare-Medicare Advantage, +148885,3934,44364,Removal of small bowel polyps or growths using an endoscope,CPT/HCPCS,10797.17,10797.17,6897.0,9033.0,United Healthcare-Medicare Advantage, +148886,3934,44366,Control of bleeding in small bowel using an endoscope,CPT/HCPCS,12043.37,12043.37,12527.0,15469.0,United Healthcare-Medicare Advantage, +148887,3934,44369,Destruction of small bowel polyps or growths using an endoscope,CPT/HCPCS,14336.56,14336.56,2892.33,86302.33,United Healthcare-Medicare Advantage, +148888,3934,44372,Insertion of feeding tube (accessed beneath the skin) into small bowel using an endoscope,CPT/HCPCS,14123.33,14123.33,939.68,939.68,United Healthcare-Medicare Advantage, +148889,3934,44376,Diagnostic examination of small bowel using an endoscope,CPT/HCPCS,10849.97,10849.97,2249.42,10090.0,United Healthcare-Medicare Advantage, +148890,3934,44377,Biopsy of small bowel using an endoscope,CPT/HCPCS,14125.08,14125.08,19606.0,19606.0,United Healthcare-Medicare Advantage, +148891,3934,44380,Diagnostic examination of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,3952.58,3952.58,1349.46,1349.46,United Healthcare-Medicare Advantage, +148892,3934,44381,Balloon dilation of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,13533.86,13533.86,1010.76,1010.76,United Healthcare-Medicare Advantage, +148893,3934,44382,Biopsy of small bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,4596.53,4596.53,2243.14,3419.0,United Healthcare-Medicare Advantage, +148894,3934,44385,Diagnostic examination of defect in wall of small bowel using an endoscope,CPT/HCPCS,2277.0,2277.0,462.72,1754.08,United Healthcare-Medicare Advantage, +148895,3934,44386,Biopsy of small bowel using an endoscope,CPT/HCPCS,5838.78,5838.78,6039.0,8947.0,United Healthcare-Medicare Advantage, +148896,3934,44388,Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,5251.17,5251.17,1020.44,9153.0,United Healthcare-Medicare Advantage, +148897,3934,44389,Biopsies of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,6998.67,6998.67,8319.0,8319.0,United Healthcare-Medicare Advantage, +148898,3934,44394,Removal of large bowel polyps or growths using an endoscope,CPT/HCPCS,7411.13,7411.13,3252.61,9528.0,United Healthcare-Medicare Advantage, +148899,3934,44404,Injections of large bowel using an endoscope which is inserted through abdominal opening,CPT/HCPCS,12785.0,12785.0,8961.25,8961.25,United Healthcare-Medicare Advantage, +148900,3934,44799,Small bowel procedure,CPT/HCPCS,10113.52,10113.52,1966.14,29278.0,United Healthcare-Medicare Advantage,952.14 +148901,3934,44950,Removal of appendix,CPT/HCPCS,69043.16,69043.16,68880.55,69115.43,United Healthcare-Medicare Advantage, +148902,3934,44955,Removal of appendix,CPT/HCPCS,2907.33,2907.33,12365.39,12365.39,United Healthcare-Medicare Advantage, +148903,3934,44970,Removal of appendix using an endoscope,CPT/HCPCS,15844.37,15844.37,1790.56,41043.54,United Healthcare-Medicare Advantage, +148904,3934,44979,Appendix procedure using an endoscope,CPT/HCPCS,37884.85,37884.85,37884.85,37884.85,United Healthcare-Medicare Advantage, +148905,3934,45005,Drainage of rectal abscess,CPT/HCPCS,3085.5,3085.5,1525.4,1525.4,United Healthcare-Medicare Advantage, +148906,3934,45100,Biopsy of rectum,CPT/HCPCS,7295.96,7295.96,9849.0,14373.63,United Healthcare-Medicare Advantage, +148907,3934,45171,Removal of rectal growth,CPT/HCPCS,6426.33,6426.33,1753.1,4800.7,United Healthcare-Medicare Advantage, +148908,3934,45300,Diagnostic examination of rectum and large bowel using an endoscope,CPT/HCPCS,5726.68,5726.68,3035.86,6015.0,United Healthcare-Medicare Advantage, +148909,3934,45330,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,3564.85,3564.85,313.29,11248.0,United Healthcare-Medicare Advantage, +148910,3934,45331,Biopsy of large bowel using an endoscope,CPT/HCPCS,5412.22,5412.22,1775.72,8895.0,United Healthcare-Medicare Advantage,925.44 +148911,3934,45332,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,8923.62,8923.62,6366.67,14069.0,United Healthcare-Medicare Advantage, +148912,3934,45334,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,32839.81,32839.81,25275.28,25275.28,United Healthcare-Medicare Advantage, +148913,3934,45335,Injections into large bowel using an endoscope,CPT/HCPCS,3527.81,3527.81,1753.56,2985.33,United Healthcare-Medicare Advantage, +148914,3934,45338,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,5837.16,5837.16,2467.61,6935.0,United Healthcare-Medicare Advantage, +148915,3934,45340,Dilation of large bowel stricture using an endoscope,CPT/HCPCS,5394.32,5394.32,2282.23,9310.0,United Healthcare-Medicare Advantage, +148916,3934,45341,Ultrasound examination of large bowel using an endoscope,CPT/HCPCS,5130.98,5130.98,208.52,6568.0,United Healthcare-Medicare Advantage, +148917,3934,45342,Ultrasound guided needle aspiration or biopsy of large bowel using an endoscope,CPT/HCPCS,9910.43,9910.43,1747.56,4150.0,United Healthcare-Medicare Advantage, +148918,3934,45346,Destruction of polyps or growths of large bowel using an endoscope,CPT/HCPCS,6139.45,6139.45,6475.0,10700.0,United Healthcare-Medicare Advantage, +148919,3934,45347,Placement of stent in large bowel using an endoscope,CPT/HCPCS,8478.89,8478.89,5574.0,5574.0,United Healthcare-Medicare Advantage, +148920,3934,45349,Removal of large bowel tissue using an endoscope,CPT/HCPCS,16134.17,16134.17,1551.04,39812.0,United Healthcare-Medicare Advantage, +148921,3934,45378,Diagnostic examination of large bowel using an endoscope,CPT/HCPCS,5445.8,5445.8,212.68,12422.18,United Healthcare-Medicare Advantage,894.52 +148922,3934,45379,Removal of foreign bodies in large bowel using an endoscope,CPT/HCPCS,4681.07,4681.07,1935.74,5561.33,United Healthcare-Medicare Advantage, +148923,3934,45380,Biopsy of large bowel using an endoscope,CPT/HCPCS,7073.27,7073.27,108.85,12422.18,United Healthcare-Medicare Advantage,912.46 +148924,3934,45381,Injections of large bowel using an endoscope,CPT/HCPCS,9928.93,9928.93,1695.61,26141.0,United Healthcare-Medicare Advantage, +148925,3934,45382,Control of bleeding in large bowel using an endoscope,CPT/HCPCS,8070.8,8070.8,4040.43,4040.43,United Healthcare-Medicare Advantage, +148926,3934,45384,Removal of polyps or growths in large bowel using an endoscope,CPT/HCPCS,8533.83,8533.83,3629.41,8086.0,United Healthcare-Medicare Advantage, +148927,3934,45385,Removal of polyps or growths of large bowel using an endoscope,CPT/HCPCS,7199.19,7199.19,470.52,12422.18,United Healthcare-Medicare Advantage,1216.61 +148928,3934,45386,Balloon dilation of large bowel using an endoscope,CPT/HCPCS,5736.18,5736.18,2750.35,12531.67,United Healthcare-Medicare Advantage, +148929,3934,45388,Destruction of large bowel growths using an endoscope,CPT/HCPCS,6932.61,6932.61,1796.58,10509.0,United Healthcare-Medicare Advantage, +148930,3934,45389,Stent placement of large bowel using an endoscope,CPT/HCPCS,28550.0,28550.0,28550.0,28550.0,United Healthcare-Medicare Advantage, +148931,3934,45390,Removal of large bowel tissue using an endoscope,CPT/HCPCS,9723.67,9723.67,1170.58,34710.0,United Healthcare-Medicare Advantage,2839.97 +148932,3934,45391,Ultrasound examination of lower large bowel using an endoscope,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +148933,3934,45392,Ultrasound guided needle aspiration or biopsy of lower large bowel using an endoscope,CPT/HCPCS,3572.22,3572.22,4328.33,4328.33,United Healthcare-Medicare Advantage, +148934,3934,45399,Large bowel procedure,CPT/HCPCS,6855.39,6855.39,1236.13,26476.0,United Healthcare-Medicare Advantage, +148935,3934,45560,Repair of herniated rectum,CPT/HCPCS,12716.25,12716.25,2861.06,2861.06,United Healthcare-Medicare Advantage, +148936,3934,45905,Dilation of anal muscle under anesthesia,CPT/HCPCS,4416.5,4416.5,1279.07,1279.07,United Healthcare-Medicare Advantage, +148937,3934,45910,Dilation of rectal scar tissue under anesthesia,CPT/HCPCS,2126.0,2126.0,2314.0,5731.46,United Healthcare-Medicare Advantage, +148938,3934,45915,Removal of impacted stool or foreign body under anesthesia,CPT/HCPCS,9721.24,9721.24,2417.0,2417.0,United Healthcare-Medicare Advantage, +148939,3934,45990,Diagnostic examination of anus and rectum under anesthesia,CPT/HCPCS,5186.33,5186.33,2824.33,2824.33,United Healthcare-Medicare Advantage, +148940,3934,45999,Rectal procedure,CPT/HCPCS,27541.36,27541.36,1458.5,48894.0,United Healthcare-Medicare Advantage, +148941,3934,46020,Insertion of drain device in anus,CPT/HCPCS,6135.69,6135.69,3618.57,9368.29,United Healthcare-Medicare Advantage, +148942,3934,46040,Drainage of rectal abscess,CPT/HCPCS,6342.53,6342.53,100.0,5461.0,United Healthcare-Medicare Advantage, +148943,3934,46050,Drainage of rectal abscess,CPT/HCPCS,14069.63,14069.63,122.09,19236.0,United Healthcare-Medicare Advantage, +148944,3934,46060,Drainage of anal abscess,CPT/HCPCS,5534.92,5534.92,1783.99,3651.89,United Healthcare-Medicare Advantage, +148945,3934,46080,Division of muscle of anus,CPT/HCPCS,10209.47,10209.47,6261.0,6261.0,United Healthcare-Medicare Advantage, +148946,3934,46083,Incision of engorged external hemorrhoid,CPT/HCPCS,1046.17,1046.17,1208.55,1208.55,United Healthcare-Medicare Advantage, +148947,3934,46200,Excision of abnormal anal drainage tract,CPT/HCPCS,6259.93,6259.93,3796.57,8388.0,United Healthcare-Medicare Advantage, +148948,3934,46220,Removal of anal growth,CPT/HCPCS,4557.58,4557.58,5461.0,5461.0,United Healthcare-Medicare Advantage, +148949,3934,46230,Removal of multiple external anal growths,CPT/HCPCS,4521.33,4521.33,5269.0,5269.0,United Healthcare-Medicare Advantage, +148950,3934,46250,Removal of multiple external hemorrhoids,CPT/HCPCS,19415.56,19415.56,4482.06,4482.06,United Healthcare-Medicare Advantage, +148951,3934,46255,Removal of internal and external hemorrhoids,CPT/HCPCS,7209.78,7209.78,4643.2,9993.0,United Healthcare-Medicare Advantage, +148952,3934,46257,Removal of internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,5221.0,5221.0,5221.0,5221.0,United Healthcare-Medicare Advantage, +148953,3934,46258,Removal of internal and external hemorrhoids with repair of abnormal anal drainage tract,CPT/HCPCS,5209.0,5209.0,1822.3,1822.3,United Healthcare-Medicare Advantage, +148954,3934,46260,Removal of multiple internal and external hemorrhoids,CPT/HCPCS,8666.81,8666.81,2862.3,13044.0,United Healthcare-Medicare Advantage, +148955,3934,46261,Removal of multiple internal and external hemorrhoids with excision of abnormal anal drainage tract,CPT/HCPCS,7220.5,7220.5,1822.3,1822.3,United Healthcare-Medicare Advantage, +148956,3934,46270,Repair of abnormal anal drainage tract,CPT/HCPCS,5921.83,5921.83,5304.0,10400.0,United Healthcare-Medicare Advantage, +148957,3934,46275,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6018.9,6018.9,5660.39,11778.0,United Healthcare-Medicare Advantage, +148958,3934,46280,Repair of anal muscle and abnormal anal drainage tract,CPT/HCPCS,6471.83,6471.83,1753.1,5461.0,United Healthcare-Medicare Advantage, +148959,3934,46500,Injection of hemorrhoids,CPT/HCPCS,9417.36,9417.36,9317.36,9317.36,United Healthcare-Medicare Advantage, +148960,3934,46505,Injection of agent to paralyze anal muscle,CPT/HCPCS,6620.38,6620.38,5041.0,5041.0,United Healthcare-Medicare Advantage, +148961,3934,46600,Diagnostic examination of the anus using an endoscope,CPT/HCPCS,1844.25,1844.25,397.29,397.29,United Healthcare-Medicare Advantage, +148962,3934,46606,Biopsy of anus using an endoscope,CPT/HCPCS,6316.99,6316.99,2773.67,10896.97,United Healthcare-Medicare Advantage, +148963,3934,46614,Control of anal bleeding using an endoscope,CPT/HCPCS,5668.5,5668.5,5041.0,5041.0,United Healthcare-Medicare Advantage, +148964,3934,46910,Destruction of anal growths using electric current,CPT/HCPCS,4282.75,4282.75,3071.99,8173.0,United Healthcare-Medicare Advantage, +148965,3934,46917,Laser destruction of anal growths,CPT/HCPCS,5414.1,5414.1,4390.0,4390.0,United Healthcare-Medicare Advantage, +148966,3934,46922,Excisional destruction of anal growths,CPT/HCPCS,7019.34,7019.34,2899.88,10305.1,United Healthcare-Medicare Advantage, +148967,3934,46924,Destruction of anal growths,CPT/HCPCS,6524.6,6524.6,3357.03,9765.1,United Healthcare-Medicare Advantage, +148968,3934,46946,Removal and tying of multiple hemorrhoid groups,CPT/HCPCS,4845.0,4845.0,2803.55,2803.55,United Healthcare-Medicare Advantage, +148969,3934,46948,Tying of arteries to internal hemorrhoid,CPT/HCPCS,12106.67,12106.67,6756.0,16255.0,United Healthcare-Medicare Advantage, +148970,3934,46999,Anus procedure,CPT/HCPCS,9384.23,9384.23,2456.0,29796.0,United Healthcare-Medicare Advantage, +148971,3934,47000,"Needle biopsy of liver, accessed through the skin",CPT/HCPCS,4996.5,4996.5,1591.38,10216.17,United Healthcare-Medicare Advantage, +148972,3934,47100,Partial removal of liver tissue,CPT/HCPCS,5129.86,5129.86,1225.23,2178.0,United Healthcare-Medicare Advantage, +148973,3934,47379,Liver procedure using an endoscope,CPT/HCPCS,11550.62,11550.62,12196.57,28115.28,United Healthcare-Medicare Advantage, +148974,3934,47383,"Destruction of 1 or more liver growths, accessed through the skin",CPT/HCPCS,9118.0,9118.0,2980.04,2980.04,United Healthcare-Medicare Advantage, +148975,3934,47490,Insertion of catheter (accessed through the skin) into gallbladder using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2569.75,2569.75,2273.0,8170.0,United Healthcare-Medicare Advantage, +148976,3934,47531,Injection of bile duct for X-ray imaging procedure accessed through the skin using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,1514.93,1514.93,494.09,3780.83,United Healthcare-Medicare Advantage, +148977,3934,47533,"Placement of drainage catheter of biliary duct, accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,12221.35,12221.35,4434.0,4434.0,United Healthcare-Medicare Advantage, +148978,3934,47536,Replacement of liver duct drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2360.21,2360.21,325.0,4800.7,United Healthcare-Medicare Advantage, +148979,3934,47562,Removal of gallbladder using an endoscope,CPT/HCPCS,14908.45,14908.45,2377.7,40054.93,United Healthcare-Medicare Advantage, +148980,3934,47563,Removal of gallbladder with X-ray study of bile ducts using endoscope,CPT/HCPCS,16755.98,16755.98,1087.79,37227.05,United Healthcare-Medicare Advantage, +148981,3934,47564,Removal of gallbladder with exploration of common bile duct using endoscope,CPT/HCPCS,38639.12,38639.12,11103.89,52278.92,United Healthcare-Medicare Advantage, +148982,3934,47999,Bile duct procedure,CPT/HCPCS,10544.0,10544.0,8264.0,9504.0,United Healthcare-Medicare Advantage, +148983,3934,48999,Pancreas procedure,CPT/HCPCS,6893.0,6893.0,1512.07,11273.33,United Healthcare-Medicare Advantage, +148984,3934,49000,Exploration of abdomen and abdominal organs,CPT/HCPCS,7451.61,7451.61,975.92,975.92,United Healthcare-Medicare Advantage, +148985,3934,49082,Drainage of fluid from abdominal cavity,CPT/HCPCS,3228.57,3228.57,1307.73,6694.51,United Healthcare-Medicare Advantage, +148986,3934,49083,Drainage of fluid from abdominal cavity using imaging guidance,CPT/HCPCS,4877.14,4877.14,131.85,10965.0,United Healthcare-Medicare Advantage, +148987,3934,49084,Irrigation of abdominal cavity,CPT/HCPCS,33139.95,33139.95,3551.53,3551.53,United Healthcare-Medicare Advantage, +148988,3934,49180,"Needle biopsy of abdominal cavity growth, accessed through the skin",CPT/HCPCS,6184.31,6184.31,429.75,12552.8,United Healthcare-Medicare Advantage, +148989,3934,49185,Injection of abnormal fluid accumulation using imaging guidance with radiological supervision and interpretation,CPT/HCPCS,3279.67,3279.67,3800.0,3800.0,United Healthcare-Medicare Advantage, +148990,3934,49250,Removal of navel and surrounding tissue,CPT/HCPCS,8376.0,8376.0,3037.35,3037.35,United Healthcare-Medicare Advantage, +148991,3934,49320,Diagnostic examination of the abdomen using an endoscope,CPT/HCPCS,9658.31,9658.31,1210.61,25277.66,United Healthcare-Medicare Advantage, +148992,3934,49321,Biopsy of abdomen using an endoscope,CPT/HCPCS,13503.82,13503.82,4156.63,20614.63,United Healthcare-Medicare Advantage, +148993,3934,49322,Aspiration of abdominal cavity or cyst using an endoscope,CPT/HCPCS,9535.63,9535.63,2032.44,9215.0,United Healthcare-Medicare Advantage, +148994,3934,49324,Insertion of abdominal cavity catheter using an endoscope,CPT/HCPCS,13315.75,13315.75,4252.68,15440.0,United Healthcare-Medicare Advantage, +148995,3934,49329,Procedure on abdomen using an endoscope,CPT/HCPCS,11800.38,11800.38,2424.0,6056.04,United Healthcare-Medicare Advantage, +148996,3934,49400,Injection of air or X-ray contrast material into abdominal cavity,CPT/HCPCS,2322.0,2322.0,2279.0,4287.0,United Healthcare-Medicare Advantage, +148997,3934,49405,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2267.42,2267.42,687.76,17326.73,United Healthcare-Medicare Advantage, +148998,3934,49406,"Fluid collection drainage by catheter using imaging guidance, accessed through the skin",CPT/HCPCS,2716.57,2716.57,990.76,5932.85,United Healthcare-Medicare Advantage, +148999,3934,49407,"Fluid collection drainage by catheter using imaging guidance, accessed through vagina or rectum",CPT/HCPCS,4112.0,4112.0,679.91,4336.1,United Healthcare-Medicare Advantage, +149000,3934,49419,Insertion of abdominal cavity catheter for drug delivery beneath the skin,CPT/HCPCS,17210.78,17210.78,16760.78,16760.78,United Healthcare-Medicare Advantage, +149001,3934,49422,Removal of abdominal cavity catheter,CPT/HCPCS,5501.67,5501.67,759.17,4035.0,United Healthcare-Medicare Advantage, +149002,3934,49423,Exchange of abdominal cavity drainage catheter using imaging guidance,CPT/HCPCS,2437.55,2437.55,679.91,4859.0,United Healthcare-Medicare Advantage, +149003,3934,49424,Injection of contrast through abdominal cavity catheter for X-ray study,CPT/HCPCS,1331.62,1331.62,45.1,5511.1,United Healthcare-Medicare Advantage, +149004,3934,49427,Injection for X-ray study of shunt from jugular vein to abdominal cavity,CPT/HCPCS,669.75,669.75,61.7,1206.67,United Healthcare-Medicare Advantage, +149005,3934,49440,Insertion of stomach tube (accessed through the skin) using fluoroscopic guidance with contrast,CPT/HCPCS,6081.85,6081.85,1619.6,12188.0,United Healthcare-Medicare Advantage, +149006,3934,49450,"Replacement of stomach or large bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,1801.36,1801.36,651.6,5008.0,United Healthcare-Medicare Advantage, +149007,3934,49451,"Replacement of small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3326.49,3326.49,947.73,4901.0,United Healthcare-Medicare Advantage, +149008,3934,49452,"Replacement of stomach to small bowel tube using fluoroscopic guidance with contrast, accessed through the skin",CPT/HCPCS,3175.68,3175.68,991.35,3310.0,United Healthcare-Medicare Advantage, +149009,3934,49465,"Contrast injections for x-ray imaging through existing tube in stomach, small bowel or large bowel, accessed through the skin",CPT/HCPCS,1296.22,1296.22,136.23,1505.0,United Healthcare-Medicare Advantage, +149010,3934,49491,Repair of groin hernia preterm infant younger than 37 weeks gestation performed from birth to 50 weeks postconception,CPT/HCPCS,7409.45,7409.45,2364.31,2364.31,United Healthcare-Medicare Advantage, +149011,3934,49495,Repair of groin hernia full term infant younger than age 6 months or preterm infant older than 50 weeks postconception age and younger than age 6 months at time of surgery,CPT/HCPCS,12501.5,12501.5,4568.42,4568.42,United Healthcare-Medicare Advantage, +149012,3934,49500,Repair of groin hernia patient age 6 months to younger than 5 years,CPT/HCPCS,6945.89,6945.89,2211.35,8089.0,United Healthcare-Medicare Advantage, +149013,3934,49505,Repair of groin hernia patient age 5 years or older,CPT/HCPCS,11413.39,11413.39,329.38,33061.0,United Healthcare-Medicare Advantage, +149014,3934,49507,Repair of trapped groin hernia patient age 5 years or older,CPT/HCPCS,13287.89,13287.89,3711.35,23428.0,United Healthcare-Medicare Advantage, +149015,3934,49520,Repair of trapped groin hernia,CPT/HCPCS,12444.11,12444.11,4031.45,22423.33,United Healthcare-Medicare Advantage, +149016,3934,49521,Repair of trapped groin hernia,CPT/HCPCS,14805.2,14805.2,17894.0,17894.0,United Healthcare-Medicare Advantage, +149017,3934,49560,Repair of incisional or abdominal hernia,CPT/HCPCS,10450.01,10450.01,2311.88,18751.0,United Healthcare-Medicare Advantage, +149018,3934,49561,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,9794.88,9794.88,3139.29,18693.0,United Healthcare-Medicare Advantage, +149019,3934,49565,Repair of incisional or abdominal hernia,CPT/HCPCS,10261.23,10261.23,3302.48,6039.11,United Healthcare-Medicare Advantage, +149020,3934,49566,Repair of incisional or abdominal hernia,CPT/HCPCS,9284.48,9284.48,5285.03,6684.85,United Healthcare-Medicare Advantage, +149021,3934,49568,"Placement of mesh to repair incisional or abdominal hernia, open procedure",CPT/HCPCS,3063.98,3063.98,1712.0,19116.0,United Healthcare-Medicare Advantage, +149022,3934,49570,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,11408.98,11408.98,9184.29,9846.16,United Healthcare-Medicare Advantage, +149023,3934,49572,Repair of trapped incisional or abdominal hernia,CPT/HCPCS,7883.7,7883.7,1826.45,8208.45,United Healthcare-Medicare Advantage, +149024,3934,49580,Repair of hernia at navel patient younger than age 5 years,CPT/HCPCS,7145.33,7145.33,15.0,9312.0,United Healthcare-Medicare Advantage, +149025,3934,49585,Repair of hernia at navel patient age 5 years or older,CPT/HCPCS,8842.85,8842.85,1433.27,21958.0,United Healthcare-Medicare Advantage, +149026,3934,49587,Repair of trapped hernia at navel patient age 5 years or older,CPT/HCPCS,9181.67,9181.67,2597.19,10717.58,United Healthcare-Medicare Advantage, +149027,3934,49590,Repair of hernia between abdominal muscles,CPT/HCPCS,10330.62,10330.62,4356.0,4356.0,United Healthcare-Medicare Advantage, +149028,3934,49600,Repair of fluid accumulation at navel,CPT/HCPCS,9706.0,9706.0,2946.33,2946.33,United Healthcare-Medicare Advantage, +149029,3934,49650,Repair of groin hernia using an endoscope,CPT/HCPCS,14055.43,14055.43,3092.1,33769.0,United Healthcare-Medicare Advantage, +149030,3934,49652,Repair of hernia using an endoscope,CPT/HCPCS,14988.14,14988.14,3283.12,30164.83,United Healthcare-Medicare Advantage, +149031,3934,49653,Repair of trapped hernia using an endoscope,CPT/HCPCS,15590.45,15590.45,5277.74,19218.97,United Healthcare-Medicare Advantage, +149032,3934,49654,Repair of incisional hernia using an endoscope,CPT/HCPCS,12583.47,12583.47,6604.79,14042.77,United Healthcare-Medicare Advantage, +149033,3934,49655,Repair of trapped incisional hernia using an endoscope,CPT/HCPCS,17742.58,17742.58,4255.68,30060.0,United Healthcare-Medicare Advantage, +149034,3934,49656,Repair of incisional hernia using an endoscope,CPT/HCPCS,19016.34,19016.34,4278.03,17307.5,United Healthcare-Medicare Advantage, +149035,3934,49659,Hernia repair procedure using an endoscope,CPT/HCPCS,11776.98,11776.98,13414.22,13414.22,United Healthcare-Medicare Advantage, +149036,3934,49999,Abdominal procedure,CPT/HCPCS,1678.94,1678.94,782.0,4356.0,United Healthcare-Medicare Advantage, +149037,3934,50081,"Removal or crushing kidney stone (over 2 centimeters) or insert kidney stent using an endoscope, accessed through the skin",CPT/HCPCS,16571.53,16571.53,1573.89,8869.82,United Healthcare-Medicare Advantage, +149038,3934,50200,"Needle biopsy of kidney, accessed through the skin",CPT/HCPCS,2868.29,2868.29,632.19,64285.0,United Healthcare-Medicare Advantage, +149039,3934,50382,"Removal and replacement of indwelling stent in urinary duct (ureter) including radiological supervision and interpretation, accessed through the skin",CPT/HCPCS,4582.25,4582.25,2956.23,6697.0,United Healthcare-Medicare Advantage, +149040,3934,50387,Removal and replacement of stent in kidney and urinary duct (ureter) using fluoroscopic guidance including radiological supervision and interpretation,CPT/HCPCS,3005.63,3005.63,1634.0,4822.0,United Healthcare-Medicare Advantage, +149041,3934,50389,Removal of kidney drainage tube (ureter) using fluoroscopic guidance,CPT/HCPCS,1996.08,1996.08,674.24,1579.75,United Healthcare-Medicare Advantage, +149042,3934,50390,"Aspiration and/or injection kidney cyst, accessed through the skin",CPT/HCPCS,2164.33,2164.33,741.75,4356.0,United Healthcare-Medicare Advantage, +149043,3934,50431,Injection procedure for x-ray imaging of kidney and urinary duct (ureter) using imaging guidance including radiological supervision and interpretation,CPT/HCPCS,2585.4,2585.4,163.48,8301.0,United Healthcare-Medicare Advantage, +149044,3934,50432,"Placement of catheter of kidney, accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,3731.63,3731.63,1077.36,5089.02,United Healthcare-Medicare Advantage, +149045,3934,50433,"Placement of catheter of kidney and urinary tube (ureter), accessed through the skin using imaging guidance with radiological supervision and interpretation",CPT/HCPCS,10864.06,10864.06,10635.42,10635.42,United Healthcare-Medicare Advantage, +149046,3934,50434,Conversion of nephrostomy catheter to nephroureteral catheter accessed through the skin using imaging guidance with study of kidney and ureter and radiological supervision and interpretation,CPT/HCPCS,5076.48,5076.48,3337.0,10812.88,United Healthcare-Medicare Advantage, +149047,3934,50435,Replacement of kidney drainage catheter accessed through the skin with imaging and radiological supervision and interpretation,CPT/HCPCS,2399.31,2399.31,700.0,5612.0,United Healthcare-Medicare Advantage, +149048,3934,50544,Repair of kidney using an endoscope,CPT/HCPCS,39304.21,39304.21,11894.5,11902.79,United Healthcare-Medicare Advantage, +149049,3934,50549,Kidney procedure using an endoscope,CPT/HCPCS,13665.94,13665.94,9012.0,9012.0,United Healthcare-Medicare Advantage, +149050,3934,50553,Insertion of catheter into urinary duct (ureter) using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,4390.4,4390.4,892.57,895.39,United Healthcare-Medicare Advantage, +149051,3934,50555,Kidney biopsy using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,14442.46,14442.46,9774.3,9774.3,United Healthcare-Medicare Advantage, +149052,3934,50561,Removal of kidney foreign body or stone using an endoscopy which is inserted through an already created kidney opening,CPT/HCPCS,9031.1,9031.1,1784.5,1784.5,United Healthcare-Medicare Advantage, +149053,3934,50590,Shock wave crushing of kidney stones,CPT/HCPCS,14258.44,14258.44,1606.21,15270.0,United Healthcare-Medicare Advantage, +149054,3934,50592,"Destruction of 1 or more growths in one kidney, accessed through the skin",CPT/HCPCS,17952.5,17952.5,2772.0,4018.0,United Healthcare-Medicare Advantage, +149055,3934,50593,"Destruction of growths in one kidney, accessed through the skin",CPT/HCPCS,13953.56,13953.56,6639.0,26683.48,United Healthcare-Medicare Advantage, +149056,3934,50690,Injection of bladder and urinary duct (ureter) for X-ray imaging,CPT/HCPCS,4454.92,4454.92,4718.33,4718.33,United Healthcare-Medicare Advantage, +149057,3934,50693,"Placement of stent of urinary duct (ureter), accessed through the skin with imaging including radiological supervision and interpretation",CPT/HCPCS,5507.96,5507.96,5030.54,8449.08,United Healthcare-Medicare Advantage, +149058,3934,51040,Incision of bladder with drainage,CPT/HCPCS,8513.88,8513.88,3321.0,17894.0,United Healthcare-Medicare Advantage, +149059,3934,51050,Incision of bladder with removal of bladder stone,CPT/HCPCS,14134.92,14134.92,14134.92,14134.92,United Healthcare-Medicare Advantage, +149060,3934,51102,Aspiration of bladder with insertion of bladder tube to skin surface,CPT/HCPCS,7233.19,7233.19,3135.94,11910.0,United Healthcare-Medicare Advantage, +149061,3934,51500,Repair of congenital bladder defect,CPT/HCPCS,24314.0,24314.0,2614.22,4207.65,United Healthcare-Medicare Advantage, +149062,3934,51600,Injection procedure for X-ray imaging of the bladder or during voiding,CPT/HCPCS,2293.6,2293.6,494.84,3085.33,United Healthcare-Medicare Advantage, +149063,3934,51610,Injection procedure through the bladder and bladder canal (urethra) for X-ray imaging,CPT/HCPCS,2895.2,2895.2,1998.0,5795.0,United Healthcare-Medicare Advantage, +149064,3934,51700,Bladder irrigation and/or instillation,CPT/HCPCS,1582.9,1582.9,532.37,2185.0,United Healthcare-Medicare Advantage, +149065,3934,51701,Insertion of temporary bladder catheter,CPT/HCPCS,337.18,337.18,61.72,630.59,United Healthcare-Medicare Advantage, +149066,3934,51702,Insertion of indwelling bladder catheter,CPT/HCPCS,296.94,296.94,29.11,4176.0,United Healthcare-Medicare Advantage, +149067,3934,51703,Insertion of indwelling bladder catheter,CPT/HCPCS,3066.94,3066.94,169.2,378.0,United Healthcare-Medicare Advantage, +149068,3934,51705,Removal of skin suture with change of bladder tube,CPT/HCPCS,1143.02,1143.02,277.91,4568.67,United Healthcare-Medicare Advantage, +149069,3934,51710,Removal of suture around skin surface tube with change of bladder tube,CPT/HCPCS,3036.44,3036.44,417.02,3996.0,United Healthcare-Medicare Advantage, +149070,3934,51715,Injection or implant of synthetic material into bladder and/or bladder canal (urethra) using an endoscope,CPT/HCPCS,4548.78,4548.78,1186.77,6303.0,United Healthcare-Medicare Advantage, +149071,3934,51720,"Bladder instillation of cancer preventive, inhibiting, or suppressive agent",CPT/HCPCS,2639.72,2639.72,278.58,6236.58,United Healthcare-Medicare Advantage, +149072,3934,51728,Insertion of electronic device into bladder with voiding pressure studies,CPT/HCPCS,2389.04,2389.04,270.46,2396.0,United Healthcare-Medicare Advantage, +149073,3934,51729,Insertion of electronic device into bladder with voiding and bladder canal (urethra) pressure studies,CPT/HCPCS,3332.73,3332.73,341.5,3611.0,United Healthcare-Medicare Advantage, +149074,3934,51736,Timed assessment of bladder emptying,CPT/HCPCS,347.0,347.0,347.0,347.0,United Healthcare-Medicare Advantage, +149075,3934,51741,Electronic assessment of bladder emptying,CPT/HCPCS,568.53,568.53,85.51,889.36,United Healthcare-Medicare Advantage, +149076,3934,51784,Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings,CPT/HCPCS,968.22,968.22,48.9,1047.0,United Healthcare-Medicare Advantage, +149077,3934,51797,Insertion of device into the abdomen with measurement of pressure and urine flow rate,CPT/HCPCS,504.94,504.94,25.5,546.0,United Healthcare-Medicare Advantage, +149078,3934,51798,Ultrasound measurement of bladder capacity after voiding,CPT/HCPCS,205.23,205.23,12.48,463.59,United Healthcare-Medicare Advantage, +149079,3934,51860,"Suture of wound, injury, or rupture of the bladder",CPT/HCPCS,11982.59,11982.59,4722.9,7269.98,United Healthcare-Medicare Advantage, +149080,3934,52000,Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,2918.2,2918.2,247.5,10680.0,United Healthcare-Medicare Advantage, +149081,3934,52001,Irrigation and removal of multiple blood clots from bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6591.22,6591.22,9499.48,9499.48,United Healthcare-Medicare Advantage, +149082,3934,52005,Insertion of catheter into urinary duct (ureter) using an endoscope,CPT/HCPCS,6429.41,6429.41,887.71,23730.0,United Healthcare-Medicare Advantage, +149083,3934,52204,Biopsy of the bladder using an endoscope,CPT/HCPCS,7888.1,7888.1,791.81,32031.0,United Healthcare-Medicare Advantage, +149084,3934,52214,"Destruction of tissue in the bladder, bladder canal (urethra) or surrounding glands using an endoscope",CPT/HCPCS,9141.52,9141.52,5172.33,12145.0,United Healthcare-Medicare Advantage, +149085,3934,52224,Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,6895.82,6895.82,1777.36,14604.0,United Healthcare-Medicare Advantage, +149086,3934,52234,Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endoscope,CPT/HCPCS,7220.23,7220.23,1320.83,19442.0,United Healthcare-Medicare Advantage, +149087,3934,52235,Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder canal (urethra) using an endoscope,CPT/HCPCS,7502.89,7502.89,1258.43,16667.0,United Healthcare-Medicare Advantage, +149088,3934,52240,Destruction and/or removal of large growths of the bladder using an endoscope,CPT/HCPCS,9602.61,9602.61,2319.9,24492.0,United Healthcare-Medicare Advantage, +149089,3934,52260,Dilation of the bladder using an endoscope under general or spinal anesthesia,CPT/HCPCS,5567.04,5567.04,1846.24,4356.0,United Healthcare-Medicare Advantage, +149090,3934,52275,"Incision of the bladder canal (urethra) using an endoscope, male",CPT/HCPCS,5973.42,5973.42,5973.42,5973.42,United Healthcare-Medicare Advantage, +149091,3934,52276,Incision of the bladder canal (urethra) using an endoscope,CPT/HCPCS,6457.98,6457.98,3062.0,11188.0,United Healthcare-Medicare Advantage, +149092,3934,52281,Dilation of bladder canal (urethra) using an endoscope,CPT/HCPCS,7817.81,7817.81,662.98,23001.0,United Healthcare-Medicare Advantage, +149093,3934,52283,Steroid injection into bladder canal (urethra) stricture using an endoscope,CPT/HCPCS,6687.04,6687.04,3934.67,3934.67,United Healthcare-Medicare Advantage, +149094,3934,52285,Examination of bladder and bladder canal (urethra) for treatment of female urethral syndrome using an endoscope,CPT/HCPCS,7026.96,7026.96,6975.27,6975.27,United Healthcare-Medicare Advantage, +149095,3934,52287,Examination with injections of chemical for destruction of bladder using an endoscope,CPT/HCPCS,6604.02,6604.02,2612.0,12807.0,United Healthcare-Medicare Advantage, +149096,3934,52300,Removal or destruction of abnormal pouches of urinary duct (ureter) at bladder using an endoscope,CPT/HCPCS,8463.0,8463.0,5511.1,5511.1,United Healthcare-Medicare Advantage, +149097,3934,52310,"Removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,3516.68,3516.68,177.96,13172.0,United Healthcare-Medicare Advantage, +149098,3934,52315,"Complicated removal of foreign body, stone, or stent from bladder canal (urethra) or bladder using an endoscope",CPT/HCPCS,7762.89,7762.89,3554.67,3554.67,United Healthcare-Medicare Advantage, +149099,3934,52317,"Crushing, fragmenting, and removal of (less than 2.5 centimeters) bladder stone",CPT/HCPCS,7218.15,7218.15,3171.5,14023.67,United Healthcare-Medicare Advantage, +149100,3934,52318,"Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters",CPT/HCPCS,8949.23,8949.23,2527.16,32159.0,United Healthcare-Medicare Advantage, +149101,3934,52320,Removal of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,6236.0,6236.0,1846.24,3629.7,United Healthcare-Medicare Advantage, +149102,3934,52327,Injection of implant material in bladder using an endoscope,CPT/HCPCS,9578.2,9578.2,5229.14,5229.14,United Healthcare-Medicare Advantage, +149103,3934,52332,Insertion of stent in urinary duct (ureter) using an endoscope,CPT/HCPCS,6451.89,6451.89,237.67,31936.15,United Healthcare-Medicare Advantage, +149104,3934,52341,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,7785.6,7785.6,3733.0,28661.12,United Healthcare-Medicare Advantage, +149105,3934,52344,Treatment of stricture in urinary duct (ureter) using an endoscope,CPT/HCPCS,10553.56,10553.56,4570.43,15054.33,United Healthcare-Medicare Advantage, +149106,3934,52345,Treatment of kidney stricture using an endoscope,CPT/HCPCS,11483.33,11483.33,4370.67,6534.0,United Healthcare-Medicare Advantage, +149107,3934,52351,"Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope",CPT/HCPCS,6394.23,6394.23,958.75,17308.0,United Healthcare-Medicare Advantage, +149108,3934,52352,Removal or manipulation of stone in urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,8560.9,8560.9,2992.0,21309.67,United Healthcare-Medicare Advantage, +149109,3934,52353,Crushing of stone in urinary duct (ureter) using an endoscope,CPT/HCPCS,10518.5,10518.5,7512.0,17955.33,United Healthcare-Medicare Advantage, +149110,3934,52354,Biopsy and/or destruction of growth of urinary duct (ureter) or kidney using an endoscope,CPT/HCPCS,11507.29,11507.29,2936.86,26011.0,United Healthcare-Medicare Advantage, +149111,3934,52356,Crushing of stone in urinary duct (ureter) with stent using an endoscope,CPT/HCPCS,11073.36,11073.36,591.98,29343.0,United Healthcare-Medicare Advantage, +149112,3934,52441,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,818.81,818.81,488.65,5511.1,United Healthcare-Medicare Advantage, +149113,3934,52442,Insertion of implant in bladder canal (urethra) within prostate gland using an endoscope,CPT/HCPCS,369.05,369.05,1377.78,4544.0,United Healthcare-Medicare Advantage, +149114,3934,52500,Removal of bladder neck through bladder canal (urethra),CPT/HCPCS,3515.53,3515.53,1938.0,3729.94,United Healthcare-Medicare Advantage, +149115,3934,52601,Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope,CPT/HCPCS,12251.49,12251.49,1510.34,25596.0,United Healthcare-Medicare Advantage, +149116,3934,52630,Removal of remaining or regrown prostate tissue with control of bleeding using an endoscope,CPT/HCPCS,10702.94,10702.94,4459.9,23674.0,United Healthcare-Medicare Advantage, +149117,3934,52648,Laser vaporization of prostate including control of bleeding using an endoscope,CPT/HCPCS,10985.96,10985.96,2281.4,26346.0,United Healthcare-Medicare Advantage, +149118,3934,53020,Incision of external urinary opening,CPT/HCPCS,5201.92,5201.92,1382.98,4740.21,United Healthcare-Medicare Advantage, +149119,3934,53230,Removal of pouch of female bladder canal (urethra),CPT/HCPCS,24225.5,24225.5,3996.0,3996.0,United Healthcare-Medicare Advantage, +149120,3934,53265,Removal or destruction of growth of bladder canal (urethra),CPT/HCPCS,8604.53,8604.53,2648.97,2968.77,United Healthcare-Medicare Advantage, +149121,3934,53410,"Reconstruction of bladder canal (urethra), male",CPT/HCPCS,21100.53,21100.53,3996.0,3996.0,United Healthcare-Medicare Advantage, +149122,3934,53445,Insertion of inflatable bladder canal (urethra) or bladder neck sphincter,CPT/HCPCS,16293.71,16293.71,2171.48,27085.16,United Healthcare-Medicare Advantage, +149123,3934,53450,Repair of bladder canal (urethra) and urinary opening,CPT/HCPCS,5205.08,5205.08,2486.77,7822.46,United Healthcare-Medicare Advantage, +149124,3934,53460,Repair and partial removal of bladder canal (urethra) and urinary opening,CPT/HCPCS,3979.77,3979.77,2530.6,3598.5,United Healthcare-Medicare Advantage, +149125,3934,53600,"Dilation of narrowing of bladder canal (urethra), male",CPT/HCPCS,4908.73,4908.73,417.76,417.76,United Healthcare-Medicare Advantage, +149126,3934,53605,"Dilation of narrowing of bladder canal (urethra) under general or spinal anesthesia, male",CPT/HCPCS,11106.0,11106.0,5004.5,5004.5,United Healthcare-Medicare Advantage, +149127,3934,53899,Urinary system procedure,CPT/HCPCS,4555.43,4555.43,2601.0,2908.0,United Healthcare-Medicare Advantage, +149128,3934,54001,Incision of penile foreskin,CPT/HCPCS,9659.0,9659.0,9659.0,9659.0,United Healthcare-Medicare Advantage, +149129,3934,54055,Destruction of penile growths using electric current,CPT/HCPCS,5258.67,5258.67,1866.96,1866.96,United Healthcare-Medicare Advantage, +149130,3934,54057,Laser destruction of growths of penis,CPT/HCPCS,4482.0,4482.0,1125.28,3360.0,United Healthcare-Medicare Advantage, +149131,3934,54060,Excisional destruction of penile growths,CPT/HCPCS,5458.04,5458.04,3329.63,5140.9,United Healthcare-Medicare Advantage, +149132,3934,54065,Destruction of multiple penile growths,CPT/HCPCS,7001.83,7001.83,2272.0,4287.0,United Healthcare-Medicare Advantage, +149133,3934,54100,Biopsy of penis,CPT/HCPCS,5838.25,5838.25,6273.0,6273.0,United Healthcare-Medicare Advantage, +149134,3934,54111,Removal of abnormally thickened tissue in penis with up to 5 centimeter graft,CPT/HCPCS,23816.45,23816.45,5723.5,27963.0,United Healthcare-Medicare Advantage, +149135,3934,54112,Removal of abnormally thickened tissue in penis with greater than 5 centimeter graft,CPT/HCPCS,21108.54,21108.54,9558.0,9558.0,United Healthcare-Medicare Advantage, +149136,3934,54120,Partial amputation of penis,CPT/HCPCS,18395.09,18395.09,3478.42,3478.42,United Healthcare-Medicare Advantage, +149137,3934,54161,"Removal of foreskin, patient older than 28 days of age",CPT/HCPCS,7484.29,7484.29,762.99,12411.0,United Healthcare-Medicare Advantage, +149138,3934,54162,Removal of scar tissue following penile foreskin removal,CPT/HCPCS,4736.26,4736.26,2007.69,7116.0,United Healthcare-Medicare Advantage, +149139,3934,54163,Repair of incomplete removal of penile foreskin,CPT/HCPCS,6615.94,6615.94,2432.23,7116.0,United Healthcare-Medicare Advantage, +149140,3934,54220,Injection of drug into erectile tissue at sides and back of penis,CPT/HCPCS,667.33,667.33,317.86,1949.0,United Healthcare-Medicare Advantage, +149141,3934,54235,Injection procedure to induce erection,CPT/HCPCS,4005.6,4005.6,317.86,3975.33,United Healthcare-Medicare Advantage, +149142,3934,54300,Repair of curvature of penis,CPT/HCPCS,7903.6,7903.6,1649.59,6827.31,United Healthcare-Medicare Advantage, +149143,3934,54304,Repair of curvature and urinary outlet of penis,CPT/HCPCS,8080.75,8080.75,504.79,4287.0,United Healthcare-Medicare Advantage, +149144,3934,54322,Repair of urinary outlet of penis,CPT/HCPCS,7776.0,7776.0,1173.35,1173.35,United Healthcare-Medicare Advantage, +149145,3934,54324,Repair of urinary outlet of penis with skin flap,CPT/HCPCS,13692.54,13692.54,1125.28,1204.5,United Healthcare-Medicare Advantage, +149146,3934,54326,Repair of urinary outlet at underside of penis with skin flap,CPT/HCPCS,12702.38,12702.38,1125.28,5461.0,United Healthcare-Medicare Advantage, +149147,3934,54328,Repair of urinary outlet at underside of penis with skin graft and/or flap,CPT/HCPCS,10612.88,10612.88,4544.0,4544.0,United Healthcare-Medicare Advantage, +149148,3934,54332,Repair of urinary outlet at underside of penis with skin graft or flap,CPT/HCPCS,14011.0,14011.0,1173.35,1173.35,United Healthcare-Medicare Advantage, +149149,3934,54340,Repair of urinary outlet of penis,CPT/HCPCS,8748.0,8748.0,1125.28,1125.28,United Healthcare-Medicare Advantage, +149150,3934,54360,Reconstructive surgery to correct angle penis,CPT/HCPCS,8848.82,8848.82,4287.0,4287.0,United Healthcare-Medicare Advantage, +149151,3934,54400,Insertion of non-inflatable penile prosthesis,CPT/HCPCS,11939.34,11939.34,8668.67,15210.0,United Healthcare-Medicare Advantage, +149152,3934,54405,Insertion of multi-component inflatable penile prosthesis,CPT/HCPCS,32179.09,32179.09,6827.93,61539.0,United Healthcare-Medicare Advantage, +149153,3934,54406,Removal of all components of inflatable penile prosthesis,CPT/HCPCS,14453.11,14453.11,10932.33,10932.33,United Healthcare-Medicare Advantage, +149154,3934,54410,Removal and replacement of all components of a multi-component inflatable penile prosthesis at same surgery,CPT/HCPCS,49687.67,49687.67,16410.8,56978.0,United Healthcare-Medicare Advantage, +149155,3934,54437,Repair of penis,CPT/HCPCS,17286.5,17286.5,1311.0,6440.65,United Healthcare-Medicare Advantage, +149156,3934,54440,Plastic repair of penile injury,CPT/HCPCS,16278.11,16278.11,16278.11,16278.11,United Healthcare-Medicare Advantage, +149157,3934,54450,Repositioning of foreskin including scar tissue removal,CPT/HCPCS,2064.75,2064.75,3892.0,4287.0,United Healthcare-Medicare Advantage, +149158,3934,54505,Incisional biopsy of testis (testicle),CPT/HCPCS,13121.77,13121.77,3805.0,3805.0,United Healthcare-Medicare Advantage, +149159,3934,54512,Excision of testis (testicle) lesion,CPT/HCPCS,6018.49,6018.49,5008.0,7308.0,United Healthcare-Medicare Advantage, +149160,3934,54520,Removal of testis (testicle),CPT/HCPCS,10218.17,10218.17,3063.59,16942.0,United Healthcare-Medicare Advantage, +149161,3934,54530,Removal of one testis (testicle) for tumor,CPT/HCPCS,12739.37,12739.37,1719.28,21017.18,United Healthcare-Medicare Advantage, +149162,3934,54600,Repair of twisted testicle,CPT/HCPCS,13442.44,13442.44,3431.33,9310.87,United Healthcare-Medicare Advantage, +149163,3934,54620,Anchoring of opposite testicle to other testicle,CPT/HCPCS,15153.06,15153.06,3296.8,3296.8,United Healthcare-Medicare Advantage, +149164,3934,54640,Repositioning and fixation of misplaced testicle,CPT/HCPCS,7889.18,7889.18,1429.05,10690.99,United Healthcare-Medicare Advantage, +149165,3934,54690,Removal of one or both testicles using an endoscope,CPT/HCPCS,10086.0,10086.0,1125.28,8268.0,United Healthcare-Medicare Advantage, +149166,3934,54692,Removal of congenital malpositioned testicle using an endoscope,CPT/HCPCS,11920.23,11920.23,1125.28,1125.28,United Healthcare-Medicare Advantage, +149167,3934,54700,"Incision and drainage of sperm reservoir, testis, and/or scrotal area",CPT/HCPCS,6941.0,6941.0,7176.0,7176.0,United Healthcare-Medicare Advantage, +149168,3934,54830,Removal of sperm duct growth,CPT/HCPCS,7986.13,7986.13,999.0,5041.0,United Healthcare-Medicare Advantage, +149169,3934,54840,Removal of fluid accumulation in sperm reservoir,CPT/HCPCS,8585.4,8585.4,1572.79,5110.2,United Healthcare-Medicare Advantage, +149170,3934,55040,Removal of fluid accumulation in one testicle and sperm reservoir,CPT/HCPCS,8376.94,8376.94,1481.8,20429.0,United Healthcare-Medicare Advantage, +149171,3934,55041,Removal of fluid accumulation in both testicles and sperm reservoirs,CPT/HCPCS,10019.89,10019.89,2649.76,8377.62,United Healthcare-Medicare Advantage, +149172,3934,55060,Repair of fluid accumulation in testicle and sperm reservoir,CPT/HCPCS,8188.25,8188.25,12021.0,12021.0,United Healthcare-Medicare Advantage, +149173,3934,55100,Incision and drainage of abscess in scrotal sac of testicle,CPT/HCPCS,3997.79,3997.79,1431.14,2484.0,United Healthcare-Medicare Advantage, +149174,3934,55110,Exploration of the scrotal sac of testicle,CPT/HCPCS,10686.33,10686.33,3656.96,4544.0,United Healthcare-Medicare Advantage, +149175,3934,55175,Repair of the scrotum,CPT/HCPCS,8368.0,8368.0,1503.59,1503.59,United Healthcare-Medicare Advantage, +149176,3934,55250,Removal of sperm duct,CPT/HCPCS,6211.94,6211.94,3998.96,9518.19,United Healthcare-Medicare Advantage, +149177,3934,55500,Removal of fluid accumulation in one spermatic cord,CPT/HCPCS,16754.2,16754.2,4356.0,4356.0,United Healthcare-Medicare Advantage, +149178,3934,55520,Removal of spermatic cord growth,CPT/HCPCS,7766.88,7766.88,769.5,769.5,United Healthcare-Medicare Advantage, +149179,3934,55530,Removal of spermatic cord venous dilation or tying of spermatic veins,CPT/HCPCS,12569.82,12569.82,486.29,6828.0,United Healthcare-Medicare Advantage, +149180,3934,55700,Biopsy of prostate gland,CPT/HCPCS,5887.84,5887.84,837.63,12248.0,United Healthcare-Medicare Advantage, +149181,3934,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,CPT/HCPCS,54716.68,54716.68,21033.67,21033.67,United Healthcare-Medicare Advantage, +149182,3934,55873,Destruction of prostate gland using ultrasound guidance,CPT/HCPCS,27156.14,27156.14,19199.17,28576.0,United Healthcare-Medicare Advantage, +149183,3934,55874,Injection of biodegradable material next to prostate,CPT/HCPCS,19729.69,19729.69,7156.91,20601.0,United Healthcare-Medicare Advantage, +149184,3934,55875,Insertion of needles or catheters into prostate for radiation therapy,CPT/HCPCS,7345.5,7345.5,5126.61,6483.12,United Healthcare-Medicare Advantage, +149185,3934,55876,Insertion of radiation therapy devices in prostate gland for radiation therapy guidance,CPT/HCPCS,4431.84,4431.84,257.18,4700.0,United Healthcare-Medicare Advantage, +149186,3934,55899,Male genital system procedure,CPT/HCPCS,8987.78,8987.78,2706.79,4052.0,United Healthcare-Medicare Advantage, +149187,3934,56405,Incision and drainage of female genitals abscess,CPT/HCPCS,1637.71,1637.71,152.9,1839.0,United Healthcare-Medicare Advantage, +149188,3934,56420,Incision and drainage of female genital gland abscess,CPT/HCPCS,1098.82,1098.82,111.19,377.25,United Healthcare-Medicare Advantage, +149189,3934,56440,Creation of drainage tract for female genital gland or cyst,CPT/HCPCS,2814.38,2814.38,1443.37,5461.0,United Healthcare-Medicare Advantage, +149190,3934,56441,Removal of external female genital scar tissue,CPT/HCPCS,8928.74,8928.74,1567.47,1567.47,United Healthcare-Medicare Advantage, +149191,3934,56501,Destruction of external female genital growths,CPT/HCPCS,5882.46,5882.46,3055.0,7771.0,United Healthcare-Medicare Advantage, +149192,3934,56515,Destruction of extensive growths of external female genitals,CPT/HCPCS,7061.03,7061.03,1443.37,4918.42,United Healthcare-Medicare Advantage, +149193,3934,56605,Biopsy of external female genitals,CPT/HCPCS,1915.55,1915.55,73.9,2803.5,United Healthcare-Medicare Advantage, +149194,3934,56606,Biopsy of external female genitals,CPT/HCPCS,1224.98,1224.98,36.33,1401.75,United Healthcare-Medicare Advantage, +149195,3934,56620,Partial removal of external female genitals,CPT/HCPCS,7802.09,7802.09,3622.52,10802.25,United Healthcare-Medicare Advantage, +149196,3934,56625,Removal of external female genitals,CPT/HCPCS,11717.33,11717.33,14710.0,14710.0,United Healthcare-Medicare Advantage, +149197,3934,56630,Partial removal of external female genitals,CPT/HCPCS,6742.84,6742.84,5346.39,5346.39,United Healthcare-Medicare Advantage, +149198,3934,56700,"Partial removal of membrane at uterine opening, open procedure",CPT/HCPCS,6073.0,6073.0,3996.0,5731.46,United Healthcare-Medicare Advantage, +149199,3934,56740,Removal of female genital gland or cyst,CPT/HCPCS,11342.8,11342.8,715.0,5461.0,United Healthcare-Medicare Advantage, +149200,3934,56800,Plastic repair of uterine opening,CPT/HCPCS,32643.36,32643.36,8794.78,8794.78,United Healthcare-Medicare Advantage, +149201,3934,57023,Incision and drainage of vaginal blood accumulation,CPT/HCPCS,23890.3,23890.3,10391.0,10391.0,United Healthcare-Medicare Advantage, +149202,3934,57061,Destruction of vaginal growths,CPT/HCPCS,6286.89,6286.89,3322.0,4844.17,United Healthcare-Medicare Advantage, +149203,3934,57100,Biopsy of vaginal mucous membrane,CPT/HCPCS,7765.61,7765.61,4559.0,13673.0,United Healthcare-Medicare Advantage, +149204,3934,57106,Partial removal of vaginal wall,CPT/HCPCS,8393.3,8393.3,4544.0,4544.0,United Healthcare-Medicare Advantage, +149205,3934,57120,Suture closure of the vagina and vaginal opening,CPT/HCPCS,21532.56,21532.56,21384.56,34964.31,United Healthcare-Medicare Advantage, +149206,3934,57130,Removal of abnormal tissue dividing the vagina,CPT/HCPCS,5362.68,5362.68,4356.0,4356.0,United Healthcare-Medicare Advantage, +149207,3934,57135,Excision of vaginal cyst or tumor,CPT/HCPCS,6770.32,6770.32,1584.2,4038.6,United Healthcare-Medicare Advantage, +149208,3934,57155,Insertion of radiation therapy devices in uterus for radiation therapy,CPT/HCPCS,6399.13,6399.13,1494.03,6115.38,United Healthcare-Medicare Advantage, +149209,3934,57156,Insertion of radiation therapy devices in vagina for radiation therapy,CPT/HCPCS,8549.92,8549.92,1112.94,8913.0,United Healthcare-Medicare Advantage, +149210,3934,57200,Suture of non-obstetrical vaginal injury,CPT/HCPCS,8673.77,8673.77,467.0,5041.0,United Healthcare-Medicare Advantage, +149211,3934,57210,Suture of non-obstetrical injury of the vagina and/or skin,CPT/HCPCS,13289.56,13289.56,3596.0,4544.0,United Healthcare-Medicare Advantage, +149212,3934,57240,Repair of herniation of bladder into vaginal wall,CPT/HCPCS,11179.93,11179.93,1307.89,27364.89,United Healthcare-Medicare Advantage, +149213,3934,57250,Repair of herniated rectum into vaginal wall,CPT/HCPCS,12453.69,12453.69,3107.17,26757.58,United Healthcare-Medicare Advantage, +149214,3934,57260,"Plastic repair of vagina and tissue separating vagina, rectum, and bladder",CPT/HCPCS,17263.51,17263.51,2025.62,40665.28,United Healthcare-Medicare Advantage, +149215,3934,57280,Attachment of vagina to rear pelvic bone (sacrum),CPT/HCPCS,13446.42,13446.42,7920.0,7920.0,United Healthcare-Medicare Advantage, +149216,3934,57282,Vaginal repair of pelvic ligaments,CPT/HCPCS,12691.98,12691.98,2989.52,25744.94,United Healthcare-Medicare Advantage, +149217,3934,57284,"Repair through abdomen of vaginal wall defect, open procedure",CPT/HCPCS,29139.5,29139.5,7520.54,7520.54,United Healthcare-Medicare Advantage, +149218,3934,57285,Repair through the vagina of vaginal wall defect,CPT/HCPCS,8026.5,8026.5,6793.5,6944.0,United Healthcare-Medicare Advantage, +149219,3934,57287,Removal or revision of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,9466.53,9466.53,4759.77,7813.53,United Healthcare-Medicare Advantage, +149220,3934,57288,Creation of sling around bladder canal (urethra) to control leakage,CPT/HCPCS,13958.88,13958.88,1064.7,30148.28,United Healthcare-Medicare Advantage, +149221,3934,57300,Closure of abnormal drainage tract from rectum into vagina,CPT/HCPCS,12483.87,12483.87,4800.7,4800.7,United Healthcare-Medicare Advantage, +149222,3934,57410,Pelvic examination under anesthesia,CPT/HCPCS,4282.41,4282.41,1312.97,5748.0,United Healthcare-Medicare Advantage, +149223,3934,57420,Examination of the vagina using an endoscope,CPT/HCPCS,6956.01,6956.01,1765.59,12131.83,United Healthcare-Medicare Advantage, +149224,3934,57421,Biopsy of vagina and cervix using an endoscope,CPT/HCPCS,3429.0,3429.0,636.26,8455.0,United Healthcare-Medicare Advantage, +149225,3934,57425,Vaginal defect repair using an endoscope,CPT/HCPCS,20726.0,20726.0,14730.54,20714.14,United Healthcare-Medicare Advantage, +149226,3934,57452,Examination of the vagina and cervix using an endoscope,CPT/HCPCS,735.33,735.33,408.46,973.0,United Healthcare-Medicare Advantage, +149227,3934,57454,Biopsy and scraping of the cervix using an endoscope,CPT/HCPCS,943.63,943.63,152.83,2112.0,United Healthcare-Medicare Advantage, +149228,3934,57456,Scraping of the cervix using an endoscope,CPT/HCPCS,1324.67,1324.67,6903.0,6903.0,United Healthcare-Medicare Advantage, +149229,3934,57460,Biopsy of cervix using an endoscope,CPT/HCPCS,5942.0,5942.0,6715.0,11256.0,United Healthcare-Medicare Advantage, +149230,3934,57461,Cone biopsy of the cervix and vagina using an endoscope,CPT/HCPCS,6840.86,6840.86,646.66,11739.0,United Healthcare-Medicare Advantage, +149231,3934,57500,Biopsy of cervix or excision of local growths,CPT/HCPCS,2186.11,2186.11,636.26,743.45,United Healthcare-Medicare Advantage, +149232,3934,57505,Scraping of tissue of cervix,CPT/HCPCS,2876.0,2876.0,636.26,636.26,United Healthcare-Medicare Advantage, +149233,3934,57511,Freezing destruction of cervix,CPT/HCPCS,590.87,590.87,172.49,639.45,United Healthcare-Medicare Advantage, +149234,3934,57513,Laser destruction of cervix,CPT/HCPCS,4793.16,4793.16,6082.32,6082.32,United Healthcare-Medicare Advantage, +149235,3934,57520,Removal or destruction of cervix,CPT/HCPCS,8006.61,8006.61,2684.55,9018.24,United Healthcare-Medicare Advantage, +149236,3934,57522,Removal or destruction of cervix,CPT/HCPCS,3087.2,3087.2,282.23,5461.0,United Healthcare-Medicare Advantage, +149237,3934,57720,Plastic repair of cervix,CPT/HCPCS,8103.59,8103.59,1746.36,4514.97,United Healthcare-Medicare Advantage, +149238,3934,58100,Biopsy of uterine lining,CPT/HCPCS,683.25,683.25,78.25,636.26,United Healthcare-Medicare Advantage, +149239,3934,58120,D&C for diagnosis and/or therapy (non-obstetrical),CPT/HCPCS,7707.29,7707.29,2121.38,16741.33,United Healthcare-Medicare Advantage, +149240,3934,58145,Vaginal removal of fibroid tumors (250 grams or less) of uterus,CPT/HCPCS,7564.25,7564.25,1200.0,2178.0,United Healthcare-Medicare Advantage, +149241,3934,58180,Abdominal removal of uterus,CPT/HCPCS,15152.67,15152.67,4356.0,4356.0,United Healthcare-Medicare Advantage, +149242,3934,58260,Vaginal removal of uterus (250 grams or less),CPT/HCPCS,18061.43,18061.43,1488.02,5602.13,United Healthcare-Medicare Advantage, +149243,3934,58262,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries",CPT/HCPCS,19701.2,19701.2,1664.79,28056.67,United Healthcare-Medicare Advantage, +149244,3934,58263,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries with repair of herniated bowel",CPT/HCPCS,21937.67,21937.67,8667.11,28443.11,United Healthcare-Medicare Advantage, +149245,3934,58270,Vaginal removal of uterus (250 grams or less) with repair of herniated bowel,CPT/HCPCS,21683.49,21683.49,11491.4,17400.52,United Healthcare-Medicare Advantage, +149246,3934,58300,Placement of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1601.67,1601.67,90.87,4575.0,United Healthcare-Medicare Advantage, +149247,3934,58301,Removal of intra-uterine device (IUD) for pregnancy prevention,CPT/HCPCS,1005.48,1005.48,76.51,3497.0,United Healthcare-Medicare Advantage, +149248,3934,58345,Insertion of catheter through the cervix into fallopian tube,CPT/HCPCS,5381.24,5381.24,1606.41,4287.0,United Healthcare-Medicare Advantage, +149249,3934,58350,Injection of saline or X-ray contrast material into tubes,CPT/HCPCS,10680.93,10680.93,1338.22,8667.48,United Healthcare-Medicare Advantage, +149250,3934,58353,Destruction of lining of uterus,CPT/HCPCS,5552.29,5552.29,1995.21,7259.39,United Healthcare-Medicare Advantage, +149251,3934,58541,Partial removal of uterus (250 grams or less) with retention of cervix using an endoscope,CPT/HCPCS,38128.24,38128.24,38122.53,38133.95,United Healthcare-Medicare Advantage, +149252,3934,58542,"Partial removal of uterus (250 grams or less), tubes and/or ovaries with retention of cervix using an endoscope,",CPT/HCPCS,24145.73,24145.73,13197.85,28044.49,United Healthcare-Medicare Advantage, +149253,3934,58543,Partial removal of uterus (greater than 250 grams) with retention of cervix using an endoscope,CPT/HCPCS,26530.15,26530.15,8823.0,8823.0,United Healthcare-Medicare Advantage, +149254,3934,58544,"Partial removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25645.39,25645.39,7582.34,9701.08,United Healthcare-Medicare Advantage, +149255,3934,58545,Removal of uterine fibroid tumors (250 grams or less) using an endoscope,CPT/HCPCS,20692.18,20692.18,8052.5,15067.5,United Healthcare-Medicare Advantage, +149256,3934,58546,Removal of uterine fibroid tumors (greater than 250 grams) using an endoscope,CPT/HCPCS,29525.36,29525.36,6956.33,17607.7,United Healthcare-Medicare Advantage, +149257,3934,58548,"Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy using an endoscope",CPT/HCPCS,18653.56,18653.56,7631.0,10058.55,United Healthcare-Medicare Advantage, +149258,3934,58552,"Vaginal removal of uterus (250 grams or less), tubes, and/or ovaries using an endoscope",CPT/HCPCS,23956.53,23956.53,3749.82,11301.46,United Healthcare-Medicare Advantage, +149259,3934,58555,Diagnostic examination of uterus using an endoscope,CPT/HCPCS,6314.9,6314.9,4379.0,8363.36,United Healthcare-Medicare Advantage, +149260,3934,58558,Biopsy and/or removal of polyp of the uterus using an endoscope,CPT/HCPCS,6860.98,6860.98,320.46,21794.0,United Healthcare-Medicare Advantage, +149261,3934,58559,Release of uterine adhesions using an endoscope,CPT/HCPCS,5394.0,5394.0,1862.24,1862.24,United Healthcare-Medicare Advantage, +149262,3934,58560,Release of uterine adhesions and abnormal partition using an endoscope,CPT/HCPCS,6310.86,6310.86,3139.55,4199.5,United Healthcare-Medicare Advantage, +149263,3934,58561,Removal of uterine muscle tumor using an endoscope,CPT/HCPCS,8234.44,8234.44,2680.78,14664.0,United Healthcare-Medicare Advantage, +149264,3934,58562,Removal of foreign body in uterus using an endoscope,CPT/HCPCS,5901.95,5901.95,1547.55,7631.0,United Healthcare-Medicare Advantage, +149265,3934,58563,Examination of uterus with destruction of uterine lining using an endoscope,CPT/HCPCS,6894.95,6894.95,3885.61,11962.43,United Healthcare-Medicare Advantage, +149266,3934,58570,Abdominal removal of uterus (250 grams or less) using an endoscope,CPT/HCPCS,19960.51,19960.51,7024.8,7024.8,United Healthcare-Medicare Advantage, +149267,3934,58571,Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope,CPT/HCPCS,21832.24,21832.24,1417.45,61221.13,United Healthcare-Medicare Advantage, +149268,3934,58573,"Abdominal removal of uterus (greater than 250 grams), tubes, and/or ovaries using an endoscope",CPT/HCPCS,25282.65,25282.65,4473.98,35929.98,United Healthcare-Medicare Advantage, +149269,3934,58579,Uterus procedure using an endoscope,CPT/HCPCS,6162.87,6162.87,5089.02,9012.0,United Healthcare-Medicare Advantage, +149270,3934,58660,Removal of scar tissue of ovaries or uterine tubes using an endoscope,CPT/HCPCS,10619.0,10619.0,2804.2,3815.5,United Healthcare-Medicare Advantage, +149271,3934,58661,Removal of ovaries and/or tubes using an endoscope,CPT/HCPCS,11857.83,11857.83,1466.92,25816.44,United Healthcare-Medicare Advantage, +149272,3934,58662,Destruction or removal of ovary or pelvic growths using an endoscope,CPT/HCPCS,12837.27,12837.27,687.71,25254.06,United Healthcare-Medicare Advantage, +149273,3934,58670,Destruction of ovaries using an endoscope,CPT/HCPCS,11086.5,11086.5,2804.2,2804.2,United Healthcare-Medicare Advantage, +149274,3934,58679,Procedure on fallopian tube or ovary using an endoscope,CPT/HCPCS,10704.9,10704.9,2785.09,2785.09,United Healthcare-Medicare Advantage, +149275,3934,58720,Removal of uterine tubes and ovaries,CPT/HCPCS,11005.67,11005.67,116.98,5511.1,United Healthcare-Medicare Advantage, +149276,3934,58925,Removal of ovaries,CPT/HCPCS,15725.89,15725.89,2048.7,4378.03,United Healthcare-Medicare Advantage, +149277,3934,58940,Removal of ovaries,CPT/HCPCS,7765.25,7765.25,3960.0,3960.0,United Healthcare-Medicare Advantage, +149278,3934,58999,Female genital system (nonobstetric) procedure,CPT/HCPCS,6254.36,6254.36,4544.0,7857.51,United Healthcare-Medicare Advantage, +149279,3934,59000,Abdominal aspiration of fluid surrounding fetus for diagnosis,CPT/HCPCS,1768.0,1768.0,1171.06,1171.06,United Healthcare-Medicare Advantage, +149280,3934,59012,Aspiration of blood from fetal umbilical cord,CPT/HCPCS,1780.02,1780.02,1780.02,1780.02,United Healthcare-Medicare Advantage, +149281,3934,59025,Fetal non-stress test,CPT/HCPCS,3477.41,3477.41,40.75,4889.0,United Healthcare-Medicare Advantage, +149282,3934,59151,Removal of ovarian or tubal pregnancy including removal of the ovary and/or tube using an endoscope,CPT/HCPCS,15161.13,15161.13,3448.53,16105.88,United Healthcare-Medicare Advantage, +149283,3934,59160,Scraping of lining of uterus post-delivery,CPT/HCPCS,4948.81,4948.81,1175.29,5800.66,United Healthcare-Medicare Advantage, +149284,3934,59200,Insertion dilator device into cervix,CPT/HCPCS,676.85,676.85,27.67,4602.0,United Healthcare-Medicare Advantage, +149285,3934,59300,Episiotomy or vaginal repair,CPT/HCPCS,806.84,806.84,1140.69,1215.78,United Healthcare-Medicare Advantage, +149286,3934,59320,Vaginal suture of cervix during pregnancy,CPT/HCPCS,6303.2,6303.2,1185.29,5869.18,United Healthcare-Medicare Advantage, +149287,3934,59400,Obstetrical pre- and postpartum care and vaginal delivery,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +149288,3934,59409,Vaginal delivery,CPT/HCPCS,4513.4,4513.4,2296.07,2296.07,United Healthcare-Medicare Advantage, +149289,3934,59412,Turning of fetus from breech to presenting position,CPT/HCPCS,6562.13,6562.13,47.62,4943.2,United Healthcare-Medicare Advantage, +149290,3934,59414,Vaginal delivery of placenta,CPT/HCPCS,9528.0,9528.0,4356.0,4356.0,United Healthcare-Medicare Advantage, +149291,3934,59430,Post-delivery care,CPT/HCPCS,47.72,47.72,45.0,51.0,United Healthcare-Medicare Advantage, +149292,3934,59510,Cesarean delivery with pre- and post-delivery care,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +149293,3934,59610,Vaginal delivery after prior cesarean delivery,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +149294,3934,59812,Treatment of incomplete abortion,CPT/HCPCS,4969.15,4969.15,421.25,8411.97,United Healthcare-Medicare Advantage, +149295,3934,59820,Treatment of first trimester missed abortion,CPT/HCPCS,6958.9,6958.9,680.24,15825.0,United Healthcare-Medicare Advantage, +149296,3934,59821,Treatment of second trimester missed abortion,CPT/HCPCS,6663.94,6663.94,983.81,5539.9,United Healthcare-Medicare Advantage, +149297,3934,59840,Induced abortion by dilation and uterine scraping,CPT/HCPCS,7574.89,7574.89,1027.05,5611.22,United Healthcare-Medicare Advantage, +149298,3934,59841,Induced abortion by dilation and removal of pregnancy contents,CPT/HCPCS,5571.87,5571.87,849.2,5824.0,United Healthcare-Medicare Advantage, +149299,3934,59855,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5394.98,5394.98,18.49,5757.0,United Healthcare-Medicare Advantage, +149300,3934,59856,Induced abortion by insertion of vaginal suppositories,CPT/HCPCS,5121.73,5121.73,892.97,5041.0,United Healthcare-Medicare Advantage, +149301,3934,59870,Aspiration of abnormal pregnancy contents with scraping of uterine wall,CPT/HCPCS,6023.8,6023.8,1906.41,4109.35,United Healthcare-Medicare Advantage, +149302,3934,59871,Removal of suture of cervix under anesthesia,CPT/HCPCS,5701.5,5701.5,1215.78,1215.78,United Healthcare-Medicare Advantage, +149303,3934,59899,Maternity care and delivery procedure,CPT/HCPCS,3919.43,3919.43,601.94,6936.26,United Healthcare-Medicare Advantage, +149304,3934,60100,"Needle biopsy of thyroid, accessed through the skin",CPT/HCPCS,3897.67,3897.67,5160.0,5160.0,United Healthcare-Medicare Advantage, +149305,3934,60220,Total removal of thyroid lobe on one side of the neck,CPT/HCPCS,15311.99,15311.99,3863.03,17970.0,United Healthcare-Medicare Advantage, +149306,3934,60240,Removal of thyroid,CPT/HCPCS,20273.29,20273.29,2707.56,10349.15,United Healthcare-Medicare Advantage, +149307,3934,60252,Removal of thyroid and surrounding lymph nodes,CPT/HCPCS,23275.31,23275.31,2270.07,8046.57,United Healthcare-Medicare Advantage, +149308,3934,60260,Removal of remaining thyroid tissue,CPT/HCPCS,17704.79,17704.79,4728.73,11944.67,United Healthcare-Medicare Advantage, +149309,3934,60280,Removal of thyroid cyst or drainage of thyroid gland duct,CPT/HCPCS,14409.71,14409.71,3233.76,7262.0,United Healthcare-Medicare Advantage, +149310,3934,60500,Removal or exploration of parathyroid glands,CPT/HCPCS,17937.33,17937.33,3492.04,25560.0,United Healthcare-Medicare Advantage, +149311,3934,60512,Excision and reimplantation of parathyroid tissue,CPT/HCPCS,6073.3,6073.3,1094.3,7262.0,United Healthcare-Medicare Advantage, +149312,3934,60520,Removal of thymus gland through neck incision,CPT/HCPCS,26241.37,26241.37,1458.18,1573.88,United Healthcare-Medicare Advantage, +149313,3934,61070,Aspiration or injection of cerebrospinal fluid shunt tubing or reservoir,CPT/HCPCS,997.34,997.34,80.28,1632.0,United Healthcare-Medicare Advantage, +149314,3934,61624,"Occlusion of abnormal artery, accessed through the skin",CPT/HCPCS,3296.21,3296.21,2337.5,45347.55,United Healthcare-Medicare Advantage, +149315,3934,61626,"Occlusion of head or neck artery, accessed through the skin",CPT/HCPCS,22385.53,22385.53,14967.51,29316.87,United Healthcare-Medicare Advantage, +149316,3934,61782,Computer-assisted procedure outside the brain,CPT/HCPCS,2712.78,2712.78,1089.0,19186.91,United Healthcare-Medicare Advantage, +149317,3934,61885,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,9672.46,9672.46,5110.0,25950.05,United Healthcare-Medicare Advantage, +149318,3934,61886,Insertion or replacement of brain neurostimulator generator or receiver,CPT/HCPCS,49984.98,49984.98,22309.69,53246.04,United Healthcare-Medicare Advantage, +149319,3934,62223,Creation of brain fluid drainage shunt,CPT/HCPCS,6348.67,6348.67,2178.0,20235.23,United Healthcare-Medicare Advantage, +149320,3934,62230,Replacement or revision of brain fluid drainage shunt valve or catheter,CPT/HCPCS,20832.88,20832.88,4544.0,18524.37,United Healthcare-Medicare Advantage, +149321,3934,62252,Reprogramming of programmable brain and spinal fluid shunt,CPT/HCPCS,9409.0,9409.0,2913.0,2913.0,United Healthcare-Medicare Advantage, +149322,3934,62268,"Aspiration of spinal cord cyst or fluid-filled cavity, accessed through the skin",CPT/HCPCS,5954.0,5954.0,4356.0,4356.0,United Healthcare-Medicare Advantage, +149323,3934,62270,Spinal tap for diagnosis,CPT/HCPCS,2293.97,2293.97,89.74,10145.57,United Healthcare-Medicare Advantage, +149324,3934,62272,Spinal tap with drainage of spinal fluid,CPT/HCPCS,1873.94,1873.94,227.0,1277.0,United Healthcare-Medicare Advantage, +149325,3934,62273,Injection of blood or blood clot into spinal canal,CPT/HCPCS,2262.53,2262.53,604.5,1560.74,United Healthcare-Medicare Advantage, +149326,3934,62284,Injection of dye for X-ray imaging and/or CT of lower spinal canal,CPT/HCPCS,2152.04,2152.04,99.84,4544.0,United Healthcare-Medicare Advantage, +149327,3934,62304,X-ray of lower spinal canal with radiological supervision and interpretation,CPT/HCPCS,2769.0,2769.0,2769.0,2769.0,United Healthcare-Medicare Advantage, +149328,3934,62321,Injection of substance into spinal canal of upper or middle back using imaging guidance,CPT/HCPCS,3645.04,3645.04,181.17,13534.46,United Healthcare-Medicare Advantage, +149329,3934,62322,Injection of substance into spinal canal of lower back or sacrum,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +149330,3934,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidance,CPT/HCPCS,1218.1,1218.1,112.23,5858.63,United Healthcare-Medicare Advantage, +149331,3934,62328,Diagnostic spinal tap of lower spine using imaging guidance,CPT/HCPCS,2858.16,2858.16,707.22,5511.1,United Healthcare-Medicare Advantage, +149332,3934,62329,Therapeutic spinal tap of lower spine using imaging guidance,CPT/HCPCS,6915.0,6915.0,6915.0,6915.0,United Healthcare-Medicare Advantage, +149333,3934,62350,"Implantation, revision, or repositioning of spinal canal medication catheter",CPT/HCPCS,33074.22,33074.22,34372.67,34372.67,United Healthcare-Medicare Advantage, +149334,3934,62361,Implantation or replacement of spinal canal drug infusion pump,CPT/HCPCS,41351.0,41351.0,41351.0,41351.0,United Healthcare-Medicare Advantage, +149335,3934,62362,Implantation or replacement of programmable spinal canal drug infusion pump,CPT/HCPCS,36315.66,36315.66,16814.9,38709.0,United Healthcare-Medicare Advantage, +149336,3934,62365,"Removal of spinal canal drug infusion pump or device, accessed beneath the skin",CPT/HCPCS,55631.68,55631.68,33246.4,33246.4,United Healthcare-Medicare Advantage, +149337,3934,62367,Electronic analysis of spinal canal drug infusion pump,CPT/HCPCS,730.5,730.5,83.4,83.4,United Healthcare-Medicare Advantage, +149338,3934,62368,Electronic analysis and reprogramming of spinal canal drug infusion pump,CPT/HCPCS,500.29,500.29,41.7,83.4,United Healthcare-Medicare Advantage, +149339,3934,62370,Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician,CPT/HCPCS,704.33,704.33,83.4,154.99,United Healthcare-Medicare Advantage, +149340,3934,63030,Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine,CPT/HCPCS,15348.49,15348.49,3924.84,34557.51,United Healthcare-Medicare Advantage, +149341,3934,63035,Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine,CPT/HCPCS,4532.0,4532.0,2178.0,2178.0,United Healthcare-Medicare Advantage, +149342,3934,63042,Re-exploration of spine repair with release of lower spinal cord or nerves,CPT/HCPCS,15693.89,15693.89,4641.62,9652.54,United Healthcare-Medicare Advantage, +149343,3934,63045,Partial removal of upper spine bone with release of spinal cord and/or nerves,CPT/HCPCS,13610.16,13610.16,8198.0,8198.0,United Healthcare-Medicare Advantage, +149344,3934,63047,Partial removal of middle spine bone with release of spinal cord and/or nerves,CPT/HCPCS,11716.53,11716.53,5883.26,11406.26,United Healthcare-Medicare Advantage, +149345,3934,63048,Partial removal of spine bone with release of spinal cord and/or nerves,CPT/HCPCS,4578.73,4578.73,4099.0,4099.0,United Healthcare-Medicare Advantage, +149346,3934,63650,"Implantation of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,6643.33,6643.33,1731.0,33780.0,United Healthcare-Medicare Advantage, +149347,3934,63661,"Removal or revision of spinal neurostimulator electrodes, accessed through the skin",CPT/HCPCS,12100.67,12100.67,10971.0,10971.0,United Healthcare-Medicare Advantage, +149348,3934,63685,Insertion of spinal neurostimulator pulse generator or receiver,CPT/HCPCS,55171.21,55171.21,9270.0,105298.79,United Healthcare-Medicare Advantage, +149349,3934,63688,Removal or revision of neurostimulator pulse generator or receiver,CPT/HCPCS,7236.0,7236.0,3348.0,7998.0,United Healthcare-Medicare Advantage, +149350,3934,64400,Injection of anesthetic agent and/or steroid into trigeminal nerve of face,CPT/HCPCS,2831.13,2831.13,1576.0,3386.72,United Healthcare-Medicare Advantage, +149351,3934,64405,Injection of anesthetic agent and/or steroid into greater occipital nerve of upper neck and back of head,CPT/HCPCS,966.75,966.75,529.39,767.35,United Healthcare-Medicare Advantage, +149352,3934,64418,Injection of anesthetic agent and/or steroid into suprascapular nerve of shoulder,CPT/HCPCS,1019.25,1019.25,2162.0,2162.0,United Healthcare-Medicare Advantage, +149353,3934,64420,Injection of anesthetic agent and/or steroid into single intercostal nerve of rib,CPT/HCPCS,3349.19,3349.19,279.7,5015.0,United Healthcare-Medicare Advantage, +149354,3934,64421,Injection of anesthetic agent and/or steroid into multiple intercostal nerves of ribs for regional nerve block,CPT/HCPCS,2506.56,2506.56,245.11,7023.0,United Healthcare-Medicare Advantage, +149355,3934,64425,Injection of anesthetic agent and/or steroid into ilioinguinal and iliohypogastric nerves of lower abdomen and groin,CPT/HCPCS,1438.33,1438.33,610.01,610.01,United Healthcare-Medicare Advantage, +149356,3934,64430,Injection of anesthetic agent and/or steroid into pudendal nerve of external genitals and area around anus,CPT/HCPCS,1640.0,1640.0,628.75,628.75,United Healthcare-Medicare Advantage, +149357,3934,64450,Injection of anesthetic agent and/or steroid into other peripheral nerve or branch,CPT/HCPCS,1100.46,1100.46,50.56,1544.79,United Healthcare-Medicare Advantage, +149358,3934,64451,Injection of anesthetic agent and/or steroid into nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,7233.87,7233.87,7233.87,7233.87,United Healthcare-Medicare Advantage, +149359,3934,64479,Injections of anesthetic and/or steroid drug into upper or middle spine nerve root using imaging guidance,CPT/HCPCS,4053.0,4053.0,3678.7,3892.0,United Healthcare-Medicare Advantage, +149360,3934,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,3563.51,3563.51,244.17,14397.94,United Healthcare-Medicare Advantage, +149361,3934,64484,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,CPT/HCPCS,352.67,352.67,12.8,4125.96,United Healthcare-Medicare Advantage, +149362,3934,64490,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,1584.24,1584.24,626.64,4160.36,United Healthcare-Medicare Advantage, +149363,3934,64491,Injections of upper or middle spine facet joint using imaging guidance,CPT/HCPCS,607.64,607.64,418.89,1173.0,United Healthcare-Medicare Advantage, +149364,3934,64493,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,4009.48,4009.48,1521.92,13395.68,United Healthcare-Medicare Advantage, +149365,3934,64494,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,402.84,402.84,29.96,4544.0,United Healthcare-Medicare Advantage, +149366,3934,64495,Injections of lower or sacral spine facet joint using imaging guidance,CPT/HCPCS,301.78,301.78,216.0,612.0,United Healthcare-Medicare Advantage, +149367,3934,64505,"Injection of anesthetic agent, trigeminal nerve bundle",CPT/HCPCS,1081.78,1081.78,4356.0,4356.0,United Healthcare-Medicare Advantage, +149368,3934,64510,"Injection of anesthetic agent, sympathetic nerve bundle",CPT/HCPCS,4776.39,4776.39,1671.45,2291.83,United Healthcare-Medicare Advantage, +149369,3934,64517,"Injection of anesthetic agent, sacral nerve bundle",CPT/HCPCS,1251.5,1251.5,144.9,1152.0,United Healthcare-Medicare Advantage, +149370,3934,64520,"Injection of anesthetic agent, middle or lower spine sympathetic nerves",CPT/HCPCS,5145.17,5145.17,2098.5,8448.3,United Healthcare-Medicare Advantage, +149371,3934,64530,"Injection of anesthetic agent, abdominal sympathetic nerve bundle",CPT/HCPCS,4894.77,4894.77,3919.33,6294.0,United Healthcare-Medicare Advantage, +149372,3934,64561,"Insertion of sacral nerve neurostimulator electrodes, accessed through the skin",CPT/HCPCS,17207.5,17207.5,7571.12,27733.0,United Healthcare-Medicare Advantage, +149373,3934,64568,Implantation of cranial nerve neurostimulator electrodes and generator,CPT/HCPCS,94554.32,94554.32,42303.74,52947.74,United Healthcare-Medicare Advantage, +149374,3934,64570,Removal of cranial nerve neurostimulator electrodes,CPT/HCPCS,12076.7,12076.7,3996.0,4500.0,United Healthcare-Medicare Advantage, +149375,3934,64581,Incision to insert sacral nerve neurostimulator electrodes,CPT/HCPCS,16723.2,16723.2,5055.66,45029.56,United Healthcare-Medicare Advantage, +149376,3934,64585,Revision or removal of peripheral neurostimulator electrode array,CPT/HCPCS,2394.89,2394.89,1258.0,6142.0,United Healthcare-Medicare Advantage, +149377,3934,64590,Insertion or replacement of peripheral or gastric neurostimulator generator,CPT/HCPCS,2639.2,2639.2,612.0,24460.2,United Healthcare-Medicare Advantage, +149378,3934,64595,Revision or removal of peripheral nerve or gastric neurostimulator generator,CPT/HCPCS,3726.34,3726.34,1887.0,7075.5,United Healthcare-Medicare Advantage, +149379,3934,64612,Injection of chemical for destruction of nerve muscles on one side of face,CPT/HCPCS,6252.73,6252.73,3994.02,7332.15,United Healthcare-Medicare Advantage, +149380,3934,64615,Injection of chemical for destruction of facial and neck nerve muscles on both sides of face,CPT/HCPCS,6655.41,6655.41,1717.03,5523.7,United Healthcare-Medicare Advantage, +149381,3934,64616,Injection of chemical for destruction of nerve muscles on one side of neck excluding voice box accessed through the skin,CPT/HCPCS,5511.86,5511.86,818.14,818.14,United Healthcare-Medicare Advantage, +149382,3934,64620,Injection of agent to destroy rib nerve,CPT/HCPCS,5079.09,5079.09,505.02,4495.13,United Healthcare-Medicare Advantage, +149383,3934,64624,Destruction of genicular nerve branches of knee by injection using imaging guidance,CPT/HCPCS,5508.31,5508.31,1861.01,12971.56,United Healthcare-Medicare Advantage, +149384,3934,64625,Radiofrequency destruction of nerves supplying joint between spine and pelvis using imaging guidance,CPT/HCPCS,5478.82,5478.82,4656.0,5008.0,United Healthcare-Medicare Advantage, +149385,3934,64633,Destruction of upper or middle spinal facet joint nerves using imaging guidance,CPT/HCPCS,5182.43,5182.43,1714.5,12812.19,United Healthcare-Medicare Advantage, +149386,3934,64634,Destruction of upper or middle spinal facet joint nerves with imaging guidance,CPT/HCPCS,663.64,663.64,360.0,6152.62,United Healthcare-Medicare Advantage, +149387,3934,64635,Destruction of lower or sacral spinal facet joint nerves using imaging guidance,CPT/HCPCS,4540.58,4540.58,1554.32,22410.26,United Healthcare-Medicare Advantage, +149388,3934,64636,Destruction of lower or sacral spinal facet joint nerves with imaging guidance,CPT/HCPCS,581.67,581.67,216.0,5263.61,United Healthcare-Medicare Advantage, +149389,3934,64640,Destruction of peripheral nerve or branch,CPT/HCPCS,3556.24,3556.24,2700.31,8730.6,United Healthcare-Medicare Advantage, +149390,3934,64643,"Injection of chemical for destruction of nerve muscles on arm or leg, 1-4 muscles",CPT/HCPCS,100.45,100.45,628.75,628.75,United Healthcare-Medicare Advantage, +149391,3934,64644,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,834.0,834.0,535.43,535.43,United Healthcare-Medicare Advantage, +149392,3934,64645,"Injection of chemical for destruction of nerve muscles on arm or leg, 5 or more muscles",CPT/HCPCS,72.71,72.71,628.75,628.75,United Healthcare-Medicare Advantage, +149393,3934,64646,"Injection of chemical for destruction of nerve muscles on trunk, 5 or more muscles",CPT/HCPCS,7863.0,7863.0,788.17,818.14,United Healthcare-Medicare Advantage, +149394,3934,64702,Release of nerve of finger,CPT/HCPCS,7146.04,7146.04,708.19,4544.0,United Healthcare-Medicare Advantage, +149395,3934,64704,Release of nerve of hand or foot,CPT/HCPCS,7169.69,7169.69,7392.0,7392.0,United Healthcare-Medicare Advantage, +149396,3934,64708,"Release of nerve of arm or leg, open procedure",CPT/HCPCS,8997.33,8997.33,2475.74,15696.3,United Healthcare-Medicare Advantage, +149397,3934,64712,"Release of sciatic nerve, open procedure",CPT/HCPCS,10469.11,10469.11,8919.64,8919.64,United Healthcare-Medicare Advantage, +149398,3934,64713,"Release of major nerve of arm or leg, open procedure",CPT/HCPCS,17543.79,17543.79,2730.5,2730.5,United Healthcare-Medicare Advantage, +149399,3934,64718,Release and/or relocation of ulnar nerve at elbow,CPT/HCPCS,7481.83,7481.83,1185.69,21807.0,United Healthcare-Medicare Advantage, +149400,3934,64719,Release and/or relocation ulnar nerve at wrist,CPT/HCPCS,6488.19,6488.19,1365.25,2865.73,United Healthcare-Medicare Advantage, +149401,3934,64721,Release and/or relocation of median nerve of hand,CPT/HCPCS,6295.56,6295.56,979.61,26229.19,United Healthcare-Medicare Advantage, +149402,3934,64727,Release of nerve requiring use of operating microscope,CPT/HCPCS,4568.67,4568.67,973.0,3210.23,United Healthcare-Medicare Advantage, +149403,3934,64772,Incision or removal of spinal nerve,CPT/HCPCS,6614.11,6614.11,5285.0,6040.59,United Healthcare-Medicare Advantage, +149404,3934,64774,Removal of growth of skin nerve,CPT/HCPCS,35282.0,35282.0,35282.0,35282.0,United Healthcare-Medicare Advantage, +149405,3934,64776,Removal of growth of finger or toe nerve,CPT/HCPCS,5198.84,5198.84,3996.0,3996.0,United Healthcare-Medicare Advantage, +149406,3934,64788,Removal of growth of skin nerve or nerve lining,CPT/HCPCS,11344.29,11344.29,1532.08,4416.0,United Healthcare-Medicare Advantage, +149407,3934,64795,Biopsy of nerve,CPT/HCPCS,10674.79,10674.79,4662.28,10242.28,United Healthcare-Medicare Advantage, +149408,3934,64831,Suture of hand or foot digital nerve,CPT/HCPCS,7644.79,7644.79,725.74,8400.84,United Healthcare-Medicare Advantage, +149409,3934,64832,Suture of hand or foot digital nerve,CPT/HCPCS,1845.85,1845.85,2143.5,2143.5,United Healthcare-Medicare Advantage, +149410,3934,64835,Suture of median motor thenar nerve (hand),CPT/HCPCS,21354.7,21354.7,6565.2,6565.2,United Healthcare-Medicare Advantage, +149411,3934,64856,"Suture of peripheral nerve, arm or leg, with relocation to new site",CPT/HCPCS,11491.04,11491.04,714.67,1980.0,United Healthcare-Medicare Advantage, +149412,3934,64857,"Suture of peripheral nerve, arm or leg",CPT/HCPCS,10889.33,10889.33,2178.0,2178.0,United Healthcare-Medicare Advantage, +149413,3934,64861,Suture of nerve bundle to arm,CPT/HCPCS,35721.21,35721.21,20294.0,20294.0,United Healthcare-Medicare Advantage, +149414,3934,64872,Delayed suture nerve repair,CPT/HCPCS,3239.5,3239.5,1365.25,1365.25,United Healthcare-Medicare Advantage, +149415,3934,64910,Repair of nerve with graft,CPT/HCPCS,8571.82,8571.82,1075.7,7920.0,United Healthcare-Medicare Advantage, +149416,3934,64911,Repair of nerve using vein graft,CPT/HCPCS,22028.58,22028.58,4931.66,5047.36,United Healthcare-Medicare Advantage, +149417,3934,64999,Nervous system procedure,CPT/HCPCS,6454.41,6454.41,4218.0,5952.0,United Healthcare-Medicare Advantage, +149418,3934,65091,Removal of eye contents,CPT/HCPCS,10171.89,10171.89,3572.94,3572.94,United Healthcare-Medicare Advantage, +149419,3934,65093,Removal of eye contents with insertion of implant,CPT/HCPCS,10823.5,10823.5,3788.43,3788.43,United Healthcare-Medicare Advantage, +149420,3934,65105,Removal of eyeball with implant attached to muscles,CPT/HCPCS,12957.31,12957.31,4583.31,11654.29,United Healthcare-Medicare Advantage, +149421,3934,65205,"Removal of foreign body in external eye, conjunctiva",CPT/HCPCS,2273.75,2273.75,332.1,2271.0,United Healthcare-Medicare Advantage, +149422,3934,65220,"Removal of foreign body, external eye, cornea",CPT/HCPCS,784.41,784.41,97.74,1264.0,United Healthcare-Medicare Advantage, +149423,3934,65222,"Removal of foreign body, external eye, cornea with slit lamp examination",CPT/HCPCS,2767.0,2767.0,239.98,3670.0,United Healthcare-Medicare Advantage, +149424,3934,65235,Removal of foreign body from inside the eye or lens,CPT/HCPCS,12851.17,12851.17,3183.19,5253.57,United Healthcare-Medicare Advantage, +149425,3934,65260,Removal of foreign body from inside eye,CPT/HCPCS,20066.75,20066.75,7561.5,7561.5,United Healthcare-Medicare Advantage, +149426,3934,65275,Repair of lacerated cornea,CPT/HCPCS,14898.2,14898.2,18048.0,18048.0,United Healthcare-Medicare Advantage, +149427,3934,65285,Repair of perforating laceration of cornea and/or sclera,CPT/HCPCS,33573.24,33573.24,8354.0,11006.0,United Healthcare-Medicare Advantage, +149428,3934,65286,Repair of lacerated cornea and/or sclera,CPT/HCPCS,3813.0,3813.0,1710.7,1710.7,United Healthcare-Medicare Advantage, +149429,3934,65410,Biopsy of cornea,CPT/HCPCS,6175.5,6175.5,4988.0,4988.0,United Healthcare-Medicare Advantage, +149430,3934,65426,Removal or relocation of corneal conjunctiva,CPT/HCPCS,9052.39,9052.39,5532.73,15377.31,United Healthcare-Medicare Advantage, +149431,3934,65430,Scraping of cornea for diagnosis,CPT/HCPCS,11726.3,11726.3,11520.3,11520.3,United Healthcare-Medicare Advantage, +149432,3934,65710,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,29703.07,29703.07,17746.96,17746.96,United Healthcare-Medicare Advantage, +149433,3934,65730,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10364.91,10364.91,5140.8,29318.16,United Healthcare-Medicare Advantage, +149434,3934,65750,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,10499.54,10499.54,11577.58,11577.58,United Healthcare-Medicare Advantage, +149435,3934,65755,Transplantation of tissue from one cornea to other cornea,CPT/HCPCS,12580.56,12580.56,3264.6,23109.0,United Healthcare-Medicare Advantage, +149436,3934,65756,Transplant of outer layer of corneal tissue,CPT/HCPCS,11006.94,11006.94,2121.07,27470.75,United Healthcare-Medicare Advantage, +149437,3934,65770,Placement of tube with optical power to cornea,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,United Healthcare-Medicare Advantage, +149438,3934,65772,Incisions to cornea to correct astigmatism,CPT/HCPCS,3948.13,3948.13,3609.06,4319.57,United Healthcare-Medicare Advantage, +149439,3934,65775,Excision of corneal tissue to correct astigmatism,CPT/HCPCS,9926.95,9926.95,2456.5,2456.5,United Healthcare-Medicare Advantage, +149440,3934,65800,Aspiration of eye fluid,CPT/HCPCS,3690.12,3690.12,4022.42,4751.91,United Healthcare-Medicare Advantage, +149441,3934,65815,Aspiration of blood from eye,CPT/HCPCS,11522.84,11522.84,2520.5,2520.5,United Healthcare-Medicare Advantage, +149442,3934,65820,Incision to improve eye fluid flow,CPT/HCPCS,4981.69,4981.69,2591.19,12259.28,United Healthcare-Medicare Advantage, +149443,3934,65850,Insertion of eye fluid drainage tube,CPT/HCPCS,3418.03,3418.03,1356.13,4949.93,United Healthcare-Medicare Advantage, +149444,3934,65870,Removal of scar tissue in eye,CPT/HCPCS,6936.28,6936.28,6703.48,6703.48,United Healthcare-Medicare Advantage, +149445,3934,65920,Removal of implanted lens in eye,CPT/HCPCS,3173.45,3173.45,4934.17,4934.17,United Healthcare-Medicare Advantage, +149446,3934,66020,Injection of air or liquid into eye,CPT/HCPCS,6514.91,6514.91,4357.59,4357.59,United Healthcare-Medicare Advantage, +149447,3934,66170,Creation of eye fluid drainage tract,CPT/HCPCS,6935.47,6935.47,2986.82,19209.11,United Healthcare-Medicare Advantage, +149448,3934,66172,Creation of eye fluid drainage tract,CPT/HCPCS,6635.1,6635.1,5505.39,12108.53,United Healthcare-Medicare Advantage, +149449,3934,66180,Creation of shunt to improve eye fluid flow with graft,CPT/HCPCS,8329.17,8329.17,4156.95,16286.48,United Healthcare-Medicare Advantage, +149450,3934,66184,Revision of shunt to improve eye fluid flow,CPT/HCPCS,9625.79,9625.79,5041.0,5041.0,United Healthcare-Medicare Advantage, +149451,3934,66185,Revision of eye fluid drainage shunt with graft,CPT/HCPCS,8406.84,8406.84,4406.0,12407.67,United Healthcare-Medicare Advantage, +149452,3934,66250,Revision or repair of operative wound of eye,CPT/HCPCS,11053.06,11053.06,2754.62,4261.19,United Healthcare-Medicare Advantage, +149453,3934,66625,Removal of iris to improve eye fluid flow,CPT/HCPCS,6235.33,6235.33,4915.03,8182.03,United Healthcare-Medicare Advantage, +149454,3934,66680,Repair of iris and lens tissue,CPT/HCPCS,29345.85,29345.85,29345.85,29345.85,United Healthcare-Medicare Advantage, +149455,3934,66682,Repair of iris and lens tissue,CPT/HCPCS,8331.56,8331.56,5088.0,7620.0,United Healthcare-Medicare Advantage, +149456,3934,66710,Destruction of lens tissue using laser,CPT/HCPCS,5694.48,5694.48,3796.96,12183.95,United Healthcare-Medicare Advantage, +149457,3934,66711,Destruction of tissue encircling lens using endoscope,CPT/HCPCS,3776.67,3776.67,816.0,5700.0,United Healthcare-Medicare Advantage, +149458,3934,66761,"Creation of eye fluid drainage tracts in iris using laser, per session",CPT/HCPCS,1331.0,1331.0,613.17,613.17,United Healthcare-Medicare Advantage, +149459,3934,66821,Removal of recurring cataract in lens capsule using laser,CPT/HCPCS,1426.0,1426.0,613.17,613.17,United Healthcare-Medicare Advantage, +149460,3934,66825,Repositioning of lens prosthesis,CPT/HCPCS,4129.79,4129.79,3377.59,5447.6,United Healthcare-Medicare Advantage, +149461,3934,66840,Aspiration removal of lens material,CPT/HCPCS,4129.64,4129.64,4656.63,4774.53,United Healthcare-Medicare Advantage, +149462,3934,66850,"Fragmenting, aspiration, and removal of lens material",CPT/HCPCS,9849.25,9849.25,2290.99,8953.0,United Healthcare-Medicare Advantage, +149463,3934,66852,Removal of lens material,CPT/HCPCS,8183.26,8183.26,9050.62,10540.53,United Healthcare-Medicare Advantage, +149464,3934,66982,Complex removal of cataract with insertion of lens,CPT/HCPCS,6605.87,6605.87,1536.32,32663.81,United Healthcare-Medicare Advantage, +149465,3934,66984,Removal of cataract with insertion of lens,CPT/HCPCS,5527.27,5527.27,641.28,23491.15,United Healthcare-Medicare Advantage, +149466,3934,66985,Insertion of lens prosthesis,CPT/HCPCS,7185.95,7185.95,2272.0,5461.0,United Healthcare-Medicare Advantage, +149467,3934,66986,Exchange of lens prosthesis,CPT/HCPCS,9698.14,9698.14,4422.73,15173.91,United Healthcare-Medicare Advantage, +149468,3934,66999,Anterior (front) eye procedure,CPT/HCPCS,6056.82,6056.82,6170.9,6308.39,United Healthcare-Medicare Advantage, +149469,3934,67005,Partial removal of eye fluid between the lens and retina,CPT/HCPCS,6024.8,6024.8,1777.97,12654.95,United Healthcare-Medicare Advantage, +149470,3934,67015,Aspiration or release of eye fluid between the lens and retina,CPT/HCPCS,9399.67,9399.67,5994.33,5994.33,United Healthcare-Medicare Advantage, +149471,3934,67028,Injection of drug into eye,CPT/HCPCS,1377.77,1377.77,268.08,366.32,United Healthcare-Medicare Advantage, +149472,3934,67036,Removal of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,11679.42,11679.42,2406.45,19380.29,United Healthcare-Medicare Advantage, +149473,3934,67039,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,9739.13,9739.13,4375.73,12275.44,United Healthcare-Medicare Advantage, +149474,3934,67040,Laser destruction of eye fluid (vitreous) between the lens and retina,CPT/HCPCS,13693.92,13693.92,6264.08,15701.62,United Healthcare-Medicare Advantage, +149475,3934,67041,Removal of membrane from the retina,CPT/HCPCS,11835.76,11835.76,7821.29,18548.13,United Healthcare-Medicare Advantage, +149476,3934,67042,"Removal of membrane from the retina, pars plana approach",CPT/HCPCS,12240.03,12240.03,4442.12,13340.42,United Healthcare-Medicare Advantage, +149477,3934,67107,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,21797.01,21797.01,3079.93,4356.0,United Healthcare-Medicare Advantage, +149478,3934,67108,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18483.01,18483.01,3998.66,32176.15,United Healthcare-Medicare Advantage, +149479,3934,67113,Repair of detached retina and drainage of eye fluid between lens and retina,CPT/HCPCS,18110.31,18110.31,8237.21,18538.0,United Healthcare-Medicare Advantage, +149480,3934,67121,Removal of implant material from inside the eye,CPT/HCPCS,9863.33,9863.33,2178.0,2178.0,United Healthcare-Medicare Advantage, +149481,3934,67141,"Preventive retinal detachment treatment by heat or freezing, 1 or more sessions",CPT/HCPCS,2481.0,2481.0,653.51,653.51,United Healthcare-Medicare Advantage, +149482,3934,67145,"Preventive retinal detachment treatment by heat or laser, 1 or more sessions",CPT/HCPCS,3536.67,3536.67,613.17,613.17,United Healthcare-Medicare Advantage, +149483,3934,67228,"Laser destruction of leaking retinal blood vessels, 1 or more sessions",CPT/HCPCS,1349.0,1349.0,613.17,613.17,United Healthcare-Medicare Advantage, +149484,3934,67255,Repair of defect of sclera with graft,CPT/HCPCS,10068.22,10068.22,9917.33,9917.33,United Healthcare-Medicare Advantage, +149485,3934,67311,Realignment of the eye with repair of one horizontal eye muscle,CPT/HCPCS,7155.16,7155.16,3480.0,15809.74,United Healthcare-Medicare Advantage, +149486,3934,67312,Realignment of the eye with repair of two horizontal eye muscles,CPT/HCPCS,9191.26,9191.26,2562.44,8266.65,United Healthcare-Medicare Advantage, +149487,3934,67314,Realignment of the eye with repair of one vertical muscle,CPT/HCPCS,8939.42,8939.42,4544.0,14270.05,United Healthcare-Medicare Advantage, +149488,3934,67320,Relocation of eye muscles to restore function,CPT/HCPCS,1178.46,1178.46,4544.0,15393.47,United Healthcare-Medicare Advantage, +149489,3934,67340,Realignment of eye with repair of detached eye muscles,CPT/HCPCS,2384.0,2384.0,3496.0,6992.0,United Healthcare-Medicare Advantage, +149490,3934,67400,"Exploration of cavity behind eye, frontal or transconjunctival approach",CPT/HCPCS,10122.01,10122.01,4516.45,5179.31,United Healthcare-Medicare Advantage, +149491,3934,67412,Removal of growth in cavity behind eye,CPT/HCPCS,9117.01,9117.01,4162.72,7657.32,United Healthcare-Medicare Advantage, +149492,3934,67414,Removal of bone from cavity behind eye,CPT/HCPCS,36802.69,36802.69,5028.73,5032.0,United Healthcare-Medicare Advantage, +149493,3934,67445,Removal of bone from cavity behind eye,CPT/HCPCS,38194.68,38194.68,4815.63,4817.87,United Healthcare-Medicare Advantage, +149494,3934,67560,Removal or revision of implant outside eye muscles,CPT/HCPCS,9189.41,9189.41,2314.99,2809.09,United Healthcare-Medicare Advantage, +149495,3934,67800,Removal of eyelid growth,CPT/HCPCS,559.34,559.34,327.7,898.43,United Healthcare-Medicare Advantage, +149496,3934,67805,Removal of multiple growths of different eyelids,CPT/HCPCS,6009.92,6009.92,8490.39,8490.39,United Healthcare-Medicare Advantage, +149497,3934,67808,Removal of eyelid growth under general anesthesia and/or requiring hospitalization,CPT/HCPCS,5263.95,5263.95,932.6,4800.7,United Healthcare-Medicare Advantage, +149498,3934,67810,Biopsy of eyelid,CPT/HCPCS,6604.06,6604.06,6604.06,6604.06,United Healthcare-Medicare Advantage, +149499,3934,67825,Removal of eyelashes,CPT/HCPCS,8306.78,8306.78,9042.83,9042.83,United Healthcare-Medicare Advantage, +149500,3934,67840,Removal of eyelid growth,CPT/HCPCS,5992.86,5992.86,2849.34,11172.04,United Healthcare-Medicare Advantage, +149501,3934,67850,Destruction of (up to 1 centimeter) growth of eyelid margin,CPT/HCPCS,9692.04,9692.04,4544.0,4544.0,United Healthcare-Medicare Advantage, +149502,3934,67875,Temporary closure of eyelids by suture,CPT/HCPCS,5728.42,5728.42,740.66,8076.3,United Healthcare-Medicare Advantage, +149503,3934,67880,Creation of permanent eyelid margin scarring,CPT/HCPCS,6249.71,6249.71,3996.0,3996.0,United Healthcare-Medicare Advantage, +149504,3934,67900,Repair of brow paralysis,CPT/HCPCS,7277.71,7277.71,4195.55,11288.79,United Healthcare-Medicare Advantage, +149505,3934,67901,Repair of upper eyelid muscle to correct drooping or paralysis,CPT/HCPCS,7827.15,7827.15,2344.49,4544.0,United Healthcare-Medicare Advantage, +149506,3934,67904,Repair of tendon of upper eyelid,CPT/HCPCS,7417.7,7417.7,4322.32,10175.24,United Healthcare-Medicare Advantage, +149507,3934,67908,"Removal of tissue, muscle, and membrane to correct eyelid drooping or paralysis",CPT/HCPCS,7448.62,7448.62,5172.82,13106.4,United Healthcare-Medicare Advantage, +149508,3934,67911,Correction of widely-opened upper eyelid,CPT/HCPCS,6811.42,6811.42,2671.31,10985.91,United Healthcare-Medicare Advantage, +149509,3934,67912,Restoration of eyelid blinking function,CPT/HCPCS,2720.05,2720.05,932.6,3773.6,United Healthcare-Medicare Advantage, +149510,3934,67917,Extensive repair of turning-outward eyelid defect,CPT/HCPCS,6322.32,6322.32,1177.12,17890.19,United Healthcare-Medicare Advantage, +149511,3934,67921,Suture repair of turning-inward eyelid defect,CPT/HCPCS,6371.22,6371.22,6963.87,7011.47,United Healthcare-Medicare Advantage, +149512,3934,67923,Repair of turning-inward eyelid defect,CPT/HCPCS,7695.59,7695.59,8078.98,8214.5,United Healthcare-Medicare Advantage, +149513,3934,67924,Repair of turning-inward eyelid defect,CPT/HCPCS,7274.74,7274.74,630.89,13563.15,United Healthcare-Medicare Advantage, +149514,3934,67935,Repair of wound of eyelid margin,CPT/HCPCS,3078.95,3078.95,932.6,2344.49,United Healthcare-Medicare Advantage, +149515,3934,67938,Removal of embedded foreign body in eyelid,CPT/HCPCS,1046.94,1046.94,1013.91,1209.58,United Healthcare-Medicare Advantage, +149516,3934,67950,Enlargement of eyelid margin,CPT/HCPCS,5978.75,5978.75,3987.89,6703.7,United Healthcare-Medicare Advantage, +149517,3934,67961,Removal of up to one-fourth of the eyelid involving lid margin,CPT/HCPCS,7289.46,7289.46,2013.56,26656.99,United Healthcare-Medicare Advantage, +149518,3934,67966,Removal of over one-fourth of the eyelid involving lid margin,CPT/HCPCS,6919.71,6919.71,5712.39,9003.78,United Healthcare-Medicare Advantage, +149519,3934,67971,Reconstruction of up to two-thirds of the eyelid by transfer of opposite eyelid tissue,CPT/HCPCS,7586.68,7586.68,4721.62,10040.36,United Healthcare-Medicare Advantage, +149520,3934,67999,Eyelid procedure,CPT/HCPCS,11236.35,11236.35,6694.0,14748.0,United Healthcare-Medicare Advantage, +149521,3934,68110,Removal of (up to 1 centimeter) growth of sclera,CPT/HCPCS,10349.88,10349.88,1069.08,2389.61,United Healthcare-Medicare Advantage, +149522,3934,68320,Repair of conjunctiva,CPT/HCPCS,4506.47,4506.47,4169.59,7434.19,United Healthcare-Medicare Advantage, +149523,3934,68440,Snip incision of tear-drainage opening at inner corner of the eye,CPT/HCPCS,7494.65,7494.65,6449.53,6449.53,United Healthcare-Medicare Advantage, +149524,3934,68510,Biopsy of tear-producing gland,CPT/HCPCS,9809.65,9809.65,8910.98,11098.98,United Healthcare-Medicare Advantage, +149525,3934,68700,Plastic repair of tear ducts,CPT/HCPCS,6695.76,6695.76,7140.3,7140.3,United Healthcare-Medicare Advantage, +149526,3934,68720,Creation of drainage tract from tear sac to the nasal cavity,CPT/HCPCS,10689.18,10689.18,7646.88,13407.97,United Healthcare-Medicare Advantage, +149527,3934,68761,Closure of tear duct opening using plug,CPT/HCPCS,1106.13,1106.13,268.08,2143.5,United Healthcare-Medicare Advantage, +149528,3934,68770,Closure of abnormal tear-drainage tract,CPT/HCPCS,7155.65,7155.65,932.6,932.6,United Healthcare-Medicare Advantage, +149529,3934,68815,Probing of nasal-tear duct with insertion of tube or stent,CPT/HCPCS,6472.65,6472.65,4875.32,11718.61,United Healthcare-Medicare Advantage, +149530,3934,68816,Probing of nasal-tear duct with balloon catheter dilation,CPT/HCPCS,6081.09,6081.09,408.45,932.6,United Healthcare-Medicare Advantage, +149531,3934,68840,Probing of nasal-tear duct,CPT/HCPCS,5845.93,5845.93,3959.37,7285.19,United Healthcare-Medicare Advantage, +149532,3934,69000,Incision and drainage of external ear abscess or blood accumulation,CPT/HCPCS,539.98,539.98,144.25,695.72,United Healthcare-Medicare Advantage, +149533,3934,69020,Incision and drainage of ear canal abscess,CPT/HCPCS,2484.0,2484.0,377.25,377.25,United Healthcare-Medicare Advantage, +149534,3934,69110,Removal of portion of external ear,CPT/HCPCS,42298.02,42298.02,42298.02,42298.02,United Healthcare-Medicare Advantage, +149535,3934,69120,Removal of entire ear,CPT/HCPCS,17380.0,17380.0,17380.0,17380.0,United Healthcare-Medicare Advantage, +149536,3934,69200,Removal of foreign body from ear canal,CPT/HCPCS,2198.32,2198.32,264.56,2692.29,United Healthcare-Medicare Advantage, +149537,3934,69205,Removal of foreign body from ear canal under anesthesia,CPT/HCPCS,3540.7,3540.7,1444.99,4544.0,United Healthcare-Medicare Advantage, +149538,3934,69209,Removal of impacted ear wax by washing,CPT/HCPCS,286.21,286.21,66.52,3569.0,United Healthcare-Medicare Advantage, +149539,3934,69210,"Removal of impact ear wax, one ear",CPT/HCPCS,297.97,297.97,10.0,5731.46,United Healthcare-Medicare Advantage, +149540,3934,69300,Repair of protruding ear,CPT/HCPCS,11864.19,11864.19,2650.21,2650.21,United Healthcare-Medicare Advantage, +149541,3934,69320,Creation of an ear canal,CPT/HCPCS,16473.58,16473.58,3764.71,3764.71,United Healthcare-Medicare Advantage, +149542,3934,69421,"Incision, aspiration, and inflation of eardrum under anesthesia",CPT/HCPCS,3358.7,3358.7,664.64,4437.0,United Healthcare-Medicare Advantage, +149543,3934,69424,Removal of implanted eardrum tube under anesthesia,CPT/HCPCS,5362.01,5362.01,664.64,4471.9,United Healthcare-Medicare Advantage, +149544,3934,69436,Incision of eardrum with insertion of eardrum tube under general anesthesia,CPT/HCPCS,4268.78,4268.78,831.37,11772.94,United Healthcare-Medicare Advantage, +149545,3934,69540,Removal of polyp of external ear,CPT/HCPCS,3499.84,3499.84,5511.1,5511.1,United Healthcare-Medicare Advantage, +149546,3934,69602,Revision of previous mastoid surgery,CPT/HCPCS,25188.91,25188.91,25188.91,25188.91,United Healthcare-Medicare Advantage, +149547,3934,69603,Revision of previous mastoid surgery,CPT/HCPCS,32461.89,32461.89,4398.43,4398.43,United Healthcare-Medicare Advantage, +149548,3934,69610,Repair of eardrum,CPT/HCPCS,4264.41,4264.41,771.2,7662.22,United Healthcare-Medicare Advantage, +149549,3934,69620,Repair of defect or perforation of eardrum,CPT/HCPCS,4798.58,4798.58,1903.9,3324.45,United Healthcare-Medicare Advantage, +149550,3934,69631,Repair of eardrum and ear canal with opening to ear bones,CPT/HCPCS,13443.74,13443.74,3765.21,7920.5,United Healthcare-Medicare Advantage, +149551,3934,69632,"Repair of eardrum, ear canal, and bones",CPT/HCPCS,33700.07,33700.07,6630.44,8597.19,United Healthcare-Medicare Advantage, +149552,3934,69645,Repair of eardrum and ear canal with removal of mastoid bone,CPT/HCPCS,30015.0,30015.0,3833.91,3833.91,United Healthcare-Medicare Advantage, +149553,3934,69660,Incision or removal of ear bone with insertion of prosthesis,CPT/HCPCS,21253.67,21253.67,3626.77,3626.77,United Healthcare-Medicare Advantage, +149554,3934,69710,Implantation or replacement of temporal bone conduction hearing device,CPT/HCPCS,19285.0,19285.0,3764.71,3764.71,United Healthcare-Medicare Advantage, +149555,3934,69930,Implantation of cochlear device,CPT/HCPCS,32717.41,32717.41,11517.92,29505.44,United Healthcare-Medicare Advantage, +149556,3934,70100,"X-ray of mandible, less than 4 views",CPT/HCPCS,162.25,162.25,74.81,74.81,United Healthcare-Medicare Advantage, +149557,3934,70160,"X-ray of bones of nose, minimum of 3 views",CPT/HCPCS,448.57,448.57,462.0,462.0,United Healthcare-Medicare Advantage, +149558,3934,70200,"X-ray of eye bones, minimum of 4 views",CPT/HCPCS,914.7,914.7,623.76,1494.0,United Healthcare-Medicare Advantage, +149559,3934,70210,"X-ray of paranasal sinus, less than 3 views",CPT/HCPCS,266.0,266.0,24.84,24.84,United Healthcare-Medicare Advantage, +149560,3934,70220,"X-ray of paranasal sinus, complete, minimum of 3 views",CPT/HCPCS,1009.65,1009.65,33.72,1078.0,United Healthcare-Medicare Advantage, +149561,3934,70250,"X-ray of skull, less than 4 views",CPT/HCPCS,625.43,625.43,17.43,1140.0,United Healthcare-Medicare Advantage, +149562,3934,70260,"X-ray of skull, complete, minimum of 4 views",CPT/HCPCS,791.39,791.39,15.0,560.0,United Healthcare-Medicare Advantage, +149563,3934,70336,MRI scan of jaw joints,CPT/HCPCS,2666.5,2666.5,2152.0,2517.84,United Healthcare-Medicare Advantage, +149564,3934,70360,X-ray of soft tissue of neck,CPT/HCPCS,399.61,399.61,10.0,426.0,United Healthcare-Medicare Advantage, +149565,3934,70450,CT scan head or brain,CPT/HCPCS,1970.91,1970.91,4.74,9326.61,United Healthcare-Medicare Advantage, +149566,3934,70460,CT scan head or brain with contrast,CPT/HCPCS,2756.92,2756.92,186.72,3050.0,United Healthcare-Medicare Advantage, +149567,3934,70470,CT scan head or brain before and after contrast,CPT/HCPCS,3239.9,3239.9,155.59,3790.0,United Healthcare-Medicare Advantage, +149568,3934,70480,CT scan of cranial cavity,CPT/HCPCS,2049.75,2049.75,120.0,2248.0,United Healthcare-Medicare Advantage, +149569,3934,70481,CT scan of cranial cavity with contrast,CPT/HCPCS,3462.87,3462.87,241.59,4778.0,United Healthcare-Medicare Advantage, +149570,3934,70482,CT scan of cranial cavity before and after contrast,CPT/HCPCS,2954.05,2954.05,367.55,367.55,United Healthcare-Medicare Advantage, +149571,3934,70486,CT scan of face,CPT/HCPCS,4581.61,4581.61,130.84,7731.1,United Healthcare-Medicare Advantage, +149572,3934,70487,CT scan of face with contrast,CPT/HCPCS,3861.85,3861.85,218.97,4154.0,United Healthcare-Medicare Advantage, +149573,3934,70488,CT scan of face before and after contrast,CPT/HCPCS,4017.56,4017.56,220.76,4231.0,United Healthcare-Medicare Advantage, +149574,3934,70490,CT scan of neck,CPT/HCPCS,2262.64,2262.64,132.12,2502.1,United Healthcare-Medicare Advantage, +149575,3934,70491,CT scan of neck with contrast,CPT/HCPCS,3009.14,3009.14,102.0,6175.0,United Healthcare-Medicare Advantage, +149576,3934,70492,CT scan of neck before and after contrast,CPT/HCPCS,3231.49,3231.49,180.99,3429.0,United Healthcare-Medicare Advantage, +149577,3934,70496,CT scan of blood vessel of head with contrast,CPT/HCPCS,8472.51,8472.51,262.18,11531.0,United Healthcare-Medicare Advantage, +149578,3934,70498,CT scan of neck blood vessels with contrast,CPT/HCPCS,8379.59,8379.59,363.47,9697.0,United Healthcare-Medicare Advantage, +149579,3934,70540,"MRI scan bones of the eye, face, and/or neck",CPT/HCPCS,3322.75,3322.75,215.3,3514.0,United Healthcare-Medicare Advantage, +149580,3934,70543,"MRI scan bones of the eye, face, and/or neck before and after contrast",CPT/HCPCS,5307.96,5307.96,300.0,7629.82,United Healthcare-Medicare Advantage, +149581,3934,70544,MRA scan of head blood vessels,CPT/HCPCS,4847.04,4847.04,205.83,10498.0,United Healthcare-Medicare Advantage, +149582,3934,70545,MRA scan of head blood vessels with contrast,CPT/HCPCS,4787.33,4787.33,1695.5,1855.0,United Healthcare-Medicare Advantage, +149583,3934,70546,MRA scan of head blood vessels before and after contrast,CPT/HCPCS,6747.87,6747.87,243.99,7593.0,United Healthcare-Medicare Advantage, +149584,3934,70547,MRA scan of neck blood vessels,CPT/HCPCS,9056.61,9056.61,450.52,15406.0,United Healthcare-Medicare Advantage, +149585,3934,70549,MRA scan of neck blood vessels before and after contrast,CPT/HCPCS,4591.33,4591.33,243.99,5333.0,United Healthcare-Medicare Advantage, +149586,3934,70551,MRI scan brain,CPT/HCPCS,5357.12,5357.12,50.0,10342.0,United Healthcare-Medicare Advantage, +149587,3934,70552,MRI scan of brain with contrast,CPT/HCPCS,6279.36,6279.36,4864.86,6674.0,United Healthcare-Medicare Advantage, +149588,3934,70553,MRI scan of brain before and after contrast,CPT/HCPCS,7734.87,7734.87,40.5,8258.0,United Healthcare-Medicare Advantage, +149589,3934,70554,Functional MRI scan of brain,CPT/HCPCS,2038.83,2038.83,194.35,2136.0,United Healthcare-Medicare Advantage, +149590,3934,71045,"X-ray of chest, 1 view",CPT/HCPCS,873.29,873.29,11.31,5693.48,United Healthcare-Medicare Advantage, +149591,3934,71046,"X-ray of chest, 2 views",CPT/HCPCS,515.26,515.26,0.61,4065.48,United Healthcare-Medicare Advantage, +149592,3934,71100,"X-ray of ribs of one side of body, 2 views",CPT/HCPCS,502.97,502.97,15.0,538.0,United Healthcare-Medicare Advantage, +149593,3934,71101,"X-ray of ribs on one side of body including the chest, minimum of 3 views",CPT/HCPCS,653.52,653.52,26.25,870.0,United Healthcare-Medicare Advantage, +149594,3934,71110,"X-ray of both sides of the ribs, 3 views",CPT/HCPCS,571.4,571.4,31.55,677.0,United Healthcare-Medicare Advantage, +149595,3934,71111,"X-ray of both sides of the ribs including the chest, minimum of 4 views",CPT/HCPCS,758.63,758.63,691.6,988.0,United Healthcare-Medicare Advantage, +149596,3934,71120,"X-ray of breast bone, minimum of 2 views",CPT/HCPCS,249.28,249.28,23.36,415.0,United Healthcare-Medicare Advantage, +149597,3934,71130,"X-ray of junction of breast and collar bones, minimum of 2 views",CPT/HCPCS,291.0,291.0,191.08,191.08,United Healthcare-Medicare Advantage, +149598,3934,71250,CT scan chest,CPT/HCPCS,2438.92,2438.92,27.16,6891.0,United Healthcare-Medicare Advantage, +149599,3934,71260,CT scan chest with contrast,CPT/HCPCS,8072.26,8072.26,74.59,21042.54,United Healthcare-Medicare Advantage, +149600,3934,71270,CT scan chest before and after contrast,CPT/HCPCS,10759.07,10759.07,390.74,11192.0,United Healthcare-Medicare Advantage, +149601,3934,71271,"Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)",CPT/HCPCS,486.47,486.47,33.56,845.0,United Healthcare-Medicare Advantage, +149602,3934,71275,CT scan of blood vessels in chest with contrast,CPT/HCPCS,4697.05,4697.05,54.58,11106.0,United Healthcare-Medicare Advantage, +149603,3934,71550,MRI scan of chest,CPT/HCPCS,3760.16,3760.16,2001.0,4282.0,United Healthcare-Medicare Advantage, +149604,3934,71552,MRI scan of chest before and after contrast,CPT/HCPCS,5513.5,5513.5,418.37,5806.0,United Healthcare-Medicare Advantage, +149605,3934,71555,MRI scan of blood vessels of chest,CPT/HCPCS,3793.25,3793.25,2049.0,3878.16,United Healthcare-Medicare Advantage, +149606,3934,72020,"X-ray of spine, 1 view",CPT/HCPCS,338.29,338.29,9.63,750.0,United Healthcare-Medicare Advantage, +149607,3934,72040,"X-ray of spine of neck, 2 or 3 views",CPT/HCPCS,492.6,492.6,9.0,926.5,United Healthcare-Medicare Advantage, +149608,3934,72050,"X-ray of upper spine, 4 or 5 views",CPT/HCPCS,767.04,767.04,12.0,913.0,United Healthcare-Medicare Advantage, +149609,3934,72052,"X-ray of upper spine, 6 or more views",CPT/HCPCS,858.21,858.21,18.0,1015.0,United Healthcare-Medicare Advantage, +149610,3934,72070,"X-ray of middle spine, 3 views",CPT/HCPCS,365.11,365.11,9.0,572.5,United Healthcare-Medicare Advantage, +149611,3934,72072,"X-ray of middle spine, 3 views",CPT/HCPCS,596.18,596.18,585.0,585.0,United Healthcare-Medicare Advantage, +149612,3934,72080,"X-ray of middle and lower spine, 2 views",CPT/HCPCS,348.58,348.58,377.0,403.0,United Healthcare-Medicare Advantage, +149613,3934,72081,"X-ray of spine, 1 view",CPT/HCPCS,384.88,384.88,11.29,735.5,United Healthcare-Medicare Advantage, +149614,3934,72082,"X-ray of spine, 2 or 3 views",CPT/HCPCS,646.05,646.05,18.12,896.0,United Healthcare-Medicare Advantage, +149615,3934,72083,"X-ray of spine, 4 or 5 views",CPT/HCPCS,817.69,817.69,20.43,867.0,United Healthcare-Medicare Advantage, +149616,3934,72084,"X-ray of spine, minimum of 6 views",CPT/HCPCS,685.36,685.36,24.3,483.75,United Healthcare-Medicare Advantage, +149617,3934,72100,"X-ray of lower and sacral spine, 2 or 3 views",CPT/HCPCS,615.49,615.49,9.0,1358.0,United Healthcare-Medicare Advantage, +149618,3934,72110,"X-ray of lower and sacral spine, minimum of 4 views",CPT/HCPCS,737.94,737.94,18.0,962.0,United Healthcare-Medicare Advantage, +149619,3934,72114,X-ray lower and sacral spine including bending views minimum 6 views,CPT/HCPCS,889.21,889.21,38.53,995.0,United Healthcare-Medicare Advantage, +149620,3934,72125,CT scan of upper spine,CPT/HCPCS,3653.54,3653.54,89.16,7315.1,United Healthcare-Medicare Advantage, +149621,3934,72126,CT scan of upper spine with contrast,CPT/HCPCS,9926.0,9926.0,9926.0,9926.0,United Healthcare-Medicare Advantage, +149622,3934,72128,CT scan of middle spine,CPT/HCPCS,1550.5,1550.5,130.19,1947.0,United Healthcare-Medicare Advantage, +149623,3934,72129,CT scan of middle spine with contrast,CPT/HCPCS,2337.0,2337.0,2416.0,2416.0,United Healthcare-Medicare Advantage, +149624,3934,72131,CT scan of lower spine,CPT/HCPCS,1664.5,1664.5,84.0,2502.1,United Healthcare-Medicare Advantage, +149625,3934,72132,CT scan of lower spine with contrast,CPT/HCPCS,2554.51,2554.51,299.78,5622.55,United Healthcare-Medicare Advantage, +149626,3934,72133,CT scan of lower spine before and after contrast,CPT/HCPCS,2700.0,2700.0,2700.0,2700.0,United Healthcare-Medicare Advantage, +149627,3934,72141,MRI scan of upper spinal canal,CPT/HCPCS,4414.85,4414.85,128.25,5431.0,United Healthcare-Medicare Advantage, +149628,3934,72142,MRI scan of upper spinal canal with contrast,CPT/HCPCS,14331.66,14331.66,528.39,15180.0,United Healthcare-Medicare Advantage, +149629,3934,72146,MRI scan of middle spinal canal,CPT/HCPCS,3780.01,3780.01,83.86,4557.0,United Healthcare-Medicare Advantage, +149630,3934,72147,MRI scan of middle spinal canal with contrast,CPT/HCPCS,6076.55,6076.55,248.81,6444.0,United Healthcare-Medicare Advantage, +149631,3934,72148,MRI scan of lower spinal canal,CPT/HCPCS,4635.8,4635.8,50.0,5363.0,United Healthcare-Medicare Advantage, +149632,3934,72149,MRI scan of lower spinal canal with contrast,CPT/HCPCS,6821.78,6821.78,2554.2,6670.0,United Healthcare-Medicare Advantage, +149633,3934,72156,MRI scan of upper spinal canal before and after contrast,CPT/HCPCS,5739.41,5739.41,267.6,6217.0,United Healthcare-Medicare Advantage, +149634,3934,72157,MRI scan of middle spinal canal before and after contrast,CPT/HCPCS,5826.68,5826.68,281.54,6318.0,United Healthcare-Medicare Advantage, +149635,3934,72158,MRI scan of lower spinal canal before and after contrast,CPT/HCPCS,5685.4,5685.4,133.8,6161.0,United Healthcare-Medicare Advantage, +149636,3934,72170,"X-ray of pelvis, 1 or 2 views",CPT/HCPCS,388.96,388.96,12.04,882.0,United Healthcare-Medicare Advantage, +149637,3934,72190,"X-ray of pelvis, minimum of 3 views",CPT/HCPCS,348.46,348.46,19.27,706.0,United Healthcare-Medicare Advantage, +149638,3934,72191,CT scan of pelvic blood vessels with contrast,CPT/HCPCS,3170.5,3170.5,3116.0,4392.0,United Healthcare-Medicare Advantage, +149639,3934,72192,CT scan pelvis,CPT/HCPCS,2145.89,2145.89,27.16,2502.1,United Healthcare-Medicare Advantage, +149640,3934,72193,CT scan pelvis with contrast,CPT/HCPCS,3072.15,3072.15,341.73,3116.0,United Healthcare-Medicare Advantage, +149641,3934,72195,MRI scan of pelvis,CPT/HCPCS,3936.92,3936.92,50.0,4322.0,United Healthcare-Medicare Advantage, +149642,3934,72196,MRI scan of pelvis with contrast,CPT/HCPCS,4443.43,4443.43,462.61,4845.0,United Healthcare-Medicare Advantage, +149643,3934,72197,MRI scan of pelvis before and after contrast,CPT/HCPCS,5486.27,5486.27,92.52,5870.0,United Healthcare-Medicare Advantage, +149644,3934,72202,"X-ray of sacroiliac joints, 3 or more views",CPT/HCPCS,476.0,476.0,12.0,477.0,United Healthcare-Medicare Advantage, +149645,3934,72220,"X-ray of pelvis, minimum of 2 views",CPT/HCPCS,421.53,421.53,9.0,488.0,United Healthcare-Medicare Advantage, +149646,3934,73000,X-ray of collar bone,CPT/HCPCS,470.83,470.83,9.63,721.0,United Healthcare-Medicare Advantage, +149647,3934,73010,X-ray of shoulder blade,CPT/HCPCS,504.08,504.08,11.77,724.0,United Healthcare-Medicare Advantage, +149648,3934,73020,"X-ray of shoulder, 1 view",CPT/HCPCS,391.72,391.72,15.38,740.0,United Healthcare-Medicare Advantage, +149649,3934,73030,"X-ray of shoulder, minimum of 2 views",CPT/HCPCS,506.2,506.2,5.0,1617.0,United Healthcare-Medicare Advantage, +149650,3934,73050,X-ray of both collar bones,CPT/HCPCS,341.72,341.72,17.5,247.52,United Healthcare-Medicare Advantage, +149651,3934,73060,"X-ray of upper arm, minimum of 2 views",CPT/HCPCS,466.39,466.39,9.63,1413.0,United Healthcare-Medicare Advantage, +149652,3934,73070,"X-ray of elbow, 2 views",CPT/HCPCS,460.04,460.04,9.63,479.0,United Healthcare-Medicare Advantage, +149653,3934,73080,"X-ray of elbow, minimum of 3 views",CPT/HCPCS,496.26,496.26,7.5,1138.0,United Healthcare-Medicare Advantage, +149654,3934,73090,"X-ray of forearm, 2 views",CPT/HCPCS,494.06,494.06,9.63,1028.0,United Healthcare-Medicare Advantage, +149655,3934,73100,"X-ray of wrist, 2 views",CPT/HCPCS,564.61,564.61,9.63,823.0,United Healthcare-Medicare Advantage, +149656,3934,73110,"X-ray of wrist, minimum of 3 views",CPT/HCPCS,619.11,619.11,4.0,2776.26,United Healthcare-Medicare Advantage, +149657,3934,73120,"X-ray of hand, 2 views",CPT/HCPCS,653.28,653.28,10.0,989.0,United Healthcare-Medicare Advantage, +149658,3934,73130,"X-ray of hand, minimum of 3 views",CPT/HCPCS,726.57,726.57,7.5,2144.0,United Healthcare-Medicare Advantage, +149659,3934,73140,"X-ray of fingers, minimum of 2 views",CPT/HCPCS,539.86,539.86,4.5,1184.0,United Healthcare-Medicare Advantage, +149660,3934,73200,CT scan of arm,CPT/HCPCS,1638.85,1638.85,21.0,3430.0,United Healthcare-Medicare Advantage, +149661,3934,73201,CT scan of arm with contrast,CPT/HCPCS,2668.55,2668.55,493.78,2619.0,United Healthcare-Medicare Advantage, +149662,3934,73206,CT scan of arm blood vessels with contrast,CPT/HCPCS,2685.71,2685.71,499.18,2672.0,United Healthcare-Medicare Advantage, +149663,3934,73218,MRI scan of arm,CPT/HCPCS,4201.43,4201.43,255.51,4434.0,United Healthcare-Medicare Advantage, +149664,3934,73220,MRI scan of arm before and after contrast,CPT/HCPCS,5028.8,5028.8,412.85,5625.0,United Healthcare-Medicare Advantage, +149665,3934,73221,MRI scan of arm joint,CPT/HCPCS,3596.28,3596.28,179.02,4094.0,United Healthcare-Medicare Advantage, +149666,3934,73223,MRI scan of arm joint before and after contrast,CPT/HCPCS,4485.42,4485.42,382.48,4781.0,United Healthcare-Medicare Advantage, +149667,3934,73501,"X-ray of hip with pelvis, 1 view",CPT/HCPCS,513.81,513.81,9.03,1075.8,United Healthcare-Medicare Advantage, +149668,3934,73502,"X-ray of hip with pelvis, 2-3 views",CPT/HCPCS,505.8,505.8,7.48,1204.5,United Healthcare-Medicare Advantage, +149669,3934,73503,"X-ray of hip with pelvis, minimum of 4 views",CPT/HCPCS,632.26,632.26,15.59,753.0,United Healthcare-Medicare Advantage, +149670,3934,73521,"X-ray of both hips with pelvis, 2 views",CPT/HCPCS,598.9,598.9,18.06,641.0,United Healthcare-Medicare Advantage, +149671,3934,73522,"X-ray of both hips with pelvis, 3-4 views",CPT/HCPCS,613.26,613.26,8.84,652.0,United Healthcare-Medicare Advantage, +149672,3934,73523,"X-ray of both hips with pelvis, minimum of 5 views",CPT/HCPCS,862.49,862.49,16.46,918.0,United Healthcare-Medicare Advantage, +149673,3934,73551,"X-ray of femur, 1 view",CPT/HCPCS,375.52,375.52,24.27,385.0,United Healthcare-Medicare Advantage, +149674,3934,73552,"X-ray of femur, minimum 2 views",CPT/HCPCS,394.26,394.26,9.42,489.5,United Healthcare-Medicare Advantage, +149675,3934,73560,"X-ray of knee, 1 or 2 views",CPT/HCPCS,437.07,437.07,9.63,720.0,United Healthcare-Medicare Advantage, +149676,3934,73562,"X-ray of knee, 3 views",CPT/HCPCS,472.06,472.06,9.0,1182.0,United Healthcare-Medicare Advantage, +149677,3934,73564,"X-ray of knee, 4 or more views",CPT/HCPCS,670.68,670.68,15.17,937.0,United Healthcare-Medicare Advantage, +149678,3934,73565,"X-ray of both knees, standing, front to back view",CPT/HCPCS,364.33,364.33,19.35,398.0,United Healthcare-Medicare Advantage, +149679,3934,73590,"X-ray of lower leg, 2 views",CPT/HCPCS,528.98,528.98,6.0,1204.0,United Healthcare-Medicare Advantage, +149680,3934,73592,X-ray of leg in infant minimum of 2 views,CPT/HCPCS,689.64,689.64,24.84,460.75,United Healthcare-Medicare Advantage, +149681,3934,73600,"X-ray of ankle, 2 views",CPT/HCPCS,475.01,475.01,9.63,984.0,United Healthcare-Medicare Advantage, +149682,3934,73610,"X-ray of ankle, minimum of 3 views",CPT/HCPCS,611.4,611.4,7.5,2736.0,United Healthcare-Medicare Advantage, +149683,3934,73620,"X-ray of foot, 2 views",CPT/HCPCS,440.85,440.85,10.0,463.0,United Healthcare-Medicare Advantage, +149684,3934,73630,"X-ray of foot, minimum of 3 views",CPT/HCPCS,637.66,637.66,7.5,1600.0,United Healthcare-Medicare Advantage, +149685,3934,73650,"X-ray of heel, minimum of 2 views",CPT/HCPCS,441.58,441.58,6.0,698.0,United Healthcare-Medicare Advantage, +149686,3934,73660,"X-ray of toes, minimum of 2 views",CPT/HCPCS,589.52,589.52,7.23,628.0,United Healthcare-Medicare Advantage, +149687,3934,73700,CT scan leg,CPT/HCPCS,1798.84,1798.84,71.73,4098.0,United Healthcare-Medicare Advantage, +149688,3934,73701,CT scan leg with contrast injection,CPT/HCPCS,3092.43,3092.43,352.69,7926.0,United Healthcare-Medicare Advantage, +149689,3934,73706,CT scan of lower leg blood vessels with contrast,CPT/HCPCS,2967.91,2967.91,587.09,3179.0,United Healthcare-Medicare Advantage, +149690,3934,73718,MRI scan of leg,CPT/HCPCS,3946.83,3946.83,50.0,4375.5,United Healthcare-Medicare Advantage, +149691,3934,73720,MRI scan of leg before and after contrast,CPT/HCPCS,5803.53,5803.53,314.27,10153.49,United Healthcare-Medicare Advantage, +149692,3934,73721,MRI scan of leg joint,CPT/HCPCS,4157.7,4157.7,56.47,4963.5,United Healthcare-Medicare Advantage, +149693,3934,73723,MRI scan of leg joint before and after contrast,CPT/HCPCS,5870.24,5870.24,75.0,5787.0,United Healthcare-Medicare Advantage, +149694,3934,73725,MRA scan of leg blood vessels,CPT/HCPCS,5347.5,5347.5,329.64,334.78,United Healthcare-Medicare Advantage, +149695,3934,74018,"X-ray of abdomen, 1 view",CPT/HCPCS,553.64,553.64,10.0,1596.0,United Healthcare-Medicare Advantage, +149696,3934,74019,"X-ray of abdomen, 2 views",CPT/HCPCS,632.02,632.02,9.0,666.0,United Healthcare-Medicare Advantage, +149697,3934,74150,CT scan abdomen,CPT/HCPCS,2382.67,2382.67,99.37,2548.0,United Healthcare-Medicare Advantage, +149698,3934,74160,CT scan abdomen with contrast,CPT/HCPCS,3713.16,3713.16,192.21,3945.0,United Healthcare-Medicare Advantage, +149699,3934,74170,CT scan abdomen before and after contrast,CPT/HCPCS,4090.72,4090.72,216.48,4423.0,United Healthcare-Medicare Advantage, +149700,3934,74174,CT scan of abdominal and pelvic blood vessels with contrast,CPT/HCPCS,5033.11,5033.11,92.52,5347.0,United Healthcare-Medicare Advantage, +149701,3934,74175,CT scan of abdominal blood vessels with contrast,CPT/HCPCS,4004.36,4004.36,165.09,4276.0,United Healthcare-Medicare Advantage, +149702,3934,74176,CT scan of abdomen and pelvis,CPT/HCPCS,4198.5,4198.5,48.46,5708.15,United Healthcare-Medicare Advantage, +149703,3934,74177,CT scan of abdomen and pelvis with contrast,CPT/HCPCS,5275.96,5275.96,9.2,11852.0,United Healthcare-Medicare Advantage, +149704,3934,74178,CT scan of abdomen and pelvis before and after contrast,CPT/HCPCS,6193.41,6193.41,131.73,6585.0,United Healthcare-Medicare Advantage, +149705,3934,74181,MRI scan of abdomen,CPT/HCPCS,1985.08,1985.08,50.0,2127.0,United Healthcare-Medicare Advantage, +149706,3934,74183,MRI scan of abdomen before and after contrast,CPT/HCPCS,6897.88,6897.88,92.52,7359.0,United Healthcare-Medicare Advantage, +149707,3934,74185,MRI scan of blood vessels of abdomen,CPT/HCPCS,3963.57,3963.57,589.77,3548.5,United Healthcare-Medicare Advantage, +149708,3934,74190,Radiological supervision and interpretation X-ray of lower abdominal and genital region,CPT/HCPCS,1081.91,1081.91,65.58,1115.0,United Healthcare-Medicare Advantage, +149709,3934,74220,X-ray of esophagus with single contrast,CPT/HCPCS,850.06,850.06,19.27,814.0,United Healthcare-Medicare Advantage, +149710,3934,74221,X-ray of esophagus with double contrast,CPT/HCPCS,836.13,836.13,274.95,932.0,United Healthcare-Medicare Advantage, +149711,3934,74230,Imaging for evaluation of swallowing function,CPT/HCPCS,817.55,817.55,19.27,1412.5,United Healthcare-Medicare Advantage, +149712,3934,74240,X-ray of upper digestive tract with single contrast,CPT/HCPCS,834.01,834.01,28.9,871.0,United Healthcare-Medicare Advantage, +149713,3934,74246,X-ray of upper digestive tract with double contrast,CPT/HCPCS,754.52,754.52,48.17,871.0,United Healthcare-Medicare Advantage, +149714,3934,74248,Follow-through X-ray of upper digestive tract with multiple serial films,CPT/HCPCS,81.64,81.64,17.09,86.0,United Healthcare-Medicare Advantage, +149715,3934,74250,X-ray of upper digestive tract with single contrast and multiple serial films,CPT/HCPCS,871.0,871.0,811.65,811.65,United Healthcare-Medicare Advantage, +149716,3934,74261,Diagnostic CT scan of large bowel,CPT/HCPCS,2917.29,2917.29,135.11,135.11,United Healthcare-Medicare Advantage, +149717,3934,74270,X-ray of large bowel with single contrast,CPT/HCPCS,929.33,929.33,113.56,908.0,United Healthcare-Medicare Advantage, +149718,3934,74280,X-ray of large bowel with double contrast,CPT/HCPCS,1294.0,1294.0,905.8,905.8,United Healthcare-Medicare Advantage, +149719,3934,74283,Imaging of colon using enema,CPT/HCPCS,7888.46,7888.46,317.24,464.39,United Healthcare-Medicare Advantage, +149720,3934,74300,Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery,CPT/HCPCS,4148.33,4148.33,381.85,381.85,United Healthcare-Medicare Advantage, +149721,3934,74410,Imaging of urinary tract using infusion technique,CPT/HCPCS,3273.0,3273.0,3125.0,3125.0,United Healthcare-Medicare Advantage, +149722,3934,74420,Imaging of urinary tract,CPT/HCPCS,21932.99,21932.99,4488.54,4492.94,United Healthcare-Medicare Advantage, +149723,3934,74430,"Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views",CPT/HCPCS,1409.15,1409.15,431.05,1491.0,United Healthcare-Medicare Advantage, +149724,3934,74450,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,987.0,987.0,272.46,282.33,United Healthcare-Medicare Advantage, +149725,3934,74455,Radiological supervision and interpretation X-ray of urinary bladder and urethra,CPT/HCPCS,1573.68,1573.68,33.72,2660.0,United Healthcare-Medicare Advantage, +149726,3934,74712,"Magnetic resonance imaging of fetus, single or first pregnancy",CPT/HCPCS,3399.87,3399.87,145.13,3133.83,United Healthcare-Medicare Advantage, +149727,3934,74740,Radiological supervision and interpretation X-ray of uterine tubes and ovaries,CPT/HCPCS,890.58,890.58,25.0,612.5,United Healthcare-Medicare Advantage, +149728,3934,74742,Radiological supervision and interpretation of placement of catheter of uterine tube procedure,CPT/HCPCS,989.67,989.67,364.52,364.52,United Healthcare-Medicare Advantage, +149729,3934,75557,MRI of heart,CPT/HCPCS,2308.17,2308.17,276.87,2485.0,United Healthcare-Medicare Advantage, +149730,3934,75561,MRI of heart before and after contrast,CPT/HCPCS,7793.19,7793.19,94.56,9574.0,United Healthcare-Medicare Advantage, +149731,3934,75565,MRI of blood flow of heart,CPT/HCPCS,736.58,736.58,44.56,2049.0,United Healthcare-Medicare Advantage, +149732,3934,75572,CT scan of heart structure with contrast,CPT/HCPCS,1206.26,1206.26,44.16,1454.5,United Healthcare-Medicare Advantage, +149733,3934,75574,CT scan of heart blood vessels and grafts with contrast dye,CPT/HCPCS,2756.22,2756.22,3.13,30283.27,United Healthcare-Medicare Advantage, +149734,3934,75625,Radiological supervision and interpretation X-ray of abdominal aorta,CPT/HCPCS,22081.88,22081.88,13129.99,22612.22,United Healthcare-Medicare Advantage, +149735,3934,75635,CT scan of abdominal aorta and both leg arteries with contrast,CPT/HCPCS,3050.31,3050.31,197.57,3308.0,United Healthcare-Medicare Advantage, +149736,3934,75710,Radiological supervision and interpretation of imaging of artery of one arm or leg,CPT/HCPCS,6461.76,6461.76,5766.0,7233.0,United Healthcare-Medicare Advantage, +149737,3934,75716,Radiological supervision and interpretation of imaging of arteries of both arms or legs,CPT/HCPCS,8146.11,8146.11,7999.0,10782.0,United Healthcare-Medicare Advantage, +149738,3934,75726,Radiological supervision and interpretation of imaging of abdominal artery,CPT/HCPCS,11390.13,11390.13,243.6,15463.85,United Healthcare-Medicare Advantage, +149739,3934,75736,Radiological supervision and interpretation of imaging of artery of pelvis,CPT/HCPCS,26753.39,26753.39,2140.11,31960.43,United Healthcare-Medicare Advantage, +149740,3934,75774,Radiological supervision and interpretation of imaging of artery,CPT/HCPCS,3698.07,3698.07,65.85,2689.0,United Healthcare-Medicare Advantage, +149741,3934,75809,Radiological supervision and interpretation of imaging of previous placed shunt,CPT/HCPCS,2923.1,2923.1,156.15,3109.0,United Healthcare-Medicare Advantage, +149742,3934,75820,Radiological supervision and interpretation of imaging of vein of one arm or leg,CPT/HCPCS,4759.33,4759.33,4769.0,4769.0,United Healthcare-Medicare Advantage, +149743,3934,75889,Radiological supervision and interpretation of imaging of liver vein with assessment of blood flow,CPT/HCPCS,15997.39,15997.39,18339.0,18339.0,United Healthcare-Medicare Advantage, +149744,3934,75891,Radiological supervision and interpretation of imaging of liver vein,CPT/HCPCS,19041.4,19041.4,189.19,378.39,United Healthcare-Medicare Advantage, +149745,3934,75893,Radiological supervision and interpretation of drawing blood via catheter procedure,CPT/HCPCS,12804.08,12804.08,4822.2,5126.46,United Healthcare-Medicare Advantage, +149746,3934,75894,Radiological supervision and interpretation of obstruction of blood vessel via catheter,CPT/HCPCS,6081.44,6081.44,458.22,5697.0,United Healthcare-Medicare Advantage, +149747,3934,75898,Imaging of blood vessel,CPT/HCPCS,6659.76,6659.76,2931.83,8622.0,United Healthcare-Medicare Advantage, +149748,3934,75970,Radiological supervision and interpretation of biopsy procedure,CPT/HCPCS,2946.75,2946.75,378.39,2823.0,United Healthcare-Medicare Advantage, +149749,3934,75984,Radiological supervision and interpretation of change of tube (accessed through the skin) or drainage catheter with contrast monitoring,CPT/HCPCS,668.68,668.68,381.85,673.0,United Healthcare-Medicare Advantage, +149750,3934,75989,Radiological supervision and interpretation of placement of catheter with drainage (accessed through the skin) procedure,CPT/HCPCS,1915.13,1915.13,378.39,1997.0,United Healthcare-Medicare Advantage, +149751,3934,76000,"Imaging guidance for procedure, up to 1 hour",CPT/HCPCS,4129.02,4129.02,104.0,13606.0,United Healthcare-Medicare Advantage, +149752,3934,76010,"Imaging from nose to rectum, single view, child",CPT/HCPCS,492.01,492.01,20.0,474.0,United Healthcare-Medicare Advantage, +149753,3934,76080,Imaging for abscess or abnormal drainage tract procedure,CPT/HCPCS,2541.41,2541.41,81.7,3885.0,United Healthcare-Medicare Advantage, +149754,3934,76098,Imaging of surgical specimen,CPT/HCPCS,6718.48,6718.48,296.05,17632.0,United Healthcare-Medicare Advantage, +149755,3934,76376,3D radiographic procedure,CPT/HCPCS,1322.65,1322.65,14.99,3880.59,United Healthcare-Medicare Advantage, +149756,3934,76377,3D radiographic procedure with computerized image postprocessing,CPT/HCPCS,813.26,813.26,34.7,1568.0,United Healthcare-Medicare Advantage, +149757,3934,76390,MRI study,CPT/HCPCS,2690.43,2690.43,393.89,393.89,United Healthcare-Medicare Advantage, +149758,3934,76498,MRI scan,CPT/HCPCS,3077.0,3077.0,96.69,3077.0,United Healthcare-Medicare Advantage, +149759,3934,76506,Ultrasound of brain,CPT/HCPCS,680.25,680.25,92.66,473.46,United Healthcare-Medicare Advantage, +149760,3934,76511,Ultrasound of eye disease or growth,CPT/HCPCS,471.0,471.0,95.34,189.44,United Healthcare-Medicare Advantage, +149761,3934,76512,"Ultrasound of eye disease, growth, or structure",CPT/HCPCS,380.0,380.0,78.0,334.0,United Healthcare-Medicare Advantage, +149762,3934,76514,Ultrasound of corneal structure and measurement,CPT/HCPCS,66.67,66.67,45.44,90.88,United Healthcare-Medicare Advantage, +149763,3934,76519,Ultrasound of eye for determination of lens power,CPT/HCPCS,935.0,935.0,435.62,435.62,United Healthcare-Medicare Advantage, +149764,3934,76529,Ultrasound of eye foreign body localization,CPT/HCPCS,573.8,573.8,97.74,183.67,United Healthcare-Medicare Advantage, +149765,3934,76536,Ultrasound of head and neck,CPT/HCPCS,1083.18,1083.18,18.0,1196.5,United Healthcare-Medicare Advantage, +149766,3934,76604,Ultrasound of chest,CPT/HCPCS,1043.95,1043.95,63.29,1678.0,United Healthcare-Medicare Advantage, +149767,3934,76641,Ultrasound of one breast,CPT/HCPCS,834.55,834.55,17.94,2551.5,United Healthcare-Medicare Advantage, +149768,3934,76642,Ultrasound of one breast,CPT/HCPCS,773.66,773.66,16.0,1500.0,United Healthcare-Medicare Advantage, +149769,3934,76700,Ultrasound of abdomen,CPT/HCPCS,1137.35,1137.35,36.0,1335.0,United Healthcare-Medicare Advantage, +149770,3934,76705,Ultrasound of abdomen,CPT/HCPCS,1327.89,1327.89,17.85,2803.0,United Healthcare-Medicare Advantage, +149771,3934,76706,Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm),CPT/HCPCS,781.41,781.41,22.25,966.0,United Healthcare-Medicare Advantage, +149772,3934,76770,Ultrasound behind abdominal cavity,CPT/HCPCS,1155.25,1155.25,25.0,3099.0,United Healthcare-Medicare Advantage, +149773,3934,76775,"Ultrasound behind abdominal cavity, limited",CPT/HCPCS,1064.71,1064.71,32.74,1133.0,United Healthcare-Medicare Advantage, +149774,3934,76776,Ultrasound of transplanted kidney,CPT/HCPCS,961.35,961.35,78.72,1908.0,United Healthcare-Medicare Advantage, +149775,3934,76800,Ultrasound of spinal canal,CPT/HCPCS,578.77,578.77,57.8,471.9,United Healthcare-Medicare Advantage, +149776,3934,76801,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus,CPT/HCPCS,2983.0,2983.0,100.5,3085.0,United Healthcare-Medicare Advantage, +149777,3934,76802,Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days),CPT/HCPCS,306.4,306.4,68.65,68.65,United Healthcare-Medicare Advantage, +149778,3934,76805,Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus,CPT/HCPCS,944.17,944.17,55.0,715.26,United Healthcare-Medicare Advantage, +149779,3934,76811,Abdominal ultrasound of pregnant uterus single or first fetus,CPT/HCPCS,706.29,706.29,92.66,199.25,United Healthcare-Medicare Advantage, +149780,3934,76812,Abdominal ultrasound of pregnant uterus,CPT/HCPCS,712.0,712.0,123.02,123.02,United Healthcare-Medicare Advantage, +149781,3934,76813,Ultrasound of pregnant uterus (first trimester) single or first fetus,CPT/HCPCS,257.87,257.87,69.4,127.66,United Healthcare-Medicare Advantage, +149782,3934,76815,"Ultrasound of pregnant uterus, 1 or more fetus(es)",CPT/HCPCS,508.62,508.62,9.7,1760.66,United Healthcare-Medicare Advantage, +149783,3934,76816,"Ultrasound re-evaluation of pregnant uterus, per fetus",CPT/HCPCS,679.24,679.24,25.0,480.9,United Healthcare-Medicare Advantage, +149784,3934,76817,Vaginal ultrasound of pregnant uterus,CPT/HCPCS,876.63,876.63,11.85,1942.0,United Healthcare-Medicare Advantage, +149785,3934,76818,Ultrasound and monitoring of heart of fetus,CPT/HCPCS,4358.52,4358.52,190.14,5102.89,United Healthcare-Medicare Advantage, +149786,3934,76819,Ultrasound of fetus,CPT/HCPCS,4084.21,4084.21,234.57,4519.0,United Healthcare-Medicare Advantage, +149787,3934,76820,Ultrasound of fetal umbilical artery flow rate,CPT/HCPCS,455.18,455.18,24.44,127.66,United Healthcare-Medicare Advantage, +149788,3934,76825,Ultrasound of fetal heart blood flow,CPT/HCPCS,3564.07,3564.07,64.06,9157.0,United Healthcare-Medicare Advantage, +149789,3934,76827,Ultrasound of fetal heart,CPT/HCPCS,3564.07,3564.07,64.45,8020.25,United Healthcare-Medicare Advantage, +149790,3934,76830,Ultrasound pelvis through vagina,CPT/HCPCS,5344.99,5344.99,102.36,8191.5,United Healthcare-Medicare Advantage, +149791,3934,76856,Ultrasound of pelvis,CPT/HCPCS,3814.62,3814.62,41.16,6225.5,United Healthcare-Medicare Advantage, +149792,3934,76857,Ultrasound of pelvis,CPT/HCPCS,664.16,664.16,26.5,703.0,United Healthcare-Medicare Advantage, +149793,3934,76870,Ultrasound of scrotum,CPT/HCPCS,3446.54,3446.54,43.0,4588.5,United Healthcare-Medicare Advantage, +149794,3934,76872,Ultrasound of rectum,CPT/HCPCS,6260.29,6260.29,1712.73,8853.0,United Healthcare-Medicare Advantage, +149795,3934,76873,Ultrasound of prostate,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Medicare Advantage, +149796,3934,76881,Complete ultrasound of joint of arm or leg,CPT/HCPCS,750.28,750.28,36.55,752.0,United Healthcare-Medicare Advantage, +149797,3934,76882,Partial ultrasound of joint or other non-blood vessel structure of arm or leg,CPT/HCPCS,537.69,537.69,5.92,800.5,United Healthcare-Medicare Advantage, +149798,3934,76885,"Ultrasound of hips with manipulation, infant",CPT/HCPCS,532.5,532.5,28.9,569.0,United Healthcare-Medicare Advantage, +149799,3934,76886,"Ultrasound of hips, infant",CPT/HCPCS,538.17,538.17,98.09,414.96,United Healthcare-Medicare Advantage, +149800,3934,76937,Ultrasound guidance for accessing into blood vessel,CPT/HCPCS,554.29,554.29,27.66,643.0,United Healthcare-Medicare Advantage, +149801,3934,76942,Ultrasonic guidance imaging supervision and interpretation for insertion of needle,CPT/HCPCS,2197.85,2197.85,25.0,2348.0,United Healthcare-Medicare Advantage, +149802,3934,76946,Ultrasonic guidance imaging supervision and interpretation for amniocentesis,CPT/HCPCS,408.0,408.0,212.07,212.07,United Healthcare-Medicare Advantage, +149803,3934,76981,Elastography ultrasound of organ tissue,CPT/HCPCS,1233.66,1233.66,65.0,1407.5,United Healthcare-Medicare Advantage, +149804,3934,76999,Ultrasound procedure,CPT/HCPCS,686.67,686.67,351.0,492.0,United Healthcare-Medicare Advantage, +149805,3934,77001,"Fluoroscopic guidance for insertion, replacement or removal of central venous access device",CPT/HCPCS,558.48,558.48,45.22,599.0,United Healthcare-Medicare Advantage, +149806,3934,77002,Fluoroscopic guidance for insertion of needle,CPT/HCPCS,788.0,788.0,454.07,801.0,United Healthcare-Medicare Advantage, +149807,3934,77003,Fluoroscopic guidance for injection into spine or muscle next to spine,CPT/HCPCS,853.07,853.07,24.08,1103.0,United Healthcare-Medicare Advantage, +149808,3934,77012,Radiological supervision and interpretation of CT guidance for needle insertion,CPT/HCPCS,2400.47,2400.47,85.12,2598.0,United Healthcare-Medicare Advantage, +149809,3934,77013,CT scan guidance for and monitoring of tissue destruction,CPT/HCPCS,1115.38,1115.38,208.13,1203.0,United Healthcare-Medicare Advantage, +149810,3934,77046,MRI of one breast,CPT/HCPCS,3175.8,3175.8,276.87,3395.0,United Healthcare-Medicare Advantage, +149811,3934,77047,MRI of both breasts,CPT/HCPCS,3097.47,3097.47,282.33,3395.0,United Healthcare-Medicare Advantage, +149812,3934,77048,MRI of one breast with and without contrast,CPT/HCPCS,3991.4,3991.4,313.56,3702.0,United Healthcare-Medicare Advantage, +149813,3934,77049,MRI of both breasts with and without contrast,CPT/HCPCS,3998.62,3998.62,306.39,6217.39,United Healthcare-Medicare Advantage, +149814,3934,77053,Radiological supervision and interpretation of imaging of breast duct,CPT/HCPCS,4564.67,4564.67,715.74,715.74,United Healthcare-Medicare Advantage, +149815,3934,77061,Digital tomography of one breast,CPT/HCPCS,161.0,161.0,7.86,1628.0,United Healthcare-Medicare Advantage, +149816,3934,77062,Digital tomography of both breasts,CPT/HCPCS,160.41,160.41,0.01,1880.9,United Healthcare-Medicare Advantage, +149817,3934,77063,Screening digital tomography of both breasts,CPT/HCPCS,187.95,187.95,6.07,1457.0,United Healthcare-Medicare Advantage, +149818,3934,77065,Mammography of one breast,CPT/HCPCS,704.94,704.94,23.05,1828.0,United Healthcare-Medicare Advantage, +149819,3934,77066,Mammography of both breasts,CPT/HCPCS,878.63,878.63,29.35,1766.85,United Healthcare-Medicare Advantage, +149820,3934,77067,Mammography of both breasts,CPT/HCPCS,872.14,872.14,58.2,1361.5,United Healthcare-Medicare Advantage, +149821,3934,77072,Imaging for bone age assessment,CPT/HCPCS,525.36,525.36,15.0,681.0,United Healthcare-Medicare Advantage, +149822,3934,77073,Imaging for bone length assessment,CPT/HCPCS,734.66,734.66,24.08,1045.8,United Healthcare-Medicare Advantage, +149823,3934,77075,X-ray survey of forearm or wrist bone density,CPT/HCPCS,787.0,787.0,27.16,851.0,United Healthcare-Medicare Advantage, +149824,3934,77076,"X-ray survey of bones, infant",CPT/HCPCS,571.46,571.46,33.72,545.0,United Healthcare-Medicare Advantage, +149825,3934,77080,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,933.24,933.24,25.76,4256.5,United Healthcare-Medicare Advantage, +149826,3934,77085,Bone density measurement using dedicated X-ray machine,CPT/HCPCS,281.51,281.51,42.71,2062.43,United Healthcare-Medicare Advantage, +149827,3934,77280,"Management of radiation therapy simulation, simple",CPT/HCPCS,1077.45,1077.45,38.8,9842.5,United Healthcare-Medicare Advantage, +149828,3934,77290,"Management of radiation therapy, simulation, complex",CPT/HCPCS,2758.48,2758.48,81.22,2960.0,United Healthcare-Medicare Advantage, +149829,3934,77293,Respiratory motion management simulation,CPT/HCPCS,275.21,275.21,124.42,8796.0,United Healthcare-Medicare Advantage, +149830,3934,77295,"Management of radiation therapy, 3D",CPT/HCPCS,19303.3,19303.3,364.78,43116.0,United Healthcare-Medicare Advantage, +149831,3934,77300,Calculation of radiation therapy dose,CPT/HCPCS,3628.36,3628.36,37.82,9999.0,United Healthcare-Medicare Advantage, +149832,3934,77301,Management of modulation radiotherapy planning,CPT/HCPCS,15032.61,15032.61,281.34,24579.0,United Healthcare-Medicare Advantage, +149833,3934,77307,Radiation therapy plan,CPT/HCPCS,9697.32,9697.32,562.03,30711.5,United Healthcare-Medicare Advantage, +149834,3934,77316,Radiation therapy plan,CPT/HCPCS,8551.48,8551.48,1112.94,8913.0,United Healthcare-Medicare Advantage, +149835,3934,77317,Radiation therapy plan,CPT/HCPCS,6282.57,6282.57,670.79,6529.0,United Healthcare-Medicare Advantage, +149836,3934,77318,Radiation therapy plan,CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Medicare Advantage, +149837,3934,77321,Radiation therapy total body port plan,CPT/HCPCS,5784.6,5784.6,122.9,14947.0,United Healthcare-Medicare Advantage, +149838,3934,77331,Special radiation therapy planning,CPT/HCPCS,3922.89,3922.89,290.73,7620.0,United Healthcare-Medicare Advantage, +149839,3934,77332,"Radiation treatment devices, design and construction, simple",CPT/HCPCS,18188.0,18188.0,17596.58,18188.0,United Healthcare-Medicare Advantage, +149840,3934,77334,"Radiation treatment devices, design and construction, complex",CPT/HCPCS,4215.52,4215.52,63.89,22248.0,United Healthcare-Medicare Advantage, +149841,3934,77336,Radiation therapy consultation per week,CPT/HCPCS,1379.45,1379.45,1.5,6119.0,United Healthcare-Medicare Advantage, +149842,3934,77338,Design and construction of device for radiation therapy,CPT/HCPCS,15038.65,15038.65,232.6,21915.0,United Healthcare-Medicare Advantage, +149843,3934,77370,Radiation therapy consultation,CPT/HCPCS,1968.94,1968.94,148.56,2123.0,United Healthcare-Medicare Advantage, +149844,3934,77372,"Radiation therapy delivery, stereotactic radiosurgery (SRS) for cranial growths, per session",CPT/HCPCS,28190.43,28190.43,1252.75,28135.0,United Healthcare-Medicare Advantage, +149845,3934,77373,Stereotactic body radiation therapy 1 or more lesions using imaging guidance,CPT/HCPCS,9341.91,9341.91,805.71,10005.0,United Healthcare-Medicare Advantage, +149846,3934,77385,Radiation therapy delivery,CPT/HCPCS,2578.27,2578.27,52.22,12319.0,United Healthcare-Medicare Advantage, +149847,3934,77386,Radiation therapy delivery,CPT/HCPCS,3224.41,3224.41,3.5,46839.1,United Healthcare-Medicare Advantage, +149848,3934,77387,Guidance for localization of target delivery of radiation treatment,CPT/HCPCS,456.84,456.84,70.4,958.5,United Healthcare-Medicare Advantage, +149849,3934,77402,Simple radiation treatment delivery >/=1 MeV,CPT/HCPCS,857.69,857.69,148.66,880.0,United Healthcare-Medicare Advantage, +149850,3934,77407,Intermediate radiation treatment delivery >/=1 MeV,CPT/HCPCS,7911.86,7911.86,7269.22,8764.49,United Healthcare-Medicare Advantage, +149851,3934,77412,Complex radiation treatment delivery >/=1 MeV,CPT/HCPCS,1488.28,1488.28,57.28,2940.0,United Healthcare-Medicare Advantage, +149852,3934,77417,Therapeutic radiology port films,CPT/HCPCS,683.7,683.7,13.53,730.0,United Healthcare-Medicare Advantage, +149853,3934,77470,Special radiation treatment procedure,CPT/HCPCS,7145.78,7145.78,92.34,19357.0,United Healthcare-Medicare Advantage, +149854,3934,77768,"High dose brachytherapy through skin surface, 2 channels or more than 2.0 cm",CPT/HCPCS,6286.39,6286.39,946.8,6529.0,United Healthcare-Medicare Advantage, +149855,3934,77770,"High dose brachytherapy , 1 channel",CPT/HCPCS,8549.92,8549.92,1185.05,8913.0,United Healthcare-Medicare Advantage, +149856,3934,77771,"High dose brachytherapy , 2- 12 channels",CPT/HCPCS,9305.71,9305.71,731.06,18356.97,United Healthcare-Medicare Advantage, +149857,3934,77772,"High dose brachytherapy , more than 12 channels",CPT/HCPCS,25149.0,25149.0,15923.2,15923.2,United Healthcare-Medicare Advantage, +149858,3934,77790,"Supervision, handling, loading of radiation",CPT/HCPCS,336.11,336.11,127.53,341.0,United Healthcare-Medicare Advantage, +149859,3934,78014,Nuclear medicine imaging for thyroid uptake measurements,CPT/HCPCS,1978.85,1978.85,278.86,2081.0,United Healthcare-Medicare Advantage, +149860,3934,78018,Nuclear medicine whole body study for thyroid cancer,CPT/HCPCS,2070.58,2070.58,54.0,2297.0,United Healthcare-Medicare Advantage, +149861,3934,78072,Imaging of parathyroid with CT and nuclear medicine study,CPT/HCPCS,1459.81,1459.81,646.0,1708.0,United Healthcare-Medicare Advantage, +149862,3934,78185,Imaging of spleen,CPT/HCPCS,4918.0,4918.0,4918.0,4918.0,United Healthcare-Medicare Advantage, +149863,3934,78195,Imaging of lymphatic tissue and lymph node,CPT/HCPCS,1846.46,1846.46,31.5,1958.0,United Healthcare-Medicare Advantage, +149864,3934,78215,Imaging of liver and spleen,CPT/HCPCS,6055.0,6055.0,344.05,6055.0,United Healthcare-Medicare Advantage, +149865,3934,78226,Imaging of liver and bile duct system,CPT/HCPCS,2182.03,2182.03,176.74,2305.0,United Healthcare-Medicare Advantage, +149866,3934,78227,Imaging of liver and bile duct system with use of drugs,CPT/HCPCS,1919.72,1919.72,499.48,2072.0,United Healthcare-Medicare Advantage, +149867,3934,78264,Stomach emptying study,CPT/HCPCS,3432.93,3432.93,92.5,3705.0,United Healthcare-Medicare Advantage, +149868,3934,78290,Intestine imaging,CPT/HCPCS,2065.5,2065.5,40.0,457.24,United Healthcare-Medicare Advantage, +149869,3934,78306,"Bone and/or joint imaging, whole body",CPT/HCPCS,2622.04,2622.04,80.81,2846.0,United Healthcare-Medicare Advantage, +149870,3934,78315,"Bone and/or joint imaging, 3 phase study",CPT/HCPCS,3069.31,3069.31,123.57,3072.0,United Healthcare-Medicare Advantage, +149871,3934,78451,Nuclear medicine study of vessels of heart using drugs or exercise single study,CPT/HCPCS,2824.18,2824.18,148.92,2857.0,United Healthcare-Medicare Advantage, +149872,3934,78452,Nuclear medicine study of vessels of heart using drugs or exercise multiple studies,CPT/HCPCS,7886.52,7886.52,72.08,20961.16,United Healthcare-Medicare Advantage, +149873,3934,78459,Single nuclear medicine study of heart muscle with metabolic evaluation,CPT/HCPCS,2894.0,2894.0,1541.26,1541.26,United Healthcare-Medicare Advantage, +149874,3934,78472,"Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study",CPT/HCPCS,2997.1,2997.1,263.36,3173.0,United Healthcare-Medicare Advantage, +149875,3934,78580,Nuclear medicine study of blood circulation in the lungs,CPT/HCPCS,1581.02,1581.02,424.92,1655.0,United Healthcare-Medicare Advantage, +149876,3934,78582,Nuclear medicine study of lung ventilation and blood circulation in the lungs,CPT/HCPCS,2118.32,2118.32,121.89,2189.0,United Healthcare-Medicare Advantage, +149877,3934,78597,Nuclear medicine study with measurement of blood circulation in the lungs,CPT/HCPCS,1439.51,1439.51,96.34,1501.0,United Healthcare-Medicare Advantage, +149878,3934,78598,Nuclear medicine study with measurement of blood circulation in the lungs and ventilation,CPT/HCPCS,2484.67,2484.67,612.4,2445.0,United Healthcare-Medicare Advantage, +149879,3934,78608,Nuclear medicine study brain with metabolic evaluation,CPT/HCPCS,8348.78,8348.78,346.46,8946.0,United Healthcare-Medicare Advantage, +149880,3934,78630,Imaging of brain and spinal cord fluid flow at base of brain,CPT/HCPCS,1992.5,1992.5,593.38,593.38,United Healthcare-Medicare Advantage, +149881,3934,78645,Imaging of brain and spinal cord fluid flow shunt evaluation,CPT/HCPCS,4774.25,4774.25,808.17,5082.0,United Healthcare-Medicare Advantage, +149882,3934,78700,Imaging of kidney,CPT/HCPCS,2087.0,2087.0,1479.1,1479.1,United Healthcare-Medicare Advantage, +149883,3934,78707,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2013.0,2013.0,1344.0,2175.0,United Healthcare-Medicare Advantage, +149884,3934,78708,Nuclear medicine study of kidney with assessment of blood flow and function,CPT/HCPCS,2197.44,2197.44,100.0,2326.0,United Healthcare-Medicare Advantage, +149885,3934,78800,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,1397.45,1397.45,1175.0,1175.0,United Healthcare-Medicare Advantage, +149886,3934,78802,"Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, single day imaging",CPT/HCPCS,2259.14,2259.14,60.0,2332.0,United Healthcare-Medicare Advantage, +149887,3934,78803,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging",CPT/HCPCS,2830.25,2830.25,115.0,3117.0,United Healthcare-Medicare Advantage, +149888,3934,78811,Nuclear medicine study limited area,CPT/HCPCS,4195.0,4195.0,1476.34,1476.34,United Healthcare-Medicare Advantage, +149889,3934,78812,Nuclear medicine imaging from skull base to mid-thigh,CPT/HCPCS,11155.63,11155.63,319.0,11990.0,United Healthcare-Medicare Advantage, +149890,3934,78813,Nuclear medicine imaging whole body,CPT/HCPCS,11621.59,11621.59,1245.9,12333.0,United Healthcare-Medicare Advantage, +149891,3934,78814,Nuclear medicine study with CT imaging,CPT/HCPCS,12633.0,12633.0,6530.0,6530.0,United Healthcare-Medicare Advantage, +149892,3934,78815,Nuclear medicine study with CT imaging skull base to mid-thigh,CPT/HCPCS,11057.72,11057.72,381.7,11816.0,United Healthcare-Medicare Advantage, +149893,3934,78816,Nuclear medicine study with CT imaging whole body,CPT/HCPCS,11567.42,11567.42,349.67,12446.0,United Healthcare-Medicare Advantage, +149894,3934,78830,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,3832.45,3832.45,84.43,4008.0,United Healthcare-Medicare Advantage, +149895,3934,78832,"SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in multiple areas, or in single area with imaging over multiple days, with concurrently acquired CT transmission scan, 1 day of imaging",CPT/HCPCS,2719.0,2719.0,259.94,2887.0,United Healthcare-Medicare Advantage, +149896,3934,79005,Oral administration of radioactive material therapy agent,CPT/HCPCS,4944.19,4944.19,58.0,9265.0,United Healthcare-Medicare Advantage, +149897,3934,79101,Radioactive material therapy into vein,CPT/HCPCS,1566.25,1566.25,271.72,1723.0,United Healthcare-Medicare Advantage, +149898,3934,79445,Radioactive material therapy into artery,CPT/HCPCS,55937.32,55937.32,56461.36,57965.85,United Healthcare-Medicare Advantage, +149899,3934,80047,"Blood test, basic group of blood chemicals",CPT/HCPCS,313.22,313.22,12.91,314.0,United Healthcare-Medicare Advantage, +149900,3934,80048,"Blood test, basic group of blood chemicals",CPT/HCPCS,213.82,213.82,0.2,14801.04,United Healthcare-Medicare Advantage, +149901,3934,80051,"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",CPT/HCPCS,127.71,127.71,6.04,125.0,United Healthcare-Medicare Advantage, +149902,3934,80053,"Blood test, comprehensive group of blood chemicals",CPT/HCPCS,465.79,465.79,3.19,1403.0,United Healthcare-Medicare Advantage, +149903,3934,80055,Obstetric blood test panel,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +149904,3934,80061,"Blood test, lipids (cholesterol and triglycerides)",CPT/HCPCS,218.0,218.0,0.48,1949.0,United Healthcare-Medicare Advantage, +149905,3934,80069,Kidney function blood test panel,CPT/HCPCS,242.6,242.6,8.68,258.0,United Healthcare-Medicare Advantage, +149906,3934,80074,Acute hepatitis panel,CPT/HCPCS,603.61,603.61,12.44,3269.0,United Healthcare-Medicare Advantage, +149907,3934,80076,Liver function blood test panel,CPT/HCPCS,277.34,277.34,0.3,2170.8,United Healthcare-Medicare Advantage, +149908,3934,80145,Measurement of adalimumab,CPT/HCPCS,455.31,455.31,10.5,404.25,United Healthcare-Medicare Advantage, +149909,3934,80151,Amiodarone,CPT/HCPCS,19.0,19.0,19.0,19.0,United Healthcare-Medicare Advantage, +149910,3934,80156,Carbamazepine level,CPT/HCPCS,178.36,178.36,14.57,362.0,United Healthcare-Medicare Advantage, +149911,3934,80157,Carbamazepine level,CPT/HCPCS,13.0,13.0,13.0,13.0,United Healthcare-Medicare Advantage, +149912,3934,80158,Cyclosporine level,CPT/HCPCS,474.53,474.53,10.5,503.0,United Healthcare-Medicare Advantage, +149913,3934,80159,Clozapine level,CPT/HCPCS,24.0,24.0,10.5,24.0,United Healthcare-Medicare Advantage, +149914,3934,80162,Digoxin level,CPT/HCPCS,137.62,137.62,10.5,152.0,United Healthcare-Medicare Advantage, +149915,3934,80164,Valproic acid level,CPT/HCPCS,178.96,178.96,10.5,380.0,United Healthcare-Medicare Advantage, +149916,3934,80165,Valproic acid level,CPT/HCPCS,55.97,55.97,8.48,60.0,United Healthcare-Medicare Advantage, +149917,3934,80168,Ethosuximide level,CPT/HCPCS,17.0,17.0,8.48,62.68,United Healthcare-Medicare Advantage, +149918,3934,80169,Everolimus level,CPT/HCPCS,82.0,82.0,57.4,57.4,United Healthcare-Medicare Advantage, +149919,3934,80171,Gabapentin level,CPT/HCPCS,19.0,19.0,10.85,19.0,United Healthcare-Medicare Advantage, +149920,3934,80175,Lamotrigine level,CPT/HCPCS,14.69,14.69,7.0,16.96,United Healthcare-Medicare Advantage, +149921,3934,80177,Levetiracetam level,CPT/HCPCS,19.69,19.69,10.5,17.0,United Healthcare-Medicare Advantage, +149922,3934,80178,Lithium level,CPT/HCPCS,109.72,109.72,6.61,113.0,United Healthcare-Medicare Advantage, +149923,3934,80180,Mycophenolate (mycophenolic acid) level,CPT/HCPCS,224.17,224.17,8.17,239.0,United Healthcare-Medicare Advantage, +149924,3934,80183,Oxcarbazepine level,CPT/HCPCS,22.0,22.0,10.5,29.25,United Healthcare-Medicare Advantage, +149925,3934,80184,Phenobarbital level,CPT/HCPCS,159.84,159.84,10.5,158.0,United Healthcare-Medicare Advantage, +149926,3934,80185,Phenytoin level,CPT/HCPCS,139.96,139.96,13.25,274.0,United Healthcare-Medicare Advantage, +149927,3934,80186,Phenytoin level,CPT/HCPCS,151.02,151.02,13.76,288.0,United Healthcare-Medicare Advantage, +149928,3934,80195,Sirolimus level,CPT/HCPCS,204.09,204.09,10.5,214.0,United Healthcare-Medicare Advantage, +149929,3934,80197,Tacrolimus level,CPT/HCPCS,279.23,279.23,8.48,594.0,United Healthcare-Medicare Advantage, +149930,3934,80198,Theophylline level,CPT/HCPCS,145.5,145.5,19.2,148.0,United Healthcare-Medicare Advantage, +149931,3934,80201,Topiramate level,CPT/HCPCS,32.0,32.0,11.92,32.0,United Healthcare-Medicare Advantage, +149932,3934,80202,Vancomycin (antibiotic) level,CPT/HCPCS,168.39,168.39,13.54,326.0,United Healthcare-Medicare Advantage, +149933,3934,80230,Measurement of infliximab,CPT/HCPCS,539.0,539.0,10.5,539.0,United Healthcare-Medicare Advantage, +149934,3934,80235,Measurement of lacosamide,CPT/HCPCS,105.0,105.0,27.11,27.11,United Healthcare-Medicare Advantage, +149935,3934,80280,Measurement of vedolizumab,CPT/HCPCS,635.0,635.0,23.14,23.14,United Healthcare-Medicare Advantage, +149936,3934,80285,Measurement of voriconazole,CPT/HCPCS,68.18,68.18,10.5,27.11,United Healthcare-Medicare Advantage, +149937,3934,80299,Quantitation of therapeutic drug,CPT/HCPCS,135.51,135.51,11.48,118.5,United Healthcare-Medicare Advantage, +149938,3934,80305,Testing for presence of drug,CPT/HCPCS,61.72,61.72,5.0,46.5,United Healthcare-Medicare Advantage, +149939,3934,80307,Testing for presence of drug,CPT/HCPCS,544.69,544.69,7.23,3162.0,United Healthcare-Medicare Advantage, +149940,3934,80320,Alcohols levels,CPT/HCPCS,201.4,201.4,5.0,797.7,United Healthcare-Medicare Advantage, +149941,3934,80323,Alkaloids levels,CPT/HCPCS,37.0,37.0,5.0,25.9,United Healthcare-Medicare Advantage, +149942,3934,80324,Amphetamines levels,CPT/HCPCS,20.0,20.0,5.0,5.0,United Healthcare-Medicare Advantage, +149943,3934,80329,Analgesics levels,CPT/HCPCS,235.57,235.57,11.37,464.0,United Healthcare-Medicare Advantage, +149944,3934,80338,Antidepressants levels,CPT/HCPCS,64.0,64.0,43.52,43.52,United Healthcare-Medicare Advantage, +149945,3934,80339,Antiepileptics levels,CPT/HCPCS,141.0,141.0,16.37,16.44,United Healthcare-Medicare Advantage, +149946,3934,80346,Benzodiazepines levels,CPT/HCPCS,43.5,43.5,5.0,5.0,United Healthcare-Medicare Advantage, +149947,3934,80348,Buprenorphine level,CPT/HCPCS,38.0,38.0,5.0,5.0,United Healthcare-Medicare Advantage, +149948,3934,80349,Cannabinoids levels,CPT/HCPCS,36.0,36.0,5.0,36.0,United Healthcare-Medicare Advantage, +149949,3934,80353,Cocaine level,CPT/HCPCS,36.0,36.0,5.0,5.0,United Healthcare-Medicare Advantage, +149950,3934,80354,Fentanyl level,CPT/HCPCS,70.0,70.0,16.42,17.5,United Healthcare-Medicare Advantage, +149951,3934,80358,Methadone level,CPT/HCPCS,44.0,44.0,5.0,5.0,United Healthcare-Medicare Advantage, +149952,3934,80359,Methylenedioxyamphetamines levels,CPT/HCPCS,21.0,21.0,5.0,5.0,United Healthcare-Medicare Advantage, +149953,3934,80361,Opiates levels,CPT/HCPCS,32.0,32.0,5.0,5.0,United Healthcare-Medicare Advantage, +149954,3934,80500,Clinical pathology consultation,CPT/HCPCS,213.0,213.0,33.79,33.79,United Healthcare-Medicare Advantage, +149955,3934,81000,Manual urinalysis test with examination using microscope,CPT/HCPCS,42.33,42.33,35.47,75.9,United Healthcare-Medicare Advantage, +149956,3934,81001,Manual urinalysis test with examination using microscope,CPT/HCPCS,145.39,145.39,0.94,3026.0,United Healthcare-Medicare Advantage, +149957,3934,81002,"Urinalysis, manual test",CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +149958,3934,81003,Automated urinalysis test,CPT/HCPCS,71.63,71.63,1.93,97.37,United Healthcare-Medicare Advantage, +149959,3934,81025,Urine pregnancy test,CPT/HCPCS,21.59,21.59,2.0,33.13,United Healthcare-Medicare Advantage, +149960,3934,81050,Urine volume measurement,CPT/HCPCS,27.09,27.09,1.35,27.0,United Healthcare-Medicare Advantage, +149961,3934,81105,Gene analysis (Human Platelet Antigen 1) for common variant,CPT/HCPCS,100.71,100.71,72.75,369.0,United Healthcare-Medicare Advantage, +149962,3934,81106,Gene analysis (Human Platelet Antigen 2) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Medicare Advantage, +149963,3934,81107,Gene analysis (Human Platelet Antigen 3) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Medicare Advantage, +149964,3934,81108,Gene analysis (Human Platelet Antigen 4) for common variant,CPT/HCPCS,100.71,100.71,97.0,97.0,United Healthcare-Medicare Advantage, +149965,3934,81109,Gene analysis (Human Platelet Antigen 5) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,United Healthcare-Medicare Advantage, +149966,3934,81110,Gene analysis (Human Platelet Antigen 6) for common variant,CPT/HCPCS,101.0,101.0,97.0,97.0,United Healthcare-Medicare Advantage, +149967,3934,81112,Gene analysis (Human Platelet Antigen 15) for common variant,CPT/HCPCS,101.0,101.0,72.75,97.0,United Healthcare-Medicare Advantage, +149968,3934,81120,"Gene analysis (isocitrate dehydrogenase 1 [NADP+], soluble) for common variants",CPT/HCPCS,252.71,252.71,183.59,281.0,United Healthcare-Medicare Advantage, +149969,3934,81121,"Gene analysis (isocitrate dehydrogenase 2 [NADP+], mitochondrial) for common variants",CPT/HCPCS,281.67,281.67,281.0,282.0,United Healthcare-Medicare Advantage, +149970,3934,81162,Gene analysis (breast cancer 1 and 2) of full sequence and analysis for duplication or deletion variants,CPT/HCPCS,760.0,760.0,760.0,760.0,United Healthcare-Medicare Advantage, +149971,3934,81170,"Gene analysis (ABL proto-oncogene 1, non-receptor tyrosine kinase)",CPT/HCPCS,757.0,757.0,197.71,300.0,United Healthcare-Medicare Advantage, +149972,3934,81175,"Gene analysis (additional sex combs like 1, transcriptional regulator) full sequence analysis",CPT/HCPCS,1810.0,1810.0,1223.56,1223.56,United Healthcare-Medicare Advantage, +149973,3934,81176,"Gene analysis (additional sex combs like 1, transcriptional regulator) targeted sequence analysis",CPT/HCPCS,523.0,523.0,523.0,523.0,United Healthcare-Medicare Advantage, +149974,3934,81189,Gene analysis (cystatin B) of full sequence,CPT/HCPCS,606.0,606.0,171.33,171.33,United Healthcare-Medicare Advantage, +149975,3934,81206,Translocation analysis (BCR/ABL1) minor breakpoint,CPT/HCPCS,1705.33,1705.33,160.68,1685.0,United Healthcare-Medicare Advantage, +149976,3934,81207,Translocation analysis (BCR/ABL1) major breakpoint,CPT/HCPCS,1311.03,1311.03,139.54,1311.0,United Healthcare-Medicare Advantage, +149977,3934,81208,Translocation analysis (BCR/ABL1) other breakpoint,CPT/HCPCS,295.0,295.0,214.62,214.62,United Healthcare-Medicare Advantage, +149978,3934,81210,Gene analysis (v-raf murine sarcoma viral oncogene homolog B1),CPT/HCPCS,152.0,152.0,152.0,152.0,United Healthcare-Medicare Advantage, +149979,3934,81218,"Gene analysis (ccaat/enhancer binding protein [c/ebp], alpha) full gene sequence",CPT/HCPCS,418.71,418.71,428.0,428.0,United Healthcare-Medicare Advantage, +149980,3934,81219,"Gene analysis (calreticulin), common variants",CPT/HCPCS,207.06,207.06,82.71,219.26,United Healthcare-Medicare Advantage, +149981,3934,81220,Gene analysis (cystic fibrosis transmembrane conductance regular) common variants,CPT/HCPCS,151.68,151.68,130.0,487.5,United Healthcare-Medicare Advantage, +149982,3934,81222,Gene analysis (cystic fibrosis transmembrane conductance regular) duplication or deletion variants,CPT/HCPCS,606.13,606.13,153.5,153.5,United Healthcare-Medicare Advantage, +149983,3934,81223,Gene analysis (cystic fibrosis transmembrane conductance regular) full gene sequence,CPT/HCPCS,715.67,715.67,176.25,552.54,United Healthcare-Medicare Advantage, +149984,3934,81229,Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants,CPT/HCPCS,1813.25,1813.25,16.04,1998.55,United Healthcare-Medicare Advantage, +149985,3934,81235,"Gene analysis (epidermal growth factor receptor), common variants",CPT/HCPCS,365.0,365.0,365.0,365.0,United Healthcare-Medicare Advantage, +149986,3934,81240,"Gene analysis (prothrombin, coagulation factor II) A variant",CPT/HCPCS,318.63,318.63,16.95,259.6,United Healthcare-Medicare Advantage, +149987,3934,81241,Gene analysis (coagulation factor V) Leiden variant,CPT/HCPCS,398.1,398.1,21.2,664.0,United Healthcare-Medicare Advantage, +149988,3934,81243,Gene analysis (fragile X mental retardation) abnormal alleles,CPT/HCPCS,95.0,95.0,19.0,234.26,United Healthcare-Medicare Advantage, +149989,3934,81244,Gene analysis (fragile X mental retardation 1) for characterization of alleles,CPT/HCPCS,443.0,443.0,121.83,121.83,United Healthcare-Medicare Advantage, +149990,3934,81245,Gene analysis (fms-related tyrosine kinase 3) internal tandem duplication variants,CPT/HCPCS,174.5,174.5,165.51,356.0,United Healthcare-Medicare Advantage, +149991,3934,81246,Test for detecting genes associated with blood cancer,CPT/HCPCS,87.37,87.37,83.0,178.0,United Healthcare-Medicare Advantage, +149992,3934,81252,"Gene analysis (gap junction protein, beta 2, 26kda, connexin 26), full gene sequence",CPT/HCPCS,299.67,299.67,32.0,32.0,United Healthcare-Medicare Advantage, +149993,3934,81256,Gene analysis (hemochromatosis) common variants,CPT/HCPCS,95.0,95.0,57.0,95.0,United Healthcare-Medicare Advantage, +149994,3934,81257,Gene analysis (alpha globin 1 and alpha globin 2) for common deletions or variant,CPT/HCPCS,358.25,358.25,71.2,269.25,United Healthcare-Medicare Advantage, +149995,3934,81261,Gene rearrangement analysis (immunoglobulin heavy chain locus) to detect abnormal clonal population amplified methodology,CPT/HCPCS,545.37,545.37,184.37,728.0,United Healthcare-Medicare Advantage, +149996,3934,81263,"Gene rearrangement analysis (immunoglobulin heavy chain locus), variable region somatic mutation analysis",CPT/HCPCS,465.0,465.0,294.52,327.24,United Healthcare-Medicare Advantage, +149997,3934,81264,Gene rearrangement analysis (immunoglobulin kappa light chain locus) to detect abnormal clonal population,CPT/HCPCS,185.5,185.5,184.0,185.0,United Healthcare-Medicare Advantage, +149998,3934,81265,Comparative analysis using Short Tandem Repeat (STR) markers of patient and specimen,CPT/HCPCS,1237.43,1237.43,233.07,1212.29,United Healthcare-Medicare Advantage, +149999,3934,81267,Chimerism analysis post transplantation,CPT/HCPCS,1153.45,1153.45,141.07,1138.0,United Healthcare-Medicare Advantage, +150000,3934,81268,Chimerism analysis post transplantation,CPT/HCPCS,2978.09,2978.09,124.6,3314.0,United Healthcare-Medicare Advantage, +150001,3934,81269,Gene analysis (alpha globin 1 and alpha globin 2) for duplication/deletion variants,CPT/HCPCS,380.71,380.71,190.68,292.46,United Healthcare-Medicare Advantage, +150002,3934,81270,Gene analysis (Janus kinase 2) variant,CPT/HCPCS,160.16,160.16,62.33,1923.5,United Healthcare-Medicare Advantage, +150003,3934,81272,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), targeted sequence",CPT/HCPCS,508.77,508.77,252.5,329.51,United Healthcare-Medicare Advantage, +150004,3934,81273,"Gene analysis (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog), D816 variants",CPT/HCPCS,289.29,289.29,195.05,195.05,United Healthcare-Medicare Advantage, +150005,3934,81288,Test for detecting genes associated with colon cancer,CPT/HCPCS,153.48,153.48,71.35,148.0,United Healthcare-Medicare Advantage, +150006,3934,81291,"Gene analysis (5, 10-methylenetetrahydrofolate reductase) common variants",CPT/HCPCS,69.0,69.0,48.3,607.0,United Healthcare-Medicare Advantage, +150007,3934,81302,Gene analysis (methyl CpG binding protein 2) full sequence analysis,CPT/HCPCS,229.0,229.0,116.25,116.25,United Healthcare-Medicare Advantage, +150008,3934,81305,Gene analysis (myeloid differentiation primary response 88) for p.Leu265Pro variant,CPT/HCPCS,294.91,294.91,112.65,112.65,United Healthcare-Medicare Advantage, +150009,3934,81306,Gene analysis (nudix hydrolase 15) for common variants,CPT/HCPCS,222.0,222.0,155.4,222.0,United Healthcare-Medicare Advantage, +150010,3934,81310,Gene analysis (nucleophosmin) exon 12 variants,CPT/HCPCS,332.68,332.68,246.52,294.0,United Healthcare-Medicare Advantage, +150011,3934,81311,Gene analysis for cancer (neuroblastoma),CPT/HCPCS,190.0,190.0,190.0,190.0,United Healthcare-Medicare Advantage, +150012,3934,81314,"Gene analysis ((platelet-derived growth factor receptor, alpha polypeptide) targeted sequence",CPT/HCPCS,252.5,252.5,252.5,252.5,United Healthcare-Medicare Advantage, +150013,3934,81315,Translocation analysis (PML-RARA regulated adaptor molecule 1) common breakpoint,CPT/HCPCS,300.0,300.0,207.31,334.0,United Healthcare-Medicare Advantage, +150014,3934,81321,"Gene analysis (phosphatase and tensin homolog), full sequence analysis",CPT/HCPCS,910.17,910.17,528.0,604.0,United Healthcare-Medicare Advantage, +150015,3934,81323,"Gene analysis (phosphatase and tensin homolog), duplication or deletion variant",CPT/HCPCS,301.5,301.5,88.08,88.08,United Healthcare-Medicare Advantage, +150016,3934,81324,"Gene analysis (peripheral myelin protein 22), duplication or deletion analysis",CPT/HCPCS,1160.0,1160.0,1017.37,1017.37,United Healthcare-Medicare Advantage, +150017,3934,81329,"Gene analysis (survival of motor neuron 1, telomeric) for dosage/deletion",CPT/HCPCS,229.1,229.1,130.15,130.15,United Healthcare-Medicare Advantage, +150018,3934,81331,Methylation analysis (small nuclear ribonucleoprotein polypeptide N and ubiquitin protein ligase E3A),CPT/HCPCS,245.0,245.0,49.0,61.25,United Healthcare-Medicare Advantage, +150019,3934,81335,Gene analysis (thiopurine S-methyltransferase) for common variant,CPT/HCPCS,252.9,252.9,93.1,166.07,United Healthcare-Medicare Advantage, +150020,3934,81338,"MPL (MPL proto-oncogene, thrombopoietin receptor) (eg, myeloproliferative disorder) gene analysis; common variants (eg, W515A, W515K, W515L, W515R)",CPT/HCPCS,337.0,337.0,67.4,252.75,United Healthcare-Medicare Advantage, +150021,3934,81342,Gene rearrangement analysis detection abnormal clonal population (T cell antigen receptor gamma),CPT/HCPCS,677.15,677.15,223.88,1680.0,United Healthcare-Medicare Advantage, +150022,3934,81351,"TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis; full gene sequence",CPT/HCPCS,1219.0,1219.0,641.85,641.85,United Healthcare-Medicare Advantage, +150023,3934,81370,"HLA class I and II typing low resolution HLA-A, -B, -C, -DRB1/3/4/5 and -DQB1",CPT/HCPCS,1266.24,1266.24,341.8,1184.88,United Healthcare-Medicare Advantage, +150024,3934,81371,"HLA class I and II typing, low resolution HLA-A, -B, and -DRB1",CPT/HCPCS,755.0,755.0,404.52,404.52,United Healthcare-Medicare Advantage, +150025,3934,81373,HLA class I typing low resolution one locus,CPT/HCPCS,472.33,472.33,138.13,1810.8,United Healthcare-Medicare Advantage, +150026,3934,81374,"HLA class I typing, low resolution one antigen equivalent",CPT/HCPCS,346.2,346.2,334.21,334.21,United Healthcare-Medicare Advantage, +150027,3934,81377,HLA class II typing low resolution one antigen equivalent,CPT/HCPCS,280.0,280.0,140.0,140.0,United Healthcare-Medicare Advantage, +150028,3934,81380,HLA class I typing high resolution one locus,CPT/HCPCS,299.83,299.83,2.0,272.8,United Healthcare-Medicare Advantage, +150029,3934,81381,HLA class I typing high resolution one allele or allele group,CPT/HCPCS,152.5,152.5,105.9,129.74,United Healthcare-Medicare Advantage, +150030,3934,81382,HLA class II typing high resolution one locus,CPT/HCPCS,360.0,360.0,0.75,339.32,United Healthcare-Medicare Advantage, +150031,3934,81383,HLA class II typing high resolution one allele or allele group,CPT/HCPCS,124.4,124.4,149.7,149.7,United Healthcare-Medicare Advantage, +150032,3934,81400,Molecular pathology procedure level 1,CPT/HCPCS,342.0,342.0,18.5,256.5,United Healthcare-Medicare Advantage, +150033,3934,81401,Molecular pathology procedure level 2,CPT/HCPCS,497.77,497.77,137.0,490.0,United Healthcare-Medicare Advantage, +150034,3934,81402,Molecular pathology procedure level 3,CPT/HCPCS,334.97,334.97,67.4,1160.5,United Healthcare-Medicare Advantage, +150035,3934,81403,Molecular pathology procedure level 4,CPT/HCPCS,417.51,417.51,59.0,535.0,United Healthcare-Medicare Advantage, +150036,3934,81404,Molecular pathology procedure level 5,CPT/HCPCS,526.22,526.22,40.2,496.18,United Healthcare-Medicare Advantage, +150037,3934,81405,Molecular pathology procedure level 6,CPT/HCPCS,711.32,711.32,44.0,1752.74,United Healthcare-Medicare Advantage, +150038,3934,81406,Molecular pathology procedure level 7,CPT/HCPCS,638.63,638.63,24.75,970.0,United Healthcare-Medicare Advantage, +150039,3934,81407,Molecular pathology procedure level 8,CPT/HCPCS,1025.53,1025.53,102.75,1782.0,United Healthcare-Medicare Advantage, +150040,3934,81408,Molecular pathology procedure level 9,CPT/HCPCS,1208.23,1208.23,76.2,1270.0,United Healthcare-Medicare Advantage, +150041,3934,81442,Gene analysis (noonan syndrome) genomic sequence analysis,CPT/HCPCS,1295.0,1295.0,647.5,647.5,United Healthcare-Medicare Advantage, +150042,3934,81443,Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes,CPT/HCPCS,4244.33,4244.33,2326.13,2461.6,United Healthcare-Medicare Advantage, +150043,3934,81450,Test for detecting genes associated with blood related cancer,CPT/HCPCS,2243.1,2243.1,652.94,2620.0,United Healthcare-Medicare Advantage, +150044,3934,81479,Molecular pathology procedure,CPT/HCPCS,686.94,686.94,7.4,1520.0,United Healthcare-Medicare Advantage, +150045,3934,81511,"Fetal congenital abnormalities, biochemical assays of four analytes (afp, ue3, hcg [any form], dia) utilizing maternal serum, algorithm reported as a risk score",CPT/HCPCS,57.0,57.0,34.2,42.87,United Healthcare-Medicare Advantage, +150046,3934,81539,Measurement of proteins associated with prostate cancer,CPT/HCPCS,770.0,770.0,760.0,760.0,United Healthcare-Medicare Advantage, +150047,3934,82010,Ketone bodies analysis,CPT/HCPCS,166.2,166.2,8.17,436.02,United Healthcare-Medicare Advantage, +150048,3934,82017,Chemical test for genetic disorder,CPT/HCPCS,29.2,29.2,5.38,25.43,United Healthcare-Medicare Advantage, +150049,3934,82024,Adrenocorticotropic hormone (ACTH) level,CPT/HCPCS,21.99,21.99,8.5,413.85,United Healthcare-Medicare Advantage, +150050,3934,82040,Albumin (protein) level,CPT/HCPCS,57.83,57.83,0.8,1284.0,United Healthcare-Medicare Advantage, +150051,3934,82042,"Cerebrospinal fluid, or amniotic fluid albumin (protein) level",CPT/HCPCS,54.2,54.2,0.8,62.0,United Healthcare-Medicare Advantage, +150052,3934,82043,Urine microalbumin (protein) level,CPT/HCPCS,127.89,127.89,0.8,193.5,United Healthcare-Medicare Advantage, +150053,3934,82085,Aldolase (enzyme) level,CPT/HCPCS,6.23,6.23,1.35,10.75,United Healthcare-Medicare Advantage, +150054,3934,82088,Aldosterone hormone level,CPT/HCPCS,20.15,20.15,3.0,107.13,United Healthcare-Medicare Advantage, +150055,3934,82103,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,201.71,201.71,10.75,189.17,United Healthcare-Medicare Advantage, +150056,3934,82104,Alpha-1-antitrypsin (protein) blood test,CPT/HCPCS,15.0,15.0,12.29,14.0,United Healthcare-Medicare Advantage, +150057,3934,82105,"Alpha-fetoprotein (AFP) level, serum",CPT/HCPCS,257.29,257.29,6.26,278.0,United Healthcare-Medicare Advantage, +150058,3934,82107,Alpha-fetoprotein (AFP) analysis,CPT/HCPCS,124.0,124.0,64.41,64.41,United Healthcare-Medicare Advantage, +150059,3934,82108,Aluminum level,CPT/HCPCS,14.0,14.0,11.9,30.9,United Healthcare-Medicare Advantage, +150060,3934,82131,Amino acid analysis,CPT/HCPCS,186.02,186.02,14.0,152.05,United Healthcare-Medicare Advantage, +150061,3934,82136,"Amino acid level, multiple amino acids",CPT/HCPCS,404.33,404.33,16.67,16.67,United Healthcare-Medicare Advantage, +150062,3934,82139,"Amino acid level, multiple amino acids",CPT/HCPCS,78.0,78.0,14.0,82.34,United Healthcare-Medicare Advantage, +150063,3934,82140,Ammonia level,CPT/HCPCS,127.72,127.72,13.76,272.0,United Healthcare-Medicare Advantage, +150064,3934,82150,Amylase (enzyme) level,CPT/HCPCS,120.35,120.35,3.22,1686.0,United Healthcare-Medicare Advantage, +150065,3934,82157,Androstenedione (hormone) level,CPT/HCPCS,36.94,36.94,12.62,30.0,United Healthcare-Medicare Advantage, +150066,3934,82164,Angiotensin l - converting enzyme (ACE) level,CPT/HCPCS,13.73,13.73,0.16,111.03,United Healthcare-Medicare Advantage, +150067,3934,82172,Apolipoprotein level,CPT/HCPCS,15.0,15.0,15.93,138.9,United Healthcare-Medicare Advantage, +150068,3934,82175,Arsenic level,CPT/HCPCS,21.94,21.94,8.0,23.55,United Healthcare-Medicare Advantage, +150069,3934,82180,"Ascorbic acid (Vitamin C) level, blood",CPT/HCPCS,23.0,23.0,9.54,104.78,United Healthcare-Medicare Advantage, +150070,3934,82232,Beta-2 microglobulin (protein) level,CPT/HCPCS,214.77,214.77,0.73,255.0,United Healthcare-Medicare Advantage, +150071,3934,82239,Bile acids level,CPT/HCPCS,14.0,14.0,9.8,19.58,United Healthcare-Medicare Advantage, +150072,3934,82247,Bilirubin level,CPT/HCPCS,123.85,123.85,0.79,132.0,United Healthcare-Medicare Advantage, +150073,3934,82248,Bilirubin level,CPT/HCPCS,108.72,108.72,0.79,116.0,United Healthcare-Medicare Advantage, +150074,3934,82270,Stool analysis for blood to screen for colon tumors,CPT/HCPCS,42.69,42.69,3.0,56.0,United Healthcare-Medicare Advantage, +150075,3934,82272,Stool analysis for blood,CPT/HCPCS,51.39,51.39,2.73,55.0,United Healthcare-Medicare Advantage, +150076,3934,82274,Stool analysis for blood,CPT/HCPCS,29.0,29.0,3.4,46.5,United Healthcare-Medicare Advantage, +150077,3934,82300,Cadmium level,CPT/HCPCS,15.25,15.25,7.5,16.91,United Healthcare-Medicare Advantage, +150078,3934,82306,Vitamin D-3 level,CPT/HCPCS,460.73,460.73,10.3,2376.5,United Healthcare-Medicare Advantage, +150079,3934,82308,Calcitonin (hormone) level,CPT/HCPCS,65.18,65.18,14.72,291.94,United Healthcare-Medicare Advantage, +150080,3934,82310,Calcium level,CPT/HCPCS,81.02,81.02,0.8,237.0,United Healthcare-Medicare Advantage, +150081,3934,82330,Calcium level,CPT/HCPCS,266.14,266.14,5.03,680.58,United Healthcare-Medicare Advantage, +150082,3934,82340,Urine calcium level,CPT/HCPCS,83.0,83.0,3.15,82.5,United Healthcare-Medicare Advantage, +150083,3934,82365,Infrared analysis of stone,CPT/HCPCS,15.08,15.08,1.93,48.8,United Healthcare-Medicare Advantage, +150084,3934,82374,Carbon dioxide (bicarbonate) level,CPT/HCPCS,115.96,115.96,0.65,232.0,United Healthcare-Medicare Advantage, +150085,3934,82375,Carboxyhemoglobin (protein) level,CPT/HCPCS,146.34,146.34,17.22,144.0,United Healthcare-Medicare Advantage, +150086,3934,82378,Carcinoembryonic antigen (CEA) protein level,CPT/HCPCS,277.82,277.82,5.38,379.44,United Healthcare-Medicare Advantage, +150087,3934,82379,Carnitine level,CPT/HCPCS,28.82,28.82,5.38,25.43,United Healthcare-Medicare Advantage, +150088,3934,82380,Carotene level,CPT/HCPCS,15.0,15.0,9.22,9.67,United Healthcare-Medicare Advantage, +150089,3934,82384,Catecholamines (organic nitrogen) level,CPT/HCPCS,33.58,33.58,18.4,25.76,United Healthcare-Medicare Advantage, +150090,3934,82390,Ceruloplasmin (protein) level,CPT/HCPCS,135.58,135.58,5.38,106.92,United Healthcare-Medicare Advantage, +150091,3934,82397,Analysis using chemiluminescent technique (light and chemical )reaction,CPT/HCPCS,102.31,102.31,9.6,309.18,United Healthcare-Medicare Advantage, +150092,3934,82435,Blood chloride level,CPT/HCPCS,72.1,72.1,0.37,144.0,United Healthcare-Medicare Advantage, +150093,3934,82436,Urine chloride level,CPT/HCPCS,64.32,64.32,4.0,68.0,United Healthcare-Medicare Advantage, +150094,3934,82438,Chloride level,CPT/HCPCS,38.86,38.86,5.0,36.84,United Healthcare-Medicare Advantage, +150095,3934,82465,Cholesterol level,CPT/HCPCS,102.44,102.44,3.34,111.0,United Healthcare-Medicare Advantage, +150096,3934,82507,Citrate level,CPT/HCPCS,31.64,31.64,16.1,30.36,United Healthcare-Medicare Advantage, +150097,3934,82523,"Collagen cross links test, (urine test to evaluate bone health)",CPT/HCPCS,75.59,75.59,18.68,20.0,United Healthcare-Medicare Advantage, +150098,3934,82525,Copper level,CPT/HCPCS,12.53,12.53,6.0,174.06,United Healthcare-Medicare Advantage, +150099,3934,82530,Cortisol (hormone) measurement,CPT/HCPCS,19.0,19.0,9.5,65.49,United Healthcare-Medicare Advantage, +150100,3934,82533,Cortisol (hormone) measurement,CPT/HCPCS,239.81,239.81,16.3,560.0,United Healthcare-Medicare Advantage, +150101,3934,82542,Chemical analysis using chromatography technique,CPT/HCPCS,227.66,227.66,10.75,3126.0,United Healthcare-Medicare Advantage, +150102,3934,82550,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,88.14,88.14,0.8,1339.0,United Healthcare-Medicare Advantage, +150103,3934,82552,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,14.0,14.0,9.4,173.02,United Healthcare-Medicare Advantage, +150104,3934,82553,Creatine kinase (cardiac enzyme) level,CPT/HCPCS,17.0,17.0,8.05,11.55,United Healthcare-Medicare Advantage, +150105,3934,82565,Blood creatinine level,CPT/HCPCS,94.33,94.33,0.8,1041.0,United Healthcare-Medicare Advantage, +150106,3934,82570,Creatinine level to test for kidney function or muscle injury,CPT/HCPCS,78.95,78.95,0.5,187.72,United Healthcare-Medicare Advantage, +150107,3934,82575,Creatinine clearance measurement to test for kidney function,CPT/HCPCS,229.44,229.44,1.6,245.0,United Healthcare-Medicare Advantage, +150108,3934,82585,Cryofibrinogen (protein) level,CPT/HCPCS,10.0,10.0,6.82,10.0,United Healthcare-Medicare Advantage, +150109,3934,82595,Cryoglobulin (protein) measurement,CPT/HCPCS,89.59,89.59,5.48,94.0,United Healthcare-Medicare Advantage, +150110,3934,82607,Cyanocobalamin (vitamin B-12) level,CPT/HCPCS,168.3,168.3,3.45,823.5,United Healthcare-Medicare Advantage, +150111,3934,82610,Cystatin C (enzyme inhibitor) level,CPT/HCPCS,46.0,46.0,9.52,50.43,United Healthcare-Medicare Advantage, +150112,3934,82626,Dehydroepiandrosterone (DHEA) hormone level,CPT/HCPCS,29.45,29.45,18.36,384.41,United Healthcare-Medicare Advantage, +150113,3934,82627,Dehydroepiandrosterone (DHEA-S) hormone level,CPT/HCPCS,14.14,14.14,9.52,337.51,United Healthcare-Medicare Advantage, +150114,3934,82642,Measurement of dihydrotestosterone,CPT/HCPCS,36.0,36.0,19.91,30.9,United Healthcare-Medicare Advantage, +150115,3934,82652,"Dihydroxyvitamin D, 1, 25 level",CPT/HCPCS,20.09,20.09,5.5,491.32,United Healthcare-Medicare Advantage, +150116,3934,82657,Enzyme activity measurement,CPT/HCPCS,146.8,146.8,5.38,140.0,United Healthcare-Medicare Advantage, +150117,3934,82658,Enzyme activity measurement,CPT/HCPCS,564.0,564.0,18.92,59.88,United Healthcare-Medicare Advantage, +150118,3934,82664,"Electrophoresis, laboratory testing technique",CPT/HCPCS,156.0,156.0,31.09,41.82,United Healthcare-Medicare Advantage, +150119,3934,82668,Erythropoietin (protein) level,CPT/HCPCS,10.29,10.29,1.0,18.79,United Healthcare-Medicare Advantage, +150120,3934,82670,Estradiol (hormone) level,CPT/HCPCS,434.38,434.38,12.62,724.5,United Healthcare-Medicare Advantage, +150121,3934,82671,Estrogen analysis,CPT/HCPCS,36.0,36.0,24.84,39.47,United Healthcare-Medicare Advantage, +150122,3934,82677,Estriol (hormone) level,CPT/HCPCS,14.0,14.0,14.0,176.76,United Healthcare-Medicare Advantage, +150123,3934,82679,Estrone (hormone) level,CPT/HCPCS,36.0,36.0,24.95,225.26,United Healthcare-Medicare Advantage, +150124,3934,82705,Stool fat analysis,CPT/HCPCS,19.0,19.0,5.1,13.3,United Healthcare-Medicare Advantage, +150125,3934,82710,Stool fat measurement,CPT/HCPCS,48.0,48.0,12.6,12.6,United Healthcare-Medicare Advantage, +150126,3934,82725,Fatty acids measurement,CPT/HCPCS,57.0,57.0,38.53,38.53,United Healthcare-Medicare Advantage, +150127,3934,82726,Very long chain fatty acids level,CPT/HCPCS,128.46,128.46,19.75,22.29,United Healthcare-Medicare Advantage, +150128,3934,82728,Ferritin (blood protein) level,CPT/HCPCS,184.28,184.28,4.58,1901.5,United Healthcare-Medicare Advantage, +150129,3934,82731,Fetal fibronectin (protein) analysis,CPT/HCPCS,763.73,763.73,22.15,1000.0,United Healthcare-Medicare Advantage, +150130,3934,82746,Folic acid level,CPT/HCPCS,184.32,184.32,3.2,423.5,United Healthcare-Medicare Advantage, +150131,3934,82747,Folic acid level,CPT/HCPCS,19.0,19.0,12.5,19.0,United Healthcare-Medicare Advantage, +150132,3934,82784,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,426.33,426.33,1.63,835.04,United Healthcare-Medicare Advantage, +150133,3934,82785,IgE (immune system protein) level,CPT/HCPCS,288.35,288.35,5.38,307.0,United Healthcare-Medicare Advantage, +150134,3934,82787,Gammaglobulin (immune system protein) measurement,CPT/HCPCS,38.7,38.7,1.64,144.05,United Healthcare-Medicare Advantage, +150135,3934,82803,Blood gases measurement,CPT/HCPCS,312.53,312.53,58.29,443.1,United Healthcare-Medicare Advantage, +150136,3934,82805,Blood gases measurement,CPT/HCPCS,280.77,280.77,16.16,1000.0,United Healthcare-Medicare Advantage, +150137,3934,82941,Gastrin (GI tract hormone) level,CPT/HCPCS,12.0,12.0,3.3,96.82,United Healthcare-Medicare Advantage, +150138,3934,82945,Glucose (sugar) level on body fluid,CPT/HCPCS,67.18,67.18,1.32,72.0,United Healthcare-Medicare Advantage, +150139,3934,82947,Blood glucose (sugar) level,CPT/HCPCS,58.49,58.49,3.22,116.0,United Healthcare-Medicare Advantage, +150140,3934,82948,Blood glucose (sugar) measurement using reagent strip,CPT/HCPCS,77.97,77.97,2.0,77.0,United Healthcare-Medicare Advantage, +150141,3934,82950,Blood glucose (sugar) level after receiving dose of glucose,CPT/HCPCS,84.5,84.5,5.69,54.4,United Healthcare-Medicare Advantage, +150142,3934,82951,Blood glucose (sugar) tolerance test,CPT/HCPCS,218.84,218.84,6.19,190.65,United Healthcare-Medicare Advantage, +150143,3934,82952,Blood glucose (sugar) tolerance test,CPT/HCPCS,74.5,74.5,1.4,35.41,United Healthcare-Medicare Advantage, +150144,3934,82955,G6PD (enzyme) level,CPT/HCPCS,16.0,16.0,9.7,38.32,United Healthcare-Medicare Advantage, +150145,3934,82963,Glucosidase (sugar enzyme) measurement,CPT/HCPCS,87.0,87.0,26.52,26.52,United Healthcare-Medicare Advantage, +150146,3934,82977,Glutamyltransferase (liver enzyme) level,CPT/HCPCS,81.42,81.42,0.8,93.0,United Healthcare-Medicare Advantage, +150147,3934,82985,Glycated protein level,CPT/HCPCS,11.03,11.03,5.5,198.0,United Healthcare-Medicare Advantage, +150148,3934,83001,"Gonadotropin, follicle stimulating (reproductive hormone) level",CPT/HCPCS,286.89,286.89,10.5,309.0,United Healthcare-Medicare Advantage, +150149,3934,83002,"Gonadotropin, luteinizing (reproductive hormone) level",CPT/HCPCS,306.74,306.74,10.5,310.0,United Healthcare-Medicare Advantage, +150150,3934,83003,Human growth hormone level,CPT/HCPCS,52.5,52.5,12.0,70.0,United Healthcare-Medicare Advantage, +150151,3934,83006,Test for detecting genes associated with growth stimulation,CPT/HCPCS,168.0,168.0,30.17,35.54,United Healthcare-Medicare Advantage, +150152,3934,83010,Haptoglobin (serum protein) level,CPT/HCPCS,177.4,177.4,5.38,189.0,United Healthcare-Medicare Advantage, +150153,3934,83014,Administration of drug for helicobacter pylori,CPT/HCPCS,196.29,196.29,5.94,138.0,United Healthcare-Medicare Advantage, +150154,3934,83018,Heavy metal level,CPT/HCPCS,76.0,76.0,73.0,73.0,United Healthcare-Medicare Advantage, +150155,3934,83020,Hemoglobin analysis and measurement,CPT/HCPCS,147.78,147.78,5.38,263.11,United Healthcare-Medicare Advantage, +150156,3934,83021,Hemoglobin analysis and measurement,CPT/HCPCS,37.67,37.67,20.61,30.92,United Healthcare-Medicare Advantage, +150157,3934,83036,Hemoglobin A1C level,CPT/HCPCS,197.46,197.46,5.38,212.0,United Healthcare-Medicare Advantage, +150158,3934,83050,Methemoglobin (hemoglobin) analysis,CPT/HCPCS,134.19,134.19,4.88,135.0,United Healthcare-Medicare Advantage, +150159,3934,83070,Hemosiderin (hemoglobin breakdown product) analysis,CPT/HCPCS,12.0,12.0,4.75,4.75,United Healthcare-Medicare Advantage, +150160,3934,83088,Histamine (immune system substance) level,CPT/HCPCS,28.0,28.0,28.0,28.0,United Healthcare-Medicare Advantage, +150161,3934,83090,Homocysteine (amino acid) level,CPT/HCPCS,301.58,301.58,15.23,320.0,United Healthcare-Medicare Advantage, +150162,3934,83150,Homovanillic acid (organic acid) level,CPT/HCPCS,17.0,17.0,6.25,12.75,United Healthcare-Medicare Advantage, +150163,3934,83497,Hydroxyindolacetic acid (product of metabolism) level,CPT/HCPCS,19.2,19.2,12.9,20.44,United Healthcare-Medicare Advantage, +150164,3934,83498,"Hydroxyprogesterone, 17-D (synthetic hormone) level",CPT/HCPCS,24.55,24.55,12.62,375.66,United Healthcare-Medicare Advantage, +150165,3934,83516,Analysis of substance using immunoassay technique,CPT/HCPCS,51.83,51.83,3.5,2695.0,United Healthcare-Medicare Advantage, +150166,3934,83519,Measurement of substance using immunoassay technique,CPT/HCPCS,201.64,201.64,12.51,588.32,United Healthcare-Medicare Advantage, +150167,3934,83520,Measurement of substance using immunoassay technique,CPT/HCPCS,153.0,153.0,10.86,3048.5,United Healthcare-Medicare Advantage, +150168,3934,83525,Insulin measurement,CPT/HCPCS,8.15,8.15,4.0,42.76,United Healthcare-Medicare Advantage, +150169,3934,83540,Iron level,CPT/HCPCS,123.84,123.84,0.5,148.3,United Healthcare-Medicare Advantage, +150170,3934,83605,Lactic acid level,CPT/HCPCS,192.92,192.92,1.22,534.0,United Healthcare-Medicare Advantage, +150171,3934,83615,Lactate dehydrogenase (enzyme) level,CPT/HCPCS,88.06,88.06,0.8,9007.11,United Healthcare-Medicare Advantage, +150172,3934,83625,Lactate dehydrogenase (enzyme) measurement,CPT/HCPCS,15.0,15.0,16.44,16.44,United Healthcare-Medicare Advantage, +150173,3934,83630,Stool lactoferrin (immune system protein) analysis,CPT/HCPCS,30.0,30.0,5.2,5.2,United Healthcare-Medicare Advantage, +150174,3934,83655,Lead level,CPT/HCPCS,6.34,6.34,1.65,31.09,United Healthcare-Medicare Advantage, +150175,3934,83690,Lipase (fat enzyme) level,CPT/HCPCS,138.38,138.38,0.51,2423.94,United Healthcare-Medicare Advantage, +150176,3934,83695,Lipoprotein (A) level,CPT/HCPCS,12.0,12.0,8.16,106.74,United Healthcare-Medicare Advantage, +150177,3934,83704,Lipoprotein level,CPT/HCPCS,20.0,20.0,23.84,117.74,United Healthcare-Medicare Advantage, +150178,3934,83718,HDL cholesterol level,CPT/HCPCS,46.52,46.52,41.91,49.5,United Healthcare-Medicare Advantage, +150179,3934,83721,LDL cholesterol level,CPT/HCPCS,11.0,11.0,5.5,38.96,United Healthcare-Medicare Advantage, +150180,3934,83735,Magnesium level,CPT/HCPCS,81.33,81.33,0.09,3293.0,United Healthcare-Medicare Advantage, +150181,3934,83785,Manganese (heavy metal) level,CPT/HCPCS,16.0,16.0,27.43,30.37,United Healthcare-Medicare Advantage, +150182,3934,83789,Mass spectrometry (laboratory testing method),CPT/HCPCS,49.0,49.0,34.3,34.3,United Healthcare-Medicare Advantage, +150183,3934,83825,Mercury level,CPT/HCPCS,11.76,11.76,5.5,196.8,United Healthcare-Medicare Advantage, +150184,3934,83835,Metanephrines level,CPT/HCPCS,37.04,37.04,12.62,105.75,United Healthcare-Medicare Advantage, +150185,3934,83864,Mucopolysaccharides (protein) level,CPT/HCPCS,73.0,73.0,20.15,20.15,United Healthcare-Medicare Advantage, +150186,3934,83873,"Myelin basic protein (nerve protein) level, spinal fluid",CPT/HCPCS,25.0,25.0,1.31,27.41,United Healthcare-Medicare Advantage, +150187,3934,83874,Myoglobin (muscle protein) level,CPT/HCPCS,24.22,24.22,9.76,57.06,United Healthcare-Medicare Advantage, +150188,3934,83876,Myeloperoxidase (white blood cell enzyme) measurement,CPT/HCPCS,211.76,211.76,18.91,3576.5,United Healthcare-Medicare Advantage, +150189,3934,83880,Natriuretic peptide (heart and blood vessel protein) level,CPT/HCPCS,323.34,323.34,0.37,547.5,United Healthcare-Medicare Advantage, +150190,3934,83883,"Nephelometry, test method using light",CPT/HCPCS,377.65,377.65,9.25,432.0,United Healthcare-Medicare Advantage, +150191,3934,83916,Measurement of immune substance (oligoclonal bands),CPT/HCPCS,32.0,32.0,1.68,35.08,United Healthcare-Medicare Advantage, +150192,3934,83918,Organic acids level,CPT/HCPCS,95.0,95.0,20.06,47.5,United Healthcare-Medicare Advantage, +150193,3934,83921,Organic acid level,CPT/HCPCS,21.0,21.0,0.4,164.86,United Healthcare-Medicare Advantage, +150194,3934,83930,Blood osmolality (concentration) measurement,CPT/HCPCS,75.91,75.91,5.25,158.0,United Healthcare-Medicare Advantage, +150195,3934,83935,Urine osmolality (concentration) measurement,CPT/HCPCS,90.57,90.57,5.25,174.0,United Healthcare-Medicare Advantage, +150196,3934,83945,Oxalate level,CPT/HCPCS,17.22,17.22,7.7,14.49,United Healthcare-Medicare Advantage, +150197,3934,83951,Oncoprotein (cancer related gene) measurement,CPT/HCPCS,118.0,118.0,64.41,64.41,United Healthcare-Medicare Advantage, +150198,3934,83970,Parathormone (parathyroid hormone) level,CPT/HCPCS,495.71,495.71,25.0,1976.0,United Healthcare-Medicare Advantage, +150199,3934,83986,Body fluid pH level,CPT/HCPCS,42.35,42.35,2.43,55.0,United Healthcare-Medicare Advantage, +150200,3934,83992,PCP drug level,CPT/HCPCS,69.0,69.0,15.41,15.41,United Healthcare-Medicare Advantage, +150201,3934,83993,Stool calprotectin (protein) level,CPT/HCPCS,85.0,85.0,10.5,622.0,United Healthcare-Medicare Advantage, +150202,3934,84066,"Phosphatase, prostatic (prostate enzyme) level",CPT/HCPCS,14.0,14.0,9.66,14.0,United Healthcare-Medicare Advantage, +150203,3934,84075,Phosphatase (enzyme) level,CPT/HCPCS,88.99,88.99,0.8,202.0,United Healthcare-Medicare Advantage, +150204,3934,84080,Phosphatase (enzyme) measurement,CPT/HCPCS,28.67,28.67,9.91,27.54,United Healthcare-Medicare Advantage, +150205,3934,84100,Phosphate level,CPT/HCPCS,60.62,60.62,0.07,8195.75,United Healthcare-Medicare Advantage, +150206,3934,84105,Urine phosphate level,CPT/HCPCS,52.47,52.47,4.5,57.0,United Healthcare-Medicare Advantage, +150207,3934,84112,Cervicovaginal secretion of placenta protein,CPT/HCPCS,213.43,213.43,2.78,210.0,United Healthcare-Medicare Advantage, +150208,3934,84120,Urine porphyrins (metabolism substance) measurement,CPT/HCPCS,29.0,29.0,15.94,29.0,United Healthcare-Medicare Advantage, +150209,3934,84126,Stool porphyrins (metabolism substance) level,CPT/HCPCS,127.0,127.0,88.9,88.9,United Healthcare-Medicare Advantage, +150210,3934,84132,Blood potassium level,CPT/HCPCS,83.54,83.54,3.22,258.0,United Healthcare-Medicare Advantage, +150211,3934,84133,Urine potassium level,CPT/HCPCS,66.4,66.4,0.8,130.0,United Healthcare-Medicare Advantage, +150212,3934,84134,Prealbumin (protein) level,CPT/HCPCS,137.22,137.22,5.38,146.0,United Healthcare-Medicare Advantage, +150213,3934,84143,17-hydroxypregnenolone (hormone) level,CPT/HCPCS,41.25,41.25,22.81,44.88,United Healthcare-Medicare Advantage, +150214,3934,84144,Progesterone (reproductive hormone) level,CPT/HCPCS,302.91,302.91,12.62,282.0,United Healthcare-Medicare Advantage, +150215,3934,84145,Procalcitonin (hormone) level,CPT/HCPCS,155.9,155.9,3.58,387.61,United Healthcare-Medicare Advantage, +150216,3934,84146,Prolactin (milk producing hormone) level,CPT/HCPCS,387.62,387.62,10.23,884.25,United Healthcare-Medicare Advantage, +150217,3934,84150,Prostaglandin (hormone) level,CPT/HCPCS,220.0,220.0,23.1,150.04,United Healthcare-Medicare Advantage, +150218,3934,84153,PSA (prostate specific antigen) measurement,CPT/HCPCS,238.55,238.55,3.3,278.71,United Healthcare-Medicare Advantage, +150219,3934,84154,PSA (prostate specific antigen) measurement,CPT/HCPCS,12.85,12.85,3.3,116.27,United Healthcare-Medicare Advantage, +150220,3934,84155,"Total protein level, blood",CPT/HCPCS,62.82,62.82,3.34,73.0,United Healthcare-Medicare Advantage, +150221,3934,84156,"Total protein level, urine",CPT/HCPCS,58.57,58.57,3.12,62.0,United Healthcare-Medicare Advantage, +150222,3934,84157,"Total protein level, body fluid",CPT/HCPCS,79.15,79.15,1.57,85.0,United Healthcare-Medicare Advantage, +150223,3934,84165,"Protein measurement, serum",CPT/HCPCS,182.29,182.29,4.38,197.0,United Healthcare-Medicare Advantage, +150224,3934,84166,"Protein measurement, body fluid",CPT/HCPCS,180.37,180.37,5.38,193.0,United Healthcare-Medicare Advantage, +150225,3934,84181,Protein measurement,CPT/HCPCS,120.0,120.0,17.03,159.38,United Healthcare-Medicare Advantage, +150226,3934,84182,Protein measurement,CPT/HCPCS,208.94,208.94,19.86,127.53,United Healthcare-Medicare Advantage, +150227,3934,84202,Protoporphyrin (metabolism substance) level,CPT/HCPCS,46.38,46.38,9.0,62.0,United Healthcare-Medicare Advantage, +150228,3934,84207,Vitamin B-6 level,CPT/HCPCS,10.42,10.42,5.0,376.89,United Healthcare-Medicare Advantage, +150229,3934,84210,Pyruvate (organic acid) level,CPT/HCPCS,28.83,28.83,9.85,20.3,United Healthcare-Medicare Advantage, +150230,3934,84220,Pyruvate kinase (enzyme) level,CPT/HCPCS,55.0,55.0,9.44,9.44,United Healthcare-Medicare Advantage, +150231,3934,84244,Renin (kidney enzyme) level,CPT/HCPCS,13.0,13.0,6.5,207.87,United Healthcare-Medicare Advantage, +150232,3934,84252,Vitamin B-2 (riboflavin) level,CPT/HCPCS,45.0,45.0,20.24,33.11,United Healthcare-Medicare Advantage, +150233,3934,84255,Selenium (vitamin) level,CPT/HCPCS,15.0,15.0,7.5,216.91,United Healthcare-Medicare Advantage, +150234,3934,84260,Serotonin (hormone) level,CPT/HCPCS,34.0,34.0,9.35,34.0,United Healthcare-Medicare Advantage, +150235,3934,84270,Sex hormone binding globulin (protein) level,CPT/HCPCS,8.26,8.26,2.56,89.98,United Healthcare-Medicare Advantage, +150236,3934,84295,Blood sodium level,CPT/HCPCS,66.55,66.55,0.58,140.0,United Healthcare-Medicare Advantage, +150237,3934,84300,Urine sodium level,CPT/HCPCS,66.46,66.46,0.8,130.0,United Healthcare-Medicare Advantage, +150238,3934,84302,Sodium level,CPT/HCPCS,38.88,38.88,4.86,45.0,United Healthcare-Medicare Advantage, +150239,3934,84305,Somatomedin (growth factor) level,CPT/HCPCS,13.0,13.0,6.5,422.88,United Healthcare-Medicare Advantage, +150240,3934,84311,Chemical analysis using spectrophotometry (light),CPT/HCPCS,26.0,26.0,5.51,14.0,United Healthcare-Medicare Advantage, +150241,3934,84315,Specific gravity (liquid weight) measurement,CPT/HCPCS,31.25,31.25,8.98,34.0,United Healthcare-Medicare Advantage, +150242,3934,84376,Carbohydrate analysis,CPT/HCPCS,13.0,13.0,40.71,40.71,United Healthcare-Medicare Advantage, +150243,3934,84378,Carbohydrate analysis,CPT/HCPCS,59.0,59.0,11.5,41.3,United Healthcare-Medicare Advantage, +150244,3934,84392,Urine sulfate (acid) level,CPT/HCPCS,23.38,23.38,3.5,4.83,United Healthcare-Medicare Advantage, +150245,3934,84402,Testosterone (hormone) level,CPT/HCPCS,6.21,6.21,4.08,329.0,United Healthcare-Medicare Advantage, +150246,3934,84403,Testosterone (hormone) level,CPT/HCPCS,13.42,13.42,0.7,343.37,United Healthcare-Medicare Advantage, +150247,3934,84425,Vitamin B-1 (thiamine) level,CPT/HCPCS,11.0,11.0,5.38,231.92,United Healthcare-Medicare Advantage, +150248,3934,84432,Thyroglobulin (thyroid related hormone) level,CPT/HCPCS,21.99,21.99,0.78,96.82,United Healthcare-Medicare Advantage, +150249,3934,84436,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,143.83,143.83,1.11,216.0,United Healthcare-Medicare Advantage, +150250,3934,84439,Thyroxine (thyroid chemical) measurement,CPT/HCPCS,200.4,200.4,7.67,247.0,United Healthcare-Medicare Advantage, +150251,3934,84442,Thyroxine binding globulin (thyroid related protein) level,CPT/HCPCS,17.0,17.0,8.5,145.19,United Healthcare-Medicare Advantage, +150252,3934,84443,"Blood test, thyroid stimulating hormone (TSH)",CPT/HCPCS,262.41,262.41,0.3,4165.0,United Healthcare-Medicare Advantage, +150253,3934,84445,Thyroid stimulating immune globulins (thyroid related protein) level,CPT/HCPCS,41.0,41.0,20.5,226.54,United Healthcare-Medicare Advantage, +150254,3934,84446,Vitamin E level,CPT/HCPCS,30.0,30.0,5.38,182.37,United Healthcare-Medicare Advantage, +150255,3934,84450,"Liver enzyme (SGOT), level",CPT/HCPCS,76.9,76.9,0.8,93.84,United Healthcare-Medicare Advantage, +150256,3934,84460,"Liver enzyme (SGPT), level",CPT/HCPCS,89.66,89.66,0.8,97.0,United Healthcare-Medicare Advantage, +150257,3934,84466,Transferrin (iron binding protein) level,CPT/HCPCS,165.02,165.02,5.18,175.0,United Healthcare-Medicare Advantage, +150258,3934,84478,Triglycerides level,CPT/HCPCS,121.75,121.75,3.34,121.0,United Healthcare-Medicare Advantage, +150259,3934,84479,Thyroid hormone evaluation,CPT/HCPCS,123.27,123.27,0.71,140.0,United Healthcare-Medicare Advantage, +150260,3934,84480,"Thyroid hormone, T3 measurement",CPT/HCPCS,131.98,131.98,5.49,214.87,United Healthcare-Medicare Advantage, +150261,3934,84481,"Thyroid hormone, T3 measurement",CPT/HCPCS,10.0,10.0,0.5,306.97,United Healthcare-Medicare Advantage, +150262,3934,84482,"Thyroid hormone, T3 measurement",CPT/HCPCS,24.0,24.0,5.7,84.97,United Healthcare-Medicare Advantage, +150263,3934,84484,Troponin (protein) analysis,CPT/HCPCS,221.09,221.09,0.17,3563.0,United Healthcare-Medicare Advantage, +150264,3934,84510,Tyrosine (amino acid) level,CPT/HCPCS,83.39,83.39,5.38,67.32,United Healthcare-Medicare Advantage, +150265,3934,84520,Urea nitrogen level to assess kidney function,CPT/HCPCS,75.66,75.66,0.5,154.0,United Healthcare-Medicare Advantage, +150266,3934,84540,Urea nitrogen level to assess kidney function,CPT/HCPCS,73.4,73.4,0.8,78.0,United Healthcare-Medicare Advantage, +150267,3934,84550,"Uric acid level, blood",CPT/HCPCS,85.1,85.1,0.29,91.0,United Healthcare-Medicare Advantage, +150268,3934,84560,Uric acid level,CPT/HCPCS,16.2,16.2,2.1,5.52,United Healthcare-Medicare Advantage, +150269,3934,84585,Urine vanillylmandelic acid,CPT/HCPCS,16.77,16.77,11.9,28.7,United Healthcare-Medicare Advantage, +150270,3934,84586,Vasoactive intestinal peptide (intestinal hormone) level,CPT/HCPCS,39.0,39.0,26.36,35.33,United Healthcare-Medicare Advantage, +150271,3934,84588,ADH (antidiuretic hormone) level,CPT/HCPCS,31.0,31.0,15.19,31.0,United Healthcare-Medicare Advantage, +150272,3934,84590,Vitamin A level,CPT/HCPCS,14.0,14.0,5.38,208.6,United Healthcare-Medicare Advantage, +150273,3934,84597,Vitamin K level,CPT/HCPCS,60.0,60.0,5.25,60.0,United Healthcare-Medicare Advantage, +150274,3934,84630,Zinc level,CPT/HCPCS,11.0,11.0,5.5,134.13,United Healthcare-Medicare Advantage, +150275,3934,84681,C-peptide (protein) level,CPT/HCPCS,11.39,11.39,0.55,211.73,United Healthcare-Medicare Advantage, +150276,3934,84702,"Gonadotropin, chorionic (reproductive hormone) level",CPT/HCPCS,332.92,332.92,4.62,8886.67,United Healthcare-Medicare Advantage, +150277,3934,84703,Gonadotropin (reproductive hormone) analysis,CPT/HCPCS,248.11,248.11,1.93,658.5,United Healthcare-Medicare Advantage, +150278,3934,84704,"Gonadotropin, chorionic (reproductive hormone) measurement",CPT/HCPCS,13.0,13.0,5.38,13.24,United Healthcare-Medicare Advantage, +150279,3934,84999,Chemistry procedures,CPT/HCPCS,1310.07,1310.07,6.68,2000.0,United Healthcare-Medicare Advantage, +150280,3934,85007,Microscopic examination for white blood cells with manual cell count,CPT/HCPCS,107.56,107.56,1.43,113.0,United Healthcare-Medicare Advantage, +150281,3934,85008,Microscopic examination for white blood cells,CPT/HCPCS,39.22,39.22,10.86,27.14,United Healthcare-Medicare Advantage, +150282,3934,85014,Red blood cell concentration measurement,CPT/HCPCS,49.67,49.67,2.0,147.34,United Healthcare-Medicare Advantage, +150283,3934,85018,Hemoglobin measurement,CPT/HCPCS,48.94,48.94,2.0,143.83,United Healthcare-Medicare Advantage, +150284,3934,85025,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,126.45,126.45,0.14,1839.0,United Healthcare-Medicare Advantage, +150285,3934,85027,"Complete blood cell count (red cells, white blood cell, platelets), automated test",CPT/HCPCS,92.1,92.1,0.1,2494.0,United Healthcare-Medicare Advantage, +150286,3934,85044,"Red blood count, manual test",CPT/HCPCS,29.91,29.91,1.43,21.7,United Healthcare-Medicare Advantage, +150287,3934,85045,"Red blood count, automated test",CPT/HCPCS,67.72,67.72,3.05,1411.2,United Healthcare-Medicare Advantage, +150288,3934,85048,Automated white blood cell count,CPT/HCPCS,63.77,63.77,2.54,67.0,United Healthcare-Medicare Advantage, +150289,3934,85049,"Platelet count, automated test",CPT/HCPCS,88.98,88.98,3.17,95.0,United Healthcare-Medicare Advantage, +150290,3934,85097,"Bone marrow, smear interpretation",CPT/HCPCS,11635.43,11635.43,118.57,20598.46,United Healthcare-Medicare Advantage, +150291,3934,85210,"Clotting factor II prothrombin, measurement",CPT/HCPCS,263.0,263.0,12.98,260.0,United Healthcare-Medicare Advantage, +150292,3934,85220,Clotting factor V (AcG or proaccelerin) measurement,CPT/HCPCS,223.36,223.36,19.3,165.2,United Healthcare-Medicare Advantage, +150293,3934,85230,"Clotting factor VII (proconvertin, stable factor)",CPT/HCPCS,485.35,485.35,15.22,366.75,United Healthcare-Medicare Advantage, +150294,3934,85240,Clotting factor VIII (AHG) measurement,CPT/HCPCS,417.12,417.12,9.4,440.0,United Healthcare-Medicare Advantage, +150295,3934,85245,Clotting factor VIII (VW factor) measurement,CPT/HCPCS,336.53,336.53,9.06,334.0,United Healthcare-Medicare Advantage, +150296,3934,85246,Clotting factor VIII (VW factor) antigen,CPT/HCPCS,303.7,303.7,9.06,303.0,United Healthcare-Medicare Advantage, +150297,3934,85247,Clotting factor VIII (von Willebrand factor) measurement,CPT/HCPCS,169.23,169.23,11.77,170.0,United Healthcare-Medicare Advantage, +150298,3934,85250,Clotting factor IX (PTC or Christmas) measurement,CPT/HCPCS,424.05,424.05,16.18,593.6,United Healthcare-Medicare Advantage, +150299,3934,85260,Clotting factor X (Stuart-Prower) measurement,CPT/HCPCS,257.8,257.8,17.9,190.4,United Healthcare-Medicare Advantage, +150300,3934,85270,Clotting factor XI (PTA) measurement,CPT/HCPCS,339.25,339.25,15.22,340.0,United Healthcare-Medicare Advantage, +150301,3934,85280,Clotting factor XII (Hageman) measurement,CPT/HCPCS,239.0,239.0,16.45,197.33,United Healthcare-Medicare Advantage, +150302,3934,85291,Clotting factor XIII (fibrin stabilizing) screening test,CPT/HCPCS,226.29,226.29,7.1,171.0,United Healthcare-Medicare Advantage, +150303,3934,85300,Antithrombin III antigen (clotting inhibitor) activity,CPT/HCPCS,285.05,285.05,9.09,305.0,United Healthcare-Medicare Advantage, +150304,3934,85301,Antithrombin III antigen (clotting inhibitor) level,CPT/HCPCS,221.28,221.28,10.81,10.81,United Healthcare-Medicare Advantage, +150305,3934,85302,"Protein C, (clotting inhibitor) activity",CPT/HCPCS,175.94,175.94,12.01,281.0,United Healthcare-Medicare Advantage, +150306,3934,85303,Protein C antigen (clotting inhibitor) measurement,CPT/HCPCS,409.03,409.03,11.76,437.0,United Healthcare-Medicare Advantage, +150307,3934,85306,Protein S (clotting inhibitor) measurement,CPT/HCPCS,432.77,432.77,14.85,764.0,United Healthcare-Medicare Advantage, +150308,3934,85307,Activated protein resistance assay,CPT/HCPCS,22.0,22.0,14.73,22.0,United Healthcare-Medicare Advantage, +150309,3934,85335,Clotting factor inhibitor test,CPT/HCPCS,359.0,359.0,13.53,35.23,United Healthcare-Medicare Advantage, +150310,3934,85378,Coagulation function measurement,CPT/HCPCS,92.56,92.56,86.95,100.0,United Healthcare-Medicare Advantage, +150311,3934,85379,Coagulation function measurement,CPT/HCPCS,218.58,218.58,0.25,460.0,United Healthcare-Medicare Advantage, +150312,3934,85384,Fibrinogen (factor 1) activity measurement,CPT/HCPCS,148.19,148.19,6.9,170.0,United Healthcare-Medicare Advantage, +150313,3934,85397,Measurement of blood coagulation and fibrinolysis (clot dissolving) function,CPT/HCPCS,154.06,154.06,9.4,105.71,United Healthcare-Medicare Advantage, +150314,3934,85415,Plasminogen activator (fibrinolytic factor) measurement,CPT/HCPCS,87.45,87.45,8.78,171.02,United Healthcare-Medicare Advantage, +150315,3934,85420,Plasminogen (fibrinolytic factor) measurement,CPT/HCPCS,21.0,21.0,4.94,18.42,United Healthcare-Medicare Advantage, +150316,3934,85421,Plasminogen antigenic (factor inhibitor) measurement,CPT/HCPCS,184.0,184.0,161.38,161.38,United Healthcare-Medicare Advantage, +150317,3934,85461,Fetal hemoglobin or red blood cells measurement for assessment of fetal-maternal circulation,CPT/HCPCS,146.37,146.37,9.36,115.14,United Healthcare-Medicare Advantage, +150318,3934,85520,Heparin assay,CPT/HCPCS,757.51,757.51,0.82,800.0,United Healthcare-Medicare Advantage, +150319,3934,85576,Platelet function test,CPT/HCPCS,661.93,661.93,10.32,1470.0,United Healthcare-Medicare Advantage, +150320,3934,85610,"Blood test, clotting time",CPT/HCPCS,87.87,87.87,0.1,3168.21,United Healthcare-Medicare Advantage, +150321,3934,85611,"Blood test, clotting time",CPT/HCPCS,194.33,194.33,2.68,142.1,United Healthcare-Medicare Advantage, +150322,3934,85613,Clotting factor X assessment test,CPT/HCPCS,256.47,256.47,4.74,426.0,United Healthcare-Medicare Advantage, +150323,3934,85635,Blood coagulation screening test,CPT/HCPCS,169.0,169.0,8.48,8.48,United Healthcare-Medicare Advantage, +150324,3934,85652,"Red blood cell sedimentation rate, to detect inflammation",CPT/HCPCS,80.49,80.49,1.7,86.0,United Healthcare-Medicare Advantage, +150325,3934,85660,Red blood cell sickling measurement,CPT/HCPCS,51.11,51.11,51.0,51.0,United Healthcare-Medicare Advantage, +150326,3934,85670,"Thrombin time, fibrinogen screening test",CPT/HCPCS,71.11,71.11,5.3,72.0,United Healthcare-Medicare Advantage, +150327,3934,85730,Coagulation assessment blood test,CPT/HCPCS,116.06,116.06,0.13,4226.15,United Healthcare-Medicare Advantage, +150328,3934,85732,Coagulation assessment blood test,CPT/HCPCS,249.31,249.31,6.19,284.0,United Healthcare-Medicare Advantage, +150329,3934,85810,Blood viscosity measurement,CPT/HCPCS,135.22,135.22,11.67,146.0,United Healthcare-Medicare Advantage, +150330,3934,85999,Hematology and coagulation procedures,CPT/HCPCS,231.75,231.75,7.82,249.0,United Healthcare-Medicare Advantage, +150331,3934,86003,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,66.36,66.36,2.5,2521.28,United Healthcare-Medicare Advantage, +150332,3934,86005,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,6.91,6.91,5.42,8.36,United Healthcare-Medicare Advantage, +150333,3934,86008,Measurement of antibody (IgE) to allergic substance,CPT/HCPCS,74.75,74.75,3.65,154.13,United Healthcare-Medicare Advantage, +150334,3934,86021,Antibody identification test for white blood cell antibodies,CPT/HCPCS,73.0,73.0,11.38,107.93,United Healthcare-Medicare Advantage, +150335,3934,86022,Antibody identification test for platelet antibodies,CPT/HCPCS,294.21,294.21,13.88,300.0,United Healthcare-Medicare Advantage, +150336,3934,86038,Screening test for autoimmune disorder,CPT/HCPCS,170.61,170.61,4.42,229.84,United Healthcare-Medicare Advantage, +150337,3934,86039,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,126.69,126.69,5.01,135.95,United Healthcare-Medicare Advantage, +150338,3934,86060,Measurement for Strep antibody (strep throat),CPT/HCPCS,154.82,154.82,4.87,105.0,United Healthcare-Medicare Advantage, +150339,3934,86140,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,119.67,119.67,1.32,1311.9,United Healthcare-Medicare Advantage, +150340,3934,86141,Measurement C-reactive protein for detection of infection or inflammation,CPT/HCPCS,177.45,177.45,10.25,183.75,United Healthcare-Medicare Advantage, +150341,3934,86146,Beta 2 glycoprotein 1 antibody (autoantibody) measurement,CPT/HCPCS,35.7,35.7,0.66,260.72,United Healthcare-Medicare Advantage, +150342,3934,86147,Cardiolipin antibody (tissue antibody) measurement,CPT/HCPCS,532.79,532.79,7.82,574.0,United Healthcare-Medicare Advantage, +150343,3934,86148,Phospholipid antibody (autoimmune antibody) measurement,CPT/HCPCS,38.6,38.6,7.82,101.09,United Healthcare-Medicare Advantage, +150344,3934,86152,Cell enumeration using immunologic selection and identification in fluid specimen,CPT/HCPCS,310.0,310.0,310.0,310.0,United Healthcare-Medicare Advantage, +150345,3934,86157,Measurement of cold agglutinin (protein) to detect infection or disease,CPT/HCPCS,14.0,14.0,5.2,14.0,United Healthcare-Medicare Advantage, +150346,3934,86160,Measurement of complement (immune system proteins),CPT/HCPCS,504.44,504.44,5.23,560.0,United Healthcare-Medicare Advantage, +150347,3934,86161,Measurement of complement function (immune system proteins),CPT/HCPCS,55.2,55.2,12.0,61.5,United Healthcare-Medicare Advantage, +150348,3934,86162,Measurement of complement (immune system proteins),CPT/HCPCS,15.88,15.88,5.5,20.76,United Healthcare-Medicare Advantage, +150349,3934,86200,Measurement of antibody for rheumatoid arthritis assessment,CPT/HCPCS,156.95,156.95,5.23,155.0,United Healthcare-Medicare Advantage, +150350,3934,86215,Measurement of DNA antibody,CPT/HCPCS,11.0,11.0,5.2,12.06,United Healthcare-Medicare Advantage, +150351,3934,86225,Measurement of DNA antibody,CPT/HCPCS,227.94,227.94,5.01,243.0,United Healthcare-Medicare Advantage, +150352,3934,86235,Measurement of antibody for assessment of autoimmune disorder,CPT/HCPCS,398.85,398.85,5.2,1136.0,United Healthcare-Medicare Advantage, +150353,3934,86255,Screening test for antibody to noninfectious agent,CPT/HCPCS,178.57,178.57,5.2,2677.0,United Healthcare-Medicare Advantage, +150354,3934,86256,Measurement of antibody to noninfectious agent,CPT/HCPCS,139.82,139.82,5.23,166.0,United Healthcare-Medicare Advantage, +150355,3934,86300,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,339.43,339.43,4.66,594.3,United Healthcare-Medicare Advantage, +150356,3934,86301,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,344.05,344.05,9.66,366.0,United Healthcare-Medicare Advantage, +150357,3934,86304,Immunologic analysis for detection of tumor antigen,CPT/HCPCS,377.06,377.06,4.83,399.0,United Healthcare-Medicare Advantage, +150358,3934,86305,Analysis of female reproductive genetic marker,CPT/HCPCS,84.83,84.83,20.81,85.0,United Healthcare-Medicare Advantage, +150359,3934,86308,Screening test for mononucleosis (mono),CPT/HCPCS,144.44,144.44,3.13,1660.89,United Healthcare-Medicare Advantage, +150360,3934,86316,Analysis for detection of tumor marker,CPT/HCPCS,40.37,40.37,1.95,65.51,United Healthcare-Medicare Advantage, +150361,3934,86317,Detection of infectious agent antibody,CPT/HCPCS,44.76,44.76,5.23,1007.19,United Healthcare-Medicare Advantage, +150362,3934,86328,"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])",CPT/HCPCS,80.0,80.0,10.97,80.0,United Healthcare-Medicare Advantage, +150363,3934,86331,Immunologic analysis for detection of antigen or antibody,CPT/HCPCS,26.93,26.93,11.74,37.5,United Healthcare-Medicare Advantage, +150364,3934,86334,Immunologic analysis technique on serum,CPT/HCPCS,226.93,226.93,5.04,458.0,United Healthcare-Medicare Advantage, +150365,3934,86335,Immunologic analysis technique on body fluid,CPT/HCPCS,264.74,264.74,18.7,289.0,United Healthcare-Medicare Advantage, +150366,3934,86336,Inhibin A (reproductive organ hormone) measurement,CPT/HCPCS,35.52,35.52,6.5,19.78,United Healthcare-Medicare Advantage, +150367,3934,86337,Insulin antibody measurement,CPT/HCPCS,35.0,35.0,12.5,35.0,United Healthcare-Medicare Advantage, +150368,3934,86340,Intrinsic factor (stomach protein) antibody measurement,CPT/HCPCS,24.0,24.0,11.36,26.31,United Healthcare-Medicare Advantage, +150369,3934,86341,Islet cell (pancreas) antibody measurement,CPT/HCPCS,98.26,98.26,12.5,912.0,United Healthcare-Medicare Advantage, +150370,3934,86352,Analysis of cell function and analysis for genetic marker,CPT/HCPCS,166.7,166.7,37.41,1320.5,United Healthcare-Medicare Advantage, +150371,3934,86353,White blood cell function measurement,CPT/HCPCS,349.67,349.67,37.04,51.37,United Healthcare-Medicare Advantage, +150372,3934,86355,Total cell count for B cells (white blood cells),CPT/HCPCS,264.51,264.51,18.7,300.0,United Healthcare-Medicare Advantage, +150373,3934,86356,White blood cell antigen measurement,CPT/HCPCS,129.64,129.64,19.0,160.68,United Healthcare-Medicare Advantage, +150374,3934,86357,Total cell count for natural killer cells (white blood cell),CPT/HCPCS,301.3,301.3,18.01,350.0,United Healthcare-Medicare Advantage, +150375,3934,86359,"T cells count, total",CPT/HCPCS,306.2,306.2,18.01,327.0,United Healthcare-Medicare Advantage, +150376,3934,86360,T cell count and ratio,CPT/HCPCS,452.58,452.58,15.9,484.0,United Healthcare-Medicare Advantage, +150377,3934,86367,"Stem cells count, total",CPT/HCPCS,503.87,503.87,37.41,564.0,United Healthcare-Medicare Advantage, +150378,3934,86376,Microsomal antibodies (autoantibody) measurement,CPT/HCPCS,8.88,8.88,2.13,197.33,United Healthcare-Medicare Advantage, +150379,3934,86431,Rheumatoid factor level,CPT/HCPCS,91.23,91.23,2.16,97.0,United Healthcare-Medicare Advantage, +150380,3934,86480,Tuberculosis test,CPT/HCPCS,343.17,343.17,50.0,692.74,United Healthcare-Medicare Advantage, +150381,3934,86580,Skin test for tuberculosis,CPT/HCPCS,49.69,49.69,4.82,37.63,United Healthcare-Medicare Advantage, +150382,3934,86592,Syphilis detection test,CPT/HCPCS,78.77,78.77,0.78,96.0,United Healthcare-Medicare Advantage, +150383,3934,86593,Syphilis test,CPT/HCPCS,67.09,67.09,3.7,53.13,United Healthcare-Medicare Advantage, +150384,3934,86603,Analysis for antibody to adenovirus (respiratory virus),CPT/HCPCS,79.0,79.0,8.03,8.03,United Healthcare-Medicare Advantage, +150385,3934,86606,Analysis for antibody to aspergillus (fungus),CPT/HCPCS,30.29,30.29,8.03,74.69,United Healthcare-Medicare Advantage, +150386,3934,86609,Analysis for antibody bacteria,CPT/HCPCS,71.0,71.0,25.24,47.59,United Healthcare-Medicare Advantage, +150387,3934,86611,Analysis for antibody to Bartonella (bacteria),CPT/HCPCS,24.0,24.0,5.23,78.93,United Healthcare-Medicare Advantage, +150388,3934,86615,Analysis for antibody bordetella (respiratory bacteria),CPT/HCPCS,30.87,30.87,8.03,348.5,United Healthcare-Medicare Advantage, +150389,3934,86617,Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,298.09,298.09,5.23,578.0,United Healthcare-Medicare Advantage, +150390,3934,86618,Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria),CPT/HCPCS,219.53,219.53,4.97,396.0,United Healthcare-Medicare Advantage, +150391,3934,86619,Analysis for antibody to Borrelia (relapsing fever bacteria),CPT/HCPCS,113.17,113.17,14.79,198.0,United Healthcare-Medicare Advantage, +150392,3934,86622,Analysis for antibody to Brucella (bacteria),CPT/HCPCS,13.0,13.0,8.93,8.93,United Healthcare-Medicare Advantage, +150393,3934,86631,Analysis for antibody to Chlamydia (bacteria),CPT/HCPCS,27.0,27.0,7.43,9.0,United Healthcare-Medicare Advantage, +150394,3934,86632,Analysis for antibody (IgM) to Chlamydia (bacteria),CPT/HCPCS,28.0,28.0,7.7,9.34,United Healthcare-Medicare Advantage, +150395,3934,86635,Analysis for antibody to Coccidioides (bacteria),CPT/HCPCS,15.56,15.56,7.7,11.0,United Healthcare-Medicare Advantage, +150396,3934,86638,Analysis for antibody to Coxiella burnetii (Q fever bacteria),CPT/HCPCS,52.5,52.5,8.03,8.03,United Healthcare-Medicare Advantage, +150397,3934,86644,Analysis for antibody to Cytomegalovirus (CMV),CPT/HCPCS,218.1,218.1,5.23,232.0,United Healthcare-Medicare Advantage, +150398,3934,86645,Analysis for antibody (IgM) to Cytomegalovirus (CMV),CPT/HCPCS,9.11,9.11,5.23,9.87,United Healthcare-Medicare Advantage, +150399,3934,86658,Analysis for antibody to Enterovirus (gastrointestinal virus),CPT/HCPCS,93.59,93.59,5.23,780.18,United Healthcare-Medicare Advantage, +150400,3934,86663,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,4.06,4.06,0.4,41.28,United Healthcare-Medicare Advantage, +150401,3934,86664,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,5.06,5.06,0.5,171.42,United Healthcare-Medicare Advantage, +150402,3934,86665,Analysis for antibody to Epstein-Barr virus (mononucleosis virus),CPT/HCPCS,14.13,14.13,1.4,406.66,United Healthcare-Medicare Advantage, +150403,3934,86666,Analysis for antibody to Ehrlichia (bacteria transmitted by ticks),CPT/HCPCS,41.06,41.06,8.03,208.7,United Healthcare-Medicare Advantage, +150404,3934,86668,Analysis for antibody to Francisella tularensis (bacteria transmitted by rodents),CPT/HCPCS,49.13,49.13,24.12,35.83,United Healthcare-Medicare Advantage, +150405,3934,86671,Analysis for antibody to fungus,CPT/HCPCS,49.0,49.0,4.26,53.57,United Healthcare-Medicare Advantage, +150406,3934,86682,Analysis for antibody to helminth (intestinal worm),CPT/HCPCS,41.19,41.19,6.09,90.0,United Healthcare-Medicare Advantage, +150407,3934,86689,Confirmation test for antibody to Human T-cell lymphotropic virus (HTLV) or HIV,CPT/HCPCS,76.83,76.83,19.35,19.35,United Healthcare-Medicare Advantage, +150408,3934,86694,Analysis for antibody to Herpes simplex virus,CPT/HCPCS,22.65,22.65,5.2,25.0,United Healthcare-Medicare Advantage, +150409,3934,86695,"Analysis for antibody to Herpes simplex virus, type 1",CPT/HCPCS,18.33,18.33,8.97,136.93,United Healthcare-Medicare Advantage, +150410,3934,86696,"Analysis for antibody to Herpes simplex virus, type 2",CPT/HCPCS,25.23,25.23,14.5,143.99,United Healthcare-Medicare Advantage, +150411,3934,86698,Analysis for antibody to histoplasma (fungus),CPT/HCPCS,35.0,35.0,12.41,35.0,United Healthcare-Medicare Advantage, +150412,3934,86701,Analysis for antibody to HIV -1 virus,CPT/HCPCS,122.71,122.71,117.0,125.0,United Healthcare-Medicare Advantage, +150413,3934,86702,Analysis for antibody to HIV-2 virus,CPT/HCPCS,185.57,185.57,177.0,189.0,United Healthcare-Medicare Advantage, +150414,3934,86703,Analysis for antibody to HIV-1 and HIV-2 virus,CPT/HCPCS,191.16,191.16,13.7,167.41,United Healthcare-Medicare Advantage, +150415,3934,86704,Hepatitis B core antibody measurement,CPT/HCPCS,102.96,102.96,2.53,134.77,United Healthcare-Medicare Advantage, +150416,3934,86705,Hepatitis B core antibody (IgM) measurement,CPT/HCPCS,174.84,174.84,10.1,186.0,United Healthcare-Medicare Advantage, +150417,3934,86706,Hepatitis B surface antibody measurement,CPT/HCPCS,119.66,119.66,2.94,246.0,United Healthcare-Medicare Advantage, +150418,3934,86707,Hepatitis Be antibody measurement,CPT/HCPCS,14.0,14.0,9.45,40.81,United Healthcare-Medicare Advantage, +150419,3934,86708,Measurement of Hepatitis A antibody,CPT/HCPCS,10.4,10.4,2.67,139.83,United Healthcare-Medicare Advantage, +150420,3934,86709,Measurement of Hepatitis A antibody (IgM),CPT/HCPCS,153.32,153.32,3.63,152.0,United Healthcare-Medicare Advantage, +150421,3934,86710,Analysis for antibody to Influenza virus,CPT/HCPCS,27.67,27.67,11.0,14.99,United Healthcare-Medicare Advantage, +150422,3934,86713,Analysis for antibody to Legionella (waterborne bacteria),CPT/HCPCS,12.0,12.0,12.0,120.36,United Healthcare-Medicare Advantage, +150423,3934,86735,Analysis for antibody to mumps virus,CPT/HCPCS,203.73,203.73,5.23,221.0,United Healthcare-Medicare Advantage, +150424,3934,86738,Analysis for antibody to Mycoplasma (bacteria),CPT/HCPCS,16.79,16.79,11.0,22.0,United Healthcare-Medicare Advantage, +150425,3934,86741,Analysis for antibody to Neisseria meningitidis (bacterial meningitis),CPT/HCPCS,223.1,223.1,8.03,16.06,United Healthcare-Medicare Advantage, +150426,3934,86747,Analysis for antibody to parvovirus,CPT/HCPCS,27.75,27.75,7.84,65.84,United Healthcare-Medicare Advantage, +150427,3934,86753,Analysis for antibody to protozoa (parasite),CPT/HCPCS,24.33,24.33,4.88,139.13,United Healthcare-Medicare Advantage, +150428,3934,86757,Analysis for antibody to Rickettsia (bacteria),CPT/HCPCS,50.25,50.25,21.4,925.95,United Healthcare-Medicare Advantage, +150429,3934,86762,Analysis for antibody to Rubella (German measles virus),CPT/HCPCS,136.09,136.09,3.26,173.29,United Healthcare-Medicare Advantage, +150430,3934,86765,Analysis for antibody to Rubeola (measles virus),CPT/HCPCS,150.24,150.24,4.15,149.0,United Healthcare-Medicare Advantage, +150431,3934,86769,Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]),CPT/HCPCS,77.39,77.39,15.91,126.39,United Healthcare-Medicare Advantage, +150432,3934,86777,Analysis for antibody to Toxoplasma (parasite),CPT/HCPCS,142.05,142.05,5.23,151.0,United Healthcare-Medicare Advantage, +150433,3934,86778,Analysis for antibody (IgM) to Toxoplasma (parasite),CPT/HCPCS,133.51,133.51,5.23,142.0,United Healthcare-Medicare Advantage, +150434,3934,86780,"Analysis for antibody, Treponema pallidum",CPT/HCPCS,140.07,140.07,5.23,159.38,United Healthcare-Medicare Advantage, +150435,3934,86787,Analysis for antibody to varicella-zoster virus (chicken pox),CPT/HCPCS,222.09,222.09,4.01,426.0,United Healthcare-Medicare Advantage, +150436,3934,86788,Analysis for antibody (IgM) to West Nile virus,CPT/HCPCS,23.13,23.13,4.01,17.0,United Healthcare-Medicare Advantage, +150437,3934,86789,Analysis for antibody to West Nile virus,CPT/HCPCS,20.93,20.93,14.96,15.91,United Healthcare-Medicare Advantage, +150438,3934,86790,Analysis for antibody to virus,CPT/HCPCS,155.96,155.96,4.88,90.0,United Healthcare-Medicare Advantage, +150439,3934,86800,Thyroglobulin (thyroid protein) antibody measurement,CPT/HCPCS,8.39,8.39,0.39,178.51,United Healthcare-Medicare Advantage, +150440,3934,86803,Hepatitis C antibody measurement,CPT/HCPCS,215.55,215.55,0.26,239.0,United Healthcare-Medicare Advantage, +150441,3934,86805,Immunologic analysis for autoimmune disease,CPT/HCPCS,886.04,886.04,115.12,910.0,United Healthcare-Medicare Advantage, +150442,3934,86812,Immunologic analysis for autoimmune disease,CPT/HCPCS,368.76,368.76,17.55,274.5,United Healthcare-Medicare Advantage, +150443,3934,86828,Assessment of antibodies to Class I and Class II human leukocyte antigens (HLA) antigens,CPT/HCPCS,183.81,183.81,18.3,196.0,United Healthcare-Medicare Advantage, +150444,3934,86832,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class I",CPT/HCPCS,537.74,537.74,19.79,569.0,United Healthcare-Medicare Advantage, +150445,3934,86833,"Assessment of antibody to human leukocyte antigens (HLA) with high definition qualitative panel for identification of antibody specificities, HLA class II",CPT/HCPCS,529.99,529.99,19.79,561.0,United Healthcare-Medicare Advantage, +150446,3934,86850,Screening test for red blood cell antibodies,CPT/HCPCS,761.36,761.36,1.19,25179.3,United Healthcare-Medicare Advantage, +150447,3934,86860,Removal of antibodies from surface of red blood cell,CPT/HCPCS,1364.88,1364.88,43.42,2066.05,United Healthcare-Medicare Advantage, +150448,3934,86870,Identification of red blood cell antibodies,CPT/HCPCS,1009.19,1009.19,21.11,4547.5,United Healthcare-Medicare Advantage, +150449,3934,86880,Red blood cell antibody detection test,CPT/HCPCS,784.49,784.49,18.68,1790.3,United Healthcare-Medicare Advantage, +150450,3934,86886,Red blood cell antibody level,CPT/HCPCS,322.03,322.03,10.97,715.8,United Healthcare-Medicare Advantage, +150451,3934,86891,Processing and storage of blood unit or component,CPT/HCPCS,5105.77,5105.77,49.54,2272.0,United Healthcare-Medicare Advantage, +150452,3934,86900,Blood group typing (ABO),CPT/HCPCS,548.01,548.01,0.95,9938.59,United Healthcare-Medicare Advantage, +150453,3934,86901,Blood typing for Rh (D) antigen,CPT/HCPCS,548.01,548.01,0.95,6298.65,United Healthcare-Medicare Advantage, +150454,3934,86902,Screening test for compatible blood unit,CPT/HCPCS,6188.7,6188.7,290.01,8070.0,United Healthcare-Medicare Advantage, +150455,3934,86905,Blood typing for red blood cell antigens,CPT/HCPCS,1558.69,1558.69,29.46,3049.5,United Healthcare-Medicare Advantage, +150456,3934,86920,Blood unit compatibility test,CPT/HCPCS,385.54,385.54,3.2,1254.0,United Healthcare-Medicare Advantage, +150457,3934,86922,Blood unit compatibility test,CPT/HCPCS,1332.82,1332.82,26.73,3528.0,United Healthcare-Medicare Advantage, +150458,3934,86923,Blood unit compatibility test,CPT/HCPCS,782.62,782.62,27.67,3901.5,United Healthcare-Medicare Advantage, +150459,3934,87015,Concentration of specimen for infectious agents,CPT/HCPCS,168.27,168.27,3.25,669.0,United Healthcare-Medicare Advantage, +150460,3934,87040,Bacterial blood culture,CPT/HCPCS,219.73,219.73,4.0,7896.0,United Healthcare-Medicare Advantage, +150461,3934,87045,Stool culture,CPT/HCPCS,199.21,199.21,4.83,214.0,United Healthcare-Medicare Advantage, +150462,3934,87046,Stool culture,CPT/HCPCS,278.88,278.88,8.85,371.0,United Healthcare-Medicare Advantage, +150463,3934,87070,Bacterial culture,CPT/HCPCS,254.05,254.05,1.72,1155.0,United Healthcare-Medicare Advantage, +150464,3934,87076,Bacterial culture for anaerobic isolates,CPT/HCPCS,405.15,405.15,6.87,1296.0,United Healthcare-Medicare Advantage, +150465,3934,87077,Bacterial culture for aerobic isolates,CPT/HCPCS,96.73,96.73,1.96,486.0,United Healthcare-Medicare Advantage, +150466,3934,87081,Screening test for pathogenic organisms,CPT/HCPCS,129.38,129.38,4.2,444.0,United Healthcare-Medicare Advantage, +150467,3934,87086,"Bacterial colony count, urine",CPT/HCPCS,149.06,149.06,1.0,2940.0,United Healthcare-Medicare Advantage, +150468,3934,87088,Bacterial urine culture,CPT/HCPCS,197.96,197.96,4.83,424.0,United Healthcare-Medicare Advantage, +150469,3934,87101,"Fungal culture (mold or yeast) of skin, hair, or nail",CPT/HCPCS,95.61,95.61,6.55,111.5,United Healthcare-Medicare Advantage, +150470,3934,87102,Fungal culture (mold or yeast),CPT/HCPCS,211.97,211.97,6.3,641.99,United Healthcare-Medicare Advantage, +150471,3934,87103,Fungal blood culture (mold or yeast),CPT/HCPCS,80.13,80.13,4.83,62.0,United Healthcare-Medicare Advantage, +150472,3934,87106,"Fungal culture, yeast",CPT/HCPCS,82.74,82.74,8.4,158.0,United Healthcare-Medicare Advantage, +150473,3934,87107,Culture for identification of yeast,CPT/HCPCS,64.0,64.0,9.7,63.0,United Healthcare-Medicare Advantage, +150474,3934,87109,Mycoplasma culture,CPT/HCPCS,48.0,48.0,8.15,35.89,United Healthcare-Medicare Advantage, +150475,3934,87110,Culture for chlamydia,CPT/HCPCS,13.2,13.2,15.47,15.47,United Healthcare-Medicare Advantage, +150476,3934,87116,Culture for acid-fast bacilli,CPT/HCPCS,104.98,104.98,2.05,462.0,United Healthcare-Medicare Advantage, +150477,3934,87140,Identification of organisms by immunologic analysis,CPT/HCPCS,10.0,10.0,10.0,113.82,United Healthcare-Medicare Advantage, +150478,3934,87147,Identification of organisms by immunologic analysis,CPT/HCPCS,35.52,35.52,2.58,70.0,United Healthcare-Medicare Advantage, +150479,3934,87149,Identification of organisms by genetic analysis,CPT/HCPCS,159.2,159.2,20.05,384.0,United Healthcare-Medicare Advantage, +150480,3934,87153,Identification of organisms by genetic analysis,CPT/HCPCS,173.64,173.64,63.36,275.0,United Healthcare-Medicare Advantage, +150481,3934,87158,Microbial identification,CPT/HCPCS,65.5,65.5,50.32,64.9,United Healthcare-Medicare Advantage, +150482,3934,87168,Macroscopic examination (visual inspection) of insect,CPT/HCPCS,82.48,82.48,4.27,83.0,United Healthcare-Medicare Advantage, +150483,3934,87172,Pinworm test,CPT/HCPCS,464.5,464.5,3.0,3.0,United Healthcare-Medicare Advantage, +150484,3934,87177,Smear for parasites,CPT/HCPCS,195.15,195.15,8.4,322.52,United Healthcare-Medicare Advantage, +150485,3934,87181,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,80.23,80.23,4.04,2143.5,United Healthcare-Medicare Advantage, +150486,3934,87184,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,114.09,114.09,2.9,1845.4,United Healthcare-Medicare Advantage, +150487,3934,87185,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,26.33,26.33,4.5,4.5,United Healthcare-Medicare Advantage, +150488,3934,87186,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,106.57,106.57,4.83,616.0,United Healthcare-Medicare Advantage, +150489,3934,87188,"Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral)",CPT/HCPCS,325.0,325.0,221.0,221.0,United Healthcare-Medicare Advantage, +150490,3934,87205,Special stain for microorganism,CPT/HCPCS,79.32,79.32,0.85,360.0,United Healthcare-Medicare Advantage, +150491,3934,87206,Special stain for microorganism,CPT/HCPCS,147.3,147.3,4.58,750.0,United Healthcare-Medicare Advantage, +150492,3934,87207,Special stain for microorganism,CPT/HCPCS,88.4,88.4,4.2,94.0,United Healthcare-Medicare Advantage, +150493,3934,87209,Special stain for parasites,CPT/HCPCS,68.36,68.36,5.85,73.0,United Healthcare-Medicare Advantage, +150494,3934,87252,Tissue culture inoculation for virus isolation,CPT/HCPCS,26.9,26.9,10.2,55.0,United Healthcare-Medicare Advantage, +150495,3934,87253,Tissue culture for virus isolation,CPT/HCPCS,12.34,12.34,8.16,124.6,United Healthcare-Medicare Advantage, +150496,3934,87254,Virus isolation,CPT/HCPCS,71.0,71.0,10.14,1381.23,United Healthcare-Medicare Advantage, +150497,3934,87305,Detection test for aspergillus (fungus),CPT/HCPCS,97.2,97.2,4.66,102.0,United Healthcare-Medicare Advantage, +150498,3934,87324,Detection test for clostridium difficile toxins (stool pathogen),CPT/HCPCS,49.3,49.3,11.98,51.0,United Healthcare-Medicare Advantage, +150499,3934,87327,Detection test for cryptococcus neoformans (yeast),CPT/HCPCS,36.67,36.67,8.03,13.42,United Healthcare-Medicare Advantage, +150500,3934,87329,Detection test for giardia (intestinal parasite),CPT/HCPCS,16.0,16.0,4.4,167.07,United Healthcare-Medicare Advantage, +150501,3934,87338,"Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step method",CPT/HCPCS,39.77,39.77,4.83,231.96,United Healthcare-Medicare Advantage, +150502,3934,87340,Detection test for Hepatitis B surface antigen,CPT/HCPCS,123.72,123.72,3.03,136.0,United Healthcare-Medicare Advantage, +150503,3934,87341,Detection test for Hepatitis B surface antigen,CPT/HCPCS,114.16,114.16,10.33,122.0,United Healthcare-Medicare Advantage, +150504,3934,87350,Detection test for Hepatitis Be surface antigen,CPT/HCPCS,14.0,14.0,4.83,36.26,United Healthcare-Medicare Advantage, +150505,3934,87385,Detection test for histoplasma capsulatum (parasite),CPT/HCPCS,96.92,96.92,12.41,13.25,United Healthcare-Medicare Advantage, +150506,3934,87389,Detection test for HIV-1 and HIV-2,CPT/HCPCS,106.54,106.54,4.66,113.0,United Healthcare-Medicare Advantage, +150507,3934,87425,Detection test for Rotavirus,CPT/HCPCS,138.5,138.5,11.98,11.98,United Healthcare-Medicare Advantage, +150508,3934,87427,Detection test for bacteria toxin (shiga-like toxin),CPT/HCPCS,20.0,20.0,14.08,14.08,United Healthcare-Medicare Advantage, +150509,3934,87430,"Detection test for Strep (Streptococcus, group A)",CPT/HCPCS,119.7,119.7,5.57,98.12,United Healthcare-Medicare Advantage, +150510,3934,87449,Immunologic analysis for detection of organism,CPT/HCPCS,186.37,186.37,4.66,360.0,United Healthcare-Medicare Advantage, +150511,3934,87450,Immunologic analysis for detection of organism,CPT/HCPCS,31.24,31.24,3.75,32.0,United Healthcare-Medicare Advantage, +150512,3934,87451,Immunologic analysis for detection of organism,CPT/HCPCS,33.5,33.5,1.68,32.0,United Healthcare-Medicare Advantage, +150513,3934,87471,Detection Bartonella henselae and Bartonella quintana (bacteria),CPT/HCPCS,215.0,215.0,23.86,146.2,United Healthcare-Medicare Advantage, +150514,3934,87476,Detection test for borrelia burgdorferi (bacteria),CPT/HCPCS,72.75,72.75,7.02,72.0,United Healthcare-Medicare Advantage, +150515,3934,87480,Detection test for candida species (yeast),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Medicare Advantage, +150516,3934,87481,Detection test for candida species (yeast),CPT/HCPCS,212.0,212.0,24.2,140.36,United Healthcare-Medicare Advantage, +150517,3934,87483,Test for detecting nucleic acid of organism causing infection of central nervous system,CPT/HCPCS,330.0,330.0,6.08,330.0,United Healthcare-Medicare Advantage, +150518,3934,87486,Detection test for Chlamydia pneumoniae,CPT/HCPCS,198.78,198.78,19.14,209.0,United Healthcare-Medicare Advantage, +150519,3934,87491,Detection test for chlamydia,CPT/HCPCS,309.5,309.5,5.78,1606.0,United Healthcare-Medicare Advantage, +150520,3934,87493,Detection test for clostridium difficile,CPT/HCPCS,283.54,283.54,19.14,513.0,United Healthcare-Medicare Advantage, +150521,3934,87496,Detection test for Cytomegalovirus (CMV),CPT/HCPCS,81.58,81.58,3.67,70.0,United Healthcare-Medicare Advantage, +150522,3934,87497,"Detection test for cytomegalovirus, quantification",CPT/HCPCS,108.56,108.56,6.5,178.0,United Healthcare-Medicare Advantage, +150523,3934,87502,Detection test for multiple types influenza virus,CPT/HCPCS,459.0,459.0,19.14,625.51,United Healthcare-Medicare Advantage, +150524,3934,87503,Detection test for multiple types of influenza virus,CPT/HCPCS,220.07,220.07,16.07,226.42,United Healthcare-Medicare Advantage, +150525,3934,87507,Detection test for digestive tract pathogen,CPT/HCPCS,178.0,178.0,178.0,178.0,United Healthcare-Medicare Advantage, +150526,3934,87510,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Medicare Advantage, +150527,3934,87512,Detection test for gardnerella vaginalis (bacteria),CPT/HCPCS,117.6,117.6,28.33,43.75,United Healthcare-Medicare Advantage, +150528,3934,87516,Detection test for Hepatitis B virus,CPT/HCPCS,59.95,59.95,21.43,35.09,United Healthcare-Medicare Advantage, +150529,3934,87517,Detection test for Hepatitis B virus,CPT/HCPCS,85.0,85.0,15.15,85.0,United Healthcare-Medicare Advantage, +150530,3934,87521,Detection test for Hepatitis C virus,CPT/HCPCS,59.0,59.0,28.71,348.4,United Healthcare-Medicare Advantage, +150531,3934,87522,Detection test for Hepatitis C virus,CPT/HCPCS,680.39,680.39,16.64,748.0,United Healthcare-Medicare Advantage, +150532,3934,87529,Detection test for herpes simplex virus,CPT/HCPCS,64.82,64.82,6.5,173.25,United Healthcare-Medicare Advantage, +150533,3934,87530,Detection test for herpes simplex virus,CPT/HCPCS,189.03,189.03,19.14,178.0,United Healthcare-Medicare Advantage, +150534,3934,87533,Detection test for herpes virus-6,CPT/HCPCS,178.79,178.79,16.03,178.0,United Healthcare-Medicare Advantage, +150535,3934,87535,Detection test for HIV-1 virus,CPT/HCPCS,75.32,75.32,21.43,369.0,United Healthcare-Medicare Advantage, +150536,3934,87536,Detection test for HIV-1 virus,CPT/HCPCS,592.58,592.58,37.59,632.0,United Healthcare-Medicare Advantage, +150537,3934,87538,Detection test for HIV-2 virus,CPT/HCPCS,96.0,96.0,96.0,96.0,United Healthcare-Medicare Advantage, +150538,3934,87541,Detection test for legionella pneumophila (water borne bacteria),CPT/HCPCS,78.17,78.17,67.0,67.0,United Healthcare-Medicare Advantage, +150539,3934,87563,Detection of Mycoplasma genitalium by DNA or RNA probe,CPT/HCPCS,102.0,102.0,25.5,25.5,United Healthcare-Medicare Advantage, +150540,3934,87581,Detection test for Mycoplasma pneumoniae (bacteria),CPT/HCPCS,198.07,198.07,19.14,214.0,United Healthcare-Medicare Advantage, +150541,3934,87591,Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria),CPT/HCPCS,301.22,301.22,5.78,844.27,United Healthcare-Medicare Advantage, +150542,3934,87624,Detection test for human papillomavirus (hpv),CPT/HCPCS,194.76,194.76,19.14,380.5,United Healthcare-Medicare Advantage, +150543,3934,87631,Detection test for multiple types of respiratory virus,CPT/HCPCS,508.93,508.93,32.88,554.0,United Healthcare-Medicare Advantage, +150544,3934,87632,Detection test for multiple types of respiratory virus,CPT/HCPCS,613.0,613.0,613.0,613.0,United Healthcare-Medicare Advantage, +150545,3934,87633,Detection test for multiple types of respiratory virus,CPT/HCPCS,1781.94,1781.94,25.0,2081.76,United Healthcare-Medicare Advantage, +150546,3934,87635,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique",CPT/HCPCS,89.53,89.53,0.84,9249.9,United Healthcare-Medicare Advantage, +150547,3934,87641,"Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)",CPT/HCPCS,278.3,278.3,19.14,241.0,United Healthcare-Medicare Advantage, +150548,3934,87660,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,16.0,16.0,1.6,28.02,United Healthcare-Medicare Advantage, +150549,3934,87661,Detection test for Trichomonas vaginalis (genital parasite),CPT/HCPCS,228.65,228.65,19.14,176.4,United Healthcare-Medicare Advantage, +150550,3934,87798,Detection test for organism,CPT/HCPCS,212.43,212.43,6.56,2291.5,United Healthcare-Medicare Advantage, +150551,3934,87799,Detection test for organism,CPT/HCPCS,109.91,109.91,7.5,331.0,United Healthcare-Medicare Advantage, +150552,3934,87801,Detection test for multiple organisms,CPT/HCPCS,277.41,277.41,38.29,474.67,United Healthcare-Medicare Advantage, +150553,3934,87807,Detection test for respiratory syncytial virus (RSV),CPT/HCPCS,230.24,230.24,14.5,156.35,United Healthcare-Medicare Advantage, +150554,3934,87880,"Strep test (Streptococcus, group A)",CPT/HCPCS,111.24,111.24,3.19,119.0,United Healthcare-Medicare Advantage, +150555,3934,87899,Detection test for identification of organism,CPT/HCPCS,123.75,123.75,6.61,126.0,United Healthcare-Medicare Advantage, +150556,3934,87901,Analysis test for HIV-1 virus,CPT/HCPCS,326.32,326.32,250.0,317.84,United Healthcare-Medicare Advantage, +150557,3934,87902,Analysis test for Hepatitis C virus,CPT/HCPCS,360.12,360.12,82.0,317.84,United Healthcare-Medicare Advantage, +150558,3934,87903,Analysis test for HIV-1 virus,CPT/HCPCS,979.75,979.75,488.66,603.28,United Healthcare-Medicare Advantage, +150559,3934,87904,Analysis test for HIV-1 virus,CPT/HCPCS,5783.14,5783.14,57.0,286.77,United Healthcare-Medicare Advantage, +150560,3934,87906,Analysis test for HIV-1 virus,CPT/HCPCS,193.17,193.17,128.73,158.92,United Healthcare-Medicare Advantage, +150561,3934,87912,Analysis test for hepatitis b virus,CPT/HCPCS,318.2,318.2,257.45,257.45,United Healthcare-Medicare Advantage, +150562,3934,87999,Microbiology procedures,CPT/HCPCS,448.0,448.0,448.0,448.0,United Healthcare-Medicare Advantage, +150563,3934,88104,Cell examination of body fluid,CPT/HCPCS,160.49,160.49,19.12,164.0,United Healthcare-Medicare Advantage, +150564,3934,88108,Cell examination of specimen,CPT/HCPCS,225.41,225.41,8.1,5126.61,United Healthcare-Medicare Advantage, +150565,3934,88121,Cell examination of urine,CPT/HCPCS,452.0,452.0,452.0,452.0,United Healthcare-Medicare Advantage, +150566,3934,88142,Pap test (Pap smear),CPT/HCPCS,191.7,191.7,20.26,215.63,United Healthcare-Medicare Advantage, +150567,3934,88184,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6888.72,6888.72,23.73,18447.0,United Healthcare-Medicare Advantage, +150568,3934,88185,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,6458.58,6458.58,15.45,14160.0,United Healthcare-Medicare Advantage, +150569,3934,88187,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,84.8,84.8,20.0,35.7,United Healthcare-Medicare Advantage, +150570,3934,88188,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,228.3,228.3,10.22,268.29,United Healthcare-Medicare Advantage, +150571,3934,88189,Flow cytometry technique for DNA or cell analysis,CPT/HCPCS,174.92,174.92,1.16,739.9,United Healthcare-Medicare Advantage, +150572,3934,88230,Tissue culture to identify white blood cell disorders,CPT/HCPCS,344.79,344.79,40.0,290.78,United Healthcare-Medicare Advantage, +150573,3934,88233,Tissue culture to identify skin disorders,CPT/HCPCS,717.75,717.75,50.0,1282.0,United Healthcare-Medicare Advantage, +150574,3934,88237,Tissue culture for tumor disorders of bone marrow and blood cells,CPT/HCPCS,1128.49,1128.49,96.37,4362.28,United Healthcare-Medicare Advantage, +150575,3934,88239,Tissue culture for tumor disorders,CPT/HCPCS,850.0,850.0,131.91,1522.0,United Healthcare-Medicare Advantage, +150576,3934,88248,Chromosome analysis for genetic defects,CPT/HCPCS,455.0,455.0,100.0,100.0,United Healthcare-Medicare Advantage, +150577,3934,88249,Chromosome analysis for genetic defects,CPT/HCPCS,747.0,747.0,100.0,100.0,United Healthcare-Medicare Advantage, +150578,3934,88262,Chromosome analysis for genetic defects,CPT/HCPCS,1048.65,1048.65,96.34,1131.0,United Healthcare-Medicare Advantage, +150579,3934,88267,Chromosome analysis of amniotic fluid or placenta for genetic defects,CPT/HCPCS,1498.0,1498.0,90.0,90.0,United Healthcare-Medicare Advantage, +150580,3934,88271,DNA testing for genetic defects,CPT/HCPCS,1450.42,1450.42,21.42,2754.0,United Healthcare-Medicare Advantage, +150581,3934,88273,Chromosome analysis for genetic defects,CPT/HCPCS,375.0,375.0,39.66,210.0,United Healthcare-Medicare Advantage, +150582,3934,88275,Genetic testing,CPT/HCPCS,2670.27,2670.27,51.19,5049.0,United Healthcare-Medicare Advantage, +150583,3934,88280,Chromosome analysis for genetic defects,CPT/HCPCS,414.52,414.52,9.63,447.0,United Healthcare-Medicare Advantage, +150584,3934,88291,Interpretation and report of genetic testing,CPT/HCPCS,208.83,208.83,20.0,20.0,United Healthcare-Medicare Advantage, +150585,3934,88300,"Pathology examination of tissue using a microscope, limited examination",CPT/HCPCS,3416.18,3416.18,923.32,16143.0,United Healthcare-Medicare Advantage, +150586,3934,88302,Pathology examination of tissue using a microscope,CPT/HCPCS,4221.79,4221.79,342.97,12213.0,United Healthcare-Medicare Advantage, +150587,3934,88304,"Pathology examination of tissue using a microscope, moderately low complexity",CPT/HCPCS,3691.3,3691.3,145.88,17177.0,United Healthcare-Medicare Advantage, +150588,3934,88305,"Pathology examination of tissue using a microscope, intermediate complexity",CPT/HCPCS,912.94,912.94,1.13,6096.0,United Healthcare-Medicare Advantage, +150589,3934,88307,"Pathology examination of tissue using a microscope, moderately high complexity",CPT/HCPCS,4366.9,4366.9,195.71,19069.16,United Healthcare-Medicare Advantage, +150590,3934,88309,"Pathology examination of tissue using a microscope, high complexity",CPT/HCPCS,4025.15,4025.15,827.61,16067.0,United Healthcare-Medicare Advantage, +150591,3934,88311,Preparation of tissue for examination by removing any calcium present,CPT/HCPCS,102.22,102.22,6.13,1662.0,United Healthcare-Medicare Advantage, +150592,3934,88312,Special stained specimen slides to identify organisms including interpretation and report,CPT/HCPCS,2843.37,2843.37,177.5,10780.0,United Healthcare-Medicare Advantage, +150593,3934,88313,Special stained specimen slides to examine tissue including interpretation and report,CPT/HCPCS,1405.23,1405.23,28.6,4626.0,United Healthcare-Medicare Advantage, +150594,3934,88314,Special stained specimen slides to examine tissue and frozen preparation of specimen including interpretation and report,CPT/HCPCS,778.19,778.19,153.18,784.0,United Healthcare-Medicare Advantage, +150595,3934,88323,Surgical pathology consultation and report,CPT/HCPCS,925.33,925.33,384.04,920.0,United Healthcare-Medicare Advantage, +150596,3934,88329,Pathology examination of specimen during surgery,CPT/HCPCS,3511.0,3511.0,1944.0,2603.0,United Healthcare-Medicare Advantage, +150597,3934,88331,Pathology examination of tissue during surgery,CPT/HCPCS,3425.12,3425.12,264.36,16602.0,United Healthcare-Medicare Advantage, +150598,3934,88332,Pathology examination of specimen during surgery,CPT/HCPCS,230.91,230.91,16.29,924.0,United Healthcare-Medicare Advantage, +150599,3934,88333,Pathology examination of tissue specimen during surgery,CPT/HCPCS,2303.35,2303.35,283.22,11525.52,United Healthcare-Medicare Advantage, +150600,3934,88334,Pathology examination of specimen during surgery,CPT/HCPCS,229.84,229.84,20.81,695.0,United Healthcare-Medicare Advantage, +150601,3934,88341,Special stained specimen slides to examine tissue,CPT/HCPCS,831.34,831.34,24.44,3536.0,United Healthcare-Medicare Advantage, +150602,3934,88342,Tissue or cell analysis by immunologic technique,CPT/HCPCS,1550.92,1550.92,34.72,7731.0,United Healthcare-Medicare Advantage, +150603,3934,88344,Special stained specimen slides to examine tissue,CPT/HCPCS,985.0,985.0,25.37,4000.0,United Healthcare-Medicare Advantage, +150604,3934,88346,Antibody evaluation,CPT/HCPCS,992.45,992.45,35.5,4761.0,United Healthcare-Medicare Advantage, +150605,3934,88348,Electron microscopy for diagnosis,CPT/HCPCS,1537.5,1537.5,120.01,3320.0,United Healthcare-Medicare Advantage, +150606,3934,88350,Antibody evaluation,CPT/HCPCS,757.59,757.59,16.25,4240.0,United Healthcare-Medicare Advantage, +150607,3934,88360,Microscopic genetic analysis of tumor,CPT/HCPCS,2579.7,2579.7,62.56,6753.0,United Healthcare-Medicare Advantage, +150608,3934,88365,Analysis of genetic material,CPT/HCPCS,3149.99,3149.99,180.63,2080.0,United Healthcare-Medicare Advantage, +150609,3934,88366,Cell examination,CPT/HCPCS,5646.76,5646.76,4006.38,7746.99,United Healthcare-Medicare Advantage, +150610,3934,88371,Protein analysis of tissue with interpretation and report,CPT/HCPCS,232.8,232.8,232.8,232.8,United Healthcare-Medicare Advantage, +150611,3934,88377,Microscopic genetic examination manual,CPT/HCPCS,3398.17,3398.17,114.71,9828.0,United Healthcare-Medicare Advantage, +150612,3934,88381,"Preparation of specimen, manual",CPT/HCPCS,180.58,180.58,34.6,153.0,United Healthcare-Medicare Advantage, +150613,3934,89051,Body fluid cell count with cell identification,CPT/HCPCS,56.35,56.35,1.08,7233.0,United Healthcare-Medicare Advantage, +150614,3934,89060,Crystal identification from tissue or body fluid,CPT/HCPCS,74.79,74.79,1.47,79.0,United Healthcare-Medicare Advantage, +150615,3934,89230,Sweat collection,CPT/HCPCS,173.2,173.2,11.38,165.64,United Healthcare-Medicare Advantage, +150616,3934,90371,Hepatitis B immune globulin for injection into muscle,CPT/HCPCS,2057.78,2057.78,735.21,2413.32,United Healthcare-Medicare Advantage, +150617,3934,90375,Rabies immune globulin for injection beneath the skin and/or into muscle,CPT/HCPCS,9055.67,9055.67,427.11,15338.52,United Healthcare-Medicare Advantage, +150618,3934,90460,Administration of first vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,209.32,209.32,16.07,263.25,United Healthcare-Medicare Advantage, +150619,3934,90461,Administration of vaccine or toxoid component through 18 years of age with counseling,CPT/HCPCS,203.36,203.36,29.05,87.15,United Healthcare-Medicare Advantage, +150620,3934,90471,Administration of 1 vaccine,CPT/HCPCS,144.04,144.04,10.0,10292.0,United Healthcare-Medicare Advantage, +150621,3934,90472,Administration of vaccine,CPT/HCPCS,124.23,124.23,2.14,1949.0,United Healthcare-Medicare Advantage, +150622,3934,90473,Administration of 1 nasal or oral vaccine,CPT/HCPCS,95.33,95.33,18.76,18.76,United Healthcare-Medicare Advantage, +150623,3934,90474,Administration of nasal or oral vaccine,CPT/HCPCS,99.63,99.63,14.53,14.53,United Healthcare-Medicare Advantage, +150624,3934,90648,Vaccine for Hemophilus influenza B (4 dose schedule) injection into muscle,CPT/HCPCS,43.99,43.99,10.28,56.25,United Healthcare-Medicare Advantage, +150625,3934,90651,Vaccine for human papilloma virus (3 dose schedule) injection into muscle,CPT/HCPCS,670.0,670.0,0.01,0.01,United Healthcare-Medicare Advantage, +150626,3934,90662,Vaccine for influenza for injection into muscle,CPT/HCPCS,161.43,161.43,28.69,192.58,United Healthcare-Medicare Advantage, +150627,3934,90670,Pneumococcal vaccine for injection into muscle,CPT/HCPCS,490.4,490.4,57.32,647.42,United Healthcare-Medicare Advantage, +150628,3934,90675,Vaccine for rabies injection into muscle,CPT/HCPCS,905.17,905.17,59.5,1178.28,United Healthcare-Medicare Advantage, +150629,3934,90682,Vaccine for influenza for injection into muscle,CPT/HCPCS,75.29,75.29,49.72,49.72,United Healthcare-Medicare Advantage, +150630,3934,90686,"Vaccine for influenza for administration into muscle, 0.5 ml dosage",CPT/HCPCS,41.42,41.42,0.01,200.85,United Healthcare-Medicare Advantage, +150631,3934,90707,"Vaccine for measles, mumps, and rubella (German measles) injection beneath skin",CPT/HCPCS,239.96,239.96,83.99,239.96,United Healthcare-Medicare Advantage, +150632,3934,90713,Vaccine for polio injection beneath the skin or into muscle,CPT/HCPCS,92.74,92.74,27.02,111.35,United Healthcare-Medicare Advantage, +150633,3934,90714,"Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older",CPT/HCPCS,61.74,61.74,12.37,115.29,United Healthcare-Medicare Advantage, +150634,3934,90715,"Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older",CPT/HCPCS,115.09,115.09,10.0,1433.56,United Healthcare-Medicare Advantage, +150635,3934,90732,"Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older",CPT/HCPCS,224.53,224.53,4.93,312.16,United Healthcare-Medicare Advantage, +150636,3934,90734,Vaccine for meningococcus for administration into muscle,CPT/HCPCS,348.88,348.88,0.01,94.77,United Healthcare-Medicare Advantage, +150637,3934,90746,Vaccine for Hepatitis B adult dosage (3 dose schedule) injection into muscle,CPT/HCPCS,162.39,162.39,13.82,67.95,United Healthcare-Medicare Advantage, +150638,3934,90750,Vaccine for shingles for injection into muscle,CPT/HCPCS,402.47,402.47,126.89,347.76,United Healthcare-Medicare Advantage, +150639,3934,90785,Interactive complexity,CPT/HCPCS,28.67,28.67,14.56,28.9,United Healthcare-Medicare Advantage, +150640,3934,90791,Psychiatric diagnostic evaluation,CPT/HCPCS,3132.37,3132.37,74.62,3383.0,United Healthcare-Medicare Advantage, +150641,3934,90792,Psychiatric diagnostic evaluation with medical services,CPT/HCPCS,454.93,454.93,150.45,437.37,United Healthcare-Medicare Advantage, +150642,3934,90832,"Psychotherapy, 30 minutes",CPT/HCPCS,319.17,319.17,65.81,400.0,United Healthcare-Medicare Advantage, +150643,3934,90833,"Psychotherapy, 30 minutes",CPT/HCPCS,377.59,377.59,65.85,341.99,United Healthcare-Medicare Advantage, +150644,3934,90834,"Psychotherapy, 45 minutes",CPT/HCPCS,376.38,376.38,87.98,376.67,United Healthcare-Medicare Advantage, +150645,3934,90836,"Psychotherapy, 45 minutes",CPT/HCPCS,414.08,414.08,88.05,400.76,United Healthcare-Medicare Advantage, +150646,3934,90837,"Psychotherapy, 60 minutes",CPT/HCPCS,391.51,391.51,86.73,408.0,United Healthcare-Medicare Advantage, +150647,3934,90838,"Psychotherapy, 60 minutes",CPT/HCPCS,65.4,65.4,63.0,106.32,United Healthcare-Medicare Advantage, +150648,3934,90839,"Psychotherapy for crisis, first 60 minutes",CPT/HCPCS,343.73,343.73,119.14,341.0,United Healthcare-Medicare Advantage, +150649,3934,90840,Psychotherapy for crisis,CPT/HCPCS,159.0,159.0,159.0,159.0,United Healthcare-Medicare Advantage, +150650,3934,90846,"Family psychotherapy, 50 minutes",CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +150651,3934,90847,"Family psychotherapy including patient, 50 minutes",CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +150652,3934,90853,Group psychotherapy,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +150653,3934,90870,Shock treatment and monitoring,CPT/HCPCS,1790.56,1790.56,546.72,1920.0,United Healthcare-Medicare Advantage, +150654,3934,90901,Biofeedback training,CPT/HCPCS,502.74,502.74,298.5,597.0,United Healthcare-Medicare Advantage, +150655,3934,90912,"Biofeedback training for bowel or bladder control, initial 15 minutes",CPT/HCPCS,271.0,271.0,49.28,49.28,United Healthcare-Medicare Advantage, +150656,3934,90913,"Biofeedback training for bowel or bladder control, additional 15 minutes",CPT/HCPCS,316.05,316.05,27.46,54.93,United Healthcare-Medicare Advantage, +150657,3934,90945,Dialysis procedure including one evaluation,CPT/HCPCS,5462.0,5462.0,5462.0,5462.0,United Healthcare-Medicare Advantage, +150658,3934,91010,Measurement of esophageal swallowing movement,CPT/HCPCS,4962.1,4962.1,231.6,5371.0,United Healthcare-Medicare Advantage, +150659,3934,91035,Monitoring and recording of gastroesophageal reflux with pH electrode insertion including analysis and interpretation,CPT/HCPCS,1226.25,1226.25,466.52,1240.0,United Healthcare-Medicare Advantage, +150660,3934,91037,Monitoring of gastroesophageal reflux including analysis and interpretation,CPT/HCPCS,4981.05,4981.05,231.6,5371.0,United Healthcare-Medicare Advantage, +150661,3934,91038,"Monitoring of gastroesophageal reflux including analysis and interpretation, prolonged (greater than 1 hour, up to 24 hours)",CPT/HCPCS,1199.42,1199.42,133.75,1216.0,United Healthcare-Medicare Advantage, +150662,3934,91040,Evaluation of non-cardiac chest pain using esophageal balloon,CPT/HCPCS,8631.6,8631.6,8631.6,8631.6,United Healthcare-Medicare Advantage, +150663,3934,91065,Measurement of hydrogen in breath to test for GI symptoms,CPT/HCPCS,377.14,377.14,25.0,385.0,United Healthcare-Medicare Advantage, +150664,3934,91110,Imaging of digestive tract done from the inside of the digestive tract,CPT/HCPCS,2881.67,2881.67,2816.0,2816.0,United Healthcare-Medicare Advantage, +150665,3934,91112,Transit and pressure measurement of stomach through colon with wireless capsule,CPT/HCPCS,2789.71,2789.71,574.44,2816.0,United Healthcare-Medicare Advantage, +150666,3934,91120,Testing of tone and sensation of rectum and anus,CPT/HCPCS,1226.33,1226.33,142.55,1253.0,United Healthcare-Medicare Advantage, +150667,3934,91122,Study of anorectal pressure generated by muscles surrounding anus (sphincter),CPT/HCPCS,1225.88,1225.88,108.07,1253.0,United Healthcare-Medicare Advantage, +150668,3934,92002,"Eye and medical examination for diagnosis and treatment, new patient",CPT/HCPCS,333.67,333.67,191.73,231.55,United Healthcare-Medicare Advantage, +150669,3934,92004,"Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits",CPT/HCPCS,365.35,365.35,125.41,247.47,United Healthcare-Medicare Advantage, +150670,3934,92012,"Eye and medical examination for diagnosis and treatment, established patient",CPT/HCPCS,239.1,239.1,16.0,222.49,United Healthcare-Medicare Advantage, +150671,3934,92014,"Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits",CPT/HCPCS,281.94,281.94,125.41,218.6,United Healthcare-Medicare Advantage, +150672,3934,92015,Assessment for prescription eye wear using a range of lens powers,CPT/HCPCS,54.65,54.65,45.45,90.89,United Healthcare-Medicare Advantage, +150673,3934,92018,Diagnostic eye examination under general anesthesia,CPT/HCPCS,6236.33,6236.33,1093.19,9392.0,United Healthcare-Medicare Advantage, +150674,3934,92020,Examination of cornea and iris using lens device and slit lamp,CPT/HCPCS,162.33,162.33,45.44,90.89,United Healthcare-Medicare Advantage, +150675,3934,92025,Computerized mapping of corneal curvature,CPT/HCPCS,142.11,142.11,45.44,90.89,United Healthcare-Medicare Advantage, +150676,3934,92060,Measurement of eye muscles to detect deviation of eyeball,CPT/HCPCS,220.82,220.82,45.44,90.88,United Healthcare-Medicare Advantage, +150677,3934,92081,Measurement of field of vision during daylight conditions,CPT/HCPCS,10295.0,10295.0,421.95,421.95,United Healthcare-Medicare Advantage, +150678,3934,92083,Measurement of field of vision during daylight conditions,CPT/HCPCS,257.72,257.72,45.44,162.47,United Healthcare-Medicare Advantage, +150679,3934,92133,Diagnostic imaging of optic nerve of eye,CPT/HCPCS,165.08,165.08,45.44,90.89,United Healthcare-Medicare Advantage, +150680,3934,92134,Diagnostic imaging of retina,CPT/HCPCS,167.69,167.69,45.44,90.89,United Healthcare-Medicare Advantage, +150681,3934,92136,Measurement of corneal curvature and depth of eye,CPT/HCPCS,693.5,693.5,45.44,103.68,United Healthcare-Medicare Advantage, +150682,3934,92230,Examination of retinal blood vessels by ophthalmoscope,CPT/HCPCS,990.0,990.0,395.96,395.96,United Healthcare-Medicare Advantage, +150683,3934,92235,Imaging of blood vessels in back of eye using fluorescein dye,CPT/HCPCS,644.14,644.14,268.08,268.08,United Healthcare-Medicare Advantage, +150684,3934,92250,Photography of the retina,CPT/HCPCS,299.33,299.33,51.84,90.89,United Healthcare-Medicare Advantage, +150685,3934,92285,Photography of content of eyes,CPT/HCPCS,255.5,255.5,90.88,90.88,United Healthcare-Medicare Advantage, +150686,3934,92507,"Treatment of speech, language, voice, communication, and/or hearing processing disorder",CPT/HCPCS,333.46,333.46,4.7,3285.0,United Healthcare-Medicare Advantage, +150687,3934,92511,Examination of the nose and throat using an endoscope,CPT/HCPCS,547.2,547.2,144.25,196.91,United Healthcare-Medicare Advantage, +150688,3934,92521,Evaluation of speech fluency,CPT/HCPCS,841.0,841.0,34.29,198.13,United Healthcare-Medicare Advantage, +150689,3934,92522,Evaluation of speech sound production,CPT/HCPCS,461.39,461.39,4.49,463.08,United Healthcare-Medicare Advantage, +150690,3934,92523,Evaluation of speech sound production with evaluation of language comprehension and expression,CPT/HCPCS,788.5,788.5,45.47,786.0,United Healthcare-Medicare Advantage, +150691,3934,92524,Behavioral and qualitative analysis of voice and resonance,CPT/HCPCS,798.6,798.6,29.03,872.0,United Healthcare-Medicare Advantage, +150692,3934,92526,Treatment of swallowing and/or oral feeding function,CPT/HCPCS,464.3,464.3,76.74,1065.0,United Healthcare-Medicare Advantage, +150693,3934,92537,Assessment and recording of balance system during hot and cold irrigation of both ears,CPT/HCPCS,1761.87,1761.87,51.14,2629.5,United Healthcare-Medicare Advantage, +150694,3934,92538,Assessment and recording of balance system during irrigation of both ears,CPT/HCPCS,1443.0,1443.0,1443.0,1443.0,United Healthcare-Medicare Advantage, +150695,3934,92540,"Observation, testing, and recording of abnormal eye movement",CPT/HCPCS,1767.34,1767.34,51.14,1896.0,United Healthcare-Medicare Advantage, +150696,3934,92541,Observation and recording of abnormal eye movement,CPT/HCPCS,1254.5,1254.5,821.0,821.0,United Healthcare-Medicare Advantage, +150697,3934,92547,Use of vertical electrodes during eye or balance evaluation,CPT/HCPCS,518.33,518.33,9.99,530.0,United Healthcare-Medicare Advantage, +150698,3934,92550,Assessment of eardrum and muscle function,CPT/HCPCS,430.88,430.88,12.13,1885.5,United Healthcare-Medicare Advantage, +150699,3934,92551,Air tone conduction hearing assessment screening,CPT/HCPCS,30.45,30.45,5.0,152.51,United Healthcare-Medicare Advantage, +150700,3934,92552,Pure tone air conduction threshold hearing assessment,CPT/HCPCS,190.78,190.78,5.0,647.5,United Healthcare-Medicare Advantage, +150701,3934,92553,Pure tone air and bone conduction hearing assessment,CPT/HCPCS,630.24,630.24,15.0,668.0,United Healthcare-Medicare Advantage, +150702,3934,92555,Assessment of speech hearing loss,CPT/HCPCS,181.96,181.96,5.0,791.5,United Healthcare-Medicare Advantage, +150703,3934,92556,Assessment of hearing loss and speech recognition,CPT/HCPCS,1544.54,1544.54,30.91,1665.0,United Healthcare-Medicare Advantage, +150704,3934,92557,Air and bone conduction assessment of hearing loss and speech recognition,CPT/HCPCS,539.43,539.43,17.98,1462.5,United Healthcare-Medicare Advantage, +150705,3934,92558,Placement of ear probe for computerized measurement and automated analysis of sound,CPT/HCPCS,520.0,520.0,104.0,104.0,United Healthcare-Medicare Advantage, +150706,3934,92563,Hearing test using earphones,CPT/HCPCS,1608.0,1608.0,140.0,140.0,United Healthcare-Medicare Advantage, +150707,3934,92565,Assessment of simultaneous but different hearing tones in same ear,CPT/HCPCS,1300.0,1300.0,40.46,40.46,United Healthcare-Medicare Advantage, +150708,3934,92567,Eardrum testing using ear probe,CPT/HCPCS,183.26,183.26,5.94,968.0,United Healthcare-Medicare Advantage, +150709,3934,92570,Detection of middle ear fluid with assessment of eardrum and muscle function,CPT/HCPCS,494.54,494.54,32.95,523.0,United Healthcare-Medicare Advantage, +150710,3934,92579,Hearing test for children,CPT/HCPCS,684.58,684.58,19.49,762.0,United Healthcare-Medicare Advantage, +150711,3934,92582,Hearing tests for children,CPT/HCPCS,539.38,539.38,14.0,788.0,United Healthcare-Medicare Advantage, +150712,3934,92583,Hearing test in a booth,CPT/HCPCS,720.28,720.28,113.42,591.75,United Healthcare-Medicare Advantage, +150713,3934,92584,Testing of nerve from ear to brain (cochlear),CPT/HCPCS,998.56,998.56,57.96,1075.0,United Healthcare-Medicare Advantage, +150714,3934,92585,Placement of scalp electrodes for assessment and recording of responses from several areas of the nerve-brain hearing system,CPT/HCPCS,1378.15,1378.15,38.64,1327.87,United Healthcare-Medicare Advantage, +150715,3934,92587,Placement of ear probe for computerized measurement of sound with interpretation and report,CPT/HCPCS,690.67,690.67,4.45,2089.0,United Healthcare-Medicare Advantage, +150716,3934,92588,Placement of ear probe for computerized cochlear assessment of repeated sounds with interpretation and report,CPT/HCPCS,655.2,655.2,5.82,444.81,United Healthcare-Medicare Advantage, +150717,3934,92597,Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech,CPT/HCPCS,1083.76,1083.76,25.0,1204.0,United Healthcare-Medicare Advantage, +150718,3934,92602,"Analysis and reprogramming of inner ear (cochlear) implant, patient younger than 7 years of age",CPT/HCPCS,1148.79,1148.79,77.33,962.26,United Healthcare-Medicare Advantage, +150719,3934,92603,"Analysis and programming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,965.92,965.92,135.47,1203.0,United Healthcare-Medicare Advantage, +150720,3934,92604,"Analysis and reprogramming of inner ear (cochlear) implant, patient age 7 years or older",CPT/HCPCS,882.45,882.45,70.0,1088.0,United Healthcare-Medicare Advantage, +150721,3934,92607,Evaluation of patient with prescription of speech-generating and alternative communication device,CPT/HCPCS,834.0,834.0,583.8,583.8,United Healthcare-Medicare Advantage, +150722,3934,92608,Evaluation and prescription of speech-generating and alternative communication device,CPT/HCPCS,305.33,305.33,160.3,160.3,United Healthcare-Medicare Advantage, +150723,3934,92610,Evaluation of swallowing function,CPT/HCPCS,821.98,821.98,20.57,900.0,United Healthcare-Medicare Advantage, +150724,3934,92611,Fluoroscopic and video recorded motion evaluation of swallowing function,CPT/HCPCS,1062.84,1062.84,22.1,1110.0,United Healthcare-Medicare Advantage, +150725,3934,92612,Evaluation and recording of swallowing using an endoscope,CPT/HCPCS,869.5,869.5,241.48,574.44,United Healthcare-Medicare Advantage, +150726,3934,92620,Evaluation of hearing function brain responses first 60 minutes,CPT/HCPCS,816.0,816.0,60.0,1178.0,United Healthcare-Medicare Advantage, +150727,3934,92621,Evaluation of hearing function brain responses,CPT/HCPCS,210.53,210.53,17.54,162.24,United Healthcare-Medicare Advantage, +150728,3934,92626,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; first hour",CPT/HCPCS,621.18,621.18,82.87,666.0,United Healthcare-Medicare Advantage, +150729,3934,92627,"Evaluation of hearing function to determine candidacy for, or postoperative status of, surgically implanted hearing device; additional 15 minutes",CPT/HCPCS,212.0,212.0,134.64,134.64,United Healthcare-Medicare Advantage, +150730,3934,92651,"Auditory evoked potentials; for hearing status determination, broadband stimuli, with interpretation and report",CPT/HCPCS,1250.0,1250.0,77.28,250.0,United Healthcare-Medicare Advantage, +150731,3934,92652,"Auditory evoked potentials; for threshold estimation at multiple frequencies, with interpretation and report",CPT/HCPCS,1551.0,1551.0,77.28,1085.7,United Healthcare-Medicare Advantage, +150732,3934,92653,"Auditory evoked potentials; neurodiagnostic, with interpretation and report",CPT/HCPCS,1250.0,1250.0,98.05,250.0,United Healthcare-Medicare Advantage, +150733,3934,92700,"Ear, nose, or throat procedure",CPT/HCPCS,1759.51,1759.51,428.98,1896.0,United Healthcare-Medicare Advantage, +150734,3934,92920,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,21018.43,21018.43,2516.48,45080.42,United Healthcare-Medicare Advantage, +150735,3934,92921,Balloon dilation of narrowed or blocked major coronary artery or branch (accessed through the skin),CPT/HCPCS,15089.56,15089.56,2964.84,28536.0,United Healthcare-Medicare Advantage, +150736,3934,92924,"Removal of plaque of major coronary artery or branch, accessed through the skin",CPT/HCPCS,32479.59,32479.59,26055.57,33150.53,United Healthcare-Medicare Advantage, +150737,3934,92928,"Catheter insertion of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,31447.39,31447.39,709.14,51152.97,United Healthcare-Medicare Advantage, +150738,3934,92929,"Catheter placement of stents in major coronary artery or branch, accessed through the skin",CPT/HCPCS,22852.24,22852.24,2745.05,21672.0,United Healthcare-Medicare Advantage, +150739,3934,92933,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,40346.82,40346.82,8100.07,41762.22,United Healthcare-Medicare Advantage, +150740,3934,92934,"Removal of plaque and insertion of stent in major coronary artery or branch, accessed through the skin",CPT/HCPCS,20963.0,20963.0,13322.68,13322.68,United Healthcare-Medicare Advantage, +150741,3934,92937,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,32442.52,32442.52,19375.35,31946.21,United Healthcare-Medicare Advantage, +150742,3934,92941,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack, accessed through the skin",CPT/HCPCS,21672.0,21672.0,19483.0,19483.0,United Healthcare-Medicare Advantage, +150743,3934,92943,"Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel, accessed through the skin",CPT/HCPCS,29928.28,29928.28,1300.9,60263.58,United Healthcare-Medicare Advantage, +150744,3934,92950,Attempt to restart heart and lungs,CPT/HCPCS,929.76,929.76,55.95,20652.0,United Healthcare-Medicare Advantage, +150745,3934,92960,External shock to heart to regulate heart beat,CPT/HCPCS,2883.57,2883.57,20.0,20652.0,United Healthcare-Medicare Advantage, +150746,3934,92978,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9713.3,9713.3,221.07,10376.0,United Healthcare-Medicare Advantage, +150747,3934,92979,Ultrasound evaluation of heart blood vessel or graft,CPT/HCPCS,9832.78,9832.78,3995.0,10376.0,United Healthcare-Medicare Advantage, +150748,3934,92986,"Catheter based repair of left lower heart (aortic) valve, accessed through the skin",CPT/HCPCS,22173.55,22173.55,22173.55,22173.55,United Healthcare-Medicare Advantage, +150749,3934,93000,Routine EKG using at least 12 leads including interpretation and report,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +150750,3934,93005,Routine electrocardiogram (EKG) with tracing using at least 12 leads,CPT/HCPCS,361.31,361.31,0.39,2573.5,United Healthcare-Medicare Advantage, +150751,3934,93017,Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring,CPT/HCPCS,1342.07,1342.07,1.38,6126.0,United Healthcare-Medicare Advantage, +150752,3934,93225,Heart rhythm tracing of 48-hour EKG,CPT/HCPCS,1715.84,1715.84,60.82,1780.0,United Healthcare-Medicare Advantage, +150753,3934,93226,"Heart rhythm analysis, interpretation and report of 48-hour EKG",CPT/HCPCS,1715.84,1715.84,75.41,1780.0,United Healthcare-Medicare Advantage, +150754,3934,93261,"Evaluation of defibrillator with analysis, review, and report",CPT/HCPCS,1921.85,1921.85,1926.78,1926.78,United Healthcare-Medicare Advantage, +150755,3934,93283,"Evaluation, testing and programming adjustment of defibrillator with analysis, review and report",CPT/HCPCS,151.5,151.5,98.7,162.0,United Healthcare-Medicare Advantage, +150756,3934,93285,"Evaluation, testing, and programming adjustment of heart rhythm monitor system system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,98.78,98.78,25.91,104.0,United Healthcare-Medicare Advantage, +150757,3934,93288,"Evaluation of parameters of leadless, single, dual, or multiple lead pacemaker system with qualified health care professional analysis, review, and report",CPT/HCPCS,848.0,848.0,447.74,11838.0,United Healthcare-Medicare Advantage, +150758,3934,93289,"Evaluation of defibrillator including connection, recording and disconnection",CPT/HCPCS,981.31,981.31,98.86,2935.0,United Healthcare-Medicare Advantage, +150759,3934,93291,"Evaluation of heart rhythm monitor system implanted under skin with qualified health care professional analysis, review, and report",CPT/HCPCS,835.88,835.88,691.0,1055.0,United Healthcare-Medicare Advantage, +150760,3934,93303,Ultrasound examination of congenital heart defect,CPT/HCPCS,4730.67,4730.67,99.42,8321.5,United Healthcare-Medicare Advantage, +150761,3934,93304,Follow-up or limited ultrasound examination of congenital heart defect,CPT/HCPCS,4153.0,4153.0,447.56,715.03,United Healthcare-Medicare Advantage, +150762,3934,93306,"Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function",CPT/HCPCS,4056.5,4056.5,10.49,10717.13,United Healthcare-Medicare Advantage, +150763,3934,93308,Follow-up or limited ultrasound examination of heart,CPT/HCPCS,1768.54,1768.54,99.31,5983.61,United Healthcare-Medicare Advantage, +150764,3934,93312,Insertion of probe in esophagus for heart ultrasound examination including interpretation and report,CPT/HCPCS,5686.48,5686.48,207.89,6181.0,United Healthcare-Medicare Advantage, +150765,3934,93315,Insertion of probe in esophagus for congenital heart ultrasound examination with interpretation and report,CPT/HCPCS,6760.0,6760.0,480.43,495.89,United Healthcare-Medicare Advantage, +150766,3934,93320,"Doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1238.14,1238.14,40.84,2781.0,United Healthcare-Medicare Advantage, +150767,3934,93321,"Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers",CPT/HCPCS,1371.14,1371.14,22.48,2742.0,United Healthcare-Medicare Advantage, +150768,3934,93325,"Doppler ultrasound study of color-directed heart blood flow, rate, and valve function",CPT/HCPCS,979.12,979.12,25.0,2989.0,United Healthcare-Medicare Advantage, +150769,3934,93350,"Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report",CPT/HCPCS,6264.5,6264.5,223.86,7636.0,United Healthcare-Medicare Advantage, +150770,3934,93355,Insertion of probe in esophagus for heart ultrasound examination during procedure on heart or great blood vessel via catheter,CPT/HCPCS,5846.0,5846.0,5846.0,5846.0,United Healthcare-Medicare Advantage, +150771,3934,93356,Heart muscle strain imaging,CPT/HCPCS,95.99,95.99,0.7,2742.0,United Healthcare-Medicare Advantage, +150772,3934,93451,Insertion of catheter for diagnostic evaluation of right heart structures,CPT/HCPCS,12282.58,12282.58,2442.65,13281.0,United Healthcare-Medicare Advantage, +150773,3934,93452,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,,,,,United Healthcare-Medicare Advantage, +150774,3934,93453,Insertion of catheter into right and left heart for diagnosis,CPT/HCPCS,12763.18,12763.18,13010.85,13010.85,United Healthcare-Medicare Advantage, +150775,3934,93454,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,12148.33,12148.33,1011.63,25643.68,United Healthcare-Medicare Advantage, +150776,3934,93455,Insertion of catheter for imaging of heart blood vessels or grafts,CPT/HCPCS,11841.29,11841.29,2053.4,12686.76,United Healthcare-Medicare Advantage, +150777,3934,93456,Insertion of catheter in right heart for X-ray imaging of blood vessels or grafts,CPT/HCPCS,12128.92,12128.92,4137.77,13809.14,United Healthcare-Medicare Advantage, +150778,3934,93457,Insertion of catheter in right heart for imaging of blood vessels or grafts,CPT/HCPCS,12305.54,12305.54,4986.38,13760.67,United Healthcare-Medicare Advantage, +150779,3934,93458,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12068.87,12068.87,123.77,25308.93,United Healthcare-Medicare Advantage, +150780,3934,93459,Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12494.98,12494.98,536.91,22801.99,United Healthcare-Medicare Advantage, +150781,3934,93460,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12591.42,12591.42,2042.99,15079.07,United Healthcare-Medicare Advantage, +150782,3934,93461,Insertion of catheter in right and left heart for imaging of blood vessels or grafts and left lower heart,CPT/HCPCS,12584.45,12584.45,4540.35,14778.45,United Healthcare-Medicare Advantage, +150783,3934,93462,Insertion of catheter into left heart for diagnosis,CPT/HCPCS,11407.0,11407.0,11927.0,11927.0,United Healthcare-Medicare Advantage, +150784,3934,93463,Drug infusion during cardiac catheterization,CPT/HCPCS,372.2,372.2,370.0,9782.0,United Healthcare-Medicare Advantage, +150785,3934,93567,Injection for X-ray imaging of aorta above heart valve,CPT/HCPCS,2331.8,2331.8,2319.0,2481.0,United Healthcare-Medicare Advantage, +150786,3934,93571,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,9576.06,9576.06,56.36,10190.0,United Healthcare-Medicare Advantage, +150787,3934,93572,Ultrasound evaluation of heart blood vessel during diagnosis or treatment,CPT/HCPCS,3131.53,3131.53,1998.0,3047.0,United Healthcare-Medicare Advantage, +150788,3934,93580,"Catheter based closure of congenital heart defect with implant, accessed through the skin",CPT/HCPCS,70927.57,70927.57,6586.31,78010.96,United Healthcare-Medicare Advantage, +150789,3934,93609,Insertion of catheter for recording to identify origin of abnormal heart rhythm,CPT/HCPCS,12646.67,12646.67,994.67,13522.0,United Healthcare-Medicare Advantage, +150790,3934,93613,Insertion of catheters for 3D mapping of electrical impulses to heart muscles,CPT/HCPCS,16854.28,16854.28,31.18,62194.0,United Healthcare-Medicare Advantage, +150791,3934,93620,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in right upper and lower heart",CPT/HCPCS,13923.19,13923.19,6355.02,20483.4,United Healthcare-Medicare Advantage, +150792,3934,93621,"Insertion of catheters for recording, pacing, and attempted induction of abnormal rhythm in left upper heart",CPT/HCPCS,16805.31,16805.31,958.22,54909.0,United Healthcare-Medicare Advantage, +150793,3934,93623,Programmed heart rhythm stimulation after drug infusion into a vein,CPT/HCPCS,12709.42,12709.42,994.67,62194.0,United Healthcare-Medicare Advantage, +150794,3934,93641,Evaluation of single or dual chamber pacing cardioverter-defibrillator and generator at time of implantation or replacement,CPT/HCPCS,3827.33,3827.33,3740.0,4002.0,United Healthcare-Medicare Advantage, +150795,3934,93644,Evaluation implantable defibrillator,CPT/HCPCS,3675.0,3675.0,109.0,7241.0,United Healthcare-Medicare Advantage, +150796,3934,93650,Insertion of catheters for creation of complete heart block,CPT/HCPCS,20457.11,20457.11,18483.72,23929.99,United Healthcare-Medicare Advantage, +150797,3934,93653,Evaluation and insertion of catheters for creation of complete heart block,CPT/HCPCS,67307.44,67307.44,18240.44,110244.39,United Healthcare-Medicare Advantage, +150798,3934,93654,"Evaluation and insertion of catheters for recording, pacing, and attempted induction of abnormal heart rhythm",CPT/HCPCS,50575.69,50575.69,16518.97,75677.0,United Healthcare-Medicare Advantage, +150799,3934,93655,Insertion of catheters for treatment of abnormal heart rhythm,CPT/HCPCS,9889.43,9889.43,9883.0,10575.0,United Healthcare-Medicare Advantage, +150800,3934,93656,"Evaluation and insertion of catheters for recording, pacing, and treatment of abnormal heart rhythm",CPT/HCPCS,87731.24,87731.24,13930.86,139227.14,United Healthcare-Medicare Advantage, +150801,3934,93657,Destruction of tissue of right or left upper heart chamber via catheter for treatment of abnormal heart rhythm,CPT/HCPCS,9894.25,9894.25,9883.0,10575.0,United Healthcare-Medicare Advantage, +150802,3934,93660,Evaluation of heart function using tilt table,CPT/HCPCS,1161.33,1161.33,107.04,7022.92,United Healthcare-Medicare Advantage, +150803,3934,93662,Ultrasound evaluation of heart blood vessel,CPT/HCPCS,10200.46,10200.46,165.85,10880.0,United Healthcare-Medicare Advantage, +150804,3934,93740,Insertion of catheter for assessment of heart blood vessel function at various temperatures,CPT/HCPCS,302.17,302.17,156.0,219.0,United Healthcare-Medicare Advantage, +150805,3934,93750,Evaluation of lower heart chamber assist device with physician analysis,CPT/HCPCS,804.71,804.71,266.92,4724.7,United Healthcare-Medicare Advantage, +150806,3934,93798,Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session,CPT/HCPCS,322.1,322.1,15.55,640.0,United Healthcare-Medicare Advantage, +150807,3934,93799,Heart and blood vessel procedure,CPT/HCPCS,3079.92,3079.92,4362.37,11657.62,United Healthcare-Medicare Advantage, +150808,3934,93880,Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck,CPT/HCPCS,2060.77,2060.77,25.0,2207.0,United Healthcare-Medicare Advantage, +150809,3934,93882,Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited,CPT/HCPCS,839.29,839.29,79.45,852.0,United Healthcare-Medicare Advantage, +150810,3934,93886,Ultrasound scanning of head and neck vessel blood flow (inside the brain),CPT/HCPCS,1390.14,1390.14,108.0,943.25,United Healthcare-Medicare Advantage, +150811,3934,93922,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,839.85,839.85,85.33,900.0,United Healthcare-Medicare Advantage, +150812,3934,93923,Ultrasound study of arteries of both arms and legs,CPT/HCPCS,1327.17,1327.17,77.07,1425.0,United Healthcare-Medicare Advantage, +150813,3934,93925,Ultrasound study of arteries and arterial grafts of both legs,CPT/HCPCS,2002.92,2002.92,56.47,2120.0,United Healthcare-Medicare Advantage, +150814,3934,93926,Ultrasound study of arteries and arterial grafts of one leg or limited,CPT/HCPCS,1268.56,1268.56,79.45,2688.0,United Healthcare-Medicare Advantage, +150815,3934,93930,Ultrasound study of arteries and arterial grafts of both arms,CPT/HCPCS,1971.04,1971.04,189.44,2096.0,United Healthcare-Medicare Advantage, +150816,3934,93931,Ultrasound study of arteries and arterial grafts of one arm or limited,CPT/HCPCS,1093.57,1093.57,79.45,1159.0,United Healthcare-Medicare Advantage, +150817,3934,93970,Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers,CPT/HCPCS,2099.48,2099.48,64.8,2228.0,United Healthcare-Medicare Advantage, +150818,3934,93971,Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers,CPT/HCPCS,1557.94,1557.94,55.8,1760.66,United Healthcare-Medicare Advantage, +150819,3934,93975,"Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,2188.52,2188.52,25.0,4894.0,United Healthcare-Medicare Advantage, +150820,3934,93976,"Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow",CPT/HCPCS,1929.39,1929.39,58.0,1929.0,United Healthcare-Medicare Advantage, +150821,3934,93978,Ultrasound scan of vena cava or groin graft or vessel blood flow,CPT/HCPCS,489.96,489.96,56.47,712.44,United Healthcare-Medicare Advantage, +150822,3934,93979,"Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limited scan",CPT/HCPCS,654.0,654.0,427.0,653.0,United Healthcare-Medicare Advantage, +150823,3934,93986,Ultrasound scan of blood flow in extremity on both sides of body for preoperative assessment of blood vessel for dialysis access,CPT/HCPCS,416.33,416.33,407.0,407.0,United Healthcare-Medicare Advantage, +150824,3934,94002,"Ventilation assistance and management, hospital inpatient or observation",CPT/HCPCS,1872.29,1872.29,233.2,22091.44,United Healthcare-Medicare Advantage, +150825,3934,94010,Measurement and graphic recording of total and timed exhaled air capacity,CPT/HCPCS,349.06,349.06,25.62,671.5,United Healthcare-Medicare Advantage, +150826,3934,94060,"Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,968.87,968.87,34.05,1872.0,United Healthcare-Medicare Advantage, +150827,3934,94070,"Multiple measurements and graphic recordings of the amount and speed of breathed air, before and following medication administration",CPT/HCPCS,934.65,934.65,26.76,1131.0,United Healthcare-Medicare Advantage, +150828,3934,94150,Measurement of largest amount of air exhaled from lungs,CPT/HCPCS,857.58,857.58,738.05,903.14,United Healthcare-Medicare Advantage, +150829,3934,94617,Exercise test for spasm of lung airways,CPT/HCPCS,265.0,265.0,72.29,369.58,United Healthcare-Medicare Advantage, +150830,3934,94618,Test for exercise-induced lung stress,CPT/HCPCS,554.73,554.73,238.7,602.0,United Healthcare-Medicare Advantage, +150831,3934,94621,Test for exercise-induced heart and lung stress,CPT/HCPCS,1075.74,1075.74,98.0,1195.0,United Healthcare-Medicare Advantage, +150832,3934,94640,Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen,CPT/HCPCS,249.5,249.5,3.0,10492.0,United Healthcare-Medicare Advantage, +150833,3934,94660,Initiation and management of continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,2383.86,2383.86,207.75,4646.55,United Healthcare-Medicare Advantage, +150834,3934,94664,"Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device",CPT/HCPCS,356.0,356.0,3.0,19.98,United Healthcare-Medicare Advantage, +150835,3934,94726,Determination of lung volumes using plethysmography,CPT/HCPCS,1904.65,1904.65,55.99,2292.68,United Healthcare-Medicare Advantage, +150836,3934,94727,Determination of lung volumes using gas dilution or washout,CPT/HCPCS,994.68,994.68,30.21,1178.0,United Healthcare-Medicare Advantage, +150837,3934,94729,Measurement of lung diffusing capacity,CPT/HCPCS,341.5,341.5,16.65,363.0,United Healthcare-Medicare Advantage, +150838,3934,94761,Multiple measurements of oxygen saturation in blood using ear or finger device,CPT/HCPCS,181.75,181.75,4.95,216.0,United Healthcare-Medicare Advantage, +150839,3934,94799,Pulmonary service or operation,CPT/HCPCS,1139.32,1139.32,145.64,1254.0,United Healthcare-Medicare Advantage, +150840,3934,95004,"Injection of allergenic extracts into skin, accessed through the skin",CPT/HCPCS,839.9,839.9,5.22,3708.54,United Healthcare-Medicare Advantage, +150841,3934,95018,"Allergy testing with drugs or biologicals into or within the skin, immediate type reaction, including test interpretation and report",CPT/HCPCS,1050.0,1050.0,444.98,444.98,United Healthcare-Medicare Advantage, +150842,3934,95076,"Ingestion of test items for allergies, 120 minutes",CPT/HCPCS,1076.67,1076.67,574.44,574.44,United Healthcare-Medicare Advantage, +150843,3934,95700,"Continuous measurement of brain wave activity (EEG), administered in person by EEG technologist",CPT/HCPCS,10910.18,10910.18,866.8,30972.0,United Healthcare-Medicare Advantage, +150844,3934,95711,"Measurement of brain wave activity with video (VEEG), 2-12 hours, unmonitored",CPT/HCPCS,13969.18,13969.18,2100.15,23053.56,United Healthcare-Medicare Advantage, +150845,3934,95712,"Measurement of brain wave activity with video (VEEG), 2-12 hours with intermittent monitoring and maintenance",CPT/HCPCS,5179.4,5179.4,397.03,15635.0,United Healthcare-Medicare Advantage, +150846,3934,95713,"Measurement of brain wave activity with video (VEEG), 2-12 hours with continuous, real-time monitoring and maintenance",CPT/HCPCS,9974.0,9974.0,9222.0,10726.0,United Healthcare-Medicare Advantage, +150847,3934,95714,"Measurement of brain wave activity with video (VEEG), 12-26 hours, unmonitored",CPT/HCPCS,20371.79,20371.79,7036.33,29751.59,United Healthcare-Medicare Advantage, +150848,3934,95715,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with intermittent monitoring and maintenance",CPT/HCPCS,20334.35,20334.35,3056.37,38074.0,United Healthcare-Medicare Advantage, +150849,3934,95716,"Measurement of brain wave activity with video (VEEG), 12-26 hours, with continuous, real-time monitoring and maintenance",CPT/HCPCS,22820.77,22820.77,636.94,649.85,United Healthcare-Medicare Advantage, +150850,3934,95782,Sleep monitoring of patient (younger than 6 years) in sleep lab,CPT/HCPCS,5745.83,5745.83,916.01,4994.74,United Healthcare-Medicare Advantage, +150851,3934,95805,Diagnostic test for sleep disorder,CPT/HCPCS,10071.83,10071.83,680.0,10648.0,United Healthcare-Medicare Advantage, +150852,3934,95810,Sleep monitoring of patient (6 years or older) in sleep lab,CPT/HCPCS,5025.44,5025.44,490.0,6094.0,United Healthcare-Medicare Advantage, +150853,3934,95811,Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube,CPT/HCPCS,4813.45,4813.45,476.0,6094.0,United Healthcare-Medicare Advantage, +150854,3934,95812,"Measurement of brain wave (EEG) activity, 41-60 minutes",CPT/HCPCS,2971.29,2971.29,52.5,1315.51,United Healthcare-Medicare Advantage, +150855,3934,95813,"Measurement of brain wave activity (EEG) extended monitoring, 61-119 minutes",CPT/HCPCS,3828.97,3828.97,35.0,4087.0,United Healthcare-Medicare Advantage, +150856,3934,95816,"Measurement and recording of brain wave (EEG) activity, awake and drowsy",CPT/HCPCS,844.6,844.6,35.0,904.0,United Healthcare-Medicare Advantage, +150857,3934,95819,"Measurement and recording of brain wave (EEG) activity, awake and asleep",CPT/HCPCS,1024.51,1024.51,35.0,1118.0,United Healthcare-Medicare Advantage, +150858,3934,95822,"Measurement and recording of brain wave (EEG) activity, in coma or asleep",CPT/HCPCS,932.89,932.89,178.28,908.0,United Healthcare-Medicare Advantage, +150859,3934,95851,"Range of motion testing of arm, leg or each spine section",CPT/HCPCS,208.79,208.79,8.47,294.9,United Healthcare-Medicare Advantage, +150860,3934,95852,Range of motion testing of hand,CPT/HCPCS,201.26,201.26,6.33,294.9,United Healthcare-Medicare Advantage, +150861,3934,95860,Needle measurement and recording of electrical activity of muscles of arm or leg,CPT/HCPCS,955.0,955.0,955.0,955.0,United Healthcare-Medicare Advantage, +150862,3934,95870,"Needle measurement and recording of electrical activity of muscles in arm or leg or muscles in trunk or head, limited study",CPT/HCPCS,955.0,955.0,955.0,955.0,United Healthcare-Medicare Advantage, +150863,3934,95885,Needle measurement and recording of electrical activity of muscles of arm or leg limited study,CPT/HCPCS,782.67,782.67,103.23,103.23,United Healthcare-Medicare Advantage, +150864,3934,95886,Needle measurement and recording of electrical activity of muscles of arm or leg complete study,CPT/HCPCS,1178.63,1178.63,68.62,1600.0,United Healthcare-Medicare Advantage, +150865,3934,95908,"Nerve transmission studies, 3-4 studies",CPT/HCPCS,640.0,640.0,208.82,208.82,United Healthcare-Medicare Advantage, +150866,3934,95910,"Nerve transmission studies, 7-8 studies",CPT/HCPCS,1283.14,1283.14,97.81,208.82,United Healthcare-Medicare Advantage, +150867,3934,95911,"Nerve transmission studies, 9-10 studies",CPT/HCPCS,2689.83,2689.83,2315.0,2315.0,United Healthcare-Medicare Advantage, +150868,3934,95912,"Nerve transmission studies, 11-12 studies",CPT/HCPCS,5023.8,5023.8,208.82,1117.57,United Healthcare-Medicare Advantage, +150869,3934,95913,"Nerve transmission studies, 13 or more studies",CPT/HCPCS,1545.0,1545.0,546.72,1839.0,United Healthcare-Medicare Advantage, +150870,3934,95921,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,930.14,2181.0,United Healthcare-Medicare Advantage, +150871,3934,95923,Testing of autonomic (sympathetic) nervous system function,CPT/HCPCS,2181.0,2181.0,1474.36,2181.0,United Healthcare-Medicare Advantage, +150872,3934,95930,Measurement and recording of nerve conduction patterns using visually-evoked stimulation,CPT/HCPCS,1266.09,1266.09,56.6,907.9,United Healthcare-Medicare Advantage, +150873,3934,95937,Testing with stimulation for assessment of function at muscle-nerve junction,CPT/HCPCS,1563.0,1563.0,223.52,223.52,United Healthcare-Medicare Advantage, +150874,3934,95938,Insertion of needles and skin electrodes for measurement and recording of stimulated sites in the arms and legs,CPT/HCPCS,951.0,951.0,475.5,951.0,United Healthcare-Medicare Advantage, +150875,3934,95970,"Electronic analysis of implanted brain, spinal cord or peripheral stimulation device",CPT/HCPCS,317.5,317.5,83.4,331.0,United Healthcare-Medicare Advantage, +150876,3934,96110,Developmental screening,CPT/HCPCS,324.44,324.44,4.62,480.62,United Healthcare-Medicare Advantage, +150877,3934,96112,"Developmental test administration by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,384.6,384.6,139.08,223.46,United Healthcare-Medicare Advantage, +150878,3934,96116,"Neurobehavioral status examination by qualified health care professional with interpretation and report, first 60 minutes",CPT/HCPCS,666.89,666.89,58.78,716.0,United Healthcare-Medicare Advantage, +150879,3934,96121,"Neurobehavioral status examination by qualified health care professional with interpretation and report, additional 60 minutes",CPT/HCPCS,662.16,662.16,73.17,909.84,United Healthcare-Medicare Advantage, +150880,3934,96127,Brief emotional or behavioral assessment,CPT/HCPCS,49.64,49.64,1.31,76.3,United Healthcare-Medicare Advantage, +150881,3934,96130,"Psychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,2080.0,2080.0,335.41,356.93,United Healthcare-Medicare Advantage, +150882,3934,96131,"Psychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,80.0,80.0,80.0,80.0,United Healthcare-Medicare Advantage, +150883,3934,96132,"Neuropsychological testing evaluation by qualified health care professional, first 60 minutes",CPT/HCPCS,659.35,659.35,27.52,1028.5,United Healthcare-Medicare Advantage, +150884,3934,96133,"Neuropsychological testing evaluation by qualified health care professional, additional 60 minutes",CPT/HCPCS,844.95,844.95,22.55,2125.0,United Healthcare-Medicare Advantage, +150885,3934,96136,"Psychological or neuropsychological test administration and scoring by qualified health care professional, first 30 minutes",CPT/HCPCS,2208.97,2208.97,43.09,2882.0,United Healthcare-Medicare Advantage, +150886,3934,96137,"Psychological or neuropsychological test administration and scoring by qualified health care professional, additional 30 minutes",CPT/HCPCS,1226.69,1226.69,10.0,1816.8,United Healthcare-Medicare Advantage, +150887,3934,96138,"Psychological or neuropsychological test administration and scoring by technician, first 30 minutes",CPT/HCPCS,507.2,507.2,44.95,337.0,United Healthcare-Medicare Advantage, +150888,3934,96139,"Psychological or neuropsychological test administration and scoring by technician, additional 30 minutes",CPT/HCPCS,976.45,976.45,179.82,808.8,United Healthcare-Medicare Advantage, +150889,3934,96360,Hydration infusion into a vein 31 minutes to 1 hour,CPT/HCPCS,1351.61,1351.61,39.79,15004.72,United Healthcare-Medicare Advantage, +150890,3934,96361,Hydration infusion into a vein,CPT/HCPCS,1207.56,1207.56,10.63,13277.38,United Healthcare-Medicare Advantage, +150891,3934,96365,"Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour",CPT/HCPCS,630.79,630.79,29.75,10492.0,United Healthcare-Medicare Advantage, +150892,3934,96366,"Infusion into a vein for therapy, prevention, or diagnosis",CPT/HCPCS,2201.54,2201.54,63.01,15219.61,United Healthcare-Medicare Advantage, +150893,3934,96367,Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour,CPT/HCPCS,1075.5,1075.5,1.08,10825.45,United Healthcare-Medicare Advantage, +150894,3934,96368,"Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion",CPT/HCPCS,673.82,673.82,14.78,1949.0,United Healthcare-Medicare Advantage, +150895,3934,96372,"Injection beneath the skin or into muscle for therapy, diagnosis, or prevention",CPT/HCPCS,528.82,528.82,9.15,26828.23,United Healthcare-Medicare Advantage, +150896,3934,96374,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1060.68,1060.68,3.24,14431.38,United Healthcare-Medicare Advantage, +150897,3934,96375,"Injection of different drug or substance into a vein for therapy, diagnosis, or prevention",CPT/HCPCS,1466.17,1466.17,2.14,13327.38,United Healthcare-Medicare Advantage, +150898,3934,96376,"Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility",CPT/HCPCS,1681.33,1681.33,6.71,10492.0,United Healthcare-Medicare Advantage, +150899,3934,96377,Application of on-body injector for injection under skin,CPT/HCPCS,3745.72,3745.72,226.15,17583.14,United Healthcare-Medicare Advantage, +150900,3934,96401,Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle,CPT/HCPCS,999.98,999.98,47.14,6516.0,United Healthcare-Medicare Advantage, +150901,3934,96402,Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle,CPT/HCPCS,862.79,862.79,14.66,6939.0,United Healthcare-Medicare Advantage, +150902,3934,96409,Infusion of chemotherapy into a vein using push technique,CPT/HCPCS,1067.58,1067.58,18.25,6939.0,United Healthcare-Medicare Advantage, +150903,3934,96411,Infusion of different chemotherapy drug or substance into a vein,CPT/HCPCS,4109.43,4109.43,54.06,18879.54,United Healthcare-Medicare Advantage, +150904,3934,96413,Infusion of chemotherapy into a vein up to 1 hour,CPT/HCPCS,1624.77,1624.77,1.68,24988.12,United Healthcare-Medicare Advantage, +150905,3934,96415,Infusion of chemotherapy into a vein,CPT/HCPCS,2776.88,2776.88,86.86,13786.48,United Healthcare-Medicare Advantage, +150906,3934,96416,Prolonged chemotherapy infusion into a vein by portable or implanted pump more than 8 hours,CPT/HCPCS,4126.03,4126.03,40.0,32261.04,United Healthcare-Medicare Advantage, +150907,3934,96417,Infusion of different chemotherapy drug or substance into a vein up to 1 hour,CPT/HCPCS,3100.56,3100.56,3.21,14241.87,United Healthcare-Medicare Advantage, +150908,3934,96446,Chemotherapy infusion into abdominal cavity,CPT/HCPCS,4030.73,4030.73,2137.92,6438.27,United Healthcare-Medicare Advantage, +150909,3934,96450,Chemotherapy administration into spinal canal requiring spinal tap,CPT/HCPCS,9001.57,9001.57,16.48,302546.0,United Healthcare-Medicare Advantage, +150910,3934,96523,Irrigation of implanted venous access drug delivery device,CPT/HCPCS,274.56,274.56,13.34,1388.93,United Healthcare-Medicare Advantage, +150911,3934,96549,Chemotherapy procedure,CPT/HCPCS,1997.31,1997.31,1150.41,2016.0,United Healthcare-Medicare Advantage, +150912,3934,97010,Application of hot or cold packs to 1 or more areas,CPT/HCPCS,108.42,108.42,4.42,3777.0,United Healthcare-Medicare Advantage, +150913,3934,97012,Application of mechanical traction to 1 or more areas,CPT/HCPCS,98.67,98.67,13.69,73.5,United Healthcare-Medicare Advantage, +150914,3934,97014,"Application of electrical stimulation to 1 or more areas, unattended by physical therapist",CPT/HCPCS,110.65,110.65,12.67,100.0,United Healthcare-Medicare Advantage, +150915,3934,97018,Application of hot wax bath to 1 or more areas,CPT/HCPCS,94.72,94.72,5.33,96.0,United Healthcare-Medicare Advantage, +150916,3934,97022,Application of whirlpool therapy to 1 or more areas,CPT/HCPCS,183.65,183.65,14.4,248.5,United Healthcare-Medicare Advantage, +150917,3934,97032,"Application of electrical stimulation to 1 or more areas, each 15 minutes",CPT/HCPCS,154.77,154.77,13.69,111.0,United Healthcare-Medicare Advantage, +150918,3934,97035,"Application of ultrasound to 1 or more areas, each 15 minutes",CPT/HCPCS,110.65,110.65,2.59,87.51,United Healthcare-Medicare Advantage, +150919,3934,97110,"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",CPT/HCPCS,443.19,443.19,5.49,4904.55,United Healthcare-Medicare Advantage, +150920,3934,97112,"Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes",CPT/HCPCS,303.22,303.22,6.22,531.3,United Healthcare-Medicare Advantage, +150921,3934,97113,"Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes",CPT/HCPCS,757.54,757.54,110.79,196.9,United Healthcare-Medicare Advantage, +150922,3934,97116,"Walking training to 1 or more areas, each 15 minutes",CPT/HCPCS,276.69,276.69,5.0,501.75,United Healthcare-Medicare Advantage, +150923,3934,97129,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes",CPT/HCPCS,56.62,56.62,17.0,142.95,United Healthcare-Medicare Advantage, +150924,3934,97130,"Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes",CPT/HCPCS,94.18,94.18,17.0,142.95,United Healthcare-Medicare Advantage, +150925,3934,97139,Therapeutic procedure,CPT/HCPCS,64.96,64.96,1.29,135.0,United Healthcare-Medicare Advantage, +150926,3934,97140,"Manual (physical) therapy techniques to 1 or more regions, each 15 minutes",CPT/HCPCS,309.73,309.73,5.12,909.0,United Healthcare-Medicare Advantage, +150927,3934,97150,Therapeutic procedures in a group setting,CPT/HCPCS,175.46,175.46,16.62,142.95,United Healthcare-Medicare Advantage, +150928,3934,97161,"Evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,231.09,231.09,15.0,345.0,United Healthcare-Medicare Advantage, +150929,3934,97162,"Evaluation of physical therapy, typically 30 minutes",CPT/HCPCS,335.5,335.5,5.0,350.0,United Healthcare-Medicare Advantage, +150930,3934,97163,"Evaluation of physical therapy, typically 45 minutes",CPT/HCPCS,443.37,443.37,75.44,468.0,United Healthcare-Medicare Advantage, +150931,3934,97164,"Re-evaluation of physical therapy, typically 20 minutes",CPT/HCPCS,281.86,281.86,81.48,345.0,United Healthcare-Medicare Advantage, +150932,3934,97165,"Evaluation of occupational therapy, typically 30 minutes",CPT/HCPCS,268.94,268.94,5.0,295.0,United Healthcare-Medicare Advantage, +150933,3934,97166,"Evaluation of occupational therapy, typically 45 minutes",CPT/HCPCS,341.37,341.37,18.41,339.0,United Healthcare-Medicare Advantage, +150934,3934,97167,"Evaluation of occupational therapy established plan of care, typically 60 minutes",CPT/HCPCS,475.25,475.25,87.38,396.0,United Healthcare-Medicare Advantage, +150935,3934,97168,"Re-evaluation of occupational therapy established plan of care, typically 30 minutes",CPT/HCPCS,348.36,348.36,73.45,279.0,United Healthcare-Medicare Advantage, +150936,3934,97530,"Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes",CPT/HCPCS,471.37,471.37,2.52,2789.0,United Healthcare-Medicare Advantage, +150937,3934,97535,"Self-care or home management training, each 15 minutes",CPT/HCPCS,230.59,230.59,5.93,633.0,United Healthcare-Medicare Advantage, +150938,3934,97597,Removal of tissue from wounds per session,CPT/HCPCS,314.3,314.3,40.1,989.09,United Healthcare-Medicare Advantage, +150939,3934,97750,"Physical performance test or measurement with report, each 15 minutes",CPT/HCPCS,252.2,252.2,41.01,78.83,United Healthcare-Medicare Advantage, +150940,3934,97760,"Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes",CPT/HCPCS,331.72,331.72,17.0,684.0,United Healthcare-Medicare Advantage, +150941,3934,97802,"Medical nutrition therapy, assessment and intervention, each 15 minutes",CPT/HCPCS,299.38,299.38,39.68,648.0,United Healthcare-Medicare Advantage, +150942,3934,97803,"Medical nutrition therapy re-assessment and intervention, each 15 minutes",CPT/HCPCS,224.18,224.18,31.92,392.0,United Healthcare-Medicare Advantage, +150943,3934,97804,"Medical nutrition therapy performed in a group setting, each 30 minutes",CPT/HCPCS,62.0,62.0,30.06,30.06,United Healthcare-Medicare Advantage, +150944,3934,99024,After surgery follow-up visit,CPT/HCPCS,36.3,36.3,32.75,36.0,United Healthcare-Medicare Advantage, +150945,3934,99151,"Moderate sedation services by physician also performing a procedure, patient younger than 5 years of age, first 15 minutes",CPT/HCPCS,1262.72,1262.72,16.44,9045.4,United Healthcare-Medicare Advantage, +150946,3934,99152,"Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,1244.59,1244.59,8.57,12624.0,United Healthcare-Medicare Advantage, +150947,3934,99153,"Moderate sedation services by physician also performing a procedure, additional 15 minutes",CPT/HCPCS,632.87,632.87,217.25,705.0,United Healthcare-Medicare Advantage, +150948,3934,99155,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.85,382.85,95.0,95.0,United Healthcare-Medicare Advantage, +150949,3934,99156,"Moderate sedation services by physician not performing a procedure, patient 5 years of age or older, first 15 minutes",CPT/HCPCS,382.01,382.01,40.49,402.0,United Healthcare-Medicare Advantage, +150950,3934,99157,"Moderate sedation services by physician not performing a procedure, each additional 15 minutes",CPT/HCPCS,539.79,539.79,30.68,804.0,United Healthcare-Medicare Advantage, +150951,3934,99173,Eye chart testing of visual acuity of both eyes,CPT/HCPCS,188.73,188.73,1.97,226.28,United Healthcare-Medicare Advantage, +150952,3934,99195,Therapeutic removal of whole blood to correct blood level imbalance,CPT/HCPCS,320.68,320.68,32.01,831.0,United Healthcare-Medicare Advantage, +150953,3934,99201,"New patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,276.9,276.9,30.28,256.21,United Healthcare-Medicare Advantage, +150954,3934,99202,"New patient office or other outpatient visit, typically 20 minutes",CPT/HCPCS,335.35,335.35,56.36,254.09,United Healthcare-Medicare Advantage, +150955,3934,99203,"New patient office or other outpatient visit, typically 30 minutes",CPT/HCPCS,387.06,387.06,85.25,412.0,United Healthcare-Medicare Advantage, +150956,3934,99204,"New patient office or other outpatient visit, typically 45 minutes",CPT/HCPCS,472.82,472.82,58.43,411.33,United Healthcare-Medicare Advantage, +150957,3934,99205,"New patient office or other outpatient visit, typically 60 minutes",CPT/HCPCS,487.49,487.49,117.31,397.3,United Healthcare-Medicare Advantage, +150958,3934,99211,"Established patient office or other outpatient visit, typically 5 minutes",CPT/HCPCS,269.7,269.7,6.38,297.0,United Healthcare-Medicare Advantage, +150959,3934,99212,"Established patient office or other outpatient visit, typically 10 minutes",CPT/HCPCS,319.09,319.09,12.16,819.24,United Healthcare-Medicare Advantage, +150960,3934,99213,"Established patient office or other outpatient visit, typically 15 minutes",CPT/HCPCS,371.37,371.37,23.06,442.13,United Healthcare-Medicare Advantage, +150961,3934,99214,"Established patient office or other outpatient, visit typically 25 minutes",CPT/HCPCS,419.15,419.15,36.06,1753.16,United Healthcare-Medicare Advantage, +150962,3934,99215,"Established patient office or other outpatient, visit typically 40 minutes",CPT/HCPCS,440.31,440.31,70.0,1521.5,United Healthcare-Medicare Advantage, +150963,3934,99241,"Patient office consultation, typically 15 minutes",CPT/HCPCS,202.0,202.0,177.16,206.65,United Healthcare-Medicare Advantage, +150964,3934,99242,"Patient office consultation, typically 30 minutes",CPT/HCPCS,242.23,242.23,56.36,220.3,United Healthcare-Medicare Advantage, +150965,3934,99243,"Patient office consultation, typically 40 minutes",CPT/HCPCS,281.1,281.1,67.25,263.75,United Healthcare-Medicare Advantage, +150966,3934,99244,"Patient office consultation, typically 60 minutes",CPT/HCPCS,340.93,340.93,80.14,325.62,United Healthcare-Medicare Advantage, +150967,3934,99245,"Patient office consultation, typically 80 minutes",CPT/HCPCS,354.11,354.11,127.88,306.09,United Healthcare-Medicare Advantage, +150968,3934,99281,"Emergency department visit, self limited or minor problem",CPT/HCPCS,1115.54,1115.54,17.0,2484.0,United Healthcare-Medicare Advantage, +150969,3934,99282,"Emergency department visit, low to moderately severe problem",CPT/HCPCS,1402.3,1402.3,1.0,5705.11,United Healthcare-Medicare Advantage, +150970,3934,99283,"Emergency department visit, moderately severe problem",CPT/HCPCS,1905.72,1905.72,1.0,5099.5,United Healthcare-Medicare Advantage, +150971,3934,99284,"Emergency department visit, problem of high severity",CPT/HCPCS,2857.78,2857.78,3.37,62194.0,United Healthcare-Medicare Advantage, +150972,3934,99285,"Emergency department visit, problem with significant threat to life or function",CPT/HCPCS,3705.97,3705.97,4.09,20507.01,United Healthcare-Medicare Advantage, +150973,3934,99291,"Critical care delivery critically ill or injured patient, first 30-74 minutes",CPT/HCPCS,10312.58,10312.58,134.08,11040.0,United Healthcare-Medicare Advantage, +150974,3934,99381,Initial new patient preventive medicine evaluation infant younger than 1 year,CPT/HCPCS,228.32,228.32,56.0,220.9,United Healthcare-Medicare Advantage, +150975,3934,99382,"Initial new patient preventive medicine evaluation, age 1 through 4 years",CPT/HCPCS,227.06,227.06,61.0,213.51,United Healthcare-Medicare Advantage, +150976,3934,99383,"Initial new patient preventive medicine evaluation, age 5 through 11 years",CPT/HCPCS,226.85,226.85,60.0,213.51,United Healthcare-Medicare Advantage, +150977,3934,99384,"Initial new patient preventive medicine evaluation, age 12 through 17 years",CPT/HCPCS,227.94,227.94,65.0,211.4,United Healthcare-Medicare Advantage, +150978,3934,99385,Initial new patient preventive medicine evaluation age 18-39 years,CPT/HCPCS,226.67,226.67,74.0,301.79,United Healthcare-Medicare Advantage, +150979,3934,99386,Initial new patient preventive medicine evaluation age 40-64 years,CPT/HCPCS,282.06,282.06,80.0,256.21,United Healthcare-Medicare Advantage, +150980,3934,99387,"Initial new patient preventive medicine evaluation, age 65 years and older",CPT/HCPCS,286.0,286.0,199.47,199.47,United Healthcare-Medicare Advantage, +150981,3934,99391,Established patient periodic preventive medicine examination infant younger than 1 year,CPT/HCPCS,228.85,228.85,49.33,241.94,United Healthcare-Medicare Advantage, +150982,3934,99392,"Established patient periodic preventive medicine examination, age 1 through 4 years",CPT/HCPCS,229.14,229.14,30.61,236.07,United Healthcare-Medicare Advantage, +150983,3934,99393,"Established patient periodic preventive medicine examination, age 5 through 11 years",CPT/HCPCS,227.96,227.96,50.0,367.09,United Healthcare-Medicare Advantage, +150984,3934,99394,"Established patient periodic preventive medicine examination, age 12 through 17 years",CPT/HCPCS,227.52,227.52,54.0,252.69,United Healthcare-Medicare Advantage, +150985,3934,99395,Established patient periodic preventive medicine examination age 18-39 years,CPT/HCPCS,226.48,226.48,75.0,263.75,United Healthcare-Medicare Advantage, +150986,3934,99396,Established patient periodic preventive medicine examination age 40-64 years,CPT/HCPCS,281.22,281.22,90.0,271.67,United Healthcare-Medicare Advantage, +150987,3934,99397,"Established patient periodic preventive medicine examination, age 65 years and older",CPT/HCPCS,292.0,292.0,199.47,199.47,United Healthcare-Medicare Advantage, +150988,3934,99401,"Preventive medicine counseling, approximately 15 minutes",CPT/HCPCS,76.33,76.33,31.0,31.0,United Healthcare-Medicare Advantage, +150989,3934,99402,"Preventive medicine counseling, approximately 30 minutes",CPT/HCPCS,162.14,162.14,40.0,128.54,United Healthcare-Medicare Advantage, +150990,3934,99403,"Preventive medicine counseling, approximately 45 minutes",CPT/HCPCS,237.5,237.5,60.0,153.85,United Healthcare-Medicare Advantage, +150991,3934,99404,"Preventive medicine counseling, approximately 60 minutes",CPT/HCPCS,302.0,302.0,79.0,191.79,United Healthcare-Medicare Advantage, +150992,3934,99406,"Smoking and tobacco use intermediate counseling, greater than 3 minutes up to 10 minutes",CPT/HCPCS,84.25,84.25,14.0,123.03,United Healthcare-Medicare Advantage, +150993,3934,99408,"Alcohol and/or substance abuse screening and intervention, 15-30 minutes",CPT/HCPCS,144.96,144.96,19.71,9373.71,United Healthcare-Medicare Advantage, +150994,3934,99409,"Alcohol and/or substance abuse screening and intervention, greater than 30 minutes",CPT/HCPCS,258.88,258.88,55.32,10258.0,United Healthcare-Medicare Advantage, +150995,3934,0031A,"Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sarscov-2) (Coronavirus Disease [Covid-19]) Vaccine, Dna, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5X1010 Viral Particles/0.5Ml Dosage, Single Dose",CPT/HCPCS,157.15,157.15,68.0,68.0,United Healthcare-Medicare Advantage, +150996,3934,003X,Bone Marrow Transplant,DRG,437152.65,437152.65,12904.89,70548.72,United Healthcare-Medicare Advantage, +150997,3934,0042T,"Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast",CPT/HCPCS,3055.85,3055.85,149.89,6040.0,United Healthcare-Medicare Advantage, +150998,3934,004X,Tracheostomy W Mv 96+ Hours W Extensive Procedure,DRG,1309584.81,1309584.81,18745.58,261690.14,United Healthcare-Medicare Advantage, +150999,3934,0100U,"Test for detection of respiratory disease-causing organism using amplified probe, 20 target organisms (adenovirus, coronavirus 229E, coronavirus HKU1, coronavirus NL63, coronavirus OC43, human metapneumovirus, human rhinovirus/enterovirus, influenza A, including subtypes H1, H1-2009, and H3, influenza B, parainfluenza virus 1, parainfluenza virus 2, parainfluenza virus 3, parainfluenza virus 4, respiratory syncytial virus, Bordetella parapertussis [IS1001], Bordetella pertussis [ptxP], Chlamydia pneumoniae, Mycoplasma pneumoniae)",CPT/HCPCS,716.0,716.0,716.0,716.0,United Healthcare-Medicare Advantage, +151000,3934,0191T,Internal insertion of eye fluid drainage device,CPT/HCPCS,9219.3,9219.3,6722.46,21227.49,United Healthcare-Medicare Advantage, +151001,3934,0202U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogenreported As Detected Or Not Detected.",CPT/HCPCS,859.54,859.54,55.9,900.0,United Healthcare-Medicare Advantage, +151002,3934,020X,Open Craniotomy For Trauma,DRG,581438.53,581438.53,7677.6,223326.09,United Healthcare-Medicare Advantage, +151003,3934,021X,Open Craniotomy Except Trauma,DRG,193170.46,193170.46,4883.06,140070.43,United Healthcare-Medicare Advantage, +151004,3934,0223U,"Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (Dna Or Rna), 22 Targets Including Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2), Qualitative Rt-Pcr, Nasopharyngeal Swab, Each Pathogen Reported As Detected Or Not Detected",CPT/HCPCS,834.0,834.0,0.01,834.0,United Healthcare-Medicare Advantage, +151005,3934,022X,Ventricular Shunt Procedures,DRG,94389.79,94389.79,3833.09,200209.44,United Healthcare-Medicare Advantage, +151006,3934,023X,Spinal Procedures,DRG,335421.21,335421.21,4453.95,197225.78,United Healthcare-Medicare Advantage, +151007,3934,0241U,Nfct Ds Vir Resp Rna 4 Trgt,CPT/HCPCS,433.38,433.38,137.62,137.62,United Healthcare-Medicare Advantage, +151008,3934,024X,Open Extracranial Vascular Procedures,DRG,145282.37,145282.37,1707.0,229761.51,United Healthcare-Medicare Advantage, +151009,3934,026X,Other Nervous System & Related Procedures,DRG,51366.35,51366.35,3751.54,107685.44,United Healthcare-Medicare Advantage, +151010,3934,0335T,Insertion of implant into subtalar (below ankle) foot joint,CPT/HCPCS,12741.5,12741.5,4829.67,6887.5,United Healthcare-Medicare Advantage, +151011,3934,0376T,Insertion of eye drainage device,CPT/HCPCS,628.46,628.46,460.8,5137.4,United Healthcare-Medicare Advantage, +151012,3934,040X,Spinal Disorders & Injuries,DRG,87003.53,87003.53,3849.2,125584.0,United Healthcare-Medicare Advantage, +151013,3934,041X,Nervous System Malignancy,DRG,89167.03,89167.03,3140.68,42678.8,United Healthcare-Medicare Advantage, +151014,3934,042X,Degenerative Nervous System Disorders Exc Mult Sclerosis,DRG,104240.7,104240.7,2752.1,61753.9,United Healthcare-Medicare Advantage, +151015,3934,043X,Multiple Sclerosis & Other Demyelinating Diseases,DRG,91914.85,91914.85,3000.81,41246.0,United Healthcare-Medicare Advantage, +151016,3934,0441T,"Freezing destruction of nerve in leg, accessed through the skin, using imaging guidance",CPT/HCPCS,10413.5,10413.5,8051.71,12071.0,United Healthcare-Medicare Advantage, +151017,3934,0449T,Insertion of aqueous fluid drainage device into eye,CPT/HCPCS,4049.58,4049.58,3361.38,6717.64,United Healthcare-Medicare Advantage, +151018,3934,044X,Intracranial Hemorrhage,DRG,181098.92,181098.92,5258.42,36572.0,United Healthcare-Medicare Advantage, +151019,3934,045X,Cva & Precerebral Occlusion W Infarct,DRG,103070.98,103070.98,3023.53,138419.36,United Healthcare-Medicare Advantage, +151020,3934,046X,Nonspecific Cva & Precerebral Occlusion W/O Infarct,DRG,75798.12,75798.12,3110.17,64137.98,United Healthcare-Medicare Advantage, +151021,3934,0479T,Laser destruction of scar tissue,CPT/HCPCS,5275.74,5275.74,3672.0,11700.0,United Healthcare-Medicare Advantage, +151022,3934,047X,Transient Ischemia,DRG,53141.7,53141.7,37590.23,114936.6,United Healthcare-Medicare Advantage, +151023,3934,0480T,Laser destruction of scar tissue,CPT/HCPCS,506.13,506.13,156.0,4356.0,United Healthcare-Medicare Advantage, +151024,3934,048X,"Peripheral, Cranial & Autonomic Nerve Disorders",DRG,49033.35,49033.35,2610.7,57372.63,United Healthcare-Medicare Advantage, +151025,3934,050X,Non-Bacterial Infections Of Nervous System Exc Viral Meningitis,DRG,174327.04,174327.04,3964.82,35324.35,United Healthcare-Medicare Advantage, +151026,3934,052X,Alteration In Consciousness,DRG,60828.51,60828.51,2904.0,31083.96,United Healthcare-Medicare Advantage, +151027,3934,053X,Seizure,DRG,94411.28,94411.28,2470.5,60674.13,United Healthcare-Medicare Advantage, +151028,3934,054X,Migraine & Other Headaches,DRG,70069.08,70069.08,2506.09,30549.57,United Healthcare-Medicare Advantage, +151029,3934,055X,Head Trauma W Coma >1 Hr Or Hemorrhage,DRG,71190.76,71190.76,2615.95,32726.36,United Healthcare-Medicare Advantage, +151030,3934,057X,"Concussion, Closed Skull Fx Nos,Uncomplicated Intracranial Injury, Coma < 1 Hr Or No Coma",DRG,42851.0,42851.0,2344.69,33346.06,United Healthcare-Medicare Advantage, +151031,3934,058X,Other Disorders Of Nervous System,DRG,67623.4,67623.4,2584.76,35132.0,United Healthcare-Medicare Advantage, +151032,3934,070X,Orbital Procedures,DRG,52563.09,52563.09,3763.58,49092.15,United Healthcare-Medicare Advantage, +151033,3934,080X,Acute Major Eye Infections,DRG,113931.46,113931.46,2862.47,13511.47,United Healthcare-Medicare Advantage, +151034,3934,082X,Eye Infections & Other Eye Disorders,DRG,94284.62,94284.62,2501.68,96215.1,United Healthcare-Medicare Advantage, +151035,3934,089X,Major Cranial/Facial Bone Procedures,DRG,404857.78,404857.78,3983.3,27952.32,United Healthcare-Medicare Advantage, +151036,3934,090X,Major Larynx & Trachea Procedures,DRG,571113.59,571113.59,5523.92,101892.69,United Healthcare-Medicare Advantage, +151037,3934,091X,Other Major Head & Neck Procedures,DRG,123227.81,123227.81,6502.0,40201.0,United Healthcare-Medicare Advantage, +151038,3934,092X,Facial Bone Procedures Except Major Cranial/Facial Bone Procedures,DRG,153685.75,153685.75,3454.67,22513.0,United Healthcare-Medicare Advantage, +151039,3934,097X,Tonsil & Adenoid Procedures,DRG,23768.56,23768.56,2492.7,58009.66,United Healthcare-Medicare Advantage, +151040,3934,098X,"Other Ear, Nose, Mouth & Throat Procedures",DRG,58026.47,58026.47,2832.63,93215.78,United Healthcare-Medicare Advantage, +151041,3934,110X,"Ear, Nose, Mouth, Throat, Cranial/Facial Malignancies",DRG,103891.74,103891.74,4678.59,34310.08,United Healthcare-Medicare Advantage, +151042,3934,111X,Vertigo & Other Labyrinth Disorders,DRG,43252.81,43252.81,2590.18,5026.77,United Healthcare-Medicare Advantage, +151043,3934,113X,Infections Of Upper Respiratory Tract,DRG,87083.14,87083.14,2329.77,36142.57,United Healthcare-Medicare Advantage, +151044,3934,114X,Dental Diseases & Disorders,DRG,25560.35,25560.35,2483.37,24391.41,United Healthcare-Medicare Advantage, +151045,3934,115X,"Other Ear, Nose, Mouth,Throat & Cranial/Facial Diagnoses",DRG,51510.12,51510.12,2420.47,25734.48,United Healthcare-Medicare Advantage, +151046,3934,120X,Major Respiratory & Chest Procedures,DRG,150945.42,150945.42,4609.42,32201.61,United Healthcare-Medicare Advantage, +151047,3934,121X,Other Respiratory & Chest Procedures,DRG,127670.35,127670.35,3721.02,51611.99,United Healthcare-Medicare Advantage, +151048,3934,130X,Respiratory System Diagnosis W Ventilator Support 96+ Hours,DRG,438029.55,438029.55,7487.38,91496.21,United Healthcare-Medicare Advantage, +151049,3934,132X,Bpd & Oth Chronic Respiratory Diseases Arising In Perinatal Period,DRG,15525.76,15525.76,2672.41,23865.24,United Healthcare-Medicare Advantage, +151050,3934,133X,Respiratory Failure,DRG,90498.48,90498.48,3237.32,20467.59,United Healthcare-Medicare Advantage, +151051,3934,134X,Pulmonary Embolism,DRG,72204.63,72204.63,3257.16,34083.03,United Healthcare-Medicare Advantage, +151052,3934,135X,Major Chest & Respiratory Trauma,DRG,78829.97,78829.97,2549.32,19352.02,United Healthcare-Medicare Advantage, +151053,3934,136X,Respiratory Malignancy,DRG,90940.61,90940.61,3204.26,22875.89,United Healthcare-Medicare Advantage, +151054,3934,137X,Major Respiratory Infections & Inflammations,DRG,84427.7,84427.7,3419.41,279543.8,United Healthcare-Medicare Advantage, +151055,3934,138X,Bronchiolitis & Rsv Pneumonia,DRG,12870.5,12870.5,2498.63,22614.4,United Healthcare-Medicare Advantage, +151056,3934,139X,Other Pneumonia,DRG,55940.32,55940.32,2542.71,26989.06,United Healthcare-Medicare Advantage, +151057,3934,140X,Chronic Obstructive Pulmonary Disease,DRG,45033.95,45033.95,2895.87,15226.01,United Healthcare-Medicare Advantage, +151058,3934,141X,Asthma,DRG,22017.93,22017.93,2474.73,14257.33,United Healthcare-Medicare Advantage, +151059,3934,142X,Interstitial & Alveolar Lung Diseases,DRG,90864.34,90864.34,3928.03,10739.52,United Healthcare-Medicare Advantage, +151060,3934,143X,"Other Respiratory Diagnoses Except Signs, Symptoms & Minor Diagnoses",DRG,80872.13,80872.13,2572.21,14071.89,United Healthcare-Medicare Advantage, +151061,3934,144X,"Respiratory Signs, Symptoms & Minor Diagnoses",DRG,35290.72,35290.72,2439.29,17510.37,United Healthcare-Medicare Advantage, +151062,3934,161X,Implantable Heart Assist Systems,DRG,279313.84,279313.84,8477.66,203930.94,United Healthcare-Medicare Advantage, +151063,3934,162X,Cardiac Valve Procedures W Ami Or Complex Pdx,DRG,353909.99,353909.99,9270.78,67056.15,United Healthcare-Medicare Advantage, +151064,3934,163X,Cardiac Valve Procedures W/O Ami Or Complex Pdx,DRG,261616.43,261616.43,7944.97,27181.43,United Healthcare-Medicare Advantage, +151065,3934,165X,Coronary Bypass W Ami Or Complex Pdx,DRG,209713.45,209713.45,8363.56,64535.48,United Healthcare-Medicare Advantage, +151066,3934,166X,Coronary Bypass W/O Ami Or Complex Pdx,DRG,174281.38,174281.38,7201.53,56986.39,United Healthcare-Medicare Advantage, +151067,3934,167X,Other Cardiothoracic & Thoracic Vascular Procedures,DRG,201683.7,201683.7,6486.24,47674.64,United Healthcare-Medicare Advantage, +151068,3934,169X,Major Abdominal Vascular Procedures,DRG,229916.38,229916.38,5551.56,51546.08,United Healthcare-Medicare Advantage, +151069,3934,171X,"Perm Cardiac Pacemaker Implant W/O Ami, Heart Failure Or Shock",DRG,114069.02,114069.02,4621.45,28923.19,United Healthcare-Medicare Advantage, +151070,3934,174X,Percutaneous Cardiac Intervention W Ami,DRG,128993.37,128993.37,2256.98,158536.18,United Healthcare-Medicare Advantage, +151071,3934,175X,Percutaneous Cardiac Intervention W/O Ami,DRG,168103.97,168103.97,4173.19,45670.64,United Healthcare-Medicare Advantage, +151072,3934,176X,"Insertion, Revision & Replacements Of Pacemaker & Other Cardiac Devices",DRG,258966.13,258966.13,7376.16,33884.27,United Healthcare-Medicare Advantage, +151073,3934,180X,Other Circulatory System Procedures,DRG,356006.45,356006.45,5773.82,57144.7,United Healthcare-Medicare Advantage, +151074,3934,181X,Lower Extremity Arterial Procedures,DRG,122561.22,122561.22,5533.42,63695.22,United Healthcare-Medicare Advantage, +151075,3934,182X,Other Peripheral Vascular Procedures,DRG,124418.55,124418.55,4215.57,57527.47,United Healthcare-Medicare Advantage, +151076,3934,190X,Acute Myocardial Infarction,DRG,112019.18,112019.18,2919.09,20960.25,United Healthcare-Medicare Advantage, +151077,3934,191X,Cardiac Catheterization For Coronary Artery Disease,DRG,68304.92,68304.92,2887.39,20082.38,United Healthcare-Medicare Advantage, +151078,3934,192X,Cardiac Catheterization For Other Non-Coronary Conditions,DRG,71080.61,71080.61,2889.25,38957.19,United Healthcare-Medicare Advantage, +151079,3934,193X,Acute & Subacute Endocarditis,DRG,35717.33,35717.33,4008.22,21653.01,United Healthcare-Medicare Advantage, +151080,3934,194X,Heart Failure,DRG,76668.88,76668.88,2637.82,33637.86,United Healthcare-Medicare Advantage, +151081,3934,196X,Cardiac Arrest & Shock,DRG,46309.73,46309.73,2861.11,25481.06,United Healthcare-Medicare Advantage, +151082,3934,197X,Peripheral & Other Vascular Disorders,DRG,55982.38,55982.38,3015.05,88846.18,United Healthcare-Medicare Advantage, +151083,3934,198X,Angina Pectoris & Coronary Atherosclerosis,DRG,39388.21,39388.21,2364.02,10020.9,United Healthcare-Medicare Advantage, +151084,3934,199X,Hypertension,DRG,41563.9,41563.9,2438.95,84196.91,United Healthcare-Medicare Advantage, +151085,3934,200X,Cardiac Structural & Valvular Disorders,DRG,48168.34,48168.34,2531.86,44591.05,United Healthcare-Medicare Advantage, +151086,3934,201X,Cardiac Arrhythmia & Conduction Disorders,DRG,51342.07,51342.07,2405.04,30906.6,United Healthcare-Medicare Advantage, +151087,3934,203X,Chest Pain,DRG,67178.39,67178.39,2504.73,7233.63,United Healthcare-Medicare Advantage, +151088,3934,204X,Syncope & Collapse,DRG,66304.36,66304.36,2452.18,7907.0,United Healthcare-Medicare Advantage, +151089,3934,205X,Cardiomyopathy,DRG,34475.22,34475.22,6461.94,6461.94,United Healthcare-Medicare Advantage, +151090,3934,206X,"Malfunction,Reaction,Complication Of Cardiac/Vasc Device Or Procedure",DRG,65428.39,65428.39,3781.21,25107.94,United Healthcare-Medicare Advantage, +151091,3934,207X,Other Circulatory System Diagnoses,DRG,66492.02,66492.02,2500.67,18952.7,United Healthcare-Medicare Advantage, +151092,3934,220X,"Major Stomach, Esophageal & Duodenal Procedures",DRG,80607.82,80607.82,3636.08,89036.54,United Healthcare-Medicare Advantage, +151093,3934,221X,Major Small & Large Bowel Procedures,DRG,182309.09,182309.09,4192.18,181183.84,United Healthcare-Medicare Advantage, +151094,3934,222X,"Other Stomach, Esophageal & Duodenal Procedures",DRG,152381.74,152381.74,3066.93,68900.44,United Healthcare-Medicare Advantage, +151095,3934,223X,Other Small & Large Bowel Procedures,DRG,144976.9,144976.9,3667.11,69246.85,United Healthcare-Medicare Advantage, +151096,3934,224X,Peritoneal Adhesiolysis,DRG,96091.1,96091.1,4386.64,19842.14,United Healthcare-Medicare Advantage, +151097,3934,225X,Appendectomy,DRG,64181.77,64181.77,2892.48,52007.7,United Healthcare-Medicare Advantage, +151098,3934,226X,Anal Procedures,DRG,61782.08,61782.08,2721.07,9945.84,United Healthcare-Medicare Advantage, +151099,3934,227X,"Hernia Procedures Except Inguinal, Femoral & Umbilical",DRG,156272.2,156272.2,3433.99,31866.68,United Healthcare-Medicare Advantage, +151100,3934,228X,"Inguinal, Femoral & Umbilical Hernia Procedures",DRG,138696.65,138696.65,2853.82,13545.18,United Healthcare-Medicare Advantage, +151101,3934,229X,Other Digestive System & Abdominal Procedures,DRG,195740.62,195740.62,3403.3,53301.41,United Healthcare-Medicare Advantage, +151102,3934,240X,Digestive Malignancy,DRG,64947.29,64947.29,3281.23,86948.91,United Healthcare-Medicare Advantage, +151103,3934,241X,Peptic Ulcer & Gastritis,DRG,54919.32,54919.32,2588.15,30158.26,United Healthcare-Medicare Advantage, +151104,3934,242X,Major Esophageal Disorders,DRG,99860.6,99860.6,7021.14,23282.61,United Healthcare-Medicare Advantage, +151105,3934,243X,Other Esophageal Disorders,DRG,56478.36,56478.36,2408.61,16107.78,United Healthcare-Medicare Advantage, +151106,3934,244X,Diverticulitis & Diverticulosis,DRG,65378.09,65378.09,2553.73,95964.19,United Healthcare-Medicare Advantage, +151107,3934,245X,Inflammatory Bowel Disease,DRG,80764.24,80764.24,2730.9,35028.86,United Healthcare-Medicare Advantage, +151108,3934,247X,Intestinal Obstruction,DRG,65389.95,65389.95,2503.38,24663.56,United Healthcare-Medicare Advantage, +151109,3934,248X,Major Gastrointestinal & Peritoneal Infections,DRG,58073.59,58073.59,2680.72,70502.68,United Healthcare-Medicare Advantage, +151110,3934,249X,"Other Gastroenteritis, Nausea & Vomiting",DRG,53165.04,53165.04,2392.5,31772.4,United Healthcare-Medicare Advantage, +151111,3934,251X,Abdominal Pain,DRG,36632.62,36632.62,2397.92,10279.58,United Healthcare-Medicare Advantage, +151112,3934,252X,"Malfunction, Reaction & Complication Of Gi Device Or Procedure",DRG,81053.62,81053.62,2704.79,87697.41,United Healthcare-Medicare Advantage, +151113,3934,253X,Other & Unspecified Gastrointestinal Hemorrhage,DRG,59848.88,59848.88,2706.66,36623.77,United Healthcare-Medicare Advantage, +151114,3934,254X,Other Digestive System Diagnoses,DRG,70895.6,70895.6,2518.47,51771.46,United Healthcare-Medicare Advantage, +151115,3934,260X,"Major Pancreas, Liver & Shunt Procedures",DRG,87894.97,87894.97,4146.74,30107.54,United Healthcare-Medicare Advantage, +151116,3934,262X,Cholecystectomy Except Laparoscopic,DRG,91064.48,91064.48,4393.76,26737.87,United Healthcare-Medicare Advantage, +151117,3934,263X,Cholecystectomy,DRG,78575.58,78575.58,3171.54,20463.43,United Healthcare-Medicare Advantage, +151118,3934,264X,"Other Hepatobiliary, Pancreas & Abdominal Procedures",DRG,103042.32,103042.32,2574.5,56560.58,United Healthcare-Medicare Advantage, +151119,3934,279X,Hepatic Coma & Other Major Acute Liver Disorders,DRG,50938.13,50938.13,1135.47,11184.19,United Healthcare-Medicare Advantage, +151120,3934,280X,Alcoholic Liver Disease,DRG,78427.71,78427.71,2580.35,25086.76,United Healthcare-Medicare Advantage, +151121,3934,281X,Malignancy Of Hepatobiliary System & Pancreas,DRG,90365.88,90365.88,3265.8,24019.41,United Healthcare-Medicare Advantage, +151122,3934,282X,Disorders Of Pancreas Except Malignancy,DRG,48292.95,48292.95,2607.65,55168.35,United Healthcare-Medicare Advantage, +151123,3934,283X,Other Disorders Of The Liver,DRG,79694.46,79694.46,2627.31,43895.7,United Healthcare-Medicare Advantage, +151124,3934,284X,Disorders Of Gallbladder & Biliary Tract,DRG,51390.11,51390.11,2651.05,28772.41,United Healthcare-Medicare Advantage, +151125,3934,301X,Hip Joint Replacement,DRG,101969.32,101969.32,492.25,32645.44,United Healthcare-Medicare Advantage, +151126,3934,302X,Knee Joint Replacement,DRG,60310.76,60310.76,521.14,113614.78,United Healthcare-Medicare Advantage, +151127,3934,303X,Dorsal & Lumbar Fusion Proc For Curvature Of Back,DRG,204979.98,204979.98,592.92,87319.45,United Healthcare-Medicare Advantage, +151128,3934,304X,Dorsal & Lumbar Fusion Proc Except For Curvature Of Back,DRG,159786.96,159786.96,683.81,65813.3,United Healthcare-Medicare Advantage, +151129,3934,305X,Amputation Of Lower Limb Except Toes,DRG,99342.47,99342.47,4922.05,69926.19,United Healthcare-Medicare Advantage, +151130,3934,308X,Hip & Femur Fracture Repair,DRG,116093.8,116093.8,3936.17,105141.0,United Healthcare-Medicare Advantage, +151131,3934,309X,Other Significant Hip & Femur Surgery,DRG,97677.16,97677.16,3783.24,29219.33,United Healthcare-Medicare Advantage, +151132,3934,310X,Intervertebral Disc Excision & Decompression,DRG,61295.9,61295.9,3133.05,42729.54,United Healthcare-Medicare Advantage, +151133,3934,312X,"Skin Graft, Except Hand, For Musculoskeletal & Connective Tissue Diagnoses",DRG,301018.43,301018.43,5492.05,16953.74,United Healthcare-Medicare Advantage, +151134,3934,313X,Knee & Lower Leg Procedures Except Foot,DRG,129286.38,129286.38,3700.0,128518.4,United Healthcare-Medicare Advantage, +151135,3934,314X,Foot & Toe Procedures,DRG,92265.05,92265.05,3466.2,59583.59,United Healthcare-Medicare Advantage, +151136,3934,315X,"Shoulder, Upper Arm & Forearm Procedures Except Joint Replacement",DRG,77309.1,77309.1,3042.86,26138.63,United Healthcare-Medicare Advantage, +151137,3934,316X,Hand & Wrist Procedures,DRG,68280.2,68280.2,3673.38,21477.94,United Healthcare-Medicare Advantage, +151138,3934,317X,"Tendon, Muscle & Other Soft Tissue Procedures",DRG,42887.88,42887.88,3197.31,35511.18,United Healthcare-Medicare Advantage, +151139,3934,320X,Other Musculoskeletal System & Connective Tissue Procedures,DRG,95274.87,95274.87,3410.25,36324.85,United Healthcare-Medicare Advantage, +151140,3934,321X,Cervical Spinal Fusion & Other Back/Neck Proc Exc Disc Excis/Decomp,DRG,96891.11,96891.11,4438.18,47466.77,United Healthcare-Medicare Advantage, +151141,3934,322X,Shoulder & Elbow Joint Replacement,DRG,135053.63,135053.63,4631.29,13649.14,United Healthcare-Medicare Advantage, +151142,3934,340X,Fracture Of Femur,DRG,61815.54,61815.54,5601.91,17736.16,United Healthcare-Medicare Advantage, +151143,3934,342X,"Fractures & Dislocations Except Femur, Pelvis & Back",DRG,71604.84,71604.84,2425.56,54029.18,United Healthcare-Medicare Advantage, +151144,3934,343X,Musculoskeletal Malignancy & Pathol Fracture D/T Muscskel Malig,DRG,127709.94,127709.94,3078.46,24834.85,United Healthcare-Medicare Advantage, +151145,3934,344X,"Osteomyelitis, Septic Arthritis & Other Musculoskeletal Infections",DRG,141960.59,141960.59,3035.06,64463.33,United Healthcare-Medicare Advantage, +151146,3934,346X,Connective Tissue Disorders,DRG,85772.66,85772.66,2911.97,45617.09,United Healthcare-Medicare Advantage, +151147,3934,347X,"Other Back & Neck Disorders, Fractures & Injuries",DRG,60201.81,60201.81,2602.73,19172.96,United Healthcare-Medicare Advantage, +151148,3934,349X,"Malfunction, Reaction, Complic Of Orthopedic Device Or Procedure",DRG,73742.36,73742.36,2593.91,16468.86,United Healthcare-Medicare Advantage, +151149,3934,351X,Other Musculoskeletal System & Connective Tissue Diagnoses,DRG,52615.03,52615.03,2504.06,29544.01,United Healthcare-Medicare Advantage, +151150,3934,361X,Skin Graft For Skin & Subcutaneous Tissue Diagnoses,DRG,92278.81,92278.81,4855.59,31988.21,United Healthcare-Medicare Advantage, +151151,3934,362X,Mastectomy Procedures,DRG,49758.07,49758.07,3983.81,27153.24,United Healthcare-Medicare Advantage, +151152,3934,363X,Breast Procedures Except Mastectomy,DRG,76177.31,76177.31,3206.63,17327.43,United Healthcare-Medicare Advantage, +151153,3934,364X,"Other Skin, Subcutaneous Tissue & Related Procedures",DRG,69783.7,69783.7,2976.4,62624.92,United Healthcare-Medicare Advantage, +151154,3934,380X,Skin Ulcers,DRG,104262.89,104262.89,2835.68,17904.31,United Healthcare-Medicare Advantage, +151155,3934,383X,Cellulitis & Other Skin Infections,DRG,50154.31,50154.31,2528.13,112069.14,United Healthcare-Medicare Advantage, +151156,3934,384X,"Contusion, Open Wound & Other Trauma To Skin & Subcutaneous Tissue",DRG,92148.23,92148.23,2371.65,8334.12,United Healthcare-Medicare Advantage, +151157,3934,385X,"Other Skin, Subcutaneous Tissue & Breast Disorders",DRG,40223.16,40223.16,2484.39,12145.92,United Healthcare-Medicare Advantage, +151158,3934,401X,Adrenal Procedures,DRG,215155.24,215155.24,3769.17,117504.49,United Healthcare-Medicare Advantage, +151159,3934,403X,Procedures For Obesity,DRG,36874.12,36874.12,3604.55,15961.71,United Healthcare-Medicare Advantage, +151160,3934,404X,"Thyroid, Parathyroid & Thyroglossal Procedures",DRG,132800.98,132800.98,2804.99,65975.2,United Healthcare-Medicare Advantage, +151161,3934,405X,"Other Procedures For Endocrine, Nutritional & Metabolic Disorders",DRG,168233.77,168233.77,9322.46,60065.49,United Healthcare-Medicare Advantage, +151162,3934,420X,Diabetes,DRG,58674.89,58674.89,595.46,52316.53,United Healthcare-Medicare Advantage, +151163,3934,421X,"Malnutrition, Failure To Thrive & Other Nutritional Disorders",DRG,64559.48,64559.48,2731.41,38109.67,United Healthcare-Medicare Advantage, +151164,3934,422X,Hypovolemia & Related Electrolyte Disorders,DRG,46613.0,46613.0,2312.81,105543.18,United Healthcare-Medicare Advantage, +151165,3934,423X,Inborn Errors Of Metabolism,DRG,35052.38,35052.38,4384.1,12367.96,United Healthcare-Medicare Advantage, +151166,3934,424X,Other Endocrine Disorders,DRG,69157.09,69157.09,2517.62,27246.03,United Healthcare-Medicare Advantage, +151167,3934,425X,Other Non-Hypovolemic Electrolyte Disorders,DRG,75366.63,75366.63,2690.38,18877.77,United Healthcare-Medicare Advantage, +151168,3934,440X,Kidney Transplant,DRG,230616.21,230616.21,9547.64,41016.16,United Healthcare-Medicare Advantage, +151169,3934,441X,Major Bladder Procedures,DRG,143765.8,143765.8,3842.58,16764.28,United Healthcare-Medicare Advantage, +151170,3934,442X,Kidney & Urinary Tract Procedures For Malignancy,DRG,120657.45,120657.45,4278.13,27423.34,United Healthcare-Medicare Advantage, +151171,3934,443X,Kidney & Urinary Tract Procedures For Nonmalignancy,DRG,88996.37,88996.37,3490.11,47038.97,United Healthcare-Medicare Advantage, +151172,3934,444X,Renal Dialysis Access Device Procedures & Vessel Repair,DRG,227542.8,227542.8,18169.82,56777.55,United Healthcare-Medicare Advantage, +151173,3934,446X,Urethral & Transurethral Procedures,DRG,91819.72,91819.72,4228.12,16031.62,United Healthcare-Medicare Advantage, +151174,3934,447X,"Other Kidney, Urinary Tract & Related Procedures",DRG,150561.97,150561.97,3879.88,69360.78,United Healthcare-Medicare Advantage, +151175,3934,462X,Nephritis & Nephrosis,DRG,35493.57,35493.57,3816.13,10098.97,United Healthcare-Medicare Advantage, +151176,3934,463X,Kidney & Urinary Tract Infections,DRG,61532.45,61532.45,2514.23,49273.53,United Healthcare-Medicare Advantage, +151177,3934,466X,"Malfunction, Reaction, Complic Of Genitourinary Device Or Proc",DRG,59666.14,59666.14,2855.01,38161.6,United Healthcare-Medicare Advantage, +151178,3934,468X,"Other Kidney & Urinary Tract Diagnoses, Signs & Symptoms",DRG,63110.66,63110.66,2525.59,9230.04,United Healthcare-Medicare Advantage, +151179,3934,469X,Acute Kidney Injury,DRG,103319.68,103319.68,2934.01,124170.14,United Healthcare-Medicare Advantage, +151180,3934,470X,Chronic Kidney Disease,DRG,63062.35,63062.35,2830.25,43446.43,United Healthcare-Medicare Advantage, +151181,3934,480X,Major Male Pelvic Procedures,DRG,78915.94,78915.94,3534.36,16359.43,United Healthcare-Medicare Advantage, +151182,3934,481X,Penis Procedures,DRG,37598.14,37598.14,4985.63,16973.75,United Healthcare-Medicare Advantage, +151183,3934,484X,Other Male Reproductive System & Related Procedures,DRG,38970.77,38970.77,5015.13,14979.78,United Healthcare-Medicare Advantage, +151184,3934,501X,Male Reproductive System Diagnoses Except Malignancy,DRG,48372.25,48372.25,2834.66,25672.24,United Healthcare-Medicare Advantage, +151185,3934,511X,Uterine & Adnexa Procedures For Ovarian & Adnexal Malignancy,DRG,59563.03,59563.03,3843.43,25143.95,United Healthcare-Medicare Advantage, +151186,3934,513X,Uterine & Adnexa Procedures For Non-Malignancy Except Leiomyoma,DRG,42286.4,42286.4,3151.36,65519.09,United Healthcare-Medicare Advantage, +151187,3934,514X,Female Reproductive System Reconstructive Procedures,DRG,61410.76,61410.76,3357.36,8200.84,United Healthcare-Medicare Advantage, +151188,3934,517X,Dilation & Curettage For Non-Obstetric Diagnoses,DRG,57873.74,57873.74,3256.14,20631.34,United Healthcare-Medicare Advantage, +151189,3934,519X,Uterine & Adnexa Procedures For Leiomyoma,DRG,39877.6,39877.6,3127.8,8768.32,United Healthcare-Medicare Advantage, +151190,3934,530X,Female Reproductive System Malignancy,DRG,47022.8,47022.8,4133.35,24735.46,United Healthcare-Medicare Advantage, +151191,3934,531X,Female Reproductive System Infections,DRG,54013.57,54013.57,2587.3,9534.43,United Healthcare-Medicare Advantage, +151192,3934,532X,Menstrual & Other Female Reproductive System Disorders,DRG,37434.32,37434.32,2619.01,11353.52,United Healthcare-Medicare Advantage, +151193,3934,540X,Cesarean Section W/O Sterilization,DRG,38979.06,38979.06,757.49,122116.3,United Healthcare-Medicare Advantage, +151194,3934,541X,Vaginal Delivery W Sterilization &/Or D&C,DRG,27043.23,27043.23,2863.82,22356.87,United Healthcare-Medicare Advantage, +151195,3934,542X,Vaginal Delivery W O.R. Procedure Except Sterilization &/Or D&C,DRG,30874.92,30874.92,2680.72,34854.43,United Healthcare-Medicare Advantage, +151196,3934,544X,"D&C, Aspiration Curettage Or Hysterotomy For Obstetric Diagnoses",DRG,23249.64,23249.64,2485.41,12474.49,United Healthcare-Medicare Advantage, +151197,3934,545X,Ectopic Pregnancy Procedure,DRG,37585.83,37585.83,3002.68,9027.01,United Healthcare-Medicare Advantage, +151198,3934,546X,Other O.R. Proc For Obstetric Diagnoses Except Delivery Diagnoses,DRG,70241.09,70241.09,2647.32,23714.11,United Healthcare-Medicare Advantage, +151199,3934,560X,Vaginal Delivery,DRG,25661.21,25661.21,665.98,24057.84,United Healthcare-Medicare Advantage, +151200,3934,561X,Postpartum & Post Abortion Diagnoses W/O Procedure,DRG,26994.49,26994.49,942.25,23289.93,United Healthcare-Medicare Advantage, +151201,3934,563X,Preterm Labor,DRG,32844.49,32844.49,2261.78,9764.54,United Healthcare-Medicare Advantage, +151202,3934,564X,"Abortion W/O D&C, Aspiration Curettage Or Hysterotomy",DRG,76262.03,76262.03,2387.75,4105.12,United Healthcare-Medicare Advantage, +151203,3934,565X,False Labor,DRG,14092.32,14092.32,2150.56,3207.91,United Healthcare-Medicare Advantage, +151204,3934,566X,Antepartum W/O O.R. Procedure,DRG,54712.19,54712.19,151.63,45699.25,United Healthcare-Medicare Advantage, +151205,3934,588X,Neonate Bwt <1500G W Major Procedure,DRG,738220.19,738220.19,44454.1,222742.56,United Healthcare-Medicare Advantage, +151206,3934,589X,"Neonate Bwt < 500G, Or Bwt 500-999G & Gestational Age <24 Wks, Or Bwt 500-749G W Major Anomaly Or W/O Life Sustaining In",DRG,2230044.06,2230044.06,9131.41,744798.13,United Healthcare-Medicare Advantage, +151207,3934,591X,Neonate Birthwt 500-749G W/O Major Procedure,DRG,46539.48,46539.48,34519.5,91283.53,United Healthcare-Medicare Advantage, +151208,3934,602X,Neonate Bwt 1000-1249G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,1447996.43,1447996.43,20596.12,134662.52,United Healthcare-Medicare Advantage, +151209,3934,607X,Neonate Bwt 1250-1499G W Resp Dist Synd/Oth Maj Resp Or Maj Anom,DRG,609712.01,609712.01,17183.26,87825.47,United Healthcare-Medicare Advantage, +151210,3934,611X,Neonate Birthwt 1500-1999G W Major Anomaly,DRG,484515.42,484515.42,8512.59,244176.06,United Healthcare-Medicare Advantage, +151211,3934,612X,Neonate Bwt 1500-1999G W Resp Dist Synd/Oth Maj Resp Cond,DRG,435554.54,435554.54,9386.07,60665.23,United Healthcare-Medicare Advantage, +151212,3934,614X,Neonate Bwt 1500-1999G W Or W/O Other Significant Condition,DRG,177502.56,177502.56,5053.44,31682.4,United Healthcare-Medicare Advantage, +151213,3934,621X,Neonate Bwt 2000-2499G W Major Anomaly,DRG,377853.38,377853.38,3210.7,43510.98,United Healthcare-Medicare Advantage, +151214,3934,622X,Neonate Bwt 2000-2499G W Resp Dist Synd/Oth Maj Resp Cond,DRG,246850.28,246850.28,4956.3,199376.17,United Healthcare-Medicare Advantage, +151215,3934,625X,Neonate Bwt 2000-2499G W Other Significant Condition,DRG,103263.85,103263.85,4384.1,25489.64,United Healthcare-Medicare Advantage, +151216,3934,626X,"Neonate Bwt 2000-2499G, Normal Newborn Or Neonate W Other Problem",DRG,23386.46,23386.46,2024.93,33421.98,United Healthcare-Medicare Advantage, +151217,3934,631X,Neonate Birthwt >2499G W Other Major Procedure,DRG,43218.32,43218.32,4432.08,119695.3,United Healthcare-Medicare Advantage, +151218,3934,633X,Neonate Birthwt >2499G W Major Anomaly,DRG,181484.98,181484.98,2149.55,254139.52,United Healthcare-Medicare Advantage, +151219,3934,634X,"Neonate, Birthwt >2499G W Resp Dist Synd/Oth Maj Resp Cond",DRG,147656.49,147656.49,3035.06,94927.16,United Healthcare-Medicare Advantage, +151220,3934,636X,Neonate Birthwt >2499G W Congenital/Perinatal Infection,DRG,58997.92,58997.92,3345.83,20630.27,United Healthcare-Medicare Advantage, +151221,3934,639X,Neonate Birthwt >2499G W Other Significant Condition,DRG,65137.16,65137.16,2239.86,46898.42,United Healthcare-Medicare Advantage, +151222,3934,640X,"Neonate Birthwt >2499G, Normal Newborn Or Neonate W Other Problem",DRG,13500.8,13500.8,586.3,41363.73,United Healthcare-Medicare Advantage, +151223,3934,650X,Splenectomy,DRG,252570.39,252570.39,3874.63,257903.22,United Healthcare-Medicare Advantage, +151224,3934,660X,Major Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul,DRG,118528.24,118528.24,3197.48,117038.5,United Healthcare-Medicare Advantage, +151225,3934,661X,Coagulation & Platelet Disorders,DRG,102804.49,102804.49,3682.2,35366.77,United Healthcare-Medicare Advantage, +151226,3934,662X,Sickle Cell Anemia Crisis,DRG,61674.03,61674.03,2805.67,31804.34,United Healthcare-Medicare Advantage, +151227,3934,663X,Other Anemia & Disorders Of Blood & Blood-Forming Organs,DRG,65988.91,65988.91,2542.03,13189.43,United Healthcare-Medicare Advantage, +151228,3934,680X,Major O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,427623.49,427623.49,8230.81,341920.46,United Healthcare-Medicare Advantage, +151229,3934,681X,Other O.R. Procedures For Lymphatic/Hematopoietic/Other Neoplasms,DRG,616631.31,616631.31,3279.37,78607.38,United Healthcare-Medicare Advantage, +151230,3934,690X,Acute Leukemia,DRG,306370.15,306370.15,6281.09,79193.33,United Healthcare-Medicare Advantage, +151231,3934,691X,"Lymphoma, Myeloma & Non-Acute Leukemia",DRG,172248.57,172248.57,4187.77,58112.68,United Healthcare-Medicare Advantage, +151232,3934,694X,Lymphatic & Other Malignancies & Neoplasms Of Uncertain Behavior,DRG,111860.06,111860.06,4419.87,341138.59,United Healthcare-Medicare Advantage, +151233,3934,695X,Chemotherapy For Acute Leukemia,DRG,132598.84,132598.84,3208.16,223161.05,United Healthcare-Medicare Advantage, +151234,3934,696X,Other Chemotherapy,DRG,44473.29,44473.29,2938.08,18595.28,United Healthcare-Medicare Advantage, +151235,3934,710X,Infectious & Parasitic Diseases Including Hiv W O.R. Procedure,DRG,199054.94,199054.94,3741.53,282965.33,United Healthcare-Medicare Advantage, +151236,3934,711X,"Post-Op, Post-Trauma, Other Device Infections W O.R. Procedure",DRG,242048.66,242048.66,3635.57,59906.1,United Healthcare-Medicare Advantage, +151237,3934,720X,Septicemia & Disseminated Infections,DRG,93061.21,93061.21,54.0,257333.14,United Healthcare-Medicare Advantage, +151238,3934,721X,"Post-Operative, Post-Traumatic, Other Device Infections",DRG,79639.92,79639.92,2763.28,83757.23,United Healthcare-Medicare Advantage, +151239,3934,722X,Fever & Inflammatory Conditions,DRG,34741.83,34741.83,2542.2,13716.68,United Healthcare-Medicare Advantage, +151240,3934,723X,Viral Illness,DRG,33080.45,33080.45,2451.33,20945.05,United Healthcare-Medicare Advantage, +151241,3934,724X,Other Infectious & Parasitic Diseases,DRG,64446.91,64446.91,2767.18,14769.55,United Healthcare-Medicare Advantage, +151242,3934,740X,Mental Illness Diagnosis W O.R. Procedure,DRG,54235.06,54235.06,2467.62,16446.91,United Healthcare-Medicare Advantage, +151243,3934,750X,Schizophrenia,DRG,74970.33,74970.33,1067.74,155880.87,United Healthcare-Medicare Advantage, +151244,3934,751X,Major Depressive Disorders & Other/Unspecified Psychoses,DRG,73010.3,73010.3,1071.26,88835.49,United Healthcare-Medicare Advantage, +151245,3934,752X,Disorders Of Personality & Impulse Control,DRG,41583.01,41583.01,2183.9,33003.73,United Healthcare-Medicare Advantage, +151246,3934,753X,Bipolar Disorders,DRG,64146.77,64146.77,1633.58,37627.88,United Healthcare-Medicare Advantage, +151247,3934,754X,Depression Except Major Depressive Disorder,DRG,38484.23,38484.23,2184.24,39093.84,United Healthcare-Medicare Advantage, +151248,3934,755X,Adjustment Disorders & Neuroses Except Depressive Diagnoses,DRG,29408.63,29408.63,2236.32,15025.3,United Healthcare-Medicare Advantage, +151249,3934,756X,Acute Anxiety & Delirium States,DRG,61484.61,61484.61,1400.11,160617.4,United Healthcare-Medicare Advantage, +151250,3934,757X,Organic Mental Health Disturbances,DRG,53402.31,53402.31,3039.81,46545.96,United Healthcare-Medicare Advantage, +151251,3934,758X,Behavioral Disorders,DRG,72768.76,72768.76,3589.12,59990.56,United Healthcare-Medicare Advantage, +151252,3934,759X,Eating Disorders,DRG,65165.36,65165.36,3869.54,5742.87,United Healthcare-Medicare Advantage, +151253,3934,770X,"Drug & Alcohol Abuse Or Dependence, Left Against Medical Advice",DRG,31424.06,31424.06,750.94,27457.42,United Healthcare-Medicare Advantage, +151254,3934,772X,Alcohol & Drug Dependence W Rehab Or Rehab/Detox Therapy,DRG,21179.99,21179.99,3350.41,19250.12,United Healthcare-Medicare Advantage, +151255,3934,773X,Opioid Abuse & Dependence,DRG,40075.13,40075.13,750.94,18428.78,United Healthcare-Medicare Advantage, +151256,3934,774X,Cocaine Abuse & Dependence,DRG,62469.2,62469.2,766.13,13020.34,United Healthcare-Medicare Advantage, +151257,3934,775X,Alcohol Abuse & Dependence,DRG,54542.41,54542.41,750.94,29870.91,United Healthcare-Medicare Advantage, +151258,3934,776X,Other Drug Abuse & Dependence,DRG,33686.36,33686.36,2314.74,9801.48,United Healthcare-Medicare Advantage, +151259,3934,791X,O.R. Procedure For Other Complications Of Treatment,DRG,109471.98,109471.98,3109.49,88889.91,United Healthcare-Medicare Advantage, +151260,3934,811X,Allergic Reactions,DRG,16623.79,16623.79,2246.52,11835.85,United Healthcare-Medicare Advantage, +151261,3934,812X,Poisoning Of Medicinal Agents,DRG,58454.86,58454.86,2366.05,137164.02,United Healthcare-Medicare Advantage, +151262,3934,813X,Other Complications Of Treatment,DRG,70155.75,70155.75,2515.25,26688.77,United Healthcare-Medicare Advantage, +151263,3934,815X,"Other Injury, Poisoning & Toxic Effect Diagnoses",DRG,42849.35,42849.35,1071.26,12084.28,United Healthcare-Medicare Advantage, +151264,3934,816X,Toxic Effects Of Non-Medicinal Substances,DRG,104928.72,104928.72,2431.32,60646.45,United Healthcare-Medicare Advantage, +151265,3934,842X,Burns W Skin Graft Except Extensive 3Rd Degree Burns,DRG,110167.44,110167.44,5325.73,32012.45,United Healthcare-Medicare Advantage, +151266,3934,844X,Partial Thickness Burns W/O Skin Graft,DRG,48079.48,48079.48,2772.61,169297.62,United Healthcare-Medicare Advantage, +151267,3934,850X,"Procedure W Diag Of Rehab, Aftercare Or Oth Contact W Health Service",DRG,1063570.54,1063570.54,4482.43,412184.56,United Healthcare-Medicare Advantage, +151268,3934,861X,"Signs, Symptoms & Other Factors Influencing Health Status",DRG,58408.72,58408.72,2435.05,75295.56,United Healthcare-Medicare Advantage, +151269,3934,862X,Other Aftercare & Convalescence,DRG,37992.23,37992.23,2915.53,11383.56,United Healthcare-Medicare Advantage, +151270,3934,890X,Hiv W Multiple Major Hiv Related Conditions,DRG,135056.56,135056.56,4937.14,91478.3,United Healthcare-Medicare Advantage, +151271,3934,892X,Hiv W Major Hiv Related Condition,DRG,115092.39,115092.39,3253.77,37053.32,United Healthcare-Medicare Advantage, +151272,3934,911X,Extensive Abdominal/Thoracic Procedures For Mult Significant Trauma,DRG,344280.26,344280.26,6017.29,46753.33,United Healthcare-Medicare Advantage, +151273,3934,912X,Musculoskeletal & Other Procedures For Multiple Significant Trauma,DRG,318071.59,318071.59,5682.78,68704.73,United Healthcare-Medicare Advantage, +151274,3934,930X,Multiple Significant Trauma W/O O.R. Procedure,DRG,77785.61,77785.61,3174.76,26858.06,United Healthcare-Medicare Advantage, +151275,3934,950X,Extensive Procedure Unrelated To Principal Diagnosis,DRG,243123.85,243123.85,3981.61,73573.77,United Healthcare-Medicare Advantage, +151276,3934,951X,Moderately Extensive Procedure Unrelated To Principal Diagnosis,DRG,294425.64,294425.64,3233.42,228318.52,United Healthcare-Medicare Advantage, +151277,3934,952X,Nonextensive Procedure Unrelated To Principal Diagnosis,DRG,98154.76,98154.76,3699.83,97691.54,United Healthcare-Medicare Advantage, +151278,3934,A0425,"Ground mileage, per statute mile",CPT/HCPCS,441.82,441.82,0.29,2172.5,United Healthcare-Medicare Advantage, +151279,3934,A0426,"Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)",CPT/HCPCS,1281.21,1281.21,15.0,1360.0,United Healthcare-Medicare Advantage, +151280,3934,A0427,"Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)",CPT/HCPCS,2029.4,2029.4,52.08,2011.0,United Healthcare-Medicare Advantage, +151281,3934,A0428,"Ambulance service, basic life support, non-emergency transport, (bls)",CPT/HCPCS,1076.02,1076.02,0.01,1137.0,United Healthcare-Medicare Advantage, +151282,3934,A0429,"Ambulance service, basic life support, emergency transport (bls-emergency)",CPT/HCPCS,1708.64,1708.64,87.06,1500.0,United Healthcare-Medicare Advantage, +151283,3934,A0433,"Advanced life support, level 2 (als 2)",CPT/HCPCS,2664.75,2664.75,748.18,748.18,United Healthcare-Medicare Advantage, +151284,3934,A0434,Specialty care transport (sct),CPT/HCPCS,3472.2,3472.2,178.58,3443.0,United Healthcare-Medicare Advantage, +151285,3934,A4306,"Disposable drug delivery system, flow rate of less than 50 ml per hour",CPT/HCPCS,550.0,550.0,21.36,21.36,United Healthcare-Medicare Advantage, +151286,3934,A4335,Incontinence supply; miscellaneous,CPT/HCPCS,121.0,121.0,121.0,121.0,United Healthcare-Medicare Advantage, +151287,3934,A4340,"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each",CPT/HCPCS,298.5,298.5,304.0,304.0,United Healthcare-Medicare Advantage, +151288,3934,A4550,Surgical trays,CPT/HCPCS,93.23,93.23,35.73,35.73,United Healthcare-Medicare Advantage, +151289,3934,A4648,"Tissue marker, implantable, any type, each",CPT/HCPCS,311.68,311.68,18.0,2380.0,United Healthcare-Medicare Advantage, +151290,3934,A6222,"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing",CPT/HCPCS,155.0,155.0,155.0,155.0,United Healthcare-Medicare Advantage, +151291,3934,A6253,"Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,75.06,75.06,32.67,32.67,United Healthcare-Medicare Advantage, +151292,3934,A6258,"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing",CPT/HCPCS,388.56,388.56,956.0,956.0,United Healthcare-Medicare Advantage, +151293,3934,A6403,"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing",CPT/HCPCS,102.0,102.0,14.07,102.0,United Healthcare-Medicare Advantage, +151294,3934,A6410,"Eye pad, sterile, each",CPT/HCPCS,174.0,174.0,174.0,174.0,United Healthcare-Medicare Advantage, +151295,3934,A9500,"Technetium tc-99m sestamibi, diagnostic, per study dose",CPT/HCPCS,332.65,332.65,18.65,522.39,United Healthcare-Medicare Advantage, +151296,3934,A9503,"Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,131.98,131.98,20.81,137.0,United Healthcare-Medicare Advantage, +151297,3934,A9505,"Thallium tl-201 thallous chloride, diagnostic, per millicurie",CPT/HCPCS,331.4,331.4,147.0,147.0,United Healthcare-Medicare Advantage, +151298,3934,A9512,"Technetium tc-99m pertechnetate, diagnostic, per millicurie",CPT/HCPCS,20.65,20.65,4.0,40.0,United Healthcare-Medicare Advantage, +151299,3934,A9513,"Lutetium lu 177, dotatate, therapeutic, 1 millicurie",CPT/HCPCS,94821.71,94821.71,253.99,161600.0,United Healthcare-Medicare Advantage, +151300,3934,A9516,"Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries",CPT/HCPCS,100.18,100.18,8.64,192.0,United Healthcare-Medicare Advantage, +151301,3934,A9517,"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie",CPT/HCPCS,2359.89,2359.89,8.4,6450.0,United Healthcare-Medicare Advantage, +151302,3934,A9520,"Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries",CPT/HCPCS,900.0,900.0,900.0,900.0,United Healthcare-Medicare Advantage, +151303,3934,A9521,"Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,3083.0,3083.0,2121.0,3242.0,United Healthcare-Medicare Advantage, +151304,3934,A9537,"Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,138.37,138.37,47.6,146.0,United Healthcare-Medicare Advantage, +151305,3934,A9538,"Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,96.56,96.56,33.25,102.0,United Healthcare-Medicare Advantage, +151306,3934,A9539,"Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries",CPT/HCPCS,160.35,160.35,55.65,170.0,United Healthcare-Medicare Advantage, +151307,3934,A9540,"Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,59.37,59.37,20.3,62.0,United Healthcare-Medicare Advantage, +151308,3934,A9541,"Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries",CPT/HCPCS,153.02,153.02,7.5,161.0,United Healthcare-Medicare Advantage, +151309,3934,A9548,"Indium in-111 pentetate, diagnostic, per 0.5 millicurie",CPT/HCPCS,3094.49,3094.49,471.04,3268.0,United Healthcare-Medicare Advantage, +151310,3934,A9551,"Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries",CPT/HCPCS,915.0,915.0,640.5,640.5,United Healthcare-Medicare Advantage, +151311,3934,A9552,"Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries",CPT/HCPCS,326.03,326.03,9.65,343.0,United Healthcare-Medicare Advantage, +151312,3934,A9556,"Gallium ga-67 citrate, diagnostic, per millicurie",CPT/HCPCS,116.0,116.0,58.0,290.0,United Healthcare-Medicare Advantage, +151313,3934,A9560,"Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries",CPT/HCPCS,172.77,172.77,59.5,182.0,United Healthcare-Medicare Advantage, +151314,3934,A9562,"Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,421.44,421.44,143.85,440.0,United Healthcare-Medicare Advantage, +151315,3934,A9567,"Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries",CPT/HCPCS,55.74,55.74,54.0,54.0,United Healthcare-Medicare Advantage, +151316,3934,A9570,"Indium in-111 labeled autologous white blood cells, diagnostic, per study dose",CPT/HCPCS,4013.0,4013.0,4013.0,4013.0,United Healthcare-Medicare Advantage, +151317,3934,A9582,"Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries",CPT/HCPCS,609.5,609.5,57.31,589.0,United Healthcare-Medicare Advantage, +151318,3934,A9584,"Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries",CPT/HCPCS,4068.79,4068.79,1386.0,4237.0,United Healthcare-Medicare Advantage, +151319,3934,A9587,"Gallium ga-68, dotatate, diagnostic, 0.1 millicurie",CPT/HCPCS,10285.68,10285.68,3468.42,10914.0,United Healthcare-Medicare Advantage, +151320,3934,A9588,"Fluciclovine f-18, diagnostic, 1 millicurie",CPT/HCPCS,1542.59,1542.59,29.15,1637.0,United Healthcare-Medicare Advantage, +151321,3934,A9589,"Instillation, hexaminolevulinate hydrochloride, 100 mg",CPT/HCPCS,1706.08,1706.08,106.08,2058.0,United Healthcare-Medicare Advantage, +151322,3934,A9606,"Radium ra-223 dichloride, therapeutic, per microcurie",CPT/HCPCS,46831.22,46831.22,7779.04,55610.0,United Healthcare-Medicare Advantage, +151323,3934,B4082,Nasogastric tubing without stylet,CPT/HCPCS,94.0,94.0,94.0,94.0,United Healthcare-Medicare Advantage, +151324,3934,C1713,Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable),CPT/HCPCS,1687.23,1687.23,9.0,17580.0,United Healthcare-Medicare Advantage, +151325,3934,C1715,Brachytherapy needle,CPT/HCPCS,335.0,335.0,167.5,167.5,United Healthcare-Medicare Advantage, +151326,3934,C1717,"Brachytherapy source, non-stranded, high dose rate iridium-192, per source",CPT/HCPCS,1780.46,1780.46,290.78,1763.0,United Healthcare-Medicare Advantage, +151327,3934,C1721,"Cardioverter-defibrillator, dual chamber (implantable)",CPT/HCPCS,35666.67,35666.67,16450.0,38000.0,United Healthcare-Medicare Advantage, +151328,3934,C1722,"Cardioverter-defibrillator, single chamber (implantable)",CPT/HCPCS,36344.93,36344.93,13000.0,41000.0,United Healthcare-Medicare Advantage, +151329,3934,C1724,"Catheter, transluminal atherectomy, rotational",CPT/HCPCS,4133.59,4133.59,450.0,11440.0,United Healthcare-Medicare Advantage, +151330,3934,C1725,"Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability)",CPT/HCPCS,984.37,984.37,2.77,11120.0,United Healthcare-Medicare Advantage, +151331,3934,C1726,"Catheter, balloon dilatation, non-vascular",CPT/HCPCS,596.85,596.85,17.0,3492.0,United Healthcare-Medicare Advantage, +151332,3934,C1727,"Catheter, balloon tissue dissector, non-vascular (insertable)",CPT/HCPCS,1051.09,1051.09,477.6,2874.0,United Healthcare-Medicare Advantage, +151333,3934,C1728,"Catheter, brachytherapy seed administration",CPT/HCPCS,4244.5,4244.5,2298.0,2298.0,United Healthcare-Medicare Advantage, +151334,3934,C1729,"Catheter, drainage",CPT/HCPCS,202.48,202.48,8.81,5200.0,United Healthcare-Medicare Advantage, +151335,3934,C1730,"Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes)",CPT/HCPCS,1200.68,1200.68,140.0,3984.0,United Healthcare-Medicare Advantage, +151336,3934,C1731,"Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes)",CPT/HCPCS,3518.16,3518.16,995.0,7672.0,United Healthcare-Medicare Advantage, +151337,3934,C1732,"Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping",CPT/HCPCS,8683.2,8683.2,1760.0,16852.0,United Healthcare-Medicare Advantage, +151338,3934,C1733,"Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip",CPT/HCPCS,3863.94,3863.94,816.0,9300.0,United Healthcare-Medicare Advantage, +151339,3934,C1750,"Catheter, hemodialysis/peritoneal, long-term",CPT/HCPCS,706.97,706.97,48.6,842.0,United Healthcare-Medicare Advantage, +151340,3934,C1751,"Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)",CPT/HCPCS,477.48,477.48,75.0,2384.0,United Healthcare-Medicare Advantage, +151341,3934,C1752,"Catheter, hemodialysis/peritoneal, short-term",CPT/HCPCS,140.57,140.57,14.0,84.42,United Healthcare-Medicare Advantage, +151342,3934,C1753,"Catheter, intravascular ultrasound",CPT/HCPCS,1334.82,1334.82,375.0,3040.0,United Healthcare-Medicare Advantage, +151343,3934,C1757,"Catheter, thrombectomy/embolectomy",CPT/HCPCS,1154.03,1154.03,166.0,2730.0,United Healthcare-Medicare Advantage, +151344,3934,C1758,"Catheter, ureteral",CPT/HCPCS,29.66,29.66,2.48,155.0,United Healthcare-Medicare Advantage, +151345,3934,C1759,"Catheter, intracardiac echocardiography",CPT/HCPCS,5818.17,5818.17,187.0,14040.0,United Healthcare-Medicare Advantage, +151346,3934,C1760,"Closure device, vascular (implantable/insertable)",CPT/HCPCS,451.06,451.06,22.17,3124.0,United Healthcare-Medicare Advantage, +151347,3934,C1762,"Connective tissue, human (includes fascia lata)",CPT/HCPCS,2796.26,2796.26,111.0,6722.0,United Healthcare-Medicare Advantage, +151348,3934,C1763,"Connective tissue, non-human (includes synthetic)",CPT/HCPCS,2385.59,2385.59,931.0,2472.3,United Healthcare-Medicare Advantage, +151349,3934,C1764,"Event recorder, cardiac (implantable)",CPT/HCPCS,9990.58,9990.58,296.62,10290.0,United Healthcare-Medicare Advantage, +151350,3934,C1765,Adhesion barrier,CPT/HCPCS,655.19,655.19,119.0,585.0,United Healthcare-Medicare Advantage, +151351,3934,C1766,"Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away",CPT/HCPCS,2025.67,2025.67,850.0,4272.0,United Healthcare-Medicare Advantage, +151352,3934,C1767,"Generator, neurostimulator (implantable), non-rechargeable",CPT/HCPCS,20367.57,20367.57,205.8,36800.0,United Healthcare-Medicare Advantage, +151353,3934,C1768,"Graft, vascular",CPT/HCPCS,2153.3,2153.3,654.0,5990.0,United Healthcare-Medicare Advantage, +151354,3934,C1769,Guide wire,CPT/HCPCS,360.73,360.73,1.65,12004.12,United Healthcare-Medicare Advantage, +151355,3934,C1771,"Repair device, urinary, incontinence, with sling graft",CPT/HCPCS,3045.06,3045.06,261.27,3278.0,United Healthcare-Medicare Advantage, +151356,3934,C1772,"Infusion pump, programmable (implantable)",CPT/HCPCS,22966.54,22966.54,11127.9,22400.0,United Healthcare-Medicare Advantage, +151357,3934,C1773,"Retrieval device, insertable (used to retrieve fractured medical devices)",CPT/HCPCS,1394.12,1394.12,140.25,1280.0,United Healthcare-Medicare Advantage, +151358,3934,C1776,Joint device (implantable),CPT/HCPCS,11743.16,11743.16,200.0,21560.0,United Healthcare-Medicare Advantage, +151359,3934,C1777,"Lead, cardioverter-defibrillator, endocardial single coil (implantable)",CPT/HCPCS,8851.06,8851.06,4200.0,9600.0,United Healthcare-Medicare Advantage, +151360,3934,C1778,"Lead, neurostimulator (implantable)",CPT/HCPCS,6882.73,6882.73,960.4,19120.0,United Healthcare-Medicare Advantage, +151361,3934,C1780,"Lens, intraocular (new technology)",CPT/HCPCS,350.0,350.0,350.0,350.0,United Healthcare-Medicare Advantage, +151362,3934,C1781,Mesh (implantable),CPT/HCPCS,544.49,544.49,6.73,2663.0,United Healthcare-Medicare Advantage, +151363,3934,C1783,"Ocular implant, aqueous drainage assist device",CPT/HCPCS,3965.83,3965.83,2494.08,4550.0,United Healthcare-Medicare Advantage, +151364,3934,C1785,"Pacemaker, dual chamber, rate-responsive (implantable)",CPT/HCPCS,8843.87,8843.87,3396.4,18100.0,United Healthcare-Medicare Advantage, +151365,3934,C1786,"Pacemaker, single chamber, rate-responsive (implantable)",CPT/HCPCS,15485.19,15485.19,1022.03,26500.0,United Healthcare-Medicare Advantage, +151366,3934,C1787,"Patient programmer, neurostimulator",CPT/HCPCS,1704.16,1704.16,384.0,3400.0,United Healthcare-Medicare Advantage, +151367,3934,C1788,"Port, indwelling (implantable)",CPT/HCPCS,656.7,656.7,91.53,1017.0,United Healthcare-Medicare Advantage, +151368,3934,C1789,"Prosthesis, breast (implantable)",CPT/HCPCS,2460.97,2460.97,40.0,5970.0,United Healthcare-Medicare Advantage, +151369,3934,C1813,"Prosthesis, penile, inflatable",CPT/HCPCS,13975.53,13975.53,900.0,29940.0,United Healthcare-Medicare Advantage, +151370,3934,C1815,"Prosthesis, urinary sphincter (implantable)",CPT/HCPCS,12511.6,12511.6,490.0,17501.0,United Healthcare-Medicare Advantage, +151371,3934,C1817,"Septal defect implant system, intracardiac",CPT/HCPCS,17840.67,17840.67,129.0,19990.0,United Healthcare-Medicare Advantage, +151372,3934,C1819,Surgical tissue localization and excision device (implantable),CPT/HCPCS,270.54,270.54,19.48,16453.0,United Healthcare-Medicare Advantage, +151373,3934,C1820,"Generator, neurostimulator (implantable), with rechargeable battery and charging system",CPT/HCPCS,29808.98,29808.98,4600.0,64453.0,United Healthcare-Medicare Advantage, +151374,3934,C1821,Interspinous process distraction device (implantable),CPT/HCPCS,7058.33,7058.33,1151.12,11800.0,United Healthcare-Medicare Advantage, +151375,3934,C1822,"Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system",CPT/HCPCS,47700.0,47700.0,31950.0,53000.0,United Healthcare-Medicare Advantage, +151376,3934,C1874,"Stent, coated/covered, with delivery system",CPT/HCPCS,4183.95,4183.95,241.43,13130.0,United Healthcare-Medicare Advantage, +151377,3934,C1876,"Stent, non-coated/non-covered, with delivery system",CPT/HCPCS,3839.78,3839.78,565.6,9580.0,United Healthcare-Medicare Advantage, +151378,3934,C1878,"Material for vocal cord medialization, synthetic (implantable)",CPT/HCPCS,932.11,932.11,440.0,1250.0,United Healthcare-Medicare Advantage, +151379,3934,C1880,Vena cava filter,CPT/HCPCS,1591.67,1591.67,125.0,2500.0,United Healthcare-Medicare Advantage, +151380,3934,C1882,"Cardioverter-defibrillator, other than single or dual chamber (implantable)",CPT/HCPCS,41403.46,41403.46,20000.0,47000.0,United Healthcare-Medicare Advantage, +151381,3934,C1883,"Adapter/extension, pacing lead or neurostimulator lead (implantable)",CPT/HCPCS,1419.73,1419.73,300.0,3580.0,United Healthcare-Medicare Advantage, +151382,3934,C1884,Embolization protective system,CPT/HCPCS,2714.67,2714.67,1419.71,5000.0,United Healthcare-Medicare Advantage, +151383,3934,C1885,"Catheter, transluminal angioplasty, laser",CPT/HCPCS,4544.44,4544.44,3990.0,4990.0,United Healthcare-Medicare Advantage, +151384,3934,C1886,"Catheter, extravascular tissue ablation, any modality (insertable)",CPT/HCPCS,2480.74,2480.74,1133.0,3082.0,United Healthcare-Medicare Advantage, +151385,3934,C1887,"Catheter, guiding (may include infusion/perfusion capability)",CPT/HCPCS,534.83,534.83,10.73,5502.0,United Healthcare-Medicare Advantage, +151386,3934,C1889,"Implantable/insertable device, not otherwise classified",CPT/HCPCS,10999.78,10999.78,8400.0,8400.0,United Healthcare-Medicare Advantage, +151387,3934,C1892,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away",CPT/HCPCS,133.99,133.99,56.0,297.0,United Healthcare-Medicare Advantage, +151388,3934,C1893,"Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away",CPT/HCPCS,195.7,195.7,1.23,1186.0,United Healthcare-Medicare Advantage, +151389,3934,C1894,"Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser",CPT/HCPCS,125.69,125.69,6.22,2000.0,United Healthcare-Medicare Advantage, +151390,3934,C1895,"Lead, cardioverter-defibrillator, endocardial dual coil (implantable)",CPT/HCPCS,8240.95,8240.95,2150.0,12700.0,United Healthcare-Medicare Advantage, +151391,3934,C1896,"Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)",CPT/HCPCS,8312.5,8312.5,4000.0,18000.0,United Healthcare-Medicare Advantage, +151392,3934,C1897,"Lead, neurostimulator test kit (implantable)",CPT/HCPCS,3796.51,3796.51,2000.0,5980.0,United Healthcare-Medicare Advantage, +151393,3934,C1898,"Lead, pacemaker, other than transvenous vdd single pass",CPT/HCPCS,1713.55,1713.55,522.5,2840.0,United Healthcare-Medicare Advantage, +151394,3934,C1900,"Lead, left ventricular coronary venous system",CPT/HCPCS,4872.22,4872.22,2150.0,9900.0,United Healthcare-Medicare Advantage, +151395,3934,C2616,"Brachytherapy source, non-stranded, yttrium-90, per source",CPT/HCPCS,55937.32,55937.32,57965.85,57965.85,United Healthcare-Medicare Advantage, +151396,3934,C2617,"Stent, non-coronary, temporary, without delivery system",CPT/HCPCS,298.15,298.15,17.5,4000.0,United Healthcare-Medicare Advantage, +151397,3934,C2618,"Probe/needle, cryoablation",CPT/HCPCS,5788.93,5788.93,2315.0,9600.0,United Healthcare-Medicare Advantage, +151398,3934,C2621,"Pacemaker, other than single or dual chamber (implantable)",CPT/HCPCS,17005.56,17005.56,4400.0,18000.0,United Healthcare-Medicare Advantage, +151399,3934,C2624,"Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components",CPT/HCPCS,44040.0,44040.0,39000.0,44880.0,United Healthcare-Medicare Advantage, +151400,3934,C2625,"Stent, non-coronary, temporary, with delivery system",CPT/HCPCS,743.97,743.97,115.0,1907.0,United Healthcare-Medicare Advantage, +151401,3934,C2627,"Catheter, suprapubic/cystoscopic",CPT/HCPCS,89.0,89.0,89.0,89.0,United Healthcare-Medicare Advantage, +151402,3934,C2628,"Catheter, occlusion",CPT/HCPCS,1231.39,1231.39,890.0,2108.0,United Healthcare-Medicare Advantage, +151403,3934,C2631,"Repair device, urinary, incontinence, without sling graft",CPT/HCPCS,1781.0,1781.0,1100.0,1100.0,United Healthcare-Medicare Advantage, +151404,3934,C8902,"Magnetic resonance angiography without contrast followed by with contrast, abdomen",CPT/HCPCS,4099.5,4099.5,3961.0,3961.0,United Healthcare-Medicare Advantage, +151405,3934,C8905,"Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral",CPT/HCPCS,4023.57,4023.57,465.11,4238.0,United Healthcare-Medicare Advantage, +151406,3934,C8908,"Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral",CPT/HCPCS,4003.95,4003.95,92.52,6652.55,United Healthcare-Medicare Advantage, +151407,3934,C8910,"Magnetic resonance angiography without contrast, chest (excluding myocardium)",CPT/HCPCS,2539.0,2539.0,2703.0,2703.0,United Healthcare-Medicare Advantage, +151408,3934,C8911,"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium)",CPT/HCPCS,4979.67,4979.67,4647.0,5320.0,United Healthcare-Medicare Advantage, +151409,3934,C8920,"Magnetic resonance angiography without contrast followed by with contrast, pelvis",CPT/HCPCS,11299.0,11299.0,5813.0,5813.0,United Healthcare-Medicare Advantage, +151410,3934,C8924,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, follow-up or limited study",CPT/HCPCS,2755.0,2755.0,209.46,2879.0,United Healthcare-Medicare Advantage, +151411,3934,C8928,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report",CPT/HCPCS,6793.45,6793.45,2284.08,7196.0,United Healthcare-Medicare Advantage, +151412,3934,C8929,"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography",CPT/HCPCS,5121.5,5121.5,197.63,9971.97,United Healthcare-Medicare Advantage, +151413,3934,C9046,"Cocaine hydrochloride nasal solution for topical administration, 1 mg",CPT/HCPCS,640.62,640.62,1.29,635.97,United Healthcare-Medicare Advantage, +151414,3934,C9113,"Injection, pantoprazole sodium, per vial",CPT/HCPCS,20.26,20.26,0.62,108.0,United Healthcare-Medicare Advantage, +151415,3934,C9132,"Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity",CPT/HCPCS,5297.17,5297.17,100.0,6831.0,United Healthcare-Medicare Advantage, +151416,3934,C9248,"Injection, clevidipine butyrate, 1 mg",CPT/HCPCS,98.57,98.57,98.57,98.57,United Healthcare-Medicare Advantage, +151417,3934,C9254,"Injection, lacosamide, 1 mg",CPT/HCPCS,197.76,197.76,178.35,178.35,United Healthcare-Medicare Advantage, +151418,3934,C9358,"Dermal substitute, native, non-denatured collagen, fetal bovine origin (surgimend collagen matrix), per 0.5 square centimeters",CPT/HCPCS,307.2,307.2,150.0,312.0,United Healthcare-Medicare Advantage, +151419,3934,C9363,"Skin substitute, integra meshed bilayer wound matrix, per square centimeter",CPT/HCPCS,7061.31,7061.31,1033.15,10730.0,United Healthcare-Medicare Advantage, +151420,3934,C9399,Unclassified drugs or biologicals,CPT/HCPCS,5797.11,5797.11,44.41,23400.0,United Healthcare-Medicare Advantage, +151421,3934,C9460,"Injection, cangrelor, 1 mg",CPT/HCPCS,4691.28,4691.28,439.28,2696.4,United Healthcare-Medicare Advantage, +151422,3934,C9600,"Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,37472.1,37472.1,7487.4,95476.18,United Healthcare-Medicare Advantage, +151423,3934,C9601,"Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,30078.66,30078.66,27532.0,55064.0,United Healthcare-Medicare Advantage, +151424,3934,C9602,"Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch",CPT/HCPCS,45142.47,45142.47,26110.5,70386.31,United Healthcare-Medicare Advantage, +151425,3934,C9603,"Percutaneous transluminal coronary atherectomy, with drug-eluting intracoronary stent, with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to code for primary procedure)",CPT/HCPCS,27532.0,27532.0,27532.0,27532.0,United Healthcare-Medicare Advantage, +151426,3934,C9604,"Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel",CPT/HCPCS,33131.88,33131.88,15294.99,40042.79,United Healthcare-Medicare Advantage, +151427,3934,C9607,"Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, atherectomy and angioplasty; single vessel",CPT/HCPCS,33849.28,33849.28,16021.64,45639.38,United Healthcare-Medicare Advantage, +151428,3934,C9739,"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants",CPT/HCPCS,11416.29,11416.29,5168.41,5168.41,United Healthcare-Medicare Advantage, +151429,3934,C9740,"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants",CPT/HCPCS,18854.81,18854.81,11805.04,40904.92,United Healthcare-Medicare Advantage, +151430,3934,C9752,"Destruction of intraosseous basivertebral nerve, first two vertebral bodies, including imaging guidance (e.g., fluoroscopy), lumbar/sacrum",CPT/HCPCS,11134.38,11134.38,9352.0,13056.0,United Healthcare-Medicare Advantage, +151431,3934,C9755,"Creation of arteriovenous fistula, percutaneous using magnetic-guided arterial and venous catheters and radiofrequency energy, including flow-directing procedures (e.g., vascular coil embolization with radiologic supervision and interpretation, when performed) and fistulogram(s), angiography, venography, and/or ultrasound, with radiologic supervision and interpretation, when performed",CPT/HCPCS,10541.0,10541.0,2964.84,2964.84,United Healthcare-Medicare Advantage, +151432,3934,C9764,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,16489.81,16489.81,9384.24,28040.0,United Healthcare-Medicare Advantage, +151433,3934,C9765,"Revascularization, Endovascular, Open Or Percutaneous, Any Vessel(S); With Intravascular Lithotripsy, And Transluminal Stent Placement(S), Includes Angioplasty Within The Same Vessel(S), When Performed",CPT/HCPCS,24428.02,24428.02,11759.68,11759.68,United Healthcare-Medicare Advantage, +151434,3934,C9803,"Hospital Outpatient Clinic Visit Specimen Collection For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]), Any Specimen Source",CPT/HCPCS,279.6,279.6,23.43,10850.87,United Healthcare-Medicare Advantage, +151435,3934,D1110,Prophylaxis - Adult,CPT/HCPCS,8113.36,8113.36,61.48,63.82,United Healthcare-Medicare Advantage, +151436,3934,D1120,Prophylaxis - Child,CPT/HCPCS,5879.69,5879.69,63.82,5268.8,United Healthcare-Medicare Advantage, +151437,3934,D1351,Sealant - Per Tooth,CPT/HCPCS,3662.47,3662.47,30.08,1286.06,United Healthcare-Medicare Advantage, +151438,3934,D2140,"Amalgam - One Surface, Primary Or Permanent",CPT/HCPCS,4397.45,4397.45,96.24,859.0,United Healthcare-Medicare Advantage, +151439,3934,D2150,"Amalgam - Two Surfaces, Primary Or Permanent",CPT/HCPCS,5305.82,5305.82,96.24,859.0,United Healthcare-Medicare Advantage, +151440,3934,D2160,"Amalgam - Three Surfaces, Primary Or Permanent",CPT/HCPCS,4998.09,4998.09,1718.0,1718.0,United Healthcare-Medicare Advantage, +151441,3934,D2330,"Resin-Based Composite - One Surface, Anterior",CPT/HCPCS,3766.3,3766.3,96.24,1982.09,United Healthcare-Medicare Advantage, +151442,3934,D2331,"Resin-Based Composite - Two Surfaces, Anterior",CPT/HCPCS,3792.42,3792.42,96.24,1933.08,United Healthcare-Medicare Advantage, +151443,3934,D2332,"Resin-Based Composite - Three Surfaces, Anterior",CPT/HCPCS,3715.73,3715.73,96.25,125.11,United Healthcare-Medicare Advantage, +151444,3934,D2335,Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior),CPT/HCPCS,3619.76,3619.76,144.4,308.24,United Healthcare-Medicare Advantage, +151445,3934,D2391,"Resin-Based Composite - One Surface, Posterior",CPT/HCPCS,3545.67,3545.67,96.24,2634.4,United Healthcare-Medicare Advantage, +151446,3934,D2392,"Resin-Based Composite - Two Surfaces, Posterior",CPT/HCPCS,3797.84,3797.84,96.24,3809.16,United Healthcare-Medicare Advantage, +151447,3934,D2393,"Resin-Based Composite - Three Surfaces, Posterior",CPT/HCPCS,4412.51,4412.51,96.24,3809.16,United Healthcare-Medicare Advantage, +151448,3934,D2394,"Resin-Based Composite - Four Or More Surfaces, Posterior",CPT/HCPCS,3574.29,3574.29,96.24,96.24,United Healthcare-Medicare Advantage, +151449,3934,D2920,Recement Crown,CPT/HCPCS,88.0,88.0,192.06,192.06,United Healthcare-Medicare Advantage, +151450,3934,D2930,Prefabricated Stainless Steel Crown - Primary Tooth,CPT/HCPCS,3529.29,3529.29,144.4,4053.33,United Healthcare-Medicare Advantage, +151451,3934,D2932,Prefabricated Resin Crown,CPT/HCPCS,5526.9,5526.9,308.24,308.24,United Healthcare-Medicare Advantage, +151452,3934,D3220,Therapeutic Pulpotomy (Excluding Final Restoration) - Removal Of Pulp Coronal To The Dentinocemental Junction And Application Of Medicament,CPT/HCPCS,2867.99,2867.99,91.7,1613.16,United Healthcare-Medicare Advantage, +151453,3934,D4320,Provisional Splinting - Intracoronal,CPT/HCPCS,342.6,342.6,160.53,160.53,United Healthcare-Medicare Advantage, +151454,3934,D7111,"Extraction, Coronal Remnants - Deciduous Tooth",CPT/HCPCS,4676.12,4676.12,75.0,7618.32,United Healthcare-Medicare Advantage, +151455,3934,D7140,"Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)",CPT/HCPCS,7973.7,7973.7,171.26,11466.67,United Healthcare-Medicare Advantage, +151456,3934,D7210,"Surgical Removal Of Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated",CPT/HCPCS,2722.77,2722.77,50.0,4876.67,United Healthcare-Medicare Advantage, +151457,3934,D7220,Removal Of Impacted Tooth - Soft Tissue,CPT/HCPCS,8896.97,8896.97,109.89,262.22,United Healthcare-Medicare Advantage, +151458,3934,D7230,Removal Of Impacted Tooth - Partially Bony,CPT/HCPCS,7650.21,7650.21,146.52,3436.0,United Healthcare-Medicare Advantage, +151459,3934,D7240,Removal Of Impacted Tooth - Completely Bony,CPT/HCPCS,8482.63,8482.63,3996.0,4802.0,United Healthcare-Medicare Advantage, +151460,3934,D7250,Surgical Removal Of Residual Tooth Roots (Cutting Procedure),CPT/HCPCS,7598.3,7598.3,172.34,288.04,United Healthcare-Medicare Advantage, +151461,3934,D7270,Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth,CPT/HCPCS,1160.43,1160.43,147.86,1233.0,United Healthcare-Medicare Advantage, +151462,3934,D7910,Suture Of Recent Small Wounds Up To 5 Cm,CPT/HCPCS,1173.86,1173.86,147.86,147.86,United Healthcare-Medicare Advantage, +151463,3934,D9110,Palliative (Emergency) Treatment Of Dental Pain - Minor Procedure,CPT/HCPCS,134.53,134.53,91.56,135.0,United Healthcare-Medicare Advantage, +151464,3934,D9210,Local Anesthesia Not In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,88.56,88.56,5.14,95.0,United Healthcare-Medicare Advantage, +151465,3934,D9211,Regional Block Anesthesia,CPT/HCPCS,165.32,165.32,30.0,2484.0,United Healthcare-Medicare Advantage, +151466,3934,D9215,Local Anesthesia In Conjunction With Operative Or Surgical Procedures,CPT/HCPCS,119.54,119.54,27.1,300.0,United Healthcare-Medicare Advantage, +151467,3934,D9930,"Treatment Of Complications (Post-Surgical) - Unusual Circumstances, By Report",CPT/HCPCS,5887.39,5887.39,244.78,1243.82,United Healthcare-Medicare Advantage, +151468,3934,D9971,Odontoplasty 1 - 2 Teeth; Includes Removal Of Enamel Projections,CPT/HCPCS,2624.65,2624.65,68.05,88.47,United Healthcare-Medicare Advantage, +151469,3934,G0008,Administration of influenza virus vaccine,CPT/HCPCS,111.39,111.39,13.23,125.0,United Healthcare-Medicare Advantage, +151470,3934,G0009,Administration of pneumococcal vaccine,CPT/HCPCS,1112.38,1112.38,731.2,2951.43,United Healthcare-Medicare Advantage, +151471,3934,G0010,Administration of hepatitis b vaccine,CPT/HCPCS,342.49,342.49,87.95,87.95,United Healthcare-Medicare Advantage, +151472,3934,G0103,Prostate cancer screening; prostate specific antigen test (psa),CPT/HCPCS,235.15,235.15,9.44,188.25,United Healthcare-Medicare Advantage, +151473,3934,G0104,Colorectal cancer screening; flexible sigmoidoscopy,CPT/HCPCS,3412.44,3412.44,1861.07,3780.0,United Healthcare-Medicare Advantage, +151474,3934,G0105,Colorectal cancer screening; colonoscopy on individual at high risk,CPT/HCPCS,4753.44,4753.44,837.26,11680.0,United Healthcare-Medicare Advantage, +151475,3934,G0108,"Diabetes outpatient self-management training services, individual, per 30 minutes",CPT/HCPCS,287.03,287.03,35.59,501.0,United Healthcare-Medicare Advantage, +151476,3934,G0109,"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes",CPT/HCPCS,493.92,493.92,109.08,164.76,United Healthcare-Medicare Advantage, +151477,3934,G0121,Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,CPT/HCPCS,4836.89,4836.89,852.72,12150.67,United Healthcare-Medicare Advantage, +151478,3934,G0123,"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision",CPT/HCPCS,182.87,182.87,13.78,161.64,United Healthcare-Medicare Advantage, +151479,3934,G0260,"Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography",CPT/HCPCS,4035.97,4035.97,1756.8,9408.0,United Healthcare-Medicare Advantage, +151480,3934,G0279,"Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)",CPT/HCPCS,161.23,161.23,6.13,145.56,United Healthcare-Medicare Advantage, +151481,3934,G0283,"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care",CPT/HCPCS,112.15,112.15,2.41,120.0,United Healthcare-Medicare Advantage, +151482,3934,G0297,Low dose ct scan (ldct) for lung cancer screening,CPT/HCPCS,449.02,449.02,74.81,1363.0,United Healthcare-Medicare Advantage, +151483,3934,G0378,"Hospital observation service, per hour",CPT/HCPCS,7203.72,7203.72,1.03,42397.85,United Healthcare-Medicare Advantage, +151484,3934,G0379,Direct admission of patient for hospital observation care,CPT/HCPCS,12789.44,12789.44,4261.26,20865.53,United Healthcare-Medicare Advantage, +151485,3934,G0390,Trauma response team associated with hospital critical care service,CPT/HCPCS,18377.34,18377.34,1338.3,1338.3,United Healthcare-Medicare Advantage, +151486,3934,G0396,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes",CPT/HCPCS,381.98,381.98,43.15,2636.0,United Healthcare-Medicare Advantage, +151487,3934,G0397,"Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes",CPT/HCPCS,207.11,207.11,92.07,199.0,United Healthcare-Medicare Advantage, +151488,3934,G0416,"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method",CPT/HCPCS,1069.07,1069.07,343.35,1130.0,United Healthcare-Medicare Advantage, +151489,3934,G0463,Hospital outpatient clinic visit for assessment and management of a patient,CPT/HCPCS,283.24,283.24,17.57,537.0,United Healthcare-Medicare Advantage, +151490,3934,G0480,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed",CPT/HCPCS,314.33,314.33,8.39,1240.0,United Healthcare-Medicare Advantage, +151491,3934,G0483,"Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 22 or more drug class(es), including metabolite(s) if performed",CPT/HCPCS,808.33,808.33,115.94,1839.0,United Healthcare-Medicare Advantage, +151492,3934,G8989,"Self care functional limitation, discharge status, at discharge from therapy or to end reporting",CPT/HCPCS,1.0,1.0,0.69,0.69,United Healthcare-Medicare Advantage, +151493,3934,H0037,"Community psychiatric supportive treatment program, per diem",CPT/HCPCS,1983.77,1983.77,399.4,1997.0,United Healthcare-Medicare Advantage, +151494,3934,H0049,Alcohol and/or drug screening,CPT/HCPCS,145.89,145.89,15.0,1100.44,United Healthcare-Medicare Advantage, +151495,3934,H0050,"Alcohol and/or drug services, brief intervention, per 15 minutes",CPT/HCPCS,237.13,237.13,45.9,85.88,United Healthcare-Medicare Advantage, +151496,3934,J0129,"Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,10673.36,10673.36,622.26,15066.0,United Healthcare-Medicare Advantage, +151497,3934,J0130,"Injection abciximab, 10 mg",CPT/HCPCS,307.71,307.71,307.71,307.71,United Healthcare-Medicare Advantage, +151498,3934,J0131,"Injection, acetaminophen, 10 mg",CPT/HCPCS,113.54,113.54,1.76,15000.0,United Healthcare-Medicare Advantage, +151499,3934,J0132,"Injection, acetylcysteine, 100 mg",CPT/HCPCS,1050.92,1050.92,437.21,437.21,United Healthcare-Medicare Advantage, +151500,3934,J0133,"Injection, acyclovir, 5 mg",CPT/HCPCS,82.8,82.8,8.74,85.28,United Healthcare-Medicare Advantage, +151501,3934,J0153,"Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)",CPT/HCPCS,276.22,276.22,0.86,1103.76,United Healthcare-Medicare Advantage, +151502,3934,J0171,"Injection, adrenalin, epinephrine, 0.1 mg",CPT/HCPCS,50.71,50.71,7.25,491.67,United Healthcare-Medicare Advantage, +151503,3934,J0278,"Injection, amikacin sulfate, 100 mg",CPT/HCPCS,55.15,55.15,14.25,132.36,United Healthcare-Medicare Advantage, +151504,3934,J0282,"Injection, amiodarone hydrochloride, 30 mg",CPT/HCPCS,35.39,35.39,5.08,66.0,United Healthcare-Medicare Advantage, +151505,3934,J0289,"Injection, amphotericin b liposome, 10 mg",CPT/HCPCS,417.96,417.96,386.36,386.36,United Healthcare-Medicare Advantage, +151506,3934,J0290,"Injection, ampicillin sodium, 500 mg",CPT/HCPCS,24.7,24.7,1.96,51.82,United Healthcare-Medicare Advantage, +151507,3934,J0295,"Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm",CPT/HCPCS,50.11,50.11,7.49,154.95,United Healthcare-Medicare Advantage, +151508,3934,J0300,"Injection, amobarbital, up to 125 mg",CPT/HCPCS,2638.98,2638.98,2638.98,2638.98,United Healthcare-Medicare Advantage, +151509,3934,J0330,"Injection, succinylcholine chloride, up to 20 mg",CPT/HCPCS,69.05,69.05,69.05,69.05,United Healthcare-Medicare Advantage, +151510,3934,J0360,"Injection, hydralazine hcl, up to 20 mg",CPT/HCPCS,64.54,64.54,3.67,383.18,United Healthcare-Medicare Advantage, +151511,3934,J0456,"Injection, azithromycin, 500 mg",CPT/HCPCS,23.17,23.17,7.56,51.9,United Healthcare-Medicare Advantage, +151512,3934,J0461,"Injection, atropine sulfate, 0.01 mg",CPT/HCPCS,20.03,20.03,0.44,64.8,United Healthcare-Medicare Advantage, +151513,3934,J0475,"Injection, baclofen, 10 mg",CPT/HCPCS,3358.32,3358.32,328.16,6192.0,United Healthcare-Medicare Advantage, +151514,3934,J0485,"Injection, belatacept, 1 mg",CPT/HCPCS,4603.52,4603.52,840.3,6645.6,United Healthcare-Medicare Advantage, +151515,3934,J0490,"Injection, belimumab, 10 mg",CPT/HCPCS,7186.77,7186.77,93.93,15051.12,United Healthcare-Medicare Advantage, +151516,3934,J0500,"Injection, dicyclomine hcl, up to 20 mg",CPT/HCPCS,105.4,105.4,92.21,92.21,United Healthcare-Medicare Advantage, +151517,3934,J0515,"Injection, benztropine mesylate, per 1 mg",CPT/HCPCS,84.01,84.01,67.63,69.3,United Healthcare-Medicare Advantage, +151518,3934,J0561,"Injection, penicillin g benzathine, 100,000 units",CPT/HCPCS,259.11,259.11,67.63,181.13,United Healthcare-Medicare Advantage, +151519,3934,J0571,"Buprenorphine, oral, 1 mg",CPT/HCPCS,6.23,6.23,0.66,812.78,United Healthcare-Medicare Advantage, +151520,3934,J0583,"Injection, bivalirudin, 1 mg",CPT/HCPCS,2793.91,2793.91,3.21,9144.0,United Healthcare-Medicare Advantage, +151521,3934,J0585,"Injection, onabotulinumtoxina, 1 unit",CPT/HCPCS,2107.13,2107.13,6.06,29954.52,United Healthcare-Medicare Advantage, +151522,3934,J0595,"Injection, butorphanol tartrate, 1 mg",CPT/HCPCS,12.96,12.96,3.32,35.14,United Healthcare-Medicare Advantage, +151523,3934,J0604,"Cinacalcet, oral, 1 mg, (for esrd on dialysis)",CPT/HCPCS,169.59,169.59,64.38,64.38,United Healthcare-Medicare Advantage, +151524,3934,J0610,"Injection, calcium gluconate, per 10 ml",CPT/HCPCS,125.32,125.32,1.79,2005.48,United Healthcare-Medicare Advantage, +151525,3934,J0630,"Injection, calcitonin salmon, up to 400 units",CPT/HCPCS,0.02,0.02,1106.19,1136.74,United Healthcare-Medicare Advantage, +151526,3934,J0640,"Injection, leucovorin calcium, per 50 mg",CPT/HCPCS,384.78,384.78,8.21,720.0,United Healthcare-Medicare Advantage, +151527,3934,J0690,"Injection, cefazolin sodium, 500 mg",CPT/HCPCS,37.53,37.53,0.21,426.19,United Healthcare-Medicare Advantage, +151528,3934,J0692,"Injection, cefepime hydrochloride, 500 mg",CPT/HCPCS,52.15,52.15,7.28,123.04,United Healthcare-Medicare Advantage, +151529,3934,J0694,"Injection, cefoxitin sodium, 1 gm",CPT/HCPCS,87.07,87.07,25.84,354.65,United Healthcare-Medicare Advantage, +151530,3934,J0696,"Injection, ceftriaxone sodium, per 250 mg",CPT/HCPCS,32.2,32.2,0.06,1185.12,United Healthcare-Medicare Advantage, +151531,3934,J0702,"Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg",CPT/HCPCS,45.78,45.78,18.6,184.5,United Healthcare-Medicare Advantage, +151532,3934,J0713,"Injection, ceftazidime, per 500 mg",CPT/HCPCS,24.12,24.12,61.48,61.48,United Healthcare-Medicare Advantage, +151533,3934,J0714,"Injection, ceftazidime and avibactam, 0.5 g/0.125 g",CPT/HCPCS,528.14,528.14,268.72,268.72,United Healthcare-Medicare Advantage, +151534,3934,J0740,"Injection, cidofovir, 375 mg",CPT/HCPCS,603.95,603.95,402.63,402.63,United Healthcare-Medicare Advantage, +151535,3934,J0744,"Injection, ciprofloxacin for intravenous infusion, 200 mg",CPT/HCPCS,11.44,11.44,0.37,46.8,United Healthcare-Medicare Advantage, +151536,3934,J0775,"Injection, collagenase, clostridium histolyticum, 0.01 mg",CPT/HCPCS,22786.21,22786.21,38.3,34908.06,United Healthcare-Medicare Advantage, +151537,3934,J0780,"Injection, prochlorperazine, up to 10 mg",CPT/HCPCS,48.82,48.82,1.18,66.6,United Healthcare-Medicare Advantage, +151538,3934,J0834,"Injection, cosyntropin, 0.25 mg",CPT/HCPCS,304.47,304.47,27.2,268.58,United Healthcare-Medicare Advantage, +151539,3934,J0878,"Injection, daptomycin, 1 mg",CPT/HCPCS,743.99,743.99,0.01,80.22,United Healthcare-Medicare Advantage, +151540,3934,J0881,"Injection, darbepoetin alfa, 1 microgram (non-esrd use)",CPT/HCPCS,5629.87,5629.87,110.72,16718.4,United Healthcare-Medicare Advantage, +151541,3934,J0883,"Injection, argatroban, 1 mg (for non-esrd use)",CPT/HCPCS,191.78,191.78,52.65,852.3,United Healthcare-Medicare Advantage, +151542,3934,J0885,"Injection, epoetin alfa, (for non-esrd use), 1000 units",CPT/HCPCS,2295.19,2295.19,12.14,3530.88,United Healthcare-Medicare Advantage, +151543,3934,J0894,"Injection, decitabine, 1 mg",CPT/HCPCS,2281.31,2281.31,3.43,5851.62,United Healthcare-Medicare Advantage, +151544,3934,J0895,"Injection, deferoxamine mesylate, 500 mg",CPT/HCPCS,67.75,67.75,67.75,67.75,United Healthcare-Medicare Advantage, +151545,3934,J0896,"Injection, Luspatercept-Aamt, 0.25 Mg",CPT/HCPCS,21793.15,21793.15,49552.98,49552.98,United Healthcare-Medicare Advantage, +151546,3934,J0897,"Injection, denosumab, 1 mg",CPT/HCPCS,6150.13,6150.13,284.2,7538.4,United Healthcare-Medicare Advantage, +151547,3934,J1040,"Injection, methylprednisolone acetate, 80 mg",CPT/HCPCS,22.61,22.61,36.09,36.09,United Healthcare-Medicare Advantage, +151548,3934,J1050,"Injection, medroxyprogesterone acetate, 1 mg",CPT/HCPCS,350.05,350.05,0.32,627.54,United Healthcare-Medicare Advantage, +151549,3934,J1097,"Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml",CPT/HCPCS,1638.45,1638.45,67.63,1674.0,United Healthcare-Medicare Advantage, +151550,3934,J1100,"Injection, dexamethasone sodium phosphate, 1 mg",CPT/HCPCS,5.08,5.08,0.06,20921.84,United Healthcare-Medicare Advantage, +151551,3934,J1110,"Injection, dihydroergotamine mesylate, per 1 mg",CPT/HCPCS,472.86,472.86,472.86,472.86,United Healthcare-Medicare Advantage, +151552,3934,J1120,"Injection, acetazolamide sodium, up to 500 mg",CPT/HCPCS,188.85,188.85,28.52,288.0,United Healthcare-Medicare Advantage, +151553,3934,J1160,"Injection, digoxin, up to 0.5 mg",CPT/HCPCS,10.12,10.12,3.66,3.66,United Healthcare-Medicare Advantage, +151554,3934,J1170,"Injection, hydromorphone, up to 4 mg",CPT/HCPCS,8.66,8.66,0.22,76.15,United Healthcare-Medicare Advantage, +151555,3934,J1200,"Injection, diphenhydramine hcl, up to 50 mg",CPT/HCPCS,3.24,3.24,0.04,19.8,United Healthcare-Medicare Advantage, +151556,3934,J1250,"Injection, dobutamine hydrochloride, per 250 mg",CPT/HCPCS,114.76,114.76,2.44,251.22,United Healthcare-Medicare Advantage, +151557,3934,J1265,"Injection, dopamine hcl, 40 mg",CPT/HCPCS,57.99,57.99,64.11,64.11,United Healthcare-Medicare Advantage, +151558,3934,J1300,"Injection, eculizumab, 10 mg",CPT/HCPCS,88021.6,88021.6,1363.48,93931.2,United Healthcare-Medicare Advantage, +151559,3934,J1303,"Injection, ravulizumab-cwvz, 10 mg",CPT/HCPCS,246195.03,246195.03,61095.6,253677.6,United Healthcare-Medicare Advantage, +151560,3934,J1327,"Injection, eptifibatide, 5 mg",CPT/HCPCS,1109.15,1109.15,500.7,500.7,United Healthcare-Medicare Advantage, +151561,3934,J1335,"Injection, ertapenem sodium, 500 mg",CPT/HCPCS,351.28,351.28,136.71,421.45,United Healthcare-Medicare Advantage, +151562,3934,J1430,"Injection, ethanolamine oleate, 100 mg",CPT/HCPCS,5643.14,5643.14,4617.12,4617.12,United Healthcare-Medicare Advantage, +151563,3934,J1439,"Injection, ferric carboxymaltose, 1 mg",CPT/HCPCS,3127.62,3127.62,0.8,6384.55,United Healthcare-Medicare Advantage, +151564,3934,J1442,"Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram",CPT/HCPCS,1316.63,1316.63,0.67,4533.6,United Healthcare-Medicare Advantage, +151565,3934,J1450,"Injection fluconazole, 200 mg",CPT/HCPCS,39.88,39.88,1.96,71.36,United Healthcare-Medicare Advantage, +151566,3934,J1453,"Injection, fosaprepitant, 1 mg",CPT/HCPCS,835.66,835.66,0.57,1083.0,United Healthcare-Medicare Advantage, +151567,3934,J1454,"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg",CPT/HCPCS,2016.0,2016.0,301.87,2016.0,United Healthcare-Medicare Advantage, +151568,3934,J1459,"Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,15850.68,15850.68,38.28,40032.0,United Healthcare-Medicare Advantage, +151569,3934,J1566,"Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg",CPT/HCPCS,11859.92,11859.92,888.0,9377.2,United Healthcare-Medicare Advantage, +151570,3934,J1569,"Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg",CPT/HCPCS,10311.27,10311.27,1413.0,24354.0,United Healthcare-Medicare Advantage, +151571,3934,J1572,"Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg",CPT/HCPCS,9681.19,9681.19,4.9,35028.0,United Healthcare-Medicare Advantage, +151572,3934,J1580,"Injection, garamycin, gentamicin, up to 80 mg",CPT/HCPCS,18.16,18.16,0.16,104.69,United Healthcare-Medicare Advantage, +151573,3934,J1599,"Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg",CPT/HCPCS,5204.62,5204.62,799.28,3048.19,United Healthcare-Medicare Advantage, +151574,3934,J1610,"Injection, glucagon hydrochloride, per 1 mg",CPT/HCPCS,684.51,684.51,72.39,1235.52,United Healthcare-Medicare Advantage, +151575,3934,J1630,"Injection, haloperidol, up to 5 mg",CPT/HCPCS,16.59,16.59,0.66,86.25,United Healthcare-Medicare Advantage, +151576,3934,J1631,"Injection, haloperidol decanoate, per 50 mg",CPT/HCPCS,145.74,145.74,11.6,475.2,United Healthcare-Medicare Advantage, +151577,3934,J1642,"Injection, heparin sodium, (heparin lock flush), per 10 units",CPT/HCPCS,1.59,1.59,0.04,5.13,United Healthcare-Medicare Advantage, +151578,3934,J1644,"Injection, heparin sodium, per 1000 units",CPT/HCPCS,17.77,17.77,0.01,1460.76,United Healthcare-Medicare Advantage, +151579,3934,J1650,"Injection, enoxaparin sodium, 10 mg",CPT/HCPCS,118.41,118.41,0.7,894.22,United Healthcare-Medicare Advantage, +151580,3934,J1670,"Injection, tetanus immune globulin, human, up to 250 units",CPT/HCPCS,1560.95,1560.95,234.19,234.19,United Healthcare-Medicare Advantage, +151581,3934,J1720,"Injection, hydrocortisone sodium succinate, up to 100 mg",CPT/HCPCS,27.19,27.19,0.01,21989.1,United Healthcare-Medicare Advantage, +151582,3934,J1741,"Injection, ibuprofen, 100 mg",CPT/HCPCS,51.9,51.9,0.81,141.28,United Healthcare-Medicare Advantage, +151583,3934,J1742,"Injection, ibutilide fumarate, 1 mg",CPT/HCPCS,2279.42,2279.42,624.74,1074.59,United Healthcare-Medicare Advantage, +151584,3934,J1745,"Injection, infliximab, excludes biosimilar, 10 mg",CPT/HCPCS,21937.63,21937.63,6.34,63057.6,United Healthcare-Medicare Advantage, +151585,3934,J1756,"Injection, iron sucrose, 1 mg",CPT/HCPCS,232.79,232.79,0.54,720.0,United Healthcare-Medicare Advantage, +151586,3934,J1790,"Injection, droperidol, up to 5 mg",CPT/HCPCS,9.56,9.56,1.02,24.48,United Healthcare-Medicare Advantage, +151587,3934,J1815,"Injection, insulin, per 5 units",CPT/HCPCS,101.94,101.94,0.03,1100.76,United Healthcare-Medicare Advantage, +151588,3934,J1885,"Injection, ketorolac tromethamine, per 15 mg",CPT/HCPCS,13.55,13.55,0.25,72.0,United Healthcare-Medicare Advantage, +151589,3934,J1930,"Injection, lanreotide, 1 mg",CPT/HCPCS,27984.24,27984.24,1235.62,28681.2,United Healthcare-Medicare Advantage, +151590,3934,J1940,"Injection, furosemide, up to 20 mg",CPT/HCPCS,18.83,18.83,0.6,89.5,United Healthcare-Medicare Advantage, +151591,3934,J1950,"Injection, leuprolide acetate (for depot suspension), per 3.75 mg",CPT/HCPCS,3675.77,3675.77,695.28,7700.76,United Healthcare-Medicare Advantage, +151592,3934,J1953,"Injection, levetiracetam, 10 mg",CPT/HCPCS,94.77,94.77,28.08,270.0,United Healthcare-Medicare Advantage, +151593,3934,J1956,"Injection, levofloxacin, 250 mg",CPT/HCPCS,36.3,36.3,9.7,43.2,United Healthcare-Medicare Advantage, +151594,3934,J2001,"Injection, lidocaine hcl for intravenous infusion, 10 mg",CPT/HCPCS,8.87,8.87,0.02,57.55,United Healthcare-Medicare Advantage, +151595,3934,J2020,"Injection, linezolid, 200 mg",CPT/HCPCS,194.99,194.99,94.5,237.73,United Healthcare-Medicare Advantage, +151596,3934,J2060,"Injection, lorazepam, 2 mg",CPT/HCPCS,4.79,4.79,0.01,30.25,United Healthcare-Medicare Advantage, +151597,3934,J2175,"Injection, meperidine hydrochloride, per 100 mg",CPT/HCPCS,3.61,3.61,1.4,6.48,United Healthcare-Medicare Advantage, +151598,3934,J2182,"Injection, mepolizumab, 1 mg",CPT/HCPCS,9857.87,9857.87,9640.8,11232.68,United Healthcare-Medicare Advantage, +151599,3934,J2185,"Injection, meropenem, 100 mg",CPT/HCPCS,91.81,91.81,20.51,237.6,United Healthcare-Medicare Advantage, +151600,3934,J2210,"Injection, methylergonovine maleate, up to 0.2 mg",CPT/HCPCS,39.89,39.89,15.43,17.71,United Healthcare-Medicare Advantage, +151601,3934,J2212,"Injection, methylnaltrexone, 0.1 mg",CPT/HCPCS,283.6,283.6,359.99,360.0,United Healthcare-Medicare Advantage, +151602,3934,J2248,"Injection, micafungin sodium, 1 mg",CPT/HCPCS,261.02,261.02,65.16,235.62,United Healthcare-Medicare Advantage, +151603,3934,J2250,"Injection, midazolam hydrochloride, per 1 mg",CPT/HCPCS,3.17,3.17,0.06,26.96,United Healthcare-Medicare Advantage, +151604,3934,J2260,"Injection, milrinone lactate, 5 mg",CPT/HCPCS,111.53,111.53,39.04,39.04,United Healthcare-Medicare Advantage, +151605,3934,J2270,"Injection, morphine sulfate, up to 10 mg",CPT/HCPCS,9.32,9.32,0.16,87.97,United Healthcare-Medicare Advantage, +151606,3934,J2274,"Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg",CPT/HCPCS,7.73,7.73,0.15,43.2,United Healthcare-Medicare Advantage, +151607,3934,J2310,"Injection, naloxone hydrochloride, per 1 mg",CPT/HCPCS,97.71,97.71,3.0,119.68,United Healthcare-Medicare Advantage, +151608,3934,J2323,"Injection, natalizumab, 1 mg",CPT/HCPCS,21600.0,21600.0,21600.0,21600.0,United Healthcare-Medicare Advantage, +151609,3934,J2326,"Injection, nusinersen, 0.1 mg",CPT/HCPCS,304656.7,304656.7,819.0,99999.99,United Healthcare-Medicare Advantage, +151610,3934,J2350,"Injection, ocrelizumab, 1 mg",CPT/HCPCS,90082.54,90082.54,24941.52,117000.0,United Healthcare-Medicare Advantage, +151611,3934,J2353,"Injection, octreotide, depot form for intramuscular injection, 1 mg",CPT/HCPCS,16440.42,16440.42,156.48,19992.81,United Healthcare-Medicare Advantage, +151612,3934,J2354,"Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg",CPT/HCPCS,67.68,67.68,1.5,178.88,United Healthcare-Medicare Advantage, +151613,3934,J2357,"Injection, omalizumab, 5 mg",CPT/HCPCS,4571.62,4571.62,840.32,7809.54,United Healthcare-Medicare Advantage, +151614,3934,J2370,"Injection, phenylephrine hcl, up to 1 ml",CPT/HCPCS,85.44,85.44,32.74,93.53,United Healthcare-Medicare Advantage, +151615,3934,J2400,"Injection, chloroprocaine hydrochloride, per 30 ml",CPT/HCPCS,80.57,80.57,80.57,80.57,United Healthcare-Medicare Advantage, +151616,3934,J2405,"Injection, ondansetron hydrochloride, per 1 mg",CPT/HCPCS,2.47,2.47,0.02,1916.01,United Healthcare-Medicare Advantage, +151617,3934,J2469,"Injection, palonosetron hcl, 25 mcg",CPT/HCPCS,518.63,518.63,3.19,1467.54,United Healthcare-Medicare Advantage, +151618,3934,J2505,"Injection, pegfilgrastim, 6 mg",CPT/HCPCS,17003.97,17003.97,473.48,46694.72,United Healthcare-Medicare Advantage, +151619,3934,J2540,"Injection, penicillin g potassium, up to 600,000 units",CPT/HCPCS,141.36,141.36,7.38,176.58,United Healthcare-Medicare Advantage, +151620,3934,J2543,"Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)",CPT/HCPCS,123.0,123.0,6.58,313.29,United Healthcare-Medicare Advantage, +151621,3934,J2550,"Injection, promethazine hcl, up to 50 mg",CPT/HCPCS,4.29,4.29,4.53,4.75,United Healthcare-Medicare Advantage, +151622,3934,J2560,"Injection, phenobarbital sodium, up to 120 mg",CPT/HCPCS,293.3,293.3,194.34,340.1,United Healthcare-Medicare Advantage, +151623,3934,J2562,"Injection, plerixafor, 1 mg",CPT/HCPCS,23676.56,23676.56,1261.84,30332.73,United Healthcare-Medicare Advantage, +151624,3934,J2590,"Injection, oxytocin, up to 10 units",CPT/HCPCS,22.06,22.06,1.88,13.01,United Healthcare-Medicare Advantage, +151625,3934,J2597,"Injection, desmopressin acetate, per 1 mcg",CPT/HCPCS,980.0,980.0,68.27,1706.64,United Healthcare-Medicare Advantage, +151626,3934,J2680,"Injection, fluphenazine decanoate, up to 25 mg",CPT/HCPCS,364.81,364.81,5.7,446.31,United Healthcare-Medicare Advantage, +151627,3934,J2690,"Injection, procainamide hcl, up to 1 gm",CPT/HCPCS,209.93,209.93,68.95,235.8,United Healthcare-Medicare Advantage, +151628,3934,J2704,"Injection, propofol, 10 mg",CPT/HCPCS,128.0,128.0,0.7,452.0,United Healthcare-Medicare Advantage, +151629,3934,J2720,"Injection, protamine sulfate, per 10 mg",CPT/HCPCS,54.94,54.94,1.77,84.24,United Healthcare-Medicare Advantage, +151630,3934,J2765,"Injection, metoclopramide hcl, up to 10 mg",CPT/HCPCS,3.58,3.58,0.17,1100.44,United Healthcare-Medicare Advantage, +151631,3934,J2783,"Injection, rasburicase, 0.5 mg",CPT/HCPCS,21910.36,21910.36,14045.1,28090.2,United Healthcare-Medicare Advantage, +151632,3934,J2785,"Injection, regadenoson, 0.1 mg",CPT/HCPCS,741.0,741.0,37.05,741.0,United Healthcare-Medicare Advantage, +151633,3934,J2790,"Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.)",CPT/HCPCS,294.0,294.0,67.63,294.0,United Healthcare-Medicare Advantage, +151634,3934,J2794,"Injection, risperidone (risperdal consta), 0.5 mg",CPT/HCPCS,1605.71,1605.71,363.69,2334.42,United Healthcare-Medicare Advantage, +151635,3934,J2795,"Injection, ropivacaine hydrochloride, 1 mg",CPT/HCPCS,294.68,294.68,24.23,521.28,United Healthcare-Medicare Advantage, +151636,3934,J2796,"Injection, romiplostim, 10 micrograms",CPT/HCPCS,9031.58,9031.58,280.75,28074.96,United Healthcare-Medicare Advantage, +151637,3934,J2800,"Injection, methocarbamol, up to 10 ml",CPT/HCPCS,209.63,209.63,6.1,641.58,United Healthcare-Medicare Advantage, +151638,3934,J2850,"Injection, secretin, synthetic, human, 1 microgram",CPT/HCPCS,1343.8,1343.8,610.47,1942.0,United Healthcare-Medicare Advantage, +151639,3934,J2920,"Injection, methylprednisolone sodium succinate, up to 40 mg",CPT/HCPCS,25.56,25.56,0.54,76.36,United Healthcare-Medicare Advantage, +151640,3934,J2930,"Injection, methylprednisolone sodium succinate, up to 125 mg",CPT/HCPCS,28.65,28.65,0.91,132.99,United Healthcare-Medicare Advantage, +151641,3934,J2997,"Injection, alteplase recombinant, 1 mg",CPT/HCPCS,662.4,662.4,34.7,31681.29,United Healthcare-Medicare Advantage, +151642,3934,J3010,"Injection, fentanyl citrate, 0.1 mg",CPT/HCPCS,6.46,6.46,0.09,60.9,United Healthcare-Medicare Advantage, +151643,3934,J3030,"Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)",CPT/HCPCS,141.89,141.89,28.51,255.0,United Healthcare-Medicare Advantage, +151644,3934,J3105,"Injection, terbutaline sulfate, up to 1 mg",CPT/HCPCS,23.71,23.71,0.61,21.12,United Healthcare-Medicare Advantage, +151645,3934,J3230,"Injection, chlorpromazine hcl, up to 50 mg",CPT/HCPCS,202.1,202.1,2.39,721.68,United Healthcare-Medicare Advantage, +151646,3934,J3240,"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial",CPT/HCPCS,3793.26,3793.26,216.94,4460.84,United Healthcare-Medicare Advantage, +151647,3934,J3262,"Injection, tocilizumab, 1 mg",CPT/HCPCS,4119.73,4119.73,197.09,5229.25,United Healthcare-Medicare Advantage, +151648,3934,J3301,"Injection, triamcinolone acetonide, not otherwise specified, 10 mg",CPT/HCPCS,35.91,35.91,2.66,130.44,United Healthcare-Medicare Advantage, +151649,3934,J3358,"Ustekinumab, for intravenous injection, 1 mg",CPT/HCPCS,14429.03,14429.03,71.05,63649.59,United Healthcare-Medicare Advantage, +151650,3934,J3360,"Injection, diazepam, up to 5 mg",CPT/HCPCS,76.63,76.63,0.56,179.92,United Healthcare-Medicare Advantage, +151651,3934,J3370,"Injection, vancomycin hcl, 500 mg",CPT/HCPCS,47.36,47.36,3.3,176.4,United Healthcare-Medicare Advantage, +151652,3934,J3380,"Injection, vedolizumab, 1 mg",CPT/HCPCS,14534.43,14534.43,14.74,17348.4,United Healthcare-Medicare Advantage, +151653,3934,J3410,"Injection, hydroxyzine hcl, up to 25 mg",CPT/HCPCS,10.72,10.72,8.53,8.53,United Healthcare-Medicare Advantage, +151654,3934,J3411,"Injection, thiamine hcl, 100 mg",CPT/HCPCS,23.31,23.31,0.58,149.28,United Healthcare-Medicare Advantage, +151655,3934,J3420,"Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg",CPT/HCPCS,22.06,22.06,1.73,26.22,United Healthcare-Medicare Advantage, +151656,3934,J3430,"Injection, phytonadione (vitamin k), per 1 mg",CPT/HCPCS,154.58,154.58,153.96,347.2,United Healthcare-Medicare Advantage, +151657,3934,J3471,"Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)",CPT/HCPCS,281.32,281.32,151.7,151.7,United Healthcare-Medicare Advantage, +151658,3934,J3475,"Injection, magnesium sulfate, per 500 mg",CPT/HCPCS,40.63,40.63,0.12,574.77,United Healthcare-Medicare Advantage, +151659,3934,J3480,"Injection, potassium chloride, per 2 meq",CPT/HCPCS,15.71,15.71,0.04,52.59,United Healthcare-Medicare Advantage, +151660,3934,J3489,"Injection, zoledronic acid, 1 mg",CPT/HCPCS,1171.18,1171.18,20.17,3013.26,United Healthcare-Medicare Advantage, +151661,3934,J3490,Unclassified drugs,CPT/HCPCS,56.35,56.35,0.03,1961.33,United Healthcare-Medicare Advantage, +151662,3934,J3535,Drug administered through a metered dose inhaler,CPT/HCPCS,209.29,209.29,22.28,270.0,United Healthcare-Medicare Advantage, +151663,3934,J7030,"Infusion, normal saline solution , 1000 cc",CPT/HCPCS,7.59,7.59,0.18,184.58,United Healthcare-Medicare Advantage, +151664,3934,J7040,"Infusion, normal saline solution, sterile (500 ml = 1 unit)",CPT/HCPCS,6.55,6.55,0.02,309.6,United Healthcare-Medicare Advantage, +151665,3934,J7042,5% dextrose/normal saline (500 ml = 1 unit),CPT/HCPCS,7.15,7.15,0.12,28.68,United Healthcare-Medicare Advantage, +151666,3934,J7050,"Infusion, normal saline solution, 250 cc",CPT/HCPCS,7.83,7.83,0.02,49.14,United Healthcare-Medicare Advantage, +151667,3934,J7060,5% dextrose/water (500 ml = 1 unit),CPT/HCPCS,8.34,8.34,0.11,70.6,United Healthcare-Medicare Advantage, +151668,3934,J7070,"Infusion, d5w, 1000 cc",CPT/HCPCS,14.12,14.12,0.5,80.4,United Healthcare-Medicare Advantage, +151669,3934,J7120,"Ringers lactate infusion, up to 1000 cc",CPT/HCPCS,7.1,7.1,0.12,53.41,United Healthcare-Medicare Advantage, +151670,3934,J7170,"Injection, emicizumab-kxwh, 0.5 mg",CPT/HCPCS,18560.53,18560.53,47.31,14328.0,United Healthcare-Medicare Advantage, +151671,3934,J7187,"Injection, von willebrand factor complex (humate-p), per iu vwf:rco",CPT/HCPCS,3337.5,3337.5,793.8,1765.8,United Healthcare-Medicare Advantage, +151672,3934,J7189,"Factor viia (antihemophilic factor, recombinant), per 1 microgram",CPT/HCPCS,14000.0,14000.0,4340.0,18000.0,United Healthcare-Medicare Advantage, +151673,3934,J7192,"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified",CPT/HCPCS,5122.71,5122.71,621.18,6853.28,United Healthcare-Medicare Advantage, +151674,3934,J7298,"Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg",CPT/HCPCS,1973.25,1973.25,328.38,10618.5,United Healthcare-Medicare Advantage, +151675,3934,J7307,"Etonogestrel (contraceptive) implant system, including implant and supplies",CPT/HCPCS,1016.61,1016.61,429.66,429.66,United Healthcare-Medicare Advantage, +151676,3934,J7500,"Azathioprine, oral, 50 mg",CPT/HCPCS,4.33,4.33,1.77,10.14,United Healthcare-Medicare Advantage, +151677,3934,J7502,"Cyclosporine, oral, 100 mg",CPT/HCPCS,28.14,28.14,16.49,32.98,United Healthcare-Medicare Advantage, +151678,3934,J7503,"Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg",CPT/HCPCS,77.36,77.36,14.0,224.06,United Healthcare-Medicare Advantage, +151679,3934,J7507,"Tacrolimus, immediate release, oral, 1 mg",CPT/HCPCS,32.85,32.85,0.57,107.02,United Healthcare-Medicare Advantage, +151680,3934,J7508,"Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg",CPT/HCPCS,71.35,71.35,28.54,156.97,United Healthcare-Medicare Advantage, +151681,3934,J7509,"Methylprednisolone oral, per 4 mg",CPT/HCPCS,19.95,19.95,4.52,25.84,United Healthcare-Medicare Advantage, +151682,3934,J7510,"Prednisolone oral, per 5 mg",CPT/HCPCS,2.54,2.54,0.54,6.53,United Healthcare-Medicare Advantage, +151683,3934,J7512,"Prednisone, immediate release or delayed release, oral, 1 mg",CPT/HCPCS,1.51,1.51,0.07,431.63,United Healthcare-Medicare Advantage, +151684,3934,J7515,"Cyclosporine, oral, 25 mg",CPT/HCPCS,20.63,20.63,8.25,8.25,United Healthcare-Medicare Advantage, +151685,3934,J7517,"Mycophenolate mofetil, oral, 250 mg",CPT/HCPCS,37.89,37.89,23.78,95.12,United Healthcare-Medicare Advantage, +151686,3934,J7518,"Mycophenolic acid, oral, 180 mg",CPT/HCPCS,33.79,33.79,6.18,80.93,United Healthcare-Medicare Advantage, +151687,3934,J7611,"Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg",CPT/HCPCS,9.25,9.25,1.69,1.69,United Healthcare-Medicare Advantage, +151688,3934,J7620,"Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme",CPT/HCPCS,11.36,11.36,0.67,7.54,United Healthcare-Medicare Advantage, +151689,3934,J7627,"Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg",CPT/HCPCS,77.57,77.57,0.11,619.26,United Healthcare-Medicare Advantage, +151690,3934,J7644,"Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram",CPT/HCPCS,6.54,6.54,3.25,8.2,United Healthcare-Medicare Advantage, +151691,3934,J7674,"Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg",CPT/HCPCS,197.49,197.49,95.4,190.8,United Healthcare-Medicare Advantage, +151692,3934,J8499,"Prescription drug, oral, non chemotherapeutic, nos",CPT/HCPCS,13.0,13.0,3.56,15.51,United Healthcare-Medicare Advantage, +151693,3934,J8501,"Aprepitant, oral, 5 mg",CPT/HCPCS,306.67,306.67,0.01,405.66,United Healthcare-Medicare Advantage, +151694,3934,J8530,"Cyclophosphamide; oral, 25 mg",CPT/HCPCS,368.07,368.07,9.27,721.61,United Healthcare-Medicare Advantage, +151695,3934,J8540,"Dexamethasone, oral, 0.25 mg",CPT/HCPCS,5.79,5.79,0.01,36.0,United Healthcare-Medicare Advantage, +151696,3934,J8597,"Antiemetic drug, oral, not otherwise specified",CPT/HCPCS,1.78,1.78,0.04,7.8,United Healthcare-Medicare Advantage, +151697,3934,J8610,"Methotrexate; oral, 2.5 mg",CPT/HCPCS,123.37,123.37,2.3,2.4,United Healthcare-Medicare Advantage, +151698,3934,J8999,"Prescription drug, oral, chemotherapeutic, nos",CPT/HCPCS,86.16,86.16,0.52,0.52,United Healthcare-Medicare Advantage, +151699,3934,J9000,"Injection, doxorubicin hydrochloride, 10 mg",CPT/HCPCS,146.74,146.74,2.61,327.6,United Healthcare-Medicare Advantage, +151700,3934,J9017,"Injection, arsenic trioxide, 1 mg",CPT/HCPCS,2474.62,2474.62,251.08,3742.31,United Healthcare-Medicare Advantage, +151701,3934,J9022,"Injection, atezolizumab, 10 mg",CPT/HCPCS,26775.43,26775.43,78.18,33098.52,United Healthcare-Medicare Advantage, +151702,3934,J9023,"Injection, avelumab, 10 mg",CPT/HCPCS,19130.81,19130.81,236.52,23681.28,United Healthcare-Medicare Advantage, +151703,3934,J9025,"Injection, azacitidine, 1 mg",CPT/HCPCS,2587.5,2587.5,149.6,3853.0,United Healthcare-Medicare Advantage, +151704,3934,J9030,"Bcg live intravesical instillation, 1 mg",CPT/HCPCS,506.68,506.68,103.0,522.54,United Healthcare-Medicare Advantage, +151705,3934,J9034,"Injection, bendamustine hcl (bendeka), 1 mg",CPT/HCPCS,9561.75,9561.75,2355.24,9853.43,United Healthcare-Medicare Advantage, +151706,3934,J9035,"Injection, bevacizumab, 10 mg",CPT/HCPCS,14093.81,14093.81,37.24,49918.86,United Healthcare-Medicare Advantage, +151707,3934,J9039,"Injection, blinatumomab, 1 microgram",CPT/HCPCS,39292.36,39292.36,36018.0,36018.0,United Healthcare-Medicare Advantage, +151708,3934,J9040,"Injection, bleomycin sulfate, 15 units",CPT/HCPCS,221.35,221.35,1.15,192.19,United Healthcare-Medicare Advantage, +151709,3934,J9041,"Injection, bortezomib (velcade), 0.1 mg",CPT/HCPCS,3434.59,3434.59,32.88,5770.8,United Healthcare-Medicare Advantage, +151710,3934,J9042,"Injection, brentuximab vedotin, 1 mg",CPT/HCPCS,41326.12,41326.12,4734.0,71010.0,United Healthcare-Medicare Advantage, +151711,3934,J9043,"Injection, cabazitaxel, 1 mg",CPT/HCPCS,24009.16,24009.16,1848.5,1848.5,United Healthcare-Medicare Advantage, +151712,3934,J9045,"Injection, carboplatin, 50 mg",CPT/HCPCS,135.27,135.27,0.09,8683.1,United Healthcare-Medicare Advantage, +151713,3934,J9047,"Injection, carfilzomib, 1 mg",CPT/HCPCS,10249.34,10249.34,27.45,18926.4,United Healthcare-Medicare Advantage, +151714,3934,J9055,"Injection, cetuximab, 10 mg",CPT/HCPCS,9729.99,9729.99,258.85,24619.32,United Healthcare-Medicare Advantage, +151715,3934,J9060,"Injection, cisplatin, powder or solution, 10 mg",CPT/HCPCS,84.66,84.66,1.71,276.81,United Healthcare-Medicare Advantage, +151716,3934,J9070,"Cyclophosphamide, 100 mg",CPT/HCPCS,2843.5,2843.5,23.29,8438.4,United Healthcare-Medicare Advantage, +151717,3934,J9100,"Injection, cytarabine, 100 mg",CPT/HCPCS,3.57,3.57,0.63,7.52,United Healthcare-Medicare Advantage, +151718,3934,J9119,"Injection, cemiplimab-rwlc, 1 mg",CPT/HCPCS,18720.0,18720.0,4680.0,4680.0,United Healthcare-Medicare Advantage, +151719,3934,J9120,"Injection, dactinomycin, 0.5 mg",CPT/HCPCS,13380.52,13380.52,0.01,8514.87,United Healthcare-Medicare Advantage, +151720,3934,J9130,"Dacarbazine, 100 mg",CPT/HCPCS,116.46,116.46,4.46,172.8,United Healthcare-Medicare Advantage, +151721,3934,J9145,"Injection, daratumumab, 10 mg",CPT/HCPCS,16568.59,16568.59,200.05,42009.66,United Healthcare-Medicare Advantage, +151722,3934,J9150,"Injection, daunorubicin, 10 mg",CPT/HCPCS,679.42,679.42,338.04,507.06,United Healthcare-Medicare Advantage, +151723,3934,J9155,"Injection, degarelix, 1 mg",CPT/HCPCS,1986.7,1986.7,615.45,5487.06,United Healthcare-Medicare Advantage, +151724,3934,J9171,"Injection, docetaxel, 1 mg",CPT/HCPCS,4686.34,4686.34,0.87,9037.46,United Healthcare-Medicare Advantage, +151725,3934,J9173,"Injection, durvalumab, 10 mg",CPT/HCPCS,17872.03,17872.03,250.37,39582.0,United Healthcare-Medicare Advantage, +151726,3934,J9177,"Injection, Enfortumab Vedotin-Ejfv, 0.25 Mg",CPT/HCPCS,16555.06,16555.06,27.96,27.96,United Healthcare-Medicare Advantage, +151727,3934,J9179,"Injection, eribulin mesylate, 0.1 mg",CPT/HCPCS,6163.64,6163.64,1274.4,7560.0,United Healthcare-Medicare Advantage, +151728,3934,J9181,"Injection, etoposide, 10 mg",CPT/HCPCS,45.65,45.65,5.4,65.65,United Healthcare-Medicare Advantage, +151729,3934,J9190,"Injection, fluorouracil, 500 mg",CPT/HCPCS,58.23,58.23,1.25,133.23,United Healthcare-Medicare Advantage, +151730,3934,J9201,"Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg",CPT/HCPCS,334.81,334.81,10.14,633.6,United Healthcare-Medicare Advantage, +151731,3934,J9202,"Goserelin acetate implant, per 3.6 mg",CPT/HCPCS,1994.08,1994.08,170.82,6534.0,United Healthcare-Medicare Advantage, +151732,3934,J9205,"Injection, irinotecan liposome, 1 mg",CPT/HCPCS,13245.25,13245.25,49.78,25156.73,United Healthcare-Medicare Advantage, +151733,3934,J9206,"Injection, irinotecan, 20 mg",CPT/HCPCS,322.06,322.06,5.36,635.4,United Healthcare-Medicare Advantage, +151734,3934,J9209,"Injection, mesna, 200 mg",CPT/HCPCS,46.0,46.0,5.04,151.2,United Healthcare-Medicare Advantage, +151735,3934,J9214,"Injection, interferon, alfa-2b, recombinant, 1 million units",CPT/HCPCS,5032.8,5032.8,5531.4,5531.4,United Healthcare-Medicare Advantage, +151736,3934,J9217,"Leuprolide acetate (for depot suspension), 7.5 mg",CPT/HCPCS,4728.39,4728.39,16.2,9756.48,United Healthcare-Medicare Advantage, +151737,3934,J9227,"Injection, Isatuximab-Irfc, 10 Mg",CPT/HCPCS,13957.85,13957.85,936.0,31824.0,United Healthcare-Medicare Advantage, +151738,3934,J9228,"Injection, ipilimumab, 1 mg",CPT/HCPCS,75940.17,75940.17,19983.75,88036.53,United Healthcare-Medicare Advantage, +151739,3934,J9229,"Injection, inotuzumab ozogamicin, 0.1 mg",CPT/HCPCS,76913.63,76913.63,25393.71,142839.6,United Healthcare-Medicare Advantage, +151740,3934,J9250,"Methotrexate sodium, 5 mg",CPT/HCPCS,5.06,5.06,0.18,32.92,United Healthcare-Medicare Advantage, +151741,3934,J9261,"Injection, nelarabine, 50 mg",CPT/HCPCS,11763.85,11763.85,2290.8,7941.95,United Healthcare-Medicare Advantage, +151742,3934,J9263,"Injection, oxaliplatin, 0.5 mg",CPT/HCPCS,1005.4,1005.4,0.26,2160.0,United Healthcare-Medicare Advantage, +151743,3934,J9264,"Injection, paclitaxel protein-bound particles, 1 mg",CPT/HCPCS,8977.75,8977.75,175.01,15626.61,United Healthcare-Medicare Advantage, +151744,3934,J9266,"Injection, pegaspargase, per single dose vial",CPT/HCPCS,51597.72,51597.72,21382.19,133929.96,United Healthcare-Medicare Advantage, +151745,3934,J9267,"Injection, paclitaxel, 1 mg",CPT/HCPCS,110.21,110.21,0.07,278.64,United Healthcare-Medicare Advantage, +151746,3934,J9271,"Injection, pembrolizumab, 1 mg",CPT/HCPCS,31870.91,31870.91,36.57,71063.4,United Healthcare-Medicare Advantage, +151747,3934,J9280,"Injection, mitomycin, 5 mg",CPT/HCPCS,3012.38,3012.38,50.82,4246.92,United Healthcare-Medicare Advantage, +151748,3934,J9299,"Injection, nivolumab, 1 mg",CPT/HCPCS,26147.8,26147.8,2467.67,47379.24,United Healthcare-Medicare Advantage, +151749,3934,J9301,"Injection, obinutuzumab, 10 mg",CPT/HCPCS,13741.46,13741.46,1140.48,23937.36,United Healthcare-Medicare Advantage, +151750,3934,J9302,"Injection, ofatumumab, 10 mg",CPT/HCPCS,678.78,678.78,678.78,678.78,United Healthcare-Medicare Advantage, +151751,3934,J9303,"Injection, panitumumab, 10 mg",CPT/HCPCS,17330.41,17330.41,461.88,36950.16,United Healthcare-Medicare Advantage, +151752,3934,J9305,"Injection, pemetrexed, 10 mg",CPT/HCPCS,17549.93,17549.93,52.94,24215.44,United Healthcare-Medicare Advantage, +151753,3934,J9306,"Injection, pertuzumab, 1 mg",CPT/HCPCS,16145.71,16145.71,9.23,34018.68,United Healthcare-Medicare Advantage, +151754,3934,J9308,"Injection, ramucirumab, 5 mg",CPT/HCPCS,22235.4,22235.4,728.52,35422.92,United Healthcare-Medicare Advantage, +151755,3934,J9311,"Injection, rituximab 10 mg and hyaluronidase",CPT/HCPCS,22210.65,22210.65,6001.66,23675.7,United Healthcare-Medicare Advantage, +151756,3934,J9312,"Injection, rituximab, 10 mg",CPT/HCPCS,19502.27,19502.27,91.26,47237.58,United Healthcare-Medicare Advantage, +151757,3934,J9315,"Injection, romidepsin, 1 mg",CPT/HCPCS,31613.85,31613.85,8749.03,22129.7,United Healthcare-Medicare Advantage, +151758,3934,J9340,"Injection, thiotepa, 15 mg",CPT/HCPCS,15290.92,15290.92,7056.0,7056.0,United Healthcare-Medicare Advantage, +151759,3934,J9354,"Injection, ado-trastuzumab emtansine, 1 mg",CPT/HCPCS,26521.27,26521.27,1816.99,39178.79,United Healthcare-Medicare Advantage, +151760,3934,J9355,"Injection, trastuzumab, excludes biosimilar, 10 mg",CPT/HCPCS,12478.23,12478.23,3.37,30968.93,United Healthcare-Medicare Advantage, +151761,3934,J9357,"Injection, valrubicin, intravesical, 200 mg",CPT/HCPCS,14556.76,14556.76,4207.19,4207.19,United Healthcare-Medicare Advantage, +151762,3934,J9358,"Injection, Fam-Trastuzumab Deruxtecan-Nxki, 1 Mg",CPT/HCPCS,29304.88,29304.88,4959.29,44633.59,United Healthcare-Medicare Advantage, +151763,3934,J9360,"Injection, vinblastine sulfate, 1 mg",CPT/HCPCS,65.73,65.73,3.98,131.21,United Healthcare-Medicare Advantage, +151764,3934,J9370,"Vincristine sulfate, 1 mg",CPT/HCPCS,72.62,72.62,3.83,113.78,United Healthcare-Medicare Advantage, +151765,3934,J9390,"Injection, vinorelbine tartrate, 10 mg",CPT/HCPCS,269.95,269.95,90.72,259.2,United Healthcare-Medicare Advantage, +151766,3934,J9395,"Injection, fulvestrant, 25 mg",CPT/HCPCS,4417.88,4417.88,144.71,6926.52,United Healthcare-Medicare Advantage, +151767,3934,J9999,"Not otherwise classified, antineoplastic drugs",CPT/HCPCS,21594.29,21594.29,5377.05,29019.0,United Healthcare-Medicare Advantage, +151768,3934,L3650,"Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf",CPT/HCPCS,135.0,135.0,64.13,135.0,United Healthcare-Medicare Advantage, +151769,3934,L3763,"Elbow wrist hand orthosis, rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,1268.0,1268.0,685.72,685.72,United Healthcare-Medicare Advantage, +151770,3934,L3806,"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,748.0,748.0,149.6,404.24,United Healthcare-Medicare Advantage, +151771,3934,L3807,"Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise",CPT/HCPCS,415.0,415.0,124.95,313.93,United Healthcare-Medicare Advantage, +151772,3934,L3808,"Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,699.81,699.81,229.12,679.93,United Healthcare-Medicare Advantage, +151773,3934,L3906,"Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,692.0,692.0,346.0,375.03,United Healthcare-Medicare Advantage, +151774,3934,L3913,"Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,446.0,446.0,223.0,337.38,United Healthcare-Medicare Advantage, +151775,3934,L3921,"Hand finger orthosis, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment",CPT/HCPCS,529.0,529.0,285.84,289.97,United Healthcare-Medicare Advantage, +151776,3934,L3925,"Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf",CPT/HCPCS,84.0,84.0,28.81,63.54,United Healthcare-Medicare Advantage, +151777,3934,L3933,"Finger orthosis, without joints, may include soft interface, custom fabricated, includes fitting and adjustment",CPT/HCPCS,351.0,351.0,189.85,189.85,United Healthcare-Medicare Advantage, +151778,3934,L8509,"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type",CPT/HCPCS,459.47,459.47,65.32,745.0,United Healthcare-Medicare Advantage, +151779,3934,L8600,"Implantable breast prosthesis, silicone or equal",CPT/HCPCS,3281.73,3281.73,1041.0,4272.0,United Healthcare-Medicare Advantage, +151780,3934,L8609,Artificial cornea,CPT/HCPCS,10000.0,10000.0,10000.0,10000.0,United Healthcare-Medicare Advantage, +151781,3934,L8610,Ocular implant,CPT/HCPCS,1498.22,1498.22,1468.0,1604.0,United Healthcare-Medicare Advantage, +151782,3934,L8612,Aqueous shunt,CPT/HCPCS,1933.71,1933.71,1318.0,4100.0,United Healthcare-Medicare Advantage, +151783,3934,L8613,Ossicula implant,CPT/HCPCS,422.14,422.14,796.46,796.46,United Healthcare-Medicare Advantage, +151784,3934,L8614,"Cochlear device, includes all internal and external components",CPT/HCPCS,54810.0,54810.0,75770.0,75770.0,United Healthcare-Medicare Advantage, +151785,3934,L8679,"Implantable neurostimulator, pulse generator, any type",CPT/HCPCS,800.0,800.0,800.0,800.0,United Healthcare-Medicare Advantage, +151786,3934,L8681,"Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only",CPT/HCPCS,3050.0,3050.0,2200.0,2200.0,United Healthcare-Medicare Advantage, +151787,3934,L8689,"External recharging system for battery (internal) for use with implantable neurostimulator, replacement only",CPT/HCPCS,1000.0,1000.0,1000.0,1000.0,United Healthcare-Medicare Advantage, +151788,3934,L8699,"Prosthetic implant, not otherwise specified",CPT/HCPCS,8555.12,8555.12,710.0,15200.0,United Healthcare-Medicare Advantage, +151789,3934,M0239,"Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring",CPT/HCPCS,752.79,752.79,1.0,754.0,United Healthcare-Medicare Advantage, +151790,3934,M0243,"Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring",CPT/HCPCS,753.0,753.0,309.6,753.0,United Healthcare-Medicare Advantage, +151791,3934,P3000,"Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision",CPT/HCPCS,124.33,124.33,28.92,28.92,United Healthcare-Medicare Advantage, +151792,3934,P9011,"Blood, split unit",CPT/HCPCS,1382.28,1382.28,727.7,2901.0,United Healthcare-Medicare Advantage, +151793,3934,P9012,"Cryoprecipitate, each unit",CPT/HCPCS,2541.03,2541.03,180.7,2765.0,United Healthcare-Medicare Advantage, +151794,3934,P9016,"Red blood cells, leukocytes reduced, each unit",CPT/HCPCS,4782.61,4782.61,53.19,28316.0,United Healthcare-Medicare Advantage, +151795,3934,P9017,"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit",CPT/HCPCS,1252.63,1252.63,225.75,1421.0,United Healthcare-Medicare Advantage, +151796,3934,P9035,"Platelets, pheresis, leukocytes reduced, each unit",CPT/HCPCS,6457.4,6457.4,570.61,5150.0,United Healthcare-Medicare Advantage, +151797,3934,P9037,"Platelets, pheresis, leukocytes reduced, irradiated, each unit",CPT/HCPCS,8389.56,8389.56,109.59,22782.0,United Healthcare-Medicare Advantage, +151798,3934,P9040,"Red blood cells, leukocytes reduced, irradiated, each unit",CPT/HCPCS,5550.01,5550.01,75.07,12750.0,United Healthcare-Medicare Advantage, +151799,3934,P9041,"Infusion, albumin (human), 5%, 50 ml",CPT/HCPCS,1592.0,1592.0,1592.0,1592.0,United Healthcare-Medicare Advantage, +151800,3934,P9044,"Plasma, cryoprecipitate reduced, each unit",CPT/HCPCS,2910.36,2910.36,472.86,2764.5,United Healthcare-Medicare Advantage, +151801,3934,P9045,"Infusion, albumin (human), 5%, 250 ml",CPT/HCPCS,3002.84,3002.84,38.35,4725.0,United Healthcare-Medicare Advantage, +151802,3934,P9046,"Infusion, albumin (human), 25%, 20 ml",CPT/HCPCS,595.31,595.31,18.97,2390.34,United Healthcare-Medicare Advantage, +151803,3934,P9047,"Infusion, albumin (human), 25%, 50 ml",CPT/HCPCS,371.04,371.04,180.0,1613.55,United Healthcare-Medicare Advantage, +151804,3934,P9059,"Fresh frozen plasma between 8-24 hours of collection, each unit",CPT/HCPCS,1826.71,1826.71,144.07,5196.0,United Healthcare-Medicare Advantage, +151805,3934,P9073,"Platelets, pheresis, pathogen-reduced, each unit",CPT/HCPCS,8477.34,8477.34,118.98,17486.88,United Healthcare-Medicare Advantage, +151806,3934,Q0161,"Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,39.51,39.51,1.96,172.09,United Healthcare-Medicare Advantage, +151807,3934,Q0162,"Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,111.65,111.65,0.03,346.7,United Healthcare-Medicare Advantage, +151808,3934,Q0163,"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.25,1.25,0.03,58.1,United Healthcare-Medicare Advantage, +151809,3934,Q0164,"Prochlorperazine maleate, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,1.84,1.84,0.59,1.84,United Healthcare-Medicare Advantage, +151810,3934,Q0166,"Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 24 hour dosage regimen",CPT/HCPCS,287.87,287.87,1.33,354.05,United Healthcare-Medicare Advantage, +151811,3934,Q0167,"Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,27.72,27.72,0.7,0.7,United Healthcare-Medicare Advantage, +151812,3934,Q0175,"Perphenazine, 4 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,9.65,9.65,0.21,11.79,United Healthcare-Medicare Advantage, +151813,3934,Q0177,"Hydroxyzine pamoate, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen",CPT/HCPCS,3.17,3.17,0.01,16.47,United Healthcare-Medicare Advantage, +151814,3934,Q0243,"Injection, casirivimab and imdevimab, 2400 mg",CPT/HCPCS,1.0,1.0,0.7,161.94,United Healthcare-Medicare Advantage, +151815,3934,Q0481,"Microprocessor control unit for use with electric ventricular assist device, replacement only",CPT/HCPCS,11000.0,11000.0,11000.0,11000.0,United Healthcare-Medicare Advantage, +151816,3934,Q0495,"Battery/power pack charger for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,14400.0,14400.0,4100.51,4100.51,United Healthcare-Medicare Advantage, +151817,3934,Q0497,"Battery clips for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,2750.0,2750.0,458.65,1100.0,United Healthcare-Medicare Advantage, +151818,3934,Q0506,"Battery, lithium-ion, for use with electric or electric/pneumatic ventricular assist device, replacement only",CPT/HCPCS,1309.52,1309.52,836.81,2510.43,United Healthcare-Medicare Advantage, +151819,3934,Q0508,Miscellaneous supply or accessory for use with an implanted ventricular assist device,CPT/HCPCS,62.09,62.09,6.0,20.0,United Healthcare-Medicare Advantage, +151820,3934,Q2009,"Injection, fosphenytoin, 50 mg phenytoin equivalent",CPT/HCPCS,567.28,567.28,1194.22,1194.22,United Healthcare-Medicare Advantage, +151821,3934,Q2050,"Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg",CPT/HCPCS,9926.51,9926.51,1154.21,13969.58,United Healthcare-Medicare Advantage, +151822,3934,Q4104,"Integra bilayer matrix wound dressing (bmwd), per square centimeter",CPT/HCPCS,2874.55,2874.55,985.15,4874.0,United Healthcare-Medicare Advantage, +151823,3934,Q4107,"Graftjacket, per square centimeter",CPT/HCPCS,6718.67,6718.67,995.3,7950.0,United Healthcare-Medicare Advantage, +151824,3934,Q4110,"Primatrix, per square centimeter",CPT/HCPCS,5231.5,5231.5,10395.0,10395.0,United Healthcare-Medicare Advantage, +151825,3934,Q4116,"Alloderm, per square centimeter",CPT/HCPCS,7791.83,7791.83,295.0,10125.43,United Healthcare-Medicare Advantage, +151826,3934,Q4130,"Strattice tm, per square centimeter",CPT/HCPCS,6561.0,6561.0,8748.0,8748.0,United Healthcare-Medicare Advantage, +151827,3934,Q4137,"Amnioexcel, amnioexcel plus or biodexcel, per square centimeter",CPT/HCPCS,2893.5,2893.5,174.0,3800.0,United Healthcare-Medicare Advantage, +151828,3934,Q4186,"Epifix, per square centimeter",CPT/HCPCS,3814.78,3814.78,1033.15,8364.0,United Healthcare-Medicare Advantage, +151829,3934,Q5101,"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram",CPT/HCPCS,888.87,888.87,0.34,987.69,United Healthcare-Medicare Advantage, +151830,3934,Q5103,"Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg",CPT/HCPCS,8395.66,8395.66,1362.65,13115.49,United Healthcare-Medicare Advantage, +151831,3934,Q5107,"Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg",CPT/HCPCS,6932.98,6932.98,271.52,7226.5,United Healthcare-Medicare Advantage, +151832,3934,Q5111,"Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg",CPT/HCPCS,10882.42,10882.42,321.85,15030.0,United Healthcare-Medicare Advantage, +151833,3934,Q9950,"Injection, sulfur hexafluoride lipid microspheres, per ml",CPT/HCPCS,578.0,578.0,202.3,202.3,United Healthcare-Medicare Advantage, +151834,3934,Q9956,"Injection, octafluoropropane microspheres, per ml",CPT/HCPCS,366.0,366.0,21.94,366.0,United Healthcare-Medicare Advantage, +151835,3934,Q9957,"Injection, perflutren lipid microspheres, per ml",CPT/HCPCS,364.34,364.34,18.11,364.0,United Healthcare-Medicare Advantage, +151836,3934,Q9963,"High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml",CPT/HCPCS,87.0,87.0,87.0,87.0,United Healthcare-Medicare Advantage, +151837,3934,Q9966,"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml",CPT/HCPCS,99.2,99.2,62.0,124.0,United Healthcare-Medicare Advantage, +151838,3934,Q9968,"Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg",CPT/HCPCS,847.73,847.73,188.28,3410.97,United Healthcare-Medicare Advantage, +151839,3934,S0073,"Injection, aztreonam, 500 mg",CPT/HCPCS,288.88,288.88,146.16,168.71,United Healthcare-Medicare Advantage, +151840,3934,S0077,"Injection, clindamycin phosphate, 300 mg",CPT/HCPCS,59.21,59.21,4.38,4382.85,United Healthcare-Medicare Advantage, +151841,3934,S0088,"Imatinib, 100 mg",CPT/HCPCS,5764.36,5764.36,5055.58,5055.58,United Healthcare-Medicare Advantage, +151842,3934,S0166,"Injection, olanzapine, 2.5 mg",CPT/HCPCS,98.92,98.92,85.53,85.53,United Healthcare-Medicare Advantage, +151843,3934,S2900,Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure),CPT/HCPCS,5398.37,5398.37,35.0,24804.32,United Healthcare-Medicare Advantage, +151844,3934,S9485,"Crisis intervention mental health services, per diem",CPT/HCPCS,2009.08,2009.08,458.71,2795.8,United Healthcare-Medicare Advantage, +151845,3934,U0001,CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel,CPT/HCPCS,103.01,103.01,0.12,812.78,United Healthcare-Medicare Advantage, +151846,3934,U0002,Currently selected code,CPT/HCPCS,238.2,238.2,43.61,405.19,United Healthcare-Medicare Advantage, +151847,3934,U0003,"Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,300.0,300.0,4.07,300.0,United Healthcare-Medicare Advantage, +151848,3934,U0004,"2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R",CPT/HCPCS,149.84,149.84,6.0,812.78,United Healthcare-Medicare Advantage, +151849,3934,U0005,"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2",CPT/HCPCS,50.05,50.05,2.0,75.0,United Healthcare-Medicare Advantage, +151850,3934,V2630,Anterior chamber intraocular lens,CPT/HCPCS,170.0,170.0,170.0,170.0,United Healthcare-Medicare Advantage, +151851,3934,V2632,Posterior chamber intraocular lens,CPT/HCPCS,332.62,332.62,51.65,684.0,United Healthcare-Medicare Advantage, +151852,3934,V2785,"Processing, preserving and transporting corneal tissue",CPT/HCPCS,6415.04,6415.04,1498.2,15200.0,United Healthcare-Medicare Advantage, +151853,3934,V2787,Astigmatism correcting function of intraocular lens,CPT/HCPCS,442.09,442.09,66.82,414.0,United Healthcare-Medicare Advantage, +151854,3934,V2788,Presbyopia correcting function of intraocular lens,CPT/HCPCS,990.97,990.97,661.0,1014.0,United Healthcare-Medicare Advantage, +151855,3934,V2790,"Amniotic membrane for surgical reconstruction, per procedure",CPT/HCPCS,1805.0,1805.0,1540.0,1590.0,United Healthcare-Medicare Advantage, +151856,3934,30000004,SEMI-PRIVATE,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151857,3934,30000012,PRIVATE,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151858,3934,30000020,MEDICALLY JUSTIFIED,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151859,3934,30000038,ICU,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151860,3934,30000046,BURN UNIT,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151861,3934,30000053,NICU,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151862,3934,30000061,ICR ROOM,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151863,3934,30000079,PSYCH,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151864,3934,30000087,NEWBORN,,4140.0,4140.0,,,United Healthcare-Medicare Advantage, +151865,3934,30100002,R&B REV SURG 19N,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151866,3934,30100101,R&B 19N PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151867,3934,30100119,R&B 19N PACKET FOR PT-W,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151868,3934,30100606,R&B 19N PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151869,3934,30100903,R&B 19N PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151870,3934,30101000,R&B REV SURG 19N PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151871,3934,30101059,19N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151872,3934,30102008,R&B REV SURG 19N PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151873,3934,30103006,R&B REV SURG 19N PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151874,3934,30103014,R&B REV SURG 19N PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151875,3934,30110001,R&B REV MED 12S2 PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151876,3934,30111009,R&B REV MED 12N2 PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151877,3934,30112007,R&B REV MED 12N2 PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151878,3934,30113005,R&B REV MED 12N2 PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151879,3934,30120000,R&B 05PS/11PS PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151880,3934,30121008,R&B 05PS/11PS PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151881,3934,30122006,R&B 05PS/11PS PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151882,3934,30123004,R&B 05PS/11PS PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151883,3934,30130009,R&B REV SHA 14HA PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151884,3934,30131007,R&B REV SHA 14HA PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151885,3934,30131056,14HA HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151886,3934,30132005,R&B REV SHA 14HA PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151887,3934,30133003,R&B REV SHA 14HA PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151888,3934,30133011,R&B REV SHA 14HA PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151889,3934,30141006,R&B REV MED 13N PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151890,3934,30141055,MRN HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151891,3934,30141105,R&B REV MED 13N PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151892,3934,30141204,R&B REV MED 13N PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151893,3934,30141303,R&B REV MED 13N PT-W,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151894,3934,30142004,R&B REV MED 13N PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151895,3934,30143002,R&B REV MED 13N PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151896,3934,30143010,R&B PEDS 06W2 - PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151897,3934,30147003,R&B REV MED 13N PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151898,3934,30147011,R&B REV MED 13N PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151899,3934,30150007,R&B REV MED 15N PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151900,3934,30150106,R&B 15N PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151901,3934,30150601,R&B 15N PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151902,3934,30150908,R&B 15N PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151903,3934,30151005,R&B REV MED 15N PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151904,3934,30151054,15N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151905,3934,30152003,R&B REV MED 15N PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151906,3934,30153001,R&B REV MED 15N PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151907,3934,30153019,R&B REV MED 15N PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151908,3934,30160006,R&B REV SURG 19S1,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151909,3934,30160105,R&B 09S PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151910,3934,30160600,R&B 09S PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151911,3934,30160907,R&B 09S PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151912,3934,30161004,R&B 09S PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151913,3934,30161053,09S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151914,3934,30162002,R&B 09S PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151915,3934,30163000,R&B 09S PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151916,3934,30163026,R&B 09S PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151917,3934,30170005,R&B REV MED 16N PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151918,3934,30171003,R&B REV MED 16N PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151919,3934,30171052,16N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151920,3934,30172001,R&B REV MED 16N PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151921,3934,30173009,R&B REV MED 16N PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151922,3934,30173017,R&B REV MED 16N PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151923,3934,30174007,R&B ICR W/TELEMETRY 16N PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151924,3934,30175004,R&B ICR ROOM 16N PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151925,3934,30176002,R&B ROOM W/TELEMETRY 16N PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151926,3934,30180004,R&B REV MED 16S PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151927,3934,30180103,R&B REV MED 16S PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151928,3934,30181002,R&B REV MED 16S PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151929,3934,30181051,16S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151930,3934,30182000,R&B REV MED 16S PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151931,3934,30183008,R&B REV MED 16S PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151932,3934,30184006,R&B ICR W/TELEMETRY 16S PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151933,3934,30185003,R&B ICR ROOM 16S PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151934,3934,30186001,R&B ROOM W/TELEMETRY 16S PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151935,3934,30190003,R&B REV SURG 18N,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151936,3934,30190102,R&B 18N PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151937,3934,30190607,R&B 18N PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151938,3934,30190904,R&B 18N PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151939,3934,30191001,R&B REV SURG 18N PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151940,3934,30191050,18N HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151941,3934,30191100,R&B REV SURG 18N PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151942,3934,30191209,R&B REV SURG 18N PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151943,3934,30192009,R&B REV SURG 18N PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151944,3934,30193007,R&B REV SURG 18N PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151945,3934,30197008,R&B REV SURG 18N PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151946,3934,30199103,R&B 05CH PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151947,3934,30199111,R&B 05CH PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151948,3934,30199129,R&B 05CH PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151949,3934,30199152,05CH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151950,3934,30199301,R&B 05CH PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151951,3934,30199400,R&B 05CH PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151952,3934,30199707,R&B 05CH PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151953,3934,30200000,R&B REV ORTHO 05L1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151954,3934,30201008,R&B REV ORTHO 14S PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151955,3934,30201057,14S HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151956,3934,30202006,R&B REV ORTHO 14S PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151957,3934,30203004,R&B REV ORTHO 14S PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151958,3934,30203012,R&B REV ORTHO 14S PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151959,3934,30210009,R&B REV GERI 15S3 PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151960,3934,30210108,R&B 15S3 PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151961,3934,30210603,R&B 15S3 PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151962,3934,30210900,R&B 15S3 PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151963,3934,30211007,R&B REV GERI 15S3 PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151964,3934,30212005,R&B REV GERI 15S3 PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151965,3934,30213003,R&B REV GERI 15S3 PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151966,3934,30221006,R&B 12S1 MEDICINE PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151967,3934,30221055,12S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151968,3934,30222004,R&B 12S1 MEDICINE PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151969,3934,30223002,R&B 12S1 MEDICINE PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151970,3934,30223010,R&B 12S1 MEDICINE PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151971,3934,30224000,12S1 ICR W/TELEMETRY TYPE=C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151972,3934,30225007,12S1 ICR ROOM TYPE=Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151973,3934,30226005,12S1 SEMI-PRIV.W/TELE.TYPE=M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151974,3934,30261002,R&B 18N OBSERVATION PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151975,3934,30261051,R&B 18N OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151976,3934,30262000,R&B 18N OBSERVATION PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151977,3934,30263008,R&B 18N OBSERVATION PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151978,3934,30264006,R&B 18N OBSERVATION PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151979,3934,30266001,R&B 18N OBSERVATION PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151980,3934,30310007,R&B REV MTU 12S3 PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151981,3934,30311005,R&B REV MTU 12S3 PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151982,3934,30312003,R&B REV MTU 12S3 PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151983,3934,30313001,R&B REV MTU 12S3 PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151984,3934,30320006,R&B REV EMER 04PT PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151985,3934,30321004,R&B REV EMER 04PT PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151986,3934,30321053,04PT HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151987,3934,30322002,R&B REV EMER 04PT PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +151988,3934,30323000,R&B REV EMER 04PT PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151989,3934,30324008,R&B REV EMER 04PT PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151990,3934,30333009,R&B ROPH PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151991,3934,30333058,ROPH HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151992,3934,30334007,R&B ROPH PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151993,3934,30351001,HICS - PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151994,3934,30351050,HICS HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151995,3934,30351100,HICS - PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151996,3934,30354005,HICS - PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +151997,3934,30357008,HICS - PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +151998,3934,30400006,R&B REV IMU 15S1 PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +151999,3934,30400105,R&B 15S1 PACKET FOR PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +152000,3934,30400600,R&B 15S1 PACKET FOR PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +152001,3934,30400907,R&B 15S1 PACKET FOR PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152002,3934,30401004,R&B REV IMU 15S1 PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152003,3934,30401053,15S1 HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152004,3934,30402002,R&B REV IMU 15S1 PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +152005,3934,30403000,R&B REV IMU 15S1 PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152006,3934,30403018,R&B REV IMU 15S1 PT-I,,12700.0,12700.0,,,United Healthcare-Medicare Advantage, +152007,3934,30500003,R&B REV 05CA PT-X,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152008,3934,30501001,R&B REV 05CA PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152009,3934,30502009,R&B REV 05CA PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +152010,3934,30503007,R&B REV 05CA PT-J,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152011,3934,30506000,R&B REV 05CA PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152012,3934,30507008,R&B REV 05CA PT-C,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +152013,3934,30511000,R&B REV 05SD PT-S,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152014,3934,30511059,05SD HOSP.OBSERVATION PT-T,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152015,3934,30511109,R&B REV 05SD PT-M,,7630.0,7630.0,,,United Healthcare-Medicare Advantage, +152016,3934,30511208,R&B REV 05SD PT-Z,,11300.0,11300.0,,,United Healthcare-Medicare Advantage, +152017,3934,30512008,R&B REV 05SD PT-P,,8380.0,8380.0,,,United Healthcare-Medicare Advantage, +152018,3934,30513006,R&B REV 05SD PT-J,,7630.0,7630.0,,,United 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Healthcare-Medicare Advantage, +152318,3934,33120007,TELEMETRY - 17SD,,443.0,443.0,,,United Healthcare-Medicare Advantage, +152319,3934,33150004,TELEMETRY - 17N,,479.0,479.0,,,United Healthcare-Medicare Advantage, +152320,3934,33180142,MTU LOW CMPLX OVN,,1310.0,1310.0,,,United Healthcare-Medicare Advantage, +152321,3934,33180159,MTU MOD CMPLX OVN,,1963.0,1963.0,,,United Healthcare-Medicare Advantage, +152322,3934,33180167,MTU HI CMPLX OVN,,2618.0,2618.0,,,United Healthcare-Medicare Advantage, +152323,3934,33180175,GCRC ROOM & BOARD,,4147.0,4147.0,,,United Healthcare-Medicare Advantage, +152324,3934,33187014,TELEMETRY - 17DI,,483.0,483.0,,,United Healthcare-Medicare Advantage, +152325,3934,37111986,SHOCK TRAUMA,,2748.0,2748.0,,,United Healthcare-Medicare Advantage, +152326,3934,37112000,ACUTE ED,,1580.0,1580.0,,,United Healthcare-Medicare Advantage, +152327,3934,37112026,IMMEDIATE CARE,,459.0,459.0,,,United Healthcare-Medicare Advantage, +152328,3934,37112034,TRIAGE,,277.0,277.0,,,United Healthcare-Medicare Advantage, +152329,3934,37116183,SHOCK TRAUMA II,,3383.0,3383.0,,,United Healthcare-Medicare Advantage, +152330,3934,37116209,TRAUMA CODE,,29875.0,29875.0,,,United Healthcare-Medicare Advantage, +152331,3934,37116217,TRAUMA CODE,,15506.0,15506.0,,,United Healthcare-Medicare Advantage, +152332,3934,39150016,HOME TRN HEMODIAL,,808.0,808.0,,,United Healthcare-Medicare Advantage, +152333,3934,40100174,LDR DELIVERY-SPONTANEOUS,,2821.0,2821.0,,,United Healthcare-Medicare Advantage, +152334,3934,40100448,LDR DELIVERY-FORCEPS & VACUUM,,2358.0,2358.0,,,United Healthcare-Medicare Advantage, +152335,3934,40100455,LDR DELIVERY-VACUUM,,2358.0,2358.0,,,United Healthcare-Medicare Advantage, +152336,3934,40100463,LDR DELIVERY-FORCEPS,,2358.0,2358.0,,,United Healthcare-Medicare Advantage, +152337,3934,40100471,LDR DELIVERY-VAGINAL BREECH,,2358.0,2358.0,,,United Healthcare-Medicare Advantage, +152338,3934,40100703,OB/GYN O.R..5HR,,3937.0,3937.0,,,United Healthcare-Medicare Advantage, +152339,3934,40100711,OB/GYN O.R.1HR,,4499.0,4499.0,,,United Healthcare-Medicare Advantage, +152340,3934,40100729,OB/GYN O.R.1.5HR,,4633.0,4633.0,,,United Healthcare-Medicare Advantage, +152341,3934,40100737,OB/GYN O.R.2HRS,,4983.0,4983.0,,,United Healthcare-Medicare Advantage, +152342,3934,40100745,RECOVERY RM 2HRS,,1816.0,1816.0,,,United Healthcare-Medicare Advantage, +152343,3934,40100760,RECOVERY RM 4HRS,,2080.0,2080.0,,,United Healthcare-Medicare Advantage, +152344,3934,40100778,RECOVERY RM 6HRS,,2427.0,2427.0,,,United Healthcare-Medicare Advantage, +152345,3934,40100786,RECOVERY RM 8HRS,,2777.0,2777.0,,,United Healthcare-Medicare Advantage, +152346,3934,40100992,OB/GYN OR 2.5HRS,,5332.0,5332.0,,,United Healthcare-Medicare Advantage, +152347,3934,40101008,OB/GYN OR 3HRS,,5681.0,5681.0,,,United Healthcare-Medicare Advantage, +152348,3934,40101016,OB/GYN OR 3.5HRS,,6031.0,6031.0,,,United Healthcare-Medicare Advantage, +152349,3934,40101024,OB/GYN OR 4HRS,,6377.0,6377.0,,,United Healthcare-Medicare Advantage, +152350,3934,40101032,RECOVERY RM 10HRS,,3125.0,3125.0,,,United Healthcare-Medicare Advantage, +152351,3934,40101040,RECOVERY RM 12HRS,,3476.0,3476.0,,,United Healthcare-Medicare Advantage, +152352,3934,40101057,RECOVERY RM 14HRS,,3822.0,3822.0,,,United Healthcare-Medicare Advantage, +152353,3934,40101065,RECOVERY RM 16HRS,,4172.0,4172.0,,,United Healthcare-Medicare Advantage, +152354,3934,40101073,RECOVERY RM 18HRS,,4519.0,4519.0,,,United Healthcare-Medicare Advantage, +152355,3934,40101081,RECOVERY RM 20HRS,,4871.0,4871.0,,,United Healthcare-Medicare Advantage, +152356,3934,40101099,RECOVERY RM 22HRS,,5218.0,5218.0,,,United Healthcare-Medicare Advantage, +152357,3934,40101107,RECOVERY RM 24HRS,,5568.0,5568.0,,,United Healthcare-Medicare Advantage, +152358,3934,40110116,RECOVERY RM 0.5H,,1648.0,1648.0,,,United Healthcare-Medicare Advantage, +152359,3934,40110124,RECOVERY RM 1 H,,1691.0,1691.0,,,United Healthcare-Medicare Advantage, +152360,3934,40110132,RECOVERY RM 1.5H,,1734.0,1734.0,,,United Healthcare-Medicare Advantage, +152361,3934,40470130,OR CHARGE 6.5 HRS,,18371.0,18371.0,,,United Healthcare-Medicare Advantage, +152362,3934,40470254,OR MINUTE CHARGE,,102.0,102.0,,,United Healthcare-Medicare Advantage, +152363,3934,40480253,BONE MARROW HARVEST,,12401.0,12401.0,,,United Healthcare-Medicare Advantage, +152364,3934,40600538,MOR RECOVERY MIN,,30.0,30.0,,,United Healthcare-Medicare Advantage, +152365,3934,42133678,MICROALBUMIN-RANDOM URINE,,249.0,249.0,,,United Healthcare-Medicare Advantage, +152366,3934,42152215,INFLUENZA&RSV PCR,,593.0,593.0,,,United Healthcare-Medicare Advantage, +152367,3934,42171330,BLOOD TYPE & ANTIBODY SCREEN,,542.0,542.0,,,United Healthcare-Medicare Advantage, +152368,3934,42171348,CORD BLOOD TYPING,,339.0,339.0,,,United Healthcare-Medicare Advantage, +152369,3934,42171355,PRENATAL BLOOD TYPE & SCREEN,,542.0,542.0,,,United Healthcare-Medicare Advantage, +152370,3934,42321240,CHROMOSOME ANALYSIS-TUMOR,,3182.0,3182.0,,,United Healthcare-Medicare Advantage, +152371,3934,42321265,CHROM ANAL LYMPHO,,3182.0,3182.0,,,United Healthcare-Medicare Advantage, +152372,3934,42391516,INSTITUT/RENAL BIOPSY,,2230.0,2230.0,,,United Healthcare-Medicare Advantage, +152373,3934,42391540,INST/OUTSIDE SLIDES,,387.0,387.0,,,United Healthcare-Medicare Advantage, +152374,3934,42391565,INSTITUTION/LYMPH NODE,,1476.0,1476.0,,,United Healthcare-Medicare Advantage, +152375,3934,42391573,INSTITUTION/MUSCLE BX,,2005.0,2005.0,,,United Healthcare-Medicare Advantage, +152376,3934,42391581,INSTITUTION/NERVE BX,,2644.0,2644.0,,,United Healthcare-Medicare Advantage, +152377,3934,42391607,INST/LEUKEMIA WORKUP,,1243.0,1243.0,,,United Healthcare-Medicare Advantage, +152378,3934,42391615,INSTITUTION/LIVER,,781.0,781.0,,,United Healthcare-Medicare Advantage, +152379,3934,42391623,INSTITUTION/BONE MAR,,933.0,933.0,,,United Healthcare-Medicare Advantage, +152380,3934,42391631,INSTITUTION/CNS SPEC,,1552.0,1552.0,,,United Healthcare-Medicare Advantage, +152381,3934,42391649,INSTITUTION/ELECTRON,,1450.0,1450.0,,,United Healthcare-Medicare Advantage, +152382,3934,42392316,INST/MD PANEL,,2556.0,2556.0,,,United Healthcare-Medicare Advantage, +152383,3934,42392324,INST/DET/CYTOCHEM,,302.0,302.0,,,United Healthcare-Medicare Advantage, +152384,3934,42392332,INST/IMMHIST/EAAB,,257.0,257.0,,,United Healthcare-Medicare Advantage, +152385,3934,42392340,INST/SPEC.STAINII,,101.0,101.0,,,United Healthcare-Medicare Advantage, +152386,3934,43108208,CATH LAB .5HR,,12162.0,12162.0,,,United Healthcare-Medicare Advantage, +152387,3934,43108216,CATH LAB 1HR,,14026.0,14026.0,,,United Healthcare-Medicare Advantage, +152388,3934,43108224,CATH LAB 1.5HR,,15884.0,15884.0,,,United Healthcare-Medicare Advantage, +152389,3934,43108232,CATH LAB 2HR,,17745.0,17745.0,,,United Healthcare-Medicare Advantage, +152390,3934,43108240,CATH LAB 2.5HR,,19606.0,19606.0,,,United Healthcare-Medicare Advantage, +152391,3934,43108257,CATH LAB 3HR,,21468.0,21468.0,,,United Healthcare-Medicare Advantage, +152392,3934,43108265,CATH LAB 3.5HR,,23329.0,23329.0,,,United Healthcare-Medicare Advantage, +152393,3934,43108273,CATH LAB 4HR,,25190.0,25190.0,,,United Healthcare-Medicare Advantage, +152394,3934,43108281,CATH LAB 4.5HR,,27052.0,27052.0,,,United Healthcare-Medicare Advantage, +152395,3934,43108299,CATH LAB 5HR,,28912.0,28912.0,,,United Healthcare-Medicare Advantage, +152396,3934,43108307,CATH LAB 5.5HR,,30771.0,30771.0,,,United Healthcare-Medicare Advantage, +152397,3934,43108315,CATH LAB 6HR,,32634.0,32634.0,,,United Healthcare-Medicare Advantage, +152398,3934,43108323,CATH LAB 6.5HR,,34495.0,34495.0,,,United Healthcare-Medicare Advantage, +152399,3934,43108331,CATH LAB 7HR,,36360.0,36360.0,,,United Healthcare-Medicare Advantage, +152400,3934,43108349,CATH LAB 7.5HR,,38219.0,38219.0,,,United Healthcare-Medicare Advantage, +152401,3934,43108356,CATH LAB 8HR,,40078.0,40078.0,,,United Healthcare-Medicare Advantage, +152402,3934,43108364,CATH LAB 8.5HR,,41939.0,41939.0,,,United Healthcare-Medicare Advantage, +152403,3934,43108372,CATH LAB 9HR,,43800.0,43800.0,,,United Healthcare-Medicare Advantage, +152404,3934,43108380,CATH LAB 9.5HR,,45660.0,45660.0,,,United Healthcare-Medicare Advantage, +152405,3934,43108398,CATH LAB 10HR,,47520.0,47520.0,,,United Healthcare-Medicare Advantage, +152406,3934,43125020,CATH LAB 11HR,,49383.0,49383.0,,,United Healthcare-Medicare Advantage, +152407,3934,43152644,EP LAB .5HR,,12162.0,12162.0,,,United Healthcare-Medicare Advantage, +152408,3934,43152651,EP LAB 1HR,,14026.0,14026.0,,,United Healthcare-Medicare Advantage, +152409,3934,43152669,EP LAB 1.5HR,,15884.0,15884.0,,,United Healthcare-Medicare Advantage, +152410,3934,43152677,EP LAB 2HR,,17745.0,17745.0,,,United Healthcare-Medicare Advantage, +152411,3934,43152685,EP LAB 2.5HR,,19606.0,19606.0,,,United Healthcare-Medicare Advantage, +152412,3934,43152693,EP LAB 3HR,,21468.0,21468.0,,,United Healthcare-Medicare Advantage, +152413,3934,43152701,EP LAB 3.5HR,,23329.0,23329.0,,,United Healthcare-Medicare Advantage, +152414,3934,43152719,EP LAB 4HR,,25190.0,25190.0,,,United Healthcare-Medicare Advantage, +152415,3934,43152727,EP LAB 4.5HR,,27052.0,27052.0,,,United Healthcare-Medicare Advantage, +152416,3934,43152735,EP LAB 5HR,,28912.0,28912.0,,,United Healthcare-Medicare Advantage, +152417,3934,43152743,EP LAB 5.5HR,,30771.0,30771.0,,,United Healthcare-Medicare Advantage, +152418,3934,43152750,EP LAB 6HR,,32634.0,32634.0,,,United Healthcare-Medicare Advantage, +152419,3934,43152768,EP LAB 6.5HR,,34495.0,34495.0,,,United Healthcare-Medicare Advantage, +152420,3934,43152776,EP LAB 7HR,,36360.0,36360.0,,,United Healthcare-Medicare Advantage, +152421,3934,43152784,EP LAB 7.5HR,,38219.0,38219.0,,,United Healthcare-Medicare Advantage, +152422,3934,43152792,EP LAB 8HR,,40078.0,40078.0,,,United Healthcare-Medicare Advantage, +152423,3934,43152800,EP LAB 8.5HR,,41939.0,41939.0,,,United Healthcare-Medicare Advantage, +152424,3934,43152818,EP LAB 9HR,,43800.0,43800.0,,,United Healthcare-Medicare Advantage, +152425,3934,43152826,EP LAB 9.5HR,,45660.0,45660.0,,,United Healthcare-Medicare Advantage, +152426,3934,43152834,EP LAB 10HR,,47520.0,47520.0,,,United Healthcare-Medicare Advantage, +152427,3934,43152842,EP LAB 11HR,,49383.0,49383.0,,,United Healthcare-Medicare Advantage, +152428,3934,43275791,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicare Advantage, +152429,3934,43275809,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152430,3934,43275817,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152431,3934,43275825,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152432,3934,43275833,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152433,3934,43275841,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152434,3934,43294008,PROC RM .5HR.,,2015.0,2015.0,,,United Healthcare-Medicare Advantage, +152435,3934,43294016,PROC RM 1HR.,,2877.0,2877.0,,,United Healthcare-Medicare Advantage, +152436,3934,43294024,PROC RM 1.5HRS,,3740.0,3740.0,,,United Healthcare-Medicare Advantage, +152437,3934,43294032,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152438,3934,43294040,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152439,3934,43294057,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152440,3934,43294065,PROC RM 3.5HRS,,6251.0,6251.0,,,United Healthcare-Medicare Advantage, +152441,3934,43294073,PROC RM 4HRS,,7002.0,7002.0,,,United Healthcare-Medicare Advantage, +152442,3934,43294081,PROC RM 4.5HRS,,7753.0,7753.0,,,United Healthcare-Medicare Advantage, +152443,3934,43294099,PROC RM 5HRS,,8502.0,8502.0,,,United Healthcare-Medicare Advantage, +152444,3934,43294107,PROC RM 5.5HRS,,8877.0,8877.0,,,United Healthcare-Medicare Advantage, +152445,3934,43294115,PROC RM 6HRS,,9256.0,9256.0,,,United Healthcare-Medicare Advantage, +152446,3934,43294123,PROC RM 6.5HRS,,9630.0,9630.0,,,United Healthcare-Medicare Advantage, +152447,3934,43294131,PORC RM 7HRS,,10003.0,10003.0,,,United Healthcare-Medicare Advantage, +152448,3934,43294149,PROC RM 7.5HRS,,10376.0,10376.0,,,United Healthcare-Medicare Advantage, +152449,3934,43294156,PROC RM 8HRS,,10757.0,10757.0,,,United Healthcare-Medicare Advantage, +152450,3934,43294164,PROC RM 8.5HRS,,11128.0,11128.0,,,United Healthcare-Medicare Advantage, +152451,3934,43294172,PROC RM 9HRS,,11501.0,11501.0,,,United Healthcare-Medicare Advantage, +152452,3934,43294180,PROC RM 9.5HRS,,11876.0,11876.0,,,United Healthcare-Medicare Advantage, +152453,3934,43294198,PROC RM 10HRS,,12256.0,12256.0,,,United Healthcare-Medicare Advantage, +152454,3934,43294206,PROC RM 10.5HRS,,12632.0,12632.0,,,United Healthcare-Medicare Advantage, +152455,3934,43294214,PROC RM 11HRS,,13006.0,13006.0,,,United Healthcare-Medicare Advantage, +152456,3934,43294222,PROC RM 11.5HRS,,13378.0,13378.0,,,United Healthcare-Medicare Advantage, +152457,3934,43294230,PROC RM 12HRS,,13756.0,13756.0,,,United Healthcare-Medicare Advantage, +152458,3934,43301043,ALBUNEX,,357.0,357.0,,,United Healthcare-Medicare Advantage, +152459,3934,43301399,PROC RM .5HR,,2015.0,2015.0,,,United Healthcare-Medicare Advantage, +152460,3934,43301407,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152461,3934,43301415,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152462,3934,43301423,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152463,3934,43301431,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152464,3934,43301449,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152465,3934,43354364,RAD SPECIAL PM,,49.0,49.0,,,United Healthcare-Medicare Advantage, +152466,3934,43450022,REC RM .5HR,,541.0,541.0,,,United Healthcare-Medicare Advantage, +152467,3934,43450030,REC RM 1HR,,1242.0,1242.0,,,United Healthcare-Medicare Advantage, +152468,3934,43450048,REC RM 1.5HRS,,1622.0,1622.0,,,United Healthcare-Medicare Advantage, +152469,3934,43450055,REC RM 2HRS,,2164.0,2164.0,,,United Healthcare-Medicare Advantage, +152470,3934,43450063,REC RM 2.5HRS,,2702.0,2702.0,,,United Healthcare-Medicare Advantage, +152471,3934,43450071,REC RM 3HRS,,3242.0,3242.0,,,United Healthcare-Medicare Advantage, +152472,3934,43450089,REC RM 3.5HRS,,3784.0,3784.0,,,United Healthcare-Medicare Advantage, +152473,3934,43450097,REC RM 4HRS,,4324.0,4324.0,,,United Healthcare-Medicare Advantage, +152474,3934,43450105,REC RM 4.5HRS,,4866.0,4866.0,,,United Healthcare-Medicare Advantage, +152475,3934,43450113,REC RM 5HRS,,5405.0,5405.0,,,United Healthcare-Medicare Advantage, +152476,3934,43450121,REC RM 5.5HRS,,5947.0,5947.0,,,United Healthcare-Medicare Advantage, +152477,3934,43450139,REC RM 6HRS,,6491.0,6491.0,,,United Healthcare-Medicare Advantage, +152478,3934,43450147,REC RM 6.5HRS,,7030.0,7030.0,,,United Healthcare-Medicare Advantage, +152479,3934,43450154,REC RM 7HRS,,7571.0,7571.0,,,United Healthcare-Medicare Advantage, +152480,3934,43450162,REC RM 7.5HRS,,8108.0,8108.0,,,United Healthcare-Medicare Advantage, +152481,3934,43450170,REC RM 8HRS,,8652.0,8652.0,,,United Healthcare-Medicare Advantage, +152482,3934,43450188,RAD OP HOLDING,,20.0,20.0,,,United Healthcare-Medicare Advantage, +152483,3934,43462621,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicare Advantage, +152484,3934,43462639,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152485,3934,43462647,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152486,3934,43462654,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152487,3934,43462662,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152488,3934,43462670,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152489,3934,43463173,CT:ANTHROPOLOGY,,72.0,72.0,,,United Healthcare-Medicare Advantage, +152490,3934,43883941,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152491,3934,43883958,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicare Advantage, +152492,3934,43883966,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152493,3934,43883974,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152494,3934,43883982,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152495,3934,43883990,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152496,3934,43901487,CT:ANTHROPOLOGY,,67.0,67.0,,,United Healthcare-Medicare Advantage, +152497,3934,43913169,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicare Advantage, +152498,3934,43913177,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152499,3934,43913185,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152500,3934,43913193,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152501,3934,43913201,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152502,3934,43913219,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152503,3934,43931419,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicare Advantage, +152504,3934,43931427,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152505,3934,43931435,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152506,3934,43931443,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152507,3934,43931450,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152508,3934,43931468,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152509,3934,43940774,PET MR RES TIME .5HR,,855.0,855.0,,,United Healthcare-Medicare Advantage, +152510,3934,43940782,PET MR RES TIME 1HR,,1710.0,1710.0,,,United Healthcare-Medicare Advantage, +152511,3934,43940790,PET MR RES TIME 1.5HR,,2565.0,2565.0,,,United Healthcare-Medicare Advantage, +152512,3934,43940808,PET MR RES TIME 2HR,,3418.0,3418.0,,,United Healthcare-Medicare Advantage, +152513,3934,43940816,PET MR RES TIME 2.5HR,,4273.0,4273.0,,,United Healthcare-Medicare Advantage, +152514,3934,43940824,PET MR RES TIME 3HR,,5126.0,5126.0,,,United Healthcare-Medicare Advantage, +152515,3934,43940832,PET MR RES TIME 3.5HR,,5982.0,5982.0,,,United Healthcare-Medicare Advantage, +152516,3934,43940840,PET MR RES TIME 4HR,,6836.0,6836.0,,,United Healthcare-Medicare Advantage, +152517,3934,43950633,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicare Advantage, +152518,3934,43950641,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152519,3934,43950658,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152520,3934,43950666,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152521,3934,43950674,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152522,3934,43950682,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152523,3934,43959014,ACP PX ROOM-15M,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152524,3934,43959022,ACP PX RM-ADD 15M,,375.0,375.0,,,United Healthcare-Medicare Advantage, +152525,3934,45102837,PT EXMAINTAIN 1MO,,198.0,198.0,,,United Healthcare-Medicare Advantage, +152526,3934,45102845,PT EXMAINTAIN 3MO,,546.0,546.0,,,United Healthcare-Medicare Advantage, +152527,3934,45102878,THERAPEUTIC YOGA,,40.0,40.0,,,United Healthcare-Medicare Advantage, +152528,3934,45845443,ACP ENDO PROC STE,,174.0,174.0,,,United Healthcare-Medicare Advantage, +152529,3934,45845450,ACP ENDO REC RM,,30.0,30.0,,,United Healthcare-Medicare Advantage, +152530,3934,45921798,PRO SUITE .5HR,,5207.0,5207.0,,,United Healthcare-Medicare Advantage, +152531,3934,45921806,PRO SUITE 1HR,,6213.0,6213.0,,,United Healthcare-Medicare Advantage, +152532,3934,45921814,PRO SUITE 1.5HR,,6276.0,6276.0,,,United Healthcare-Medicare Advantage, +152533,3934,45921822,PRO SUITE 2HR,,7145.0,7145.0,,,United Healthcare-Medicare Advantage, +152534,3934,45921830,PRO SUITE 2.5HR,,8018.0,8018.0,,,United Healthcare-Medicare Advantage, +152535,3934,45921848,PRO SUITE 3HR,,8892.0,8892.0,,,United Healthcare-Medicare Advantage, +152536,3934,45921855,PRO SUITE 3.5HR,,9763.0,9763.0,,,United Healthcare-Medicare Advantage, +152537,3934,45921863,PRO SUITE 4HR,,10634.0,10634.0,,,United Healthcare-Medicare Advantage, +152538,3934,45921871,PRO SUITE 5HR,,11510.0,11510.0,,,United Healthcare-Medicare Advantage, +152539,3934,45921889,PRO SUITE 6HR,,12383.0,12383.0,,,United Healthcare-Medicare Advantage, +152540,3934,45921897,PRO SUITE 7HR,,13254.0,13254.0,,,United Healthcare-Medicare Advantage, +152541,3934,45922366,RECOVERY RM-30MIN,,836.0,836.0,,,United Healthcare-Medicare Advantage, +152542,3934,45922788,PRO STE .5HR W L,,8335.0,8335.0,,,United Healthcare-Medicare Advantage, +152543,3934,45922796,PRO STE 1HR W L,,9342.0,9342.0,,,United Healthcare-Medicare Advantage, +152544,3934,45922804,PRO STE 1.5HR W L,,9403.0,9403.0,,,United Healthcare-Medicare Advantage, +152545,3934,45922812,PRO STE 2HR W L,,10276.0,10276.0,,,United Healthcare-Medicare Advantage, +152546,3934,45922820,PRO STE 2.5HR W L,,11147.0,11147.0,,,United Healthcare-Medicare Advantage, +152547,3934,45922838,PRO STE 3HR W L,,12019.0,12019.0,,,United Healthcare-Medicare Advantage, +152548,3934,45922846,PRO STE 3.5HR W L,,12894.0,12894.0,,,United Healthcare-Medicare Advantage, +152549,3934,45922853,PRO STE 4HR W L,,13767.0,13767.0,,,United Healthcare-Medicare Advantage, +152550,3934,45922861,PRO STE 5HR W L,,14637.0,14637.0,,,United Healthcare-Medicare Advantage, +152551,3934,45922879,PRO STE 6HR W L,,15511.0,15511.0,,,United Healthcare-Medicare Advantage, +152552,3934,45922887,PRO STE 7HR W L,,16384.0,16384.0,,,United Healthcare-Medicare Advantage, +152553,3934,45924370,ENT SUITE .5HR,,5207.0,5207.0,,,United Healthcare-Medicare Advantage, +152554,3934,45924388,ENT SUITE 45 MIN,,5711.0,5711.0,,,United Healthcare-Medicare Advantage, +152555,3934,45924396,ENT SUITE 1HR,,6213.0,6213.0,,,United Healthcare-Medicare Advantage, +152556,3934,45924404,ENT SUITE 1HR15MN,,6719.0,6719.0,,,United Healthcare-Medicare Advantage, +152557,3934,45924412,ENT SUITE 1.5HR,,7223.0,7223.0,,,United Healthcare-Medicare Advantage, +152558,3934,45924420,ENT SUITE 1HR45MN,,7725.0,7725.0,,,United Healthcare-Medicare Advantage, +152559,3934,45924438,ENT SUITE 2HR,,8227.0,8227.0,,,United Healthcare-Medicare Advantage, +152560,3934,45924537,OBERA PLACE/RETRV,,1432.0,1432.0,,,United Healthcare-Medicare Advantage, +152561,3934,45924545,ENDO PROC SUITE,,174.0,174.0,,,United Healthcare-Medicare Advantage, +152562,3934,45924552,ENDO REC RM,,30.0,30.0,,,United Healthcare-Medicare Advantage, +152563,3934,45932969,TELEMETRY-PER DAY,,1289.0,1289.0,,,United Healthcare-Medicare Advantage, +152564,3934,45970019,RECOVERY RM-1HR,,994.0,994.0,,,United Healthcare-Medicare Advantage, +152565,3934,45970027,RECOVERY RM-1.5HR,,1000.0,1000.0,,,United Healthcare-Medicare Advantage, +152566,3934,45970035,RECOVERY RM-2HR,,1141.0,1141.0,,,United Healthcare-Medicare Advantage, +152567,3934,45970043,RECOVERY RM 2.5HR,,1280.0,1280.0,,,United Healthcare-Medicare Advantage, +152568,3934,45970050,RECOVERY RM-3HR,,1421.0,1421.0,,,United Healthcare-Medicare Advantage, +152569,3934,45970068,RECOVERY RM-3.5HR,,1559.0,1559.0,,,United Healthcare-Medicare Advantage, +152570,3934,45970076,RECOVERY RM-4HR,,1702.0,1702.0,,,United Healthcare-Medicare Advantage, +152571,3934,45970084,RECOVERY RM-4.5HR,,1837.0,1837.0,,,United Healthcare-Medicare Advantage, +152572,3934,45970092,RECOVERY RM-5HR,,1982.0,1982.0,,,United Healthcare-Medicare Advantage, +152573,3934,45970100,RECOVERY RM-5.5HR,,2121.0,2121.0,,,United Healthcare-Medicare Advantage, +152574,3934,45970118,RECOVERY RM-6HR,,2260.0,2260.0,,,United Healthcare-Medicare Advantage, +152575,3934,45970126,RECOVERY RM-6.5HR,,2400.0,2400.0,,,United Healthcare-Medicare Advantage, +152576,3934,45970134,RECOVERY RM-7HR,,2536.0,2536.0,,,United Healthcare-Medicare Advantage, +152577,3934,45970142,RECOVEY RM-7.5HR,,2678.0,2678.0,,,United Healthcare-Medicare Advantage, +152578,3934,45970159,RECOVERY RM-8HR,,2818.0,2818.0,,,United Healthcare-Medicare Advantage, +152579,3934,46113676,CV MINUTE CHARGE,,59.0,59.0,,,United Healthcare-Medicare Advantage, +152580,3934,47190061,HEMOPERFUS W/CHAR,,2311.0,2311.0,,,United Healthcare-Medicare Advantage, +152581,3934,47190103,CAVH W/WO DISLYSIS,,2311.0,2311.0,,,United Healthcare-Medicare Advantage, +152582,3934,47190111,CVVH W/WO DIALYSIS,,2311.0,2311.0,,,United Healthcare-Medicare Advantage, +152583,3934,47300017,KIDNEY ACQ LV DON,,139427.0,139427.0,,,United Healthcare-Medicare Advantage, +152584,3934,47300025,KIDNEY ACQ CADAVR,,111543.0,111543.0,,,United Healthcare-Medicare Advantage, +152585,3934,47310016,KIDNEY UNKWN DON,,96994.0,96994.0,,,United Healthcare-Medicare Advantage, +152586,3934,47500020,CORNEA ACQUIS CHG,,3119.0,3119.0,,,United Healthcare-Medicare Advantage, +152587,3934,47500038,LIVE SKIN ACQUIS,,2427.0,2427.0,,,United Healthcare-Medicare Advantage, +152588,3934,47500046,LIVER RETRIEVAL,,20784.0,20784.0,,,United Healthcare-Medicare Advantage, +152589,3934,49102346,PROC RM .5HR,,1753.0,1753.0,,,United Healthcare-Medicare Advantage, +152590,3934,49102353,PROC RM 1HR,,2502.0,2502.0,,,United Healthcare-Medicare Advantage, +152591,3934,49102361,PROC RM 1.5HRS,,3253.0,3253.0,,,United Healthcare-Medicare Advantage, +152592,3934,49102379,PROC RM 2HRS,,4002.0,4002.0,,,United Healthcare-Medicare Advantage, +152593,3934,49102387,PROC RM 2.5HRS,,4755.0,4755.0,,,United Healthcare-Medicare Advantage, +152594,3934,49102395,PROC RM 3HRS,,5502.0,5502.0,,,United Healthcare-Medicare Advantage, +152595,3934,49104334,MRV:RUE W/CON,,5809.0,5809.0,,,United Healthcare-Medicare Advantage, +152596,3934,53200010,GUEST TRAY,,24.0,24.0,,,United Healthcare-Medicare Advantage, +152597,3934,53200028,OUTPATIENT MEAL,,11.0,11.0,,,United Healthcare-Medicare Advantage, +152598,3934,53309662,ONCOLOGY VISIT,,185.0,185.0,,,United Healthcare-Medicare Advantage, +152599,3934,53309670,DIALYSIS VISIT,,413.0,413.0,,,United Healthcare-Medicare Advantage, +152600,3934,53309688,SPEECH THER VISIT,,231.0,231.0,,,United Healthcare-Medicare Advantage, +152601,3934,53329447,INFUSION TX-CHEMO,,438.0,438.0,,,United Healthcare-Medicare Advantage, +152602,3934,53329835,HIV COUNSELLING AND TESTING,,242.0,242.0,,,United Healthcare-Medicare Advantage, +152603,3934,53329843,HIV POST TEST NEGATIVE,,199.0,199.0,,,United Healthcare-Medicare Advantage, +152604,3934,53329850,COMPREHENSIVE MED. EXAM. ASYMP,,550.0,550.0,,,United Healthcare-Medicare Advantage, +152605,3934,53329876,HIV MONITORING,,416.0,416.0,,,United Healthcare-Medicare Advantage, +152606,3934,53331112,HIV POST TEST POSITIVE,,242.0,242.0,,,United Healthcare-Medicare Advantage, +152607,3934,53331120,BLOOD TX 1 UNIT,,562.0,562.0,,,United Healthcare-Medicare Advantage, +152608,3934,53331138,BLOOD TX 2 UNITS,,820.0,820.0,,,United Healthcare-Medicare Advantage, +152609,3934,53331146,BLOOD TX 3 UNITS,,1060.0,1060.0,,,United Healthcare-Medicare Advantage, +152610,3934,53331153,BLOOD TX 4 UNITS,,1327.0,1327.0,,,United Healthcare-Medicare Advantage, +152611,3934,55215925,UPST EL-CORNEA OD,,7996.0,7996.0,,,United Healthcare-Medicare Advantage, +152612,3934,55433676,FEMTOSECOND LASER,,870.0,870.0,,,United Healthcare-Medicare Advantage, +152613,3934,74510652,MOP PX ROOM - 15M,,2175.0,2175.0,,,United Healthcare-Medicare Advantage, +152614,3934,74510660,MOP PX RM-ADD 15M,,325.0,325.0,,,United Healthcare-Medicare Advantage, +152615,3934,76010107,COPY X-RAY,,22.0,22.0,,,United Healthcare-Medicare Advantage, +152616,3934,76011170,BC PROC RM 120 M,,5921.0,5921.0,,,United Healthcare-Medicare Advantage, +152617,3934,76011188,BC PROC RM 30 M,,3397.0,3397.0,,,United Healthcare-Medicare Advantage, +152618,3934,76011196,BC PROC RM 60 M,,4535.0,4535.0,,,United Healthcare-Medicare Advantage, +152619,3934,76011204,BC PROC RM 90 M,,4933.0,4933.0,,,United Healthcare-Medicare Advantage, +152620,3934,76011394,BC PROC RM 150MIN,,6908.0,6908.0,,,United Healthcare-Medicare Advantage, +152621,3934,76011402,BC PROC RM 180MIN,,7898.0,7898.0,,,United Healthcare-Medicare Advantage, +152622,3934,76011410,BC PROC RM 210MIN,,8887.0,8887.0,,,United Healthcare-Medicare Advantage, +152623,3934,76011428,BC PROC RM 240MIN,,9875.0,9875.0,,,United Healthcare-Medicare Advantage, +152624,3934,76011436,BC PROC RM 270MIN,,10863.0,10863.0,,,United Healthcare-Medicare Advantage, +152625,3934,76900026,PEDIATRIC PX ROOM,,7505.0,7505.0,,,United Healthcare-Medicare Advantage, +152626,3934,76901040,PSP PROCEDURE MINUTE,,87.0,87.0,,,United Healthcare-Medicare Advantage, +152627,3934,76901057,PSP RECOVERY MINUTE,,17.0,17.0,,,United Healthcare-Medicare Advantage, diff --git a/transformation/dataFiles/homework/cleaning.py b/transformation/dataFiles/homework/cleaning.py new file mode 100644 index 0000000..24e633b --- /dev/null +++ b/transformation/dataFiles/homework/cleaning.py @@ -0,0 +1,3 @@ +import pandas as pd + +df = pd.read_excel('/Users/hantswilliams/Downloads/FoodAccessResearchAtlasData2019.xlsx') \ No newline at end of file diff --git a/transformation/pyScripts/p1_cleaningTemplate.py b/transformation/pyScripts/p1_cleaningTemplate.py index 3b64923..0963eb6 100644 --- a/transformation/pyScripts/p1_cleaningTemplate.py +++ b/transformation/pyScripts/p1_cleaningTemplate.py @@ -3,9 +3,11 @@ import uuid import numpy as np + # load in messy data df = pd.read_csv('transformation/dataFiles/raw/113243405_StonyBrookUniversityHospital_standardcharges.csv') +df # get a count of the number of rows and columns countRows, countColumns = df.shape @@ -16,7 +18,9 @@ # change countRows to full integer tenPercent = int(countRows * 0.1) -sample_df = df.sample(tenPercent) +sample_df_1 = df.sample(tenPercent) +sample_df_2 = df.sample(int(countRows * 0.1)) + ## clean the data # list columns @@ -27,7 +31,7 @@ ############## COLUMN NAMES ############## ############## COLUMN NAMES ############## -df.columns +df.columns column_names = list(df) @@ -36,11 +40,13 @@ list(df) # renaming columns -df.rename(columns={'code':'billing_code'}) # rename the column, where the first value is the old name and the second value is the new name +df = df.rename(columns={'Code':'billing_code'}) # rename the column, where the first value is the old name and the second value is the new name +df df = df.rename(columns={ - 'emblemhealth_ghi_commercial':'emblemhealth_ghi_commercial_mod' -}) + 'emblemhealth_ghi_commercial':'emblemhealth_ghi_commercial_mod', + 'emblemhealth_hip_medicare_advantage':'emblemhealth_hip_medicare_advantage_mod', + }) # change all column names to lowercase df.columns = df.columns.str.lower() @@ -52,8 +58,8 @@ df.columns = df.columns.str.replace(' ', '_') # droping columns -df.drop(['billing_code', 'Description', 'Code_Type'], axis=1, inplace=True, errors='ignore') # remember this is CASE SENSITIVE - +df.drop(['billing_code'], axis=1, inplace=True, errors='ignore') # remember this is CASE SENSITIVE +df.columns ############## REMOVING WHITESPACE ############## ############## REMOVING WHITESPACE ############## @@ -62,7 +68,7 @@ # remove all whitespace for values within a specific column df['x'] = df['x'].str.strip() # remove all special characters and whitespace ' ' from a specific column -df['x'] = df['x'].str.replace('[^A-Za-z0-9]+', '_') ## regex # regex tutorial/info: https://www.w3schools.com/python/python_regex.asp; https://www.regular-expressions.info/refquick.html +df['billing_code'] = df['billing_code'].str.replace('[^A-Za-z0-9]+', '_') ## regex # regex tutorial/info: https://www.w3schools.com/python/python_regex.asp; https://www.regular-expressions.info/refquick.html @@ -91,9 +97,12 @@ ## you would then manually go through each of these, and determine if the column ## type is appropriate for the data model you are creating - -# billing code is not in the chart, but this is an example on how to change the type from obj to str df['billing_code'] = df['billing_code'].astype(str) +df['billing_code'] = str(df['billing_code']) + +# get billing_code type +df.dtypes + ########## DATES ########## ########## DATES ########## @@ -142,10 +151,10 @@ # Example 1 ## create a unique id for each row using uuid -df['id'] = df.apply(lambda row: uuid.uuid4(), axis=1) +df['id'] = df.apply(lambda x: uuid.uuid4(), axis=1) -# create a unique id for each row using uuid that contains 8 characters -df['id'] = df.apply(lambda row: uuid.uuid4().hex[:8], axis=1) +## create a unique id for each row using uuid that contains 8 characters +df['id'] = df.apply(lambda x: uuid.uuid4().hex[:8], axis=1) # Example 2 ## create a function that will create a unique id for each row diff --git a/transformation/pyScripts/p3_stonyBrookClean.py b/transformation/pyScripts/p3_stonyBrookClean.py index 82c6f36..4058aea 100644 --- a/transformation/pyScripts/p3_stonyBrookClean.py +++ b/transformation/pyScripts/p3_stonyBrookClean.py @@ -13,8 +13,7 @@ ## transofmring with the melt function from a wide dataframe to a stacked dataframe stonybrook_modified = stonybrook.melt(id_vars=idVars, value_vars=valueVars) -# Saves new dataframe into csv file - -stonybrook_modified.to_csv('transformation/dataFiles/clean/113243405_StonyBrookUniversityHospital_standardcharges.csv') - +print(stonybrook_modified.head(50)) +stonybrook_modified.to_csv('transformation/dataFiles/clean/113243405_StonyBrookUniversityHospital_standardcharges_clean.csv') +stonybrook_modified.shape \ No newline at end of file